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Contribution of cardiac resynchronization therapy in hypertrophic cardiomyopathy with systolic dysfunction: A case-control study
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Rhythmology and stimulation
Background Epicardial fat (EF) plays an established role in genesis and persistence of atrial fibrillation (AF) but its impact on endocavitary radiofrequency (RF) ablation remains not considered. This study sought to determine the impact of EF volume on duration of RF during AF ablation procedure. Method EF volume was assessed by computed tomography scans that were systematically performed before ablation. Primary endpoints were total duration of RF and duration of pulmonary vein isolation. Secondary endpoint was the conversion or organization of an arrhythmia after pulmonary vein isolation. The mean follow-up duration was 18 ± 7.3 month. Results A total of 165 subjects, including 72 persistent AF patients, benefit from a first endocavitary RF ablation procedure from March 2015 to July 2017 in Reims university hospital. Persistent AF patients had higher total EF volume than paroxysmal AF patients (72.5 ± 31.7 vs. 55.8 ± 24.5 ml; P = 0.0002). Total duration of RF and duration of pulmonary vein isolation were significantly associated with higher total EF volume (respectively P = 0.007 and P = 0.037) and peri-ventricular EF volume (P = 0.009 and P = 0.029). In multivariate analysis, total EF volume was not significantly associated with total duration of RF (P = 0.46). Regarding individuals with arrhythmia at the time of the procedure, patients whose AF was reduced or organized after pulmonary vein isolation had no less total EF than those whose AF was not (62.6 ± 36.7 vs. 71.3 ± 31.5 ml; P = 0.112) (Fig. 1). Conclusion We highlight a significative association between total, especially peri-ventricular EF volume, and total duration of RF and duration of pulmonary vein isolation. This relation was no more significant in multivariate analysis which gives EF the state of marker of ablation complexity. These results support the causal link between epicardial fat and AF and emphasize the importance of peri-ventricular EF role.
Methods From implantable cardioverter defibrillator (ICD) database of a single university center, patients with HCM, who received CRT, were identified and matched with resynchronized DCM in a 2:1 ratio on age at implantation (± 5 years), gender and left ventricular ejection fraction (LVEF) at implantation (± 5%). Clinical, electrocardiographic and echocardiographic parameters were gathered at 1—6 months, 6—12 months and last follow-up after implantation. Results Between 2007 and 2018, we included 18 HCM patients (women 7(39%); at ICD implantation, age 59 ± 9 years, LVEF 38 ± 6%, NYHA class 2.8 ± 0.4) matched with 36 controls. At one year after implantation, the relative median change from baseline showed better improvement in HCM patients regarding: 1/NYHA class (−50% vs. − 20%, P < 0.001), 2/LVEF (+ 30% vs. + 6%, P < 0.01), 3/left ventricular end-systolic (LVES) volume (− 39% vs. − 21%, P < 0.01), 4/cardiac output (+ 18% vs. + 5%, P < 0.001) and 5/BNP (− 51% vs. − 24%, P = 0.02). HCM patients retained the benefit of CRT at last follow-up (41 ± 24 months) for NYHA (− 33% vs. − 12%, P < 0.01), LVEF (− 36% vs. − 11%, P < 0.01), LVES volume (− 42% vs. − 20%, P = 0.01) and cardiac output (+1 8% vs. − 2%, P < 0.001). The rate of bi-ventricular pacing (98% vs. 99%, P = 0.81) and the QRS duration (130ms vs. 130ms, P = 0.57) at one year after CRT were comparable in the both groups. Among HCM patients, 2 (11%) of them died and 2 (11%) had a heart transplant. Conclusion CRT improved heart failure symptoms and carried out reverse remodeling of the left ventricle in HCM with better outcomes than in DCM in long-term follow-up. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.253 234
Acute and long-term ablation results of extra pulmonary vein drivers detected by ultra high density mapping on top of PVI in persistent AF B. Enache 1,2,∗ , D.G. Latcu 1 , K. Hasni 1 , S. Bun 1 , N. Saoudi 1 Cardiologie, Centre Hospitalier Princess-Grâce-Monaco, Monaco 2 Cardiologie, Université de Médecine et Pharmacie ‘‘Victor Babes’’ de Timisoara, Timisoara, Roumanie ∗ Corresponding author. E-mail address: [email protected] (B. Enache)
1
Fig. 1 Relation between epicardial fat volume (EFV) and duration of radiofrequency (RF). Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.09.252 332
Contribution of cardiac resynchronization therapy in hypertrophic cardiomyopathy with systolic dysfunction: A case-control study F. Arregle ∗ , J. Hourdain , G. Habib , F. Lavagna , N. Peres , O. Torras , L. Koutbi , N. Dognin , B. Maille , F. Franceschi , J.C. Deharo Hôpital La Timone, Marseille, France ∗ Corresponding author. E-mail address: fl[email protected] (F. Arregle) Background Cardiac resynchronization therapy (CRT), known as an effective treatment for heart failure in dilated cardiomyopathy (DCM), remains uncertain in hypertrophic cardiomyopathy (HCM), with conflicting results reported from previous studies. Purpose We aimed to study the efficiency of CRT in patients with HCM, heart failure and left ventricle systolic dysfunction.
Background Whether ultra-high density (UHD) contact mapping is useful in radiofrequency ablation of persistent atrial fibrillation (AF) is unknown. Objective To sequentially map the left atrial (LA) activation during AF ablation (circumferential PVI and ablation of extra pulmonary vein drivers). Methods Time reference was an LA appendage (LAA) electrogram (EGM). Points were acquired with respiratory gating if reference, cycle length (10 ms tolerance) and electrode location were stable. For fragmented EGM the timing of the surrounding area was used. In case of extremely low voltage (< 0.01 mV) or lack of local statistical coherence no colour-code was displayed (grey area). Circular propagation around single points was defined as organized rotating drivers (Fig. 1). All pts had PVI followed by remapping and ablation of the centre of rotational regions and at sites with focal type propagation. DC or chemical cardioversion were not performed in the first 48 h. Results Out of 41 patients (pts) undergoing first time ablation with the above described protocol, 30 (66 ± 8 y, mean current episode duration 8 months) were followed for a mean time of 14,7 months. At 48 hours post-procedure, 70% of pts were no longer in AF: 6 (20%) in sinus rhythm and 15 (50%) in atrial tachycardias. At 1 year after a single procedure, freedom from AF was 87% and freedom from AF and AT was 60% (Fig. 1).
Rhythmology and stimulation
Background Epicardial fat (EF) plays an established role in genesis and persistence of atrial fibrillation (AF) but its impact on endocavitary radiofrequency (RF) ablation remains not considered. This study sought to determine the impact of EF volume on duration of RF during AF ablation procedure. Method EF volume was assessed by computed tomography scans that were systematically performed before ablation. Primary endpoints were total duration of RF and duration of pulmonary vein isolation. Secondary endpoint was the conversion or organization of an arrhythmia after pulmonary vein isolation. The mean follow-up duration was 18 ± 7.3 month. Results A total of 165 subjects, including 72 persistent AF patients, benefit from a first endocavitary RF ablation procedure from March 2015 to July 2017 in Reims university hospital. Persistent AF patients had higher total EF volume than paroxysmal AF patients (72.5 ± 31.7 vs. 55.8 ± 24.5 ml; P = 0.0002). Total duration of RF and duration of pulmonary vein isolation were significantly associated with higher total EF volume (respectively P = 0.007 and P = 0.037) and peri-ventricular EF volume (P = 0.009 and P = 0.029). In multivariate analysis, total EF volume was not significantly associated with total duration of RF (P = 0.46). Regarding individuals with arrhythmia at the time of the procedure, patients whose AF was reduced or organized after pulmonary vein isolation had no less total EF than those whose AF was not (62.6 ± 36.7 vs. 71.3 ± 31.5 ml; P = 0.112) (Fig. 1). Conclusion We highlight a significative association between total, especially peri-ventricular EF volume, and total duration of RF and duration of pulmonary vein isolation. This relation was no more significant in multivariate analysis which gives EF the state of marker of ablation complexity. These results support the causal link between epicardial fat and AF and emphasize the importance of peri-ventricular EF role.
Methods From implantable cardioverter defibrillator (ICD) database of a single university center, patients with HCM, who received CRT, were identified and matched with resynchronized DCM in a 2:1 ratio on age at implantation (± 5 years), gender and left ventricular ejection fraction (LVEF) at implantation (± 5%). Clinical, electrocardiographic and echocardiographic parameters were gathered at 1—6 months, 6—12 months and last follow-up after implantation. Results Between 2007 and 2018, we included 18 HCM patients (women 7(39%); at ICD implantation, age 59 ± 9 years, LVEF 38 ± 6%, NYHA class 2.8 ± 0.4) matched with 36 controls. At one year after implantation, the relative median change from baseline showed better improvement in HCM patients regarding: 1/NYHA class (−50% vs. − 20%, P < 0.001), 2/LVEF (+ 30% vs. + 6%, P < 0.01), 3/left ventricular end-systolic (LVES) volume (− 39% vs. − 21%, P < 0.01), 4/cardiac output (+ 18% vs. + 5%, P < 0.001) and 5/BNP (− 51% vs. − 24%, P = 0.02). HCM patients retained the benefit of CRT at last follow-up (41 ± 24 months) for NYHA (− 33% vs. − 12%, P < 0.01), LVEF (− 36% vs. − 11%, P < 0.01), LVES volume (− 42% vs. − 20%, P = 0.01) and cardiac output (+1 8% vs. − 2%, P < 0.001). The rate of bi-ventricular pacing (98% vs. 99%, P = 0.81) and the QRS duration (130ms vs. 130ms, P = 0.57) at one year after CRT were comparable in the both groups. Among HCM patients, 2 (11%) of them died and 2 (11%) had a heart transplant. Conclusion CRT improved heart failure symptoms and carried out reverse remodeling of the left ventricle in HCM with better outcomes than in DCM in long-term follow-up. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.253 234
Acute and long-term ablation results of extra pulmonary vein drivers detected by ultra high density mapping on top of PVI in persistent AF B. Enache 1,2,∗ , D.G. Latcu 1 , K. Hasni 1 , S. Bun 1 , N. Saoudi 1 Cardiologie, Centre Hospitalier Princess-Grâce-Monaco, Monaco 2 Cardiologie, Université de Médecine et Pharmacie ‘‘Victor Babes’’ de Timisoara, Timisoara, Roumanie ∗ Corresponding author. E-mail address: [email protected] (B. Enache)
1
Fig. 1 Relation between epicardial fat volume (EFV) and duration of radiofrequency (RF). Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.09.252 332
Contribution of cardiac resynchronization therapy in hypertrophic cardiomyopathy with systolic dysfunction: A case-control study F. Arregle ∗ , J. Hourdain , G. Habib , F. Lavagna , N. Peres , O. Torras , L. Koutbi , N. Dognin , B. Maille , F. Franceschi , J.C. Deharo Hôpital La Timone, Marseille, France ∗ Corresponding author. E-mail address: fl[email protected] (F. Arregle) Background Cardiac resynchronization therapy (CRT), known as an effective treatment for heart failure in dilated cardiomyopathy (DCM), remains uncertain in hypertrophic cardiomyopathy (HCM), with conflicting results reported from previous studies. Purpose We aimed to study the efficiency of CRT in patients with HCM, heart failure and left ventricle systolic dysfunction.
Background Whether ultra-high density (UHD) contact mapping is useful in radiofrequency ablation of persistent atrial fibrillation (AF) is unknown. Objective To sequentially map the left atrial (LA) activation during AF ablation (circumferential PVI and ablation of extra pulmonary vein drivers). Methods Time reference was an LA appendage (LAA) electrogram (EGM). Points were acquired with respiratory gating if reference, cycle length (10 ms tolerance) and electrode location were stable. For fragmented EGM the timing of the surrounding area was used. In case of extremely low voltage (< 0.01 mV) or lack of local statistical coherence no colour-code was displayed (grey area). Circular propagation around single points was defined as organized rotating drivers (Fig. 1). All pts had PVI followed by remapping and ablation of the centre of rotational regions and at sites with focal type propagation. DC or chemical cardioversion were not performed in the first 48 h. Results Out of 41 patients (pts) undergoing first time ablation with the above described protocol, 30 (66 ± 8 y, mean current episode duration 8 months) were followed for a mean time of 14,7 months. At 48 hours post-procedure, 70% of pts were no longer in AF: 6 (20%) in sinus rhythm and 15 (50%) in atrial tachycardias. At 1 year after a single procedure, freedom from AF was 87% and freedom from AF and AT was 60% (Fig. 1).