- Email: [email protected]
EFFECT OF BASELINE ANTIARRHYTHMIC DRUG ON OUTCOMES WITH ABLATION IN ISCHEMIC VENTRICULAR TACHYCARDIA: A VANISH SUBSTUDY
S66
ventricular irritability (VI, a non-sustained arrhythmic response < 1 sec). A single dose of ibrutinib increased AF inducibility (4/10 vs. 0/10, P < 0.05, duration 36.6 +/- 56.5 sec) and VI (5/10 vs. 0/10, P < 0.05). There was no difference after chronic dosing for both AF (2/8 vs. 2/8, P¼1) and VI (2/8 vs. 1/8, P¼0.52). We demonstrated that ibrutinib acutely increased atrial and non-sustained ventricular arrhythmia susceptibility in the mouse. Our results suggest that chronic exposure with washout does not promote persistent electrical remodelling. Together this suggests that arrhythmia inducibility is a transient, potentially off-target, drug effect.
112 EFFECT OF BASELINE ANTIARRHYTHMIC DRUG ON OUTCOMES WITH ABLATION IN ISCHEMIC VENTRICULAR TACHYCARDIA: A VANISH SUBSTUDY R Parkash, I Nault, L Rivard, L Gula, V Essebag, P Nery, S Tung, J Raymond, L Sterns, S Doucette, G Wells, A Tang, W Stevenson, J Sapp Halifax, Nova Scotia BACKGROUND:
The interaction of antiarrhythmic drugs with catheter ablation for ventricular tachycardia has not been previously described. Using data from the VANISH study, we sought to examine the effect of these treatments by antiarrhythmic drug prescribed at baseline. METHODS: All patients enrolled in the VANISH study were included (n¼259). Analysis was conducted based on whether patients had recurrent VT refractory to Amio as compared to sotalol. Baseline characteristics and outcomes were compared between the two groups. Outcomes were death, VT storm or appropriate ICD shock. RESULTS: At baseline, 169 (65.2%) were on Amio, 90 (34.7%) on sotalol (1 was on procainamide). Patients on Amio had more renal insufficiency (23.7% vs 10%, p¼0.0008), worse NYHA class (82.3% II/III vs 65.5%, p¼0.0003), lower ejection fraction (29 9.7% vs 35.2 11, p < 0.0001). After adjusting for these baseline differences, there was no difference in the primary outcome or its components. When examined within the escalated drug therapy arm, patients on Amio had a higher primary outcome (HR 1.94 95%CI 1.14,3.29, p¼0.0144), and trend to higher mortality (HR 2.4 95%CI 0.93, 6.22, p¼0.07). Within the Amio group, ablation was significantly better than escalated drug therapy in reduction of any ventricular arrhythmia (HR 0.53 95%CI 0.31,0.9, p¼0.0195). Patients on sotalol had a trend towards higher mortality and VT storm with ablation, as compared to escalated drug therapy, with no effect on ICD shocks. CONCLUSION: The benefit of catheter ablation is greater for patients with VT despite amiodarone than for patients with VT despite sotalol who are then switched to amiodarone.
Canadian Journal of Cardiology Volume 33 2017
Canadian Institutes of Health Research (CIHR) - Operating Grant
Canadian Cardiovascular Society (CCS) ePosters CARDIAC TRANSPLANTATION AND MECHANICAL CIRCULATORY SUPPORT Sunday, October 22, 2017 113 CARDIAC TRANSPLANTATION IN PATIENTS SUPPORTED WITH EXTRACORPOREAL MEMBRANE OXYGENATION: EARLY AND MIDTERM RESULTS M Hebert, P Noly, E Flécher, Y Lamarche, A Ducharme, M Carrier Montréal, Québec BACKGROUND:
The number of patients who underwent heart transplantation (HT) after a bridge with Extracorporeal Membrane Oxygenation (ECMO) is increasing. This strategy remains controversial because of the reported poor outcomes and the organ donor shortage. The aim of this study was to review the results of bridge-to-transplant (BTT) in patients supported with ECMO. METHODS AND RESULTS: All adults (n¼280) who underwent HT in two institutions between 2003 and 2013 were retrospectively reviewed. Prospective follow-up data was available in both centers. Outcomes of 34 patients (12%) supported with ECMO at transplantation time were compared to 246 unsupported patients. Etiology of refractory cardiogenic shock before ECMO implantation was terminal heart failure (22/34, 65%), refractory ventricular arrhythmia (6/34, 17%), and acute myocardial infarction (6/34, 17%). Patients were supported on ECMO 6.71 days and waited of total 346 days before HT compared with 24611 days for unsupported patients (p¼0.03). Patients with ECMO had older donors (443 vs. 401 years, p¼0.07), a longer ischemic time (23915 vs. 1794 min, p¼0.001), and a longer CBP time (159 8 vs. 129 3, P¼0.01). Most of patients (17/34, 68%) needed temporary circulatory support after HT in the supported group, compared with (48/246, 19%) in the unsupported group (p¼0.01).
ventricular irritability (VI, a non-sustained arrhythmic response < 1 sec). A single dose of ibrutinib increased AF inducibility (4/10 vs. 0/10, P < 0.05, duration 36.6 +/- 56.5 sec) and VI (5/10 vs. 0/10, P < 0.05). There was no difference after chronic dosing for both AF (2/8 vs. 2/8, P¼1) and VI (2/8 vs. 1/8, P¼0.52). We demonstrated that ibrutinib acutely increased atrial and non-sustained ventricular arrhythmia susceptibility in the mouse. Our results suggest that chronic exposure with washout does not promote persistent electrical remodelling. Together this suggests that arrhythmia inducibility is a transient, potentially off-target, drug effect.
112 EFFECT OF BASELINE ANTIARRHYTHMIC DRUG ON OUTCOMES WITH ABLATION IN ISCHEMIC VENTRICULAR TACHYCARDIA: A VANISH SUBSTUDY R Parkash, I Nault, L Rivard, L Gula, V Essebag, P Nery, S Tung, J Raymond, L Sterns, S Doucette, G Wells, A Tang, W Stevenson, J Sapp Halifax, Nova Scotia BACKGROUND:
The interaction of antiarrhythmic drugs with catheter ablation for ventricular tachycardia has not been previously described. Using data from the VANISH study, we sought to examine the effect of these treatments by antiarrhythmic drug prescribed at baseline. METHODS: All patients enrolled in the VANISH study were included (n¼259). Analysis was conducted based on whether patients had recurrent VT refractory to Amio as compared to sotalol. Baseline characteristics and outcomes were compared between the two groups. Outcomes were death, VT storm or appropriate ICD shock. RESULTS: At baseline, 169 (65.2%) were on Amio, 90 (34.7%) on sotalol (1 was on procainamide). Patients on Amio had more renal insufficiency (23.7% vs 10%, p¼0.0008), worse NYHA class (82.3% II/III vs 65.5%, p¼0.0003), lower ejection fraction (29 9.7% vs 35.2 11, p < 0.0001). After adjusting for these baseline differences, there was no difference in the primary outcome or its components. When examined within the escalated drug therapy arm, patients on Amio had a higher primary outcome (HR 1.94 95%CI 1.14,3.29, p¼0.0144), and trend to higher mortality (HR 2.4 95%CI 0.93, 6.22, p¼0.07). Within the Amio group, ablation was significantly better than escalated drug therapy in reduction of any ventricular arrhythmia (HR 0.53 95%CI 0.31,0.9, p¼0.0195). Patients on sotalol had a trend towards higher mortality and VT storm with ablation, as compared to escalated drug therapy, with no effect on ICD shocks. CONCLUSION: The benefit of catheter ablation is greater for patients with VT despite amiodarone than for patients with VT despite sotalol who are then switched to amiodarone.
Canadian Journal of Cardiology Volume 33 2017
Canadian Institutes of Health Research (CIHR) - Operating Grant
Canadian Cardiovascular Society (CCS) ePosters CARDIAC TRANSPLANTATION AND MECHANICAL CIRCULATORY SUPPORT Sunday, October 22, 2017 113 CARDIAC TRANSPLANTATION IN PATIENTS SUPPORTED WITH EXTRACORPOREAL MEMBRANE OXYGENATION: EARLY AND MIDTERM RESULTS M Hebert, P Noly, E Flécher, Y Lamarche, A Ducharme, M Carrier Montréal, Québec BACKGROUND:
The number of patients who underwent heart transplantation (HT) after a bridge with Extracorporeal Membrane Oxygenation (ECMO) is increasing. This strategy remains controversial because of the reported poor outcomes and the organ donor shortage. The aim of this study was to review the results of bridge-to-transplant (BTT) in patients supported with ECMO. METHODS AND RESULTS: All adults (n¼280) who underwent HT in two institutions between 2003 and 2013 were retrospectively reviewed. Prospective follow-up data was available in both centers. Outcomes of 34 patients (12%) supported with ECMO at transplantation time were compared to 246 unsupported patients. Etiology of refractory cardiogenic shock before ECMO implantation was terminal heart failure (22/34, 65%), refractory ventricular arrhythmia (6/34, 17%), and acute myocardial infarction (6/34, 17%). Patients were supported on ECMO 6.71 days and waited of total 346 days before HT compared with 24611 days for unsupported patients (p¼0.03). Patients with ECMO had older donors (443 vs. 401 years, p¼0.07), a longer ischemic time (23915 vs. 1794 min, p¼0.001), and a longer CBP time (159 8 vs. 129 3, P¼0.01). Most of patients (17/34, 68%) needed temporary circulatory support after HT in the supported group, compared with (48/246, 19%) in the unsupported group (p¼0.01).