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HIgh frequency reentry circuits driving permanent AF - evidence from global left atrial mapping in humans
Poster 1 in R vs. HH subjects (1 year: 90%/84%, 2 years: 81%/75%, p ⫽ 0.04; Figure) and was mostly due to decreased pump failure death in the R vs. HH subjects (p ⫽ 0.04). In ischemic patients (n⫽215), there was a trend towards improved survival in the R vs. HH groups (p ⫽ 0.15), with decreased pump failure death (p ⫽ 0.03) and no effect on sudden death (p ⫽ 0.8). In non-ischemic patients (n ⫽ 213), survival was significantly improved in the R vs. HH groups (p ⫽ 0.03) with a trend towards decreased sudden death (p ⫽ 0.12) and no effect on pump failure death (p ⫽ 0.4). Conclusion: The R allele of the SCN5A H558R polymorphism predicts improved survival in heart failure patients. The SCN5A H558R polymorphism may normalize Na⫹ current, leading to improved conduction, less ventricular dyssynchrony, and improved calcium handling. This could slow heart failure progression and/or lower the risk of sudden death.
S105 Conclusions: Organised egm activity identified by FFT is due to stable reentry circuits. Tissue surrounding the LAA and LSPV can support reentry circuits that drive AF in some pts. Ablation of these drivers may be a successful strategy but would require energy delivery outside regions enclosed by most current strategies.
POSTER SESSION 1 Wednesday, May 4, 2005 Session Time: 5:30 p.m.–7:00 p.m. Presenter Available: 5:30 p.m.–7:00 p.m. Location: Hilton Hotel; Grand Salon A & B P1-1 AGE BUT NOT GENDER DIFFERENCES ARE SEEN IN ADJUSTMENT TO IMPLANTED DEVICES Theresa A. Beery, RN, PhD, Linda S. Baas, RN, PhD, *Helga Matthews, RN, BSN, Jefferson Burroughs, MD and Richard Henthorn, MD. University of Cincinnati, Cincinnati, OH, Medtronic, Inc., Cincinnati, OH and Greater Cincinnati Cardiology Consultants, Inc., Cincinnati, OH.
YI1-6 HIGH FREQUENCY REENTRY CIRCUITS DRIVING PERMANENT AF - EVIDENCE FROM GLOBAL LEFT ATRIAL MAPPING IN HUMANS *Mark J. Earley, MRCP, Dominic J. Abrams, MRCP, Simon C. Sporton and *Richard J. Schilling, MD. St. Bartholomew’s Hospital, London, United Kingdom. Introduction: Fast Fourier transformation (FFT) of electrograms (egms) in animal models and epicardial arrays in human atria suggest highest frequency activation arises in the LA driving AF. We present FFT of global endocardial egms in permanent human AF, hypothesising that areas driving AF are characterised by organised high frequency signals that remain in a constant location. Methods: Patients (pts) with permanent AF underwent catheter ablation in the LA guided by non contact mapping (NCM). Before ablation 19.5s of AF was recorded and FFT applied to a grid of 64 virtual egms evenly distributed over the LA. The dominant frequency (DF) of each egm was defined as the largest peak in the resultant frequency spectrum. Thus FFT maps of the entire LA were obtained and at areas revealed as potential drivers isopotential maps analysed to identify wavefront characteristics. Results: 25 pts aged 51⫾9 were studied. In 4 pts FFT demonstrated a discreet area in the LA where egms were highly organised, with a frequency gradient away from that area. NCM revealed stable reentry circuits; 2 were clockwise around the os of the left superior pulmonary vein (LSPV), including the roof and base of LA appendage (LAA), 1 anticlockwise around the LAA and 1 clockwise following a circuit including the LAA, LSPV os, roof and posterior LA. The DF at this area was 7.6⫾0.7Hz (132⫾12ms). The shortest pathway length and velocity were 93⫾21mm and 71⫾19 cm/s. In 14 pts, FFT revealed areas with discreet peaks DF 7.1⫾0.7Hz (144⫾17ms) but spectral analysis was much more irregular. NCM either did not reveal reentry circuits or they were intermittent during the sampled period. In 7 pts FFT revealed no areas of organisation in the LA. Compared to the other 18pts they had lower amplitude egms (-0.6⫾0.4 v -1.6⫾0.5mV p⬍0.01) and a longer duration of AF (77⫾33 v 35⫾24 months p⫽0.04). NCM either demonstrated no or short lived reentry circuits.
More people than ever need implanted devices like cardiac pacemakers and internal cardioverter defibrillators to support, replace, or maintain organ function. Currently there are nearly 25 million persons in the United States with implanted medical devices. While most patients adapt well to having a device, a subset of individuals experience psychological difficulties. The implanted device adjustment scale (IDAS) has demonstrated strong reliability and validity in a pilot sample of 45 persons with pacemakers and implanted cardioverter defibrillators. A revised 22 item Likert-type IDAS was used with a new sample of 136 persons (35 women; mean age 70, range 35-88) with implanted devices (51 with pacemakers and 82 with cardioverter defibrillators). Subjects also completed scales measuring quality of life (SF-36) and mood states (POMS). Subjects were divided into three age groups (65 or under, 66-75, and over 76). No significant age group differences were found in physical or mental components of quality of life or in mood states (vitality, anxiety, depression, anger, confusion, fatigue). However, a significant difference was seen in the IDAS (F ⫽ 4.56, p ⫽ .012). Younger device recipients reported poorer adjustment than older device recipients. Gender differences were not found on the IDAS. Men reported higher scores on the physical dimension of quality of life (F⫽7.67, p⫽.007) while women reported a higher degree of fatigue (F⫽5.42, p⫽.02), but no other gender differences in mood or quality of life were found. Predicting populations that may be at risk for difficulty adjusting to living with an implanted device could lead to the provision of interventions that will improve patient outcomes. P1-2 THE IMPACT OF REMOTE ICD FOLLOW UP ON A LARGE TERTIARY CARE CENTER *Elizabeth A. Ching, RN, *Bruce L. Wilkoff, MD, Beverly M. Foxhall, RN, Miriam Grooms, RN, BSN, Janet Davis, RN, BSN, Betty Whitlow, RN, BSN, Janet Gates, RN, William Grapes, RN, Paul Egan, RN, MS, Jennifer Jerik, RN, Monica Moore, Kim Klee-Connors, Judy Khalfoun and *Patrick J. Tchou, MD. Cleveland Clinic Foundation, Cleveland, OH. Implanted cardiac devices especially Implantable Cardioverter Defibrillators (ICD’s) have increased in implant frequency. The “down stream” impact of this increase in implants has been felt in the follow up Device Clinics. Not only is device implantation increasing but also the diagnostics obtained from the device have become very powerful in helping to care for this patient population Managing the growth in volume has been difficult, requiring consistent increases in rooms and personnel allocated to the task. The purpose of this analysis is to demonstrate the impact of remote follow up on patient visits to the Device Clinic. Method: Beginning in 2003 all patients implanted with ICD’s that were covered by remote follow up were given the option of routine follow up in the
S105 Conclusions: Organised egm activity identified by FFT is due to stable reentry circuits. Tissue surrounding the LAA and LSPV can support reentry circuits that drive AF in some pts. Ablation of these drivers may be a successful strategy but would require energy delivery outside regions enclosed by most current strategies.
POSTER SESSION 1 Wednesday, May 4, 2005 Session Time: 5:30 p.m.–7:00 p.m. Presenter Available: 5:30 p.m.–7:00 p.m. Location: Hilton Hotel; Grand Salon A & B P1-1 AGE BUT NOT GENDER DIFFERENCES ARE SEEN IN ADJUSTMENT TO IMPLANTED DEVICES Theresa A. Beery, RN, PhD, Linda S. Baas, RN, PhD, *Helga Matthews, RN, BSN, Jefferson Burroughs, MD and Richard Henthorn, MD. University of Cincinnati, Cincinnati, OH, Medtronic, Inc., Cincinnati, OH and Greater Cincinnati Cardiology Consultants, Inc., Cincinnati, OH.
YI1-6 HIGH FREQUENCY REENTRY CIRCUITS DRIVING PERMANENT AF - EVIDENCE FROM GLOBAL LEFT ATRIAL MAPPING IN HUMANS *Mark J. Earley, MRCP, Dominic J. Abrams, MRCP, Simon C. Sporton and *Richard J. Schilling, MD. St. Bartholomew’s Hospital, London, United Kingdom. Introduction: Fast Fourier transformation (FFT) of electrograms (egms) in animal models and epicardial arrays in human atria suggest highest frequency activation arises in the LA driving AF. We present FFT of global endocardial egms in permanent human AF, hypothesising that areas driving AF are characterised by organised high frequency signals that remain in a constant location. Methods: Patients (pts) with permanent AF underwent catheter ablation in the LA guided by non contact mapping (NCM). Before ablation 19.5s of AF was recorded and FFT applied to a grid of 64 virtual egms evenly distributed over the LA. The dominant frequency (DF) of each egm was defined as the largest peak in the resultant frequency spectrum. Thus FFT maps of the entire LA were obtained and at areas revealed as potential drivers isopotential maps analysed to identify wavefront characteristics. Results: 25 pts aged 51⫾9 were studied. In 4 pts FFT demonstrated a discreet area in the LA where egms were highly organised, with a frequency gradient away from that area. NCM revealed stable reentry circuits; 2 were clockwise around the os of the left superior pulmonary vein (LSPV), including the roof and base of LA appendage (LAA), 1 anticlockwise around the LAA and 1 clockwise following a circuit including the LAA, LSPV os, roof and posterior LA. The DF at this area was 7.6⫾0.7Hz (132⫾12ms). The shortest pathway length and velocity were 93⫾21mm and 71⫾19 cm/s. In 14 pts, FFT revealed areas with discreet peaks DF 7.1⫾0.7Hz (144⫾17ms) but spectral analysis was much more irregular. NCM either did not reveal reentry circuits or they were intermittent during the sampled period. In 7 pts FFT revealed no areas of organisation in the LA. Compared to the other 18pts they had lower amplitude egms (-0.6⫾0.4 v -1.6⫾0.5mV p⬍0.01) and a longer duration of AF (77⫾33 v 35⫾24 months p⫽0.04). NCM either demonstrated no or short lived reentry circuits.
More people than ever need implanted devices like cardiac pacemakers and internal cardioverter defibrillators to support, replace, or maintain organ function. Currently there are nearly 25 million persons in the United States with implanted medical devices. While most patients adapt well to having a device, a subset of individuals experience psychological difficulties. The implanted device adjustment scale (IDAS) has demonstrated strong reliability and validity in a pilot sample of 45 persons with pacemakers and implanted cardioverter defibrillators. A revised 22 item Likert-type IDAS was used with a new sample of 136 persons (35 women; mean age 70, range 35-88) with implanted devices (51 with pacemakers and 82 with cardioverter defibrillators). Subjects also completed scales measuring quality of life (SF-36) and mood states (POMS). Subjects were divided into three age groups (65 or under, 66-75, and over 76). No significant age group differences were found in physical or mental components of quality of life or in mood states (vitality, anxiety, depression, anger, confusion, fatigue). However, a significant difference was seen in the IDAS (F ⫽ 4.56, p ⫽ .012). Younger device recipients reported poorer adjustment than older device recipients. Gender differences were not found on the IDAS. Men reported higher scores on the physical dimension of quality of life (F⫽7.67, p⫽.007) while women reported a higher degree of fatigue (F⫽5.42, p⫽.02), but no other gender differences in mood or quality of life were found. Predicting populations that may be at risk for difficulty adjusting to living with an implanted device could lead to the provision of interventions that will improve patient outcomes. P1-2 THE IMPACT OF REMOTE ICD FOLLOW UP ON A LARGE TERTIARY CARE CENTER *Elizabeth A. Ching, RN, *Bruce L. Wilkoff, MD, Beverly M. Foxhall, RN, Miriam Grooms, RN, BSN, Janet Davis, RN, BSN, Betty Whitlow, RN, BSN, Janet Gates, RN, William Grapes, RN, Paul Egan, RN, MS, Jennifer Jerik, RN, Monica Moore, Kim Klee-Connors, Judy Khalfoun and *Patrick J. Tchou, MD. Cleveland Clinic Foundation, Cleveland, OH. Implanted cardiac devices especially Implantable Cardioverter Defibrillators (ICD’s) have increased in implant frequency. The “down stream” impact of this increase in implants has been felt in the follow up Device Clinics. Not only is device implantation increasing but also the diagnostics obtained from the device have become very powerful in helping to care for this patient population Managing the growth in volume has been difficult, requiring consistent increases in rooms and personnel allocated to the task. The purpose of this analysis is to demonstrate the impact of remote follow up on patient visits to the Device Clinic. Method: Beginning in 2003 all patients implanted with ICD’s that were covered by remote follow up were given the option of routine follow up in the