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Left Ventricular Electrical Characteristics at Implant Predict Response to Cardiac Resynchronisation Therapy
group = 0.001). Using random effects model, the effect size for CRP increased to 2.53 (CI: 1.33–4.82) and for BNP group the effect size increased to 6.38 (CI: 1.58–25.82). Publication bias was not evident for CRP and BNP group (p-value 0.43 and 0.24, respectively). Conclusion: Increased CRP and BNP levels are associated with greater risk of AF recurrence after successful DCCV. The use of these markers for the prediction of those who maintain sinus rhythm after DCCV appears promising but requires further study. http://dx.doi.org/10.1016/j.hlc.2012.05.322 313 Left of the Middle: Paraseptal Atrial Tachycardias from an Uncommon Focus M. Wong 1,2,4,∗ , J. Kalman 1,2 , H. Liang 1,2,3,4 , C. Medi 1,2 , A. Teh 1,2,4 , G. Lee 1,2,4 , S. Kumar 1,2,4 , J. Morton 1 , P. Kistler 1,2,3,4 1 Royal
Melbourne Hospital, Melbourne Health, Australia Department of Medicine, University of Melbourne, Parkville, Victoria, Australia 3 The Baker IDI Research Institute, Melbourne, Australia 4 The Heart Centre, The Alfred Hospital, Melbourne, Australia 2 The
Introduction: Focal atrial tachycardias (FAT) typically occur at predefined anatomic locations. We described ATs originating from the left septum (LS) looking at electrocardiographic (ECG), electrophysiological (EP) features and long term radiofrequency ablation (RFA) outcomes with comparison made to adjacent FAT foci including coronary sinus (CS) ostium and the superior mitral annulus (SMA). Methods: We report on 29 patients (7 LS, 14 CS and eight SMA) from a consecutive series of 384 who underwent EP/RFA for symptomatic FAT. Results: Mean age was 49 ± 17 years; 18F with symptoms for 21 ± 17 months. Tachycardia was incessant in 5/7 patients at LS, 1/14 at CS and 0/8 at SMA. Mean cycle length was 421 ± 61 ms at LS; 360 ± 74 ms at CS and 365 ± 44 ms at SMA (p = 0.33). P wave morphology (PWM) was biphasic across the precordium at all sites whilst the inferior leads revealed low amplitude pos in 8/8 SMA patients compared with ±(4) or −(3) at LS and ±(4) or −(10) at CS. His A was earlier for foci at the LS (−15 ± 4ms) and SMA (−20 ± 14 ms) compared with CS ostium (4 ± 16 ms, p < 0.05). CS proximal was earlier for foci at the CS ostium (−15 ± 8 ms) compared with LS (3 ± 11 ms, p < 0.05) and SMA (0 ± 16 ms, p < 0.05). Mean follow up was 26 ± 23 months with focal ablation successfully achieved in 27/29 (93%) patients. Conclusion: Left septal AT is an uncommon but discrete entity with distinguishing ECG and EP features that differ from adjacent FAT locations at the CS ostium and mitral annulus. http://dx.doi.org/10.1016/j.hlc.2012.05.323
CSANZ 2012 Abstracts
S129
314 Left Ventricular Electrical Characteristics at Implant Predict Response to Cardiac Resynchronisation Therapy T. Lin 1,∗ , P. Rae 2 , M. Ord 1 , K. Lu 1 , P. Srivastava 1 , D. O’Donnell 1 1 Austin 2 Heart
Health, Australia Care Victoria, Australia
Aims: The optimal site for left ventricular (LV) lead placement with cardiac resynchronisation therapy (CRT) is uncertain. This study analysed intracardiac electrogram (EGM) characteristics at implant and response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Patients in sinus rhythm, with an ejection fraction (EF) <35% and abnormal Dyssynchrony Index (DI) were included. The RV lead was placed in the mid septum and the LV lead targeted to a delayed zone identified by echocardiogram. Intracardiac EGMs measured the intrinsic delay (Int RV-LV), the RV paced delay (RVpLV) and LV paced delay (LVp-RV). The difference between the LVp-RV and RVp-LV was recorded as the delta LV. Response was defined as an improvement of EF > 10%, a reduction in LVEDD >15% and improvement of 1 NYHA class. Results: There was no significant correlation between lead position, baseline DI, QRS duration or EF and IEGM measurements. Overall RR was 79%. The LV lead was placed in the target location in 91%. The Int RV-LV was 101 ± 14 ms in the responders and 78 ± 11 ms in the nonresponders (p < 0.05). An Int RV-LV > 100 had a RR of 87% and an Int RV-LV < 100 had a RR of 68%. The LVp-RV and RVp-LV did not differ significantly between the responders and the non-responders. A Delta LV > 70ms had a RR 56%; compared with a delta LV < 70ms RR 85%. Conclusions: Intracardiac EGMs measured at implant can predict response to CRT. This information may be used to guide lead placement. http://dx.doi.org/10.1016/j.hlc.2012.05.324 315 Left Ventricular Lead Reposition for Non-Response to Cardiac Resynchronisation Therapy T. Lin ∗ , P. Srivastava, D. O’Donnell Austin Health, Australia Aims: A significant proportion of patients are nonresponders to cardiac resynchronisation therapy (CRT). We hypothesised that repositioning the left ventricular (LV) lead could improve resynchronisation and clinical parameters in non-responders. Methods: We evaluated seven non-responders to CRT, age 63 ± 9, with no improvement in ejection fraction (EF) left ventricular end diastolic diameter (LVEDD) or NYHA Class following CRT. All original LV leads were successfully implanted in targeted areas identified by pre-implant echocardiographic assessment. The LV lead reposition
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142
Melbourne Hospital, Melbourne Health, Australia Department of Medicine, University of Melbourne, Parkville, Victoria, Australia 3 The Baker IDI Research Institute, Melbourne, Australia 4 The Heart Centre, The Alfred Hospital, Melbourne, Australia 2 The
Introduction: Focal atrial tachycardias (FAT) typically occur at predefined anatomic locations. We described ATs originating from the left septum (LS) looking at electrocardiographic (ECG), electrophysiological (EP) features and long term radiofrequency ablation (RFA) outcomes with comparison made to adjacent FAT foci including coronary sinus (CS) ostium and the superior mitral annulus (SMA). Methods: We report on 29 patients (7 LS, 14 CS and eight SMA) from a consecutive series of 384 who underwent EP/RFA for symptomatic FAT. Results: Mean age was 49 ± 17 years; 18F with symptoms for 21 ± 17 months. Tachycardia was incessant in 5/7 patients at LS, 1/14 at CS and 0/8 at SMA. Mean cycle length was 421 ± 61 ms at LS; 360 ± 74 ms at CS and 365 ± 44 ms at SMA (p = 0.33). P wave morphology (PWM) was biphasic across the precordium at all sites whilst the inferior leads revealed low amplitude pos in 8/8 SMA patients compared with ±(4) or −(3) at LS and ±(4) or −(10) at CS. His A was earlier for foci at the LS (−15 ± 4ms) and SMA (−20 ± 14 ms) compared with CS ostium (4 ± 16 ms, p < 0.05). CS proximal was earlier for foci at the CS ostium (−15 ± 8 ms) compared with LS (3 ± 11 ms, p < 0.05) and SMA (0 ± 16 ms, p < 0.05). Mean follow up was 26 ± 23 months with focal ablation successfully achieved in 27/29 (93%) patients. Conclusion: Left septal AT is an uncommon but discrete entity with distinguishing ECG and EP features that differ from adjacent FAT locations at the CS ostium and mitral annulus. http://dx.doi.org/10.1016/j.hlc.2012.05.323
CSANZ 2012 Abstracts
S129
314 Left Ventricular Electrical Characteristics at Implant Predict Response to Cardiac Resynchronisation Therapy T. Lin 1,∗ , P. Rae 2 , M. Ord 1 , K. Lu 1 , P. Srivastava 1 , D. O’Donnell 1 1 Austin 2 Heart
Health, Australia Care Victoria, Australia
Aims: The optimal site for left ventricular (LV) lead placement with cardiac resynchronisation therapy (CRT) is uncertain. This study analysed intracardiac electrogram (EGM) characteristics at implant and response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Patients in sinus rhythm, with an ejection fraction (EF) <35% and abnormal Dyssynchrony Index (DI) were included. The RV lead was placed in the mid septum and the LV lead targeted to a delayed zone identified by echocardiogram. Intracardiac EGMs measured the intrinsic delay (Int RV-LV), the RV paced delay (RVpLV) and LV paced delay (LVp-RV). The difference between the LVp-RV and RVp-LV was recorded as the delta LV. Response was defined as an improvement of EF > 10%, a reduction in LVEDD >15% and improvement of 1 NYHA class. Results: There was no significant correlation between lead position, baseline DI, QRS duration or EF and IEGM measurements. Overall RR was 79%. The LV lead was placed in the target location in 91%. The Int RV-LV was 101 ± 14 ms in the responders and 78 ± 11 ms in the nonresponders (p < 0.05). An Int RV-LV > 100 had a RR of 87% and an Int RV-LV < 100 had a RR of 68%. The LVp-RV and RVp-LV did not differ significantly between the responders and the non-responders. A Delta LV > 70ms had a RR 56%; compared with a delta LV < 70ms RR 85%. Conclusions: Intracardiac EGMs measured at implant can predict response to CRT. This information may be used to guide lead placement. http://dx.doi.org/10.1016/j.hlc.2012.05.324 315 Left Ventricular Lead Reposition for Non-Response to Cardiac Resynchronisation Therapy T. Lin ∗ , P. Srivastava, D. O’Donnell Austin Health, Australia Aims: A significant proportion of patients are nonresponders to cardiac resynchronisation therapy (CRT). We hypothesised that repositioning the left ventricular (LV) lead could improve resynchronisation and clinical parameters in non-responders. Methods: We evaluated seven non-responders to CRT, age 63 ± 9, with no improvement in ejection fraction (EF) left ventricular end diastolic diameter (LVEDD) or NYHA Class following CRT. All original LV leads were successfully implanted in targeted areas identified by pre-implant echocardiographic assessment. The LV lead reposition
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142