- Email: [email protected]
OP-129 Catheter Ablation of Drug Refractory Electrical Storm in Ischemic Cardiomyopathy: Single Centre Experience
MARCH 26e29, 2015
O R A L A B S T R A C T S
In this study, we aimed to investigate the clinical impact of the bonus freeze on the longterm electrical isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation (PAF). Methods: A total of 134 patients with PAF were ablated using the second generation Cryoballon. In group I, patients with one bonus freeze after successfull pulmonary vein isolation 93 pts (female: 34; age: 62 years) were included, while in group II, patients without bonus freeze after the first successfull application 41 patients (female; 63years) were investigated. Follow up of the study group were performed at 3rd and 6th months after the procedure in the outpatients clinic using a 7day Holter-ECG recording. In addition, a telephone interview was made with all patients. The primary endpoint was the absence of atrial fibrillation and atrial tachycardia. Results: Acute PVI of all PVs was obtained in all patients. After a mean follow-up time of 218.11 days (SD 100.21 days) in group I and 126.24 days (SD 85.4 days) in group II, the long-term success rate was 82.8 % (77/93 patients) in group I and 87.5 % (4/32 patients; 9 lost to follow-up) in group II, respectively (p>0.05). Procedure duration for group I & group II were 115 21 minutes versus 61 10 minutes (p<0.05). There was a significantly reduction in right phrenic nerve palsy (PNP) in patients without bonus freeze. PNP reduced from 5.4 % in group I (5/93 pts) to 2.4 % in group II (1/41 pts) significantly (p<0.05). Conclusion: Bonus freeze after the first successful application did not increase the long-term success rate of the pulmonary vein isolation, however associated with a significant increase in phrenic nerve palsy.
- OP-128 Localization of Conduction Gaps Following Pulmonary Vein Isolation Using the Second Generation Cryoballoon. Bülent Köktürk, Hikmet Yorgun, Cem Hakan Turan, Alina Dahmen, Ramazan Gökmen Turan, Eduard Gorr, Alexander Yang, Christian Hoppe, Marc Horlitz. Krankenhaus Porz Am Rhein, Köln, Deutschland. Objective: Conduction recovery characterizations after pulmonary vein isolation (PVI) using the first generation cryoballoon (CB) were already described. The aim of this study was to characterize the conduction recovery localization in case of recurrence after second generation CB - PVI. Methods: Patients with recurrent atrial fibrillation (AF) after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by irrigated radiofrequency ablation using three dimensional (3-D) electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into four equally distributed quadrants. Results: A total of 36 patients with recurrent PVI were enrolled but reconnection was detected in 34 patients (52% male, mean age 65.4 8.6 years). Seventeen patients had (50%) persistent AF in the study group. Conduction gaps were detected in multiple (>2) PVs in 17 patients (53%). Conduction gaps were abolished by single point ablation in most of the patients (32, 94%) or by incomplete circular lesions in the remaining patients (6%). The localization of conduction gaps did not differ between atrial fibrillation type. A significantly higher number of patients exhibited conduction recovery at inferior segments of both left and right inferior PVs (83% and 91%, respectively) compared with superior segments (p<0.05). Superior PVs of both left and right PVs exhibit lesser conduction gaps with a tendency for gaps at upper quadrants (71% and 80%, respectively) (p<0.05).
Conclusion: Conduction gaps after second generation CB-PVI is higher in both right and left inferior PVs than superior PVs. The predilection sites for the inferior PVs are mostly at lower quadrants of those PV ostia. However, conduction gaps tend to occur at upper quadrants of both right and left superior PVs. Further studies are needed in order to evaluate the role of modifications in the PVI technique to improve long-term success rates after the intervention.
- OP-129 Catheter Ablation of Drug Refractory Electrical Storm in Ischemic Cardiomyopathy: Single Centre Experience. Fırat Özcan, Serkan Topaloglu, Serkan Çay, Ugur Canpolat, Özcan Özeke, Osman Turak, Hande Çetin, Dursun Aras. _ Türkiye Yüksek Ihtisas Training and Research Hospital, Department of Cardiology, Division of Cardiac Arrhythmia and Electrophysiology, Ankara, Turkey. Background: Electrical storm (ES) is known as a life-threatening pathology which requires immediate and effective treatment due to increased morbidity and mortality. Catheter ablation provides an effective therapeutic option especially in patients with drug resistant ventricular arrhythmia episodes. These procedures should only be performed in highly specialized and experienced centers. Herein, we aimed to assess safety and efficacy of catheter ablation in a relatively large cohort with ES in our tertiary centre hospital. Methods: A total of 44 patients (90.9% male; mean age: 59.710.3 years) with ischemic cardiomyopathy undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Procedures were performed using the non-contact and electro-anatomic mapping systems. Long-term follow-up analysis addressed the predictors of ES recurrence and cardiac mortality. Results: Acute success for clinical and non-clinical VTs were 90.8% and 55.5%. At a mean follow-up of 2811 months, cardiac mortality was observed in 8 (18%) patients, 39 (88.6%) patients were free from the ES and 24 (55%) patients remained free from both ES and paroxysmal VT episodes. In multivariate regression analysis, recurrence of ES (OR: 3.11, 95% CI: 1.65-4.62, p¼0.001), LVEF and serum creatinine were found as independent predictors of cardiac mortality. Also, substrate based ablation, implantation of ICD for
Figure.
S56 The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
MARCH 26e29, 2015 secondary prophylaxis, LVEF and serum creatinine well predicted the ES recurrence. Conclusion: Catheter ablation of ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe and effective, and probably improves their prognosis.
- OP-130 Development of Arrhythmogenic Cardiac Cardiomyopathy in Patients with Ventricular Extrasystoles. Ashot Hovhannesyan. Yerevan Cardiology Institute. Aim: To find scintigraphic criterions of beginning of arrhythmogenic cardiomyopathy in patients with ventricular extrasystoli (VE). Material-Methods: 63 patients with ventricular extrasystoles was included in the study. 29 mean, 34 wemen. Mean age 29 e 63 year. Inclusion criterions into study was registered ventricular extrasystoli by 12 lead ECG, >4000 es/24h on Holther monitoring. In 16 patient electrophysiological study (EP) following radiofrequency ablation (RF) was performed. In 21 patients coronaroangiography was performed, no evidence of ischemic heart disease (IHD) was found. We exclude all patients with evidence of organic heart diseases, atrial arrhythmias and QT segment changes. 12 patients with no evidence of arrhythmia formed control group. In all patients Echocardiography with tissue doppler and synchronized myocardial quantitative gated SPECT was performed using 99Tc-pyrophospate using AnyScan Multimodality Imaging System. In RF ablation group myocardial quantitative gated SPECT was performed also 3 monts after procedure. Results: Areas of local asynchronous contraction was seen in all patients. Asynchronous contraction zones was the same with ECG what confirmed by intracardiac ECG during EP study. Echocardiography with tissue Doppler was less sensitive. We observed 3 kind of disturbances: when patients have only right, left or VE’s originated from both ventricles. And also multifocal (2 and more foci) VE’s seen in LV localizations. All this sites was estimated as electrical and mechanical heterogenic sites. In 38 patients (60,3%) VE’s arising from RV outflow tract, VE’s source localization and preliminary contraction areas was RV anterior wall. LV VE’s, especially monofocal, was located in sinus of Valsalva and asyncronious zones located in the septum. In LV VE group moderate LV dilatation and reduced contraction was observed. Conclusion: Zones of asyncroni on the scintigraphic phase polarity maps in patients with VE could considered as sign of ectopy and beginning of arrhythmogenic cardiomyopathy.
Novel Parameters fort he Prediction of Atrial Fibrillation Development Saturday, March 28, 2015 17:00 PM w 18:30 PM, Hall 8 (Abstract nos. OP-131 w OP-137)
- OP-131
O R A L
Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?. Pakize Kirdemir1, Vedat Yildirim2, Ilker Kiris3, Senol Gulmen4, Erkan Kuralay5, Erdogan Ibrisim6, Ertugrul Ozal7. 1Department of Anesthesiology, University of Suleyman Demirel, Isparta, Turkey; 2Department of Anesthesiology and Reanimation, Gulhane Military Academy of Medicine, Ankara, Turkey; 3Department of Cardiovascular Surgery, S¸ifa University, Izmir, Turkey; 4Department of Cardiovascular Surgery, University of Suleyman Demirel, Isparta, Turkey; 5Department of Cardiovascular Surgery, Lokman Hekim Hospital, Ankara, Turkey; 6Department of Cardiovascular Surgery, Anatolia Hospital, Antalya, Turkey; 7 Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey. Objective: To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias. Material: Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers. Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient’s glycemic response during the prior 4 hours. Results: There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p ¼ 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p ¼ 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p ¼ 0.045). Univariate analysis identified positive inotropic drug requirement (p ¼ 0.011, odds ratio [OR] ¼ 3.41), ejection fraction (EF) (p ¼ 0.001, OR ¼ 0.92), cross-clamp time (p ¼ 0.046, OR ¼ 0.97), left internal mammary artery (p ¼ 0.023, OR ¼ 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p ¼ 0.009, OR ¼ 2.02), intra-aortic balloon pump (p ¼ 0.045, OR ¼ 1.23), body mass index (p ¼ 0.035 OR ¼ 5.60), and CII (p < 0.001, OR ¼ 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR ¼ 0.91), positive inotropic drug requirement (p < 0.001, OR ¼ 3.94), COPD (p ¼ 0.036, OR ¼ 2.11), and CII (p < 0.001, OR ¼ 0.19). Conclusion: Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.
The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
S57
A B S T R A C T S
O R A L A B S T R A C T S
In this study, we aimed to investigate the clinical impact of the bonus freeze on the longterm electrical isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation (PAF). Methods: A total of 134 patients with PAF were ablated using the second generation Cryoballon. In group I, patients with one bonus freeze after successfull pulmonary vein isolation 93 pts (female: 34; age: 62 years) were included, while in group II, patients without bonus freeze after the first successfull application 41 patients (female; 63years) were investigated. Follow up of the study group were performed at 3rd and 6th months after the procedure in the outpatients clinic using a 7day Holter-ECG recording. In addition, a telephone interview was made with all patients. The primary endpoint was the absence of atrial fibrillation and atrial tachycardia. Results: Acute PVI of all PVs was obtained in all patients. After a mean follow-up time of 218.11 days (SD 100.21 days) in group I and 126.24 days (SD 85.4 days) in group II, the long-term success rate was 82.8 % (77/93 patients) in group I and 87.5 % (4/32 patients; 9 lost to follow-up) in group II, respectively (p>0.05). Procedure duration for group I & group II were 115 21 minutes versus 61 10 minutes (p<0.05). There was a significantly reduction in right phrenic nerve palsy (PNP) in patients without bonus freeze. PNP reduced from 5.4 % in group I (5/93 pts) to 2.4 % in group II (1/41 pts) significantly (p<0.05). Conclusion: Bonus freeze after the first successful application did not increase the long-term success rate of the pulmonary vein isolation, however associated with a significant increase in phrenic nerve palsy.
- OP-128 Localization of Conduction Gaps Following Pulmonary Vein Isolation Using the Second Generation Cryoballoon. Bülent Köktürk, Hikmet Yorgun, Cem Hakan Turan, Alina Dahmen, Ramazan Gökmen Turan, Eduard Gorr, Alexander Yang, Christian Hoppe, Marc Horlitz. Krankenhaus Porz Am Rhein, Köln, Deutschland. Objective: Conduction recovery characterizations after pulmonary vein isolation (PVI) using the first generation cryoballoon (CB) were already described. The aim of this study was to characterize the conduction recovery localization in case of recurrence after second generation CB - PVI. Methods: Patients with recurrent atrial fibrillation (AF) after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by irrigated radiofrequency ablation using three dimensional (3-D) electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into four equally distributed quadrants. Results: A total of 36 patients with recurrent PVI were enrolled but reconnection was detected in 34 patients (52% male, mean age 65.4 8.6 years). Seventeen patients had (50%) persistent AF in the study group. Conduction gaps were detected in multiple (>2) PVs in 17 patients (53%). Conduction gaps were abolished by single point ablation in most of the patients (32, 94%) or by incomplete circular lesions in the remaining patients (6%). The localization of conduction gaps did not differ between atrial fibrillation type. A significantly higher number of patients exhibited conduction recovery at inferior segments of both left and right inferior PVs (83% and 91%, respectively) compared with superior segments (p<0.05). Superior PVs of both left and right PVs exhibit lesser conduction gaps with a tendency for gaps at upper quadrants (71% and 80%, respectively) (p<0.05).
Conclusion: Conduction gaps after second generation CB-PVI is higher in both right and left inferior PVs than superior PVs. The predilection sites for the inferior PVs are mostly at lower quadrants of those PV ostia. However, conduction gaps tend to occur at upper quadrants of both right and left superior PVs. Further studies are needed in order to evaluate the role of modifications in the PVI technique to improve long-term success rates after the intervention.
- OP-129 Catheter Ablation of Drug Refractory Electrical Storm in Ischemic Cardiomyopathy: Single Centre Experience. Fırat Özcan, Serkan Topaloglu, Serkan Çay, Ugur Canpolat, Özcan Özeke, Osman Turak, Hande Çetin, Dursun Aras. _ Türkiye Yüksek Ihtisas Training and Research Hospital, Department of Cardiology, Division of Cardiac Arrhythmia and Electrophysiology, Ankara, Turkey. Background: Electrical storm (ES) is known as a life-threatening pathology which requires immediate and effective treatment due to increased morbidity and mortality. Catheter ablation provides an effective therapeutic option especially in patients with drug resistant ventricular arrhythmia episodes. These procedures should only be performed in highly specialized and experienced centers. Herein, we aimed to assess safety and efficacy of catheter ablation in a relatively large cohort with ES in our tertiary centre hospital. Methods: A total of 44 patients (90.9% male; mean age: 59.710.3 years) with ischemic cardiomyopathy undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Procedures were performed using the non-contact and electro-anatomic mapping systems. Long-term follow-up analysis addressed the predictors of ES recurrence and cardiac mortality. Results: Acute success for clinical and non-clinical VTs were 90.8% and 55.5%. At a mean follow-up of 2811 months, cardiac mortality was observed in 8 (18%) patients, 39 (88.6%) patients were free from the ES and 24 (55%) patients remained free from both ES and paroxysmal VT episodes. In multivariate regression analysis, recurrence of ES (OR: 3.11, 95% CI: 1.65-4.62, p¼0.001), LVEF and serum creatinine were found as independent predictors of cardiac mortality. Also, substrate based ablation, implantation of ICD for
Figure.
S56 The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
MARCH 26e29, 2015 secondary prophylaxis, LVEF and serum creatinine well predicted the ES recurrence. Conclusion: Catheter ablation of ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe and effective, and probably improves their prognosis.
- OP-130 Development of Arrhythmogenic Cardiac Cardiomyopathy in Patients with Ventricular Extrasystoles. Ashot Hovhannesyan. Yerevan Cardiology Institute. Aim: To find scintigraphic criterions of beginning of arrhythmogenic cardiomyopathy in patients with ventricular extrasystoli (VE). Material-Methods: 63 patients with ventricular extrasystoles was included in the study. 29 mean, 34 wemen. Mean age 29 e 63 year. Inclusion criterions into study was registered ventricular extrasystoli by 12 lead ECG, >4000 es/24h on Holther monitoring. In 16 patient electrophysiological study (EP) following radiofrequency ablation (RF) was performed. In 21 patients coronaroangiography was performed, no evidence of ischemic heart disease (IHD) was found. We exclude all patients with evidence of organic heart diseases, atrial arrhythmias and QT segment changes. 12 patients with no evidence of arrhythmia formed control group. In all patients Echocardiography with tissue doppler and synchronized myocardial quantitative gated SPECT was performed using 99Tc-pyrophospate using AnyScan Multimodality Imaging System. In RF ablation group myocardial quantitative gated SPECT was performed also 3 monts after procedure. Results: Areas of local asynchronous contraction was seen in all patients. Asynchronous contraction zones was the same with ECG what confirmed by intracardiac ECG during EP study. Echocardiography with tissue Doppler was less sensitive. We observed 3 kind of disturbances: when patients have only right, left or VE’s originated from both ventricles. And also multifocal (2 and more foci) VE’s seen in LV localizations. All this sites was estimated as electrical and mechanical heterogenic sites. In 38 patients (60,3%) VE’s arising from RV outflow tract, VE’s source localization and preliminary contraction areas was RV anterior wall. LV VE’s, especially monofocal, was located in sinus of Valsalva and asyncronious zones located in the septum. In LV VE group moderate LV dilatation and reduced contraction was observed. Conclusion: Zones of asyncroni on the scintigraphic phase polarity maps in patients with VE could considered as sign of ectopy and beginning of arrhythmogenic cardiomyopathy.
Novel Parameters fort he Prediction of Atrial Fibrillation Development Saturday, March 28, 2015 17:00 PM w 18:30 PM, Hall 8 (Abstract nos. OP-131 w OP-137)
- OP-131
O R A L
Does Continuous Insulin Therapy Reduce Postoperative Supraventricular Tachycardia Incidence after Coronary Artery Bypass Operations in Diabetic Patients?. Pakize Kirdemir1, Vedat Yildirim2, Ilker Kiris3, Senol Gulmen4, Erkan Kuralay5, Erdogan Ibrisim6, Ertugrul Ozal7. 1Department of Anesthesiology, University of Suleyman Demirel, Isparta, Turkey; 2Department of Anesthesiology and Reanimation, Gulhane Military Academy of Medicine, Ankara, Turkey; 3Department of Cardiovascular Surgery, S¸ifa University, Izmir, Turkey; 4Department of Cardiovascular Surgery, University of Suleyman Demirel, Isparta, Turkey; 5Department of Cardiovascular Surgery, Lokman Hekim Hospital, Ankara, Turkey; 6Department of Cardiovascular Surgery, Anatolia Hospital, Antalya, Turkey; 7 Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey. Objective: To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias. Material: Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers. Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient’s glycemic response during the prior 4 hours. Results: There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p ¼ 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p ¼ 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p ¼ 0.045). Univariate analysis identified positive inotropic drug requirement (p ¼ 0.011, odds ratio [OR] ¼ 3.41), ejection fraction (EF) (p ¼ 0.001, OR ¼ 0.92), cross-clamp time (p ¼ 0.046, OR ¼ 0.97), left internal mammary artery (p ¼ 0.023, OR ¼ 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p ¼ 0.009, OR ¼ 2.02), intra-aortic balloon pump (p ¼ 0.045, OR ¼ 1.23), body mass index (p ¼ 0.035 OR ¼ 5.60), and CII (p < 0.001, OR ¼ 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR ¼ 0.91), positive inotropic drug requirement (p < 0.001, OR ¼ 3.94), COPD (p ¼ 0.036, OR ¼ 2.11), and CII (p < 0.001, OR ¼ 0.19). Conclusion: Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.
The American Journal of Cardiologyâ MARCH 26e29, 2015 11th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
S57
A B S T R A C T S