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Optimisation and Utility of Endocardial Catheter Based Electroanatomical Mapping for Discrimination of Adipose Infiltration within Left Ventricular Scar in an Ovine Post Infarct Model
Abstracts
355 Meta-Analysis of Minimally-Invasive MAZE to Treat Atrial Fibrillation T. Wang 1,∗ , T. Kulasegaran 1 , M. Wang 2 , T. Ramanathan 1 1 Green
Lane Cardiovascular Service, Auckland City Hospital, New Zealand 2 Department of Medicine, University of Auckland, New Zealand Background: Management of atrial fibrillation is frequently challenging, and traditionally catheter or surgical procedures are the main modalities for ablation. Minimally invasive thoracoscopic techniques recently developed endeavor to preserve the advantages of both traditional modalities. We reviewed the efficacy and safety of minimally-invasive MAZE to treat atrial fibrillation in this meta-analysis. Methods: We searched Pubmed and Embase databases from 1 January 1980 to 30 June 2015 for original studies. Two authors evaluated these studies for inclusion independently, and retrieved data for pooled analyses. Results: From the search, 1,098 abstracts were screened with 206 full-articles evaluated for the final inclusion of 31 studies (all observational). Pooled proportion of patients in sinus rhythm at 3 months was 0.85 (0.77-0.93) in 5 studies, at 6 months was 0.88 (0.83-0.94) in 8 studies and at 12 months was 0.84 (0.81-0.97) in 6 studies. Pooled proportion of patients off anti-arrhythmic drugs at 3 months was 0.52 (0.01-1.03) in 3 studies, at 6 months as 0.73 (0.64-0.83) in 9 studies and at 12 months 0.67 (0.58-0.77) in 11 studies. Adverse event rates of mortality (0-2%), stroke/TIA (0-3%) and bleeding (0-15%) in studies reported were low. Conclusion: Efficacy and safety of minimally-invasive MAZE is high and similar to catheter and surgical ablation. Ongoing development and larger and randomised studies of this procedure would facilitate more precise comparisons with other treatment modalities and guide clinical practice. http://dx.doi.org/10.1016/j.hlc.2016.06.356 356 Optimisation and Utility of Endocardial Catheter Based Electroanatomical Mapping for Discrimination of Adipose Infiltration within Left Ventricular Scar in an Ovine Post Infarct Model R. Samanta 1,2,∗ , M. Barry 1 , S. Al raisi 1,2 , P. Kovoor 1,2 , A. Thiagalingam 1,2 , J. Poulipoulos 1,2 1 Westmead 2 Sydney
Hospital, Sydney, Australia University, Sydney, Australia
Background: Electrogram amplitude is commonly used to identify scar during electrophysiological mapping of postmyocardial infarction ventricular tachycardia. Post-infarct ventricular scar comprises of adipose and collagen. We aimed to identify the influence of collagen and adipose on scar defined by endocardial catheter based mapping. We also
S151
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aimed to optimise the criteria for identification of adipose within scar using endocardial mapping. Methods: Left-ventricular plunge-needle and catheter mapping was performed in sheep with healed MI (n=8). Histological quantity of adipose tissue and collagen, was coregistered with endocardial catheter based mapping points. Results: We used traditional values of < 1.5 V for identification of scar and < 0.5 V for dense scar during bipolar mapping. Adipose (AUC-0.815, p < 0.001-scar and AUC-0.730, p < 0.001-dense scar) had a stronger influence than collagen (AUC-0.659, p-0.039-scar and AUC-0.589, p-0.071-dense scar) during bipolar mapping. Based on previous studies we used -6.2 V as the cut-off for identifying scar tissue with unipolar mapping. During unipolar mapping adipose (AUC-0.707, p0.042) but not collagen (AUC-0.588, p-0.067) contributed to identification of scar. We also assessed the ability of endocardial mapping to identify areas with adipose: scar ratio greater than 0.1. In this regard only unipolar mapping was useful (AUC-0.896, p-0.05-unipolar and AUC-0.420, p-0.653bipolar). A cut off – 9.2 V or more had a sensitivity of 85.7% and a specificity of 100% in identifying these areas. Conclusion: Adipose has a stronger influence than collagen while identifying scar using endocardial catheter mapping. Unipolar mapping is more useful than bipolar mapping while assessing the adipose content of scar. http://dx.doi.org/10.1016/j.hlc.2016.06.357 357 Outcomes after Cardiac Device Implantation in Australia: Results from a National Multi-Centre Registry D. Eccleston 1,∗ , D. O’Donnell 2 , D. Cehic 3 , T. Lin 2 , P. Sakiani 4 , M. Santos 5 1 Royal Melbourne Hospital, Melbourne, Australia 2 HeartCare Victoria, Australia 3 Adelaide Cardiology, Australia 4 HeartCare Western Australia, Australia 5 HeartCare Partners Queensland, Australia
Background: Although pacemaker and ICD implant numbers have been intermittently reported from device company records, there is a lack of data regarding outcomes after cardiac device implantation in Australia. We aimed to report implant and outcome data in Australian private hospitals from a new national clinical quality register. Methods: We prospectively collected data on 248 patients from 10 centres between December 2015 - January 2016 in the Genesis HeartCare Cardiovascular Outcomes Registry (GCOR). Baseline patient/procedural data, in-hospital and 30-day outcomes, and AHA/ACC performance measures and quality metrics were recorded in an electronic database at Monash University. 1 year follow-up data will be collected. Results: Patients’ mean age was 67 ± 12 years. Females comprised 36%, 32.9% had a history of heart failure, 47.8% AF and 23.0% myocardial infarction. 71.9% received a pacemaker, 7.3% a loop recorder and 20.9% an ICD; 82.7% were de novo or upgrades. 43.5% were discharged on antiplatelet agents and 37.5% on anticoagulants
355 Meta-Analysis of Minimally-Invasive MAZE to Treat Atrial Fibrillation T. Wang 1,∗ , T. Kulasegaran 1 , M. Wang 2 , T. Ramanathan 1 1 Green
Lane Cardiovascular Service, Auckland City Hospital, New Zealand 2 Department of Medicine, University of Auckland, New Zealand Background: Management of atrial fibrillation is frequently challenging, and traditionally catheter or surgical procedures are the main modalities for ablation. Minimally invasive thoracoscopic techniques recently developed endeavor to preserve the advantages of both traditional modalities. We reviewed the efficacy and safety of minimally-invasive MAZE to treat atrial fibrillation in this meta-analysis. Methods: We searched Pubmed and Embase databases from 1 January 1980 to 30 June 2015 for original studies. Two authors evaluated these studies for inclusion independently, and retrieved data for pooled analyses. Results: From the search, 1,098 abstracts were screened with 206 full-articles evaluated for the final inclusion of 31 studies (all observational). Pooled proportion of patients in sinus rhythm at 3 months was 0.85 (0.77-0.93) in 5 studies, at 6 months was 0.88 (0.83-0.94) in 8 studies and at 12 months was 0.84 (0.81-0.97) in 6 studies. Pooled proportion of patients off anti-arrhythmic drugs at 3 months was 0.52 (0.01-1.03) in 3 studies, at 6 months as 0.73 (0.64-0.83) in 9 studies and at 12 months 0.67 (0.58-0.77) in 11 studies. Adverse event rates of mortality (0-2%), stroke/TIA (0-3%) and bleeding (0-15%) in studies reported were low. Conclusion: Efficacy and safety of minimally-invasive MAZE is high and similar to catheter and surgical ablation. Ongoing development and larger and randomised studies of this procedure would facilitate more precise comparisons with other treatment modalities and guide clinical practice. http://dx.doi.org/10.1016/j.hlc.2016.06.356 356 Optimisation and Utility of Endocardial Catheter Based Electroanatomical Mapping for Discrimination of Adipose Infiltration within Left Ventricular Scar in an Ovine Post Infarct Model R. Samanta 1,2,∗ , M. Barry 1 , S. Al raisi 1,2 , P. Kovoor 1,2 , A. Thiagalingam 1,2 , J. Poulipoulos 1,2 1 Westmead 2 Sydney
Hospital, Sydney, Australia University, Sydney, Australia
Background: Electrogram amplitude is commonly used to identify scar during electrophysiological mapping of postmyocardial infarction ventricular tachycardia. Post-infarct ventricular scar comprises of adipose and collagen. We aimed to identify the influence of collagen and adipose on scar defined by endocardial catheter based mapping. We also
S151
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
aimed to optimise the criteria for identification of adipose within scar using endocardial mapping. Methods: Left-ventricular plunge-needle and catheter mapping was performed in sheep with healed MI (n=8). Histological quantity of adipose tissue and collagen, was coregistered with endocardial catheter based mapping points. Results: We used traditional values of < 1.5 V for identification of scar and < 0.5 V for dense scar during bipolar mapping. Adipose (AUC-0.815, p < 0.001-scar and AUC-0.730, p < 0.001-dense scar) had a stronger influence than collagen (AUC-0.659, p-0.039-scar and AUC-0.589, p-0.071-dense scar) during bipolar mapping. Based on previous studies we used -6.2 V as the cut-off for identifying scar tissue with unipolar mapping. During unipolar mapping adipose (AUC-0.707, p0.042) but not collagen (AUC-0.588, p-0.067) contributed to identification of scar. We also assessed the ability of endocardial mapping to identify areas with adipose: scar ratio greater than 0.1. In this regard only unipolar mapping was useful (AUC-0.896, p-0.05-unipolar and AUC-0.420, p-0.653bipolar). A cut off – 9.2 V or more had a sensitivity of 85.7% and a specificity of 100% in identifying these areas. Conclusion: Adipose has a stronger influence than collagen while identifying scar using endocardial catheter mapping. Unipolar mapping is more useful than bipolar mapping while assessing the adipose content of scar. http://dx.doi.org/10.1016/j.hlc.2016.06.357 357 Outcomes after Cardiac Device Implantation in Australia: Results from a National Multi-Centre Registry D. Eccleston 1,∗ , D. O’Donnell 2 , D. Cehic 3 , T. Lin 2 , P. Sakiani 4 , M. Santos 5 1 Royal Melbourne Hospital, Melbourne, Australia 2 HeartCare Victoria, Australia 3 Adelaide Cardiology, Australia 4 HeartCare Western Australia, Australia 5 HeartCare Partners Queensland, Australia
Background: Although pacemaker and ICD implant numbers have been intermittently reported from device company records, there is a lack of data regarding outcomes after cardiac device implantation in Australia. We aimed to report implant and outcome data in Australian private hospitals from a new national clinical quality register. Methods: We prospectively collected data on 248 patients from 10 centres between December 2015 - January 2016 in the Genesis HeartCare Cardiovascular Outcomes Registry (GCOR). Baseline patient/procedural data, in-hospital and 30-day outcomes, and AHA/ACC performance measures and quality metrics were recorded in an electronic database at Monash University. 1 year follow-up data will be collected. Results: Patients’ mean age was 67 ± 12 years. Females comprised 36%, 32.9% had a history of heart failure, 47.8% AF and 23.0% myocardial infarction. 71.9% received a pacemaker, 7.3% a loop recorder and 20.9% an ICD; 82.7% were de novo or upgrades. 43.5% were discharged on antiplatelet agents and 37.5% on anticoagulants