- Email: [email protected]
P1-29
Poster 1
S117
Variable
Successful ECV
Failed ECV
p value
Age(years) Duration (months) LA size (mm) LVEF (%) Decel time (sec) IVRT (sec) BNP pre (pg/ml) Hypertension (%) B-blocker use (%) Amiodarone use (%)
65.9 15.7 40.1 46.9 0.22 0.065 253.2 62.8 68.6 20
61.9 7.9 39.8 42.4 0.17 0.066 229.3 37.5 62.5 87.5
ns ns ns ns ns ns ns ⬍0.001 ⬍0.001 ⬍0.001
Conclusion: This data demonstrates an overall success rate of ECV comparable to previously published data. Although hypertension was commoner in the success group, success was independent of markers of diastolic dysfunction, LA size and duration of AF. B-blocker usage was associated with a higher chance of ECV success. BNP levels prior to ECV did not predict immediate ECV success. P1-29
cardiographic (ICE) images of the crista terminalis (CT) and transverse conduction properties of the CT between chronic and paroxysmal common type AFL. Methods: Chronic AFL (n⫽5) was defined as non-self terminating AFL lasting ⬎ 1 month and paroxysmal AFL (n⫽12) was defined as an intermittent arrhythmia with symptomatic episodes of 24 hours maximal duration. The ICE images of the RA were recorded by 9F, 9MHz intracardiac ultrasound catheter (Boston Scientific) during pulling back every 0.5mm from superior vena cava to inferior vena cava triggered by electrocardiogram and respiration. Three dimensional (3-D) image of the right atrium was reconstructed using 3-D reconstruction system (USE-1200, TomTec Imaging Systems). Results: 3-D image of the CT in patients with chronic AFL showed thick and continuous configuration and conduction across the CT during coronary sinus ostium pacing was blocked at pacing rate just above sinus rhythm. In contrast, 3-D image of the CT in patients with paroxysmal AFL showed thin and discontinuous configuration and conduction across the CT during coronary sinus ostium pacing was present in 9 of 12 patients with paroxysmal AFL. Conclusion: Chronic AFL is characterized by anatomical and electrophysiological characteristics of the CT.
DISPERSION OF ATRIAL REPOLARIZATION IN BRUGADA SYNDROME Kee-Joon Choi, MD, Gi-Byoung Nam, MD and You-Ho Kim, MD. Asan Medical Center, Seoul, Republic of Korea. Background: The reason for a higher incidence of atrial fibrillation(AF) in patients with Brugada syndrome(BS) has not been elucidated. Increased atrial vulnerability with increased intraatrial conduction time has been reported. However, the role of dispersion of atrial repolarization has not been investigated. Methods: Monophasic action potentials (MAPs) were recorded from four right atrial regions in 10 patients (M/F 9/1, 40 ⫾ 9 years) with BS and in 8 controls (M/F 6/2, 35 ⫾ 8 years) with paroxysmal supraventricular tachycardia. There was no history of AF in both groups. MAPs were recorded during atrial pacing at a drive cycle length of 600msec. Dispersion of MAPD90 (MAP duration at 90% of repolarization) was measured by the difference between the maximum and minimum MAPD90. Inducibility of AF and repetitive atrial firing(occurrence of two or more successive atrial activities induced by single atrial premature stimulation) was also studied with extrastimuli until atrial effective refractory period. Results: The MAPD90 was not significantly different between the two groups (251 ⫾ 40 ms in BS and 230 ⫾ 25 ms in control group, p ⫽ ns), but dispersion of MAPD90 was significantly increased in patients with BS versus control group (73.3 ⫾ 35.0ms and 39.8 ⫾ 9.8ms, p ⬍ 0.05). AF was induced in 6 and repetitive atrial firing in 4 patients with BS but in none of the control subjects. Conclusions: Dispersion of atrial repolarization was significantly increased in patients with BS, suggesting that the heterogeneity of atrial repolarization may contribute to the development of atrial fibrillation. P1-30 ANATOMIC AND ELECTROPHYSIOLOGICAL DIFFERENCES BETWEEN CHRONIC AND PAROXYSMAL FORMS OF COMMON ATRIAL FLUTTER: 3-DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHIC ANALYSIS Kimie Ohkubo, MD, Ichiro Watanabe, MD, PhD, Yasuo Okumura, MD, PhD, Yasuo Okumura, MD, PhD, Sonoko Ashino, MD, Masayoshi Kofune, MD, Masayoshi Kofune, MD, Kazunori Kawauchi, MD, Takeshi Yamada, MD, Kenichi Hashimoto, MD, PhD, Atsushi Shindo, MD, PhD, Hidezou Sugimura, MD, PhD, Toshiko Nakai, MD, PhD and Satoshi Saito, MD, PhD. Nihon University Hospital, Tokyo, Japan. Background: It remains unknown why AFL is present as chronic or paroxysmal. The aim of the study was to compare the intracardiac echo-
P1-31 SERIAL CHANGES OF INFLAMMATORY CYTOKINES AND NEUROHUMORAL FACTORS WITH RAPID ATRIAL PACING IN HUMANS Tetsuzou Kanemori, MD, Tsuyoshi Sakoda, MD, PhD, Takashi Doi, MD, Toshio Naka, MD, Yoshio Furukawa, MD, Hiroki Shimizu, MD, PhD, Tohru Masuyama, MD, PhD and Mitsumasa Naka, MD, PhD. Hyogo College of Medicine, Nishinomiya, Japan. Background: Previous studies have shown tachycardia is known to cause myocardial dysfunction. We have demonstrated increased levels of cytokines especially TNF␣, Interleukin 6 (IL-6), or Interleukin 18 (IL-18) induced cardiac myocyte apoptosis. However, the effect of rapid pacing on inflammatory cytokine induction remains unclear in humans. The purpose of this study was to assess acute changes of plasma levels of inflammatory cytokines and neurohumoral factors after short-term rapid pacing in humans. Methods: The study group consisted of 9 patients (7 male, 2 female, mean age of 52⫾16) who underwent radiofrequency catheter ablation of supraventricular tachycardia. After successful ablation, plasma levels of atrial natriuretic peptides (ANP), brain natriuretic peptides (BNP), IL-6, IL-18, high sensitive C-reactive protein (hsCRP), high sensitive TNF-␣ (hsTNF␣), and hepatocyte growth factor (HGF) were analyzed in blood samples from coronary sinus (CS) and peripheral vein (PV) before and after continuous right atrial pacing (120⬃150 beats/min) without Wenckebach block for 30 minutes. All patients received informed consent. Results: After continuous pacing, ANP and IL-6 showed significant increases in both CS and PV. BNP was significant increase in PV, however,
S117
Variable
Successful ECV
Failed ECV
p value
Age(years) Duration (months) LA size (mm) LVEF (%) Decel time (sec) IVRT (sec) BNP pre (pg/ml) Hypertension (%) B-blocker use (%) Amiodarone use (%)
65.9 15.7 40.1 46.9 0.22 0.065 253.2 62.8 68.6 20
61.9 7.9 39.8 42.4 0.17 0.066 229.3 37.5 62.5 87.5
ns ns ns ns ns ns ns ⬍0.001 ⬍0.001 ⬍0.001
Conclusion: This data demonstrates an overall success rate of ECV comparable to previously published data. Although hypertension was commoner in the success group, success was independent of markers of diastolic dysfunction, LA size and duration of AF. B-blocker usage was associated with a higher chance of ECV success. BNP levels prior to ECV did not predict immediate ECV success. P1-29
cardiographic (ICE) images of the crista terminalis (CT) and transverse conduction properties of the CT between chronic and paroxysmal common type AFL. Methods: Chronic AFL (n⫽5) was defined as non-self terminating AFL lasting ⬎ 1 month and paroxysmal AFL (n⫽12) was defined as an intermittent arrhythmia with symptomatic episodes of 24 hours maximal duration. The ICE images of the RA were recorded by 9F, 9MHz intracardiac ultrasound catheter (Boston Scientific) during pulling back every 0.5mm from superior vena cava to inferior vena cava triggered by electrocardiogram and respiration. Three dimensional (3-D) image of the right atrium was reconstructed using 3-D reconstruction system (USE-1200, TomTec Imaging Systems). Results: 3-D image of the CT in patients with chronic AFL showed thick and continuous configuration and conduction across the CT during coronary sinus ostium pacing was blocked at pacing rate just above sinus rhythm. In contrast, 3-D image of the CT in patients with paroxysmal AFL showed thin and discontinuous configuration and conduction across the CT during coronary sinus ostium pacing was present in 9 of 12 patients with paroxysmal AFL. Conclusion: Chronic AFL is characterized by anatomical and electrophysiological characteristics of the CT.
DISPERSION OF ATRIAL REPOLARIZATION IN BRUGADA SYNDROME Kee-Joon Choi, MD, Gi-Byoung Nam, MD and You-Ho Kim, MD. Asan Medical Center, Seoul, Republic of Korea. Background: The reason for a higher incidence of atrial fibrillation(AF) in patients with Brugada syndrome(BS) has not been elucidated. Increased atrial vulnerability with increased intraatrial conduction time has been reported. However, the role of dispersion of atrial repolarization has not been investigated. Methods: Monophasic action potentials (MAPs) were recorded from four right atrial regions in 10 patients (M/F 9/1, 40 ⫾ 9 years) with BS and in 8 controls (M/F 6/2, 35 ⫾ 8 years) with paroxysmal supraventricular tachycardia. There was no history of AF in both groups. MAPs were recorded during atrial pacing at a drive cycle length of 600msec. Dispersion of MAPD90 (MAP duration at 90% of repolarization) was measured by the difference between the maximum and minimum MAPD90. Inducibility of AF and repetitive atrial firing(occurrence of two or more successive atrial activities induced by single atrial premature stimulation) was also studied with extrastimuli until atrial effective refractory period. Results: The MAPD90 was not significantly different between the two groups (251 ⫾ 40 ms in BS and 230 ⫾ 25 ms in control group, p ⫽ ns), but dispersion of MAPD90 was significantly increased in patients with BS versus control group (73.3 ⫾ 35.0ms and 39.8 ⫾ 9.8ms, p ⬍ 0.05). AF was induced in 6 and repetitive atrial firing in 4 patients with BS but in none of the control subjects. Conclusions: Dispersion of atrial repolarization was significantly increased in patients with BS, suggesting that the heterogeneity of atrial repolarization may contribute to the development of atrial fibrillation. P1-30 ANATOMIC AND ELECTROPHYSIOLOGICAL DIFFERENCES BETWEEN CHRONIC AND PAROXYSMAL FORMS OF COMMON ATRIAL FLUTTER: 3-DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHIC ANALYSIS Kimie Ohkubo, MD, Ichiro Watanabe, MD, PhD, Yasuo Okumura, MD, PhD, Yasuo Okumura, MD, PhD, Sonoko Ashino, MD, Masayoshi Kofune, MD, Masayoshi Kofune, MD, Kazunori Kawauchi, MD, Takeshi Yamada, MD, Kenichi Hashimoto, MD, PhD, Atsushi Shindo, MD, PhD, Hidezou Sugimura, MD, PhD, Toshiko Nakai, MD, PhD and Satoshi Saito, MD, PhD. Nihon University Hospital, Tokyo, Japan. Background: It remains unknown why AFL is present as chronic or paroxysmal. The aim of the study was to compare the intracardiac echo-
P1-31 SERIAL CHANGES OF INFLAMMATORY CYTOKINES AND NEUROHUMORAL FACTORS WITH RAPID ATRIAL PACING IN HUMANS Tetsuzou Kanemori, MD, Tsuyoshi Sakoda, MD, PhD, Takashi Doi, MD, Toshio Naka, MD, Yoshio Furukawa, MD, Hiroki Shimizu, MD, PhD, Tohru Masuyama, MD, PhD and Mitsumasa Naka, MD, PhD. Hyogo College of Medicine, Nishinomiya, Japan. Background: Previous studies have shown tachycardia is known to cause myocardial dysfunction. We have demonstrated increased levels of cytokines especially TNF␣, Interleukin 6 (IL-6), or Interleukin 18 (IL-18) induced cardiac myocyte apoptosis. However, the effect of rapid pacing on inflammatory cytokine induction remains unclear in humans. The purpose of this study was to assess acute changes of plasma levels of inflammatory cytokines and neurohumoral factors after short-term rapid pacing in humans. Methods: The study group consisted of 9 patients (7 male, 2 female, mean age of 52⫾16) who underwent radiofrequency catheter ablation of supraventricular tachycardia. After successful ablation, plasma levels of atrial natriuretic peptides (ANP), brain natriuretic peptides (BNP), IL-6, IL-18, high sensitive C-reactive protein (hsCRP), high sensitive TNF-␣ (hsTNF␣), and hepatocyte growth factor (HGF) were analyzed in blood samples from coronary sinus (CS) and peripheral vein (PV) before and after continuous right atrial pacing (120⬃150 beats/min) without Wenckebach block for 30 minutes. All patients received informed consent. Results: After continuous pacing, ANP and IL-6 showed significant increases in both CS and PV. BNP was significant increase in PV, however,