- Email: [email protected]
P1-63
S128
Poor rate control metric at least 1 day with: AT/AF ⱖ 30 min. and V ⱖ 140 bpm
Heart Rhythm, Vol 3, No 5, May Supplement 2006 Intermittent evaluation N ⫽ 784 pts 0.7% pts
Continuous monitoring N ⫽ 784 pts 2.4% pts
P-value P ⬍ 0.001
P1-62 IMAGING OF THE LEFT ATRIAL APPENDAGE IN PATIENTS WITH ATRIAL FIBRILLATION: A COMPARISON OF TEE AND CARDIAC CT Loren P. Budge, MD, David C. Isbell, MD, J. Randall Moorman, MD, Douglas E. Lake, PhD and J. Michael Mangrum, MD. University of Virginia, Charlottesville, VA. Percutaneous left atrial appendage (LAA) occlusion devices are being evaluated as an alternative to warfarin therapy for stroke prevention in pts with atrial fibrillation (AF). Accurate sizing of these devices is critical and is currently being done by TEE measurements. We report an in vivo assessment of LAA size in a large group of pts with AF and compared TEE and cardiac CT measurements. Methods: Sixty-six pts underwent both TEE and cardiac CT from 1/05 to 11/05. Fifty-four had both studies adequate for LAA measurements. Cardiac CTs were performed on a GE Lightspeed 16 slice scanner and measurements were made using GE Voxtool 3.0.64q 3D MIP software. TEEs were performed on a Philips M2424A Ultrasound System (Andover, MA) using a Philips T6207 multi-plane transducer (Andover, MA). For all pts the LAA orifice diameter, width diameter (1 cm below orifice) and lengths were measured: for TEE at angles of 0, 45, 90, and 135 degrees, and for CT in sagittal, horizontal, and coronal sections. The greatest of these values was used as the measured parameter. Results: Mean LAA orifice diameter for cardiac CT and TEE was 26.3⫾4.1 mm and 26.1⫾6.3 mm, respectively with a mean difference of 0.2 mm (95% CI: ⫺9.1 mm to 9.5 mm). The correlation coefficient of the orifice diameter for these two studies was 0.44. The regression was CT ⫽ 0.4 TEE ⫹ 15 mm. The CT orifice values were usually larger than TEE for smaller orifices, but smaller than TEE for larger orifices. Mean LAA width diameter for cardiac CT and TEE was 23.5 ⫾ 4.2 mm and 23.0 ⫾ 5.8 mm, respectively with the mean difference in LAA width of 0.6 mm (95% CI: ⫺11.2 mm to 12.3 mm). Mean LAA depth for cardiac CT and TEE was 25.1 ⫾ 6.3 mm and 35.9 ⫾ 6.2 with a mean difference in LAA depth of ⫺10.9 mm (95% CI: ⫺27.6 mm to 5.9 mm), meaning that TEE tended to yield larger values for depth. Conclusions: This represents largest known study evaluating LAA measurements in vivo of pts with AF with different imaging modalities. CT and TEE measurements correlate minimally and the values are not interchangeable. This difference may be clinically significant because of the need for accurate sizing of LAA occlusion devices. A gold standard needs to be established.
and had at least one EF measurement which qualified them for ICD implant. In 39% of these pts, the EF measurements were discordant with regard to ICD eligibility. Discordance was considered present when at least one EF placed the patient in a CMS covered indication for ICD while EF measured by a different technique was above the cutoff for that indication. Among the 34 pts in whom one at least one EF measurement was ⬍25%, only 5 (15%) had discordance, whereas among the 27 pts in whom all EF measurements were ⬎ or equal to 25%, 19 (70%) had discordance. Conclusion: Patients with less severe LV dysfunction often have discordant results with regard to ICD indication when EF is measured by different techniques. P1-64 ARE MADIT II CRITERIA FOR ICD IMPLANTATION APPROPRIATE FOR JAPANESE PATIENTS? Kaoru Tanno, MD, Fumito Miyoshi, MD, Norikazu Watanabe, MD, Mitsuharu Kawamura, MD, Taku Asano, MD, Youichi Kobayashi, MD and Takashi Katagiri, MD. Showa University, Tokyo, Japan. Background: The Multicenter Automatic Defibrillator Implantation Trial (MADIT) II investigators concluded that prophylactic use of an implantable cardioverter defibrillator (ICD) improved survival in patients with prior myocardial infarction (MI) and reduced left ventricular ejection fraction (LVEF). However, it is unclear whether MADIT II criteria for ICD implantation are appropriate for Japanese patients. Methods and Results: Ninety (Men/Women:75/15, Mean age: 659 years) of the 3258 patients who underwent elective cardiac catheterization at our institution during the period 1997 to 2001 met MADIT II criteria (Q-wave MI more than 4 weeks prior; LVEF ⱕ 0.30; ⬎ 21 years of age; electrophysiologic testing not required) and were selected in this retrospective study of patient prognosis after catheterization. During the 3712-month follow-up period, 15 patients died of congestive heart failure (n⫽9), sudden cardiac death (n⫽2), acute MI (n⫽1), or non-cardiac causes (n⫽3). The survival rate in our series was comparable to that in the MADIT II defibrillator group but higher than that in the MADIT II conventional therapy group. We compared the characteristics of our patients with those of these two MADIT II groups. A significantly greater percentage of patients were found to be in New York Heart Association functional class I status and were also found to undergo percutaneous coronary intervention in our patients than in MADIT II patients, whereas a significantly fewer percentage of patients were found to undergo coronary artery bypass grafting in our patients than in MADIT II patients. In addition, a significantly higher prevalence of QRS width of more than 0.12 seconds was observed in the MADIT II patients than that in our patients. Conclusion: These results suggest that it may be inappropriate to apply MADIT II criteria to Japanese patients. P1-65
VARIABILITY OF EJECTION FRACTION MEASUREMENTS IN PATIENTS BEING EVALUATED FOR ICD IMPLANT Susan O’Donoghue, MD, Jean M. Fenton, MS, RN, Zayd Eldadah, MD, PhD, S. Adam Strickberger, MD and Edward V. Platia, MD. Washington Hospital Center, Washington, DC.
EVALUATION OF FOUR DISTINCT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR (S-ICD“) LEAD SYSTEMS IN HUMANS Andrew A. Grace, MD, PhD, Margaret A. Hood, MBChB, Warren M. Smith, MD, Andrey Ardashev, MD, Riccardo Cappato, MD and Gust H. Bardy, MD. Papworth Hospital NHS Trust, Cambridge, United Kingdom, Auckland City Hospital, Auckland, New Zealand, Burdenko Hospital, Moscow, Russian Federation, San Donato, Milano, Italy and University of Washington, Seattle, WA.
Left ventricular ejection fraction (EF) has emerged as the sole determinant of ICD eligibility for patients with ischemic and nonischemic cardiomyopathy. Among 120 inpatients prospectively evaluated for ICD over a 7 month period, 61 underwent EF measurement by two or more techniques (angiography, radionuclide scanning, echocardiography, MRI) in the absence of acute MI or intervening revascularization,
Background: The S-ICD provides an opportunity to avoid lead-related complications and chronic issues of lead integrity inherent to transvenous ICDs. Pulse generator position, electrode size and location and practical surgical issues are important considerations when evaluating S-ICD system efficacy. Methods: Following informed consent, 10 pts undergoing standard
P1-63
Poor rate control metric at least 1 day with: AT/AF ⱖ 30 min. and V ⱖ 140 bpm
Heart Rhythm, Vol 3, No 5, May Supplement 2006 Intermittent evaluation N ⫽ 784 pts 0.7% pts
Continuous monitoring N ⫽ 784 pts 2.4% pts
P-value P ⬍ 0.001
P1-62 IMAGING OF THE LEFT ATRIAL APPENDAGE IN PATIENTS WITH ATRIAL FIBRILLATION: A COMPARISON OF TEE AND CARDIAC CT Loren P. Budge, MD, David C. Isbell, MD, J. Randall Moorman, MD, Douglas E. Lake, PhD and J. Michael Mangrum, MD. University of Virginia, Charlottesville, VA. Percutaneous left atrial appendage (LAA) occlusion devices are being evaluated as an alternative to warfarin therapy for stroke prevention in pts with atrial fibrillation (AF). Accurate sizing of these devices is critical and is currently being done by TEE measurements. We report an in vivo assessment of LAA size in a large group of pts with AF and compared TEE and cardiac CT measurements. Methods: Sixty-six pts underwent both TEE and cardiac CT from 1/05 to 11/05. Fifty-four had both studies adequate for LAA measurements. Cardiac CTs were performed on a GE Lightspeed 16 slice scanner and measurements were made using GE Voxtool 3.0.64q 3D MIP software. TEEs were performed on a Philips M2424A Ultrasound System (Andover, MA) using a Philips T6207 multi-plane transducer (Andover, MA). For all pts the LAA orifice diameter, width diameter (1 cm below orifice) and lengths were measured: for TEE at angles of 0, 45, 90, and 135 degrees, and for CT in sagittal, horizontal, and coronal sections. The greatest of these values was used as the measured parameter. Results: Mean LAA orifice diameter for cardiac CT and TEE was 26.3⫾4.1 mm and 26.1⫾6.3 mm, respectively with a mean difference of 0.2 mm (95% CI: ⫺9.1 mm to 9.5 mm). The correlation coefficient of the orifice diameter for these two studies was 0.44. The regression was CT ⫽ 0.4 TEE ⫹ 15 mm. The CT orifice values were usually larger than TEE for smaller orifices, but smaller than TEE for larger orifices. Mean LAA width diameter for cardiac CT and TEE was 23.5 ⫾ 4.2 mm and 23.0 ⫾ 5.8 mm, respectively with the mean difference in LAA width of 0.6 mm (95% CI: ⫺11.2 mm to 12.3 mm). Mean LAA depth for cardiac CT and TEE was 25.1 ⫾ 6.3 mm and 35.9 ⫾ 6.2 with a mean difference in LAA depth of ⫺10.9 mm (95% CI: ⫺27.6 mm to 5.9 mm), meaning that TEE tended to yield larger values for depth. Conclusions: This represents largest known study evaluating LAA measurements in vivo of pts with AF with different imaging modalities. CT and TEE measurements correlate minimally and the values are not interchangeable. This difference may be clinically significant because of the need for accurate sizing of LAA occlusion devices. A gold standard needs to be established.
and had at least one EF measurement which qualified them for ICD implant. In 39% of these pts, the EF measurements were discordant with regard to ICD eligibility. Discordance was considered present when at least one EF placed the patient in a CMS covered indication for ICD while EF measured by a different technique was above the cutoff for that indication. Among the 34 pts in whom one at least one EF measurement was ⬍25%, only 5 (15%) had discordance, whereas among the 27 pts in whom all EF measurements were ⬎ or equal to 25%, 19 (70%) had discordance. Conclusion: Patients with less severe LV dysfunction often have discordant results with regard to ICD indication when EF is measured by different techniques. P1-64 ARE MADIT II CRITERIA FOR ICD IMPLANTATION APPROPRIATE FOR JAPANESE PATIENTS? Kaoru Tanno, MD, Fumito Miyoshi, MD, Norikazu Watanabe, MD, Mitsuharu Kawamura, MD, Taku Asano, MD, Youichi Kobayashi, MD and Takashi Katagiri, MD. Showa University, Tokyo, Japan. Background: The Multicenter Automatic Defibrillator Implantation Trial (MADIT) II investigators concluded that prophylactic use of an implantable cardioverter defibrillator (ICD) improved survival in patients with prior myocardial infarction (MI) and reduced left ventricular ejection fraction (LVEF). However, it is unclear whether MADIT II criteria for ICD implantation are appropriate for Japanese patients. Methods and Results: Ninety (Men/Women:75/15, Mean age: 659 years) of the 3258 patients who underwent elective cardiac catheterization at our institution during the period 1997 to 2001 met MADIT II criteria (Q-wave MI more than 4 weeks prior; LVEF ⱕ 0.30; ⬎ 21 years of age; electrophysiologic testing not required) and were selected in this retrospective study of patient prognosis after catheterization. During the 3712-month follow-up period, 15 patients died of congestive heart failure (n⫽9), sudden cardiac death (n⫽2), acute MI (n⫽1), or non-cardiac causes (n⫽3). The survival rate in our series was comparable to that in the MADIT II defibrillator group but higher than that in the MADIT II conventional therapy group. We compared the characteristics of our patients with those of these two MADIT II groups. A significantly greater percentage of patients were found to be in New York Heart Association functional class I status and were also found to undergo percutaneous coronary intervention in our patients than in MADIT II patients, whereas a significantly fewer percentage of patients were found to undergo coronary artery bypass grafting in our patients than in MADIT II patients. In addition, a significantly higher prevalence of QRS width of more than 0.12 seconds was observed in the MADIT II patients than that in our patients. Conclusion: These results suggest that it may be inappropriate to apply MADIT II criteria to Japanese patients. P1-65
VARIABILITY OF EJECTION FRACTION MEASUREMENTS IN PATIENTS BEING EVALUATED FOR ICD IMPLANT Susan O’Donoghue, MD, Jean M. Fenton, MS, RN, Zayd Eldadah, MD, PhD, S. Adam Strickberger, MD and Edward V. Platia, MD. Washington Hospital Center, Washington, DC.
EVALUATION OF FOUR DISTINCT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR (S-ICD“) LEAD SYSTEMS IN HUMANS Andrew A. Grace, MD, PhD, Margaret A. Hood, MBChB, Warren M. Smith, MD, Andrey Ardashev, MD, Riccardo Cappato, MD and Gust H. Bardy, MD. Papworth Hospital NHS Trust, Cambridge, United Kingdom, Auckland City Hospital, Auckland, New Zealand, Burdenko Hospital, Moscow, Russian Federation, San Donato, Milano, Italy and University of Washington, Seattle, WA.
Left ventricular ejection fraction (EF) has emerged as the sole determinant of ICD eligibility for patients with ischemic and nonischemic cardiomyopathy. Among 120 inpatients prospectively evaluated for ICD over a 7 month period, 61 underwent EF measurement by two or more techniques (angiography, radionuclide scanning, echocardiography, MRI) in the absence of acute MI or intervening revascularization,
Background: The S-ICD provides an opportunity to avoid lead-related complications and chronic issues of lead integrity inherent to transvenous ICDs. Pulse generator position, electrode size and location and practical surgical issues are important considerations when evaluating S-ICD system efficacy. Methods: Following informed consent, 10 pts undergoing standard
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