- Email: [email protected]
P3-99
S210
Heart Rhythm, Vol 3, No 5, May Supplement 2006
units (du). The percent change in du between baseline and the ON and OFF 3 months phases was calculated. Results: The 3 months therapy OFF phase was associated with increased expression of ANP and BNP and decreased expression of ␣-MHC, SERCA-2a, PLB and RYR (Table). In contrast, the 3 months ON therapy phase resulted in decreased expression of ANP and BNP and increased expression of ␣-MHC, SERCA-2a, PLB and RYR (Table). Conclusions: In patients with HF, CCM therapy reverses the cardiac maladaptive fetal gene program and normalizes expression of key SR Ca2⫹ cycling genes. These observations are consistent with the observed improvement in LV function in patients with HF following long-term CCM therapy. mRNA Expression (% Change from Baseline)
ANP BNP ␣-MHC SERCA-2a PLB RYR
OFF Phase
ON Phase
P-Value
82 ⫾ 26 81 ⫾ 28 -29 ⫾ 9 -21 ⫾ 10 4 ⫾ 18 -20 ⫾ 6
-57 ⫾ 9 -55 ⫾ 9 80 ⫾ 16 45 ⫾ 14 93 ⫾ 45 34 ⫾ 6
0.009 0.007 0.004 0.039 0.084 0.002
P3-97 CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION - A META-ANALYSIS Carlo Bonanno, MD, Renato Ometto, MD, Mariemma Paccanaro, MD and Alessandro Fontanelli, MD. S. Bortolo Hospital, Vicenza, Italy. Introduction: Cardiac resynchronization therapy (CRT) is a new therapeutic option for patients who have advanced heart failure (HF). Much information has been obtained from patients who have sinus rhythm, but the use of CRT in patients who have permanent atrial fibrillation (AF) has not been studied extensively. Only recently have trials been designed to specifically study CRT in patients with AF. In this study, a meta-analysis was used to clarify clinical outcomes and survival after CRT in patients with AF, using data from the published literature. Methods and Results: Randomized controlled trials, including patients with symptomatic HF and AF, were used in the meta-analysis. Active CRT versus univentricular pacing (mostly right ventricular pacing), both with optimal medical therapy, were compared. Six-minute walk test distance, peak oxygen consumption, quality of life, left ventricular function and mortality were the outcomes measured. Data were analyzed using a random effects model in Review Manager 4.2.7. Calculations included: relative risk (RR) for dichotomous variables; weighted mean difference (WMD) for continuous variables. All results were reported with 95% confidence intervals (95% CI). In four RCTs included in the meta-analysis CRT did not improve six-minute walk distance (WMD 18.80 m, 95% CI - 4.20 m to 41.81 m), peak oxygen consumption (WMD 1.56 ml/kg/min, 95% CI - 0.13 to 3.26 ml/kg/min), and quality of life (WMD reduction of - 3.47 points, 95% CI - 9.77 to 2.82 points on the Minnesota Living with HF Questionnaire). Left ventricular ejection fraction was increased (WMD 4.02 %, 95% CI 1.64 to 6.41 %) and all-cause mortality was reduced by 49% (RR 0.51, 95% CI 0.28 to 0.92). Both these results were statistically significant. Conclusions: In patients with HF and AF, CRT improves left ventricular function and reduces all-cause death, without evidence of benefits on functional outcomes. P3-98 LONG TERM EFFECT OF REPEATED SEQUENTIAL VV OPTIMIZATION IN PATIENTS WITH CRT-THERAPY? Anett Groe, MD, Burkhard J. Hu¨gl, MD, Zdravena Findeisen, MD, Angela Germer, PhD, Franziska Biedermann, PhD, Marcus Jahnecke, MD and Christoph J. Geller, MD.
Zentralklinik Bad Berka, Bad Berka, Germany and Medtronic, Du¨sseldorf, Germany. Background: Cardiac resynchronisation therapy (CRT) is well established in patients (pts) with severe heart failure. Biventricular devices offer the possibility to stimulate the right and left ventricle (VV) separately. Aim of our study is to analyse the effect of a sequential VV-optimization over time trough invasive and non-invasive measurements. Methods: In this prospective study pts with CRT-therapy (NYHAⱖIII, LBB⬎150ms, ejection fraction (EF) ⬍ 35%) were included. All pts received a CRT-device with the option of VV-optimization (Insync III or Insync III Marquis; Medtronic Inc.) After one month without biventricular pacing (VVI 30) all pts received a baseline investigation with an invasive AV (60-150 ms) and VV (-40 to ⫹40 ms) optimization using a micro tip pressure catheter (Millar, SPC790), which was placed in the left ventricle. Additional a non-invasive impedance-cardiographic measurement was performed to figure out the cardiac output (CO). These procedures were repeated after 3 months. After one year. the non-invasive measurement was repeated. Results: 15 pts with CRT were included (age: 66⫾8,7 years; EF 23⫾7 %, 9 pts with DCM). Without stimulation we measured at baseline a CO of 4,2⫾1,3 l/min with a dp/dtmax of 835⫾184 mmHg/s. With simultaneously biventricular stimulation and optimized AV-delay the CO increased to 5,3⫾1,5 l/min with a dp/dtmax. of 1021⫾214,4 mmHg/s (p⬍0,01). After optimization of the VV-time the dp/dtmax. increased additionally to 1090⫾127,8 mmHg/s with a CO of 5,9⫾1,8 l/min (p ⬍ 0,01). After 3 months of CRT nearly the same results could be performed. (dp/dt max :915⫾114/951⫾129/1024⫾120 mmHg/s; CO: 4,4⫾1,1/4,7⫾1,2/5,5⫾1,2 l/min). But in 11/15 pts the VV-interval was changed in relation to the baseline measurement. After one year the hemodynamic situation becomes more stable. In 3/11 pts a change of the VV-interval was related to a significant change of the cardiac output (⬎ 10%). Conclusion: A sequential VV optimization improves the hemodynamic parameters besides AV-optimization in pts with CRT. A repeated optimization should be required at the beginning of the therapy . After one year the hemodynamic situation has been stabilized. P3-99 CARDIAC SYMPATHETIC ACTIVITY EVALUATED BY SCINTIGRAPHICS 123I-MIBG IMAGING PRE AND POST RESYNCHRONIZATION THERAPY Martino Martinelli, PhD, Silvana A. D. Nishioka, PhD, Simone C. S. Branda˜o, MD, Clementina Giorgi, PhD, Clementina Giorgi, PhD, Cla´udio Meneguetti, PhD, Marcelo Vieira, PhD, Viviane Hotta, MD, Anı´sio A. A. Pedrosa, PhD, Sergio F. Siqueira, ScD, Eduardo A. Sosa, MD, PhD and Jose A. F. Ramires, MD, PhD. InCor - HCFMUSP, Sa˜o Paulo, Brazil, InCor - Heart Institute, Sa˜o Paulo, Brazil and Heart Institute (InCor), University of Sao Paulo, Sa˜o Paulo, Brazil. Background: Sympathetic nervous system (SNS) activation plays an important role in the physiopathology of heart failure (HF). Heart imaging with an analogue of norepinephrine, 123I-meta-iodobenzylguanidine (123I-MIBG), can be used for the non-invasive SNS assessment, and could be considered an useful prognostic tool as well as for the therapeutic follow up of such patients (pts). We ought to analyse SNS activity comparing 123I-MIBG imaging pre and post Cardiac Resynchronization Therapy (CRT), and to correlate such data to survival. Methods: Orospective study, 17pts (60⫾13years, 53%males), with HF (FC II-IV), left bundle branch block (QRS⬎130ms), LV ejection fraction⬍35%, under pharmacological optimized treatment, underwent CRT. We analysed Heart/Mediastinum (H/M) later index and the 123I-MIBG washout rate (WO), pre and in the 3 month follow up. Studied parameters were correlated to survival. To statistical analysis we employed Wilcoxon and Mann-Whitney tests, p⬍0.05. Results: Pre CRT, 2 (11.8%) pts were in NYHA FC II, 14 (82.3%) pts in FC III, 1 (5.9%) pt in FC IV. Post CRT, 8 (47%) pts were in NYHA FC I, 6 (35.3%) pts in FC II, 2 (11.8%) pts in FC III, 1 (5.9%) pt in FC IV. Four
Poster 3 (23.5%) pts died. H/M index ranged from 1.48(pre) to 1,62 (post) (p⫽0.06); WO ranged from (pre) 48.9% to 34.6% (post) (p⫽0,02). H/M index showed different values (pre CRT) relative to pts who survived (H/M⫽1.56) or died (H/M⫽1.23)(p⫽0.08). Conclusions: In pts with HF, CRT improved FC and SNS cardiac activity. Adverse clinical outcome (death) can be associated to lower H/M later 123I-MIBG index, pre CRT. P3-100 CLUSTERING OF VENTRICULAR TACHYARRHYTHMIAS IN HEART FAILURE PATIENTS IMPLANTED WITH A BIVENTRICULAR CARDIOVERTER-DEFIBRILLATOR Maurizio Lunati, MD, Maurizio Gasparini, MD, Massimo Santini, MD, Mario Bocchiardo, MD, Maurizio Landolina, MD, Massimo Sassara, MD, Giovanni B. Perego, MD, Luigi Padeletti, MD, PhD, Valeria Burrone, MS and Alessandra Denaro, MS. Ospedale Niguarda Ca’ Granda, Milano, Italy, Instituto Clinico Humanitas, Rozzano, Italy, Ospedale S. Filippo Neri, Rome, Italy, Ospedale Civile, Asti, Italy, Ospedale S. Matteo, Pavia, Italy, Ospedale Belcolle, Viterbo, Italy, Instituto Auxologico, Milano, Italy, Ospedale Careggi, Florence, Italy, Medtronic Italia, Sesto San Giovanni, Italy and Medtronic Italia, Rome, Italy. Background: Temporal patterns of ventricular tachyarrhythmias (VT/VF) have been studied only in patients who received implantable cardioverter defibrillators (ICD) for secondary prevention (SP) of sudden death. Aim: of the study was to prospectively evaluate VT/VF long-term temporal patterns occurring in heart failure (HF) patients with biventricular ICD stratifying results for HF etiology and ICD indication. Methods and Results: 421 patients (93.2% male, age 65⫾9 years) were enrolled from 41 Italian cardiological centres, between January 2001 and January 2005, and received a biventricular Medtronic ICD. HF etiology was ischemic (I) in 292 patients and non-ischemic (NI) in 129 patients. ICD indication was primary prevention (PP) in 227 patients and SP in 194 patients. At baseline left ventricular ejection fraction was 26⫾7%, QRS duration was 168⫾32 ms and NYHA class was 2.9⫾0.6. In a mean follow-up of 19⫾11 months, 1838 VT/VF were appropriately detected in 110 patients. 59 patients had more than 4 VT/VF. In 13/59 (22%) patients the observed cumulative relative frequency of tachycardia detections may be fitted by an exponential distribution, while in 46/59 (78%) patients the experimental distribution was not compatible with a random occurrence. Non-random detection of VT/VF episodes was not significantly different between HF etiology and ICD indication. In the whole population, 65% of interdetection intervals were within 1 day. Conclusions: In most (78%) studied patients, VT/VF episodes are nonrandomly distributed over time rather tend to cluster, regardless ICD indication and heart failure etiology. 2127.101 P3-101 DO PATIENTS WITH PERMANENT ATRIAL FIBRILLATION HAVE A DIFFERENT PROGNOSIS FROM PATIENTS IN SINUS RHYTHM FOLLOWING CARDIAC RESYNCHRONISATION THERAPY? Marjaneh Fatemi, MD, Philippe Castellant, MD, Gregoire Le Gal, MD, Yves Etienne, MD, Feriel Baraket, MD and JeanJacques Blanc, MD. Brest University Hospital, Brest, France. Background and Objectives: Cardiac resynchronisation therapy (CRT) has been demonstrated to improve functional status, quality of life, exercise capacity and to decrease total mortality in patients (pts) with severe heart failure and large QRS duration. These results have been reported in pts in sinus rhythm (SR). However, it is unclear whether pts with permanent atrial fibrillation (AF) have the same prognosis following CRT as those in SR. The goal of our study was to compare these 2 groups of pts in terms of baseline characteristics and long-term outcome. Patients and Methods: All consecutive pts (mean age: 72⫾13 years, 71
S211 men) implanted with a CRT device between March 1996 and December 2004 were included in our study. Pts were followed at 1, 6 and 12 months and then every year in our institution. At each visit, clinical, echocardiographic parameters, peak VO2 were collected. Pts were considered to be responders if they improved their functional status by at least one NYHA class. Results: During the inclusion period, 94 pts were recruited. Sixty seven were in SR and 27 in AF. At baseline, AF pts had more dilated left atrium (41⫾8 vs. 34⫾7 cm2). After a mean follow-up of 24⫾22 months, AF pts were less likely to be responders (41% vs. 63%, p⫽0.05) and had less improvement or their functional class (⌬NYHA: -0.3 vs. - 0.9, p⫽0.01) at last follow-up. Forty three patients died during follow-up. The only independent predictor of long term survival was functional response to CRT. Although there was a trend for higher mortality in AF patients, the difference was not statistically significant (63% vs. 39%, p⫽NS). However, response to CRT was no longer a predictor of better survival in AF patients (odds ratio: 0.4, CI⫽0.1-1.1, p⫽0.1). In SR pts, response to CRT was still associated with 74% mortality reduction (odds ratio: 0.26, CI: 0.1-0.6, p⫽0.03). Conclusion: Response to CRT was an independent predictor of improved survival. Pts with permanent AF seem to have less functional benefit from CRT. Although their mortality rate is not significantly higher than in SR pts, response to CRT in AF pts is no longer an independent predictor of better prognosis. P3-102 DUAL-CHAMBER PACING INDUCED LEFT VENTRICULAR REMODELING FOR SEVERE DRUG REFRACTORY SYMPTOMATIC OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY Tomohito Inage, MD, Teruhisa Yoshida, MD, PhD, Tomohiro Takeuchi, MD, PhD, Yasutsugu Nagamoto, MD and Tsutomu Imaizumi, MD, PhD. Kurume University School of Medicine, Kurume, Japan. Purpose: Recently, several studies showed that dual-chamber pacing (DDD-pacing) in patients with symptomatic obstructive hypertrophic cardiomyopathy (HOCM) can relieve symptoms and decrease the left ventricular outflow tract (LVOT) gradients. However, it remains unknown whether LV remodeling occurs by chronic DDD-pacing. Methods and Results: Fifteen patients (51.3⫾5.2 years) with HOCM and severe drug refractory symptoms were implanted a dual-chamber pacemaker. Echocardiographic studies were performed before and every 6 month after continuous DDD-pacing. They had LVOT gradient (mean 77.4⫾31mmHg) by echocardiography at rest. There were no sudden cardiac death and worsening of heart failure. The LVOT gradients were significantly reduced (77.4⫾31 versus 22.8⫾7.2mmHg, p⬍0.05) during 5.8⫾ 3.5 years (0.8⬃10.2 years). The interventricular septal thickness (21.6⫾3.1 to 16.9⫾2.4mm, p⬍0.05) and posterior LV wall thickness (14.1⫾3.7 to 10.9⫾1.6mm, p⬍0.05) were significantly reduced. LV diastolic dimension was significantly increased (40.8⫾5.6 to 47.8⫾3.1mm, p⬍0.05) but LV systolic function did not changed (EF 71.6⫾7.5% to 69.0⫾5.5%, p⫽NS). Furthermore, NYHA classification (III to II in all patients) was improved as well. Conclusions: Chronic DDD-pacing induced LV remodeling with reducing LVOT gradients and LV wall thickness and without deterioration of systolic function. Quality of life was remarkably improved. P3-103 FOCAL ATRIAL TACHYCARDIA CURED WITH CATHETER ABLATION FROM THE AORTIC ROOT Jorge Salinas Arce, MD, PhD, Rodrigo Isa Param, MD, Julia´n P. Villacastı´n, MD, PhD, Nicasio Pe´rez-Castellano, Sr., MD, PhD, Damia´n Sa´nchez Quintana, MD, Javier Moreno Planas, MD, PhD, Manuel Doblado Calatrava, MD, Ramo´n Bover Freire, MD, Ricardo Morales, MD and Carlos Macaya, MD. Cardiovascular Institute, San Carlos University
Heart Rhythm, Vol 3, No 5, May Supplement 2006
units (du). The percent change in du between baseline and the ON and OFF 3 months phases was calculated. Results: The 3 months therapy OFF phase was associated with increased expression of ANP and BNP and decreased expression of ␣-MHC, SERCA-2a, PLB and RYR (Table). In contrast, the 3 months ON therapy phase resulted in decreased expression of ANP and BNP and increased expression of ␣-MHC, SERCA-2a, PLB and RYR (Table). Conclusions: In patients with HF, CCM therapy reverses the cardiac maladaptive fetal gene program and normalizes expression of key SR Ca2⫹ cycling genes. These observations are consistent with the observed improvement in LV function in patients with HF following long-term CCM therapy. mRNA Expression (% Change from Baseline)
ANP BNP ␣-MHC SERCA-2a PLB RYR
OFF Phase
ON Phase
P-Value
82 ⫾ 26 81 ⫾ 28 -29 ⫾ 9 -21 ⫾ 10 4 ⫾ 18 -20 ⫾ 6
-57 ⫾ 9 -55 ⫾ 9 80 ⫾ 16 45 ⫾ 14 93 ⫾ 45 34 ⫾ 6
0.009 0.007 0.004 0.039 0.084 0.002
P3-97 CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH ATRIAL FIBRILLATION - A META-ANALYSIS Carlo Bonanno, MD, Renato Ometto, MD, Mariemma Paccanaro, MD and Alessandro Fontanelli, MD. S. Bortolo Hospital, Vicenza, Italy. Introduction: Cardiac resynchronization therapy (CRT) is a new therapeutic option for patients who have advanced heart failure (HF). Much information has been obtained from patients who have sinus rhythm, but the use of CRT in patients who have permanent atrial fibrillation (AF) has not been studied extensively. Only recently have trials been designed to specifically study CRT in patients with AF. In this study, a meta-analysis was used to clarify clinical outcomes and survival after CRT in patients with AF, using data from the published literature. Methods and Results: Randomized controlled trials, including patients with symptomatic HF and AF, were used in the meta-analysis. Active CRT versus univentricular pacing (mostly right ventricular pacing), both with optimal medical therapy, were compared. Six-minute walk test distance, peak oxygen consumption, quality of life, left ventricular function and mortality were the outcomes measured. Data were analyzed using a random effects model in Review Manager 4.2.7. Calculations included: relative risk (RR) for dichotomous variables; weighted mean difference (WMD) for continuous variables. All results were reported with 95% confidence intervals (95% CI). In four RCTs included in the meta-analysis CRT did not improve six-minute walk distance (WMD 18.80 m, 95% CI - 4.20 m to 41.81 m), peak oxygen consumption (WMD 1.56 ml/kg/min, 95% CI - 0.13 to 3.26 ml/kg/min), and quality of life (WMD reduction of - 3.47 points, 95% CI - 9.77 to 2.82 points on the Minnesota Living with HF Questionnaire). Left ventricular ejection fraction was increased (WMD 4.02 %, 95% CI 1.64 to 6.41 %) and all-cause mortality was reduced by 49% (RR 0.51, 95% CI 0.28 to 0.92). Both these results were statistically significant. Conclusions: In patients with HF and AF, CRT improves left ventricular function and reduces all-cause death, without evidence of benefits on functional outcomes. P3-98 LONG TERM EFFECT OF REPEATED SEQUENTIAL VV OPTIMIZATION IN PATIENTS WITH CRT-THERAPY? Anett Groe, MD, Burkhard J. Hu¨gl, MD, Zdravena Findeisen, MD, Angela Germer, PhD, Franziska Biedermann, PhD, Marcus Jahnecke, MD and Christoph J. Geller, MD.
Zentralklinik Bad Berka, Bad Berka, Germany and Medtronic, Du¨sseldorf, Germany. Background: Cardiac resynchronisation therapy (CRT) is well established in patients (pts) with severe heart failure. Biventricular devices offer the possibility to stimulate the right and left ventricle (VV) separately. Aim of our study is to analyse the effect of a sequential VV-optimization over time trough invasive and non-invasive measurements. Methods: In this prospective study pts with CRT-therapy (NYHAⱖIII, LBB⬎150ms, ejection fraction (EF) ⬍ 35%) were included. All pts received a CRT-device with the option of VV-optimization (Insync III or Insync III Marquis; Medtronic Inc.) After one month without biventricular pacing (VVI 30) all pts received a baseline investigation with an invasive AV (60-150 ms) and VV (-40 to ⫹40 ms) optimization using a micro tip pressure catheter (Millar, SPC790), which was placed in the left ventricle. Additional a non-invasive impedance-cardiographic measurement was performed to figure out the cardiac output (CO). These procedures were repeated after 3 months. After one year. the non-invasive measurement was repeated. Results: 15 pts with CRT were included (age: 66⫾8,7 years; EF 23⫾7 %, 9 pts with DCM). Without stimulation we measured at baseline a CO of 4,2⫾1,3 l/min with a dp/dtmax of 835⫾184 mmHg/s. With simultaneously biventricular stimulation and optimized AV-delay the CO increased to 5,3⫾1,5 l/min with a dp/dtmax. of 1021⫾214,4 mmHg/s (p⬍0,01). After optimization of the VV-time the dp/dtmax. increased additionally to 1090⫾127,8 mmHg/s with a CO of 5,9⫾1,8 l/min (p ⬍ 0,01). After 3 months of CRT nearly the same results could be performed. (dp/dt max :915⫾114/951⫾129/1024⫾120 mmHg/s; CO: 4,4⫾1,1/4,7⫾1,2/5,5⫾1,2 l/min). But in 11/15 pts the VV-interval was changed in relation to the baseline measurement. After one year the hemodynamic situation becomes more stable. In 3/11 pts a change of the VV-interval was related to a significant change of the cardiac output (⬎ 10%). Conclusion: A sequential VV optimization improves the hemodynamic parameters besides AV-optimization in pts with CRT. A repeated optimization should be required at the beginning of the therapy . After one year the hemodynamic situation has been stabilized. P3-99 CARDIAC SYMPATHETIC ACTIVITY EVALUATED BY SCINTIGRAPHICS 123I-MIBG IMAGING PRE AND POST RESYNCHRONIZATION THERAPY Martino Martinelli, PhD, Silvana A. D. Nishioka, PhD, Simone C. S. Branda˜o, MD, Clementina Giorgi, PhD, Clementina Giorgi, PhD, Cla´udio Meneguetti, PhD, Marcelo Vieira, PhD, Viviane Hotta, MD, Anı´sio A. A. Pedrosa, PhD, Sergio F. Siqueira, ScD, Eduardo A. Sosa, MD, PhD and Jose A. F. Ramires, MD, PhD. InCor - HCFMUSP, Sa˜o Paulo, Brazil, InCor - Heart Institute, Sa˜o Paulo, Brazil and Heart Institute (InCor), University of Sao Paulo, Sa˜o Paulo, Brazil. Background: Sympathetic nervous system (SNS) activation plays an important role in the physiopathology of heart failure (HF). Heart imaging with an analogue of norepinephrine, 123I-meta-iodobenzylguanidine (123I-MIBG), can be used for the non-invasive SNS assessment, and could be considered an useful prognostic tool as well as for the therapeutic follow up of such patients (pts). We ought to analyse SNS activity comparing 123I-MIBG imaging pre and post Cardiac Resynchronization Therapy (CRT), and to correlate such data to survival. Methods: Orospective study, 17pts (60⫾13years, 53%males), with HF (FC II-IV), left bundle branch block (QRS⬎130ms), LV ejection fraction⬍35%, under pharmacological optimized treatment, underwent CRT. We analysed Heart/Mediastinum (H/M) later index and the 123I-MIBG washout rate (WO), pre and in the 3 month follow up. Studied parameters were correlated to survival. To statistical analysis we employed Wilcoxon and Mann-Whitney tests, p⬍0.05. Results: Pre CRT, 2 (11.8%) pts were in NYHA FC II, 14 (82.3%) pts in FC III, 1 (5.9%) pt in FC IV. Post CRT, 8 (47%) pts were in NYHA FC I, 6 (35.3%) pts in FC II, 2 (11.8%) pts in FC III, 1 (5.9%) pt in FC IV. Four
Poster 3 (23.5%) pts died. H/M index ranged from 1.48(pre) to 1,62 (post) (p⫽0.06); WO ranged from (pre) 48.9% to 34.6% (post) (p⫽0,02). H/M index showed different values (pre CRT) relative to pts who survived (H/M⫽1.56) or died (H/M⫽1.23)(p⫽0.08). Conclusions: In pts with HF, CRT improved FC and SNS cardiac activity. Adverse clinical outcome (death) can be associated to lower H/M later 123I-MIBG index, pre CRT. P3-100 CLUSTERING OF VENTRICULAR TACHYARRHYTHMIAS IN HEART FAILURE PATIENTS IMPLANTED WITH A BIVENTRICULAR CARDIOVERTER-DEFIBRILLATOR Maurizio Lunati, MD, Maurizio Gasparini, MD, Massimo Santini, MD, Mario Bocchiardo, MD, Maurizio Landolina, MD, Massimo Sassara, MD, Giovanni B. Perego, MD, Luigi Padeletti, MD, PhD, Valeria Burrone, MS and Alessandra Denaro, MS. Ospedale Niguarda Ca’ Granda, Milano, Italy, Instituto Clinico Humanitas, Rozzano, Italy, Ospedale S. Filippo Neri, Rome, Italy, Ospedale Civile, Asti, Italy, Ospedale S. Matteo, Pavia, Italy, Ospedale Belcolle, Viterbo, Italy, Instituto Auxologico, Milano, Italy, Ospedale Careggi, Florence, Italy, Medtronic Italia, Sesto San Giovanni, Italy and Medtronic Italia, Rome, Italy. Background: Temporal patterns of ventricular tachyarrhythmias (VT/VF) have been studied only in patients who received implantable cardioverter defibrillators (ICD) for secondary prevention (SP) of sudden death. Aim: of the study was to prospectively evaluate VT/VF long-term temporal patterns occurring in heart failure (HF) patients with biventricular ICD stratifying results for HF etiology and ICD indication. Methods and Results: 421 patients (93.2% male, age 65⫾9 years) were enrolled from 41 Italian cardiological centres, between January 2001 and January 2005, and received a biventricular Medtronic ICD. HF etiology was ischemic (I) in 292 patients and non-ischemic (NI) in 129 patients. ICD indication was primary prevention (PP) in 227 patients and SP in 194 patients. At baseline left ventricular ejection fraction was 26⫾7%, QRS duration was 168⫾32 ms and NYHA class was 2.9⫾0.6. In a mean follow-up of 19⫾11 months, 1838 VT/VF were appropriately detected in 110 patients. 59 patients had more than 4 VT/VF. In 13/59 (22%) patients the observed cumulative relative frequency of tachycardia detections may be fitted by an exponential distribution, while in 46/59 (78%) patients the experimental distribution was not compatible with a random occurrence. Non-random detection of VT/VF episodes was not significantly different between HF etiology and ICD indication. In the whole population, 65% of interdetection intervals were within 1 day. Conclusions: In most (78%) studied patients, VT/VF episodes are nonrandomly distributed over time rather tend to cluster, regardless ICD indication and heart failure etiology. 2127.101 P3-101 DO PATIENTS WITH PERMANENT ATRIAL FIBRILLATION HAVE A DIFFERENT PROGNOSIS FROM PATIENTS IN SINUS RHYTHM FOLLOWING CARDIAC RESYNCHRONISATION THERAPY? Marjaneh Fatemi, MD, Philippe Castellant, MD, Gregoire Le Gal, MD, Yves Etienne, MD, Feriel Baraket, MD and JeanJacques Blanc, MD. Brest University Hospital, Brest, France. Background and Objectives: Cardiac resynchronisation therapy (CRT) has been demonstrated to improve functional status, quality of life, exercise capacity and to decrease total mortality in patients (pts) with severe heart failure and large QRS duration. These results have been reported in pts in sinus rhythm (SR). However, it is unclear whether pts with permanent atrial fibrillation (AF) have the same prognosis following CRT as those in SR. The goal of our study was to compare these 2 groups of pts in terms of baseline characteristics and long-term outcome. Patients and Methods: All consecutive pts (mean age: 72⫾13 years, 71
S211 men) implanted with a CRT device between March 1996 and December 2004 were included in our study. Pts were followed at 1, 6 and 12 months and then every year in our institution. At each visit, clinical, echocardiographic parameters, peak VO2 were collected. Pts were considered to be responders if they improved their functional status by at least one NYHA class. Results: During the inclusion period, 94 pts were recruited. Sixty seven were in SR and 27 in AF. At baseline, AF pts had more dilated left atrium (41⫾8 vs. 34⫾7 cm2). After a mean follow-up of 24⫾22 months, AF pts were less likely to be responders (41% vs. 63%, p⫽0.05) and had less improvement or their functional class (⌬NYHA: -0.3 vs. - 0.9, p⫽0.01) at last follow-up. Forty three patients died during follow-up. The only independent predictor of long term survival was functional response to CRT. Although there was a trend for higher mortality in AF patients, the difference was not statistically significant (63% vs. 39%, p⫽NS). However, response to CRT was no longer a predictor of better survival in AF patients (odds ratio: 0.4, CI⫽0.1-1.1, p⫽0.1). In SR pts, response to CRT was still associated with 74% mortality reduction (odds ratio: 0.26, CI: 0.1-0.6, p⫽0.03). Conclusion: Response to CRT was an independent predictor of improved survival. Pts with permanent AF seem to have less functional benefit from CRT. Although their mortality rate is not significantly higher than in SR pts, response to CRT in AF pts is no longer an independent predictor of better prognosis. P3-102 DUAL-CHAMBER PACING INDUCED LEFT VENTRICULAR REMODELING FOR SEVERE DRUG REFRACTORY SYMPTOMATIC OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY Tomohito Inage, MD, Teruhisa Yoshida, MD, PhD, Tomohiro Takeuchi, MD, PhD, Yasutsugu Nagamoto, MD and Tsutomu Imaizumi, MD, PhD. Kurume University School of Medicine, Kurume, Japan. Purpose: Recently, several studies showed that dual-chamber pacing (DDD-pacing) in patients with symptomatic obstructive hypertrophic cardiomyopathy (HOCM) can relieve symptoms and decrease the left ventricular outflow tract (LVOT) gradients. However, it remains unknown whether LV remodeling occurs by chronic DDD-pacing. Methods and Results: Fifteen patients (51.3⫾5.2 years) with HOCM and severe drug refractory symptoms were implanted a dual-chamber pacemaker. Echocardiographic studies were performed before and every 6 month after continuous DDD-pacing. They had LVOT gradient (mean 77.4⫾31mmHg) by echocardiography at rest. There were no sudden cardiac death and worsening of heart failure. The LVOT gradients were significantly reduced (77.4⫾31 versus 22.8⫾7.2mmHg, p⬍0.05) during 5.8⫾ 3.5 years (0.8⬃10.2 years). The interventricular septal thickness (21.6⫾3.1 to 16.9⫾2.4mm, p⬍0.05) and posterior LV wall thickness (14.1⫾3.7 to 10.9⫾1.6mm, p⬍0.05) were significantly reduced. LV diastolic dimension was significantly increased (40.8⫾5.6 to 47.8⫾3.1mm, p⬍0.05) but LV systolic function did not changed (EF 71.6⫾7.5% to 69.0⫾5.5%, p⫽NS). Furthermore, NYHA classification (III to II in all patients) was improved as well. Conclusions: Chronic DDD-pacing induced LV remodeling with reducing LVOT gradients and LV wall thickness and without deterioration of systolic function. Quality of life was remarkably improved. P3-103 FOCAL ATRIAL TACHYCARDIA CURED WITH CATHETER ABLATION FROM THE AORTIC ROOT Jorge Salinas Arce, MD, PhD, Rodrigo Isa Param, MD, Julia´n P. Villacastı´n, MD, PhD, Nicasio Pe´rez-Castellano, Sr., MD, PhD, Damia´n Sa´nchez Quintana, MD, Javier Moreno Planas, MD, PhD, Manuel Doblado Calatrava, MD, Ramo´n Bover Freire, MD, Ricardo Morales, MD and Carlos Macaya, MD. Cardiovascular Institute, San Carlos University