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Tako-tsubo Cardiomyopathy Following Catheter Ablation of Atrial Tachycardia
S140
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
Conclusions: Successful CA and maintenance of SR leads to a decrease in platelet activation and improvement in endothelial function in patients with AF. These findings suggest that the prothrombotic state in AF patients can be reduced following successful CA and maintenance of SR. http://dx.doi.org/10.1016/j.hlc.2012.05.352 343 Supraventricular Tachyarrhythmias (SVA) are Extremely Strong Predictors for Future Inappropriate Therapies (IT) and can be Significantly Minimized by Utilisation of a SVA Discriminator Algorithm in Patients with an Implantable Cardioverter Defibrillator (ICD) W. Chik 1,∗ , G. Sivagangabalan 1 , S. Zaman 1 , R. 2 3 3 Denman , W. Stafford , J. Hayes , G. Young 4 , P. Sanders 4 , P. Kovoor 1 1 Cardiology
Department, Westmead Hospital, Westmead, NSW, Australia 2 Princess Alexandra Hospital, Woolloongabba, QLD, Australia 3 St Andrew’s Hospital, Toowoomba, QLD, Australia 4 Royal Adelaide Hospital, Adelaide, SA, Australia Inappropriate shocks from ICD devices reduce battery longevity, increase morbidity and mortality. However, incidence of IT remains high. We hypothesised SVA as a key predisposing factor to IT and devised a SVA discriminator programming algorithm to minimise IT. Methods: This was a pre-specified sub-study of a large prospective multicentre clinical trial. Discriminators included onset, stability, wavelet, and PR Logic. Aetiologies were classified as SVA (sinus tachycardia (ST), atrial fibrillation (AF)/flutter (AFL)); or T wave over-sensing (TWO). Results: 602 patients (64.3 ± 12.1) enrolled from 2007 to 2010 had 1795 tachyarrhythmia episodes in 152 pts. 235 (8.3%) were IT occurring in 22/602 (3.7%) pts. 83.4% IT were painless ATP, 16.6% were painful shocks. SVA accounted for all but 1 IT pt. 35/602 (5.8%) had SVA and all had ICD therapy (vs. 20.7% without SVA, p < 0.001). Absence of SVA conferred greater likelihood of appropriate therapies (81.7% vs. 18.3%, p < 0.001). Conversely, SVA increased IT risk (95.5% vs. 4.5%, p < 0.001). Sixty percent of (21/35) SVA pts had IT compared to 0.9% (1/117) without SVA (HR: 161.09 (95% CI: 37–693), p < 0.001). 11/11 ST vs. 9/23 AF/AFL had IT (p < 0.001). When SVT 1:1 discriminator was turned on, 3/14 vs. 9/13 had IT, a 48% absolute risk reduction. Conclusions: (1) Lower incidence (3.7%) of IAPT when SVA discriminators were switched on. (2) SVA is an extremely strong predictor for IT, conferring ∼160-fold increased risk. (3) ST confers the greatest risk of any SVA for IT as not well discriminated. (4) SVT 1:1 discriminator reduced AF/AFL related IT by 48%. http://dx.doi.org/10.1016/j.hlc.2012.05.353
344 Tako-tsubo Cardiomyopathy Following Catheter Ablation of Atrial Tachycardia K. Lim ∗ , G. Trim, J. Meulet, J. Brabant, A. Henry, S. Myers John Flynn Hospital, Australia A 76 year-old lady presented for ablation of paroxysmal atrial tachycardia (AT). She underwent catheter ablation for persistent AF two years prior. The first procedure consisted of pulmonary vein (PV) isolation, roof and mitral isthmus lines. The AF reverted to an atypical tachycardia which was successfully ablated from the right inferior vein. Despite being predominantly in sinus rhythm, she continued to be symptomatic with PAT and sought a repeat catheter ablation. Transeptal access was gained via an existing PFO. Her PV’s were isolated at baseline. The roof line was complete while the mitral isthmus was re-ablated. Burst atrial pacing induced an AT with a proximal to distal CS activation. An Ensite Velocity activation map suggested earliest activation in the coronary sinus ostium where RF application terminated the tachycardia. She was extubated but developed progressive hypotension requiring inotropic support. An urgent echocardiogram showed no pericardial effusion but severe systolic dysfunction (LV ejection fraction <30%). Coronary angiography revealed normal coronary arteries with a ventriculogram confirming Tako-Tsubo Cardiomyopathy (TTCM). She was managed with conventional heart failure therapy. A repeat echo three weeks later confirmed complete normalisation of her LV systolic function. TTCM following transcatheter RF ablation has been previously described. It is characterised by transient apical ballooning of the left ventricle resembling Tako-tsubo – a Japanese pot used to capture octopus. The prevailing theory behind the exact pathophysiology appeared to be a hyperadrenergic state in response to physical or psychosocial stress. This is a first case of TTCM in our series of 270 catheter ablation of AF over the last three years. http://dx.doi.org/10.1016/j.hlc.2012.05.354 345 The Green Lane and Auckland City Hospital Cardiac Resynchronisation Therapy Experience A. Martin ∗ , S. Sinclair, M. Hood, N. Lever, J. Stewart Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: Cardiac resynchronisation therapy (CRT) is an advanced adjunctive treatment indicated for a subgroup of patients with severe left ventricular (LV) systolic dysfunction. We have compared our patient population with current guidelines and audited the acute complications of device implantation. Methods: Retrospective chart review of all patients undergoing CRT implantation at Green Lane and Auckland City Hospitals since the introduction of this service in 2000.
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
Conclusions: Successful CA and maintenance of SR leads to a decrease in platelet activation and improvement in endothelial function in patients with AF. These findings suggest that the prothrombotic state in AF patients can be reduced following successful CA and maintenance of SR. http://dx.doi.org/10.1016/j.hlc.2012.05.352 343 Supraventricular Tachyarrhythmias (SVA) are Extremely Strong Predictors for Future Inappropriate Therapies (IT) and can be Significantly Minimized by Utilisation of a SVA Discriminator Algorithm in Patients with an Implantable Cardioverter Defibrillator (ICD) W. Chik 1,∗ , G. Sivagangabalan 1 , S. Zaman 1 , R. 2 3 3 Denman , W. Stafford , J. Hayes , G. Young 4 , P. Sanders 4 , P. Kovoor 1 1 Cardiology
Department, Westmead Hospital, Westmead, NSW, Australia 2 Princess Alexandra Hospital, Woolloongabba, QLD, Australia 3 St Andrew’s Hospital, Toowoomba, QLD, Australia 4 Royal Adelaide Hospital, Adelaide, SA, Australia Inappropriate shocks from ICD devices reduce battery longevity, increase morbidity and mortality. However, incidence of IT remains high. We hypothesised SVA as a key predisposing factor to IT and devised a SVA discriminator programming algorithm to minimise IT. Methods: This was a pre-specified sub-study of a large prospective multicentre clinical trial. Discriminators included onset, stability, wavelet, and PR Logic. Aetiologies were classified as SVA (sinus tachycardia (ST), atrial fibrillation (AF)/flutter (AFL)); or T wave over-sensing (TWO). Results: 602 patients (64.3 ± 12.1) enrolled from 2007 to 2010 had 1795 tachyarrhythmia episodes in 152 pts. 235 (8.3%) were IT occurring in 22/602 (3.7%) pts. 83.4% IT were painless ATP, 16.6% were painful shocks. SVA accounted for all but 1 IT pt. 35/602 (5.8%) had SVA and all had ICD therapy (vs. 20.7% without SVA, p < 0.001). Absence of SVA conferred greater likelihood of appropriate therapies (81.7% vs. 18.3%, p < 0.001). Conversely, SVA increased IT risk (95.5% vs. 4.5%, p < 0.001). Sixty percent of (21/35) SVA pts had IT compared to 0.9% (1/117) without SVA (HR: 161.09 (95% CI: 37–693), p < 0.001). 11/11 ST vs. 9/23 AF/AFL had IT (p < 0.001). When SVT 1:1 discriminator was turned on, 3/14 vs. 9/13 had IT, a 48% absolute risk reduction. Conclusions: (1) Lower incidence (3.7%) of IAPT when SVA discriminators were switched on. (2) SVA is an extremely strong predictor for IT, conferring ∼160-fold increased risk. (3) ST confers the greatest risk of any SVA for IT as not well discriminated. (4) SVT 1:1 discriminator reduced AF/AFL related IT by 48%. http://dx.doi.org/10.1016/j.hlc.2012.05.353
344 Tako-tsubo Cardiomyopathy Following Catheter Ablation of Atrial Tachycardia K. Lim ∗ , G. Trim, J. Meulet, J. Brabant, A. Henry, S. Myers John Flynn Hospital, Australia A 76 year-old lady presented for ablation of paroxysmal atrial tachycardia (AT). She underwent catheter ablation for persistent AF two years prior. The first procedure consisted of pulmonary vein (PV) isolation, roof and mitral isthmus lines. The AF reverted to an atypical tachycardia which was successfully ablated from the right inferior vein. Despite being predominantly in sinus rhythm, she continued to be symptomatic with PAT and sought a repeat catheter ablation. Transeptal access was gained via an existing PFO. Her PV’s were isolated at baseline. The roof line was complete while the mitral isthmus was re-ablated. Burst atrial pacing induced an AT with a proximal to distal CS activation. An Ensite Velocity activation map suggested earliest activation in the coronary sinus ostium where RF application terminated the tachycardia. She was extubated but developed progressive hypotension requiring inotropic support. An urgent echocardiogram showed no pericardial effusion but severe systolic dysfunction (LV ejection fraction <30%). Coronary angiography revealed normal coronary arteries with a ventriculogram confirming Tako-Tsubo Cardiomyopathy (TTCM). She was managed with conventional heart failure therapy. A repeat echo three weeks later confirmed complete normalisation of her LV systolic function. TTCM following transcatheter RF ablation has been previously described. It is characterised by transient apical ballooning of the left ventricle resembling Tako-tsubo – a Japanese pot used to capture octopus. The prevailing theory behind the exact pathophysiology appeared to be a hyperadrenergic state in response to physical or psychosocial stress. This is a first case of TTCM in our series of 270 catheter ablation of AF over the last three years. http://dx.doi.org/10.1016/j.hlc.2012.05.354 345 The Green Lane and Auckland City Hospital Cardiac Resynchronisation Therapy Experience A. Martin ∗ , S. Sinclair, M. Hood, N. Lever, J. Stewart Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: Cardiac resynchronisation therapy (CRT) is an advanced adjunctive treatment indicated for a subgroup of patients with severe left ventricular (LV) systolic dysfunction. We have compared our patient population with current guidelines and audited the acute complications of device implantation. Methods: Retrospective chart review of all patients undergoing CRT implantation at Green Lane and Auckland City Hospitals since the introduction of this service in 2000.