Value of immediate postoperative electrocardiogram to readjust risk stratification of patients undergoing major noncardiac surgery

124A

ABSTRACTS - Cardiac Arrhythmias

(EM) of iachemic

JACC

origin and patients w%h idiopathic DCM. This study included 93 patients

consecuttvefy implanted

with a Biventricular

pacemaker

between August 1994 and February

regurgitation

improved

atrial fibrillation

by biventricular

and intraventricular

March 6,2002

pacing in these patients with severe heart failure,

conduction

delay.

2C00. Patients were retrospectively divtdsd into two groups (idiopathic and ischemic) according to the results of a recent coronary

angiogram.

Symptoms

and objective

: Permanent

Conclusion in symptoms,

:

in this table

n=32

n=29

7M9

66flO

66i6

LVEDD (mm)

BIV 12M

Biventrtcular pacing provides significant and sustained improvement LVESD (mm)

exercise tolerance and LVEF in both idiopathtc and ischemic DCM patients.

6ltlO

MR area (cmz)

lss**6

158*19

<0.0001

1s4t.25

15s*16


1m*2

158**1

<0.0001

cm.5 BXIS (“)

-IS*60

+53*76

<0.0001

-32i4s

t&5*75

4cco1

-3rm

+50*7s

0.002

NYHA

3.3t0.5

ho.6

‘0.0001

3.3+0.5

2*0.5

CO.Oml

3.4ko.5 2.1iO.6
12*5

16*4

<0.0001

13e4

17-A

O.OM)3

10*4.7

21*s

2sts

oslow

2o*s

as**

O.W7

57fll

346C99

M=months,

#p=O.O6, ‘~~0.05,

all compared

58i5

6.4k6.2

5.4zt3.9’

357*133

405?143#

10.6f13.7

DFf

QRS

BIV 9M

“=67

data were

assessed before PM implant (pre-I) and 6 months (M-6) after. within the 2 groups. Results are summarized

Rand

to baseline

duration (Rx,

class

Peak"02

15*4

878-4

Can

0.02

Angelo

0008

Auricchio,

Hoersch,

p.m.

4:15 078-2

influence

of Antitachy

of Ventricular

Pacing

Tachycardia

Location

on the

the

Optimum

Therapy

fml.kc.min) LVEF ,%)

Efficacy

Andrew

Christian

Universify

Warzok,

Barbara Lamp, Johannes Berthold

Kramm,

Heintze,

Butter, Christoph

Hospital, Magdeburg,

Reiner Koerfer, Dieter Horstkotte,

Westphalia,

Bad Oeynhausen,

Background:

Biventdcular

Germany

Center. Maastricht,

(BV) pacing is an important treatment

dsk of malignant tachyarrhythmias

with BV pacing is expected to help managing

Berlin, Germany,

(NYHA

were used in the development the test data set (TST).

the AV delay that provided

AV interval were separately

calculated

optimum

(RV)-ATP

and ICD indication. ICDs were randomly

or BV-ATP. The VT termination

efficacy and VT

optimum

the estimated

population. (&0.96,

Results: pcO.0001;

population,

acceleration was evaluated for both padng locations and for VT cycle length (CL). VT episodes cccurred in 26 pts. 17 pts were programmed

to RV-

ATP, 9 patients to BV-ATP. Overall ATP efficacy was 64%, with 75% for RV-ATP and 91% for

to.01

For the M.03

depicted

and 10.26 respectively,

mum dP/dt,,,

patients

in the

TST

and i0.43

Figure,

can be reliably predicted

ms

at the esti-

in the TST and for the entire

group

dP/d&=.99’dP/dL,“t-1.75

1 .Ol’dP/d&,-2.19

p
coeffiintrinsic

AV delay for

obtained

p=O.O002 respectively).

dP/d&

99 pro-

at actual optimum

in dP/dt,,,

both for the patients

p
in the

Meth-

ms 8 QRSs150 optimum

in dP/dt,,,

with the improvement

AV delay (dP/d&)

and the measured

for the cases with QRS>lSO we calculated

AV delay (dP/dt,& mated

optimum

leads. Linear regression

dP/dt,,

the cases in the TST and for all cases. The improvement was compared

to provide

(AV) interval.

Intrinsic AV intervals were measured

from the atrial event to the earliest peak in the ventricular cients between

required

data set (DST) and 50 tests/37

81 patients with severe HF

to right-ventricular

groups,

class II-IV, EF c 30%) in the PATH CHF studies.

with dual chamber detection Inclusion

Yu, Walter

Guidant CRM, St. Paul,

of pre-excitation

ICD and BV pacemaker

and NYHA 2.6&6).

Eiectrogram?

PATH CHF I & II investigator

The InSync ICD study enrolled

cdterta were NYHA II-IV, LVEF<35%, LVEDD>55mm

Results: 457 spontaneous

intracardiac

Jiang Ding, Yinghong

from the intrinsic atrioventricular

in the DST. Using these coefficients

(93% male, 64t9 y, CAD 56%, LVEF 25+7% LVEDD 7lallmm programmed

the

in this population.

Methods: The InSync ICD is a combined and flexibte ATP programming.

option in patients (pts) with

Aachen,

that the degree

spective patients constitute

Belgium.

Stellbrink,

can be predicted

tests in 60 patients

Hear-f Center North Rhine-

Bakken Research

severe heart failure (HF). ICD-implantation

Vogt. Frank

the

Minnesota.

resynchronization

Bert Hansky, Juergen

of Resynchronization

From

Kramer, Julio C. E&(6&.

We tested the hypothesis

Termination

Dosage

be Derived

ods: We tested 117 patients &~&&ef,

p.m.

4:45

For the entire

(&0.97,

pc0.0001;

The AV delay that provides

opti-

from the intrinsic AV interval.

BV-ATP. Mean VT cycle length was significantly shorter for RV-ATP (369ms YS 369ms). After calculation for VTCL and initial therapy using logistic regression termination

efficacy remained

signiffcantty

(2.4 times ) higher

Condusion:

BV-ATP in this limited population appears to be more effective in VTiFVT termina-

with BV-ATP.

tion and may reduce the number of VTIFVT accelerations. Spontaneous

Episode

ATP Therapy

Detection

ATP Site RV

Efficacy

VT Zone;

vT=vT

Zone)

terminated

accelerated 15 (30%)

FVT

50

31 (62%)

VT

154

123 (60%)

5(5%)

204

154 (75%)

23 (11%) 9 (16%)

VTNFT BV

(FvTcFast

#Episodes

FVT

57

43 (75%)

VT

170

163 (96%)

3 (2%)

VTIFVT

227

206 (91%)

12 (5%)

ORAL CONTRIBUTIONS 430

Reverse Mechanical

870-3

Pacing

Remodeling

in Congestive

From

Patients

(MUltisite

Heart

in Atrial

by Biventricuiar

Failure:

One-Year

in the

Fibrillation

STimuiation

p.m.

Wednesday, March 20, 2002, 8:30 a.m.-10:OO Georgia World Congress Center, Room 257W

Results

MUSTIC

in Cardiomyopathy)

Noninvasive Testing: Predicting Future Events

884

a.m.

Study 8:30

Cecilia Linde, Christoohe

Leclerco, Serae Cazeau,

Christophe

Bailleul,

Jean-Claude,

Karolinska

Hospital,

Stockholm,

Lukas KaDDenbemer,

on behalf of the MUSTIC

884-l

Sweden.

Value

of Immediate

Readjust Background:

The MUSTIC

efficacy of biventdcular

study is a controlled

pacing

@IV) in patients

multicenter

trial, to assess the clinical

with chronic

intrinsic QRS >150 or RV paced QRS >200 ms. We recently from the crossover

phase (CO) with progressive

this study was to assess if left ventricular patients

with atrial fibrillation

NYHA

ill heart failure

and

reported

symptomatic

relief

improvements

function

improves

(AF) and slow ventricular

over a year. The aim of over time in the group

of

rate either due to spontaneous

rhythm or His-ablation. Methods:

Of 64 included

patients 39 completed

excluding

these 35 preferred

and were programmed

parameters,

Doppler

Major sRinfret.

two patients

echocardiography

the 6 month CO single blind comparison

who due to fast AF were not BIV paced. to BIV and followed

and left ventricular

longitudinally

(LV) ejection

Of

by clinical

fraction

mea-

sured by radionucleides.

Risk

Postoperative

Stratification

Noncardiac

Dame, Montreal, Background:

Thomas

Centre Hospitalier

H. Lee, Brigham and Women’s Hospital,

de I’Universite

de Montreal,

increased

from 26.7 * 6.6 % at randomisation

i: 7.6 % after 1 year of BIV (p
by Doppler

(DFT), left ventricular

diameters

enddiastolic

and systolic

regurgitation

(MR) are given in the Figure.

Conclusion:

In parallel

with clinical

benefits,

(rand) to 30.4

cations (MCC) and guide therapy.

stratification,

additional

The usefulness

performed

in the recovery room is unknown.

Methods:

Between 07169 and OZ94, perioperative

echo i.e. diastolic filling time (LVEDD,

Results:

who underwent

ejection

edema,

analysis ventricular

LVESD)

and mitral

block) in patients

fraction

and mitral

(6.7 VS. 1.9%, p
malities) left ventricular

Univariate

pulmonary

major NC procedures showed

a higher

fibrillation

with signs of ischemia

on the immediate

information

of a simple

peripheral,

collected

shortly

electrocardiogram

data and outcomes at Brigham

postoperative Patients

incidence

or primary

(ST depression

end Woman’s

or cerebrovascular

disease,

on

Hospital.

in the recovery room. infarction,

arrest, and complete

or elevation,

(PO) ECG compared

who presented

(ECG)

were collected

of MCC (myocardial

cardiac

heart

or T wave abnor-

to those without ischemia

signs of ischemia

older, more likely to be diabetic and treated with insulin, nary artery

Hopitsl Notre-

(NC) surgery might help to reassess risk of major cardiac compli-

From this cohort, 3622 (63.9%) patients had an ECG performed

Results: LV ejection fraction

to

Undergoing

Quebec, Canada.

Despite preoperative

4315 patients

Electrocardiogram

of Patients

Surgery

Carisi A. Polanczyk.

Boston, Massachusetts,

after major non-cardiac

of BIV and no-BIV

a.m.

Richard Sutton,

Study Group,

on PO ECG were

had a higher prevalence

hypertension,

congestive

of coroheart fail-

JACC we,

March 6,2002

elevated

serum

hypertrophy, MCC

creatinine,

positive

(all p < 0.05).

on the immediate

Ratio (O&1.6;

preoperative Using

mUltipIe

PO ECG remained

95% Confidence

tion by initial Revised Cardiac ment (Class I-II). presence

Interval

routine performance

of of

regression

analysis.

predictor

Signs Of

Atrial Electrlcal Function in Patients With Atrial Flutter Recover?

884-4

Does

risk assess-

m,

PO ECG identified

a subgroup

Sakai. Keiji Matsuda.

In class III-IV patients,

These

of the ECG in the recovery room following

PO

95%Cl=l.l-3.6).

PO ECG were associated

at low risk preoperatlvely.

with higher

results argue for

major NC surgery.

a:45 a.m.

Hidekazu

Time to Relapse of Atrial Fibrillation and SignalAveraged P Wave Duration

uDlxen, University

Jan Pamer, Vemer

Rasmussen,

Hospital of /fvidovre,

Background:

Prolonged

as a risk marker fibrillation

Copenhagen,

Signal-Averaged

for atrial fibrillation.

relapse

in patients

Kazuaki

School of Medicine,

Background:

The

(SAPD)

has been established

the time to first symptomatic

or present

atrial fibrillation

and the duration

atrial

in relation

to the

of the atrial fibrillation

dis-

ease. Methods-111

consecutive

patients

(71/40 men/women;

65 years) with earlier or acute atrial fibrillation tive cardioversion included.

of long-lasting

regarded

as endpoint

treating

during

at inclusion,

undergoing

the inclusion

and the follow-up

period

elec-

were not

time was six months

Results-

During follow-up hazard

135145

duration

50 patients

regression

showed

a significant

ratio 3.31, Cl 1.47.7.46),

of the atrial fibrillation

Conclusions:

atria1 fibrillation

and

patients

without

disease

no predictive

attack of atrial fibrillation. effect of moderately

of severely

a common

prolonged

Pro-

prolonged

SAPD above

p value of 0.005, and of longer total

than two years (hazard

effect of age, gender,

ratio 2.06, Cl 1.13-3.75,

diagnosed

hypertension,

above

y.&J& N. Batchvu,

were prolonged

with atria1 flutter (AFL). We analyzed for AFL to determine

135 ins, and a total duration

Katerina

A John Camm,

Ventricular

gradient

prognosis

in myocardiil

of atria1 fibrillation

disease

a.m.

Hnatkova,

Azad Ghuran,

Marek Malik, StGeoge’s

Jan Poloniecki,

Peter

PSAE of patients

atrial

electrical

has been clinically little is known about

after successful

function

(VG) reflects inhomogeneity

between an optimised

infarction

of ventricular

(Ml) is unknown.

repolarisation.

We examined

version of VG (TCRT, angular difference

Methods: Age, left ventricular ventricular

The study group consisted AFL for 2lfl7months.

arrhythmias. annulus

of 10 patients

Ablation

The control

was performed

group consisted

by creating

and inferior vena cava. AFL ablation

ablation

with

the link

between spatial QRS and T

tered P wave duration All patients

was significantly

were no recurrence

prolonged

had docuwithout

lesion between

leads of the SAECGs) years, 61% men).

were measured

During

All parameters

the most risk-associated EFc33%

a follow-up

Halter, and TCRT (calculated before discharge censored

were dichotomised

(HRV) index, (age 58*9

124 (12%) cardiac separating

XYZ

deaths

20% of pts with

values.

in control

isthmus

3.6, Cl

7.1 .p=O.O2) were independent

1.2-11.3.

1.4-5.6, psO.003) and TCRT<-0.66

predictors p=O.O3) and

of 5year

cardiac mortality,

TCRTc-O.66

(RR while

(RR 2.9, Cl 1.2.

predictors of 1 -year cardiac mortality.Five-year

tality in pts with both EF>33% and TCRT>-0.66 it was appr.l6%.

cardiac mor-

was appr. 6%, in pts with either EF<33% or

and in pts with both EF<33% and TCRTc-0.66

it was >50%

(Figure). Decreased

TCRT

the fil20

after the ablation.

after the ablation

The PD

compared

with

p=O.O003). LP20 and LP30 were lower in patients

group

(1.4fo.5

vs. 2.011.OpV;

and 146k21ms;

2.6i0.7

and 3.7+1.2pV

LP20 and LP30 were greater

1.9fo.2

vs. 3.0+1.6lV,

LP20 was 1.4m.5,

2.0x).7

and

at 1 day, 7 day and 1 month after

at 1 month

than those

at 1 day (p=O.O02,

p=O.OOl) Conclusion:

The findings

of this study showed:

LP20 and LP30 were greater findings

after the ablation. fibrillation

Catheter

1) The PD was significantly

was improved

in 1 month

suggest that atrial electrical ablation

the patients with recurrence

prolonged

in

for 1 month after the ablation;

2)

after the ablation

dysfunction

than those in 1 day. These

in patients with AFL

for AFL can improve

in patients with atrial fibrillation/flutter.

recover for1 month

the electrical

substrate

of atrial

PSAE may be clinical use to distinguish

of AFL or atrial fibrillation

from those without

recurrence.

Deficits in Knowledge Related to the OT Interval That Could Impact Patient Safety

884-5

mM.

Sana M. Al-Khatib,

Background:

(‘optimised’ VG) is an independent

predictor

of cardiac

Institute,

Several medications

because

of QT-interval

changes

and warnings

(QTI)

tion to determine

if knowledge

and torsade

inappropriate

from the US drug market

de pointes.

to reduce inappropriate

medications

knowledge

M. Kramer, Judy Battle, Robert M.

North Carolina.

have recently been removed

de pointes,

tion of practitioner

Judith

Durham,

prolongation

to attempt

Despite

labeling

use of these agents and mini-

prescribing

continued

remain on the market,

of the QTI and medications

to occur. Since

we conducted

an evalua-

that may cause QTI- prolonga-

deficits exist that could partially

explain

the inappropriate

use of these agents in clinical practice. Methods:

Practitioners

practitioners Results:

were surveyed

of cardiology

at a cardiology

investigators

in February

who correctly answered

questions

A total of 334 respondents

symposium

completed

the survey

and 3 (0.9%) pharmacists].

measure

percent

a QTI before

prolongation,

Eighty-six

Cardiology

a QTI

Twenty

percent

a QT prolonging

Less than 1% of respondents

that prolong

the QTI or drug combinations

Conclusion:

Although

when starting

most cardiology

a QTI-prolonging

on an EKG, but only

measure

with QTI prolongation.

ners knowledge

on this important

with increased

were able to correctly

that prolong practitioners

medication,

stated

medication.

were able to identify causes of QTI

and 7% were able to identify patient factors associated

of torsade de pointes.

was the area of

percent of respondents

and after starting

149

5(2%) study coordina-

were able to identify what the QTI represented

36% ware able to measure

associated

16(5%) unspecified,

for 271 (61%) of the respondents.

that they would

of

[127 (36%) physicians,

tors, 4 (1%) physician

assistants,

2000 and

and percentage

related to the QTI were detenined.

in training,

specialization

in November

2001. The number

(45%) nurses, 30(9%) physicians

their ability to correctly

death in survivors of acute MI.

block.

We measured

(LP20, LP30) for the terminal

of AFL for 1 month

PD was 161+17, 156f30

3.0*1 .OFV; LP30 was 1.9fl.2,

Sixty-one

(relative risk (RR) 2.9, 95%CI: (RR

ECG

from averaged

in 1047 Ml survivors

at 5 years,

by the percentile

3.4, Cl 1.6-6.4. p=O.O002) were independent tndexl6.3U

any

the tricuspid

end point was bidirectional

in patients with AFL at lday

with AFL than those

the ablation.

of 20 patients

P wave.

vs. 134?llms,

respectively).

a linear

(PD) and the root mean voltage

control group (161i17

a meeting

mean RR interval, heart rate variability

slope on 24.hour

AFL

of chronic coun-

The patients

1 day, 7 days and 1 month after the ablation.

and 30 ms of the filtered Results:

undergoing

typical AFL. The flutter cycle length was 251*7ms.

many other QTI-prolonging

Its relation to

multivariately

ejection fraction (EF), QRS duration on signal-averaged

ectopicshour,

heari rate turbulence

catheter

in patients

recover.

mize the risk of torsade

Hospifal Medical School, London,

vectors) and cardiac mortality in survivors of acute Ml.

Conclusions:

whether

(PSAE) However,

signal-aver-

United Kingdom.

TCRT<-0.68

Hiroshima

930 a.m. relapse

Ventricular Gradient Is an Independent Risk Factor in Survivors of Acute Myocardial Infarction

884-3

HRV

electrocardiogram atrial fibrillation.

ablation

Califf. Duke Clinical Research

Results:

of Internal Medicine,

the left

9:00

occurred.

Ueda. Kenya Hideo

or low ejection fraction. Risk factors for early atrial fibrillation

P wave duration

(SAECG),

Kentaro

Togo Yamagata.

Japan.

patients

longer than two years.

Smetana,

Hiroshima,

patients with AFL. And this prolongation

ratio 2.74, Cl 1.23-6.12),

p=O.O2). We found atrial diameter

without

had a symptomatic

analysis

ms (hazard

145 ms (hazard

deaths

was

as censorings.

portional

aged

age 65 years, range 30Patients

164 days; range 171-437 days). The time to first relapse of atrial fibrillation

relapse during follow-up

SAPD

atrial fibrillation

The SAPD was measured

(median

median

were enrolled.

First Department

The P wave signal-averaged

PSAE was recorded

P Wave Duration

of the patients,

Chayama,

Yukiko Nakano,

Hiroki Teragawa,

applied to detect patients with paroxysmal

mented

Gorm B. Jensen,

Fukuda,

University

terclockwise

Denmark.

We assessed

with earlier

SAPD, clinical characteristics

Steen M. Pehrson,

Hirao, Sou Takenaka,

Yukihiro

Matsuura.

Methods:

884-2

125A

stratifica-

lower preoperative

of MCC (OR=2.0,

Cardiac Arrhythmias

-

9:15 a.m.

of MCC (Odds

Furthermore.

95%CI=1.4-12.6).

on the immediate

stratified

or signs

StatuS. all risk factors

p&05).

on the immediate

with higher incidence

Signs of ischemla

MCC rate, even in patients

logistic

index showed that despite

of ischemia

was also associated

Conclusion:

abnormalities

an independent

(CI)=l.O-3.3,

of patient with higher risk of MCC (O&4.2. ischemia

ECG ischemic

stress test, and had a worse functional

in that cohort

ischemia

ABSTRACTS

risk

identify drugs

the QTI. said that they

this survey indicated

measured

marked

the QTI

deficiencies

in

the QTI and to identify patient factors and medications This study demonstrates

the need to improve

practitio-

patient safety issue

9:45 a.m. Prolonged PR Interval Is Associated With increased Risk of Atrial Fibrillation: The Framingham Heart Study

884-6

Vasan D’Agostino, Framingham Medicine,

G. Larson, Daniel Levy, Eric P. Leip, Ralph B.

Heart Sfudv, Framingham,

B. Kannel,

Emelia J. Benjamin,

Massachusetts,

NHLBl’s

Boston University

School Of

Boston, Massachuseffs.

Background: fibrillation

1Marlin

Sr., Philip A. Wolf, William

P wave prolongation

on the ECG is associated

(AF). The PR interval is an easily measured

lar conduction.

We hypothesized

increased

risk of AF.

Methods:

We examined

that prolonged

the association

marker

PR interval

tith

increased

risk of atrial

of atrial and atrioventricumay be associated

ot PR interval, measured

with digital calipers

with on