scholarly journals LONG-TERM OUTCOMES OF SCAR-RELATED VT ABLATION FOR ICM IN SINUS RHYTHM BY SUBSTRATE MODIFICATION

2014 ◽  
Vol 63 (12) ◽  
pp. A306
Author(s):  
Jorge Romero ◽  
Patricia Chavez ◽  
Jay Doshi ◽  
Faraj Kargoli ◽  
Grushko Michael ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Long Term Outcomes ◽  
Substrate Modification ◽  
Vt Ablation

P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Vidal-Perez ◽  
R Agra-Bermejo ◽  
D Pascual-Figal ◽  
F Gude Sampedro ◽  
C Abou Jokh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Acute Heart Failure ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
All Cause Mortality ◽  
One Year

Abstract Background The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. Purpose The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1) Effect of post-discharge heart rate Conclusions In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients Acknowledgement/Funding Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de

scholarly journals Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease

2015 ◽  
Vol 4 (3) ◽  
pp. 177 ◽  
Author(s):  
Jackson J Liang ◽  
Pasquale Santangeli ◽  
David J Callans ◽  
◽  
◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
Implantable Cardioverter Defibrillators ◽  
Mortality Benefit ◽  
Long Term Outcomes ◽  
Ventricular Tachycardia Ablation ◽  
Different Types ◽  
Vt Ablation

Ventricular tachycardia (VT) often occurs in the setting of structural heart disease and can affect patients with ischaemic or nonischaemic cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) provide mortality benefit and are therefore indicated for secondary prevention in patients with sustained VT, but they do not reduce arrhythmia burden. ICD shocks are associated with increased morbidity and mortality, and antiarrhythmic medications are often used to prevent recurrent episodes. Catheter ablation is an effective treatment option for patients with VT in the setting of structural heart disease and, when successful, can reduce the number of ICD shocks. However, whether VT ablation results in a mortality benefit remains unclear. We aim to review the long-term outcomes in patients with different types of structural heart disease treated with VT ablation.

Abstract 16730: Prognostic Biomarker for Prediction of Sinus Rhythm Maintenance, Stroke and Long-Term Survival Following Successful Electrical Cardioversion of Non-Valvular Atrial Fibrillation: The Role of Left Atrial Appendage Flow

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rowlens M Melduni ◽  
Jorge Roman ◽  
Hon-Chi Lee ◽  
Paul A Friedman ◽  
Joseph F Malouf ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Flow Velocity ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Electrical Cardioversion ◽  
Atrial Appendage ◽  
Long Term Outcomes ◽  
Af Recurrence

Introduction: Left atrial appendage (LAA) flow depends largely on left ventricular compliance and may play a role in mediating the regulation of left atrial volume-pressure relationships. Hypothesis: We hypothesize that LAA emptying flow velocity (LAAEV) is a predictive factor of long-term outcomes (e.g. recurrent AF, stroke, and survival) after cardioversion for non-valvular AF. Method: We identified 3,251 consecutive patients with non-valvular AF who underwent successful TEE-guided electrical cardioversion (ECV) at our institution between May 2000 and March 2012. Successful ECV was defined as sinus rhythm at time of discharge from the cardioversion unit. Patients were monitored following their ECV procedure for first documentation of recurrent AF, stroke or death. Multivariate Cox proportional hazards models were used to identify independent predictors of long-term outcomes. Patients with >= moderate valvular regurgitation or stenosis were excluded. Results: Among the 3,251 patients who were successfully cardioverted to sinus rhythm, the mean (±SD) LAAEV was 38.43±23 cm/s and the median was 33 cm/s, (interquartile range [IQR], 20-50). Patients with LAAEV <=33 cm/s had higher CHA 2 DS 2 -VASc score (2.6±1.2 vs. 1.9±1.3, P =.009), larger LAVI (52.0±20.9 cc/m 2 vs. 43.3±13.6 cc/m 2 , P <.001) than those with LAAEV >33 cm/s. Pre or post-procedure antiarrhythmic drug use was similar between the two groups. During 1-year follow-up, patients with LAAEV <=33 cm/s had significantly higher rate of AF recurrence than those with LAAEV >33 cm/s (55% vs 45%, P <.001). Likewise, during a mean follow-up of 4.9±3.6 years, similar patterns in 5-year rates were observed for first recurrence of AF (81% vs 73%, P <.001), stroke (7% vs 4%, P =.003) and mortality (31% vs 23%, P <.001) for LAAEV <=33 vs > 33cm/s, respectively. Stepwise multivariate Cox regression analysis revealed that LAAEV <=33 cm/s, age, CHA 2 DS 2 -VASc score were independent predictors of AF recurrence, stroke and mortality. Conclusions: LAA emptying flow velocity is an effective and convenient method for risk stratification of patients undergoing cardioversion for AF. Our data showed that patients with reduced LAAEV have an increased risk for AF recurrence, stroke and death following electrical cardioversion.

scholarly journals Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation

2021 ◽  
Author(s):  
Riccardo Proietti ◽  
Rory Dowd ◽  
Lim Ven Gee ◽  
Shamil Yusuf ◽  
Sandeep Panikker ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
High Density ◽  
Long Term Outcomes ◽  
Density Mapping ◽  
Significant Difference ◽  
Vt Ablation ◽  
Mapping Catheter

Abstract Background Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Methods Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Results Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). Conclusions This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.

scholarly journals Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Titin Cardiomyopathy: A Multicenter Study

2021 ◽  
Author(s):  
Andres Enriquez ◽  
Jackson Liang ◽  
Jeffrey Smietana ◽  
Daniele Muser ◽  
Pablo Salazar ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Electrical Storm ◽  
Circulatory Support ◽  
Long Term Outcomes ◽  
Bundle Branch Block ◽  
Ventricular Tachycardia Ablation ◽  
Increased Risk ◽  
Arrhythmogenic Substrate ◽  
Vt Ablation

Background - Truncating variants of the titin gene (TTNtv) are a leading cause of dilated cardiomyopathy (DCM) and have been associated with an increased risk of ventricular arrhythmias. This study evaluated the substrate distribution and the acute and long-term outcomes of patients with TTN-related cardiomyopathy undergoing ventricular tachycardia (VT) ablation. Methods - This multicenter registry included 15 patients with DCM (age 59±11 years, 93% male, ejection fraction 30±12%) and genotypically confirmed TTNtvs who underwent VT ablation between July 2014 and July 2020. Results - All patients presented with sustained monomorphic VT, including electrical storm in 4 of them. A median of 2 VTs per patient were induced during the procedure (cycle-length 318±68 ms) and the predominant morphologies were left bundle branch block with inferior axis (39%) and right bundle branch block with inferior axis (29%). A complete map of the left ventricle (LV) was created in 12 patients and showed voltage abnormalities mainly at the periaortic (92%) and basal septal region (58%). A preprocedural cardiac magnetic resonance imaging was available in 13 patients and in 11 there was evidence of LV delayed gadolinium enhancement, with predominantly midmyocardial distribution. Sequential ablation from both sides of the septum was required in 47% of patients to target septal intramural substrate and epicardial ablation was performed in 20%. At the end of the procedure, the clinical VT was noninducible in all patients, while in 3 cases a non-clinical VT was still inducible. After a follow-up of 26.5±23.0 months, 53% of patients experienced VT recurrence, 20% received transplant or mechanical circulatory support and 7% died. Conclusion - The arrhythmogenic substrate in TTN-related cardiomyopathy involves the basal septal and perivalvular regions. Long-term outcomes of catheter ablation are modest, with high recurrence rate, likely related to an intramural location of VT circuits.

Abstract 18662: Ablation of Regions of Very Slow Conduction Within a Myocardial Scar and Recurrence of Ventricular Tachycardia After Catheter Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Asad A Aboud ◽  
M. Benjamin Shoemaker ◽  
Pablo Saavedra ◽  
Juan C Estrada ◽  
Sharon Shen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ventricular Tachycardia ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
Myocardial Scar ◽  
Activation Time ◽  
Substrate Modification ◽  
Slow Conduction ◽  
Vt Ablation

Background: It has been established that areas of slow conduction within a myocardial scar identified by isochronal mapping during sinus rhythm harbor the functional substrate that is involved in sustaining ventricular tachycardia (VT). We sought to test the hypothesis that targeting the region of slowest conduction during sinus rhythm would reduce VT recurrence following ablation. Methods and Results: 32 subjects underwent ablation for sustained monomorphic VT associated with structural heart disease from 2013 to 2014. Sustained VT recurred in 12 patients (37.5%). Isochronal late activation maps were created to display activation during sinus rhythm in the region of bipolar scar. The scar was divided into three zones of equal activation time. The zone with the densest isochrones was designated as having the slowest conduction . We retrospectively analyzed isochronal maps and measured the proportion of the slowest zone that was ablated (median 14%, IQR 0-50). During a mean follow-up of 6 months, recurrence of ventricular arrhythmia was significantly associated with ablation of the slowest zone (OR 0.126, CI 0.024-0.68, p 0.016). Furthermore, univariate logistic regression demonstrated reduction of 30% in the 6-month VT recurrence rate for every 10% increase in percent of the slowest zone ablated (OR 0.7, 95% CI 0.5-1.0, p=0.05). Conclusions: Patients who had ablation in the region of slowest conduction were significantly less likely to have recurrence of ventricular tachycardia. Our data suggests a strategy to target the slowest region of conduction for substrate modification may hold promise for improving outcomes of scar-mediated VT ablation.

scholarly journals Left atrial dysfunction still exists in patients who obtain normal left atrial volume after successful ablation of atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Kawakami ◽  
K Inoue ◽  
T Nagai ◽  
A Fujii ◽  
Y Sasaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Late Recurrence ◽  
Reverse Remodeling ◽  
Long Term Outcomes ◽  
Af Ablation ◽  
Af Recurrence

Abstract Introduction Atrial fibrillation (AF) promotes left atrial (LA) remodeling and vice versa. LA volume index (LAVI) ≥34 mL/m2 is an established cut-off value for identifying an enlarged left atrium. Catheter ablation has become an established therapy for AF and provides a reduction of LA volume by maintaining sinus rhythm (reverse remodeling). However, the definition of LA reverse remodeling after AF ablation is undetermined. Purpose We hypothesized that patients with LA dilatation who obtain normal LA volume (LAVI &lt;34 mL/m2) after AF ablation would have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume could also obtain normal LA function with AF ablation. Methods We enrolled 140 AF patients with baseline LAVI ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 h and at 1 year after the procedure. Late recurrence was defined as AF recurrence &gt;1 year after the initial ablation. To define the normal range of LA function, age-and sex-matched 140 controls without a history of AF were also enrolled. Results After restoration of sinus rhythm, overall LA structural and functional parameters were significantly improved, and 75 patients (54%) had normal LA volume at the time of follow-up (Table). During a median follow-up of 44 (31–61) months, 32 patients (23%) experienced a late recurrence of AF. Patients who obtained normal LA volume after AF ablation had fewer late recurrences than those who did not (P&lt;0.01) (Figure). However, LA functional abnormalities still existed in AF patients, even if LA volume was normalized as in controls (Table). Conclusion Patients who obtain normal LA volume have better long-term outcomes of AF ablation than those who do not. Although AF ablation promotes beneficial effects on LA structure and function, LA function cannot be normalized even in patients who obtain normal LA volume after successful ablation. Thus, physicians should carefully consider long-term follow-up and residual AF risks, regardless of sinus rhythm restoration by catheter ablation. FUNDunding Acknowledgement Type of funding sources: None.

Traumatic Brain Injury: A Trauma Surgeon's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 82-89
Author(s):  
Oscar D. Guillamondegui
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multidisciplinary Approach ◽  
Trauma Team ◽  
The United States ◽  
Long Term Outcomes ◽  
Term Care ◽  
Injured Brain ◽  
The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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