Abstract 4089: Unique Epicardial Substrate in Non-Ischemic CM: Echo Signature, Electrogram Correlates and Outcome with Substrate Based Ablation

We present a unique series of patients (pts) with non-ischemic cardiomyopathy (NICM) and unmappable ventricular tachycardia (VT) who demonstrated predominantly normal left ventricular (LV) endocardial (ENDO) voltage and abnormal epicardial (EPI) substrate defined by intracardiac echo (ICE) and fractionated electrograms (EGMS). This substrate served as an appropriate ablation target for VT. All patients underwent ICE imaging and detailed ENDO and EPI voltage mapping to further characterize the substrate and define the EGM correlates. 5 pts with NICM had increased echogenicity in the lateral epicardium by ICE imaging. Detailed LV ENDO mapping (199 ± 94.5 points) identified no voltage abnormalities in 4 pts. In one pt, a 16.2cm2 low voltage area in the LV ENDO was present and adjacent to the EPI abnormality. In all pts, detailed EPI mapping (477 ± 158 points) revealed a distinct area (20.6 ± 3.6 cm2) of low voltage (<1.0mV) that correlated with the echogenic area. These areas displayed low amplitude EGMS that were wide (>80msec), split, and late (beyond QRS). (Figure 1 ). After excluding coronary branch vessels and the course of the phrenic nerve, all pts underwent substrate based ablation based on pace-mapping and targeting of abnormal EGMS to eliminate the targeted VT. No VT has recurred during mean follow-up of 20mo (range 1–30 mo). Unique EPI substrate in NICM, defined by echo imaging and confirmed by EGM correlates, can be successfully targeted for RF ablation to provide effective VT control.

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Abstract 4088: Isolated Potentials and Pace-Mapping to Guide Ablation for Ventricular Tachycardia in Patients with Non-Ischemic Cardiomyopathy

Circulation ◽

10.1161/circ.118.suppl_18.s_826 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Michael Kuhne ◽

Jean-Francois Sarrazin ◽

Darryl Wells ◽

Nagib Chalfoun ◽

Thomas Crawford ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Sinus Rhythm ◽

Ischemic Cardiomyopathy ◽

Low Voltage ◽

Radiofrequency Energy ◽

Target Sites ◽

Group A ◽

Group B ◽

Pace Mapping

Background : Isolated potentials (IPs) during sinus rhythm are indicators of fixed scar in patients with prior infarcts. IPs in conjunction with pace-mapping (PM) have been helpful to guide ablation of post-infarction ventricular tachycardia (VT). The purpose of this study was to determine the value of IPs in conjunction with PM to guide VT ablation in patients with non-ischemic cardiomyopathy. Methods : 32 consecutive patients (23 male, age 56±13 years, ejection fraction 0.30±0.14) with VT and non-ischemic cardiomyopathy were analyzed. Thirty/32 patients had an implanted cardioverter defibrillator (ICD). Electroanatomic maps of the left (n=21) and right ventricle (n=13), the coronary sinus (n=3), and the epicardium (n=4) were obtained during baseline rhythm. PM was performed at sites with low voltage (<1.5mV). Radiofrequency energy was delivered at sites with concealed entrainment or matching pace-maps. Mean follow-up time was 10±9 months. Results : 173 VTs (cycle length 359±86 ms) were induced. Appropriate ablation sites with IPs during sinus rhythm were recorded in 19/32 patients (59%) (group A). In these patients, a total of 195 appropriate target sites were identified for 56/100 induced VTs (56%); 136/195 sites (70%) displayed IPs. In the remaining 13 patients, no target sites with IPs were identified (group B) despite combined endocardial and transcutaneous epicardial mapping in 3/13 patients. In these 13 patients, a total of 96 appropriate target sites were identified for 25/73 induced VTs (34%). Fifteen/19 patients (79%) in group A were non-inducible at the end of the procedure compared to 2/13 patients (15%) in group B. During a mean follow-up of 10±9 months, 15/19 patients (79%) in group A compared to 1/13 patients (8%) in group B remained arrhythmia free (p=0.0002). Conclusion : IPs in conjunction with PM are helpful in identifying critical isthmus areas for ablation of VT in patients with non-ischemic cardiomyopathy. Differences in the extent of fixed scar tissue may be the reason for differences in the prevalence of IPs, and this might explain better ablation results in some patients with non-ischemic cardiomyopathy.

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Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

Current Cardiology Reviews ◽

10.2174/1573403x15666191120114442 ◽

2020 ◽

Vol 16 (3) ◽

pp. 241-246

Author(s):

Dipesh Ludhwani ◽

Belaal Sheikh ◽

Vasu K Patel ◽

Khushali Jhaveri ◽

Mohammad Kizilbash ◽

...

Keyword(s):

Case Report ◽

Takotsubo Cardiomyopathy ◽

Systolic Dysfunction ◽

Obstructive Coronary Artery Disease ◽

Left Ventricular ◽

Reduced Ejection Fraction ◽

Coronary Syndrome ◽

Normal Left Ventricular ◽

Artery Disease

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing. Case report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality. Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

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Cardiac Amyloidosis with Discordant QRS Voltage between Frontal and Precordial Leads

Medicina ◽

10.3390/medicina57070660 ◽

2021 ◽

Vol 57 (7) ◽

pp. 660

Author(s):

Csilla-Andrea Eötvös ◽

Roxana-Daiana Lazar ◽

Iulia-Georgiana Zehan ◽

Erna-Brigitta Lévay-Hail ◽

Giorgia Pastiu ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Cardiac Amyloidosis ◽

Ventricular Hypertrophy ◽

Low Voltage ◽

Disease Process ◽

Left Ventricular ◽

Clinical Suspicion ◽

Immunoglobulin Light Chain ◽

Different Types

Among the different types, immunoglobulin light chain (AL) cardiac amyloidosis is associated with the highest morbidity and mortality. The outcome, however, is significantly better when an early diagnosis is made and treatment initiated promptly. We present a case of cardiac amyloidosis with left ventricular hypertrophy criteria on the electrocardiogram. After 9 months of follow-up, the patient developed low voltage in the limb leads, while still maintaining the Cornell criteria for left ventricular hypertrophy as well. The relative apical sparing by the disease process, as well as decreased cancellation of the opposing left ventricular walls could be responsible for this phenomenon. The discordance between the voltage in the frontal leads and precordial leads, when present in conjunction with other findings, may be helpful in raising the clinical suspicion of cardiac amyloidosis.

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Endocardial vs endo-epicardial ablation of ventricular arrhythmia in arrhythmogenic right ventricular cardiomyopathy: a single center experience

European Heart Journal ◽

10.1093/ehjci/ehaa946.0433 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.A Simonova ◽

A.V Kamenev ◽

R.B Tatarskiy ◽

M.A Naymushin ◽

V.S Orshanskaya ◽

...

Keyword(s):

Ventricular Arrhythmia ◽

Low Voltage ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Control Group ◽

Definite Diagnosis ◽

Premature Ventricular Contractions ◽

Single Center Experience ◽

Voltage Mapping ◽

Epicardial Access

Abstract Background The majority of patients have a sub-epicardial scar as a substrate for VT episodes. Purpose We sought to compare the efficacy of endocardial (ENDO) and epicardial (EPI) substrate modification in patients with ARVC. Methods 20 consecutive ARVC patients (mean age 41,4±13,8, 70% males; ICD previously implanted in 10 patients) with indications to ventricular arrhythmia ablation (RFA) were included into a prospective observational study. The EPI group consisted of 10 patients with sustained ventricular tachycardia (VT) (definite diagnosis ARVC – 8 patients; borderline – 1, possible – 1) who signed an informed consent to epicardial access. The ENDO group included 10 patients (definite diagnosis ARVC – 9 patients), five of them demonstrated sustained VT and 5 patients had frequent symptomatic premature ventricular contractions (PVC). Epicardial access in the EPI group was obtained through subxyphoid puncture. Bi- and unipolar voltage mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of local abnormal ventricular electrical activity (LAVA, low-voltage areas and sites with highly fractionated or late activity). Ablation was performed at sites of LAVA on either side of the ventricular wall. In the ENDO group endocardial only ablation at LAVA sites was performed. RF energy ablation was 40W at the epicardial surface and 40–50W at the endocardial surface. Results In the EPI group endocardially mapped area of unipolar endocardial low voltage zone (LVZ) significantly prevailed over bipolar endocardial area of LVZ: 75.4 cm2 [IQR: 23.2; 211.9] vs 6.7 cm2 [IQR: 4.4; 35.5](P=0.009). Epicardial bipolar LVZ area prevailed over unipolar epicardial LVZ area: 65.3 cm2 [IQR: 55.6; 91.3] vs 6.7 cm2 [IQR: 4.4; 35.3] (P=0.005). Endocardial unipolar LVZ area in the EPI group was larger than in the ENDO group (P>0,05). After ablation non-inducibility of any ventricular arrhythmia was achieved in 90% of patients in the EPI group and in 80% of cases in the ENDO group. During a mean follow-up period of 22.3±10.5 months freedom of ventricular arrhythmia recurrence was 70% in the EPI group and 100% in the control group. Conclusions Although epicardial area of abnormal potentials significantly prevails over endocardial area, endocardial unipolar mapping and higher RF ablation power allow performing successful ventricular arrhythmia treatment in the majority of ARVC patients. Funding Acknowledgement Type of funding source: None

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Abstract 5697: Echocardiographic Detected Hibernating Myocardium Can Predict Arrhythmic Events in Patients with Ischemic Cardiomyopathy

Circulation ◽

10.1161/circ.118.suppl_18.s_987-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ken Matsuoka ◽

Masami Nishino ◽

Daisuke Nakamura ◽

Takahiro Yoshimura ◽

Yasuharu Ri ◽

...

Keyword(s):

Myocardial Viability ◽

Cardiac Death ◽

Ischemic Cardiomyopathy ◽

Coronary Revascularization ◽

Nuclear Imaging ◽

Left Ventricular ◽

Hibernating Myocardium ◽

Low Grade ◽

Regional Dysfunction

Backgrounds: In medically treated patients with ischemic cardiomyopathy, myocardial viability is associated with a worse prognosis than scar. Hibernating myocardium (chronic regional dysfunction with reduced resting flow) assessed with nuclear imaging is a major risk factor for cardiac death when left ventricular function is depressed. End-diastolic wall thickness (EDWT) is an important and easy marker of myocardial viability in patients with suspected hibernation, as well as Tl-201 scintigraphy. Thus, in this study, we assessed whether hibernating myocardium evaluated by echocardiography could identify patients with ischemic cardiomyopathy who are at high risk for sudden cardiac death (SCD) and mortality. Methods: Patients with ischemic cardiomyopathy who showed low-grade cardiac function (ejection fraction (EF) < or =50%) and had no plans for coronary revascularization were enrolled. All patients underwent coronary angiography and echocardiography. Hibernating myocardium was defined as the area with major epicardial artery stenosis > or =75%, wall motion abnormality, and EDWT >6mm. The onset of SCD or mortality was determined by outpatient or telephone follow-up. Results: The study patients consisted of 60 consecutive patients (47 men, EF: 35 ± 8%, follow-up duration: 38 ± 16 months). Results were shown in a figure . Hibernating myocardium significantly increased the risk of SCD and mortality. Conclusion: Hibernating myocardium evaluated by echocardiography can predict SCD and mortality in medically treated patients with ischemic cardiomyopathy. Figure Kalpan-Meler Estimates of the Time to SCD or Mortality

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Cardiac mechanics as predictors of left ventricular reverse remodelling in patients with dilated non-ischemic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehab724.0281 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Ferrandez ◽

F Islas ◽

A Travieso ◽

J Diz-Diaz ◽

A Restrepo ◽

...

Keyword(s):

Heart Failure ◽

Ischemic Cardiomyopathy ◽

Multimodality Imaging ◽

Global Longitudinal Strain ◽

Cardiac Mechanics ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Imaging Parameters ◽

Reverse Remodelling

Abstract Background and purpose The appearance of left ventricular reverse remodelling (LVRR) is associated with a better prognosis in patients with dilated non-ischemic cardiomyopathy (DCM). Our aim was to identify cardiac imaging parameters, including speckle tracking by transthoracic echocardiography (TTE) and feature tracking by CMR, associated with LVRR in a prospective cohort of patients with DCM. Methods From 2014 to 2021, 182 patients with DCM and left ventricle ejection fraction (LVEF) <40% were prospectively evaluated in our hospital. LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50%, associated with a reduction in left ventricular end- diastolic diameter ≥10%. Patients underwent multimodality imaging evaluation including CMR with a 1.5 Tesla scanner, and TTE. Cardiac mechanics, including global longitudinal strain (GLS), strain rate (SR) and mechanical dispersion (MD) were measured. Results Median age of our cohort was 62.3 (14.4) years, and 67.7% were male. Most patients (>90%) were treated with beta-blockers or RASS blockers, and 67% with mineralocorticoid receptor antagonists. 30% had cardiac resynchronization therapy (CRT) and 37% had ICD as primary prevention. Mean LVEF was 31.3%. During a mean follow-up period of 35.9 (35.4) months, 38.3% of patients had LVRR. Age and gender distribution were similar in both groups. Regarding cardiovascular risk factors and pharmacological treatment, no differences were found between patients with and without LVRR. Baseline CRT therapy was not associated with LVRR (22.6% vs 34.7%; p=0.249). However, there was a trend towards higher LVRR in those who received CRT during follow-up 18.8% vs 0%; p=0.069). Patients who experienced LVRR had lower basal LVEF (23.4% vs 29%; p<0.008), as well as poorer RV function, including lower RVEF (40.5% vs 51%; p=0.006) and lower TAPSE (16 mm vs 19 mm; p=0.021). Regarding cardiac mechanics, those patients with lower GLS (−9% vs −12%; p=0.001), and higher MD (73 mm vs 55 mm; p=0,050) had LVRR more frequently during follow-up. The presence of a left bundle branch block (LBBB) contraction pattern by strain was associated with higher rate of LVRR (83.3% vs 30.4%; p=0.011). The burden of fibrosis measured by LGE with CMR was not associated with LVRR (14% vs 12%; p=NS). Patients with LVRR had a lower cardiovascular mortality (3.3 vs 14.3%; p=0.117), lower mortality due to heart failure (0% vs 12.2%; p=0.046), less heart failure hospitalizations (20% vs 46.9%; p=0.016), and a lower incidence of ventricular tachyarrhythmias (3.3% vs 18.4%; p=0.051). Conclusions LVRR in patients with DCM receiving optimized medical therapy is associated with a better prognosis. Imaging parameters, including a lower basal LVEF, RVEF, GLS and higher MD, as well as LBBB echo pattern, were associated with a higher frequency of LVRR, and might help to identify patients who could benefit from CRT/and may be helpful to stratify patients's risk. FUNDunding Acknowledgement Type of funding sources: None.

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Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy

Journal of Clinical Medicine ◽

10.3390/jcm10214989 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4989

Author(s):

Mohammad Abumayyaleh ◽

Christina Pilsinger ◽

Ibrahim El-Battrawy ◽

Marvin Kummer ◽

Jürgen Kuschyk ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Ischemic Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Tachyarrhythmias ◽

Ventricular Ejection Fraction ◽

One Year ◽

The Impact

Background: The angiotensin receptor-neprilysin inhibitor (ARNI) decreases cardiovascular mortality in patients with chronic heart failure with a reduced ejection fraction (HFrEF). Data regarding the impact of ARNI on the outcome in HFrEF patients according to heart failure etiology are limited. Methods and results: One hundred twenty-one consecutive patients with HFrEF from the years 2016 to 2017 were included at the Medical Centre Mannheim Heidelberg University and treated with ARNI according to the current guidelines. Left ventricular ejection fraction (LVEF) was numerically improved during the treatment with ARNI in both patient groups, that with ischemic cardiomyopathy (n = 61) (ICMP), and that with non-ischemic cardiomyopathy (n = 60) (NICMP); p = 0.25. Consistent with this data, the NT-proBNP decreased in both groups, more commonly in the NICMP patient group. In addition, the glomerular filtration rate (GFR) and creatinine changed before and after the treatment with ARNI in both groups. In a one-year follow-up, the rate of ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) tended to be higher in the ICMP group compared with the NICMP group (ICMP 38.71% vs. NICMP 17.24%; p = 0.07). The rate of one-year all-cause mortality was similar in both groups (ICMP 6.5% vs. NICMP 6.6%; log-rank = 0.9947). Conclusions: This study shows that, although the treatment with ARNI improves the LVEF in ICMP and NICMP patients, the risk of ventricular tachyarrhythmias remains higher in ICMP patients in comparison with NICMP patients. Renal function is improved in the NICMP group after the treatment. Long-term mortality is similar over a one-year follow-up.

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Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽

10.1161/circ.102.suppl_3.iii-101 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

Jian Xin Qin ◽

Takahiro Shiota ◽

Patrick M. McCarthy ◽

Michael S. Firstenberg ◽

Neil L. Greenberg ◽

...

Keyword(s):

New York ◽

Ischemic Cardiomyopathy ◽

Heart Association ◽

Left Ventricular ◽

Functional Class ◽

Before And After ◽

Infarct Exclusion ◽

New York Heart Association ◽

Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

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P4525Differential effect of CRT in ischemic and non-ischemic cardiomyopathy: longterm follow-up data from a single center cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0918 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P C Kahr ◽

P Kaufmann ◽

J Kuster ◽

J Tonko ◽

A Breitenstein ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Ischemic Cardiomyopathy ◽

Left Ventricular ◽

Male Gender ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Study Endpoint ◽

Ventricular Ejection Fraction

Abstract Background Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in selected symptomatic patients with reduced left ventricular ejection fraction (LVEF) and wide QRS complex. However, some patients fail to benefit from CRT. Data on the differential role of baseline and follow-up left ventricular ejection fraction (LVEF) on outcome in patients with ischemic compared to non-ischemic cardiomyopathy (ICM, N-ICM) is controversial. Purpose To test, whether ICM and N-ICM patients differ in outcome after CRT during long-term follow-up and whether predictors for survival after CRT differ between the two groups. Methods All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were evaluated (n=418). All ICM/N-ICM patients with follow-up echocardiography within 1 year after CRT implantation (FU1) and a second echocardiography >1 year after FU1 (FU2) were included in the analysis (n=253). Primary post-hoc defined study endpoint was the composite of all-cause death, heart transplantation or implantation of a ventricular assist device. Results Compared to patients with N-ICM (n=160, median age 64 years [IQR 54–71], 71% male), ICM patients (n=93, median age 70 years [IQR 61–75], 84% male) were significantly older and had a higher prevalence of male gender, concomitant diabetes mellitus and arterial hypertension. There were no significant differences in pre-implantation echocardiographic features (LVEF, LVEDV, RV-FAC, severity of mitral regurgitation), QRS width and NT-proBNP levels between the groups. However, the hazard for reaching the primary endpoint was significantly higher in patients with ICM compared to N-ICM both on univariate analysis (HR 1.62 [95% CI 1.09–2.42], p=0.018) and after multivariate correction (aHR 2.13 [1.24–3.66], p=0.006). While higher NT-proBNP levels and greater right ventricular fractional area change were positively correlated with the hazard of death in both ICM and N-ICM (see Figure), lower LVEF at baseline was associated with an increased risk of death only in ICM but not in N-ICM (HR 0.95 [0.91–0.99], p=0.029 vs. HR 1.00 [0.96–1.04], p=0.945). Male gender, lower BMI and NYHA class ≥ III were positively correlated with the endpoint in N-ICM, but not in ICM. Importantly, LVEF at FU1 (median 4.7 months after implantation) and FU2 (median 47.1 months after implantation) were found to correlate signficantly with the endpoint in both ICM and N-ICM. Conclusion Our findings highlight important differences in ischemic and non-ischemic patient populations undergoing CRT. While overall survival of patients with N-ICM exceeds survival in ICM, several other factors (including LVEF) have differential effects on response to CRT in these two patient groups.

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P1896Single-procedure success-rate of pulmonary vein isolation using point-by-point tagging lesions algorithm based on contact force technology: preliminary results of the multicentric SMOP study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0643 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Rordorf ◽

S Cornara ◽

L Frigerio ◽

A Sanzo ◽

E Chieffo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Success Rate ◽

Contact Force ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Italian Population ◽

Ablation Lesion ◽

Rf Ablation ◽

The Mean

Abstract Background Pulmonary veins isolation (PVI)is an effective therapy for atrial fibrillation (AF), recommended by current guidelines. However, recurrences after first radio-frequency (RF) catheter ablation (CA) are still high. PV reconnection could be due to ineffective transmural lesions; automated ablation lesion tags (the VisiTag algorithm) based on predefined parameters of catheter stability and contact force (CF) have been developed to allow the detection of ineffective ablation lesion, nevertheless there is a lack of multicenter studies exploring this technology. Objective the aim of our study was to assess the rate of recurrence after a first PVI procedure in a large, multicentric Italian population and to explore the efficacy of Visitag algorithm (CARTO 3) used to guide RF ablation of AF. Methods we analyzed 214 patients of the SMOP-AF study (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric study enrolling patients with paroxysmal and persistent AF undergoing a first PVI procedure after an high-density mapping during sinus rhythm. During the procedure, ablation was guided by an automated annotation system in which tag based on predefined parameters were displayed real-time in each lesion site on the electroanatomical map. Visitag settings for the catheter position stability were a 2,5 mm distance limit for at least 7 sec and a minimum CF of 5 g over 30% of the ablation and a FTI>400 g*s. Where available (n=106, 49.5%), Ablation Index (AI), which also incorporates information on delivered RF power, was used instead of FTI to guide RF ablation with a threshold range of 400–550 for anterior/roof and 330–420 for posterior/inferior segments. Minimum and mean contact force, time and power values for each RF-lesion were recorded while both FTI and AI values were calculated automatically by the CARTO system. Comparison between groups were made by cross-tables, Mann-Whitney or Student T test as appropriated. Results the mean age of the enrolled population was 59±9 years, left ventricular ejection fraction was 59±9%. AF was paroxysmal in 89.7%, persistent in 10.3% of the patients and refractory to at least one anti-arrhythmic drug in 86.4% of the population. At 3 months follow-up 85% of the patients were free from AF recurrences and the success rate increased to 90.8% at 3–6 months, and 86.3% at 3–12 months follow-up. The mean ablation time was shorter in AI-guided vs. FTI-guided procedures (31±9 vs 46±29 min; p<0.001). There was a trend toward a reduction in AF recurrences when AI vs. FTI was used, both at 6 and 12 months (respectively 5,4% vs 13.6%; p 0.06 and 9.6% vs 18.5%; p 0.08). Conclusion PVI isolation using dedicated algorithms developed to guide the effectiveness of RFCA leads to a very high success-rate after a single procedure. The use of AI, which integrates contact force information with delivered power, reduces the procedural time and increases the overall success-rate

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