Does radiofrequency with contact force supersede cryoballoon for atrial fibrillation ablation? A one-year follow-up retrospective study

Introduction If catheter ablation of atrial fibrillation (AF) is now proved to be a safe and superior alternative to antiarrhythmic drugs for maintenance of sinus rhythm and improvement of symptoms, the best transcatheter technique is still a matter of debate. Radiofrequency (RF) and cryoballoon (CRYO) are the principal technologies sharing the spotlight, and several observational studies and RCT have compared both techniques with conflicting results. Purpose Current RF catheters now use contact-force technologies to precisely calibrate the energy delivered to tissue, according to the force applied to adjacent tissue in grams, time of contact in seconds and more recently power delivered in watts. The purpose of our study is to evaluate the contribution of this technology in “real life ” conditions and its hypothetical potential to supersede CRYO for the ablation of AF. Methods Design and population. We conducted a single center retrospective study, spreading over two years (1st January 2018–30th December 2019) and enrolling 376 patients that underwent a first ablation procedure in this period. Endpoints. The primary endpoint was a comparison of the rate of AF recurrence for each technique, twelve months after initial procedure, respecting an initial 90 days blanking period. Recurrence was defined as documented AF, atrial flutter, atrial tachycardia lasting at least 30 seconds (12-lead ECG, holter or telemetry) or 6 minutes (for atrial high rate episode on pacemaker interrogation), and/or the need of a second ablation procedure. We evaluated secondary efficacy endpoints including death, procedure duration, fluoroscopy time and hospitalization for cardiovascular causes. Complications in direct relation with the initial procedure were the primary safety endpoint. Finally, we studied the impact of five factors on recurrence: temporal pattern of AF, left atrium dimension, arrhythmia duration, body mass index and CHADS2VA2Sc score. Results Patients who underwent RF ablation were similar to those who underwent cryoablation except for chronic kidney disease, type 2 diabetes and coronaropathy which were more prevalent in RF group. We found a trend toward lower incidence of recurrences in the cryoballoon group, despite not statistically significant. Hospitalizations for cardiovascular causes and deaths from any cause were slightly higher in the radiofrequency group. As expected, time of procedure was lower and fluoroscopy time higher in cryoballoon group. Significant association was detected between recurrence and both left atrium diameter and CHADS2VA2Sc score. Conclusion In this retrospective study, albeit using latest generation ablation catheters in the two different technics, we found no significant difference in recurrence of AF between radiofrequency and cryoballoon ablation of AF. Left atrium diameter and higher CHADS2VA2Sc score are two predictors of recurrence, easy to use in daily clinical practice. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics – endpoints Primary efficacy end point

Triangular plasty of left atrium in correction of mitral failure

Objective. Studying of possibilities of procedure of the left atrium triangular plasty while doing correction of mitral failure, coexisted with left atriomegaly. Materials and methods. There were analyzed results of surgical treatment of 330 patients, suffering mitral failure in combination with left atriomegaly, who were operated in Amosov National Institute of Cardiovascular Surgery in period from 1 Jan 2005 to 1 Jan 2021 yr. The main group have consisted of 143 patients, to whom correction of mitral failure together with original procedure of triangular plasty of left atrium was performed. The control group have consisted of 187 patients, to whom correction of mitral failure was done only, although they suffered concurrent left atriomegaly. Results. Of 143 patients operated in the main group 3 died (lethality have constituted 2.1%). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle – (69.1 ± 12.1) ml/m2 before the operation, (59.3 ± 8.5) ml/m2 postoperatively, (48.4 ± 9.5) ml/m2 in late period; the left ventricle ejection fraction – 0.51 ± 0.05 preoperatively, 0.54 ± 0.05 postoperatively 0.56 ± 0.04 in late period. The left atrium diameter dynamics was following: (65.8 ± 4.1) mm preoperatively, (52.3 ± 2.1) mm postoperatively, and (53.5 ± 2.2) mm in late period. Of 187 оperated patients of control group 6 have died, (lethality have constituted 3.2%). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle – (68.3 ± 11.3) ml/m2 before the operation, (60.4 ± 9.3) ml/m2 postoperatively, (52.7 ± 7.2) ml/m2 in late period; the left ventricle ejection fraction – 0.52 ± 0.05 preoperatively, 0.53 ± 0.05 postoperatively, 0.5 ± 0.04 in late period. Diameter of left atrium: (66.5 ± 3.7) mm preoperatively, (63.5 ± 2.3) mm postoperatively, (71.5 ± 2.4) mm in late period. Conclusion. Triangular plasty of left atrium is a low-traumatic and effective procedure, leading to significant improvement in its morphometry and accompanied by low risk of hospital lethality.

Does Serum Uric Acid Status Influence the Association Between Left Atrium Diameter and Atrial Fibrillation in Hypertension Patients?

Objective: Both serum uric acid (SUA) levels and left atrium diameter (LAD) associate with AF. However, the influence of SUA status for the associated risk of AF related to LAD in hypertension patients is currently unknown.Methods: We retrospectively analyzed a hospital-based sample of 9,618 hypertension patients. Standard electrocardiograms were performed on all patients and were interpreted by expert electro-physiologists.Results: Overall 1,028 (10.69%) patients had AF out of 9,618 patients. In men >65 years of age, the prevalence of AF in the1st, 2nd, and 3rd tertiles of SUA among those grouped in the third tertile of LAD were 9, 12.3, and 21.7%, respectively. In the hyperuricemia group, the OR (95% CI) of AF for the highest tertile of LAD in men ≤ 65 years of age was 3.150 (1.756, 5.651; P < 0.001). Similarly, the hyperuricemic men in the 3rd LAD tertile had a higher likelihood of AF than those belonging to the 1st tertile. The ORs and (95% CIs) were 3.150 (1.756, 5.651; P < 0.001) and 5.522 (2.932, 10.400; P ≤ 0.001) for patients ≤ 65 and >65 years of age. An increase in SUA values was significantly associated with an increased likelihood of AF among women at the top tertiles of LAD, with the OR (95% CI) = 4.593 (1.857, 11.358; P = 0.001). Also, men> 65 years of age with large LAD, present at the third tertile of SUA, had a higher likelihood of AF, with the OR (95% CI) = 2.427 (1.039, 5.667; P < 0.05).Conclusion: SUA levels and LAD are associated with AF in patients with hypertension and the risk of AF associated with LAD increases among those with hyperuricemia.

Echocardiographic study in children with osteogenesis imperfecta

Background:Osteogenesis imperfecta is a collagen type I bone disorder. Recently, extra-skeletal manifestations have been described, including many cardiovascular alterations. This study aims to report echocardiogram study in children with osteogenesis imperfecta compared to a control group.Methods:A cross-sectional comparative study took place in the Reference Center for Treatment of Osteogenesis Imperfecta in Southern Brazil. Fifty-four patients with osteogenesis imperfecta were paired with 54 controls, based on body surface area, and echocardiogram findings were compared.Results:All cases were asymptomatic for cardiac manifestations. The case group presented significant larger values in aortic diameter, left atrium diameter, left ventricule end-diastolic diameter, left ventricule end-systolic diameter, and right ventricle diameter compared with the control group. The analysis considering the severity of osteogenesis imperfecta shows that in mild osteogenesis imperfecta, the aortic diameter (p < 0.001), left atrium diameter (p = 0.002), left ventricule end-diastolic diameter (p = 0.001), left ventricule end-systolic diameter (p = 0.026), and right ventricle diameter (p < 0.001) were significantly larger than in the control group. Patients with moderate/severe osteogenesis imperfecta had similar results, with aortic diameter (p < 0.001), left atrium diameter (p < 0.001), left ventricule end-diastolic diameter (p = 0.013), and left ventricule end-systolic diameter (0.004) statistically larger than controls. Twenty-six (48.1%) of the cases had physiological tricuspid regurgitation and in controls this finding was observed in eight (14.8%) (p < 0.001).Conclusion:Children with osteogenesis imperfecta presented cardiac function within the normal pattern, but dimensions of left ventricular dimensions were increased compared to the ones of the controls.

Echocardiographic, morphometric and biomarker changes in female cats followed from 6 to 24 months of life

Objectives The aim of the study was to evaluate cardiac size and early growth through echocardiographic, bodyweight (BW), body condition score (BCS), morphometric and biomarker changes in cats followed from 6 to 24 months of age. Methods Twenty-four female European shorthair colony cats were evaluated at birth for BW and at 6, 12, 18 and 24 months of age for BW, BCS, head length (HL) and head width (HW), N-terminal pro B-type natriuretic peptide (NT-proBNP), insulin-like growth factor-1 (IGF-1) and echocardiographic measurements. Results BCS, HW, left ventricular free wall in diastole, left atrium diameter and aortic diameter increased significantly between 6 and 12 months, while BW, HL and interventricular septum in diastole increased significantly between 6, 12 and 18 months, and BW decreased significantly between 18 and 24 months. NT-proBNP decreased significantly between 6 and 12 months. IGF-1 increased significantly between 6 and 12 months but decreased significantly between 12 and 18 months. Conclusions and relevance This study prospectively evaluated changes in echocardiographic measurements, BW, BCS, HL, HW, IGF-1 and NT-proBNP in cats during the first 2 years of life. Results show a comparable change over time for different variables. These findings contribute to the understanding of a possible relationship between cardiac measures and body size from young age through to adulthood.

Triangular plasty of left atrium in a left-sided atriomegaly

Objective. Studying possibilities of the triangular plasty of left atrium procedure, performed while prosthesis of a mitral valve. Materials and metods. Into the main group 137 patients, suffering isolated mitral failure, complicated by left atriomegaly (diameter of left atrium ≥ 6.0 cм), to whom surgical treatment was performed in Amosov National Institute of Cardiovascular Surgery from 01.10.2010 to 01.01.2019 yr, were included. In all the patients a prosthesis of a mitral valve, preserving native structures of a mitral valve with reduction of the left atrium cavity, using procedure of the left atrium triangular plasty, was performed. Into a control group were included 57 patients, in whom a mitral valve correction without a left atrium reduction was performed only for a mitral valve failure and a left-sided atriomegaly (diameter of left atrium was ≥ 6.0 cm). Results. Of 137 patients of the main group on the hospital stage 3 (2.2%) have died. Dynamics of echocardiographic indices of the left atrium diameter on different stages was following: (65.5 ± 3.8) mm preoperatively, (51.5 ± 2.1) mm postoperatively, (52.5 ± 2.2) mm in a remote follow-up period, in a remote follow-up period in (5.1 ± 0.4) years at average, thromboembolic complications (the transient disorders of the brain blood circulation) were noted in (1.6%) of 125 patients. Of 57 patients of a control group on the hospital stage 2 (3.5%) have died. Dynamics of echocardiographic indices, concerning diameter of the left atrium on various stages was following: (66.7 ± 2.7) mm preoperatively, (63.5 ± 2.3) mm postoperatively, (71.5 ± 2.4) mm in the remote follow-up period. In the remote follow-up period in (7.1 ± 0.4) years, thromboembolic complications were noted in 7 (14.6%) of 48 patients. Conclusion. The procedure of triangular plasty of left atrium constitutes an obligatory stage while performing correction of a mitral failure in presence of a left-sided atriomegaly (diameter of left atrium ≥ 6.0 cm). The procedure is miniinvasive and effective, leads to significant improvement of the left atrium morphometry and is accompanied by low risk of the complications occurrence and hospital mortality. The data accumulated and estimation of remote results of the procedure permits her to occupy a significant place among other methods of atrioplasty.

Expression of microRNAs (133b and 138) and Correlation with Echocardiographic Parameters in Patients with Alcoholic Cardiomyopathy

Introduction: Alcoholic Cardiomyopathy (ACM) is a disease with a difficult diagnosis. The real mechanisms related to its pathophysiology are not fully understood. Objective: The aims of this study were to investigate whether miR-133b and miR-138 could be associated with ACM. Method: Forty-four patients were included comprising 24 with ACM and 20 with cardiomyopathies of different etiologies (control group). Real-time PCR was performed to verify the relative expression among the studied groups. In the statistical analysis, the quantitative variables t-student Mann- Whitney and correlation of Pearson tests were carried out, while the qualitative variable comprised the chi-square test, with p<0.05 being considered statistically significant. Results: There was no association between clinical and sociodemographic characteristics of the groups. The patients with ACM presented downregulation of miR-133b in comparison with control patients (p=0.004). On the other hand, for the miR-138, there was no association when the ACM group was compared with the control group. The presence of miR-133b among cases and controls was not correlated with any of the echocardiographic parameters. However, the increase in the expression of miR-138 was correlated with an increase in the ejection fraction (r=0.28, p=0.01) and the diameter of the left atrium (r=0.23, p=0.04) in patients with ACM. Conclusion: The downregulation of miR-133b might be a marker for ACM and, in addition, miR- 138 could be used to correlate the increase in ejection fraction with and normalization of the diameter of the left atrium diameter in patients with this disease.

P1490Exercise lung ultrasound in patients with exertional dyspnea: pilot study

Purpose The aim of the present study was to test the correlation of the exercise lung ultrasound (LUS) and B-lines count with clinical, laboratory and echocardiographic parameters among patients with preserved left ventricle ejection fraction and without signs of congestion reffered for cardiopulmonary exercise test (CPET) for exertional dyspnea. Methods The study population consisted of 39 patients (age 63.0±9.3 years; 62% females) with preserved ejection fraction (≥50%) and without signs of congestion reffered for exercise testing. Pulmonary disease and coronary artery disease was ruled out. CPET, rest and stress echocardiography and B-lines count assessed by 8 zone LUS were performed. Results Exercise B-lines count was significantly higher than rest B-lines count (3.1±0.5 vs. 1.1±0.2; p<0.001). No correlation was found between B-lines count and peakVO2, workload, NT-proBNP. Among echocardiographic parameters only left atrium diameter correlated weakly (r=0.35; p=0.027) with exercise B-lines count. Difference between rest and exercise B-lines count correlated weakly with VE/VCO2 (r=0.41; p=0.015). Characteristics of study population <3 B-lines (n=22) ≥3 B-lines (n=17) p Age (years) 62.2±6.2 64.1±12.1 NS Females (n; %) 16 (72.7%) 8 (47.1%) NS DM (n; %) 3 (14%) 1 (6%) NS Arterial hypertension (n; %) 15 (68%) 14 (82%) NS BMI (kg/m2) 29.4±5.7 31.3±3.3 NS NYHA class 1.9±0.5 2.0±0.4 NS HFpEF (n; %) 8 (57.1%) 8 (42.1%) NS NT-proBNP (pg/ml) 240.0±472.8 275.4±323.1 NS E/e' 9.8±2.7 10.4±2.2 NS Left atrial diameter (mm) 36.4±4.7 39.4±4.6 p=0.039 LVEF (%) 62.9±5.6 60.6±4.7 NS PeakVO2 (ml/kg/min) 20.2±5.7 19.5±3.6 NS VE/VCO2 32.3±5.7 35.9±6.2 NS WR (W/kg) 1.7±0.5 1.5±0.3 NS DM = diabetes mellitus; LVEF = left ventricle ejection fraction; WR = workload. Rest and peak exercise B-lines count Conclusion We observed weak but significant correlation between exercise B-lines count and left atrium diameter. However we didn't observe significant difference between HFpEF patients and rest of study population in B-lines count. Limitation of our observation is small study population.

Hubungan Kejadian Fibrilasi Atrium dengan Diameter Atrium Kiri pada Fibrilasi Atrium Valvular dan Fibrilasi Atrium Non-Valvular Di RSUD Arifin Achmad

Atrial Fibrillationis a kind of arrhythmia which has the most incidence. Based on its Etiology, atrial fibrillationcouldbe divided in to two, valvular and nonvalvular atrial fibrillation. This study was aimed toknow the correlation ofatrial fibrillation incidence between valvular and nonvalvular with its left atrium diameter in Arifin Achmad ProvinsiRiau’s General Hospital. This study was analytical and done by cross sectional approach with 185 patient. The datawere processing with computerize to univariate analysis and chi-square for bivarite analysis. From this study it can beconcluded that the most occurrence of atrial fibrillation was non valvular atrial fibrillation which was 76,8% with theetiology mostly of hypertension which was 41,5%. Valvular atrial fibrillation was mostly caused by mitral stenosiswhich was 37,2% and there were no correlation between the diameter of left atrium to the occurrence of valvular andnon valvular atrial fibrillation (p=0,273.)