a prospective, multicenter cohort study comparing

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TEMPLATES TO GUIDE ATRIAL TACHYCARDIA ... ping of focal atrial tachycardia (AT). We have ... in 61 patients (95%) in the right atrium and in 15 patients.
Abstracts

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240 VALIDATION OF PACED P-WAVE MORPHOLOGY TEMPLATES TO GUIDE ATRIAL TACHYCARDIA LOCALIZATION A AbdelWahab, D Yahya, J Sapp, H Rizk, R Parkash, M Gardner, C Gray, A El-Damaty Halifax, Nova Scotia BACKGROUND:

Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT). We have previously proposed an algorithm based on paced P wave morphology templates by pacing from different anatomical sites in both atria. OBJECTIVE: Validation of this algorithm in a retrospective series of AT patients who underwent catheter ablation. METHODS: We prospectively enrolled consecutive patients who underwent electrophysiology study, had no heart disease and no atrial enlargement. Atrial pacing, at twice diastolic threshold, was carried out at different anatomical sites in both atria. Paced P wave morphology and duration were assessed. An algorithm was generated from the constructed templates of each pacing site. The algorithm was applied on a retrospective series of successfully ablated AT patients between 2006 and 2016. Overall and site-specific accuracy were determined. RESULTS: Derivation cohort included 65 patients (25 men, age 3713 years). Atrial pacing was performed in 1025 sites in 61 patients (95%) in the right atrium and in 15 patients (23%) in the left atrium. The validation cohort included 71 patients (28 men, age 5219 years). AT were right atrial in 66.2%. The algorithm successfully predicted AT origin in 91.5% of patients (100% in LA and 87.2% in RA). It was off by 1 adjacent segment in the remaining 8.5%. Site-specific accuracies are shown in Table1. CONCLUSION: A simple ECG algorithm based on paced P-wave morphology templates was highly accurate in localizing sites of origin of focal atrial tachycardia particularly those of LA origin.

241 A PROSPECTIVE, MULTICENTER COHORT STUDY COMPARING PHASED MULTIPOLAR VERSUS TRADITIONAL RADIOFREQUENCY ABLATION Z Azizi, V Essebag, P Alipour, Y Khaykin, P Leong-Sit, J Sarrazin, M Sturmer, S Patterson, C Morillo, G Amit, J Roux, A Verma Newmarket, Ontario BACKGROUND:

Percutaneous catheter ablation has emerged as an effective therapeutic method for Atrial Fibrillation as the most common arrhythmia. Multipolar, phased radiofrequency (RF) catheter ablation (PVAC) has been shown to have comparable efficacy, and reduced fluoroscopy and procedural times compared to traditional RF. These studies have been small, therefore, we performed this multicenter cohort study in order to assess the efficacy and efficiency (procedural time and safety) of using this catheter for ablation in patients with highly symptomatic paroxysmal AF (PAF). METHOD: This is a multicenter, sequential, prospective, cohort study between 2012 to 2016 in 6 tertiary care centers. The protocol of the study was registered on Clinicaltrials.gov website (NCT01562912). Patients were enrolled if they had symptomatic, paroxysmal AF (less than 7 days) refractory to at least one antiarrhythmic medication. A total of 230 patients were enrolled in a 2:1 ratio of PVAC (group A) to control (group B). Ablations were performed by the same operators. ECG and 48 hour Holter monitor were used to assess patients at 3, 6, 9 and 12 months post-ablation follow up. Recurrence was defined as any atrial arrhythmia >30 seconds. The primary endpoint was PVAC efficiency combining procedural time, efficacy, and repeat procedures. Intention to treat analysis was utilized for this study. RESULTS: Overall, 230 patients consisted of 162 males (70.4%) with mean age 57  11 years were analyzed. Recurrence post ablation was 73.2% (101) and 58.9% (43) in groups A, and B respectively (p¼0.034). Three, 6, 9, and 12-month recurrence for Group A versus B were 56.7% vs 49.3%, (p¼0.31), 48.3% vs. 29.9%, (p¼0.013), 44.3% vs 30.6, (p¼0.07), and 35.2% vs 29.4%, (p¼0.42) respectively.

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Among these patients, 14.7% (21) in group A and 7.7% (6) in group B had redo procedure (p¼0.12). Procedure time was significantly lower in Group A than Group B (190.239.9 vs. 23050.38 minutes, P < 0.0001). There was not any significant difference in fluoroscopy time between the two groups (p¼0.49). Mean survival from recurrence for group A and B at 12 months was 26.8% vs 41.1% respectively (p¼0.051). There were no significant differences in adverse events between the two groups in 12-month follow-up (P¼0.16). CONCLUSION: This study demonstrated that PVAC catheter can significantly reduce procedure time for PVAI procedure, however, it may increase the likelihood of further recurrence of atrial tachyarrhythmia. 242 VASOVAGAL SYNCOPE PATIENTS HAVE A REDUCED QUALITY OF LIFE AND GREATER PSYCHOLOGICAL DISTRESS COMPARED TO HEALTHY SUBJECTS J Ng, R Sheldon, D Ritchie, V Raj, S Raj Calgary, Alberta BACKGROUND:

Patients with vasovagal syncope (VVS) are highly symptomatic and have a reduced health-related quality of life (HRQoL). There is limited data comparing the HRQoL and psychological profile between VVS patients and healthy individuals. The purpose of this study was to examine the differences in HRQoL and psychological distress between VVS patients and healthy subjects. We tested the hypothesis that VVS patients will have greater impairment in both HRQoL and psychological profile compared to healthy individuals. METHODS: The RAND 36-Item Health Survey (RAND36), Hospital Anxiety and Depression Scale (HADS), and Anxiety Sensitivity Index (ASI) were completed at baseline by VVS patients and healthy subjects enrolled in the Second Prevention of Syncope Trial (POST II), a randomized, placebocontrolled trial of fludrocortisone for VVS. Data are reported as meanSD with Student’s t-tests. RESULTS: Data are available on 76 VVS patients (3414 years; 68% F) and 85 healthy subjects (3511 years; 80% F). For the RAND36 (Table), VVS patients reported poorer physical functioning (p < 0.001), emotional well-being (p < 0.001), social functioning (p < 0.001), and general health (p < 0.001) compared to healthy subjects. They also had less energy (p < 0.001), more pain (p < 0.001), and greater role limitations due to both physical health (p < 0.001) and emotional problems (p < 0.001). For the HADS, VVS patients had greater anxiety (p < 0.001) and were more depressed (p < 0.001). VVS patients also reported greater anxiety sensitivity in the ASI (p < 0.001). CONCLUSION: VVS patients have a reduced HRQoL and poorer psychological profile compared to healthy subjects. VVS patients may benefit from targeted interventions addressing these concerns.

243 PREDICTORS OF ATRIAL FIBRILLATION AFTER CATHETER ABLATION IN A HYPERTENSIVE POPULATION: A SUB-STUDY OF SMAC-AF W Weng, J Bernick, G Wells, J Tardif, A Tang, J Sapp, C Gray, M Gardner, J Healey, R Parkash Halifax, Nova Scotia

Radiofrequency ablation for atrial fibrillation (AF) has emerged as a valuable therapy option; however, high rates of AF recurrence after ablation remain a limitation of this procedure. The recent Substrate Modification with Aggressive Blood Pressure Control (SMAC-AF) randomized controlled trial enrolled hypertensive patients, defined as BP>130/ 80mmHg, who had either persistent or paroxysmal AF, resistant or intolerant to at least one class I or III antiarrhythmic drug, who were scheduled for catheter ablation. 173 patients were randomly assigned to standard-of-care blood pressure target, 140/90mmHg or aggressive target, 120/ 80mmHg; there was no reduction in recurrence (HR 0.94, 95% CI 0.65-1.38 for aggressive control). This post-hoc analysis of the SMAC-AF population aimed to compare the risk factors for AF recurrence in each of the two cohorts. METHODS: Using the SMAC-AF cohorts, we investigated how baseline characteristics and serum NT-pro-brain-natriuretic-peptide measured after AF ablation were associated with AF recurrence, defined as >30s of AF, more than 3 months post-ablation. Univariate Cox regression analysis was used to determine association between variables and AF recurrence. RESULTS: Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. 106 (61.3%) patients had AF recurrence and 67 (38.7%) patients did not. Table 1 shows variables associated with AF recurrence. In the standard group, age (HR 1.03, p¼0.04), number of antihypertensive medications (HR 1.31, p¼0.048), and use of a calcium channel blocker (HR 1.81, p¼0.03) were associated BACKGROUND: