Jun 4, 2018 - Results: A total of 776 patients underwent 28-mm cryoballoon PVI for ... isthmus ablation in patients with "isolated" typical atrial flutter.
Poster session 3
Little is known about the mechanisms underlying such improvement and whether the benefit of CB2 is similar for all four pulmonary veins (PVs). Purpose: The aim of this multicenter observational study was to compare the PV reconduction rates and patterns in patients referred for redo procedures of symptomatic paroxysmal AF and initially ablated with CB1 and CB2 cryoballoons, in order to elucidate the mechanisms explaining the clinical benefit observed in the latter group. Methods: Consecutive patients referred in 3 tertiary centers from 2010 to 2016 for a redo ablation of symptomatic paroxysmal AF previously ablated with a first or second generation 28-mm cryoballoon were included in the study. All the patients had the redo-procedure performed using RF energy. All data were evaluated retrospectively. Results: A total of 776 patients underwent 28-mm cryoballoon PVI for symptomatic paroxysmal AF in 3 centers, 279 with CB1 and 497 with CB2. Among them, 94 patients (12.1%) had symptomatic recurrences requiring a redo ablation, 43 (15.4%) and 51 (10.3%) previously ablated with CB1 and CB2, respectively. The benefit of CB2 over CB1 was compared for each PV. Durable PVI was confirmed in 7 CB1 (16.3%) and 14 CB2 (27.4%) patients, and in the overall population, 2.762.1 and 1.461.4 gaps per patient were found, respectively (p¼0.002). Significantly more left superior PVs (LSPV) and left inferior PVs (LIPV) were found to be isolated in the CB2 compared to the CB1 group (78.4% vs. 48.8%, p¼0.005 and 78.4% vs. 46.5%, p¼0.003, respectively) while the rate of durable right superior PVs (RSPV) and right inferior PVs (RIPV) isolation were similar (68.6% vs. 60.5%, p¼0.542 and 66.7% vs. 55.8%, p¼0.387, respectively). Consequently, significantly fewer gaps were found in left PVs in CB2 patients, while there was no significant difference for right PVs. Gaps were predominantly localized in the anterior segments of superior PVs and inferior segments of inferior PVs, regardless of the cryoballoon used. Conclusion: Fewer reconnection gaps are observed during redo ablations of paroxysmal AF in patients primarily ablated with CB2. This difference is driven by less reconnection gaps observed in both left PVs, while no difference was observed for right PVs.
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hypertension is an important clinical predictor of AF occurrence in this cohort of patients.
Abstract P1445 Figure. ROC-analysis of hypertension history.
ATRIAL FIBRILLATION - PACING P1446 Can we predict new atrial fibrillation occurrence in single-chamber ICD patients ? M. Ziacchi1; M. Biffi1; RP. Ricci2; D. Facchin3; G. Morani4; M. Landolina5; M. Lunati6; S. Iacopino7; A. Capucci8; S. Bianchi9; T. Infusino10; GL. Botto11; L. Padeletti12; G. Boriani13 1 University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy; 2San Filippo Neri Hospital, Department of Cardiology, Rome, Italy; 3University Hospital Santa Maria della Misericordia, Department of Cardiology, Udine, Italy; 4Civil Hospital Maggiore at Borgo Trento, Department of Cardiology, Verona, Italy; 5Maggiore Hospital of Crema, Department of Cardiology, Crema, Italy; 6Niguarda Ca’ Granda Hospital, Department of Cardiology, Milan, Italy; 7Maria Cecilia Hospital, Department of Cardiology, Cotignola, Italy; 8University Hospital Riuniti of Ancona, Department of Cardiology, Ancona, Italy; 9S.Giovanni Calibita Fatebenefratelli Hospital, Department of Cardiology, Rome, Italy; 10S.Anna Hospital, Department of Cardiology, Catanzaro, Italy; 11Sant’Anna Hospital, Department of Cardiology, Como, Italy; 12IRCCS Multimedica of Milan, Department of Cardiology, Milan, Italy; 13University of Modena & Reggio Emilia, Department of Cardiology, Modena, Italy
Abstract P1444 Figure. Durable PVI during redo ablation.
P1445 Occurence and determinants of new-onset atrial fibrillation after cavotricuspid isthmus ablation in patients with "isolated" typical atrial flutter P. Novikov; A. Pevzner; N. Shlevkov; E. Maykov; S. Sokolov; S. Golitsyn Cardiology Research and Production Center, Clinical electrophysiology and endovascular treatment of cardiac rhythm disorders, Moscow, Russian Federation Introduction: Radiofrequency ablation (RFA) is an effective treatment for typical atrial flutter (AFL). However, previous studies showed wide variability of new-onset atrial fibrillation (AF) and analysis of AF risk factors showed contradictory results. Purpose: To determine factors of new-onset atrial fibrillation occurrence after cavotricuspid isthmus (CTI) radiofrequency ablation in patients with "isolated" typical atrial flutter. Methods: In this study we included 28 patients (24 men (86%), mean age 55611 years), with paroxysmal (n¼11, 40%) or persistent (n¼ 17, 60%) AFL, without any documented history of AF. All patients underwent successful RFA, reaching bidirectional conduction block through the CTI as a procedural endpoint. During follow-up period (mean 24 615 months) after ablation patients were divided into two groups: Group @1 -"with AF", group @2- "without AF". Univariate analysis was performed between the following groups in total of 39 clinical characteristics including age, presence and duration of arterial hypertension, coronary artery disease, thyroid disease, diabetes mellitus, typical atrial flutter features, echocardiography data, electrophysiology study data (intraatrial and interatrial conduction time, effective refractory periods in different right atrium sites, inducibility of atrial fibrillation during programmed and rapid atrial stimulation). Results: At the end of follow-up AF occurred in 17 (60%) patients, of which 3 (10%) patients had persistent AF. There was no statistical significance between two groups by all characteristics, except duration of hypertension history. AF significantly more often occurred in patients with long-term history of arterial hypertension (p¼0,02), sixyear anamnesis of arterial hypertension had 80% sensitivity, 89% specificity, 80% positive predictive value. Conclusions: Sustained AF was observed in 60% of patients with "isolated" typical atrial flutter after cavotricuspid isthmus ablation during follow-up. Long-term history of
On behalf of: Italian Clinical Service Project Background: Atrial tachyarrhythmias (AT/AF) have been associated with an increased risk of mortality, morbidity and ischemic stroke. Up to now, single chamber ICD diagnostics was not able to detect AT/AF, therefore the incidence of new onset AT/AF in patients with single chamber ICD is not known. Objective: To evaluate incidence and predictors of AT/AF occurrence in patients with dual-chamber ICD with no pacing indications and no history of AT/AF that strictly mimic single chamber ICD recipient Methods: Consecutive dual-chamber ICD patients were prospectively followed by 47 Italian cardiologic centers in an observational research. Clinical and device data were reviewed by expert cardiologists to assess AT/AF occurrence. Multivariate regression analysis evaluated the risk of new-onset AT/AF and its association with patients’ baseline characteristics and with CHADS2 score. Results: 428 (13.4% female, 64 years old) patients were followed for a median observation period of 31 months. AT/AF episodes occurred in 160 (37.4%) patients when considering at least 5 minutes duration, in 95 (22.2%) for AT/AF 6 hours, in 47 (11.0%) for AT/AF 1 day, in 29 (6.8%) for AT/AF 7 days. Patients with CHADS22, who comprised 36% of the whole population, showed higher incidence of AT/AF 6 hours compared with patients with CHADS2 < 2 (Hazard Ratio¼1.69, 95% Confidence Interval¼1.13-2.53, p¼0.011). Conclusions: Our observations in a population of dual-chamber ICD patients with no pacing indications and no history of AT/AF ,who strictly mimic single–chamber ICD recipients, highlight that CHADS2 score is predictive of new-onset AT/AF.
P1447 Incorrect coding of atrial fibrillation leads to under-treatment with anticoagulation in pacing clinics MB. Kahn; A. Unsworth; N. Evenson; N. Dawson; A. Hopkins; NG. Campbell University Hospital of South Manchester, Cardiology, Manchester, United Kingdom Background: Atrial Fibrillation (AF) is both under-recognised and under-treated with anticoagulation. Patients with established AF who are inappropriately coded will not
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