Jun 14, 2018 - with loss of ventriculo-atrial (VA) conduction. Complete elimination of SP is highly pre- dictive of long term success while SP modification has ...
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Poster session 2
Abstract P939 Figure.
mode, 30W/15-30 ml flow. All survivors underwent implantation of an ICD. Patients were followed in institutional outpatient clinic. Results: CA was successful in suppressing electrical storm completely in 19 out of 22 patients (86 %). Mean procedural time reached 171 6 53 min with fluoroscopic time of 12 6 9 min. In all but one case, the triggering focus originated from Purkinje fibers. Eight (36 %) early recurrences of ectopy were observed from a different region than originally ablated. It was transient in 2, 4 subjects underwent successful second ablation. Four patients deceased early after the procedure, two due to progressive heart failure, one due to multi-organ failure and the other due to electromechanical dissociation. Importantly, 78 % (14/18) of acute survivors had no recurrence of ES during 29 6 14 months of follow-up. Two patients were re-ablated successfully (1 for new different source at 6 month, 1 for recurrence of monomorphic VT 2 years later). Conclusions: CA is efficacious strategy for intractable cases of electrical storm due to focally triggered VF in patients with ischemic heart disease.
CATHETER ABLATION - RESULTS P936 The FLUTFIB Survey: procedural characteristics, oral anticoagulation management and concomitant atrial fibrillation in patients undergoing catheter ablation of typical atrial flutter M. Huemer; T. Budde; P. Lacour; B. Pieske; F. Blaschke; W. Haverkamp; LH. Boldt; P. Attanasio Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany Background: Catheter ablation of typical atrial flutter is a highly effective procedure. Though recurrence rates of typical atrial flutter are low, a considerable amount of patients develops atrial fibrillation in the long term. Oral anticoagulation regimes as well as ECG monitoring strategies differ between electrophysiology centers and no uniform recommendations are available yet. The purpose of this survey was to assess procedural characteristics, oral anticoagulation management and ECG monitoring approaches for detection of atrial fibrillation in different electrophysiology centers. Methods: We conducted a web-based survey in european electrophysiology centers. Responses were received from 44 (16,2% of 271) centers. The survey investigated the following subjects: procedural characteristics, oral anticoagulation management, ECG monitoring and detection of atrial fibrillation after successful cavotricuspid isthmus ablation. Results: The majority of participating centers (64%) perform CTI ablation in patients with typical atrial flutter already when the first episode of atrial flutter is documented. More than 55% of centers estimated a more than 30% risk for atrial fibrillation occurrence in the long term. Most of the centers (66%) indicated that atrial fibrillation will most frequently occur later than three months after CTI ablation. Centers permanently discontinue oral anticoagulation after successful CTI ablation in patients with a CHADS2-VA2SC-score of more than 1 point in case of documentation of sinus rhythm: in one or more resting ECG (7%), in one Holter ECG (17%), in multiple Holter ECGs (36%) or during continuous monitoring by implantable loop recorders (10%). Permanent discontinuation of oral anticoagulation is implemented by 36% of all centers within the first three months after CTI ablation, by 43% of centers after three to six months. The majority of the interviewed centers (81%) state that oral anticoagulation should be discontinued in case of exclusion of atrial fibrillation after CTI ablation by implantable loop recorder. However most of the centers provide patients never (66%) or only in a small amount (31%) with implantable loop recorders after CTI ablation.
Conclusion: Though plenty of patients will develop atrial fibrillation after successful ablation of atrial flutter this problem does not affect all patients. Currently centers’ regimes for management of oral anticoagulation and continuation of ECG monitoring significantly differ. This reflects the clear lack of study evidence concerning this topic.
P937 Prediction of impending atrioventricular block during ablation of slow pathway in typical atrioventricular nodal reentry tachycardia: advanced age is a possible risk factor N. Fragakis; L. Krexi; M. Sotiriadou; A. Fotoglidis; S. Tsakiroglou; S. Avramidou; P. Kyriakou; V. Skeberis; V. Vassilikos Third Department of Cardiology, Hippokration General Hospital, Aristotle University, Thessaloniki, Greece Background/Introduction: Occasionally radiofrequency (RF) ablation of the slow pathway (SP) of atrioventricular nodal reentry tachycardia (AVNRT) is complicated with various degrees of atrioventricular block (AVB) predicted by junctional beats (JB) with loss of ventriculo-atrial (VA) conduction. Complete elimination of SP is highly predictive of long term success while SP modification has been associated with an increased risk of recurrent AVNRT. Purpose: We evaluated if intervals in Koch’s triangle can predict the risk of loss of VA conduction during JB and the modification or complete elimination of SP. We also investigated whether age influences the risk of loss of VA conduction. Methods: We analysed retrospectively 153 consecutive patients (107 women and 46 men, mean age 48 6 17 years) undergoing ablation of SP for typical AVNRT. Patients were divided into two groups: group I 137 patients 70 years and group II 16 patients >70 years. We measured the conduction time between the atrial electrograms recorded on the His-bundle position, the distal ablation catheter [A(H)-A(RFd)] and on the proximal coronary sinus catheter [A(H)-A(CS)] placed at the CS os as well as the A(RFd)-A(CS) interval in those RF applications that produced JB. Results: The A(H)-A(RFd) and A(RFd)-A(CS) intervals were significantly shorter in RFs causing JB with VA block than in RFs with VA conduction (29611ms vs 35611ms, P70 years (36611ms vs 2968ms, P¼ 0.012, 1768ms vs 1367ms, P¼0.027 respectively). The A(H)-A(RFd) interval was also shorter in complete elimination than in modification of SP (34611ms vs 37610ms, P
