0107: Strategy of early detection and active management of supraventricular arrhythmia with remote monitoring: the randomized, multicenter SETAM trial

ObjectiveAtrial fibrillation (AF) is a common arrhythmia associated with increased risk of thromboembolic events or other complications. The French randomized, multicenter, SETAM trial assessed the impact of the home monitoring (HM) technology on detection and treatment of supra-ventricular arrhythmia (SVA).MethodsPatients (pts) implanted with a dual chamber pacemaker were enrolled in the study at hospital discharge if they had a sinusal rhythm at enrollment, no antiarrhythmic, anticoagulant or dual-antiplatelet therapy, and if they had a CHA2DS2-VASc score of 2 or more. The pts were randomly assigned to an active group (Act Gp), followed by Biotronik HM, or a control group (Cont Gp) without HM surveillance. The time from implantation to the first SVA-related intervention was compared between the 2 groups (primary endpoint).ResultsA total of 595 pts (mean age = 79±8 y.o, 63% male, mean CHA2DS2-VASc score = 3.7±1.2) were followed during 12.8±3.3Mo. The most prevalent co-morbidities were hypertension (82% pts), diabetes (29%) and vascular disease (24%). Implantation indications were atrio-ventricular blocks in 77% of pts, sinus node disease in 20% and others in 3%.The global SVA incidence was 25% (29% in the Act Gp vs 22% in the Cont Gp, p=ns).A therapy (drugs or ablation) was instituted for 49/291 pts (17%) in the Act Gp vs 43/304 pts (14%) in the Cont Gp (p=ns). The median time from implantation to the first therapy for SVA was 114 [44; 241] days in the Act Gp vs 224 [67; 366] days in the Cont Gp, representing a median gain of 110-days in SVA management (50% reduction, p=0.01). Over these 92 pts, 54 had AF (59%) and 38 had atrial flutter or tachyarrhythmia (41%). Anticoagulation was initiated in 80% of pts and antiarrhythmic drugs in 55%.ConclusionThe SETAM study demonstrated that HM allows earlier detection and treatment of SVA in pacemaker pts. The next step is to report how early detection of SVA with HM can possibly improve the patients clinical outcome

Additional value of three-dimensional echocardiography in patients with cardiac resynchronization therapy

SummaryBackgroundThere is no gold standard technique for quantification of ventricular dyssynchrony.AimTo investigate whether additional real-time three-dimensional morphologic assessment of ventricular dyssynchrony affects response after biventricular pacing.MethodsForty-one patients with severe heart failure were implanted with a biventricular pacing device and underwent two-dimensional (time dispersion of 12 left ventricular electromechanical delays) and three-dimensional echocardiographic assessment of ventricular dyssynchrony (dispersion of time to minimum regional volume for 16 left ventricular segments), before implantation, 2 days postimplantation with optimization of the pacing interventricular delay and 6 months postimplantation.ResultsIndividual optimization of sequential biventricular pacing based on three-dimensional ventricular dyssynchrony provided more improvement (p<0.05) in left ventricular ejection fraction and cardiac output than simultaneous biventricular pacing. During the different configurations of sequential biventricular pacing, the changes in three-dimensional ventricular dyssynchrony were highly correlated with those of cardiac output (r=−0.67, p<0.001) and ejection fraction (r=−0.68, p<0.001). The correlations between two-dimensional ventricular dyssynchrony and cardiac output or ejection fraction were significant but less (r=−0.60, p<0.01 and r=−0.56, p<0.05, respectively). After 6 months, 76% of patients were considered responders (10% decrease in end-systolic volume). Before implantation, we observed a significant difference between responders and non-responders in terms of three-dimensional (p<0.05) – but not two-dimensional – ventricular dyssynchrony.ConclusionThis prospective study demonstrated the additional value of three-dimensional assessment of ventricular dyssynchrony in predicting response after biventricular pacing and optimizing the pacing configuration

Intérêt de l'échocardiographie tridimensionnelle temps réel dans la sélection et le suivi des patients candidats à une resynchronisation biventriculaire

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Catheter ablation of atrial tachycardia following atrial fibrillation ablation.

Atrial tachycardias represent the second front of atrial fibrillation (AF) ablation. They are frequently encountered during the index ablation for patients with persistent AF and are common following ablation of persistent AF, occurring in half of all patients who have had AF successfully terminated. An atrial tachycardia is rightly seen as a failure of AF ablation, as these tachycardias are poorly tolerated by patients. This article describes a simple, practical approach to diagnosis and ablation of these atrial tachycardias.Journal ArticleFLWINinfo:eu-repo/semantics/publishe

Identification and characterization of super-responders after cardiac resynchronization therapy.

International audienceCardiac resynchronization therapy (CRT) has been shown to induce a spectacular effect on left ventricular (LV) function in certain patients. Our aim was to analyze and characterize the super-responders (SRs) to CRT using echocardiography in 186 patients with a conventional indication according to the European Society Cardiology guidelines. The investigation took place before and 6 months after implantation. CRT-SRs were defined by an improvement of the New York Heart Association functional class and LV ejection fraction to > or = 50% in absolute values associated with a relative LV end-systolic volume reduction of > or = 15%. Of the 186 patients, 18 (9.7%) were identified as CRT-SRs and had a significantly lower prevalence of ischemic etiology (11%), lower LV dimensions, lower left atrial volume, and greater global longitudinal strain at baseline. Receiver operating characteristics curves identified global longitudinal strain as the strongest parameter for predicting CRT-SRs, with a cutoff value of -12% (area under the curve 0.87, sensitivity 71%, and specificity 85%, p <0.01). In conclusion, in the present retrospective study, only a left atrial volume <55 ml and global longitudinal strain < or = -12% were independent predictors of CRT-SRs

199 Unipolar vs Bipolar pacing for ventricular tachycardia pace-mapping: Does it make a difference?

Bipolar (BI) pacing is commonly used for pace-mapping during VT ablation although the potential for capture at the proximal ring electrode can reduce accuracy. BI pacing with 2 mm interelectrode spacing has not been compared to unipolar (UNI) pacing in scared ventricular myocardium.MethodsNineteen pts (18 M, 63 ±12 yo, LVEF: 33 ±12%) referred for scar-related VT ablation were studied. Both UNI and BI pacing (random order) were performed at the same site; at normal ventricular voltage areas (>1.5mV), at areas with voltage between 1.5 and 0.5 mV and at low voltage (<0.5mV) areas. BI pacing was performed between the 2 distal electrodes of the ablation catheter. UNI pacing was performed betweeen the distal electrode of the ablation catheter and an electrode in the IVC. Output was 10 mA for 2 ms and then decreased until threshold (TSD). QRS morphology, QRS duration and S-QRS duration were collected and analyzed off-line. To compare QRS morphology, we used the Template Matching software (Bard Electrophysiology).ResultsWe performed pacing at 19 sites with voltage > 1.5 mV, 35 sites with voltage between 0.5 and 1.5 mV and 71 sites with voltage < 0.5mV. In voltage area > 1.5 mV, there was no statistical difference in term of S-QRS duration, QRS duration and morphology when pacing UNI vs BI or pacing at 10 mA and 2 msec vs threshold. Where voltage area were < 0.5 mV, S-QRS and QRS duration were shorter, when pacing at 10 mA compared to TSD in BI pacing as well as UNI pacing mode. But there was no difference comparing the 2 pacing modes at the same output. Differences in QRS morphology did occur when reducing the output to TSD (in both pacing mode). QRS morphologies were significantly different (<90% of similarity) in 29% of the sites <0.5 mV.ConclusionFor mapping purposes in areas of scar, close spaced bipolar pacing produces similar findings to unipolar pacing. With either pacing mode, the stimulus strength does influence QRS morphology and S-QRS delays

High efficacy of the multifaceted strategy for persistent atrial fibrillation

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Radiofrequency puncture of the fossa ovalis for resistant transseptal access.

Transseptal puncture with a conventional mechanical technique can fail because of a resistant interatrial septum. We evaluated the efficacy and safety of a new method to cross-resistant septae by transmitting radiofrequency (RF) energy through the transseptal needle.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe