Baseline aortic pre-ejection interval predicts reverse remodeling and clinical improvement after cardiac resynchronization therapy

Background: Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure-related morbidity and mortality. However, approximately one in three patients do not respond to CRT. The aim of the current study was to determine the parameter(s) which predict reverse remodeling and clinical improvement after CRT. Methods: A total of 54 patients (43 male, 11 female; mean age 61.9 ± 10.5 years) with heart failure and New York Heart Association (NYHA) class III–IV symptoms and in whom left ventricular ejection fraction (LVEF) was £ 35% and QRS duration was ≥ 120 ms, despite optimal medical therapy, were enrolled. An echocardiographic examination was performed before, and six months after, CRT. An echocardiographic response was defined as a reduction of end-systolic volume ≥ 10% after six months, and a clinical response was defined as a reduction ≥ 1 in the NYHA functional class score. Results: An echocardiographic response was observed in 38 (70.4%) of the patients and a clinical response occurred in 41 (75.9%) of the patients. Of the dyssynchrony parameters, only the aortic pre-ejection interval (APEI) was observed to significantly predict the clinical response (p = 0.048) and echocardiographic response (p = 0.037). A 180.5 ms cut-off value for the APEI predicted the clinical response with a sensitivity of 92.3% and a specificity of 39%, and the echocardiographic response with a sensitivity of 93.0% and a specificity of 42%. Conclusions: APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT. (Cardiol J 2011; 18, 6: 639–647

Randomized comparison of oesophageal protection with a temperature control device: results of the IMPACT study.

AIMS : Thermal injury to the oesophagus is an important cause of life-threatening complication after ablation for atrial fibrillation (AF). Thermal protection of the oesophageal lumen by infusing cold liquid reduces thermal injury to a limited extent. We tested the ability of a more powerful method of oesophageal temperature control to reduce the incidence of thermal injury. METHODS AND RESULTS : A single-centre, prospective, double-blinded randomized trial was used to investigate the ability of the ensoETM device to protect the oesophagus from thermal injury. This device was compared in a 1:1 randomization with a control group of standard practice utilizing a single-point temperature probe. In the protected group, the device maintained the luminal temperature at 4°C during radiofrequency (RF) ablation for AF under general anaesthesia. Endoscopic examination was performed at 7 days post-ablation and oesophageal injury was scored. The patient and the endoscopist were blinded to the randomization. We recruited 188 patients, of whom 120 underwent endoscopy. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 vs. 2/60; P = 0.008), with a trend toward reduction in gastroparesis (6/60 vs. 2/60, P = 0.27). There was no difference between groups in the duration of RF or in the force applied (P value range= 0.2-0.9). Procedure duration and fluoroscopy duration were similar (P = 0.97, P = 0.91, respectively). CONCLUSION : Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared with standard care. This method of oesophageal protection is safe and does not compromise the efficacy or efficiency of the ablation procedure

Entrapment Of Focal Atrial Tachycardia Using Cryoballoon Ablation; Sinus Rhythm In The Left Atrium And Ongoing Atrial Tachycardia In The Left Atrial Appendage

Left atrial appendage (LAA) is a well-known source of focal atrial tachycardias (AT). Although radio-frequency (RF) energy is the most commonly used technique in such cases, there was an option other than epicardial approach when RF technique fails. Cryoballoon technology is primarily developed to be used for pulmonary vein isolation (PVI). Also, there was no report regarding the isolation of LAA by using cryo-balloon in patients with focal AT. In this case, for the first time in the literature, we successfully isolated the LAA because of failed attempts of RF ablation for focal AT in whom the surface electrogram showed a sinus rhythm while arrhythmia continues inside the LAA

Predictors of Atrial Fibrillation Recurrence After Atrial Fibrillation Ablation with Cryoballoon

Background: Catheter ablation of atrial fibrillation is recommended for patients with symptomatic paroxysmal atrial fibrillation (PAF) despite anti-arrhythmic drugs (AADs). Radiofrequency ablation is widely accepted as an effective treatment for PAF. Cryoenergy by cryoballoon technique is an alternative to radiofrequency (RF) ablation. Cryoballoon ablation is safe, and has a similar success rate in comparison to RF ablation. AF recurrence with cryoballoon ablation is roughly 30%. The aim of this study is to determine the predictors of AF recurrence after cryoballoon ablation. Methods and Results: Sixty one patients with symptomatic PAF despite AADs without structural heart disease were included. Cryoballoon ablation was performed in 60 patients (36 males, mean age: 54.6 +/- 10.7, mean left atrium size: 3.74 +/- 0.39 mm). Transthoracic echocardiography including tissue Doppler imaging was performed in all subjects during sinus rhythm at baseline and after the ablation. Intra-atrial and inter-atrial electromechanical delays, and PA-lateral were measured. All patients were scheduled for 24 h Holter recording at baseline and at 3, 6, 9 months follow-up. Venous samples were collected to measure CK-MB, Troponin-T (TnT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels at baseline and 24 h after ablation. Median follow up was 10 (8-12) months. Forty eight (80%) patients were in sinus rhythm during the follow up. In receiver operating curve (ROC) analysis, intraleft atrial electromechanical delay and PA-lateral achieve an area under the curve (AUC) 0.97 (p < 0.001) and 0.69 (p < 0.001) for the ability to predict AF recurrence. A cut-off value for baseline intraleft atrial electromechanical delay of 29.5 ms predicted AF recurrence with sensitivity of 85% and specifity of 98%. A cut-off value for PA-lateral of 125 ms predicted AF recurrence with sensitivity of 80% and specifity of 90%. In ROC analysis, age achieves an AUC 0.822 (p = 0.006) for the ability to predict AF recurrence. A cut-off value for age of 64 predicted AF recurrence with sensitivity of 71% and specifity of 90%. Early recurrence of AF (HR = 60, 95% CI 18.61-417.86, p < 0.001) predicted also late recurrence of AF. Conclusions: The increase in AF recurrence by increased intraleft atrial electromechanical delay, PA-lateral and older age show the importance of substrate in AF mechanism. Early recurrence was the strongest predictor of late recurrence of AF; therefore, existence of blanking period for cryoballoon ablation should be questioned.WoSScopu

Baseline Aortic Pre-Ejection Interval Predicts Reverse Remodeling and Clinical Improvement After Cardiac Resynchronization Therapy

Background: Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure-related morbidity and mortality. However, approximately one in three patients do not respond to CRT. The aim of the current study was to determine the parameter(s) which predict reverse remodeling and clinical improvement after CRT. Methods: A total of 54 patients (43 male, 11 female; mean age 61.9 +/- 10.5 years) with heart failure and New York Heart Association (NYHA) class III-IV symptoms and in whom left ventricular ejection fraction (LVEF) was = 120 ms, despite optimal medical therapy, were enrolled. An echocardiographic examination was performed before, and six months after, CRT. An echocardiographic response was defined as a reduction of end-systolic volume >= 10% after six months, and a clinical response was defined as a reduction >= 1 in the NYHA functional class score. Results: An echocardiographic response was observed in 38 (70.4%) of the patients and a clinical response occurred in 41 (75.9%) of the patients. Of the dyssynchrony parameters, only the aortic pre-ejection interval (APEI) was observed to significantly predict the clinical response (p = 0.048) and echocardiographic response (p = 0.037). A 180.5 ms cut-off value for the APEI predicted the clinical response with a sensitivity of 92.3% and a specificity of 39%, and the echocardiographic response with a sensitivity of 93.0% and a specificity of 42%. Conclusions: APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT. (Cardiol J 2011; 18, 6: 639-647)WoSScopu