UM\u27s 14th Spring in Vienna program gets rolling with preregistration

Conclusion: d-CRT may produce greater reverse remodeling than s-CRT, although this difference may be marginal when the LV lead in s-CRT is positioned in the optimal basal/mid lateral position

C-PO04-116: Atrial fibrillation as a surrogate marker for mortality and hospital readmission post typical atrial flutter ablation

BACKGROUND: There is strong evidence to suggest an association between typical cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) and atrial fibrillation (AF). The long-term morbidity and mortality of typical AFL ablation has been well defined; however, the effect of AF on morbidity and mortality post typical AFL ablation has not been described. We predict AF will be associated with a less favorable long-term morbidity and mortality after CTI ablation for typical AFL.OBJECTIVE: Retrospective observational cohort study to compare the outcomes of typical AFL ablation in patients with and without a history of AF.METHODS:Five hundred and forty-seven patients who underwent (CTI) ablation without pulmonary vein isolation between November 2011 and December 2015 were included in the study and followed for a mean of 30.1 months. Twelve-lead ECG, Holter monitor, event monitor, and device interrogations were reviewed to accurately confirm rhythms. Comparison testing was conducted to determine outcome differences between patients with and without pre-existing AF.RESULTS: Among the 547 patients there were 256 patients with a history of AF prior to CTI ablation (group hxAF) and 291 patients without a history of AF prior to CTI ablation (group NohxAF). The mean age was 65.3±10.3 years old in hxAF and 64.5±12.2 years old in NohxAF (p=0.389). All other demographics of both groups were the same except the hxAF group had fewer males (65.2% vs. 77.7%, p=0.001) and more Caucasians (88.7% vs. 82.1, p=0.04). Both groups had similar echocardiogram findings (LVEF, left atrial volume index, mitral valve, aortic valve, and pulmonary artery systolic pressure). As expected, recurrence of AF at 12 months was significantly increased in the hxAF group (69.9% vs. 21.6%, p\u3c0.001). In addition, the use of anticoagulation, antiarrhythmics and beta blockers at 12 months was higher in the hxAF group (43% vs. 20.6%, 32.8% vs. 10.3%, and 51.6% vs. 40.5%, respectively, with p\u3c0.01). One-year all-cause mortality was higher in group hxAF (5.1% vs. 1.4%, p=0.013). The 1-year readmission rate for any cause also was higher in the hxAF group (57.0% vs. 45.0%, p=0.005). CONCLUSIONS: AF increases the all-cause mortality and hospital readmission at 12 months post typical AFL ablation

Real-World Relevance of Manual Electrocardiography QT Interval Measurement

Background: Electrocardiography (ECG) QT interval (QTI) prolongation independently predicts sudden death. Hospitalized patients are commonly exposed to multiple QT-prolonging drugs, and manual measurement of ECG QTI based on identifying the intersection of isoelectricity with the tangent to the terminal phase T-wave slope (QTTTT) is advocated due to inaccuracies in automated detection algorithms that may imprecisely identify QT duration. Purpose: We evaluated the performance of QTTTT compared to a standard automated (12SL, GE Healthcare) method (QT-12SL). Methods: Consecutively obtained ECGs of 250 hospitalized patients were reviewed. The QTI in leads II, aVR, V5 and V6 determined by QT-12SL and QTTTT were compared. ECGs in which QT-12SL and QTTTT differed by \u3e 10 ms were further characterized. Results: The T-wave end was not reliably identified in 6 ECGs (2.4%). Of the remaining 244 ECGs (976 leads), QTTTT differed from QT-12SL by \u3c 10 ms in 52 ECGs (21.3%). QT-12SL differed from QTTTT by \u3e 10 ms in lead II in 140 leads (14.3%), V5 in 149 leads (15.3%), V6 in 152 leads (15.6%) and aVR in 143 leads (14.7%). ECGs with mutually exclusive lead combinations in which QTTTT differed from QT-12SL by \u3e 10 ms were: 1) II, aVR, V5, V6 (39.8%); 2) V5, V6 (7.8%); 3) II, aVR (4.9%); and 4) II, V5, V6 (3.7%). The expected overestimation of QTI by QT-12SL compared to QTTTT exceeded 10 ms in 105 leads (10.8%), related to T-waves with “normal” appearance, or biphasic (negative-to-positive) morphology; U-wave; and TP segment voltage exceeding PR segment voltage. Compared to QTTTT, QT-12SL underestimated QTI in 479 leads (49.1%), in association with biphasic T-waves (positive-to-negative); atrial arrhythmias; downsloping baseline near the T-wave end resulting in TP segment voltage less than PR segment voltage; and slow return of T-wave terminus to baseline. Conclusion: Multiple clinical and electrical phenomena impacted automated QTI determination. QT-12SL and QTTTT were comparable across all analyzed leads in only 1/5 of ECGs. Compared to QTTTT, QT-12SL QTI determinations were discordant in 3/5 of all leads, and underestimated QTI nearly half the time. Perhaps most important, for a given ECG, manual review of any of the analyzed leads identified these differences 2/3 of the time

Benefit of implantable cardioverter-defibrillator in patients with improved left ventricular systolic function

Conclusions: In the Aurora cohort of patients with transient LV dysfunction recovered to EF≥40%, characteristics of ICD recipients were similar to prior primary prevention ICD trials. ICD recipients were more likely to have diabetes, and EF improved to a lesser degree and over a longer period. An associated between presence of ICD and better all-cause survival was observed. This difference was driven by a benefit in patients with EF 40-49%. Our findings suggest: in patients who develop significant LV dysfunction, recovery of LV function to EF\u3e35% does not afford adequate SCD protection, and that ICD therapy may be appropriate and protective in patients with EF improved up to 49%

The one year mortality and hospital readmission post typical atrial flutter ablation in patients with a history of atrial fibrillation

Conclusion: AF increases the all cause mortality, hospital readmission at 12 moths, and atrial flutter recurrence post typical atrial flutter

The One year mortality and hospital readmission post Typical Atrial Flutter Ablation in Patients with a History of Atrial Fibrillation

Conclusion: AF increases the all cause mortality, hospital readmission at 12 moths, and atrial flutter recurrence post typical atrial flutter