092: Prognosis value of QRS duration in patients with heart disease and syncope

BackgroundPatients with heart disease (HD) and syncope are at high risk of sudden death. Implantable defibrillator (ICD) is recommended in patients with unexplained syncope and left ventricular ejection fraction (LVEF) < 30% or in patients with LVEF >30% and inducible ventricular tachycardia (VT).AimThe purpose of the study was to evaluate the prognostic significance of QRS duration measurement in patients with HD and syncope.Methods528 patients, 89 women and 439 men, mean age 65±12 years, were admitted for syncope. All of them had an HD, either ischemic HD (n=382) or left ventricular impairment of other origin (n=115). Holter monitoring, electrophysiological study and head-up tilt test were systematic. Filtered QRS duration was measured at signal-averaged ECG (Fidelity 2000 of Cardionics) (filter 40 Hz, noise level < 0.6 μV). The patients were followed from 3 months up to 18 years (mean 5 ±4 years).ResultsMean LVEF was 40±14%. Cardiac defibrillator was implanted in 73 patients. 30 patients died suddenly, 75 died from heart failure or were transplanted (n=9). Remaining patients are alive or died from non cardiac death (n= 8). The last group differed from group who died suddenly by an higher LVEF (42±14% vs 32±13) (p< 0.00001) and a shorter QRS duration (125±34 msec vs 144±31) (p< 0.026). They tended to be older (65±12 years vs 61±13) (p<0.09). The alive group differed also from group who died from heart failure by an higher LVEF (42±14% vs 33±13) (p< 0.001) and a shorter QRS duration (125±34 msec vs 141±31) (p< 0.0033). They tended to be younger (65±12 years vs 67±10) (p<0.08). Patients who died suddenly and those who died from heart failure had similar LVEF and QRS duration but patients who died suddenly are younger than patients who died from heart failure (p<0.01).ConclusionsLow LVEF is a classical risk of worse prognosis in patients with HD and syncope. A longer QRS duration is also a noninvasive and simple test of worse prognosis. A QRS duration more than 125 msec had a sensitivity of 73% and a specificity of 64% to predict cardiac mortality

Risk of Atrial Fibrillation After Atrial Flutter Ablation: Impact of AF History, Gender, and Antiarrhythmic Drug Medication

International audienceINTRODUCTION:Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation.METHODS AND RESULTS:A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00-1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42-2.54, P 20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis

180 Is it a risk of stroke in Wolff Parkinson White syndrome?

Atrial fibrillation (AF) is a major cause of stroke. AF incidence is increased in Wolff-Parkinson-White syndrome (WPW), represents about 10% of spontaneous arrhythmias and has several mechanisms as the degeneration of atrioventricular reentrant tachycardia (AVRT) into AF, the AF facilitation by the atrial insertion of accessory pathway (AP) or another origin. The purpose of study was to assess the incidence of stroke in patients (pts) who had a preexcitation syndrome.Population707 pts aged from 5 to 85 years (mean 34.5±17) were studied for a WPW: 93 pts had unexplained syncope; 247 pts were asymptomatic; 367 pts had spontaneous tachycardias; among these pts 52 had documented AF. Electrophysiological study (EPS) consisted of atrial pacing and programmed atrial stimulation in control state and if necessary after infusion of isoproterenol. Clinical and electrophysiological data were collected.ResultsStroke was noted in 5 pts (0.7%), 2 women, 3 men aged from 53 to 75 years. They had a normal carotid and transcranial Doppler ultrasonography. One pt had ischemic heart disease and the remaining pts had no heart disease. Their age was significantly older than remaining population (62±9 years vs 34±17) (p<0.0002). Only one pt had spontaneous AF; 51 other pts with spontaneous AF had no stroke. One of 247 was asymptomatic; one pt of 93 had syncope and 2 pts of 315 had spontaneous AVRT. At EPS, one asymptomatic pt had AP with long refractory period and no inducible tachycardia. Two pts with spontaneous tachycardias had only inducible AVRT and the pt with spontaneous AF had inducible antidromic tachycardia and AF. The pt with syncope had only inducible AF. These electrophysiological data did not differ from the remaining population. Anticoagulants were maintained after AP ablation, although the disappearance of arrhythymias.ConclusionsThe risk of stroke in WPW syndrome is very low (0.7%). Only one clinical factor differs significantly from remaining population, the relatively old age (mean 62±9 years). All other clinical factors as sex, associated heart disease, spontaneous symptoms and all electrophysiological data did not differ from remaining population