0304: How long should we keep a temporary pace maker after transcatheter aortic valve replacement (TAVR)

A temporary pace-maker (TPM) is often used after TAVR due to the risk of atrioventricular block (AVB) in the following days, related to progressive conduction system injuries. However guidelines are unclear as when to safely remove it. Between 2013 and 2014, 195 patients without previous permanent pacemaker, were prospectively followed after TAVR (69 Edwards Sapiens (ES) and 126 CoreValve (CV)). 47 had preoperative bundle branch block, 23 left (LBBB), 24 right sided (RBBB). Peri-operative high degree AVB was noted in 37 patients (20%). 24 were transient, less than 10mn and; 13 persisted at the end of the procedure and were implanted with a permanent pace-maker. New LBBB was observed in 55 patients (28%). In the post-operative period, 23 patients (13%) developped AVB (20 patients within 5 days, and 3 patients after 7 days) (4 ES and 19 CV). No new AV block had occurred at one month in the remaining population. Risk factors for late AVB were peri-operative transient AVB (40%), post-operative RBBB (30%), or LBBB (20%); preexistent RBBB and Corevalve model. Conversely 41 of the 42 patients without AVB or bundle branch block did not need temporary pacing in the post operative time. The only patient without any perioperative event who developed a late AV block at day 7 had a CV inserted in an old surgical valve. However, sinus dysfunction occurred in 2 patients treated with amiodarone for atrial fibrillation in the post operative period, needing temporary pacing. Conclusion: The use of TPM after TAVR is common for the management of delayed high degree AVB. The main risk factors are peri-operative AVB and post-operative BBB. Most of delayed AVB occur within 5 days. Later AVB preceded by prolonged PR interval and BBB should increase the length of TPM. However, in the absence of these factors TPM could be shortened.Abstract 0304 – Figure: Time occurence of AVB (CV=Corevalve, ES=Sapien

The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: Baseline data and contemporary management of adult patients with cardiomyopathies

Aims The Cardiomyopathy Registry of the EURObservational Research Programme is a prospective, observational, and multinational registry of consecutive patients with four cardiomyopathy subtypes: Hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM). We report the baseline characteristics and management of adults enrolled in the registry. Methods and results A total of 3208 patients were enrolled by 69 centres in 18 countries [HCM (n = 1739); DCM (n = 1260); ARVC (n = 143); and RCM (n = 66)]. Differences between cardiomyopathy subtypes (P < 0.001) were observed for age at diagnosis, history of familial disease, history of sustained ventricular arrhythmia, use of magnetic resonance imaging or genetic testing, and implantation of defibrillators. When compared with probands, relatives had a lower age at diagnosis (P < 0.001), but a similar rate of symptoms and defibrillators. When compared with the Long-Term phase, patients of the Pilot phase (enrolled in more expert centres) had a more frequent rate of familial disease (P < 0.001), were more frequently diagnosed with a rare underlying disease (P < 0.001), and more frequently implanted with a defibrillator (P = 0.023). Comparing four geographical areas, patients from Southern Europe had a familial disease more frequently (P < 0.001), were more frequently diagnosed in the context of a family screening (P < 0.001), and more frequently diagnosed with a rare underlying disease (P < 0.001). Conclusion By providing contemporary observational data on characteristics and management of patients with cardiomyopathies, the registry provides a platform for the evaluation of guideline implementation. Potential gaps with existing recommendations are discussed as well as some suggestions for improvement of health care provision in Europe. © The Author 2017

Significance of NT-proBNP and High-Sensitivity Troponin in Friedreich Ataxia

International audienceackground: Friedreich's ataxia (FA) is a rare autosomal recessive mitochondrial disease resulting of a triplet repeat expansion guanine-adenine-adenine (GAA) in the frataxin (FXN) gene, exhibiting progressive cerebellar ataxia, diabetes and cardiomyopathy. We aimed to determine the relationship between cardiac biomarkers, serum N-terminal pro-brain natriuretic peptide (NT-proBNP), and serum cardiac high-sensitivity troponin (hsTnT) concentrations, and the extent of genetic abnormality and cardiac parameters.Methods: Between 2013 and 2015, 85 consecutive genetically confirmed FA adult patients were prospectively evaluated by measuring plasma hsTnT and NT-proBNP concentrations, electrocardiogram, and echocardiography.Results: The 85 FA patients (49% women) with a mean age of 39 ± 12 years, a mean disease onset of 17 ± 11 years had a mean SARA (Scale for the Assessment and Rating of Ataxia) score of 26 ± 10. The median hsTnT concentration was 10 ng/L (3 to 85 ng/L) and 34% had a significant elevated hsTnT ≥ 14 ng/L. Increased septal wall thickness was associated with increased hsTnT plasma levels (p < 0.001). The median NT-proBNP concentration was 31 ng/L (5 to 775 ng/L) and 14% had significant elevated NT-proBNP ≥ 125 ng/L. Markers of increased left ventricular filling pressure (trans mitral E/A and lateral E/E' ratio) were associated with increased NT-proBNP plasma levels (p = 0.01 and p = 0.01). Length of GAA or the SARA score were not associated with hsTnT or NT-proBNP plasma levels.Conclusion: hsTnT was increased in 1/3 of the adult FA and associated with increased septal wall thickness. Increased NT-proBNP remained a marker of increased left ventricular filling pressure. This could be used to identify patients that should undergo a closer cardiac surveillance

Evolution of high‐grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode—that minimizes ventricular pacing—activated

International audienc

External validation of risk factors for malignant ventricular arrhythmias in lamin A/C mutation carriers

International audienc

Evaluation of an Ambulatory ECG Analysis Platform Using Deep Neural Networks in Routine Clinical Practice

Background Holter analysis requires significant clinical resources to achieve a high‐quality diagnosis. This study sought to assess whether an artificial intelligence (AI)‐based Holter analysis platform using deep neural networks is noninferior to a conventional one used in clinical routine in detecting a major rhythm abnormality. Methods and Results A total of 1000 Holter (24‐hour) recordings were collected from 3 tertiary hospitals. Recordings were independently analyzed by cardiologists for the AI‐based platform and by electrophysiologists as part of clinical practice for the conventional platform. For each Holter, diagnostic performance was evaluated and compared through the analysis of the presence or absence of 5 predefined cardiac abnormalities: pauses, ventricular tachycardia, atrial fibrillation/flutter/tachycardia, high‐grade atrioventricular block, and high burden of premature ventricular complex (>10%). Analysis duration was monitored. The deep neural network–based platform was noninferior to the conventional one in its ability to detect a major rhythm abnormality. There were no statistically significant differences between AI‐based and classical platforms regarding the sensitivity and specificity to detect the predefined abnormalities except for atrial fibrillation and ventricular tachycardia (atrial fibrillation, 0.98 versus 0.91 and 0.98 versus 1.00; pause, 0.95 versus 1.00 and 1.00 versus 1. 00; premature ventricular contractions, 0.96 versus 0.87 and 1.00 versus 1.00; ventricular tachycardia, 0.97 versus 0.68 and 0.99 versus 1.00; atrioventricular block, 0.93 versus 0.57 and 0.99 versus 1.00). The AI‐based analysis was >25% faster than the conventional one (4.4 versus 6.0 minutes; P<0.001). Conclusions These preliminary findings suggest that an AI‐based strategy for the analysis of Holter recordings is faster and at least as accurate as a conventional analysis by electrophysiologists

0281: His bundle recording during and after TAVR to predict early and late atrio-ventricular block

BackgroundEarly and late atrioventricular blocks (AVB) are frequent during trans-aortic valve replacement (TAVR) leading to permanent pacemaker (PPM) implantation.Whether His Bundle recording (HBR) during and after TAVR can predict AVB remains a matter of debate.ObjectiveTo correlate HV interval during and after TAVR with early and late AVB occurrence.MethodsBetween January 2013 and December 2014, HBR was assessed prospectively before balloon inflation (HV1), 15minutes after (HV2), and at day 2 and 5 for Sapiens and CoreValve (HV3) in all pacemaker-free patients undergoing TAVR. PPM was implanted when permanent AVB persisted over day, or if paroxystic AVB occurred within the first 5 days or if HV3>80ms. Logistic regression was performed to assess if HVB could well predict early (from day 1 to day 5) or late (from day 5 to day 30) AVB occurrence.Results86 patients aged of 85±8,2 years old, with a Euroscore of 15,3±9,3 and of whom 50(79%) were female were recruited. Corevalve was predominantly used (59(66%)). HV1, HV2 and HV3 were 56±9ms, 70±19ms and 63±14ms respectively. In total, 29 (34%) PPM were implanted before discharge of which 18 (19,7%) for documented AV bloc, 8 for prolonged HV interval and 3 for sick sinus syndrome. 12 patients (13,9%) showed AVB during follow-up after discharge, all implanted for early AVB. There was no AVB recorded in PPM for prolonged HV interval, programmed with a diagnostic atrio-ventricular conduction preservation algorithm. HV1 and HV2 were not associated with early AVB occurrence (p=0,79 and p=0,34 respectively).Prolonged HV1, HV2 or HV3 did not predict late AVB occurrence either (p=0,54, p=0,90 and p=0,91 respectively).ConclusionHigh degree AVB is a common finding after TAVR and can occur late. Repeated HBR before and after TAVR did not show any significant predictive value for early and delayed AVB

Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia Without an Implantable Cardioverter-Defibrillator

International audienceObjectives: The purpose of this study was to identify clinical factors associated with arrhythmic events and sudden cardiac death (SCD), and to evaluate the prognostic value of electrophysiological study (EPS) in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients without implantable cardioverter-defibrillators (ICDs).Background: ARVC/D is an inherited cardiomyopathy characterized by a risk of SCD. Few studies have evaluated predictive factors of ventricular arrhythmias (VAs) in patients without ICDs.Methods: Between 2000 and 2010, all consecutive patients with ARVC/D without ICDs and with EPS at diagnosis were enrolled. Patients that received an ICD during follow-up were censored at the date of implantation, and in that case, only VAs that occurred before ICD implantation were analyzed. Risk factors for any VA event were determined by Cox regression. Patients that only experienced SCD or aborted cardiac arrest (ACA) were reported.Results: A total of 137 consecutive patients (78% male) diagnosed with ARVC/D without ICD were enrolled. 31% had sustained ventricular tachycardia at diagnosis. After mean follow-up of 42 ± 31 months, 19 patients experienced an episode of sustained VA and 5 patients experienced a SCD/ACA. No event occurred in asymptomatic patients. Left ventricular ejection fraction ≤50% (p = 0.024), positive EPS (p = 0.017), and physical activity >6 h/week (p = 0.025) were independently associated with occurrence of VAs. SCD/ACA exclusively occurred in male probands with definite diagnosis and syncope.Conclusions: In this cohort of ARVC/D patients without ICD, left ventricular ejection fraction ≤50%, positive EPS, and physical activity >6 h/week were independent predictors of VAs, whereas asymptomatic patients at diagnosis were at low risk. EPS predicted all VAs but had limited value to predict SCD/ACA

Thrombus composition in sudden cardiac death from acute myocardial infarction

International audienceBackground and aimIt was hypothesized that the pattern of coronary occlusion (thrombus composition) might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial infarction (MI).MethodsThe TIDE (Thrombus and Inflammation in sudden DEath) study included patients with angiographically-proven acute coronary occlusion as the cause of a ST elevation MI (STEMI) complicated by Sudden Cardiac Death (SCD group) or not (STEMI group). Thrombi were obtained by thrombo-aspiration before primary percutaneous coronary stenting and analyzed with a quantitative method using scanning electron microscopy. We compared the composition of the thrombi responsible for the coronary occlusion between the two groups and evaluated factors influencing its composition.ResultsWe included 121 patients and found that thrombus composition was not different between the SCD group (n = 23) and the STEMI group (n = 98) regarding content of fibrin fibers (60.3 ± 18.4% vs. 62.4 ± 18.4% respectively, p = 0.68), platelets (16.3 ± 19.2% vs. 15.616.7 ±%, p = 0.76), erythrocytes (14.6 ± 12.5% vs. 13 ± 12.1%, p = 0.73) and leukocytes (0.6 ± 0.9% vs. 0.8 ± 1.5%, p = 0.93). Thrombus composition did not differ between patients receiving upstream-use of glycoprotein IIb/IIIa platelet receptor inhibitors (GPI) and patients free of GPI. The only factor found to influence thrombus composition was the ischemic time from symptom onset to primary PCI, with a decreased content in fibrin fibers (57.8 ± 18.5% vs. 71.9 ± 10.1%, p = 0.0008) and a higher platelet content (19.2 ± 19.1% vs. 7.9 ± 5.7% p = 0.014) in early presenters (6 h of ischemic time).ConclusionComposition of intracoronary thrombi in STEMI patients does not differ between those presenting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in