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iii262 Moderated Poster session 6 - Atrial fibrillation mechanisms and atrial fibrillation surgery
Independent risk factors for AF were history of thromboembolic events (HR 4.72; 95%
CI 2.279-9.77; h<0.0001), increased left atrial volume index (HR 2.07; 95% CI
1.075-3.975; h¼0.029) and low hemoglobin level (HR 2.58; 95% CI 1.245-5.35;
h¼0.011).
Conclusions: The incidence of AF in pacemaker recipients was quite high. The
majority of device-detected episodes were asymptomatic. AF was most frequently
detected within the first 3 months following surgery. A history of thromboembolic
events, increased left atrial volume index and low hemoglobin level were independent
risk factors for AF in patients with a pacemaker.
1313
The length but no the number of late-enhanced gadolinum MRI gaps were
associated with increased risk of recurrences of atrial fibrillation (AF) after
pulmonary vein isolation in paroxysmal AF
M. Linhart; EM. Benito; F. Alarcon; A. Carlosena; F. Chipa; J. Cozzari; JM. Tolosana;
E. Arbelo; E. Guasch; A. Berruezo; JL. Mont
Universitat de Barcelona, Institut Clınic Cardiovascular. Institut d’Investigacions
Biomèdiques August Pi i Sunyer (IDIBAPS)., Barcelona, Spain
Background: Pulmonary vein isolation (PVI) is an established treatment option for
rhythm control in atrial fibrillation (AF). However, recurrence rate is high, and many
patients need to undergo redo-procedures. Complete isolation of pulmonary veins
(PV) seems to be important for durable success.
Purpose: To investigate the impact of anatomical gaps as assessed by late gadoli-
nium-enhanced cardiac magnetic resonance (LGE-CMR) on AF recurrence rate after
first PVI.
Methods: 53 patients (53611 yrs, 85% male) underwent circumferential PVI by
means of electroanatomical mapping and radiofrequency ablation and were followed
for 3, 6 and 12 months and every 12 months thereafter with 24-h-Holter. LGE-CMR
was performed 3 months after PVI. Images were processed by ADAS-AF software,
applying previously established image intensity ratio thresholds that indicate dense
atrial scarring. Perimeter of each PV was measured and number, absolute and rela-
tive lengths of anatomical gaps were calculated. 7 patients had to be excluded
because of low quality CMR. A total of 179 PV were assessed.
Results: 26 patients had paroxysmal AF (PAF) (57%), 20 had persistent AF (Pers
AF) (43%) before PVI. 5 patients (11%) had common trunk of the left PV. Mean fol-
low-up duration was 21610 months. 36% of patients with PAF and 55% of patients
with Pers AF had recurrence of AF after a mean of 9.766.8 months. There were no
differences in age, sex, CHA2DS2-VASc score, left atrial diameter or left ventricular
ejection fraction between the groups. In PAF patients, the length of gaps was signifi-
cantly higher in patients with than without recurrence (54626 vs. 27617%, p¼0.003).
A percentage of >40% gap had a sensitivity of 81% and specifity of 80% for recur-
rence of AF. In patients with Pers AF, relative gap length was non-significantly higher
in patients without or with recurrence (52630 vs. 29618%, p¼0.89). Furthermore,
mean number of gaps was not different in patients with or without recurrences
(4.3 vs. 4.7 in PAF, and 4.4 vs. 4.2 in Pers AF, p¼ns ).
Conclusion: In patients with PAF, length of anatomical gaps as assessed by
LGE-CMR was associated with higher recurrence rate of AF after first PVI, whereas
in patients with Pers AF gap length had no impact on recurrence of AF.
1314
Endothelial progenitor cells and apoptotic endothelial cell-derived
microparticle ratio predicts atrial fibrillation in chronic heart failure
AE. Berezin; A. Kremzer
State Medical University, Zaporozhye, Ukraine
Background: Chronic heart failure (HF) remains a leading cause of cardiovascular
(CV) mortality and morbidity worldwide. The aim of the study was to investigate
whether the pattern of angiogenic endothelial progenitor cells (EPCs) and apoptotic
endothelial cell-derived microparticles (EMPs) would be able to predict newly atrial
fibrillation (AF) in HF with reduced (HFrEF) and preserved (HFpEF) left ventricular
ejection fraction.
Methods: One hundred sixty four chronic HF subjects with HFrEF or HFpEF and
sinus rhythm on ECG were retrospectively enrolled in the study. Patients with
global left ventricular ejection fraction 41% and < 59% were categorized as the
HFpEF group (n¼79) and those with 40% as the HFrEF group (n¼85).
Therefore, to compare the circulating levels of biological markers 35 control sub-
jects without HF were included in the study. All control individuals were age- and
sex-matched chronic HF patients. The serum level of biomarkers was measured
at baseline. The flow cytometric technique was used for predictably distinguishing
circulating cell subsets depending on expression of CD45, CD34, CD14, Tie-2,
and CD309 antigens and determining endothelial cell-derived microparticles.
CD31þ/annexin Vþ was defined as apoptotic endothelial cell-derived MPs, MPs
labeled for CD105þ or CD62Eþ were determined as MPs produced due to activa-
tion of endothelial cells.
Results: In multivariate logistic regression model T2DM (R2 ¼ 0.33; P¼0.001), pre-
vious MI (R2 ¼ 0.19; P¼0.001), galectin-3 (R2 ¼ 0.67; P¼0.003), CD31þ/annexin
Vþ EMPs (R2 ¼ 0.11; P¼0.001), NT-proBNP (R2 ¼ 0.11; P¼0.046), CD14þCD309þ
cells (R2 ¼ 0.06; P¼0.001), and CD14þ‘D309þ Tie-2þ cells (R2 ¼ 0.044; P¼0.001)
were found as independent predictors of AF in HFpEF. In HFrEF cohort previous MI
(R2 ¼ 0.46; P¼0.001), hypertension (R2 ¼ 0.19; P¼0.001), galectin-3 (R2 ¼ 0.67;
P¼0.001), CD31þ/annexin Vþ EMPs (R2 ¼ 0.17; P¼0.001), NT-proBNP (R2 ¼ 0.11;
P¼0.003), CD14þCD309þ cells (R2 ¼ 0.12; P¼0.001), and CD14þ‘D309þ Tie-2þ
cells (R2 ¼ 0.048; P¼0.001) predicted AF.
Europace Abstracts Supplement, 2017
Using multivariate Cox-regression analysis adjusted etiology (previous myocardial
infarction), cardiovascular risk factors (obesity, type 2 diabetes mellitus, hypertension)
we found that CD31þ/annexin Vþ EMPs to CD14þCD309þ cells ratio (OR 1.18;
95% CI ¼ 1.09 – 1.23; P ¼ 0.001) were independent predictor for newly AF in both
HFpEF and HFrEF.
Conclusion: We found that CD31þ/annexin Vþ EMPs to CD14þCD309þ cells ratio
added to NT-proBNP, clinical data, and cardiovascular risk factors has exhibited the
best discriminate value and higher reliability to predict newly AF in HF individuals. We
suggested that the results could improve further screening of the HF individuals at
higher risk of AF development.
1315
Effectiveness of a reactive atrial antitachycardia pacing feature in patients with
ICDs: A large database analysis
G. Boriani1; SL. Zweibel2; L. Padeletti3; H. Hudnall4; YX. Zhang4; GH. Crossley5
1
University of Modena & Reggio Emilia, Cardiology Division, Modena, Italy; 2Hartford
Hospital, Hartford Healthcare Heart and Vascular Institute, Hartford, United States of
America; 3University of Modena & Reggio Emilia, Cardiology Department, Modena,
Downloaded from https://academic.oup.com/europace/article/19/suppl_3/iii262/3873035 by guest on 21 May 2024
Italy; 4Medtronic, Inc, CRDM, Mounds View, United States of America; 5Vanderbilt
University, Heart and Vascular Institute, Nashville, United States of America
Background: The MINERVA trial showed benefits of a suite of pacing features in
patients with bradycardia and history of symptomatic atrial fibrillation. We sought to
identify the real-world effectiveness of one of these features, Reactive Antitachycardia
Pacing (ATP), at slowing the progression of atrial tachyarrhythmias (AT/AF) in
patients implanted with implantable cardioverter defibrillators (ICDs) from a large
database.
Methods: A retrospective analysis was performed using ICD data from the de-identi-
fied Medtronic CareLink database. Patients were grouped via device programming of
Reactive ATP On or atrial ATP disabled (Control) at their first transmission (Day 0)
and consistently thereafter. Qualifying patients were implanted with their first device
on or after January 1, 2012 and had at least 5 minutes of device detected AT/AF any
day during a baseline period of 12 months preceding Day 0. Individual 1:1 matching
between groups was conducted using the Greedy method from the baseline factors:
age, gender, pacing mode, AT/AF, and % ventricular pacing. AT/AF event rates at 2
years were estimated by Kaplan-Meier method, and hazard ratios were calculated
through frailty models.
Results: Of 8273 qualifying patients, mostly from US centres (98%), 634 (8%) were
in the Reactive ATP group. Matching resulted in 591 pairs (N¼1182, 80% male, age
69 6 12 years at Day 0). Programmed pacing modes at Day 0 were MVP (86.8%),
DDD/R (12.7%) and DDI/R (0.5%). During 2 years of follow-up, the Reactive ATP
group was associated with significantly lower risks of AT/AF events lasting 1 day
(HR 0.75), 7 days (persistent, HR 0.65), and 30 days (HR 0.57) compared to
Control (p<0.01 for all, table).
Conclusion: In a real-world analysis of a large database, Reactive ATP was associ-
ated with slowed atrial fibrillation progression in ICD patients as highlighted by a 35%
reduced risk of persistent AT/AF at 2 years of follow-up. This is the first evidence of
the effectiveness of Reactive ATP in an ICD population.
AT/AF: atrial tachyarrhythmia; ATP: antitachycardia pacing; CI: confidence interval
1316
Local left atrial conduction velocity and rate-dependent slowing and its
relationship with bipolar voltage and drivers in atrial tachycardia and
fibrillation
S. Honarbakhsh; W. Ullah; E. Keating; G. Dhillon; M. Finlay; MJ. Earley; RJ. Schilling;
RJ. Hunter
Barts Health NHS Trust, Electrophysiology, London, United Kingdom
Funding Acknowledgements: British Heart Foundation
Background: Conduction velocity (CV) heterogeneity have shown to be associated
with persistent atrial fibrillation (AF) and AF initiation. The relationship between rate-
dependent CV slowing and structural remodelling and drivers of atrial tachycardia
(AT) and AF has not yet been established.
Purpose: Determine the direct relationship between local CVs in the human LA and
bipolar voltage using simultaneous mapping with a 64-pole basket catheter. Identify
sites of rate-dependent CV slowing and determine its relationship with bipolar voltage
and sites of drivers in AT and AF.
Methods: Patients undergoing catheter ablation for left sided AT (de novo or post
previous AF ablation) and persistent AF were enrolled. A 64-pole basket catheter was
used to record 30 seconds of unipolar signals during sinus rhythm and atrial pacing at
cycle lengths of 600ms, 450ms and 350ms from four different pacing sites. CV
between pole pairs along the path of the wavefront was calculated and correlated to
bipolar voltage along the path. Rate-dependent CV slowing was defined as 15%
reduction in CV between slowest and fastest cycle lengths. Low voltage zones (LVZs)
were defined as sites with a bipolar voltage <0.5 mV. AF drivers were defined as
rotational activity of 1.5 rotations or focal triggers occurring over two consecutive
wavefronts.
Results: Twenty-two patients were included in this study (11 AT and 11 AF, mean
age 65 6 11 yrs.). Mean bipolar voltage was 0.47 6 0.14 mV over a total of 15,132
points. CV was calculated between a total of 4675 pairs. Mean CV at 600ms was
1.37 6 0.12 m/s whilst at LVZs this was 0.85 6 0.05 m/s (p¼0.0001). Sites of rate-
dependent CV slowing were predominantly in LVZs (73.3%) and demonstrated a
broad restitution curve. The less frequent sites at non-LVZs had a steep restitution