Ecas 2015 PDF

J Interv Card Electrophysiol (2015) 42:173326
DOI 10.1007/s10840-015-9975-6
174
Special Program and Abstract issue of the 11th Annual Congress of the European
Cardiac Arrhythmia Society (ECAS)
April 19-21, 2015
Paris, France
Hotel Meriden-Etoile
Guest Editor: Prof. Samuel Lvy, MD Aix-Marseille Universit, Marseille, France
ECAS Scientific Program
PROGRAM AT A GLANCE
11th Annual Congress of the European Cardiac Arrhythmia Society
SCIENTIFIC PROGRAM OF PRE-ARRANGED SESSIONS
ECAS 2015 ABSTRACT SESSIONS 14
Sunday, April 19, 2015, 10:30 AM12:00 PM
Abstract Session 1: Atrial fibrillation ablation
Abstract Session 2: Sudden cardiac death. Prevention and management
Abstract Session 3: Atrial fibrillation and prevention of related thromboembolism
Abstract Session 4: Mechanisms of ventricular arrhythmias
Monday, April 20, 2015, 10:30 AM12:00 PM
Abstract Session 5: Advances in atrial fibrillation ablation II
Abstract Session 6: Cardiac resynchronization therapy: techniques and outcome
Abstract Session 7: Mapping and ablation of ventricular arrhythmias
Abstract Session 8: Clinical and genetic aspects of ARVD/C
Tuesday, April 21, 2015, 08:30 AM10:00 AM
Abstract Session 9: Atrial fibrillation mechanisms and management I
Abstract Session 10: Atrial arrhythmia mechanisms II
Abstract Session 11: Management of atrial arrhythmias
Abstract Session 12: Atrial fibrillation ablation III
ECAS 2015 POSTER SESSION A: PARTS 1 AND 2

Part 1: Supraventricular arrhythmias. Advances in mechanisms and management
Part 2: Atrial fibrillation characteristics and management
ECAS 2015 POSTER SESSION B: PARTS 1 AND 2
B Part 1: Arrhythmias and heart disease
Techniques and tools
B Part 2: Atrial fibrillation ablation
Screening athletes
ECAS 2015 POSTER SESSION C: PARTS 1 AND 2
Part 1: Cardiac resynchronization therapy
Arrhythmia mechanisms
Part 2: Sudden cardiac death and implantable cardioverter defribrillator
ECAS 2015 POSTER SESSION D: PARTS 1 AND 2
Part 1: Pacing and related complications
Atrial fibrillation and anticoagulant therapy
Part 2: Syncope
Ablation of ventricular arrhythmias
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176
Invitation
Dear Colleagues,
This is an invitation to join us at the 11th Annual Scientific Congress of the European Cardiac Arrhythmia Society ECAS 2015
to be held in Paris, France April 19 to 21, 2015, at the Meridien-Etoile Hotel (Porte Maillot). All those who attended previous
editions of ECAS Congress know that it is a highly scientific and educational event in a cheerful atmosphere which facilitates
interaction between the renowned faculty and the audience which is particularly appreciated by fellows. This edition promises to
be successful and we will be delighted to have you among us in Paris next April.
Riccardo Cappato, MD
Nicolas Lellouche, MD
Xavier Jouven, MD
President of ECAS
Congress Chairman
Scientific Program chair
EXECUTIVE COMMITTEE OF THE EUROPEAN CARDIAC ARRHYTHMIA SOCIETY

President
Riccardo Cappato (Milan, IT)
Past President
Wyn Davies (London, GB)
Vice-President (Education and Research)
Richard Hauer (Utrecht, NL)
Vice-President (National Societies)
Massimo Santini (Rome, IT)
Vice-President (International Societies and EU)
Samuel Lvy (Marseille, FR)
Treasurer
Eli Ovsyshcher (Beersheba, IL)
Secretary General
Continuing Medical Education
Leo Van Wersch (Paris, FR)

Nicholas Peters (London, GB)
Relation with European Societies
Stefan Kaab (Munich, DE)
Chair Membership Program
Neil Sulke (Eastbourne, GB)
Organizing annual Congress

Education Committee
Gerhard Steinbeck (Munich, DE)

Thorsten Lewalter (Munich, DE)
Organizing Committee ECAS 2015
Gerhard Steinbeck MD
177
Samuel Levy MD
Nicolas Lellouche, MD
Program Committee
Andrey Ardashev; Alawi Alsheikh-Ali; Serge Barold; Leonardo Calo; David S Cannom; Riccardo Cappato; Sumeet Chugh;
Wyn Davies; Roberto De Ponti; Heidi Estner; Jeronimo Farre; Mark Estes III; John Fisher; Robert Hatala; Richard Hauer; Ellen
Hoffmann; Charles Jazra; Xavier Jouven (Chair); Stefan Kb; Jean-Franois Leclercq; Gilles Lascault; Samuel Lvy; Thorsten
Lewalter; Jean-Yves Le Heuzey; Shaowen Liu; Peter Loh; Pierpaolo Lupo; Chang Sheng Ma; Michal Nbauer; Mohan Nair;
Yuji Nakazato; Andrea Natale; Petr Neuzil; Promund Obel; Eli Ovsyshcher; Douglas L Packer; Luigi Padeletti; Nicholas S.
Peters; Dubravko Petrac; Antonio Raviele; Amiran Revishvilli; Sanjeev Saksena; Richard Schilling; Gerhard Steinbeck;
Massimo Santini; Neil Sulke; Dorwarth Uwe; Reza Wakili; Bruce Wilkoff.
Scientific Advisory Board
Masood Akhtar (Milwaukee, USA)
Bulent Gorenek (Eskisehir, TR)
Bertil S. Olsson (Lund, SE)
Etienne Aliot (Nancy, FR)
Stephen C. Hammill (Rochester, USA)
Oscar Oseroff (Buenos Aires, AR)
Maurits A. Allessie (Maastricht, NL)
Richard Hauer(Utrecht, NL)
Ali Oto (Ankara, TR)
Eckhard Alt (Munich, DE)
Habib Haouala (Tunis, TN)
Eli Ovsyshcher (Beersheba, IL)
Charles Antzelevitch (Utica, USA)
Yoshito Iesaka (Tokyo, JP)
Douglas L. Packer (Rochester, USA)
Andrey Ardashev (Moscow, RU)
Michiel Janse (Amsterdam, NL)
Luigi Padeletti (Florence, IT)
Serge S. Barold (Boca Raton, USA)

David Benditt (Minneapolis, USA)
Charles Jazra (Beirut, LB)

Xavier Jouven (Paris, FR)
Nicholas S Peters, (London, GB)

Dubravko Petrac (Zagreb, HR)
Poul Erik Bloch-Thomsen (Hellerup, DK)
Werner Jung (Villingen, DE)
Eric N. Prystowsky (Indianapolis, USA)
Jozsef Borbola (Budapest, HU)
Stefan Kb (Munich, DE)
Antonio Raviele(Venice, IT)
Johannes Brachmann (Coburg, DE)
Prapa Kanagaratnam (London, GB)
Amiran Revishvili (Moskow, RU)
A John Camm (London, GB)
Joergen Kanters (Copenhagen, DK)
Dwight Reynolds (Oklahoma, USA)
Alessandro Capucci (Ancona, IT)

Bondo Kobulia (Tbilisi, GE)

Karl-Heinz Kuck (Hamburg, DE)
Edward Rowland (London, GB)

Sanjeev Saksena (New Brunswick, USA)
David S. Cannom (Los Angeles, USA)
Jean-Franois Leclercq (Paris, FR)
Massimo Santini (Rome, IT)
Sumeet Chugh (Los Angeles, USA)
Jean-Yves Le Heuzey (Paris, FR)
Maurizio Santomauro (Naples, IT)
Antonio Curnis (Brescia, IT)
Dipen Shah (Geneva, CH)
Philippe Coumel*
Berndt Luderitz (Bonn, DE)
Richard Schilling (London, GB)
D. Wyn Davies (London, GB)
Damian Gascon Lopez (Sevilla, ES)
Georg Schmidt (Munich, DE)
Hu Dayi (Beijing, CN)
Marek Malik (London, GB)
Jabir Sra (Milwaukee, USA)
Luc De Roy (Yvoir, BE)
Harry G. Mond (Melbourne, AU)
Sergio Dubner (Buenos Aires, AR)
Alessandro A Montenero (Rome, IT)
Nils G. Edvardsson (Goteborg, SE)
Conception Moro Serrano (Madrid, ES)
Paul Touboul (Lyon, FR)
Michal Eldar (Tel Aviv, IL)
Arthur J. Moss (Rochester, NY, USA)
Albert Waldo (Cleveland, USA)
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(continued)
Nabil El-Sherif (New York, USA)
Jeronimo Farre (Madrid, ES)
John Fisher (New-York, USA)
Guy Fontaine (Paris, FR)
Robert Frank (Paris, FR)
Seymour Furman (New York, USA)*
Michael Nabauer (Munich, DE)

Gerald V. Nacarelli (Hershey, USA)
Yuji Nakazato (Tokyo, JP)
Andrea Natale (Cleveland, USA)
Promound I. W.Obel (Johannesburg, ZA)
Brian Olshansky (Iowa City, USA)
Hein JJ Wellens (Maastricht, NL)

Bruce Wilkoff (Cleveland, USA)
David Wilber (Chicago, USA)
George D. Wyse (Calgary, CA)
*In memoriam
Abstract Selection
Each abstract has been sent to eight reviewers and been evaluated by a minimum of four of them.
The organizing committee would like to thank the abstract reviewers for their valuable help in the abstract selection for
the ECAS 2015 program:
Etienne Aliot; Elad Anter; Serge Barold; Jean-Jacques Blanc; Poul-Erik Block Thomsen; Gerard Boink; Gunter Breithardt; Hugh
Calkins; Leonardo Calo; John Camm; Riccardo Cappato; Mario Delmar; Roberto De Ponti; Luigi Di Biase; Nils Edvardsson;
Nabil El Sherif; Mark Estes; Heidi Estner; Gerard Guiraudon; Sam Hanon; Richard Hauer; Bengt Herweg; Ellen Hoffman;
Carsten Israel; Michiel Janse; Prapa Kanagaratnam; Helmut Klein; Yusuke Kondo; Jean-Yves Le Heuzey; Nicolas Lellouche;
Thorsten Lewalter; Berndt Lderitz; Marek Malik; Robert Myerburg; Yuji Nakazato; Brian Olshansky; Ali Oto; Eli Ovshyscher;
Dubravko Petrac; Sanjeev Saksena; Walid Saliba; Massimo Santini; Peter Schwartz; Robert Schweikert; Dipen Shah; Claudio
Shuger; Jasbir Sra; Gerhard Steinbeck; Neil Sulke; Richard Sutton; Tamas Szili-Torok; Jacob Tfelt-Hansen; Antonello Vado;
Peter Van Tintelen; Reza Wakili; Albert Waldo; David Wilber; Bruce Wilkoff; Roger Winkle.
General Information
Congress Venue
LE MERIDIEN ETOILE Htel
81 Boulevard Gouvion Saint Cyr,
75848 Paris Cedex 17
Tel: (33) (0)1 40 68 34 34
www.lemeridienetoile.com
Congress Chairman
Nicolas Lellouche, MD Secretary:
Hpital Henri Mondor
51 avenue du Marchal
de Lattre De Tassigny
94000 Crteil, France
Email: nicolas.lellouche@hmn.aphp.fr
Sandrine Bordire
Tel: +33149 814350
Email: sandrinebordiere@hmn.aphm.fr
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Abstract Awards
Awards for the best oral abstracts will be presented during the opening ceremony to take place on Sunday April 19, 2015, at Room Derain
Presentation of the awards for best poster presentations will take place on Tuesday April 21, 2015, 12:00 PM12:30 PM Room
Diderot (Meridien-Etoile Hotel)
11th Philippe Coumel Lecture 2015
Will be presented on Sunday April 19, 2015, from 5:30 PM to 6:00 PM as part of the opening ceremony
Badges
Badges and Final program will be available for pre-registered participants and faculty at the ECAS welcome desk, Hotel
Meridien Etoile, Paris, starting Sunday April 19, 2015, from 2:00 PM to 6:00 PM
ECAS Congress Secretariat
Josette Razafimbelo
Tel/FAX: + 33 (0)4 89 14 45 33
Cell: +336 26 07 55 74
E-mail: josette.razafimbelo@sfr.fr
Registration
Registration and payment of Congress fees as well as payment of membership dues can be done through the website. Registration
on site will start on Sunday April 19, 2015, at 8:00 AM at Hotel Meridien-Etoile.
Currency
Payment in cash for registration on site must be made in euros only. Payment using Visa credit cards will be accepted on the
Congress site. Personal checks cannot be accepted.
Congress Website
All information, Scientific Program and registration to the congress, abstract submission and membership subscription with
secured payment can be done through our website http://www.ecas-heartrhythm.org
Pre-Arranged Sessions
The program includes 33 pre-arranged sessions and workshops or debates. It can be downloaded from our website as well as the
program of abstracts selected for oral or poster presentations
Publications
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Sanjeev Saksena MD
JICE Editor-in-Chief
Leonardo Calo MD
Abstract Presentations
The abstracts accepted for oral or poster presentation will be published in a supplement issue of the Journal of Interventional
Cardiac Electrophysiology (JICE), the official journal of ECAS provided the authors attend the congress and present their work.
The oral presentation of abstracts is 10 min plus 5 min for discussion.
All posters accepted for presentation will be chaired. Please check the day and time at which your poster will be presented to the
chairpersons and the time at which the presenter should be near their poster board.
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PROGRAM AT A GLANCE ECAS 2015

SUNDAY APRIL 19, 2015
8:00am
5:00pm
Registration
Concurrent Workshops
8:30am
10:00am
Room TBA
Room PASCAL
Room DIDEROT
Session WS-06
Session WS-01
Session WS-02
Atrial Fibrillation
ablation
D L Packer
Cardiac
Resynchronization
therapy
Bruce Wilkoff
Session WS-03
Pacemaker, ICD and
CRT:Case studies
S Barold
E Ovsyshcher
C Israel
B Herweg
Five year
Experience with
NOACs
Room DESCARTES
Chaired poster
session A
8:30-12:00
Coffee break
Concurrent Abstract Sessions
10:30am
12:00pm
2:00pm
3:30pm
Room DERAIN
Room DIDEROT
Room DESCARTES
Room PASCAL
Room GAUGUIN
Oral Abstract 1
Oral Abstract 2
Oral Abstract 3
Oral Abstract 4
Session A cont.
12:150pm-1:45pm
12:15pm-1:45pm
Seated Luncheon Panel 1
Room DERAIN
Room DIDEROT
Session AB-01
Session HD-01
Pulmonary Vein
Isolation and
related strategies
Inherited
potentially lethal
syndromes
Room DESCARTES
Room PASCAL
Room GAUGUIN
Session SP-07
Session SP-02
ECAS-WSA
New frontiers in cardiac
pacing
Session B
Prevention of sudden
cardiac death
Chaired poster
Room PASCAL
Room GAUGUIN
3:30pm - 4:00pm: Coffee break and visit to posters

Room DERAIN
Room DIDEROT
Room DESCARTES
Session SP-03
Session SP-04
Session AB-02
4.00pm
5:30pm
5:30pm
Ventricular
tachycardia
ablation (I)
The MADIT Trials
Intracardiac imaging
Session SP-05
Stroke prevention in
atrial fibrillation
Room DERAIN Special lecture: A tribute to Philippe Coumel
Session B
Chaired poster
182
6:00pm
Opening ceremony
Chaired By Prof. Samuel LEVY (Marseille, FR) and Prof. Gerhard Steinbeck (Munich, DE) and
OUTSTANDING ACHIEVEMENT AWARDS Presented by
Dr Riccardo Cappato (Milan, IT) President of ECAS
Prof. Nicolas Lellouche (Paris, FR) Congress Chairman
Dr Fernand Hessel (Mulhouse, FR) President Lucien Dreyfus Foundation
183
MONDAY APRIL 20, 2015
8:30am
10:00am
Room COROT
Room DIDEROT
Room DESCARTES
Room PASCAL
Room
GAUGUIN
Session SP-06
Session SP-07
HRS-ECAS Session I Session AB-03
Session C
AF: beyond stroke

prevention
Sudden cardiac
Arrhythmogenic
death : and left
ventricular
Cardiomyopathy I
hypertrophy (LVH)
catheter ablation of
complex arrhythmias
Chaired
posters
10:00am - 10:30am: Coffee break and visit to the posters

Concurent Oral Abstract sessions
Room COROT
Room DIDEROT
Room DESCARTES
Room PASCAL
Oral abstract 5
Oral abstract 6
Oral abstract 7
Oral abstract 8
10:30am
12:00pm
12:15pm-1:45pm
12:15pm-1:45pm
Luncheon Panel 3
Luncheon Panel 4
Room COROT
2:00pm
3:30pm
Room DIDEROT
Room DESCARTES
Room PASCAL
Chaired
Posters
(cont.)
Room
GAUGUIN
Session HD-06
Session AB-04
Current issues in
atrial fibrillation
Session HD-07
Biomarker-based
HRS-ECAS Session
therapeutic
Arrhythmogenic
decision making in
Cardiomyopathy II
AF
Session SP-15
Approaches in VT
Ablation
Session D
Chaired
poster
3:30pm - 4:00pm: Coffee break and visit to the posters

Simultaneous sessions
4:00pm
5:30pm
Room COROT
Room DIDEROT
Room DESCARTES
Room PASCAL
Room
GAUGUIN
Session AB-05
SP-14
Session SP-13
Session HD-04
Session D
AF ablation not
targetting
pulmonary veins
8th Japan HRSECAS

CRT therapy
Y. Nakazato
Automatic nervous
Sudden cardiac death system and
arrhythmias
Chaired
poster
184
TUESDAY APRIL 21, 2015
8:30am
10:00am
Room DIDEROT
Room DESCARTES
Room PASCAL
Room TBA
Oral abstract 9
Oral abstract 10
Oral abstract 11
Oral abstract 12
Room DESCARTES
Room PASCAL
Room TOCQUEVILLE
10:00am - 10:30am: Coffee break

Room DIDEROT
Session SP-11
10:30am
12:00pm
12:00pm
12:30pm
Unresolved questions
Session SP-12
Session WS-05
Session WS-04
New tools and techniques

Current Issues in AF
in cardiac arrhythmias for AF
management
Abstract Poster AWARDS
Nightmares in catheter
ablation
SATURDAY APRIL 18, 2015

REGISTRATION from 2:00 PM to 5:00 PM
Hotel Meridien Etoile (Lobby)
SCIENTIFIC SESSIONS
8:30 AM10:00 AM
ROOM TBA
WS-06
Five Year Experience with NOACs: Time for a First Review
Chairpersons: Jean-Yves Le Heuzey (Paris, FR), Riccardo Cappato (Milan, IT)
1. NOACs in venous thromboembolism
Giancarlo Agnelli (Perugia, IT)
2. Stroke prevention of AF: Respective indications of NOAcs versus LAA device closure
3. NOACs in catheter ablation
Wyn Davies (London, GB)
4. NOACs in cardioversion
8:30 AM10:00 AM
ROOM PASCAL
Workshop WS-01
Atrial Fibrillation Ablation: A New Generation of Approaches
Chairpersons: Douglas L. Packer (Rochester, USA), Karl-Heinz Kuck (Hamburg, DE)
1. Linear cold balloon therapy for persistent atrial fibrillation
Suraj Kapa (Rochester, USA)
2. Impact of Contact Force Ablation on Clinical Outcomes in Patients with Atrial Fibrillation
Dipen Shah (Geneva, CH)
3. 45 D Mapping for Intracardiac and Extracorporeal Ablation of AF
David Wilber (Maywood, USA)
4. The Biophysics of New Generation Cryoballoon and Contact Source Ablative Intervention
Douglas L. Packer (Rochester, USA)
8:30 AM10:00 AM
ROOM DIDEROT
Workshop WS-02
185
186
Cardiac Resynchronization Therapy

Improving Outcomes and Reducing Adverse events
Chairpersons: Bruce Wilkoff (Cleveland, USA), Helmut Klein (Munich, DE)
1. Pre-operative assessment of CRT Responsiveness
Bruce L. Wilkoff MD
2. Impact of RV pacing vs prevention of dyssynchrony
Jean-Jacques Blanc (Brest, FR)
3. Approaches to upgrading vs avoiding CRT
Mark Estes III (Boston, USA)
4. Management of atrial fibrillation in CRT Patients: PVI or AV junctional ablation
Walid Saliba (Cleveland, USA)
5. Alternatives to the CS for left ventricular pacing
Tamas Szili-Torok (Rotterdam, NL)
8:30 AM10:00 AM
ROOM DESCARTES
Workshop WS-03
Pacemaker ECG, ICD and CRT interpretation: Case studies
Chairpersons: Serge Barold (Tampa, USA), Eli Ovsyshcher (Beersheba, IL),
Carsten Israel (Bielefeld, DE), Bengt Herweg (Tampa, USA)
8:30 AM12:00 PM
ROOM GAUGUIN
Chaired poster session A
10:30 AM12:00 PM: Concurrent Abstract oral sessions
ROOM DERAIN
Abstract session 1
ROOM DIDEROT
Abstract session 2
ROOM DESCARTES
Abstract session 3
ROOM PASCAL
Abstract session 4
187
Luncheon Panels
12:15 PM1:45 PM

2:00 PM3:30 PM
ROOM DERAIN
Session AB-01
Pulmonary vein isolation and related strategies
Chairpersons: Douglas Packer (Rochester, USA), Wyn Davies (London, GB)
1. AF mechanisms and role of pulmonary veins in various AF presentations
Karl-Heinz Kuck (Hamburg, DE)
2. Periprocedural dormant conduction after PV isolation: how does it affect AF recurrence?
Heidi Estner (Munich, DE)
3. Do catheter techniques make a difference in success rates?
Leonardo Calo (Rome, IT)
4. Role of autonomic ganglia in AF ablation success rates
Yusuke Kondo (Chiba, JP)
2:00 PM3:30 PM
ROOM DIDEROT
HD-01
Update on inherited potentially lethal syndromes
Chairpersons: Peter Schwartz (Pavia, IT), Hugh Calkins (Baltimore, USA)
1. Long QT syndrome
Peter Schwartz (Pavia, IT)
2. Cathecholaminergic polymorphic VT
Jacob Tfelt-Hansen (Copenhagen, DK)
3. Brugada syndrome
Herve Le Marec (Nantes, FR)
4. Early repolarization syndrome
Juhani Junttila (Oulu, FI)
12:15 PM1:45 PM
188

2:00 PM3:30 PM
ROOM DESCARTES
SP-07
Joint session of ECAS-WSA (World Society of Arrhythmology)
The new frontiers in cardiac pacing
Chairpersons: Massimo Santini (Rome, DE), Eli Ovsyshcher (Beer Sheba, IL)
1. 50 years of cardiac pacing: where are we now?
Joo Rodrigues de Sousa (Lisbon, PT)
2. The leadless pacemaker
Antonio Curnis (Brescia, IT)
3. Multipoint pacing to optimize CRT outcome
Antonello Vado (Cuneo, IT)
4. Remote control: from device to patient management
Xavier Violas (Barcelona, ES)
5. Advances in biological pacing
Gerard Boink (Amsterdam, NL)
2:00 PM3:30 PM
ROOM PASCAL
Session SP-02
Prevention of sudden cardiac death in heart disease
Chairpersons: David Cannom (Los Angeles, USA), Poul Erik Bloch-Thomsen (Copenhagen, DK)
1. Effectiveness of Automatic External Defibrillators: availability and employability
Alessandro Capucci (Ancona, IT)
2. Indications and effectiveness of wearable ICDs
Johannes Brachmann (Coburg, DE)
3. What have we learned from prophylactic ICD trials?
Robert Myerburg (Miami, USA)
4. What have we learned from ICD registries?
Robert Hauser (Minneapolis, USA)
2:00 PM3:30 PM
ROOM GAUGUIN
Chaired Poster session B
189
3:30 PM4:00 PM Coffee break and Posters

4:00 PM5:30 PM
ROOM DERAIN
Session AB-02
Issues in ventricular tachycardia ablation (I)
Chairpersons: Nicholas Peters (London, DE), Jasbir Sra (Milwaukee, USA)
1. New insights into the VT substrate using the Rhythmia System
Elad Anter (Boston, USA)
2. Functional characterization of VT scar by ripple mapping
Prapa Kanagaratnam (London, GB)
3. Epicardial ablation of VT
Katja Zeppenfeld (Leiden, NL)
4. Ablation of bundle branch and fascicular ventricular tachycardia
Jasbir Sra (Milwaukee, USA)
4:00 PM5:30 PM
ROOM DIDEROT
SP-03
The MADIT (Multicenter Automatic Defibrillator Implantation) Trials
Chairpersons: David Cannom (Los Angeles, USA), Luigi Padeletti (Florence, IT)
1. Long-term prognosis of MADIT-CRT patients: new data
Mark Estes III (Boston, USA)
2. MADIT-CHAGAS study: design and early data
Claudio Schuger (Detroit, USA)
3. MADIT-CHIC study: design and early data
Jagmeet P. Singh, (Boston, USA)
4. Importance of LBBB in predicting a positive response to CRT therapy in Class I/II heart failure
David S. Cannom (Los Angeles, USA)
5. Impact of type II diabetes on the prognosis of coronary patients with heart failure: what would an ICD trial look like in
this patient group?
Helmut Klein (Munich, DE)

4:00 PM5:30 PM
190
Room DESCARTES
SP-04
Advances in Intracardiac Imaging for Interventional Electrophysiologists: 2015 and beyond
Chairpersons: Andrea Natale (Austin, USA), Roger Winkle (Palo Alto, USA)
1. Cardiac CT for definition of left atrial appendage morphology and risk stratification
Luigi Di Biase (New York, USA)
2. Intracardiac echocardiography performed from and for the pulmonary vasculaturetechnique and application
Sanjeev Saksena (Warren, USA)
3. Magnetic resonance imaging of the atrial substrate and progression of atrial fibrillation: a critical analysis
Mark ONeill (London, GB)
4. Real-time three dimensional imaging of cardiac chambers
Mohammad Shenasa (San Jose, USA)
4:00 PM5:30 PM
Room PASCAL
SP-05
Stroke prevention in atrial fibrillation
Chairpersons: John Camm (London, GB), Johannes Brachmann (Coburg, DE)
1. NOACs5 years after RE-LY: What have we learned?
Michael Nbauer (Munich, DE)
2. Interventional therapy by occluder deviceswhich patients should be considered?
Thorsten Lewalter (Munich, DE)
3. Ablation therapy for stroke prevention in patients with AF
John Fisher (New York, USA)
4. Role of continuous rhythm monitoringidentification of cause or bystander?
Albert Waldo (Cleveland, USA)
3:30 PM5:00 PM
ROOM GAUGUIN
Chaired poster session B (Cont.)
Room DERAIN
5:30 PM to 6:00 PM
Special lecture: A tribute to Philippe Coumel TBA
Opening ceremony
Prof. Samuel Lvy (Marseille, FR) and Prof. Gerhard Steinbeck (Munich, DE)
Outstanding Achievement Awards
Best Abstracts Awards
Presented by Dr Riccardo Cappato (Milan, IT)
President of ECAS
Prof. Nicolas Lellouche (Paris, FR)
Congress Chairman
Dr Fernand Hessel (Mulhouse, FR)
President Lucien Dreyfus Foundation
Followed by a cocktail reception
08:30 AM10:00 AM
ROOM COROT
SESSION SP-06
Atrial Fibrillation: Beyond Stroke Prevention
Chairpersons: Nils Edvardsson (Gothenburg, SE), Amiran Revishvili (Moscow, RU)
1. Cardiovascular Morbidity and Mortality of AF
Christine Albert (Boston, USA)
2. Atrial Fibrillation and Sudden Cardiac Death
Eloi Marijon (Paris, FR)
3. Role of Pharmacology
Juan Tamargo (Madrid, ES)
4. Role of Catheter Ablation
Walid Saliba (Cleveland, USA)
08:30 AM10:00 AM
ROOM DIDEROT
Session SP-07
Sudden cardiac death: Focus on at risk patients with secondary left ventricular hypertrophy (LVH)
Chairpersons: John Fisher (New-York, USA), Dubravko Petrac (Zagreb, HR)
191
192
ECG and MRI criteria of LVH

James Harrison (London, GB)
Mechanism of ventricular arrhythmias in patients with LVH
Nabil El-Sherif (New York, USA)
Risk stratification of patients with LVH at risk of sudden cardiac death
Regression of LVH and clinical outcome
Ariel Cohen (Paris, FR)
08:30 AM10:00 AM
ROOM DESCARTES
Session HD-03
HRS-ECAS SPECIAL SESSION I
Arrhythmogenic Cardiomyopathy I
Diagnosis and Mechanisms
Chairpersons: Peter Van Tintelen (Amsterdam, NL), Connie Bezzina (Amsterdam, NL)
History of the disease
Guy Fontaine (Paris, Fr)
Advantages/limitations of the Revised Task Force Criteria
Richard Hauer (Utrecht, NL)
Pathogenicity of genetic variants
Dennis Dooijes (Utrecht, NL)
Role of substructures in the Intercalated disk
Mario Delmar (New York, USA)
08:30 AM10:00 AM
ROOM PASCAL
AB-03
Highly technologic approach in catheter ablation of complex arrhythmias
Chairpersons: Richard Schilling (London, GB), Andrey Ardashev (Moscow, RU)
1. 3-D mapping and contact force sensing in ablation of atrial fibrillation
Roberto De Ponti, (Varese, IT)
2. Remote navigation ablation of atrial fibrillation and flutter using remote manipulation of multiple catheters
Eugene Crystal (Toronto, CA)
193
3. Preprocedural imaging and 3-D mapping in patients with ventricular tachycardia associated with structural heart
disease
4. 3-D mapping and contact force sensing in ablation of idiopathic ventricular tachycardia
David Wilber (Chicago, USA)
08:30 AM10:30 AM
ROOM GAUGUIN
Chaired Poster session C Part 1
10:00 AM10:30 AM Coffee break and Posters
10:30 AM12:00 PM
Concurrent Oral Abstract sessions
ROOM COROT
Abstract session 5
ROOM DIDEROT
Abstract session 6
ROOM DESCARTES
Abstract session 7
ROOM PASCAL
Abstract session 8
12:15 PM1:45 PM Room Dufy
12:15 PM1:45 PM
Luncheon Panel 3
Luncheon Panel 4

2:00 PM3:30 PM
ROOM COROT
SESSION AB-04
Current issues in atrial fibrillation
Chairpersons: Antonio Raviele (Venice, IT), Leonardo Calo (Rome, IT) TBC
Patients Selection: Do we already need updated guidelines?
Periprocedural Anticoagulation for AF ablation with warfarin and NOACs: beyond clinical stroke prevention
Etienne Aliot (Nancy, FR)
194
Energy Sources and tools: To whom, when and why?

New generation cryothermia balloon
Ellen Hoffmann (Munich, DE)
Laser balloon ablation
Thomas Deneke (Bad Neustadt, DE)
Lesion visualization and future directions
Matthew Wright (London, GB)
2:00 PM3:30 PM
ROOM DIDEROT
SESSION: HD-06
Biomarker-based therapeutic decision making in atrial fibrillation
Chairpersons: Stefan Kb (Munich, DE), Nicholas Peters (London, GB)
BiosignalsAF complexity guiding treatment strategies?
Ulrich Schotten (Maastricht, NL)
Biomarkers for the patient at risk for AF
Moritz Sinner (Munich, DE)
Genetics of AFReady for clinical decision making?
Stefan Kb (Munich, DE)
MicroRNAsPotential biomarkers for AF and AF therapy?
Reza Wakili (Munich, DE)
2:00 PM3:30 PM
ROOM DESCARTES
HD-07
HRS-ECAS SPECIAL SESSION
ECAS-HRS Joint Special Session (organized by Richard Hauer)
Arrhythmogenic Cardiomyopathy II
Risk Stratification and Therapy
Chairpersons: Corrina Brunckhorst (Zurich, CH), Richard Hauer (Utrecht, NL)
1. Electrophysiologic substrate and risk stratification
Alessandro Zorzi (Padova, IT)
2. Long-term Follow-up of ICD Therapy in ARVD/C
Hugh Calkins (Baltimore, USA)
3. Towards Elimination of the Electrophysiologic Substrate

Francis Marchlinski (Philadelphia, USA)
4. Towards New Drug Therapy
Jeffrey Saffitz (Boston, USA)
2:00 PM3:30 PM
ROOM PASCAL
SP-15
Approaches in VT Ablation
Chairpersons: Francis Marchlinski (Philadelphia, USA), Walid Saliba (Cleveland, USA)
1. Mechanisms of VT in structural heart disease
Michiel Janse (Amsterdam, NL)
2. Ischemic cardiomyopathy: The homogenization approach
Andrea Natale (Austin, USA)
3. VT ablation in non-ischemic cardiomyopathy
Jasbir Sra (Milwaukee, USA)
4. The impact of pre and post VT ablation inducibility on long-term success, re-hospitalization and mortality.
Gerhard Hindricks (Leipzig, DE)
2:00 PM5:00 PM
ROOM GAUGUIN
Chaired Poster presentation D
3:30 PM4:00 PM Coffee break and Posters
4:00 PM5:30 PM
ROOM COROT
AB-05
AF ablation techniques not targeting the pulmonary veins
Chairpersons: Riccardo Cappato (Milan, IT), David Wilber (Maywood, USA)
1. Detection and role of non-pulmonary vein AF triggers
2. Targeting complex fractionated atrial electrograms
Julien Seitz (Marseille, FR)
195
196
3. Mapping techniques for detecting rotors

Omer Berenfeld (Ann Arbor, USA)
4. Rotors-based AF ablation strategies
Paul Wang (Stanford, USA)
4:00 PM5:30 PM
ROOM DIDEROT
SP-14
8th Japanese HRS/ECAS SYMPOSIUM
New Insights in CRT therapy
Chairpersons: Yuji Nakazato (Chiba, JP), Gilles Lascault (Paris, FR)
1. Impact of multisite LV pacing in heart failure patients
Werner Jung (Villingen, DE)
2. Trans-septal endocardial LV pacing
Hidemori Hayashi (London, GB)
3. Role of surgical approach: An update
Katsuhiko Imai (Hiroshima, JP)
4. Clinical efficacy of optimization algorithm
Toshiiyuki Ishikawa (Yokohama, JP)
4:00 PM5:30 PM
ROOM DESCARTES
SP-13
Sudden cardiac death on a population levelStratification methods for the patient with ejection fraction >35 %
Chairpersons: Stefan Kb (Munich, DE), Brian Olshansky (Iowa City, USA)
1. Epidemiology of SCD
Xavier Jouven (Paris, FR)
2. ECGRisk stratification for SCD
Pieter Postema (Amsterdam, NL)
3. Holter-ECG: Potential parameters for risk stratification
Marek Malik (London, GB) TBC
4. Genetics of SCDWhat have we learned?
Vincent Probst (Nantes, FR)
197

4:00 PM5:30 PM
ROOM PASCAL
HD-04
Role of the autonomic nervous system in cardiac arrhythmias
Chairpersons: Gunter Breithardt (Muenster, DE), Shlomo Ben Haim (London-GB)
1. Role of multimodal imaging in arrhythmia patients
Reza Wakili (Munich, DE)
2. Risk stratification by autonomic biosignaling
Axel Bauer (Munich, DE)
3. Role of sympathetic innervation in ARVD patients
Matthias Paul (Munich, DE)
4. Autonomic testing for risk stratification in Long-QT patients
Peter Schwartz (Milan, IT)
5. Renal DenervationA treatment option for ventricular storm tachycardias
Noel Boyle (Los Angeles, USA)
4:00 PM5:30 PM
ROOM GAUGUIN
Chaired Poster session D (Cont.)
5:30 PM6:15 PM
ROOM COROT
Debate 1
Successful RF ablation alone is an acceptable treatment for monomorphic, well-tolerated VT with an ejection fraction
above 30 %
Chairpersons: Francis Marchlinski, (Philadelphia, USA), Gerhard Steinbeck (Munich, DE)
Protagonist: Philippe Maury (Toulouse, FR)
Antagonist: Brian Olshansky (Iowa City, USA)
5:30 PM6:15 PM
ROOM DIDEROT
Debate 2
198
Chairpersons: Berndt Lderitz (Munich, DE), Pro Obel (Johannesburg, ZA)

Rhythm control in patients with atrial fibrillation should not be pursued vigorously in the post AFFIRM era?
Protagonist: A. John Camm (London, GB)
Antagonist: Sanjeev Saksena (Warren, USA)
5:30 PM6:15 PM
ROOM PASCAL
Debate 3: Right ventricular apical pacing should be abandoned
Chairpersons: Luigi Padeletti (Florence, IT), Pascal Defaye (Grenoble, FR)
Protagonist: Carsten Israel (Bielefeld, DE)
Antagonist: Eli Ovsyshcher (Beer Sheba, IL)
08:30 AM10:00 AM
ROOM DIDEROT
Abstract session 9
ROOM DESCARTES
Abstract session 10
ROOM PASCAL
Abstract session 11
ROOM TBA
Abstract session 12
Coffee Break
10:30 AM12:00 PM
ROOM DIDEROT
Session SP-11
Unresolved questions in the management of cardiac arrhythmias
Chairpersons: Edward Rowland (London, GB), Maurice Khoury (Beirut, LB)
1. How to interpret short runs of AF on Holter monitoring?
Taya V. Glotzer (Hackensack, NJ, USA)
2. How much redo after a first AF ablation procedure?

David Keane (Dublin, IE)
3. Does revascularization prevent SCD?
Gerard Guiraudon (London, CA)
4. How safe are PVCs in patients without structural heart disease?
Charles Jazra (Beirut, LB)
5. Ablation of PVCs: When and how?
Oussama Wazni (Cleveland, USA)
10:30 AM12:00 AM
ROOM DESCARTES
SP-12
New tools and techniques for AF therapy
Young German electrophysiologistsSession of the German EP Fellow program
Chairpersons: Reza Wakili (Munich, DE), Roland Tilz (Hamburg DE)
1. Potential role of multimodal mapping for a better understanding of the AF substrate
Armin Luik (Karlsruhe, DE)
2. Role of continuous ECG monitoring by implantable loop recorders
Joern Schmitt (Giessen DE)
3. The nMARQ-catheter: initial experience and results
Stephanie Fichtner (Munich DE)
4. Rotor mapping: do different tools lead to different results?
Roland Tilz (Hamburg, DE)
10:30 AM12:00 AM
ROOM PASCAL
WS-04
Current Issues in AF management
Chairpersons: Roberto de Ponti (Varese, IT), Michiel Janse (Amsterdam, NL)
1. Remodelling and Anti-arrhythmic Agents
Dobromir Dobrev (Essen, DE)
2. Monitoring Ablation Outcomeswhat really happens to AF?
199
200
3. Thoracoscopic Surgery and Hybrid Therapy Outcomes

Alaadin Yilmaz (Amsterdam, NL)
4. Hot versus ColdThe latest outcomes of CRYO and RF techniques in paroxysmal and persistent AF
Ross Hunter (London, GB)
10:30 AM12:00 AM
ROOM TOCQUEVILLE
WS-05
Nightmares in catheter ablation: case presentations
Chairpersons: Riccardo Cappato (Milan), Ali Oto (Ankara, TR)
My worst case of
1. Atrial flutter ablation
Isabel Deisenhofer (Munich, DE)
2. Atrial fibrillation ablation
Nicolas Lellouche (Paris, FR)
3. Accessory pathway ablation
Peter Loh (Utrecht, NL)
4. Ventricular tachycardia ablation
Bharat Kantharia (Houston, USA)
Abstract oral session 1: Atrial fibrillation ablation

11 Abstract 1821
EFFECT OF ANTIARRHYTHMICS DRUG INIT
IATION ON READMISSION AFTER CATHETER
ABLATION FOR ATRIAL FIBRILLATION
Peter Noseworthy 1 , Holly Van Houten 1 , Lindsey
Sangaralingham1, Abhishek Deshmuk1, Suraj Kapa1, Siva
Mulpuru1, Christopher McLeod1, Samuel Asirvatham1, Nilay
Shah1, Douglas Packer1
1
Mayo Clinic, Rochester, MN, United States
Background: Hospital readmission, a commonly tracked indicator of quality and efficiency of care delivery, occurs in about
15 % patients within 90 days of undergoing catheter ablation for
atrial fibrillation (AF). We sought to evaluate the impact on
antiarrhythmic drug (AAD) initiation on the risk of readmission.
Methods and Results: Using a large national administrative
claims database, we identified all atrial fibrillation patients
(age 18 years) who underwent catheter ablation between
2005 and 2013. We identified the subset of patients who had
201
not been on an AAD in the 90 days prior to the ablation (n=

2542) and, among those, the patients in whom an AAD was
initiated within 7 days of the ablation (n=826). A total of 387
(15.2 %) patients were readmitted within 90 days of ablation for
any cause, and 161 (6.3 %) were readmitted with atrial fibrillation or atrial flutter as the primary discharge diagnosis. The
readmission rate was significantly lower among patients who
were initiated on an antiarrhythmic drug compared to those who
were not (11.7 vs. 16.9 %, p=0.0007). In a multivariate model,
age 65+years, Charlson index of 3, CHADS2 score of 3,
and year of service in 20092010 were significantly associated
with risk of readmission (p<0.05). The association between
antiarrhythmic drug initiation and reduced readmission
persisted after adjustment for these variables (OR 0.84 [95 %
CI 0.740.95], p=0.0058). Amiodarone (HR 0.63 [0.420.95],
p=0.025) and class Ic agents (HR 0.65 [0.430.98], p=0.04)
were associated with the greatest reduction in readmission
whereas dronedarone and class II agents had no statistically
significant effect in time to event analysis. Conclusions: Initiation of an AAD within 7 days of catheter ablation is associated
with a significant reduction in readmission within 90 days. Routine initiation of an AAD after catheter ablation may reduce
health care utilization in the peri-ablation period.
1-2 Abstract 18-22

CONTACT FORCE DATA AVAILABILITY
REDUCES ACUTE PULMONARY VEIN
RECONNECTION: EARLY RESULTS FROM THE
SMART AF TRIAL
Waqas Ullah1, Ailsa McLean1, Muzahir Tayebjee2, Dhiraj
Gupta3, Matthew Ginks4, Guy Haywood5, Mark ONeill6,
Pier Lambiase7, Mark Earley1, Richard Schilling1, Smart AF
Trial Group UK8
St Bartholomews Hospital, London, UK; 2 Leeds General

Infirmary, Leeds, UK; 3 Liverpool Heart and Chest Hospital,
Liverpool, UK; 4 John Radcliffe Hospital, Oxford, UK; 5
Derriford Hospital, Plymouth, UK; 6St Thomas Hospital,
London, UK; 7 The Heart Hospital, London, UK; 8 Smart
AF Trial Group, UK
BACKGROUND: Contact force (CF) sensing data may facilitate

wide area circumferential ablation (WACA). We present data
202
from an interim analysis of the first multicentre randomised controlled trial studying the impact of this data on the ablation of
paroxysmal atrial fibrillation (PAF). METHODS: At seven UK
centres, patients undergoing first-time PAF ablation were
randomised to ablation with (CF-on) or without CF data (CFoff) available to the operator. Planned recruitment is 120 patients
with 1-year follow-up. Using a 3D mapping system and the
SmartTouch CF-sensing catheter (Biosense Webster), all patients
underwent WACA. Subsequently a 1-h waiting time was observed before assessing acute pulmonary vein (PV) reconnection;
if the PV remained isolated, 18 mg adenosine was administered
intravenously. The primary end point was acute PV reconnection
(spontaneous/adenosine induced). PVs were assessed separately,
but cases of a common trunk were taken as one vein. PVs that
appeared isolated but were assessed without completing the

waiting period were excluded from the acute reconnection analysis. Follow-up is ongoing and 3-month outcomes are reported.
RESULTS: One hundred sixteen patients have been recruited:
age 5911 years, 57 % male, EHRA score 2.70.6 and AF
duration 37 [1670] months (no significant baseline characteristic differences between groups). There were no differences in
procedural parameters (Table). There was a significant, 40 %,
reduction in acute PV reconnection in the CF-on group (Table).
There were two tamponades and one minor pericardial effusion
in the CF-on group, and one minor hematoma in the CF-off
group. Ninety patients (43 CF-off, 47 CF-on) have completed
3-month follow-up: at this point, there is no difference in EHRA
scores (CF-off 1.60.6, CF-on 1.50.6, p=0.8).
CF-off group
60
CF-on group
56
p value
Total procedure time (min)
195 [165216]
193 [171219]
0.97
Total fluoroscopy time (min)
13 [623]
904 [2921684]
10 [630]
813 [3652187]
0.96
0.88
2446 [18982862]
2446 [20232956]
0.46
Number
Total fluoroscopy dose (cGy.cm2)

Total radiofrequency ablation rime (s)
Total pulmonary vein acute reconnections
68/227 (30 %)
38/202 (18 %)
0.01
Left pulmonary vein acute reconnections
35/115 (30 %)
17/103 (17 %)
0.017
Right pulmonary vein acute reconnections
33/112 (30 %)
21/99 (21 %)
0.2
CONCLUSIONS: Addition of CF sensing data had no impact

on procedure, fluoroscopy or ablation times, but did reduce
acute PV reconnection rates, suggesting more effective ablation application and consequently more durable PV isolation.
Whether this translates to improved long-term success will be
assessed on study completion.
13 Abstract 1826
PAROXYSMAL ATRIAL FIBRILLATION ABLATION
WITHOUT PULMONARY VEIN ISOLATION
Clement Bars1, Julien Seitz2, Guillaume Theodore3, Ange
Ferracci2, Michel Bremondy2, Jacques Faure2, Andr Pisapia2
1
Institut Mutualiste Montsouris, Paris, France; 2Hpital Saint
Joseph, Marseille, France; 3University Hospital, Nice,
France
Background: Pulmonary vein isolation (PVI) is the most popular approach for paroxysmal atrial fibrillation (PAF) ablation.
This method is a probabilistic one and do not specifically
target AF substrate which could lead either to under- or
over-treatment. Objectives: We aimed to evaluate in PAF an
electrogram substrate ablation technique guided by regional
high-density mapping. Methods: We analysed the PAF subgroup of the SUBSTRATE HD study (multicentric study with
seven operators involved). Twenty-four patients undergoing
PAF ablation were thus prospectively enrolled for a first ablation procedure (mean age=61.7+10.25). A substrate biatrial
highdensity mapping with a 20-pole-contact electrode
PentaRay NAV catheter (Biosense Webster) was performed.
AF substrate was detected both automatically with a new
CFAE algorithm setting and visually by operators (continuous
CFAE and temporal gradient of activation). Ablation end
points were AF termination (sinus rhythm or atrial tachycardia
conversion), sinus conversion and non-inducibility (atrial
devulnerabilisation). Results: AF was induced in 16 patients
(66.6 %) by rapid atrial pacing. The median mapping times
and number of acquisition points/patient in the right and left
atria were, respectively, as follows: 7 [47] and 14 [9.2515]
min with 569 [285739] and 831 [1052490] points. Substrate ablation without PVI terminated AF in 23/24 (96 %)
patients in 15.3+14.8 mean min RF time. Sinus rhythm was
restored in 23/24 (96 %) patients and non-inducibility was
achieved in 75 %. The total mean procedure and RF time
were, respectively, 153.9+36 and 43 min +18.4. No procedural complications occurred. After a mean follow-up of 6.5+
2.8 months 23/24 (96 %), patients were free from AF and
19/24 (79.16) were free from any atrial arrhythmias. Conclusion: Electrogram-based substrate ablation guided by bi-atrial
high-density mapping for PAF without PVI is feasible, safe,
reproducible and efficient.
203
An easily determined clinical scoring system was derived retrospectively and applied prospectively. CAAP-AF predicted
the final outcome of AF ablation in both a development and a
test cohort of AF ablation patients. CAAP-AF may provide a
realistic AF ablation outcome expectation for individual pts.
14 Abstract 1816
15 Abstract 1832
PREDICTION OF AF ABLATION OUTCOME: THE
CAAP-AF SCORE
Roger Winkle1, Julian Jarman2, R. Hardwin Mead1, Gregory
Engel1, Melissa Kong1, William Fleming1, Rob Patrawala1
1
Silicon Valley Cardiology, E Palo Alto, CA, USA; 2Royal
Brompton Hospital, London, UK
Objectives: To develop a clinical scoring system to predict the
final outcome for all patients undergoing atrial fibrillation (AF)
ablation. Methods: We examined a development cohort (DC) of
1125 consecutive patients undergoing 1.340.53 AF ablations
from 2003 to 2010. Results: Pt. demographics were as follows:
age=62.310.3, male=71.2 %, LA size=4.300.69 cm, paroxysmal AF 30.9 %, drugs failed=1.31.1, hypertension=
46.7 %, diabetes=8.9 %, prior CVA/TIA=6.9 %, prior cardioversion=46.9 % and CHADS2=0.870.97. Multivariate analysis showed six independent variables predicting outcome after
final ablation: CAD (p=0.021), atrial diameter (p=0.0003), age
(p=0.004), persistent or longstanding AF (p<0.0001), antiarrhythmic drugs failed (p<0.0001) and female (p=0.0001). We
created a scoring system (CAAP-AF) using these six variables
with total CAAP-AF scores ranging from 0 to 13 points.
CAAP-AF Score: CAD=1 pt; atrial diameter <4.0=0 pts, 4 to
<4.5=1 pt,.4.5 to <5=2 pts, 5.0 to <5.5=3 pts, 5.5=4 pts; age
<50=0 pts, 50 to <60=1 pt, 60 to <70=2 pts, 70=3 pts;
persistent or longstanding AF=2 pts; antiarrhythmic drugs
failed none=0 pts, 1 or 2=1 pt, 3=2 pts; female=1 pt.
CAAP-AF score predicted final outcome (C statistic=0.691,
p = 0.0006). The 2-year Kaplan-Meier AF free rates by
CAAP-AF scores were as follows: 0=100 %, 1=95.7 %, 2=
96.3 %, 3=83.1 %, 4=85.5 %, 5=79.9 %, 6=76.1 %, 7=
63.4 %, 8 = 51.1 %, 9 = 53.6 % 10 = 29.1 %. CochranArmitage trend test showed worsening 2-year outcome with
higher CAAP-AF scores (p<0.0001). The CAAP-AF score
was then applied prospectively to 937 patients in a test cohort
(TC) undergoing AF ablation from 2010 to 2012. The CAAPAF score also predicted final outcome in the TC (C statistic=
0.651, p=0.009). The 2-year Kaplan-Meier AF free rates by
CAAP-AF scores were as follows: 0=100 %, 1=87.0 %, 2=
89.0 %, 3=91.6 %, 4=90.5 %, 5=84.4 %, 6=70.1 %, 7=
71.0 %, 8 = 60.7 %, 9 = 68.9 % 10 = 51.3 %. CochranArmitage trend test showed worsening 2-year outcome for the
TC with higher CAAP-AF scores (p<0.0001). Conclusions:
A COMBINED APPROACH OF POINT BY POINT

RADIOFREQUENCY ABLATION FOLLOWED BY
CRYOBALLOON ABLATION DRAMATICALLY
IMPROVES THE RATE OF LONG TERM
PULMONARY VEIN ISOLATION FOR PATIENTS
WITH PAROXYSMAL AF
Richard Ang1, Aaisha Opel1, Waqas Ullah1, Victoria Baker1,
Malcolm Finlay1, Mehul Dhinoja1, Mark Earley1, Simon
Sporton1, Richard Schilling1, Ross Hunter1
1
St Bartholomews Hospital, London, UK
Introduction: In a randomized controlled trial, patients undergoing first-time paroxysmal AF ablation were randomized to pulmonary vein (PV) isolation by wide-area circumferential ablation with radiofrequency energy (RF), cryoballoon (CRYO), or
RF followed by CRYO (COMBINED). We report the long-term
PV reconnection rates and sites. Methods: In patients who had a
recurrence of AF, a repeat procedure was offered. A
duodecapolar PV mapping catheter was used to identify whether
each PV had reconnected. In a subset from each group, the sites
of PV reconnection were prospectively defined during ablation
as sites where ablation caused a change in PV activation sequence or PV isolation (>1 site possible per PV) and were categorized into one of eight segments (figure). Results: Two hundred thirty-four patients entered the study, and at a median
follow-up of 41 (IQR 3051) months, only 17/79 (22 %) in
the COMBINED group required a repeat procedure compared
with RF 38/77 (49 %) and CRYO 33/78 (42 %), both p<0.01,
with no significant difference between RF and CRYO alone, p=
0.42. In the COMBINED group, 6/17 (35 %) had no PV
reconnected, compared to only one in the RF and none in the
CRYO groups, both p<0.01. The number of PVs reconnected
per patient was also lower (1.2 vs. 2.5 RF and 2.3 CRYO, both
p<0.01). The frequency of reconnections for each PV and the
PV reconnection sites for 25 consecutive cases in the CRYO and
RF groups and 10 cases for the COMBINED group are presented in the figure. Conclusions: A combined approach dramatically reduces long-term PV reconnection and the need for repeat
procedures compared to either RF or CRYO. The PV reconnection pattern differs between CRYO and RF and may explain the
synergistic effect of the combined approach.
204
16 Abstract 1825
USE OF CONTACT FORCE TECHNOLOGY IN AF
ABLATION PROCEDURES DOES NOT IMPROVE
CLINICAL OUTCOME RATESINSIGHTS FROM
A 3 YEAR SINGLE CENTER EXPERIENCE
Stefan Sattler1, Johannes Siebermair1, Eva Klocker1, Lucia
Olesch1, Samira Saraj1, Ina Klier1, Christoph Schuhmann1,
Sebastian Clauss1, Moritz Sinner1, Stephanie Fichtner1,
Stefan Kb1, Heidi Estner1, Reza Wakili1
1
Medical Department I, Klinikum Grosshadern, LudwigMaximilians-University, Munich, Germany
Introduction: Pulmonary vein isolation (PVI) is an established
method to treat atrial fibrillation (AF). Contact force (CF) sensing
catheters have been introduced with the purpose to improve procedural parameters and clinical outcome of AF ablation. In this
study, we evaluated >300 PVI procedures regarding the role of

CF catheters with respect to procedural parameters and mid-term
clinical outcome. Methods: We performed an analysis of a total
of 302 patients with paroxysmal (n=141) or persistent AF (n=
161) undergoing PVI; patients were divided into two groups: (1)
n=158, ablation performed with CF sensing SMARTtouch catheter (ST) aiming for a CF>10 g/lesion, and (2) n=144, patients
undergoing PVI with a standard ablation catheter (SAC). Complete electrical isolation of all PVs was considered as procedural
endpoint (PE). FU was performed on regularly basis by 7-day
ECG Holter recordings in 6 months terms. Results: Patient characteristics regarding percentage of paroxysmal AF, male gender,
age, LA size, LV ejection fraction, history of hypertension or
concomitant structural heart disease did not differ significantly
between both groups. PE was reached in all patients. Application
of CF measurement feature in the ST group did result in a significant reduction of whole procedure time (232151 vs. 269
57 min, **p<0.01), lower number of energy applications (33
205
17 vs. 3817, **p<0.01) and a decreased fluoroscopy time (29

14 vs. 4727 min, **p<0.01) compared to the SAC group.
However, analysis of clinical outcome (freedom from AF) revealed no significant difference between both groups during a
mean FU period of 254178 days (74 % ST vs. 73 % SAC, ns,

see figure). Conclusions: Our results suggest that the use of CF
catheters show a beneficial effect on procedural parameters but
failed to result in an improved clinical outcome over time.
Abstract oral session 2: Sudden cardiac death: prevention

and management
Jacques Mansourati 6 , Dominique Babuty 7 , Jean-Luc

Pasqui8, Pierre Jais1, Nicolas Derval1, Arnaud Denis1,
Meleze Hocini1, Michel Hassaguerre1, Vincent Probst2
1
CHU Bordeaux, Bordeaux, France; 2 CHU Nantes, Nantes,
France; 3CHU Toulouse, Toulouse, France; 4CHU Dijon, Dijon, France; 5CHU Rennes, Rennes, France; 6CHU Brest,
Brest, France; 7CHU Tours, Tour, France; 8CHU Montpellier,
Montpellier, France

21 Abstract 1013
OUTCOME OF PATIENT WITH EARLY
REPOLARIZATION AFTER UNEXPLAINED
SYNCOPE
Mathieu Le Bloa1, Frederic Sacher1, Jean-Baptiste Gourraud2,
Philippe Maury3, Gabriel Laurent4, Christophe Leclercq5,
Background: Early repolarization (ER) is a common finding in

the general population (5 %). It has been reported to increase
the risk of arrhythmic death. We sought to compare incidence
of ventricular tachycardia (VT) and/or sudden cardiac death
206
(SCD) after unexplained syncope without cardiomyopathy, on

patients with or without ER. Methods: From January 2009 to
December 2013, all patients hospitalized for unexplained syncope, presenting J wave elevation 0.1 mV in at least two
inferior (II, III, aVF) and/or lateral leads (V4V6, I, aVL)
from 23 centers, have been included in a prospective registry.
Their outcome was compared with patient admitted in University Hospital of Bordeaux on the same period, without
cardiomyopathy nor ER. Referring physicians managed the
patients according to their local practice. Results: One hundred patients were included in ER group (84 (84 %) males, 33
16.5 years old), 53 (53 %) received an implantable loop
recorder (ILR). During a mean follow-up of 31.8
17.9 months, and 11 (11 %) experienced a ventricular arrhyth-
mia (10 VT (figure) and 1 SCD). In the group without ER

(n=139, 84 (60 %) males, 5119 years old), 70 (50.4 %)
had an ILR. During a mean follow-up of 36.819.7 months,
4 (2,8 %) had a ventricular arrhythmia (2 VT and 2 SCD).
ER was associated with an increased hazard ratio (HR) for
ventricular arrhythmia of 5.07 (IC95 % [1.6116.0], p=
0.03) and 4.55 (IC95 % [1.1717.8], p=0.029) when adjusted on sex. In ER group, only inferior ER was associated
with arrhythmia. J wave amplitude, ER pattern, ST segment
aspect, regional and transmural dispersions of repolarization were not associated with a different outcome. Conclusions: ER pattern after an episode of unexplained syncope
is associated with an increased risk of ventricular
arrhythmia.
207
22 Abstract 1924
23 Abstract 1925
DAYTIME AND SEASON AS PREDICTORS

FOR CARDIAC RHYTHM DISTURBANCES IN DIFF
ERENT DISEASESA LARGE REAL-LIFE ANAL
YSIS
RANOLAZINE AMELIORATES
POST-RESUSCITATION ELECTRICAL INST
ABILITY AND MYOCARDIAL DYSFUNCTION AND
IMPROVES OUTCOME IN A RAT MODEL OF VENT
RICULAR FIBRILLATION
Eimo Martens1, Johannes Siebermair1, Regina Freeden2,

Carsten Koenig2, Stefan Veith1, Moritz Sinner1, Stefan Kb1
1
Klinikum der Universitt Mnchen, Muenchen, Germany; 2Medtronic GmbH, Meerbusch, Germany
Background. SCD underlies until now a not-understood circadian rhythm during the day and during the year. Only for a
small part of the SCD predictors are known. Implantable
cardioverter-defibrillator (ICD) systems are well established
to prevent sudden cardiac death (SCD). It is important to understand the predictors for rhythm disturbances to identify
patients at risk for SCD. Objective. The objective of this analysis was to retrospectively investigate the temporal distribution of rhythm disturbances of ICD patients in dependence of
clinical patient parameters. Methods. Anonymized follow-up
data of ICD and CRT-D of the time between 2002 and 2014
were collected and pooled from our clinic. Data were analyzed
in a database that allows the collection of follow-up from ICD
programmer as well as telemedicine transmissions. Within the
database, all parameters as well as EGMs, episode- and
patient-data is stored and can be analyzed. Physicians classified the occurrence of appropriate vs. inappropriate therapy or
episode type. Results. Data were analyzed from 8300 followups of 704 patients (952 ICD/CRT-D devices). We specified
79 % male, mean age 6613 years, 62,7 % primary prevention, 55 % ICM, 39 % DCM and 6 % other diseases. We
detected 4888 episodes overall, thereof 1369 with relevant
rhythm disturbances. Eight hundred ninety-nine VT episodes
(median cycle length 409 ms) and 470 VF episodes (median
cycle length 231 ms) were found. For VF episodes, we could
find a significant peak around 8 pm (p=0.03, Fig. 1) for primary and secondary prevention patients. For VT episodes, it
was in contrast to the overall distribution a significant peak
found in ICM patients in the early morning (p=0.02, Fig. 2).
During the year, we found significant higher incidence of VF
and VT episodes in April (primary and secondary prevention)
and September/October (secondary prevention) (Figs 3 and
4). In ischemic patients, significantly more episodes occur in
April; patients with dilative cardiomyopathy showed significant higher incidence of episodes in September (Fig. 3). Conclusion. ICD patients have relevant VT and VF episodes during their life. Underlying disease and the difference between
primary and secondary prevention cause significant different
distribution of VF and VT episodes during the day and the
year. It is the duty of further investigations to investigate the
daily or yearly predictors for the higher incidence rate.
Francesca Fumagalli1, Ilaria Russo1, Lidia Staszewsky1,

Roberto Latini1, Antonio Zaza2, Giuseppe Ristagno1
1
IRCCS-Istituto di Ricerche Farmacologiche Mario Negri,
Milan, Italy; 2Dipartimento di Biotecnologie e Bioscienze,
Universit degli Studi Milano-Bicocca, Milan, Italy
Dysregulation of intracellular Ca2+ homeostasis plays a critical role in the pathophysiology of cardiac arrest and cardiopulmonary resuscitation (CPR), leading to ventricular arrhythmias and left ventricle (LV) dysfunction. We investigated the
effects of the INaL blocker ranolazine on outcome of CPR.
Methods. Eighteen rats were assigned to receive intravenous
ranolazine, 10 mg/kg, or vehicle. Ventricular fibrillation (VF)
was then induced and untreated for 8 min. CPR was then
performed for 8 min. ECG, arterial, and right atrial pressures
were monitored up to 3 h after CPR. LV function was monitored by echocardiography, and 72-h survival was evaluated.
Incidence, frequency, and duration of ventricular arrhythmias
were quantified. Effects of ranolazine on VF waveform features were assessed by measuring the amplitude spectrum area
(AMSA), peak (PF), median (MDF), mean frequency (MNF),
and root mean square amplitude (RMS). Results. All animals
in the ranolazine group were resuscitated and survived up to
72 h, whereas 72 % in the vehicle group were resuscitated and
54 % survived. AMSA and RMS were consistently higher in
animals pretreated with ranolazine (p<0.01 vs. vehicle). PF,
MNF, and MDF during untreated VF, and MNF and MDF
during CPR, were significantly lower in the ranolazine group.
Successful resuscitation was immediately followed by a period of severe arrhythmias, including VPBs and runs of VT and
VF, leading to hemodynamic instability. The presence of arrhythmias, including any type of arrhythmic episode, was observed in 100 % of rats in the vehicle group, in contrast to only
43 % of rats in the ranolazine group (p<0.03). The number of
VPBs and VTs, and duration of VTs, was greater in rats resuscitated in the vehicle group, compared to rats pretreated
with ranolazine. This period of arrhythmias lasted more than
11 min in vehicle animals and less than 3 min in ranolazine
ones (p<0.02). At 10 min after resuscitation, heart rate, mean
arterial pressure, and CPP were significantly higher in the
ranolazine group (p<0.05 vs. vehicle). No differences in the
duration of PR, QRS, and QT electrocardiographic intervals
were observed between the two study groups, except for a
transient increase in QT duration in the ranolazine group prior
to onset of VF (p < 0.01). Seventy-two hours after
208
resuscitation, LV systolic and diastolic functions were better

in ranolazine group (p<0.05 vs. vehicle). Full neurological
recovery was observed in all ranolazine animals, while neurological impairment persisted in vehicle ones (p<0.02). Conclusion. Ranolazine pretreatment reduced post-resuscitation
electrical and hemodynamic instability and improved postresuscitation LV function and survival.
ing structural or electrical heart disease during followup, with VF as first manifestation. These data emphasize the importance of comprehensive follow-up of IVFpatients, regarding its impact on patient diagnosis, treatment and genetic- and family counselling. Keywords:
Follow-up, Idiopathic Ventricular Fibrillation
25 Abstract 1926
24 Abstract 1916
FOLLOW-UP OF PATIENTS WITH IDIOPATHIC
VENTRICULAR FIBRILLATION (THE FU-IVF
STUDY)PRELIMINARY RESULTS
Marloes Visser1, Charlotte Siegers1, Jeroen van der Heijden1,
Peter Loh1, Pieter Doevendans1, Rutger Hassink1
1
UMC Utrecht, Utrecht, Netherlands
Background: Idiopathic ventricular fibrillation (IVF) is the underlying cause of 510 % of out-of-hospital cardiac arrest patients. IVF is defined as VF without structural or electrical heart
disease present upon first presentation. Little is known regarding
long-term outcome and clinical characteristics during follow-up
of IVF patients. The purpose of this study is to further elucidate
underlying causes and to more accurately assess the prognosis.
Methods: This retrospective cross-sectional study describes the
follow-up of 100 IVF patients diagnosed since 1985. IVF diagnoses were reassessed and reclassified if needed according to
current guidelines. Additional testing (e.g. ajmalin-testing, echocardiography, genetic testing) was performed if needed. Genetic
testing was performed with a custom gene panel containing 33
genes associated with VF and cardiomyopathy. Results: Fiftynine males and 41 females were included, with a mean age at
event of 41.6 years. A previous history of syncope was
reported in 24 % of patients. Ninety patients (90 %)
received an ICD, of which 36 % (32/90) received appropriate ICD therapy. During a mean follow-up of
10 years, diagnosis was revised in 18 % of patients
(e.g. to structural disease such as arrhythmogenic and
dilated cardiomyopathy or electrical disease such as
Brugada and long QT syndrome). A genetic diagnosis
was obtained in 11 patients. The all-cause mortality was
13 %. Conclusion: Our results show a high mortality
and recurrence rate of ventricular arrhythmia requiring
ICD-therapy in IVF patients. A substantial amount of
patients initially diagnosed with IVF reveal an underly-
BENEFITS OF ICD THERAPY: CONNECTING TREA

TMENT DECISIONS TO INDIVIDUALIZED SCD
RISK ESTIMATES WITHIN SCD-HEFTSEATTLE
PROPORTIONAL RISK MODEL
Wayne Levy 1, Jeanne Poole1, Anne Hellkamp2, Ramin
Shadman3, Todd Dardas1, Jill Anderson4, George Johnson4,
Daniel Fishbein1, Daniel Mark2, Kerry Lee2, Gust Bardy4
1
University of Washington, Seattle, WA, USA; 2Duke University, Durham,NC, USA; 3 Southern California Permanente
Medical Group, Los Angeles, CA, USA; 4 Seattle Institute
for Cardiac Research, Seattle, WA, USA
Introduction. Currently, there is no method to predict if a patient dies, the likelihood that the death will be a sudden death
(potentially preventable with an ICD) vs. a non-sudden death.
Hypothesis. We developed the Seattle Proportional Risk Model (SPRM) to predict the proportion of death that is due to
sudden death in 9985 patients using age, gender, EF, NYHA,
SBP, Na, Cr, digoxin use, BMI, and diabetes. We prospectively tested this model in the patients enrolled in SCD-HeFT to
determine the extent to which ICD benefit for sudden death
and all-cause mortality would vary based on the predicted
proportional risk of sudden death. We tested the concept that
a patient with a higher estimated proportion of sudden death
will benefit more from an ICD than a similar patient with a
lower estimated proportion of sudden death (i.e. 70 vs. 40 %).
Methods. A Cox proportional hazards model was used to determine if the ICD benefit varied by the SPRM. Results. In a
Cox proportional hazard model, the adjusted ICD benefit for
all-cause mortality (27 %, p=0.0016) and sudden death (62 %,
p<0.0001) was as anticipated, consistent with the primary
results of SCD-HeFT. However, the ICD benefit varied markedly with the SPRM for both sudden death (interaction
p<0.0001) and all-cause mortality (interaction p=0.0003)
with markedly greater benefit of the ICD in patients with a
higher predicted proportion of sudden death. The ICD reduc-
tion in sudden death from lowest to highest SPRM quartiles

(low to high proportion sudden death) was 19, 57, 78, and 95 %
(p=0.55, 0.02, 0.007, and 0.003, respectively). The ICD benefit
varied markedly for all-cause mortality across SPRM quartiles
from a 10 % increase in the 1st quartile to decreases of 28, 47,
and 66 % in the 2nd to 4th quartiles (p=0.38, 0.055, 0.01,
0.001, respectively). Conclusions. Although a primary prevention ICD in SCD-HeFT reduced sudden death by 62 % and allcause mortality by 27 %, the benefit is not uniform. In SCDHeFT, the reduction in sudden death and all-cause mortality
was confined to those with a higher proportional risk of sudden
death, whereas patients in the lowest quartile of SPRM risk had
no mortality benefit from the ICD. The SPRM can be a realtime tool to identify individuals who are most appropriate for a primary prevention ICD.
26 Abstract 1930
IMPLANTABLE CARDIAC DEFIBRILLATOR
IN THE SETTING OF TETRALOGY OF FALLOT
Abdeslam Bouzeman 1 , Guillaume Duthoit 2 , Magalie
Ladouceur1, Raphael Martins3, Maxime De Guillebon4,
Laurent Fauchier5, Pascal Defaye6, Jean-Baptiste Gourraud7,
Jean-Marc Sellal8, Pierre Mondoly9, Fabien Lalombarda10,
Frederic Anselme11, Linda Koutbi12, Nicolas Lellouche13,
Franck Halimi14, Anne Messali15, Amel Mathiron16, Nicolas
Sadoul 8 , Laurence Iserin 1 , Pierre Bordachar 4 , Nicolas
Combes17, Jean-Benoit Thambo4, Eloi Marijon1
1
Paris Cardiovascular Research Center, Inserm U970, Paris,
France/European Georges Pompidou Hospital, Paris, France/
Paris Descartes University, Paris, France; 2CHU La Pitie
Salpetriere Hospital, Cardiology Department, Paris, France;
3
CHU Pontchaillou, Cardiology Department, Rennes, France;
4
CHU Haut Leveque, Cardiology Department, Bordeaux,
France; 5CHU Trousseau, Tours, France; 6CHU Michallon,
Grenoble, France; 7CHU Nantes, Nantes, France; 8CHU
Brabois, Nancy, France; 9Hopital Rangueil, Toulouse, France;
10
CHU Caen, Caen, France; 11CHU Rouen, Rouen, France;
12
CHU La Timone, Marseille, France; 13CHU Henri Mondor,
Creteil, France; 14Hopital Prive Parly II, Le Chesnay, France;
15
CHU Bichat, Paris, France; 16CHU Amiens, Amiens,
France; 17Clinique Pasteur, Toulouse, France
BackgroundTetralogy of Fallot (TOF) is the most frequent
form of congenital heart disease managed by EP physicians
209
for potential implantable cardioverter defibrillator (ICD).

However, few studies have reported long-term outcomes of
TOF patients with ICD. MethodsBetween 2005 and 2014,
all TOF patients with ICD in 17 French centers were enrolled
in a specific evaluation aiming to determine characteristics at
implantation as well as outcomes (overall mortality, appropriate ICD therapies, and device-related complications). ResultsOverall, 78 patients were enrolled with a mean age at
implantation of 4513 years. Fifty patients (64 %) were male.
A majority of patients were implanted in the setting of secondary prevention (73 %), whereas the remaining (27 %) in
primary prevention. Among the latest group, characteristics,
known as risk factors of appropriate therapy, were observed as
follows: important pulmonary regurgitation in 30 %, prior
palliative shunt in 50 %, syncope with unknown origin in
25 %, inducible ventricular tachycardia in 45 %, QRS duration 180 ms in 18 %, non-sustained ventricular tachycardia
in 25 %. In addition, 45 % had documented sustained supra
ventricular tachycardia, and 30 % presented symptoms of
heart failure. Twenty-eight patients (37 %) finally received a
single-chamber ICD, 37 patients (49 %) dual chamber and 8
patients (11 %) had ICD with resynchronization therapy. After
a mean follow-up of 4.93.8 years, 35 patients experienced at
least one appropriate therapy (45 %): 25 % appropriate therapy in the primary prevention group compared to 53 % of
patients in the secondary prevention group (P=0.45). The
mean time between ICD implantation and the first appropriate
therapy was 2.23.2 years. Overall, one ICD-related complication occurred in 30 patients (38 %), including inappropriate shock (n=9), major pocket hematoma (n=1), lead dysfunction (n=12), infection (n=4), shoulder algodystrophia
(n=2), device failure or dislodgement needing reintervention
(n=2). Eventually, four patients were transplanted (5 %), and
six patients (8 %) died during the course of follow-up (including two without previous appropriate therapy). Conclusions
Considering relatively long-term follow-up, patients with
TOF and ICDs experience high rates of appropriate ICD therapies, in both primary and secondary prevention. Major ICDrelated complications remain, however, high. Selection of candidates, especially for primary prevention implantation, remains challenging and may be improved in the future.
Abstract oral session 3: Atrial fibrillation and prevention
of related thromboembolism
210
31 Abstract 1525
32 Abstract 1557
PERSISTENT LEFT ATRIAL APPENDAGE

THROMBUS IN NON-VALVULAR ATRIAL
FIBRILLATION AND RISK OF
THROMBOEMBOLISM
FEASIBILITY AND SAFETY OF UNINTERRUPTED

PERI-PROCEDURAL APIXABAN ADMINISTRA
TION IN PATIENTS UNDERGOING
RADIOFREQUENCY CATHETER ABLATION FOR
ATRIAL FIBRILLATION: RESULTS FROM A
MULTICENTER STUDY
Omer Iqbal1, Yassar Nabeel1, Hardik Doshi1, Lee Joseph1,

Prashant Bhave1, Miriam Zimmerman1, Michael Giudici1
1
University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Background: In patients with non-valvular atrial fibrillation
(NVAF), a transoesophageal echocardiogram (TEE) is usually
performed to rule out left atrial appendage (LAA) thrombus
prior to initiating rhythm control, in order to reduce the risk of
thromboembolism (TE). When thrombus is detected by TEE, a
repeat study is often performed after 34 weeks of continuous
oral anticoagulation in order to document resolution of the
thrombus prior to restoring sinus rhythm. There are few data
assessing TE risk in patients with NVAF who have TEE which
document thrombus. We conducted this study to quantify the
TE risk in such patients. Methods: A single-center retrospective
review identified 65 patients with NVAF who were found to
have LAA thrombus on TEE and had a CHA2DS2VASCscore
of at least 1 between 2002 and 2014. Depending on subsequent
TEE findings, they were divided into three groups: patients with
persistent LAA thrombus (PLAAT) [N=15], resolved LAA
thrombus (RLAAT) [N=13], and unknown LAA thrombus
evolution (ULAAT) in patients with no repeat TEE [N=37].
TE event rates per person-year and all-cause mortality in these
groups were assessed. Results: Median follow-up was
1.93 years (PLAAT), 1.91 years (RLAAT), and 0.49 years
(ULAAT). Actual thromboembolic events/person-year were
4.2 (ULAAT), 0.36 (PLAAT), and 0.03 (RLAAT). The ULAAT
group had higher TE event rates when compared to PLAAT
(p=0.006) or RLAAT (p<0.0001); however, comparing event
rate between PLAAT and RLAAT, there was no significant
difference (p<0.115). After adjustment for CHA2DS2VASC
score, results did not differ. There was no significant difference
in overall mortality between three groups (p=0.48); however,
1-year mortality rates in each group were very high: 29 % for
ULAAT, 14 % for PLAAT, and 8 % for RLAAT. Conclusions:
In patients with no repeat TEE to ensure resolution of LAA
thrombus, there was an increased TE risk and increased mortality rate compared to those with persistent or resolved LAA
thrombus. This finding could be related to how closely patients
were followed up and treated in the RLAAT and PLAAT
groups. This finding could also be related to the fact that patients in the ULAAT group did not receive repeat TEE because
of their overall severity of illness.
Luigi Di Biase1, Dhanujaya Lakkireddy2, Chintan Trivedi3,

Thomas Deneke4, Martin Martinek5, Sanghamitra Mohanty3,
Prasant Mohanty6, Sameer Prakash7, Rong Bai3, Carola
Gianni8, Rodney Horton5, Elisabeth Sigmund5, Michael
Derndorfer 4 , Anja Schade 9 , Patrick Mueller 10 , Atilla
Szoelloes5, Javier Sanchez3, Amin Al-Ahmad 3, Patrick
Hranitzky5, G. Joseph Gallinghouse5, Richard H. Hongo5,
Salwa Beheiry10, Helmut Puererfellner5, Andrea Natale3
1. Texas Cardiac Arrhythmia Institute at St Davids Medical
Center and Albert Einstein College of Medicine at Montefiore
Hospital, Austin and New York, TX, USA 2. University of
Kansas Medical Center, Kansas City, KS, USA 3. Texas Cardiac Arrhythmia Institute at St. Davids Medical Center, Austin, TX, USA 4. Heartcenter Bad Neustadt, Bad Neustadt,
Germany 5. Elisabethinen Linz GmbH, University Teaching
Hospital, Linz, Austria 6. Texas College of Osteopathic Medicine, Fort worth, TX, USA 7. Tong Ji Hospital Tong Ji Medical College Hust, Wuhan, China 8. Texas Cardiac Arrhythmia Research, Austin, TX, USA 9. Northern California Heart
Care, San Francisco, CA, USA 10. California Pacific Medical
Center, San Francisco, CA, USA
Introduction: Periprocedural anticoagulation management
with uninterrupted warfarin with a therapeutic INR represents the best approach reducing both thromboembolic and
bleeding complications in the setting of catheter ablation for
atrial fibrillation (AF). The purpose of this study was to evaluate the safety and feasibility of uninterrupted apixaban administration in this setting.
Methods: We performed a prospective multicenter registry of
AF patients undergoing radiofrequency catheter ablation at
four Institutions in the USA and Europe with an uninterrupted
apixaban strategy. These patients were compared with an
equal number of patients, matched for age, gender, and type
of AF, undergoing AF ablation on uninterrupted warfarin.
The apixaban group comprised consecutive patients who
were on twice-daily 5 mg Apixaban for at least 30 days
prior to ablation. The last dose of apixaban was taken
the morning of the procedure. A subset of 29 patients
underwent dMRI to detect silent cerebral ischemia (SCI)
in the apixaban group.
Results: A total of 400 patients (200 patients in each group)

were included in the study. The average age was 65.9
9.9 years with 286 (71.5 %) male and 334 (83.5 %) patients
having non-paroxysmal AF. There were no differences in major (1 vs. 0.5 %,p=1.0), minor (3.5 vs. 2.5 %,p=0.56), and
total bleeding complications (4.5 vs. 3 %,p=0.43) between the
apixaban and the warfarin group, respectively. There were no
symptomatic thromboembolic complications. All the dMRIs
were negative for SCI in the apixaban group.
Conclusions: Uninterrupted apixaban administration in patients undergoing AF ablation appears to be feasible and effective in preventing clinical and silent thromboembolic
events without increasing the risk of major bleedings.
33 Abstract 1528
HYPERACUTE AND CHRONIC CHANGES IN
CEREBRAL MAGNETIC RESONANCE IMAGES
AFTER PVAC, NMARQ AND EPICARDIAL
THORACOSCOPIC SURGICAL ABLATION FOR
PAROXYSMAL ATRIAL FIBRILLATION
Conn Sugihara 1 , Neil Barlow 1 , Emma Owens 1 , David
Sallomi1, Steve Furniss1, Neil Sulke1
1
East Sussex Healthcare NHS Trust, Eastbourne, UK
Background: Asymptomatic cerebral events (ACEs) detected
with cerebral MRI immediately post AF ablation have been
reported with a number of AF ablation techniques. Methods:
Patients ablated with either PVAC, nMARQ or thoracoscopic
epicardial surgical AF ablation had cerebral MRIs performed
before, immediately after and 3 months after ablation. All
MRIs were independently reported by three radiologists
blinded to treatment assignment, in two phases. Firstly, MRIs
were anonymised, randomised and examined individually.
Then, each patients MRIs were compared in sequence to look
for new changes. Results: Fifty-four patients (mean age
65 years, median CHA2DS2-Vasc score 2) were analysed.
Sixty-five percent of patients received an immediate postablation MRI. Prior to ablation, although no patient had a prior
history of cerebral infarction (CI), 15.6 % of patients had MRI
evidence of CI, and 84.4 % had white matter change (WMC).
Of all scans, 8.3 % were reported to have a lesion consistent
with an ACE. However, most ACEs appeared on the baseline
or 3-month scans, hence were not ablation-related. Once
MRIs were compared in sequence, two ACEs on the hyperacute scan were shown to be pre-existing. There were two
(13.3 %) PVAC patients, one (6.7 %) nMARQ patient and
no surgical patients with ablation-related ACE. Three months
after ablation, there were no new CIs detected, but 43 % of
211
patients had evidence of progressive white matter change. No

patient had any clinical neurological abnormality detected at
any time during the study period. Conclusions: There was a
high background rate of asymptomatic cerebral lesions in patients undergoing AF ablation. The majority of ACEs were not
ablation-related. Cerebral MRIs in AF patients demonstrated a
very high rate of both baseline undocumented, and rapidly
progressive, asymptomatic cerebrovascular disease. The clinical relevance of cerebral MRI changes in AF ablation remains
unclear.
34 Abstract 1551
RIVAROXABAN AND TWO DOSAGES DABIGATR
AN VERSUS WARFARIN IN PATIENTS WITH HIGH
RISK OF STROKE AND EMBOLISM UNDERGOING
ELECTRICAL CARDIOVERSION WITH PERS
ISTENT AND LONG-ACTING ATRIAL
FIBRILLATION
Oskars Kalejs1, Olga Litunenko2, Aldis Strelnieks3, Sandis
Sakne 1, Milana Zabunova 1, Marina Kovalova 4 , Galina
Dormidontova5, Iveta Sime6, Natalija Pontaga5, Kaspars
Kupics1, Maija Vikmane1, Janis Guslens7, Aivars Lejnieks3,
Andrejs Erglis1
1
P. Stradins Clinical University Hospital, Riga, Latvia; 2Riga
Stradins University, Riga, Latvia; 3Riga East University Hospital, Riga, Latvia; 4Jelgava Regional Hospital, Jelgava,
Latvia; 5Daugavpils Regional Hospital, Daugavpils, Latvia;
6
Liepaja Regional Hospital, Liepaja, Latvia; 7Riga Technical
University, Riga, Latvia
Background. The important factor of safety in patients with
atrial fibrillation (AF) undergoing electrical cardioversion
(ECV) is appropriate use of oral anticoagulants (OAC). Novel
anticoagulants (NOAC) are a possible alternative to warfarin.
Methods. We have analysed the data in 1512 patients (pts)
undergoing ECV. One thousand one hundred ninety-three AF
defined as persistent and 319 as long-standing mean CHA2
DS2 VASc score was 3.61.9; 1025 had one or two ECV in
history. Nine hundred seventy-three (64.3 %) pts started the use
of NOAC: dabigatran (D) 405 pts 150 mg twice or 302 pts
110 mg twice or 266 rivaroxaban (R) 20 mg daily before
ECV for at least 21 days, 539 (35.6 %) started warfarin (W)
and 21 days start after INR was in range 2.03.0. One hundred
ten milligrams twice were prescribed for pts 75 years old,
HASBLEED risk score 3 and kidney problems.
Transoesophageal echocardiography (TEE) was encouraged
before ECV in all groups for pts with CHA2DS2VASc score
4, left atrial dilatation and AF duration 6 months. ECG and
212
echo data were analysed 30 and 90 days after ECV. Results.

ECV was successful after first shock in 1239 (92 %) pts, total
success ECVin 1318 (97.9 %) pts. Left atrial thrombi were
detected on TEE before ECV in 31 pts in NOAC group and 28
pts in W group, so pts continued OAC therapy for 2 months
and TEE had been performed again. Nine pts in D (150 mg
twice), 6 pts in R (20 mg od) group and 5 pts in W group were
free of thrombus and have been referred for ECV. Average time
of treatment before ECV was significantly lower for NOAC
(25 days) than with W (48 days, p<0.01). Stroke and systemic
embolism at 90 days were lower in the NOAC group (0.1 %)
than in the W group (1.5 %). The events in the NOAC group
were documented after discontinuation of the drug while in the
W group, eight events were detected during the use of OAC.
There was no difference in analysis of events between TEE and
non-TEE pts in D and R. NOAC pts had significantly lower
clinical relevant bleeding rate vs W (D 110 mg 0, D 150 mg
0.47 %, R 0.39 % vs W 2.87 %, p<0.04). Conclusions.
Dabigatran 150 and 110 mg twice and rivaroxaban 20 mg daily
are a safe, effective and reasonable alternative to warfarin for
patients undergoing ECV despite high CHA2DS2VASc risk
score, HASBLEED score and AF duration. The frequencies
of stroke and embolic events were lower in the dabigatran
150 and 110 mg and rivaroxaban 20 mg than in the warfarin
group with lower major bleeding within 30 and 90 days after
ECV. Patients on NOACs had a shorter anticoagulation period
before cardioversion.
35 Abstract 1536
SINUS RHYTHM AND QUALITY OF LIFE
IN THE AGE OF MODERN THERAPIES FOR
ATRIAL FIBRILLATION: RESULTS FROM
THE PREFER IN AF REGISTRY
Liang-han Ling 1 , Hunter Ross 1 , Waqas Ullah 1 , Alex
Breitenstein1, Finlay Malcolm1, Aaisha Opel1, Sarah Horan1,
Bernd Brggenjrgen 2 , Harald Darius 3 , Raffaele De
Caterina4, Kamran Iqbal5, Jean-Yves Le Heuzey6, Paulus
Kirchhof7, Josef Schmitt8, Jose Luis Zamorano9, Richard
Schilling1
1
St Bartholomews Hospital, London, UK; 2Steinbeis-University, Institute for Health Economics, Berlin, Germany; 3Vivantes Hospital, Berlin, Germany; 4University Chieti-Pescara, Cardiology, Pisa, Italy; 5Daiichi-Sankyo UK Ltd,
Gerrards Cross, UK; 6Georges Pompidou Hospital, Ren
Descartes University, Paris, France; 7University of Birmingham, Birmingham, UK; 8 Daiichi-Sankyo, Munich, Germany;
9
University Hospital Ramn y Cajal, Madrid, Spain
Background: Clinical determinants of quality of life (QoL) in
AF have been poorly investigated. We evaluated these in a large
cross-sectional study and compared QoL measures between
patients on vitamin K antagonists (VKAs) versus the novel oral

anticoagulants (NOACs dabigatran, rivaroxaban, and
apixaban). Methods: The PREFER in AF registry (Prevention
of Thromboembolic EventsEuropean Registry in Atrial Fibrillation) enrolled 7243 consecutive AF patients aged above
18 years from centres in seven European countries from January 2012 to January 2013. Socio-demographic data, co-morbidities, AF characteristics, and therapies were evaluated for independent predictors of EuroQol-5D-5L (EQ-5D-5L) index value, an overall questionnaire-based measure of QoL, using simple and multiple logistic regression. Paired comparisons between matched patients taking VKAs versus NOACs (396 per
group) were made of (i) EQ-5D-5L component scores, (ii) Perception of Anticoagulant Treatment Questionnaire 2 (PACTQ2) measures of satisfaction and convenience, (iii) GP and
cardiologist outpatient encounters, and (iv) working days lost
to AF. Results: Reduced EQ-5D-5L index value (0.84)
was independently associated with the following: age >75 years
(OR 2.32), female gender (OR 1.80), unskilled occupation (OR
1.25), diabetes (OR 1.34), congestive heart failure (OR 1.24),
coronary artery disease (CAD, OR 1.35), prior ischaemic stroke
(OR 1.64), obesity (OR 1.41), left ventricular systolic dysfunction (OR 1.42), EHRA maximum score of 4 (OR 2.53), and
therapy with amiodarone (OR 1.40) (p<0.01 in all cases). Sinus
rhythm at assessment independently predicted higher EQ-5D5L score >0.84 (OR 1.5, p<0.001). NOAC therapy was associated with greater convenience and satisfaction than VKA
therapy, by PACT-Q2 measures (p<0.01). No significant differences in EQ-5D-5L index value, its subcomponent scores, GP
and cardiologist outpatient encounters, or working days lost to
AF, were found between matched VKA and NOAC users.
Conclusion: Maintenance of sinus rhythm is associated with
higher QoL in AF patients, even after accounting for the independent effects of multiple socio-demographic factors and comorbidities. Efforts to maintain SR, other than with the use of
amiodarone, may be of importance in improving QoL in the
patient subgroups most likely to be underservedthe elderly,
women, those of lower socioeconomic background, and those
with cardiovascular comorbidities. NOAC therapy is associated
with greater convenience and satisfaction over the use of VKAs
in a general AF population, but in this analysis was not associated with greater overall QoL.
36 Abstract 1533
PRIMARY PERIPHERAL ARTERY EMBOLISM:

ATRIAL FIBRILLATION RELATED RISK-STRA
TIFICATION AND RECURRENT EMBOLIC EVENTS
DURING LONG-TERM FOLLOW-UP.
Christian Mllenhoff 1 , Dirk Bastian 2 , Athanasios
Katsargyris1, Konrad Ghl2, Eric L. G. Verhoeven1

1
Paracelsus Medical University, Nuremberg Hospital, Dept.

of Vascular and Endovascular Surgery, Nuremberg,
Germany; 2Paracelsus Medical University, Nuremberg Hospital, Dept. of Cardiology/Rhythmology, Nuremberg,
Germany
213
Abstract oral session 4: Mechanisms of ventricular

arrhythmias
41 Abstract 0112
Acute peripheral ischemia of the upper extremity [API] is a

disease with standardized procedure in diagnostic and therapy in vascular surgery. In addition to specific vascular
therapy, one has to search for the source of the embolus.
In most cases, the embolus originates from the heart, due to
structural or rhythmological diseases. When atrial flutter or
fibrillation [AF] is detected, the indication for permanent
oral anticoagulation [OAC] is given. Chad2sVasc2-Index
supports risk stratification and decision making. But without the proof of AF, the level of cardiologic and
rhythmologic investigations is uncertain, also the need for
OAC. The aim is to evaluate the incidence of recurrent
embolic events during long-term follow-up after primary
API and its correlation with AF-associated risk factors. We
analysed hospital records of patients with API referred to
our department in 2005 for the diagnosis of peripheral embolisation, stroke, heart rhythms, cardiac disorders and
vascular diseases. Medical course as well as surgical therapy and medication at discharge were documented. Additionally, we screened our hospital database for recurrent
embolic events up to 2013. In 2005, 16 patients attended
our hospital with the diagnosis of API (mean age 73.6 years
0.6a). At admission, the surface electrocardiogram [ECG]
showed AF in 10 patients; 6 patients were in sinus rhythm
[SR]. In 10 out of 16 patients, a transthoracic echocardiography for embolus screening was performed; no patient
with SR received a long-term-ECG [TL-ECG] to rule out
AF. Mean Chad2sVasc2-Score was 3.622.0 over all, and
3.671.97 in SR group. While patients with AF received
OAC, SR patients were treated only with acetylsalicylic
acid [ASS] 100 mg/day. During follow-up period, recurrent embolic events occurred in 4 of 6 patients in SR group:
2 cases of embolisation of the upper extremity, 1 stroke, 1
transitoric ischemic attack. At the time of the recurrent
event, 3 of 4 patients were in SR, in one nothing was
documented. One was under therapy of ASS; no patient
was treated with OAC. Our retrospective study shows that
examination for the source of embolic events in patients
with API is inadequate. Patients with peripheral embolism
have a high risk according to the Chad2sVasc2-Score. During long-term follow-up, the rate of recurrent embolic
events is high, even if SR is documented. Therefore, a
prospective trial with long-term follow-up is needed to
evaluate the efficiency of a standardized diagnostic workup including LT-ECG and a risk adopted anticoagulation
strategy for secondary prevention of recurrent embolic
events.
PREVALENCE OF RIGHT VENTRICULAR

ENDOCARDIAL BIPOLAR LATE POTENTIALS
IN BRUGADA SYNDROME
Luigi Sciarra1, Ermenegildo De Ruvo1, Chiara Lanzillo1,
Alessio Borrelli 1 , Antonio Scar 1 , Marco Rebecchi 1 ,
Alessandro Fagagnini1, Marta Marziali1, Lucia De Luca1,
Domenico Grieco 1 , Ludovica Scialla 2 , Elisa Salustri 3 ,
Annamaria Martino1, Leonardo Cal1
1
Cardiologia - Policlinico Casilino, Italia, Italy; 2Cardiologia Policlinico Umberto I, Rome, Italy; 3Cardiologia - Universit
de LAquila, LAquila, Italy
Introduction: Brugada syndrome (BS) is considered to
be an electrical disease in structurally normal hearts.
The electrophysiological substrate of the syndrome is
not clarified. Late potentials (LPs) are bipolar signals
occurring after the QRS complex and have been identified as good target for VT ablation in structural heart
disease. Delayed ventricular activity has been identified
in a limited population of symptomatic BS patients at
the anterior epicardial aspect of the right ventricular
outflow tract (RVOT). Aim of our study: We aim to
assess the presence of endocardial right ventricular LP
in a BS population. Methods: We studied 10 patients
(mean age 3813 years; 7 males) with BS. Diagnosis
of BS was based on the typical ECG alterations: 9 patients showed spontaneous type 1 pattern; in 5 patients ,we observed a coved type pattern after flecainide
infusion. Control group: Eight patients (mean age 47
17 years; six males) without structural heart disease undergone to an ablation for atrio-ventricular nodal reentrant tachycardia. Every subject underwent to right
ventricular electroanatomical mapping with the Carto3
system (Biosense Webster). Low-voltage areas are areas
with a local voltage >1.5 and <0.5 mV. Scar areas are
areas with a local voltage <0.5 mV and absence of
ventricular capture with 10 V of output. LPs were defined as bipolar signals recorded after QRS termination.
Results: LPs were present in 6 patients with BS (60 %)
and in none of the controls (p<0.01). The number of
collected points was comparable in both groups (198
83 in BS vs 18142 in controls; p=NS). In all cases,
LPs were found in the RVOT tract: 4 anterior, 1 posterior and 1 septal RVOT. In all cases, LP areas were
coincidence or in proximity of low-voltage or scar
214
areas. In the 4 patients without LP, we did not find any

low-voltage or scar area. All patients with BS and evidence of LP showed a type 1 pattern ECG patter at the
time of endocardial mapping. Conclusions: Endocardial
bipolar LPs are common in patients with BS and are
mainly located at the RVOT. Our results need to be
confirmed in larger series and could be important for
future therapeutical developments in high risk BS pts.
42 Abstract 0211
SLOWING OF CONDUCTION VELOCITY VIA

GAP-JUNCTIONAL UNCOUPLING IS SUFFICIENT
TO CAUSE ELECTROGRAM FRACTIONATION
Shaun Selvadurai1, Emmanuel Dupont1, Caroline Roney1,
Norman Qureshi1, Fu Siong Ng1, Rasheda Chowdhury1,
Nicholas Peters1
1
Imperial College London, London, UK
Electrogram fractionation is commonly used to identify
areas of abnormal electrical activity to guide catheter ablation. Cellular mechanisms for this fractionation remain
largely unknown. In silico modelling questions whether
cell-cell coupling can lead to fractionation. We aimed to
investigate if conduction slowing by cellular uncoupling
alone was sufficient to lead to an increase in electrogram
fractionation in an in vitro simple cell model. A monolayer of HL-1 cell line myocytes was seeded onto 88 microelectrode arrays (100 mm electrodes/ 700 mm spacing)
and loaded with voltage sensitive dye di-8-ANEPPS.
Carbenoxolone (gap-junction uncoupler) was administered in incremental doses (050 M). After 5 min of
stabilisation, electrogram recordings were taken while optical images were simultaneously recorded. Administration of carbenoxolone resulted in up to 65 % conduction
slowing (p<0.001), with a significant increase in fractionation seen between 30, 40, and 50 M compared to baseline (p<0.05). Linear regression showed a significant correlation (p<0.001) between conduction velocity and percentage of fractionation (r2 = 0.5773). Reduced electrogram amplitude (p < 0.05) and increased duration
(p < 0.05) was seen with slower conduction, though no
significant change in total area under the curve (AUC)
was seen. Action potential duration (APD) remained unchanged. A correlation was found between cell-cell
uncoupling-induced conduction slowing and proportion
of electrogram fractionation; supporting current computer
models. The unchanged AUC and APD suggest ion exchange remains unaltered. We have shown that conduction slowing via cell-cell uncoupling may be sufficient for
electrogram fractionation.
43 Abstract 0116
GAP JUNCTION UNCOUPLING DURING ISCH
AEMIA ACTIVATES NORMALLY QUIESCENT
PURKINJE-MYOCARDIAL JUNCTIONS
RESULTING IN MORE COMPLEX ACTIVATION
PATTERNS
Fu Siong Ng1, Elham Behradfar2, Michael T Debney1, Anders
Nygren2, Adam Hartley1, Alexander Lyon1, Igor Efimov3,
Edward Vigmond4, Nicholas S Peters1
1
Imperial College London, London, UK; 2University of Calgary, Calgary, Canada; 3Washington University in Saint Louis, Saint Louis, MO, USA; 4 Universite Bordeaux 1, Bordeaux,
France
Introduction: The His-Purkinje system activates ventricular
myocardium through Purkinje-myocardial junctions (PMJs).
It has been suggested that most PMJs are normally nonfunctional at baseline due to sourcesink mismatches at these
junctions. We hypothesised that gap junctional uncoupling at
the PMJs during acute ischaemia facilitates propagation across
a greater number of functional PMJs, thereby leading to accelerated but more complex activation patterns. Methods: In
aortic-perfused rabbit hearts (n=8), the right ventricles (RV)
were exposed, preserving the Purkinje system (Figure), and
the endocardium optically mapped. Activation of the RV endocardium during atrial pacing was recorded during 40 min of
global ischemia followed by 30 min reperfusion. A corresponding detailed 3D computer model of rabbit ventricles
with Purkinje system was also constructed to test the hypothesis. Results: Optical mapping studies revealed that the percentage of RV area activated within the first 5 ms decreased
from baseline 53 6 to 43 8 % during early ischemia
(<20 min), and paradoxically then increased to 598 %, with
more complex activation (p<0.001). This coincided with
more surface breakthroughs at more PMJs during late
ischaemia (Figure). Activation normalised after reperfusion. In the computer model, a 6 % reduction in conductivity was sufficient to render quiescent PMJs active.
Increasing the fraction of functioning PMJs from 5 to
100 % accelerated endocardial activation from 27.1 to
15.8 ms, compensating for reduced conduction velocity.
Surface breakthroughs increased, as did the complexity
of activation, matching the experiments. Conclusion: At
baseline, most PMJs are quiescent. Ischaemia-induced
closure of gap junction channels reduces conduction velocity, but as the uncoupling progresses, more PMJs become functional due to reduced sourceload mismatch.
The altered, more complex, activation patterns during
ischaemia may be pro-arrhythmic as they increase the
pathways for meandering wavefronts and the likelihood
of wave collision.
44 Abstract 0214
CELLULAR CHARACTERISATION OF STROMAL
CELL AND CARDIOMYOCYTE COUPLING AT THE
CRITICAL ISTHMUS IN AN IN VIVO SWINE
MODEL OF POST-INFARCTION RE-ENTRANT
VENTRICULAR TACHYCARDIA
Tarvinder Dhanjal1, Nicolas Lellouche2, Chris Von Ruhling1,
David Edwards1, Chris George1, Alan Williams1
1
Wales Heart Research Institute, Cardiff, UK; 2 Henri Mondor
Hopital, Paris, France
Introduction: Electroanatomical- and MRI-based mapping techniques have defined the critical isthmus (CI)
in the post-myocardial infarction (MI) re-entrant VT
215
circuit as heterogeneous areas of myocardium within

the scar border zone (BZ). In vitro studies show
myofibroblast-cardiomyocyte (MFB-CM) coupling results in slow conduction, a pre-requisite for re-entry.
However, the nature and extent of functional coupling
between MFBs and CMs in vivo remains controversial.
We have performed a comprehensive evaluation of the
structural relationship between surviving CMs and stromal cells at the VT CI. Methods: All studies are performed according to the position of the European Union
Directive 2010/63/EU and approved by the Animal Care
a n d U s e C o m m i t te e o f t h e C e n t re H o s p i t a l i e r
Universitaire Henri Mondor (INSERM U955). Domestic
pigs underwent MI induction. The VT study was performed after 6 weeks with a substrate, pace and entrainment mapping approach to identify scar, BZ, CI, late
216
potentials and LAVAs. Electroanatomic-histological

overlay was achieved with three epicardial location
points assigned to the map and markers sutured at the
corresponding locations prior to explantation and histological analysis. Results: Table 1 shows voltage characteristics of VT-inducible (n=6) and non-inducible (n=6)
pigs. Histological analysis was focused on five distinct
regions: (1) VT CI sites, (2) BZ regions not VT CI, (3)
LAVAs, (4) dense scar and (5) normal myocardium.
Immunohistological analysis assessed cell-type-specific
markers identifying CMs, MFBs and fibroblasts with
regional extracellular matrix composition. Furthermore,
the distribution and magnitude of connexin (37, 40, 43
and 45) and cadherin (pan, OB and N) coupling between MFBs and cardiomyocytes was defined. Conclusion: This study demonstrates key electrophysiological
and histological differences in the post-infarct VT inducible heart and novel insights in the cellular composition
and architecture of the VT CI which forms the basis for
further molecular investigation which may lead to improved VT CI targeting for catheter ablation.
Table 1. Characterisation of post-MI myocardium associated
with non-inducible and inducible VT
p value
CARTO points (nsSE)
Non-inducible
VT
(n=6)
454112
Inducible
VT
(n=6)
39350
LV mass (g)
1463
14514
0.87
Voltage area bipolar

<2 mV (cm2)
Voltage area bipolar
<1 mV (cm2)
Border zone area (cm2)
Border zone area (% of scar)
2712
264
0.52
167
101
0.005
115
173
0.055
413
642
0.004
0.34
45 Abstract 01233
THE DEVELOPMENT OF A NOVEL SYSTEM FOR

THE STUDY OF CARDIAC
ARRHYTHMIASIMULTANEOUS
MEASUREMENT OF CALCIUM TRANSIENTS AND
ELECTRICAL ACTIVITY IN MURINE CARDIAC
TISSUE
Alastair Yeoh1, Malcolm Finlay2, Naomi Anderson3, Stephen
Harmer3, Andrew Tinker3
1
UCL and QMUL, London, UK; 2 Barts Health NHS Trust
and QMUL, London, UK; 3QMUL, London, UK
Introduction: More effective diagnosis and treatment of
cardiac arrhythmia requires a deeper understanding of
the underlying pathophysiology of arrhythmia. Existing

research primarily employs single-cell or whole-heart
models, but there is a translational gap between these
levels of study. This study describes the development of
a novel system to simultaneously measure calcium and
electrophysiology at the tissue level, intended to bridge
the gap between cell and organ research. Methods: A
combined calcium fluorescence and solid-state electrical
recording system was set up on an inverted microscope.
Samples of murine tissue were loaded with a fluorescent
calcium indicator dye (Fluo-4AM). Intracellular calcium
transients (elicited by electrical stimulation via external
electrodes) were recorded by a CMOS digital camera,
which measured emission light from samples excited
with a narrow wavelength LED. The validity of this
calcium imaging system was assessed by measuring
the effects of decreased cycle length and pharmacological agents on calcium transients. Electrical and fluorescence data were then obtained simultaneously. Electrical
data were recorded by contact electrodes in a multielectrode array. Results: Tissue was successfully loaded
with fluorescent dye and calcium transients (observed as
increases in green fluorescence, Figure) elicited by electrical stimulation were recorded. Calcium transient
height and duration decreased by 19 % (p<0.001) and
16 ms (95 % CI 1320), respectively, when coupling
intervals were reduced from 400 to 200 ms (n=5). Isoprenaline 100 nm reduced calcium transient length by
10 ms (95 % CI 4.816) (n=5). Increasing concentrations of nifedipine showed a dose-dependent decrease in
calcium transient size. Calcium fluorescence transients
were successfully measured in tandem with electrical
activity. Conclusion: The current study describes the
successful development of a calcium fluorescence imaging system and its integration into a multi-electrode array recording system. This system provides a novel
multi-parametric tool for the study of arrhythmia in cardiac tissue.
46 Abstract 1713
MELATONIN AND OMACOR INCREASE THRE

SHOLD TO INDUCE VF AND NORMALIZE
MYOCARDIAL CONNEXIN-43 EXPRESSION IN
FEMALE RATS EXPOSED TO HIGH SUCROSE DIET.
Tamara Benova1, Csilla Viczenczova1, Jana Radosinska2,
Vladimir Knezl 3 , Barbara Bacova 1 , Jana Navarova 3 ,
Branislav Obsitnik4, Jan Slezak1, Narcisa Tribulova1
1
Institute for Heart Research, Slovak Academy of Sciences,
Bratislava, Slovakia; 2Institute of Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia; 3Institute of
Experimental Pharmacology & Toxicology, Slovak Academy
of Sciences, Bratislava, Slovakia; 4St. Elisabeth Institute of
Oncology, Bratislava, Slovakia
Rationale and purpose: Abnormal localization and/or dysfunction of cardiac connexin-43 (Cx43) channels have been implicated in the occurrence of life-threatening arrhythmias. Our
previous studies indicate that diabetes is associated with Cx43
and PKC-epsilon alterations linked with slower conduction.
To elucidate the impact of glucose metabolism disorders on
development of Cx43 alterations and susceptibility of the
heart to inducible VF, we examined female rats that underwent
high sucrose diet. Moreover, we tested antiarrhythmic effects
of melatonin and Omacor and possible implication of Cx43
in this condition. Design and methods: The experiment was
performed on 9-month-old female Wistar rats that were divided into four groups: (1) controls, (2) rats drinking 30 % sucrose solution (HSD), (3) HSD supplemented with melatonin
(40 g/ml in drinking water) and (4) HSD supplemented with
omega-3 fatty acids (Omacor, 25 g/kg per diet). Left ventricle
was used for analysis of Cx43 mRNA and protein levels as
well as protein expression of PKC (which phosphorylates
Cx43) and PKC (which is implicated in pro-apoptotic signaling). Electrically inducible sustained VF was examined
using isolated-perfused heart. Results: High sucrose diet resulted in an increase of body weight, adiposity, plasma triglycerides
and cholesterol as well as heart and left ventricular weight. The
threshold to induce sustained VF was lower in rats exposed to
high sucrose diet, while both melatonin and Omacor significantly increased it. There were no changes in Cx43mRNA among
the groups. However, melatonin normalized the decreased Cx43
protein expression and its phosphorylation in HSD rats. Omacor
did not affect total Cx43 levels, but enhanced functional phosphorylated forms of Cx43. Moreover both, melatonin and
Omacor normalized diminished expression of PKCe and elevated expression of PKCd in rats exposed to high sucrose diet.
Conclusions: Findings indicate that high sucrose diet of female
Wistar rats results in downregulation of myocardial Cx43 and
PKC signaling that may be related to the increased susceptibility
217
of these rats to malignant arrhythmias. The adverse effects

can be attenuated by the treatment with either melatonin
or Omacor. This work was supported by VEGA 2/0046/
12, 1/0032/14, 2/0167/15, 2/0021/15 and APVV
0241/11, 0348/12 grants.
Abstract oral session 5: Advances in atrial fibrillation
ablation II
51 Abstract 0413
SITES OF ATRIAL FIBRILLATION ROTORS MAY

OVERLAY GANGLIONATED PLEXI IN LEFT
ATRIUM
Tina Baykaner 1, Junaid Zaman2, Theodoros Zografos3,
Ioannis Pantos3, David Krummen1, Demosthenes Katritsis3,
Sanjiv Narayan4
1
University of California, San Diego, San Diego, CA, USA, 2
Imperial College London, London, UK; 3 Athens Euroclinic,
Athens, Greece; 4 Stanford University, Palo Alto, CA, USA
Introduction: The cardiac autonomic nervous system plays
an important role in atrial fibrillation (AF). Recent advances
in mapping human AF report localised sources (rotors) treatable by focal ablation. We hypothesised that such rotors may
co-localise with ganglionated plexi (GP). Methods: We studied 70 consecutive patients with AF (61.18.6 years, 73 %
persistent) recorded with 64 pole contact catheters (Constellation, BSCI) and phase mapping of AF singularities (rotors)
at EP study. Electroanatomic shells were analysed independently by four blinded observers for overlap with superior/
inferior left GPs (SLGP, ILGP) or anterior/inferior right GPs
(ARGP, IRGP). GP locations were referenced to a database.
Results: AF sources arose in 68/70 (97 %) patients with a
mean of 2.11.0/each (left atria, LA 1.40.8, right atria, RA
1.00.7). Of all patients, 65 patients had LA sources. Of
these, 55 patients (85 %) had at least 1 rotor that colocalised with a GP, either definitely (24 patients, 27 %) or
possibly (31 patients, 48 %). Out of 96 LA rotors identified,
only 15 were not related to any GP. The figure shows 3
targeted rotors overlapping GP, and 1 RA rotor with no
GP overlap. There was a correlation between increasing
number of LA rotors and the likelihood of a rotor coinciding
with a GP site (p<0.001). Conclusions: Fibrillatory rotors in
human left atria commonly occur at sites of GPs, offering a
possible physiological basis for source formation and
targeted ablation. Future studies should define how patientspecific GP locations may sustain AF and the order of importance of these sites of structure/function co-localisation.
218
52 Abstract 2816
FEASIBILITY OF A NON-INVASIVE ELEC
TROCARDIOGRAPHIC MAPPING SYSTEM AT
LOCALISATION OF ECTOPY TO GUIDE ABLATION
IN PATIENTS UNDERGOING REPEAT CATHETER
ABLATION FOR ATRIAL FIBRILLATION
Norman Qureshi1, Cheng Yao2, Shahnaz Jamil-Copley1,
Michael Koa-Wing1, Sajad Hayat1, Fu Siong Ng1, Afzal
Sohaib1, Elaine Lim1, Ian Wright1, Nick Linton1, David
Lefroy 1 , Zachary Whinnett 1 , Nicholas Peters 1 , Prapa
Kanagaratnam1, Phang Boon Lim1, D Wyn Davies1
1
Imperial College, London, UK; 2 CardioInsight Technologies,
Cleveland, OH, USA
Pulmonary vein isolation (PVI) is the cornerstone of
atrial fibrillation (AF) ablation. Long-term outcomes
with PVI are plagued with recurrences necessitating

multiple procedures. The major causes of recurrence
are PV re-connection and non-PV triggers. We used a
non-invasive electrocardiographic mapping (ECM) system to localise PV and non-PV triggers, and guide ablation, in patients undergoing repeat AF ablations.
Twelve patients undergoing repeat AF ablation for recurrent symptomatic paroxysmal atrial tachycardia (AT)/
AF documented on ambulatory ECG monitoring
underwent pre/peri-procedural mapping using a 252electrode vest to locate the premature atrial complex
(PAC) break-out sites. All PVs were re-isolated, and
non-PV triggers mapped were targeted during the procedure. Twelve patients (54 11 years, 50 % male,
CHADSVASC 1 (03)) undergoing repeat AF ablation
(mean no. of previous procedures 2.9 (14)) underwent
pre and peri-procedural ECM. Eleven (92 %) patients
had at least 1 PV reconnection (mean 2 (14)), and only
one patient had maintained PV isolation in all four
veins (8 %). Seven PV and eight non-PV foci were
mapped with ECM. The PV foci originated from the
RUPV (4), RIPV (2) (see Fig. 2) and L common PV
(1). The non-PV foci originated from the superior vena
cava (4) (see Fig. 1), left atrial septum (2), right atrial
septum (1) and cristae terminal is (1). One patient did
not have any PAC on the day of the procedure. Three
patients had multiple foci, and the remaining (8/12) had
a single focus (4 PV and 4 non-PVI foci). Five of 11
(45 %) had recurrence of symptoms with documented
paroxysmal AF/AT at 6 months, but two of these were
likely to represent un-ablated ATs seen during the procedure. One patient has yet to reach the 6-month follow-up. Conclusion: Non-invasive ECM can accurately
identify sites of PV and non-PV triggers in patients
undergoing repeat catheter ablation for AF. This can
help devise an ablation strategy pre-procedurally.
219
220
53 Abstract 1546
SIMILARITY OF SUBSTRATES IN PATIENTS WITH

POST-ABLATION RECURRENT PAROXYSMAL
ATRIAL FIBRILLATION VERSUS PERSISTENT
ATRIAL FIBRILLATION: A 10-CENTER
PROSPECTIVE STUDY
Junaid Zaman1, Vijay Swarup 2, Robert Kowal 3, James
Daubert4, John Day5, John Hummel6, David Krummen7,
Moussa Mansour8, Vivek Reddy9, Kevin Wheelan3, Sanjiv
Narayan1, John Miller10
1
Stanford University, Stanford, CA, USA, 2 Arizona Heart
Rhythm Center, Phoenix,AZ, USA; 3Baylor University Medical Center, Dallas, TX, USA, 4 Duke University Medical Center, Durham, NC, USA; 5Intermountain Medical Center, Salt
Lake City, UT, USA; 6Ohio State University, Columbus, OH,
USA; 7University of California, San Diego, San Diego, CA,
USA; 8 Massachusetts General Hospital, Boston, MA, USA;
9
Mount Sinai School of Medicine, New York, NY, USA;
10
Indiana University School of Medicine, Indianapolis, IN,
USA
Introduction: The role of atrial fibrillation (AF) substrates is unclear in patients with paroxysmal AF (PAF)
that recurs after pulmonary vein (PV) isolation. We
hypothesised that AF-maintaining substrates in redoPAF patients is closer to those with persistent AF than
to initial PAF. Methods: In 134 patients (LA size 56.6
8 mm, LVEF 55.69 %), AF was recorded in both atria
using 64 pole-baskets, and custom software was used to
identify sources. Substrate characteristics were compared
between patients at 1st ablation for PAF, redo-ablation
for PAF and persistent AF. Results: AF sources occurred
in 99 % of patients (133/134). Patients at first PAF ablation (n =22), compared to persistent AF (n=88), had
fewer sources (2.31.0 vs 2.81.3, p=0.08), nearer the
PVs (24.0 vs 18.0 %, p=0.18), and required less ablation
time (13.29.0 vs 18.611.7 min, p<0.03; figure). Conversely, compared to persistent AF patients, those for
redoPAF (n= 24) had similar source numbers (3.0 1.6
vs 2.81.3, p=0.44) proportions near the PVs (16.2 vs
18.3 %, p=0.68), and ablation time (15.912.2 vs 18.6
11.7, p=0.29). PAF patients at first ablation had lower
LA diameters (p < 0.004), heart failure class (p = 0.05),
and CHADS2 score (p=0.07) than persistent AF patients.
These differences did not exist in redoPAF patients. Conclusions: PAF patients with recurrent AF after PVI are
closer to patients with persistent AF, in numbers and
locations of substrates (rotors) and comorbid conditions,
than to first-time PAF ablation patients. This implies

common mechanisms of AF in diverse groups. Classifying substrate may help to define a more accurate patient
classification in order to tailor ablation to individual
physiology.
54 Abstract 1537
FEASIBILITY, SAFETY AND COSTS OF DAY CASE

AF ABLATION
Sarah Anderson1, Conn Sugihara1, Ragunath Shunmugam1,
Rick Veasy1, Aerakondal Gopalamurugan1, Steve Furniss1,
Neil Sulke1
1
Cardiology Research Department, Eastbourne Hospital,
East Sussex Healthcare NHS Trust, UK, Eastbourne, UK
Background: In most institutions, patients undergoing
AF ablation are routinely admitted for at least one
night post-procedure. At our institution, if patients are
clinically stable and accompanied, they are offered day
case discharge. All patients are instructed to re-present
directly to the cardiac care unit at any time if they have
any concerns. Methods: The medical records for 150
consecutive AF ablations performed under sedation between October 2013 and July 2014 were examined.
Demographics, procedural factors and complications
were described. All re-attendances to secondary care
within 30 days of the ablation were recorded regardless
of the cause. Results: Thirty-one percent of AF ablations were performed as day case procedures. There
were no complications. There were no significant differences in demographics, procedure times or early post
procedural reattendance compared to overnight stay
patients.
221
Day case AF
ablation
46
Overnight stay
after ablation
104
Total
A 86 %, B 7 %, C 7 %
A 88 %, B 9 %, C 3 %
A 87 %, B 8 %, C 5 %
NS
1. 86 %, 2. 19 %
66 (44 to 83)
1. 80 %, 2. 18 %
66 (34 to 88)
1. 83 %, 2. 18 %
66 (34 to 88)
NS
NS
Female (%)
50
48
49
NS
Mean overall procedure duration (min)

Median duration of hospital stay
Any re-attendance within 30 days
100
9h
5 (11 %)
102
27 h
15 (14 %)
102
26 h
20 (13 %)
NS
<0.001
NS
2014 NHS tariff cost of admission hospital bed
225
705
N
Technology used, A multipolar cathether RF
ablation, B point-to-point ablation, C Cryo ablation
1. Paraxsysmol AF, 2. Persistant AF
Age in years (range)
5-5 Abstract 1541

SAFETY AND EFFICACY OF PULMONARY VEIN
ISOLATION USING A CIRCULAR, OPEN IRRI
GATED MAPPING AND ABLATION CATHETER: A
MULTI CENTER REGISTRY
Ermenegildo de Ruvo 1, Massimo Grimaldi 2, Giovanni
Rovaris 3 , Ezio Soldati 4 , Giuseppe Stabile 5 , Matteo
Anselmino 6 , Francesco Solimene 7 , Assunta Iuliano 5 ,
Vincenzo Schillaci6, Luigi Sciarra1, Maria Grazia Bongiorni4,
Fiorenzo Gaita6, Leonardo Cal1
1
Policlinico Casilino ASL RM/B, Rome, Italy; 2Ospedale
Miulli, Acquaviva delle Fonti, Italy; 3Osedale San Gerardo,
Monza, Italy; 4Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; 5Clinica Mediterranea, Napoli, Italy; 6Dipartimento
Scineze Mediche, Universit di Torino, Torino, Italy; 7Clinica
Montevergine, Mercogliano, Italy
Introduction. Pulmonary vein isolation (PVI) is the cornerstone
of catheter ablation in patients with atrial fibrillation (AF). Single shot ablation devices have been recently engineered. We
report on the acute safety and efficacy of a novel ablation catheter
for PVI in patients with paroxysmal and persistent AF. Methods.
One hundred-eighty consecutive patients (5810 years, 125
males, 31 % with structural heart disease) referred for paroxysmal (140 patients) or persistent (40 patients) AF underwent PVI
by an open-irrigated mapping and radiofrequency (RF) decapolar
ablation catheter (nMARQ, Biosense-Webster Inc., Diamond
Bar, CA) in seven Italian centers. Ablation was guided by electroanatomic mapping allowing RF energy delivery in the antral
region of pulmonary veins (PVs) from ten irrigated electrodes
simultaneously. A maximum of 25 W were applied per vein.
Results. Mean overall procedure time was 11353 min with a
mean fluoroscopy time of 13.18.4 min. The use of a preablation PV imaging related to a significant reduction in fluoroscopy time (from 14.79.7 to 8.76.6, p<0.001). Mean ablation
P value
150
time (RF time needed for PVI) was 12.55.1 min; 98 % of the
targeted veins were isolated with a mean of 23.46.3 RF pulses
per patient. In only four patients, a single point ablation strategy
was required to achieve the PVI. No stroke/TIA, pericardial effusion, or cardiac tamponade were observed. Only one groin
hematoma was reported. Conclusions. In this multicenter registry, irrigated multi-electrode RF ablation resulted widely feasible,
achieving a high rate of isolated PVs. In addition, procedural and
fluoroscopy times were comparable with other techniques and,
importantly, related to low complication rates. Pre-ablation imaging allowed reduced fluoroscopy time.
56 Abstract 1540
SINGLE-CENTRE EXPERIENCE AND OUTCOME

OF PERSISTENT AF ABLATION USING THE NMAR
Q CATHETER: 2-YEAR FOLLOW-UP
Shunmugam Ragunath Shunmugam1, Rick Veasey1, Conn
Sugihara1, Sarah Anderson1, Aerakondal Gopalamurugan1,
Furniss Steve1, Sulke Neil1
1
East Sussex health care NHS trust, Eastbourne, UK
Introduction: The nMARQ ablation system allows for mapping
and AF ablation via a continuously irrigated decapolar lassoconfiguration catheter. nMARQ ablation was initially used in
paroxysmal AF (PAF), but is increasingly being used in persistent AF (PersAF). We describe our experience of nMARQ ablation for PersAF, with 2-year follow-up data available. Methods:
Fifty-seven consecutivenMARQablations for PersAF performed
between September 2012 and March 2014 were analysed. Medical history, screening and procedure times, requirement and time
duration to repeat ablation and ablation complications were collated. Repeat ablations for AF or atrial tachycardia (AT) were
compared with 100 nMARQ and 100 PVAC ablations for PAF,
at our institution. Results: The mean age of patients was
222
64.9 years, and 20 % were female. Mean AF duration prior to

ablation was 39 months. Mean ejection fraction was 55 %, mean
left atrial diameter 4.6 cm. Thirty-nine percent had hypertension.
Mean CHA2DS2-Vasc score was 1.6. Mean procedure time was
94.5 min. All patients underwent pulmonary vein isolation, and
70 % received additional CAFE guided ablation: 50 % to the
septum, 50 % to inferior LA and 30 % also had a cavotricuspid
isthmus line. There were no procedural complications. Fourteen
percent of patients required a repeat ablation for AF recurrence
(8.8 %) or AT (5.2 %). The mean duration to repeat ablation from
the first procedure was 547 days. Time to requirement of repeat

ablation from first ablation did not show any significant difference between nMARQ ablations for Pers AF and nMARQ or
PVAC ablations for PAF. Conclusions: Use of nMARQ catheters
for Pers AF ablation is safe and has a similar time required to
repeat ablations compared to PAF ablation with nMARQ and
PVAC catheters. The nMARQ catheters and the system is flexible enough to allow non-pulmonary vein targets to be ablated
and hence can be considered a potential first-line technology for
Pers AF ablation.
Abstract oral session 6: Cardiac resynchronization

therapy: techniques and outcome
Department of Cardiology, St Bartholomews Hospital, London, UK; 2 The Bristol Heart Institute, University Hospital
Bristol NHS Foundation Trust, Bristol, UK

61 Abstract 2420
A HIGHLY EFFECTIVE TECHNIQUE FOR TRAN

SSEPTAL ENDOCARDIAL LEFT VENTRICULAR
LEAD PLACEMENT FOR DELIVERY OF CARDIAC
RESYNCHRONISATION THERAPY
Giulia Domenichini1, Ihab Diab2, Niall Campbell1, Mehul
Dhinoja1, Ross Hunter1, Simon Sporton1, Mark Earley1,
Richard Schilling1
Background: Endocardial transseptal left ventricular

(LV) lead delivery is challenging due to the absence
of dedicated equipment designed for this procedure.
We describe a new technique for delivery of a
transseptal LV lead. Methods: Patients (pts) with class
1 indication for CRT and a previous failed attempt at
conventional LV lead placement via the coronary sinus
were offered this procedure. All pts were anticoagulated
with warfarin. The implantation technique is shown in
the Figure. A left subclavian and right femoral venous
access are initially obtained. a a gooseneck snare (a) is
opened in the right atrium (RA) through which an
Endrys needle and Mullins sheath (b) are advanced

into the RA. b A transseptal puncture is made and a
wire is placed in the left upper pulmonary vein. c The
snare is advanced into the left atrium (LA) and an Attain sheath is advanced over the snare. d The snare is
removed leaving the Attain sheath in the LA. e An
active fixation lead is advanced through the sheath into
the LV and screwed into the lateral wall. The sheath is
split and removed. f All three LV leads are seen: (c) a
previous transvenous lead, (d) a surgical epicardial lead
and (e) the new active fixation lead. Results: The pro-
223
cedure was performed successfully in all 12 patients

attempted. The median procedure and fluoroscopy time
were 148 min (IQR 113176) and 16 min (IQR 1019).
Endocardial LV lead electrical parameters were satisfactory at implant and stable over time. The only complication was a pocket haematoma in a pt with a subpectoral generator. There was no need for repeat procedures after a median follow-up of 97 days (IQR 36
250). Conclusion: This approach provides a reliable
and effective alternative technique for delivery of an
endocardial LV lead inserted transseptally into the LV.
224
62 Abstract 2414
COMPARATIVE EFFECTIVENESS OF LEFT VENT

RICULAR VERSUS BIVENTRICULAR PACING FOR
CARDIAC RESYNHRONIZATION THERAPY: A
META-ANALYSIS OF RANDOMIZED
CONTROLLED TRIALS
transplantation, hospitalization, improvement in LVEF,

and exercise tolerance. In patients treated with CRT
who are not pacemaker-dependent, LV-only pacing is
an alternative to increase battery longevity.
63 Abstract 3116
Daniele Muser1, Pasquale Santangeli2, Andrew Epstein2,

Mathew Hutchinson 2 , Erica Zado 2 , David Callans 2 ,
Alessandro Proclemer1, Francis Marchlinski2
1
Azienda Ospedalieera Santa Maria della Misericordia, Udine, Italy; 2Hospital of the University of Pennsylvania, Philadelphia, PA, USA
ATRIAL RESYNCHRONIZATION COMBINED WITH

BACKGROUND ANTIARRHYTHMIC THERAPY
IMPROVES SURVIVAL IN PATIENTS WITH ATRIAL
FIBRILLATION AND HEART FAILURE WITH OR
WITHOUT SYSTOLIC LEFT VENTRICULAR
DYSFUNCTION
Background: Cardiac resynchronization therapy (CRT)

reduces symptoms and improves survival in patients
with severe left ventricular (LV) dysfunction and
prolonged QRS duration. The extent to which such benefit is due to biventricular (BV) versus LV pacing is
unclear. This systematic review and meta-analysis of
randomized trials compares BV versus LV-only pacing
in patients undergoing CRT. Methods: we searched
PubMed central, BioMed Central, Embase,
Cardiosource, clinicaltrials.gov, and ISI web of Science
for randomized controlled trials specifically designed to
compare BV versus LV only pacing in patients undergoing CRT. Data regarding all-cause mortality or heart
transplantation, hospitalization, LV ejection fraction
(LEF), and exercise tolerance (i.e., 6-min walking test
and MWT) were extracted. Odds ratios (OR) and
weighted mean difference (WMD) with their 95 % confidence intervals (CI) were calculated and pooled using
a random-effect model. Results: We identified eight trials that enrolled 786 patients (age 63.32,9 years, 73 %
males) with severe LV dysfunction (LVEF 23.41,9 %,
57 % ischemic cardiomyopathy, average QRS duration
17318 ms). Three hundred forty-two (43 %) patients
were randomized to LV-only pacing. The mean followup duration was 6.54.1 month. On pooled analysis, no
difference was found between LV-only and BV pacing
for the endpoints of death or heart transplantation (OR
1.12, 95 % CI 0.532.39, P=0.77) and hospitalization
(OR 0.46, 95 % CI 0.092.26, P=0.34). Compared to
BV pacing, LV-only pacing provided similar improvements in LVEF (mean increase 5.3 1.1 % vs 6.4
2.9 %, respectively; WMD 0.98, 95 % CI 2.47 to
0.51, P=0.19) and exercise tolerance at 6 MWT (mean
increase 46.4 24.6 m vs 51.9 20.4 m, respectively;
WMD 4.43, 95 % CI 15.46 to 6.59, P=0.43). Conclusions: LV-only pacing provides similar benefits to
BV pacing in terms of all-cause mortality, need for
Sanjeev Saksena1, Marwan Saad1, April Slee1, Hansini

Laharawani1, Rangadham Nagarakanti1
1
Electrophysiology Research Foundation, Warren, MI, USA
Background: Dual-site right atrial pacing (DAP) produces
biatrial electrical resynchronization, improved left atrial filling
and reverse remodeling. We examined the long-term (>5 year)
outcomes of DAP added to background (AAD) and/or ablation (ABL) therapy (Rx) in atrial fibrillation (AF) patients
(pts) with heart failure (HF). Methods: Seventy-one pts with
AF and HF refractory to AADs and/or ABL (n=27) were
implanted with DAP systems. HF subgroups were stratified
by LV ejection fraction (LVEF) >45 % (HF preserved {p} EF)
or <45 %(HF reduced {r}EF). Sinus rhythm maintenance
(rhythm control) and long-term survival were evaluated. Results: HFpEF (n=36) and HFrEF (n=35) pts, mean age 67
10 years, 69 % male, mean LV ejection fraction 43+14 %,
mean NYHA class 2.5 were followed for 5.4 years (median,
IQR 2.911.0). HFpEF pts were comparable for age, gender,
AF class, prior AADs and NYHA HF class to HFrEF pts but
had higher LVEF (53+5 vs. 31+10 % p<.001). Long-term
follow-up was comparable (HFpEF median = 7.2 years,
HFrEF=5.1 years, p=0.7) After DAP, rhythm control at last
follow-up was comparable in HFpEF (89 %) and HFreF
(85 %, p=ns) pts and in paroxysmal AF (90 %) and persistent AF (83 %, p=ns) pts. Fifty-seven percent of pts had >1
AF recurrence but 87 % of these pts remained in rhythm
control. Total survival was 72 % at 5 years. Survival in pts
with HFpEF was superior to HFrEF at 5 and 10 year (Figure). Conclusions: 1. AF pts with HFpEF and HFrEF
achieve a comparably high degree of rhythm control with
DAP and is maintained in a majority of AF pts with HF at
5 years. 2. Survival of HFpEF pts after DAP was superior to
HFrEF and both were superior to historical data for AF with
HF. 3. DAP may offer additional rhythm control and survival benefits for AF pts with HF due to electrical and
mechanical resynchronization
64 Abstract 3110
RATE DEPENDENT LEFT ATRIAL PRESSURE

CHANGE IN PATIENTS WITH IMPAIRED LEFT
VENTRICULAR DIASTOLIC FUNCTION: PACING
VS. ISOPROTERENOL
Tae-Hoon Kim1, Junbeom Park1, Jin-Kyu Park1, Jae-Sun
Uhm1, Boyoung Joung1, Moon-Hyoung Lee1, Hui-Nam Pak1
1
Yonsei University Health System, Seoul, Republic of Korea
Background: Although we previously reported that peak
left atrial (LA) pressure during sinus rhythm (LAPpeak)
is associated with the degree of LA remodeling and left
ventricular (LV) diastolic function estimated by E/Em
among the patients with atrial fibrillation (AF), hemodynamic linkage between LAPpeak and LV diastolic function has not yet been clearly explored. We hypothesized
that isoproterenol (Iso) stress results in different
LAPpeak responses depending on the existence of LV
diastolic dysfunction. Methods: We measured LAPpeak
in 175 patients (67.4 % male, 59.1 10.5 years old,
225
69.7 % paroxysmal AF) who underwent radiofrequency

catheter ablation for AF at the beginning of the procedures. LAPpeak was measured in sinus rhythm with right
atrial pacing and Iso infusion (5 g/min) at the heart
rates (HR) of 90, 100, 110, and 120 bpm, respectively.
We compared dynamic changes of LAPpeak between the
patients with LVDD (E/Em>15) (n=26) and those without (control group, E/Em15) (n=149). Results: 1. In
contrast, LAPpeak was increased as paced heart rate (HR)
increased generally (p<0.001); it was gradually reduced
as Iso induced HR increased (p=0.014). 2. As increase of
paced HR, LAPpeak was increased in both the control
group (E/Em15) (p < 0.001) and the LVDD group
(E/Em > 15, p = 0.034). 3. With Iso stress HR response,
LAPpeak was reduced in the control group (p =0.006).
However, LAPpeak response to Iso stress HR change
was blunted in the LVDD group (p=0.745). Conclusions:
Responses of LAPpeak to HR increase have opposite tendency between paced tachycardia and Iso stress in total
study population. However, LAPpeak change response to
Iso stress is impaired in patients with LVDD, suggesting
Iso-augmented LV diastolic function contributes to the
reduction of LAPpeak.
226
65 Abstract 2419
66 Abstract 2413
LONG-TERM FOLLOW-UP AFTER LEFT VENT

RICULAR ENDOCARDIAL RESYNCHRONIZATION
THERAPY: MORTALITY AND THROMBOEMBOLIC
COMPLICATION
NON-ISCHEMIC CARDIOMYOPATHY AND LOW

BURDEN OF SCAR AS REVEALED BY AN
ECG-SCORE: NO NEED FOR A DEFIBRILLATOR IN
SPECIAL PATIENTS AFTER CARDIAC RESYNC
HRONISATION?
Zsuzsanna Kis 1 , Imre Kassai 1 , Attila Mihalcz 1 , Attila

Kardos1, Csaba Foldesi1, Andrea Arany2, Gabriella Gyori2,
Tamas Szili-Torok3
1
Gottsegen Gyorgy National Cardiology Institute, Budapest,
Hungary; 2United St. Istvan and Laszlo Hospital, Budapest,
Hungary; 3Erasmus University, Rotterdam, Netherlands
Introduction: Cardiac resynchronization therapy (CRT) is an
established therapeutic option in selected end-stage heart failure patients (pts). Despite the technological improvements in
considerable amount of pts, the traditional transvenous left
ventricle (LV) pacing lead implantation fails. The transapical
LV lead implantation is a minimally invasive, surgical,
endocardiac implanting technique. The long-term outcome
of endocardial LV lead placement is unknown. Hypothesis:
The aim of this prospective study was to determine the longterm mortality and cerebrovascular thromboembolic complications of patients who underwent transapical endocardial LV
lead placement. Methods: Twenty-three CRT candidate pts
(18 men (78 %); mean age 61.210.5 years) not responding
to traditional CRT or with a failed coronary sinus approach
underwent transapical LV lead placement between 2007 and
2013. In all cases, the LV electrode was fixed into the basallateral segment of the LV. After the operation, the target INR
level was aimed to be between 2.5 and 3.5. We assessed the
long-term mortality rate and performed cerebrovascular CT
scan to determine any possible thromboembolic event in relation to LV lead implantation. Results: Eleven out of 23
(47.8 %) patients were alive after a follow-up of 40
24.5 months. One out of 11 alive patients was lost to followup. In two patients LV lead repositioning was performed.
Native cerebral CT scan examination was performed in 7
out of 10 followed-up pts. Major acute ischaemic stroke
occurred in one case (14.2 %) after transvenous implant
of LV lead following transapical LV lead fracture. Due to
the early postoperative period and oral anticoagulation
therapy, thrombolytic therapy was contraindicated. In another case, transapical LV lead repositioning was indicated due to LV lead capture problem; 1 month later, left
ventricle assist device was implanted. Conclusions: Endstage heart failure patients who underwent transapical LV
lead implantation have a long-term mortality rate of approximately 50 %. Major ischaemic cerebrovascular
event after transapical LV lead implantation is expected
in limited cases.
Martin Grett1, Hans-Joachim Trappe1

Department of Cardiology and Angiology, University of
Bochum, Bochum, Germany
1
Purpose: A definition of patients (pts) at very low risk for

sustained ventricular tachycardia or ventricular fibrillation could
lead to a more widespread use of CRT-pacemakers instead of
defibrillators. A high burden of scar as a substrate of ventricular
tachyarrhythmia can be ruled out by the modified SelvesterECG-score (MSES), which correlates with the scar burden. Every 1 point raise counts for 3 % additional scar of the left ventricle (LV). In a retrospective analysis of SCD-HeFT it has
shown a value in describing pts at high vs low risk for ICDtherapy. Its value in pts with indication for CRT was investigated
by our department. Methods: We studied 74 pts who underwent
CRT-D implantation and had complete follow-up of device interrogations for 3 years at our department. Pts with secondary
prophylactic indication for ICD or upgrade from existing devices were not studied. Following characteristics among others
were investigated: modified Selvester-ECG-score, LVEF and
occurrence of adequate ICD-therapy. Results: Median LVEF
was 20 % (range 10.029.0 %); median ECG-score was 4 (0
12). Eighty-five percent were male; mean age was 65,7 years.
Aetiology of cardiomyopathy was ischemic (ICM) in 33 pts,
non-ischemic (NICM) in 41. About one third of the pts (25/
74) suffered adequate ICD-therapy in the 3-year period. NICM
pts with a MSES of 3 points or less had no need for adequate
ICD-therapies. These findings are shown in the table:
ICM orNICM
and MSES
4
NICM and
MSES
3
p value
55
19
Age (mean)
66.7
62.7
0.052
Male (%)
89
74
0.106
LVEF % (mean)
19.8
21.8
0.144
ICD therapy
45 % (25/55)
0 % (0/19)
Relative risk for ICD

therapy (95 %
confidence interval)
18.21 (1.16285.47)
0.038
Conclusion: Applying the modified Selvester-ECG-score to pts

with non-ischemic cardiomyopathy and indication for CRT is a
promising way to identify pts at very low risk for ICD-therapy.
Management of pts with indication for CRT could be improved

by use of this parameter, particularly with regard to the question
if a CRT-Pacemaker is an alternative in more pts.
Abstract oral session 7: Mapping and ablation of
ventricular arrhythmias
227
showed a recurrence of clinical VPBs. However, none of them

experienced VF recurrence during a follow-up time of 5 years,
8 months and 10 years, respectively, as confirmed by interrogation of the ICD. Conclusion: Ablation of short coupled
VPBs triggers shows a high efficacy in preventing VF recurrence in an intermediate and long-term follow-up in patients
with idiopathic VF.

72 Abstract 1710
71 Abstract 1718
INTERMEDIATE TO LONG-TERM FOLLOW-UP OF

IDIOPATHIC VENTRICULAR FIBRILLATION
ABLATION
Cheryl Teres1, Mehdi Namdar1, Pascale Gentil-Baron1, Henri
Sunthorn1, Haran Burri1, Dipen Shah1
1
Hpitaux Universitaires de Genve, Service de Cardiologie,
Geneva, Switzerland, Geneva, Switzerland
Introduction: Catheter ablation of idiopathic ventricular fibrillation (VF) targeting ventricular premature beats (VPBs) originating from the ordinary myocardial muscle or within the
Purkinje system has been shown to be very effective for the
prevention of VF recurrences. Methods: Patients were referred
for ablation of idiopathic VF triggered by short coupled VPBs
after exclusion of a macroscopic arrhythmogenic substrate by
extensive diagnostic workup including physical exam, blood
tests, Holter monitoring, cardiac ultrasound and coronary angiography. They all had experienced cardiopulmonary resuscitation due to an episode of idiopathic VF and multiple VF
episodes terminated by their ICD before radiofrequency (RF)
ablation. RF ablation was guided by activation and pace mapping and aimed to abolish all clinical VPBs. Results: Three
male patients (29, 55 and 58 years) underwent the ablation
procedure. All three patients had experienced multiple appropriate ICD shocks for VF. VPBs showed LBBB morphology
in all of them and had an ectopic QRS duration of 138, 168
and 158 ms and a coupling interval initiating VF of 384, 291
and 378 ms, respectively. Triggering VPBs originated from
the RVapex, the anterior wall of the RVOT and the RVanterior
muscular wall, respectively. In two patients, RF delivery triggered polymorphic non-sustained VT even at sites without
Purkinje potentials and subsequently eliminated ectopy and
Purkinje potentials at sites where best pace map was achieved.
Suppression of reproducibly induced mechanical and RF provoked polymorphic VT and VF from a localized site in the RV
anterior wall (with best pace map) was observed in one patient, suggesting combined suppression of trigger and local
substrate. Ablation dramatically reduced the percentage of
VPBs in two patients as confirmed by Holter ECG monitoring
at maximal follow-up (1 and 10 VPBs), while one patient
ACUTE HEMODYNAMIC DECOMPENSATION

DURING CATHETER ABLATION OF
SCAR-RELATED VT: INCIDENCE, PREDICTORS
AND IMPACT ON MORTALITY
Daniele Muser1, Pasquale Santangeli2, Silvia Magnani3, Erica
Zado 2 , Mathew Hutchinson 2 , Gregory Supple 2 , David
Frankel2, Fermin Garcia2, Rupa Bala2, Michael Riley 2,
Eduardo Rame2, Sanjay Dixit2, Alessandro Proclemer1,
Francis Marchlinski2, David Callans2
1
Azienda Ospedaliera Santa Maria della Misericordia di Udine, Udine, Italy; 2Hospital of the University of Pennsylvania,
Philadelphia, PA, USA; 3Azienda Ospedaliera di Trieste,
Trieste, Italy
Introduction: The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients (pts) undergoing
catheter ablation (CA) of scar-related VT has not been previously investigated. Methods: Using logistic regression analysis, we identified predictors of AHD in 148 consecutive pts
undergoing CA of scar-related VT. Periprocedural AHD was
defined as persistent hypotension (systolic blood pressure
<8090 mmHg) despite vasopressors and requiring mechanical support and/or procedure discontinuation. A risk score was
created from the rounded univariate odds ratios (OR). Results:
Periprocedural AHD occurred in 19 (13 %) pts and was
predicted by six factors: ischemic cardiomyopathy
(OR = 6.12 [1.3627.60], P = 0.018), EF < 25 % (OR =
2.97 [1.10 7.98], P = 0.031), NYHA class III or IV
(OR = 6.84 [2.3919.53], P < 0.001), COPD (OR = 3.84
[1.3311.12], P = 0.013), VT storm (OR = 5.09 [1.41
18.32], P = 0.013), and general anesthesia (OR = 7.23
[2.4321.53], P<0.001). When applying the risk score
derived from the ORs of the predictors (Figure), the risk
of AHD was 2, 5, and 44 %, respectively, for increasing
risk score tertile. At 208 months follow-up, the mortality rate in the AHD group was 58 vs. 14 % in the
rest of the population (P<0.001). AHD was associated
with increased risk of 6-month (OR = 6.36, P = 0.008)
and 1-year (OR=5.05, P=0.008) mortality, independently of the risk score. Conclusions: Periprocedural acute
hemodynamic decompensation occurs in 13 % of
228
patients undergoing catheter ablation of scar-related VT

and is associated with increased risk of mortality. A risk
score comprising six factors can be used to identify

these patients.
73 Abstract 2814
Introduction: Ripple mapping (RM) displays each component of

the electrogram at its corresponding 3D coordinate overlying a
voltage map as a dynamic bar that changes in height according to
the electrogram voltage-time relationship. We tested the feasibility of using CARTO Ripple Map to identify conduction channels
(RM-CC) in a prospective series of ischemic ventricular tachycardia (VT) ablations for recurrent implantable-defibrillator
(ICD) therapies Methods: Bipolar LV endocardial voltage maps
were collected with CARTO3 v4 in sinus or paced rhythms by
robotic navigation (Sensei System) with Smart Touchirrigated catheter. Ripple maps were reviewed for RM-CCs with
4/5 criteria used to define RM-CCs (see figure). VT induction
was performed and ablation was delivered in stable VT and at all
RM-CC sites. Results: Seven patients (100 % male, age 749,
FEASIBILITY OF USING RIPPLE MAPPING TO

IDENTIFYAND ABLATE CONDUCTION CHANNELS
WITHIN THE VENTRICULAR SCAR
Vishal Luther1, Shahnaz Jamil-Copley1, Nicholas Linton1,
Michael Koa-Wing1, Sajad Hayat1, Pasquale Vergara2, FuSiong Ng1, Zachary Whinnett1, Phang Boon Lim1, David
Lefroy1, David Wyn Davies1, Nicholas Peters1, Paolo Della
Bella2, Prapa Kanagaratnam1
1
Imperial College Healthcare NHS Trust, London, UK; 2San
Raffaele Hospital, Milan, Italy
229
ejection fraction 317 %) with a median of 7 ATPs and 2 shocks

in the 30-day pre-ablation period were recruited. Dense LV maps
were collected (total area 24354 cm2, scar percentage 44
22 %, 607296 scar points). Six maps were collected with
ConfiDense-automated point collection. RM-CCs (median 3,
range (15)) were seen within each map (3515-mm length),
11 of which exited within scar-border zone. Six of 20 RM-CCs
co-located to voltage channels (mean 0.350.45 mV). Clinical
VT (45083 ms) was induced in 6/7 cases and 2 were ablated in
VT by conventional criteria, and sites of termination were within

an RMCC. All RM-CCs were ablated (median 8 lesions per
RMCC). Clinical VT was non-inducible in all cases and procedure duration was 29574 min. There were no peri-procedural
complications. There were no episodes of sustained VT recurrence or ICD therapies at 30 days. Conclusion: In this small series
of prospective VT ablations, identification of CCs using ripple
mapping was feasible, ablation of which lead to elimination of
the clinical VT.
74 Abstract 1819
depth. There is very limited data on the clinical effectiveness of

robotically guided VT ablation. We performed a non-randomised
comparison of patients undergoing ventricular tachycardia (VT)
ablation either manually or robotically using the Hansen Sensei
system for recurrent implantable defibrillator (ICD) therapy.
METHODS: Patients with infarct-related scar underwent VT
ablation using the Hansen system to assess feasibility compared
with patients undergoing manual VT ablation during a similar
time period. All cases underwent a transeptal endocardial approach, using CARTO and irrigated catheter ablation guided
by activation and entrainment manoeuvres if VT was sustained
and tolerated, or substrate modification. Power delivery during
robotic ablation was restricted to 30 W at 60 s. VT inducibility
was checked at the end of the procedure. Pre-ablation ICD therapy burdens over 6 months were compared with post-ablation
NON-RANDOMISED COMPARISON OF ACUTE AND

LONG TERM OUTCOMES OF ROBOTIC VERSUS
MANUAL VENTRICULAR TACHYCARDIA
ABLATION.
Vishal Luther1, Shahnaz Jamil-Copley1, Michael Koa-Wing1,
Matthew ShunShin1, Ian Wright1, Sajad Hayat1, Nicholas
Linton1, Phang Boon Lim1, Zachary Whinnett1, David Lefroy1,
Nicholas Peters1, David Wyn Davies1, Prapa Kanagaratnam1
1
Imperial College Healthcare NHS Trust, London, UK
INTRODUCTION: Robotically guided radiofrequency (RF) ablation offers greater catheter stability that may improve lesion
230
therapy averaged to a 6-month period. RESULTS: Twelve consecutive patients who underwent robotic VT ablation were compared to 12 consecutive patients undergoing a manual ablation.
Patient demographics and comorbidities were similar in the two
groups. A significantly higher proportion of robotic cases were
urgent (9/12 (75 %)) vs. manual (4/12 (33 %)) (p=0.01). Postablation VT stimulation did not induce clinical VT in 11/12
(92 %) in each group. There were no peri-procedural complications related to ablation delivery. Patients were followed up for
approximately 2 years. Averaged over 6 months, robotic ICD

therapy burdens fell from 32 (5400) events to 2.5 (011) (p=
0.015). This represented a 95 % therapy burden reduction.
Therapy burden fell from 14 (1025) to 1 (05) (p=0.023)
in the manual group. There was no difference in long-term
outcome (p=0.60) and mortality (4/12 (33 %) p=1.0). CONCLUSION: Robotically guided VT ablation is both feasible
and safe when compared to manual ablation with good acute
and long term outcomes.
Clinical characteristics
N
Age/year (meanSD)
LVEF 2D echo (meanSD)
Total ATPs 6 months pre abl. (median (IQR))
Total shocks 6 months preabl. (median (IQR))
Previous manual ablation
No. of VTs induced (meanSD)
Scar location
Robotic
12
70.85.5
28.113.7 %
19 (4396)
1.5 (14)
4/12 (33 %)
2.41.9
Manual
12
73.86.7
31.210.7 %
11 (822)
1 (03)
1/12 (8 %)
1.71.0
p value
1a
0.24c
0.53c
0.56c
0.73c
0.32a
0.31c
Anterior
Inferior
Apical
Maximum power/W (meanSD)
Overall procedure duration/min (meanSD)
4
4
4
29.62.7
31291
3
7
2
44.610.0
21893
1a
0.41a
0.65a
<0.001c
0.02c
Post proc VT non-ind

Post proc non-clinical VT ind
Post proc clinical VT ind
Follow up (months) (meanSD) (median (IQR))
Total ATPs post abl. (median (IQR))
Total Shocks post abl. (median (IQR))
Total ICD therapies post abl (median (IQR))
6-month averaged ICD therapies (median (IQR))
Post 2.5 (011)
p=0.015d
Further ablation procedure
6/12 (50 %)
5/12 (42 %)
1/12 (8 %)
24.119.1, 27 (540)
3.5 (110)
0.6 (01)
3.5 (111)
Pre 32 (5400)
Post 1 (05)
p=0.023d
3/12 (21 %)
8/12 (67 %)
3/12 (25 %)
1/12 (8 %)
21.114.6, 22 (932)
0.5 (011)
0 (02)
1 (014)
Pre 14 (1025)
0.60b
0.68a
0.67a
1a
0.77b
0.38b
0.52b
0.38b
0.49b
4/12 (29 %)
1a
abl ablation, Atp Anti-tachycardia pacing, ICD implantable cardioverter defibrillator, ind inducible, LVEF left ventricular ejection fraction, proc
procedural
a
Fishers exact test
b
MannWhitney U test
c
Students t test
d
Wilcoxon signed rank test
75 Abstract 1714
CLINICAL EXPERIENCE USING A NEW
FLUOROSCOPY-INTEGRATED CATHETER TRAC
KING SYSTEM (MEDIGUIDE) FOR ABLATION OF
VENTRICULAR TACHYCARDIAA
CASE-MATCHED COMPARISON
Michael Derndorfer1, Elisabeth Sigmund1, Georgios Kollias1,
Siegmund Winter1, Helmut Prerfellner1, Josef Aichinger1,
Martin Martinek1
Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna and Graz; Linz, Austria, Linz, Austria
Mediguide (MG) represents a new catheter tracking system
integrated into the C-arm of a standard fluoro unit. After recording of short fluoro loops (RAO, LAO position), the tip of
MG-catheters is precisely visualized onto these, allowing nonfluoroscopic tracking within EnSite NavX. Objective: We
assessed system feasibility, safety and intraprocedural
231
parameters for radiofrequency-ablation of ventricular tachycardias (VT) in patients with structural heart disease (SHD)
or idiopathic VT. Methods: Sixty-three consecutive VTpatients (21 MG, 42 conventional using a standard 3D system) were retrospectively compared in a 2:1, closely casematched comparison. Thirteen patients (61.9 %) in the MGgroup and 23 patients (54.7 %) in the conventional group
showed SHD. Ten (MG, 47.6 %) vs. 25 (conventional,
59.5 %) patients had a history of recurrent ICD shocks. Procedural parameters were compared between both groups. The end
point of non-inducibility was used for all patients. Results:
Mean fluoroscopy time (p = 0.0001) and radiation dose

(p=0.008) were significantly reduced by the use of MG.
Of fluoroscopy dose in the MG group, 58.3 % was acquired
in non-MG-dependent situations (positioning of conventional reference catheters, introducing sheaths, performing
transseptal punctures) showing a great potential in further
improvement. No major complications occurred in both
groups. Conclusions: The use of the novel MG catheter
positioning system is feasible and safe in VT ablation, significantly reducing fluoroscopy time and radiation dose
compared to standard 3D systems.
76 Abstract 1835
Methods: In 20032014, 505 children aged 1 to 17 received

invasive treatment of VA in one hospital. Three hundred
thirty-seven of them (144 females) have been included into
the study. ECG, 24-h Holter monitoring and echocardiography were performed. Activation and pace mapping results
have been included into logistic regression model. Regression
coefficients, odds ratio and probability of effective ablation
depending from results of endocardial mapping were calculated. Results: The probability of successful ablation (P) was
divided into three grades: low (P<0.75), medium (0.75
< P < 0.9) and high (P > 0.9). During evaluation of
presystolic activation time (T), low P was calculated for T<
29 ms, medium P was calculated if 29 ms<T73 ms and high
P was determined for T>73 ms. Early presystolic spike was
recorded in most cases in this group. In pace mapping study,
results were divided in two groups: similar and identical.
Only medium P was found in both cases. But, P in identical
pace mapping group was found in 2.6 times higher than in
similar. Conclusion: Evaluation of presystolic activity allows
PROGNOSTIC VALUE OF ENDOCARDIAL MAPP

ING RESULTS IN PEDIATRIC PATIENTS WITH
IDIOPATHIC VENTRICULAR ARRHYTHMIAS
Sergey Termosesov 1 , Igor Khamnagadaev 1 , Maria
Shkolnikova1, Ilya Ilich1, Yanina Volkova1, Rustem Garipov1
1
Research and Clinical Institute for Pediatrics at the Pirogov
Russian National Research Medical University, Moscow,
Russia
Background: Idiopathic ventricular arrhythmias (VAs) in children can cause significant morbidity and, although rare, mortality. Mapping of VA substrate should be precise because of
safety reasons in pediatrics patients. The purpose of this study
is to evaluate the prognostic value of endocardial activation
and pace mapping of VA substrate in pediatric patients.
232
predicting the successful ablation of VA. The probability of

successful ablation of VA can be divided in low, medium and
high grades during endocardial mapping. Earliest presystolic
activation greater than 72 ms is associated with highest success rate. Pace mapping may be useful if results of activation
mapping are not acceptable.
Abstract oral session 8: Clinical and genetic aspects of
ARVD/C
81 Abstract 0712
CLINICAL CHARACTERISTICS AND OUTCOME

OF PEDIATRIC-ONSET ARRHYTHMOGENIC
RIGHT VENTRICULAR DYSP
LASIA/CARDIOMYOPATHY
Anneline S. te Riele1, Cynthia A. James1, Abhishek C.
Sawant1, Brittney Murray1, Crystal Tichnell1, Ryan Tedford1,
Jane Crosson1, Daniel P. Judge1, Hugh Calkins1, Harikrishna
Tandri1
1
Johns Hopkins University School of Medicine, Baltimore,
MD, USA
Background: Arrhythmogenic right ventricular dysplasia/
cardiomyopathy (ARVD/C) is an inherited cardiomyopathy with
an increased risk of sudden death. While affected patients typically present in the third decade of life, ARVD/C is not uncom-
mon among adolescents. However, the clinical characteristics of

pediatric-onset ARVD/C are largely unknown. Objective: (1) to
describe the presenting symptoms, clinical attributes, and outcome of pediatric-onset ARVD/C and (2) to compare these to
adult-onset ARVD/C. Methods: We obtained detailed phenotypic, genetic, and outcome data of 347 definite ARVD/C patients.
Patients were grouped into pediatric (diagnosis <18 years) and
adult (diagnosis 18 years) ARVD/C. Details regarding clinical
presentation and outcomes (sustained ventricular tachycardia
[VT], cardiac transplantation, and death) were ascertained. Results: Among 347 ARVD/C patients, 52 (15 %) were diagnosed
prior to the age of 18 years. Pediatric cases were 28 (54 %) males,
with a mean age of 15.41.8 years at time of diagnosis. Compared to adult cases, pediatric cases were more likely to present
with sudden cardiac death or resuscitated sudden cardiac arrest
(25 vs 11 %, p=0.004). Conversely, adult cases more often presented with sustained monomorphic VT (38 vs 21 %, p=0.022).
Compared to adult cases, pediatric cases were disproportionately
mutation carriers (77 vs 59 %, p=0.026), but not more likely to
carry multiple mutations (3 vs 4 %, p=0.729) or to be probands
(28 vs 28 %, p=0.968). There were no other differences in demographic characteristics or in any domain of the TFC. During
8.17.3 years follow-up, there were no differences in survival
free from sustained VT (p=0.657), cardiac transplantation (p=
0.624), or death (p=0.293) between pediatric and adult cases.
Conclusion: Pediatric ARVD/C patients are more likely to present with sudden cardiac arrest, whereas adult cases more often
present with sustained monomorphic VT. Pediatric ARVD/C
cases are disproportionately mutation carriers. All other clinical
characteristics and outcomes are similar between pediatric and
adult ARVD/C patients.
82 Abstract 0719
SARCOMERIC MUTATIONS ARE ASSOCIATED

WITH ARRHYTHMOGENIC RIGHT VENTRICULAR
DYSPLASIA/CARDIOMYOPATHY (ARVD/C)
Dennis Dooijes, University Medical Center Utrecht, Utrecht,
The Netherlands; Judith A Groeneweg, University Medical
Center Utrecht and Interuniversity Cardiology Institute of
the Netherlands, Utrecht, The Netherlands; Brittney Murray,
Johns Hopkins University School of Medicine, Baltimore,
MD, USA; Daniel P Judge, Johns Hopkins University School
of Medicine, Baltimore, MD, USA; Crystal Tichnell, Johns
Hopkins University School of Medicine, Baltimore, MD,
USA; Jan DH Jongbloed, University Medical Center Groningen, Groningen, The Netherlands; J Peter van Tintelen, Univ e r s i t y M e d i c a l C e n t e r G ro n i n g e n , G ro n i n g e n ,
The Netherlands; Hugh Calkins, Johns Hopkins University
School of Medicine, Baltimore, MD, USA; Richard N Hauer,
University Medical Center Utrecht and Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands;
Cynthia A James, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Introduction: Arrhythmogenic right ventricular dysplasia/
cardiomyopathy (ARVD/C) is in over 60 % of cases related
to pathogenic mutations in desmosomal genes PKP2, DSG2,
DSC2, DSP and JUP and non-desmosomal genes TMEM43
and PLN. However, in a significant proportion of proven
ARVD/C patients, no pathogenic mutation can be identified
in any of the known ARVD/C genes.
Aim: The study aims to investigate the contribution of sarcomeric gene mutations to the aetiology of ARVD/C.
Methods: Fifty-one proven ARVD/C patients (fulfilment
of 2010 Task Force Criteria), from 43 families, were
selected from the joint transatlantic JHU/ICIN ARVD/C
registry in whom previous genetic analyses failed to
identify a pathogenic mutation in any of the PKP2,
DSC2, DSG2, DSP, JUP and TMEM43 genes. DNA
from these 51 patients was analysed for mutations in
the sarcomeric ACTC1, MYBPC3, MYH7, MYL2,
MYL3, TNNC1, TNNI3, TNNT2 and TPM1 genes.
DNA variants were assessed for potential pathogenic
character using available in silico analysis tools and
international databases.
Results: In 20 % of patients (10/51), a likely pathogenic
mutation was identified in the sarcomeric MYBPC3,
MYH7 or MYL3 gene, not previously associated with
ARVD/C. Of these patients, eight had a mutation in
the MYBPC3 gene, one had a mutation within the
MYH7 gene and one had a mutation in the MYL3 gene.
Following the identification of sarcomeric gene
233
mutations in ARVD/C patients, a second group of 15

ARVD/C patients were genetically analysed using a
panel also including sarcomeric genes. In this group,
three additional patients were identified with an MYH7
mutation (20 %).
Conclusion: Analysis of sarcomeric ACTC1, MYBPC3,
MYH7, MYL2, MYL3, TNNC1, TNNI3, TNNT2 and
TPM1 genes in a group of proven ARVD/C patients without pathogenic mutation in the known ARVD/C genes
resulted in the identification of likely pathogenic mutations in the sarcomeric MYBPC3, MYH7 and MYL3 genes.
These data for the first time show an association between
mutations in the sarcomere and the ARVD/C phenotype.
Currently, patient numbers are too small to investigate
genotype-phenotype relations. However, the present results
warrant genetic testing of sarcomeric genes in ARVD/C patients without underlying genetic defect in any of the known
ARVD/C genes.
83 Abstract 0718
PREGNANCY IN ARRHYTHMOGENIC RIGHT

VENTRICULAR DYSPLASIA/CARDIOMYOPATHY
IS ASSOCIATED WITH A LARGELY UNEVENTFUL
COURSE DELIVERY
Anke R. Hodes1, Crystal Tichnell2, Anneline S.J.M. te Riele3,
Brittney Murray2, Judith A. Groeneweg4, Abhishek C.
Sawant2, Stuart D. Russell2, Maarten P. van den Berg1, Arthur
A. Wilde5, Harikrishna Tandri2, Daniel P. Judge2, Richard
N.W. Hauer4, Hugh Calkins2, J. Peter van Tintelen5, Cynthia
A. James2
1
University Medical Center Groningen, Groningen, Netherlands, 2Johns Hopkins University, Baltimore, MD, USA;
3
University Medical Center Utrecht, Utrecht, Netherlands;
4
Interuniversity Cardiology Institute of the Netherlands,
Utrecht, Netherlands; 5Academic Medical Center, Amsterdam, Netherlands
Background: Arrhythmogenic right ventricular dysplasia/
cardiomyopathy (ARVD/C) is an autosomal-dominant
inherited cardiomyopathy clinically characterized by a high
incidence of ventricular arrhythmias and an increased risk of
sudden cardiac death. Earlier detection and successful treatment of ARVD/C has increased the number of patients considering pregnancy. Present literature regarding pregnancy
and ARVD/C only includes one small (n=6) case series and
five isolated case reports. We aim to provide additional clinical insight in pregnancy outcome for both mother and child.
Methods: In a combined Johns Hopkins/Interuniversity Cardiology Institute of the Netherlands ARVD/C registry, we
identified 26 women (5 Dutch; 13 probands, 13 relatives)
234
who met ARVD/C 2010 Task Force Criteria during 39 singleton pregnancies >13 weeks (14 per woman). Cardiac and
obstetric outcomes were ascertained in all. Results: Pregnancy
began at a mean age of 31.23.5 years. ARVD/C was diagnosed prior to most pregnancies (n=29; 74 %), whereas in 7
(18 %), ARVD/C was present but not yet clinically recognized
and 3 pregnancies (8 %) were ongoing at diagnosis. Treatment
in pregnancies included beta blockers (n=16), sotalol (n=4),
flecainide (n=1), digoxine (n=1), diuretics (n=3) and ICDs
(n=28). Most pregnancies were uneventful (n=23; 59 %);
new or worsening symptoms were noted in 9 (23 %): 6
palpitations/PVCs and 3 fatigue/dyspnea. A single sustained
VT or appropriate ICD therapy occurred in 5 pregnancies
(13 %): 3 first trimester sustained VTs (ARVD/C not yet
established), 1 second trimester anti-tachycardia pacing
(ARVD/C established) and 1 first trimester ICD discharge in
a woman with a history of sustained VT. In contrast, 9 other
pregnancies in women with VT/ICD discharge history were
without events. AHA Class C heart failure (HF) developed in
2 pregnancies (5 %), in women with either biventricular structural disease or tricuspid valve disease pre-pregnancy. They
were managed outpatient and are stable 2 and 5 years postdelivery. In 9 other pregnancies with significant right ventricular structural disease, no HF developed. All pregnancies resulted in live-born children without major obstetric complications. Of 11 C-sections (28 %), only 1 was exclusively
ARVD/C-related (HF). At last follow-up all children were
healthy (023 years old); mothers had no cardiac mortality
or transplant. Conclusion: Although caution is warranted in
women with established biventricular or valve disease, pregnancy and delivery appear to be reasonably safe in ARVD/C,
especially when it is recognized beforehand. With adequate
guidance and treatment, a favorable outcome for both mother
and child is generally obtained.
during pregnancy. In this study, we aimed to assess the

risk of ventricular arrhythmias in pregnant mothers and
the impact of ARVD and of anti-arrhythmic drug-therapy
in newborn children. Methods and resultsWe included
all female patients with ARVD followed at La Piti
Salptrires hospital who had a pregnancy. We retrospectively collected clinical and para-clinical characteristics of
mothers at the time of pregnancy or at the time of ARVD
diagnosis. We recorded all cardiac events that occurred
during pregnancy, birth or post-partum period, cardiac
events in children and maternal anti-arrhythmic drug therapy during pregnancy. Fifty-eight pregnancies (21 patients) between 1968 and 2013 were identified. Altogether, seven cardiac events (12.1 %) including two serious
rhythmic events (ventricular tachycardia, 3.4 %) occurred
during pregnancy with no serious consequences on mother or children. There was a non-significant trend toward
more cardiac events in non-localized forms (23.8 % versus 5.4 %, p=0.09) and arrhythmogenic forms (14.9 %
versus 0 %, p = 0.33). Neither hemodynamic complications nor rhythmic events during delivery or postpartum
period were observed. The rate of cardiac events under
the age of 25 was high in children (eight events,
13.8 %), including two unexplained deaths under the
age of 1 (3.4 %) and three sudden cardiac deaths
(5.2 %, with a mean age of 17.75.1). Anti-arrhythmic
drug therapy during pregnancy was associated with a lower birth weight (2598.2807.8 g versus 3394.5544.3 g;
p = 0.04) with no other consequences. Conclusion
ARVD is associated with a low rate of serious rhythmic
events during pregnancy and safe delivery. The risk of
rhythmic event seems poorly predictable and supports
the continued use of anti-arrhythmic drug therapy during
pregnancy. Monitoring of children after birth appears
highly important considering the risk of cardiac events.
84 Abstract 0715
85 Abstract 0714
ARRHYTHMOGENIC RIGHT VENTRICLAR DYSP
LASIA DURING PREGNANCY: RETROSPECTIVE
STUDY OF 21 PATIENTS
Emilie Varlet1, Jacky Nizard2, Guillaume Duthoit2, Veronique
Fressart2, Nicolas Badenco2, Xavier Waintraub2, Caroline
Himbert2, Carole Maupain2, Thomas Chastre2, Franoise
Hidden-Lucet2, Estelle Gandjbakhch2
1
Hopital Bichat, Paris, France; 2Hopital La Pitie Salpetriere,
Paris, France
IntroductionArrhythmogenic right ventricular dysplasia
(ARVD) is an inherited heart disease responsible for lifethreatening ventricular arrhythmias. There are few data
concerning complications associated with this disease
PREDICTIVE VALUE OF LOCAL PROLONGED

ELECTRO-MECHANICAL INTERVAL IN THE
CONCEALED STAGE OF ARRHYTHMOGENIC
RIGHT VENTRICULAR DYSP
LASIA/CARDIOMYOPATHY
Thomas P Mast1, Arco J Teske1, Anneline S Te Riele1, Judith
A Groeneweg 1 , Jeroen F Heijden van der 1 , Birgitta K
Velthuis 1 , Peter Loh 1 , Pieter A Doevendans 1 , Dennis
Dooijes1, Jaques M Bakker de2, Richard N Hauer3, Maarten
J Cramer1
1
UMC Utrecht, Utrecht, Netherlands; 2AMC Amsterdam, Amsterdam, Netherlands; 3ICIN - Netherlands Heart Institute,
Utrecht, Netherlands
Introduction: The concealed stage of arrhythmogenic

right ventricular dysplasia/cardiomyopathy (ARVD/C) is
associated with increased risk of sudden death. However,
at this stage, disease detection and risk stratification are
hampered by paucity of criteria. Activation delay (AD) is
a hallmark of arrhythmogenesis in ARVD/C. Echocardiographic deformation imaging may unmask AD in the
absence of electrocardiographic and structural abnormalities. Methods: Three groups were compared (1) symptomatic definite desmosomal mutation-positive ARVD/C
patients (n=52), (2) asymptomatic desmosomal mutation
carriers (AMC) not fulfilling ARVD/C diagnosis according to the Task-Force criteria (TFC) and without VT and
premature ventricular complexes (PVC)>500/24 h (n=
33) and (3) healthy controls (n = 30). All groups
underwent echocardiographic deformation imaging of
the right ventricular (RV) free wall and ECG recording
according the TFC. As surrogate for local AD, the
electro-mechanical interval (EMI) was measured, defined
as time between first ECG-detected electrical deflection
and local onset of mechanical shortening. Arrhythmic
235
outcome (VT, PVC count) of all mutation carriers was

correlated to EMI and electrocardiographic TFC
depolarization/repolarization criteria. Results: Mean EMI
was prolonged in all RV segments in ARVD/C patients
compared to controls. In AMC, prolonged EMI was detected in the subtricuspid area in 18/33 subjects and occurred isolated (absence of ECG and imaging criteria) in
10/33 AMC. Terminal activation duration (TAD) 55 ms
was the only ECG abnormality found in this group (10/
33). After a mean follow-up of 3.42.7 years, 8/33 subjects experienced an increase in ventricular arrhythmic
burden. Prolonged subtricuspid EMI at baseline was the
only parameter significantly correlated to
arrhythmogenesis during follow-up (Figure 1). Conclusion: Deformation imaging reveals AD in both ARVD/C
patients and AMC. In AMC, prolonged EMI in the
subtricuspid region is often detected without any additional abnormalities. Prolonged EMI in the subtricuspid
area is a new noninvasive parameter unmasking AD in
the concealed ARVD/C stage and may contribute to risk
stratification.
236
86 Abstract 0312
A NEW RYANODINE RECEPTOR MUTATION

ILLUSTRATES THE NEED FOR FAMI
LY-CENTERED CARE AND GENETIC TESTING IN
PATIENTS WITH FAMILIAL ARRHYTHMOGENIC
DISORDERS
Cordula M Wolf1, Isabel Deisenhofer1, Michaela Horndasch1,
Heide Seidel1, Peter Ewert1, Gabriele Hessling1
1
German Heart Centre Munich/Technical University Munich,
Munich, Germany
Background: Despite an increasing body of knowledge on the
genetic basis of familial arrhythmogenic disorders, the diagnosis of those diseases remains a clinical challenge. Genetic
testing can identify patients at risk and avoid sudden arrhythmic death by appropriate management. Purpose of study: This
case series describes a family in which two children and their
mother experienced repeated stress-induced ventricular arrhythmias causing syncope, aborted sudden death, and appropriate implantable cardiac defibrillator (ICD) discharges,
starting at the age of 12 years. The maternal grandmother
had died suddenly at the age of 21 years. Methods: DNA
was extracted from blood of all three patients. All 105 exons
of the Ryanodine receptor isoform 2 (RYR2) gene, including
slice-sites, were amplified by polymerase chain reaction, and
double-stranded DNA sequencing analysis was performed.
The mutation was confirmed by second sequencing of an independent DNA-isolate. Results: Clinical testing of the affected individuals revealed normal physical exam and cardiac
anatomy in all patients, normal electrocardiogram (ECG) findings in the mother and the daughter, and an epsilon wave at the
end of the QRS complex at the sons ECG. Stress testing
showed polymorphic ventricular beats and tachycardia in all
three patients. Biomarker testing discovered a novel mutation
in the RYR2 gene, coding for the cardiac sarcoplasmic reticulum calcium release channel ryanodine receptor 2 protein.
The mutation was a heterozygous substitution in exon 46 in
the gene, resulting in the replacement of a glycine with a
valine amino acid in the highly conserved domain two of the
protein (c.7025G>T; pGly2342Val; Exon 46, RYR2 gene).
This mutation was not found in the Human Gene Mutation
Database (HGMD professional). The diagnosis of catecholaminergic polymorphic ventricular tachycardia, an
autosomal-dominant inherited arrhythmic disorder, was made.
Patients were started on beta-blocker and/or flecainide therapy
and since then did not experience any malignant events or
ICD discharges. Conclusion: This identification of a novel
mutation contributes to the growing genetic database for
familial arrhythmogenic disorders and underlines that molecular testing and genetic consultation of the entire family
should be performed early in disease management. A genetic
diagnosis allows optimal patient management, identifies relatives at risk for sudden death and allows initiation of preventive measures in those individuals.
Abstract oral session 9: Atrial fibrillation mechanisms I
91 Abstract 0121
A NOVEL AUTOMATED METHOD FOR DETE

CTING NEAR-INSTANTANEOUS RE-INITIATION OF
ATRIAL FIBRILLATION
Caroline H Roney1, Chris D Cantwell1, Norman A Qureshi1,
Michael T Debney 1, Prapa Kanagaratnam 1, Jennifer H
Siggers1, Nicholas S Peters1, Fu Siong Ng1
1
Introduction: During atrial fibrillation (AF), it is often
difficult to distinguish continuous rotor/multiple wavelet
activity from rapid reinitiation of AF following termination. We aimed to develop a novel computational method for identifying foci responsible for neari n s t a n t a n e o u s r e i n i t i at i o n o f A F. Me t ho d s : A F
wavefront dynamics were analysed over 80 s for four
optically mapped canine cholinergic AF preparations.
Phase singularities (PS) were identified and tracked
over time in order to calculate lifetimes and number of
rotations (Fig. A). Active pixels were identified
(isophase = pi/2); instances of zero active pixels were
used to identify when the arrhythmia terminates and
new instances were used to identify focal sources of
reinitiation (Fig. B). Results: Our method successfully
tracked locations of PSs and identified areas of
reinitiations of AF in all four experimental preparations.
Near-instantaneous reinitiations of AF were important in
sustaining AF in three of the preparations, where incidence of arrhythmia termination was higher (0.53, 0.64,
0.39 vs 0.08/s), whilst AF in the final preparation was
primarily driven by rotor activity (PS density 814 334
vs 615 320, 454 226, 593 279/cm2/s). Our algorithm
detected single stable trigger foci in two preparations,
which were responsible for rapid reinitiation of AF following termination (Fig). Conclusion: We have developed a novel method for determining the interactions
between different AF mechanisms, capable of detecting
237
near-instantaneous re-initiations of AF and locating these foci critical in sustaining the arrhythmia. This meth-
od may have clinical utility in guiding ablative therapy

towards foci responsible for sustaining AF.
92 Abstract 1421
of the underlying rhythm as a function of the spatial wavelength, together with a method for estimating the spatial wavelength. Methods: Simulations of rotors and focal sources with
the spatial wavelength within the range for human AF (n=9,
range 3278 mm; downsampling range 0.125 mm) were
used to estimate the minimum number of points (N) per spatial
wavelength. Spatial wavelength was estimated (conduction
velocitycycle length), and the number of points required
for estimation was investigated. Realistic catheter arrangements (spiral, circular, five-spline and basket) were compared.
Results: The minimum value of N necessary to identify a rotor
were as follows: 2.5 (for visual identification), 2.7 (for determining rotor core location with a threshold distance of 4 mm)
and 3.1 (for a distribution of false phase singularity detections
below threshold). Focal sources could be detected with N=3.3
(visual), N=1.6 (maximum divergence location). The spatial
wavelength was determined accurately using 7 points. When
placed over the rotor core, all of the catheters performed well
(core location error for wavelength of 33.5 mm: spiral 0.7 mm,
circular 3.5 mm, five-spline 0.5 mm; for wavelength of
75.2 mm: basket 5.4 mm, Fig). Conclusions: For the range
DETERMINING THE RELATIONSHIP BETWEEN

RESOLUTION REQUIREMENTS AND WAVEFRONT
SPATIAL WAVELENGTH FOR IDENTIFYING
ROTORS, FOCI AND MULTIPLE WAVELETS
Caroline H Roney1, Chris D Cantwell1, Rheeda L Ali1,
Norman A Qureshi 1, Eugene TY Chang 1, Phang Boon
Lim1, Spencer J Sherwin1, Jennifer H Siggers1, Fu Siong
Ng1, Nicholas S Peters1
1
Introduction: It is important to have adequate data resolution
to distinguish the mechanisms for human atrial fibrillation
(AF), which are a subject of much debate (drivers vs. multiple
wavelets), although the minimum resolution to distinguish
mechanisms is unclear. Resolution requirements for a given
rhythm depend on the distance between successive
wavefronts (the spatial wavelength). We determined this relationship to give the resolution requirements for identification
238
of spatial wavelengths seen in human AF all commonly used

catheters offer sufficient resolution to distinguish rotors and
focal sources. A high-density-mapping catheter is required to
accurately determine spatial wavelength.
Results: During the median follow-up of 14.4 years, ischemic

stroke occurred in 73 subjects in which 21 had ESVEA at
baseline (hazard ratio, 2.91; 95 % confidence interval, 1.77
4.90). Censoring at time of AF, ESVEA remained associated
with stroke after adjusting for relevant baseline risk factors
(hazard ratio, 1.96; 95 % confidence interval, 1.103.49).
The absolute risk of stroke in subjects with ESVEA and a
CHA2DS2VASC score of 2 were 2.4 % per year, which is
comparable to the risk observed in AF. Day-to-day analysis
showed that ESVEA was a consistent finding. Conclusion:
ESVEA increased the risk of ischemic stroke beyond manifest
atrial fibrillation in this middle-aged and elderly population.
Stroke was often the first clinical presentation rather than atrial
fibrillation in these subjects. ESVEA was a clinically stable
finding, which seemed to confer the same absolute risk as
atrial fibrillation.
94 Abstract 1526
93 Abstract 1420
ALTERNATIVE TO CURRENT INTERVENTIONAL

RATIONALES FOR PERSISTENT ATRIAL
FIBRILLATION: RIGHT ATRIAL ISOLATION.
Gerard Guiraudon1, Douglas Jones1
University of Western Ontarion, London-Ontario, Canada
EXCESSIVE ATRIAL ECTOPY AND SHORT RUNS

INCREASE THE RISK OF STROKE BEYOND INCI
DENT ATRIAL FIBRILLATION
Bjrn Larsen1, Preman Kumarathurai1, Julie Falkenberg1,
Olav Wendelboe1, Ahmad Sajadieh1
1
Copenhagen University Hospital of Bispebjerg, Kbenhavn
N, Denmark
Background: About 30 % of ischemic strokes are of unknown
source. Increased atrial ectopy, which has shown to increase
the risk of atrial fibrillation, could be one source. However, the
absolute risk of stroke in these subjects is unknown, and likewise, it is not known whether they present with clinical atrial
fibrillation before any stroke or with stroke as the first clinical
manifestation. We aimed to examine whether increased atrial
ectopy and short runs increases the risk of stroke beyond incident atrial fibrillation (AF). Furthermore, we estimated the
absolute risk of stroke in these subjects. Methods: The study is
based on 15-year follow-up of the Copenhagen Holter Study
cohort with 678 men and women aged between 55 and
75 years, with no prior history of cardiovascular disease,
stroke or atrial fibrillation. Subjects had 48-h ambulatory
ECG recording, fasting blood work, and clinical examination.
According to previous studies, excessive supraventricular ectopic activity (ESVEA) was defined as either 30 premature
atrial contractions (PACs) per hour or any runs of 20 PACs.
Introduction: The goal of surgical or catheter-based interventions for atrial fibrillation (AF) is to restore normal cardiac
function, i.e., restoration of normal ventricular function, in
particular left ventricular (LV) function, since good LV function can sustain the entire circulatory need, including atrial
hemodynamics. Restoring cardiac physiology: Normal LV
function requires a normal chronotropic response with early
activation by the Purkinje system of the papillary muscles for
the earliest closing of the mitral valve. The LV is an active
suction pump that, in each beat, aspirates the entire left atrial
(LA) volume. Indeed, we recently, documented that the LV
stroke volume is equal to the LA prediastolic volume. Therefore, the explosive suction of the LV, combined with LA recoil, allows complete flushing of the LA. However, irregular
LV rhythm disables effective flushing of the LA, a major cause
of thrombosis. Restoring normal LV function in chronic or
persistent AF can be achieved by permanently ablating the
AF anatomical substrate using multiple catheter sessions or
surgical access or focusing only on protecting the sinus
node-AV node-His-Purkinje system by isolating, in part or in
full, the right atrium (RA) from the fibrillating LA. The experience with the Corridor operation, which is a variety of RA
isolation, documented excellent cardiac function with normal
flushing of the fibrillating LA. RA isolation: Recent publications have documented that multiple extensive catheter ablations of the LA result in normal LA physiology as
documented for the Corridor or RA isolation: the three approaches listed above produce identical cardiac physiology.
The advantages of RA isolation include the following: (a)
an intervention focusing on discrete, well-defined targets,
i.e. the three discrete interatrial bundles, the Bachmann, the
coronary sinus and the LA-AV nodal bundles; (b) a single
shot intervention that can be delivered, by catheter or surgical access, easily combined with open heart access and
easily performed via minimally invasive access for lone
AF; (c) the single-shot catheter ablation should increase
the effectiveness of electrophysiology procedures and decrease patient wait times, and (d) last but a critical advantage, RA access will eliminate the added risk of stoke which
is currently associated with extensive LA catheter ablation.
Conclusions: We have presented arguments in support of
RA isolation as an addition and alternative to current ablative rationales. RA isolation may become a first choice for
persistent AF, and with more experience, be a valid alternative for paroxysmal AF
95 Abstract 1519
A CELLULAR AUTOMATON MODEL TO IDENTIFY

CRITICAL SITES IN ATRIAL FIBRILLATION
Kishan Manani1, Kim Christensen1, Nicholas S Peters1
1
239
Background: Identifying critical sites of the myocardial

substrate which initiate and maintain atrial fibrillation is
of therapeutic significance. We implemented a simple
two-dimensional computer model, a cellular automaton
(CA), of the myocardial substrate which shows that particular structures are responsible for the initiation and
maintenance of fibrillatory activity. Results: A CA model
of the myocardial substrate is generated by randomly
assigning the connectivity between cells. This generates
a substrate which mimics the myocardial microstructure.
In addition to this, electrical cellular dysfunction is incorporated by introducing a degree of heterogeneity in cell
firing. The interaction between these two variables generates a substrate in which planar wave fronts of activation
will either spontaneously evolve into fibrillation or not,
and in which the resulting fibrillation will either persist
or spontaneously terminate. We found that fibrillatory behaviour could be terminated when particular structures
within the substrate are made unexcitable. The transition
from paroxysmal to persistent atrial fibrillation in the
model can be explained by an increase in the number of
critical sites. Conclusions: We have produced a simple
CA model of the myocardial substrate which exhibits a
wide range of phenomenological behaviour associated
with atrial fibrillation. The existence of critical structures
within the model raises the possibility that such structures
might be detected in real myocardium by clinically accessible data such as electrograms.
240
96 Abstract 0213
CHARACTERISATION OF BASELINE STRUCTURE

OF CANINE LEFT ATRIUM DURING ACUTE
INDUCED AF
Christian Eichhorn1, Rasheda A Chowdhury1, Michael T
Debney1, Norman A Qureshi1, Caroline H Roney1, Nicholas
S Peters1, Fu Siong Ng1
1
Imperial College, London, UK
Background: Recent clinical studies have supported a role for
focal drivers in maintaining atrial fibrillation (AF), with some
studies showing that these drivers/rotors have a preference for
anchoring to specific sites in the left atrium (LA). We hypothesized that regional heterogeneities in fibrosis and gap junctional
cell-to-cell coupling in the LA may contribute towards determining the locations of these drivers in the LA. We performed
regional analysis of cardiac gap junctions and fibrosis in the
canine LA to assess this hypothesis. Methods: Five explanted
canine left atria were used for these studies, with the LA divided
into nine regions (Figure) and frozen for subsequent analysis.
LA structure was assessed by immunohistochemistry of
connexin 40 and 43 proteins and autofluorescence of fibrosis.
For fibrosis, the total amount of fibrosis, the proportion of
stringy (interstitial) and circular (scar) fibrosis were analysed,
and for connexins, the heterogeneity of connexin 40, the
colocalisation of connexin 40 and 43 in intercalated disks, the
size of en-face intercalated disks and the proportional occupation by connexin43 of these en-face disks were calculated. Results: Gap junctional disk size was increased in the midposterior wall of the LA compared with other regions (p=
0.03). We did not detect any other regional differences in fibrosis quantity/proportions nor in connexin heterogeneity or
colocalisation. Conclusion: There were detectable differences
in gap junctional disk size between regions in the LA as
assessed by immunohistochemistry, though we detected no other spatial heterogeneities of fibrosis and connexins. Correlation
of the structural data above with optical mapping data of AF in
these preparations may help to explain if any spatial structural
heterogeneities contribute to the locations of drivers in AF.
Abstract oral session 10: Atrial arrhythmia mechanisms II

101 Abstract 0210
241
regulatory function in the progression of LSAF and are involved in atrial arrhythmogenic structural remodeling. Identification of key miRNAs in atrial remodeling will advance our
understanding of the determinants of AF and suggest novel
therapeutic possibilities to prevent clinical AF.
102 Abstract 0114
PARTICIPATION OF MIRNAS IN ATRIAL ARRH

YTHMOGENIC STRUCTURAL REMODELING IN
PATIENTS WITH ATRIAL FIBRILLATION
Marina Eremeeva 1 , A mina Ibragimova 1 , Tati ana
Sukhacheva1, Valentin Vaskovskiy1, Amiran Revishvili1
1
Bakoulev Center for Cardiovascular Surgery, Moscow,
Russia
Aim: We aim to determine the role of key stress-responsive
miRNAs involved in AF and induced atrial arrhythmogenic
structural remodeling. Methods: The study included 16 patients (age 51.39.8) with long-standing atrial fibrillation
(LSAF) undergone bipolar RF maze procedure and 10 patients
(age 497.9) in the control group with sinus rhythm (SR) after
aortic valve replacement. The level of expression of miRNAs
(mir1, mir133a, mir133b, mir208a, mir208b, mir499, mir195,
mir29, mir21) in atrial myocardium (intraoperative biopsy of
left atrial appendage (LAA) and right atrial appendage (RAA)
tissues) by qRT-PCR was analyzed. Morphometric study of
LAA and RAA myocardium was performed. Statistical analysis was made using a MannWhitney U test, non-parametric
Spearman correlation; p<0.05 was considered significant. Results: The analysis of 9 miRNA expression in the LAA and
RAA tissues in LSAF patients showed a significant upregulation in miRNA 208b expression both in RAA (p<0.01) and in
LAA (p<0.01) compared with the SR group. When comparing LAA and RAA significant differences in miRNA21 expression in LSAF group were determined, the expression level
was higher in the LAA (p<0.05). Screening of LAA and RAA
myocardium from LSAF patients revealed a high proportion
of interstitial fibrosis (LAA 46.8 10.7 %; RAA 47.2
11.4 %) and lipomatosis. Forty-eight percent of LAA biopsy
and 44.4 % of RAA biopsy were involved with isolated atrial
amyloid deposits which reacted with anti-alpfa-ANP. The increase in the cardiomyocyte diameter and length were correlated, both parameters did not differ significantly between
LAA and RAA, but were higher in LSAF than in SR patients.
In 39.5 % LAA biopsy and 45.7 % RAA biopsy from LSAF
patients, marked sarcomere loss in cardiomyocytes was detected. LAA cardiomyocyte diameter was larger in patients
with increasing size of the LA and cardiomyocyte length
was larger in patients with greater duration of AF. Overexpression of mir208b in LSAF patients correlated with the
increased interstitial fibrosis and the decreased sarcomere loss
in cardiomyocytes. Conclusion: miRNA 208b have a
DETERMINANTS OF PREFERENTIAL ROTOR

LOCATIONS AND STABILITY IN ATRIAL
FIBRILLATION
Fu Siong Ng1, Caroline H Roney1, Michael T Debney1,
Christian Eichhorn1, Arun Nachiappan1, Norman Qureshi1,
Rasheda A Chowdhury1, Alexander Lyon 1, Nicholas S
Peters1
1
Introduction: Rotors have been shown to drive atrial fibrillation (AF) and targeting these sites has emerged as an ablation
strategy. However, factors that influence the locations and
stability of rotors and spiral waves in AF remain unclear and
have mainly be studied in silico or in cell monolayers, which
lack the anatomical and structural complexities of real atria.
We experimentally assessed the relative importance of various
anatomical, structural and functional factors in determining
rotor locations in the left atrium. Methods: Isolated, perfused
canine left atrial preparations (n=6) were optically mapped at
baseline and after AF induction with pacing and acetylcholine.
Rotor core locations were tracked using a novel computational
algorithm for 80 s of AF. The left atria were then divided into
nine regions for Cx43 immunohistochemistry and fibrosis
analysis. Conduction and repolarization data from optical
mapping, and Cx43 and fibrosis data were compared between
regions with high and low rotor densities to assess for determinants of rotor locations. Results: Rotors in AF locate preferentially to specific regions of the left atrium (Figure), though
their distributions vary between hearts. Areas of high rotor
densities are often closely associated with pulmonary
vein (PV) ostia. There were no differences between
Cx43 and fibrosis quantity/distribution between areas
of high and low rotor density. There were slower AP
upstrokes (p < 0.05) and trends towards shorter APDs
(APD75 at 300 ms, 41 8 ms vs. 63 12 ms, p=0.1)
in areas with high incidences of rotors. Conclusions:
There are preferential locations for AF rotors in the left
atrium. Anatomical (locations of PVs) and functional
factors (spatial heterogeneities of repolarization and conduction) are more important in determining rotor sites
than structural factors such as regions of fibrosis. Identification of the determinants of preferential rotor sites
can help optimize ablative therapy for AF.
242
103 Abstract 0111

ANTIARRHYTHMIC MECHANISMS OF SK CHAN
NEL INHIBITION IN THE RAT ATRIUM
Lasse Skibsbye1, Xiaodong Wang1, Lene Axelsen1, Morten
Schak Nielsen1, Morten Grunnet1, Bo Bentzen1, Thomas
Jespersen1
1
University of Copenhagen, Copenhagen, Denmark
Introduction: SK channels have functional importance in
the cardiac atrium of many species, including humans.
Pharmacological blockage of SK channels has been reported to be antiarrhythmic in different animal models of
atrial fibrillation; however, the exact antiarrhythmic
mechanism of SK channel inhibition remains unclear.
Objectives: We speculated that together with a direct inhibition of repolarizing SK current, the previously observed depolarization of the atrial resting membrane potential (RMP) after SK channel inhibition reduces sodium channel availability and thereby prolongs the effective refractory period (ERP) and slows conduction velocity. We therefore aimed at elucidating these properties of
SK channel inhibition and the underlying antiarrhythmic
mechanisms by using microelectrode action potential
recordings and conduction velocity measurements in isolated rat atrium. Moreover, automated patch-clamping
(Qpatch) was used to access sodium current inhibition.
Results: Runs of atrial fibrillation observed in the isolated right atrium was not inducible after pharmacological
SK channel inhibition. The SK channel inhibitor
N-(pyridin-2 -yl)-4-(pyridin-2-yl)thiazol-2-amine
(ICAGEN) exhibited antiarrhythmic effects. Without directly inhibiting sodium channels, ICAGEN induced atrial post-repolarization-refractoriness and slowed conduction velocity. However, due to a marked prolongation
of ERP, the calculated wavelength was increased. Furthermore, at increased pacing frequencies, SK channel
inhibition showed more prominent effects on sodium
channel-dependent parameters. Contractility was not affected. Conclusion: SK channel inhibition modulates
multiple parameters of the action potential, including
prolongation through direct blockage of the repolarizing
SK current, and shifting the resting membrane potential
towards more depolarized potentials, which leads to an
indirect sodium channel inhibition and ultimately conduction slowing and decreased excitability. Hence, we
propose that the antiarrhythmic mechanism of SK channel inhibition is generated both through direct potassium
channel block and via indirect sodium channel inhibition.
104 Abstract 0113

ELECTROGRAMS ARE MORE THAN THE SUM OF
THEIR PARTSA NEW RAT MODEL OF ATRIAL
ARRHYTHMIAS REFUTES THE CRITICAL MASS
HYPOTHESIS AND REVEALS NEW INSIGHTS INTO
HUMAN ATRIAL FIBRILLATION
Junaid Zaman1, Pravina Patel1, Jennifer Simonotto1, Nicholas
Peters1
1
Intro: Spontaneous models of AF, especially studying age and
blood pressure (BP), are lacking. Small atria were thought not to
be able to harbor sufficient path length to sustain re-entrant AF.
We hypothesize that the aged rat atrium, especially in the presence of hypertension, is a model substrate with structure function
insights relevant to all forms of AF. Methods: Forty normotensive rats (BN) and 40 hypertensive rats (SHR) from 3 to 12 m
had ex vivo Langendorff perfusion, recording AF>30 s using biatrial microelectrode arrays (MiEA). AF was mapped using ac-
243
tivation time, dominant frequency (DF), organizational index

(OI), Shannon entropy (ShEn) and magnitude squared coherence
(MSC) and related to fibrosis and connexin 43 (Cx43) levels.
Physical summation of the MiEA electrodes was performed to
test effect on AF indices using a bridge. Subsets had
non-invasive BP (36 m) measured and telemetry implanted
(912 m) age to check in vivo data. Results: In vivo data confirm
the presence of naturally occurring atrial tachycardia (AT) and
AF in both rats from 9 m old despite SHR BP elevation from
3 m. Ex vivo BN were equally inducible to AT/AF to SHR
throughout. Mean ShEn and MSC correlated with fibrosis but
not when the electrodes were bridged to summate output across a
1.5-mm square. Conversely, mean DF and OI showed no correlation with Cx43 unless electrodes were bridged together. Conclusions: (1) BN are a new small animal model of in vivo and
ex vivo AT/AF. (2) Age is a more potent risk factor for AF than
BP. (3) Cx43 correlates with bridged arrays only and fibrosis
individual electrodes only, akin to SD and HD substrate factors, respectively. (4) This novel finding suggests substrate
changes in AF come in and out of focus as spatial resolution
varies.
244
105 Abstract 0119

THE FUNCTIONAL EXPRESSION OF ELEC
TROPHYSIOLOGIC PARAMETERS IN THE
ORGANIZED VS. DISORGANIZED RHYTHM: A
COMPARATIVE ASSESSMENT OF VOLTAGE,
CONDUCTION VELOCITY, AND FRACTIONATION
DURING ATRIAL FIBRILLATION AND THE PACED
RHYTHM IN THE PERSISTENT AF SUBSTRATE
Norman Qureshi1, Steve Kim2, Chris Cantwell1, Rheeda Ali1,
Caroline Roney1, Fu Siong Ng1, Arunashis Sau1, Rasheda
Chowdhury1, Michael Kao-Wing1, Sajad Hayat1, Elaine
Lim1, Ian Wright1, Nick Linton1, David Lefroy1, Zachary
Whinnett1, D Wyn Davies1, Prapa Kanagaratnam1, Nicholas
Peters1, Phang Boon Lim1
1
Imperial College, London, UK; 2St Jude Medical, St. Paul,
MN, USA
Background. The complexities of mapping the spatiotemporal variations in AF limit the understanding of the functional
electrophysiological determinants of AF. This study sought
to simplify the problem of understanding the electrical properties of AF by assessing the regional electrophysiologic
(EP) relationship between AF and the paced rhythm.
Methods. Patients undergoing PsAF ablation underwent
electroanatomical mapping using a 20-pole spiral catheter.
Voltage and fractionation mapping were performed in AF
over various left atrial (LA) sites, and following DCCV,
voltage and activation mapping during LA pacing (cycle
lengths 300/600 ms) were performed over the same sites.
Deflections and scores were calculated using an automated
custom electrogram (EGM) analysis tool. Results. 35 LA
sites were analysed from 12 patients (age 6511years, LA
417 mm, CHADS2VASC2 2.8 (06)). At each mapped
LA site, the mean peak-to-peak voltage over 8 s in AF
(AF-V) correlated with the mean paced voltages (P-V)
(300 and 600 ms) (R2 =0.5114 p<0.0001 and R2 =0.4742
p<0.0001, respectively). There was also a positive correlation of the mean of both AF-V and P-V (300/600 ms) to the
percentage of fractionated electrograms (%EGMs with
NavX CFE mean score <80 ms) at each site [R2(AF)=
0.4310, p < 0.0001, R2(300 ms) = 0.4310, p < 0.001 and
R2(600 ms)=0.498, p<0.001]. There were poor correlations
between conduction velocity (CV) at both 300 and 600 ms
LA pacing, with mean AF-V, P-V and percentage fractionated EGMs. Conclusion. Voltages in AF correlated to that in
the paced rhythm and to fractionation of EGMs, but not CV.
The EP substrate of AF can be interrogated in the paced
rhythm and could provide crucial insights into the underlying mechanisms of AF.
106 Abstract 0212
VERY-LOW-DENSITY LIPOPROTEIN OF INDI

VIDUALS WITH METABOLIC SYNDROME
SHORTENS ATRIAL ACTION POTENTIAL
DURATION BY CHANGING CALCIUM TRANSIENT
Hsiang-Chun Lee1, Wei Chi1, Hsin-Ting Lin1, I-Hsin Liu1,
Liang-Yin Ke2, Chu-Huang Chen2, Bin-Nan Wu3, ShengHsiung Sheu1
1
Division of Cardiology, Department of Internal Medicine,
Kaohsiung Medical University Hospital, Kaohsiung Medical
University, Kaohsiung, Taiwan; 2Center of Lipid Biosciences,
Kaohsiung Medical University (KMU) Hospital, KMU,
Kaohsiung, Taiwan; 3Department of Pharmacology, College
of Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan
Background: Compared to that of healthy normal subjects,
plasma very-low-density lipoprotein (VLDL) of patients with
the metabolic syndrome (MetS) has been shown to be more
electronegative and atherogenic. Given the association between MetS and increased prevalence of atrial fibrillation
(AF), we investigated the mechanistic role of VLDL in the
AF pathogenesis. Methods: We extracted VLDL via peripheral blood obtained from normal, healthy volunteers and MetS
individuals. The normal-VLDL and MetS-VLDL samples
were treated to HL-1 atrial cardiomyocytes, respectively, for
12 h before experiments. Whole-cell patch clamp was used for
monitoring the action potentials and voltage-gated L-type calcium currents (ICaL). Calcium image with Fura-4-AM Ca2+
indicator was applied for the intracellular calcium measurements. Results: MetS-VLDL-treated HL-1 cells exhibited significantly higher densities of ICaL. MetS-VLDL shifted the
activation curve of ICaL toward more negative membrane
potentials. Intracellular calcium signals were significantly enhanced by MetS-VLDL but not by normal-VLDL. MetSVLDL significantly shortened action potential durations
(MetS-VLDL 178.132.0 ms vs control 257.252.7 ms;
P=0.0017). Additionally, frequent occurrences of early afterdepolarization on action potentials were noted in MetSVLDL-treated HL-1 cells. Conclusions: The VLDL of MetS
individuals augmented repolarizing calcium currents, increased intracellular calcium release, and significantly shortened action potentials. These changes may contribute in coordination to increased AF vulnerability in MetS.
Abstract oral session 11: Management of atrial
arrhythmias
Tuesday, April 21, 2015, 8:30 AM-10:00 AM
111 Abstract 1532
NONINVASIVE ELECTROCARDIOGRAPHIC IMAG

ING AND CATHETER ABLATION OF PERSISTENT
ATRIAL FIBRILLATION
Amiran Revishvili1, Oleg Sopov1, Evgenii Labartkava1,
Vitalii Kalinin1, George Matsonashvili1
1
Bakoulev Scientific Center for Cardiovascular Surgery,
Moscow, Russia
Introduction. Recent achievements in noninvasive electrocardiographic (ECG) imaging allowed its extensive use in diagnostics and treatment of different arrhythmias. This study
aimed to identify sources of initiation and maintenance of
atrial fibrillation (AF) by means of surface ECG-based mapping technology combined with CT scan or MRI and to evaluate results of ablation guided by these maps. Methods. We
applied noninvasive mapping using 240-lead ECG combined
with CT scan- or MRI-based anatomy (Amycard LCC) to 23
patients (15 male/8 female) with persistent AF (mean continuous AF duration 42 months). Fragments with spontaneous
pauses (prolonged R-R interval) during AF were selected for
mapping before procedure. We evaluated electrical activity in
the left and right atrium and atrial septum using specific algorithm. In 22 patients, radiofrequency (RF) ablation was performed at the sites of sustained circular electrical activity
followed by antral pulmonary vein (PV) isolation. One patient
underwent Maze IV procedure due to thrombus in left atrial
appendage. Results. During evaluation of electrical activity in
the left and right atrium, we found from 2 to 4 simultaneously
coexisting rotors. RF application in this areas resulted in
alteration of frequency or direction of electrical activity registered at CS or Lasso catheters. Targeted ablation terminated
AF and maintained sinus rhythm in 8 patients (35 %). Mean
RF application time was 2618 min. In 15 patients (65 %), we
registered prolongation of arrhythmia cycle length but its termination was achieved only after pharmacological or electrical cardioversion. Conclusion. In all patients (100 %), we
245
observed two rotors (a system of two rotors connected of the

excitation wave front). In 13 patients (56 %), we observed the
second intermittent pair of rotors. In all patient rotors, movement includes two types of drifting: slow drifting (when rotors
are situated in abnormal myocardium zones) and fast drifting
(as result of wave front collision with refractory myocardium).
Sinus rhythm recovery observations support simulation based
theory of scroll wave collapse. Ablation of rotors works if
rotors drop the anchor for a long time (>4 rotation cycles)
and anchoring zones are narrow. Initial experience with
noninvasive ECG imaging using 3D-4D mapping system
combined with CT scan or MRI shows its clinical utility, feasibility to provide noninvasive evaluation and features of arrhythmogenic areas and to increase effectiveness of interventional AF treatment.
112 Abstract 1534
MEASUREMENT OF THE ACTIVATED CLOTTING

TIME (ACT) TO CONTROL ANTICOAGULATION
DURING PULMONARY VEIN ISOLATION: A
COMPARISON OF METHODS
Reinhard Hltgen1, Martin Brck2, Dirk Bandorski3, Jessica
Hirsch4, Marcus Wieczorek1
1
I. Medizinische Klinik - Kardiologie/Elektrophysiologie; St.
Agnes-Hospital, Bocholt, Germany; 2Medizinische Klinik I;
Klinikum Wetzlar, Wetzlar, Germany; 3Medizinische Klinik 2,
Universittsklinikum Gieen, Gieen, Germany; 4Institut fr
Medizinsche Biometrie und Epidemiologie; Universitt Witten/Herdecke, Witten, Germany
Introduction: Effective anticoagulation is a cornerstone to reduce the number of thromboembolic complications during
pulmonary vein isolation (PVI). The poignancy of
anticoagulation is monitored by measurement of the ACT.
Yet, a methodological gold standard for the determination of
the ACT is not available. The aim of the study was to clarify, if
different methods for the determination of the ACT lead to
different results. Patients and methods: In 31 consecutive patients (pts) (age 5812 years), ACT-measurement was conducted during PVI in intervals of 15 min. A total amount of
150 blood samples was controlled simultaneously, using two
different measuring devices: ACT-Messgert Hemochron Signature Plus, Keller Medical (ACT 1), and ACT-Plus,
Medtronic Inc. (ACT 2). All pts were under uninterrupted
anticoagulation with Phenprocoumon (Ph). During PVI,
unfractionated heparin was applied repetitively, following a
predefined protocol in order to lift the ACT to a level of
350 s. Results: For both measuring methods, we found an
inverse correlation between the initial international normalized ratio (INR) and the average cumulative dose of heparin.
246
Between ACT-measurements by ACT 1 (343.1796.09 s)

and ACT 2 (313.85111.61), a highly significant difference
(p<0.001) could be proven. The median by ACT 1 was 28 s
longer than by ACT 2. Pts with an INR<1.8 showed significantly longer ACT values, when tested with ACT 1 compared
to those tested with ACT 2, whereas in the two groups with
higher INR-levels (INR 1.82.0 or INR>2.0), only a nonsignificant trend could be observed as follows:
INR<1.8
INR 1.82.0
INR>2.0
ACT 1
360.52133.249
311.5673.284
348.5890.744
ACT 2
P value
311.67131.192
0.02
297.7691.123
n.s.
319.32112.483
n.s.
Conclusions: The utilization of different methods to measure

the ACT in identical blood samples leads to significantly different results. This difference is mostly pronounced in pts with
sub-therapeutic oral anticoagulation. In an intra-individual
comparison, the different results of the ACT measurements
lead to a relevantly different assessment of the dosage of heparin, applied during PVI-procedure.
113 Abstract 1512
PREDICTORS OF CEREBRAL
MICROEMBOLIZATION DURING PHASED
RADIOFREQUENCY ABLATION OF ATRIAL
FIBRILLATION: ANALYSIS OF BIOPHYSICAL
PARAMETERS FROM THE ABLATION GENE
RATOR.
Edina Nagy-Bal1, Alexandra Kiss1, Catherine Condie2,
Mark Stewart2, Zoltn Csndi1
1
University of Debrecen, Institution of Cardiology, Debrecen,
Hungary; 2Medtronic Inc., Minneapolis, MN, USA
BACKGROUND: Pulmonary vein isolation with phased radiofrequency current and use of a pulmonary vein ablation
catheter (PVAC) has recently been associated with a high incidence of clinically silent brain infarcts on diffusionweighted magnetic resonance imaging and a high
microembolic signal (MES) count detected by transcranial
Doppler. OBJECTIVE: The purpose of this study was to investigate the potential correlation between different biophysical parameters of energy delivery (ED) and MES generation
during PVAC ablation. METHODS: MES counts during consecutive PVAC ablations were recorded for each ED and time
stamped for correlation with temperature, power, and impedance data from the GENius 14.4 generator. Additionally,
catheter-tissue contact was characterized by the template
deviation score, calculated by comparing the temperature

curve with an ideal template representing good contact, and
by the respiratory contact failure score, to quantify temperature variations indicative of intermittent contact due to
respiration. RESULTS: A total of 834 EDs during 48
PVAC ablations were analyzed. A significant increase in
MES count was associated with a lower average temperature, a temperature integral over 62 C, a higher average
power, the total energy delivered, higher respiration and
template deviation scores (P<0.0001), and simultaneous
ED to the most proximal and distal poles of the PVAC
(P<0.0001). CONCLUSION: MES generation during ablation is related to different indicators of poor electrodetissue contact, the total power delivered, and the interaction between the most distal and the most proximal
electrodes.
114 Abstract 1511
REDUCED LEFT ATRIAL COMPLIANCE

CONTRIBUTES TO THE RECURRENCE AFTER
CATHETER ABLATION IN PATIENTS WITH LONE
ATRIAL FIBRILLATION
Junbeom Park1, Jin-Kyu Park1, Jae-Sun Uhm1, Boyoung
Joung1, Moon-Hyoung Lee1, Hui-Nam Pak1
1
Objective: Stiff left atrial (LA) syndrome was initially
reported in post-cardiac surgery patients and known to
be associated with low LA compliance. We investigated
the physiological and clinical implications of LA compliance, estimated by LA pulse pressure (LApp) among
patients with lone AF. Methods: Among 1038 consecutive patients with LA pressure measurements in the
Yonsei AF Ablation Cohort, we included 334 patients
with lone AF (81.7 % male, 54.110.6 years, 77.0 %
paroxysmal AF) after excluding those with hypertension,
diabetes, systolic or diastolic dysfunction, any structural
heart disease, and previous ablation or cardiac surgery.
We measured LApp (peak LA pressure [v-wave]nadir
LA pressure [x-wave]) at the beginning of the ablation
procedure, and compared the values with clinical imaging parameters and AF recurrence rate. Results: 1. Patients with lone AF were younger (p<0.001), more likely to be male (p < 0.001), have paroxysmal AF
(p< 0.001) and have lower BMI (p=0.041) and LApp
(p<0.001) compared to those with other diseases. Based
on the median value, low LA compliance group
(LApp313mmHg) had a smaller LA volume index (3DCT; 73.1 19.9 vs. 78.4 19.3 ml/m 2 , p = 0.035) and
lower LA voltage (1.20.6 vs. 1.40.8 mV, p=0.032)

than those with high LA compliance (LApp<13 mmHg).
During a median follow-up of 12 months,
LApp313mmHg was independently associated with clinical recurrence of lone AF (HR=3.16, 95 %CI 1.146
8.711, p=0.026). Conclusions: Reduced LA compliance
estimated by an elevated LApp was associated with
smaller LA volume index and lower LA voltage and
also independently associated with higher clinical recurrence after catheter ablation in patients with lone AF.
115 Abstract 1527
IMPACT OF LEFT ATRIAL LOW VOLTAGE EXTENT

ON OUTCOMES AFTER ABLATION FOR PERS
ISTENT ATRIAL FIBRILLATION
Jeremie Sorrel1, Amir Jadidi1, Heiko Lehrmann1, Thomas
Arentz1
1
Herzzentrum Bad Krozingen, Bad Krozingen, Germany
Objective: Atrial fibrosis is implicated in maintenance of
persistent atrial fibrillation (AF). We hypothesized that the
extent of atrial low-voltage areas (low voltage in AF <
0.5 mV) may be predictive for clinical outcomes in patients
undergoing ablation for persistent AF. Methods: Seventy-
247
eight consecutive patients with persistent AF (648 years

old, 68 % male) underwent left atrial (LA) voltage mapping
at high density (912134 sites) in AF using a 20-pole Lasso
catheter in combination with Velocity (SJM) or Carto3
(BW). If AF persisted after completion of PV isolation,
patients underwent additional ablation of prolonged and
fractionated electrograms within low-voltage sites
<0.5 mV. Single procedural recurrence rate (AF and atrial
tachycardia (AT)) was assessed at 6, 9 and 12 months by
24 h ECG. Results: The mean extent of LA low voltage
was 3527 % for the total study group. Arrhythmia freedom (AF and AT) was maintained in 59/78 (76 %) patients after a single procedure and a mean follow-up of 9
2 months. Arrhythmia freedom was 95 % (20/21) in patients with low extent (<15 %, group A) of LA low voltage vs. 71 % (17/24) in patients with intermediate extent
(1535 %, group B) of LA low voltage and 66 % (22/33)
in patients with high extent (>35 %, group C) of LA low
voltage (p=0.02 for A vs C). However, AF freedom did
not differ significantly between these three groups (95 %
(20/21) group A, vs 75 % (18/24) group B, vs 82 % (27/
33) group C (p=0.23). Conclusion: The baseline extent of
LA low-voltage areas in AF predicts rate of arrhythmia
freedom after a single ablation for persistent AF. Patients
with increased low voltage areas (>35 % of LA surface)
present an increased risk for arrhythmia recurrence especially for atrial tachycardia.
248
116 Abstract 1830
121 Abstract 1416
ATRIAL TACHYCARDIAS ORIGINATING FROM

THE NON-CORONARY CUSPS: THE TEL-AVIV
MEDICAL CENTER EXPERIENCE IN 7 PATIENTS.
IDIOPATHIC ATRIAL FIBRILLATION, INFL

AMMATION, AND CLINICAL RESULTS OF
RADIOFREQUENCY ABLATION
Yoav Michowitz1, Raphael Rosso1, Aharon Glick1, Sami

Viskin1, Bernard Belhassen1
1
Tel-Aviv Medical Center, Tel-Aviv, Israel
Roman Batalov1, Yulia Rogovskaya1, Viacheslav Ryabov1,

Roman Tatarskiy1, Svetlana Sazonova1, Mikhail Khlinin1,
Sergei Popov1
1
RI of cardiology, Tomsk, Russia
Background: Atrial tachycardia (AT) originating from

the non-coronary cusp (NCC) has been recently described. Objectives: The study aims to describe the clinical and electrophysiological characteristics of AT originating from the NCC and treated with radiofrequency
ablation (RFA) at our center. Methods: Files of patients
(pts) with NCC-AT were retrospectively studied. Data
were obtained from pts charts, ECGs, electrophysiological reports and digital recording systems. Results: Of
101 pts with AT referred for RFA between January
2008 and October 2014, we identified 7 pts (4 females,
aged 2478 years, mean 5519) with NCC-AT. Clinical
symptoms included recurrent episodes of palpitations in
4, syncope in 2 and exercise-test induced AT in 1 pt.
Mean rate of the clinical tachycardia was 172+40 bpm.
Mapping the right atrium during tachycardia revealed
earliest activity in the His area in 6 pts and in both
the His area and the CS-ostium in 1. The left atrium
was also mapped in 2 pts. Retrograde aortic approach
was used for mapping the aortic cusps in all pts.
Electro-anatomical mapping systems were used in 2
pts. In 2 pts ablation was attempted first in the RA
and in 2 also in the LA. The earliest local atrial activation in the NCC preceded the atrial activation in the His
area by 2910 ms. In 4 pts, the AT mimicked AVNRT.
Since it was impossible to clearly distinguish the atrial
activation pattern in 1 pt, slow pathway ablation was
necessary. Ablation was carried out with regular 4-mm
and irrigated 3.5-mm ablation catheters (with up to 40W power) in 4 and 2 pts, respectively. In our first pt,
ablation was not attempted. Acute successful ablation
was uncomplicated, especially no AV block was observed. During follow-up of 2522 month, 1 pts had
recurrence of AT without medications (excluding the
first pt who was not ablated). Conclusions: AT may
originate from the NCC. Catheter ablation of this rare
arrhythmia is safe and effective.
Abstract oral session 12: Atrial fibrillation ablation III

Tuesday, April 21, 2015, 8:30 AM10:00 PM
The aim of the study was to evaluate the role of inflammation

in clinical results of radiofrequency ablation (RFA) of atrial
fibrillation (AF). Material and methods. The study comprised
274 patients admitted to clinic with diagnosis of idiopathic
form of AF. At the first stage of examination, this diagnosis
was confirmed only in 67 (24.5 %) patients. All patients received AF RFA and endomyocardial biopsy study with histological and immunohistochemical determination of the myocardial infiltrating cells and the expression of cardiotropic viral antigens. Catheter treatment efficacy and the presence of
early and late recurrences was evaluated. Results. According
to endomyocardial biopsy study, histological changes in the
right ventricular myocardium were absent in 9 (13.4 %). Signs
of myocardial fibrosis were found in 26 (38.8 %) mostly suggesting the presence of perivascular fibrosis in 11 (42.3 %),
microfocal fibrosis in 8 (30.8 %), and perimuscular fibrosis in
7 (26.9 %). Inflammatory changes were found in 32 (47.8 %)
where 9 (28.1 %) had lymphocytic infiltration. One of these
patients (3.1 %) had a combination of the expression of human
herpes simplex virus type 2 and Epstein-Barr virus. Among 23
(34.3 %) with myocarditis, viral expression was found in 18
(78.3 %). Expression of three viruses was found in one
(5.6 %); two viruses was identified in six (33.3 %); and one
viral antigen was found in 11 (61.1 %). Mean duration of
follow-up was 19.33.7 months. Primary RFA efficacy rate
was 88.9 % in patients with intact myocardium, 46.2 % with
fibrotic changes of various severities, and 34.4 % in the presence of the criteria for myocarditis. Early recurrences of arrhythmias were absent when myocardium was unchanged. In
the presence of fibrotic changes, early recurrences were registered more frequently (53.8 %); late recurrences were less
often (34.6 %). In the presence of inflammatory changes, the
late recurrences were more frequently (53.1 %) whereas the
early recurrences were less often (37.5 %). Conclusion. According to our study, only 24.5 % of patients were free of
diseases facilitating the development of arrhythmias. Histological study showed that only 10 % of patients had idiopathic
form of arrhythmia, half had inflammatory changes in the
myocardium, and the rest of patients presented with fibrotic
changes. The presence of inflammatory and fibrotic changes
in the myocardium increased the number of early and late
249
recurrences of arrhythmia and, correspondingly, attenuated

the efficacy of AF RFA by twofold.
123 Abstract 1828
122 Abstract 1833
MECHANISMS OF ATRIAL ARRHYTHMIAS AFTER

MAZE PROCEDURE AND LONG-TERM OUTCOME
AFTER CATHETER ABLATION
CHARACTERISTICS OF PATIENTS THAT FAILED

CATHETER ABLATION OF ATRIAL FIBRILLATION,
A SINGLE CENTER EXPERIENCE
C Teunissen 1 , J.F. vd Heijden 1 , R.J. Hassink 1 , W
Kassenberg1, P.A.F.M Doevendans1, K.P. Loh1
1
UMC Utrecht, Utrecht, Netherlands
Introduction: Catheter ablation is a successful treatment
option in patients suffering from symptomatic, drug refractory atrial fibrillation (AF). Single-procedure success is
modest and patients with AF recurrence usually undergo
repeated and sometimes extensive ablations. Patients can
be free of tachycardia off antiarrhythmic drugs or achieve
clinical benefit with reduced AF burden. Treatment strategy of patients with AF recurrence is influenced by patients
symptoms and preferences and by physicians choices. Objectives: The sudty aims to analyze patients with AF recurrences after single or multiple ablations in our center and to
characterize patients that ultimately did not benefit from
treatment. Methods: From January 2005 to January 2013,
736 consecutive patients (mean age 57 years, 59.5 % paro x y s m a l A F, 2 8 . 4 % p e r s i s t e n t A F a n d 1 2 . 1 %
longstanding persistent AF) suffering from symptomatic,
drug refractory AF underwent catheter ablation. The primary ablation strategy was pulmonary vein antrum isolation. If necessary, substrate modification was added in redo
procedures. Results: After single or multiple procedures
(follow-up after last procedure 44 months), 222 of 736
patients (30.2 %) had AF recurrence. Of these 222 patients,
143 achieved clinical benefits and no further ablation was
performed. No success or clinical benefit was achieved in
79 of 736 patients (10.7 %). Of these 79 patients, 53 patients chose rate control: 26/53 after 1 PVAI only, 24/53
after >1 PVAI but no additional substrate modification, and
3/53 after unsuccessful surgical MAZE. In the remaining
26 patients (3.5 %), multiple ablations (mean 2.7) with
extensive substrate modification had been performed. These patients had mostly (longstanding) persistent AF
(84.6 %), mean AF duration of 8.3 years and mean left
atrial size of 48 mm. Conclusion: After single or repeated
catheter ablations, 10.7 % of patients do not show success
or clinical benefit. In most of these patients, rate control
was chosen over repeated or extensive ablation. Eventually, catheter ablation truly failed in only 3.5 %. These patients had mostly (longstanding) persistent AF and an increased left atrial size.
Andrea Tordini1, Madhan Nellaiyappan 1, Thanh Tran1,

Sanders Chae1, Michael Fradley1, S. Serge Barold1, Bengt
Herweg1
1
University of South Florida, Tampa, FL, USA
Background: Although the MAZE procedure is considered a
highly effective therapy for atrial fibrillation (AF), recurrent
atrial arrhythmias (AA) after MAZE are common and can
alter quality of life and long-term outcome. The purpose of
this study was to evaluate the mechanisms of AA, the procedural results and outcome of catheter ablation in patients after
MAZE. Methods: We have identified 27 patients who
underwent electrophysiology studies and catheter ablation
for sustained AA after MAZE between 2002 and 2013. A
retrospective review of the medical records and procedural
data was performed. Results: Patient age was 6610 years;
19 (70 %) were male (EF=4914 %, left atrial diameter=48
6 mm). Sixteen patients (59 %) had open chest, 9 (41 %) a
minimally invasive MAZE and 18 (67 %) had additional cardiac surgery. The time from MAZE to ablation was 2.8
2.3 years. The presenting AA was AF in 10 patients (37 %),
a more organized AA in 17 patients (63 %), and was sustained
in 10 patients. The number of AA substrates targeted was 2.4
0.9 per patient. Pulmonary vein re-isolation was performed
in 16 patients (59 %), targeting gaps in the surgical lesion set,
requiring 1921 RF applications per patient. Right-sided linear ablation was performed in 12 patients (cavo-triscuspid
isthmus [n=12], scar dependent AA [n=8]). Left-sided linear
ablation was performed in 14 patients (mitral isthmus [n=9],
roof [n=3], septum [n=2]). In addition, we ablated focal right
AT in 4 patients, focal left AT in 6 patients, a posterior wall
rotor in 1 patient, and AVNRT in 1 patient. At the end of the
procedure, 16 patients (59 %) were non-inducible by atrial
burst pacing. The procedure time was 255103 min, fluoroscopy time was 5746 min. Re-ablation was performed in 10
patients (37 %). During a follow-up of 2.62.5 years, one
patient developed recurrent persistent atrial flutter after 8 years
of follow-up. However, 12 patients (44 %) continued to have
non-sustained AA and nine patients (33 %) remained on antiarrhythmic therapy with Dofetilide (n=8) or Sotalol (n=1).
Three patients with refractory AA underwent AV junctional
ablation. Conclusion: Patients with recurrent AA after Maze
frequently have advanced atrial remodeling. Ablative therapy
requires a step-wise approach, often targeting multiple different AA substrates. Re-isolation of the pulmonary veins was
required in more than half of the patients. Scar-dependent
250
right and left atrial flutters are frequently encountered. Aggressive ablative therapy leads to acceptable long-term results.
However, adjunctive anti-arrhythmic therapy is needed in a
third of patients.
comparison to CC group. CF technology is able to significantly reduce procedure time without compromising complication
rate.
125 Abstract 1411
124 Abstract 1814
IMPACT OF CONTACT FORCE TECHNOLOGY ON

ATRIAL FIBRILLATION ABLATION: A
META-ANALYSIS
ANTIARRHYTHMIC THERAPY POST-ABLATION

TO REDUCE ATRIAL FIBRILLATION
RECURRENCE: A META-ANALYSIS
Mohammed Shurrab , Luigi Di Biase , David Briceno , Anna

Kaoutskaia1, David Newman1, Ilan Lashevsky1, Hiroshi
Nakagawa3, Eugene Crystal1
1
Sunnybrook Health Sciences Centre, Toronto, Canada; 2 Texas Cardiac Arrhythmia Institute, Austin, TX, US; 3 University
of Oklahoma Health Sciences Center, Oklahoma City, OK,
USA
Gustavo Goldenberg 1, Daniel Burd 1 , Piotr Lodzinski 2 ,

Giussepe Stabile 3, Jacob Udell4, Mohammed Shurrab1,
Eugene Crystal1
1
Sunnybrook Hospital, Toronto, Ontario, Canada; 2Medical
University of Warsaw, Department of Cardiology, Warsaw,
Poland; 3Laboratorio di Elettrofisiologia, Casa di Cura San
Michele, Maddaloni, Italy; 4Toronto General Hospital,
Toronto, Ontario, Canada
Background: Cathetertissue contact is essential for effective

lesion formation; hence, there is a growing usage of contact
force (CF) technology in atrial fibrillation (AF) ablation. Data
regarding the efficacy and safety of CF for catheter ablation of
AF are limited. We conducted a meta-analysis to assess the
impact of CF on clinical outcomes and procedural parameters
in comparison to conventional catheter (CC) for AF ablation.
Methods: An electronic search was performed using Cochrane
central database, PubMed, Embase, and Web of Knowledge.
References were searched manually. Outcomes of interest
were as follows: recurrence rate, major complications (including major bleeding, ischemic stroke, embolism, or transient
ischemic attack), total procedure, and fluoroscopic times.
Continuous variables were reported as standardized difference
in means (SDM); odds ratios (OR) were reported for dichotomous variables. Results: Eight studies (two randomized controlled studies and six cohorts) involving 530 adult patients
(mean age 602.3 years; 453 patients (85 %) with paroxysmal
AF) were identified. CF was deployed in 203 patients. The
range of CF used was between 5 and 40 g-force. Follow-up
period ranged between 10 and 53 weeks. In comparison between CF and CC groups, a lower recurrence rate was noted
with CF (19 vs. 33 %, OR 0.48 (95 % confidence interval [CI]
0.28; 0.79), P=0.004). No significant heterogeneity was noted
for the comparison (I2 =8 %, P=0.37). Shorter procedure but
similar fluoroscopic times were achieved with CF (132 vs.
154 min, SDM 0.89 (95 % CI 1.74; 0.05), P=0.04; 35
vs. 40 min, SDM 1.13 (95 % CI 2.51; 0.25), P=0.11, respectively). Major complication rate was higher numerically
in the CF group but this did not reach statistical significance
(1.7 vs. 0.7 %, OR 1.98 (95 % CI 0.37; 10.59), P=0.42).
Conclusion: The use of CF technology results in a significant
reduction of AF recurrence rate after AF ablation in
INTRODUCTION: Three months of empirical antiarrhythmic drug (AAD) therapy after atrial fibrillation ablation (AFA) is common to prevent early AF recurrence
with limited data to support this practice. OBJECTIVE:
The study aims to perform a meta-analysis of published
controlled trials comparing temporary AAD therapy after
AFA with standard care in patients after AFA. The primary outcome was recurrence of arrhythmia. A subgroup analysis stratified patients by durations of
follow-up at 6 months. RESULTS: Seven trials were
included; six were randomized and one was a retrospective controlled study. Among 1245 patients, 763
(61.3 %) had paroxysmal AF, and 318 (25.5 %) had
persistent AF. In total, 747 patients were treated with
AADs and 498 patients served as a control group (no
AA therapy). Various class IC-III antiarrhythmics were
used. Length of AAD administration varied between
6 weeks immediately following AFA to 3 months. The
follow-up duration ranged from 1.5 to 12 months.
Among AAD-treated patients, the recurrence of arrhythmia rate was 33.4 vs. 39.5 % in control patients (odd
ratio 0.75, 95 % CI 0.541.03, P = 0.08)., Subgroup
analysis revealed that among patients followed for
6 months or longer after AFA, AAD-treated patients
had an arrhythmia recurrence rate of 32.9 % compared
with 45.1 % among control (odds ratio 0.55, 95 % CI
0.330.91, P=0.02). However, no significant heterogeneity was noted compared with patients followed for less
than 6 months (I2 =39 %, P=0.18). CONCLUSION: Antiarrhythmic therapy may help to reduce delayed
(6 months or longer) recurrence of AF after AFA. A
definitive large randomized controlled trial appears warranted to confirm these findings.
251
126 Abstract 1812
Poster session A part 1: Supraventricular arrhythmias:

advances in mechanisms and management
ACUTE PROCEDURAL RESULTS AND MID-TERM

OUTCOME OF ELECTROANATOMICAL GUIDED
PULMONARY VEIN ISOLATION: A SINGLE
CENTREOBSERVATIONAL STUDY COMPARING A
REAL-TIME CONTACT FORCE SENSING VERSUS
STANDARD TIP IRRIGATED ABLATION
CATHETER
Sunday, April 19, 2015

Posters exposed from 8:30 AM to 12:00 PM
Presenters and chairpersons present from 09:00 AM to
10:30 AM
Daniele Muser 1 , Luca Rebellato 1 , Gaetano Nucifora 1 ,

Domenico Facchin1, Mauro Toniolo1, Silvia Magnani2,
Alessandro Proclemer1
1
Azienda Ospedaliera Santa Maria della Misericordia di
Udine, Udine, Italy; 2Azienda Ospedaliera di Trieste, Trieste,
Italy
IVABRADINE VERSUS BISOPROLOL FOR INAP

PROPRIATE SINUS TACHYCARDIA
Aims: The additional benefit of real-time contact force

(CF) measurement during pulmonary vein isolation (PVI)
to improve procedural parameters and clinical outcome is
unclear. We prospectively assessed the impact of realtime CF measurement on acute procedural parameters,
procedural-related complications and mid-term outcome.
Methods and results: One hundred consecutive patients
(73 males) with paroxysmal (78) or persistent (22) atrial
fibrillation (AF) who underwent PVI with CARTO 3
electro-anatomical mapping (EAM) system (Biosense
Webster Inc.) were consecutively assigned to either radiofrequency (RF) ablation using the 3.5-mm open irrigated NavistarThermocoolcatheter (50 patients, standard group) or the new SmartTouchTM catheter with
CF measurement capabilities (50 patients, CF group).
PVI end point was set as validation of entry and exit
block. Acute procedural parameters were assessed as
well as mid-term follow-up. Baseline demographic, cardiovascular and anatomical characteristics were similar in
both groups. Procedural data showed no significant differences in RF ablation time and in overall procedure
duration. Significant reduction in fluoroscopy time (57
16 vs. 29 16 min) and a trend in reduction of
procedural-related complications (10 vs. 2 %) were reported inCF group patients. No differences in mid-term
risk of AF recurrence were observed between the two
groups (8 % in the CF group vs. 10 % in the standard
group at 12 months, respectively, log rank test p=0.376).
However, in CF group, patients with higher (>13.5 g)
mean time-weighed CF resulted in a lower risk of 12month follow-up AF recurrence (18 vs. 0 %; p=0.041).
Conclusion: The use of CF sensing technology in PVI
reduces significantly fluoroscopy time and improves procedural safety. Patients with optimized contact force, presented lower risk of AF recurrences.
131 Abstract 1419
Annamaria Martino1, Antonella Sette1, Marco Rebecchi1,

Ermenegildo de Ruvo1, Luigi Sciarra1, Lucia De Luca1,
Alessio Borrelli1, Alessandro Fagagnini1, Antonio Scar1,
Leonardo Calo1
1
Cardiology Department, Policlinic Casilino, Rome, Italy
Background: Inappropriate sinus tachycardia (IST) is commonly treated with beta-blockers. Ivabradine has been recently proved effective in IST. The aim of our study was to compare ivabradine and bisoprolol in the treatment of IST.
Methods: Consecutive IST patients (pts) underwent an Holter
ECG monitoring and a stress test. Thereafter, they were randomized to treatment with ivabradine or bisoprolol, started at
an initial dosage of 5 mg bid or 1.25 mg/day, respectively.
After 3 months of pharmacological treatment, all pts
underwent an Holter ECG and a stress test. Results: Overall,
24 IST pts (mean age 34 12 years; 23 women), all
complaining of palpitations and stress intolerance, were administered ivabradine or bisoprolol (12 pts for each group).
Baseline Holter ECG and stress test parameters were comparable in the two groups. The mean doses of ivabradine and
bisoprolol administered were 51.3 mg bid and 21 mg/day,
respectively. Mean Holter ECG HR lowered from 924.3 to
768 bpm with ivabradine (P<0.001) and from 915 to 81
12 bpm with bisoprolol (P=0.006, bisoprolol vs baseline; P=
0.02 ivabradine vs bisoprolol) after 3 months. Ivabradine, but
non-bisoprolol, improved maximal Holter ECG HR (from
15216.6 to 12818 bpm; P<0.001) and maximal HR at
stress test (from 154 12.5 bpm to 146 15.5 bpm; P =
0.044). Minimal Holter ECG HR also lowered from 589.5
to 529 bpm with ivabradine (P=0.039). An increase of at
least 50 W in the maximal step at the stress test was
observed in 41.7 and 50 % of ivabradine- and
bisoprolol-treated pts, respectively. Complete resolution
of IST-related symptoms occurred in the 89.5 and 75 %
of cases with ivabradine and bisoprolol, respectively.
Phosphenes occurred in 5.3 % of pts with ivabradine,
whilst bisoprolol caused hypotension in 25 % of cases.
Conclusions. In our population of pts affected by IST, 3-
252
month treatment of ivabradine caused a stronger attenuation of mean and maximal Holter ECG HR and of maximal HR at stress test in comparison to bisoprolol.
Ivabradine was also more effective in controlling symptoms and was better tolerated than bisoprolol.
which provides a powerful noninvasive tool for guiding

catheter ablation.
132 Abstract 2815
ABLATION OF ATYPICAL ATRIAL FLUTTERS

USING ULTRA-HIGH-DENSITY ACTIVATION
SEQUENCE MAPPING
NONINVASIVE ELECTROCARDIOGRAPHIC
IMAGING OF ATRIAL FLUTTER IN HUMANS
USING PHASE MAPPING
Amiran Revishvili1, Dmitry Lebedev2, Michail Chmelevsky2,
Alexander Kalinin3, Vitaly Kalinin1, Evgenii Labartkava1,
Oleg Sopov1, Stepan Zubarev2
1
Bakoulev Scientific Center for Cardiovascular Surgery,
Moscow, Russia; 2Almazov Federal Heart, Blood and Endocrinology Centre, St. Petersburg, Russia; 3Lomonosov Moscow State University, Moscow, Russia
Introduction. Noninvasive electrocardiographic imaging
(ECGi) is a state-of-the-art electrophysiology methodology that has been used to reconstruct local unipolar
electrograms at the epicardium from the body-surface
potentials. We have extended ECGi to map both endo
and epicardium. Here, we introduce phase mapping to
analyze stable reentrant atrial flutter. The stability of
flutter allowed us to validate ECGi with invasive electroanatomic mapping. Methods and results. Nine consecutive patients with type I atrial flutter (AFl) were examined. All patients underwent ECGi using an Amycard
01 C system (Amycard, Moscow, Russia). Data processing included reconstruction of unipolar electrograms,
phase and isochronal mapping. Validation of the methodology was carried out based on electroanatomical
mapping using a CARTO XP EP Navigation system
(Biosense Webster, Diamond Bar, USA). Using isochronal maps of the right atrium, we conducted radiofrequency ablation of cavo-tricuspid isthmus in all patients. We visualized the spread of excitation using noninvasive phase mapping. A typical counterclockwise reentry circuit around the tricuspid valve with a transition
through the cavo-tricuspid isthmus was the mechanism of
AFl. We visualized two types of patterns of atrial activation which are typical for type I (N=8) and lower-loop
(N=1) AFl. The results were confirmed using a CARTO
XP system in all patients. Catheter ablation of the isthmus resulted in successful termination of AFl in all patients. Conclusions. Noninvasive phase mapping enables
accurate detection of the activation pattern in type I AFl,
133 Abstract 2811
Roger Winkle1, Ryan Moskovitz2 , R. Hardwin Mead 1,

Gregory Engel1, Melissa Kong1, William Fleming1, Rob
Patrawala1
1
Silicon Valley Cardiology, E Palo Alto, CA, USA; 2St. Jude
Medical, St. Paul, MN, USA
Objectives: The study aims to evaluate ultra-high-density activation sequence mapping (UHD-ASM) for understanding
and ablating atypical atrial flutters (AAFs) encountered during
ablations. Methods: We examined 23 patients with 31
spontaneous/induced AAF. We created UHD-ASM during
AAF using a 20-pole circular catheter and the EnSite Velocity
System using the Precision Mapping Module. Results: The
following are the patient demographics: age = 65.3 8.5,
male=78 %, LA size=4.660.64 cm, hypertension=60.8 %,
paroxysmal AF=21.7 %, and redo ablation in 20/23 (87 %).
The AAF were LA in 30 (97 %) and RA in 1 (3 %). For each
AAF, we mapped 38152526 points and 1273697 points
were used for UHD-ASM. The time to create and interpret
the UHD-ASM was 2011 min. For every AAF, the entire
circuit was identified. AAF was macroreentry in 30 (97 %)
and microreentry in 1 (3 %). AAF cycle length was 267
49 ms and the macroreentry circuit length was 13838 mm
(range 35187). Macroreentry flutters took varied pathways
around the atria, but each had an area of slow conduction
(ASC) averaging 166 mm (range 629) in length. Conduction velocity for the rapid portion of the circuit was 0.70
0.22 m/s and for the ASC was 0.210.11 m/s. Entrainment
was not utilized. We targeted the ASC (location roof=5, typical mitral isthmus (MI) flutter (circuit exclusively around the
valve)=4, complex MI flutter using the perivalvular region
extensively but also with non-mitral ASC=11, LAA/LSPV
ridge=2, anteroseptal LA=4, PVs=2, posterior LA=1, RA=
1). Ablation terminated AAF directly in 19/31 (61.3 %) and
altered AAF activation in 7/31 (22.6 %) and the altered AAF
terminated directly in all 7 with additional ablation and/or
remapping. AAF degenerated to AF in 2/31 (6.5 %) with RF
and could not be reinduced after ablation of the ASC. Thus,
28/31 (90.3 %) terminated with RF energy and/or could not be
reinduced after ASC or micro reentry focus ablation. Median
time from initial RF to AAF termination was 64 s. Eleven
patients with complex MI flutter had the ASC away from

the MI; ten were ablated successfully. Two of 4 patients
with true complete MI flutter did not terminate with ASC
ablation. All patients had pulmonary veins re-isolated when
appropriate. Procedure time was 13232 min. There were
no complications. Conclusions: Using only rapidly acquired UHD-ASM for AAF, the entire flutter circuit as well
as a target ASC can be identified. Most AAFs were LA
macroreentry. MI flutters were frequently complex and
had the target ASC away from the MI. Ablation of the
ASC or microreentry focus directly terminated or eliminated inducible AAF in 90.3 %.
134 Abstract 2813
FEASIBILITY OF USING RIPPLE MAPPING IN A

CONSECUTIVE SERIES OF ATRIAL TACHYCARDIA
ABLATIONS
Vishal Luther1, Shahnaz Jamil-Copley1, Nicholas Linton1,
Michael Koa-Wing1, Sajad Hayat1, Norman Qureshi1, FuSiong Ng1, Belinda Sandler1, Kevin Leong1, Ian Wright1,
Zachary Whinnett1, Phang Boon Lim1, David Lefroy1, David
Wyn Davies1, Nicholas Peters1, Prapa Kanagaratnam1
1
Imperial College Healthcare NHS Trust, London, UK
Background: Ripple mapping (RM) is a novel clinical
tool that displays electrograms at their corresponding
3D coordinate as a dynamic bar extending from a surface
bipolar voltage map that changes in height according to
253
the electrogram voltage-time relationship, gated to a fiduciary time point that enables mapping without point annotation or window-of-interest adjustments. We prospectively tested the RM module on CARTO3 v4 in a consecutive series of atrial tachycardia (AT) ablations. Methods:
3D maps were collected with CARTO3 v4 with color and
fill threshold reduced to 5 mm to ensure dense and even
point collection. RM preferences were set to clip bars at
0.25 mV and exclude points <0.03 mV. During RM playback, the bipolar voltage threshold was modified to display scar as areas devoid of ripple activation. Results:
Nine patients (mean age 66 years, six male) were studied.
The mean number of points collected was 837 (range
1822426) over a mean chamber area of 205 36 cm2
(seven left atrium) and mapping time of 358mins. Five
maps were collected with ConfiDense automated mapping. RM demonstrated a focal origin in four patients
and ablation at the earliest ripple bar terminated all cases.
Macro-re-entry was demonstrated in the remaining five
patients (see figure). Dual-loop re-entry involving the roof
and mitral annulus was evident in three patients. Modifying the voltage threshold identified isthmuses of conduction bounded by islands of scar or previous ablation lines
critical to these circuits. Ablation transecting these isthmuses changed or terminated tachycardia in each case.
Automated isochronal maps were un-interpretable in two
focal cases owing to inappropriate setting of the window
of interest and four re-entrant studies due to the complexity of propagation. Conclusion: In this small series of
prospective AT ablations, RM correctly defined the mechanism of AT and critical sites for ablation delivery.
254
135 Abstract 1831
marker of ablation lesion efficacy in the ablation of typical

right atrial flutter.
USE OF ELECTRICAL COUPLING INDEX IN TYPI

CAL ATRIAL FLUTTER ABLATION
136 Abstract 1417
Massimiliano Maines 1 , Domenico Catanzariti 1 , Carlo

Angheben1, Maurizio Del Greco1
1
Santa Maria del Carmine Hospital, Rovereto, Italy
INTERVENTIONAL TREATMENT
SUPRAVENTRICULAR TACHYARRHYTHMIAS IN
CHILDREN WITH CONGENITAL HEART DISEASE
Introduction. A new generation ablation system with an irrigated ablation catheter in conjunction with an advanced electroanatomic mapping and navigation system allows the evaluation
of the electrical coupling index (ECI), an indication of tip-totissue contact. The aim of our study was to evaluate if this index
could also give an indication about ablation lesion efficacy.
Methods. In patients undergoing typical right atrial flutter ablation, we compared the values of the ECI before, during (at the
plateau) and after isthmus ablation. Permanent tissue damage or
ablation lesion efficacy was defined as the reduction in the local
potential >90 % or as potential split in two separate signals. In
the absence of these endpoints, lesions were deemed ineffective.
Results. Fifteen consecutive patients (11 males, age 69.3
11.4 years) with history of typical atrial flutter underwent an
ablation with Contact Therapy Cool Path Cardiac Ablation System in conjunction with EnSite Velocity Contact
technology between Sep 2012 and Aug 2013. The target site for
ablation was the isthmus between the inferior vena cava and the
tricuspid valve. All the procedures were successful, without
complications. The number of radiofrequency (RF) applications
was 10.86.7 (range 628) and RF time was 330.3177.5 s.
ECI values are reported in the table:
Elena Artyukhina1, Amiran Revishvili1

1
Bakulev Scientific Center for Cardiovascular Surgery,
Moscow, Russia
Overall
RF effective
shots
RF ineffective
shots
p*
RF duration (s)
31.73.7
31.43.9
36.14.5
0.02
ECI pre ablation
100.110.5
101.610.8
104.819.3
ns
Min ECI during RF

(plateau)
ECI post ablation
56.39.6
55.89.7
6820.1
ns
81.09.6
79.610.9
95.416.9
0.03
19.15
223.6
9.42.5
<0.001
18.54.2
21.03.6
8.81.2
<0.001
Delta ECI
(pre-post ablation)
Delta% ECI
(pre-post ablation)
RF effective applications needed less time and the ECI

post-ablation was inferior compared to ineffective RF applications. The absolute and percentage ECI variations
(pre-post ablation) were significantly greater when applications were effective (p<0.001). From our data, it is possible
to determine a 13 % cutoff value in the ECI variation that
could be considered as the target for an effective ablation.
Conclusion: The electrical coupling index can be used as a
Purpose: The study aims to evaluate the results of ablation of supraventricular tachyarrhythmia (SVT) in pediatric patients with congenital heart disease (CHD).
Material and methods: From 2000 to 2014, electrophysiological study and catheter radiofrequency ablation for
atrial tachyarrhythmias was performed in 215 children
with congenital heart disease from 1 to 18 years. The
median age was 104.8 years (132 boys and 83 girls).
Patients performed surgery on the following congenital
heart disease: ASD, VSD, tetralogy of Fallot, Ebstein
anomaly (in some casesoperation Sealy), transposition
of great vessels and Fontan operation. Results: One
hundred and thirteen patients had typical or atypical
atrial flutterallin the postoperative period. Other arrhythmias were as follows: WPW syndrome 65 patients,
AVNRT 18, ectopic atrial tachycardia 17 children, occurrence in preoperative (51 %) and in the postoperative
period (49 %). The overall effectiveness of catheter ablation after repeated treatments was 87.2 %. Repeat procedures were performed totally in 10 % of patients and
5 % of them after Ebstein anomaly correction. Conclusion: the effectiveness of interventional treatment SVT
in child with CHD in all cases depends on the age of
the child, such as congenital heart disease and methods
of surgical correction of congenital heart disease.
137 Abstract 0812
CLINICAL IMPLICATION OF UNIPOLAR

RECORDING FOR THE SLOW PATHWAY MAPPING
IN PATIENT WITH TYPICAL AV NODE RE-ENTRY
TACHYCARDIA AND PROLONGED PR INTERVAL
Andrey Ardashev1, Evgeny Zhelyakov1
1
Federal Scientific and Clinical Centre, Moscow, Russia
Case report: We describe the case of a 71-year-old female with
slow-fast atrioventricular (AV) nodal reentrant tachycardia
255
(AVNRT) who had prolonged PR interval (260 ms) during

sinus rhythm. Diagnosis was verified during electrophysiological study. At the beginning of the procedure, AH and HV
intervals were 174 and 48 ms, respectively. Ablation targeting
site was determined at the superior edge of the CS ostium
guided by bipolar and unipolar recording. Slow pathway potential characterized by atrial component of the bipolar EG
had qRs-like morphology, and the A/V ratio was 1.0. The
unipolar targeting potential showed dual-component atrial
EG, where the first component was a positive delta-like wave,
which corresponded to isoelectric phase preceding qRsr-like
configuration on a bipolar EG. The second rS/RS component
of unipolar EG had a sharp and biphasic morphology and
corresponded to so-called R wave on a bipolar atrial EG
(fig). RF-application at this site with target temperature of 55

C and power output 45 W resulted in appearance of accelerated junctional rhythm without VA conduction block. Following the elimination of the slow pathway, the PR and atrio-His
intervals became shortened from 260 to 174 to 200 and
100 ms, respectively. The slow pathway RF-modification improved conduction of the proximal AV nodal structures and
resulted in decreasing of the PR and atrio-His intervals. Moreover, the improvement of AV conduction after the slow pathway ablation lasted for at least 18 months. Conclusion: The
main clinical implication of unipolar and bipolar recording for
the AV slow pathway mapping and ablation in patients with
prolonged PR concludes that this approach can allow treating
AVNRT avoiding AV conduction impairment
138 Abstract 0110
Background: It is suggested that adenosine resistance of retrograde fast pathway in slowfast atrioventricular nodal reentrant tachycardia (AVNRT) confirms the participation of a
concealed retrograde atriohisian pathway, rather than a conventional fast pathway in the arrhythmia circuit of slow-fast
AVNRT. Methods: Electrophysiologic parameters and adenosine sensitivity of the retrograde fast pathway were studied in
21 consecutive patients (18 women; age 5710 years) with
slowfast AVNRT and in a control group of 24 patients (11
women; age 4616 years) without documented supraventricular tachycardia in which AVNRT, accessory pathways, and
other supraventricular tachycardias had been excluded. Results: Fifteen patients (71 %) with AVNRT and 18 patients
(75 %) in the control group developed a transient VA block
after intravenous administration of adenosine (P = 0.79).
Among patients with slowfast AVNRT, female gender (P=
ADENOSINE SENSITIVITY OF RETROGRADE FAST

PATHWAY CONDUCTION IN PATIENTS WITH
SLOW-FAST ATRIOVENTRICULAR NODAL REEN
TRANT TACHYCARDIA: A PROSPECTIVE STUDY
Elena Efimova1, Sam Riahi2, Yan Huo1, Andreas Bollmann1,
Masahiro Esato 3 , Thomas Gaspar 1 , Philipp Sommer 1 ,
Christopher Piorkowski1, Gerhard Hindricks1, Arash Arya1
1
Heart Center University Leipzig, Leipzig, Germany; 2Center
for Cardiovascular Research, Aalborg Hospital, Aarhus University, Aalborg, Denmark; 3Division of Cardiovascular Medicine, Yamaguchi University School of Medicine, Ube,
Yamaguchi, Japan
256
0.003), longer VA interval during right ventricular pacing

(P<0.001), and longer tachycardias cycle length (P<0.001),
but not age (P=0.87), HA and VA intervals during tachycardia
(P=0.82 and P=0.99) and ventricular pacing (P=0.85) predicted transient VA block after intravenous administration of
adenosine. Among patients in the control group, a shorter VA
interval during fixed rate right ventricular apical pacing (P=
0.009) and the presence of dual AV nodal physiology (P=
0.002) were associated with adenosine resistance of the retrograde fast pathway. Conclusion: The prevalence of adenosine
resistance of the retrograde fast pathways conduction is comparable between patients with and without slowfast AVNRT.
This finding can be better explained by the existence of an
insulated intranodal tract with Purkinje-like properties or a
superior atrionodal connection to the nodo-hisian region of
the AV node, rather than presence of an atriohisian pathway.
139 Abstract 1310
EXTRACORPORAL MEMBRANE OXYGENATION

SUPPORT FOR LIFE-THREATENING
ATRIOVENTRICULAR REENTRY TACHYCARDIA
IN A NEWBORN
Fridrike Stute1, Florian Arndt1, Urda Gottschallk1, Boris
Hoffmann2, Thomas S. Mir1, Goetz C. Mueller1, Christian
Thiel1, Rainer Kozlik-Feldmann1
1
Department of pediatric Cardiology, Hamburg, Germany;
2
University Heart Center, Hamburg, Germany
Life-threatening atrioventricular reentry tachycardia in newborn is a rare disease. We report the case of a 16-day-old
newborn submitted in cardiogenic shock requiring cardio pulmonary resuscitation (CPR) and extracorporeal membrane oxygenation (ECMO). The patient was presented with a history
of occasional vomiting over the past 6 days and an accelerated
heart beat was noticed the evening before admission by the
parents. At the time of admission, the child showed clinical
signs of severe cardiac failure and an atrioventricular reentry
tachycardia with a heart rate of 240 bpm and a left bundle
brunch block. Echocardiography showed highly reduced left
ventricular function and a massive dilatation of the left ventricle. Therapy with adenosine and amiodarone led to conversion to sinus rhythm detecting an antidromic leading accessory pathway conduction but was not sufficient to restore a permanent stable circulation. Regarding a continuous need of
CPR, a venous-arterial ECMO must be established leading
to resumption of proper organ functions. Therapy with intravenous amiodarone and flecainide led up to control of frequency and increasingly normal cardiac rhythm and the extracorporeal circulatory support could be explanted after 4 days.
The initiation of propafenone and medical cardioversion with

adenosine restored permanent sinus rhythm after 6 days. Two
recurrences of tachycardia could be controlled with
propafenone, metoprolol and adenosine boluses. The child
was discharged from hospital at day 25 in sinus rhythm and
completely restored left ventricular function. This case report
demonstrates the rapid deterioration of a seemingly healthy
newborn as the consequence of previously undiagnosed accessory pathway conduction. Maximal technical and pharmacological efforts were needed to treat severe cardiac failure
until coordinated rhythm was restored but complete restitution
of cardiac function could be achieved at last.
1310 Abstract 1415
OUR EXPERIENCE OF RADIOFREQUENCY

ABLATION OF ISTHMUS DEPENDENT ATRIAL
FLUTTER IN EARLY POSTOPERATIVE PERIOD
AFTER OPEN HEART SURGERY
Roman Marchenko1, Sergey Durmanov1, Natalia Makarova1,
Alexander Kozlov1, Vladlen Bazilev1
1
Federal Center of Cardiovascular Surgery, Penza, Russia
Isthmus-dependent atrial flutter (IDAF) is the most common
atrial arrhythmia occurring in early postoperative period after
open heart surgery. There are no current guidelines for management and no data regarding effectiveness of radiofrequency ablation (RFA) in this cohort of patients. Purpose: The
study aims to assess the effectiveness of RFA of IDAF in early
postoperative period after open heart surgery. Materials and
methods: During the period of time from January 2012 to
November 2013, 185 patients with IDAF were undergone
RFA procedure in our hospital and included into study. Mean
age of patients was 58.48.4 years, 142 males (76.8 %). The
first group included 14 patients with IDAF appeared in early
postoperative period after open heart surgery with cardiopulmonary bypass due to CAD, congenital or acquired valvular
heart disease. IDAF appeared on 29 days (mean 5.32.4).
RFA of IDAF was performed on 618 days after surgery
(mean 10.43.3). The second group included 20 patents with
IDAF and history of open heart surgery 4606 months ago.
The third group (control) included 151 patients with IDAF
with no history of open heart surgery. Results. Effectiveness
of RFA of IDAF was evaluated by assessment of bidirectional
block of conduction through the isthmus, duration of procedure and fluoroscopy time. Criteria of conduction block were
achieved in 174 out of 185 patients. Effectiveness of procedure was 94.1 % and did not differ among the groups. Mean
procedure duration was 73.333.6 min. Significant differences of procedure duration were revealed between the second
and thirrd groups (p=0.004). Mean fluoroscopy time was
717.7453.5 s. Fluoroscopy time differed in the second and

third groups (p=0.004). All procedures were performed without complications. Conclusion. RFA of IDAF can be effectively performed shortly after open heart surgical operation.
1311 Abstract 1817
A NEW METHOD TO DETERMINE
BIDIRECTIONAL BLOCK OF THE
CAVOTRICUSPID ISTHMUS
Concepcion Alonso-Martin1, Enrique Rodriguez-Font1, Jose
Guerra1, Francisco Mendez1, Marcos Rodriguez1, Douglas
Alvarez1, Pelayo Torner1, Xavier Violas1
1
Hospital de Sant Pau, Barcelona, Spain
Introduction. Bidirectional conduction block through the
cavotricuspid isthmus is the main goal of typical atrial flutter
(AFL) ablation. Assessment of conduction block requires
mapping of activation at both sides of the ablation line during
pacing from the proximal coronary sinus and lateral right atrium. Several methods have been proposed to assess isthmus
block. However, they do not explore the line itself and require
a high number of catheters. We sought to describe a simple
257
pacing maneuver to assess conduction block at the ablation

line during pacing from the ablation catheter. Methods. Patients underwent a typical AFL ablation were included. Multipolar catheters were positioned inside the coronary sinus and
at the His region. Once isthmus block was achieved, the ablation catheter was positioned along the ablation line, where
double potentials were recorded. Pacing was performed from
the distal and proximal bipoles in an attempt to capture only
one of the double potentials and record the other one. Conduction time from the pacing artifact to the second potential
was measured. The results were validated with classical pacing maneuvers. Results. Forty patients (age 6512, 90 %
male) were included. The maneuver was successfully performed in 37/40 (92.5 %). A positive maneuver from lateral
to septal was obtained in 30/40 (75 %) patients, from septal to
lateral in 18/40 (45 %) and in both directions in 15/40 (38 %).
Mean conduction time during the pacing maneuver was longer than with classical maneuvers: 18325 ms when pacing
lateral to septal versus 14432 ms during pacing from the
lateral right atrium and 18223 ms when pacing septal to
lateral versus 14231 ms during pacing form the proximal
coronary sinus. Conclusion. The presented pacing maneuver
allows ensuring isthmus block from the isthmus line itself
with fewer numbers of catheters.
258
1312 Abstract 1834
BENEFICIAL USE OF A DUODECAPOLAR CATH

ETER FOR MAPPING AND ABLATION OF RIGHT
FREE WALL ACCESSORY PATHWAYS.
Yoav Michowitz1, Aharon Glick1, Bernard Belhassen1
1
Cardiac Electrophysiology Laboratory, Department of Cardiology, Tel-Aviv Sourasky Medical Center., Tel-Aviv, Israel
Background: Ablation of right free wall accessory pathways
(RFWAP) is sometimes difficult due to the catheter instability
at the tricuspid valve annulus (TVA) and the lack of anatomic
guidance such the coronary sinus for left APs. Methods: For the
last 4 years, we have systematically used a duodecapolar (DD)
mapping catheter (St Jude) in which the proximal ten electrodes
are in close contact with the TVA with the hope it will facilitate
mapping and ablation of RFWAP located at the TVA. Results:
Eight consecutive patients (four M, four F, aged 1934 years),
suffering from palpitations (suspected SVT) in the presence of
manifest WPW (n=4 pts) and LBBB-tachycardias mediated by a
Mahaim fiber (n=3) as well as one asymptomatic WPW patient
were included. Three patients had undergone prior ablation procedures. With the DD catheter deployed at the TVA, the AP
location was rapidly identified as follows: (a) in patients with
AVRT using the sites of earliest ventricular activation in sinus
rhythm, or earliest atrial activation during AVRT or ventricular
pacing (5/5 patients); (b) in patients with atriofascicular Mahaim
fiber by the recording of a Mahaim potential in sinus rhythm
(2/3 patients). In all these seven patients, APs were ablated after
positioning the ablation catheter close to these areas. In one patient with Mahaim, the AP was ablated empirically. Successful
ablation was achieved with one RF pulse (five patients), three RF
(two patients), and nine RF (one patient). AP locations were:
anterior (n=1), lateral (n=2), antero-lateral (n=1), posterolateral (n=3), and posterior (n=1). One patient with AVRT required an additional procedure. All patients have remained freesymptoms with no AP recurrence after a mean follow-up of 19
18 months. Conclusion: A DD catheter positioned at the TVA
facilitates fast localization of RFWAP and guides their successful
ablation.
Background: Amiodarone is a widely used antiarrhythmic

drug in Tunisia worldwide. However, its side effects are quite
frequent hampering its use despite its efficacy. The purpose of
our study was to determine the prevalence of amiodarone side
effects and to analyze its predictors in our population.
Methods: Amiotox registry is a multicenter cross-sectional
study including patients receiving amiodarone for more than
6 months regardless of the indication. We sought to detect the
frequency and predictors of amiodarone side effects in our
population. Results: From 1st May 2010 to 30th April 2012,
200 consecutive patients (mean age 61, 912, 9 years) were
included. Mean duration of amiodarone therapy was 51.9
48.4 months with a mean dose of 288.1274.2 g. Atrial fibrillation (81, 5 %) was the most common indication. Amiodarone side effects occurred in 144 patients (72 %): ocular
(65.5 %), thyroid (47.5 %), cardiac (35 %), cutaneous
(30.5 %), hepatic (16.5 %) and neurological (14.5 %) toxicity.
No case of pulmonary toxicity was reported. Referring to
multivariate analysis, independent predictors were as follows:
advanced age (p=0.02), treatment duration (p<0.01) and cumulative dose (p<0.01) for occurrence of all side effects;
treatment duration sup 6 months (p=0.008) for corneal deposits; age >70 years (p = 0.002) and treatment duration
(p<0.001) with a linear correlation for cutaneous toxicity;
cumulative dose>300 g (p=0.016) and heart failure (p=
0.05) for bradycardia; cumulative dose >100 g (p=0,012)
for QT prolongation; treatment duration (p<0, 001) with a
linear correlation and betablockers concomitant use (p=
0.046) for PR elongation; treatment duration (p<0, 001) with
an exponential correlation and concomitant vitamin K anticoagulant use (p=0.018) for hepatic toxicity; and treatment duration >18 months (p=0.009) and concomitant calcium channel blocker use (p<0.001) for neurological toxicity. Conclusion: The results of our study confirmed that amiodarone side effects are quite frequent in our population
and that in addition to treatment dose and duration,
other predictors for these effects were identified such
as age and some drug associations. Clinicians may be
able to use the present results to identify patients at
higher risk for amiodarone toxicity and implement strategies to improve the monitoring of these effects.
1314 Abstract 0710
1313 Abstract 2011
MEDIUM- AND LONG-TERM SIDE EFFECTS OF

AMIODARONE AMIOTOX STUDY
DYSRHYTHMIA IN PATIENTS WITH DIFFERENT

TYPES OF ATRIAL SEPTAL DEFECTS: A
COMPARISON OF INCIDENCES
Marouane Mahjoub1, Mejdi Ben Messaoud1, Majed Hassine1,

Wiem Selmi1, Zohra Dridi1, Fethi Betbout1, Habib Gamra1
1
Cardiology Department A: Fattouma Bourguiba University
Hospital, Monastir, Tunisie
Charlotte Houck1, Christophe Teuwen1, Rik Jansen1, Karin

Kraaier2, Jurren van Opstal2, Joris Vriend3, Pepijn van der
Voort4, Thelma Konings5, Maarten Witsenburg1, Jolien
Roos-Hesselink1, Ad Bogers1, Natasja de Groot1

1
Erasmus Medical Center, Rotterdam, Netherlands; 2Medisch

Spectrum Twente, Enschede, Netherlands; 3Haga Hospital,
The Hague, Netherlands; 4Catharina Hospital, Eindhoven,
Netherlands; 5VU University Medical Center, Amsterdam,
Netherlands
Background: Dysrhythmia are a common complication in
patients with an atrial septal defect (ASD), often leading
to morbidity and mortality. Many studies only examined
the occurrence of atrial tachyarrhythmia, but little is
known about the incidences of sinus node dysfunction
(SND), ventricular tachyarrhythmia (VT) and atrioventricular blocks (AVB) in ASD patients. The aim of this study
is to (1) determine incidences of dysrhythmia and AVB
and their development over time in patients with five different types of ASD and (2) study the association between
age at surgical ASD repair and development of dysrhythmia and AVB. Methods: We included adult patients (N=
285) with a primum ASD, secundum ASD, sinus venosus
ASD, patent foramen ovale (PFO) or complete atrioventricular septal defect (cAVSD) who underwent either surgical, percutaneous or no ASD repair. Patients medical
records were reviewed for the occurrence of SND, atrial
and ventricular tachyarrhythmia and AVB. Results: Patients either had a primum ASD (n=52), secundum ASD
(N=155), sinus venosus ASD (N=24), PFO (N=39) or a
cAVSD (N =15). These patients had undergone surgical
(N=178), percutaneous (N=66) or no (N=41) ASD repair.
At 80 years of age, over 70 % of all ASD patients had
presented with SND and over 50 % had experienced at
least one episode of atrial tachycardia (AT). Furthermore,
less than 10 % of all patients were free from atrial fibrillation (AF) after 80 years. The cumulative incidence of
VT remained relatively low (15 to 20 % after 80 years).
AVBs were commonly observed in all ASD patients
(65 % after 80 years) but they developed significantly
earlier and more often in patients with a primum ASD
or cAVSD. Patients who were younger than 25 years at
the time of surgical ASD repair developed SND, AT and
AVB 20 to 50 years earlier compared to patients who
were older than 25 years during ASD repair. Patients
who were between 26 and 45 years during ASD closure
developed SND, AF and AVB approximately 20 years
earlier than patients who were older than 46 years during
ASD repair. However, cumulative incidences of these dysrhythmia and AVB after 70 years were comparable. Conclusions: SND and atrial tachyarrhythmia were often observed in all patients, whereas AVBs were more prevalent
in patients with a primum ASD or cAVSD. Age at the
time of surgical ASD repair appeared to influence the
development of dysrhythmia over time, whereas the cumulative incidences after 70 years were comparable between all age groups.
259
1315 Abstract 0711
DEVELOPMENT OF ATRIAL FIBRILLATION IN

PATIENTS WITH CONGENITAL HEART DEFECTS
Christophe Teuwen1, Tanwier Ramdjan1, Ameeta Yaksh1,
Luca Jansz1, Dominic Theuns1, Sander Molhoek2, Reinhart
Dorman 3 , Jurren van Opstal 3 , Thelma Konings 4 , Joris
Vriend5, Marco Gtte 5, Pepijn van der Voort6, Etienne
Delacretaz7, John Triedman8, Natasja de Groot1
1
Erasmus Medical Centre, Rotterdam, Netherlands; Amphia
Hospital, Breda, Netherlands; 3Medisch Spectrum Twente,
Enschede, Netherlands; 4VU Unitversity Medical Centre, Amsterdam, Netherlands; 5 Haga Hospital, The Hague,
Netherlands; 6Catharina Hospital, Eindhoven, Netherlands;
7
Inselspital, University of Bern, Bern, Switzerland;
8
Childrens Hospital and the Department of Pediatrics,
Harvard Medical School, Boston, MA, USA
Background: Regular atrial tachycardia (AT) and atrial fibrillation (AF) occur frequently in patients with congenital
heart defects (CHD). Whereas AT has extensively been
studied, studies about AF in CHD patients are rare, despite
the reported incidence of AF which ranges up to 30 %. The
aim of this multicenter study was to examine the development of AF over time in a large cohort of patients with a
variety of CHD by relating patient with arrhythmia characteristics. The time course of AF after the first episode and
the outcome of AF therapy during long-term follow-up was
additionally evaluated. Methods: Electrocardiograms
(ECG) and 24-h Holter registrations were retrospectively
reviewed for the presence of AF and regular AT. Patients
were then classified according to the severity of CHD. Ventricular response was determined during the first episode of
AF. Finally, deterioration of AF from paroxysm to longstanding persistent/permanent AF was reviewed. Results:
In total, 193 CHD patients presented with a documented
episode of AF at the age of 4917 years. Patients with a
simple defect developed AF at an older age (N=71, 59
15 years, p<0.001) compared to patients with a moderate
(N = 88, 47 14 years) or complex (N = 34, 36 15 years)
CHD. Ventricular response was 10131 bpm; patients with
a moderate defect had a higher ventricular response than
patients with complex CHD (107 32 bpm versus 91
30 bpm, p=0.01). AF developed as de novo in 160 patients, and regular AT preceded AF 5 5 years in 33 patients. Subsequently, another 18 patients initially developed
AF which was followed by regular AT 55 years after the
first episode. Of all the patients, 23 patients progressed
from paroxysm AF to long-standing persistent/permanent
AF 44 years after the initial episode. Conclusion: AF occurs in all types of CHD and the age at which this occurs
260
appears to depend on the complexity of the CHD. In this

complex group, ventricular response is relatively low,
which may indicate a reduced function of the atrioventricular node. In a considerable part of this patient group, AF
co-existed with regular AT; regular AT preceded AF and
vice versa. Furthermore, paroxysmal AF progressed relatively fast to long-standing persistent/permanent AF and,
therefore, an aggressive therapy of both regular AT and
AF is reasonable.
in AF burden on treatment with ISIS-CRPRx versus baseline

(OR 1.6, 95 % CI 2.42 to 5.62, p=0.37). ISIS CRPRx was
safe and well tolerated and there were no serious adverse
events. Conclusions: Treatment with ISIS-CRPRx did not reduce AF burden in patients with paroxysmal AF and PPMs,
despite a large relative reduction in CRP. In this population,
highly specific CRP reduction had no clinically discernable
effect upon paroxysmal AF. CRP does not appear to have a
causal relationship with AF.
Poster session A part 2: Atrial fibrillation characteristics

and management
1317 Abstract 1544

Posters exposed from 8:30:00 AM to 12:00 PM
Presenters and chairpersons present from 10:30AM to
12:00 PM
1316 Abstract 2010
QUICK INFUSION VS REPEATED INTRAVENOUS

BOLUSES OF FLECAINIDE FOR ATRIAL
FIBRILLATION TERMINATION: A SINGLE-BLIND,
TREATMENT REGIMEN CONTROLLED TRIAL.
Saverio Lavanga1, Daniele Nassiacos1
Saronno Hospital-AO Busto Arsizio (VA), Pogliano
Milanese, Italy
1
THE EFFECT OF CRP REDUCTION WITH A HIGH

LY SPECIFIC ANTISENSE OLIGONUCLEOTIDE ON
PAROXYSMAL ATRIAL FIBRILLATION ASSESSED
USING BEAT-TO-BEAT PACEMAKER HOLTER
FOLLOW-UP
Conn Sugihara1, Nick Freemantle2, Steven Hughes3, Steve
Furniss1, Neil Sulke1
1
East Sussex Healthcare NHS Trust, Eastbourne, UK;
2
University College London, London, UK; 3ISIS Pharmaceuticals, Carlsbad, CA, USA
Background: Atrial fibrillation (AF) is well-recognised to
have an inflammatory component. C-reactive protein (CRP)
is known to be strongly associated with AF. However, it is not
clear if CRP is a causal factor for AF. ISIS-CRPRx is a novel
antisense oligonucleotide that reduces CRP production by
specifically inhibiting mRNA translation. Methods: A
double-blind phase II trial of ISIS-CRPRx in patients with
paroxysmal AF and DDDRP permanent pacemakers (PPMs)
with advanced atrial and ventricular Holters allowing beat to
beat arrhythmia follow up. Results: Twenty-six patients were
screened and seven patients dosed with ISIS-CRPRx. After
4 weeks of baseline assessment, patients were randomly
assigned to two treatment periods of either placebo then
ISIS-CRPRx or ISIS-CRPRx then placebo. All patients were
followed up for 8 weeks after the active treatment period.
There was a 63.7 % (95 % CI 38.4 % to 78.6 %, p=0.003)
relative reduction in CRP on treatment with ISIS-CRPRx versus baseline. Sensitivity analyses demonstrated a consistent
treatment effect. The primary endpoint was change in AF
burden assessed by PPM. There was no significant difference
To assess the efficacy of a quick infusion of flecainide (fleca)

vs repeated intravenous boluses of fleca in terminating, acute
atrial fibrillation (AAF) within 20 min, 67 patients (pts) were
randomized 33 to quick infusion and 34 to boluses. One patient assigned to boluses group was excluded for sinus rhythm
restoration at the beginning of treatment. This study was approved by our ethical committee, began on February 20th,
2007, and was closed on December 31st, 2013. Method: In
pts with AAF (<48-h duration), stable for at least 1 h, with a
ventricular response rate (VRR) greater than 70 bpm and without signs of heart failure, acute myocardial infarction, arterial
hypotension, clinically evident mitral stenosis, non-corrected
myocardial ischaemia, electrolyte imbalances, significant hepatic or renal disease, acidosis, pulmonary embolism or pregnancy, we gave intravenously either 2.1 mg/kg of fleca in
15 min or 0.7 mg/kg boluses of the same drug, with a maximum of 50 mg per bolus, in 2030 s every 3 min, until sinus
rhythm (SR) was restored or the full dose of 2.1 mg/kg was
reached. Each treatment was carried out during continuous 12
lead ECG recording, until SR restoration or to 20 min from the
beginning of treatment. Cuff blood pressure was detected every 3 min. Results: Success rate for infusion group (I-GR) and
for boluses group (B-GR) was as follows:
1 bolus 2 boluses 3 boluses Total
Percentage of success
I-GR
B-GR 8
10
14/33
25/33
<0.002 0.002
42
76
Mean time to SR restoration was 9.94 for the I-GR vs 6.11

4.4 min for the B-GR (p = 0.008). The electrical pause
before SR was 1071 381 ms in the I-GR vs 1350
1150 ms in the B-GR (p=NS). The mean RR interval before
treatment was 540114 in the I-GR vs 509102 ms in the
B-GR (p=NS). The mean age was 65.813 in the I-GR vs
64.4 10.6 years in the B-GR (p = NS). Associated heart
disease was, respectively, hypertensive in 11 and 11, valvular in 9 and 10, others in 1 and 3 and absent in 12 and 9
patients. Eighteen pts were males and 15 were females in
the I-GR and 21 were males and 12 were females in the BGR. Mean duration of arrhythmia before treatment was
13.6 9.6 h in the I-GR vs 10.68.2 h in the B-GR (p=
NS). Conclusions: These data suggest that flecainide given
in boluses is more effective and quicker than flecainide
given in infusion in converting AAF to SR.
1318 Abstract 2111
ATRIAL FIBRILLATION BURDEN ON THERAPY

IS RELATED TO OUTCOMES ON ANTIARRH
YTHMIC DRUG THERAPY
Sanjeev Saksena1, April Slee1, Rangadham Nagarakanti1,
Marwan Saad1
1
Electrophysiology research Foundation, Warren, MI, USA
1319 Abstract 0910
SINUS NODE DYSFUNCTION IS ASSOCIATED WITH

HIGHER LEFT ATRIAL PRESSURE DURING SINUS
RHYTHM THAN ATRIAL FIBRILLATION IN PATI
ENTS WITH ATRIAL FIBRILLATION
Tae-Hoon Kim1, Junbeom Park1, Jin-Kyu Park1, Jae-Sun
Uhm1, Boyoung Joung1, Moon-Hyoung Lee1, Hui-Nam Pak1
1
261
Introduction: The relationship between atrial fibrillation (AF)

recurrences and major cardiovascular events is unclear.
Methods: We quantitated electrocardiographic burden (burden) of recurrent AF in the rhythm control arm of the AFFI
RM trial. We examined cardiovascular hospitalizations
(CVH) and death (D), based on initial antiarrhythmic drug
(AAD) selection. Amiodarone (Amio), sotalol (Sot) and class
1C (flecainide and propafenone) gps were compared to propensity score matched (PSM) rate gps for freedom from CVH
or D. AF burden at follow-up visits was stratified as <25 or
>25 % of all visits during follow-up. Results: 687 Amio patients, 581 Sot patients and 251 1C patients from the rhythm
arm were matched 1:1 to PSM rate cohorts. They were comparable for baseline characteristics. CVH risk was significantly higher during follow-up when AF burden was >25 % compared to <25 % for all three AADs (Amio hazard ratio {HR}=
1.44, p=.001; Sot HR=1.46, p=.0011; class 1C HR=2.76,
p<.0001) (Figure). Mortality for both AF strata for all three
AADs was comparable to their matched rate gps. Conclusions: 1. While infrequent AF recurrence on AADs used in
the AFFIRM trial did not increase risk for CVH or D compared to rate, > 25 % AF burden was associated with substantially increased CVH risk. 2. In AF patients on AADs, total
mortality did not differ among the AF burden strata studied. 3.
Quantitation of AF recurrences on AADs may be important in
therapeutic decision making to avoid CVH and permit earlier
institution of alternative rate or rhythm control
Background: Although atrial fibrillation (AF) is commonly associated with sinus node dysfunction (SND), hemodynamic characteristics of those patients have not yet been investigated. Objective: The purpose of this study was to determine whether elevated
LAP plays some role in the pathogenesis of SND among patients
with AF. Methods: We included 182 patients (67.6 % male, 59.0
11.1 years old, 69.2 % paroxysmal AF) who underwent radiofrequency catheter ablation for AF. We measured both
LAPpeak(SR), LAPpeak(AF), and LA pulse pressure [LApp=
LAPpeak(SR)-LAPnadir(SR)] at the beginning of the ablation
procedure, and compared LAPs from 30 patients with SND (19
262
sick sinus syndrome, 11 tachycardia-bradycardia syndrome) and

those from 152 patients without SND (control). Results: 1. Patients with SND were older (p=0.040), more likely to be female
(p=0.007), and had a greater E/Em ratio (p=0.042) than those
without SND. 2. In the SND group, LAPpeak(SR) and LApp(SR)
were significantly higher than LAPpeak(AF) (p=0.005) and
LPpp(AF) (p<0.001), respectively. However, that was not the
case in the Control group. 3. LAPpeak(SR-AF) (OR 1.08, 95 %
CI 1.021.14, p=0.008) and Lapp (SR-AF) (OR 1.08, 95 % CI
1.021.15, p=0.014) were independently associated with SND. 4.
Pacing rate (90120 bpm)-dependent escalation of
LAPpeak(pace) was significant in the control group (p<0.001),
but blunted in the SND group (p=0.724) due to pre-elevated
LAPpeak(pace) at low heart rate. Conclusions: In AF patients
with SND, hemodynamic loading measured by LAPpeak and
atrial stiffness estimated by LApp were significantly higher during
SR than AF compared to AF patients without SND.
1320 Abstract 1522
ELECTRICAL CONNECTIONS BETWEEN

IPSILATERAL PULMONARY VEINS MIGHT BE
EASILY IDENTIFIED USING A SPECIFIC PACING
MANEUVER
Concepcion Alonso-Martin 1 , Jose Guerra 1 , Enrique
Rodriguez-Font1, Marcos Rodriguez1, Douglas Alvarez1,
Pelayo Torner1, Francisco Mendez1, Xavier Violas1
1
Hospital de Sant Pau, Barcelona, Spain
Introduction. Anatomical studies have shown muscular connection between ipsilateral pulmonary veins (PV) in more than
80 % of hearts. However, electrical connections have been rarely reported during electrophysiological studies. We sought to
demonstrate electrical connections between ipsilateral PVs by
using a pacing maneuver after circumferential ablation of the
PVs. Methods. Consecutive patients who underwent a circumferential AF ablation procedure were included. After circumferential ablation and once entrance block was achieved, a pacing
maneuver was performed. The circular catheter was positioned
in one vein and the ablation catheter in the ipsilateral vein.
During pacing from one of the ipsilateral veins, demonstration
of synchronous local capture in both veins dissociated from the
left atrium ensured the presence of electrical connection between the veins. Results. Twenty-nine consecutive patients
(mean age 608, 75 % males, 96 % Paroxysmal AF) were
included. Electrical connections were demonstrated by using
the pacing maneuver in 9/29 (31 %): 6 (28 %) had PV connections in the left PVs and 3 (22 %) in the right PVs. Conclusion:
The presented pacing maneuver allowed demonstration of electrical connections in 31 % of our patients. This may have implications in defining the best ablation approach.
1321 Abstract 1521
CONSISTENCY OF QTC MEASUREMENTS IN

ATRIAL FIBRILLATION PATIENTS BEFORE AND
AFTER CARDIOVERSION
Vincent Jacquemet1, Bruno Dub2, Omar Mahiddine2, Alain
Vinet1, Aim-Robert LeBlanc2, Marcio Sturmer2, Giuliano
Becker2, Teresa Kus2, Rginald Nadeau2
1
Universit de Montral, Montral, Canada; 2Hpital du
Sacr-Coeur de Montral, Montral, Canada
Background: Measurement of QTc intervals during atrial arrhythmias is relevant to the safety of antiarrhythmic drug delivery. Atrial fibrillation (AF) waves may affect the T wave
and hinder the identification of fiducial points, possibly
resulting in inaccurate QT measurements. In addition, constant fluctuation in heart rate complicates the analysis. Aim:
The study aims to compare QT and QTc intervals in AF patients before and after cardioversion. Methods: Twenty-one
patients suffering from AF underwent electrical cardioversion.
All were in AF at the time of the procedure. Cardioversion
restored sinus rhythm in all patients. Pseudo-orthogonal
Holter ECGs were continuously recorded during at least 1 h
before and 1 h after the procedure. RR and QT time series
were extracted and semi-automatically validated. For Q onset
and T end identification, the lead with the most identifiable T
wave was used. QTc intervals were computed using Bazett,
Fridericia and patient-specific correction formulae, both with
and without QT hysteresis correction with a time constant of
2 min (moving average of past RR values). Results: Both RR
and QT intervals were prolonged after cardioversion (RR=
1048172 ms in sinus rhythm vs 691127 ms in AF; QT=
41223 vs 36126 ms). After correction for heart rate, the
difference QTc(sinus rhythm)-QTc(AF) was 28 20 ms
(p < 0.001) with Bazetts formula, thus indicating
overcorrection, 0.210.2 ms (p=0.9) with Fridericias and
0.95.1 ms (p=0.4) with patient-specific correction. The
root-mean-square difference between QTc (sinus rhythm)
and QTc (AF) was 34 ms with Bazetts formula, 10 ms with
Fridericias and 5 ms with patient-specific correction. The
variability of QTc over 1 h during AF was smaller with
patient-specific correction (Bazett 519 ms; Fridericia 34
8 ms; patient-specific 207 ms). QTc variability was significantly further reduced when hysteresis correction was applied
(Bazett 2210 ms; Fridericia 2010 ms; patient-specific 17
7 ms). Conclusion: QTc measurements during AF were consistent with values obtained after sinus rhythm was restored.
Although patient-specific formula performance was better,
Fridericias correction combined with hysteresis reduction
was found to be sufficiently reliable for the assessment of
the QTc in AF.
263
1322 Abstract 1520

MINIMIZING RADIATION EXPOSURE USING
REMOTE MAGNETIC CATHETER NAVIGATION
FOR PULMONARY VEIN ISOLATION IN PATIENTS
WITH PAROXYSMAL ATRIAL FIBRILLATION
Dirk Bastian1, Johannes Schwab2, Andrea Brinker-Paschke1,
Arno Boessenecker1, Wolfgang Kirste1, Reinhard Doering1,
Zeynep Karakurt1, Matthias Pauschinger1, Konrad Ghl1
1
Div. of Cardiology/Electrophysiology, Paracelsus Medical
University Nuremberg, Nuremberg, Germany; 2Div. of Cardiology and dpt. for Radiology/Neuroradiology, Paracelsus
Medical University Nuremberg, Nuremberg, Germany
Background: Although it is believed that the use of remote
magnetic catheter navigation (RMN) will reduce radiation exposure in complex ablation procedures, data proving this hypothesis are still rare. Aim: The study aims to evaluate radiation
exposure in patients undergoing RMN-guided primary pulmonary vein (PV) antral isolation (PVAI) for paroxysmal atrial
fibrillation (PAF). Methods: Primary RMN-guided PVAI was
performed in 233 patients with symptomatic PAF by two operators including the learning curve. The following technologies/
techniques were used: Niobe/Epoch; Siemens AXIOM-Artis
zee BP-MN 17.5 fps; Carto-RMT non-fluoroscopic mapping
(NFM), MR-Image-integration; TEE-guided transseptal puncture, steerable coronary sinus catheter, single catheter ablation
technique Navistar-RMT Thermocool; and endpoint bidirectional PV-block. The fluoroscopy time (FT) was documented
for system calibration (A), transseptal access/catheter positioning (B), and mapping/ablation (C). The procedure duration included a 30-min waiting period after PV-block (skin to skin).
Results: Overall, 941 of 945 targeted PVs (99.6 %) were successfully isolated requiring a total FT of 4.73.6 min with an
effective dose (ED) of only 0.50.7 mSv. The major proportion
of radiation exposure was attributable to transseptal puncture
and catheter positioning (Table 1).
CMapping, Total
ARMT/NFM BTransseptal
calibration
access, catheter ablation
positioning
(n=213)
(n=213)
(n=213)
(n=233)
FT [min]
00.1
3.72.6
0.50.8
4.73.6
DAP [Gy/cm2] 00.1
1.62.0
0.30.9
2.33.4
ED [mSv]
0.30.4
0.10.2
0.50.7
Table 1. Radiation exposure of patients undergoing first RMNguided PVAI for PAF. FT fluoroscopy time, DAP dose area
product, ED effective dose. After having finished the learning
curve PVAI in the last 150 patients required a total FT of 3.5
2.2 min corresponding to an ED of 0.280.3 mSv. Total
procedure duration of 30090 min was reduced to 236

96 min in the last 100 patients. Completely avoiding cardiac
tamponade, stroke and atrioesophageal fistula, vascular complications occurred in 7 patients (2.9 %). After a mean follow-up of
11.1 months, 72.5 % of 211 patients were free of atrial arrhythmias. Conclusion: Fluoroscopy durations of 14 to more than
60 min associated with a mean ED of 16.6 mSv (6.6
59.6 mSv) were reported for AF ablation procedures depending
on patients age, type and duration of AF, underlying cardiac
disease, ablation method, technology and operators experience.
Our single-center evaluation demonstrates that high acute AF
ablation success rate can be achieved by means of RMN combined with a low complication rate and reduction of effective
radiation dose by more than 90 %. The prolonged overall procedure time could be reduced further on.
1323 Abstract 1524
ACUTE MANAGEMENT OF ATRIAL FIBRILLATION
IN ELDERLY: IS THERE A PLACE FOR
IMPROVEMENT?
Antonio Bonora1, Gianni Turcato2, Elena Franchi3, Piero
Castiglioni1, Giulio Trecco2, Federico Beltrame3, Oliviero
Olivieri4, Claudio Pistorelli1
1
Department of Emergency and Intensive Therapy - University Hospital of Verona, VERONA, Italy; 2Postgraduate School
of Emergency Medicine - University of Verona, VERONA,
Italy; 3Department of Cardiology - Hospital University of
Verona, VERONA, Italy; 4Department of Internal Medicine
and Postgraduate School of Medicine - University of Verona,
VERONA, Italy
Acute management of atrial fibrillation (AF) in elderly is still a
matter of debate. Although underlying structural heart disease
often forces to rate control strategy, aging itself appears in many
cases to lead to a non-aggressive approach. Therefore, we considered our experience to evaluate if management of AF in elderly could be improved. From January 2008 to December 2012
in the Emergency Department of University Hospital of Verona,
1437 patients (676 males, 761 females, mean age 70 years) were
observed for recent-onset AF. Out of these, 601 patients (41.8 %)
were over 75 years, with an expected prevalence of females and
cardiovascular disease. Attempt at cardioversion rate was significantly less in over 75 groups compared to younger ones (43.9 %
vs 69.4 %, p<0.05). Surprisingly, even in the former group,
timing >48 h was the main contraindication (57.3 %). In 264
patients over 75 (96 males, 168 females, mean age 81 years),
we attempted at pharmacological cardioversion. As well as in
younger group, onset <24 h was the predominant timing
(89 %) and palpitations the main symptom (76 %). Being considered most manageable and safer, amiodarone was the treatment of choice (69 % of patients). We reached a restoration of
264
sinus rhythm within 12 h in 61.3 % of the cases, ranging from

54.4 % of amiodarone to 85 % of flecainide. In 8 patients, we
performed an electrical cardioversion after pharmacological approach failed. Overall successful rate was thus 64.4 %. We reported a very low complications rate (3 %), with any regard to
treatment strategy. A larger number of patients were hospitalized
after ED stay (55.3 %). Hospitalization rate was significantly
higher in older group (55.3 vs 34 %, p<0.05), but persistence
of high-rate AF remained the main reason to (35.6 %), in like
manner with younger group. Although elderly people are considered to be a fragile group, the pattern of presentation of recentonset AF similar to overall population seems to discredit aging
itself could be a contraindication to rhythm control strategy.
Therefore, an improvement in the acute management of AF and a
reduction of hospitalization rate could be expected even in elderly, by means either a larger use of class 1c antiarrhythmic drugs,
when allowed by clinical conditions, or a most accurate indication to rate control therapy, when restoration or maintenance of
sinus rhythm is not likely. A 2-year follow-up is carried out to
compare rhythm control with rate control strategy regarding
to wellness and disease-free period.
1324 Abstract 1554
QUANTIFICATION OF THE RELATIONSHIP

BETWEEN LATE-GADOLINIUM INTENSITY AND
CONDUCTION VELOCITY IN THE LEFT ATRIUM
Rheeda L Ali1, Norman A Qureshi1, Chris D Cantwell1,
Caroline H Roney1, Phang Boon Lim1, Jennifer H Siggers1,
Spencer J Sherwin1, Nicholas S Peter1
Introduction: Late-gadolinium enhanced (LGE) cardiac MRI

(CMRI) is thought to be an indicator of regions of disease and
abnormal conduction. We developed a technique to quantify the
relationship between LGE-CMRI intensity and localised conduction velocity (CV). Method: Six electrical datasets were collected
from five patients. The epicardial surface was manually segmented from the LGE-CMRI. The maximum voxel intensity (normalised as SDs above blood pool mean) along a 3-mm inwardfacing normal was assigned to each vertex of a triangulation of
the surface (Fig. A). Unipolar electrogram data were collected
from the atrial wall paced (cycle length 600 ms) either from the
coronary sinus (CS) or left atrial appendage (LAA). The electroanatomic surface and electrogram data were exported from the
mapping system (EnSite Velocity). The electro-anatomic surface
was the registered with the CMRI surface using an automated
landmark selection algorithm and the registration error was estimated. Poor-quality electrograms were rejected. A novel quantitative approach was used to select triplets of electrodes and relate
average CV with average normalised voxel intensity. Results:
Surface registration error was 3.320.60 mm. When the minimum electrode distance was chosen as twice the registration
error, a statistically significant (p<0.05) negative correlation coefficient was observed for four datasets (CS 0.55, 0.75; LAA
0.18, 0.27). Example correlation is shown in Fig. B. Nonplanar and non-circular complex activation sequences were
found to produce a broad spread of conduction velocities. Conclusion: Our method suggests a reduction in CV in regions on the
posterior wall with greater enhancement on LGE-CMRI. This
can be used to interrogate both the underlying structural and
functional substrates in patients with AF.
1325 Abstract 1552
THE RISK OF CARDIOVASCULAR EVENTS IN PATI

ENTS WITH ATRIAL FIBRILLATION AFTER ELEC
TRICAL CARDIOVERSION
Olga Litunenko1, Oskars Kalejs2, Aldis Strelnieks1, Marina
Kovalova3, Iveta Sime4, Milana Zabunova2, Biruta Tilgale5,
Ilze Konrade5, Evija Miglane2 , Kaspars Kupics 2, Irina
Pupkevica1, Aivars Lejnieks5
1
Riga Stradins University, Riga, Latvia; 2P. Stradins Clinical
University Hospital, Riga, Latvia; 3Jelgava Regional Hospital, Jelgava, Latvia; 4Liepaja Regional Hospital, Liepaja,
Latvia; 5Riga East University Hospital, Riga, Latvia
Atrial fibrillation (AF) is the most common type of
sustained arrhythmia which may be associated with serious complications: cerebrovascular accidents, systemic
embolism, heart failure and an increased risk of bleeding
in patients who take anticoagulants. Aim: The study aims
to evaluate clinical events in patients following electrical
cardioversion (ECV) according to cardiovascular risk
f a c t o r s , C H A 2 D S 2 - VA S c s c a l e a n d p h a r m a c o therapeutical methods used, with the use of anticoagulants included. Material and methods: Two hundred and
sixty prospective and 225 retrospective patients with atrial fibrillation, who had an ECV in 2013 in Latvian Centre of Cardiology. The data acquired in medical data
bases and control questionnaire were used. Results: The
most common cardiovascular risk factor was found to be
arterial hypertension (AH) (83.1 %), chronic heart failure
(CHF) (66.6 %) and metabolic syndrome (16.1 %). Diabetes was less common (12.6 %), patients after myocardial infarction, cerebrovascular accidents (5.6 %) and
TIA (3.9 %). Thromboembolism risk evaluated with
CHA2DS2-VASc score in 38 (7.8 %) patients was 1
and in 447 (92.2 %) 2 points. The mean score was
3.8. A month after ECV the following cardiovascular
episodes were observed: acute coronary syndrome
(ACS) (0.9 %), CHF decompensated (0.4 %), PE/DVT
(0.4 %), AF recurrence (20.5 %). Over 3 months the
events were ACS (0.5 %) CHF decompensation
(0.5 %), PE/DVT (0.5 %) and AF recurrence (26.3 %).
Six months after ECV, 0.7 % of patients had ACS, 2 %
had CHF decompensation, 0.7 % had PE/DVT, 1.4 %
had cerebral stroke and 36.4 % had AF recurrence. The
occurrence of bleeding on warfarin ranged from 4.62 %
(p=0.013) to 6.62 % (p=0,067), for aspirin from 3.13 %
(p=0.119) to 3.31 (p=0.067). The occurrence of bleeding
during 1 and 3 month on dabigatran was 1.2 % and for
rivaroxaban 1.5 %. Conclusion: The occurrence of cardiovascular events following cardioversion is similar to
265
that reported in the literature except for AH and CHF,

which were higher in this study. The risk of clinical
episodes using CHA2DS2-VASc score was higher than
in other studies. Most often bleeding occurred while
using warfarin during the first month after ECV. Using
novel oral anticoagulants according to the guidelines before and after ECV is safer than with warfarin
1326 Abstract 1553
A NOVEL METHOD FOR ROTOR TRACKING

USING BIPOLAR ELECTROGRAM PHASE TESTED
ON SIMULATED, CELL CULTURE AND CLIN
ICALLY ACQUIRED ELECTROGRAMS
Caroline H Roney1, Rasheda A Chowdhury1, Chris D Cantwell1,
Norman A Qureshi1, Emmanuel Dupont1, Phang Boon Lim1,
Jennifer H Siggers1, Fu Siong Ng1, Nicholas S Peters1
1
Introduction: Assessing the location and stability of rotors can
help target ablation therapy for atrial fibrillation (AF). Phase
singularity (PS) tracking techniques are applied to unipolar
electrogram (UE) and action potential (AP) data, but not commonly to bipolar electrogram (BE) data, which contains local
activation only. We developed and tested a technique to track
PSs from simulated, cell culture and clinically acquired BE
data. Methods: UEs were computed (at 210-mm spacing)
from simulated rotor AP data. UEs were also recorded from
a cell culture monolayer of HL-1 atrial myocytes using a
multi-electrode array (MEA, 88, 700 mm spacing). BEs
were computed from pairs of UE. UE and BE were also recorded from an a-focus catheter (4-mm spacing) during human AF. BEs were filtered and the moving-mean removed
from the signal so as to conserve small-amplitude deflections
due to wavefront direction. The phase angle was calculated,
and PS trajectories and lifetimes were determined using automated algorithms. Wavefront dynamics and singularity positions computed using UE, BE and AP data were compared.
Results: Interpolated wavefront patterns were qualitatively
similar between AP, UE and BE for simulated data and between UE and BE for cell culture and clinical data, where
differences were largest for clinical data (Fig). For cell culture
MEA data, the average framewise core location difference
was 570263 mm and the average number of PS per frame
was 0.750.63. The mean number of PS per frame for clinical
a-focus data was slightly larger for BE than UE (0.490.73 vs
0.310.55). Conclusion: BE phase is as effective as AP phase
for rotor tip detection when using simulated data and performed similarly to UE for cell culture and clinical data. This
suggests it may be used clinically as an alternative method to
UE phase.
266
1327 Abstract 1548

RISK FACTORS OF RECURRENCE ATRIAL
FIBRILLATION AFTER ELECTRICAL CARD
IOVERSION
Olga Litunenko1, Aldis Strelnieks2, Milana Zabunova3,
Kaspars Kupics3, Kristine Jubele3, Janis Pudulis2, Sandis
Sakne3, Maija Vikmane3, Marina Kovalova4, Ilze Vinkalna1,
Aivars Lejnieks2, Oskars Kalejs3
1
Riga Stradins University, Riga, Latvia; 2Riga East University
Hospital, Riga, Latvia; 3P. Stradins Clinical University Hospital, Riga, Latvia; 4Jelgava Regional Hospital, Riga, Latvia
Atrial fibrillation is associated with increased risk of embolic
events and development of heart failure. Electrical cardioversion is a safe, fast and effective way to restore sinus rhythm,
but does not prevent the high possibility of recurrent atrial
fibrillation. Therefore, antiarrhythmic therapy to prevent recurrences is needed. Aim of study: The study aims to evaluate
the effectiveness of antiarrhythmic drug therapy and risk factors of recurrences after electrical cardioversion. Methods:
Review the medical data records and information from control
phone calls 1, 3 and 6 months after electrical cardioversion of
256 prospective and medical records of 229 retrospective patients undergoing electrical cardioversion of atrial fibrillation
during year 2013 at Latvian Centre of Cardiology. For statistical analysis, program SPSS 17.0 was used. Results: Atrial
fibrillation recurred in 32.6 % of patients. There was statistically significant higher rate of recurrences (OR 0.324; p=
0.020) and hospitalizations (p=0.010) in case of chronic kidney disease over 1, 3 and 6 months after electrical cardioversion. Patients in age group from 45 to 55 (40.5 %) had atrial
fibrillation recurrences more frequently during 3 months (OR
0.648; p=0.011). IC and III class antiarrhythmic drugs were
prescribed in 83.1 % of cases with amiodarone in 62.1 %.
There were fewer recurrences with amiodarone (33.3 %) and
sotalol (33.3 %, than with propafenone (63.6 %) and
aethacizine (83.3 %)) (p = 0.002). Beta-blockers were
prescribed in 81.986.8 % of patients, and angiotensinconverting enzyme inhibitors55.558.1 % of patients.

There was fewer episodes of recurrent atrial fibrillation in
patient groups, where statins (26.9 % (n=32) vs. 38.6 % (n=
39); p=0.044), aldosterone antagonists (12.5 % (n=3) vs.
34.7 % (n=68); p=0,036) and diuretics (15.4 % (n=4) vs.
41.5 % (n=51); p=0.014) were used. Conclusion: Recurrent
atrial fibrillation occurs in one third of patients after electrical
cardioversion of atrial fibrillation. The use of beta-blockers
and ACEI after electrical cardioversion is frequent. The use
of statins, diuretics and aldosterone antagonists decreases the
number of atrial fibrillation recurrences. Amiodarone is more
effective and decreases significantly the risk of recurrence of
atrial fibrillation as compared with propafenone, ethacizine
and sotalol. A significant higher risk of atrial fibrillation recurrences and hospitalization was noted during the 6 months
after electrical cardioversion in patients with chronic kidney
disease and in the 3-month follow-up in patients aged 45
55 years.
1328 Abstract 1547
ADDITION OF ATRIAL ECTOPY AND NT-PROBNP

TO FRAMINGHAM ATRIAL FIBRILLATION RISK
ALGORITHM IMPROVES RISK PREDICTION
Preman Kumarathurai1, Mette Mouridsen1, Nick Mattsson1,
Bjrn Larsen1, Olav Nielsen1, Thomas Gerds 2, Ahmad
Sajadieh1
1
University Hosptial of Bispebjerg, Copenhagen, Denmark;
Department of Biostatistics, Copenhagen University,
Copenhagen, Denmark
Background: Atrial fibrillation (AF) is a common arrhythmia
associated with increased morbidity. Models for prediction of
AF can be relevant in examining the AF pathogenesis and AF
prevention therapies. We aimed to investigate whether elevated NT-proBNP or increased rate of premature atrial contractions (PACs) improved risk prediction for AF compared to
Framingham AF risk score. Methods: Subjects from the
population-based cohort in the Copenhagen Holter Study,
consisting of 678 men and women between 55 and 75 years
of age and with no history of prior atrial fibrillation, stroke or
cardiovascular disease, were followed for the diagnosis of
incident AF or death (median follow-up time14.4 years).
Baseline examination included physical examination, laboratory testing and 48-h ambulatory ECG monitoring. Subjects
with missing values were excluded, and Framingham risk
score for AF was calculated for the remaining 646 subjects.
In order to investigate the predictive ability ofPAC (log-scale)
and NT-proBNP (log-scale), we computed the time-dependent
area under the ROC curve (AUC) for the AF status 10 years
267
after the baseline examination. Results: Two hundred and

sixty-nine subjects (41.6 %) were women, mean systolic
blood pressure was 156.2 mmHg and 72 subjects (11.1 %)
had diabetes. Median NT-proBNP was 6.7 mmol/L (IQR:
3.613.5) and median PAC count was 1.4 beats/h (IQR 0.6
4.5). During the 14.4 years of observation, 77 (11.4 %) subjects developed AF and 224 (33.0 %) died. In multiple Cox
model adjusted for Framingham AF risk score, logtransformed NT-proBNP and log-transformed PAC was associated with a significant increase in AF risk (HR 1.44 [95 %CI
1.131.82], p= 0.001; HR 1.22 [95 % CI 1.091.39] p=
0.002). The addition of PAC to the Framingham AF risk model significantly improved AF risk discrimination (AUC 65.7
vs. 72.2; p=0.0072), while the addition of NT-proBNP did not
(AUC 68.4; p=0.23). The addition of both PAC and NTproBNP to the Framingham risk score also improved the AF
discrimination capability (AUC 72.3; p=0.013).
Marker
AUC
p value
Framingham score
65.7 [60.85;78.77]
Framingham score+PAC
72.2 [66.35;84.29]
0.0072
Framingham score+NT-proBNP
68.4 [61.98;81.43]
0.23
Framingham score+PAC+NT-proBNP
72.3 [66.43;84.22]
0.013
Table 1. Conclusions: AF risk discrimination was significantly

improved by addition of PAC to the existing Framingham AF
risk prediction model but not by addition of NTproBNP.
history of systemic embolism (9.4 vs. 1.6 %, p<0.001) and of

mitral commissurotomy (28.1 vs. 19.4 %, p=0.035). Symptoms were similar between the two groups (NYHA>II 48.9
vs. 49.9 %, p=0.648). Patients with AF had more, frequently,
a Wilkins score >8 (51.4 vs. 30.9 %, p<0.001), a larger left
atrium (41 vs. 32 cm2, p=0.001) and a lower transmitral gradient (11.1 vs. 16.6 mmHg, p<0.001). BMV was equally successful in the two groups (90.6 vs. 94 %, p=0.187) but resulted
in a smaller post BMV area (2 vs. 2.15 cm2, p=0.012) with a
lower mitral valve area gain (0.9 cm2 vs. 1 C, p=0.015). BMV
was not associated with a higher risk of complications (4.3 vs.
4.7 %, p=0.844). After a mean follow-up of 74 months, patients with AF had the same rate of restenosis (28.3 vs. 25.6 %,
p=0.96) but required more frequently a mitral valve replacement (16.3 vs. 7.7 %, p=0.012). They also experienced higher
rates of systemic embolism (3.8 vs. 0.6 %, p=0.018) and had a
lower rate of event free survival (freedom from death, restenosis
and systemic embolism) (52.2 vs 68.8 %, p=0.047).In the
group of patients in AF, predictive factors for combined adverse
events including death, restenosis, and systemic embolism and
mitral valve replacement are as follows: post BMVarea <2 cm2
(OR 2.5, 95 % CI [1.2; 5.18], p=0.014), procedural complications including severe mitral regurgitation and tamponade (OR
3.95, 95 % CI [1.4; 11.13], p=0.009) and NYHA class II during
follow up (OR 3.46,, 95 % CI [2.09; 5.73], p<0.001). Conclusion: Our data support the fact that patients with AF have worse
immediate and long term outcomes after BMV. Post BMV area
<2 cm2, procedural complications and dyspnea predict adverse
events during follow-up.
1329 Abstract 1543

1330 Abstract 1542
BALLON MITRAL VALVULOTOMY FOR PATIENTS
WITH MITRAL STENOSIS IN ATRIAL
FIBRILATION: IMMEDIATE AND LONG TERM
PROGNOSIS
Marouane Mahjoub1, Majed Hassine1, Ghassan Cheniti1,
Ibtihel Mechri1, Majdi Ben Massaoud1, Zohra Dridi1, Fethi
Betbout1, Habib Gamra1
1
Cardiology department A: Fattouma Bourguiba University
Hospital, Monastir, Tunisie
Background: Atrial fibrillation (AF) is a common finding in
patients with severe mitral stenosis requiring balloon mitral
valvulotomy (BMV). Its immediate and long-term prognosis
remains controversial. We sought to evaluate the effect of AF
on the immediate and long-term (23 years) outcome of patients
undergoing BMV. Methods: The immediate procedural and the
long-term clinical outcome after BMV of 139 patients with AF
were collected and compared with those of 381 patients in
normal sinus rhythm (NSR). Results: Patients with AF were
older (43.3 vs. 29.7 years; p<0.001) and had frequently a
SURFACE ECG IDENTIFICATION OF PERSISTENT

AF DRIVER ACTIVITY DETECTED BY
NONINVASIVE ELECTROCARDIOGRAPHIC
IMAGING
Torsten Konrad1, Sebastien Knecht2, Isabel Deisenhofer3,
Thomas Arentz4, Mattias Duytschaever5, Thomas Neumann6,
Bruno Cauchemez7, Jean-Paul Albenque8, Thomas Mnzel9,
Cathrin Theis1, Thomas Rostock1
1
II. Med. Clinic, Department for Electrophysiology, Johannes
Gutenberg-University, Mainz, Germany; 2CHU Brugmann,
Brussels, Belgium; 3Dept. of Electrophysiology, Deutsches
Herzzentrum Mnchen, Technische Universitt, Munich,
Germany; 4 Universitts-Herzzentrum Freiburg-Bad
Krozingen, Bad Kronzingen, Germany; 5Univ Hospital
Ghent, Ghent, Belgium; 6 Kerckhoff Heart Center, Bad
Nauheim, Germany; 7Clinique Ambroise Par, Neuilly-surSeine, France; 8Clinique Pasteur, Toulouse, France; 9II.
Med. Clinic, Johannes Gutenberg-University, Mainz,
Germany
268
Introduction: Body potential mapping and phase analysis

of unipolar signals has been implemented to identify
rotor or focal driver activity in patients with persistent
AF. This study aimed to identify specific surface ECG
activation patterns at the time of stable driver activity
(SDA) identified by noninvasive electrocardiographic
imaging (ECGI). Methods: Surface ECG (lead V1) and
phase maps from 17 patients (male=76 %, age 64.2
4.5 years, BMI 305.8, uninterrupted AF duration 5.7
3.3 months) undergoing persistent AF ablation during
the AFACART study were analyzed. From each patient,
three pauses (defined as 1 s between the QRS-complexes) with SDA (SDA pauses) and three pauses without SDA (non-SDA pauses) were analyzed (total 102
pauses). For the purpose of this study, SDA was defined
as reentrant activity with 2 completed 360 rotations
or 3 repetitive focal discharges. ECGI was performed
with the ECVUETM system (CardioInsight, USA). The
following ECG score for SDA identification was developed: 1. changes in single beat AFCL 10 ms, 2.
changes in F-wave amplitudes 0.05 mV, and 3. changes of F-wave polarity (positive/biphasic/negative). The
observation of each of the above parameters was counted with 1 point. Results: The developed score was significantly higher during pauses with stable driver activity as compared to those without (2.110.87 vs. 0.31
0.52, p=0.01). The positive predictive value (PPV) for a
score 2 was 0.97, the negative predictive value (NPV)
0.76. The best predictive value of the score parameters
was identified for the change of AFCL 10 ms during
pauses (PPV 0.95, NPV 0.87). The occurrence of SDA
was associated with organization of the global activation
pattern in approximately half of the patients. Conclusion: 1. We developed a new scoring system for the
identification of SDA in the conventional surface
ECG.2. The most important predictor for the presence
of a SDA is a significant change in AFCL during
pause. 3. Stable driver activity appears to coordinate
the atrial activation wave-fronts resulting in changes of
F-wave characteristics in the surface ECG. 4. Typically,
the occurrence of SDA leads to deceleration of AFCL,
increase of F-wave amplitude and F-wave polarity shift.
Poster session B part 1
Posters exposed from 02:00 PM to 05:00 PM
Presenters and chairpersons present from 02:00 PM
to 03:30 PM
Arrhythmias and heart disease
141 Abstract 1715
VENTRICULAR TACHYARRHYTHMIA IN PATI

ENTS WITH CONGENITAL HEART DISEASE:
WAIT-AND-SEE OR PREDICTABLE?
Christophe Teuwen1, Tanwier Ramdjan1, Joris Vriend2,
Marco Gotte2, Sander Molhoek3, Reinhart Dorman4, Jurren
van Opstal4, Thelma Konings5, Pepijn van der Voort6, Etienne
Delacretaz7, Ameeta Yaksh1, Nienke Wolfhagen1, Peter de
Klerk1, Dominic Theuns1, Maarten Witsenburg 1, Jolien
Roos-Hesselink 1 , Paul Knops 1 , Eva Lanters 1 , John
Triedman8, Ad Bogers1, Natasja de Groot1
1
Erasmus Medical Centre, Rotterdam, Netherlands;2 Haga
Hospital, The Hague, Netherlands; 3Amphia Hospital, Breda,
Netherlands; 4 Medisch Spectrum Twente, Enschede,
Netherlands; 5VU University Medical Centre, Amsterdam,
Netherlands; 6Catharina Hospital, Eindhoven, Netherlands;
7
Inselspital, University of Bern, Bern, Switzerland; 8Boston
Childrens Hospital, Harvard Medical School, Boston, MA,
USA
Background: Ventricular tachycardia (VT) and ventricular fibrillation (VF) have been reported as common late post-operative
complications in patients with congenital heart defects (CHD).
These ventricular tachyarrhythmia (VTA) can lead to increased
morbidity and are associated with sudden cardiac death. We
aimed to investigate the occurrence of VTA in CHD patients
over time. In addition, we looked for new clinical and electrophysiological predictors of VTA. Methods: CHD patients with a
documented episode of VTA on an electrocardiogram (ECG) or
24-h Holter registration were analyzed. Patients were divided
into groups according to their severity of CHD. Furthermore,
VTA were classified as non-sustained VT (nsVT), sustained
VT (sVT) or VF. On ECGs, the QRS duration (QRS) and QTc
interval (QTc) were reviewed <1 year prior to VTA and 5 years
earlier. Finally, echocardiograms were assessed <1 year before
VTA. Results: VTA episodes were documented in 149 patients
(60 % male) at a mean age of 4014 years (range 1570 years);
VTA consisted of nsVT (N=110), sVT (N=23) and VF (N=16).
QRS and QTc did not change (QRS 13231 versus 12928 ms,
p=0.56; QTc 39540 versus 40336 ms, p=0.11). Echocardiograms were available in 125 patients, of whom 23 had a depressed right and/or left ventricular function. Fifty-one (34 %)
patients received an ICD; VTA recurred in 15 (29 %) patients of
them during a follow-up period of 74 years; inappropriate
shocks caused by supraventricular tachycardia (SVT) occurred
in 13 patients (25 %). Conclusion: VTA initially developed at a
mean age of 40 years, which was approximately 30 years after
the first cardiac surgery. Intra-ventricular conduction delay,
269
dispersion in ventricular refractoriness and cardiac function were

of limited value in order to predict development of VTA. In
patients with an ICD, VTA recurred frequently during longterm follow-up. Moreover, SVT developed often as well, causing inappropriate shocks.
permanent AF, while there was no significant difference among

AF subgroups in non-STEMI patients.
142 Abstract 1549
INCIDENCES OF DYSRHYTHMIA IN THE

OPERATING ROOM IN CHILDREN AFTER
SURGERY FOR CONGENITAL HEART DISEASE
SIGNIFICANT DIFFERENCES IN PRESENTATION

OF ATRIAL FIBRILLATION IN PATIENTS WITH
STEMI AND NON-STEMI BUT SIMILAR
ALL-CAUSE MORTALITY RISK AT 30 DAYS
Dritan Poci 1 , Marianne Hartford 2 , Thomas Karlsson 2 ,
Kenneth Caidahl3, Nils Edvardsson2
1
Department of Cardiology, Univ. Hospital rebro, rebro,
Sweden; 2Institute of Medicine, Department of Molecular and
Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of
Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Background: The aim of this study was to determine the prognostic implications of pre-existent and new-onset atrial fibrillation AF in patients (pts) with ST-segment elevation myocardial
infarction (STEMI) and non-STEMI. Methods and results:
Among 2335 consecutive patients with ACS, 54 pts had known
permanent, 37 known paroxysmal AF and 54 their first ever AF
on admission, while 184 pts developed their first ever AF during
hospitalization. There were 859 pts with STEMI and 792 with
non-STEMI. Any AF occurred in similar proportions of STEMI
and non-STEMI pts, 19 vs 23 % (p=0.06). There were statistically a significant difference in the distribution of AF subgroups
between AF patients with STEMI and AF patients with nonSTEMI (p<0.0001). In STEMI patients, new AF during hospitalization was found in 60 % of the AF patients versus 33 % in
non-STEMI patients. Corresponding proportions for known paroxysmal AF were 21 and 38 % in the STEMI and non-STEMI
group, respectively. The 30-day mortality was significantly
higher in patients with any AF as compared to no AF, both in
STEMI patients, 21 vs. 9 % (p<0.0001), and in non-STEMI
patients, 12 vs. 5 % (p=0.002). In STEMI patients, but not in
non-STEMI patients, there was a statistically significant difference in mortality among the AF subgroups (p=0.03 and p=0.56,
respectively). Conclusion: The presentation of AF differed between patients with STEMI and patients with non-STEMI.
Thirty-day mortality was more than doubled in patients with
any AF as compared to patients without AF, both among those
with STEMI and those with non-STEMI. In STEMI patients, the
30-day mortality was highest in the subgroup with known
143 Abstract 0717
Charlotte Houck1, Ameeta Yaksh1, Eva Lanters1, Lisette van

der Does1, Christophe Teuwen1, Maarten Witsenburg1, Jolien
Roos-Hesselink1, Ad Bogers1, Natasja de Groot1
1
Erasmus Medical Center, Rotterdam, Netherlands
Background: Several studies have reported incidences of dysrhythmia in the intensive care unit in children after surgery for
congenital heart disease (CHD) varying from 15 to 48 %. However, the incidence of dysrhythmia in the operating room (OR)
in this population has never been reported. The aims of this
study are to determine the incidence of dysrhythmias in the intra
and immediate postoperative period in children after surgery for
CHD and to identify pre and intraoperative risk factors for the
development of these dysrhythmias. Methods: We included 84
patients younger than 18 years who underwent cardiac surgery
for various CHD. Continuous rhythm registrations were analyzed from the moment the aortic clamps were taken off or,
when aortic clamps were not used, the sternum was closed until
the moment the child left the OR. Rhythm registrations were
analyzed for the occurrence of atrial and ventricular tachyarrhythmia, atrioventricular conduction blocks (AVB), junctional
rhythm and ectopic atrial rhythm. Results: Second-degree AVB
was observed in 42 % of patients and third-degree AVB in
25 %. Longer duration of aortic cross clamp time or bypass
time was associated with a higher incidence of AVBs. However,
these factors appeared not to influence the incidence of junctional or ectopic atrial rhythm, which were both observed in
23 % of all patients. Four patients, all with a VSD, had more
than 30 ventricular premature beats (VPBs) per hour and 14
patients, of which 9 had a VSD, had 10 to 30 VPBs per hour.
Ventricular runs were also more often observed in patients with
a VSD or univentricular heart. Atrial fibrillation (N=1), nonsustained ventricular tachycardia (N=1) and ventricular fibrillation (N=1) were infrequently observed. When leaving the
OR, 93 % of all patients had sinus rhythm and 6 % had junctional or ectopic atrial rhythm. One patient (1 %) had received a
temporary atrial pacemaker lead for sinus node dysfunction,
which recovered a few days postoperatively. Conclusion: Dysrhythmia and AVB were frequently observed in the OR in children after surgery for CHD. However, most children (93 %) left
the OR in sinus rhythm. Longer duration of aortic cross clamp
270
time and bypass time were risk factors for development of

AVB. The presence of a VSD was associated with a higher
incidence of ventricular tachyarrhythmia.
144 Abstract 1412
DO ECTOPIC SUPRAVENTRICULAR PREMATURE

BEATS PREDICT EARLY NEW-ONSET ATRIAL
FIBRILLATION AFTER CORONARY ARTERY
BYPASS SURGERY?
Ameeta Yaksh1, Charles Kik1, Eva A.H. Lanters1, Upaashna
Chigharoe1, Paul Knops1, Maarten J.B. Van Ettinger1, Marcel
C.J. De Wijs1, Peter Van de Kemp2, Jan Hofland1, Ad J.J.C.
Bogers1, Natasja N.M. De Groot1
1
Erasmus MC, Rotterdam, Netherlands; 2Sorin, Rotterdam,
Netherlands
Background: Early new-onset postoperative atrial fibrillation
(PoAF) occurs frequently after CABG, but the exact mechanism is unknown. In the general population, frequent supraventricular premature beats (SVPBs) are associated with AF.
Whether SVPBs also play a role in development of PoAF is
unknown. This study examines the frequency and burden of
postoperative supraventricular dysrhythmia SVPBs, SV-couplets/runs in patients with coronary artery disease in relation to
PoAF. Methods: Patients (N=105, 83 male, 669 years) undergoing CABG were included. Postoperative continuous
rhythms were recorded and semi-automatically analysed in
multichannel Holter scanning software SynescopeTM (Sorin
Group). SVPBs were defined as singles 25 % shorting of
SVPBs cycle length (CL) compared to the average CL of
the two preceding beats, couplets or runs (containing 3 beats
and during<30 s). PoAF was defined as episodes lasting
30 s. Single SVPBs prematurity index (PI%) was assessed
by dividing its CL to the averaged CL of the two preceding
beats. Single SVPBs burden per patient was obtained by dividing the sum of all SVPB by the total number of beats. The
burden of couplets and runs was defined as the total duration
of all couplets/runs divided by the recording time. The top
10th and 25th percentile of atrial characteristics were used to
predict PoAF. Results: Recorded in 8231 h, 42,583,846 beats
were analysed. SVPBs, SV-couplets, SV-runs and PoAF occurred in, respectively, 100, 90, 81 and 28 % of the patients.
PoAF developed in 29 (28 %) patients. Patients with PoAF
had a significantly higher frequency and burden of single
SVPBs/couplets/runs compared to patients without PoAF (Table 1). Similar results were demonstrated for single SVPBs PI.
Using the atrial dysrhythmias cutoff values, PoAF could be
predicted by SVPBs57/h (OR 6.4), 1196/day (OR 8.4),
SVPB burden1.2 % (OR 6.1), SV-run0.2/h (OR 5.1), 5/
day (OR 4.7) and SV-run burden0.2 % (OR 9.7).
Conclusion: Supraventricular dysrhythmia occurs in the majority of patients after CABG, whereas PoAF develops in
28 % of the patients. Independent risk factors for development
of AF after CABG were the frequency and burden of SVPBs
and SV-runs. Hence, these parameters could be used to identify patients at risk for developing PoAF and allows preventive measures to be taken.
No PoAF
PoAF
P value
SVPB per day/burden ()

Prematurity index (%)
178/0.02
65
540/0.09
63
0.01/0.00
0.02
SV-couplet per day/burden ()

SV-run per day/burden ()
22/0.02
6/0.2
45/0.05
34/0.9
0.09/0.05
0.02
14-5 Abstract 1555
PERIOPERATIVE INDUCIBILITY OF AF: PRED

ICTOR FOR DEVELOPMENT OF EARLY
POSTOPERATIVE AF?
Eva Lanters 1 , Ameeta Yaksh 1 , Lisette van der Does 1 ,
Christophe Teuwen1, Paul Knops1, Charles Kik1, Ad Bogers1,
Natasja de Groot1
1
Erasmus MC, Rotterdam, Netherlands
Introduction: Development of Atrial Fibrillation (AF) requires
a trigger, initiator and a substrate. Human epicardial mapping
studies are currently being performed to acquire insight into
the substrate underlying AF. For these studies, electrical induction of AF is essential. The aim of the present study is to
assess whether perioperative inducibility of AF predicts development of early postoperative AF (PoAF). Methods: Patients (n=181) undergoing coronary artery bypass grafting
without a history of AF were included for an epicardial mapping study of the entire atria (mapping array 192 electrodes)
during sinus rhythm and AF. In all patients, fixed rate atrial
pacing (250300350 bpm) was used for induction of AF.
Fibrillation maps at ten different atrial sites during 10 s of
AF were analyzed using custom made software. AF was defined as a beat-to-beat change in (1) activation pattern, (2)
cycle length and (3) electrogram morphology. Early PoAF
was detected by continuous rhythm registration/ECGs during
the first five post-operative days. Results: In 150 (82.3 %)
patients, either AF (n=128, 82.1 %) or atrial flutter (AFL,
n = 22, 14.7 %) was successfully induced. AF sustained
throughout the entire mapping procedure in 74 patients
(57.8 %), whereas 54 (42.2 %) patients required re-induction.
In 31 (17.1 %) patients, atrial tachyarrhythmia could not be
induced. Early PoAF developed in only 3 (9.1 %) of patients
without inducible arrhythmia versus 32 (21.3 %) patients with
inducible arrhythmia, including 15 (20.3 %) patients with

sustained and 13 (24.1 %) patients with non-sustained induced
AF and 4 (18.2 %) patients with induced AFL. Conclusion:
Perioperative inducibility of AF or AFL is a predictive parameter for development of early PoAF. There is no difference
between induction of sustained or non-sustained AF and development of early PoAF.
146 Abstract 1712
EARLY VENTRICULAR TACHYARRHYTHMIAS

AFTER CORONARY ARTERY BYPASS GRAFTING
SURGERY: IS IT A REAL BURDEN?
Elisabeth Mouws1, Ameeta Yaksh1, Paul Knops1, Charles
Kik1, M.J.B. van Ettinger1, M. de Wijs1, P. van de Kemp2,
Eric Boersma1, Ad Bogers1, Natasja de Groot1
1
Erasmus Medical Center, Rotterdam, Netherlands,2 Sorin
Group, Amsterdam, Netherlands
Background: Ventricular tachyarrhythmias (VTA) have been
reported with incidences varying from 0.95 to 5 % after coronary artery bypass grafting (CABG). Ventricular dysrhythmias
(VD) (ventricular premature beats (VPBs), ventricular couplets
(Vcouplets) and ventricular runs (Vruns)) on the other hand
271
have so far not been examined. The goal of this study is to

examine characteristics of VD and VTA during a postoperative
follow-up period of 5 days using continuous rhythm registrations. In addition, we determined predictive factors of VD/
VTA. Methods: The study population consisted of 105 successive patients undergoing elective CABG in the Erasmus MC
Rotterdam. Postoperative continuous rhythm registrations
were obtained and analyzed. Independent predictors of ventricular arrhythmia were identified by multivariate binary logistic regression analysis in a stepwise fashion. Incidences
and burdens of VD/VTA were calculated. Results: One hundred five patients (83 male (79 %), age 659 (4283) years)
were included. A total of 430,006 VPBs, 8032 Vcouplets and
2153Vruns were found in these patients. VPBs, Vcouplets
and Vruns occurred in, respectively, 100, 82.9 and 48.6 %
of patients, with corresponding burdens of 0.05, 0 and 0 %.
Incidences were highest on the first postoperative day.
Sustained VT and VF did not occur in our cohort. Independent risk factors for VD included male gender, mitral valve
insufficiency, hyperlipidemia and age60 years. Conclusion:
VDs are common in patients with coronary artery disease
after CABG. Despite high incidences of these dysrhythmias,
corresponding burdens are low and VTA did not occur. Future studies including patients with VTA are necessary to
analyze the prognostic value of characteristics of VD for
VTA in the early postoperative phase and long-term survival.
272
147 Abstract 0814
Techniques and tools

148 Abstract 0117
SYMPTOMATIC HIGH DEGREE HEART BLOCK

COMPLICATING SYSTEMIC SARCOIDOSIS
Malka Yahalom1, Ofir Koren2, Yoav Turgeman1
1
Cardiolog Department, HaEmek Medical Center, Afula,
Israel; 2Internal Medicine C, HaEmek Medical Center, Afula,
Israel
THE SIGNIFICANCE OF HEART RATE

TURBULENCE MEASUREMENT IN OLDER MEN
WITH HIGH CARDIOVASCULAR RISK.
Elisaveta Guliaeva1
Kemerovo medical academy, Kemerovo, Russia
Background. Myocardial involvement in sarcoidosis may

be a benign disease or in some instances may be a lifethreatening condition. We report two cases of highdegree AV block associated with systemic sarcoidosis.
Purpose. The purpose is to raise awareness of cardiac
involvement in sarcoidosis and its clinical implications.
Patients and methods. Patient 1. This 43-year-old male,
presented Stokes-Adams syndrome, related to paroxysmal complete heart block, which required cardiopulmonary resuscitation, treated by a temporary pacing,
and shortly after, a permanent pacemaker was implanted. On a chest X-ray, CT and Gallium-scan, there
was evidence of hilar and axillar lymphadenopathy. The
diagnosis of sarcoidosis was confirmed by a mediastinal
lymph node biopsy. Patient 2 was a 58-year-old female,
followed for hyperlipidemia and pulmonic Sarcoidosis
(presented 2 years earlier by cough and dyspnea) and
was proven by a CT scan (demonstrating enlarged
mediastinal lymph-nodes) and by mediastinal lymph
node biopsy. The patient presented a month earlier with
fatigue, dizziness and almost syncope, and evidence of a
high degree atrio-ventricular (AV) block (with no evidence of cardiac ischemia), treated by a permanent
pacemaker implantation. Prior to the implantation, there
was no evidence of inducible tachyarrhythmia on an
electro-physiological-study (EPS). Conclusions. We
present two patients with cardiac sarcoidosis presenting
with high-degree AV block, who needed a pacemaker
therapy. One was known as suffering from pulmonary
sarcoidosis, and in the second case, the diagnosis was
established during the recent event. Our case reports
aim to increase awareness on cardiac sarcoidosis as a
possible cause of syncope and sometimes of cardiac
arrest. It is recommended by us and other investigators
to follow patients with sarcoidosis for early screening
for cardiac involvement (by detailed clinical history), a
12-lead ECG and even echocardiogram, and when needed other modalities, and thus save lives.
The purpose of the present study was to examine indicators of heart rate turbulence on this 24-h ECG in
older men suffering from essential arterial hypertension
(AH) with high cardiovascular risk. Materials and
methods. The group surveyed was consisted of 75 men
with arterial hypertension of degree III, risk 4, in middle age 67.42.5 years. AG diagnostics was carried out
taking into account the recommendations of the RSC
(Russian Society of Cardiology) (2010). All patients
were evaluated for quality of life (GL) on the scale of
the SF-36. The assessments of the level of depression
by Beck questionnaire and of reactive and personal anxiety on the evaluation scale of Ch. Spilbergera and Y.l.
Hanina had place. A 6-min walk test, the study of biological age by V.P. Voitenko method as well as ECG,
echocardiography, a daily monitoring of ECG in order
to evaluate the heart rate variability and study of heart
rate turbulence with an assessment of turbulence onset
(TO) and turbulence slope (TS) according to the 24-h
ECG monitoring were performed. The comparison group
was consisted of 25 male with AG at the age of 46.3
3.8 years. It was found that elderly patients with high
cardiovascular risk differ from the patients of the comparison group by an increased performance of TO and
decrease of TS (P<0.05). Pathological night values of
TO was associated with a reliable (P<0.05) increase in
body mass index (BMI), the average heart rate (AHR),
the reduction of circadian index, decreased power of the
low- and high-frequency components of heart rate variability spectrum, elongation QT according to standard
ECG, an increase of the minute bloodstream (IOC)
and the index of left ventricular myocardium mass
(iLVMM). An equation of multifactor regression analysis including 12 parameters of clinical-functional status
of elderly patients as independent variables found the
influence of independent myocardial mass index of left
ventricle of the heart on the night TO reducing.
Conclusion. Analysis of heart rate turbulence in older

patients with AG is useful for clarifying the severity
of their clinical status and can be used in the cardiovascular risk stratification.
149 Abstract 1813
PHYSICS OF RADIOFREQUENCY ABLATION

IN-VITRO TEACHING SYSTEM FOR PHYSICIANS
AND MEDICAL ENGINEERING STUDENTS
Tobias Haber1, Gennadie Kleister1, Burcu Selman1, Johannes
Hrtig2, Juraj Melichercik2, Bruno Ismer1
1
Peter Osypka Institute for Pacing and Ablation, Offenburg,
Germany; 2 MediClin Heart Center Lahr/Baden, Lahr,
Germany
Radiofrequency (RF) ablation is the most popular method in the treatment of supraventricular re-entrant and
focal tachycardias, atrial fibrillation and an increasing
number of ventricular tachycardias. It is utilized by
computer-controlled application of RF current. Nevertheless, despite lots of developments in the last years, RF
ablation is still a complex procedure requiring the physicians electrophysiological experience and expertise, as
well as physical science basics knowledge. Thus, there
is a need of in vitro essays to explain several effects
observed during clinical application. Aims: The study
aims to create an in-vitro RF ablation teaching system
in order to school physicians and medical engineering
students the physical science basics of radiofrequency
catheter ablation. Methods: To enable in vitro RF ablation experiments on pork in small groups, six workstations were equipped with computer-controlled RF ablation generators. A connection box was prepared to allow ablations with catheters of different make and model. Special wetlab was established combining a basin
containing physiological saline solution with a thermostat and a pump to simulate an adjustable blood flow.
Screenshot software was installed to document the
graphical trends of temperature, power and impedance.
Any workstations screen can also be displayed on additional large-scale monitors for discussions of the observed effects. Results: The RF ablation teaching system
was successfully used to demonstrate the differences in
lesion size and geometry between standard 4- and 8mm-tip electrodes with single or dual sensor technology.
Effects of larger and deeper lesion size were studied
273
using open and closed irrigated RF ablation. Furthermore, prevention of pops and the influences of blood
flow as well as position of tip electrode with a specific
angle to the myocardium could be clearly demonstrated.
Conclusions: In several workshops, the in vitro teaching
system provided excellent requirements for both physicians and medical engineering students, to become
acquainted with the physical science basics of RF
catheter ablation.
1410 Abstract 0411
IMPAIRED ADAPTATION OF WHOLE HEART

ACTION POTENTIAL DURATION IN RESPONSE TO
PHYSIOLOGICAL AUTONOMIC STRESS IN
BRUGADA SYNDROME.
Kevin Ming Wei Leong1, Fu Siong Ng1, Caroline Roney1,
Phang Boon Lim1, Sian E Harding1, Nicholas S Peters1,
Amanda Varnava1, Prapa Kanagaratnam1
1
NHLI, Imperial College London, London, UK
Introduction: Sudden death in Brugada syndrome (BrS)
is associated with rest, when parasympathetic tone predominates and/or sympathetic tone is diminished. Using
non-invasive electrocardiographical imaging (ECGi) with
a vest, this pilot study aims to characterise the electrophysiological substrate in BrS patients during different
states of autonomic stress. Methods: The ECGi vest projects patients reconstructed electrograms (EGMs) onto
an image of their own heart geometry. This was applied
to eight patients (four BrS, four controls; mean age
40.5 years; six males) during rest, treadmill and tilt table
testing. Activation recovery interval (ARI), an action potential duration surrogate, of the epicardial EGM was
taken from right and left apical, mid and basal regions
from each individual and corrected for heart rate (cARI).
Results: Baseline cARI was not significantly different in
both groups (29917 ms vs 28418 ms; p=ns) (Graph
1). There was appropriate shortening of cARI (299
17 msec to 258 22 msec; p = 0.006) from baseline to
peak exertion, and prolongation on recovery (258
22 ms to 296 23 ms; p = 0.03) in the control group,
but not in the BrS group. With upright tilt, a significant
increase in cARI was noted in the control group by 5
and 20 min (p<0.05). A smaller rise was seen in the BrS
group with a significant rise noted later at 20 min (p=
0.04). These results suggest BrS patients have an
274
impaired response to physiological sympathetic stressors.

Conclusion: This study shows how cARI alters with various autonomic stresses in normal and BrS patients. Its
findings suggest individuals with BrS have impaired

sympathetic autonomic function which may contribute
to arrhythmogenesis.
1411 Abstract 0310
polymorphism influences AF occurrence after treatment with

statins. Methods. Two hundred unrelated dyslipidemic Caucasian patients (100 men and 100 women; mean age 758) from
Salento (Southern Italy) were enrolled and assigned to atorvastatin treatment. All patients were followed at 6-month intervals. CETP TaqIB polymorphism was genotyped by RFLPPCR. Results. During a mean follow-up time of 476 months,
73 patients (36.5 %) experienced at least one episode of AF,
while the remaining 127 patients (63.5 %) were free of AF
episodes. No significant differences were observed between
the two groups with regard to demographic, clinical and echocardiographic data, as also regarding the values of lipid parameters before and after statin therapy. B2B2 genotype was
associated to higher AF frequency (27 patients 37 % vs 6
patients 5 %), while B1-carriers had lower AF incidence (46
LACK OF ATORVASTATIN PROTECTIVE EFFECT

AGAINST ATRIAL FIBRILLATION IN B2B2 CETP
GENOTYPE
Francesca Galati1, Antonio Galati2, Serafina Massari1
1
DiSTeBA, University of Salento, Lecce, Italy; 2Division of
Cardiology, Card. G. Panico Hospital, Tricase, Italy
Introduction. There has been some evidence for a role of
statins in reducing the risk of atrial fibrillation (AF), but the
response to statin treatment varies considerably due to environmental and genetic factors. One of these is related to CETP
expression. So, we assessed whether CETP TaqIB
275
patients 63 % vs 121 patients 95 %); this difference was statistically significant (p<0.0001).
AF
not AF
B2B2
27 (37 %)
6 (5 %)
B1B2
B1B1
17 (23 %)
29 (40 %)
80 (63 %)
41 (32 %)
Conclusions. Because statins reduce CETP activity up to

30 %, we hypothesize that such CETP activity reduction by
statins, in patients with low CETP levels induced by polymorphism, may counteract the beneficial effect of statins on AF.
1412 Abstract 0412
WHOLE HEART ACTIVATION PATTERNS DURING
PHYSIOLOGICAL STRESS IN BRUGADA SYND
ROME.
Kevin Ming Wei Leong1, Fu Siong Ng1, Caroline Roney1,
Phang Boon Lim1, Sian E Harding1, Nicholas S Peters1,
Amanda Varnava1, Prapa Kanagaratnam1
1
NHLI, Imperial College London, London, UK
Introduction: Non-invasive electrocardiographical imaging
(ECGi) reconstructs epicardial electrograms from body surface
potentials collected from 250 electrode vest and displays the

activation on a 3D cardiac image segmented from a chest CT.
This enables whole heart activation to be studied in vivo under
different physiological situations. We hypothesised that conduction patterns are abnormal in patients with Brugada syndrome
(BrS) during various states of autonomic stress. Methods: Eight
patients who were planned EP studies were recruited (four BrS,
four controls; mean age 40.5 years; six males). Activation was
recorded with the patients wearing an ECVue vest and ECGi
maps were derived from a single cardiac cycles during rest,
immediate recovery after peak exertion following an exercise
treadmill and 5 min into an upright tilt test. Results: Although
there was variability in ventricular activation patterns between
individuals, some general patterns could be observed. In both
groups, the left ventricle had a later activation time (AT) than the
right ventricle during rest and exercise and with upright posturing. ATs of the left ventricle (LV) and right ventricle (RV) were
noted to become closer during exercise as well. At baseline, ATs
in the RVOT and RV were similar for all. The main difference
noted between the groups was during exercise recovery, when
AT in the RVOT was more delayed than the RV in three out of
four BrS patients but only one out of four of the controls. Figure 1 provides an illustrative example of the findings. Conclusion: We demonstrate the feasibility of measuring physiological
activation patterns during autonomic stress using the ECGi system. During recovery from exercise, activation delay in the
RVOT is noted more frequently in the BrS group.
276
1413 Abstract 0414

ELECTROPHYSIOLOGICAL RESPONSES TO
AUTONOMIC STIMULATION ARE BLUNTED IN A
MURINE MODEL OF BRUGADA SYNDROME
Malcolm Finlay1, Vishal Vyas2, Alastair Yeoh1, Stephen
Harmer3, Christopher Huang4, Pier Lambiase5, Andrew Tinker3
1
Barts Health NHS Trust and QMUL, London, UK; 2UCL and
QMUL, London, UK; 3Queen Mary University of London, London,
UK, 4 Cambridge University, Cambridge, UK; 5UCL, London, UK
INTRODUCTION. Autonomic stimuli are often identified as
precipitants of clinical arrhythmia in Brugada syndrome. This
has been attributed to either abnormal electrophysiological modulation by autonomic stimuli or to primary abnormalities in cardiac neuronal innervation. We use a heterozygotic SCN5a+/
murine tissue-slice model to test these hypotheses. METHODS.
Two hundred-micrometer-thin ventricular slices were cut from 3month-old murine SCN5a+/ hearts (HET) and littermate controls (WT) following pre-treatment with cardioplegic solution via
Langendorff perfusion. Slices were superfused on an 88 microelectrode array (MEA2100, MultiChannel Systems, panel A),
and stimulated externally in a decremental S1S2 protocol. Conduction velocity was calculated using a gradient of activation
times. Values are given as meanstandard error. RESULTS.
HET myocardium had a lower conduction velocity (0.310.04
vs 0.510.14 ms1), higher thresholds (4.00.7 vs 2.70.4 V)
and longer effective refractory periods (ERP 794 vs 633 ms,
p<0.001) than controls. A blunted response to 10 nM isoprenaline (Iso) was observed in SCN5a tissue, with only a 10 % increase in conduction velocity (c.f. 31 % increase in controls, p=
0.02, panel B). Decreased in ERP with Iso was smaller in HETs
than WTs (ERP with Iso 731 vs 517 ms). Carbachol restored
conduction velocities towards baseline without lengthening ERP
in WT. Iso reduced thresholds in WT significantly more than in
HET samples (3.90.9 vs 1.90.4 V, p<0.001). CONCLUSION. SCN5a +/ murine myocardium fails to increase excitability in response to sympathetic stimuli. This demonstrates a
mechanism by which autonomic state may accentuate predisposition to arrhythmia in sodium channel disease.
1414 Abstract 0512
THE LASER DOPPLER VIBROMETRY: A

NON-CONTACT TECHNIQUE FOR HEART RHYT
HM MONITORING
Armin Luik1, Laura Mignanelli2, Kristian Kroschel3, Claus
Schmitt1, Lorenzo Scalise2, Christian Rembe4
1
Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany;
2
Universit Politecnica delle Marche, Ancona, Italy;
3
Fraunhofer Institut IOSB, Karlsruhe, Germany; 4Polytech,
Waldbronn, Germany
Background: Monitoring of the hearts rhythm is the cornerstone of the diagnosis of cardiac arrhythmias. The current technologies are all based on the electrocardiogram
(ECG). Major limitation of the ECG is the need of special
electrodes attached to the body. We introduce a new technique which allows a non-contact registration of the heart
rhythm. The laser Doppler vibrometry (LDV) is a noncontact interferometric technique which is capable to detect
smallest vibrations of, i.e., the skin. Recording the vibrations of the hearts contractions is called vibrocardiography
(VCG). This technique enables a non-contact registration of
the heart rate due to the vibrations on the skin caused by the
contracting ventricles. A reliable detection of the heart rate
has already been shown. However, a complete patient monitor requires both, a reliable detection of the ventricular and
atrial contraction. The aim of this study was to evaluate
whether the VCG allows a reliable detection of the atrial
contraction and the different degrees of AV-blocks.
Methods: 13P were analyzed. The ECG and VCG were
recorded simultaneously. The infrared laser LDV was positioned in 1-m distance from the measurement point. The
best measurement location was defined by echocardiography. In the pacemaker patients, the pacemaker was temporarily inhibited to reveal a higher degree AV-block. The
equivalent of the PR interval was analyzed and the accuracy
calculated. In addition, in two subjects, the feasibility to
acquire a VCG signal through a cotton shirt was evaluated.
Results: A reliable VCG signal could be recorded in all
subjects and patients. The induced third-degree AV blocks
in the pacemaker patients showed in the VCG a clear atrial
and ventricular signature. The M-wave was traceable even
during sinus rhythm or fusion beats. To prove the reliability
of the PR interval of the VCG, 20 repetitive heart beats of
every subject were analyzed. The PR interval of the VCG
could be determined with an uncertainty of 13.66.5 ms.
Although the VCG through the cotton shirt was lower in
amplitude, it presented with the equivalent information.
Conclusion: The VCG recorded from a thoracic point enables a reliable non-contact monitoring of the heart rhythm.
277
The PR interval can be detected with an accuracy of >90 %

which allows a reliable detection of AV block of all degrees.
The VCG signal can be recorded even through a cotton
shirt. Therefore, the IR-LDV technology suits well for routine clinical applications.
1415 Abstract 0514
SENSITIVITY OF OPTICAL MAPPING PHASE DYNA

MICS TO POST-PROCESSING PARAMETERS
INCLUDING LOW-PASS FILTER CUTOFF
FREQUENCY AND SPATIAL BINNING
Caroline H Roney1, Chris D Cantwell1, Michael T Debney1,
Norman A Qureshi1, Prapa Kanagaratnam1, Jennifer H
Siggers1, Nicholas S Peters1, Fu Siong Ng1
1
Introduction: During fibrillation, the observed activation
patterns depend critically on the post-processing techniques applied. In this study, we examined the sensitivity
of wavefront dynamics observed in optical mapping data to
the choice of filtering and post-processing parameters
used. Methods: Complex arrhythmia wavefront dynamics
were analysed for an optically mapped canine cholinergic
atrial fibrillation preparation. The following parameters
were varied, either individually or in combination: spatial
bin size for voltage, low-pass filter, and spatial bin size for
phase. The following were calculated: dominant frequency
(DF), number of phase singularities (PSs) by duration, spatial distribution, maximum duration, and mean duration of
PSs. Results: Low-pass filtering at 100 % of DF removed
physiological frequencies, whilst 200 % resulted in more
PSs and a decrease in the ability of the algorithm to track
longer lasting PSs. For filter choices of 125175 % of DF,
heat maps correlated well (r>0.8). Voltage and phase bin
sizes had a larger effect than filter settings on the number
of PSs (Fig) and were not independent; binning each at 5
5 led to a larger number of PSs than at 99 (13.9 vs 5.5 per
frame), which were short lived (1.2 vs 1.4 per frame
>50 ms). Bin sizes of 99 were found to be sufficient to
identify true PSs, without over-smoothing the data. Mean
duration increased for larger bin sizes as PSs became easier
to track (17.316.6 vs 20.819.5 ms, 55 vs 99). Conclusion: The total number of PSs was most affected by
changes in spatial binning of voltage and phase, with an
increase in false-positive PSs for small bin sizes, which
reduces the ability of the algorithm to track PSs faithfully.
DF maps were more affected by filter settings than by
voltage bin size. These findings indicate that careful consideration is required for choice of post-processing
parameters.
1416 Abstract 2810
FIRST APPLICATION OF A NOVEL, MULTI-SITE,

HIGH-RESOLUTION EPICARDIAL, MAPPING
APPROACH
Natasja de Groot1, Ameeta Yaksh1, Charles Kik1, Paul
Knops 1, Frans Oei 1, Pieter van de Woestijne1, Maurits
Allessie1, Ad Bogers1
1
Erasmus Medical Center, Rotterdam, Netherlands
Background: Based on the premise that atrial fibrillation (AF)
can be eliminated by ablation of either the trigger or the substrate perpetuating AF, it is expected that multi-site high-density mapping is a suitable tool to diagnose AF thereby
allowing individualization of AF treatment. The goal of this
study was to assess the feasibility and safety of a new highresolution epicardial mapping approach of the entire atria for
assessment of the degree and extension of electropathology as
a routine procedure during cardiac surgery. Methods: Epicardial mapping (128/192 electrodes; inter-electrode distance
2 mm) was performed in 291 patients (218 male, age 66
11 years) undergoing elective surgery during sinus rhythm
(SR) and (induced) AF. A temporary bipolar epicardial pacemaker wire stitched to the right atrial free wall served as a
temporal reference electrode and a steal wire fixed to subcutaneous tissue of the thoracic cavity as an indifferent electrode.
Fixed rate pacing at the right atrial free wall was applied on a
different temporary bipolar pacing wire in order to induce AF.
Total duration of the mapping procedure was defined as time
between onset of the preparation process until the end of the
last recording. Electro-physiological parameters within mapping quadrants covering the entire atrial epicardial surface
were quantified and designated to anatomical quadrants of
1 cm2. Results: Total mapping time during SR or AF was,
278
respectively, 31 and 42 min. Hemodynamic parameters

(mean arterial pressure (MAP), right atrial pressure (RA),
BIS score, ST-T segment alterations) before and during SR
mapping were comparable (P<0.22). During AF, only MAP
(7111 vs 6710 mmHg (p<0.004)) and RA (104 vs 11
4 mmHg (p<0.0001)) decreased. Beat-to-beat variation of SR
cycle length and peak-to-peak amplitude of unipolar potentials was, respectively, 0.0414.42 ms and 0.010.53 mV,
reflecting stability of the mapping array. Complications were
not observed. Conclusion: our novel intra-operative epicardial
atrial mapping approach allows determination of the degree
and extension of electropathology and can be safely applied
during both SR and AF. This mapping approach is the first
technique allowing identification of the arrhythmogenic substrate in the individual patient thereby taking the first step
towards personalizing treatment of AF.
patients (men=10, women=2) with a mean age of 6212 years

(range 42 to 80 years) were included in this study. Pulmonary
vein isolation was successfully achieved in all 48 treated PVs and
sustained bidirectional CTI conduction block obtained in all patients. Mean number of cryoapplications per patient was 8.20.6
(range 8 to 10). Mean procedure duration and radioscopy exposure were 8229 min (range 60 to 165 min) and 227 min
(range 12 to 31 min), respectively. The reported ablation protocol
of combined paroxysmal AF and typical AFL did not result in
prolongation of the procedure duration or in prolonged radiation
exposure when compared to CB-PVI alone. No interferences
between both ablation energy systems were observed. ConclusionsThese preliminary results suggest that combined paroxysmal AF and typical AFL can be successfully and safely ablated
using hybrid energy sources with simultaneous CTI ablation
using RF during CB applications at the PV ostia. PV pulmonary
vein, CB cryoballoon, CTI cavotricuspid isthmus, RF radiofrequency, LA left atrium
Poster session B part 2

Presenters and chairpersons present from 03:30 PM to
5:00 PM
05:30 PM Atrial fibrillation ablation
PV-CB ablation/
CTI RF
PV-CB
ablation
p value
Age (years)
6212
6111
0.79
LA diameter (mm)
416
405
0.94
Procedure duration (min)
8229
7924
0.76
Radiation exposure (min)
227
2010
0.51
Nb. of CB applications
8.20.6
8.41.0
0.65
1417 Abstract 1539

1418 Abstract 1530
SIMULTANEOUS PULMONARY VEIN
CRYOABLATION AND CAVOTRICUSPID ISTHMUS
RADIOFREQUENCY ABLATION IN PATIENTS
WITH COMBINED ATRIAL FIBRILLATION AND
TYPICAL ATRIAL FLUTTER
FEASIBILITY AND SAFETY OF NURSE-DIRECTED

DEEP SEDATION
Michael Peyrol , Pascal Sbragia , Thibault Ronchard ,

Jennifer Cautela1, Chlo Villacampa1, Marc Laine1, Laurent
Bonello1, Franck Thuny1, Franck Paganelli1, Samuel Lvy2
1
CHU Nord, Marseille, France; 2Aix-Marseille Universit,
Marseille, France
Laura Varotto1, Mehdi Namdar1, Franois Mattey-Prvot1,

Jacques Lyvet 1, Dominique Marcelot 1, Alain-Stphane
Eichenberger1, Pascale Gentil-Baron1, Henri Sunthorn1,
Haran Burri1, Dipen Shah1
1
Hpitaux Universitaires de Genve, Service de Cardiologie,
Geneva, Switzerland, Geneva, Switzerland
PurposePulmonary vein isolation (PVI) using cryoballoon

(CB) technique and cavotricuspid isthmus (CTI) ablation using
radiofrequency (RF) are established interventions for the management of paroxysmal drug-resistant atrial fibrillation (AF) and
typical atrial flutter (AFL). Whether simultaneous delivery of
cryoenergy at the PVs using the CB technique and RF energy
at the CTI is feasible and safe is still to be demonstrated.
MethodsConsecutive patients with combined paroxysmal
AF and typical AFL were prospectively included in the present
study and underwent simultaneous delivery of RF energy at the
CTI during CB applications at the PVs ostia. ResultsTwelve
Introduction: Benzodiazepines and opiate boluses are currently widely used for catheter ablation of atrial fibrillation (AF).
However, patient comfort, compliance and prolonged immobility are difficult to manage with conscious sedation. Therefore, we aimed to determine the feasibility and safety of deep
sedation with propofol/fentanyl infusion directed by specialized nurses in patients undergoing an AF ablation procedure.
Methods: Three nurses of our catheterization laboratory completed training for inducing and managing deep sedation under supervision of experienced anesthesiologists in patients
undergoing AF ablation procedures. The training included a
theoretical knowledge base (42 h) and a practical part (2 h)

using a simulator for ventilator and basic life support and
finally a practical exam during an ablation procedure, after
which the nurses were institutionally certified to manage deep
sedation without ventilatory support in selected low-risk
(ASA classes I and II) patients undergoing AF ablation procedures with supervision of the operator, if needed. After an iv
propofol bolus, maintenance of sedation was achieved with
continuous iv administration of propofol. Heart rate, arterial
blood pressure, and oxygenation were continuously monitored. Feasibility and safety aspects of this approach were
analyzed and scores (010) for pain, patient and operator satisfaction were assessed after the procedure. Results: A total of
68 consecutive patients (5513 years, range 1876 years)
were included in this analysis. Mean total sedation time was
17955 min (range 45300 min), mean total administered
dosages of propofol and fentanyl 281140 mg (range 0
680 mg) and 27393 g (range 75650 g), respectively.
Mean scores for pain, patient and operator satisfaction were
5.52 (range 010), 9.10.9 (range 510) and 9.10.7 (range
710), respectively. No correlations were found between the
assessed parameters. No sedation-related complications occurred during the procedures, minor incidents without the
need of further anesthesiologic interventions included nausea
(1), apnea >10 s, but <30 s (2), oxygen desaturation <95 %
<30 s (2) and hypotension corrected by minor doses of vasopressors (2). Conclusion: Deep sedation without assisted
ventilation directed by specialized nurses for AF ablation procedures in selected low-risk patients is feasible and safe; results in excellent patient and operator satisfaction and should
be more widely used.
279
was 62.510.4 years, and the prevalence of paroxysmal,

persistent and long-standing (LS-persistent) AF was 37.6,
11.2 and 51.2 %, respectively, with a median AF duration
of 60 months. Mean left atrial antero-posterior diameter
was 48.68.6 mm. Results: The procedure was successfully accomplished via an endoscopic approach in all patients
except one requiring conversion to mini-sternotomy. Hospital mortality was 0 % and no major complications occurred during the post-operative hospital stay except for a
thromboembolic event occurring in 2 patients (1.6 %).
Multivariate Cox regression analysis identified longstanding persistent AF (OR 9.5; CI=2.535.4; p=0.001)
and female gender (OR 3.03; CI=1.068.7; p=0.039) as
independent risk factors for AF recurrence; instead, paroxysmal AF was associated with improved rhythm outcomes
(OR 0.12; CI=0.040.36; p<0.001). At a median followup of 60 months, overall stable sinus rhythm was achieved
in 79.2 % (99/125 patients) (paroxysmal 91.5 %, 43/47
patients; persistent: 78.6 %, 11/14 patients; LS-persistent:
70.3 %, 45/64 patients); Finally, there was a trend towards
the stabilization of rhythm over the follow-up time, as
depicted by Spearman analysis showing a positive correlation among sinus rhythm restoration and follow-up duration (rho=0.82). Conclusion: Totally endoscopic AF surgical ablation (box lesion) is a safe and effective procedure
providing excellent and stable results over time at longterm follow-up. Rhythm outcomes in patients with LSpersistent AF may be further improved with an integrated
hybrid approach.
1420 Abstract 1514
1419 Abstract 1531
MINIMALLY INVASIVE SURGICAL ABLATION FOR

STAND-ALONE ATRIAL FIBRILLATION IS
ASSOCIATED WITH EXCELLENT OUTCOMES AT
LONG-TERM FOLLOW-UP
Gianluigi Bisleri1, Fabrizio Rosati1, Lorenzo Di Bacco1,
Claudio Muneretto1
1
University of Brescia Medica School, Brescia, Italy
Background: Minimally invasive surgical treatment of atrial fibrillation (AF) has gained popularity during the past
decade; however, there is paucity of data about the longterm outcomes of this novel approach. Methods: Study
population included 125 consecutive patients undergoing
stand-alone surgical treatment of atrial fibrillation via a
closed-chest, right-sided monolateral thoracoscopic approach (box lesion set) by means of a versapolar (combining uni/bipolar) radiofrequency ablation device. Mean age
TIME COURSE OF LUMINAL ESOPHAGEAL TEMP

ERATURE DURING SECOND-GENERATION
CRYOBALLOON ABLATION: COMPARISON OF
THE 23- AND 28-MM BALLOON
Benedikt Bunz1, Florian Straube1, Uwe Dorwarth1, Martin
Schmidt1, Michael Wankerl1, Stephen Howard2, Stefan
Hartl1, Hans Ullrich Ebersberger1, Ellen Hoffmann1
1
Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal
Hospital Group, Munich, Germany; 2Medtronic Inc., Mounds
View, MN, USA
Background: Second-generation cryoballoon (CB) ablation
attains high rates of acute pulmonary vein isolation (PVI)
within a significantly faster and less complex procedure compared to first-generation CB. Thermal esophageal lesions were
reported with the 28-mm CB. Currently, there exist no data
concerning the time course of luminal esophageal temperature
(LET) comparing the 23- and 28-mm CB. The aim of this
280
prospective, observational study is to determine the differences between the 23- and 28-mm CB regarding the LET
during CB ablation. Methods: Thirty consecutive patients
with paroxysmal or persistent atrial fibrillation underwent
CB PVI. The 28-mm, 23-mm, or both balloons were applied
with respect to the LA/PV-anatomy as determined by preprocedural cardiac imaging. Standard freezing time was
180 s with an additional bonus freeze after PVI. LET was
continuously recorded during the whole procedure. Prespecified cutoff value for premature termination of a
cryoapplication was a LET +15 C. Esophagoscopy was
planned in case of symptoms suggestive for esophageal lesions. Results: In total, 395 freeze cycles were applied in
125 veins, 149 (38.0 %) with the 23 mm and 246 (62.0 %)
with the 28 mm CB. PVI was achieved in 100 % of the veins.
Premature termination of the freeze cycle because of low LET
occurred only during ablation of the inferior pulmonary veins.
None of the patients developed symptomatic esophageal
lesions. Minimal LET (median) was 35.3 (14.236.4) C
with the 23-mm CB and 35.4 (12.836.7) C with the
28-mm CB, p=0.30. In subgroup analysis of the pulmonary veins, there was no significant difference either. The
freeze time after which LET started to drop showed a
positive correlation to minimal LET, p=0.001. LET drop
within 25 s predicted a LET +15 C with the
highest sensitivity (83 %) and specificity (92 %) in
ROC curve analysis. Conclusion: Low LET +15 C
occurred rarely with both balloon sizes and was without
statistical significance. Moreover, no symptomatic esophageal lesions were reported. CB ablation following an
individualized anatomic approach seems to be equally
safe with either the 23- or the 28-mm CB concerning
the LET. LET drop within 25 s predicts a minimal
LET +15 C with a high sensitivity and specificity.
with atrial fibrillation (AF). Objective: The purpose of

this study was to explore the effects of elevated LAP
on pathophysiology and clinical outcome after radiofrequency catheter ablation (RFCA) in patients with AF.
Methods: We measured LAP during both sinus rhythm
(SR) and AF in 454 patients (76.7 % male, 5811 years
old, 71.8 % paroxysmal AF) who underwent RFCA, and
compared LAPv-wave (LAPpeak) and LAPy-wave
(LAPnadir) with imaging (echocardiography and CT),
electrophysiologic mapping (NavX), and clinical data.
In 280 patients, pulmonary vein (PV) diastolic flow velocity was measured during SR by trans-esophageal
echocardiography. Results: 1. Patients with LAPpeak
(SR) 19 mmHg had greater LA dimension (p<0.001),
LA volume index (p=0.003), and E/Em (p=0.001), and
reduced LA voltage (p<0.001) and S (p=0.006) compared to those with low LAPpeak (SR). 2. High
LAPpeak (SR) was an independently associated with anterior LA volume (B = 0.381, 95 %CI 0.1690.593,
p < 0.001) and low LA voltage (B = 0.022, 95 %CI
0.0300.013, p<0.001). 3. PV diastolic flow velocity
(B = 0.161, 95 %CI 0.0830.239, p < 0.001) and E/Em
(B = 0.430, 95 %CI 0.0960.763, p= 0.012) were independent, non-invasive parameters associated with high
LApeak(SR). 4. During 13.16.0 months of follow-up,
high LAPpeak(SR) was an independent predictor for
clinical recurrence of AF (HR 1.887, 95 %CI
1.0633.350, p=0.028). Conclusions: Elevated LAP was
closely associated with electroanatomical remodeling of
the LA and was an independent predictor for recurrence
after AF ablation. PV diastolic flow velocity and E/Em
can be utilized as a non-invasive parameter predicting
high LAPpeak(SR) in patients with AF.
1422 Abstract 1824
1421 Abstract 1510
HIGH LEFT ATRIAL PRESSURES ARE

ASSOCIATED WITH ADVANCED ELEC
TROANATOMICAL REMODELING OF LEFT
ATRIUM AND INDEPENDENT PREDICTORS FOR
CLINICAL RECURRENCE OF ATRIAL
FIBRILLATION AFTER CATHETER ABLATION
ASSESSMENT OF BMI AND HEMODYNAMIC PARA

METERS IN AF PATIENTS UNDERGOING
PULMONARY VEIN ISOLATION
PROCEDURESPOTENTIAL IMPACT ON
PROCEDURAL PARAMETERS AND AF
RECURRENCE
Junbeom Park1, Boyoung Joung1, Jae-Sun Uhm1, Chi Young

Shim1, Moon Hyoung Lee1, Hui-Nam Pak1
1
Johannes Siebermair1, Stefan Sattler1, Eva Klocker1, Lucia

Olesch1, Samira Saraj1, Ina Klier1, Christoph Schuhmann1,
Sebastian Clauss1, Moritz Sinner1, Stefanie Fichtner1, Stefan
Kb1, Heidi L. Estner1, Reza Wakili1
1
Medical Department I, KlinikumGrosshadern Munich,
University of Munich, Munich, Germany
Background: The clinical significance of left atrial pressure (LAP) has not yet been clearly elucidated in patients
INTRODUCTION: Pulmonary vein isolation (PVI) is an

established therapy option for atrial fibrillation (AF)
treatment. Hemodynamic parameters and body mass index (BMI) have recently been investigated in these patients in regard to potential impact on electrophysiological properties. The objective of this study was to assess
hemodynamic parameters, BMI, procedural parameters
of patients undergoing PVI for AF treatment to evaluate
potential correlations to procedural parameters and clinical outcome. METHODS: We studied a cohort of 302
patients undergoing PVI for treatment of AF (141/302
paroxysmal AF, 161/302 persistent AF, mean age 63
11) over a mean follow-up (FU) period of 254
178 days. Left atrial (LA) diameter, left ventricular
end-diastolic pressure (LVEDP) and LA pressure were
measured invasively prior to ablation. In addition, total
procedure time, cumulative radiation dose and body
mass index (BMI) were assessed. Clinical outcome
(freedom from AF) was determined 3, 6 and 12 months
post PVI by interview and 7d Holter ECG. RESULTS:
Our analysis revealed significant higher LA diameter
and LA pressure values in patients with persistent AF
vs. paroxysmal AF (median LA 40 mm [29;64], LA
pressure 16 mmHg [5;32] in paroxysmal, and median
LA 42 mm [20;57], LA pressure 18 mmHg [5;40], respectively). LA pressure was independently associated
with LA diameter and cumulative radiation dose (r =
0.183/p<0.029 and r=0.266/p<0.005, respectively). Furthermore, BMI showed a correlation to LVEDP and LA
pressure prior ablation (r=0.176, p<0.05 and r=0.275,
p < 0.005, respectively). BMI per se was significantly
positively correlated with longer cumulative procedure
time (p = 0.029), while BMI > 26 kg/m2 and persistent
AF and were independently predictors of longer cumulative procedure times (p=0.03 and p=0.01, respectively). Interestingly, only elevated LA pressures >17 mmHg
(median) during PVI were associated with an impaired
clinical outcome with respect to freedom from AF during FU (low LA pressure 77 % vs. high LA pressure
52 %, respectively). However, BMI and other hemodynamic parametersdid not show any positive correlation
in regard to AF recurrence. CONCLUSION: LA diameter and LA pressure are elevated in patients with persistent AF. BMI>26 and persistent AF seem to be predictive in regard to procedural complexity, however
without prediction on short-term ablation outcome in
the studied collective. LA pressure was the only parameter being predictive for mid-term clinical outcome after
PVI. Further studies are required to elucidate the potential value of hemodynamic parameters and BMI in defining treatment strategies for AF patients.
281
1423 Abstract 1815
LONG-TERM EFFICACY OF PULMONARY VEIN

ANTRUM ISOLATION ALONE IN ATRIAL
FIBRILLATION ABLATION, A SINGLE CENTER
COHORT STUDY.
Cas Teunissen1, Jeroen vd Heijden1, Rutger Hassink1, Wil
Kassenberg1, Rolf Brummel1, Peter Loh1
1
Utrecht Medical Center Utrecht, Utrecht, Netherlands
Introduction: Pulmonary vein antrum isolation (PVAI) is
a well-established treatment option in patients with
symptomatic, drug refractory atrial fibrillation (AF).
There is an ongoing discussion on whether and when
to add substrate modification to PVAI, especially in
(longstanding) persistent AF. Long-term follow-up studies of PVAI alone as a primary ablation strategy are
limited. Objectives: The study aims to evaluate the
long-term efficacy of PVAI alone as a primary ablation
strategy in all patients independently from the nature of
AF and to assess predictors of arrhythmia recurrence.
Methods: From January 2005 to March 2011, 509 consecutive patients (mean age 57 years, 61.1 % paroxysmal AF, 25.5 % persistent AF and 13.4 % longstanding
persistent AF) suffering from symptomatic, drug refractory AF underwent PVAI in the University Medical
Center Utrecht. In redo procedures, pulmonary veins
(PVs) were checked for reconnection. In case of PV
reconnection, ablation was restricted to re-PV isolation
without substrate modification. If the PVs were found to
be isolated, substrate modification was performed. The
mean follow-up duration after the first and last ablation
was, respectively, 66 and 55 months. Results: In total,
774 procedures were performed. After a single procedure, PVAI was sufficient in restoring and maintaining
sinus rhythm in 41.3 % (n=210). Success increased to
62.5 % (n=318) after multiple procedures (mean 1.5).
In 93.4 % of these 318 patients, success was reached by
PVAI alone. Five percent of the recurrences after PVAI
were based on left-sided atrial flutter (AFl) or atrial
tachycardia (AT). Independent predictors for arrhythmia
recurrence after the last ablation were persistent and
long-standing persistent AF (figure), female sex, hypertension and AF-duration. Conclusion: Long-term freedom of atrial arrhythmia can be achieved by PVAI
alone in a substantial number of patients suffering from
AF. Left-sided AFl an AT were a rare finding during
follow-up. This argues for a restrained primary
approach.
282
1424 Abstract 1818

SAFETY OF THE 56-HOLE OPEN IRRIGATION
ABLATION CATHETER IN PULMONARY VEIN
ISOLATION FOR ATRIAL ABLATION
Wahaj Aman1, Mohamed Bassiouny1, Ayman Hussein1, John
Rickard2, Khaldoun Tarakji1, Bryan Baranowski1, Thomas
Callahan1, Mandeep Bhargava1, Thomas Dresing1, Mohamed
Kanj 1, Patrick Tchou 1, Bruce Lindsay1, Walid Saliba 1,
Oussama Wazni1
1
Cleveland Clinic, Cleveland, OH, USA; 2John Hopkins,
Baltimore, MD, USA
Introduction: Data regarding the safety of use the 56hole open irrigation radiofrequency (RF) ablation catheter (Thermocool SF, Biosense-Webster, Diamond Bar,
CA) in pulmonary vein isolation (PVI) are controversial
with recent reports of higher incidence of fatal atrialesophageal fistulas and acute cardiac tamponade. Our
study reports on the acute procedural outcomes of PVI
using the 56-hole catheter in a high-volume center.
Methods: Data from all consecutive PVI performed
using the 56-hole, 3.5 mm, open-irrigation, radiofrequency ablation catheter between June 2012 and June
2014 were analyzed for complications. All four pulmonary veins were isolated guided by fluoroscopy, 3D
navigation, and intracardiac echocardiography. RF delivery was power-controlled with up to 30 W along the
posterior wall and 40 W elsewhere. Esophageal temperature was continuously monitored and RF was
discontinued if temperatures above 39 C or with rapid
rise. Results: Four hundred sixty-six patients underwent
PVI, 108 females (23 %), with a mean age of 62.6
10.0 years, paroxysmal AF in 195 (42 %), persistent AF
in 269 (58 %), and AFL in 2 (0.4 %). The median AF
Duration since diagnosis was 48 months (IQR 24, 96);
mean LVEF was 55.19.8 %. Mean CHA2DS2-VASC
was 2.11.5, CAD 93 (20 %), CHF 101 (22 %), DM
54 (12 %), HTN 252 (54 %); TIA/Stroke 49 (11 %),
age 65, 221 (47 %), age 75, 48 (10 %). Average
procedure time was 24277.3 min and radiation exposure was 0.510.36 Gy. Ninety-nine cases (21 %) were
done under general anesthesia. Thirty-day complications
included four pericardial effusions (0.9 %): acute
tamponade in three (0.6 %),and mild-moderate pericardial effusion requiring no intervention in one (0.2 %),
one ischemic stroke (0.2 %), and seven groin hematoma
(1.5 %). On long-term follow-up, moderate to severe
PV stenosis occurred in nine patients (1.9 %). There
were no atrio-oesophageal fistulae and no deaths. Conclusion: PVI using the 56-hole open-irrigation ablation
catheter was not associated with excess complication on
short and long-term follow-up.
1425 Abstract 1535
CLINICAL 1-YEAR EXPERIENCE WITH A NOVEL

MULTIPOLAR IRRIGATED ABLATION CATHETER
IN AF ABLATION PROCEDURES
Reza Wakili1, Johannes Siebermair1, Eva Klocker1, Stephanie
FIchtner1, Stefan Sattler1, Moritz F. Sinner1, Lucia Olesch1,
Samira Saraj1, Christoph Schuhmann1, Stefan Kb1, Heidi
Estner1
1
Medizinische Klinik und Poliklinik I, Grosshadern Clinic,
University of Munich, Munich, Germany
Introduction: Pulmonary vein isolation (PVI) is an
established method to treat atrial fibrillation (AF). However, PVI is still a time-consuming procedure. Thus, new
methods are necessary to improve procedural parameters.
A novel multipolar irrigated radiofrequency (RF) ablation
catheter is a new tool trying to improve PVI procedures by
generating more effective lesions in a short time. In this
study, we investigated the influence on procedural parameters using a multipolar irrigated ablation catheter (MIAC).
Methods: We investigated 48 consecutive patients with AF
undergoing PVI, two groups: (1) n=24, standard ablation
catheter (SAC, Thermocool Biosense Webster), and (2)
n=24, MIAC (nMARQ Biosense Webster). Procedural
endpoint (PE): complete electrical isolation of all PVs.
Study endpoints were left atrial (LA) procedure time (PT),
fluoroscopy time (FT), radiation dose (RD), RF time, percentage of dormant PV conduction (adenosin), number of
energy applications (EA) and clinical outcome. In all MIAC
patients, an additional confirmation of PV disconnection
was performed by a separate circular mapping catheter
(CMC). All MIAC patients underwent periprocedural
phrenic nerve stimulation, esophagus temperature monitoring, and endoscopy post PVI for safety assessment. Results:
Patient characteristics did not differ significantly between
both groups. PE was reached in all patients in the SAC
group. However, in the MIAC group in >50 % (13/24) of
all patients, PE of PV disconnection, suggested by the
MIAC mapping, could not be confirmed with the CMC.
Despite further MIAC ablation PE could still not be
achieved in 5/24 patients. Mean FT, RD, LA PT or PV
dormant conduction did not differ between both groups.
However, number of EA (20 1 vs. 29 4, p < 0.05) and
cumulative RF time (16 1 vs. 24 5 min, p < 0.001) to
achieve PVI were significantly lower in MIAC group vs.
SAC. Analysis of clinical outcome revealed no differences
meanbetween both groups (freedom from AF MIAC 85 %
vs. SAC: 76 %, mean follow-up of 263131 days). Regarding safety, one catheter charring event, one phrenic nerve
injury (despite prophylactic stimulation), and one thermal
283
esophageal lesions was observed in the MIAC group. Conclusions: In our small cohort, ablation with MIAC, under
phrenic nerve and esophagus temperature monitoring, seems
to still bear a potential for complications along with important
device related limitations to successfully assess and achieve
PV disconnection. Furthermore, ablation with MIAC failed to
show significant benefits regarding relevant procedural parameters or clinical outcome compared to a SAC cohort.
1426 Abstract 2819
EARLY CLINICAL EXPERIENCE WITH THE RHYT

HMIA 3D MAPPING SYSTEM: RAPID, AUTOMATIC,
ACCURATE, HIGH-DENSITY MAPPING OF
COMPLEX ARRHYTHMIAS FACILITATES
SUCCESSFUL ABLATION
Markus Sikkel1, Vishal Luther2, James Harrison1, Louisa
Malcolm-Lawes1, Sajad Hayat1, Fu-Siong Ng2, Ian Wright1,
Norman Qureshi2, Kevin Leong2, Nicholas Linton1, Michael
Koa-WIng1, David Lefroy1, Phang Boon Lim1, Zachary
Whinnett2, Nicholas Peters2, Prappa Kanagaratnam1, D Wyn
Davies1
1
Imperial NHS Healthcare Trust, London, UK; 2 Imperial
College, London, UK
INTRODUCTION: Current 3D electroanatomical mapping
systems offer limited point density and attaining highresolution activation maps is time consuming. The new
Rhythmia mapping system circumvents these issues using a
small 64-electrode roving basket array catheter and automation of mapping. This study presents our initial experience.
METHODS: Seven patients (714.7 years, five male) were
mapped using Rhythmia. System performance was assessed
by: time taken to map the arrhythmia, number of mapping
points collected, requirement for manual correction and contribution to successful ablation. RESULTS: The LA was
mapped in four patients (for recurrent PAF/AT post-AF ablation), the RA was mapped in two patients (for focal para-AV
nodal AT/typical atrial flutter) and the LV was mapped in one
patient (for post MI VT). Mean procedure time was 187
70 min and fluoroscopy time was 3321 min; 12,1525959
points were collected per map over 18.612 min (948516
beats, at a rate of 13.89.5 points per second). Chamber volume was 11744 cm3 giving an approximate point density of
11574 points/cm2 (assuming sphericity). The system guided
successful re-isolation of PVs using the basket to map PV
activation. It demonstrated a gap in a WACA around the RPVs
allowing re-isolation with two adjacent RF applications (Figure). When differential pacing had shown CTI conduction
block, it demonstrated persistent, slow concealed CTI conduction directing further successful ablation. CONCLUSION:
284
Early experience of the Rhythmia mapping system is of a

versatile and accurate 3D mapping system rapidly creating
high-density maps that facilitate ablation of complex

arrhythmias.
1427 Abstract 2818
Methods: We studied 17 AF patients at ablation (age 58 years,

persistent 54 %) with transitions to AT. From 64 pole baskets
(Boston Scientific) and the ECG, we measured 3-dimensional
spatial and temporal periodicity in AF at 15, 10, 5, 3 and 1 min
prior to AT (defined clinically) using sliding-correlation spatial loops and width of the Fast-Fourier spectral dominant
frequency using custom software (Labview). Results: Spatial
organization of AF occurred minutes before onset of AT
(predominantly left atrial), on ECG (p<0.05, fig A). Temporal organization occurred later. Fig B shows spatial variability 10 min before AT, but spatial consistency 1 min
prior to AT (fig C). This anticipatory organization was
most marked in the XY plane (p<0.05). Intra-cardiac leads
showed less consistency throughout ablation and were
more sensitive to actual AT location. Conclusions: During
ablation, AF shows anticipatory organization even before
termination to AT, first spatially then temporally. Studies
should determine if ablating in regions causing anticipatory
organization better eliminates AF, and whether this may
form the basis for a quantitative classification separating
AT from AF.
DOES ATRIAL FIBRILLATION ORGANIZE SPAT

IALLY OR TEMPORALLY BEFORE TERM
INATION? CONTINUOUS TRACKING OF SPAT
IO-TEMPORAL PERIODICITY DURING ABLATION
Junaid Zaman1 , Rishi Trikha 1 , Tina Baykaner 2 , David
Krummen 2 , Paul Wang 1 , Wouter-Jan Rappel 2 , Sanjiv
Narayan1
1
Stanford University, Stanford, CA, USA, 2University of
California, San Diego, San Diego, CA, USA
Introduction: During ablation, organized atrial fibrillation
(AF) is sometimes difficult to separate from macro-reentrant
tachycardia (AT) that may vary in rate or exit sites. Mechanistically, this distinction may define fibrillatory conduction, and
clinically, it directly impacts entrainment or ablation. We hypothesized that organization of AF to AT initiates spatially,
with later elimination of rate fluctuations, and tested if it can
be tracked from ECG or intracardiac leads during AF ablation.
285
cardioversion at the end of procedure in all patients. Mathematical phase. Ablation formatting (corresponding to linear ablation) transformed 6-wave re-entry to 4-wave re-entry. Following
mathematical simulation of cardioversion effectively terminated
4-wave AF, whereas did not terminate 6-wave re-entry AF.
Conclusion: (1) Mathematical modeling of 6-wave re-entry
and linear ablation formatting may simulate long-lasting persistent AF and subsequent AF organization due to antral and linear
ablation. (2) Transformation of 6-wave re-entry to 4-wave reentry with following AF termination after cardioversion may
be effective ablation end-point recording tj mathematical
approach. Our clinical results are consistent with ablation formatting data.
1429 Abstract 0513
1428 Abstract 0120
MIGHT CARDIOVERSION BE THE END-POINT FOR

RADIOFREQUENCY ABLATION OF
LONG-LASTING PERSISTENT ATRIAL
FIBRILLATION PATIENTS: EXTRAPOLATION OF
MATHEMATICAL MODELING DATA TO CLINICAL
RESULTS OF ABLATION
Andrey Ardashev1, Mikhail Mazurov2, Yury Belenkov3, Ilia
Kolodyazhny2, Vasily Finko1, Evgeny Zhelyakov1
1
Federal Scientific and Clinical Centre of FMBA, Moscow,
Russia; 2Moscow University of Economic, Statistic and Informatic, Moscow, Russia; 3 Lomonosov State University,
Moscow, Russia
Aim: The study aims (1) to estimate theoretical probability of
existing of 6-wave re-entry as a model of long-lasting persistent
AF and (2) to extrapolate mathematical modeling data to clinical
results of linear ablation in patients with long-lasting persistent
AF. Material and methods: clinical phase. Study was conducted
on consecutive 20 patients (6 women, 58.210.6 years of age)
with long-lasting persistent AF who underwent index RFA. Ablation approach consisted of three steps. The first step was antral
isolation of PVs, the second step included mitral isthmus ablation and the third step was linear roof ablation. We evaluated AF
CL into the CS after each step. Mathematical phase. As the first
step numeric reconstruction of the autowave process in excitable tissues of the LA and the simulation of 6-wave re-entry AF
was performed using Fitzhugh-Nagumo equation. A special
scanning method was used for calculating characteristics of
autowave processes in a 2D mathematical model in LA. Then,
ablation formatting (corresponding to all ablation lines) was
performed. Results: clinical phase. Organization of AF CL
(from 11224 to 20435 ms) was verified in 12 of 20 patients
during ablation. SR was effectively restored after external
THE IMPACT OF CATHETER CONTACT FORCE ON

HUMAN LEFT ATRIAL ELECTROGRAM CHAR
ACTERISTICS IN SINUS RHYTHM AND ATRIAL
FIBRILLATION
Waqas Ullah1, Ross Hunter1, Baker Victoria1, Liang-han
Ling2, Mehul Dhinoja1, Simon Sporton1, Mark Earley1,
Richard Schilling1
1
St Bartholomews Hospital, London, UK; 2Alfred Hospital
and Baker IDI Heart and Diabetes Institute, Melbourne,
Australia
BACKGROUND: During left atrial (LA) mapping, optimal
contact parameters minimizing variation secondary to catheter
contact are not established. METHODS: In patients undergoing first-time ablation for AF, stable mapping points
comprising 8 s of contact force (CF) and bipolar electrogram data were analysed. Points were taken at locations in groups, with CF or catheter orientation actively
changed between acquisitions. This allowed for a paired
analysis to establish the effect of catheter contact on the
electrogram. For points taken in persistent AF patients,
automated complex fractionated electrogram (CFAE),
dominant frequency (DF) and organization index (OI)
analysis were performed. RESULTS: Thirty patients
were studied: 15 with persistent AF and 15 paroxysmal
AF. In total, 1965 mapping points were collected: 1409
in AF and 556 sinus rhythm (SR). Complexes were less
positive at higher CF (Pearsons correlation 0.2,
p < 0.005, both rhythms). Increasing CF at a location
significantly increased complex size, but only where
initial CF was <10 g, and the change was 4.5 g in
SR or 8 g in AF (Table). Atrial ectopics in SR were
observed more frequently when CF was 10 g
(p<0.0005). Increasing CF at a location was associated
with increasing CFAE interval confidence level score,
286
but only if initial CF was <10 g and CF increased 8 g

(p=0.003). The dominant frequency (DF) and organization index (OI) were unaffected by CF (p>0.1 for both).
Changing catheter orientation from perpendicular to parallel was associated with smaller, more positive complexes (p = 0.001 for both), but no change in CFAE
scores, DF or OI (p>0.08 for each).
Rhythm
SR
AF
Initial CF
in a pair
Increase in CF between paired measurements

<4.5 g SR and
<8 g AF
Median change
in complex
size (%)
4.5 g SR
and 8 g AF
Median change
in complex
size (%)
110 g
6 [834]
0.06
13 [1660]
<0.005
10 g
3 [822]
0.28
0.3 [2926]
0.43
110 g
0 [1216]
0.28
6 [1141]
<0.005
10 g
2 [1318]
0.09
0 [1624]
0.12
CONCLUSIONS: During LA mapping, including CFAE

but not spectral parameter mapping, CF and catheter
orientation influence results. Low CF (<10 g) is associated with lower measured electrogram amplitude and
hence reduced apparent fractionation. Mapping CFs
should therefore be 10 g to avoid CF-dependent electrogram variation. Spectral measurements are unaffected
by catheter contact, suggesting this does not significantly impact on the underlying physiology.
1430 Abstract 1556
RADIOFREQUENCY ATRIAL FIBRILLATION

ABLATION USING 3D MAPPING SYSTEM NAVI
GATION: FIRST SINGLE-CENTRE EXPERIENCE IN
NORTH AFRICA.
Sonia Marrakchi1, Azima Ben Tanfous1, Bechir Zouari2,
Abdelatif Lefi1, Hend Keskes1, Afef Ben Halima1, Faouzi
Added1, Ikram Kammoun1, Salem Kachboura1
1
Abderrahmane Mami Hospital, Tunis, Tunisie; 2Tunis
Medical University, Tunis, Tunisia
Background: We report the first single-centre experience in
North Africa with the navigation system in an unselected subset of patients with atrial fibrillation (AF). Methods: Data were
recorded prospectively of all consecutive patients who
underwent atrial fibrillation ablation with radiofrequency and
3D mapping navigation system at the Aberrahman Mami Hospital, in Tunisia, in North Africa, from January 2010 to December 2013. Outcomes were defined every 3 months. Results: A total of 35 patients were included: 80 % had
paroxysmal AF and 17 % had persistent AF and 3 % had

longstanding persistent AF. The mean procedure, fluoroscopy
and ablation times were 2110 min (with extreme 858 min)
and 180 min, respectively. The procedural endpoint of the
study was successfully achieved in 98 % patients. The follow
up was 17.72 months. At a median of 17.72 months followup, 34 % had atrial fibrillation recurrence. Six patients had two
procedures. The mean of procedure was 1.2 per patient.
Seventy-four percent were AF-free off anti-arrhythmic drugs
AADs, and 89 % were AF-free on AADs. Conclusion: The
3D mapping navigation system offers a safe and effective
approach for the treatment of AF in North Africa. There was
a learning curve with regard to fluoroscopy and procedure
time, after which point reduction in radiation exposure and
operator strain, as well as improvement in procedure throughputs were even more pronounced.
Screening athletes
1431 Abstract 0716
ELECTROCARDIOGRAPHIC AND
ECHOCARDIOGRAPHIC EVALUATION OF A
LARGE COHORT OF YOUNG SOCCER PLAYERS
DURING PRE-PARTICIPATION SCREENING.
Annamaria Martino1, Fabio Sperandii1, Emanuele Guerra1,
Elena Cavarretta 2 , Federico Quaranta 3, Attilio Parisi 3 ,
Antonia Nigro2, Luigi Sciarra1, Ermenegildo de Ruvo1,
Antonio Spataro4, Fabio Pigozzi3, Leonardo Calo1
1
Cardiology Department, Policlinic Casilino, Rome, Italy;
2
FMSI Sport Medicine Institute, Villa Stuart Sport ClinicFIFA Centre of Excellence and Department of MedicalSurgical Sciences and Biotechnologies, Sapienza University,
Rome, Italy; 3Department of Health Sciences, University of
Rome Foro Italico, Rome, Italy; 4Institute of Sports Medicine and Science (CONI), Rome, Italy
Background. The early diagnosis of cardiac abnormalities in
young athletes may be helpful not only to identify subjects
potentially at risk of sudden cardiac death but also to prevent
evolution towards cardiac dysfunction. The aim of our study
was to investigate the prevalence of cardiac abnormalities in a
population of young male soccer players undergoing preparticipation screening (PPS) through ECG and transthoracic
echocardiography (TTE). Methods. All consecutive male
football players undergoing PPS in the FMSI Sport Medicine
Institute in Rome, between January 2008 and March 2009,
were enrolled in the study and underwent standardized medical history, physical examination, 12-lead ECG and TTE. Results. The study population consisted of 2261 consecutive
young athletes aged 12.42.6 years. Positive family history
for cardiovascular disease was present in 1.9 % of athletes.

Cardiac symptoms and abnormal physical examination were
present in 1.2 and 0.8 % of the study populations, respectively.
Uncommon and training-unrelated ECG abnormalities and
anomalous TTE examinations were observed in 182 (8 %)
and 102 (4.5 %) athletes, respectively. Abnormal ECG was
associated with anomalous TTE in 11/182 (6 %) cases, including two hypertrophic cardiomyopathy and two mild left ventricular hypertrophy. Among 2079 athletes with normal ECG,
92 cases of cardiac abnormalities at TTE were observed. TTE
abnormalities were associated with pathological ECG in 9/102
(8.8 %) cases. Conclusions. In a wide population of young
male athletes undergoing PPS, the combination of ECG and
TTE allowed the identification of several otherwise
underdiagnosed electrical and structural cardiac abnormalities, requiring sport disqualification in some cases or periodic
follow-ups over time.
Monday, April 20, 2015
Poster session C part 1
10:30 AM
Cardiac resynchronization therapy
287
(RV) pacing. The latest activated regions are reported

in Table 1.
Delay in LAO
Latest activation during

spontaneous rhythm
number of patients
Latest activation
during RV pacing
number of patients
Anterior
10
Antero-lateral
Lateral
8
27
8
18
Postero-lateral
Posterior
8
1
10
0
Delay in RAO
Basal
25
16
Medium
Apical
16
5
15
15
Conclusion. Coronary venous EAM can be used intra procedurally to guide LV lead placement to the latest activated
region. This approach especially contributes to optimization
of LV lead electrical delay in patients with multiple target
veins. Conventional anatomical LV lead placement strategy
does not target the vein with maximal electrical delay in many
of these patients.
152 Abstract 2411
151 Abstract 2426
CARDIAC RESYNCHRONIZATION THERAPY:

LEFT VENTRICULAR LEAD PLACEMENT GUIDED
BY CORONARY VENOUS ELECTROANATOMIC
MAPPING
Massimiliano Maines1, Carlo Angheben1, Massimiliano
Marini2, Alessio Coser2, Domenico Catanzariti1, Maurizio
Del Greco1
1
Santa Maria del Carmine Hospital, Rovereto, Italy; 2Santa
Chiara Hospital, Trento, Italy
Introduction. The implant of cardiac resynchronization
therapy (CRT) devices driven by non-fluoroscopic navigation systems demonstrates how an electroanatomical
mapping of the coronary sinus for the optimization of
the left electrode placement, is feasible. Purpose. The
aim of this study was to evaluate the latest activated
region in coronary sinus (CS) in patients who underwent
CRT devices implant. Methods and results: 46 consecutive CRT patients (38 males, age 72.9 7.3 years)
underwent intra-procedural coronary venous EAM using
EnSite NavX. A guidewire was used to map the coronary
veins during intrinsic activation and right ventricular
ACUTE HEMODYNAMIC MEASUREMENTS AND

CONTACT ACTIVATION MAPPING DURING
MULTIPOINT LEFT VENTRICULAR PACING
Antonello Vado1, Endrj Menardi1, Ballari Gian Paolo1, Guido
Rossetti1
1
Ospedale S. Croce e Carle, Cuneo, Italy
Background. MultiPoint left ventricular (LV) pacing
(MultiPoint Pacing [MPP], St. Jude Medical, Sylmar, CA)
in a single coronary sinus branch has been introduced as a
novel means of cardiac resynchronization therapy (CRT). It
may improve CRT response by capturing a larger LV tissue
area than conventional biventricular (BIV) pacing. We evaluated this new feature by means of contact mapping and hemodynamic measures in order to understand the underlying
mechanisms and effects. Methods. Ten non-ischemic patients
(699 years, 6 males, NYHA class II or III, QRS duration 173
20 ms, LVEF 27 5 %) received a CRT-Defibrillator
(Quadra Assura MP, St. Jude Medical, Sylmar, CA) with
the ability to deliver MPP. After the implantation procedure,
an acute pacing protocol was implemented, including two
BIV configurations, by using a proximal and a distal LV pacing vector and up to nine MPP interventions. In all the pacing
configurations, in addition to QRS duration (QRSd), LV
288
electrical activation patterns and hemodynamics (dP/dtmax)

were evaluated by means of EnSite NavX (St. Jude Medical, St. Paul, MN) and PressureWire CertusTM (St. Jude
Medical, St. Paul, MN), respectively. For each of the parameters analyzed, the best values resulting from the MPP and
BIV pacing configurations were selected and compared. Results. We observed an increase in dP/dtmax (3013 vs. 25
11 %; p=0.041), a reduction in QRSd (2211 vs. 11 %11;
p=0.01) and a decrease in total activation time (TAT) (2515
vs. 10 %20; p=0.01). Furthermore, during the first 25 ms
after pacing, the electrically activated LV portion was greater
during the best MPP configuration (3522 vs. 16 %8; p=
0.005). The MPP wavefront was also faster during the first
50 ms, resulting in the activation of only 6023 % of the
endocardial LV during BIV, versus 7827 % during MPP
pacing (p=0.03). Conclusions; In this acute study, MultiPoint
left ventricular pacing in CRT improved both endocardial and
surface electrical parameters and hemodynamics in comparison with conventional biventricular pacing
MPP group. Conclusions: pts with dilated cardiomyopathy

implanted with biv-ICD and with a good anatomical target
pacing in coronary sinus can improve their NHp after RT.
The benefits are similarly manifest in both groups, this being
the case also for the changes in neurohormonal variables.
Group 1 (10 pts)
Group 2 (8 pts)
Pre-implant
Post-implant
BNP 2865 pg/ml
BNP 420 pg/ml
NE 750 pg/ml
E 92 pg/ml
NE 280 pg/ml
E 47 pg/ml
BNP 2375 pg/ml

NE 813 pg/ml
BNP 370 pg/ml

NE 299 pg/ml
E 89 pg/ml
E 40 pg/ml
154 Abstract 2416
153 Abstract 2412
DISTRIBUTION OF ESOPHAGEAL INTE

RVENTRICULAR CONDUCTION DELAYS IN CRT
PATIENTS AND HEALTHY SUBJECTS
COMPARISON BETWEEN NEUROHORMONAL

PROFILE AFTER IMPLANT OF BIVENTRICULAR
ICD AND PROFILE AFTER BIVENTRICULAR ICD
WITH MULTIPOLAR PACING IN PATIENTS WITH
HEART FAILURE
Johannes Hrtig1, Anna Nagel2, Kirsten Rotter2, Tobias

Haber2, Laura Perez Escobar2, Juraj Melichercik1, Bruno Ismer2
1
MediClin Heart Center Lahr/Baden, Lahr, Germany, 2Peter
Osypka Institute for Pacing and Ablation, Offenburg,
Germany
Domenico Spaziani 1 , Laura Striuli 1 , Roberto Turato 1 ,

Pasquale Gangitano1, Maurizio DUrbano1, Guido Grassi2
1
Ospedale Fornaroli, Magenta, Italy, 2 Universit MilanoBicocca, Milano, Italy
Accurate selection of eligible patients as well as optimal specification of their individual left ventricular electrode position
can increase responder-rate in cardiac resynchronization therapy (CRT). This could be fulfilled preoperatively by selecting
patients characterized by a distinct interventricular conduction
delay and intraoperatively by placing the LV electrode within
a desynchronized left ventricular region. Esophageal left heart
electrogram was proposed (applied) in symptomatic heart failure patients in sinus rhythm or atrial fibrillation, preoperatively, to measure interventricular conduction delay (IVCD), to
justify CRT and to intraoperatively guide the left ventricular
electrode placement. Nevertheless, there is a lack concerning
the distribution of esophageal IVCDs in healthy subjects.
Aims: The study aims to compare the esophageal IVCDs between guideline CRT patients and healthy subjects. Methods:
Esophageal IVCD was measured between onsets of QRS in
surface ECG and left ventricular deflection in the esophageal
left heart electrogram by perorally applied 4 F bipolar electrode (Osypka TOslim) in position of maximum left ventricular deflection using the Biotronic ICS3000 esophageal electrogram feature in 32 consecutive symptomatic heart failure
patients (24 male, 8 female, 66.57.8 years) 1 week after
implantation of CRT systems according to the guidelines. Results were compared with IVCDs of 31 healthy medical
Background: The benefits of resynchronization therapy (RT)

on the functional heart profile are well defined and largely
dependent on a more organized movement of left ventricle.
The RT for heart failure (HF) reduces mortality, hospitalization rate and improves ejection fraction. Also the neurohormonal profile (NHp) after implant of biventricular ICD (bivICD) is improved as documented by the behavior of sympathetic markers such as plasma norepinephrine and epinephrine
(NE/E). The aim of our study was to compare the NHp after
implant of biv-ICD to single polar pacing in coronary sinus or
with new multipolar pacing (MPP) by new catheter St. Jude
Medical. Method: Ten patients (pts) got single polar biv-ICD
and eight pts got MPP. We evaluated their activation profile by
brain natriuretic peptide (BNP) and NE/E before the implant
and after 1 month. All pts were at optimal medical therapy,
sinus rhythm and had a previous hospitalization for HF. Results: In both groups, there were a significant reduction after
1 month of all markers (BNP-NE/E): p\0.05. No significant
differences were seen between single polar biv-ICD group and
engineering students (24 male, 7 female, 21.43.2 years)

volunteered during their Cardiological devices and methods
internship. Results: In the CRT patients with sinus rhythm, left
bundle branch block and QRS width of 168.221.4 ms, we
found IVCDs of 66.718.9 ms with minimum of 37 and maximum of 108 ms. In the healthy students with QRS of 87.8
9.9 ms, IVCDs of 17.43.9 ms with minimum of 11 and
maximum of 23 ms were measured. Between both groups,
esophageal IVCDs differed significantly by p=0.000000.
Conclusions: Esophageal IVCDs differ highly significantly
between CRT patients and healthy subjects. Thus, it could
be used as an additional parameter to characterize ventricular
desynchronization. Guideline CRT was found to be linked
with IVCDs of about 40 ms and more.
155 Abstract 2418
RIGHT VENTRICULAR SEPTAL PACING IN PATI

ENTS WITH RIGHT BUNDLE BRANCH BLOCK,
ELECTRO- AND ECHO-CARDIOGRAPHIC
OUTCOMES
Belal Al Khiami1, Basil Abu-El-Haija1, Omer Iqbal1, Paul
Lindower1, Michael Giudici1
1
University of Iowa Hospitals and Clinics, Iowa City, IA,
United States
BACKGROUND: Cardiac resynchronization therapy (CRT)
has shown improvement in left ventricular (LV) size and function and survival in heart failure patients with reduced LV
ejection fraction (HFrEF) and LBBB. Patients with RBBB,
however, do not have a similar positive response to standard
CRT with an LV lead in a lateral cardiac vein and apical right
ventricular (RV) lead; in fact, they may do worse. We hypothesized that pacing the right ventricular mid-septum (RVS) near
the right bundle minimizes the conduction abnormalities in
RBBB patients and improves biventricular size and function.
METHODS: We studied 78 patients (72 % male, 28 % female;
7411 years old) with RBBB and underwent pacemaker or
ICD implantation for standard indications. Baseline PR interval 206 40 ms, pre-implant QRS duration 147 19 ms.
Active-fixation leads were placed in the right atrium and
RVS. The AV delay was adjusted at the bedside to yield the
narrowest QRS. We reviewed retrospectively baseline preimplant and follow-up post-implant echocardiograms on a
sample of 8 patients with mean follow-up of 384200 days
of RBBB pacing for the following parameters: LV ejection
fraction (LVEF) by method of discs, LV end-systolic and
end-diastolic volumes (LVESV and LVEDV) by biplane
method, RVend-diastolic diameter (RVIDd), mitral and tricuspid regurgitation (MR and TR) by color Doppler, and septal
wall motion abnormalities (WMA) by visual assessment.
289
Results: At the optimal AV delay, QRS duration was 112

20 ms with a mean QRS narrowing of 3420 ms (p<0.001).
In echocardiogram samples, RVIDd significantly decreased
on follow-up (from 382.8 to 353.7 mm, P=0.035), and
septal WMA resolved in 4/5 patients. However, improvement
in LV volume and function was not statistically significant
(P>0.05); (LVEF from 4715.8 to 48.810.1 %; LVESV
from 8160.9 to 65.336.5 ml; LVEDV from 14079.6 to
120.446.7 ml). Overall, there was only mild/trace MR or/
and TR at baseline with no significant difference on follow up.
Conclusion: RVS pacing in RBBB patients resulted in significant improvement of electrical synchronization and RV size
but without significant improvement in LV size and function,
though our results showed a positive trend. The small sample
size and marginal baseline LVEF are the main limitations. A
Clinical trial to test this novel CRT therapy in patients with
RBBB and HFrEF is warranted to confirm the above results in
this group.
156 Abstract 2422
PATIENTS WITH LEFT BUNDLE BRANCH BLOCK

AND LEFT AXIS DEVIATION SHOW A SPECIFIC
LEFT VENTRICULAR ASYNCHRONY PATTERN:
POSSIBLE IMPLICATIONS FOR LEFT VENT
RICULAR LEAD PLACEMENT DURING CRT IMPL
ANTATION
Luigi Sciarra1, Paolo Golia2, Monia Minati1, Ermenegildo De
Ruvo1, Antonio Scar1, Alessio Borrelli1, Lucia De Luca1,
Chiara Lanzillo1, Alessandro Fagagnini1, Marco Rebecchi1,
Ludovica Scialla 1 , Elisa Salustri 3 , Domenico Grieco 1 ,
Leonardo Cal1
1
Cardiologia - Universit La Sapienza, Rome, Italy;
2
Cardiologia - Ospedale di Forl, Forl, Italy; 3Cardiologia Universit de LAquila, LAquila, Italy
Background: It has been observed that candidates to cardiac
resynchronization therapy (CRT) with an ECG pattern of left
bundle branch block (LBBB) and left axis deviation (LAD)
may have a worse response to biventricular pacing. A possible
reason of this observation could be that the left ventricular
lead is normally placed in a postero-lateral branch of the coronary sinus, but the postero-lateral left ventricular wall could
not be the most delayed one in such a subgroup of subjects.
Aim of our study: to test if patients with LBBB and left axis
deviation show a specific asynchrony echocardiographic pattern. Methods: Our study population included 17 patients (14
males; mean age 71.88.4 years) with severe depression of
ventricular function (mean ejection fraction 0.260.09), advanced heart failure (mean NYHA class 2.80.5), complete
LBBB (mean QRS duration 17528 ms) with LAD at the
290
surface ECG. All patients were candidate to CRT through

biventricular pacing. Every patient underwent an echocardiogram with tissue-doppler analysis, in order to evaluate the
asynchrony pattern of the left ventricular contraction. The
time from the QRS onset to maximum wall velocity (Qpeak) at tissue Doppler was evaluated in different areas of
the left ventricle: septum, inferior, postero-lateral, and
antero-lateral wall. Results: The mean Q-peak time at tissue
Doppler analysis resulted to be significantly prolonged in the
antero-lateral wall, when compared to the other regions (280.0
68.2 vs 210.854.4 ms; p=0.001). In all but two patients,
the most delayed wall resulted to be the antero-lateral one. The
patients without significant antero-lateral delay had a previous
anterior myocardial infarction. Conclusions: Patients with advanced heart failure, severe depression of left ventricular systolic function, and complete LBBB with left axis deviation at
the surface ECG show a specific pattern of ventricular asynchrony with delayed activation of the antero-lateral wall. Our
results may have clinical impact in target vessel identification
during CRT implantation in pts with LBBB and LAD.
157 Abstract 2423
PROGNOSTIC VALUE OF EPIC

ARDIAL-ENDOCARDIAL GRADIENT MEASURED
BY ECHOCARDIOGRAPHY TO PREDICT CARDIAC
RESYNCHRONIZATION THERAPY (CRT)
RESPONSE
Frederic Sebag1, Nicolas Lellouche 1, Nicolas Mignot1,
Nathalie Elbaz1
1
Departement de Cardiologie CHU Mondor, CRETEIL,
France
Introduction: Cardiac resynchronization therapy (CRT) is
an effective treatment for patients with systolic heart failure and cardiac dyssynchrony. However, up to one third
of patients do not respond to CRT. As right ventricular
(RV) lead is positioned endocardialy and left ventricular
(LV) lead epicardialy, we hypothesized that baseline epiendo gradient could predict CRT response. Methods: We
studied 46 patients referred to our centre for CRT. These
patients had LVEF <35 % and QRS duration >120 ms
under maximal medical therapy. Transthoracic echocardiography (TTE) was performed for all patients before and
1 year after CRT implantation. Offline analysis with a
specific software (Echo PAC from GE) allowing speckle
tracking imaging (STI) analysis of LV endocardial and
epicardial wall was performed. Specifically, epi-endo
gradient delay (GD) and gradient contraction (GC) measurements were performed on the septal and lateral LV
wall before and at 1 year after CRT implantation. CRT
response was defined as a reduction >15 % of LV end

systolic volume 1 year after CRT. Results: In our population, mean age was 6211 years old and mean LVEF
was 267 %. Twenty-two patients (48 %) were classified
as responders. Baseline characteristics of patients with or
without CRT response were similar. However, baseline
QRS duration was higher in patients with CRT response
(16035 vs. 14027 ms, p=0.03). Before implantation,
septal (1031 vs. 20133 ms, p=0.67) and lateral GD
(125 vs. 426 ms, p=0.76) were low and similar in
both groups. However, lateral GC was higher in CRT
responders (4.05 2.29 vs. 2.38 2.82 %, p = 0.009).
After multivariate analysis, lateral GC was the best predictor of CRT response (p=0.013). One year after implantation, septal GD and GC were comparable in CRT
responders or not. However lateral GC significantly decreased in CRT responders (4.05 2.29 % at baseline
vs. 1.862.2 %, p<0.01) whereas no changes were observed for non-responders. Finally, lateral GD was significantly increased at 1 year in CRT non responders 4
26 ms at baseline vs. 1843 ms, p<0.01). Conclusion:
At baseline, no significant LV epicardial-endocardial delay gradient was observed in patients with CRT response
or not. However, lateral epi-endo gradient contraction is
highly independently associated with CRT response. Finally, this gradient was homogenizing 1 year after CRT
for responders.
158 Abstract 2424
LARGE CAPACITY LIMNO2 BATTERIES

EXTENDED CRTD LONGEVITY IN CLINICAL USE
COMPARED TO SMALLER CAPACITY LISVO
BATTERIES OVER 6 YEARS
Ernest Lau1, Carol Wilson1, Kyle Ashfield1, Wilson McNair1,
David McEneaney1, Michael Roberts1
1
Royal Victoria Hospital, Belfast, UK
Introduction: CRTD batteries need to supply both regular lowvoltage pacing impulses and occasional high-voltage defibrillation discharges. The longevities of CRTDs powered by large
capacity LiMnO2 batteries (introduced in 2008) and contemporary smaller capacity LiSVO batteries after 6 years of clinical use were compared. Methods: CRTDs implanted in our
hospital in 20089 were tracked for survival up to ERI. NonERI events removing devices from service were censored.
Device models using the same batteries were grouped for
analysis. Results: The 2 Ah LiMnO2 CRTDs (group 1)
showed 100 % survival after 6 years. The 1.87 Ah (group 2)
and 1.4 Ah (group 3) LiSVO CRTDs began to reach ERI after
2.8 and 2.5 years, respectively, and none were in service after
291
6 years in either group. Pairwise comparisons show significant

differences between group 1 and group 2 (p=0.0018), between groups 1 and 3 (p<0.0001), and between groups 2
and 3 (p=0.0386). Conclusions: Large capacity LiMnO2
CRTDs outlasted traditional smaller capacity LiSVO CRTDs
in clinical use. Both battery chemistry and capacity impact
device longevity.
Manufacturer
CRTD models
Chemistry Capacity
(Ah)
Ratio
Total Usable
Boston Scientific Cognis
LiMnO2
(group 1)
St Jude Medical Promote/Atlas HF LiSVO
(group 2)
Medtronic
Consulta/
LiSVO
(group 3)
Concerto/
Maximo
1.8
0.9
1.87 1.31
0.7
1.4
0.7
1.0
159 Abstract 2427
failure patients who met the criteria of CRT implantation.

Aim: The aim of this study is to investigate whether CRT
improves atrial function and induces atrial reverse remodeling.
Methods: A total of 24 patients with heart failure (mean age,
55.39.64 years) who underwent CRT were evaluated with
echocardiography before and after 3 months of optimized
CRT. Atrial function and LV function were assessed with Mmode, two-dimensional echocardiography, Doppler, tissue
Doppler velocity, and 2D strain (E) imaging. LV reverse remodeling was defined as a reduction in LV end-systolic volume of >10 %. Results: In responders (n=16), significant
improvements in left atrial (LA) functional and structural remodeling were observed. LA area and volumes decreased, the
LA emptying fraction increased, LA global positive longitudinal strain (E) increased from 12.456.12 to 16.595.89 %
(P<0.001), and LA global negative longitudinal (E) 1.62
1.2 to 3.31.9 (P<0.003). LA reverse remodeling was more
frequent in patients with LV reverse remodeling (P<0.005).
We also noticed the LA area and volumes were significantly
less in the responders group prior to CRT implantation. Conclusions: CRT induce LA structural and electrical reverse remodeling that could be assessed more accurately by LA 2D
(E) strain as well as LA volumes and functions. Keywords:
Cardiac resynchronization therapy, left atrium, remodeling
Model
AUC (CI)
p value Correct
Nagelkerke
prediction
R square
(%)
Clinical+wide
QRS
Clinical+wide
QRS+ECHO
Clinical+wide
QRS+ECHO+
Lab
Clinical+wide
QRS+ECHO+
Lab+HM
0.794 (0.692;0.897) <0.001 74
0.336
0.802 (0.699;0.806) <0.001 79.3
0.35
0.842 (0.728;0.955) <0.001 81
0.423
0.879 (.786;.972)
0.478
<0.001 84.5
Table 1. Comparison of risk assessment models. AUC area

under the curve, CI, confidence interval, EF echocardiography, HM Holter monitoring, Lab laboratory data
1510 Abstract 3111
ATRIAL REVERSE REMODELING AFTER CARD

IAC RESYNCHRONIZATION THERAPY FOR
HEART FAILURE
EFFECT OF LEFT VENTRICULAR REMODELING

ON ENDOCARDIAL SENSED R WAVE AMPLITUDES
Alaa Allah Al Anany1, Said Khaled1, Mazen Ibrahim1,

Mohamed Abdel Hameed1, Ayman Abdel Motalib1, John
Zarif1
1
Ain Shams University hospital, Cairo, Egypt
Omer Iqbal 1 , Lee Joseph 1 , Siva Krothapalli 1 , Miriam

Zimmerman1, Michael Giudici1, Kanu Chatterjee1
1
University of Iowa hospitals and clinics, Iowa City, IA, USA
Background: Cardiac resynchronization therapy (CRT) improves LV functions and NYHA class in the majority of heart
Background: Low R-wave sensed amplitude (RWSA) has

been noticed in dilated cardiomyopathy and other cardiac
292
conditions like arrhythmogenic hypertrophy cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy

(ARVC), and sarcoidosis and has been associated with
high incidence of inappropriate ICD shocks in these patients. Also, at the time of ICD implantation, low RWSA
<9 mV has been associated with an increased risk of allcause mortality when compared with RWSA>15 mV in
primary prevention population. It has not been studied if
left ventricular (LV) remodeling can result in changes in
endocardial RWSA. We conducted this study to determine the effect of LV remodeling on endocardial RWSA.
Methods: A retrospective single-center review of endocardial RWSAs from 212 ICD and pacemaker interrogations in total 132 patients with bipolar leads was done.
Interrogations of pacemaker-dependent patients and those
receiving advanced heart failure therapies (left ventricular assisted device; cardiac transplant) were excluded. LV
stroke volume (SV) and ejection fraction (EF) were measured on TTE by Simpsons equation. Endocardial
RWSA were correlated with LV dynamic variables (SV
and EF). RESULTS: RWSAs were similar when compared between device types (biventricular versus right
ventricular device; p=0.102), lead locations (apex, right
ventricular outflow tract, septum; p=0.186), EF [%] (<50
and >50, p=0.618). In patients without coronary artery
disease (CAD), there was a significant increase in RWSA
with decrease in SV (p = 0.008) and a non-significant
trend towards increase in RWSA with decrease in EF
(p=0.06) (Figure 1). In the presence of CAD, there was
no significant correlation between RWSA versus SV (p=
0.32) or RWSA versus EF (p=0.30). Conclusion: In the
absence of CAD, RWSA changes are inversely related to
the changes in stroke volume; however, no such association was noted in the presence of CAD.
Arrhythmia mechanisms
1511 Abstract 0215
TISSUE STRUCTURE FUNCTION RELATIONSHIPS SIZE AND DIRECTION DO MATTER.
Junaid Zaman1, Sayed Al-Aidarous1, Samha Alayoubi1,
Pravina Patel1, Cesare Terracciano1, Nicholas Peters1
1
Intro: We tested whether structure (connexin43, Cx43/fibrosis)
function (electrograms Eg, conduction velocity, CV) relations
vary with size of electrode and direction of pacing. Methods:
Macro: Functionpaced (633 Hz) Langendorff perfused rat
hearts (312 m, n=80). Microelectrode array (MiEA) mean and
max CV calculated by isochronal mapping. AF (>30s) dominant
frequency (DF), organizational index (OI), Shannon entropy
(ShEn) andmagnitude squared coherence (MSC) calculated with
small (30 mm), medium (150 mm) and large (1.5 mm) electrodes. Structurewhole atrial Cx43 phosphofractions (P0, P1,
293
P2) and fibrosis. Micro: Functionsuperfused isolated atria (3,

12 and 20 m n=40) on glass MiEAs, orthogonal pacing (1
25 Hz), unipolar Eg time and frequency domain characterization,
optical mapping using di-4-ANEPPS. Structureoverlay grid of
electrodes and fibrosis. Results: (1) Mean CV is inversely correlated to fibrosis. (2) Max/mean CV is correlated to Cx43 P0/P12
ratios. (3) In AF MiEA recordings, ShEn and MSC correlate with
fibrosis at the smallest scale whereas DF and OI correlate with
Cx43 at the largest scale only. (4) Unipolar Eg morphology correlates with duration, amplitude, line length, fractionation score,
DF, DF dv/vt and ShEn only in one direction of pacing. (5)
APD90 is inversely correlated to Eg duration and fractionation
score. Conclusions: (1) CV is linearly related to interstitial fibrosis
and Cx43 phosphorylation ratio. (2) AF organization and fibrosis
are related at the smallest scale whereas AF and Cx43 at the
largest scale only. (3) Tissue anisotropy is a major factor in structure function relationships. (4) Fractionated Egs are not summated individual action potentials. (5) Accurate co-localisation and
annotation are critical to identifying subtle structure function relationships and may be the limiting factor in human studies.
1512 Abstract 1717
ANTIARRHYTHMIC EFFECT OF THE

CONSECUTIVE ISOPROTERENOL/ADENOSINE
TREATMENT DURING REGIONAL ISCHAEMIA.
Background: We have recently found that consecutive

isoproterenol/adenosine treatment (Iso/Ade), mediated by the
consecutive activation of cAMP-PKA and PKC signalling pathways, is a potent cardioprotective pharmacological intervention,
which significantly reduces necrotic damage and improves
Igor Khaliulin1, Andrew F. James1, M.-Saadeh Suleiman1
University of Bristol, Bristol, UK
294
haemodynamic function recovery after global ischaemia. However, this intervention had no significant effect on the
reperfusional arrhythmias after global normothermic ischaemia.
The purpose of the present study was to assess the effects of Iso/
Ade on cardiac function, including ventricular arrhythmias, and
necrotic damage during regional ischaemia and reperfusion.
Methods: Experiments were performed on isolated
Lengendorff-perfused rat heart. All hearts were subjected to
30-min regional ischaemia and 2-h reperfusion. Regional ischaemia was induced by occlusion of the left anterior descending coronary artery (LAD). The hearts were divided into control
and Iso/Ade groups according to the preischaemic protocol.
Hearts of the Iso/Ade group were perfused with 10 nM isoproterenol for 2 min followed by 5 min perfusion with 30 M
adenosine. Electrocardiogram (ECG) and left ventricular pressure were monitored throughout the experiment. Ventricular arrhythmias (number of ventricular premature beats (VPBs), number and total duration of ventricular tachycardia and ventricular
fibrillation (VT and VF)) were assessed using ECG. At the end
of reperfusion, infarct size-to-area at risk ratio (IS/AAR) was
determined in the hearts. In a separate series of experiments,
mitochondria were isolated from Iso-perfused and control
hearts, and the ability of mitochondria to retain Ca2+ was
assessed fluorimetrically. Results: During LAD occlusion, arrhythmias were dramatically reduced in the treated hearts. Thus,
in the control and Iso/Ade groups, the number of VPBs were
678172 vs. 13539, the number of VT and VF were 9124
vs. 73, and the total duration of VT and VF were 24385 vs. 3
1 s, respectively. During reperfusion, the number of VPBs was
similar in the two groups. However, the number and duration of
VT and VF were still significantly lower in the Iso/Ade group.
Iso/Ade also considerably improved hemodynamic function recovery and reduced IS/AAR during reperfusion. Interestingly,
that perfusion of hearts with Iso significantly enhanced ability of
mitochondria to retain Ca2+. Conclusion: Thus, in contrast to
the global ischaemia, consecutive isoproterenol/adenosine treatment effectively prevented the development of ventricular arrhythmias during regional ischaemia and reperfusion. This treatment also significantly improved functional recovery and reduced infarct size after the LAD ligation. This effect could be
a result of the improved Ca2+ handling by the myocardium in
the treated hearts during regional ischaemia and reperfusion.
1513 Abstract 1919
ASSOCIATION OF TERC RELATED GENETIC VARI

ATION AND TELOMERASE ACTIVITY WITH VENT
RICULAR ARRHYTHMIAS IN ISCHAEMIC CARD
IOMYOPATHY
Vinit Sawhney1, Scott Brouilette2, Niall Campbell1, Steven
Coppen2, Victoria Baker1, Claire Kirkby1, Ross Hunter1,
Mehul Dhinoja 1 , Mark Earley 1 , Simon Sporton 1 , Ken

Suzuki2, Richard Schilling1
1
St Bartholomews hospital, London, UK; 2William Harvey
Heart Centre, London, UK
Introduction: Implantable cardioverter defibrillators (ICD)
reduce mortality in ischaemic cardiomyopathy patients at a
high risk of ventricular arrhythmias (VA). However, ICDs
are associated with morbidity and mortality. There is need
for better risk stratification. Telomere and telomerase activity (TA) in leukocytes have recently been shown to correlate with biological ageing and pathogenesis of cardiovascular diseases. Telomerase maintains telomere length and is
composed of a reverse transcriptase, TERT, and an RNA
template, TERC. Evidence suggests that genetic variation
in key genes has a key impact on TA. Association of
SNP12696304 on chromosome 3q26 (at a locus that includes TERC) with telomere length has been shown. We
investigated the association between genetic variation in
SNP12696304 and leukocyte TA with incidence of VA in
ischaemic cardiomyopathy patients. Methods: Ninety ischaemic cardiomyopathy patients with primary prevention
ICDs were recruited. Genomic DNA was isolated from venous blood samples. TA was measured telomere repeat amplification (TRAP) protocol and genotyping by Taqman
SNP assay. Logistic regression was used to determine correlation of genotype and TA with VA. Results: There was no
significant difference in baseline demographics including
age, sex, lvef, and follow-up since ICD implant between
patients with VA (cases, n=35) and no-VA (controls, n=
55). TA was significantly higher in the cases and correlated
with incidence of VA (p value 0.02). No significant correlation between the genotype and VA was identified (C/C
OR 1; C/G OR 0.54, p value 0.343; G/G OR 0.80, p value
0.907). There was a significant correlation between risk of
VA and TA increase in C/C genotype only (OR 7.5, CI156.6, p value 0.04) as shown in Figure 1. Conclusion: There
is a significant correlation between TA and VA in ischaemic
cardiomyopathy patients. Moreover, homozygosity for C
allele of SNP 12696304 (encoding TERC) significantly effects telomerase expression. Thus, increased TA predisposes individuals with C/C genotype to a higher incidence
of VA
295
Table 1. *p<0.0001
1514 Abstract 0115

THE QT INTERVAL INCREASES WITH DECR
EASING PLASMA POTASSIUM IN THE DANISH
GENERAL POPULATION
Jorgen Kanters 1 , Claus Graff 2 , Jimmi Nielsen 2 , Lise
Henriksen1, Anne Sofie Petri1, Michael Christiansen3, Jan
Kvetny4, Christina Ellervik4
1
University of Copenhagen, Copenhagen N, Denmark; 2Aalborg
University, Aalborg, Denmark; 3Statens Serum Institut, Copenhagen, Denmark; 4Nstved Hospital, Nstved, Denmark
It is well known that hypokalemia is associated with
prolonged QT interval. However, the relation between plasma
potassium and the QT interval has not been established in a
general population. Methods: As part of the Danish General
Suburban Population Study (GESUS) in Naestved Municipality, a general population cohort was established. We examined
8779 individuals with digitally recorded ECGs on a
MAC5000 (GE Healthcare, Milwaukee). QT and RR intervals
were measured by the 12SL algorithm (GE Healthcare, Milwaukee, WI) and corrected with both Fridericia (QTcF) and
Bazetts (QTcB) method. Persons with cardiovascular disease,
diabetes, increased creatinine (>95 % percentile for gender
and age) or pulmonary disease were assumed non-healthy,
whereas the rest were assumed to be healthy. Statistics are
given as meanSE or as 95 % confidence Interval. Results:
QTcF was univariately correlated to potassium concentration
r2 =0.0. The relation was nicely linear even in the extremes of
potassium concentration (range 2.74.9 mM). As seen in Table 1, assumed healthy subjects had slightly shorter corrected
QT intervals and longer mean RR intervals than non-healthy.
The corrected QT interval depended in a multivariate interval
on age, sex and Se-potassium.
MeanSD
Full cohort
Assumed nonhealthy
8779
3438
Assumed
healthy
Demographics
n
Age
years 56.4513.53 64.1111.62*
Male
5341
51.5212.32
45.8 %
47.1 % (p=0.052) 45.0 %
ECG parameters
QTcF
ms
416.520.4
420.521.8*
QTcB
ms
420.924.5
427.725.2*
413.919.0
RR
ms
956.0163.9 918.6159.8*
980.2162.0
SemM
Potassium
Se-Sodium mM
3.8830.297 3.8940.342*
3.8760.264
140.702.24 140.522.52*
140.822.03
77.3919.42 80.9425.45*
75.1413.83
416.422.9
Clinical chemistry
Creatinine
QTcF
Univariate 95 % CI
a
Multivariate 95 % CI
a
Age (years)
0.21*
[0.17; 0.25]
0.26*
[0.21; 0.30]
Gender
(M vs. F)
Se-potassium
(mM)
Se-sodium
(mM)
Creatinine
(M)
Intercept
7.4*
[8.4;6.4]
6.7*
[7.7; 5.7]
8.4*
[10.3;6.4]
8.3*
[10.2;6.3]
0.12
[0.12; 0.38]
0.17
[0.21; 0.14]
436*
[429; 443]
Table 2. *p<0.0001. Conclusion: The corrected QT interval

increases with 8.4 ms/mM decrease in potassium nearly independent of age and gender. Since FDA has a threshold of
concern of DQTc=5 ms, it seems necessary to take plasma
levels of potassium into account when analyzing data in studies on drug-induced QTc- prolongation.
1515 Abstract 0410
LOCALISATION OF GANGLIONIC PLEXI SITES
WITHIN THE LEFT ATRIUM
Belinda Sandler1, Nick Linton1, Michael Koa Wing1, Saj
Hayet1, Norman Qureshi1, Vishal Luther1, Nicholas Peters1,
Wyn Davies1, Louisa Malcome Lawes1, Boon Lim1, Prapa
Kanagaratnam1
1
Background: The autonomic nervous system has been
implicated in the pathogenesis of AF. High-frequency
stimulation (HFS) can be used to identify endocardial
ganglionated plexi sites. We studied the left atrial distribution of these sites in patients undergoing ablation for
AF. Methods: Synchronised HFS delivering 15 V at
20 Hz was performed through a CARTO Smart Touch
catheter during fixed rate pacing within the local refractory period (100 ms post-pacing spike). A positive site
was a location where HFS produced either ectopy or AF
reproducibly. A negative site was defined as a location
where HFS did not initiate AF/ectopy. All sites were
tagged using 3D geometry for analysis. Systematic testing was done throughout the left atrium. Results: Six
patients were recruited. The mapping time was 76.3
14 min with 8017 locations tested per patient. There
were 196 positive sites and 6125 negative HFS sites
per patient. The positive HFS sites were located at the
PV antrum in 103 sites and non-antral regions were in
94, respectively. Chi-squared analysis indicated no difference between antral and non-antral regions (p=0.19).
296
In the non-antral regions, 22/56 (39.2 %) sites were on

the roof, 16/56 (28.6 %) at the septum and 18/56
(32.1 %) on the posterior wall. Conclusion: This study
suggests that GP sites that trigger ectopy are not confined to the PV antrum as suggested by post-mortem
studies.
Poster session C part 2: Sudden cardiac death and

implantable cardioverter defibrillator
autopsy rates, and prior known disease have not been systematically investigated in a nationwide setting before. Methods:
All deaths in persons aged 135 years in Denmark in 2000
2009 were included. To chart causes of death and incidence
rates, death certificates, and autopsy reports were collected
and read. By additional use of the extensive health care registries in Denmark, we were also able to investigate prior disease. SCDw were compared to SCDm. Results: During the
10-year study period, there was an average of 2.37 million
persons aged 135 years (49 % women). There were a total
of 8756 deaths from 23.7 million person-years. Of these, 10 %
(n=848) were sudden unexpected deaths. In total, 635 of sudden unexpected deaths were SCD, of which SCDw constituted 205 deaths (32 %). Compared to SCDm, women less often
died in a public place (16 vs 26 %, p=0.02). Women more
often died during sleep, and less often during moderate- to
high-intensity activity (40 and 3 vs 33 and 11 %, respectively,
p=0.036). There were no differences between genders in regard to age at death, witnessed deaths, ratio of autopsies, and
ratio of sudden unexplained deaths. Likewise, there were no
differences in comorbidity between SCDw and SCDm. Most
common structural heart diseases in SCDw were ischemic
heart disease (n=17, 13 % of autopsied SCD), followed by
myocarditis and ARVC (n=9 each, 7 % of autopsied SCD). In

12:00 PM
1516 Abstract 1917
SUDDEN CARDIAC DEATH IN YOUNG WOMEN IN
DENMARK
Bo Gregers Winkel1, Bjarke Risgaard1, Reza Jabbari1, Thomas
Hadberg Lynge1, Charlotte Glinge1, Henning Bundgaard1, Stig
Hauns1, Jacob Tfelt-Hansen1
1
Rigshospitalet, department of Cardiology, Copenhagen,
Denmark
Introduction: Hitherto, sudden cardiac death (SCD) in the
youngdefined as SCD in 135 years oldhas been described with no distinction between genders. Most data suggest a lower incidence rate of SCD in young women (SCDw)
than in men (SCDm). However, causes of SCDw, as well as
the subgroup of SCD in children (118 years), females were

less often autopsied (62 vs 81 %, p=0.027). The incidence rate
of SCDw was half of that of SCDm (1.8 vs 3.6 per 100,000
person-years, Incidence rate ratio 2.0 (95 % CI 1.72.4),
p<0.01). Conclusions: This nationwide study describes SCD
in young women and gender differences. Young women only
die half as often from SCD than young men. Causes of death
were largely comparable with SCDm. Women die more often
during sleep and less often during sports activity. This study
will help better understand the role of gender in SCD in the
young and put forward attention on the importance of these
deaths being properly investigated by autopsy. This will help
the subsequent familial cascade screening.
297
diagnosis, 64 % was acute coronary insufficiency. Nineteen

percent of the causes of death was a myocardial infarction
of different localization. Eight percent of cases the cause of
sudden cardiac death was defined as alcoholic cardiomyopathy. Conclusions. According to the study, a large percentage of sudden cardiac death cases are patients of working
age (22 %). Males are in the greater risk of SCD. The main
cause of sudden cardiac death is coronary heart disease.
Alcoholic cardiomyopathy takes up a large percentage in
SCD structure in Chita Area. The reports of autopsies prove
that clinical diagnosis of sudden cardiac death was not identified in 98 % of cases.
1518 Abstract 3115
1517 Abstract 1921
SUDDEN CARDIAC DEATH PROTOCOL ANALYSIS

OF POSTMORTEM AUTOPSIES
Sergey Mikhaylichenko 1 , Vladimir Gorbunov 2 , Egor
Bogatikov2, Maxim Mikhaylichenko2
1
Bakoulev Center for Cardiovascular Surgery, Moscow,
Russia; 2Chita State Medical Academy, Chita, Russia
Sudden cardiac death (SCD) occurs in case of various heart
diseases, as well as in different types of arrhythmia. According to different studies, in all causes of death, the
SCD rate is about 40 %. In all cases of SCD, less than
10 % of patients get hospitalized (less than 40,000); half
of the patients die before discharge from the hospital (20,
000); 20,000 patients stay alive but need treatment. Aim of
study. To analyze cases of sudden cardiac death in Chita
Area, Russia; to identify the percentage of the patients died
suddenly of cardiovascular disease in the mortality structure in Chita Area in 2013; to evaluate the gender, age
profile of the patients who died suddenly; to identify possible causes of sudden cardiac death; and to assess possible
impact of alcohol on the risk of sudden cardiac death. Content and methods. Analysis of 500 postmortem autopsy
protocols of cardiovascular disease cases in Chita in 2013.
Statistical analysis was carried out by continuous sampling.
Results. The postmortem autopsies analysis of patients died
of cardiovascular disease in Chita Area in 2013 proved that
22 % of patients died suddenly. The average age was 54.3
10.9 years. Of those who died suddenly, the largest percentage are males (78 %). It was found that 16 % of patients
misused alcohol. The main cause of sudden cardiac death is
coronary artery disease. Atherosclerotic coronary vessels
disease was found in 88 % of cases. Dilatation of the left
ventricle was stated in 12 % of deaths, 3 % had hypertrophic cardiomyopathy, hypertrophy of the left ventricle was
found in 43 % of suddenly died. Among pathological
CLINICAL CHARACTERISTICS AND EVOLUTION

OF PATIENTS WITH AN IMPLANTABLE CARD
IOVERTER DEFIBRILLATOR THAT HAVE BEEN
TRANSPLANTED.
Francisco Mndez Z1, Enrique Rodriguez1, Concepcin
Alonso1, Jos Guerra1, Eulalia Roig1, Sonia Mirabet1, Marcos
Rodrguez G1, Xavier Violas P1
1
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
INTRODUCTION. A high proportion of patients eligible for
cardiac transplant (CT) also met criteria for an implantable
cardioverter defibrillator (ICD). In Spain, 5 % of the patients
die during the waiting time of a CT. The aim of this study was
to evaluate the clinical characteristics, safety and therapies of
patients with an ICD who were later transplanted.
METHODS. Retrospective study. We included all patients
with an ICD implanted in our center since 1998, which later
received a CT. Clinical and echocardiographic characteristics,
time from implant to CT, appropriate and inappropriate therapies, device related complications and mortality were analyzed. RESULTS. A total of 1132 ICD patients were evaluated. Fifty-nine patients (5.21 %) received a CT (age 52.2
10.1 years, 83.1 % male). The cardiac etiology was ischemic
in 39 % and non-ischemic in 44 %. The indication for primary
prevention ICD was 64.4 %. The time from implant to CT was
significantly lower in patients with primary prevention (773
vs. 98216071461 days, p=0.043). During this period,
39 % of patients received at least one appropriate therapy
(31 % in primary prevention and secondary prevention
55 %, p=0.064). Seventeen percent of patients received at
least one inappropriate therapy (15 % primary and 20 % secondary prevention, p=0.72). CONCLUSION. Among patients with an ICD who receive a CT, the percentage of appropriate therapies is high, particularly in patients with secondary
prevention indication. The time to transplant is lower in patients with primary prevention. A low percentage of patients
298
with ICD in our series received a CT. Table 1. Evolution of

trasplanted patients according ICD indication
Primary
prevention
Secondary
prevention
p value
Waiting time until

CT (days)
Appropriate therapy
982773
16071461
0.043
12/39
11/20
0064
Inappropriate therapy
6/39
4/20
0.72
1519 Abstract 2510
IS IMPLANTABLE CARD
IOVERTER-DEFIBRILLATOR REPLACEMENT
NECESSARY IN THE PRIMARY PREVENTION PATI
ENT WHOSE LEFT VENTRICULAR EJECTION
FRACTION HAS NORMALIZED?
JoEllyn Abraham1, Deepa McGriff1, C. Dennis OHare2,
Raed Abdelhadi1, Jay Sengupta1, Robert Hauser1
1
Minneapolis Heart Institute, Abbott Northwestern Hospital,
part of Allina Health, Minneapolis, MN, USA; 2 Abbott Northwestern Hospital, part of Allina Health, Minneapolis, MN,
USA
Background: There are limited data on the need for implantable cardioverter-defibrillator (ICD) pulse generator
(PG) replacement in primary prevention patients who
have not received appropriate ICD therapy (ICD-Rx)
and whose left ventricular ejection fractions (LVEF) have
normalized. Accordingly, we assessed the outcomes of
such patients at our center who did and did not undergo
ICD replacement for battery depletion. Methods: This
was a single-center retrospective study. Patients were
age 18 years who had ischemic cardiomyopathy
(ICM) or dilated cardiomyopathy (DCM) and who
underwent primary prevention ICD implantation from
2000 to 2014. Patients who had received ICD-Rx for
ventricular tachycardia (VT) or ventricular fibrillation
(VF) were excluded. Results: The cohort included 82
patients (average age 6512 years; 66 % male) whose
average LVEF was 24.27.0 % at initial ICD implant
(range 1037 %) and 49.33.9 % (range 4555 %) when
their PGs reached end-of-battery life. None had received
ICD-Rx for VT or VF. The majority of patients had
DCM (n = 48; 59 %) and the remaining patients had
ICM (41 %). Of the 82 patients, 72 (88 %) underwent
ICD replacement, 6 (7 %) were downgraded to a pacemaker, and 4 (5 %) patients had their ICDs removed or
abandoned. During average follow-up of 19
14.3 months, nine patients died, including seven in the

replacement group, and one each in the pacemaker and
removed/abandoned groups. No death was sudden or primarily arrhythmic. Four of 72 patients (5.6 %) in the
ICD replacement group received appropriate device therapy for VT (n=3) or VF (n=1); two of these patients had
DCM and two had ICM with %LVEFs of 60, 50, 45, and
45, respectively. Conclusions: These data suggest that
LVEF normalization is not associated with complete freedom from VT/VF in primary prevention patients who
present for elective ICD replacement. However, the risk
of mortality/morbidity for such patients and the need for
ICD-Rx appears to be low.
1520 Abstract 2511
IMPLANTED CARDIOVERTER DEFIBRILLATOR

SHOCK RISK AND MORTALITY IN WOMEN WITH
ADRIAMYCIN-INDUCED CARDIOMYOPATHY
Marc Lahiri1, Arfaat Khan1, Gurjit Singh1, Claudio Schuger1
1
Henry Ford Hospital, Detroit, MI, USA
Background: The benefit of implanted cardioverter defibrillators (ICDs) for primary prevention of sudden death
is established in patients with nonischemic dilated cardiomyopathy (NIDCM). However, frequency of ICD
shocks and survival is unknown in the subset of such
patients with adriamycin-induced cardiomyopathy (ACM). Methods: Retrospective case control analysis was
performed on 15 women with A-CM with primary prevention ICD implanted at Henry Ford Hospital from
2001 to 2012. Shocks were adjudicated by trained electrophysiologists. Wilcoxon and chi-squared tests were
used to analyze continuous and nominal variables between the study group and a control of 60 women with
ICD for traditional non-adriamycin NIDCM. Negative
binomial modeling was used to analyze incidence of
shocks delivered for the study vs. control groups. Results: Subjects and controls were well matched in demographics (table), follow-up duration, baseline left ventricular ejection fraction, and therapy rate cutoff. Women with A-CM were less likely to receive a shock than
controls (rate ratio 0.06, p=0.038) with a trend toward
less appropriate shocks (rate ratio 0.13, p=0.115). However, there was a near-significant trend toward higher
mortality in the A-CM group vs. control (40 vs 15 %,
p=0.06). Conclusion: Women with ICDs for Ad-CM are
less likely to receive shocks than those with traditional NIDCM, but have a nearly significant trend toward
higher mortality. Further study is needed to determine
299
the efficacy and appropriateness of primary prevention

ICD use in women with A-CM.
Control
Adriamycin
group
cardiomyopathy
(n=60)
(n=15)
Demographics/baseline characteristics
Age (years)
63.511.7
LVEF at implant (%)
Months of follow-up
22.56.9
33.122.6
Clinical events
Patientss with appropriate 1 (6.7 %)
shocks (%)
Mortality (%)
6 (40 %)
p value
59.212.9
0.33
22.59.6
34.330.7
0.77
0.76
10 (16.7 %) 0.45
9 (15 %)
0.06
1521 Abstract 1910
INAPPROPRIATE SUBCUTANEOUS IMPLANTABLE

CARDIOVERTER DEFIBRILLATOR SHOCKS DUE
TO T-WAVE OVERSENSING CAN BE PREVENTED.
Kirsten M. Kooiman1, Reinoud E. Knops1, Louise R. Olde
Nordkamp1, Arthur A. Wilde1, Joris R. de Groot1
1
Academic Medical Centre, Amsterdam, Netherlands
Introduction: Inappropriate shocks (IAS) complicate implantable cardioverter defibrillator (ICD) therapy. The management
of IAS in patients with a subcutaneous ICD (S-ICD) differs from
conventional ICDs because of different sensing and programming. We describe the management of IAS in patients with a SICD. Methods: Patients were implanted with a S-ICD 2009 and
2012. The prevalence and clinical determinants data of IAS were
prospectively collected. In case of T-wave oversensing (TWOS),
an exercise test was performed, and all possible sensing vectors
were screened on TWOS. Absence of TWOS defined a suitable
vector. Results: Eleven out of 69 patients (54 % male, age 39
14 years, 73 % primary prevention) received IAS after 8.9
10 months following implantation (10.8 % annual incidence
rate). Bundle branch block or digoxin use was associated with
IAS. In eight cases, TWOS caused IAS. Seven of these occurred
during exercise and one during atrial fibrillation with a high
ventricular rate, and an exercise test was performed. Additionally, in seven patients, the sensing vector and in five patients the
(un)conditional zone was changed. Hereafter, IAS recurred in
three of these 11 patients, in two due to human error. After
optimization we observed no IAS during a follow-up of 14.1
13 months. Conclusion: IAS due to TWOS in the S-ICD can be
managed with reprogramming the sensing vector and/or the
therapy zones of the device using a template acquired during
exercise. Exercise-optimized programming can reduce future
IAS, and standard exercise testing shortly after implantation of

a S-ICD may be considered in patients at risk for TWOS.
1522 Abstract 1918
SUB-MAMMARY ICD IMPLANTATION: LEAD

CHARACTERISTICS, LONGEVITY, AND
COMPLICATIONS. A RETROSPECTIVE REVIEW.
Nicole E Worden1, Lee Joseph1, Chad C Ward1, Samih L
Khauli1, Brodie R Marthalar1, Musab N Alqasrawi1, Michael
C Giudici1
1
University of Iowa Hospitals and Clinics, Iowa City, AI, USA
Introduction: Infra-clavicular device implantation is standard.
However, female patients can find this location troublesome.
Devices rub against purse straps, seatbelts, and undergarments
and can interfere with psychosocial functioning. Previous reports show significant satisfaction with sub-mammary device
implantation. Lead longevity, characteristics, and complications
have not been reported in a sizeable cohort. We hypothesized
that lead pacing thresholds, intrinsic amplitudes, impedances,
lead malfunction, ICD discharges, and peri-procedural complications would be similar to previously reported values at implant and most recent follow-up. Methods: We retrospectively
reviewed medical records for demographic, medical, outcome,
and complication data for patients who received sub-mammary
ICD implantation between 01/01/1995 and 11/01/2014. Results: Thirty female patients underwent sub-mammary device
implantation. They were followed for an average of 27.5 (20
101.8) months. Sixty percent of the patients had hypertension,
43 % had non-ischemic cardiomyopathy. The majority of the
devices were implanted for primary prevention (66.7 %) due to
hypertrophic cardiomyopathy, non-ischemic cardiomyopathy,
and cardiac resynchronization therapy among others. Secondary prevention devices were 13.3 % of implantations. Indications for a secondary prevention device included the following:
arrhythmogenic right ventricular dysplasia and ventricular
tachycardia. Three patients received pacemakers for sick sinus
syndrome, neurogenic syncope, or atrial arrhythmia. Capture
threshold and intrinsic amplitude for the atrial lead was not
significantly different between implantation and most recent
interrogation. Atrial lead impedance was significantly less at
follow-up (p=0.04) although both were within the clinically
acceptable range. Right ventricular lead baseline thresholds
were significantly less than the most recent follow-up threshold
(p=0.000). Intrinsic amplitude for the right and left ventricular
leads was not significantly different over time. Decrease in right
ventricular lead impedance over time was significant (p=
0.018). None of the lead characteristics in the left ventricular
leads were significant over time. Defibrillation impedance was
300
significantly higher at follow-up (p=0.01) although still within

the clinically acceptable range. There were six complications
including the following: one lead dislodgement (3.3 %), two
device infections (6.7 %), and three explantations related to the
previously mentioned complications. Two patients had appropriate shocks and one patient had an inappropriate shock. Conclusion: Sub-mammary device implantation is a durable alternative to traditional infra-clavicular device implantation as
demonstrated by lead characteristics at implantation and
follow-up which were well within the acceptable clinical range.
There was only one case of lead dislodgement. There was
higher percentage of infections than is typical. Prospective studies are needed to further elucidate lead performance and complications when placed in the sub-mammary location.
1523 Abstract 1920
INFLUENCE OF TELEMONITORING SYSTEMS ON
QUALITY OF LIFE AND DEVICE-ACCEPTANCE IN
PATIENTS WITH IMPLANTABLE CARD
IOVERTER-DEFIBRILLATORS 12 MONTHS FU
DATA
Johannes Siebermair1, Eimo Martens1, Florian Leppert2,
Stefanie Fichtner1, Stefan Sattler1, Heidi Estner1, Regina
Freeden 3 , Alexander Balke 3 , Josef Lauter 3 , Wolfgang
Greiner2, Reza Wakili1, Stefan Kb1
1
Medizinische Klinik und Poliklinik I, LMU Klinikum der
Universitt Mnchen, Mnchen, Germany; 2Fakultt fr
Gesundheitswissenschaften, Universitt Bielefeld, Bielefeld,
Germany; 3Medtronic, Meerbusch, Meerbusch, Germany
INTRODUCTION: Telemonitoring systems (TMS) for ICDs

are gaining attention as a strategy to optimize patient care and
to save costs. OBJECTIVES: This study prospectively investigated the influence of telemonitoring on the levels of depression, QoL and device acceptance in ICD patients over a period
of 12 months. METHODS: In this prospective controlled randomized single-center trial, 180 patients (82 % male; age 62.9
14.8; 47 % with coronary artery disease, 37 % with dilated
cardiomyopathy, NYHA class 2.00.7) were randomized at
the day of ICD implantation to either telemonitoring (n=91)
or control group (n=89). Patients in the intervention group
were equipped with a telemonitoring system. In the control
group, only conventional in-office follow-up (FU) visits were
performed. Patients had to fill out three questionnaires at baseline; patients were followed up for 12 months, with postal
surveys on a monthly basis. RESULTS: One hundred fiftythree patients finished at least the 3-month questionnaire and
were included in the further analyses. The telemonitoring
group showed a mean improvement in the health-related
QoL (EQ-5D-Index) by 8.62 points compared to baseline
levels after 12 months (p=.0234), while the QoL levels in
the control group did not differ significantly vs. baseline over
time (see figure). However, FPAS and HADS-D showed only
a positive non-significant trend for beneficial effects for the
telemonitoring group concerning device-acceptance and level
of depression, respectively. CONCLUSIONS: Our results
suggest that the use of TMS seems to improve QoL of ICD
patients over time. In addition, the results indicate marginal
effects on the levels of depression, anxiety, and device acceptance, which have to be further validated by in larger patient
cohorts with longer FU periods.
1524 Abstract 1922
301
1
Klinikum der Universitt Muenchen, Muenchen, Germany;

Medtronic GmbH, Meerbusch, Germany
REDUCTION OF INAPPROPRIATE THERAPIES:

REMOTE MONITORING FOLLOW-UP OF 387
CRT-D
Peggy Jacon1, Alix Martin1, Natacha Pellet1, Hager Rekik1,
Jean Jacques Ndjessan1, Pascal Defaye1
1
CHU Grenoble, Grenoble, France
Purpose: Remote monitoring (RM) is now accepted as a safe
alternative to standard follow-up (sFU) for ICD. Methods: We
analyzed the long term arrhythmic events and device-related
outcomes in the specific setting of CRT-D. Patients (pts) were
equipped with Boston (52 %), Medtronic (36 %), St Jude Medical (10 %), Biotronik (1 %) and Sorin (1 %) RM systems. FU
started after hospital discharge. Automatic FU with RM was
performed every 3 months, with at least one sFU/year. In emergency cases, pts were invited for in-hospital control visits. ICDs
were programmed with two zones (VT zone >180 bpm/VF
zone>220 bpm). All RM alerts and related EGMs as well as
the reasons of therapies were reviewed by two physicians Results: Three hundred eighty-seven pts (83 % male, 679 year
olds) were enrolled. Forty-six percent had ischemic cardiomyopathy, 43 % previous history of AF. Seventy-eight percent
were primary prevention ICDs. During a FU period of 32
12 months, we noted 1814 automatic RM FU and 21 sFU
visits/patient. Fifty-two pts died during FU. Fifty-five pts had
major alerts (26 for ICD lead dysfunction, 15 for ERI reached,
12 for electrical storm, two therapies off). Within 157 pts with
minor alerts, 78 refers to AF, with for 28 pts early detection of
unknown AF resulting in therapy modifications. One hundred
one appropriate (app) shocks occurred in 33 pts (9 %). Thirtytwo inappropriate shocks occurred in 11 pts (3 %) and were
mainly due to AF (64 %, other: sinus tachycardia 18 %, lead
dysfunction 9 %, T oversensing 9 %). Sixty-five pts had app
ATP (17 % of the population). Fourteen pts with high LV lead
impedance detected by RM had LV lead dislodgement and
underwent early intervention. Conclusion: In a large singlecenter observational study, RM has demonstrated to be an effective method of FU for ICD-CRT recipients. Early diagnoses
of AF or lead failure allow rapid management of patients and
are associated with a very low rate of inappropriate shocks
Background. Defibrillation threshold (DFT) testing for ICDs is an

established procedure to assess the ICDs ability to terminate VF
or VT. DFT-testing is controversially discussed in the literature
and is performed differently depending on the implanting facility.
Several factors have been described affecting the success of DFTtesting. In fact, no survival benefit was shown if testing was
performed or not. Predictors for the success of DFT-testing remain
incompletely understood. Objective. The study aims to retrospectively investigate the DFT-test success or failure in dependence of
disease, type of prevention and ejection fraction. Methods.
Anonymized follow-up data of ICD and CRT-D of the time between 2002 and 2013 were collected and pooled from our clinic.
Data were analyzed in a database that allows the collection of
follow-up from ICD programmer as well as telemedicine transmissions. Within the database, all parameters as well as EGMs,
episode and patient data are stored and can be analyzed. The
occurrence of successful vs. unsuccessful DFT-test was classified
by trained physicians. Results. Data were analyzed from 8300
follow-ups of 704 patients (952 ICD/CRT-D devices). We specified 79 % male, mean age 6613 years, 62.7 % primary prevention, 55 % ICM, 39 % DCM and 6 % other diseases. The cohort
encompassed 446 (47 %) single chamber, 232 (24 %) dual chamber, and 274 (29 %) three chamber devices. The devices shock
energy was 35 J (n=746), 34 J (n=7, models included 7221 and
InSync), or 30 J (n=199). During the implantation procedures,
238 DFT-tests were performed (25 %) with a mean safety-margin
of 11.69 J. Thereof, 165 tests had stored electrograms available
for the assessment of success. DFT-tests with available electrograms were performed with 15 J (n=11 (6.8 %)), 20 J (n=43
(25.9 %)), 35 J (n=96 (58.0 %)), 30 J (n=2 (1.3 %)), and 35 J
(n=13 (7.9 %)). The mean RV-shock-impedance was 55 in the
test-group and 56 in the no-DFT-test-group (not significant). In
12 (7.5 %) cases, we adjudicated DFT-test-failure. All test-failures
occurred with 35-J devices. For the test failures, there was no
statistically significant difference between primary or secondary
prevention as well as different diseases or ejection fraction. Conclusion. DFT-testing is still controversially discussed. In our cohort, DFT-testing failure was a rare but relevant problem. In our
analysis, clinical parameters have no influence of success or failure of DFT-Test. Further data is necessary to identify other relevant predictors of DFT-test failure.
1525 Abstract 1923

1526 Abstract 1928
DEFIBRILLATION THRESHOLD TESTINGIS IT
STILL NECESSARY FOR ANY PATIENT
SUBGROUP? A LARGE REAL LIFE ANALYSIS
Eimo Martens1, Johannes Siebermair1, Regina Freeden2,
Carsten Koenig2, Stefan Veith1, Moritz Sinner1, Stefan Kb1
PROJECTED NUMBERS OF REPLACEMENTS

REQUIRED DURING NATURAL LIFESPAN OF
CRTD/ICD RECIPIENTS
Ernest Lau1, Eric Hammill2, Nicholas Wold2
302
1
Royal Victoria Hospital, Belfast, UK; 2Boston Scientific

Corp, St Paul, MN, USA
Introduction: Patient life expectancy and device longevity together determine the number of replacements required during
the natural lifespan of CRTD/ICD recipients. Device longevity
can be extended by increasing the battery capacity, at the expense of a larger can size. An attempt was made to define the
optimal device longevity based on the known life expectancy of
CRTD/ICD recipients by age at first implantation. Methods:
The Device Tracking Database at Boston Scientific was interrogated for patients implanted with a CRTD (>115,000) or an
ICD (>300,000) over 18 years between 1993 and 2011. The life
expectancy of the cohort up to 1/1/2012 stratified by age at first
implantation was used to project the numbers of replacements

required for different device longevities during the lifespan of
CRTD/ICD recipients (based on the 25 % percentile of life
expectancy). Results: CRTD/ICD recipients<40 years at first
implantation had life expectancy 30 years, requiring 27
CRTD or 14 ICD replacements during their lifespan with contemporary device longevities. Recipients >70 years at first implantation had life expectancy 10 years. Device longevities of
9 years and 12 years for CRTD and ICD, respectively, will
eliminate replacement for >75 % of patients during their natural
lifespan. Conclusions: Based on actuarial data, longevity of 9
and 12 years for CRTDs and ICDs, respectively, may strike a
reasonable balance between avoidance of device replacement
and can size for patients >70 years old.
1527 Abstract 1929
IMPLANTABLE CARDIAC DEFIBRILLATOR

AMONG ADULTS WITH TRANSPOSITION OF THE
GREAT ARTERIES AND ATRIAL SWITCH
OPERATION
Abdeslam Bouzeman 1 , Eloi Marijon 1 , Maxime De
Guillebon2, Magalie Ladouceur, Guillaume Duthoit3, Raphael
Martins4, Pierre Bordachar2, David Celermajer5, Jean-Benoit
Thambo2, Laurence Iserin1, Nicolas Combes6
1
European Georges Pompidou Hospital, Cardiology Department, Paris, France Paris Cardiovascular Research Center,
Paris, France; 2CHU Haut Leveque, Cardiology Department,
Bordeaux, France; 3CHU La Pitie Salpetriere Hospital, Cardiology Department, Paris, France; 4CHU Pontchaillou,
Cardiology Department, Rennes, France; 5Sydney Medical
School, Sydney, Australia; 6Clinique Pasteur, Toulouse,
France
BackgroundThe experience with the implantable cardiac defibrillator (ICD) in patients with transposition of the
great arteries (TGA) and history of atrial switch surgery
remains limited. MethodsRetrospective evaluation
aiming to assess characteristics and outcomes of consecutive TGA patients with history of atrial switch surgery
implanted with an ICD between January 2005 and June
2012 in four French centers. ResultsOf the 12 patients
(median 34 years [28, 40]; 67 % male), four patients
(33 %) were implanted for secondary prevention after
symptomatic documented sustained ventricular tachycardia or sudden cardiac arrest. ICDs were implanted for
primary prevention in 8 patients (67 %), including cardiac resynchronization in three patients; severe systemic
ventricle dysfunction was present in all cases (median
ejection fraction 27 % [20, 40]). Overall, one patient
died during the ICD implantation secondary to refractory
cardiac arrest after defibrillation testing. Over a median
follow-up of 19 months [10, 106], six patients out of 11
(54 %) experienced worsening of congestive heart failure, including five who were eventually transplanted.
Overall, three patients (27 %) experienced significant
ICD-related complications, whereas only one patient (primary prevention indication) developed appropriate ICD
therapy (successful anti-tachycardia pacing without
shock). Half of patients presented with at least one episode of sustained (5 min) atrial arrhythmia during follow-up. ConclusionsOur findings underline the key
role of progressive heart failure in dictating outcomes
among TGA patients with prior atrial switch repair. Our
results also underline the need of better risk-stratification
for sudden cardiac death in those patients.
303
1528 Abstract 1911
AZYGOS VEIN COIL: AN ATRACTIVE ALTE

RNATIVE
Andrew Behunin 1, Michael Giudici1, Prashant Bhave 1,
Alexander Mazur1, Dwayne Campbell1
1
Introduction: In spite of improvements in implantable
cardioverter-defibrillators (ICD) such as biphasic waveforms and increased delivered shock outputs, some patients, often those with high BMI and/or dilated cardiomyopathies, will still have inadequate defibrillation with
a standard lead-to-can vector. In these patients, a subcutaneous array (SQA) may be required which adds substantial morbidity to the implant procedure. The azygos
vein (AV) courses behind the left ventricle and may
provide an improved shock vector with lower defibrillation thresholds (DFT) and avoid the procedural risks
and morbidity of a SQA. Methods: Four male patients
with failed defibrillation for ventricular tachycardia or
ventricular fibrillation (VT/VF) underwent AV coil
placement without procedural complications. In two patients, the elevated DFT was detected at initial implant,
whereas the remaining two patients were shocked three
and seven times, respectively, for clinical VT/VF before
the arrhythmia terminated.
Age BMI Heart
EF (%) LVEDD DFT before
disease
(cm)
DFT
after
40
42.8
ICM
30
7.7
Fail 40 J
41 J
29
53.1
NICM
35
6.7
Fail 30 J
28 J
52
44.3
NICM
30
6.7
3 shocks of 35 J 20 J
62
29.9
NICM
20
6.4
7 shocks of 41 J 21 J
Results: In all cases, placement of the AV coil resulted in a

successful decrease in the defibrillation threshold. In one
case, the defibrillation threshold remained at maximum output of his device; however, previous DFT testing on two
separate occasions were unsuccessful at aborting induced
VT/VF and external rescue was required. Conclusion: Azygos vein coils offer an attractive alternative for patients with
high defibrillation thresholds. The AV runs posterior to the
heart allowing for a true anterior-posterior defibrillation
vector. This coil can be placed at the time of initial implant
without significant additional procedure time or patient
morbidity. While subcutaneous arrays are also efficacious,
they may expose the patient to additional risk of bleeding,
infection, pneumothorax, extra scars, and post-procedural
pain.
304
1529 Abstract 1913
1530 Abstract 1915
REDUCTION OF INAPPROPRIATE SHOCK THER

APY IN S-ICD PATIENTS THROUGH INTR
AOPERATIVE SELECTION OF IMPLANTATION
SITE ACCORDING TO NEUROANATOMICAL CRIT
ERIA OF SENSORY NERVE SUPPLY IN ADJACENT
THORACIC MUSCLE
IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

IN PRIMARY PREVENTION FOR CHRONIC HEART
FAILURE: INCIDENCE AND PREDICTORS OF
APPROPRIATE THERAPY.
Ulrich Backenkoehler1
1
Praxis fr Kardiologie, Hamburg, Germany
Background: Implantation of subcutaneous ICD (S-ICD) has
become a routine intervention in patients in whom out of
distinct reasons the deployment of a conventional intracardiac
lead system is impossible or contraindicated. However, the
implantation of the S-ICD-can and the subcutaneous lead with
a wide field of detection may typically lead to inappropriate
myopotential detection and S-ICD-therapy as caused by ICDmovement or externally applied mechanical muscle irritation.
Myopotentials are mediated by proprioceptive sensory nerve
receptors (SNR). Therefore, we searched for number, location
and structure of SNR in the adjacent thoracic tissue of the
anterior serratus muscle (ASM) in order to identify optimal
implantation sites allowing for improvement of postoperative
results. Methods: Topography and ultrastructure of SNR in the
anterior serratus muscle were analyzed in 12 models of adult
female NMRI-mice. Three SNR-types were identified using
light and electron microscopy: muscle spindles (MSP),
lamellated Pacini corpucles (PC) and Golgi tendon organs
(GTO). Their location within the skeletal muscle was determined by 3D-image processing of three complete thorax section series. Results: Within the relevant structure of the anterior serratus muscle (ASM), a total amount of n=275 MSP
were found per thorax. The vast majority of SNR of the
MSP-type were identified either within the area of tendinous origin (n=114) or the fibromuscular tissue of
muscle insertion (n=134), respectively; in all samples,
only a very small number of MSP were located within
the central portions of the ASM (n=31). GTO (n=3
1) and rare PC were exclusively found within the fibrous tissue of the tendinous muscle insertions Conclusion: To avoid SNR irritation near the tendinous zones
of origin and insertion of the ASM that are richly supplied with a large number of MSP as well as GTO and
PC, special attention should be paid to the implantation
of the S-ICD-can within the anterolateral central muscle
region close to the landmark of the anterior axillary
line. Thus, the risk of electrical noise and thoracic
myopotential interference resulting in inappropriate SICD therapy may be reduced by a neuroanatomically
guided implantation site
Arsne Monnier1, Franois Lesaffre1, Jean Pierre Chabert1,

Pierre Nazeyrollas1, Damien Metz1
1
Service de Cardiologie CHU de Reims, Reims, France
Background: implantable cardioverter defibrillator (ICD) has
been shown to be associated with a significant reduction in the
risk of sudden cardiac death. Despite this benefit, considering
the morbidity related to implantation and the financial impact
on the health care system, it may be helpful to distinguish
patients who would most benefit from primary ICD treatment
and thus improve patient selection. The aim of this study was
to assess the prevalence and to identify the clinical predictors
of appropriate ICD therapy in patients with chronic heart failure following implantation of an ICD for primary prevention.
Methods: A monocenter retrospective analysis was performed
and all consecutive patients undergoing implantation of ICD
for primary prevention were included. Baseline patient demographic and medical data was collected from our institutional
database. Device interrogations during visits were performed
and appropriate therapies, either ATP or shock, were recorded.
The endpoint follow-up was the last available device interrogation in our center. Results: Of 317 primary prevention patients undergoing ICD implantation, 203 (64 %) had ischemic
cardiomyopathy (ICM) and 114 had non-ischemic dilated cardiomyopathy (NIDCM). After a mean follow-up time 760
599 days, 56 (17.7 %) had received appropriate ICD therapies.
Mean LVEF was 266 %. By univariate comparison, left
ventricular diastolic diameter (LVDD) 65 mm (p=0.035)
and lack of diuretic (p=0.024) were predictors for ICD therapy. Absence of cardiac resynchronization therapy device
(CRTD) was close to be significant (p=0.055). ICM and
NIDCM patients benefit from ICD implantation did not differ
(p = 0.941). By multivariate analysis, elderly patients
65 years (HR 1.92 CI 95 % 1.063.51, p=0.032), LVDD
65 mm (HR 2.01, CI 95 % 1.113.65, p=0,022) and lack of
diuretic (HR 0.31, CI 95 % 0.160.61, p<0.001) were all
significant independent predictors for ICD therapy. Overall,
the absence of CRTD device was close to be significant (HR
0.53, CI 95 % 0.281.03, p=0.062), but was significant in
NIDCM population (p=0.007). During follow-up, the onset
of atrial fibrillation (p=0.027) and hospitalization for acute
heart failure (p=0.002) were significantly associated with
ICD-delivered therapy. Conclusions: ICD therapy occurred
in 17.7 % of primary prevention patients without any difference between ischemic and non-ischemic dilated
cardiomyopathy. Older age, left ventricular dilatation and absence of diuretic were predictive factors for ICD therapy and
presence of CRTD was close to be significant.
305
approach. This has the potential to be the first line-approach for

patients on hemodialysis requiring pacing.
Poster session D part 1:

3:30 PM
Pacing and related complications
161 Abstract 2210
LIMITED VASCULAR ACCESS AND CARDIAC

PACEMAKER IMPLANTATION A NEW
APPROACH
Niall Campbell1, Ross Hunter1, Richard Schilling1
1
Queen Mary, University of London, London, UK
INTRODUCTION: Patients with long venous lines frequently have occlusion of veins in the upper mediastinum. This is
the first description of leadless pacing technology utilized in a
patient with limited vascular access and at risk of recurrent
device infection. CASE: A sixty-six-year-old man had recurrent unexplained episodes of sepsis over 8 months, which
clinically responded to broad spectrum antibiotics. He had a
history of end-stage renal disease secondary to diabetes
mellitus, requiring hemodialysis and a dual chamber pacemaker implanted in 2004 for complete AV block. Blood cultures grew Staphylococcus aureus. Transoesophageal echocardiography showed vegetations on his RV lead. LV systolic
function was good. All leads and generator were then extracted; the leads were removed percutaneously using mechanical
sheaths, although the distal tip of the RA lead remained in situ.
He received intravenous antibiotics for 3 weeks until infection
had clinically and biochemically resolved. Selective contract
injection via subclavian vein showed venous occlusion at
SVC to RA junction. Decision was made to implant a leadless
pacemaker (Nanostim, St Jude Medical). Delivery system was
administered via the right femoral vein (Figure: marked a)
and device was placed at the RV apex (b). Procedure and
screening times were 24.0 and 3.8 min respectively, with no
complications. Device parameters at 1 year follow-up were
stable with no evidence of infection recurrence. DISCUSSION:
Options for permanent cardiac pacemaker implantation are limited in patients with occlusion of the superior mediastinal veins.
In patients with limited access via the superior approach, leadless pacemaker technology provides a novel, alternative novel
162 Abstract 2312

THE PROBABILITY OF FORMATION OF VEGE
TATIONS IN PATIENTS WITH LEAD DEPENDENT
INFECTIVE ENDOCARDITIS
Anna Polewczyk1, Wojciech Jache2, Andrzej Tomaszewski3,
Wojciech Brzozowski3, Maranna Janion1, Andrzej Kutarski3
1
Swietokrzyskie Cardiology Center, II Department of Cardiology,The Jan Kochanowski University, Department of Health
Sciences, Kielce, Poland; 2Silesian Medical University, II
Cardiology Department, Zabrze, Poland; 3Medical University,
Department of Cardiology, Lublin, Poland
Background. Lead dependent infective endocarditis (LDIE) is
a serious disease with very often incidence of right heart vegetations (RHV). Factors affecting vegetations development
are relatively little known. Methods. Multivariable analysis
of factors potentially related to risk of vegetations development in group 414 patients with LDIE (280 with confirmed
RHV presence) was conducted. This group was separated
from 1426 consecutive subjects underwent transvenous lead
extraction (TLE) procedures in years 20062013 in the TLE
306
single Reference Center. Results. The results were demonstrated in the figure (Fig 1). Multivariable Cox analysis effect
of test parameters on the probability of the formation of vegetations in LDIE patients Conclusions: ICD leads presence
was a key positive factors in formation of RHV (HR 2746;
95 %CI (19143938)). Other prognostic factors were amount
of leads (increased risk by 22 %) and previous pocket inter-
ventions (increased risk by 21.5 %). Bigger left ventricle

ejection fraction was considered with lower probability of
vegetation presence It is problematic why the previously
procedures of pacemaker implantations were also a protective factor (decreased risk by 53.5 %). Both previously antibiotic and antiplatelet therapy had statistically borderline
impact
163 Abstract 2317
134 subjects without RHV was conducted. Patients were

underwent TLE due to LDIE in years 20062013 in single Reference Center. Results are demonstrate in the table and figures
IS TRANSVENOUS LEADS EXTRACTION MORE

RISKY IN PATIENTS WITH VEGETATIONS?
Anna Polewczyk 1 , Andrzej Tomaszewski 2 , Wojciech
Brzozowski2, Marianna Janion1, Andrzej Kutarski2
1
Swietokrzyskie Cardiology Center, II Department of Cardiology; The Jan Kochanowski University, Department of Health
Sciences, Kielce, Poland; 2Medical University, Department of
Cardiology, Lublin, Poland
Background. Transvenous lead extraction (TLE) is the key procedure in management of lead-dependent infective endocarditis
(LDIE). Right heart vegetations (RHV) are probably a risk factor
of procedural complications. The aim of this study is assessment
of efficacy and safety of TLE in patients with the RHV. Methods.
The comparative retrospective analysis of efficacy and safety of
TLE procedures in 280 patients with right heart vegetations and
Patients/procedures
LDIE patients LDIE patients P

with RHV
without
RHV
Number
280 (67.6 %)
134 (32.4 %)
Age of pts (years)
65.514.4
67.514.8
0.2
Sex, male (%)
186 (66.4 %)
98 (73.1 %)
0.17
Number of leads extracted (mean) (SD)
2.120.93
2.070.90
0.61
ICD lead
65 (23.21 %)
22 (16.4 %)
0.11
CS lead
58 (20.71 %)
22 (16.42 %)
0.30
Lead dwell timein months (mean)

(SD)
Unecessary loops of the leads (%)
84.6561.33
77.2458.74
0.24
25 (8.93 %)
10 (7.46 %)
0.61
Number of procedures before

2.251.43
2.271.21
0.89
extraction (mean) (SD)
Procedure timein minutes (mean) (SD) 111.4348.68 110.0761.21 0.80
Conclusions: Both groups of patients with LDIE were comparable in terms of procedural risk factors. TLE in patients
with LDIE was safety and efficacy, but presence of vegetations increased the risk of procedure. Nevertheless, clinical
success and frequency of major and minor complications were
also comparable.
307
6 (7 %), wet perforation (thin layer of fluid 5 (6 %), deep

subepicardial tip penetration 4 (5 %) but in 3 (%) of patients
diagnosis was based on other symptoms (P/S/I abnormalities).
Indications for TLE: lead dysfunction 54 (62 %), diagnosed
perforation 13 (15 %) and infection 13 (15 %). In 18 patients,
all parameters of pacing/sensing/impedance were normal
(21 %) but in other drop of sensing 41 (47 %) or sizzles 15
(18 %) were noted, rise of Pth or loss of pacing in 41 (47 %)
were observed as rise or drop in 3 of impedance in 42 (52 %)
were noted in different combinations. Atypical chest pain was
presented by 6 patients (7 %). Perforating lead location: RVA
80 (93 %), RVOT 7 %. Leads model: active fixation 45
(52 %), passive 41 (48 %). Time implantationdiagnosis:
aver. 51.0 (1146) months; 5 years 35. Fifty-nine of 86 (69 %)
perforations were diagnosed >3 years after implantation. Dry
perforation was rarely visible in standard chest X-ray, standard
ECHO showed very low sensitivity; the tip of lead must to be
search using additional projections. Conclusion: 1. Dry perforation (without cardiac tamponade or marked volume of
fluid in pericardial space) consists relatively frequent finding
in ICD pts referred fort TLE (86/390, 22 %). It demonstrates
usually as lead dysfunction mask but in remaining pts is
asymptomatic. 2. Exact ECHO examination using additional
projections and careful evaluation of evolution of P/S/I conditions permit to put more accurate diagnosis 3. Dry perforation consist late complication of ICD therapy and manner of
lead implantation seems to play important role.
164 Abstract 2320

165 Abstract 2313
DRY PERFORATIONFREQUENT MECHANISM

OF ICD LEAD DYSFUNCTION
Andrzej Kutarski 1 , Andrzej Tomaszewski 1 , Wojciech
Brzozowski1, Krzysztof Oleszczak1
1
Dept. of Cardiology, Medical University, Lublin, Poland
Theoretically increased risk of perforating lead extraction inclined us for attempt to localize tip of lead in relation to epicardium and the commonness of the observed phenomenon
was surprising. Methods: TEE and TTE and other preoperative findings from computer clinical data of patients
underwent transvenous leads extraction (TLE) in single reference center were analyzed. Results: We have extracted 2574
ingrown leads from 1536 patients; in 390 ICD leads were
extracted due to infection (39.4 %) or different form of lead
dysfunction (63,6 %). In 86 patients (22 %), we diagnosed
different forms of perforation of right ventricle wall with
ICD lead. ECHO: dry perforation (tip in epicardial space, no
fluid) 64 (74 %), small lens of dense fluid round the lead tip
LONG-TERM FOLLOW RELIABILITY OF SWEE

T-TIP TYPE SCREW-IN LEADS IN A SINGLE
JAPANESE HEART CENTER
Hidemori Hayashi1, Richard Schlling1, Asuka Takano2, Gaku
Sekita2, Hiroyuki Daida2, Yuji Nakazato3
1
St Bartholomews Hospital, London, UK; 2Juntendo University
Hospital, Tokyo, Japan; 3Juntendo Urayasu Hospital, Chiba,
Japan
Introduction: According to recent increase of patients with
cardiac implantable devices, the implanting number of pacing leads has also been increased. Although active-fixation
leads made stable atrial and ventricular pacing feasible, the
pacing lead longevity is affected by various factors such as
insulation materials, lead structures and the methods of venous approach. The purpose of this study is to investigate
long-term reliability of active-fixation leads and stability of
electrical characteristics. Methods and results: A total of
1196 pacing leads were implanted in 830 patients
308
consecutively from 2006 to 2013 in a single implanting

center in Japan. In this retrospectively study, we could trace
1092 leads in 750 patients for investigating the prognosis of
implanted leads. The measurements value of pacing thresholds, sensing amplitudes of the atrial or ventricular activities, and lead impedances were obtained from the medical
records at the time of implantation and during follow-up at
the device clinic. All pacing leads were FINELINE II
Sterox EZ Leads (Boston Scientific, MN, USA) except for
shock lead in ICD patients. The mean follow-up period was
51.329.2 month (median 48 month). Six hundred eightytwo leads were implanted in the atrium, and 410 leads in the
ventricle. The cephalic vein cut down access was 914 leads
and subclavian puncture approach was 178 leads. The overall survival rate was 99.6 % at 5 years, and 99.6 % at
10 years. The electrical characteristics of both atrial and
ventricular leads have slightly changed after implantation
but all of them remained stable during follow-up period.
Verified complete lead fractures were observed in 3 out of
1092 leads (0.27 %), and incomplete fracture in 1 lead
(0.09 %) all of which were implanted by the subclavian
puncture method. The device-related infection was observed in 4 patients (0.37 %) but all devices and leads were
extracted and then re-implanted safely. Conclusion: The
overall reliability of Sweet-tip type screw-in leads is satisfactory and electrical characteristics also clinically acceptable through long-term follow up period. The cut-down
access from cephalic vein should be recommended as the
first-line approach if considering the long-term durability

of pacing leads.
166 Abstract 2311
THE INFLUENCE OF VEGETATIONS ON CLINICAL

PRESENTATION OF LEAD DEPENDENT INFE
CTIVE ENDOCARDITIS
Anna Polewczyk 1 , Andrzej Tomaszewski 2 , Wojxiech
1
Swietokrzyskie Cardiology Center II Department of Cardiology The Jan Kochanowski University, Department of Health
Background. Right heart vegetations (RHV) are the serious
signs of lead dependent infective endocarditis (LDIE) and one
of the big diagnostic criteria of LDIE. Clinical presentation of
LDIE is very differentiated and RHV probably influence the
some symptoms and laboratory or echocardiographic parameters. Methods. The comparative analysis of clinical presentation of 280 patients with RHV with 134 subjects without
confirmed vegetations presence was conducted. These groups
were underwent transvenous leads extraction (TLE) procedure
due to LDIE in single Reference Center in years 2006-2013.
Results. The results were demonstrated in the table.
Patients / clinical presentations

n=280
Clinical symptoms
LDIE with RHV

n=134
Fever, chills (%)
LDIE without RHV
66.1
34.4
Pocket infection (%)
58.7
85.6
0.0001
Pulmonary infections (%)
28.3
17.8
0.02
Positive blood cultures (%)
66.1
75.3
0.06
Laboratory parameters
Leucocytes WBC (/l) (meanSD)
99184852
90505818
ESR (mm after1 h) (meanSD)

CRP (mg/dl) (meanSD)
44.330.2
52.566.2
39.628.5
35.052.8
0.41
0.01
Proalcitonin (pg/ml) (meanSD)
1.94.8
0.20.2
0.09
Echocardio-graphy findings
LVEF (%) (meanSD)
49.414.4
52.513.5
LVDD (mm) (meanSD)
53.710.5
54.49.4
0.55
PASP (mmHg) (meanSD)
34.717.1
29.717.0
0.06
Conclusions: RHV presence is connected with more acute

clinical manifestations of LDIE: fever, chills and pulmonary infections are significantly more frequent in these patients. Conversely, the pocket infections (PI) are less often
in LDIE with RHVprobably patients with PI are earlier
treated. From inflammatory parameters, only high CRP level is specific for RHV occurrence. Patients with RHV have
also more often systolic dysfunction of left ventricle..
0.0001
0.12
0.05
167 Abstract 2310
UNDECIDED ABOUT GETTING A PACEMAKER?

TAKE ONE FOR A TEST-DRIVE
Michael Giudici1
1
University of Iowa Hospitals, Iowa City, IA, USA
Background: Bradycardia due to sinus node disease or slow

conduction of atrial fibrillation may be a slowly progressive
problem that occurs over years. Some patients, and implanters,
are ambivalent about proceeding with pacemaker implantation
where there may not be clear evidence of benefit. We offer these
patients a 2-week test-drive to allow them to assess the potential
benefit of a permanent pacemaker implantation. Methods: Over
a 42-month period, five patients (3 F/2 M, aged 4082 years)
with sinus bradycardia-4 and slow conduction of atrial
fibrillation-1 underwent percutaneous placement of a permanent pacing lead via a subclavian approach in either the right
atrium-4 or right ventricular septum-1. The lead was then attached to a non-sterile permanent pacemaker which was sewn
to the skin and an occlusive dressing was applied. The device
was then programmed to a rate-responsive mode at appropriate
heart rates for each patient. After 2 weeks, the devices were
removed. Results: All five patients subsequently chose to undergo permanent pacemaker placement. There were no complications associated with the initial implantation procedure, the 2week trial period, or device removal. Conclusions: In
bradycardic patients who are undecided about pacemaker implantation, a 2-week test-drive with percutaneously placed temporary permanent pacemaker allows the patient to experience
the clinical impact of pacing therapy and may aid in their decision to proceed with the permanent implant.
309
white (11.5 F) frequently needed for ICD leads removal were

second (31 %), orange (13 F) used as an option if procedural
difficulties arose, were broken rarely (15 %). In 20 % of procedures fracture of another sheath occurred in the same location. Eighty percent of damages were eliminated by covering
the broken inner sheath with outer sheath and their removal. In
10 % cases, wider dilator was introduced over the damaged
one and extracted at the end of the procedure with the lead.
BDF was observed more frequently in younger patients, in
those with more implanted leads, with longer lead body dwelling time, with unnecessary lead loops and with leads on both
sides of the chest. Fractures may be connected with the phenomenon of lead-to-lead adherence and TLE from right subclavian approach. Although BDF concerned more difficult
procedures, complications rate in these cases was not significantly higher. Full radiological success rate was slightly lower
probably because the leads were strongly ingrown in vessel
walls. Conclusion: Byrd dilator fracture phenomenon should
be well known to the operator. To prevent serious consequences, a whole sheath ought to be observed all the time
during procedure. Keywords: lead extraction, lead extraction
technical problems, Byrd dilator fracture, sheath fracture,
extracting damaged sheath, complications of lead extraction
169 Abstract 3113
168 Abstract 2324
POLYPROPYLENE BYRD DILATOR SHEATH FRAC

TUREMAY LEAD TO SERIOUS PROBLEMS IF
NOT IDENTIFIED ON TIME.
Andrzej Kutarski1, Maciej Polewczyk2, Aneta Polewczyk2,
Anna Polewczyk3
1
Dept of Cardiology Medical University, Lublin, Poland;
2
District Hospital, Kielce, Poland; 3II Dept. of Cardiology
Swiektokrzyskie Cardiology Center; Dept. of Health Scientes
The Jan Kochanowski University, Kielce, Poland
Byrd dilator sheath fracture (BDF) during transvenous lead
extraction (TLE)is not a complication if recognized by the
operator immediately and eliminated by replacing a damaged
sheath with a new one. Objective: The evaluation of BDF
prevalence, circumstances and its impact on TLE efficacy.
Methods: The retrospective analysis of 1728 TLE procedures
(2901 extracted leads) in Reference Centre in Lublin. Results:
Fracture or even rupture of mechanical sheath occurred relatively rarely (2.25 % procedures, 1.34 % extracted leads).
BDF was identified in: superior vena cava (45 %), right atrium
(20 %), right brachiocephalic vein (20 %), left subclavian vein
(13 %) and right ventricle (3 %). Green sheaths (10 F) used in
pacemaker leads extraction were most often damaged (51 %),
TIME COURSE AND CHARACTERISTICS OF TACH

YARRHYTHMIAS AFTER IMPLANTATION OF THE
HEARTMATE II
Ameeta Yaksh1, Charles Kik1, Paul Knops1, Korinne Zwiers1,
Maarten J.B. Van Ettinger1, Marcel C.J. De Wijs1, Peter Van
de Kemp2, Olivier C. Manintveld1, Alina A. Constantinescu1,
Ad J.J.C. Bogers1, Natasja N.M. De Groot1
1
Erasmus MC, Rotterdam, Netherlands; Sorin, Rotterdam,
Netherlands
Background: Ventricular tachyarrhythmias (VTA) have been
frequently reported after implantation of left ventricular assist
devices but there is no information on supraventricular tachycardias. The goal of this study was to examine not only the
frequency and characteristics of ventricular tachycardias (VT)
after implantation of the Heartmate II but also (supra) ventricular
ectopic beats ((S)VEB) and atrial flutter (AFL)/fibrillation (AF).
Methods: Continuous rhythm registrations were obtained from 8
patients (7 male; 4312 years) during the first 5 days after
Heartmate II implantation. Hospital records were analysed to
examine late postoperative tachyarrhythmias. Hemodynamic
parameters (mean arterial pressure (MAP), right atrial pressure
(RAP), heart rate (HR) and ST-deviation (d-ST)) prior to VT
episodes were compared with sinus/pacing rhythms (reference
periods). Results: VT (N=6), AF (N=3) and AFL (N=1) were
310
pre-operatively present in 6 patients. VEBs were postoperatively

observed in all patients. Frequent single VEBs (>10/H,N=
90.111), ventricular-couplets, runs, single SVEBs, SV-couplets,
runs occurred in, respectively, 42.2, 34, 20, 3.9, 2.6 and 1.4 % of
the recording time. Prior to VT episodes (N=121), MAP decreased, HR, d-ST increased and RAP remained unaltered. Postoperatively, 5 patients developed either VT (N=2), AF (N=1) or
both VT/AF (N=2) during a follow-up of 1814 months. PoVT
were mainly preceded with sinus rhythm (46 %) or short-longshort-sequence (43 %) and initiated by V-run (43 %). Conclusion: Both atrial and ventricular tachyarrhythmias are frequently
observed in patients after Heartmate II implantation despite improvement in cardiac hemodynamics caused by cardiac
unloading.
1610 Abstract 2316
TRANSVENOUS LEADS EXTRACTION IN
DIABETIC PATIENTS- SAFETY AND EFFE
CTIVENESSESS, SINGLE CENTER ANALYSIS
AMONG 1715 PROCEDURES
Anna Polewczyk 1 , Andrzej Tomaszewski 2 , Wojciech
1
Swietokrzyskie Cardiology Center, II Department of Cardiology; The Jan Kochanowski University, Department of Health
Background. The relationship between diabetes mellitus and
risk of transvenous leads extraction (TLE) procedure has not
been investigated thoroughly. Methods. Analysis of clinical
data two groups of patients: 323 diabetic and 1392 nondiabetic underwent TLE in single Reference Center in years
20062013 was conducted. Clinical and procedural risk factors
were assessed with comparison of safety and efficacy of TLE in
these patients. Results. The results are demonstrated in the table
BMI
Number of leads in heart before
lead extraction (SD)
Number of extracted leads in
one patient (SD)
Number of leads in the system
Number of abandoned leads
29.45.0
1.930.76
26.98.0
1.990.80
<0.0001
0.22
1.640.82
1.650.79
0.84
1.780.67
0.160.50
1.800.63
0.230.57
0.61
0.04
CS lead extraction
ICD lead extraction
4513.93 %
9629.72 %
19,514.01 %
846.03 %
0.97
<0.0001
Overmuch of lead length in

right atriumtoo long loops
or long loop in tricuspid
valve
Number of procedures before
lead extraction
Mean extracted lead body
dwelling time (months)
Intracardiac abrasion of the
leads
Operating room stay-in time
(whole procedure duration)
(minutes)
Major complications
5115.79 %
34,124.50 %
<0.01
1.751.03
1.921.19
0.02
71.857.9
84.360.6
0.0008
5517.03 %
27,019.40 %
0.31
106.939.7
109.246.7
0.41
20.62 %
221.58 %
0.18
Minor complications
61.86 %
201.44 %
0.58
Technical problems during

TLE
Full radiological success
4012.38 %
22,616.24 %
0.09
31,296.59 % 132,094.83 % 0.18
Clinical success
32,099.07 % 136,297.84 % 0.15
Full procedural success
31,296.59
131,994.76 % 0.17
Death during periprocedural

period
20.62 %
60.43 %
0.63
Conclusion. Safety and efficacy of TLE procedures were comparable in two groups of patients butparadoxicallypatients with diabetes had less potential procedural risk factors.
Especially, the lead dwelling time was significantly longer in
non-diabetic population. Additionally, abandoned leads and
loops of the leads, often ingrown, were also more often in
patients without diabetes mellitus. Probably, these differences
balanced the risk of TLE in patients with vegetationsmore
often in diabetic subjects.
Atrial fibrillation and anticoagulant therapy
Patient/system/procedure
information
Diabetes
No diabetes
1611 Abstract 1518

1392
Number of patients
323
Patients age (SD)
69.0010.28 63.7016.85
<0.0001
Sex (female)
11,134.37 % 56640.66 %
0.04
Infective indications (LDIE)
6319.50 %
21,715.59 %
0.09
Vegetations
Infective indications (pocket
infection)
Infective indications (total)
7924.46 %
8526.32 %
26,819.25 %
32,323.20 %
0.04
0.23
14,845.82 % 54,038.79 %
0.03
Non-infective indications
17,554.18 % 85,261.21 %
0.03
Prior sternotomy
4915.17 %
20,214.51 %
0.75
Renal failure (crea >2.0) or

hemodialysis
154.64 %
332.37 %
0.03
A CROSS-SECTIONAL SURVEY ON THE PERC

EPTION OF THE ANTICOAGULANT TREATMENT
IN ATRIAL FIBRILLATION IN PHYSICIANS FROM
COUNTY HOSPITALS
Yihong Sun1, Changying Wang2, Yitong Wang1, Dayi Hu3,
Lina Wang3
1
Heart Center, Peking University Peoples Hosiptal, Beijing,
China; 2 Department of Cardiology,The First Affiliated
Hosiptal of Chongqing Medical University, Chongqing,
China; 3Peking University Peoples University, Beijing, China
Objective: Warfarin was underused in Chinese patients with

atrial fibrillation (AF) especially in low-level hospitals. The
purpose of this survey was to investigate the perceptions of
the prevention from stroke by giving warfarin in physicians
from county hospitals. Methods: A cross-sectional survey
was conducted in a convenience sample of physicians from 9
county hospitals in Jiangsu, Henan, Zhejiang provinces. The
questionnaire consisted of questions on physicians knowledge, awareness and concerns regarding atrial fibrillation diagnosis, risk score of thrombosis and hemorrhage and warfarin
treatment, including the rate of anticoagulation, CHAD
S2score, CHA2DS2-VASC score, HAS-BLED score and the
target of international normalized ratio (INR),etc. Results:
From Jun to Nov in 2013, 292 questionnaires were returned
from 9 county hospitals. Most of physicians 83.2 % (173) were
from tier 1 and 2 hospitals. The median percentage of the
anticoagulant treatment self-reported was
30.0 %(10.0 %60.0 %) in patients with rheumatic valvular
AF, 20.0 %(10.0%50.0 %) in patients with non valvular
AF and80.0 %(40.0%100.0 %) with post mechanical heart
valve replacement. The most common concerns of prescribing
warfarin were about the bleeding adverse reactions related to
warfarin 74.0 % (154), regular assessment of monitor coagulation 65.4 % (136) and advanced age 44.7 %(93). Half 51 %
(106) of the physicians will use ECG for the diagnosis of AF
and only 28.3 % (59) will use both ECG and Holter. Among
the physicians who reported using INR to monitor warfarin,
62.5 % (130) indicated a target range between 2 and 3 and
lower target were indicated in one third of the participants.
The proportion of the physicians who were aware of CHAD
S2 score and CHA2DS2-VASC score were 51.0 % (106) and
41.3 %(86), but the correct answer to the risk factors only
accounted for 15.4 %(32and 6.3 %(13) respectively. Although 34.6 % (72) of the physicians were aware of HASBLED score, only 5.3 % (11) correctly selected the 9 parameters. 68.3 % (142) of the physicians indicated the Vitamin K is
the antidote for warfarin. Conclusions: This study highlighted
physicians concerns and deficits in knowledge regarding the
risk stratification and anticoagulant treatment in AF patients.
Concerns about the risks of bleeding and INR monitoring appeared to be the biggest barriers for anticoagulant. Keywords:
Atrial fibrillation, Anticoagulation; Knowledge; Warfarin;
311
She had presented with persistent atrial fibrillation and mild

hypertension in 2008 at age 57 (CHADSVASC score of 2)
and was started on warfarin. Later that year, she was fitted with
a DDD pacemaker because of severe symptomatic bradycardia
induced by beta blockers used for rhythm control. She was
paced at 80 BPM and free of atrial fibrillation for at least
6 months prior to her presentation to the emergency (ER) Nov
2, 2013, with acute appendicitis. Her INR was reversed with
vitamin K; she underwent appendectomy later that day and
was discharged on warfarin, Nov 4, with an INR of 1.4. On
Nov 7, she had a massive right hemispheric stroke and was
given immediate thrombolysis which resulted in a hemorrhagic
transformation of the stroke; warfarin was stopped. Dec 2, she
presented again to ER with deep vein thrombosis and was fitted
with an inferior vena cava (IVC) filter. For stroke prevention,
she was considered for a left atrial occlusive device (LAOD). A
transoesophageal echo (TEE), however, revealed two left atrial
clots. A CT scan revealed only partial resolution of the right
hemispheric hematoma. The patient was started on apixaban
2.5 mg BID. Two months later, there was a complete resolution
of all left atrial clots. Her repeat CT scan had also shown continuous resolution of the right hemispheric clot and the dose of
apixaban was increased to full dose, 5 mg BID. Nov 2015, the
patient has made a substantial recovery of her left hemiplegia is
able to talk and walk unaided. She remains in SR on apixaban
5 mg BID, sotalol and anti-hypertensive. Conclusion: Apixaban
2.5 mg can resolve left atrial clots without increasing preexisting brain hematoma. Vitamin K may result in a prothrombotic state, when used to reverse warfarin anticoagulation.
1613 Abstract 1414
A CROSS-SECTIONAL SURVEY ON THE PERC

EPTION OF THE ANTICOAGULANT TREATMENT
IN ATRIAL FIBRILLATION IN PHYSICIANS FROM
COUNTY HOSPITALS
Yihong Sun1, Changying Wang2, Yitong Wang1, Dayi Hu1,
Lina Wang1
1
Heart Center, Peking University Peoples Hosiptal, Beijing,
China; 2 Department of Cardiology,The First Affiliated
Hosiptal of Chongqing Medical University, Chongqing, China
1612 Abstract 1517

APIXABAN 2.5 MG BID CAN REVERSE LEFT ATRI
AL APPENDAGE CLOT.
Magdi Sami1, Beatriz Vaquerizo1
1
McGill University, Montreal, Canada
This is the case presentation of a 63-year-old woman who
sustained a massive right hemispheric stroke on Nov 7, 2013.
Background: Warfarin was underused in Chinese patients with

atrial fibrillation (AF) especially in low-level hospitals. The purpose of this survey was to investigate the perceptions of the
prevention from stroke by giving warfarin in physicians from
county hospitals. Methods: A cross-sectional survey was conducted in a convenience sample of physicians from 9 county
hospitals. The questionnaire consisted of questions on physicians knowledge and concerns regarding atrial fibrillation diagnosis and warfarin treatment, including anticoagulation rate,
312
CHADS2score, CHA2DS2-VASC score, HAS-BLED score and

the target of international normalized ratio (INR). Results: From
Jun to Nov in 2013, 292 questionnaires were returned from 9
county hospitals. The median percentage of the anticoagulant
treatment self-reported was 30.0 % (10.0%60.0 %) in patients
with rheumatic valvular AF, 20.0 % (10.0%50.0 %) with
non-valvular AF and80.0 % (40.0%100.0 %) with post mechanical heart valve replacement. The most common concerns of
prescribing warfarin were about the bleeding adverse reactions
related to warfarin 74.0 % (154), regular assessment of monitor
coagulation 65.4 % (136) and advanced age 44.7 % (93). Half
51 % (106) of the physicians will use ECG for the diagnosis of
AF. Among the physicians who reported using INR to monitor
warfarin, 62.5 % (130) indicated a target range between 2 and 3.
The proportion of the physicians who were aware of CHADS2
score and CHA2DS2-VASC score were 51.0 % (106) and
41.3 % (86), but the correct answer to the risk factors only
accounted for 15.4 % (32and 6.3 % (13)), respectively.
Although 34.6 % (72) of the physicians were aware of HASBLED score, only 5.3 % (11) correctly selected the 9 parameters.
Of the physicians, 68.3 % (142) indicated the vitamin K is the
antidote for warfarin. Conclusions: This study highlighted physicians concerns and deficits in knowledge regarding the risk
stratification and anticoagulant treatment in AF patients. Concerns about bleeding risks and INR monitoring appeared to be
the biggest barriers for anticoagulant.
1614 Abstract 1550
DIFFERENT ORAL ANTICOAGULANTS IN

REAL-LIFE PATIENTS WITH ATRIAL
FIBRILLATION : CLINICAL ASPECTS AND
PROBLEMS
Olga Litunenko1, Baiba Lurina1, Marina Kovalova2, Gita
Rancane, Iveta Sime4, Valters Stirna4, Galina Dormidontova5,
Janis Guslens6, Biruta Tilgale7, Davis Polins1, Janis Raibarts,
Janis Pudulis7, Evija Miglane8, Aivars Lejnieks7, Oskars
Kalejs8
1
Riga Stradins University, Riga, Latvi; 2Jelgava Regional
Hospital, Jelgava, Latvia; 3Ventspils Regional Hospital,
Ventspils, Latvia; 4Liepaja Regional Hospital, Liepaja,
Latvia; 5Daugavpils Regional Hospital, Daugavpils, Latvia;
6
Riga Technical University, Riga, Latvia; 7Riga East University Hospital, Riga, Latvia; 8P. Stradins Clinical University
Hospital, Riga, Latvia
Background. Oral anticoagulants (OAC) have been the firstline medication for prevention of thromboembolic events in
patients with non-valvular atrial fibrillation (NVAF) for a long
time, although the usage of vitamin K antagonists (VKA)
causes many problems for patients and physicians. Novel
OAC (NOAC) implementation in practice is undergoing

slowly. Methods. The study enrolled 3542 patients with
NVAF under OAC therapy in Latvian hospitals and praxis.
Side effects, drug interactions, and complexity of OAC usage
were analysed. Events of bleeding were defined as clinically
relevant major bleeding (CRMB) and clinically relevant nonmajor bleeding (CRNMB) according to international guidelines. The second study group included 245 medical practitioners with clinical experience in care of NVAF patients.
Results. There were 2214 (62.5 %) users of VKA and 1328
(37.5 %) users of NOAC. According to CHA2DS2-VASc, in
VKA group, scale median was 3.9, in NOAC groupit was
2.8. Significantly higher incidence of side effects was detected
among VKA compared to NOAC users. All cases of bleeding
were reported as follows: 31 % in VKA vs 3.3 % in NOAC
users (p< 0.001); CRMB in VKA group had 52 patients
(2.3 %) vs 3 (0.2 %) CRMB were observed in NOAC (702
dabigatran and 626 rivaroxaban). CRNMB in VKA group had
194 patients (8.76 %) vs 21 (1.6 %) in NOAC (p<0.01). No
significant difference between dabigatran 150 mg and
Rivaroxaban 20 mg, but only one CRNMB in dabigatran
110 mg. More than 50 % of the VKA users had difficulties
to adjust OAC dose and to keep the INR between 2.0 and 3.0
and 31.8 % had problems with INR control. Dabigatran was
preferred in electrical cardioversion subgroup 64.7 vs. 35.3 %
VKA with significantly lower rates of adverse events
(p<0.001) and bleeding. In physicians group, 13.9 % cardiologists, 20.8 % internal specialties, 23.8 % general practitioners, 8.9 % surgeons and others, 32.7 % resident physicians48.5 % did use NOAC in practice. Not sufficient clinical experience was mentioned as main problems for NOAC.
The main problems for VKA are lack of compliance, poor
INR control and difficulties in dose adjustment. Conclusions.
Clinical usage of OAC for AF patients is more complicated in
VKA group due to side effects and complexity of use. NOAC
are more safety and have significantly less complications and
bleeding rate. In electrical cardioversion group, NOAC are
preferable for use before and after procedure. Physicians find
the usage of NOAC less problematic and they would be ready
to use NOAC in practice more often.
1615 Abstract 0118
ASSESSMENT OF THE SPATIO-TEMPORAL

STABILITY OF VOLTAGE DURING ATRIAL
FIBRILLATION: QUANTIFYING THE TIME COUSE
OF MEAN PEAK-TO-PEAK AF VOLTAGE ALLOWS
FOR MEANINGFUL SPATIAL DIFFERENTIATION
FOR THE PERSISTENT AF SUBSTRATE
Norman Qureshi1, Matt Shun-Shin1, Steve Kim2, Chris
Cantwell1, Rheeda Ali1, Caroline Roney1, Fu Siong Ng1,
Arunashis Sau1, Sajad Hayat1, Michael Kao-Wing1, Elaine

Lim1, Ian Wright1, Nick Linton1, David Lefroy1, Zachary
Whinnett1, D Wyn Davies1, Prapa Kanagaratnam1, Nicholas
Peters1, Phang Boon Lim1
1
Imperial College, London, UK; 2St Jude Medical, St Paul,
MN, USA
Background. Voltage mapping in atrial fibrillation (AF)
has been largely ignored due to its spatiotemporal variability and limitations of current 3D mapping systems.
Although varying with time, AF voltage may inform us
of the underlying AF substrate. We sought to systematically characterize voltages in AF over varying sampling
windows in patients with persistent AF (PsAF).
Methods. Patients undergoing PsAF ablation underwent
sequential voltage mapping of the entire left atrium
(LA) using a 20-pole spiral catheter. The mapping catheter was held stable at each LA site for at least 8 s.
Data acquired was exported into a custom-written software for analysis of the mean AF peak-to-peak voltage
313
(AF-V) over multiple sampling windows. Results. We

analyzed 51,706 AF cycles (AFCY) from 1113 electrode
positions from 8 patients [6211 years, LA 416 mm,
CHADSVASC 1.8 (03)]. The cycle-to-cycle AF-V variability of a single AFCY was large, with a coefficient
of variation (CoV) of 62 %. Increasing the number of
AFCY sampled improved the CoV (2 AFCY 40 %, 40
AFCY 8 %). Figure 1 shows the crossover of mean AFV between the top and bottom quartiles of 172 electrograms sampled over approximately 50 AFCY in a single
patient. Across 8 patients, this trend was consistent,
with clear separation of the bottom and top AF-V quartiles when sampling was above 1015 AFCY. In addition, the mean AF-V tends to settle to a stable baseline over a similar sampling window. Conclusion. Peakto-peak voltage in AF is highly variable but increasing
its sampling window allows for meaningful spatial differentiation. Further interrogation of these distinct sites
may yield crucial insights into the underlying mechanisms of AF maintenance.
314
Arrhythmias in childhood
1616 Abstract 0122
ENDOGENOUS INTOXICATION IN CHILDREN

WITH HEART RHYTHM DISTURBANCES AND DISE
LEMENTOSIS
Ann Dubova1
1
Donetsk national medical university named after M. Gorky,
Donetsk, Ukraine
The study purpose is the assessment of endogenous
intoxication rates in children with heart rhythm disturbance having diselementosis. The main group included
59 children (36 girls and 23 boys) in the age from 6 to
18 years old with different heart rhythm disturbances.
The control group consisted of 35 health children of
the same age (18 girls and 17 boys). Functional state
of cardiovascular system was assessed by the standard
ECG data, 24-h monitoring by Holter ECG. The biochemical markers of endogenous intoxication were as
follows: the concentration of malonic dialdehyde in
blood plasma, reduced glutathione (GSH) in red blood
cells, lactate dehydrogenase activity in red blood cells.
The content of 17 chemical elements (9 toxic and 8
potentially toxic) in children bodies was determined
by its level in hair with the help of atomic absorption
spectrometry and atomic emission spectrometry. The
statistic processing of study results was made by the
variational statistics and alternative statistics methods
by rate calculation of Spearman rank correlation. In
44 (74.6 %) patients with arrhythmia was documented
the exceeding of acceptable concentration of the following toxic chemical elements: barium, cadmium,
lead, quicksilver, strontium, aluminium, bismuth (in
healthy, ones it was 17.1 %, <0.01). In 29 (49.2 %)
patients was stated an excess of potentially toxic microelements: strontium, nickel, lithium, arsenic. In all the
patients with clinical signs of endotoxicosis was fixed a
raised lactate level that was reliably more frequent in
comparison with the health controls (11.4 %, <0.001).
At the same time, the lactate dehydrogenase activity
decrease was notable in 36 (61.0 %) persons with arrhythmia (in healthy controls, it was 31.4 %). It is
important to notice that in 48 (81.4 %) patients with
arrhythmia, the GS level was decreased whereas in
the healthy control group, this decrease had only 8
(25.7 %) persons ( < 0.05). Increase grade of lactate
in patients with arrhythmia highly correlated with the

severity of clinical signs of endogenous intoxication
(r =0.88), the concentration of toxic chemical elements
(r =0.86), life-threatening nature of the arrhythmia (r=
0.84). All the patients with arrhythmia and
diselementosis the clinical manifestations of chronic endogenous intoxication, confirmed by laboratory studies,
are identified that reliably distinguished from the health
control rates. The lactate increase grade in patients with
arrhythmia was highly correlated with the severity of
clinical signs of endogenous intoxication, the concentration of toxic chemical elements, life-threatening nature of the arrhythmia.
Poster session D part 2:
05:00 PM
Syncope
1617 Abstract 1015
CARDIONEUROBLATION IN THE RIGHT ATRIUM

AS THERAPY FOR CARDIOINHIBITORY
NEUROCARDIOGENIC SYNCOPE
Marco Rebecchi1, Luigi Sciarra1, Ermenegildo De Ruvo1,
Alessio Borrelli 1 , Antonella Sette 1 , Antonio Scar 1 ,
Domenico Grieco 1 , Marianna Sgueglia 1 , Alessandro
Politano1, Annamaria Martino1, Giacomo Strano2, Stefano
Strano2, Leonardo Cal1
1
Policlinico Casilino, ASL RMB, Rome, Italy; 2Universit of
Rome La Sapienza, Rome, Italy
Introduction. Clinical management of cardio-inhibitory
neurocardiogenic syncope (CNS) is often considered difficult especially in young patients with frequent refractory episodes also considering the problematic choice
regarding an eventual pacemaker (PMK) implant. Background. Considering that a significant number of ganglionated plexi (GP) are placed in the right atrium (RA),
we hypothesized that transcatheter radiofrequency ablation of these selected areas could be an effective treatment to abolish or to reduce CNS episodes. Methods.
Seven patients (mean age 477 years) affected by frequent typical CNS episodes associated a physical trauma
and with a positive response during HU tilt test (T)
underwent to RA vagal denervation. An extensive ablation approach at anatomical site of GP (previously described in anatomical study) was performed until atrial
electrical activity was completely eliminated (<0.1 mV)
and/or vagal reflexes disappeared. Heart rate variability
(HRV) and HUT evaluation was assessed at baseline, at
1 day after ablation and at 1,3, 6 and 12 months followup. Results. Six patients were free from new syncopal
episodes (and cardioinhibitory response at HUT) at a
mean FU of 13.24.4 months. The patient with early
315
vagal tone restoration suffering from 3 episodes of nausea and dizziness, not followed by the loss of consciousness for effective counter-pressure maneuvers.
Conclusions. Cardioneuroablation in RA could be considered an alternative and safe strategy to reduce CNS
episodes especially in young patients avoiding or
delaying as much as possible PMK implant. A study
including a greater number of patients and long term
FU is necessary to understand the real efficacy of this
procedure.
316
Table 1. Clinical characteristics of the study group
1618 Abstract 1010
THE IMPACT OF GENDER ON THE FREQUENCY

OF SYNCOPE PROVOKING FACTORS AND
PRODROMAL SIGNS IN PATIENTS WITH
VASOVAGAL SYNCOPE
1
Piotr J. Stryjewski ; Agnieszka Kuczaj ; Jadwiga Nessler ;

Bohdan Nessler3; Ryszard Braczkowski4; Ewa NowalanyKozielska2
1
Cardiology Department, Chrzanow City Hospital, Poland
2
2nd Department of Cardiology, Zabrze, Medical University
of Silesia, Katowice, Poland
3
Coronary Disease Department, Institute of Cardiology, Medical School of Jagiellonian University, John Paul II Hospital,
Cracow, Poland
4
Department of Public Health, Medical University of Silesia,
Katowice, Poland
Background: The aim of the study was a comparative
analysis of syncope provoking factors and prodromal
signs in patients with vasovagal syncope with consideration given to gender. Materials and methods: We investigated 80 patients (40 men and 40 women), aged 18
75 years with previously diagnosed vasovagal cause of
syncope. History was obtained from all the patients,
with consideration given to the total number of syncopal
and presyncopal episodes and age at first syncope. Special attention was paid to the frequency of precipitating
factors such as a supine, sitting or standing position,
activity and prodromal signs. Results. In the studied
group, the mean age at first syncope was significantly
lower in women (23.210.7) as compared to men (30.7
17.4). The mean total number of syncopal and
presyncopal episodes was higher in women (13.311.0
vs. 7.86.6, p=0.02; 26.622.9 vs. 13.826.9, p=0.01)
(Table 1). In the group of men, syncopal episodes were
more frequent after urination and defecation. The remaining circumstances related to syncope were more
prevalent in women, but only the occurrence of a syncopal episode during walking achieved statistical significance. All the prodromal signs that were analysed occurred more frequently in the group of women compared to men. Statistical significance was achieved for
the analysed signs such as generalized weakness, dyspnea, heart palpitations, cold sweats, feeling of cold or
heat, visual disturbances, tinnitus, headache (Table 2).
Conclusions. Syncope provoking factors and prodromal
signs occur more frequently in women.
Parameter
Whole studied Men n=40XSD Women

p (women vs.
group
n=40X
men)
n=80XSD
SD
Age (SD)
in years
Weight
4316.5
44.616.6
42.116.6
0.01
72.414.0
81.511.7
63.710.5
<0.0001
Height
168.49.5
177.36.8
162.75.9
<0.0001
BMI
24.64.0
25.73.8
23.94.1
NS
30.717.4
23.210.7
0.01
7.86.6
13.311.0
0.02
13.826.9
26.622.9
0.01
Age at first
27.114.2
syncope
(years)
Number of
11.110.4
syncopal
episodes
before
admission
Number of
18.325.6
presyncopal
episodes
Table 2. Frequency of triggering factors in the studied groups
Parameter
Whole
studied
group
n=80n
(%)
62 (77.5)
Men
n=40n
(%)
Women
n=40n
(%)
p (women
vs. men)
30 (75)
32 (80)
NS
Syncope in a standing
position n (%)
Syncope in a sitting
position n (%)
Syncope in a standing
position n (%)
Syncope during walking
n (%)
Syncope after urination
n (%)
Syncope after Defecation
n (%)
Prodromal signs n (%)
73 (91.3) 36 (90)
37 (92.5) NS
General weakness n (%)

Dyspnea n (%)
49 (61.3) 22 (55)
46 (57.5) 20 (50)
27 (67.5) 0.02
26 (66)
0.01
34 (42.5) 15 (37.5) 19 (47.5) NS

3 (3.8)
1 (2.5)
2 (5)
NS
34 (42.5) 12 (30)
24 (55)
0.01
3 (3.8)
3 (7.5)
0.001
7 (8.8)
4 (10)
3 (7.5)
NS
Heart palpitations n (%)
45 (56.3) 19 (47.5) 26 (65)
0.01
Cold sweats n (%)
37 (46.3) 11 (27.5) 26 (65)
0.001
Feeling of hot/cold n (%)
42 (52.5) 18 (45)
0.002
Visual disturbances n (%) 56 (70)
24 (60)
27 (67.5) 29 (72.5) 0.01
Dizziness n (%)
43 (53.8) 21 (52.5) 17 (42.5) NS
Tinnitus n (%)
Headache n (%)
35 (43.8) 13 (32.5) 22 (55)

27 (33.8) 11 (27.5) 16 (40)
0.01
0.02
Stomachache n (%)
13 (16.3) 5 (12.5)
NS
Nausea n (%)
28 (35)
8 (20)
13 (32.5) 15 (37.5) NS
317
1619 Abstract 1016
COMPARISON OF SYNCOPE PRODROMAL SIGNS

REPORTED DURING HEAD-UP TILT TEST WITH
OCCURRING BEFORE SPONTANEOUS SYNCOPAL
EPISODES IN PATIENTS WITH VASOVAGAL
SYNCOPE
Piotr Stryjewski1, Agnieszka Kuczaj2, Ryszard Braczkowski3,
Jadwiga Nessler 4 , Bohdan Nessler 4 , Ewa NowalanyKozielska2
1
Cardiology Department, Chrzanow City Hospital, Poland,
Chrzanow, Poland; 22nd Department of Cardiology, Zabrze,
Medical University of Silesia, Katowice, Poland, Zabrze,
Poland; 3Silesian Medical University, School of Public
Health, Department of Public Health Bytom, Poland, Bytom,
Poland; 4Coronary Disease Department, Institute of Cardiology, Medical School of Jagiellonian University, John Paul II
Hospital, Cracow, Poland, Krakow, Poland
Background. The aim of the study was a comparative analysis
of syncope prodromal signs in patients with vasovagal syncope
during head-up tilt test (HUTT) and their relationships with
those reported before spontaneous episodes. Materials and
methods. We investigated 80 patients (40 men and 40 women),
aged 1875 years with previously diagnosed vasovagal cause
of syncope. In all the patients, clinical history according prodromal signs occurring before spontaneous syncopal episode
and during HUTT was taken. Frequencies of occurrence of
prodromal signs such as the following were analysed: general
weakness, dyspnea, heart palpitation, cold sweats, feeling of
hot/cold, visual disturbances, dizziness, tinnitus, headache and
stomachache. Results. Prodromal signs were reported more frequently during HUTT when compared with spontaneous syncopal episode (91.3 vs. 98.8 %, p=0.001). All the prodromal
signs that were analysed occurred more frequently during headup tilt test. Statistical significance was achieved for the analysed
signs such as heart palpitations, dizziness and tinnitus (Table 1).
Conclusions. Prodromal signs occur more frequently during
HUTT when compared with spontaneous syncopal episodes.
Table 1. Occurrence of prodromal signs before spontaneous
syncopal episode and during tilt test in patients with vasovagal
syncope
Parameter
Spontaneus syncope
(%)
HUTT n
(%)
Prodromal signs n (%)
73 (91.3)
78 (98.8)
0.001
Dyspnea n (%)
46 (57.5)
52 (65)
NS
Heart palpitations n (%)
45 (56.3)
66 (82.5)
0.001
Cold sweats n (%)

Feeling of hot/cold n (%)
37 (46.3)
42 (52.5)
43 (53.8)
48 (60)
NS
NS
Visual disturbances n (%)

Dizziness n (%)
56 (70)
43 (53.8)
59 (73.8)
61 (76.25)
NS
0.001
Tinnitus n (%)
Headache n (%)
35 (43.8)
27 (33.8)
52 (65)
31 (38.8)
0.001
NS
Stomachache n (%)
Nausea n (%)
13 (16.3)
28 (35)
17 (21.3)
32 (40)
NS
NS
Ablation of ventricular arrhythmias

1620 Abstract 2817
ROLE OF NEGATIVE CONCORDANCE OF

UNIPOLAR AND BIPOLAR ELECTROGRAMS IN
THE SINGLE CATHETER DETERMINATION OF
SITE OF ORIGIN OF FOCAL ARRHYTHMIAS
Gianluca Epicoco 1 , Antonio Sorgente 1 , Hussam Ali 1 ,
Gianluca Bonitta1, Sara Foresti1, Guido De Ambroggi1,
Cristina Balla1, Pierpaolo Lupo1, Riccardo Cappato1
1
IRCCS Policlinico San Donato, San Donato Milanese, Italy
Introduction. The relevance of the temporal relationship
between unipolar (UEGM) and bipolar electrograms
(BEGM) in determining the site of origin of focal arrhythmias has been largely demonstrated. We sought to
demonstrate that also a negative concordance in the initial forces of EGM is helpful in predicting the success of
radiofrequency (RF) catheter ablation of these arrhythmias. Methods. Mapping and RF ablation were performed in 29 patients with focal premature ventricular
contractions (PVC). At 201 mapping sites, where RF
application was attempted, simultaneous recordings of
minimally filtered UEGM (0.5500 Hz) and filtered
BEGM (30500 Hz) were analyzed. A negative concordance between UEGM and BEGM was defined as the
presence of a negative deflection during the first 20 ms
of each EGM (black arrows, Figure 1). Two-sided Fisher
exact test compared mapping sites with concordance with
those without it. Results. RF ablation obtained PVC suppression in 23 sites (23/201, 11 %). At 22 out of 23
sites, a negative concordance of the initial forces of
UEGM and BEGM was found (22/23 sites vs 1/169,
p< 0,005) with a sensitivity of 96 % and a specificity
of 97 %. The positive predictive and negative predictive
values were 76 and 100 %, respectively. Conclusion. A
318
negative concordance between initial forces of UEGM

and BEGM on top of EGM temporal relationship assess-
ment may be considered a valid technique useful to identify the site of origin of focal arrhythmias.
1621 Abstract 1711
Purpose: Left ventricular (LV) scar is a potential substrate for

ventricular arrhythmias (VAs). Analysis of QRS morphology
on ECG during VA has been demonstrated to accurately identify the site of origin of monomorphic VA among patients with
ischemic LV scar. The aim of the present study was to investigate the relation between site of origin of monomorphic VA
and myocardial tissue characteristics among pts with nonischemic LV structural heart disease. Methods: Twenty-six
consecutive patients (96 % males, mean age 4813 years)
with monomorphic VAs (i.e. frequent ventricular premature
beats, recurrent non-sustained and sustained ventricular tachycardia) and non-ischemic LV structural heart disease were
included in the study. Non-ischemic LV structural heart disease was defined on the basis of (1) cardiac magnetic resonance imaging (cMRI) evidence of LV late gadolinium
RELATION BETWEEN SITE OF ORIGIN OF

MONOMORPHIC VENTRICULAR ARRHYTHMIAS
AND MYOCARDIAL TISSUE CHARACTERISTICS
IN NON-ISCHEMIC LEFT VENTRICULAR HEART
DISEASE
Daniele Muser1, Piergiorgio Masci2, Gianluca Piccoli1, Luca
Rebellato1, Domenico Facchin1, Mauro Toniolo1, Massimo
Lombardi2, Alessandro Proclemer1, Gaetano Nucifora1
1
Azienda Ospedalieera Santa Maria della Misericordia,
Udine, Italy; 2Gabriele Monasterio Foundation-CNR Region
Toscana, MRI Laboratory, Pisa, Italy
enhancement (LGE), a surrogate of scar, with non-ischemic

(intramyocardial or subepicardial) distribution, and (2) absence of significant coronary artery disease on exercise stress
testing, multi-slice computed tomography or invasive coronary angiography. Site of origin of VA was identified analyzing QRS morphology on ECG during VA as previously suggested by Segal and colleagues (J Cardiovasc Electrophysiol.
2007;18:161168). The relation between site of origin of VA
and myocardial tissue characteristics as evaluated by cMRI
was investigated. Results: Mean LVEDV and mean RVEDV
were 9624 ml/m2 and 8013 ml/m2, respectively. LV dilatation was observed in 10 (38 %) patients; none had RV dilatation. Mean LVEF and mean RVEF were 5712 and 67
8 %, respectively. Reduced LV and RV systolic function were
observed in 14 (54 %) and 1 (4 %) patients, respectively. Mean
number of LV segments with LGE per patient was 4.83.8. A
total of 127 (28 %) LV segments showed LGE; 42 LV segments had intramyocardial LGE and 71 LV segments had
subepicardial LGE. Site of origin of VA was located at
basal- or mid-posterior LV wall in 17 (65 %) patients,
posteroapical LV wall in 4 (15 %) patients, mid-anterior LV
wall in 1 (4 %) patient and basal- or mid-septum in 4 (15 %)
patients. Site of origin of VA matched with the presence of LV
LGE in 22 (85 %) patients. At the site of origin of VA, LGE
was intramyocardial in 6 and subepicardial in 16 patients.
Conclusions: In patients with non-ischemic LV structural
heart disease, VAs usually originate from scar zone. In these
patients, identification of scar using cMRI with LGE technique may be of value for mapping and ablation procedures.
1622 Abstract 2821
PROCEDURAL BENEFIT OF SUBSTRATE BASE

ABLATION VERSUS CONVENTIONAL MAPPING
AND ABLATION OF CLINICAL STABLE VENT
RICULAR TACHYCARDIA: RESULTS FROM THE
VISTA RANDOMIZED TRIAL
Luigi Di Biase 1 , J. David Burkhardt 2 , Dhanujaya R.
Lakkireddy3, Corrado Carbucicchio4, Sanghamitra Mohant2
Chintan Trivedi2, Prasant Mohanty2, Pasquale Santangeli2,
Rong Bai2, Giovanni Forleo5, Rodney Horton2 Shane Bailey2,
Javier Sanchez2, Amin Al-Ahmad2 Patrick Hranitzky2, Gemma
Pelargonio6, Richard Hongo, Salwa Beheiry7, Steven Hao7,
Madhu Reddy3, Antonio Rossillo8, Sakis Themistoclakis8,
Antonio Dello Russo4, Claudio Tondo4, Andrea Natale2
1. Albert Einstein Coll of Med at Montefiore Hosp And Texas
Cardiac Arrhythmia Inst at St Davids Medical Ctr, New York
and Austin, TX, USA; 2. Texas Cardiac Arrhythmia Inst at St.
Davids Medical Ctr, Austin, TX, USA; 3. Univ of Kansas
Medical Ctr, Kansas City, KS, USA;4 Cardiac Arrhythmia
Res Ctr, Ctr Cardiologico Monzino, IRCCS, Milan, Italy; 5.
319
Univ of Tor Vergata, Rome, Italy; 6. Catholic Univ of the

Sacred Heart - Insitute of Cardiology, Rome, Italy; 7. California Pacific Medical Ctr, San Francisco, CA, USA;8. Ospedale
DellAngelo - Mestre, Mestre-Venice, Italy
Introduction: Catheter ablation of ventricular tachycardia
(VT) in patients with ischemic cardiomyopathy (IC) represents a valid therapeutic option to AADs to reduce ICDs
shocks and freedom from VT.
We sought to evaluate whether a substrate based ablation approach produce procedural benefit when compared to conventional ablation of the clinical VT in a randomized prospective
trial.
Methods: This was an open-label, randomized, multicenter
study. Patients were randomly assigned (1:1 ratio) to undergo
ablation only of the presenting clinical VT at the site of the
critical isthmus (group 1) versus a substrate-based ablation
approach (group 2). Substrate ablation was empirically extended throughout the entire scar to target all abnormal electrograms. Procedural parameters were collected and analyzed.
Results: The final study population was composed by 118
patients (60 patients assigned to group 1, and 58 to group 2).
The clinical baseline characteristics were not different between groups. The mean cycle length of the induced clinical
VTs was 41090 ms in group 1 and 39986 ms in group 2
(p=0.49). In group 2, pre ablation induction was not required
by protocol and was performed in 22 patients. The procedural
(4.61.6 and 4.21.3 h [p=0.14]) and fluoroscopy time (28
16 and 3532 min, p=0.13) were not statistically different
between groups. However, after removing group II patients
where induction of VT was performed (22 cases), the procedural time decreased to 3.41.7 h, which was significantly
shorter than in group I [(4.21.3 vs. 3.41.7), p=0.018]. Radiofrequency time was substantially longer in group 2 (3527
and 6821 min [p<0.001]). In addition, cardiopulmonary
support for hemodynamically unstable patients was used in
8 patients in group 1 and none in group 2.
Conclusion: This is the first randomized trial showing that a
substrate based ablation approach allows ablation in sinus
rhythm with a shorter procedural time and better hemodynamic
stability for the patients.
1623 Abstract 1829
CATHETER-INDUCED MECHANICAL TRAUMA

DURING ABLATION OF OUTFLOW TRACT VENT
RICULAR ARRHYTHMIAS: INCIDENCE AND CLIN
ICAL IMPLICATIONS.
Jeremy Ben-Shoshan1, Yoav Michowitz1, Aharon Glick1,
Bernard Belhassen1
1
Tel-Aviv Medical Center, Tel-Aviv, Israel
320
INTRODUCTION: The incidence and significance of

catheter-induced trauma to ventricular arrhythmias (VA) originating from the outflow tract (OT) area during radiofrequency ablation (RFA) have not been described yet. METHODS:
Consecutive patients (n = 340; 48 % females, aged 57
11.6 years) undergoing RFA of right/left OT-VA (total 364
RFA procedures; 290 RVOT-VA and 74 LVOT-VA) were
closely monitored for appearance of mechanical block of VA
during catheter manipulation. RESULTS: Mechanical trauma
to OT-VA was observed in 9 (2.4 %) patients (55 % females,
aged 53.212 years): in 8 patients during RVOT ablation
(2.8 % procedures) and in 1 patients during LVOT ablation
(1.3 % procedures) (p=NS). Catheter-induced trauma was due
to the ablation catheter in all pts. In 3 patients who underwent
>1 procedure, catheter-mechanical trauma occurred in only 1
procedure. In 3 patients (group I), the arrhythmia recurred
spontaneously within a few minutes and was subsequently
successfully ablated. In the remaining 6 patients (group II),
RF was delivered at the site of the presumed catheterinduced trauma. In all 9 patients, the RFA procedure was
acutely successful. However, the arrhythmia recurred during
follow-up in 3 of 6 group II patients while no recurrence was
recorded in all 3 group I patients. CONCLUSIONS: Catheterinduced mechanical trauma occurs in a small percentage of pts
with OT-VA during RFA. Its occurrence may influence the
results of the course of the ablation procedure. RFA of OTVA guided by catheter-induced trauma may correlate with a
high rate of long-term VA recurrence.
platform of RMN EpochTM. OBJECTIVE: The aim of this

study was to retrospectively evaluate the clinical and procedural outcomes in a cohort of patients undergoing RVOT
PVCs/VT ablation procedures using RMN vs. MCC.
METHODS: Thirty-seven consecutive patients (mean age
53, range 2384 years, 16 females) who had RVOT PVCs/VT
ablation were included (RMN 20 patients vs MCC 17 patients). Endocardial mapping using CARTOXPTM or
CARTO3 (Biosense Webster) was used in 6/20 (30 %) in
RMN group and 6/17 (35 %) in MCC group; EnSiteTM
NavXTM (St. Jude Medical) system was used in the rest of
the cohort. NiobeTM II EpochTM platform (Stereotaxis Inc,
St. Louis, MO) was used for RMN approach. RESULTS: The
procedural time was 10966 min in the RMN group and 109
71 min MCC (p=0.98). However, total fluoroscopic time
was 10.07.1 min in RMN vs. 17.68.8 in MCC group (p=
0.01). Total ablation energy application time was 9.45.2 min
in RMN vs. 9.76.0 min in RCC (p=0.88). There were no
complications in the RMN group and four tamponade events
in the MCC group (p=0.04). Acute procedural success rate
was 75 % in RMN vs 76 % in MCC group (p=1.0). Longterm success was available for 32 of the 37 patients. The
success rate during median follow-up of 10.25.9 months
was 63 % in both groups (P=1.0) CONCLUSION: RVOT
arrhythmia ablation using novel platform of RMN demonstrates lower fluoroscopic time and lower tamponade rate than
ablation with manual approach. Acute and long-term success
rate are not significantly different.
1624 Abstract 1827
1625 Abstract 1823
REMOTE MAGNETIC NAVIGATION VERSUS

MANUALLY CONTROLLED CATHETER
ABLATION OF RIGHT VENTRICULAR OUTFLOW
TRACT VENTRICULAR ARRHYTHMIAS: A
RETROSPECTIVE SINGLE CENTER EXPERIENCE
SIMULTANEOUS UNIPOLAR RADIOFREQUENCY

ABLATION OF VENTRICULAR TACHYCARDIA
USING TWO ABLATION CATHETERS
Ayelet Shauer1, Jorge Palazzolo1, Mohammed Shurrab1,

Sheldon Singh 1 , Ilan Lashevsky 1 , Irvin Tiong 1 , David
Newman1, Eugene Crystal1
1
Sunnybrook Health Sciences Centre, Toronto, Canada
BACKGROUND: Remote magnetic navigation (RMN) has
been introduced as an alternative to manual catheter control
(MCC) radiofrequency ablation of right ventricular outflow
tract (RVOT) arrhythmia. The comparative data to support
RMN approach are limited, especially so for the novel
Vivek Iyer1, Alok Gambhir1, Shalin P. Desai1, Hasan Garan1,

William Whang1
1
Columbia University Medical Center, New York, NY, USA
Catheter ablation of ventricular tachycardia (VT) has become
a cornerstone in the management of patients with refractory
episodes. However, incomplete penetration into the VT substrate may account for a large proportion of acute procedural
failure. We present a case of incessant VT mapped to the
ventricular septum, which was initially unsuccessfully controlled with an attempt at endocardial catheter ablation. Subsequently, in a repeat procedure, the VT was targeted using
simultaneous unipolar radiofrequency (SURF) ablation

with an ablation catheter on each side of the ventricular
septum, with acute procedural success and long-term control of arrhythmia. To our knowledge, this is the first report
of successful arrhythmia termination with SURF in a patient. RF delivery in this configuration produces intramural
heating via synchronous resistive tissue heating at each
catheter-myocardium interface (which can be optimized
by tissue contact force and power delivery) and conductive
heating to the midpoint of the muscle wall from opposing
directions. This theoretically differs from sequential unipolar delivery in that the heat sink on the opposing tissue
321
aspect (as occurs with sequential unipolar ablation) is replaced with another heat source (namely, simultaneous
heating via the second catheter), which may produce higher
intramural tissue temperatures during an application. Possible risks and limitations of the approach are discussed,
and SURF ablation is placed in the context of alternative
options in the management of the inaccessible substrate
(including the bipolar configuration, intramyocardial techniques such as the needle electrode, and ethanol delivery).
We conclude that SURF ablation may be an effective option
in the management of VT refractory to conventional
unipolar ablation.
322
1626 Abstract 1413
EFFICACY AND SAFETY OUTCOMES OF VARIOUS

RATE CONTROL STRATEGIES FOR PATIENTS
WITH ACUTE DECOMPENSATED HEART FAILURE
WITH REDUCED EJECTION FRACTION AND ATRI
AL FIBRILLATION OR FLUTTER WITH RAPID
VENTRICULAR RESPONSE
Lee Joseph1, Siva Krothapalli1, Omer Iqbal1, Olurotimi
Mesubi1, Hardik Doshi1, Nicole Worden1, Jayasheel Eshcol1,
Musab Alqasrawi1, Prashant Bhave1, Michael Giudici1
1
University of Iowa, Iowa City, IA, USA
Background: There is no current evidence regarding the safety
and efficacy of various rate control strategies for rapid atrial
fibrillation or atrial flutter (AF/AFL; heart rate >100 bpm) in
hospitalized patient with acute decompensated heart failure
with reduced ejection fraction (ADHFrEF). Methods: Single
center retrospective study of hospitalized patients with
ADHFrEF and rapid AF/AFL. Results: We included 52
Outcome
Survival to mean
follow up, N (%)
Survival to hospital
discharge, N (%)
Symptom control,
N (%)
Length of
hospitalization,
median (IQR)
Major bleeding
event, N (%)
Systemic embolism,
N (%)
Worsening heart
failure, N (%)
Procedure related
complication,
N (%)
Beta
blocker
Calcium
channel
blocker
patients with ADHFrEF and rapid AF/AFL (mean age, 64.3

13.9 years; 39 (75 %) males; mean left ventricular EF [%],
29.48.1; median follow up duration [months], [13] (IQR,
5.319): 42 (80.8 %) received beta blockers (BB), 10
(19.2 %) calcium channel blockers (CCB), 22 (42.3 %) digoxin and 2 (3.8 %) had AV node ablation and pacemaker (PPM)
implantation. Patients treated with BB had significant higher
rates of survival to hospital discharge, median follow-up and
lower procedural complications. There was an increase in survival rate to discharge in those treated with digoxin. There
were no significant differences in symptom control, thromboembolism, worsening heart failure and mean length of hospital
stay between patients treated with and without BB, CCB,
digoxin and AV node ablation followed by PPM implantation
(Table 1). Conclusion: Treatment with BB and digoxin for
acute control of rapid AF/AFl appears to improve survival to
hospital discharge and median follow up in hospitalized patients with ADHFrEF.
Table 1: Efficacy and safety outcomes of various rate control
strategies for patients with acute decompensated heart failure
with reduced ejection fraction and atrial fibrillation or flutter
with rapid ventricular response (N=52)
Digoxin
[PB1]
Atrioventricular
node ablation
and permanent
pacemaker
placement
No
P value Yes
No
P value Yes
No
P value
25 (56.8) 0.275 18 (81.8) 19 (63.3) 0.146 2 (100)
35 (70) 0.358
Yes
No
33 (78.6) 4 (40)
P value Yes
0.016 9 (90)
34 (80.9) 5 (50)
0.042
10 (100) 25 (56.8) 0.068
20 (90.9) 19 (63.3) 0.023
2 (100)
37 (74) 0.405
34 (80.9) 5 (50)
0.501
10 (100) 29 (65.9) 0.248
17 (77.3) 22 (73.3) 0.230
2 (100)
37 (74) 0.643
5 (6)
5.5 (11) 0.935
6.5 (8)
4 (6)
0.288
6 (11)
5 (5)
0.448
0.5 ()
5 (6)
0.541
1 (2.4)
1 (10)
0.260
0 (0)
2 (4.5)
0.432
0 (0)
2 (6.7)
0.217
0 (0)
2 (4)
0.773
3 (7.1)
0 (0)
0.384
1 (10)
1 (2.3)
0.346
0 (0)
3/(10)
0.127
0 (0)
3 (6)
0.721
17 (40.5) 4 (40)
0.826
5 (50)
14 (31.8) 0.673
11 (50)
10 (33.3) 0.174
2 (100)
19 (38) 0.085
0 (0)
0.000
0 (0)
2 (4.5)
0 (0)
2 (6.7)
0 (0)
2 (4)
2 (20)
0.401
0.193
0.724
1627 Abstract 3112
RHYTHM VERSUS RATE CONTROL FOR PATIENTS

WITH ACUTE DECOMPENSATED HEART FAILURE
WITH REDUCED EJECTION FRACTION AND ATRI
AL FIBRILLATION OR FLUTTER WITH RAPID
VENTRICULAR RESPONSE
Lee Joseph1, Nicole Worden1, Jayasheel Eshcol1, Hardik
Doshi1, Siva Krothapalli1, Omer Iqbal1, Olurotimi Mesubi1,
Musab Alqasrawi1, Prashant Bhave1, Michael Giudici1
1
University of Iowa, Iowa City, IA, USA
Background: The best approach for acute control of rapid
atrial fibrillation or flutter (AF/AFL; heart rate >100 bpm)
in hospitalized patients with acute decompensated heart
failure with reduced ejection fraction (ADHFrEF) has
not been previously studied, and remains a challenge owing to the neutral results of prior studies comparing rhythm
versus rate control strategies. Objectives: The study aims
to compare the safety and efficacy of rhythm versus rate
control strategies for acute control of rapid AF/AFL in
hospitalized patients with ADHFrEF. Methods: A single
center retrospective study of hospitalized patients with
ADHFrEF and rapid AF/AFL. Results: We identified 52
patients with ADHFrEF and rapid AF/AFL (age, 64
14 years; 39 (75 %) males; left ventricular EF [%], 29.4
8.1; median follow-up duration [months], 13 [IQR, 5.3
19]): 40 (76.9 %) received a rhythm control strategy and
12 (23.1 %) a rate control strategy. There was no significant differences in the survival rates at follow-up, survival
to hospital discharge, symptom control, major bleeding
event, systemic embolism, worsening heart failure,
procedure-related complications, and mean length of hospital stay between the rate and rhythm control groups
(Table 1). Conclusion: Acute control of rapid AF/AFL in
hospitalized patients with ADHFrEF using a rhythm control strategy does not improve the survival and morbidity
outcomes over a rate control strategy in this study, and
both may have similar safety and efficacy profiles in this
critically ill population.
Table 1. Rhythm versus rate control for patients with acute
decompensated heart failure with reduced ejection fraction
and atrial fibrillation or flutter with rapid ventricular response
323
Outcome
Survival to mean follow up,
N (%)
Survival to hospital discharge,
N (%)
Symptom control, N (%)
Length of hospitalization,
median days (IQR)
Major bleeding event, N (%)
Systemic embolism, N (%)
Rate control Rhythm control P value

(N=12)
(N=40)
8 (66.7)
29 (72.5)
0.696
9 (75.0)
30 (75)
1.000
8 (66.7)
31 (77.5)
0.834
4.0 (10)
5.0 (7)
0.980
0 (0)
1 (8.3)
2 (0.05)
2 (0.05)
0.430
0.664
Worsening heart failure, N (%) 5 (41.7)
16 (40)
0.969
Procedure related complication, 0 (0)

N (%)
2 (0.05)
0.515
1628 Abstract 0610
THE LUNG IMPEDANCE MONITORING IN TREA

TMENT OF CHRONIC HEART FAILURE: PREL
IMINARY RESULTS FROM THE LIMIT-CHF STUDY
Giulia Domenichini1, Cveta Rahneva1, Ihab Diab1, Onkar
Dhillon1, Victoria Baker1, Ross Hunter1, Mark Earley1,
Richard Schilling1
1
Department of Cardiology, St Bartholomews Hospital,
London, UK
Background: The study aims to assess the usefulness of intrathoracic impedance monitoring (IIM) alerts in guiding medication therapy in chronic heart failure (CHF) patients to prevent hospitalisations. Methods: CHF patients with OptiVol
or CorVue capable ICDs were randomised to either the
active group (IIM alarm turned on and diuretic dose increased
by 50 % for 1 week) or the control group (IIM alarm turned
off). The primary endpoint was the number of hospitalisations
or acute unscheduled care episodes at 1 year. The NYHA
class, 6-min walk test (6MWT), BNP and Minnesota Living
with HF (MLWHF) questionnaire score were collected at
baseline and follow-up. Results: Eighty patients were included
and 71 reached 1-year follow-up (7 patients died, 1 patient
was lost at follow-up and 1 patient was excluded from analysis
since the congestion data were not collected by the device).
The baseline characteristics and study outcomes are shown in
the Table. In the active group, 55.9 % (33/59) of alerts lead to
increasing the diuretic dose. There was a total of 14 endpoint
324
episodes in the active group vs. 8 in the control group without

significant differences in the number of episodes per patient
(0.41.0 vs. 0.20.4, p=0.70). There was a moderate but
significant reduction in heart failure-related quality of life
scores. Conclusion: In this study, IIM did not reduce emergency treatment of heart failure; however, there was a positive
impact on quality of life. This technology may have a useful
role in managing heart failure patients with implantable
devices.
Active group
(n=36)
Control group
(n=35)
Age (years)
7011
6612
0.20
LVEF (%)
CRT-devices (%)
298
61
287
71
0.39
0.50
No. of alerts/patient
NYHA
161.4
0.0 (2.01.5)
1.21.0
0.0 (1.01.0)
0.19
0.61
6MWT (m)
3597
1457
0.78
BNP (pg/mL)
3193
2144
0.80
MLWHF
516
512
0.005
1629 Abstract 1523
OUTCOMES OF RHYTHM CONTROL FOR ATRIAL

FIBRILLATION/FLUTTER IN ACUTE
DECOMPENSATED HEART FAILURE
Jayasheel Eshcol1, Michael Giudici1, Lee Joseph1, Nicole
Worden1, Musab Alqasrawi1, Hardik Doshi1, Omer Iqbal1
1
Background: The safety and efficacy of rhythm control
strategies for the management of atrial fibrillation or flutter
(AF/AFL) in patients with acute decompensated heart failure with reduced ejection fraction (ADHFrEF) has not been
Outcome
Amiodarone
Survival to mean follow up, N (%)
established. It is unclear if there is a difference in outcomes

between various rhythm control strategies such as amiodarone and other anti-arrhythmic drugs (AAD), electrical cardioversion, catheter-based ablation and permanent pacemaker (PPM) placement with AAD. Objectives: The study
aims to report the safety and efficacy outcomes of different
rhythm control strategies for acute control of rapid AF/AFL
in hospitalized patients with ADHFrEF. Methods: A retrospective cohort study of patients hospitalized with
ADHFrEF and rapid AF/AFL in a single center over a 2year period, median follow-up 13 months [interquartile
range, 5.319]. Results: Fifty-two patients hospitalized
with ADHFrEF and rapid AF/AFL managed with a rhythm
control strategy were identified [mean age 64.313.9 years;
39 (75 %) males; mean left ventricular EF 29.48.1 %].
Thirty patients (57.7 %) received amiodarone, 1 (1.9 %)
received other AAD, 19 (36.5 %) received electrical cardioversion, and none received PPM. There were 10 (19.2 %)
patients who received catheter ablation, all of which had
AFL. No differences were observed between rhythm control strategies for AF in time to effective symptom control,
in-hospital survival, worsening heart failure, mean length
of stay, systemic embolism, major bleeding event or procedure related complications (Table 1). Patients who were
treated with catheter-based ablation had significantly
higher rates of survival to discharge and to median follow-up. New onset AF/AFL, new onset heart failure, left
ventricular ejection fraction, New York Heart Association
functional class, and loading with AAD did not predict
response to electrical cardioversion (Table 2). Conclusion:
Catheter-based ablation of atrial flutter improved survival
in patients hospitalized with ADHFrEF. Rhythm control
strategy is a reasonable choice with few adverse events in
the management of rapid AF/AFL in these patients.
Table 1. Rhythm control strategies for patients with acute
decompensated heart failure with reduced ejection fraction and atrial fibrillation or flutter with rapid ventricular
response
Yes
19 (63.3)
Electrical
cardioversion
No
P value Yes
No
P value
18 (81.8) 0.146
15 (78.9)
22 (66.7) 0.347
Catheter ablation
(AFL)
Yes
No
P value
10 (100)
27 (64.3) 0.025
Survival to hospital discharge, N (%)
20 (66.7)
19 (86.4) 0.105
17 (89.5)
22 (66.7) 0.067
10 (100)
Symptom control, N (%)
22 (73.3)
17 (77.3) 0.473
15 (78.9)
24 (72.7) 0.653
8 (80)
31 (73.8) 0.834
Length of hospitalization, median days 5.5 (7)

(IQR)
Major bleeding event, N (%)
2 (6.7)
5 (7)
0.713
4 (7)
6 (6)
0.463
2.5 (5)
5.5 (10)
0.431
0 (0)
0.217
1 (5.3)
1 (3.0)
0.687
0 (0)
2 (4.8)
0.482
Systemic embolism, N (%)
1 (3.3)
2 (9.1)
0.379
2 (10.5)
1 (3.0)
0.264
0 (0)
3 (7.1)
0.384
Worsening heart failure, N (%)
12 (40)
9 (40.9)
0.973
10 (52.6)
11 (33.3) 0.200
4 (40)
17 (40.5) 0.933
0 (0)
0.274
1 (5.3)
1 (3.0)
0 (0)
2 (4.8)
Procedure related complication, N (%) 2 (6.7)
0.806
29 (69.0) 0.042
0.401
AUTHORS INDEX BY ABSTRACT NUMBER (original

number given at submission)
Abraham J. et al. Abs. 2510 Session C part 2
Al Anany AA. et al. Abs. 2427 Session C part 1
Al Khiami B. et al. Abs. 2418 Session C part 1
Ali RL. et al. Abs. 1554 Session A part 2
Alonso-Martin C. et al. Abs. 1817 Session A part 1, 1522
Session A part 2
Aman W. et al. Abs. 1818 Session B part 2
Anderson S. et al. Abs. 1537 Session 5
Ang R. et al. Abs. 1832 Session 1
Ardashev A. et al. Abs. 0812 Session A part 1, 0120
Session B part 2
Artyukhina E. et al. Abs. 1417 Session A part 1
Backenkoehler U. et al. Abs. 1913 Session C part 2
Bars C. et al. Abs. 1826 Session 1
Bastian D. et al. Abs. 1520 Session A part 2
Batalov R. et al. Abs. 1416 Session 12
Baykaner T. et al. Abs. 0413 Session 5
Behunin A. et al. Abs. 1911 Session C part 2
Benova T. et al. Abs. 1713 Session 4
Ben-Shoshan J. et al. Abs. 1829 Session D part 2
Bisleri G. et al. Abs. 1531 Session B part 2
Bonora A. et al. Abs. 1524 Session A part 2
Bouzeman A. et al. Abs. 1930 Session 2, 1929 Session C
part 2
Bunz B. et al. Abs. 1514 Session B part 2
Campbell N. et al. Abs. 2210 Session D part 1
de Groot N. et al. Abs. 2810 Session B part 1
de Ruvo E. et al. Abs. 1541 Session 5
Derndorfer M. et al. Abs. 1714 Session 7
Dhanjal T. et al. Abs. 0214 Session 4
Di Biase L. et al. Abs. 1557 Session 3, 2821 Session D part 2
Domenichini G. et al. Abs. 0610 Session D part 2
Domenichini G. et al. Abs. 2420 Session 6
Dooijes D. et al. Abs. 0719 Session 8
Dubova A. et al. Abs. 0122 Session D part 1
Efimova E. et al. Abs. 0110 Session A part 1
Eichhorn C. et al. Abs. 0213 Session 9
Epicoco G. et al. Abs. 2817 Session D part 2
Eremeeva M. et al. Abs. 0210 Session 10
Eshcol J. et al. Abs. 1523 Session D part 2
Finlay M. et al. Abs. 0414 Session B part 1
Fumagalli F. et al. Abs. 1925 Session 2
Galati F. et al. Abs. 0310 Session B part 1
Giudici M. et al. Abs. 2310 Session D part 1
Goldenberg G. et al. Abs.14-11 Session 12
Gregers Winkel B. et al. Abs. 1917 Session C part 2
Grett M. et al. Abs. 2413 Session 6
Guiraudon G. et al. Abs. 1526 Session 9
Guliaeva E. et al. Abs. 0117 Session B part 1
Haber T. et al. Abs. 1813 Session B part 1
325
Hrtig J. et al. Abs. 2416 Session C part 1

Hayashi H. et al. Abs. 2313 Session D part 1
Hodes AR. et al. Abs. 0718 Session 8
Hltgen R. et al. Abs. 1534 Session 11
Houck C. et al. Abs. 0710 Session A part 1, 0717 Session B
part 1
Iqbal O. et al. Abs. 1525 Session 3,31-11 Session C part 1
Iyer V. et al. Abs. 1823 Session D part 2
Jacon P. et al. Abs. 1922 Session C part 2
Jacquemet V. et al. Abs. 1521 Session A part 2
Joseph L. et al. Abs. 1413, 3112 Session D part 2
Kalejs O. et al. Abs. 1551 Session 3
Kanters J. et al. Abs. 0115 Session C part 1
Khaliulin I. et al. Abs. 1717 Session C part 1
Kim TH. et al. Abs. 3110 Session 6, 0910 Session A part 2
KIS Z. et al. Abs. 2419 Session 6
Konrad T. et al. Abs. 1542 Session A part 2
Kooiman KM. et al. Abs. 1910 Session C part 2
Kumarathurai P. et al. Abs. 1547 Session A part 2
Kutarski A. et al. Abs. 2320, 2324 Session D part 1
Lahiri M. et al. Abs. 2511 Session C part 2
Lanters E. et al. Abs. 1555 Session B part 1
Larsen B. et al. Abs. 1420 Session 9
Lau E. et al. Abs. 2424 Session C part 1, 1928 Session C
part 2
Lavanga S. et al. Abs. 1544 Session A part 2
Le Bloa M. et al. Abs. 1013 Session 2
Lee HC. et al. Abs. 0212 Session 10
Levy W. et al. Abs. 1926 Session 2
Ling Lh. et al. Abs. 1536 Session 3
Litunenko O. et al. Abs. 1552, 1548 Session A part 2,
1550 Session D part 1
Luik A. et al. Abs. 0512 Session B part 1
Luther V. et al. Abs. 2814, 1819 Session 7, 2813 Session
A part 1
Mahjoub M. et al. Abs. 2011 Session A part 1, 1543
Session A part 2
Maines M. et al. Abs. 1831 Session A part 1, 2426 Session
C part 1
Manani K. et al. Abs. 1519 Session 9
Marchenko R. et al. Abs. 1415 Session A part 1
Marrakchi S. et al. Abs. 1556 Session B part 2
Martens E. et al. Abs. 1923 Session C part 2
Martens E. et al. Abs. 1924 Session 2
Martino A. et al. Abs. 1419 Session A part 1, 0716 Session
B part 2
Mast TP. et al. Abs. 0714 Session 8
Mndez Z F. et al. Abs. 3115 Session C part 2
Michowitz Y. et al. Abs. 1830 Session 11, 1312 Session A
part 1
Mikhaylichenko S. et al. Abs. 1921 Session C part 2
Ming Wei Leong K. et al. Abs. 0411, 0412 Session B part 1
Mllenhoff C. et al. Abs. 1533 Session 3
326
Monnier A. et al. Abs. 1915 Session C part 2

Mouws E. et al. Abs. 1712 Session B part 1
Muser D. et al. Abs. 1710, Session 7, 2414 Session 6,18-12
Session 12, 1711 Session D part 2
Nagy-Bal E. et al. Abs. 1512 Session 11
Ng FS. et al. Abs. 0116 Session 4, 0114 Session 10
Noseworthy P.et al. Abs. 1821 Session 1
Park J. et al. Abs. 1511 Session 11, 1510 Session B part 2
Peyrol M. et al. Abs. 1539 Session B part 2
Poci D. et al. Abs. 1549 Session B part 1
Polewczyk A. et al. Abs. 2312, 2317, 2311, 2316 Session
D part 1
Qureshi N. et al. Abs. 2816 Session 5, 0119 Session 10, 01
18 Session D part 1
Ragunath Shunmugam S. et al. Abs. 1540 Session 5
Rebecchi M. et al. Abs. 1015 Session D part 2
Revishvili A. et al. Abs. 1532 Session 11, 2815 Session A
part 1
Roney CH. et al. Abs. 0121, 1421 Session 9, 1553 Session
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Saksena S. et al. Abs. 3116 Session 6, 2111 Session A part 2
Sami M. et al. Abs. 1517 Session D part 1
Sandler B. et al. Abs. 0410 Session C part 1
Sattler S. et al. Abs. 1825 Session 1
Sawhney V. et al. Abs. 1919 Session C part 1
Sciarra L. et al. Abs. 0112 Session 4, 2422 Session C part 1
Sebag F. et al. Abs. 2423 Session C part 1
Selvadurai S. et al. Abs. 0211 Session 4
Shauer A. et al. Abs. 1827 Session D part 2
Shurrab M. et al. Abs. 1814 Session 12
Siebermair J. et al. Abs. 1824 Session B part 2, 1920
Session C part 2
Sikkel M. et al. Abs. 2819 Session B part 2

Skibsbye L. et al. Abs. 0111 Session 10
Sorrel J. et al. Abs. 1527 Session 11
Spaziani D. et al. Abs. 2412 Session C part 1
Stryjewski PJ.et al. Abs. 1010, 1016 Session D part 2
Stute F. et al. Abs. 1310 Session A part 1
Sugihara C. et al. Abs. 1528 Session 3
Sugihara C. et al. Abs. 2010 Session A part 2
Sun Y. et al. Abs. 1518, 1414 Session D part 1
te Riele AS. et al. Abs. 0712 Session 8
Teres C. et al. Abs. 1718 Session 7
Termosesov S. et al. Abs. 1835 Session 7
Teunissen C. et al. Abs. 1815 Session B part 2
Teunissen C. et al. Abs. 1833 Session 12
Teuwen C. et al. Abs. 0711 Session A part 1, 1715 Session
B part 1
Tordini A. et al. Abs. 1828 Session 12
Ullah W. et al. Abs. 1822 Session 1, 0513 Session B part 2
Vado A. et al. Abs. 2411 Session C part 1
Varlet E. et al. Abs. 0715 Session 8
Varotto L. et al. Abs. 1530 Session B part 2
Visser M. et al. Abs. 1916 Session 2
Wakili R. et al. Abs. 1535 Session B part 2
Winkle R. et al. Abs. 1816 Session 1, 2811 Session A part 1
Wolf CM. et al. Abs. 0312 Session 8
Worden NE. et al. Abs. 1918 Session C part 2
Yahalom M. et al. Abs. 0814 Session B part 1
Yaksh A. et al. Abs. 1412 Session B part 1
Yaksh A. et al. Abs. 3113 Session D part 1
Yeoh A. et al. Abs. 0123 Session 4
Zaman J. et al. Abs. 0113 Session 10, 1511 Session C part 1
Zaman J. et al. Abs. 1546 Session 5, 2818 Session B part 2

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J Interv Card Electrophysiol (2015) 42:173326

J Interv Card Electrophysiol (2015) 42:173326

ECAS Scientific Program

J Interv Card Electrophysiol (2015) 42:173326

ECAS 2015 POSTER SESSION A: PARTS 1 AND 2

J Interv Card Electrophysiol (2015) 42:173326

Scientific Program chair

EXECUTIVE COMMITTEE OF THE EUROPEAN CARDIAC ARRHYTHMIA SOCIETY

Riccardo Cappato (Milan, IT)

Wyn Davies (London, GB)

Vice-President (Education and Research)

Richard Hauer (Utrecht, NL)

Vice-President (National Societies)

Massimo Santini (Rome, IT)

Vice-President (International Societies and EU)

Samuel Lvy (Marseille, FR)

Eli Ovsyshcher (Beersheba, IL)

Leo Van Wersch (Paris, FR)

Relation with European Societies

Stefan Kaab (Munich, DE)

Chair Membership Program

Neil Sulke (Eastbourne, GB)

Organizing annual Congress

Gerhard Steinbeck (Munich, DE)

Organizing Committee ECAS 2015

J Interv Card Electrophysiol (2015) 42:173326

Bulent Gorenek (Eskisehir, TR)

Bertil S. Olsson (Lund, SE)

Etienne Aliot (Nancy, FR)

Stephen C. Hammill (Rochester, USA)

Oscar Oseroff (Buenos Aires, AR)

Maurits A. Allessie (Maastricht, NL)

Richard Hauer(Utrecht, NL)

Ali Oto (Ankara, TR)

Eckhard Alt (Munich, DE)

Habib Haouala (Tunis, TN)

Eli Ovsyshcher (Beersheba, IL)

Charles Antzelevitch (Utica, USA)

Yoshito Iesaka (Tokyo, JP)

Douglas L. Packer (Rochester, USA)

Andrey Ardashev (Moscow, RU)

Michiel Janse (Amsterdam, NL)

Luigi Padeletti (Florence, IT)

Serge S. Barold (Boca Raton, USA)

Charles Jazra (Beirut, LB)

Nicholas S Peters, (London, GB)

Poul Erik Bloch-Thomsen (Hellerup, DK)

Werner Jung (Villingen, DE)

Eric N. Prystowsky (Indianapolis, USA)

Jozsef Borbola (Budapest, HU)

Stefan Kb (Munich, DE)

Antonio Raviele(Venice, IT)

Johannes Brachmann (Coburg, DE)

Prapa Kanagaratnam (London, GB)

Amiran Revishvili (Moskow, RU)

A John Camm (London, GB)

Joergen Kanters (Copenhagen, DK)

Dwight Reynolds (Oklahoma, USA)

Alessandro Capucci (Ancona, IT)

Bondo Kobulia (Tbilisi, GE)

Edward Rowland (London, GB)

David S. Cannom (Los Angeles, USA)

Jean-Franois Leclercq (Paris, FR)