S212 Abstracts

182 .. 183
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Echocardiographic Findings in Critically .. Electrophysiologic Substrate of Ventricular
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Unwell Patients with New-Onset Atrial .. Arrhythmias in Ventricular Noncompaction
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Fibrillation .. - A Systematic Review
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D. Lancini 1,∗ , S. Prasad 1 , R. Boots 2 , .. A. Bhaskaran 1,∗ , T. Campbell 2 , I. Trivic 2 ,
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K. Guppy-Coles 1 , J. Atherton 1 , P. Martin 1 .. S. Virk 1 , S. Kumar 1,2
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1 Cardiology Department, Royal Brisbane And .. 1 Cardiology Department, Westmead Hospital,
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Women’s Hospital, Herston, Australia .. Westmead, Australia
2 Burns, Trauma and Critical Care Research .. 2 Westmead Applied Research Centre, Westmead
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Centre, University of Queensland, Herston, .. Hospital, Westmead, Australia
Australia ..
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.. Introduction: Ventricular noncompaction (VNC) is a form
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Background: New-onset atrial fibrillation (NOAF) com- .. of structural cardiomyopathy that arises from prominent ven-
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monly occurs amongst critically unwell individuals and .. tricular trabeculae and deep intratrabecular recesses with a
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represents a management challenge. However, limited data .. predilection for ventricular arrhythmias (VAs).
exist regarding the role of structural cardiac abnormalities in .. Methods: a systematic review of case reports, case series
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NOAF. .. and observational studies was conducted to characterise the
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Methods: All patients in a tertiary general ICU develop- .. electrophysiologic features of VA substrate in VNC. Stud-
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ing AF between Dec 2015 to Dec 2016 were identified by .. ies were included if they described/included 12-lead ECG
an automated alert system. Patients with a previous history .. morphology of VAs and/or electrophysiology study.
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of AF were excluded. Data on left atrial size (left atrial vol- .. Results: A total of 68 cases were included from 43 studies.
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ume index, LAVI) and ejection fraction (LVEF) were collected .. Median age at presentation was 39. The most common areas
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on patients who underwent an echocardiogram during their .. of left ventricular noncompaction were the apex (50%) and
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admission. .. lateral wall (43%). 10 patients had right ventricular noncom-
Results: 111 patients developed NOAF during the study .. paction. Median left ventricular ejection fraction was 44%. Of
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period, and 84 (75.7%) underwent echocardiography. The dis- .. the VAs, 19 were polymorphic and 49 were monomorphic
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tribution of left atrial (LA) size and ejection fraction is shown .. with 29% (14/49) of these cases having 2 or more VT mor-
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in Figures 1 and 2 below. 26 patients (31%) had a normal LAVI, .. phologies. 12-lead ECG morphologies were heterogenous,
63 patients (75%) had an LVEF > 50%, and 21 patients (25%) .. with 13% arising from the superolateral LV apex, 11% from the
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had both normal LA size and LVEF. .. infero-basal RV septum and 9% from the RVOT. 21 patients
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Conclusions: A substantial proportion of NOAF in the ICU .. had RV substrate on voltage/activation mapping, of which
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population occurs in the presence of normal LA size and LV .. 67% did not have imaging evidence of RV noncompaction. 3
systolic function. These findings highlight the significance of .. patients had pathogenic mutations (2/3 RYR2; 1/3 CASQ).
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extracardiac factors in driving NOAF in critically unwell indi- .. There was no significant association between the degree of
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viduals. .. systolic impairment and the number of VAs (p = 0.66) or
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.. success of radiofrequency ablation (p = 0.82). 23/28 (82%)
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.. patients had successful elimination of their VA with radiofre-
.. quency ablation. Antiarrhythmics failed to control VT in 16
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.. cases.
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.. Conclusion: VA substrate appears more heterogenous than
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.. originally thought with a notable proportion of arrhythmias
.. arising from structurally normal myocardium.
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.. http://dx.doi.org/10.1016/j.hlc.2019.06.184
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http://dx.doi.org/10.1016/j.hlc.2019.06.183 ..
.. 184
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.. Evaluating Patient Attitudes and Barriers
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.. towards Smart Technology for Cardiac
.. Monitoring: Results from a Prospective
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.. Multi-Centre Study in an Elderly
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.. Population
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.. J. Ko
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.. Austin Health, Melbourne, Australia
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.. Background: The incidence of atrial fibrillation (AF) is ris-
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.. ing in the context of an ageing population. Remote assessment
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.. of heart rate and rhythm using smart technology (ST) holds
.. promise in AF screening and monitoring. However, patient
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Abstracts S213

engagement is paramount to the success of ST. We sought .. Conclusion: In our patients with a Linox family or Sorin
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to survey the attitudes and potential barriers towards ST for .. Vigila lead, the failure rate was 5.9%.
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arrhythmia monitoring in an elderly population. ..
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Methods: Consecutive inpatients were recruited across .. http://dx.doi.org/10.1016/j.hlc.2019.06.186
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three tertiary hospitals in Australia. Participants were admin- ..
istered a standardised survey regarding attitudes towards ST .. 186
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for arrhythmia detection. Survey responses were either binary ..
.. Gender Difference in Clinical Outcomes
(yes or no) or on a five-point Likert scale from “Strongly .. after Percutaneous Left Atrial Appendage
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Disagree” (score 1) to “Strongly Agree” (score 5). .. Closure in Patients with Atrial Fibrillation
Results: Of the 363 participants, (mean age 66 ± 15 years, ..
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mean CHA2 DS2 VASC score 3 ± 2), 68.9% were interested in .. S. Iwai 1,∗ , S. Worthley 2 , P. Sanders 1 ,
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ST for cardiac monitoring. Those with AF (n = 112) were more .. G. Young 1,2
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likely to be interested (mean score 4.2 vs 3.5, p < 0.001). Cost .. 1 Centre
.. for Heart Rhythm Disorders, South
(66.7%) and complexity (71.1%) of mobile devices were iden- ..
.. Australian Health and Medical Research
tified as major barriers to their adoption, particularly in older .. Institute, University of Adelaide and Royal
participants (p = 0.02). While only 52% of participants trusted ..
.. Adelaide Hospital, Adelaide, Australia
ST accuracy, over 90% would seek medical attention based on .. 2 Genesiscare, Sydney, Australia
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aberrant readings. ..
Conclusion: We report a high level of interest among an ..
.. Background: Females with atrial fibrillation (AF) could
older, high-risk patient cohort in utilising ST for cardiac mon- ..
.. have a greater risk for ischaemic stroke and systemic emboli
itoring. Despite a level of distrust, abnormal ST readings ..
.. compared with males. However, the incidence of these events
would still prompt the overwhelming majority of patients ..
.. by gender after percutaneous left atrial appendage (LAA)
to seek medical attention. Clinicians and patients both need ..
.. closure is not clear.
to be aware of the strengths and inherent limitations of this ..
.. Objective: To compare gender differences in clinical out-
nascent technology for sustainable incorporation into clinical
.. comes after LAA closure.
practice. ..
.. Methods: The consecutive patients who underwent per-
.. cutaneous LAA closure were studied. We examined gender
http://dx.doi.org/10.1016/j.hlc.2019.06.185 ..
.. differences in ischaemic stroke, haemorrhagic stroke, sys-
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185 .. temic emboli, device-related thrombus and procedure-related
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.. adverse events.
Failure rate in Biotronik Linox/Sorin Vigila .. Results: The consecutive 124 pts (45 females and 79 males;
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ICD leads .. age 75 ± 7) underwent LAA closure with Amplatzer in 68,
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.. Watchman in 37 and WaveCrest in 19. Females had higher
M. Alasti, E. Kotschet ∗ , D. Adam, S. Healy, ..
L. Bittinger, J. Krafchek, J. Alison .. CHA2 DS2 -VASc score (4.8 ± 0.8 vs 3.6 ± 1.3, p < 0.0001) and
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.. more prior stroke/transient ischaemic attack (15 [33%] vs
Monash Health, Clayton, Australia .. 12 [15%], p = 0.019) compared with males. Seven procedure-
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.. related adverse events (cardiac tamponade: 1, device emboli:
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Background: Failure of the Biotronik Linox/Sorin Vig- .. 1, haematoma: 5) occurred in 3 (6.7%) females and 4 (5.1%)
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ila implantable cardioverter-defibrillator leads has been .. males (p = 0.71). Device-related thrombus was observed in
reported at rates above other ICD leads. The aim of this study .. 1 (2.2%) females and 4 (5.1%) males (p = 0.44). During the
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was to assess failure rate in these leads implanted in our .. mean follow-up (30 ± 18 vs 24 ± 17 month, p = 0.08), there
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centre. .. was no significant difference in events rate between females
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Methods: We performed a retrospective analysis of all .. and males; ischaemic stroke (5 [11.1%] vs 5 [6.3%], p = 0.35),
implantations of Linox/Vigila leads over the last 12 years at .. haemorrhagic stroke (0 [0%] vs 2 [2.5%], p = 0.29) and systemic
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our centre. All patients with a Linox family ICD Lead or Vig- .. emboli (2 [4.4%] vs 2 [2.5%], p = 0.56).
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illa lead implanted at our center were identified and all clinical .. Conclusion: Females had higher embolic event risk com-
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data and device interrogations including a new device check .. pared with males, but no gender difference was found in
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were considered. .. complications, all-cause stroke and systemic emboli after
Results: A total of 205 patients [169 (82.4%) men] had one .. LAA closure.
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of these leads (166 Linox family leads and 39 Vigila leads) ..
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implanted at our center between 2007 till 2015. 164 (80%) of .. http://dx.doi.org/10.1016/j.hlc.2019.06.187
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implantations had been because of a secondary prevention ..
indication and 140 (68.3%) leads had been implanted in right ..
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ventricular apex. Cephalic access had been used in 116 (56.9%) ..
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of patients. ..
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Of these, 12 patients (5.9%) had lead failure. In four patients, ..
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lead fracture was the reason for lead failure, while noise and ..
inappropriate shock was the issue in 4 patients and sens- ..
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ing/pacing problems in two patients. ..
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