Rhythmology and stimulation
The etiological examinations performed during the initial hospital-
ization or planned after discharge were collected.
Results In a cohort of 66 patients, retrospectively included,
a minimal assessment including twelve-lead ECG, trans-thoracic
echocardiography and coronary imaging allowed to unmask etiology
for 40 (61%) patients. Ventricular fibrillation remained idiopathic
for 16(24%) patients by adding magnetic resonance imaging, and
for 12(18%) patients by performing provocative and genetic tests.
Among the 54 patients for whom the diagnosis was confirmed, we
reported 12(22%) electrical cardiac disorders, 11(20%) ischemic car-
diopathy, 9(17%) dilated cardiomyopathy, 9(17%) valvular disease,
8(15%) hypertrophic cardiomyopathy, 4(7%) myocarditis and 1(2%)
tako-tsubo syndrome. The number of examinations carried out in
the IVF cohort did not differ from the others (6 vs. 5, P = 0.06). In
the IVF group, SCD event occurred more frequently at rest (8/12 vs.
14/54, P = 0.02) and the patients were preferably women (9/12 vs.
13/54, P = 0.02).
Conclusion Systematic etiologic investigations, carried out during
initial assessment after SCD, allowed to unmask etiology for a large
number of patients. Further studies are needed to standardize the
workup to implement in all tertiary centers.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2019.09.233
121
Primary prevention of sudden cardiac death
in patients with tetralogy of Fallot with
implantable cardioverter defibrillator:
Insights from the DAI-T4F study
V. Waldmann 1,∗ , A. Bouzeman 2 , F. Bessiere 3 , F. Labombarda 4 ,
M. Ladouceur 1 , C. Marquié 5 , C. Guenancia 6 , C. Audinet 7 ,
P. Defaye 8 , A. Mathiron 9 , C. Walton 3 , P. Winum 10 , P. Bru 11 ,
B. Guy-Moyat 12 , Y. Bernard 13 , L. Iserin 1 , J.B. Thambo 14 ,
J.L. Pasquié 15 , N. Combes 16 , E. Marijon 1
1 Cardiologie, Hôpital Européen Georges Pompidou, Paris
2 Parly II, Le Chesnay
3 Hôpital Louis Pradel, Lyon
4 CHU Caen, Caen
5 CHU Lille, Lille
6 CHU Dijon, Dijon
7 CH de Lorient, Lorient
8 CHU Grenoble, Grenoble
9 CHU Amiens, Amiens
10 CHU Nimes, Nimes
11 CH La Rochelle, La Rochelle
12 CHU Limoges, Limoges
13 CHU Besançon, Besançon
14 CHU Bordeaux, Bordeaux
15 CHU Montpellier, Montpellier
16 Clinique Pasteur, Toulouse, France
∗ Corresponding author.
E-mail address: victor.waldmann@gmail.com (V. Waldmann)
Background Ventricular arrhythmias and sudden death are feared
late complications in patients with tetralogy of Fallot. Selection of
candidates for primary prevention implantable cardioverter defi-
brillator (ICD) remains challenging.
Purpose To identify patients with tetralogy of Fallot at high-risk
of sudden cardiac death in primary prevention.
Methods The DAI-T4F study is an ongoing national French reg-
istry including all patients with tetralogy of Fallot and ICD
(NCT03837574). Information have been collected prospectively
since 2010. Cox proportional hazard models were used to identify
factors associated with appropriate ICD therapies.
Results Among 134 patients enrolled, 47 (35.1%) underwent ICD
implantation for primary prevention (median age 49.1 years, 76.6%
107
males). At baseline, 20 (42.6%) patients had NSVT, 17 (36.2%) had
altered LVEF ≤ 35%, 16 (34.0%) had positive programmed ventricu-
lar stimulation, and 16 (34.0%) had QRS duration ≥ 180ms. During a
median (IQR) follow-up duration of 5.3 (2.1—8.0) years, 14 (29.8%)
patients had at least one appropriate ICD therapy. The annual inci-
dence of appropriate ICD therapies were 2.8%, 4.6%, 6.3%, and
8.6% in patients with none, one, two, or ≥ three of these fac-
tors (P for trend = 0.145). None of predictors, considered isolated,
was significantly associated with ICD appropriate therapies. Patients
with non-sustained ventricular tachycardia (NSVT) and positive pro-
grammed ventricular stimulation had a significant increased risk of
ICD appropriate therapies (HR = 3.8, 95% CI: 1.1—14.3, P = 0.035),
as well as patients with NSVT and QRSd ≥ 180 ms (HR = 7.2, 95% CI:
1.6—32.7, P = 0.003). No patient with severe altered LVEF without
other risk factor had appropriate ICD therapy.
Conclusions Our data illustrate that specific risk stratification
and primary prevention for sudden cardiac death in patients with
tetralogy of Fallot may be improved. The value of a severely altered
LVEF appears low in the absence of other risk factors.
Disclosure of interest The authors declare that they have no com-
peting interest.
https://doi.org/10.1016/j.acvdsp.2019.09.234
Friday, January 17th, 2020
041
Prevalence, incidence and prognostic
implications of left bundle branch block in
patients with stable coronary artery disease.
An analysis from the CLARIFY registry
A. Darmon 1,∗ , G. Ducrocq 1 , Y. Elbez 1 , E. Sorbets 2 , R. Ferrari 3 ,
I. Ford 4 , J.C. Tardif 5 , M. Tendera 6 , K.M. Fox 7 , P.G. Steg 1
1 Cardiologie, Hopital Bichat, Paris
2 92, Hopital Avicenne, Bobigny, France
3 Department of Cardiology, Maria Cecilia Hospital, Department
of Cardiology and LTTA Centre, University Hospital of Ferrara and
Maria Cecilia Hospital, Cotignola, Italy
4 University of Glasgow, Robertson Centre for Biostatistics,
Glasgow, United Kingdom of Great Britain & Northern Ireland
5 Montreal Heart Institute, University of Montreal, Montreal,
Canada
6 Medical University of Silesia, Katowice, Poland
7 Royal Brompton Hospital, NHLI Imperial College, ICMS, London,
United Kingdom of Great Britain & Northern Ireland
∗ Corresponding author.
E-mail address: arthur.darmon@gmail.com (A. Darmon)
Background The prevalence, and prognostic implication of left
bundle branch block (LBBB) patients with stable coronary artery
disease (CAD) is unknown.
Purpose To describe the prevalence, incidence and prognostic
implications of LBBB in patients with stable CAD.
Methods CLARIFY is an international registry of more than
30.000 patients with stable CAD. LBBB was defined as a QRS
complex > 120 milliseconds. Patients with previous pacemaker
implantation or defibrillator were excluded. The primary outcome
was a composite of cardiovascular (CV) Death, MI or stroke, and
secondary outcomes included hospitalization for heart failure (HF)
or the need for pacemaker implantation.
Results From the 23.457 patients with available data, 1.041
(4.4%) had LBBB at baseline and 1.237 (5.3%) during 5-year follow-
up. Only 21 patients with newly diagnosed LBBB overtime, had
a documented MI the same year. Compared to patients without
108 Rhythmology and stimulation

LBBB, patients with LBBB had a higher risk profile regarding age 357
(67.2 ± 10.1 versus 63.6 ± 10.4 years, P < 0.0001), history of coro- Epicardial atrial fat and left atrium
nary artery bypass grafting (29.2% vs. 23.7%, P < 0.0001), diabetes remodeling
(35.1% vs. 28.4%, P < 0.0001), and HF (25.2% vs. 16.8%, P < 0.0001).
A. Felder 1,∗ , M. Kibler 1 , S. El Ghannudi-Abdo 2 , P. Ohlmann 1 ,
In multivariate analysis there was no difference in the rate of pri-
O. Morel 1 , L. Jesel 1
mary outcome between LBBB or no-LBBB patients (adjusted HR 1 Cardiologie, Université de Strasbourg, Pôle d’Activité
1.04, 95% CI 0.85—1.29). Patients with LBBB had a higher rate
Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil,
of pacemaker implantation (adjusted HR 2.21, 95% CI 1.55—3.15,
Centre Hospitalier Universitaire, Strasbourg, France
P < 0.0001) and hospitalization for HF (adjusted HR 1.53, 95% CI 2 Université de Strasbourg, Pôle Imagerie, Nouvel Hôpital Civil,
1.25—1.88, P < 0.0001) (Table 1, Fig. 1).
Centre Hospitalier Universitaire, Strasbourg, France
Conclusion The prevalence of LBBB in patients with stable CAD ∗ Corresponding author.
was 4.4% and 5.3% with 5-year follow-up. The majority of newly
E-mail address: antoine.felder@lilo.org (A. Felder)
diagnosed LBBB were not contemporary of myocardial infarction.
LBBB was not associated with a higher rate of major adverse cardio- Background Increasing data have reported a potent link between
vascular events, but with a higher risk of pacemaker implantation epicardial atrial fat (EAF) and atrial fibrillation (AF) that could
and hospitalization for heart failure. This is the first study reporting contribute to atrial substrate remodeling through its paracrine func-
such results in a broad population of stable CAD patients. tion. High burden of AF is associated with progressive left atrium
(LA) structural remodeling but little is known about the relationship
between LA reverse remodeling (LARR) and EAF thickness evolution
according to AF burden. The objective of the study was to evaluate
EAF thickness using 2 consecutive CT scan in a cohort of patients
with recurrent AF after ablation and to analyze its relation with LA
volume and LARR.
Methods We included 90 patientswho had a first AF ablation and
a redo procedure along with two computed tomographies (CT). EAF
thickness and LARR defined as a 15% reduction of LA volume were
measured on 2 consecutive CT. The patients were divided into two
groups—those with LARR (LARR +) and those without (LARR-).
Results LARR occurred in 23% (21) of the cohort despite AF recur-
rence in both group. There was no significant difference in terms
of age, BMI, cardiovascular risk factors between the two groups.
LA volume was the only multivariate predictor of an important
Fig. 1 EAF thickness (HR 1.01; 95%CI 1.001—1.026; P = 0.04). BMI was not
associated to EAF. Hypertension and EAF thickness (HR 5.71; 95%CI
1.22—26.75; P = 0.009; HR 1.41; 95%CI 1.09—1.84; P = 0.009 respec-
Table 1 Baseline characteristics of the study population according tively) were independent predictive factors of LA enlargement
to the presence of absence of LBBB. whereas glomerular filtration rate was protective (HR 0.95; 95%CI
0.92—0.99; P = 0.010). We could not identify LARR predictor except
Patients Patients P value
ACEI/ARB treatment (HR 2.78; 95%; CI 1.023—7.597; P = 0.044). No
with LBBB without LBBB
n = 1041 n = 22506 significant decrease of EAF could be observed in LARR+ and LARR-
groups.
Age, mean (SD), y 67.2 (10.1) 63.6 (10.4) < 0.0001
Conclusion LA volume was the sole independent predictor of
Male, n (%) 765 (73.5%) 17521 (77.9%) 0.0009
Medical history, n (%):
EAF thickness. Hypertension, EAF thickness were associated with
Myocardial infarction 659 (63.3%) 13539 (60.2%) 0.043 LA enlargement. ACEI/ARB was predictive of LARR. No significant
Percutaneous coronary 505 (48.5%) 13346 (59.3%) < 0.0001 decrease in EAF thickness was associated with reverse remodeling
intervention after AF ablation.
Coronary artery bypass 304 (29.2%) 5324 (23.7%) < 0.0001 Disclosure of interest The authors declare that they have no com-
grafting peting interest.
Hospitalization for heart 139 (13.4%) 900 (4.0%) < 0.0001
failure https://doi.org/10.1016/j.acvdsp.2019.09.236
Diabetes 365 (35.1%) 6390 (28.4%) < 0.0001
Left Ventricular Ejection 50.3 (12.4) 57.0 (10.3) < 0.0001 105
Fraction (SD), (%) Can chronic his bundle pacing be safely
started in centers with lack of experience of
Disclosure of interest Bourse d’etude de Abbot> Frais de voyages this technique? Mid-term data from a
de AlviMedica et Bayer. multicentric registry
https://doi.org/10.1016/j.acvdsp.2019.09.235 C. Chaumont 1,∗ , N. Auquier 2 , E. Popescu 2 , A. Milhem 3 ,
A. Savoure 1 , B. Godin 1 , A. Mirolo 1 , H. Eltchaninoff 1 ,
F. Anselme 1
1 Cardiology, University Hospital of Rouen, Rouen
2 Cardiology, Le Havre Hospital, Le Havre
3 Cardiology, La Rochelle Hospital, La Rochelle, France
∗ Corresponding author.

E-mail address: corentinchaumont@hotmail.com (C. Chaumont)

Introduction Right ventricular pacing (RVP) induces ventricular
asynchrony in patients with normal QRS and increases the risk of
heart failure and atrial fibrillation on long-term. His bundle pacing