Journal of Interventional Cardiac Electrophysiology (2018) 51(Suppl 1):S1–S147 https://doi.org/10.1007/s10840-018-0338-y

Special Program and Abstract issue of the 14th Annual Congress of the European Cardiac Arrhythmia Society (ECAS) Published online: 15 March 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018

Special Program and Abstract issue of the 14th Annual Congress of the European Cardiac Arrhythmia Society (ECAS) April 15–17, 2018 Paris, France Hotel Meridien Etoile Guest Editor: Prof. Samuel Lévy, MD, Aix-Marseille Université, Marseille, France

Abstract Oral Session 9: Heart failure with depressed or preserved left ventricular function Abstract Oral Session 10: New insights in the mechanisms of Cardiac Arrhythmias Abstract Oral Session 11: Cardiac arrhythmia mechanisms ECAS 2018 ORAL ABSTRACT SESSIONS 12–15 Tuesday April 17, 2018, 08:30 am–10:00 am

INVITATION PROGRAM AT A GLANCE SCIENTIFIC PROGRAM OF PRE-ARRANGED SESSIONS ECAS 2018 ORAL ABSTRACT SESSIONS 1–6 Sunday April 15, 2018, 10:30 am–12:00 pm Abstract Oral Session 1: Catheter ablation of atrial fibrillation Abstract Oral Session 2: Cardiac resynchronization therapy: role of His-bundle pacing Abstract Oral Session 3: Cardiomyopathies. Risk stratification and outcomes Abstract Oral Session 4: Catheter ablation of supraventricular or ventricular arrhythmias Abstract Oral Session 5: Stroke prevention in patients with or without atrial fibrillation Abstract Oral Session 6: Sudden Cardiac Death: from cardiac arrest to post-ICD implant ECAS 2018 ORAL ABSTRACT SESSIONS 7–11 Monday April 16, 2018, 10:30 am–12:00 pm Abstract Oral Session 7: Catheter ablation of atrial fibrillation 2 Abstract Oral Session 8: Progress in Cardiac Pacing and outcomes

Abstract Oral Session 12: Atrial fibrillation ablation 3: Technical aspects and results Abstract Oral Session 13: Non-ablative treatment of atrial fibrillation Abstract Oral Session 14: Risk factors for atrial fibrillation Abstract Oral Session 15: Lead extraction techniques ECAS 2018 CHAIRED POSTER SESSION A: PARTS 1 AND 2 Sunday April 15, 2018, 08:30 am–12:00 pm Chaired poster session A part 1: Cardiac Resynchronization Therapy (CRT) Techniques and tools for cardiac arrhythmias Mechanisms or triggers of cardiac arrhythmias Chaired poster session A part 2: Genetics aspects of cardiac arrhythmias Channel currents and biological markers in atrial fibrillation Antiarrhythmic agents in atrial fibrillation ECAS 2018 CHAIRED POSTER SESSION B: PARTS 1 AND 2 Sunday April 15, 2018, 02:00 pm–05:30 pm Chaired poster session B part 1: Sudden cardiac death and ICD Wearable defibrillators

S2

Chaired poster session B part 2: Atrial Fibrillation ECAS 2018 CHAIRED POSTER SESSION C: PARTS 1 AND 2 Monday April 16, 2018, 08:30 am–12:00 pm Chaired poster session C part 1: Bradycardia and cardiac pacing Arrhythmia detection and monitoring Chaired poster session C part 2: Ventricular Arrhythmias Oral anticoagulation Mapping techniques

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

ECAS 2018 CHAIRED POSTER SESSION D: PARTS 1 AND 2 Monday April 16, 2018, 02:00 pm–05:30 pm Chaired Poster Session D part 1 Atrial arrhythmias Left Atrial Appendage Occlusion Chaired Poster Session D part 2 Ablation of Supraventricular tachycardias Management of patients with atrial fibrillation Risk stratification and prevention in patients with heart disease Ablation of ventricular arrhythmias AUTHORS INDEX BY ABSTRACT NUMBER

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S3

S4

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Special Program and Abstract issue of the 14th Annual Congress of the European Cardiac Arrhythmia Society (ECAS) April 15–17, 2018 Paris, France Hotel Meridien Etoile Guest Editor: Prof. Samuel Lévy, MD, Aix-Marseille Université, Marseille, France Invitation Dear Colleagues, This is an invitation to join us at the Fourteenth Annual Scientific Congress of the European Cardiac Arrhythmia Society “ECAS 2018” to be held in Paris, France April 15 to 17, 2018 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. Organizing Committee ECAS 2018 Leonardo Calò, Riccardo Cappato, Fernand Hessel, Ellen Hoffmann, Stefan Kääb, Gilles Lascault, Samuel Lévy (Chair), Gerhard Steinbeck

Prof. Riccardo Cappato, MD President of ECAS

Prof. Samuel Lévy MD Congress Chairman

EXECUTIVE COMMITTEE OF THE EUROPEAN CARDIAC ARRHYTHMIA SOCIETY President Riccardo Cappato (Milan, IT) Past President Wyn Davies (London, GB) Vice-President (Education & Research) Richard Hauer (Utrecht, NL) Vice-President (National Societies) Massimo Santini (Rome, IT) Vice-President (International Societies & EU) Samuel Lévy (Marseille, FR) Treasurer Eli Ovsyshcher (Beersheba, IL) Secretary General Leo Van Wersch (Paris, FR) Continuing Medical Education Nicholas Peters (London, GB) Relation with European Societies Stefan Kääb (Munich, DE) Chair Membership Program Neil Sulke (Eastbourne, GB) Organizing annual Congress Gerhard Steinbeck (Munich, DE) Education Committee Thorsten Lewalter (Munich, DE)

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S5

Program Committee Alawi Alsheikh-Ali; Elad Anter; Charles Antzelevitch; Andrey Ardashev; Adrian Baranchuk; Serge Barold; Antonio Bayes De Luna; David Benditt; Leonardo Calò; David S Cannom; Riccardo Cappato; Wyn Davies; Roberto De Ponti; Luigi Di Biase; Mark Estes III; Heidi Estner; Jerónimo Farré; John Fisher; Richard Hauer; Ellen Hoffmann; Wael Jaber; Warren Jackman; Charles Jazra; Xavier Jouven; Stefan Kääb; Helmut Klein; Gilles Lascault; Jean-Yves Le Heuzey; Samuel Lévy; Thorsten Lewalter; Bruce Lindsay; Shaowen Liu; Peter Loh; Pierpaolo Lupo; Michael Näbauer; Yuji Nakazato; Andrea Natale; Petr Neuzil; Eli Ovsyshcher; Ali Oto; Douglas L Packer; Luigi Padeletti*; Nicholas S. Peters; Dubravko Petrač; Antonio Raviele; Edward Rowland; Sanjeev Saksena; Massimo Santini; Richard Schilling; Jasbir Sra; Gerhard Steinbeck; Neil Sulke; Ernst Vester; Reza Wakili; Albert Waldo; Bruce Wilkoff. *In memoriam Scientific Advisory Board Masood Akhtar (Milwaukee, USA) Etienne Aliot (Nancy, FR) Maurits A. Allessie (Maastricht, NL) Eckhard Alt (Munich, DE) Charles Antzelevitch (Utica, USA) Andrey Ardashev (Moscow, RU) Serge S. Barold (Boca Raton, USA) David Benditt (Minneapolis, USA) Poul Erik Bloch-Thomsen (Hellerup, DK) Jozsef Borbola (Budapest, HU) Johannes Brachmann (Coburg, DE) A John Camm (London, GB) Alessandro Capucci (Ancona, IT) Riccardo Cappato (Milan, IT) David S. Cannom (Los Angeles, USA) Sumeet Chugh (Los Angeles, USA) Antonio Curnis (Brescia, IT) Philippe Coumel* D. Wyn Davies (London, GB) Hu Dayi (Beijing, CN) Luc De Roy (Yvoir, BE) Sergio Dubner (Buenos Aires, AR) Nils G. Edvardsson (Goteborg, SE) Michaël Eldar (Tel Aviv, IL) Nabil El-Sherif (New York, USA) Jerónimo Farré (Madrid, ES) John Fisher (New-York, USA) Guy Fontaine (Paris, FR) Robert Frank (Paris, FR) Seymour Furman* Bulent Gorenek (Eskisehir, TR) Stephen C. Hammill (Rochester, USA) Richard Hauer (Utrecht, NL) Habib Haouala (Tunis, TN) Yoshito Iesaka (Tokyo, JP) Michiel Janse (Amsterdam, NL)

Charles Jazra (Beirut, LB) Xavier Jouven (Paris, FR) Werner Jung (Villingen, DE) Stefan Kääb (Munich, DE) Prapa Kanagaratnam (London, GB) Joergen Kanters (Copenhagen, DK) Bondo Kobulia (Tbilisi, GE) Karl-Heinz Kuck (Hamburg, DE) Jean-François Leclercq (Paris, FR) Jean-Yves Le Heuzey (Paris, FR) Samuel Lévy (Marseille, FR) Berndt Lüderitz (Bonn, DE) Damian Gascon Lopez (Sevilla, ES) Marek Malik (London, GB) Harry G. Mond (Melbourne, AU) Alessandro A Montenero (Rome, IT) Conception Moro Serrano (Madrid, ES) Arthur J. Moss (Rochester, NY, USA)* Michael Näbauer (Munich, DE) Gerald V. Nacarelli (Hershey, USA) Yuji Nakazato (Tokyo, JP) Andrea Natale (Cleveland, USA) Promund I. W.Obel (Johannesburg, ZA) Brian Olshansky (Iowa City, USA) Bertil S. Olsson (Lund, SE) Oscar Oseroff (Buenos Aires, AR) Ali Oto (Ankara, TR) Eli Ovsyshcher (Beersheba, IL) Douglas L. Packer (Rochester, USA) Luigi Padeletti* Nicholas S Peters, (London, GB) Dubravko Petrač (Zagreb, HR) Eric N. Prystowsky (Indianapolis, USA) Antonio Raviele(Venice, IT) Amiran Revishvili (Moskow, RU) Dwight Reynolds (Oklahoma, USA) Edward Rowland (London, GB)

Sanjeev Saksena (New Brunswick, USA) Massimo Santini (Rome, IT) Maurizio Santomauro (Naples, IT) Dipen Shah (Geneva, CH) Richard Schilling (London, GB) Georg Schmidt (Munich, DE) Jabir Sra (Milwaukee, USA) Gerhard Steinbeck (Munich, DE) Neil Sulke (Eastbourne, GB) Paul Touboul (Lyon, FR) Albert Waldo (Cleveland, USA) Hein JJ Wellens (Maastricht, NL) Bruce Wilkoff (Cleveland, USA) David Wilber (Chicago, USA) George D. Wyse (Calgary, CA)

*In memoriam

S6

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Abstract Selection Each abstract has been sent to 8 reviewers and been evaluated by a minimum of 4 of them. The Organizing Committee would like to thank the abstract reviewers for their valuable help in abstract selection for the ECAS 2018 program: Etienne Aliot; Matteo Anselmino; Elad Anter; David Benditt; Tina Baykaner; Jean-Jacques Blanc; Noel Boyle; Günter Breithardt; Hugh Calkins; Leonardo Calò; John Camm; David Cannom; Antony Chu; Wyn Davies; Roberto De Ponti; Nils Edvardsson; John Fisher; Ellen Hoffmann; Michiel Janse; Prapa Kanagaratnam; Suraj Kapa; David Keane; Helmut Klein; Thorsten Lewalter; Bruce Lindsay; Maurizio Lunati; William McKenna; Michael Näbauer; Yuji Nakazato; Sanjiv Narayan; Brian Olshansky; Antonio Raviele; Andrea Russo; Sanjeev Saksena; Walid Saliba; Massimo Santini; Robert Schweikert; Dipen Shah; Mohammed Shenasa; Gerhard Steinbeck; Ernst Vester; Pugazhendhi Vijayaraman; Reza Wakili; Albert Waldo; Roger Winkle. General Information Congress Venue Hotel Le Meridien-Etoile 81 Boulevard Gouvion Saint Cyr 75848 Paris Cedex 17 Tel: +33 (0)1 40 68 34 34 www.lemeridienetoile.com

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S7

Abstract Awards Presentation of the Awards for the Best Oral Abstracts will take place during the Opening Ceremony on Sunday April 15, 2018 in Room Wagram B (Hotel Meridien-Etoile) starting at 5:30PM Presentation of the Awards for Best Poster Presentations will take place on Tuesday April 17, 2018 12:00 PM–12:30 PM The 14th Philippe Coumel Lecture 2018 will be presented on Sunday April 15, 2018 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 Saturday April 14, 2018 from 2:00 PM to 5:00 PM ECAS Congress Secretariat Josette Razafimbelo Tel: + 33 (0)4 89 98 98 08 Cell: +336 26 07 55 74 E-mail: [email protected] 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 15, 2018 from 7:30 AM to 5:00 PM at Hotel Meridien-Etoile (Lobby). 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 Scientific Program The Program includes 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. The time allotted to Faculty presentation is 22 minutes including discussion when the session includes 4 speakers and 18 minutes including discussion in the 5 speaker sessions. Publications

S8

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

JICE (Journal of Interventional Cardiac Electrophysiology) is the official Journal of the European Cardiac Arrhythmia Society.

Sanjeev Saksena MD JICE Editor-in-Chief

Leonardo Calò MD ECAS JICE co-Editor

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 minutes plus 5 minutes for discussion. All posters accepted for presentation will be chaired. Please to check the day and time at which your poster will be presented to the chairpersons and the time at which the presenters should be near their poster board.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S9

PROGRAM AT A GLANCE ECAS 2018 SUNDAY APRIL 15, 2018 08:00 am Registration 05:00 pm

08:30 am 10:00 pm

Room WAGRAM B Session WS-06

Room COURCELLES Session WS-01

LAA

Syncope

10:00 am 10:30 am

10:30 am 12:00 pm

Concurrent Workshops Room Room Room DAMES DEBARCADERE EPINETTES Session WS-02 Session WS-03 Session WS-04 ECG of PM and AF ablaon VT ablaon CRT

Room REMBRANDT Session WS-05 Device management

Room WAGRAM B

Room COURCELLES

Concurrent Abstract Sessions Room Room Room DAMES DEBARCADERE EPINETTES

Room REMBRANDT

Room COURCELLES Session SP-01

Room WAGRAM B Session HD-01

Room DAMES Session AB-01

Room DEBARCADERE Session SP-02

Ancoagulaon

AF in HF

VT ablaon

ECG Part 1

03:30 pm 04:00 pm

Chaired poster session A cont.

Room EPINETTES Session SP-03 Septal accessory path.

Room REMBRANDT Session SP-04

Room TERNES

Device therapy

Chaired poster session B

Room TERNES

Coffee break and visit to posters Room COURCELLES

Room WAGRAM B

Room DAMES

Room DEBARCADERE

Room EPINETTES

Room REMBRANDT

Session SP-05

Session HD-02 Ventricular arrhythm. in HD

Session AB-02

Session SP-06

Session SP-07

Session SP-08

PVI

ECG Part 2

ANS

SCD

NOACs

Room WAGRAM B 05:30 pm 07:00 pm

Room TERNES

Sunday April 15, 2018 - Room WAGRAM A Seated Luncheon Panel

12:15 pm 01:45 pm

04.00 pm 05:30 pm

Chaired poster session A

Coffee break and visit to posters

Oral Abstract 1 Oral Abstract 2 Oral Abstract 3 Oral Abstract 4 Oral Abstract 5 Oral Abstract 6

02:00 pm 03:30 pm

Room TERNES

Opening ceremony OUTSTANDING ACHIEVEMENT AWARDS AND BEST ABSTRACTS Followed by a Cock tail Reception

Chaired poster session B cont.

S10

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

PROGRAM AT A GLANCE ECAS 2018 MONDAY APRIL 16, 2018 08:30 am 10:00 am

Room COURCELLES Session HD-03

Room DAMES Session AB-03

Room DEBARCADERE Session SP-09

Room EPINETTES Session SP-10

Room REMBRANDT Session SP-11

ARVD/C

AF ablaon

Surface ECG

Mechanisms of CA

CRT

Chaired poster session C

Room REMBRANDT

Room TERNES

Oral Abstract 11

Chaired poster session C cont.

10:00 am 10:30 am

10:30 am 12:00 pm

Coffee break and visit to posters Concurrent Abstract Sessions Room Room DEBARCADERE EPINETTES

Room COURCELLES

Room DAMES

Oral Abstract 7

Oral Abstract 8

05:30 pm 06:15 pm

05:30 pm 06:15 pm

Oral Abstract 10

Session HD-04

Room DAMES Session AB-04

Room DEBARCADERE Session SP-12

Room EPINETTES Session SP-13

Room REMBRANDT Session SP-14

AF in HF

VT ablaon

ECG Part 3

Precision medicine

SCD and ICD

Chaired poster session D

Room COURCELLES

03:30 pm 04:00 pm

04.00 pm 05:30 pm

Oral Abstract 9

Monday April 16, 2018 - Room WAGRAM A Seated Luncheon Panel

12:15 pm 01:45 pm

02:00 pm 03:30 pm

Room TERNES

Room TERNES

Coffee break and visit to posters

Room COURCELLES

Room DAMES

Room DEBARCADERE

Room EPINETTES

Room REMBRANDT

Room TERNES

Session HD-05

Session SP-15

Session AB-05

Session SP-16

AF management

CRT

Persistent AF

Dysautonomia

Session SP-17 Device management

Chaired poster session D cont.

Debate 1 Room COURCELLES

Debate 2 Room DAMES

PVI in heart failure paents with AF should be first line therapy

CRT responders can be predicted using a pre-defined score (L2ANDS2)

Debate 3 Room EPINETTES

Debate 4 Room DEBARCADERE Despite the progress in technologies for AF catheter ablaon, the success rates have not shown significant improvement

The guidelines on primary prevenon ICD in nonischemic cardiomyopathy should be revised

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S11

PROGRAM AT A GLANCE ECAS 2018 TUESDAY APRIL 17, 2018

08:30 am 10:00 am

Room DAMES Oral Abstract 12

Concurrent Abstract Sessions Room Room DEBARCADERE EPINETTES Oral Abstract 13

10:00 am 10:30 am

10:30 am 12:00 pm

12:00 pm 12:30 pm

Oral Abstract 14

Room MONTENOTTE Oral Abstract 15

Coffee break Room DAMES Session SP-18

Room DEBARCADERE Session SP-19

Room EPINETTES Session SP-20

Room MONTENOTTE Session SP-21

CRT

AF ablaon

ICD

SCD

BEST POSTER AWARDS

S12

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

ECAS 2018 PRELIMINARY SCIENTIFIC PROGRAM 22/01/2018 This program is susceptible to evolve slightly. All Faculty has accepted their commitments. When the response to our invitation is not yet known TBA = to be announced, TBC = to be confirmed. SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM WAGRAM B Workshop WS-06 Left atrial appendage (LAA) occlusion: imaging before, during and after the procedure Chairpersons: John Camm (London, GB), Charles Jazra (Beirut, LB) 1. The ideal occluder device Oussama Wazni (Cleveland, USA) 2. Surgical versus percutaneous LAA exclusion Walid Saliba (Cleveland, USA) 3. The ideal patient for LAA occlusion Thorsten Lewalter (Munich, DE) 4. Outcome in high risk patients Andrea Natale (Austin, USA) SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM COURCELLES Workshop WS-01 Syncope in patients with heart disease: case studies and keynote lecture Chairpersons: David Benditt (Minneapolis, USA), Ali Oto (Ankara, TR) 1. Syncope in a patient with an ICD (15min) Noel Boyle (Los Angeles, USA) 2. Syncope in a patient with hypertrophic cardiomyopathy (15 min) Michael Nabauer (Munich, DE) 3. Syncope in a patient with cardiac sarcoidosis Sam Hanon (New York City, USA) 4. Syncope in a patient with dilated cardiomyopathy (15 min) Nils Edvardsson (Gothenburg, SE) 5. Special lecture: prognosis of patients with cardiovascular syncope (20 min) Haruhiko Abe (Kitakyushu, JHRS) SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM DAMES Workshop WS-02 ECG pacemaker and CRT dysfunction (case studies) Chairpersons: Serge Barold (San Diego, USA), Eli Ovsyshcher (Beersheba, IL) 1. 2. 3. 4.

Bengt Herweg (Tampa, USA) Serge Barold (San Diego, USA) Pugazhendhi Vijayaraman (Wilkes Barre, USA) Brian Olshansky (Iowa City, USA)

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S13

SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM DEBARCADERE Workshop WS-03 AF ablation: role of new technologies Chairpersons: Wyn Davies (London, GB), Roberto de Ponti (Varese, IT) 1. High density mapping Mohammad Shenasa (San Jose, USA) 2. Direct sense technology—learning from fish Armin Luik (Karlsruhe, DE) 3. Single shot devices: already 1st choice? Claudio Tondo (Milan, IT) TBC 4. Update on rotors Sanjiv Narayan (Palo Alto, USA) SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM EPINETTES Workshop WS-04 Ablation for ventricular tachycardia: increasing clinical success Chairpersons: Douglas Packer (Rochester, USA), Elad Anter (Boston, USA) 1. The understanding of what ventricular anatomy is mandatory for successful VT ablation Suraj Kapa (Rochester, USA) 2. Should MR imaging be mandatory prior to ablative intervention: what can we learn from MR integrated substrate mapping? Thorsten Lewalter (Munich, DE) 3. Is substrate-based ablation better than entrainment targeted-specific VT ablation? Douglas Packer (Rochester, USA) 4. Epicardial ablation for ventricular tachycardia: avoiding the pitfalls of related complications Richard Schilling (London, GB) SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM REMBRANDT Workshop WS-05 New developments in device management Chairpersons: Christine Albert (Boston, USA), Andrzej Kutarski (Lublin, PL) 1. Antibiotic pouch for prevention of device infections Khaldoun Tarakji (Cleveland, USA) 2. Modern external cardiac monitors Neil Sulke (Eastbourne, GB) 3. Management strategies for emergent intervention for catastrophic complications during lead extractions Charles Kennergren (Goteborg, SE) 4. Selection of patients for His-bundle pacing TBA 5. Impact of remote monitoring on patient outcomes Giovanni Forleo (Milan, IT)

S14

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

SUNDAY APRIL 15, 2018 8:30 AM–10:00 AM ROOM TERNES Chaired Poster session A 10:00 AM–10:30 AM Coffee break and visit to posters SUNDAY APRIL 15, 2018 10:30 AM–12:00 PM ROOM WAGRAM B Oral abstract–1 ROOM COURCELLES Oral abstract–2 ROOM DAMES Oral abstract–3 ROOM DEBARCADERE Oral abstract–4 ROOM EPINETTES Oral abstract–5 ROOM REMBRANDT Oral abstract–6 SUNDAY APRIL 15, 2018 10:30 AM–12:00 PM ROOM TERNES Chaired Poster session A cont.

Sunday April 15, 2018 12:15 pm–1:45 pm Room Wagram A Luncheon Panel (Reserved for Boehringer-Ingelheim)

SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM COURCELLES Session SP-01 Issues in anticoagulation and atrial fibrillation Chairpersons: Riccardo Cappato (Milan, IT), Ernst Vester (Dusseldorf, DE) 1. Do we know the threshold for initiating oral anticoagulation in patients with atrial high rate events (AHREs)? John Camm (London, GB) 2. Can we use direct oral anticoagulants (DOACs) to treat patients with AF and stroke risks with moderate-to-severe valvular heart disease (excluding moderate-to-severe mitral stenosis or presence of a mechanical heart valve)? Ernst Vester (Düsseldorf, DE) 3. When do the risks of bleeding outweigh the risks of stroke, such that oral anticoagulation is not indicated? Brian Olshansky (Iowa City, USA) 4. How should we use oral anticoagulation and antiplatelet therapy in patients with atrial fibrillation and coronary artery disease with or without stent(s)? Letizia Riva (Bologna, IT)

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM WAGRAM B Session HD-01 Atrial fibrillation in heart failure Chairpersons: Andrea Natale (Austin, USA), Thorsten Lewalter (Munich, DE) 1. Prognosis of AF in heart failure with reduced and preserved ejection fraction Christian Torp-Pedersen (Copenhagen, DK) 2. Medical therapy in atrial fibrillation with heart failure: is there any role? Gerhard Steinbeck, (Munich, DE) 3. Catheter ablation in atrial fibrillation with reduced ejection fraction Johannes Brachmann (Coburg, DE) 4. Therapeutic options in atrial fibrillation with preserved ejection fraction Sanjeev Saksena (Warren, USA) SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM DAMES Session AB-01 Aggressive ablation for ventricular tachycardia? Chairpersons: Roger Winkle (Palo Alto, USA), Leonardo Calo (Rome, IT) 1. Intracardiac ultrasound-guided VT ablation: from PVCs to cartosound-guided structural interventions Suraj Kapa (Rochester, USA) 2. What is the effect of LAVA, border-zone homogenization, and substrate ablation on ablating ventricular tachycardia? Sakis Themistoclakis (Mestre, IT) 3. Clinical outcomes of external particle therapy, and needle catheter ablation Douglas Packer (Rochester, USA) 4.Best ablative guides for ARVC, sarcoid, and other unusual ventricular tachycardias David Wilber (Maywood, USA) SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM DEBARCADERE Session SP-02 ECG interpretation course (Part 1: conduction disturbances) A tribute to Agustín Castellanos Jr (1927–2017) Chairpersons: Sanjeev Saksena (Warren, USA), Antonio Bayes de Luna (Barcelona, SP) Introduction: Agustin Castellanos Jr, A Giant in Electrocardiology Samuel Lévy (Marseille, FR) 1. Inter and intra-atrial block and role in AF development Antonio Bayes de Luna (Barcelona, SP) 2. New concepts in AV block Bengt Herweg (Tampa, USA) 4. Bundle branch blocks and hemiblocks complicating myocardial ischemia and infarction Samuel Lévy (Marseille, FR)

S15

S16

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM EPINETTES Session SP-03 Septal accessory pathways: diagnosis and ablation. Interactive case discussions Session proposed and conducted by Jasbir Sra (Milwaukee, USA), Warren Jackman (Milwaukee and Oklahoma City, USA) 1. Anteroseptal pathway-interactive case discussion 2. Left vs right mid septal pathway-interactive case discussion 3. Posteroseptal vs accessory pathway from the middle cardiac vein-interactive case discussion 4. Discussion with audience participation SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM REMBRANDT Session SP-04 Issues in device therapy Chairpersons: Promund Obel (Johannesburg, ZA), Poul Erik Bloch-Thomsen (Copenhagen, DK) TBC 1. What is the indication for placement of a leadless pacemaker? Dwight Reynolds (Oklahoma City, USA) 2. What is the indication for placement of a subcutaneous defibrillator? Luc Jordaens (Brussels, BE) 3. Who should be getting an ICD for primary prevention? Do we have all the answers? Andrea Russo (Camden, USA) 4. In patients without left bundle branch block and with a QRS complex duration > 0.12 s: which patients will benefit from bi-ventricular pacing? Varun Sundaram (London, GB) SUNDAY APRIL 15, 2018 2:00 PM–3:30 PM ROOM TERNES Chaired Poster session B 3:30 PM–4:00 PM Coffee break and visit to posters SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM COURCELLES Session SP-05 Impact of NOACs on the daily therapy now and in the future Chairpersons: John Camm (London, GB), Edward Rowland (London, GB) 1. Best anticoagulation for AF patients with CAD or/and PCI Reza Wakili (Essen, DE) 2. Best anticoagulation in AF patients undergoing ablation Dipen Shah (Geneva, CH) 3. OAC in patients with CHADS-Vasc score < 2 (The BRAIN-AF Trial) Lena Rivard (Montreal, CA) 4. What is coming after COMPASS? Potential new target populations? Riccardo Cappato (Milan, IT)

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM WAGRAM B Session HD-02 Management of sustained ventricular arrhythmias in heart disease Chairpersons: Jasbir Sra (Milwaukee, USA), Peter Zimetbaum (Boston, USA) 1. Sustained VT after previous myocardial infarction Peter Zimetbaum (Boston, USA) 2. VT complicating non-ischemic cardiomyopathy Stephen Furniss (Eastbourne, GB) 3. Ventricular arrhythmias in patients with congenital heart disease George van Hare (St Louis, USA) 4. VT complicating cardiac sarcoidosis Pier Lambiase (London, GB) SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM DAMES Session AB-02 How to optimize pulmonary vein isolation? Chairpersons: Ellen Hoffmann (Munich, DE), Antony Chu (Providence, USA) 1. Twenty years of pulmonary vein isolation—today results Mélèze Hocini (Bordeaux, FR) 2. Strategies to optimize PVI using radiofrequency energy David Haines (Royal Oak, USA) 3. Strategies to optimize PVI using cryoablation Florian Straube (Munich, DE) 4. The Multielectrode RF Balloon: is it a solution? TBA SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM DEBARCADERE Session SP-06 ECG interpretation course (Part 2: Important concepts for the understanding of complex arrhythmias) A tribute to Richard Langendorf, a pioneer in ECG interpretation Chairpersons: Eli Ovsyshcher (Beersheba, IL), Luc Jordaens (Brussels, BE) Introduction: Richard Langendorf, a pioneer in complex ECG interpretation Michiel Janse (5 min) 1. Concealed conduction of the cardiac impulse Michiel Janse (Amsterdam, NL) 2. Aberrant ventricular conduction Jeronimo Farre (Madrid, ES) 3. Diagnosis and mechanisms of AVNRT: lessons learnt from ablation Kenzo Hirao (Tokyo, JP)

S17

S18

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM EPINETTES Session SP-07 Autonomic nervous system and arrhythmias Chairpersons: Peter Schwartz (Milan, IT), Axel Bauer (Munich, DE) 1. Ablation of cardiac ganglia: in which patients? Leonardo Calo (Rome, IT) 2. Role of atrial and ventricular innervation on PVCs Christian Meyer (Hamburg, DE) 3. Role of MIBG imaging in inherited arrhythmia syndromes Reza Wakili (Essen, DE) 4. Left sympathetic denervation in the prevention of sudden cardiac death Peter Schwartz (Milan, IT) SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM REMBRANDT Session SP-08 Prediction and prevention of sudden cardiac death (SCD) in hypertrophic cardiomyopathy Chairpersons: Nicholas Peters (London, GB), John Fisher (New York City, USA) 1. Preventing sudden death in hypertrophic cardiomyopathy: new backing for ESC guidelines (HCM-EVIDENCE) William McKenna (London, GB) 2. Role of genetic testing in risk stratification for SCD Audrey Farrugia-Jacamon (Strasbourg, FR) 3. S-ICD in primary and secondary prevention of SCD Mark Estes III (Boston, USA) 4. Role of athletic restriction in prevention of SCD Xavier Jouven (Paris, FR) 5. Role of MRI in risk stratification for SCD Christine Albert (Boston, USA) SUNDAY APRIL 15, 2018 4:00 PM–5:30 PM ROOM TERNES Chaired Poster session B cont.

Room WAGRAM B 5:30 PM to 6:00 PM Philippe Coumel Special lecture: 6:00 PM to 7:00 PM

Opening ceremony Outstanding Achievement Awards Followed by a cocktail Reception

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Monday April 16, 2018 12:15 PM to 1:45 PM 12:15 pm–1:45 pm Room Wagram A

Luncheon Panel MONDAY APRIL 16, 2018 8:30 AM–10:00 AM ROOM COURCELLES Session HD-03 Risk stratification and therapy of arrhythmogenic cardiomyopathy Chairpersons: Frank Marcus (Tucson, USA) TBC, Richard Hauer (Utrecht, NL) 1. Does the concealed stage exist? Richard Hauer (Utrecht, NL) 2. About men and women at risk for the disease Firat Duru (Zurich, CH) 3. Towards individualized risk stratification of ARVD/C Frank Marcus (Tucson, USA) 4. Ablation of VT related to ARVD/C Luigi Di Biase (New York City, USA) MONDAY APRIL 16, 2018 8:30 AM–10:00 AM ROOM DAMES Session AB-03 AF ablation beyond pulmonary vein isolation Chairpersons: Ellen Hoffmann (Munich, DE), Gerhard Hindricks (Leipzig, DE) 1. Non-pulmonary vein foci as a target for atrial fibrillation ablation Ng Fu Siong (London, USA) 2. Magnetic resonance directed AF ablation Nassir Marrouche (Salt Lake City, USA) 3. Modification of arrhythmogenic substrate—strategies of today Sascha Rolf (Leipzig, DE) 4. Ablation of rotors and focal triggers Roland Richard Tilz (Lübeck, DE) MONDAY APRIL 16, 2018 8:30 AM–10:00 AM ROOM DEBARCADERE Session SP-09 Surface ECG in the 21st Century (ISE-ISHNE-ECAS Joint meeting) Chairpersons: Adrian Baranchuk (Ontario, CA), Niraj Varma (Cleveland, USA) 1. P-wave: The past, the present and the future Antonio Bayes de Luna (Barcelona, ES) 2. Update in early repolarization Peter Macfarlane (Glasgow, GB) 3. Definition of LBBB: does it matter? Ljuba Bacharova (Bratislava, SK) 4. VF risk in Brugada type I ECG patients: is the ECG the key? Philippe Chevalier (Lyon, FR)

S19

S20

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

MONDAY APRIL 16, 2018 8:30 AM–10:00 AM ROOM EPINETTES Session SP-10 Mechanisms of cardiac arrhythmias—relevance of high-density mapping in special cases Chairpersons: Francis Marchlinski (Philadelphia, USA), Jasbir Sra (Milwaukee, USA) 1. Atypical flutter in congenital heart disease George van Hare (St Louis, USA) 2. Atypical flutter after surgical procedures Roger Winkle (Palo Alto, USA) 3. Epicardial mapping in ablation procedures for ventricular tachycardia Tom Wong (London, GB) 4. Scar mapping in ablations of VTs in the context of dilated cardiomyopathy Heidi Estner (Munich, DE) MONDAY APRIL 16, 2018 8:30 AM–10:00 AM ROOM REMBRANDT Session SP-11 Challenges in cardiac resynchronization therapy Chairpersons: Michael Eldar (Tel Aviv, IL), Peter Loh (Utrecht, NL) 1. Pathophysiology of bundle branch block: has this been ignored? Roberto De Ponti (Varese, IT) 2. Optimal assessment of ventricular dyssynchrony: electrical, electro-anatomic or imaging? Andrey Ardashev (Moscow, RU) 3. Multisite ventricular pacing: options, techniques and future directions Yuji Nakazato (Tokyo, JP) 4. Intra-atrial dyssynchrony and its therapy Jean-Claude Daubert (Rennes, FR) ROOM TERNES MONDAY APRIL 16, 2018 8:30 AM–10:00 AM ROOM TERNES Chaired Poster session C 10:00 AM–10:30 AM Coffee break and visit to posters MONDAY APRIL 16, 2018 10:30 AM–12:00 PM ROOM COURCELLES Oral abstract–7 ROOM DAMES Oral abstract–8 ROOM DEBARCADERE Oral abstract–9 ROOM EPINETTES Oral abstract–10 ROOM REMBRANDT Oral abstract–11 MONDAY APRIL 16, 2018 10:30 AM–12:00 PM

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Chaired Poster session C cont.

Monday April 16, 2018 12:15 PM to 1:45 PM 12:15 pm–1:45 pm Room Wagram A

Luncheon Panel MONDAY APRIL 16, 2018 2:00 PM–3:30 PM ROOM COURCELLES Session HD-04 Atrial fibrillation and heart failure: where are we now? Chairpersons: Sanjeev Saksena (Warren, USA), Antonio Raviele (Venice, IT) 1. Prognostic significance of atrial fibrillation in patients with heart failure Antonio Raviele (Venice, IT) 2. Interference of atrial fibrillation with heart failure therapy Dubravko Petrac (Zagreb, HR) 3. Role of antiarrhythmic therapy in patients with AF and heart failure Samuel Lévy (Marseille, FR) 4. Is it the time to offer catheter ablation of AF as a first-line therapy in chronic heart failure? Riccardo Cappato (Milan, IT) MONDAY APRIL 16, 2018 2:00 PM–3:30 PM ROOM DAMES Session AB-04 Advances in VT ablation: from physiology to therapy “We need to learn before we burn!” Mark Josephson Chairpersons: Noel Boyle (Los Angeles, USA), Peter Zimetbaum (Boston, USA) 1. Determinants of slow conduction in the diseased heart Andre Kleber (Bern, CH and Boston, USA) 2. “The reentry vulnerable zone” a new target for VT ablation Elad Anter (Boston, USA) 3. Mapping techniques to identify the reentry vulnerable zones Luigi Di Biase (New York City, USA) 4. “Core isolation of VT substrate: subendocardial resection without surgery, is it possible?” Wendy Tzou (Aurora, USA) MONDAY APRIL 16, 2018 2:00 PM–3:30 PM ROOM DEBARCADERE Session SP-12 ECG Interpretation course (Part 3: tachycardia with wide QRS complexes) A tribute to Boris Surawicz (1917–2015) Chairpersons: Hein Wellens (Maastricht, NL), Nicholas Peters (London, GB) Introduction: Boris Surawicz, A great Electrocardiography Teacher Hein Wellens (Maastricht, NL) 5min 1. Tachycardias with pre-excited QRS complexes Leonardo Calo (Rome, IT) 2. Ventricular tachycardias: diagnostic criteria and what we learnt from ablation?

S21

S22

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Francis Marchlinski (Philadelphia, USA) 3. Supraventricular tachycardias with aberrant conduction Hein Wellens (Maastricht, NL) MONDAY APRIL 16, 2018 2:00 PM–3:30 PM ROOM EPINETTES Session SP-13 “Precision medicine” in arrhythmology Chairpersons: Albert Waldo (Cleveland, USA), Alawi Alsheikh-Ali (Dubai, UAE) 1. Atrial fibrillation: how to better characterize the different subgroups of patients in this syndrome Etienne Aliot (Nancy, FR) 2. Mechanism-based stratification of atrial fibrillation: achievable goal or fiction? Dobromir Dobrev (Essen, DE) 3. Risk stratification in idiopathic cardiomyopathy: LV ejection fraction only? Stefan Kaab (Munich, DE) 4. ECG mapping: the future? Leonardo Calo (Rome, IT) MONDAY APRIL 16, 2018 2:00 PM–3:30 PM ROOM REMBRANDT Session SP-14 Evolution of ICD trials for the prevention of sudden cardiac death Chairpersons: Gerhardt Steinbeck (Munich, DE), Poul Erik Bloch-Thomsen (Copenhagen, DK) 1. "What have we learned, then and now, from the MADIT trials, SCD-heft, IRIS, and other similar trials? David Cannom (Los Angeles, USA) 2. Do we need better risk assessment to increase the benefit of future primary prevention trials? Helmut Klein (Munich, DE) 3. The DANISH Trial—current results and future directions Lars Kober (Copenhagen, DK) 4. Are we ready to change practice guidelines based on the DANISH trial and recent meta-analysis: are more trials needed? David Benditt (Minneapolis, USA) MONDAY APRIL 16, 2018 2:00 PM–3:30 PM ROOM TERNES Chaired Poster session D 3:30 PM–4:00 PM Coffee break and visit to posters MONDAY APRIL 16, 2018 4:00 PM–5:30 PM ROOM COURCELLES Session HD-05 Issues in management of atrial fibrillation Chairpersons: Mark Estes III (Boston, USA), Alessandro Capucci (Ancona, IT) 1. Still valuable lessons learned from the rate vs rhythm control trials (AFFIRM, AF CHF, etc.) Albert Waldo (Cleveland, USA) 2. Lessons learned from Registry (“real world”) study data (PINNACLE, PREFER, GARFIELD AF, ORBIT AF, Record AF, GLORIA AF, AFNET) Gunter Breithardt (Munster, DE) 3. What is new in the last version of the consensus document on AF ablation

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S23

Mark Estes III (Boston, USA) 4. What do the data instruct us about utilizing anticoagulation and transesophageal echocardiography (TEE) in patients with new onset atrial fibrillation undergoing cardioversion? Alessandro Capucci (Ancona, IT) MONDAY APRIL 16, 2018 4:00 PM–5:30 PM ROOM DAMES Session SP-15 Japan HRS-ECAS (DRAFT) Program coordinators: Samuel Lévy (ECAS) and Yuji Nakazato (JHRS) Cardiac Resynchronization Therapy (CRT): unsolved issues Chairpersons: Yuji Nakazato (Tokyo, JP), Mohammad Shenasa (San Jose, USA) 1. Responder with non-LBBB ECG Haruhiko Abe (Kitakyushu, JHRS 2. Proarrhythmic effect of CRT Gilles Lascault (Paris, FR) 3. Upgrade strategy from PM/ICD Masahiko Takagi (Osaka, JHRS) 4. Multipoint pacing: bright future? Luca Santini (Rome, IT) MONDAY APRIL 16, 2018 4:00 PM–5:30 PM ROOM DEBARCADERE Session AB-05 Atrial fibrillation II: honing in persistent AF Chairpersons: Wyn Davies (London, GB), Jasbir Sra (Milwaukee, USA) 1. One-shot ablation one year after FIRE and ICE: is cryoballoon ablation better than RF balloon ablation? Prapa Kanagaratnam (London, GB) 2. Countering the dangers of contact force ablation for atrial fibrillation: what the clinician needs to know? Richard Schilling (London, GB) 3. Is it time for ablation of asymptomatic atrial fibrillation to prevent stroke and mortality occurrence? Sakis Themistoclakis (Mestre, IT) 4. Ground breaking innovations in ablation therapy Gerhard Hindricks (Leipzig, DE) TBC MONDAY APRIL 16, 2018 4:00 PM–5:30 PM ROOM EPINETTES Session SP-16 Cardiovascular manifestations of dysautonomia syndromes Chairpersons: David Cannom (Los Angeles, USA), David Benditt (Minneapolis, USA) 1. The spectrum of dysautonomia syndromes that cardiologists need to be aware of Gert van Dijk (Leiden, NL) 2. Inflammatory conditions and mast cell disorders causing POTs-like presentations David Cannom (Los Angeles, USA) 3. Vasovagal and reflex: why are they only present in Humans? Jean-Jacques Blanc (Brest, FR) 4. Vasovagal and reflex syncope: evolving understanding of the neuroendocrine milieu Richard Sutton (Monaco, MC) 5. Plasma catecholamines and susceptibility to reflex syncope during head-up Tilt testing

S24

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

David Benditt (Minneapolis, USA) MONDAY APRIL 16, 2018 4:00 PM–5:30 PM ROOM REMBRANDT Session SP-17 Developments in device management Chairpersons: Thomas Deering (Atlanta, USA), Massimo Santini (Rome, IT) 1. Antibiotic pouch for prevention of device infections Khaldoun Tarakji (Cleveland, USA) 2. Personal remote monitoring using smartphones Muzahir HassanTayebjee (Leeds, GB) 3. Management strategies for emergent intervention for catastrophic complications during lead extractions Werner Jung (Villingen, DE) 4. Selection of patients for His Bundle Pacing Pugazhendhi Vijayaraman (Wilkes Barre, USA) 5. Impact of remote monitoring on patient outcomes. Niraj Varma, (Cleveland, USA) MONDAY APRIL 16, 2018 4:00 PM–5:30 PM ROOM TERNES Chaired Poster session D cont. MONDAY APRIL 16, 2018 5:30 PM–6:15 PM ROOM COURCELLES Debate 1 PVI in heart failure patients with AF should be first line therapy Chairpersons: Wyn Davies (London, GB), Andrey Ardashev (Moscow, RU) Protagonist: Luigi Di Biase, (New York City, USA) Antagonist: Fiorenzo Gaita (Turin, IT) MONDAY APRIL 16, 2018 5:30 PM–6:15 PM ROOM DAMES Debate 2 CRT responders can be predicted using a pre-defined score (L2ANDS2) Chairpersons: Werner Jung (Villingen, DE), Heidi Estner (Munich, DE) Protagonist: Erwan Donal (Rennes, FR) Antagonist: TBA MONDAY APRIL 16, 2018

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S25

5:30 PM–6:15 PM ROOM EPINETTES Debate 3 The guidelines on primary prevention ICD in non-ischemic cardiomyopathy should be revised Chairpersons: Luc De Roy (Louvain, BE), Martin Borggrefe (Mannheim, DE) Protagonist: Lars Køber (Copenhagen, DK) Antagonist: John Fisher (New York City, USA) MONDAY APRIL 16, 2018 5:30 PM–6:15 PM ROOM DEBARCADAIRE Debate 4 Despite the progress in technologies for AF catheter ablation, the success rates have not shown significant improvement Chairpersons: Thorsten Lewalter (Munich, DE), Walid Saliba (Rochester, USA) Protagonist: Richard Schilling (London, GB) Antagonist: David Haines (Royal Oak, USA) TUESDAY APRIL 17, 2018 8:30 AM–10:00 AM ROOM DAMES Oral abstract–12 ROOM DEBARCADERE Oral abstract–13 ROOM EPINETTES Oral abstract–14 ROOM MONTENOTTE Oral abstract–15 TUESDAY APRIL 17, 2018 10:30 AM–12:00 PM ROOM DAMES Session SP-18 CRT in ischemic cardiomyopathy Chairpersons: Leonardo Calo (Rome), Magdi Sami (Montreal, CA) 1. Multimodality imaging to identify the right patient and the right site Matteo Bertini (Cona-Ferrara, IT) 2. Imaging during CRT implantation: present and future Ermenegildo De Ruvo (Rome, IT) 3. Multipoint pacing: a new expensive toy or a revolution in CRT? Francesco Zanon (Rovigo, IT) 4. Cardiac resynchronization therapy: how to measure the benefit in a given patient? Thomas Deering (Atlanta, USA) TUESDAY APRIL 17, 2018 10:30 AM–12:00 PM ROOM DEBARCADERE Session SP-19 AF ablation: beyond the pulmonary veins Chairpersons: Reza Wakili (Essen, DE), Luigi Di Biase (New York City, USA) 1. Heart failure patients in AF: PVI only or more? Matteo Anselmino (Turin, IT)

S26

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

2. Targeting fibrosis in AF ablation: how to translate it into clinical practice? Ali Oto (Ankara, TR) 3. Targeting rotors for AF ablation Tina Baykaner (Palo Alto, USA) 4. Atrial myocardial fiber orientation: implications for AF mapping David Keane (Dublin, IE) TUESDAY APRIL 17, 2018 10:30 AM–12:00 PM ROOM EPINETTES Session SP-20 Current issues in ICD Patients Chairpersons: Massimo Santini (Rome, IT), Luis Molina (Mexico City, MX) 1. Driving and ICD: are current guidelines evidence-based? Eugene Crystal (Toronto, CA) 2. MRI in patients with an ICD: what are the risks? Bharat Kantharia (New York City, USA) 3. Effects of shock delivery on the duration and quality of life David Cannom (Los Angeles, USA) 4. Sports practice in patients with an ICD Karin Nentwich (Bad Neustadt, DE) TUESDAY APRIL 17, 2018 10:30 AM–12:00 PM ROOM MONTENOTTE Session SP-21 Perspectives on Sudden Cardiac Death Chairpersons: Jacob Tfelt-Hansen (Copenhagen, DK), Francesco Furlanello (Trento, IT) 1. Exercise induced ventricular arrhythmias in trained athletes Marek Malik (London, GB) TBC 2. Early repolarization as a risk factor for sudden death Heikki Huikuri (Oulu, FI) 3. Long term impact of ICD therapy on Brugada syndrome Jacob Tfelt-Hansen (Copenhagen, DK) 4. Competitive sports practice in patients with heart disease: towards a consensus? François Carré (Rennes, FR) 5. Energy drinks and cardiac arrhythmias Maurizio Santomauro (Naples, IT) 12:00 PM–12:30 PM BEST POSTER AWARDS

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Part III Abstract Oral Session 1: Catheter ablation of atrial fibrillation 1 Sunday April 15, 2018, 10:30 am–12:00 pm ROOM WAGRAM B 1-1 Abstract 18-37

S27

0.50, 0.36, 0.38). Conclusion: Catheter ablation for AF can be performed safely and effectively in patients anticoagulated with NOACs and heparinized with a therapeutic ACT. There is no increased risk of peri-procedural bleeding when compared to uninterrupted warfarin. Further multicenter studies and randomized control trials will be required to confirm these findings.

C AT H E T E R A B L AT I O N F O R AT R I A L FIBRILLATION ON UNINTERRUPTED NOACS: A SAFE APPROACH?

n = 1884

NOAC (n = 1123) Sex, M, n (%) 613 (55) Age, years, (mean ± SD) 61 ± 12

WARFARIN (n = 761) 393 (52) 62 ± 14

0.20 0.10

Vinit Sawhney 1, Masooma Shaukat 1, Elena Volkova 1, Qiang Yao 1, Nicola Jones 1, Waqas Ullah 1, Shoreh Honarbakhsh 1, Gurpreet Dhillon 1, Martin Lowe 1, Anthony Chow 1, Pier Lambiase 1, Mehul Dhinoja 1, Malcolm Finlay 1, Mehul Dhinoja 1 , Simon Sporton 1 , Mark Earley 1 , Richard Schilling 1, Ross Hunter 1 1 Barts Heart Centre, London, United Kingdom

Background heart disease Normal heart, n (%)

Introduction: Non-vitamin K oral anticoagulants (NOACs) are an alternative to Vitamin K antagonists for prevention of thromboembolic events in patients with atrial fibrillation (AF). Current consensus guidelines advocate that NOACs be discontinued 2 days prior to catheter ablation (CA) due to increased bleeding risk. However, interrupting oral anticoagulants may predispose patients to the risk of thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted NOACs by comparing the outcomes to patients undergoing CA on warfarin. Methods: This was a single centre, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinized prior to transseptal puncture with a target activated clotting time (ACT) of 300– 350 s. Patients who had procedures performed on continuous NOAC were compared to those on continuous warfarin. Clinical and procedural data, and complications occurring up to 3 months, were analyzed from a prospective registry with additional review of notes and electronic health records. Results: One thousand eight hundred eighty-four procedures were performed over 28 months: 761 on uninterrupted warfarin and 1123 on uninterrupted NOAC (rivaroxaban 64%, apixaban 32%, and dabigatran 4%). There were no significant differences between groups in clinical or procedural characteristics. There was no difference in the overall procedure complication rate between the two groups; tamponade, haematoma, pseudoaneurysm, transfusion (p values 0.28, 0.13, 0.45, and 0.36). There were no strokes/TIAs in the entire cohort. Of the patients with tamponade, there was no difference between groups in the proportion requiring reversal of oral anticoagulation, the volume of blood lost, the proportion transfused, or the proportion drained percutaneously (p values

Ischemic heart disease n (%) Dilated cardiomyopathy n (%) Valvular, n (%) Others, n (%)

P value

868 (77)

561 (74)

0.13

61 (5)

51 (7)

0.07

94 (8)

64 (8)

1

32 (3) 68 (6)

30 (4) 55 (7)

0.24 0.38

332 (44) 429 (56) 479 (63) 409 (54)

0.660.66

AF, n (%) 504 (45) 619 Persistent paroxysmal (55) Hypertension, n (%) 721 (64) Diabetes mellitus, n (%) 621 (55)

0.65 0.66

1-2 Abstract 18-15 W I D E A R E A L E F T AT R I A L A P P E N D A G E I S O L AT I O N F O R AT R I A L F I B R I L L AT I O N T H E R A P Y: L O N G - T E R M S U C C E S S A N D INCIDENCE OF STROKE AND THROMBUS FORMATION Christian Heeger 1, Andreas Rillig 1, Tobias Fink 1, Shibu Mathew 1, Roland Richard Tilz 2, Bruno Reissmann 1, Christine Lemes 1, Tilman Maurer 1, Francesco Santoro 1, Hannes Alessandrini 1, Inge Dotz 1, Andreas Metzner 1, Karl-Heinz Kuck 1, Feifan Ouyang 1 1 Asklepios Klinik St. Georg, Hamburg, Germany, 2 Dept. of Cardiology, University of Luebek, Luebeck, Germany Background: Pulmonary vein isolation (PVI) has evolved into an effective strategy for the treatment of atrial fibrillation (AF). Yet, stable sinus rhythm (SR) cannot be achieved by PVI alone in some patients. Wide area left atrial appendage isolation (LAAI) has been suggested to potentially improve outcome in recurrent AF. Yet, this strategy may be associated with an increased risk of LAA thrombus and subsequent embolic events. This study sought to assess the long-term success and the incidence of embolic events and LAA thrombus formation after LAAI. Methods: A total of 116 patients with

S28

radiofrequency (RF)-based LAAI were prospectively enrolled (LAAI group). LAAI was achieved after a median of three (interquartile range 2, 4) procedures. Oral anticoagulation (OAC) independently of the individual CHA2DS2-VASc score was recommended to all patients. The patients were compared with matched patients with comparable baseline characteristics who underwent RF-based AF ablation without LAAI (n = 116, control group). A transesophageal echocardiography was performed during follow-up in 95/116 (82%, LAAI) and 89/116 (77%, control) patients. Results: During a follow-up period of 60 months, 36.6% (LAAI) and 27.1% (control) of patients showed stable SR (p = 0.0179). Embolic cerebrovascular events occurred in 17/116, 14.7% (LAAI) and 3/116, 2.6% patients (control, p = 0.00147). LAA thrombus was identified in 22/95, 23.2% (LAAI) and 2/89, 2.2% patients (control, < 0.0001). LAA-closure was recommended to the LAAI patients and has been performed in 46/116 (39.7%) patients. Except 1/46 patient (2.2%) with thrombus formation on the LAA-closure device, no further thrombi of stroke occurred. Conclusions: This prospective study showed that RF-based LAAI is able to improve long-term outcome of AF ablation procedures compared to a matched control group without LAAI. However, a high incidence of embolic events as well as LAA thrombus formation was observed despite sufficient OAC. Therefore, LAAI should be taken into consideration due to a moderate benefit and potential risk of embolic events. Furthermore, LAA closure should be considered in those patients to maybe prevent LAA thrombi and embolic stroke.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

assessing pulmonary vein occlusion were included. Results: Cryoballoon ablation, with additional segmental radiofrequency ablation in 13.7%, resulted in complete pulmonary vein isolation in 100% of patients. The single procedure freedom from recurrence of atrial arrhythmia beyond the initial 3 months post-ablation was 81.2% at a mean follow-up of 237 days. Recurrence of atrial arrhythmia within 3 months post-ablation was 11.1% and predicted recurrence beyond 3 months. Repeat ablation was performed in 12.0% of patients. Conclusions: In the largest study to date on this topic and the only study to focus on clinical outcomes, pressure waveform analysis as the primary method of determining pulmonary vein occlusion in cryoballoon ablation of atrial fibrillation resulted in acute and long-term procedural success rates comparable to those reported with use of routine pulmonary venography.

1-3 Abstract 18-27 O U T C O M E S F O L L O W I N G C RY O B A L L O O N ABLATION FOR ATRIAL FIBRILLATION GUIDED B Y P R E S S U R E WAV E F O R M M O N I T O R I N G WITHOUT THE ROUTINE USE OF PULMONARY VENOGRAPHY Akshit Sharma 1, Jashdeep Dhoot 1, Jingyan Wang 2, Phil Jones 2, Sanjaya Gupta 2, Alan Wimmer 2 1 University of Missouri-Kansas City, Kansas City, United States, 2 Saint-Luke's Mid America Heart Institute, Kansas City, United States Purpose: Pressure waveform analysis may facilitate assessment of pulmonary vein occlusion during cryoballoon ablation for atrial fibrillation. We sought to validate through clinical outcomes the use of pressure waveform analysis as the primary method of determining pulmonary vein occlusion during cryoballoon ablation. Methods: One hundred twenty-two consecutive patients with atrial fibrillation (85% paroxysmal) undergoing cryoballoon ablation from May 2014 through July 2015 at a single institution using pressure waveform analysis as the primary method of

1-4 Abstract 15-62 DEEP CONVOLUTIONAL NEURAL NETWORKS (CNNS) FOR IDENTIFYING ELECTROGRAM TARGETS WHERE ABLATION TERMINATES PERSISTENT ATRIAL FIBRILLATION Mahmood Alhusseini 1, Firas Abuzaid 1, Paul Clopton 1, Mark Swerdlow 1, Natasha Maniar 1, Albert Rogers 1, Miguel Rodrigo 1 , Tina Baykaner 1 , Junaid Zaman 1 , Christopher Kowalewski 1, Fatemah Shenasa 1, Mohan Viswanathan 1, Paul Wang 1, Wouter-Jan Rappel 2, Peter Bailis 1, Matei Zaharia 1, Sanjiv Narayan 1

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147 1

Stanford University, Stanford, United States, Diego, United States

S29 2

UCSD, San

Background: It is increasingly important to define critical features of persistent AF electrograms to improve the results of ablation, yet ablation guidance based on analyses of voltage, fractionation, and frequency have been disappointing. We aim to test the hypothesis that CNNs, a novel approach to pattern recognition, may identify electrogram patterns which are therapeutic targets using a registry of 23 patients in whom ablation terminates persistent AF. Methods: Electrograms in n = 23 patients (60% M; 67 ± 9.1 years) underwent non-proprietary Hilbert phase analysis. Spatiotemporal features were extracted in 4X4 electrode arrays in 5-m intervals for 1 s, for 90,176 input maps. A 25-layer CNN was constructed in Matlab, using 68,309 inputs (n = 17) for training and a blinded cohort of 21,867 inputs (n = 6) for testing. Results: AF terminated by ablation in each case (n = 12 to sinus). Figure A shows persistent AF in a 52year-old man terminating by ablating a BB 1.5 cm2 region, where mapping showed rotation (red-blue; Fig. B). Overall, maps showed 2.2 ± 0.2 sites/patient with 12.1 ± 4.9 rotations at termination sites. In training, the CNN reached 100% accuracy. In blinded testing, the network was 88.1% accurate (Fig. C) for potential drivers (yellow; Fig. A) and detected all sites of AF termination (< 0.01). Conclusion: CNNs provide a novel paradigm to analyze and classify AF electrograms to identify clinically relevant areas, where ablation terminates persistent AF. This deep learning approach is scalable and may improve AF mechanism interpretation and guide therapy.

disappointing. Catheter ablation offers a promising alternative, but ablation procedures are often challenging and time consuming. The aim of this study was to evaluate whether high density mapping offers new insights into the tachycardia’s mechanism and enables a quick termination using an individualized approach. Methods: Patients with stable atrial tachycardia and a history of a previous catheter ablation of atrial fibrillation were included into the study. A high-density LAT map (Rhythmia, Boston Scientific) was performed and dominant and bystander activation patterns were defined. Within the dominant reentry the region with the slowest local conduction was defined and targeted first with RF ablation. Results: Thirty-one patients (mean age 66 ± 7 years, 65% men) were analyzed. Previous ablations were performed in 2.0 ± 1 per patient; previous PVI 87% and PVI + substrate modification in 86%. Mechanisms of the tachycardia were 77% macro, 29% micro reentrant. Local slow conduction within the dominant reentry could be defined in 25/31 P (80%). Ablation at this point terminated the tachycardia independent of the tachycardia`s mechanism (micro versus macro). All tachycardia could be terminated into SR. Mean RF application number was 3.6 ± 4.4. Time to termination was 301 ± 477 s. In 80%, non-inducibility could be demonstrated. Total procedure time was 196 ± 57 min, mean fluoroscopy time was 7.8 ± 7.5 min. Conclusion: Our initial experience with this individualized ablation approach for left atrial tachycardia after previous ablation procedures for atrial fibrillation is promising. It leads to a quick termination into SR. Further standardization and evaluation of clinical success rates are needed. 1-6 Abstract 23-19 UNRECOGNIZED VENOUS INJURIES AFTER CARDIAC IMPLANTABLE ELECTRONIC DEVICE TRANSVENOUS LEAD EXTRACTION

1-5 Abstract 18-19 LEFTATRIALTACHYCARDIA CAN BE TERMINATED QUICKLY USING HIGH DENSITY MAPPING Armin Luik 1, Tobias Oesterlein 2, Kerstin Schmidt 1, Patrick Hörmann 1, Thomas Schenk 1, Matthias Merkel 1, Claus Schmitt 1 1 Städtisches Klinikum Karlsruhe, Karlsruhe, Germany, 2 Institute of Technology, Karlsruhe, Germany Introduction: Left atrial tachycardia is a heterogeneous arrhythmia. The reported prevalence after catheter ablation of atrial fibrillation (AF) is between 2 and 20%. It can be subdivided into macro-, micro-, and focal mechanisms. Relapse after external cardioversion (CV) is high and medical rate control is often

Khaldoun Tarakji 1, Walid Saliba 1, Danny Markavawi 1, Rene Rodriguez 1, Yoaav Krauthammer 1, Michael Brunner 1, Ayman Hussein 1, Bryan Baranowski 1, Daniel Cantillon 1, Mohamed Kanj 1, Mark Niebauer 1, Jack Rickard 1, Thomas Callahan 1, Mingyuan Shao 1, David Martin 1, Oussama Wazni 1, Bruce Wilkoff 1, Carmela Tan 1 1 Cleveland Clinic, Cleveland, United States Background: Major complication rate of transvenous lead extraction (TLE) is estimated around 1–2.0%. Laceration of the central veins can be fatal. Objectives: To define the incidence and extent of venous injuries on a microscopic level after TLE and compare it with the incidence of clinically documented events of venous laceration. Methods: We studied all patients who underwent TLE at our tertiary center within 30 months via a variety of techniques. Extracted leads and tissue around them were fixed in formalin. P athologic e xamination w as

S30

standardized to examine the leads identifying the areas covered by tissue cuffs along the length of the lead. The cuffs were removed and sectioned transversely to their longitudinal axis. Microscopic examination was performed using H&E and Movat stains to identify the presence of vein tissue. Results: Four hundred sixty-one patients (63 ± 15 years) had a total of 861 leads extracted (585 pacemaker and 272 defibrillator leads) with an average of 1.9 leads per patient and a median lead age of 2546 days. Upon microscopic review, 80 leads (9.3%) in 72 out of the total 461 patients (15.6%) demonstrated segments of vein, the majority of which were transmural (venous tissue including adventitia). Despite this finding, only five (1.1%) catastrophic complications occurred that required emergent surgical intervention. Risk factors for venous injury included ICD lead, age of lead, and the use of laser sheath. Conclusions: Microscopic venous injuries during lead extraction are common but often not recognized clinically.

Abstract Oral Session 2: Cardiac resynchronization therapy: role of His-bundle pacing Sunday April 15, 2018, 10:30 am–12:00 pm ROOM COURCELLES 2-1 Abstract 24-12 CARDIAC RESYNCHRONIZATION THERAPY UTILIZING PERMANENT HIS BUNDLE PACING IN PATIENTS WITH RIGHT BUNDLE BRANCH BLOCK AND LEFT VENTRICULAR SYSTOLIC DYSFUNCTION

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Pugazhendhi Vijayaraman 1, Angela Naperkowski 1, Parikshit Sharma 2, Joseph Chan 3, Kenneth A Ellenbogen 4 1 Geisinger Heart Institute, Wilkes Barre, United States, 2 Rush University Medical Center, Chicago, United States, 3 Prince of Wales Hospital, Hong Kong, China, 4 Virginia Commonwealth University Health System, Richmond, United States 1 Background: Biventricular pacing (BVP) is a less effective form of cardiac resynchronization therapy (CRT) in patients with cardiomyopathy (CMP), heart failure, and right bundle branch block (RBBB). Permanent His bundle pacing (HBP) has been reported to correct RBBB and normalize conduction. The aim of the study is to report the feasibility and outcomes of HBP in pts with RBBB and CMP. Methods: HBP was attempted in patients with CMP and RBBB as an alternative to BVP. HBP was performed using Medtronic 3830 pacing lead. Implant characteristics, NHYA functional class, and LV ejection fraction were assessed in follow-up. Results: HBP was successful in 20 of 22 patients (age 70 ± 9 years, male 20, CAD 13, RBBB 15, AV nodal block with RBBB escape rhythm 7). Ischemic CMP 60%. Selective HBP was achieved in 5 (25%) and nonselective HBP in 15 (75%). NYHA functional status improved from 2.9 to 2.1 (< 0.01); LVEF improved from 30 ± 10 to 38 ± 14% (p = 0.03); QRS duration improved from 164 ± 28 to 131 ± 9 ms with HBP (< 0.001). Echocardiographic response (absolute increase in LVEF BB 5%) was noted in 9 of 17 patients (53%) while clinical response (no heart failure hospitalization and improvement by at least one NYHA class) was noted in 14 of 20 patients (60%). One patient died during a mean f/u of 13 ± 8 months (stroke). HB capture threshold at implant was 1.3 ± 0.8 V and remained stable at 1.4 ± 0.6 V at 1 ms during f/u. Conclusions: Permanent HBP improved NYHA functional class and LV systolic function in patients with CMP and RBBB. Permanent HBP can be used as an alternative to BVP in patients with CMP, RBBB, and heart failure.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S31

2-2 Abstract 24-14 P E R M A N E N T H I S BU N D L E PA C I N G AS AN ALTERNATIVE TO BIVENTRICULAR PACING IN PAT I E N T S R E Q U I R I N G C A R DI AC RESYNCHRONIZATION THERAPY Sarah Worsnick 1, Parikshit Sharma 2, Gopi Dandamudi 3, Bengt Herweg 4, David Wilson 4, Rajeev Singh 3, Angela Naperkowski 1, Jayanthi Koneru 5, Kenneth Ellenbogen 5, Pugazhendhi Vijayaraman 1 1 Geisinger Health System, Plains, United States, 2 Rush University Medical Center, Chicago, United States, 3 Indiana University, Indianapolis, United States, 4 University of South Florida College of M e d i c i n e , Ta m p a , U n i t e d S t a t e s , 5 Vi r g i n i a Commonwealth University Health System, Richmond, United States Background: Cardiac resynchronization therapy (CRT) using biventricular pacing is effective in patients with heart failure, bundle branch block, or right ventricular pacing. Permanent His bundle pacing (HBP) has been reported as an alternative option for CRT. Objective: To assess the feasibility and outcomes of HBP in CRT eligible or failed patients. Methods: HBP was attempted as a rescue strategy in patients with failed LV lead or non-response to BVP (group I); or as a primary strategy in patients with AV block, BBB, or high ventricular pacing burden as an alternative to BVP (group II) in patients with indications for CRT. Implant characteristics: NYHA functional class and echocardiographic data were assessed in follow-up. Results: HBP was successful in 95 of 106 patients (90%); 30 patients in group I and 65 in group II. Mean age was 71 ± 12 years, female 30%, BBB 45%, paced rhythm 39%, AV block 16%. His capture and BBB correction thresholds were 1.4 ± 0.9 and 2.0 ± 1.2 V at 1 ms, respectively. During a mean follow-up of 14 months, both groups demonstrated significant narrowing of QRS from 157 ± 33 to 117 ± 18 ms (p = 0.0001), increase in LVEF from 30 ± 10 to 43 ± 13% (p = 0.0001) and improvement in NYHA class from 2.8 ± 0.5 to 1.8 ± 0.6 (p = 0.0001) with HBP. Leadrelated complications occurred in seven patients. Conclusions: Permanent HBP is a promising alternative for CRT. HBP may be considered as a rescue strategy for failed biventricular pacing and may be a reasonable primary alternative to biventricular pacing for CRT.

2-3 Abstract 24-11

HIS-OPTIMIZED CARDIAC RESYNCHRONIZATION THERAPY (HOT-CRT): A NOVEL APPROACH TO ENHANCE CRT RESPONSE Pugazhendhi Vijayaraman 1, Kenneth A Ellenbogen 2, Jacek Gazek 3 1 Geisinger Heart Institute, Wilkes Barre, United States, 2 Virginia Commonwealth University Health System, R i c h m o n d , U n i t e d S t a t e s , 3 Wro k l a w M e d i c a l University, Wroklaw, Poland AIM: Cardiac resynchronization therapy (CRT) is an important therapeutic modality for patients with cardiomyopathy, left bundle branch block (LBBB), and advanced heart failure. Recent reports suggest that His bundle pacing (HBP) may also improve clinical outcomes by significantly narrowing QRS duration. The QRS narrowing by HBP may not always be complete. We hypothesized that cardiac resynchronization therapy can be best optimized by sequential HBP followed by left ventricular (LV) pacing (His OpTimized CRT— HOT CRT) to maximize electrical resynchronization. METHODS: We attempted permanent HBP in ten patients (LBBB eight, RV pacing two) referred for CRT in addition to LV lead. The HBP lead was connected to the atrial port in patients with chronic AF (four), RV port in CRT-P (two), and LV port in CRT-D (LV lead in RV port, four). HBP was followed by LV pacing at a

S32

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

delay equal to HV interval. QRS duration at baseline, during HBP, BVP, and HOT-CRT, were measured. LV ejection fraction (EF) and NYHA functional class were assessed at baseline and during follow-up. Results: HOT-CRT was successful in all ten patients (age 78 ± 7 years; men nine; ischemic nine, AF four). QRS duration at baseline was 185 ± 16 ms and significantly narrowed to 136 ± 9 ms during HBP (< 0.001) and to 110 ± 14 ms during HOT CRT (< 0.001) compared to 160 ± 11 ms with BVP (p = 0.01). During HOT-CRT, maximal electrical resynchronization was achieved with 40% reduction in QRSd. During a mean follow-up of 9 ± 8 months, LVEF improved from 26 ± 4 to 37 ± 5% (p = 0.02) and NYHA functional class changed from 3.1 to 1.8. Nine of ten patients (90%) were clinical responders while seven of eight (88%) showed echocardiographic response. CONCLUSIONS: His OpTimized CRT can result in maximal electrical resynchronization. HOT-CRT may further improve clinical response rates in patients requiring CRT.

capture) compared to RC (loss or delay of VA conduction—loss of retrograde His capture) was assessed. The location of HBP lead was identified as proximal to block, if CAC occurred before CRC and vice-versa. Results: Ten patients with IHB underwent successful HBP. The location of HBP lead was identified to be proximal to the site of IHB in six patients and distal to block in four patients. The threshold difference between AC and RC was 0.8 ± 0.6 V. Conclusions: The location of HBP lead was proximal to site of intra-Hisian block in 60% and distal in 40% in patients with successful HBP. Relatively low threshold difference in AC vs RC would suggest the intra-Hisian lesion to be discrete.

2-5 Abstract 23-26 2-4 Abstract 22-11 LEAD LOCATION IN RELATION TO SITE OF INTRA-HISIAN BLOCK IN SUCCESSFUL HIS BUNDLE PACING (HBP) 1

1

Sarah Worsnick , Pugazhendhi Vijayaraman 1 Geisinger Health System, Plains, United States Background: Permanent HBP can correct intra-Hisian AV block (IHB). Proximal His EGMs with HV block are often recorded on HBP lead. Postulated mechanisms for correction of HV block is pacing distal to the site of block versus pacing proximal to block with source versus sink relationship/virtual electrode polarization effect. Objective: To assess the HBP lead location in relation to the site of IHB. Methods: Patients with IHB and successful HBP were included. Pacing from HBP lead was performed at cycle lengths faster than sinus rhythm to assess anterograde (AC) and retrograde (RC) His conduction. During threshold testing, output-dependent change (C) in AC (change in QRS morphology—loss of anterograde His

PERMANENT HIS BUNDLE PACING: A SINGLE CENTER EXPERIENCE FROM AN ACADEMIC MEDICAL CENTER Nicholas Serafini 1, Estefania Oliveros-Sole 1, Ryan Zimberg , Henry Huang 1, Pratik Patel 1, Kousik Krishnan 1, Richard Trohman 1, Parikshit Sharma 1 1 Rush University Medical Center, Chicago, United States 1

Background: Permanent HIS bundle pacing (PHBP) is gaining popularity, with limited data on outcomes. Objective: We sought to review the success rates of PHBP, the ability to recruit bundle branch block (BBB), safety of PHBP, and outcomes data. Methods: Ninety-five patients with an indication for pacing based on current guidelines underwent an attempt at PHBP starting September 2016 by various operators and were followed prospectively. Results: PHBP was successful in 99% of all attempted cases. Selective or nonselective HBP in those with baseline narrow QRS (BB 120 ms, N = 45) and wide QRS (BB 120 ms, N = 49) occurred without a significant difference (p = 0.097). There was no

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

difference in selective or non-selective HBP subcategorizing into left or right bundle branch block, interventricular conduction delay, or narrow QRS. Of patients with a wide QRS, 25 (51%) had complete recruitment (paced QRS BB 120ms), 15 (30.6%) had partial recruitment (paced QRS decrease by at least 20% and BB 120 ms), and 9 (18.4%) showed no recruitment. Pacing capture thresholds were similar from implant to follow-up. Five patients (5.3%) had a threshold increase by 2 mV or greater. In patients with heart failure, the LVEF increased from 29 to 37.75% (p = 0.002) and NYHA class improved from 3 to 2. There were five (18.2%) heart failure hospitalizations in follow up, five (5.3%) deaths, and one (1.1%) from a cardiovascular cause. Conclusions: Of 95 patients over 1.5 years at a single academic medical center, 99% of patients achieved selective or non-selective PHBP. We were successfully able to achieve complete or partial recruitment in 81.6% of patients with a baseline wide QRS. Clinical follow up demonstrated an improvement in LV ejection fraction in those with preexisting heart failure and an improvement in NYHA functional class.

S33

Background: Obstructive sleep apnea (OSA) is highly prevalent in patients with advanced heart failure. However, the role of OSA on all-cause mortality in patients receiving cardiac resynchronization therapy (CRT) is not well studied. In this retrospective cohort analysis, we assessed the association between OSA and all-cause mortality in patients receiving CRT. Methods: We analyzed records of 548 consecutive patients (mean age 65 ± 13 years, 39% women, mean period of follow-up: 76 ± 17 months) who received a CRT-defibrillator (D) device between 2007 and 2016 at our tertiary care referral center. Results: One hundred eighty (33%) patients had OSA diagnosis. One hundred forty-four (27%) patients died by the end of follow-up [OSA group: 61 (33%), non-OSA group 83 (23%), P BB 0.001]. In unadjusted analysis [hazard ratio (HR) 3.64, 95% CI 2.50–5.32, P BB 0.001], adjusted analysis [HR 4.5, 95% CI 2.9–6.8, P BB 0.001], and in patients with non-ischemic cardiomyopathy [HR 3.89, 95% CI 2.11–6.97, P BB 0.001], OSA diagnosis significantly increased the risk of all-cause mortality. This was true in CPAP (continuous positive airway pressure) compliant patients as well. However, among patients with ischemic cardiomyopathy (ICM), the risk of all-cause mortality was similar among patients with OSAwhen compared to those without OSA [HR 1.07, 95% CI 0.77–4.68, P = 0.372]. Conclusions: OSA is associated with an increased risk of all-cause mortality in patients receiving CRTD device. The rationale behind the attenuation of mortality risk in ICM patients with OSA compared to those without OSA is not known and warrants further study. Abstract Oral Session 3: Cardiomyopathies. Risk stratification and outcomes Sunday April 15, 2018, 10:30 am–12:00 pm ROOM DAMES 3-1 Abstract 17-23

2-6 Abstract 24-10 ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP A P N E A A N D A L L - C A U S E M O RTA L I T Y I N PAT I E N T S R E C E I V IN G C A R D I A C R E S Y N C H R O N I Z AT I O N T H E R A P Y: A RETROSPECTIVE COHORT STUDY Ghanshyam Palamaner Subash Shantha 1, Naga Venkata Pothineni 2, Amgad Mentias 1, Taylor Rasmussen 1, Frank Pelosi 3, Hakan Oral 3, Prashant Bhave 4, Brian Olshansky 1, Mary Vaughan Sarrazin 1, Michael Giudici 1 1 University of Iowa Hospitals and Clinics, Iowa City, United States, 2 University of Arkansas, Little Rock, United States, 3 University of Michigan, Ann Arbor, United States, 4 Wake Forest University, Winston-Salem, United States

A R R H Y T H M I A T Y P E A N D D U R AT I O N O N MYOCARDIAL RECOVERY IN PATIENTS WITH ARRHYTHMIA INDUCED CARDIOMYOPATHY: A MULTICENTER STUDY Rakesh Gopinathannair 1, Dhanunjaya Lakkireddy 2, Rahul Dhawan 1 , Andrew Murray 3 , Talha Farid 1 , Brian Olshansky 3 1 Section of Electrophysiology, University of Louisville, Louisville, United States, 2 University of Kansas Medical Center, Kansas City, United States, 3 Mercy Heart and Vascular Institute, Mason City, United States Background: Atrial arrhythmias and premature ventricular contractions (PVCs) are common causes of arrhythmiainduced cardiomyopathy (AIC), the hallmark of which is partial or complete reversibility of left ventricular ejection

S34

fraction (LVEF) after arrhythmia suppression or elimination. Predictors of myocardial recovery, however, are not well understood. Objective: We evaluated arrhythmia duration and type on LVEF recovery in treated AIC patients. Methods: Two hundred forty-three patients (age 65 ± 11 years, 73% male) with treated AIC from 3 US centers were included in this retrospective analysis. Patients, divided into known (KN, n = 130) and unknown (UNK, n = 49) arrhythmia duration had otherwise similar characteristics. LVEF pre- and posttreatment was assessed between KN and UNK groups and between the lowest and highest quartiles in the KN group. Results: AIC was due to atrial fibrillation [AF], n = 119 (49%); atrial flutter/atrial tachycardia [AT], n = 51 (21%); and PVCs, n = 73 (30%). AIC treatment was rhythm control in 95%. Median arrhythmia duration in the KN group was 48 months (IQR 62; 25–75th percentile 25–84 months) and median time from arrhythmia suppression to follow-up echo was 131 days. The mean index LVEF in the KN group was higher than in the UNK group (34.9 ± 7 vs 28.6 ± 10, < 0.0001). However, LVEF post-arrhythmia treatment was similar in both groups (55.9 ± 7.2 vs 55 ± 7.5%, p = 0.48). Comparing lowest quartile (longest arrhythmia duration) vs others in the KN group, the extent of LVEF improvement after treatment was the same (19.4 ± 7.4 vs 21.8 ± 9.1%, p = 0.1). The index LVEF (25.1 ± 6.7 [PVC] vs 34.1 ± 8.6 [AT] vs 33.6 ± 7.7% [AF], < 0.0001) and LVEF post-treatment (40.7 ± 10.9 [PVC] vs 56.9 ± 7.1 [AT] vs 55.7 ± 6.8% [AF], < 0.0001) was lower in PVC-mediated AIC patients vs AT and AF groups. Conclusion: In this multicenter study, arrhythmia suppression improved LVEF similarly in the KN and UKN arrhythmia duration groups. Patients with PVC-mediated AIC had lower index LVEF vs. AT/AF-mediated AIC at diagnosis and less LVEF recovery after arrhythmia treatment.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

absolute length of TAD and the occurrence of sustained ventricular arrhythmia (SVA) in ACM. Methods: We included consecutive patients fulfilling the 2010 diagnostic TFC and underwent 12 leads ECG recording (filter setting 100– 150 Hz) while off anti-arrhythmic drugs. The TAD in ms was defined as the longest interval between the nadir of the S wave and the end of all depolarization deflections in leads V1–3. Two independent investigators (RR and RH) were blinded for patient outcomes. SVA was defined as ventricular fibrillation, sustained ventricular tachycardia, or sudden cardiac arrest within 1 year before or after ECG recording. The association of TAD with SVA was evaluated by logistic regression analysis using the continuous value, as well as the dichotomous 55 ms cutoff value. Results: TAD was measured in 190 patients (mean age 42 ± 15, 50% males), of which 64 (34%) had experienced SVA. The overall mean TAD was 54 ± 14 ms, and ≥ 55 ms in 35% of the patients. TAD ≥ 55 ms was not significantly associated with SVA (p = 0.073). In contrast, patients with SVA had a significantly (p = 0.047) higher mean TAD (56 ± 16 ms) compared to patients without SVA (52 ± 12 ms). Prolongation of TAD was associated with SVA with an odds ratio of 1.29 per 10 ms (95% CI [1.004–1.049], p = 0.023). Conclusion: Continuous prolongation of TAD was associated with a significantly higher occurrence of sustained ventricular arrhythmias. In contrast, this relation was not significant when a dichotomous cutoff value of 55 ms for TAD was used. Our findings support the hypothesis of TAD as marker for arrhythmic risk in ACM.

3-2 Abstract 07-18 C O R R E L AT I O N B E T W E E N T E R M I N A L ACTIVATION DURATION AND VENTRICULAR ARRHYTHMIA IN ARRHYTHMOGENIC CARDIOMYOPATHY Rob Roudijk 1, Laurens Bosman 1, Maarten van den Berg 2, Katja Zeppenfeld 3, Peter Loh 4 , Peter van Tintelen 1, Anneline te Riele 1, Richard Hauer 1 1 Netherlands Heart Institute, Utrecht, Netherlands, 2 UMCG, Groningen, Netherlands, 3 LUMC, Leiden, Netherlands, 4 UMC Utrecht, Utrecht, Netherlands Background: Prolonged terminal activation duration (TAD ≥ 55 ms) due to activation delay (AD) is a minor diagnostic revised Task Force Criterion (TFC) in arrhythmogenic cardiomyopathy (ACM). AD is a hallmark of reentrant arrhythmic mechanisms. We hypothesized an association between the

3-3 Abstract 07-20 REGIONAL LONGITUDINAL STRAIN BY FEATURE TRACKING CARDIAC MAGNETIC RESONANCE P R E D I C T S S U S TA I N E D V E N T R I C U L A R ARRHYTHMIAS IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY Mimount Bourfiss 1, Cynthia A. James 2, Mounes Aliyari Ghasabeh 2, Laurens P. Bosman 3, Jeroen F. van der Heijden 1 , Ihab R. Kamel 2, Harikrishna Tandri 2, Richard N. Hauer 3,

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Hugh Calkins 2, David A. Bluemke 4, Stefan L. Zimmerman 2, Birgitta K. Velthuis 1, Anneline S.J.M. te Riele 1 1 University Medical Center Utrecht, Utrecht, Netherlands, 2 Johns Hopkins Hospital, Baltimore, United States, 3 Netherlands Heart Institute, Utrecht, Netherlands, 4 University of Wisconsin School of Medicine and Public Health, Wisconsin, United States Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular dysfunction and ventricular arrhythmias (VA). Feature tracking cardiac magnetic resonance (FT CMR) is a novel method to quantitatively assess ventricular function. While prior studies confirmed the diagnostic value of FT CMR in ARVC, its prognostic value remains unknown. Objective: To assess whether FT CMR predicts VA in ARVC. Methods: Four-chamber cine CMR images of 58 definite ARVC patients (36% male, 39 ± 16 years) with a desmosomal mutation and without prior sustained VA were analyzed for average and regional (subtricuspid, mid, apical) right ventricular (RV) longitudinal strain. We also performed stratified analyses by RV ejection fraction (RV EF). Primary outcome was sustained VA (sustained VT, appropriate ICD intervention, sudden cardiac arrest) in follow-up. Results: During 5.1 ± 3.3 years followup, 13 (22%) patients experienced VA (cycle length 313 ± 67 ms). Compared to patients without VA, those with VA had significantly reduced average (− 14 ± 6 vs – 19 ± 6%, p = 0.003) and regional (subtricupid – 23 ± 7 vs – 34 ± 12%, p = 0.007; mid – 14 ± 6 vs – 23 ± 11%, p = 0.009) free wall strain, as well as reduced RV EF (38 ± 10 vs 49 ± 10%, p = 0.001). Worse VA-free survival was seen for reduced subtricuspid (− 28% cutoff p = 0.003) and mid (− 20% cutoff p = 0.004) free wall strain; this remained significant for mid free wall strain in patients with RV EF BB 45% (p = 0.023). Conclusion: Both average and regional RV strain by FT CMR is reduced in ARVC patients with sustained VA. RV mid free wall strain predicts VA in patients with reduced RV EF, suggesting incremental value over conventional CMR measures.

S35

3-4 Abstract 07-17 RISK STRATIFICATION OF FAMILY MEMBERS IN ARRHYTMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY BY ECHOCARDIOGRAPHIC DEFORMATION IMAGING Karim Taha 1, Thomas Mast 1, Maarten-Jan Cramer 1, Joost Lumens 2, Jeroen van der Heijden 1, Berto Bouma 3, Maarten van den Berg 4, Folkert Asselbergs 1, Pieter Doevendans 1, Arco Teske 1 1 UMCU, Utrecht, Netherlands, 2 Maastricht University, Maastricht, Netherlands, 3 AMC, Amsterdam, Netherlands, 4 UMCG, Groningen, Netherlands Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease that is characterized by a variable disease expressivity among family members, which complicates family screening protocols. Previous reports have shown that echocardiographic deformation imaging detects abnormal right ventricular (RV) deformation in the absence of established disease expression in ARVC. Objectives: We aimed to investigate the prognostic value of echocardiographic deformation imaging in ARVC to optimize family screening protocols. Methods: First-degree relatives of ARVC patients were serially evaluated according to 2010 Task Force Criteria (TFC), including RV deformation imaging. Relatives with structural TFC were excluded. At baseline, deformation patterns of the subtricuspid region were scored by type-I: normal deformation; type-II: delayed onset, decreased systolic peak, and post-systolic shortening; or type-III: systolic stretching and large post-systolic shortening. The final study population comprised relatives who underwent a second evaluation during follow-up. Disease progression was defined as the development of a new 2010 TFC during follow-up that was absent at baseline. Results: Sixty-five relatives were included in the study and underwent a second evaluation after a mean follow-up of 3.7 ± 2.1 years. At baseline, 28 relatives (43%) had normal deformation (type-I) and 37 relatives (57%) had abnormal deformation (type-II/type-III) in the subtricuspid area. Disease progression occurred in 4% of the relatives with normal deformation at baseline and in 43% of the relatives with abnormal deformation at baseline (< .001). Positive and negative predictive values of abnormal deformation were respectively 43 and 96%. Conclusion: Normal RV deformation of the subtricuspid region is associated with absence of disease progression during a nearly 4-year follow-up in ARVC relatives. Abnormal RV deformation seems to precede the established signs of ARVC.

S36

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

ablation led to VT termination. Amiodarone was discontinued 3 months post ablation and patient has been arrhythmia free 2 years post ablation. Conclusions: Scar-related re-entrant sustained monomorphic VT can present as VT storm in HCM patient with successful long-term catheter ablation results, targeting endocardial and epicardial isthmuses defined using classing entrainment mapping techniques.

3-5 Abstract 17-24

3-6 Abstract 07-21

3 YEAR OUTCOME OF SUCCESSFUL EPICARDIALE N D O C A R DI A L CATH E T E R A BL AT I O N O F S U S TA I N E D R E E N T R A N T M O N O M O R P H I C V E N T R I C U L A R TA C H Y C A R D I A I N HYPERTROPHIC CARDIOMYOPATHY PATIENT

CLINICAL PERFORMANCE OF THE 2017 AHA/ACC/ HRS GUIDELINE FOR MANAGEMENT OF VENTRICULAR ARRHYTHMIAS IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY

Gurjit Singh 1, Marc K Lahiri 1, Arfaat Khan 1, Waddah Maskoun 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States

Laurens Bosman 1, Julia Cadrin-Tourigny 2, Weijia Wang 3, Mimount Bourfiss 4, Brittney Murray 3, Crystal Tichnell 3, Katja Zeppenfeld 5, Arthur Wilde 6, Maarten van den Berg 7, Folkert Asselbergs, Harikrishna Tandri 3, Peter van Tintelen 6, Hugh Calkins 3, Richard Hauer 1, Cynthia James 3, Anneline te Riele 1 1 Netherlands Heart Institute, Utrecht, Netherlands, 2 Montreal Heart Institute, Université de Montréal, Montreal, Canada, 3 Johns Hopkins Hospital, Baltimore, United States, 4 UMC Utrecht, University of Utrecht, Utrecht, Netherlands, 5 Leiden University Medical Center, Leiden, Netherlands, 6 Amsterdam Medical Center, Amsterdam, Netherlands, 7 UMC Groningen, Groningen, Netherlands

Background: Reentry based sustained monomorphic ventricular tachycardia (SMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). We present a case of successful endocardialepicardial ablation of drug refractory SMVT in a patient with HCM with recurrent defibrillator shocks. Objective: To describe re-entrant scar related monomorphic VT in a HCM patient and successful management with epicardial ablation Methods: N/A Results: A 63-year-old African-American male with nonobstructive HCM, hepatitis C, paroxysmal atrial fibrillation was evaluated for recurrent ICD shocks for SMVT refractory to disopyramide and amiodarone. Twelve lead ECG during VT storm showed a RBB, left superior axis VT which was not amenable to pace termination from the device at multiple cycle lengths. Endocardial 3D mapping during VT showed bystander sites. After obtaining sub-xyphoid epicardial access, entrainment mapping revealed a large diastolic isthmus corridor in the apicolateral left ventricle where ablation using an irrigated catheter led to termination. Patient had to be taken back to laboratory 24 h later for a slower SMVT where re-do mapping in the epicardium did not reveal any mid-diastolic potentials. Endocardial mapping showed entry site opposite to epicardial ablation site where

Background: Ventricular arrhythmias (VA) are an unpredictable complication of arrhythmogenic right ventricular cardiomyopathy (ARVC). The 2017 AHA/ACC/HRS guideline for management of VA specify recommendations for ICD implantation in ARVC.Objective: To assess the performance of this guideline for ARVC. Methods: We categorized 549 patients (51% male, 38 ± 15 years) with definite ARVC by guideline ICD indication: prior sustained VA or severe ventricular dysfunction (class I, n = 247); and syncope (class IIa, n = 54). As per the guideline, the remaining patients (n = 248) were stratified by signal averaged ECG (SAECG) and

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

electrophysiology study (EPS) inducibility. The outcome of interest was (1) any sustained VA and (2) fast VA (cycle length [CL] ≤ 240 ms or sudden cardiac arrest). Results: During 6.9 [IQR 8.8] years follow-up, 243 (44%) patients experienced any sustained VA (CL 287 ± 55 ms) while 61 (10%) had fast VA (CL 224 ± 27 ms). The incidence of any sustained VA was 9.3%/year (95% CI 8.2–10.6) which differed significantly among groups (< 0.001) (Fig. 1A). The incidence of fast VA was 1.5%/year (95% CI 1.1–1.9), which did not differ among groups (p = 0.270) (Fig. 1B). In the absence of ICD indication, positive SAECG or EPS inducibility were significantly associated with higher risk of any sustained VA (p = 0.023, < 0.001 respectively) as well as fast VA (p = 0.021, p = 0.010 respectively). Conclusion: The 2017 AHA/ACC/HRS ICD indications accurately distinguish subjects at high risk of any sustained VA, but not fast VA. While SAECG and EPS may aid further stratification, the risk of patients without ICD indication is still considerable. This should be kept in mind when managing this high-risk population.

Abstract Oral Session 4: Catheter ablation of supraventricular or ventricular arrhythmias Sunday April 15, 2018, 10:30 am–12:00 pm ROOM DEBARCADERE 4-1 Abstract 18-13 COOLING DYNAMICS: A NEW PREDICTOR OF LONG-TERM EFFICACY OF ATRIOVENTRICULAR N O D A L R E E N T R A N T TA C H Y C A R D I A CRYOABLATION Mario Matta 1, Matteo Anselmino 1, Marco Scaglione 2, Marco Vitolo 1, Federico Ferraris 1, Paolo Di Donna 2, Domenico Caponi 2, Davide Castagno 1, Fiorenzo Gaita 1 1 Division of Cardiology, Department of Medical Sciences, BCittà della Salute e della Scienza Hospital, University of

S37

Turin, Torino, Italy, 2 Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy Purpose. Catheter ablation of the slow pathway is the most effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). Cryoenergy, compared to radiofrequency, relates to lower heart block risk but higher incidence of AVNRT recurrences. The aims of this study are to confirm the safety and efficacy of AVNRT cryoablation and to identify predictors of long-term recurrences. Methods. Among 241 patients undergoing AVNRT cryoablation, 239 (99.2%) experienced acute effective cryoablation of the slow pathway, and no procedure-related complications were reported. Results. After a follow-up of 44.9 ± 31.7 months, 28 (11.7%) patients presented AVNRT recurrences. A shorter preablation (p = 0.05) and postablation anterograde Wenckebach cycle length (p BB 0.01), a shorter postablation atrioventricular node refractory period (p = 0.04), and persistence of the crossover sign (p = 0.03) were associated with higher incidence of long-term recurrences. Considering cooling dynamics, a longer time to reach temperature ≤ − 70 °C (p = 0.03) and a higher minimal temperature during ablation (p = 0.04) were related to recurrences. Patients without residual markers of dual AV node physiology (AH jump, single atrial echo beat, crossover) reported a lower recurrence rate (p = 0.05) compared to those without. At multivariate analysis, a longer time to – 70 °C was the strongest independent predictor of longterm recurrence (OR 1.75, 95% CI 1.01–3.03, p = 0.04; Fig. 1). Conclusions. AVNRT cryoablation is safe and effective. Long-term recurrence rate was 11.7%. An ablation approach directed to the complete elimination of dual AV node physiology, along with assessment of the tissue’s cooling dynamics, holds the potential to improve longterm AVNRT cryoablation efficacy.

S38

4-2 Abstract 18-16 EFFICACY AND SAFETY OF CRYOABLATION OF PARA-HISIAN AND MID-SEPTAL ACCESSORY PATHWAYS USING A SPECIFIC PROTOCOL: SINGLE CENTER EXPERIENCE IN CONSECUTIVE PATIENTS Giuseppe Fonte 1, Jacopo Marazzato 1, Beatrice Bellini 1, Gaia Telli 1, Manola Vilotta 1, Raffaella Marazzi 1, Lorenzo Adriano Doni 1, Roberto De Ponti 1 1 Department of Heart & Vessels, Ospedale di Circolo and Fondazione Macchi-University of Insusbria, Varese, Italy Background: Cryoablation (CA) is preferred to radiofrequency energy ablation in case of para-hisian (PH) and intermediateseptal (IS) atrioventricular accessory pathways (APs) for the possible complication of damage to the normal atrioventricular conduction system. The aim of this study is to assess the efficacy and safety of the APs CA in a cohort of consecutive patients using a specific protocol. Methods: From 2003 to 2016, 50 patients (40% F, average age 25 ± 13, range 12–61 years) were considered; 42 (84%) had PH AP and 8 (6%) IS AP. Ventricular pre-excitation was present in 39 (78%) patients and in 27 patients (54%) an electrophysiologic procedures had been already performed in another center. A cryocathter (Freezor or Freezor Max, 53 or 58 mm, Medtronic Inc) connected to a cryoconsole was used to deliver cryothermal energy at − 75° for up to 480 s; before ablation, test applications with a decreasing temperature (from − 30 to – 70 °C) for 30 s at the most suitable site were performed. To optimize catheter/tissue contact, both the superior (SVC) and inferior (IVC) vena cava approaches were considered. If CA was unsuccessful using a 4mm tip catheter, a 6-mm tip catheter was used, and trans-septal catheterization considered. CA was promptly interrupted in case of any damage to the normal atrioventricular conduction. Results: CA was successful in 43 patients (86%) with 43 procedures. In 7 patients (14%), despite performing 11 procedures, CA was unsuccessful for persistent conduction over the AP (3 patients), intraprocedural resumption of AP conduction not abolished by further CA (3 patients) and transient CA-induced A-H interval prolongation (1 patient). Successful CAwas obtained by SVC approach in 22/36 (61%) with PH APs. The unsuccessfully treated group was associated with a significantly greater number of procedures, use of 6-mm tip catheter, and CA times if compared to the successfully treated population. No complications were recorded for all the procedures. Three of 43 patients (7%) experienced relapse of AP conduction at follow-up; all these patients were successfully re-treated. Conclusions: CA of PH and IS APs is a highly safe and effective procedure even if prolonged application at lower temperature are used. SVC approach should be considered in PH APs to optimize catheter/ tissue contact. Peculiar anatomical features of the AP may

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

explain failure of CA, despite a more aggressive approach used in case of persistent AP, interruption is not obtained. 4-3 Abstract 18-29 ABLATION OF SLOW PATHWAY FOR AVNRT WITH Z E R O X - R AY E X P O S U R E U S IN G V I RT U A L ANATOMY, LOCAL POTENTIAL COMBINED DROP-OFF MOTION RESULTED IN NO HIGH DEGREE ATRIOVENTRICULAR BLOCK Jian Qiang Zhang 1, Wei Wei Wang 2, Jian Zhou 1, Ying Hao 1, Jie Lin Pu 1 1 Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China, 2 Department of Cardiovascular Medicine, Juxian People’s Hospital, Rizhao, China Background Conventional ablation using X-ray exposure of atrioventricular nodal reentrant tachycardia (AVNRT) is associated with risk of high degree atrioventricular block. Threedimensional (3D) mapping system can provide more anatomic information of right atrium, including the His bundle and orifice of coronary sinus vein (CSO). It can also show the drop-off motion of catheter tip when the catheter moves into the CSO. The local potential of His bundle and slow pathway can also be recorded by the catheter tip. Objective: To investigate the feasibility and safety of zero X-ray exposure during reconstruction right atrium (RA) and ablation of the slow pathway. Methods. Patients were randomly into two groups. In group 1, reconstruction RA and ablation slow pathway were performed with the help of 3D mapping system, while in group 2, X-ray was utilized to ablate the slow pathway. All patients were followed up for 12 months. Results. A total of 212 AVNRT patients were continuously enrolled. The basic clinical characteristics of the two groups showed no significant difference. Parameters related to the procedure, ablation procedure time, and mean power applied during radiofrequency application showed no significant difference between the two groups. In group 1, the average procedure time was significantly longer than that in group 2 (57 ± 12.4 vs. 42 ± 15.6 min, p < 0.001). The average fluoroscopy time during ablation was significantly lower than that in group 2 (0 vs. 6.3 ± 1.2 min, p < 0.001). The total X-ray exposure dose of the procedure was significantly lower than that in group 2 (0 vs. 13.7 ± 5.4 mGy, respectively, p < 0.001). Kaplan-Meier analysis indicated that there were no statistical differences in the probability of freedom from tachycardia recurrence at 12 months between group 1 and group 2 (p = 0.237). The success rate at 12 months was not significantly different between the two groups (98.6%, 95% CI 96–100% in group 1 and 98.2%, 95% CI 95–100% in group 2, p = 0.312). No high degree atrioventricular block events occurred in the patients enrolled. Procedural-related adverse events showed no significant different incidence between group

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

1 and group 2. Conclusions. Reconstruction RA and ablation slow pathway using 3-D mapping system to provide precise positioning, local characteristic potential combined drop-off motion without X-ray exposure were both safe and effective. 4-4 Abstract 17-22 ABLATION OF VENTRICULAR TACHYCARDIA IN PATIENTS WITH STRUCTURAL HEART DISEASE AND ELECTRICAL STORM Shibu Mathew 1, Tilmann Maurer 1, Bruno Reismann 1, Christian Heeger 1, Christine Lemeš 1, Andreas Rillig 1, Andreas Metzner 1, Karl-Heinz Kuck 1, Feifan Ouyang 1 1 Asklepios St. George, Hamburg, Germany Background: Electrical storm is a life-threatening situation in patients (pts) with structural heart disease. But still there are only limited information about outcome and safety in endocardial- and epicardial ablation of ventricular arryhtmia (VA) in this condition. Methods and Results: In 187 patients (pts; 170 male; 64 ± 13 years) with electrical storm and structural heart disease (SHD), catheter ablation of ventricular arryhthmia (VA) was performed in 229 procedures and retrospectively analysed. The underlying heart diseases were ischemic heart disease (IHD) in 121/ 187 pts (64.7%), dilative cardiomyopathy (DCM) in 48/187 pts (25.7%) and different entities of cardiomyopathy in 18/187 pts (9.6%). Mean LVEF was 33 ± 13 and 168/187 pts (89.8%) presented with an ICD at time of procedure. A history of coronary artery bypass graft (CABG) was present in 43/121 pts (35.5%). VT Procedure was performed despite severe infection or sepsis due to electrical and hemodynamical instability in 3/187 pts (1.6%). General anesthesia was necessary prior to ablation in 32/187 pts (17.1%). An extracorporeal membrane oxygen system (ECMO) was implanted in 2/187 pts prior to ablation and in 2/187 pts during ablation, whereas one procedure was performed under Heart Mate II assistance. In 47/229 procedures (20.5%), a combined endo-/epicardial procedure was performed. In pts with IHD in 109/145 procedures (75.2%) acute success and in 21/145 procedured (14.5%) partial success could be achieved, whereas procedures without success were 15/145 (10.3%). Acute, partial and no success were in 45/60 (75%), 3/60 (5%) and 12/60 (20%) procedures in pts with DCM respectively. Conclusions: Catheter ablation of VA in pts with electrical storm is an effective treatment option in this patient population.

S39

Kaoru Okishige 1, Harumizu Sakurada 2, Yuka Mizusawa 2, Yasuteru Yamauchi 3, Seiji Fukamizu 2, Hideshi Aoyagi 1, Yoshifumi Okano 4, Koji Azegami 1, Tetsuo Sasano 5, Kenzo Hirao 5 1 Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan, 2 Cardiovascular division, Tokyo Metropolitan Hiroo Hospital, Tokyo, Tokyo, Japan, 3 Cardiology Division, Musashino Red Cross Hospital, Tokyo, Tokyo, Japan, 4 Cardiology Division, Ohmori Medical Center, Tohou Medical School, Tokyo, Japan, 5 Arrhythmia Center, Tokyo Medical and Dental University, School of Medicine, Tokyo, Tokyo, Japan Introduction: Macro-reentrant ventricular tachycardias (VT) utilizing the bundle branches and Purkinje fibers have been reported as verapamil sensitive VT (idiopathic left VT), bundle branch reentrant VT (BBRT) and inter-fascicular reentrant tachycardia (inter-fascicular VT). However, diagnostic confusion exists with these VTs due to the difficulty in differentiating between them with conventional EP studies. The aim of this study was to clarify the electrophysiological (EP) and anatomical entity of inter-fascicular VT, and provide successful methods for the radiofrequency catheter ablation (RFCA) of inter-fascicular VT. Methods and Results: A total of nine patients were included in this study. All patients were diagnosed with idiopathic left VT in the first session, and underwent a second session after a failed RFCA. Detailed EP studies guided by a three-dimensional mapping system (3D) were performed to further analyze the VTs. All VTs were finally diagnosed and successfully cured with RFCA targeting the left anterior or the posterior fascicle, which was regarded as a requisite part of the reentrant circuit of the interfascicular VT, using 3D and fluoroscopic images combined with a detailed EP investigation instead of the conventional RFCA method targeting Purkinje potentials for the RFCA of idiopathic left VT. Conclusions: Inter-fascicular VT could be misdiagnosed as idiopathic left VT due to the limitations of the conventional EP study. Failed RFCA in presumed idiopathic left VT cases have to be carefully investigated by further analysis, and a tailored RFCA strategy targeting the necessary portions of the left fascicles of the inter-fascicular VT reentrant circuit required for the successful elimination of the inter-fascicular VT. 4-6 Abstract 18-14 CEREBRAL PROTECTION DURING CATHETER ABLATION OF VENTRICULAR TACHYCARDIA IN PATIENTS WITH ISCHEMIC HEART DISEASE

4-5 Abstract 15-67 THE RADIOFREQUENCY CATHETER ABLATION O F I N T E R - FA S C I C U L A R R E E N T R A N T TACHYCARDIA: NEW INSIGHTS INTO THE ELECTROPHYSIOLOGICAL AND ANATOMICAL CHARACTERISTICS

Christian Heeger 1, Andreas Metzner 1, Michael Schlüter 1, Andreas Rillig 1, Maria E. Romero 2, Shibu Mathew 1, Renu Virmani 1, Fink Thomas 1, Bruno Reissmann 1, Christine Lemes 1, Tilman Maurer 1, Francesco Santoro 1, Tobias Schmidt 1, Alexander Ghanem 1, Christian Frerker 1, KarlHeinz Kuck 1, Feifan Ouyang 1

S40 1

Asklepios Klinik St. Georg, Hamburg, Germany, 2 CV Path Institute Inc., Gaithersburg, United States

Background: Catheter ablation (CA) of ventricular tachycardia (VT) is associated with the risk of cerebral embolism. The origin of periprocedural brain embolism in the setting of VT ablation is often unknown and strategies to avoid it are sparse. The aim of this study was to assess the safety and feasibility of an endovascular two-filter based cerebral protection system (CPS, Fig. 1) in left ventricular VT ablation procedures in patients with ischemic heart disease. Furthermore, histopathological correlates of periprocedural embolization were investigated. Methods and Results: In this pilot study, 11 patients with ischemic heart disease and sustained VT underwent left ventricular CA under CPS surveillance. The placement of the CPS was conduced before the ablation procedure via the right radial artery. The VT ablation procedure was performed via a combined transaortic and transseptal approach. All VTs were successfully ablated. Placement and retrieval of the CPS was successful and safe in all cases. No periprocedural complications related to the CPS were observed and no periprocedural transient ischemic attack or stroke occurred. Debris captured by the CPS was detected in all patients. Histology revealed that acute thrombus was the most common type of debris (91%), followed by arterial wall tissue (73%) and foreign material (55%). Less frequently found were myocardium (27%), calcification (9%), necrotic core (9%) and valve tissue (9%) (Table 1). Conclusions: Cerebral protection during VT ablation seems to be safe and feasible. Ablation procedures of VT are associated with a very high rate of cerebral embolic debris, which was found in every patient.

Abstract Oral Session 5: Stroke prevention in patients with or without atrial fibrillation Sunday April 15, 2018, 10:30 am–12:00 pm ROOM EPINETTES

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

5-1 Abstract 15-19 SHOULD PATIENTS > 65 YEARS WITH INCIDENT ATRIAL FIBRILLATION AND A CHA2DS2-VASC SCORE 1 BE QUALIFIED FOR ANTICOAGULATION TREATMENT? Tommy Andersson 1, Anders Magnuson 2, Ole Fröbert 1, IngLiss Bryngelsson 3, Karin M. Henriksson 4, Nils Edvardsson 5 , Dritan Poci 1 1 Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, 2 Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden, 3 Department of Occupational and Environmental Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden, 4 Department of Medical Science, Uppsala University, Uppsala, Sweden, 5 Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden Background: Patients with atrial fibrillation and a low risk of stroke, especially those with a CHA2DS2-VASc score of 1 point are not eligible for anticoagulation treatment according to the current guidelines. Methods: In a retrospective, nationwide cohort study, using the Swedish national registries, 59,981 hospitalized patients were identified with incident AF. Then, 11,548 patients were excluded because of being already on warfarin before the AF diagnosis, or death, emigration or stroke within 30 days of AF diagnosis. The remaining 48,433 patients were, after adjustment for age, sex and year of AF diagnosis, divided according to age, sex and CHA2DS2-VASc score 0, 1, 2 and ≥ 3 and included in a time-varying analysis of warfarin treatment versus no treatment. The primary end-point was cerebral infarction and stroke. The including period was between January 2006 and December 2008, and patients were followed until December 31, 2009. Results: Patients with CHA2DS2VASc score 1 and treated with warfarin had a lower relative risk of cerebral infarction and stroke even compared to younger age groups. HR was 0.46 (95% CI 0.25–0.83) in men 65–74 year old, while 1.11 (95% CI 0.56–2.23) in younger men under 65 years, and HR 2.13 (95% CI 0.94–4.82) in women < 65 years. The relative risk in men younger than 65 years and with a CHA2DS2-VASc score 2 or ≥ 3 was lower when they received warfarin treatment, HR 0.35 (95% CI 0.18–0.69) and HR 0.37 (95% CI 0.23–0.59) in those without warfarin. Only CHA2DS2-VASc score of ≥ 3 points showed a low relative risk in women under 65 years, HR 0.31 (95% CI 0.16–0). The risk of intracranial bleeding was low and similar in all subgroups on anticoagulation except in the youngest men without risk factors. Conclusions: Patients with AF and older than 65 years who were on warfarin had, as expected, a lower risk of stroke and cerebral infarction compared to patients without warfarin. Our results support the possibility of considering the anticoagulation treatment in all patients with incident AF and

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

an age of 65 years and older, i.e. also when the CHA2DS2VASc score is 1. 5-2 Abstract 15-20 THE IMPACT OF POLYPHARMACY ON THE EFFECTIVENESS OF ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION: A MEDICARE ANALYSIS Ghanshyam Palamaner Subash Shantha 1, Amgad Mentias 1, Naga Venkata K. Pothineni 2, Michael Giudici 1, Mary Vaughan Sarrazin 1 1 University of Iowa Hospitals and Clinics, Iowa City, United States, 2 University of Arkansas, Little Rock, United States Introduction: Non-vitamin K oral anticoagulants (NOACs) and warfarin mitigate stroke risk in elderly patients with atrial fibrillation (AF). However, the relative effectiveness of NOACs or warfarin in patients with complex medication regimens is not known. In this retrospective cohort analysis, we assessed the impact of polypharmacy on the effectiveness of oral anticoagulants in patients with AF. Methods: We used Medicare claims data for beneficiaries with new AF diagnosed during 2010–2013 who initiated an oral anticoagulant within 90 days of diagnosis. Polypharmacy for each patient was measured as a count of unique active ingredients (generic names) in pharmacy claims during the 12 months prior to AF diagnosis (categorized 0–5, 6–10, ≥ 11). Within each category, patients receiving dabigatran (DABI), rivaroxaban (RIVA), or warfarin were matched using a three-way propensity matching algorithm, and the relative hazards of stroke, major bleeding (MB), and death were evaluated in propensity matched samples. Results: A total of 21,979 DABI users, 23,177 RIVA users, and 101,715 warfarin users formed the study cohort. In the propensity matched cohorts, stroke risk was similar in the three anticoagulant groups in all three polypharmacy categories. DABI use was associated with a lower risk of major bleeding (MB) in the low and medium polypharmacy categories compared to warfarin (HR range 0.64–0.82), while RIVA use increased MB risk in the medium and high polypharmacy groups (HR range 1.29–1.30) compared to warfarin. RIVA use increased MB risk in all three polypharmacy categories, compared to DABI (HR range 1.30–1.45). Risk of death was lower with RIVA and DABI use compared to warfarin use and was similar when compared to each other in all three polypharmacy categories. Conclusion: Oral anticoagulants are similarly effective for stroke prevention even among AF patients with complex medication regimens. Comparatively, DABI use may be associated with lesser bleeding in this patient subset.

S41

5-3 Abstract 15-15 COMPARATIVE EFFECTIVENESS OF ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL F I B R I L L AT IO N A N D M U LT I P L E C H R O N I C CONDITIONS: A MEDICARE ANALYSIS Ghanshyam Palamaner Subash Shantha 1, Amgad Mentias 1, Prashant Bhave 2, Michael Giudici 1, Frank Pelosi 3, Hakan Oral 3, Mary Vaughan Sarrazin 1 1 University of Iowa Hospitals and Clinics, Iowa City, United States, 2 Wake Forest University, Winston-Salem, United States, 3 University of Michigan, Ann Arbor, United States Introduction: Little is known about the comparative effectiveness of oral anticoagulants in patients with atrial fibrillation (AF) and multiple chronic conditions (MCC) since this patient subset is under represented in RCTs. In this retrospective cohort analysis, we assessed the comparative effectiveness of oral anticoagulants in AF patients with MCC. Methods: We used Medicare (USA) claims data for beneficiaries with new AF diagnosed during 2010–2013 who initiated an oral anticoagulant within 90 days of diagnosis. Patients with CHA2DS2-Vasc scores 1–3, 4–5, and BB = 6; HAS-BLED scores 0–1, = 2, and BB = 3; and Gagne comorbidity scores 0–2, 3–4, and BB = 5 were categorized as having low, moderate, or high morbidity respectively. Within morbidity categories, patients receiving dabigatran (DABI), rivaroxaban (RIVA), or warfarin were matched using a threeway propensity matching algorithm, and the relative hazards of stroke, major bleeding, and death were evaluated in propensity matched samples. Results: A total of 21,979 DABI users, 23,177 RIVA users, and 101,715 warfarin users formed the study cohort. In the propensity matched cohorts, there were few differences in ischemic stroke between DABI, RIVA, or warfarin users. DABI users had lower incidence of major hemorrhage (MH) (HR range 0.62–0.82) in the low morbidity group and similar hemorrhage risk in moderate and high morbidity groups compared to warfarin users. While there was no difference in MH between RIVA and warfarin users, RIVA users had significantly higher MH risk compared to DABI users in the medium and high comorbidity groups (HR range 1.24–1.32). DABI and RIVA users had lower risk of death compared to warfarin users (HR range 0.65–0.74) and similar risk of death compared to each other in all morbidity groups. Conclusion: Oral anticoagulants are similarly effective in stroke prevention among AF patients with MCC. However, DABI use may be associated with a lower risk of bleed in this patient subset. 5-4 Abstract 06-14 POTENTIAL ROLE OF PFO IN PATIENTS AFTER AN ESUS EVENT AND WITH IMPLANTABLE CARDIAC MONITOR

S42

Claudia Sabrina Summo 1, Lisa Riesinger 1, Michael Mehr 1, Johannes Siebermair 2, Stephanie Fichtner 1, Christoph Schuhmann 1, Steffen Massberg 1, Reza Wakili 2 1 Klinikum der Universität München, Medizinische Klinik I, Munich, Germany, 2 Klinik für Kardiologie und Angiologie Westdeutsches Herz- und Gefäßzentrum Essen, Essen, Germany Introduction: The concept of the “Embolic Stroke of Undetermined Source” (ESUS) was introduced to better define the “cryptogenic” ischemic stroke. The minimal cardiac diagnostic to exclude atrial fibrillation (AF) includes a 24-h holter monitoring. According to recent studies, the implantation of an implantable cardiac monitor (ICM) is also considered to detect asymptomatic AF. Another possible mechanism discussed is the paradoxical embolism in patients with patent foramen ovale (PFO). However, the role of PFO as a cause within the framework of ESUS is currently not fully understood. The aim of this study was to examine all patients after an ESUS index event and an ICM for the detection of AF and the presence of PFO. Methods: In this retrospective analysis, in the period from 03/13 to 04/15, a total of 42 patients were included with a history of ESUS and who underwent ICM implantation for AF detection. Endpoints were the incidence of AF after at least 24 months and the incidence of PFO. We also recorded a recurrent stroke/TIA regarding the secondary prevention as part of the follow-up (median FU 28.5 ± 3.2 months). Results: Our population was younger (mean 58a) than patients in previous studies with a comparable risk profile (mean CHA2DS2-VASc score 4.2). Overall, 19% of the patients (8/42) had newly detected AF. These patients were older (60a vs. 52a, AF vs. no AF) with a higher CHA2DS2VASc score (AF: 5.1 vs. no AF: 3.8, p = 0.001). Recurrent stroke occurred in 12% (5/42) of patients, with a significantly higher incidence in the group with newly detected AF (37.5 vs. 5.8% w/o AF, p = 0.003). In the total collective, 43.75% of the patients examined by echocardiography were found to have a PFO. Interestingly, it can be seen here that the PFO group is younger (48.7a vs. 57.8a, p = 0.047) and that less AF could be detected in the FU period compared to patients w/o PFO (7 vs. 22.2%, p = 0.014). Conclusion: In a representative ESUS collective, a PFO can be detected in almost half of the patients. These patients are younger and have significantly less AF in the course. These results provide evidence for a possible causal role of PFO in ESUS patients. In this context, however, it still needs to be clarified whether young ESUS patients with PFO and lack of detection of AF over a longer period possibly benefit of a PFO closure.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

I N FA R C T I O N I N PAT I E N T S W I T H AT R I A L FIBRILLATION: A MEDICARE ANALYSIS Ghanshyam Shantha 1, Amgad Mentias 1, Alexander Mazur 1, Michael Giudici 1, Oluwaseun Adeola 1, Frank Pelosi 2, Hakan Oral 2, Rajan Sah 1, Mary Vaughan Sarrazin 1 1 University of Iowa Hospitals and Clinics, Iowa City, United States, 2 University of Michigan, Ann Arbor, United States Background: Thromboembolism and atherothrombosis are the two predominant mechanisms associating atrial fibrillation (AF) with cardiovascular outcomes. Recent evidence has shown that insulin use in patients with DM probably increases risk of thromboembolic outcomes like ischemic stroke in patients with AF. It remains unknown if the same is true with atherothrombotic outcomes like myocardial infarction (MI) in these patients. In order to bridge this literature gap we assessed the role of insulin in the risk of ischemic stroke and MI in patients with AF using a retrospective cohort analysis of Medicare beneficiaries. Methods: We identified Medicare beneficiaries with new AF diagnosis from November 2011 through October 2013. Primary outcomes were inpatient admissions for stroke and MI. Multivariate Cox regression models were used to assess the association between AF and time to stroke and MI while controlling for patient risk factors and anticoagulant use as time dependent covariate. Results: From a total of 798,592 patients with AF, 53,212 (6.7%) were insulin requiring diabetics (IRD), 250,214 (31.3%) were non-insulin requiring diabetics (NIRD) and 495,166 (62%) were non-diabetics (ND). In the adjusted analysis, IRD had a higher risk of stroke when compared to NIRD [HR: 1.19 (95% CI 1.14–1.25)] and ND [1.22 (1.16– 1.29)]. However, the risk of stroke were similar between NIRD and ND [1.02 (0.98–1.06)]. For the outcome of MI, IRD had a higher risk when compared to NIRD [1.27 (1.21–1.34)] and ND [1.62 (1.53–1.71)]. However, risk of MI remained higher among NIRD compared to ND [1.27 (1.22–1.32)]. Conclusion: Our results allude to the possibility that insulin use probably increases stroke risk among diabetic patients with AF, while diabetes increases the risk of MI regardless of insulin use. This supports the hypothesis that insulin plays a significant role in thromboembolic risk, while diabetes itself is a risk factor for atherothrombosis. Further validation with robust adjustment for measures of diabetes severity is needed to confirm our findings. 5-6 Abstract 15-32 S A F E D I S C O N T I N U AT I O N O F O R A L ANTICOAGULATION FOLLOWING ABLATION FOR ATRIAL FIBRILLATION

5-5 Abstract 15-13 ROLE OF DIABETES AND INSULIN USE IN THE RISK OF STROKE AND ACUTE MYOCARDIAL

Jeffrey Snow 1, Juliana Welk 1, Erik Altman 1, Seth Bender 1, Sameer Parekh 1 1 Island Cardiac Specialists, Garden City, United States

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Background: Owing to the established risk of arrhythmia recurrence, anticoagulation management post ablation of atrial fibrillation can be challenging. Missing recurrent arrhythmia in a non-anticoagulated patient may lead to thromboembolic complications, while continuing anticoagulation in patients without arrhythmia can increase bleeding risk without offering benefit. Methods: We have implemented a strategy of anticoagulation guided by daily implantable recorder monitoring. Patient’s remaining in sinus rhythm three months following ablation are discontinued from anticoagulation and monitored remotely with an implantable cardiac monitor (Medtronic LINQ). Patients remained off anticoagulation unless an episode of atrial fibrillation lasting more than 6 min was detected. Results: A retrospective analysis of this strategy was conducted over a 3-year period. Ninety patients were followed for a mean of 21 months or 156 patient years. The mean age was 66 years. Sixty-four percent of the patients were men. The mean CHADS-VASC score was 2.2. No thromboembolic events occurred during the study period, while the predicted number of events over the follow up period based on the patients CHADS-VASC score was 4. This strategy resulted in 907 months free of anticoagulation, a 53% reduction compared to continuous anticoagulation. Anticoagulation was successfully restarted within 48 h of a recurrent atrial fibrillation episode in all but one incidence. Conclusion: We demonstrate the feasibility and utility of a novel implantable cardiac monitorguided anticoagulation strategy to minimize thromboembolic events while limiting exposure to oral anticoagulation in patients following atrial fibrillation ablation. Abstract Oral Session 6: Sudden Cardiac Death: from cardiac arrest to post-ICD implant

S43

data in this registry which included the intervention of a witness, the Firemen services and the French Mobile Emergency Services called SAMU. In every instance, the data were collected by the physicians of the SAMU. Data collected between July 2011 and July 2017 were reviewed. Results: A total of 43,931 OHCAwere recorded during the period analyzed. It was estimated that this number represents approximately one-fourth of the OHCA occurring in France during the analyzed period. OHCA occurred in 29,873 men or 67.9% and in 14,058 women or 32.0%. The mean age of the total population was 67 ± 19 years (M ± SD). OHCA occurred at patient home in 31,762 patients (72.3%), in a public location in 9137 patients (20.8%) and in nursing home in 3031 patients (6.9%). Emergency services were contacted by phone (call number 15) and a rescue action was started before their arrival in 45% including cardiac massage alone in 62.4% and with ventilation in 37.6% of cases. The emergency services arrived on the scene of the cardiac arrest in a median time of 10.4 ± 12.4 min for firefighter service and 19.6 ± 16.0 min for SAMU. An automatic external defibrillator (AED) was used in 6721 patients (15.3%) of cases. The initial ECG rhythm recorded at arrival of emergency services was ventricular fibrillation in 9.8% of patients, pulseless asystole in 75.9% of patients, electromechanical dissociation in 6.9% of patients and sinus rhythm in 7.3% of patients after resuscitation measures. Then, 3382 patients were alive at 30 days or 7.7% with CPC 1-2 in 85%. Survival at 30 days when AED was used for a shockable rhythm was 35.7%. This occurred in 1469 patients. Conclusions: These data are similar to other series of the literature but compared to the best results published, room for improvement of OHCA management is obvious particularly the need to decrease the time of arrival of emergency services at the site of OHCA. 6-2 Abstract 19-15

Sunday April 15, 2018, 10:30 am–12:00 pm ROOM REMBRANDT 6-1 Abstract 19-20 O U T O F H O S P I TA L C A R D I A C A R R E S T I N POPULATION BASED IN FRANCE Jacques Beaune 1, Gérard Helft 2, Valentine Baert 3, Josephine Escutnaire 3, Hervé Hubert 3, Pierre Yves Gueugniaud 4 1 University of Lyon, School of medicine, 2 University Parisla Pitié Salpétrière, 3 University of Lille-Santé Publique, 4 Hopital Edouard Herriot- SAMU de Lyon Objectives: In managing patients suffering from out of hospital cardiac arrest (OHCA), improving the management of the first ring is essential. The French Federation of Cardiology, a nonprofit organization undertook a prospective registry of OHCA in order to define areas where improvement is possible. Methods: We conducted a retrospective analysis of prospectively collected

SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATORS AMONG PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY Austin Burrows 1, Christopher Phelan 1, Yazan Daaboul 1, William C. Daly 1, Charles Miller 1, Christopher Madias 1, N. A. Mark Estes III 1 1 Tufts Medical Center, Boston, United States Background: Hypertrophic cardiomyopathy (HCM) patients can have implantable cardioverter defibrillators (ICDs) placed for prevention of sudden death (SCD). Subcutaneous (S) ICDs can be an attractive alternative to transvenous (TV) ICDs for reduction of lead complications. The association between SICDs and inappropriate shock (IS) remains uncertain in HCM patients. Methods: A retrospective analysis of all ICD implants in HCM patients (Nov 2012 to Oct 2017) with minimum 6 months follow up was performed. Student’s t test was performed for comparisons between continuous variables, and

S44

Chi-square and Fisher’s tests for categorical variables (Stata 13; StataCorp, LP). A multivariate logistic regression model was performed to evaluate association between IS and clinical variables. Results: Eighty-six HCM patients (24 S-ICD vs. 62 TV-ICD) were included with mean follow up of 26.5 ± 14.9 months. S-ICD patients were younger than TV-ICD (43.6 ± 14.2 vs. 51.4 ± 17.2 years, p = 0.04), with no difference in other variables. Defibrillation threshold testing (DFT) was successful in 23 of 24 S-ICD patients (DFT ≤ 65J). DFT was successful in 49 of 62 patients with TV-ICD (BB 10J safety margin), with no DFT in 7 patients and no data for 6. Appropriate shocks (AS) for ventricular tachycardia (VT) occurred in 3 patients (1 in S-ICD vs. 2 in TV-ICD, < 0.99). A four-fold increase in the frequency of IS was seen in the SICD group (21.7% [5/24] S-ICD vs. 5% [3/62] TV-ICD, p = 0.034). Logistic regression showed independent association with IS and S-ICD (OR = 5.53, 95% CI [1.08, 28.46], p = 0.04). Three total AS occurred in 1 S-ICD patient compared to 4 AS in 2 TV-ICD patients. Eight IS events (7 for T-wave oversensing, 1 for external interference) occurred in 5 S-ICD patients and 5 IS events (3 for non-sustained VT and 2 for atrial fibrillation) in 3 TV-ICD patients. Conclusions: Our data demonstrate that adequate DFT can be obtained in HCM patients with S-ICD and TV-ICD. IS occurs more frequently with S-ICD compared to TV-ICD in HCM patients. Further research is needed to compare outcomes of S-ICD versus TVICD in this patient population. Association of development of inappropriate shock (N = 83) p p Multivariate Clinical variables Univariate value value association association (OR, 95% (OR, 95% CI) CI) Subcutaneous-ICD 5.28 0.03 5.53 0.04 (1.15, 24.28) (1.08, 28.46) Age 0.99 0.97 1.02 0.49 (0.96, 1.04) (0.98, 1.07) Female gender 0.30 0.28 0.37 0.38 (0.35, 2.61) (0.04, 3.49) BMI 1.00 0.90 1.01 0.90 (0.90, 1.13) (0.88, 1.15) LV ejection 0.99 0.80 – fraction (0.93, 1.06) LV mean wall 0.95 0.48 – thickness (0.82, 1.09) History of syncope 1.31 0.75 – (0.24, 7.2) History of NSVT 0.48 0.51 – (0.05, 4.17) History of 1.97 0.56 – cardiac arrest (0.20, 19.34) History of apical 1.62 0.68 – aneurysm (0.17, 15.44) Risk factors 0.64 0.58 – for SCD (0.14, 2.96)

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

6-3 Abstract 23-12 GENDER DIFFERENCES IN ICD-IMPLANTATION RATES AND THE UNDERLYING DISEASE FOR ICD-IMPLANTATION—A LARGE REAL-LIFE ANALYSIS Margarethe Wiedenmann 1, Alessandra Buiatti 1, Johannes Siebermair 2, Moritz F. Sinner 3, Stefan Kääb 3, Eimo Martens 1 1 1. Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany, 2 Nordwestdeutsches Herzzentrum, Klinik für Kardiologie und Angiologie, Universität Essen, Essen, Germany, 3 Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Großhadern, Munich, Germany Background. Gender differences play an important part in cardiac disease with women, e.g., having a lower cardiac risk until menopause. Implantable cardioverter-defibrillator (ICD) systems are well established to prevent sudden cardiac death from rhythm disturbances resulting from underlying cardiac disease. Objective. A retrospective analysis to investigate whether there is a gender distribution in ICD-implantation and its underlying cardiac disease in a registry of a German university hospital. Methods. Anonymized data of ICD implantations between 2002 and 2014 were collected and pooled from a German university hospital. Data were analyzed from a database containing detailed patient, underlying disease, and implant information. Physicians classified the underlying disease of patients. Results. Data were analyzed from 710 patients (~ 1398 episodes) of whom 79% were male and 21% were female. For both male and female patients, the age group with the highest implantation rate was 61–80 years (m 56%; f 48%), followed by the age group of 41–60 years (m 24%; f 27%). Fewest implantations were performed in patients older than 81 years independent of their gender (m 5%, f 2%). The major reason for ICD-implantations in both men and women until age 60 is dilated cardiomyopathy (DCM) (m 52%; f 69%). For males older than age 60, coronary artery disease (CAD) takes over as the major reason for ICDimplantation (69%). For females older than age 60, CAD increases in importance (30%); however, DCM stays the major risk factor for ICD-implantations (66%). Both males and females received the highest rate of shocks in case of CAD as the underlying disease, followed by DCM. In addition, the underlying ventricular tachycardias (VTs) or ventricular fibrillations (VFs) resulting in these shocks most often happen to males and females aged 61–80 years of age (VTs: m 86%, f 61%; VFs: m 48%; f 47%), followed by the next lower age group of 41–60 years (VTs: m 2%, f 7%; VFs: m 26%; f 20%). Overall shocks were successful in 93% of patients when administered. Between appropriate shocks, success of ATP, or inappropriate therapy, we could not find a significant difference, but men show a significant higher acceleration under ATP than women (3.9% vs. 1.3%, p =

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S45

0.05). Conclusion. Men and women have a different risk profile for receiving an ICD with CAD playing a more prominent role for men and DCM for women. There is a significant higher burden of acceleration under ATP for male ICD patients. 6-4 Abstract 03-10 A NOVEL LONG QT SYNDROME TYPE 1 M U TAT I O N C A U S E S S E V E R E C H A N N E L DYSFUNCTION BUT WITH PRESERVED ADRENERGIC RESPONSE Vrijraj Sinhji Rathod 1 , Stephen C Harmer 1 , Grace Salsbury 1, Maria Bitner-Glindzicz 2, Pier D Lambiase 3, Andrew Tinker 1 1 Queen Mary University, London, United Kingdom, 2 University College London, London, United Kingdom, 3 Barts Health, London, United Kingdom Patients with congenital long QT syndrome (LQTS) are predisposed to Torsades de Pointes. We report the identification of a novel Long QT Syndrome type 1 mutation. The mutation is a result of a 3 base duplication in the KCNQ1 gene (739_741dulpACC) which results in a duplication of Theronine at position 247 (p.Thr247dup). The KCNQ1 protein co-assembles with KCNE1 at the surface membrane and contributes to cardiac repolarisation. During sympathetic stimulation, there is upregulation of the IKs current to ensure shortening of QTc during exercise. We introduced the mutation using sitedirected mutagenesis into a mammalian expression. The effects of KCNQ1-p.Thr247dup on IKs channel function were analysed by patch-clamp in transiently transfected Human Embryonic Kidney-293 (HEK-293) cells. Whole-cell voltage-clamp (VC) recording revealed that KCNQ1-p.Thr247dup+KCNE1 current density from 20 to 120 mv was significantly lower (< 0.01) than for the wild-type (WT) channel (Fig. 1). The steady state of channel activation (V0.5) for the mutant channel was also significantly (< 0.01) shifted towards more depolarised potentials than the WT channel (96.22 + 0.13 vs 56.77 + 0.03 mV respectively). In comparison to WT channels, mutant channels had significantly (< 0.05) slower rates of channel activation and faster rates of channel deactivation. Given the key role of the IKs current under sympathetic stimulation, we utilised perforated patch clamp method, transiently transfected HEK-293 cells were perfused with extracellular solution and VC recordings to resemble basal conditions. The cells were then perfused with extracellular solution containing 100 nM of Isoprenaline (ISO) and VC recordings performed until a maximal response was reached. Both the WT and mutant channel responded to ISO infusion and current density increased by twofold at +60 mV (Fig. 2). We can conclude that the mutation is likely caused by QT prolongation with significant channel dysfunction in basal state but with preserved response to sympathetic stimulation.

6-5 Abstract 17-16 CLINICAL PREDICTORS OF UNSUCCESSFUL ANTI-TACHYCARDIA PACING IN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PATIENTS Joshua Harrison 1, Kavitha Kalluri 1, Zachary Tushak 1, Dalia Giedrimiene 1, Lane Duvall 1, Jeffrey Kluger 1 1 Hartford Hospital, Hartford, CT, United States Background: Antitachycardia pacing (ATP) provides safe and painless termination of reentrant arrhythmias in patients with implantable cardioverter defibrillators (ICDs), improving their quality of life. Failure to respond to ATP is associated with worse outcomes. Established predictors of ATP responsiveness are not well known; only longer VT cycle length and higher ejection fraction have been found to predict painless VT termination. We sought to investigate clinical and ECG predictors of ATP responsiveness. Methods: The Hartford Hospital ICD database was searched for monomorphic VT events requiring ICD therapy in patients with structural heart disease. The first VT encounter for each patient was assessed for patient demographics, clinical characteristics, VT rate, and ATP responsiveness. Patients with multiple events were categorized as always, sometimes, and never responders. Additionally, an ECG nearest the time of VT was analyzed for QRS morphology and duration. Data was assessed by logistic regression for predictors of ATP responsiveness. Results: In this study of 527 patients, characteristics associated with always successful ATP included ACE-I/ ARB therapy and slower VT rate (unsuccessful ATP 197.3 ± 27.5 bpm, sometimes successful ATP 190.1 ± 27.3 bpm, always

S46

successful ATP 183.4 ± 21.8 bpm, < 0.0001). Secondary prevention indication, Amiodarone therapy, and longer QRS duration were associated with ATP failure. After multivariate analysis, only faster VT rate and Amiodarone therapy were predictive of ATP failure. Conclusions: In this cohort, only slower VT rate was predictive of repeated ATP responsiveness. Amiodarone therapy, which is known to increase VT cycle length, interestingly was associated with ATP failure. Neither QRS morphology nor duration were predictors of ATP success.

6-6 Abstract 25-12 EFFECT OF ELECTROMAGNETIC I N T E R F E R E N C E S O N I M P L A N TA B L E CARDIOVERTER DEFIBRILLATORS WHILE CHARGING A TESLA CAR BY A SUPERCHARGER Abdul Wase 1, Theresa Ratajczak 2, Thein Aung 3, Umbreen Hussain 2 Ronald Markert2 1 Wright State University, Good Samaritan Hospital, Dayton, United States, 2 Wright State University, Dayton, United States, 3 Univ. of Iowa Hosp and Clinics, North Liberty, United States Background: Electric vehicles (EV) ownership is increasing worldwide. It is estimated that by year 2020, 20 million EV will be on the road. We previously demonstrated that there is no effect of electromagnetic interference (EMI) from an EV on implantable cardioverter defibrillator (ICD) performance when using an alternating current regular charging station port (17.2 kW, 30 A). The effect of a supercharging station with direct current (120 kW,

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

85 A) has not been evaluated. There are 1043 supercharger stations with 7496 superchargers in the USA. It is reported they charge EV in less than 30 min with 480 V of direct current providing up to 120 kW of power per car, becoming the favored charging option. Objective: To assess potential influence of EMI from EV supercharger on ICD performance. Methods: This is a proof of concept study to explore potential effect of EMI from supercharger stations for EV on ICD. We enrolled 35 patients with stable ICD function; 14% (5/35) were single chamber, 40% (14/35) were dual chamber and 46% (16/35) were biventricular ICDs. Thirty-one percent (11/35) of these were Medtronic, 51% (18/35) Boston Scientific, and 17% (6/35) St Jude Medical. Tesla Model S and Model X were used while charging at supercharging station. ICDs were interrogated before and after the procedure. Tracings were obtained while the patients sat in the driver seat, passenger seat, backseats, and supercharging port at nominal and highest sensitivity settings. Results: Mean age of patients was 69. ± 9.7 (40–86) years; 83% (29/35) were Caucasian, 14% (5/35) African American, 2.8% (1/35) Asian; 77% (27/35) were male; 49% (17/35) patients had an underlying paced rhythm. Then, 19/35 patients had LV systolic dysfunction only (LVSD), 34% (12/ 35) had LVSD with prior ventricular arrhythmia or cardiac arrest. Eleven percent (4/35) had normal ventricular function. Five percent (2/35) had history of syncope. Five percent (2/35) has structural heart disease. There was no sensing of EMI at any settings, and no inappropriate ICD shock or damage to the device noted. Conclusion: In this single-center, in-vivo study, ICD functions were not influenced by EMI from EV while charging at a supercharging station. Abstract Oral Session 7: Catheter ablation of atrial fibrillation 2 Monday April 16, 2018, 10:30 am–12:00 pm ROOM COURCELLES 7-1 Abstract 18-32 LOW COMPLICATION RATES USING HIGH POWER (45W UP TO 50W) FOR SHORT DURATION FOR ATRIAL FIBRILLATION ABLATIONS Roger A. Winkle 1 , Sanghamitra Mohanty 2 , Rob A. Patrawala 1 , R. Hardwin Mead 1 , Melissa H. Kong 1 , Gregory Engel 1, Jonathan Salcedo 1, Chintan G. Trivedi 2, Carola Gianni 2, Pierre Jais 3, Andrea Natale 2, John D. Day 4 1 Silicon Valley Cardiology, PAMF and Sutter Health, East Palo Alto, United States, 2 Texas Cardiac Arrhythmia Insitute at St. David’s Medical Center, Austin, United States,

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147 3

S47

Hôpital Haut-Lévêque, Bordeaux, France, 4 Intermountain Heart Rhythm Specialists, Park City, United States Background: Many centers use radiofrequency (RF) power of 25–35 W for atrial fibrillation(AF) ablations for durations of 30– 60 s at each site. There is concern about the safety of using higher power for AF ablation, especially on the posterior wall. Methods: To examine the complication rates of four experienced centers doing RF ablations for AF at powers from 45 to 50 W for short durations. We examined 13,974 ablations done in 10,284 patients. All centers used irrigated tip RF at power 45– 50 W in the left atrium for 5–15 s at each site. On the posterior wall, 11,436 ablations used 45–50 W for 2–10 s and 2538 had the power reduced to 35 W applied for 20 s. Esophageal temperature monitoring was used in 13,858 (99.2)%. If a temperature rise occurred, additional ablation was delayed until temperature returned to baseline. Results: Demographics: age = 64.1 ± 11.0, male = 67.7%, LA size = 4.35 ± 0.74 cm, paroxysmal AF = 37.2%, persistent AF = 42.4%, longstanding AF = 20.3%, drugs failed = 1.39 ± 0.72, hypertension = 53.9%, diabetes = 14.7%, prior CVA/TIA = 7.0%, and CHA2DS2VASC = 2.081 ± 1.43. Initial ablation procedure time was 116.5 ± 41.3 min, fluoroscopy time was 32.6 ± 25.9 min and RF time was 2345 ± 1791 s. Per procedure complication rates were death 2 (0.014%, 1 due to stroke and 1 due to VT), pericardial tamponade 33 (0.24%, 26 tapped , 7 surgical), strokes BB 48 h 6 (0.043%), strokes 48 h–30 days 6 (0.043%), PV stenosis requiring intervention 2 (0.014%), phrenic nerve paralysis 2 (0.014%, both resolved), steam pops 2 (0.014%) and catheter char 0 (0.00%). One atrioesophageal(AE) fistula occurred in 11,436 ablations using 45–50 W power on the posterior wall and 3 occurred in the 2538 ablated with 35 W on the posterior wall (P = 0.021 vs. 45–50 W), although 2 of the 3 using 35 W had no esophageal temperature monitoring during a fluoroless procedure. Conclusion: Doing AF ablations at 45 W up to 50 W for short durations is associated with very low complication rates. Not monitoring the esophageal temperature was associated with high risk of AE fistula. High power, short duration ablations have the potential to shorten both procedure and total RF times and create more localized and durable lesions.

inferior in randomised controlled trials (RCT). However, there are significant differences in procedural data. In all RTCs, Cryo procedures were faster but required more fluoroscopy. The Fire and ICE trail showed a significant increase in fluoroscopy time, other RCTs showed an increase in fluoroscopy dosage. Similar to the coronary angiography, the amount of contrast dye should be evaluated as it might be harmful for the patients. Aim: The aim of this study was therefore to evaluate the fluoroscopy time/dosage and the amount of contrast dye during PVI. The investigators were encouraged to use as little as possible. Methods: Consecutive patients (P) with paroxysmal atrial fibrillation (PAF) were enrolled into the study. In the Cryo group, PVI was performed with the second generation Cryo balloon + Achieve catheter. Two freeze cycles (time to effect + 120 s) were applied in each vein. In the RF-group, circumferential PVI was performed using RF-energy in combination with a high-density 3D mapping system. No further technologies to reduce fluoroscopy (i.e. Mediguide, CartoUNIVU) were used. No other imaging was performed. Procedural endpoint was the demonstration of an entrance block in each vein. Results: Fiftytwo consecutive P (mean 62 years, 40% female) with PAF were evaluated (Cryo n = 31, RF n = 21). The groups were equally distributed. All PVs could be successfully isolated in both groups. Neither group was superior in terms of freedom of atrial arrhythmias after a mean follow up of 6 months. Using Cryo, PVI was significantly faster compared to RF (Cryo 99 ± 30 min versus RF 150 ± 40 min; < 0.001). However, Cryo procedures required twice the amount of contrast dye (Cryo 50 ± 16 ml versus RF 25 ± 10 ml, < 0.001) and a significant increased fluoroscopy time (Cryo 9.7 ± 6.2 min versus RF 4.4 ± 2.8 min; p BB 0.001) and dosage (Cryo 7.3 ± 14.9 cGy*cm2 versus RF 2.9 ± 7.3 cGy*cm2; p = 0.003). Conclusion: As suspected, PVIsolation using Cryo energy was faster compared to RF in combination with a high-density 3D mapping system. However, it required twice the amount of contrast dye and the fluoroscopy exposure was 2.5-fold higher for patient and staff. The discussion begins, what is worth more: speed or radiation protection?

7-2 Abstract 15-33

CONTACT-FORCE VERSUS NON-CONTACT FORCE S E N S I N G C AT H E T E R C O M P L I C AT I O N S : A DISTURBANCE IN THE FORCE

CRYO VERSUS RF USING NEXT GENERATION TECHNIQUES: SPEED AGAINST RADIATION PROTECTION Kerstin Schmidt 1, Patrick Hörmann 1, Thomas Schenk 1, Matthias Merkel 1, Claus Schmitt 1, Armin Luik 1 1 Städtisches Klinikum Karlsruhe, Karlsruhe, Germany Introduction: Success rates for pulmonary vein isolation (PVI) using Cryo energy compared to RF energy in combination with a 3D mapping system have already been proven to be non-

7-3 Abstract 18-12

Brian McCauley 1, Esseim Sharma 1, Antony Chu 1 1 Alpert Medical School, Brown University, Providence, United States Introduction: Contact-force sensing (CF) radiofrequency (RF) ablation catheters allow direct real-time assessment of contact force between catheter tip and cardiac tissue. This technology has the potential to improve both efficacy and safety of RF ablation. Data analysis of the Manufacturer and User Facility Device Experience

S48

(MAUDE) database, however, showed that 5.4% (65 of 1202) of all adverse event reports for CF sensing catheters used in atrial fibrillation (AF) ablation involved atrio-esophageal fistulas (AEF), versus only 0.9% (13 of 1487) of all adverse event reports for non-CF sensing (NCF) catheters. To further characterize this phenomenon, we performed a systematic meta-analysis of complications reported between CF and NCF catheters used in AF ablation. Methods: We performed a systematic meta-analysis of 22 published studies comparing the rates of complications between CF and NCF catheters during AFablation. Randomized and non-randomized observational studies comparing ablation of AF with CF and NCF catheters were identified using the Cochrane Library, EMBASE, and PubMed. This data was compared with the MAUDE database. Results: A total of 22 studies were identified (n = 4122). There were 138 complications, 53 (3.15%) in the CF arm and 85 (3.49%) in the NCF arm. There were no significant differences in the rates of pericardial effusion (OR 0.78, 95% 0.36–1.72), pericarditis (2.07 [0.39–10.98]), cardiac tamponade (0.92 [0.44–1.93]), groin-related complications (0.99 [0.54–1.83]), phrenic nerve palsy (0.62 [0.10, 3.82]) or AEF (0.66 [0.03–16.38]). One AEF event was reported and occurred in the NCF sensing arm. Conclusions: We found no statistically significant difference in complications between CF and NCF catheters used in AF ablation. Amongst published clinical trials, there were no AEF complications reported using CF catheters. However, AEF accounted for 5.4% of all adverse event reports associated with CF catheters in the MAUDE database. This discordance suggests a disparity between published and actual complication rates of CF catheters. Our study highlights the need for creation of a national registry to assess device-specific AF ablation complications.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

male, age 64 ± 10 years, 21 paroxysmal AF patients). We analyzed those patients by the presence or absence of AF or atrial tachycardia (AT) recurrence after the last procedure (no recurrence group 26 patients, recurrence group 29 patients). There were no significant differences in AF type, CHADS2 score and BNP levels, LA diameter, ejection fraction between the two groups. The ratio of AT only recurrence before last procedure is significantly higher in the no recurrence group than in the recurrence group 65.4% (17 patients) vs 17.2% (5 patients), p < 0.05). There were 32 patients with AT only recurrence before last procedure (AT only group) and 23 patients with AF with or without AT recurrence before last procedure (AF group). In those two groups, the AF recurrence rates after the final procedure on anti-arrhythmic drugs were 42 and 73% in AT group and AF group at 1 year (log rank test, p = 0.004). Conclusion: The AT-only-recurrence patients before last procedure could get the better success rate compared with the AF recurrence patients after multiple procedures.

7-4 Abstract 15-29 T H E FA C T O R S W H I C H A F F E C T AT R I A L F I B R I L L AT I O N R E C U R R E N C E S A F T E R MULTIPLE CATHETER ABLATIONS 7-5 Abstract 15-37 Masahiro Sekigawa 1, Mototada Lee 2, Shinya Shiohira 2, Atsuhiko Yagishita 2, Shingo Maeda 2, Yoshihide Takahashi 2 , Masahiko Goya 2, Kenzo Hirao 2 1 Department of Cardiology, Tokyo Medical and Dental University/Japan Redcross Musashino Hospital, Tokyo, Japan, 2 Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan Background: Catheter ablation for atrial fibrillation (AF) is a well-established treatment. Despite repeated procedures, some patients have recurrence of AF. Methods and Results: We enrolled patients who underwent over three times catheter ablation for paroxysmal AF and persistent AF from January 2011 to March 2017 and examined the success rate and predictors of AF recurrence. Fifty-five patients were selected (46

HYBRID ABLATIVE THERAPY FOR PATIENTS W I T H P E R S I S T E N T O R L O N G S TA N D I N G PERSISTENT ATRIAL FIBRILLATION: A FRENCH SINGLE CENTER EXPERIENCE Franck Mandel 1, Anne Rollin 1, Etienne Grunenwald 1, Pierre Mondoly 1, Benjamin Monteil 1, Bertrand Marcheix 1, Philippe Maury 1 1 CHU Rangueil, Toulouse, France Background: Catheter ablation for persistent AF (p-AF) is disappointing carrying a limited success rate, at least after a single procedure. Hybrid therapy, combining both epicardial surgical and endocardial percutaneous catheter ablation, is expected to

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S49

be a more effective technique, providing a more complete lesion set. The aim of this monocentric prospective study was to analyze the feasibility, efficiency and complication rates of the single-step hybrid ablation, in patients with p-AF and longstanding persistent AF (LSP-AF). Methods: From November 2015 to January 2017, 12 patients with symptomatic and drug refractory p-AF (5/12 pts) or LSP-AF (7/12 pts) have been prospectively included in our study to undergo hybrid ablation in a single step procedure. The surgical procedure consisted of a bilateral thoracoscopic approach to perform pulmonary veins (PVs) isolation and “posterior box” lesion set with epicardial radiofrequency (RF) bipolar device. During the same procedure, additional percutaneous RF ablation was performed when needed after transseptal access and assessment of the completeness of the box lesion and PV isolation. The primary endpoint was to assess the completeness of the procedure. Results: Hybrid procedure was successfully performed in 91% of patients (11/12). One patient had a left atrium perforation during epicardial ablation, requiring thoracotomy for haemostasis. At the electrophysiological time, isolation of the PV was completed in 11/11 patients and isolation of the posterior wall of the left atrium (box lesion) was completed in 10/11 patients. No deaths were encountered. Two patients (16%) had severe complications (one left atrium perforation and one reversible phrenic nerve injury). After a 3-month blanking period, six (50%) patients had recurrences of sustained atrial tachycardia. All of these, had prior endocardial ablation procedure for AF, and five out of six patients (83%) had a history of LSP-AF. All of these patients with AF/AT recurrences underwent redo endocardial procedure and were ablated for mitral isthmus flutter (3/6), left AT (2/6), or right atrial flutter (1/6). Left posterior box and pulmonary veins were isolated in all patients at the time of redo procedure. After a mean follow-up of 12 months, 11 patients (92%) were in sinus rhythm and free from anti-arrhythmic drugs. Conclusion: This study confirmed the feasibility and safety of hybrid ablation. Further randomized trials with longterm follow-up are needed to confirm the superiority of hybrid procedures over repeated catheter ablations in a population of patients with persistent and long standing persistent AF.

Background: Cryoballoon pulmonary vein isolation (PVI) has become an effective treatment of symptomatic atrial fibrillation (AF). The standard spiral mapping catheter (SMC) is used for positioning of the balloon and for determination of the time to PV isolation (TTI). The larger 25 mm SMC has been designed for a better support in pulmonary vein positioning and to increase the rate of TTI measurements as compared to the 20 mm SMC. The TTI is regarded as the best predictor for permanent PVI. The aim of this study was to investigate if the larger loop size of the SMC (25 mm) influences the efficacy of the cryoballoon technique. Methods: Consecutive patients with symptomatic AF underwent PVI using the 28 mm cryoballoon. The first group was treated with the 20 mm SMC and the second group with the 25 mm SMC. Baseline characteristics and procedural data were investigated prospectively. The primary endpoint was the feasibility of measuring the TTI. Other procedural and periprocedural data were assessed as a secondary endpoint. Results: A total of 97 patients (68 ± 9 years, 42% female) were included. Fortyseven patients were treated with the 20 mm SMC (group 1) and 50 patients with the 25 mm SMC (group 2). There were no major differences in baseline characteristics. In the 25 mm SMC group, the feasibility of measuring the TTI was significantly higher (82.6 vs. 71.7%, p = 0.02) as compared to the 20 mm SMC group. There were no significant differences in TTI duration (48 ± 28 vs. 50 ± 28 s, p = 0.52). In the 20 mm SMC group, the LA time and the total procedure time tended to be shorter (62 ± 17 vs. 68 ± 22 min, p = 0.11 and 100 ± 21 vs. 106 ± 27 min, p = 0.22). In case of three patients, the 25 mm SMC had to be changed to the 20 mm SMC during the procedure due to an oversizing which resulted in an insufficient balloon occlusion. In some cases, a gentle 180° torque in clockwise direction on the SMC facilitated the positioning of the SMC in the pulmonary vein. Conclusion: Our study demonstrates that the general use of the 25 mm SMC results in a higher TTI detection rate as compared to the 20 mm SMC. Nevertheless, catheter handling might be more difficult as the 25 mm SMC is sometimes oversized in relation to the PV diameter resulting in insufficient balloon occlusion. In conclusion, the 20 mm SMC remains the preferred size, the 25 mm SMC can be useful in larger veins.

7-6 Abstract 15-25

Abstract Oral Session 8: Progress in Cardiac Pacing and outcomes

COMPARISON OF THE 25MM AND THE 20MM S P I R A L M A P P I N G C AT H E T E R F O R CRYOBALLOON POSITIONING AND DETERMINATION OF THE TIME TO PV ISOLATION

Monday April 16, 2018, 10:30 am–12:00 pm ROOM DAMES 8-1 Abstract 23-20

Valerie Elisabeth Weitensteiner 1, Florian Straube 1, Uwe Dorwarth 1, Stefan Hartl 1, Hans-Jürgen Krieg 1, Michael Wankerl 1, Ellen Hoffmann 1 1 Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany

ANALYSING MORTALITY VARIANCES BETWEEN RIGHT VENTRICULAR HIGH SEPTAL PACING AND RIGHT VENTRICULAR APICAL PACING F O L L O W I N G AT R I O V E N T R I C U L A R N O D E ABLATION: 10 YEARS FOLLOW-UP

S50

William Eysenck 1, Neil Sulke 1, Stephen Furniss 1, Rick Veasey 1 1 Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom Introduction: Right ventricular septal (RVS) pacing is often recommended as a more physiological alternative to right ventricular apical (RVA) pacing. Most comparisons between the two sites have had short follow up and few trials have assessed the different pacing sites following atrioventricular node (AVN) ablation. We investigated 200 consecutive patients (pts) aged 66– 96 (51% male) who underwent implantation of a pacemaker prior to AVN ablation with either RVA- or RVS-pacing between 1996 and 2016. Methods: All hospital notes were retrieved and reviewed. Ventricular lead site was determined by implantation data including orthogonal fluoroscopic x-ray report and chest xray review in all pts. Mortality data were obtained by death certificates and post mortem exam where available. Results: See Fig. 1. Seventy-two of the 200 (36%) pts died over the course of the study. Forty-eight of these pts (67%) had an apical lead. Mortality rate with RVA-pacing was significantly lower than mortality rate with RVS-pacing (p = 0.0001). Mean survival from AVN ablation to death was 13.9 ± 0.61 years for RVA pacing and 10.5 ± 1.07 years for RVS pacing. However, we found no significant differences in causes of death between the two PPM sites. Conclusions: There was a decreased mortality rate with RVA pacing following AVN ablation after long-term follow up in this age group. The reason for this is elusive and not an expected finding. Analysis of cause of death revealed no significant differences between the two sites. There were no differences in rates of heart failure admission and there was no diminution in EF with either PPM site with 10 years follow-up.

8-2 Abstract 22-10 REVERSAL OF ADVERSE STRUCTURAL AND ELECTRICAL REMODELING INDUCED BY RIGHT V E N T R I C U L A R PA C I N G I N C H R O N I C AT R I O V E N T R I C U L A R B L O C K U T I L I Z I N G PERMANENT HIS BUNDLE PACING: IMPLICATIONS FOR PACING INDUCED CARDIOMYOPATHY

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Pugazhendhi Vijayaraman 1, Gopi Dandamudi 2, Suneet Mittal 3 1 Geisinger Heart Institute, Wilkes Barre, United States, 2 Inidiana University, Indianapolis, United States, 3 Valley Health System, Ridgewood, United States Introduction: His bundle pacing is a physiological alternative to right ventricular pacing (RVP). Adverse electrical and structural remodeling is caused by chronic RVP. The aim of the study is to assess (1) the feasibility of HBP in pts with longstanding complete heart block (L-CHB); (2) reversal of remodeling induced by RVP. Methods: HBP was attempted in 50 patients (age 75 ± 15 years; men 59%; HTN 61%, DM 17%, CAD 35%, AF 41%, AVN ablation 11%) with LCHB (mean duration 92 ± 60 months, range 1–24 years) and chronic RVP. HBP was performed using Medtronic SelectSecure 3830 lead delivered via C315His sheath. Indications for HBP: pacing-induced cardiomyopathy (PIC) 30, lead failure 13, infection 7. Results: HBP was successful in 46 of 50 (92%) pts. AV nodal block was present in 34 and 16 had HV block. Mean fluoroscopy duration 12 ± 9 min. QRS duration significantly narrowed from 179 ± 19 ms (146–216 ms, RVP) to 116 ± 20 ms (70–148 ms, HBP, < 0.001). HBP threshold at implant was 1.5 ± 1.0 V at 0.7 ms; at last f/u (23 ± 18 months) was 1.75 ± 1.5 V at 0.5 ms. Ventricular sensing amplitude 4.0 ± 3.9 mV (range 0.9– 15 mV). LVEF decreased from 53 ± 9% at baseline to 33 ± 11% following RVP and improved to 47 ± 11% (20–64%) during follow-up in the 30 pts with PIC (< 0.001). NYHA functional status improved by at least 1 class in 24 of 30 pts. Forty-two of 46 pts showed evidence for paradoxical acute T wave memory changes with HBP and normalized in 2– 6 weeks. Conclusions: Permanent HBP was successful in 92% of pts with L-CHB and chronic RVP. Despite long duration of CHB (nodal and infra-nodal), conduction through distal HB and normalization of QRS could be achieved with HBP. Chronic RVP-induced electrical (depolarization and repolarization) and structural (LV function) changes could be reversed with HBP.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S51

8-3 Abstract 08-15

8-4 Abstract 23-13

PERMANENT PACEMAKER IMPLANTATION FOLLOWING TRICUSPID VALVE REPLACEMENT IN CARCINOID HEART DISEASE

10-YEAR EXPERIENCE OF SINGLE CHAMBER P E R M A N E N T E P I C A R D I A L PA C E M A K E R PLACEMENT FOR CHILDREN WITH CONGENITAL HEART DISEASES

Igor Sunjic 1, Vamsi Gaddipati 1, Edin Sadic 1, Dany Sayad 1 1 University of South Florida Department of Cardiovascular Medicine, Tampa, United States Background: Carcinoid tumors are a rare, predominantly secretin-producing subset of neuroendocrine tumors that may lead to fibrous deposition, thickening, and dysfunction of the valvular apparatus. Prognosis averages 4 y e a r s w i t h m o r t a l i t y l a rg e l y r e s u l t a n t f r o m valvulopathy and ensuing decompensated heart failure. Atrioventricular block (AVB) necessitating permanent pacemaker (PPM) placement is a known complication of cardiac surgery, especially with tricuspid valve surgery, for which incidence has been reported at 27%. Data specific to carcinoid heart disease is rare and could be of high utility for risk stratification. Accordingly, this analysis seeks to identify likelihood of AVB in the postoperative setting. Methods: Twenty-seven patients with carcinoid heart disease were identified for retrospective chart review and categorized by baseline demographic, clinical, and surgical characteristics. Of these patients, 20 required valvular replacement (1 tricuspid valve, 1 pulmonic valve, and 18 combined tricuspid and pulmonic valve procedures) for NYHA class III/IV symptoms. One patient was excluded from analysis due to PPM presence prior to surgery. Results: Of the 19 patients included, 8 were female and 11 were male. Thirty-two percent (n = 6; 5 females and 1 male) required PPM placement in the post-operative setting due to development of high-degree AVB. Average time of implantation was 6.3 days (± 1.2 days). Two patients died in the follow-up period—both approximately 4 months postsurgery (one requiring PPM placement and one who did not). These data are similar to, though slightly higher than tricuspid valve interventions at our center, where 24% (10/41) over a 1.5-year period required postoperative PPM implantation. Conclusion: Incidence of post-operative AVB following tricuspid valve intervention appears to be slightly higher amongst the carcinoid heart disease population. Given these findings, prophylactic placement of epicardial right ventricular leads should be carefully considered. Further cohort and prospective studies could help clarify optimal surgical techniques and procedures for this high-risk subset of patients to minimize repeat thoracotomy or placement of pacemaker leads across artificial valves.

Maurizio Santomauro 1 , Gaetano Palma 1 , Giuseppe Comentale 1, Raffaele Giordano 1, Carla Riganti 1, Vincenzo de Amicis 1, Giulio Garofalo 1, Gabriele Iannelli 1 1 Department of Cardiology, Cardiac Surgery and Cardiovascular Emergency, School of Medicine and Surgery, "Federico II" University of Naples, Napoli (NA), Italy Background. As pacemaker-dependent children require lifelong electrical therapy and consequently are inseparable from the implanted hardware, some special points regarding surgical intervention have to be considered. Aim. To analyze the 10-year experience of single chamber permanent epicardial pacemaker placement for children with congenital heart diseases (CHD) after surgical repair. Methods. Between 2007 and 2017, a total of 37 patients with CHD (age 36.9 ± 23.2 months, weight 12.7 ± 5.6 kg) received permanent epicardial pacemaker placement following corrective surgery. In all pts, the device model used was a Medtronic Kappa PM 700 or 901 or Adapta with Ventricular Capture Management™ (VCM) feature that automatically measures pacing threshold through detection of the evoked response after a pacing stimulus. These are patients who might be safer with an algorithm capable of automatically adjusting pacing output according to the measured threshold rather than with a fixed output. This ratio is useful to identify patients at risk since the nominal VCM safety margin is 2. By using epicardial systems, by electrodes steroid eluting and bipolar, implanted by a subxiphoidal approach, a generator pocket is created abdominally behind the anterior sheet of the rectus muscle. Echocardiography and programming information of the pacemaker, as well as major adverse cardiac events (MACE) as heart failure or sudden death, were recorded during follow-up in office and at home (78.8 ± 43.2 months). Acute ventricular stimulation threshold was 1.34 ± 0.72 V and a significant increase was observed at the last follow-up 3.37 ± 0.81 V (p = 0.001) in 12/37 (32.4%). Compared with initial pacemaker implantation, the last follow-up did not show significant increases in impedance (p = 0.327) or R wave (p = 0.835). Ten patients received pacemaker replacement because of battery depletion (27%). Then, 2/37 (5.4%) patients experienced MACE. Although the age and body weight were similar between patients with and without MACE, the patients with MACE had complex CHD. High-degree iatrogenic atrioventricular block was the primary reason for placement of the epicardial pacemaker in patients with CHD after surgical

S52

repair. Pacemaker placement with the steroid-eluting leads resulted in acceptable outcomes; however, the pacemaker type should be optimized for children with complex CHD. The absolute stability was very good in all patients. The analysis of successful measurements showed that factors contributing to the stability of thresholds are epicardial pacing and the presence of CHD. Epicardial pacing contributes to threshold stability, probably due to the surgical fixation of the leads to the epicardium.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

was seen (− 19 ± 9.5 mmHg), whilst improving BP (5.3 ± 4.1 mmHg). Unless stated, all values are mean ± SE. Conclusion: High precision, automated measurements may detect the AVI that balances the increased LVOT size, reduced myocardial performance and altered AV filling that occur with RVAp for HCM.

8-5 Abstract 23-11 A UTOM AT E D, HIGH-PRECIS ION ECHOCARDIOGRAPHIC AND HAEMODYNAMIC ASSESSMENT OF THE EFFECT OF ATRIOVENTRICULAR INTERVAL DURING RIGHT V E N T R I C U L A R PA C I N G I N O B S T R U C T E D HYPERTROPHIC CARDIOMYOPATHY Kayla Chiew 1, Ahran Arnold 1, Matthew Shun-Shin 1, Afzal Sohaib 1, Kevin Leong 1, James Howard 1, Daniel Keene 1, Leah Burden 1, Katherine March 1, Yousif Ahmad 1, Graham Cole 1, Prapa Kanagaratnam 1, David Lefroy 1, Darrel Francis 1 , Amanda Varnava 1, Zachary Whinnett 1 1 Imperial College London, London, United Kingdom Background: The role of right ventricular apical pacing (RVAp) in reducing left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) remains controversial, partly due to heterogeneity in studied atrioventricular interval (AVI). We identified the optimal AVI using automated, high-precision haemodynamic and echocardiographic measurements. Methods: Five patients with obstructed HCM and dual chamber implantable cardioverterdefibrillators (ICDs) were recruited. Pacing mode was alternated between atrial pacing (AAI) and AV sequential pacing (DDD) ten times, whilst recording ECG, non-invasive beatby-beat blood pressure (BP), and live screen output of echocardiography during continuous wave doppler through the LVOT. This was repeated for AV delays in 40 ms increments from 40 ms to pseudocapture. Automated software detected the trough of the LVOT-CWD trace to identify beat-by-beat instantaneous gradient (LVOTg). The change in gradient was calculated as the mean difference when changing pacing mode. Automated analysis of BP was similarly performed. Results: Mean LVOTg at protocol was 37 ± 19 mmHg. At 10 bpm above sinus rate, optimal AVI reduced LVOTg (− 5. 7 ± 2.9 m m H g ) w i t ho ut r edu ci n g B P (− 0 .44 ± 0.44 mmHg). Individual data revealed an AVI where LVOTg was reduced and BP preserved in four patients (median AVI 160). At 100 bpm, the fifth patient also exhibited an AVI with LVOTg reduction and preserved BP. In the four patients who tolerated 100 bpm, greater LVOTg reduction

8-6 Abstract 23-28 REAL WORLD EXPERIENCE: PACEMAKER IMPLANTATION FOLLOWING IMPLANTATION OF THE COREVALVE EVOLUTE PRO VALVE James Gabriels 1, Joseph Donnelly 1, Jonathan Willner 1, Stuart Beldner 1, Apoor Patel 1 1 North Shore University Hospital - Northwell Health, Manhasset, United States Background: Conduction abnormalities leading to pacemaker (PPM) implantation following TAVR range from 6 to 25%. The self-expanding CoreValveTM EvoluteTM PRO Valve (Medtronic, Inc.; Minneapolis, MN) has an external pericardial wrap in an effort to reduce prosthetic valve regurgitation. This valve was approved for use based on 30-day follow up data from 60 patients (15 patients had pre-existing PPMs). Five of the remaining 45 patients (11.1%) required PPMs. Methods: Data from a single-center was collected on all patients implanted with the PRO Valve to date. This data was compared to the Evolute Pro data and to the same center’s PPM implant data with the Medtronic CORE Valve (Medtronic, Inc.; Minneapolis, MN). Results: Fifty-nine patients received the PRO Valve to date at a single center with a mean age of 84 ± 6.7 years, 77.9% female. Of the 47 patients without a pre-existing PPM, 12 (25.5%) required a PPM following TAVR. The pacing indications were complete heart block (n:8), slow AF with a new LBBB (n:1), new

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

LBBB (n:2, 1 of these patients had an HV interval of 78 ms) and Mobitz 1 with ventricular rate of 30 bpm (n:1). Compared to the Evolute PRO data, with a postTAVR PPM rate of 11.1%, we observed a higher PPM implant rate of 25.5% (95% CI − 2.9 to 30.9, P: 0.07). Between 8/2014 and 12/2014, at the same institution, 101 patients without prior PPMs received the Medtronic CORE Valve. Of these, 21 (20.7%) required a PPM post-TAVR. The rate of PPM implant of 25.5% with the PRO Valve was also higher compared with the earlier generation CORE Valve (95% CI − 9.9 to 21.3, P: 0.51). Conclusion: In the real-world experience at a single-center with the PRO Valve, there was a 25.5% post-TAVR PPM implant rate. The rate was higher when compared with the rate of 11.1% in the Evolute PRO data, and when compared to the rate of 20.7% at the same institution with the CORE Valve. Further work is needed to determine if there is a statistically significantly higher rate of PPM implantation following insertion of the PRO Valve in the realworld setting. Abstract Oral Session 9: Heart failure with depressed or preserved left ventricular function Monday April 16, 2018, 10:30 am–12:00 pm ROOM DEBARCADERE 9-1 Abstract 15-14 RISK OF ATRIAL FIBRILLATION IN HEART FA I L U R E W I T H P R E S E R V E D E J E C T I O N FRACTION: RESULTS FROM THE TREATMENT OF CARDIAC FUNCTION WITH AN ALDOSTERONE ANTAGONIST (TOPCAT) STUDY Jolien Neefs 1, Nicoline W.E. van den Berg 1, Sarah W. Baalman 1, Robin Wesselink 1, Wouter R. Berger 1, Eva Meulendijks 1, Makiri Kawasaki 1, Joris R. de Groot 1 1 Academic Medical Center, Amsterdam, Netherlands Background: Mineralocorticoid receptor antagonists (MRA) reduce the risk of AF in patients with HF and a reduced ejection fraction. However, the efficacy of MRAs on AF suppression in HF and a preserved ejection fraction (HFpEF) is unclear. The objective of this analysis is to assess the efficacy of spironolactone to prevent new-onset AF or recurrence of paroxysmal AF (pAF) in patients with HFpEF. Methods: All patients (n: 3425) with HFpEF from the TOPCAT study were included. They were 1:1 randomised to spironolactone or placebo. New-onset AF and pAF were defined by using the study case forms obtained from the National Heart, Lung and Blood Institute. Subgroups analysis based on mean left atrial volume index

S53

(LAVI) was performed. Results: At baseline, 2228 patients (64.7%) had no history of AF. LAVI was significantly lower in patients without a history of AF (25 [IQR 19–31] vs. 29 [IQR 22–37] ml/m2 < 0.001) compared to pAF. During a median follow-up of 3.1 [IQR 2.0–4.9] years, new-onset AF occurred in 5.2% (n:58) vs. 4.4% (n:49), spironolactone vs. placebo respectively (p = 0.41). The risk of new-onset, AF did not differ per treatment-arm, HR: 1.19 (CI 0.81– 1.74, p = 0.38). LAVI did not influence risk of new-onset AF (LAVIBB 25 ml/m2 HR: 1.76 (CI 0.42–7.37, p = 0.44); LAVI ≥ 25 ml/m2 HR: 0.79 (CI 0.29–2.18, p = 0.65)). At baseline, 505 patients (14.7%) had pAF. During a median follow-up of 3.3 [QR 1.9–4.7] years, AF recurred in 11.5% (n: 30) vs. 12.0% (n: 29), spironolactone vs. placebo respectively (p = 1.00). The risk of recurrence of AF did not differ per treatment-arm, HR: 0.94 (CI 0.57–1.58, p = 0.83). LAVI did not influence risk of recurrence (LAVIBB 29 ml/m2, HR 0.34 (CI 0.08–1.37, p = 0.13); LAVI ≥ 29 ml/m2, HR 0.86 (CI 0.29–2.57, p = 0.79)). Conclusion: The MRA, spironolactone, does not reduce the risk of new-onset or of recurrence of AF in patients with HF and a preserved ejection fraction. There results are in contrast to previous results of MRAs in patients with HF and a reduced ejection fraction.

S54

9-2 Abstract 31-12 RESPONSE TO THE VALSALVA MANEUVER IN PATIENTS WITH HEART FAILURE, PULMONARY ARTERIAL HYPERTENSION, AND IN HEART TRANSPLANT RECIPIENTS Jagdesh Kandala 1, Franz Rischard 2, Jennifer Huang Tsang 1, Mark Friedman 1, Frank Marcus 1 1 The University of Arizona, Sarver Heart, Tucson, United States, 2 The University of Arizona, College of Medicine, Tucson, United States Abstract: Introduction: We sought to predict left ventricular filling pressures (FPs) in patients with heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), (heart transplant (HT) recipients, and pulmonary arterial hypertension (PAH) by analyzing their cardiovascular (CV) response to Valsalva maneuver (VM). Methods: A prospective cohort of 82 patients who were referred for right heart catheterization (RHC) performed the VM to achieve a forceful expiration pressure of 40 mmHg for 15 s. The response to the VM was recorded using finger photoplethysmography (Finapres). The pulse amplitude ratio (PAR) was defined as the ratio of lowest pulse pressure during the strain phase to the pulse pressure at baseline. The Valsalva ratio (VR) was defined as the ratio of minimum heart rate during phase IV to the maximum heart rate during phase II. Results: Of the 82 patients (mean age 58.5 ± 12 years, 34% females), 31 had HFrEF, 17 had HFpEF, 21 had HT, and 13 had PAH. PAR correlated significantly with pulmonary capillary wedge pressure (PCWP) in the entire cohort (r = 0.63, < 0.00001) and in sub-groups (HFrEF: r = 0.78, < 0.001; HFpEF: r = 0.76, p = 0.0003; OHT: r = 0.48, p = 0.02; PH: r = 0.69, p = 0.008). A PAR of 0.62 had a sensitivity of 79%, and specificity of 86% to predict PCW < 15 mmHg in the entire cohort. The VR correlated significantly with right atrial pressure (r = − 0.76, p = 0.005) and PCWP (r = − 0.49, p = 0.05) in HFpEF. Moreover, the VR was a predictor of freedom from all cause death in heart failure patients. Conclusions: The CV response to VM is a simple, noninvasive tool for bedside estimation of FPs in patients with heart failure, HT recipients, and PAH. Additionally, it may provide prognostic data in heart failure patients. Keywords: Heart failure, Valsalva maneuver, filling pressure.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Background: In the AFFIRM trial, the primary outcome of mortality or stroke in patients with recurrent atrial fibrillation (AF) was not impacted by the choice of treatment strategy. However, the impact of this choice on the development of subsequent heart failure (HF) in AF patients has not been studied. Methods: A subgroup of AFFIRM subjects with no history of congestive heart failure at baseline, New York Heart Association (NYHA) class 0 and normal baseline ejection fraction were identified. Time to development of NYHA class II or more advanced HF, and a composite of development of NYHA class II or more HF or cardiac death were compared across randomization assignment to rate control or rhythm control in this AF patient subpopulation. Kaplan-Meier curves and Cox Proportional Hazards were used to compare time-dependent outcomes. Results: Among the 4060 subjects randomised in AFFIRM, 1826 met the criteria for this analysis (914 from rate and 912 from rhythm). On average, these subjects were 69.5 years of age, 43% were female, 34% had new onset AF and 17% had previously failed an antiarrhythmic drug. CAD was present in 26% of subjects, and there were no significant differences between baseline clinical or demographic characteristics. By year 5, 20% of rate and 15% of rhythm subjects had developed class 2 HF (HR 1.30, 95% CI 1.0; 1.69, p = 0.047, Fig. A). For the composite of HF and cardiovascular death, 21% of rate and 17% or rhythm subjects had an event by year 5 (HR 1.33, 95% CI 1.04, 1.69, p = 0.023, Fig. B). Conclusions: In this AF subpopulation in the AFFIRM trial, a rhythm control strategy was associated with better HF and cardiac survival outcomes. Maintenance of rhythm control could offer benefits in preventing development of HF in this AF subpopulation.

9-4 Abstract 31-10 INFLUENCE OF HEART RATE VARIABILITY ON HEART FAILURE DETERIORATION IN PATIENTS WITH ARTERIAL HYPERTENSION

9-3 Abstract 31-11 CAN HEART FAILURE DEVELOPMENT IN ATRIAL FIBRILLATION PATIENTS BE IMPACTED BY THE CHOICE OF INITIAL TREATMENT STRATEGY? April Slee 1, Sanjeev Saksena 1 1 Electrophysiology Research Foundation, Warren, United States

Yuliya Shaposhnikova 1, Iryna Ilchenko 1 1 Kharkiv National Medical University, Kharkiv, Ukraine The aim of study was to investigate heart rate variability (HRV) indexes by the frequency analysis and to evaluate the prognostic value of heart rate (HR) and HRV on the course of HF in patients with arterial hypertension (AH). Material and methods.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

The study group consisted of 184 patients with CHF (110 males, 74 females, mean age 58.4 ± 9.7 years) and 2–3° AH (mean systolic and diastolic blood pressure, respectively: 164.4 ± 8.6 mmHg; 98.3 ± 7.4 mmHg). All patients had II-III NYHA functional class (FC), EF < 40%, body mass index (BMI) = 28.2 ± 2.0 kg/m² and received comparable therapy. Respectively two groups of patients were allocated according to the NYHA FC of CHF: Group 1–II FC (102 patients), Group 2–III FC (82 patients). In all patients, a 5-min interval electrocardiogram (ECG) recording during the morning time slot from 08.00 till 09.00 on an empty stomach was performed every 3 months for 1 year. Standard spectral analysis parameters of HRV were assessed and analyzed: high-frequency component (HF), low-frequency component (LF), their ratio (L/H) and the total spectral power (TP). The control group consisted of 20 gender and age-matched healthy subjects. Results. The mean HR at the baseline in groups 1 and 2, was 82.2 ± 4.8 and 88.2 ± 6.4 beats per min (control 60.2 ± 2.4; p < 0.05) respectively. When evaluating the reduction of HRV indexes set of spectral analysis, more pronounced in patients two groups. In both groups of patients, a decrease of TP was found (respectively 1286.4 ± 78.6 ms² (< 0.05); 967.8 ± 53.5 ms² (p < 0.05); in control group 1682.8 ± 83.2 ms²); significant reduction in HF (respectively 342.7 ± 38.9 ms² (p < 0.05); 289.5 ± 37.5 ms² (p < 0.05), of 486.2 ± 41.4 ms²) and LF (respectively 219.3 ± 22.4 ms² (p < 0.05); 182.3 ± 20.3 ms² (p < 0.05); control of 295.5 ± 18.2 ms²). During the follow-up period in groups 1 and 2, HR increased associated with a worsening of HRV spectral parameters. A negative correlation between HR and HF [r = − 0.48; CI 95% 0.84–1.68, p = 0.042] LF [r = − 52; CI 95% 1.57–1.83; p = 0.034]. By the end of the observation period while preserves increased HR functional class of CHF worsened in 23 and 36% of patients in group 1 and group 2 respectively. Conclusions. Increased HR in patients with AH and HF was associated with a deterioration of spectral parameters of HRV, which had a negative predictive value for HF worsening, and determines the need for active treatment.

S55

in-hospital complications and survival during 2-year follow-up. Methods. Prospective, observational study, including 116 patients (67.5 ± 1.0 years) hospitalized due to ADHF, required loop diuretics use. The univariate and multivariate analysis, the chisquare, Student t and Mann-Whitney tests and log rank were used. Results. The prevalence of AF was 54.3%, and the permanent type was predominant (84.7%). On multivariate model, AF was associated with younger age (< 0.05), non-ischemic etiology (< 0.05), non-diabetes mellitus (< 0.01), lower systolic blood pressure (< 0.05), higher left ventricle ejection fraction (p < 0.01) and higher glomerular filtration rate (< 0.05). The mean CHA2DS2-VASc score was 4.3, and in 80.7% of the cases it was ≥ 2. The anticoagulation rate was 58.1% on admission and 87.1% on discharge, being lower for higher CHA2DS2-VASc scores. Total in-hospital death occured in 2.6% (ns between groups). The group with AF had a lower 2-year cardiovascular mortality (8.1 versus 27.8%) and hospital readmission due to heart failure decompensation (22.6 versus 29.7%), p < 0.05 by Log rank. Incidence of stroke was 4.8 versus 3.7% (ns). Conclusions. AF was frequent in ADHF, mostly in its permanent type. AF was associated with younger age, non-ischemic HF etiology, lower systolic blood pressure, higher ejection fraction and higher glomerular filtration rate. Despite the high thromboembolic risk profile, anticoagulation was underutilized. AF presence was not associated with a higher hospital eadmission or a higher mortality rate during the 2-year follow-up. 9-6 Abstract 24-17 SECONDARY MITRAL REGURGITATION IN HEART FAILURE. BENEFIT FROM CARDIAC RESYNCHRONIZATION THERAPY Nestor Galizio 1, Guillermo Carnero 1, Alejo Tronconi 1, Mauricio Mysuta 1, Alejandro Palazzo 1, José Luis Gonzalez 1, Liliana Favaloro 1, Rene Favaloro 1, Margarita Peradejordi 1, Roxana Ratto 1, Eduardo Guevara 1, José Salmo 1, Hugo Fraguas 1 1 University Hospital-Favaloro Foundation, CABA, Argentina

9-5 Abstract 15-34 LONG-TERM PROGNOSTIC IMPACT OF ATRIAL FIBRILLATION IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE Sergey Kozhukhov 1, Alexander Parkhomenko 1, Nataliia Dovganych 1 1 NSC “The M.D. Strazhesko Institute of Cardiology”, Kiev, Ukraine Background. Limited data exists about the long-term prognosis of patients with acute decompensated heart failure (ADHF) according to the presence or absence of atrial fibrillation (AF) on admission. Aim: To determine AF prevalence and type of AF in patients hospitalized due to ADHF; to assess the impact of AF on

Introduction: Moderate/severe secondary mitral regurgitation (M/S-MR) due to left ventricular (LV) dysfunction is predictor of death, heart failure hospitalization (HFH) and heart transplant (HT). Purpose: 1. To describe the response of cardiac resynchronization therapy (CRT) in all patients (pts). 2. To show the effect of CRT on M/S-MR. Methods: Between 2009 and 2015, 238 pts implanted with CRT were followed at 12 and 24 months (m). To evaluate: 1. CRT Responders from a composite endpoint of decrease ≥ 1 NYHA functionalm class or increase in LVEF ≥ 5% and no death, HFH or HT. 2. MR Responders at 12 and 24 m: a. M/S-MR improvement by ≥ 1 degree, b. To describe LV remodeling (by LVDD, LVSD and LVEF) in pts with S/M-MR and c. Outcome. Baseline characteristics: Age 63 ± 10 years, men 160 p (67%), ischemic

S56

cardiomyopathy 85 pts (36%), non-ischemic cardiomyopathy 153 pts (64%), FC II-III NYHA 223 pts (94%), LBBB 171 pts (72%), QRSd 165 ± 25 ms, LVDD 69 ± 11 mm, LVSD 56 ± 12 mm, LVEF 23 ± 7%, β-blockers 92%, ACEi/ARBs 94%, mineral receptor blockers 83% and diuretics 82%. M/S-MR 139 pts (58%): 50 pts (36%) severe (S-MR) and 89 (64%) moderate MR (M-MR). Results: 1. CRT Responders: 167/238 pts (70%) at 12 m and 121/176 (69%) at 24 m, 2. MR Responders: M/S-MR improved in 108/139 pts (78%) at 12 m and 60/71 (84.5%) at 24 m. a. S-MR: 42/50 p (84%) improved ≥ 1 degree at 12 m and 22/24 pts (91.6%) at 24 m. MMR: 66/89 pts (74%) improved ≥ 1 degree at 12 m and 38/49 pts (77.5%) at 24 m. b. LV remodeling in pts with S/M-MR at baseline and 12 m: LVDD 70.5 ± 11 mm vs 67.5 ± 13 mm (p = 0.03), LVSD 59.3 ± 12 mm vs 54.3 ± 15 mm (p = 0.02) and LVEF 23.3 ± 6.7% vs 30 ± 10% (p = 0.01), respectively. At baseline and 24 m: LVDD 68 ± 11 vs 63 ± 13 mm (p = 0.3), LVSD 59 ± 12 vs 50 ± 15 mm (p = 0.04) and LVEF 30 ± 6 vs 36 ± 10% (p = 0.01), respectively. c. Outcome at 12 m: 31/139 pts (22%) had M/S-MR: 5 pts (16%) died, 7 pts (23%) presented HFH and 3 pts (9.7%) underwent HT. There were 87/139 pts (63%) who improved to Mild/No-MR: 3 p (3.4%) had HFH. There were no death or HT. At 24 m, 16/71 pts (22.5%) remained with M/S-MR: 4/16 (25%) died, 4/16 (25%) presented HFH and 2/16 (12.5%) underwent HT. The combined endpoint of death, HFH and HT was present in 15/31 pts (48.7%) with M/S-MR vs 3/108 pts (2.8%) with Mild/No-MR (< 0.001) at 12 m and 10/16 pts (62.5%) vs 5/55 (9%) at 24 m (< 0.001), respectively. Conclusions: 1. The response of CRT by the composite endpoint was high. 2. MR by ≥ 1 grade, LV remodeling and outcome were significantly better in pts who improved from S/M-MR to Mild/No-MR. Abstract Oral Session 10: New insights in the mechanisms of Cardiac Arrhythmias Monday April 16, 2018, 10:30 am–12:00 pm ROOM EPINETTES 10-1 Abstract 01-29 GAP JUNCTION COUPLING IS A MAJOR D E T E R M I N A N T O F T H E U N D E R LY I N G MECHANISM OF MYOCARDIAL FIBRILLATION Balvinder Handa 1, Caroline Roney 2, David Pitcher 1, Charles Houston 1 , Konstantinos Tzortzis 1 , Richard Jabbour 1 , Javier Carbello Garcia 1 , Catherine A Mansfield 1 , Chris Cantwell 1 , Emmanuel Dupont 1 , Rasheeda Chowdhury 1 , Steven Niederer 2 , Nicholas Peters 1, Fu Siong Ng 1 1 Imperial College London, London, United Kingdom, 2 Kings College London, London, United Kingdom

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Introduction: There is intense debate surrounding the mechanisms that underlie myocardial fibrillation. There are both clinical and experimental data to support the existence of rotational drivers of fibrillation, though other conflicting studies have not demonstrated such drivers, and have suggested that fibrillation is the result of disorganized myocardial activation. Abnormal electrical coupling between cardiomyocytes through gap junctions (GJ) has been considered an important factor in electrical remodelling associated with atrial fibrillation (AF). Objective: We hypothesized that the underlying mechanism of myocardial fibrillation is determined by the degree of GJ remodelling, and that changes in GJ coupling can shift or modify the predominant mechanism of fibrillation along the spectrum between organized drivers and disorganized activity. Methods: An acute model of ventricular fibrillation (VF) was used. Seven Sprague-Dawley rat hearts were explanted and perfused ex vivo with 200 μM of pinacidil, and VF was induced with burst pacing. Optical mapping of transmembrane potential was performed using voltage sensitive dye RH237 and excitationcontraction uncoupler blebbistatin. This was done at baseline and the effects of GJ uncoupling on myocardial fibrillation dynamics was studied by perfusing with increasing concentrations of carbenoxolone (10–50 μM, CBX). Fibrillatory dynamics, dominant frequency and Shannon’s entropy were quantified for the different degrees of GJ uncoupling. Results: Pincadil shortened the action potential duration by 15 ms (111 ± 11 vs 96 ± 13 ms; < 0.01). CBX reduced the number of stable rotational drivers in a concentration-dependent manner (baseline: 2 ± 0.4 vs 50 μM CBX: 0 ± 0; < 0.01), reduced the duration of stable rotational drivers (2130 ± 323 vs 305 ± 36 ms; < 0.01), and increased the number of short-lived rotational activity (3 ± 1.3 vs 12 ± 3.2; < 0.01). CBX increased number of dominant frequencies (DF) (1.3 ± 0.4 vs 4.9 ± 0.7; < 0.01), though the highest DF did not change significantly. CBX increased Shannon’s Entropy in a concentration-dependent manner by 12.8% (9.02 ± 0.25 vs 10.18 ± 0.21; < 0.01). Conclusion: GJ coupling is a key determinant of the underlying mechanism of myocardial fibrillation. GJ uncoupling modifies the mechanism of fibrillation by transforming organized fibrillation with stable drivers into disorganized fibrillation. The range of reported activation patterns in clinical atrial fibrillation may be the consequence of differing degrees of GJ remodelling. 10-2 Abstract 01-21 MACHINE LEARNING PREDICTS FIBROSIS IN EX VIVO HUMAN CARDIAC SLICES USING ELECTROGRAM FEATURES BUT NOT VOLTAGE AND FRACTIONATION Konstantinos Tzortzis 1, Andre Simon 2, Filippo Perbellini 1, Cesare Terracciano 1, Chris Cantwell 1, Nicholas S. Peters 1, Rasheda A. Chowdhury 1

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147 1

Imperial College London, London, United Kingdom, 2 Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom

Background: Fractionation and low electrogram (EGM) voltage are poor predictors of scar regions leading to limited success of ablation procedures. EGMs are clinically categorised by binary descriptors, such as simple and complex, which does not fully utilise the detailed information available. Extraction of additional features may enhance the predictive capabilities of the EGM. This study aims to assess whether EGM features, including fractionation and voltage, can be used for predicting fibrosis burden in ex vivo human heart slices. Methods: Left ventricular tissue samples were collected from end-stage heart failure patients (n = 10). Then, 300 μm epicardial slices were prepared. EGM recordings were collected using microelectrode arrays (8 × 8 electrodes/100 μm diameter/700 μm spacing). One frequency-domain, 17 timedomain and 7 time-frequency domain EGM features were analysed. Second harmonic generation microscopy was used to quantify collagen coverage. High scar regions were defined as areas with BB15% collagen. Classification training was carried out using the k-nearest neighbour algorithm on a training dataset of 275 EGMs to group them according to collagen content. The prediction model was evaluated using a test dataset. Results: Voltage was lower in high scar areas (low scar: 3.7 ± 0.19 mV, N = 9 slices; high scar: 3 ± 0.2 mV; < 0.05, N = 12). Counter-intuitively, fractionation was also lower in high scar areas (low scar: 3.3 ± 0.3; high scar: 2.6 ± 0.2; < 0.01). Fibrotic areas could be predicted using these features with only 58.4% accuracy. However, dominant frequency, Rpeak width and the ratio R-peak width/EGM duration were selected by automated feature selection as predictors of fibrotic areas. High scar areas could be distinguished with sensitivity: 88.9%, specificity: 90.2%, positive predictive value: 85%, negative predictive value: 86.3%. Conclusion: Fractionation, but not voltage, correlates inversely and counter-intuitively with scar content. However, scar burden can be successfully predicted using other EGM morphology features and not fractionation and voltage.

S57

10-3 Abstract 15-26 RELAXIN ACTS VIA WNT SIGNALING TO SUPPRESS ATRIAL FIBRILLATION Guy Salama 1, Guillermo Romero 1, Beth Gabris-Weber 1, Brian Martin 1 1 University of Pittsburgh, Pittsburgh, United States Background: Relaxin, a hormone of reproduction has substantial cardioprotective effects including suppression of arrhythmia by inhibiting fibrosis, upregulating the voltage gated sodium channel, Nav1.5, and increasing conduction velocity. However, the mechanisms by which relaxin increases Nav1.5 and inhibits fibrosis are largely unknown. Wnt signaling has been associated with reduced Nav1.5, increased connexin43 and β-catenin colocalization at the intercalated disk, and may be involved in activation of fibroblasts, resulting in increased collagen secretion. Objective: To test the hypothesis that relaxin’s effects are mediated by Wnt signaling. Methods: Aged (24-months) and young (9-months) male and female F-344, rats, were treated with vehicle or relaxin (400 μg/kg/day) for 14 days followed by optical mapping, RNA-seq and histology. In addition, isolated myocytes and cardiac fibroblasts were cultured without or with relaxin, TGFβ, Wnt1, Wnt3a, and/or DKK recombinant proteins for 48 h followed by immunofluorescence to measure Nav1.5, collagen and Wnt peptides. Results: Relaxin treated rats were rescued from atrial fibrillation (AF) and exhibited: ↑Wnt1 (68 and 85%) and ↓Wnt3a (56%, fourfold) expression in aged rat left ventricles. Cardiomyocytes treated with relaxin, Wnt1 or Wnt3a recombinant protein significantly ↑Nav1.5 expression in isolated cardiomyocytes by 96, 64 and 76%, respectively. Importantly, isolated myocytes treated with relaxin or Wnt1 in combination with the Wnt inhibitor, Dikkopf-1, showed significant block of relaxin and Wnt1’s effect on Nav1.5 expression. In addition to the effects of Wnt signaling in cardiomyocytes, we show that TGFβ ↑collagen secretion by fibroblasts (+3.1-fold) and that relaxin significantly blunts this effect (− 2.3-fold) and that TGFβ significantly ↓Wnt7a (60%) in fibroblasts, though Wnt7a levels were unaltered by relaxin treatment. However, TGFβ treated fibroblasts exhibit significantly reduced colocalization of Wnt7a with collagen I compared to control, which is reversed by relaxin treatment. Conclusions: These data suggest a close interplay between Relaxin and Wnt-signaling and their pleitropic i n t e r a c t i o n s m o s t l i k e l y a c c o u n t f o r R e l a x i n ’s cardioprotective actions.

S58

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

10-4 Abstract 01-28 INTERVENTRICULAR ACTION POTENTIAL D U R AT I O N R E S T I T U T I O N D I F F E R E N C E S CONTRIBUTE TO DIFFERENTIAL CYCLE LENGTHS OBSERVED DURING VENTRICULAR TACHYCARDIA Balvinder Handa 1, Saheed Lawal 1, Ian J Wright 1, Catherine A Mansfield 1, Rasheeda Chowdhury 1, Richard J Jabbour 1, Nicholas Peter 1, Fu Siong Ng 1 1 Imperial College London, London, United Kingdom Background: Interventricular differences in ventricular tachycardia (VT) rate have been reported in humans from interrogation of cardiac resynchronization therapy defibrillators, with slower rates observed in the right ventricle (RV). This has the potential to prevent implantable defibrillators from appropriately sensing and delivering therapies for VT. This phenomenon is poorly understood but we hypothesize it may be due to intrinsic interventricular differences in electrophysiological properties. Objective: To investigate the conditions that predispose to, and the mechanisms that underlie, the occurrence of interventricular differences in VT cycle lengths (CLs). Methods: Fourteen Sprague-Dawley rat hearts were explanted and Langendorff-perfused with control perfusate (n = 6) or containing 10 μM lidocaine (n = 8). Bipolar electrograms were recorded simultaneously from left ventricle (LV) and RV and optical mapping of transmembrane voltage was performed using voltage sensitive dye RH237 and excitation-contraction uncoupler blebbistatin. Data was collected during RV and LV pacing, and during VT, induced with burst pacing and short bursts of ischemia. Results: RV/LV CL discrepancy was observed during VT in both the control and lidocaine group. Lidocaine reduced the LV cycle length at which the CL discrepancy occurred (40 ± 7 vs 63 ± 4 ms; < 0.01). The average ratio of LV to RV rate in VT was greater in the lidocaine group than control (1.7 ± 0.25 vs. 1.5 ± 0.2; < 0.01). The gradient of the action potential duration restitution curve was less steep in the RV compared with LV (0.01 ± 0.03 vs 0.13 ± 0.02, p < 0.01), leading to LV-to-RV conduction block during VT (Figure). Sodium channel blockade increases the likelihood of interventricular differences in VT rate. Differences in APD restitution properties between the ventricles likely contribute to this by causing functional conduction block from the LV to RV.

10-5 Abstract 01-17 THE UPSLOPE OF THE PRECORDIAL ECG T-WAVE R E P R E S E N T S L O C A L R E P O L A R I Z AT I O N DIFFERENCES BETWEEN RIGHT AND LEFT VENTRICLE Neil Srinivasan 1, Michele Orini 1, Rui Providencia 1, Ron Simon 1, Martin Lowe 1, Oiliver Segal 1, Anthony Chow 1, Fakhar Khan 1, Peter Taggart 1, Peter Taggart 1, Pier Lambiase 1 1

Barts Heart Centre, London, United Kingdom

Introduction: The relationship between body surface ECG T-wave to intracardiac repolarization is poorly understood. The concordance of the precordial T-wave to the QRS complex is unexplained, and the reason why T-waves are positive or negative on the body surface unknown. Previous studies have focused on single repolarization gradients in the heart to explain the morphology of the T-wave, without taking into account the farfield effect within the body surface ECG. Aim: We

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

studied the relationship between intracardiac repolarization and 12-Lead ECG during cardiac restitution studies in the intact human heart. Method: Ten patients (Age 45 ± 15 years, 6 Male) with structurally normal hearts were studied. Decapolar catheters were placed in the right ventricle (RV) and lateral left ventricle (LV) to record in an apico-basal orientation, as well as a lateral LV epicardium (Epi) via a branch of the coronary sinus for transmural (TM) LV recordings. Each cathater (Epi, LV, RV) was sequentially paced using a restitution protocol. Intracardiac repolarization times (RT) were calculated as dV/dt max on the unipolar electrogram. Intracardiac repolarization time in the apico-basal, RV and LV orientations as well as TM repolarization gradients were correlated with body surface markers of the T-wave during simultaneous 12-Lead ECG recording. Results: Figure 1 demonstrates the relationship between the regional intracardiac unipolar electrograms within the heart and the surface precordial ECG in leads V1and V6. RV endocardial repolarization occurred on the upslope of the V1-V3 SECG electrogram with a sensitivity of 0.89, 0.91 and 0.84, and a specificity of 0.67, 0.68 and 0.65 respectively (Fig. 1). LV basal endocardial, epicardial and mid endocardial repolarization occurred on the upslope of V6 and I, with a sensitivity of 0.79 and 0.8, and specificity of 0.66 and 0.67 (Fig. 1). LV apical repolarization showed a poor sensitivity and specificity to the SECG. Differences between the end of the upslope in V1-3 vs V6 substantially correlated with right to left dispersion of repolarization (ICC 0.85, r 2 0.55 < 0.001) regardless of T-wave polarity (Fig. 2A). Tpeak-Tend showed poor correlation to dispersion of repolarization in the major anatomical axes (Fig. 2B). Poor association between the T-wave to apicobasal and transmural dispersion of repolarization was seen (Fig. 2C). Conclusions: The SECG T-wave in leads V1-3 and V6 reflects regional repolarization differences between right and the left heart. The upslope of the body surface T-wave represents local repolarization of the nearby tissue, and thus positive T-wave represent early local repolarizaton, while negative T-wave represent later local repolarization. These findings have important implications for accurately modelling repolarization & identifying biomarkers of arrhythmogenic risk in disease.

S59

10-6 Abstract 17-18 NITROCELLULOSE CARBON NANOTUBE BIOINK IMPROVES CONDUCTION WHEN DIRECTLY INJECTED INTO INFARCTED MYOCARDIUM Dawn Pedrotty 1 , Erdem Karabulut 2 , Alan Sugrue 3 , Christopher Livia 3, Vaibhav Vaidya 3, Christopher McLeod 3 , Paul Gatenholm 2, Suraj Kapa 3 1 University of Pennsylvania, Philadelphia, United States, 2 Chalmers University, Gotenberg, Sweden, 3 Mayo Clinic College of Medicine, Rochester, United States Background: Current therapies for substrate-related ventricular arrhythmias (VT) include ablation or antiarrhythmic drugs targeted at altering conductive properties, disrupting slow conducting circuits, or homogenizing tissue. Injectable conductive compounds that restore/homogenize conduction through infarcted myocardium may provide a novel personalizable

S60

therapy for treatment of VT. Methods: Four canine hearts were evaluated in an ex vivo Langendorff setup. Prior studies have shown hearts can be maintained up to 8 h with stable electrical and mechanical function (unpublished). A CARTO electroanatomic mapping (EAM) system was utilized to map the epicardial ventricular surface. Then radiofrequency ablation was used to create epicardial lesions, delivering 30–45 W of energy for 60 s each. EAM was again performed in the same region to evaluate conduction by isochronal mapping. A conductive nitrocellulose carbon nanotube bioink was then injected parallel to the ventricular surface in different planes and EAM was performed again. Finally, gross histology to evaluate distribution of the bioink was obtained. Results: In four canine hearts, initial isochronal maps demonstrated sequential myocardial activation (Figure). Upon creation of radiofrequency lesions, isochronal mapping suggested a shift in direction of activation, with activation front running around the infarcted site and colliding distal to the lesion. After injection of conductive bioink, isochronal mapping suggested similar sequential myocardial activation to baseline, with wider isochrones through region of injection suggesting more rapid activation here. Histology demonstrated distribution of bioink throughout the infarcted region. Conclusion: This proof-of-concept study demonstrates conductive nitrocellulose carbon nanotube bioink can be directly injected into infarcted ventricular myocardium and restore conduction in that area. Biocompatibility and chronic experiments are needed to assess if direct injection is feasible for long term applications.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

CELL-SPECIFIC ABLATION FOR CARDIAC ARRHYTHMIAS Jerome Kalifa 1 Brown University, Providence, United States

1

Introduction: Regional myocardial ablation enabled by radiofrequency or other energies is currently the main treatment modality for drug-refractory arrhythmias. However, the highly unspecific nature of current ablation methodologies is responsible for unnecessary injury to cardiac or peri-cardiac tissue, thus severely hampering ablation safety and efficacy. Photodynamic therapy (PDT) has been extensively studied for treating cancerous cells. In PDT, after activation by light, photosensitizer agents transfer energy to oxygen molecules and generate reactive oxygen species which induce cell death exquisitely confined to the photosensitized cells, while adjacent, non-photosensitized cells are spared. Here, we have implemented in pre-clinical models a cell-targeted, photodynamic therapy (PDT), so as to achieve non-thermal cardiomyocyte-specific PDT. Methods and Results: Preliminary invitro and in-vivo experiments were performed with the photosensitizer chlorin-e6 (Ce6) and a recently developed myocyte-targeting moiety, the cardiac targeting peptide (CTP), which we conjugated to a star-shaped 8-arm polyethylene-glycol supra-molecule nanoplatform (just 6 nm in size). We show that in-vivo MSPDT photo-ablation in sheep enables the formation of a complete electrical block across the regions ablated. In order to achieve the same electrophysiological outcome, non-specific PDT, RF and HPL lesions generate extensive tissue damage. Then, we have examined the mechanisms of post-ablation tissue remodeling after MSPDT photo-ablation. Preliminary results indicate that, in cardiomyocytes, low levels of laser energy trigger cell apoptosis, while higher energy levels cause necrosis. Conclusions: MSPDT allows a dually modulated ablation: the cell-selective targeting of cardiomyocytes only, as well as the modulation of the mechanism of cell death towards apoptosis. Our preliminary results indicate that such myocyte-specific PDT (MSPDT) is a potentially safer alternative to current ablation approaches, including radio-frequency and non-specific PDT. 11-2 Abstract 15-30

Abstract Oral Session 11: Cardiac arrhythmia mechanisms Monday April 16, 2018, 10:30 am–12:00 pm ROOM REMBRANDT 11-1 Abstract 05-15

CHARACTERIZATION OF LOCALIZED DRIVERS T H AT P L AY A M E C H A N I S T I C R O L E I N PERSISTENT ATRIAL FIBRILLATION Shohreh Honarbakhsh 1 , Richard J Schilling 1 , Rui Providencia 1, Emily Keating 1, Simon Sporton 1, Martin Lowe 1, Anthony Chow 1, Mark J Earley 1, Ross J Hunter 1 1 Barts Heart Centre, Barts Health NHS trust, London, United Kingdom

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Background: The mechanistic role of local drivers in persistent atrial fibrillation (AF) remains unclear. Purpose of the study was to characterize drivers in persistent AF. Methods: Patients undergoing catheter ablation for persistent AF were included. Unipolar signals were recorded with a 64-pole basket catheter and analyzed by the CARTOFINDER system to identify local drivers with rotational (≥ 1.5 rotations of 360°) or focal activity (focal with radial activation over ≥ 2 consecutive wavefronts). Ablation effect on drivers identified post-PV isolation (PVI) was assessed. The sites of drivers with an ablation response were correlated to sites of fastest cycle length (CL), highest dominant frequency (DF) and greatest organization using lowest CL variability and regularity index (RI) as surrogates. The temporal stability and recurrence rate of these drivers were assessed. The PVI effect on AF CL and driver characteristics was measured. Results: Thirty patients were included in the study with 154 CARTOFINDER maps created. Forty-four potential drivers were mapped in 29/30 patients with AF with a pre-defined ablation response achieved in 39 drivers (89%): 19 drivers CL prolongation ≥ 30 ms in 19, organization to atrial tachycardia in 10 and termination to sinus rhythm in 10. Out of the 39 drivers, 23 were rotational and 16 were focal. The drivers demonstrated spatial stability with temporal periodicity with no driver demonstrating a consecutive repetition of BB6. CL stability correlated best with driver sites, with 29 out of 39 confirmed drivers (74%) occurring at the site of least CL variability. Fastest CL and highest DF correlated to driver sites where drivers showed greater temporal stability and higher recurrence rate. Drivers with rotational activity showed a predilection to low voltage zones (LVZs) (74%) whilst focal drivers did not (56%). PVI did not impact AF CL (142 ± 25 ms pre-PVI vs. 146 ± 26 ms post-PVI; p = 0.68). PVI did not influence driver recurrence rate during 30s recordings (8.4 ± 4.8 pre-PVI vs. 8.5 ± 5.5 post-PVI; p = 0.89) or temporal stability (3.0 ± 0.7 pre-PVI vs. 3.1 ± 0.9 post-PVI; p = 0.90). PVI also did not impact the CL, DF, CL variability and RI at the driver site. Conclusions: Drivers were identified in almost all patients in the form of intermittent but repetitive focal or rotational activation patterns. The mechanistic importance of these phenomena was confirmed by the response to ablation. Sites of greater organization can be used as potential surrogates for driver sites. PVI did not impact driver characteristics suggesting that these are independent phenomenon.

S61

Introduction: CARTOFINDER is a novel mapping system developed to generate dynamic wavefront maps using local activation times with no need for a fixed reference. This study sought to validate it in terms of mapping (1) atrial-paced beats and (2) complex wavefront patterns in AT. Methods: Patients undergoing catheter ablation for AT and persistent AF were included. A 64-pole-basket catheter was used to acquire unipolar signals which were processed by CARTOFINDER. The LA was paced from four sites to demonstrate focal activation. ATs were mapped with the mechanism confirmed by conventional mapping, entrainment and ablation response. All maps were reviewed by two independent blinded observers to ensure pacing site and AT mechanism could be confirmed. Results: Twenty-two patients were included in the study (16 ATs and 6 AFs who terminated to AT during ablation) with 172 CARTOFINDER maps created. It correctly identified all atrial-pacing sites and manual analysis confirmed that poles closest to the pacing sites showed earliest activation. The CARTOFINDER system accurately mapped 9 focal/micro-reentrant and 18 macro-reentrant ATs both in the left and right atrium. Figure 1A-D: Still CARTOFINDER maps (AC) that show a focal AT mapped to the LA septum in an area of low voltage zone as per the voltage map (D). Eliciting a diagnosis from the CARTOFINDER maps took 2.3 ± 0.4 min whilst doing so from a conventional local activation map took 9.0 ± 3.3 min (< 0.001). The two observers identified all the atrial pacing sites and AT mechanisms from the CARTOFINDER maps whilst being blinded to the conventional activation maps. Conclusions: The system was effectively validated by mapping focal activation patterns from atrial-paced beats and mapping complex wavefront patterns in a range of ATs. The system may therefore be of practical use in the ablation of AT and could have potential for mapping wavefront activations in AF.

11-3 Abstract 14-11 11-4 Abstract 17-25 VALIDATION OF A NOVEL MAPPING SYSTEM AND UTILITY FOR MAPPING COMPLEX ATRIAL TACHYCARDIAS Shohreh Honarbakhsh 1, Richard J Schilling 1, Gurpreet Dhillon 1, Rui Providencia 1, Emily Keating 1, Anthony Chow 1, Mark J Earley 1, Ross J Hunter 1 1 Barts Heart Centre, Barts Health NHS trust, London, United Kingdom

NEGATIVE ALLOSTERIC MODULATION OF SMALL-CONDUCTANCE CALCIUM-ACTIVATED P O TA S S I U M C H A N N E L S D U R I N G A C U T E MYOCARDIAL INFARCTION IN A PORCINE MODEL Anniek Frederike Lubberding 1, Stefan M. Sattler 2, Shaida Panbachi 1, Morten Grunnet 3, Jacob Tfelt-Hansen 2, Thomas Jespersen 1

S62 1

Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 2 Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 3 Acesion Pharma, Copenhagen, Denmark Background: Acute myocardial infarction (AMI) causes electrophysiological imbalance, leading to ventricular fibrillation (VF) and sudden cardiac death. Small conductance Ca2+ activated K+ (SK) channels are not involved in ventricular repolarization under physiological conditions, but in heart failure and chronic MI SK current is increased. AMI is associated with increased intracellular calcium which could potentially lead to SK channel activation. Recently, we demonstrated reduced arrhythmic load in AMI rats treated with SK blocker. The aim of this study was to assess the effect of two negative allosteric modulators of SK channels on arrhythmia development in AMI in a porcine model. Methods: Twenty-Four Danish Landrace pigs of 50 kg were anesthetized and randomized 1:1:1 into treatment with NS8593, AP14145 or vehicle. Electrocardiogram (ECG), blood pressure (BP) and monophasic action potentials (MAP) were recorded continuously and cardiac output (CO) was measured every 15 min. A percutaneous coronary intervention balloon was placed in the mid-left anterior descending artery using angiography. Blinded treatment infusion was started 10 min prior to occlusion and continued until 30 min after. NS8593 and AP14145 plasma concentrations were analyzed in two pigs each. Occlusion was maintained for 60 min, followed by 120 min of reperfusion. Results: Plasma concentrations of NS8593 and AP14145 were stable during infusion. Upon occlusion, CO dropped similarly in all groups, while BP dropped with vehicle and NS8593, but slightly increased with AP14145. The ECG revealed increased RR interval in the NS8593 group, but stable PQ and QT intervals in all groups. Immediately upon occlusion, QRS duration increased in all groups, but significantly more in the AP14145 group (vehicle 17 ± 7%, NS8593 18 ± 6%, AP14145 30 ± 12%; < 0.05). Non-infarct MAPs were stable, while infarct MAPs shortened similarly in all groups (vehicle – 24 ± 4 ms, NS8593 – 29 ± 7 ms, AP14145 – 26 ± 5 ms; < 0.05). VF developed in 3/8 vehicle-, 1/8 NS8593- and 3/8 AP14145-treated pigs (< 0.05). Tachyarrhythmias were rarely observed. All groups experienced a similar number of premature ventricular contractions (PVCs) in the first 10 min of occlusion (vehicle 56 ± 17, NS8593 72 ± 26, AP14145 45 ± 9 PVCs; < 0.05). Conclusion: While treatment with NS8593 and AP14145 had some effects on BP and the ECG, we did not observe any alterations in MAP duration. However, MAPs were recorded unpaced, making heart rate a possible confounder. Arrhythmic incidence, including VF, tachyarrhythmias and PVCs, was comparable in all groups, suggesting that

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

negative modulation of SK channels is neither beneficial nor detrimental in the setting of AMI. 11-5 Abstract 15-38 APPLICATION OF A NOVEL SILICON RHODAMINE BASED VOLTAGE SENSITIVE DYE FOR LONGTERM MAPPING OF COMPLEX CONDUCTION AND FIBRILLATION David S. Pitcher 1, Rasheda A. Chowdhury 1, Gloria Ortiz 2, Steven Boggess 2, Evan W. Miller 2, Prapa Kanagaratnam 1, Fu Siong Ng 1, Nicholas S. Peters 1 1 Imperial College London, London, United Kingdom, 2 University of California, Berkeley, California, United States Introduction: Low spatial resolution of clinical conduction maps makes it hard to elucidate arrhythmogenic mechanisms. Optical mapping of slice and cellular electrophysiology has allowed us to probe cardiac conduction in much greater resolution down to a subcellular level and correlate these conduction patterns with the substrate at a microscopic level. Di-8-/ Di-4-ANNEPS Voltage Sensitive Dyes (VSDs) developed in the mid-1980s are still favoured and widely used in the cardiac field. A number of published limitations have shown that these VSDs are not electrophysiologically inert. These findings make it difficult to map spatio-temporally unstable arrhythmias which require long periods of illumination. The VSD BeRST1, boasts greater photostability, lower toxicity, lower membrane internalisation and 24% ΔF/F. However, it has not been characterised in cardiac myocytes. Methods: Monolayers (4–5 mm) of neonatal rat ventricular myocytes (NRVMs) were stained with Di-8-ANNEPS or BeRST1 and illuminated with their corresponding Ex.-LED at 70% intensity for 10 min. Every minute, a 5-s recording was taken at 1000 FPS. Analysis of action potential (AP) morphology, AP duration, upstroke duration and bleaching were calculated. Results: A mixture of cytotoxic and phototoxic effects were seen within the first minute with Di-8-ANNEPS causing variation in AP morphology (Fig. A) with a mean SEM of 6.61% (Fig. C). In comparison, BeRST1 showed little variance in AP morphology (Fig. B) with a mean SEM of 2.73% (Fig. C). Continuous recording lead to catastrophic blebbing (like that shown in Fig. D) at around 1 min illumination with Di-8ANNEPS and 8 min with BeRST1. Conclusion: Di-8ANNEPS and other members of the ANNEPS family shows toxicity to cells, variance in AP morphology, slow upstroke kinetics and strong florescence bleaching. In comparison, the newly developed BeRST1 showed a high level of reproducibility and low cytotoxicity allowing for recordings around 8× longer than that of Di-8-ANNEPS. The ability to record for longer allows successful mapping of spatio-temporally unstable arrhythmias.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S63

of AT and AF were analyzed using CARTOFINDER system. Results: Twenty-five patients were included (14 AT and 11 AF). CV at 600 ms was 1.59 ± 0.14 and 0.97 ± 0.22 m/s in non-LVZs and LVZs respectively (< 0.001) with a positive correlation seen with bipolar voltage (R = 0.97, < 0.001). CV dynamics were different in non-LVZs ≥ 0.5 mV, LVZs [0.2–0.5 mV] and LVZs [0–0.2 mV] as shown in Fig. 1. RD-CV slowing sites were predominantly in LVZs (0.2–0.5 mV, 82.1 ± 15.3%; < 0.001) and more frequent in patients with a lower mean bipolar voltage (R = − 0.91, < 0.001). In the 14 AT patients, 16 ATs were ablated with 6 having a micro-reentry mechanism. In the 11 AF patients, ablation effect at 15 of 18 plausible drivers met study criteria of a confirmed driver (n = 11 rotational and n = 4 focal). Confirmed driver sites for micro-reentrant ATs and AF were mapped to RD-CV slowing sites in 81.8% of cases (sensitivity 81.8% and specificity 82.4%). Conclusions: Heterogeneous CV dynamics is more marked with greater proportion of LVZs where RD-CV slowing is more commonly identified. The correlation between abnormal CV dynamics and drivers of AF highlight a potential role for substrate modification in AF management.

11-6 Abstract 15-48 STRUCTURAL REMODELING AND CONDUCTION VELOCITY DYNAMICS IN THE HUMAN LEFT ATRIUM: RELATIONSHIP WITH REENTRANT M E C H A N I S M S S U S TA I N I N G AT R I A L TACHYCARDIA AND ATRIAL FIBRILLATION Shohreh Honarbakhsh 1, Richard J Schilling 1, Michele Orini , Rui Providencia 1, Emily Keating 1, Martin Lowe 1, Simon Sporton 1, Malcolm Finlay 1, Anthony Chow 1, Mark J Earley 1 , Ross J Hunter 1 1 Barts Heart Centre, Barts Health NHS trust, London, United Kingdom 1

Background: Rate-dependent (RD)-conduction velocity (CV) slowing is associated with AF initiation and reentry mechanisms. Study purpose was to establish the relationship of CV dynamics to bipolar voltage and atrial arrhythmia drivers. Methods: Patients undergoing catheter ablation for AT and persistent AF were enrolled. Unipolar signals were recorded with a basket catheter during atrial pacing at four pacing intervals (PI) (250, 300, 450, and 600 ms). CV dynamics were measured between pole pairs along wavefront path and correlated to underlying bipolar voltage. Heterogeneity within LVZs and non-LVZs, were identified as RD-CV sites where CV reduction was ≥ 20% of the mean CV reduction between 600 and 250 ms for that voltage zone. The relationship between RD-CV slowing sites and drivers

Abstract Oral Session 12: Atrial fibrillation ablation 3: Technical aspects and results Tuesday April 17, 2018, 08:30 am–10:00 am ROOM DAMES 12-1 Abstract 04-12 THE ET-GP STUDY: ABLATION OF ECTOPYTRIGGERING GANGLIONATED-PLEXI WITHOUT PULMONARY VEIN ISOLATION AS A THERAPY FOR PAROXYSMAL ATRIAL FIBRILLATION Belinda Sandler 1, Markus Sikkel 1, Min Young-Kim 1, Fu Ng 1 , Ian Mann 1, Hanney Gonna 1, Amy Roberts 2, Dejana

S64

Martic 2, Michael Koa-Wing 1, Norman Qureshi 1, Zachary Whinnett 1, Wyn Davies 1, Nicholas Peters 1, Nick Linton 1, Boon Lim 1, Prapa Kanagaratnam 1 1 Imperial College London, London, United Kingdom, 2 Watford General Hospital, Watford, United Kingdom Background: High-frequency stimulation (HFS) delivered within the myocardial refractory period enables isolated neural stimulation without myocardial capture. There are presumed ganglionated plex sites (GP) in the left atrium that reproducibly trigger atrial ectopy and fibrillation. It is not known if these ectopy-triggering GP sites (ET-GP) have a role in the pathogenesis of atrial fibrillation (AF). In order to address this, we conducted a prospective, randomised, blinded, feasibility study of ET-GP ablation (without pulmonary vein isolation (PVI)) versus PVI. Methods: Patients undergoing ablation for paroxysmal AF were recruited. Patients randomised to ET-GP ablation had a left atrial geometry created and a Smart-Touch™ catheter was used to deliver HFS of 15 V at 40 Hz for 120 ms post-pacing spike (refractory period) at fixed rate pacing. Simultaneously, a multi-electrode circular catheter, in the nearest PV, was monitored for ectopy. Point-bypoint mapping was used to locate all ET-GP sites. Standard RF settings were used to ablate the ET-GP sites with confirmation that ectopy triggering was abolished. Patients randomised to PVI had a standard circumferential PV ablation with confirmation of PV electrical isolation. The primary endpoint was recurrent atrial arrhythmia lasting BB 30 s after 8-week blanking period. Results: Sixtyeight patients were recruited, and 39 patients were randomised to ET-GP ablation, with the protocol completed in 31 patients. Crossover to PVI was due to recurrent AF precluding further mapping. Thirty-seven patients in total underwent PVI. Groups were comparable in terms of age, sex and CHA2DS2Vasc scores. In the ET-GP group, 101 ± 20 left atrial sites were tested per patient in 89 ± 21 min to identify 23 ± 6 ET-GP sites per patient. Ablation and retesting of these ET-GP sites took 52 ± 24 mins compared to 68.3 ± 23 min for PVI with RF energy delivered in the ET-GP groups (22 ± 15 versus 54 ± 21 kWs). Resting heart rate and QTc were measured pre-ablation and 24 h post ablation in both groups and there was prolongation of QTc in the PVI arm (442 vs 451 ± 30.8 ms, p = 0.05), with all other parameters being unchanged. Freedom from BB 30 s of atrial arrhythmias on Holter analysis occurred in 19/31 (61%) in the ET GP arm and 23/37 (57%) in the PVI arm at mean follow up 9.1 ± 4.4 months. Conclusion: ET-GP ablation achieves similar outcomes to PVI with less tissue injury implying it is a more specific target for AF ablation.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

12-2 Abstract 04-15 ABLATION OF THE GANGLIONATED PLEXUS TERMINATES SUSTAINED ATRIAL FIBRILLATION Min-young Kim 1, Belinda Sandler 1, Markus Sikkel 1, Afzal Sohaib 2, Louisa Malcolme-Lawes 2, Kevin Leong 2, Vishal Luther 2, Michael Koa-Wing 2, Zachary Whinnett 2, Fu Siong Ng 2, Norman Qureshi 2, Nicholas S Peters 1, Wyn Davies 2, Elaine Lim 2, Michael Fudge 2, Michelle Todd 2, Ian Wright 2, Nick W F Linton 1, Phang Boon Lim 1, Prapa Kanagaratnam 1 1 Imperial College London, London, United Kingdom, 2 Imperial College NHS Trust, London, United Kingdom Background: Classical electrophysiological studies involve inducing a tachycardia to prove mechanism, ablating the target and then confirming non-inducibility. This has not been the case in atrial fibrillation (AF) as the mechanisms are not known. We postulated that ablation of ectopy-triggering ganglionated plexus (ET-GP) that trigger AF would also terminate AF, thus proving their role in the pathophysiology of AF. We sought to determine whether sustained AF triggered by high frequency stimulation (HFS) at a GP site can be terminated by ablation of GPs. Methods: Patients with paroxysmal AF were recruited and underwent left atrial mapping for ET-GP with bursts of HFS within the local refractory period at each site. An ET-GP was defined as any response that triggered ectopy or atrial arrhythmia (Fig1A). Any ET-GP that triggered AF which sustained for BB 2 min was either cardioverted or underwent ET-GP ablation (Fig. 1B). Results: Forty-three patients were studied. ET-GP mapping triggered sustained AF in 26/43 (60%). Then, 14/26 (54%) patients went directly to external DC cardioversion (DCCV), of whom 6/14 (43%) had incessant AF resistant to DCCV. The subsequent 12 patients underwent ET-GP ablation and 10/12 (83%) reverted to sinus rhythm (ET-GP ablation alone or with additional cardioversions). Further, 2/12 (17%) patients remained in incessant AF. Ablated ET-GP sites that terminated AF were retested and did not induce further ectopy or AF. Conclusion: For the first time, we have demonstrated that AF triggered and sustained by ET-GP stimulation can be ablated to terminate AF and restore sinus rhythm. This is a compelling finding that ET-GP contributes to the autonomic activity in the triggering and maintenance of AF.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S65

12-3 Abstract 04-13

12-4 Abstract 18-26

NEURO-SPECIFIC STIMULATION OF THE LEFT ATRIAL GANGLIONATED-PLEXI SITES REVEALS TRIGGERING PATTERNS SIMILAR TO HOLTER RECORDINGS

ATRIAL FIBRILLATION ABLATION USING VERY S H O RT D U R AT I O N 5 0 W A B L AT I O N S A N D CONTACT FORCE SENSING CATHETERS

1

1

1

Belinda Sandler , Markus Sikkel , Chris Cantwell , Rheeda Ali 1, Hanney Gonna 1, Min Young-Kim 1, Ian Mann 1, Fu Ng 1 , Michael Koa-Wing 1, Norman Qureshi 1, Zachary Whinnett 1 , Wyn Davies 1, Nicholas Peters 1, Nick Linton 1, Boon Lim 1 , Prapa Kanagaratnam 1 1 Imperial College London, London, United Kingdom Background: Holter recordings, in patients with paroxysmal atrial fibrillation (AF), can show a range of atrial activity including: single ectopic, repetitive ectopy, self-terminating AF and sustained AF. It is not known why this variation occurs, though autonomic causes are often suggested. A short burst of high output HFS (high-frequency stimulation) can be used to study the specific effects of neural stimulation without myocardial capture, by timing the burst to coincide with the local refractory period. Methods: Patients undergoing ablation for paroxysmal AF were studied. A left atrial geometry was created (CARTOTM) and a Smart-Touch™ catheter used to deliver HFS during fixed rate atrial pacing, 15 V for [pulse width] at 40 Hz for 120 ms following the pacing stimulus. Multi-electrode catheters were positioned in the nearest pulmonary vein and in the coronary sinus. Results: The left atrium was mapped in 34 patients. Eight developed incessant AF (resistant to cardioversion) and one had a corrupted data file. Data from the remaining 25 patients was analysed. A mean of 104 ± 22 sites were tested in each patient. The total number of ganglionated plexi (GP) sites with atrial activity triggered was 527 (17% of 3043) with a mean of 22 per patient (range 6 to 41). A total of 527 GP sites triggered atrial activity. At 63/527 (12%) of sites, a sustained atrial arrhythmia was induced lasting BB 30 s. This included repetitive organized activity consistent with an atrial tachycardia as well as more disorganized activation typical of AF. These atrial arrhythmias selfterminated (after BB 30 s) at 46/527 (9%) sites. The AF/AT induced at the remaining 17/527 (3%) required cardioversion or overdrive pacing to restore sinus rhythm. Then, 464/527 (88%) sites triggered repetitive atrial activity for BB 30 s, of which 225/527 (43%) were BB 3 ectopic beats. Conclusion: We demonstrate for the first time that in patients with paroxysmal AF, the majority of GP sites trigger ectopy and nonsustained atrial arrhythmias. A minority of GP sites trigger sustained atrial arrhythmias. Importantly, there also appear to be some sites where GP stimulation can trigger incessant AF resistant to cardioversion. Neuro-specific stimulation of the left atrial GPs can replicate common findings on Holter recording of patients with paroxysmal AF.

Roger Winkle 1, Ryan Moscovitz 2, R. Hardwin Mead 1, Gregory Engel 1, Melissa Kong 1, William Fleming 1 , Jonathan Salcedo 1, Rob Patrawala 1, John Tranter 2, Isaac Shai 2 1 Silicon Valley Cardiology, Palo Alto, United States, 2 Abbott Medical, St. Paul, United States Purpose: The optimal radiofrequency (RF) power and lesion duration using contact force (CF) sensing catheters for atrial fibrillation (AF) ablation is unknown. We evaluate 50 W RF power for very short durations using CF sensing catheters during AF ablation. Methods: We evaluated 51 patients with paroxysmal (n = 20) or persistent (n = 31) AF undergoing initial RF ablation. Results: A total of 3961 50 W RF lesions were given (average 77.6 + 19.1/patient) for an average duration of only 11.2 + 3.7 s. As CF increased from BB 10 g to BB 40 g, the RF application duration decreased from 13.7 ± 4.4 to 8.6 ± 2.5 s (< 0.0005). Impedance drops occurred in all ablations and for patients in sinus rhythm there was loss of pacing capture during RF delivery suggesting lesion creation. Only 3% of ablation lesions were at BB 5 g and 1% at BB 40 g of force. As CF increased, the force time integral (FTI) increased from 47 ± 24 to 376 ± 102 g (< 0.0005) and the lesion index (LSI) increased from 4.10 ± 0.51 to 7.63 ± 0.50 (< 0.0005). Both procedure time (101 + 19.7 min) and total RF energy time (895 ± 258 s) were very short. For paroxysmal AF, the single procedure freedom from AF was 86% at 1 and 2 years. For persistent AF, it was 83% at 1 year and 72% at 2 years. There were no complications. Conclusions: Short duration 50 W ablations using CF sensing catheters are safe and result in excellent long-term freedom from AF for both paroxysmal and persistent AF with short procedure times and small amounts of total RF energy delivery.

S66

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

12-5 Abstract 15-58

12-6 Abstract 18-35

PERIOPERATIVE OUTCOMES AND SAFETY OF ATRIAL FIBRILLATION CATHETER ABLATION IN C A N C E R PAT I E N T S : A S I N G L E C E N T R E EXPERIENCE

CRYOABLATION FOR PERSISTENT AND LONG STANDING PERSISTENT ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE

1

2

1

Michela Giustozzi , Hussam Ali , Giancarlo Agnelli , Riccardo Cappato 2 1 Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy, 2 Humanitas University, IRCCS Humanitas Research Hospital, Milano, Italy Introduction: The management of atrial fibrillation (AF) in cancer patients remains a critical issue. Catheter ablation of AF is commonly performed in patients with AF to prevent recurrent AF. However, there are no data available in patients with cancer and AF undergoing catheter ablation. The aim of our study was to evaluate the safety of catheter ablation in patients with cancer. Methods: Consecutive patients undergoing catheter ablation at our center for nonvalvular AF from March 1st, 2015 through March 31th, 2017 were retrospectively analyzed. Hazard ratios (HR) for perioperative outcomes in patients with cancer undergoing AF ablation were estimated. Results: Overall, 192 patients were included in the study. Of them, 22 patients (11.4%) had cancer (9.4% with a history of cancer and 2.0% with active cancer). Sites of cancer more frequent were gastrointestinal 36.4%, breast 22.7% and genitourinary 18.2%. The mean CHA2DS2-Vasc score was 2.8 ± 1.5 and 1.44 ± 1.4 (p = 0.23) and the mean HAS-BLED score was 1.1 ± 1.0 and 0.7 ± 0.8 (p = 0.05) in cancer and non-cancer patients, respectively. Mean age, hypertension, diabetes, previous bleeding or predisposition and mean BMI were significantly higher in cancer patients compared to non-cancer patients. During the hospital stay, the composite endpoint of thromboembolic events and bleedings occurred in five cancer patients (22.7%) and in nine noncancer patients (5.3%) (HR = 4.661, 95% CI 1.659– 16.877). After adjustment, the rates of major bleedings were higher in cancer compared to non-cancer patients (9.1 vs 3.5%, HR = 6.396, 1.049–29.882). One thromboembolic event (transient ischemic attack) occurred in one patient with cancer and in none of non-cancer patients. Both perioperative adverse events (AE) and recurrence of AF during hospital stay were more frequent in cancer patients (HR for AE = 4.233, 95% CI 0.693–9.378; HR for recurrence AF = 2.489, 95 % CI 1.052–6.791). None of such events required emergency treatment. Conclusions: The prevalence of patients with cancer undergoing catheter ablation of AF is not negligible. Perioperative thromboembolic and bleeding events were significantly higher in cancer patients compared to non-cancer patients.

Vinit Sawhney 1, Dhanuka Perera 1, Salman Chatha 1, Luisa Baca 1, Matthew Cadd 1, Rangeena Assadi 1, Pier Lambiase 1, Syed Ahsan 1, Anthony Chow 1, Martin Lowe 1, Mehul Dhinoja 1, Malcolm Finlay 1, Simon Sporton 1, Mark Earley 1, Richard Schilling 1, Ross Hunter 1 1 Barts Heart Centre, London, United Kingdom Background: Pulmonary vein isolation using the cryoballoon is an effective treatment option for patients with atrial fibrillation (AF). Although it is well established in the treatment of paroxysmal AF, the role of cryoablation in persistent AF remains unknown. We examined the procedural success and long-term outcomes of cryoablation in persistent AF and long standing persistent AF. Methods: A prospective single centre registry of consecutive patients undergoing cryoablation for persistent AF was analysed. All procedural data, complications and follow up were prospectively recorded. Patients were followed up at 3, 6 and 12 months with an ECG with open access to arrhythmia nurse specialists thereafter. Ambulatory monitoring was dictated by symptoms. Results: Over 28-month period, 251 patients underwent ablation with the cryoballoon for persistent AF. Sixty-six percent were male with a mean age of 63 ± 13 years. Two hundred four (81%) had persistent AF (BB 1 year duration) and 47 (19%) had long standing persistent AF (BB 1 year). Acute procedural success (defined as pulmonary vein isolation using the cryoballoon alone) was 98%. Major complications were seen in four (1.6%) patients (two tamponades, one phrenic nerve palsy and one haematoma). Mean procedure time was 74 ± 34 min and fluoroscopy time was 10 ± 9 min. Over a follow-up of 1.7 ± 0.5 years, the single procedure success rates were 114/177 (64%) for persistent AF and 17/27 (62%) for longstanding persistent AF. The rate of repeat procedures was 31/177 (18%) for persistent AF and 9/27 (33%) for longstanding persistent AF. Conclusions: Cryoablation for persistent AF is safe, fast and has good outcomes at 1-year follow-up. Cryoablation is reasonable as a first line option for patients with persistent AF and longstanding persistent AF. The short procedure time may help increase capacity of cardiac units to help meet the rising demand for AF ablation. Randomized controlled trials are needed to compare outcomes with different techniques.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Abstract Oral Session 13: Non-ablative treatment of atrial fibrillation Tuesday April 17, 2018, 08:30 am–10:00 am ROOM DEBARCADERE 13-1 Abstract 15-59 CURRENT PRACTICE OF ANTITHROMBOTIC T R E AT M E N T I N PAT I E N T S W I T H AT R I A L FIBRILLATION: DATA FROM THE GERMAN ATRIAL FIBRILLATION NETWORK (AFNET) REGISTRY 2 ON BEHALF OF AFNET GERMANY Andrea Gerth 1, Michael Nabauer 1, Paulus Kirchhof 2, Gerhard Steinbeck 3, Günter Breithardt 4 1 University of Munich, Munich, Germany, 2 College of Medical and Dental Science, Institute of Cardiovascular Sciences, Birmingham, United Kingdom, 3 Zentrum für Kardiologie am Klinikum Starnberg, Starnberg, Germany, 4 Department of Cardiovascular Medicine, University Hospital, Münster, Germany Background: Oral anticoagulation is recommended for patients with atrial fibrillation and stroke risk factors. The purpose of this analysis was to assess patterns of antithrombotic treatment and to investigate factors associated with use of either vitamin K antagonists (VKA) or non-vitamin K oral anticoagulants (NOAC) in a real-world cohort. Methods: The German AFNET Registry 2, a prospective multi-center registry on atrial fibrillation, enrolled a total of 3485 patients from all levels of medical care (general practitioners, cardiologists, hospitals) from 05/2014 to 03/2016. The registry was conducted within the EORP framework. Results: The study population consisted of 3396 patients (59.8% male). Mean age was 72.8 ± 9.6 years, CHA2DS2-VASc 3.7 ± 1.7, HAS-BLED 1.7 ± 1.0. A total of 92.6% patients were treated with oral anticoagulants (OAC; with or without antiplatelet therapy), 3.0% received antiplatelets only, and 4.4% no antithrombotic medication. Of patients on anticoagulation, 52.5% received VKA and 47.5% NOACs at discharge. By univariate comparison, patients on VKA were older (74.4 ± 8.4 vs 72.8 ± 9.9 years, < 0.001), had more coronary artery disease (31.5 vs 25.9%, p = 0.006), more valve disease (53.1 vs 44.2%, < 0.001). CHA2DS2-VASc score and HASBLED score were higher in patients on VKA than in patients on NOAC (VKA: 3.8 ± 1.7 and 1.9 ± 1.0, NOAC: 3.6 ± 1.8 and 1.5 ± 1.0, < 0.001 respectively). Using logistic regression analysis, NOAC use was associated with nonpermanent forms of AF, previous thromboembolic events, previous intracranial bleeding, and an eGFR of 30–60 ml/ min. Predictors of use of VKA were an increased bleeding risk as judged by the HAS-BLED score and an eGRF below

S67

15 ml/min. The CHA2DS2-VASc score had no significant association with the use of either VKA or NOAC. Conclusions: Anticoagulant use in Germany in patients with AF has significantly increased with now the vast majority of AF patients receiving oral anticoagulation. However, in this cross-sectional analysis, the preferential prescription of VKA to patients with higher overall bleeding risk suggests that NOACs are not yet used to their full potential given their improved risk-benefit ratio in comparison to VKA as well as the recommendations in the current ESC guidelines. Note: The AFNET Registry 2 is conducted in the EORP Framework of the ESC. Financial Support was obtained from Bristol-Myers-Squibb Germany, Pfizer Germany, and the DZHK. AFNET: Atrial Fibrillation NETwork e.V., Mendelstrasse 11, 48149 Munster. 13-2 Abstract 15-35 MANAGEMENT OF LEFT ATRIAL APPENDAGE THROMBUS DESPITE OF DIRECT ORAL ANTICOAGULANTS Osama Alshoubaki 1, Jean-Benoît le Polain de Waroux 1, Sebastien Marchandise 1, Christophe Scavee 1 1 Cliniques Universitaires St. Luc, Brussels, Belgium Background: The appropriate anticoagulation approach to left atrial appendage (LAA) thrombus formation in atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) is still unanswered question. Therefore, we aimed to describe the result of different anticoagulation strategies of LAA thrombus in one center. Method: In this retrospective analysis, a total of 28 out 2450 AF patients on DOAC who were scheduled for electrical cardioversion (EEC) or ablation were proven to have LAA thrombus by transesophageal echocardiography (TEE) between March 2013 and October 2017 in our center. Four patients were excluded because of non-compliance. Patients were divided into two groups, first group was treated by Nadroparin calcium 171 IU/kg once daily for 6 weeks followed by DOAC (n = 11) and second group continued on DOAC (n = 13). The thrombus was reassessed by TEE later. Results: LAA thrombus was detected with TEE in 24 (0.01%) patients who had different treatment plans (EEC n = 22, AF ablation n = 2). DOACs distribution as follow; Dabigatran 150 mg twice daily n = 7, Rivaroxaban 20 mg once daily n = 8, Apixaban 5 mg twice daily n = 5 and Edoxaban 60 mg once daily n = 4. Mean age (72 ± 15 years), male to female ratio (65 vs. 35%), average CHA2DS2VASC score (5) and mean TEE follow up (3.8 months). In Nadroparin group, after treatment adaptation, persistent LAA thrombus was detected in 3 out of 11 patients. LAA thrombus persists in 2/6 and 1/3 patients on Rivaroxaban and Apixaban respectively, where was thrombus completely vanished with Edoxaban n = 2. On the other hand,

S68

thrombus persists in 2 out of 13 patients who were continued on DOAC. The observations showed disappearance of LAA thrombus in 8/9 patients who continued n = 7 or switched to Dabigatran n = 2 (Rivaroxaban and Edoxaban), thrombus persists in 1/2 patient who continued Apixaban. No more thrombus was detected in patients who continued Rivaroxaban n = 1 and Edoxaban n = 1. Conclusion: As demonstrated, there is no statistically significant difference between the mode of anticoagulation after LAA thrombus formation in the patients who are already on direct oral anticoagulants in one center. This addresses the necessity for more prospective studies.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

and ischemic efficacy endpoints in this TT cohort. NOACs seem to be a valid alternative to VKA in TT, but failed to show significant benefit in this cohort. Future controlled trials are required to further evaluate the potential role of NOACs in combination with DAPT in TT.

13-3 Abstract 15-64 THE MUNICH TRIPLE COHORT - INFLUENCE OF A GUIDELINE IMPLEMENTATION ON MEDICAL TREATMENT AND CLINICAL OUTCOME OF PATIENTS WITH AF UNDERGOING PCI Lisa Riesinger 1, Katarina Opitz 1, Claudia Sabrina Summo 1, Michael Mehr 1, Johannes Siebermair 2, Jörg Hausleiter 1, Julinda Mehilli 1, Steffen Massberg 1, Reza Wakili 2 1 Klinikum der Universität München, Medizinische Klinik I, Munich, Germany, 2 Westdeutsches Herz- und Gefäßzentrum, Kardiologie, Universitätsklinikum Essen, Essen, Germany Introduction: Patients with atrial fibrillation (AF) and coronary artery disease undergoing percutaneous coronary intervention (PCI) are in need of “triple therapy” (TT). The most recent revascularization guideline (GL) was the first to introduce a risk-stratified TT duration and the option of NOAC use in TT. Despite recently published studies, data regarding the use of NOACs in combination with DAPT are still scarce. Objective of our cohort study was to evaluate the impact of a new revascularization GL implementation by a standardized operated procedure (SOP) into the daily routine of an interventional highvolume center and the use of NOACs vs vitamin-K-antagonists (VKA) in TT patients with respect to bleeding and ischemic endpoints. Methods and results: Nine hundred twenty-eight patients were enrolled between 01/2013 and 06/2016 with AF undergoing PCI. Cohort 1 consisted of 482 patients before, and cohort 2 of 446 patients after the introduction of the new GL (11/2014). Pre-defined endpoints included bleeding events BARC ≥ 2 for safety and a composite clinical efficacy endpoint (Fig. D). The follow up was 464 ± 476 days. Cohort 2 received significantly less VKA and the duration of TT in cohort 2 was significantly different to cohort 1 consistent with the GL recommendation (Fig. A, B). There were no significant differences in bleeding (Fig. C) and the combined ischemic efficacy endpoint (D). Sub-analyses revealed no differences between NOAC and VKA use in this cohort regarding safety and efficacy endpoints (Fig. E, F). Conclusion: Based on these results, GL were well implemented but did not significantly affect pre-defined safety

13-4 Abstract 15-57 T H E I M PA C T O F D C C A R D I O V E R S I O N , P E R M A N E N T PA C E M A K E R A N D AV N O D E ABLATION AND AF ABLATION ON EXERCISE C A PA C I T Y I N PAT I E N T S O V E R 6 5 W I T H PERSISTENT AF AT 6 MONTHS: A RANDOMISED CONTROLLED TRIAL William Eysenck 1, Neil Sulke 1, Stephen Furniss 1, Rick Veasey 1 1 Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom Introduction. International guidelines suggest the following treatment options can be considered for patients (pts) with persistent atrial fibrillation (AF): (1) DC cardioversion (DCCV) with concomitant anti-arrhythmic treatment, (2) permanent pacemaker (PPM) implantation and atrio-ventricular (AV) node ablation and (3) left atrial catheter ablation including pulmonary vein isolation (PVI). Cardiopulmonary

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

exercise testing (CPET) has been found to have high prognostic value in predicting future cardiac events in such pts. The purpose of this study was to investigate the most effective treatment for persistent AF in pts over the age of 65. Methods. Thirty pts aged 66–90 years (21 males) with persistent AF were included. All patients underwent advanced CPETs at baseline and at 6 months following their randomised AF intervention. Results. See Fig. 1. There was a significant overall improvement in power reached during CPET testing following AF intervention (mean power 64.11 ± 37.25 W at baseline vs. 96.06 ± 34.24 W at 6 months; p = 0.012). There was an overall increase in VO2 max (mean VO2 max at baseline 11.19 ± 4.93 ml/min/kg vs. VO2 max at 6 months 15.38 ± 4.32 ml/min/kg; p = 0.003). Further analysis shows a significant improvement in power reached with PPM and AVNA (baseline power 53.67 ± 31.82 vs. 96.89 ± 33.09 W at 6 months; p = 0.004). VO2 max also increased following PPM and AVNA (VO2 max at baseline 10.82 ± 3.20 ml/min/ kg at baseline vs. 17.00 ± 3.60 ml/min/kg at 6 months; p = 0.004). There was a significant reduction in breathing reserve (BR) following PPM and AVNA (52.34 ± 10.42% at baseline vs. 41.46 ± 8.87% at 6 months). Conclusion. There is a significant improvement in power and VO2 max reached 6 months following AF intervention. Interestingly, the improvement was most marked with PPM and AVNA suggesting this intervention as an appropriate first line option for persistent AF in this age group. Reduction in BR is likely explained by the increased ventilatory demand post intervention.

S69 1

Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan, 2 Division of Cardiology, Edogawa Hospital, Tokyo, Japan, 3 Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan, 4 Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, Houston, United States

Background. Ethanol infusion (EI) in the vein of Marshall (VOM) has multifactorial effects that could be synergistic to pulmonary vein isolation (PVI) in ablation of atrial fibrillation (AF). The efficacy of radiofrequency (RF) versus cryoablation when combined with a VOM-EI has never been investigated. Objective. We sought to evaluate outcome differences of AF ablation using RF versus cryoablation when combined with a VOM-EI. Methods. Consecutive patients (n = 342) underwent catheter ablation of paroxysmal AF with either RF or cryoballoon (CB) for PVI, alone or combined with VOM-EI. Bi-directional conduction block at the mitral isthmus was attempted. The end-point was the freedom from any atrial arrhythmias documented after a blanking period of 90 days after the procedure. Results. Kaplan-Meier estimates of the arrhythmia-free survival after 1 year were 66.5 (RF and CB) and 72.7% (RF + VOM and CB + VOM). Comparison between CB versus RF + VOM and between CB + VOM versus RF + VOM reached a significance (p = 0.0033 and 0.0292, respectively). The periprocedural complication rate was comparable in all groups (5.0% RF, 5.8% CB; p = 0.14) with a significant difference in the incidence of phrenic nerve palsy (0% RF, 2.0% CB; < 0.05). Conclusions. PVI with a CB had an increased freedom from AF recurrence compared to RF combined with VOM-EI. VOM-EI itself failed to improve the clinical efficacy of treating AF when combined with RF. The present results suggest a potential additive effect of a VOM-EI to CB application. 13-6 Abstract 08-16 I N T E R AT R I A L B L O C K P R E D I C T S AT R I A L FIBRILLATION IN PATIENTS WITH CORONARY AND CAROTID ARTERY DISEASE

RADIOFREQUENCY FOR PULMONARY VEIN I S O L AT I O N C O M B I N E D W I T H V E I N O F MARSHALL ETHANOL INFUSION FOR PA R O X Y S M A L AT R I A L F I B R I L L AT I O N COMPARISON WITH CRYOABLATION

Bryce Alexander 1, Adrian Baranchuk 1, Henri van Rooy 1, Sohaib Haseeb 1, Omar Ibrahim 1, Adrian Kuchtaruk 1, Wilma Hopman 1, Göksel Çinier 2, Marie-France Hetu 1, Terri Li 1, Amer Johri 1 1 Queen's University, Kingston, Canada, 2 Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey

Kaoru Okishige 1, Naohiko Kawaguchi 1, Shinsuke Iwai 1, Hideshi Aoyagi 1 , Tomofumi Nakamura 1 , Yasuteru Yamauchi 1, Takehiko Keida 2, Tetsuo Sasano 3, Kenzo Hirao 3, Miguel Valderrábano 4

Background: Interatrial block has been previously associated with atrial fibrillation in various cardiac populations. This study sought to evaluate the relationship between interatrial block and new onset atrial fibrillation (AF) in a population of

13-5 Abstract 15-66

S70

patients undergoing clinically indicated coronary angiography and carotid ultrasonography. Methods: Three hundred and fifty-five subjects undergoing a clinically indicated coronary angiogram and carotid ultrasound were retrospectively studied. Common carotid artery far-wall intimal medial thickness (CIMT), maximum carotid plaque height and total carotid plaque area were measured for each subject. Coronary artery disease was independently measured by coronary angiography. IAB was measured from the surface ECG by two independent reviewers blinded to the results of angiogram and carotid ultrasound. Subjects were followed for a minimum of 1 year and AF was determined through review of medical records. Results: Mean age 64.4 years, 70.4% were male and mean BMI of 29.9 kg/m2. Patients with IAB had a higher incidence of new-onset AF (52.5 vs. 29.9%; p = 0.001). There was a significant difference in AF-free survival time between patients with IAB and without IAB determined using Cox proportional hazard analysis (52.9 months (95% CI 47.1– 58.7 months) vs. 62.6 months (95% CI 58.8–66.5 months); p = 0.006.). The strongest predictors of AF on multivariate analysis were partial or advanced IAB (OR 2.40, 95% CI 1.33–4.29; p = 0.003), increased maximum carotid plaque height (OR 1.41, 95% CI 1.06–1.87; p = 0.019) and multivessel coronary artery disease (OR 1.59, 95% CI 0.85– 2.96; p = 0.144.) Patients with IAB had a significantly greater carotid artery atherosclerotic burden determined by CIMT (0.883 ± 0.193 vs. 0.829 ± 0.192 mm; p = 0.013). The strongest clinical characteristics associated with IAB on multivariate analysis were BMI BB 30 kg/m2 (OR 3.14, 95% CI 1.14– 1.88, p = 0.003), P-wave voltage BB 0.1 mV in lead 1 (OR 1.97, 95% CI 1.23–3.15, p = 0.004), male sex (OR 1.78, 95% CI 1.05–3.03, p = 0.034), increased mean common carotid artery intima-media thickness (per 0.1 mm increase) (OR 1.75, 95% CI 1.00–3.07, p = 0.050) and increased age (per 10-year increase) (OR 1.46, 95% CI 1.14–1.88, p = 0.003). Conclusions: IAB is a predictor of new-onset AF in this population. Both carotid artery disease and coronary artery disease are strongly associated with a higher prevalence of IAB. Abstract Oral Session 14: Risk factors for atrial fibrillation Tuesday April 17, 2018, 08:30 am–10:00 am ROOM EPINETTES 14-1 Abstract 15-65 ATRIAL FIBROSIS IN NON-ATRIAL FIBRILLATION INDIVIDUALS AND PREDICTION OF ATRIAL FIBRILLATION BY USE OF LATE GADOLINIUM ENHANCEMENT (LGE) MRI Johannes Siebermair 1, Promporn Suksaranjit 2, Christopher J. McGann McGann 3 , Kathryn A. Peterson 4 , Mobin

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Kheirkhahan 2, Alex A. Baher 2, Kavitha Damal 2, Reza Wakili 1, Nassir F. Marrouche 2, Brent D. Wilson 2 1 Department of Cardiology and Vascular Medicine, WestGerman Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany, 2 Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, Salt Lake City, United States, 3 Swedish Heart and Vascular Institute, Seattle, Washington, United States, 4 Division of Gastroenterology, University of Utah, Utah, United States Background. Besides the traditional concept of AF perpetuating atrial remodeling (“AF begets AF”), there is increasing evidence that structural alterations precede AF in terms of an atrial myopathy. There is a need for better characterization of this myopathy in terms of fibrotic substrate and its influencing factors. Objective. This study aimed to assess atrial remodeling by late gadolinium enhanced (LGE) MRI and its influencing clinical risk factors in non-AF individuals. Second, we aimed to establish a scoring system for predicting presence of AF using left atrial LGE, in addition to clinical parameters, to generate a hypothesis for future prospective studies. Methods. N = 91 non-AF individuals without a history of structural heart disease were recruited from the colonoscopy clinic, n = 91 age- and sex-matched AF individuals served as controls. All patients underwent LGE-MRI on either a 1.5 or 3 Tesla scanner. Late enhancement ≥ 20% was considered extensive atrial remodeling. Results. The mean left atrial LGE in non-AF and AF individuals was 8.8 ± 6.5 and 12.5 ± 5.8%, respectively. A body-mass index BB 30 kg/ m² was identified as predictor of LGE, while diastolic dysfunction failed to demonstrate a significant association. A scoring system for the prevalence of AF (two points for arterial hypertension and LVEF ≤ 55%, respectively; 5 points for LGE BB 6%) was derived. Comparing to patients with a low risk for AF, patients in the intermediate and high-risk group showed a significantly increased risk for AF (OR 3.5). Conclusion. This study reports an unexpectedly high percentage of atrial LGE in a non-AF cohort, highlighting the hypothesis that structural alterations precede AF onset in a significant proportion of individuals. BMI was identified as significant predictor of remodeling, providing a basis for studies investigating the influence of lifestyle modification and drug interventions, i.e. weight reduction, on structural remodeling. The newly derived risk score for AF prevalence provides the basis for further prospective studies on AF incidence in individuals before AF onset. 14-2 Abstract 07-10 INFLAMMATORY CONDITION OF MYOCARDIUM I N PAT I E N T S W I T H I D I O PAT H I C AT R I A L FIBRILLATION

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Roman Batalov 1, Mikhail Khlynin 1, Vyacheslav Ryabov 1, Yana Anfinogenova 1, Julia Rogovskaya 1, Sergey Popov 1 1 Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia Atrial fibrillation (AF) epidemic is a ticking time-bomb affecting about 2.5 million people in the USA and this number may reach 15 million in 2050. Exact causes of increasing AF incidence are poorly understood. The objective of our study was to elucidate the role of inflammation in various forms of AF including idiopathic AF. A total of 1997 patients with AF were examined. Endomyocardial biopsy material was sampled from the intraventricular septum and the right ventricle; integrated morphological study included histology, immunohistochemistry, and polymerase chain reaction tests. Intracardiac hemodynamics was assessed invasively. The role of inflammation and fibrosis in cardiac remodeling was studied by immunoenzyme assay for interleukin-1β, tumor necrosis factor-α, C-reactive protein, heart-type fatty acid binding protein, matrix metalloproteinases (MMPs), tissue inhibitors of MMPs, tissue growth factor-β1, and fibroblast growth factor. Interventional treatment consisted in catheter ablation of AF and arrhythmogenic zones of atrial tachyarrhythmias by using electrophysiology mapping/navigation systems. High levels of markers for myocardial inflammation and damage suggested the presence of inflammatory process in the myocardium of patients with various forms of AF. Changes in extracellular matrix proteolysis system and growth factors were associated with structural remodeling and inflammation in patients with various forms of AF. Signs of inflammation including lymphocytic infiltration were found in 43.8% of idiopathic AF patients; myocardial fibrosis was found in 35.6% of them; 31.5% of these patients had myocarditis positive for human parainfluenza viruses 1 and 2, human herpesvirus 6, parvovirus В19, enterovirus, and Epstein-Barr virus. Our findings suggest that inflammation plays an important role in AF and idiopathic AF may be considered an inflammatory condition requiring anti-inflammatory treatment. These results allowed us to developing approaches improving treatment efficacy in patients with AF. 14-3 Abstract 07-15 AT R I A L A R R H Y T H M I A S A N D T H R O M B O E M B O L I C C O M P L I C AT I O N S I N A D U LT S A F T E R U N I V E N T R I C U L A R O R B I V E N T R I C U L A R R E PA I R O F S E V E R E CONGENITAL HEART DISEASE Darryl Wan 1, Clara Tsui 1, Christopher Cheung 1, Jasmine Grewal 1, Amanda Barlow 1, Marla Kiess 1, Derek Human 1, Andrew D. Krahn 1, Santabhanu Chakrabarti 1 1 University of British Columbia, Vancouver, Canada

S71

Background: Adults with surgically corrected/palliated severe congenital heart disease represent one of the fastest growing groups of patients in contemporary cardiology practice. Although atrial arrhythmias (AA) are relatively common in these individuals, comprehensive data about aetiology and associated thromboembolic complications in this cohort is sparse. Objective: To compare the development and progression of atrial arrhythmias and associated thromboembolic complications post-biventricular and univentricular repair of severe complex congenital heart disease in adults. Methods: We performed a single centre observational cohort study including all consecutive patients ≥ 18 years of age with univentricular physiology (Fontan circulation) and biventricular repaired Tetralogy of Fallot (ToF) who have been followed for at least 1 year at our quaternary adult congenital heart disease clinic. Results: Three hundred fifty-three patients met inclusion criteria for this study. Baseline characteristics of the study population are depicted in Table 1. The Fontan cohort was significantly younger. While diabetes and hypertension were more common in the ToF group, treatment with warfarin, digoxin and angiotensin converting enzyme (ACE) inhibitors were more common in the Fontan population. Although prevalence of atrial arrhythmias (OR 3.93; 95% CI [2.15–7.19]) was more frequent in the Fontan group, there was no significant difference in individual type of AA: atrial fibrillation (14 vs. 10%), atrial flutter (17.2 vs. 14.6%) and ectopic atrial tachycardia (17.2 vs. 15.8%). Age (OR 1.08; 95% CI [1.05–1.11]) and treated heart failure (OR 3.94) were significant predictors of atrial arrhythmia in multivariate analysis in either cohort. More than one AA pattern was observed in the same patients in both cohorts (8.6 vs. 15.4 %). A high prevalence of thromboembolic complications (stroke, TIA, pulmonary embolism, atrial thrombus) was noted in the study population; age (adjusted OR 1.03; 95% CI [1.00–1.06]) and the presence of Fontan circulation (adjusted OR 3.62; 95% CI [1.65–7.96]) were significant predictors of thromboembolic events in univariate and multivariate analyses. Conclusion: Adult patients with univentricular physiology (Fontan) represent a younger population that is more severely affected by atrial arrhythmia and associated systemic thromboembolism when compared to patients with repaired biventricular physiology (ToF) despite having less hypertension or diabetes. Characteristic Demographics Male Mean age (years) Heart failure Diabetes mellitus Hypertension Medications Antiplatelet

Fontan (n = 93)

Tetralogy (n = 260)

p value (αBB0.05)

54 (58.1%) 30.3 5 (5.4%) 1 (1.1%) 2 (2.2%)

149 (57.3%) 37.6 13 (5%) 21 (8.1%) 28 (10.8%)

1.0 BB0.001 1.0 0.012 0.009

27 (29%)

72 (27.7%)

0.79

S72

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Warfarin

49 (52.7%)

23 (8.8%)

BB0.001

NOAC Digoxin

3 (3.2%) 11 (11.8%)

3 (1.2%) 6 (2.3%)

0.19 BB0.001

ACEi BB

34 (36.6%) 29 (31.2%)

31 (11.9%) 62 (23.8%)

BB0.001 0.17

Any atrial arrhythmia Atrial fibrillation

37 (39.8%) 13 (14%)

65 (25%) 26 (10%)

0.011 0.335

Atrial flutter Ectopic atrial tachycardia

16 (17.2%) 16 (17.2%)

38 (14.6%) 41 (15.8%)

0.615 0.744

29 (31.2%)

30(11.5%)

BB0.001

CVA or TIA

16 (17.2%)

19 (7.3%)

0.009

CVA only

14 (15.1%)

10 (3.8%)

BB0.001

PE

7 (7.5%)

3 (1.2%)

0.004

Atrial arrhythmia

Thromboembolism Any thromboembolism

was detected. Conclusions: The world’s first analysis of the impact of the ROX Coupler on pts with PAF and resistant HTN suggests that the device is safe and effective in lowering BP in this cohort. We observed a trend in reduction in AF burden, but this did not reach statistical significance. This warrants further study. There were no significant changes in key CPET parameters at 6 months, confirming no detrimental effect of iliac anastomosis in this pt cohort.

14-4 Abstract 01-25 THE IMPACT OF A CENTRAL ARTERIO-VENOUS ILIAC FISTULA ON BLOOD PRESSURE AND AF B U R D E N I N PAT I E N T S W I T H R E S I S TA N T HYPERTENSION AND PAROXYSMAL AF 1

1

2

William Eysenck , Jet vanZalen , Guy Lloyd , Andrew Marshall 1, Rick Veasey 1, Stephen Furniss 1, Neil Sulke 1 1 Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom, 2 St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom Introduction: Improved blood pressure (BP) control has been hypothesised to decrease atrial fibrillation (AF). A central stent-derived arterio-venous iliac fistula using the ROX Coupler reduces blood pressure (BP) in patients (pts) with resistant and/or uncontrolled hypertension (HTN). We evaluated the impact of the device in pts with HTN and paroxysmal AF (PAF) using continuous heart rhythm monitoring with implantable cardiac monitors (ICMs). We performed detailed cardiopulmonary exercise testing (CPET) before and after intervention. Methods: Ten pts aged 46–78 (75% male) with a history of HTN, PAF and an indication for a ROX Coupler were recruited. All patients underwent implantation of an ICM and were monitored for 1 month prior to ROX Coupler insertion. The patients had 24-h BP monitors and ICM downloads at baseline, 1 month, 3 months and 6 months following intervention. Advanced CPETs were performed at baseline and 6 months following ROX Coupler implantation. Results: See Fig. 1. There was an immediate reduction in BP 1-day post procedure (mean 24 h BP at baseline 145/79 falling to 132/70 on day 1; p = 0.015). There was an increased reduction in diastolic BP at 3 months. This BP control was maintained for 6 months. There were no significant changes in CPET parameters and although there was a numerical decrease in AF burden, no significant change in mean AF burden

14-5 Abstract 01-26 SCREENING FOR SLEEP-DISORDERED BREATHING IN PATIENTS OVER 65 YEARS WITH P E R S I S T E N T A F A N D T H E I M PA C T O F A F INTERVENTION William Eysenck 1, Neil Sulke 1, Stephen Furniss 1, Rick Veasey 1 1 Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom Introduction: Epidemiological data have demonstrated an independent association between sleep-disordered breathing (SDB) and atrial fibrillation (AF). We have developed an efficient and reliable screening service investigating SDB in patients (pts) BB 65 years with persistent AF. The Watch PAT (WP) shows strong correlation to the gold-standard overnight polysomnography (PSG). We used the WP to assess the impact of standard AF treatment (AF ablation, permanent pacemaker (PPM) and atrioventricular node ablation (AVNA) and direct current cardioversion (DCCV)) upon sleep data at baseline and 6 months following intervention. Methods: Fifty-four pts aged 66–90 (48% female) with persistent AF were investigated for SDB with WP. Twenty-five pts underwent follow-up WP 6 months following their randomised AF intervention (8 DCCV, 7 CRYO ablation and 10 PPM and AVNA). Results: See Fig. 1. According to UK NICE definition, 47/54 (87%) had evidence of SDB. Then, 17/ 54 (31.5%) had severe sleep apnoea vs. 14.3% post AF intervention (< 0.05). The mean apnoea-hypopnoea index (AHI) improved post DCCV (pre-DCCV AHI 28.18 ± 12.92 vs. 22.33 ± 9.29 post-DCCV; p = 0.002). The mean AHI did not change

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

significantly with AVNA but increased significantly with AF ablation from 18.33 ± 27.95 to 28.33 ± 25.78), p = 0.006 with an associated increase in Epworth score from 6.00 ± 4.60 to 7.50 ± 6.41, p = 0.033. There was a significant reduction in central apnoeic events post AF ablation (21.00 to 4.00, < 0.001). Conclusion: There is a high prevalence of SDB in older pts with AF and use of the WP as a screening option is feasible. DCCV improves AHI scores at 6 months. AF ablation reduces number of central apnoeic events but increases AHI and Epworth scores. We propose that changes in sympathetic/parasympathetic tone is the likely explanation for this.

S73

to our ophthalmology department within the last 3 years. After informed consent, clinical data was obtained in n = 210 patients using a standardized questionnaire over a mean FU duration of 20 ± 12 months. Finally, 174/210 patients were included in the final analysis (12 patients died, 24 patients already presented with a history of AF). Only 50% of the patients underwent a cardiological work-up including a single 24h-Holter-ECG for AF screening. In this subgroup, new-onset AF was detected in 18.2% (16/88 cases) compared to 7% (6/88 patients) new-onset AF in patients without Holter-ecg (12.6% AF incidence in the patient cohort overall). Eighty-six percent (170/198) underwent a duplex sonography of carotid arteries, with a significant carotid artery stenosis in about 25% of patients. With respect to anticoagluation, patients with a known history as well as patients with first diagnosis of AF were not on a (N)OAC in 30%. During the FU, a history of (C)RAO turned out a significant predictor of further cerebrovascular events (n = 17 stroke/TIA; n = 12 2nd (C)RAO). Conclusions Only 50 and 86% of patients with (C)RAO underwent a cardiological and neurological work-up, respectively. We identified a high diagnostic accuracy of one single Holter-ECG with regard to AF detection in this cohort. Our data support the hypothesis that (C)RAO identifies a high-risk population for AF providing a further basis to generate study hypotheses for risk assessment in those patients.

14-6 Abstract 07-22 Abstract Oral Session 15: Lead extraction techniques CENTRAL RETINAL ARTERY OCCLUSION AS STROKE EQUIVALENT: A PREDICTOR FOR ATRIAL FIBRILLATION?

Tuesday April 17, 2018, 08:30 am–10:00 am ROOM MONTENOTTE

Nadine Vonderlin 1, Johannes Siebermair 1, Stefan Kääb 2, Karsten Kortüm 3, Siegfried Priglinger 3, Reza Wakili 1 1 Department of Cardiology and Vascular Medicine, WestGerman Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany, 2 Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany, 3 University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany

EXTRACTION OF HIS BUNDLE PACING LEAD: SAFETY OF EXPLANTATION AND FEASIBILITY OF REIMPLANTATION

Introduction (Central) retinal artery occlusion ((C)RAO) is considered ischemic stroke equivalent with a similar clinical approach. Identifying the source of thromboembolism is crucial to avoid future events. Nevertheless, the current guidelines do not provide a standardized diagnostic approach after (C)RAO. Objective Out of all patients admitted to our ophthalmology department for (C)RAO, we aimed to identify the percentage of patients who received a cardiological/neurological diagnostic work-up. Second goal was to evaluate the diagnostic accuracy of a sole 24h-Holter ECG with respect to new-onset AF in comparison to patients not receiving any specific rhythm monitoring. The number of patients with AF on a (new) oral anticoagulation (N)OAC) was evaluated. Methods and Results We identified n = 292 patients with (C)RAO admitted

Background: Right ventricular pacing (RVP) is known to cause ventricular dyssynchrony and heart failure. Permanent His bundle pacing (HBP) is a physiologic alternative to RVP. However, concerns remain regarding the outcomes of lead extraction at this site in addition to the feasibility of reimplantation of HBP lead. The aim of our study is to describe our single-center experience of extraction of chronically implanted permanent HBP leads. Methods: Patients undergoing extraction of leads from His bundle location for standard indications were enrolled and studied. The primary outcomes were removal success rates, need for extraction tools and feasibility of re-implantation in the His bundle region. In addition, associated complication rates including development of new conduction abnormalities were tracked. Results: Twenty-

15-1 Abstract 23-10

Pugazhendhi Vijayaraman 1 1 Geisinger Heart Institute, Wilkes Barre, United States

S74

one patients (male 15, age 72 ± 16 years) with permanent HBP leads of at least 6-months duration were included. Indication for removal of the HBP leads were infection 3, lead failure 15 and upgrade to ICD 3. Removal of HBP leads was successful in 20 of 21 pts (95%). Mean duration of the implanted leads was 26 ± 18 months (range 6–72 months). Extraction tools were used in 3 of 21 patients, while manual traction was successful in the reminder. In one patient, extraction was unsuccessful due to damage to the lead during attempt. No new conduction or valve abnormalities were noted following extraction. Repeat HBP was successful in 10 of 13 (77%) pts. There were no complications. Conclusions: Permanent HBP leads were successfully explanted in 95% of pts. Reimplantation of HBP lead was feasible in 77% of pts.

15-2 Abstract 23-19 moved to 6-1 on Sunday morning 15-3 Abstract 23-21 TRANSVENOUS LEAD EXTRACTION ON UNINTERRUPTED ANTICOAGULATION: A SAFE APPROACH? Vinit Sawhney 1, Sarah Whittaker-Axon 1, Luisa Baca 1, Vivienne Ezzat 1, Pier Lambiase 1, Anthony Chow 1, Martin Lowe 1, Simon Sporton 1, Ross Hunter 1, Mark Earley 1, Mehul Dhinoja 1 1 Barts Heart Centre, London, United Kingdom Introduction: Transvenous lead extraction (TLE) is associated with a risk of potentially life-threatening haemmorhagic events. Current consensus guidelines advocate reviewing peri-procedural anticoagulation on an individual case basis. Limited data exist on the safety of patients undergoing TLE on uninterrupted anticoagulation. We investigated the safety of TLE on uninterrupted warfarin with therapeutic INR.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Methods: A prospective registry of patients undergoing TLE over 18 months at a single centre was analysed. Consecutive patients in whom TLE was performed on uninterrupted warfarin (cases) were included. An age and sex matched control group, who were not on an oral anticoagulant and underwent TLE in the same time period was also included. Both groups were compared over a 6-month follow-up period. Results: Of at total of 79 TLEs over 18 months, 14 patients were on uninterrupted anticoagulation peri-procedurally. These were compared to 14 patients in the control group. There was no significant difference in the clinical and procedural characteristics between the two groups—Table 1. In the anticoagulated patients, the mean INR was 2.3 ± 0.4 (range 2–3.5) and CHA2DS2VASc score of 3.2 ± 1.8. Indication for anticoagulation was prosthetic valve in 7, AF in 6 and multiple PEs in 1. A total of 26/29(90%) leads were removed completely successfully in the cases compared to 23/ 25(92%) in the controls, p = 0.59. In the cases, these included 52% defibrillator leads, 34% pace-sense leads and 14% CS leads of average duration 7 years. One patient in the anticoagulated group required 24 h of inotropic support post-procedure. Two patients in the control group had device site haematomas, which were conservatively managed. Thre was no difference in the drop of Hb post-procedure between the groups (p = 0.11). There were no procedure related deaths in either group and no significant difference in the overall complication rate (p = 0.50). Over a follow-up period of 6 months, one patient had lead displacement amongst the cases and one patient had infection of the re-implanted device in the control group. Two cases and one control died over the follow-up period. Cause of death was end stage heart failure in two and small cell cancer in one. Conclusion: TLE can be carried out safely in patients anticoagulated with warfarin with therapeutic INRs. Larger studies are required to confirm these findings. Table 1: Clinical and procedural characteristics N = 28 Age [years]

Cases 71 ± 13

Controls 65 ± 18

p value 0.32

Sex [male,%] Underlying heart Diseasenormal heart [%] Ischemic heart disease [%] Dilated cardiomyopathy [%] Others [n, %] AF [%] LVEF [mean ± SD] INR at procedure [mean ± SD] Type of devicePPM [%] ICD [%] CRTP [%] CRTD [%] Extraction indication infection [%] Lead malfunction [%] Other [%] Drop in Hb [mean ± SD]

70

73

0.86

2136367

14432914 0.630.710.690.55

50 28 ± 10 2.3 ± 0.4

13 31 ± 16 1.1 ± 0.5

0.04 0.55 0.0001

21431422 30291229 0.590.440.870.67 434215

502921

0.710.480.68

1.3 ± 0.9

0.8 ± 0.7

0.11

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147 93 ± 19

S75

Creat [mean ± SD]

109 ± 25

Elective procedure [%] Procedure time [min]

50 40 229 ± 149 186 ± 91

0.60 0.36

Fluoroscopy time [min]

33 ± 18

0.37

27 ± 17

0.07

15-4 Abstract 23-25 P R E - E M P T I V E PAT E N T F O R A M E N O VA L E CLOSURE IN A PATIENT UNDERGOING LEAD EXTRACTION DUE TO SEPTIC SHOCK AND ENDOCARDITIS Miguel Leal 1, Jill Triphan 1, Anne Barnett 1, Micah Roberts 1, Graham Adsit 1, Amanda Breuer 1, Kurt Jacobson 1 1 University of Wisconsin, Madison, United States Introduction: The occurrence of distal embolization during lead extraction procedures may lead to significant complications, especially in patients with a patent foramen ovale (PFO) or an atrial septal defect (ASD). Case Report: We report a complex case that involved an acutely ill patient with history of quadriplegia due to a prior motor vehicle accident, neurogenic bladder requiring frequent intermittent catheterization, non-ischemic cardiomyopathy, atrial fibrillation and a previous defibrillator (ICD) implant, subsequently followed by an upgrade to a biventricular ICD system. The patient was diagnosed with septic shock requiring vasoactive medications, acute renal failure and Staphylococcus bacteremia. Transthoracic echocardiography revealed large soft tissue densities adherent to the endovascular leads, as well as the tricuspid and pulmonic valves. A CT scan of the chest indicated multiple septic emboli involving both lungs. In addition, the patient exhibited hypoxia and a significant right-to-left intracardiac shunt in the setting of a large PFO. After cardiovascular surgery felt that the patient presented a prohibitively high risk for open surgical repair, electrophysiology was consulted for percutaneous system (device and leads) extraction. In order to mitigate the risk of systemic embolization, prior to the lead extraction procedure, a 25-mm Amplatzer septal occlusive device was successfully placed, achieving adequate closure of the PFO. All four endovascular leads were then successfully extracted in their entirety with the assistance of a rotating mechanical dilator sheath. The patient tolerated both procedure wells with no complications and repeat blood cultures obtained 1 and 3 weeks following the procedure remained sterile. The patient eventually underwent a contralateral biventricular ICD implant approximately 1 month following the previous system extraction. Conclusion: Preemptive closure of PFO or ASD should be considered to minimize the risk of systemic embolization during lead extraction procedures when large or multiple masses (e.g., vegetations or thrombi) are present in that patient population.

15-5 Abstract 23-23 P R E D I C T O R S O F E X T R A C T I O N S H E AT H ASSISTANCE FOR CHRONICALLY INDWELLING ENDOVASCULAR LEADS Miguel Leal 1, Matthew Tattersall 1, Douglas Kopp 1, Sean Swearingen 1, Ryan Kipp 1 1 University of Wisconsin, Madison, United States Introduction: Recently, implanted pace-sense and defibrillator (ICD) leads are typically removable via gentle manual traction. Clinical predictors of the need for dedicated extraction sheaths (ES—laser or mechanical cutting sheaths) during extraction of pace-sense or ICD leads have not been defined. Methods: A retrospective, single-center analysis was performed on all patients referred for lead extraction between 2010 and 2016. Baseline and lead characteristics were included in a multivariate logistic regression model assessing the need for ES during the procedure. Results: A total of 296 patients (478 leads) was included in this analysis. A total of 77% of the leads required ES. No lead implanted for less than 6 months required ES. Time since lead implantation and ICD lead type were significantly associated with need for ES (OR 1.052 per 30 days, 95% CI 1.02–1.08, and OR 5.16, 95% CI 1.72–13.93, respectively). When analyzed independently, ICD leads with longer dwell time and younger patient age were associated with increased risk of requiring ES (OR 1.06 per 30 days, 95% CI 1.02–1.08, and OR 0.702 per 5 years, 95% CI 0.48–0.92, respectively). For pace-sense leads, the need for ES was significantly associated with lead dwell time (OR 1.04 per 30 days, 95% CI 1.01–1.05). Higher patient age did not reduce the need for ES during extraction of pace-sense leads (p = 0.79). Conclusion: ICD and pace-sense leads implanted less than 6 months prior to removal are more likely to be safely extracted with manual traction. ICD leads implanted in younger patients and/or associated with longer endovascular dwell time were significantly associated with increased risk of ES requirement, while increased need for ES for extraction of pace-sense leads was only affected by lead dwell time. 15-6 Abstract 23-14 VENOGRAPHY BEFORE TRANSVENOUS LEAD EXTRACTION: FRIEND OR FOE? Francesca Esposito 1, Cristina Esposito 2, Fabio Franculli 2, Gaetana Melchiorre 2, Michele Brigante 2, Gennaro Vitulano 2 , Michele Manzo 2 1 Ospedale Civile “Santa Incoronata dell’Olmo- Cava de’ Tirreni, Cava de' tirreni, Italy, 2 AOU S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy

S76

The implantation rate of cardiac implantable electronic devices (CIED) has significantly increased over the last decades. As a consequence, EP specialists are called to face an evergrowing number of CIED-related infections and lead failures. Transvenous lead extraction (TLE) is nowadays a safe and effective procedure. However, several aspects such as leads’ characteristics and age, operator’s experience, patient’s features and TLE methods should be carefully evaluated to prevent rare but even possible life-treathning complications. TLE procedures are usually performed using a stepwise approach where simple traction is the first choise method, followed by use of non-powered tools (such as locking stilets and manual dilator sheats) and eventually by powered tools (such as laser sheats or rotating threaded tip sheats) in the hardest cases. Preprocedural subclavian venography could help in procedural planning as it provides information about the degree of fibrosis and the location and strenght of catheter’s adhesions. We present the case of a 78-year-old man undergoing the explantation of a dual-chamber pacemaker and transvenous extraction of related leads for exposed pocket infection. Preprocedural left subclavian venography showed two big vascular aneurysms with unclear relationship to leads’ endovascular run. This raised safety concerns, especially related to the distal location of the aneurysms which could have hampered post-procedural mechanical haemostasis following leads’ extraction. We repeated venography in a latero-lateral projection. This fluoroscopic image showed that the catheters run into the left subclavian vein that was completely thrombosed, while the aneuryms belonged to a collateral circuit originating from the cephalic vein and joining distally to the left subclavian vein proximally to its outlet into the upper vena cava. Thus, venography proved useful as we decided to use powered tools, specifically a rotating threaded tip sheat, due to the high grade of fibrosis extending up to the distal segment of the left subclavian vein. Both leads were safely extracted and no haemorragic complication occurred. Patient was reimplated 4 days later and discharged the day after. This case report emphasizes the importance of accurate preprocedural planning in TLE and suggest a role for venography as a cost-effective and time-sparing maneuver to guide the choise of the most safe and effective method for TLE. Chaired Poster Session A part 1 Sunday April 15, 2018, Posters displayed from 08:30 am–12:00 pm Presenters and Chairpersons present from 8:30 am– 10:00 am ROOM TERNES CRT

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

16-1 Abstract 24-16 LEFT VENTRICULAR MASS PREDICTS RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY IN MEN BUT NOT WOMEN Chad Ward 1, Hakeem Ayinde 1, Casey Adams 1, Oluwaseun Adeola 1, Josiah Zubairu 1, Musab Alqasrawi 1, Christopher Dezorzi 1, Ghanshyam Palamaner Subash Shantha 1, James Hopson 1, Gardar Sigurdsson 1, Michael Giudici 1 1 University of Iowa, Iowa City, United States Introduction: The effect of left ventricular mass (LVM) on response to cardiac resynchronization therapy (CRT) is not well known. We hypothesize that baseline LVM would be positively associated with improved CRT outcomes. Methods: We retrospectively studied 343 consecutive patients who received CRT at our institution between 2008 and 2014. LVM was measured by echocardiography using the truncated ellipsoid method. Primary outcome was allcause mortality. Secondary outcomes were (1) change in left ventricular ejection fraction (LVEF) by BB 5% at 6– 12 months and (2) change in QRSd within 3 months. Results: There were 241 males and 102 females. Mean age at CRT implant was 63.6 ± 11.9 years. LVM was 366 ± 367 g. Ischemic cardiomyopathy and left bundle branch block (LBBB) were present in 57 and 67% respectively. Fifty-three percent of the study cohort had NYHA class III or IV at the time of implant. Death occurred in 36% of patients at a median follow up of 2.2 years. LVEF improved by BB 5 in 65% of patients at 6–12 months while QRSd decreased by a mean of 6.7 ± 27.8 ms within 3 months. The relationship between LVM and CRT response appeared to be strongly sex-specific. Higher LVM was associated with reduced mortality in men when LVM was used as a continuous and categorical variable dichotomized at the 75th percentile ([OR 0.999 (0.998–1.0000; p = 0.068)] and [OR 0.47 (0.23– 1.00; p = 0.05)] respectively). There was no association in women (p = 0.826). Higher LVM predicted improvement in LVEF in men [OR 0.99898 (0.9983–0.9997; p = 0.005)] but not in women (p = 0.324). Men with higher LVM experienced greater reduction in QRSd [OR 1.0015 (1.0006– 1.0024; p = 0.001)]. Again, there was no association in women (p = 0.322). The relationship between LVM and change in both LVEF and QRSd remained significant and sex-specific after adjusting for age, LBBB, ischemic cardiomyopathy and atrial fibrillation (OR 0.99904, p = 0.039 and OR 1.001, p = 0.028 respectively in men). Conclusion: Left ventricular mass is an independent predictor of CRT outcomes in men but not in women. In males, greater left ventricular mass predicted improvement in LVEF as well as reduction in QRSd. This remained significant after adjusting for age, LBBB, ischemic cardiomyopathy, and atrial fibrillation.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S77

Techniques and tools for cardiac arrhythmias 16-2 Abstract 05-14 A RANDOMISED CONTROLLED TRIAL ANALYSING NOVEL ECMS IN AF MONITORING: THE REMAP-AF TRIAL William Eysenck 1, Nick Freemantle 2, Oliver Waller 1, Rick Veasey 1, Stephen Furniss 1, Neil Sulke 1 1 Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom, 2 Clinical Trials Unit, University College, London, United Kingdom 16-3 Abstract 05-11 Introduction Novel external ECG recording external cardiac monitors (ECMs) have been developed including the Zio patch (ZP), NUUBO vest (NV) and the Carnation Ambulatory Monitor (CAM). We compared patient (pt) satisfaction, accuracy of atrial fibrillation (AF) detection and cost efficacy of ZP, NV and CAM with Novacor ‘R’ test IV, our clinical standard. All pts had dual chamber DDDRP permanent pacemakers (PPMs) implanted allowing continuous assessment of the accuracy of the ECMs. Methods 21 pts aged 66–90 years (70% male) were included. 18 had PAF and 3 persistent AF. Each pt underwent PPM Holter download immediately before and after wearing the ECMs for 14 days. Pt satisfaction with the monitors was documented. Total device expenditure including pt and technician costs were evaluated. Results See Fig. 1. All three ECMs predict AF burden better than ‘R’ test; < 0.0001. The probability of inaccurate AF diagnosis (either false positive or false negative) was higher for ‘R’ test than for either ZP or CAM (OR 12.31 and 5.85; p = 0.025 and p = 0.042 respectively). The wear time of the ZP (307:11:26 h) was longer than ‘R’ test (223:42:00), < 0.05. The discomfort attaching the ‘R’ test was 1.86 (± 2.63) out of 10 compared with 0.57 (±1.17) for the CAM, p = 0.026. The mean cost of the ‘R’ test was significantly less than the novel ECMs (£15.64 for ‘R’ test, compared with £293 for ZP, £198 for NV and £258 (+VAT) for CAM, < 0.0001). Conclusions Our clinical standard Novacor ‘R’ test is less accurate in AF burden assessment than either the ZP, NV or CAM. The ‘R’ test is more likely to give inaccurate AF diagnoses than either ZP or CAM. The ZP is associated with a longer wear time than ‘R’ test while the CAM was found to be more acceptable to pts using visual analogue scores.

THE USE OF A NOVEL SOFTWARE-BASED DATA M A N A G E M E N T S Y S T E M TO S T R E A M L I N E REMOTE MONITORING WORKFLOW IN THE E VA L U AT I O N O F I M P L A N TA B L E L O O P RECORDERS (ILR) Kevin Campbell 1, Jason Hale 1, Noemi Ray 1 1 PaceMate, Raleigh, United States Introduction: Remote monitoring has been proven to reduce hospitalizations, prevent AF related strokes and reduce mortality [1], [2]. Implantable loop recorders (ILR) constitute a large proportion of cardiac implants. Each ILR device has the potential to generate an enormous amount of data but false positives are common. Currently, remote monitoring is performed manually, and workflow is complicated and cumbersome. To date there are no comprehensive solutions. Objective: We suggest that an automated, software-based solution that employs artificial intelligence (AI) and machine learning may allow providers to better manage device patients, better adjudicate resources and provide more efficient care. Methods: Data was obtained via automated remote follow up of CIED utilizing PaceMate software technology from October 1, 2017 to November 1, 2017. Data from devices was compiled and events and downloads were evaluated. Device data was analyzed by type for accuracy and the numbers of false positives were calculated. Results: A total of 1441 devices were followed. Then, 1247 total transmissions were received during the study and 719 (49.9%) were patient activated transmissions. Other downloads were due to routine scheduled remote follow up. There were 253 (17%) ICDs, 682 (47%) PMs, 182 (12.6%) BIV ICDs 37 (2.6%)

S78

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

BIV PMs and 237 (16.4%) ILR devices. The largest volume of transmissions were generated by implantable loop recorders (ILR). There were 342 ILR transmissions and of these, 179 were determined to be false positives. The rate of ILR transmissions was 144% or nearly 1.5 transmissions per device. The false positive rate in our patient population was 52%. ILR data accounted for 27.4% of all remote follow up downloads during this follow up period. Conclusions/Discussion: Data management is a challenge in EP. The explosion of ILR technology in the last decade has led to an enormous volume of implants. These devices now comprise the largest growing CIED demographic and account for the majority of patient activated transmissions, many of which are false positives. Our study demonstrates that by using a software-based, monitoring solution that employs AI and machine learning, we can quickly and accurately manage device data. [1] Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial.

were 131 Yellow alerts and 1 Red (due to ATP delivered during the VF zone). There were 114 alerts from ILRs (86%), 9 from ICDs (6.8%), 9 from PPMs (6.8%). Of the transmissions, there were 53 false positive (46%) transmissions all generated by ILRs. All alerts were reviewed by IHBRE certified staff and on call clinicians were notified of actionable alerts. Discussion: A significant proportion of transmissions and alerts from remotely monitored CIEDs occur over weekends and holidays. While many of these alerts are actionable, there is also a very high rate of false positives that are almost all derived from ILR transmissions. This large volume of data that is downloaded over weekends can create a significant clinical burden and many actionable alerts may be missed when clinics are closed. Using a software-based remote monitoring system with artificial intelligence and machine learning can improve workflow and allow clinicians to quickly identify patients that need to be seen or require intervention over weekend periods.

16-4 Abstract 06-13

16-5 Abstract 22-12

THE UTILITY AND EFFECTIVENESS OF A U T O M AT E D R E M O T E M O N I T O R I N G O F DEVICES AFTER HOURS (WEEKENDS AND HOLIDAYS)

FLUOROSCOPY TIMES IN ELECTROPHYSIOLOGY AND DEVICE PROCEDURES: IMPACT OF SINGLE FRAME LOCATION FLUOROSCOPY

1

Kevin Campbell 1 PaceMate, Raleigh, United States Introduction: Data generated by cardiac implantable electronic devices (CIED) must be continuously monitored and this can present a significant challenge to clinical teams on weekends and holidays. During these time periods, there are often no staff available to manage data downloads and take appropriate clinical actions when necessary. While some transmissions are actionable, there is a sizeable number of false positive transmissions that have been reported, particularly when it comes to implantable loop recorders (ILRs). PaceMate software employs artificial intelligence (AI) and machine learning in order to process the large data sets generated by devices and can manage these transmissions effectively even during non-clinical business hours. Objective: To determine the number of transmissions of remotely followed CIED devices during non-business hours and to demonstrate the effectiveness of an automated software system with AI for monitoring devices after hours. Methods: Weekend transmissions and alerts were reviewed for 1400 patients followed by PaceMate remote monitoring software over weekends for the month of October 2017 (5 pm Friday thru 8 am Monday). Data was analyzed by device type, alert type and number of false positives. Results: Over the study period, there were 1201 total transmission and 256 (21.3%) of these were over the 4 weekends. On the weekends, there

Vinit Sawhney 1, Holly Daw 1, Sarah Whittaker-Axon 1, Colin Allan 1, Pier Lambiase 1, Martin Lowe 1, Mark Earley 1, Simon Sporton 1, Ross Hunter 1, Richard Schilling 1, Mehul Dhinoja 1 1 Barts Heart Centre, London, United Kingdom Background: The current European Heart Rhythm Survey has shown that occupational X-ray hazard in electrophysiology (EP) and device procedures is notable and has not changed in the last few years. Consensus guidelines recommend that current fluoroscopy practice should be revised. We investigated the impact of non-gridded, single frame location fluoroscopy on screening times for EP and device procedures. Methods and Results: Retrospective analyses of 496 device and EP procedures carried out by a single operator from 2012 to 2016 at Barts Heart Centre. Fluoroscopy times and procedural complications pre and post introduction of single frame location fluoroscopy in 2013 (rather than continuous screening) were noted. Then, 239 AF ablations and 257 simple and complex device procedures included. The reduction in fluoroscopy times over the years is shown in Fig. 1. The initial drop in fluoroscopy times in EP procedures (2011–2013) could be attributed to advances in mapping technology. However, the subsequent decrease in radiation exposure (EP, simple and complex devices; 41.05 ± 12.18 vs 2.02 ± 2.6; 12.46 ± 15.11 vs 3.73 ± 3.14 and 28.70 ± 21.85 vs 10 ± 8.85; < 0.0001, 0.0001, 0.0001) is attributable to change

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

in screening practice. No significant change in procedural complications was noted (p = 0.48, 0.6,0.52). Conclusions: Non-gridded single frame location fluoroscopy leads to significant reduction in radiation exposure. This is suitable for EP and device procedures wherein anatomical location of catheters is not affected by image quality. Reduction in radiation exposure can be achieved by using this technique without compromising the safety and effectiveness of the procedure. 16-6 Abstract 05-10 ALTERING INTER-ELECTRODE DISTANCE, BUT N O T O R I E N TAT I O N , A F F E C T S B I P O L A R ELECTROGRAM MORPHOLOGY Vignesh Dhileepan 1, Konstantinos N Tzortzis 1, Ian Mann 1, Norman A Qureshi 1, Elaine Lim 2, Prapa Kanagaratnam 1, André R Simon 3, Chris D Cantwell 1, Nicholas S Peters 1, Rasheda A Chowdhury 1 1 National Heart and Lung Institute, Imperial College London, London, United Kingdom, 2 Imperial College Healthcare NHS Trust, London, United Kingdom, 3 Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom Background: Morphology of bipolar extracellular electrograms (EGMs) is currently categorised in the clinical setting using binary descriptors. Targeting ablations based on these simplistic descriptors has not improved therapeutic efficacy. To fully utilise EGM morphology, firstly the effects of physical electrode configurations need to be better understood. This study aimed to compare calculated and physical bipolar EGMs, and the effect of both interelectrode distance and orientation relative to wavefront angle on bipolar EGM morphology. Methods: Unipolar and bipolar EGMs, recorded with various inter-electrode distances and orientations, were obtained from six ex-vivo failing human myocardial slices using micro-electrode arrays and from the atria of a patient with persistent atrial fibrillation undergoing wide-area circumferential ablation, post-cardioversion. EGMs were analysed using an inhouse automated detection algorithm for nine EGM features. For inter-electrode distance, five EGMs were analysed per slice (n = 30) from the ex-vivo data, and six EGMs (n = 6) were analysed from in-vivo data. For inter-electrode orientation, 32 EGMs were analysed per slice from the ex-vivo data (n = 192). The nine EGM features were then correlated against inter-electrode distance and orientation. Results: Physical and calculated bipolar EGMs from in vivo were equivalent (n = 9, mean correlation coefficient 0.94 ± 0.05). In both in vivo and ex vivo, inter-electrode distance correlated positively with

S79

fractionation index (ex vivo: r2 = 0.42, < 0.001; in vivo: r2 = 0.66, p = 0.048) and logarithmic energy entropy (ex vivo: r2 = 0.49, < 0.001; in vivo: r2 = 0.98, < 0.001), and negatively with inter-peak gradient (ex vivo: r2 = 0.42, < 0.001; in vivo: r2 = 0.82, p = 0.013) and dominant frequency (ex vivo: r2 = 0.27, p = 0.003; in vivo: r2 = 0.73, p = 0.031). Larger distances trended towards the values for unipolar EGMs. Counterintuitively, no correlation was found between inter-electrode orientation and any features of EGM morphology. Conclusion: This study showed that calculated and physical bipolar EGMs are equivalent. Importantly, altering inter-electrode distance, but not orientation, affected bipolar EGM morphology. Therefore, inter-electrode spacing should be considered when selecting electrode types. The physical characterisation of electrode configuration can inform future studies which aim to model the relationship between tissue electro-architecture and EGM morphology. 16-7 Abstract 07-19 H E A R T FA I L U R E P H E N O T Y P E S C A N B E PREDICTED IN EX VIVO HUMAN CARDIAC TISSUE SLICES USING ELECTROGRAM MOR PHO LO GY A ND MAC HINE LEAR NING ALGORITHMS Konstantinos Tzortzis 1, Andre Simon 2, Filippo Perbellini 1, Cesare Terracciano 1, Rasheda A. Chowdhury 1, Nicholas S. Peters 1, Chris D. Cantwell 1 1 Imperial College London, London, United Kingdom, 2 Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom Background: The contact electrogram (EGM) is routinely used to guide treatment strategies often with less than adequate outcomes. The wealth of information encoded into the EGM has been binarised into simple and complex, leaving the EGM an under-utilised tool. Extraction of further electrogram features could lead to more efficient predictive diagnostic tools. As proof of concept of the diagnostic capabilities of machine learning applied to the contact electrogram, we assessed if heart failure phenotypes can be predicted in ex vivo adult human heart slices using the EGM morphology. Methods: Left ventricular slices with 300 μm thickness were obtained from the epicardial surface of human end-stage heart failure transplants (N = 21). EGM recordings were collected using microelectrode arrays (8 × 8 electrodes/100 μm diameter/ 700 μm spacing). One frequency-domain, 17 time-domain and 7 time-frequency domain EGM features were analysed. Bagging ensemble method was applied on a training dataset to distinguish 225 EGMs according to

S80

patients’ clinical condition followed by evaluation of the prediction model. Results: EGM data were classified according to the aetiology: ischaemic heart disease, dilated c a r d i o m y o p a t h y, h y p e r t r o p h i c c a r d i o m y o p a t h y. Automated feature selection process indicated that dominant frequency, QS interval and the signal frequency at maximum energy levels could be used for classification training. A prediction model was extracted with 92.4% sensitivity, 93.2% specificity 92.7% positive predictive value and 91.9% negative predictive value. The same heart diseases were correctly predicted with 90.2 and 91% specificity during the evaluation of prediction model using an independent EGM test dataset. Conclusion: This proof-of-concept machine learning analysis shows that clinical conditions can be successfully predicted using a combination of domain- and frequency-analysis EGM morphology features when data are obtained from ex vivo human ventricular slices. Such algorithms may be of benefit to clinical electrophysiology applications.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Real-time recordings during the ablation process defined lesion formation. Notably, lesion growth was heterogeneous, with rapid changes in ultrasonic appearance localised to tendril-like regions. Conclusion. We present the first video-rate, depth-resolved 2D images of RF ablation during treatment acquired through all-optical ultrasound imaging. Heterogeneous lesion formation was noted, in contrast to often assumed lesion homogeneity. Optical ultrasound is a promising new method for optimising ablation delivery.

16-8 Abstract 28-13 16-9 Abstract 23-24 DEPTH-RESOLVED, REAL-TIME AND VIDEO-RATE IMAGING OF RADIOFREQUENCY ABLATION LESIONS Erwin J. Alles 1, Richard J. Colchester 1, Yousuf Makki 1, Sacha Noimark 1, Edward Z. Zhang 1, Paul C. Beard 1, Ivan P. Parkin 1, Malcolm C. Finley 2, Adrien E. Desjardins 1 1 University College London, London, United Kingdom, 2 St Bartholomew’s Hospital and Queen Mary University of London, London, United Kingdom Background. Real-time ultrasound imaging of the formation of radiofrequency ablation lesions is severely limited by RF noise, electrical interference, low bandwidths and poor tissue contrast. We developed an entirely new method of ultrasound imaging using lasers to generate and receive ultrasound. Insensitive to electromagnetic interference, this system is ideally suited to visualisation of RF ablation lesion delivery. Methods. The benchtop alloptical imaging system comprises a pulsed laser, scanning across a nanocomposite membrane optimised for photoacoustic ultrasound generation (transmitter), and a second tunable laser interrogating a miniature (125 μm diameter) fibre-optic ultrasound receiver. This permitted synthesis of an optimised broad aperture, and real-time processing and image reconstruction were performed in parallel processes. Lesion formation was imaged during ablation (max. 30W, 65 °C, 60 s) in both homogeneous (poultry breast) and inhomogeneous (swine belly) samples. Results. Sustained frame rates of 9 Hz, depth BB 15mm, and isotropic resolution ~ 100 μm were achieved.

INTRA-OPERATIVE ANGIOVAC AS A TOOL IN D I F F E R E N T I AT I N G V E G E TAT I O N V E R S U S THROMBUS TO PREVENT UNWARRANTED LEAD EXTRACTION Miguel Leal 1, Jill Triphan 1, Anne Barnett 1, Micah Roberts 1, Graham Adsit 1, Amanda Breuer 1, Kurt Jacobson 1 1 University of Wisconsin, Madison, United States Introduction: Transesophageal (TEE) and transthoracic (TTE) echocardiography have a major role in the diagnosis of infective endocarditis. However, neither TTE nor TEE imaging is 100% sensitive or specific and repeat studies may be necessary in complex clinical scenarios. The results must always be interpreted in the context of the clinical presentation (pre-test probability). Case Report: We report a complex case that involved a 43-year-old acutely ill female whose medical history included Turner’s syndrome, partial AV canal defect (statuspost repair as a child), cleft mitral valve, non-ischemic cardiomyopathy associated with biventricular failure (NYHA functional class IV), persistent left superior vena cava (SVC), atrial fibrillation, complete heart block, original pacemaker implant in 1978 and subsequent upgrade to a biventricular defibrillator in 2009. The patient recently underwent bi-atrial orthotopic heart transplant during which the four previously implanted leads were cut at the level of the SVC and left in place. The patient had a prolonged post-operative course with positive sputum cultures (Pseudomonas and MRSA). Blood cultures remained negative. TTE and TEE imaging revealed a new large mobile mass associated with lead remnants just distal

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

to the SVC-RA junction (thrombus versus vegetation). Given the gravely ill state of the patient, she was taken to the Hybrid Room. AngioVac was used to aspirate the mass under TEE and fluoroscopy guidance. The retrieved material was sent to stat laboratory evaluation (GRAM staining), which indicated that the sample was negative for organisms and likely thrombotic in nature. Laser-assisted lead extraction of the leads was not deemed necessary. Blood cultures obtained on postoperative day 1, 7 and 14 remained sterile. Conclusion: The use of intra-operative AngioVac may be useful to help determine if intracardiac masses represent thrombi versus vegetations, which can potentially avoid unwarranted high-risk procedures with significant morbidity and mortality.

S81

YELLOW (potential clinical impact) and RED (immediately clinically actionable). A comprehensive analysis of the data collected was broken down by device type. Results: 1441 patients were followed. 719 (49.9%) transmissions were due to patient activation. Other downloads were due to routine scheduled remote follow up. 1247 total transmissions were received during the study period. There were 253 (17%) ICDs, 682 (47%) PMs, 182 (12.6%) BIV ICDs 37 (2.6%) BIV PMs and 237 (16.4%) ILR devices followed. There were 7 RED alerts noted and all were generated by either ICDs or BIV ICDs. 6 of 7 were due to VF or VT. 1/7 was due to an abnormal lead impedence. There were 387 YELLOW alerts and 342 (88.4%) were generated from data derived from ILRs. Of the ILR YELLOW alerts, 179 (52%) were false positives. Other YELLOW alerts were generated from 10 (2.5%) PMs, 11 (2.8%) ICDs and 23 (5.9%) BIVICDs. Conclusions: Remote monitoring of devices has become a major challenge for cardiac device clinics. Data over the last decade has made it clear that robust remote monitoring can improve outcomes in cardiac device patients. Using a software-based data management system can assist clinics in managing device patients. While all devices generate data, ILR devices generate a larger proportion of alerts that must be reviewed and adjudicated by a clinician and many of these alerts are due to false positives. The use of Artificial Intelligence and Machine learning can allow clinicians to better manage a device clinic and streamline workflow.

16-10 Abstract 05-12 16-11 Abstract 25-13 THE UTILITY OF SOFTWARE-BASED ARTIFICIAL INTELLIGENCE REMOTE MONITORING DATA MANAGEMENT SYSTEMS IN CIED CLINICS Kevin Campbell 1 1 PaceMate, Raleigh, United States Introduction: Remote monitoring has been proven to reduce hospitalizations, prevent AF-related strokes and reduce mortality. Currently, most remote monitoring is performed manually, and workflow is often complicated. Physicians face challengs in managing the large volume of data and to date, there are no comprehensive solutions. Objectives: We suggest that an automated, software-based solution that employs artificial intelligence (AI) and machine learning may allow providers to better adjudicate resources and provide more efficient care. Methods: Data from 1441 CIED patients followed by PaceMate data management software was evaluated from October 2017 to November 2017. Data from devices was compiled and the numbers of events and downloads was evaluated. PaceMate software classifies downloaded events into

WHEN TO STOP PULLING DURING PERCUTANEOUS LEAD EXTRACTION: ROLE OF COLLABORATIVE MULTIDISCIPLINARY TEAM APPROACH Gurjit Singh 1, Marc K Lahiri 1, Arfaat Khan 1, Waddah Maskoun 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States Background: Pacemaker and ICD leads are usually extracted safely with percutaneous approaches using mechanical and laser tools. Open surgical extraction is usually not required to high success rates of percutaneous approach. Objectives: To highlight risks and limitations of percutaneous lead extraction methods and need for converting the procedure to an open surgical extraction Methods: N/A Results: A 65-year-old female with hypertension, diabetes mellitus, and ischemic cardiomyopathy was transferred for ICD lead extraction due to persistent MSSA bacteremia after failing intravenous antibiotics course. TEE revealed vegetations on 20-year-old dual

S82

coil defibrillator lead in the SVC region and tricuspid valve region (Fig. A). Binding sites were lased with a 16 Fr Spectranetics ® sheath until significant resistance was noted at the level of low right atrium and tricuspid valve. Patient became hypotensive and developed ventricular arrhythmia requiring external defibrillation during attempts to advance the laser and mechanical sheaths when intra-procedural TEE showed obliteration of RV inflow due to lead adhesion at the tricuspid valve level (Fig. B). Further percutaneous attempts were abandoned due to risk of perforation and severe valve damage and patient underwent successful open surgical extraction (Fig. C). Conclusion: This case highlights presence of significant adhesions with long dwelling ICD leads at the level of tricuspid valve and low right atrium thus limiting safe removal using percutaneous techniques and importance of intraprocedural TEE with timely switch to open surgical procedure in a non-emergent fashion.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

parameter rather than point estimates. We hypothesised that ABC can be used to parameterise a new full cell model of heterogeneous HL-1 myocytes with uncertainty quantification. Methods: Experimental patch clamp data measuring HL-1 ion channel dynamics were extracted from published sources. Ion channel equations were adopted from popular cell models and their parameters fit to data using the ABC approach, and then combined to build the full cell model. Uncertainty in model outputs was assessed by taking random draws from parameter distributions for each simulation run. These were compared to measurements of action potentials by patch clamp in our homogeneous subclone of the HL-1 cell line: HL1-6 myocytes. Results: The eight ion currents fit by ABC showed close agreement with patch clamp data and small uncertainties for steadystate dynamics. However, the method highlighted that available data was insufficient to fit temporal dynamics. The range of potential outputs in the full model confirms the heterogeneity in the original HL-1 cell line. We show the true model for homogeneous HL1-6 subclone exists within this population of outputs (Fig. 1). Conclusion: This study applies a machine learning technique as an informative fitting method for action potential models. The work represents a first step towards uncertainty quantification in full heart models, which is critical to ensure confidence in clinical decision-making informed by computer simulations.

Mechanisms or triggers of cardiac arrhythmias 16-12 Abstract 01-24 QUANTIFYING UNCERTAINTY IN A FULL ACTION POTENTIAL MODEL USING MACHINE LEARNING INFERENCE Charles Houston 1, Rasheda A Chowdhury 1, Fu Siong Ng 1, Nicholas S Peters 1, Emmanuel Dupont 1, Chris D Cantwell 1 1 Imperial College London, London, United Kingdom Background: Mathematical models of single cell action potentials are a key component of cardiac electrophysiology computer simulations. Parameters in these models are typically fit to data using techniques that do not account for uncertainty, which has led to discrepancies between models of the same cell type. Approximate Bayesian computation (ABC) is a statistical inference method that provides additional information on uncertainty in a parameter fit, by producing distributions for each

16-13 Abstract 01-20 IN REAL TIME SIMULATIONS OF IONIC MODELS FOR THE STUDY OF DEFIBRILLATION IN 2D AND 3D Yanyan Ji 1, Abouzar Kaboudian 1, Flavio Fenton 1 Georgia Institute of Technology, Atlanta, United States

1

Background. Simulations of complex ionic cell models (over 20 variables) in 2D and 3D have been restricted mostly to the few cardiac groups who have access to large

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

clusters or super-computers. We present for the first time the possibility of performing defibrillation simulations at close to real time with some of the most complex ionic models such as the TNNP human model in large 2D and 3D ventricular or atrial structures using a simple PC with high end graphic cards. Methods. To achieve real-time simulations on large 2D domains as well as 3D realistic heart geometry, Web Graphic Library (WebGL), a new parallel GPU programing language, is used to implement models such as the human ventricular model (Ten Tusscher et al. 2012) on 2D and 3D domains. In the 2D simulation, a square domain with multiple unexcitable circles randomly distributed represents a slice of cardiac tissue with lowconductive blood vessels. The size distribution of blood vessels follows a power law obtained from experiments. The 3D simulation runs on accurate structure of canine left ventricles with coronary vessels obtained through micro-CT scans at 25 microns resolution. In both 2D and 3D simulations, shocks are simulated from parallel plane electrodes. We also implemented simulations where the shocks are delivered by one-point electrode and one surface electrode with a plane/convex/concave shapes to investigate the improvement of defibrillation driven by different possible clinical settings. Results. We first validate our simulations by verifying that excitations generated from single shocks, as a function of electric field strength, propagate through the entire domain (activation time) following the same power law as measured in optical mapping experiments. We then verify that single defibrillation sock follows a sigmoidal success curve centered close to 5 V/cm as in experiments. Because these programs run in parallel on graphic cards via a web-browser, all these simulations can be interactive and visualized at the same time. Furthermore, they do not need to be compiled and can be run by virtually anyone on a desktop, independent of operating systems. These programs can be used to study defibrillation protocols/methods including electrode positions and configurations and multi pulses with low energy defibrillation among others. Conclusion. We achieved real-time simulation on 2D and 3D domain using WebGL to reproduce important characteristics in defibrillation experiments such as activation time and defibrillation success rate. Parameters such as electrode shapes can be modified to improve defibrillation performance. 16-14 Abstract 01-10 ACUTE ALCOHOL CONSUMPTION AND EFFECTS ON CARDIAC EXCITATION, CONDUCTION, AND R E P O L A R I Z AT I O N — R E S U LT S F R O M T H E MUNICHBREW STUDY Moritz Sinner 1, Cathrine Drobesch 1, Rebecca Herbel 1, Konstantinos Rizas 1, Steffen Massberg 1, Stefan Kääb 1, Stefan Brunner 1 1 Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Germany

S83

Background Prospective evidence for alcohol induced Holiday Heart Syndrome is sparse. The recent MunichBREW Study described a significant increase in arrhythmias with higher acute alcohol intake. Here, we quantitatively characterize this influence on cardiac excitation (heart rate), conduction (PQ, QRS), and repolarization (QTc). Methods At the 2015 Munich Octoberfest, we examined 3042 voluntary participants by digital 30 s lead I electrocardiograms (ECGs), breath alcohol concentration (BAC) measurements, and questionnaires. Two trained readers analyzed all ECGs. We fitted linear regression models to examine the relation of ECG measures and BAC, adjusting for age, sex, country of origin, history of heart disease, use of cardiovascular and antiarrhythmic drugs, and active smoking status. Results After exclusions, 3012 individuals were analyzed. The mean age was 35 ± 13years, 30% were women, and the mean BAC was 0.85 ± 0.54 g/kg (range 0–2.94 g/kg). The mean heart rate was 91 ± 16 bpm (range 52–152 bpm), the mean PQ intervals was 135 ± 27 ms (range 66–279 ms), the mean QRS duration was 115 ± 21 ms (range 64–243 ms), and the mean Fridericia adjusted QTc was 382 ± 29 ms (range 261–726 ms). Linear regression revealed no significant relation between BAC and PQ, QRS, or QTc, but confirmed a significant association of heart rate with BAC (relative risk 5.4, 95% confidence interval 4.4–6.4, < 0.0001). The relation is visualized in the figure by the predicted heart rate for each BAC (line and 95% confidence interval bands), indicating a continuous increase in heart rate with increasing BAC. Discussion Increasing acute alcohol intake appears not to affect cardiac conduction and repolarization, but significantly increases cardiac excitation, reflected by a continuous rise in heart rate. Our results consistently quantify the MunichBREW Study results. There, BAC associated dichotomous sinus tachycardia was possibly mediated by an alcohol dependent increase in sympathetic tone. Further analyses need to quantitatively assess heart rate variability markers to support this relation.

S84

16-15 Abstract 04-10 ANXIOUSHEART: WHEN BOTH CARDIAC AND ANXIOUS DISEASES MEET Valérie Long 1, Marie-Claude Guertin 1, Katia Dyrda 1, Judith Brouillette 1 1 Montreal Heart Institute, Montreal, Canada Background. Anxiety disorders have received less attention than depression in cardiac patients but are of clinical importance since they are associated with negative cardiac prognosis. The present study aims to (1) evaluate the proportion of patients referred by a cardiologist for depressive or anxious symptoms that receive a concordant diagnosis by the psychiatrist, (2) compare the distribution of various anxious disorders in cardiac patients followed in a psychosomatic clinic vs in the general population, and (3) assess whether there are specific associations between cardiovascular diseases (CVD) and anxiety disorders. Methods and Results. The records of 450 patients referred to the psychosomatic clinic of the Montreal Heart Institute (MHI) were reviewed. Seventy-six percent of patients referred for anxiety received a concordant diagnosis while only 51% of those referred for depressive symptoms did. Of the 335 patients with CVD (coronary heart disease, heart failure, arrhythmia), 102 suffered from the following anxious disorders (49, panic disorder; 44, generalized anxiety disorder (GAD); and 9, posttraumatic stress disorder (PTSD)), while 50 patients had depression. The distribution of the types of anxiety studied here was different than that of the Canadian population (< 0.0001). The type of CVD had no impact on the type of anxiety, but congenital disease was more strongly associated with GAD. Interpretation. Anxiety disorders were twice more frequent than depression in cardiac patients referred to the MHI psychosomatic clinic. To our surprise, PTSD was underrepresented. This study will help the elaboration of interventions directed to improve the detection of cardiac patients suffering from anxiety. 16-16 Abstract 15-52 DOES PULMONARY VEIN SLEEVE SIZE C O R R E L AT E W I T H L O C ATI O N O F FO C A L TRIGGERS FOR ATRIAL FIBRILLATION? James Gabriels 1, Jonah Zeitlin 1, Mohammad Khan, 1, Haisam Ismail 1, Bruce Goldner 1, Ram Jadonath 1, Apoor Patel 1, Stuart Beldner 1 1 North Shore University Hospital - Northwell Health, Manhasset, United States

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Background: Ectopic foci originating from sleeves of myocardial tissue within the pulmonary veins (PV) are well-established triggers for atrial fibrillation (AF). The site of PV trigger(s) for atrial fibrillation likely is directly related to pulmonary vein size as the PV sleeve area determines the amount of automatic myocardial tissue. Methods: Twenty consecutive patients undergoing an initial radiofrequency ablation of AF with intracardiac echocardiography images sufficient for identification of the ostia and measurement of PV diameters were included. These images were fused with 3D mapping and ostia were tagged with 3D markers. PV length was measured by advancing the ablation catheter into the superior aspect of the superior veins and inferior aspect of the inferior veins. PV index (PVI) was calculated by multiplying the ostial diameter by the PV length. Results: The left superior (LS) PV had the largest PVI in 12 (60%) of patients. This was followed by the right superior PV in 6 (30%), the left inferior (LI) PV in 2 (10%), and right inferior (RI) PV in 0 patients. The RIPV had the smallest PVI in 14 (70%) patients while the LIPV had the smallest in the remaining 6 (30%) patients. This population was comprised of 75% males with a mean age of 58.6 ± 8.5 years. Of these patients, 60% had paroxysmal AF, 70% had hypertension, 60% had hyperlipidemia, 20% had diabetes, and 5% had one of the following: coronary artery disease, peripheral vascular disease, or a prior stroke. Their mean ejection fraction was 59.6 ± 7.8%, mean left atrial (LA) size was 4.1 ± 0.6 cm, and mean LA volume index was 32.9 ± 8.8 ml/m2. Seventy-five percent of patients had mild mitral regurgitation (MR) with the remaining 25% having moderate MR. Conclusions: In a patient population similar to that described in other studies of AF, the LSPV had the largest PVI in 60% and the RIPV had the smallest PVI in 70% of patients. Previous studies have shown that the LSPV is the most common and RIPV is the least common site for PV triggers. This may be a function of the amount of excitable tissue in the vein sleeves. Patients with smaller PV sleeves may require ablation strategies that include the posterior wall and other non-PV triggers. Further work is needed, in a larger cohort of patients, to confirm these findings. Chaired Poster Session A part 2 Sunday April 15, 2018, Posters displayed from 08:30 am–12:00 pm

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S85

Presenters and Chairpersons present from 10:30 am– 12:00 pm ROOM TERNES Genetics aspects of cardiac arrhythmias 16-17 Abstract 01-22 V I S U A L I S I N G F U N C T I O N A L R O TAT I O N A L ACTIVITY AT SINGLE-CELL RESOLUTION IN HL1-6 MYOCYTES Charles Houston 1, Konstantinos-Nektarios Tzortzis 1 , Caroline Roney 2, Freddie Sasada 1, Andrea Saglietto 1, Prapa Kanagaratnam 1 , David S Pitcher 1 , Rasheda A Chowdhury 1, Fu Siong Ng 1, Chris D Cantwell 1, Nicholas S Peters 1, Emmanuel Dupont 1 1 Imperial College London, London, United Kingdom, 2 King's College London, London, United Kingdom Background: Mechanisms underlying fibrillation are poorly understood. Functional rotational activity is a potential driver but studying its conduction patterns in detail pushes imaging technology to its limit. Reduced conduction velocity in functionally homogeneous HL1-6 myocytes enables recording of propagation at single-cell resolution in the absence of structural obstacles. We hypothesised that rotational activity can be a purely functional mechanism and studied the core of this activity at single-cell resolution. Methods: Rotational activity in monolayers (diameter 2–4 mm) of HL1-6 myocytes was visualised on a high aperture × 10 magnification lens at 100FPS. Ca2+ transients were recorded using Fluo-4 and action potential presence confirmed by simultaneous optical mapping with Di-8-ANEPPS. Stability was tested by depolarising cells with K+ solution and checking for reappearance at the same location after return to medium. Cores were characterised by processing recordings to generate heatmaps showing conduction slowing/block. Cell morphology was captured by live-staining membranes with WGA. Results: All rotational activity (n = 9) remained in the same location for the recording duration (10 s) and time to visually track cores (up to several minutes). Cores were characterised by lines of conduction slowing/block connecting small groups of cells. Cells within cores showed either no periodic Ca2+ transients or appeared to fire at double the rotation rate. Rotational activity never reappeared in the same location after depolarisation; experiments either showed rotational activity at another location (56%), only trigger activity (33%) or no activity after depolarisation (11%). Conclusion: This study characterises the core of rotational activity at single-cell resolution in a functionally homogeneous system. It reveals this activity manifests at lines of conduction block/ slowing in the core which are not a permanent obstacle in the monolayer. The work highlights the importance of study at single-cell resolution in understanding drivers of fibrillation.

16-18 Abstract 01-27 MACHINE LEARNING UNRAVELS THE CELLULAR DETERMINANTS OF ELECTROGRAM MORPHOLOGY USING CONVOLUTIONAL NEURAL NETWORKS Yumnah Mohamied 1, Konstantinos N. Tzortzis 1, Rasheda A. Chowdhury 1, Chris D. Cantwell 1, Anil A. Bharath 1, Nicholas S. Peters 1 1 Imperial College London, London, United Kingdom The interaction of cellular electrophysiology and myocardial architecture manifests itself in the morphology of the contact electrogram, but the relationship between characteristics of the electrogram and its cellular determinants is poorly understood. Clinical classification of electrograms remains largely binary (simple or fractionated), overlooking a wealth of information that could improve arrhythmia diagnosis and treatment. In this study, we explore the potential of machine learning, and specifically convolutional neural networks, to elucidate the information

S86

present in electrogram signals by identifing characteristics associated with specific cellular abnormalities; consequently, to classify abnormalities present in electrograms. Previous work collected 10-s recordings of extracellular unipolar electrograms in monolayers of cultured myocytes derived from primary neonatal rat ventricles and stimulated at 1 Hz using a microelectrode array system (8 × 8 electrodes/100 μm diameter/700 μm spacing). Gap junction cell-cell coupling was pharmacologically modulated using carbenoxolone (20 μM). Here, a preliminary convolutional neural network was designed and trained on 5520 randomly selected 1 s electrogram segments recorded from control cells (n = 6 monolayers) and reduced gap junction coupling cells (n = 6). Prediction accuracy was assessed using 112 unseen electrograms from both cell groups (n = 2). A convolutional neural network was successfully trained to predict with an accuracy of 85% whether an electrogram signal is derived from control or reduced gap junction coupling groups. Exploring the effect of network complexity by increasing the depth (from two to five convolutional layers) and the number of connecting artificial neurons within a layer (the network width), increased prediction accuracy to 95%. Our approach demonstrates that machine learning techniques can be used to predict the electrogram characteristics of at least one functional abnormality of cellular electrophysiology. Understanding the features of electrogram morphology identified by the network and extending to more classes of abnormalities (and subsequently to tissue and clinical data), will give mechanistic insight that can benefit catheter ablation procedures. 16-19 Abstract 01-13 MULTIPLE TIME- AND FREQUENCY-DOMAIN ELECTROGRAM FEATURES CHANGE WITH ADDITION OF FIBROBLASTS BUT NOT MYOFIBROBLASTS Efthyvoulos Sokratous 1, Konstantinos N. Tzortzis 1, Norman Qureshi 1, Prapa Kanagaratnam 1, Chris D. Cantwell 1, Rasheda A. Chowdhury 1, Nicholas S. Peters 1 1 National Heart and Lung Institute, Imperial College London, London, United Kingdom Background: Recent evidence has highlighted the importance of the cellular component of scar in cardiac disease. Fibroblasts can undergo a phenotypic shift during altered mechanical activations or in the presence of inflammatory mediators. Myofibroblasts, the result of this transition, have been shown to express increased levels of connexins 43 and 45. It is speculated that myofibroblasts can form gap-junctions and couple with myocytes more readily than fibroblasts. This in vitro study aims to assess the electrogram (EGM) morphology modifications due to increased myofibroblast presence compared to fibroblasts. Methods: Neonatal rat ventricular myocytes were seeded onto multielectrode arrays (MEAs; 8 × 8 electrodes/100 μm diameter/700 μm

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

spacing) in three groups: myocyte only (n = 3), natural composition of fibroblasts (NC; n = 7) and myofibroblast group (n = 4). EGMs from each group were analysed using automated algorithms for 17 time-domain and time-frequency domain EGM parameters. Results: Conduction velocity and amplitude were decreased by myofibroblasts whereas EGM duration was increased (Figure a). Six features were altered by fibroblasts, but not myofibroblasts: S width, R-/S- width ratio, R-width/EGM duration ratio, fractionation frequency, Shannon entropy, percentage of energy (Fig. b); and four were altered by myofibroblasts, but to a lesser extent than fibroblasts: RS interval, electrogram onset/Rpeak gradient, maximum modulus, variance of energy (Fig. c). Conclusions: Myofibroblasts are shown to alter EGM morphology. However, the number and extent of changes are less than those caused by fibroblasts. This suggests that myofibroblasts can partially normalise aspects of electrophysiology altered by fibroblasts. Low fractionation levels also support the speculation over stronger coupling between myocytes and myofibroblasts compared to fibroblasts. Activation of myofibroblasts may be an electrophysiological compensatory mechanism and may explain lack of correlation between scar and electrophysiological parameters.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S87

16-20 Abstract 01-18 COMPLEX ELECTRICAL DISORDER IN A PATIENT WITH PRKAG2 MUTATION Sarah Worsnick 1, Angela Naperkowski 1, Pugazhendhi Vijayaraman 1 1 Geisinger Health System, Plains, United States Case Study: Twenty-six-year-old male presented with syncope. Polymorphic VT required defibrillation. ECG showed transient Brugada pattern and episodes of sinus rhythm with wide LBBB (Fig. 1). ECG 2 years prior showed short QT with early repolarization changes. Echo, cath and cardiac MRI were normal. Dual chamber ICD was implanted, and low dose metoprolol was started. Recurrent ICD therapy was noted due to slow sinusoidal VF (Fig. 2). Cardiac monitoring showed slow VT and evidence for intermittent ventricular non-capture. Device log also showed high atrial and ventricular pacing burden. EP study demonstrated HV of 80 ms and increasing HV at HR of 120 bpm on isuprel. QT shortened from 540 ms at 50 bpm to 390 ms at 100 bpm. Genetic testing revealed PRKAG2 mutation—a rare autosomal dominant cardiac glycogenosis disorder. Cardiac PET scan demonstrated patchy LV uptake of FDG. While quinidine and mexiletine were ineffective, he has remained arrhythmia free for 15 months on a strict diet of high protein and low carbohydrates. Conclusions: This case represents PRKAG2 mutation associated with unusual complex electrical disorder resulting in intermittent sinus node, AV node dysfunction, abnormal His-Purkinje and intramyocardial conduction disorder with ventricular arrhythmias along with short QT and Brugada like EKG patterns.

16-21 Abstract 03-12 FATAL ARRHYTHMIAS ASSOCIATED WITH GENETIC VARIANTS IN TYPE 2 RYANODINE RECEPTOR CHANNEL GENE Minoru Horie 1 1 Shiga University of Medical Science, Otsu, Shiga, Japan Cardiac ryanodine receptor Ca releasing channel is encoded by RYR2 gene and is expressed on the membrane of sarcoplastic reticulum (SR), an intracellular organella containing millimolar order of calcium. RYR2 is one of largest genes, encompassing 105 exons on chromosome 1q43. In collaboration with L-type Ca channel, the channel opens and releases Ca ions into the cytoplasm which then triggers the cellular contraction. The ryanodine channel is therefore a key player to maintain healthy Ca dynamics. Its malfunction has been shown to cause a variety of atrial or ventricular arrhythmias associated with abnormal intracellular Ca handling such as heart failure. For last decade, genetic RYR2 variants have been shown to result in several fatal inherited arrhythmic and abnormal structural diseases: (1) catecholaminergic polymorphic ventricular tachycardia (CPVT1), (2) arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C type 2), (3) left ventricular non-compaction (LVNC) or “spongy” heart, and very recently (4) short-coupled variant of torsade de points (ScTdP1). ScTdP presents a bizarre form of polymorphic VT triggered by premature ventricular contractions with an extremely short-coupling interval in normally-structured hearts. It is considerably difficult to record its VT initiation unless patients undergo ICD therapy as a secondary prevention. Among those cases, we experienced a 13-year-old boy with typical ScTdP, in whom a heterozygous RYR2 mutation, p. Ser4983Phe was identified. The mutation was novel and located in the very last C-terminus in the cytoplasmic region. In order to study the genotype-phenotype relation, we constructed the heterologous expression system with wild type

S88

and mutant ryanodine channel by using HEK293 cells and conducted simultaneous Ca monitoring in both cytosol and the endoplasmic reticulum (ER corresponding to SR in humans). Ca-dependent tritium-binding activity was also measured as a total capacity of Ca release. As the result, p. Ser4983P mutant showed a severe loss-of-function and impaired Ca release from ER compared to those in wild type channel. Mechanisms underlying the loss-of-function RYR2 mutation and occurrence of ScTdP remain unknown; however, overall diastolic Ca concentration in ER with the mutant RYR2 was significantly higher indicating a Ca overloading condition, which may induce a triggered activity (afterdepolarizations). Further experiments using experimental animal or iPS cell models based on our results are definitely required especially for the search of potential drugs to treat fatal arrhythmias associated with SR Ca overloading.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

entire gene deletions (PKP2 and DSP) and one a DSG2 missense variant. In contrast, inherited variants were often splicesite (46%), premature terminating (37%), or missense (11%) changes. Eleven (6%) were deletions larger than one exon. Five Dutch PKP2 variants shared six haplotypes. Two of these (c.235CBBT and c.2146-1GBBC) were also shared with US patients, suggesting common founders. Conclusion: Desmosomal gene mutations underlying ARVC are rarely de novo, and when de novo disproportionately involve whole gene deletions. Variants identified more than once are likely founder mutations. Most desmosomal mutation carriers have inherited their mutation, even in the absence of family history. This highlights the importance of testing seemingly healthy family members and using genetic tests that can also identify large deletions. 16-23 Abstract 03-14

16-22 Abstract 03-13 IS ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY (ARVC) ALWAYS FAMILIAL? A S Y S T E M I C E VA L U AT I O N O F D E N O V O MUTATIONS IN A LARGE TRANSATLANTIC ARVC REGISTRY Freyja van Lint 1, Crystal Tichnell 2, Brittney Murray 2, Sven Dittmann 3 , Birgit Stallmeyer 3 , Hugh Calkins 2 , Jan Jongbloed 4, Jasper van der Smagt 5, Ronald Lekanne Deprez 1, Eric Schulze-Bahr 3, Dennis Dooijes 5, Paul van der Zwaag 4, Peter van Tintelen 1, Cynthia James 2 1 Academic Medical Center, Amsterdam, Netherlands, 2 Johns Hopkins University, Baltimore, United States, 3 University Hospital Münster, Münster, Germany, 4 University of Groningen, Groningen, Netherlands, 5 University Medical Center, Utrecht, Netherlands Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with mutations in genes encoding the cardiac desmosome. ARVC is generally autosomal dominantly inherited but may also result from a de novo mutation. Purpose: We aim to give a first description of the prevalence and characteristics of de novo desmosomal mutations. Methods: We identified 172 index patients (75 Dutch) who met 2010 ARVC Task Force Criteria, carried pathogenic/ likely pathogenic desmosomal variants, and whose family had undertaken genetic cascade screening. Variant inheritance was assessed by pedigree analysis. Haplotyping was conducted for five PKP2 variants (c.2386TBBC, c.1848CBBA, c.397CBBT, c.235CBBT, c.2146-1GBBC). Results: Patients were predominantly male (66%). Half (52%) had no affected family members. Most had one pathogenic variant (157 PKP2, 7 DSP, 6 DSG2, 1 DSC2); one had variants in PKP2 and DSP. Three (1.7%) variants were de novo: two involved

ENPEP RS10004516 VARIATION IS ASSOCIATED WITH ATRIAL FIBRILLATION RISK Irina Rudaka 1, Dmitrijs Rots 2, Arturs Uzars 2, Oskars Kalejs , Linda Gailite 2 1 Faculty of Continuing Education, Riga Stradiņš University, Riga, Latvia, 2 Scientific Laboratory of Molecular Genetics, Riga Stradiņš University, Riga, Latvia, 3 Pauls Stradiņš Clinical University Hospital, Riga, Latvia 3

Introduction. It is known that atrial fibrillation (AF) has a heritable component. The most significantly associated locus is 4q25, located approximately 170 kilobases upstream of PITX2 gene. However, the relation of 4q25 and PITX2 is still under investigation. The next closest gene to 4q25 is ENPEP. To our knowledge, this is the first attempt to investigate potential association of current variation and risk of AF. Aim. The aim of the study was to determine whether genetic variant ENPEP rs10004516 is associated with risk of AF development. Material and methods. We enrolled 196 non-valvular AF patients and 91 control persons into the study. We extracted DNA from periferal blood samples using commercially available kit innuPREP Blood DNA Mini Kit (Analytik Jena AG, Germany) and performed genotyping of ENPEP rs10004516 by PCR-RFLP assay. Statistical analysis was performed in SPSS 20.0. Results. Genotype of ENPEP rs10004516 was found to be associated with lower risk of AF development in three models of inhertitance: in additive model OR = 0.379, 95% CI = 0.257–0.561, < 0.001; in dominant model OR = 0.354, 95% CI = 0.212–0.592, < 0.001 and in recessive model OR = 0.120, 95% CI = 0.046–0.313, < 0.001. After adjusment for potential confounders (gender, age, presence of coronary heart disease, cardiomyopathy, diabetes, chronic kidney disease), the association maintained statistical significance: in additive model OR = 0.389, 95% CI =

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

0.249–0.606, < 0.001; in dominant model OR = 0.344, 95% CI = 0.192–0.616, < 0.001 and in recessive model OR = 0.05, 95% CI = 0.05–0.43, < 0.001. Conclusion. Variation ENPEP rs10004516 is strongly associated with lower risk of atrial fibrillation development. Channel currents and biological markers in atrial fibrillation 16-24 Abstract 15-53 ELECTROPHYSIOLOGICAL PROPERTIES OF A SELECTIVE IK,ACH INHIBITOR IN AN EQUINE, ATRIAL-TACHYPACING-INDUCED MODEL OF PERSISTENT ATRIAL FIBRILLATION Merle Friederike Fenner 1 , Eva Hesselkilde 1 , Helena Carstensen 1, Sarah Nissen 1, Christine Lunddahl 1, Maja Jensen 1, Ameli Loft-Andersen 1, James Milnes 2, Stefan Sattler 3, Thomas Jespersen 4, Rikke Buhl 1 1 Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 2 Xention Ltd., Cambridge, United Kingdom, 3 Rigshospitalet, Department of Cardiology, Copenhagen, Denmark, 4 Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Background: Current antiarrhythmic drugs for treatment of atrial fibrillation (AF) are typified by either poor efficacy or serious adverse effects, including ventricular proarrhythmia. The G-protein gated acetylcholine-activated potassium current (IK,ACh) participates in the late repolarization of the atrial action potential and pharmacological inhibition is reported to prolong the atrial refractory period (aERP). Selectively targeting atrial IK,ACh is expected to yield new effective therapies with a low risk of ventricular pro-arrhythmia. Objective: This study examined whether the IK,ACh inhibitor, XAF-1407, can terminate persistent AF in a newly established equine model of long-term AF, that recapitulates features of this human disease. Methods: Atrial fibrillation was induced by atrial-tachypacing through implanted ICD units in 11 healthy Standardbred mares (age 7 ± 3 years). Following a safety assessment with XAF-1407 (up to 9 mg/kg), 3 mg/kg IV were administered at baseline and 1, 3, 9, 15 and 27 days following AF induction, to attempt cardioversion. Dependent upon successful cardioversion, aERP was measured and AF re-induced. Remodeling was assessed by AF cycle length (AFCL). Possible effects on atrioventricular conduction were taken into account by measuring heart rate, QRS and QTc duration. Results: All horses were in self-sustained AF after 5 ± 3 days of

S89

tachypacing and AFCL decreased over time. XAF-1407 cardioverted all horses on day 1 and 3, 9/11 on day 9, 8/11 on day 15 and 5/11 horses on day 27. XAF-1407 significantly increased aERP at basic cycle length of 1000 ms, 800 ms (< 0.05) at baseline. No changes in aERP after cardioversion from AF and no cardiovascular or clinical side effects, apart from a transient increase in heart rate at end of drug infusion (CI 95% = [3.16;11.59]; < 0.05) were observed. Conclusion: Inhibition of atrial IK,ACh prolongs aERP without observed ventricular side-effects, confirming the atrial-specificity of this potassium current. XAF-1407 is able to abrogate AF in this equine model, but its efficacy decreases with AF duration. It therefore still remains questionable whether blocking this current is superior to the currently available treatment modalities. 16-25 Abstract 15-16 EXPRESSION LEVEL AND STRUCTURAL CHANGES IN THE EQUINE HEART FOLLOWING ATRIAL FIBRILLATION Ditte Dybvald Kruse 1, Eva Zander Hesselkilde 2, Helena Carstensen 2, Rikke Buhl 2, Thomas Hartig Braunstein 1, Thomas Jespersen 1 1 Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 2 Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Atrial fibrillation (AF) is a frequent arrhythmia in both human and horse. In horses, AF appears spontaneously, in particular on highly trained horses, where it is associated with reduced performance. Horses with non-diseased hearts can relatively easily be electrically triggered into sustained AF, making it an interesting large animal model of AF. AF has traditionally been considered an electrical disease, but an increasing amount of evidence reveal that the incidence of AF is also closely coupled to structural abnormalities. The aim of this study is to quantify the expression level of the most prominent cardiac ion channels following almost 2 months of AF, as well as analyse structural abnormalities together with altered ion channel location/expression by confocal microscopy. Methods: Eight clinically healthy horses were included in the study and had a pacemaker implanted. Five of the horses were electrically triggered into persistent or permanent AF by the implanted pacemaker. Three sham-operated horses without AF were included as controls. After 55 days of AF, horses were euthanized, and hearts taken out for in vitro studies. Quantitative real-time PCR (TaqMan) of

S90

13 mRNA transcripts was performed on cardiac tissue collected from 6 different locations in the equine heart: Right atrial appendage, left atrial appendage (LAA), right ventricle, left ventricular endocardium, left ventricular mid-myocardium and left ventricular epicardium. Connective tissue stain was conducted on 10 μm cryosections of atrial myocardium and examined by light microscopy to document structural changes due to AF. Results: Quantifications of the most prominent cardiac ion channels in the AF affected equine heart revealed an expression pattern that largely resembled those from the controls. However, the expression of KCNN2, encoding the calcium-activated SK2 potassium channel, was downregulated in the LAA of the AF group compared to the controls. Microscopy data from both AF and sham atrial tissue will also be displayed.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

(chi-square p=0.007). After adjusting for age, gender, AF duration and LA size BB 4.5 cm, LA scar area BB 75% was significantly associated with higher odds of persistent AF (odds ratio 11.27; p = 0.013). Conclusion: LA scar burden is associated with higher odds of persistent AF, independent of LA size. Early ablation before significant remodeling and scar formation in the LA may alter the progression to persistent AF. Considering the small sample of our analysis, larger studies are needed to validate our findings. 16-27 Abstract 15-61 CYCLE LENGTH STATISTICS DURING ATRIAL F I B R I L L AT I O N R E F L E C T R E F R A C T O R Y P R O P E R T I E S O F T H E U N D E R LY I N G SUBSTRATE

16-26 Abstract 18-23 LEFT ATRIAL SCAR BURDEN PREDICTS THE P E R S I S T E N T V S PA R O X Y S M A L AT R I A L FIBRILLATION Oluwaseun Adeola 1, Dinesh Voruganti 1, Ghanshyam Shantha 1, Chad Ward 1, Amgad Mentias 1, Michael Giudici 1 1 University of Iowa Hospitals, Iowa City, United States Introduction: The definition of paroxysmal vs persistent atrial fibrillation is based on duration of episodes and self-termination. As mapping techniques have advanced, we are now able look at the left atrium on a more “granular” level and focus our ablation efforts rather than making anatomic lines of block. High-density electro anatomic mapping system may be used to estimate left atrial (LA) scar burden and scar in the LA may be responsible for both the genesis and perpetuation of atrial fibrillation (AF). It is unclear if LA scar burden predicts type of AF (paroxysmal or persistent). Methods: Sixty-two consecutive patients [48 M/ 14 F, mean age 59.2 years (26–78 years)] underwent pulmonary vein isolation (PVI) with a cryo balloon technique followed by high density mapping of the LA with an HD (St. Jude Medical) catheter. We defined the areas with low voltage amplitudes (BB 0.05 mV) as scar and performed ablation of low voltage “bridges” using RF energy. We followed patients for at least 1 year after ablation to assess recurrence of AF. Multivariate logistic regression analyses were used to assess the association between LA scar burden and type of AF. Results: Of 62 patients, 38 (61%) had paroxysmal AF while 24 (39%) had persistent AF. Forty-five (73%) had scar area BB 75%. Twenty-three of 38 with paroxysmal (61%) and 22 of 24 (92%) with persistent AF had scar area BB 75%

Laura Anna Unger 1, Tobias Oesterlein 1, Peter Spector 2, Armin Luik 3, Claus Schmitt 3, Axel Loewe 1, Olaf Dössel 1 1 Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany, 2 College of Medicine, University of Vermont, Burlington, Vermont, United States, 3 Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany Acquiring adequate mapping data in patients with atrial fibrillation (AFib) is a main obstacle in the treatment of this arrhythmia. Because activation patterns change rapidly, sequential techniques such as local activation time (LAT) mapping are not applicable. Mapping timeindependent tissue properties instead is suited for the concept of sequential mapping. In this study, we measured the cycle length (CL) statistics of intraatrial electrograms with the aim of estimating refractory properties of the substrate. Electrograms from two patients in AFib were analyzed. Electrograms of at least 30 s length were recorded with the RHYTHMIA HDx mapping system while the Orion catheter (Boston Scientific) was held in a stable position. The protocol was applied at five sites per patient. Only electrodes with tissue contact were further considered. CLs were calculated as intervals between subsequent LATs. To consider a cycle valid, the signal energy of the gap segment between the LATs defining the cycle may not exceed 1/8 of the signal energy within the segments around the LATs. The minimally observed CL was assumed to approximate the refractory period of the tissue. Using the 25% quantile mitigated the presence of noise and the finite dimension of electrodes in clinical data. For patient A, the 25% quantile of CLs at 56 electrode positions ranged from 77 to 195 ms. For patient B, we saw 25% quantiles of CLs from 70 to 171 ms at 78 electrode positions. The smooth spatial distribution of

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

25% quantiles suggested a realistic correlation with the underlying refractory properties. CL statistics may help to understand the likelihood of a substrate to maintain AFib. Areas of decreased refractory periods are likely to drive the arrhythmia and hence are potential targets for ablation. Figure: CL histograms at exemplary electrode positions in patient A ((a1), (a2)) and B ((b1), (b2)). Vertical lines mark the 25% quantiles.

S91

expressed by the DHA to AA ratio is also significantly altered from 0.42 ± 0.02 to 0.33 ± 0.02 between control and AF groups. Conclusion: Knowing the metabolic competition between both n-3 and n-6 PUFA families, n-3 FA dietary interventions could also be of benefit for pts with idiopathic AF. 16-29 Abstract 15-21 PROGNOSTIC VALUE OF INSULIN-LIKE GROWTH FACTOR-1 IN PATIENTS WITH DIFFERENT TYPES OF ATRIAL FIBRILLATION Yuliya Shaposhnikova 1, Iryna Ilchenko 1 1 Kharkiv National Medical University, Kharkiv, Ukraine

16-28 Abstract 15-36 MODIFIED OMEGA-3 FATTY ACID PROFILES IN PAT I E N T S W I T H I D I O PAT H I C AT R I A L FIBRILLATION Jean Michel Maixent 1, Wafaa El Mejaber 2 1 Université de Toulon, toulon, France, 2 Sanofi, Paris, France Background: Recent developments confirm and extend the concept that n-3 (omega 3) fatty acids (FA) are beneficial in the prevention of cardiovascular diseases and sudden cardiac death. Many reports have shown positive correlation between n-3 polyunsaturated FA (PUFA) and coronary artery disease (CAD). The mechanism of prevention by n-3 PUFA involves cardiac antiarrhythmic properties. All the evidences could be applied to atrial fibrillation (AF) but nothing is known in about n-3 PUFA status from patients with idiopathic AF. Objective: To examine FA patterns associated in Mediterranean patients (pts) with AF. Methods: A total of 38 consecutive pts with idiopathic AF were included. Exclusion criteria were diabetes and CAD. The gas chromatography method was used to analyze erythrocyte membrane FA patterns from pts with idiopathic AF were analyzed by gas chromatography. Pts without coronary stenosis were used as controls (n = 12). Results: Pts with AF showed increased percentages of arachidonic acid (AA) [(n-6) serie) (15.9 ± 0.6 vs. 17.2 ± 0.4%, < 0.05) as well as decreased percentages of docosahexaenoic acid (DHA) [(C22: 6 (n-3) (6.6 ± 0.2 vs. 5.6 ± 0.2%, < 0.05)]. The n-3/n-6 PUFA balance

The aim of the present study was to evaluate the serum IGF-1 concentration and its dynamic changes during 1 year in patients with different types of AF. Material and methods. Seventy-six patients with non-valvular AF (42 men and 34 women, mean age 46.3 ± 5.2 years) were included. All patients were divided into 3 groups depending on the variant of AF: first group (22 patients) with paroxysmal AF (AFpr), second group (30 patients) with persistent AF (AFps), and third group (24 patients) with a permanent AF (AFpm). General clinical and standard laboratory examination and IGF-1 level was dynamically measured at the baseline, at 6 and 12 months. Serum IGF-1 levels were determined by immunoassay using Immulite kits (Siemens AG, Germany). Results. Initially, in all three groups of examined patients with AF, the concentration of IGF-1 was lower than in the control group. Were established certain differences of IGF-1 values in patients with various types of AF. Initially, the highest level of IGF-1 was in patients with AFpr which exceed IGF-1 at AFps and was significantly higher than when AFpm (respectively AFpr and AFps (ng/ml): 178.52 ± 10.16 and 169.46 ± 9.23 (< 0.05), AFpr and APpm (ng/ml): 178.52 ± 10.16 and 161.37 ± 8.24 (p BB0.05). After 6 months, in all groups of patients, there was a tendency to decrease the level of IGF-1 in comparison with baseline values, which was most pronounced in patients with AFpm (respectively, AFpr, AFps, AFpm (ng/ml): 174.48 ± 10.24, 166.52 ± 9.16, 152.29 ± 9.27). After 12 months of follow-up, the value of IGF-1 continued to decrease in patients with AFps and AFpm. At the same time, patients with AFpr did not noted any significant changes in IGF-1 content (respectively AFps, APps, AFpm (ng/ml): 167.32 ± 10.10; 162.48 ± 9.12; 154.32 ± 7.25). Conclusions. The highest values of IGF-1 were determined in patients with AFpr, moderately decreased with AFps and reliably—with AFpm.

S92

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Dynamics reduce of IGF-1 levels in patients with different types of AF maintained during the year of observation. In severe AF forms, namely in AFpm, decreases of serum IGF-1 concentration may be associated with weakening of the reparative function and worsen the prognosis of the disease.

16-31 Abstract 15-55

Antiarrhythmic agents in atrial fibrillation

Helena Carstensen 1, Eva Z. Hesselkilde 1, Thomas Jespersen , Steen Pehrson 3, Jonas Carlson 4, Pyotr G. Platonov 4, Rikke Buhl 1 1 Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark, 2 Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 3 D e p a r t m e n t o f C a rd i o l o g y, T h e H e a r t C e n t re , Copenhagen University Hospital, Copenhagen, Denmark, 4 Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden

EFFECTS OF DOFETILIDE AND RANOLAZINE ON ATRIAL FIBRILLATORY RATE IN THE HORSE M O D E L O F A C U T E LY I N D U C E D AT R I A L FIBRILLATION

2

16-30 Abstract 01-19 D I G O X I N A N D P U FA D U R I N G D I G I TA L I S TREATMENT Monique Bernard 1, Jean Michel Maixent 2 Univercité Aix-Marseille, Marseille, France, 2 Université de Toulon, Toulon, France

1

Digoxin is effective in relieving symptoms of heart failure and atrial fibrillation. However, digitalis in the treatment of heart failure has an extremely narrow therapeutic index due to cardiac arrhythmia and alteration of energy metabolism. We previously evidenced that a dietary fish oil is beneficial during digitalis therapy both in term of arrhythmia and cardiac energy metabolism. Fish oils are enriched of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) but EPA could induce adverse effects. We tested the hypothesis that diet enrichment with DHA alone allows to modify the fatty acid composition of heart membranes with physiological and metabolic consequences and modify the digitalis induced cardiac arrythmia. Four groups of 13 rats were fed for 4 weeks a diet supplemented with regular eggs (10 mg DHA/kg of body weight) or DHA-enriched eggs (35 or 60 mg DHA/kg) powder or standard rat chow (Control). We determined fatty acid profiles of heart membranes by gas chromatography, contractile responsiveness to digitalis (ouabain-10-7 to 3 × 10−4 M) and relative variations in cardiac energy metabolism using phosphorus-31 magnetic resonance spectroscopy in isolated perfused rat hearts. Supplementation led to a dosedependent increase in cardiac membrane incorporation of DHA resulting in significantly increased contents in phosphocreatine at baseline in DHA35 and DHA60 groups and during digitalis perfusion in group DHA60. The maximum positive inotropy achieved with digitalis was significantly increased in DHA35 and DHA60 groups vs. control without increased depletion of energy metabolism. This study demonstrates that DHA supplementation alone improves energy metabolism through baseline contents in phosphocreatine and digitalis efficiency on myocardial contractility without toxicity.

Background: The study of atrial fibrillatory rate (AFR) on surface ECGs has been proposed as a non-invasive way of assessing the effects of antiarrhythmic drugs in atrial fibrillation (AF). Horses can be used as a model for human AF. The purpose of this study was to measure the effects of dofetilide and ranolazine alone as well as in combination on AFR in the horse model of acute AF. Methods: Eight horses were subjected to pacing-induced AF on four separate procedure days and treated with either saline (control), dofetilide, ranolazine or a combination of the two in four incremental doses. AFR was calculated from surface ECGs using spatiotemporal QRST cancellation. Results: The change in AFR to each drug infusion and P values of the differences are presented in Table 1. When comparing AFR leading up to cardioversion with AFR before dose 1, the rate decreased over a period of 5 min in dofetilide procedures (P = 0.02), whereas AFR was only reduced in the last minute before cardioversion in ranolazine procedures (P = 0.02). The combination of drugs also reduced AFR in the 5-min preceding cardioversion (P = 0.04). Conclusion: Dofetilide infusion alone and in combination with ranolazine resulted in an immediate and dose-dependent decrease i n AFR, whereas ranolazine’s AF cardioverting mechanisms were not as clearly related to slowing of the atrial fibrillatory process. This suggests a difference in the antiarrhythmic mode of action of the two drugs detectable by a non-invasive approach. The results support the use of AFR for assessment of antiarrhythmic drugs.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S93

Table 1. Changes in AFR due to drug infusions Dose 1

Dose

Dose 3

Dose

2

Control

4

ΔAFR

P

ΔAFR

P

ΔAFR

P

ΔAFR

− 1 ± 12c

0.82

4 ± 10c

0.37

− 2 ± 9c

0.59

− 1 ± 9c 0.76

P

Dofetilide

− 1 ± 13a

0.90

− 14 ± 11b 0.015

− 27 ± 7d 0.0008 − 18f

–

Ranolazine

− 3 ± 12a

0.50

− 5 ± 6c

0.12

− 19 ± 7e 0.013

− 19f

–

Combination

− 12 ± 11c 0.041 − 2f

–

− 12f

− 25f

–

–

by fitting the PDF of IEGMs in time domain to a Gaussian distribution or in frequency domain to a Rayleigh distribution, the effect of Ibutilide can easily be tracked using the statistics of their PDF while this is difficult through the waveform of IEGMs.

Values of AFR used for the comparisons are averages of 5 min before and after each dosing. Values are given in fibrillations per minute ± SD. (a) n = 8, (b) n = 7, (c) n = 6, (d) n = 5, (e) n = 4, (f) n = 1

16-32 Abstract 15-10 EFFECTS OF IBUTILIDE ON DISTRIBUTION OF AMPLITUDE AND FREQUENCY OF FIBRILLATORY INTRACARDIAC ELECTROGRAMS Habib Hajimolahoseini 1, Javad Hashemi 1, Damian Redfearn 1 Cardiac Arrhythmia Signal Analysis Lab, School of Medicine, Queen's University, Kingston, Canada 1

Background: Catheter ablation is an effective therapy for atrial fibrillation (AF). The intracardiac electrogardiogram (IEGM) collected during this procedure contains precious information that has not been explored to its full capacity. Novel techniques allow looking at these recordings from different perspectives which can lead to improved therapeutic approaches. The aim of this study is to further investigate the effect of Ibutilide on characteristics of the recorded signals from the left atrium (LA) of a patient with persistent AF before and after administration of the drug. Methods: The IEGMs collected from different intraatrial sites of 12 patients were studied and compared before and after Ibutilide administration. First, the before and after Ibutilide IEGMs that were recorded within a Euclidian distance of 3 mm in LA were selected as pairs for comparison. For every selected pair of IEGMs, the probability distribution function (PDF) of the amplitude in time domain and magnitude in frequency domain was estimated using the regression analysis. The PDF represents the relative likelihood of a variable falling within a specific range of values. Results: Our observations showed that in time domain, the PDF of amplitudes was fitted to a Gaussian distribution (Fig. 1A) while in frequency domain, it was fitted to a Rayleigh distribution (Fig. 1B). Our observations also revealed that after Ibutilide administration, the IEGMs would have significantly narrower short-tailed PDFs both in time and frequency domains. Conclusion: This study shows that the PDFs of the IEGMs before and after administration of Ibutilide represent significantly different properties, both in time and frequency domains. Hence,

Chaired Poster Session B part 1 Sunday April 15, 2018, Posters displayed from 02:00 pm–05:30 pm Presenters and Chairpersons present from 02:00 pm– 03:30 pm ROOM TERNES Sudden cardiac death and ICD 16-33 Abstract 25-11 INCIDENCE OF APPROPRIATE ICD THERAPY AND MORTALITY IN RECIPIENTS OF PRIMARY PREVENTION BIVENTRICULAR ICDS Miguel Leal 1, Brian Brown 1, Zach Hollis 1, Lee Eckhardt 1, Ryan Kipp 1 1 University of Wisconsin, Madison, United States Introduction: Clinical trials have demonstrated numerous benefits of cardiac resynchronization therapy (CRT), including

S94

reverse ventricular remodeling and decreased incidence of ventricular tachyarrhythmias. Current practice guidelines have incorporated some predictors of reverse remodeling into the class I recommendations for CRT, including sinus rhythm and LBBB greater than 150 ms. We hypothesize that recipients of CRT-capable defibrillator systems (CRT-D) who meet class I criteria will suffer fewer tachyarrhythmias and have improved survival compared with class II recipients. Methods: A retrospective study was performed on all primary prevention CRTDs implanted at three separate medical centers between January 1, 2006 and December 31, 2010. Events were assessed through June 30, 2011 and were analyzed by at least two physicians. Class I and II recipients were defined according to recent HRS guidelines. Time to appropriate ICD therapy and death were analyzed using log-rank analysis. Results: Out of 120 recipients of primary prevention CRT-Ds, 31.7% met class I indications. After an average of 2.5 years of followup, 6% of class I and 35% of class II recipients received appropriate shock (p = 0.016) (Fig. 1). Class I recipients also had reduced incidence of death (p = 0.037). There was no difference in use of beta-blockers, ACE-inhibitors or antiarrhythmic drugs. Conclusion: Recipients of primary prevention CRT-Ds who meet class I recommendations may receive fewer appropriate ICD shocks and have reduced mortality compared with class II recipients, supporting the strength of current guideline recommendations. 16-34 Abstract 25-10 INCIDENCE OF EJECTION FRACTION IMPROVEMENT AND CORRELATION WITH O U TC O M E S I N R E C I P I E N T S O F P R I M A RY PREVENTION ICDS Miguel Leal 1, Zach Hollis 1, Lee Eckhardt 1, Brian Brown 1, Ryan Kipp 1 1 University of Wisconsin, Madison, United States Introduction: Current evidence-based guidelines recommend ICD implantation for primary prevention of sudden cardiac death in patients with medically refractory, symptomatic ischemic and non-ischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) ≤ 35%. Despite meeting guideline criteria for implant, ICD recipients may have their LVEF improve following device placement. The number of patients with LVEF improvement following ICD placement and their outcomes are unknown. We hypothesize that less than 25% of guideline-based primary prevention ICD recipients will have their LVEF improve to BB 35%, and those with improved LVEF will receive fewer appropriate shocks and have improved survival. Methods: A retrospective study was performed on all recipients of guideline-directed primary prevention single- and dual-chamber ICDs with severely reduced

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

LVEF (≤ 35%) and post-implant LVEF assessment at three separate medical centers between January 1, 2006 and December 31, 2010. Recipients of biventricular ICDs were excluded. LVEF by echocardiogram, delivery of appropriate and inappropriate shocks, and mortality were assessed through June 30, 2011. Incidence of appropriate and inappropriate shocks, and death were analyzed using Fischer’s exact test. Results: Over a mean follow-up of 3.1 years, 30.8% of 107 primary prevention ICD recipients with a severely reduced LVEF at time of implant had their LVEF improve to BB 35%. Patients with and without LVEF improvement had a high incidence of beta-blocker (92 and 93%, respectively) and ACE-inhibitor or angiotensin receptor blocker (85 and 84%, respectively) use. There was a trend toward fewer appropriate shocks among subjects with improved LVEF (OR 3.94, 95% CI 0.85–18.35, p = 0.086), and no difference in incidence of inappropriate shocks or death (p = 0.501 and 0.440, respectively). Conclusion: Over 30% of patients with a reduced LVEF who received primary prevention ICDs had their LVEF improve to BB 35% during a mean follow-up of approximately 3 years. Patients whose LVEF improves above 35% may be less likely to receive appropriate shocks for treatment of ventricular tachyarrhythmias. 16-35 Abstract 07-11 INVESTIGATION OF ECG REPOLARIZATION PARAMETERS AND RISK FACTORS OF SUDDEN C A R D I A C D E AT H I N PAT I E N T S W I T H HYPERTROPHIC CARDIOMYOPATHY Andrea Orosz 1, Tamás Szűcsborus 2, Lili Adrienn Szabó 2, István Baczkó 1, Viktória Nagy 2, Tamás Forster 2, J. Gyula Papp 3, András Varró 3, Róbert Sepp 2 1

Department of Pharmacology and Pharmacotherapy, University of Szeged, Hungary, Szeged, Hungary, 2 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary, Szeged, Hungary, 3 Department of Pharmacology and Pharmacotherapy, University of Szeged, Hungary; MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary, Szeged, Hungary Background: Hypertrophic cardiomyopathy (HCM) is a common inherited disease of the myocardium, associated with increased propensity for ventricular arrhythmias and increased risk of sudden cardiac death (SCD). The identification of patients with high risk for SCD is considered incomplete. Previously, we observed that ECG repolarization parameters are increased in patients with HCM, and these parameters may represent a novel marker in SCD risk assessment. In this present study, we investigated the correlation between different

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

ECG parameters characterizing ventricular repolarization and SCD risk factors in patients with HCM. Methods: We examined 62 HCM patients (35 males, age 48 ± 14 years). From 5min digitized ECG recordings, the following parameters were determined: frequency corrected QT interval (QTc), QT dispersion (QTd), T wave peak-to-end distance (Tpeak-Tend) and short-term QT variability (QT-STV). SCD risk was determined as the number of traditional risk factors or as the 5-year risk of SCD calculated by the HCM-Risk-SCD Calculator. Patients were categorized as having low or high risk (BB 1 vs. ≥ 2 risk factors or BB 4% vs. BB 6% 5-year risk of SCD). Results: Low or high SCD risk patients had a similar age and sex distribution. Patients with ≥ 2 risk factors had higher value of QT dispersion (QTd: 44 ± 20 vs. 49 ± 10 ms; P = 0.3912) and lower values of other repolarization parameters (QTc: 507 ± 66 vs. 467 ± 63 ms, P = 0.085; Tpeak-Tend: 112 ± 33 vs. 102 ± 30 ms; P = 0.3819; QT-STV: 0.0048 ± 0 vs. 0.0045 ± 0 s; P = 0.568), but the difference was not significant. However, patients with BB 6% 5-year SCD risk had a non-significantly increased value of the repolarization parameters (QTc: 493 ± 59 vs. 522 ± 60 ms; P = 0.3247; Tpeak-Tend: 109 ± 31 vs. 114 ± 41 ms; P = 0.7260; QT-STV: 0.0044 ± 0 vs. 0.0048 ± 0 s; P = 0.3059). Conclusion: There is a non-significant increase of ECG parameters in HCM patients with high 5-year risk for SCD. The lack of significance might be due to the relatively low number of patients. This work was supported by GINOP-2.3.2-15-201600047 and GINOP-2.3.2-15-2016-00012 projects. 16-36 Abstract 19-18 LONG-TERM OUTCOMES OF ICD IMPLANTS IN ADULT CONGENITAL HEART DISEASE PATIENTS: A SINGLE CENTRE EXPERIENCE Vinit Sawhney 1, Sarah Whittaker-Axon 1, Holly Daw 1, Seamus Cullen 1, Katherine Von Klemperer 1, Bejal Pandya 1 , Fiona Walker 1, Vivienne Ezzat 1 1 Barts Heart Centre, London, United Kingdom Background: Sudden cardiac death (SCD) due to ventricular arrhythmias (VA) accounts for nearly a third death in the adult congenital heart disease (ACHD) population. Implantable cardioverter defibrillators (ICD) are effective in preventing SCD. However, there is little evidence to establish the safety and efficacy of ICDs in the ACHD population. We reviewed the indications and long-term outcomes of ICD implants in our ACHD patients. Methods: Retrospective analyses of all ACHD patients undergoing ICD implants at a single centre. All procedural data, complications and follow-up were prospectively recorded. Appropriate and inappropriate device therapy was recorded over the follow-up period. Results: Over a 5-year period, 30 patients with ACHD had ICD implants. Seventy-three percent male, mean age 43 (22–67) years. Mean age at implant was 41 years. Underlying etiology was repaired tetralogy of Fallot

S95

(TOF) in 30% patients, Mustard for transposition of great arteries (TGA) in 30%, tricuspid atresia in 7% and other (ASD/VSD/ coarctation of aorta/AS) in 33%. The vast majority (63%) had secondary prevention devices. Of these, 5 patients had OOHCA, 3 presented with syncope and 11 had sustained VA. Acute procedural success was 90% with failed DFT requiring new lead implant in 1, failed CS lead in 1 and heamatoma due to inadvertent arterial puncture leading to a contralateral implant in 1 patient. Over a mean follow-up of 3 years, 8 patients (27%) received appropriate ICD shocks for VA. These included 4 TGA, 2 TOFs, 1 aortic coarctation and 1 Ebsteins’ patient. Atrial arrhythmias were logged in 63% of patients; however, the rate of inappropriate device therapy was small (1 of 30 patients). Late complications were seen in 3 patients (2 A-lead and 1 V displacements requiring re-positioning). All cause mortality over the follow-up period was 30%. Conclusions: At our centre, the majority of ICD implants in the ACHD population are for secondary prevention and in patients with TOF or TGA. Rate of inappropriate therapy is low (BB3%) and incidence of major complications (20%) smaller than that reported in the current literature. ICD implants in ACHD population come with a modest risk of complications but are efficacious with a low rate of inappropriate therapy in a carefully selected group of patients. 16-37 Abstract 19-19 T WAV E O V E R S E N S I N G C A U S I N G INAPPROPRIATE SHOCK AND VENTRICULAR F I B R I L L AT I O N I N A S U B C U TA N E O U S IC D RECIPIENT Gurjit Singh 1, Marc K Singh 1, Arfaat Khan 1, Waddah Maskoun 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States Background: T wave over sensing (TWOS) is a known phenomenon with trans-venous and subcutaneous ICD systems and various algorithms exist to mitigate TWOS. Objective: To describe importance of proper lead positioning in a subcutaneous ICD system and harmful results of inappropriate shocks Methods: N/A Results: A 73-year-old male with hypertension, preserved left ventricular function, idiopathic pulmonary fibrosis and obesity (BMI 34.2) was transferred to our institution for multiple ICD shocks (13) over a period of 2 h on amiodarone and procainamide infusions. Patient has previously undergone a subcutaneous ICD implantation (2-incision technique) for sustained monomorphic VT (SMVT) programmed with primary vector for sensing. ICD interrogation showed multiple appropriate shocks for SMVT (Fig. A) and inappropriate shocks for TWOS with one of the shock on T wave resulting in sustained ventricular fibrillation with successful termination by shock (Fig. B). CXR showed significant displacement of ICD lead into the left lateral chest wall (Fig. C). EP study revealed a

S96

spontaneous SMVT which was not inducible with programmed electrical stimulation and a HV interval of 82 ms. Subcutaneous ICD was extracted, and a trans-venous dual chamber ICD was implanted. Patient has remained arrhythmia free on betablocker therapy. Conclusion: Inappropriate shocks in subcutaneous ICD recipients could be due to lead malpositioning thus calling for strict attention to details during lead implantation and need for post implant imaging surveillance. Inappropriate shock on T wave can lead to life-threatening arrhythmias.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Multivariate regression was used to identify predictors of EF recovery. Results: AIC was due to AF (n = 119; 49%), AT (n = 51; 21%) and PVCs (n = 73; 30%). SHD was present in 124 (51%). AIC treatment was rhythm control in 95%. Patients in the lowest index EF quartile (n = 74) were more likely to have PVC-induced AIC vs other patients (61 vs 17%; < 0.0001). The lowest quartile EF group had a lower index EF [21 ± 4 vs 36 ± 6%, p = 0.0095], greater EF improvement after treatment [24 ± 17 vs 19 ± 7%; p BB 0.0001] but lower post-treatment EF [45 ± 14 vs 54 ± 8%; < 0.0001] vs other patients over a median of 131 days of post-treatment follow-up. Patients with SHD had lower index EF (28 ± 8 vs 34 ± 8%, < 0.0001) but less EF recovery (19 ± 10 vs 22 ± 10%; p = 0.02), and a lower final EF after treatment (47 ± 12 vs 56 ± 7; < BB 0.0001) vs those without SHD. In a multivariate regression, the lowest index EF quartile was the only predictor of post-treatment EF recovery (estimate 11.4; < 0.005). Conclusions: In this multicenter AIC cohort, successful arrhythmia treatment led to significant improvement in EF, particularly in those with the lowest index EF, but without complete normalization of EF. SHD in AIC patients was associated with a lower index EF and less EF recovery. 16-39 Abstract 31-13

16-38 Abstract 31-14

CONDUCTIVE POLYMERS AFFECT MYOCARDIAL CONDUCTION VELOCITY BUT ARE NOT PROARRHYTHMIC

PREDICTING MYOCARDIAL RECOVERY IN ARRHYTHMIA-INDUCED CARDIOMYOPATHY PATIENTS: ROLE OF INDEX LEFT VENTRICULAR FUNCTION AND UNDERLYING STRUCTURAL HEART DISEASE

Richard Jabbour 1 , Kella Kapnisi 1 , Damia Mawad 1 , Balvinder Handa 1, Catherine Mansfield 1, Fillipo Perbellini 1 , Cesare Terracciano 1, Molly Stevens 1, Godfrey Smith 1, Nicholas Peters 1, Fu Siong Ng 1, Sian Harding 1 1 Imperial College London, London, United Kingdom

Rakesh Gopinathannair 1, Dhanunjaya Lakkireddy 2, Rahul Dhawan 1, Andrew Murray 3, Talha Farid 1, Brian Olshansky 3 1 Section of Electrophysiology, University of Louisville, Louisville, United States, 2 University of Kansas Medical Center, Kansas City, United States, 3 Mercy Heart and Vascular Institute, Mason City, United States

Introduction Conducting polymers are being developed as vehicle for pluripotent stem cell grafting as they are both flexible and electroactive and therefore may increase safety during the integration of graft with myocardium. Objective To test the electrophysiological properties of a patch consisting of polyaniline, phytic acid and chitosan, which is known to be relatively stable in oxidized form with retained electro-activity and low surface resistivity. Methods Ex-vivo optical mapping of transmembrane voltage was performed on explanted rabbit hearts (n = 8), perfused using the voltage sensitive dye RH237 and excitation contraction uncoupler blebbistatin. Recordings were conducted before and after attachment of the patch (sutured using Prolene 8.0), during ventricular pacing. Arrhythmia susceptibility was then tested using extrastimulus provocation protocols. The effect of the conductive polymer on regional and global conduction velocities and APDs were analysed. Results Application of the patch to the epicardial surface of heart ex vivo slowed global conduction velocity (70.6 ± 6.8 cm/s [without patch] vs 52.0 ± 9.3 cm/s

Background: Arrhythmia-induced cardiomyopathy (AIC) due to atrial fibrillation/tachycardia (AF/AT) or premature ventricular contractions (PVCs) can lead to partial or complete recovery of left ventricular ejection fraction (EF) after arrhythmia treatment but factors predicting recovery are uncertain. Objective: To assess the role of index EF (at diagnosis of cardiomyopathy) and underlying structural/ischemic heart disease (SHD) on myocardial recovery in a multicenter AIC patient cohort. Methods: Two hundred forty-three patients (age 65 ± 11 years, 73% male) with AIC treated at 3 US centers were included in a retrospective analysis. Patients were stratified based on EF quartiles at presentation as well as presence of SHD and then compared.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

[with patch] p = 0.0002; Figure). Regional analysis indicated that there was a significant reduction of conduction velocity adjacent to the patch, but no change remote from the patch (42.8 ± 9.6 cm/s [around patch] vs 64.5 ± 18.5 cm/s [away from patch]; p = BB 0.0001). There was no significant change in APD 90 (154 ± 11 ms [without patch] vs 156.99 ± 10.5 ms [with patch]). Extra-stimulus provocation protocols revealed that the patch did not increase susceptibility to ventricular arrhythmias. Conclusion The conductive nature of the patch affected myocardial electrophysiology, by slowing conduction in areas adjacent to the patch, though these changes did not appear to be arrhythmogenic. There were no conduction changes remote from the patch and no repolarization changes. These preliminary findings suggest that the conductive polymer is safe to use as a vehicle to aid graft integration.

16-40 Abstract 19-12 MECHANICAL DISPERSION AS A PREDICTOR OF ARRHYTHMIC DEATH IN PATIENTS WITH ISCHAEMIC AND NON-ISCHAEMIC LEFT VENTRICULAR DYSFUNCTION Vincenzo Nissardi 1, Roberta Montisci 1, Cinzia Soro 1, Roberto Floris 2, Luigi Meloni 1 1 Azienda Ospedaliero-Universitaria - Cagliari, Cagliari, Italy, 2 Azienda per la Tutela della Salute - Sardegna, San Gavino, Italy

S97

with ICD. Methods: We recruited 48 patients with ischaemic/non-ischaemic dilative cardiomyopathy (39 M, 9 F), middle aged (63.7 years), implanted with ICD or CRT-D in primary (34 pts)/secondary (14 pts) prevention. Each patient underwent clinical examination, ECG, transthoracic echocardiography with the analysis of traditional and speckle tracking parameters (global longitudinal strain, GLS; mechanical dispersion MD) and device interrogation. Average FU = 34.6 months. Results: During the FU, life-threatening ventricular arrhythmias occurred in 16 patients (events group). No difference of age, gender, cardiovascular risk factors and etiology were observed. Echocardiographic parameters (LVEF), wall motion score index and GLS were comparable between in the two groups before and after device implantation. Patients with arrhythmic events (AE) exhibited a higher mechanical dispersion (SD time to peak 112.7 ± 33 vs. 68.5 ± 30.8 p = 0.0001); we found a linear correlation between the MD value and the presence of ventricular AE, but there was a correlation with MD (SD time to peak 112.7 ± 33 vs 68.5 ± 30.8 ms, p = 0.0001), supported also by ROC curve analysis (r = − 0.56, p = 0.0001). From the ROC curves analysis, a mechanical discontinuity value ≥ 103 ms was a predictor of AE (area under curve = 0.835, p = 0.0001 sensitivity 63%, specificity 94%). In a multivariate analysis, only a 103 ms mechanical dissynchronous value was found to be an independent predictive value of AE (HR 6.6, 95% IC 1.9–21.2, p = 0.006). The correlation between AE and MD was confirmed in both ischaemic/non-ischaemic patients (r = 0.61, p = 0.001 and r = 0.48, p = 0.0178). A MD value ≥ 103 ms has been found to be a predictor of ventricular sustained arrhythmias in the two groups (ischaemic pts: log rank p = 0.012, Ki square 6.0—non ischaemic pts: log rank p = 0.015, Ki square 5.885). Conclusions: MD evaluated using speckle tracking technique is a valid technique for risk stratification of ventricular arrhythmias in patients with dilative ischaemic/non-ischaemic cardiomyopathy. 16-41 Abstract 19-13

Background: Implantable cardioverter-defibrillators (ICD) is a cost-effective treatment in the primary/secondary prevention of ventricular arrhythmia in patients with ischaemic/ non-ischaemic heart failure. The decision to implant an ICD should take into account several factors including clinical history, NYHA class, left ventricular ejection fraction and life expectancy. Myocardial strain assessed using speckle tracking echocardiography represents a novel tool to quantify global and regional myocardial function. The aim of our study was to evaluate the correlation between myocardial strain and ventricular arrhythmias in patients treated

M Y O C A R DI UM SC I N T I G R AP H Y WI T H ¹ ²³ IMETAIODO-BENZYLGUANIDINE IN EVALUATION OF THE VENTRICULAR TACHYARRHYTHMIA INCIDENCES IN PATIENTS WITH CORONARY ARTERY DISEASE AND ICD Tariel Atabekov 1, Roman Batalov 1, Svetlana Sazonova 1, Sergey Popov 1 1 Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia

S98

Introduction. The coronary artery disease (CAD) is the cause of sudden cardiac death (SCD) in 80% of cases. In SCD structure, 75% of deaths are due to ventricular tachyarrhythmia (VTA). The main method of SCD prevention is ICD implantation. However, only 15–25% patients after ICD implantation have VTA events. So it is necessary to find out new predictors of VTA. Purpose. To study the possibility of myocardium scintigraphy (MS) with ¹²³I-metaiodo-benzylguanidine (123I-MIBG) in VTA incidences assessment in patients with CAD. Methods. Fifty patients (male 41, age 65.3 ± 84 years) with CAD and indications for the ICD implantation were examined. Echocardiography and MS (SPECT and planar) with 111-370 MBq 123I-MIBG were performed before ICD implantation. All patients were treated with antiarrhythmic therapy (beta-blockers and amiodarone). Patients were divided into two groups according to the ICD implantation indications (primary and secondary SCD prevention). The ICD parameters and VTA events were evaluated after the 6th months follow-up. Results. The 1st group consisted of 21 (42%) patients with primary prevention (male 19, age 63.2 ± 7.7 years). Eighteen (85.7%) patients have VTA events. There were statistically significant differences between patients with and without VTA before ICD implantation in terms of average accumulation defect index of 123IMIBG on early scintigrams (SSe%)—29.55 ± 14.97 and 11.33 ± 6.35% (р = 0.006) and delayed scintigrams (SSd%)—36.77 ± 14.72 and 18.66 ± 4.04% (р = 0.03), respectively. The 2nd group consisted of 29 (58%) patients with secondary prevention (male 22, age 66.7 ± 8.7 years). Nineteen (65.5%) patients have VTA events according to results of ICD programming. There were statistically significant differences between patients with and without VTA before ICD implantation in terms of left ventricle ejection fraction (LVEF)—50.6 ± 9.2 and 63.8 ± 8.2% (p = 0.001), SSe%—31.68 ± 17.70 and 7.60 ± 2.22% (p = 0.0004), SSd%—33.05 ± 18.08 and 9.80 ± 3.85% (р = 0.0001), respectively. Conclusion. In patients with ICD for primary prevention large defects of 123I-MIBG (29.55% and more) in early and late scintigrams is independent predictor of VTA development. In patients with ICD for secondary prevention, extensive (31.60% and more) accumulation defects of 123I-MIBG on early and late scintigrams is also independent predictor of the VTA regardless of arrhythmia presence before the ICD implantation, which makes it the possible alternative to the device implantation criteria—low LVEF.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

16-42 Abstract 19-16 EFFECT OF HALOPERIDOL DURING ACUTE M Y O C A R D I A L I N FA R C T I O N O N C A R D I A C FUNCTION AND ARRHYTHMIAS: A PORCINE MODEL Stefan M. Sattler 1, Anniek F. Lubberding 2, Charlotte B. Kristensen 1, Shaida Panbachi 2, Rasmus Møgelvang 1, Reza Wakili 3, Thomas Engstrøm 1, Thomas Jespersen 2, Jacob Tfelt-Hansen 1 1

Department of Cardiology, Heart Centre Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 2 Department of Biomedical Sciences, Faculty o f H e a l t h a n d M e d i c a l S c i e n c e s , U n i v er s i t y o f Copenhagen, Copenhagen, Denmark, 3 Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen, Germany Patients receiving psychiatric medication are more likely to die suddenly due to ventricular fibrillation (VF) during acute myocardial infarction (AMI). Haloperidol, which is an antipsychotic drug, is known to block the delayed rectifier potassium current (IKr), potentially leading to life threatening Torsades de pointes. Nevertheless, various animal models studying arrhythmias suggest a potential anti-arrhythmic effect, while data on acute ischemia is lacking. Our aim was to test acute admission of haloperidol on arrhythmias and hemodynamic parameters during AMI in a porcine model. Twenty Danish Landrace pigs (50 kg, range 47–55) randomized 1:1 into an intervention or a control group were anesthetized and baseline electro- (ECG) and echocardiogram (echo) were obtained. An intravenous injection of 5 mg haloperidol or saline was given. Forty-five minutes later, a blinded operator induced AMI, using a percutaneous coronary intervention balloon in the mid-left descending artery. Occlusion was kept for 120 min followed by 60 min of reperfusion. ECG, monophasic action potentials (MAP), blood pressure (BP), cardiac output (CO) and echo measurements were performed during occlusion. Six of the control and three of the haloperidol treated animals experienced VF during the occlusion period (< 0.05). Haloperidol reduced the mean number of premature ventricular contractions per minute from 2.4 ± 0.3 compared to control 4.7 ± 0.5 (< 0.001) in the first 15 min of coronary occlusion.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Further, it decreased mean BP (91 ± 2 vs. 77 ± 1 mmHg, < 0.001) and CO (4.1 ± 0.1 vs. 3.8 ± 0.1 l/ min, < 0.001) during AMI. Ejection fraction decreased to a similar extend in both groups, while tissue Doppler stayed unchanged. ECG analysis revealed a trend towards longer RR intervals, while no effect on QRS, QT or MAP duration could be observed. We found haloperidol to have anti-arrhythmic effects and to depress hemodynamic parameters during AMI. Our results point towards that haloperidol is antiarrhythmic also during AMI. This may be caused by the α1-adrenergic receptor antagonistic effect of haloperidol.

S99

Boxing 2). Forty-six isometric (static) sports body builders. Follow up by telephone quesionnaire was done. Results: Twenty-three had either or both abnormalities. Early repolarization (Fig.) was found in 19, and Rsr' was present in 9 (5 had both). None was diagnosed as Brugada or RV dysplasia. Exercise ECG was not done, provocation tests were not done. Follow up was up to 2 years. No one reported tachyarrhythmia or syncope neither before recruitment in the study (retrospective) nor after follow up (prospective). Conclusion: Early repolarization and RV conduction disturbance did not prove hazardous.

16-43Abstract 08-10 THE SIGNIFICANCE OF EARLY REPOLARIZATION AND INCOMPLETE RIGHT BUNDLE BLOCK IN ATHLETES Samir Rafla 1, Tarek El-Zawawy 1, Gamal Abdel Nasser Mahmoud 2 1 Alexandria University-Cardiology Department, Alexandria, Egypt, 2 Biological Sciences and Sports Health Faculty of Sports, Alexandria Univ. Egypt, Alexandria, Egypt Sudden death in athletes is a major concern. The predictors and value of prior investigations remain to be settled. Of the electrocardiographic findings (ECG) is early repolarization, its incidence and significance is the subject of this work. Methods: The study included hundred persons engaged in competitive sports for duration not less than 6 months; with training at least 3 days per week and at least 2 h per day. All were males. Collection of cases started March till December. 2015. Full history especially for syncope, palpitations or chest pain was obtained as well as family history of sudden death or coronary disease. Examination for BP, any cardiac murmur or arrhythmia. ECG was done for all plus echo Doppler for some cases. Early repolarization was accepted present if J point is elevated more than one mm in LII, LIII, aVF or ST elevation more than 1 mm in chest leads. RV conduction disturbance was considered present if there is Rsr' or bifid R in V1 or V2. Minor or minimal changes were not counted. During the period from 1/1/2015 to 1/10/2016, 100 athletes were screened by ECG, mean age 23 years; 54 played isotonic (dynamic) sports (Bicycling 6, Football 15, Tennis 3, Basketball 16, Volleyball 8, Swimming 4,

16-44 Abstract 19-10 INITIAL EXPERIENCE OF SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR Fuminori Odagiri 1, Yuji Nakazato 1, Yasutoshi Akiyama 1, Hiroya Shimano 1, Rie Takano 1, Takashi Tokano 1, Hiroyuki Daida 2 1 Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan, 2 Department of Cardiology Juntendo University, Tokyo, Japan Objective. The efficacy and safety of the S-ICD system for the treatment of life-threatening ventricular arrhythmias have already been reported in large prospective studies. However, there are limited data on S-ICD use in Japan. We report our initial experience of S-ICD. Methods and Results. We analyzed 17 patients who underwent S-ICD (7) or transvenous-ICD (TVICD, 10) implantation at our institution from March 2016 to September 2016. In the S-ICD group, all patients were male,

S100

the mean age was 46.3 ± 14.1 years, and the mean BMI (body mass index) was 23.3 ± 2.6 kg/m2. Patients who received SICD implantation for primary prevention were four (57.1%) and for secondary prevention were three (42.9%). Underlying cardiac diseases in S-ICD group were ischemic cardiomyopathy (two), nonischemic cardiomyopathy (two) and others (three). Defibrillation testing was performed intraoperatively in all patients who received SICD. One of these patients had an initial conversion failure that required additional procedure to reposition of the system. Although there was no episode of appropriate therapy recorded in both groups, two episodes of inappropriate shocks due to oversensing of atrial flutter waves and myopotential were recorded in S-ICD group during follow-up period. Conclusions. Initial experience of S-ICD at our institution appears to be favorable. However, as the two episodes of inappropriate shocks were recorded, further studies are needed to confirm the optimal screening strategies, sensing vector and therapeutic zone. 16-45 Abstract 01-15 IS CRISTA SUPRAVENTRICULARIS THE FULCRUM OF TORSADES DE POINTES? Guoliang Li 1, Guy Fontaine 1, Ardan Saguner 2, Deniz Akdis 2 , Peng Liu 3 1 Institut de Cardiologie, Unité de Rythmologie, Groupe hospitalier Pitié-Salpetrière, Paris, France, 2 University Heart Center Zurich, Zurich, Switzerland, 3 First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China Background: Torsades de pointes tachycardia (TdP) is a rare but important cause of sudden death in people with Long QT Syndrome. They also occur in patients with high-degree atrioventricular (AV) block. However, the exact mechanism of TdP and its relation to VT and VF has never been elucidated. Objective: The objective of this article was to attempt to answer the question of the mechanism of TdP from patients with spontaneous high-degree AV block. Methods: Episodes of TdP in 16 consecutive patients in spontaneous atrioventricular block (AV) block type II or III (BB 65 years; 80% females) were prospectively recorded by a single bipolar V2-V4 lead or three frontal plane ECG leads. The critical coupling interval (CCI) between the last beat during AV block and before the first ventricular event: 160 PVCs, 121 couplets, 21 triplets and 107 TdPs were measured. Results: The QT interval during AV block (mean heart rate 39 ± 8 bpm) was 653 ± 67 ms. The CCI before the onset of PVCs/couplets vs TdP was shorter in the latter (672 ± 44 and 676 ± 37 ms vs 639 ± 52 ms, < 0.05). A rhythmic

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

crescendo of ventricular events (in 100%) and major T wave distortion (75%) was observed before the onset of TdP. These data suggest two consecutive mechanisms: a phase 2 reentry phenomenon in adjacent myocardial fibers for the first beat initiating TdP followed by a fast circus movement reentry with two exit sites or two independent circus movement can explain the morphology of TdP. This mechanism is in agreement with vortexlike wave studied with optical mapping reported in Proc Ntl Acad Sciences 1990. Because of its flat structure (verified by gross pathology), crista supraventricularis is the only place where circus movement tachycardia is taking place. A VT pattern was observed if a single circus movement was operative, VF in two cases of myocardial ischemia after long lasting episodes of TdP at around 300 bpm. Conclusion: Dispersed repolarization of adjacent ventricular myocardial fibers suggests a phase 2 reentry for the first TdP beat followed by a circus movement reentry occurring in the crista supraventricularis is the only mechanism to explain TdP perpetuation in patients with spontaneous high degree AV block. 16-46 Abstract 17-17 MECHANICAL AND ELECTRICAL DYSSYNCHRONY AS PREDICTORS OF VENTRICULAR TACHYCARDIA IN PATIENTS WITH IMPLANTED CARDIOVERTER DEFIBRILLATORS Joshua Harrison 1, Kavitha Kalluri 1, Zachary Tushak 1, Dalia Giedrimiene 1, Lane Duvall 1, Jeffrey Kluger 1 1 Hartford Hospital, Hartford, CT, United States Background: It has been suggested that left ventricular dyssynchrony (LVD) assessed by myocardial perfusion imaging (MPI) is associated with death and implantable cardioverter defibrillator (ICD) shocks. We sought to investigate the role of LVD and other clinical factors in predicting ventricular tachycardia (VT) in an ICD patient population. Methods: The Hartford Hospital ICD database was searched for VT patient encounters that had myocardial perfusion imaging (MPI) studies within 2 years of the VT event. Patients with at least 2 years of ICD follow-up without VT events and a MPI study within 2 years of an ICD encounter were also identified. Patients without structural heart disease were excluded. Patient demographics, clinical characteristics, ECG data, MPI results, and LVD data were collected. Data was analyzed to assess for predictors of VT. Results: Two hundred nine patients without VT events and 172 patients with VT were identified. Secondary

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

prevention ICD indication (OR 8.5, 95% CI 1.5–46.4), Sotalol therapy (OR 10.4, 95% CI 1.4–75.9), RV pacing (OR 10.6, 95% CI 0.97–116), and lower ejection fraction (EF) (28.6 ± 11.4 vs 35.8 ± 14.2, p BB 0.0001) were predictive of VT occurrence. One hundred thirty-six studies were available for MPI-based LVD assessment. LVD and MPI results were not predictive of VT occurrence. Conclusions: In this study of 381 patients with ICDs and MPI studies, neither MPI results nor LVD was predictive of the occurrence of VT. Secondary prevention ICD indication, Sotalol therapy, RV pacing, and lower EF were predictive of VT occurrence.

S101

Background: Wearable cardioverter defibrillator (WCD) therapy is feasible and safe in patients as a transient protection against sudden cardiac death (SCD). Though, impact of WCD therapy on quality of life (QoL) has not been studied. Methods: In our single centre study, 109 consecutive patients were retrospectively analysed. Quality of life has been assessed by a standardized questionnaire (EQ-5D-3L, modified). Additionally, clinical baseline and follow up data and recorded arrhythmic episodes were evaluated. Results: Mean WCD therapy time was 56.2 (± 42.4) days, with a daily wear time of 19.7 (± 5) hours. A total of 3441 arrhythmia episodes were detected. Of these, 27 (1%) were adequate, but did not require shock therapy. Likewise, no inadequate shock therapy occurred. WCD therapy negatively affected quality of life: 43% of patients reported mental health issues; 37% reported pain or discomfort. Self care and usual activities and mobility were restricted in 17, 48 and 36%, respectively. Twenty-nine percent were afraid of receiving shock therapy, 64% indicated to have felt safe during WCD therapy. Forty-eight percent suffered from disturbance of night sleep. Accordingly, average quality of life was rated 70/100 points. Conclusion: In our cohort, no SCD was prevented by WCD therapy. In contrast, quality of life was markedly reduced Thus, careful recommendation of WCD therapy for high risk patients is pivotal. 16-48 Abstract 19-11 VENTRICULAR ARRHYTHMIA OCCURRENCE AND COMPLIANCE IN PATIENTS TREATED WITH THE WEARABLE CARDIOVERTER DEFIBRILLATOR FOLLOWING PERCUTANEOUS CORONARY INTERVENTION

Wearable defibrillators 16-47 Abstract 19-17 IMPAIRMENT OF QUALITY OF LIFE AMONG PATIENTS WITH WEARABLE CARDIOVERTER DEFIBRILLATOR THERAPY (LIFEVEST®) Korbinian Lackermair 1, Christoph Schuhmann 1, Michaela Kubieniec 1, Heidi Estnerr 1, Stephanie Fichtner 1 1 University of Munich, Department of Cardiology, Munich, Germany

Jérémie Barraud 1 , Pauline Pinon 1 , Marc Laine 1 , Jennifer Cautela 1 , Morgane Orabona 1 , Linda Koutbi 2 , Johan Pinto 1 , Franck Thuny 1 , Frédéric Franceschi 2 , Franck Paganelli 1, Laurent Bonello 1, Michael Peyrol 1 1 Aix-Marseille University, Assistance Publique Hôpitaux de Marseille (AP-HM), Department of Cardiology, Hôpital Nord, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France, Marseille, France, 2 AixMarseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Department of Cardiology, Hôpital Timone, France, Marseille, France Background The wearable cardioverter defibrillator (WCD) is a life-saving therapy in patients with high

S102

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

risk of arrhythmic death. We aimed to evaluate ventricular arrhythmia (VA) occurrence rate and compliance with the WCD during the first 90 days following myocardial revascularization with percutaneous coronary intervention (PCI) in patients with left ventricular eject i on f r ac t i o n (LV E F ) B B 3 0 % . Me t h od s F r om September 2015 to November 2016, clinical characteristics, WCD recordings and compliance data of the aforementioned subset of patients were prospectively collected. Results Twenty-four patients (men = 20, 80%) were included in this analysis. Mean age was 56 ± 10 years and mean LVEF at enrollment was 26.6 ± 4.3%. During a mean wearing period of 3.0 ± 1.3 months, two episodes of VA occurred in two patients (8.3%): one successfully treated with WCD shock and one with spontaneous termination. The mean and median daily use of the WCD was 21.5 and 23.5 h a day, respectively. Eighteen patients (75%) wore the WCD more than 22 h a day. Conclusions The rate of VA, during the WCD period use after myocardial revascularization with PCI, was high in our study. Otherwise, it underlined that patient compliance is critical during the WCD period use. Remote monitoring and patient education are keys to achieve good compliance. Table 1. Clinical characteristics and medications of patient at enrollment.

Number of patients Male,n (%) Age,mean (SD)

24 20 (80) 56 ± 10

BMI,mean (SD) (kg/m²)

27 ± 7

LVEF (%) Pre-existing LV systolic dysfunction, n (%) NYHA functionnal class - II,n (%) - III or IV, n (%) QRS duration (ms) Coronary artery disease - 1 vessel, n (%) - 2 vessels, n (%) - 3 vessels, n (%) Medications at enrollment - Antiplatelet agents, n (%) - Oral anticoagulant therapy, n (%) - β blocker, n (%) - ACE inhibitor, n (%) - Loop diuretic n (%) - Aldosterone antagonist, n (%) - Statin, n (%)

27.3 ± 4.7 9 (37.5) 20 (91.7) 2 (8.3) 102 ± 21 0 10 (41.7) 14 (57.3) 24 (100) 9 (37.5) 24 (100) 22 (91.7) 16 (66.7) 18 (75) 22 (91.7)

BMI Body Mass Index; LV Left Ventricular; ACE Angiotensine-converting enzyme Chaired Poster Session B part 2 Sunday April 15, 2018, Posters displayed from 02:00 pm–05:30 pm Presenters and Chairpersons present from 04:00 pm– 05:30 pm ROOM TERNES Atrial Fibrillation 16-49 Abstract 04-14 NON-PULMONARY VEIN TRIGGERS OF ATRIAL FIBRILLATION IN PATIENTS WITH COMPLETE PULMONARY VEIN ISOLATION Min-young Kim 1, Markus B Sikkel 1, Afzal Sohaib 2, Louisa Malcolme-Lawes 2, Kevin Leong 2, Vishal Luther 2, Belinda Sandler 1, Michael Koa-Wing 2, Zachary Whinnett 2, Norman Qureshi 2, Fu Siong Ng 2, Nicholas S Peters 1, Wyn Davies 2, Elaine Lim 2, Michael Fudge 2, Michelle Todd 2, Ian Wright 2, Nick W F Linton 2, Phang Boon Lim 2, Prapa Kanagaratnam 1 1 Imperial College London, London, United Kingdom, 2 Imperial College NHS Trust, London, United Kingdom Background. Patients with recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) present a clinical dilemma when veins remain isolated. High-frequency stimulation (HFS) delivered within the local myocardial refractory period enables neural stimulation, without myocardial capture, of presumed ganglionated plexus sites (GP) that reproducibly trigger atrial ectopy and AF. We sought to determine whether non-PV triggers can be identified using HFS in patients with previously isolated PVs. Methods. Patients undergoing redo ablation for paroxysmal AF were recruited. A 3D left atrial geometry was created (CARTO) and a mapping catheter was used to deliver HFS within the local refractory period with fixed rate pacing (12 V, 40 Hz, 20 ms delay, 80 ms train duration). A multielectrode catheter in the nearest PV and coronary sinus monitored for atrial activity. Results. Thirteen patients were studied. Two patients had completely isolated PVs at the start of the procedure. In total, 34/194 (18%) HFS points were GPs. There was no PV activity throughout (Fig. 1). The remaining ten patients had 1–3 PV reconnections. In average, 69 ± 39 HFS points were tested identifying 11 ± 6 (16%) GPs in average per patient. One patient had no GPs after testing 115 HFS

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

sites. After PV re-isolation, 4/13 (31%) patients had re-testing of the GPs identified before re-isolation. In average, 10 ± 4 HFS points were tested which revealed 2 ± 1 (20%) GPs still positive per patient. Conclusion. For the first time, we have demonstrated that non-PV triggers of AF can be identified in patients with prior PVI using HFS to stimulate GPs. PVI inadvertently damaged GPs along the ablation lines, but most GPs away from the ablation lines remained positive.

16-50 Abstract 15-31 HEMODYNAMIC EFFECT OF PAROXYSMAL ATRIAL FIBRILLATION ABLATION IN PATIENTS WITH NORMAL AND MID-RANGE LEFT VENTRICULAR SYSTOLIC FUNCTION Aleksandra Liżewska-Springer 1, Alicja Dąbrowska-Kugacka 1 , Łukasz Drelich 1, Tomasz Królak 1, Ewa Lewicka 1, Grzegorz Raczak 1 1 Department of Cardiology and Electrotherapy Medical University of Gdańsk, Gdańsk, Poland

S103

minimal volume, LA volume index (LAVI) and increase in LA strain and the global longitudinal strain (GLS) of the left ventricle (LV) was observed. Significant increase in right atrium (RA), right ventricle (RV) and LA-RA free wall strain was also noticed. Moreover, RA area and RA major diameter significantly decreased. Conclusion: Radiofrequency AF ablation among patients with normal and mid-range LVEF results in statistically significant reverse structural remodeling not only of the LA but also LV, RA and RV. Moreover, successful PVI in patients with AF significantly decreases LA volume and RA size.

LA max. volume (ml)

Baseline (mean ± SD) 86 ± 23

After PVI (mean ± SD) 75 ± 22

P value 0.0035

LA min. volume (ml) LAVI (ml/m²)

50 ± 23 42 ± 12

40 ± 18 38 ± 11

0.017 0.03

LA strain (%) GLS of the LV (%) RA strain (%)

21 ± 9 17 ± 4 25 ± 12

26 ± 8 19 ± 3 34 ± 9

0.001 0.036 0.0006

RV strain (%) LA-RA free wall strain (%) RA area (cm²) RA major diameter (mm) LVEF (%)

18 ± 5 17 ± 9

22 ± 4 24 ± 8

0.0004 0.001

19 ± 4 55 ± 6

18 ± 3 52 ± 5

0.012 0.01

59 ± 9

61 ± 7

0.20

Values are mean ± SD, LA- left atrium, LAVI- left atrial volume index, GLS- global longitudinal strain, LV- left ventricle, RAright atrium, RV- right ventricle, LVEF- LV ejection fraction 16-51 Abstract 18-11 16-52 Abstract 15-28

Background Radiofrequency pulmonary vein isolation (PVI) changes the process of heart remodeling in patients with atrial fibrillation (AF). Simultaneously, there are conflicting data as to whether AF-associated remodeling reverses after effective ablation. The purpose of this study was to evaluate the changes of atrial and ventricular size, volumes and function in patients with AF after PVI.Methods. Thirty-two patients (aged 55 ± 12 years; 21 male, 11 female), presenting with paroxysmal AF and left ventricular ejection fraction (LVEF ≥ 40%) who were treated with PVI were studied. Patients underwent echocardiographic assessment of strain variables and size of cardiac chambers before and at least 6 months after PVI. Seven patients had AF during baseline examination whereas 32 patients had sinus rhythm during examination after PVI.Results In the follow-up examination (15 ± 4 months after PVI), significant decrease in LA maximal,

LEFT ATRIAL EJECTION FORCE PREDICTOR OF RECURRENCE IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION Horatiu Rus 1, Elena Bobescu 1, Cristina Dascalescu 1, Cezar Luca 1, Elena Grancea 1 1 University Transilvania, Brasov, Romania Introduction. Left atrium (LA) systolic dysfunction is present in early stages of atrial fibrillation (AF) prior to LA anatomical changes. We evaluate whether LA systolic dysfunction predicts recurrent AF after conversion (medical or electrical) in patients with paroxysmal atrial fibrilation. Methods and Results: We studied 100 patients who underwent medical or electrical conversion for paroxysmal AF. LA systolic function was appreciated with the LA emptying volume = maximum LA volume

S104

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

(LAVmax) − minimum LA volume (LAVmin), LA emptying fraction = [(LAVmax − LAVmin) / LAVmax] × 100, and LA ejection force calculated with Manning’s method [LA ejection force = (0.5 × ρ × mitral valve area × A2)], where ρ was blood density and A was late-diastolic mitral inflow velocity. Recurrent AF was registered in 40/100 (40%) 13.5 ± 10 months. Univariate analysis revealed reduced LA ejection force, decreased LA emptying fraction, larger LA, high PCR, high BMI index. On multivariate analysis, reduced LA ejection force and larger LA diameter, and high BMI were independently associated with recurrent AF. Patients with reduced LA ejection force and larger LA diameter had a higher risk of recurrent AF than preserved LA ejection force (log-rank p = 0.0002). Conclusions: Reduced LA ejection force and larger LA diameter can be considered as new predictors of AF recurrence in patients with paroxysmal atrial fibrillation.

acute PVI was still achieved in all patients with a mean number of 5.8 ± 1.8 applications per vein. Atypical PV anatomy was not associated with procedural failure nor with the number of applications needed for PVI. During 1-year follow-up, AF recurrence was observed in 90 patients (31.4%), of which 60 patients (20.9%) underwent a redo PVI procedure. Variant PV anatomy was not associated with higher AF recurrence nor presence and site of PV reconnection during long-term clinical follow-up. Conclusion: This large-scaled cohort study shows that in patients with PAF undergoing PVAC GOLD PVI, the presence of variant anatomical variations was not associated with AF recurrence during clinical follow-up nor with reconnection site during redo PVI procedure.

16-53 Abstract 18-21

SPECKLE-TRACKING ECHOCARDIOGRAPHY DURING CATHETER ABLATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION

ANATOMY OF THE PULMONARY VEINS AND CLINICAL OUTCOME AFTER PULMONARY VEIN I S O L AT I O N I N PA R O X Y S M A L AT R I A L FIBRILLATION: A LARGE-SCALED SINGLECENTRE EXPERIENCE Lisette Wintgens 1, Martijn Klaver 1, Marisevi Chaldoupi 2, Vincent van Dijk 1, Arash Alipour 1, Maurits Wijffels 1, Jippe Balt 1, Lucas Boersma 1 1 St. Antonius Hospital, Nieuwegein, Netherlands, 2 Haga Hospital, The Hague, Netherlands Background: After catheter ablation (CA) by pulmonary vein isolation (PVI), AF recurrences are common and mainly due reconnection of pulmonary veins. Atypical anatomical variations of the pulmonary veins (PV’s) may form a challenge in creating durable isolation specifically for single-shot ablation catheters. The aim of study was to evaluate impact of anatomical PV characteristics on acute and chronic isolation with the multi-electrode PVAC GOLD catheter and AF freedom during 1-year clinical follow-up. Methods: Consecutive patients with symptomatic paroxysmal AF (PAF) were included. During the procedure, PV anatomy was visualized by fluoroscopy/contrast venography. PVI was performed using the PVAC GOLD catheter. Follow-up was performed at 3 and 12 months with electrocardiography and Holter recordings. Results: A total number of 1136 PV’s in 287 patients (207(72%) male, age 61.5 ± 9.6 years) were targeted. Then, 258 patients (89.9%) had a separate left superior PV and left inferior PV. Further, 268 patients (93.4%) had a separate right superior PV and right inferior PV. A left common PV (LCPV) was found in 29 (10.1%) patients, a separate right middle PV (RMPV) was seen in 19 (6.6%). Thus, variant PV anatomy was found in a total number of 44 patients (15.3%). Successful

16-54 Abstract 15-18

Askhat Dubanaev 1, Andrey Smorgon 1, Evgeniy Archakov 1, Stanislav Usenkov 1, Roman Batalov 1, Sergey Popov 1 1 Cardiology Research Institute, Tomsk, Russia Backround: Currently, there are no methods for the detection of the transmural myocardial damage of pulmonary veins (PV) during the catheter ablation procedure (CAP). We use indirect signs for the control of the electrical isolation: a change of the tissue impedance under catheter’s tip; a decrease of the electrogram amplitude. The intracardiac echocardiography allows to visualize the PVostia and to estimate the changes in the rate of the tissue deformation during CAP. The aim of the study is to evaluate the rate of the tissue deformation by speckle-tracking echocardiography in patients with the paroxysmal atrial fibrillation (AF) during CAP. Methods: The study included 17 patients with paroxysmal AF (the mean age 59.4 ± 5.9 years). Radiofrequency ablation (RFA) was performed in eight patients, and cryoballon ablation (CBA) in nine cases. The electrophysiological criterion of PV isolation was the disappearance of the PV potential on the circular electrode and “entrance”/“exit” block. The intracardiac speckle-tracking echocardiography was used during CAP for the evaluation of the longitudinal deformation of PV muscular sleeves. Results: The results of the study are shown in the table. In RFA group, min tissue deformation (TD) is 6.1% in left superior PV and max TD is 7.7% in right superior PV. In CBA group, min TD is 7.7% in right superior PV and max TD is 7.7% in left inferior PV (Table 1). Conclusion: The reliable change of TD according to the speckle-tracking echocardiography is achieved at the moment of PVelectrical isolation. The speckle-tracking echocardiography can be used as a method for PV isolation control during CAP.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

16-55 Abstract 15-11 MID-TERM EXPERIENCE WITH A NOVEL HYBRID CRYO/RF FOCUSED TECHNIQUE IN PA R O X Y S M A L A N D P E R S I S T E N T AT R I A L F I B R I L L AT I O N — L O W V O LTA G E B R I D G E MAPPINGBACKGROUND: DESPITE ADVANCES IN CATHETER TECHNOLOGIES AND ENERGY SOURCES FOR ATRIAL FIBRILLATION (AF) ABLATION Michael Giudici 1, Steven Bailin 1, Hardik Doshi 1, Siva Krothapalli 1 1 University of Iowa Hospitals, Iowa City, United States Background: Despite advances in catheter technologies and energy sources for atrial fibrillation (AF) ablation, patient outcomes when treating long-standing persistent AF with pulmonary vein isolation (PVI) combined with empiric roof and isthmus lines is inferior to those seen in paroxysmal AF. Advances in mapping systems allow very detailed substrate analysis to be performed rapidly. We previously described a method of substrate ablation (SA) by targeting low voltage bridges (LVB) based upon voltage gradient mapping (VGM). Studies have suggested that targeting “low-voltage bridges” (LVB) can be successful in ablating atrial fibrillation, atrial flutter, and slow pathways. We sought to apply this technique in these difficult patients with AF including longstanding paroxysmal and persistent AF. Methods: Sixty-one pts (46M/15F) mean age 59 (26–78 years) with mean AF duration 4.5 (.75–15.0 years) underwent AF ablation between December 2014 and September 2017. Twenty-nine patients were considered paroxysmal AF and 32 persistent AF. The procedure consisted of initial PVI using a 28-mm cryoballoon (Arctic Front, Medtronic, Mpls., MN) followed by detailed mapping of the left atrium using the Navix mapping system and an HD catheter (St. Jude Medical, Mpls, MN). Two pts required additional right atrial mapping. Low-voltage bridges were determined and then ablated using a 4-mm tip RF catheter. Sequential mapping was performed after each “layer” of LVBs were eliminated until no LVBs could be found in the chamber. Results: Fifty-six of 61 patients remain in sinus rhythm at most recent f/u on no (46 pts) or lower potency (10 pts) antiarrhythmic drug therapy. Three of the patients

S105

on no anti-arrhythmic therapy underwent a second procedure for left atrial flutter. Mean f/u duration 16.5 months (1–34). The five pts without long-term success have undergone pacing procedures ± AV nodal ablation. There were three complications—one small CVA which resolved quickly, a retroperitoneal bleed that required no intervention, and an esophagealpericardial fistula requiring surgery. Conclusion: These positive outcomes suggest that a more targeted approach to ablation in long-standing persistent AF targeting LVBs may be superior to empiric roof and isthmus lines. Our mean followup is 16 months, however, and will need more patients and longer follow-up to confirm these results. 16-56 Abstract 01-11 N O N - PAT I E N T S P E C I F I E D M O D E L I N G PA R O X Y S M A L A N D P E R S I S T E N T AT R I A L FIBRILLATION ABLATION APPROACHES AND THEIR EXTRAPOLATION TO CLINICAL RESULTS Evgeny Zhelyakov 1, Mikhail Mazurov 2, Andrey Ardashev 1, Yury Belenkov 1 1 Moscow State University, Moscow, Russia, 2 Economic and Statistic University, Moscow, Russia Background: We have simulated of paroxysmal (4-wave reentry) and persistent (6-wave reentry) atrial fibrillation (AF) as a autowave processing in a 2D active medium by means of scanning algorithm based on left atrial (LA) geometry as well as ablation formatting, simulating ablation impact. Aim: The objectives of this study are (1) to estimate probability of 4- and 6-waves re-entry to eliminate as a results of ablation simulation in 2D-mathematical modeling of LA, and (2) to extrapolate modeling data to clinical results of ablation strategies. Modeling of AF (Methods): Numeric reconstruction of the autowave process in excitable tissues of the LA and the simulation of 4- and 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 of the LA. Then two ablation formatting approaches (simulating clinical ablation strategies) were performed. Results: For 4-wave reentry AF model (paroxysmal), there was no elimination of reentry while circular LASSO-like ablation pattern was used. Linear ablation patterns (corresponding to linear ablation) suppress arrhythmias caused by 4-waves re-entry. For persistent AF model ablation, formatting transformed 6- to 4-wave reentry. Clinical data (Methods): Study was conducted on 40 pts with paroxysmal and persistent AF. First group (paroxysmal) included 20 pts (6 women, 51.4 ± 13.6 years of age) with paroxysmal AF, who were divided into subgroups A and B. The subgroup A included of 10 pts who underwent PVI using LASSO technique. The subgroup B included of 10

S106

pts who underwent antral PVI added by roof and mitral isthmus lines. Second group (persistent) concluded 20 consecutive pts (6 women, 58.2 ± 10.6 years of age, history of arrhythmia—7.1 ± 1.1 years) with persistent AF who underwent circumferential ablation combined with roof and mitral isthmus lines. We evaluated AF CL into the CS after antral isolation of all PV, after mitral isthmus ablation and after roof ablation. Results: AAD free effectiveness in the first/second groups were 80/20% at 12 months respectively (р = 0.003). In the second group, organization of AF CL (from 112 ± 24 to 204 ± 35 ms) was verified in 12 of 20 pts. Conclusion: Nonpatient-specified modeling of AF based on mathematical scanning approach may simulate paroxysmal and persistent AF as sustained 4- and 6-wave re-entry. Linear ablation modeling for 4-waves re-entry suppressed arrhythmia comparing to LASSO-like modeling. Linear ablation modeling for 6-waves re-entry transformed it to 4-wave re-entry. Results of ablation strategies modeling may consistent to clinical data.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

related to SR recovery only in younger patients and not in those aged > 75 years. Preoperative pulmonary artery pressure was the only independent predictor of mortality in elderly patients, while SR at the end of follow-up and preoperative duration of AF and were independently related to survival in younger patients. Conclusion: Although the rate of sinus rhythm restoration after RF ablation associated with mitral valve surgery was not significantly different between patients aged > 75 years and younger patients, only in this latter group sinus rhythm recovery was associated with an longer survival rate and with the degree of functional improvement.

16-57 Abstract 15-47 SINUS RHYTHM RECOVERY AFTER ATRIAL FIBRILLATION RADIOFREQUENCY ABLATION IS NOT ASSOCIATED WITH LONGER SURVIVAL IN PAT IE NT S AG ED > 75 Y EA R UN D ERG O I NG MITRAL VALVE SURGERY Carlo Rostagno 1, Pier Luigi Stefàno 2 1 Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Firenze, Italy, 2 Cardiochirurgia AOU Careggi, Firenze, Italy Aim of present investigation was to evaluate the effects on sinus rhythm recovery on long-term survival in patients aged > 75 years undergoing ablation of AF in association with mitral valve surgery. This study included 95 consecutive patients with AF (64 men and 51 women) aged > 75 years (mean age 78+ years) (group I) underwent RF ablation associated with mitral valve surgery. Two hundred six younger patients (mean age 65 + 8 years) (group II) treated in the same period were considered as the control group. Six patients died during hospitalization (three in each group). Baseline clinical and echocardiographic characteristics did not differ between the two groups. In patients aged > 75 years, duration of AF was shorter (26 vs 54 months). At 5-year follow-up, overall mortality was not significantly different between the groups (21 vs 18%) while sinus rhythm in elderly patients was present in 58/78 (74 %) in comparison to 149/181 (82 %) of younger patients. Recurrence rate was respectively 32 and 33%. Overall in elderly patients, 26% never recovered SR in comparison to 17% in patients aged < 75 years. Mortality at follow-up was statistically

16-58 Abstract 07-23 PREVALENCE OF SIGNIFICANT CORONARY D I S E A S E I D E N T I F I E D B Y P R E - AT R I A L F I B R I L L AT I O N A B L AT I O N C A R D I A C C T ANGIOGRAPHY Meet Patel 1, Vishal Goyal 1, Ilana Kutinsky 1 1 Beaumont Health, Royal Oak, Michigan, United States Background: An estimated 2.7–6.1 million people in the USA have AF. With the aging of the US population, this number is expected to increase. The incidence of coronary artery disease in patients with AF ranges between 24 and 65%. The primary indication for AF ablation is the presence of symptoms associated with the arrhythmia. The symptoms of atrial fibrillation are very similar to those of flow-limiting coronary artery disease (e.g. shortness of breath, exercise intolerance, fatigue). Despite the plethora of research in these areas, there is a lack of data regarding the presence and severity of coronary artery disease in patients undergoing AF ablation. We aimed to assess for the prevalence of significant coronary disease (BB 70% stenosis) found on pre-ablation cardiac CT angiography (CCTA) Methods: All patients that undergo AF ablation at our institution undergo a CCTA–PVI protocol, which includes an interpretation of coronary anatomy/presence of atherosclerosis, as well as dimensions and anatomy of the pulmonary veins. Using an existing database of CCTA, we identified studies that were completed for pre-AF ablation and assessed

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

for the presence and severity of coronary disease between the years 2009 to 2013. Results: A total of 362 CCTAs were identified. Of these studies, the severity of coronary stenosis could not be interpreted in 157 (43.4%) of the studies. Of the 206 studies that were interpreted, 60 (16.6%) studies showed no coronary disease, 46 (12.7%) showed BB 25% stenosis, 32 (8.8%) showed 26–50% stenosis, and 44 (12.2%) showed BB 50% stenosis. Of these 44 patients, 28 (7.7%) patients had severe stenosis, which is defined as one or more vessels with BB 70% stenosis or BB 50% stenosis in the left main artery (LMA). Two patients had significant disease in the LMA and 1 patient had three vessel disease. Of the 28 patients with severe disease, 8 went on to have coronary intervention within 1 year. Conclusion: Coronary disease is not uncommon in patients who are referred for AF ablation. CCTA is a useful tool in identifying significant disease, which may also be contributing to the patient’s symptoms and outcomes. Knowledge of concomitant coronary disease may affect further management of such patients. 16-59 Abstract 18-17 ENTRAPMENT OF LASSO CATHETER IN CHIARI NETWORK WITH SUCCESSFUL EXTRACTION Sarah Worsnick 1, Angela Naperkowski 1, Pugazhendhi Vijayaraman 1 1 Geisinger Health System, Plains, United States Case Study: Fifty-seven-year-old male with atrial fibrillation refractory to tikosyn underwent PVI ablation. Bidirectional block was achieved in all 4 veins and the patient was then having PACS in a bigeminal pattern. The LASSO mapping catheter (Biosense Webster Inc.) was brought into the right atrium (RA) where the earliest signal was sought. On advancing the LASSO catheter into the RA, it was noted to be entrapped in the RA-IVC junction and attempts to pull the catheter back into the sheath were unsuccessful (Fig. 1A). Intracardiac echocardiography (ICE) demonstrated the catheter to be stuck at the lower portion of the RA above the Eustachian valve. Protamine sulfate was administered, and right internal jugular access was obtained. A snare tool was used to apply cephalad force to the LASSO catheter and free it from its confinement. Examination of the LASSO catheter afterwards displayed a fibrous network of tissue attached to the catheter 5 mm from the tip (Fig. 1B). Further, ICE imaging demonstrated no pericardial effusion. Conclusions: LASSO entrapment in the mitral valve has been reported in a number of cases. The Chiari network has also been described as a location for entrapment of pacing leads. The case described above highlights the catheter’s ability to be entrapped in the Chiari network as well the feasibility to be safely removed without complication. ICE imaging during the case was useful

S107

in that it confirmed the location of the catheter as well as assured the catheter was removed safely without complication afterward.

16-60 Abstract 18-42 META ANALYSIS OF FLUOROSCOPY REDUCTION TECHNIQUES FOR ATRIAL FIBRILLATION ABLATION John Ferguson 1 1 UVA Health Science Center, Charlottesville, United States Background. Low as reasonably achievable (ALARA) fluoroscopy (FL) exposure is a recommended guideline for atrial fibrillation (AF) ablation. We have reviewed published studies on techniques to reduce or eliminate FL for AF ablation. Methods. Randomized and cohort studies were identified searching the Ovid Medline and PubMed databases from 2007 to 2017. Key words included atrial fibrillation, ablation, fluoroscopy, radiation, fluoroless, reduction, minimal, minimize, no, zero. Studies were included if they reported techniques specifically intended to reduce FL exposure for AF ablation. Outcomes included FL time, secondary outcomes included FL time reduction (%), radiation dose area product (cGycm2) and procedure time. Results. We found 24 studies (6 randomized) including 7943 patients with paroxysmal and persistent AF from 9 countries, 18 studies reporting significant FL reductions (mean FL time 16 min, mean reduction in FL time 57%) and 6 studies complete elimination of FL for the entire procedure (407 patients). Techniques were grouped into 11 categories (Table). Intracardiac echo (ICE) was used in only 2/18 reduced FL studies but in all zero FL studies. Mean procedure time was significantly longer in zero vs. no FL cases (199 vs. 149 min, p = 0.01). Operators removed protective lead in techniques #1, 4, 6 and 11. Radiation dose was incompletely reported (12/24 studies, mean 946 cGycm2). No studies reported an increase in complications. Conclusion. Diverse techniques are used to reduce FL. Operators who commit to systematic FL reduction work-flow are able to significantly reduce

S108

or completely eliminate FL for AF ablation. Some work flows also allow removal of lead protection.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

inferior PV of total occlusion. A 6 mm × 40 mm balloon was firstly used to dilate the left superior PV. A stenosis of 7.5 mm × 15 mm was confirmed by CAG. After a bare-metal stent (8 mm × 24 mm) was placed, there was no residual stenosis in left superior PV. Secondly, a 2.5 mm × 20 mm balloon was used to dilate left inferior PV. A stenosis of 7.5 mm × 15 mm was confirmed by CAG. After a drug-eluting stent (4 mm × 24 mm) was placed, there was no residual stenosis in left superior PV. Oral oral medications of antiplatelet were prescribed. Holter showed sinus rhythm and CTA showed adequate patency during the follow-up 1, 3, 6 months after discharge. Conclusion: Severe pulmonary vein stenosis following RFCA for AF should be treated promptly because of its rapid progression. Combination of balloon and stents can much more significantly restore the patency of PVS than balloons alone. 16-62 Abstract 18-44

16-61 Abstract 18-43 PULMONARY VEIN STENOSIS AFTER RADIOFREQUENCY ABLATION FOR ATRIAL FIBRILLATION Guoliang Li 1, Peng Liu 1, Chaofeng Sun 1, Lingping Xu 2 First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China, 2 Xian Yang Central Hospital, Xian Yang, China

1

Background: Pulmonary vein stenosis (PVS) is one of the most complications after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). Controversies are existing concerning the optimal approach for this issue. Objecctive: To evlaute the potential of combination of balloon and stents to restore the patency of PVS. Methods: N/A. Results: A 68year-old man presented with paroxysmal AF (PAF) refractory to conventional measures. Transabdominal ultrasound demonstrated left atrial diameter was 37 mm, right atrial diameter 32 mm, EF 66%. Computed tomography angiography (CTA) indicated left superior PV of 16 mm, left inferior PV of 10.7 mm, right superior PV of 11.8 mm, right inferior PV of 8.6 mm. The patient received circumferential pulmonary vein isolation (CPVI). At the schedualed follow-up 12 months after CPVI, the patient complained of paroxysmal palpitations. Holter monitor indicated PAF. The pre-procedural CTA before the second CPVI indicated left superior PV of 1.4 mm with a sever stenosis of 7.5 × 14 mm, left inferior PVof 6.9 mm, right superior PV of 14 mm, right inferior PV of 9.7 mm. A 4 mm × 15 mm balloon was used to dilate left inferior PV with a residual stenosis of 70% because other types of balloons were unaccessable by then. At the follow-up 1 month after the second CPVI, CTA indicated a rapid progression of stenosis to occlusion. Left superior PV showed a stenosis of 85% and left

RESULTS OF LESION SIZE INDEX GUIDED A B L AT I O N O F PA R O X Y S M A L AT R I A L FIBRILLATION Nway Ko Ko 1, Uyanga Batnyam 1, Usman Siddiqui 1 1 University of Central Florida, Orlando, United States Background: Achieving durable pulmonary vein isolation (PVI) remains a challenge. Among several advances in PVI techniques, the important one is development of a contact force (CF) sensing catheter which measures real-time contact force during ablation to ensure that operator delivers optimal CF and force time interval (FTI) as defined by TOCATTA and EFFICAS I studies. A following study by Neuzil, et al, after lesion size index (LSI) values were retrospectively evaluated from EFFICAS I study data, showed that LSI is also a predictor for the outcomes of PVI. Katuzner et al. showed that CF variation across all segments was 18.6% and LSI variation was only 4.9%. Therefore, taking LSI into consideration provides more uniform lesion delivery. Titrating power and duration to compensate for CF variability appears to result in uniform lesion quality as quantified by LSI.Hypothesis: A new feature, AutoMark LSI guided PVI, will provide optimized ablation using LSI as a target parameter. It uses LSI of an area to achieve adequate lesion formation of particular area of the segment. In that way, adequate lesion formation is ensured without excessive or insufficient lesions while avoiding the need to deal with enormous CF variation of different segments. Method: Prospective randomized non-blinded singlecentered study to compare the outcomes of AutoMark LSI guided PVI (treatment arm) versus non-LSI guided PVI using CF sensing catheter (control arm). Three patients were in treatment arm and three patients were in control. Inclusion criteria includes patients with paroxysmal atrial fibrillation (AF), age of 18 or older, signed informed consent and no prior AF or

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

atrial flutter ablation. Excluded patients are those with life expectancy less than 6 months, acute myocardial infarction within last 30 days and pregnant patients. Total number of lesions in treatment group was compared to control group. Data on radiofrequency (RF) time, lesion time in minutes (time from first to last lesion) and number of additional RF sessions were also compared. Results: Treatment (avg 3 cases)

Control (avg 3 cases)

Total automark or manual points Total rf time (s)

105.3 2691

226 (81 if automark used) 2256

Time from first to last lesion (min) Number of additional rf sessions

105.3

80.33

3.7

5.3

S109

termination strongly correlated with existence of right atrial rotors (p = 0.005). Among RA locations, lateral RA rotor ablation trended with AF termination (p = 0.061) compared to other locations. Among left atrial ablation sites, rotors located to the LA roof correlated significantly with acute success (p = 0.045). Smaller LA volume, higher EF, lower BMI and shorter duration of AF (all, < 0.05) also related to AF termination (Fig.). On multivariate analysis, smaller LA volume, higher EF and shorter duration of AF (all, < 0.05) remained significant correlates of acute procedural success (Fig.). Conclusion: In this large AF registry of PVI/driver ablation, several demographic factors were associated with intra-procedural AF termination. Additional mechanistic studies and outcomes data may help to clarify the implications of these findings.

Conclusion: In treatment arm, fewer lesion points as well as less additional RF sessions were required after the initial PVI although total number of RF time was greater than control arm. Based on these data, LSI guided ablation is optimal for completion of ablation with lesser number of leision which will lead to less lesion related complication. 16-64 Abstract 18-40 16-63 Abstract 18-41 PROCEDURAL AND CLINICAL DETERMINANTS OF ACUTE SUCCESS OF DRIVER ABLATION FOR PERSISTENT ATRIAL FIBRILLATION Albert Rogers 1, Tina Baykaner 1, Joao Mesquita 2, Fatemah Shenasa 1, Mallika Tamboli 1, Mohan Viswanathan 1, Paul Wang 1, Sanjiv Narayan 1, Stefan Spitzer 3, Tamas SziliTorok 4 1 Stanford University, Stanford, United States, 2 Hospital de Santa Cruz, Carnaxide, Portugal, 3 Praxisklinik Herz und Gefäße, Dresden, Germany, 4 Erasmus MC, Rotterdam, Netherlands Background: Ablation of AF drivers is an increasingly used adjunct to pulmonary vein isolation (PVI) for persistent AF, but studies show diverse results that may reflect their small size. Objective: We aimed to find physiological determinants of acute success in patients treated by focal impulse and rotor modulation (FIRM) in a large registry of AF driver ablation from four centers. Methods: Consecutive patients with persistent AF undergoing PVI with rotor ablation with documentation of clinical and procedural covariates were assessed univariate and multivariate analyses with regards to acute procedural outcomes. Results: Data were available for 402 patients (age 64 ± 12 years, EF 56 ± 10%, LA volume: 76 ± 38 ml, BMI: 30 ± 6kg/m2). Overall, 188 (47%) had intra-procedural AF termination to sinus or atrial tachycardia. On univariate analysis, AF

PROCEDURAL EFFICACY AND SAFETY OF THE GLOBALLY LARGEST PROSPECTIVE SINGLE C E N T E R R E G I S T RY F O R P VA C G O L D P V ISOLATION FOR AF Martijn Klaver 1, Lisette Wintgens 1, Vincent van Dijk 1, Maurits Wijffels 1, Jippe Balt 1, Lucas Boersma 1 1 St. Antonius Hospital, Nieuwegein, Netherlands Background: Pulmonary vein isolation (PVI) is the wellestablished cornerstone of ablation for atrial fibrillation (AF). As there is no superior technology to date, ease of use and procedural efficacy and safety are important selection criteria. Objectives: We summarize the procedural characteristics and safety of the second-generation multi-electrode PV ablation catheter (PVAC GOLD) in the largest real-world cohort currently available. The PVAC GOLD consists of a circular array with nine gold electrodes and is driven by the GENius IQ duty-cycled phased RF generator. Methods and results: This real-world single-center registry contains 831 consecutive AF patients who underwent first-time ablation for atrial fibrillation between May 2013 and December 2015 using the second generation, multi-electrode PVAC GOLD ablation catheter. Table 1 shows the baseline characteristics. AF ablation was performed on uninterrupted oral anticoagulation in 98% of patients (64% VKA, 34% NOAC). Eighty-five percent of patients underwent PVI and 15% PVI + substrate modification using additional MASC

S110

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

MAAC catheters (PVAC+). As expected, PVAC+ had longer procedure times (84 vs. 106 min, < 0.001). Table 2 shows PVI success rate and 30-day safety outcomes. Successful PVI was achieved in 97% of the patients and in 99% of the PVs. The LCPV and the RIPV showed a higher chance for incomplete isolation with 4.2 and 1.5% respectively. Univariable and multivariable analyses showed successful PVI was independent of all measured baseline and procedural characteristics. Age BB 75years (p = 0.006) and BMI BB 30 (p = 0.042) were prognostic factors for safety outcomes. Vascular access and bleeding complications did not differ between patients on VKA vs NOAC (p = 0.341). Ninety-eight percent of all patients were discharged on day 1 and 99% on day 2. Conclusion: These data show that the second-generation multi-electrode circumferential PV ablation catheter, PVAC GOLD, has a very favorable procedural and safety profile in everyday practice with short procedure times, high acute PVI efficacy, and very low complication rates. Table 1 Baseline characteristics Age Gender (% male)

N = 831 62 ± 10 70%

BMI Type AF (% paroxysmal) CHA2DS2VASC Heart failure

27.0 ± 4.1 67% 2 [iqr; 1-3] 7.6%

Hypertension Age 65–74

44.5% 35.5%

Age 75+ Diabetes Stroke

6.3% 6.7% 7.2%

Vascular Female

16.2% 30%

CHA2DS2VASC BB 2 Chronic lung disease LAVI BB 35

27% 14.2% 34 ± 10 68.9%

35–41 BB 42 Mitral valve regurgitation ≥ II/III

24.6% 6.6% 10%

Table 2 Efficacy and safety outcomes Successful PVI worsened patient condition Not all PVs isolated Anatomical limitations Procedure related safety outcomes Air embolus

N = 831 (%) 808/831 (97%) 2 (0.2) 19 (2.3) 2 (0.2) 14/831 (1.7) 6 (.7)

Tamponade Sedation related Bradycardia/sick sinus syndrome 30-day safety outcomes

0 (0) 4 (.5) 4 (.5) 22/831 (2.6)

(continued) Vascular access complications Cardiac tamponade requiring intervention Minor stroke Major stroke TIA Pacemaker implantation Pericarditis Delirium Phrenic nerve injury Clinical esophageal injury Myocardial infarction in the context of AF ablation Mortality Safety outcomes total

10 (1.2) 2 (.2) 2 (.2) 0 (0) 2 (.2) 2 (.2) 2 (.2) 1 (.1) 1 (.1) 0 (0) 0 (0) 0 (0) 34/831 (4.1)

16-65 Abstract 15-17 THE INTRACARDIAC SPECKLE-TRACKING ECHOCARDIOGRAPHY AS A METHOD OF THE CRYOABLATION EFFICACY ASSESSMENT IN PATIENTS WITH ATRIAL FIBRILLATION Andrey Smorgon 1 1 Scientific Research Institute Of Cardiology, Tomsk, Russia Background: Valid methods for detection of transmural myocardial damage during application of cryoablation are currently unavailable. In clinical practice, doctors use indirect signs such as a decrease in the amplitude of the potential on the electrogram registered by the catheter. The use of intracardiac echocardiography allows for intraoperative visualization of the pulmonary vein ostia and for the assessment of changes in the rate (speed) of tissue deformation of the pulmonary vein ostia using echocardiographic speckle tracking imaging. Aim: The aim of the study was to implement measurements of tissue deformation of the pulmonary artery ostia in patients with atrial fibrillation (AF) during cryotherapy using intracardiac echocardiography to evaluate the effective isolation. Materials and Methods: The study comprised 40 patients (29 men (55%)) with persistent and paroxysmal forms of AF who received cryoablation treatment with pulmonary vein isolation using intracardiac echocardiography. Age of patients was 51.2 ± 7.6 years ranging from 38 to 65 years. During the procedure, intracardiac echocardiographic speckle tracking imaging was used. Electrophysiology criterion for pulmonary vein isolation consisted in a disappearance of pulmonary vein potential on the lasso electrode. During stimulation, “entrance block” and “exit block” were registered. Intracardiac echocardiographic speckle tracking imaging is based on the analysis of spacial pattern of speckles during ordinary 2D sonography. In our study, we assessed only longitudinal deformation of the muscular sleeves of the pulmonary veins. Recorded data were processed using special acoustic-tracking software. Results: In

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S111

our patients, mean deformation of the upper left pulmonary vein was 26 ± 1.5% before and 23.4 ± 1.1% after RFA; tissue deformation decreased by 10% (р < 0.001). Mean deformation of the lower left pulmonary vein was 24 ± 0.9% before and 21.6 ± 0.9% after RFA; tissue deformation decreased by 11% (р < 0.001). Mean deformation of the upper right pulmonary vein was 23.2 ± 1.3% before and 20.9 ± 1.1% after RFA; tissue deformation decreased by 9.5% (р < 0.001). Mean deformation of the lower right pulmonary vein was 24. 5 ± 1.1% before and 22.2 ± 1.1% after RFA; tissue deformation decreased by 9.3% (р BB 0.001). There were no AF recurrences for 6 months follow up after cryotherapy. Conclusions: Providing that the electrophysiology criteria of the pulmonary vein isolation are met, tissue deformation significantly changes according to data of intracardiac echocardiography. This approach allows to use the parameters of changes in the speed of myocardial deformation to determine electrical isolation of the pulmonary veins. Chaired Poster Session C part 1 Monday April 16, 2018, Posters displayed from 08:30 am–12:00 pm Presenters and Chairpersons present from 08:30 am– 10:00 am ROOM TERNES Bradycardia and cardiac pacing 16-66 Abstract 26-10 THE IMPACT OF BRADYCARDIA MANAGEMENT STRATEGIES ON HOSPITALIZATION COSTS IN THE UNITED STATES

Victor Abrich 1, Matthew Spear 2, Banveet Khetarpal 1, Mac McCullough 2, Siva Mulpuru 1, Eric Yang 1 1 Mayo Clinic Arizona, Phoenix, United States, 2 Arizona State University, Phoenix, United States Background: Permanent pacemaker (PPM) implantation for non-reversible causes of bradycardia is usually performed during regular business hours. As a result, patients admitted to the hospital over the weekend may experience a delay in PPM implantation. The majority of patients who require a PPM are 65 or older and are insured by Medicare, a federal health insurance program. We sought to determine the costs of different bradycardia management strategies and to identify possible cost-saving opportunities. Methods: We retrospectively reviewed 486 patients who were admitted to the hospital with heart rates ≤ 50 beats per minute at two Mayo Clinic sites from 2010 to 2015. Patients with sinus bradycardia were excluded. Patients were divided into the following management strategies: observation [n = 212], conservative management (medications ± transcutaneous pacing) [n = 50], early PPM implantation (≤ 2 days) [n = 182], and delayed PPM implantation (≥ 3 days) [n = 40]. For each management strategy, average hospitalization cost was calculated using mean length of stay (LOS), room and board costs at each level of care, and device implantation costs. Potential cost savings were calculated as the cost of hospital room and board at each level of care minus laboratory personnel weekend overtime compensation. Results: The average hospitalization cost was $8880 ± $9329 for observation, $20,754 ± $27,739 for conservative management, $14,767 ± $8412 for early PPM implantation, and $28,124 ± $23,258 for delayed PPM implantation. Shortening hospital LOS by 1 day by implanting a PPM during the weekend instead of the next business day could reduce hospitalization costs by up to $2284 for a ward bed with telemetry and by up to $4544 for an intensive care unit bed (Table 1).

Table 1. Potential cost savings Phoenix, Arizona Level of care Daily room and board cost Hospital ward bed with telemetry $2775 Intermediate care unit bed $3000

Rochester, Minnesota Shorten length of stay by 1 day $2284 $2509

Shorten length of Daily room and Shorten length of Shorten length of stay by 2 days board cost stay by 1 day stay by 2 days $5059 $2125 $1634 $3759 $5509 – – –

Intensive care unit bed

$3709

$7909

$4200

Conclusion: Early PPM implantation was associated with lower hospitalization costs compared to delayed PPM implantation. The potential cost savings from weekend PPM implantation are substantial and should be considered to reduce total hospitalization costs.

$5035

$4544

$9579

16-67 Abstract 23-18 EVALUATION OF EXPANSION AND OUTCOME OF THE INFECTIVE PROCESS IN CARDIAC ELECTRONIC DEVICES RECIPIENTS-

S112

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

P R E D I C T I V E VA L U E O F B I O C H E M I C A L PARAMETERS Anna Polewczyk 1, Wojciech Jachec 2, Maciej Polewczyk 1, Andrzej Tomasik 2, Andrzej Kutarski 3 1 Faculty of Medicine and Health Studies, Jan Kochanowski University, Kielce, Poland Department of Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland, Kielce, Poland, 2 2nd Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Poland, Zabrze, Poland, 3 Department of Cardiology, Medical University, Lublin, Poland, Lublin, Poland

Conclusions Clinical manifestation of systemic infectionLRIE was more severe with often presence fever, pulmonary infections, and necessity of early antibiotic therapy. Biochemical parameters demonstrated more often anemia, higher typical inflammatory markers (leucocytes level, ESR, CRP) with the higher ratio of neutrophil to lymphocyte and neutrophil to platelets. The analysis of the parameters should be helpful in the assessment of the spreading infectious process in patients with PI. It is very important because of significantly higher long-term mortality of patients with LRIE (about 45% after 5 years in comparison to 20% in patients with PI) 16-68 Abstract 15-54

Background Cardiac device infections (CDI) are divided into infections of the generator pocket (PI) and leadrelated infective endocarditis (LRIE). Classification according to this scheme.is often problematic, becouse the difficulties in excluding infection spread in case of local inflammatory process. Methods Comparative analysis of clinical and biochemical parameters of 235 patients with isolated PI and 511 patient with LRIE undergoing transvenous leads extraction (TLE) procedures in single center in years 2006–2015 was conducted. Long-term survival (mean follow-up 2.86 ± 1.72 years) after TLE was also assessed. Results: Results are presented in the table and figure.

Number of pts

PI235

LRIE511

p

Fever, shiver (n %) Pulmonary infections (n %) Antibiotic therapybefore admission (n %) WBC (103/μl) SD Lymphocytes (103/μl) SD Neutrophils (103/μl )SD PLT(/mm3) SD Neu/Limf SD Neu/Limf % SD Neu/PLT SD Limf/ PLT SD Hemoglobin (mg/dl) SD ESR (mm/h) SD CRP mg/l SD

24 (10.3%) 2 (0.86%)

324 (62.9%) 183 (35.5%)

p BB 0 .001 p BB 0 .001

130 (55.8%)

366 (71.1%)

p BB 0 .001

7.79 ± 2.67 1.99 ± 1.39

9.65 ± 5.01 2.05 ± 2.18

p BB 0 .001 p BB 0 .10

5.11 ± 2.16

6.63 ± 3.97

p BB 0 .001

229.94 ± 78.49 3.26 ± 2.36 3.08 ± 2.17 0.02 ± 0.01 0.01 ± 0.01 13.27 ± 1.67

246.34 ± 104.99 4.34 ± 4.21 4.26 ± 4.18 0.03 ± 0.02 0.01 ± 0.02 12.07 ± 2.03

p BB 0 .05 p BB 0 .005 p BB 0 .001 p BB 0 .005 p BB 0 .10 p BB 0 .001

29.06 ± 22.17 18.94 ± 30.34

42.20 ± 31.78 52.37 ± 66.29

p BB 0 .05 p BB 0 .001

ABLATION OR PACING, WHICH GOES FIRST FOR PATIENTS WITH TACHYCARDIA-BRADYCARDIA SYNDROME: TWO CASE COMPARISON AND CLINICAL ENLIGHTENMENT Dan Han 1, Jianqing She 1, Hui Guo 1, Chaofeng Sun 1, Hongbing Li 1 1 First Hospital of Xi’an Jiaotong University, Xi'an, China When atrial fibrillation (AF) and sinus node dysfunction (SND) are caused by electric remodeling, therapy of one may cure the other. However, structural remodeling such as fibrosis further promote both arrhythmias. Thus, patients with tachycardia-bradycardia syndrome (TBS) are often recommended implantation of permanent pacemaker. We here report two patients both manifested TBS yet with different causes. Patient A showed bradycardia, but suffered significant prolonged RR up to 6.48 s during the ablation after conversion, so she was protected by temporary pacemaker immediately. Patient B manifested syncope due to prolonged RR up to 5.216 s before the procedure. On the first day after ablation, she underwent several prolonged RRs up to 7.05 s again, so she was implanted permanent pacemaker to control normal rhythm. Transesophageal atrial pacing (TEAP) was performed for A after 6 months, the sinus node(SN) and atrioventricular node(AVN) went well, which suggested that the prolonged RR resulted from transient vagal stimulation. ECG monitoring of B after 3 months showed pacing rate all the time with negative atropine test, which meant SN dysfunction. Therefore, we suggest that testing SN function before ablation in patients with TBS is necessary to determine permanent pacemaker implantation and enhanced recognition of the

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S113

radical pathogenesis is imperative to formulate better treatment.

75-year-old male with hypertension, paroxysmal atrial fibrillation, AV block s/p dual chamber pacemaker (2 years) was evaluated for decompensated heart failure and acute renal dysfunction. His echocardiogram showed dilated left ventricle with EF of 12% compared to 58% prior to pacemaker implant. He underwent pacemaker upgrade to a biventricular ICD (Boston Scientific) due to suspected pacing induced cardiomyopathy. A quadripolar lead was implanted with difficulty in a high posterolateral venous branch (1E). ECG post implant showed intermittent wide paced QRS complexes which resembled RV only paced complexes (1B). Device interrogation revealed LV pacing inhibition due to left atrial sensing (1C) which resolved by lowering the sensitivity to 1.5 mV in the LV channel (1D). LV inhibition was also rectified by programming LV ahead of RV during biventricular pacing. LV inhibition can also be corrected by turning off the LV sensing capability in Boston Scientific devices. Conclusion: This case highlights the importance of ECG post CRT implant, nuances of coronary sinus lead implant close to atrioventricular groove and knowledge of manufacturer specific device sensing capabilities with possible ways to rectify LV pacing inhibition non-invasively.

16-69 Abstract 24-18

16-70 Abstract 01-12

INTERMITTENT WIDE QRS DURING B I V E N T R I C U L A R PA C I N G ? W H AT I S T H E MECHANISM?

A CASE OF PAUSE-DEPENDENT PAROXYSMAL P H A S E I V AT R I O V E N T R I C U L A R B L O C K PRESENTING WITH RECURRENT SYNCOPE

Gurjit Singh 1, Arfaat Khan 1, Marc K Lahiri 1, Waddah Maskoun 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States

Kelvin Bush 1, Linda Huffer 1, Gregg Gerasimon 1 1 San Antonio Military Medical Center, San Antonio, United States

Background: QRS narrowing signifies electrical resynchronization after implanting a cardiac resynchronization therapy (CRT) device and 12 lead ECG is an important tool to assess appropriate biventricular pacing and to optimize programming. Objective: To highlight issues of LV pacing inhibition due to atrial activity sensing, importance of coronary sinus lead position and post implant ECG. Methods: N/A. Results: A

Introduction: Phase IV atrioventricular (AV) block remains an under-recognized cause of syncope. We review a case of recurrent syncope featuring this mechanism. Case Description: The patient is a 65-year-old man with a history of ischemic heart disease, prior myocardial infarction with a preserved left ventricular ejection fraction of 60% and paroxysmal atrial fibrillation. He presented with more than thirty unprovoked syncopal

S114

events within the three days prior to hospitalization. The electrocardiogram on presentation showed normal sinus rhythm, ventricular rate of 68 bpm, PR interval of 210 ms, QRS duration of 144 ms consistent with a nonspecific intraventricular conduction delay, and evidence of a prior lateral myocardial infarction. Telemetry monitoring following admission revealed recurrent paroxysmal AV block, of up to 6 s per episode, associated with syncope. Each episode was initiated by an atrial premature depolarization. Evaluation was negative for other reversible causes. A dual-chamber pacemaker was implanted during the hospitalization without complication. Discussion: Phase IVAV conduction block manifests as the abrupt conduction block of atrial impulses to the ventricular conduction system. Phase IV block classically occurs in a diseased HisPurkinje system (HPS), when a premature beat prolongs the P-P or H-H interval and leads to HPS spontaneous depolarization during phase IV of the ventricular myocyte action potential. A diastolic membrane potential threshold is reached, beyond which conduction to the ventricles can no longer occur until an escape or premature beat resets the membrane potential to its baseline resting value. The paroxysmal nature of phase IV block manifests infrequently, leading to the difficulty in making this diagnosis. Conclusions: Phase IV AV block is an underappreciated disorder in the diseased HPS. This case highlights an atypical presentation with an extraordinarily high number of syncopal episodes prior to patient presentation. Pacemaker implantation is the appropriate definitive management.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

minute. The patient was transferred to our Intensive Cardiology Unit for continuos monitoring, during which other episodes of third degree atrio-ventricular block and a sinus pause of 8 s were pointed out. The laboratory tests and echocardiogram revealed no alterations of note. Our recommendation was a pacemaker implantation. To minimize fetal exposure to fluoroscopy, we used an electroanatomic navigation system ENSITE NavX® (St. Jude Medical, St. Paul, MN). Cephalic vein access was achieved by tissue dissection and direct visualization, a guidewire was inserted and subsequently a sheath was placed. Then a pocket for the device was fashioned. A deflectable decapolar catheter was used to build the superior and inferior cava vein, right atrium, right atrial appendage, right ventricle, the His bundle and the first part of coronary sinus. After that, the distal electrode of the ventricular lead was connected to the NavX System by using a small alligator clip. Thereby the lead was visualized by the mapping system. The ventricular lead was positioned in the right ventricular (RV) apical septum using three-dimensional (3D) mapping (Fig. 1). We obtained satisfactory values of sensing, pacing threshold and impedance (11.3 V, 0.4 mV at 0.5 ms, 870 Ohm). We used a minimal time of fluoroscopy to confirm the lead position (4 seconds) and BB 36,6 cGycmq for total radiation dose. The patient was discharged 2 days after the procedure in healthy conditions.

16-71 Abstract 28-11 NEAR- Z E R O F L U O R O S C O P Y PA C E M A K E R I M P L A N T A T I O N I N P R E G N A N C Y: T H E ESSENTIAL TOOL OF ELECTROANATOMIC MAPPING 16-72 Abstract 23-22 Maurizio Del Greco 1, Francesco Peruzza 1, Massimiliano Maines 1, Carlo Angheben 1, Domenico Catanzariti 1 1 Ospedale Santa Maria del Carmine, Rovereto, Italy Case report: Complete atrio-ventricular block is a rare condition in patient’s < 40-year-old and is even less common in females during pregnancy. We present a case of a 30-year-old woman at 15 weeks gestational age, admitted to our Emergency Department with a 1-week history of symptoms like fatigue, dyspnoea for minimal exertion and dizziness. The electrocardiographic monitoring during observation showed paroxysmal complete atrio-ventricular block, with a heart rate of 33 beats per

D E T E C T I O N O F C O M P L I C AT I O N S P O S T PACEMAKER IMPLANTATION Chad Ward 1, Michael Giudici 1, Oluwaseun Adeola 1, Musab Alqasrawi 1, Brodie Marthaler 1 1

University of Iowa Hospitals and Clinics, Iowa City, United States Introduction: Nearly 200,000 patients receive permanent pacemakers each year in the USA. Consensus

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

recommendations are lacking to guide patient care immediately following pacemaker implantation. The purpose of this study is to determine if inpatient monitoring, imaging, and interrogation are necessary following pacemaker implantation. Methods: A retrospective chart review was conducted on 176 patients following pacemaker implantation to examine complications and the method by which they were detected. Patients were evaluated at key times including implantation, next day interrogation and chest X-ray, and from discharge until 3- and 6-month follow-up. Two sample t tests were performed to determine statistical significance. Results: The average age at implant was 68.4 years: 52.9% were male. Further, 93.8% of the pacemakers were placed on the left sided, 83% were dual chamber pacemakers, 8.5% were single chamber and 8.5% Bi Ventricular pacemakers. AV block was the most common indication (47.7%), followed by sick sinus syndrome (44.9%), and post AV node ablation (7.3%). The average length of hospitalization for the pacemaker implantation was 1.9 nights. A total of 21 (11.9%) complications occurred. There were ten lead complications: seven RV leads and three RA leads. Nearly all (9/10) were detected at 3-month follow up or later. There were three pocket infections that required intervention, three pocket hematomas (none required intervention), and two patients had a pneumothorax. All patients had lead characteristics documented at implantation, 97.7% had post-procedure interrogation, and 85.8% had a follow-up interrogation. Of the 21 complications, 12 required intervention. No patients died as a direct result of complications. Further, 174/176 (98.8%) had a post procedural chest x-ray (CXR): only 2 patients had a pneumothorax. Both patients were asymptomatic yet received procedure. Of the 174 patients that had CXR, only one detected a lead complication. Conversely, nine patients eventually had lead complications that were undetected on CXR. In all, 3/176 patients had a complication detected via the inpatient post-procedural CXR, whereas 19/176 patients had a complication detected at follow up (< 0.0001). Of patients that had post procedural interrogations, only 1.1% detected any abnormalities. Significantly more complications were detected at follow up, 9.1% (p = 0.0006). When patients stay an extra night for CXR and interrogation, 58.6 nights were required to detect one complication at a cost of $117,333 (estimated $2000/night). Conclusion: Post-pacemaker CXR has low detection rates of lead complications. Next day interrogation has a significantly lower detection rate of lead complication compared to followup interrogation. It is feasible for patients to be discharged home the day of pacemaker implantation given the low yield of post procedural CXR or interrogation and significantly higher rates of complications detected during follow up.

S115

16-73 Abstract 08-12 AURICULO VENTRICULAR BLOCK IN ACUTE CORONARY SYNDROME WITH ST SEGMENT E L E VAT I O N ( S T E M I ) : I N C I D E N C E A N D PROGNOSTIC SIGNIFICANCE Marouane Mahjoub 1, Wajih Abdallah 1, Mejdi Ben Messaoud 1, Wassim Saoudi 1, Ala Jalled 1, Aymen Najjar 1, Majed Hassine 1, Zohra Dridi 1, Fethi Betbout 1, Habib Gamra 1 1 Cardiology department A: Fattouma Bourguiba University Hospital, Monastir, Tunisie Backgroud: The occurrence of atrioventricular block (AVB) in acute coronary syndrome with ST segment elevation (STEMI), particularly in their lower localization is a well-known and often reversible complication. We describe the AVB observed in the MIRAMI (Monastir Acute Myocardial Infarction) register, their predictive factors and their prognostic value. Methods: One thousand three hundred eighty-eight patients were admitted in the cardiology department for STEMI and included in the MIRAMI register. Moreover, we studied patients having presented a recent AVB during hospitalization. Circumstances of the occurrence of AVB as well as prognosis are reported. Results: AVB appeared in 131 (9.4%) patients with an average delay of 19 ± 13 h in 86.9%, in inferior wall myocardiadial infarction and creatinine below 130 μmol/l. OR = 2.69), anemia (p = 0.002, OR = 1.9 for hemoglobin < 12g/dl) and the inferior localization of the infarct (p < 0.001, OR = 2.46). Neither the advanced age nor the success of reperfusion was found as predictors of mortality. Hospital mortality was increased in patients with AVB (22 vs 8.2%, p < 0.001) as were cardiogenic shock (p < 0.001) and ischemic recurrence (p = 0.005). Finally, AVB was felt responsible for ptient-death in only three (2%) patients. Conclusion: The occurrence of AVB was more common in patients with inferior infarct localization, anemia or/and renal failure. It was independent of the success of myocardial reperfusion and of patient age and was associated with a higher morbidity and mortality. 16-74 Abstract 23-17 UNRECOGNIZED MALPOSITION OF A HIS BUNDLE PACING LEAD IN THE LEFT VENTRICLE VIA AN INTACT ATRIAL SEPTUM Sarah Worsnick 1, Angela Naperkowski 1, Ragesh Panikkath 1 , Pugazhendhi Vijayaraman 1 1 Geisinger Health System, Wilkes Barre, United States Background: Malposition of the ventricular lead into the left ventricle is a rare complication. If unrecognized, potential adverse events include thromboembolism, endocarditis or phrenic nerve stimulation. Objective: We report a case of

S116

inadvertent placement of ventricular lead in LV in a patient with intact atrial septum. Case Study: A 71-year-old male presented to an outside facility with RBBB and intermittent AV block. Attempted His bundle pacing with a 3830 lead was unsuccessful and final reports indicated lead placement in the RV septum. Patient presented 2 months later with transient aphasia. EKG showed RBBB pattern during ventricular pacing. CXR and CT scan confirmed lead in the left ventricle. After oral anticoagulation with apixaban, the patient was admitted for lead extraction. TEE showed no clot on the lead or PFO. Intracardiac echo and TEE revealed the lead traversing through the septum above the fossa ovalis. The lead was easily removed with manual traction and a new lead placed in the His bundle region. Conclusion: This case represents an unusual situation of unrecognized malposition of a pacing lead in the left ventricle via an intact atrial septum.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

pacing. The strain echocardiography evaluates ventricular mechanics. The current technique for HBP, demonstrates up to 20% of implant failure, due to lack of a proper His bundle electrogram. Method: An 80-year-old woman was implanted with a dual-chamber pacemaker due to sinoatrial block and 1st degree AV block. HBP was achieved by means of a steerable catheter sheath (Medtronic C304-69) through the left subclavian vein and placed in the supero-septal region of the tricuspid ring. The His bundle electrogram was obtained by mapping with a tetrapolar catheter. Then, a pacing lead (Medtronic 3830–59 cm) was placed and fixed to the endocardium where the best His bundle electrogram was obtained. The pacing threshold was 1.1 V with a 483 ohm impedance, and programmed DDDR with a 200 ms paced AV delay. Results: Left ventricular ejection fraction (LVEF) before the procedure was 0.72 with a global deformation percentage of − 21%, and 0.73 with − 21.6% deformation during HBP. Conclusion: The strain rate showed that HBP a very similar ventricular contraction compared to intrinsic rhythm. The localization the His electrogram through the steerable sheath provides a better assistance for the HBP lead placement.

16-75 Abstract 23-16 MODIFIED TECHNIQUE FOR HIS BUNDLE PACING AND ITS EVALUATION WITH STRAIN RATE Oscar Bazán Rodríguez 1, Eduardo Del Río Bravo 1, Carlos Gutierrez González 1, Carlos González Rebeles 1, Cynthia Ortiz 1, Jaime Sánchez 1, Luis Molina 1 1 Electrophysiology Laboratory UNAM., City of México, Mexico Background: Permanent His bundle pacing (HBP) has proven to be a more physiological form as compared to apical or septal

16-76 Abstract 18-25 E F F I C I E N T A P P R O A C H F O R ATRIOVENTRICULAR JUNCTION ABLATION WITH PACEMAKER IMPLANTATION Mohammed Djelmami-Hani 1, Danielle Martin 1, Emily Queen 1, Julie Solie 1, Jasbir Sra 1 1 Aurora Health Care, Milwaukee, United States

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Background: Concomitant atrioventricular junction ablation (AVJA) and ventricular pacing device implantation are used for rate control when appropriate in atrial fibrillation. Traditionally, AVJA is performed from femoral access requiring a separate access and procedure set. Objective: We describe our single-center, single-operator experience with using same device lead access for AVJA. Methods: We report 20 consecutive cases performed in a single center by a single operator. Patients who underwent concomitant pacemaker and AVJA procedures between 2013 and 2016 were included. Incision was made to the pectoral fascia but the device pocket was not made until all leads were in place. Axillary venous access was obtained. The RV lead was implanted first. Second axillary access was obtained and used to advance the ablation catheter to the map and ablate the AV node. With backup RV pacing, AVJA was performed. After achieving complete AV block, the rest of the leads were implanted if indicated. Results: The mean age was 76 ± 7, with 13 (65%) female. Mean LVEF was 54 ± 10.5%. Diabetes, COPD, and chronic kidney disease were present in 15, 30, and 20%, respectively. Total of 18 (90%) were on anticoagulation, with 30% warfarin, 55% apixaban, and 25% rivaroxaban. INR day of procedure was 2.0 ± 0.8. Devices implanted were 75% dual chamber, 20% biventricular, and 5% single chamber. The time from start of ablation to achieving complete AV block was 7 ± 7.5 min. Total of lesions delivered was 7.2 ± 4.7. Total time for AVJA part was 9.3 ± 7.9 min. There was no pneumothorax, hematoma requiring drainage, infection, or lead dislodgement. Cost savings per case is estimated at $1000. Conclusions: Performing AVJA using the same venous access as used for the leads during concomitant device implantation is safe and efficient. Avoiding separate femoral access for AVJA helps avoid potential groin complications and prolonged bed rest for the patient. It is more cost efficient by eliminating the need for a separate procedure table, and reducing procedure time by eliminating the need to wait for groin hemostasis. It also is more comfortable for the patient.

S117

stroke. Obstructive sleep apnea (OSA) is one of the modifiable risk factors associated with AF. The aim of this study was to determine electrical predictors of new onset AF in patients with severe OSA and no prior history of AF using 24-Holter recordings. Methods: A prospective observational study included patients with severe OSA (Apnea-Hypopnea Index ≥ 30) and no history of AF followed on extended cardiac monitoring. The primary outcome was detection of AF lasting ≥ 10 s. Patients were subjected to two 24-h Holter monitors, and if no AF was detected, implanted with a Medtronic Reveal XT implantable loop recorder (ILR). The Holters were analyzed, and heart rate, ventricular and supraventricular ectopics (isolated, couplets, bigeminal cycles, runs, and percent of total beats), and pauses were documented. Exclusion criteria included prior history of AF, congestive cardiac failure, or any cardiac device. Follow up was done at 6, 12, 18, 24, 30, and 36 months post-implant. ILR was explanted if the primary outcome was detected (AF) or the battery was exhausted (3 years). Results: Of the 25 patients implanted with an ILR, AF ≥ 10 s was detected in 5 patients. None of the parameters investigated from the Holter monitors were significantly different between the patients who did and did not develop AF. All patients had premature atrial contractions in at least one 24-h Holter. Of the patients who developed AF during the follow-up, 3 (60%) had supraventricular couplets versus 11 (55%) in patients who did not develop AF (p = NS). Patients presenting with ventricular couplets exhibited a similar trend (p = 0.60). Likewise, the presence (or duration) of supraventricular runs did not differentiate the populations either. Sinus pauses were similar in both groups. Conclusion: Extended cardiac monitoring of patients with severe OSA may facilitate the identification of new onset AF and subsequent treatment. Short monitoring using 24-Holters was not useful in identifying patients at risk of developing AF. 16-78 Abstract 15-44

Arrhythmia detection and monitoring 16-77 Abstract 15-45 S H O RT- T E R M C A R D IA C M O N I TO R I N G O F PATIENTS WITH SEVERE SLEEP APNEA DOES NOT ALLOW FOR THE PREDICTION OF ATRIAL FIBRILLATION Cynthia Yeung 1, Doran Drew 1, Sharlene Hammond 1, Gwen Ewart 1 , Laiden Suarez-Fuster 1 , Damian Redfearn 1 , Christopher Simpson 1 , Hoshiar Abdollah 1 , Benedict Glover 1, Adrian Baranchuk 1 1 Queen's University, Kingston, Canada Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is an important risk factor for ischemic

EXTENDED CARDIAC MONITORING IN PATIENTS WITH SEVERE SLEEP APNEA AND NO HISTORY OF ATRIAL FIBRILLATION (THE REVEAL XT-SA STUDY) Cynthia Yeung 1, Doran Drew 1, Sharlene Hammond 1, Gwen Ewart 1, Damian Redfearn 1, Christopher Simpson 1, Hoshiar Abdollah 1, Benedict Glover 1, Adrian Baranchuk 1 1 Queen's University, Kingston, Canada Background: Atrial fibrillation (AF) is an important risk factor for ischemic stroke and reported to be associated with severe obstructive sleep apnea (OSA). The aim of this study was to determine the occurrence of new onset AF in patients with severe OSA and no prior history of AF. Methods: Prospective observational study included patients with severe

S118

OSA (Apnea-Hypopnea Index (AHI) ≥ 30) and no history of AF followed on extended cardiac monitoring. The primary outcome was detection of AF lasting ≥ 10 s. Patients were subjected to two 24-h Holter monitors, and if no AF was detected, implanted with a Medtronic Reveal XT implantable loop recorder (ILR). Exclusion criteria included prior history of AF, cardiac heart failure, or any cardiac device. Follow up was done at 6, 12, 18, 24, 30, and 36 months post-implant. ILR was explanted if the primary outcome was detected (AF) or the battery was exhausted (3 years). Results: Of the 31 patients enrolled, 6 withdrew participation in the study prior to implantation. Mean age was 57.5 ± 9.6 years, and mean BMI was 37.0 ± 11.7; 48% female patients. Hypertension 56%, coronary artery disease 24%, diabetes mellitus 12%, transient ischemic attack 4%, and no stroke. Mean CHADS2 score was 0.83. Mean AHI was 55.9 ± 18.1. AF was detected in five patients (20%). AF mean duration was 4.8 h (range 20 s–15.3 h). Mean time to diagnosis was 10.8 ± 6.8 months. Male gender was predictive for AF detection (p = 0.04). Two patients were withdrawn from the study due to complications (1 allergic to silicone, 1 pain). CPAP was used by 87% of patients with 100% compliance. CPAP pressure prescribed mean was 10.0 ± 2.1 cm H2O, and daily CPAP usage mean was 7.3 ± 1.4 h. The mean follow up in this interim analysis is 25.1 months. Conclusion: Despite the adequate use of CPAP, 20% of the patients with severe OSA had new onset AF. Extended cardiac monitoring of patients with severe OSA may facilitate the identification of new onset AF and subsequent treatment. 16-79 Abstract 14-12 ARRHYTHMIA OUTREACH SERVICE

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

presented to the Emergency Department (ED) over the 2week period. Eighty-one (n = 17/21) were admitted into hospital. Of those admitted, 67% (n = 14/17) could have been discharged if early specialist assessment had been available. Potential financial implications based on one bed-day stay per patient per annum were estimated at £100,800. Fourteen percent (n = 3/21) of patients were followed up after discharge. Only 47% (n = 10/21) of patients diagnosed with AF/A. Flutter had been risk stratified and had appropriate stroke preventative therapy commenced. To streamline patients’ pathway the Arrhythmia ANP role was introduced. Results: Between 01/04/17 and 22/09/17 (100 working days), 127 patients presented to the Emergency Department with AF, A. Flutter, SVT and Palpitations. Only 35% of patients (n = 45/ 127) were admitted: follow up rate was 94% (n = 119/127). Risk stratification and adequate stroke preventative therapy was commenced in 96% (n = 122/127) of patients presenting with AF/A. Flutter. A nurse-led follow-up clinic was set up to provide early review post-discharge (two weeks). One hundred eighty-eight patients were referred for follow-up (119 post-emergency, 65 from General Practitioners and 2 from other areas). Total estimated saving based on reduced admission per annum (based on one bed day): £49,200. Estimated income generated from clinic referrals: £50,896 per annum. Conclusions: These data suggest the Arrhythmia ANP role is effective at preventing hospital admissions, providing early risk stratification, specialist patient assessment and robust post-discharge follow-up. A patient satisfaction survey was developed to evaluate patients’ experience of the service. One hundred percent of patients that attended the nurse-led follow up clinic reported that the care received by the ANP in ED and at clinic’s appointment was good or excellent and that the clinic appointment was helpful and informative.

Valentino Oriolo 1, Anna Sice 1 University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom

Anatomic anomalies

Arrhythmia Advanced Nurse Practitioner Outreach Service Background: The Arrhythmia Advanced Nurse Practitioner (ANP) role encompasses a number of responsibilities, namely early patient assessment and risk stratification, admission avoidance, fast track to arrhythmia/electrophysiology services, reduced length of stay and robust/early follow-up, thus increasing patient safety. Methods: We completed a retrospective baseline audit between 02/01/17 and 15/01/17 (ten working days) of patients admitted with atrial fibrillation (AF), atrial flutter (A. Flutter), supraventricular tachycardia (SVT) and palpitations. Patients were identified via the hospital electronic records. The audit aims were as follows: to evaluate the number of admissions, report on the number of preventable admissions, and evaluate the rate of stroke risk stratification in patients with AF/A. Baseline Data: Twenty-one patients

A LARGE VEIN OF MARSHALL ANEURYSM

1

16-80 Abstract 24-19

Gurjit Singh 1, Arfaat Khan 1, Marc K Singh 1, Waddah Maskoun 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States Background: Vein of Marhsall (VOM) is a remnant of anterior cardinal vein and joins coronary sinus at the level of valve of Vieussens. VOM is usually a small caliber vein and can participate in atrial arrythmia’s Objective: N/A Methods: N/A Results: An 85-year-old male with hypertension, diabetes mellitus and ischemic cardiomyopathy with AV block underwent biventricular ICD in 2015 who presented for generator replacement due to device recall. He also underwent coronary sinus lead revision

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

due to elevated threshold. Coronary sinus cannulation was difficult due to posterior take off and venogram showed a large aneurysmal VOM as shown in Fig. A and B. The coronary sinus main body take off was anterior which was eventually cannulated, and a CS lead was implanted in a high anterolateral branch due to absence of pacing capture in mid posterolateral wall. Pacing thresholds were found to be adequate in anterolateral branch. Conclusions: This case highlights presence of a large vein of Marshall aneurysmal dilatation which could be mistaken for a main coronary sinus and inappropriate cannulation can lead to adverse outcomes due to vein perforation.

S119

remaining four patients (9%), there was no vessel in this zone. Thirty-two patients showed LBBB and 16 non-LBBB electrocardiographic patterns. A total of 116 CS branches (mean 2.4 per patient, range 1–4 per patient) were mapped. The most delayed coronary sinus/magna cardiac vein was anterior in 5, anterolateral in 17, inferolateral in 22 and inferior in 3 patients. Patients with LBBB showed higher maximum LVED (134 vs. 89 ms; P 0.001) than patients without LBBB. Conclusion: The most delayed coronary sinus/cardiac magna vein site predicts the vessel’s venue with more delay in 91% of our patients with the ability to make the procedure faster by directly searching for a target vessel at that venue. Chaired Poster Session C part 2 Monday April 16, 2018, Posters displayed from 08:30 am–12:00 pm Presenters and Chairpersons present from 10:30 am– 12:00 pm ROOM TERNES

16-81 Abstract 24-13 Ventricular Arrhythmias C O R O N A RY A N D M A G N A C A R D I A C V E I N ELECTROANATOMIC MAPPING PREDICTS THE CORONARY BRANCH SITE WITH LONGER ACTIVATION DELAY Massimiliano Maines 1, Francesco Peruzza 1, Alessandro Zorzi 1 , Carlo Angheben 1 , Domenico Catanzariti 1 , Maurizio Del Greco 1 1 Ospedale Santa Maria del Carmine, Rovereto, Italy Background. Implantation of left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT). Often the search for the late activation site takes time. Aim of our work was to see if the coronary and magna cardiac vein delay predicts the coronary branch site with longer activation delay. Methods. We enrolled 48 patients who underwent electroanatomic mapping system-guided CRT device implantation. The activation mapping of the coronary sinus (CS) and relative branches was performed using an insulated guide wire. The structure of the coronary sinus and the magna cardiac vein was divided into four zones: anterior (from 11 am to 13 pm), anterolateral (from 13 to 15), inferolateral (from 15 to 17) and inferior (from 17 to 19). LVED was defined as the interval between the beginning of the QRS complex on the electrocardiogram (ECG) and the local electrogram and expressed in milliseconds. Results: In 44 patients (91%), the most delayed site in the coronary sinus or cardiac magna vein was at the same site of origin of the vessel with longer delay. In the

16-82 Abstract 18-39 R E T R O G R A D E C O R O N A RY V E N O U S A N D INTRACORONARY ETHANOL ABLATION OF VENTRICULAR ECTOPICS: A CASE SERIES Vinit Sawhney 1, Sarah Whittaker–Axon 1, Alex McLellan 1, Costas O'Mahoney 1, Mick Ozkor 1, Charles Knight 1, Elliot Smith 1, Pier Lambiase 1, Anthony Chow 1, Martin Lowe 1, Richard Schilling 1, Ross Hunter 1, Simon Sporton 1, Mehul Dhinoja 1 1 Barts Heart Centre, London, United Kingdom Introduction: Ventricular ectopics (VE) refractory to antiarrhythmic medication and standard percutaneous catheter ablation techniques are likely to have a poor prognosis. Alternative approaches may be required in patients where endocardial and epicardial approaches have failed to terminate VEs originating from an intramural focus. We report our experience with intracoronary and retrograde coronary venous ethanol ablation for VE. Methods: All patients undergoing ethanol ablation for symptomatic VEs between 2015 and 2017 at a single centre were included. Coronary angiogram and coronary venogram-guided venous mapping was performed, and targeted veins/arteries included those with early pre-systolic potentials and excellent pace-maps. Data were collected from a prospective registry and electronic health records. All patients had a holter monitor pre-

S120

procedure and on follow-up. Patients were contacted for follow-up data where necessary. Results: Nine ablations in 8 patients. Sixty-seven percent men with a mean age of 52 ± 22 years. Five patients had structurally normal heart, one ischaemic heart disease, one dilated cardiomyopathy and one valvular heart disease. VE burden pre-procedure was 28 ± 9% with 62% patients having LVOT VE morphology. VE-related left ventricular impairment was noted in 38% patients. Mean LVEF was 49 ± 7%. All patients had undergone a previous endocardial and epicardial ablation. Targeted vessels for absolute ethanol injection included LAD septal perforators (n = 3), tributaries of anterior interventricular vein (n = 3), anteroseptal branch of great cardiac vein (n = 3). Mean procedure and fluoroscopy times were 273 ± 44 and 27 ± 11 min. Clinical VE was successfully ablated in 75% cases. Procedural complications included access site haematoma in one patient. There was no procedurerelated mortality. Over a mean follow-up of 7 months, arrhythmia-free survival was 62% with a mean VE burden of 2%. Conclusions: Ethanol ablation is a safe and feasible alternative in patients with failed endocardial and epicardial VE ablation with a likely intramural focus. Short-term (< 1 year) arrhythmia free survival is good. 16-83 Abstract 18-45 DIFFERENT RESPONSE TO RADIOFREQUENCY ENERGY AND FOCUS DEPTH IN EFFECTIVE P R E M AT U R E V E N T R I C U L A R C O M P L E X E S ABLATION Giuseppina Belotti 1, Paola Negrini 1, Maria Elisabetta Bellebono 1 1 ASST Bergamo Ovest, Treviglio, Italy Background. The occurrence of accelerated beats during radiofrequency (RF) delivery is considered predictive of successful ablation of the premature ventricular complexes (PVC). However, the reason of effectiveness of PVC ablation also in the absence of this phenomenon is not known. Purpose. To investigate in effective PVC ablation procedure, the role of depth of PVC focus in the different type of RF energy response. Methods. We evaluated consecutive 25 patients (pts, 15 males, mean age 65 ± 11 years) referred for symptomatic frequent (BB 10% at 24-h Holter monitoring) monomorphic PVC underwent acute effective RF ablation with endocardial approach, confirmed after 3 months by 24-h Holter monitoring. Electroanatomic mapping system and irrigated RF catheter with force monitoring were used in all procedures. Time between signal on mapping catheter and the earliest PVC onset at 12 lead-ECG (precocity) and concordance degree of pace-mapping at effective ablation site were

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

calculated. Time between the onset and QRS peak (tOP) and the QRS duration (tQRS) of the PVC were measured; the ratio tO-P/tQRS, defined as “deepness index” of the PVC at 12-lead ECG, was obtained. Results. In 18 pt (10 males, mean age 68 ± 12 years), repetitive PVC response (group A) before disappearance was observed, while in 8 pts (5 males, mean age 63 ± 10 years), PVC were eliminated without accelerated beats (group B). There were no differences in PVC site (outflow tract or not, left vs right origin), PVC duration (Gr A: 142 ± 19 vs Gr B: 144 ± 23 ms, p: NS), precocity (Gr A: − 29 ± 5 vs Gr B: − 27 ± 6 ms, p: NS) and pace-mapping concordance degree (Gr A: 0.95 ± 0.1 vs Gr B: 0.93 ± 0.2 ms, p: NS) at the effective site. On the contrary, the “silent” PVC disappearance was associated with greater “deepness index” than in PVC elimination after accelerated beats (Gr B: 0.55 ± 0.03 ms vs Gr A: 0.46 ± 0.09 vs p BB 0.05). Conclusions. In the setting of PVC ablation by RF energy, the occurrence of accelerated repetitive beats with the same morphology of the PVC target is not the unique behavior associated with acute and late RF efficacy. The absence of this response might be due to the more intramurally or epicardially location of the PVC focus, not in direct contact with the catheter tip located at endocardial site. 16-84 Abstract 18-47 CLINICAL EFFICACY OF REMOTE MAGNETIC NAVIGATION-GUIDED CATHETER ABLATION OF PREMATURE VENTRICULAR CONTRACTIONS Gurjit Singh 1, Marc K Lahiri 1, Arfaat Khan 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States Background: Premature ventricular contraction (PVC) mapping and ablation requires precise and stable catheter positioning. Remote magnetic navigation (RMN) is an underutilized tool for ablation of idiopathic PVC’s. Objectives: To describe feasibility, acute success and procedural safety of RMNguided catheter ablation of PVC’s. Methods: Twenty-two consecutive patients underwent PVC ablation by a single operator using Niobe ® magnetic navigation system (Stereotaxis, Inc) and CARTO 3/RMT catheter. Intracardiac echocardiography (ICE) was used during all cases and earliest pre-QRS unipolar (QS) and bipolar electrograms were sought for. Mapping in anterior coronary sinus veins was performed in majority of cases. Retrograde aortic approach was aided with left atrial multi purpose sheath and a Mullin17-1=s sheath was used for trans-septal approach. Ablation power varied from 25 to 50 W using irrigated catheter. Results: Twenty-seven foci were targeted in 22 patients (59% females) with a mean age

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S121

54 years and ejection fraction (EF) of 48%. Six (27%) patients had reduced EF prior to ablation. PVC’s were mapped in RVOT, LVOT, aorto-mitral continuity (AMC), basal anterolateral LV wall, peri-mitral (M), aortic cusps and in the cardiac veins as shown in figure. Excellent catheter stability was achieved in all cases especially in papillary muscle locations. No complications were observed. Acute success was achieved in 95% cases which was maintained at 6 months of mean follow up. Conclusion: Mapping and ablation of idiopathic PVC foci is feasible, safe and effective using remote magnetic navigation with additional benefits of reduced fluoroscopy exposure along with reduced operator fatigue.

16-85 Abstract 18-31 D O E S A N T I - T H R O M B O T I C U S E I M PA C T C O M P L I C AT I O N R AT E S I N PAT I E N T S UNDERGOING VT OR PVC ABLATION? Douglas Cannie 1, Jem Lane 1, Elena Volkova 1, Anthony Chow , Mark Earley 1, Ross Hunter 1, Fakhar Khan 1, Pier Lambiase 1, Richard Schilling 1, Simon Sporton 1, Mehul Dhinoja 1

1

Complications

Group

Ablation procedures PVC

VT

Total

A B C

6 14 51

41 32 57

47 46 108

Pericardial effusion (no tamponade) 0 1 1

1

Barts Heart Centre, London, United Kingdom

Introduction: Many patients undergoing ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation receive anti-thrombotic medications. We assessed the incidence of complications in patients undergoing these procedures, to characterise the risk to patients on these drugs. Methods: From June 2014 to June 2016, 201 VT and PVC ablations were performed at a single UK centre. Patients were allocated to three groups: A—anticoagulation group (INR ≥ 1.5 or NOAC or full-dose low molecular weight heparin (LMWH) on day of procedure); B—antithrombotic group (antiplatelet therapy and/or prophylactic LMWH on day of procedure); C—no anti-thrombotics group. Using patients’ records, we assessed demographic and co-morbidity data, and peri-procedural complication rates. Multivariable analysis was performed using binary logistic regression. Results: Table 1 summarises the results. In group A, there was an 8.5% complication rate: one ischaemic stroke, one pseudoaneurysm requiring surgery, one femoral artery occlusion and one access site haematoma. In group B, there was a 6.5% complication rate: two pericardial tamponades (one death 9 days post-procedure) and one pericardial effusion without haemodynamic compromise. In group C, there was a 5.6% complication rate: three pericardial tamponades (one peri-procedural death), one gastric vessel injury, one pericardial effusion without haemodynamic compromise, one stomach perforation and two access site haematomas. Multivariable analysis did not show any significant predictors of complications. Conclusions: Complication rates were not significantly different between groups and are consistent with previously published data. These findings suggest that VT and PVC ablation can be performed safely in patients on anti-thrombotic medications.

Pericardial tamponade

Access-site haematoma

Other

No. of procedures with complications

Complication rate (%)

0 2 3

1 0 2

3 0 2

4 3 6

8.5 6.5 5.6

16-86 Abstract 17-12 PREMATURE VENTRICULAR CONTRACTIONS ORIGINATING FROM LEFT VENTRICLE CLOSE TO THE HIS BUNDLE REGION Tomomichi Suzuki 1, Daizo Ishihara 1, Shigeki Kobayashi 1

1

Department of Cardiology, Inazawa municipal hospital, Inazawa, Japan Background: Little is known about the features of ventricular arrhythmias originating from the left ventricle (LV) close to the His bundle (HB) region. Objective: To investigate the electrophysiological characteristics

S122

and mechanisms of these ventricular arrhythmias. Methods and Results: Six patients (six men, age 72 ± 4 years) underwent successful catheter ablation of premature ventricular contractions (PVCs) originating from the LV close to the HB region. QRS morphologies of these PVCs were characterized by a left bundle branch block and QS pattern in lead V1 in all and left superior (n = 4) or inferior axis (n = 2). In all patients, the earliest ventricular activation sites during PVCs were detected underneath the His potential recording sites within LV and at the lower border of the low voltage zone (BB 1.0 mV) underneath the noncoronary cusp. These sites were considered to be LV underneath the membranous septum. At the sites of earliest activation, high-frequency presystolic potentials (PP) were recorded during PVCs, preceding the QRS by − 37.7 ± 26 ms (range − 10 to – 80 ms) in all patients. Moreover, the ventricular late diastolic potentials (LDP) were detected during sinus rhythm at these sites, and the morphologies of LDP and PP were identical. The intervals from the ventricular potentials to LDP and PP were equal (363 ± 14 ms, range 355 to 380 ms). Therefore, it was considered that PVCs were induced at the time of intermittent conduction of PP to the ventricular potentials. Radiofrequency delivery at these sites successfully eliminated PVCs in all patients. Conclusions: PP and LDP are critical potentials in PVCs originating from the LV close to the HB region. The mechanism of this PVCs is the intermittent conduction from the localized tissue underneath the left HB region to the interventricular septum. 16-87 Abstract 28-10 THE ROLE OF PREOPERATIVE NONINVASIVE M A P P I N G I N T H E E L I M I N AT I O N O F VENTRICULAR ARRHYTHMIAS Elena Artyukhina 1, Amiran Revishvili 1, Maxim Yshkov 1 1 Institute of Surgery named after A.V. Vishnevsky, Moscow, Russia Purpose: To verify the accuracy of noninvasive preoperative mapping of ventricular arrhythmias using the Amicard system (Russia). Material and methods: Noninvasive preoperative mapping was performed in 23 patients (16 m, 7 g) with non-ischemic ventricular arrhythmias of various localizations. Indications for performing preoperative surface mapping are the presence of stable arrhythmia, atypical location of the focus according to ECG criteria, previous noneffective RFA, patients after correction of congenital heart defects. Results: With non-invasive mapping, 3D models of the right and left ventricles were reconstructed, isopotential and

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

isochronous maps were constructed on the epicardium and endocardium of the ventricles, localization of early activity: RVOT—in ten patients, the supply department of the RVIT—3, the apex of the LV—1, the apex of the RV—1, the papillary muscles of the LV—3, LVIT—3, LVOT—2. For enocardial mapping, the systems of electroanatomical mapping of Astrocard (Russia) or Carto 3 (USA) were used. The overall effectiveness of RFA was 80%. The accuracy of the coincidence of noninvasive and endocardial invasive mapping was 98%. Conclusion: The use of non-invasive preoperative mapping makes it possible to verify with accuracy the arrhythmogenic focus in the ventricles of the heart at the preoperative stage, which is confirmed by the results of invasive electroanatomical mapping. Oral anticoagulation 16-88 Abstract 15-39 QI AND AUDIT PROJECT ON IMPROVEMENT O F A N T I C O A G U L AT I O N I N AT R I A L FIBRIL LAT ION TO PREVE NT ISCHAE MIC S T R O K E U S I N G A R I S K S T R AT I F Y I N G DISCHARGE CHECKLIST Omotomilola Bajomo 1, Aye Hline 1, Fred Foo 1 Barking, Havering and Redbridge NHS Trust, London, United Kingdom 1

Background: Stroke is the leading cause of disability in developed countries with up to 15–30% of ischaemic strokes attributed to a cardioembolic source. Atrial Fibrillation boosts the annual risk of stroke from 0.5 to 12%. High-risk patients are identifiable by scoring system and risk minimised by anti-coagulation. Aim: Identify proportion of patients presenting with acute ischaemic stroke with pre-existing atrial fibrillation receiving appropriate anti-coagulation. Access efficacy of atrial fibrillation discharge summary checklist in improving proportion of anticoagulated patients. Problem: The initial audit identified 43% of patients with pre-existing atrial fibrillation presenting with acute ischaemic stroke were not anti-coagulated. Method: Using case notes and Solus programme, we identified 40 patients with non-valvular atrial fibrillation who presented with acute ischaemic stroke in a 4-month period. We collected data on baseline demographic characteristics, co-morbidities and medications. Intervention: An anticoagulation discharge checklist which includes stroke and bleeding risk stratifying scoring was created. Subsequently, we collected data on 20 patients who met the inclusions criteria using the aforementioned method. Results and discussions: Introduction of

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

the checklist produced the following results: 70% of patients in comparison to 43% received appropriate anticoagulation. Sixty-nine percent of patients were anticoagulated with non-vitamin K oral anticoagulants in contrast to 23%. Developed ischaemic stroke despite therapeutic INR in 50% of patients. Conclusions: Higher proportion of patients received appropriate anticoagulation following the implementation of the atrial fibrillation discharge checklist. Risk assessment of patients with atrial fibrillation using CHADSVASc vs HASBLED scoring is essential n stroke prevention.

S123

therapeutic range (TTR). The objective of this study was to evaluate the predictive and discriminative capacity of the SAMeTT2R2 score in a non-Caucasian population. Materials and methods: Retrospective cohort analysis in patients with nonvalvular AF treated with warfarin between 2013 and 2016 in an anticoagulation clinic. Poor control of anticoagulation was defined (TTR / PINNR BB 65%). The TTR/PINNR BB 65% and SAMeTT2R2 BB = 2 versus BB 2 were compared with the Mann-Whitney U and Chi-square test. ROC curves were constructed to determine scale discrimination. Each of its elements was evaluated through logistic regression. Results: Six hundred forty-six patients were included (mean age 77 ± 8.8 years, 51.4% men). The mean TTR was 67.7% and the PINNR was 63.6%. When comparing the frequency of poor control between SAMeTT2R2 score ≤ 2 versus BB 2, the discriminative capacity of the scale for the TTR/PINNR was low (AUC: 0.52 and 0.54 respectively). No relationship was found between each of the variables that make up the SAMeTT2R2 score and the TTR/PINNR. Conclusions: The SAMeTT2R2 score did not show good predictive and non-discriminative capacity in the studied population. The quality of anticoagulation is the result of a dynamic process in relation to compliance, health status or intercurrent illness. Mapping techniques 16-90 Abstract 15-60 RETRO-MAPPING: A NOVEL 5D MAPPING METHOD FOR ATRIAL FIBRILLATION SHOWS SPATIOTEMPORAL STABILITY Ian Mann 1, Nick Linton 1, Szabolcs Nagy 1, Norman Qureshi 1 , Mike Koa-Wing 1, Phang Boon Lim 1, Zachary Whinnett 1, D. Wyn Davies 1, David Lefroy 1, Darrel Francis 1, Nicholas Peters 1, Prapa Kanagaratnam 1 1 Imperial College Heathcare NHS Trust, London, United Kingdom

16-89 Abstract 07-13 HIGH SAMETT2R2 DOES NOT PREDICT POOR ANTICOAGULATION WITH WARFARIN IN A COLOMBIAN POPULATION Guillermo Mora 1, Carmenza Sandoval 1, Fabio Sierra 1, Martha Hernandez 2 1 Universidad Nacional de Colombia, Bogota, Colombia, 2 Clínica Colombia, Bogota, Colombia Atrial fibrillation is associated with embolic events. The efficacy and safety of warfarin in stroke prevention depends on time in

Background: AF can be represented as dynamic wavefronts on a 3D left atrial (LA) geometry. This type of 4D mapping shows disorganised activation. We developed RETRO-Mapping as a new technique to track the direction of every uniform wavefront on a patch of endocardium. Every directional vector is then displayed on an orbital plot for that region. RETRO-Mapping produces a 5D map by displaying all activation directions over the mapped period on a 3D LA geometry. We tested the hypothesis that AF is spatiotemporally stable in 5D. Methods: Four patients with persistent AF underwent mapping of the LA roof, posterior wall and floor using a 20-pole double-loop spiral catheter (AFocusII) in multiple 30-s data segments. Prior to pulmonary vein isolation (PVI), 2 datasets were collected from 25 stable catheter locations with good electrode contact. These data were exported and post-processed into RETRO-maps. The

S124

algorithm had been validated against manual activation mapping of 705 uniform wavefronts from 15 data segments in 5 patients. Dominant direction of activation was taken as the largest peak and the two datasets from each location directly compared. Dominant activation directions were reported as the same if they were within 15° either side of one another. Results: Datasets were collected consecutively from 25 stable catheter locations in 4 patients before PVI. Wavefronts showing directional uniformity were observed in all data segments. The figure illustrates the two RETRO-maps in each patient at different times. Dominant directions of activation for the two datasets were within 15° either side of one another in 19 out of 25 locations, while 6 out of 25 showed a different direction. Conclusion: Activation during psAF is not random, and shows spatiotemporal stability. It may be possible to use these activation patterns to identify the underlying mechanism of psAF

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

patients with clear identification of the potential mechanism of AF. Bi-atrial pathology was recognized in all subjects. Rotor and macro re-entry activity was present in all patients, whereas only three patients had focal activity (Table 1). Rotor activity in the right atrium was documented in all patients (Table 1). At 3 months follow-up, all patients were free from AF recurrence and were discontinued of antiarrhythmic drugs. Conclusion: This is the first report on the preoperative use of the ECUVE™ in surgical candidates for concomitant surgical procedures. The fact that bi-atrial mechanism for atrial fibrillation was detected in all patients emphasizes the importance of a Coxmaze III/IV procedure. Preoperative mapping carries the potential to significantly improve our understanding in the pathophysiology of AF and better guide the surgical ablation procedure of choice in a single patient. Table 1 Patients FA No of L of FA RA No of Locations of rotor FA RA activity Pat 1 Yes 6 1 (2x) / 5 Yes 17 1 (4x) / 2 (8x) / 3 (4x) (4x) / 4 (1x) Pat 2 Yes 1 1 (1x) Yes 19 1 (4x) / 2 (6x) / 3 (3x) / 4 (2x) / 5 (3x) / 6 (1x) Pat 3

No 0

Pat 4

Yes 1

1 (1x)

16-91 Abstract 15-51 THE USE OF BEAT TO BEAT NON-INVASIVE 3D MAPPING TO GUIDE CONCOMITANT SURGICAL ABLATION FOR ATRIAL FIBRILLATION: FIRST CLINICAL APPLICATION

Yes 27

1 (6x) / 2 (4x) / 3 (3x) / 4 (7x) / 5 (1x) / 6 (1x) / 7 (5x)

Yes 21

1 (3x) / 2 (5x) / 3 (6x) / 5 (1x) / 7 (6x)

FA = focal activity; No = number; L = location; RA = rotor activity

Marek Ehrlich 1, Stephane Mahr 1, Lore Schrutka 2, Niv Ad 3, Günther Laufer 1, Günter Stix 2 1 Dept. Cardiac Surgery, Univ. of Vienna, Vienna, Austria, 2 Dept. Cardiology, Univ. of Vienna, Vienna, Austria, 3 Washington Adventist Hospital, Washingotn, United States Objective: To assess with a noninvasive three-dimensional, beatby-beat 3D mapping technique, the mechanism of persistent atrial fibrillation (PAF) to guide a bi-atrial vs. left atrial only ablation approach in patients requiring concomitant surgery. Patients and Methods: In this pilot trial, four patients (three males; mean age 69 years) with persistent AF were mapped preoperatively with a non-invasive surface system (ECVUE™, Cardioinsight Inc., Cleveland). All patients were candidates for mitral valve surgery. In two patients, tricuspid valve repair was also performed. Cox Maze III/IV was performed using combined cryoablation and bipolar radiofrequency and the left appendage was removed in all cases. Median preprocedural duration of AF as well as diameter of the left atrium were 36 months and 60 mm, respectively. Atrial regions were divided according to the Bordeaux classification figure). Results: Preoperative mapping was successful in all

16-92 Abstract 18-38 UTILITY OF ULTRA-HIGH-DENSITY ACTIVATION MAPPING FOR ABLATION IN CONGENITAL HE ART D IS E A S E C OM PA RE D TO STRUCTURALLY NORMAL HEARTS Vinit Sawhney 1, Sarah Whittaker-Axon 1, Luisa Baca 1, Holly Daw 1, Anthony Chow 1, Pier Lambiase 1, Vivienne Ezzat 1, Martin Lowe 1 1 Barts Heart Centre, London, United Kingdom

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Introduction: Catheter ablation for atrial arrhythmias is an effective treatment modality. Current electroanatomical mapping (EAM) systems are limited by their ability to accurately define the tachycardia circuit. This can pose a challenge in patients with complex congenital heart disease (CHD) and affect procedure times. A new EAM (Rhythmia, Boston Scientific, MA) is capable of automatic annotation with high resolution using a mini-basket 64electrode mapping catheter. We hypothesized that Rhythmia would significantly reduce procedure times in CHD patients. Methods: Retrospective analyses of consecutive patients undergoing atrial arrhythmia ablation using the Rhythmia mapping system over 18 months at a single centre. An age- and sex-matched control group, who underwent ablation using a non-rhythmia EAM, for both the CHD and normal heart patients over the same time period was included. Procedure times and outcomes were compared between cases and controls. Results: Seven patients with CHD and 19 with structurally normal hearts underwent atrial arrhythmia ablation using Rhythmia. Control patients (7 CHD and 19 normal hearts) were included. Controls (non-Rhythmia) were matched for age, gender, procedure type and operator. Of the seven CHD cases, three had ASD (surgical repair), one Mustard, one Fontan, one VSD with pulmonary atresia and one dysplastic TV. Ablated arrhythmias included CTI-dependent flutter (n = 4), mitral isthmus flutter (n = 1), roof-dependent AT (n = 1) and focal right septal AT (n = 1). Two patients had multiple circuits. Mean procedure time and fluoroscopy times were 160 ± 58 and 6 ± 7 in CHD cases and 245 ± 82 and 7 ± 5 min in CHD controls. Amongst the normal heart cases, ablated arrhythmias included CTI line (n = 6), PVI (n = 4), SVT (n = 2), left-sided AT (n = 7). Mean procedure time and fluoroscopy times were 151 ± 76 and 8 ± 5 in normal heart cases and 138 ± 86 and 7 ± 5 min in normal heart controls. There was a significant reduction in procedure times in CHD patients using rhythmia (p = 0.04) but not in normal heart cases vs controls (p = 0.62). There was no difference in the overall complication rates in both groups. Conclusions: Our results show feasibility of the Rhythmia system to elucidate arrhythmia circuits in complex anatomy allowing successful ablation in lesser time compared to other EAM systems. This difference was not seen in patients with normal hearts. 16-93 Abstract 08-14 IMPACT OF CLINICAL PROFILE ON CONDUCTION ACROSS BACHMANN'S BUNDLE DURING SINUS RHYTHM

S125

Christophe Teuwen 1, Lisette van der Does 1, Charles Kik 1, Elisabeth Mouws 1, Eva Lanters 1, Paul Knops 1, Yannick Taverne 1, Ad Bogers 1, Natasja de Groot 1 1 Erasmus Medical Center, Rotterdam, Netherlands Introduction: Valvular heart disease (VHD) is a common risk factor for atrial fibrillation (AF) development. Conduction abnormalities (CA) across Bachmann’s bundle (BB) are associated with AF. The aims of this study are to compare electrophysiological characteristics across BB during sinus rhythm (SR) between patients with ischemic heart disease (IHD) and VHD and between patients with and without AF. Methods: High-resolution epicardial mapping of BB with a 128 or 192unipolar electrode array (inter-electrode distance 2 mm) was performed during open-chest cardiac surgery. The amount and length of CA was calculated and entry sites of SR wavefronts into BB were classified; right, middle and/or left. Results: A total of 304 patients (78% male, age 66 ± 10 years; IHD: N = 193, VHD: N = 111) were mapped; 40 patients had a history of AF. In 116 patients (38%), there was a mid-entry site. There was a trend towards more mid-entry sites in patients with VHD vs IHD (p = 0.061), whereas patients with AF had significant more mid-entry sites than without AF (p = 0.007). CA were equally present in patients with IHD and VHD (< 0.05) and a history of AF was positively associated with CA (< 0.05). Altogether, patients without a mid-entry site or long lines of CA (≥ 12 mm) were unlikely to have AF (sensitivity 90%, negative predictive value 96%). Conclusions: There are no outspoken differences in entry-sites and CA between patients with IHD and VHD. Yet, patients with AF have more entry-sites in the middle of BB and more CA compared to patients without AF. Absence of a mid-entry sites or long lines of CA can exclude AF episodes with a high certainty.

S126

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

16-94 Abstract 08-13 QUANTIFICATION OF THE ARRHYTHMOGENIC E F F E C T S O F S P O N TA N E O U S AT R I A L EXTRASYSTOLE USING HIGH-RESOLUTION EPICARDIAL MAPPING Christophe P. Teuwen 1, Charles Kik 1, Lisette J.M.E. van der Does 1, Eva A.H. Lanters 1, Paul Knops 1, Elisabeth M.J.P. Mouws 1, Ad J.J.C. Bogers 1, Natasja M.S. de Groot 1 1 Erasmus Medical Cente, Rotterdam, Netherlands Background: Atrial extrasystoles (AES) can initiate atrial fibrillation (AF). However, the impact of spontaneous AES on intra-atrial conduction is unknown. The aims of this study were to examine conduction disorders provoked by AES and to correlate these conduction differences with patient characteristics, mapping locations and type of AES. Methods: High-resolution epicardial mapping (electrodes N = 128 or N = 192; inter-electrode distance: 2 mm) of the entire atrial surface was performed in patients (N = 164; 69.5% male; age 67.2 ± 10.5 years) undergoing open-chest cardiac surgery. AES were classified as premature, aberrant or prematurely aberrant. Conduction delay (CD) and block (CB) were quantified during SR and AES and subsequently compared. Results: Median incidence of CD and CB during SR was 1.2% (interquartile 0–2.3%) and 0.4% (interquartile 0–2.1%). In comparison, the median incidence of CD and CB during 339 AES was respectively 2.8% (interquartile 1.3–4.6%) and 2.2% (interquartile 0.3–5.1%) and differed between the types of AES (prematurely aberrant BB aberrant BB premature). The degree of prematurity was not associated with a higher incidence of conduction disorders (p < 0.05). In contrast, a higher degree of aberrancy was associated with a higher incidence of conduction disorders; AES emerging as epicardial breakthrough provoked most conduction disorders (p < 0.002). AES caused most conduction disorders in patients with diabetes mellitus and left atrial dilatation (p < 0.05). Conclusions: Intra-operative high-resolution epicardial mapping showed that conduction disorders are mainly provoked by prematurely aberrant AES, particularly in patients with left atrial dilation and diabetes mellitus or emerging as epicardial breakthrough.

16-95 Abstract 18-34 BIPOLAR VOLTAGE VARIABILITY IN LEFT AT R I A L U LT R A - H I G H - D E N S I T Y 3 D M A P S (RHYTHMIA®) IN PATIENTS WITH PAROXYSMAL AF Korbinian Lackermair 1, Konstantinos Rizas 1, Moritz Sinner 1 , Stephanie Fichtner 1, Heidi Estner 1 1 University of Munich, Department of Cardiology, Munich, Germany Background: Mapping with Rhythmia® leads to a significant increase of acquired EGMs and might beneficial for

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

identification of substrate by higher resoluting maps. Although, Rhythmia® is widely used for left atrial ablation, little is known about the optimal window of interest (WOI) for the interpretation of voltage maps and standard setups are overtaken from experiences from previous mapping systems. Nevertheless, it remains unclear if these settings are appropriate for ultra-high-density maps with Rhythmia®. Methods: As this category of patients might have been considered as most likely homogeneous, especially compared to other patients undergoing pulmonary vein isolation, five LA maps of patients with paroxysmal AF without structural heart disease acquired during sinus rhythm were reworked. The distribution of the EGM´s bipolar voltage was compared between each single map. In addition, the percentage of EGMs within the standard WOI (0.2–0.5 mV, considered as “substrate”) was compared as well as percentage of EMGs below the standard WOI (considered as “scar”). Results: A total of 41,346 EGMs was analysed. There were significant differences in the distribution of voltage (Fig. 1). Mean voltage was 2.09 ± 2.6, 1.78 ± 2.4, 0.98 ± 1.6, 0.81 ± 1.3 and 1.43 ± 1.7 mV (statistical significant different distribution between one map and every other map). Accordingly, the percentage of EGMs lying within the WOI ranged from 8.8 to 23.3% (8.9, 14.8, 17, 23.3 and 8.8%) and the percentages of EGMs below the WOI interest were 31.1, 26.2, 43, 41.1 and 34.1%. Conclusion: Our data could demonstrate relevant variability of voltage distribution in patients with lone paroxysmal AF. As this category of patients might have been considered as most likely homogeneous especially compared to other patients undergoing pulmonary vein isolation, doubts might seem justified that an approach with a standard setup for the WOI satisfies the requirements of ablations using ultra-high-density mapping.

16-96 Abstract 28-14 HIGH DENSITY MAPPING OF RECURRENT RIGHT ATRIAL FLUTTER IN A BIATRIAL ORTHOTOPIC

S127

HEART TRANSPLANT RECIPIENT Gurjit Singh 1, Arfaat Khan 1, Marc K Lahiri 1, Waddah Maskoun 1, Claudio D Schuger 1 1 Henry Ford Hospital, Detroit, MI, United States Background: Atrial flutter in heart transplant recipients can vary from typical cavotricuspid isthmus dependent (CTI) flutter to scar related flutter with complex circuits Objective: We describe a case of typical right atrio-tricuspid flutter in a biatrial heart transplant patient using high density mapping and describe neo-anastomotic connections between donor and recipient atrium. Methods: N/A. Results: A 65-year-old female with ischemic cardiomyopathy status post biatrial heart transplant (1997), dual chamber pacemaker (2001) and CTI ablation in year 2003 was evaluated for symptomatic atrial flutter (Fig. A). High density (~ 75,000) activation mapping during tachycardia (cycle length 240 ms) with ORION® basket catheter showed a counterclockwise reentrant circuit involving the donor atriotricuspid isthmus (Fig. B). Anastomosis line was clearly defined and conduction into the recipient atrium was noted at the superior-lateral right atrium. Catheter manipulation in recipient right atrium led to fast flutter/fibrillation in the recipient atrium which continued despite termination of donor flutter during ablation in the atrio-tricuspid isthmus (Fig. C). Further mapping showed unidirectional conduction into the recipient atrium (Fig. D). Patient has remained arrhythmia free for a year now post ablation. Conclusion: Typical right atrial flutter can recur years after ablation in heart transplant patient involving atrio-tricuspid isthmus and high-density mapping using basket catheter is successful in defining the reentrant circuit. Electrical conduction channels can develop between recipient and donor atria which may or may not participate in arrhythmogenesis.

S128

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

16-97 Abstract 18-33 BIPOLAR VOLTAGE VARIABILITY IN LEFT AT R I A L U LT R A - H I G H - D E N S I T Y 3 D M A P S (RHYTHMIA®) IN PATIENTS UNDERGOING PULMONARY VEIN ISOLATION Korbinian Lackermair 1, Kostantinos Rizas 1, Moritz Sinner 1, Stephanie Fichtner 1, Heidi Estner 1 1 University of Munich, Department of Cardiology, Munich, Germany Background: Mapping with Rhythmia® leads to a significant increase of acquired EGMs and might be benficial for identification of substrate by higher resoluting maps. Although Rhythmia® is widely used for PVI, little is known about the optimal window of interest (WOI) for the interpretation of voltage maps and standard setups are overtaken from experiences from previous mapping systems. Nevertheless, it remains unclear if these settings are appropriate for ultra-high-density maps. Methods: Twenty-two LA maps of patients undergoing PVI were reworked. Ten maps were acquired in patients with paroxysmal AF (5 maps in sinus rhythm, 5 maps in AF), 12 maps were acquired in patients with persistent AF (6 maps in sinus rhythm, 6 maps in AF). The distribution of the EGM’s bipolar voltage was compared between paroxysmal and persistent AF patients as well as between maps in sinus rhythm and AF. In addition, the percentage of EGMs within the standard WOI (0.2–0.5 mV) was compared as well as the percentage of EMGs below the standard WOI. Results: A total of 221,413 EGMs was analysed. There were significant differences in the distribution of voltage. Mean voltage was 1.34 ± 1.94 mV (paroxysmal AF, map in SR), 0.56 ± 0.94 mV (paroxysmal AF, map in AF), 0.65 ± 1.06 mV (persistent AF, SR) and 0.36 ± 0.62 mV (persistent AF, map in AF; statistical significant different distribution between each group). Accordingly, the percentage of EGMs in the WOI ranged from 13.8 to 21.2% (13.8, 21.2, 18.1 and 18.7%) and the percentage of EGMs below WOI was 37.3, 45.8, 46.4 and 59.7%. Conclusion: Our data could demonstrate relevant variability of voltage distribution in patients undergoing PVI depending on the type of AF and the current rhythm. Thus, doubts might seem justified that an approach with a standard setup for the WOI satisfies the requirements of ablations using ultrahigh-density mapping.

Chaired Poster Session D part 1 Monday April 16, 2018, Posters displayed from 02:00 pm–05:30 pm Presenters and Chairpersons present from 02:00 pm– 03:30 pm ROOM TERNES Atrial arrhythmias 16-98 Abstract 18-36 ATRIAL TACHYARRHYTHMIA ABLATION IN LATERAL TUNNEL FONTAN PATIENTS: A CASE SERIES Vinit Sawhney 1, Holly Daw 1, Sarah Whittaker-Axon 1, Seamus Cullen 1, Katherine Von Klemperer 1, Bejal Pandya 1 , Fiona Walker 1, Martin Lowe 1, Vivienne Ezzat 1 1 Barts Heart Centre, London, United Kingdom Background: Atrial tachyarrhythmia (AT) are common in Fontan patients and may cause haemodynamic compromise. Radiofrequency ablation (RFA) has a role in this group of patients but access to target chamber may be challenging if the arrhythmia originates from the excluded native atrium. Patients who have undergone lateral tunnel surgery may also have

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

significant substrate within the intracardiac tunnel itself and it is possible that transbaffle puncture or a retrograde approach may not be necessary. In approaching these cases, there are limited data on which to base RFA strategy. We present our experience of RFA in patients with univentricular physiology who have undergone a lateral tunnel procedure. Methods: Retrospective analyses of lateral tunnel Fontan patients undergoing AT ablation at a single centre over five years were included. All procedures were performed using electroanatomic mapping systems. CT integrated images were available for the vast majority. Data were collected from a prospective registry and electronic health records. Results: Eighteen ablations in 14 patients. Sixty-one percent of patients were men, mean age 34 years. Six out of 14 patients (43%) were AP Fontans with subsequent lateral tunnel conversions. Mean age at conversion was 15 years. Forty-three percent of the patients had a device (5 pacemakers and 1 ICD) at the time of ablation. All patients were anticoagulated (12 on warfarin and 2 on rivaroxaban). Mean ventricular ejection fraction was 47 ± 10%. AF was documented in 36% of the cases. Multiple tachycardias (≥ 3) were induced in five patients. Mean tachycardia cycle length (TCL) was 323 ± 68 ms. Irrigated bidirectional ST ablation catheter and Agilis sheath were used in the vast majority of cases. The TCL was covered within the tunnel in nearly a third (33%) of the cases. Two of the fourteen patients required DCCV and one required atrial ATP to restore SR at the end of the case. Mean procedure time was 162 min and mean fluoroscopy time of 36 ± 30 min. There were no reported complications. Arrhythmia-free survival was 57% over a median follow-up of 18 months. Two patients required a second procedure over the follow-up period. Conclusions: RFA is a safe and effective therapeutic option in patients with previous lateral tunnel Fontan surgery. A large proportion have AT that are entirely mappable within the tunnel and do not require transbaffle puncture or retrograde arterial access. Arrhythmia-free survival is good at 1.5 years. This should be considered as a first line treatment option in this group of patients. 16-99 Abstract 15-41 MOST COMMON POTENTIAL DRUG INTERACTIONS WITH ORAL ANTICOAGULANTS FOR ATRIAL FIBRILLATION PATIENTS Ketija Apsite 1, Katrina Pukite 1, Andris Tupahins 1, Natalija Nikrus 1, Baiba Lurina 1, Irina Pupkevica 1, Aivars Lejnieks 1, Oskars Kalejs 1 1 Riga Stradins University, Riga, Latvia Introduction. Multiple drug regime that includes oral anticoagulant usage carries a high risk of potential drug-drug interactions (DDI) among atrial fibrillation patients. These interactions could lead to a higher bleeding risk. The possible DDI occurs because of one metabolic pathway through P-Glycoprotein and CYP450.

S129

If drugs are taken simultaneously, it can slow down the drug metabolic process following with an increased drug concentration in blood. Increased anticoagulant levels in blood poses an increased possible bleeding event risk. Purpose. The purpose of this study was to define the most common used drugs and food supplements that atrial fibrillation patients use, which have the potential to interact with oral anticoagulants. Methods. Patients with high-risk atrial fibrillation were included in this prospective cross-sectional study from Pauls Stradins Clinical university hospital, Latvian Centre of Cardiology. Patients were divided into three groups—vitamin K antagonist, warfarin, direct oral anticoagulant (DOAC) rivaroxaban and dabigatran users. Oral interview included questions about demographic data, frequently and regularly used medications and food supplements, medical history. All collected data were analyzed using IMB SPSS Statistics. Results. Altogether, 143 patients participated in this study: 46.2% male and 53.8% female. The mean age was 69.7 (SD 9.9) years. The chosen oral anticoagulant for thrombosis prophylaxis in 49.7% was warfarin, 16.8% dabigatran and in 33.6% rivaroxaban. From all patients, 49.7% used medication that could potentially interact with oral anticoagulants. In warfarin user group, 30.56% had potentially major DDI: with amiodarone 16.7%, nonsteroidal anti-inflammatory drugs (NSAIDs) 12.5%, aspirin 4.2%. Potentially moderate DDI were identified for 33.33% of patients: 20.8% with omega-3 supplements, 13.8% with proton pump inhibitors (PPIs), rosuvastatin 5.6%. In dabigatran user group, 4.3% of patients had a potentially major drug interaction with NSAIDs. Potentially moderate in 47.8% of cases: 26.1% with PPIs, 17.4% with amiodarone, 13.0% with omega-3 supplements. In rivaroxaban user group, 4.2% of patients had potentially major drug interaction with NSAIDs; potentially moderate: with amiodarone 29.2%, omega-3 supplements 16.7%, selective serotonin reuptake inhibitors 2.1%. Conclusion. Potential drug interactions with oral anticoagulants are a common occurrence among high-risk atrial fibrillation patients. Highlighting the most commonly used medications that have the potential to increase the anticoagulant concentration in blood could draw more attention on choosing the most suitable pharmacotherapy. Taking in count the possible DDI would lead to a safer pharmacotherapy selection. 16-100 Abstract 15-42 DOES GOUT MATTER IN PATIENTS WITH ATRIAL FIBRILLATION? Antoniya Kisheva 1, Yoto Yotov 1, Trifon Chervenkov 1, Yana Bocheva 1 1 University hospital "St Marina", Varna, Bulgaria Background: In the last years, several studies were published to assess the association between hyperuricemia and occurrence of atrial fibrillation (AF), but there are little data on the

S130

importance of gout in patients, who already have paroxysmal or persistent AF. Purpose: To assess the impact of gout on the clinical course of AF in patients with restored synus rhythm. Methods: Overall, 101 patients—51 females and 50 males at mean age 68.02 ± 7.001, with AF after sinus rhythm restoration were included in a clinical trial of 1year placebo-controlled treatment with spironolactone. Gout was reported in 6.8% of them. They were analysed for AF recurrence, hospitalization for AF, all-cause admissions, composite end point (recurrence episodes of AF, allcause hospitalization and death) and value of biomarker Galectin-3 (Gal-3). Results: Patients with gout had double risk of recurrence of AF, even though not significant, HR = 1.97, 95% CI = 0.78–4.98, p = 0.15. In our study, the presence of gout was a significant predictor for hospitalization for AF in unifactor analysis (HR 4,46, 95% CI = 1.51–13.19, p = 0.007) and the only significant in multifactor analysis— model, including gender, age categories, hypertension, diabetes and use of spironolactone (HR = 4.23, 95% CI = 1.28– 14.1, p = 0.018). Gout influenced significant also the allcause hospitalizations, HR = 3.17, 95% CI 1.10–9.14, p = 0.033. We found no relationship between gout and composite end point. There was a significant difference between the value of Gal-3 in patients with gout as opposed to patients without (28.52 ± 15 vs 16.02 ± 5.49, р = 0.002). Conclusion: Presence of gout in patients with atrial fibrillation is a risk factor for recurrence and hospitalization—cause-specific for AF and all-cause. The value of Gal-3 as a marker of fibrosis and inflammation is higher in patients with AF and gout.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

flecainide in healthy horses. Methods: The study group consisted on 3 horses with spontaneous persistent AF and 14 with pace-induced AF. Of these, seven were treated with saline (control) and seven with flecainide (2 mg/kg). Cardioversion with flecainide was also attempted in one horse with spontaneous persistent AF. ECGs were analysed using spatiotemporal cancellation of QRST complexes and calculation of AFR from the residual atrial signal. Results: At AF onset, AFR was 295 ± 52 fibrillations per minute (fpm) in the horses with induced AF treated with flecainide, 269 ± 36 fpm in the control group (ns), and 364 ± 26 fpm in the horses with spontaneous persistent AF (P BB 0.05). Flecainide caused a decrease in AFR in all animals and restored sinus rhythm in the animals with induced AF (Fig. 1A). In the horse with persistent AF, AFR diminished from 450 to the minimal value of 311 fpm followed by return to baseline AFR values without conversion to sinus rhythm (Fig. 1B). Conclusion: AFR values and their evolution during induced AF in horses resemble AFR dynamics in humans with paroxysmal AF. Flecainide caused a rapid decrease in AFR further supporting feasibility of the methodology for non-invasive monitoring of antiarrhythmic drug effects in equine AF model and horses with spontaneous AF. Our study further supports the validity of the horse as model for human AF.

16-101 Abstract 15-46 FEASIBILITY OF NON-INVASIVE ASSESSMENT OF AT R I A L F I B R I L L AT O R Y R AT E A N D I T S MODIFICATION BY FLECAINIDE IN HORSES WITH INDUCED ATRIAL FIBRILLATION 16-102 Abstract 15-49 Eva Zander Hesselkilde 1, Helena Carstensen 1, Maria Mathilde Haugaard 1, Jonas Carlson 2, Thomas Jespersen 3, Rikke Buhl 1, Pyotr G. Platonov 2 1 Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, 2 Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden, Lund, Sweden, 3 Department of Biomedicine Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Background: Atrial electrical remodeling during atrial fibrillation (AF) can be assessed using atrial fibrillatory rate (AFR). Horses have been suggested as a bona fide model for AF studies since horses too, develop lone AF. We aimed to study characteristics of induced AF and its modification by

POSTOPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING SURGERY FOR HIP FRACTURE Carlo Rostagno 1, Alessandro Cartei 2, Claudia Ranalli 2, Andrea Carlo Rostagno 2, Gian Luca Polidori 2, Roberto Civinini 3, Massimo Innocenti 3 1 Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Firenze, Italy, 2 Medicina Interna e post-chirurgica AOU Careggi, Firenze, Italy, 3 Traumatologia AOU Careggi, Firenze, Italy In this study, we evaluated the incidence, risk factors and prognostic effects, both in-hospital and at 1 year, of postoperative atrial fibrillation (POAF) in patients undergoing surgery

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

for hip fracture. There were 3283 patients who were referred to trauma Center of AOU Careggi (Florence) between February 2012 and July 2016 for hip fracture. Two hundred and seventy-seven were in permanent atrial fibrillation at hospital admission and were excluded from the study. Overall, 104 patients (mean age 84 years, females 73%) developed a POAF (3.4%). Average time of onset after surgery was 2 days. Eight patients died during hospitalization. Then, 81.7% were discharged in sinus rhythm. POAF group in comparison to control group (e.g. patients in stable sinus rhythm) had a longer time to surgery (3.8 ± 3.3 vs. 2.4 ± 1.6 days) and length in hospital stay (19.7 ± 10.4 vs. 14.4 ± 5.1 days). Furthermore, 1year mortality was significantly higher in POAF group in comparison to control group (39.3 vs. 20.9%, < 0.001). Two or more comorbidities were present in 74% of patients with POAF and in 47% in the control group. Among echocardiographic parameters, only a moderate-severe mitral regurgitation was associated with an higher risk of developing POAF. Postoperative atrial fibrillation in patients undergoing surgery for hip fracture is associated with increased length and costs of hospitalization and with a lower 1-year survival.

S131

three patients were included in this study (age 30.2 ± 8.8 years, 58% male). Twenty-eight (30%) had classic Fontan connection, 35 (37.6%) had a lateral tunnel Fontan, and 29 (31.1%) had an extra-cardiac Fontan pathway. After a mean of 7.27 ± 5.1 years follow-up, atrial arrhythmia was noted in 37 (39.8%) patients, of which 13 (14%) had atrial fibrillation, 16 (17.2%) had atrial flutter, and 16 (17.2%) had ectopic atrial tachycardia. The presence of any atrial arrhythmia was predicted by number of prior cardiac surgeries/procedures, age, prior classic Fontan operation, and cirrhosis in multivariate analysis. Atrial arrhythmias were not significantly associated with gender, congestive heart failure, hypertension, or diabetes. Thirty-one patients had thromboembolic events: 14 (15.1%) has stroke, 3 (3.2%) had transient ischemic attack, 7 (7.5%) had pulmonary embolism, and 5 (5.4%) had a history of atrial thrombus. The presence of thromboembolic events was only associated with cirrhosis in multivariate analysis adjusting for co-morbidities. Conclusion: Atrial arrhythmias are common in adults with Fontan circulation. Risk factors associated with the development of atrial arrhythmia include prior surgical history, age, and cirrhosis. Traditional risk factors such as hypertension and diabetes are not associated with atrial arrhythmia or thromboembolism.

16-103 Abstract 14-10 ATRIAL ARRHYTHMIAS IN ADULTS WITH FONTAN CIRCULATION

Characteristic

p value (αBB 0.05)

OR (95% CI)

Classic Fontan Age Male sex Number of cardiac surgeries/procedures CHF

0.01 0.006 0.261 0.023

5.008 (1.478–16.971) 1.125 (1.034–1.223) 1.932 (0.613–6.083) 1.532 (1.062–2.211)

0.909

0.858 (0.063–11.771)

HTN DM Cirrhosis Atrial fibrillation Classic Fontan Age Male sex Number of cardiac surgeries/procedures CHF HTN DM

0.999 1.0 0.045

– – 7.928 (1.043–60.236)

0.436 0.016 0.188 0.843

1.872 (0.387–9.057) 1.102 (1.018–1.193) 3.906 (0.514–29.663) 1.056 (0.614–1.817)

0.116 0.999 1.00

7.838 (0.600–102.366) – –

0.035

11.081 (1.190–103.165)

0.903 0.425 0.133 0.083

1.078 (0.322–3.614) 1.536 (0.535–4.412) 1.049 (0.985–1.118) 1.329 (0.964–1.834)

0.302

3.121 (0.360–27.077)

Any atrial arrhythmia

Darryl Wan 1, Jasmine Grewal 1, Amanda Barlow 1, Marla Kiess 1, Derek Human 1, Andrew D. Krahn 1, Santabhanu Chakrabarti 1 1 University of British Columbia, Vancouver, Canada Background: The Fontan operation is a palliative procedure most commonly performed in infancy to improve survival in patients born with univentricular physiology. Due to the advances in pediatric cardiology and cardiac surgery, these patients are surviving into adulthood, which is accompanied by a variety of late complications. These include arrhythmia, thromboembolism, heart failure, and extra-cardiac complications. Onset of atrial arrhythmias can be worrisome and a harbinger of a failing Fontan circuit. There is paucity of data regarding the factors which are associated with the development of atrial arrhythmias and subsequent complications like thromboembolism and Fontan failure. Objective: This study aims to study the factors associated with the development, maintenance and progression of atrial arrhythmias and the associated risk factors in an adult population with Fontan physiology. Methods: We performed a single-centre retrospective cohort study to collect clinical characteristics of all patients ≥ 18 years of age with Fontan circulation who have ever been followed at our quaternary care centre. Patients with BB 1 year of follow-up were excluded from this study. Statistical analysis of association was performed using Fisher’s exact test and a multivariate logistic regression model. Results: Ninety-

Cirrhosis Any thromboembolism Classic Fontan Male sex Age Number of cardiac surgeries/procedures CHF

S132

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

(continued) HTN DM Cirrhosis Any atrial arrhythmia

16-105 Abstract 28-12 0.913 1.00 0.016 0.273

1.184 (0.057–24.749) – 8.428(1.495–47.526) 0.502 (0.146–1.722)

16-104 Abstract 26-11 A NEW MANAGEMENT STRATEGY FOR AF IN THE EMERGENCY DEPARTMENT Sorabh Kothari 1, Sujeen Adhikari 1, Michelle Nellett 2, William Spear 2 1 University of Illinois Chicago/Advocate Christ Medical Center, Oak Lawn, United States, 2 Advocate Christ Medical Center, Oak Lawn, United States Background: Atrial fibrillation (AF), the most prevalent cardiac dysrhythmia seen in U.S. emergency departments (ED), often results in hospital admission with an average length of stay (LOS) of 4 days and annual hospital expenditures exceeding $7 billion. The standard of care has relied on rate control with IV calcium channel blockers and anticoagulation with heparin bridging to warfarin prior to discharge. The introduction of direct oral anticoagulants (DOAC) and rapid availability of both chemical and electrical cardioversion (CV) is challenging this paradigm. Objective: The objective of this retrospective study was to evaluate the safety and efficacy of an AF Emergency Protocol (AFEP) initiated for patients presenting to the ED with a primary diagnosis of new onset AF. Methods: Two groups were divided equally into control (n = 50) and AFEP (n = 50). Control group received standard of care. AFEP group was divided into onset BB 24 h, receiving DOAC if appropriate, and expedited CV (chemical or electrical). Patients with onset BB 24 h received TEE prior to CV. After CV, patients were discharged when criteria was met. Outcomes including LOS, CV success rate, immediate and delayed adverse outcomes, and DOAC utilization were compared between the two groups. Results: There was a significant difference in LOS between control 2.59 days and AFEP groups 0.71 days (< 0.0001). Conversion to sinus rhythm occurred in 86% of AFEP group; 98% meeting discharge criteria from the ED with no immediate adverse events. Readmission rates within 30 days occurred in 10% of the control group compared to 4%. Other delayed adverse events (bleeding) occurred in 2% of the control group only. Furthermore, there was a significant difference in the ED use of DOACs between groups, 14.8% in the control compared to 64.3% in the AFEP (p = 0.0002). Conclusion: The implementation of the AFEP, focusing on appropriate anticoagulation with DOACs and early targeted CV, can significantly reduce LOS and potential hospital cost of patients admitted with the primary diagnosis of AF. This benefit is seen without increasing risk of adverse events and a potential to save billions of dollars in hospital related costs associated to AF management.

DIFFERENCES IN ATRIAL FIBRILLATION DRIVER CHARACTERISTICS ON 2D GRIDS COMPARED TO PATIENT-SPECIFIC 3D ATRIAL CONTOURS Albert Rogers 1, Orvil Collart 1, Ricardo Abad 1, Rachita Navara 1, Mark Swerdlow 1, Mahmood Alhusseini 1, Miguel Rodrigo 1, Christopher Kowalewski 1, Junaid Zaman 1, Tina Baykaner 1, Wouter-Jan Rappel 1, Sanjiv Narayan 1 1 Stanford University, Stanford, United States Background: Localized drivers are a proposed mechanism for atrial fibrillation (AF), yet it is uncertain if rotational activity on 2D maps is similarly rotational when mapped to the irregularities of 3D patient-specific anatomy. Objective: To quantify differences between 2D grids vs 3D AF maps and potential driver regions, identified by non-proprietary phase mapping, focusing on regions of rotational activity in 2D and on curved surfaces, e.g. near pulmonary veins (PVs). Methods: In N = 21 AF patients, maps of AF from 64-pole basket recordings (Abbott, CA) identified drivers. Phase maps by non-proprietary Hilbert transform analyses were compared for 2D versus patient-specific 3D atrial contours (NavX, Abbott, CA) created in Matlab with coordinates of identified electrodes. Results: 2D maps from N = 21 patients (60.0 ± 12.7 years, 62% M) showed 7.1 ± 3.5 drivers/patient (74.8/25.2% rotational/focal). Ablation terminated AF in 14/21 patients (67%). AF maps had similar numbers/type (rotational/ focal) of drivers in 2D vs 3D (< 0.01). In a 66-year-old woman, figure shows one driver where ablation terminated AF remote from PVs (A) 2D, 30% of grid area; (B) 3D, 17% of atrial area. Ablation was easier to target in 3D given smaller targets. Overall, AF drivers controlled 40.3 ± 17.1% of 2D grids, vs 28.3 ± 17.3% of 3D atria (< 0.05). 3D maps more clearly showed smaller domain drivers, to assist ablation, that were obscured in 2D. 2D vs 3D driver comparisons were similar for right/left atrium (p = NS). Conclusion: AF maps are qualitatively similar in 2D grids and patient-specific 3D shells, but AF driver domains were smaller in 3D and easier to interpret relative to critical structures for ablation planning.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

16-106 Abstract 18-22 LEFT ATRIAL DIAMETER DOES NOT PREDICT LEFT ATRIAL SCAR BURDEN: A COHORT STUDY Dinesh Voruganti 1, Oluwaseun Adeola 1, Ghanshyam Shantha 1, Amgad Mentias 1, Chad Ward 1, Michael Giudici 1 1 University of Iowa Hospitals, Iowa City, United States Introduction: The definition of paroxysmal vs persistent atrial fibrillation is based on duration of episodes and self-termination. As mapping techniques have advanced, we now are able look at the left atrium on a more “granular” level and focus our ablation efforts rather than making anatomic lines of block. Knowing the degree of LA scar in advance could assist procedural planning to help achieve successful AF ablation. Our previous studies have suggested that BB 75% scar burden is predictive of persistent AF and requires more adjunctive RF ablation at the initial procedure. LA diameter has been suggested as a surrogate for tissue health in the atrium. We sought to determine if there is a relationship between LA diameter by echo and scar burden in the atrium. Methods: Sixty-two consecutive patients [48 M/14 F, mean age 59.2 years (26– 78 years)] underwent pulmonary vein isolation (PVI) with a cryo balloon technique followed by high-density mapping of the LA with a high-density (HD, St. Jude Medical) mapping catheter between September 2014 and October 2017. We defined the areas with low voltage amplitudes (BB 0.05 mV) as scar and performed ablation of low voltage “bridges” using RF energy. Multivariate logistic regression analyses were used to assess the association between LA diameter and scar burden. Results: Of 62 patients, 38 (61%) had paroxysmal AF while 24 (39%) had persistent AF. Forty-three (69%) had LA scar burden (LAS) BB 75%. In patients with LA diameter (LAD) BB 4.5 cm, 14 of 28 (50%) had LAS BB 75% compared to 29 of 43 (67%) patients with LAD BB 4.5 cm who had LAS BB 75% (p = 0.005). However, after adjusting for age, gender, presence of structural heart disease and type of AF, LA size BB 4.5 cm was not significantly associated with higher incidence of LAS BB 75% (p = 0.338). Conclusion: LAS BB 75% was independent of age, gender, structural heart disease and LA diameter. This was a surprising finding as one would expect larger LA diameter to be associated with a higher percentage of low voltage tissue. Considering the small sample size of our analysis, perhaps we will see a different result with a larger patient population as we continue patient enrollment. 16-107 Abstract 18-46 ABLATION OF ATRIO-VENTRICULAR NODAL REENTRY TACHYCARDIA WITH A FORCED SENSE AND OPEN IRRIGATED CATHETER: A SINGLE CENTER EXPERIENCE

S133

Bengt Herweg 1, Nicholas Kotch 1, Anant Kharod 1, Sanders Chae 1, Michael Fradley 1, Raymond Cutro 1, David Wilson 1 1 University of South Florida Morsani College of Medicine, Tampa, Florida, United States Background: Treatment of atrioventricular nodal reentrant tachycardia (AVNRT) requires ablation in the area of the AV nodal slow pathway (AVNSP) and is curative in the majority of cases. Iatrogenic AV block occurs in 1–2% of cases. Open irrigation and contact force (CF) sensing technology has resulted in more predictable lesion formation. However, the efficacy and safety of these technologies have not been validated for AVNSP modification. Objective: We are reporting our experience using CFguided and open-irrigated tip catheters for AVNSP modification. Methods: We retrospectively reviewed the medical records of 39 consecutive patients who underwent 41 AVNSP modification procedures between July 2014 and Nov 2017. We utilized irrigated catheters, either the 4 mm EZ Steer Nav or the 3.5 mm SmartTouch Thermocool (Biosense Webster, Inc.). Energy was delivered in the power-controlled mode in incremental steps from 15 to 35 W. AVNSP modification was performed in standard technique. All lesions were tagged on the Carto 3 mapping system. Results: CF catheters were used in 30/41 AVNSP modifications (73%). During the first procedure, non-inducibility was achieved in 36/39 patients (92%). At a mean follow up of 12 ± 11 months, four patients (10%) developed recurrent AVNRT (one non-sustained, three sustained). Two of four patients were successfully re-ablated. No patient suffered permanent AV block (one patient experienced transient AV block). Ablation of additional arrhythmia mechanisms was performed in nine patients (23%). Conclusion: In our experience, the use of irrigated and CF sensing catheters is safe and efficacious for AVNSP modification with no incidence of permanent AV block and ablative cure in 37/39 patients (95%). In addition, 23% of our patients required ablation of other arrhythmia mechanisms for which these catheters are routinely used. Prospective and randomized studies should be performed to prove the safety and efficacy in this setting. 16-108 Abstract 15-22 PREVENTION OF ATRIAL FIBRILLATION BY STATINS IN THE ACUTE CORONARY SYNDROM WITH ST SEGMENT ELEVATION (STEMI) Marouane Mahjoub 1, Waies Labidi 1, Mejdi Ben Messaoud 1, Ayoub Belfkih 1, Majed Hassine 1, Zohra Dridi 1, Fethi Betbout 1, Habib Gamra 1 1 Cardiology department A: Fattouma Bourguiba University Hospital, Monastir, Monastir, Tunisie Backgroud: While the role of statins in the primary and secondary prevention of atrial fibrillation (AF) currently has little

S134

evidence, their postoperative benefit from cardiac surgery is well proven and currently recommended. The existence of an effect similar to the acute phase of acute coronary syndromes with persistent ST-segment elevation (SCA ST +) is however not known. Methods: To study the correlation between statin intake in the acute phase of coronary syndrom with ST segment elevation (STEMI) and the occurrence of AF in the MIRAMI registry. Results: Among the 1588 patients admitted to the acute phase of STEMI, 91 (6.6%) experienced a switch to AF. Five hundred seventy-nine patients (41.7%) received a statin at the acute phase of their STEMI. Statin therapy was found to be protective of AF reducing the risk of 7.7% in patients not receiving statins at 5% in patients treated with statins (p = 0.0049). This effect is found only in the case of anterior localization of the infarct (5.5 vs 9.2%, p = 0.005), the difference is not significant in inferior localisation of the infarct (5.1 vs 6.8%, p = 0.37). The protective effect of statins disappears, however, in diabetics (7.5 vs. 8%, p = 0.86), hypertensive patients (7.6 vs. 7%, p = 0.29), and non-smokers (8.8 vs. 9.1%, p = 0.91). Conclusion: Treatment with statins appears to protect against the occurrence of AF in the acute phase of STEMI in anterior localisation. This effect is more pronounced in the tobacco population with few cardiovascular risk factors (hypertension and diabetes). 16-109 Abstract 13-13

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

bias was assessed. Random method was applied for all dichotomous values. Odds ratio and confidence intervals were assessed for each risk factor. Results: Four studies were included with 582 participants. Mean follow up was 29 ± 3.3 months. Mean age was 44 ± 4 years. Age was the only significant risk factor for AF recurrence (OR 3.4, CI 2.1– 5.3, p BB 0.001). Atrial vulnerability did not correlate with a higher risk of AF recurrence (OR 4.8, CI 0.7–29, p BB 0.008). Neither male gender (OR 1.5, CI 0.8–2.8, < 0.16) nor left atrial diameter (OR 1.5, CI 0.2–10, < 0.67) were significant risk factors for recurrence of AF after either slow pathway modification or accessory pathway ablation. Conclusion: Older age was the only significant predictor of AF recurrence. Atrial vulnerability does not seem to correlate with a higher recurrence rate of AF. Further studies are needed to determine the age cutoff at which pulmonary vein isolation would be beneficial regardless of the coexisting regular reentrant tachycardia. Left Atrial Appendage Occlusion 16-110 Abstract 15-63 3 YEAR RESULTS WITH INTERVENTIONAL LEFT ATRIAL APPENDAGE OCCLUSION IN A 2-CENTEREXPERIENCE

Estelle Torbey 1, Malcolm Kirk 1, Antony Chu 1 1 Brown University, Rhode Island, United States

Michael Mehr 1, Lisa Riesinger 1, Claudia Sabrina Summo 1, Daniel Braun 1, Heidi Estner 1, Steffen Massberg 1, Jörg Hausleiter 1, Martin Hinterseer 2, Reza Wakili 3 1 Munich University Clinic (LMU), Munich, Germany, 2 Füssen Hospital, Füssen, Germany, 3 Westdeutsches Herzund Gefäßzentrum, Essen, Germany

Background: Nodal or atrioventricular reentrant tachycardia (AVNRT/AVRT) predisposes to atrial fibrillation (1–2). Targeting the slow or accessory pathways has been advocated as therapy for coexisting AF (1). Post ablation for SVT, AF recurred in 9% of cases which is more frequent than in the general population (1). Persisting atrial vulnerability post ablation was demostrated as a prognostic factor for recurrence as well as age and left atrial enlargement (2–3). Objectives: The primary aim of this metaanalysis is to investigate the factors related to the recurrence of AF after ablation for reentrant regular tachycardia in the setting of preexisting AF and AVNRT/AVRT.Methods: After review of Pubmed, Cochrane and Embase literature, 30 relevant studies were identified. Among the inclusion criteria were prior documented AF and either AVRT or AVNRT, clinically documented AF recurrence during follow up of at least 12 months, discontinued antiarrythmics post ablation, ageBB 18, noted risk factors of age, sex, left atrial diameter and atrial vulnerability as defined by induction of AF sustained for longer than 30 s. Publication

Background: ESC guidelines on atrial fibrillation (AF) encourage considering interventional left atrial appendage occlusion (LAAO) in patients with AF and a contraindication for oral anticoagulation (OAC). However, published data on LAAO are still very limited. We aimed to investigate deescalation of OAC therapy and its impact on bleeding and stroke in a real-life-setting. Methods: We investigated 142 cases of LAAO in 2 centers since 2012. We retrospectively analyzed all patients with respect to the intervention itself, planned follow-up with TEE and prespecified endpoints. The primary endpoint was ischemic stroke/systemic embolism (IS/SES). Secondary endpoints included procedural success and complications, device embolization, device thrombosis, significant side-flow BB 5 mm and bleeding episodes BARC ≥ 3a. Results were compared with published data from the PROTECT-AF trial (PAF). Results: Since 2012, there have been 140/142 (98.5%) successful LAAO implantations (40/41 Watchman®, and 100/101 Amplatzer®). Mean patient age was 75 ± 7 years (PAF 71 ± 9 years). Seventy-nine percent

ATRIAL FIBRILLATION RECURRENCE AFTER ABLATION OF NODAL AND ATRIOVENTRICULAR REENTRANT TACHYCARDIA: A METAANALYSIS

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

of patients had a history of relevant bleeding episodes (46% gastrointestinal, 14% intracranial) and 37% of IS. Mean CHA2DS2-VASc-score was 4.6 and mean HAS-BLEDscore 3.8. We observed no procedure-related transfusions (0%, PAF 3.5%), one device embolization (0.7%, PAF 0.6%) and one pericardial tamponade with drainage (0.7%, PAF 4.8%). Follow-up (323 ± 357 days) revealed two patients with an IS/SES (1.4%, PAF 2.3%), four cases of device thrombosis (3.5%, PAF 5.7%) and three cases of relevant side-flow (2.6%, PAF 14%). Antithrombotic medication was significantly de-escalated over time (previous vs. 6 months, Fig. 1). Notably, we observed 13 BARC ≥ 3a bleeding episodes (9.2%, PAF 4.8%), most often under escalated antithrombotic therapy shortly after LAAO. Conclusion: LAAO is a valid alternative in patients with high risk of bleeding and stroke. However, LAAO does not translate into an immediate cessation of antithrombotic treatment which may imply bleeding complications in these patients.

S135

follow-up to assess the presence of peridevice leaks and exclude thrombus on the device. Peridevice leaks are common, but their clinical significance and implications for antithrombotic management remain unclear. Aim: We report on the incidence and clinical impact of peridevice leaks after percutaneous LAAC. Methods and results: One hundred seventytwo patients that underwent LAAC implantation (n = 162 (94%) Watchman; n = 10 (6%) ACP) were included (103 (60% male, age 68.8 ± 8.5 years, CHA2DS2-VASc 4.0 [3.0– 5.0]; HASBLED 3.0 [2.0–4.0]; 86 (50%) paroxysmal AF). LAAC implantation was successful in all patients. Periprocedural TEE showed complete closure in 161 (94%), and minimal residual flow in 11 (6%) patients. The mean size of peridevice leak during implant was 2.0 ± 0.5 mm. During TEE follow-up at 45–60 days, 3 devices were embolised, complete closure was seen in 100 (58%), whereas peridevice flow was seen in 69 patients (40%). Mean size of peridevice leak at follow-up was 2.7 ± 1.4 mm. (N)OAC therapy was discontinued in 91% of patients. After a follow-up of 26 months, six ischemic strokes were observed (four patients with residual peridevice flow on TEE, two patients with complete closure). The presence of a peridevice leak was not significantly associated with an increased stroke risk. Conclusion: Peridevice leaks after LAAC appear to be common. The complete sealing rate diminished from 94% at implant to 58% at TEE follow-up. The presence of a peridevice leak was not associated with an increased stroke risk. 16-112 Abstract 15-12 LEFT ATRIAL APPENDAGE PATENCY AND DEVICERELATED THROMBUS AFTER PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION: A COMPUTED TOMOGRAPHY STUDY

16-111 Abstract 15-56 CLINICAL IMPACT OF INCOMPLETE LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION Lisette Wintgens 1, Martijn Klaver 1, Martin Swaans 1, Arash Alipour 1, Benno Rensing 1, Lucas Boersma 1 1 St Antonius Hospital, Nieuwegein, Netherlands Background: Left atrial appendage closure (LAAC) with the Watchman device or the Amplatzer Cardiac Plug (ACP) is an increasingly used therapy as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). Transesophageal echocardiography (TEE) is used both during the procedure and at 45–60 days

Xavier Iriart 1, Hubert Cochet 1, Soumaya Sridi 1, Claudia Camaioni 1, Olivier Corneloup 1, Michel Montaudon 1, François Laurent 1 , Wieme Selmi 1 , Pauline Renou 1 , Zakaria Jalal 1, Jean-Benoit Thambo 1 1 CHU de Bordeaux, Pessac, France Background: Transesophageal echocardiography (TEE) studies have reported frequent peri-device leaks and device-related thrombi (DRT) after percutaneous left atrial appendage occlusion (LAAO). Objective: To assess the prevalence and characteristics of leaks and DRT on CT after LAAO. Methods: Consecutive patients underwent a CT before LAAO to assess LA volume and LAA anatomy. Follow-up CT was performed to assess implantation criteria, device leaks and DRT. Results: One hundred seventeen patients (age 74 ± 9, 37% women) were implanted with Amulet (71%) or Watchman (29%). LAA patency was detected in 44% on arterial phase CT images and 69% on venous phase images. LAA patency

S136

related to LA dilatation, LVEF impairment, non-chicken wing LAA shape, large landing zone diameter, incomplete device lobe thrombosis and disc/lobe misalignment with Amulet. DRT were detected in 19(16%), most being laminated. DRT did not relate to clinical or imaging characteristics nor to implantation criteria, but to total thrombosis of device lobe. Over a mean 13 months follow-up, stroke/TIA occurred in eight patients, unrelated to DRT or LAA patency. Conclusion: LAA patency on CT is common after LAAO. Leaks relate to LA/LAA anatomy, and device malposition. DRT is also quite common but poorly predicted by patient and device-related factors.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

atrial fibrillation (AF). Feasibility and safety of left atrial (LA) catheter ablation (CA) in patients with previously implanted LAAC devices remains unclear. We report on the feasibility, safety and efficacy of LA CA in the presence of a previously implanted WATCHMAN LAAC device. Methods and results: Twenty-three LA CA ablation procedures were performed in 19/162 AF patients with a previously implanted Watchman device (47% male, age 63.9 ± 6.2 years, CHA2DS2-VASc 4.0 [3.0–5.0]; HASBLED 3.0 [2.0–4.0]; 63% paroxysmal AF). LA CA was performed with irrigated RF for a redo procedure (n = 20 (87%)) or phased RF for index ablation (n = 3 (13%)) in a mean of 18 months (range 4–80) after LAAC implantation. Targets of CA consisted of pulmonary vein isolation (n = 19 (83%)), superior vena cava isolation (n = 13 (57%)), and additional LA linear lesions or complex fractionated atrial electrograms (n = 8 (35%)). Procedures were carried out under anticoagulant therapy with VKA (n = 6 (26%)), NOAC (n = 8 (35%)), or single antiplatelet therapy alone (n = 9 (39%)). LA CA was successful without any signs of interference from the device. Periprocedural complications such as pericardial effusion, bleeding or stroke were not observed. During a mean follow-up of 28 months, 11 patients (58%) remained free of AF recurrence while 1 stroke was observed 50 months after the procedure under single antiplatelet therapy with no detection of AF on the pacemaker. Conclusion: LA CA after LAAC appears to be feasible, effective and safe in this single center cohort. Previously implanted Watchman device should not be a reason to relinquish CA in symptomatic AF patients, even in patients on single antiplatelet therapy alone. Chaired Poster Session D part 2 Monday April 16, 2018, Posters displayed from 02:00 pm–05:30 pm Presenters and Chairpersons present from 04:00 pm– 05:30 pm ROOM TERNES

16-113 Abstract 18-20

Ablation of Supraventricular tachycardias

LEFT ATRIAL CATHETER ABLATION IN PATIENTS WITH PREVIOUSLY IMPLANTED LEFT ATRIAL APPENDAGE CLOSURE DEVICES

16-114 Abstract 13-10

Lisette Wintgens 1, Martijn Klaver 1, Martin Swaans 1, Arash Alipour 1, Jippe Balt 1, Vincent van Dijk 1, Benno Rensing 1, Maurits Wijffels 1, Lucas Boersma 1 1 St. Antonius Hospital, Nieuwegein, Netherlands Background: Left atrial appendage closure (LAAC) is an increasingly used therapy as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with

BENEFIT OF HIGH-DENSITY 3D MAPPING IN ACCESSORY PATHWAYS ABLATION PROCEDURES Kerstin Schmidt 1, Patrick Hörmann 1, Matthias Merkel 1, Gerhard Schymik 1, Claus Schmitt 1, Armin Luik 1 1 Medizinische Klinik IV, Kardiologie, Angiologie und Internistische Intensivmedizin, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany Introduction: Radiofrequency ablation of an accessory pathway (AP) is the treatment of choice in WPW syndrome. It can be

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

performed safely with a very high success rate. However, catheter stability, contact force and bumping of the accessory pathway may limit and prolong the procedure. A prolonged procedure duration is often leading to an increase of fluoroscopy. The mean fluoroscopy time in the literature is 25–38 min 1, 2. The usage of a 3D mapping system can reduce fluoroscopy but will need some time to build the system up. Published values are around 7.5 min fluoroscopy and 211 min total procedure time1. The aim of this study was to evaluate, whether mapping and ablation of the accessory pathway using a high-density 3D mapping system can further reduce fluoroscopy time and speed up the procedure. Methods: Nine consecutive patients presenting with WPW underwent an electrophysiological study using a high-density 3D mapping system. Standard catheters (CS, RV, His) were placed using fluoroscopy, no additional imaging (e.g. TEE) was used. Mapping of the AP was performed during RV pacing or during tachycardia using the automated algorithm of the system. Results: In all nine patients (age 19 ± 6, four male), the automatic algorithm of the high-density mapping system showed clearly the earliest breakthrough of the AP. Successful ablation could be performed at these spots in all patients. Seven APs were located on the right side (2× posteroseptal, 2 lateral, 3 anterior) and two on the left side (anterolateral). Total procedure time was 144 ± 59 min, fluoroscopy time was 2.3 ± 1.7 min, radiation dose was 50 ± 48 cGy*cm², total RF-time 525 ± 308 s. No minor and no major complications were observed. Conclusion: Ablation of APs using a high-density mapping system is feasible and safe. The automated algorithms enabled a clear view on the earliest breakthrough of the AP. Compared to the literature, fluoroscopy and procedure time could be further reduced. This is of special importance in these young patients. Literature: 1 Miyake CY, Mah DY, Atallah J et al (2011) Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 8:519–525 ² Efstathopoulous EP, Katritsis DG, Kottou S, et al (2006). Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis. Europace; 8:443–448

S137

Introduction. Transcatheter ablation is the most effective treatment for patients with symptomatic or high-risk accessory pathways (AP). At present, no clear recommendations have been issued on the optimal approach for left AP ablation. We performed this meta-analysis to compare the safety and efficacy of transaortic retrograde versus transseptal approach for left AP ablation. Methods and Results. MEDLINE/PubMed and Cochrane database were searched for pertinent articles from 1990 until 2016. Following inclusion/exclusion criteria application, 29 studies were selected including 2030 patients (1013 retrograde, 1017 transseptal) from 28 observational single-centre studies and 1 randomized trial. Patients approached by transseptal puncture presented a significantly higher acute success (98 vs. 94%, p = 0.040; Fig.). The incidence of late recurrences (p = 0.381) and complications (p = 0.301) did not differ among the two groups, but the pattern of complications differed: vascular complications were more frequent with transaortic retrograde approach, while cardiac tamponade was the main transseptal complication. No difference was noted in terms of procedural duration and fluoroscopy time (p = 0.230 and p = 0.980, respectively). Metaregression analysis showed no relation between year of publication and acute success (p = 0.325) or incidence of complications (p = 0.795); additionally, no direct relation was found between age and acute success (p = 0.256) or complications (p = 0.863). Conclusions. Left side AP transcatheter ablation is effective in around 95% of the cases, with a very limited incidence of complications. Transseptal access provides higher acute success in achieving AP ablation; late recurrences are rare but observed similarly following both approaches. Retrograde approach is affected by a relatively high incidence of vascular complications.

16-115 Abstract 13-11 TRANSSEPTAL OR RETROGRADE APPROACH FOR TRANSCATHETER ABLATION OF LEFT SIDED ACCESSORY PATHWAYS: A SYSTEMATIC REVIEW AND META-ANALYSIS Matteo Anselmino 1, Mario Matta 1, Andrea Saglietto 1, Leonardo Calò 2, Carla Giustetto 1, Marco Scaglione 3, Fiorenzo Gaita 1 1 Cardiology Division, Department of Medical Sciences, University of Turin, Torino, Italy, 2 Cardiology Division, Policlinico Casilino, Roma, Italy, 3 Cardiology Division, Cardinal Massaia Hospital, Asti, Italy

16-116 Abstract 13-12 ACCESSORY PATHWAYS IN ELDERLY PATIENTS: CLINICAL AND ELECTROPHYSIOLOGICAL FEATURES Carlos Gonzalez-Rebeles Guerrero 1 , Carlos Gutierrez Gonzalez 1, Oscar Bazan Rodriguez 1, Eduardo Del Rio Bravo 1 Luis Molina 1 1 General Hospital of Mexico, Mexico City, Mexico

S138

Background: Accessory pathways are diagnosed mainly in children and in young adults but are rare in elderly patients. The diagnosis in patients over 60 years of age can induce severe symptoms and can even be life threatening. Methods: We studied all patients who underwent electrophysiological study for accessory pathways in the last 15 years at our institution. We analyzed the clinical and electrophysiological features in patients over 60 years of age. Results: There were a total of 514 electrophysiological studies for accessory pathways in the last 15 years. Twenty-three (4.5%) of them were in patients over 60 years of age (61 to 83 years). The patients over 60 had the following features: 13 (56.5%) were males, the clinical presentation showed orthodromic atrioventricular reentrant tachycardia in 19 (82.6%) patients and 4 (17.4%) with pre-excited atrial fibrillation with high ventricular rates. The resting electrocardiogram showed delta waves in 19 (82.6%) patients. The electrophysiological studies found left accessory pathways in 13 (56.5%) patients and 10 (43.5%) in the tricuspid annulus. All the patients with left pathways underwent a transseptal puncture without complications. The ablation was successful in all the 23 patients and one patient had a post ablation atrioventricular block (midseptal location) and required a pacemaker implant. Conclusion: Accessory pathways in elderly patients are a rare diagnosis but present a high morbidity risk and a risk of lethal ventricular arrhythmias associated to pre-excited atrial fibrillation. In contrast to younger age groups, we found a higher percentage of right-sided accessory pathways and pre-excited resting electrocardiograms, which add to the risk of high ventricular rate with atrial fibrillation. The electrophysiologic study and ablation of accessory pathways in this age group is a relatively safe procedure.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

for proof of concept that atrial morphology may be used to discriminate an SVT from VT. Patients with paroxysmal tachycardias with A rates equal to V rates were included for analysis. Patients with 1:1 tachycardias were identified, and the patient’s device interrogation was then reviewed for VVI pacing and assessed for the presence of VA conduction. If VA conduction was present, the patient was included for study. Six patients with 1:1 tachycardia and VA conduction were identified. Of these six patients, five demonstrated a VA-conducted atrial electrogram that differed from the atrial tachycardia atrial electrogram. Morphology was assessed by eight independent observers. Covariables of gender, antiarrhythmic therapy, history of heart failure, blood pressure, lead location and lead type were collected. In conclusion, patients with VA conduction often demonstrate a change in atrial EGM morphology and with comparison of the clinical 1:1 tachycardia may support the diagnosis of nonventricular tachycardia; i.e. atrial tachycardia.

16-117 Abstract 05-13 H E U S E O F AT R I A L E L E C T R O G R A M MORPHOLOGY AS A SUPRAVENTRICULAR TACHYCARDIA DISCRIMINATOR Joseph Donnelly 1, Jonah Zeitlin 1, Jonathan Willner 1, Apoor Patel 1, Haisam Ismail 1, Ram Jadonath 1, Stuart Beldner 1 1 Northwell Health, Manhasset, United States The implantable cardioverter-defibrillator (ICD) has evolved over the years to become an indispensable component of standard therapy for the prevention of sudden cardiac death in patients with reduced left ventricular function. VT discrimination algorithms in patients with an atrial lead involve comparison of atrial and ventricular rates, after which patients are divided into VBB A, VBB A, V = A, as well as VA coupling. Patients with V = A (1:1) continue to pose a diagnostic challenge. Ventricular electrogram, farfeiled and near morphology is a well-recognized discriminator. This may fail in the setting of abberancy. We hypothesized that atrial electrogram morphology may increase specificity in discrimination. We collected a case series to assess

16-118 Abstract 12-10 I N C E S S A N T AT R I O V E N T R I C U L A R N O D A L REENTRY LEADING TO SYSTOLIC HEART FAILURE Audrey Nicholson 1, Keith Suarez 1, Steven Costa 1, Javier Banchs 1 1 Baylor Scott & White Health, Temple, United States

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Incessant Atrioventricular Nodal Reentry Leading to Systolic Heart Failure: An 88-year-old male was referred to cardiology for new onset dyspnea. Echocardiogram showed a normal ejection fraction. ECG demonstrated known complete RBBB and left anterior fascicular block with an absence of visible p waves and ventricular rate 96 bpm (Fig. 1A), faster than his baseline sinus bradycardia at 50 bpm. He had minimal improvement with furosemide. The presenting arrhythmia was noted to be incessant. Repeat echocardiogram two months later revealed a depressed ejection fraction of 35%. An electrophysiology study was ordered with suspicion of a focal atrial tachycardia versus bundle branch reentry. Catheters were placed in the coronary sinus, right ventricle, and His bundle. At baseline, atrial and ventricular signals superimposed with cycle length (CL) = 710 ms (Fig. 1B). These signals were consistently preceded by a His potential. Termination of the clinical arrhythmia resulted in sinus bradycardia CL = 1200 ms. AV Wenckebach was elicited with atrial pacing at 710 ms. Conduction over the slow pathway of the AV node was stable with an AH interval of 400 ms. The arrhythmia was consistently induced with atrial pacing after critical delay on AH conduction. Shortest VA interval was BB 70 ms. Ventricular entrainment demonstrated a VAHV response consistent with AV node reentry at unusually slow rate. Radiofrequency energy was delivered to the area of the slow pathway resulting in accelerated junctional rhythm and rendering the arrhythmia non-inducible. Conclusion: It is rare for atrioventricular nodal reentry to manifest with a heart rate so slow that does not meet the definition of “tachycardia.” We attribute the new onset heart failure to his arrhythmia.

S139

for ablation. Results: A 91-year-old man presented to the laboratory in AFL with a cycle length (CL) of 281 ms and the activation pattern compatible with counterclockwise AFL (right half of Fig. A). Overdrive pacing was performed at a CL of 270 ms along the CTI. During entrainment, there was a change in the activation of the CS, and a long post-pacing interval and tachycardia CL difference (PPI-TCL) of 56 ms (Fig. A). Despite these, the CTI was targeted for ablation. During the ablation, the AFL CL slowed to 330 ms with a change of the activation pattern in the CS (Fig. B) that resembled the activation pattern seen during entrainment. Further ablation along the CTI terminated the AFL. Conclusion: In typical AFL, entrainment from the CTI results in concealed fusion with a PPI-TCL of ≤ 30 ms. A long PPI can occur from decremental conduction and pacing latency. What makes this case unusual is the CS activation also changed while pacing. These represent fusion and exclude CTI-dependent AFL. The most likely explanation is there was longitudinal dissociation along the CTI. The pacing site during entrainment was within the CTI, but dissociated from the fibers responsible for the AFL, and predestined to activate the CS differently. Ablation of the CTI first abolishes the pathway conducting during AFL and switches to the other pathway, thereby changing the CS activation. Continuing ablation terminates the AFL. This case demonstrates the importance of considering to ablate the CTI during AFL despite contradictory findings from entrainment.

Management of patients with atrial fibrillation 16-120 Abstract 15-24

16-119 Abstract 18-30 AN ATYPICAL TYPICAL ATRIAL FLUTTER Mark Shen 1, Bradley Knight 1, Susan Kim 1 1 Northwestern University, Chicago, United States Background: In a typical atrial flutter (AFL), cavotricuspid isthmus (CTI) is a critical component of the circuit and target

A NEW APPROACH FOR CARDIOVERSION OF RECENT ONSET ATRIAL FIBRILLATION Stefanos Papastefanou 1, Ioanna Sideri 1, Ioannis Tsounos 1 1 Department of Cardiology, G.H ''St. Paul'', Thessaloniki, Greece Background: Vernakalant (V) is a relatively new antiarrhythmic intravenous pharmacological agent which induce rapid cardioversion of recent onset atrial fibrillation (AF) to sinus

S140

rhythm (SR). In the current study, we measured the time to cardioversion of patients with recent onset AF. All patients were heamodynamically stable without structural heart disease that were submitted to the emergency department of our hospital. Methods: In the current study, a total of 35 patients, 20 men and 15 women with medium age of 57 ± 2.5 years, with symptomatic recent onset AF (symptoms of AF BB 48 h), were included. All patients entered the cardio ICU for 3 h after the cardioversion and their heart rate was monitored. The initial dose of (V) was 3.0 mg/kg for 10 min, followed by 15-min monitoring. In case of cardioversion failure, a second dose of 2.0 mg/kg for another 10 min was given. All patients had full blood test analysis as well as thyroid hormones assessment. All patients had ECHO-TRIPLEX for testing all structural and functional cardiac parameters. Results: Twenty-five out of 35 patients converted to SR (21 on the 1st dose). The median time to cardioversion was 10 ± 2 min. From the ten patients that were not converted to SR, seven of them had past recurrent AF symptoms (AFBB 2) and three of them had abnormal thyroid hormone levels. No lifethreatening arrhythmias were observed after (V) infusion. The only minor side effects were transient dizziness (2) and paroxysmal coughing (1). Conclusion: The use of intravenous (V) proved effective and safe for the cardioversion of recent onset AF. A (V) major advantage is the very rapid cardioversion that means shorter hospitalization and less treatment cost. It (V) is less effective in patients with recurrent past AF. Therefore, it is very important to choose the right patients for the drug. 16-121 Abstract 15-23 IDENTIFYING THE UNDIAGNOSED AF PATIENT THROUGH 'KNOW YOUR PULSE' COMMUNITY PHARMACY-BASED EVENTS HELD ACROSS TEN COUTNRIES Trudie Lobban 1, Nigel Breakwell 1, Sotiris Antoniou 2, Nadya Hamedi 3, Filipa Alves de Costa 4, Vivian Lee 5, Katarina Mala 6, John Papastergiou 7, Dale Griffiths 8, Fabio deRango 9 , Lola Murillo 10 , Marie-Camille Chaumais 11 , Reke Viola 12 , Ema Paulino 13 , Kurt Hersberger 14, Ben Freedman 15 1 Arrhythmia Alliance, Chipping Norton, United Kingdom, 2 UCL Partners, London, United Kingdom, 3 Health Innovation Network, London, United Kingdom, 4 Centro de Investigacao Interdisciplinar Egas Moniz, Lisbon, Portugal, 5 School of Pharmacy, Chinese University of Hong Kong, China, 6 Charles University, Prague, Czech Republic, 7 University of Toronto, Toronto, Canada, 8 Westview Pharmacy, Auckland, New Zealand, 9 Shoppers Drug Mart, Toronto, Canada, 10 Sociedad Espanola de Farmacia Familiar

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

y Comunitaria, Sociedad, Spain, 11 Universite Paris Sud, Paris, France, 12 Faculty of Pharmacy, University of Szeged, Szeged, Hungary, 13 Farmacias Holon, Almada, Portugal, 14 University of Basel, Basel, Switzerland, 15 Heart Resarch Institute, University of Sydney, Sydney, Australia It is estimated that a third of all people with AF are currently undiagnosed. A simple manual pulse check of the regularity of an individual’s pulse rhythm can help to improve detection rates and use of mobile ECG technology can help in the diagnosis of people with AF. Previous studies have shown the value of Community Pharmacy in helping to opportunistically screen for people with various conditions, such as diabetes and hypertension, and AF. An e-learning was platform developed by iPACT to support education and dissemination materials for display in pharmacies. A secure web based application was developed for all pharmacists to enter patient relevant data and findings. Resources for public use created by A-A provided to participating countries, translated into local language. Pharmacists took manual pulse checks, assessed symptoms, and risk factors. When an abnormal heart rate or rhythm was detected, patient referred to physician. In some countries, irregular rhythm confirmed using mobile single lead ECG. Further, 3974 participants took part in the campaign. A total of 2573 patients were included in the final analysis. The majority were female; mean age was approx. 65 years. Risk factors identified: hypertension, diabetes, and peripheral heart disease. Bradycardia detected in 107 patients, an irregular pulse in 212 patients. AF confirmed in 35 (detection rate 1.4%). This study suggests that community pharmacies may be a good location for identifying undiagnosed people with AF. Results reflective of meta-analysis data that the number of people with undiagnosed AF in the general population is approximately 1.4%.

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

S141

16-122 Abstract 15-68

16-123 Abstract 15-43

OBSTRUCTIVE SLEEP APNEA: A KEY DETERMINANT IN THE SUCCESS OR FAILURE OF A B L AT I V E T H E R A P Y F O R AT R I A L FIBRILLATION?

A NURSE-DELIVERED MINDFULNESSE D U C AT I O N I N T E RV E N T I O N TO R E D U C E SYMPTOMS AND IMPROVE QUALITY OF LIFE IN PAT I E N T S W I T H PA R O X Y S M A L AT R I A L FIBRILLATION: THE MEND-AF STUDY

Brian C. Pomerantz1, Andrea N. Dore1, Jisuk Park1, Vincent Mysliwiec1, Gregg G. Gerasimon1 1 San Antonio Military Medical Center, San Antonio, USA Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice today. Obstructive sleep apnea (OSA) is rapidly increasing in prevalence and has been associated with the development of AF as well as increased hospitalization and symptom burden. Although some studies suggest that pulmonary vein isolation (PVI) is less successful in patients with OSA, there is limited data comparing the severity of polysomnography-proven OSA with success rates of PVI in AF. We examined the role of the severity of OSA in the success or failure of PVI for AF. Methods: This is a single-center, retrospective cohort study of patients who underwent PVI for AF between 2013 and 2016. Three hundred thirty PVI patients were screened, of whom 131 had available polysomnography data. Patients were grouped into a moderate to severe OSA group and a no OSA to mild OSA group based on apnea-hypopnea index. Endpoints included recurrence of AF, need for cardioversion, and need for antiarrhythmic drug therapy. Results: Of 79 patients with no OSA or mild OSA, 27 had recurrence of AF post-PVI, while of 52 patients with moderate to severe OSA, 27 had recurrence of AF post-PVI (34.2 vs. 51.9%, p = 0.048). No significant difference in rate of recurrence of AF was identified between patients treated with CPAP and those not treated at time of PVI (36.8 vs. 44.6%, p = 0.47). Subgroup analysis of the severity groups as well as a post-hoc analysis of all OSA patients both failed to show a difference in rate of recurrence with CPAP compliance. Patients with moderate to severe OSA were more likely to require antiarrhythmic drug therapy after PVI than patients with no OSA or mild OSA (48.1 vs. 21.5%, p = 0.002), but did not require more cardioversions (11.5 vs. 8.9%, p = 0.767). Conclusions: Our study, utilizing polysomnography data to define degree of OSA, suggests that patients undergoing PVI with moderate or severe OSA have higher rates of recurrence of AF than patients with normal polysomnography or mild OSA. Patients with moderate to severe OSA were also more likely to require antiarrhythmic drug therapy after PVI. Interestingly, our study did not find that CPAP therapy ameliorates increased risk of recurrence of AF. In the context of societal pressure for resource stewardship and ongoing efforts to maximize first-time success rates in PVI, this data may help predict the likelihood of successful PVI and aid in patient selection.

Linda Ottoboni 1, Paul Wang 1, Janine Cataldo 2 1 Stanford Healthcare, Stanford, United States, 2 University of California, School of Nursing, San Francisco, CA, United States Background: Paroxysmal atrial fibrillation (PAF) increases stroke risk and can result in pronounced symptoms. Current treatment modalities are targeted at stroke risk reduction, rhythm restoration, rate control, and symptom reduction. Despite improved outcomes with catheter ablation procedures, symptoms persist and quality of life (QOL) is compromised. Therefore, less costly, more effective interventions for symptom reduction are needed. Objective: This study was to determine the effects of a six-week mindfulness meditation and AF education intervention (MEND AF) on overall symptoms, specific symptoms (anxiety, fatigue, and sleep disturbances) and QOL. The effect of meditation on PAF patients is unknown. Methods: Symptomatic patients were enrolled in MEND AF in a single center with a prospective, preposttest design. Inclusion criteria: BB 18 years of age; English speaking; able to ambulate independently; able to hear audio recorder; able to attend two 90-min sessions 6 weeks apart; and able to participate in weekly phone calls. Exclusion criteria: NYHA Class IV; life expectancy BB 6 month; hospitalized within the prior 3 months with unrelated PAF diagnosis; previous experience practicing mindfulness; cognitive impairment determined with the Mini-Cognitive screening; or schedule for PAF treatment procedure during the 6-week intervention. Each patient attended an indvidual initial introductory session, followed by 6 weeks of daily guided meditation and weekly review of education materials, and then returned for the final session. Efficacy was evaluated using the initial and final assessment scores on the Symptom Frequency/Severity Checklist, Cardiac Anxiety Questionnaire, Fatigue Severity Scale, the Pittsburg Sleep Quality Index, and the Atrial Fibrillation Effect on QOL Questionnaire. Results: A significant reduction in AF symptom frequency (19.71 to 13.14; p = 0.004) and severity (15.46 to 11.04; p = 0.001) was found. Anxiety, fatigue and sleep disturbance scores were decreased; but not significantly. A significant improvement QOL (89.09 to 90.47; p = 0.011) and two QOL subscales, treatment concern (89.50 to 91.34; p = 0.007) and symptom severity (89.23 to 90.84; p 0.003). Conclusions: This is the first study to examine the efficacy of a mindfulness meditation and AF education intervention for PAF patients. Results suggest that individuals who struggle with symptoms and reduced QOL from PAF could benefit from the MEND AF intervention.

S142

Risk stratification and prevention in patients with heart disease 16-124 Abstract 21-10 ELEVATED LONG-TERM RESTING HEART RATE AND SYSTOLIC BLOOD PRESSURE VARIATION IS ASSOCIATED WITH INCREASED RISK OF ALLCAUSE MORTALITY IN NORTHERN CHINA Xiaolei Yang 1, Tesfaldet Habtemariam Hidru 1, Xu Han 1, Binhao Wang 2, Shouling Wu 3, Yunlong Xia 1 1 First Affiliated Hospital of Dalian Medical University, Dalian, China, 2 Ningbo First Hospital, Ningbo, China, 3 Kailuan General Hospital, Tangshan, China Background: Resting heart rate (RHR) and systolic blood pressure (BP) are important risk markers for allcause mortality. However, the estimated combined effect of RHR and systolic BP in all causes of death remained unclear. We here aimed to investigate the joint effect of RHR and SBP variability on the risk of all-cause mortality in the general population without cardiovascular diseases. Methods: We investigated the joint effect of RHR and SBP variability among 46,751 residents of Tangshan city, China, (mean age: 53.58 ± 11.64 years; 78.1% male). RHR readings and systolic BP recordings were taken during three separate examinations (2006– 2007, 2008–2009, 2010–2011), from which the standard deviation (SD) derived. Participants were stratified into quartiles based on the SD of SBP and RHR, and we further investigated the estimated risk of all-cause mortality associated with an increase in 1 SD in RHR-SD (4 bpm) and SBP-SD (7 mmHg) against the stratified quartiles of SPB and RHR, respectively. Cox proportional hazard model was used to estimate the hazard ratios (HR) and 95% confidence interval (CI) adjusting for clinical characteristics assessed at the last examination (2010–2011). Results: A total of 1667 deaths were recorded over 4.97 ± 0.69 years follow-up. Participants in the highest quartile (Q4) of RHR-SD and systolic BP-SD had a higher risk of death than the participants in Q1–Q3. Across the quartiles of RHR-SD, the adjusted HRs for 1 SD increase of SBP were 1.09 (95% CI 0.97–1.22), 1.11 (95% CI 1.01–1.23), 1.14 (95% CI 1.07–1.21), and 1.21 (95% CI 1.12–1.30), respectively. Similarly, the adjusted HRs for 1 SD increase of RHR were 1.10 (95% CI 0.98–1.23), 1.05 (95% CI 0.96– 1.16), 1.10 (95% CI 1.03–1.67), and 1.16 (95% CI 1.03–1.30) respectively. There was a significant

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

interaction between an increase in 1 SD in RHR-SD (4 bpm) and the quartiles of SBP as well as the interaction between SBP-SD (7 mmHg) and the stratified quartiles of RHR (P for interactionBB 0.001). Conclusion: Elevated long-term RHR and SBP variations are independent risk markers for all-cause mortality in the general population without known cardiovascular diseases. An elevated long-term SBP variability combined with increased RHR variability may amplify the risk of all-cause mortality. 16-125 Abstract 07-12 COMBINED APPROACH USING CATHETER-BASED RENAL SYMPATHETIC DENERVATION AND CATHETER ABLATION OF LEFT ATRIUM FOR T R E AT M E N T PAT I E N T W I T H R E S I S TA N T ARTERIAL HYPERTENSION AND PERSISTENT ATRIAL FIBRILLATION: A CASE REPORT Evgeny Zhelyakov 1, I Zotova 2, Aleksey Konev 3, Orys Khymiy 3, Anton Staferov 3, Aleksey Knigin 1, Vladimir Kolesnikov 4, Madina Baykulova 4, Natalia Maskova 4, Andrey Aradshev 1 1 Moscow State University, Moscow, Russia, 2 Central State Medical Academy, Moscow, Russia, 3 Federal Scientific and Clinical Centre of FMBA, Moscow, Russia, 4 Regional Clinical Cardiological Dispensary, Stavropol, Russia Background: We proposed combining renal sympathetic denervation and catheter ablation of left atrium may improve clinical course in patient with resistant arterial hypertension and atrial fibrillation (AF) Case report: A 62-year-old male patient (BMI: 26.4 kg/m2) was admitted to our outpatient clinics with poorly controlled hypertension. His creatinine was concentration of 4.3 mg/ dl. With 10-year diabetes, he presented with longstanding hypertension that was resistant to pharmacological therapy with five different anti-hypertensive drugs, namely Irbesartan 300 mg/day, Lercanidipinum 40 mg/ day, Carvedilolol 50 mg/day, Torasemide 20 mg/day and Moxonidine 0.6 mg/day. His office blood pressure was 180–210/90–120 mmHg. Echocardiography showed normal left ventricular systolic function and moderate enlargement of LA. Due to the uncontrolled nature of the resistant hypertension, the patient was eligible for percutaneous renal denervation treatment (RDN). RDN was performed with mean temperature 45 °C and 10 W radiofrequency nerve ablations lasted up to 2 min at each point, with two points on the left and two points on the

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

right. During procedure, we revealed dissection of left renal artery with subsequent stent implantation. The patient was discharged at the fourth day with 140/ 85 mmHg at office. The patient was prescribed with Lercanidipinum 40 mg/day, Carvedilolol 50 mg/day, Torasemide 10 mg/day and Moxonidine 0.6 mg/day. Three months after his first hospitalization, he was hospitalized again for catheter ablation because of symptomatic persistent AF. The ablation performed using 3D mapping system (CARTO-3) and included antral isolation of the PVs with additional left atrial linear ablation of the roof, mitral isthmus and substrate modification of the left atrium posterior wall. Ambulatory blood pressure and ECG have been monitored regularly which revealed an average systolic and diastolic blood pressure of 130/ 70 mmHg and sustained sinus rhythm without antiarrhythmic drugs 12 months later. Conclusion: Treatment of a patient with AF and resistant arterial hypertension and suffering from severe comorbidities which combines drug therapy and interventional strategies (RND and ablation of AF) resulted in a significant clinical success, and increased quality of life during one year follow-up. 16-126 Abstract 07-16 AMBULANT ECG CHANGINGS PREVIOUS TO PHENOTYPIC EXPRESSION FOR 8 YEARS IN AN E L I T E AT H L E T E W I T H H Y P E R T R O P H I C CARDIOMYOPATHY: PUT THE EVIDENCE INTO PRACTICE Dan Han 1, Guoliang Li 1 1 First Hospital of Xi’an Jiaotong University, Xi'an, China An underlying pathologic cardiac condition such as hypertrophic cardiomyopathy (HCM), representing the most common cause of sudden cardiac death in young population especially trained athletes, can be detected by electrocardiogram (ECG) with high sensitivity and specificity, even in the absence of detectable heart morphologic change. We here report a young football player accompanied by abnormal ECGs without any subjective discomfort. ECGs revealed abnormal Q waves which gradually deepen and widen on II, III, avF and contiguous T wave inversion on I and avL leaders for the last 8 years. Echocardiography showed the thickness of interventricular septum increased from 10 to 13 mm, increasing enlargement of left atrium and ventricular, and decreasing left ventricular diastolic function. It has been validated that pathological Q waves result from loss of

S143

myocardial electrical activity due to infarction, infiltration or fibrosis and T wave inversion means abnormal repolarization of the ventricular myocardium. In view of this, we proposed that abnormal ambulant ECGs findings, representing the primary expression of genetic cardiac disease such as HCM and preceding by many years phenotypic expression and adverse clinical outcomes, provide the further evidence to the fact that the alterations of cardiac electrical activities are previous to cardiac structural changes.

S144

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

screening in family experiencing sudden death is imperative to avoid or decrease the risk of the rapid progression of DCM triggered by pregnancy or other factors for family members.

16-127 Abstract 03-15 CONGENITAL DILATED CARDIOMYOPATHY UNMASKED BY PREGNANCY Dan Han 1, Yanrong Yin 1, Chaofeng Sun 1, Guoliang Li 1 1 First Hospital of Xi’an Jiaotong University, Xi'an, China Peripartum cardiomyopathy (PPCM) is one common type of dilated cardiomyopathy (DCM). The causes of PPCM remain unclear though lines of hypothesis are existing. Genetic susceptibility is an increasingly recognized hypothesis. Several lines of evidence indicate that more than 10% of women undergo PPCM with a pathogenic mutation. TTN gene has attracted a lot of attention. It has been confirmed that TTN truncations are the most frequent genetic cause of DCM. We here report a case that in a family-experiencing sudden death, a patient who manifested deteriorating heart function following delivery was diagnosed as PPCM. Gene screening indicated a brand-new TTN gene heterozygous mutation c.77785GBB A (p.Q25929X), which is rarely reported in China. We concluded that pregnancy may be a trigger for the rapid progression of DCM. Therefore, gene

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Ablation of ventricular arrhythmias 16-128 Abstract 17-11

S145

gradients result in localised regional and transmural dispersion of repolarization, dependent on the scar pattern and the activation sequence, which play an important role in the initiation of reentrant VT.

VENTRICULAR SCAR PROLONGS ACTION P O T E N T I A L D U R AT I O N , R E S U LT I N G I N SPATIAL DISPERSION OF REPOLARISATION T H AT P R O M O T E S R E G I O N A L A N D TRANSMURAL REENTRY IN PATIENTS WITH VENTRICULAR TACHYCARDIA Neil Srinivasan 1, Michele Orini 1, Rui Providencia 1, Claire Martin 1, Mehul Dhinoja 1, Peter Taggart 1, Syed Ahsan 1, Martin Lowe 1, Anthony Chow 1, Ross Hunter 1, Richard Schilling 1, Pier L 1 1 Barts Heart Center, London, United Kingdom Introduction: The transmural differences of action potential duration (APD) across scar are poorly defined in the intact human heart. Heterogeneity in APD across the ventricular wall may play an important part in the generation of threedimensional ventricular tachycardia (VT) circuits. Aim: This study aimed to investigate the transmural differences in APD of patients admitted for VT ablation. Methods: Six patients (age 63 ± 5 years, 5 male); 1 myocarditis, 3 DCM and 2 ischemic cardiomyopathies (mean EF 30%), were studied as part of their clinical ablation procedure. All patients underwent endocardial and epicardial 3D electroanatomic mapping. A bipolar voltage of BB 0.5 mv was defined as dense scar, a voltage of 0.5–1.5 mv as scar borderzone and voltages of BB 1.5 mv were defined as healthy tissue. Decapolar catheters were then positioned across the scar borderzone and restitution pacing performed from the endocardium and epicardium to assess transmural differences of APD and repolarization (RT). Unipolar electrograms were recorded and the Wyatt method was used to measure activation recovery interval (ARI) as a surrogate marker of APD. Results: Epicardial and endocardial scar resulted in a significant prolongation of ARI when compared to normal tissue (Fig. 1A and B). During endocardial pacing in regions of dense transmural scar (d_d) and regions of normal endocardial tissue with dense scar epicardially (n_d), a significant negative transmural endocardial to epicardial RT gradient was seen when compared to normal tissue (Fig. 1C). During epicardial pacing, the endocardial to epicardial RT difference was positive in regions of endocardial or epicardial scar, when compared to normal tissue (Fig. 1D). Figure 2 demonstrates the association between dispersion of repolarization and arrhythmogenesis in an individual patient. Conclusions: The main findings of this study are as follows: (1) areas of myocardial scar, regardless of pathology, have prolonged APD compared to normal healthy tissue. (2) Alterations in regional and transmural APD

16-129 Abstract 17-20 EXPERIENCE OF SURGICAL ABLATION FOR REFRACTORY VENTRICULAR TACHYCARDIA Masahiko Goya 1, Shingo Maeda 1, Atsuhiko Yagishita 1, Masahiro Sekigawa 1 , Shinya Shiohira 1 , Yoshihide Takahashi 1, Mihoko Kawabata 1, Kiko Lee 1, Tomohiro Mizuno 2, Hirokuni Arai 2, Kenzo Hirao 1 1 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan, 2 Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan Background: Endocaridal catheter ablation is a well-established therapy for ventricular tachycardia (VT). However, in 15–30% of patients, endocardial mapping techniques fail to identify a critical site of the arrhythmia and epicardial mapping and ablation are needed. Percutaneous epicardial access is usually accomplished by the subxiphoid puncture technique. However, in some patients, percutaneous approach is difficult and alternative approaches are required. Soejima et al. initially described a surgical subxiphoid approach for epicardial mapping and ablation; however, the anterior and lateral walls were not accessible in 33% of cases with this technique. We describe our experience with hybrid surgical access to the epicardium for mapping and ablation of VT. Methods and Results: We report three patients with a history of prior cardiac surgery who underwent surgical radiofrequency (RF) ablation for refractory VT after failed percutaneous catheter ablation. Electroanatomical mapping (EAM) displayed low voltage areas in inferolateral left ventricular (LV) endocardium, where good pace-mapping was obtained. Surgical access was obtained via left-sided mini-thoracotomy. Epicardial EAM identified frationated delayed potentials (FDPs). RF lesions were given targeting FDPs. All patients have free from VT reurrences. Conclusion: Surgical ablation

S146

of refractroy VT can be safely and effectively performed using RF energy via minimally invasive left-sided thoracotomy in patients with prior cardiac surgery.

Part IV AUTHORS INDEX BY ABSTRACT NUMBER (original number given at submission) Abrich V. et al. Abs. 26-10 Session C part 1 Adeola O. et al. Abs. 18-23 Session A part 2 Alexander B. et al. Abs. 08-16 Session 13 Alhusseini M. et al. Abs. 15-62 Session 1 Alles EJ. et al. Abs. 28-13 Session A part 1 Alshoubaki O. et al. Abs. 15-35 Session 13 Andersson T. et al. Abs. 15-19 Session 5 Anselmino M. et al. Abs. 13-11 Session D part 2 Apsite K. et al. Abs. 15-41 Session D part 1 Artyukhina E. et al. Abs 28-10 Session C part 2 Atabekov T. et al. Abs. 19-13 Session B part 1 Bajomo O. et al. Abs. 15-39 Session C part 2 Barraud J. et al. Abs. 19-11 Session B part 1 Batalov R. et al. Abs. 07-10 Session 14 Bazán Rodríguez O. et al. Abs. 23-16 Session C part 1 Beaune. J et al. Abs. 19-20 Session 6 Belotti G. et al. Abs. 18-45 Session C part 2 Bernard M. et al. Abs. 01-19 Session A part 2 Bosman L. et al. Abs. 07-21 Session 3 Bourfiss M. et al. Abs. 07-20 Session 3 Burrows A. et al. Abs. 19-15 Session 6 Bush K. et al. Abs. 01-12 Session C part 1 Campbell K. et al. Abs. 05-11, 05-12, 06-13 Session A part 1 Cannie D. et al. Abs. 18-31 Session C part 2 Carstensen H. et al. Abs. 15-55 Session A part 2 Chiew K. et al. Abs. 23-11 Session 8 Del Greco M. et al. Abs. 28-11 Session C part 1 Dhileepan V. et al. Abs. 05-10 Session A part 1 Djelmami-Hani M. et al. Abs. 18-25 Session C part 1 Donnelly J. et al. Abs. 05-13 Session D part 2 Dubanaev A. et al. Abs. 15-18 Session B part 2 Ehrlich M. et al. Abs. 15-51 Session C part 2

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Esposito F. et al. Abs. 23-14 Session 15 Eysenck W. et al. Abs. 23-20 Session 8, Abs. 15-57 Session 13, Abs. 01-25, 01-26 Session 14, Abs. 05-14 Session A part 1 Fenner MF. et al. Abs. 15-53 Session A part 2 Ferguson J. Abs. 18-42 Session B part 2 Fonte G. et al. Abs. 18-16 Session 4 Gabriels J. et al. Abs. 23-28 Session 8, Abs. 15-52 Session A part 1 Galizio N. et al. Abs. 24-17 Session 9 Gerth A. et al. Abs. 15-59 Session 13 Giudici M. et al. Abs. 15-11 Session B part 2 Giustozzi M. et al. Abs. 15-58 Session 12 Gonzalez-Rebeles Guerrero C. et al. Abs. 13-12 Session D part 2 Gopinathannair R. et al. Abs. 17-23 Session 3, Abs. 31-14 Session B part 1 Goya M. et al. Abs. 17-20 Session D part 2 Hajimolahoseini H. et al. Abs. 15-10 Session A part 2 Han D. et al. Abs. 15-54 Session C part 1, Abs. 03-15, 07-16 Session D part 2 Handa B. et al. Abs. 01-29, 01-28 Session 10 Harrison J. et al. Abs. 17-16 Session 6, Abs. 17-17 Session B part 1 Heeger C. et al. Abs. 18-15 Session 1 Abs. 18-14 Session 4 Hermida A. et al. Abs. 18-28 Session 1 Herweg B. et al. Abs. 18-46 Session D part 1 Honarbakhsh S. et al. Abs. 15-30, 14-11, 15-48 Session 11 Horie M. Abs. 03-12 Session A part 2 Houston C. et al. Abs 01-24. Session A part 1, Abs 01-22. Session A part 2 Iriart X. et al. Abs. 15-12 Session D part 2 Jabbour R. et al. Abs. 31-13 Session B part 1 Ji Y.et al. Abs. 01-20 Session A part 1 Kalifa J. Abs. 05-15 Session 11 Kandala J. et al. Abs. 31-12 Session 9 Kim M-Y. et al. Abs. 04-15 Session 12, Abs. 04-14 Session B part 2 Kisheva A. et al. Abs. 15-42 Session D part 1 Klaver M. et al. Abs. 18-40 Session B part 2 Ko Ko N. et al. Abs. 18-44 Session B part 2 Kothari S. et al. Abs. 26-11 Session D part 1 Kozhukhov S. et al. Abs. 15-34 Session 9 Kruse DD. et al. Abs. 15-16 Session A part 2 Lackermair K. et al. Abs. 19-17 Session B part 1, Abs. 18-34, 18-33 Session C part 2 Leal M. et al. Abs. 23-25, 23-23 Session 15, Abs. 23-24 Session A part 1, Abs. 25-11, 25-10, Session B part 1 Li G. et al. Abs. 01-15 Session B part 1, Abs. 18-43 Session B part 2 Liżewska-Springer A. et al. Abs. 15-31 Session B part 2 Lobban T. et al. Abs. 15-23 Session D part 2 Long V. et al. Abs. 04-10 Session A part 1 Lubberding AF. et al. Abs. 17-25 Session 11

J Interv Card Electrophysiol (2018) 51(Suppl 1):S1–S147

Luik A. et al. Abs. 18-19 Session 1 Mahjoub M. et al. Abs. 08-12 Session C part 1, Abs. 15-22 Session D part 1 Maines M. et al. Abs. 24-13 Session C part 1 Maixent JM. et al. Abs. 15-36 Session A part 2 Mandel F. et al. Abs. 15-37 Session 7 Mann I. et al. Abs. 15-60 Session C part 2 Mathew S. et al. Abs. 17-22 Session 4 Matta M. et al. Abs. 18-13 Session 4 McCauley B. et al. Abs. 18-12 Session 7 Mehr M. et al. Abs. 15-63 Session D part 1 Mohamied Y. et al. Abs. 01-27 Session A part 2 Mora G. et al. Abs. 07-13 Session C part 2 Neefs J. et al. Abs. 15-14 Session 9 Nicholson A. et al. Abs. 12-10 Session D part 2 Nissardi V. et al. Abs. 19-12 Session B part 1 Odagiri F. et al. Abs. 19-10 Session B part 1 Okishige K. et al. Abs. 15-67 Session 4, Abs. 15-66 Session 13 Oriolo V. et al. Abs. 14-12 Session C part 1 Orosz A. et al. Abs. 07-11 Session B part 1 Ottoboni L. et al. Abs. 15-43 Session D part 2 Papastefanou S. et al. Abs. 15-24 Session D part 2 Patel M. et al. Abs. 07-23 Session B part 2 Pedrotty D. et al. Abs. 17-18 Session 10 Pitcher DS. et al. Abs. 15-38 Session 11 Polewczyk A. et al. Abs. 23-18 Session C part 1 Pomerantz BC. et al. Abs. 15-68 Session D part 2 Rafla S. et al. Abs. 08-10 Session B part 1 Riesinger L. et al. Abs. 15-64 Session 13 Rogers A. et al. Abs. 18-41 Session B part 2, Abs. 28-12 Session D part 1 Rostagno C. et al. Abs. 15-47 Session B part 2, Abs. 15-49 Session D part 1 Roudijk R. et al. Abs. 07-18 Session 3 Rudaka I. et al. Abs. 03-14 Session A part 2 Rus H. et al. Abs. 15-28 Session B part 2 Salama G. et al. Abs. 15-26 Session 10 Sandler B. et al. Abs. 04-12, 04-13 Session 12 Santomauro M. et al. Abs. 23-13 Session 8 Sattler SM. et al. Abs. 19-16 Session B part 1 Sawhney V. et al. Abs. 18-37 Session 1, Abs. 18-35 Session 12, Abs. 23-21 Session 15, Abs. 22-12 Session A part 1, Abs. 19-18 Session B part 1, Abs. 18-39, 18-38 Session C part 2, Abs. 18-36 Session D part 1 Schmidt K. et al. Abs. 15-33 Session 7, Abs. 13-10 Session D part 2 Sekigawa M. et al. Abs. 15-29 Session 7 Serafini N. et al. Abs. 23-26 Session 2 Shantha G et al. Abs. 24-10 Session 2, Abs. 15-20, 15-15, 1513 Session 5 Shaposhnikova Y. et al. Abs. 31-10 Session 9, Abs. 15-21 Session A part 2

S147

Sharma A. et al. Abs. 18-27 Session 1 Shen M. et al. Abs. 18-30 Session D part 2 Siebermair J. et al. Abs. 15-65 Session 14 Singh G. et al. Abs. 17-24 Session 3, Abs. 25-13 Session A part 1, Abs. 19-19 Session B part 1, Abs. 24-18 Session C part 1, Abs. 24-19 Session C part 1, Abs. 18-47, 28-14 Session C part 2 Sinhji Rathod V. et al. Abs. 03-10 Session 6 Sinner M. et al. Abs. 01-10 Session A part 1 Slee A. et al. Abs. 31-11 Session 9 Smorgon A. Abs. 15-17 Session B part 2 Snow J. et al. Abs. 15-32 Session 5 Sokratous E. et al. Abs. 01-13 Session A part 2 Srinivasan N. et al. Abs. 01-17 Session 10, Abs. 17-11 Session D part 2 Summo CS. et al. Abs. 06-14 Session 5 Sunjic I. et al. Abs. 08-15 Session 8 Suzuki T. et al. Abs. 18-11 Session B part 2, Abs. 17-12 Session C part 2 Taha K. et al. Abs. 07-17 Session 3 Tarakji K. et al. Abs. 23-19 Session 15 Teuwen C. et al. Abs. 08-14, 08-13 Session C part 1 Torbey E. et al. Abs. 13-13 Session D part 1 Tzortzis K. et al. Abs. 01-21 Session 10, Abs. 07-19 Session A part 1 Unger LA. et al. Abs. 15-61 Session A part 2 Van Lint F. et al. Abs. 03-13 Session A part 2 Vijayaraman P. et al. Abs. 24-12, 24-11 Session 2, Abs. 22-10 Session 8, Abs. 23-10 Session 15 Vonderlin N. et al. Abs. 07-22 Session 14 Voruganti D. et al. Abs. 18-22 Session D part 1 Wan D. et al. Abs. 07-15 Session 14, Abs. 14-10 Session D part 1 Ward C. et al. Abs. 24-16 Session A part 1, Abs 23-22. Session C part 1 Wase A. et al. Abs. 25-12 Session 6 Weitensteiner VE. et al. Abs. 15-25 Session 7 Wiedenmann M. et al. Abs. 23-12 Session 6 Winkle RA.et al. Abs. 18-32 Session 7, Abs. 18-26 Session 12 Wintgens L. et al. Abs. 18-21 Session B part 2, Abs. 15-56, 18-20 Session D part 1 Worsnick S. et al. Abs. 24-14, 22-11 Session 2, Abs. 01-18 Session A part 2, Abs. 18-17 Session B part 2, Abs. 23-17 Session C part 1 Yang X.et al. Abs. 21-10 Session D part 2 Yeung C. et al. Abs. 15-45, 15-44 Session C part 1 Zander Hesselkilde E. et al. Abs. 15-46 Session D part 1 Zhang J. et al. Abs. 18-29 Session 4 Zhelyakov E. et al. Abs. 01-11 Session B part 2, Abs. 07-12 Session D part 2