Challenges in comparing the non-vitamin K antagonist oral anticoagulants for atrial fibrillation-related stroke prevention
AbstractThe aim of this review is to provide context for meta-analyses interpreting data from phase III stroke prevention studies of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (NVAF). Differences between the four phase III NOAC stroke prevention studies in patients with NVAF (ROCKET AF, ARISTOTLE, RE-LY, and ENGAGE AF), their potential impact on outcomes, and inter-study differences were evaluated, as well as the potential role of real-world evidence in evaluating NOACs in this setting. Study design differences included blinding strategy, dose-reduction options, a...
Source: Europace - October 13, 2017 Category: Cardiology Source Type: research

Is the rapidly paced pig the optimal model for endocardial cardiac resynchronization therapy? —Authors’ reply
We very much appreciate the insightful letter by Niedereret al.1 about our recent publication inEuropace.2 Most of the scientific evidence supporting the hypothetical superiority of left ventricular endocardial pacing comes from animal studies using canine models or simulation studies also based on this model.3 Unfortunately, these results have not been reproduced in clinical studies. The large multicentre prospective human trial ALternate Site Cardiac ReSYNChronization (ALSYNC), which included only patients who had failed or were unsuitable for conventional cardiac resynchronization therapy (CRT), showed that the rate of ...
Source: Europace - October 12, 2017 Category: Cardiology Source Type: research

Is the rapidly paced pig the optimal model for endocardial cardiac resynchronization therapy?
Current endocardial cardiac resynchronization therapy (CRT) is performed predominantly in non-responders to CRT.1 Previous clinical,2 pre-clinical,3 and simulation4 comparisons found endocardial CRT offered a more physiological and rapid activation pattern to epicardial CRT. In contrast the study by Amor ós-Figueraset al.5 found endocardial pacing induced similar haemodynamic changes to epicardial pacing in a porcine animal model of right ventricular (RV) pacing induced non-ischaemic cardiomyopathy. While these results are interesting, highlighting the need to identify the optimal pacing site for both epicardial and...
Source: Europace - October 12, 2017 Category: Cardiology Source Type: research

Transient complete atrioventricular block during catheter balloon cryoablation of atrial fibrillation: a case report
A 27-year-old man with normal heart and paroxysmal atrial fibrillation was referred for AF cryoablation. At first, the left pulmonary veins (PVs) were isolated with two 180  s cryoenergy applications in each vein. Then, the balloon was moved to the right inferior PV (RIPV) and two consecutive applications of cryoenergy, reaching a minimum temperature of −38 °C and −35 °C, were unable to isolate RIPV. The balloon was positioned in the right superior PV and i solation was obtained with two cryoenergy applications at −57ºC and −56ºC. The balloon was then repositio...
Source: Europace - October 12, 2017 Category: Cardiology Source Type: research

Response to letter to the editor from F. Jacques et al.
We would like to thank colleagues Jacqueset al.1 for their valuable additional comments. We fully agree that the problems we currently encounter in transvenous pacing in infants are only the tip of the iceberg of long-term complications in this patient group. Our article focusses on a small group of neonates/infants who received a transvenous pacemaker system and have the greatest risk for long-term complications.2 Unfortunately, in daily practice we encounter the complications mentioned by Jacqueset al. in a significant proportion of our complete paediatric pacemaker population. Regarding pacemaker therapy in children in ...
Source: Europace - October 11, 2017 Category: Cardiology Source Type: research

Long-term outcome of transvenous pacemaker implantation in infants: a retrospective cohort study
In theEuropace April 2017 issue, Voset al.1 reported long-term follow-up of infants and neonates receiving transvenous pacemaker systems. From their seven patients, they derived the conclusion that epicardial pacing should be favoured in this age group. The authors have to be congratulated on reporting these honest results. Their 15-year long-term follow-up is remarkable. From this long follow-up, we see terrible foreseeable and preventable problems occurring. Authors underlined that as most complications occurred only late in follow-up, most complications might not have been seen yet. One can easily imagine that lifespan ...
Source: Europace - October 11, 2017 Category: Cardiology Source Type: research

European Society of Cardiology smartphone and tablet applications for patients with atrial fibrillation and their health care providers
AbstractWe are in the midst of a digital revolution in health care, although the application of new and useful technology in routine clinical practice is variable. The Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly (CATCH ME) Consortium, in collaboration with the European Society of Cardiology (ESC), has funded the creation of two applications (apps) in atrial fibrillation (AF) for use in smartphones and tablets. The patient app aims to enhance patient education, improve communication between patients and health care professionals, and encourage active patient involvement ...
Source: Europace - October 10, 2017 Category: Cardiology Source Type: research

Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey
In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs. (Source: Europace)
Source: Europace - October 10, 2017 Category: Cardiology Source Type: research

miRNA-based antiarrhythmics after myocardial ischaemic injury: Authors ’ reply
This article states that miR-1231 is upregulated during the acute phase upon MI in humans and in rats, and that this miRNA supresses Cacna2d2 which encodes for the alpha-2/delta-2 subunit of the voltage-dependent calcium channel complex by which it potentially exerts a pro-arrhythmic effect.2 Yet, another article shows opposite results in patients with chronic heart failure claiming a downregulation of miR1231 in those patients.3 As shown in a rat model of acute MI, a possible antiarrhythmic strategy could embody a temporal downregulating of miR1231 to decrease arrhythmogeneity in the acute phase resulting from the instant...
Source: Europace - October 6, 2017 Category: Cardiology Source Type: research

20 A multi-centre UK clinical experience with wireless intracardiac left ventricular endocardial stimulation for delivery of cardiac resynchronisation therapy (WiSE CRT).
Introduction: A significant minority of patients fail to derive clinical benefit from cardiac resynchronisation therapy (CRT) delivered via an epicardial LV lead and many patients requiring an upgrade can have unfavourable central or coronary venous anatomy. CRT delivered through LV endocardial stimulation has demonstrated superior haemodynamic and electrical properties; access to the entire myocardium presents additional opportunity to identify the optimal LV site which appears to be patient specific. We evaluated the clinical effectiveness and safety of a wireless intracardiac LV electrode pacing system, for delivery of ...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

19 Clinical outcomes of cardiac resynchronization therapy with or without defibrillation in non-ischemic cardiomyopathy: impact of left ventricular midwall fibrosis
Background: Recent studies have cast doubt on the benefit of cardiac resynchronization therapy with defibrillation (CRT-D) versus CRT-pacing (CRT-P) in patients with non-ischemic cardiomyopathy (NICM). Left ventricular (LV) myocardial scar portends poor clinical outcomes. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

18 Assessment of cardiac arrhythmias at extreme high altitude using an implantable cardiac monitor: REVEAL HA Study
In this study we aimed to assess, for the first time the effects of significant HA on heart rhythm using an auto-detection cardiac Implantable Cardiac Monitor (ICM). (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

17 Atrial arrhythmia detection by implantable loop recorder in patients with and without previous stroke; implications for investigating patients with unexplained ischaemic stroke
Background/Introduction: Among patients with unexplained ischaemic stroke, prolonged cardiac rhythm monitoring with an Implantable Loop Recorder (ILR) has been found to uncover a high incidence of Atrial Fibrillation (AF). However, the incidence of AF detected by ILR in the general population is not known, making it possible that AF detected among stroke patients simply reflects background “noise.” It is also unclear what burden of AF is required to increase stroke risk and whether short bursts of AF are truly pathologic or simply normal phenomena, detected in the general population. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

16 Left atrial appendage occlusion in patients meeting the “commissioning through evaluation” eligibility criteria: high all-cause mortality seen in spite of successful device implant
Background: The Commissioning through Evaluation (CtE) programme launched by NHS England in 2014 provided limited access to left atrial appendage occlusion (LAAO) at 10 UK sites for selected high risk patients. The influence of this selection process on patient outcomes has not been described. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

151 A profile of a UK paediatric population with postural tachycardia syndrome
Introduction: Postural Tachycardia Syndrome (PoTS) is an abnormal response by the autonomic nervous system to upright posture. Little is understood about this debilitating condition, especially in children. This survey considers the effects of PoTS in people under the age of 18 in the UK and compares their experience to that of affected adults. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

150 Not narrow, not wide: a 15 year old with recurrent episodes of tachyarrhythmia
Case report: A 15-year-old boy  presented to the emergency department of his district general hospital with a history of palpitations for 20 hours following a bike ride. On examination he was alert and haemodynamically stable. His ECG showed a tachycardia of 180 bpm with QRS duration of 122 ms and left axis deviation. SVT wa s presumed, hence, vagal manoeuvres and i.v. Adenosine (3mg, 6mg, 12 mg) were tried unsuccessfully. After discussion with the paediatric cardiologist he was transferred to the paediatric critical care unit for Amiodarone infusion and review by the cardiologist. The tachyarrhyt...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

149 Arrhythmia alliance patient survey: device related infection in implanted cardiac electronic devices
Background: Implanted cardiac electronic devices (ICED) provide diagnosis, manage the rhythm of the heart and are life saving for potentially fatal arrhythmias. ICED ’s can be implanted as day cases or in outpatients with little or no discomfort. However, on rare occasions an infection may occur in the wound or around the leads or device in the heart. Device Related Infections (DRI) can be distressing for patients and their families and patients may have to be without their therapy while the infection is treated. A DRI may mean the patient’s device will need to be removed and replaced, procedures which are asso...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

15 Early prolonged ambulatory cardiac monitoring in stroke (EPACS) – an open-label randomised controlled trial
Introduction: Cardioembolism in paroxysmal atrial fibrillation (PAF) is a preventable cause of transient ischaemic attack (TIA) or ischaemic stroke, however, due its transient nature, a short-duration Holter monitor may miss a significant proportion of events. There are current limitations in ECG recording beyond 3-7 days. While implantable loop recorders require a minor surgical procedure, event-triggered loop recorders are cumbersome to use. We investigated whether there was a role for early prolonged cardiac monitoring using a novel patient-friendly cardiac monitoring system on patients presenting early after a stroke o...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

14 Primary care based opportunistic screening for atrial fibrillation increases detection rates
Introduction: Atrial fibrillation (AF) remains a leading cause of ischaemic stroke despite the availability of effective medications. A major hurdle for effective management is often the asymptomatic nature of AF. Improved diagnosis and management has potential significant benefits for individual patients and economically for our health service due to the expensive nature of stroke care. In conjunction with Hounslow Cardiovascular Clinical Network (a collaborative of primary, secondary, community care and patient groups) and the NIHR CLAHRC Northwest London, we set out to improve the detection, quality of care and outcomes...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

148 The sawtooth EKG pattern of typical atrial flutter is not related to differences in conduction velocity around the flutter circuit
Introduction: Typical atrial flutter (AFL) is described as cavotricuspid isthmus (CTI) dependent. The P  waves have a classic saw tooth pattern on the ECG. A widely accepted explanation for this is slow conduction through the CTI region. Using the high-density Rhythmia mapping system, we aimed to facilitate a more complete understanding of the link between the classic ECG and the local conduction vel ocity of the activation wavefront in typical AFL. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

147 Service evaluation: to identify how Plymouth NHS trust statistics for primary and secondary ICD and CRT-D intervention comply with NICE guidelines and compare with national statistics.
SUBMISSION FOR ALLIED PROFESSIONAL ORAL ABSTRACT SESSION (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

146 The prevalence of sleep disordered breathing in patients more than 65 years with persistent AF and the impact of AF intervention on sleep scores AT 6 month follow-up
Introduction: Epidemiological data have demonstrated an independent association between sleep-disordered breathing (SDB) and atrial fibrillation (AF). We wanted to develop an efficient and reliable screening service investigating SDB in patients (pts)> 65 years with persistent AF. Polysomnography (PSG) in a sleep laboratory (lab) is the gold standard diagnostic tool but expense and pt waiting lists for sleep centres have resulted in a search for alternative methods. The Watch PAT (WP) is efficient and reliable with strong correlation to PSG, potentially negating the requirement for a sleep lab. We utilised the WP to ass...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

145 Remote monitoring of implantable cardioverter-defibrillators: can usage be predicted at a UK tertiary centre?
This study investigated the percentage of patients who do not use RM at a London tertiary centre and identified groups of patients where usage is low. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

144 Implantable cardiac monitors (ICM): quality assurance audit outcomes of an innovative specialist nurse led service.
Background/Objective: A Cardiac Rhythm Management (CRM) nurse-led service was developed in 2015 utilising Medtronic Reveal LINQ ICM devices and advanced remote monitoring technology. Advances in technology have allowed for implantation in a procedure room by CRM specialist nurses. Following implant, all patients received remote monitoring equipment and access to a nurse-led telephone helpline. Daily assessment, management of patient transmissions and follow-up care by scheduled telephone appointments were coordinated by the CRM nurse team. Outcomes were compared from the nurse-led service versus traditional pathway over th...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

143 AV delay optimisation in patients with congenitally corrected transposition of the great arteries.
Background: Adults with congenitally corrected transposition of the great arteries (ccTGA) are at risk of systemic right ventricular failure and cardiac arrhythmias requiring the implantation of pacemakers, ICDs and CRT devices. These devices permit adjustment of the atrioventricular delay to restore atrioventricular synchrony. The importance of atrioventricular delay optimisation in patients with ccTGA has not been investigated. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

142 Do atrial high rate episodes & lt;6  minutes in duration in pacemaker patients increase stroke risk?
Introduction: Atrial fibrillation (AF) is a well-known risk factor for stroke. Recently, episodes as short as 6  minutes in duration have been linked with an increased risk of ischaemic stroke in pacemaker (PPM) patients (Healeyet al., 2012). (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

141 Remote monitoring of ILRs, when is more too much?
Introduction: Remote monitoring has become an accepted and utilised tool for use with implantable cardiac devices: with safety at heart it is easy to see why when it comes to implantable defibrillators. The same is not so evident for implantable loop recorders (ILRs). This paper explores the impact of remote ILR monitoring on cardiac departmental workload. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

140 A retrospective study to assess feasibility of daycase complex device insertion
Introduction: Routinely, patients undergoing elective complex device insertion are discharged the day post-procedure after satisfactory pacing interrogation and chest radiography to confirm lead placements. However, there is a paucity of data relating to early complication rates in patients with device therapy that are discharged on the day of procedure. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

139 Day-case device implantation- a prospective single-centre experience including patient satisfaction data
Introduction; Cardiac rhythm management (CRM) device implantation is associated with serious complications and traditionally patients are admitted overnight for observation. As operative experience has increased, many centres now perform new device implants as day-case procedures. Retrospective studies have evaluated the safety of this approach but there is a lack of prospective data. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

138 Failure of timely referral to acute in-hospital heart failure services
Introduction: Acute heart failure is the leading cause of hospital admissions inpatients 65 years or older. Current guidelines from National institute for Health and Clinical Excellence (UK) recommends all patients admitted with acute heart failure be seen within 24  hours of admission by a specialist multidisciplinary team. Early input from a dedicated heart failure team reduces mortality and hospital readmission rates. The ESC advices appropriate referral and consultation with the multidisciplinary team. We evaluated adherence to these guidelines at our in stitution.  (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

137 Do octogenarians tolerate CRT-P insertion?
Introduction: Cardiac resynchronisation therapy via biventricular pacing (CRT-P) is of established benefit in patients with congestive heart failure (CHF) that are on optimised pharmacotherapy and fulfil specific criteria relating to NYHA class and QRS duration. However, there is a paucity of data relating to procedural tolerability and complication rates in octogenarians undergoing CRT-P implantation.   (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

136 Cardiac resynchronization pacing in patients with chronic heart failure
The objective of this study was to investigate whether cardiac resynchronization therapy improved morbidity among patients with heart failure. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

134 Implantable cardioverter defibrillator use in octogenarians
Introduction: Implantable cardioverter-defibrillators (ICDs) have international guideline endorsement as a therapy to reduced sudden cardiac death in patients with severe systolic cardiac dysfunction. However, their role in octogenarians is uncertain. We sought to describe current practice pertaining to octogenarians and ICD implantation at a tertiary referral centre. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

133 Lower complication rates with MicraTPS versus transvenousVVI pacemakers; a single centre experience
We present our experience utilizing this new technology in a single center retrospective observational study. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

132 The prevalence of upgrade to biventricular pacing after bradycardia pacing is less than 2%: a 12-year series of over 750 patients from a ‘real world’ district general cohort
In this study, we examined a large cohort of patients undergoing bradycardia pacing over a 12-year period and assessed the prevalence of upgrade to biventricular pacing (CRT-D or CRT-P). (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

131 ‘Silent’ atrial tachyarrhythmia and potential cryptogenic stroke: a ‘real-world’ study
Background: Atrial Fibrillation (AFib) and Flutter (AFl) are known to be associated with embolic stroke and current guidelines rightly recommend anticoagulation in these patients to reduce this risk. However, the management of other Atrialtachyarrhythmias (ATAs) in relation to stroke is unclear. The aim of this study was to explore whether ATAs (other than AFib/AFl) could be associated with stroke or progress to AF. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

130 Improving the implementation of anti-coagulation therapy in AF patients at risk of stroke in a primary care setting
Background: Atrial fibrillation (AF) is the most common sustained arrhythmia of the heart and is of increasing prevalence1. There are strong implications of increased stroke risk in AF patients2. In particular, AF related stroke carries a near 50% risk of persisting disability and directly increases costs for treatment by over a third in comparison with non AF stroke patients3,4. As an estimated contributing cause of 15-20% of all strokes, the economic and societal impact of AF is of extreme importance5. To monitor how efficiently stroke prevention is implemented in a primary care setting we will identify those ‘at r...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

129 Atrial flutter in hospital practice: the burden of atrial flutter on a regional cardioversion service, and barriers to referral for ablation
Introduction: Atrial flutter (AFL) is a common arrhythmia with an incidence of 88 per 100 000 person-years. Morbidity from AFL arises from tachycardia, loss of atrial transport, or thromboembolism. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

128 Internal loop recorder ( ‘Reveal’) implantation as a diagnostic tool in patients with unexplained syncope
Introduction: Establishing a precise diagnosis in patients with syncope or palpitations relies on the correlation between symptoms and electrocardiography evidence. In a vast majority of patients the symptoms are paroxysmal and unpredictable. Traditional methods (e.g. external Holter monitoring and Tilt testing etc.) generally fail to provide diagnostic information. Over the last few years, long-term monitoring using an implantable loop recorder (ILR) has gained popularity as a diagnostic tool in the management of these patients. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

127 Setting up a VT ablation service – where to set the bar of patient selection?
Introduction: When developing a VT ablation service, setting an appropriate threshold for patient selection is crucial to ensure that outcomes are optimised. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

126 Implantable loop recorders - diagnostic yield in patients with syncope and presyncope
Syncope is the transient loss of consciousness which results in loss of consciousness and postural tone often leading to collapse and is frequently followed by a spontaneous recovery1. Implantable loop recorders (ILRs) are a reliable means of investigating these events. Current guidelines recommend implantable loop recorders for any patient with syncope that remains unexplained after a conventional work up.1 (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

124 GP-led anticoagulation counselling for non-valvular atrial fibrillation (AF) in the community is neither comprehensive nor accurate: Results from a service improvement project.
Background: Stroke risk in NVAF can be reduced significantly by anticoagulation with either warfarin or the non- vitamin K antagonist (NOACs). NICE recommendations state that NOACs are as efficacious but also associated with significantly less intracranial bleeding compared to Warfarin and in this sense are safer than warfarin. Additionally NOACs do not require regular monitoring of their anticoagulant effects and therefore offer convenience to the patient. However they are not as tried and tested as warfarin and at the time of our study, did not have an available agent to reverse their effects in the event of a bleeding c...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

123 CMRI-assessed left ventricular extra-cellular volume fraction, not left atrial late gadolinium uptake, is related to higher left atrial pressure and increased type 1 collagen telopeptide levels in pre-ablation AF patients
Background: Left atrial (LA) fibrosis assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) and raised LA pressure predict recurrence of atrial fibrillation (AF) after ablation, however the mechanistic links between LA or left ventricular (LV) fibrosis and AF recurrence are not clear. Using CMR techniques and invasive measurements we tested the hypotheses that LA and LV fibrosis are related to each other, LA pressure, and fibrosis biomarker levels. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

122 Reducing the burden of unnecessary LINQ implantable loop recorder remote downloads by implementing an in-hospital multidisciplinary strategy to individualise management of patients with high volume downloads
Introduction: LINQTM implantable loop recorders (ILRs) were first implanted at Nottingham University Hospitals in January 2015. Unlike conventional ILRs which rely on in-clinic downloads (typically routine three-monthly follow up (FU) or when patient-activated), LINQTMILRs are capable of continuous remote downloads either for routine 3-monthly FU, patient-activated events or pre-specified alerts. This has led to a significant increase in workload for our Pacing clinic (25 conventional ILR in-office downloads per month prior to introduction of LINQTMILRS; 150 LINQTM remote downloads per month after introduction of LINQTMILR...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

121 Effective atrial conducting size does not predict human AF vulnerability
Background: The multiple wavelet hypothesis is an established theory to explain initiation and maintenance of atrial fibrillation (AF). (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

120 Cardiopulmonary exercise testing echocardiography features predicting the safety and efficacy of a central arterio-venous fistula with subgroup analysis assessing the impact of the device on blood pressure control and AF burden
Introduction: A central stent derived arterio-venous iliac fistula using the ROX CouplerTM reduces blood pressure (BP) in patients (pts) with resistant and/or uncontrolled hypertension (HTN). We performed detailed stress echocardiograms (echos) during concurrent cardiopulmonary exercise testing (CPET) pre and post insertion of a ROXTMCoupler for HTN. We evaluated the pre and post ROX Coupler characteristics of pts who might progress to cardiac decompensation. We evaluated the impact of perfect blood pressure control in a sub-analysis of paroxysmal atrial fibrillation (PAF) pts. using continuous heart rhythm monitoring with...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

119 P wave duration and spectral analysis of signal averaged P wave: can this guide us in deciding the extent of af ablation required beyond pulmonary vein isolation? - A prospective study
Background& Purpose: Pulmonary vein isolation (PVI) is an established treatment for paroxysmal atrial fibrillation (PAF) however recurrence can occur despite pulmonary vein (PV) isolation because of abnormal left atrial (LA) substrate which requires additional ablation. The P wave triggered signal averaged ECG (SAECG) has been shown to demonstrate longer P wave duration and higher P wave energies in patients with paroxysmal atrial fibrillation (PAF) compared to controls. We postulated that this technique might be used to identify patients with significant atrial substrate change who may require additional ablation beyo...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

13 SAFE2SCREEN - can patient initiated kiosk-based self-screening provide an opportunity to identify atrial fibrillation within a GP waiting room environment?
Introduction: Atrial fibrillation (AF) remains undiagnosed in many patients in the community. We explored the use of a new electrocardiogram (ECG) screening technique to identify patients with AF who were attending GP surgeries for routine appointments. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

12 Is cardiac resynchronisation therapy more effective in females than males? A comparison of STH patients and the findings of MADIT-CRT
Background: Cardiac resynchronisation therapy (CRT) aims to improve cardiac output in patients with heart failure (HF) and electro-mechanical dyssynchrony of the left ventricle. Response to CRT still displays large individual variations, therefore it is important to identify characteristics which may indicate the success of the device. Differences in sex-specific outcomes for death and heart failure events were examined in a sub-study to the MADIT-CRT study, revealing females to achieve significantly better results from CRT devices than males. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

11 Analysis of trigger factors is one of the important point in the management of patients with stable coronary artery disease and high-grade ventricular arrhythmias
Introduction: To study trigger factors of the ventricular arrhythmias (VA) in patients (pts) with stable coronary artery disease (S СAD) and to evaluate antiarrhythmic effect (AAE) of the individualized and pathogenetic therapy. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research