Search

Introduction Feasibility of concomitant leadless-pacemaker (LP) implantation plus atrioventricular node ablation (AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming. Objective We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes. Methods Single center, prospective and observational study of 256 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 255/256 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted. Results 33 out of 255 patients underwent immediate AV ablation. Mean age was 75.2±8.3 years. Were predominantly females: 25 (75.7%) and indication was fast conduction atrial fibrillation (n=25), atypical flutter or atrial tachycardia (n=8). Mean acute “R wave” was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes. There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 27.9±12 months, all patients remained alive without notable event, and electrical parameters remained unchanged (Figure 1). Actuarial survival was shown in Figure 2. Conclusions Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Funding Acknowledgement Type of funding sources: None. Electrical performanceSurvival

Funding Acknowledgements Type of funding sources: None. Introduction Feasibility of concomitant leadless-pacemaker(LP) implantation plus atrioventricular node ablation(AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming . Objective We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes. Methods Single center, prospective and observational study of 243 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 242/243 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted. Results 33 out of 242 patients underwent immediate AV ablation. Mean age was 75.2 ± 8.3 years. Were predominantly females: 25(75.7%) and indication was fast conduction atrial fibrillation(n = 25), atypical flutter or atrial tachycardia (n = 8). Mean acute "R wave" was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes. There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 19.9± 12 months, all patients remained alive without notable event, and electrical parameters remained unchanged.(Figure 1) Conclusions Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Abstract Figure. Electrical performance

Aims Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Its associated proteins are differentially released between male and female. FABP4 and leptin are mediators in adipose tissue-inflammatory effects. Our aim was to study their gender differential behavior on mechanisms associated with AF progression. Methods and results Two independent cohorts were analyzed: A) patients referred for AF catheter ablation (n=217) and patients with suspected coronary artery disease referred for a CT scan (without previous history of AF) (n=105). Protein levels were determined by multiplex fluorometric immunoassay. Gene mRNA expression was analyzed by real time polymerase chain reaction. Correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients. Logistic regression and random forest model determined the best predictors of AF recurrence after catheter ablation. Our results showed: 1) a distinctive profile according to gender, with an increment of FABP4 levels in women (20±14, 29±18 and 31±17 ng/mL; p=0.007) and a decrease of leptin levels in men (22±15, 13±16 and 13±11 ng/mL; p=0.001) among control, paroxysmal and persistent AF groups, respectively; 2) sex differences regarding inflammatory profile, oxidative stress and autonomic indirect markers in AF; 3) a prominent role of adipokines to discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor (LR coefficient 1.067, 95% CI 1–1.14, p=0.046). Conclusion The major finding of the present study is the sex differences of FABP4 and leptin according to AF burden. The relationship of these adipokines with oxidative stress, inflammatory and autonomic indirect markers might explain part of the mechanisms underlying the AF perpetuation. Adipokines regarding Gender & AF burden Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Institute of Health Carlos III

Aims Acetylcholine (ACh) released modulation by botulinum toxin injection into epicardial fat diminish atrial fibrillation (AF) recurrence. These results suggest an interaction between autonomic imbalance and epicardial fat as risk factors of AF. Our aim was to study the inflammatory and lipid profile of epicardial stroma from AF patients and their regulation by high cholinergic activity. Methods and results We performed in vitro assays with primary cultures from paired subcutaneous and epicardial stromal cells from 33 patients. We analysed ACh effect on gene expression, intracellular calcium mobilization and neutrophil migration. Plasma protein regulation by parasympathetic denervation was performed in vagotomised rats. Acute ACh treatment up-regulated MCP1 levels on epicardial stromal cells and suggested a neutrophil infiltration enhancement. Patients with AF had a greater FABP4 gene expression (1.54±0.01 vs 1.47±0.01, p=0.005). Its plasma levels were pronouncedly declined on vagotomised rats (2.02±0.21 ng/mL vs 0.65±0.23 ng/mL, p Conclusions Acute ACh activity up-regulates MCP1 and calcium mobilization on epicardial stromal cells. Longer ACh treatment enhanced lipid accumulation. In this line, epicardial stroma from patients with permanent AF contains higher FABP4 expression levels. Thus, modulate cholinergic activity might reduce FABP4 since vagus nerve denervation is associated with a sharply decrease in FABP4 plasma levels. FABP4 in human AF and vagotomised rats Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Carlos III Health Institute; Health Research Institute of Santiago de Compostela

Introduction and objectives Initial results of Leadless pacemakers (LPM) has been promising in worldwide, nevertheless there are still no long term experience published, so the objective of our study was to evaluate electrical parameters at mid and long term follow-up, describing as well total complications and mortality in a single center-study. Methods This was a prospective, observational clinical trial that included 183 consecutive patients, with an indication for a single-chamber pacemaker implantation. Results All successful implantation included a total of 183 patients with a mean age of 79,2 ±6,6 years (range 54-93y/o); 111 (60,6%) were men and more frequent rhythm was permanent atrial fibrillation (160), including those in which a node ablation was performed in the same procedure (22). Clinical and echocardiographyc characteristics are described in table 1.Mean follow-up was of 26 ±10 months including: 64 patient at 24 months, 46 at 36 months and 7 patients at 48 months. Electrical parameters are represented in figure 1, which were stable and flawless at long term follow-up. Total complications were 3,3%, with only 2 patient requiring surgery for resolution (1,7%), and all were acute during LPM implantation. A total of 17 patients (9,3%) died with no relation to pacemaker. Conclusions In our experience, leadless pacemakers electrical performance continues stable, appropriate at long term follow-up, and no other complications developed. Baseline Characteristics of Patients Age(years) 79.2 ± 6.6[54-93] Male gender, n (%) 118 (60.6%) Hypertension, n (%) 149 (81.7%) Diabetes mellitus, n (%) 64 (34.9%) COPD, n (%) 33(18.3%) Renal dysfunction, n (%) 30 (16.7%) Valvular disease, n (%) 74 (41.1%) Atrial Fibrillation, n (%) 161 (98.0%) LVEF(%) 60.0 ± 8 OAC, n (%) 123(67.2%) NOAC, n (%) 23 (10.0%) Abstract Figure. Electrical performance

Background As more experience is obtained with leadless pacemakers systems (LPM), a great group of patients is considered for its implantation. There are issues that cannot be completely avoided with conventional transvenous pacemaker (VVI-PM) such as infectious or pocket related complications in which LPM are clearly superior. Purpose The aim of the study was to compare the clinical and device performance between LPM and VVIPM in the same period of time in a “real-world” population. Methods We performed a prospective, observational, one center study, including all patients with a single chamber pacemaker implantation within 3 years (June 2015-December 2018) and its mid-term follow-up. All clinical, electrical and echocardiographic characteristics, as well as implantation characteristics and complications, were described. Results We included a total of 339 patients with transvenous pacemakers, 195 patients with VVI-PM and 144 LPM. There were no significant differences in mortality between both groups during the follow-up (12,3±10 months), Figure 1. Although there were no significant differences in major complications (P-value 0,54), the number of total complications was lower in the LPM group (P-value 0,01) at the expense of fewer minor ones (P-value 0,02), Table 1. Table 1. Complications TVP (195) LPM (144) P value Major complications 11 (5.6%) 6 (4.2%) 0.54 Minor complications 10 (5.1%) 0 (0.0%) 0.01 Total Complications 21 (10.7%) 6 (4,2%) 0.02 Figure 1 Conclusions In our study, during the med-term follow-up, there were no significant differences in terms of mortality and the major complications between LMP and VVI-PM. Although, the number of minor complications were less with the LMP.

Introduction Atrial fibrillation (AF) is a highly prevalent heart disease, affecting a significant proportion of patients over 65 years old. The CHA2DS2-VASc score predicts 1 year risk of a thromboembolic (TE) event and is well validated against several populations. However, calibration may vary if there is subgroup heterogeneity. Purpose To compare the CHA2DS2-VASc score calibration, in patients with or without anticoagulation (AC) in a real population of AF patients in our healthcare area. Methods Patients with an episode with atrial fibrillation/flutter were selected from a general population in a healthcare area (383,000 subjects), with 21/12/2013 as a cut-off date. Patients with valve disease, anticoagulation or antiplatelet therapy were identified. The CHA2DS2-VASc score was calculated as stipulated in the European Society of Cardiology guidelines. A CHA2DS2-VASc score of 0 is considered to be low risk for TE events (0% at 1 year), score of 1 intermediate risk (0.6% rate at 1 year), and greater than 1 high risk (3% rate at 1 year). Quantitative variables are presented as mean and standard deviation (SD). Categorical variables were presented as frequencies and percentages. A logistic regression was fitted to predict 1-year risk TE outcomes with CHA2DS2-VASc as the only covariate. Model calibration was assessed using the predicted versus actual probabilities of TE events. All analyses were performed using R v.3.4 (R Core Team, Vienna, Austria) with the packages rms and ggplot2. Results CHA2DS2-VASc was calculated in 7990 patients with AF. A total of 1824 patients were excluded either due to valvular disease (846) or due to previous antiplatelet treatment (1047). From them, 143 patients were excluded for an incomplete follow-up time ( As of December 31, 2015, 67 stroke cases had been notified from 6023 patients (1.1%) (Table 1). Mortality rate was 181 (3%) at 1 year. Patients presented overall low risks of stroke with a poor score calibration. Higher scores presented risks that were lower than predicted by CHA2DS2-VASc. Event rate at 1 year was similar regardless of the AC regime at the initial date, and also similar to a previous cohort of anticoagulated patients (Lip et al.). This similarity may indicate confounding by later AC therapy initiation, before the final assessment date. Table 1. Comparison of thromboembolic event rates in several studies % (No-AC) % (AC) % Lip 2010 % Poli 2011 % Friberg 2012 % Okumura 2014 0.01 0.01 0.02 4.5 4.5 1 AC: anticoagulation. CHA2DS2VASc score calibration Conclusion Higher CHA2DS2-VASc scores are not associated to higher risks of stroke in our healthcare area, in patients with non-valvular AF and without antiplatelet therapy.

Background Real-world data reinforce positive results in different implant locations of leadless pacemaker (LPM). LPM have special characteristics regarding accelerometer programmation. Purpose The purpose of the study was to describe our experience with LPM different implantation location and its programmation according the vector accelerometer. Methods We performed a prospective observational one center study including all patients with LPM implantation within 3 years (June 2015-December 2018). Location of deployment was classified as apicalseptal, midseptal or right ventricle outflow tract (RVOT). Vector programmation was performed from the second visit in patients with acceptable mobility and heart rate below 80 bpm, with the abbreviated protocol recommended by the brand. Clinical evaluation according to vector programmed was performed 3 to 6 months later. Results We include a total of 144 LPM, and exercise test was performed in 86 patients. There were 86 men (59.7%) with a mean age of 79.1±6.9 years-old (54 to 89). Location of deployment was distributed as follows: 32.4% in apicalseptal, 54.5% in midseptal and 13.1% in RVOT. Vector 1 was the more frequent programmation, specially in apicalseptal position. Correlation between location and vector of programmation could not be predicted (p=0.2381), but there was a non-significant tendency (p=0.08) between patients with LPM in RVOT location and Vector 3 programmation. Table 1 and Figure 1. Table 1. Micra Location and Activity Vector Apicalseptal Midseptal RVOT P Value Test Vector 39 (84.8%) 40 (58.5%) 7 (46.7%) NS Vector 1 22 (56.4%) 26 (65.0%) 2 (28.6%) NS Vector 2 8 (20.5%) 4 (10.0%) 1 (14.3%) NS Vector 3 9 (23.1%) 10 (25.0%) 4 (57.1%) 0.08 Figure 1 Conclusions In our series, Vector 1 was the predominant accelerometer programmation specially in apicalseptal LPM position and Vector 3 in RVOT position.