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Objectives The aim of this study was to evaluate the efficacy of radiofrequency (RF) energy applications targeting the atrial side of a significant residual leak in patients with acute and chronic evidence of incomplete percutaneous left atrial appendage (LAA) occlusion. Background RF applications have been proved to prevent recanalization of intracranial aneurysms after coil embolization, thereby favoring complete sealing. From a mechanistic standpoint, in vitro and in vivo experiments have demonstrated that RF promotes collagen deposition and tissue retraction. Methods Forty-three patients (mean age 75 ± 7 years mean CHA2DS2-VASc score 4.6 ± 1.4, mean HAS-BLED score 4.0 ± 1.1) with residual leaks ≥4 mm after Watchman implantation were enrolled. Procedural success was defined as complete LAA occlusion or presence of a mild or minimal (1- to 2-mm) peridevice leak on follow-up transesophageal echocardiography (TEE), which was performed approximately 45 days after the procedure. Results RF-based leak closure was performed acutely after Watchman implantation in 19 patients (44.2%) or scheduled after evidence of significant leaks on follow-up TEE in 24 others (55.8%). The median leak size was 5 mm (range: 4-7 mm). On average, 18 ± 7 RF applications per patient (mean maximum contact force 16 ± 3 g, mean power 44 ± 2 W, mean RF time 5.1 ± 2.5 minutes) were performed targeting the atrial edge of the leak. Post-RF median leak size was 0 mm (range: 0-1 mm). A very low rate (2.3% [n = 1]) of major periprocedural complications was observed. Follow-up TEE revealed complete LAA sealing in 23 patients (53.5%) and negligible residual leaks in 15 (34.9%). Conclusions RF applications targeting the atrial edge of a significant peri-Watchman leak may promote LAA sealing via tissue remodeling, without increasing complications. (RF Applications for Residual LAA Leaks [REACT]; NCT04726943 )

The impact of cardioneuroablation (CNA) on ventricular repolarization by using corrected QT interval (QTc) measurements has been recently demonstrated. The effects of cardiac pacing (CP) on ventricular repolarization have not been studied in patients with vasovagal syncope (VVS). We sought to compare ventricular repolarization effects of CNA (group 1) with CP (group 2) in patients with VVS.We enrolled 69 patients with age 38 ± 13 years (53.6% male), n = 47 in group 1 and n = 22 in group 2. Clinical diagnosis of cardioinhibitory type was supported by cardiac monitoring or tilt testing. QTc was calculated at baseline (time-1), at 24 h after ablation (time-2), and at 9-12 months (time-3) in the follow-up.In the group 1, from time-1 to time-2, a significant shortening in QTcFredericia (from 403 ± 27 to 382 ± 27 ms, p0.0001), QTcFramingham (from 402 ± 27 to 384 ± 27 ms, p0.0001), and QTcHodges (from 405 ± 26 to 388 ± 24 ms, p0.0001) was observed which remained lower than baseline in time-3 (373 ± 29, 376 ± 27, and 378 ± 27 ms, respectively). Although the difference between measurements in time-1 and time-2 was not statistically significant for QTcBazett, a significant shortening was detected between time-1 and time-3 (from 408 ± 30 to 394 ± 33, p = 0.005). In the group 2, there was no time-based changes on QTc measurements. In the linear mixed model analysis, the longitudinal reduction tendency in the QTcFredericia and QTcFramingham was more pronounced in group 1.Our results demonstrate that CNA reduces QTc levels through neuromodulation effect whereas CP has no effect on ventricular repolarization in patients with VVS.

Left atrial appendage occlusion is an evolving technology with demonstrable benefits of stroke prophylaxis in patients with atrial fibrillation unsuitable for anticoagulation. This has resulted in the development of a plethora of transcatheter devices to achieve epicardial exclusion and endocardial occlusion. In this review, the authors summarize the differences in technique, target patient population, outcomes, and complication profiles of endocardial and epicardial techniques.

Left atrial appendage (LAA) is the dominant source of systemic thromboembolic (TE) events in patients with nonvalvular atrial fibrillation (AF). In patients with significant bleeding risk, various LAA exclusion strategies have been developed as an alternative to pharmacologic TE prophylaxis. Nevertheless, in a relatively small percentage of patients, incomplete LAA closure can be documented, either at the time of procedure or during follow-up. This persistent patency can potentially jeopardize an effective stroke prophylaxis. Hereby, we report an update on the current clinical implications of LAA leaks and how to manage them.

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: There are recent reports of neurological manifestations (NMs) from COVID-191 We present a healthy male who developed multiple strokes likely from direct endothelial dysfunction (ED) CASE PRESENTATION: 66M with GERD presents with 5 days of cough, fever, and chills He was febrile and hypoxic Work-up revealed CRP 19 mg/dL, ferritin 594 ng/mL, D-dimer 2 01 mg/L, positive COVID-19 PCR, and normal lipid panel He had wheezing and no NMs He was treated with antibiotics, enoxaparin, and oxygen On day 14 he acutely developed altered mental status, aphasia, and unilateral weakness CT head revealed acute left ischemic infarct CTA head/neck revealed proximal left ICA dissection Aspirin and Atorvastatin were given Further studies revealed D-dimer 0 4 mg/L, no inheritable hypercoagulopathy, and negative TTE and lower extremity venous duplex MRI brain confirmed multiple acute infarcts Left ICA thrombectomy and stent placement were performed It was found that there was a pseudo-dissection with a ruptured plaque and an overlying thrombus resulting in a 75% stenosis DISCUSSION: Arterial complications from COVID-19 have recently been reported 3 Studies from Wuhan, China showed that 36 7% of COVID-19 patients had NMs, most commonly dizziness (16 8%) and headache (13 1%);5 7% had acute ischemic stroke These patients had severe respiratory symptoms and developed neurologic signs in 1-2 days 1 Another study revealed that stroke occurred in elevated CRP (51 1 vs 12 1 ng/L) and D-dimer (6 9 vs 0 5 mg/L)2 It is believed that the virus directly invades and injures endothelial cells (ECs), changes prothrombotic factors, and promotes a hypercoagulable state secondary to a profound inflammatory response4 ACE-2-receptors on ECs are used for viral adhesion Viral replication causes EC apoptosis, which promotes vasoconstriction, organ ischemia, tissue edema, and microvascular prothrombotic sequelae 5 In our case, COVID-19 had profound ED distal to the carotid artery bifurcation Arterial bifurcations are sites of turbulent blood flow that are athero-prone 6 The stroke occurred in the setting of moderate elevations of D-dimer, suggesting an alternate mechanism 2 Plaque rupture occurred with prophylactic anticoagulation and normal lipid panel At the time of the stroke, D-dimer and inflammatory markers largely normalized His late onset NMs indicate that prothrombotic sequelae and ED persist after the cytokine storm has improved 1 Further studies are needed to investigate the duration of cytokine storm and prothrombotic state, and appropriate screening measures CONCLUSIONS: Clinicians must be cognizant of NMs from COVID-19 such as thromboembolic strokes from direct ED Reference #1: 1 Mao L et al Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China JAMA Neurol Epub 2020 Apr 10 Reference #2: 2 Li Y, Wang M, Zhou Y, Chang J Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study Available at SSRN: https://ssrn com/abstract=3550025 2020 Mar 3 Reference #3: 3 Oxley, Thomas et al Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young N Engl J Med Epub 2020 Apr 28 4 Connors JM, Levy JH COVID-19 and its implications for thrombosis and anticoagulation Blood Epub 2020 Apr 27 5 Ferrario CM et al Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2 Circulation 2005;111:2605-10 6 Ku DN, Giddens DP, Zarins CK, Glagov S Pulsatile flow and atherosclerosis in the human carotid bifurcation: positive correlation between plaque location and low oscillating shear stress Atherosclerosis 1985 May-Jun;5:293-302 DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Luke Alessi, source=Web Response No relevant relationshi s by David Capone, source=Web Response No relevant relationships by Olga McAbee, source=Web Response No relevant relationships by Heidi Roppelt, source=Web Response No relevant relationships by Fredric Weinbaum, source=Web Response No relevant relationships by Daisy Young, source=Web Response

Inducible focal firings arising from the coronary sinus (CS) are a common finding during atrial fibrillation (AF) ablation procedures. To date, no studies have compared the clinical impact of electrical isolation versus focal ablation of the CS in patients with inducible triggers from this site.

Incomplete left atrial appendage (LAA) closure is common after interventional therapies targeting the LAA. Detachable coils have found a wide range of applications for transcatheter vascular occlusion/embolization procedures. We report the feasibility and efficacy of transcatheter leak closure with

Cardiac implantable electronic devices (CIED) have shown survival benefit in certain patient populations and as these devices continue to gain popularity, complications remain a concern, in particular CIED infection. An absorbable mesh envelope (TYRX, Medtronic), coated with absorbable polymer mixed

We prospectively evaluated the electrophysiological features and ablation outcomes in a large cohort of Persistent AF patients. All patients (n=1803) underwent pulmonary vein antrum isolation (PVAI) extended to the entire posterior wall (PW). A standardized protocol was performed to elicit any AF

While Mobitz Type II Atrioventricular block (AVB) is always associated with conduction abnormalities below the AV node, Type I AVB can be due to nodal or infranodal pathology. 2° AVB with 2:1 conduction cannot be described as Mobitz I or II; however, QRS morphology can localize the conduction

SESSION TITLE: Miscellaneous Critical CareSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PMPURPOSE: Spinal injury in the absence of neurologic deficit is a common cause of morbidity in trauma patients. As neurologic injury is the most common