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4. ORAL ABSTRACTS (2)EP & Ablation19CARDIAC ABLATION PATIENT REPORTED OUTCOMES MEASURES (PROMS): ANALYSIS OF POST-ABLATION AND 1 YEAR FOLLOW-UP DATA20INTENTIONAL CORONARY VEIN EXIT AND CARBON DIOXIDE INSUFFLATION TO ALLOW SAFE SUBXIPHOID EPICARDIAL ACCESS FOR VENTRICULAR MAPPING AND ABLATION - FIRST EXPERIENCE21PACED FRACTIONATION DETECTION AS A TOOL FOR MAPPING SCARS IN VT22DOES USE OF CONTACT-FORCE SENSING CATHETERS IMPROVE THE OUTCOME OF ABLATION OF VENTRICULAR TACHYCARDIA?23RETROGRADE AORTIC ACCESS OF THE PULMONARY VENOUS ATRIUM PROVIDES EQUIVALENT OUTCOMES TO RIGHT ATRIAL OR TRANSEPTAL ACCESS OF THE LEFT ATRIUM IN PATIENTS WITH CONGENITAL HEART DISEASE24COMPUTATIONAL THREE-DIMENSION LEFT ATRIAL APPENDAGE WALL THICKNESS MAPS AND HISTOLOGICAL ANALYSIS TO GUIDE LEFT ATRIAL APPENDAGE ELECTRICAL ISOLATIONPacing & Devices25IDENTIFYING THE OPTIMAL LOCATION FOR LV ENDOCARIDAL PACING:RESULTS FROM A MULTICENTRE INTERNATIONAL REGISTRY OF LV ENDOCARDIAL PACING26UK MULTI-CENTRE REGISTRY OF TRANSVENOUS LEAD EXTRACTION: CLINICAL OUTCOME USING TRACTION, CUTTING SHEATHS AND LASER TECHNIQUES27SKIN FISTULA FORMATION - A NEW EXPERIENCE WITH THE NEW TYRX ABSORBABLE ANTIMICROVIAL ENVELOPE28BIFOCAL RIGHT VENTRICULAR PACING IN PATIENTS WITH FAILED CORONARY-SINUS LEAD IMPLANTS: LONG-TERM RESULTS FROM MULTICENTRE REGISTRY29REAL TIME X-MRI GUIDED LEFT VENTRICULAR LEAD IMPLANTATION FOR TARGETED DELIVERY OF CARDIAC RESYNCHRONIZATION THERAPY30ACUTE AND CHRONIC PERFORMANCE OF COMMUNICATING LEADLESS ANTI-TACHYCARDIA PACEMAKER AND SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR

Author

Evans, J.M., primary, Silberbauer, John, primary, Glover, B., primary, Kontogeorgis, A., primary, McLellan, A.J.A., primary, Panikker, S., primary, Sieniewicz, B.J., primary, Martin, C.A., primary, Burg, M.R., primary, Providencia, R., primary, Behar, J.M., primary, Burke, M.C., primary, Withers, K.L., additional, White, J., additional, Lencioni, M., additional, Carolan-Rees, G., additional, Wood, K.A., additional, Patrick, H., additional, Griffith, M., additional, Gomes, J., additional, Kirubakaran, S., additional, O'Nunain, S., additional, Bencat, M., additional, McCready, J., additional, Michael, K., additional, Hashemi, J., additional, Gupta, D., additional, Akl, S., additional, Redfearn, D., additional, Lim, E., additional, Panikker, S., additional, Butcher, C., additional, Khan, H., additional, Mantziari, L., additional, Jarman, J.W.E., additional, Hussain, W., additional, Jones, D., additional, Clague, J.R., additional, Ernst, S., additional, Markides, V., additional, Wong, T., additional, Ezzat, V.A., additional, Schilling, R.J., additional, Lowe, M.D., additional, Whitaker, J., additional, Virmani, R., additional, Kutys, R., additional, Fastl, T., additional, Haldar, S., additional, O'Neill, M., additional, Corado, C., additional, Nicol, E., additional, Foran, J.P., additional, Niederer, S., additional, Behar, J., additional, Sohal, M., additional, Jais, P., additional, Derval, N., additional, Spragg, D., additional, Van Gelder, B., additional, Bracke, F., additional, Steendijk, P., additional, Rinaldi, C.A., additional, Chooneea, B., additional, Gajendragadkar, P.R., additional, Ahsan, S., additional, Begley, D.A., additional, Dhinoja, M., additional, Earley, M.J., additional, Finlay, M., additional, Grace, A.A., additional, Heck, P.M., additional, Hunter, R.J., additional, Lambiase, P.D., additional, Rowland, E., additional, Segal, O.R., additional, Sporton, S., additional, Virdee, M.S., additional, Chow, A., additional, Apap Bologna, R., additional, Camilleri, W., additional, Sammut, M.A., additional, Aquilina, O., additional, Barra, S., additional, Papageorgiou, N., additional, Falconer, D., additional, Duehmke, R., additional, Rehal, O., additional, Ezzat, V., additional, Ioannou, A., additional, Segal, O., additional, Lowe, M., additional, Lambiase, P., additional, Agarwal, S., additional, Chow, A.W., additional, Toth, D., additional, Mountney, P., additional, Reiml, S., additional, Panayioutu, M., additional, Brost, A., additional, Fahn, B., additional, Patel, N.R., additional, Claridge, S., additional, Jackson, T., additional, Adhya, S., additional, Sieniwicz, B., additional, Razavi, R., additional, Rhode, K., additional, Tjong, F.V.Y., additional, Brouwer, T.F., additional, Koop, B., additional, Soltis, B., additional, Shuros, A., additional, and Knops, R.E., additional

Published
2016
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6. Authors' reply to Vinden

Author

Gajendragadkar, P. R., primary, Moualed, D. J., additional, Nicolson, P. L. R., additional, Adjei, F. D., additional, Cakebread, H. E., additional, Duehmke, R. M., additional, and Martin, C. A., additional

Published
2014
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9. Abstracts

Author

Barthelemy, O., primary, Silvain, J., additional, Brieger, D., additional, Bellemain-Appaix, A., additional, Cayla, G., additional, Beygui, F., additional, Lancar, R., additional, Collet, J. P., additional, Mercadier, A., additional, Montalescot, G., additional, Cha, K. S., additional, Nam, Y. H., additional, Kim, J. H., additional, Park, S. Y., additional, Park, T. H., additional, Kim, M. H., additional, Kim, Y. D., additional, Lee, H. C., additional, Ahn, M. S., additional, Hong, T. J., additional, Blanco, R., additional, Blanco, F., additional, Szarfer, J., additional, Garcia Escudero, A., additional, Gigena, G., additional, Gagliardi, J., additional, Rodriguez, A., additional, Sarmiento, R., additional, Affatatto, S., additional, Riccitelli, M., additional, Petris, A., additional, Datcu, M. D., additional, Pop, C., additional, Radoi, M., additional, Arsenescu-Georgescu, C., additional, Petrescu, I., additional, Petrescu, L., additional, Serban, L., additional, Nechita, E., additional, Tatu-Chitoiu, G., additional, Dorobantu, M., additional, Benedek, I., additional, Craiu, E., additional, Sinescu, C., additional, Ionescu, D. D., additional, Ginghina, C., additional, Minescu, B., additional, Izzo, A., additional, Mantovani, P., additional, Tomasi, L., additional, Dall'oglio, L., additional, Bonatti, S., additional, Rosiello, R., additional, Romano, M., additional, Agostini, F., additional, Zanini, R., additional, Zhao, Z. Y., additional, Wu, Y. J., additional, Li, J. J., additional, Yany, Y. J., additional, Qian, H. Y., additional, Tang, Y. D., additional, Timoteo, A. T., additional, Toste, A., additional, Lousinha, A., additional, Ramos, R., additional, Oliveira, J. A., additional, Ferreira, M. L., additional, Ferreira, R. C., additional, Cabades, C., additional, Diez Gil, J. L., additional, Aguar, P., additional, Sanmiguel, D., additional, Lopez-March, A., additional, Marmol, R., additional, Guerra, L., additional, Girbes, V., additional, Ferrando, J., additional, Rincon De Arellano, A., additional, Patricio, L., additional, Blondal, M., additional, Ainla, T., additional, Marandi, T., additional, Eha, J., additional, Oliveira, M. M., additional, Silva, M. N., additional, Cunha, P. S., additional, Feliciano, J., additional, Silva, S., additional, Kanovsky, J., additional, Kala, P., additional, Parenica, J., additional, Poloczek, M., additional, Prymusova, K., additional, Kubkova, L., additional, Spinar, J., additional, Olinic, D., additional, Homorodean, C., additional, Ober, M., additional, Olinic, M., additional, Andrioaia, C., additional, Condac, A., additional, Masmoudi, M., additional, Berdaoui, B., additional, Labidi, S., additional, Tapia Ballesteros, C., additional, Hernandez Luis, C., additional, Sandin, M. G., additional, Vegas, J. M., additional, Andion, R., additional, Martinez, N., additional, Gonzalez, I. A., additional, Alvarado, M., additional, Amat, I. J., additional, San Roman, J. A., additional, Garcia Gonzalez, M. J., additional, Arroyo Ucar, E., additional, Hernandez Garcia, C., additional, Dorta Martin, M., additional, Marrero Rodriguez, F., additional, Dragu, R., additional, Kapeliovich, M., additional, Hammerman, H., additional, Silva, D., additional, Cortez-Dias, N., additional, Jorge, C., additional, Silva Marques, J., additional, Carilho Ferreira, P., additional, Robalo Martins, S., additional, Almeida Ribeiro, M., additional, Calisto, C., additional, Fiuza, M., additional, Lopes, M. G., additional, Milicevic, P., additional, Panic, M., additional, Stankovic, I., additional, Milicevic, D., additional, Kalezic, T., additional, Kafedzic, S., additional, Ilic, I., additional, Cerovic, M., additional, Putnikovic, B., additional, Neskovic, A., additional, Rott, D., additional, Leibowitz, D., additional, Monhart, Z., additional, Reissigova, J., additional, Grunfeldova, H., additional, Jansky, P., additional, Valente, B., additional, Villanueva Benito, I., additional, Solla, I., additional, Paredes, E., additional, Diaz Castro, O., additional, Calvo, F., additional, Baz, J. A., additional, Iniguez, A., additional, Aleksova, A., additional, Gerloni, R., additional, Belfiore, R., additional, Carriere, C., additional, Barbati, G., additional, Fabris, E., additional, Possa, F., additional, Nait, D., additional, Milo, M., additional, Sinagra, G., additional, Marques, N., additional, Mimoso, J., additional, Gomes, V., additional, Agra Bermejo, R. M., additional, Emad Abu Assi, E. A. A., additional, Sergio Raposeiras Roubin, S. R. R., additional, Pilar Cabanas Grandio, P. C. G., additional, Carlos Pena Gil, C. P. G., additional, Jose Maria Garcia Acuna, J. M. G. A., additional, Jose Ramon Gonzalez Juanatey, J. R. G. J., additional, Daly, M. J., additional, Scott, P., additional, Owens, C. G., additional, Tomlin, A., additional, Smith, B., additional, Adgey, A. A. J., additional, Alvarez-Contreras, L. R., additional, Juarez, U., additional, Altamirano, A., additional, Arias, A., additional, Alvarez-San Gabriel, A., additional, Gonzalez-Pacheco, H., additional, Martinez-Sanchez, C., additional, Rahnavardi, M., additional, Keshtkar-Jahromi, M., additional, Vakili, H., additional, Gholamin, S., additional, Razavi, S. M., additional, Gilis-Januszewski, T., additional, Mellwig, K.- P., additional, Wiemer, M., additional, Gilis-Januszewski, J., additional, Peterschroeder, A., additional, Koerfer, J., additional, Horstkotte, D., additional, Vrsalovic, M., additional, Getaldic, B., additional, Vrkic, N., additional, Pintaric, H., additional, Khan, S., additional, Wasan, B., additional, Moretti, L., additional, Grossi, P., additional, Silenzi, S., additional, Testa, M., additional, Candelori, L., additional, Clementi, L. N., additional, Forlini, M., additional, Lando, L., additional, Pezzuoli, M. L., additional, Corradetti, P., additional, Leurent, G., additional, Pennec, P. Y., additional, Filippi, E., additional, Moquet, B., additional, Hacot, J. P., additional, Druelles, P., additional, Rialan, A., additional, Rouault, G., additional, Coudert, I., additional, Le Breton, H., additional, Gevaert, S., additional, Tromp, F., additional, Vandecasteele, E., additional, De Somer, F., additional, Van Belleghem, Y., additional, Bouchez, S., additional, Martens, F., additional, Herck, I., additional, De Pauw, M., additional, Ludka, O., additional, Sepsi, M., additional, Miklik, R., additional, Dusek, L., additional, Tomcikova, D., additional, Garcia-Acuna, J. M., additional, Aguiar-Souto, P., additional, Raposeiras Roubin, S., additional, Agra-Bermejo, R., additional, Jacquet, M., additional, Abu-Assi, E., additional, Gonzalez-Juanatey, J. R., additional, Ibatov, A., additional, Labrova, R., additional, Karlik, R., additional, Lokaj, P., additional, She, Q., additional, Deng, S. B., additional, Huang, S. H., additional, Gu, L. J., additional, Rong, J. I. A. N., additional, Wu, Z. K., additional, Li, Y., additional, Zhang, J., additional, Parascan, L., additional, Campanile, A., additional, Spinelli, L., additional, Santulli, G., additional, Ciccarelli, M., additional, De Gennaro, S., additional, Assante Di Panzillo, E., additional, Trimarco, B., additional, Iaccarino, G., additional, Bobescu, E., additional, Datcu, G., additional, Dobreanu, D., additional, Doka, B., additional, Charniot, J.- C., additional, Cosson, C., additional, Albertini, J. P., additional, Bittar, R., additional, Giral, P., additional, Cherfils, C., additional, Guillerm, E., additional, Bonnefont-Rousselot, D., additional, Rusali, A., additional, Cojocaru, L., additional, Parepa, I., additional, Koizumi, T., additional, Iida, S., additional, Sato, J., additional, Kikutani, T., additional, Muramatsu, T., additional, Nishimura, S., additional, Komiyama, N., additional, Lee, W. P., additional, Ong, B. B., additional, Haralambos, K., additional, Townsend, D., additional, Rees, J. A. E., additional, Williams, E. J., additional, Halcox, J. P., additional, Mcdowell, I., additional, Damjanovic, M., additional, Koracevic, G., additional, Djordjevic-Radojkovic, D., additional, Pavlovic, M., additional, Krstic, N., additional, Ciric-Zdravkovic, S., additional, Stojkovic, A., additional, Perisic, Z., additional, Apostolovic, S., additional, Faustino, A., additional, Seca, L., additional, Barra, S., additional, Caetano, F., additional, Providencia, R., additional, Silva, J., additional, Gomes, P., additional, Costa, G., additional, Costa, M., additional, Leitao-Marques, A., additional, Volkova, A. L., additional, Arutyunov, G. P., additional, Bylova, N. A., additional, Dayter, I. I., additional, Jao, Y. T. F. N., additional, Fang, C. C., additional, Chen, Y., additional, Yu, C. L., additional, Wang, S. P., additional, Valencia, J., additional, Perez-Berbel, P., additional, Ruiz-Nodar, J. M., additional, Pineda, J., additional, Bordes, P., additional, Quintanilla, M., additional, Mainar, V., additional, Sogorb, F., additional, Santos, N., additional, Serrao, M., additional, Cafe, H., additional, Silva, B., additional, Oliveira, R., additional, Caires, G., additional, Drumond, A., additional, Araujo, J., additional, Providencia, R. A., additional, Gomes, P. L., additional, Pais, J. R., additional, Mota, P., additional, Leitao-Marques, A. M., additional, Farhan, S., additional, Jarai, R., additional, Tentzeris, I., additional, Vogel, B., additional, Freynhofer, M. K., additional, Wojta, J., additional, Huber, K., additional, Poli, M., additional, Trambaiolo, P., additional, Corsi, F., additional, De Luca, M., additional, Mustilli, M., additional, Lukic, V., additional, Simonetti, M., additional, Ferraiuolo, G., additional, Lettino, M., additional, Casella, G., additional, Conte, M. R., additional, De Luca, L., additional, Geraci, G., additional, Ceravolo, R., additional, Pani, A., additional, Fradella, G., additional, Schratter, A., additional, Thiele, H., additional, Klemm, T., additional, Demmin, K., additional, Lehmann, D., additional, Mende, M., additional, Schuler, G., additional, Pittl, U., additional, Chernova, A., additional, Nikulina, S. U., additional, Naruke, T., additional, Inomata, T., additional, Yanagisawa, T., additional, Maekawa, E., additional, Mizutani, T., additional, Shinagawa, H., additional, Nishii, M., additional, Takeuchi, I., additional, Takehana, H., additional, Izumi, T., additional, Paulo, C., additional, Mascarenhas, J., additional, Patacho, M., additional, Pimenta, J., additional, Bettencourt, P., additional, Nardai, S., additional, Szabo, G. Y., additional, Berta, B., additional, Edes, I., additional, Merkely, B., additional, Delgado Silva, J., additional, Baptista, R., additional, Faria, R., additional, Trigo, J., additional, Gago, P., additional, Gheorghe, G., additional, Nanea, I. T., additional, Cristea, A., additional, Almarichi, S., additional, Martins, H., additional, Saraiva, F., additional, Jorge, E., additional, Mendes, P. L., additional, Monteiro, P., additional, Costa, S., additional, Franco, F., additional, Providencia, L. A., additional, Nanea, T., additional, Gheorghe, G. S., additional, Visan, S., additional, Paun, N., additional, Gaber, R., additional, Delewi, R., additional, Nijveldt, R., additional, De Bruin, H. A., additional, Hirsch, A., additional, Van Der Laan, A., additional, Bouma, B. J., additional, Tijssen, J. P. G., additional, Van Rossum, A. C., additional, Zijlstra, F., additional, Piek, J. J., additional, Rus, H., additional, Donea, M., additional, Ciurea, C., additional, Ifteni, G., additional, Casolo, G., additional, Chioccioli, M., additional, Magnacca, M., additional, Del Meglio, J., additional, Comella, A., additional, Baratto, M., additional, Lera, J., additional, Salvadori, L., additional, Tessa, C., additional, Vignali, C., additional, Keca, Z., additional, Momcilov Popin, T., additional, Panic, G., additional, White, R., additional, Mateen, F., additional, Weaver, A., additional, Agmon, Y., additional, Okisheva, E., additional, Tsaregorodtsev, D., additional, Sulimov, V., additional, Amat Santos, I. J., additional, Hernandez, C., additional, Tapia, C., additional, Campo, A., additional, Fredman, D., additional, Svensson, L., additional, Rosenqvist, M., additional, Tadel-Kocjancic, S., additional, Radsel, P., additional, Knafelj, R., additional, Gorjup, V., additional, Noc, M., additional, Zima, E., additional, Jenei, Z. S., additional, Kovacs, E., additional, Osztheimer, I., additional, Molnar, L., additional, Horvath, A., additional, Becker, D., additional, Geller, L., additional, Maggi, R., additional, Furukawa, T., additional, Viscardi, V., additional, Brignole, M., additional, Leal, S. R. N., additional, Dores, H., additional, Rosario, I., additional, Monge, J., additional, Carvalho, M. J., additional, Arroja, I., additional, Leitao, A., additional, Fonseca, C., additional, Aleixo, A., additional, Silva, A., additional, Keuleers, S., additional, Herijgers, P., additional, Herregods, M. C., additional, Budts, W., additional, Dubois, C., additional, Meuris, B., additional, Verhamme, P., additional, Flameng, W., additional, Van De Werf, F., additional, Adriaenssens, T., additional, Badran, H., additional, Elnoamany, M., additional, Lolah, T., additional, Olariu, C., additional, Macarie, C., additional, Mollik, M. A. H., additional, Hassan, A. I., additional, Paul, T. K., additional, Haque, M. Z., additional, Jahan, R., additional, Rahmatullah, M., additional, Khatun, M. A., additional, Rahman, M. T., additional, Chowdhury, M. H., additional, Bustamante Munguira, J., additional, Tamayo, E., additional, Garcia-Cuenca, I., additional, Bustamante, E., additional, Gualis, J., additional, Gomez-Martinez, M. L., additional, Florez, S., additional, Gomez-Herreras, J. I., additional, Ramirez Rodriguez, R., additional, Ramirez Rodriguez, A. M., additional, Garcia-Bello, M. A., additional, Hernadez Ortega, E., additional, Caballero Dorta, E., additional, Garcia Quintana, A., additional, Piro Mastraccio, V., additional, Medina Fernandez Aceytuno, A., additional, Assanelli, E., additional, De Metrio, M., additional, Rubino, M., additional, Lauri, G., additional, Cabiati, A., additional, Campodonico, J., additional, Grazi, M., additional, Moltrasio, M., additional, Marana, I., additional, Marenzi, G., additional, Lovlien, M., additional, Schei, B., additional, Picon-Heras, R., additional, Acebal, C., additional, Garcia Rubira, J. C., additional, Vivas Balcones, D., additional, Nunez-Gil, I., additional, Ruiz-Mateos, B., additional, Ibanez, B., additional, Fernandez-Ortiz, A., additional, Vintila, V. D., additional, Enescu, O. A., additional, Stoicescu, C. I., additional, Udroiu, C., additional, Cinteza, M., additional, Tatu - Chitoiu, G., additional, Vinereanu, D., additional, Fresco, C., additional, De Biasio, M., additional, Muser, D., additional, Sappa, R., additional, Morocutti, G., additional, Bernardi, G., additional, Proclemer, A., additional, Fontanella, B., additional, Affatato, A., additional, Ciccarese, C., additional, Sacchini, M., additional, Volpini, M., additional, Bianchetti, F., additional, Verzura, G., additional, Dei Cas, L., additional, Pudil, R., additional, Blaha, V., additional, Vojacek, J., additional, Paraskevaidis, I., additional, Ikonomidis, I., additional, Parissis, J., additional, Papadopoulos, C., additional, Stasinos, V., additional, Bistola, V., additional, Anastasiou-Nana, M., additional, Shochat, M., additional, Shotan, A., additional, Kazatsker, M., additional, Gurovich, V., additional, Asif, A., additional, Noiman, E., additional, Levy, Y., additional, Blondhaim, D., additional, Rabinovich, P., additional, Meisel, S., additional, Petrovic, S., additional, Glasnovic, J., additional, Tomasevic, M., additional, Sakac, D., additional, Obradovic, S., additional, Londono Sanchez, O., additional, Pacreu, S., additional, Torres, L., additional, Mihaylov, G., additional, Shaban, G. M., additional, Trendafilova, E., additional, Krasteva, V., additional, Mudrov, T. S., additional, Didon, J. P., additional, Panageas, V., additional, Vlachos, N., additional, Pernat, A., additional, Radan, I., additional, Mozina, H., additional, Pepi, P., additional, Cionini, F., additional, Baccaglioni, N., additional, Viertel, A., additional, Havers, J., additional, Ballard, G., additional, Groenefeld, G., additional, Branco, L. M., additional, Ferreira, L., additional, Fiarresga, A., additional, Lettieri, L., additional, Reggiani, A., additional, Juarez Prera, R., additional, Blanco Palacios, G., additional, Martin, A.- C., additional, Manzo Silberman, S., additional, Chaib, A., additional, Varenne, O., additional, Allouch, P., additional, Salengro, E., additional, Jegou, A., additional, Margot, O., additional, Spaulding, C., additional, Diego, A., additional, De Miguel, A., additional, Cuellas, C., additional, Fraile, E., additional, Martin, J., additional, Vega, B., additional, Bangueses, R., additional, Fernandez-Vazquez, F., additional, Perez De Prado, A., additional, Leal, S., additional, Correia, M. J., additional, Monge, J. C., additional, Abecasis, J., additional, Garcia-Garcia, C., additional, Subirana, I., additional, Sala, J., additional, Bruguera, J., additional, Valle, V., additional, Sanz, G., additional, Fiol, M., additional, Aros, F., additional, Marrugat, J., additional, Elosua, R., additional, Barra, S. N. C., additional, Leitao Marques, A., additional, Yang, Y. J., additional, Xu, B., additional, Song, G. Y., additional, G, R. L., additional, Aleksic, A., additional, Serpytis, P., additional, Rucinskas, K., additional, Kalinauskas, A., additional, Karvelyte, N., additional, Santos De Sousa, C. I., additional, Ferreira, S., additional, Calaca, J., additional, Lousada, N., additional, Palma Reis, R., additional, Gualandro, D. M., additional, Seguro, L. F. B. C., additional, Braga, F. G. M., additional, Silvestre, O. M., additional, Lage, R. L., additional, Fabri, J., additional, Oliveira, M. T., additional, Urbano Moral, J. A., additional, Torres Llergo, J., additional, Solanilla Rodriguez, R., additional, Sanchez Gonzalez, A., additional, Martinez Martinez, A., additional, Den Uil, C. A., additional, Lagrand, W. K., additional, Van Der Ent, M., additional, Jewbali, L. S. D., additional, Cheng, J. M., additional, Spronk, P. E., additional, Simoons, M. L., additional, Mornos, C., additional, Dragulescu, D., additional, Ionac, A., additional, Guardado, J., additional, Azevedo, O., additional, Fernandes, M., additional, Canario-Almeida, F., additional, Sanfins, V., additional, Pereira, A., additional, Almeida, J., additional, Kaplunova, V. U., additional, Belenkov, Y. N., additional, Privalova, E. V., additional, Fomin, A. A., additional, Suvorov, A. Y., additional, Goodkova, A., additional, Rubakova, M. G., additional, Kuznetsova, I. A., additional, Semernin, E. N., additional, Keshavarzi, F., additional, Kojuri, J., additional, Mikhailov, V. M., additional, Vezhenkova, I. V., additional, Goodkova, A. Y. A., additional, Pavlovic, I., additional, Schwarz, M., additional, Jakl, G., additional, Smetana, P., additional, Perkmann, T., additional, Mayr, A., additional, Mair, J., additional, Klug, G., additional, Schocke, M., additional, Trieb, T., additional, Jaschke, W., additional, Pachinger, O., additional, Metzler, B., additional, Bronze Carvalho, L., additional, Azevedo, J., additional, Andrade, M. L., additional, Relvas, M. J., additional, Coucello, J., additional, Morais, G., additional, Seabra, M., additional, Afamefule, F., additional, Luaces Mendez, M., additional, Teijeiro-Mestre, R., additional, Nunez-Gil, I. J., additional, Leco-Gil, N., additional, Madronal-Cerezo, E., additional, Zannin, I., additional, Ruiz, J., additional, Orynchak, M. A., additional, Vakalyuk, I. I., additional, Vakalyuk, I. 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Published
2010
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12. Differences in sino-atrial and atrio-ventricular function with age and sex attributable to the Scn5a +/− mutation in a murine cardiac model.

Author

Jeevaratnam, K., Zhang, Y., Guzadhur, L., Duehmke, R. M., Lei, M., Grace, A. A., and Huang, C. L.-H.

Subjects
BRUGADA syndrome, VENTRICULAR fibrillation, ANIMAL models in research, CARDIAC pacemakers, HEART conduction system
Abstract

Aim: To investigate the interacting effects of age and sex on electrocardiographic (ECG) features of Scn5a +/− mice modelling Brugada syndrome. Methods: Recordings were performed on anaesthetized wild-type (WT) and Scn5a +/− mice and differences attributable to these risk factors statistically stratified. Results: Scn5a +/− exerted sex-dependent effects upon sino-atrial function that only became apparent with age. RR intervals were greater in old male than in old female Scn5a +/−. Atrio-ventricular (AV) conduction was slower in young female mice, whether WT and Scn5a +/−, than the corresponding young male WT and Scn5a +/− . However, PR intervals lengthened with age in male but not in female Scn5a +/− giving the greatest PR intervals in old male Scn5a +/− compared with either old male WT or young male Scn5a +/− mice. In contrast, PR intervals were similar in old female Scn5a +/− and in old female WT. QTc was prolonged in Scn5a+/ − compared with WT, and female Scn5a+/ − compared with female WT. Age-dependent alterations in durations of ventricular repolarization relative to WT affected male but not female Scn5a +/− . Thus, T-wave durations were greater in old male Scn5a +/− compared with old male WT, but indistinguishable between old female Scn5a +/− and old female WT. Finally, analysis for combined interactions of genotype, age and sex demonstrated no effects on P wave and QRS durations and QTc intervals. Conclusion: We demonstrate for the first time that age, sex and genotype exert both independent and interacting ECG effects. The latter suggest alterations in cardiac pacemaker function, atrio-ventricular conduction and ventricular repolarization greatest in ageing male Scn5a +/− . [ABSTRACT FROM AUTHOR]

Published
2010
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15. 16. Delayed conduction and its implications in murine SCN5a+/- hearts: independent and interacting effects of genotype, age and sex.

Author

Jeevaratnam, K., Tee, S. P., Zhang, Y., Guzadhur, Y., Duehmke, R., Grace, A. A., Lammers, W., Lei, M., and Huang, C. L. H.

Subjects
HEART conduction system, HEART diseases, RIGHT heart ventricle, ARRHYTHMIA, HEART beat
Abstract

SCN5A haploinsufficiencies are implicated in clinical arrhythmic conditions associated with cardiac conduction disorders. We examined myocardial conduction and its dispersion, and relationships between them, in murine Scn5a+/-" hearts modelling such clinical conditions. A 64- channel, multi-electrode array of electrode spacing 0.55-mm compared patterns of right ventricular activation in intrinsically beating Langendorff-perfused, male and female, and young (3⇔…months) and old (>12-month-old), Scn5a+/⇔' and WT hearts, from which monophasic action potentials were also obtained. Mean ventricular activation times (T*MEAN), spatial dispersions (D*S) between recording channels within a given cardiac cycle, and maximum activation times (T*MAX) representing the slowest possible conduction in any given heart were all higher in old male Scn5a+/-" compared to young male and old female Scn5a+/-" and old male WT. Temporal dispersions (D*T) of ventricular activation times at given recording channels were similarly higher in old male Scn5a+/-" compared to old male WT. In contrast, T*MEAN, D*T, D*S and T*MAX were indistinguishable between all WT groups. All groupings of D*T, D*S and T*MAX gave linear correlations with T*MEAN, each with indistinguishable slopes. In contrast, measures of monophasic action potential duration were indistinguishable between all groups. Genotype, age and sex thus exert significant (p<0.05) independent and/or interacting effects on both myocardial conduction and its dispersion. These variates appeared to influence D*T, D*S and T*MAX through actions on T*MEAN. Effects on both myocardial conduction and dispersion were greatest in old male Scn5a+/-" in direct parallel with features of the corresponding clinical arrhythmogenecity in Brugada Syndrome. [ABSTRACT FROM AUTHOR]

Published
2011
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17. The Importance of Mitral Valve Prolapse Doming Volume in the Assessment of Left Ventricular Stroke Volume with Cardiac MRI.

Author

Li R, Assadi H, Matthews G, Mehmood Z, Grafton-Clarke C, Kasmai B, Hewson D, Greenwood R, Spohr H, Zhong L, Zhao X, Sawh C, Duehmke R, Vassiliou VS, Nelthorpe F, Ashman D, Curtin J, Yashoda GK, Van der Geest RJ, Alabed S, Swift AJ, Hughes M, and Garg P

Subjects
Humans, Stroke Volume, Retrospective Studies, Ventricular Function, Left, Magnetic Resonance Imaging, Mitral Valve Prolapse pathology
Abstract

There remains a debate whether the ventricular volume within prolapsing mitral valve (MV) leaflets should be included in the left ventricular (LV) end-systolic volume, and therefore factored in LV stroke volume (SV), in cardiac magnetic resonance (CMR) assessments. This study aims to compare LV volumes during end-systolic phases, with and without the inclusion of the volume of blood on the left atrial aspect of the atrioventricular groove but still within the MV prolapsing leaflets, against the reference LV SV by four-dimensional flow (4DF). A total of 15 patients with MV prolapse (MVP) were retrospectively enrolled in this study. We compared LV SV with (LV SV MVP ) and without (LV SV standard ) MVP left ventricular doming volume, using 4D flow (LV SV 4DF ) as the reference value. Significant differences were observed when comparing LV SV standard and LV SV MVP ( p < 0.001), and between LV SV standard and LV SV 4DF ( p = 0.02). The Intraclass Correlation Coefficient (ICC) test demonstrated good repeatability between LV SV MVP and LV SV 4DF (ICC = 0.86, p < 0.001) but only moderate repeatability between LV SV standard and LV SV 4DF (ICC = 0.75, p < 0.01). Calculating LV SV by including the MVP left ventricular doming volume has a higher consistency with LV SV derived from the 4DF assessment. In conclusion, LV SV short-axis cine assessment incorporating MVP dooming volume can significantly improve the precision of LV SV assessment compared to the reference 4DF method. Hence, in cases with bi-leaflet MVP, we recommend factoring in MVP dooming into the left ventricular end-systolic volume to improve the accuracy and precision of quantifying mitral regurgitation.

Published
2023
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18. An updated systematic review on heart failure treatments for patients with renal impairment: the tide is not turning.

Author

Hey CY, Barra S, Duehmke R, Pettit S, Levy WC, Silva-Cardoso J, and Providência R

Subjects
Chronic Disease, Humans, Heart Failure complications, Heart Failure therapy, Renal Insufficiency, Chronic complications
Abstract

Advanced chronic kidney disease (CKD) frequently aggravates heart failure (HF). However, these patients have inherently been excluded from most HF trials. We aim to provide updated estimates of the representation of patients with advanced CKD and the provision of baseline renal function indices in HF trials with a focused interest on the landmark trials. Updated systematic review was performed from the inception of MEDLINE to 31 December 2019 to identify all chronic HF randomized trials published in the three major cardiology and medical journals, respectively, which included mortality endpoint. The included studies were analysed based on the representativeness of the advanced CKD population and the reporting of baseline renal function. A total of 187 eligible randomized trials with 322,374 participants were included in our analysis. One hundred and six trials (56.7%) had exclusion criteria related to renal function, which remained a continuing trend-55.1% (27/49) from inception-2000, 53.4% (39/73) from 2001-2010 and 61.5% (40/65) from 2011 (P = 0.64). The exclusion criteria, however, have become less restrictive. There was a temporal improvement in the likelihood of HF trials in providing baseline renal function indices (28.6% from inception-2000 versus 53.4% from 2001-2010 and 83.1% from 2011, P < 0.001). Concordant findings were observed in the landmark trials. Patients with advanced CKD remain underrepresented in HF trials in the contemporary era, even though the exclusion criteria have become less restrictive, and the quality of renal function monitoring has improved. The continued underrepresentation of patients with advanced CKD in HF trials merits measured broadening of eligibility in further trial studies., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2022
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19. Long-Term Impact of Body Mass Index on Survival of Patients Undergoing Cardiac Resynchronization Therapy: A Multi-Centre Study.

Author

Papageorgiou N, Briasoulis A, Barra S, Sohrabi C, Lim WY, Agarwal S, Oikonomou E, Duehmke R, Roubicek T, Polasek R, Behar JM, Rinaldi CA, Neto M, Goncalves M, Adragao P, Tousoulis D, Creta A, Rowland E, Ahsan S, Schilling RJ, Lambiase PD, Lowe M, Chow AW, and Providencia R

Subjects
Aged, Aged, 80 and over, Body Mass Index, Cardiac Resynchronization Therapy Devices, Defibrillators, Implantable statistics & numerical data, Female, Heart Failure epidemiology, Heart Transplantation statistics & numerical data, Heart-Assist Devices statistics & numerical data, Humans, Male, Middle Aged, Overweight epidemiology, Retrospective Studies, Survival Rate, Cardiac Resynchronization Therapy, Heart Failure therapy, Mortality, Obesity epidemiology
Abstract

Obesity is a risk factor for heart failure (HF), but its presence among HF patients may be associated with favorable outcomes. We investigated the long-term outcomes across different body mass index (BMI) groups, after cardiac resynchronization therapy (CRT), and whether defibrillator back-up (CRT-D) confers survival benefit. One thousand two-hundred seventy-seven (1,277) consecutive patients (mean age: 67.0 ± 12.7 years, 44.1% women, and mean BMI: 28.3 ± 5.6 Kg/m 2 ) who underwent CRT implantation in 5 centers between 2000-2014 were followed-up for a median period of 4.9 years (IQR 2.4 to 7.5). More than 10% of patients had follow-up for ≥10 years. Patients were classified according to BMI as normal: <25.0 Kg/m 2 , overweight: 25.0 to 29.9 Kg/m 2 and obese: ≥30.0 Kg/m 2 . 364 patients had normal weight, 494 were overweight and 419 were obese. CRT-Ds were implanted in >75% of patients, but were used less frequently in obese individuals. The composite endpoint of all-cause mortality or cardiac transplant/left ventricular assist device (LVAD) occurred in 50.9% of patients. At 10-year follow-up, less than a quarter of patients in the lowest and highest BMI categories were still alive and free from heart transplant/LVAD. After adjustment BMI of 25 to 29.9 Kg/m 2 (HR = 0.73 [95%CI 0.56 to 0.96], p = 0.023) and use of CRT-D (HR = 0.74 [95% CI 0.55 to 0.98], p = 0.039) were independent predictors of survival free from LVAD/heart transplant. BMI of 25 to 29.9 Kg/m 2 at the time of implant was independently associated with favourable long-term 10-year survival. Use of CRT-D was associated with improved survival irrespective of BMI class., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Published
2021
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20. Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review.

Author

Barra S, Providência R, Narayanan K, Boveda S, Duehmke R, Garcia R, Leyva F, Roger V, Jouven X, Agarwal S, Levy WC, and Marijon E

Subjects
Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac prevention & control, Electric Countershock, Humans, Risk Factors, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Cardiac Resynchronization Therapy, Defibrillators, Implantable, Heart Failure complications, Heart Failure therapy
Abstract

Aims: While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years., Methods and Results: Literature search from inception to 30 April 2018 for observational and randomized studies involving CRT patients, with or without defibrillator, providing specific cause-of-death data. Sudden cardiac death was the primary endpoint. For each study, rate of SCD per 1000 patient-years of follow-up was calculated. Trend line graphs were subsequently constructed to assess change in SCD rates over time, which were further analysed by device type, patient characteristics, and medical therapy. Fifty-three studies, comprising 22 351 patients with 60 879 patient-years of follow-up and a total of 585 SCD, were included. There was a gradual decrease in SCD rates since the early 2000s in both randomized and observational studies, with rates falling more than four-fold. The rate of decline in SCD was steeper than that of all-cause mortality, and accordingly, the proportion of deaths which were due to SCD declined over the years. The magnitude of absolute decline in SCD was more prominent among CRT-pacemaker (CRT-P) patients compared to those receiving CRT-defibrillator (CRT-D), with the difference in SCD rates between CRT-P and CRT-D decreasing considerably over time. There was a progressive increase in age, use of beta-blockers, and left ventricular ejection fraction, and conversely, a decrease in QRS duration and antiarrhythmic drug use., Conclusion: Sudden cardiac death rates have progressively declined in the CRT heart failure population over time, with the difference between CRT-D vs. CRT-P recipients narrowing considerably., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Published
2020
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21. Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients.

Author

Barra S, Duehmke R, Providência R, Narayanan K, Reitan C, Roubicek T, Polasek R, Chow A, Defaye P, Fauchier L, Piot O, Deharo JC, Sadoul N, Klug D, Garcia R, Dockrill S, Virdee M, Pettit S, Agarwal S, Borgquist R, Marijon E, and Boveda S

Subjects
Aged, Cohort Studies, Defibrillators, Implantable, Female, Humans, Male, Middle Aged, Propensity Score, Risk Factors, Severity of Illness Index, Survival Analysis, Time Factors, Cardiac Resynchronization Therapy mortality, Death, Sudden, Cardiac epidemiology
Abstract

Aims: The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D)., Methods and Results: A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death., Conclusion: In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Published
2019
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22. Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention.

Author

Barra S, Providência R, Boveda S, Duehmke R, Narayanan K, Chow AW, Piot O, Klug D, Defaye P, Gras D, Deharo JC, Milliez P, Da Costa A, Mondoly P, Gonzalez-Panizo J, Leclercq C, Heck P, Virdee M, Sadoul N, Le Heuzey JY, and Marijon E

Subjects
Aged, Cardiac Resynchronization Therapy adverse effects, Cardiomyopathy, Dilated complications, Female, Humans, Male, Propensity Score, Risk Factors, Tachycardia, Ventricular etiology, Tachycardia, Ventricular physiopathology, Treatment Outcome, Cardiac Resynchronization Therapy methods, Cardiomyopathy, Dilated therapy, Defibrillators, Implantable adverse effects, Pacemaker, Artificial adverse effects, Primary Prevention methods, Tachycardia, Ventricular prevention & control
Abstract

Objective: In patients indicated for cardiac resynchronisation therapy (CRT), the choice between a CRT-pacemaker (CRT-P) versus defibrillator (CRT-D) remains controversial and indications in this setting have not been well delineated. Apart from inappropriate therapies, which are inherent to the presence of a defibrillator, whether adding defibrillator to CRT in the primary prevention setting impacts risk of other acute and late device-related complications has not been well studied and may bear relevance for device selection., Methods: Observational multicentre European cohort study of 3008 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias, undergoing CRT implantation with (CRT-D, n=1785) or without (CRT-P, n=1223) defibrillator. Using propensity score and competing risk analyses, we assessed the risk of significant device-related complications requiring surgical reintervention. Inappropriate shocks were not considered except those due to lead malfunction requiring lead revision., Results: Acute complications occurred in 148 patients (4.9%), without significant difference between groups, even after considering potential confounders (OR=1.20, 95% CI 0.72 to 2.00, p=0.47). During a mean follow-up of 41.4±29 months, late complications occurred in 475 patients, giving an annual incidence rate of 26 (95% CI 9 to 43) and 15 (95% CI 6 to 24) per 1000 patient-years in CRT-D and CRT-P patients, respectively. CRT-D was independently associated with increased occurrence of late complications (HR=1.68, 95% CI 1.27 to 2.23, p=0.001). In particular, when compared with CRT-P, CRT-D was associated with an increased risk of device-related infection (HR 2.10, 95% CI 1.18 to 3.45, p=0.004). Acute complications did not predict overall late complications, but predicted device-related infection (HR 2.85, 95% CI 1.71 to 4.56, p<0.001)., Conclusions: Compared with CRT-P, CRT-D is associated with a similar risk of periprocedural complications but increased risk of long-term complications, mainly infection. This needs to be considered in the decision of implanting CRT with or without a defibrillator., Competing Interests: Competing interests: RP received training grant from Boston Scientific and Sorin Group and a Research Grant from Medtronic. SBo received consulting fees from Medtronic, Boston Scientific and Sorin Group. OP received travel support and consulting fees from Abbott, Boston Scientific, LivaNova and Medtronic. DK received consultant fees from St. Jude Medical, Medtronic, Sorin Group, Boston Scientific and Biotronik. PD received consulting fees from Boston Scientific, Medtronic, St Jude Medical and LivaNova. DG receiving consulting fees from Boston scientific, Medtronic, Biotronik, Abbot. PM received consulting fees from Biotronik, Boston Scientific and St Jude Medical. NS received consulting fees from Biotronik, Boston Scientific, Medtronic, Sorin Group and St. Jude Medical. J-YLH received consulting fees from Astra Zeneca, Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Meda, Novartis , Sanofi, Servier. All other authors have reported that they have no relationships relevant to the contents of this article to disclose., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2018
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23. Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy.

Author

Providencia R, Marijon E, Barra S, Reitan C, Breitenstein A, Defaye P, Papageorgiou N, Duehmke R, Winnik S, Ang R, Klug D, Gras D, Oezkartal T, Segal OR, Deharo JC, Leclercq C, Lambiase PD, Fauchier L, Bordachar P, Steffel J, Sadoul N, Piot O, Borgquist R, Agarwal S, Chow A, and Boveda S

Subjects
Aged, Female, Follow-Up Studies, Glomerular Filtration Rate physiology, Heart Failure diagnosis, Humans, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Treatment Outcome, Cardiac Resynchronization Therapy trends, Heart Failure physiopathology, Heart Failure therapy
Abstract

Background: Almost 1/3 of heart failure patients fail to respond to cardiac resynchronization therapy (CRT). A simple clinical score to predict who these patients are at the moment of referral or at time of implant may be of importance for early optimization of their management., Methods: Observational study. A risk score was derived from factors associated to CRT response. The derivation cohort was composed of 1301 patients implanted with a CRT defibrillator in a multi-center French cohort-study. External validation of this score and assessment of its association with CRT response and all-cause mortality and/or heart transplant was performed in 1959 CRT patients implanted in 4 high-volume European centers., Results: Independent predictors of CRT response in the derivation cohort were: female gender (OR = 2.08, 95% CI 1.26-3.45), NYHA class ≤ III (OR = 2.71, 95% CI 1.63-4.52), left ventricular ejection fraction ≥ 25% (OR = 1.75, 95% CI 1.27-2.41), QRS duration ≥ 150 ms (OR = 1.70, 95% CI 1.25-2.30) and estimated glomerular filtration rate ≥ 60 mL/min (OR = 2.01, 95% CI 1.48-2.72). Each was assigned 1 point. External validation showed good calibration (Hosmer-Lemeshow test-P = 0.95), accuracy (Brier score = 0.19) and discrimination (c-statistic = 0.67), with CRT response increasing progressively from 37.5% in patients with a score of 0 to 91.9% among those with score of 5 (Gamma for trend = 0.44, P < 0.001). Similar results were observed regarding all-cause mortality or heart transplant., Conclusion: The ScREEN score (Sex category, Renal function, ECG/QRS width, Ejection fraction and NYHA class) is composed of widely validated, easy to obtain predictors of CRT response, and predicts CRT response and overall mortality. It should be helpful in facilitating early consideration of alternative therapies for predicted non-responders to CRT therapy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Published
2018
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24. Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis.

Author

Barra S, Providência R, Duehmke R, Boveda S, Begley D, Grace A, Narayanan K, Tang A, Marijon E, and Agarwal S

Subjects
Aged, Cardiac Resynchronization Therapy adverse effects, Cause of Death, Electric Countershock adverse effects, Female, Heart Failure diagnosis, Humans, Incidence, Male, Middle Aged, Protective Factors, Risk Factors, Time Factors, Treatment Outcome, Cardiac Resynchronization Therapy mortality, Cardiac Resynchronization Therapy Devices, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable, Electric Countershock instrumentation, Electric Countershock mortality, Heart Failure mortality, Heart Failure therapy
Abstract

Aims: The additional benefit of a defibrillator in cardiac resynchronization therapy (CRT) patients is a matter of debate. Cause-of-death analysis in a CRT population has been recently proposed as a useful approach to gain insight into this problem. We performed a systematic review and meta-analysis looking at cause of death in studies involving CRT subjects with (CRT-D) or without (CRT-P) a defibrillator., Methods and Results: Literature search performed from inception to 31 March 2016 for relevant studies. Proportional and conventional meta-analyses were performed to obtain and compare causes of death in CRT-D vs. CRT-P patients, including sudden cardiac death (SCD), all-cause mortality, heart failure, cardiovascular, and non-cardiovascular mortalities. The systematic review included a total of 44 studies and 18 874 patients (13 248 receiving CRT-D and 5626 receiving CRT-P), representing 48 504 patient-years of follow-up. CRT-D recipients were younger, more often male, had lower NYHA class, less atrial fibrillation, more ischaemic heart disease and were more often on beta-blockers than those receiving CRT-P. There were an additional 42 deaths per 1000 patient-years in the CRT-P group compared with CRT-D (97 ± 9, 95% CI 79-115 vs. 55 ± 5, 95% CI 44-65, respectively), of which 35.7% were due to SCD (20 ± 2, 95% CI 15-24 vs. 5 ± 1, 95% CI 3-6) and the remaining 64.3% due to non-SCD. Of all deaths reported in CRT-D and CRT-P patients, 9.1% and 20.6% were due to SCD, respectively. The extent of SCD in CRT-P patients significantly increased in studies with higher percentage of males, ischaemic cardiomyopathy and NYHA class 3., Conclusion: Overall, compared with CRT-D patients, unadjusted mortality rate was almost two-fold higher in CRT-P recipients, with SCD representing one third of the excess mortality. Rate of SCD was significantly higher in certain subgroups (males, ischaemic cardiomyopathy, NYHA class 3), where a CRT-D may be of more pronounced benefit. This deserves further focused investigation., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)

Published
2018
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25. Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis.

Author

Barra S, Duehmke R, Providencia R, Marijon E, Boveda S, Virdee M, Heck P, Fynn S, Begley D, Grace A, and Agarwal S

Subjects
Aged, Aged, 80 and over, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac mortality, Arrhythmias, Cardiac physiopathology, Cardiac Pacing, Artificial methods, Cardiac Pacing, Artificial mortality, Cardiomyopathies etiology, Cardiomyopathies mortality, Cardiomyopathies physiopathology, Cause of Death, Death, Sudden, Cardiac etiology, Disease-Free Survival, Electric Countershock adverse effects, Electric Countershock mortality, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Arrhythmias, Cardiac therapy, Cardiac Pacing, Artificial adverse effects, Cardiac Resynchronization Therapy adverse effects, Cardiac Resynchronization Therapy mortality, Cardiac Resynchronization Therapy Devices, Cardiomyopathies therapy, Death, Sudden, Cardiac prevention & control, Defibrillators, Implantable, Electric Countershock instrumentation
Abstract

Aims: Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which these patients would also benefit from defibrillator back-up at the time of CRT upgrade is, however, unknown., Methods and Results: Retrospective observational cohort study of 199 patients with pacing-induced cardiomyopathy and no history of sustained ventricular arrhythmia, including 104 upgraded to CRT-Pacemaker (CRT-P) and 95 upgraded to CRT-Defibrillator (CRT-D). The incidence of ventricular arrhythmias and the risk of sudden arrhythmic death obtained through a cause-of-death analysis based on clinical data and necropsy results were assessed and compared between the two groups. During a mean follow-up of 66 ± 24 months, 40 (38.5%) CRT-P patients died: three from primary arrhythmic death, while the remaining died of different causes (especially progressive heart failure), giving an incidence of 6.2 sudden arrhythmic deaths per 1000 patient-years. No episode of sustained VT was observed in the study group. There were no sudden arrhythmic deaths in the CRT-D group during a shorter follow-up, but the small and non-significant difference in all-cause mortality between CRT-Pacemaker (CRT-P) and CRT-D groups was mostly accounted for by an increase in non-sudden death. Women upgraded to CRT were at particularly low risk of all-cause mortality compared with men (HR 0.232, P = 0.048)., Conclusion: Our findings suggest that patients who develop pacing-induced cardiomyopathy and are upgraded to CRT may not derive any significant benefit from the addition of the defibrillator in the absence of a history of ventricular arrhythmias., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.)

Published
2018
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26. Dual-site right ventricular pacing in patients undergoing cardiac resynchronization therapy: Results of a multicenter propensity-matched analysis.

Author

Providencia R, Barra S, Papageorgiou N, Ioannou A, Rogers D, Wongwarawipat T, Falconer D, Duehmke R, Colicchia M, Babu G, Segal OR, Sporton S, Dhinoja M, Ahsan S, Ezzat V, Rowland E, Lowe M, Lambiase PD, Agarwal S, and Chow AW

Subjects
Aged, Female, Heart Failure mortality, Humans, Male, Retrospective Studies, Survival Rate, Treatment Outcome, Cardiac Resynchronization Therapy methods, Defibrillators, Implantable, Heart Failure surgery, Pacemaker, Artificial, Propensity Score
Abstract

Background: Dual-site right ventricular pacing (Dual RV) has been proposed as an alternative for patients with heart failure undergoing cardiac resynchronization therapy (CRT) with a failure to deliver a coronary sinus (CS) lead. Only short-term hemodynamic and echocardiographic results of Dual RV are available. We aimed to assess the long-term results of Dual RV and its impact on survival., Methods: Multicenter retrospective assessment of all CRT implants during a 12-year period. Patients with failed CS lead implantation, treated with Dual RV, were followed and assessed for the primary endpoint of all-cause mortality and/or heart transplant. A control group was obtained from contemporary patients using propensity matching for all available baseline variables., Results: Ninety-three patients were implanted with Dual RV devices and compared with 93 matched controls. During a median of 1,273 days (interquartile range 557-2,218), intention-to-treat analysis showed that all-cause mortality and/or heart transplant was higher in the Dual RV group (adjusted hazard ratio [HR] = 1.66, 95% confidence interval [CI] 1.12-2.47, P = 0.012). As-treated analysis yielded similar results (HR = 1.97, 95% CI 1.31-2.96, P = 0.001). Cardiac device-related infections occurred seven times more frequently in the Dual RV site group (HR = 7.60, 95% CI 1.51-38.33, P = 0.014). Among Dual RV nonresponders, four had their apical leads switched off, five required an epicardial LV lead insertion, a transseptal LV lead was implanted in two, and in nine patients, after reviewing the CS venogram, a new CS lead insertion was successfully attempted., Conclusion: Dual RV pacing is associated with worse clinical outcomes and higher complication rates than conventional CRT., (© 2017 Wiley Periodicals, Inc.)

Published
2017
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27. Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure.

Author

Barra S, Providência R, Duehmke R, Boveda S, Marijon E, Reitan C, Borgquist R, Klug D, Defaye P, Sadoul N, Deharo JC, Sadien I, Patel K, Looi KL, Begley D, Chow AW, Le Heuzey JY, and Agarwal S

Subjects
Aged, Death, Sudden, Cardiac prevention & control, Europe epidemiology, Female, Follow-Up Studies, Heart Failure mortality, Heart Failure physiopathology, Humans, Incidence, Male, Propensity Score, Retrospective Studies, Risk Factors, Sex Distribution, Sex Factors, Survival Rate trends, Time Factors, Treatment Outcome, Ventricular Function, Left, Cardiac Resynchronization Therapy methods, Death, Sudden, Cardiac epidemiology, Electric Countershock methods, Heart Failure therapy
Abstract

Objective: Among primary prevention patients with heart failure receiving cardiac resynchronisation therapy (CRT), the impact of additional implantable cardioverter defibrillator (ICD) treatment on outcomes and its interaction with sex remains uncertain. We aim to assess whether the addition of the ICD functionality to CRT devices offers a more pronounced survival benefit in men compared with women, as previous research has suggested., Methods: Observational multicentre cohort study of 5307 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias having CRT implantation with (cardiac resynchronisation therapy defibrillator (CRT-D), n=4037) or without (cardiac resynchronisation therapy pacemaker (CRT-P), n=1270) defibrillator functionality. Using propensity score (PS) matching and weighting and cause-of-death data, we assessed and compared the outcome of patients with CRT-D versus CRT-P. This analysis was stratified according to sex., Results: After a median follow-up of 34 months (interquartile range 22-60 months) no survival advantage, of CRT-D versus CRT-P was observed in both men and women after PS matching (HR=0.95, 95% CI 0.77 to 1.16, p=0.61, and HR=1.30, 95% CI 0.83 to 2.04, p=0.25, respectively). With inverse-probability weighting, a benefit of CRT-D was seen in male patients (HR 0.78, 95% CI 0.65 to 0.94, p=0.012) but not in women (HR 0.87, 95% CI 0.63 to 1.19, p=0.43). The excess unadjusted mortality of patients with CRT-P compared with CRT-D was related to sudden cardiac death in 7.4% of cases in men but only 2.2% in women., Conclusions: In primary prevention patients with CRT indication, the addition of a defibrillator might convey additional benefit only in well-selected male patients., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Published
2017
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28. Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate.

Author

Barra S, Boveda S, Providência R, Sadoul N, Duehmke R, Reitan C, Borgquist R, Narayanan K, Hidden-Lucet F, Klug D, Defaye P, Gras D, Anselme F, Leclercq C, Hermida JS, Deharo JC, Looi KL, Chow AW, Virdee M, Fynn S, Le Heuzey JY, Marijon E, and Agarwal S

Subjects
Aged, Aged, 80 and over, Cardiomyopathy, Dilated mortality, Cohort Studies, Europe epidemiology, Female, Humans, Male, Myocardial Ischemia mortality, Cardiac Resynchronization Therapy, Cardiac Resynchronization Therapy Devices, Cardiomyopathy, Dilated therapy, Defibrillators, Implantable, Myocardial Ischemia therapy
Abstract

Background: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT)., Objectives: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure., Methods: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes., Results: After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM., Conclusions: Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM., (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2017
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29. Determination of cable parameters in skeletal muscle fibres during repetitive firing of action potentials.

Author

Riisager A, Duehmke R, Nielsen OB, Huang CL, and Pedersen TH

Subjects
Animals, Membrane Potentials, Mice, Mice, Inbred C57BL, Muscle Fibers, Skeletal metabolism, Action Potentials, Muscle Fibers, Skeletal physiology, Patch-Clamp Techniques methods
Abstract

Recent studies in rat muscle fibres show that repetitive firing of action potentials causes changes in fibre resting membrane conductance (Gm) that reflect regulation of ClC-1 Cl(-) and KATP K(+) ion channels. Methodologically, these findings were obtained by inserting two microelectrodes at close proximity in the same fibres enabling measurements of fibre input resistance (Rin) in between action potential trains. Since the fibre length constant (λ) could not be determined, however, the calculation of Gm relied on the assumptions that the specific cytosolic resistivity (Ri) and muscle fibre volume remained constant during the repeated action potential firing. Here we present a three-microelectrode technique that enables determinations of multiple cable parameters in action potential-firing fibres including Rin and λ as well as waveform and conduction velocities of fully propagating action potentials. It is shown that in both rat and mouse extensor digitorum longus (EDL) fibres, action potential firing leads to substantial changes in both muscle fibre volume and Ri. The analysis also showed, however, that regardless of these changes, rat and mouse EDL fibres both exhibited initial decreases in Gm that were eventually followed by a ∼3-fold, fully reversible increase in Gm after the firing of 1450-1800 action potentials. Using this three-electrode method we further show that the latter rise in Gm was closely associated with excitation failures and loss of action potential signal above -20 mV., (© 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society.)

Published
2014
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30. The impact of the right ventricular lead position on response to cardiac resynchronization therapy.

Author

Khan FZ, Salahshouri P, Duehmke R, Read PA, Pugh PJ, Elsik M, Begley D, Fynn SP, Dutka DP, and Virdee MS

Subjects
Aged, Cardiac Resynchronization Therapy methods, Cardiac Resynchronization Therapy statistics & numerical data, Female, Heart Failure diagnosis, Heart Ventricles, Humans, Male, Prevalence, Prosthesis Implantation methods, Treatment Outcome, United Kingdom epidemiology, Cardiac Resynchronization Therapy Devices statistics & numerical data, Electrodes, Implanted, Heart Failure epidemiology, Heart Failure prevention & control, Prosthesis Implantation statistics & numerical data
Abstract

Introduction: Left ventricular (LV) lead placement to the latest contracting area (concordant LV lead) is associated with better response to cardiac resynchronization therapy (CRT) compared to a discordant LV lead. However, the effect of the right ventricular (RV) lead site on CRT response is unclear. We investigated the relationship of the RV and LV lead positions on CRT response., Methods: In 131 CRT patients, the LV lead was positioned preferentially in a lateral or posterolateral vein and the RV lead to either the RV septum (RVS, n = 55) or RV apex (RVA, n = 76). The latest site of contraction was determined with two-dimensional speckle tracking radial strain imaging and patients had a concordant LV lead position if pacing the latest segment, and discordant if not. Response was defined as ≥15% reduction in LV end systolic volume (LVESV) at 6-month follow-up., Results: There were no significant differences in mean reduction of LVESV at follow-up (RVS vs RVA: -23.3 ± 16% vs 22.1 ± 18%, P = 0.70) or rate of responders (58.2% vs 57.9%, P = 0.97) between the two groups. In patients with a concordant LV lead (n = 71), the response rate was significantly higher than those with a discordant lead (76.1% vs 36.7%, P < 0.001). There were no differences in outcomes in patients with a concordant or discordant LV lead according to the RV lead location., Conclusion: The extent of LV reverse remodeling following CRT is not related to the RV lead position, but is significantly higher in patients with a concordant LV lead., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)

Published
2011
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31. Delayed conduction and its implications in murine Scn5a(+/-) hearts: independent and interacting effects of genotype, age, and sex.

Author

Jeevaratnam K, Poh Tee S, Zhang Y, Rewbury R, Guzadhur L, Duehmke R, Grace AA, Lei M, and Huang CL

Subjects
Action Potentials, Aging, Animals, Female, Fibrosis, Genotype, Haploinsufficiency, Heart drug effects, Ion Channel Gating physiology, Male, Mice, Mice, Knockout, Myocardium pathology, NAV1.5 Voltage-Gated Sodium Channel, Sex Factors, Heart physiology, Heart Conduction System physiology, Sodium Channels genetics
Abstract

We explored for relationships between SCN5A haploinsufficiency, implicated in clinical arrhythmogenicity, and right ventricular (RV) conduction disorders in Langendorff-perfused, male and female, and young (3 months) and old (>12 month old) Scn5a ( +/-) and wild type (WT) hearts. The investigated conditions of genotype, age, and sex affected latencies but not repolarization time courses of RV monophasic action potentials. This prompted examination of the patterns of RV epicardial activation, its dispersion, and their interrelationships as possible arrhythmic mechanisms using a 64-channel, multi-electrode array. Mean ventricular activation times (T*(MEAN)), spatial dispersions (D* (S)) between recording channels/cardiac cycle, and maximum activation times (T* (MAX)) representing the slowest possible conduction in any given heart were all higher in old male Scn5a ( +/-) compared with young male and old female Scn5a ( +/-) and old male WT. Temporal dispersions (D*(T)) of recording channels were similarly higher in old male Scn5a (+/-) compared with old male WT. All groupings of D*(T), D*(S), and T*(MAX) nevertheless linearly correlated with T*(MEAN), with indistinguishable slopes. The variates explored thus influence D*(T), D*(S), and T*(MAX) through actions on T*(MEAN). These findings in turn correlated with increased levels of fibrosis in young male, young female, and old male Scn5a ( +/-) compared with the corresponding WTs. We thus demonstrate for the first time independent and interacting effects of genotype, age, and sex on epicardial conduction and its dispersions at least partially attributable to fibrotic change, resulting in the greatest effects in old male Scn5a ( +/-) in an absence of alterations in repolarization time courses. This directly implicates altered depolarization in the clinical arrhythmogenicity associated with Scn5a ( +/-).

Published
2011
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