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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dr. Valeriano and Dr. Fabbricatore have been supported by a research grant provided by the Cardiopath PhD program (University of Naples Federico II) Background Recent developments in radiofrequency (RF) ablation technologies have improved the efficacy of pulmonary vein isolation (PVI). The combination of the ablation index, lesion tags, and optimized inter-lesion distance (CLOSE protocol) has further reduced the incidence of gaps along the ablation lines. This high acute success rate challenged the use of conventional circular mapping catheters and prompted a single catheter-approach ablation strategy. Modulating the relationship between resistive and conductive heating, high-power short-duration (HPSD) ablation technology can potentially increase lesion-to-lesion consistency. A novel catheter with optimized temperature control and microelectrodes has been recently designed to further improve workflow efficiency. Purpose: This study aimed to assess the efficacy and efficiency of HPSD ablation in a standardized single-catheter workflow for PVI. Methods: Data on consecutive AF ablations performed with HPSD catheter from December 2020 to December 2021 at a single tertiary-care center were prospectively collected. The workflow consisted of a procedure sequence including single transeptal access with a bidirectional steerable sheath, 3D modeling with 3D rotational angiography, assessment of PV potentials with microelectrodes in each vein (figure 1), followed by radiofrequency encircling of the PVs using a high-power setting of 50W in a temperature- and flow-controlled mode with CLOSE-guided protocol. Isolation was validated by reassessing the previously observed PV potentials and by pacing within the lesion set. Results: A total of 73 consecutive AF patients (67% paroxysmal, 33% persistent) were included. All patients received PVI, 15 underwent additional cavotricuspid isthmus ablation and 6 received additional treatments (table 1). Mean procedure time was 68±27 min with minimal fluoroscopy time and dose (3.2±2.1 min; 4.7±3.9 Gycm2). Complications were infrequent with 1 cardiac tamponade and 1 pericarditis. First-pass isolation was achieved in 91% of the circles and validation by microelectrodes successfully identified the residual gaps with 100% of acute procedural success. In a selected cohort of 20 patients with paroxysmal AF undergoing PVI-only procedure performed by an expert operator, the ablation time was 22.8±5.1 min with a skin-to-skin time of 47.3±7.1 min (table 2). The median follow-up duration was 397 days (IQR: 367-462). AT/AF free survival rate was 90% at 12 months. Conclusions: HPSD ablation using a standardized single-catheter workflow improved the procedural efficiency of PVI and resulted in a high rate of first-pass isolation with a low recurrence rate at 12-month follow-up.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Background Electrogram morphology is used to identify the atrio-ventricular annuli during catheter ablation procedures with a "balanced" signal considered to represent the annuli. However, anatomical studies highlight a significantly greater mass of ventricular myocardium compared to atrial myocardium at the valve plane suggesting the correct electrical signature of the anatomical annulus may not be a balanced signal. Purpose To identify the relationship between atrial and ventricular electrogram components at the anatomically defined mitral valve annulus. Methods Mapping of the mitral annulus was performed in patients undergoing ablation for paroxysmal atrial fibrillation. Following femoral venous access and trans-septal puncture, left atrial anatomy was defined using rotational angiography performed using a 100ml contrast injection 4 seconds prior to X-ray acquisition, during rapid pacing and apnoea while covering 200 degrees at 40 degrees/s. A SmartTouch SF ablation catheter (Biosense Webster) was advanced into the left atrium and used to record intracardiac electrograms at four positions around the mitral annulus and at five predetermined levels ranging from ventricular to atrial (Figure, panel A). Data analysis was performed using OpenEP (https://openep.io). For each electrogram, the distance to the mitral valve plane and the amplitudes of atrial and ventricular electrogram components were calculated (Figure, panel B and C). Mean electrogram component amplitudes were calculated including all points recorded within ±2.5mm of the mitral valve plane. For each patient, a linear regression model was fitted and used to identify the atrial/ventricular ratio at the anatomically defined mitral valve annulus (Figure, panel D). Results The protocol was completed in 9 patients, including analysis of 240 atrial or ventricular electrogram components. Within ±2.5mm of the anatomically defined mitral valve annulus, the mean recorded amplitudes of atrial and ventricular electrogram components was 0.15±0.17mV and 1.35±1.27mV, respectively (A/V ratio 1:9). Using the linear regression model, the ventricular electrogram component was calculated to be 16.5±11.6 times greater in amplitude than the atrial electrogram component at the mitral valve plane (A/V ratio 1:16). The use of a balanced signal to identify the mitral valve annulus resulted in a positional error of -7.9±9.5mm (i.e. identifying a level which is approximately ~8mm too "atrial" compared to the anatomically defined annulus). Conclusion The conventional use of a "balanced" electrogram signal does not identify the anatomical mitral valve annulus. An atrial/ventricular electrogram ratio between 1:9 and 1:16 best approximates the mitral valve annular plane determined by left atrial rotational angiography. These findings have relevance in target site selection for an accessory pathway and the ventricular extent of linear ablation at the mitral isthmus.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dr. Fabbricatore and Dr Valeriano have been supported by a research grant provided by the Cardiopath PhD program (University of Naples Federico II) Background Pulmonary vein isolation (PVI) is increasingly performed globally for the treatment of atrial fibrillation [1]. Using a standardized and reproducible workflow, we previously reported an average procedure time of 76.1 ± 26.2 min [2]. Over the last few years, due to workflow optimization and new technological developments, we were able to reduce the skin-to-skin time towards 47.3 ± 7.1 min (unpublished data). Our workflow implements rotational angiography (RA) of the left atrium (LA), which is segmented manually, then converted to a 3D mesh and finally imported into the electroanatomical mapping system (EAM). A second 3D mesh is created by cutting the left bottom anterior part of the LA, including the left atrial appendage, in order to clearly visualize the ridge (Figure 1). Recently, we developed an integrated artificial intelligence (AI) pipeline to automate this process (Figure 2). OBJECTIVE The aim of the study was to evaluate the efficiency of the new AI-based fully automated anatomical mapping of the LA and the efficacy of the automated segmentation. Methods The last 50 PVI procedures that were manually segmented in our lab were processed once more using the AI pipeline. The efficiency of the AI pipeline was assessed by comparing the elapsed time, for both our current manual workflow and the AI pipeline, between the reconstruction of the computed tomography (CT) volume from the 2D RA and the moment both 3D meshes are imported into the EAM. The efficacy of the pipeline was analyzed by calculating the Dice coefficient between the manual and automated segmentation as well as by visually grading segmentation quality on a 4-point Likert scale (1: Bad,2: Sufficient, 3: Good, 4: Excellent) by an experienced cardiac electrophysiologist. Significance testing of timing and visual grading differences between both workflows was performed using a one-sided Wilcoxon signed-rank test. Variables were summarized using median (Q1-Q3). Results The time to segment the LA, create the 3D meshes and import them into the EAM was significantly reduced from 560.0 (513.0–636.5) seconds to 52.0 (49.0–56.0) seconds for the manual and automated workflow respectively (p Conclusion We developed an efficient and effective AI pipeline enabling fully automated anatomical mapping of the LA, potentially reducing our current PVI skin-to-skin time by 18%. The robustness of the AI segmentation model has been validated objectively (Dice coefficient) and subjectively. The efficacy of the AI cut model, the second model in the pipeline, remains to be verified.

Funding Acknowledgements Type of funding sources: None. Background The early AF treatment by radio-frequency catheter ablation is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing catheter ablation is still under debate. Aims To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing catheter ablation. Methods We prospectively enrolled (between September 2017 and May 2019) 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views. Results After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p < 0.001) and LASct (10.9% vs. 13.2%, p < 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p < 0.001) and the strongest independent predictive value (LASr > 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not. Conclusion In HFpEF patients with paroxysmal AF undergoing catheter ablation, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm.

Introduction Coronavirus disease 2019 (COVID-19) rapidly spread across the globe,evolving into a global pandemic,with a crucial impact on healthcare systems. Several short-term follow-up studies emphasized the persistence of symptoms, referred as long COVID, in a significant number of discharged patients even without history of cardiopulmonary diseases, with dyspnea being one of the most frequent complaint [1–3]. Even though those reports on recovered COVID-19 patients did not describe major left ventricle (LV) function abnormalities, subtle cardiac changes may be present. Purpose We aimed to investigate the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE) in recovered COVID-19 patients, without previous cardiopulmonary disease at 1 year follow-up. Methods 310 COVID-19 consecutive hospitalized patients were prospectively included between March and April 2020. 66 patients out of 251 recovered patients had no previous history of coronary artery disease, arrhythmia, arterial hypertension, valvular heart disease, asthma, chronic obstructive pulmonary disease and obstructive sleep apnea, respectively and were included in the final analysis (Figure 1). The follow-up consisted in 2 parts, a 6-months visit including clinical and physical examination, chest computed tomography and spirometry and a 12-months visit including clinical and physical examination, spirometry and TTE. Results 66 patients (mean age 51.39±11.15 years, 45 (68.2%) males) were included in the final analysis. 23 (34.8%) patients reported dyspnea at 1 year. TTE parameters were in the normal range, with a mean LV ejection fraction of 56.9±4.6%, mean global longitudinal strain (GLS) of −20.9±2.3%, global constructive work (GCW) of 2381.4±463.6 mmHg% and global work index (GWI) of 2132.5±419.2 mmHg%. Type 1 diastolic dysfunction was observed in 11 (16.7%) patients. One (1.5%) patient had type 2 diastolic dysfunction. A normal respiratory pattern was reported in 31 (47%) patients at 6 months spirometry, while 19 (28.8%) patients had a restriction pattern. No significant differences regarding clinical, laboratory or imaging findings at baseline were found between groups. The following TTE parameters were significantly different in patients with and without dyspnea at 1 year: GLS (−19.97±2.14 vs. −21.38±2.37, p=0.039), GCW (2183.72±487.93 vs. 2483.14±422.42, p=0.024) and GWI (1960.06±396.21 vs. 2221.17±407.99, p=0.030). Multivariable logistic regression showed that GCW and GWI were inversely and independently associated with persistent dyspnea, one year after COVID-19 (p=0.035, OR 0.998, 95% CI 0.997–1.000; p=0.040, OR 0.998, 95% CI 0.997–1.000) (Table 1). Conclusions Persistent dyspnea one year after COVID-19 was present in more than a third of patients without known cardiovascular or pulmonary diseases. GCW and GWI were the only echocardiographic parameters independently associated with symptoms, suggesting a decrease in myocardial performance in this population and subclinical cardiac dysfunction. Funding Acknowledgement Type of funding sources: None.

Background Long COVID emerged as a new condition, following the acute episode of coronavirus disease 2019 (COVID-19),exerting a significant impact on patients' quality of life [1]. Several studies involving COVID-19 survivors emphasized the presence of cardiac abnormalities following the acute infection. However, data on possible mechanisms associated to long COVID remain limited. Clinical applications of myocardial work (MW) analysis, assessed by transthoracic echocardiography (TTE) have expended recently, showing an additional value in detecting cardiac dysfunction compared to standard parameters such as left ventricle ejection fraction (LVEF) or global longitudinal strain (GLS) in various pathologies, including COVID-19 [2]. Nevertheless, its potential role in detecting subclinical cardiac dysfunction in long COVID remained unexplored. Purpose We assessed the association between subclinical cardiac dysfunction evaluated by global work index (GWI) and global constructive work (GCW) and long COVID. Methods We included 310 COVID-19 patients hospitalized between March and April 2020. All patients were invited to a systematic one-year follow-up, including clinical evaluation, TTE with MW assessment, chest-computed tomography and spirometry. 140 patients completed the follow-up. Normal values for GWI and GCW were defined as 1926±247 mmHg% and 2224±229 mmHg% [3]. The primary endpoint was long COVID, characterized by a cluster of symptoms such as fatigue or dyspnea more than 3 months after the acute infection, without any other explanation. Results 140 patients (57.1±13.9 years, 90 (64.3%) males) had a mean follow-up of 337.1±34.5 days.The mean values of LVEF, GWI and GCW were 55.2±3.2%, 2105.9±403.3 mmHg% and 2377.8±446.2 mmHg%. 83 (61%) patients had long COVID. No significant differences in terms of comorbidities, clinical evaluation and COVID-19 severity were found between patients with and without long COVID. GCW (2276.7±410.3 vs 2516.5±458.6, p=0.006) and GWI (2008.5±358.9 vs 2242.2±427.0, p=0.003) were the only TTE parameters different between patients with and without long COVID. Multivariable regression analysis showed that GWI Conclusions Long COVID, frequently observed in recovered COVID-19 patients may indicate the presence of subclinical cardiac dysfunction, reflected by a decrease of the left ventricle performance, assessed by GWI and GCW.Long-term follow-up including cardiac screening should be performed in order to identify patients at risk who would benefit from cardiac rehabilitation programs. Funding Acknowledgement Type of funding sources: None.

Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with dyspnea and paroxysmal atrial fibrillation (AF) is challenging. Speckle tracking-derived left atrial strain (LAS) provides an accurate estimate of left ventricular (LV) filling pressures and left atrial (LA) phasic function. However, data on clinical utility of LAS in patients with dyspnea and AF are scarce. Objective: To assess relationship between the LAS and the probability of HFpEF in patients with dyspnea and paroxysmal AF. Methods: The study included 205 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%), who underwent speckle tracking echocardiography during sinus rhythm. Probability of HFpEF was estimated using H2FPEF and HFA-PEFF scores, which combine clinical characteristics, echocardiographic parameters and natriuretic peptides. Results: Patients with high probability of HFpEF were significantly older, had higher body mass index, NT-proBNP, E/e’, pulmonary artery pressure and larger LA volume index than patients in low-to-intermediate probability groups (all p < 0.05). All components of LAS and LA strain rate showed proportional impairment with increasing probability of HFpEF (all p < 0.05). Out of the speckle tracking-derived parameters, reservoir LAS showed the largest area under the curve (AUC = 0.78, p < 0.001) and the strongest independent predictive value (OR: 1.22, 95% CI 1.08–1.38) to identify patients with high probability of HFpEF. Conclusions: Reservoir LAS shows a high diagnostic performance to distinguish HFpEF from non-cardiac causes of dyspnea in symptomatic patients with paroxysmal AF.

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiovascular Abbott D. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program Background Pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is an increasingly performed procedure worldwide, presenting an attractive opportunity for performing it in a day care setting.[1] The main reason for delayed discharge are the potential vascular complications that may occur.[2–5] There is still a lack of knowledge considering the usage of vascular closure devices in the electrophysiological field. Purpose The aim of the study was to evaluate feasibility, safety, and efficacy of a suture-mediated vascular closure device in ambulatory management after PVI. Methods Prospective single-centre cohort study on 50 patients admitted for PVI from January 2020 to May 2021. At the end of the procedure, a suture-mediated vascular closure system was used for each vascular access. The feasibility of an ambulatory PVI strategy was assessed as the percentage of patients being able to be discharged the same day of the procedure. Outcomes were defined as acute rate of vascular device closure performance, postprocedural time to haemostasis, time to ambulation and time to discharge. Vascular complications, analysed on the total number of patients enrolled, were assessed during the 30-days follow-up. Results A total of 48/50 (96%) patients were discharged at the same day of the procedure. Haemostasis was reached within 1 minute after the deployment of the device in 30 patients (60%). During the post-operative stay, two patients had minor bleeding without necessity of intervention and one patient was kept in supine position until an ultrasound evaluation resulted negative. Mean and median time to be deemed suitable for discharge in the 48 patients who reached the primary endpoint were 4:55 (±00:54) and 4:48 (2:50-7:30) hours respectively. Mean and median time to discharge were 5:48 (± 1:03) and 5:51 (3:38-7:57) hours respectively. Patient satisfaction was queried and resulted excellent. No major vascular complications were observed during 30-days follow up. Minor complications occurred in 4 patients and were three minor superficial haematomas ( Conclusion The use of a closure device for femoral venous accesses after PVI led to a safe discharge of patients within 6 hours from the intervention in 96% of the population. The ambulatory management described in the abstract could be useful for minimizing the overcrowding of healthcare facilities and reduce the post-operative recovery time and management. Additionally, patients were satisfied with the treatment received. Randomised trials are needed for further evaluate the efficacy of this approach.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dr. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program Background Gram-negative bacteria (GNB) are unfrequently isolated from patients with cardiac implantable electronic device (CIED) infection. However, data about risk factors for GNB-CIED-infection and associated clinical outcome are missing. Methods Multicenter, retrospective case-control-control study. Adult patients undergoing CIED implantation from Jan 2015 to Dec 2019 were included and classified as case (C) if diagnosed of GNB-CIED-infection; control 1 (C1) if diagnosed with Gram positive bacteria (GPB)-CIED infection; and control 2 (C2) if no CIED-infection was diagnosed during the study period. Patients were matched by center and risk period (from CIED implantation to infection diagnosis ±1 month), with a minimum follow-up period after infection diagnosis of 180 days. Results Study cohort consisted of 134 patients (33 C, 53 C1 and 42 C2) from 11 centers. Overall, 99 (73.9%) were male, median age 73 (IQR 66-81) years. Cardiac diseases leading to CIED implantation were bradi-arrythmia (48%), hearth failure (23.5), and primary prevention (20.6%). There were not differences for demographic variables and Charlson Index between C, C1 and C2. Time from implantation to infection diagnosis was similar between C and C1 [274 (39-621) vs 220 (58-866) days, p=0.581]. Shariff score was lower in C compared with C1 [1(1-2) vs 2 (1-3); p Conclusions GNB-CIED infection is associated with higher 6-month mortality than GPB- or no-CIED infections, prior GNB infection may favor subsequent GNB-CIED infection, the role of PET-FDG in diagnosing GNB-CIED infection seems to be key.

Background/Introduction The inspIRE clinical trial was designed to assess the safety and efficacy of a fully integrated biphasic pulsed field ablation (PFA) system comprised of a multi-channel generator, variable decapolar irrigated loop circular catheter, and mapping system (Figure A) for the treatment of paroxysmal atrial fibrillation (PAF). Purpose Using this novel PFA system in a multicentre clinical trial, we present the initial feasibility of electrical pulmonary vein isolation (PVI), procedural performance, and acute safety results. Methods inspIRE is a prospective, non-randomized, multi-centre study, planned to enrol up to 550 patients. PVI is performed with the novel, variable loop circular catheter, compatible mapping system and generator. Acute procedural effectiveness (entrance block in all clinically targeted PVs post adenosine/isoproterenol challenge) and the incidence of primary adverse events (PAEs) were assessed. PAEs are defined as the occurrence of cardiac tamponade/perforation, myocardial infarction, stroke/cerebrovascular accident, thromboembolism, transient ischemic attack, permanent phrenic nerve paralysis, pulmonary edema, pericarditis, and any major vascular access complications within 7 days of the ablation procedure. Additionally, any incidence of procedure or device related death, atrio-esophageal fistula, or PV stenosis (related to the ablation procedure or study catheter) within the 12M follow-up period is classified as a PAE. Results A total of 35 PAF subjects (age 59.7±10.7 years, 54.3% male) were treated across 5 European sites by 6 operators. Acute procedural success was achieved in 100% of study subjects (Figure B) with zero incidence of PAEs. Mean total procedure time was 82.9±19.9 minutes with 27.0±11.9 minutes of PFA from first to last application. Average fluoroscopy use was 10.6±6.8 minutes and LA dwell time was 45.6±15.3 minutes. Conclusion Initial results of the inspIRE trial demonstrate the acute safety and effectiveness of the new integrated IRE circular catheter, mapping system and generator for PVI in PAF patients. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): inspIRE is a company-sponsored study funded by Biosense Webster, Inc. Figure 1. (A) PFA System; (B) PVI Voltage Map

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): International PhD Program in Cardiovascular Pathophysiology and Therapeutics CardioPaTh Background Radio-frequency catheter ablation (CA) is associated with changes of left atrial (LA) structure and function. However, the data on the accuracy of automated analysis of LA strain (LAS) are unavailable. Therefore, the aim of the present study was to compare automated with manual LAS analysis in patients with atrial fibrillation (AF) undergoing CA during sinus rhythm. Methods We prospectively enrolled 36 consecutive patients (age: 62 ± 22 years, 33% female) with symptomatic AF and preserved left ventricular (LV) ejection fraction (≥50%) undergoing the CA during sinus rhythm. All patients underwent comprehensive echocardiography at 1-day pre-CA and at 1-day post-CA. Reservoir and contractile LAS were assessed using both the automated and the manual technique as average of segmental values in apical four-chamber (4CH) view using the onset of QRS as a reference point. Results Radio-frequency CA was associated with significant decrease in magnitude of reservoir and contractile LAS in all patients, and increase in LA end-systolic (max) and end-diastolic (min) volume index (all p Conclusion The AutoStrain-derived LAS analysis showed a high correlation with manual LAS analysis. Moreover, the AutoStrain technique was associated with significantly shorter analysis time and lower interobserver variability compared with the manual technique. Abstract Figure.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): International PhD Program in Cardiovascular Pathophysiology and Therapeutics CardioPaTh Background Radio-frequency catheter ablation (CA) is associated with changes of left atrial (LA) structure and function. However, there is limited knowledge regarding the long-term impact of successful CA on atrial morphology and mechanics. Purpose To compare the time course of LA and right atrial (RA) performance in patients with paroxysmal atrial fibrillation (AF) undergoing the first CA. Methods This prospective study included 89 consecutive patients (age:62 ± 21 years; 66% male) with a history of symptomatic AF who underwent successful CA. All patients maintained SR during follow-up. A comprehensive echocardiographic examination was performed 1- day before and 1-day, 3-month and 12-month after CA. The reservoir and contractile strain for both LA and RA (LAS, RAS), and left intra-atrial mechanical dispersion (LAMD) were assessed using 2D speckle tracking echocardiography in all three apical views (only 4CH view for RAS and LAMD). Results At baseline, all patients with paroxysmal AF showed a significant reduction of reservoir and contractile LAS and RAS compared with controls (all p Conclusion Although the radio-frequency CA affected negatively LA performance in the acute phase, it has a long-term positive impact on both left and right atrial function. Figure Time course of reservoir and contractile LAS and RAS at Baseline, 1-day, 3-month and 12-month follow-up. Abstract Figure.

Funding Acknowledgements Type of funding sources: None. Background Speckle Tracking Echocardiography (STE) provides a comprehensive and quantitative assessment of myocardial function. However, the accuracy of STE-derived indices to predict maintenance of sinus rhythm (SR) following radio-frequency catheter ablation (CA) is still under debate. Therefore, the aim of the present study is to define the accuracy of STE-derived parameters to predict long-term maintenance of SR in patients with paroxysmal AF undergoing CA. Methods We prospectively enrolled 218 consecutive patients (age: 62 ± 10 years, 30% females) with paroxysmal AF undergoing first-CA. All patients with preserved ejection fraction (EF ≥ 50%) underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional STE in apical views. Results At 12 months follow up, a total of 39 (18%) patients had a documented recurrence of AF. Among imaging parameters, LASr > 23% showed the largest area under the curve (0.80) to predict long-term maintenance of SR with sensitivity of 79% and specificity of 72%. Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve (Figure 1). Using multi-variable logistic regression, LASr (OR 1.19, 95% CI 1.10-1.23, p Conclusion In patients with paroxysmal AF undergoing radio-frequency CA, preserved LA reservoir and contractile strain is independently associated with long-term maintenance of SR, whereas LA diameter or volumes were not. LA strain may therefore be useful in management of patients with paroxysmal AF. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd), LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm. Abstract Figure.

Background Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR). Methods We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up. Results During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group. Conclusion LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration. Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

Background Diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with dyspnea and paroxysmal atrial fibrillation (AF) is challenging. Speckle tracking-derived left atrial strain (LAS) provides an accurate estimate of left ventricular filling pressures and left atrial phasic function. However, data on clinical utility of LAS in patients with dyspnea and AF are scarce. Objective To assess relationship between LAS and probability of HFpEF in patients with dyspnea and paroxysmal AF. Methods The study included 205 consecutive patients (62±10 years, 58% males) with limiting dyspnea (NYHA ≥ II), paroxysmal AF and preserved LVEF (≥50%), who underwent speckle tracking echocardiography and natriuretic peptide (NT-proBNP) assessment during sinus rhythm. Patients with manifest ischemic heart or valve disease, and cardiomyopathy were excluded. Probability of HFpEF was estimated using H2FPEF and HFA-PEFF scores, which combine clinical characteristics, echocardiographic parameters and natriuretic peptides. Results A total of 61 (30%), 115 (56%) and 29 (14%) had respectively high, intermediate and low probability of HFpEF. Patients with high probability of HFpEF were significantly older, had higher body mass index, NT-proBNP, E/e', pulmonary artery pressure and larger LA volume index than patients in low-to-intermediate probability groups (all p Conclusions Reservoir LAS shows a strong independent association with probability of HFpEF in patients with dyspnea and paroxysmal AF. This advocates for more liberal use of LAS assessment to distinguish cardiac from non-cardiac dyspnea in patients with history of AF. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

Funding Acknowledgements None. OnBehalf Go for Zero Fluoroscopy Project investigators Background Contact force sensing catheters provide electrophysiologists with direct feedback and therefore improve safety and help to generate more effective lesions. The use of contact force may also reduce fluoroscopy and procedure times. Purpose The aim of this study was to systematically evaluate the impact of using contact force sensing catheters (CFSCs) on fluoroscopy times and procedure times in left-sided atrial procedures. Methods In this multinational, multicenter study, data from 622 left-sided procedures (142 without and 480 with CFSCs) of 25 participating European centers were prospectively collected with a structured questionnaire. Examinations comprised 393 pulmonary vein isolations (PVIs, group 1[G1]), 122 PVIs with linear lesions (group 2[G2]), 65 left-sided accessory pathway ablations (group 3 [G3]) and 42 ablations for left atrial tachycardia (group 4 [G4]). Fluoroscopy and procedure times were compared with respect to the use of CFSCs, procedure type, and level of operator experience as possible confounders. A Mann-Whitney U-test was applied for comparison, and a p-value Results With the use of CFSCs, fluoroscopy time was significantly reduced when performing pulmonary vein isolations (G1 median [IQR]: 19 [11.0-33.7] vs. 7.2 [4.0-13.0] min., p 15 years: -6.5 min., p 40: -1.5 min., p = 0.346). Conclusion Contact force sensing catheters can help to reduce fluoroscopy times, especially when performing pulmonary vein isolations. This effect could be demonstrated for all career levels. However, it diminished with the operator"s caseload. A shortening of procedure time was found for PVIs with additional linear lesions.

Background/Introduction The ‘CLOSE’ protocol, incorporating standardized ablation index (AI) targets in conjunction with defined inter-tag distance (ITD) has been shown to improve the acute and long-term success of pulmonary vein isolation (PVI) when treating paroxysmal atrial fibrillation (PAF). The reproducibility and learning curve for this protocol has not been studied. Purpose To assess the acute and long-term efficacy of CLOSE PVI across multiple operators (n = 37) in the 17-centre European study ‘VISTAX’. Methods 329 patients with PAF (61.8% male, 61.3 ± 10.1 years) underwent PVI according to the CLOSE protocol, with target AI values for each lesion of ≥400 on the posterior wall and ≥550 on the anterior wall, and target ITD of ≤6mm. Each 3-dimensional electroanatomic map was evaluated at a core lab where adherence to each of these criteria was assessed. 281/329 patients (85.1%) fulfilled all standardized workflow requirements and were adjudicated as having their PVI per-protocol (PP). First pass PVI and acute effectiveness (adenosine-proof first pass PVI at 30-minute challenge) were recorded. Clinical effectiveness was assessed as freedom from atrial arrhythmia recurrence through 12 months recorded via transtelephonic monitoring (weekly and symptomatically), in addition to holter and electrocardiogram monitoring during 3,6,12 month follow up visits. Learning curve analysis was evaluated on all investigators. Results First pass PVI rates were similar in the overall (86%) and PP cohorts (85%), as was acute effectiveness (82% in both cohorts). Freedom from atrial arrhythmia at 12 months too was identical for both cohorts (79%). Total procedure time and total ablation time decreased by an average 8 minutes and 10 minutes respectively after the first procedure and then showed further steady decreases over the number of ablations performed by the investigator (Figure). The procedural efficiencies and clinical success were reproducible across different centers. No significant deviations were found from individual sites. Conclusion The standardized CLOSE workflow is reproducible across centres, and is ‘forgiving’ without impacting on high efficacy of almost 80%. The learning curve is short, suggesting that the excellent clinical results can be replicated widely and easily. Abstract Figure. Learning Curves- Procedure & Ablation

Background/Introduction The use of a standardized ‘CLOSE’ ablation workflow for pulmonary vein isolation (PVI), with defined inter-tag distance (ITD) with targeted ablation index (AI) values, has been shown in single centre reports to result in good outcomes. The effect of this approach on patients’ quality of life (QoL) has not been studied. Purpose To evaluate the effects of paroxysmal atrial fibrillation (PAF) ablation by the CLOSE workflow on QoL and symptomatic AF reduction in the multicenter VISTAX study. Methods 329 patients with PAF (61.5% male, 61.3 ± 10.1 year) were treated at 17 European centres by point-by-point radiofrequency ablation using the CLOSE protocol to achieve PVI. An ITD ≤6mm and AI values of ≥400 on the posterior wall and ≥550 on the anterior wall were targeted. The AI value on the posterior wall was lowered as per investigator discretion in case of safety concerns. Patients were monitored for atrial arrhythmia recurrences via weekly and symptom-activated transtelephonic monitoring (TTM), for 12 months post procedure. Patients completed an Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire at their baseline and 12-month follow up visits. Results Majority (83.3% [274/329]) of patients experienced freedom from symptomatic atrial recurrence through 12 months. Of the 70 documented recurrences, 34 (49%) were documented by trans-telephonic monitoring only. All domains captured on the AFEQT questionnaire showed improvement with the overall score improving by 25.7, which exceeded the threshold of clinically meaningful improvement (±5) (Table). Patient reported most improvements in PAF control and symptoms relieved. The overall AFEQT score improvement was seen both in patients with or without documented atrial arrhythmia recurrence, with improvement by 21.5 and 26.8, respectively. Conclusion PAF ablation using a standardized CLOSE workflow resulted in consistent improvements in QoL. The improved QoL was observed regardless of atrial arrhythmia recurrence likely reflecting the low residual arrhythmia burden in patients with documented recurrence identified only on TTM. AFEQT Scores Through 12 Months AFEQT Domain Baseline 12 Months Change from Baseline* Daily Activities 59.2 85.3 26.0 Treatment Concerns 62.2 88.1 26.0 Controlling PAF 50.2 87.8 37.5 Symptoms 63.7 89.0 25.1 Symptoms Relieved 52.0 88.4 36.3 Overall AFEQT Score 61.3 87.2 25.7 *only includes patients who completed both baseline and 12 month AFEQT questionnaire

Background Radio-frequency catheter isolation of pulmonary veins (RF-PVI) is associated with changes of left atrial (LA) structure and function. However, there is limited knowledge regarding the long-term impact of successful RF-PVI on the LA mechanics. The aim of the current study was to assess the time course of LA performance in patients with paroxysmal atrial fibrillation (pAF) undergoing RF-PVI. Methods The study population included 24 consecutive patients (age:62 ± 21 years; 66% male) with symptomatic pAF and preserved left ventricular ejection fraction (≥50%) undergoing the first RF-PVI and 23 healthy controls. A comprehensive echocardiographic examination was performed one day before and 1 day, 3- and 12- months after RF-PVI. The reservoir, conduit and contractile LA strain (LAS), strain rate (LASR) and mechanical dispersion (LAMD) were assessed using two-dimensional speckle tracking echocardiography in apical views. Results At baseline, patients with pAF showed a significant reduction of all three components of LAS and LASR compared with controls (all p Conclusion Successful RF-PVI is associated with acute decrease in LAS, followed by recovery to baseline values within 3 months and further improvement during one year. Reservoir and contractile LAS appears to be the most clinically useful indices to monitor LA performance in patients with pAF undergoing RF-PVI. Figure Time course of LA reservoir and contractile strain, LA max and min volume index, and LA mechanical dispersion (Baseline, 1-day FUP, 3- and 12-month FUP). Abstract 1039 Figure.

Background Atrial mechanical dispersion (MD) might increase the risk of atrial fibrillation (AF). However, the data on atrial mechanical dispersion in patients with AF undergoing catheter ablation (CA) are scarce. Purpose To describe effects of CA on inter- and left intra-atrial MD in patients with different sub-types of AF undergoing CA. Methods We prospectively enrolled 138 symptomatic patients (age: 63 ± 21 years, 32% females) with paroxysmal AF undergoing first (81%) or redo (19%) CA during sinus rhythm, and 20 individuals (age: 66 ± 23 years, 20% females) with long-standing persistent AF undergoing first CA during AF. All patients had normal (≥50%) left ventricular ejection fraction. Control group consisted of 23 healthy controls. The atrial strain and strain rate (SR) were assessed using the two-dimensional speckle tracking echocardiography as average of segmental values in all apical views for LA and in four chamber (4CH) apical view for RA. We quantified inter-atrial MD as the standard deviation of time from the onset of the P wave to peak negative strain curves (Figure 1), and left intra-atrial MD as the standard deviation of time from the onset of QRS wave to peak positive strain curves (Figure 2) of all LA segmental components in 4CH apical view after setting adjusting the reference frame to coincide with the onset of the QRS. Results Figure 3 shows a time course of reservoir LA strain and left intra-atrial MD in patients with paroxysmal AF undergoing the First-CA (3A) versus the Redo-CA (3B), and in patients with long-standing persistent AF (3C). At 1-day pre-ablation, patients with long-standing persistent AF showed significantly lower reservoir strain of both atria and higher left intra-atrial MD as compared with both paroxysmal AF groups and controls (all p Conclusion Atrial strain and MD shows distinct behavior in patients with different sub-types of AF post CA. Atrial MD may provide a complimentary information to strain when assessing LA function. Abstract 554 Figure.

Background/Introduction The novel catheter with 6 thermocouples for real-time temperature monitoring during irrigated radiofrequency ablation was designed to potentially enhance safety and effectiveness of the Smart Touch Surround Flow (STSF) catheter by incorporating real-time temperature sensing. A supplementary, novel algorithm was developed to modulate power to maintain target temperature during high power/short duration ablation (90W, 4s). Purpose This sub-analysis was performed to examine consistency and reproducibility of the procedural efficiencies and acute success of the novel catheter with optimized temperature control and microelectrodes in treating paroxysmal atrial fibrillation (PAF) across multiple sites from two initial feasibility studies, in standard (QMODE) and high power/short duration (QMODE+) temperature-control ablation modes. Methods The QDOT-MICRO (QMODE, NCT02944968; N=42) and QDOT-FAST (QMODE+, NCT03459196; N=52) studies were both prospective, non-randomized multi-center, clinical investigations completed across 6 and 7 centers, respectively, in Europe. Procedural efficiencies and acute success (PVI via entrance block) was examined across sites within the study. Results In the QDOT-MICRO study, median procedure time (105–155 min), RF ablation time (27.7–39.5 min), and fluoroscopy times (2.2–8 min) during QMODE ablation were similar across the 6 sites. In QMODE+ ablation, median procedure time, RF ablation time, and fluoroscopy times all fall within (84–134 min), (4.8–9.7 min) and (1.1–9.6 min), respectively, across the 7 sites. Fluid delivery by the study catheter was low in both studies: QDOT-MICRO 547±278mL (mean ± SD); QDOT-FAST 382±299. mL (mean ± SD); which is 39.1 and 57.4% lower, respectively, than reported in the SMART SF trial. Esophageal temperature probe was used in the majority of patients (30/42 for QDOT MICRO and 51/52 for QDOT-FAST). Acute PVI was successful in 100% of patients in both studies with no deaths or unanticipated AEs. Conclusion(s) In both feasibility studies, procedural efficiencies were reproducible across study sites in both QMODE and QMODE+, with 100% acute success and good safety outcomes. Efficiencies are likely to improve with further experience. These results need to be confirmed in larger trials. Acknowledgement/Funding Both Studies are Company Sponsored Studies funded by Biosense Webster, Inc.

Background Both atrial fibrillation (AF) and catheter ablation (CA) may be associated with changes in left atrial (LA) structure and function. However, the data describing acute and short-term effects of CA on LA contractile function in different sub-types of AF are scarce. Purpose First, to describe patterns of LA structural and functional remodeling in patients with paroxysmal AF (PAF) or long-standing persistent AF (LSPAF) undergoing first or redo CA. Second, to assess clinical feasibility of LA strain and strain rate (SR) to monitor effect of AF and CA on LA contractile function. Methods We prospectively enrolled 138 consecutive patients (age: 63±21 years, 32% females) with PAF undergoing first (81%) or redo (19%) CA during sinus rhythm, and 20 individuals (age: 66±23 years, 20% females) with LSPAF undergoing first CA during AF. All patients were symptomatic and preserved (≥50%) left ventricular ejection fraction. Control group consisted of 23 healthy controls. All patients underwent comprehensive echocardiography one day pre-CA and post-CA, and at 3 month follow-up. The LA reservoir, conduit and contractile longitudinal strain (LAS) and LASR were assessed using 2D speckle tracking echocardiography as average of segmental values in apical views. Results A total of 14 (9%) patients had insufficient image quality for LA assessment and were excluded (feasibility: 91%). Pre-CA, patients with LSPAF showed the largest left atrial volume index (LAVI) (45±14 ml/m2), followed by PAF (35±8 ml/m2) and controls (24±10 ml/m2) (p Conclusion Different sub-types of AF show different patterns of LA structural and functional remodeling after CA. Both reservoir and contractile LAS appear highly feasible and reproducible to monitor LA contractile function in this clinical setting.

Background: Catheter ablation is the recommended treatment in patients with paroxysmal atrial fibrillation (AF). However, the data on acute effects of catheter ablation on left atrial (LA) contractile function are scarce. Therefore, the purpose of the study was twofold:Purpose: Firstly, to describe acute effects of catheter ablation on LA contractile function in patients with paroxysmal AF and in sinus rhythm at the time of ablation. Secondly, to assess potential value of different indices of LA morphology and function. Background: Catheter ablation is the recommended treatment in patients with paroxysmal atrial fibrillation (AF). However, the data on acute effects of catheter ablation on left atrial (LA) contractile function are scarce. Therefore, the purpose of the study was twofold:Purpose: Firstly, to describe acute effects of catheter ablation on LA contractile function in patients with paroxysmal AF and in sinus rhythm at the time of ablation. Secondly, to assess potential value of different indices of LA morphology and function. ispartof: Eur Heart J vol:39 issue:suppl_1 status: Published online

NICM VT Ablation Aim To determine whether ventricular tachycardia (VT) recurrences in arrhythmogenic RV cardiomyopathy (ARVC) and nonischemic cardiomyopathy (NICM) are related to incomplete ablation or disease progression. Methods ARVC and NICM patients with two substrate maps of the same diseased ventricle with an interprocedural delay of ≥12 months were included. Disease progression was defined as ≥1 factor: scar area progression (PROG, +5%), ventricular remodeling (dilatation [+25 mL] or decreased ejection fraction [–5%EF]). Incomplete ablation was defined as index VT recurrence or ablation in previously unablated regions inside index scar without PROG. Results Twenty patients from nine centers were included (80% male 55 ± 16 years, 7 ARVC and 13 NICM, LVEF 43 ± 14%). Mean delay was 28 ± 18 months. Disease progression occurred in 75% with ventricular remodeling in 70%: ventricular dilation in 45% (ARVC [71%]; NICM [38%]), decreased EF in 60% [RVEF in ARVC (71%); LVEF in NICM (54%)], and scar progression in 50% (in ARVC [57%] and NICM [46%]). Index VT recurrence was observed in 40%. Redo ablation sites were located in previously unablated regions inside the index scar in 70% of patients. VT recurrence following the second procedure was seen in 25%. Fifteen percent died during a follow-up of 17 ± 17 months. Conclusion Disease progression is the rule in ARVC and NICM while scar progression occurs in half. However, even if disease progression is frequently observed, incomplete index ablation is the most common finding, strongly suggesting the need for more extensive ablation.

BACKGROUND: Volumetric monitoring with right ventricular end-diastolic volume indexed (RVEDVi) and global end-diastolic volume indexed (GEDVi) is increasingly being suggested as a superior preload indicator compared with the filling pressures central venous pressure (CVP) or the pulmonary capillary wedge pressure (PCWP). However, static monitoring of these volumetric parameters has not consistently been shown to be able to predict changes in cardiac index (CI). The aim of this study was to evaluate whether a correction of RVEDVi and GEDVi with a measure of the individual contractile reserve, assessed by right ventricular ejection fraction (RVEF) and global ejection fraction, improves the ability of RVEDVi and GEDVi to monitor changes in preload over time in critically ill patients. METHODS: Hemodynamic measurements, both by pulmonary artery and by transcardiopulmonary thermodilution, were performed in 11 mechanically ventilated medical ICU patients. Correction of volumes was achieved by normalization to EF deviation from normal EF values in an exponential fashion. Data before and after fluid administration were obtained in eight patients, while data before and after diuretics were obtained in seven patients. RESULTS: No correlation was found between the change in cardiac filling pressures (DeltaCVP, DeltaPCWP) and DeltaCI (R(2) 0.01 and 0.00, respectively). Further, no correlation was found between DeltaRVEDVi or DeltaGEDVi and DeltaCI (R(2) 0.10 and 0.13, respectively). In contrast, a significant correlation was found between DeltaRVEDVi corrected to RVEF (DeltacRVEDVi) and DeltaCI (R(2) 0.64), as well as between DeltacGEDVi and DeltaCI (R(2) 0.59). An increase in the net fluid balance with +844 + or - 495 ml/m(2) resulted in a significant increase in CI of 0.5 + or - 0.3 l/min/m(2); however, only DeltacRVEDVi (R(2) 0.58) and DeltacGEDVi (R(2) 0.36) correlated significantly with DeltaCI. Administration of diuretics resulting in a net fluid balance of -942 + or - 658 ml/m(2) caused a significant decrease in CI with 0.7 + or - 0.5 l/min/m(2); however, only DeltacRVEDVi (R(2) 0.80) and DeltacGEDVi (R(2) 0.61) correlated significantly with DeltaCI. CONCLUSION: Correction of volumetric preload parameters by measures of ejection fraction improved the ability of these parameters to assess changes in preload over time in this heterogeneous group of critically ill patients.

Background: To identify and characterise pre-procedural and procedural parameters which predict maintenance of sinus rhythm after a first circumferential pulmonary vein isolation (CPVI) for recurrent atrial fibrillation (AF).

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Purpose: We implemented a strategy of cumulative dose rate savings in the setting of pulmonary vein isolation (PVI) and report on its effectiveness and impact on image quality. Methods: All patients that underwent PVI with 3D rotation angiography (3DRA) were included over 18 months. Dose per frame of the 3DRA acquisition was reduced by 50% and dose per frame of standard fluoroscopy acquisition was lowered. Results: In 133 patients (84 male, mean age 61.3±10.9 years, mean BMI 27.2), baseline procedure duration was 155.1±37.9 minutes and mean total dose area product (DAP) 34.73±16.85 Gy.cm2. The use of 3DRA accounted for 52.8% of total DAP (17.05±9.39 Gy.cm2). After 3DRA optimization, cine DAP was 10.06±4.30 Gy.cm2 (59.0% reduction). Image quality was unaffected in all patients. After fluoro optimization, fluoro DAP dropped to 5.64±7.01 Gy.cm2 (70.6% reduction). Average DAP rate dropped from 81 Gy.cm2/h to 31 Gy.cm2/h with the new protocol (p < 0.05). Image quality was sufficient for catheter manipulation in all patients. Mean total DAP using combined optimizations was 13.96±9.43 Gy.cm2 (estimated effective exposure of 2.8 mSv). Conclusion: Impressive exposure reduction is possible by optimizing X-ray acquisition parameters. In specific electrophysiological procedures, further gains are expected to be possible by compromising on image quality

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Volumetric monitoring with right ventricular end-diastolic volume indexed (RVEDVi) and global end-diastolic volume indexed (GEDVi) is increasingly being suggested as a better preload indicator than traditional intracardiac filling pressures (central venous pressure [CVP] and pulmonary artery occlusion pressure [PAOP]). Static volumetric monitoring, however, has not consistently been shown to correlate with the cardiac index (CI). This study aims (1) to evaluate the influence of ejection fraction (EF) on RVEDVi and GEDVi, (2) to study the effect of RVEDVi and GEDVi changes (Δ) corrected for right ventricle ejection fraction (RVEF) and global ejection fraction (GEF), respectively, on ΔCI, and (3) to identify optimal resuscitation target volumes.

Indocyaninegreen (ICG) clearance can be measured with the LiMON® device (Pulsion, Germany) and is expressed by the plasma disappearance rate (PDR) for ICG (normal value 18–25%) and the residual ICG after 15 min (R15, normal value 0–10%). In this study we investigated the correlation between PDR/R15 and IAP, SOFA score, and classic liver function tests in mixed ICU patients.

Definitions for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) stand or fall with the reproducibility and accuracy of the IAP measurement. The aim of this study is to validate a novel fully-automated continuous technique to measure IAP via a balloon-tipped catheter connected to an IAP monitor (Spiegelberg, Hamburg, Germany) versus a novel bladder FoleyManometer (Holtech Medical, Copenhagen, Denmark), and to look for the COVA (SD divided by mean) for IAP and APP during different 24 hour monitoring periods.