Prophylactic Implantation Research Articles

Right Bundle Branch Block Predicts Appropriate Implantable Cardioverter Defibrillator Therapies in Patients with Non-Ischemic Dilated Cardiomyopathy and a Prophylactic Implantable Cardioverter Defibrillator.

Background: The benefit of prophylactic implantable cardioverter defibrillators (ICDs) in patients with severe systolic dysfunction of non-ischemic origin is still unclear, and the identification of patients at risk for sudden cardiac death remains a major challenge. Aims/Methods: We retrospectively reviewed all consecutive patients with non-ischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify the predictors of appropriate ICD therapies (anti-tachycardia pacing [ATP] and/or shocks) in this cohort of patients. Results: A total of 224 patients were included. After a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD therapies. Patients with appropriate ICD therapies were more frequently men (87% vs. 69%, p = 0.006), of younger age (59 years, (53-65) vs. 64 years, (57-70); p = 0.02), showed more right bundle branch blocks (RBBBs) (15% vs. 4%, p = 0.007) and less left bundle branch blocks (LBBBs) (26% vs. 47%, p = 0.005) in the ECG, and had higher left ventricular end-diastolic (100 mL/m2, (90-117) vs. 86, (71-110); p = 0.011) and systolic volumes (72 mL/m2, (59-87) vs. 61, (47-81), p = 0.05). In a multivariate competing-risks regression analysis, RBBB (HR 2.26, CI 95% 1.02-4.98, p = 0.043) was identified as an independent predictor of appropriate ICD therapies. Conclusion: RBBBs may help to identify patients with NICM at high risk of ventricular arrhythmias and requiring ICD intervention.

Effectiveness of prophylactic capsular tension ring implantation during cataract surgery in highly myopic eyes.

To assess the effectiveness of prophylactic capsular tension ring (CTR) implantation during cataract surgery in highly myopic eyes. Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China. Prospective cohort study. Consecutive highly myopic patients treated with cataract surgery were recruited and randomized to undergo CTR implantation or not. The outcomes compared between the 2 groups included axial lens position (ALP), intraocular lens (IOL) decentration and tilt, area of anterior capsule opening, severity of anterior capsular opacification (ACO), and posterior capsular opacification (PCO) at 1 year postoperatively. A total of 55 highly myopic eyes with CTRs implanted and 55 without were included in the analysis. At 1 year postoperatively, no significant differences were detected between the CTR and non-CTR groups for the mean ALP, IOL decentration, or tilt (all P > .05). However, the CTR group had a significantly larger area of anterior capsule opening (23.62 ± 3.30 mm2 vs 21.85 ± 2.30 mm2, P = .003), and less severe ACO (P = .033) and PCO (PCO-3 mm: 0.06 ± 0.13 vs 0.13 ± 0.20, P = .038; PCO-C: 0.15 ± 0.18 vs 0.25 ± 0.26, P = .026) than the non-CTR group. The corrected distance visual acuity, prediction error, and higher-order aberrations did not differ between the 2 groups (all P > .05). In highly myopic eyes, although prophylactic CTR implantation can reduce the severity of capsular contraction and opacification, it does not significantly affect postoperative IOL stability or visual outcomes.

Regional disparities and risk factors of mortality among patients at high risk of sudden cardiac death in emerging countries: a nonrandomized controlled trial

BackgroundComprehensive data on patients at high risk of sudden cardiac death (SCD) in emerging countries are lacking. The aim was to deepen our understanding of the SCD phenotype and identify risk factors for death among patients at high risk of SCD in emerging countries.MethodsPatients who met the class I indication for implantable cardioverter-defibrillator (ICD) implantation according to guideline recommendations in 17 countries and regions underrepresented in previous trials were enrolled. Countries were stratified by the WHO regional classification. Patients were or were not implanted with an ICD at their discretion. The outcomes were all-cause mortality and SCD.ResultsWe enrolled 4222 patients, and 3889 patients were included in the analysis. The mean follow-up period was 21.6 ± 10.2 months. There were 433 (11.1%) instances of all-cause mortality and 117 (3.0%) cases of SCD. All-cause mortality was highest in primary prevention (PP) patients from Southeast Asia and secondary prevention (SP) patients from the Middle East and Africa. The SCD rates among PP and SP patients were both highest in South Asia. Multivariate Cox regression modelling demonstrated that in addition to the independent predictors identified in previous studies, both geographic region and ICD use were associated with all-cause mortality in patients with high SCD risk. Primary prophylactic ICD implantation was associated with a 36% (HR = 0.64, 95% CI 0.531–0.802, p < 0.0001) lower all-cause mortality risk and an 80% (HR = 0.20, 95% CI = 0.116–0.343, p < 0.0001) lower SCD risk.ConclusionsThere was significant heterogeneity among patients with high SCD risk in emerging countries. The influences of geographic regions on patient characteristics and outcomes were significant. Improvement in increasing ICD utilization and uptake of guideline-directed medical therapy in emerging countries is urgent.Trial registrationClinicalTrials.gov, NCT02099721.

Prophylactic surgical mesh placement as a prevention of parastomal hernia in open radical cystectomy with ileal conduit diversion - pilot study.

This study examines the efficacy of prophylactic mesh implantation during open radical cystectomy with ileal conduit diversion in preventing parastomal hernias (PH). Despite PH being a common complication, prophylactic methods have been underexplored. A pilot, single-center, prospective cohort study was conducted involving five patients undergoing surgery with mesh implantation. Demographic and clinical characteristics were monitored, including the incidence of PH, operation time, blood loss, and hospitalization duration. During the mean follow-up period of 9.1±3.2 months post-operation, no occurrences of PH were observed in the patient group. Despite the risks associated with implanting foreign material in an area of surgery involving open small intestine, no infectious complications were noted. Prophylactic mesh implantation in radical cystectomy with ileal conduit diversion appears to be an effective preventive measure against PH. Further extensive studies are required to definitively confirm the efficacy and safety of mesh use in this context.

Conduction system disease management in patients candidate and/or treated for the aortic valve disease: an Italian Survey promoted by Italian Association of Arrhythmology and Cardiac Pacing (AIAC)

Background Conduction system disorders represent a frequent complication in patients undergoing surgical (surgical aortic valve replacement, SAVR) or percutaneous (transcatheter aortic valve implantation, TAVI) aortic valve replacement. The purpose of this survey was to evaluate experienced operators approach in this clinical condition. Methods This survey was independently conducted by the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) and it consisted of 24 questions regarding the respondents’ profile, the characteristics of participating centres, and conduction disease management in different scenarios. Results Fifty-five physicians from 55 Italian arrhythmia centres took part in the survey. Prophylactic pacemaker implantation is rare. In case of persistent complete atrioventricular block (AVB), 49% and 73% respondents wait less than one week before implanting a definitive pacemaker after SAVR and TAVI, respectively. In case of second degree AVB, the respondents wait some days more for definitive implantation. Respondents consider bundle branch blocks, in particular pre-existing left bundle branch block (LBBB), the worst prognostic factors for pacemaker implantation after TAVI. The implanted valve type is considered a relevant element to evaluate. In patients with new-onset LBBB and severe/moderate left ventricular systolic dysfunction, respondents would implant a biventricular pacemaker in 100/55% of cases, respectively. Conclusions Waiting time before a definitive pacemaker implantation after aortic valve replacement has reduced compared to the past, and it is anticipated in TAVI vs. SAVR. Bundle branch blocks are considered the worse prognostic factor for pacemaker implantation after TAVI. The type of pacemaker implanted in new-onset LBBB patients without severe left ventricular systolic dysfunction is heterogeneous.

Wound healing and hernia after abdominal aortic aneurysm repair: Onlay self-gripping polyester mesh reinforcement compared with small bite sutured closure.

Prophylactic mesh implantation following open surgical repair of abdominal aortic aneurysm is a debatable subject. To assess the efficacy of a self-gripping polyester mesh used in on-lay technique to prevent incisional hernia after open abdominal aortic aneurysm repair. We retrospectively reviewed the records of 495 patients who underwent aortic surgery between May 2017 and May 2021. Patients included in the study underwent open surgical repair for infrarenal abdominal aortic aneurysm (AAA) with closure of the abdominal wall with either small bite suture technique or prophylactic mesh reinforcement. Primary endpoint of the study was the occurrence of incisional hernia during a two-year follow-up period. Secondary endpoints were mesh-related complications. Mesh implantation with the on-lay technique was successful in all cases. No patient in the mesh group developed an incisional hernia during the 24-month follow-up period. Two patients in the non-mesh group developed a symptomatic incisional hernia during the follow-up period at 6 months. Three cases of post-operative access site complications were observed in the mesh group. Application of a self-gripping polyester mesh using the on-lay technique demonstrates acceptable early-durability after open surgical repair of abdominal aortic aneurysms. However, it appears to be associated with a number of post-operative access site complications.

Prolonged mHealth-Based Arrhythmia Monitoring in Patients With Hypertrophic Cardiomyopathy (HCM-PATCH): Protocol for a Single-Center Cohort Study.

Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias and other arrhythmias. Screening for arrhythmias is mandatory to assess the individual SCD risk, but long-term electrocardiography (ECG) is rarely performed in routine clinical practice. Intensified monitoring may increase the detection rate of ventricular arrhythmias and identify more patients with an increased SCD risk who are potential candidates for the primary prophylactic implantation of an implantable cardioverter-defibrillator. To date, reliable data on the clinical benefit of prolonged arrhythmia monitoring in patients with HCM are rare. This prospective study aims to measure the prevalence of ventricular arrhythmias in patients with HCM observed by mobile health (mHealth)-based continuous rhythm monitoring over 14 days compared to standard practice (a 24- and 48-h long-term ECG). The frequency of ventricular arrhythmias in this 14-day period is compared with the frequency in the first 24 or 48 hours for the same patient (intraindividual comparison). Following the sample size calculation, 34 patients with a low or intermediate risk for SCD, assessed by the HCM Risk-SCD calculator, will need to be recruited in this single-center cohort study between June 2023 and February 2024. All patients will receive an ECG patch that records their heart activity over 14 days. In addition, cardiac magnetic resonance imaging and genetic testing data will be integrated into risk stratification. All patients will be asked to complete questionnaires about their symptoms; previous therapy; family history; and, at the end of the study, their experience with the ECG patch-based monitoring. The Hypertrophic Cardiomyopathy: Clinical Impact of a Prolonged mHealth-Based Arrhythmia Monitoring by Single-Channel ECG (HCM-PATCH) study investigates the prevalence of nonsustained ventricular tachycardia (ie, ≥3 consecutive ventricular beats at a rate of 120 beats per minute, lasting for <30 seconds) in low- to intermediate-risk patients with HCM (according to the HCM Risk-SCD calculator) with additional mHealth-based prolonged rhythm monitoring. The study was funded by third-party funding from the Department of Cardiology and Intensive Care Medicine, University Hospital Ostwestfalen-Lippe of Bielefeld University in June 2023 and approved by the institutional review board in May 2023. Data collection began in June 2023, and we plan to end the study in February 2024. Of the 34 patients, 26 have been recruited. Data analysis has not yet taken place. Publication of the results is planned for the fall of 2024. Prolonged mHealth-based rhythm monitoring could lead to differences in the prevalence of arrhythmias compared to 24- and 48-hour long-term ECGs. This may lead to improved identification of patients at high risk and trigger therapeutic interventions that may provide better protection from SCD or atrial fibrillation-related complications such as embolic stroke. Deutsches Register Klinischer Studien DRKS00032144; https://tinyurl.com/498bkrx8. DERR1-10.2196/52035.

Contemporary Use of Prophylactic Inferior Vena Cava Filters in Patients With Severe Traumatic Injuries and High Thromboembolic Event Risk

PurposeThe aim of this study was to evaluate the relationship between prophylactic inferior vena cava filter (IVCF) implantation and in-hospital deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality among adults with intracranial, pelvic or lower extremity, and spinal cord injuries. MethodsPatients 18 years and older with severe intracranial, pelvic or lower extremity, or spinal cord injuries captured by the Trauma Quality Improvement Program (2010-2019) were identified. IVCFs implanted ≤72 hours after hospital presentation and before performance of lower extremity ultrasonography were defined as prophylactic. Patients were stratified by pharmacologic venous thromboembolism (VTE) prophylaxis status. Logistic regression models estimated prophylactic inferior vena cava (IVC) filtration’s effect on selected outcomes and identified attributes associated with prophylactic IVCF implantation. ResultsOf 544,739 included patients, 1.3% (n = 7,247) underwent prophylactic IVCF implantation. Among patients who received pharmacologic VTE prophylaxis, prophylactic IVC filtration compared with expectant management was positively associated with DVT (odds ratio [OR], 4.30; P < .001) and PE (OR, 4.30; P < .001) but not associated with mortality (OR, 0.92; P = .43). Among patients who received no pharmacologic prophylaxis, prophylactic IVC filtration was positively associated with DVT (OR, 4.63; P < .001) and PE (OR, 5.02; P < .001) but negatively associated with mortality (OR, 0.43; P < .001). ConclusionsProphylactic IVC filtration was associated with increased likelihood of VTE among all adults with severe intracranial, pelvic or lower extremity, and spinal cord injuries. In patients who received no pharmacologic VTE prophylaxis, prophylactic IVC filtration was associated with decreased likelihood of in-hospital mortality.

Periodic Repolarization Dynamics (PRD) identifies patients who profit from ICD implantation, A meta-analysis of the predictive value of PRD

Abstract Background Periodic repolarization dynamics (PRD) is an electrocardiographic marker that quantifies sympathetic-activity associated instabilities of cardiac repolarization. PRD is a strong predictor of mortality in patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM) and has been proposed to identify patients who benefit from prophylactic ICD implantation. Purpose To conduct a systematic review and meta-analysis concerning the prognostic value of PRD for predicting all-cause mortality in relation to prophylactic ICD-implantation. Methods This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 25 articles were screened and 7 randomized and non-randomized controlled trials identified. Finally, a total of 5 could be included in the analysis (Fig.1). Patients were stratified into patients with or without prophylactic ICD-implantation (Fig.2). The prognostic value of PRD for predicting all-cause mortality was extracted from published data as hazard ratio (HR) per 1 deg2 increase in PRD. We used inverse-variance-weighted average meta-analysis to calculate fixed and random effect models to estimate the overall predictive value of PRD in both groups. The interaction between PRD and prophylactic ICD-implantation for predicting mortality was calculated using meta-regression analysis. All analyses were performed using CRAN R v. 4.1.2 and the meta-package v 5.2.0. Results We included 4,338 patients in this meta-analysis, of whom 3,167 (73%) suffered from ICM and 1,171 (27%) from NICM. 1,906 (44%) patients were treated with an ICD. During an estimated mean follow-up time of 3.2 years, 604 (14%) patients died. Fig. 2 (left) shows patients without ICD treatment (N = 2,432, 56%). In these patients, a 1 deg2 increase in PRD was significantly associated with an overall 8% increase in mortality (fixed effect HR 1.08; 95% CI 1.06-1.10; p&amp;lt; 0.001, random effect HR 1.08; 95% CI 1.06-1.11; p &amp;lt; 0.001). Fig. 2 (right) displays the prognostic value of PRD in patients treated by ICD (N = 1,906). In these patients, a 1 deg2 increase in PRD was significantly associated with an overall 3% increase in mortality (fixed-effect HR 1.03; 95% CI 1.01-1.05; p&amp;lt; 0.001, random-effect HR 1.03; 95% CI 1.00-1.06; p &amp;lt; 0.001). An increase in PRD was not significantly associated with an increase in mortality in patients from the EU-CERT-ICD and DANISH trial. There was a significant interaction between PRD and prophylactic ICD-implantation for predicting all-cause mortality (p = 0.008). Conclusion In patients with ICM and NICM, PRD is a strong predictor of all-cause mortality in patients with and without prophylactic ICD. The significant interaction between PRD and prophylactic ICD-implantation most probably implies a reduction in the risk identified by PRD through ICD implantation. Consequently, PRD could prove a useful tool for identifying patients that might benefit from ICD treatment.Figure 1Figure 2

Prophylactic epicardial pacemaker implantation in tricuspid valve replacement.

Patients undergoing surgical tricuspid valve replacement (TVR) are at high risk of atrioventricular conduction disorders. Because implanting a lead through the tricuspid bioprosthesis is discouraged, the patients who undergo TVR in our centre are usually given a prophylactic epicardial pacemaker. Our aim was to assess the benefits and risks of this strategy. Among the patients who underwent TVR with prophylactic epicardial pacemaker implantation, clinical evaluations and pacemaker reports were analysed retrospectively after surgery. The need for cardiac pacing were assessed by characterizing the atrioventricular conduction, while the risks were evaluated by listing and adjudicating post-operative events. A total of 80 patients were analysed (mean age was 57 ± 16 years old, 30% males). TVR was isolated in 28 (35%) patients, but most often associated with another valve surgery. In the postoperative period, heart rhythm was analysed in 59/80 patients during a median follow-up of 35 months. Cardiac pacing was needed in 46% patients: 14% had complete pacing dependency, 17% had high degree AV block, while 15% had a high ventricular pacing rate (>80%). No pre- or per-operative variables could predict cardiac pacing requirement. Post-operatively, a spontaneous heart rate >70bpm (P = 0.02) and the presence of narrow QRS (P = 0.03) were significantly associated with a lower risk of cardiac pacing requirement. Complications related to epicardial pacemaker were documented in 2 (2.5%) patients. After TVR, cardiac pacing was needed in 46% of patients for post-operative atrioventricular conduction disorders. This high incidence associated with an acceptable safety profile supports a prophylactic epicardial pacing strategy for the patients undergoing TVR.

Arrhythmias in Patients with Cardiac Amyloidosis: A Comprehensive Review on Clinical Management and Devices.

Cardiac amyloidosis (CA) is a rare but potentially life-threatening disease in which misfolded proteins accumulate in the cardiac wall tissue. Heart rhythm disorders in CA, including supraventricular arrhythmias, conduction system disturbances, or ventricular arrhythmias, play a major role in CA morbidity and mortality, and thus require supplementary management. Among them, AF is the most frequent arrhythmia during CA hospitalizations and is associated with significantly higher mortality, while ventricular arrhythmias are also common and are usually associated with poor prognosis. Early diagnosis of potential arrythmias could be performed through ECG, Holter monitoring, and/or electrophysiology study. Clinical management of these patients is quite significant, and it usually includes initiation of amiodarone and/or digoxin in patients with AF, potential electrical cardioversion, or ablation in specific patients with indication, as well as initiation of anticoagulants in all patients, independent of AF and CHADS-VASc score, for potential intracardiac thrombus. Moreover, identification of patients with conduction disorders that could benefit from prophylactic pacemaker implantation and/or CRT as well as identification of patients with life-threatening ventricular arrythmias that could benefit from ICD could both increase the survival rates of these patients and improve their quality of life.

Outcomes in Dutch DPP6 risk haplotype for familial idiopathic ventricular fibrillation: afocused update.

The genetic risk haplotype DPP6 has been linked to familial idiopathic ventricular fibrillation (IVF), but the associated long-term outcomes are unknown. DPP6 risk haplotype-positive family members (DPP6cases) and their risk haplotype-negative relatives (DPP6 controls) were included. Clinical follow-up data were collected through March 2023. Implantable cardioverter-defibrillator (ICD) indication was divided in primary or secondary prevention. Cumulative survival and event rates were calculated. We included 327 DPP6cases and 315 DPP6 controls. Median follow-up time was 9years (interquartile range: 4-12). Of the DPP6cases, 129 (39%) reached the composite endpoint of appropriate ICD shock, sudden cardiac arrest or death, at amedian age of 45years (range: 15-97). Median overall survival was 83years and 87years for DPP6cases and DPP6 controls, respectively (p < 0.001). In DPP6cases, median overall survival was shorter for males (74years) than females (85years) (p < 0.001). Of the DPP6cases, 97 (30%) died, at amedian age of 50years. With aprophylactic ICD implantation advise based on risk haplotype, sex and age, 137 (42%) of DPP6cases received an ICD, for primary prevention (n = 109) or secondary prevention (n = 28). In the primary prevention subgroup, 10patients experienced atotal of 34 appropriate ICD shocks, and there were no deaths during follow-up. DPP6cases with asecondary prevention ICD experienced atotal of 231 appropriate ICD shocks. Patients with the DPP6 risk haplotype, particularly males, are at an increased risk of IVF and sudden cardiac death. Using arisk stratification approach based on risk haplotype, sex and age, asubstantial proportion of patients with aprimary prevention ICD experienced appropriate ICD shocks, showing the benefit of prophylactic ICD implantation with this strategy.

Survival, ventricular arrhythmia, and implantable cardioverter-defibrillator usefulness in toxic cardiomyopathy due to substance abuse.

Toxic dilated cardiomyopathy (T-DCM) due to substance abuse is now recognized as a potential cause of severe left ventricular dysfunction. The burden of ventricular arrhythmias (VA) and the role of a prophylactic implantable cardioverter-defibrillator (ICD) are not well documented in this population. We aim to assess the usefulness of ICD implantation in a T-DCM cohort. Patients younger than 65 years with a left ventricular ejection fraction (LVEF)<35% followed at a tertiary center heart failure (HF) clinic between January 2003 and August 2019 were screened for inclusion. The diagnosis of T-DCM was confirmed after excluding other etiologies, and substance abuse was established according to the DSM-5 criteria. The composite primary endpoints were arrhythmic syncope, sudden cardiac death (SCD), or death of unknown cause. The secondary endpoints were the occurrence of sustained VA and/or appropriate therapies in ICD carriers. Thirty-eight patients were identified, and an ICD was implanted in 19 (50%) of these patients, only one for secondary prevention. The primary outcome was similar between the two groups (ICD vs. non-ICD; p=1.00). After a mean follow-up of 33±36 months, only two VA episodes were reported in the ICD group. Three patients received inappropriate ICD therapies. One ICD implantation was complicated with cardiac tamponade. Twenty-three patients (61%) had an LVEF ≥35% at 12 months. VA are infrequent in the T-DCM population. The prophylactic ICD benefit was not observed in our cohort. The ideal timing for potential prophylactic ICD implantation in this population needs further studies.

Incidence of ventricular tachyarrhythmias and clinical outcomes in primary prophylactic ICD patients in relation to localization of myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction According to current guidelines, primary prophylactic ICD implantation is indicated with a class IA recommendation in patients with severely reduced EF &amp;lt; 35% and ischaemic heart disease. However, it is unclear whether there are differences in patient outcomes related to the localization of myocardial infarction. Aim of the study was to compare the incidence of ventricular tachyarrhythmias and clinical outcomes in primary prophylactic ICD-patients with ischaemic heart disease in relation to the localization of myocardial infarction. Methods A total of 448 consecutive ICD patients from a prospective single-centre ICD-registry who underwent primary prophylactic ICD implantation due to ischaemic cardiomyopathy between 1996 and 2021 were analyzed. Patients with previous anterior wall myocardial infarction (AWMI, n = 293) were compared to those with posterior wall myocardial infarction (PWMI, n = 155). Patients with both AWMI and PWMI were excluded. The median follow-up time was 6 years in both groups. Results Patients with AMWI were younger, more often female, and less often received cardiac synchronization therapy (Table 1). Patients with previous PWMI more often had ICD therapy during follow-up (Figure 1) due to the higher incidence of ventricular tachycardias (Table 1). The all-cause mortality rate was similar between both groups. Conclusion Primary prophylactic ICD patients with previous PWMI have a 10% higher incidence of ventricular tachycardias after 6-year follow-up than ICD patients with previous AMWI. This might be explained by the proximity of the inferior infarction to the mitral isthmus and should be considered when ablating VTs in patients with PWMI.

Role of periprocedural HV interval assessment to determine the risk of atrioventricular block after transcatheter aortic valve replacement

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fondation vaudoise de cardiologie interventionnelle. Background The identification of patients at risk of post-procedural high-grade atrio-ventricular block (HAVB) is one of the major unmet challenges in transcatheter aortic valve replacement (TAVR). Some studies have suggested that periprocedural electrophysiological (EP) testing might help to identify patients at risk, but its role is controversial. Purpose To determine whether the immediate postvalve deployment HV and the Delta-HV interval (difference between post- and prevalve deployment HV interval) are predictive of HAVB and pacemaker (PM) need over 1 year follow-up. Methods We prospectively analysed consecutive patients undergoing TAVR between August 2019 and October 2021, and without prior PM implantation. ECG and standardized HV interval measurements were performed pre- and postvalve deployment with the quadripolar catheter used for rapid pacing. The primary outcome was either documented HAVB beyond 24h after TAVR or ventricular pacing &amp;gt;1% in patients who underwent prophylactic PM implantation because of abnormal EP testing in the days following TAVR. Minimal follow-up was 12 months. Results 97 patients were included. The primary outcome occurred in 8 patients (8.3%): HAVB occurred in 7 patients (5 during hospitalisation and 2 within one month of follow-up), and 1 patient underwent PM implantation because of abnormal EP testing (HV interval≥70 ms) with ventricular pacing up to 11% despite an algorithm to minimize pacing. Among ECG and EP findings, univariate predictors of the primary outcome were the pre- and postvalve deployment PR interval and both the postvalve deployment HV and Delta-HV interval (Table 1). By ROC analysis, a Delta-HV interval ≥18ms predicted HAVB with 50% sensitivity and 90% specificity (AUC=0.708, PPV 31%), and an HV interval ≥ 60ms after TAVR predicted HAVB with 63% sensitivity and 79% specificity (AUC=0.681, PPV 21%) (Figure 1). Conclusion The yield of the periprocedural HV interval assessment alone is limited in ruling out the risk of HAVB since about half of the patients at risk fail to be identified. However, abnormal postvalve deployment HV or Delta-HV interval may identify a subgroup at particularly higher risk, with up to one third of HAVB during follow-up.

In-hospital predictors for primary prevention of sudden death after acute myocardial infarction with cardiac dysfunction

BackgroundCurrent guidelines recommend prophylactic defibrillator implantation in patients with acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤40 % or LVEF ≤35 % plus heart failure symptoms or inducible ventricular tachyarrhythmias during an electrophysiology study at 40 days after AMI or 90 days after revascularization. In-hospital predictors of sudden cardiac death (SCD) after AMI during the index hospitalization remain unsettled. We sought to examine in-hospital predictors of SCD in patients with AMI and LVEF ≤40 % evaluated during the index hospitalization. MethodsWe retrospectively evaluated 441 consecutive patients with AMI and LVEF ≤40 % admitted to our hospital between 2001 and 2014 (77 % male gender; median age: 70 years; median hospitalization length: 23 days). The primary endpoint was a composite of SCD or aborted SCD at ≥30 days after AMI onset (composite arrhythmic event). LVEF and QRS duration (QRSd) on electrocardiography were measured at a median of 12 days and 18 days, respectively. ResultsDuring a median follow-up of 7.6 years, the incidence of composite arrhythmic events was 7.3 % (32 of 441 patients). In multivariable analysis, QRSd ≥100 msec (beta-coefficient = 1.54, p = 0.003), LVEF ≤23 % (beta-coefficient = 1.14, p = 0.007), and onset-reperfusion time > 5.5 h (beta-coefficient = 1.16, p = 0.035) were independent predictors of composite arrhythmic events. The combination of these 3 factors was associated with the highest rate of composite arrhythmic events compared with 0–2 factors (p < 0.001). ConclusionsThe combination of QRSd ≥100 msec, LVEF ≤23 %, and onset-reperfusion time > 5.5 h during the index hospitalization provides precise risk stratification for SCD in patients early after AMI.

OC-091 PREVENTION OF PARASTOMAL HERNIAS WITH 3D FUNNEL MESHES IN INTRAPERITONEAL ONLAY POSITION

Abstract Introduction In patients with permanently intended terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. Various strategies have been evaluated, but there is still a lack of evidence with regard to the best surgical technique for PSH- prevention Methods We conducted a retrospective analysis of prospectively collected data of 98 patients, who underwent elective permanent ostomy formation between 2009 and 2019 by means of prophylactic implantation of a specially designed three-dimensional funnel mesh in intraperitoneal onlay position. Results PSH developed in five (5.1%) of 92 patients available for follow-up (88 by CT-scan). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in eight (8.2%) cases. Follow-up time was a median 38 (range 12–60) months. Conclusion The prophylactical implantation of a funnel mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with purely keyhole meshes regardless of their position in relation to the abdominal wall layers, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D design and there is no weak point at the lateral edge of the stoma as is typical for the sugarbaker access. A further improvement could be achieved by lengthening the tunnel by the manufacturer in order to counteract the shrinkage of the implant.

Value of programmed electrical stimulation in Brugada Syndrome: a cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prognostic value of programmed electrical stimulation (PES) in Brugada Syndrome (BrS) remains controversial. Substantial controversy exists regarding usefulness of PES in identifying BrS patients at risk of sudden cardiac death (SCD). Implantation of an implantable cardioverter-defibrillator is the only reliable form of SCD prevention in this specific population Purpose To determine if induction of sustained ventricular arrhythmia (VA) in PES is a predictor of cardiac events (CE), defined as the composite of SCD, appropriate ICD therapy for VA or unexplained syncope. Methods A retrospective analysis of 34 patients with spontaneous or pharmacologically induced type 1 Brugada pattern, submitted to electrophysiology study with PES between 2015 and 2019 in a Portuguese Center, was performed. Patients were followed for 24 months. Hospital records and monitoring data from cardiac devices were consulted. The Mann-Whitney U test was used for median comparison between groups. Binary logistic regression through the stepwise method was performed to evaluate categorical features. Results 35% (n=12) and 27% (n=9) had spontaneous type 1 and type 2 Brugada pattern in basal electrocardiography, respectively. 23% (n=8) had VA induced by PES. The mean age was 51,2±12,3 years. 71% (n=24) were male. 15% (n=5) had history of cardiac syncope, and 27% (n=9) had a family history of SCD. 9% (n=3) were carriers of a SNC5A mutation. Mean AH time and HV time were, respectively, 105±31,9, and 49±8,5ms. During the 24 months of follow-up, 9% (n=3) suffered a CE (2 unexplained syncope and 1 SCD). None of the patients who suffered CE had VA inducible at PES study. There was no statistical significance in the occurrence of cardiac events when comparing both groups (VA induced in PES vs. no induced arrhythmia) (p=0,49, OR 0,89, IC 95% 0,70;1,02). Through binary logistics, adjusted for potential confounders (gender, history of syncope, history of family SCD and identification of a genetic variant), patients with spontaneous type 1 Brugada pattern in basal electrocardiography were 2,2 times more likely to have a CE (IC 95% 0,12;40,2). Conclusion In this population, VA induced by PES was not a predictor of CE during the follow-up period, which highlights the difficulty of risk stratification in patients with BrS. New risk-stratification tools are urgently needed to select those patients at higher-risk of SCD, which are candidates for prophylactic ICD implantation.

AP-452680-1 CLINICAL, ANATOMICAL AND PACING CHARACTERISTICS ASSOCIATED WITH FOLLOW-UP PACING BURDEN OF PROPHYLACTIC PERMANENT PACEMAKER FOR TRANSCATHETER AORTIC VALVE IMPLANTATION PATIENTS

Prophylactic implantation of permanent pacemaker (PPM) prior to transcatheter aortic valve implant (TAVI) is an option for patients at high-risk of atrioventricular block. The long-term follow-up ventricular pacing (VP) burden and associated clinical features of this group are not well known due to pre-existing PPM commonly being excluded by studies assessing TAVI patient outcomes. To identify features associated with longer-term VP in TAVI patients receiving prophylactic PPM. Using our prospectively maintained institutional TAVI database, we identified patients who had a PPM implanted up to 100-days before TAVI (Pre-TAVI), on the TAVI date (Same-day), and up to 30-days after TAVI (Post-TAVI) and evaluated their medical history, clinical parameters and pacing follow-up data up until 31st December 2020. Pre-TAVI patients receiving prophylactic PPM, due to baseline conduction abnormality, also had additional measurement of TAVI implant depth (ID) and membranous septum (MS) length performed by blinded investigators from preprocedural computed tomography (CT) and intraoperative fluoroscopic imaging. Of 681 TAVI procedures, we identified 122 (17.9%) patients (n=79 male; median age 85 [IQR 81-88] years old) who received PPM (including n=47 pre-TAVI), with a total median follow-up after TAVI of 751 days (IQR 323 – 1311). At first PPM check after TAVI (1 day, IQR 1-48 days after TAVI), 32% of patients (34 of 107) had not used VP (<1% burden, “Nil-VP”), with the remaining 73 patients (68% of 107) having used VP (≥1% burden). Nil-VP at first check after TAVI were 6 times more likely to have baseline LBBB (OR 6.79, 95%CI 1.13-40.84, p=.035). At the end of follow-up, there were 27 patients (25% of 107) who did not use VP (<1% burden). Among Pre-TAVI, there were 15 patients with <1% VP burden both before and after TAVI (nil-group), and 13 who had a sudden VP% increase after TAVI (change-group). The nil-group had significantly longer membranous septum ‘MS’ length (5.47 ± 1.7mm vs 2.94 ± 1.28mm, p=.024), shallower implant depth ‘ID’ (1mm [IQR 0-2.5] vs 5mm [IQR 3.5-10], p=.009) and different deltaMSID (4.13 ± 2.50mm vs -3.46 ± 3.69mm p=.007). A quarter of TAVI patients receiving periprocedural PPM did not use VP from their PPM throughout follow-up. The presence of long MS and an intraoperatively measured shallow ID with resultant positive deltaMSID may be features that warrant only periprocedural temporary pacing wire, rather than PPM due to low usage of VP during follow-up.

Clinical, electrocardiographic, and echocardiographic parameters associated with the development of pacing and implantable cardioverter-defibrillator indication in patients with transthyretin amyloid cardiomyopathy.

This study aimed to identify factors for attention leading to future pacing device implantation (PDI) and reveal the necessity of prophylactic PDI or implantable cardioverter-defibrillator (ICD) implantation in transthyretin amyloid cardiomyopathy (ATTR-CM) patients. This retrospective single-center observational study included consecutive 114 wild-type ATTR-CM (ATTRwt-CM) and 50 hereditary ATTR-CM (ATTRv-CM) patients, neither implanted with a pacing device nor fulfilling indications for PDI at diagnosis. As a study outcome, patient backgrounds were compared with and without future PDI, and the incidence of PDI in each conduction disturbance was examined. Furthermore, appropriate ICD therapies were investigated in all 19 patients with ICD implantation. PR-interval ≥220 msec, interventricular septum (IVS) thickness ≥16.9 mm, and bifascicular block were significantly associated with future PDI in ATTRwt-CM patients, and brain natriuretic peptide ≥35.7 pg/mL, IVS thickness ≥11.3 mm, and bifascicular block in ATTRv-CM patients. The incidence of subsequent PDI in patients with bifascicular block at diagnosis was significantly higher than that of normal atrioventricular (AV) conduction in both ATTRwt-CM [hazard ratio (HR): 13.70, P = 0.019] and ATTRv-CM (HR: 12.94, P = 0.002), whereas that of patients with first-degree AV block was neither (ATTRwt-CM: HR: 2.14, P = 0.511, ATTRv-CM: HR: 1.57, P = 0.701). Regarding ICD, only 2 of 16 ATTRwt-CM and 1 of 3 ATTRv-CM patients received appropriate anti-tachycardia pacing or shock therapy, under the number of intervals to detect for ventricular tachycardia of 16-32. According to our retrospective single-center observational study, prophylactic PDI did not require first-degree AV block in both ATTRwt-CM and ATTRv-CM patients, and prophylactic ICD implantation was also controversial in both ATTR-CM. Larger prospective, multi-center studies are necessary to confirm these results.