Validation of a Machine Learning Algorithm to Identify Pulmonary Vein Isolation during Ablation Procedures for the Treatment of Atrial Fibrillation: Results of the PVISION Study

BACKGROUND AND AIMS

Pulmonary Vein Isolation (PVI) is the cornerstone of ablation for atrial fibrillation. Confirmation of PVI can be challenging due to far field electrograms and sometimes requires additional pacing maneuvers or mapping. This prospective multicenter study assessed the agreement between a previously trained automated algorithm designed to determine vein isolation status with expert opinion in real-world clinical setting.

METHOD

Consecutive patients scheduled for PVI were recruited at four centers. The ECGenius electrophysiology recording system (CathVision ApS, Denmark) was connected in parallel with the lab's existing system. Electrograms from a circular mapping catheter were annotated during sinus rhythm at baseline pre-ablation, time of isolation, and post-ablation. The ground truth for isolation status was based on operator opinion. The algorithm was applied to the collected PV signals off-line and compared to expert opinion. The primary endpoint was a sensitivity and specificity exceeding 80%.

RESULTS

Overall, 498 electrograms (248 at baseline and 250 at PVI) with 5,473 individual PV beats from 89 patients (32 females, 62 ±12 years) were analyzed. The algorithm performance reached an area under curve (AUC) of 92% and met the primary study endpoint with a sensitivity and specificity of 86% and 87%, respectively (p = 0.005; p = 0.004). The algorithm had an accuracy of 87% in classifying the time of isolation.

CONCLUSION

This study validated an automated algorithm using machine learning (ML) to assess the isolation status of pulmonary veins in patients undergoing PVI with different ablation modalities. The algorithm reached an AUC of 92% with both sensitivity and specificity exceeding the primary study endpoints.

Evaluation of a multisensory algorithm to prevent acute decompensation of heart failure in patients implanted with a cardioverter defibrillator: rationale and design

Background

Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re-hospitalizations and associated costs [1–4]. HeartLogic is an algorithm incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing preemptive treatment of congestion to prevent acute decompensation [5–7].

Objectives

We aim to provide real-world data on the impact of pre-emptive HF management, guided by the HeartLogic index on unscheduled HF hospitalizations in a substantial cohort of patients.

Methods

The HeartLogic French Study is an investigator-initiated, prospective, multi-centre, non-randomized study. All in all, 310 patients with a history of HF (left ventricular ejection fraction ≤40%; or at least one episode of clinical HF with elevated NT-proBNP ≥450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic index calculation will be included across 10 French centers. The HeartLogic index will be monitored remotely on a weekly basis for 12 months and in case of HeartLogic index ≥16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all-cause mortality, cardiovascular death, HF-related death, and unscheduled hospitalizations for ventricular or atrial arrhythmia. Blood samples will be collected for biobanking, and quality of life will be assessed. A blind and independent committee will adjudicate the events.

Conclusions

The HeartLogic French Cohort Study will provide robust real-world data on HF hospitalization in a cohort of patients managed with the HeartLogic algorithm allowing preemptive treatment of congestion.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific

Chronic outcomes of leadless vs transvenous single chamber ventricular pacemakers in high-risk subgroups

Background

The Micra leadless pacemaker (LP-VVI) has been shown to have lower chronic complications and device-related reinterventions compared to transvenous ventricular pacemakers (TV-VVI) in a large, real-world population. This study compares the complication and reintervention rate in subgroups with comorbidities associated with higher risk of pacemaker complications and hypothesized to benefit from leadless pacing.

Methods

The longitudinal Micra Coverage with Evidence Development (CED) Study compared the outcomes of Medicare patients receiving LP-VVI to those receiving a TV-VVI in the US. Patients in the Micra CED study were included in this study if they had a diagnosis of chronic kidney disease Stages 4–5 (CKD45), end-stage renal disease (ESRD), malignancy, diabetes, tricuspid valve disease (TVD), or chronic obstructive pulmonary disease (COPD) on any administrative claim in the 12 months prior to pacemaker implant. A pre-specified set of complications and system reinterventions were identified using the relevant diagnosis and procedure codes. Adjusted and unadjusted Fine-Gray competing risks models were used to compare reinterventions and complications between LP-VVI and TV-VVI patients within each subgroup. All results were adjusted for multiple comparisons using a Bonferroni correction. An ad-hoc comparison of a composite endpoint of select reinterventions (system replacement, removal, revision, and lead reinterventions) and device complications was also conducted.

Results

The sample size of patients in each subgroup ranged from 2,032 patients with ESRD to 11,936 patients with diabetes. The percent of LP-VVI patients in each subgroup ranged from 44.0 in the TVD subgroup to 74.9 in the ESRD subgroup. Compared to patients implanted with a TV-VVI, patients with a LP-VVI with malignancy, diabetes, TVD, and COPD had significantly fewer complications (Table 1; Malignancy, HR 0.68, [0.48–0.95]; Diabetes, HR 0.69, [0.53–0.89]; TVD, HR 0.60 [0.44–0.82]; COPD, HR 0.73, [0.55–0.98]). LP-VVI patients with diabetes, TVD, and COPD also had lower rates of reintervention (Table; Diabetes, HR 0.58, [0.37–0.89]; TVD, HR 0.46 [0.28–0.76]; COPD, HR 0.51, [0.29–0.90]). LP-VVI patients with malignancy, diabetes, TVD, and COPD had lower rates of the combined endpoint of device complications and select reinterventions (Table; Malignancy, HR 0.52, [0.32–0.83]; Diabetes, HR 0.52, [0.35–0.77]; TVD, HR 0.44 [0.28–0.70]; COPD, HR 0.55, [0.34–0.89]).

Conclusions

In a real-world study of US Medicare patients, the leadless pacemaker was associated with lower rates of chronic complications and reinterventions at 2 years compared with TV-VVI pacing in several high-risk subgroups.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Medtronic

Current practices and expectations to reduce Electrophysiology catheters environmental impact: a large EHRA/LIRYC European survey

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific

Background

Despite aiming at improving patients’ health, healthcare consumes a large amount of resources and contributes to 4.6% of the global GHG/carbon emissions, 71% of the footprint being due the supply chain. It also produces millions of tons of complex waste per year. Yet, sustainability in EP remains a complex challenge as the performance and safety for patients are critical.

Objective

To set the ground to reduce electrophysiology (EP) catheters’ environmental impact.

Methods

A survey was conducted to poll European EP centers on 24 questions on sustainability practices and expectations.

Results

278, mostly EP doctors (84%, 76% male, 43yo), working in a public environment (89%, >100 procedures/year in 53% and > 500 in 36%) participated. A majority of EP doctors uses 2 to 4 more catheters/sheath per paroxysmal AF ablation procedure. MAPPING/ABLATION catheters are discarded after the procedure (73&78%), with partial re-cycling (electrodes) in 23&26 %. Local/external sterilization is rarely used (12% & 9%).

Catheters’ packaging are discarded in medical or general waste (38 & 31%) while it is recycled in only 19%.

EP Healthcare professionals are highly motivated in being environment friendly in their personal (82%) and in EP practice (62%). They identify a lack of interest from their hospital in 59% (only 16% having an executive in charge). Other barriers are the complexity of sustainability processes (48%), the effort required to change practice (47%), infectious risk (41%), lack of training (37%) and cost (33%). EP Healthcare professionals would favor sustainable mapping /ablation catheters if performances were preserved (60 & 50%). They consider re-use as the most relevant solution (60%) while being currently illegal in some European countries. Packaging should be reduced in size or made reusable. Finally, they consider that regulatory (31%), education (19%) and recommendations by companies (19%) would encourage the field to transition to more environmentally friendly practices. Interestingly, age, gender, type of practice, country or experience did not impact the results.

Conclusion

EP Healthcare professionals demonstrate a willingness to adopt sustainable practices. They consider re-use as the most relevant approach as of today. 60/50 % would favour sustainable mapping/ablation catheters providing preserved performances. Leaping to the next level of sustainability will request development of new sustainable solutions, models and technologies. Reaching this urgent goal will require governments, industry, hospitals and doctors to work closely in a coordinated approach.

Infection and infective endocarditis after cardiac implantable electronic device implantation: a contemporary nationwide cohort study

Funding Acknowledgements

Type of funding sources: None.

Aims

To determine the contemporary incidence and risk factors of infection and infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED).

Methods

This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals from January 1, 2010 to December 31, 2019, who underwent a de novo permanent pacemaker (PM) or implantable cardioverter defibrillator (ICD) implantation were identified together with the occurrence of post-implantation infection and IE-events during follow-up.

Results

In total 688,007 CIED patients with de novo implants were identified (single-chamber pacemaker 18.8%, dual-chamber pacemaker 64.9%, cardiac resynchronization therapy [CRT]pacemaker 3.2%, single-chamber ICD 4.3%, dual-chamber ICD 3.4%, CRT ICD 5.5%). Follow-up was 2.6±2.6 years (median 1.9, IQR 0.2-4.3 years) and total follow-up time was 1,788,166person-years (PYs). There were 9,804 patients with CIED-related infection during follow-up (incidence rate 5.48 per 1000 patient.year) among whom 2,658 had IE (incidence rate 1.49 per 1000 patient.year).

The incidence rate (per 1000 PYs) of CIED-related infection and IE in the different subgroups of patients with pacemakers and ICD (single-chamber, dual-chamber, CRT) are in table 1. Incidence rates were higher in patients with an ICD than in those with a pacemaker, and higher in those with CRT. Incidence rates of CIED-related infection and IE were not different in single-chamber vs dual-chamber CIEDs(table 1).

In multivariable analysis, ICD (vs pacemaker, HR: 1.59; 95% CI 1.40-1.80) and CRT (vs no CRT, HR: 1.21; 95% CI: 1.07-1.37) were independent risk factors for CIED-related infection. Dual-chamber pacemakers were not associated with a higher risk of CIED-related infection than single-chamber pacemakers. Similarly, dual-chamber ICDs were not associated with a higher risk of CIED-related infection than single-chamber ICDs (table). There were similar findings when analysing the risk of IE during FU. ICD (vs pacemaker, HR: 1.31; 95% CI 1.23-1.40) and CRT (vs no CRT, HR: 1.24; 95% CI: 1.16-1.32) were independent risk factors for IE. Dual-chamber pacemakers were not associated with a higher risk of IE than single-chamber pacemakers and dual-chamber ICDs were not associated with a higher risk of IE than single-chamber ICDs (table).

Results were similar when one considered separately the periods 2010-2014 and 2015-2019

Conclusion

The risk of CIED-related infection and IE was significantly higher in patients with ICDs than in those with pacemakers and significantly higher with CRT than with no CRT. By contrast, there was no statistical difference in the risk of CIED-related infection and IE in patients with single-chamber or dual-chamber CIEDs in this contemporary analysis at a nationwide level.

Management of conduction disorders after transcatheter aortic valve implantation: results of an EHRA survey

Funding Acknowledgements

Type of funding sources: None.

Background

Left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) and is an indicator of subsequent high-grade atrioventricular block. Consensus regarding a reasonable strategy to manage cardiac conduction disturbances after TAVI has been elusive

Methods

The European Heart Rhythm Association (EHRA) conducted a survey to capture contemporary clinical practice for conduction disorders after TAVI. A 25-item online questionnaire was developed and distributed among the EHRA electrophysiology research network centres.

Results

Of 117 respondents, 44% were affiliated with university hospitals. This survey has revealed that a standardized management protocol for advanced conduction disorders such as LBBB or AVB after TAVR is available in 63% of participating centres. Telemetry was chosen by most participants as the most frequent management strategy for patients with new or preexisting LBBB after TAVI (79%, 70%, respectively, Figure 1). Duration of telemetry in patients with new LBBB varied: 18% chose 24 hours, 35% 48 hours, 27% 72 hours and 20% ≥ 72 hours. Similarly, in patients with new LBBB after TAVI undergoing EP study, the cut-off for a prolonged HV interval for PM implantation was heterogenous among European centers (7.4% ≥ 55ms and 44% ≥ 75ms). Conduction system pacing was chosen as preferred device therapy in patients with LBBB and normal LVEF in 3.7% and in patients with LBBB and reduced LVEF in 5.6%.

Conclusions

The management of conduction disorders after TAVI is very heterogeneous across European centres. Risk stratification strategies vary substantially. The role of conduction system pacing in patients with LBBB after TAVI needs to be defined. There is a considerable room for better uniformity in clinical practice.

Risk of pacemaker implantation after radiotherapy for breast cancer: A study based on French nationwide health care database sample

Background

Among cardiac complications of breast cancer radiotherapy (BC RT), there are very limited data on arrhythmia and conduction disorders, in particular severe cases requiring permanent pacemaker implantation (PPMI). Therefore, this exploratory study aimed to evaluate the risk of PPMI for BC patients treated with RT, compared with the general population and with BC patients not treated with RT.

Methods

The study was performed on a 1/97 representative sample of the French health care database (EGB database). Adult women with a first BC treated with or without RT between 2008 and 2016 were included, followed until 2018, and de novo PPMI were identified. We compared the PPMI incidence in BC cohort relative to the general population with standardized incidence ratio (SIR) and evaluated the risk of PPMI in RT patients compared to patients without RT with a competing risk survival analysis.

Results

A total of 3853 BCE patients were included. Among BC patients treated with RT, 28 PPMI cases were observed compared with 13 expected cases, corresponding to a SIR of 2.18 [95% CI: 1.45-3.06]. For BC patients not treated with RT, the SIR was 1.01 [95% CI: 0.40-1.90]. Patients treated with RT showed a borderline significant higher risk of PPMI compared with those not treated with RT (subdistribution Hazard Ratio = 2.08, 95% CI 0.87-4.97, p = 0.09).

Conclusions

Our exploratory findings indicate that, over the last decade in France, BC patients treated with RT appeared to be at higher risk of PPMI than general population. Further studies are needed to expand on this topic.

Breast cancer radiotherapy and risk of pacemaker implantation: an epidemiologic analysis using the French nationwide claims database

Background

Radiotherapy (RT) is a major treatment for breast cancer (BC), but it is also associated with an increased long-term (>5–10 years) risk of cardiac complications. Specific data on cardiac arrhythmias and conduction disorders are warranted.

Purpose

To evaluate whether pacemaker (PM) implantation risk is higher in BC patients treated with RT compared to the general population or population of BC patients treated without RT.

Methods

Our study was based on the Echantillon Généraliste de Bénéficiaires (EGB), the 1/97 random sample of the French nationwide health insurance claims database. The population of patients treated for BC consisted of adult women with a first BC identified by the ICD-10 diagnosis codes between 2008 and 2016, and followed through 2018. PM implantations and RT were identified with medical procedures codes in the french Common Classification of Medical Procedures (CCAM). For each year from 2008 to 2018, the reference population included all adult women of the EGB database. History of PM or BC was an exclusion criteria. Annual incidence rates of PM implantations were evaluated between 2008 and 2018 in the reference populations. The number of PM cases observed in BC patients at least one year after BC diagnosis was compared with the expected number of PM cases calculated by using reference incidence rates with age standardization. We then computed the standardized incidence ratio (SIR) as the ratio of the observed number of PM to the expected number of PM, with 95% confidence intervals (CIs). Thereafter, a survival analysis was performed in BC patients using a Cox regression model (Hazard Ratio – HR) in order to evaluate the risk of PM associated with treatment including RT (RT) compared with treatment not including RT (no RT).

Results

A total of 3,853 patients were included in the population of patients treated for BC between 2008 and 2016 with a mean age of 60 years old and a mean follow-up of 5.6 years. In this population, 35 cases of PM were observed, compared with 19.9 expected cases of PM, corresponding to a significant SIR=1.76 (95% CI: 1.22 - 2.39). This excess risk was carried by the RT group of 2973 patients (77% of BC population): 28 observed PM vs 12.9 expected, SIR=2.18 (95% CI: 1.45–3.06). In Cox regression analysis, after adjustment on age, RT was associated with an increased risk of PM compared with no RT, but this result did not reach statistical significance (HR=1.73; p-value=0.21).

Conclusion

Based on our study, BC patients receiving RT appeared to be at higher risk of PM implantation than general female population and BC patients without RT, illustrating a potential association between cardiac exposure during BC RT and conduction disorders.

Funding Acknowledgement

Type of funding sources: None.

Real-world experience on the safety and effectiveness of Micra TPS in patients with pre-existing in situ CIEDs

Background

The Micra pre-market study showed that the Micra transcatheter pacing system could be safely implanted in patients with pacing indications. Patients with pre-existing cardiac implantable electronic devices (CIED) were excluded from this clinical trial; however, this group of patients might benefit from a leadless pacemaker especially when a lead fails or after incidence of system-related infections.

Objective

To determine the outcome of patients with a pre-existing CIED or lead that remains in situ at the time of Micra implant attempt.

Methods

Patients who had a pre-existing CIED and/or lead at the time of Micra implantation attempt were identified from the Micra Post-Approval Registry and Micra Acute Performance studies. Baseline characteristics were summarized, and a Fine-Gray competing risk model was used to compare risk for major complication through 24 months for patients with and without a pre-existing CIED.

Results

Of the 2323 patients included in the analysis, 111 patients had a pre-existing CIED or lead at the time of Micra implantation attempt that remained in situ. Types of pre-existing devices included 81 pacemakers (45 single chamber, 32 dual chamber, 4 of unknown type), 10 ICDs (2 single chamber, 2 dual chamber, 6 unknown type), 10 CRT devices (6 CRT-P, 4 CRT-D), 3 generators of unknown type, and 7 patients had only leads remaining. Patients with pre-existing devices were younger and less likely to have a pacing indication of bradyarrhythmia with atrial fibrillation compared to patients without pre-existing devices (p<0.001 for both). Patients with prior devices were more likely to have a condition precluding implant of a transvenous pacemaker (67.6% vs. 21.3%, p<0.001). The presence of a pre-existing CIED did not impact the outcome of the Micra TPS implant procedure: implant success was >99% for both cohorts. Mean follow-up duration was 21.2±14.3 months (range 0–56) for pre-existing devices patients and 23.3±15.8 months (range 0–62) for other patients. The rate of major complications through 24 months was 1.8% for patients with and 3.8% for patients without prior devices (p=0.36). There were no major complications related to device malfunction or device-device interaction. There were 6 system revisions in 4 patients with preexisting devices and 52 revisions in 51 patients without preexisting devices. Pacing thresholds for patients with and without prior devices were similar at implant (0.72 and 0.63, respectively; p=0.31) and remained stable through 12 months.

Conclusion

Micra can be safely and successfully implanted in patients with a pre-existing CIED remaining in situ. It should be considered a treatment option for patients in whom CIED extraction may be deemed high risk.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Risk of major complications

Impact of transcatheter aortic valve implantations on temporal trends of pacemaker implantations among French octogenarians: a nation-wide cohort study over the period 2008–2018

Background

The indications for permanent pacemaker implantation (PPMI) are strongly associated with age, with the highest rates for octogenarians (>80 years old). Over the last decade, impact of aging on temporal trends in PPMI rates among octogenarians is questionable. In the 2010's, transcatheter aortic valve implantation (TAVI) has emerged for inoperable or high-risk patients, mainly octogenarians, with an exponential increase over years. PPMI is a common short-term complication after TAVI procedure. Many studies have explored these post-TAVI PPMI in terms of incidence, timing and outcomes of PPMI following TAVI, but there are no data on the impact of TAVI on PPMI temporal trend at a nationwide scale.

Purpose

To evaluate whether PPMI in octogenarians have increased during the last decade, independently from age and sex, on a nationwide scale. Eventually, to estimate the potential contribution of TAVI in PPMI increase in this setting.

Methods

Our study was based on octogenarians from the Echantillon Généraliste de Bénéficiaires, the 1/97 random sample of the French nationwide health insurance claims database. Between 2008 and 2018, we identified de novo PPMI and TAVI with medical procedures codes in the French Common Classification of Medical Procedures (CCAM). Annual incidence rates of PPMI were evaluated between 2008 and 2012 (preTAVI-period). The number of observed PPMI cases, O, in the period 2013–2018 (TAVI-period) was compared with the expected number of PPMI cases, E, calculated by using 2008–2012 incidence rates with age and sex standardization. We then computed the standardized incidence ratio (SIR) of the observed number of PPMI to the expected number of PPMI (O/E), with 95% confidence intervals (CIs). Thereafter, we evaluated the contribution of post-TAVI PPMI in the number of excess cases of PPMI (O-E) for the period 2013–2018.

Results

The population of octogenarians increased from 23,822 in 2008 to 33,752 in 2018. In 2008, 130 PPMI were observed (546/100,000 inhabitants) reaching 228 PPMI (676/100,000) in 2018 with a marked increase in rates from the year 2012. During the period 2013–2018, for all octogenarians, 1242 cases of PPMI were observed, compared with 1171.3 expected cases of PPMI, corresponding to a significant SIR=1.06 (95% CI: 1.01–1.12). For the subpopulation of octogenarians without TAVI, no excess risk was observed with a SIR=1.01 (95% CI: 0.95–1.06). Among the excess cases of PPMI observed in 2013–2018 in all octogenarians, 72% were post-TAVI PPMI.

Conclusion

Based on our study, the number of observed PPMI in octogenarians in period 2013–2018 is 6% higher than the number we would expect. Nearly three-quarter of these excess cases are attributable to TAVI complication.

Funding Acknowledgement

Type of funding sources: None.

The use of instant messaging in clinical data sharing: the EHRA SMS survey

Funding Acknowledgements

Type of funding sources: None.

Background

Nowadays, instant messaging (IM) provides fast and widespread communication. These platforms and apps enable the physicians to quickly share and send clinical data to their peers, to send information to their patients regarding their illnesses and to be reached for counselling and advise. Nevertheless, the use of IM has never been assessed in the cardiology community up until now.

Purpose

To assess the habits of cardiologists related to modern communication tools, their primary and secondary uses in clinical practice and the potential differences and preferences between different media in terms of ease of access, usefulness and trustworthiness.

Methods

An online survey was promoted by the EHRA e-Communication Committee and the EHRA Scientific Initiative Committee during the ESC Digital Health Week. All cardiologists were invited to participate via Twitter, LinkedIn, Facebook and other dedicated channels. The survey consisted of 22 questions and was made anonymous. The questions were made on an individual-basis and collected on SurveyMonkey.

Results

287 physicians from 33 countries responded to the survey. The mean age of the respondents was 43.4 ± 11.5 years, and 74.8% of them were male. 88.3% of all respondents routinely sends and 90.3% receives clinical data through IM. IM is used at least once a week (36.4%) or even once or more a day (40.4%) for sharing clinical data. WhatsApp is the most used IM app to share clinical data (79.4%). On a scale of 1 to 5, IM was second only to face-to-face contact (average 4.46) as the preferred method for sharing clinical data (average 3.69) and was considered better than phone calls (average 3.34) and e-mails (average 3.21). Twelve-lead ECGs (88.6%), medical history (61.4%) and echo loops (55.7%) are the data shared most often. Among potential pros of IM, the respondents listed being a fast way of communication (82.0%) and making it easy to contact colleagues (76.7%), while privacy issues regarding IM apps providers (62.7%) and other colleagues (45.6%) were commonly perceived as drawbacks. Only 57.4% of all respondents anonymize clinical data before sharing them through IM, and only 44.0% of the data received are reported to be anonymized. Of note, 29.3% of the respondents were not aware of the European General Data Protection Regulation (GDPR) on data protection at the time of the survey, and 29.8% do not know if their institution has a specific policy regarding the use of IM for professional use.

Conclusions

IM apps are used by cardiologists worldwide to share and discuss clinical data and are preferred to many other methods of data sharing, being second only to face-to-face contact. IM are often used and to share many different types of clinical data, being perceived as a fast and easy way of communication. Cardiologists should be sensitised to appropriate use of IM in accordance to GDPR and local policies in order to prevent legal and privacy issues.

Compared prognostic impact of incident atrial fibrillation versus history of atrial fibrillation in patients with AMI: the FAST-MI programme

Background

History of atrial fibrillation (HxAF) and new onset atrial fibrillation (NOAF) at acute stage of MI are associated with poorer survival. Whether both entities carry an increased risk of stroke is uncertain.

Using data from the FAST-MI 2010 and 2015 registries, we analysed the associations between HxAF and NOAF and risk of 3-year death, nonfatal stroke or combined death or stroke.

Methods

The FAST-MI registries are nationwide French cohorts consecutively including AMI patients admitted over a 1-month period every 5 years. Baseline characteristics, acute management and medications at discharge are collected. Among 9460 patients with STEMI or NSTEMI, 610 (6.4%) had HxAF, and 626 (6.6%) developed NOAF.

Main characteristics

Table 1 Overall, NOAF was associated with larger and more severe AMIs.

Results

In hospital survivors, 3-year death was 8.6% in patients without AF, 23.2% in those with NOAF and 29.2% in those with HxAF. 3-year Kaplan-Meier rates of non-fatal stroke were 1.1%, 0.3% and 3.6%, respectively (Figure).

Compared with no AF, NOAF was not associated with non-fatal stroke (Cox HR, 95% CI: 0.17, 0.02–1.21), while HxAF was (HR, 95% CI 2.04, 1.13–3.66, P=0.017). Risk of death or stroke was increased for both NOAF (HR, 95% CI 1.35, 1.10–1.65, P=0.004) and HxAF (HR 95% CI, 1.37, 1.14–1.65, P=0.001). Risk of all-cause death at 3 years was increased for NOAF (HR, 95% CI 1.32, 1.09–1.60) and HxAF (HR, 95% CI 1.30, 1.09–1.55). The results were concordant in patients not receiving oral anticoagulants at discharge.

Conclusion

Both NOAF and HxAF are associated with increased risk of death at 3 years after AMI. NOAF, however, is not associated with an increased risk of non-fatal stroke.

Figure 1. Non-fatal stroke

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Pharma companies

Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology (SFC) and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) on magnetic resonance imaging in patients with cardiac electronic implantable devices

Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.