P1496Impact of electrical reverse remodeling by cardiac resynchronization therapy on adverse cardiac events in patients of heart failure with reduced ejection fraction

Background

Recently, structural reverse remodeling (SRR) and electrical reverse remodeling (ERR) after cardiac resynchronization therapy (CRT) have been reported in patients of heart failure with reduced ejection fraction (HFrEF). However the relationship between ERR and subsequent adverse cardiac events is still unknown. We aimed to elucidate the impact of ERR after CRT on the occurrence of heart failure events and ventricular arrhythmias.

Methods

A total of 36 HFrEF patients who underwent newly CRT implantation were investigated retrospectively. The intrinsic QRS duration (iQRSd) had been recorded before and more than 6 months after CRT implantation. Biventricular pacing was temporarily turned off during measurement of iQRSd. ERR was defined as positive shortening of iQRSd and SRR was defined as reduction of left ventricular end systolic volume by more than 15% after CRT implantation. The primary endpoint was a composite of all cause death, heart failure hospitalizations and ventricular tachyarrhythmia events.

Results

ERR was observed in 17 patients (47.2%) and SRR in 22 patients (61.1%). The group with ERR included more patients with lower NYHA class prior to CRT and patients with SRR. The primary endpoint was observed in 15 patients (51.4 %) for a median of 181 [63, 367] days during follow-up. Kaplan-Meier analysis revealed that the group without ERR was poor prognosis compared with the group with ERR (p = 0.022, Log-rank test).

Conclusion

Patients of HFrEF with ERR after CRT may have fewer adverse cardiac events such as worsening heart failure or ventricular arrhythmia events from this short-term study.

Abstract Figure. Adverse cardiac events and ERR

P1353Echocardiographic predictor of sick sinus syndrome following catheter ablation of persistent atrial fibrillation

Funding Acknowledgements

Abbott Medical Japan, Medtronic Japan, Boston Scientific Japan, Biotronic Japan, Japan Life Line

Background / Introduction

Although sick sinus syndrome(SSS) can be associated with atrial fibrillation(AF), predictive factors of SSS following catheter ablation(CA) of persistent atrial fibrillation(perAF) are not well known.

Purpose

We investigated echocardiographic parameters to predict occurrence of SSS after restoration of sinus rhythm by CA for perAF patients.

Methods

Ninety-eight consecutive perAF patients from June 2014 to May 2018 treated with CA were retrospectively reviewed. Twelve patients(12%, SSS group) developed SSS after successful CA and 86 patients(88%, non-SSS group) did not. Baseline characteristics, blood exam, and echocardiographic findings(RA area size, LA area size, EF, etc) before AF CA were analyzed using Student’s t test, Mann-Whitney test, Chi-square test and Univariate analysis. Multivariate logistic analysis was then performed using those parameters. The atrial area size was calculated from 4 chamber view at the atrial end- systole.

Results

The multivariate analysis for predictive factors of SSS is shown in the table. Right atrium(RA) area could predict SSS(17.3 ± 4.8cm2 vs. 14.7 ± 3.6cm2, odds ratio 1.468; 95% confidence interval 1.088 to 1.981, p = 0.012). Gender (female) was also an independent predictor(4/12 (33%) vs. 8/86 (9%), odds ratio 39.832; 95% confidence interval 2.589 to 612.938, p = 0.008). The other echocardiographical findings(LA area size, EF, etc), baseline characteristics and blood exam results were not related to SSS after successful CA of perAF patients.

Conclusions

The large RA area size and gender (female) could predict SSS in perAF patients after restoration of sinus rhythm by successful CA. We may need to inform possible SSS after CA to female patients with a large RA before CA.

Multivariate Logistic analysis Total(N = 98) SSS group (N = 12) Non SSS group (N = 86) Odds ratio 95% CI P-value Age 64(58-69) 68(60-72) 63(57-69) 1.032 0.929-1.145 0.560 Gender/Female 12(12%) 4(33%) 8(9%) 39.832 2.589-612.938 0.008 CKD 27(28%) 6(50%) 21(24%) 1.264 0.179-8.945 0.814 BNP 91(53-180) 206(167-304) 82(48-169) 1.003 0.993-1.012 0.609 RDW 45.1 ± 3.9 46.4 ± 4.8 44.9 ± 3.8 1.242 0.971-1.588 0.085 RA area 15.1 ± 3.8 17.3 ± 4.8 14.7 ± 3.6 1.468 1.088-1.981 0.012 LA area 24.2(17.0-24.9) 24.4(17.7-26.3) 24.1(16.8-24.4) 0.967 0.803-1.165 0.726 Right atrium area and gender were the independent predictor of SSS in persistent atrial fibrillation patients after restoration of sinus rhythm