PT010 Predictors of asymptomatic atrial fibrillation in pacemaker patients
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PT008 The Role of an Integrated Nurse Led Service in the Management of Acute Symptomatic Atrial Fibrillation John D. Hung 1 , Muhammad Rashid* 1 , Hossam Elsayed 1 , Paula Dawson 1 , Paul Nugent 1 , Paula McCarten-Twiss 1 , Homeyra Douglas 1 1 Cardiology, Aintree University Hospital, Liverpool, United Kingdom Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia managed by emergency and acute physicians, with a wide variation in management practices. 1,2 Early specialist input in the management of AF improves patient outcomes. 3 Objectives: The AF service was set up with 3 arrhythmia specialist nurses (ASNs) in 2011. The aim of the service was to improve quality of care by standardising treatment, streamlining patient care, and reducing hospital admissions for acute symptomatic AF. Decisions regarding rate vs rhythm control and anticoagulation are undertaken on dis- cussion with a cardiologist, and subsequent treatment regimes are as per the standardised AF management pathways. All patients are reviewed by the ASNs within 48 hours of being discharged from hospital, who oversee the entire patient journey. Methods: Data was recorded for all patients referred to the AF service from 2011 to 2013. Patients were followed up until the point of discharge. Results: A total of 1020 patients aged 28 – 92 years old were referred to the service be- tween 2011 and 2013. Thirty three percent of patients were seen and discharged on the same day (n¼343). Of those who required admission (n¼677), 36% were discharged within the first 48 hours (n¼246). The majority of patients were considered for a rate control strategy and one third of patients were referred for direct current cardioversion (DCCV). (See figure 1) The DCCV was performed by the same nurses. There were no reported deaths or major adverse cardiac events (MACE). There were a total of 12 patients (1%) readmitted within 2 weeks of discharge with unsettled, symp- tomatic AF. Conclusion: An integrated nurse led service expedites early specialist input and streamlines patient care by standardising treatment in acute symptomatic atrial fibrillation. Disclosure of Interest: None Declared PT009 Effect of preaortic fat pad removal on atrial fibrillation post off-pump coronary artery bypass grafting (CABG): A randomized controlled trial Neda Fotoohi 1 , Masoud Mirzaei* 1 , Mehdi Haddadzadeh 2 1 Yazd Cardiovascular Research Centre, 2 Department of Cardiac Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic Of Introduction: An anterior periaortic fat pad (AFP) in human containing parasympathetic ganglia has been described in the aorto-pulmonary window. Changes in the autonomic nervous system (ANS) tone can lead to postoperative atrial fibrillation (POAF). The AFP is usually removed during coronary bypass grafting (CABG) to fully expose the aortic root. Objectives: The purpose of this study was to evaluate the effect of AFP removal during CABG on the ANS tone, incidence of POAF, length of hospital stay in-hospital morbidity and mortality. Methods: In this double blind randomized controlled trial, a total of 184 patients who were nominated for off pump CABG were randomized in to either removal (n ¼90) or maintenance (n ¼94) of the AFP arms during their first CABG. All patients underwent continuous telemetry monitoring after surgery. POAF was defined as fibrillation for more than five minutes or fibrillation causing hemodynamic instability. Results: The mean of participants was 60 years, and 69.6% were male. There was no difference in the incidence of POAF between the retained and removed AFP arms (12.2% Vs. 5.3% respectively; P ¼0.12). Length of -hospital stay, and postoperative morbidity and mortality were similar in both arms, except for the bleeding incidence which was higher in the retained AFP arm (P¼0.014). Conclusions: Removal of AFP during CABG has no significant effect on the incidence of POAF, other arrhythmia, and postoperative morbidity or mortality. Disclosure of Interest: None Declared PT010 Predictors of asymptomatic atrial fibrillation in pacemaker patients Nikola Bulj 1 , Vjekoslav Radelji c 1 , Bogdan Radakovi c 1 , Vedran Bursic* 1 1 University Hospital Sisters of Mercy, Zagreb, Croatia Introduction: The intention of this study was to investigate predictors of asymptomatic atrial fibrillation occurrence in homogenous patients group with complete atrioventricular block treated with pacemaker. Objectives: We hypothesized that new risk factors for asymptomatic atrial fibrillation can be identified analyzing atrial electrogram and that patients with lower atrial electrogram amplitude and wider atrial signal are prone to develop asymptomatic atrial fibrillation. We also hypothesized that patients prone to develop asymptomatic atrial fibrillation would show higher level of natriuretic peptides at time of the pacemaker implantation. Methods: In the enrollment period 194 patients with complete heart block and indication for pacemaker implantation were hospitalized. All patients with known risk factors for atrial fibrillation such as heart failure, heart cavity dilatation, structural heart disease, hy- perthyroidisms were excluded. Dual chamber pacemaker was implanted in 141 cases while single chamber pacemaker was implanted in 53 other. From 141 patients with dual chamber pacemaker, 51 were excluded due exclusion criteria while 90 other were followed. According to defined criteria in third month after pacemaker implantation 65 patients meat asymptomatic atrial fibrillation criteria (cumulative AF time of more than 1 %). Same criteria in 24th month after implantation meat 60 % of enrolled patients. Results: History of hypertension was steady risk factor for asymptomatic atrial fibrillation in third month after implantation (P¼0,036) and 24 month after implantation as well (P¼0,02). Group of patients with asymptomatic atrial fibrillation had higher occurrence of atrial signal width of more than 50 ms, but statistically insignificantly. On the other side patients with later developed asymptomatic atrial fibrillation had higher occurrence of P wave width of more than >100 ms (P<0,001). In this way standard electrocardiogram superiority over intacardial recordings was shown. Patients with later developed asymptomatic atrial fibrillation had significantly higher level of BNP at the time of implantation (P¼0,031). After the follow-up period difference in mortality neither major cardiovascular events was not shown. Conclusion: P wave width >100 ms in standard electrocardiogram and elevated levels of BNP at the time of pacemaker implantation could identify pacemaker patients with increased risk of developing asymptomatic atrial fibrillation Disclosure of Interest: None Declared PT011 NOX4 as a new biomaker of non-valvular atrial fibrillation Tong Liu* 1 , Qingmiao Shao 1 , Panagiotis Korantzopoulos 2 , Hongmei Liu 1 , Enzhao Liu 1 , Gang Xu 1 , Guangping Li 1 1 Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China, 2 Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece Introduction: Recent evidence indicates that NADPH oxidases (NOX)-derived reactive oxygen species (ROS) play a pivotal role in the development of atrial fibrillation (AF). Objectives: We sought to investigate the potential association between serum levels of NOX4, as well as inflammatory biomarkers, and AF. Methods: We enrolled 108 patients with AF (71 with paroxysmal AF and 37 with persistent/ permanent AF) and 68 patients without AF as controls. Demographic, clinical, laboratory, electrocardiographic and echocardiographic characteristics were carefully recorded. Results: Serum levels of myeloperoxidase (MPO), hs-CRP and NOX4 were assessed. Left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD) and P wave dispersion (PWD) were significantly increased in patients with paroxysmal AF and persistent/permanent AF compared with controls while NOX4 levels were significantly higher in patients with parox- ysmal AF and persistent/permanent AF compared to controls (155.5790, 155.8864.79 vs 126.7223.51pg/mL, respectively, P<0.05). A significant correlation between serum NOX4 levels and hs-CRP, and between NOX4 levels and MPO was also evident (r¼0.170; r¼0.227, p<0.05, respectively). Multivariate analysis demonstrated that baseline serum NOX4 level was independently associated with paroxysmal AF (OR: 1.014, 95% CI: 1.001-1.027, p<0.05) and with persistent/permanent AF (OR: 1.022, 95% CI: 1.000-1.044, p<0.05). Conclusion: There seems to be an association between increased NOX4 levels and AF, sug- gesting NOX4 involvement in the pathophysiology of human AF. Further studies are needed to elucidate its role in atrial remodeling and to examine its potential prognostic impact. Disclosure of Interest: None Declared PT012 ICD insertion confers reduced mortality and improved survival in patients with Dilated Cardiomyopathy: Real-life data from Manchester, UK, 2000-2013 Rahul Potluri* 1 , Amir Aziz 2 , Haren E. Wijesinghe 3 , Nicholas Gollop 4 , Noman Ali 2 , Hardeep Uppal 5 , Suresh Chandran 6 , Michael Coupe 7 1 Acalm Study Unit in collaboration with School of Medical Sciences, Aston University, Birmingham, 2 Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, 3 The Medical School, University of Birmingham, Birmingham, 4 The Norfolk and Norwich University Hospital, Norwich, 5 Department of Psychiatry of Learning Disability, Brooklands Hospital, Birmingham, 6 Training Programme Director in Acute Medicine, North Western Deanery, 7 Department of Cardiology, Pennine Acute Hospitals NHS Foundation Trust, Manchester, United Kingdom Introduction: Dilated cardiomyopathy(DCM) is associated with adverse mortality. A high percentage of deaths from DCM are sudden, mostly due to ventricular arrhythmias. RCTs e166 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters POSTER ABSTRACTS
Transcript of PT010 Predictors of asymptomatic atrial fibrillation in pacemaker patients
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RACTS
PT008
The Role of an Integrated Nurse Led Service in the Management of AcuteSymptomatic Atrial Fibrillation
John D. Hung1, Muhammad Rashid*1, Hossam Elsayed1, Paula Dawson1, Paul Nugent1,Paula McCarten-Twiss1, Homeyra Douglas11Cardiology, Aintree University Hospital, Liverpool, United Kingdom
Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia managed byemergency and acute physicians, with a wide variation in management practices.1,2 Earlyspecialist input in the management of AF improves patient outcomes.3
Objectives: The AF service was set up with 3 arrhythmia specialist nurses (ASNs) in 2011.The aim of the service was to improve quality of care by standardising treatment,streamlining patient care, and reducing hospital admissions for acute symptomatic AF.Decisions regarding rate vs rhythm control and anticoagulation are undertaken on dis-cussion with a cardiologist, and subsequent treatment regimes are as per the standardisedAF management pathways. All patients are reviewed by the ASNs within 48 hours of beingdischarged from hospital, who oversee the entire patient journey.Methods: Data was recorded for all patients referred to the AF service from 2011 to 2013.Patients were followed up until the point of discharge.Results: A total of 1020 patients aged 28 – 92 years old were referred to the service be-tween 2011 and 2013. Thirty three percent of patients were seen and discharged on thesame day (n¼343). Of those who required admission (n¼677), 36% were dischargedwithin the first 48 hours (n¼246). The majority of patients were considered for a ratecontrol strategy and one third of patients were referred for direct current cardioversion(DCCV). (See figure 1) The DCCV was performed by the same nurses.There were no reported deaths or major adverse cardiac events (MACE). There were a
total of 12 patients (1%) readmitted within 2 weeks of discharge with unsettled, symp-tomatic AF.
Conclusion: An integrated nurse led service expedites early specialist input and streamlinespatient care by standardising treatment in acute symptomatic atrial fibrillation.Disclosure of Interest: None Declared
PT009
Effect of preaortic fat pad removal on atrial fibrillation post off-pump coronary arterybypass grafting (CABG): A randomized controlled trial
Neda Fotoohi1, Masoud Mirzaei*1, Mehdi Haddadzadeh21Yazd Cardiovascular Research Centre, 2Department of Cardiac Surgery, Shahid SadoughiUniversity of Medical Sciences, Yazd, Iran, Islamic Republic Of
Introduction: An anterior periaortic fat pad (AFP) in human containing parasympatheticganglia has been described in the aorto-pulmonary window. Changes in the autonomicnervous system (ANS) tone can lead to postoperative atrial fibrillation (POAF). The AFP isusually removed during coronary bypass grafting (CABG) to fully expose the aortic root.Objectives: The purpose of this study was to evaluate the effect of AFP removal duringCABG on the ANS tone, incidence of POAF, length of hospital stay in-hospital morbidityand mortality.Methods: In this double blind randomized controlled trial, a total of 184 patients whowere nominated for off pump CABG were randomized in to either removal (n ¼90) ormaintenance (n ¼94) of the AFP arms during their first CABG. All patients underwentcontinuous telemetry monitoring after surgery. POAF was defined as fibrillation for morethan five minutes or fibrillation causing hemodynamic instability.Results: The mean of participants was 60 years, and 69.6% were male. There was nodifference in the incidence of POAF between the retained and removed AFP arms (12.2%Vs. 5.3% respectively; P ¼0.12). Length of -hospital stay, and postoperative morbidity andmortality were similar in both arms, except for the bleeding incidence which was higher inthe retained AFP arm (P¼0.014).Conclusions: Removal of AFP during CABG has no significant effect on the incidence ofPOAF, other arrhythmia, and postoperative morbidity or mortality.Disclosure of Interest: None Declared
e166
PT010
Predictors of asymptomatic atrial fibrillation in pacemaker patients
Nikola Bulj1, Vjekoslav Radelji�c1, Bogdan Radakovi�c1, Vedran Bursic*11University Hospital Sisters of Mercy, Zagreb, Croatia
Introduction: The intention of this study was to investigate predictors of asymptomaticatrial fibrillation occurrence in homogenous patients group with complete atrioventricularblock treated with pacemaker.Objectives: We hypothesized that new risk factors for asymptomatic atrial fibrillation canbe identified analyzing atrial electrogram and that patients with lower atrial electrogramamplitude and wider atrial signal are prone to develop asymptomatic atrial fibrillation. Wealso hypothesized that patients prone to develop asymptomatic atrial fibrillation wouldshow higher level of natriuretic peptides at time of the pacemaker implantation.Methods: In the enrollment period 194 patients with complete heart block and indicationfor pacemaker implantation were hospitalized. All patients with known risk factors foratrial fibrillation such as heart failure, heart cavity dilatation, structural heart disease, hy-perthyroidisms were excluded. Dual chamber pacemaker was implanted in 141 cases whilesingle chamber pacemaker was implanted in 53 other. From 141 patients with dualchamber pacemaker, 51 were excluded due exclusion criteria while 90 other were followed.According to defined criteria in third month after pacemaker implantation 65 patients meatasymptomatic atrial fibrillation criteria (cumulative AF time of more than 1 %). Samecriteria in 24th month after implantation meat 60 % of enrolled patients.Results: History of hypertension was steady risk factor for asymptomatic atrial fibrillation inthirdmonth after implantation (P¼0,036) and 24month after implantation as well (P¼0,02).Group of patients with asymptomatic atrial fibrillation had higher occurrence of atrial signalwidth ofmore than 50ms, but statistically insignificantly. On the other side patients with laterdeveloped asymptomatic atrial fibrillation had higher occurrence of P wave width of morethan>100ms (P<0,001). In thisway standard electrocardiogram superiority over intacardialrecordings was shown. Patients with later developed asymptomatic atrial fibrillation hadsignificantly higher level of BNP at the time of implantation (P¼0,031). After the follow-upperiod difference in mortality neither major cardiovascular events was not shown.Conclusion: P wave width >100 ms in standard electrocardiogram and elevated levels ofBNP at the time of pacemaker implantation could identify pacemaker patients withincreased risk of developing asymptomatic atrial fibrillationDisclosure of Interest: None Declared
PT011
NOX4 as a new biomaker of non-valvular atrial fibrillation
Tong Liu*1, Qingmiao Shao1, Panagiotis Korantzopoulos2, Hongmei Liu1, Enzhao Liu1,Gang Xu1, Guangping Li11Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China,2Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
Introduction: Recent evidence indicates that NADPH oxidases (NOX)-derived reactiveoxygen species (ROS) play a pivotal role in the development of atrial fibrillation (AF).Objectives: We sought to investigate the potential association between serum levels ofNOX4, as well as inflammatory biomarkers, and AF.Methods:We enrolled 108 patients with AF (71 with paroxysmal AF and 37 with persistent/permanent AF) and 68 patients without AF as controls. Demographic, clinical, laboratory,electrocardiographic and echocardiographic characteristics were carefully recorded.Results: Serum levels ofmyeloperoxidase (MPO), hs-CRP andNOX4were assessed. Left atrialdiameter (LAD), left ventricular end diastolic diameter (LVEDD) and Pwave dispersion (PWD)were significantly increased in patients with paroxysmal AF and persistent/permanent AFcompared with controls while NOX4 levels were significantly higher in patients with parox-ysmal AF and persistent/permanent AF compared to controls (155.57�90, 155.88�64.79 vs126.72�23.51pg/mL, respectively, P<0.05). A significant correlation between serum NOX4levels and hs-CRP, and between NOX4 levels and MPO was also evident (r¼0.170; r¼0.227,p<0.05, respectively).Multivariate analysis demonstrated that baseline serumNOX4 level wasindependently associatedwithparoxysmalAF (OR: 1.014, 95%CI: 1.001-1.027, p<0.05) andwith persistent/permanent AF (OR: 1.022, 95% CI: 1.000-1.044, p<0.05).Conclusion: There seems to be an association between increased NOX4 levels and AF, sug-gestingNOX4 involvement in thepathophysiologyof humanAF.Further studies are needed toelucidate its role in atrial remodeling and to examine its potential prognostic impact.Disclosure of Interest: None Declared
PT012
ICD insertion confers reduced mortality and improved survival in patients withDilated Cardiomyopathy: Real-life data from Manchester, UK, 2000-2013
Rahul Potluri*1, Amir Aziz2, Haren E. Wijesinghe3, Nicholas Gollop4, Noman Ali2,Hardeep Uppal5, Suresh Chandran6, Michael Coupe71Acalm Study Unit in collaboration with School of Medical Sciences, Aston University,Birmingham, 2Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds,3The Medical School, University of Birmingham, Birmingham, 4The Norfolk and NorwichUniversity Hospital, Norwich, 5Department of Psychiatry of Learning Disability, BrooklandsHospital, Birmingham, 6Training Programme Director in Acute Medicine, North WesternDeanery, 7Department of Cardiology, Pennine Acute Hospitals NHS Foundation Trust,Manchester, United Kingdom
Introduction: Dilated cardiomyopathy(DCM) is associated with adverse mortality. A highpercentage of deaths from DCM are sudden, mostly due to ventricular arrhythmias. RCTs
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
