TY - JOUR
AB -   P74 PACEMAKER THERAPY IN VERY ELDERLY PATIENTS: SURVIVAL AND PROGNOSTIC PARAMETERS M Saltori M Saltori CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO M Marini M Marini CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO M Martin M Martin CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO F Guarracini F Guarracini CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO S Quintarelli S Quintarelli CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO F Zilio F Zilio CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO A Coser A Coser CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO S Valsecchi S Valsecchi CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO R Bonmassari R Bonmassari CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO CARDIOLOGIA OSPEDALE SANTA CHIARA TRENTO, ITALIA, TRENTO; BOSTON SCIENTIFIC, MILANO, ITALIA, MILANO Background Permanent pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmia. The number of very elderly patients receiving pacemakers is increasing and little is known about survival in this specific subgroup. This study is aimed at assessing the actual survival of patients requiring pacing therapy at age >85 years and investigating variables associated with death. Methods Between 2010 and 2017, 572 patients aged >85 years underwent pacemaker implantation for conventional bradycardia indications at our Institution. Results Thirty percent of patients were ≥90–year–old, 48% male, 7% had an ejection fraction <45%, 76% arterial hypertension, 47% history of atrial fibrillation. Nineteen percent had diabetes, 29% chronic kidney disease, 15% dementia/dysautonomia, 6% were diagnosed with cancer. Fifty–seven percent of patients required pacing for prognostic reasons (acquired atrioventricular block), and the remaining for symptom relief (other indications). A dual–chamber pacemaker was implanted in 34% of patients. The 5–year survival was 45% [SE: 3%], and the 8–year survival was 26% [SE: 4%]. At multivariate analysis, following variables were associated with death: age ≥90–year–old (HR: 1.54, 95%CI: 1.18–2.03, p = 0.002), low ejection fraction (HR: 1.32, 95%CI: 1.11–1.56, p = 0.002), chronic kidney disease (HR: 1.31, 95%CI: 1.01–1.70, p = 0.044), dementia/dysautonomia (HR: 1.40, 95%CI: 1.01–1.93, p = 0.043). Diagnosis of cancer showed a borderline association (HR: 1.58, 95%CI: 0.99–2.54, p = 0.058), and implantation of a dual–chamber pacemaker seemed associated with better prognosis (HR: 0.74, 95%CI: 0.56–0.99, p = 0.041). The risk of death was similar in patients who received pacemaker for symptom relief and for prognostic reasons in the overall population (HR: 1.19, 95%CI: 0.94–1.51, p = 0.159) and in the ≥90–year–old group (HR: 1.40, 95%CI: 0.93–2.11, p = 0.107). Conclusion This study showed a good life expectancy in patients aged >85 who received a pacemaker. The majority of risk factors for all–cause death are non–cardiac. Pacemaker therapy seems a clinically effective therapeutic option to improve survival and to control bradyarrhythmia–related symptoms in very elderly patients. P75 BILATERAL CARDIAC SYMPATHETIC DENERVATION IN STRUCTURAL HEART DISEASE: FIRST EUROPEAN CASE SERIES V Dusi V Dusi L Pugliese L Pugliese I Passarelli I Passarelli R Camporotondo R Camporotondo M Driussi M Driussi M Antonutti M Antonutti D Miani D Miani A Mori A Mori M Maurelli M Maurelli D Facchin D Facchin S Savastano S Savastano C Raineri C Raineri R Rordorf R Rordorf L Oltrona Visconti L Oltrona Visconti A Proclemer A Proclemer G M De Ferrari G M De Ferrari CORONARY CARE UNIT – FONDAZIONE IRCCS POLICLINICO SAN MATTEO AND UNIVERSITY OF PAVIA, DEPARTMENT OF MOLECULAR MEDICINE, PAVIA, ITALY DEPARTMENT OF SURGERY - FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA, ITALY CORONARY CARE UNIT, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA, ITALY DIVISION OF CARDIOLOGY, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA, UDINE, ITALY DEPARTMENT OF EMERGENCY AND URGENCY - FONDAZIONE IRCCS, POLICLINICO SAN MATTEO, PAVIA, ITALY DEPARTMENT OF CARDIOLOGY - FONDAZIONE IRCCS, POLICLINICO SAN MATTEO, PAVIA, ITALY Background Left cardiac sympathetic denervation (LCSD) is an established therapy for refractory ventricular arrhythmias (VAs) in channelopathies. A multicentric American case series recently suggested a greater efficacy of bilateral denervation (BCSD) in patients with structural heart disease (SHD). Purpose and methods We present the first 8 patients (75% males, mean age 55 ± 20 years, mean LVFE 31 ± 13%) with SHD and refractory VAs treated with BCSD in our center. In 6 cases the procedure was performed using a classic mini-invasive thoracoscopic surgery, in 2 cases the robotic technique was associated. The series includes 4 cases (50%) of non-ischemic dilated cardiomyopathy (NICMP), two of post-ischemic CMP, one of arrhythmogenic right ventricular cardiomyopathy (ARVC) and one related to lamin A/C deficiency. All patients had an ICD, 50% a CRT-D. Half of them (n = 4) were in the NYHA functional class I, the rest were in class II or III. Three patients were candidates to heart transplant/LV assistance device. Overall, 87.5% of patients had a history of electrical storm (ES) and the median number of shocks/patient before BCSD was 6 (range IQ 4-18). All patients took at least one antiarrhythmic dug (amiodarone in 5 cases, sotalol in 1), unless contraindicated (25% of the patients). Drug refractory VAs were fast (cycle <250 msec) in 75% of patients and 37% had undergone at least one VT ablation procedure. Results no major complications occurred. Overall, 4 patients had ICD shock recurrences during a median follow-up (FU) of 9 months (IQR 3-12). Two patients (mean LVEF 17.5%, NYHA class III) during severe hemodynamic instability leading to death, one patient 20 months after BCSD in the setting of a severe amiodarone induced thyrotoxicosis, the last patient received a single intra-hospital ICD shock 5 days after BCSD during reintroduction of full-dose beta-blocker. In the 5 cases with FU > 6 months, ICD shocks were reduced from a median of 4 (IQR 3-14) in the 6 months before BCSD to 0 in the following 6 months. Conclusions our case series, although numerically small, has a good follow-up and is the first reported in Europe. The results, in line with the American ones, suggest a remarkable efficacy in patients with good functional capacity and fast ventricular arrhythmias. Therefore, cardiac sympathetic denervation should always be considered in patients with SHD and refractory ventricular tachyarrhythmias, especially in case VT ablation is either not indicated or fails. P76 DIAGNOSTIC AND PROGNOSTIC ROLE OF THE TILT TABLE TEST IN THE NEURALLY MEDIATED SYNCOPE M Cavarra M Cavarra UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA R Milluzzo R Milluzzo UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA F Privitera F Privitera UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA G Chiarandà G Chiarandà UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA D Capodanno D Capodanno UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA C Tamburino C Tamburino UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA UOC CARDIOLOGIA POLICLINICO UNIVERSITARIO, CATANIA; UOC CARDIOLOGIA PO UMBERTO I ASP SIRACUSA, SIRACUSA; UOC CARDIOLOGIA PO GRAVINA ASP CATANIA, CALTAGIRONE; UOC CARDIOLOGIA POLICLINICO CATANIA, CATANIA Background The neurally mediated syncope (NMS) represents from 35% to 60% of the syncopes (SI) experienced and, supposedly, the majority of the indeterminate syncopes would actually be neurally mediated.The aim of this study is to assess if the Tilt table test (TT) is an accurate and reproducible in NMS and its prognostic evaluation. Methods 630 pts with indeterminate syncope have been evaluated and subjected to an initial assessment and ECG. The drug therapy analyzing the presence of absence of prodrome has been considered. Subsequently a TT has been performed according to the Italian protocol, evaluating the syncope o pre-syncope reoccurrences for 8 years. Results The average age of the population is 42±19 years with a women predominance in the age group between 8 and 30 years. The TT was positive in 57,94% of cases (P < 0.0001) with a T3 response in 53,79% (P < 0.0001), a T1 response in 22,07% (P < 0.0001) and a 2B response in 11,72% (P < 0.0001). The 13% has shown only orthostatic hypotension . The prodromes were present in 61,76% of the type 2b cases (P < 0.0001), in 55,12% of the type 3 cases (P = 0.0008) and in 50% of the type 1 cases (P < 0.0001). The 11% of patients has revealed a sinus node dysfunction (SND), diagnosticated with the TT, with an indication of pacemaker implantation. At the follow up, syncope reoccurrences were the 34,64% (P < 0.0001), especially in the type 3 (41%). Reoccurrences were absent in 65,39% of patients meanwhile pre-syncopes were shown with a percentage of 29,49 (P < 0.0001). Reoccurrences in patients educated to physical counter-pressure manoeuvres ( PCPN) were present in 21,08% versus the 35% in patients treated with drug therapy, with a ratio between the effectiveness of the PCPN and their execution of 75,76%. The 24,24% of patients who did not benefit from the PCPN, has revealed speed in the onset of syncope. Conclusions The TT has allowed to reduce the diagnosis of indeterminate syncope both in case of vaso-depressor and cardioinhibitory forms, revealing an important diagnostic aid in some doubt SND cases and in those in which the initial evaluation depended for a vaso-depressor mechanism. Furthermore, It has allowed a correct therapeutic approach so much so that in the long term the percentage of reoccurrences is low, affecting almost exclusively the vasodepressor drugs. In addition, the TT has represented a useful moment for the patient, allowing him to become aware of the first manifestations of the syncope, so that he could recognize them early and implement the PCPN. The latter were found to be ineffective to avoid syncopes except the cases with early onset and less prodromes. P77 PERFORMANCE AND SUSTAINABILITY OF A MANAGEMENT MODEL FOR CIED WEB REMOTE CONTROL: DATA FROM A SINGLE TERTIARY CENTER F Zoppo F Zoppo CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO E Bacchiega E Bacchiega CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO A Brazzolotto A Brazzolotto CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO C Carraro C Carraro CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO L Lago L Lago CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO A Lupo A Lupo CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO G Mugnai G Mugnai CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO E Piccoli E Piccoli CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO F Zerbo F Zerbo CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO CARDIOLOGIA, GORIZIA; CARDIOLOGIA, VICENZA; CARDIOLOGIA, MIRANO Introduction The remote control (RC) of cardiac implantable electronic devices (CIED) has become to be almost necessary for a modern management of patients. In most of Centers, the ratio of CIED followed up with RC/CIED with standard in–office follow up is continuously increasing and soon will reach the 100% of CIED with RC follow up. We sought assess an organizational model based on available facilities and a long–term projection of RC data burden. Methods The total population of our Hospital area has been obtained (271.260 citizens), timed at December 31st 2014, by means of a demographic Services data by checking the Hospital patients’ data files, the total number of CIED patients followed up timed at January 1st 2011 (3995; 1.47 % of all population) has been then calculated, which was compared with the same data timed at January 1st 2015 (3902; 1.43% of all population), the check for the “stability” of that data over time. At this time (on an average of 300–350 CIEDs implanted/replaced per year, all provided with and a RC facilities), 1582/3902 (40,5%) of CIED patients were followed by RC.This progressive rate of RC CIEDs compared with CIED traditionally followed up is therefore deemed to increase by 8 to 10 % per year and assumed to reach the break–even of 100% of RC CIEDs, in 2021 (projection model). The RC transmissions (Tx) have been qualified as 5 types (clusters) of events (see Fig. 1). The timing of RC patient file managing (RC file analysis) was calculated over 10 Tx per day in 3 days. Results Of 3902 CIED patient, 1582 (40%) were RC followed up (3261 pacemakers, 594 ICDs and 47 implantable loop recorder). During the year 2015 we received a total number of 10396 Tx: 128 (1.2%) red alert; 1944 (18,6%) yellow alert, 141 (1.3%) atrial fibrillation; 403 (3.9%) lost Tx (disconnected or uncompliant patients) and 7780 (75%) Tx “OK” with NO events. (See Fig. 2). The projection model at 2021 with 100% RC patients shows a total 25990 Tx: 320 red alert; 1944 yellow alert, 352 atrial fibrillation; 1007 lost Tx and 19459 Tx “OK”. The 2021 monthly Tx would be 2320 (26 red alert; 405 yellow alert, 29 atrial fibrillation; 91 lost Tx and 1769 (75%) Tx “OK) (Fig. 3) The RC file analysis was calculated around 3 minutes (116 hours/month); 5,8 hours/business day (Monday–Friday). Conclusion The rate of RC followed up CIEDs will inexorably increase by time. The projection management model presented could help to build a sustainable organization. View largeDownload slide View largeDownload slide Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2019. For permissions please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - ARRHYTHMIAS PACING 1
JO - European Heart Journal Supplements
DO - 10.1093/eurheartj/suz095
DA - 2019-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/arrhythmias-pacing-1-AM0MRI6k8k
SP - E111
VL - 21
IS - Supplement_E
DP - DeepDyve
ER -