Poster session 3

2013 Europace  
In experimental models, ranolazine exerts a synergistic effect which enhances amiodarone's potential to suppress atrial fibrillation (AF). The clinical effect of ranolazine added to amiodarone for AF conversion has only undergone minimal investigation. Purpose: This study compared the safety and effectiveness of ranolazine in combination with amiodarone versus amiodarone alone for conversion of paroxysmal AF. Methods: We prospectively enrolled all consecutive patients with paroxysmal AF who
more » ... deemed eligible for pharmacologic cardioversion. Exclusion criteria were QTc . 440msec, hepatic, renal, or thyroid disorders, acute coronary syndrome, prior use of ranolazine, and use of strong CYP3A inhibitors which could affect ranolazine's metabolism. Patients were randomized to either iv amiodarone alone (loading dose of 5md/kg followed by a maintenance dose of 50mg/h for 24h), or to the combination of iv amiodarone plus a single oral dose of ranolazine 1500mg. Patients remained on continuous ECG monitoring. We measured the time to conversion to sinus rhythm, and the proportion of patients with AF conversion within 12h and within 24h. Results: 72 patients were enrolled (mean age 59+7 years): 35 in the amiodarone-only group and 37 in the amiodarone plus ranolazine combination group. The two groups did not differ in terms of clinical characteristics and echocardiographic parameters, including left atrium diameter. Time to conversion was shorter in the combination group compared with the amiodaroneonly group (8.4 + 3.8h vs.15.1 + 4.8 h; p , 0.001). Conversion was achieved in more patients in the combination group as compared to the amiodarone-only group (57% vs. 20% at 12h, respectively, p=0.001; and 86% vs. 68% at 24h, respectively, p=0.07). There were no cases of excessive QT prolongation (.550msec) and no proarrhythmic events in either treatment group. Conclusions: The addition of ranolazine to standard amiodarone treatment is safe, and it leads to faster conversion of paroxysmal AF. Consistent with substantial preclinical research on ranolazine's AF-suppressing potential, the present clinical study demonstrates a synergistic effect of ranolazine and amiodarone for conversion of paroxysmal AF. . Petersburg, Russian Federation Purpose: To assess antiarrhythmic effect of ethyl esters of omega-3 polyunsaturated fatty acids in patients with paroxysmal atrial fibrillation. Methods: We conducted a study of 37 men aged 44 -71 years with paroxysmal atrial fibrillation within 24 months. Patients were treated with angiotensin-converting enzyme inhibitors, statins, beta-blockers and anticoagulants. On the 13th month of the study 23 patients (group 1) to treatment was added Omacor at a daily dose of 1 gram. The remaining 12 patients (group 2) continued previous treatment. The overall incidence of paroxysms of atrial fibrillation was analyzed in all patients during the period of the study. The left atrial volume was measured by echocardiography using Simpson' method in patients at the start and at the end of the study. Results: The average number of registered paroxysms in patients of group 1 decreased from 19,16 þ 7,19 paroxysms at year to 11,42 þ 8,67 paroxysms at year for the 1st and 2nd years of the study, p = 0,001. At years 1 and 2 the average number of registered paroxysms in patients of group 2 was 17,90 þ 7,67 paroxysms and 22,64 þ 10,11 paroxysms at year respectively, p = 0,02. The average volume of the left atrium in patients of group 1 was 65,57 þ 9,19 ml at the start and 68,18 þ 8,15 ml, p=0,26, at the end of the study; in patients of group 2 -61,33 þ 14,19 ml and 67,56 þ 8,82 ml, p=0,13, respectively. 2 patients from group 1 and 3 patients from group 2 were excluded from the study due to the onset of antiarrhythmic therapy with amiodarone. Conclusions: Our results showed a decrease in the frequency of paroxysms of atrial fibrillation in patients treated with ethyl esters of omega-3 polyunsaturated fatty acids. Atrial fibrillation P624 P625 P627 P628 Published on behalf of the Purpose: Pulmonary Vein Isolation (PVI) has become the cornerstone procedure for the treatment of Atrial Fibrillation (AF). At the present time, PVI using irrigated Radiofrequency (RF) is the most used ablation technique. However, precise catheter navigation and catheter stability is crucial, requiring experienced operators. Robotic Navigation Systems (RNS) have been introduced to facilitate catheter navigation and to reduce the need of operator experience. To date, no prospective randomized trial has evaluated the efficacy and safety of PVI using RNS compared to manually conventional ablation. A new RNS has recently been introduced into clinical practice, the Amigo Remote Catheter System (ARCS). It may be the simplest in terms of installation and more accessible in terms of cost. We present our initial experience with this novel RNS in patients with AF undergoing PVI. Methods: Patients with symptomatic paroxysmal AF undergoing of PVI using ARCS. In all patients, PVI was performed using irrigated RF ablation, in combination with a 3D mapping system, with a 4-mm tip, catheter (508C, maximum 40 W, 30s). The catheter was guided by remote control from a work station. Primary end point of the ablation was bidirectional block of PV. Failure to achieve adequate maneuverability or technical problems leading to manual manipulation of the ablation catheter were secondary end points. Follow-up of 6 months was performed looking for AF recurrences. The feasibility and safety of this novel RNS was assesed. Results: RNS was used in 8 patients (male 50%, age 47 + 8, score CHADS2VASC2 2, LA 28 + 0,7 mm) without major complications. ARCS combined with manual navigation was needed in 3 patients for PVI and only ARCS was used for this in the latter 5. In total 26 PV were isolated, including PV trunks; 20 PV were completely isolated with ARCS and 6 required a combined manual navigation with ARCS. Four patients underwent cavotricuspid isthmus ablation with ARCS, without complications. At follow-up there were not AF recurrences. Conclusions: this report proves for the first time that PVI with this novel RNS is feasible and apparently non-associated with significant complications. Randomized studies (ongoing) are needed to validate the technique. Introduction: The aim of the study was to evaluate the acute therapeutic success and clinical long term outcome of Atrial Fibrillation (AF) ablation using the High Density Mesh Mapper catheter (HDMM). Methods: 362 patients with paroxysmal AF (260 males, 71.8 %, 56.5 +11.1 years) underwent pulmonary vein (PV) isolation. We used HDMM catheter in 234 patients (64.6%) and standard circular catheter (SCC) in 128 patients (33.6%). LA diameter was normal in 141 patients (38.9%). The endpoint for the ablation procedure was PV isolation. Results: PV variants were found in 28 patients (11.9%) of the HDMM group and in 17 patients (13.2%) of the SCC group. It was not possible to insert HDMM catheter into 12 PVs neither the SCC in 6 PVs. The average follow-up was 28.1 + 11.8 months. AF free survival was slightly higher in patients treated by PV isolation guided by HDMM (82%), than in patients with SCC (78.8%, p=0.12). The need of AF ablation redo procedure was lower in the HDMM group (12.8%) than in the SCC group (25%, p=0.003). In the subgroup of patients with normal atrial size, the use of HDMM catheter was associated to lower arrhythmia recurrence rate (90.5% of patients free from AF) compared to the use of SCC (71.4%, p=0.001). Conclusions: PV isolation guided by HDMM is feasible in the vast majority of patients. It allows a stable registration of pulmonary veins potentials that improves the long term procedure efficacy in patients with normal left atrial diameter. Purpose: Left atrial flutter (LAFL) ablation is very challenging, often requires detailed mapping and linear RF application. Remote magnetic catheter navigation (RCN) may provide advantages over conventional manual navigation, such as better chamber geometry, detailed tachycardia mapping, improved navigation and stable positioning of the catheter at difficult anatomic sites. We report our initial experience in ablating LAFL using a novel RCN. Methods: The RCN device is composed of 8-electromagnets placed around the thorax, remotely controlled from a console. The system provides up to 0.16 Tesla adjustable magnetic force to the tip of a magnetic catheter. LAFL was characterized by entrainment, activation and voltage electroanatomic mapping. Ablation was attempted by focal or linear RF application during RCN in either the "operator" (remote operator activation of the RCN) or "automatic" (automated catheter navigation without intervention of the operator) navigation modes. Results: 10 P with 11 symptomatic LAFL. Ablation of all LAFLs was successfully achieved by RF application during RCN in all P, either in the operator (9 AFLs) or automatic (2 LAFLs, roof and posterior wall lines) modes. Two P had flutter recurrences at 6-month follow-up. Without complications. Conclusions: LAFL by RCN is feasible and apparently safe. Automatic RCN during RF application may enhance and facilitate the creation of lines of conduction block in the LA, thereby improving the outcome of challenging LAFL ablation cases. P Structural heart disease Previous AF ablation AFL circuit Ablation RMCN automatic mode Ablation success
doi:10.1093/europace/eut173 fatcat:ttj6xmhdtzapbhhgsiiimzjrci