Abstracts
Posters
EVALUATION OF LEFT BUNDLE BRANCH BLOCK BY REAL TIME 3D ECHOCARDIOGRAPHY 2eroen van Diik. Herman FJ Mannaerts, Cees A Visser, Otto Kamp. VU University Medical Center, Amsterdam, Netherlands. Purpose: Left Bundle Branch Block (LBBB) is a conduction disorder that is observed in 1/3 of patients with advanced heart failure. However, there are patients with an isolated LBBB, without any underlying cardiac disease. Real time 3D echocardiography (RT 3DE) allows measurement of global and regional cardiac function and quantifies left ventricular (LV) mechanical asynchrony. Little is known about regional cardiac function and mechanical contraction of patients with an isolated LBBB without underlying cardiac disease or obvious LV dysfunction. Methods: We studied a group of 8 healthy subjects (QRS duration 94
±llms, mean age 26 ±3 years), a group of 14 patients with an isolated LBBB, NYHA I (QRS duration 146 ±17 ms, mean age 66 ±11 years) and a group of 9 patients with end stage drug refractory heart failure and a LBBB, NYHA IV (QRS 149 ±26 ms, mean age 63 ±8 years). RT 3DE was performed in each patient. Global ejection fractions, LV end-diastolic and LV end-systolic volumes were measured off-line. The LV was divided in segments according to the 16-segments model of the American Society of Echocardiography. Of each segment, the time-volume curve was calculated. LV mechanical asynchrony was defined as difference in percentage of RR-interval (i.e. time difference) between the first and last segment reaching its minimal volume in systole. Results: Global ejection fraction in the healthy subjects group was 53 ±7%, in the isolated LBBB-group 40 ±11% and in the heart failure group 24 +7 % (healthy subjects vs. heart failure group, p=0.005; healthy subjects vs. isolated LBBB, p-NS; isolated LBBB vs. heart failure group, p=0.011). End-diastolic volumes were 128 +21 ml for the healthy subjects, 119 ±33 ml for the isolated LBBB-group, and 190 + 62 ml for the heart failure group. (p=0.025, p-NS, p=0.03). End-systolic volumes were 61 ±13 ml, 73 +29 ml and 153 ±63 ml, respectively (p=0.0005, p=NS, p=0.001). LV mechanical asynchrony was 0 %, 11±13 % and 17+8 % for each group (p= 0.008, p-0.049, p=NS).
Conclusion: LV mechanical asynchrony is subtle, but significant, different between healthy subjects and isolated LBBB patients. Global ejection fraction, LV end-diastolic and LV end-systolic volumes are not significantly different between patients with an isolated LBBB and healthy subjects. Isolated LBBB patients' global LV function is in accordance with healthy subjects, as their LV mechanical asynchrony is with heart failure patients.
VERAPAMIL VERSUS DIGOXIN AND ACUTE VERSUS ROUTINE REPEATED CARDIOVERSION FOR IMPROVEMENT OF RHYTHM CONTROL FOR PERSISTENT ATRIAL FIBRILLATION LONG-TERM DATA FROM VERDICT Martin E.W. Hemels. Trudeke Van Noord, Dirk J. Van Veldhuisen, Harry J.G.M. Crijns', Hans A. Bosker*, Ans C.P. Wiesfeld, Maarten P. Van den Berg, Isabelle C. Van Gelder. Thoraxcenter, Department of Cardiology, University Medical Center Groningen, 'University Hospital Maastricht, *Rijnstate Ziekenhuis Amhem. Purpose: The Verapamil vERsus Digoxin and acute versus routine repeated Cardioversion Trial (VERDICT) was a prospective, randomized study to investigate whether (a) acute repeated electrical cardioversions (ECVs) after a relapse of atrial fibrillation (AF), and (b) prevention of intracellular calcium overload by verapamil will decrease intractability of AF.
Methods: Patients with persistent AF were randomized to (a) acute (within 24 hours) or routine (rhythm follow-up at the outpatient clinic) serial ECVs and (b) verapamil or digoxin for rate control preECV (2 by 2 factorial design) and continued during follow-up. Class III antiarrhythmic drugs were instituted in both groups after a relapse of AF. Follow-up was 18 months in all patients. Results: A total of 144 patients were included. Seventy-four (51%) patients were randomized to the acute and 70 (49%) to the routine cardioversion group, 74 (51%) were randomized to verapamil and 70 (49%) to digoxin. The only significant difference at baseline was betablocker use in the verapamil versus digoxin group (39% versus 60% respectively, p=0.013). No difference in outcome in the acute versus routine cardioversion group was observed in accepted AF (32% versus 31%, respectively, p=ns) despite more ECVs in the acute group (median 3 versus 2, p=0.02, and 2 3 ECVs in 54% versus 33% (p 12 mm STsegment shift and no contraindications to thrombolytic therapy were included. They were randomized to transport for abciximab facilitated primary angioplasty (FP) or to on-site thrombolysis (UT) with an advocated rescue strategy in case of failed reperfusion (< 50%/o ST-resolution at 60 min. after initiation of UT). Of the originally planned 900 patients only 48 were included, due to suspension of financial funding. Complete STsegment resolution (.70 YO) two hours after randomization occurred more frequently in the FP-group as compared to the UT-group (52% vs. 35Y/, p=0.2). One year composite endpoint of death, recurrent MI, stroke and revascularization occurred significantly less in the FP-group as compared to the UT-group (8% vs. 43Y/, p
Posters
EVALUATION OF LEFT BUNDLE BRANCH BLOCK BY REAL TIME 3D ECHOCARDIOGRAPHY 2eroen van Diik. Herman FJ Mannaerts, Cees A Visser, Otto Kamp. VU University Medical Center, Amsterdam, Netherlands. Purpose: Left Bundle Branch Block (LBBB) is a conduction disorder that is observed in 1/3 of patients with advanced heart failure. However, there are patients with an isolated LBBB, without any underlying cardiac disease. Real time 3D echocardiography (RT 3DE) allows measurement of global and regional cardiac function and quantifies left ventricular (LV) mechanical asynchrony. Little is known about regional cardiac function and mechanical contraction of patients with an isolated LBBB without underlying cardiac disease or obvious LV dysfunction. Methods: We studied a group of 8 healthy subjects (QRS duration 94
±llms, mean age 26 ±3 years), a group of 14 patients with an isolated LBBB, NYHA I (QRS duration 146 ±17 ms, mean age 66 ±11 years) and a group of 9 patients with end stage drug refractory heart failure and a LBBB, NYHA IV (QRS 149 ±26 ms, mean age 63 ±8 years). RT 3DE was performed in each patient. Global ejection fractions, LV end-diastolic and LV end-systolic volumes were measured off-line. The LV was divided in segments according to the 16-segments model of the American Society of Echocardiography. Of each segment, the time-volume curve was calculated. LV mechanical asynchrony was defined as difference in percentage of RR-interval (i.e. time difference) between the first and last segment reaching its minimal volume in systole. Results: Global ejection fraction in the healthy subjects group was 53 ±7%, in the isolated LBBB-group 40 ±11% and in the heart failure group 24 +7 % (healthy subjects vs. heart failure group, p=0.005; healthy subjects vs. isolated LBBB, p-NS; isolated LBBB vs. heart failure group, p=0.011). End-diastolic volumes were 128 +21 ml for the healthy subjects, 119 ±33 ml for the isolated LBBB-group, and 190 + 62 ml for the heart failure group. (p=0.025, p-NS, p=0.03). End-systolic volumes were 61 ±13 ml, 73 +29 ml and 153 ±63 ml, respectively (p=0.0005, p=NS, p=0.001). LV mechanical asynchrony was 0 %, 11±13 % and 17+8 % for each group (p= 0.008, p-0.049, p=NS).
Conclusion: LV mechanical asynchrony is subtle, but significant, different between healthy subjects and isolated LBBB patients. Global ejection fraction, LV end-diastolic and LV end-systolic volumes are not significantly different between patients with an isolated LBBB and healthy subjects. Isolated LBBB patients' global LV function is in accordance with healthy subjects, as their LV mechanical asynchrony is with heart failure patients.
VERAPAMIL VERSUS DIGOXIN AND ACUTE VERSUS ROUTINE REPEATED CARDIOVERSION FOR IMPROVEMENT OF RHYTHM CONTROL FOR PERSISTENT ATRIAL FIBRILLATION LONG-TERM DATA FROM VERDICT Martin E.W. Hemels. Trudeke Van Noord, Dirk J. Van Veldhuisen, Harry J.G.M. Crijns', Hans A. Bosker*, Ans C.P. Wiesfeld, Maarten P. Van den Berg, Isabelle C. Van Gelder. Thoraxcenter, Department of Cardiology, University Medical Center Groningen, 'University Hospital Maastricht, *Rijnstate Ziekenhuis Amhem. Purpose: The Verapamil vERsus Digoxin and acute versus routine repeated Cardioversion Trial (VERDICT) was a prospective, randomized study to investigate whether (a) acute repeated electrical cardioversions (ECVs) after a relapse of atrial fibrillation (AF), and (b) prevention of intracellular calcium overload by verapamil will decrease intractability of AF.
Methods: Patients with persistent AF were randomized to (a) acute (within 24 hours) or routine (rhythm follow-up at the outpatient clinic) serial ECVs and (b) verapamil or digoxin for rate control preECV (2 by 2 factorial design) and continued during follow-up. Class III antiarrhythmic drugs were instituted in both groups after a relapse of AF. Follow-up was 18 months in all patients. Results: A total of 144 patients were included. Seventy-four (51%) patients were randomized to the acute and 70 (49%) to the routine cardioversion group, 74 (51%) were randomized to verapamil and 70 (49%) to digoxin. The only significant difference at baseline was betablocker use in the verapamil versus digoxin group (39% versus 60% respectively, p=0.013). No difference in outcome in the acute versus routine cardioversion group was observed in accepted AF (32% versus 31%, respectively, p=ns) despite more ECVs in the acute group (median 3 versus 2, p=0.02, and 2 3 ECVs in 54% versus 33% (p 12 mm STsegment shift and no contraindications to thrombolytic therapy were included. They were randomized to transport for abciximab facilitated primary angioplasty (FP) or to on-site thrombolysis (UT) with an advocated rescue strategy in case of failed reperfusion (< 50%/o ST-resolution at 60 min. after initiation of UT). Of the originally planned 900 patients only 48 were included, due to suspension of financial funding. Complete STsegment resolution (.70 YO) two hours after randomization occurred more frequently in the FP-group as compared to the UT-group (52% vs. 35Y/, p=0.2). One year composite endpoint of death, recurrent MI, stroke and revascularization occurred significantly less in the FP-group as compared to the UT-group (8% vs. 43Y/, p
