Cardiology News / Recent Literature Review / Third Quarter 2017

Abstract

HCS 2017, 28^th Panhellenic Cardiology Congress: Athens, 19-21/10/2017

TCT Congress: Denver, Colorado, 29/10-2/11/2017

AHA Meeting: Anaheim, Ca, 11-15/11/2017

ACC.18 Congress: Orlando, FL, 10-12/3/2018

HRS Meeting: Boston, 9-12/5/2018

ESC Meeting: Munich, 25-29/8/2018

Long QT syndrome (LQTS): Although Outcomes Have Improved, 1 in 4 Patients with Prior Symptoms Experience at Least 1 Subsequent, Albeit Nonlethal, Cardiac Event Demanding Further Optimization of Treatment Strategies

Among 606 patients with LQTS (LQT1 in 47%, LQT2 in 34%, and LQT3 in 9%), a potentially lethal cardiac channelopathy with a 1-5% annual risk of LQTS-triggered syncope, aborted cardiac arrest, or sudden cardiac death, there were 166 (27%) patients who were symptomatic prior to their first Mayo Clinic evaluation at a median age of 12 years at first symptom. Treatment strategies included no active therapy in 47 (8%) patients, beta-blockers alone in 350 (58%) patients, ICDs alone in 25 (4%) patients, left cardiac sympathetic denervation alone in 18 (3%) patients, and combination therapy in 166 (27%) patients. Over a median follow-up of 6.7 years, 556 (92%) patients did not experience a cardiac event. Only 8 of 440 (2%) previously asymptomatic patients experienced a single event. In contrast, 42 of 166 (25%) previously symptomatic patients experienced >1 events. Among the 30 patients with >2 events, 2 patients died and 3 LQT3 patients underwent cardiac transplantation (Rohatgi RK et al, J Am Coll Cardiol 2017;70:453–62).

TRAC-AF Study: Temperature-Controlled Irrigated Ablation Produces Rapid, Efficient, and Durable PV Isolation

A novel irrigated RF catheter (DiamondTemp -DT) designed with a diamond-embedded tip (for rapid cooling) and thermocouples to monitor tissue temperature, was first used in 6 pigs for atrial ablation in a temperature control mode (60°C/50 W) until there was ∼80% EGM amplitude reduction; lesion histology revealed transmurality in 51 of 55 lesions (92.7%). In a clinical feasibility study, the study group of 35 patients having PV isolation with the DT catheter, compared with a control group of 35 patients undergoing PV isolation with a standard force-sensing catheter, had shorter mean RF application duration (26.3 ± 5.2 min vs. 89.2 ± 27.2 min; p < 0.001), shorter mean fluoroscopic time (11.2 ± 8.5 min vs. 19.5 ± 6.8 min; p < 0.001), and lower acute dormant PV reconduction (0 of 35 vs. 5 of 35; p = 0.024). At 3 months, among 23 patients undergoing remapping, 39 of 46 PV pairs (84.8%) remained durably isolated in 17 of these patients (73.9%) (Iwasawa J et al, J Am Coll Cardiol 2017;70:542-553)... (excerpt)