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EUROPEAN JOURNAL OF ARRHYTHMIA & ELECTROPHYSIOLOGY – VOLUME 8 SUPPLEMENT 1 – 2022

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The official abstracts from the Heart Rhythm Congress (HRC) 2022

Young Investigators Competition
Oral Abstracts 1 – Allied & Service Development
Oral Abstracts 1 – Arrhythmia Clinical
Oral Abstracts 2 – High-scoring Abstracts
Oral Abstracts 2 – Arrhythmia Mechanisms/In Silico Tools
Oral Abstracts 3 – Devices
Oral Abstracts 3 – Mapping & Ablation
Moderated Posters 1
Moderated Posters 2
Paediatric
Index of Presenting Authors

Young Investigators Competition

Arrhythmia
Arrhythmia
1/Impact of left ventricular scar burden on acute response to conduction system pacing
N Ali (Presenting Author) - National Heart and Lung Institute, Imperial College London, London; AA Miyazawa - National Heart and Lung Institute, Imperial College London, London; AD Arnold - National Heart and Lung Institute, Imperial College London, London; P Kanagratnam - National Heart and Lung Institute, Imperial College London, London; NS Peters - National Heart and Lung Institute, Imperial College London, London; N Qureshi - National Heart and Lung Institute, Imperial College London, London; B Lim - National Heart and Lung Institute, Imperial College London, London; F Ng - National Heart and Lung Institute, Imperial College London, London; N Linton - National Heart and Lung Institute, Imperial College London, London; D Lefroy - National Heart and Lung Institute, Imperial College London, London; A Muthumala - St Bartholomews Hospital and North Middlesex University Hospital, London; MA Tanner - St Richards Hospital, University Hospitals Sussex NHS Foundation Trust, London; D Keene - National Heart and Lung Institute, Imperial College London, London; GD Cole - National Heart and Lung Institute, Imperial College London, London; D Francis - National Heart and Lung Institute, Imperial College London, London; ZA Whinnett - Imperial College London, London

Introduction: Conduction system pacing is a novel way for delivering cardiac resynchronisation therapy (CRT). This may deliver more effective ventricular resynchronisation than the gold standard, biventricular pacing (BVP). In BVP scar burden is known to impact response but whether this is true for conduction system pacing is unknown. Methods: Patients with standard CRT indications were […]

Arrhythmia
Arrhythmia
2/Yield of 12-lead 24-hour ambulatory ECG monitoring in the identification of a spontaneous type 1 Brugada pattern and its prognostic value. A sub-study of the BHF RASE Brugada project
C Scrocco (Presenting Author) – St George’s University of London, St George’s Hospital NHS Trust, London; Y Ben-Haim – St George’s University of London, St George’s Hospital NHS Trust, London; C Miles – St George’s University of London, St George’s Hospital NHS Trust, London; M Specterman – St George’s University of London, St George’s Hospital NHS Trust, London; M Tome-Esteban – St George’s University of London, St George’s Hospital NHS Trust, London; M Papadakis – St George’s University of London, St George’s Hospital NHS Trust, London; S Sharma – St George’s University of London, St George’s Hospital NHS Trust, London; ER Behr – St George’s University of London, St George’s Hospital NHS Trust, London

Background: A type 1 Brugada pattern (T1-BrS) is a recognised marker of arrhythmic risk. Twelve-lead 24-hour Holter monitoring with V1 and V2 in standard and high precordial electrocardiogram (ECG) lead (HPL) positions, can identify transient spontaneous T1-BrS pattern in BrS patients with a concealed T1-BrS at presentation. Aim: To investigate the yield and prognostic value […]

Devices
Devices
3/Cardiac resynchronisation therapy acutely alters cardiac metabolic substrate uptake, correlating with improvements in systolic function and long-term reverse remodelling
PG Green (Presenting Author) – University of Oxford, Oxford; WD Watson – University of Oxford, Oxford; GL De Maria – Oxford University Hospitals NHS Foundation Trust, Oxford; AJM Lewis – University of Oxford, Oxford; OJ Rider – University of Oxford, Oxford; N Herring – University of Oxford, Oxford

Introduction: The failing heart is thought to be metabolically inflexible, and oxygen limited, shifting from free fatty acid (FFA) oxidation towards glucose metabolism. Whilst glucose metabolism is more oxygen efficient, fatty acid (FA) metabolism generates more adenosine triphosphate (ATP) per mole of substrate. Cardiac resynchronisation therapy (CRT) acutely improves cardiac haemodynamics in patients with severe […]

Basic Scientist

Atrial Fibrillation
Atrial Fibrillation
4/Selective T-type calcium current block affects action potential dynamics in murine atrial myocytes
AR Jones (Presenting Author) – Queen Mary University London, London; A Tinker – Queen Mary University London, London

Introduction: The T-type calcium current (ICaT) is down-regulated in atrial fibrillation and may be involved in its pathogenesis. Previous attempts to target ICaT pharmacologically have been limited by lack of compounds that specifically antagonise the T-type compared with the L-type. In recent years new compounds have been developed that both open and block the membrane […]

Atrial Fibrillation
Atrial Fibrillation
5/Defining the local immune drivers in atrial fibrillation: the role of tissue-resident memory T cells
V Vyas (Presenting Author) – Queen Mary University of London & Barts Health NHS Trust, London; B Sandhar – Queen Mary University of London, London; A Jones – Queen Mary University of London & Barts Health NHS Trust, London; E Wood – Queen Mary University of London, London; H Blythe – Queen Mary University of London, London; M Finlay – Queen Mary University of London & Barts Health NHS Trust, London; MP Longhi – Queen Mary University of London, London

Introduction: Increased volume of epicardial adipose tissue (EAT) is now well established as an independent risk factor for all forms of atrial fibrillation (AF). EAT acts as a local compartment of immune cells and mediators that can infiltrate the myocardium given the lack of fascial boundaries between them. However, a comprehensive immune characterization of EAT […]

Devices
Devices
6/The effect of radiotherapy on the voltage output of cardiac implantable devices
A Fenwick (Presenting Author) – Freeman Hospital, Newcastle upon Tyne; S Manley – Freeman Hospital, Newcastle upon Tyne; M Lowrey – Freeman Hospital, Newcastle upon Tyne; N West – Freeman Hospital, Newcastle upon Tyne; E Shepherd – Freeman Hospital, Newcastle upon Tyne

Purpose: It has historically been established that radiotherapy can potentially cause cardiac implantable electrical devices (CIEDs) to malfunction. Guidelines were established in 1994 for the management of patients undergoing radiotherapy with CIEDs. They recommend a total dose constraint of 2 Gy to any part of a pacemaker (0.5 Gy for ICDs), and that devices should […]

Oral Abstracts 1 - Allied and Service Development

Arrhythmia
Arrhythmia
7/Outcomes from a ‘low biventricular pacing’ MDT service
BJ Jones (Presenting Author) – Barts Health NHS Trust, London; JR Ramplin – Barts Health NHS Trust, London; ZC Carter – Barts Health NHS Trust, London; NM Mark – Barts Health NHS Trust, London; PL Lloyd – Barts Health NHS Trust, London; BP Patel – Barts Health NHS Trust, London; SC Cowap – Barts Health NHS Trust, London; HG Granville – Barts Health NHS Trust, London; AM Muthumala – Barts Health NHS Trust, London

Introduction: A greater biventricular pacing percentage (BiVp%) is associated with greater left ventricular reverse remodelling and reduction in all-cause mortality in patients with cardiac synchronisation therapy devices (CRT). A multi-disciplinary team (MDT) service was implemented at Barts Health NHS Trust to discuss patients with low BiVp%, to determine the cause, increase BiVp%, and provide a […]

Atrial Fibrillation
Atrial Fibrillation
8/Improving adoption of evidence-based implantable cardioverter defibrillator programming – a single-centre experience
P Khan (Presenting Author) – King’s College Hospital NHS Trust, London; B Gopinath – King’s College Hospital, London; M Laybourn – King’s College Hospital NHS Trust, London; N Jahagirdar – King’s College Hospital NHS Trust, London; A Cannata – King’s College Hospital NHS Trust, London; D Bromage – King’s College Hospital, London; F Murgatroyd – King’s College Hospital, London; PA Scott – King’s College Hospital, London

Introduction: Strategic implantable cardioverter defibrillator (ICD) programming, with the use of high-rate detection zones and long detection times, can significantly reduce non-essential ICD therapy and mortality. Despite the published data and guideline recommendations, the implementation of strategic programming into clinical practice has been modest. Here we describe our approach to improve ICD programming and its […]

Devices
Devices
9/Auditing the clinical accuracy of Reveal Linq Interpretation via external analysis provider Focus On™
D Walker (Presenting Author) – The Royal Wolverhampton NHS Trust, Wolverhampton; S Petkar – The Royal Wolverhampton NHS Trust, Wolverhampton; S Velu – The Royal Wolverhampton NHS Trust, Wolverhampton; N Sunni – Walsall Healthcare NHS Trust, Walsall; C Barr – The Dudley Group NHS Foundation Trust, Dudley; G Leventogiannis – The Dudley Group NHS Foundation Trust, Dudley; J Kelly – The Royal Wolverhampton NHS Trust, Wolverhampton; E Painter – The Royal Wolverhampton NHS Trust, Wolverhampton; L Bradley – The Royal Wolverhampton NHS Trust, Wolverhampton

Introduction: With the ever-increasing importance of home monitoring for the follow-up of cardiac implanted electronic devices (CIED), emphasised during the COVID pandemic, the workload for CIED follow-up clinics has grown exponentially. The demand on services is exceeding resource, with innovative solutions needed to maximise efficiency, safety and quality. One potential solution has been offered by […]

Devices
Devices
10/Incidence and type of alerts for low voltage devices – a 12-month high-volume centre experience from a de novo deployment
ALW Wharmby (Presenting Author) – Barts Health NHS Trust, London; CB Butcher – Barts Health NHS Trust, London; AN Nogueira – Barts Health NHS Trust, London; JC Collinson – Barts Health NHS Trust, London; CM Monkhouse – Barts Health NHS Trust, London; ZC Carter – Barts Health NHS Trust, London; EM Maclean – Barts Health NHS Trust, London; SH Honarbakhsh – Barts Health NHS Trust, London; AM Muthumala – Barts Health NHS Trust, London; PM Moore – Barts Health NHS Trust, London

Background: Remote monitoring (RM) has routinely not been provided to patients with low-energy devices; there are limited data on the service burden, volume of and type of alerts received and their management. Objective: Collect and analyse data on alert type, service burden and management of alerts in low-voltage devices over 12 months of RM. Methods: […]

COVID-19
COVID-19
11/Increased activity targets, remote monitoring for all patients, same workforce, no capital funding. How will this device clinic cope?
Z Carter (Presenting Author) – Barts Health NHS Trust, London; C Monkhouse – Barts Health NHS Trust, London; B Patel – Barts Health NHS Trust, London; A Nogueira – Barts Health NHS Trust, London; P Moore – Barts Health NHS Trust, London; A Muthumala – Barts Health NHS Trust, London; E Dooley – Barts Health NHS Trust, London; J Elliott – Barts Health NHS Trust, London; J Collinson – Barts Health NHS Trust, London

In response to COVID-19 at this tertiary cardiac centre, based on triaged risk, the number of patients on remote monitoring (RM) increased 1.75-fold, from 4,000 to 7,000 (55% of the total patient population). Pre-pandemic, this centre gave RM to high-voltage devices only. RM for all device patients aligns with NHS England guidance to reduce outpatient […]

Atrial Fibrillation
Atrial Fibrillation
12/AF virtual ward – the way forward …
S Armstrong (Presenting Author) – University Hospital Leicester, Leicester

Introduction: Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia. Acute hospital admissions are rising with significant cost and capacity implications. Recent pathway reviews led to service innovations to provide remote out-of-hospital care for patients with haemodynamically stable AF/atrial flutter (Afl) with fast ventricular response. Patients remain in hospital, attached to a heart monitor until […]

Oral Abstracts 1 – Arrhythmia Clinical

Arrhythmia
Arrhythmia
13/The impact of frailty on atrial fibrillation ablation outcomes
CP Uy (Presenting Author) – East Sussex Healthcare, Eastbourne; R Dulai – East Sussex Healthcare, Eastbourne; NR Patel – East Sussex Healthcare, Eastbourne; SS Furniss – East Sussex Healthcare, Eastbourne; N Sulke – East Sussex Healthcare, Eastbourne; RA Veasey – East Sussex Healthcare, Eastbourne

Background: Catheter ablation for atrial fibrillation (AF) has been shown to reduce symptoms and improve quality of life when compared with medical treatment. It is unclear whether frailty impacts on the outcome of pulmonary vein isolation in patients with symptomatic AF. We sought to evaluate the association between frailty as measured by the validated NHS […]

Arrhythmia
Arrhythmia
14/Arrhythmia Alliance Patient Survey: remote care, what is the impact on follow-up?
T Lobban (Presenting Author) – Arrhythmia Alliance, Stratford Upon Avon; B Sieniewicz – Queen Alexandra Hospital, Portsmouth

Background: Remote monitoring (RM) refers to the ability of a cardiac implantable electronic device (CIED) to monitor both the patient and the CIED system, ‘remote’ from the hospital. Studies have demonstrated the advantages of this approach including early detection of clinically actionable events, a decrease in the frequency and need for inpatient visits and improved […]

Arrhythmia
Arrhythmia
15/Artificial intelligence-enabled electrocardiogram to distinguish atrioventricular re-entrant tachycardia from atrioventricular nodal re-entrant tachycardia
A Sau (Presenting Author) – Imperial College London, London; S Ibrahim – Imperial College London, London; N Qureshi – Imperial College London, London; M Koa-Wing – Imperial College London, London; D Keene – Imperial College London, London; L Malcolme-Lawes – Imperial College London, London; DC Lefroy – Imperial College London, London; NWF Linton – Imperial College London, London; PB Lim – Imperial College London, London; A Varnava – Imperial College London, London; ZI Whinnett – Imperial College London, London; P Kanagaratnam – Imperial College London, London; D Mandic – Imperial College London, London; NS Peters – Imperial College London, London; FS Ng – Imperial College London, London

Background: Accurately determining arrhythmia mechanism from a 12-lead ECG of supraventricular tachycardia (SVT) can be challenging. Machine learning, with convolutional neural networks (CNNs) in particular, has been used to classify arrhythmias using the 12-lead ECG with great accuracy. However, most studies use human interpretation of the ECG as the ground truth to label the arrhythmia […]

Cardiovascular Disease
Cardiovascular Disease
16/Effects of sodium-glucose cotransporter-2 inhibitors on ventricular arrhythmias or sudden cardiac death: a propensity score-matched population-based study

Introduction: Numerous trials have studied the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2Is) on ventricular tachycardia/fibrillation (VT/VF) or sudden cardiac death (SCD), with conflicting findings. However, this has not been explored in population-based real-world studies. We compared the risks of VT/VF/SCD between SGLT2I and dipeptidyl peptidase-4 inhibitors (DPP4Is) in a Chinese population. Methods: The was a […]

Arrhythmia
Arrhythmia
17/Are consumer-grade ECG devices as good as a 12 lead ECG? A comparison of the Apple Watch Series 6, KardiaMobile 6L and Withings Scanwatch with the 12 lead ECG
S Brown (Presenting Author) – Musgrove Park Hospital, Taunton; N Sunderland – Musgrove Park Hospital, Taunton; R Wang – Musgrove Park Hospital, Taunton; K Venu-Gopal – University of Plymouth, Plymouth; M Dayer – Musgrove Park Hospital, Taunton; G Furniss – Musgrove Park Hospital, Taunton

Introduction: The use of consumer-grade electronic devices capable of recording an electrocardiogram (ECG) is increasing but there is a lack of comparative data between technologies. We initiated this unsponsored study to compare three consumer-grade devices to the 12-lead (12L) ECG. Methods: A total of 11 healthy volunteers had an ECG recorded consecutively using four devices: […]

Atrial Fibrillation
Atrial Fibrillation
18/Virtual wards – a futuristic insight into atrial fibrillation care
A Kotb (Presenting Author) – University of Leicester, Leicester; S Armstrong – University Hospitals of Leicester, Leicester; I Koev – University of Leicester, Leicester; G Panchal – University of Leicester, Leicester; A Mavilakandy – University of Leicester, Leicester; I Antoun – University of Leicester, Leicester; Z Vali – University of Leicester, Leicester; J Barker – University of Leicester, Leicester; M Ibrahim – University Hospitals of Leicester, Leicester; A Sandilands – University Hospitals of Leicester, Leicester; M Lazdam – University Hospitals of Leicester, Leicester; S Chin – University Hospitals of Leicester, Leicester; R Somani – University Hospitals of Leicester, Leicester; G. Andre Ng – University of Leicester, Leicester

Background: Atrial fibrillation (AF) hospital admissions represent significant national health and economic burden. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual AF ward providing multidisciplinary care could reshape the future model of AF management. Methods: An AF virtual ward was implemented […]

Oral Abstracts 2 – High-scoring Abstracts

Arrhythmia
Arrhythmia
19/The electrophysiologic substrate of Brugada syndrome patients can be revealed by electrocardiographic imaging
JJ Chow (Presenting Author) – Imperial College Healthcare NHS Trust, London; K Leong – Imperial College Healthcare NHS Trust, London; M Shun-Shin – Imperial College Healthcare NHS Trust, London; OP Guttmann – Barts Health NHS Trust, London; SA Mohiddin – Barts Health NHS Trust, London; P Lambiase – Barts Health NHS Trust, London; PM Elliott – Barts Health NHS Trust, London; JOM Ormerod – Oxford University Hospitals NHS Trust, Oxford; M Koa-Wing – Imperial College Healthcare NHS Trust, London; DC Lefroy – Imperial College Healthcare NHS Trust, London; P Boon Lim – Imperial College Healthcare NHS Trust, London; NWF Linton – Imperial College Healthcare NHS Trust, London; FS Ng – Imperial College Healthcare NHS Trust, London; NA Qureshi – Imperial College Healthcare NHS Trust, London; ZI Whinnett – Imperial College Healthcare NHS Trust, London; NS Peters – Imperial College Healthcare NHS Trust, London; DP Francis – Imperial College Healthcare NHS Trust, London; AM Varnava – Imperial College Healthcare NHS Trust, London; P Kanagaratnam – Imperial College Healthcare NHS Trust, London

Introduction: Brugada syndrome (BrS) is an important cause of sudden cardiac death but diagnosis can be challenging. Body surface ECG changes in BrS are dynamic, and elicitation by sodium channel blockade carries a risk of death. The epicardial substrate of the overt Type 1 BrS ECG is known but not always spontaneously present in cardiac […]

Atrial Fibrillation
Atrial Fibrillation
20/Real-world results of oesophageal protection during left atrial ablation
L Leung (Presenting Author) – St George’s University Hospitals NHS Foundation Trust, London; A Bajpai – St George’s University Hospitals NHS Foundation Trust, London; A Li – St George’s University Hospitals NHS Foundation Trust, London; M Norman – St George’s University Hospitals NHS Foundation Trust, London; R Kaba – St George’s University Hospitals NHS Foundation Trust, London; G Dhillon – St George’s University Hospitals NHS Foundation Trust, London; Z Akhtar – St George’s University Hospitals NHS Foundation Trust, London; M Sohal – St George’s University Hospitals NHS Foundation Trust, London; N Al-Subaie – St George’s University Hospitals NHS Foundation Trust, London; J Louis-Auguste – St George’s University Hospitals NHS Foundation Trust, London; J Hayat – St George’s University Hospitals NHS Foundation Trust, London; Z Zuberi – St George’s University Hospitals NHS Foundation Trust, London; MM Gallagher – St George’s University Hospitals NHS Foundation Trust, London

Background: Randomised trial evidence suggests that active control of local temperature can prevent thermal injury to the oesophagus; alternative methods of protection have been proposed, including the measurement of luminal temperature, and mechanical deviation away from the source of energy. Specific devices are available for each role. Objective: To use multiple sources of real-world evidence […]

Atrial Fibrillation
Atrial Fibrillation
21/Silent veins during cryoballoon ablation of atrial fibrillation as a novel and independent predictor of long-term outcome: results from the Middelheim-PVI Registry 2
Y De Greef (Presenting Author) – ZNA Heart Center, Middelheim, Antwerp; I Buysschaert – Cardiovascular Center, AZ St Jan Bruges, Bruges; F Cecchini – ZNA Heart Center, Middelheim Antwerp; D Sofianos – ZNA Heart Center, Middelheim, Antwerp; M Wolf – ZNA Heart Center, Middelheim, Antwerp; B Schwagten – ZNA Heart Center, Middelheim, Antwerp; JP Abugattas – Erasmus Hospitals, Brussel, Brussels

Background: The absence of pulmonary vein potential (PVP) recordings by the Achieve catheter occurs in 15% to 40% of the veins during cryoballoon ablation (CBA) of atrial fibrillation (AF). The long-term clinical implications of this absence of PVP during CBA are yet unknown. Aim: To determine whether the absence of PVP recording (silent vein) by […]

Arrhythmia
Arrhythmia
22/Predictors and clinical value of late gadolinium enhancement on CMR in patients with premature ventricular contractions and normal echocardiogram
WC Ng (Presenting Author) – Barts and the London Medical School, Queen Mary, University of London, London; G Joy – Barts Health NHS Trust, London; N Giannainas – Barts Health NHS Trust, London; H Shiwani – Barts Health NHS Trust, London; R Davies – University College London, London; A Bhuva – Barts Health NHS Trust, London; C Manisty – Barts Health NHS Trust, London; R Ang – Barts Health NHS Trust, London

Background: Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging can detect subtle abnormalities including scar undetectable by echocardiography, and hence may aid diagnosis and guide clinical management in patients with premature ventricular contractions (PVCs) where decision making can be complex. However, it remains unclear which patients are most likely to benefit from further […]

Atrial Fibrillation
Atrial Fibrillation
23/Redefining atrial scar: an analysis using pacing thresholds, electrogram amplitudes and local impedance. Can we improve on 0.05 and 0.5mV?
AP Bates (Presenting Author) – Cardiology Department, University Hospital Southampton, Southampton; JR Paisey – Cardiology Department, University Hospital Southampton, Southampton; AM Yue – Cardiology Department, University Hospital Southampton, Southampton; PR Roberts – Cardiology Department, University Hospital Southampton, Southampton; W Ullah – Cardiology Department, University Hospital Southampton, Southampton

Background: Common cut-offs for dense scar and ‘low-voltage areas’ on atrial 3D electroanatomical mapping are 0.05 mV and 0.50 mV, respectively. These are based upon statistical assessment of left atrial voltages in healthy individuals, rather than physiological assessment and may not fully represent underlying scar compared with unipolar readings or the novel parameter local impedance […]

Heart Failure
Heart Failure
24/The effect of His bundle pacing vs conventional biventricular pacing on repolarisation in patient’s with heart failure and reduced ejection fraction and left bundle branch block?
JW Samways (Presenting Author) – Imperial College Healthcare NHS Trust, London; AD Arnold – Imperial College Healthcare NHS Trust, London; MJ Shun-Shin – Imperial College Healthcare NHS Trust, London; N Ali – Imperial College Healthcare NHS Trust, London; T Cheng – Imperial College London, London; JP Howard – Imperial College Healthcare NHS Trust, London; D Keene – Imperial College Healthcare NHS Trust, London; FS Ng – Imperial College Healthcare NHS Trust, London; M Tanner – Imperial College Healthcare NHS Trust, London; PB Lim – Imperial College Healthcare NHS Trust, London; NW F Linton – Imperial College Healthcare NHS Trust, London; NS Peters – Imperial College Healthcare NHS Trust, London; P Kanagaratnam – Imperial College Healthcare NHS Trust, London; DP Francis – Imperial College Healthcare NHS Trust, London; ZI Whinnett – Imperial College Healthcare NHS Trust, London

Introduction: Left bundle branch block (LBBB) is associated with an increased risk of ventricular arrhythmia. Biventricular pacing (BVP) improves symptoms, systolic left ventricular function and mortality in heart failure with LBBB, but can be pro-arrhythmic. His bundle pacing (HBP) can overcome LBBB to produce more synchronous ventricular activation than BVP, but it is not known […]

Oral Abstracts 2 – Arrhythmia Mechanisms/In Silico Tools

Atrial Fibrillation
Atrial Fibrillation
25/Creating patient-specific atrial fibrillation models from imaging and electroanatomic mapping data
GR Raffaele (Presenting Author) – Faculty of Life Sciences and Medicine, King’s College London, London; CHR Roney – School of Biomedical Engineering and Imaging Sciences, King’s College London; School of Engineering and Materials Science, Queen Mary University of London, London; IK Kotadia – School of Biomedical Engineering and Imaging Sciences, King’s College London, London; JAS-L Solis-Lemus – School of Biomedical Engineering and Imaging Sciences, King’s College London, London; IS Sim – School of Biomedical Engineering and Imaging Sciences, King’s College London, London; JW Whitaker – School of Biomedical Engineering and Imaging Sciences, King’s College London; The Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston; OR Razeghi – School of Biomedical Engineering and Imaging Sciences, King’s College London, London; MO O’Neill – School of Biomedical Engineering and Imaging Sciences, King’s College London, London; SEW Williams – School of Biomedical Engineering and Imaging Sciences, King’s College London, London; Centre for Cardiovascular Science, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh; SMN Narayan – Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto; SAN Niederer – School of Biomedical Engineering and Imaging Sciences, King’s College London, London

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting over 1.4 million people in the UK alone, and is associated with an increased risk of cardiovascular diseases, stroke and death. AF is often treated by catheter ablation therapy, which aims to isolate regions of the atrial tissue that are critical for driving the […]

Arrhythmia
Arrhythmia
26/Heart rhythm variability in patients with atrial fibrillation and atrial flutter depending on immune status, systemic inflammation and renin-angiotensin-aldosterone system activity
OY Ilchyshyna (Presenting Author) – NSC M. D. Strazhesko Institute of cardiology NAMS of Ukraine, Kyiv; OS Sychov – NSC M. D. Strazhesko Institute of cardiology NAMS of Ukraine, Kyiv; TV Talaieva – NSC M. D. Strazhesko Institute of cardiology NAMS of Ukraine, Kyiv

Aims: Arterial hypertension (AH) is one of the most common causes of atrial fibrillation (AF) and atrial flutter (AFl), but still the concrete reason for their onset is not known. Indication and comparison of systemic inflammation and renin-angiotensin-aldosterone system activity and heart rhythm variability differences in these patients have become the background of our study. […]

Arrhythmia
Arrhythmia
27/Artificial intelligence-enabled electrocardiogram to distinguish cavotricuspid isthmus dependence from other atrial tachycardia mechanisms
A Sau (Presenting Author) – Imperial College London, London; S Ibrahim – Imperial College London, London; A Ahmed – Imperial College London, London; B Handa – Imperial College London, London; DB Kramer – Beth Israel Deaconess Medical Center, Boston; JW Waks – Beth Israel Deaconess Medical Center, Boston; AD Arnold – Imperial College London, London; JP Howard – Imperial College London, London; N Qureshi – Imperial College London, London; M Koa-Wing – Imperial College London, London; D Keene – Imperial College London, London; L Malcolme-Lawes – Imperial College London, London; DC Lefroy – Imperial College London, London; NWF Linton – Imperial College London, London; PB Lim – Imperial College London, London; A Varnava – Imperial College London, London; ZI Whinnett – Imperial College London, London; P Kanagaratnam – Imperial College London, London; D Mandic – Imperial College London, London; NS Peters – Imperial College London, London; FS Ng – Imperial College London, London

Background: Accurately determining atrial arrhythmia mechanisms from a 12-lead ECG can be challenging. Given the high success rate of cavotricuspid isthmus (CTI) ablation, accurate identification of CTI-dependent typical atrial flutter (AFL) is important for treatment decisions and procedure planning. Machine learning, with convolutional neural networks (CNNs) in particular, has been used to classify arrhythmias using […]

Arrhythmia
Arrhythmia
28/UHF-ECG detected QRS fractionation predicts arrhythmic risk in patients with hereditary arrhythmic conditions
K Saleh (Presenting Author) – National Heart and Lung Institute, Imperial College London, London; A Varnava – National Heart and Lung Institute, Imperial College London, London; M Shun-Shin – National Heart and Lung Institute, Imperial College London, London; N Ali – National Heart and Lung Institute, Imperial College London, London; J Mohal – National Heart and Lung Institute, Imperial College London, London; K Chiew – National Heart and Lung Institute, Imperial College London, London; M Hanif – National Heart and Lung Institute, Imperial College London, London; A Merzah – National Heart and Lung Institute, Imperial College London, London; J Howard – National Heart and Lung Institute, Imperial College London, London; P Jurak – Institute of Scientific Instruments of the Czech Academy of Sciences, Brno; P Leinveber – International Clinical Research Center, St. Anne’s University Hospital, Brno; P Kanagaratnam – National Heart and Lung Institute, Imperial College London, London; D Francis – National Heart and Lung Institute, Imperial College London, London; Z Whinnett – National Heart and Lung Institute, Imperial College London, London; A Arnold – National Heart and Lung Institute, Imperial College London, London

Introduction: Fragmentation of the QRS complex is a feature of arrhythmogenic conditions including primary arrhythmia syndromes, ischaemic and non-ischaemic cardiomyopathy and in the presence of myocardial scar. While gross fragmentation can be observed on 12-lead ECG, more subtle abnormalities may be missed. Ultra-high-frequency ECG (UHF-ECG) is an ECG-based technique that measures electrical activation signals in […]

Arrhythmia
Arrhythmia
29/The electrophysiological substrate of HCM and propensity to ventricular fibrillation as measured by ECG imaging
JJ Chow (Presenting Author) – Imperial College Healthcare NHS Trust, London; K Leong – Imperial College Healthcare NHS Trust, London; M Shun-Shin – Imperial College Healthcare NHS Trust, London; OP Guttmann – Barts Health NHS Trust, London; SA Mohiddin – Barts Health NHS Trust, London; P Lambiase – Barts Health NHS Trust, London; PM Elliott – Barts Health NHS Trust, London; JOM Ormerod – Oxford University Hospitals NHS Trust, Oxford; M Koa-Wing – Imperial College Healthcare NHS Trust, London; DC Lefroy – Imperial College Healthcare NHS Trust, London; P Boon Lim – Imperial College Healthcare NHS Trust, London; NWF Linton – Imperial College Healthcare NHS Trust, London; FS Ng – Imperial College Healthcare NHS Trust, London; NA Qureshi – Imperial College Healthcare NHS Trust, London; ZI Whinnett – Imperial College Healthcare NHS Trust, London; NS Peters – Imperial College Healthcare NHS Trust, London; DP Francis – Imperial College Healthcare NHS Trust, London; AM Varnava – Imperial College Healthcare NHS Trust, London; P Kanagaratnam – Imperial College Healthcare NHS Trust, London

Patients with hypertrophic cardiomyopathy (HCM) are at risk of lethal ventricular arrhythmia. The electrical substrate for this has not been well elucidated. Furthermore, despite extensive knowledge of the structural differences in HCM vs the normal heart, the effects of electrophysiology are not known. Methods: HCM patients surviving ventricular fibrillation or haemodynamically unstable ventricular tachycardia (HCM […]

Atrial Fibrillation
Atrial Fibrillation
30/Assessment of scar between atria, rhythms and atrial fibrillation types. Does ultra-high-density mapping offer new insights?
AP Bates (Presenting Author) – Cardiology Department, University Hospital Southampton, Southampton; JR Paisey – Cardiology Department, University Hospital Southampton, Southampton; AM Yue – Cardiology Department, University Hospital Southampton, Southampton; PR Roberts – Cardiology Department, University Hospital Southampton, Southampton; W Ullah – Cardiology Department, University Hospital Southampton, Southampton

Background: 3D electroanatomical mapping systems demonstrate atrial scar by recording local tissue voltages as a surrogate. Increased scar has been shown with both progression of atrial fibrillation (AF, paroxysmal [PAF] to persistent [PeAF]), and between sinus rhythm (SR) and AF on low-density mapping systems. The introduction of ultra-high-density mapping allows a more detailed comparison. Objectives: […]

Oral Abstracts 3 – Devices

Devices
Devices
31/When to measure changes during CRT optimisation. Guidance from computer simulation studies
I Turner (Presenting Author) – Royal Papworth Hospital, Cambridge; S Silva – Royal Papworth Hospital, Cambridge; J Hutchinson – Royal Papworth Hospital, Cambridge

Introduction: Cardiac resynchronisation therapy (CRT) has become a widely used pacing technique in the treatment of heart failure. Optimisation of AV and VV delays to maximise therapeutic benefit has proven difficult and is therefore often not performed. The haemodynamics vary considerably after changes in pacing parameters and there are conflicting results as to when is […]

Syncope
Syncope
32/Syncope in ICD recipients – data from unselected patients in a real-world setting
P Khan (Presenting Author) – King’s College Hospital NHS Trust, London; K Selvarajah – King’s College Hospital NHS Trust, London; S Gohel – King’s College Hospital NHS Trust, London; B Sidhu – King’s College Hospital NHS Trust, London; A Cannata – King’s College Hospital NHS Trust, London; D Bromage – King’s College Hospital NHS Trust, London; T McDonagh – King’s College Hospital NHS Trust, London; F Murgatroyd – King’s College Hospital NHS Trust, London; PA Scott – King’s College Hospital NHS Trust, London

Aims: Previous studies have evaluated the incidence and prognostic significance of syncope in ICD recipients; however, these have been almost exclusively derived from randomised controlled trials (RCTs) of primary prevention patients with severe left ventricular systolic dysfunction (LVSD). There is little evidence of the impact of syncope in implantable cardioverter defibrillator (ICD) patients in a […]

Arrhythmia
Arrhythmia
33/Predicting permanent pacemaker implantation after transcatheter aortic valve implantation (TAVI) – building a risk score calculator
J Li (Presenting Author) – University of Cambridge, School of Clinical Medicine, Cambridge; J Cranley – Royal Papworth Hospital NHS Foundation Trust, Cambridge; B Clay – University of Cambridge, School of Clinical Medicine, Cambridge; A Christodoulidou – University of Cambridge, School of Clinical Medicine, Cambridge; F Ara – Royal Papworth Hospital NHS Foundation Trust, Cambridge; P Costanzo – Royal Papworth Hospital NHS Foundation Trust, Cambridge; C Costopoulos – Royal Papworth Hospital NHS Foundation Trust, Cambridge; M O’Sullivan – Royal Papworth Hospital NHS Foundation Trust, Cambridge; W Davies – Royal Papworth Hospital NHS Foundation Trust, Cambridge; C Densem – Royal Papworth Hospital NHS Foundation Trust, Cambridge; C Martin – Royal Papworth Hospital NHS Foundation Trust, Cambridge

Background: Transcatheter aortic valve implantation (TAVI) is increasingly adopted in clinical practice for treatment of severe aortic stenosis, particularly for high-risk patients unfit for surgery. However, a major complication of TAVI is high-degree AV block necessitating permanent pacemaker (PPM) implantation. Objective: The aim of our study was to evaluate standard available demographic, clinical and imaging […]

Cardiovascular Disease
Cardiovascular Disease
34/Cardiac computed tomography prior to cardiac resynchronisation therapy upgrade enhances pre-procedural planning by accurately predicting coronary sinus target vessel localisation and venous access patency
L Whittaker (Presenting Author) – James Cook University Hospital, Middlesbrough; M Chapman – James Cook University Hospital, Middlesbrough; M Dewhurst – James Cook University Hospital, Middlesbrough; M Bates – James Cook University Hospital, Middlesbrough; A Thornley – James Cook University Hospital, Middlesbrough; A Turley – James Cook University Hospital, Middlesbrough; N Child – University Hospital of North Tees, Stockton-on-Tees

Introduction: With advances in cardiac resynchronisation therapy (CRT) equipment and operator experience, implant success is increasing. However, the commonest cause for procedural failure remains a lack of suitable pacing site due to an absent or insufficiently sized target vein. The role of computed tomography (CT) prior to CRT remains investigational, but improved imaging techniques allow […]

Devices
Devices
35/Long-term follow-up and procedural safety of pacemaker implantation in nonagenarians
A Gomaa (Presenting Author) – East Sussex Healthcare NHS Trust, Eastbourne; R Dulai – East Sussex Healthcare NHS Trust, Eastbourne; C Uy – East Sussex Healthcare NHS Trust, Eastbourne; NR Patel – East Sussex Healthcare NHS Trust, Eastbourne; S Furniss – East Sussex Healthcare NHS Trust, Eastbourne; R Veasey – East Sussex Healthcare NHS Trust, Eastbourne

Introduction: The life expectancy of the general population has increased over the past few decades. This has led to a more elderly population and more frail patients requiring pacemaker implantation. It may be perceived by physicians, relatives and patients that pacemaker implantation in this cohort may be too invasive or have a higher complication rate. […]

Heart Failure
Heart Failure
36/Optimising pacemaker therapy using multi-point pacing (the OPT-MPP Study)
JE Lowry – University of Leeds, Leeds; S Straw – University of Leeds, Leeds; CA Cole – University of Leeds, Leeds; MF Paton – University of Leeds, Leeds; MT Kearney – University of Leeds, Leeds; KK Witte – University of Leeds, Leeds; J Gierula (Presenting Author) – University of Leeds, Leeds

Background: Heart failure with reduced ejection fraction (HFrEF) is characterised by an attenuation of the positive relationship between heart rate and left ventricular (LV) contractility, known as the force-frequency relationship (FFR). Optimal therapy for around 1/3 of people with HFrEF includes a resynchronisation (CRT) cardiac implantable electronic device (CIED). We have previously demonstrated that programming […]

Oral Abstracts 3 – Mapping and Ablation

Atrial Fibrillation
Atrial Fibrillation
37/Patient experience of very high-power short-duration radiofrequency ablation for atrial fibrillation under mild conscious sedation
GS Chu (Presenting Author) – Lancashire Cardiac Centre, Blackpool; P Calvert – Liverpool Heart and Chest Hospital, Liverpool; B Sidhu – University of Leicester, Leicester; A Mavilakandy – University of Leicester, Leicester; A Kotb – University of Leicester, Leicester; L Tovmassian – Liverpool Heart and Chest Hospital, Liverpool; N Kozhuharov – Liverpool Heart and Chest Hospital, Liverpool; C Biermé – Liverpool Heart and Chest Hospital, Liverpool; N Denham – Liverpool Heart and Chest Hospital, Liverpool; C Pius – Liverpool Heart and Chest Hospital, Liverpool; J O’Brien – Liverpool Heart and Chest Hospital, Liverpool; WY Ding – Liverpool Heart and Chest Hospital, Liverpool; V Luther – Liverpool Heart and Chest Hospital, Liverpool; R Snowdon – Liverpool Heart and Chest Hospital, Liverpool; GA Ng – University of Leicester, Leicester; D Gupta – Liverpool Heart and Chest Hospital, Liverpool

Background: Conventional radiofrequency (RF) ablation for atrial fibrillation (AF) can cause significant patient discomfort even under mild conscious sedation (mCS), contributing to the predominant use of cryoablation (Cryo) for pulmonary vein isolation (PVI). We hypothesized that by reducing energy delivery times, a very high-power short-duration (vHPSD) RF protocol could offer a patient experience comparable to […]

Arrhythmia
Arrhythmia
38/Integration of structural and functional data in VT ablation
F Bangash (Presenting Author) – Anglia Ruskin University, Chelmsford; J Collinson – Basildon and Thurrock University Hospital, Basildon; J Dungu – Basildon and Thurrock University Hospital, Basildon; S Gedela – Basildon and Thurrock University Hospital, Basildon; M Westwood – Barts Heart Centre, London; C Manisty – Barts Heart Centre, London; D Farwell – Basildon and Thurrock University Hospital, Basildon; S Tan – Barts Heart Centre, London; H Savage – Basildon and Thurrock University Hospital, Basildon; K Vlachos – Onassis Cardiac Surgery Centre, Athens; R Schilling – Barts Heart Centre, London; R Hunter – Barts Heart Centre, London; N Srinivasan – Anglia Ruskin University, Chelmsford

Background: We have previously developed the sense protocol functional substrate mapping technique for ventricular tachycardia (VT) ablation. However, functional substrate characterization can involve protracted mapping time. Purpose: We incorporated the integration of magnetic resonance imaging (MRI) data using ADAS-3D software into the mapping workflow to integrate structural mapping information into the functional mapping substrate characterization […]

Arrhythmia, Electrophysiology
Arrhythmia, Electrophysiology
39/Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (The Achieve Plus Study)
Y De Greef (Presenting Author) – ZNA Heart Center, Antwerp, Grimbergen; M Tijskens – ZNA Heart Center, Antwerp; JP Abugattas de Torres – ULB Erasmus Hospital, Brussels; D Sofianos – ZNA Heart Center, Antwerp; K De Schouwer – OLV Hospital Alost, Alost; J De Cocker – ZNA Heart Center, Antwerp; I Buysschaert – Heart Centre AZ Sint Jan, Bruges; V Varnavas – University Hospital Saint-Luc UCL, Brussels; M Wolf – ZNA Heart Centre, Antwerp

Background: Validation of pulmonary vein (PV) isolation (PVI) using only the Achieve catheter following cryoballoon ablation (CBA) is imperfect since pulmonary vein potentials (PVP) can be recorded in only 50–85% of the veins and residual PVP are found in up to 4.3–7.6% of the veins in remapping studies. Aims: To study whether addition of electroanatomical […]

Arrhythmia, Electrophysiology
Arrhythmia, Electrophysiology
40/Electro-architectural differences between septal and non-septal post-infarct ventricular scars identified using ripple mapping
P Calvert (Presenting Author) – Liverpool Heart & Chest Hospital, Liverpool; D Khanra – Liverpool Heart & Chest Hospital, Liverpool; S Hughes – Liverpool Heart & Chest Hospital, Liverpool; J Waktare – Liverpool Heart & Chest Hospital, Liverpool; S Modi – Liverpool Heart & Chest Hospital, Liverpool; M Hall – Liverpool Heart & Chest Hospital, Liverpool; D Todd – Liverpool Heart & Chest Hospital, Liverpool; S Mahida – Liverpool Heart & Chest Hospital, Liverpool; D Gupta – Liverpool Heart & Chest Hospital, Liverpool; V Luther – Liverpool Heart & Chest Hospital, Liverpool

Background: Post-infarct septal scars are unique in their potential association with the native conduction system, but the influence of this relationship during ventricular tachycardia (VT) ablation has yet to be studied. High-density 3D mapping has offered new insights into the post-infarct ventricular electro-architecture. CARTO Ripple Maps (Biosense Webster) display myocardial activation as moving bars that […]

Arrhythmia, Atrial Fibrillation
Arrhythmia, Atrial Fibrillation
41/A local impedance-based comparison of IntellaNav MiFi and Stablepoint catheters
AP Bates (Presenting Author) – Cardiology Department, University Hospital Southampton, Southampton; JR Paisey – Cardiology Department, University Hospital Southampton, Southampton; AM Yue – Cardiology Department, University Hospital Southampton, Southampton; P Banks – Cardiology Department, University Hospital Southampton, Southampton; PR Roberts – Cardiology Department, University Hospital Southampton, Southampton; W Ullah – Cardiology Department, University Hospital Southampton, Southampton

Background: Local impedance (LI) drop is a novel parameter that correlates with ablation lesion size in preclinical studies. Values for LI drop that establish effective pulmonary vein isolation were established in the LOCALIZE trial using the IntellaNav MiFi catheter. However, a new contact force sensing catheter (IntellaNav Stablepoint [SP]) has recently come to market and […]

Arrhythmia, Atrial Fibrillation
Arrhythmia, Atrial Fibrillation
42/RETRO-map: A novel algorithm to map persistent atrial fibrillation shows a reduction in wavefront collision following circumferential pulmonary vein isolation
I Kanella (Presenting Author) – Imperial College London, London; C Coyle – Hammersmith Hospital, London; I Mann – Hammersmith Hospital, London; E Lim – Hammersmith Hospital, London; M Fudge – Hammersmith Hospital, London; N Qureshi – Hammersmith Hospital, London; M Koa-Wing – Hammersmith Hospital, London; Z Whinnett – Hammersmith Hospital, London; P Boon Lim – Hammersmith Hospital, London; F Siong Ng – Hammersmith Hospital, London; NS Peters – Hammersmith Hospital, London; DP Francis – Hammersmith Hospital, London; N Linton – Hammersmith Hospital, London; P Kanagaratnam – Hammersmith Hospital, London

Background: Determining the mechanisms driving atrial fibrillation (AF) during clinical procedures remains challenging. RETRO-map enables the analysis of intracardiac electrograms (EGM) to display activation maps during AF. We used RETRO-map to study the impact of circumferential pulmonary vein ablation (CPVA) on activation patterns in persistent AF. Methods: Patients undergoing CPVA for persistent AF using the […]

Moderated Posters 1

Atrial Fibrillation, Stroke
Atrial Fibrillation, Stroke
43/Immediate inpatient implantable loop recorder implantation for the detection of atrial fibrillation in cryptogenic stroke
J Hunt (Presenting Author) – East Sussex Healthcare NHS Trust, Eastbourne; R Dulai – East Sussex Healthcare NHS Trust, Eastbourne; RA Veasey – East Sussex Healthcare NHS Trust, Eastbourne; C Biyanwila – East Sussex Healthcare NHS Trust, Eastbourne; B Zemanova – East Sussex Healthcare NHS Trust, Eastbourne; N Patel – East Sussex Healthcare NHS Trust, Eastbourne

Introduction: Undetected atrial fibrillation (AF) is suspected as the main cause of stroke in the majority of patients presenting with cryptogenic stroke (CS). Implantable loop recorders (ILRs) are indicated for the detection of AF in these patients. This allows for continuous monitoring for up to 3 years; however, nationally there is a delay in the […]

Electrophysiology
Electrophysiology
44/First worldwide report of CT/TOE fusion tool to guide electrophysiology procedures
G Suna (Presenting Author) – Royal Papworth Hospital, Cambridge; J Weir-McCall – Royal Papworth Hospital, Cambridge; L D’Errico – Royal Papworth Hospital, Cambridge; C Densem – Royal Papworth Hospital, Cambridge; M Garbi – Royal Papworth Hospital, Cambridge; CA Martin – Royal Papworth Hospital, Cambridge

Introduction: Image integration has been used to good effect in electrophysiological (EP) procedures to aid in understanding the cardiac anatomy especially in complex cases. A computed tomography (CT) fusion tool has recently been developed (GE Healthcare Systems, Chicago, Illinois, USA). This new technology enables co-alignment of CT images with real-time 4D trans-oesophageal (TOE) images to […]

Arrhythmia
Arrhythmia
45/Drug-related atrioventricular conductive disorders – a predictive-oriented approach
DTM Marcu (Presenting Author) – Grigore T. Popa University of Medicine and Pharmacy, Iasi; CA Adam – Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu”, Iasi; DM Dorobanțu – Children’s Health and Exercise Research Centre (CHERC), University of Exeter, Exeter; C Arsenescu-Georgescu – Grigore T. Popa University of Medicine and Pharmacy, Iasi; RA Sascău – Grigore T. Popa University of Medicine and Pharmacy, Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu”, Iasi; C Stătescu – Grigore T. Popa University of Medicine and Pharmacy, Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu”, Iasi

Introduction: Adverse drug reactions (ADRs) are responsible for 6% of annual hospitalizations and 2% of deaths, representing a significant burden on the healthcare system. Cardiovascular drugs are responsible for most ADRs, among which bradyarrhythmias are frequent outcomes. Recent studies suggest that in most cases of drug-associated atrioventricular (AV) conduction disorders, a subclinical dysfunction of the […]

Devices
Devices
46/Transvenous lead extraction: a single-centre experience of the Tandem procedure
MM Gallagher (Presenting Author) – St George’s University Hospital, London; Z Akhtar – St George’s University Hospital, London; LWM Leung – St George’s University Hospital, London; M Sohal – St George’s University Hospital, London

Background: Transvenous lead extraction (TLE) is integral to the management of patients with cardiac implantable electronic devices (CIEDs). There are notable procedural risks; however, development of techniques has contributed to an improvement in safety. The mechanical rotational dissecting sheath is safe and efficacious whilst the Needle’s Eye Snare (NES) is an additional ‘bail-out’ strategy. We […]

Imaging
Imaging
47/Omnipolar Electrograms are more consistent and improve substrate characterisation in Human Atrial Flutter
D Panagopoulos (Presenting Author) – Imperial College Healthcare NHS Trust, London; S Kim – Abbott UK, New York; B Porter – Imperial College Healthcare NHS Trust, London; B Handa – Imperial College Healthcare NHS Trust, London; A Arnold – Imperial College Healthcare NHS Trust, London; D Keene – Imperial College London, London; FS Ng – Imperial College London, London; N Linton – Imperial College, London; Z Whinnett – Imperial Colelge London, London; M Koa-Wing – Imperial College Healthcare NHS Trust, London; L Malcolme-Lawes – Imperial College Healthcare NHS Trust, London; P Kanagaratnam – Imperial College Healthcare NHS Trust, London; NS Peters – Imperial College London, London; PB Lim – Imperial College Healthcare NHS Trust, London; N Qureshi – Imperial College Healthcare NHS Trust, London

Background: The limitations of bipolar electrograms (EGM) due to catheter orientation are well described. Omnipolar electrograms may be able to accurately identify substrate characteristics as they are not affected by directionality. Objectives: To investigate the difference in voltage maps between omnipolar and bipolar electrograms in human atrial flutter. Methods: We recruited 15 patients with typical […]

Cardiovascular Disease
Cardiovascular Disease
48/Application of the MADIT ICD Benefit Score to a tertiary UK centre primary prevention population
N Jathanna (Presenting Author) – Nottingham University Hospitals NHS Trust, Nottingham; R Oliver – Nottingham University Hospitals NHS Trust, Nottingham; S Jamil-Copley – Nottingham University Hospitals NHS Trust, Nottingham

Introduction: Guidelines recommend the implantation of primary prevention defibrillators (pICD) in patients with a left ventricular ejection fraction (LVEF) of <35% due to the associated higher risk of ventricular arrhythmias (VA) in this cohort. However, reported incidence of VA in this cohort is only 5–10%/year with many deaths occurring prior to VA events and up […]

Interventional Cardiology
Interventional Cardiology
49/Initial experience of a novel radiofrequency wire-based transseptal puncture system
FA Wardak (Presenting Author) – University Hospital Southampton NHS Foundation Trust, Southampton; JR Paisey – University Hospital Southampton NHS Foundation Trust, Southampton; RW Bowers – Hampshire Hospitals NHS Foundation Trust, Basingstoke; University Hospital Southampton NHS Foundation Trust, Southampton; AM Yue – University Hospital Southampton NHS Foundation Trust, Southampton; PR Roberts – University Hospital Southampton NHS Foundation Trust; School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton; W Ullah – University Hospital Southampton NHS Foundation Trust; School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton

Background: Transseptal puncture is a key component of cardiac ablation and structural interventional procedures. The VersaCross RF transseptal puncture (TSP) platform (Baylis Medical) is a novel system comprising a blunt radiofrequency (RF) wire rather than a needle, passed through a malleable sheath/dilator. The wire forms a pigtail on deployment and is firm enough to exchange […]

Hypertension
Hypertension
50/Patients with severe systolic hypertension requiring pacemaker implantation are more likely to have preserved left ventricular systolic function: an observational study
DR Morgan (Presenting Author) – Lincolnshire Heart Centre, Lincoln; H Saleem – Lincolnshire Heart Centre, Lincoln; J Sharma – Lincolnshire Heart Centre, Lincoln; W Arthur – Lincoln County Hospital, Lincoln; K Lee – Lincoln County Hospital, Lincoln; K Gaughan – Lincolnshire Heart Centre, Lincoln; D Coates – Lincolnshire Heart Centre, Lincoln; J Ratcliffe – Lincolnshire Heart Centre, Lincoln; B Thornalley – Lincolnshire Heart Centre, Lincoln; E Gauci – Lincolnshire Heart Centre, Lincoln; A Majeed – Lincolnshire Heart Centre, Lincoln

Background: Hypertension is associated with Mobitz II and Complete Heart Block (CHB) (JAMA Netw Open. 2019;2:e194176). Profound bradycardia such as caused by Mobitz II and CHB have also been reported to cause hypertension (Ann Pediatr Cardiol. 2020;13:248–51) albeit usually in specialist situations such as congenital CHB. Purpose: We investigated the incidence of hypertension and the […]

Arrhythmia
Arrhythmia
51/Assessment of optimal thresholds for ventricular scar substrate characterization
F Bangash (Presenting Author) – Anglia Ruskin University, Chelmsford; J Collinson – Basildon and Thurrock University Hospital, Basildon; J Dungu – Basildon and Thurrock University Hospital, Basildon; S Gedela – Basildon and Thurrock University Hospital, Basildon; M Westwood – Barts Heart Centre, London; C Manisty – Barts Heart Centre, London; D Farwell – Basildon and Thurrock University Hospital, Basildon; S Tan – Barts Heart Centre, London; H Savage – Basildon and Thurrock University Hospital, Basildon; K Vlachos – Onassis Cardiac Surgery Centre, Athens; J Silberbaur – Sussex Cardiac Centre, Brighton; J Calvo – Brighton and Sussex University Hospital NHS Trust, Brighton; R Hunter – Barts Heart Centre, London; R Schilling – Basildon and Thurrock University Hospital, Basildon; N Srinivasan – Anglia Ruskin University, Chelmsford

Background: Voltage thresholds for ventricular scar definition are based on historic data collected using catheters with widely spaced bipoles in the absence of contact force. Modern multipolar mapping catheters employ smaller electrodes and interelectrode spacing that theoretically allows for mapping with increased resolution and reduced far-field electrogram (EGM) component. Despite the advancement in technology, historic […]

Arrhythmia
Arrhythmia
52/Acute and long-term outcome of radiofrequency ablation for outflow tract ventricular arrhythmias: impact of anatomy and high-density mapping
JR Griffiths (Presenting Author) – Department of Cardiology, Glenfield Hospital, Leicester; RK Somani – Department of Cardiology, Glenfield Hospital, Leicester; G Panchal – Department of Cardiology, Glenfield Hospital, Leicester; PJ Stafford – Department of Cardiology, Glenfield Hospital, Leicester; A Sandilands – Department of Cardiology, Glenfield Hospital, Leicester; GA Ng – Department of Cardiology, Glenfield Hospital, Leicester; SH Chin – Department of Cardiology, Glenfield Hospital, Leicester

Introduction: High-density (HD) mapping with multipolar catheter for ventricular arrhythmias with structural heart disease is well described. However, evidence of its efficacy in ablation of outflow tract (OT) origin premature ventricular contractions (PVC) is lacking. This study aims to: 1) compare procedural and clinical outcomes of point-by-point (PBP) mapping against HD mapping in patients undergoing […]

Moderated Posters 2

Arrhythmia
Arrhythmia
53/Improving understanding of lesion parametrics in high-power short-duration ablation
G Panchal (Presenting Author) – Glenfield hospital, Leicester; A Mavilakandy – Glenfield hospital, Leicester; I Koev – Glenfield hospital, Leicester; A Kotb – Glenfield hospital, Leicester; M Ibrahim – Glenfield hospital, Leicester; M Lazdam – Glenfield hospital, Leicester; SH Chin – Glenfield hospital, Leicester; A Sandilands – Glenfield hospital, Leicester; R Somani – Glenfield hospital, Leicester; GA Ng – Glenfield hospital, Leicester

Background: Pulmonary vein isolation (PVI) is the gold standard management for patients with atrial fibrillation (AF) refractory to medical therapy. Contact-force (CF) sensing very-high-power short-duration (vHPSD) radiofrequency (RF) ablation (90 W/4 seconds) has emerged as a novel ablation modality. Previous RF ablation utilized Ablation Index (AI) as a surrogate marker of lesion quality to guide […]

Arrhythmia
Arrhythmia
54/Radiofrequency ablation of the diseased human left ventricle: biophysical and electrogram based analysis
AP Bates (Presenting Author) – Cardiology Department, University Hospital Southampton, Southampton; JR Paisey – Cardiology Department, University Hospital Southampton, Southampton; AM Yue – Cardiology Department, University Hospital Southampton, Southampton; P Banks – Cardiology Department, University Hospital Southampton, Southampton; PR Roberts – Cardiology Department, University Hospital Southampton, Southampton; W Ullah – Cardiology Department, University Hospital Southampton, Southampton

Background: Predictors of effective ablation lesion delivery in the human left ventricle are not established, particularly in scar. Impedance drop and electrogram (EGM) attenuation are potential surrogates to assess this. Objectives: Establish the relationships between Ablation Index (AI) and Force Time Integral (FTI) with impedance drop and EGM attenuation in the human left ventricle. Methods: […]

Arrhythmia
Arrhythmia
55/Invasive assessment of haemodynamic compromise and coronary blood flow during simulated VT
AA Miyazawa (Presenting Author) – Imperial College London, London; AD Arnold – Imperial College London, London; H Seligman – Imperial College London, London; N Ali – Imperial College London, London; S Bangi – Imperial College London, London; M Liistro – Imperial College London, London; D Keene – Imperial College London, London; MJ Shun-Shin – Imperial College London, London; R Petraco – Imperial College London, London; ZI Whinnett – Imperial College London, London

Introduction: Reducing unnecessary and inappropriate implantable cardioverter defibrillator (ICD) therapies reduces mortality. This was demonstrated in studies that investigated using higher rates for treatment zones and longer detection windows. ICDs currently do not utilise haemodynamic measurements to guide therapies. We have previously shown that a potentially implantable sensor can reliably identify loss of perfusion in […]

Devices
Devices
56/Exploiting SMART Pass filter deactivation detection to minimise inappropriate subcutaneous implantable cardioverter defibrillator (S-ICD) therapies: a real-world single-centre experience and management guide
C Monkhouse (Presenting Author) - Barts Heart Centre, London; A Chow - Barts Heart Centre, London; R Hunter - Barts Heart Centre, London; P Lambiase - Barts Heart Centre, London; M Earley - Barts Heart Centre, London; RJ Schilling - Barts Heart Centre, London; N Srinivasan - Barts Heart Centre, London

Introduction: Concern persists regarding inappropriate therapy (IT) burden from the subcutaneous implantable cardioverter defibrillator (S-ICD). The SMART Passä (SP) algorithm is a bandpass filter that aims to reduce IT. The algorithm’s ability to deactivate itself in community has implications for IT that require evaluation. Objective: To investigate the effect of SP deactivation, its causes and […]

Devices
Devices
57/A surface evaluation of single and dual chamber ICD discriminators
KCC Chong (Presenting Author) – Barts Trust, London; CM Monkhouse – Bart NHS Trust, London; JM Malcolmson – Barts NHS Trust, London

Introduction: Ventricular tachycardia and fibrillation are both life-threatening arrhythmias. Implantable cardioverter defibrillators (ICDs) can be used to cardiovert these arrhythmias via high-voltage therapy. However, ICDs must distinguish life-threatening arrhythmias from physiological cardiac rhythms, doing so via algorithms specific to device type and manufacturer. The aim of this service evaluation was to determine rates of appropriate […]

Arrhythmia
Arrhythmia
58/Incidence and predictors of ventricular arrhythmia and mortality in a primary prevention defibrillator cohort in the era of improved heart failure and arrhythmia management
N Jathanna (Presenting Author) – Nottingham University Hospitals NHS Trust, Nottingham; R Oliver – Nottingham University Hospitals NHS Trust, Nottingham; S Jamil-Copley – Nottingham University Hospitals NHS Trust, Nottingham

Primary prevention implantable cardioverter defibrillators (ICD) including those combined with cardiac resynchronisation therapy (CRT-D) are implanted primarily on the premise that reduced left ventricular ejection fraction (EF) has a higher risk of ventricular arrhythmias (VA). However, emerging data suggest that EF alone may no longer be sufficient to predict VA risk and with advances in […]

Devices
Devices
59/Virtual reality – a new addition to the anxiolytic armamentarium during implantation of cardiac devices
C Brown (Presenting Author) – The Allan Lab, Jersey; A Gibbs – The Allan Lab, Jersey; A Mitchell – The Allan Lab, Jersey

Pacemaker implantation can be a painful and anxiety-provoking intervention. Virtual reality (VR) offers a simple and low-cost opportunity to improve the experience of patients undergoing these procedures through immersion in a distracting and meditative virtual environment. Procedure-related complications and side effects could be avoided, and VR may result in reduced analgesic and anxiolytic medication use. […]

Atrial Fibrillation
Atrial Fibrillation
60/The utility of transoesophageal echocardiography-derived left atrial appendage velocity in predicting postoperative atrial fibrillation in mitral valve surgery patients
JJ Sun (Presenting Author) – Department of Cardiology, Harefield Hospital, Uxbridge, London; J Pan – Department of Cardiology, Harefield Hospital, Uxbridge, London; AJ Barron – Department of Cardiology, Harefield Hospital, Uxbridge, London

Background: Postoperative atrial fibrillation (POAF) is a recognised complication of cardiac surgery associated with adverse outcomes. Preoperative left atrial dysfunction is thought to be associated with the development of POAF. In our centre, transoesophageal echocardiography (TOE) is used as part of the work-up for patients undergoing mitral valve surgery and left atrial appendage velocity is […]

Posters 1

Arrhythmia
Arrhythmia
61/Bariatric surgery partially reverses subclinical proarrhythmic remodelling in obese patients: a non-invasive electrocardiographic imaging study
KHK Patel (Presenting Author) – Imperial College London NHLI, London; N Bajaj – Imperial College London NHLI, London; BK Statton – Imperial College London , London; NS Herath – Imperial College London NHLI, London; J Stok – Maastricht University, Maastricht; X Li – Imperial College London NHLI, London; K Nyamakope – Imperial College London NHLI, London; R Davidson – Imperial College London NHLI, London; JA Coghlin – Imperial College London NHLI, London; J Cousins – Imperial College London , London; JS Ware – Imperial College London NHLI, London; S Purkayastha – Imperial College London , London; D O’Regan – Imperial College London, London; NS Peters – Imperial College London NHLI, London; PD Lambiase – University College London, London; M Cluitmans – Maastricht University, Maastricht; FS Ng – Imperial College London NHLI, London

Introduction: Obesity confers higher risks of cardiac arrhythmias and sudden cardiac death. Given that early bariatric surgery reverses and prevents some metabolic complications of obesity, the same may also be true for the risk of cardiac arrhythmias. However, the evidence for weight loss mitigating arrhythmic risk is conflicting and inconclusive. We therefore used electrocardiographic imaging […]

Atrial Fibrillation
Atrial Fibrillation
62/Enhancing the identification of atrial fibrillation using prescribing records in electronic medical record research
CV Moore (Presenting Author) – University of Dundee, Dundee; MM Oo – University of Dundee, Dundee; CX Kocherry – University of Dundee, Dundee; M Guignard-Duff – University of Dundee, Dundee; C Guo – University of Dundee, Dundee; IR Mordi – University of Dundee, Dundee; CC Lang – University of Dundee, Dundee

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that is associated with increased risk of stroke, heart failure and mortality. The increasing availability of electronic medical records (EMRs) for clinical research offers opportunities to generate timely real-world evidence to enhance patient care and facilitate research. Previous EMR-derived AF patient cohorts that had […]

Devices
Devices
63/AF Association Patient Survey – remote monitoring and alert-based systems
T Lobban (Presenting Author) – AF Association, Stratford Upon Avon; S Kempton – AF Association, Stratford Upon Avon; N Breakwell – AF Association, Stratford Upon Avon

Background: The term remote monitoring means monitoring your heart and implanted device while you are at home, and ‘remote’ from the care team at your hospital. Remote monitoring of pacemakers, ICDs and ICMs, uses a special transmitter. Using an integrated aerial, the implant automatically sends medical and technical information from your heart, to your doctor, […]

Devices
Devices
64/Inappropriate shocks from an S-ICD
L Whittaker (Presenting Author) – James Cook University Hospital, Middlesbrough; M Chapman – James Cook University Hospital, Middlesbrough; A Turley – James Cook University Hospital, Middlesbrough; M Dewhurst – James Cook University Hospital, Middlesbrough

Case: A 62-year-old man attended electively for implantation of a subcutaneous implantable cardioverter defibrillator (S-ICD) for primary prevention due to dilated cardiomyopathy with severe left ventricular systolic dysfunction (LVSD). His past medical history included type II diabetes. Screening prior to implant demonstrated that the primary and alternative vectors were acceptable. The S-ICD was implanted under […]

Devices
Devices
65/Contemporary CIED complications in a major tertiary centre: insights into rates of bleeding, infection and lead displacement
MNS Niespialowska-Steuden (Presenting Author) – University Hospital Southampton, Southampton; MA Abouelasaad – University Hospital Southampton, Southampton; JRP Paisey – University Hospital Southampton, Southampton; PRR Roberts – University Hospital Southampton, Southampton; WXU Ullah – University Hospital Southampton, Southampton; AMY Yue – University Hospital Southampton, Southampton

Introduction and methods: Cardiac implantable electronic device (CIED) procedures are associated with complications. Our centre has incorporated multiple measures to minimize implant complications, but the rates of complications in contemporary clinical practice are not well described. We avoid heparin bridging, interrupt direct oral anticoagulants 48 hours before procedures, and maintain an international normalized ratio of […]

Devices
Devices
66/Efficacy and safety of a remote monitoring program for low-energy devices – 1-year follow-up
A Wharmby – Barts Health NHS Trust, London; C Butcher – Barts Health NHS Trust, London; A Nogueira – Barts Health NHS Trust, London; Z Carter – Barts Health NHS Trust, London; A Muthumala – Barts Health NHS Trust, London; P Moore – Barts Health NHS Trust, London

Background: Remote monitoring (RM) is not routinely deployed in patients with low-energy devices, but there are limited efficacy and safety data in this population. In response to the COVID-19 pandemic, our institution enrolled all low-voltage devices onto RM to reduce clinic footfall. Purpose: To assess the efficacy and safety at 1 year of RM in […]

Devices
Devices
67/Unscheduled downloads from implantable cardiac device home monitoring: benefit or burden?
C Stafford (Presenting Author) – Portsmouth Hospitals University NHS Trust, Portsmouth; Dr G Morton – Portsmouth Hospitals University NHS Trust, Portsmouth; R Dixon – Portsmouth Hospitals University NHS Trust, Portsmouth

Introduction: Increasing numbers of patients receive implantable cardiac devices capable of home monitoring (HM). Whilst providing many advantages, HM can create an overwhelming data burden with a low signal to noise ratio. This has a significant impact on cardiac physiologists’ work patterns. The aim of this work was to assess the volume and causes of […]

Devices
Devices
68/The application of deep learning methods in S-ICD screening – a promising approach?
Mohamed ElRefai (Presenting Author) – University Hospital Southampton NHS foundation trust, Southampton; M Abouelasaad – University Hospital Southampton NHS foundation trust, Southampton; B Wiles – University of Aberdeen NHS trust, Aberdeen; A Dunn – School of Mathematics, University of Southampton, Southampton; S Coniglio – School of Mathematics, University of Southampton, Southampton; A Zemkoho – School of Mathematics, University of Southampton, Southampton; P Roberts – University Hospital Southampton NHS foundation trust, Southampton

Background: Subcutaneous implantable cardiac defibrillators (S-ICDs) offer defibrillation protection therapy while avoiding lead-related complications associated with traditional ICDs. A major predictor of S-ICD eligibility is the T:R ratio. Despite current screening processes, T-wave oversensing remains the commonest cause of inappropriate shocks in S-ICD patients. The concept of varying S-ICD eligibility, owing to the dynamicity of […]

Devices
Devices
69/Peri-procedural complications and 3-month re-intervention rates associated with cardiac device implantation: our tertiary centre experience
Christina Menexi (Presenting Author) – University Hospital Southampton, Southampton; M Elrefai – University Hospital Southampton, Southampton; A Chua – University Hospital Southampton, Southampton; I Handa – University Hospital Southampton, Southampton; M Abouelasaad – University Hospital Southampton, Southampton; J Paisey – University Hospital Southampton, Southampton

Introduction: Cardiac implantable electronic devices (CIEDs) therapy can be associated with complications. The European Society of Cardiology guidelines on pacing recommend routine follow-up of all newly implanted devices within 72 hours of implant. The European Heart Rhythm Association expert consensus and practical guide on CIEDs recommend that a chest X-ray should be performed within 24 […]

Atrial Fibrillation
Atrial Fibrillation
70/Pilot study of non-contact mapping-guided ablation of atrial fibrillation in high complexity congenital heart disease
J Kakarla (Presenting Author) – Freeman Hospital, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne; E Shepherd – Freeman Hospital, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne; R Martin – Freeman Hospital, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne; N Seller – Freeman Hospital, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne

Introduction: Atrial arrhythmias are a common and challenging complication of complex congenital heart disease with significant clinical implications. The limited data on ablation of atrial fibrillation (AF) within this cohort are guided by conventional mapping and pulmonary vein isolation (PVI). Rapid, charge density, non-contact mapping technology allows for specific, targeted lesion sets of great relevance […]

Devices
Devices
71/Millimetre-scale batteries enable miniaturisation of cardiac implanted sensors
D Pasero (Presenting Author) – Ilika Technologies, Romsey

Purpose: A new generation of miniaturised, implanted, cardiac sensing devices, possibly introduced via a catheter, is being developed by disruptive product designers. Conventional medical batteries are packaged within metallic cans for safety purposes; they are also typically primary (non-rechargeable) and must contain the whole energy required during the life of the device they power from […]

Arrhythmia
Arrhythmia
72/Unsticking the spaghetti of ventricular tachycardia
G Panchal (Presenting Author) – Glenfield hospital, Leicester; M Ibrahim – Glenfield hospital, Leicester

Case presentation: The 62-year-old man had a history of anterior myocardial infarction 30 years ago, severe left ventricle (LV) systolic dysfunction due to apical scar and aneurysmal apical anterior wall in LV, with cardiac resynchronisation therapy with defibrillator in 2013 for primary prevention, atrial fibrillation and transient ischemic attack. He presented with an episode of […]

Arrhythmia
Arrhythmia
73/Automated, high-precision echocardiographic and haemodynamic atrioventricular delay assessment for right ventricular pacing in hypertrophic obstructive cardiomyopathy
JS Mohal (Presenting Author) – National Heart & Lung Institute, Imperial College London, London; F Simader – National Heart & Lung Institute, Imperial College London, London; M Shun-Shin – National Heart & Lung Institute, Imperial College London, London; A Arnold – National Heart & Lung Institute, Imperial College London, London; Z Whinnett – National Heart & Lung Institute, Imperial College London, London

Background: Right ventricular pacing (RVP) to reduce left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructed cardiomyopathy (HOCM) remains controversial. Imprecise and variable atrioventricular delay (AVD) selection methods have contributed to the uncertainty. Using automated, high-precision AVD selection methods that target cardiac output incrementation may allow reliable identification of the optimal AVD to determine whether […]

Arrhythmia
Arrhythmia
74/Safety and tolerability of inpatient and outpatient initiation of disopyramide for obstructive hypertrophic cardiomyopathy in a referral centre for septal reduction
YW Liao (Presenting Author) – Liverpool Heart and Chest Hospital, Liverpool; U Raza – Liverpool Heart and Chest Hospital, Liverpool; RM Cooper – Liverpool Heart and Chest Hospital, Liverpool

Introduction: Left ventricular outflow tract obstruction (LVOTO) is reported in up to two-thirds of hypertrophic cardiomyopathy (HCM) patients. This can cause symptoms of dyspnoea, chest pain, pre-syncope, and syncope. Disopyramide is a negative inotrope that can reduce the pressure gradient created by LVOTO. Disopyramide has a class 1B recommendation for LVOTO in the European Society […]

Devices
Devices
75/The development of a Comprehensive Cardiac Devices Service, NHS Forth Valley
K Hutchison (Presenting Author) – University of Glasgow, Glasgow; O Fersia – FVRH, Larbert; H Robinson – FVRH, Larbert; S Venkatasubramanian – FVRH, Larbert; G Padfield – FVRH, Larbert; J Maclachlan – FVRH, Larbert; J McDonald – FVRH, Larbert; C Mondoa – FVRH, Larbert; C Labinjoh – FVRH, Larbert

Introduction: In October 2020, Forth Valley Royal Hospital’s (FVRH) pacing service underwent a full repatriation from the Royal Infirmary of Edinburgh. Interventional radiology (IR) was established as the main inpatient pacing site (2 sessions a week) with IR staff education, training and developing standard operative procedures. Theatre capacity was increased from 1 to 2 sessions […]

Arrhythmia
Arrhythmia
76/Prevalence of arrhythmia among patients attending adult congenital heart diseases clinics
A Ebeid (Presenting Author) – East Midlands Congenital Heart Centre, Leicester; S Alkhafaji (Presenting Author) – East Midlands Congenital Heart Centre, Leicester; S Mansoor (Presenting Author) – East Midlands Congenital Heart Centre, Leicester; M Kurian – East Midlands Congenital Heart Centre, Leicester; F Mahamoud – East Midlands Congenital Heart Centre, Leicester; R Debiec – East Midlands Congenital Heart Centre, Leicester; AP Bolger – East Midlands Congenital Heart Centre, Leicester; M Lazdam – East Midlands Congenital Heart Centre, Leicester

Introduction: Arrhythmias constitute an important cause of hospitalization, morbidity and mortality among adult patients with congenital heart diseases (ACHD). These patients are more predisposed to arrhythmias due to many factors including congenital and acquired abnormalities of conduction system, abnormal loading conditions leading to structural and electrical remodelling, myocardial fibrosis due to longstanding hypoxia and presence […]

Atrial Fibrillation
Developed by Touch
Atrial Fibrillation
77/Procedural safety and acute effectiveness of pulsed field ablation for treatment of atrial fibrillation – a report on the first series of cases in the UK
LH Hong (Presenting Author) – University of Cambridge, Cambridge; J Mesquita – Royal Papworth Hospital, Cambridge; J Eldridge – Royal Papworth Hospital, Cambridge; DA Begley – Royal Papworth Hospital, Cambridge; PM Heck – Royal Papworth Hospital, Cambridge; CA Martin – Royal Papworth Hospital, Cambridge

Introduction: Pulsed field ablation (PFA) is a novel, non-thermal, atrial fibrillation (AF) ablation technique, in which delivery of millisecond electrical pulses generates pores in cell membranes, leading to its disruption (electroporation). PFA has demonstrated high selectivity for cardiomyocytes, thus reducing the risk of collateral extracardiac tissue damage often associated with thermal ablation methods. Both preclinical […]

Cardiovascular Disease
Developed by Touch
Cardiovascular Disease
78/Gender-specific and cardiomyopathy-specific differences in heart rate variability under the aspect of circadian rhythm
S Metje (Presenting Author) – CAU, Kiel; B Baldauf – CAU, Kiel; H Bonnemeier – CAU and Helios Cuxhaven, Cuxhaven

Introduction: In the past decades, a significant association between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death, has been recognised. Experimental evidence of an association between the propensity for fatal arrhythmias and signs of increased sympathetic or decreased vagal activity has encouraged the development of quantitative markers of autonomic activity. Heart rate […]

Devices
Developed by Touch
Devices
79/In-patient pacemaker implantation for sinus node dysfunction is associated with an increased mortality
AJ Sharp (Presenting Author) – Norfolk & Norwich University Hospital, Norwich; P Garg – Norfolk & Norwich University Hospital, Norwich; W Lim – Norfolk & Norwich University Hospital, Norwich

Introduction: Permanent pacemaker (PPM) implant is a well-established treatment to reduce morbidity in patients with symptomatic sinus node dysfunction (SND). Common symptoms of shortness of breath on exertion, fatigue, dizziness and syncope can be incredibly disabling. When we consider its increased prevalence in the elderly, where falls and deconditioning are leading drivers of mortality, the […]

Atrial Fibrillation
Developed by Touch
Atrial Fibrillation
80/Atrial fibrillation organisation correlates with ventricular response regularity in patients with persistent atrial fibrillation undergoing catheter ablation
N Ahsan (Presenting Author) – Imperial College London, London; A Sau – Imperial College London, London; R Neerahoo – Imperial College London, London; N Qureshi – Imperial College London, London; M Koa-Wing – Imperial College London, London; D Keene – Imperial College London, London; L Malcolme-Lawes – Imperial College London, London; DC Lefroy – Imperial College London, London; NWF Linton – Imperial College London, London; PB Lim – Imperial College London, London; A Varnava – Imperial College London, London; ZI Whinnett – Imperial College London, London; P Kanagaratnam – Imperial College London, London; DP Mandic – Imperial College London, London; NS Peters – Imperial College London, London; FS Ng – Imperial College London, London

Background: Atrial fibrillation (AF) is characterised by an irregularly irregular ventricular rhythm. However, an understanding of the mechanisms by which the regularity of ventricular response is influenced by AF dynamics is still lacking. In AF, atrial electrical activity can have different levels of organisation on a spectrum, from organised AF sustained by focal drivers through […]

COVID-19, Devices
Developed by Touch
COVID-19, Devices
81/Sorry we missed you – increasing rates of CIED non-elective battery replacement in the COVID-19 era
JH Harfield (Presenting Author) – Peninsula Medical School, Plymouth; BS Sieniewicz – University Hospitals Plymouth NHS Foundation Trust, Plymouth

Introduction: Cardiac implantable electronic devices (CIEDs) are a well-established treatment of cardiac arrhythmias, comprising pacemakers, implantable cardioverter defibrillators and cardiac resynchronisation therapy. In order to ensure continued reliable delivery of CIED therapy, it is essential patients receive high-quality device monitoring.1 This is mostly done with in-person reviews of symptoms, disease events and device function. However, newer […]

Cardiovascular Disease
Developed by Touch
Cardiovascular Disease
82/Cardiac ablation in premature ventricular contraction-induced cardiomyopathy
XL Ling (Presenting Author) – Royal Papworth Hospital NHS Foundation Trust, Cambridge; S Kassou – Royal Papworth Hospital NHS Foundation Trust, Cambridge; M Virdee – Royal Papworth Hospital NHS Foundation Trust, Cambridge; S Fynn – Royal Papworth Hospital NHS Foundation Trust, Cambridge; D Begley – Royal Papworth Hospital NHS Foundation Trust, Cambridge; C Martin – Royal Papworth Hospital NHS Foundation Trust, Cambridge; S Agarwal – Royal Papworth Hospital NHS Foundation Trust, Cambridge

Introduction: Premature ventricular contraction (PVC) is commonly seen on routine electrocardiograms. Most are deemed benign and inconsequential. However, in some patients with ventricular ectopic, left ventricular (LV) impairment is observed on imaging. This study aims to investigate whether suppression of PVC with cardiac ablation is effective at improving ejection fraction (EF) of patients with PVC-induced […]

Devices
Developed by Touch
Devices
83/A doubly shocking case
RL Warren (Presenting Author) – Northumbria Specialist Emergency Care Hospital, Newcastle; A Hall – Northumbria Specialist Emergency Care Hospital, Newcastle; HE Thomas – Northumbria Specialist Emergency Care Hospital, Newcastle

Introduction: Conducted energy devices (CED), commonly branded as ‘Tasers’ were authorised for use by specially trained officers in response to incidents with potential conflict in the UK in 2008. When activated, probes deliver short bursts of electric current to the target with an open circuit peak voltage of 50,000 volts. Generation of an electromagnetic field […]

Syncope
Developed by Touch
Syncope
84/Developing a postural orthostatic tachycardia syndrome (POTS) pathway
KS Minn (Presenting Author) – Cambridge University Hospitals NHS Foundation Trust, Cambridge; MK Zaw – Cambridge University Hospitals NHS Foundation Trust, Cambridge; NT Lin – Cambridge University Hospitals NHS Foundation Trust, Cambridge; S Kulkarni – Cambridge University Hospitals NHS Foundation Trust, Cambridge; J Graggaber – Cambridge University Hospitals NHS Foundation Trust, Cambridge; J Hampton – Cambridge University Hospitals NHS Foundation Trust, Cambridge

Introduction: The Syncope Service has been running for a decade and is the only clinic to offer beat-to-beat plethysmography in Addenbrooke’s Hospital. An increasing number of younger patients have been referred to the clinic with suspected postural orthostatic tachycardia syndrome (POTS) though the Syncope Service is not an ideal pathway. This project evaluated referrals to […]

Arrhythmia
Developed by Touch
Arrhythmia
85/Impact of a telemetry monitoring sheet on detection and actioning of cardiac events at a tertiary cardiac centre – updating of British Heart Rhythm Society telemetry guidelines
W Ries (Presenting Author) – Bristol Heart Institute, Bristol Royal Infirmary, Bristol; F Mouy – Bristol Heart Institute, Bristol Royal Infirmary, Bristol; P Marques – Bristol Heart Institute, Bristol Royal Infirmary, Bristol; A Nisbet – Bristol Heart Institute, Bristol Royal Infirmary, Bristol; P Barman – Bristol Heart Institute, Bristol Royal Infirmary, Bristol

Introduction: Ward telemetry aims to promptly identify cardiac arrest and life-threatening arrhythmia. The value of telemetry systems relies upon staff to regularly interrogate and action recordings. Several factors, such as alarm fatigue, system unfamiliarity or staffing pressures, can serve as barriers to regular interrogation and judicious discontinuation of telemetry. British Heart Rhythm Society (BHRS) and […]

Arrhythmia
Developed by Touch
Arrhythmia
86/The role of atrioventricular delay shortening and ventricular resynchronisation in achieving the haemodynamic benefit seen in biventricular pacing
A Naraen (Presenting Author) – St Helen’s Knowlsely Teaching Hospitals Trust, Liverpool; AD Arnold – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; MJ Shun-Shin – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; N Ali – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; D Keene – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; JP Howard – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; J Chow – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; IJ Wright – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; FS Ng – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; NA Qureshi – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; M Koa-Wing – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; DC Lefroy – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; NWF Linton – Department of Bioengineering, Imperial College London, Hammersmith Hospital, London; PB Lim – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; NS Peters – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; A Muthumala – Cardiology Department, North Middlesex University Hospital NHS Trust; Cardiology Department, St Bartholomew’s Hospital, Barts Health NHS Trust, London; M Tanner – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; KA Ellenbogen – Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond; P Kanagaratnam – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; DP Francis – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London; ZI Whinnett – National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London

Background: It is assumed that resynchronisation of the ventricles in patients with heart failure and left bundle branch block (LBBB) delivers the most benefit in biventricular pacing (BVP). Because cardiac resynchronisation therapy (CRT) with BVP both shortens atrioventricular delay and reduces ventricular dyssynchrony, it is difficult to isolate their individual impact. Objectives: In this invasive […]

Arrhythmia
Developed by Touch
Arrhythmia
87/The impact of setting up an arrhythmia nurse-led, Kardia monitor loan library
CM Shannon (Presenting Author) – Hospital, Brighton

Introduction: The COVID-19 pandemic created a number of challenges in monitoring patients with arrhythmias and associated symptoms. This study looks at the impact of loaning 15 Kardia monitors from the arrhythmia nurses to patients in Sussex, over an 18-month period. Explanation of basic methods: In 2020 we started to loan the monitors to patients to […]

Devices
Developed by Touch
Devices
88/Initial experience using a diamond tip ablation catheter in conjunction with a basket high density mapping system, for the treatment of atrial flutter and ventricular tachycardia
J Mesquita (Presenting Author) – Royal Papworth Hospital, Cambridge; J Eldridge – Royal Papworth Hospital, Cambridge; CA Martin – Royal Papworth Hospital, Cambridge

Introduction: The recently introduced DiamondTemp® (DT; Medtronic, Minneapolis, USA) has been proved non-inferior to standard irrigated force-sensing radiofrequency (RF) catheters with respect to safety, efficacy and procedural efficiency. Paired with the RealTemp® (Medtronic) technology, the diamond-embedded composite-tip is able to accurately measure tissue surface temperature in real time, and promptly adjust RF power accordingly (Figure A). This […]

Arrhythmia, Devices
Developed by Touch
Arrhythmia, Devices
89/Benefits of support groups for patients living with implantable cardioverter defibrillators: a mixed-methods systematic review and meta-analysis
KH Sanders (Presenting Author) – Cambridge University Hospitals, Cambridge; PA Chousou – Cambridge University Hospitals, Cambridge; K Carver – Cambridge University Hospitals, Cambridge; PJ Pugh – Cambridge University Hospitals, Cambridge; H Degens – Manchester Metropolitan University, Manchester; M Azzawi – Manchester Metropolitan University, Manchester

Background: Patients with implantable cardioverter defibrillators (ICD) experience anxiety, depression and reduced quality of life (QoL). Patient support groups are recommended in national guidelines for follow-up of patients with ICDs; however, although ICD recipients share experiences of patients with other long-term conditions, their risk of recurrent shocks is something unique to these patients and it […]

Arrhythmia, Devices
Developed by Touch
Arrhythmia, Devices
90/Loss of capture during pacemaker generator replacement: an unexpected surprise!
L Whittaker (Presenting Author) – James Cook University Hospital, Middlesbrough; C Benson – James Cook University Hospital, Middlesbrough; M Bates – James Cook University Hospital, Middlesbrough; S James – James Cook University Hospital, Middlesbrough; A Thornley – James Cook University Hospital, Middlesbrough; A Turley – James Cook University Hospital, Middlesbrough; M Chapman – James Cook University Hospital, Middlesbrough

Background/case: A 27-year-old female presented electively for a dual-chamber pacemaker generator replacement as her existing generator was approaching elective replacement indicator (ERI). Her past medical history included Kearns–Sayre syndrome. Her original system was implanted in 2011 (at another centre) for acquired third-degree atrio-ventricular (AV) block (Medtronic 5076 52 cm and 45 cm leads, St Jude […]

Atrial Fibrillation
Atrial Fibrillation
91/Innovative primary care-led community palpitation management and investigation pathway for Wakefield district
MM Khan (Presenting Author) – Health Care First, Methley; S Childe – Health Care First, Methley

Background: Palpitations are a common reason for GP appointments in primary care and a frequent reason for cardiology referral. In Wakefield, this translated to approximately 24,000 primary care and out-of-hours consultations in 2021. Purpose: The purpose of this pilot was to evaluate a pathway for palpitations diagnosis and management in primary care. The proposed pathway […]

Devices
Devices
92/Incidence and predictors of permanent pacemaker implant in patients undergoing transcatheter aortic valve replacement: a single-centre retrospective study
Mr Singleton (Presenting Author) – Royal Papworth Hospital, Cambridge

Background: Permanent pacemaker implant (PPI) is a frequent complication of transcatheter aortic valve replacement (TAVR), with potential long-term implications for patient morbidity and mortality. TAVR is expected to expand towards the treatment of lower-risk patients and other aortic valve pathologies; however, the current capacity within the National Health Service (NHS) to deliver TAVR is discordant […]

Atrial Fibrillation
Atrial Fibrillation
93/Time is brain – remote follow-up (RFU) improves new onset of atrial fibrillation (AF) diagnosis and treatment in the cardiac devices population
S Silva (Presenting Author) – Royal Papworth Hospital, Cambridge; I Turner – Royal Papworth Hospital, Cambridge

Introduction: With the rapid implementation of remote follow-up (RFU) during the COVID-19 period, the cardiac devices population under Royal Papworth Hospital has benefitted from this technology, with a great increase in patients followed up remotely, from 19.7% at pre-pandemic level, to 56.7% in the first year of the pandemic and 61% in the year after […]

Devices
Devices
94/Outsourcing management of disconnected remote monitors – collaborating with industry
HG Granville (Presenting Author) – Barts Health NHS Trust, London; CC Clottey – Barts Health NHS Trust, London; CM Monkhouse – Barts Health NHS Trust, London; ZC Carter – Barts Health NHS Trust, London; JC Collinson (Presenting Author) – Barts Health NHS Trust, London

Background: Remote monitoring (RM) for implanted cardiac devices continues to increase nationally. Ensuring patient RMs maintain connectivity is key to patient safety and service delivery. At a large tertiary centre with over 7,000 patients enrolled on RM, management of patients with disconnected remote monitors is challenging. We collaborated with industry and piloted a new disconnected […]

Atrial Fibrillation
Atrial Fibrillation
95/The Application of Atrial Fibrillation clinical risk scores and differences in AF risk based on ethnicity and sex within the UK Biobank Population Cohort
P Sivanandarajah (Presenting Author) – Chelsea and Westminster NHS Foundation Trust, Imperial College London, London; H Wu – Imperial College London, London; M Ardissino – Imperial College London, London; L Myslivecek – Imperial College London, London; S Khan – Chelsea and Westminster NHS Foundation Trust, Imperial College London, London; FS Ng – Chelsea and Westminster NHS Foundation Trust, Imperial College London, London

Introduction: Several clinical risk scores have been developed from specific population cohorts to predict the likelihood of atrial fibrillation (AF) occurrence for individuals. However, these risk scores often underperform when applied to an external validation cohort. These risk scores have never been compared head-to-head in a UK population. Previous observational cohort studies have also suggested […]

Posters 2

Devices
Devices
96/“Tomorrow I’m going to die”: the role of patient support groups in adapting to life with an implantable cardioverter defibrillator
KH Sanders (Presenting Author) – Cambridge University Hospitals, Cambridge; PJ Pugh – Cambridge University Hospitals, Cambridge; M Azzawi – Manchester Metropolitan University, Manchester

Background: Patients with implantable cardioverter defibrillator (ICDs) are known to experience psychosocial difficulties such as anxiety and depression. The British Heart Rhythm Society encourages the use of patient support groups for patients with ICDs; however, it is not clear what patients need from a support group or what format they should take to meet these […]

Devices
Devices
97/Biotronik DX lead failure – recency bias or real issue?
S Brown (Presenting Author) – Musgrove Park Hospital, Taunton; M Jones – Musgrove Park Hospital, Taunton; O Clayton – Musgrove Park Hospital, Taunton; G Furniss – Musgrove Park Hospital, Taunton; M Dayer – Musgrove Park Hospital, Taunton

Introduction: The Biotronik DX lead is a defibrillator lead that has been in use since 2010. It offers atrial sensing from the floating dipole as it passes through the atrium. This improves tachyarrhythmia discrimination and can provide atrioventricular synchrony in patients who develop a need for pacing with a single ventricular lead in situ. Our […]

Devices
Devices
98/Cardiac implantable electronic device infections: multicentre validation of a novel risk score and its cost–utility implications for antimicrobial envelope use
E Maclean (Presenting Author) – St Bartholomew’s Hospital, London; K Mahtani – St. Bartholomew’s Hospital, London; S Honarbakhsh – St. Bartholomew’s Hospital, London; C Butcher – St. Bartholomew’s Hospital, London; N Ahluwalia – St. Bartholomew’s Hospital, London; ASC Dennis – St. Bartholomew’s Hospital, London; P Waddingham – St. Bartholomew’s Hospital, London; A Creta – St. Bartholomew’s Hospital, London; M Finlay – St. Bartholomew’s Hospital, London; M Elliott – St. Thomas’ Hospital, London; V Mehta – St. Thomas’ Hospital, London; N Wijesuriya – St. Thomas’ Hospital, London; O Shaikh – Royal Papworth Hospital, Cambridge; M Zaw – Royal Papworth Hospital, Cambridge; CN Ranmuthu – Royal Papworth Hospital, Cambridge; CR Ranmuthu – Royal Papworth Hospital, Cambridge; RJ Schilling – St. Bartholomew’s Hospital, London; PD Lambiase – St. Bartholomew’s Hospital, London; MJ Earley – St. Bartholomew’s Hospital, London; P Moore – St. Bartholomew’s Hospital, London; A Muthumala – St. Bartholomew’s Hospital, London; S Sporton – St. Bartholomew’s Hospital, London; RJ Hunter – St. Bartholomew’s Hospital, London; C Rinaldi – St. Thomas’ Hospital, London; JM Behar – St. Thomas’ Hospital, London; C Martin – Royal Papworth Hospital, Cambridge; C Monkhouse – St. Bartholomew’s Hospital, London; A Chow – St. Bartholomew’s Hospital, London

Introduction: Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device (CIED) infections; however, patient selection strategies are poorly defined and cost–utility data are limited. Methods: In a preliminary internal analysis, we examined the factors associated with infection for all transvenous CIED implants, generator changes and non-infected lead interventions at a single tertiary centre from […]

Atrial Fibrillation, COVID-19
Atrial Fibrillation, COVID-19
99/The impact of COVID-19 on amiodarone use in Nottingham University Hospitals DC cardioversion service
F Doleman (Presenting Author) – Nottingham University Hospitals, Nottingham; J Teoh – Nottingham University Hospitals, Nottingham; B Doleman – University Hospitals of Derby & Burton, Derby; T Robinson – Nottingham University Hospitals, Nottingham

Background: DC cardioversion (DCCV) is commonly used to restore sinus rhythm (SR) in patients with persistent atrial fibrillation or flutter (AF). DCCV is not always successful and often AF recurs soon after. Oral amiodarone therapy increases the efficacy of DCCV on the day and increases duration of SR after DCCV. The NUH elective DCCV service […]

Atrial Fibrillation, COVID-19
Atrial Fibrillation, COVID-19
100/COVID-19-associated atrial fibrillation: its incidence and potential implications, a retrospective 1-year study in a UK tertiary care hospital
M Ahmad (Presenting Author) – University Hospital Plymouth, Plymouth; MA Noushad – University Hospital Plymouth, Plymouth

Introduction: There are very few studies conducted to date linking COVID-19 with incidences of atrial fibrillation (AF) in patients. Though not so common, cardiovascular diseases and complications do occur, affecting morbidity and mortality of COVID-19 patients. The underlying mechanism of AF in COVID-19 is largely unknown. Some proposed putative mechanisms include a reduction in angiotensin-converting […]

Atrial Fibrillation
Atrial Fibrillation
101/UK multicentre retrospective study of the learning curve and relative impact on success rates and procedural metrics of the Rhythmia Mapping System
AP Bates (Presenting Author) – Cardiology Department, University Hospital Southampton, Southampton; M Naseer – Cardiology Department, University Hospital Southampton, Southampton; M Taylor – Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; N Denham – Department of Cardiology, Manchester University Foundation Trust, Manchester; A Yue – Cardiology Department, University Hospital Southampton, Southampton; M Das – Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne; GM Morris – Department of Cardiology, Manchester University Foundation Trust, Manchester; W Ullah – Cardiology Department, University Hospital Southampton, Southampton

Background: The learning curve for the novel 3D electroanatomical system Rhythmia is unknown. Methods: Retrospective data were collected from three UK centres from the introduction of Rhythmia. Procedures considered were de novo and redo atrial fibrillation (AF), cavotricuspid isthmus dependent atrial flutter and left-sided atrial tachycardias. Patients were matched with controls undergoing the same procedure […]

Electrophysiology
Electrophysiology
102/Electroanatomic mapping data analysis using OpenEP
SE Williams (Presenting Author) – The University of Edinburgh, Edinburgh; P Smith – King’s College London, London; A Gharaviri – The University of Edinburgh, Edinburgh; C O’Shea – University of Birmingham, Birmingham; A Connolly – King’s College London, London; L O’Neill – King’s College London, London; I Kotadia – King’s College London, London; I Sim – King’s College London, London; N Bodagh – King’s College London, London; N Grubb – NHS Lothian, Edinburgh; J Whitaker – King’s College London, London; M Wright – Guy’s and St Thomas’ NHS Foundation Trust, London; S Niederer – King’s College London, London; M O’Neill – Guy’s and St Thomas’ NHS Foundation Trust, London; M Bishop – King’s College London, London; NWF Linton – Imperial College London, London

Introduction: OpenEP (https://openep.io) is widely used to streamline electrophysiology research, removing the need for researchers to write code to import and analyse data. OpenEP provides a common interface for the storage, representation and analysis of electroanatomic and electrophysiological data from the major system manufacturers. Significant updates to OpenEP have been added since initial release in […]

Arrhythmia
Arrhythmia
103/Using transthoracic echocardiogram (TTE) to risk-stratify patients with inherited arrhythmia syndromes (IAS)
AI Iqbal (Presenting Author) and G Mellor – Royal Papworth Hospital, Cambridgeshire

Background: Electromechanical window (EMW) defines the difference between the end of mechanical systole and the termination of electrical repolarisation [EMW= QAoC – QT]. A negative EMW has been established in patients with long QT syndrome (LQTS) when compared with controls, with marked EMW negativity in symptomatic LQTS. EMW negativity has been shown to be a […]

COVID-19, Devices
COVID-19, Devices
104/An evaluation of the remote follow-up (RFU) service for cardiac pacing devices at Royal Papworth Hospital (RPH) and the impact of this service on patient care during the COVID-19 pandemic
N Case (Presenting Author) – Royal Papworth Hospital NHS Foundation Trust, Cambridge; S Silva – Royal Papworth Hospital NHS Foundation Trust, Cambridge; Dr I Turner – Royal Papworth Hospital NHS Foundation Trust, Cambridge

Background: During COVID-19, Royal Papworth Hospital (RPH) expanded remote follow-up (RFU) services for cardiac pacing device patients in line with recommendations by current guidelines. RFU allows for detection of adverse clinical events such as arrhythmias, battery depletion and lead damage via monitoring of associated parameters. Whilst RFU has not been shown to increase occurrence of […]

Atrial Fibrillation, Devices
Atrial Fibrillation, Devices
105/What governs immediate or delayed DC cardioversion of atrial fibrillation?
A Al-Hamdi (Presenting Author) – Alhamdi Heart Clinic, Sulaimanya

Introduction: DC-cardioversion of atrial fibrillation may be immediate or delayed after shock delivery. What characterises each phenomenon is not clearly known. Patients and methods: A total of 100 patients with persistent atrial fibrillation were reverted to sinus rhythm with DC cardioversion. One group showed immediate reversion and the other showed delayed reversion after shock delivery. […]

Cardiovascular Disease
Cardiovascular Disease
106/Implantable cardioverter defibrillators: the prophylaxis of sudden cardiac death in patients with ischaemic and non-ischaemic cardiomyopathy. Contemporary clinical outcomes from a single tertiary centre
J Mayer – Royal Stoke Hospital, Stoke on Trent; V Walker – Royal Stoke Hospital, Stoke on Trent; CS Kwok – Royal Stoke Hospital, Stoke on Trent; A Patwala – Royal Stoke Hospital, Stoke on Trent; T Phan – Royal Stoke Hospital, Stoke on Trent

Background: Contemporary clinical questions exist around the modern-day efficacy of implantable cardioverter defibrillators (ICDs) for the prophylaxis of sudden cardiac death. The increased use of anti-arrhythmic medications, beta-blockers and renin–angiotensin aldosterone system inhibitors have significantly improved clinical outcomes in heart failure patients and have been shown to reduce mortality and morbidity. Appropriate patient selection is […]

Arrhythmia
Arrhythmia
107/Service development of a pathway for generator changes in older adults with frailty
FM Carr (Presenting Author) – Sheffield Teaching Hospitals foundation trust, Sheffield; G Kirkwood – Sheffield Teaching Hospitals Foundation Trust, Sheffield

Introduction: The average age of patients presenting to healthcare services with complex arrythmias needing intervention is increasing. With the average life span of a pacemaker generator ranging from 5 to 12 years, this often means that these already older patients have become even older with complex comorbidities and frailty by the time the device goes […]

Syncope
Syncope
108/Trauma and syncope: looking beyond the injury
KS Kavi (Presenting Author) – Leeds Teaching Hospitals Trust, Leeds

Introduction: This review examines the current literature and guidance relating to syncope in the trauma patient, exploring the causes of syncopal falls that may be overlooked, and discussing the optimal evaluation and safe management of syncope patients. Discussion: Overall, 42% of the population will experience syncope by the age of 70 years, with 36% of […]

Heart Failure
Heart Failure
109/Structural and functional characteristics of the heart after CRT in patients with heart failure
BA Akhyt (Presenting Author) – Institute of Cardiology and Internal Medicine, Almaty; RT Kuanyshbekova – Institute of Cardiology and Internal Medicine, Almaty; AT Mussagaliyeva – Institute of Cardiology and Internal Medicine, Almaty; KN Madaliyev – Institute of Cardiology and Internal Medicine, Almaty; KM Koshumbayeva – Institute of Cardiology and Internal Medicine, Almaty; KA Atageldiyeva – Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan

Aim: The aim of the study was to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure. Materials and methods: Seventy-six consecutive patients underwent echocardiography, New York Heart Association (NYHA) classification, 6-minute walk test and clinical assessment scale modified by Mareev, before and after cardiac resynchronization therapy. All had […]

Arrhythmia
Arrhythmia
110/Sotalol and mexiletine in combination are effective in suppressing ventricular arrhythmias in high-risk patients with ARVC: a single-centre experience
MA Rauf (Presenting Author) – University Hospitals Birmingham NHS Foundation Trust, Birmingham; A Aljehani – University Hospitals Birmingham NHS Foundation Trust, Birmingham; B Ensam – University Hospitals Birmingham NHS Foundation Trust, Birmingham; L Fabritz – University Hospitals Birmingham NHS Foundation Trust, Birmingham; R Steeds – University Hospitals Birmingham NHS Foundation Trust, Birmingham; J De Bono – University Hospitals Birmingham NHS Foundation Trust, Birmingham; M Kalla – University Hospitals Birmingham NHS Foundation Trust, Birmingham

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare, inherited non-ischaemic cardiomyopathy, which is linked to a high incidence of recurrent ventricular arrhythmias (VA) and sudden death, especially in young and athletic people. The purpose of this study was to describe the experience with mexiletine and sotalol combination for the treatment of VA. Methods: This […]

Arrhythmia
Arrhythmia
111/Ventricular tachycardia burden between surgical and control group
R Mravljak (Presenting Author) – Barts Heart Centre, London; J Elliott – Barts Heart Centre, London; C Monkhouse – Barts Heart Centre, London; P Waddingham – Barts Heart Centre, London; J Bennett – Barts Heart Centre, London; S Honarbakhsh – Barts Heart Centre, London; G Thornton – Barts Heart Centre, London; P Lambiase – Barts Heart Centre, London; T Treibel – Barts Heart Centre, London

Introduction: Aortic valve replacement (AVR) improves outcome in patients with severe aortic stenosis (AS). Nevertheless, late mortality remains high (15–35% at 3.5 years in some series) following AVR and is associated with myocardial scarring. Whether excessive mortality is due to heart failure or arrhythmia is unknown, and the burden of ventricular arrhythmia after surgical AVR […]

Electrophysiology
Electrophysiology
112/Consult requests by emergency department (ED) or medical teams due to atrial fibrillation (AF) made to the cardiology ANP service: a review of the reliance on and compounding factors that reduce the accuracy of automated ECG software reports
P Stoneman (Presenting Author) – Beaumont Hospital, Dublin; F Colbert – Beaumont Hospital, Dublin; J Adams – Beaumont Hospital, Dublin; R Sheahan – Beaumont Hospital, Dublin

Aim: Within the 6-month prospective timeframe: 1. to determine the extent to which clinicians referring to the cardiology advanced nurse practitioner (ANP) service have relied on automated electrocardiogram (ECG) machine software reports to confirm or rule out the diagnosis of atrial fibrillation; 2. to determine the false-positive or false-negative rates of AF made by the […]

Atrial Fibrillation
Atrial Fibrillation
113/Left atrial appendage occlusion for atrial fibrillation and bleeding diathesis
BS Kailey (Presenting Author) – Imperial College London, London; M Koa-Wing – Imperial College Healthcare NHS Trust, London; N Sutaria – Imperial College Healthcare NHS Trust, London; T Mott – Abbott Healthcare, London; A Sohaib – Barts Healthcare NHS Trust, London; N Qureshi – Imperial College Healthcare NHS Trust, London; C Wadsworth – Imperial College Healthcare NHS Trust, London; S Jamil – Imperial College Healthcare NHS Trust, London; L D’Anna – Imperial College Healthcare NHS Trust, London; C Shi – Imperial College Healthcare NHS Trust, London; P Padam – Imperial College Healthcare NHS Trust, London; J Howard – Imperial College Healthcare NHS Trust, London; S Levy – Imperial College Healthcare NHS Trust, London; B Porter – Imperial College Healthcare NHS Trust, London; Z Whinnett – Imperial College Healthcare NHS Trust, London; N Linton – Imperial College Healthcare NHS Trust, London; B Lim – Imperial College Healthcare NHS Trust, London; N Peters – Imperial College Healthcare NHS Trust, London; FS Ng – Imperial College Healthcare NHS Trust, London; D Keene – Imperial College Healthcare NHS Trust, London; L Malcolme-Lawes – Imperial College Healthcare NHS Trust, London; D Lefroy – Imperial College Healthcare NHS Trust, London; G Cole – Imperial College Healthcare NHS Trust, London; P Asaria – Imperial College Healthcare NHS Trust, London; B Ariff – Imperial College Healthcare NHS Trust, London; D Gopalan – Imperial College Healthcare NHS Trust, London; A Varnava – Imperial College Healthcare NHS Trust, London; P Pabari – Imperial College Healthcare NHS Trust, London; B Rana – Imperial College Healthcare NHS Trust, London; P Kanagaratnam – Imperial College Healthcare NHS Trust, London

Introduction: Patients with atrial fibrillation (AF) and likelihood of bleeding can undergo left atrial appendage occlusion (LAAO) as an alternative method of stroke prophylaxis. A short course of anti-thrombotic drugs is used post-procedure to offset the risk of device-related thrombus, but evidence for this practice is limited. Methods: Patients with AF and high risk for […]

Atrial Fibrillation
Atrial Fibrillation
114/Adverse LA remodelling is needed to decrease success rates in obese patients with AF: a single-centre retrospective study on RECURrence of Atrial Fibrillation following first time ablation (RECUR-AF)
KZ Win (Presenting Author) – Queen Elizabeth Hospital Birmingham/University of Birmingham, Birmingham; MA Rauf – Queen Elizabeth Hospital Birmingham, Birmingham; I Shakeel – University of Birmingham, Birmingham; J De Bono – Queen Elizabeth Hospital Birmingham, Birmingham; M Lencioni – Queen Elizabeth Hospital Birmingham, Birmingham; H Marshall – Queen Elizabeth Hospital Birmingham, Birmingham; JN Townend – Queen Elizabeth Hospital Birmingham, Birmingham; R Steeds – Queen Elizabeth Hospital Birmingham, Birmingham; M Kalla – Queen Elizabeth Hospital Birmingham, Birmingham

Introduction: The outcome of atrial fibrillation (AF) ablation is suboptimal in overweight patients. This study reports the relationship of overweight patients and AF ablation outcome from a high-volume UK centre (>250 per year). Methods: The study population consisted of 283 patients (mean age 62 ± 11 years, 61% male) who underwent their first-time AF ablation […]

Atrial Fibrillation, Devices
Atrial Fibrillation, Devices
115/Conduction system pacing and AV node ablation – Glenfield stepwise approach for perfection
M Ibrahim – Glenfield, Leicester; I Koev (Presenting Author) – Glenfield, Leicester

Introduction: Pacemaker implantation and atrioventricular node (AVN) ablation is the last option for rate control of atrial fibrillation (AF) in patients unresponsive or intolerant to intensive rate and rhythm control and not eligible for rhythm control by pulmonary vein isolation (Class IIa indication in the European Society of Cardiology guidelines). Conduction system pacing is slowly […]

Arrhythmia
Arrhythmia
116/Substrate-based modification in ventricular tachycardia: ablation of the local abnormal ventricular activity only should we focus on LAVA? Learning from a case series
S Borov (Presenting Author) – CAU and Landshut Achdorf Hospital, Landshut; B Baldauf – CAU, Kiel; EW Lau – RVH, Belfast; M Giaccardi – Santa Maria Annunziata Hospital, Florence; H Bonnemeier – CAU and Helios Cuxhaven, Cuxhaven

Introduction: Local abnormal ventricular activities (LAVAs) are key targets for substrate-based ablation of ventricular tachycardia (VT). LAVAs are traditionally mapped with the ablation catheter. The distal electrode of the ablation catheter has to be large for effective lesion formation (whether by radiofrequency energy or cryothermia), but this is not conducive to high-definition mapping of low-amplitude […]

Arrhythmia
Arrhythmia
117/Single-centre retrospective evaluation of procedure time, fluoroscopy time and complication rates of conduction system pacing compared with traditional methods
P Veacock (Presenting Author) – Great Western Hospital, Swindon; MA Swift – Great Western Hospital, Swindon; P Foley – Great Western Hospital, Swindon; B Chandrasekaran – Great Western Hospital, Swindon; N Hadgraft – Manchester Metropolitan University, Manchester

Introduction: Physiological pacing is a new and innovative technique of activating the heart’s native conduction system via a pacing lead situated at the His bundle or left bundle branch first reported by Deshmukh et al. (2000). The technique was developed as an alternative to right ventricular pacing, which is known to cause ventricular dyssynchrony (Figure […]

Arrhythmia
Arrhythmia
118/Things that go ‘brady’ in the night
S Manjooran (Presenting Author) – Mid and South Essex, Chelmsford; A Jha (Presenting Author) – Mid and South Essex NHS Trust, Chelmsford; O Dhillon – Mid and South Essex NHS Trust, Chelmsford

A 28-year-old man who worked as a scaffolder had been waking up in the middle of night gasping for air and with a sensation of chocking. His 7-day Holter revealed a 16-second pause (p wave asystole) associated with his symptoms (Figure). He had been experiencing such nocturnal symptoms sporadically for several years, having first been […]

Atrial Fibrillation
Atrial Fibrillation
119/The long-term effect of thoracoscopic ablation on atrial fibrillation burden using continuous monitoring
R Dulai (Presenting Author) – East Sussex Healthcare NHS Trust, Eastbourne; C Sugihara – Maidstone and Tunbridge Wells NHS Trust, Maidstone; M Lewis – Royal Sussex County Hospital, Brighton; J Hyde – Royal Sussex County Hospital, Brighton; R Veasey – East Sussex Healthcare NHS Trust, Eastbourne; S Furniss – East Sussex Healthcare NHS Trust, Eastbourne; N Sulke – East Sussex Healthcare NHS Trust, Eastbourne

Introduction: There are limited long-term data using continuous monitoring to assess outcomes of thoracoscopic ablation in patients with paroxysmal atrial fibrillation (AF). This study evaluated the long-term outcomes of thoracoscopic AF ablation in patients with implantable cardiac devices, allowing long-term beat-to-beat monitoring. Methods: A total of 19 patients with paroxysmal AF (PAF) undergoing thoracoscopic ablation […]

Atrial Fibrillation
Atrial Fibrillation
120/Stridor and dyspnoea after atrial fibrillation catheter ablation: a case report
MM Gallagher (Presenting Author) – St George’s University Hospitals NHS Foundation Trust, London; Z Akhtar – St George’s University Hospitals NHS Foundation Trust, London; LWM Leung – St George’s University Hospitals NHS Foundation Trust, London; K Waleed – St George’s University Hospitals NHS Foundation Trust, London

Introduction: Catheter ablation for atrial fibrillation (AF) is safer than pharmacological alternatives but requires constant vigilance to maintain this safety. We present a case report of a patient who developed stridor and progressive dyspnoea in the hours after ablation for AF. Case report: A 74-year-old female with impaired ventricular function (ejection fraction 35%) underwent redo ablation […]

Atrial Fibrillation
Atrial Fibrillation
121/Temporal trends of catheter ablation for patients with atrial fibrillation: earlier is better
Y De Greef (Presenting Author) – ZNA Heart Center, Middelheim, Antwerp; M Wolf – ZNA Heart Center, Middelheim, Antwerp; B Schwagten – ZNA Heart Center, Middelheim, Antwerp; I Buysschaert – Cardiovascular Centre AZ St. Jan Bruges, Bruges

Background: Diagnosis-to-ablation time (DAT) of less than 1 year improves outcome and encourages earlier referral. The linear relation between DAT and outcome suggests that DATs of <1 year could further improve outcome. Aims: 1. To determine whether a linear relation persists and/or whether a threshold can be defined within a DAT of <1 year. 2. […]

Arrhythmia, Heart Failure
Arrhythmia, Heart Failure
122/Implementing a service to identify and manage patients with low biventricular pacing
BJ Jones (Presenting Author) – Barts Health NHS Trust, London; JR Ramplin – Barts Health NHS Trust, London; ZC Carter – Barts Health NHS Trust, London; NM Mark – Barts Health NHS Trust, London; PL Lloyd – Barts Health NHS Trust, London; BP Patel – Barts Health NHS Trust, London; SC Cowap – Barts Health NHS Trust, London; HG Granville – Barts Health NHS Trust, London; AM Muthumala – Barts Health NHS Trust, London

Introduction: Cardiac resynchronisation therapy (CRT) has proven to improve left ventricular function, symptoms and quality of life in patients with symptomatic heart failure. Its effectiveness is largely dependent on the percentage of biventricular pacing (BiVp%). This can be reduced by a number of factors such as atrial and ventricular dysrhythmias and device programming. Barts Health […]

Syncope
Syncope
123/Therapeutic options for syncope: a meta-analysis of blinded and unblinded randomised controlled trials
N Kaza (Presenting Author) – Imperial College London, London; M Sorbini – Imperial College London, London; M Dani – Imperial College London, London; P Taraborelli – Imperial College London, London; PB Lim – Imperial College London, London; D Francis – Imperial College London, London; MJ Shun-Shin – Imperial College London, London; D Keene – Imperial College London, London

Background: About 25% of the population suffers from syncope, and 8% of the population experience recurrent episodes, which can cause physical injury and psychological morbidity. Methods: We performed a meta-analysis of randomised trials of pacing, pharmacological and physical interventions for syncope. We assessed the effect of these therapeutic interventions on clinical syncope recurrence. We stratified […]

Electrophysiology
Electrophysiology
124/Evaluation of a novel, digitised pre-procedural assessment pathway
OR Riad (Presenting Author) – Royal Brompton Hospital, Guy’s and St Thomas’ NHS foundation trust, London; BM Moloce – Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London; AI Igra – Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London; JMB Behar – Guy’s and St Thomas’ NHS Foundation Trust, Department of Imaging Sciences and Biomedical Engineering, King’s College London, London

Aims: The pre-procedural assessment for elective procedures requires an important shared decision-making process and consent, which is a conversation about the procedure, benefits, risks and alternatives. The guidance from the General Medical Council highlights important steps clinicians should take to ensure patients have a comprehensive understanding of their forthcoming procedure. Handwritten consent forms are often […]

Arrhythmia, Devices
Arrhythmia, Devices
125/Complex device nurse-led VT clinic – a single-centre experience (OxVT)
R Imms (Presenting Author) – Oxford University Hospitals (OUH), Oxford; MJ Davies – OUH, Oxford; R Sumner – OUH, Oxford; J Cole – OUH, Oxford; K Rajappan – OUH, Oxford; MR Ginks – OUH, Oxford; J Ormerod – OUH, Oxford; J Gamble – OUH, Oxford; N Herring – OUH, Oxford; TR Betts – OUH, Oxford; Y Bashir – OUH, Oxford

Introduction: Patients with established implantable defibrillation devices (ICDs) are traditionally reviewed in routine ICD or complex device clinic as part of their ongoing surveillance. Advances in remote monitoring have led to a high frequency of automated alerts to life-threatening arrhythmias such as ventricular tachycardia (VT). This has driven demands in patient care to identify patients […]

Arrhythmia, Devices
Arrhythmia, Devices
126/The PADIT score and antibiotic decision making for patients undergoing cardiac implantable electronic device (CIEDs) procedures – time for a rethink?
PL Galaway (Presenting Author) – James Cook University Hospital, Middlesbrough; AJ Turley – James Cook University Hospital, Middlesbrough; JE Peal – Newcastle University Teaching Hospitals, Newcastle; S Mani – County Durham and Darlington NHS Foundation Trust, Darlington; S Watson – South Tyneside & Sunderland NHS Foundation Trust, Sunderland; SR Ali – Northumbria Healthcare Trust, Cramlington; F Ahmed – North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees; D Chan – Queen Elizabeth Hospital, Gateshead

Introduction: Infection of cardiac implantable electronic devices (CIEDs) poses considerable risk to patients in terms of morbidity and mortality. The recently published, independently validated Prevention of Arrhythmia Device Infection Trial (PADIT) score predicts infection risk at the time of the device procedure based on non-modifiable risk factors (higher score correlates to greater risk). The risk […]

Arrhythmia
Arrhythmia
127/Atrial tachycardia masquerading as inappropriate sinus tachycardia
I Koev (Presenting Author) – Glenfield, Leicester; P Stafford – Glenfield, Leicester; M Lazdam – Glenfield, Leicester

Introduction: A number of patients present with recurrent palpitations and documented tachycardia where the P wave morphology on electrocardiogram (ECG) is similar to sinus P wave, making it difficult to distinguish between sinus or atrial tachycardia. Case presentation: We present the case of a 22-year-old patient with incidental finding of incessant tachycardia and mild left […]

Arrhythmia, Devices
Arrhythmia, Devices
128/Service evaluation of the effectiveness and potential benefits of a mobile Kardia clinic for an NHS cardiology department
MCD Dale (Presenting Author) – Buckinghamshire Healthcare NHS Trust, High Wycombe

For years we have used ambulatory Holter monitoring to try and detect symptomatic arrhythmias in patients. However, many of these tests are ineffective when patient symptoms are less frequent than daily or even weekly. We have looked at a subgroup of patients suffering from infrequent palpitations and offered them a Kardia device for a 25-day […]

Arrhythmia, Devices
Arrhythmia, Devices
129/Taurolidine containing antimicrobial wash to prevent cardiac implantable electronic device infection
J Henke (Presenting Author) – CAU, Kiel; B Baldauf – CAU, Kiel; EW Lau – RVH, Belfast; H Pavacci – Lakumed, Landshut; J Dietl – Lakumed, Landshut; A Perani – Lakumed, Landshut; J Mehilli – Lakumed, Landshut; B Zrenner – TUM, Landshut; M Giaccardi – Santa Maria Annunziata Hospital, Florence; H Bonnemeier – CAU and Helios Cuxhaven, Cuxhaven; R Vonthein – IMBS, Luebeck; S Borov – CAU and Lakumed, Landshut

Background: Cardiac implantable electronic device (CIED) infection has risen faster than the volume of procedures. Many measures against CIED infection have been tried, but only peri-operative antibiotics and an antibiotic-eluting envelope have proved effective. Taurolidine is a long-established antimicrobial agent with a wide range of chemical activities and biological effects. The effectiveness of a taurolidine-containing […]

Arrhythmia, Devices
Arrhythmia, Devices
130/Arrhythmia Alliance and Mended Hearts Survey – to highlight patient understanding of the risk of device infection
T Lobban – Arrhythmia Alliance, Stratford-upon-Avon; A Bauer – The Mended Hearts, Inc, Albany, Georgia

Background: Survey undertaken to assess the level of patients and carer understanding of CIED device infection. Cardiac implantable electronic devices (CIEDs) continuously monitor heart rhythm. The device can slow or increase the heart rhythm and can shock it back into normal rhythm when a potentially fatal arrhythmia is detected. CIEDs are life-saving medical devices. By […]

Paediatric

Arrhythmia
Arrhythmia
131/Late presentation of Wolff–Parkinson–White syndrome in children with previously normal electrocardiogram (ECG) – a case series
M Ravichandran (Presenting Author) – Department of Paediatric Cardiology, University Hospital of Wales, Cardiff; A Wong – Department of Paediatric Cardiology, University Hospital of Wales, Cardiff; O Uzun – Department of Paediatric Cardiology, University Hospital of Wales, Cardiff

Introduction: Wolff–Parkinson–White (WPW) syndrome is an important cause of arrhythmias in children. Despite having significant evidence and guidelines on diagnosis and management of this condition, it still proves enigmatic. We discuss here three cases with late manifestations of WPW syndrome that were not evident on previous electrocardiograms (ECGs), Holter and exercise tests. Case 1: A […]

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