O220Percutaneous Left Ventricular Assist in Ischaemic Cardiac Arrest

V. Tuseth1, M Salem, R Pettersen, S Rotevatn, K Grong, JE Nordrehaug . 1Department ofHeart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 2Department ofHeart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 3Department ofHeart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 4Department ofHeart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 5Department forSurgical Sciences, University of Bergen, Haukeland University Hospital, N-5021 Bergen,Norway. 6Department of Heart Disease, Haukeland University Hospital, Institute ofMedicine.-5021 Bergen, Norway.

Background: Ischemic cardiac arrest represents a challenge for optimal emergency revascu-larization. A percutaneous left ventricular assist device (LVAD) may help support circulationduring percutaneous coronary intervention (PCI) and could improve clinical outcomes. Such adevice could help maintain systemic blood delivery during cardiopulmonary resuscitation (CPR)and may also facilitate PCI by allowing short-term interruption of chest compression with lessdetrimental consequences. We investigated the ability of a percutaneous transfemoral leftventricular assist device (Recover LP 2,5®; Abiomed, Aachen, Germany) to deliver blood to thesystemic circulation during cardiac arrest, and randomized two groups to receive eitherconventional or intensive fluid infusion to evaluate the effect of increased right side filling onpump function. Methods and Results: The study was an acute experimental trial with pigsunder general anaesthesia. Farm pigs (n!16) of both sexes had LVAD support duringventricular fibrillation (VF) and were randomized to conventional or intensive fluid. Afterrandomisation for fluid infusion VF was induced by balloon occlusion of the proximal leftanterior descending artery. LVAD and fluid was started after VF had been induced. Brain, kidneyand myocardial tissue perfusion, and cardiac index, were measured with microsphere injectiontechnique at baseline, 3 and 15 minutes. Additional hemodynamic monitoring continued for atmost 30 minutes. Mean cardiac index at 3 minutes of VF was 1.2 L.min/m2 (28% of baseline).Compared to baseline; mean perfusion at 3 minutes was 65% in the brain and 74% in theepicardial myocardium supplied by the open left circumflex artery suggesting possibleautoregulation augmenting the proportion of flow to these organs. A moderate but nonsignificant decline was seen at 15 minutes. At 30 minutes LVAD function above 30% of theinitial value after induction of VF was sustained in 11 animals (8/8 intensified fluid vs 3/8conventional fluid) and was associated with intensified fluid loading (P"0.001). Conclusions:During VF a percutaneous LVAD may assist systemic circulation with potential preferential flowto vital organs. Intensified fluid loading may be beneficial for LVAD performance. This approachmay improve clinical and technical results in PCI during cardiac arrest. Further investigation isneeded to establish a potential clinical benefit.

O221The microvascular rheology of ultrasound contrast in ischemia-reperfusioninjury, diabetes and sepsis

A. Camarozano1, F Cyrino2, E Bouskela2, A Siqueira-Filho1, K Camarozano3, R Noe1.1Federal University of Rio de Janeiro 2Estadual University of Rio de Janeiro 3Universty ofABC Fundation

Purpose: There has been much debate on the adhesion of microspheres to the leukocytes ininflammatory tissue, however, little is known about their behavior in the capillaries. Evaluationof the circulatory effects of this agent may explain its effect on the myocardium. Aim: toevaluate the microvascular and hemodynamic behavior of the microspheres in the followingsub-groups: ischemia-reperfusion, type-2 diabetes, diabetes with ischemia and sepsis.Method: an experimental study of the micro-circulation in 65 male hamsters’ cheek poucheswas done. The animals were divided into groups according to induction of disease:GC!control; GIR!ischemia/reperfusion; GD!diabetes; GDI!diabetes with ischemia; andGS!sepsis. We analyzed arterial blood pressure (BP), heart rate (HR), blood flow (BF) andreology, according to mean leukocyte response of three capillaries at each time point(AL!adhered leukocytes, RL!rolling leukocytes), and DV!vein diameter, at baseline, after 60minutes intervention and the post to pre delta(#). During the procedure we administered:Definity(D), a lipid coated microsphere containing perfluoropropane gas, or a placebo(P).Mann-Whitney test was used for comparisons, with significance level set at 5%. Results: thediabetic hamsters presented greater weight while the septic animals showed a worsening ofgeneral condition with higher mortality. The number of AL and RL was higher in the pre andpost in GDI (mainly RL) and GS (mainly AL) compared to GC and GIR (p"0,05). There was nodifference in VD, AL, RL, and # with or without microspheres in the different groups. There wasalso no difference in BP and HR before and after Definity(NS) and BF was subjectively worsein GS. The mortality was significantly higher in GS. Conclusion: The inflammatory responseseemed to be higher in GDI and GS, independent of microsphere-Definity usage. Reology andhemodynamics showed no alteration with this agent. These findings may be important toestablish the safety level when using contrast for ultrasound.

O222Imaging of coronary artery fistulas by multidetector computed tomography:Is Multidetector computed tomography sensitive?

F. Kacmaz1, N. Isiksalan Ozbulbul2, O. Alyan3, O. Maden4, A.D. Demir4, R. Atak4, A.R.Erbay4, Y. Balbay4, T. Olcer2, E. Ilkay5. 1Bingol State Hospital, Department of Cardiology,Bingol, TURKEY 2Turkiye Yuksek Ihtisas Hospital,Department of Radiology, Ankara, TURKEY3Dicle University, Department of Cardiology, Diyarbakir, TURKEY 4Turkiye Yuksek IhtisasHospital,Department of Cardiology, Ankara, TURKEY 5Mesa Hospital, Department ofCardiology, Ankara, TURKEY

Background: Coronary artery fistula (CAF) is a rare anomaly in which a communication ispresent between a coronary arteries and either a cardiac chambers or another vascular

structures. It is observed in 0.3% to 0.8% of patients who underwent coronary angiography.Coronary angiography is gold standart for diagnosis of coronary artery fistulas (CAFs).Multidetector computed tomography(MDCT) is a recently developed imaging technique todetect coronary artery stenosis, coronary artery anomalies and coronary artery fistulas and theircourses. Objective: We aimed to discribe diagnostic sensitivity of MDCT in a series of 13patients with 15 coronary artery fistulas. This is first study as well as we know in currentliterature.We aimed to determine accuracy or sensitivity of MDCT in patients having CAF.Method: Between June 2005 and June 2006 a total of 7854 consecutive patients underwentcoronary angiography and 13 patients were incidentally found to have coronary artery fistulas.All patients were informed clearly about study orally and study was started after obtainingapproval of patients whose gave written informed consent and the study protocol was approvedby the institutional review board. To detection sensitivity of MDCT, the results of MDCT wereevaluated by two experienced radiologist and one cardiologist who were unaware about studyprotocol. Finally, we determined diagnostic sensitivity of MDCT in patients had coronary arteryfistula detected by coronary angiography before. Results: Thirteen patients (8 men, 5 women;age ranged 31–78) had CAFs detected by coronary angiography before were evaulated. Allpatients had sinus rhythm. In present study 12 of 15 (80%) CAFs were originated from leftcoronary artery system. CAFs were originated from right coronary artery(RCA) in remain. Elevenof 15 CAFs were shown on MDCT and the overall sensitivity of MDCT was found 73%. Sevenof 8 CAFs that coursing between two vascular structures were detected and the sensitivity ofMDCT in these group was found 87%. However, the sensitivity of 58% of MDCT in patients withfistula coursing between coronary arteries and cardiac chambers was found. Conclusion:Although coronary angiography is gold standart diagnostic test for detection CAF, MDCT maybe alternative test especially, CAF coursing between vascular structures to detect origin, courseand drainage site of fistula via its excellent spatial resolution and ability to show relationshipof anatomic structures. Key words: coronary artery fistula, coronary angiography, multidetectorcomputed tomography

O224Biventricular Pacing Using Conventional Dual-Chamber Pacemakers inPatients with Permanent Atrial Fibrillation and Heart Block

S. Pinski1, B Kuo1, F Arnaldo1, M Helguera1. 1Cleveland Clinic Florida

Background: Biventricular pacing is an attractive option in patients with heart block,permanent atrial fibrillation, and congestive heart failure. However, the atrial channel is“wasted” when using resynchronization pacemakers in patients with chronic AF. Objective: Wepropose that properly adapted and programmed conventional dual-chamber pacemakers(DCPM) are safe and cost-effective for these patients. Methods: DCPM were used in patientswith permanent AF and indication for biventricular pacing. Patients underwent complete AVnodal ablation followed by “modified” DCPM implantation. The left ventricular (LV) lead wasconnected to the atrial port and the right ventricular (RV) lead to the ventricular port.Programming was DDIR with the shortest available AV delay (10 ms in Guidant, 30 ms inMedtronic pacemakers), resulting in biventricular stimulation with the LV preceding the RV.Sensitivity was decreased in the LV channel (2.5 mV or above), to prevent oversensing of Twaves or far-field atrial signals. Results: Twenty-one patients (11 men, age 80 $ 8) werefitted with DCPM as described, 5 patients were upgrades from single-chamber RV pacing.During the follow up 1 patient had dislodgement of the RV lead to the RA shortly after implant,with intermittent pacing inhibition. His DCPM was reprogrammed AAI ( LV pacing alone) untilthe lead was repositioned. Twenty patients remained alive during a follow-up of 18 $ 12months. All DCPM worked as intended, providing close to 100% biventricular pacing. Nopacemaker-mediated arrhythmias were observed. The estimated cost-saving was $4300 percase as compared with conventional resynchronization pacemakers. Conclusion: Conventionaldual-chamber pacemakers provide reliable biventricular pacing in patients with permanent AFat significant cost-savings. Manufacturers could easily modify their existing platforms tocommercialize dedicated resynchronization pacemakers for this indication.

O225Alarming prevalence of metabolic risk for cardiovascular diseases in aphysician population of southern India

A Mathavan1, A Chockalingam2, S Chockalingam3, B Bilchik4, V Saini4. 1ApolloHospital,Madurai, Tamilnadu, India 2Simon Fraser University,Vancouver, Canada 3SomayyaFoundation,Karaikudi, Tamilnadu, India 4Harvard School of Public Health and the LownCardiovascular Research Foundation, Boston, MA, USA.

In the past decade we have observed an increasing incidence of cardiovascular disease (CVD)among people living in the southern districts of Tamilnadu, India. Metabolic syndrome has beenincreasingly recognized as a major risk factor for CVD and stroke in South Asian populations.In order to evaluate the prevalence of constituent elements of the metabolic syndrome amonga well-educated and high-income sector of the population, we conducted a cross-sectionalsurvey of physicians living in and around Madurai, a major metropolis. We contacted over 4,000physicians in the districts of Madurai, Sivaganga, Virudhunagar, Dindugal, Karur, Ramanatha-puram, Thirunelveli and Theni. The population of these 8 districts is about 16 million. 1,514physicians between the ages of 30–81 responded, completed questionnaires provided bloodpressure measurements and fasting blood samples. All samples were assessed in a centrallaboratory in Madurai where quality control was maintained. Blood pressures were measuredusing a WHO approved automatic monitor. Complete data were available for a total of 1,433(942 M and 491 F) physicians and were used in our analysis. 94% of the participants earnedtheir University 5-year medical degree or further post graduation and 6% obtained indigenousmedical qualifications such as ‘ayurvedhic’ or ‘siddha’. All of them reported a monthly incomein the highest quintile of the population in this region. Thus this cohort of participants belongsto a high socioeconomic stratum of the society. The prevalence of risk factors in this populationare: BP (% 130/% 85 mmHg): 22.5% F, 41.2%M; HDL-C (F " 50 & M " 40 mg/dl): 75.6%F, 46.8% M; Triglycerides (% 150 mg/dl): 32.6% F, 53.2% M; FBG using ATP III criteria (% 110

2008 World Congress of Cardiology Abstracts e459

by guest on March 17, 2014http://circ.ahajournals.org/Downloaded from