P5-40

GENDER-RELATED DIFFERENCES IN CLINICALCHARACTERISTICS OF PATIENTS WITH CONGESTIVE HEARTFAILURE. DATA FROM THE ALPHA STUDY REGISTRYMassimo Tritto, MD, Elisa Favro, MD, Giacinto Pettinati,MD, Enrico Barbieri, MD, Giosue Mascioli, MD, ValentinaConti, MD, Miriam Revera, MD, Simona Sarzi Braga, MD,Giorgio Bartesaghi, MD, Catherine Klersy, MD, *LucianoSallusti and Jorge A. Salerno-Uriarte, MD. University ofInsubria, Clinical Institute Mater Domini, Castellanza (VA),Italy, University of Torino, San G.Battista Hospital, Torino,Italy, F. Ferrari Hospital, Casarano (LE), Italy, Sacro CuoreHospital, Negrar, Italy, University of Brescia, Spedali CiviliHospital, Brescia, Italy, University of Piemonte Orientale,Maggiore Hospital, Novara, Italy, University of Pavia,IRCCS San Matteo Hospital, Pavia, Italy, IRCCS SalvatoreMaugeri Foundation, Scientific Institute, Tradate (VA), Italy,University of Insubria, Circolo Hospital and MacchiFoundation, Varese, Italy and Guidant Italia, Milano, Italy.

Few information are available about gender-related differences amongpatients affected by congestive heart failure (CHF). In addition, data aboutthis topic are usually derived from clinical trials and not from routine dailypractice. Aim of the present analysis is to assess the influence of gender onthe main clinical and demographic characteristics of patients with CHF,evaluated in 9 centers in Italy and included in the registry of the ALPHA(T-wave Alternans in Patients with Heart fAilure) study, a trial aimed toanalyze the prognostic value of T-wave alternans in CHF of non ischemicetiology. The ALPHA study registry included 3513 consecutive outpa-tients: 29% females; age 67�13 years; echocardiography LVEF 34�10 %;QRS duration � 120 ms 47%; NYHA class I-IV were 9, 56, 29 and 6%respectively; 46% were affected by coronary artery disease, 26% haddilated and 15% hypertensive cardiomyopathy, 10% valvular heart diseaseand 11% CHF of different etiologies. We compared main clinical anddemographic characteristics of women and men; results are summarized inthe following table.

In this outpatient population, which is representative of patients with heartfailure in routine daily practice, significant differences were related togender: women were older than men, presented more frequently a non-ischemic etiology of CHF and a greater functional impairment according toNYHA class; moreover women had an higher LVEF, suggesting an higherproportion of CHF related to left ventricular diastolic dysfunction. Thesedifferences may have relevant clinical implications in prognostic andtherapeutic scenarios of CHF.

P5-41

DELAYED CONTRAST ENHANCEMENT ON MAGNETICRESONANCE IMAGES IS ASSOCIATED WITH CONDUCTIONSLOWING IN PATIENTS WITH HYPERTROPHICCARDIOMYOPATHYW. Haverkamp, Jeantette Schulz-Menger and Rainer Dietz.Charite - Campus Virchow Clinic, Berlin, Germany andCharite, Berlin, Germany.

In patients with hypertrophic cardiomyopathy (HCM), fibrotic lesions inthe myocardium exhibit delayed contrast enhancement (DCE) on magnetic

resonance images (MRI). It was the aim of our study to assess, whetherDCE is associated with conduction slowing as detected by the surfaceelectrocardiogram (ECG) (prolongation of the QRS complex, slurring ofQRS up- or downstroke).Methods: We studied 11 patients (mean age 53 �/- 15 years, 9 males) withHCM who had undergone MRI. The relationship of DCE to changes inQRS complex duration and morphology on the standard 12-lead ECG wasfurther investigated. Eleven normal subjects served as controls.Results: DCE occurred in 8 (73%) patients with HCM (mean 6�/-5% ofleft ventricular mass, 0.8 - 16.6%) and none of the controls. Patients withDCE had a significant greater QRS complex duration than normals(102�/-8 ms vs. 91�/-9 ms, p�0.001). Furthermore, QRS was longer inpatients with (111�/-10 ms) than without DCE ( 99�/-6 ms, p� 0.001).Slurring of QRS was more often observed in patients with than withoutDCE (2.4�/-2.2 vs. 1.3�/-0.6 leads).Conclusion: In patients with HCM, DCE on MRI is associated withmyocardial conduction slowing. Further investigations are required todetermine the role of DCE is arrhythmogenesis in HCM.

P5-42

INFLAMMATION AND MARKERS OF THROMBOEMBOLIC RISKON TRANSOESOPHAGEAL ECHOCARDIOGRAPHY IN ATRIALFIBRILLATIONCinzia Cianfrocca, MD, Maria Luisa Loricchio, MD,Vincenzo Pasceri, MD, PhD, Antonio Auriti, MD, SabinaFicili, MD, Leopoldo Bianconi, MD, Marco Galeazzi, MD,Vincenzo Guido, MD, Ermenegildo De Ruvo, MD, LeonardoCalo’, MD and Massimo Santini, MD. San Filippo NeriHospital, Rome, Italy.

Studies have suggested a relationship between inflammation and thrombo-sis in several clinical conditions. However, there are limited data on thepossible association between inflammation and markers of thromboem-bolic risk on transoesophageal echocardiography (TEE) in patients withatrial fibrillation (AF). Thus, we assessed C-reactive protein levels in atotal of 70 consecutive patients with non-valvular AF lasting �48 hoursundergoing TEE. Patients were divided into two groups according topresence (n�22) or absence (n�48) of dense spontaneous echo contrast(SES) in left atrium or left atrial appendage, assessed by TEE. Dense SECwas not related to age, sex, main risk factors, fibrinogen or D-dimer levels,however patients with dense SEC had lower peak left atrial appendagevelocity at TEE (0.38�0.21 vs 0.55�0.21 m/sec, P�0.009). High CRPlevels (�3 mg/L) were also significantly associated with dense SEC.Multivariate analysis showed that only peak left atrial appendage velocityand CRP were significantly associated with dense SEC, with an odds ratioof 4.1 (95% confidence interval 1.3-13) for CRP and 3.9 (95% confidenceinterval 1.3-12) for peak leaft atrial appendage velocity. Interestingly, CRPlevels were not related to peak velocity, suggesting that these two markersmay identify two different components of thromboembolic risk (inflam-mation and stasis) In conclusion, our result suggest that both inflammationand stasis play a role in the pathogenesis of thromboembolism in atrialfibrillation.

P5-43

ARRHYTHMOGENIC EPILEPSY: AN UNUSUAL PRESENTATIONOF RECURRENT UNEXPLAINED SYNCOPEClaude Kouakam, MD, Christine Daems-Monpeurt, MD,Laurence Guedon-Moreau, MD, Dominique Lacroix, MD,Philippe Derambure, MD and Salem Kacet, MD. LilleUniversity Hospital, Lille, France.

Background: Despite thorough investigation, approximately 15 to 20% ofsyncope (S) cases remain unexplained. An under-recognized cause of Smay occur when epileptic discharges profoundly disrupt the normal cardiacrhythm, the so-called arrhythmogenic epilepsy (AE). We report 8 cases ofAE ascertained by simultaneous prolonged video electroencephalographic(EEG) and electrocardiographic (ECG) monitoring.

S267Poster 5

Methods and Results: Eight patients with a history of recurrent unex-plained abrupt and/or convulsive S underwent complete cardiologic (in-cluding 24-hour Holter ECG, echocardiography, tilt testing and EP study in4 patients) and neurologic assessment (including standard EEG, CT andMRI scan). After evaluation, neurocardiogenic S was suspected in 6 pa-tients with tilt-induced hypotension and/or bradycardia. Further evaluationconsisting of video EEG/ECG was undertaken because of discordancebetween tilt-induced and spontaneous symptoms. While monitored in theneurophysiology lab, S recurred in all patients. An asystolic pause pre-ceded by partial seizure of temporal onset, reproducing clinical symptoms,was documented in all patients. Six patients were successfully managed byantiepileptic drugs (AED), and 2 were refractory to AED and requiredpacemaker implantation. All the patients had no recurrent S during a meanfollow-up of 40 � 18 months (range 65 to 4 months). The table summa-rizes the results.Conclusion: In patients with recurrent unexplained convulsive and/or trau-matic S, arrhythmogenic epilepsy should be considered as a possibleetiology.

P5-44

LIMITED DOSE-EFFECT RELATIONSHIP OF ADENOSINE FORDETECTION OF AV NODAL DUALITY IN PATIENTS WITHSUPRAVENTRICULAR TACHYCARDIASChristiana Schernthaner, MD, Maximilian Pichler, MD andBernhard Strohmer, MD. Salzburger Landeskliniken,Paracelsus Private Medical University, Salzburg, Austria.

Aim: The purpose of the study was to test the dose-effect relationship ofadenosine for the diagnosis of dual AV nodal physiology in patients (pts)presenting with supraventricular tachycardia (SVT).Methods: Adenosine was injected as bolus (incremental dosage 6 - 12 - 18mg) during sinus rhythm at rest in order to unmask dual AV nodalphysiology by a PR jump �50 ms on surface ECG (25 mm/sec). The studypopulation consisted of 57 pts (23 men, 34 women, age 50�14 y) whopresented with palpitations and/or syncope related to SVT (ECG availablein N�41).Results: Adenosine was tolerated without adverse events. The drug trig-gered SVT in 4 pts, but in none of the cases atrial fibrillation. EP study andablation was performed in 37 pts out of the drug-tested group. AV nodalreentrant tachycardia (AVNRT) was diagnosed in 33 pts (age 50�13 y,186�22 bpm) and atrioventricular reentrant tachycardia (AVRT) in 4 pts(age 31�10 y, 194�21 bpm). In the AVNRT group 27 pts demonstrateda significant PR jump (98�33 ms), and only 6 subjects showed no jump.A significant PR jump was noted after injection of 6 mg (N�15, 95�38ms) or 12 mg (N�16, 83�43 ms), but not after 18 mg (N�2, 30�14 ms)adenosine. Provocation of temporary AV block I was associated with thelongest increment of PR interval (N�11, 106�36 ms), and also during AVblock II all PR jumps were indicative for dual AV nodal physiology(N�10, 92�25 ms). However, induction of AV block III was less valuablein unmasking AV nodal duality (N�10, 66�48 ms). None of the 4 pts withAVRT demonstrated a PR jump �50 ms with high grade AV block after6-12 mg adenosine.Conclusion: Adenosine bedside test is safe and useful for detection of dualAV nodal physiology related to AVNRT with a high sensitivity 82% andspecificity 100%. The PPV of 100% may be helpful for patient educationand set-up of EPS. The data suggest that 6 to 12 mg of adenosine aresufficient for selective blockade of the fast pathway in most patients,typically resulting in AV block I on surface ECG. However, lack of PR

jump after adenosine (NPV � 40%) leaves the diagnosis open to invasivestudy, especially in young subjects with a high likelihood for AVRT orenhanced AV nodal conductivity.

P5-45

LONE ATRIAL FIBRILLATION AND ATRIAL FIBRILLATIONWITH HYPERTENSION ARE PRECURSORS OF OVERT HEARTFAILUREPatrick T. Ellinor, MD, PhD, Adrian F. Low, MD, Edwin G.Nam, BSc, Marisa A. Shea, BS and Calum A. Macrae, MD,PhD. Massachusetts General Hospital, Boston, MA.

Introduction: Atrial fibrillation (AF) and heart failure (HF) are each riskfactors for the other. Alterations in the natriuretic peptide axis are wellrecognized in overt HF, and we recently identified elevations of nt-proBNPin lone AF (LAF). We sought to determine whether known markers of HFwere altered in subjects with AF and hypertension (AF/HTN) withoutevidence of structural heart disease.Methods: Serial patients evaluated by the arrhythmia service with LAF orAF/HTN were enrolled between 6/01 and 8/04. Study subjects had elec-trocardiographic evidence of AF, a structurally normal heart on echocar-diography and an age less than 66 years. Controls were recruited from ahealthy outpatient population. Subjects underwent a standardized inter-view; an electrocardiogram, echocardiogram and blood sample were ob-tained. Plasma proANP, nt-proBNP and apelin-12 levels were determinedusing commercially available immunoassays.Results: 150 subjects with LAF, 54 subjects with AF/HTN and 75 controlswere enrolled during the study period. Subjects with AF/HTN were oldercompared to subjects with LAF (61.0 � 9.6 vs. 53.8 � 10.7 years). Thereis a significant difference in the level of nt-proBNP between controls andsubjects with lone AF (144 v 187, p�0.0003), HTN & AF and controls(595 v 144, p�0.00005), and between subjects with HTN & AF and loneAF (595 v 187, p�0.00005), (Fig 1A). Additionally, there is a significantdifference in the level of apelin-12 between controls and subjects with LAF(645 v 307, p�0.00005), AF/HTN and controls (645 v 426, p�0.00005),and no difference between subjects with AF/HTN and those with LAF (426v 307, p�0.97), (Fig 1B).Conclusions: A stepwise increase in nt-proBNP was observed noted be-tween controls, subjects with LAF, and AF/HTN, that re-iterates the inti-mate relationship between atrial fibrillation, hypertension and heart failure.

P5-46

PROLONGED ATRIAL ACTIVATION TIME AS DETERMINED BYTISSUE DOPPLER ECHOCARDIOGRAPHY IS ASSOCIATED WITHRECURRENCE OF ATRIAL FIBRILLATION AFTER ASUCCESSFUL CARDIOVERSIONKlaartje L. Merckx, MD, Cees B. De Vos, MS, Bas Beckers,MD, Andrea Palmans, BSc, Jos Habets, BSc, Emile C.Cheriex, MD, PhD, Harry J. G. M. Crijns, MD, PhD andRobert G. Tieleman, MD, PhD. University HospitalMaastricht, Maastricht, Netherlands.

Background: Atrial Fibrillation (AF) is a very common arrhythmia. Initialtherapy for AF is often directed towards restoration of sinus rhythm (SR)by means of electrical cardioversion (ECV). Recurrence of AF after ECVis not uncommon. Multivariate analyses have demonstrated that age, ar-rhythmia duration, atrial size, and ejection fraction are all factors related torecurrences of AF. Recently we validated a new echocardiographic tech-nique using tissue Doppler imaging (TDI) for determination of the totalatrial activation time. In the present study we evaluated the value of this

S268 Heart Rhythm, Vol 2, No 5, May Supplement 2005