B-PO04-153 SUBTLE REPOLARIZATION ABNORMALITIES IN IDIOPATHIC VENTRICULAR FIBRILLATION ARE UNCOVERED BY NONINVASIVE ELECTROCARDIOGRAPHIC IMAGING, BUT NOT THE 12-LEAD ELECTROCARDIOGRAM

Abstract

were either on Dual Antiplatelet Therapy (DAPT) or not on any anticoagulation preoperatively and all 4 of these were discharged on DAPT. Total time in the procedure room was 67 (622) minutes with 51(622) minutes of anesthesia time. A single device was used in 92% (n511). The mean LAA maximum size was 19 (63) mm with least device compression 20% (69). There were no complications. No patients had a peri-device leak at implant. One patient refused TEE at follow up. At follow-up imaging at least 45 days later there were no leaks .5mm with 91% (10/11) having no leak and 1 patient having a 4mm leak. Conclusion: Zero fluoroscopy TEE guided Watchman FLX implantation is feasible and safe with no perceptible decrease in efficiency. Background: The spatial ventricular gradient (SVG) is a vectorcardiographic measure of global electrical heterogeneity that has been associated with sudden cardiac death (SCD) in the general population. The association between SVG and inducibility of ventricular tachycardia (VT) or ventricular fibrillation (VF) during electrophysiology study (EPS) is unknown. Objective: To test the association between SVG and inducible VT/VF during EPS. Methods: We performed a retrospective study of patients presenting for EPS for evaluation of syncope or risk stratification of SCD prior to primary prevention ICD implantation between 6/2016-12/2020. 12-lead ECGs prior to EPS were converted to vectorcardiograms, and SVG magnitude, azimuth (direction in the XZ transverse plane), and elevation (direction in the XY frontal plane) were calculated. SVG components were dichotomized above and below their median values. Variables were compared with the t-test except for SVG azimuth (a circular variable), which was compared with the Mardia-Watson-Wheeler test. The odds of inducible VT/VF were regressed using a logistic model. Results: Among 100 patients presenting for EPS (mean age 65.5 6 12.1 y, 77% male, mean LVEF 46 6 12 %), 20 had inducible VT/VF. Patients with inducible VT/VF had lower LVEF (40 6 8 vs. 48 6 12 %, p50.017) and more posteriorly directed SVG azimuth (25.3 vs. 15.2 deg, p50.01) than those who were non-inducible. Unadjusted logistic regression demonstrated that the OR for inducible VT/VF was 3.86 (95% CI 1.28-11.64, p50.017) for SVG magnitude , 41.2 mv*ms and 8.07 (95% CI 2.19-29.78, p50.002) for absolute SVG azimuth. 46.6 deg. SVG elevation, QRS duration, and QT interval were not associated with VT/VF. After adjustment for age, gender, LVEF, and prior MI, both SVG magnitude and absolute azimuth remained significantly associated with inducible VT/VF: adjusted OR for inducible VT/VF was 6.66 (95% C1.82-24.43, p50.004) for SVG magnitude , 41.2 mv*ms and 7.53 (95% CI 1.81-31.35, p50.005) for absolute SVG azimuth. 46.6 deg. Conclusion: Smaller SVG magnitude and more extreme anterior or posterior SVG azimuth are associated with inducible VT/VF. SVG warrants prospective studies for risk stratification in patients undergoing EPS.