Description: Aim To assess the feasibility of administering Patient Reported Outcomes Measures (PROMs) in patients treated with ablation for cardiac arrhythmias, and to conduct the first stage of development and testing of a new PROM tool. Methods and results A new tool was developed by a multidisciplinary team and tested alongside an adaptation of the patient perception of arrhythmia questionnaire (PPAQ) and EQ-5D-5L in a multicentre retrospective audit involving 791 consecutive cardiac arrhythmia patients treated with catheter ablation at three UK centres over 13 months. Data were recorded in the National Cardiac Rhythm Management Database, part of the National Institute for Cardiovascular Outcomes Research. The response rate was 71.9% ( n = 569). Patients reported significant improvements across all outcomes and impacts, with reductions in symptoms of 51.7% (heart racing), 33.9% (fatigue) 31.8% (heart flutters), 43.5% (dizziness), 38.6% (breathlessness), 44.2% (chest pressure), 33.1% (trouble concentrating), 15.9% (headache), 28.3% (neck pressure), and 23.4% (fainting) ( P 〈 0.001). The mean number of social days affected reduced by 7.49 days/month ( P 〈 0.001); mean work/school days affected/month reduced by 6.26 ( P 〈 0.001); mean GP/hospital visits reduced by 1.36 days/month ( P 〈 0.001). The procedure met patient expectations in 72% of responders. Conclusions The high response rate suggests that the use of PROMs in this patient group is feasible, with rates equalling those of the National PROMs Programme. The results showed that patients experienced significant improvements in their quality of life following ablation, while feedback allowed the tools to be improved. Further work is required to validate these tools; however, the findings suggest that PROMs could be useful in the audit of ablation techniques.

Description: Aims The clinical response to cardiac resynchronization therapy (CRT) is variable. Multipoint left ventricular (LV) pacing could achieve more effective haemodynamic response than single-point LV pacing. Deployment of an LV lead over myocardial scar is associated with a poor haemodynamic response to and clinical outcome of CRT. We sought to determine whether the acute haemodynamic response to CRT using three-pole LV multipoint pacing (CRT 3P-MPP ) is superior to that to conventional CRT using single-site LV pacing (CRT SP ) in patients with ischaemic cardiomyopathy and an LV free wall scar. Methods and results Sixteen patients with ischaemic cardiomyopathy [aged 72.6 ± 7.7 years (mean ± SD), 81.3% male, QRS: 146.0 ± 14.2 ms, LBBB in 14 (87.5%)] in whom the LV lead was intentionally deployed straddling an LV free wall scar (assessed using cardiac magnetic resonance), underwent assessment of LV + dP/dt max during CRT 3P-MPP and CRT SP . Interindividually, the LV + dP/dt max in relation to AAI pacing with CRT 3P-MPP (6.2 ± 13.3%) was higher than with basal and mid CRT SP (both P 〈 0.001), but similar to apical CRT SP . Intraindividually, significant differences in the LV + dP/dt max to optimal and worst pacing configurations were observed in 10 (62.5%) patients. Of the 8 patients who responded to at least one configuration, CRT 3P-MPP was optimal in 5 (62.5%) and apical CRT SP was optimal in 3 (37.5%) ( P = 0.0047). Conclusions In terms of acute haemodynamic response, CRT 3P-MPP was comparable an apical CRT SP and superior to basal and distal CRT SP . In the absence of within-device haemodynamic optimization, CRT 3P-MPP may offer a haemodynamic advantage over a fixed CRT SP configuration.