Purpose: To study cardiac structural and functional abnormalities some 20 years after initial treatment in a sample of adolescent-onset anorexia nervosa (A-AN) and to compare them with matched healthy controls (HC). Methods: A sample of 29 women diagnosed and treated for AN during adolescence (A-AN) were assessed more than 20 years later. A complete cardiac evaluation was carried out including an electrocardiogram (ECG) and a standard 2D echocardiography. Thirty matched HC were also assessed. Results: In the A-AN group, four subjects had a body mass index lower than 18.5 and met full DSM 5 criteria for AN at follow-up (Low-Weight group). They were compared with the rest of the sample (n=25) who had normalized their weight (Normal-Weight group), though some still showed some eating disorder symptoms. Both groups were compared with the HC group. Subjects in the Low-Weight group presented statistically significant decreases in the left ventricular end-diastolic and left atrium dimensions and left ventricular mass in comparison with the Normal-Weight group and the HC. No other differences in cardiac parameters were found between groups. Conclusions Echocardiographic and ECG parameters of adults who had presented A-AN twenty years earlier and currently maintained normal weight were similar to those of HC who had never been treated or diagnosed with AN. Adult subjects with A-AN who still had low weight in the long term present certain cardiac abnormalities similar to those seen in short-lasting disease. More studies are needed to confirm these results in a larger sample.

Is Multipoint Pacing Superior to Optimized Single-Point Pacing?Rodolfo San Antonio1, MD; Jose María Tolosana2, MD, PhD; Lluís Mont2, MD, PhD.1Heart Institute, Teknon Medical Center, Barcelona, Spain; University of Barcelona, Spain2Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Spain; Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.Word count: 434

Background: Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods: This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results: The SPP-FOI method achieved greater QRS shortening than MPP (-56±16 vs. -42±17 ms, P<0.001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: - 58±14 ms, P=0.69). Furthermore, the biventricular activation time according to ECGI was also shorter with SPP-FOI than with MPP. The estimated battery longevity was longer with SPP than with MPP (8.1±2.3 vs. 6.3±2.0 years, P=0.03). Conclusions: SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP.

Kurose et al. report on a lower number of gaps in RF-lesions compared to Cryo-lesions as determined by late gadolinium enhancement MRI (LGE-MRI). However, unlike claimed by the authors, there is ample evidence based on LGE-MRI in this context. Most importantly we have specifically compared RF and Cryo lesions in a recent case control study on AF Ablation. In contrast to the results of Kurose et al., our study, despite larger sample size, did not detect a difference in the number of gaps between the two energy sources. While numerous factors may account for the conflicting results, two points should be considered in particular. 1. The time point of LGE-MRI at a mean of 55 days post ablation has never been validated for chronic lesion formation, and is considerably earlier than the validated and well-established 3-months timepoint chosen by most groups. In fact, according to previous reports, gadolinium enhancement at earlier time points may, at least in part, reflect a transient inflammatory response rather than chronic scar formation. 2. The method of Kurose et al. is based on the definition of an area of healthy atrial tissue in each patient as an internal reference. However, it appears almost impossible to define a truly healthy area in the atrium of patients with atrial fibrillation. Thus the method is likely to underestimate ablation-induced fibrosis in patients with advanced disease and/or underlying pathologies and to overestimate it in younger, rather healthy patients.

LEARNING OBJECTIVES-       Sustained re-entrant tachyarrhythmias treatment has become pivotal in the grown-up congenital heart patients clinical management. -       Cardiac LGE-MRI tissue characterization integrated with high definition electroanatomic map could allow fast recognition and effective treatment of substrate of tachyarrhythmias.-       Cardiac LGE-MRI areas were suggestive of post-surgical changes both in atrium and ventricle. -       High-density electro-anatomical map localized areas of slow conduction identifying conducting isthmuses of re-entrant arrhythmias.