Revistas
Revista:
JOURNAL OF ARRHYTHMIA
ISSN:
1880-4276
Año:
2023
Vol.:
39
N°:
1
Págs.:
82 - 83
Autores:
Amat-Santos, I. J. (Autor de correspondencia); Delgado-Arana, J. R.; Cruz-Gonzalez, I.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2023
Vol.:
76
N°:
7
Págs.:
503 - 510
Introduction and objectives: Transthyretin cardiac amyloidosis (ATTR-CA) patients often have atrial fibrillation and increased bleeding/thrombogenic risks. We aimed to evaluate outcomes of left atrial appendage closure (LAAC) compared with patients without a known diagnosis of CA.
Methods: Comparison at long-term of patients diagnosed with ATTR-CA who underwent LAAC between 2009 and 2020 and those without a known diagnosis of CA.
Results: We studied a total of 1159 patients. Forty patients (3.5%) were diagnosed with ATTR-CA; these patients were older and had more comorbidities, higher HAS-BLED and CHA2DS2-VASc scores, and lower left ventricular function. Successful LAAC was achieved in 1137 patients (98.1%) with no differences between groups. Regarding in-hospital and follow-up complications, there were no differences between the groups in ischemic stroke (5% vs 2.5% in those without a known diagnosis of CA; P=.283), hemorrhagic stroke (2.5% and 0.8% in the control group; P=.284), major or minor bleeding. At the 2-year follow-up, there were no significant differences in mortality (ATTR-CA: 20% vs those without known CA: 13.6%, 0.248); however, the at 5-year follow-up, ATTR-CA patients had higher mortality (40% vs 19.2%; P <.001) but this difference was unrelated to hemorrhagic complications or ischemic stroke.
Conclusions: LAAC could reduce the risk of bleeding complications and ischemic cerebrovascular events without increasing the rate of early or mid-term complications. Although long-term survival was impaired in ATTR-CA patients, it was comparable to that of patients without a known diagnosis of CA at the 2-year follow-up, suggesting that LAAC for patients with ATTR-CA might not be futile.
Revista:
CANCERS
ISSN:
2072-6694
Año:
2022
Vol.:
14
N°:
12
Págs.:
2941
Simple Summary Left ventricular dysfunction (LVD) induced by anthracycline-based cancer chemotherapy (ACC) is becoming an urgent healthcare concern. Myocardial fibrosis (MF) may contribute to LVD after ACC. We show that elevated circulating levels of procollagen type I C-terminal propeptide (PICP, biomarker of MF) are associated with early subclinical LVD and predict later development of cardiotoxicity in patients treated with ACC. In addition, an association between PICP and LVD in patients with ACC-induced heart failure is observed. These results provide novel insights into MF as a mechanism underlying LVD after ACC, with PICP emerging as a promising tool to monitor cardiotoxicity in patients treated with ACC. Anthracycline-based cancer chemotherapy (ACC) causes myocardial fibrosis, a lesion contributing to left ventricular dysfunction (LVD). We investigated whether the procollagen-derived type-I C-terminal-propeptide (PICP): (1) associates with subclinical LVD (sLVD) at 3-months after ACC (3m-post-ACC); (2) predicts cardiotoxicity 1-year after ACC (12m-post-ACC) in breast cancer patients (BC-patients); and (3) associates with LVD in ACC-induced heart failure patients (ACC-HF-patients). Echocardiography, serum PICP and biomarkers of cardiomyocyte damage were assessed in two independent cohorts of BC-patients: CUN (n = 87) at baseline, post-ACC, and 3m and 12m (n = 65)-post-ACC; and HULAFE (n = 70) at baseline, 3m and 12m-post-ACC. Thirty-seven ACC-HF-patients were also studied. Global longitudinal strain (GLS)-based sLVD (3m-post-ACC) and LV ejection fraction (LVEF)-based cardiotoxicity (12m-post-ACC) were defined according to guidelines. BC-patients: all biomarkers increased at 3m-post-ACC versus baseline. PICP was particularly increased in patients with sLVD (interaction-p < 0.001) and was associated with GLS (p < 0.001). PICP increase at 3m-post-ACC predicted cardiotoxicity at 12m-post-ACC (odds-ratio >= 2.95 per doubling PICP, p <= 0.025) in both BC-cohorts, adding prognostic value to the early assessment of GLS and LVEF. ACC-HF-patients: PICP was inversely associated with LVEF (p = 0.004). In ACC-treated BC-patients, an early increase in PICP is associated with early sLVD and predicts cardiotoxicity 1 year after ACC. PICP is also associated with LVD in ACC-HF-patients.
Autores:
Pérez Cabeza, A. I.; Rivera-Caravaca, J. M.; Roldán-Rabadán, I.; et al.
Revista:
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN:
0014-2972
Año:
2022
Vol.:
52
N°:
4
Págs.:
e13709
Background Atrial fibrillation (AF) increases the risk of thromboembolism. We investigate the efficacy and safety of oral anticoagulation (OAC) therapy and explored the number needed to treat for net effect (NNTnet) of OAC in the Spanish cohort of the EURObservational Research Programme-AF (EORP-AF) Long-term General Registry. Methods The EORP-AF General Registry is a prospective, multicentre registry conducted in ESC countries, including consecutive AF patients. For the present analysis, we used the Spanish cohort, and the primary outcome was any thromboembolism (TE)/acute coronary syndrome (ACS)/cardiovascular death during the first year of follow-up. Results 729 AF patients were included (57.1% male, median age 75 [IQR 67-81] years, median CHA(2)DS(2)-VASc and HAS-BLED of 3 [IQR 2-5] and 2 [IQR 1-2], respectively). 548 (75.2%) patients received OAC alone (318 [43.6%] on VKAs and 230 [31.6%] on DOACs). After 1 year, the use of OAC alone showed lower rates of any TE/ACS/cardiovascular death (3.0%/year; p < 0.001) compared to other regimens, and non-use of OAC alone (HR 4.18, 95% CI 2.12-8.27) was independently associated with any TE/ACS/cardiovascular death. Balancing the effects of treatment, the NNTnet to provide an overall benefit of OAC therapy was 24. The proportion of patients on OAC increased at 1 year (87% to 88.1%), particularly on DOACs (33.6% to 39.9%) (p = 0.015), with low discontinuation rates. Conclusions In this contemporary cohort of AF patients, OAC therapy was associated with better clinical outcomes at 1 year and positive NNTnet. OAC use slightly increased during the follow-up, with low discontinuation rates and higher prescription of DOACs.
Autores:
Rivera-Caravaca, J. M.; Piot, O.; Roldán-Rabadán, I.; et al.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2022
Vol.:
24
N°:
2
Págs.:
202 - 210
Aims The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] has recently been described as a novel approach to in-depth characterization of AF. We aim to determine if the 4S-AF scheme would be useful for AF characterization and provides prognostic information in real-world AF patients. Methods and results The Spanish and French cohorts of the EORP-AF Long-Term General Registry were included. The baseline 4S-AF scheme was calculated and related to the primary management strategy (rhythm or rate control). Follow-up was performed at 1-year with all-cause mortality and the composite of ischaemic stroke/transient ischaemic attack/systemic embolism, major bleeding, and all-cause death, as primary endpoints. A total of 1479 patients [36.9% females, median age 72 interquartile range (IQR 64-80) years] were included. The median 4S-AF scheme score was 5 (IQR 4-7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both P < 0.001). The predictive performances of the 4S-AF scheme for the actual management strategy were appropriate in its continuous [c-index 0.77, 95% confidence interval (CI) 0.75-0.80] and categorical (c-index 0.75, 95% CI 0.72-0.78) forms. Cox regression analyses showed that 'red category' classified patients in the 4S-AF scheme had a higher risk of all-cause death (aHR 1.75, 95% CI 1.02-2.99) and composite outcomes (aHR 1.60, 95% CI 1.05-2.44). Conclusion Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control and could also help in identifying high-risk AF patients for worse clinical outcomes in a 'real-world' setting.
Autores:
Wise, B.; Albarran Rincon, R.; De Lossada Juste, A. ; et al.
Revista:
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
ISSN:
1383-875X
Año:
2022
Vol.:
63
N°:
1
Págs.:
103 - 108
Purpose Advanced non-fluoroscopic mapping systems for radiofrequency ablation (RFA) have shown to be an effective treatment of atrial fibrillation. This study analyzes the resource usage and subsequent costs associated with the implementation of an ultra-high density mapping system (UHDMS) compared to non-ultra-high density mapping systems (NUHDMS). Methods This retrospective observational study included 120 patients (18 years or older) with paroxysmal or persistent atrial fibrillation who underwent RFA for de novo pulmonary vein isolation guided either by an UHDMS (n=63) or NUHDMS (n=57) for their index procedure. We compared patient characteristics, short- and long-term procedural outcomes, resource usage, and clinical outcomes followed up to 16 months between the two treatment groups. The cost analysis was conducted from the perspective of a single center in Spain (Clinica Universidad de Navarra). Results Neither baseline patient characteristics nor complication rate differed between groups. Repeat RFAs following recurrent arrhythmia at 16 months was lower in the UHDMS patient group than in the NUHDMS group (6 vs. 14, respectively; P=0.027). The average total cost per patient was euro1,600 lower in the UHDMS group, compared to the NUHDMS group (euro11,061 and euro12,661, respectively; P=0.03). Conclusion In patients treated with an NUHDMS, 25% had a repeat ablation for recurrent arrhythmia, whereas only 9% of patients treated with a UHDMS had one (61% relative risk reduction), resulting in an average cost saving per patient of euro1,600.
Autores:
Solimene, F. (Autor de correspondencia); Stabile, G.; Ramos, P.; et al.
Revista:
CLINICAL CARDIOLOGY
ISSN:
0160-9289
Año:
2022
Vol.:
45
N°:
6
Págs.:
597 - 604
Background The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions. Methods The improveD procEdural workfLow for cathETEr ablation of paroxysmal AF with high density mapping system and advanced technology (DELETE AF) study is a prospective, single-arm, international post-market cohort study designed to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point-by-point RF ablation technology in a multicenter setting. About 300 consecutive patients with standard indications for AF ablation will be enrolled in this study. Post-ablation, all patients will be monitored with ambulatory event monitoring, starting within 30 days post-ablation to proactively detect and manage any recurrences within the 90-day blanking period, as well as Holter monitoring at 3, 6, 9, and 12 months post-ablation. Healthcare resource utilization, clinical data, complications, patients' medical complaints related to the ablation procedure and patient's reported outcome measures will be prospectively traced and evaluated. Discussion The DELETE AF trial will provide additional knowledge on long-term outcome following a structured ablation workflow, with high density mapping, advanced algorithms and local impedance technology, in an international multicentric fashion. DELETE AF is registered at (NCT05005143).
Revista:
JACC-CLINICAL ELECTROPHYSIOLOGY
ISSN:
2405-500X
Año:
2022
Vol.:
8
N°:
5
Págs.:
595 - 604
Objectives: This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures.
Background: A radiofrequency catheter measuring LI has been shown to be effective for performing PVI in patients with paroxysmal atrial fibrillation. Previous analysis has demonstrated LI drop to be predictive of pulmonary vein segment conduction block during an atrial fibrillation ablation procedure.
Methods: Fifty-eight patients who had undergone LI-blinded de novo PVI returned for a 3-month mapping procedure. PVI ablation circles were divided into 16 anatomic segments for classification (durable block or gap), and the median LI drop within segments with an interlesion distance of ¿6 mm was compared. A total of 51 data sets met the criteria for segmental analysis of LI performance.
Results: At the 3-month procedure, PV connection was confirmed in at least 1 PV segment in 35 of the included patients. LI drop outperformed generator impedance drop as a predictor of durable conduction block (area under the receiver-operating characteristic curve: 0.79 vs 0.68; P = 0.003). Optimal LI drops were identified by left atrial region (anterior/superior: 16.9 ¿ [sensitivity: 69.1%; specificity: 85.0%; positive predictive value for durable conduction block: 97.7%]; posterior/inferior:14.2 ¿ [sensitivity: 73.8%; specificity: 78.3%; positive predictive value: 96.9%]). Starting LI before radiofrequency (RF) application was significantly different among healthy, gap, and mature scar tissue and was also a contributing factor to achieving an optimal LI drop (85.2% of RF applications with a starting LI of ¿110 ¿ achieved the optimal regional drop or greater).
Conclusions: LI drop is predictive of durable PV segment isolation. Preablation starting LI is associated with the magnitude of LI drop. These findings suggest that a regional approach to RF ablation guided by LI combined with careful interlesion distance control may be beneficial in patients with paroxysmal atrial fibrillation (Electrical Coupling Information From the Rhythmia HDx System and DirectSense Technology in Subjects With Paroxysmal Atrial Fibrillation [LOCALIZE]; NCT03232645).
Autores:
de Juan Bagudá, J. (Autor de correspondencia); Gavira, Juan José; Pachón Iglesias, M.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2022
Vol.:
75
N°:
9
Págs.:
709 - 716
Introduction and objectives: HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry.
Methods: We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively).
Results: We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001).
Conclusions: The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.
Autores:
Solimene, F. (Autor de correspondencia); Stabile, G.; Segreti, L.; et al.
Revista:
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN:
1045-3873
Año:
2022
Vol.:
33
N°:
7
Págs.:
1414 - 1424
Introduction Low-voltage activity beyond pulmonary veins (PVs) may contribute to the failure of ablation of atrial fibrillation (AF) in the long term. We aimed to assess the presence of gaps (PVG) and residual potential (residual antral potential [RAP]) within the antral scar by means of an ultra-high-density mapping (UHDM) system. Methods We studied consecutive patients from the CHARISMA registry who were undergoing AF ablation and had complete characterization of residual PV antral activity. The Lumipoint (TM) (Boston Scientific) map-analysis tool was used sequentially on each PV component. The ablation endpoint was PV isolation (PVI) and electrical quiescence in the antral region. Results Fifty-eight cases of AF ablation were analyzed. A total of 86 PVGs in 34 (58.6%) patients and 44 RAPs in 34 patients (58.6%) were found. In 16 (27.6%) cases, we found at least one RAP in patients with complete absence of PV conduction. RAPs showed a lower mean voltage than PVG (0.3 +/- 0.2 mV vs. 0.7 +/- 0.5 mV, p < .0001), whereas the mean number of electrogram peaks was higher (8.4 +/- 1.4 vs. 3.2 +/- 1.5, p < .0001). The percentage of patients in whom RAPs were detected through Lumipoint (TM) was higher than through propagation map analysis (58.6% vs. 36.2%, p = .025). Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study patients. During a mean follow-up of 453 +/- 133 days, 6 patients (10.3%) suffered an AF/AT recurrence. Conclusion Local vulnerabilities in antral lesion sets were easily discernible by means of the UHDM system in both de novo and redo patients when no PV conduction was present.
Revista:
COMPUTING IN CARDIOLOGY
ISSN:
2325-8861
Año:
2022
Vol.:
49
Págs.:
1 - 4
The aim of this work is to use biomarkers extracted from high-resolution voltage maps of atrial fibrillation (AF) patients in order to make predictions about future "redo" procedures. We collected maps of the left atrium of 122 patients, prior of being treated for AF The bipolar voltage maps were extracted with the Rythmia system from Boston Scientific and subsequently analyzed in the MATLAB environment. The present study focuses on three biomarkers extracted from those maps. Two are associated with the bipolar voltage measurements on the map, i.e., the mean voltage and the voltage dispersion on the map. The third indicator is the area of the atrium evaluated from the map. The data are used for feeding a supervised classification algorithm. The output variable is a binary variable that is set to 1 if the patient will need a "redo" procedure in the twelve months following the cardiac intervention and 0 otherwise. We show that the biomarkers have some statistical power in predicting future outcomes. Especially the mean voltage on the map is the best predictor of the future outcome. We determine the cutoff value for the mean voltage based on the best prediction accuracy of Vm=0.542 mV in agreement with previous studies. We discuss some extensions of this study that could allow improvements in predictive power.
Autores:
Rodríguez-Mañero, M. (Autor de correspondencia); Baluja, A.; Hernández, J.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2022
Vol.:
75
N°:
7
Págs.:
559 - 567
Introducción y objetivos
Se han desarrollado puntuaciones multiparamétricas para una mejor estratificación del riesgo en el síndrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparamétricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con síndrome de Brugada y estudio electrofisiológico (EEF).
Métodos
Pacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron análisis mediante estadístico C y modelos de regresión de riesgos proporcionales de Cox.
Resultados
Se incluyó en total a 831 pacientes con una media de edad de 42,8 ± 13,1 años; 623 (75%) eran varones; 386 (46,5%) tenían patrón electrocardiográfico (ECG) tipo 1; 677 (81,5%) estaban asintomáticos y 319 (38,4%) tenían un desfibrilador automático implantable. Durante un seguimiento de 10,2 ± 4,7 años, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y síncope fueron predictivos de eventos arrítmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomáticos). La evaluación de las puntuaciones de Delise y Sieira con diferente número de extraestímulos (1 o 2 frente a 3) no mejoró sustancialmente el índice c de predicción de eventos.
Conclusiones
En el SBr, los factores de riesgo clásicos como el ECG y el síncope previo predicen eventos arrítmicos. El número de extraestímulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clínico con EEF ayudan a identificar las poblaciones con más riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en población general con SBr como en pacientes asintomáticos.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2021
Vol.:
63
N°:
5
Págs.:
391 - 399
Objective: To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. Material and methods: We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 +/- 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. Results: In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 +/- 2.6 mm vs. 16.7 +/- 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 +/- 2 mm vs. 13.8 +/- 2.2 mm, p = 0.009) and larger left atrial volume (91.9 +/- 24.9 cm(3) vs. 70.7 +/- 20.3 mm(3), p = 0.001). After 22.1 +/- 12.1 months' mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 +/- 23.0 mm(3) vs. 71.1 +/- 23.2 mm(3), p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. Conclusion: The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.
Revista:
JOURNAL OF ELECTROCARDIOLOGY
ISSN:
0022-0736
Año:
2021
Vol.:
64
Págs.:
1 - 2
Autores:
Maarse, M. (Autor de correspondencia); Wintgens, L. I. S.; Ponomarenko, A.; et al.
Revista:
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN:
1045-3873
Año:
2021
Vol.:
32
N°:
3
Págs.:
737 - 744
Introduction Current guidelines recommend adequate anticoagulation for at least 3 weeks pre- and 4 weeks post-direct current cardioversion (DCCV) to reduce thrombo-embolic risk in patients with atrial fibrillation (AF) lasting greater than 48 h. No specific recommendations exist for DCCV in patients that have undergone left atrial appendage occlusion (LAAO), many of whom are ineligible for anticoagulation. This study aims to observe the efficacy and safety of DCCV post-LAAO in everyday clinical practice. Methods This prospective multicenter registry included DCCVs in patients post-LAAO. Imaging strategy or anticoagulation treatment around DCCV were analyzed. Complications during 30-day follow-up were registered. DCCVs performed in accordance with current guidelines for the general AF population were compared to DCCVs performed deviating from these guidelines. Results In 93 patients (age 65 +/- 17 years, CHA(2)DS(2)-VASC 3.0 +/- 1.3) 284 DCCVs were performed between 2010 and 2018, in 271 sinus rhythm was restored. A wide variety of imaging or anticoagulation strategies around DCCV was observed; in 128 episodes strategies deviated from current guidelines. No thrombo-embolic events were observed after any DCCV during 30-day follow-up. In 34 DCCVs trans-esophageal echocardiography (TOE) was performed before DCCV to exclude cardiac thrombi and/or (re-)verify adequate device positioning. In two patients without post-LAAO imaging before DCCV, a device rotation or embolization was observed during scheduled TOE after LAAO. Conclusion DCCV in AF patients after LAAO is highly effective. No thrombo-embolic events were observed in any patient in this observational cohort, regardless of the periprocedural anticoagulation or imaging strategy. Confirmation of adequate device positioning at least once before DCCV seems recommendable.
Autores:
Das, M. (Autor de correspondencia); Luik, A.; Shepherd, E.; et al.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2021
Vol.:
23
N°:
7
Págs.:
1042 - 1051
Aims Radiofrequency ablation creates irreversible cardiac damage through resistive heating and this temperature change results in a generator impedance drop. Evaluation of a novel local impedance (LI) technology measured exclusively at the tip of the ablation catheter found that larger LI drops were indicative of more effective lesion formation. We aimed to evaluate whether LI drop is associated with conduction block in patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI). Methods and results Sixty patients underwent LI-blinded de novo PVI using a point-by-point ablation workflow. Pulmonary vein rings were divided into 16 anatomical segments. After a 20-min waiting period, gaps were identified on electroanatomic maps. Median LI drop within segments with inter-lesion distance <= 6 mm was calculated offline. The diagnostic accuracy of LI drop for predicting segment block was assessed using receiver operating characteristic analysis. For segments with inter-lesion distance <= 6 mm, acutely blocked segments had a significantly larger LI drop [19.8 (14.1-27.1) Omega] compared with segments with gaps [10.6 (7.8-14.7) Omega, P < 0.001). In view of left atrial wall thickness differences, the association between LI drop and block was further evaluated for anterior/roof and posterior/inferior segments. The optimal LI cut-off value for anterior/roof segments was 16.1 Omega (positive predictive value for block: 96.3%) and for posterior/inferior segments was 12.3 Omega (positive predictive value for block 98.1%) where inter-lesion distances were <= 6 mm. Conclusion The magnitude of LI drop was predictive of acute PVI segment conduction block in patients with paroxysmal AF. The thinner posterior wall required smaller LI drops for block compared with the thicker anterior wall.
Autores:
Gardner, R. S. (Autor de correspondencia); D'Onofrio, A.; Mark, G.; et al.
Revista:
ESC HEAR FAILURE
ISSN:
2055-5822
Año:
2021
Vol.:
8
N°:
2
Págs.:
1675 - 1680
Aims The SMART (Strategic MAnagement to optimize response to cardiac Resynchronization Therapy) Registry was designed to assess real-world outcomes for patients receiving a cardiac resynchronization therapy defibrillator (CRT-D) and to better understand which programming and optimization techniques are used and how effective they are. Methods and results The SMART Registry is a global, multicentre, prospective, observational, post-market CRT-D registry with a planned enrolment of 2000 subjects from a maximum of 200 sites in Europe, North America, and Asia-Pacific region. Each subject will be followed up for a minimum of 12 months. The primary endpoint of CRT response rate at 12 months is defined by a clinical composite score of all-cause mortality, heart failure events, New York Heart Association Class, and quality of life as assessed by a patient global assessment instrument. A subgroup composed of the first 103 consecutive European subjects implanted with an NG4 device will have left ventricular multisite pacing feature enabled at any time during the initial 12 months of follow-up. The primary endpoint for this sub-analysis will be the NG4 PG-related complication-free rate at 36 months. Conclusions The SMART Registry achieved its recruitment target in August 2019, with 2014 patients enrolled. The baseline demographics demonstrated that patients were generally older, with greater co-morbidity, and on more contemporary medical therapy than in the key CRT trials. The results of the SMART Registry will determine which programming and optimization techniques are effective in this real-world population.
Revista:
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
ISSN:
1383-875X
Año:
2021
Vol.:
62
N°:
2
Págs.:
357 - 362
Purpose Remote system operation technology was developed and applied to a non-fluoroscopic navigation system in order to overcome Spanish mobility restrictions caused by Covid-19 pandemic infection and subsequently used routinely. Methods and results Fifty consecutive complex ablations were performed in different days using this technology. All these procedures were assisted remotely with the only intervention of a field clinical specialist located at his home who took full control of the navigation system (keyboard, mouse, and screen) and had bidirectional real-time audio/video feedback with the operating physician. Once the connection was established, the remote field clinical specialist replicated the Rhythmia screen at the remote location with all its features, and interacted identically with the physician, essentially with no perceptible differences from being physically present. There were neither interruptions nor perceptible delays in the bidirectional communications between the remote field clinical specialist and the operating physician during the procedures. Video signal delay ranged from 265 to 325 ms. All the procedures were uneventful. Conclusions Remote system operation allowed full teleoperation of a non-fluoroscopic navigation system (keyboard, mouse, and screen) as well as bidirectional real-time audio/video feedback with the operating physician, providing a fully autonomous remote assistance in 50 complex ablation procedures. This technology ensures workflow continuity and optimal workforce flexibility and has relevant and promising implications in the field of training, teaching, and resource optimization that deserves further development.
Autores:
Pujol, C.; Varo, N; Manero, M. R.; et al.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2021
Vol.:
44
N°:
2
Págs.:
205 - 214
Background. The aim of this paper is to analyze the role of the biomarkers Interleukin 6, Tumoral Necrosis Factor a, sCD40L, high sensitive Troponin T, high sensitive C-Reactive Protein and Galectin-3 in predicting super response (SR) to Cardiac Resynchronization Therapy (CRT), as they have not been studied in this field before. Methods. Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year. SR was defined as reduction in LVESV = 30% at one year follow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. Results. 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p = 0.04), suffering from less ischemic cardiomyopathy (13 vs. 63%, p < 0.0001) and lateral (0 vs. 18%, p = 0.03), inferior (4 vs. 33%, p = 0.01) and posterior infarction (0 vs. 22%, p =0.01); absence of mitral regurgitation (47% vs. 22%, p = 0.04), wider QRS width (157.7 +/- 22.9 vs. 140.8 +/- 19.2 ms, p =0.01), higher concentrations of sCD40L (6.9 +/- 5.1 vs. 4.4 +/- 3.3 ng/mL, p= 0.02), and left ventricular lead more frequent in lateral medial position (69 vs. 26%, p = 0.002). QRS width, lateral medial position of the lead and absence of mitral regurgitation were independent predictors of SR. sCD40L showed a moderate direct correlation with SR (r = 0.39, p = 0.02) and with the reduction of LVESV (r = 0.44, p = 0.02). Conclusion. sCD40L correlates significantly with SR to CRT. QRS width, absence of mitral regurgitation and lateral medial position of the lead are independent predictors of SR in this cohort.
Revista:
JOURNAL OF MEDICAL INTERNET RESEARCH
ISSN:
1438-8871
Año:
2020
Vol.:
22
N°:
12
Págs.:
e21436
Background: The Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored. Objective: This study aims to assess the effectiveness of a remotely provided Mediterranean diet-based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF). Methods: The PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the Mediterranean diet enriched with extra virgin olive oil (EVOO) on the prevention of atrial tachyarrhythmia recurrence after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (Mediterranean diet enriched with EVOO) or a control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with provision of dietary recommendations, and participants had access to a web page, a mobile app, and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, Mediterranean diet classroom, and Your personal experience. At baseline and at 1-year and 2-year follow-up, the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire were collected by a dietitian by phone. Results: A total of 720 subjects were randomized (365 to the intervention group, 355 to the control group). Up to September 2020, 560 subjects completed the first year (560/574, retention rate 95.6%) and 304 completed the second year (304/322, retention rate 94.4%) of the intervention. After 24 months of follow-up, increased adherence to the Mediterranean diet was observed in both groups, but the improvement was significantly higher in the intervention group than in the control group (net between-group difference: 1.8 points in the MEDAS questionnaire (95% CI 1.4-2.2; P<.001). Compared with the control group, the Mediterranean diet intervention group showed a significant increase in the consumption of fruits (P<.001), olive oil (P<.001), whole grain cereals (P=.002), pulses (P<.001), nuts (P<.001), white fish (P<.001), fatty fish (P<.001), and white meat (P=.007), and a significant reduction in refined cereals (P<.001), red and processed meat (P<.001), and sweets (P<.001) at 2 years of intervention. In terms of nutrients, the intervention group significantly increased their intake of omega-3 (P<.001) and fiber (P<.001), and they decreased their intake of carbohydrates (P=.02) and saturated fatty acids (P<.001) compared with the control group. Conclusions: The remote nutritional intervention using a website and phone calls seems to be effective in increasing adherence to the Mediterranean diet pattern among AF patients treated with catheter ablation.
Autores:
De-Simone, A.; Anselmino, M.; Scaglione, M.; et al.
Revista:
JOURNAL OF CARDIOVASCULAR MEDICINE
ISSN:
1558-2027
Año:
2020
Vol.:
21
N°:
2
Págs.:
113 - 122
Aims We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry. Methods A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs. Results In 18 cases the RAT matched the mid-diastolic phase of the re-entry whereas in 8 cases the RAT differed. In these patients, the mid-diastolic tissue in the active circuit never represented the area with the slowest conduction velocity of the re-entry. The mean conduction velocity at the mid-diastolic site was significantly slower in the group of patients in which the RAT matched the mid-diastolic site (P = 0.0173) and that of the remaining circuit was significantly slower in the group in which the RAT did not match (P = 0.0068). The mean conduction velocity at the RAT was comparable between the two groups (P = 0.66). Conclusion Identifying the RAT in challenging IARTs by means of high-density representation of the wavefront propagation of the tachycardia seems feasible and effective. In one-third of cases this approach identifies an area that differs from the mid-diastolic corridor.
Revista:
AMERICAN HEART JOURNAL
ISSN:
0002-8703
Año:
2020
Vol.:
220
Págs.:
127 - 136
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. Catheter ablation aims to restore sinus rhythm. However, relapses occur in up to 30% of patients. A Mediterranean diet (MedDiet) enriched with extra-virgin olive oil (EVOO) substantially reduced the incidence of AF in the PREDIMED trial. The PREDIMAR will test a similar intervention in secondary prevention. Methods PREDIMAR is a multicenter, randomized, single-blind trial testing the effect of a MedDiet enriched with EVOO to reduce tachyarrhythmia relapses after AF ablation. The primary outcome is the recurrence of any sustained atrial tachyarrhythmia after ablation (excluding those occurring only during the first 3 months after ablation). The target final sample size is 720 patients (360 per group) recruited from 4 Spanish hospitals. A remote intervention, maintained for 2 years, is delivered to the active intervention group including periodic phone calls by a dietitian and free provision of EVOO. The control group will receive delayed intervention after trial completion. Routine electrocardiogram (ECG) and Holter ECG are performed, and a portable cardiac rhythm monitoring device is provided to be worn by participants during 15 months. Results Recruitment started in March 2017. Up to July 2019, 609 patients were randomized (average inclusion rate: 5.3 patients/wk). Retention rates after 18 months are >94%. Conclusions If our hypothesis is confirmed, the utility of the MedDiet enriched with EVOO in slowing the progression of AF will be proven, preventing recurrences and potentially reducing complications.
Autores:
Hindricks, G. (Autor de correspondencia); Weiner, S.; McElderry, T.; et al.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2019
Vol.:
21
N°:
4
Págs.:
655 - 661
Aims The objective of this study was to verify acute safety, performance, and usage of a novel ultra-high density mapping system in patients undergoing ablation procedure in a real-world clinical setting. Methods and results The TRUE HD study enrolled patients undergoing catheter ablation with mapping for all arrhythmias (excluding de novo atrial fibrillation) who were followed for 1month. Safety was determined by collecting all serious adverse events and adverse events associated with the study devices. Performance was determined as the composite of: ability to map the arrhythmia/substrate, complete the ablation applications, arrhythmia termination (where applicable), and ablation validation. Use of mapping system in the ablation validation workflow was also evaluated. Among the 519 patients who underwent a complete (504) or attempted (15) procedure, 21 (4%) serious ablation-related complications were collected, with 3 (0.57%) potentially related to the mapping catheter. Four hundred and twenty treated patients resulted in a successful procedure confirmed by arrhythmia-specific validation techniques (83.3%; 95% confidence interval: 79.8-86.5%). A total of 1419 electroanatomical maps were created with a median acquisition time of 9:23min per map. Of these, 372 maps in 222 (44%) patients were collected for ablation validation purposes. Following validation mapping, 162/222 (73%) patients required additional ablation. Conclusion In the TRUE HD study mapping was associated with rates of acute success and complications consistent with previously published reports. Importantly, a low percentage of events (0.57%) was attributed to the mapping catheter. When performed, validation mapping was useful for identifying additional targets for ablation in the majority of patients.
Revista:
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN:
1045-3873
Año:
2019
Vol.:
30
N°:
8
Págs.:
1231 - 1240
Introduction Ultrahigh-density-voltage mapping (uHD(V)M) is a new tool that can add new insights into the pathophysiology of atrial fibrillation (AF). The aim of this study was to evaluate the performance of uHD(V)M in predicting postablation AF recurrence (AFR). Methods and Results We included 98 consecutive patients undergoing pulmonary vein isolation for AF (40.8% persistent) using an uHD(V)M system and followed for 1 year. The left atrium (LA) mean voltage (V-m) and the V-slope (slope of the voltage histogram calculated by linear interpolation, with the relative frequency on the vertical axis and the bipolar potential on the horizontal axis) were calculated from 12 567 +/- 5486 points per map. Patients with AFR (N = 29) had lower V-m and higher V-slope as compared with patients without AFR (N = 69). Receiver operating characteristic curves identified V-m as the strongest predictor of AFR, with a higher incidence of AFR in patients with V-m 0.758 mV (57.6%) or lower than patients with V-m higher than 0.758 mV (15.4%; P < .0001). Among patients with V-m higher than 0.758 mV, patients with V-slope 0.637 or higher exhibited higher (P = .043) AFR incidence (31.3%) than patients with V-slope lower than 0.637 (10.2%). This classification showed incremental predictive value over relevant covariables. V-m values were lower and V-slope values were higher in patients that progressed from paroxysmal to persistent AF. Patients with V-slope 0.637 or higher had a 14.2% incidence of postablation atypical atrial flutter, whereas patients with V-slope lower than 0.637 did not present this outcome. Conclusions The risk of AFR, atrial flutter, and progression from paroxysmal to persistent AF can be detected by quantitative analysis of LA uHD(V)M identifying diverse patterns of atrial substrate alterations.
Revista:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN:
0735-1097
Año:
2019
Vol.:
73
N°:
12
Págs.:
1398 - 1410
Background A combination of circulating biomarkers associated with excessive myocardial collagen type-I cross-linking or CCL+ (i.e., decreased carboxy-terminal telopeptide of collagen type-I to matrix metalloproteinase-1 ratio) and with excessive myocardial collagen type-I deposition or CD+ (i.e., increased carboxy-terminal propeptide of procollagen type-I) has been described in heart failure (HF) patients and associates with poor outcomes.
Objectives The purpose of this study was to investigate whether the CCL+CD+ combination of biomarkers associates with atrial fibrillation (AF).
Methods Biomarkers were analyzed in serum samples from 242 HF patients (study 1) and 150 patients referred for AF ablation (study 2). Patients were classified into 3 groups (CCL¿CD¿, CCL+CD¿ or CCL¿CD+, and CCL+CD+) in accordance to biomarker threshold values. Left atrial electroanatomic high-density mapping was performed in 71 patients from study 2.
Results In study 1, 53.7% patients had AF at baseline and 19.6% developed AF (median follow-up 5.5 years). Adjusted odds and hazard ratios associated with baseline and new-onset AF, respectively, were both ¿3.3 (p ¿ 0.050) in CCL+CD+ patients compared with CCL¿CD¿ patients, with nonsignificant changes in the other group. In study 2, 29.3% patients had AF recurrence during 1-year post-ablation.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2019
Vol.:
21
N°:
2
Págs.:
250 - 258
Aims Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is usually associated to conduction gaps in pulmonary veins (PVs). Our objective was to characterize gaps in patients with recurrences after a first radiofrequency (RF) or cryoballoon (CB) PVI procedure, using a high-density mapping (HDM) system. Methods and results Fifty patients with AF recurrence after a first PVI procedure (pre-RF 25 patients; pre-CB 25 patients) were included at two centres. Activation map (AM) and voltage map (VM) of the left atrium and PVs were built using the HDM Rhythmia (R) system. Superior PVs were reconnected more frequently in both groups. Right PVs were reconnected more frequently in pre-RF patients. Pre-RF patients had more reconnected veins than pre-CB patients (meanstandard deviation: 3.00 +/- 0.96 vs. 1.88 +/- 1.13; P<0.001) and more gaps (4.84 +/- 2.06 vs. 2.16 +/- 1.49; P<0.001). Gaps in the VM were wider in pre-CB patients (16.5 +/- 9.5mm vs. 12.1 +/- 4.8mm; P=0.006). There was a gap in 179 of the 800 PV segments analysed (22%); 52% were identified in both AM and VM maps; 39% only in the AM and 8% only in the VM. The highest sensitivity and specificity for gap detection was obtained with VM in pre-CB patients and with AM in pre-RF patients. Conclusion In conclusion, HDM seems to be a useful and precise tool to detect conduction gaps after a first PVI procedure. The anatomical pattern and location of gaps depends on the technique used previously, usually being multiple, smaller, and better detected by AM after RF, and fewer, wider, and better detected by VM after CB.
Autores:
Solimene, F. (Autor de correspondencia); Maddaluno, F. ; Schillaci, V. ; et al.
Revista:
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
ISSN:
1045-3873
Año:
2019
Vol.:
30
N°:
11
Págs.:
2518 - 2519
Autores:
Scaglione, M. (Autor de correspondencia); Adragao, P. ; Garcia-Bolao, I
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2019
Vol.:
21
N°:
Supl. 3
Págs.:
1 - 1
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2019
Vol.:
21
N°:
Supl. 3
Págs.:
2 - 4
Revista:
CIRCULATION
ISSN:
0009-7322
Año:
2018
Vol.:
137
N°:
7
Págs.:
743 - 746
Autores:
Lozano, I. F. (Autor de correspondencia); Osinalde, E. P.; Garcia-Bolao, I; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2018
Vol.:
71
N°:
8
Págs.:
643 - 655
Adequate, updated and functional technology is essential in cardiology. In Spain, the economic scenario has strongly impacted technology renewal programs and obsolescence is a growing problem. The current report attempts to describe the current situation and the conditions that must concur to update, replace or adopt new technologies in the field of cardiology. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores:
De Simone, A.; La Rocca, V.; Panella, A.; et al.
Revista:
CLINICAL CASE REPORTS
ISSN:
2050-0904
Año:
2018
Vol.:
6
N°:
6
Págs.:
1060 - 1065
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2018
Vol.:
20
N°:
Supl. 3
Págs.:
F351 - F358
Aims Maps obtained by means of electroanatomic high-density mapping (HDM) systems have shown their use in the identification of conduction gaps in experimental atrial linear lesion models. The objective of this study was to assess the use of HDM in the recognition of reconnection gaps in pulmonary veins (PV) in redo atrial fibrillation (AF) ablation procedures. Methods and results One hundred and eight patients were included in a non-randomized study that assessed the recognition of reconnection gaps in PV by means of HDM compared to a control group that received conventional non-fluoroscopic guidance with a circular multipolar catheter (CMC). Among the HDM group, adequate recognition of reconnection gaps was obtained in 60.99% of the reconnected PVs (86 of 141), a figure significantly higher than that achieved with analysis of CMC recorded signals (39.66%, 48 of 121; P = 0.001). The number of applications and total radiofrequency time were also significantly lower in the HDM group (12.46 +/- 6.1 vs. 15.63 +/- 7.7 and 7.61 +/- 3 vs. 9.29 +/- 5; P = 0.02, and P = 0.03, respectively). At the 6-month follow-up, no statistically significant differences were found in recurrence of AF or any other atrial tachycardia between the HDM group (8 patients, 14.8%) and the control group in (16 patients, 29.6%; P = 0.104). Conclusion An analysis of the high-density activation maps allows greater precision in the identification of reconnection gaps in PV, which results in lower radiofrequency time for the new isolation.
Autores:
Rodriguez-Manero, M. (Autor de correspondencia); Oloriz, T.; de Waroux, J. B. L.; et al.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2018
Vol.:
20
N°:
5
Págs.:
851 - 858
Aims Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
Revista:
CIRCULATION
ISSN:
0009-7322
Año:
2018
Vol.:
138
N°:
4
Págs.:
439 - 440
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2017
Vol.:
70
N°:
9
Págs.:
706 - 712
INTRODUCTION AND OBJECTIVES:
Rhythmia is a new nonfluoroscopic navigation system that is able to create high-density electroanatomic maps. The aim of this study was to describe the acute outcomes of atrial fibrillation (AF) ablation guided by this system, to analyze the volume provided by its electroanatomic map, and to describe its ability to locate pulmonary vein (PV) reconnection gaps in redo procedures.
METHODS:
This observational study included 62 patients who underwent AF ablation with Rhythmia compared with a retrospective cohort who underwent AF ablation with a conventional nonfluoroscopic navigation system (Ensite Velocity).
RESULTS:
The number of surface electrograms per map was significantly higher in Rhythmia procedures (12 125 ± 2826 vs 133 ± 21 with Velocity; P < .001), with no significant differences in the total procedure time. The Orion catheter was placed for mapping in 99.5% of PV (95.61% in the control group with a conventional circular mapping catheter; P = .04). There were no significant differences in the percentage of PV isolation between the 2 groups. In redo procedures, an ablation gap could be identified on the activation map in 67% of the reconnected PV (40% in the control group; P = .042). The measured left atrial volume was lower than that calculated by computed tomography (109.3 v 15.2 and 129.9 ± 13.2 mL, respectively; P < .001). There were no significant differences in the number of complications.
CONCLUSIONS:
The Rhythmia system is effective for AF ablation procedures, with procedure times and safety profiles similar to conventional nonfluoroscopic navigation systems. In redo procedures, it appears to be more effective in identifying reconnected PV conduction gaps.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2017
Vol.:
70
N°:
7
Págs.:
598 - 600
Revista:
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
ISSN:
0147-8389
Año:
2017
Vol.:
40
N°:
5
Págs.:
545 - 550
BackgroundFirst description of a technique for left atrium transseptal puncture (TSP) with minimal radiation exposure by using the nonfluoroscopic MediGuide tracking system (MG; St. Jude Medical, St. Paul, MN, USA) without the assistance of intracardiac echocardiography. MethodsThis study included 31 consecutive patients with atrial fibrillation undergoing an MG-assisted percutaneous catheter ablation procedure. A Brockenbrough transseptal needle (BRK) is connected to a standard pressure transducer through a two-input valve. Then, an MG-enabled guidewire is inserted so that its tip exactly matches the BRK's distal tip. After the acquisition of two short radioscopic cine-loops we are able to trace the needle tip on the MG screen, performing the usual TSP maneuver but without fluoroscopy. Successful left atrium access is confirmed by noticing the change in the pressure curve and by advancing the guidewire into the left pulmonary veins. As a control group, 31 matched patients who underwent atrial fibrillation ablation with fluoroscopically guided, pressure-monitored TSP were included. ResultsSixty-two MG-assisted TSP attempts were performed; all but two were successfully accomplished without changing to the conventional technique (96.7%). The mean total fluoroscopy time, until the double transseptal access was performed, was 26.65 37.97 seconds in the MG group and 129.13 +/- 37.77 seconds in the conventional-TSP group (P < 0.001). No major complications occurred during any of the procedures. ConclusionThis new technique for TSP using MG is feasible and can be performed with minimal radiation exposure without the need for additional imaging techniques, achieving a significant reduction of fluoroscopy time.
Revista:
JOURNAL OF ATRIAL FIBRILLATION
ISSN:
1941-6911
Año:
2016
Vol.:
8
N°:
5
Págs.:
61-66
Autores:
Rodríguez-Mañero, M.; Abu Assi, E. ; Sanchez-Gomez, J. M.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2016
Vol.:
69
N°:
11
Págs.:
1033 - 1041
Introduction and objectives: Several clinical risk scores have been developed to identify patients at high risk of all-cause mortality despite implantation of an implantable cardioverter-defibrillator. We aimed to examine and compare the predictive capacity of 4 simple scoring systems (MADIT-II, FADES, PACE and SHOCKED) for predicting mortality after defibrillator implantation for primary prevention of sudden cardiac death in a Mediterranean country. Methods: A multicenter retrospective study was performed in 15 Spanish hospitals. Consecutive patients referred for defibrillator implantation between January 2010 and December 2011 were included. Results: A total of 916 patients with ischemic and nonischemic heart disease were included (mean age, 62 +/- 11 years, 81.4% male). Over 33.4 +/- 12.9 months, 113 (12.3%) patients died (cardiovascular origin in 86 [9.4%] patients). At 12, 24, 36, and 48 months, mortality rates were 4.5%, 7.6%, 10.8%, and 12.3% respectively. All the risk scores showed a stepwise increase in the risk of death throughout the scoring system of each of the scores and all 4 scores identified patients at greater risk of mortality. The scores were significantly associated with all-cause mortality throughout the follow-up period. PACE displayed the lowest c-index value regardless of whether the population had heart disease of ischemic (c-statistic = 0.61) or nonischemic origin (c-statistic = 0.61), whereas MADIT-II (c-statistic = 0.67 and 0.65 in ischemic and nonischemic cardiomyopathy, respectively), SHOCKED (c-statistic = 0.68 and 0.66, respectively), and FADES (c-statistic = 0.66 and 0.60) provided similar c-statistic values (P >= .09). Conclusions: In this nontrial-based cohort of Mediterranean patients, the 4 evaluated risk scores showed a significant stepwise increase in the risk of death. Among the currently available risk scores, MADIT-II, FADES, and SHOCKED provide slightly better performance than PACE. (C) 2016 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2016
Vol.:
58
N°:
6
Págs.:
444 - 453
Objective: Radiofrequency ablation is an efficacious alternative in patients with symptomatic atrial fibrillation who do not respond to or are intolerant to at least one class I or class III antiarrhythmic drug. Although radiofrequency ablation is a safe procedure, complications can occur. Depending on the location, these complications can be classified into those that affect the pulmonary veins themselves, cardiac complications, extracardiac intrathoracic complications, remote complications, and those that result from vascular access. The most common complications are hematomas, arteriovenous fistulas, and pseudoaneurysms at the puncture site. Some complications are benign and transient, such as gastroparesis or diaphragmatic elevation, whereas others are potentially fatal, such as cardiac tamponade. Conclusion: Radiologists must be familiar with the complications that can occur secondary to pulmonary vein ablation to ensure early diagnosis and treatment. (C) 2016 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2015
Vol.:
10
Págs.:
1533-40
The combination of CA and percutaneous LAAC in a single procedure is technically feasible in patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to OACs, although it is associated with a significant risk of major complications
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN:
1885-5857
Año:
2015
Vol.:
68
N°:
3
Págs.:
226-233
This article discusses the main advances in cardiac arrhythmias and pacing published between 2013 and 2014. Special attention is given to the interventional treatment of atrial fibrillation and ventricular arrhythmias, and on advances in cardiac pacing and implantable cardioverter defibrillators, with particular reference to the elderly patient.
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2014
Vol.:
16
N°:
12
Págs.:
1857-1859
Conclusion We describe the implantation of a transseptal LV stimulation lead through a left subclavian access.
Revista:
JOURNAL OF ATRIAL FIBRILLATION
ISSN:
1941-6911
Año:
2014
Vol.:
6
Págs.:
32 - 36
Revista:
EUROPACE
ISSN:
1099-5129
Año:
2014
Vol.:
16
N°:
6
Págs.:
913
Revista:
EUROPEAN JOURNAL OF HEART FAILURE
ISSN:
1388-9842
Año:
2012
Vol.:
14
N°:
6
Págs.:
635-641
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2012
Vol.:
65
N°:
7
Págs.:
668
Revista:
ARCHIVOS DE CARDIOLOGIA DE MEXICO
ISSN:
1405-9940
Año:
2012
Vol.:
82
N°:
3
Págs.:
235-242
The present document reviews various aspects of the current status of cardiac resynchronization therapy: mechanisms of action, current indications and implantation technique.
Revista:
MEDICINA INTENSIVA
ISSN:
0210-5691
Año:
2012
Vol.:
36
N°:
5
Págs.:
377-9
Se trata por tanto de un caso particular debido a dos razones. La primera es la presentación temprana de una TA proveniente del donante que debuta con signos de IC. En el TC ortotópico con técnica bicava se conserva la aurícula derecha y se efectúa anastomosis de cada vena cava por separado. Por lo tanto, aunque esta técnica conlleva menores tasas de arritmias auriculares y menor necesidad de marcapasos6,7 que con la técnica clásica, en este caso concreto facilitó la preservación del foco responsable de la TA. En segundo lugar, el caso presenta como novedad la estrategia terapéutica escogida. Debido a la repercusión hemodinámica el arsenal terapéutico disponible para revertir las TSV presenta ciertos riesgos y las maniobras vagales no tienen utilidad en esta población particular. Por ende, la adenosina, en pacientes con taquicardias de QRS ancho, no está exenta de riesgos en caso de que se trate de una taquicardia ventricular. En este caso la simple sobreestimulación auricular con un catéter en la aurícula derecha yuguló la crisis de TA. Además el EEF proporcionó el diagnóstico certero a la par que la posibilidad de ablación del sustrato responsable
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2011
Vol.:
64
N°:
12
Págs.:
1147-1153
Data from the 2010 registry show that the number of ablations carried out continued to increase and exceeded 8700 ablations for the second time. In addition, they show, in general, a higher success rate and a lower number of complications. Again, cavotricuspid isthmus ablation for typical atrial flutter was the second most common condition treated. The number of catheter ablations carried out for ventricular arrhythmias in Spain is growing compared to the previous year.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2011
Vol.:
64
N°:
12
Págs.:
1147 - 1153
Introduction and Objectives: The findings of the 2010 Spanish Catheter Ablation Registry are presented.
Methods: Data were collected in two ways: retrospectively using a standardized questionnaire, and prospectively from a central database. Each participating center selected its own preferred method of data collection.
Results: Fifty-seven Spanish centers voluntarily contributed data to the survey. A total of 8762 ablation procedures was analyzed, averaging 154 (97) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2321; 27%), typical atrial flutter (n=1839; 22%), and accessory pathways (n=1738; 20%). Atrial fibrillation was the fourth most common condition treated (n=1309; 15%), and reflects mild growth. The overall success rate was 94%, major complications occurred in 1.7%, and the overall mortality rate was 0.06%.
Conclusions: Data from the 2010 registry show that the number of ablations carried out continued to increase and exceeded 8700 ablations for the second time. In addition, they show, in general, a higher success rate and a lower number of complications. Again, cavotricuspid isthmus ablation for typical atrial flutter was the second most common condition treated. The number of catheter ablations carried out for ventricular arrhythmias in Spain is growing compared to the previous year.
Revista:
CARDIOVASCULAR RESEARCH
ISSN:
0008-6363
Año:
2010
Vol.:
88
N°:
2
Págs.:
304 - 313
Revista:
EUROPEAN HEART JOURNAL
ISSN:
0195-668X
Año:
2010
Vol.:
31
N°:
8
Págs.:
1013 - 1021
Aims Although transplantation of skeletal myoblast (SkM) in models of chronic myocardial infarction (MI) induces an improvement in cardiac function, the limited engraftment remains a major limitation. We analyse in a pre-clinical model whether the sequential transplantation of autologous SkM by percutaneous delivery was associated with increased cell engraftment and functional benefit. Methods and results Chronically infarcted Goettingen minipigs (n = 20) were divided in four groups that received either media control or one, two, or three doses of SkM (mean of 329.6 x 10(6) cells per dose) at intervals of 6 weeks and were followed for a total of 7 months. At the time of sacrifice, cardiac function was significantly better in animals treated with SkM in comparison with the control group. A significantly greater increase in the Delta LVEF was detected in animals that received three doses vs. a single dose of SkM. A correlation between the total number of transplanted cells and the improvement in LVEF and Delta LVEF was found (P < 0.05). Skeletal myoblast transplant was associated with an increase in tissue vasculogenesis and decreased fibrosis (collagen vascular fraction) and these effects were greater in animals receiving three doses of cells. Conclusion Repeated injection of SkM in a model of chronic MI is feasible and safe and induces a significant improvement in cardiac function.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2010
Vol.:
63
N°:
11
Págs.:
1329 - 1339
Introduction and objectives. This article reports the findings of the 2009 Spanish national Catheter Ablation Registry.
Methods. Data were collected in two ways: retrospectively using a standard questionnaire and prospectively from a central database. Each center chose its own preferred method of data collection.
Results. Data were collected from 59 centers. The total number of ablation procedures carried out was 8546, giving a mean of 145 101 procedures per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2341; 27%), typical atrial flutter (n=1859; 21.7%) and accessory pathways (n=1758; 20.5%). The fourth most common condition was atrial fibrillation (n=1188; 14%), the number of which has grown by 44% since the 2008 registry. The overall success rate was 93%, major complications occurred in 1.9%, and the mortality rate was 0.046%.
Conclusions. Data from the 2009 registry show that the number of ablations carried out continued to increase and exceeded 8000 for the first time. In addition, they show, in general, a higher success rate and a lower number of complications. Cavotricuspid isthmus ablation, as treatment for typical atrial flutter, continued to be the second most common procedure. There was a substantial increase in the number of catheter ablations performed for atrial fibrillation compared with previous years.