1
|
Pagola J, Juega J, Francisco-Pascual J, Rodriguez M, Dorado L, Martinez R, De Lera-Alfonso M, Arenillas JF, Cabezas JA, Moniche F, de Torres R, Montaner J, Muchada M, Boned S, Requena M, García-Tornel A, Rodríguez-Villatoro N, Rodríguez-Luna D, Deck M, Olivé M, Rubiera M, Ribó M, Alvarez-Sabin J, Molina CA. Intensive 90-day textile wearable Holter monitoring: an alternative to detect paroxysmal atrial fibrillation in selected patients with cryptogenic stroke. Heart Vessels 2023; 38:114-121. [PMID: 35882656 DOI: 10.1007/s00380-022-02141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/15/2022] [Indexed: 01/06/2023]
Abstract
We aimed to demonstrate the feasibility of 90-day cardiac monitoring with an external Holter device and to find a target population able to benefit from such a technique. Cryptogenic stroke patients were continuously monitored for 90 days with a textile wearable Holter (TWH). Compliance and quality of the monitoring were assessed by the number of hours of ECG stored per month. Mean predictors of pAF, including age, gender, stroke severity, and atrial size (LAVI), were evaluated. One-year follow-up assessed pAF detection outside per protocol monitoring. Out of 224 patients included in 5 stroke centers, 163 patients (72.76%) fulfilled the criteria for the protocol. Median monitoring time was similar among the three months. Per protocol pAF detection reached 35.37% at 90 days. The age (OR 1.095; 95% CI 1.03-1.14) and the LAVI (OR 1.055; 95% CI 1.01-1.09) independently predicted pAF. The cut-off point of 70 years (AUC 0.68) (95% CI 0.60-0.76) predicted pAF with a sensitivity of 75.8% and specificity of 50.5%. The LAVI cut-off point of 28.5 (AUC 0.67) (95% CI 0.56-0.77) had a sensitivity of 63.6% and a specificity of 61.8% to detect pAF. The combination of both markers enhanced the validity of pAF detection sensitivity to 89.6%, with a specificity of 27.59%. These patients had increased risk of pAF during the 90-day monitoring HR 3.23 (χ2 7.15) and beyond 90 days (χ2 5.37). Intensive 90-days TWH monitoring detected a high percentage of pAF. However, a significant number of patients did not complete the monitoring. Patients older than 70 years and with enlarged left atria benefitted more from the protocol.
Collapse
Affiliation(s)
- Jorge Pagola
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
| | - Jesus Juega
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit-Cardiology Department, Vall d'Hebrón Hospital and CIBER-CV, Barcelona, Spain
| | - Maite Rodriguez
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Laura Dorado
- Stroke Unit Germans Trias I Pujol Hospital, Badalona, Spain
| | | | | | | | | | | | | | - Joan Montaner
- Stroke Unit, Virgen Macarena Hospital, Sevilla, Spain
| | - Marian Muchada
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Sandra Boned
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Manuel Requena
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Alvaro García-Tornel
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - David Rodríguez-Luna
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Matías Deck
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Marta Olivé
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Marta Rubiera
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Marc Ribó
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Jose Alvarez-Sabin
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Carlos A Molina
- Neurology Department, Stroke Unit Vall d'Hebrón Hospital and Autonomous University of Barcelona (Medicine Department), Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| |
Collapse
|
2
|
Palà E, Bustamante A, Pagola J, Juega J, Francisco-Pascual J, Penalba A, Rodriguez M, De Lera Alfonso M, Arenillas JF, Cabezas JA, Pérez-Sánchez S, Moniche F, de Torres R, González-Alujas T, Clúa-Espuny JL, Ballesta-Ors J, Ribas D, Acosta J, Pedrote A, Gonzalez-Loyola F, Gentile Lorente D, Ángel Muñoz M, Molina CA, Montaner J. Blood-Based Biomarkers to Search for Atrial Fibrillation in High-Risk Asymptomatic Individuals and Cryptogenic Stroke Patients. Front Cardiovasc Med 2022; 9:908053. [PMID: 35859587 PMCID: PMC9289129 DOI: 10.3389/fcvm.2022.908053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Atrial fibrillation (AF) increases the risk of ischemic stroke in asymptomatic individuals and may be the underlying cause of many cryptogenic strokes. We aimed to test the usefulness of candidate blood-biomarkers related to AF pathophysiology in two prospective cohorts representative of those populations. Methods Two hundred seventy-four subjects aged 65–75 years with hypertension and diabetes from the AFRICAT cohort, and 218 cryptogenic stroke patients aged >55 years from the CRYPTO-AF cohort were analyzed. AF was assessed by 4 weeks of monitoring with a wearable Holter device (NuuboTM™). Blood was collected immediately before monitoring started. 10 candidate biomarkers were measured by automated immunoassays (Roche, Penzberg) in the plasma of all patients. Univariate and logistic regression analyses were performed in each cohort separately. Results Atrial fibrillation detection rate was 12.4% (AFRICAT cohort) and 22.9% (CRYPTO-AF cohort). 4 biomarkers were significantly increased in asymptomatic individuals with AF [Troponin-T, Angiopoietin-2 (Ang-2), Endocan, and total N-terminal pro-B type natriuretic peptide (NT-proBNP)] and 7 biomarkers showed significantly higher concentrations in cryptogenic stroke patients with AF detection [growth differentiation factor 15, interleukin 6, Troponin-T, Ang-2, Bone morphogenic protein 10, Dickkopf-related protein 3 (DKK-3), and total NT-proBNP]. The models including Ang-2 and total NT-proBNP [AUC 0.764 (0.665–0.863)], and Ang-2 and DKK-3 [AUC = 0.733 (0.654–0.813)], together with age and sex, showed the best performance to detect AF in high-risk asymptomatic individuals, and in cryptogenic stroke patients, respectively. Conclusion Blood-biomarkers, in particular, total NT-proBNP, DKK-3, and Ang-2, were associated with AF reflecting two mechanistically different pathways involved in AF pathophysiology (AF stretch and vascular changes). The combination of these biomarkers could be useful in AF screening strategies in the primary care setting and also for searching AF after cryptogenic stroke.
Collapse
Affiliation(s)
- Elena Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jorge Pagola
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit-Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | | | - Juan F Arenillas
- Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
| | | | | | | | - Reyes de Torres
- Stroke Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Teresa González-Alujas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.,Echocardiography Lab Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
| | - Josep Lluís Clúa-Espuny
- Equip d'Atenció Primària Tortosa Est, SAP Terres de l'Ebre, Institut Català de la Salut, Tortosa, Spain.,Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Ebrictus Group, Barcelona, Spain
| | - Juan Ballesta-Ors
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Ebrictus Group, Barcelona, Spain
| | - Domingo Ribas
- EAP Sant Pere i Sant Pau, DAP Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Juan Acosta
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Alonso Pedrote
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Felipe Gonzalez-Loyola
- Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat Suport Recerca Barcelona, Barcelona, Spain
| | - Delicia Gentile Lorente
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Ebrictus Group, Barcelona, Spain.,Cardiology Department, Hospital Verge de la Cinta, Institut Català de la Salut, Tortosa, Spain
| | - Miguel Ángel Muñoz
- Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain.,Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Unitat Suport Recerca Barcelona, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Tobías-castillo PE, Jordán-marchité P, Martínez-martínez M, Francisco-pascual J. Patrón electrocardiográfico catastrófico durante neumonía por COVID-19. REC: CardioClinics 2022; 57:139-40. [DOI: 10.1016/j.rccl.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
4
|
Palà E, Pagola J, Juega J, Francisco-Pascual J, Penalba A, Rodriguez M, De Lera Alfonso M, Arenillas JF, Cabezas JA, Moniche F, de Torres R, Perez-Sanchez S, González-Alujas T, Molina CA, Bustamante A, Montaner J. Proteins and pathways in atrial fibrillation and atrial cardiomyopathy underlying cryptogenic stroke. Int J Cardiol Heart Vasc 2022; 39:100977. [PMID: 35281755 DOI: 10.1016/j.ijcha.2022.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022]
Abstract
Background Atrial fibrillation (AF) is one of the most prevalent causes of cryptogenic stroke. Also, apart from AF itself, structural and remodelling changes in the atria might be an underlying cause of cryptogenic stroke. We aimed to discover circulating proteins and reveal pathways altered in AF and atrial cardiomyopathy, measured by left atrial volume index (LAVI) and peak atrial longitudinal strain (PALS), in patients with cryptogenic stroke. Methods An aptamer array (including 1310 proteins) was measured in the blood of 20 cryptogenic stroke patients monitored during 28 days with a Holter device as a case-control study of the Crypto-AF cohort. Protein levels were compared between patients with (n = 10) and without AF (n = 10) after stroke, and the best candidates were tested in 111 patients from the same cohort (44 patients with AF and 67 without AF). In addition, in the first 20 patients, proteins were explored according to PALS and LAVI values. Results Forty-six proteins were differentially expressed in AF cases. Of those, four proteins were tested in a larger sample size. Only DPP7, presenting lower levels in AF patients, was further validated. Fifty-seven proteins correlated with LAVI, and 270 correlated with PALS. NT-proBNP was common in all the discovery analyses performed. Interestingly, many proteins and pathways were altered in patients with low PALS. Conclusions Multiple proteins and pathways related to AF and atrial cardiomyopathy have been revealed. The role of DPP7 as a biomarker for stroke aetiology should be further explored. Moreover, the present study may be considered hypothesis-generating.
Collapse
|
5
|
Francisco-Pascual J, Rivas-Gándara N, Bach-Oller M, Badia-Molins C, Maymi-Ballesteros M, Benito B, Pérez-Rodon J, Santos-Ortega A, Sambola-Ayala A, Roca-Luque I, Cantalapiedra-Romero J, Rodríguez-Silva J, Pascual-González G, Moya-Mitjans À, Ferreira-González I. Sex-Related Differences in Patients With Unexplained Syncope and Bundle Branch Block: Lower Risk of AV Block and Lesser Need for Cardiac Pacing in Women. Front Cardiovasc Med 2022; 9:838473. [PMID: 35282384 PMCID: PMC8914040 DOI: 10.3389/fcvm.2022.838473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze if there are sex-related differences in patients with unexplained syncope and bundle branch block (BBB). Background Despite increasing awareness that sex is a major determinant of the incidence, etiology, and the outcomes of different arrhythmias, no studies have examined differences in presentation and outcomes between men and women with syncope and BBB. Methods Cohort study of consecutive patients with unexplained syncope and BBB was included from January 2010 to January 2021 with a median follow-up time of 3.4 years [interquartile range (IQR) 1.7–6.0 years]. They were evaluated by a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM). Results Of the 443 patients included in the study, 165 (37.2%) were women. Compared with men, women had less diabetes (25.5 vs. 39.9%, p = 0.002) and less history of ischemic heart disease (IHD; 13.3 vs. 25.9%, p = 0.002). Left bundle branch block (LBBB) was more frequent in women (55.2 vs. 27.7%, p < 0.001) while right bundle branch block (RBBB) was more frequent in men (41.5 vs. 67.7%, p < 0.001). His to ventricle (HV) interval in the EPS was shorter in women (58 ms [IQR 52–71] vs. 60 ms [IQR 52–73], p = 0.035) and less women had an HV interval longer than 70 ms (28.5 vs. 38.1%, p = 0.039), however, EPS and ICM offered a similar diagnostic yield in both sexes (40.6 vs. 48.9% and 48.4% vs. 51.1%, respectively). Women had a lower risk of developing atrioventricular block (AVB) (adjusted odds ratio [OR] 0.44–95% CI 0.26–0.74, p = 0.002) and of requiring permanent pacemaker implantation (adjusted hazard ratio [HR] 0.72–95% CI: 0.52–0.99, p = 0.046). The mortality rate was lower in women (4.5 per 100 person-years [95% CI 3.1–6.4 per 100 person-years] vs. 7.3 per 100 person-years [95% CI 5.9–9.1 per 100 person-years]). Conclusions Compared to men, women with unexplained syncope and BBB have a lower risk of AVB and of requiring cardiac pacing. A stepwise diagnostic approach has a similar diagnostic yield in both sexes, and it seems appropriate to guide the treatment and avoid unnecessary pacemaker implantation, especially in women.
Collapse
Affiliation(s)
- Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Bach-Oller
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Maymi-Ballesteros
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonia Sambola-Ayala
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Arrhythmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Javier Cantalapiedra-Romero
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Silva
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gabriel Pascual-González
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Cardiology Department, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
6
|
Francisco-Pascual J, Cantalapiedra-Romero J, Pérez-Rodon J, Benito B, Santos-Ortega A, Maldonado J, Ferreira-Gonzalez I, Rivas-Gándara N. Cardiac monitoring for patients with palpitations. World J Cardiol 2021; 13:608-627. [PMID: 34909127 PMCID: PMC8641003 DOI: 10.4330/wjc.v13.i11.608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/27/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.
Collapse
Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Javier Cantalapiedra-Romero
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
| | - Jordi Pérez-Rodon
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Begoña Benito
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Alba Santos-Ortega
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Jenson Maldonado
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
| | - Ignacio Ferreira-Gonzalez
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Nuria Rivas-Gándara
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Barcelona, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid 28029, Spain
| |
Collapse
|
7
|
Rivas-gándara N, Francisco-pascual J, Pijuan-domenech A, Ribera-solé A, Dos-subirá L, Benito B, Terricabras M, Pérez-rodon J, Subirana MT, Santos-ortega A, Roses-noguer F, Miranda B, Moya-mitjans À, Ferreira-gonzález I. Estratificación del riesgo de arritmias ventriculares en pacientes con tetralogía de Fallot reparada. Rev Esp Cardiol 2021; 74:935-42. [PMID: 33461928 DOI: 10.1016/j.recesp.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
8
|
Rodríguez-García J, Pijuan-Domenech A, Francisco-Pascual J, Dos-Subirà L, Miranda-Barrio B, Santos-Ortega A, Rivas-Gándara N. Right ventricular resynchronization in a patient with repaired tetralogy of Fallot and severe ventricular dysfunction. Pacing Clin Electrophysiol 2021; 44:2119-2123. [PMID: 34414585 DOI: 10.1111/pace.14340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 08/07/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
Right ventricular (RV) resynchronization therapy (CRT) with stimulation electrode implantation in the latest activation area guided by a high-density electroanatomic activation map was successfully performed in a patient with repaired tetralogy of Fallot (rToF), severe pulmonary regurgitation (PR), and severe dysfunction and dilatation of the right ventricle. An improvement in his clinical condition and intraventricular synchrony was achieved. There is a mechanical-electrical interaction in the right ventricle of patients with rToF; therefore, RV CRT in selected cases may be beneficial. Electroanatomic activation mapping can help achieve maximum clinical benefit by identifying the optimal stimulation site.
Collapse
Affiliation(s)
- Julián Rodríguez-García
- Arrhythmia Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonia Pijuan-Domenech
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron-Sant Pau Integrated Unit for Congenital Heart Diseases of Adolescents and Adults, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Dos-Subirà
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron-Sant Pau Integrated Unit for Congenital Heart Diseases of Adolescents and Adults, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Berta Miranda-Barrio
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron-Sant Pau Integrated Unit for Congenital Heart Diseases of Adolescents and Adults, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
9
|
Muntané-Carol G, Urena M, Nombela-Franco L, Amat-Santos I, Kleiman N, Munoz-Garcia A, Atienza F, Serra V, Deyell MW, Veiga-Fernandez G, Masson JB, Canadas-Godoy V, Himbert D, Castrodeza J, Elizaga J, Francisco Pascual J, Webb JG, de la Torre Hernandez JM, Asmarats L, Pelletier-Beaumont E, Philippon F, Rodés-Cabau J. Arrhythmic burden in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement: 2-year results of the MARE study. Europace 2021; 23:254-263. [PMID: 33083813 DOI: 10.1093/europace/euaa213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years. Arrhythmic events were adjudicated in a central core lab. 1836 new arrhythmic events (tachyarrhythmias: 1655 and bradyarrhythmias: 181) occurred at 2 years. Of these, 283 (15%) occurred beyond 1 year (tachyarrhythmias 212, bradyarrhythmias 71) in 33 (36%) patients, without differences between valve type. Most late (>1 year) arrhythmic events were asymptomatic (94%) and led to a treatment change in 17 (19%) patients. A total of 71 late bradyarrhythmias [high-degree atrioventricular block (HAVB): 3, severe bradycardia: 68] were detected in 17 (21%) patients. At 2 years, 18 (17%) patients had received a permanent pacemaker (PPM) or implantable cardiac-defibrillator. PPM implantation due to HAVB predominated in the early phase post-TAVR, with only 1 HAVB event requiring PPM implantation after 1 year. CONCLUSION Patients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2 years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinicaltrials.gov: NCT02153307).
Collapse
Affiliation(s)
- Guillem Muntané-Carol
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Höpital Bichat-Claude Bernard, Paris, France
| | - Luis Nombela-Franco
- Department of Cardiology, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Ignacio Amat-Santos
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Neal Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Vicenç Serra
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc W Deyell
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, St Paul's hospital, Vancouver, British Columbia, Canada
| | | | - Jean-Bernard Masson
- Department of Cardiology, Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada
| | - Victoria Canadas-Godoy
- Department of Cardiology, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Dominique Himbert
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Höpital Bichat-Claude Bernard, Paris, France
| | - Javier Castrodeza
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Jaime Elizaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - John G Webb
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, St Paul's hospital, Vancouver, British Columbia, Canada
| | | | - Lluis Asmarats
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Emilie Pelletier-Beaumont
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Francois Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec City, G1V 4G5, Quebec, Canada
| |
Collapse
|
10
|
Rivas-Gándara N, Dos-Subirá L, Francisco-Pascual J, Rodríguez-García J, Pijuan-Domenech A, Benito B, Valente F, Pascual-González G, Santos-Ortega A, Miranda B, Pérez-Rodon J, Ribera-Solé A, Burcet-Rodriguez G, Roses-Noguer F, Gordon B, Rodríguez-Palomares J, Ferreira-González I. Substrate characterization of the right ventricle in repaired tetralogy of Fallot using late enhancement cardiac magnetic resonance. Heart Rhythm 2021; 18:1868-1875. [PMID: 34098087 DOI: 10.1016/j.hrthm.2021.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Three-dimensional (3D) substrate characterization by high-resolution late gadolinium enhancement cardiac magnetic resonance (LE-CMR) is useful for guiding ventricular tachycardia ablation of the left ventricle in ischemic heart disease. OBJECTIVE The purpose of this study was to validate the substrate characterization and 3D reconstruction of LE-CMR images of the right ventricle (RV) in patients with repaired tetralogy of Fallot (rTOF) and to identify the algorithm that best fits with electroanatomic mapping (EAM). METHODS RV LE-CMR images were compared with RV EAM in 10 patients with rTOF. RV LE-CMR images were postprocessed and analyzed to identify fibrotic tissue on 3D color maps. The 3D RV substrate reconstructions were created using an adjustable percentage of the maximum voxel signal intensity (MSI) of the scar region to define the threshold between core, transitional zone (TZ), and healthy tissue. Extensions of the core and TZ areas were compared with the scar (<0.5 mV) and low-voltage (0.5-1.5 mV) areas obtained by RV EAM. Agreement on anatomic isthmi identification was quantified. RESULTS The best match between core and scar was obtained at 65% MSI cutoff (mean areas 17.4 ± 9.9 cm2 vs 16.9 ± 10.0 cm2, respectively; r = 0.954; P <.001). Agreement on anatomic isthmi identification was best at 60% MSI cutoff, which identified 95% of isthmi and achieved a total fit in 90% of patients. CONCLUSION This study demonstrates that characterization of the RV substrate by postprocessing LE-CMR images in rTOF patients is feasible and validates the technique against RV EAM, which could help in planning target ablation.
Collapse
Affiliation(s)
- Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Laura Dos-Subirá
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julián Rodríguez-García
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antonia Pijuan-Domenech
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Filipa Valente
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiac Imaging Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Berta Miranda
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Aida Ribera-Solé
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Epidemiology Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Ferran Roses-Noguer
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cardiology and Pediatric Cardiac Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Blanca Gordon
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiac Imaging Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ignacio Ferreira-González
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
11
|
Muntané-Carol G, Nombela-Franco L, Serra V, Urena M, Amat-Santos I, Vilalta V, Chamandi C, Lhermusier T, Veiga-Fernandez G, Kleiman N, Canadas-Godoy V, Francisco-Pascual J, Himbert D, Castrodeza J, Fernandez-Nofrerias E, Baudinaud P, Mondoly P, Campelo-Parada F, De la Torre Hernandez JM, Pelletier-Beaumont E, Philippon F, Rodés-Cabau J. Late arrhythmias in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement using a balloon-expandable valve. Heart Rhythm 2021; 18:1733-1740. [PMID: 34082083 DOI: 10.1016/j.hrthm.2021.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The arrhythmic burden after discharge in patients with new-onset left bundle branch block (LBBB) undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable SAPIEN 3 (S3) valve remains largely unknown. OBJECTIVE The purpose of this study was to determine the incidence of late arrhythmias in patients with new-onset LBBB undergoing TAVR with the balloon-expandable S3 valve. METHODS This was a multicenter, prospective study that included 104 consecutive TAVR patients with new-onset persistent LBBB following TAVR with the S3 valve. An implantable cardiac monitor (Reveal XT, Reveal LINQ) was implanted before discharge. The primary endpoint was the incidence of high-degree atrioventricular block or complete heart block (HAVB/CHB). RESULTS A total of 40 patients (38.5%) had at least 1 significant arrhythmic event, leading to a treatment change in 17 (42.5%). Significant bradyarrhythmias occurred in 20 of 104 patients (19.2%) (34 HAVB/CHB episodes, 252 severe bradycardia episodes), with 10 of 20 patients (50%) exhibiting at least 1 episode of HAVB/CHB. Most HAVB/CHB episodes (60%) occurred within 4 weeks after discharge. Nine patients (8.7%) underwent permanent pacemaker implantation at 12 months based on the Reveal findings (6 HAVB/CHB, 3 severe bradycardia). CONCLUSION S3 valve recipients with new-onset LBBB have a high arrhythmic burden, with more than one-third of patients exhibiting at least 1 significant arrhythmic episode within 12 months (HAVB/CHB in 10% of patients). About one-half of bradyarrhythmic events occurred within 4 weeks after discharge. These results should inform future strategies on the use of continuous electrocardiographic monitoring in TAVR S3 patients with new conduction disturbances following the procedure.
Collapse
Affiliation(s)
- Guillem Muntané-Carol
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Vicenç Serra
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Höpital Bichat-Claude Bernard, Paris, France
| | - Ignacio Amat-Santos
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Victoria Vilalta
- Department of Cardiology, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Thibault Lhermusier
- Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France
| | | | - Neal Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | | | - Dominique Himbert
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Höpital Bichat-Claude Bernard, Paris, France
| | - Javier Castrodeza
- Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
| | | | - Pierre Baudinaud
- Department of Cardiology, Hôpital Européen George Pompidou, Paris, France
| | - Pierre Mondoly
- Department of Cardiology, Hôpital Universitaire de Toulouse, Toulouse, France
| | | | | | - Emilie Pelletier-Beaumont
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
| |
Collapse
|
12
|
Arbelo E, Angera I, Trucco E, Rivas-Gándara N, Guerra JM, Bisbal F, Jáuregui-Abularach M, Vallés E, Martin G, Sbraga F, Tolosana JM, Linhart M, Francisco-Pascual J, Montiel-Serrano J, Pereferrer D, Menéndez-Ramírez D, Jiménez J, Elamrani A, Borrás R, Dallaglio PD, Benito E, Santos-Ortega A, Rodríguez-Font E, Sarrias A, González-Matos CE, Martí-Almor J, Cabrera S, Mont L. Reduction in new cardiac electronic device implantations in Catalonia during COVID-19. Europace 2021; 23:456-463. [PMID: 33595062 PMCID: PMC7928966 DOI: 10.1093/europace/euab011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/13/2021] [Indexed: 12/27/2022] Open
Abstract
Aims During the COVID-19 pandemic, concern regarding its effect on the management of non-communicable diseases has been raised. However, there are no data on the impact on cardiac implantable electronic devices (CIED) implantation rates. We aimed to determine the impact of SARS-CoV2 on the monthly incidence rates and type of pacemaker (PM) and implantable cardiac defibrillator (ICD) implantations in Catalonia before and after the declaration of the state of alarm in Spain on 14 March 2020. Methods and results Data on new CIED implantations for 2017–20 were prospectively collected by nine hospitals in Catalonia. A mixed model with random intercepts corrected for time was used to estimate the change in monthly CIED implantations. Compared to the pre-COVID-19 period, an absolute decrease of 56.5% was observed (54.7% in PM and 63.7% in ICD) in CIED implantation rates. Total CIED implantations for 2017–19 and January and February 2020 was 250/month (>195 PM and >55 ICD), decreasing to 207 (161 PM and 46 ICD) in March and 131 (108 PM and 23 ICD) in April 2020. In April 2020, there was a significant fall of 185.25 CIED implantations compared to 2018 [95% confidence interval (CI) 129.6–240.9; P < 0.001] and of 188 CIED compared to 2019 (95% CI 132.3–243.7; P < 0.001). No significant differences in the type of PM or ICD were observed, nor in the indication for primary or secondary prevention. Conclusions During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia. Our findings call for measures to avoid long-term social impact.
Collapse
Affiliation(s)
- Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ignasi Angera
- Arrhythmia Section, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - José M Guerra
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felipe Bisbal
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Miguel Jáuregui-Abularach
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Ermengol Vallés
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Martin
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Fabrizio Sbraga
- Department of Cardiac Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - José María Tolosana
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - José Montiel-Serrano
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Damià Pereferrer
- Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Diego Menéndez-Ramírez
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Jesús Jiménez
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amin Elamrani
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Roger Borrás
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Arrhythmia Section, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Eva Benito
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - Enrique Rodríguez-Font
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Axel Sarrias
- Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Carlos E González-Matos
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Julio Martí-Almor
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Cabrera
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| |
Collapse
|
13
|
Francisco-Pascual J, Rivas-Gándara N, Santos-Ortega A, Pérez-Rodón J, Benito B, Belahnech Y, Ferreira-González I. [Cardiac biometric variables and arrhythmic events during COVID-19 pandemic lockdown in patients with an implantable cardiac monitor for syncope work-up]. Med Clin (Barc) 2021; 156:496-499. [PMID: 33642036 DOI: 10.1016/j.medcli.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022]
Abstract
AIM To assess the changes induced by the COVID-19 lockdown on cardiac biometric variables recorded using an implantable cardiac monitor (ICM) in a patient population monitored for syncope work-up, as well to assess whether there has been an effect on arrhythmic events among the patients. METHODS Longitudinal cohort study. We included 245 adult patients monitored with an ICM indicated for the investigation of syncope. The records from days 1 to 12 March 2020 (prior to the institution of lockdown by the state government) with days 16 to 28 March 2020 were compared. RESULTS Daily physical exercise reduced markedly after the imposition of lockdown (132 [55-233] minutes vs. 78 [21-154] minutes). The mean daytime HR prior to lockdown was 77 [69-85] bpm, whereas during lockdown it was 74 [66-81] bpm. During the lockdown period, a drop in the variability in heart rate (114 [94-136] ms vs. 111 [92-133] ms) was observed. Although the incidence of AF was similar over both periods, the daily AF burden was significantly higher post-lockdown (405 [391-425] minutes vs. 423 [423-537] minutes). No differences in the number of other arrhythmias were found. CONCLUSIONS The establishment of mandatory lockdown has led to a marked drop in daily physical activity in this population which probably explains changes observed in other cardiac biometric variables. Although, in the short term, we have not documented an increased risk of arrhythmia, we cannot rule out an effect in the medium to long term or in other populations of at-risk patients.
Collapse
Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain.
| | - Núria Rivas-Gándara
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain.
| | - Alba Santos-Ortega
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Begoña Benito
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Yassin Belahnech
- Unitat d'Arritmies. Servei de Cardiologia. Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-CV, Spain
| | - Ignacio Ferreira-González
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron. Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, CIBER-ESP, Spain
| |
Collapse
|
14
|
Francisco-Pascual J, Rodenas-Alesina E, Rivas-Gándara N, Belahnech Y, Olivella San Emeterio A, Pérez-Rodón J, Benito B, Santos-Ortega A, Moya-Mitjans À, Casas G, Cantalapiedra-Romero J, Maldonado J, Ferreira-González I. Etiology and prognosis of patients with unexplained syncope and mid-range left ventricular dysfunction. Heart Rhythm 2020; 18:597-604. [PMID: 33326869 DOI: 10.1016/j.hrthm.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Syncope in patients with mid-range left ventricular ejection fraction (LVEF) can be due to potentially serious arrhythmic causes. However, there is no clear consensus on the best way to manage these patients. OBJECTIVES The objectives of this study were to determine the causes of syncope and assess the diagnostic yield and safety of a stepwise workup protocol in this population. METHODS This was a prospective observational study. A stepwise workup protocol was applied to patients with LVEF 35%-50% and unexplained syncope after the initial assessment (step 1). RESULTS One hundred four patients were included {median age 75.6 years; (interquartile range [IQR] 67.6-81.2 years); median LVEF 45% (IQR 40%-48%); median follow-up 2.0 years (IQR 0.7-3.3 years). In 71 patients (68.3%), a diagnosis was reached: 55 (77.5%) in step 2 (hospital admission and electrophysiology study) and 16 (36.5%) in step 3 (implantable cardiac monitor). Arrhythmic causes were the most common etiology (45.2% auriculoventricular block and 9.6% ventricular tachycardia). Sixty patients (57.7%) required the implantation of a cardiac device and 11 had a defibrillation function. Patients diagnosed in step 3 had a higher global risk of recurrence of syncope (hazard ratio 6.5; 95% confidence interval 2.3-18.0). The mortality rate was 8.1 per 100 person-years, and the sudden or unknown death rate was 0.9 per 100 person-years. CONCLUSION In patients with mid-range left ventricular dysfunction and syncope of unknown cause, a systematic diagnostic strategy based on electrophysiology study and/or implantable cardiac monitor implantation allows a diagnosis to be reached in a high proportion of cases and guides the treatment. Arrhythmia is the most common cause of syncope in this population, particularly auriculoventricular block.
Collapse
Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Eduard Rodenas-Alesina
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Nuria Rivas-Gándara
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Yassin Belahnech
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Aleix Olivella San Emeterio
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Begoña Benito
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Santos-Ortega
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Àngel Moya-Mitjans
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillem Casas
- Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Javier Cantalapiedra-Romero
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jenson Maldonado
- Unitat d'Arritmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Universitat Autònoma de Barcelona, Bellaterra, Spain; Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
15
|
Rivas-Gándara N, Francisco-Pascual J. Do we have a new drug for heart rate control in patients with permanent atrial fibrillation? Rev Esp Cardiol 2020. [PMID: 32958412 DOI: 10.1016/j.recesp.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nuria Rivas-Gándara
- Unidad de Arritmias, Servicio Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Jaume Francisco-Pascual
- Unidad de Arritmias, Servicio Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| |
Collapse
|
16
|
Palà E, Pagola J, Juega J, Francisco-Pascual J, Bustamante A, Penalba A, Comas I, Rodriguez M, De Lera Alfonso M, Arenillas JF, de Torres R, Pérez-Sánchez S, Cabezas JA, Moniche F, González-Alujas T, Molina CA, Montaner J. B-type natriuretic peptide over N-terminal pro-brain natriuretic peptide to predict incident atrial fibrillation after cryptogenic stroke. Eur J Neurol 2020; 28:540-547. [PMID: 33043545 DOI: 10.1111/ene.14579] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are well-known surrogates of atrial fibrillation (AF) detection but studies usually present data on either BNP or NT-proBNP. The aim was to determine and directly compare the validity of the two biomarkers as a tool to predict AF and guide prolonged cardiac monitoring in cryptogenic stroke patients. METHODS Non-lacunar acute ischaemic stroke (<72 h) patients over 55 years of age with cryptogenic stroke after standard evaluation were included in the Crypto-AF study and blood was collected. BNP and NT-proBNP levels were determined by automated immunoassays. AF was assessed by 28 days' monitoring. Highest (optimizing specificity) and lowest (optimizing sensitivity) quartiles were used as biomarker cut-offs to build predictive models adjusted by sex and age. The integrated discrimination improvement index (IDI) and DeLong test were used to compare the performance of the two biomarkers. RESULTS From 320 patients evaluated, 218 were included in the analysis. AF was detected in 50 patients (22.9%). NT-proBNP (P < 0.001) and BNP (P < 0.001) levels were higher in subjects with AF and their levels correlated (r = 0.495, P < 0.001). BNP showed an increased area under the curve (0.720 vs. 0.669; P = 0.0218) and a better predictive capacity (IDI = 3.63%, 95% confidence interval 1.36%-5.91%) compared to NT-proBNP. BNP performed better than NT-proBNP in a specific model (IDI = 3.7%, 95% confidence interval 0.87%-6.5%), whilst both biomarkers performed similarly in the case of a sensitive model. CONCLUSIONS Both BNP and NT-proBNP were increased in cryptogenic stroke patients with AF detection. Interestingly, BNP outperforms NT-proBNP, especially in terms of specificity.
Collapse
Affiliation(s)
- E Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Pagola
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - J Juega
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - J Francisco-Pascual
- Arrhythmia Unit-Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
| | - A Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Comas
- Clinical Biochemestry Service, Clinical Laboratories, Vall d'Hebrón Hospital, Barcelona, Spain
| | - M Rodriguez
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | | | - J F Arenillas
- Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
| | - R de Torres
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - S Pérez-Sánchez
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - J A Cabezas
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - F Moniche
- Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
| | - T González-Alujas
- Echocardiography Lab Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
| | - C A Molina
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Pagola J, Juega J, Francisco-Pascual J, Bustamante A, Penalba A, Pala E, Rodriguez M, De Lera-Alfonso M, Arenillas JF, Cabezas JA, Moniche F, de Torres R, Montaner J, González-Alujas T, Alvarez-Sabin J, Molina CA. Predicting Atrial Fibrillation with High Risk of Embolization with Atrial Strain and NT-proBNP. Transl Stroke Res 2020; 12:735-741. [PMID: 33184686 DOI: 10.1007/s12975-020-00873-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
The aim of the study was to determine markers of atrial dysfunction in patients with cryptogenic stroke to predict episodes of paroxysmal atrial fibrillation with high risk of embolization (HpAF). We classified patients included in the Crypto-AF study, Cryptogenic Stroke registry, to detect paroxysmal atrial fibrillation (pAF) with wearable Holter, according to the longest episode of pAF in three groups: without pAF detection, episodes of pAF shorter than 5 h, and episodes of pAF longer than 5 h (HpAF). Atrial dysfunction surrogates were evaluated: EKG pattern, Holter record and echocardiography parameters (left atria volume (LAVI), and peak atrial longitudinal and contraction strain (PALS and PACS). The level of N-terminal pro b-type natriuretic peptide (NT-proBNP) was determined. All patients were followed for 2 years to detect pAF and stroke recurrence. From 308 patients, 253 patients with high quality Holter analysis were selected. The distribution was No pAF 78.6% (n = 199), pAF < 5 h 7.9% (n = 20), and HpAF > 5 h 13.4% (n = 34). Age of the patients and combination of PALS and NT-proBNP independently predicted HpAF OR 1.07 (1.00; 1.15) and OR 3.05 (1.08; 8.60) respectively. The validity of PALS and NT-proBNP to detect patients at risk of HpAF was higher than the validity of age (AUC 0.82, sensitivity 78.95%, specificity 63%). Patients with PALS < 25% and NT-proBNP > 283 pg/ml had more detection of pAF during follow-up 35% vs. 5.1% OR 2.33 (1.05-5.13) (p < 0.001). Multimodal assessment of atrial dysfunction with PALS and NT-proBNP improved the prediction of pAF episodes with high embolic risk in patients with cryptogenic stroke.
Collapse
Affiliation(s)
- Jorge Pagola
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
| | - Jesus Juega
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | | | | | - Anna Penalba
- Neurovascular Research Lab, Valld'Hebrón Research Institute, Barcelona, Spain
| | - Elena Pala
- Neurovascular Research Lab, Valld'Hebrón Research Institute, Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | | | - Juan F Arenillas
- Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
| | - Juan Antonio Cabezas
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | - Francisco Moniche
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | - Reyes de Torres
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | - Joan Montaner
- Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
| | | | - Jose Alvarez-Sabin
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain
| | | |
Collapse
|
18
|
Francisco-Pascual J, Olivella San Emeterio A, Rivas-Gándara N, Pérez-Rodón J, Benito B, Santos-Ortega A, Moya-Mitjans À, Rodríguez García J, Llerena Butrón SI, Cantalapiedra Romero J, Ferreira González I. High incidence of subclinical atrial fibrillation in patients with syncope monitored with implantable cardiac monitor. Int J Cardiol 2020; 316:110-116. [PMID: 32470530 DOI: 10.1016/j.ijcard.2020.05.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/11/2022]
|
19
|
Pagola J, Juega J, Francisco‐Pascual J, Bustamante A, Penalba A, Pala E, Rodriguez M, De Lera Alfonso M, Arenillas JF, Cabezas JA, Moniche F, Torres R, Montaner J, González‐Alujas T, Alvarez‐Sabin J, Molina CA. Large vessel occlusion is independently associated with atrial fibrillation detection. Eur J Neurol 2020; 27:1618-1624. [PMID: 32347993 DOI: 10.1111/ene.14281] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 01/11/2023]
Affiliation(s)
- J. Pagola
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | - J. Juega
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | - J. Francisco‐Pascual
- Arrhythmia Unit Cardiology Department Vall d'Hebrón Hospital Barcelona Spain
- CIBER‐CV. Instituto de Salud Carlos III Madrid Spain
| | - A. Bustamante
- Neurovascular Research Laboratory Vall d'Hebrón Research Institute Barcelona, Spain
| | - A. Penalba
- Neurovascular Research Laboratory Vall d'Hebrón Research Institute Barcelona, Spain
| | - E. Pala
- Neurovascular Research Laboratory Vall d'Hebrón Research Institute Barcelona, Spain
| | - M. Rodriguez
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | | | - J. F. Arenillas
- Stroke Unit University Hospital of Valladolid Valladolid Spain
| | - J. A. Cabezas
- Stroke Unit University Hospital Virgen del Rocio Sevilla Spain
| | - F. Moniche
- Stroke Unit University Hospital Virgen del Rocio Sevilla Spain
| | - R. Torres
- Stroke Unit University Hospital Virgen Macarena Sevilla Spain
| | - J. Montaner
- Stroke Unit University Hospital Virgen Macarena Sevilla Spain
| | - T. González‐Alujas
- CIBER‐CV. Instituto de Salud Carlos III Madrid Spain
- Echocardiography Laboratory Cardiology Department Vall d'Hebrón Hospital Barcelona Spain
| | - J. Alvarez‐Sabin
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | - C. A. Molina
- Stroke Unit Neurology Department and Medicine Department Vall d'Hebrón Hospital and Autonomous University of Barcelona Barcelona Spain
| | | |
Collapse
|
20
|
Francisco-Pascual J, Rodenas E, Belahnech Y, Rivas-Gándara N, Pérez-Rodon J, Santos-Ortega A, Benito B, Roca-Luque I, Cossio-Gil Y, Serra Garcia V, Llerena-Butron S, Rodríguez-García J, Moya-Mitjans A, García-Dorado D, Ferreira-González I. Syncope in Patients With Severe Aortic Stenosis: More Than Just an Obstruction Issue. Can J Cardiol 2021; 37:284-91. [PMID: 32439473 DOI: 10.1016/j.cjca.2020.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Severe aortic stenosis (AoS) is considered a primary cause of syncope. However, other mechanisms may be present in these patients and accurate diagnosis can have important clinical implications. The aim of this study is to assess the different etiologies of syncope in patients with severe AoS and the impact on prognosis of attaining a certain or highly probable diagnosis for the syncope. METHODS Out of a cohort of 331 patients with AoS and syncope, 61 had severe AoS and were included in the study. Main cause of syncope and adverse cardiac events were assessed. RESULTS In 40 patients (65.6%), we reached a certain or highly probable diagnosis of the main cause of the syncope. AoS was considered the primary cause of the syncope in only 7 patients (17.5% of the patients with known etiology). Atrioventricular block (14 patients, 35.0%) and vasovagal syncope (6 patients, 15.0%) were the most frequently diagnosed causes. The presence of a known cause for syncope during the admission was not associated with a lower incidence of recurrence during follow-up (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.20-2.40). Syncope of unknown etiology was independently associated with greater mortality during 1-year follow-up (HR 5.4, 95% CI 1.3-21.6) and 3-year follow-up (HR 3.5, 95% CI 1.2-10.3). CONCLUSIONS In a high proportion of patients with severe AoS admitted for syncope, the valvulopathy was not the main cause of the syncope. Syncope in two-thirds of this population was caused by either bradyarrhythmia or reflex causes. Syncope of unknown cause was associated with increased short- and medium-term mortality, independently from treatment of the valve disease. An exhaustive work-up should be conducted to determine the main cause for syncope.
Collapse
|
21
|
Faroux L, Muntané-Carol G, Urena M, Nombela-Franco L, Amat-Santos I, Kleiman N, Munoz-Garcia A, Atienza F, Serra V, Deyell MW, Veiga-Fernandez G, Masson JB, Canadas-Godoy V, Himbert D, Fischer Q, Castrodeza J, Elizaga J, Pascual JF, Webb JG, de la Torre JM, Asmarats L, Pelletier-Beaumont E, Alméndarez M, Couture T, Philippon F, Rodes-Cabau J. Late Electrocardiographic Changes in Patients With New-Onset Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:795-802. [PMID: 31889524 DOI: 10.1016/j.amjcard.2019.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/29/2022]
Abstract
This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.
Collapse
Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Neal Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Felipe Atienza
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc W Deyell
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | - Dominique Himbert
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Jaime Elizaga
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Marcel Alméndarez
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
| |
Collapse
|
22
|
Riera-Mestre A, Camafort M, María Suriñach J, Muñoz Rodríguez FJ, Padilla F, Francisco-Pascual J, Mateo Arranz J, Martínez Rubio A, Villuendas Sabaté R, Freixa-Pamias R, Suárez Fernández C, Santamaría A. Anticoagulación del paciente anciano pluripatológico con fibrilación auricular no valvular: papel del rivaroxabán. Revista Española de Cardiología Suplementos 2020. [DOI: 10.1016/s1131-3587(20)30011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
23
|
Cano Ó, Bellver A, Fontenla A, Villuendas R, Peñafiel P, Francisco-Pascual J, Ibáñez JL, Bertomeu-González V, García-Riesco L, García-Seara J, Martínez-Brotons Á, Calvo D, Campos B, Enero J, Peláez A, Martínez-Ferrer J, Mazuelos F, Moriñigo JL, Expósito C, Arenal Á, Pombo M, Segura F, Pastor A, Pérez F, Fernández-Lozano I, González-Ferrer JJ, Moreno S, Martín-Fernández J, Ormaetxe J, Pavón R, Tolosana JM, Mercé J, García-Almagro FJ, Álvarez M, Macías A, Peinado R, Linde C, Normand C, Dickstein K. Resultados en España de la encuesta de la Sociedad Europea de Cardiología sobre terapia de resincronización cardiaca (CRT-Survey II). Rev Esp Cardiol 2019. [PMID: 30935899 DOI: 10.1016/j.recesp.2018.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
24
|
Sambola A, Roca Luque I, Mercé J, Alguersuari J, Francisco-Pascual J, García-Dorado D, Sagristà-Sauleda J. Colchicina administrada en el primer episodio de pericarditis aguda idiopática: estudio multicéntrico abierto y aleatorizado. Rev Esp Cardiol 2019. [PMID: 30683494 DOI: 10.1016/j.recesp.2018.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Antonia Sambola
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Ivo Roca Luque
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Jordi Mercé
- Servei de Cardiologia. Hospital Universitari Joan XXII, Tarragona, Spain
| | - Joan Alguersuari
- Servicio de Cardiología. Hospital Son Espases, Palma de Mallorca, Baleares, Spain
| | - Jaume Francisco-Pascual
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - David García-Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Jaume Sagristà-Sauleda
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
| |
Collapse
|
25
|
Francisco-Pascual J, Santos-Ortega A, Roca-Luque I, Rivas-Gándara N, Pérez-Rodón J, Milà-Pascual L, García-Dorado D, Moya-Mitjans À. Rendimiento diagnóstico y evaluación económica de un protocolo diagnóstico basado en el uso sistemático de un registrador externo de eventos en asa cerrada en pacientes con palpitaciones. Rev Esp Cardiol 2019. [PMID: 29805092 DOI: 10.1016/j.recesp.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
| | - Alba Santos-Ortega
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Ivo Roca-Luque
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Nuria Rivas-Gándara
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Laia Milà-Pascual
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - David García-Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Àngel Moya-Mitjans
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| |
Collapse
|
26
|
Casas G, Rivas-Gándara N, Francisco-Pascual J, Moya-Mitjans À, García-Dorado D. Postural Orthostatic Tachycardia Syndrome and Vasospastic Angina: Therapeutic Approach to a Previously Unreported Association. Rev Esp Cardiol 2019. [PMID: 30322723 DOI: 10.1016/j.recesp.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Guillem Casas
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Nuria Rivas-Gándara
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | | | - Àngel Moya-Mitjans
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - David García-Dorado
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Barcelona, Spain
| |
Collapse
|
27
|
Roca-luque I, Francisco-pascual J, Oristrell G, Rodríguez-garcía J, Santos-ortega A, Martin-sanchez G, Rivas-gandara N, Perez-rodon J, Ferreira-gonzalez I, García-dorado D, Moya-mitjans A. Syncope, conduction disturbance, and negative electrophysiological test: Predictive factors and risk score to predict pacemaker implantation during follow-up. Heart Rhythm 2019; 16:905-12. [PMID: 30576876 DOI: 10.1016/j.hrthm.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 12/27/2022]
|
28
|
Alventosa-Zaidin M, Pera G, Roca Saumell C, Mengual Miralles N, Zamora Sanchez MV, Gros Garcia T, Guix Font L, Benitez Camps M, Francisco-Pascual J, Brugada Terradellas J. Diagnosis of right bundle branch block: a concordance study. BMC Fam Pract 2019; 20:58. [PMID: 31060516 PMCID: PMC6501399 DOI: 10.1186/s12875-019-0946-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.
Collapse
Affiliation(s)
- M Alventosa-Zaidin
- Bon Pastor, Primary Healthcare Center, Catalan Health Institute, Barcelona, Catalonia, Spain.
| | - G Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain
| | - C Roca Saumell
- EAP El Clot, Primary Healthcare Center, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - N Mengual Miralles
- EAP Ronda Cerdanya, Primary Healthcare Center, Catalan Health Institute, Mataró, Barcelona, Spain
| | - M V Zamora Sanchez
- EAP El Gòtic, Primary Healthcare Center, Catalan Health Institute, Barcelona, Spain
| | - T Gros Garcia
- EAP Ronda Cerdanya, Primary Healthcare Center, Catalan Health Institute, Mataró, Barcelona, Spain
| | - L Guix Font
- EAP Berga, Primary Healthcare Center, Catalan Health Institute, Berga, Barcelona, Spain
| | - M Benitez Camps
- EAP El Gòtic, Primary Healthcare Center, Catalan Health Institute, Barcelona, Spain
| | - J Francisco-Pascual
- Unity of arithmies. Servei de cardiologia. University Hospital Vall Hebrón, Research Institut, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - J Brugada Terradellas
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| |
Collapse
|
29
|
Roca-Luque I, Francisco-Pasqual J, Oristrell G, Rodríguez-García J, Santos-Ortega A, Martin-Sanchez G, Rivas-Gandara N, Perez-Rodon J, Ferreira-Gonzalez I, García-Dorado D, Moya-Mitjans A. Flecainide Versus Procainamide in Electrophysiological Study in Patients With Syncope and Wide QRS Duration. JACC Clin Electrophysiol 2019; 5:212-219. [PMID: 30784693 DOI: 10.1016/j.jacep.2018.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
|
30
|
Roca‐Luque I, Rivas‐Gándara N, Francisco‐Pascual J, Rodriguez‐Sanchez J, Cuellar‐Calabria H, Rodriguez‐Palomares J, García‐Del Blanco B, Pérez‐Rodon J, Santos‐Ortega A, Rosés‐Noguer F, Marsal R, Rubio B, García DG, Moya Mitjans A. Preprocedural imaging to guide transcoronary ethanol ablation for refractory septal ventricular tachycardia. J Cardiovasc Electrophysiol 2019; 30:448-456. [PMID: 30556327 DOI: 10.1111/jce.13816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/29/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ivo Roca‐Luque
- Arrhythmia UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | - Nuria Rivas‐Gándara
- Arrhythmia UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | | | - Jose Rodriguez‐Sanchez
- Cardiovascular Image UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | - Hug Cuellar‐Calabria
- Cardiovascular Image UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | | | - Bruno García‐Del Blanco
- Interventional Cardiology UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | - Jordi Pérez‐Rodon
- Arrhythmia UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | - Alba Santos‐Ortega
- Arrhythmia UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | - Ferran Rosés‐Noguer
- Arrhythmia UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| | - Roger Marsal
- Engineering UnitAbbott Medical, St. Paul Minnesota
| | | | | | - Angel Moya Mitjans
- Arrhythmia UnitCardiology Service, Hospital Universitari Vall d'HebronBarcelona Spain
| |
Collapse
|
31
|
Roca-Luque I, Oristrell G, Francisco-Pasqual J, Rodríguez-García J, Santos-Ortega A, Martin-Sanchez G, Rivas-Gandara N, Perez-Rodon J, Ferreira-Gonzalez I, García-Dorado D, Moya-Mitjans A. Predictors of positive electrophysiological study in patients with syncope and bundle branch block: PR interval and type of conduction disturbance. Clin Cardiol 2018; 41:1537-1542. [PMID: 30251426 DOI: 10.1002/clc.23079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Electrophysiological study (EPS) is indicated in patients with syncope and bundle branch block (BBB). Data about predictors of positive EPS in these patients is scarce. OBJECTIVE To assess clinical and electrocardiographic (ECG) predictors of positive EPS in patients with syncope and BBB. METHODS Observational single-center study that included all consecutive patients with syncope and BBB that underwent EPS from January 2011 to June 2017. Results of EPS were considered positive according to current ESC syncope guidelines. RESULTS During study period, 271 patients were included (64.9% male, age: 73.9 ± 12.2 years, number of syncopal episodes: 2.4 ± 2.5, LVEF: 56.1 ± 9.9%). Type of BBB: RBBB + LAFB/LPFB in 39.8%, isolated LBBB in 38.7% and isolated RBBB in 18.5% of the patients. Duration of QRS and PR interval were 141.9 ± 16.7 and 182.8 ± 52.2 milliseconds. EPS was positive in 41.7% of the patients. In multivariate analysis, conduction disturbance pattern and long PR interval (OR 8.6; 2.9-25; P < 0.0001) were predictors of positive EPS. Conduction disturbance patterns related with positive EPS were: BBB different than isolated RBBB (OR 15.2; 2.2-23.4; P = 0.005), LBBB or RBBB+long PR + left fascicular block (OR 4.5; 1.06-20.01; P < 0.042), and RBBB+left fascicular block compared with LBBB (OR 4.8; 1.2-16.7; P = 0.025). Clinical factors and syncope characteristics were not related with EPS result. CONCLUSIONS Diagnostic yield of EPS in patients with syncope and BBB is moderate (41%). Type of conduction disturbance pattern and PR interval are associated with the electrophysiological (EP) test result. Patients with LBBB or bifascicular block have the highest rate of positive EP test. Long PR interval increases the proportion of positive EPS in all conduction disturbance patterns.
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gerard Oristrell
- Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Alba Santos-Ortega
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriel Martin-Sanchez
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Rivas-Gandara
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Perez-Rodon
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Cardiovascular epidemiology Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Angel Moya-Mitjans
- Arrhythmia Unit. Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
32
|
Roca-Luque I, Rivas-Gándara N, Subirà LD, Francisco-Pascual J, Pijuan-Domenech A, Pérez-Rodon J, Teresa-Subirana M, Santos-Ortega A, Rosés-Noguer F, Ferrer JC, Ferreira-Gonzalez I, García-Dorado García D, Mitjans AM. Mechanisms of Intra-Atrial Re-Entrant Tachycardias in Congenital Heart Disease: Types and Predictors. Am J Cardiol 2018; 122:672-682. [PMID: 30001804 DOI: 10.1016/j.amjcard.2018.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 11/25/2022]
Abstract
Intra-atrial re-entrant tachycardia (IART) is a severe complication in patients with congenital heart disease (CHD). Cavotricuspid isthmus (CTI)-related IART is the most frequent mechanism. However, due to fibrosis and surgical scars, non-CTI-related IART is frequent. The main objective of this study was to describe the types of IART, circuit locations, and to analyze predictors of CTI versus non-CTI-related IART. This is an observational study that includes all consecutive patients with CHD who underwent a first IART ablation in a single referral tertiary hospital from January 2009 to December 2015 (94 patients; 39.4% women; age: 36.55 ± 14.9 years, 40.4% with highly complex cardiac disease). During the study, 114 IARTs were ablated (1.21 ± 0.41 IARTs per patient). CTI-related IART was the only arrhythmia in 51% (n = 48) of patients; non-CTI-related IART was the only mechanism in 27.7% (n = 26), and 21.3% of patients (n = 20) presented the two types of IART. Severe dilation of the systemic ventricle, absence of severe dilation of the venous atrium, highly complex cardiac defects, and nontypical electrocardiography (ECG) were related to non-CTI-related IART in univariate analysis. In multivariate analysis, nontypical ECG (odds ratio 3.64; 1.01 to 4.9; p = 0.049) and grade III CHD complexity (odds ratio 9.43; 1.44 to 11.7; p = 0.001) were predictors of non-CTI-related IART. In conclusion, in our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% (alone or with concomitant CTI-related IART). High-grade CHD complexity and nontypical ECG were strongly related to non-CTI IART.
Collapse
|
33
|
Rodés-Cabau J, Urena M, Nombela-Franco L, Amat-Santos I, Kleiman N, Munoz-Garcia A, Atienza F, Serra V, Deyell MW, Veiga-Fernandez G, Masson JB, Canadas-Godoy V, Himbert D, Castrodeza J, Elizaga J, Francisco Pascual J, Webb JG, de la Torre JM, Asmarats L, Pelletier-Beaumont E, Philippon F. Arrhythmic Burden as Determined by Ambulatory Continuous Cardiac Monitoring in Patients With New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1495-1505. [PMID: 30031719 DOI: 10.1016/j.jcin.2018.04.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
|
34
|
Roca-Luque I, Rivas Gándara N, Dos Subirà L, Francisco Pascual J, Pérez-Rodon J, Pijuan Domenech A, Subirana MT, Miranda B, Santos Ortega A, Casaldàliga Ferrer J, García-Dorado García D, Moya Mitjans A. Intra-atrial re-entrant tachycardia in patients with congenital heart disease: factors associated with disease severity. Europace 2018; 20:1343-1351. [PMID: 29016882 DOI: 10.1093/europace/eux180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
Abstract
Aim Intra-atrial re-entrant tachycardia (IART) is a common complication in patients with congenital heart disease (CHD) and is related to increased morbidity and mortality. Few reports have been published about factors associated to IART severity. The aim of this study is to analyse factors associated to severe clinical presentation of IART. Methods and Results Observational study of all consecutive CHD patients who underwent a first IART ablation from January 2009 to December 2015 (94 patients, 39.4% female, and age: 36.55 ± 14.9 years). Severe clinical presentation was defined as heart failure, syncope, shock, electromechanical dissociation (EMD), or aborted sudden death. The majority of patients had moderately or highly complex cardiac defect (90.4%). Types of IART included cavotricuspid isthmus(CTI) dependent in 51% (48), non-CTI-related in 22.3% (20), and both types in 27.7% (26). In 38 patients (40.4%), a severe event occurred and in 16 (17%), the symptoms included shock, syncope, sudden death, or EMD. In 21 (22.3%), severe symptoms were the first manifestation of IART. In multivariate analysis, transposition of the great arteries (TGA) with right systemic ventricle (OR 5.32, 95% C.I. 1.6-7.02, P = 0.0005) and severe dilation of the venous atrium (VsA) (OR 4.17; 95% CI 1.4-8.12, P = 0.0009) were factors independently associated with severity. Conclusion In our series of 94 CHD patients with a high proportion of moderately to highly complex cardiac defects, severe consequences of IART were frequent. Transposition of the great arteries with systemic right ventricle and severe dilation of VsA were independently associated to severity. Early invasive procedures should be considered for these high-risk patients.
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Laura Dos Subirà
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Antònia Pijuan Domenech
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Ma Teresa Subirana
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Berta Miranda
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Spain
| | | | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Pg Vall d' Hebron 119-129, Barcelona, Spain
| |
Collapse
|
35
|
Roca-Luque I, Rivas-Gándara N, Dos Subirà L, Francisco Pascual J, Pijuan-Domenech A, Pérez-Rodon J, Subirana-Domenech M, Santos-Ortega A, Rosés-Noguer F, Miranda-Barrio B, Ferreira-Gonzalez I, Casaldàliga Ferrer J, García-Dorado García D, Moya Mitjans A. Long-Term Follow-Up After Ablation of Intra-Atrial Re-Entrant Tachycardia in Patients With Congenital Heart Disease. JACC Clin Electrophysiol 2018; 4:771-780. [PMID: 29929671 DOI: 10.1016/j.jacep.2018.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/02/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022]
|
36
|
Pérez-Rodon J, Galve E, Pérez-Bocanegra C, Soriano-Sánchez T, Recio-Iglesias J, Domingo-Baldrich E, Alzola-Guevara M, Ferreira-González I, Marsal JR, Ribera-Solé A, Gutierrez García-Moreno L, Cruz-Carlos LM, Rivas-Gandara N, Roca-Luque I, Francisco-Pascual J, Evangelista-Masip A, Moya-Mitjans À, García-Dorado D. A risk score to predict the absence of left ventricular reverse remodeling: Implications for the timing of ICD implantation in primary prevention. J Cardiol 2018; 71:505-512. [PMID: 29183646 DOI: 10.1016/j.jjcc.2017.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
|
37
|
Moya A, Rivas-gandara N, Perez-rodón J, Franciso-pascual J, Santos-ortega A, Fumero P, Roca-luque I. Syncope and bundle branch block: Diagnostic approach. Herzschrittmacherther Elektrophysiol 2018; 29:161-5. [PMID: 29696347 DOI: 10.1007/s00399-018-0560-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/03/2018] [Indexed: 01/14/2023]
|
38
|
Roca-Luque I, Rivas-Gándara N, Dos-Subirà L, Francisco-Pascual J, Pijuan-Domenech A, Pérez-Rodon J, Santos-Ortega A, Roses-Noguer F, Ferreira-Gonzalez I, García-Dorado García D, Moya Mitjans A. Predictors of Acute Failure Ablation of Intra-atrial Re-entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation. J Am Heart Assoc 2018; 7:e008063. [PMID: 29602766 PMCID: PMC5907589 DOI: 10.1161/jaha.117.008063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/13/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Intra-atrial re-entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first-line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD. METHODS AND RESULTS The observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus-related IART was the only arrhythmia in 51%; non-cavotricuspid isthmus-related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9-17.9; P=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3-18.4; P=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4-17.2; P=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1-21.7; P=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74-0.93, P=0.001). After a mean follow-up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure). CONCLUSIONS Although ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate-highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Fibrillation/complications
- Atrial Fibrillation/diagnosis
- Atrial Fibrillation/physiopathology
- Atrial Flutter/complications
- Atrial Flutter/diagnosis
- Atrial Flutter/physiopathology
- Child
- Child, Preschool
- Echocardiography
- Electrocardiography
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Humans
- Male
- Middle Aged
- Prospective Studies
- Radiofrequency Ablation/adverse effects
- Retrospective Studies
- Risk Factors
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/etiology
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Time Factors
- Treatment Failure
- Young Adult
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Dos-Subirà
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Antònia Pijuan-Domenech
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ferran Roses-Noguer
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
39
|
Pagola J, Juega J, Francisco-Pascual J, Moya A, Sanchis M, Bustamante A, Penalba A, Usero M, Cortijo E, Arenillas JF, Calleja AI, Sandin-Fuentes M, Rubio J, Mancha F, Escudero-Martinez I, Moniche F, de Torres R, Pérez-Sánchez S, González-Matos CE, Vega Á, Pedrote AA, Arana-Rueda E, Montaner J, Molina CA. Yield of atrial fibrillation detection with Textile Wearable Holter from the acute phase of stroke: Pilot study of Crypto-AF registry. Int J Cardiol 2017; 251:45-50. [PMID: 29107360 DOI: 10.1016/j.ijcard.2017.10.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND We describe the feasibility of monitoring with a Textile Wearable Holter (TWH) in patients included in Crypto AF registry. METHODS We monitored cryptogenic stroke patients from stroke onset (<3days) continuously during 28days. We employed a TWH composed by a garment and a recorder. We compared two garments (Lead and Vest) to assess rate of undiagnosed Atrial Fibrillation (AF) detection, monitoring compliance, comfortability (1 to 5 points), skin lesions, and time analyzed. We describe the timing of AF detection in three periods (0-3, 4-15 and 16-28days). RESULTS The rate of undiagnosed AF detection with TWH was 21.9% (32 out of 146 patients who completed the monitoring). Global time compliance was 90% of the time expected (583/644h). The level of comfortability was 4 points (IQR 3-5). We detected reversible skin lesions in 5.47% (8/146). The comfortability was similar but time compliance (in hours) was longer in Vest group 591 (IQR [521-639]) vs. Lead 566 (IQR [397-620]) (p=0.025). Also, time analyzed was more prolonged in Vest group 497 (IQR [419-557]) vs. Lead (336h (IQR [140-520]) (p=0.001)). The incidence of AF increases from 5.6% (at 3days) to 17.5% (at 15th day) and up to 20.9% (at 28th day). The percentage of AF episodes detected only in each period was 12.5% (0-3days); 21.7% (4-15days) and 19% (16-28days). CONCLUSIONS 28days Holter monitoring from the acute phase of the stroke was feasible with TWH. Following our protocol, only five patients were needed to screen to detected one case of AF.
Collapse
Affiliation(s)
- Jorge Pagola
- Stroke Unit, Vall d'Hebrón Hospital, Departament de Medicina, Universitat Autònoma de Barcelona.
| | - Jesus Juega
- Stroke Unit, Vall d'Hebrón Hospital, Departament de Medicina, Universitat Autònoma de Barcelona
| | | | - Angel Moya
- Arrhythmia Unit-Cardiology Service, Vall d'Hebrón Hospital, Spain
| | - Mireia Sanchis
- Stroke Unit, Vall d'Hebrón Hospital, Departament de Medicina, Universitat Autònoma de Barcelona
| | | | - Anna Penalba
- Neurovascular Research Lab, Vall d'Hebrón Research Institute, Spain
| | - Maria Usero
- Stroke Unit, University Hospital of Valladolid, Spain
| | - Elisa Cortijo
- Stroke Unit, University Hospital of Valladolid, Spain
| | | | - Ana I Calleja
- Stroke Unit, University Hospital of Valladolid, Spain
| | | | - Jeronimo Rubio
- Arrhythmia Unit, University Hospital of Valladolid, Spain
| | - Fernando Mancha
- Stroke Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | | | - Francisco Moniche
- Stroke Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | - Reyes de Torres
- Stroke Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | | | | | - Ángela Vega
- Stroke Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | - Alonso A Pedrote
- Arrhythmia Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | - Eduardo Arana-Rueda
- Arrhythmia Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | - Joan Montaner
- Stroke Unit, University Hospitals Virgen Macaren-Virgen del Rocio, Spain
| | - Carlos A Molina
- Stroke Unit, Vall d'Hebrón Hospital, Departament de Medicina, Universitat Autònoma de Barcelona
| | | |
Collapse
|
40
|
Roca-Luque I, Rivas Gándara N, Dos Subirà L, Pascual JF, Domenech AP, Pérez-Rodon J, Subirana MT, Santos Ortega A, Miranda B, Rosés-Noguer F, Ferreira-Gonzalez I, Ferrer JC, García-Dorado García D, Mitjans AM. Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage. Europace 2017; 20:353-361. [PMID: 29016802 DOI: 10.1093/europace/eux250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
MESH Headings
- Action Potentials
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Function
- Catheter Ablation
- Child
- Child, Preschool
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Atria/physiopathology
- Heart Atria/surgery
- Heart Conduction System/physiopathology
- Heart Conduction System/surgery
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Rate
- Humans
- Male
- Middle Aged
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/etiology
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Young Adult
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Dos Subirà
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Antònia Pijuan Domenech
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - M Teresa Subirana
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Berta Miranda
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Ferran Rosés-Noguer
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - David García-Dorado García
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| |
Collapse
|
41
|
Fernández-Codina A, Francisco-Pascual J, Fonollosa-Plà V. Tratamiento exitoso de un caso de pericarditis crónica constrictiva utilizando micofenolato sódico en una paciente con esclerosis sistémica. Med Clin (Barc) 2017; 148:574-575. [PMID: 28283274 DOI: 10.1016/j.medcli.2017.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/06/2017] [Accepted: 01/12/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Andreu Fernández-Codina
- Unidad de Enfermedades Autoinmunes Sistémicas, Departamento de Medicina Interna, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Jaume Francisco-Pascual
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Vicent Fonollosa-Plà
- Unidad de Enfermedades Autoinmunes Sistémicas, Departamento de Medicina Interna, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
42
|
Roca-Luque I, Rivas N, Francisco J, Perez-Rodon J, Dos L, Moya A, García-Dorado D. Para-Hisian atrial tachycardia ablation in a patient with congenitally corrected transposition of great vessels. HeartRhythm Case Rep 2017; 3:340-343. [PMID: 28748140 PMCID: PMC5511984 DOI: 10.1016/j.hrcr.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, CIBERCV, Barcelona, Spain.,Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Nuria Rivas
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Jaume Francisco
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Jordi Perez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Laura Dos
- Grown-up Congenital Heart Disease Unit, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Angel Moya
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - David García-Dorado
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain.,Cardiology Service, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| |
Collapse
|
43
|
Pérez-Rodon J, Doiny D, Miranda B, Rivas-Gandara N, Roca-Luque I, Francisco-Pascual J, Lidón RM, García-Dorado D, Moya Mitjans A. Life-threatening and life-saving inappropriate implantable cardioverter defibrillator shocks. Clin Case Rep 2017; 5:521-525. [PMID: 28396781 PMCID: PMC5378847 DOI: 10.1002/ccr3.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/18/2017] [Accepted: 02/13/2017] [Indexed: 11/22/2022] Open
Abstract
An implantable cardioverter defibrillator (ICD) lead dislodgement into the right atrium is a dangerous situation, particularly in patients in atrial fibrillation because atrial fibrillation can be sensed as ventricular fibrillation and true ventricular fibrillation induced with an inappropriate shock. In the presence of shocks, ICD interrogation should be performed as soon as possible.
Collapse
Affiliation(s)
- Jordi Pérez-Rodon
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - David Doiny
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Berta Miranda
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Nuria Rivas-Gandara
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Ivo Roca-Luque
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Jaume Francisco-Pascual
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Rosa Maria Lidón
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - David García-Dorado
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Angel Moya Mitjans
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| |
Collapse
|
44
|
Pérez-rodon J, Rodriguez-garcía J, Sarrias-merce A, Rivas-gandara N, Roca-luque I, Francisco-pascual J, Santos-ortega A, Martín-sánchez G, Ferreira-gonzález I, Rodríguez-palomares J, Evangelista-masip A, García-dorado D, Moya-mitjans À. Predictors of acute inefficacy and the radiofrequency energy time required for cavotricuspid isthmus-dependent atrial flutter ablation. J Interv Card Electrophysiol 2017; 49:83-91. [PMID: 28265782 DOI: 10.1007/s10840-017-0232-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/06/2017] [Indexed: 12/14/2022]
|
45
|
Francisco-Pascual J. Respuesta al ECG de diciembre de 2016. Rev Esp Cardiol 2017. [PMID: 28038731 DOI: 10.1016/j.recesp.2016.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Francisco-Pascual J. ECG de diciembre de 2016. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
ROCA-LUQUE IVO, RIVAS NURIA, FRANCISCO JAUME, PEREZ JORDI, ACOSTA GABRIEL, ORISTRELL GERARD, TERRICABRES MARIA, GARCIA-DORADO DAVID, MOYA ANGEL. Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps. J Cardiovasc Electrophysiol 2016; 28:126-131. [PMID: 27759948 DOI: 10.1111/jce.13109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Affiliation(s)
| | - NURIA RIVAS
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - JORDI PEREZ
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - GERARD ORISTRELL
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - MARIA TERRICABRES
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | | | - ANGEL MOYA
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| |
Collapse
|
48
|
Sambola A, García Del Blanco B, Ruiz-Meana M, Francisco J, Barrabés JA, Figueras J, Bañeras J, Otaegui I, Rojas A, Vilardosa Ú, Montaner J, García-Dorado D. Increased von Willebrand factor, P-selectin and fibrin content in occlusive thrombus resistant to lytic therapy. Thromb Haemost 2016; 115:1129-37. [PMID: 26962963 DOI: 10.1160/th15-12-0985] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/17/2016] [Indexed: 11/05/2022]
Abstract
Therapeutic fibrinolysis is ineffective in 40 % of ST-segment elevation acute myocardial infarction (STEMI) patients, but understanding of the mechanisms is incomplete. It was our aim to compare the composition of coronary thrombus in lysis-resistant STEMI patients with that of lysis-sensitive patients. Intracoronary thrombi (n=64) were obtained by aspiration in consecutive STEMI patients. Of them, 20 had received fibrinolysis and underwent rescue percutaneous coronary intervention (r-PCI, lysis-resistant patients) and 44 underwent primary PCI (p-PCI). Lysis-sensitivity was determined in vitro by clot permeability measurements and turbidimetric lysis in plasma of 44 patients undergoing p-PCI and 20 healthy donors. Clot-lysis sensitivity was defined as a clot-lysis time not greater than 1 SD over the mean of healthy donors. Coronary thrombus composition in 20 lysis-resistant and in 20 lysis-sensitive patients was analysed by immunofluorescence with confocal microscopy. Plasma biomarkers (P-selectin, VWF, PAI-1, t-PA, D-dimer, TF pathway markers, plasmin and CD34+) were measured simultaneously on peripheral blood. Lysis-resistant clots had higher levels of fibrin (p=0.02), P-selectin (p=0.03) and VWF (p=0.01) than lysis-sensitive clots. Among thrombi obtained ≤ 6 hours after onset of symptoms, those from lysis-resistant patients showed a higher content in fibrin than those from p-PCI patients (p=0.01). Plasma PAI-1 (p=0.02) and D-dimer levels were significantly higher (p=0.003) in lysis-resistant patients, whereas plasmin levels were lower (p=0.03). Multivariate analysis showed the content of fibrin and VWF within thrombus as predictors of thrombolysis resistance. In conclusion, coronary thrombi in STEMI patients resistant to fibrinolysis are characterised by higher fibrin, P-selectin and VWF content than lysis-sensitive thrombi.
Collapse
Affiliation(s)
- Antonia Sambola
- Antonia Sambola, Department of Cardiology, Hospital Universitari Vall d'Hebron, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain, Tel.: +34 932746002, Fax: +34 932746063, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Urena M, Hayek S, Cheema AN, Serra V, Amat-Santos IJ, Nombela-Franco L, Ribeiro HB, Allende R, Paradis JM, Dumont E, Thourani VH, Babaliaros V, Francisco Pascual J, Cortés C, del Blanco BG, Philippon F, Lerakis S, Rodés-Cabau J. Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording. Circulation 2015; 131:469-77. [PMID: 25466975 DOI: 10.1161/circulationaha.114.011929] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
This study sought to evaluate the prevalence of previously undiagnosed arrhythmias in candidates for transcatheter aortic valve replacement (TAVR) and to determine the impact on therapy changes and arrhythmic events after the procedure.
Methods and Results—
A total of 435 candidates for TAVR underwent 24-hour continuous ECG monitoring the day before the procedure. Newly diagnosed arrhythmias were observed in 70 patients (16.1%) before TAVR: paroxysmal atrial fibrillation (AF)/atrial tachycardia (AT) in 28, advanced atrioventricular block or severe bradycardia in 24, nonsustained ventricular tachycardia in 26, and intermittent left bundle-branch block in 3 patients. All arrhythmic events but one were asymptomatic and led to a therapy change in 43% of patients. In patients without known AF/AT, the occurrence of AF/AT during 24-hour ECG recording was associated with a higher rate of 30-day cerebrovascular events (7.1% versus 0.4%;
P
=0.030). Among the 53 patients with new-onset AF/AT after TAVR, 30.2% had newly diagnosed paroxysmal AF/AT before the procedure. In patients who needed permanent pacemaker implantation after the procedure (n=35), 31.4% had newly diagnosed advanced atrioventricular block or severe bradycardia before TAVR. New-onset persistent left bundle-branch block after TAVR occurred in 37 patients, 8.1% of whom had intermittent left bundle-branch block before the procedure.
Conclusions—
Newly diagnosed arrhythmias were observed in approximately a fifth of TAVR candidates, led to a higher rate of cerebrovascular events, and accounted for a third of arrhythmic events after the procedure. This high arrhythmia burden highlights the importance of an early diagnosis of arrhythmic events in such patients to implement the appropriate therapeutic measures earlier.
Collapse
Affiliation(s)
- Marina Urena
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Salim Hayek
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Asim N. Cheema
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Vicenç Serra
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Ignacio J. Amat-Santos
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Luis Nombela-Franco
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Henrique B. Ribeiro
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Ricardo Allende
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Jean-Michel Paradis
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Eric Dumont
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Vinod H. Thourani
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Vasilis Babaliaros
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Jaume Francisco Pascual
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Carlos Cortés
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Bruno García del Blanco
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - François Philippon
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Stamatios Lerakis
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| | - Josep Rodés-Cabau
- From the Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada (M.U., I.J.A.-S., H.B.R., R.A., J.P., E.D., F.P., J.R.-C.); Emory University School of Medicine, Atlanta, GA (S.H., V.H.T., V.B., S.L.); St Michael’s Hospital, Toronto University, Toronto, Ontario, Canada (A.N.C.); Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., J.F.P., B.G.d.B.); Hospital Clínico Universitario de Valladolid, Valladolid, Spain (I.J.A.-S., C.C.); and Hospital Clínico San Carlos de Madrid,
| |
Collapse
|
50
|
Sambola A, Francisco J, García -Del Blanco B, Aguadé S, Candell-Riera J, Martí G, Figueras J, Barrabés JA, Millán X, García-Dorado D. Tissue factor pathway inhibitor is an early biomarker of myocardial injury in patients with ST-segment elevation acute myocardial infarction. Int J Cardiol 2014; 172:279-81. [PMID: 24461489 DOI: 10.1016/j.ijcard.2013.12.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
|