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Francisco-Pascual J, Rivas-Gándara N, Maymi-Ballesteros M, Badia-Molins C, Bach-Oller M, Benito B, Pérez-Rodón J, Santos-Ortega A, Roca-Luque I, Rodríguez-Silva J, Jordán-Marchite P, Moya-Mitjans À, Ferreira-González I. Riesgo arrítmico en episodios únicos o recurrentes de síncope inexplicado con bloqueo completo de rama. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.11.010] [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: 02/06/2023]
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Francisco-Pascual J, Rivas-Gándara N, Maymi-Ballesteros M, Badia-Molins C, Bach-Oller M, Benito B, Pérez-Rodón J, Santos-Ortega A, Roca-Luque I, Rodríguez-Silva J, Jordán-Marchite P, Moya-Mitjans À, Ferreira-González I. Arrhythmic risk in single or recurrent episodes of unexplained syncope with complete bundle branch block. Revista Española de Cardiología (English Edition) 2022:S1885-5857(22)00323-1. [PMID: 36539183 DOI: 10.1016/j.rec.2022.11.009] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with a single syncopal episode (SSE) and complete bundle branch block (cBBB) are frequently managed more conservatively than patients with recurrent episodes (RSE). The objective of this study was to analyze if there are differences between patients with single or recurrent unexplained syncope and cBBB in arrhythmic risk, the diagnostic yield of tests, and clinical outcomes. METHODS Cohort study of consecutive patients with unexplained syncope and cBBB with a median follow-up time of 3 years. The patients were evaluated via a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor. RESULTS Of the 503 patients included in the study, 238 (47.3%) had had only 1 syncopal episode. The risk of an arrhythmic syncope was similar in both groups (58.8% in SSE vs 57.0% in RSE; P=.68), also after adjustment for possible confounding variables (HR, 1.06; 95%CI, 0.81-1.38; P=.674). No significant differences between the groups were found in the EPS results and implantable cardiac monitor diagnostic yield. A total of 141 (59.2%) patients with SSE and 154 (58.1%) patients with RSE required cardiac device implantation (P=.797). After appropriate treatment, 35 (7%) patients had recurrence of syncope. The recurrence rate and mortality were also similar in both groups. CONCLUSIONS Patients with cBBB and unexplained syncope are at high risk of an arrhythmic etiology, even after the first syncopal episode. Patients with SSE and RSE have a similar arrhythmic risk and similar outcomes, and therefore there is no clinical justification for not managing them in the same manner.
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Affiliation(s)
- Jaume Francisco-Pascual
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Nuria Rivas-Gándara
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manel Maymi-Ballesteros
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bach-Oller
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jordi Pérez-Rodón
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alba Santos-Ortega
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ivo Roca-Luque
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unitat d'Arrítmies, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Jesús Rodríguez-Silva
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Jordán-Marchite
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Unitat d'Arrítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Servei de Cardiologia, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Servei de Cardiologia, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
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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.
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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
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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. Risk stratification of ventricular arrhythmias in repaired tetralogy of Fallot. ACTA ACUST UNITED AC 2021; 74:935-942. [DOI: 10.1016/j.rec.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
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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.
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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
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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]
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Francisco-Pascual J, Santos-Ortega A, Roca-Luque I, Rivas-Gándara N, Pérez-Rodón J, Milà-Pascual L, García-Dorado D, Moya-Mitjans À. Diagnostic Yield and Economic Assessment of a Diagnostic Protocol With Systematic Use of an External Loop Recorder for Patients With Palpitations. ACTA ACUST UNITED AC 2019; 72:473-478. [DOI: 10.1016/j.rec.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 04/06/2018] [Indexed: 12/27/2022]
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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
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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
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Galve E, Oristrell G, Acosta G, Ribera-Solé A, Moya-Mitjans À, Ferreira-González I, Pérez-Rodon J, García-Dorado D. Cardiac resynchronization therapy is associated with a reduction in ICD therapies as it improves ventricular function. Clin Cardiol 2018; 41:803-808. [PMID: 29604094 DOI: 10.1002/clc.22958] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Repeated implantable cardioverter-defibrillator (ICD) therapies cause myocardial damage and, thus, an increased risk of arrhythmias and mortality. HYPOTHESIS Cardiac resynchronization therapy-defibrillator (CRT-D) reduces the number of appropriate therapies in patients with left ventricular dysfunction (left ventricular ejection fraction [LVEF] <50%). METHODS The retrospective study involved 175 consecutive patients (mean age, 64.6 ±10.4 years; 86.9% males) with reduced LVEF of 27.9% ±7.6% treated with an ICD (56.6%) or CRT-D (43.4%), according to standard indications, between January 2009 and July 2014. Devices were placed for either primary (54.3%) or secondary prevention (45.7%). Mean follow-up was 2.5 ±1.5 years. Predictors of first appropriate therapy were assessed using Cox regression analysis. RESULTS Forty-four (25.1%) patients received ≥1 appropriate therapy. Although patients treated with CRT-D had lower LVEF and poorer New York Heart Association class, CRT-D patients with LVEF improvement >35% at the end of follow-up had a significantly lower risk of receiving a first appropriate therapy relative to those with an ICD (adjusted hazard ratio: 0.24, 95% confidence interval: 0.07-0.83, P = 0.025), independently of ischemic cardiomyopathy, baseline LVEF, and secondary prevention. There were no differences in mortality between the ICD and the CRT-D groups. CONCLUSIONS Although patients receiving CRT-D had a worse clinical profile, they received fewer device therapies in comparison with those receiving an ICD. This reduction is associated with a significant improvement in LVEF.
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Affiliation(s)
- Enrique Galve
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Gerard Oristrell
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Gabriel Acosta
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Aida Ribera-Solé
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Àngel Moya-Mitjans
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jordi Pérez-Rodon
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - David García-Dorado
- Department of Cardiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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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]
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Moya-Mitjans À, Lidón RM. Desfibrilador externo automático en la muerte súbita extrahospitalaria: en busca del tratamiento eficaz. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.07.008] [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: 11/25/2022]
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Moya-Mitjans À, Lidón RM. Automatic External Defibrillator in Sudden Out-of-hospital Cardiac Arrest: In Search of Effective Treatment. ACTA ACUST UNITED AC 2017; 71:64-66. [PMID: 28958405 DOI: 10.1016/j.rec.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Àngel Moya-Mitjans
- Unitat d'Arítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Rosa-Maria Lidón
- Unitat de Crítics Cardiovasculars, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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