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González-Casal D, Pérez-Castellanos A, Flores NS, Carta-Bergaz A, González-Torrecilla E, Bruña Fernández V, Ávila P, Atienza F, Arenal Á, González-Panizo J, Fernández-Avilés F, Cabrera JA, Datino T. Cannon A wave validation as a diagnostic tool in paroxysmal supraventricular tachycardias. Pacing Clin Electrophysiol 2024; 47:383-391. [PMID: 38348921 DOI: 10.1111/pace.14946] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The presence of cannon A waves, the so called "frog sign", has traditionally been considered diagnostic of atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, it has never been systematically evaluated. The aim of this study is to assess the independent diagnostic utility of cannon A waves in the differential diagnosis of supraventricular tachycardias (SVTs). METHODS We prospectively included 100 patients who underwent an electrophysiology (EP) study for SVT. The right jugular venous pulse was recorded during the study. In 61 patients, invasive central venous pressure (CVP) was registered as well. CVP increase is thought to be related with the timing between atria and ventricle depolarization; two groups were prespecified, the short VA interval tachycardias (including typical AVNRT and atrioventricular reciprocating tachycardia (AVRT) mediated by a septal accessory pathway) and the long VA interval tachycardias (including atypical AVNRT and AVRT mediated by a left free wall accessory pathway). RESULTS The relationship between cannon A waves and AVNRT did not reach the statistical significance (OR: 3.01; p = .058); On the other hand, it was clearly associated with the final diagnosis of a short VA interval tachycardia (OR: 10.21; p < .001). CVP increase showed an inversely proportional relationship with the VA interval during tachycardia (b = -.020; p < .001). CVP increase was larger in cases of AVNRT (4.0 mmHg vs. 1.2 mmHg; p < .001) and short VA interval tachycardias (3.9 mmHg vs. 1.2 mmHg; p < .001). CONCLUSION The presence of cannon A waves is associated with the final diagnosis of short VA interval tachycardias.
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Affiliation(s)
- David González-Casal
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alberto Pérez-Castellanos
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nina Soto Flores
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alejandro Carta-Bergaz
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Pablo Ávila
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Arenal
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge González-Panizo
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | | | - José Angel Cabrera
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
| | - Tomás Datino
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
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González-Casal D, Pérez-Castellanos A, Soto N, Carta-Bergaz A, González-Torrecilla E, BRUÑA VANESA, Avila P, Atienza F, Maiz AA, Datino T. CE-542-03 CANNON A WAVE VALIDATION AS A DIAGNOSTIC TOOL IN PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIAS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.721] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Soto N, González-Casal D, Ávila P. Complete Atrioventricular Block Cured by Atrial Pacing?: Nothing Is What It Seems. Circulation 2021; 143:283-286. [PMID: 33464964 DOI: 10.1161/circulationaha.120.052500] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nina Soto
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense and CIBERCV, Madrid, Spain
| | - David González-Casal
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense and CIBERCV, Madrid, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense and CIBERCV, Madrid, Spain
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Vicent L, González-Casal D, Bruña V, Devesa C, García-Carreño J, Sousa-Casasnovas I, Juárez M, Fernández-Avilés F, Martínez-Sellés M. Circadian Rhythm of Deaths in a Cardiology Department: A Five-Year Analysis. Cardiology 2020; 145:344-349. [PMID: 32114582 DOI: 10.1159/000505682] [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: 04/12/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous studies have described a circadian pattern of death from cardiovascular causes with a morning peak. Our aim is to describe the daytime oscillations in mortality in hospitalized patients with cardiovascular diseases. METHODS Our retrospective registry including all patients who died in the Cardiology Department, including the cardiac intensive care unit, Madrid, Spain. RESULTS From a total of 500 patients, time of death was registered in 373 (74.6%), which are the focus of our study; 354 (70.8%) died in the cardiac intensive care unit and 146 (29.2%) in the conventional ward. Mean age was 74.2 ± 13.1 years, and 239 (64.1%) were male. Cardiovascular causes were the leading cause of death (308 patients; 82.6%). Mortality followed a circadian biphasic pattern with a peak at dawn (00.00-05.59 a.m.: 104 patients [27.9%]) and in the afternoon (12.00-17.59 p.m.: 135 patients [36.2%]), irrespective of the cause of death. The peak of mortality occurred in the afternoon (12.00-17.59 p.m.) in the case of cardiovascular mortality (119 deaths [38.6%]) and in the evening (18.00-23.59 p.m.) for non-cardiovascular deaths (21 deaths [32.3%], p = 0.03). This pattern was present regardless from the place of death (conventional ward or cardiac intensive care unit) and also throughout the four seasons. CONCLUSIONS Mortality in hospitalized patients with cardiovascular diseases follows a circadian biphasic pattern.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David González-Casal
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Vanesa Bruña
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Carolina Devesa
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Jorge García-Carreño
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Iago Sousa-Casasnovas
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Miriam Juárez
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain, .,Universidad Complutense de Madrid, Madrid, Spain, .,Universidad Europea de Madrid, Madrid, Spain,
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González-Casal D, Mateos Gaitan R, Sánchez Prida N, González-Saldivar H, Diez-Delhoyo F. Infarto agudo de miocardio en menor de 30 años. ¡La edad no es excluyente! Semergen 2019; 45:205-207. [DOI: 10.1016/j.semerg.2018.03.013] [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] [Received: 02/12/2018] [Revised: 02/20/2018] [Accepted: 03/02/2018] [Indexed: 10/27/2022]
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