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González-Matos CE, Rodríguez-Queralto O, Záraket F, Jiménez J, Casteigt B, Vallès E. Conduction System Stimulation to Avoid Left Ventricle Dysfunction. Circ Arrhythm Electrophysiol 2024; 17:e012473. [PMID: 38284238 DOI: 10.1161/circep.123.012473] [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: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Right ventricular apical pacing (RVAP) can produce left ventricle dysfunction. Conduction system pacing (CSP) has been used successfully to reverse left ventricle dysfunction in patients with left bundle branch block. To date, data about CSP prevention of left ventricle dysfunction in patients with preserved left ventricular ejection fraction (LVEF) are scarce and limited mostly to nonrandomized studies. Our aim is to demonstrate that CSP can preserve normal ventricular function compared with RVAP in the setting of a high burden of ventricular pacing. METHODS Consecutive patients with a high-degree atrioventricular block and preserved or mildly deteriorated LVEF (>40%) were included in this prospective, randomized, parallel, controlled study, comparing conventional RVAP versus CSP. RESULTS Seventy-five patients were randomized, with no differences between basal characteristics in both groups. The stimulated QRS duration was significantly longer in the RVAP group compared with the CSP group (160.4±18.1 versus 124.2±20.2 ms; p<0.01). Seventy patients were included in the intention-to-treat analyses. LVEF showed a significant decrease in the RVAP group at 6 months compared with the CSP group (mean difference, -5.8% [95% CI, -9.6% to -2%]; P<0.01). Left ventricular end-diastolic diameter showed an increase in the RVAP group compared with the CSP group (mean difference, 3.2 [95% CI, 0.1-6.2] mm; P=0.04). Heart failure-related admissions were higher in the RVAP group (22.6% versus 5.1%; P=0.03). CONCLUSIONS Conduction system stimulation prevents LVEF deterioration and heart failure-related admissions in patients with normal or mildly deteriorated LVEF requiring a high burden of ventricular pacing. These results are only short term and need to be confirmed by further larger studies. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT06026683.
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Affiliation(s)
- Carlos E González-Matos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain (C.E.G.-M., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Universitat Pompeu Fabra, Barcelona, Spain (C.E.G.-M., E.V.)
| | - Oriol Rodríguez-Queralto
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Fátima Záraket
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Jesús Jiménez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Benjamín Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain (C.E.G.-M., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Universitat Pompeu Fabra, Barcelona, Spain (C.E.G.-M., E.V.)
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Vallès E, Jiménez J, González C, Zaraket F, Rodríguez O, Llorca L, Anguera I, di Marco A, Fan R, Casteigt B. First experience of wave speed guided point-by-point cavo-tricuspid isthmus ablation for typical atrial flutter. J Interv Card Electrophysiol 2023; 66:1325-1327. [PMID: 36943651 PMCID: PMC10457232 DOI: 10.1007/s10840-023-01531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain.
| | - Jesús Jiménez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain
| | - Carlos González
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain
| | - Fátima Zaraket
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain
| | - Oriol Rodríguez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain
| | - Laia Llorca
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain
| | - Ignasi Anguera
- Electrophysiology Unit, Cardiology Department, Hospital de Bellvitge, Universitat Central de Barcelona, Barcelona, Spain
| | - Andrea di Marco
- Electrophysiology Unit, Cardiology Department, Hospital de Bellvitge, Universitat Central de Barcelona, Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, 25-27 Passeig marítim de la Barceloneta, 08003, Barcelona, Spain
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Benito B, García-Elías A, Ois Á, Tajes M, Vallès E, Ble M, Yáñez Bisbe L, Giralt-Steinhauer E, Rodríguez-Campello A, Cladellas Capdevila M, Martí-Almor J, Roquer J, Cuadrado-Godia E. Plasma levels of miRNA-1-3p are associated with subclinical atrial fibrillation in patients with cryptogenic stroke. Rev Esp Cardiol (Engl Ed) 2022; 75:717-726. [PMID: 35067470 DOI: 10.1016/j.rec.2021.12.001] [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] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Identifying biomarkers of subclinical atrial fibrillation (AF) is of most interest in patients with cryptogenic stroke (CrS). We sought to evaluate the circulating microRNA (miRNA) profile of patients with CrS and AF compared with those in persistent sinus rhythm. METHODS Among 64 consecutive patients with CrS under continuous monitoring by a predischarge insertable monitor, 18 patients (9 with AF and 9 in persistent sinus rhythm) were selected for high-throughput determination of 754 miRNAs. Nine patients with concomitant stroke and AF were also screened to improve the yield of miRNA selection. Differentially expressed miRNAs were replicated in an independent cohort (n=46). Biological markers were stratified by the median and included in logistic regression analyses to evaluate their association with AF at 6 and 12 months. RESULTS Eight miRNAs were differentially expressed between patients with and without AF. In the replication cohort, miR-1-3p, a gene regulator involved in cardiac arrhythmogenesis, was the only miRNA to remain significantly higher in patients with CrS and AF vs those in sinus rhythm and showed a modest association with AF burden. High (= above the median) miR-1-3p plasma values, together with a low left atrial ejection fraction, were independently associated with the presence of AF at 6 and 12 months. CONCLUSIONS In this cohort, plasma levels of miR-1-3p were elevated in CrS patients with subsequent AF. Our results preliminarily suggest that miR-1-3p could be a novel biomarker that, together with clinical parameters, could help identify patients with CrS and a high risk of occult AF.
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Affiliation(s)
- Begoña Benito
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Spain.
| | - Anna García-Elías
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Research Center, Montreal Heart Institute, Montreal, Canada
| | - Ángel Ois
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Neurología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Marta Tajes
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Ermengol Vallès
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Mireia Ble
- Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - Eva Giralt-Steinhauer
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Mercè Cladellas Capdevila
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Julio Martí-Almor
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Jaume Roquer
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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Zaraket F, Bas D, Jimenez J, Casteigt B, Benito B, Martí-Almor J, Conejos J, Tizón-Marcos H, Mojón D, Vallès E. Cardiac Tomography and Cardiac Magnetic Resonance to Predict the Absence of Intracardiac Thrombus in Anticoagulated Patients Undergoing Atrial Fibrillation Ablation. J Clin Med 2022; 11:jcm11082101. [PMID: 35456193 PMCID: PMC9031153 DOI: 10.3390/jcm11082101] [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: 02/07/2022] [Revised: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Pulmonary veins isolation (PVI) is a standard treatment for recurrent atrial fibrillation (AF). Uninterrupted anticoagulation for a minimum of 3 weeks before ablation and exclusion of left atrial (LA) thrombus with transesophageal echography (TEE) immediately before or during the procedure minimize peri-procedural risk. We aimed to demonstrate the utility of cardiac tomography (CT) and cardiac magnetic resonance (CMR) to rule out LA thrombus prior to PVI. Methods: Patients undergoing PVI for recurrent AF were retrospectively evaluated. Only patients that started anticoagulation at least 3 weeks prior to the CT/CMR and subsequently uninterrupted until the ablation procedure were selected. An intracardiac echo (ICE) catheter was used in all patients to evaluate LA thrombus. The results of CT/CMR were compared to ICE imaging. Results: We included 272 consecutive patients averaging 54.5 years (71% male; 30% persistent AF). Average CHA2DS2VASC score was 0.9 ± 0.83 and mean LA diameter was 42 ± 5.7 mm, 111 (41%) patients were on Acenocumarol and 161 (59%) were on direct oral anticoagulants. Anticoagulation was started 227 ± 392 days before the CT/CMR, and 291 ± 416 days before the ablation procedure. CT/CMR diagnosed intracardiac thrombus in two cases, both in the LA appendage. A new CT/CMR revealed resolution of thrombus after six additional months of uninterrupted anticoagulation. No macroscopic thrombus was observed in any patients with ICE (negative predictive value of 100%; p < 0.01). Conclusions: CT and MRI are excellent surrogates to TEE and ICE to rule out intracardiac thrombus in patients adequately anticoagulated prior AF ablation. This is true even for delayed procedures as long as anticoagulation is uninterrupted.
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Affiliation(s)
- Fatima Zaraket
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
- Correspondence: ; Tel.: +34-932483118; Fax: +34-932483371
| | - Deva Bas
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Jesus Jimenez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Javi Conejos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Helena Tizón-Marcos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Diana Mojón
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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Benito B, García-Elías A, Ois Á, Tajes M, Vallès E, Ble M, Yáñez Bisbe L, Giralt-Steinhauer E, Rodríguez-Campello A, Cladellas Capdevila M, Martí-Almor J, Roquer J, Cuadrado-Godia E. La concentración plasmática de microARN-1-3p se asocia con fibrilación auricular subclínica en los pacientes con ictus criptogénico. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.032] [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: 11/27/2022]
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Vallès E, Jiménez J, Martí-Almor J, Toquero J, Ormaetxe JM, Barrera A, García-Alberola A, Rubio JM, Moriña P, Grande C, Fé Arcocha M, Peinado R, Cózar R, Hernández J, Pérez-Alvarez L, Gaztañaga L, Ferrero-De Loma-Osorio A, Ruiz-Granell R, Villuendas R, Martínez-Alday JD. Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA). J Clin Med 2022; 11:jcm11051166. [PMID: 35268259 PMCID: PMC8910954 DOI: 10.3390/jcm11051166] [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: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8 ± 10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs. 11.4%; p < 0.001) and left atrium dilation (72.6 vs. 43.3%; p < 0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs. 22.2%; p < 0.001), with an arterial line (32.2 vs. 44.6%; p < 0.001) and assisted transeptal puncture (11.9 vs. 17.9%; p = 0.025). During an application, PeAF patients had a longer time to −30 °C (35.91 ± 14.20 vs. 34.93 ± 12.87 s; p = 0.021) and a colder balloon nadir temperature during vein isolation (−35.04 ± 9.58 vs. −33.61 ± 10.32 °C; p = 0.004), but received fewer bonus freeze applications (30.7 vs. 41.1%; p < 0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p = 0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.
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Affiliation(s)
- Ermengol Vallès
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
- Correspondence:
| | - Jesús Jiménez
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
| | - Julio Martí-Almor
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
| | - Jorge Toquero
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - José Miguel Ormaetxe
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
| | - Alberto Barrera
- Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain;
| | | | | | - Pablo Moriña
- Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - Carlos Grande
- Hospital Universitari Son Espases, 07010 Palma de Mallorca, Spain;
| | | | | | - Rocío Cózar
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | - Julio Hernández
- Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | | | - Larraitz Gaztañaga
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
- Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
| | | | - Ricardo Ruiz-Granell
- Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (A.F.-D.L.-O.); (R.R.-G.)
| | | | - Jesús Daniel Martínez-Alday
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
- Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
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Vallès E, Martí-Almor J, Grau N, Casteigt B, Benito B, Cabrera S, Alcalde O, Benito E, Bas D, Conejos J, Cabero P, Soler C, Duran X, Fan R, Jimenez J. Influence of PACE score and conduction disturbances in the incidence of early new onset atrial fibrillation after typical atrial flutter ablation. J Cardiol 2021; 79:417-422. [PMID: 34774385 DOI: 10.1016/j.jjcc.2021.10.012] [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: 08/30/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients undergoing cavotricuspid isthmus (CTI) ablation for typical flutter (AFL) have a high incidence of new onset atrial fibrillation (AF). We aimed to analyze the influence of PACE score to predict new onset AF in this subset of patients to stratify thromboembolic risk. METHODS Between 2017 and 2019, patients undergoing CTI ablation for AFL and without history of AF were prospectively included. All patients were monitored continuously by implantable loop recorder and followed by remote monitoring. RESULTS Overall 48 patients were included. New onset AF rate at 12 months was 56.3%. We observed two very strong independent predictors for new onset AF: a PACE score ≥ 30 (HR:6.9; 95% CI:1.71-27.91; p = 0.007) and an HV interval ≥ 55 (HR:11.86; 95% CI:2.57-54.8; p = 0.002). CONCLUSIONS The incidence of newly diagnosed AF is high in patients with AFL after CTI ablation, and can occur early. A high PACE score and/or long HV interval predict even higher risk, and may be useful in the decision for empiric long-term anticoagulation.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Nuria Grau
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eva Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Deva Bas
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Javi Conejos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Paula Cabero
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Cristina Soler
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Duran
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jesus Jimenez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
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Jiménez-López J, Vallès E, Martí-Almor J, Casteigt B, Villuendas R, Bisbal F, Sarrias A, Benito E, Trucco E, Conejos J, Alcalde O, Figueras-Mari L, Fan R, Bazan V. Merged two-way mapping technique: an alternative 3D electroanatomical mapping approach to guide challenging ablation procedures of accessory pathways with bidirectional conduction properties. J Interv Card Electrophysiol 2021; 63:591-599. [PMID: 34595692 DOI: 10.1007/s10840-021-01069-w] [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: 07/09/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Catheter ablation of accessory pathways (AP) with bidirectional conduction may be challenging due to issues related to anatomical course or location. OBJECTIVE We describe an alternative electro-anatomical mapping technique which aims at depicting the entire anatomic course of the AP from the atrial toward the ventricular insertion in order to guide catheter ablation. METHODS Twenty consecutive patients with confirmed bidirectional AP conduction and at least one previous ablation procedure or para-Hisian location were included. 3-D electro-anatomical mapping was used to depict the merged 10-ms isochrone area of maximum early activation of both the ventricular and atrial signals during sinus rhythm and ventricular pacing/orthodromic tachycardia, respectively. Catheter ablation was performed within the depicted earliest isochrone area. RESULTS Acute bidirectional AP conduction block was achieved in all patients 4.2 ± 1.7 s after the first radiofrequency energy pulse was delivered, without reconnection during a 30 ± 10 min post-ablation observation time. No procedural complications were seen. After a mean follow-up period of 9 ± 7 months (range 3 to 16), no recurrences were documented. CONCLUSION This merged two-way mapping technique is a safe, efficient, and effective technique for ablation of APs with bidirectional conduction.
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Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain.
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Villuendas
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Felipe Bisbal
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Axel Sarrias
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Eva Benito
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Emilce Trucco
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Javier Conejos
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Oscar Alcalde
- Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Roger Fan
- Electrophysiology Unit, Cardiology Department, Stony Brook Heart Institute, Stony Brook, NY, USA
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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9
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Jiménez-López J, Vallès E, Martí-Almor J, González-Matos C, Bas D, Benito B, Alcalde O, Cabrera S, Altaba C, Bazan V. Mapping potentials adjacent to the cavo-tricuspid isthmus ablation line during incremental pacing: A feasible and highly accurate maneuver to confirm complete CTI conduction block. J Cardiovasc Electrophysiol 2020; 31:1649-1657. [PMID: 32400073 DOI: 10.1111/jce.14542] [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: 12/21/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnostic accuracy of incremental atrial pacing (IP) to determine complete cavo-tricuspid isthmus (CTI) block during typical atrial flutter (AFL) ablation is limited by both an extensive/nonlinear ablation and/or the presence of intra-atrial conduction delay elsewhere in the right atrium. We examined the diagnostic performance of an IP variant based on the assessment of the atrial potentials adjacent to the ablation line which aims at overcoming both limitations. METHODS From a prospective population of 108 consecutive patients, 15 were excluded due to observation of inconclusive CTI ablation potentials precluding for a straight comparison between the IP maneuver and its variant. In the remaining 93, IP was performed from the low lateral right atrium and the coronary sinus ostium, with the ablation catheter positioned both at the CTI line and adjacent (<5 mm) to its septal and lateral aspect. The IP variant consisted of measuring the interval between the two atrial electrograms situated on the same side of the ablation line, opposite to the pacing site, a ≤10 ms increase indicating complete CTI block. RESULTS The IP maneuver and its variant were consistent with complete CTI block in 82/93 (88%) and 87/93 (93%) patients, respectively. Four patients had AFL recurrence during follow-up: 2/4 and 4/4 had been adequately classified as incomplete block by the IP maneuver and its variant, respectively. Twenty-three patients (24%) had significant intra-atrial conduction delay elsewhere in the right atrium. The IP maneuver and its variant were suggestive of an incomplete CTI block in 11/23 and 4/23 in this setting (P = .028), with the later best predicting subsequent AFL relapses (2/12 vs 2/4, P = .01). CONCLUSIONS The IP variant, which was designed to overcome the limitations of the conventional IP maneuver, accurately distinguishes complete from incomplete CTI block and helps to predict AFL recurrences after ablation.
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Affiliation(s)
- Jesus Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos González-Matos
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deva Bas
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Oscar Alcalde
- Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Sandra Cabrera
- Arrhythmia Unit, Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | - Carmen Altaba
- Electrophysiology Unit, Hospital del Mar, Barcelona, Spain
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Cuadrado-Godia E, Benito B, Ois A, Vallès E, Rodríguez-Campello A, Giralt-Steinhauer E, Cabrera S, Alcalde O, Jiménez-López J, Jiménez-Conde J, Martí-Almor J, Roquer J. Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke. Eur J Neurol 2019; 27:244-250. [PMID: 31424609 DOI: 10.1111/ene.14061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/20/2019] [Accepted: 07/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Subclinical atrial fibrillation (AF) is known to underlie a number of cases of cryptogenic stroke (CrS). However, there is need to define the most effective strategy for AF detection. The diagnostic usefulness was analysed of a strategy based on ultra-early continuous monitoring in patients with CrS in terms of AF detection, oral anticoagulation treatment and stroke recurrence, in comparison to a standard outpatient strategy. METHODS Patients with ischaemic stroke of undetermined origin and confirmed to be cryptogenic after extensive work-up were searched for AF with (i) a conventional strategy (historical cohort, n = 101) with serial electrocardiograms and 24-h Holter monitoring or (ii) an ultra-early monitoring strategy with insertable cardiac monitor (ICM) implanted before discharge (prospective cohort, n = 90). AF episodes lasting >1 min, anticoagulant treatment and stroke recurrence were recorded. RESULTS During admission, AF was similarly detected in both cohorts (24% of patients). After discharge (mean follow-up 30 ± 10 months), AF detection rates were 17/80 (21.3%) and 38/65 (58.5%) for patients in the conventional versus the ultra-early ICM group (P < 0.001). Up to 41% of AF cases in the ICM cohort were detected within the first month. Oral anticoagulation was initiated in 37.6% versus 65.5% (P < 0.001) and stroke recurrence was recorded in 10.9% versus 3.3% (P 0.04) in the conventional versus the ICM cohort. CONCLUSIONS Pre-discharge ICM implant allows detection of AF during follow-up in up to 58% of selected patients with CrS. Compared to a conventional strategy, ultra-early ICM implant results in higher anticoagulation rates and a decrease in stroke recurrence.
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Affiliation(s)
- E Cuadrado-Godia
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - B Benito
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Cardiology Department, Hospital Vall d'Hebron. Vascular Biology and Metabolism Program, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A Ois
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - E Vallès
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - A Rodríguez-Campello
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - E Giralt-Steinhauer
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - S Cabrera
- Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | - O Alcalde
- Cardiology Department, Complejo Universitario de Navarra, Pamplona, Spain
| | - J Jiménez-López
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J Jiménez-Conde
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J Martí-Almor
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J Roquer
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Vallès E, Benito B, Jiménez J, Cabrera S, Alcalde O, Altaba C, Guijo MA, Fan R, Martí-Almor J. Double factor single shot to diminish complications in cryoballoon ablation procedures for atrial fibrillation. J Interv Card Electrophysiol 2018; 55:17-26. [PMID: 30411175 DOI: 10.1007/s10840-018-0483-3] [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: 06/28/2018] [Accepted: 10/30/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Cryoballoon ablation (CBA) has become a standard treatment for recurrent atrial fibrillation (AF). There is need for improved CBA protocols. We aimed to demonstrate that a new protocol including minimum temperature (minT) reached could reduce procedure times and complications. METHODS A new double factor protocol (DFP), based on the performance of one single shot per vein with variable duration, and conditional bonus shot, determined by time-to-effect (TTE) and minT, was compared with the conventional protocol (CP), with at least two shots per vein. Procedure parameters, complications, and efficacy were compared. RESULTS We prospectively included 88 consecutive patients treated with the DFP. These were compared to the previous consecutive 69 patients treated with CP. All procedures were performed with 28-mm second-generation balloon. Acute pulmonary vein (PV) isolation was similar (98.6% vs. 98.9% in CP vs. DFP, p = 0.687). Procedure and ablation times favored DFP over CP (120 vs. 134 min, p = 0.003; and 1051 vs. 1475 s, p < 0.001; respectively). A composite of major and minor complications was significantly reduced in the DFP compared to the CP (18.8% vs. 6.8%, p = 0.02; respectively). Within a follow-up of 18 months, freedom from AF was 79.7% in CP and 78.4% in DFP (Log-rank 0.501). Paroxysmal AF and absence of PV potentials predicted better arrhythmia outcomes (HR 2.14 for paroxysmal vs. persistent, p = 0.031; and HR 1.61 for absence vs. presence of PV potentials, p = 0.01). CONCLUSIONS The novel DFP results in reduced complication rates and procedure times, with similar success rates compared with a conventional strategy.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain. .,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Begoña Benito
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jesús Jiménez
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carmen Altaba
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Miguel Angel Guijo
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine Health Science Center, T16-80, Stony Brook, NY, 11794, USA
| | - Julio Martí-Almor
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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12
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Jiménez-López J, Vallès E, Benito Villabriga B, Alcalde O, Cabrera S, Martí-Almor J. Wide QRS complex tachycardia followed by 2:1 atrioventricular block: What is the mechanism? Pacing Clin Electrophysiol 2018; 41:302-303. [DOI: 10.1111/pace.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/09/2017] [Accepted: 11/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Begoña Benito Villabriga
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
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Jiménez-López J, Vallès E, Benito B, Oliveró R, Martí-Almor J. Fusion map: A useful tool to guide ablation in oblique accessory pathways. J Cardiovasc Electrophysiol 2018; 29:795-796. [PMID: 29359874 DOI: 10.1111/jce.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruperto Oliveró
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Jiménez-López J, Vallès E, Benito B, Martí-Almor J. Insights of the superior vena cava conduction properties: A 3-D high resolution mapping case of typical flutter. J Cardiovasc Electrophysiol 2017; 29:337-338. [PMID: 29090495 DOI: 10.1111/jce.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Cabrera S, Vallès E, Benito B, Alcalde Ó, Jiménez J, Fan R, Martí-Almor J. Simple predictors for new onset atrial fibrillation. Int J Cardiol 2016; 221:515-20. [DOI: 10.1016/j.ijcard.2016.07.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
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16
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Vallès E, Cabrera S, Benito B, Alcalde O, Jiménez J, Martí-Almor J. Burning the Gap: Electrical and Anatomical Basis of the Incremental Pacing Maneuver for Cavotricuspid Isthmus Block Assessment. J Cardiovasc Electrophysiol 2016; 27:694-8. [PMID: 26915806 DOI: 10.1111/jce.12965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/16/2015] [Revised: 02/01/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The incremental pacing (IP) maneuver is a highly specific technique that improves the ability to confirm complete CTI conduction block during typical atrial flutter (AFL) ablation, and reduces long-term AFL recurrences. The purpose of this study is to assess the performance of new catheters equipped with additional high precision bipoles (AHPB) to allow the visualization of the cavotricuspid isthmus (CTI) conduction gap and to compare them with the IP maneuver. METHODS AND RESULTS Twenty consecutive patients undergoing catheter ablation of the CTI for AFL were included. The IP maneuver confirmed functional versus complete CTI block. Local electrogram analysis using AHPB was then used to assess the presence or absence of gaps across the CTI line. Mean age was 67 years and 80% were male. At the end of the procedure CTI block was achieved in all patients. A transient stage of functional CTI block was observed in 40%. In all cases a continuous fragmented electrogram was present between the double potentials in the CTI in the AHPB channels. In contrast, no electrogram was observed between the CTI double potentials in any of the 20 patients once complete block was confirmed by the IP maneuver. When both techniques were compared a significant association and correlation were observed (chi-square <0.01, Spearman's rho = 1, P < 0.01). CONCLUSION Catheters equipped with AHPB can aid in the assessment of complete CTI block during AFL ablation procedures by detecting conduction gaps that correlate with incomplete functional block diagnosed by the IP maneuver.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Jiménez
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Salvà A, Roqué M, Vallès E, Bustins M, Bullich I, Sanchez P. Prognostic factors of functional status improvement in individuals admitted to convalescence care units. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.11.012] [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: 10/23/2022]
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Jauregui-Abularach ME, Bazan V, Martí-Almor J, Cian D, Vallès E, Benito B, Meroño O, Bruguera-Cortada J. Caracterización de la vía lenta nodular en pacientes con taquicardia por reentrada nodular: implicaciones clínicas para guiar la ablación. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jauregui-Abularach ME, Bazan V, Martí-Almor J, Cian D, Vallès E, Benito B, Meroño O, Bruguera-Cortada J. Characterization of the nodal slow pathway in patients with nodal reentrant tachycardia: clinical implications for guiding ablation. ACTA ACUST UNITED AC 2014; 68:298-304. [PMID: 25440045 DOI: 10.1016/j.rec.2014.04.017] [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] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Nodal slow pathway ablation is the treatment of choice for nodal reentrant tachycardia. No demographic, anatomic, or electrophysiologic variables have been reported to predict an exact location of the slow pathway in the atrioventricular node or its proximity to the fast pathway. The purpose of this study was to analyze these variables. METHODS The study prospectively included 54 patients (17 men; mean age, 55 [16] years) who had undergone successful slow pathway ablation. The refractory periods of both pathways and their differential conduction time were measured, and calculations were performed to obtain the distance from the His-bundle region (location of the fast pathway) to the coronary sinus ostium (to estimate the anteroposterior length of the triangle of Koch) and to the slow pathway area. RESULTS The differential conduction time (139 [98] ms) did not correlate with the His-coronary sinus distance (19 [6] mm; P=.6) or the His-slow pathway distance (14 [4] mm; P=.4). When the His-coronary sinus distance was larger, the His-slow pathway distance was also larger (r=0.652; P<.01) and the anatomic correlation between the triangle dimensions and the separation between the two pathways was confirmed. In patients older than 70 years, smaller triangle sizes and a shorter distance between both pathways were observed (P<.001). CONCLUSIONS A greater anteroposterior dimension of the triangle of Koch is associated with a slow-pathway location farther from the fast pathway. In elderly patients the two pathways are closer together (higher risk of atrioventricular block).
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Affiliation(s)
| | - Victor Bazan
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Debora Cian
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Ermengol Vallès
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Begoña Benito
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Oona Meroño
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
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Vallès E, Bazan V, Cainzos-Achirica M, Jáuregui ME, Benito B, Bruguera J, Martí-Almor J. Incremental pacing maneuver for atrial flutter recurrence reduction after ablation. Int J Cardiol 2014; 177:902-6. [DOI: 10.1016/j.ijcard.2014.10.033] [Citation(s) in RCA: 4] [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: 04/02/2014] [Revised: 07/15/2014] [Accepted: 10/18/2014] [Indexed: 11/30/2022]
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Martí-Almor J, Bazan V, Vallès E, Benito B, Jauregui-Abularach ME, Bruguera-Cortada J. Resultados a largo plazo de la crioablación con balón para el tratamiento de la fibrilación auricular en un centro de bajo volumen. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martí-Almor J, Bazan V, Vallès E, Benito B, Jauregui-Abularach ME, Bruguera-Cortada J. Long-term outcome of cryoballoon ablation of atrial fibrillation in a low-volume center. ACTA ACUST UNITED AC 2014; 67:577-8. [PMID: 24952401 DOI: 10.1016/j.rec.2014.02.012] [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: 12/05/2013] [Accepted: 02/18/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Victor Bazan
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Ermengol Vallès
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Jordi Bruguera-Cortada
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
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Martí-Almor J, Jauregui-Abularach ME, Benito B, Vallès E, Bazan V, Sánchez-Font A, Vollmer I, Altaba C, Guijo MA, Hervas M, Bruguera-Cortada J. Pulmonary Hemorrhage After Cryoballoon Ablation for Pulmonary Vein Isolation in the Treatment of Atrial Fibrillation. Chest 2014; 145:156-157. [DOI: 10.1378/chest.13-0761] [Citation(s) in RCA: 25] [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] [Indexed: 11/01/2022] Open
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Vallès E, Bazán V, Benito B, Jáuregui ME, Bruguera J, Guijo MA, Altaba C, Martí-Almor J. Incremental His-to-coronary sinus maneuver: a nonlocal electrogram-based technique to assess complete cavotricuspid isthmus block during typical flutter ablation. Circ Arrhythm Electrophysiol 2013; 6:784-9. [PMID: 23873249 DOI: 10.1161/circep.113.000297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Achievement of complete cavotricuspid isthmus (CTI) conduction block reduces typical atrial flutter recurrences after ablation. The lack of increase in the His-to-coronary sinus ostium atrial interval during incremental pacing (IP) from the low lateral right atrium may distinguish slow conduction from complete CTI conduction block. METHODS AND RESULTS Sixty-six consecutive patients (age, 65±13 years; 18% female) were prospectively included. A <10 ms increase in the His-to-coronary sinus ostium atrial timing during low lateral right atrium IP at cycle length of 600 ms through 300 ms was compared with the previously reported IP maneuver for the confirmation of complete CTI block. On the basis of the IP maneuver, complete CTI block (phase 2) was achieved in 59 patients, in 13 of whom an intermediate phase of functional CTI block (phase 1) was observed. In the remaining 7 patients, the IP maneuver did not allow for assessment of complete CTI block because of the presence of inconclusive potentials in the CTI ablation line. As compared with the IP maneuver, the incremental His-to-coronary sinus ostium maneuver was consistent with functional CTI block during phase 1 in all cases and conclusive of complete CTI block in 98% of cases during phase 2. CONCLUSIONS The incremental His-to-coronary sinus ostium maneuver is analogous to the IP maneuver in distinguishing complete CTI block from persistent CTI conduction. This maneuver may provide confirmation of CTI block in those patients in whom assessment of local electrogram-based criteria is not feasible because of inconclusive potentials in the CTI ablation line.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar Universitat Autònoma de Barcelona, Barcelona, Spain
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Vallès E, Martí-Almor J, Bazan V, Suarez F, Cian D, Portillo L, Bruguera-Cortada J. Diagnostic and prognostic value of electrophysiologic study in patients with nondocumented palpitations. Am J Cardiol 2011; 107:1333-7. [PMID: 21371684 DOI: 10.1016/j.amjcard.2010.12.047] [Citation(s) in RCA: 11] [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: 11/09/2010] [Revised: 12/30/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
Abstract
The 12-lead electrocardiogram helps to define the arrhythmic mechanism in patients with palpitations. However, in the setting of nondocumented palpitations the value of the electrophysiologic study (EPS) needs additional investigation. We investigated the utility of the EPS in patients with nondocumented palpitations. A total of 172 patients with normal electrocardiographic findings and nondocumented palpitations underwent an EPS. The clinical and electrophysiologic characteristics were assessed. The symptoms were long-lasting (>5 minutes) in 56%. Sudden onset was present in 99%, and termination was rapid in 65%. Neck palpitations were reported in 36%. The EPS findings were normal in 86 patients (50%); atrioventricular nodal reentrant tachycardia was induced in 43, orthodromic reentrant tachycardia in 9, and nonsustained atrial tachycardia/fibrillation (AT/AF) in 34. Long-lasting episodes, sudden termination, and neck palpitations predicted positive EPS findings and were associated with reentrant supraventricular tachycardia (p<0.001). The induction of AT/AF was associated with age >50 years and structural heart disease (p<0.001). After 53 ± 36 months of follow-up, 92% of patients with negative EPS findings were symptom free. Only 32% of patients with induced AT/AF remained free of symptoms (p<0.001). The recurrence of palpitations was more prevalent among patients with structural heart disease and aged >50 years (p<0.001). In conclusion, 50% of patients with nondocumented palpitations had positive EPS findings. A long duration, sudden termination, and neck palpitations, together with structural heart disease and age >50 years, predicted tachycardia inducibility and recurrence and could help in selecting patients suitable for EPS and ablation.
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Vallès E, Martí V, Noguero M, Guindo J, Domínguez de Rozas JM. [Prognosis of patients admitted in a coronary care unit after resucitating from out-of-hospital sudden cardiac death]. Med Clin (Barc) 2006; 127:281-5. [PMID: 16949010 DOI: 10.1016/s0025-7753(06)72232-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE The aims of the present study were to analyze the prognosis after resuscitation from out-of-hospital sudden cardiac death in patients admitted to the coronary care unit, and to identify the predictor variables of morbi-mortality. PATIENTS AND METHOD From November 1999 to January 2004 we analyzed 63 patients (47 males) aged 61 +/- 12 years who were admitted to the coronary care unit following successful resuscitation from sudden cardiac death. The clinical and electrocardiographic characteristics were correlated with the mortality and neurological impairment. RESULTS Thirty-five patients (55.5%) were discharged, while twenty-eight patients (45.5%) died 28 +/- 4 days after admission, most of them during hospitalization. The main underlying disorder was coronary artery disease (80.9%). When survivors and non-survivors were compared, the variables associated with a worse prognosis were diabetes mellitus (68.4% vs 17.1%, P < .02), the presence of valvular heart disease (28.6% vs 0%, p < 0.003), chronic atrial fibrillation (42.9% vs 14.3%, P < .02) and asystole as the initial rhythm observed (42.9% vs 11.4%, P < .01). Multivariate analysis identified asystole as an independent factor of poor prognosis (P < .02). Death was due to severe postanoxic neurological damage in 23 of 28 deaths (82.1%). The remaining 5 patients died due to their underlying cardiac disease (P < .01). The variables associated with neurological damage were out-of hospital resuscitation, delay in beginning resuscitation maneuvers, arrival time > 5 minutes and unconsciousness on admission. CONCLUSIONS Although many patients survive following resuscitation from out-of-hospital sudden cardiac death, mortality remains high. Neurological impairment is the main cause of mortality. Prognosis is determined by the variables related to the underlying disease, the delay in onset of resuscitation maneuvers and postanoxia cerebral damage.
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Affiliation(s)
- Ermengol Vallès
- Unidad de Cuidados Intensivos Coronarios. Servicio de Cardiología. Hospital de la Santa Creu i Sant Pau. Barcelona. España.
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Vallès E, Martí V, Noguero M, Guindo J, Domínguez de Rozas JM. Pronóstico de los pacientes ingresados en una unidad coronaria después de la recuperación de una muerte súbita de causa cardíaca fuera del hospital. Med Clin (Barc) 2006. [DOI: 10.1157/13091952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vallès E, Pujadas S, Guindo J, Leta R, Carreras F, Pons-Lladó G. Delayed-contrast enhancement cardioresonance in transient left ventricular apical ballooning. Int J Cardiovasc Imaging 2006; 23:243-7. [PMID: 16868858 DOI: 10.1007/s10554-006-9128-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 12/24/2005] [Accepted: 06/23/2006] [Indexed: 02/04/2023]
Abstract
Transient left ventricular apical ballooning (TAB) is a condition that mimics acute coronary syndrome typically without coronary angiographic stenosis. Patients present with typical chest pain, ECG changes suggesting ischemia, and a slight elevation of myocardial injury markers such as creatine kinase and troponines. Ballooning during ventricular systole of the cardiac apex is a characteristic feature of this entity. It is transient and it usually resolves after a few days together with normalization of ECG changes. Initially, apical dyskinesis can be diagnosed by any cardiac imaging technique that allows myocardial wall motion assessment. Recent advances in cardiovascular magnetic resonance imaging (CMR) have made this technique to become the gold-standard method to assess myocardial infarction. CMR provides an excellent and reproducible assessment of segmental wall motion abnormalities and, more importantly, it allows an accurate depiction of myocardial necrotic area by means of delayed contrast-enhancement method. Therefore, it may be particularly useful in the assessment of TAB by demonstrating segmental dysfunction in the absence of myocardial irreversible damage. We report three cases of TAB in which contrast- enhanced CMR emerged as an excellent diagnostic tool.
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MESH Headings
- Aged
- Angina Pectoris/etiology
- Angina Pectoris/pathology
- Angina Pectoris/physiopathology
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Dilated/physiopathology
- Contrast Media
- Diagnosis, Differential
- Electrocardiography
- Female
- Heart Ventricles/pathology
- Humans
- Magnetic Resonance Imaging, Cine
- Middle Aged
- Myocardial Ischemia/complications
- Myocardial Ischemia/diagnosis
- Myocardial Ischemia/pathology
- Myocardial Ischemia/physiopathology
- Radionuclide Ventriculography
- Syndrome
- Time Factors
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Ermengol Vallès
- Coronary Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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