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Jiménez-López J, Bazan V, Gonzalez-Matos CE, Di Marco A, Bottoni N, Battista A, Giacoman S, Sanchez-Millán PJ, Lozano JM, Álvarez-López M, Belarte-Tornero LC, Anguera I, Casteigt BJ, Sarrias-Mercé A, Weidmann ZM, Alonso-Martín C, Llorca L, Vallés-Gras E. "Targeting Confluent Areas of Slow Conduction and Electrogram Fragmentation for AV node Re-entrant Tachycardia ablation". Europace 2024:euae094. [PMID: 38606815 DOI: 10.1093/europace/euae094] [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] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department. Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Carlos E Gonzalez-Matos
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Andrea Di Marco
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Nicola Bottoni
- Electrophysiology Unit, Cardiology Department. Azienda USL - IRCSS of Reggio Emilia. Italy
| | - Antonella Battista
- Electrophysiology Unit, Cardiology Department. Azienda USL - IRCSS of Reggio Emilia. Italy
| | - Sebastian Giacoman
- Arrhythmia Unit. Cardiology deparment. Hospital Universitario Clínico San Cecilio. Granada. Spain
| | | | - Jose Miguel Lozano
- Arrhythmia Unit. Cardiology deparment. Hospital Universitario Clínico San Cecilio. Granada. Spain
| | | | - Laia C Belarte-Tornero
- Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute (IMIM). Barcelona. Spain
| | - Ignasi Anguera
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Benjamin Jacques Casteigt
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Axel Sarrias-Mercé
- Electrophysiology Unit, Cardiology Department. Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Zoraida Moreno Weidmann
- Electrophysiology Unit. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona. Spain
| | - Concepción Alonso-Martín
- Electrophysiology Unit. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona. Spain
| | | | - Ermengol Vallés-Gras
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
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2
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Brown PF, Di Marco A, Tsoumani Z, Reid A, Bradley J, Nucifora G, Anguera I, Miller C, Schmitt M. Predictive value of a comprehensive atrial assessment with cardiac magnetic resonance in non-ischemic cardiomyopathy: keep it simple. Int J Cardiovasc Imaging 2024; 40:557-567. [PMID: 38064141 DOI: 10.1007/s10554-023-03024-4] [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: 06/27/2023] [Accepted: 11/22/2023] [Indexed: 03/20/2024]
Abstract
Cardiac magnetic resonance (CMR) can provide a multi-parametric evaluation of left atrial (LA) size and function. A complete CMR-based LA assessment might improve the risk stratification of patients with non-ischemic dilated cardiomyopathy (DCM). We performed a comprehensive CMR-based evaluation of LA size and function, in order to assess the prognostic impact of specific LA parameters in DCM. Secondary analysis of a prospective registry (UHSM-CMR study, NCT02326324) including 648 consecutive patients with DCM and CMR evaluation of LA area and LA length. Of these, 456 had complete LA assessment covering reservoir, conduit and booster pump function and including LA reservoir strain evaluated with feature tracking. The heart failure (HF) endpoint included HF hospitalizations, HF death and heart transplant. The arrhythmic endpoint included ventricular arrhythmias (VA) (sustained or treated by implantable defibrillator) and sudden death (SD). At median follow-up of 23 months, 34 patients reached the HF endpoint; in a multivariable model including NYHA class and LVEF, LA length had incremental predictive value. LA length ≥ 69 mm was the best cut-off to predict HF events (adjusted HR 2.3, p = 0.03). Among the 456 patients with comprehensive LA assessment, only LA length was independently associated with the HF endpoint after adjusting for LVEF and NYHA class. By contrast, no LA parameter independently predicted the arrhythmic risk. In DCM patients, LA length is an independent predictor of HF events, showing stronger association than other more complex parameters of LA function. No atrial parameter predicts the risk of VA and SD.
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Affiliation(s)
- Pamela Frances Brown
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
| | - Andrea Di Marco
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
- Bio Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
- Cardiology department, Bellvitge University Hospital, carrer feixa llarga sin número, Hospitalet de Llobregat, Barcelona, 08907, Spain.
| | - Zoi Tsoumani
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anna Reid
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Joshua Bradley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Gaetano Nucifora
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Bio Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christopher Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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3
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Abstract
Left ventricular ejection fraction-based arrhythmic risk stratification in nonischemic cardiomyopathy (NICM) is insufficient and has led to the failure of primary prevention implantable cardioverter defibrillator trials, mainly due to the inability of selecting patients at high risk for sudden cardiac death (SCD). Cardiac magnetic resonance offers unique opportunities for tissue characterization and has gained a central role in arrhythmic risk stratification in NICM. The presence of myocardial scar, denoted by late gadolinium enhancement, is a significant, independent, and strong predictor of ventricular arrhythmias and SCD with high negative predictive value. T1 maps and extracellular volume fraction, which are able to quantify diffuse fibrosis, hold promise as complementary tools but need confirmatory results from large studies.
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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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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5
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Rossi P, Cauti FM, Niscola M, Magnocavallo M, Polselli M, Capone S, Della Rocca DG, Rodriguez-Garrido J, Piccirillo G, Anguera I, Dallaglio P, Bianchi S. Ventricular Electrograms Duration Map to Detect Ventricular Arrhythmia Substrate: the VEDUM Project Study. Circ Arrhythm Electrophysiol 2023; 16:447-455. [PMID: 37485678 PMCID: PMC10786440 DOI: 10.1161/circep.122.011729] [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: 11/22/2022] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The analysis of the wave-front activation patterns is crucial for the comprehension and treatment of ventricular tachycardia (VT). The ventricular electrograms duration map (VEDUM) is a potential method to identify areas (VEDUM area) with slow and inhomogeneous activation. There is no available data on the characteristics and the arrhythmogenic role of VEDUM areas identified during sinus/paced rhythm. METHODS Patients referred for VT ablation were enrolled at 3 different centers. VEDUM maps during sinus/paced rhythm as well as substrate and functional maps were created; activation mapping was performed for all hemodynamically tolerated VT. RESULTS Thirty-two patients (mean age:70.1±9.4 years; males 93.8%) were enrolled. The VEDUM approach was achieved in all patients and the mean size of the VEDUM area was 12.1±6.9 cm2 (interquartile range, 7.8-14.9 cm2). A significative difference was observed between the electrogram duration in the VEDUM area and the normal tissue (163.7 ms [interquartile range, 142.3-199.2 ms]; versus 65.5 ms [interquartile range, 59.5-76.2 ms]; P<0.001). The VEDUM area was visualized in a dense scar (<0.5 mV) in 19 (59.4%) patients. A deceleration zone and late potentials were recorded inside the VEDUM area in 56.3% and 81.3%, respectively. When a complete VT activation mapping was available, the isthmus projected in the VEDUM area in 93.5% of patients; 8 of them had multiple VTs mapped and in the 87.5% all VT isthmuses were included in the VEDUM area. CONCLUSIONS VEDUM maps allow the identification of discrete areas of inhomogeneous and slow conduction. They represent a potential target for VT ablation, including patients with multiple morphologies.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marta Niscola
- Abbott Medical Italy, Sesto San Giovanni, Milan, Italy (M.N.)
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Silvia Capone
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R.)
| | | | - Gianfranco Piccirillo
- University of Rome “Sapienza,” Department of Science of Internal Clinics, Anestesiologists & Cardiovasculars, Policlinico Umberto I, Rome, Italy (G.P.)
| | - Ignasi Anguera
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Paolo Dallaglio
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
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6
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Hindricks G, Theuns DA, Bar-Lev D, Anguera I, Ayala Paredes FA, Arnold M, Geller JC, Merkely B, Dyrda KM, Perings C, Maglia G, Ploux S, Meyhöfer J, Blomström-Lundqvist C, Karjalainen P, Liang Y, Diemberger I, Wranicz JK, Barr C, Quartieri F, Timmel T, Bollmann A. Ability to remotely monitor atrial high-rate episodes using a single-chamber implantable cardioverter-defibrillator with a floating atrial sensing dipole. Europace 2023; 25:euad061. [PMID: 37038759 PMCID: PMC10227664 DOI: 10.1093/europace/euad061] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/06/2022] [Indexed: 04/12/2023] Open
Abstract
AIMS To allow timely initiation of anticoagulation therapy for the prevention of stroke, the European guidelines on atrial fibrillation (AF) recommend remote monitoring (RM) of device-detected atrial high-rate episodes (AHREs) and progression of arrhythmia duration along pre-specified strata (6 min…<1 h, 1 h…<24 h, ≥ 24 h). We used the MATRIX registry data to assess the capability of a single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (DX ICD system) to follow this recommendation in patients with standard indication for single-chamber ICD. METHODS AND RESULTS In 1841 DX ICD patients with daily automatic RM transmissions, electrograms of first device-detected AHREs per patient in each duration stratum were adjudicated, and the corresponding positive predictive values (PPVs) for the detections to be true atrial arrhythmia were calculated. Moreover, the incidence and progression of new-onset AF was assessed in 1451 patients with no AF history. A total of 610 AHREs ≥6 min were adjudicated. The PPV was 95.1% (271 of 285) for episodes 6min…<1 h, 99.6% (253/254) for episodes 1 h…<24 h, 100% (71/71) for episodes ≥24 h, or 97.5% for all episodes (595/610). The incidence of new-onset AF was 8.2% (119/1451), and in 31.1% of them (37/119), new-onset AF progressed to a higher duration stratum. Nearly 80% of new-onset AF patients had high CHA2DS2-VASc stroke risk, and 70% were not on anticoagulation therapy. Age was the only significant predictor of new-onset AF. CONCLUSION A 99.7% detection accuracy for AHRE ≥1 h in patients with DX ICD systems in combination with daily RM allows a reliable guideline-recommended screening for subclinical AF and monitoring of AF-duration progression.
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Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig and Leipzig Heart Institute, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Dominic A Theuns
- Erasmus University Medical Center,‘s-Gravendijkwal 230, 3015 GD Rotterdam, TheNetherlands
| | - David Bar-Lev
- Chaim Sheba Medical Center,52621 Tel Hashomer, Israel
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Diseases Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Feixa Llarga, 08907 L'Hospitalet, Barcelona, Spain
| | | | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - J Christoph Geller
- Zentralklinik Bad Berka GmbH,Robert-Koch-Allee 9, 99437 Bad Berka, Germany
| | - Béla Merkely
- Semmelweis Medical University, Városmajorutca 68, 1122 Budapest, Hungary
| | - Katia Marjolaine Dyrda
- Montreal Heart Institute affiliated with Université de Montréal, 5000, rue Belanger, H1T 1C8 Montréal, Québec, Canada
| | | | - Giampiero Maglia
- Azienda Ospedaliera Pugliese Ciaccio, Via Vinicio Cortese 25, 88100 Catanzaro, Italia
| | - Sylvain Ploux
- Hôpital Haut Lévêque (CHU), 1 avenue de Magellan, 33600 Pessac Cedex, France
| | - Jürgen Meyhöfer
- Maria Heimsuchung—Caritas-Klinik Pankow,Breite Str. 46/47, 13187 Berlin, Germany
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Department of Medical Science and Cardiology, Uppsala University, S-751 85 Uppsala, Sweden
| | - Pasi Karjalainen
- Satakunta Central Hospital, Sydänyksikkö, Sairaalantie 3, 28500 Pori, Finland
| | - Yanchun Liang
- General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italia
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, Ul. Pomorska 251, 92-213 Łódź, Poland
| | - Craig Barr
- Russells Hall Hospital, Pensett Road, DY1 2HQ Dudley, UK
| | - Fabio Quartieri
- Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italia
| | - Tobias Timmel
- Biotronik SE & Co. KG,Woermannkehre 1, 12359 Berlin, Germany
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7
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Di Marco A, Brown P, Mateus G, Faga V, Nucifora G, Claver E, Viedma J, Galvan F, Bradley J, Dallaglio PD, de Frutos F, Miller CA, Comín-Colet J, Anguera I, Schmitt M. Late gadolinium enhancement and the risk of ventricular arrhythmias and sudden death in NYHA class I patients with non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:740-750. [PMID: 36781200 DOI: 10.1002/ejhf.2793] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
AIM To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between New York Heart Association (NYHA) class I and NYHA class II-III patients with non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate implantable cardioverter defibrillator (ICD) therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death. Overall, 698 patients were included, 33% in NYHA class I. During a median follow-up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA class I and NYHA class II-III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement (LGE) was the only independent predictor of the primary outcome both in NYHA class I and NYHA class II-III patients. LGE+ NYHA class I patients had a similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA class II-III (p = 0.92) and a significantly higher risk as compared to LGE- NYHA class II-III cases (p < 0.001). The risk of the secondary endpoint was significantly higher in patients in NYHA class II-III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001). CONCLUSIONS Patients with NICM in NYHA class I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high risk. NYHA class I patients with high-risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA class II-III with the same risk factors.
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MESH Headings
- Humans
- Contrast Media
- Gadolinium
- Retrospective Studies
- Heart Failure/therapy
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Myocardial Ischemia/diagnostic imaging
- Myocardial Ischemia/epidemiology
- Myocardial Ischemia/complications
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Risk Factors
- Defibrillators, Implantable/adverse effects
- Cardiomyopathies
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Pamela Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gemma Mateus
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Valentina Faga
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Jisela Viedma
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francisco Galvan
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paolo D Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Josep Comín-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Di Marco A, Brown PF, Bradley J, Nucifora G, Anguera I, Miller CA, Schmitt M. Extracellular volume fraction improves risk-stratification for ventricular arrhythmias and sudden death in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:512-521. [PMID: 35877070 DOI: 10.1093/ehjci/jeac142] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate whether cardiac magnetic resonance (CMR)-based parametric mapping and strain analysis can improve the risk-stratification for ventricular arrhythmias (VA) and sudden death (SD) in non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Secondary analysis of a prospective single-centre-registry (NCT02326324), including 703 consecutive NICM patients, 618 with extracellular volume (ECV) available. The combined primary endpoint included appropriate implantable cardioverter defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. During a median follow-up of 21 months, 14 patients (2%) experienced the primary endpoint. Native T1 was not associated with the primary endpoint. Left ventricular global longitudinal strain lost its significant association after adjustment for left ventricular ejection fraction (LVEF). Among patients with ECV available, 11 (2%) reached the primary endpoint. Mean ECV was significantly associated with the primary endpoint and the best cut-off was 30%. ECV ≥ 30% was the strongest independent predictor of the primary endpoint (hazard ratio 14.1, P = 0.01) after adjustment for late gadolinium enhancement (LGE) and LVEF. ECV ≥ 30% discriminated the arrhythmic risk among LGE+ cases and among those with LVEF ≤ 35%. A simple clinical risk-stratification model, based on LGE, LVEF ≤ 35% and ECV ≥ 30%, achieved an excellent predictive ability (Harrell's C 0.82) and reclassified the risk of 32% of the study population as compared to LVEF ≤ 35% alone. CONCLUSIONS Comprehensive CMR evaluation in NICM showed that ECV was the only parameter with an independent and strong predictive value for VA/SD, on top of LGE and LVEF. A risk-stratification model based on LGE, LVEF ≤ 35% and ECV ≥ 30% achieved an excellent predictive ability for VA/SD. CLINICAL TRIAL REGISTRATION UHSM CMR study (NCT02326324) https://clinicaltrials.gov/ct2/show/NCT02326324.
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Pamela F Brown
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Joshua Bradley
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Gaetano Nucifora
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Matthias Schmitt
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
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9
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Claver E, Di Marco A, Brown PF, Bradley J, Nucifora G, Ruiz-Majoral A, Dallaglio PD, Rodriguez M, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Prognostic impact of late gadolinium enhancement at the right ventricular insertion points in non-ischaemic dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:346-353. [PMID: 35699462 DOI: 10.1093/ehjci/jeac109] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the baseline characteristics and the prognostic implications associated with late gadolinium enhancement limited to the right ventricular insertion points (IP-LGE) or present at both the right ventricular insertion points and the left ventricle (IP&LV-LGE) in non-ischaemic dilated cardiomyopathy (DCM). METHODS AND RESULTS This is a retrospective observational multicentre cohort study including 1165 consecutive patients with DCM evaluated by cardiac magnetic resonance. The primary endpoint included appropriate defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, or sudden death. The secondary outcome encompassed heart failure hospitalizations, heart transplant, left ventricular assist device implantation, and end-stage heart failure death. IP-LGE was found in 72 patients (6%), who had clinical characteristics closer to LGE- than to LGE+ patients. During follow-up (median 36 months), none of the IP-LGE patients experienced the primary endpoint. The cumulative incidence of the primary endpoint was similar between IP-LGE and LGE- patients (P = 1), while IP-LGE had significantly lower cumulative incidence when compared with LGE+ patients (P < 0.001). When compared with IP-LGE patients, the cumulative incidence of the secondary endpoint was similar in LGE- cases (P = 0.86) but tended to be higher in LGE+ patients (P = 0.06). Both clinical characteristics and outcomes were similar between IP&LV-LGE patients and the rest of LGE+ cases. CONCLUSIONS In a large cohort of DCM patients, IP-LGE was associated with similar outcome when compared with LGE- patients and with significant lower risk of ventricular arrhythmias and sudden death when compared with LGE+ cases. Patients with IP&LV-LGE had clinical characteristics and outcomes similar to the rest of LGE+ cases.
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Affiliation(s)
- Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Alejandro Ruiz-Majoral
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodriguez
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
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10
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Pons-Riverola A, Mañas P, Claver E, Meroño O, Comín-Colet J, Anguera I. [Third-degree atrioventricular block associated with the SARS-CoV-2 mRNA vaccine]. Rev Esp Cardiol 2022; 76:384-386. [PMID: 36569215 PMCID: PMC9760634 DOI: 10.1016/j.recesp.2022.10.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022]
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11
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Di Marco A, Brown P, Anguera I, Claver E, Schmitt M. Further Insights Into the Prognostic Value of Left Atrial Strain in Dilated Cardiomyopathy? JACC Cardiovasc Imaging 2022; 15:2155-2156. [PMID: 36481087 DOI: 10.1016/j.jcmg.2022.08.021] [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] [Received: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022]
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12
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Anguera I, Cano Pérez Ó, Bazán V. [Spanish catheter ablation registry. 21st official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021)]. Rev Esp Cardiol 2022; 75:1029-1039. [PMID: 36164639 PMCID: PMC9492424 DOI: 10.1016/j.recesp.2022.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
Abstract
Introduction and objectives The results of the 2021 Spanish catheter ablation registry are presented. Methods Data collection was carried out retrospectively by filling in and sending a specific form by the participating centers. Results Data from 93 centers (65 public, 28 private) were analyzed. A total of 17941 ablation procedures were reported with a mean of 193 ± 133 clases per centre. Recovery of activity from SARS-CoV-2 pandemic lockdown has led to a notable increase in the number of procedures (+2772 procedures, +18%) despite a small decrease in participating centers (4 centers less than in 2020). Atrial fibrillation ablation continues to be the leading procedure, with 5848 procedures (32,6%). Together with ablation of the cavotricuspid isthmus (3766; 21%) and atrioventricular nodal reentrant tachycardia (3132; 17,5%) they constitute the 3 most frequently approached substrates. The total success rate reported (94%) is similar to previous years with a similar rate of complications (2%) and mortality (0.07). A total of 401 procedures were performed in pediatric patients (3,8%). Conclusions The Spanish catheter ablation registry systematically and continuously collects the national activity, which has recovered significantly from the SARS-CoV-2 pandemic impact in 2020. Success rate for 2021 remains high, with a low complication rate.
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Affiliation(s)
- Ignasi Anguera
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Óscar Cano Pérez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Víctor Bazán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
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13
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Calvo D, Salinas L, Martínez-Camblor P, García-Iglesias D, Alzueta J, Rodríguez A, Romero R, Viñolas X, Fernández-Lozano I, Anguera I, Villacastín J, Bodegas A, Fontenla A, Jalife J, Berenfeld O. Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases. Europace 2022; 24:1788-1799. [PMID: 35851611 PMCID: PMC10112842 DOI: 10.1093/europace/euac107] [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] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/09/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans. METHODS AND RESULTS Fifty-eight self-terminated and 173 shock-terminated episodes of spontaneously initiated PVT/VF recorded by Medtronic implanted cardiac defibrillators (ICDs) in 87 patients with various cardiac pathologies were analyzed by short fast Fourier transform of shifting segments to determine the dynamics of dominant frequency (DF) and regularity index (RI). The progression in the intensity of DF and RI accumulations further quantified the time course of spectral characteristics of the episodes. Episodes of self-terminated PVT/VF lasted 8.6 s [95% confidence interval (CI): 8.1-9.1] and shock-terminated lasted 13.9 s (13.6-14.3) (P < 0.001). Recordings from patients with primarily electrical pathologies displayed higher DF and RI values than those from patients with primarily structural pathologies (P < 0.05) independently of ventricular function or antiarrhythmic drug therapy. Regardless of the underlying pathology, the average DF and RI intensities were lower in self-terminated than shock-terminated episodes [DF: 3.67 (4.04-4.58) vs. 4.32 (3.46-3.93) Hz, P < 0.001; RI: 0.53 (0.48-0.56) vs. 0.63 (0.60-0.65), P < 0.001]. In a multivariate analysis controlled by the type of pathology and clinical variables, regularity remained an independent predictor of self-termination [hazard ratio: 0.954 (0.928-0.980)]. Receiver operating characteristic (ROC) curve analysis of DF and RI intensities demonstrated increased predictability for self-termination in time with 95% CI above the 0.5 cut-off limit at about t = 8.6 s and t = 6.95 s, respectively. CONCLUSION Consistent with the notion that fast organized sources maintain PVT/VF in humans, reduction of frequency and regularity correlates with early self-termination. Our findings might help generate ICD methods aiming to reduce inappropriate shock deliveries.
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Affiliation(s)
- David Calvo
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. Roma, s/n; 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Lucia Salinas
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA
| | | | - Daniel García-Iglesias
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. Roma, s/n; 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Javier Alzueta
- Arrhythmia Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | - Anibal Rodríguez
- Arrhythmia Unit, Hospital Universitario de Canarias, Canarias, Spain
| | - Rafael Romero
- Arrhythmia Unit, Hospital Universitario Ntra Señora de la Candelaria, Canarias, Spain
| | | | | | | | | | | | | | - José Jalife
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA.,Cardiac Arrhythmia Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA
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Pons-Riverola A, Mañas P, Claver E, Meroño O, Comín-Colet J, Anguera I. Third-degree atrioventricular block associated with the SARS-CoV-2 mRNA vaccine. Rev Esp Cardiol (Engl Ed) 2022; 76:384-386. [PMID: 36302470 PMCID: PMC9595393 DOI: 10.1016/j.rec.2022.10.004] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
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15
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Anguera I, Cano Pérez Ó, Bazán V. Registro español de ablación con catéter. XXI Informe oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2021). Rev Esp Cardiol (Engl Ed) 2022; 75:1029-1039. [PMID: 36244656 PMCID: PMC9558688 DOI: 10.1016/j.rec.2022.08.013] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
Introduction and objectives The results of the 2021 Spanish catheter ablation registry are presented. Methods Data collection was carried out retrospectively by filling in and sending a specific form by the participating centers. Results Data from 93 centers (65 public, 28 private) were analyzed. A total of 17941 ablation procedures were reported with a mean of 193 ± 133 cases per centre. Recovery of activity from SARS-CoV-2 pandemic lockdown has led to a notable increase in the number of procedures (+2772 procedures, +18%) despite a small decrease in participating centers (4 centers less than in 2020). Atrial fibrillation ablation continues to be the leading procedure, with 5848 procedures (32,6%). Together with ablation of the cavotricuspid isthmus (3766; 21%) and atrioventricular nodal reentrant tachycardia (3132; 17,5%) they constitute the 3 most frequently approached substrates. The total success rate reported (94%) is similar to previous years with a similar rate of complications (2%) and mortality (0.07). A total of 401 procedures were performed in pediatric patients (3,8%). Conclusions The Spanish catheter ablation registry systematically and continuously collects the national activity, which has recovered significantly from the SARS-CoV-2 pandemic impact in 2020. Success rate for 2021 remains high, with a low complication rate.
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Affiliation(s)
- Ignasi Anguera
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Óscar Cano Pérez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Víctor Bazán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Di-Marco A, Brown PF, Claver E, Bradley J, Nucifora G, Ruiz-Cueto M, Dallaglio PD, Rodriguez M, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Ventricular Arrhythmias and Sudden Death in Nonischemic Dilated Cardiomyopathy: Matter of Sex or Scar? J Card Fail 2022; 28:1278-1286. [PMID: 35176484 DOI: 10.1016/j.cardfail.2022.01.019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND To evaluate the association between sex and ventricular arrhythmias (VA) or sudden death (SD) in nonischemic dilated cardiomyopathy, including analysis of potential confounders. METHODS AND RESULTS Retrospective cohort study of consecutive patients with DCM referred for cardiac magnetic resonance at 2 tertiary hospitals. The primary combined end point encompassed sustained VA, appropriate implantable cardioverter defibrillator therapies, resuscitated cardiac arrest, and SD. We included 1165 patients with median follow-up of 36 months (interquartile range 20-58 months). The majority of patients (66%) were males. Males and females had similar left ventricular ejection fraction, but the prevalence of late gadolinium enhancement (LGE) at cardiac magnetic resonance was significantly higher among males (48% vs 30%, P < .001). Males had higher cumulative incidence of the primary end point (8% vs 4%, P = .02), and male sex was a significant predictor of the primary end point at univariate analysis (hazard ratio 1.93, P = .02). However, LGE had a major confounding effect in the association between sex and the primary outcome: the hazard ratio of male sex adjusted for LGE was 1.29 (P = .37). LGE+ females had significantly higher cumulative incidence of the primary end point than LGE- males (13% vs 1.8%, P < .001). CONCLUSIONS In patients with DCM, the prevalence of LGE is significantly higher among males, implying a major confounding effect in the association between male sex and VA or SD. LGE+ females have significantly higher risk than LGE- males. These data do not support the inclusion of sex into risk stratification algorithms for VA or SD in DCM.
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Affiliation(s)
- Andrea Di-Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, UK
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, UK
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, UK
| | - María Ruiz-Cueto
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodriguez
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, UK
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Di Marco A, Anguera I, Schmitt M. Additional Predictive Value of Gray Zone Fibrosis in Nonischemic Cardiomyopathy? J Am Coll Cardiol 2022; 79:e467. [PMID: 35654499 DOI: 10.1016/j.jacc.2022.03.373] [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] [Received: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
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Maglia G, Bollmann A, Theuns DA, Bar-Lev D, Anguera I, Ayala Paredes FA, Arnold M, Geller JC, Merkely B, Dyrda KM, Perings C, Ploux S, Meyhoefer J, Timmel T, Hindricks G. Real-world experience on implantation and atrial signal detection of a SC ICD with atrial sensing capability: The MATRIX study. Europace 2022. [DOI: 10.1093/europace/euac053.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): BIOTRONIK, Berlin, Germany
Introduction
A single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (the DX ICD system) can potentially give additive information concerning atrial diagnostics in patients requiring only a single-chamber ICD. We therefore report the real-world experience from large DX registry on implantation, atrial signal quality and detection and the long-term stability of the atrial signal.
Methods
The prospective, single-arm MATRIX (Management and Detection of Atrial Tachyarrhythmias in Patients Implanted With BIOTRONIK DX Systems, NCT01774357) registry study effectively enrolled 2041 patients at 119 sites in 24 countries. All patients had a DX system implanted for a single-chamber ICD indication for primary or secondary prevention of sudden cardiac death. Patients were followed for 24 months including remote monitoring. Implantation and follow-up data are reported for the whole patient set. For the analyses on atrial sensing amplitude values, remotely transmitted device measurements of patients without history of long-standing persistent or permanent AF at baseline were used.
Results
The mean follow-up period was 677±173 days. Implantation took place at 15±22 days before enrollment. Baseline and implantation data are shown in the table. Implantation procedure and lead insertion were rated as "easy" or "very easy" in 91.0% and 96.3% of assessments, respectively. At implantation, the investigators rated the quality of the atrial sensing amplitude as "sufficient" in 97% of the assessed cases. At enrollment (12-month/24-month follow-up), the atrial signal quality and detection were rated as "good" or "excellent" in 92.3% (89.8%/89.9%) and 92.4% (90.1%/91.3%) of assessments, respectively. For 1841 patients (90.2%), remotely transmitted device information was received. The median (mean ± SD, IQR) transmission rate was 92.5% (85.4±18.2%, 81.4-97.3%). 1746 patients (85.5%) matched the inclusion criteria for the quantitative analyses on atrial sensing. 95.6% of available RA sensing amplitude values were ≥1 mV. Based on each patient’s overall median value, the median (mean ± SD, IQR) RA sensing amplitude was 4.6 mV (4.4±2.0 mV, 2.8-6.2 mV). The time course of patient median values stratified by month is shown in the figure.
Conclusion
The study followed 2041 patients implanted with the DX ICD system for two years. In the vast majority of cases, investigators rated implantation as (very) easy and the atrial signal over 24 months as good/excellent. According to daily, automatic Home Monitoring data, the overall mean P-wave amplitude remained stable throughout the whole follow-up. The MATRIX study demonstrated functionality and clinical utility of the DX concept in an unselected, real-life setting.
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Affiliation(s)
- G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - A Bollmann
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - DA Theuns
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Bar-Lev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - I Anguera
- University Hospital of Bellvitge, Heart Diseases Institute, Barcelona, Spain
| | | | - M Arnold
- University hospital Erlangen, Erlangen, Germany
| | - JC Geller
- Central Clinic Bad Berka, Bad Berka, Germany
| | - B Merkely
- Semmelweis University, Budapest, Hungary
| | - KM Dyrda
- University of Montreal, Montreal Heart Institute, Montreal, Canada
| | - C Perings
- St.-Marien-Hospital, Luenen, Germany
| | - S Ploux
- Haut-Leveque Hospital - University Hospital Centre, Pessac, France
| | - J Meyhoefer
- Maria Heimsuchung Caritas-Clinic Pankow, Berlin, Germany
| | - T Timmel
- Biotronik SE & Co. KG, Berlin, Germany
| | - G Hindricks
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
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Faga V, Anguera I, Oloriz T, Nombela-Franco L, Teruel L, Dallaglio PD, Perez Guerrero A, Gomez Hospital JA, Rodriguez Garcia J, Rodriguez Garcia MA, Adelino Recasens R, Merce J, Viedma J, Comin Colet J, Di Marco A. Improved prediction of electrical storm in patients with prior myocardial infarction and implantaImproved prediction of electrical storm in patients with prior myocardiable cardioverter defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD).
Methods
Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation.
Results
During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p<0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p=0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%).
Conclusion
In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.
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Affiliation(s)
- V Faga
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - I Anguera
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - T Oloriz
- University Hospital Miguel Servet, Cardiology department, Zaragoza, Spain
| | - L Nombela-Franco
- Hospital Clinico San Carlos, Cardiology department, Madrid, Spain
| | - L Teruel
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - PD Dallaglio
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - A Perez Guerrero
- University Hospital Miguel Servet, Cardiology department, Zaragoza, Spain
| | - JA Gomez Hospital
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - J Rodriguez Garcia
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - MA Rodriguez Garcia
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - R Adelino Recasens
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - J Merce
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - J Viedma
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - J Comin Colet
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
| | - A Di Marco
- University Hospital of Bellvitge, Cardiology department, Hospitalet De Llobregat, Spain
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Maglia G, Hindricks G, Theuns DA, Bar-Lev D, Anguera I, Ayala Paredes FA, Arnold M, Geller JC, Merkely B, Dyrda KM, Perings C, Ploux S, Meyhoefer J, Timmel T, Bollmann A. Capability of guideline-conform remote atrial high rate episode monitoring with a single-chamber implantable defibrillator with atrial sensing. Europace 2022. [DOI: 10.1093/europace/euac053.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): BIOTRONIK, Berlin, Germany
Introduction
Device-detected atrial high-rate episodes (AHRE) and their burden progression are associated with an increased risk for thromboembolic events in correlation with CHA2DS2-VASc score and AHRE burden. To allow timely initiation of anticoagulation therapy for the prevention of stroke, the European guidelines on atrial fibrillation (AF) recommend the monitoring of AHRE progression along pre-specified strata (6min…<1h, 1h…<24, ≥24h). We sought to assess the capability of a single-lead implantable cardioverter defibrillator (ICD), that is equipped with an atrial dipole for atrial sensing, to remotely detect and monitor AHRE burden progression in patients with standard indication to single-chamber ICD.
Methods
From the MATRIX (Management and Detection of Atrial Tachyarrhythmias in Patients Implanted With BIOTRONIK DX Systems) registry, we analyzed remotely transmitted, and electrogram (IEGM) AHREs in a subset of patients with remote transmissions and without history of long-standing AF at baseline. For each patient, we selected the first occurring episode per duration stratum and the first subsequent occurrence when progressing to a stratum of any longer duration. After episode adjudication by an independent electrophysiologist, we assessed the classification performance of the device (positive predictive value [PPV]) and analyzed AHRE onset and progression pathways.
Results
Of the MATRIX cohort, 1,746 patients matched the inclusions criteria (see table for patient characteristics) and 1,451 had no AF history. Of the 258 patients with AHREs (14.8%), 450 out of 465 evaluated episodes were correctly classified as AHRE. Reasons for misclassification were artifact (13) and R-wave oversensing (2). PPV was 96.8% (95% confidence interval 94.7%-98.2%). Grouped by stratum, PPV was 93.9%, 99.5% and 100% for 6min…<1h, 1h…<24 and ≥24h, respectively. Ninety six of 240 patients (40.0%) with a first episode according to the pre-specified strata were progressing to a stratum of longer duration and 9 patients (3.8%) had further progression (see Figure). In 119 out of 1,451 patients without AF history (8.2%), the device detected AHRE and 81 of them (4.6% of analysis set) had a mid to high risk for stroke and were not on anticoagulation therapy. In 121 out of 295 patients with known history of paroxysmal and persistent AF (41.0%), the arrhythmia was confirmed by the device.
Discussion and Conclusion: The single-chamber ICD with atrial sensing capabilities correctly classified ≈97% of all adjudicated AHREs ≥6min. About 7% of patients had device-detected AHRE onset and/or progression and a mid to high stroke risk. These patients would potentially benefit the most from a guideline-conform AF monitoring strategy to timely initiate anticoagulation medication for stroke prevention.
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Affiliation(s)
- G Maglia
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - G Hindricks
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - DA Theuns
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Bar-Lev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - I Anguera
- University Hospital of Bellvitge, Heart Diseases Institute, Barcelona, Spain
| | | | - M Arnold
- University hospital Erlangen, Erlangen, Germany
| | - JC Geller
- Central Clinic Bad Berka, Bad Berka, Germany
| | - B Merkely
- Semmelweis University, Budapest, Hungary
| | - KM Dyrda
- University of Montreal, Montreal Heart Institute, Montreal, Canada
| | - C Perings
- St.-Marien-Hospital, Luenen, Germany
| | - S Ploux
- Haut-Leveque Hospital - University Hospital Centre, Pessac, France
| | - J Meyhoefer
- Maria Heimsuchung Caritas-Clinic Pankow, Berlin, Germany
| | - T Timmel
- Biotronik SE & Co. KG, Berlin, Germany
| | - A Bollmann
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
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Iannaccone M, Nombela-Franco L, Gallone G, Annone U, Di Marco A, Giannini F, Ayoub M, Sardone A, Amat-Santos I, Fernandez-Lozano I, Barbero U, Dusi V, Toselli M, Petretta A, de Salvia A, Boccuzzi G, Colangelo S, Anguera I, D'Ascenzo F, Colombo A, De Ferrari GM, Escaned J, Garbo R, Mashayekhi K. Impact of successful chronic coronary total occlusion recanalization on recurrence of ventricular arrhythmias in implantable cardioverter-defibrillator recipients for ischemic cardiomyopathy (VACTO PCI study). Cardiovascular Revascularization Medicine 2022; 43:104-111. [DOI: 10.1016/j.carrev.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
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22
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Faga V, Anguera I, Oloriz T, Nombela-Franco L, Teruel L, Dallaglio P, Guerrero AP, Salazar CH, Escaned J, Abadía AA, Hospital JAG, García JR, García MR, Colet JC, Di Marco A. Improved prediction of electrical storm in patients with prior myocardial infarction and implantable cardioverter defibrillator. Int J Cardiol 2022; 355:9-14. [PMID: 35176405 DOI: 10.1016/j.ijcard.2022.02.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
AIMS To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD). METHODS Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation. RESULTS During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p < 0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p = 0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%). CONCLUSION In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.
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Affiliation(s)
- Valentina Faga
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Ignasi Anguera
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Teresa Oloriz
- Cardiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Luis Teruel
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Paolo Dallaglio
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | | | | | - Javier Escaned
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Joan Antoni Gomez Hospital
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Julián Rodriguez García
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Marcos Rodriguez García
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Josep Comin Colet
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Andrea Di Marco
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain.
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Castro V, Toquero J, Pérez L, Orruño J, Alzueta J, Viñolas X, Álvarez L, Anguera I, Fernández I. Factores predictores de aparición de fibrilación auricular en pacientes con miocardiopatía dilatada. RCCAR 2022. [DOI: 10.24875/rccar.m21000096] [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: 11/17/2022] Open
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Schmitt J, Wenzel B, Brüsehaber B, Anguera I, de Sousa J, Nölker G, Bulava A, Marques P, Hatala R, Golovchiner G, Meyhöfer J, Ilan M. Impact of lockdown during COVID-19 pandemic on physical activity and arrhythmia burden in heart failure patients. Pacing Clin Electrophysiol 2022; 45:471-480. [PMID: 34997979 DOI: 10.1111/pace.14443] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/26/2021] [Accepted: 01/02/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Restricted outdoor activity during COVID-19 related lockdown may accelerate heart failure (HF) progression and thereby increase cardiac arrhythmias. We analyzed the impact of March/April 2020 lockdown on physical activity and arrhythmia burden in HF patients treated with cardiac resynchronization therapy (CRT) devices with daily, automatic remote monitoring (RM) function. METHODS The study cohort included 405 HF patients enrolled in Observation of Clinical Routine Care for Heart Failure Patients Implanted with BIOTRONIK CRT Devices (BIO|STREAM.HF) registry in 16 countries, who had left ventricular ejection fraction (LVEF) ≤40% (mean 28.2 ± 6.6%) and NYHA class II/III/IV (47.9%/49.6%/2.5%) before CRT pacemaker/defibrillator implantation. The analyzed RM data comprised physical activity detected by accelerometer, mean heart rate and nocturnal rate, PP variability, percentage of biventricular pacing, atrial high rate episode (AHRE) burden, ventricular extrasystoles and tachyarrhythmias, defibrillator shocks, and number of implant interrogations (i.e., follow-ups). Intraindividual differences in RM parameters before (4-week period) versus during (4-week period) lockdown were tested for statistical significance and independent predictors were identified. RESULTS There was a significant relative change in activity (mean -6.5%, p < .001), AHRE burden (+17%, p = .013), and follow-up rate (-75%, p < .001) during lockdown, with no significant changes in other RM parameters. Activity decreased by ≥8 min/day in 46.5% of patients; predictors were higher LVEF, lower NYHA class, no defibrillator indication, and more activity before lockdown. AHRE burden increased by ≥17 min/day in 4.7% of patients; predictors were history of atrial fibrillation, higher LVEF, higher body mass index, and activity decrease during lockdown. CONCLUSION Unfavorable changes in physical activity, AHRE burden, and follow-up rate were observed during lockdown, but not in ventricular arrhythmia.
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Affiliation(s)
- Jörn Schmitt
- University Hospital Giessen and Marburg, Giessen, Germany
| | | | | | | | | | | | - Alan Bulava
- Ceske Budejovice Hospital, Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | | | - Robert Hatala
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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- University Hospital Giessen and Marburg, Giessen, Germany
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25
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Lillo-Castellano JM, González-Ferrer JJ, Marina-Breysse M, Martínez-Ferrer JB, Pérez-Álvarez L, Alzueta J, Martínez JG, Rodríguez A, Rodríguez-Pérez JC, Anguera I, Viñolas X, García-Alberola A, Quintanilla JG, Alfonso-Almazán JM, García J, Borrego L, Cañadas-Godoy V, Pérez-Castellano N, Pérez-Villacastín J, Jiménez-Díaz J, Jalife J, Filgueiras-Rama D. Personalized monitoring of electrical remodelling during atrial fibrillation progression via remote transmissions from implantable devices. Europace 2021; 22:704-715. [PMID: 31840163 PMCID: PMC7203636 DOI: 10.1093/europace/euz331] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
Aims Atrial electrical remodelling (AER) is a transitional period associated with the progression and long-term maintenance of atrial fibrillation (AF). We aimed to study the progression of AER in individual patients with implantable devices and AF episodes. Methods and results Observational multicentre study (51 centres) including 4618 patients with implantable cardioverter-defibrillator +/−resynchronization therapy (ICD/CRT-D) and 352 patients (2 centres) with pacemakers (median follow-up: 3.4 years). Atrial activation rate (AAR) was quantified as the frequency of the dominant peak in the signal spectrum of AF episodes with atrial bipolar electrograms. Patients with complete progression of AER, from paroxysmal AF episodes to electrically remodelled persistent AF, were used to depict patient-specific AER slopes. A total of 34 712 AF tracings from 830 patients (87 with pacemakers) were suitable for the study. Complete progression of AER was documented in 216 patients (16 with pacemakers). Patients with persistent AF after completion of AER showed ∼30% faster AAR than patients with paroxysmal AF. The slope of AAR changes during AF progression revealed patient-specific patterns that correlated with the time-to-completion of AER (R2 = 0.85). Pacemaker patients were older than patients with ICD/CRT-Ds (78.3 vs. 67.2 year olds, respectively, P < 0.001) and had a shorter median time-to-completion of AER (24.9 vs. 93.5 days, respectively, P = 0.016). Remote transmissions in patients with ICD/CRT-D devices enabled the estimation of the time-to-completion of AER using the predicted slope of AAR changes from initiation to completion of electrical remodelling (R2 = 0.45). Conclusion The AF progression shows patient-specific patterns of AER, which can be estimated using available remote-monitoring technology.
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Affiliation(s)
- José María Lillo-Castellano
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Marina-Breysse
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Agencia Española de Protección de la Salud en el Deporte (AEPSAD), Madrid. Spain
| | | | - Luisa Pérez-Álvarez
- Department of Cardiology, Hospital Hospital Universitario de A Coruña, La Coruña, Spain
| | - Javier Alzueta
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan Gabriel Martínez
- Department of Cardiology, Hospital General Universitario de Alicante, ISABIAL-FISABIO, Alicante, Spain
| | - Aníbal Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Ignasi Anguera
- Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Xavier Viñolas
- Department of Cardiology, Hospital Santa Creu i san Pau, Barcelona, Spain
| | | | - Jorge G Quintanilla
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Manuel Alfonso-Almazán
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Javier García
- Department of Cardiology, Hospital Universitario de Getafe, Madrid, Spain
| | - Luis Borrego
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Jiménez-Díaz
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - José Jalife
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiac Arrhythmia Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - David Filgueiras-Rama
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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26
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Linhart M, Doltra A, Acosta J, Borràs R, Jáuregui B, Fernández-Armenta J, Anguera I, Bisbal F, Martí-Almor J, Tolosana JM, Penela D, Soto-Iglesias D, Villuendas R, Perea RJ, Ortiz JT, Bosch X, Auricchio A, Mont L, Berruezo A. Ventricular arrhythmia risk is associated with myocardial scar but not with response to cardiac resynchronization therapy. Europace 2021; 22:1391-1400. [PMID: 32898254 DOI: 10.1093/europace/euaa142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS Sudden cardiac death (SCD) risk estimation in patients referred for cardiac resynchronization therapy (CRT) remains a challenge. By CRT-mediated improvement of left ventricular ejection fraction (LVEF), many patients loose indication for primary prevention implantable cardioverter-defibrillator (ICD). Increasing evidence shows the importance of myocardial scar for risk prediction. The aim of this study was to investigate the prognostic impact of myocardial scar depending on the echocardiographic response in patients undergoing CRT. METHODS AND RESULTS Patients with indication for CRT were prospectively enrolled. Decision about ICD or pacemaker implantation was based on clinical criteria. All patients underwent delayed-enhancement cardiac magnetic resonance imaging. Median follow-up duration was 45 (24-75) months. Primary outcome was a composite of sustained ventricular arrhythmia, appropriate ICD therapy, or SCD. A total of 218 patients with LVEF 25.5 ± 6.6% were analysed [158 (73%) male, 64.9 ± 10.7 years]. Myocardial scar was observed in 73 patients with ischaemic cardiomyopathy (ICM) (95% of ICM patients); in 62 with non-ischaemic cardiomyopathy (45% of these patients); and in all but 1 of 36 (17%) patients who reached the primary outcome. Myocardial scar was the only significant predictor of primary outcome [odds ratio 27.7 (3.8-202.7)], independent of echocardiographic CRT response. A total of 55 (25%) patients died from any cause or received heart transplant. For overall survival, only a combination of the absence of myocardial scar with CRT response was associated with favourable outcome. CONCLUSION Malignant arrhythmic events and SCD depend on the presence of myocardial scar but not on CRT response. All-cause mortality improved only with the combined absence of myocardial scar and CRT response.
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Affiliation(s)
- Markus Linhart
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Adelina Doltra
- Non-Invasive Cardiac Imaging Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Juan Acosta
- Unidad de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain.,CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain
| | - Roger Borràs
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain
| | - Beatriz Jáuregui
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.,Cardiology Department, Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Juan Fernández-Armenta
- CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain.,Arrhythmia Unit, Cardiology Department, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009 Cádiz, Spain
| | - Ignasi Anguera
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge Hospital, University of Barcelona, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Felipe Bisbal
- Heart Institute (iCor), University Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Jose M Tolosana
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Diego Penela
- Cardiology Department, Ospedale Guglielmo da Saliceto, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - David Soto-Iglesias
- Cardiology Department, Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Roger Villuendas
- CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain.,Heart Institute (iCor), University Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Rosario J Perea
- Radiology Department, Hospital Clinic, University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Jose T Ortiz
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Xavier Bosch
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48. CH-6900 Lugano, Switzerland
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain
| | - Antonio Berruezo
- CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain.,Cardiology Department, Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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27
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Di Marco A, Brown PF, Bradley J, Nucifora G, Claver E, de Frutos F, Dallaglio PD, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Improved Risk Stratification for Ventricular Arrhythmias and Sudden Death in Patients With Nonischemic Dilated Cardiomyopathy. J Am Coll Cardiol 2021; 77:2890-2905. [PMID: 34112317 DOI: 10.1016/j.jacc.2021.04.030] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Risk stratification for ventricular arrhythmias (VA) and sudden death in nonischemic dilated cardiomyopathy (DCM) remains suboptimal. OBJECTIVES The goal of this study was to provide an improved risk stratification algorithm for VA and sudden death in DCM. METHODS This was a retrospective cohort study of consecutive patients with DCM who underwent cardiac magnetic resonance with late gadolinium enhancement (LGE) at 2 tertiary referral centers. The combined arrhythmic endpoint included appropriate implantable cardioverter-defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, and sudden death. RESULTS In 1,165 patients with a median follow-up of 36 months, LGE was an independent and strong predictor of the arrhythmic endpoint (hazard ratio: 9.7; p < 0.001). This association was consistent across all strata of left ventricular ejection fraction (LVEF). Epicardial LGE, transmural LGE, and combined septal and free-wall LGE were all associated with heightened risk. A simple algorithm combining LGE and 3 LVEF strata (i.e., ≤20%, 21% to 35%, >35%) was significantly superior to LVEF with the 35% cutoff (Harrell's C statistic: 0.8 vs. 0.69; area under the curve: 0.82 vs. 0.7; p < 0.001) and reclassified the arrhythmic risk of 34% of patients with DCM. LGE-negative patients with LVEF 21% to 35% had low risk (annual event rate 0.7%), whereas those with high-risk LGE distributions and LVEF >35% had significantly higher risk (annual event rate 3%; p = 0.007). CONCLUSIONS In a large cohort of patients with DCM, LGE was found to be a significant, consistent, and strong predictor of VA or sudden death. Specific high-risk LGE distributions were identified. A new clinical algorithm integrating LGE and LVEF significantly improved the risk stratification for VA and sudden death, with relevant implications for implantable cardioverter-defibrillator allocation.
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MESH Headings
- Aged
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Female
- Follow-Up Studies
- Humans
- Incidence
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Retrospective Studies
- Risk Assessment/methods
- Risk Factors
- Spain/epidemiology
- Survival Rate/trends
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/mortality
- United Kingdom/epidemiology
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
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28
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Schmitt J, De Sousa J, Bulava A, Golovchiner G, Hatala R, Anguera I, Reinke F, Wenzel B, Noelker G. Impact of the Covid-19 related lockdown on physical activity, heart rate and arrhythmia burden in a large prospective cohort of CHF patients. Europace 2021. [PMCID: PMC8194656 DOI: 10.1093/europace/euab116.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG OnBehalf BIO|STREAM.HF Background At the beginning of the Covid-19 pandemic in spring 2020, governments around the world issued curfews and other stay at home orders (‘lockdown’) to limit the spread of the SARS-CoV19 virus. This may have forced people to decrease their physical activity. Physical inactivity as well as social stress is known to be especially deleterious for heart failure (HF) patients. The BIO|STREAM.HF study enrolled such HF patients into a prospective registry with Home Monitoring. Purpose We aimed to evaluate the impact of the lockdown during the first Covid-19 pandemic wave on physical activity and arrhythmia burden of heart failure patients. Methods We analysed daily transmitted data of patients enrolled into a large international registry (BIO|STREAM.HF) being implanted with a cardiac resynchronization therapy (CRT) devices. Patients with NYHA ≥ II and LVEF ≤ 40% before CRT implantation were selected. Intra-individual weekly mean and median values were calculated for the following daily transmitted parameters: physical activity (measured as % of the day during which the patient moves), atrial arrhythmia burden, mean heart rate (at rest), PP variability, PVC burden, and rate of biventricular pacing. Values were calculated for 12 weeks before and 12 weeks after the country-specific effective date of most rigorous restrictions in spring 2020 to visualize the general trend of parameter changes. Moreover, values for intra-individual changes between three 28-days periods (before, during, and after the lockdown) were calculated. Results Of 444 patients, 76% were male. They had a mean age of 69 ± 10 years and LVEF of 28.2 ± 6.7%. HF was of ischemic etiology in 42% of cases and they were in NYHA class II (47.5%), III (50.0%) or IV (2.5%). On average, patients were active for 9% of the day (2 h 10 min). The physical activity decreased by approx. 10% with the onset of the lockdown (figure 1) and recovered within the following eight weeks. Comparison of the 28-days periods before, during and after the lockdown showed a statistically significant intra-individual decrease in physical activity (mean decrease 9 min per day) during the lockdown compared to pre- and post-lockdown values and a trend toward reduced mean heart rates. In parallel, a significant increase in device detected atrial arrhythmia burden (mean increase 17 min per day) was observed. All other parameters did not change significantly. Conclusion Our results show that patients reduced their physical activity during the Covid-19 related lockdown in spring 2020. This was associated with an increase in atrial arrhythmia burden and a reduction of the mean heart rate. Prognostic implications of these results will further be analysed.
Abstract Figure. ![]()
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Affiliation(s)
- J Schmitt
- University Hospital Giessen And Marburg, Giessen, Germany
| | - J De Sousa
- Hospital de Santa Marta, Lisbon, Portugal
| | - A Bulava
- Ceske Budejovice Hospital, Department of Cardiology, Ceske Budejovice, Czechia
| | | | - R Hatala
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - I Anguera
- University Hospital Bellvitge, Barcelona, Spain
| | - F Reinke
- University Hospital Muenster, Muenster, Germany
| | - B Wenzel
- BIOTRONIK SE & Co. KG, Berlin, Germany
| | - G Noelker
- Christliches Klinikum Unna, Unna, Germany
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29
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Domenico Dallaglio P, Rodríguez Garcia J, Aceña M, Di Marco A, Faga V, Garrido L, Llorca L, Anguera I. Multipolar Mapping for Ventricular Tachycardia Ablation in a Patient with Left Ventricular Assist Device. J Innov Card Rhythm Manag 2021; 12:60-64. [PMID: 33604127 PMCID: PMC7885956 DOI: 10.19102/icrm.2021.120123s] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - Marta Aceña
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Andrea Di Marco
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Valentina Faga
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Ignasi Anguera
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
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30
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Briongos-Figuero S, García-Alberola A, Rubio J, Segura JM, Rodríguez A, Peinado R, Alzueta J, Martínez-Ferrer JB, Viñolas X, Fernández de la Concha J, Anguera I, Martín M, Cerdá L, Pérez L. Long-Term Outcomes Among a Nationwide Cohort of Patients Using an Implantable Cardioverter-Defibrillator: UMBRELLA Study Final Results. J Am Heart Assoc 2020; 10:e018108. [PMID: 33356406 PMCID: PMC7955463 DOI: 10.1161/jaha.120.018108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Large‐scale studies describing modern populations using an implantable cardioverter‐defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real‐world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29–1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07–1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43–2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54–0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14–0.45) showed a lower risk. All‐cause death was 13.4% at follow‐up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58–5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18–5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25–6.99) had the worst prognoses. Delayed high‐rate detection was enabled in 39.7% of patients, and single‐zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow‐up was low (6%) and did not differ among type of ICD but was lower in SmartShock‐capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure–related disorders had a similar risk of ICD life‐saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NTC01561144.
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Affiliation(s)
- Sem Briongos-Figuero
- Hospital Universitario Infanta Leonor Madrid Spain.,Universidad Complutense de Madrid Madrid Spain
| | | | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid Valladolid Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria Málaga Spain
| | | | | | | | | | | | | | - Luisa Pérez
- Complexo Hospitalario Universitario de A Coruña A Coruña Spain
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31
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Quesada A, Arteaga F, Romero-Villafranca R, Perez-Alvarez L, Martinez-Ferrer J, Alzueta-Rodriguez J, Fernández de la Concha J, Martinez JG, Viñolas X, Porres JM, Anguera I, Porro-Fernández R, Quesada-Ocete B, de la Guía-Galipienso F, Palanca V, Jimenez J, Quesada-Ocete J, Sanchis-Gomar F. Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients. JACC Clin Electrophysiol 2020; 7:705-715. [PMID: 33358670 DOI: 10.1016/j.jacep.2020.10.009] [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] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study goal was to examine whether there are sex-related differences in the incidence of ventricular arrhythmias and mortality in CRT-defibrillator (CRT-D) recipients. BACKGROUND Few studies have evaluated sex-related benefits of cardiac resynchronization therapy (CRT). Moreover, data on sex-related differences in the occurrence of ventricular tachyarrhythmias in this population are limited. METHODS A multicenter retrospective study was conducted in 460 patients (355 male subjects and 105 female subjects) from the UMBRELLA (Incidence of Arrhythmia in Spanish Population With a Medtronic Implantable Cardiac Defibrillator Implant) national registry. Patients were followed up through remote monitoring after the first implantation of a CRT-D during a median follow-up of 2.2 ± 1.0 years. Sex differences were analyzed in terms of ventricular arrhythmia-treated incidence and death during the follow-up period, with a particular focus on primary prevention patients. RESULTS Baseline New York Heart Association functional class was worse in women compared with that in men (67.0% of women in New York Heart Association functional class III vs. 49.7% of men; p = 0.003), whereas women had less ischemic cardiac disease (20.8% vs. 41.7%; p < 0.001). Female sex was an independent predictor of ventricular arrhythmias (hazard ratio: 0.40; 95% confidence interval: 0.19 to 0.86; p = 0.020), as well as left ventricular ejection fraction and nonischemic cardiomyopathy. Mortality in women was one-half that of men, although events were scarce and without significant differences (2.9% vs. 5.6%; p = 0.25). CONCLUSIONS Women with left bundle branch block and implanted CRT have a lower rate of ventricular tachyarrhythmias than men. All-cause mortality in patients is, at least, similar between female and male subjects.
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Affiliation(s)
- Aurelio Quesada
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | - Francisco Arteaga
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | | | - Luisa Perez-Alvarez
- Arrhythmia Unit, Cardiology Service, University Hospital Complex A Coruña, A Coruña, Spain
| | - José Martinez-Ferrer
- Arrhythmia Unit, Cardiology Service, University Hospital of Araba, Vitoria, Álava, Spain
| | | | | | - Juan G Martinez
- Arrhythmia Unit, Cardiology Service, General University Hospital of Alicante, Alicante, Spain
| | - Xavier Viñolas
- Arrhythmia Unit, Cardiology Service, Santa Creu and Sant Pau Hospital, Barcelona, Spain
| | - Jose M Porres
- Arrhythmia Unit, Intensive Care Service, University Hospital of Donostia, San Sebastian, Spain
| | - Ignasi Anguera
- Arrhythmia Unit, Cardiology Service, Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Porro-Fernández
- Arrhythmia Unit, Cardiology Service, San Pedro de Alcántara Hospital, Cáceres, Spain
| | - Blanca Quesada-Ocete
- Department of Cardiology II/Electrophysiology, Center of Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Victor Palanca
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Javier Jimenez
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Javier Quesada-Ocete
- Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Quesada A, Cózar R, Anguera I. Spanish Catheter Ablation Registry. 19th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019). ACTA ACUST UNITED AC 2020; 73:1049-1060. [PMID: 33153956 DOI: 10.1016/j.rec.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES This report presents the findings of the 2019 Spanish Catheter Ablation Registry. METHODS Data collection was retrospective. A standardized questionnaire was filled by each of the participant centers. RESULTS Data sent by 102 centers were analyzed, with a total number of ablation procedures performed of 18549 (the highest historically reported in this registry) for a mean of 181.9±137.0 and a median of 144.5 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n=5164; 27.8%), cavotricuspid isthmus (n=3925; 21.1%) and atrioventricular nodal reentrant tachycardia (n=3768; 20.3%). A new peak is observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was again 91%. The rate of major complications was 1.9%, and the mortality rate was 0.03%. An electroanatomic mapping system was used in 44.5% of all procedures, with contact force-sensing irrigated catheters become the preferred for complex substrates, as atrial fibrillation (84.8%) or ventricular tachycardia (around 90%). 1.5% of the ablations were performed in pediatric patients. CONCLUSIONS The Spanish Catheter Ablation Registry enrolls systematically and uninterruptedly the ablation procedures performed in Spain, showing a progressive increasing in the number of ablations over the years with a high success rate and low percentages of complications.
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Affiliation(s)
- Aurelio Quesada
- Unidad de Arritmias, Hospital General Universitario de Valencia, Valencia, Spain.
| | - Rocío Cózar
- Unidad de Arritmias, Hospital Virgen Macarena, Sevilla, Spain
| | - Ignasi Anguera
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Briongos Figuero S, Estevez A, Perez M, Martinez-Ferrer J, Alvarez L, Anguera I, Garcia E, Perez-Lorente F, Porres M, Villacastin J, Munoz-Aguilera R. Impact of an adaptive CRT optimization algorithm on the risk of life-threatening ventricular arrythmias of heart failure patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0763] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Adaptive cardiac resynchronization therapy (aCRT) algorithm provides ambulatory CRT optimization and synchronized left-ventricular pacing instead of conventional biventricular pacing.
Purpose
To analyze the impact of aCRT on the risk of life-threatening ventricular arrythmia (VA) in patients with concomitant defibrillator therapy.
Methods
Symptomatic HF patients, in sinus rhythm, with LVEF ≤35% and QRS complex ≥130 ms undergoing first CRT-defibrillator (CRT-D) implant were collected from the multicentre, prospective and nationwide UMBRELLA study (2012–2017). All device information was automatically stored and collected through the remote monitoring system. An experts committee analysed in a blinded manner all electrograms. The endpoint was first appropriate therapy (AT) delivered within ventricular fibrillation zone at 12-months follow-up.
Results
206 patients were collected (66.1±8.7 years; 73.3% male). Fifty nine patients composed the aCRT group and 147 composed the non-aCRT group. At implant, LBBB was present in 93% of patients, functional class III or IV in 69.9%, non-ischemic HF in 63.1% of patients and mean LVEF was 26.5±5.6%. Optimal medical treatment was achieved in a majority (B-blockers in 92%; RAASi in 89% and MRA in 72.2%).
The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). At 1-year of follow-up, 16 patients were delivered an AT (event rate: 7.8%). Most of these episodes (n=14) were due to sustained monomorphic ventricular tachycardia while the rest were caused by sustained polymorphic ventricular tachycardia/VF. A lower incidence of AT was observed in aCRT patients (3.4%) compared to non-aCRT patients (9.5%) but with no statistical differences (OR=0.33, CI 0.07–1.51, p=0.155).
Conclusions
In patients undergoing CRT provided by aCRT algorithm the risk of malign VA after 1-year of follow-up was low. Randomized studies are needed to clarify the impact of this dynamic algorithm on the arrhythmic risk of HF patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Estevez
- Public Hospital of Vallecas - Hospital Infanta Leonor, Madrid, Spain
| | - M.L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | | | - L Alvarez
- University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - I Anguera
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | - E Garcia
- University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - M Porres
- Donostia University Hospital, San Sebastian, Spain
| | | | - R Munoz-Aguilera
- Public Hospital of Vallecas - Hospital Infanta Leonor, Madrid, Spain
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Di Marco A, Ruiz‐Cueto M, Salazar‐Mendiguchía J, Claver E, Roura G, Dallaglio PD, Anguera I. Genotype-phenotype correlation of LMNA variants involving the Arg541 residue: a case report with multimodality imaging and literature review. ESC Heart Fail 2020; 7:3169-3173. [PMID: 32667740 PMCID: PMC7524116 DOI: 10.1002/ehf2.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022] Open
Abstract
We present a case of atypical LMNA cardiomyopathy associated with the pathogenic variant p.Arg541Ser. The patient had early-onset severe ventricular arrhythmias but atrioventricular conduction was normal. Segmental motion abnormalities and a large transmural scar, mainly apical and lateral, were found at cardiac magnetic resonance, corresponding to areas of severe wall thinning at computed tomography and of low voltages at electroanatomic mapping. Ventricular tachycardia ablation was successful in controlling ventricular arrhythmias. Few other cases described patients with pathogenic variants in the Arg541 residue, and they displayed similar atypical features, suggesting a genotype-phenotype correlation which may have specific prognostic and therapeutic implications.
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Affiliation(s)
- Andrea Di Marco
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | - María Ruiz‐Cueto
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | | | - Eduard Claver
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | - Gerard Roura
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | | | - Ignasi Anguera
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
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Quesada A, Cózar R, Anguera I. [Spanish Catheter Ablation Registry. 19th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019)]. Rev Esp Cardiol 2020; 73:1049-1060. [PMID: 32982011 PMCID: PMC7509535 DOI: 10.1016/j.recesp.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introducción y objetivos Se describen los resultados del Registro Español de Ablación correspondientes al año 2019. Métodos La recogida de datos ha sido retrospectiva mediante la cumplimentación de un formulario de recogida de datos por cada uno de los centros participantes. Resultados Se han analizado los datos enviados por 102 centros, con un total de 18.549 procedimientos de ablación (el mayor de este registro) y con una media de 181,9 ± 137,0 y una mediana de 144,5 procedimientos por centro. Se consolida la ablación de fibrilación auricular como el sustrato abordado con más frecuencia (n = 5.164; 27,8%), que aumenta la distancia respecto al resto de sustratos. El segundo sustrato es el istmo cavotricuspídeo (n = 3.925; 21,1%) y el tercero, la taquicardia por reentrada intranodular (n = 3.768; 20,3%), desbancada del segundo puesto por aquel. La tasa total de éxito fue de nuevo del 91%; la de complicaciones mayores, del 1,9% y la mortalidad, del 0,03%. Se consolida el uso de navegadores (el 44,5% del total de procedimientos) y de los catéteres con tecnología de contacto en la fibrilación auricular (84,8%) y la taquicardia ventricular (90%). El 1,5% de las ablaciones se realizaron en pacientes pediátricos. Conclusiones El Registro Español de Ablación recoge de manera sistemática sin interrupción los procedimientos de ablación realizados en España, y permite observar a lo largo de los años un aumento progresivo del número de ablaciones manteniendo una alta tasa de éxito y unos porcentajes bajos de complicaciones.
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Affiliation(s)
- Aurelio Quesada
- Unidad de Arritmias, Hospital General Universitario de Valencia, Valencia, España
| | - Rocío Cózar
- Unidad de Arritmias, Hospital Virgen Macarena, Sevilla, España
| | - Ignasi Anguera
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Di Marco A, Rodriguez M, Cinca J, Bayes-Genis A, Ortiz-Perez JT, Ariza-Solé A, Sanchez-Salado JC, Sionis A, Rodriguez J, Toledano B, Codina P, Solé-González E, Masotti M, Gómez-Hospital JA, Cequier Á, Anguera I. New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block. J Am Heart Assoc 2020; 9:e015573. [PMID: 32627643 PMCID: PMC7660719 DOI: 10.1161/jaha.119.015573] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%–94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.
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Affiliation(s)
- Andrea Di Marco
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | - Marcos Rodriguez
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | - Juan Cinca
- Cardiology Department Hospital de la Santa Creu I Sant Pau IIB-Santpau CIBERCV Universitat Autonoma de Barcelona Spain
| | - Antoni Bayes-Genis
- Cardiology Department Germans Trias i Pujol University Hospital CIBERCV Badalona Spain
| | | | - Albert Ariza-Solé
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | | | - Alessandro Sionis
- Cardiology Department Hospital de la Santa Creu I Sant Pau IIB-Santpau CIBERCV Universitat Autonoma de Barcelona Spain
| | - Jany Rodriguez
- Cardiology Department Hospital Clinic CIBERCV Barcelona Spain
| | - Beatriz Toledano
- Cardiology Department Germans Trias i Pujol University Hospital CIBERCV Badalona Spain
| | - Pau Codina
- Cardiology Department Germans Trias i Pujol University Hospital CIBERCV Badalona Spain
| | - Eduard Solé-González
- Cardiology Department Hospital de la Santa Creu I Sant Pau IIB-Santpau CIBERCV Universitat Autonoma de Barcelona Spain
| | - Monica Masotti
- Cardiology Department Hospital Clinic CIBERCV Barcelona Spain
| | | | - Ángel Cequier
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | - Ignasi Anguera
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
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Dallaglio PD, di Marco A, Moreno Weidmann Z, Perez L, Alzueta J, García-Alberola A, Fernandez-Lozano I, Díaz-Infante E, Rodriguez A, Basterra N, Calvo D, Rodriguez Garcia M, Aceña M, Anguera I. Antitachycardia pacing for shock prevention in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Heart Rhythm 2020; 17:1084-1091. [PMID: 32113896 DOI: 10.1016/j.hrthm.2020.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden death due to ventricular arrhythmias (VAs). The implantable cardioverter-defibrillator (ICD) is a well-established therapy for treatment of VA. Monomorphic ventricular tachycardias (MVTs) are frequent in HCM patients and suitable for antitachycardia pacing (ATP) termination. OBJECTIVE The purpose of this study was to describe ventricular tachycardia (VT) characteristics in a population of HCM patients with ICD and to study the effectiveness and safety of ATP for MVT. METHODS Data were obtained from the multicenter prospective observational UMBRELLA trial, which included all patients with HCM and ICD followed by the CareLink Monitoring System. All episodes of VA were collected and analyzed. ATP effectiveness and safety were described, and factors related to ATP effectiveness were studied with generalized estimating equation (GEE) models. RESULTS Among 251 patients followed for 47 months, 67 (26.7%) were implanted as secondary prevention. Fifty-six patients presented 326 episodes of VA (286 [87%] MVT). Mean cycle length was 312 ± 64 ms. Among 264 MVTs that received ICD therapy, 202 (76.5%) were ATP terminated. The first ATP burst was effective in 169 episodes (68.4%), and overall effectiveness of the first or second ATP burst was 73.8%. Multivariate GEE-adjusted analysis showed 2 variables related to ATP effectiveness: programming fast VT zone On vs Off (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.5-5.2; P = .03) and programming ≥2 ATP bursts vs 1 burst only (OR 1.6; 95% CI 1.2-3.4; P = .04; and OR 2.9; 95% CI 1.8-6.3; P = .02; respectively). CONCLUSION MVT is the predominant VA in HCM patients with ICD. ATP is highly effective in terminating the majority of MVTs, and its proved effectiveness should guide device selection and programming in order to avoid unnecessary high-energy shocks.
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Affiliation(s)
| | - Andrea di Marco
- Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | | | - Luisa Perez
- Heart Disease Institute, University Hospital of A Coruña, A Coruña, Spain
| | - Javier Alzueta
- Heart Disease Institute, "Virgen de la Victoria" University Hospital, Málaga, Spain
| | | | | | - Ernesto Díaz-Infante
- Heart Disease Institute "Virgen de la Macarena" University Hospital, Sevilla, Spain
| | | | - Nuria Basterra
- Heart Disease Institute, Hospital de Navarra, Pamplona, Spain
| | - David Calvo
- Hospital Universitario Central de Asturias, Asturias, Spain
| | | | - Marta Aceña
- Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Ignasi Anguera
- Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
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Di Marco A, Anguera I, Nombela‐Franco L, Oloriz T, Teruel L, Rodriguez Mañero M, Toquero J, León V, Dallaglio P, Perez Guerrero A, Salazar CH, Escaned J, Asso Abadía A, Gomez Hospital JA, Cequier A. Revascularization of coronary chronic total occlusions in an infarct‐related artery and recurrence of ventricular arrhythmias among patients with secondary prevention implantable cardioverter defibrillator. Catheter Cardiovasc Interv 2020; 97:E1-E11. [DOI: 10.1002/ccd.28915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/27/2020] [Accepted: 04/04/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Di Marco
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Ignasi Anguera
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | | | - Teresa Oloriz
- Cardiology Department Hospital Miguel Servet Zaragoza Spain
| | - Luis Teruel
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Moisés Rodriguez Mañero
- Cardiology Department Hospital Universitario Santiago de Compostela Santiago de Compostela Spain
| | - Jorge Toquero
- Cardiology Department Hospital Puerta del Hierro, Majadahonda Madrid Spain
| | - Valentina León
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Paolo Dallaglio
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | | | | | - Javier Escaned
- Cardiology Department Hospital Clínico San Carlos Madrid Spain
| | | | | | - Angel Cequier
- Cardiology Department Bellvitge University Hospital Barcelona Spain
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Dallaglio PD, Oyarzabal Rabanal L, Alegre Canals O, Osorio Higa K, Rivas Gandara N, Anguera I. Extracorporeal membrane oxygenation for hemodynamic support of ventricular tachycardia ablation: a 2-center experience. ACTA ACUST UNITED AC 2019; 73:264-265. [PMID: 31740277 DOI: 10.1016/j.rec.2019.07.020] [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] [Received: 02/25/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Paolo D Dallaglio
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Loreto Oyarzabal Rabanal
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre Canals
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Karina Osorio Higa
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Rivas Gandara
- Área de Enfermedades del Corazón, Unidad de Arritmias y Electrofisiología, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Ignasi Anguera
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Anguera I, Aceña M, Moreno-Weidmann Z, Dallaglio PD, Di Marco A, Rodríguez M. Acceso epicárdico para ablación de taquicardia ventricular: experiencia con la técnica de micropunción. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Di Marco A, Claver E, Anguera I. Ablación de taquicardia ventricular guiada por cardiorresonancia magnética. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.05.011] [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: 10/28/2022]
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Anguera I, Aceña M, Moreno-Weidmann Z, Dallaglio PD, Di Marco A, Rodríguez M. Epicardial Access for Ventricular Tachycardia Ablation: Experience With the Needle-in-needle Technique. ACTA ACUST UNITED AC 2019; 72:873-874. [PMID: 30956036 DOI: 10.1016/j.rec.2019.03.003] [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] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ignasi Anguera
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Marta Aceña
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo D Dallaglio
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Di Marco
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodríguez
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Berruezo A, Penela D, Jáuregui B, Soto-Iglesias D, Aguinaga L, Ordóñez A, Fernández-Armenta J, Martínez M, Tercedor L, Bisbal F, Acosta J, Martí-Almor J, Aceña M, Anguera I, Rossi L, Linhart M, Borràs R, Doltra A, Sánchez P, Ortiz-Pérez JT, Perea RJ, Prat-González S, Teres C, Bosch X. Mortality and morbidity reduction after frequent premature ventricular complexes ablation in patients with left ventricular systolic dysfunction. Europace 2019; 21:1079-1087. [DOI: 10.1093/europace/euz027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Aims
Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population.
Methods and results
Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24–84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P < 0.001. Left ventricular ejection fraction improved from 32 ± 8% at baseline to 39 ± 12% at LTFUP (P < 0.001) and New York Heart Association class from 2.2 ± 0.6% to 1.3 ± 0.6% (P < 0.001). Brain natriuretic peptide levels decreased from 136 (78–321) to 68 (32–144) pg/mL (P = 0.007). Most of this improvement occurs during the first 6 months after ablation. Persistent abolition of at least 18 points of the baseline PVC burden was independently and inversely associated with the composite endpoint of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up [hazard ratio 0.18 (0.05–0.66), P = 0.01].
Conclusion
In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up.
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Affiliation(s)
- Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12, Barcelona, Spain
| | | | - Beatriz Jáuregui
- Heart Institute, Teknon Medical Center, C/Vilana, 12, Barcelona, Spain
| | | | | | | | | | | | | | - Felipe Bisbal
- Heart Institute (iCor), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Acosta
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Luca Rossi
- Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | | | | | | | | | | | | | - Cheryl Teres
- Heart Institute, Teknon Medical Center, C/Vilana, 12, Barcelona, Spain
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Dallaglio PD, Anguera I, Martínez Ferrer JB, Pérez L, Viñolas X, Porres JM, Fontenla A, Alzueta J, Martínez JG, Rodríguez A, Basterra N, Sabaté X. Taquicardias ventriculares rápidas en pacientes con desfibrilador implantable: reducción de choques mediante terapia antitaquicárdica antes y durante la carga. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Oyarzabal Rabanal L, Dallaglio P, Anguera I, Di Marco A, Acena M, Ariza A, Sanchez Salado JC, Lorente V, Gomez Hospital JA, Ortiz D, Miralles A, Cequier A. P6645Extracorporeal membrane oxygenation for hemodynamic support of ventricular tachycardia ablation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6645] [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: 11/14/2022] Open
Affiliation(s)
| | - P Dallaglio
- University Hospital of Bellvitge, Barcelona, Spain
| | - I Anguera
- University Hospital of Bellvitge, Barcelona, Spain
| | - A Di Marco
- University Hospital of Bellvitge, Barcelona, Spain
| | - M Acena
- University Hospital of Bellvitge, Barcelona, Spain
| | - A Ariza
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - V Lorente
- University Hospital of Bellvitge, Barcelona, Spain
| | | | - D Ortiz
- University Hospital of Bellvitge, Barcelona, Spain
| | - A Miralles
- University Hospital of Bellvitge, Barcelona, Spain
| | - A Cequier
- University Hospital of Bellvitge, Barcelona, Spain
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Anguera I, García-Alberola A, Dallaglio P, Toquero J, Pérez L, Martínez JG, Peinado R, Rubín JM, Brugada J, Cequier A. Shock Reduction With Long-Term Quinidine in Patients With Brugada Syndrome and Malignant Ventricular Arrhythmia Episodes. J Am Coll Cardiol 2018; 67:1653-1654. [PMID: 27150692 DOI: 10.1016/j.jacc.2016.01.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/07/2016] [Accepted: 01/12/2016] [Indexed: 11/25/2022]
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Di Marco A, Claver E, Anguera I. Ventricular Tachycardia Ablation Guided by Cardiac Magnetic Resonance. ACTA ACUST UNITED AC 2018; 72:418. [PMID: 29884584 DOI: 10.1016/j.rec.2018.05.011] [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] [Received: 04/07/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Di Marco
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eduard Claver
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Jiménez-Candil J, Anguera I, Durán O, Hernández J, Fernández-Portales J, Moríñigo JL, Martín A, Dallaglio P, Bravo L, di Marco A, Sánchez PL. Beta-blocker therapy is associated with a lower incidence of syncope due to fast ventricular tachycardias among implantable cardioverter-defibrillator patients with left ventricular dysfunction: results from a multicenter study. J Interv Card Electrophysiol 2018; 52:69-76. [PMID: 29557531 DOI: 10.1007/s10840-018-0344-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/24/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Among implantable cardioverter-defibrillator (ICD) patients, a substantial proportion of syncopes are due to fast ventricular tachycardias (FVTs). In the experimental models of ventricular tachycardias, the arterial vasoconstriction plays an important role in recovering the arterial pressure. Since beta-blockers increase vascular resistance, we hypothesized that beta-blockers could reduce the occurrence of syncope due to FVTs. Our objective was to determine the relationship between the beta-blocker therapy and the incidence of syncope in FVT (cycle length [CL] 250-320 ms) occurring in ICD patients. Slow VTs were excluded because of the lack of symptoms and VF episodes because of the small number. METHODS AND RESULTS In this multicenter study, 226 patients (LVEF 31 ± 10%) with single-chamber ICDs were followed. FVT programming was standardized, including antitachycardia pacing (ATP) as initial therapy. Symptoms were correlated with ICD-stored episode data of FVTs. The beta-blocker therapy was determined at each FVT presentation. We analyzed 289 FVTs (CL 291 ± 21 ms; 77% under beta-blockers; median of the duration:8 s) occurring consecutively in 52 ICD patients. The frequency of FVT-related syncope was 22 (7.6%). Beta-blockers were associated with a lower heart rate preceding FVT (85 ± 22 vs. 94 ± 23 bpm; p = 0.009), a higher ATP effectiveness (86 vs. 57%; p < 0.001), a lower duration of episodes (8 [2] vs. 10 [14] s; p < 0.001), and a lower incidence of FVT-related syncope (4.5 vs. 18%; p < 0.001). By logistic regression, a FVT > 8 s (OR = 21; p = 0.003) and the beta-blocker therapy (OR = 0.3; p = 0.012) were found as independent predictors of syncope. CONCLUSION Among ICD patients with left ventricular dysfunction, beta-blockers are associated with a lower incidence of FVT-related syncope.
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Affiliation(s)
- Javier Jiménez-Candil
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.
| | - Ignasi Anguera
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Durán
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - Jesús Hernández
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | | | - José Luis Moríñigo
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - Ana Martín
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - Paolo Dallaglio
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Loreto Bravo
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
| | - Andrea di Marco
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Luis Sánchez
- Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain
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Dallaglio PD, Anguera I, García-Alberola A, Sabaté X, Cequier Á, Brugada J. Taquicardias ventriculares monomórficas en pacientes con síndrome de Brugada tratados con quinidina: eficacia de la estimulación antitaquicardia. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.02.016] [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: 10/19/2022]
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Dallaglio PD, Anguera I, García-Alberola A, Sabaté X, Cequier Á, Brugada J. Antitachycardia Pacing Effectiveness for Monomorphic Ventricular Tachycardia in Brugada Syndrome After Quinidine Administration. Rev Esp Cardiol (Engl Ed) 2018; 71:403-406. [PMID: 28372913 DOI: 10.1016/j.rec.2017.03.002] [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] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/16/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Paolo D Dallaglio
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ignasi Anguera
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arcadi García-Alberola
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Xavier Sabaté
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ángel Cequier
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Brugada
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
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