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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Saglietto A, Turturiello D, Viveros D, Bellido A, Alderete J, Zaraket F, Franco-Ocaña P, Huguet M, Cámara Ó, Vătășescu R, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial. Europace 2024; 26:euae087. [PMID: 38652090 PMCID: PMC11036893 DOI: 10.1093/europace/euae087] [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: 02/18/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). METHODS AND RESULTS Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). CONCLUSION LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times.
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Affiliation(s)
- Giulio Falasconi
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Arrhythmology Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Saglietto
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Dario Turturiello
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Open Heart Foundation, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- Open Heart Foundation, Barcelona, Spain
| | - Fatima Zaraket
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Paula Franco-Ocaña
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | | | - Radu Vătășescu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, Calle Villana 12, 08022 Barcelona, Spain
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Francia P, Falasconi G, Penela D, Viveros D, Alderete J, Saglietto A, Bellido AF, Martí-Almor J, Franco-Ocaña P, Soto-Iglesias D, Zaraket F, Turturiello D, Berruezo A. Scar architecture affects the electrophysiological characteristics of induced ventricular arrhythmias in hypertrophic cardiomyopathy. Europace 2024; 26:euae050. [PMID: 38375690 PMCID: PMC10914403 DOI: 10.1093/europace/euae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) detects myocardial scarring, a risk factor for ventricular arrhythmias (VAs) in hypertrophic cardiomyopathy (HCM). The LGE-CMR distinguishes core, borderzone (BZ) fibrosis, and BZ channels, crucial components of re-entry circuits. We studied how scar architecture affects inducibility and electrophysiological traits of VA in HCM. METHODS AND RESULTS We correlated scar composition with programmed ventricular stimulation-inducible VA features using LGE intensity maps. Thirty consecutive patients were enrolled. Thirteen (43%) were non-inducible, 6 (20%) had inducible non-sustained, and 11 (37%) had inducible sustained mono (MMVT)- or polymorphic VT/VF (PVT/VF). Of 17 induced VA, 13 (76%) were MMVT that either ended spontaneously, persisted as sustained monomorphic, or degenerated into PVT/VF. Twenty-seven patients (90%) had LGE. Of these, 17 (57%) had non-sustained or sustained inducible VA. Scar mass significantly increased (P = 0.002) from non-inducible to inducible non-sustained and sustained VA patients in both the BZ and core components. Borderzone channels were found in 23%, 67%, and 91% of non-inducible, inducible non-sustained, and inducible sustained VA patients (P = 0.003). All 13 patients induced with MMVT or monomorphic-initiated PVT/VF had LGE. The origin of 10/13 of these VTs matched scar location, with 8/10 of these LGE regions showing BZ channels. During follow-up (20 months, interquartile range: 7-37), one patient with BZ channels and inducible PVT had an ICD shock for VF. CONCLUSION Scar architecture determines inducibility and electrophysiological traits of VA in HCM. Larger studies should explore the role of complex LGE patterns in refining risk assessment in HCM patients.
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Affiliation(s)
- Pietro Francia
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulio Falasconi
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- IRCCS Humanitas Research Hospital, Cardiovascular Department, Milan, Italy
| | - Diego Penela
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- IRCCS Humanitas Research Hospital, Cardiovascular Department, Milan, Italy
| | - Daniel Viveros
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - José Alderete
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Andrea Saglietto
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Citta della Salute e della Scienza Hospital, Turin, Italy
| | - Aldo Francisco Bellido
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Julio Martí-Almor
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Paula Franco-Ocaña
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Fatima Zaraket
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Dario Turturiello
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Saglietto A, Alderete J, Viveros D, Bellido A, Zaraket F, Martí-Almor J, Berruezo A. Cardiac magnetic resonance-aided epicardial ventricular tachycardia ablation in post-myocarditis patient. J Interv Card Electrophysiol 2024; 67:249-251. [PMID: 37721657 DOI: 10.1007/s10840-023-01647-0] [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: 07/30/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Giulio Falasconi
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Saglietto
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - José Alderete
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
| | - Fatima Zaraket
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, Calle Villana 12 (08022), Barcelona, Spain.
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Penela D, Chauca A, Fernández-Armenta J, Pavón R, Benito B, Acosta J, Lozano JM, Falasconi G, San Antonio R, Soto-Iglesias D, Martí-Almor J, Ordoñez A, Bellido A, Carreño JM, Matiello M, Cano L, Pedrote A, Viveros D, Alderete J, Francia P, Algarra-Cullell M, Silva E, Meca-Santamaria J, Franco P, Cappato R, Berruezo A. Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures-the SIMPLE study. J Interv Card Electrophysiol 2023; 66:1979-1988. [PMID: 36877415 DOI: 10.1007/s10840-023-01511-1] [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: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Catheter ablation is recommended as first-line therapy for patients with symptomatic typical AFl. Although the conventional multi-catheter approach is the standard of care for cavotricuspid isthmus (CTI) ablation, a single-catheter approach was recently described as a feasible alternative. The present study sought to compare safety, efficacy, and efficiency of single vs. multi-catheter approach for atrial flutter (AFl) ablation. METHODS In this randomized multi-center study, consecutive patients referred for AFl ablation (n = 253) were enrolled and randomized to multiple vs. single-catheter approach for CTI ablation. In the single-catheter arm, PR interval (PRI) on the surface ECG was used to prove CTI block. Procedural and follow-up data were collected and compared between the two arms. RESULTS 128 and 125 patients were assigned to the single-catheter and to the multi-catheter arms, respectively. In the single-catheter arm, procedure time was significantly shorter (37 ± 25 vs. 48 ± 27 minutes, p = 0.002) and required less fluoroscopy time (430 ± 461 vs. 712 ± 628 seconds, p < 0.001) and less radiofrequency time (428 ± 316 vs. 643 ± 519 seconds, p < 0.001), achieving a higher first-pass CTI block rate (55 (45%) vs. 37 (31%), p = 0.044), compared with the multi-catheter arm. After a median follow-up of 12 months, 11 (4%) patients experienced AFl recurrences (5 (4%) in the single-catheter arm and 6 (5%) in the multi-catheter arm, p = 0.99). No differences were found in arrhythmia-free survival between arms (log-rank = 0.71). CONCLUSIONS The single-catheter approach for typical AFl ablation is not inferior to the conventional multiple-catheter approach, reducing procedure, fluoroscopy, and radiofrequency time.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Ricardo Pavón
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Maria Matiello
- Hospital Universitario General de Cataluña, Barcelona, Spain
| | - Lucas Cano
- Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza, Rome, Italy
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain.
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Penela D, Falasconi G, Carreño JM, Soto-Iglesias D, Fernández-Armenta J, Acosta J, Martí-Almor J, Benito B, Bellido A, Chauca A, Scherer C, Viveros D, Alderete J, Silva E, Ordoñez A, Francisco-Pascual J, Rivas-Gandara N, Meca-Santamaria J, Franco P, De Lucia C, Ali H, Cappato R, Cámara O, Francia P, Berruezo A. A hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2023; 66:1877-1888. [PMID: 36795268 DOI: 10.1007/s10840-023-01507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND To predict the outflow tract ventricular arrhythmias (OTVA) site of origin (SOO) before the ablation procedure has important practical implications. The present study sought to prospectively evaluate the accuracy of a clinical and electrocardiographic hybrid algorithm (HA) for the prediction of OTVAs-SOO, and at the same time to develop and to prospectively validate a new score with improved discriminatory capacity. METHODS In this multicenter study, we prospectively enrolled consecutive patients referred for OTVA ablation (N = 202), and we divided them in a derivation sample and a validation cohort. Surface ECGs during OTVA were analyzed to compare previous published ECG-only criteria and to develop a new score. RESULTS In the derivation sample (N = 105), the correct prediction rate of HA and ECG-only criteria ranged from 74 to 89%. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3 precordial transition (V3PT) patients, and was incorporated to the novel weighted hybrid score (WHS). WHS correctly classified 99 (94.2%) patients, presenting 90% sensitivity and 96% specificity (AUC 0.97) in the entire population; WHS mantained a 87% sensitivity and 91% specificity (AUC 0.95) in patients with V3PT subgroup. The high discriminatory capacity was confirmed in the validation sample (N = 97): the WHS exhibited an AUC (0.93), and a WHS ≥ 2 allowed a correct prediction of LVOT origin in 87 (90.0%) cases, yielding a sensitivity of 87% and specificity of 90%; moreover, the V3PT subgroup showed an AUC of 0.92, and a punctuation ≥ 2 predicted an LVOT origin with a sensitivity of 94% and specificity of 78%. CONCLUSIONS The novel hybrid score has proved to accurately anticipate the OTVA's origin, even in those with a V3 precordial transition. A Weighted hybrid score. B Typical examples of the use of the weighted hybrid score. C ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the derivation cohort. D ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the V3 precordial transition OTVA subgroup.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Giulio Falasconi
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Jose Miguel Carreño
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Begoña Benito
- Hospital Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | | | - Augusto Ordoñez
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain
| | | | - Hussam Ali
- IRCCS Multimedica Group, Sesto San Giovanni, Italy
| | | | | | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Berruezo
- Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain.
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Dacher JN, Langguth P, Adam D, Winkler WB, Martí-Almor J, Prenner G, Trucco ME, Kol A, Xiang M, Melissano D, Fawaz H, Lau DH. Safety and performance of MR-conditional pacing systems with automated MRI mode at 1.5 and 3 Tesla. Eur Radiol 2023; 33:6948-6958. [PMID: 37195432 PMCID: PMC10189234 DOI: 10.1007/s00330-023-09650-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/03/2022] [Revised: 02/11/2023] [Accepted: 02/26/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To evaluate at 1.5 and 3 T MRI the safety and performance of trademarked ENO®, TEO®, or OTO® pacing systems with automated MRI Mode and the image quality of non-enhanced MR examinations. METHODS A total of 267 implanted patients underwent MRI examination (brain, cardiac, shoulder, cervical spine) at 1.5 (n = 126) or 3 T (n = 141). MRI-related device complications, lead electrical performances stability at 1-month post-MRI, proper functioning of the automated MRI mode and image quality were evaluated. RESULTS Freedom from MRI-related complications at 1 month post-MRI was 100% in both 1.5 and 3 T arms (both p < 0.0001). The stability of pacing capture threshold was respectively at 1.5 and 3 T (atrial:: 98.9% (p = 0.001) and 100% (p < 0.0001); ventricular: both 100% (p < 0001)). The stability of sensing was respectively at 1.5 and 3 T (atrial: 100% (p = 0.0001) and 96.9% (p = 0.01); ventricular: 100% (p < 0.0001) and 99.1% (p = 0.0001)). All devices switched automatically to the programmed asynchronous mode in the MRI environment and to initially programmed mode after the MRI exam. While all MR examinations were assessed as interpretable, artifacts deteriorated a subset of examinations including mostly cardiac and shoulder ones. CONCLUSION This study demonstrates the safety and electrical stability of ENO®, TEO®, or OTO® pacing systems at 1 month post-MRI at 1.5 and 3 T. Even if artifacts were noticed in a subset of examinations, overall interpretability was preserved. CLINICAL RELEVANCE STATEMENT ENO®, TEO®, and OTO® pacing systems switch to MR-mode when detecting magnetic field and switch back on conventional mode after MRI. Their safety and electrical stability at 1 month post MRI were shown at 1.5 and 3 T. Overall interpretability was preserved. KEY POINTS • Patients implanted with an MRI conditional cardiac pacemaker can be safely scanned under 1.5 or 3 Tesla MRI with preserved interpretability. • Electrical parameters of the MRI conditional pacing system remain stable after a 1.5 or 3 Tesla MRI scan. • The automated MRI mode enabled the automatic switch to asynchronous mode in the MRI environment and to initial settings after the MRI scan in all patients.
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Affiliation(s)
- Jean-Nicolas Dacher
- Department of Radiology, Normandie Univ, UNIROUEN INSERM U1096 and CHU Rouen, 37 Boulevard Gambetta, 76000, Rouen, France.
| | - Patrick Langguth
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David Adam
- Monash Cardiac Rhythm Management Department, Monash Heart, Monash Medical Centre, Melbourne, Australia
| | - Walther-Benedikt Winkler
- Medical Department II With Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar (IMAS-UAB), Barcelona, Spain
| | - Günther Prenner
- Universitätsklinik Für Innere Medizin, Klinische Abteilung Für Kardiologie, Medizinische Universität Graz, Graz, Austria
| | - María Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Amir Kol
- Department of Cardiology, San Camillo De Lellis Hospital, ASL Rieti, Rieti, Italy
| | - Meixiang Xiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Hanan Fawaz
- Clinical Affairs, MicroPort CRM, Clamart, France
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
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7
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Francia P, Viveros D, Falasconi G, Penela D, Soto-Iglesias D, Martí-Almor J, Alderete J, Saglietto A, Bellido AF, Franco-Ocaña P, Zaraket F, Matiello M, Fernández-Armenta J, San Antonio R, Berruezo A. Clinical impact of aging on outcomes of cardioneuroablation for reflex syncope or functional bradycardia: Results from the cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs-The ELEGANCE multicenter study. Heart Rhythm 2023; 20:1279-1286. [PMID: 37329936 DOI: 10.1016/j.hrthm.2023.06.007] [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: 04/20/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Cardioneuroablation (CNA) is a novel treatment for reflex syncope. The effect of aging on CNA efficacy is not fully understood. OBJECTIVE The purpose of this study was to assess the impact of aging on candidacy and efficacy of CNA for treating vasovagal syncope (VVS), carotid sinus syndrome (CSS), and functional bradyarrhythmia. METHODS The ELEGANCE (cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs) multicenter study assessed CNA in patients with reflex syncope or severe functional bradyarrhythmia. Patients underwent pre-CNA Holter electrocardiography (ECG), head-up tilt testing (HUT), and electrophysiological study. CNA candidacy and efficacy was assessed in 14 young (18-40 years), 26 middle-aged (41-60 years), and 20 older (>60 years) patients. RESULTS Sixty patients (37 men; mean age 51 ± 16 years) underwent CNA. The majority (80%) had VVS, 8% had CSS, and 12% had functional bradycardia/atrioventricular block. Pre-CNA Holter ECG, HUT, and electrophysiological findings did not differ across age groups. Acute CNA success was 93%, without differences between age groups (P = .42). Post-CNA HUT response was negative in 53%, vasodepressor in 38%, cardioinhibitory in 7%, and mixed in 2%, without differences across age groups (P = .59). At follow-up (8 months, interquartile range 4-15), 53 patients (88%) were free of symptoms. Kaplan-Meier curves did not show differences in event-free survival between age groups (P = .29). The negative predictive value of a negative HUT was 91.7%. CONCLUSION CNA is a viable treatment for reflex syncope and functional bradyarrhythmia in all ages, and is highly effective in mixed VVS. HUT is a key step in postablation clinical assessment.
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Affiliation(s)
- Pietro Francia
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain; Cardiology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy
| | - Daniel Viveros
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Giulio Falasconi
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Diego Penela
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Julio Martí-Almor
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - José Alderete
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Andrea Saglietto
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | - Paula Franco-Ocaña
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Fatima Zaraket
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain; Clínica del Pilar, Barcelona, Spain
| | | | | | - Rodolfo San Antonio
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain.
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8
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Saglietto A, Falasconi G, Penela D, Francia P, Soto-Iglesias D, Martí-Almor J, Berruezo A. Cardiac magnetic resonance-aided ventricular tachycardia substrate ablation in corrected tetralogy of Fallot. J Interv Card Electrophysiol 2023; 66:1317-1319. [PMID: 36964886 DOI: 10.1007/s10840-023-01527-7] [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: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Affiliation(s)
- Andrea Saglietto
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta Della Salute E Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giulio Falasconi
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain
- University of Barcelona, Campus Clínic, Barcelona, Spain
| | - Diego Penela
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain
| | - Pietro Francia
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain
- Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Cardiology, Rome, Italy
| | - David Soto-Iglesias
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain
| | - Julio Martí-Almor
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain
| | - Antonio Berruezo
- Teknon Medical Centre, Heart Institute, Calle Villana 12, Barcelona, 08022, Spain.
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9
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Teres C, Saglietto A, Jauregui B, Viveros D, Bellido A, Alderete J, Meca-Santamaria J, Franco P, Gaspardone C, San Antonio R, Huguet M, Cámara Ó, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation. Europace 2023; 25:euad118. [PMID: 37125968 PMCID: PMC10228614 DOI: 10.1093/europace/euad118] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023] Open
Abstract
AIMS Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF. METHODS AND RESULTS Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50-67), fluoroscopy time was 43 s (IQR 20-71), and radiofrequency (RF) time was 16.5 min (IQR 14.3-18.4). The median AI tailored to the local LAWT was 387 (IQR 360-410) for the anterior wall and 335 (IQR 300-375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up. CONCLUSION In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).
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Affiliation(s)
- Giulio Falasconi
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Diego Penela
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Pietro Francia
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Cheryl Teres
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Andrea Saglietto
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Beatriz Jauregui
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Daniel Viveros
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Aldo Bellido
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Jose Alderete
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
- Campus Clínic, University of Barcelona, C/Villarroel 170, 08024 Barcelona, Spain
| | - Julia Meca-Santamaria
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Paula Franco
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Carlo Gaspardone
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Rodolfo San Antonio
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Marina Huguet
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Óscar Cámara
- Department of Information and Communication Technologies, Pompeu Fabra University, C/Tànger 122-140, 08018 Barcelona, Spain
| | - José-Tomás Ortiz-Pérez
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Julio Martí-Almor
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022 Barcelona, Spain
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10
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Grehn M, Mandija S, Miszczyk M, Krug D, Tomasik B, Stickney KE, Alcantara P, Alongi F, Anselmino M, Aranda RS, Balgobind BV, Boda-Heggemann J, Boldt LH, Bottoni N, Cvek J, Elicin O, De Ferrari GM, Hassink RJ, Hazelaar C, Hindricks G, Hurkmans C, Iotti C, Jadczyk T, Jiravsky O, Jumeau R, Buus Kristiansen S, Levis M, López MA, Martí-Almor J, Mehrhof F, Møller DS, Molon G, Ouss A, Peichl P, Plasek J, Postema PG, Quesada A, Reichlin T, Rordorf R, Rudic B, Saguner AM, Ter Bekke RMA, Torrecilla JL, Troost EGC, Vitolo V, Andratschke N, Zeppenfeld K, Blamek S, Fast M, de Panfilis L, Blanck O, Pruvot E, Verhoeff JJC. STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe. Europace 2023; 25:1284-1295. [PMID: 36879464 PMCID: PMC10105846 DOI: 10.1093/europace/euac238] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 03/08/2023] Open
Abstract
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
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Affiliation(s)
- Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Bartłomiej Tomasik
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland.,Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, M. Sklodowskiel-Curie 3a, Gdansk 80210, Poland
| | - Kristine E Stickney
- Research Support Office, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pino Alcantara
- Department of Radiation Oncology, Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Profesor Martin Lagos, Madrid 28040, Spain
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, University of Brescia, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy.,Department of Medical Sciences, University of Turin, Via Verdi 8, Torino 10124, Italy
| | - Ricardo Salgado Aranda
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico San Carlos Madrid, Professor Martin Lagos, Madrid 28040, Spain
| | - Brian V Balgobind
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Leif-Hendrik Boldt
- Department of Rhythmology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicola Bottoni
- Cardiology Arrhythmology Center, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Jakub Cvek
- Department of Oncology, University Hospital and Faculty of Medicine, Listopadu 1790, Ostrava Poruba 70852, Czech Republic
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Colien Hazelaar
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Cinzia Iotti
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ul. Poniatowskiego 15, Katowice 40055, Poland.,Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Otakar Jiravsky
- Cardiocenter, Hospital Agel Trinec Podlesi and Masaryk University, Konska 453, Trinec 73961, Czech Republic
| | - Raphaël Jumeau
- Department of Radio-Oncology, Lausanne University Hospital, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Mario Levis
- Department of Oncology, University of Torino, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Manuel Algara López
- Department of Radiation Oncology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Felix Mehrhof
- Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Alexandre Ouss
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 9, Prague 14000, Czech Republic
| | - Jiri Plasek
- Department of Cardiovascular Medicine, University Hospital Ostrava, Listopadu 1790. Ostrava Poruba 70852, Czech Republic
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Aurelio Quesada
- Arrhythmia Unit, Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Camillo Golgi Avenue 5, Pavia 27100, Italy
| | - Boris Rudic
- Department of Medicine I, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Hospital Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - José López Torrecilla
- Department of Radiation Oncology, Hospital General Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus. Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, Dresden 01307, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, Dresden 01328, Germany
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia PV27100, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Katja Zeppenfeld
- Unit of Clinical Electrophysiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - Martin Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Ludovica de Panfilis
- Bioethics Unit, Azienda Unità Sanitaria Locale-IRCCS, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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11
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Falasconi G, Penela D, Soto-Iglesias D, Francia P, Teres C, Viveros D, Bellido A, Alderete J, Meca-Santamaria J, Franco P, Ordoñez A, Díaz-Escofet M, Matiello M, Maldonado G, Scherer C, Huguet M, Cámara Ó, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Preventive substrate ablation in chronic post-myocardial infarction patients with high-risk scar characteristics for ventricular arrhythmias: rationale and design of PREVENT-VT study. J Interv Card Electrophysiol 2023; 66:39-47. [PMID: 36227461 DOI: 10.1007/s10840-022-01392-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/03/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies showed that an early strategy for ventricular tachycardia (VT) ablation resulted in reduction of VT episodes or mortality. Cardiac magnetic resonance (CMR)-derived border zone channel (BZC) mass has proved to be a strong non-invasive predictor of VT in post-myocardial infarction (MI). CMR-guided VT substrate ablation proved to be safe and effective for reducing sudden cardiac death (SCD) and VA occurrence. METHODS PREVENT-VT is a prospective, randomized, multicenter, and controlled trial designed to evaluate the safety and efficacy of prophylactic CMR-guided VT substrate ablation in chronic post-MI patients with CMR-derived arrhythmogenic scar characteristics. Chronic post-MI patients with late gadolinium enhancement (LGE) CMR will be evaluated. CMR images will be post-processed and the BZC mass measured: patients with a BZC mass > 5.15 g will be eligible. Consecutive patients will be enrolled at 3 centers and randomized on a 1:1 basis to undergo a VT substrate ablation (ABLATE arm) or optimal medical treatment (OMT arm). Primary prevention ICD will be implanted following guideline recommendations, while non-ICD candidates will be implanted with an implantable cardiac monitor (ICM). The primary endpoint is a composite outcome of sudden cardiac death (SCD) or sustained monomorphic VT, either treated by an ICD or documented with ICM. Secondary endpoints are procedural safety and efficiency outcomes of CMR-guided ablation. DISCUSSION In some patients, the first VA episode causes SCD or severe neurological damage. The aim of the PREVENT-VT is to evaluate whether primary preventive substrate ablation may be a safe and effective prophylactic therapy for reducing SCD and VA occurrence in patients with previous MI and high-risk scar characteristics based on CMR. TRIAL REGISTRATION ClinicalTrials.gov, NCT04675073, registered on January 1, 2021.
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Affiliation(s)
- Giulio Falasconi
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Diego Penela
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | - David Soto-Iglesias
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | - Pietro Francia
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Cheryl Teres
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | - Daniel Viveros
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Aldo Bellido
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | - Jose Alderete
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | | | - Paula Franco
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | | | - Marta Díaz-Escofet
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | | | | | - Claudia Scherer
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | - Marina Huguet
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | | | - José-Tomás Ortiz-Pérez
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain
| | - Antonio Berruezo
- Teknon Medical Centre, Heart Institute, Calle Villana 12 (08022), Barcelona, Spain.
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12
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Teres C, Soto-Iglesias D, Penela D, Falasconi G, Viveros D, Meca-Santamaria J, Bellido A, Alderete J, Chauca A, Ordoñez A, Martí-Almor J, Scherer C, Panaro A, Carballo J, Cámara Ó, Ortiz-Pérez JT, Berruezo A. Relationship between the posterior atrial wall and the esophagus: esophageal position and temperature measurement during atrial fibrillation ablation (AWESOME-AF). A randomized controlled trial. J Interv Card Electrophysiol 2022; 65:651-661. [PMID: 35861901 DOI: 10.1007/s10840-022-01302-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) implies unavoidable ablation lesions to the left atrial posterior wall, which is closely related to the esophagus, leading to several potential complications. This study evaluates the usefulness of the esophageal fingerprint in avoiding temperature rises during paroxysmal atrial fibrillation (PAF) ablation. METHODS Isodistance maps of the atrio-esophageal relationship (esophageal fingerprint) were derived from the preprocedural computerized tomography. Patients were randomized (1:1) into two groups: (1) PRINT group, the PVI line was modified according to the esophageal fingerprint; (2) CONTROL group, standard PVI with operator blinded to the fingerprint. The primary endpoint was temperature rise detected by intraluminal esophageal temperature probe monitoring. Ablation settings were as specified on the Ablate BY-LAW study protocol. RESULTS Sixty consecutive patients referred for paroxysmal AF ablation were randomized (42 (70%) men, mean age 60 ± 11 years). Temperature rise (> 39.1 °C) occurred in 5 (16%) patients in the PRINT group vs. 17 (56%) in the CONTROL group (p < 0.01). Three AF recurrences were documented at a mean follow-up of 12 ± 3 months (one (3%) in the PRINT group and 2 (6.6%) in the CONTROL group, p = 0.4). CONCLUSION The esophageal fingerprint allows for a reliable identification of the esophageal position and its use for PVI line deployment results in less frequent esophageal temperature rises when compared to the standard approach. Further studies are needed to evaluate the impact of PVI line modification to avoid esophageal heating on long-term outcomes. The development of new imaging-derived tools could ultimately improve patient safety (NCT04394923).
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Affiliation(s)
- Cheryl Teres
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain.,Lausanne University Hospital, Lausanne, Switzerland
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | | | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Claudia Scherer
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Alejandro Panaro
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Julio Carballo
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain
| | - Óscar Cámara
- Department of Information and Communication Technologies, BCN-MedTech, Universitat Pompeu Fabra, PhySense group, Barcelona, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/Vilana, 12; 08022, Barcelona, Spain.
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13
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Falasconi G, Penela D, Soto-Iglesias D, Martí-Almor J, Berruezo A. Cardiac Magnetic Resonance and Segment of Origin Identification Algorithm Streamline Post-Myocardial Infarction Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2022; 8:1603-1608. [PMID: 36543516 DOI: 10.1016/j.jacep.2022.09.004] [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: 06/22/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
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14
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Benito B, García-Elías A, Ois Á, Tajes M, Vallès E, Ble M, Yáñez Bisbe L, Giralt-Steinhauer E, Rodríguez-Campello A, Cladellas Capdevila M, Martí-Almor J, Roquer J, Cuadrado-Godia E. Plasma levels of miRNA-1-3p are associated with subclinical atrial fibrillation in patients with cryptogenic stroke. Rev Esp Cardiol (Engl Ed) 2022; 75:717-726. [PMID: 35067470 DOI: 10.1016/j.rec.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Identifying biomarkers of subclinical atrial fibrillation (AF) is of most interest in patients with cryptogenic stroke (CrS). We sought to evaluate the circulating microRNA (miRNA) profile of patients with CrS and AF compared with those in persistent sinus rhythm. METHODS Among 64 consecutive patients with CrS under continuous monitoring by a predischarge insertable monitor, 18 patients (9 with AF and 9 in persistent sinus rhythm) were selected for high-throughput determination of 754 miRNAs. Nine patients with concomitant stroke and AF were also screened to improve the yield of miRNA selection. Differentially expressed miRNAs were replicated in an independent cohort (n=46). Biological markers were stratified by the median and included in logistic regression analyses to evaluate their association with AF at 6 and 12 months. RESULTS Eight miRNAs were differentially expressed between patients with and without AF. In the replication cohort, miR-1-3p, a gene regulator involved in cardiac arrhythmogenesis, was the only miRNA to remain significantly higher in patients with CrS and AF vs those in sinus rhythm and showed a modest association with AF burden. High (= above the median) miR-1-3p plasma values, together with a low left atrial ejection fraction, were independently associated with the presence of AF at 6 and 12 months. CONCLUSIONS In this cohort, plasma levels of miR-1-3p were elevated in CrS patients with subsequent AF. Our results preliminarily suggest that miR-1-3p could be a novel biomarker that, together with clinical parameters, could help identify patients with CrS and a high risk of occult AF.
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Affiliation(s)
- Begoña Benito
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Spain.
| | - Anna García-Elías
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Research Center, Montreal Heart Institute, Montreal, Canada
| | - Ángel Ois
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Neurología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Marta Tajes
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain
| | - Ermengol Vallès
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Mireia Ble
- Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - Eva Giralt-Steinhauer
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Mercè Cladellas Capdevila
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Julio Martí-Almor
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Jaume Roquer
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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15
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Ruiz-Bustillo S, Badosa N, Cabrera-Aguilera I, Ivern C, Llagostera M, Mojón D, Vicente M, Ribas N, Recasens L, Martí-Almor J, Cladellas M, Farré N. An intensive, structured, mobile devices-based healthcare intervention to optimize the lipid-lowering therapy improves lipid control after an acute coronary syndrome. Front Cardiovasc Med 2022; 9:916031. [PMID: 35958430 PMCID: PMC9360604 DOI: 10.3389/fcvm.2022.916031] [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] [Received: 04/08/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Aims Despite the evidence, lipid-lowering treatment (LLT) in secondary prevention remains insufficient, and a low percentage of patients achieve the recommended LDL cholesterol (LDLc) levels by the guidelines. We aimed to evaluate the efficacy of an intensive, mobile devices-based healthcare lipid-lowering intervention after hospital discharge in patients hospitalized for acute coronary syndrome (ACS). Methods and results Ambiespective register in which a mobile devices-based healthcare intervention including periodic follow-up, serial lipid level controls, and optimization of lipid-lowering therapy, if appropriate, was assessed in terms of serum lipid-level control at 12 weeks after discharge. A total of 497 patients, of which 462 (93%) correctly adhered to the optimization protocol, were included in the analysis. At the end of the optimization period, 327 (70.7%) patients had LDLc levels ≤ 70 mg/dL. 40% of patients in the LDLc ≤ 70 mg/dL group were upgraded to very-high intensity lipid-lowering ability therapy vs. 60.7% in the LDLc > 70 mg/dL group, p < 0.001. Overall, 38.5% of patients had at least a change in their LLT. Side effects were relatively infrequent (10.7%). At 1-year follow-up, LDLc levels were measured by the primary care physician in 342 (68.8%) of the whole cohort of 497 patients. In this group, 71.1% of patients had LDLc levels ≤ 70 mg/dL. Conclusion An intensive, structured, mobile devices-based healthcare intervention after an ACS is associated with more than 70% of patients reaching the LDLc levels recommended by the clinical guidelines. In patients with LDLc measured at 1-year follow-up, 71.1% had LDLc levels ≤ 70 mg/dL.
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Affiliation(s)
- Sonia Ruiz-Bustillo
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Departament of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medicine, Pompeu Fabra University, Barcelona, Spain
- *Correspondence: Sonia Ruiz-Bustillo,
| | - Neus Badosa
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Ignacio Cabrera-Aguilera
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciéncies de la Salut, Universitat de Barcelona, Barcelona, Spain
- Department of Human Movement Sciences, Faculty of Health Sciences, School of Kinesiology, Universidad de Talca, Talca, Chile
| | - Consol Ivern
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Marc Llagostera
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Diana Mojón
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Miren Vicente
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Núria Ribas
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Lluis Recasens
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Julio Martí-Almor
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Departament of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Mercè Cladellas
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Departament of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Núria Farré
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Cardiac Rehabilitation Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Departament of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medicine, Pompeu Fabra University, Barcelona, Spain
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16
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Falasconi G, Penela D, Soto-Iglesias D, Terés C, Jáuregui B, Martí-Almor J, Meca-Santamaria J, Franco P, Ordoñez A, Scherer C, Viveros D, Bellido A, Berruezo A. Multidetector Computed Tomography identification of previous ablation lines: insights for left atrial flutter ablation. Heart Rhythm 2022; 19:1753-1754. [PMID: 35577317 DOI: 10.1016/j.hrthm.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Diego Penela
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | | | - Cheryl Terés
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | | | | | - Daniel Viveros
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
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17
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Zaraket F, Bas D, Jimenez J, Casteigt B, Benito B, Martí-Almor J, Conejos J, Tizón-Marcos H, Mojón D, Vallès E. Cardiac Tomography and Cardiac Magnetic Resonance to Predict the Absence of Intracardiac Thrombus in Anticoagulated Patients Undergoing Atrial Fibrillation Ablation. J Clin Med 2022; 11:jcm11082101. [PMID: 35456193 PMCID: PMC9031153 DOI: 10.3390/jcm11082101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Pulmonary veins isolation (PVI) is a standard treatment for recurrent atrial fibrillation (AF). Uninterrupted anticoagulation for a minimum of 3 weeks before ablation and exclusion of left atrial (LA) thrombus with transesophageal echography (TEE) immediately before or during the procedure minimize peri-procedural risk. We aimed to demonstrate the utility of cardiac tomography (CT) and cardiac magnetic resonance (CMR) to rule out LA thrombus prior to PVI. Methods: Patients undergoing PVI for recurrent AF were retrospectively evaluated. Only patients that started anticoagulation at least 3 weeks prior to the CT/CMR and subsequently uninterrupted until the ablation procedure were selected. An intracardiac echo (ICE) catheter was used in all patients to evaluate LA thrombus. The results of CT/CMR were compared to ICE imaging. Results: We included 272 consecutive patients averaging 54.5 years (71% male; 30% persistent AF). Average CHA2DS2VASC score was 0.9 ± 0.83 and mean LA diameter was 42 ± 5.7 mm, 111 (41%) patients were on Acenocumarol and 161 (59%) were on direct oral anticoagulants. Anticoagulation was started 227 ± 392 days before the CT/CMR, and 291 ± 416 days before the ablation procedure. CT/CMR diagnosed intracardiac thrombus in two cases, both in the LA appendage. A new CT/CMR revealed resolution of thrombus after six additional months of uninterrupted anticoagulation. No macroscopic thrombus was observed in any patients with ICE (negative predictive value of 100%; p < 0.01). Conclusions: CT and MRI are excellent surrogates to TEE and ICE to rule out intracardiac thrombus in patients adequately anticoagulated prior AF ablation. This is true even for delayed procedures as long as anticoagulation is uninterrupted.
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Affiliation(s)
- Fatima Zaraket
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
- Correspondence: ; Tel.: +34-932483118; Fax: +34-932483371
| | - Deva Bas
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Jesus Jimenez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Javi Conejos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Helena Tizón-Marcos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Diana Mojón
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (D.B.); (J.J.); (B.C.); (B.B.); (J.M.-A.); (J.C.); (H.T.-M.); (D.M.); (E.V.)
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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18
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Benito B, García-Elías A, Ois Á, Tajes M, Vallès E, Ble M, Yáñez Bisbe L, Giralt-Steinhauer E, Rodríguez-Campello A, Cladellas Capdevila M, Martí-Almor J, Roquer J, Cuadrado-Godia E. La concentración plasmática de microARN-1-3p se asocia con fibrilación auricular subclínica en los pacientes con ictus criptogénico. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Vallès E, Jiménez J, Martí-Almor J, Toquero J, Ormaetxe JM, Barrera A, García-Alberola A, Rubio JM, Moriña P, Grande C, Fé Arcocha M, Peinado R, Cózar R, Hernández J, Pérez-Alvarez L, Gaztañaga L, Ferrero-De Loma-Osorio A, Ruiz-Granell R, Villuendas R, Martínez-Alday JD. Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA). J Clin Med 2022; 11:jcm11051166. [PMID: 35268259 PMCID: PMC8910954 DOI: 10.3390/jcm11051166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8 ± 10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs. 11.4%; p < 0.001) and left atrium dilation (72.6 vs. 43.3%; p < 0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs. 22.2%; p < 0.001), with an arterial line (32.2 vs. 44.6%; p < 0.001) and assisted transeptal puncture (11.9 vs. 17.9%; p = 0.025). During an application, PeAF patients had a longer time to −30 °C (35.91 ± 14.20 vs. 34.93 ± 12.87 s; p = 0.021) and a colder balloon nadir temperature during vein isolation (−35.04 ± 9.58 vs. −33.61 ± 10.32 °C; p = 0.004), but received fewer bonus freeze applications (30.7 vs. 41.1%; p < 0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p = 0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.
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Affiliation(s)
- Ermengol Vallès
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
- Correspondence:
| | - Jesús Jiménez
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
| | - Julio Martí-Almor
- Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain; (J.J.); (J.M.-A.)
| | - Jorge Toquero
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - José Miguel Ormaetxe
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
| | - Alberto Barrera
- Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain;
| | | | | | - Pablo Moriña
- Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - Carlos Grande
- Hospital Universitari Son Espases, 07010 Palma de Mallorca, Spain;
| | | | | | - Rocío Cózar
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | - Julio Hernández
- Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | | | - Larraitz Gaztañaga
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
- Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
| | | | - Ricardo Ruiz-Granell
- Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (A.F.-D.L.-O.); (R.R.-G.)
| | | | - Jesús Daniel Martínez-Alday
- Hospital Universitario de Basurto, 48013 Bilbao, Spain; (J.M.O.); (L.G.); (J.D.M.-A.)
- Clínica IMQ Zorrotzaurre, 48014 Bilbao, Spain
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20
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Vallès E, Martí-Almor J, Grau N, Casteigt B, Benito B, Cabrera S, Alcalde O, Benito E, Bas D, Conejos J, Cabero P, Soler C, Duran X, Fan R, Jimenez J. Influence of PACE score and conduction disturbances in the incidence of early new onset atrial fibrillation after typical atrial flutter ablation. J Cardiol 2021; 79:417-422. [PMID: 34774385 DOI: 10.1016/j.jjcc.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients undergoing cavotricuspid isthmus (CTI) ablation for typical flutter (AFL) have a high incidence of new onset atrial fibrillation (AF). We aimed to analyze the influence of PACE score to predict new onset AF in this subset of patients to stratify thromboembolic risk. METHODS Between 2017 and 2019, patients undergoing CTI ablation for AFL and without history of AF were prospectively included. All patients were monitored continuously by implantable loop recorder and followed by remote monitoring. RESULTS Overall 48 patients were included. New onset AF rate at 12 months was 56.3%. We observed two very strong independent predictors for new onset AF: a PACE score ≥ 30 (HR:6.9; 95% CI:1.71-27.91; p = 0.007) and an HV interval ≥ 55 (HR:11.86; 95% CI:2.57-54.8; p = 0.002). CONCLUSIONS The incidence of newly diagnosed AF is high in patients with AFL after CTI ablation, and can occur early. A high PACE score and/or long HV interval predict even higher risk, and may be useful in the decision for empiric long-term anticoagulation.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Nuria Grau
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eva Benito
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Deva Bas
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Javi Conejos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Paula Cabero
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Cristina Soler
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Duran
- Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jesus Jimenez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig marítim de la Barceloneta, Barcelona 08003, Spain; Institut Hospital del Mar Investigacions Mèdiques (IMIM), Barcelona, Spain
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21
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Jiménez-López J, Vallès E, Martí-Almor J, Casteigt B, Villuendas R, Bisbal F, Sarrias A, Benito E, Trucco E, Conejos J, Alcalde O, Figueras-Mari L, Fan R, Bazan V. Merged two-way mapping technique: an alternative 3D electroanatomical mapping approach to guide challenging ablation procedures of accessory pathways with bidirectional conduction properties. J Interv Card Electrophysiol 2021; 63:591-599. [PMID: 34595692 DOI: 10.1007/s10840-021-01069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Catheter ablation of accessory pathways (AP) with bidirectional conduction may be challenging due to issues related to anatomical course or location. OBJECTIVE We describe an alternative electro-anatomical mapping technique which aims at depicting the entire anatomic course of the AP from the atrial toward the ventricular insertion in order to guide catheter ablation. METHODS Twenty consecutive patients with confirmed bidirectional AP conduction and at least one previous ablation procedure or para-Hisian location were included. 3-D electro-anatomical mapping was used to depict the merged 10-ms isochrone area of maximum early activation of both the ventricular and atrial signals during sinus rhythm and ventricular pacing/orthodromic tachycardia, respectively. Catheter ablation was performed within the depicted earliest isochrone area. RESULTS Acute bidirectional AP conduction block was achieved in all patients 4.2 ± 1.7 s after the first radiofrequency energy pulse was delivered, without reconnection during a 30 ± 10 min post-ablation observation time. No procedural complications were seen. After a mean follow-up period of 9 ± 7 months (range 3 to 16), no recurrences were documented. CONCLUSION This merged two-way mapping technique is a safe, efficient, and effective technique for ablation of APs with bidirectional conduction.
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Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain.
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Benjamin Casteigt
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, 25-27 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Villuendas
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Felipe Bisbal
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Axel Sarrias
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Eva Benito
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Emilce Trucco
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Javier Conejos
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Oscar Alcalde
- Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Roger Fan
- Electrophysiology Unit, Cardiology Department, Stony Brook Heart Institute, Stony Brook, NY, USA
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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22
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Ble M, Benito B, Cuadrado-Godia E, Pérez-Fernández S, Gómez M, Mas-Stachurska A, Tizón-Marcos H, Molina L, Martí-Almor J, Cladellas M. Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation. J Clin Med 2021; 10:jcm10163501. [PMID: 34441797 PMCID: PMC8397042 DOI: 10.3390/jcm10163501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/08/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/01/2023] Open
Abstract
Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.
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Affiliation(s)
- Mireia Ble
- Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain;
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Correspondence: ; Tel.: +34-932-483-018
| | - Begoña Benito
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Cardiology Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Neurology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Sílvia Pérez-Fernández
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- CIBER of Cardiovascular Diseases (CIBERCV), 08003 Barcelona, Spain
| | - Miquel Gómez
- Cardiology Department, Hospital de Barcelona, 08034 Barcelona, Spain;
| | - Aleksandra Mas-Stachurska
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Helena Tizón-Marcos
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Lluis Molina
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
- Cardiology Department, Hospital de Barcelona, 08034 Barcelona, Spain;
| | - Julio Martí-Almor
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
| | - Mercè Cladellas
- Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain;
- Cardiology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (A.M.-S.); (H.T.-M.); (L.M.); (J.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (B.B.); (E.C.-G.); (S.P.-F.)
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23
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Jimenez J, Valles E, Martí-Almor J, Roger Villuendas BC, Axel Sarrias FB, Emilce Trucco EB, Óscar Alcalde JC, Basterra N, Martinez-Basterra JJ, Luis Figueras-Mari JRR, Bazan V. B-PO04-134 FUSION MAPPING: ELECTRO-ANATOMICAL ACCESSORY PATHWAY CHARACTERIZATION TO GUIDE CATHETER ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Ynsaurriaga FA, Barrios V, Amaro MB, Martí-Almor J, Martínez JG, Duque JAA, Ruiz-Ortiz M, Vázquez-García R, Muñoz AV. Chronic Coronary Syndrome: Overcoming Clinical Practice Guidelines. The role of the COMPASS Strategy. Curr Cardiol Rev 2021; 17:294-305. [PMID: 32811401 PMCID: PMC8640862 DOI: 10.2174/1573403x16999200817111150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022] Open
Abstract
Current European guidelines on chronic coronary syndromes recommend the use of low-dose aspirin (or clopidogrel if intolerance or contraindication occurs) throughout life. However, as the risk of recurrent vascular events is high, particularly in some patients (i.e. diffuse multivessel coronary artery disease, diabetes, recurrent myocardial infarction, peripheral artery disease, or chronic kidney disease,…), these guidelines also consider that in those patients at moderate or high risk of ischemic events, but without a high bleeding risk, dual antithrombotic therapy should be considered. According to these guidelines, treatment options for dual antithrombotic therapy in combination with aspirin may include clopidogrel 75 mg/daily, prasugrel 10 mg/daily, ticagrelor 60 mg bid or rivaroxaban 2.5 mg bid. Remarkably, despite the results of the clinical trials that sustain these recommendations clearly diverge, guidelines do not differentiate between them. However, although all these drugs have demonstrated a significant reduction in major cardiovascular events in patients with stable atherosclerotic disease, only the addition of rivaroxaban has been associated with a reduction in cardiovascular and overall mortality in the secondary analysis. This may be related to the fact that the activation of platelets and factor X plays a key role in the development of atherothrombosis, and, consequently, both targets should be considered for the appropriate management of these patients.
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Affiliation(s)
| | | | | | | | - Juan G Martínez
- Hospital General Universitario de Alicante- ISABIAL, Alicante, Spain
| | | | | | - Rafael Vázquez-García
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
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25
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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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26
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Grau N, Martí-Almor J, Félez MA. Relationship between SAHS and cardiac arrhythmias. Arch Bronconeumol 2021; 57:513-514. [PMID: 34147351 DOI: 10.1016/j.arbr.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nuria Grau
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel A Félez
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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27
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Arbelo E, Angera I, Trucco E, Rivas-Gándara N, Guerra JM, Bisbal F, Jáuregui-Abularach M, Vallés E, Martin G, Sbraga F, Tolosana JM, Linhart M, Francisco-Pascual J, Montiel-Serrano J, Pereferrer D, Menéndez-Ramírez D, Jiménez J, Elamrani A, Borrás R, Dallaglio PD, Benito E, Santos-Ortega A, Rodríguez-Font E, Sarrias A, González-Matos CE, Martí-Almor J, Cabrera S, Mont L. Reduction in new cardiac electronic device implantations in Catalonia during COVID-19. Europace 2021; 23:456-463. [PMID: 33595062 PMCID: PMC7928966 DOI: 10.1093/europace/euab011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/13/2021] [Indexed: 12/27/2022] Open
Abstract
Aims During the COVID-19 pandemic, concern regarding its effect on the management of non-communicable diseases has been raised. However, there are no data on the impact on cardiac implantable electronic devices (CIED) implantation rates. We aimed to determine the impact of SARS-CoV2 on the monthly incidence rates and type of pacemaker (PM) and implantable cardiac defibrillator (ICD) implantations in Catalonia before and after the declaration of the state of alarm in Spain on 14 March 2020. Methods and results Data on new CIED implantations for 2017–20 were prospectively collected by nine hospitals in Catalonia. A mixed model with random intercepts corrected for time was used to estimate the change in monthly CIED implantations. Compared to the pre-COVID-19 period, an absolute decrease of 56.5% was observed (54.7% in PM and 63.7% in ICD) in CIED implantation rates. Total CIED implantations for 2017–19 and January and February 2020 was 250/month (>195 PM and >55 ICD), decreasing to 207 (161 PM and 46 ICD) in March and 131 (108 PM and 23 ICD) in April 2020. In April 2020, there was a significant fall of 185.25 CIED implantations compared to 2018 [95% confidence interval (CI) 129.6–240.9; P < 0.001] and of 188 CIED compared to 2019 (95% CI 132.3–243.7; P < 0.001). No significant differences in the type of PM or ICD were observed, nor in the indication for primary or secondary prevention. Conclusions During the first wave of the COVID-19 pandemic, a substantial decrease in CIED implantations was observed in Catalonia. Our findings call for measures to avoid long-term social impact.
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Affiliation(s)
- Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ignasi Angera
- Arrhythmia Section, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Emilce Trucco
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - José M Guerra
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felipe Bisbal
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Miguel Jáuregui-Abularach
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Ermengol Vallés
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Martin
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Fabrizio Sbraga
- Department of Cardiac Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - José María Tolosana
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - José Montiel-Serrano
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Damià Pereferrer
- Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Diego Menéndez-Ramírez
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Jesús Jiménez
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amin Elamrani
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Roger Borrás
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Arrhythmia Section, Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Spain
| | - Eva Benito
- Arrhythmia Section, Cardiology Department, Hospital Universitari Doctor Josep Trueta. Girona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Centro de investigación biomédica en red de enfermedades cardiovasculares (CIBER-CV), Barcelona, Spain
| | - Enrique Rodríguez-Font
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBER-CV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Axel Sarrias
- Arrhythmia Section, Cardiology Department, Heart Institute (iCOR), University Hospital Germans Trias i Pujol, Badalona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Carlos E González-Matos
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomèdica de Lleida Fundació Dr Pifarré (IRBLleida), Lleida, Spain
| | - Julio Martí-Almor
- Arrhythmia Section, Cardiology Department, Hospital del Mar-IMIM. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Cabrera
- Arrhythmia Section, Cardiology Department, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain.,IISPV, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Martí-Almor J, Jiménez-López J, Casteigt B, Conejos J, Valles E, Farré N, Flor MF. Obstructive Sleep Apnea Syndrome as a Trigger of Cardiac Arrhythmias. Curr Cardiol Rep 2021; 23:20. [PMID: 33611699 DOI: 10.1007/s11886-021-01445-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea syndrome (OSAS) has a high prevalence in western countries. Many papers have been published with the purpose of demonstrating that OSAS acts as an arrhythmia trigger and is responsible for an increase in cardiovascular morbidity and mortality. The aim of this study was to review our knowledge on this topic. RECENT FINDINGS There is a lot of evidence demonstrating the relationship between OSAS and arrhythmias, but there remains a lack of an interventional randomized trial to demonstrate that by treating OSAS we can reduce arrhythmia burden. OSAS is a highly prevalent illness in western countries and is clearly related to an increase in cardiovascular mortality and morbidity. Cardiac arrhythmias are triggered by a repetitive hypoxemia, hypercapnia, acidosis, intrathoracic pressure fluctuations, reoxygenation, and arousals during apnea and hypopnea episodes. Early diagnosis and treatment of these patients can reduce further cardiovascular morbidity and mortality.
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Affiliation(s)
- Julio Martí-Almor
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain.
| | - Jesús Jiménez-López
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Benjamin Casteigt
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Javier Conejos
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Ermengol Valles
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Núria Farré
- Heart Failure Unit, Cardiology Department, Parc de Salut Mar, Universitat Autònoma de Barcelona and Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Miquel Félez Flor
- Multidisciplinary Unit of Sleep Medicine, Parc de salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Grau N, Martí-Almor J, Félez MA. Relationship between SAHS and Cardiac Arrhythmias. Arch Bronconeumol 2021; 57:S0300-2896(21)00004-1. [PMID: 33589346 DOI: 10.1016/j.arbres.2020.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nuria Grau
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel A Félez
- Unidad Multidisciplinaria de Medicina del Sueño, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, España.
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Sarquella-Brugada G, García-Algar O, Zambrano MD, Fernández-Falgueres A, Sailer S, Cesar S, Sebastiani G, Martí-Almor J, Aurensanz E, Cruzalegui JC, Merchan EF, Coll M, Pérez-Serra A, Del Olmo B, Fiol V, Iglesias A, Ferrer-Costa C, Puigmulé M, Lopez L, Pico F, Arbelo E, Jordà P, Brugada J, Brugada R, Campuzano O. Early Identification of Prolonged QT Interval for Prevention of Sudden Infant Death. Front Pediatr 2021; 9:704580. [PMID: 34395343 PMCID: PMC8358435 DOI: 10.3389/fped.2021.704580] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Long QT syndrome is the main arrhythmogenic disease responsible for sudden death in infants, especially in the first days of life. Performing an electrocardiogram in newborns could enable early diagnosis and adoption of therapeutic measures focused on preventing lethal arrhythmogenic events. However, the inclusion of an electrocardiogram in neonatal screening protocols still remains a matter of discussion. To comprehensively analyse the potential clinical value of performing an electrocardiogram and subsequent follow-up in a cohort of newborns. Methods: Electrocardiograms were performed in 685 neonates within the first week of life. One year follow-up was performed if QTc > 450 ms identified. Comprehensive genetic analysis using massive sequencing was performed in all cases with QTc > 470 ms. Results: We identified 54 neonates with QTc > 450 ms/ <470 ms; all normalized QTc values within 6 months. Eight cases had QTc > 480 ms at birth and, if persistent, pharmacological treatment was administrated during follow-up. A rare variant was identified as the potential cause of long QT syndrome in five cases. Three cases showed a family history of sudden arrhythmogenic death. Conclusions: Our prospective study identifies 0.14% of cases with a definite long QT, supporting implementation of electrocardiograms in routine pediatric protocols. It is an effective, simple and non-invasive approach that can help prevent sudden death in neonates and their relatives. Genetic analyses help to unravel the cause of arrhythmogenic disease in diagnosing neonates. Further, clinical assessment and genetic analysis of relatives allowed early identification of family members at risk of arrhythmias helping to adopt preventive personalized measures.
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Affiliation(s)
- Georgia Sarquella-Brugada
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Oscar García-Algar
- Department of Neonatology, Hospital Clínic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatología, BCNatal, Barcelona, Spain
| | - María Dolores Zambrano
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | | | - Sebastian Sailer
- Department of Neonatology, Hospital Clínic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatología, BCNatal, Barcelona, Spain.,Department of Neonatology, Faculty of Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Sergi Cesar
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Giorgia Sebastiani
- Department of Neonatology, Hospital Clínic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatología, BCNatal, Barcelona, Spain
| | | | - Esther Aurensanz
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Jose Carlos Cruzalegui
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Erika Fernanda Merchan
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Mónica Coll
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain
| | - Alexandra Pérez-Serra
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Bernat Del Olmo
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain
| | - Victoria Fiol
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Carles Ferrer-Costa
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain
| | - Marta Puigmulé
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain
| | - Laura Lopez
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain
| | - Ferran Pico
- Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain
| | - Elena Arbelo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.,Arrhythmias Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Paloma Jordà
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.,Arrhythmias Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Arrhythmias Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.,Arrhythmias Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Ramon Brugada
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Cardiology Service, Hospital Josep Trueta, University of Girona, Girona, Spain.,Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Genetics Center, University of Girona-Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
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Tizón-Marcos H, Vaquerizo B, Marrugat J, Ariza A, Carrillo X, Muñoz JF, Cárdenas M, García-Picart J, Rojas SG, Tomás-Querol C, Massotti M, Lidón RM, Jiménez J, Martí-Almor J, Farré N, Pérez-Fernández S, Curós A, Mauri Ferré J. Complicaciones y mortalidad a 30 días y al año en pacientes con primer IAMCEST tratados en la red Codi IAM en 2010-2016: análisis del efecto del género. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Fernández-Bergés D, Degano IR, Gonzalez Fernandez R, Subirana I, Vila J, Jiménez-Navarro M, Perez-Fernandez S, Roqué M, Bayes-Genis A, Fernandez-Aviles F, Mayorga A, Bertomeu-Gonzalez V, Sanchis J, Rodríguez Esteban M, Sanchez-Hidalgo A, Sanchez-Insa E, Elorriaga A, Abu Assi E, Nuñez A, Garcia Ruiz JM, Morrondo Valdeolmillos P, Bosch-Portell D, Lekuona I, Carrillo-Lopez A, Zamora A, Vega-Hernandez B, Alameda Serrano J, Rubert C, Ruiz-Valdepeñas L, Quintas L, Rodríguez-Padial L, Vaquero J, Martinez Dolz L, Barrabes JA, Sanchez PL, Sionis A, Martí-Almor J, Elosua R, Lidon RM, Garcia-Dorado D, Marrugat J. Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction. Open Heart 2020; 7:openhrt-2019-001169. [PMID: 32747454 PMCID: PMC7402007 DOI: 10.1136/openhrt-2019-001169] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/21/2020] [Accepted: 06/02/2020] [Indexed: 02/01/2023] Open
Abstract
Objective Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. Methods We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014–2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. Results Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). Conclusions Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
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Affiliation(s)
- Daniel Fernández-Bergés
- Unidad de Investigación, Hospital Don Benito-Villanueva, Don Benito, Spain .,Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain
| | - Irene R Degano
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain
| | | | - Isaac Subirana
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
| | - Joan Vila
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
| | | | - Silvia Perez-Fernandez
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
| | | | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antonio Mayorga
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | | | - Juan Sanchis
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Marcos Rodríguez Esteban
- Department of Cardiology, Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Esther Sanchez-Insa
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ane Elorriaga
- Department of Cardiology, Hospital Universitario de Basurto, Bilbao, Bilbao, Spain
| | - Emad Abu Assi
- Department of Cardiology, Hospital Álvaro Junqueiro de Vigo, Pontevedra, Vigo, Spain
| | - Alberto Nuñez
- Department of Cardiology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | | | | | - Daniel Bosch-Portell
- Department of Cardiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Iñaki Lekuona
- Department of Cardiology, Hospital Galdakao-Usansolo, Galdacano, Spain
| | | | | | | | | | | | | | | | | | - Jessica Vaquero
- Hospital Universitario Araba sede Txagorritxu, Vitoria-Gasteiz, Spain
| | | | - Jose A Barrabes
- Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pedro L Sanchez
- Department of Cardiology, Hospital Universitario Salamanca, Salamanca, Spain
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Department of Medicine, Department of Cardiology, Hospital del Mar. Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Roberto Elosua
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Universitat de Vic, Barcelona, Spain
| | | | | | - Jaume Marrugat
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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Tizón-Marcos H, Vaquerizo B, Marrugat J, Ariza A, Carrillo X, Muñoz JF, Cárdenas M, García-Picart J, Rojas SG, Tomás-Querol C, Massotti M, Lidón RM, Jiménez J, Martí-Almor J, Farré N, Pérez-Fernández S, Curós A, Mauri Ferré J. Differences in 30-day complications and 1-year mortality by sex in patients with a first STEMI managed by the Codi IAM network between 2010 and 2016. ACTA ACUST UNITED AC 2020; 74:674-681. [PMID: 32660910 DOI: 10.1016/j.rec.2020.06.002] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES ST-segment elevation myocardial infarction (STEMI) emergency care networks aim to increase reperfusion rates and reduce ischemic times. The influence of sex on prognosis is still being debated. Our objective was to analyze prognosis according to sex after a first STEMI. METHODS This multicenter cohort study enrolled first STEMI patients from 2010 to 2016 to determine the influence of sex after adjustment for revascularization delays, age, and comorbidities. End points were 30-day mortality, the 30-day composite of mortality, ventricular fibrillation, pulmonary edema, or cardiogenic shock, and 1-year all-cause mortality. RESULTS From 2010 to 2016, 14 690 patients were included; 24% were women. The median [interquartile range] time from electrocardiogram to artery opening decreased throughout the study period in both sexes (119 minutes [85-160] vs 109 minutes [80-153] in 2010, 102 minutes [81-133] vs 96 minutes [74-124] in 2016, both P=.001). The rates of primary PCI within 120 minutes increased in the same period (50.4% vs 57.9% and 67.1% vs 72.1%, respectively; both P=.001). After adjustment for confounders, female sex was not associated with 30-day complications (OR, 1.06; 95%CI, 0.91-1.22). However, female 30-day survivors had a lower adjusted 1-year mortality than their male counterparts (HR,0.76; 95%CI, 0.61-0.95). CONCLUSIONS Compared with men, women with a first STEMI had similar 30-day mortality and complication rates but significantly lower 1-year mortality after adjustment for age and severity.
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Affiliation(s)
- Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Jaume Marrugat
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Grupo de Trabajo en Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Carrillo
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan-Francisco Muñoz
- Servicio de Cardiología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Carlos Tomás-Querol
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Mònica Massotti
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - Rosa-Maria Lidón
- Servicio de Cardiología, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josep Jiménez
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Julio Martí-Almor
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Núria Farré
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Sílvia Pérez-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Grupo de Trabajo en Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain
| | - Antoni Curós
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Josepa Mauri Ferré
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
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Jiménez-López J, Vallès E, Martí-Almor J, González-Matos C, Bas D, Benito B, Alcalde O, Cabrera S, Altaba C, Bazan V. Mapping potentials adjacent to the cavo-tricuspid isthmus ablation line during incremental pacing: A feasible and highly accurate maneuver to confirm complete CTI conduction block. J Cardiovasc Electrophysiol 2020; 31:1649-1657. [PMID: 32400073 DOI: 10.1111/jce.14542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnostic accuracy of incremental atrial pacing (IP) to determine complete cavo-tricuspid isthmus (CTI) block during typical atrial flutter (AFL) ablation is limited by both an extensive/nonlinear ablation and/or the presence of intra-atrial conduction delay elsewhere in the right atrium. We examined the diagnostic performance of an IP variant based on the assessment of the atrial potentials adjacent to the ablation line which aims at overcoming both limitations. METHODS From a prospective population of 108 consecutive patients, 15 were excluded due to observation of inconclusive CTI ablation potentials precluding for a straight comparison between the IP maneuver and its variant. In the remaining 93, IP was performed from the low lateral right atrium and the coronary sinus ostium, with the ablation catheter positioned both at the CTI line and adjacent (<5 mm) to its septal and lateral aspect. The IP variant consisted of measuring the interval between the two atrial electrograms situated on the same side of the ablation line, opposite to the pacing site, a ≤10 ms increase indicating complete CTI block. RESULTS The IP maneuver and its variant were consistent with complete CTI block in 82/93 (88%) and 87/93 (93%) patients, respectively. Four patients had AFL recurrence during follow-up: 2/4 and 4/4 had been adequately classified as incomplete block by the IP maneuver and its variant, respectively. Twenty-three patients (24%) had significant intra-atrial conduction delay elsewhere in the right atrium. The IP maneuver and its variant were suggestive of an incomplete CTI block in 11/23 and 4/23 in this setting (P = .028), with the later best predicting subsequent AFL relapses (2/12 vs 2/4, P = .01). CONCLUSIONS The IP variant, which was designed to overcome the limitations of the conventional IP maneuver, accurately distinguishes complete from incomplete CTI block and helps to predict AFL recurrences after ablation.
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Affiliation(s)
- Jesus Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos González-Matos
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deva Bas
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Oscar Alcalde
- Arrhythmia Unit, Cardiology Department, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Sandra Cabrera
- Arrhythmia Unit, Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | - Carmen Altaba
- Electrophysiology Unit, Hospital del Mar, Barcelona, Spain
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Cladellas M, Garcia-Ribas C, Ble M, Gómez M, Farré N, Mas-Stachurska A, Ivern C, Vila J, Martí-Almor J. Impact of Preoperative Measurement of Right Heart Chambers in the Evaluation of Pulmonary Hypertension Following Aortic Valve Replacement. Chest 2020; 157:1597-1605. [PMID: 31958443 DOI: 10.1016/j.chest.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/17/2019] [Revised: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe pulmonary hypertension (PH) in patients with aortic stenosis is related to poor prognosis following aortic valve replacement (AVR). Current European PH guidelines recommend adding two different echocardiographic signs to tricuspid regurgitation velocity (TRV) in PH estimation, classifying its probability as low (TRV ≤ 2.8 m/s), intermediate (TRV 2.9-3.4 m/s), and high (TRV > 3.4 m/s). The right ventricle is an important determinant of prognosis in PH. The goal of this study was to analyze the value of right atrial area > 18 cm2 and right ventricular/left ventricular ratio > 1 in the long-term prognosis following AVR, mainly in the intermediate probability group. METHODS This study included 429 consecutive patients (mean age, 73 ± 8 years; 55% male) with a median follow-up of 4.25 years (completed in 98%). Patients were divided into low (n = 247), intermediate (n = 117), and high probability groups (n = 65). The intermediate probability group was divided into two subgroups: subgroup 2a (n = 27; TRV nonmeasurable or ≤ 2.8 m/s and two signs present) and subgroup 2b (n = 90; TRV 2.9-3.4 m/s, and none or only one sign present). RESULTS Overall mortality rates during follow-up of the low, intermediate, and high probability groups were 24%, 32%, and 42%, respectively. High PH probability was an independent predictor of all-cause mortality (hazard ratio [HR], 1.82; 95% CI, 1.11-3.00), but the intermediate probability group did not reach significance following multivariate analysis (HR, 1.40; 95% CI, 0.91-2.16). When the intermediate probability group was divided into subgroups, the subgroup 2a mortality rate (56%) was higher than that of both subgroup 2b (24%; P = .002) and the low probability group (24%; P < .001). Following multivariate analysis, subgroup 2a showed a significantly higher mortality (HR, 2.13; 95% CI, 1.11-4.10) in contrast to subgroup 2b (HR, 1.24; 95% CI, 0.75-2.05), both compared with the low probability group. CONCLUSIONS Incorporating measurement of the right cavities into the PH probability model in the assessment of long-term prognosis following AVR allowed better risk discrimination, especially in the intermediate probability group.
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Affiliation(s)
- Mercè Cladellas
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona.
| | - Cora Garcia-Ribas
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
| | - Mirea Ble
- Department of Cardiology, Hospital del Mar. Barcelona, Spain
| | - Miquel Gómez
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
| | - Núria Farré
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
| | | | - Consol Ivern
- Department of Cardiology, Hospital del Mar. Barcelona, Spain
| | - Joan Vila
- IMIM Hospital del Mar Medical Research Institute, Inflammatory and Cardiovascular Disorders, Barcelona; CIBER Epidemiology and Public Health
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
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Penela D, Jáuregui B, Fernández-Armenta J, Aguinaga L, Tercedor L, Ordóñez A, Acosta J, Bisbal F, Vassanelli F, Teres C, Aceña M, Martí-Almor J, De Sensi F, Vatasescu R, Borràs R, Sánchez Millán P, Soto-Iglesias D, Oller Martínez G, Carballo J, Berruezo A. Influence of baseline QRS on the left ventricular ejection fraction recovery after frequent premature ventricular complex ablation. Europace 2020; 22:274-280. [DOI: 10.1093/europace/euz330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular systolic dysfunction. We aimed to investigate the influence of the baseline QRS in the response after PVC ablation in patients with depressed left ventricular ejection fraction (LVEF).
Methods and results
Two hundred and fifteen [59 ± 13 years old, 152 (71%) men] consecutive patients with left ventricular (LV) systolic dysfunction and frequent PVCs referred for ablation were included and followed-up for 12 months. Echocardiographic response was defined as an improvement of at least five absolute points in LVEF. Clinical, electrocardiogram, and electrophysiological characteristics were analysed. Mean baseline QRS duration was 110 ms [97–140]. Premature ventricular complex burden significantly decreased after ablation from 23% [16–33] at baseline to 1% [0–8] at 12 months, P < 0.001. Mean PVC burden reduction was 18 [8–30] points. There was a significant improvement of LVEF from 35% [29–40] at baseline to 44% [35–55] at 12 months, P < 0.001. One hundred and thirty (61%) patients were considered as echocardiographic responders. Baseline QRS duration (ms) [odds ratio (OR) 0.98 (0.97–0.99), P = 0.01] was an independent predictor of echocardiographic response. Mean LVEF improvement was 16 [10–21] points when the baseline QRS duration was <90 ms; 12 [4–20] when it was 90–110 ms; 5 [0–15] when it was 110 ± 130 ms; and 0 [0–6] points when it was >130 ms.
Conclusions
In patients with LV systolic dysfunction, intrinsic QRS duration is inversely related to the probability and the degree of echocardiographic response after frequent PVC ablation. Patients with a QRS duration >130 ms at baseline have the poorer response after ablation.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | | | | | - Juan Acosta
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Felipe Bisbal
- Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cheryl Teres
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Julio Carballo
- Heart Institute, Teknon Medical Center, Barcelona, Spain
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Martí-Almor J, Jiménez-López J, Rodríguez de Dios N, Tizón H, Vallés E, Algara M. Ablación no invasiva de taquicardia ventricular con radioterapia estereotáctica en un paciente con miocardiopatía arritmogénica de ventrículo derecho. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.017] [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: 10/25/2022]
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Martí-Almor J, Jiménez-López J, Rodríguez de Dios N, Tizón H, Vallés E, Algara M. Noninvasive ablation of ventricular tachycardia with stereotactic radiotherapy in a patient with arrhythmogenic right ventricular cardiomyopathy. ACTA ACUST UNITED AC 2020; 73:97-99. [DOI: 10.1016/j.rec.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
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Cuadrado-Godia E, Benito B, Ois A, Vallès E, Rodríguez-Campello A, Giralt-Steinhauer E, Cabrera S, Alcalde O, Jiménez-López J, Jiménez-Conde J, Martí-Almor J, Roquer J. Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke. Eur J Neurol 2019; 27:244-250. [PMID: 31424609 DOI: 10.1111/ene.14061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Subclinical atrial fibrillation (AF) is known to underlie a number of cases of cryptogenic stroke (CrS). However, there is need to define the most effective strategy for AF detection. The diagnostic usefulness was analysed of a strategy based on ultra-early continuous monitoring in patients with CrS in terms of AF detection, oral anticoagulation treatment and stroke recurrence, in comparison to a standard outpatient strategy. METHODS Patients with ischaemic stroke of undetermined origin and confirmed to be cryptogenic after extensive work-up were searched for AF with (i) a conventional strategy (historical cohort, n = 101) with serial electrocardiograms and 24-h Holter monitoring or (ii) an ultra-early monitoring strategy with insertable cardiac monitor (ICM) implanted before discharge (prospective cohort, n = 90). AF episodes lasting >1 min, anticoagulant treatment and stroke recurrence were recorded. RESULTS During admission, AF was similarly detected in both cohorts (24% of patients). After discharge (mean follow-up 30 ± 10 months), AF detection rates were 17/80 (21.3%) and 38/65 (58.5%) for patients in the conventional versus the ultra-early ICM group (P < 0.001). Up to 41% of AF cases in the ICM cohort were detected within the first month. Oral anticoagulation was initiated in 37.6% versus 65.5% (P < 0.001) and stroke recurrence was recorded in 10.9% versus 3.3% (P 0.04) in the conventional versus the ICM cohort. CONCLUSIONS Pre-discharge ICM implant allows detection of AF during follow-up in up to 58% of selected patients with CrS. Compared to a conventional strategy, ultra-early ICM implant results in higher anticoagulation rates and a decrease in stroke recurrence.
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Affiliation(s)
- E Cuadrado-Godia
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - B Benito
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Cardiology Department, Hospital Vall d'Hebron. Vascular Biology and Metabolism Program, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A Ois
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - E Vallès
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - A Rodríguez-Campello
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - E Giralt-Steinhauer
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - S Cabrera
- Cardiology Department, Hospital Joan XXIII, Tarragona, Spain
| | - O Alcalde
- Cardiology Department, Complejo Universitario de Navarra, Pamplona, Spain
| | - J Jiménez-López
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J Jiménez-Conde
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J Martí-Almor
- Cardiology Department, Hospital del Mar. Group of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J Roquer
- Neurology Department, Hospital del Mar. Group of Research on Neurovascular Diseases, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Escobar C, Martí-Almor J, Pérez Cabeza A, Martínez-Zapata MJ. Anticoagulantes orales directos frente a antagonistas de la vitamina K en pacientes con fibrilación auricular de la práctica clínica: revisión sistemática y metanálisis. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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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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Ribas N, Recasens L, Pérez S, Bazán V, Pedro-Botet J, Ruiz S, Elosua R, Martí-Almor J. A new rational approach to reach LDL-cholesterol concentration objectives after an acute coronary syndrome. Clin Investig Arterioscler 2019; 31:93-100. [PMID: 30711338 DOI: 10.1016/j.arteri.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/19/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. METHODS A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (<70mg/dL) control during follow-up. RESULTS Among our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P<.001). The male gender (P<.001), the absence of prior history of dyslipemia (P<.001) and the adherence to Masana's recommendations (P=.007) were independent predictors for the achievement of targeted LDLc levels during follow-up. CONCLUSIONS In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.
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Affiliation(s)
- Núria Ribas
- Servicio de Cardiología, Hospital del Mar, Barcelona, España; Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Departamento Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Lluís Recasens
- Servicio de Cardiología, Hospital del Mar, Barcelona, España; Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Silvia Pérez
- Grupo de Investigación Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Víctor Bazán
- Servicio de Cardiología, Hospital del Mar, Barcelona, España; Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Sonia Ruiz
- Servicio de Cardiología, Hospital del Mar, Barcelona, España; Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Roberto Elosua
- Grupo de Investigación Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, España
| | - Julio Martí-Almor
- Servicio de Cardiología, Hospital del Mar, Barcelona, España; Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
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Vallès E, Benito B, Jiménez J, Cabrera S, Alcalde O, Altaba C, Guijo MA, Fan R, Martí-Almor J. Double factor single shot to diminish complications in cryoballoon ablation procedures for atrial fibrillation. J Interv Card Electrophysiol 2018; 55:17-26. [PMID: 30411175 DOI: 10.1007/s10840-018-0483-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/30/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Cryoballoon ablation (CBA) has become a standard treatment for recurrent atrial fibrillation (AF). There is need for improved CBA protocols. We aimed to demonstrate that a new protocol including minimum temperature (minT) reached could reduce procedure times and complications. METHODS A new double factor protocol (DFP), based on the performance of one single shot per vein with variable duration, and conditional bonus shot, determined by time-to-effect (TTE) and minT, was compared with the conventional protocol (CP), with at least two shots per vein. Procedure parameters, complications, and efficacy were compared. RESULTS We prospectively included 88 consecutive patients treated with the DFP. These were compared to the previous consecutive 69 patients treated with CP. All procedures were performed with 28-mm second-generation balloon. Acute pulmonary vein (PV) isolation was similar (98.6% vs. 98.9% in CP vs. DFP, p = 0.687). Procedure and ablation times favored DFP over CP (120 vs. 134 min, p = 0.003; and 1051 vs. 1475 s, p < 0.001; respectively). A composite of major and minor complications was significantly reduced in the DFP compared to the CP (18.8% vs. 6.8%, p = 0.02; respectively). Within a follow-up of 18 months, freedom from AF was 79.7% in CP and 78.4% in DFP (Log-rank 0.501). Paroxysmal AF and absence of PV potentials predicted better arrhythmia outcomes (HR 2.14 for paroxysmal vs. persistent, p = 0.031; and HR 1.61 for absence vs. presence of PV potentials, p = 0.01). CONCLUSIONS The novel DFP results in reduced complication rates and procedure times, with similar success rates compared with a conventional strategy.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain. .,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Begoña Benito
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jesús Jiménez
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carmen Altaba
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Miguel Angel Guijo
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine Health Science Center, T16-80, Stony Brook, NY, 11794, USA
| | - Julio Martí-Almor
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Farré N, Jorba I, Torres M, Falcones B, Martí-Almor J, Farré R, Almendros I, Navajas D. Passive Stiffness of Left Ventricular Myocardial Tissue Is Reduced by Ovariectomy in a Post-menopause Mouse Model. Front Physiol 2018; 9:1545. [PMID: 30455648 PMCID: PMC6230582 DOI: 10.3389/fphys.2018.01545] [Citation(s) in RCA: 6] [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] [Received: 08/04/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Heart failure (HF) – a very prevalent disease with high morbidity and mortality – usually presents with diastolic dysfunction. Although post-menopause women are at increased risk of HF and diastolic dysfunction, poor attention has been paid to clinically and experimentally investigate this group of patients. Specifically, whether myocardial stiffness is affected by menopause is unknown. Aim: To investigate whether loss of female sexual hormones modifies the Young’s modulus (E) of left ventricular (LV) myocardial tissue in a mouse model of menopause induced by ovariectomy (OVX). Methods: After 6 months of bilateral OVX, eight mice were sacrificed, fresh LV myocardial strips were prepared (∼8 × 1 × 1 mm), and their passive stress–stretch relationship was measured. E was computed by exponential fitting of the stress–stretch relationship. Subsequently, to assess the relative role of cellular and extracellular matrix components in determining OVX-induced changes in E, the tissues strips were decellularized and subjected to the same stretching protocol to measure E. A control group of eight sham-OVX mice was simultaneously studied. Results: E (kPa; m ± SE) in OVX mice was ∼twofold lower than in controls (11.7 ± 1.8 and 22.1 ± 4.4, respectively; p < 0.05). No significant difference between groups was found in E of the decellularized tissue (31.4 ± 12.05 and 40.9 ± 11.5, respectively; p = 0.58). Conclusion: Loss of female sexual hormones in an OVX model induces a reduction in the passive stiffness of myocardial tissue, suggesting that active relaxation should play a counterbalancing role in diastolic dysfunction in post-menopausal women with HF.
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Affiliation(s)
- Núria Farré
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Jorba
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.,Institute for Bioengineering of Catalonia - The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Marta Torres
- Department of Pneumology, Hospital Clinic Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Bryan Falcones
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Julio Martí-Almor
- Heart Failure Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon Farré
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Isaac Almendros
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Daniel Navajas
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.,Institute for Bioengineering of Catalonia - The Barcelona Institute of Science and Technology, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain
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Penela D, Martínez M, Fernández-Armenta J, Aguinaga L, Tercedor L, Ordóñez A, Acosta J, Martí-Almor J, Bisbal F, Rossi L, Borràs R, Linhart M, Soto-Iglesias D, Jáuregui B, Ortiz-Pérez JT, Perea RJ, Bosch X, Mont L, Berruezo A. Influence of myocardial scar on the response to frequent premature ventricular complex ablation. Heart 2018; 105:378-383. [PMID: 30242139 DOI: 10.1136/heartjnl-2018-313452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction. METHODS 70 consecutive patients (58±11 years, 58 (83%) men, 23% (18-32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done. RESULTS Left ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (p<0.01) and 48 (69%) patients were echocardiographic responders. New York Heart Association class improved from 1.96±0.9 points at baseline to 1.36±0.6 at 12 months (p<0.001). Brain natriuretic peptide decreased from 120 (60-284) to 46 (23-81) pg/mL (p=0.04). Twenty-nine (41%) patients showed scar in the preprocedural LGE-CMR with a mean scar mass of 10.4 (5-20) g. Mean scar mass was significantly smaller in responders than in non-responders (0 (0-4.7) g vs 2 (0-14) g, respectively, p=0.017). PVC burden reduction (OR 1.09 (1.01-1.16), p=0.02) and scar mass (OR 0.9 (0.81-0.99), p=0.04) were independent predictors of response, but the former showed a higher accuracy. CONCLUSIONS Presence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.
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Affiliation(s)
| | - Mikel Martínez
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | | | - Juan Acosta
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Felipe Bisbal
- Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luca Rossi
- Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Roger Borràs
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Markus Linhart
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Soto-Iglesias
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Beatriz Jáuregui
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José T Ortiz-Pérez
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosario J Perea
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Bosch
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Alcalde Ó, Cabrera Gómez S, Vallès Gras E, Benito Villabriga B, Zuccarino F, Martí-Almor J. Rheumatoid Arthritis With Severe Atrial Fibrosis and Multiple Atrial Arrhythmias: Chronic Atrial Myocarditis? ACTA ACUST UNITED AC 2018; 71:396-397. [DOI: 10.1016/j.rec.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/02/2017] [Indexed: 12/31/2022]
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Acosta J, Fernández-Armenta J, Borràs R, Anguera I, Bisbal F, Martí-Almor J, Tolosana JM, Penela D, Andreu D, Soto-Iglesias D, Evertz R, Matiello M, Alonso C, Villuendas R, de Caralt TM, Perea RJ, Ortiz JT, Bosch X, Serra L, Planes X, Greiser A, Ekinci O, Lasalvia L, Mont L, Berruezo A. Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging 2018; 11:561-572. [DOI: 10.1016/j.jcmg.2017.04.021] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 01/03/2023]
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Escobar C, Martí-Almor J, Pérez Cabeza A, Martínez-Zapata MJ. Direct Oral Anticoagulants Versus Vitamin K Antagonists in Real-life Patients With Atrial Fibrillation. A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2018; 72:305-316. [PMID: 29606361 DOI: 10.1016/j.rec.2018.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/02/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the effectiveness of direct oral anticoagulants vs vitamin K antagonists in real-life patients with atrial fibrillation. METHODS A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA statement. The ROBINS-I tool was used to assess risk of bias. RESULTS A total of 27 different studies publishing data in 30 publications were included. In the studies with a follow-up up to 1 year, apixaban (HR, 0.93; 95%CI, 0.71-1.20) and dabigatran (HR, 0.95; 95%CI, 0.80-1.13) did not significantly reduce the risk of ischemic stroke vs warfarin, whereas rivaroxaban significantly reduced this risk (HR, 0.83; 95%CI, 0.73-0.94). Apixaban (HR, 0.66; 95%CI, 0.55-0.80) and dabigatran (HR, 0.83; 95%CI, 0.70-0.97) significantly reduced the major bleeding risk vs warfarin, but not rivaroxaban (HR, 1.02; 95%CI, 0.95-1.10), although with a high statistical heterogeneity among studies. Apixaban (HR, 0.56; 95%CI, 0.42-0.73), dabigatran (HR, 0.45; 95%CI, 0.39-0.51), and rivaroxaban (HR, 0.66; 95%CI, 0.49-0.88) significantly reduced the risk of intracranial bleeding vs warfarin. Reduced doses of direct oral anticoagulants were associated with a slightly better safety profile, but with a marked reduction in stroke prevention effectiveness. CONCLUSIONS Data from this meta-analysis suggest that, vs warfarin, the stroke prevention effectiveness and bleeding risk of direct oral anticoagulants may differ in real-life patients with atrial fibrillation.
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Affiliation(s)
- Carlos Escobar
- Departamento de Cardiología, Hospital La Paz, Madrid, Spain.
| | | | | | - M José Martínez-Zapata
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain
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49
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Jiménez-López J, Vallès E, Benito Villabriga B, Alcalde O, Cabrera S, Martí-Almor J. Wide QRS complex tachycardia followed by 2:1 atrioventricular block: What is the mechanism? Pacing Clin Electrophysiol 2018; 41:302-303. [DOI: 10.1111/pace.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/09/2017] [Accepted: 11/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Begoña Benito Villabriga
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine; Hospital del Mar; Universitat Autònoma de Barcelona; Barcelona Spain
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Jiménez-López J, Vallès E, Benito B, Oliveró R, Martí-Almor J. Fusion map: A useful tool to guide ablation in oblique accessory pathways. J Cardiovasc Electrophysiol 2018; 29:795-796. [PMID: 29359874 DOI: 10.1111/jce.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Benito
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruperto Oliveró
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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