Cierre percutáneo de fugas periprotésicas con el dispositivo Amplatzer Vascular Plug III: resultados inmediatos y a corto plazo / Paravalvular leak closure with the Amplatzer Vascular Plug III device: immediate and short-term results

Introducción y objetivos: El cierre percutáneo de las fugas periprotésicas presenta tasas de éxito variables, la falta de dispositivos específicamente diseñados para este procedimiento ha limitado sus resultados. El Amplatzer Vascular Plug III, por sus características, parece un dispositivo ideal para este procedimiento, pero los datos disponibles se limitan a casos aislados o pequeñas series. El propósito de este estudio es analizar la factibilidad y la eficacia del cierre percutáneo de fugas periprotésicas con este dispositivo. Métodos: Se analizan resultados de seguridad y eficacia durante el procedimiento y a 90 días de las fugas periprotésicas mitrales y aórticas cerradas percutáneamente con este dispositivo en nuestro centro. Resultados: Se trataron 34 fugas periprotésicas, 7 a nivel aórtico y 27 a nivel mitral, correspondientes a 33 pacientes. El éxito técnico fue del 93,9% (en 2 pacientes se realizó un segundo procedimiento programado) y el éxito del procedimiento (reducción ≥ 1 grado de regurgitación) en el 90,9%. En 4 pacientes se observaron complicaciones relacionadas con el procedimiento (transfusión en 3 pacientes y cirugía por interferencia con los discos en 1 paciente). No se observó ningún caso de muerte, infarto de miocardio o accidente cerebrovascular periprocedimiento. A 90 días la supervivencia fue del 100%, y en el 90,3% de los pacientes mejoró la clase funcional; 4 pacientes sufrieron complicaciones vasculares (seudoaneurisma) en el seguimiento. Conclusiones: El cierre percutáneo de la fugas periprotésicas con el Amplatzer Vascular Plug III es un procedimiento factible, seguro y con elevadas tasas de éxito clínico y ecocardiográfico

Introduction and objectives: Percutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. Methods: The immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. Results: Percutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n=1) and blood transfusion (n=3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). Conclusions: Mitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates

Significance of the learning curve in left atrial appendage occlusion with two different devices.

OBJECTIVE: To evaluate the impact of learning on outcome with use of two different left atrial appendage (LAA) occlusion devices. BACKGROUND: Two self-expanding devices, the Watchman and the Amplatzer Cardiac Plug (ACP), have been used for LAA occlusion in the last few years. It has been demonstrated that complications associated with implantation decrease in frequency with operator experience. However, the role of operator experience has not been compared across the two device types. METHODS: The study comprises 31 consecutive patients who underwent LAA occlusion. We compare the first 10 patients in whom an ACP was implanted with the subsequent eleven patients who underwent ACP implantation and with 10 cases where a Watcthman device was implanted. The composite safety end point comprised procedure-related events and excessive bleeding events. We also performed 3 months echocardiographic and clinical follow-up. RESULTS: There were not significant differences in the basal clinical and echocardiographical characteristics across the three groups. Cardiac complications only occurred in the ACP initial experience group (9% vs. 0% vs. 0% P = 0.04). Echocardiographic and clinical follow-up at 3 months was completed in all patients. No significant residual leak was detected. One patient in the ACP initial experience group developed a thrombus on the device. One patient in ACP late experience presented an ischemic stroke. CONCLUSIONS: Complications associated with LAA occlusion cluster early in the peri-procedural period and significantly decrease in frequency with operator experience. Initial experience gained with one of device may improve outcome with use of alternative LAA occlusion devices.

Morphology of far-field electrograms and antitachycardia pacing effectiveness among fast ventricular tachycardias occurring in ICD patients: a multicenter study.

INTRODUCTION: Fast ventricular tachycardias (FVT) are less likely to be terminated by antitachycardia pacing (ATP). No information is available regarding the ability of far-field electrogram (Ff-EG) morphology (Ff-EGm) in predicting the result of the subsequent ATP. Our objective is to determine the relationship between Ff-EGm and ATP efficacy. METHODS AND RESULTS: In this multicenter study we analyzed 289 FVT (cycle length [CL]: 250-320 milliseconds) occurring consecutively in 52 ICD patients with Medtronic devices (LVEF: 37 ± 6; pacing site: right ventricular apex). FVT programming was standardized, including a single ATP burst as initial therapy. The configuration of Ff-EG was HVA versus HVB. FVTs were classified in QFVT or non-QFVT according to the presence or absence of a negative initial deflection in the Ff-EG. The mean CL was 291 ± 24 milliseconds. We observed 4 Ff-EGm: QS (n = 14, 5%), QR (n = 158, 55%), R (n = 93, 32%), and RS (n = 24, 8%). The ATP effectiveness was 80% (86% in QS, 85% in QR, 74% in R, 62% in RS). The frequency of successful ATP was higher in QFVT: 86 versus 71% (P = 0.002). By logistic regression analysis, a QFVT pattern (OR = 2.3; P = 0.015) remained as an independent predictor of effective ATP. ATP was safer in QFVTs, the frequencies of shock (14% vs 29%; P = 0.002), acceleration (5.1 vs 12.3%; P = 0.02), and syncope (4.6 vs 12.3%; P = 0.01) being lower. CONCLUSIONS: Since ATP is less effective in non-QFVTs, they are less well tolerated. Therefore, the substrate of non-QFVTs may need a specific treatment.

Influence of cycle length variations on antitachycardia pacing effectiveness among ICD patients.

BACKGROUND: Antitachycardia pacing (ATP) fails to terminate 5% to 25% of ventricular tachycardias (VTs) occurring in implantable cardioverter-defibrillator patients. We speculated that small fluctuations in VT cycle length (CL) may be related to the efficacy of subsequent ATP. OBJECTIVE: The purpose of this study was to determine the relationship between the R-R variations of the last 12 R-R intervals before ATP and the efficacy of the first ATP attempt. METHODS: We studied 551 VTs (CL 329±35 ms) occurring in 67 patients. We also analyzed the percentage of variation (P-RR), which was calculated by dividing the mean difference between each R-R interval and the next one by the CL (×100), and the acceleration index (AI), which was calculated by dividing the CL of the first 6 R-R intervals by the CL of the next 6. RESULTS: The effectiveness of the first ATP therapy was 81%, being higher in VTs with AI<1 (85% vs 64%; P<.001). After classifying the events according to the tertiles of P-RR, ATP efficiency was better in higher values of P-RR (VTs with AI<1): 99% (third tertile) vs 85% (second tertile) vs 76% (first tertile), P<.001; and for VTs with AI≥1: 94% vs 68% vs 42% (P<.001). By logistic regression, P-RR (%; odds ratio 2.37; P<.001), and AI<1 (odds ratio 4.17; P<.001) were found to be independent predictors of successful first ATP attempts. CONCLUSION: Small changes in CL increase the effectiveness of ATP significantly. VTs with lower degrees of R-R fluctuations, especially when the pattern is a progressive CL shortening, are infrequently terminated by ATP.

Fuerza terminal de la onda P y fibrilación auricular: una enseñanza de los viejos maestros. Respuesta / P-wave terminal force and atrial fibrillation: a lesson learned from old masters. Response

No disponible

Morfología de la onda P y recurrencia tras cardioversión de fibrilación auricular aislada / P wave morphology and recurrence after cardioversion of lone atrial fibrillation

No disponible

Prognostic significance of heart rate in hospitalized patients presenting with myocardial infarction.

AIM: To investigate the prognostic significance of resting heart rate in patients with acute coronary syndrome (ACS), independent of other known factors. METHODS: Patients 40 years of age or older who had been admitted with acute coronary syndrome (ACS) to one of the 94 hospitals participating in the Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome (PAMISCA) study were included. Patients were divided into two groups based on their resting heart rate (HR ≥ or < 70 bpm). Complications were recording during a follow-up period of 1 year. RESULTS: There were 1054 ACS patients analyzed (43.5% with ST segment elevation and 56.5% without elevation). Mean age was 66.6 ± 11.7 years, 70.6% were male and 29.4% of subjects were female. During follow-up, more patients in the HR ≥ 70 bpm group were hospitalized for heart failure and they also had a higher mortality rate. In the multivariate analysis, a heart rate of ≥ 70 bpm was independently related to overall mortality during the follow-up period (hazard ratio 2.5; 95% confidence interval, 1.26-4.97, P = 0.009). CONCLUSION: A resting heart rate ≥ 70 bpm in patients who survive an ACS is an indicator of a high risk of suffering cardiovascular events during follow-up.

In-hospital prognosis in non-ST-segment elevation acute coronary syndrome derived using a new risk score based on electrocardiographic parameters obtained at admission.

Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) > or =450 ms (odds ratio 4.2, P< .001), ST-segment depression >0.5 mm (odds ratio 2.7, P< .001), and left atrial enlargement (odds ratio 1.8, P =.005). After taking the odds ratios into consideration, we awarded 3 points for a QTc > or =450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. < or =1, 2-3 and > or =4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P< .001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS.

Pronóstico hospitalario del síndrome coronario agudo sin elevación del segmento ST determinado por una nueva escala de riesgo integrada por variables electrocardiográficas obtenidas al ingreso / In-hospital prognosis in non-ST-segment elevation acute coronary syndrome derived using a new risk score based on electrocardiographic parameters obtained at admission

Diferentes variables electrocardiográficas tienen capacidad predictiva en el síndrome coronario agudo sin elevación del ST (SCASEST). Tras analizar a 427 pacientes, construimos una escala de riesgo (ER) basada en el ECG al ingreso (ER-ECG) para definir la probabilidad de muerte o isquemia recurrente (M-IsqR) durante la hospitalización, que fue del 36%. En un análisis de regresión logística que incluyó siete variables electrocardiográficas y las de la ER TIMI, alcanzaron la significación estadística: QTc ≥ 450 ms (odds ratio [OR] = 4,2; p < 0,001); descenso del ST > 0,5 (OR = 2,7; p < 0,001) y crecimiento auricular izquierdo (OR = 1,8; p = 0,005). En función de la OR, se otorgó 3 puntos a QTc ≥ 450 ms, 2 a descenso del ST > 0,5 mm y 1 a crecimiento auricular izquierdo. Agrupando a los pacientes según la ER-ECG en: ≤ 1, 2-3, ≥ 4, ésta discriminó adecuadamente la probabilidad de M-IsqR: el 11 frente al 27 frente al 58% (p < 0,001). Por lo tanto, esta ER-ECG permite estratificar el pronóstico del SCASEST de una forma simple, rápida y precisa (AU)

Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) ≥450 ms (odds ratio 4.2, P < .001), ST-segment depression >0.5 mm (odds ratio 2.7, P < .001), and left atrial enlargement (odds ratio 1.8, P=.005). After taking the odds ratios into consideration, we awarded 3 points for a QTc ≥450 ms, 2 points for ST-segment depression >0.5 mm, and 1 point for left atrial enlargement. When patients were divided into three groups on the basis of their ECG-RSs (i.e. ≤1, 2-3 and ≥4), the risk of death or recurrent ischemia was significantly different between the groups, at 11%, 27% and 58%, respectively (P < .001). In conclusion, the new ECG-RS provides a simple, rapid and accurate means of determining prognosis in patients with NSTEACS (AU)

Influence of beta-blocker therapy on antitachycardia pacing effectiveness for monomorphic ventricular tachycardias occurring in implantable cardioverter-defibrillator patients: a dose-dependent effect.

AIMS: To determine, in a non-selected population of 282 implantable cardioverter-defibrillator (ICD) patients with left ventricular dysfunction, the influence of the dose of beta-blockers on antitachycardia pacing (ATP) effectiveness and on the incidence of shock due to monomorphic ventricular tachycardias (VT). METHODS AND RESULTS: We followed 282 ICD patients along 26 +/- 19 months. Antitachycardia pacing and shock programming were standardized. We determined the indexed dose equivalent of beta-blockers (IDE-BB), using metoprolol as a reference, at each VT presentation. The median of IDE-BB was 55 mg/m(2)/day. We analysed 846 VT occurred in 100 patients. The ATP success rate was 84%. Upon classification of the events into three groups (IDE-BB = 0, IDE-BB < 55, and IDE-BB > or = 55), the frequency of effective ATP increased with the IDE-BB: 75 vs. 83 vs. 92% (P < 0.001). According to logistic regression, IDE-BB remained as an independent predictor of effective ATP (P < 0.001) and VT-related shock (P = 0.001). Both the mean ATP effectiveness per patient (67 vs. 80 vs. 91%, P = 0.007) and the mean survival time free of VT-related shock (583 vs. 847 vs. 1158 days, P = 0.019, log-rank test) increased linearly with the dose of beta-blockers. CONCLUSION: Beta-blockers increase the effectiveness of ATP through a dose-dependent effect. As a result, they reduce the incidence of shocks due to VT.

Relationship between the duration of the basal QRS complex and electrical therapies for ventricular tachycardias among ICD patients.

BACKGROUND: In implantable cardioverter-defibrillators (ICD) patients, the duration of the basal QRS complex (QRSd) is not associated with a greater risk of developing ventricular tachyarrhythmias. QRSd could be inversely related to the effectiveness of antitachycardia pacing (ATP) because it may be associated with longer conduction times of the paced-impulses and hence, with a greater propensity to require shocks to terminate ventricular tachycardias (VTs). METHODS: We followed 216 ICD patients (pacing site: right ventricular apex; QRSd 100 remained as an independent predictor of receiving shocks to terminate VTs (P = 0.01). According to Kaplan-Meier analysis, the occurrence of VTs was similar regardless of the QRSd (30% vs 38%; P = 0.2), but the incidence of shock due to VTs was higher in patients with a QRSd > 100 (19% vs 7%; P = 0.01). CONCLUSION: Since QRSd is a negative and independent predictor of effective ATP, ICD patients with QRSd > 100 ms require shocks more frequently to terminate VTs.

Association between -T786C NOS3 polymorphism and resistant hypertension: a prospective cohort study.

BACKGROUND: It is estimated that 5% of the hypertensive patients are resistant to conventional antihypertensive therapy. Polymorphisms in the endothelial nitric oxide synthase (NOS3) gene have been associated with high blood pressure levels, but not with resistant hypertension. The aim of the present study was to investigate if the -786T>C and G894T (Glu298Asp) polymorphisms of the NOS3 gene were associated with resistant hypertension. METHODS: A prospective case-control observational study was performed. From a series of 950 consecutive patients followed up during 42 months, 48 patients with resistant hypertension were detected. 232 patients with controlled high blood pressure were also included. RESULTS: No differences were observed in the distribution of G894T (Glu298Asp) NOS3 genotypes between the resistant hypertension group and the controlled hypertension patients. However, genotype -786CC was more frequent in the group of patients with resistant hypertension (33.3%) than in the group of patients with controlled high blood pressure (17.7%) (p 0.03). Furthermore carriers of allele T (-786TC and -786TT) were more frequent in patients with controlled hypertension (82.3%) than those with resistant hypertension (66.7%) (Multivariate analysis; RR 2.09; 95% CI 1.03-4.24; p 0.004). CONCLUSION: Our results indicate that genotype -786CC of the NOS3 gene increase the susceptibility to suffer resistant hypertension, which suggest that resistance to conventional therapy could be determined at the endothelial level.

Early reduction of QT dispersion after primary percutaneous intervention in ST-segment elevation acute myocardial infarction. Mechanisms and clinical implications.

OBJECTIVES: To determine, in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI), the mechanisms and clinical implications of the acute changes in QT dispersion (QTd). METHODS: In this prospective study we included 216 patients admitted with a STEMI of <12 h of evolution. All were treated with PPCI. QTd was measured prior to PPCI and within 1 h after. RESULTS: The ratio of QTd reduction after PPCI (QTd-R) - defined as [(QTd before PPCI - QTd after PPCI)/QTd before PPCI] x100 - was significantly correlated with the percentage of ST-segment elevation resolution (ST-R; p < 0.001). To determine the significance of the different values of QTd-R, we further subdivided our population into 3 groups according to the tertiles of QTd-R (<10, 11-49, > or =50%). Patients with longer QTd-R had higher percentages of ST-R: 32 +/- 43 for QTd-R <10% vs. 60 +/- 21 for 11-49% vs. 71 +/- 12 for > or =50% (p < 0.05). By logistic regression, patients with QTd-R > or =50% had a reduction of 75% in the adjusted frequency of death or severe heart failure during hospitalization (95% CI 13-73%, p = 0.03). CONCLUSION: QTd-R after PPCI occurs early, is closely related to the restoration of reperfusion at the microvascular level and provides additional prognostic information.

[Hemodynamic and inflammatory markers of sleep apnea-hypopnea syndrome and nocturnal hypoxemia: effects of treatment with nasal continuous positive airway pressure]. / Marcadores hemodinámicos e inflamatorios del síndrome de apneas-hipopneas durante el sueño e hipoxemia nocturna. Efectos del tratamiento nasal con presión positiva continua de la vía aérea nasal.

OBJECTIVE: In this study, we assessed factors associated with cardiovascular risk in patients with sleep apnea-hypopnea syndrome (SAHS) through analysis of plasma concentrations of N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity C-reactive protein (hsCRP). In addition, we analyzed the effect of nasal continuous positive airway pressure (nCPAP) on these markers. PATIENTS AND METHODS: Forty-two patients with SAHS (mild to moderate in 15 cases and severe in 27) were compared with 14 individuals without SAHS. The participants were not receiving drug treatment and they did not have diabetes, hypertension, marked dyslipidemia, or cardiovascular disease, which was ruled out both clinically and by echocardiography and (99m)Tc-tetrofosmin scintigraphy at rest and during exercise. The effects of nCPAP in patients with severe SAHS were analyzed after 6 months of treatment. RESULTS: Following adjustment for age, body mass index, and smoking habit, the mean concentrations of markers were not significantly higher in patients with severe SAHS than in those with mild-to-moderate SAHS or in control subjects. Nevertheless, in patients with SAHS the main factor influencing NTproBNP concentrations was the percentage of time with a nocturnal arterial oxygen saturation of less then 90% (r=0.37, P=.017). No variables predictive of hsCRP concentration were identified. The concentrations of the markers were reduced by nCPAP, but the differences were not statistically significant. CONCLUSIONS: While nocturnal hypoxemia in SAHS is responsible for variations in the plasma concentration of NTproBNP (as a result of cardiovascular changes), SAHS appears not to be associated with the inflammatory marker hsCRP when patients with heart disease, cardiovascular risk factors, or those receiving pharmacologic treatment are excluded.

Marcadores hemodinámicos e inflamatorios del síndrome de apneas-hipopneas durante el sueño e hipoxemia nocturna. Efectos del tratamiento nasal con presión positiva continua de la vía aérea nasal / Hemodynamic and inflammatory markers of sleep apnea-hypopnea syndrome and nocturnal hypoxemia: effects of treatment with nasal continuous positive airway pressure

OBJETIVO: Investigamos los factores del síndrome de apneas-hipopneas durante el sueño (SAHS) que activan losmecanismos de riesgo cardiovascular, a través del estudio delas concentraciones plasmáticas del fragmento N-terminaldel precursor del péptido natriurético cerebral (NTproBNP)y de la proteína C reactiva de alta sensibilidad (PCRas), asícomo el efecto que sobre ellos tiene el tratamiento con presiónpositiva continua de la vía aérea nasal (CPAPn).PACIENTES Y MÉTODOS: Se estudió a 42 pacientes conSAHS (leve-moderado en 15 casos y grave en 27), comparadoscon 14 personas sin SAHS. No tomaban fármacos nipresentaban diabetes, hipertensión, dislipemia importante oenfermedad cardiovascular, que se descartó tanto clínicamentecomo por ecocardiografía y tomografía computarizadapor emisión de fotón cínico-esfuerzo con 99mTc-tetrofosmina.En los pacientes con SAHS grave se estudiaron losefectos de 6 meses con CPAPn.RESULTADOS: Ajustando por edad, índice de masa corporaly tabaquismo, las medias de los biomarcadores no fueronsignificativamente más altas en los pacientes con SAHS graveque en aquéllos con SAHS leve-moderado o en los controles.Sin embargo, en los pacientes con SAHS el principal factorque influyó en las concentraciones de NTproBNP fue elporcentaje de tiempo con saturación arterial de oxígeno nocturnamenor del 90% (r = 0,37; p = 0,017), sin que se encontraraningún predictor de los valores séricos de la PCRas. Laaplicación de CPAPn hizo descender, pero no significativamente,las concentraciones de los biomarcadores.CONCLUSIONES: Mientras que la hipoxemia nocturna en elSAHS es la responsable de las variaciones en los valores delNTproBNP, derivado de la afectación cardíaca, el SAHS noparece estar asociado con el biomarcador inflamatorioPCRas, cuando se excluye a los pacientes con alteracionescardíacas, factores de riesgo cardiovascular o en tratamiento farmacológico

OBJECTIVE: In this study, we assessed factors associated withcardiovascular risk in patients with sleep apnea-hypopneasyndrome (SAHS) through analysis of plasma concentrationsof N-terminal prohormone brain natriuretic peptide(NTproBNP) and high-sensitivity C-reactive protein (hsCRP).In addition, we analyzed the effect of nasal continuous positiveairway pressure (nCPAP) on these markers.PATIENTS AND METHODS: Forty-two patients with SAHS(mild to moderate in 15 cases and severe in 27) were comparedwith 14 individuals without SAHS. The participants were notreceiving drug treatment and they did not have diabetes,hypertension, marked dyslipidemia, or cardiovascular disease,which was ruled out both clinically and by echocardiographyand 99mTc-tetrofosmin scintigraphy at rest and duringexercise. The effects of nCPAP in patients with severe SAHSwere analyzed after 6 months of treatment.RESULTS: Following adjustment for age, body mass index,and smoking habit, the mean concentrations of markerswere not significantly higher in patients with severe SAHSthan in those with mild-to-moderate SAHS or in controlsubjects. Nevertheless, in patients with SAHS the mainfactor influencing NTproBNP concentrations was thepercentage of time with a nocturnal arterial oxygensaturation of less then 90% (r=0.37, P=.017). No variablespredictive of hsCRP concentration were identified. Theconcentrations of the markers were reduced by nCPAP, butthe differences were not statistically significant.CONCLUSIONS: While nocturnal hypoxemia in SAHS isresponsible for variations in the plasma concentration ofNTproBNP (as a result of cardiovascular changes), SAHSappears not to be associated with the inflammatory markerhsCRP when patients with heart disease, cardiovascularrisk factors, or those receiving pharmacologic treatment are excluded

Importance of the relationship between sinus cycle length and junctional rhythm cycle length (occured during radiofrequency ablation) in predicting the successful modification of the slow pathway in Atrioventricular Nodal Re-entrant Tachycardias.

BACKGROUND: In atrioventricular nodal re-entrant tachycardias (AVNRT), the achievement of Junctional Rhythms (JR) during Radiofrequency Ablation (RF) is a sensitive but non-specific marker of success. Our aim is to analyze prospectively the predictors of non-inducibility of AVNRT, focusing on the characteristics of the JR. METHODS: We included 75 patients with reproducibly inducible AVNRT. Ablation was performed following an electro-anatomical approach. After each application, the induction protocol was repeated. RESULTS: A total of 341 applications were performed. Although the achievement of >/=1 JR was necessary to obtain the non-inducibility, and the cumulative number of junctional beats (CJB) was higher in effective applications, no CJB cut-off was associated with a success rate higher than 75%. After the observation of a significant correlation between the sinus cycle length (CL) pre-RF and the CL of the JR (JR-CL) (c=0.52; p<0.001), the sinus CL pre-RF/JR-CL ratio (CL-ratio) adequately differentiated the successful vs. unsuccessful applications: 1.41+/-0.23 vs. 1.17+/-0.2 (p<0.001). In a multivariate analysis, a CBJ 11 (p<0.001) and a CL-ratio 1.25 (p<0.001) were found to be the only independent predictors of success. The combination of >/= 11 of CJB with a CL ratio >/= 1.25 achieved non-inducibility in 97% of our patients. CONCLUSION: 1) The specificity of the occurrence of JR as a marker of the successful ablation of AVNRT is increased by the CL-ratio. 2) The achievement of >/= 11 of CJB with a CL ratio >/= 1.25 predicts non-inducibility in almost all patients.