Clinical implications of nonsarcomeric gene polymorphisms in hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is characterized by cardiomyocyte hypertrophy and fibrosis. Although is an autosomal dominant trait, a group of nonsarcomeric genes have been postulated as modifiers of the phenotypic heterogeneity. MATERIAL AND METHODS: We prospectively recruited 168 HCM patients and 136 healthy controls from three referral centres. Patients and controls were clinically stable at entry in the study. Nine polymorphisms previously associated with ventricular remodelling were determined: I/D ACE, AGTR1(A1666C), CYP11B2(C344T), PGC1-α(G482S), COLIA1(G2046T), ADRB1(R389G), NOS3(G894T), RETN(-420C>G) and CALM3(-34T>A). Their potential influence on prognosis, assessed by hospital admissions, and their cause were recorded. RESULTS: The median follow-up time was 49·5 months. Allele and genotype frequencies did not differ between patients and controls. Thirty-six patients (21·5%) required urgent hospitalization (18·5% for heart failure, 22·2% for atrial arrhythmias, 11·1% for ventricular arrhythmias, 29·6% for ischaemic heart disease, 14·8% for stroke and 3·7% for other reasons) with a hospitalization rate of 8·75% per year. Multivariate analysis showed an independent predictive value for noncarriers of polymorphic COL1A1 allele [HR: 2·76(1·26-6·05), P = 0·011] and a trend in homozygous carriers of ADRB1 Arg389 variant [HR: 1·98(0·99-4·02); P = 0·057]. CONCLUSION: Our study suggests that COL1A1 polymorphism (2046G>T) is an independent predictor of prognosis in HCM patients supporting the importance of nonsarcomeric genes on clinical prognosis in HCM.

Cardiac resynchronization therapy: do patient selection and implant practice vary depending on the volume a center handles?

BACKGROUND: The annual volume of implants may condition and determine many aspects of cardiac resynchronization therapy (CRT). METHODS: After the Spanish centers performing CRT were identified, data were recorded voluntarily by each implantation team from September 2010 to September 2011. RESULT: A total of 88 implanter centers were identified, and of these 85 (96.5%) answered the questionnaire. In total, 2,147 device implantations were reported, comprising 85% of the Eucomed's overall estimate for the same period, which was 2,518 implantations. Centers handling a higher volume of implants have a higher percentage of patients referred from other centers and more indications in patients over 80 years of age, with atrial fibrillation (AF), right bundle branch block, and unspecific disorders of intraventricular conduction. These high-volume centers stimulate more frequently in patients with very wide QRS > 200 ms. Lower-volume centers select more classic patients for resynchronization, whereas higher-volume centers increase the rate of patients with AF and prior cardiac stimulation (upgrade). Implant duration is shorter for higher-volume centers, which also perform implants in patients with congenital heart disease. By contrast, there are no significant differences in terms of heart disease, device type (pacemaker or defibrillator), implant techniques, achieved optimal site location, or complications. CONCLUSIONS: High-volume centers perform CRT more frequently in elderly patients, mostly with AF and other alternative implants. No significant differences were found between the complications reported by high-volume centers and those reported by low-volume centers.

Análisis transversal de la resincronización cardiaca en España. Indicaciones, técnicas de implante, optimización y seguimiento / Cross-sectional study of cardiac resynchronization therapy in Spain. Indications, implant techniques, optimization and follow-up

Introducción y objetivos. Realizar un estudio transversal de la terapia de resincronización cardiaca en España, analizando los problemas en las indicaciones, el implante y el seguimiento del paciente. Métodos. Identificar los centros españoles que realizan implantes de resincronización solicitando un cuestionario (septiembre de 2010 a septiembre de 2011) a cada equipo. Resultados. Se identificó un total de 88 centros, de los que 85 (96,6%) cumplimentaron la hoja de recogida de datos. El número de implantes de resincronizador (marcapasos o desfibriladores) fue de 2.147 (el 85,6% del total estimado de 2.518 por la European Confederation of Medical Suppliers Associations en ese periodo). El número de implantes/millón de habitantes comunicados fue 46 y el estimado, 54 (media en Europa, 131). Los implantes/recambios de resincronizador suponen el 84% y las mejoras del modo de estimulación upgrade de dispositivos previos, un 16%. La mayor parte de los resincronizadores se implantaron en varones (70,7%), con medias de edad de 68±12 años y de fracción de eyección ventricular izquierda del 26,4±5%. La mayoría de los pacientes (67%) estaban en clase funcional III de la New York Heart Association. El grupo de pacientes con nueva indicación según la última actualización de guías es ya significativo, con el 17,3% entre los pacientes en clase II y el 21,6% de los pacientes con fibrilación auricular. El 73,8% de los implantadores son electrofisiólogos, seguidos por los cirujanos (21,4%). Conclusiones. Las nuevas indicaciones recomendadas se están implantando progresivamente según los datos obtenidos en pacientes en clase II o fibrilación auricular. Sin embargo, el número de implantes de resincronizador en España aún está lejos de la media europea (AU)

Introduction and objectives. A cross-sectional study of cardiac resynchronization therapy use in Spain was performed to analyze problems with indications, implantation, and patient follow-up. Methods. Spanish cardiac resynchronization therapy implanter centers were identified, then the department members were surveyed and the data were recorded by each implantation team. Results. Eighty-eight implanter centers were identified; of these, 85 (96.6%) answered the survey. A total of 2147 device implantations were reported, comprising 85.6% of the overall number of 2518 implantations estimated by the European Confederation of Medical Suppliers Associations for the same period. The reported implantation rate was 46 per million inhabitants versus an estimated implantation rate of 51 per million (European average, 131). Cardiac resynchronization therapy devices accounted for 84% of implantations, and upgrades to previously implanted devices, 16%. The majority of cardiac resynchronization therapy devices were implanted in men (70.7%). The mean age was 68 (12) years, and the mean left ventricular ejection fraction was 26.4% (5%). Most patients (67%) were in New York Heart Association functional class III. The group of patients for whom cardiac resynchronization therapy was indicated according to the latest update of the guidelines was significant: 17.3% among New York Heart Association class II patients and more than 21.6% among patients with atrial fibrillation. In all, electrophysiologists accounted for 73.8% of implanters, followed by surgeons, accounting for 21.4%. Conclusions. The latest update of the guidelines is being progressively implemented in Spain, according to data obtained in patients in New York Heart Association class II or with atrial fibrillation. Nevertheless, the number of cardiac resynchronization therapy device implants is still well below the European average (AU)

Health-related quality of life in different clinical subgroups with typical AFL who have undergone cavo-tricuspid isthmus ablation.

BACKGROUND: To evaluate changes in health-related quality of life (HRQOL) in different sub-groups of a cohort of patients with typical atrial flutter (AFL) treated with cavotricuspid isthmus (CTI) radiofrequency catheter ablation. METHODS: 95 consecutive patients due to undergo CTI ablation were enrolled in a study involving their completion of two SF-36 HRQOL questionnaires, before ablation and at one-year follow-up. RESULTS: 88 of the initial 95 patients finished the study. Regardless of whether patients experienced atrial fibrillation (AF) during follow-up, a statistically significant improvement in HRQOL was observed, compared with pre-ablation scores and in all dimensions except Bodily Pain. However, patients without AF during follow-up had significantly higher absolute HRQOL scores in most dimensions. No differences were seen in most HRQOL dimensions, with respect to AFL type (paroxysmal, persistent) or duration, whether AFL was first-episode or recurrent, Class I-III drug dependent, sex, or presence of structural heart disease or tachycardiomyopathy. Patients with persistent AFL showed the greatest improvement in HRQOL when they also had a ventricular cycle length ≤500 ms. The combination of recurrent AFL, ventricular cycle length ≤500 ms and structural heart disease led to a significantly greater improvement in physical HRQOL dimensions than did first-episode AFL, no structural heart disease and ventricular cycle >500 ms. The only independent factor associated with a greater improvement was structural cardiopathy. CONCLUSIONS: CTI-ablation treatment leads to a significant improvement in HRQOL in patients with typical AFL. Patients with AF during follow-up show a significantly lower HRQOL at one-year post-ablation. The only independent risk factor found to be associated with a greater improvement in the physical summary component was structural cardiopathy.

Cross-sectional study of cardiac resynchronization therapy in Spain. Indications, implant techniques, optimization and follow-up.

INTRODUCTION AND OBJECTIVES: A cross-sectional study of cardiac resynchronization therapy use in Spain was performed to analyze problems with indications, implantation, and patient follow-up. METHODS: Spanish cardiac resynchronization therapy implanter centers were identified, then the department members were surveyed and the data were recorded by each implantation team. RESULTS: Eighty-eight implanter centers were identified; of these, 85 (96.6%) answered the survey. A total of 2147 device implantations were reported, comprising 85.6% of the overall number of 2518 implantations estimated by the European Confederation of Medical Suppliers Associations for the same period. The reported implantation rate was 46 per million inhabitants versus an estimated implantation rate of 51 per million (European average, 131). Cardiac resynchronization therapy devices accounted for 84% of implantations, and upgrades to previously implanted devices, 16%. The majority of cardiac resynchronization therapy devices were implanted in men (70.7%). The mean age was 68 (12) years, and the mean left ventricular ejection fraction was 26.4% (5%). Most patients (67%) were in New York Heart Association functional class III. The group of patients for whom cardiac resynchronization therapy was indicated according to the latest update of the guidelines was significant: 17.3% among New York Heart Association class II patients and more than 21.6% among patients with atrial fibrillation. In all, electrophysiologists accounted for 73.8% of implanters, followed by surgeons, accounting for 21.4%. CONCLUSIONS: The latest update of the guidelines is being progressively implemented in Spain, according to data obtained in patients in New York Heart Association class II or with atrial fibrillation. Nevertheless, the number of cardiac resynchronization therapy device implants is still well below the European average.

[Progress in cardiac electrophysiology and arrhythmias]. / Novedades en electrofisiología cardiaca y arritmias.

This article provides a commentary on some of the most significant research on cardiac arrhythmias published during the last year. Publications were selected for their clinical importance or because they report on improvements in the invasive techniques used in cardiac electrophysiology.

Síndrome de Heyde / Heyde’s Syndrome

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Novedades en electrofisiología cardiaca y arritmias / Progress in cardiac electrophysiology and arrhythmias

En este artículo se comentan algunos de los trabajos más relevantes publicados durante el último año en el campo de las arritmias cardiacas, seleccionados por su importancia clínica o por implementar mejoras en el desarrollo tecnológico de los procedimientos invasivos en electrofisiología cardiaca (AU)

This article provides a commentary on some of the most significant research on cardiac arrhythmias published during the last year. Publications were selected for their clinical importance or because they report on improvements in the invasive techniques used in cardiac electrophysiology (AU)

Selección del mejor lugar de estimulación tras cirugía cardiaca evaluando la asincronía con strain tras diferentes estimulaciones / Selecting the best site for pacing leads after cardiac surgery by evaluating the asynchrony of myocardial deformation observed with different pacing sites

Introducción y objetivos. Implantar electrodos transitorios en ventrículo derecho (VD) tras cirugía cardiaca es habitual. El objetivo es estudiar en pacientes intervenidos el efecto de la estimulación en diferentes localizaciones ventriculares en la sincronía, analizando la deformación miocárdica (strain), y en la eficacia cardiaca. Métodos. En 19 pacientes se midió la asincronía interventricular (diferencia en el tiempo al comienzo del strain entre VD y ventrículo izquierdo [VI]: TE DI) y la intraventricular (desviación estándar [TE DE] y máxima diferencia en el tiempo de comienzo del strain en las seis caras del VI [TE MD]). Estas estimaciones y el gasto cardiaco (GC) mediante Doppler se determinaron tras la estimulación en VD en tres diferentes segmentos del VI. Resultados. La estimulación en VD fue la que más aumentó los parámetros de asincronía respecto al estudio basal: TE DI, 59,8 ± 40,5 frente a 28,23 ± 56,9 ms (p = 0,002); TE DE, 53,2 ± 34,4 frente a 36,6 ± 34,9 ms (p = 0,007); TE MD, 135,3 ± 82,9 frente a 90,5 ± 87,4 ms (p = 0,007). La estimulación en VI produjo menos asincronía (estimulación en segmento anterior del VI: TE DI, 17,2 ± 53,8 ms; TE DE, 35,8 ± 17,9 ms; TE MD, 91,3 ± 45,2 ms (sin significación estadística respecto a basal). El GC tras la estimulación en VD fue menor que tras estimulación en la cara anterior del VI: 4,36 ± 1 frente a 4,7 ± 1 (p = 0,001). Conclusiones. La estimulación en VI produce menos asincronía que en VD. Asimismo, la estimulación en la cara anterior del VI consigue mayor GC que la estimulación en VD. Estos datos indican que se debería modificar la localización de los electrodos transitorios tras cirugía cardiaca (AU)

Introduction and objectives. After cardiac surgery, temporary pacing leads are routinely implanted in the right ventricle (RV). The objective was to investigate the effect of different ventricular pacing locations on cardiac synchrony (by evaluating myocardial deformation, or strain) and efficiency in patients undergoing cardiac surgery. Methods. Interventricular asynchrony (i.e. the difference in the time of onset of deformation between right and left ventricles; TE-R/L) and intraventricular asynchrony (i.e. the standard deviation and maximum difference in the time of onset of deformation in six segments of the left ventricle [LV]; TE-SD and TE-MD, respectively) were assessed in 19 patients. Doppler echocardiography was used to evaluate these parameters and cardiac output after pacing in the RV and in three different LV segments. Results. Pacing in the RV resulted in the greatest increases in asynchrony parameters from baseline: TE- R/L 59.8 ms (standard deviation [SD] 40.5 ms) vs. 28.23 ms (SD 56.9 ms), P=.002; TE-SD 53.2 ms (SD 34.4 ms) vs. 36.6 ms (SD 34.9 ms), P=.007; and TE-MD 135.3 ms (SD 82.9 ms) vs. 90.5 ms (SD 87.4 ms), P=.007. Pacing in the LV resulted in less asynchrony: for anterior LV pacing, TE-R/L was 17.2 ms (SD 53.8 ms), TE-SD was 35.8 ms (SD 17.9 ms), and TE-MD was 91.3 ms (SD 45.2). The change from baseline was not significant. Cardiac output was lower after RV pacing than after anterior LV pacing: 4.36 (SD 1) vs. 4.70 (SD 1); P=.001. Conclusions. Pacing in the LV produced less asynchrony than RV pacing. In addition, anterior LV pacing resulted in a higher cardiac output than RV pacing. These findings suggest that the location normally used for temporary leads after cardiac surgery should be changed (AU)

Selecting the best site for pacing leads after cardiac surgery by evaluating the asynchrony of myocardial deformation observed with different pacing sites.

INTRODUCTION AND OBJECTIVES: After cardiac surgery, temporary pacing leads are routinely implanted in the right ventricle (RV). The objective was to investigate the effect of different ventricular pacing locations on cardiac synchrony (by evaluating myocardial deformation, or strain) and efficiency in patients undergoing cardiac surgery. METHODS: Interventricular asynchrony (i.e. the difference in the time of onset of deformation between right and left ventricles; Tε-R/L) and intraventricular asynchrony (i.e. the standard deviation and maximum difference in the time of onset of deformation in six segments of the left ventricle [LV]; Tε-SD and Tε-MD, respectively) were assessed in 19 patients. Doppler echocardiography was used to evaluate these parameters and cardiac output after pacing in the RV and in three different LV segments. RESULTS: Pacing in the RV resulted in the greatest increases in asynchrony parameters from baseline: Tε-R/L 59.8 ms (standard deviation [SD] 40.5 ms) vs. 28.23 ms (SD 56.9 ms), P=.002; Tε-SD 53.2 ms (SD 34.4 ms) vs. 36.6 ms (SD 34.9 ms), P=.007; and Tε-MD 135.3 ms (SD 82.9 ms) vs. 90.5 ms (SD 87.4 ms), P=.007. Pacing in the LV resulted in less asynchrony: for anterior LV pacing, Tε-R/L was 17.2 ms (SD 53.8 ms), Tε-SD was 35.8 ms (SD 17.9 ms), and Tε-MD was 91.3 ms (SD 45.2). The change from baseline was not significant. Cardiac output was lower after RV pacing than after anterior LV pacing: 4.36 (SD 1) vs. 4.70 (SD 1); P=.001. CONCLUSIONS: Pacing in the LV produced less asynchrony than RV pacing. In addition, anterior LV pacing resulted in a higher cardiac output than RV pacing. These findings suggest that the location normally used for temporary leads after cardiac surgery should be changed.

Non-antiarrhythmic drugs to prevent atrial fibrillation.

Atrial fibrillation (AF) is the most frequent arrhythmia found in clinical practice. The majority of patients with AF are still candidates for antiarrhythmic drug treatment, not only for acute reversion to sinus rhythm but also for long-term treatment to prevent recurrences of AF. Currently available antiarrhythmic drugs, however, are unable to provide complete efficacy in all patients, and present problematic risks of proarrhythmia. The progressively increasing prevalence of AF supports the need to develop improved therapeutic approaches for the clinical management of arrhythmia. Accordingly, new treatment techniques aimed at suppressing the origin of the arrhythmogenic foci have been developed in the last decade. However, ablative treatments are only available for selected patients. Because of these factors, and also because primary prevention of AF should be our goal, the introduction of non-antiarrhythmic agents that could prevent both new-onset AF and recurrences of AF may eventually improve patient outcomes and reduce the incidence of this epidemic disease. The potential clinical value of these non-antiarrhythmic options is currently under active investigation. There is now clinical and experimental evidence that many drugs may have beneficial effects in preventing AF through several possible mechanisms. Non-antiarrhythmic drugs, such as ACE inhibitors and angiotensin receptor blockers, HMG-CoA reductase inhibitors (statins), corticosteroids, and N-3 polyunsaturated fatty acids may have a positive effect in patients with AF or in preventing AF in patients at risk.

[Cardiac arrhythmias in women]. / Arritmias cardiacas en la mujer.

The aim of this study was to review published data on gender differences in cardiac electrophysiology and in the presentation and clinical treatment of arrhythmias. The evidence from studies published to date show that women have a higher mean resting heart rate, a longer QT interval, a shorter QRS duration, and a lower QRS voltage than men. Women have a higher prevalence of sick sinus syndrome, inappropriate sinus tachycardia, atrioventricular nodal reentry tachycardia, idiopathic right ventricular tachycardia, and arrhythmic events in the long-QT syndrome. In contrast, men have a higher prevalence of atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia due to accessory pathways, Wolff-Parkinson-White syndrome, reentrant ventricular tachycardia, ventricular fibrillation and sudden death, and the Brugada syndrome. With regard to implantable devices, it has been reported that defibrillators offer similar benefits in men and women. Moreover, there is no gender difference in the percentage who respond well to resynchronization therapy: survival is similar in the two sexes. However, it should be noted that few women have participated in studies of all types of therapy, including catheter ablation, resynchronization therapy, and the use of implantable defibrillators.

Arritmias cardiacas en la mujer / Cardiac arrhythmias in women

El objetivo de esta revisión fue analizar las diferencias electrofisiológicas entre sexos ya descritas, así como la presentación y el tratamiento clínico de las arritmias en las mujeres. La evidencia, según los datos de los estudios publicados hasta el momento, nos muestra que las mujeres tienen una frecuencia cardiaca media superior, un intervalo QT más largo, una menor duración del complejo QRS, así como un menor voltaje de éste respecto a los varones. Asimismo, en las mujeres son más frecuentes la enfermedad del nódulo sinusal, la taquicardia sinusal inapropiada, la taquicardia supraventricular intranodal, la taquicardia ventricular idiopática del ventrículo derecho, y el síndrome QT largo congénito y adquirido; en cambio, en los varones, la prevalencia de las siguientes arritmias es mayor: bloqueo auriculoventricular, hipersensibilidad del seno carotídeo, fibrilación auricular, taquicardia supraventricular con vía accesoria, síndrome de Wolff-Parkinson-White, taquicardia ventricular por reentrada, fibrilación ventricular y muerte súbita, así como el síndrome de Brugada. Con respecto a los dispositivos, se observó que tanto los varones como las mujeres obtienen un beneficio similar con el marcapasos y el desfibrilador, y tampoco hubo diferencias en el porcentaje de buena respuesta a la resincronización entre ambos sexos, con una supervivencia similar; sin embargo, llama la atención la escasa participación femenina en los estudios de investigación de todas las técnicas terapéuticas, tanto la ablación como la resincronización y el desfibrilador automático implantable

The aim of this study was to review published data on gender differences in cardiac electrophysiology and in the presentation and clinical treatment of arrhythmias. The evidence from studies published to date show that women have a higher mean resting heart rate, a longer QT interval, a shorter QRS duration, and a lower QRS voltage than men. Women have a higher prevalence of sick sinus syndrome, inappropriate sinus tachycardia, atrioventricular nodal reentry tachycardia, idiopathic right ventricular tachycardia, and arrhythmic events in the long-QT syndrome. In contrast, men have a higher prevalence of atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia due to accessory pathways, Wolff-Parkinson-White syndrome, reentrant ventricular tachycardia, ventricular fibrillation and sudden death, and the Brugada syndrome. With regard to implantable devices, it has been reported that defibrillators offer similar benefits in men and women. Moreover, there is no gender difference in the percentage who respond well to resynchronization therapy: survival is similar in the two sexes. However, it should be noted that few women have participated in studies of all types of therapy, including catheter ablation, resynchronization therapy, and the use of implantable defibrillators

Prevención de la fibrilación auricular en los pacientes con insuficiencia cardiaca / Prevention of atrial fibrillation in patients with heart failure

La insuficiencia cardiaca promueve la aparición de fibrilación auricular y ésta agrava la insuficiencia cardiaca. La fibrilación auricular puede afectar en cualquier momento a un gran porcentaje de los pacientes con insuficiencia cardiaca. La manifestación y presentación clínica cambia con el paso del tiempo y depende de cada paciente. Empeora la sintomatología de los pacientes, como una complicación más de su enfermedad, y causa frustración tanto a los pacientes como a los médicos. Se estima que hasta un 50% de los pacientes con insuficiencia cardiaca presentan fibrilación auricular en algún momento de su evolución, por lo que son necesarias medidas tanto para la prevención de la embolia como para el alivio de los síntomas. La interferencia farmacológica con señales específicas de las vías de transducción es prometedora. Hasta ahora, los agentes más efectivos son los inhibidores de la enzima de conversión de la angiotensina y los antagonistas de los receptores de la angiotensina II, que reducen el estrés oxidativo, restauran las concentraciones de óxido nítrico, inhiben la formación de tejido fibroso y pueden reducir la ectopia de las venas pulmonares. El desenmascaramiento de factores genéticos implicados aún no conocidos puede tener gran repercusión. Es necesario un mejor conocimiento de la fisiología molecular. Esto puede ayudar a desarrollar nuevos regímenes de tratamiento o terapia híbrida con combinación de fármacos «antiarrítmicos» y «no antiarrítmicos» para aumentar la eficacia del tratamiento (AU)

The presence of heart failure increases the risk of atrial fibrillation, a condition which in turn aggravates heart failure. At any point in time, a large percentage of patients with heart failure are affected by atrial fibrillation. Its clinical characteristics change over time and vary according to the individual patient. It worsens patients’ symptoms, adds a further a complication to their illness, and is problematic for both patients and physicians. It is estimated that 50% of patients with heart failure will experience atrial fibrillation, and will require treatment to prevent embolism and relieve symptoms. The ability of drugs to interfere with specific signal transduction pathways is promising. To date, the most effective agents appear to be angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists. These compounds reduce oxidative stress, restore the nitric oxide level, inhibit the formation of fibrous tissue, and can ameliorate pulmonary vein ectopy. Uncovering the, as yet unknown, genetic factors involved could have significant implications. Better understanding of the relevant molecular biology is essential. This could lead to new treatment regimes or to hybrid therapy with a combination of antiarrhythmic and non-antiarrhythmic drugs, which could improve treatment effectiveness (AU)

Validation of dual-chamber pacemaker diagnostic data using dual-channel stored electrograms.

BACKGROUND: Pacemaker diagnostic counters are used to guide device programming and patient management. However, these data are susceptible to inappropriate classification of events. The aim of this multicenter study was to evaluate pacemaker diagnostic data using stored intracardiac electrograms (EGMs). METHODS: The study included 351 patients (191 males, aged 71 +/- 10 years) with standard indications for dual-chamber pacemaker implantation. EGM triggers were atrial tachycardia (AT), ventricular tachycardia (VT), sudden bradycardia response (SBR), and pacemaker-mediated tachycardia (PMT). For this study, the devices could store up to 5 EGMs of 8s each (with marker annotation and onset recording). After 3 months, the EGMs were analyzed and classified as "confirmed" if the EGM validated the trigger and as "false positive" if the EGM showed an event different from the trigger. RESULTS: Of the 1,003 EGMs available, the triggers were AT in 640 EGMs, VT in 76, SBR in 105, and PMT in 178 EGMs. Four EGMs were triggered by magnet application. The trigger was confirmed in 614 EGMs (62%): 62% of AT episodes, 18% of VT episodes, 100% of SBR episodes, and 54% of PMT episodes. In 385 cases (45%), the EGMs revealed false-positive events due to far-field sensing (39%), noise and myopotential sensing (26%), sinus tachycardias (21%), double counting (9%), exit block (4%), and undersensing (1%). CONCLUSION: This large-scale study of stored EGMs revealed their value in validating diagnostic counter data. Therapeutic decisions should not be based on diagnostic counters alone; they should be validated by sophisticated tools like stored EGMs.

Ablación de fibrilación auricular familiar. Buena evolución a largo plazo / Ablation of familial atrial fibrillation. Favorable long-term outcome

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