Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study.

OBJECTIVE: We sought to identify the factors associated with a worse prognosis in Emergency Department (ED) patients with atrial fibrillation (AF), crucial information to guide management decisions. METHODS: This is a secondary analysis of a prospective, multicenter, observational cohort of consecutive AF patients attended in 62 EDs in Spain. Clinical variables were collected on enrollment. Follow-up was performed at 30 days and one year. The primary composite outcome was all-cause mortality, major bleeding and/or stroke at one year. Secondary outcomes were each of these components considered separately, plus one-year cardiovascular mortality and the composite outcome at 30 days. RESULTS: We analyzed 1107 patients. The primary outcome occurred in 209 patients (18.9%), one-year all-cause mortality in 151 (13.6%), major bleeding in 47 (4.2%), and stroke in 31 (2.8%). Disability (HR 2.064, 95% CI 1.478-2.882), previous known AF (HR 1.829, 95% CI 1.096-3.051), long duration of the AF episode (HR 1.849, 95% CI 1.052-3.252) and renal failure (HR 2.073, 95% CI 1.433-2.999) were independently associated with the primary outcome, whereas anticoagulation at discharge was inversely associated (HR 0.576, 95% CI 0.415-0.801). Disability was associated with mortality, cardiovascular mortality, and the composite at 30 days, and renal failure with mortality and major bleeding. CONCLUSIONS: Comorbidities like renal failure, long AF duration and disability were related to adverse outcomes and should be decisive to guide management decisions in ED patients with AF. Anticoagulation had a positive impact on prognosis and should be the mainstay of therapy in AF patients attended in ED.

Recolocación percutánea tardía de electrodo de seno coronario para resincronización ventricular / Late percutaneous repositioning of a coronary sinus lead used for ventricular resynchronization

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[Transseptal catheterization using electrophysiological landmarks in ablation procedures]. / Punción transeptal mediante referencias electrofisiológicas para procedimientos de ablación.

Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have experienced a significant rise in the number of transseptal catheterization procedures. Traditionally, the procedure requires the presence of a interventional cardiologist who carries out transseptal catheterization following arterial puncture and placement of a reference pigtail catheter in the aortic root. Use of His bundle and coronary sinus catheters to provide anatomical and electrophysiological landmarks enables transseptal catheterization to be carried out without the need for arterial puncture or intracavity pressure measurement. We report our experience with transseptal catheterization in an electrophysiology laboratory using only electrophysiological landmarks. The procedure was carried out on 68 occasions and was successful in all patients except one, in whom catheterization could not be performed for anatomical reasons and because the patient had previously received anticoagulation therapy. One other patient developed transient ST elevation, which was probably due to an air embolism.

Punción transeptal mediante referencias electrofisiológicas para procedimientos de ablación / Transseptal catheterization using electrophysiological landmarks in ablation procedures

Desde el desarrollo de la ablación con radiofrecuencia para el tratamiento curativo de la fibrilación auricular, los laboratorios de electrofisiología han experimentado un incremento considerable en el número de cateterismos transeptales. Tradicionalmente, el procedimiento requería la intervención de un hemodinamista que procedía a realizar el cateterismo transeptal previa punción arterial y colocación de un catéter pigtail de referencia en la raíz aórtica. Utilizando el catéter del His y el del seno coronario como referencias anatomo-electrofisiológicas se puede llevar a cabo el cateterismo transeptal sin necesidad de realizar punción arterial ni medición de presiones intracavitarias. Presentamos nuestra experiencia en cateterización transeptal en el laboratorio de electrofisiología utilizando referencias puramente electrofisiológicas. Hemos realizado el procedimiento en 68 ocasiones, con resultado exitoso en todos los casos salvo en uno, en el que la punción no pudo llevarse a cabo por dificultades en el acceso anatómico y porque el paciente se encontraba previamente anticoagulado. Un paciente presentó elevación transitoria del segmento ST, probablemente debida a un embolismo aéreo

Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have experienced a significant rise in the number of transseptal catheterization procedures. Traditionally, the procedure requires the presence of a interventional cardiologist who carries out transseptal catheterization following arterial puncture and placement of a reference pigtail catheter in the aortic root. Use of His bundle and coronary sinus catheters to provide anatomical and electrophysiological landmarks enables transseptal catheterization to be carried out without the need for arterial puncture or intracavity pressure measurement. We report our experience with transseptal catheterization in an electrophysiology laboratory using only electrophysiological landmarks. The procedure was carried out on 68 occasions and was successful in all patients except one, in whom catheterization could not be performed for anatomical reasons and because the patient had previously received anticoagulation therapy. One other patient developed transient ST elevation, which was probably due to an air embolism

[Spanish implantable cardioverter-defibrillator registry. First official report of the spanish society of cardiology working group on implantable cardioverter-defibrillators (2002-2004)]. / Registro Español de Desfibrilador Automático Implantable. Primer Informe Oficial del Grupo de Trabajo de Desfibrilador Implantable de la Sociedad Española de Cardiología (años 2002-2004).

OBJECTIVE: To report the 2002-2004 findings of the Spanish National Implantable Cardioverter-Defibrillator (ICD) Registry, established by the Spanish Society of Cardiology Working Group on Implantable Cardioverter-Defibrillators. MATERIAL AND METHOD: Data were collected prospectively after implantation using a single-page questionnaire returned to the Spanish Society of Cardiology. Participation was voluntary. RESULTS: The registry received reports on 925, 1,046 and 1414 implants, respectively, in the years 2002, 2003 and 2004. These figures represent 63%, 59% and 67.5%, respectively, of the total number of ICDs implanted. The reported implantation rates were 22, 24 and 33 per million, respectively, and the estimated total implantation rates were 35, 41 and 49, per million, respectively. The number of device replacements increased from 20% to 30% between 2002 and 2004. The majority of patients were male, their median age was 66 years, they had severe or moderate left ventricular dysfunction, and they were in functional class I or II. The most common underlying heart disease was ischemic heart disease. The main indications for an ICD were sustained monomorphic ventricular tachycardia and aborted sudden cardiac death, though the number of prophylactic indications has increased. Most ICDs were implanted in an electrophysiology laboratory by a cardiac electrophysiologist. The implantation rates of dual-chamber ICDs and ICDs with cardiac resynchronization therapy were approximately 30% and 15%, respectively. Very few complications occurred during implantation. CONCLUSIONS: The Spanish National ICD Registry contains a representative sample of ICD implantations performed in the country. The registry is one of the largest reported.