Subject(s)
Defibrillators, Implantable , Humans , Child , Death, Sudden, Cardiac/prevention & control , Male , FemaleABSTRACT
AIMS: Atrial fibrillation (AF) worsens the prognosis of patients with heart failure (HF). Successful treatments are still very scarce for those with permanent AF and preserved (HFpEF) or mildly reduced (HFmrEF) ejection fraction. In this study, the long-term benefits and safety profile of heart rate regularization through left-bundle branch pacing (LBBP) and atrioventricular node ablation (AVNA) will be explored in comparison with pharmacological rate-control strategy. METHODS AND RESULTS: The PACE-FIB trial is a multicentre, prospective, open-label, randomized (1:1) clinical study that will take place between March 2022 and February 2027. A total of 334 patients with HFpEF/HFmrEF and permanent AF will receive either LBBP followed by AVNA (intervention arm) or optimal pharmacological treatment for heart rate control according to European guideline recommendations (control arm). All patients will be followed up for a minimum of 36 months. The primary outcome measure will be the composite of all-cause mortality, HF hospitalization, and worsening HF at 36 months. Other secondary efficacy and safety outcome measures such as echocardiographic parameters, functional status, and treatment-related adverse events, among others, will be analysed too. CONCLUSION: LBBP is a promising stimulation mode that may foster the clinical benefit of heart rate regularization through AV node ablation compared with pharmacological rate control. This is the first randomized trial specifically addressing the long-term efficacy and safety of this pace-and-ablate strategy in patients with HFpEF/HFmrEF and permanent AF.
Subject(s)
Atrial Fibrillation , Heart Failure , Humans , Atrioventricular Node/surgery , Prospective Studies , Stroke Volume , Atrial Fibrillation/surgery , Atrial Fibrillation/complicationsABSTRACT
BACKGROUND: Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA. METHODS: A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built. RESULTS: Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan-Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4-75.8%) in the Prior-CB, and 89.2% (95% CI 73.6-95.9%) in the Prior-RF group (p = 0.002). Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05-6.79). CONCLUSIONS: Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991.
ABSTRACT
Antecedentes y objetivos: La enfermedad de Steinert o distrofia miotónica tipo 1 (DM1), (OMIM 160900) es la miopatía más prevalente en el adulto. Es una enfermedad multisistémica con alteración de prácticamente todos los órganos y tejidos y una variabilidad fenotípica muy amplia, lo que implica que deba ser atendida por diferentes especialistas que dominen las alteraciones más importantes. En los últimos años se ha avanzado de manera exponencial en el conocimiento de la enfermedad y en su manejo. El objetivo de la guía es establecer recomendaciones para el diagnóstico, el pronóstico, el seguimiento y el tratamiento de las diferentes alteraciones de la DM1. Material y métodos: Esta guía de consenso se ha realizado de manera multidisciplinar. Se ha contado con neurólogos, neumólogos, cardiólogos, endocrinólogos, neuropediatras y genetistas que han realizado una revisión sistemática de la literatura. Recomendaciones: Se recomienda realizar un diagnóstico genético con cuantificación precisa de tripletes CTG. Los pacientes con DM1 deben seguir control cardiológico y neumológico de por vida. Antes de cualquier cirugía con anestesia general debe realizarse una evaluación respiratoria. Debe monitorizarse la presencia de síntomas de disfagia periódicamente. Debe ofrecerse consejo genético a los pacientes con DM1 y a sus familiares. Conclusión: La DM1 es una enfermedad multisistémica que requiere un seguimiento en unidades especializadas multidisciplinares
Background and objectives: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. Material and methods: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. Recommendations: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. Conclusion: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up
Subject(s)
Humans , Myotonic Dystrophy/diagnosis , Myotonic Dystrophy/physiopathology , Prognosis , Follow-Up Studies , Myotonic Dystrophy/genetics , Neurophysiology , Family Development Planning , Prenatal Diagnosis , Myotonia , NeuroimagingABSTRACT
BACKGROUND AND OBJECTIVES: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. MATERIAL AND METHODS: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. RECOMMENDATIONS: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. CONCLUSION: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up.
Subject(s)
Myotonic Dystrophy/diagnosis , Follow-Up Studies , Humans , Myotonic Dystrophy/complications , Practice Guidelines as TopicABSTRACT
No disponible
Subject(s)
Humans , Tachycardia/diagnosis , Electrocardiography , Diagnosis, DifferentialABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Electrocardiography , Tachycardia/etiology , Aortic Valve Stenosis/diagnosis , Mitral Valve Stenosis/diagnosisABSTRACT
Clinical trials have shown that functional assessment of coronary stenosis by fractional flow reserve (FFR) improves clinical outcomes. Intravascular ultrasound (IVUS) complements conventional angiography, and is a powerful tool to assess atherosclerotic plaques and to guide percutaneous coronary intervention (PCI). Computational fluid dynamics (CFD) simulation represents a novel method for the functional assessment of coronary flow. A CFD simulation can be calculated from the data normally acquired by IVUS images. A case of coronary heart disease studied with FFR and IVUS, before and after PCI, is presented. A three-dimensional model was constructed based on IVUS images, to which CFD was applied. A discussion of the literature concerning the clinical utility of CFD simulation is provided.
Subject(s)
Computer Simulation , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Hydrodynamics , Ultrasonography, Interventional , Humans , Male , Middle AgedABSTRACT
Introducción y objetivos. El desfibrilador automático implantable (DAI) es una terapia aceptada para pacientes con taquicardia ventricular (TV) y cardiopatía estructural, pero se cuestiona su beneficio en pacientes con expectativa de vida limitada. Asimismo, se desconoce la eficacia de la ablación con catéter a largo plazo en este contexto. Métodos. Se incluyó en el estudio a 33 pacientes consecutivos de edad > 75 años sometidos a ablación con catéter de una TV sobre cardiopatía estructural. Se analizaron la eficacia y las complicaciones del procedimiento, así como la evolución de los pacientes en el seguimiento. Resultados. La media de edad en el momento del procedimiento fue de 79,7 ± 3,7 años; 27 pacientes tenían cardiopatía isquémica (CI) y 6, miocardiopatía dilatada (MCD). La fracción de eyección del ventrículo izquierdo (FEVI) fue 35,9% ± 8,9%. Se logró realizar la ablación con éxito de la TV clínica en 28 pacientes (84,8%). No se encontraron diferencias en la eficacia de la ablación entre los pacientes con cicatriz postinfarto (88,9%) y aquellos con MCD (66,7%) (p = 0,17). Se implantó un DAI tras el procedimiento a 4 pacientes. Únicamente se produjeron complicaciones relacionadas con la ablación en 3 pacientes. Se logró contactar con 20 pacientes, con un seguimiento medio de 38,5 ± 27,7 meses; 9 pacientes sobreviven en la actualidad (media de edad, 82,2 ± 4,6 años) y refieren una buena calidad de vida, sin recurrencias arrítmicas. Conclusiones. La ablación de TV en pacientes ancianos con cardiopatía estructural parece eficaz y relativamente segura, y podría constituir una alternativa al DAI en esta población seleccionada (AU)
Introduction and objectives. The implantable cardioverter-defibrillator (ICD) is a well-recognized means of providing effective treatment for patients with ventricular tachycardia (VT) and structural heart disease. However, the benefits of these devices in patients with limited life-expectancy have been questioned. Moreover, the long-term efficacy of catheter ablation of VT in this setting is unknown. Methods. This study involved 33 consecutive patients aged over 75 years with structural heart disease who underwent catheter ablation of VT. We investigated the efficacy of the procedure and its complications, and evaluated patient outcomes during follow-up. Results. The patients’ mean age at the time of the procedure was 79.7 (3.7) years. Twenty-seven had ischemic heart disease and 6 had dilated cardiomyopathy. Their mean left ventricular ejection fraction (LVEF) was 35.9 (8.9%). Ablation of clinical VT was successful in 28 patients (84.8%). There were no statistically significant differences in the efficacy of ablation between patients with post-infarction scars (88.9%) and those with dilated cardiomyopathy (66.7%; P=.17). An ICD was implanted after the procedure in 4 patients. Complications associated with the procedure occurred in only 3 patients. Twenty patients were contacted later, after a mean follow-up period of 38.5 (27.7) months. Nine (mean age, 82.2 [4.6] years) were still alive and reported a good quality of life, without recurrent arrhythmias. Conclusions. Catheter ablation of VT in elderly patients with structural heart disease appeared to be effective and relatively safe. It could provide an alternative to ICD implantation in this patient group (AU)
Subject(s)
Humans , Male , Female , Aged , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/therapy , Catheter Ablation/methods , Catheter Ablation/trends , Quality of Life , Cardiomyopathy, Dilated/epidemiology , Myocardial Ischemia/epidemiology , Electrophysiology/methods , Comorbidity , Spain/epidemiologyABSTRACT
El desarrollo tecnológico del desfibrilador automático implantable y la evidencia acumulada por sucesivos ensayos clínicos han dado lugar a que las indicaciones de estos dispositivos hayan tenido un crecimiento exponencial. Sin embargo, España es uno de los países desarrollados con menor crecimiento y menor número de implantes por millón de habitantes. Además de las diferencias con otros países, existe una significativa variabilidad en las indicaciones entre las distintas comunidades autónomas. Son necesarios estudios encaminados a mejorar la estratificación de riesgo de muerte súbita en pacientes con cardiopatía que permita una mejor selección de candidatos, una mejor relación coste-efectividad en algunas indicaciones y una mayor coherencia en las recomendaciones de implante en las distintas guías de práctica clínica. Al mismo tiempo, es necesario un mayor número de unidades de arritmias con mejor dotación de recursos humanos y técnicos para dar respuesta, junto con el constante desarrollo tecnológico en este campo, a un crecimiento en el número de indicaciones y terapias concomitantes y reducir la importante variabilidad geográfica (AU)
Technical improvements in automatic implantable defibrillators (AID) and accumulating data from a series of clinical trials have led to an exponential increase in indications for these devices. However, among developed countries, Spain has seen one of the weakest levels of growth in their use and has a low rate of implants per million inhabitants. In addition to this difference from other countries, there are significant variations in indications for these devices between the different Spanish regions. There is a need for studies specifically designed to find a better way of stratifying the risk of sudden death in patients with heart disease to ensure more appropriate candidate selection, to improve cost-effectiveness in some indications, and to provide greater consistency between the various clinical practice guidelines on recommendations for device implantation. In parallel, there is also a need for more arrhythmia units and for increased human and technical resources for these units to enable them to respond both to ongoing technological developments in the field and to the growing number of indications and concomitant treatments and to reduce the substantial geographical variability in device implantation (AU)
Subject(s)
Humans , Electric Countershock/methods , Defibrillators, Implantable , Death, Sudden, Cardiac/prevention & control , Tachycardia/therapy , Arrhythmias, Cardiac/therapy , Patient SelectionABSTRACT
BACKGROUND AND OBJECTIVE: It has been estimated that up to 12% of patients with acute myocardial infarction do not present coronary atherosclerotic disease demonstrable with angiographic studies. We assessed the clinical characteristics and prognosis of acute coronary syndrome without ST-segment elevation with angiographically normal coronary arteries. PATIENTS AND METHOD: Comparative retrospective analysis of 58 consecutive patients with this diagnosis and a sample (n = 59) with lesions in angiographic studies, analyzing demographic characteristics, analytical parameters, electrocardiogram, ventricular function and prognosis. RESULTS: The group represented 19% of the totality of acute coronary syndromes, showing a lower prevalence rates of hypercholesterolemia, diabetes mellitus and no record of ischemic heart disease (p = 0.043 to p = 0.005). The presence of regional wall motion abnormalities was significantly higher in the group with angiographic lesions (76.3% vs 41.4%; p < 0.01). In-hospital mortality rate showed a non significant trend toward to be lower in the group with normal angiogram (1.7% vs 8.4%). CONCLUSIONS: The absence of significant coronary artery disease in acute coronary syndrome without ST-segment elevation is not infrequent and was related to a lower cardiovascular risk profile and the absence of regional wall motion abnormalities showing a trend toward better in-hospital prognosis.
Subject(s)
Acute Coronary Syndrome , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/mortality , Adult , Aged , Aged, 80 and over , Angina, Unstable/diagnosis , Confidence Intervals , Coronary Angiography , Electrocardiography , Female , Hospital Mortality , Humans , Logistic Models , Male , Middle Aged , Myocardial Infarction/diagnosis , Odds Ratio , Prevalence , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION AND OBJECTIVES: This article presents the 2007 findings of the Spanish Implantable Cardioverter-Defibrillator (ICD) Registry, established by the Working Group on Implantable Cardioverter-Defibrillators, Electrophysiology and Arrhythmia Section, Spanish Society of Cardiology. METHODS: The Spanish Society of Cardiology received prospective data recorded on a single-page questionnaire on 96.6% of device implantations. RESULTS: Overall, 3,291 implantations were reported (90.1% of the estimated total). The reported implantation rate was 72.8 per million inhabitants, and 77.1% were first implantations. The majority of ICDs were implanted in males (mean age, 61 [12] years) in functional class II with severe or moderate-to-severe left ventricular dysfunction. The most frequent form of heart disease was ischemic heart disease, followed by dilated cardiomyopathy. Indications for primary prevention remained unchanged relative to the previous year and now account for half of all first implantations, with an increasing number of patients with dilated cardiomyopathy. The number of ICDs incorporating cardiac resynchronization therapy has increased slightly and now comprises 30.1% of the total. Around 70% of ICD implantations were performed in an electrophysiology laboratory by a cardiac electrophysiologist. The incidence of complications was very low. CONCLUSIONS: The 2007 Spanish Implantable Cardioverter-Defibrillator Registry contains data on more than 90% of all ICD implantations performed in Spain, thereby confirming that it has become increasingly representative in recent years. The number of implantations has continued to grow, though the proportion carried out for primary prevention has stabilized at around 50%.
Subject(s)
Arrhythmias, Cardiac/therapy , Defibrillators, Implantable/statistics & numerical data , Registries , Adolescent , Adult , Aged , Aged, 80 and over , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/prevention & control , Child , Child, Preschool , Defibrillators, Implantable/adverse effects , Female , Humans , Male , Middle Aged , Prosthesis Implantation/statistics & numerical data , Prosthesis Implantation/trends , Spain/epidemiology , Treatment Outcome , Young AdultABSTRACT
FUNDAMENTO Y OBJETIVO: Se ha estimado que hasta el 12%de los pacientes con infarto de miocardio no presentaenfermedad arteriosclerótica demostrable mediante coronariografía.El objetivo de este estudio ha sido analizarlas características clínicas y el pronóstico de los pacientescon síndrome coronario agudo sin elevación del segmentoST que no presentan lesiones coronarias.PACIENTES Y MÉTODO: Se ha realizado un análisis retrospectivode 58 pacientes consecutivos con este diagnóstico,a quienes se comparó con una muestra (n = 59) quepresentaba lesiones angiográficas. Se valoraron las característicasdemográficas, parámetros analíticos, electrocardiograma,función ventricular y pronóstico.RESULTADOS: El grupo estudiado representó el 19% de loscasos de síndrome coronario y mostró una prevalenciamenor de dislipemia, diabetes e historia de cardiopatíaisquémica (p = 0,043 a p = 0,005). La presencia de alteracionessegmentarias de la contractilidad fue mayoren el grupo de pacientes con lesiones coronarias (un76,3 frente a un 41,4%; p < 0,01). La mortalidad intrahospitalariamostró una tendencia no significativa a sermenor en el grupo sin lesiones (el 1,7 frente al 8,4%).CONCLUSIONES: La ausencia de lesiones coronarias significativasen el síndrome coronario agudo sin elevación delsegmento ST no es infrecuente. Se relaciona con un perfilde riesgo cardiovascular menor y con la ausencia dealteraciones segmentarias de la contractilidad, y muestrauna tendencia a un mejor pronóstico intrahospitalario
BACKGROUND AND OBJECTIVE: It has been estimated that upto 12% of patients with acute myocardial infarction donot present coronary atherosclerotic disease demonstrablewith angiographic studies. We assessed the clinicalcharacteristics and prognosis of acute coronary syndromewithout ST-segment elevation with angiographicallynormal coronary arteries.PATIENTS AND METHOD: Comparative retrospective analysisof 58 consecutive patients with this diagnosis and a sample(n = 59) with lesions in angiographic studies, analyzingdemographic characteristics, analytical parameters,electrocardiogram, ventricular function and prognosis.RESULTS: The group represented 19% of the totality ofacute coronary syndromes, showing a lower prevalencerates of hypercholesterolemia, diabetes mellitus andno record of ischemic heart disease (p = 0.043 top = 0.005). The presence of regional wall motion abnormalitieswas significantly higher in the group with angiographiclesions (76.3% vs 41.4%; p < 0.01). In-hospital mortalityrate showed a non significant trend toward to belower in the group with normal angiogram (1.7% vs 8.4%).CONCLUSIONS: The absence of significant coronary arterydisease in acute coronary syndrome without ST-segmentelevation is not infrequent and was related to a lowercardiovascular risk profile and the absence of regionalwall motion abnormalities showing a trend toward betterin-hospital prognosis
Subject(s)
Humans , Myocardial Infarction/epidemiology , Myocardial Infarction/complications , Electrocardiography , Angina, Unstable/epidemiology , Risk Factors , Risk Adjustment , PrognosisABSTRACT
Los pacientes con desfibrilador automático implantable (DAI) constituyen una población en riesgo de presentar alteraciones psicológicas y una peor calidad de vida. Sin embargo, datos derivados de la mayoría de los grandes ensayos clínicos aleatorios con DAI ponen de manifiesto que el efecto del dispositivo sobre la calidad de vida es beneficioso o neutro. El principal predictor de empeoramiento de la calidad de vida y ajuste psicológico al DAI, tras el implante, es el número de descargas del dispositivo. Otros predictores son la juventud, los antecedentes de trastornos de ansiedad o depresión, y el escaso apoyo social o familiar. En la mayor parte de los estudios se han realizado evaluaciones de la calidad de vida a corto plazo y se desconoce si ésta puede cambiar a más largo plazo. Además, hay menos información sobre la calidad de vida en pacientes con indicación de DAI como prevención primaria. Disponemos de diversos recursos para ayudar al paciente en el proceso de adaptación a la vida con DAI. Una adecuada programación de los criterios de detección y las terapias de estimulación antitaquicardia reducirá significativamente el número de descargas y hará menos probable el deterioro de la calidad de vida. En pacientes que han experimentado una reducción en ésta tras el implante de DAI, diversas terapias psicológicas, tanto farmacológicas como de intervención psicoterapéutica, han demostrado ser eficaces en la mejoría de la calidad de vida (AU)
Patients with an implantable cardioverter-defibrillator (ICD) form a population that is at an increased risk of presenting with a psychological disorder or a poor quality of life. However, most large randomized clinical studies demonstrate that ICD use leads to a normal or improved quality of life. The main predictor of a poor quality of life and of psychological disturbance after ICD implantation is the frequency of device firing. Other predictors are young age, a history of anxiety or depression, and poor family or social support. The majority of studies have evaluated quality of life over only the short term, and it is not known whether it could change over the long term. In addition, few data are available on the quality of life of patients using an ICD for primary prevention. A range of resources are available for helping patients adapt to life with an ICD. Accurate programming of the parameters for tachycardia detection and antitachycardia pacing therapy significantly reduces the number of ICD discharges and makes a deterioration in quality of life less likely. A range of psychological therapies, involving drugs as well as psychotherapeutic interventions, have proven effective in improving the quality of life of patients who have experienced a decline after device implantation (AU)
Subject(s)
Humans , Defibrillators, Implantable/psychology , Defibrillators, Implantable , Quality of Life/psychology , Psychopathology/methods , Anti-Arrhythmia Agents/therapeutic use , Tachycardia, Ventricular/drug therapy , Arrhythmias, Cardiac/drug therapy , Secondary Prevention/methods , Sexuality/psychology , Leisure Activities/psychologySubject(s)
Syncope/physiopathology , Heart Diseases/complications , Humans , Prognosis , Risk Assessment , Syncope/etiologyABSTRACT
No disponible
