Timing of Ablation and Prognosis of Patients With Electrical Storm and Scar-Related Left Ventricular Dysfunction.

Although radiofrequency catheter ablation (RFCA) is indicated in electrical storm (ES) refractory to antiarrhythmic drugs, its most appropriate timing has not been determined. Our objective is to analyse the impact of the timing of RFCA on 30-day mortality in patients with ES and previous scar-related systolic dysfunction. In this multi-centre study, we analysed 104 patients (age: 72 ± 10, left ventricular ejection fraction: 30 ± 6%) attended consecutively due to an ES caused by monomorphic ventricular tachycardia. Sixty-four subjects were treated with RFCA (mean time from admission = 83 ± 67 hours) and 40 were not. Upon admission 25 (24%) individuals had severe heart failure. Mortality rate at 30 days was 24 (23%) patients. RFCA was associated with a reduction of 30-day mortality (hazard ratio = 0.2; p = 0.008). After showing a positive correlation between the time of the RFCA (hours) and survival at 30 days (C-statistic = 0.77; p <0.001), we found that only subjects ablated >48 hours after admission had lower mortality at 30 days than those treated conservatively: 38% (no RFCA) versus 30% (RFCA ≤48 hours) versus 7% (RFCA >48 hours) (adjusted hazard ratio for RFCA >48 hours vs others = 0.2; p = 0.007). Among the patients ablated, those who were non-inducible had lower 30-day mortality: 8% versus 29% (p = 0.03). Extracorporeal membrane oxygenation was associated with a higher rate of non-inducibility in RFCA >48 hours (100% vs 76%; p = 0.03), but not in RFCA ≤48 hours (60% vs 60%; p = 1). In conclusion, among high-risk patients with ES, RFCA performed >48 hours after admission is associated with a reduction in 30-day mortality. In such subjects, the probability of successful RFCA increases when performed under extracorporeal membrane oxygenation support.

Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols.

AIMS: To assess in young athletes (i) the variability in the percentage of abnormal electrocardiograms (ECGs) using different criteria and (ii) the variability in ECG interpretation among cardiologists and sport physicians. METHODS AND RESULTS: Electrocardiograms of 138 athletes were categorized by seven cardiologists according to the original European Society of Cardiology (ESC) criteria by Corrado (C), subsequently modified by Uberoi (U), Marek (M), and the Seattle criteria (S); seven sports physicians only used S criteria. The percentage of abnormal ECGs for each physician was calculated and the percentage of complete agreement was assessed. For cardiologists, the median percentage of abnormal ECGs was 14% [interquartile range (IQR) 12.5-20%] for C, 11% (IQR 9.5-12.5%) for U [not significant (NS) compared with C], 11% (IQR 10-13%) for M (NS compared with C), and 7% (IQR 5-8%) for S (P < 0.005 compared with C); complete agreement in interpretation was 64.5% for C, 76% for U (P < 0.05 compared with C), 74% for M (NS compared with C), and 84% for S (P < 0.0005 compared with C). Sport physicians classified a median of 7% (IQR 7-11%) of ECGs as abnormal by S (P = NS compared with cardiologists using S); complete agreement was 72% (P < 0.05 compared with cardiologists using S). CONCLUSION: Seattle criteria reduced the number of abnormal ECGs in athletes and increased agreement in classification. However, variability in ECG interpretation by cardiologists and sport physicians remains high and is a limitation for ECG-based screening programs.

Diferencias en la calidad de vida en pacientes conflutter auricular típico sometidos a ablación del istmo cavotricuspídeo / Quality of Life Differences in Patients With Typical Atrial Flutter Following Cavotricuspid Isthmus Ablation

Introducción y objetivos El propósito de nuestro trabajo es evaluar y cuantificar los cambios en la calidad de vida (CVRS) en pacientes con flutter auricular típico sometidos a ablación con catéter de radiofrecuencia, estandarizados y normalizados para la población española ajustada por edad y sexo.MétodosHemos analizado a 95 pacientes consecutivos sometidos a ablación del istmo cavotricuspídeo que se han autoaplicado el cuestionario SF-36 antes del procedimiento y al cabo de 1 año de seguimiento. Hemos utilizado nuevas herramientas de medida de CVRS como son el tamaño de efecto y la media de respuesta estandarizada para cuantificar la magnitud del cambio y las diferencias mínimas clínicamente importantes para valorar si los cambios en la CVRS han sido percibidos clínicamente por el paciente.ResultadosDe los 95 pacientes inicialmente incluidos, 88 completaron el estudio. Se observó una magnitud de cambio grande (tamaño del efecto ≥ 0,8) en las dimensiones función física, rol físico, salud general, vitalidad y componente sumario físico, y una magnitud de cambio moderada (tamaño del efecto ≥ 0,5), en las dimensiones rol emocional, actividad social, salud mental y componente sumario mental. En el análisis de las diferencias mínimas clínicamente importantes, se observó que en todas las dimensiones, excepto dolor corporal y actividad social, se supera el mínimo exigido para que la magnitud del cambio sea percibida clínicamente por el paciente.ConclusionesSe observa una mejora en la CVRS de un grupo de pacientes con flutter auricular típico sometidos a ablación del istmo cavotricuspídeo después de 1 año del procedimiento (AU)

Introduction and objectives The aim of the study was to assess and measure health-related quality of life (HRQoL) changes in patients with typical atrial flutter following catheter ablation. The outcome was standardized and normalized to the Spanish population adjusted by age and sex.MethodsNinety-five consecutive patients who had undergone cavotricuspid isthmus ablation were included. The SF-36 questionnaire was self-administered before the procedure and at 1-year follow-up. We used the effect size and the standardized response mean as measures of responsiveness to quantify the change in HRQoL and the minimum clinically important difference to assess the smallest difference in score that patients perceived as beneficial.ResultsOf the 95 patients initially included, 88 completed the 1-year follow-up. We observed a large improvement (effect size ≥0.8) on the physical functioning, role-physical, general health, and vitality scales and on the physical component summary. We detected a moderate improvement (effect size ≥0.5) on the role-emotional, social functioning, and mental health scales and on the mental component summary. On all scales except bodily pain and social activity, the improvement was clinically perceived by patients.ConclusionsA clinically significant improvement in HRQoL measures was found in patients with typical atrial flutter who underwent cavotricuspid isthmus catheter ablation (AU)

[Quality of life differences in patients with typical atrial flutter following cavotricuspid isthmus ablation]. / Diferencias en la calidad de vida en pacientes con flutter auricular típico sometidos a ablación del istmo cavotricuspídeo.

INTRODUCTION AND OBJECTIVES: The aim of the study was to assess and measure health-related quality of life (HRQoL) changes in patients with typical atrial flutter following catheter ablation. The outcome was standardized and normalized to the Spanish population adjusted by age and sex. METHODS: Ninety-five consecutive patients who had undergone cavotricuspid isthmus ablation were included. The SF-36 questionnaire was self-administered before the procedure and at 1-year follow-up. We used the effect size and the standardized response mean as measures of responsiveness to quantify the change in HRQoL and the minimum clinically important difference to assess the smallest difference in score that patients perceived as beneficial. RESULTS: Of the 95 patients initially included, 88 completed the 1-year follow-up. We observed a large improvement (effect size ≥0.8) on the physical functioning, role-physical , general health, and vitality scales and on the physical component summary. We detected a moderate improvement (effect size ≥0.5) on the role-emotional, social functioning, and mental health scales and on the mental component summary. On all scales except bodily pain and social activity, the improvement was clinically perceived by patients. CONCLUSIONS: A clinically significant improvement in HRQoL measures was found in patients with typical atrial flutter who underwent cavotricuspid isthmus catheter ablation.