1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil and Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, and Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas and Case Western Reserve University, Cleveland, Ohio and Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, USA
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Merino JL, García E, Varillas-Delgado D, Domínguez P, Paraíso V. Answer to the article: Transonic® and DMed NephroFlow® vascular access flow measurements are not interchangeable. J Vasc Access 2023:11297298231160194. [PMID: 37083116 DOI: 10.1177/11297298231160194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Jose Luis Merino
- Sección Nefrología, Hospital Univ del Henares, Coslada, Madrid, Spain
| | - Esther García
- Sección Nefrología, Hospital Univ del Henares, Coslada, Madrid, Spain
| | | | | | - Vicente Paraíso
- Sección Nefrología, Hospital Univ del Henares, Coslada, Madrid, Spain
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Rivero-Santana B, Jurado-Roman A, Jimenez-Valero S, Galeote G, Moreno R, Merino JL. Chronic Total Occlusion Techniques to Recanalize an Occluded Pulmonary Vein After Atrial Fibrillation Ablation. J Invasive Cardiol 2023; 35:E223-E224. [PMID: 37029998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Cardiac computed tomography (CT) scan was performed in a 69-year-old male with atrial fibrillation radiofrequency ablation who was admitted for transcatheter angioplasty of left inferior pulmonary vein (LIPV) stenosis due to recurrent hemoptysis. CT showed complete ostial occlusion in the area of the LIPV. Occlusion of the pulmonary vein ostium is a rare complication. We describe the successful use of chronic occlusion techniques in the treatment of this patient.
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Merino JL, Kim S, Relan J, Castrejon Castrejon S, Sanroman M, Escobar Cervantes C, Martinez Cossiani M, Carton A. Quantifying the variability of bipolar voltage amplitude with sensing angle in residual conduction isthmuses in atrial scar. Europace 2022. [DOI: 10.1093/europace/euac053.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
The angle between the activation wavefront and bipole may conceal the conduction isthmus in conventional bipolar voltage mapping, but the extent of variability of electrogram (EGM) voltage amplitude with directional changes has not been quantified.
Purpose
Using a well-defined model of discrete atrial conduction, we sought to use Omnipolar Technology (OT) to assess variability of voltage amplitude as a function of sensing angle, in sites of residual conduction and scar tissue.
Methods
During redo pulmonary vein isolation (PVI) procedures, baseline voltage maps were acquired during coronary sinus pacing (500 ms) using a rectangular 16-pole catheter (HD Grid). During retrospective analysis with OT research software, all EGM’s ≤1 cm radius from the site of PVI were classified as GAP (vs No-GAP; Panel A) The variability of voltage amplitude (OT-ΔV) with sensing angle (θ) was computed as the difference between the maximum and minimum voltages (OT-Vmax - OT-Vmin), in both GAP and No-GAP subregions (Panels A & B).
Results
23 GAP sites were identified in 12 of 15 consecutive patients studied. 3464 EGM’s (1386 GAP vs 2078 No-GAP) were analyzed. Global mean OT-ΔV was 0.46±0.80 mV. GAP regions showed significantly (P<0.0001) higher OT-ΔV as compared with No-GAP regions (0.80±1.03 mV vs 0.24±0.47 mV respectively; Panel C) The mean Δθ angle for OT-ΔV was similar in both GAP and No-GAP regions (88.6±11.3° vs 88.0±13.6°, P=0.1; Panel D).
Conclusion
The variability of voltage amplitude as a function of bipole orientation can be significant, especially in GAP regions (0.80±1.03 mV). (2) OT-ΔV holds promise for identification of residual conduction within atrial scar tissue.
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Affiliation(s)
- JL Merino
- La Paz University Hospital, Madrid, Spain
| | - S Kim
- Abbott, New York City, United States of America
| | - J Relan
- Abbott, Minneapolis, United States of America
| | | | | | | | | | - A Carton
- La Paz University Hospital, Madrid, Spain
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Merino JL, Kim S, Relan J, Sanroman M, Castrejon S, Carton A, Cervantes C, Martinez Cossiani M, De La Vieja Alarcon JJ, Molina P, Rivero Santana B. Influence of atrial cycle length and site of origin on the peak frequency of bipolar electrograms to discriminate isthmus conduction in atrial scar. Europace 2022. [DOI: 10.1093/europace/euac053.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
Peak frequency (PF) of conventional bipolar electrograms is a novel parameter which may distinguish between near-field (NF) and far-field (FF) signals. However, the influence of activation rate and the direction of the activation front on it is unknown.
Purpose
1. To study the influence of atrial cycle length and wavefront origin on PF to detect residual conduction in a well-defined model of narrow isthmus of conduction such as subacute pulmonary vein (PV) reconnection following atrial fibrillation ablation. 2. To compare this influence with that found for Bipolar voltage (BiV).
Methods
Baseline maps were acquired in redo PV isolation (PVI) procedures with a 16-pole grid catheter (HD-Grid) during low rate sinus rhythm (SR), low rate coronary sinus pacing at 500 ms cycle length (CSLR) and high rate coronary sinus pacing at 300 ms cycle length (CSHR). PFs were retrospectively computed. PVI sites requiring ≤3 radiofrequency applications were included, with EGMʼs ≤1cm from the PVI site classified as GAP (vs >1cm, No-GAP).
Results
28 GAPs were found in 12 of 14 consecutive patients in the study. 3976 EGMʼs (1547 GAP vs 2429 No-GAP) were analyzed. In both GAP and No-GAP, PF was similar in SR vs CSLR (GAP: 363±132 Hz -SR vs 345±135 Hz -CSLR, P=NS ; No-GAP: 196±110 Hz -SR vs 181±116 Hz -CSLR, P=NS). PF was slightly higher for CSLR vs CSHR. (GAP: 345±135 Hz -CSLR vs 317±154 Hz -CSHR, P<0.001; No-GAP 181±116 mV -CSLR vs 162±129 mV -CSHR, P<0.01). (Panel A). BiV was significantly higher in SR vs CS pacing but similar between CSLR and CSHR (GAP: 1.86±2.11 mV -SR vs 0.87±1.19 mV -CSLR vs 0.74±0.92 mV -CSHR, P= NS, No-GAP: 0.62±1.22 mV -SR vs 0.33±0.68 mV - CSLR vs 0.27±0.48 mV - CSHR, P=NS. (Panel B). ROC GAP discrimination for PF was similar between SR and CSLR (AUCʼs: 0.86-SR, 0.84-CSLR) and slightly lower for CSHR (AUC: 0.81) with optimal cutoffs of 260, 240 and 220 Hz, respectively. ROC GAP discrimination for BiV was lower vs PF in all rhythm modes (AUCʼs: 0.77-SR, 0.74-CSLR, 0.75-CSHR), with optimal cutoffs of 0.3, 0.2 and 0.15 mV, respectively.
Conclusion
ROC gap discrimination was significantly higher for all rhythm modes with PF vs BiV. PF showed slightly decreasing cutoff values for SR, CSLR and CSHR respectively, whereas BiV showed a greater relative decrease in cutoffs for SR, CSLR and CSHR.
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Affiliation(s)
- JL Merino
- La Paz University Hospital, Madrid, Spain
| | - S Kim
- Abbott, New York City, United States of America
| | - J Relan
- Abbott, Minneapolis, United States of America
| | | | | | - A Carton
- La Paz University Hospital, Madrid, Spain
| | | | | | | | - P Molina
- La Paz University Hospital, Madrid, Spain
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Castrejon Castrejon S, Rigual R, Fernandez-Gasso L, Martinez-Cossiani M, Garcia-Castro J, Ruiz-Ares G, Rodriguez-Pardo J, De Celis E, Casado L, Alonso De Lecinana M, Diez-Tejedor E, Perez-David E, Fuentes B, Lopez De Sa E, Merino JL. Atrial imaging and cardiac rhythm in cryptogenic embolic stroke: a preliminary analysis of the ARIES study. Europace 2022. [DOI: 10.1093/europace/euac053.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cryptogenic stroke is frequently related to cardioembolic source previously unknown. We aim to analyze atrial fibrillation (AF), parafibrilatory status (para-AF) and echocardiographic signs of atrial dysfunction in patients (p) with cryptogenic stroke.
Methods
Consecutive p with cryptogenic stroke were prospectively enrolled in the on-going study ARIES (Atrial Imaging and cardiac Rhythm In Embolic Stroke). Cardiologic work-up includes external wearable 2-lead ECG monitoring system for 30 days (non-AF, AF, para-AF defined as >3000 atrial ectopic beats/day or >2 "micro-AF" episodes (fibrillatory burst <30 s)/day) and advanced left atrial echocardiography (signs of atrial dysfunction as strain during three phases -reservoir, conduit, and contractile-). The first monitoring was started before hospital discharge, p without AF in the first monitoring and without extremely disabling neurologic sequelae underwent a further 30 days monitoring. We describe stroke recurrence at 90 days follow-up, and we compare echocardiographic signs of atrial dysfunction according to rhythm study.
Results
78 p completed follow-up (72±12 yo, 53% females). AF was diagnosed in 27 (34%) p: 22/78 (28%) in the first monitoring and 5/43 (12%) in the second one. para-AF was diagnosed in 22/51 (43%) non-AF p. Other arrhythmias: sustained (>30 s) focal atrial tachycardia documented in 4/51 (8%) non-AF p, AVNRT in 1/51 (2%) non-AF p, advanced AV block in 1/78 (1%) p. Worse left atrial mechanical properties were demonstrated in p with para-AF compared to non-AF p (reservoir strain 22.2±9.8 vs 32.8±12, p=0.004; conduit strain -9.6±4.8 vs -14.4±9, p=0.008; contractile strain 12.6±4.8 vs 17.9±7.8, p=0.025), without significative differences compared to AF p. There were three stroke recurrences (3.8%), 2/3 in para-AF p.
Conclusion
In this preliminary analysis, patients with cryptogenic stroke presented AF in 34% and para-AF in 28%. Para-AF patients show significative atrial dysfunction in echocardiography and more stroke recurrences. A longer follow-up is required to confirm these findings.
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Affiliation(s)
| | - R Rigual
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - L Fernandez-Gasso
- La Paz University Hospital, Cardiac Image Unit, Department of Cardiology., Madrid, Spain
| | - M Martinez-Cossiani
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - J Garcia-Castro
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - G Ruiz-Ares
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - J Rodriguez-Pardo
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - E De Celis
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - L Casado
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - M Alonso De Lecinana
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - E Diez-Tejedor
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - E Perez-David
- La Paz University Hospital, Cardiac Image Unit, Department of Cardiology., Madrid, Spain
| | - B Fuentes
- La Paz University Hospital, Department of Neurology and Stroke Center, Madrid, Spain
| | - E Lopez De Sa
- La Paz University Hospital, Department of Cardiology, Madrid, Spain
| | - JL Merino
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
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Merino JL, Kim S, Relan J, Sanroman M, Castrejon S, Cervantes C, De La Vieja Alarcon JJ, Martinez Cossiani M, Rivero Santana B, Carton A, Tauber Molina P. Validation of the peak frequency of bipolar electrograms for detection of residual conduction in atrial scar tissue. Europace 2022. [DOI: 10.1093/europace/euac053.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
Activation and voltage (Bi-V) maps (Panel A) based on conventional bipolar electrograms (EGMs) are influenced by both near-field (NF) and far-field (FF) EGM components. This represents a limitation in the accurate detection of residual conduction within regions of scar. Peak frequency (PF) EGM analysis may better distinguish NF from FF activation vs conventional detection methods. (Panels B & C)
Purpose
1. To validate the use of PF to detect residual conduction in a well-defined model of narrow isthmus of conduction such as subacute pulmonary vein (PV) reconnection following atrial fibrillation ablation. 2. To compare discrimination value of PF and conventional Bi-V to detect such isthmuses.
Methods
Bi-V and activation maps were acquired during redo PV isolation (PVI) procedures using a rectangular 16-pole catheter (HD-Grid). LA-PV conduction was assessed during coronary sinus (CS) pacing (500ms cycle length). Any conduction gap (GAP) site at which PVI was established using ≤3 focal radiofrequency applications was analyzed. (Panel A) EGMʼs ≤1cm from the site of PVI were classified as GAP (vs EGMʼs ≥1cm - No-Gap). (Panel B)
Results
28 GAPs were found in 12 of 14 consecutive patients in the study. 3,976 EGMʼs (1,547 GAP vs 2,429 No-GAP) were analyzed. GAP regions showed significantly higher PF than No-GAP regions (345 ±135 vs 181±116 Hz, P<0.0001) (Panel E). GAP regions also showed significantly higher BiV than No-GAP regions
(1.86±2.11 mV vs 0.62±1.22 mV, P<0.0001) (Panel D). ROC curves for GAP vs No-GAP discrimination were better for PF (AUC 0.84) than for Bi-V (AUC 0.74) with optimal cutoffs of 240 Hz and 0.2 mV, respectively. (Panel F)
Conclusion
PF better detects residual conduction within an atrial scar region than conventional Bi-V. The PF cutoff value for gap discrimination in the PV antra is 240 Hz.
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Affiliation(s)
- JL Merino
- La Paz University Hospital, Madrid, Spain
| | - S Kim
- Abbott, New York City, United States of America
| | - J Relan
- Abbott, Minneapolis, United States of America
| | | | | | | | | | | | | | - A Carton
- La Paz University Hospital, Madrid, Spain
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10
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Merino JL, Kim S, Sanroman M, Castrejon S, Relan J, De La Vieja Alarcon JJ, Martinez Cossiani M, Cervantes C, Carton A, Rivero Santana B, Tauber Molina P. Systematic identification of low voltage-high frequency electrogram zones at sites of left atrial reentrant tachycardia termination. Europace 2022. [DOI: 10.1093/europace/euac053.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
Localization of the narrow isthmus of conduction of left atrial local and macro reentrant tachycardia (LAMRT) circuits within scar tissue is challenging. (Panel A). Near-field (NF) electrograms are often obscured by and difficult to distinguish from far-field (FF) activation. The peak frequency (PF) associated with bipolar electrograms is a novel parameter which may distinguish between NF and FF signals. (Panel B). However, the potential value of PF for LAMRT ablation has never been evaluated.
Purpose
1) To quantify the percentage of LA surface with low voltage (LV) and NF signals. 2) To study the proportion of LAMRT ablation sites which were located within a LV-NF region or in the vicinity of it (<10 mm away).
Methods
LART bipolar voltage and activation maps were generated with a 16-pole grid catheter (HD-Grid) during tachycardia. (Panels A,B). PF maps were retrospectively computed (Panels C,D). LV zones were defined according to a cutoff <0.3mV. Four different PF cut-off values (>250, >300, >350 and >400 Hz) were assessed in the delineation of overlapping LV-NF regions. (Panel E)
Results
16 consecutive patients with 24 LAMRT’s targeted for ablation were prospectively enrolled. 21/24 LAMRT’s were terminated by radiofrequency application. (Panel F). The LV area represented 47.7±14% of the LA surface. The LV-NF area represented 8.2±6.2%, 5.2±5.4%, 3.4±7.4% and 3.3±4.1% of the LA surface by using 250, 300, 350, and 400 Hz PF cutoffs respectively. There were 2.1±1 (range 0-3), 0.9±0.8(range 0-3), 0.5±0.6 (range 0-2) and 0.5±0.6 (range 0-2) LV-NF areas per patient using 250, 300, 350 and 400 Hz PF cutoffs respectively. At the optimal PF cutoff > 250Hz and voltage < 0.3mV, the site of tachycardia termination by radiofrequency application was found inside of a LV-NF region in 13/21 LAMRTs (sensitivity 68.4%), and within 1cm of a LV-NF region in 19/21 LAMRTs (sensitivity 89.5%) respectively.
Conclusion
1. Left atrial reentry termination sites by radiofrequency application are often within or nearby LV-NF areas as identified by the PF and voltage analysis of bipolar electrograms. 2. Beyond conventional substrate mapping, the systematic identification of high frequency activity within the low voltage zone holds promise for rapid identification of isthmus conduction critical to LAMRTs.
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Affiliation(s)
- JL Merino
- La Paz University Hospital, Madrid, Spain
| | - S Kim
- Abbott, New York City, United States of America
| | | | | | - J Relan
- Abbott, Minneapolis, United States of America
| | | | | | | | - A Carton
- La Paz University Hospital, Madrid, Spain
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11
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Merino-Caviedes S, Gutierrez LK, Alfonso-Almazán JM, Sanz-Estébanez S, Cordero-Grande L, Quintanilla JG, Sánchez-González J, Marina-Breysse M, Galán-Arriola C, Enríquez-Vázquez D, Torres C, Pizarro G, Ibáñez B, Peinado R, Merino JL, Pérez-Villacastín J, Jalife J, López-Yunta M, Vázquez M, Aguado-Sierra J, González-Ferrer JJ, Pérez-Castellano N, Martín-Fernández M, Alberola-López C, Filgueiras-Rama D. Time-efficient three-dimensional transmural scar assessment provides relevant substrate characterization for ventricular tachycardia features and long-term recurrences in ischemic cardiomyopathy. Sci Rep 2021; 11:18722. [PMID: 34580343 PMCID: PMC8476552 DOI: 10.1038/s41598-021-97399-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection.
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Affiliation(s)
| | - Lilian K Gutierrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain
| | | | | | - Lucilio Cordero-Grande
- Universidad Politécnica de Madrid, Biomedical Image Technologies, ETSI Telecomunicación, Madrid, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Manuel Marina-Breysse
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Enríquez-Vázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Carlos Torres
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Hospital Ruber Juan Bravo Quironsalud UEM, Cardiology Department, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,IIS-University Hospital Fundación Jiménez Díaz, Cardiology Department, Madrid, Spain
| | - Rafael Peinado
- Hospital Universitario La Paz, Cardiology Department, Madrid, Spain
| | - Jose Luis Merino
- Hospital Universitario La Paz, Cardiology Department, Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Mariano Vázquez
- Barcelona Supercomputing Center (BSC), Barcelona, Spain.,ELEM Biotech SL., Barcelona, Spain
| | | | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | | | | | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Myocardial Pathophysiology Area, Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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12
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Tzeis S, Theuns DA, Earley M, Merino JL, Leclercq C. EHRA certification: a 15-year journey of attesting excellence in arrhythmia healthcare. Europace 2021; 24:175-178. [PMID: 34279581 DOI: 10.1093/europace/euab181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stylianos Tzeis
- Cardiology Department, Mitera Hospital, Hygeia Group, 6, Erithrou Stavrou, Maroussi, Athens 15123, Greece
| | | | | | - Jose Luis Merino
- Hospital Universitario La Paz, Idipaz, Universidad Autonoma, Madrid, Spain
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13
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Abstract
Funding Acknowledgements Type of funding sources: None. Cardiac arrhythmia seems to be a risk factor for mortality in coronavirus disease 2019 (COVID-19). However, the mechanisms, risk factors and outcomes of new arrhythmic events (NAEs) in this disease are unclear. Methods All patients with confirmed COVID-19 were retrospectively included in this single centre study. Patients who were alive and admitted <30 days before the database lock were excluded. Results 3416 consecutive patients were reviewed and 1476 finally enrolled (65.9 ± 20.9 years, 57.3% male). 76 (5.1%) patients had NAEs. Most of them were new atrial fibrillation episodes (48 patients, 3.2%), mostly seen in patients with no previous arrhythmia (38 patients, 79.2%). Atrial flutter (AFL) accounted for 20% of all NAEs. Ventricular arrhythmias were seen in 9 (0.6%) patients. Multivariable analysis showed that prior AFL, heart failure, dyslipidaemia, lopinavir/ritonavir, and combined hydroxychloroquine and azithromycin were independently associated with NAEs. 66 (86.8%) patients with NAEs died. The Kaplan-Meier analysis showed a lower survival of patients with NAEs (P < 0.001). Eight out of 9 (88.9%) and 41 out of 48 (85.4%) patients with ventricular arrhythmias and atrial fibrillation respectively died. Older age, male gender and NAEs were independently associated with death. NAEs and other outcomes, such as heart failure, thromboembolism, and bleeding independently predicted death. Conclusions NAEs are relatively uncommon in COVID-19 patients and mainly have an atrial mechanism. AFL is particularly frequent in this disease. The use of hydroxychloroquine, azithromycin and lopinavir/ritonavir, is associated with them, especially when used in combination. NAEs are independently and strongly associated with death.
Abstract Figure. ![]()
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Affiliation(s)
- JL Merino
- University Hospital La Paz, Madrid, Spain
| | - J Caro
- University Hospital La Paz, Madrid, Spain
| | - JR Rey
- University Hospital La Paz, Madrid, Spain
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14
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Merino JL, Kim S, Castrejon S, Relan J, Sanroman-Junquera M, Martinez-Cossiani M, Escobar C, Carton A. Characterization of conduction gaps at the pulmonary vein antra by omnipolar voltage mapping. Europace 2021. [DOI: 10.1093/europace/euab116.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott provided some software to perform special maps
Introduction
Voltage mapping of atrial tissue may be influenced by the direction of the activation front. Omnipolar electrograms may result in better characterization of the atrial tissue. However, little is known about characterization of the pulmonary vein (PV) antra with omnipolar mapping in patients with recurrent atrial fibrillation (AF) following PV isolation (PVI).
Purpose
To study differences in voltage between regions with (Gap) and without (No-Gap) conduction recurrence at the PV antra by both omnipolar and conventional bipolar mapping in redo PVI procedures.
Methods
Single centre prospective study of consecutive patients who underwent a redo PVI procedure for AF ablation. Activation and voltage bipolar maps were developed on a electroanatomical system (Ensite Precision) by a steerable catheter with a 16 grid-patterned electrode configuration (HD-Grid) during coronary sinus pacing at both 500 and 300 ms. Precise location of conduction gaps in the PV antra was attempted by atrial and PV pacing. Only conduction gaps that were ablated by ≤3 focal radiofrequency applications were included in the analysis. Electrograms recorded within 1 cm at both sides of the RF application site were considered related to the gap region. Off-line omnipolar voltage maps were developed with a dedicated experimental software after the procedure .
Results
11 patients were included in the study and 18 gaps were found in 9 patients. 6762 (2688 Gap and 4074 No-Gap) electrograms were analyzed. Compared with No-Gap PV regions, Gap regions showed significantly (P < 0.0001) higher voltages by omnipolar mapping (0.3 ± 0.6 mV vs 1.1 ± 1.4 mV) and by absolute (0.2 ± 0.5 mV vs 0.8 ± 1.2 mV), grid-along (0.3 ± 0.5 mV vs 0.8 ± 1.2 mV) and grid-across (0.3 ± 0.5 mV vs 0.8 ± 1.1 mV) bipolar mapping. Omnipolar mapping resulted in higher voltage electrograms when compared with absolute bipole, longitudinal and horizontal bipolar electrograms (P < 0.0001). ROC curves (figure) to differentiate between Gap and No-Gap regions were slightly better for omnipolar electrograms (AUC 0.79) than for conventional grid -along or grid-across bipolar mapping (AUC 0.76 and 0.77) with the best discrimination value of 0.3 and 0.2 mV respectively. Conclusion: There are significant differences in voltage between conduction Gap and No-Gap regions at the PV antra which are more apparent with omnipolar than with conventional bipolar mapping. 0.3 mV and 0.2 mV values are the best to differentiate between PV conduction Gap and No-Gap regions with ominpolar and conventional mapping respectively
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Affiliation(s)
- JL Merino
- University Hospital La Paz, Madrid, Spain
| | - S Kim
- Abbott, Sant Paul, Minessota, United States of America
| | | | - J Relan
- Abbott, Sant Paul, Minessota, United States of America
| | | | | | - C Escobar
- University Hospital La Paz, Madrid, Spain
| | - A Carton
- University Hospital La Paz, Madrid, Spain
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15
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Castrejon Castrejon S, Ruiz-Ares G, Martinez Cossiani M, Rigual R, Gutierrez Zuniga R, Alonso De Lecinana M, Tebar D, Fernandez Gasso L, Fuentes B, Merino JL. Incidence and type of arrhythmias recorded by one-month continuous ECG monitoring in stroke patients. Europace 2021. [DOI: 10.1093/europace/euab116.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
The incidence of atrial fibrillation (AF) following stroke has been studied with implantable loop recorders. However, these devices do not record short lasting AF episodes (<30-120 seconds [s]). In addition, the incidence and type of other clinically relevant arrhythmias is poorly understood in this clinical setting.
PURPOSE
To evaluate the incidence, type and clinical relevance of arrhythmias detected by one-month continuous ECG monitoring in patients after cryptogenic stroke.
MATERIAL AND METHODS
Consecutive patients (p) with stroke and no previous AF or other cardioembolic or atheroembolic causes were prospectively enrolled in the study. An external wearable 2-lead ECG monitoring system (NUUBO) was used for 30 days (d) in all of them after the acute phase of the stroke. In the absence of documented AF, a parafibrillatory status was defined as >3000 atrial ectopic beats/d or >2 "micro AF" episodes (fibrillatory burst <30 s)/d or ≥1 episode of "micro AF" >14 s.
RESULTS
130 p. were included in the study (age 73 ± 12, 57% males, 19% previous stroke, 7% ischemic cardiopathy, CHA2DSVA2Sc pre-stroke 3.1 ± 1.7). 3 were withdrawn from the study due to inadequate use (recording time <14 d) and 1 due to stroke during SARS-CoV2 infection. Total recording time was 28 ± 3 d, total analyzable ECG time was 23 ± 5 d. ECG monitoring was repeated in 12 (9.5%) p due to poor ECG quality in 6 p or high suspicion of AF despite an initial negative result in 6 p. AF >30 s was detected in a total of 27 (21.4%) p, average AF duration was 52 hours (range 30 s-22 d). AF >30s was detected in 2 (17%) p with repeated monitoring. All these patients were placed on anticoagulation. Sustained paroxysmal supraventricular tachycardia (SVT) was documented in 4 (4.4%) p without AF. All episodes of AF and SVT were asymptomatic. Mobitz I second degree AV block in 4 (3.2%) p. 3 (2.4%) p had a pacemaker implanted: 2 for severe sinus dysfunction and 1 for AV block. High-density ventricular ectopy (>3000/d) was present in 7 (6%) p and ≥1 episode of non-sustained ventricular tachycardia was detected in 26 (21%) p. A parafibrillatory status was identified in 27 (21%) p with no AF >30 s. At 1-year follow up 4/22 (18%) of patients with parafibrillatory status and 3/59 (5%) without parafibrillatory status suffered a new stroke (p = 0.08).
CONCLUSIONS
AF and other potentially relevant arrhythmias are frequent after stroke and easily detectable with one-month non-invasive continuous ECG monitoring. Patients with a parafibrillatory status could benefit from longer monitoring time to detect AF.
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Affiliation(s)
| | - G Ruiz-Ares
- University Hospital La Paz, Department of Neurology, Stroke Center, Madrid, Spain
| | - M Martinez Cossiani
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - R Rigual
- University Hospital La Paz, Department of Neurology, Stroke Center, Madrid, Spain
| | - R Gutierrez Zuniga
- University Hospital La Paz, Department of Neurology, Stroke Center, Madrid, Spain
| | - M Alonso De Lecinana
- University Hospital La Paz, Department of Neurology, Stroke Center, Madrid, Spain
| | - D Tebar
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - L Fernandez Gasso
- University Hospital La Paz, Cardiac Image Unit, Department of Cardiology, Madrid, Spain
| | - B Fuentes
- University Hospital La Paz, Department of Neurology, Stroke Center, Madrid, Spain
| | - JL Merino
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
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16
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Camm AJ, Blomstrom-Lundqvist C, Boriani G, Goette A, Kowey PR, Merino JL, Piccini JP, Saksena S, Reiffel JA. Antiarrhythmic Medication for Atrial Fibrillation (AIM-AF) study: A physician survey of antiarrhythmic drug (AAD) treatment practices and guideline adherence in the EU and USA. Europace 2021. [DOI: 10.1093/europace/euab116.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Sanofi
Introduction
The 2020 European Society of Cardiology and the 2019 USA (AHA/ACC/HRS) guidelines recommend the use of AADs for rhythm control in patients with symptomatic AF. This study sought to understand AAD treatment practices and adherence to guidelines across the EU and the USA.
Method
An online physician survey of cardiologists, cardiac electrophysiologists and interventional electrophysiologists (N = 569) was conducted in the USA, Germany, Italy and the UK. All respondents were actively treating ≥10 AF patients who received drug therapy and/or who had received or were referred for ablation. This extensively detailed survey explored questions on physician demographics, AF types, and drug treatment and ablation practices.
Results: Of the responses obtained
(1) Amiodarone was used frequently across co-morbidity categories (highest use in those with heart failure with reduced left ventricular ejection fraction [LVEF] [80%]), including in those in which it is not indicated for initial therapy (minimal or no structural heart disease: 26%). Other deviations from guideline recommendations, include: class 1C drugs were used with structural heart disease, including coronary artery disease (CAD) (average class 1C use in CAD-related comorbidities: 6%); sotalol was used with renal dysfunction (22%); and drugs such as sotalol and dofetilide were initiated out of hospital (56% and 17% of respondents, respectively). (2) Nonetheless, a majority of respondents (53%) considered guidelines as the most important non-patient factor in influencing their choice of AF management. (3) Rhythm control was selected more frequently as primary therapy for paroxysmal AF (PAF) (59% of patients) while rate control was used more often for persistent AF (53%). (4) For PAF, AADs were preferred as 1st line more often than ablation, especially if PAF was infrequent and mildly symptomatic (59% of respondents) while ablation was preferred more if frequent symptomatic PAF and for recurrent persistent AF. (5) Rhythm control (AAD or ablation) was chosen in notable numbers for asymptomatic AF and subclinical AF (AADs: 36% and 37%, respectively; ablation: 9% and 14%, respectively). (6) AAD use for those with a first or recurrent episodes of symptomatic AF was 60% or 47%, respectively. (7) Efficacy and safety were chosen as the most important considerations for choice of specific rhythm control therapy (49% and 33%, respectively), and reduction of mortality and cardiovascular hospitalisation (23%) were as important as maintaining sinus rhythm (26%) for rhythm therapy goals.
Conclusions
Although surveyed clinicians consider guidelines important, deviations in patient types and treatments chosen that compromise safety or were not indicated were common. Findings suggest a lack of understanding of the pharmacology and safe use of AADs, highlighting an important need for further education. Abstract Figure.
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Affiliation(s)
- AJ Camm
- St George’s University, London, United Kingdom of Great Britain & Northern Ireland
| | | | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - A Goette
- Saint Vincenz Hospital Paderborn, Paderborn, Germany
| | - PR Kowey
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, United States of America
| | - JL Merino
- La Paz University Hospital, Madrid, Spain
| | - JP Piccini
- Duke Clinical Research Institute, Durham, United States of America
| | - S Saksena
- Rutgers Robert Wood Johnson Medical School, Piscataway, United States of America
| | - JA Reiffel
- Columbia University, New York, United States of America
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Castillo Villegas D, Barril S, Giner J, Millan-Billi P, Rodrigo-Troyano A, Merino JL, Sibila O. Study of Diffuse Interstitial Lung Disease With the Analysis of Volatile Particles in Exhaled Air. Arch Bronconeumol 2021; 58:99-101. [PMID: 33867204 DOI: 10.1016/j.arbres.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Diego Castillo Villegas
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España.
| | - Silvia Barril
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España; Servicio de Neumología, Hospital Arnau de Vilanova, Lleida, España
| | - Jordi Giner
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España
| | - Paloma Millan-Billi
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España; Servicio de Neumología, Hospital Arnau de Vilanova, Lleida, España; Servicio de Neumologia, Hospital Germans Trias i Pujol, Badalona, España
| | - Ana Rodrigo-Troyano
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España; Servicio de Neumología, Hospital Arnau de Vilanova, Lleida, España; Servicio de Neumologia, Hospital Germans Trias i Pujol, Badalona, España; Servicio de Neumología, Hospital Son Espases, Palma de Mallorca, España
| | - Jose Luis Merino
- Electronic Systems Group, Universitat de les Illes Balears, Palma de Mallorca, España
| | - Oriol Sibila
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, España; Instituto del Tórax, Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, España
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18
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Goette A, Lip GY, Jin J, Heidbuchel H, Cohen AA, Ezekowitz M, Merino JL. Differences in Thromboembolic Complications Between Paroxysmal and Persistent Atrial Fibrillation Patients Following Electrical Cardioversion (From the ENSURE-AF Study). Am J Cardiol 2020; 131:27-32. [PMID: 32753268 DOI: 10.1016/j.amjcard.2020.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
Abstract
It is unclear if patients with paroxysmal atrial fibrillation (AF) and persistent AF have different outcomes following electrical cardioversion (ECV). ENSURE-AF-a multicenter, prospective, randomized, open-label, blinded-endpoint evaluation trial-compared once-daily edoxaban 60 mg with enoxaparin-warfarin in 2,199 subjects undergoing ECV of nonvalvular AF (NCT02072434). Patients received ≥3 weeks of proper anticoagulation or transesophageal echocardiogram before ECV paroxysmal AF was defined as AF with spontaneous conversion of duration of <7 days; persistent AF was defined as AF lasting ≥7 days without spontaneous conversion. Clinical characteristics and outcomes were compared between subjects based on type of AF present at baseline. In total, 415 subjects had paroxysmal AF; 1,777 had persistent AF. Patients with paroxysmal AF were older (65.8 ± 10.3 vs 63.9 ± 10.5, p = 0.001) with more hypertension (82.7% vs 77.2%, p = 0.01) versus persistent AF patients. Congestive heart failure was more common in persistent AF (46.7%) versus paroxysmal AF (31.3%, p <0.0001). CHA2DS2-VASc (score >2: 52.0% vs 49.5%, p = 0.4375) and prior myocardial infarction (6.5% vs 6.8%, p = 0.91) did not significantly differ between groups. After ECV, primary endpoint events were numerically higher in paroxysmal AF versus persistent AF (1.5% vs 0.6%, p = 0.0571), approaching statistical significance. Of note, myocardial infarction was observed in paroxysmal AF (n = 4 vs 0), whereas persistent AF was accompanied by stroke (n = 0 vs 5; p <0.05). In conclusion, patients with paroxysmal AF had more frequent major cardiovascular events than patients with persistent AF. Composite event rates were driven mainly by myocardial infarction in patients with paroxysmal AF and by stroke in those with persistent AF. Overall, the absolute number of events was low after ECV under anticoagulation.
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Castrejon Castrejon S, Martinez Cossiani M, Ortega Molina M, Escobar Cervantes C, Batlle M, Gonzalez Davia R, Lopez Sendon JL, Merino JL. 1246High-power and short-duration radiofrequency ablation for atrial fibrillation: feasibility, safety and one-year results. Europace 2020. [DOI: 10.1093/europace/euaa162.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
SEC-Bayer research project 2018, Spanish Society of Cardiology. Research project 2018, FIS, Insituto de Salud Carlos III.
OnBehalf
none
Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than cryoablation. In addition, it is associated with more oesophageal lesions. The aim of this study was to evaluate the feasibility, safety and 1-year efficacy of PVI by high power short duration (HPSD) PPRF in patients with atrial fibrillation (AF).
METHODS
PPRF around the PV was performed in 125 patients (P) distributed in two groups. Conventional PPRF with 30W/≤30 s under luminal oesophageal temperature monitoring was performed in the first 47 P (Group 1). 68 P were enrolled in the HPSD (Group 2). Power was set to 50 W and delivered to reach a predefined lesion index value (LSI≥5 or AI≥350) in the first 18 P (Group 2A). 30 P underwent PPRF with 60 W for 7-10 s (Group 2B) and the last 30 P underwent PPRF with 70W for 9 s (Group 2C). Oesophageal endoscopy was performed after ablation in all P.
RESULTS
17 (36%) P in Group 1 and 30 (38%) in Group 2 had persistent AF. PVI of all targeted veins was achieved in 96% and 100% of P in both groups (p = 0,6). Total RF time was 30 [27-42], 25[ 20-29], 16 [14-20] and 13 [11-16] in Groups 1, 2A, 2B and 2C respectively (p < 0.01). RF duration per target lesions was 12[9-17], 9[8-9] and 9[9-9] s in Groups 2A, 2B and 2C respectively (p < 0.001). First-pass PVI was achieved in 35% 56%, 57% and 85% of left PV circles (p < 0.001) and in 46%, 56%, 60% and 82% of right PV circles (p = 0.04) in groups 30W, 50W, 60W and 70W respectively. Reconnections occurred in 8% of PV circles in Group 1 and in 6.5% of PV circles in Group 2 (p = 0.8). Dormant conduction was tested with adenosine in Groups 2B and 2C and the incidence was 30% and 25% of PV circles respectively (p = 0.31). The carina was the most frequent location of conduction gaps, reconnections and dormant conduction in all groups. The incidence of oesophageal lesions was 28% in Group 1, 22% in Group 2A and 0% in groups 2B and 2C (p < 0.002). The 1-year efficacy (freedom from any atrial tachycardia recurrences >30 s) was 59% in Group 1, 88% in group 2A, 77% in group 2B and 87% in group 2C (p = 0.019).
CONCLUSIONS
PVI by HPSD PPRF is feasible and results in high 1-year efficacy in P with AF. This approach appears safe and associated with low incidence of oesophageal damage especially when short application time and 60 or 70W are used. However, this latter power setting is associated with slightly better 1-year efficacy than HPSD PPRF using 60W.
Abstract Figure. Recurrences of atrial arrhythmias (>30 s
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Affiliation(s)
| | - M Martinez Cossiani
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - M Ortega Molina
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - C Escobar Cervantes
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - M Batlle
- University Hospital del Henares, Service of Cardiology, Madrid, Spain
| | - R Gonzalez Davia
- University Hospital Infanta Cristina, Department of Cardiology, Parla, Spain
| | - J L Lopez Sendon
- University Hospital La Paz, Department of Cardiology, Madrid, Spain
| | - J L Merino
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
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20
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Fernández Lucas M, Ruíz-Roso G, Merino JL, Sánchez R, Bouarich H, Herrero JA, Muriel A, Zamora J, Collado A. Initiating renal replacement therapy through incremental haemodialysis: Protocol for a randomized multicentre clinical trial. Trials 2020; 21:206. [PMID: 32075665 PMCID: PMC7031943 DOI: 10.1186/s13063-020-4058-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/08/2020] [Indexed: 01/25/2023] Open
Abstract
Background Thrice-weekly haemodialysis is the usual dose when starting renal replacement therapy; however, this schedule is no longer appropriate since it does not consider residual renal function. Several reports have suggested the potential benefit of beginning haemodialysis less frequently and incrementally increasing the dose as the residual renal function decreases. However, all the data published so far are from observational studies. Thus, this clinical trial avoids any potential selection bias and will assess the possible benefits that have been observed in observational studies. Methods/design This report describes the study protocol of a randomized prospective multi-centre open-label clinical trial to evaluate whether starting renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than the standard thrice-weekly regimen. We also explore other clinical parameters, such as concentrations of uremic toxins, dialysis doses, control of anaemia, removal of medium-weight uremic toxins, nutritional status, quality of life, hospital admissions and mortality. Only incident haemodialysis patients who can maintain a urea clearance rate KrU ≥ 2.5 mL/min/1.73 m2 are eligible. Patient recruitment began on 1 January 2017 and will last for 2 years or until the required sample size has been recruited to ensure the established statistical power has been reached. The minimum follow-up period will be 1 year. Anuric patients with acute renal failure and patients who return to haemodialysis after a kidney transplant failure are excluded. It has been calculated that 44 patients should be recruited into each group to achieve a power of 80% in a two-sided comparison of means with a usual significance level of 0.05. A time-to-event analysis will estimate the probability of kidney function survival in both groups using the Kaplan–Meier method. Survival curves will be compared with log-rank tests. This survival analysis will be complemented with a proportional hazard model to estimate the hazard ratio of kidney function survival adjusted for any confounding factors. Analyses will be carried out in accordance with the intention-to-treat principle. Discussion The incremental initiation of dialysis may preserve residual renal function better than the conventional treatment, with similar or higher survival rates, as reported by observational studies. To our knowledge, this is the first clinical trial to evaluate whether initiating renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than beginning with the standard thrice-weekly regimen. Trial registration ClinicalTrials.gov, NCT03302546. Registered on 5 October 2017.
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Affiliation(s)
- M Fernández Lucas
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. .,Departamento de Medicina, Universidad de Alcala, Alcalá de Henares, Madrid, Spain.
| | - G Ruíz-Roso
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J L Merino
- Hospital Universitario del Henares, Madrid, Spain
| | - R Sánchez
- Hospital Universitario La Paz, Madrid, Spain
| | - H Bouarich
- Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - J A Herrero
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A Muriel
- Unidad de Bioestadística, H. U, Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Zamora
- Unidad de Bioestadística, H. U, Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A Collado
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Martinez Cossiani M, Castrejon S, Escobar C, Ortega M, Batlle M, Gonzalez Davia R, Gutierrez Larraya F, Lopez-Sendon JL, Merino JL. P1013Biannular atrial flutter: clinical and electrophysiological characterization by activation and entrainment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
re-entry mechanisms around mitral and tricuspid annuli are frequent causes of left and right atrial flutter (AFt) respectively in patients with ipsilateral atrial pathology. However, clinical and electrophysiological characteristics of other types of atrial re-entries that could involve both AV annuli are less known.
Purpose
characterize biannular atrial flutters.
Methods
4 patients with AFt were submitted for ablation (aged 30, 31, 58 and 61 yo; 2 females). All had a cardiac congenital disease with a prior surgical procedure: 3 atrial septal defects (ASD) with surgical repair and 1 with transposition of the great arteries (TGA) with Senning repair. The AFt had a cycle length (CL) of 290, 315, 330 y 340 ms respectively and 1:1 AV conduction in 3 of them. For the electrophysiological study, a multipolar catheter (20 or 24 poles) was placed in the right atrium (RA) in every patient, showing counterclockwise and clockwise activation in 1 and 3 patients, respectively. Coronary sinus (CS) activation was proximal to distal in one patient and distal to proximal in the other 2. No CS activation could be obtained in the patient with Senning repair.
Results
each AFt was mapped by entrainment from different sites of the RA, showing post-pacing intervals (PPI) similar to the CL of the AFt around the tricuspid annulus in all of them and also from proximal and distal CS in the 3 patients with ASD. Access to the native left atrium (LA) was achieved in the patient with Senning repair, showing PPIs around the mitral annulus that were similar to the LC of the tachycardia. In 2 patients the attempt to get to the LA through the interatrial septum (IAS) could not be achieved and was unattempted in the other one. Recordings and PPIs of the LA roof were obtained from the right branch of the pulmonary artery in 2 patients. Counterclockwise AFt and clockwise AFt by single biannular perimitrotricuspid rotation in 1 and 3 patients respectively. The AFt was ended and no reinduction was possible after radiofrequency application that achieved cavotricuspid isthmus block in all of the patients.
Conclusions
reentry around both AV annuli is possible as a single loop, counterclockwise or clockwise, of simultaneous rotation as a clinical mechanism of Aft. This type of AFt seems to be associated to absence or severe damage in the IAS.
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Affiliation(s)
| | | | - C Escobar
- University Hospital La Paz, Madrid, Spain
| | - M Ortega
- University Hospital La Paz, Madrid, Spain
| | - M Batlle
- University Hospital La Paz, Madrid, Spain
| | | | | | | | - J L Merino
- University Hospital La Paz, Madrid, Spain
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22
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Castrejon Castrejon S, Martinez Cossiani M, Ortega Molina M, Escobar Cervantes C, Froilan Torres C, Gonzalo Bada N, Diaz De La Torre M, Suarez Parga JM, Batlle M, Gonzalez Davia R, Lopez Sendon JL, Merino JL. 6122Pulmonary vein isolation by different setting of high-power short-duration radiofrequency application: feasibility, short term efficacy and safety in patients with atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than cryoballoon ablation. In addition, it is associated with more esophageal lesions. The aim of this study was to evaluate the feasibility and safety of PVI by high power short duration (HPSD) PPRF in patients with atrial fibrillation.
Methods
PPRF around the PVs was done in 125 consecutive patients distributed in two chronologically successive groups. Conventional PPRF with 30W for ≤30 s under luminal esophageal temperature monitoring was performed in the first 47 patients (Group 1). 68 patients were enrolled in the HPSD (Group 2). Power was set to 50 W and delivered to reach a predefined lesion index value (LSI ≥5 or Abl-I ≥350) in the first 18 patients (Group 2A). 30 patients underwent PPRF with 60W for 7–10 s (Group 2B) and the last 30 patients underwent PPRF with 70W for 9 s (Group 2C). Esophageal endoscopy was performed after ablation in all patients.
Results
PVI of all targeted veins was achieved in 96% and 100% of patients of groups 1 and 2 respectively (p=0.6). Total RF time was 30 [27–43], 25 [20–29], 16 [14–20] and 14 [11–16] min in groups 1, 2A and 2B and 2C respectively (p<0.001). RF was delivered for 12 [9–17] s vs 9 [8–9]s vs 9 [8–9] per application in groups 2 A, 2B and 2C respectively (p<0.001). Total number of RFa to completely isolate all PV was 105 [90–126] in group 2A, 113 [90–135] in group 2B and 94 [79–112] in group 2C (p=0.12).
First-pass PVI was achieved in 56%, 57% and 85% of left PV (p=0.038) and in 56%, 60% and 82% of right PV (p=0.13) in groups 50W, 60W and 70W respectively. The carina was the most frequent location of persistent conduction when first-pass failed. Reconnections occurred in 6%, 3% and 11% of left PV (p=0.6) and in 6%, 7% and 4% (p=0.63) of right PV in groups 50W, 60W and 70W respectively. Adenosine test was systematically used in groups 60W and 70W: the incidence of dormant conduction was 23% and 22% (p=0.9) in left PV and 20% and 22% (p=0.8) in right PV respectively.
The incidence of esophageal lesions was 28% in Group 1, 2% in Group 2A, and 0% in groups 2B and 2C (p<0.001). No other intraprocedural complications occurred in the high-power group.
Total RF time
Conclusions
PVI is feasible with HPSD PPRF in most patients using shorter total RF times. This approach appears associated with very low incidence esophageal damage than the conventional one, especially when 60W/70W and shorter application time are used.
Acknowledgement/Funding
Grant of the Spanish Society of Cardiology
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Affiliation(s)
| | - M Martinez Cossiani
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - M Ortega Molina
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - C Escobar Cervantes
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
| | - C Froilan Torres
- University Hospital La Paz, Gastroenterology Acute Unit, Madrid, Spain
| | - N Gonzalo Bada
- University Hospital La Paz, Gastroenterology Acute Unit, Madrid, Spain
| | | | - J M Suarez Parga
- University Hospital La Paz, Gastroenterology Acute Unit, Madrid, Spain
| | - M Batlle
- University Hospital del Henares, Service of Cardiology, Madrid, Spain
| | | | - J L Lopez Sendon
- University Hospital La Paz, Department of Cardiology, Madrid, Spain
| | - J L Merino
- Robotic Cardiac Electrophysiology Unit, University Hospital La Paz, Madrid, Spain
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23
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Goette A, Auricchio A, Boriani G, Braunschweig F, Terradellas JB, Burri H, Camm AJ, Crijns H, Dagres N, Deharo JC, Dobrev D, Hatala R, Hindricks G, Hohnloser SH, Leclercq C, Lewalter T, Lip GYH, Merino JL, Mont L, Prinzen F, Proclemer A, Pürerfellner H, Savelieva I, Schilling R, Steffel J, van Gelder IC, Zeppenfeld K, Zupan I, Heidbüchel H, Boveda S, Defaye P, Brignole M, Chun J, Guerra Ramos JM, Fauchier L, Svendsen JH, Traykov VB, Heinzel FR. EHRA White Paper: knowledge gaps in arrhythmia management—status 2019. Europace 2019; 21:993-994. [DOI: 10.1093/europace/euz055] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Clinicians accept that there are many unknowns when we make diagnostic and therapeutic decisions. Acceptance of uncertainty is essential for the pursuit of the profession: bedside decisions must often be made on the basis of incomplete evidence. Over the years, physicians sometimes even do not realize anymore which the fundamental gaps in our knowledge are. As clinical scientists, however, we have to halt and consider what we do not know yet, and how we can move forward addressing those unknowns. The European Heart Rhythm Association (EHRA) believes that scanning the field of arrhythmia / cardiac electrophysiology to identify knowledge gaps which are not yet the subject of organized research, should be undertaken on a regular basis. Such a review (White Paper) should concentrate on research which is feasible, realistic, and clinically relevant, and should not deal with futuristic aspirations. It fits with the EHRA mission that these White Papers should be shared on a global basis in order to foster collaborative and needed research which will ultimately lead to better care for our patients. The present EHRA White Paper summarizes knowledge gaps in the management of atrial fibrillation, ventricular tachycardia/sudden death and heart failure.
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Affiliation(s)
- Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Cardiology and Intensive Care Medicine, Am Busdorf 2, Paderborn, Germany
- Working Group Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Angelo Auricchio
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano (Ticino), Switzerland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - A John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | - Harry Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht UMC+, Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Dobromir Dobrev
- University Duisburg-Essen, Institute of Pharmacology, Essen, Germany
| | - Robert Hatala
- Department of Cardiology and Angiology, National Cardiovascular Institute, NUSCH, Bratislava, Slovak Republic
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | | | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Department of Cardiology, University of Bonn, Bonn, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jose Luis Merino
- Hospital Universitario La Paz, Arrhythmia and Robotic EP Unit, Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Frits Prinzen
- Department of Physiology, Maastricht University, Maastricht, Netherlands
| | | | - Helmut Pürerfellner
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Academic Teaching Hospital, Linz, Austria
| | - Irina Savelieva
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, London, UK
| | | | - Jan Steffel
- University Heart Center Zurich, Zurich, Switzerland
| | - Isabelle C van Gelder
- Department Of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (Lumc), Leiden, Netherlands
| | - Igor Zupan
- Department Of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - Hein Heidbüchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pascal Defaye
- CHU Hôpital Albert Michalon, Unité de Rythmologie Service De Cardiologie, FR-38043 Grenoble Cedex 09, France
| | - Michele Brignole
- Department of Cardiology, Ospedali Del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna (GE), Italy
| | - Jongi Chun
- CCB, Cardiology Department, Med. Klinik Iii, Markuskrankenhaus, Wilhelm Epstein Str. 4, DE-60431 Frankfurt, Germany
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Frank R Heinzel
- Charité University Medicine, Campus Virchow-Klinikum, Berlin, Germany
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Portoles J, Merino JL, Dura B, Paraiso V, Lopez-Sanchez P, Garcia E, Martinez A, Carrillo S, Serrano Salazar ML, Martin-Rodriguez L. SP508DEVELOPMENT, IMPLEMENTATION AND EFICACY OF A PROTOCOL FOR INTRAVENOUS CARBOXYMALTOSE IRON IN PERITONEAL DIALYSIS PATIENTS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - J L Merino
- Nephrology, HU del Henares, Madrid, Spain
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Cossiani M, Castrejon S, Montes De Oca R, Escobar C, Ortega M, Merino JL. P800Number of CTG repeats in myotonic dystrophy: a new risk factor of ventricular tachycardia? Europace 2018. [DOI: 10.1093/europace/euy015.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Cossiani
- University Hospital La Paz, Madrid, Spain
| | | | | | - C Escobar
- University Hospital La Paz, Madrid, Spain
| | - M Ortega
- University Hospital La Paz, Madrid, Spain
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
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Cossiani M, Figueroa J, Castrejon S, Montes De Oca R, Escobar C, Ortega M, Merino JL. P1164What is the optimal pacing amplitude to demonstrate vein-to-atrium block following pulmonary vein isolation? Europace 2018. [DOI: 10.1093/europace/euy015.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Cossiani
- University Hospital La Paz, Madrid, Spain
| | - J Figueroa
- University Hospital La Paz, Madrid, Spain
| | | | | | - C Escobar
- University Hospital La Paz, Madrid, Spain
| | - M Ortega
- University Hospital La Paz, Madrid, Spain
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
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Lip GYH, Merino JL, Banach M, Al-Saady N, Jin J, Merino M, Winters SM, Merkely B, Goette A. P1181Clinical factors related to successful or unsuccessful cardioversion in the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial. Europace 2018. [DOI: 10.1093/europace/euy015.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- GYH Lip
- University of Birmingham, Birmingham, United Kingdom
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
| | - M Banach
- Medical University of Lodz, Lodz, Poland
| | | | - J Jin
- Daiichi Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Merino
- Daiichi Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - B Merkely
- Semmelweis University, Budapest, Hungary
| | - A Goette
- St Vincenz-Hosp, Paderborn, Germany
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Lloret JL, James S, Trines S, Dehnavi RA, Merino JL, Raine D, Clappers N, Jones D, Pisapia A, Gora P. P367Early European experience with a magnetic sensor enabled contact force-sensing catheter. Europace 2018. [DOI: 10.1093/europace/euy015.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J L Lloret
- Clinique de l'Espérance, Mougins, France
| | - S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - S Trines
- Leiden University Medical Center, Leiden, Netherlands
| | - R A Dehnavi
- Leiden University Medical Center, Leiden, Netherlands
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
| | - D Raine
- John Radcliffe Hospital, Oxford, United Kingdom
| | - N Clappers
- University Medical Center Utrecht, Utrecht, Netherlands
| | - D Jones
- Harefield Hospital, London, United Kingdom
| | - A Pisapia
- St. Joseph Hospital of Marseille, Marseille, France
| | - P Gora
- Abbott, Minneapolis, United States of America
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Shafiek H, Fiorentino F, Merino JL, López C, Oliver A, Segura J, de Paul I, Sibila O, Agustí A, Cosío BG. Using the Electronic Nose to Identify Airway Infection during COPD Exacerbations. PLoS One 2015; 10:e0135199. [PMID: 26353114 PMCID: PMC4564204 DOI: 10.1371/journal.pone.0135199] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/18/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The electronic nose (e-nose) detects volatile organic compounds (VOCs) in exhaled air. We hypothesized that the exhaled VOCs print is different in stable vs. exacerbated patients with chronic obstructive pulmonary disease (COPD), particularly if the latter is associated with airway bacterial infection, and that the e-nose can distinguish them. METHODS Smell-prints of the bacteria most commonly involved in exacerbations of COPD (ECOPD) were identified in vitro. Subsequently, we tested our hypothesis in 93 patients with ECOPD, 19 of them with pneumonia, 50 with stable COPD and 30 healthy controls in a cross-sectional case-controlled study. Secondly, ECOPD patients were re-studied after 2 months if clinically stable. Exhaled air was collected within a Tedlar bag and processed by a Cynarose 320 e-nose. Breath-prints were analyzed by Linear Discriminant Analysis (LDA) with "One Out" technique and Sensor logic Relations (SLR). Sputum samples were collected for culture. RESULTS ECOPD with evidence of infection were significantly distinguishable from non-infected ECOPD (p = 0.018), with better accuracy when ECOPD was associated to pneumonia. The same patients with ECOPD were significantly distinguishable from stable COPD during follow-up (p = 0.018), unless the patient was colonized. Additionally, breath-prints from COPD patients were significantly distinguished from healthy controls. Various bacteria species were identified in culture but the e-nose was unable to identify accurately the bacteria smell-print in infected patients. CONCLUSION E-nose can identify ECOPD, especially if associated with airway bacterial infection or pneumonia.
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Affiliation(s)
- Hanaa Shafiek
- Department of Respiratory Medicine, Hospital Universitario Son Espases. IdISPa. Palma de Mallorca, Spain
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Federico Fiorentino
- Department of Respiratory Medicine, Hospital Universitario Son Espases. IdISPa. Palma de Mallorca, Spain
| | - Jose Luis Merino
- Electronic Systems Group, University of the Balearic Islands (GSE-UIB), Palma de Mallorca, Spain
| | - Carla López
- Department of Microbiology, Hospital Universitario Son Espases. IdISPa. Palma de Mallorca, Spain
| | - Antonio Oliver
- Department of Microbiology, Hospital Universitario Son Espases. IdISPa. Palma de Mallorca, Spain
| | - Jaume Segura
- Electronic Systems Group, University of the Balearic Islands (GSE-UIB), Palma de Mallorca, Spain
| | - Ivan de Paul
- Electronic Systems Group, University of the Balearic Islands (GSE-UIB), Palma de Mallorca, Spain
| | - Oriol Sibila
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Alvar Agustí
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases. IdISPa. Palma de Mallorca, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- * E-mail:
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Raatikainen MP, Arnar DO, Zeppenfeld K, Merino JL, Kuck KH, Hindricks G. Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association. Europace 2015; 17 Suppl 4:iv1-72. [DOI: 10.1093/europace/euv265] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ortega M, Castrejón Castrejón S, Luis Merino J, Gutiérrez-Larraya F. Mahaim-type accessory pathway and right bundle branch electroanatomic delineation. HeartRhythm Case Rep 2015; 1:266-267. [PMID: 28491565 PMCID: PMC5419413 DOI: 10.1016/j.hrcr.2015.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Toniolo M, Figueroa J, Castrejòn-Castrejòn S, Merino JL. Induction of tachycardia confined within a pulmonary vein by electrical cardioversion of atrial fibrillation: Is it proof of reentry? HeartRhythm Case Rep 2015; 1:225-228. [PMID: 28491554 PMCID: PMC5419328 DOI: 10.1016/j.hrcr.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Merino JL, Domínguez P, Bueno B, Caserta L, López J, Tofiño D, Pérez C, Amézquita Y, Espejo B, Gómez A, Paraiso V. SP633EFFECTIVENESS OF DIFFERENT INTERDIALYTIC CATHETER-LOCKING REGIMENS OF TUNNELLED CATHETERS FOR CHRONIC HEMODIALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Arroyo M, Merino JL, Espejo B, Bueno B, Amézquita Y, Domínguez P, Paraiso V. SP180TWO YEARS FOLLOW-UP OF ANTIPROTEINURIC EFFECT OF ADITTION OF EPLERENONE TO ACE INHIBITORS OR ARBS IN NO NEPHROTIC GLOMERULAR DISEASES. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv189.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Merino JL, Teruel JL, Fernández-Lucas M, Villafruela JJ, Bueno B, Gomis A, Paraíso V, Quereda C. Effects of a Single, High Oral Dose of 25-Hydroxycholecalciferol on the Mineral Metabolism Markers in Hemodialysis Patients. Ther Apher Dial 2015; 19:212-9. [DOI: 10.1111/1744-9987.12279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jose Luis Merino
- Section of Nephrology; Hospital Universitario del Henares; Madrid Spain
| | - Jose Luis Teruel
- Department of Nephrology; Hospital Universitario Ramón y Cajal; Madrid Spain
| | | | | | - Blanca Bueno
- Section of Nephrology; Hospital Universitario del Henares; Madrid Spain
| | - Antonio Gomis
- Department of Nephrology; Hospital Universitario Ramón y Cajal; Madrid Spain
| | - Vicente Paraíso
- Section of Nephrology; Hospital Universitario del Henares; Madrid Spain
| | - Carlos Quereda
- Department of Nephrology; Hospital Universitario Ramón y Cajal; Madrid Spain
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Plaza V, Crespo A, Giner J, Merino JL, Ramos-Barbón D, Mateus EF, Torrego A, Cosio BG, Agustí A, Sibila O. Inflammatory Asthma Phenotype Discrimination Using an Electronic Nose Breath Analyzer. J Investig Allergol Clin Immunol 2015; 25:431-437. [PMID: 26817140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with persistent asthma have different inflammatory phenotypes. The electronic nose is a new technology capable of distinguishing volatile organic compound (VOC) breath-prints in exhaled breath. The aim of the study was to investigate the capacity of electronic nose breath-print analysis to discriminate between different inflammatory asthma phenotypes (eosinophilic, neutrophilic, paucigranulocytic) determined by induced sputum in patients with persistent asthma. METHODS Fifty-two patients with persistent asthma were consecutively included in a cross-sectional proof-of-concept study. Inflammatory asthma phenotypes (eosinophilic, neutrophilic and paucigranulocytic) were recognized by inflammatory cell counts in induced sputum. VOC breath-prints were analyzed using the electronic nose Cyranose 320 and assessed by discriminant analysis on principal component reduction, resulting in cross-validated accuracy values. Receiver operating characteristic (ROC) curves were calculated. RESULTS VOC breath-prints were different in eosinophilic asthmatics compared with both neutrophilic asthmatics (accuracy 73%; P=.008; area under ROC, 0.92) and paucigranulocytic asthmatics (accuracy 74%; P=.004; area under ROC, 0.79). Likewise, neutrophilic and paucigranulocytic breath-prints were also different (accuracy 89%; P=.001; area under ROC, 0.88). CONCLUSION An electronic nose can discriminate inflammatory phenotypes in patients with persistent asthma in a regular clinical setting. ClinicalTrials.gov identifier: NCT02026336.
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34:2281-329. [PMID: 23801822 DOI: 10.1093/eurheartj/eht150] [Citation(s) in RCA: 1438] [Impact Index Per Article: 130.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Michele Brignole
- Department of Cardiology, Ospedali del Tigullio, Via Don Bobbio 25, IT-16033 Lavagna, (GE) Italy.
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Arribas F, Auricchio A, Wolpert C, Merkely B, Merino JL, Boriani G, van der Velde E, Camm J, Vardas P. The EHRA White Book. ACTA ACUST UNITED AC 2012; 14 Suppl 3:iii1-55. [DOI: 10.1093/europace/eus256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H, Gasparini M, Linde C, Morgado FB, Oto A, Sutton R, Trusz-Gluza M, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Funck-Brentano C, Filippatos G, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Priori SG, Blomström-Lundqvist C, Brignole M, Terradellas JB, Camm J, Castellano P, Cleland J, Farre J, Fromer M, Le Heuzey JY, Lip GYH, Merino JL, Montenero AS, Ritter P, Schalij MJ, Stellbrink C. [Guidelines for cardiac pacing and cardiac resynchronization therapy]. Rev Port Cardiol 2008; 27:639-687. [PMID: 18717216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece.
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Merino JL, Galeano C, Martins J, Pascual J, Teruel JL, Ortuño J. [Recurrence of p-ANCA positive vasculitis with lung hemorrhage in a patient on hemodialysis]. Nefrologia 2008; 28:457-460. [PMID: 18662156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Relapses of p-ANCA vasculitis during chronic dialysis treatment are infrequent. We report a patient with a pulmonary-renal syndrome and p-ANCA vasculitis who relapsed one year after starting hemodialysis treatment. Treatment with steroids and cyclosphosphamide successfully controlled the relapse, though cyclophosphamide had to be discontinued because of leucopenia. Clinical features of renal vasculitis, relapse after dialysis, the usefulness of ANCA titles as possible predictors and therapeutic options are discussed.
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Affiliation(s)
- J L Merino
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid.
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Peinado R, Gnoatto M, Merino JL, Oliver JM. Catheter ablation of multiple, surgically created, atrioventricular connections following Fontan Bjork procedure. Europace 2007; 9:848-50. [PMID: 17522080 DOI: 10.1093/europace/eum077] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An increased incidence of Wolff-Parkinson-White (WPW) syndrome with tricuspid atresia has been reported. Although atrioventricular accessory pathways may develop across suture lines after the Fontan-Björk procedure, the presence of multiple acquired accessory pathways has only been described rarely. We report on a case of a female with tricuspid atresia who underwent the Fontan operation at 5 years of age. One year later, she developed a WPW pattern. Narrow complex tachycardias started at the age of 18. An electrophysiological study revealed the presence of three accessory pathway connections at the surgical anastomosis level. All of them were successfully ablated and there were no recurrences.
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Affiliation(s)
- Rafael Peinado
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Paz, Universidad Autónoma, Paseo de la Castellana 261, 28046, Madrid, Spain.
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Merino JL, Cobo J, Innerarity J, Diz S, Quereda C. [The figure of Chief of Residents in the Residencing training: establishment and development in a Spanish hospital]. Rev Clin Esp 2007; 207:79-82. [PMID: 17397568 DOI: 10.1157/13100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Training qualified medical specialists is one of the great supports of the Spanish health care system. The teaching structure of the hospital is essential for the correct development of this training. The figure of the chief resident (CR) is widely developed in the USA and Canada, but not in our country. Including this figure in the teaching organigram of our hospital has meant one more advance in the search for improving our teaching capacity. In the following, we explain our experience during the introduction and later development of the figure of CR, stressing its theoretical functions, the notification mechanism, constitution of the Residents' Committee and later development of activities and tasks conducted. After three years, our experience is favorable, subject to modifications, but adaptable to the idiosyncrasy of each site.
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Affiliation(s)
- J L Merino
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
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Teruel JL, Alvarez Rangel LE, Fernández Lucas M, Merino JL, Liaño F, Rivera M, Marcén R, Ortuño J. [Control of the dialysis dose by ionic dialysance and bioimpedance]. Nefrologia 2007; 27:68-73. [PMID: 17402882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
INTRODUCTION The ionic dialysance monitor allows an automated measure of Kt in each dialysis session. Bioelectrical impedance analysis (BIA) determines the total body water which it is equivalent to the urea volume of distribution (V). If the Kt, determined by ionic dialysance, is divided by the V, estimated by bioelectrical impedance, a Kt/V at the end of dialysis session (Kt/VDiBi) is obtained. AIM OF THE STUDY To evaluate the agreement between the Kt/VDiBi and the Kt/V obtained by two simplified formulas: the monocompartimental (Kt/Vm) and the equilibrated (Kt/Ve) Daugirdas equations. METHODS The Kt/VDiBi, the Kt/Vm and the Kt/Ve were determined in 38 hemodialysis patients (27 males and 11 females) in the same hemodialysis session. The patients were on dialysis three times a week for 3.5 to 4 hours. The V was determined by monofrequency bioelectrical impedance (50 kHz) at the end of the dialysis session. RESULTS The Kt/VDiBi, Kt/Vm and Kt/Ve were 1.29+/-0.26, 1.54+/-0.29 and 1.36+/-0.25, respectively (p<0.001 between the Kt/VDiBi and the KtVm, and p<0.001 between the KtV/DiBi and the Kt/Ve). The intraclass correlation coefficient showed better concordance between the KtV/DiBi and the Kt/Ve (coefficient 0.88) than between the Kt/VDiBi and the KtVm (coefficient 0.65). The relative difference of the Kt/VDiBi was 8.3+/-6.4% with respect to the Kt/Ve and 18.4+/-7.8 % with respect to the Kt/Vm (p<0.001). The relative difference between the Kt/VDiBi and the Kt/Ve was lower than 15% in the 84% of the patients and lower than 10% in the 64% of the patients. CONCLUSIONS If the V obtained by bioelectrical impedance analysis is included in the ionic dialysance monitor, we can obtain a Kt/V for each patient in real time, which is similar to the equilibrated Kt/V obtained from the Daugirdas equation.
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Affiliation(s)
- J L Teruel
- Nefrología, Hospital Ramón y Cajal, Madrid.
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Caldés S, Merino JL, Sánchez J, Ortuño J. [Idiopathic subclavian vein stenosis in a patient treated with hemodialysis]. Nefrologia 2007; 27:523-524. [PMID: 17944598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Teruel JL, Sabater J, Galeano C, Rivera M, Merino JL, Fernández Lucas M, Marcén R, Ortuño J. [The Cockcroft-Gault equation is better than MDRD equation to estimate the glomerular filtration rate in patients with advanced chronic renal failure]. Nefrologia 2007; 27:313-9. [PMID: 17725450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
ABSTRACT The aim of this study was to compare the accuracy of three kidney function estimating equations: classic Cockcroft-Gault (classic CG), corrected Cockcroft-Gault (corrected CG) and simplified Modification of Diet in Renal Disease (MDRD), in patients with advanced chronic renal failure. The study was made in 84 nondialyzed patients with chronic renal disease in stage 4 or 5. The glomerular filtration rate was measured on a 24-hour urine collection as the arithmetic mean of the urea and creatinine clearances (CUrCr). In each patient, the difference between each estimating equation and the measured glomerular filtration rate was calculated. The absolute difference expressed as a percentage of the measured glomerular filtration rate indicates the intermethod variability. In the total group the glomerular filtration rate measured as the CUrCr was de 13,5+/-5,1 ml/min/1.73 m(2); and the results of the estimating equations were: classic CG 14,2+/-5 (p<0,05); corrected CG 12+/-4,2 (p<0,01) and MDRD : 12,1+/-4,8 ml/min/1.73 m(2) (p<0,01). The variability of the estimating equations was 15,2+/-12,2%, 17,1+/-13,4 % and 19,3+/-13,3% (p<0,05), for classic CG, corrected CG and MDRD respectively. The percent of estimates falling within 30% above o below the measured glomerular filtration rate was 90% for CG classic, 87% for corrected CG and 79% for MDRD. The intraclass correlation coefficients respect to CUrCr were 0,86 for classic CG, 0,81 for corrected CG and 0,77 for MDRD. The MDRD variability, but not classic CG variability or corrected CG variability, showed a positive correlation with the glomerular filtration rate (r=0,25, p<0,05). In patients with chronic renal disease in stage 5, the variability of the different estimating equations was similar. We conclude that in our population with advanced chronic renal failure the classic CG equation is more accurate than the MDRD equation. Corrected CG equation has not any advantage respect to classic CG equation.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
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Rodríguez Mendiola N, Merino JL, Morcillo M, Fernández Lucas M. [Adaptative disorder with dermatozoic hallucinations in a patient on hemodialysis]. Nefrologia 2007; 27:658-659. [PMID: 18045053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Merino JL, Galeano C, Chinchilla A, Sánchez J. [Impactation of permanent tunneled catheter for hemodialysis in the jugular vein, an exceptional complication]. Nefrologia 2006; 26:395-6. [PMID: 16892832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Teruel JL, Martins J, Merino JL, Fernández Lucas M, Rivera M, Marcén R, Quereda C, Ortuño J. [Temperature dialysate and hemodialysis tolerance]. Nefrologia 2006; 26:461-8. [PMID: 17058858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
In this study, the effect of dialysate temperature on hemodynamic stability, patients' perception of dialysis discomfort and postdialysis fatigue were assessed. Thirty-one patients of the morning shift were eligible to participate in the study. Three patients refused. Patients were assessed during 6 dialysis sessions: in three sessions the dialysate temperature was normal (37 degrees C) and in other three sessions the dialysate temperature was low (35.5 degrees C). To evaluate the symptoms along the dialysis procedure and the postdialysis fatigue, specific scale questionnaires were administered in each dialysis session and respective scores were elaborated. Low temperature dialysate was associated with higher postdialysis systolic blood pressure (122 +/- 24 vs. 126 +/- 27 mmHg, p < 0.05), and lower postdialysis heart rate (82 +/- 13 vs. 78 +/- 9 beats/min, p < 0.05) with the same ultrafiltration rate. Dialysis symptoms score and postdialysis fatigue score were better with the low dialysate temperature (0.7 +/- 0.9 vs. 0.4 +/- 1 vs. p < 0.05, and 1.3 +/- 1 vs. 1 +/- 0.9 p < 0.05, respectively). Furthermore, low temperature dialysate shortened the post-dialysis fatigue period (5.4 +/- 6.3 vs. 3.1 +/- 3.3 vs. hours, p < 0.05). The clinical improvement experimented with the low temperature dialysate was not universal. A beneficial effect was exclusively observed in the patients with higher dialysis symptoms and postdialysis fatigue scores or having more than one episode of hypotension in a week. The patients were asked about their temperature preference, 7 patients (23%) request a dialysate at 37 degrees C, 19 patients (61%) prefered to be dialysed with the low temperature dialysate, and 5 patients (16%) were indifferent. The later two groups of the patients continued with the low temperature dialysate during other 4 weeks. At the end of that period, the clinical improvement remained unchanged. In summary, low temperature dialysate is particularly beneficial for highly symptomatic patients.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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Teruel JL, Merino JL, Fernández-Lucas M, Tenorio MT, Rivera M, Marcén R, Ortuño J. [Urea distribution volume calculated by ionic dialysance]. Nefrologia 2006; 26:121-7. [PMID: 16649433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Direct dialysis quantification is considered the gold standard for determining urea distribution volume, but it is impractical for routine use. So, urea distribution volume in hemodialysis patients is usually estimated from anthropometric equations. Ionic dialysance allows to calculate the urea distribution volume dividing the Kt obtained by ionic dialysance by the Kt/V obtained by a simplified formula. The aim of the present work was to analyse the concordance between the ionic dialysance and the direct dialysis quantification methods to estimate de urea distribution volume. MATERIAL AND METHODS In 15 hemodialysis patients (10 males and 5 females), we have estimated the urea distribution volume by the direct dialysis quantification (Vurea), by the anthropometrics equations of Watson (VWatson) and Chertow (VChertow) and by the ionic dialysance method (VDI). To obtain VDI we have used two simplified Kt/V formulas: the monocompartimental and the equilibrated Daugirdas equations (VDIm and VDIe respectively). The intermethod variability was assessed by the relative difference (absolute difference between VUrea and the other methods, divided by the mean). RESULTS VUrea (26,2 L) was statistically different from theVDIe (30,6 L, p < 0.01), VWatson 35.2 L (p < 0.001) and VChertow (38 L, p < 0.001). VDIm was 26.3 L (p = ns). VUrea represents the 42% of the body weight for the males (range 36 to 49%) and the 33% of the body weight for the female (range 28 to 38%). The intermethod variability was high for the VDIe (21.6%), VWatson (37.4%) and VChertow (48. 1%), but it was low for the VDIm (9.9%). CONCLUSIONS Urea distribution volume calculated by the ionic dialysance method using the monocompartimental Daugirdas Kt/V equation has an acceptable agreement with the urea distribution volume calculated by the direct dialysis quantification. Anthropometry-based equations overestimate the urea distribution volume in hemodialysis patients.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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Merino JL, Teruel JL, Galeano C, Fernández Lucas M, Ocaña J, Rivera M, Marcén R, Ortuño J. [Blood flow determination in vascular access with ionic dialysance]. Nefrologia 2006; 26:481-5. [PMID: 17058861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Affiliation(s)
- J L Merino
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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