1
|
Guerra JM, Moreno Weidmann Z, Perrotta L, Sultan A, Anic A, Metzner A, Providencia R, Boveda S, Chun J. Current management of atrial fibrillation in routine practice according to the last ESC guidelines: an EHRA physician survey-how are we dealing with controversial approaches? Europace 2024; 26:euae012. [PMID: 38227804 PMCID: PMC10869216 DOI: 10.1093/europace/euae012] [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: 11/01/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024] Open
Abstract
AIMS Although guidelines for the management of atrial fibrillation (AF) are regularly published, many controversial issues remain, limiting their implementation. We aim to describe current clinical practice among European Heart Rhythm Association (EHRA) community according to last guidelines. METHODS AND RESULTS A 30 multiple-choice questionnaire covering the most controversial topics related to AF management was distributed through the EHRA Research Network, National Societies, and social media between January and February 2023. One hundred and eighty-one physicians responded the survey, 61% from university hospitals. Atrial fibrillation screening in high-risk patients is regularly performed by 57%. Only 42% has access to at least one programme aiming at diagnosing/managing comorbidities and lifestyle modifications, with marked heterogeneity between countries. Direct oral anticoagulants are the preferred antithrombotic (97%). Rhythm control is the preferred strategy in most AF phenotypes: symptomatic vs. asymptomatic paroxysmal AF (97% vs. 77%), low vs. high risk for recurrence persistent AF (90% vs. 72%), and permanent AF (20%). I-C drugs and amiodarone are preferred while dronedarone and sotalol barely used. Ablation is the first-line therapy for symptomatic paroxysmal AF (69%) and persistent AF with markers of atrial disease (57%) and is performed independently of symptoms by 15%. In persistent AF, 68% performs only pulmonary vein isolation and 32% also additional lesions. CONCLUSION There is marked heterogeneity in AF management and limited accordance to last guidelines in the EHRA community. Most of the discrepancies are related to the main controversial issues, such as those related to AF screening, management of comorbidities, pharmacological treatment, and ablation strategy.
Collapse
Affiliation(s)
- Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IR SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IR SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Laura Perrotta
- Arrhythmia Unit, Careggi University Hospital, Florence, Italy
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Centre, Split, Croatia
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rui Providencia
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Institute of Health Informatics Research, University College London, London, UK
| | - Serge Boveda
- Department of Cardiology, Heart Rhythm Management, Clinique Pasteur, Toulouse, France
- Brussels University VUB, Brussels, Belgium
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| |
Collapse
|
2
|
Aguado-Sierra J, Brigham R, Baron AK, Gomez PD, Houzeaux G, Guerra JM, Carreras F, Filgueiras-Rama D, Vazquez M, Iaizzo PA, Iles TL, Butakoff C. HPC Framework for Performing in Silico Trials Using a 3D Virtual Human Cardiac Population as Means to Assess Drug-Induced Arrhythmic Risk. Methods Mol Biol 2024; 2716:307-334. [PMID: 37702946 DOI: 10.1007/978-1-0716-3449-3_14] [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] [Indexed: 09/14/2023]
Abstract
Following the 3 R's principles of animal research-replacement, reduction, and refinement-a high-performance computational framework was produced to generate a platform to perform human cardiac in-silico clinical trials as means to assess the pro-arrhythmic risk after the administrations of one or combination of two potentially arrhythmic drugs. The drugs assessed in this study were hydroxychloroquine and azithromycin. The framework employs electrophysiology simulations on high-resolution three-dimensional, biventricular human heart anatomies including phenotypic variabilities, so as to determine if differential QT-prolongation responds to drugs as observed clinically. These simulations also reproduce sex-specific ionic channel characteristics. The derived changes in the pseudo-electrocardiograms, calcium concentrations, as well as activation patterns within 3D geometries were evaluated for signs of induced arrhythmia. The virtual subjects could be evaluated at two different cycle lengths: at a normal heart rate and at a heart rate associated with stress as means to analyze the proarrhythmic risks after the administrations of hydroxychloroquine and azithromycin. Additionally, a series of experiments performed on reanimated swine hearts utilizing Visible Heart® methodologies in a four-chamber working heart model were performed to verify the arrhythmic behaviors observed in the in silico trials.The obtained results indicated similar pro-arrhythmic risk assessments within the virtual population as compared to published clinical trials (21% clinical risk vs 21.8% in silico trial risk). Evidence of transmurally heterogeneous action potential prolongations after providing a large dose of hydroxychloroquine was found as the observed mechanisms for elicited arrhythmias, both in the in vitro and the in silico models. The proposed workflow for in silico clinical drug cardiotoxicity trials allows for reproducing the complex behavior of cardiac electrophysiology in a varied population, in a matter of a few days as compared to the months or years it requires for most in vivo human clinical trials. Importantly, our results provided evidence of the common phenotype variants that produce distinct drug-induced arrhythmogenic outcomes.
Collapse
Affiliation(s)
- Jazmin Aguado-Sierra
- Barcelona Supercomputing Center, Barcelona, Spain.
- Elem Biotech S.L., Barcelona, Spain.
| | - Renee Brigham
- Visible Heart® Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Jose M Guerra
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Francesc Carreras
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - David Filgueiras-Rama
- Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERCV, Madrid, Spain
| | - Mariano Vazquez
- Barcelona Supercomputing Center, Barcelona, Spain
- Elem Biotech S.L., Barcelona, Spain
| | - Paul A Iaizzo
- Visible Heart® Laboratories, Department of Surgery and the Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tinen L Iles
- Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
3
|
Amorós-Figueras G, Casabella-Ramon S, Moreno-Weidmann Z, Ivorra A, Guerra JM, García-Sánchez T. Dynamics of High-Density Unipolar Epicardial Electrograms During PFA. Circ Arrhythm Electrophysiol 2023; 16:e011914. [PMID: 37577822 DOI: 10.1161/circep.123.011914] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/16/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel nonthermal cardiac ablation technology based on irreversible electroporation (IRE). While areas of IRE lead to durable lesions, the surrounding regions, where reversible electroporation occurs, recover. The behavior of local electrograms in areas of different electroporation levels remains unknown. The goal of this study is to characterize electrogram dynamics after PFA in IRE and reversible electroporation areas. METHODS A total of 6 domestic swine were used. PFA was applied in the epicardium of the right and left ventricles using a focal monopolar catheter. Additional radiofrequency ablations were performed. Epicardial unipolar electrograms were acquired at baseline and for 60 minutes post PFA/radiofrequency ablation using a high-density electrode matrix attached to the epicardium. Electrogram dynamics were analyzed in areas corresponding to different levels of electroporation. Acute lesion formation was assessed after 3 to 5 hours by triphenyl tetrazolium chloride staining. RESULTS Electrogram analysis demonstrated a clear association between electrogram changes and the level of electroporation. Immediately after PFA, electrograms displayed the following: a significant decrease in R/S-wave amplitude; a large elevation of the ST-segment; and a large decrease in their |(dV/dt)|max. Marked changes in electrograms were observed beyond the lesion area. Thereafter, a gradual recovery was observed. The evolution of all the electrogram parameters throughout the 60 minutes after PFA was significantly different (P<0.05) between the IRE and reversible electroporation areas. Acute lesion staining showed significantly larger depth for PFA lesions compared with radiofrequency ablation. CONCLUSIONS This study shows that unipolar electrograms can differentiate between reversible electroporation and IRE areas during the first 30 minutes post ablation. Differences after the first 30 minutes are less evident. Our findings could result useful for immediate lesion assessment after PFA and warrant further investigation.
Collapse
Affiliation(s)
- Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.)
| | - Sergi Casabella-Ramon
- Instituto de Investigaciones Biomédicas de Barcelona, (IIBB-)CSIC, CIBERCV, IIB SANT PAU, Spain (S.C.-R.)
| | - Zoraida Moreno-Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.)
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (A.I., T.G.-S.)
- Serra Hunter Fellow Programme (A.I.)
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.)
| | - Tomás García-Sánchez
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (A.I., T.G.-S.)
| |
Collapse
|
4
|
Adeliño R, Malaczynska-Rajpold K, Perrotta L, Manninger M, Vanduynhoven P, Nesti M, Goanță EV, Waldmann V, Pavlovic N, Farkowski MM, Guerra JM, Penela D, Boveda S, Chun JKR. Occupational radiation exposure of electrophysiology staff with reproductive potential and during pregnancy: an EHRA survey. Europace 2023; 25:euad216. [PMID: 37498147 PMCID: PMC10401324 DOI: 10.1093/europace/euad216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/17/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Electrophysiology (EP) is a growing field in cardiology, with an increasing involvement of young people. Nevertheless, concerns about radiation exposure and its impact on reproduction and pregnancy may discourage the choice of an EP career. The study is aimed at investigating the level of awareness and main sources of concern about the effects of radiation on reproductive potential and pregnancy, exploring the safety measures adopted in different EP labs, and verifying the adherence to the current guidelines. METHODS AND RESULTS An online survey was conducted using the European Heart Rhythm Association (EHRA) infrastructure from April to June 2022. A total of 252 EP personnel (42% women) participated, from 50 countries and different professional roles. Most participants expressed concerns regarding the effects of radiation on reproductive capacity (67.1%) and offspring diseases (68.2%). Only 37.9% of participants were aware of the EHRA 2017 consensus document about occupational radiation exposure. Most participants (80.9%) considered that occupational radiation during pregnancy is not safe. EP female staff were not allowed to work in the EP lab during pregnancy in 48.1% of cases. Zero-fluoroscopy was the preferred choice to continue working in the EP lab during pregnancy. CONCLUSION EP staff, including both men and women, have concerns about the effects of radiation on reproductive capacity. Despite the recommendations issued by international bodies, implementation of the policies regarding pregnancy and occupational radiation exposure is heterogeneous. Zero-fluoroscopy is the preferred approach to ensure safety during pregnancy in the EP lab.
Collapse
Affiliation(s)
- Raquel Adeliño
- Arrhythmia Unit, Cardiology Department, Vall d’Hebron University Hospital, Pg. de la Vall d'Hebron 119, 08035 Barcelona, Spain
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | | | - Laura Perrotta
- Arrhythmia Unit, Department of Cardiothoracovascular Medicine, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
| | - Philippe Vanduynhoven
- Department of Cardiology, Arrhythmia Clinic, Algemeen Stedelijk Ziekenhuis Aalst, Merestraat 80, 9300 Aalst, Belgium
| | - Martina Nesti
- Arrhythmia Unit, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, 56124 Pisa, Italy
| | - Emilia-Violeta Goanță
- Cardiology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 2 Eftimie Murgu 2, Timisoara 300041, Romania
| | - Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20 Rue Leblanc, 75015 Paris, France
| | - Nikola Pavlovic
- Department of Cardiology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, 08025 Barcelona, Spain
- Universidad Autonoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Vilana nº 12, 08022 Barcelona, Spain
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Im Prüfling 23, 60389 Frankfurt am Main, Germany
| |
Collapse
|
5
|
Petras A, Leoni M, Guerra JM, Gerardo-Giorda L. Calibration of a three-state cell death model for cardiomyocytes and its application in radiofrequency ablation. Physiol Meas 2023. [PMID: 37290447 DOI: 10.1088/1361-6579/acdcdd] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE 
Thermal cellular injury follows complex dynamics and subcellular processes can heal the inflicted damage if insufficient heat is administered during the procedure. This work aims to the identification of irreversible cardiac tissue damage for predicting the success of thermal treatments.

Approach. 
Several approaches exist in the literature, but they are unable to capture the healing process and the variable energy absorption rate that several cells display. Moreover, none of the existing models is calibrated for cardiomyocytes. We consider a three-state cell death model capable of capturing the reversible damage of a cell, we modify it to include a variable energy absorption rate and we calibrate it for cardiac myocytes.

Main results. 
We show how the thermal damage predicted by the model response is in accordance with available data in the literature on myocytes for different temperature distributions. When coupled with a computational model of radiofrequency catheter ablation, the model predicts lesions in agreement with experimental measurements. We also present additional experiments (repeated ablations and catheter movement) to further illustrate the potential of the model.

Significance. 
We calibrated a three-state cell death model to provide physiological results for cardiac myocytes. The model can be coupled with ablation models and reliably predict lesion sizes comparable to experimental measurements. Such approach is robust for repeated ablations and dynamic catheter-cardiac wall interaction, and allows for tissue remodeling in the predicted damaged area, leading to more accurate in-silico predictions of ablation outcomes.
Collapse
Affiliation(s)
- Argyrios Petras
- RICAM, Altenberger Strasse 69, Linz, Oberösterreich, 4040, AUSTRIA
| | | | - Jose M Guerra
- Hospital de la Santa Creu i Sant Pau, Calle Sant Antoni Maria Claret 167, Barcelona, Catalunya, 08025, SPAIN
| | - Luca Gerardo-Giorda
- Institute for Mathematical Methods in Medicine and data-based modeling, Johannes Kepler Universitat Linz, Altenberger Strasse 69, Linz, 4040, AUSTRIA
| |
Collapse
|
6
|
Januszkiewicz Ł, Barra S, Providencia R, Chun JKR, Conte G, Farkowski MM, Guerra JM, Marijon E, de Asmundis C, Boveda S. Regional disparity on patient characteristics and perceptions after implantable cardioverter-defibrillator implantation: results from an EHRA patient survey. Europace 2023; 25:euad110. [PMID: 37140046 PMCID: PMC10228611 DOI: 10.1093/europace/euad110] [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: 12/20/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
AIMS The aim of this study was to identify potential regional disparities in characteristics of implantable cardioverter-defibrillator (ICD) recipients, patient perceptions and perspectives after implantation and level of information provided to patients. METHODS AND RESULTS The prospective, multicentre, and multinational European Heart Rhythm Association patient Survey 'Living with an ICD' included patients already implanted with an ICD (median ICD dwell time - 5 years, interquartile range 2-10). An online questionnaire was filled-in by patients invited from 10 European countries. A total of 1809 patients (the majority in their 40s to 70s, 65.5% men) were enrolled, with 877 (48.5%) from Western Europe (group 1), followed by 563 from Central/Eastern Europe (group 2, 31.1%), and 369 from Southern Europe (group 3, 20.4%). A total of 52.9% of Central/Eastern Europe patients reported increased satisfaction after ICD placement compared with 46.6% from Western and 33.1% from Southern Europe (1 vs. 2 P = 0.047, 1 vs. 3 P < 0.001, 2 vs. 3 P < 0.001). About 79.2% of Central/Eastern and 76.0% of Southern Europe patients felt optimally informed at the time of device implantation compared with just 64.6% from Western Europe (1 vs. 2 P < 0.001, 1 vs. 3 P < 0.001, 2 vs. 3 P = ns). CONCLUSIONS While physicians in Southern Europe should address the patients' concerns about the impact of the ICD on quality of life, physicians from Western Europe should focus on improving the quality of information provided to their prospective ICD patients. Novel strategies to address regional differences in patients' quality of life and provision of information are warranted.
Collapse
Affiliation(s)
- Łukasz Januszkiewicz
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
- Institute of Health Informatics Research, University College London, London, UK
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Michał M Farkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB SANT PAU, CIBERCV, Barcelona, Spain
| | - Eloi Marijon
- University of Paris, Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Serge Boveda
- Department of Heart Rhythm, Clinique Pasteur, 31076 Toulouse, France
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
| |
Collapse
|
7
|
Januszkiewicz Ł, Grabowski M, Farkowski MM, Życiński P, Jędrychowski T, Pytkowski M, Chun JKR, Guerra JM, Conte G, Barra S, Boveda S, Kempa M. Implantable Cardioverter-Defibrillators in Poland Compared with other European Countries from the Patient's Perspective: Insights from the EHRA Patient Survey. Int J Environ Res Public Health 2023; 20:5045. [PMID: 36981953 PMCID: PMC10049532 DOI: 10.3390/ijerph20065045] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aim of this study was to compare differences between Polish ICD recipients and ICD recipients from other European countries in terms of quality of life, information provision before ICD implantation, and end-of-life issues. METHODS This is a sub-analysis of the "Living with an ICD" patient survey (25-item questionnaire) organized by the European Heart Rhythm Association between 12 April 2021 and 5 July 2021 in ten European countries. RESULTS There were 410 (22.7%) patients from Poland and 1399 (77.3%) from other European countries. A total of 51.0% of Polish patients reported improvement in their quality of life compared with 44.3% in other countries (p = 0.041). Remote monitoring was three times more often utilized in other countries than in Poland (66.8% vs. 21.0%, p < 0.001). While 78.1% of Poles felt well informed before ICD implantation compared with 69.6% of subjects from other countries (p = 0.001), they were less familiar with the ICD deactivation process than others (38.9% vs. 52.5%, p < 0.001). CONCLUSIONS Despite the less frequent use of remote monitoring and gaps in end-of-life issues, Polish ICD recipients reported more favorable quality of life and a higher level of information received before device placement than patients in other European countries.
Collapse
Affiliation(s)
- Łukasz Januszkiewicz
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | | | - Paweł Życiński
- 1st Department of Cardiology, Medical University of Lodz, 91-347 Lodz, Poland
| | - Tomasz Jędrychowski
- Department of Cardiology, Voivodship Specialist Hospital, 06-400 Ciechanow, Poland
| | - Mariusz Pytkowski
- II Department of Heart Arrhythmia, National Insitute of Cardiology, 04-628 Warsaw, Poland
| | - Julian K. R. Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, 60431 Frankfurt, Germany
| | - Jose M. Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB SANT PAU, CIBERCV, 08025 Barcelona, Spain
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, 6900 Lugano, Switzerland
- Università della Svizzera Italiana Lugano, 6900 Lugano, Switzerland
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrabida, 4400-346 Vila Nova de Gaia, Portugal
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Paris Cardiovascular Research Center, INSERM Unit 970, 75015 Paris, France
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland
| |
Collapse
|
8
|
Polo R, García-Albéniz X, Terán C, Morales M, Rial-Crestelo D, Garcinuño MA, García Del Toro M, Hita C, Gómez-Sirvent JL, Buzón L, Díaz de Santiago A, Arellano JP, Sanz J, Bachiller P, Alfaro EM, Díaz-Brito V, Masiá M, Hernández-Torres A, Guerra JM, Santos J, Arazo P, Muñoz L, Arribas JR, Martínez de Salazar P, Moreno S, Hernán MA, Del Amo J. Daily tenofovir disoproxil fumarate/emtricitabine and hydroxychloroquine for pre-exposure prophylaxis of COVID-19: a double-blind placebo-controlled randomized trial in healthcare workers. Clin Microbiol Infect 2023; 29:85-93. [PMID: 35940567 PMCID: PMC9352647 DOI: 10.1016/j.cmi.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the effect of hydroxychloroquine (HCQ) and Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis on COVID-19 risk. METHODS EPICOS is a double-blind, placebo-controlled randomized trial conducted in Spain, Bolivia, and Venezuela. Healthcare workers with negative SARS-CoV-2 IgM/IgG test were randomly assigned to the following: daily TDF/FTC plus HCQ for 12 weeks, TDF/FTC plus HCQ placebo, HCQ plus TDF/FTC placebo, and TDF/FTC placebo plus HCQ placebo. Randomization was performed in groups of four. Primary outcome was laboratory-confirmed, symptomatic COVID-19. We also studied any (symptomatic or asymptomatic) COVID-19. We compared group-specific 14-week risks via differences and ratios with 95% CIs. RESULTS Of 1002 individuals screened, 926 (92.4%) were eligible and there were 14 cases of symptomatic COVID-19: 220 were assigned to the TDF/FTC plus HCQ group (3 cases), 231 to the TDF/FTC placebo plus HCQ group (3 cases), 233 to the TDF/FTC plus HCQ placebo group (3 cases), and 223 to the double placebo group (5 cases). Compared with the double placebo group, 14-week risk ratios (95% CI) of symptomatic COVID-19 were 0.39 (0.00-1.98) for TDF + HCQ, 0.34 (0.00-2.06) for TDF, and 0.49 (0.00-2.29) for HCQ. Corresponding risk ratios of any COVID-19 were 0.51 (0.21-1.00) for TDF + HCQ, 0.81 (0.44-1.49) for TDF, and 0.73 (0.41-1.38) for HCQ. Adverse events were generally mild. DISCUSSION The target sample size was not met. Our findings are compatible with both benefit and harm of pre-exposure prophylaxis with TDF/FTC and HCQ, alone or in combination, compared with placebo.
Collapse
Affiliation(s)
- Rosa Polo
- Division for HIV, STI, Viral Hepatitis and TB Control, Ministry of Health, Madrid, Spain
| | - Xabier García-Albéniz
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA; RTI Health Solutions, Barcelona, Spain
| | - Carolina Terán
- Facultad de Medicina Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Hospital Santa Bárbara, Sucre, Bolivia
| | | | - David Rial-Crestelo
- Hospital Doce de Octubre, Madrid, Spain; CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain
| | | | | | | | | | - Luis Buzón
- Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Jesus Sanz
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | - Mar Masiá
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital General Universitario de Elche, Alicante, Spain
| | | | | | - Jesús Santos
- Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain
| | - Piedad Arazo
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Leopoldo Muñoz
- Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Jose Ramon Arribas
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Pablo Martínez de Salazar
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Miguel A Hernán
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julia Del Amo
- Division for HIV, STI, Viral Hepatitis and TB Control, Ministry of Health, Madrid, Spain; CIBER de Enfermedades Infecciosas, Institute of Health Carlos III, Madrid, Spain.
| |
Collapse
|
9
|
Bordignon S, Barra S, Providencia R, de Asmundis C, Marijon E, Farkowski MM, Anic A, Guerra JM, Kosiuk J, Iliodromitis K, Schmidt B, Conte G, Chun JKR, Boveda S. The blanking period after atrial fibrillation ablation: an European Heart Rhythm Association survey on contemporary definition and management. Europace 2022; 24:1684-1690. [PMID: 35942585 DOI: 10.1093/europace/euac131] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023] Open
Abstract
The use of a blanking period (BP) after an atrial fibrillation (AF) ablation procedure is a common practice, but recent data questions the benign nature of early recurrences of atrial tachyarrhythmias (ERATs). A physician-based survey was carried out by the European Heart Rhythm Association (EHRA) to investigate the current definition and applicability of BP and ERAT management. An online questionnaire was sent to clinical and interventional electrophysiologists. A total of 436 respondents (88% interventional electrophysiologists) reported observing ERATs in 25% (interquartile range 15-35) of patients, less commonly in paroxysmal AF (PAF) compared with persistent AF (persAF). The median reported duration of BP used by respondents was 90 days, with 22% preferring a shorter BP duration for PAF patients compared with persAF. Half of the patients with ERATs are expected to also experience late recurrences (LR). Isolated episodes of ERATs are treated conservatively by 99% of the respondents, but repeat ablation during the BP is preferred by 20% of electrophysiologists for multiple ERATs and by 16% in patients with organized atrial tachyarrhythmias. In conclusion, ERATs are commonly observed after AF ablation, particularly in persAF patients, and are perceived as predictors of LR by half of the respondents. A general adherence to a 90-day BP duration was observed. During this time period, ERAT is mainly treated conservatively, but repeat ablation during the BP is occasionally offered to patients with multiple ERATs and those with organized atrial tachyarrhythmias.
Collapse
Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia 4400, Portugal.,Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB20AY, UK
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE, UK.,Institute of Health Informatics, University College of London, London NW1 2DA, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels 1090, Belgium
| | - Eloi Marijon
- University of Paris, Paris 75006, France.,Cardiology Department & Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris 75015, France
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split 21000, Croatia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona 08025, Spain
| | - Jedrzej Kosiuk
- Department of Rhythmology, Helios Clinic Köthen, Köthen 06366, Germany
| | - Konstantinos Iliodromitis
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Hagen 58135, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano 6900, Switzerland
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels 1090, Belgium.,Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France.,INSERM U970 75908, Paris, France
| |
Collapse
|
10
|
Baldi E, Conte G, Zeppenfeld K, Lenarczyk R, Guerra JM, Farkowski MM, de Asmundis C, Boveda S. Contemporary management of ventricular electrical storm in Europe: results of a European Heart Rhythm Association Survey. Europace 2022; 25:1277-1283. [PMID: 36196613 PMCID: PMC10105853 DOI: 10.1093/europace/euac151] [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] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Electrical storm (ES) is a predictor of mortality, and its treatment is challenging. Moreover, not all potential therapeutic strategies are available in all hospitals, and a standardized approach among European centres is lacking. The aim of this European Heart Rhythm Association (EHRA) survey was to assess the current management of patients with ES both in the acute and post-acute phases in 102 different European centres. A 20-item online questionnaire was sent out to the EHRA Research Network Centres. The median number of patients with ES treated annually per centre is 10 (IQR 5-15). The possibility of using autonomic modulation (e.g. percutaneous stellate ganglion block or thoracic epidural anaesthesia) for the acute ES treatment is available in only 29.3% of the centres. Moreover, although over 80% of centres perform ventricular tachycardia ablation, this procedure is available 24/7 in only 16.5% of the hospitals. There is a significant heterogeneity among centres regarding the availability of AADs and their use before deciding to proceed with a non-AAD strategy; specifically, 4.4% of centres use only one drug, 33.3% use two drugs, and 12.2% >two drugs, while about 50% of the centres decide based on individual patient's characteristics. Regarding the type of AADs used for the acute and post-acute management of ES patients, important variability is reported depending upon the underlying heart disease. Most patients considered for percutaneous ablation have structural heart disease. Only 46% of centres refer patients to psychological counselling after ES.
Collapse
Affiliation(s)
- Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano 6900, Switzerland
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Radosław Lenarczyk
- Division of Medical Sciences in Zabrze, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, The Medical University of Silesia, Zabrze, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Serge Boveda
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.,Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| |
Collapse
|
11
|
Amoros-Figueras G, Casabella-Ramon S, Company G, Arzamendi D, Macias Y, Jorge E, Sanchez-Quintana D, Rosell-Ferrer J, Guerra JM, Cinca J. A closed-chest model of selective atrial myocardial infarction for the study of induced electrophysiological and structural derangements. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2907] [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
Background
The diagnosis of atrial infarction is often masked by the frequent association with ventricular infarction. For this reason, the electrophysiological and structural consequences of selective atrial ischemia are poorly understood.
Purpose
The objective of this study was to analyze the alterations in the ECG, local electrograms, and multifrequential atrial myocardial impedance in a new experimental model of acute and chronic atrial infarction.
Methods
Seven anesthetized pigs were subjected to 4h of atrial ischemia induced by selective catheter occlusion of the atrial coronary branches originating in the left circumflex coronary artery. The surface ECG was recorded and the changes in P-wave morphology analyzed. Four weeks later the animals were subjected to endocardial voltage mapping (Carto) and multifrequential impedance. The hearts were processed for anatomopathological study.
Results
Selective occlusion of the coronary atrial branches induced atrial infarction with fibrosis in the left atrium in 6 of the 7 cases (Figure). The surface ECG showed prolongation of the P-wave duration (Figure) (P-wave in lead II: from 72±8ms at baseline vs. 97±18ms at 4 weeks, ANOVA p<0.01; P-wave in lead aVR: from 71±3ms at baseline vs 87±9ms at 4 weeks, ANOVA p<0.01) with no appreciable displacement of the PR segment. Endocardial mapping of the left atrium showed low-voltage bipolar zones with decreased multi-frequency impedance phase angle values, as compared with preserved zones of the same atrium (bipolar electrograms: from 0.6±1mV to 2.0±1.9mV, T-Test p<0.01; Phase angle at 300KHz: from −5.5±2° to −9.0±4.4° T-Test p<0.05).
Conclusion
We developed a closed-chest swine model of selective atrial infarction suitable for the study of ECG patterns and electrophysiological mechanisms linked to atrial myocardial ischemia and infarction. The structural derangements are detectable by endocardial mapping of local voltage electrograms and local tissue impedance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by grants from ISCI-MINECO (FIS PI17/00069), FEDER, CIBERCV (CB16/11/00276)
Collapse
Affiliation(s)
- G Amoros-Figueras
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - S Casabella-Ramon
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - G Company
- Universitat Politècnica de Catalunya, Electronic and Biomedical Instrumentation Group, CIBERCV , Barcelona , Spain
| | - D Arzamendi
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - Y Macias
- University of Extremadura, Department of Anatomy & Cell Biology, Faculty of Medicine , Badajoz , Spain
| | - E Jorge
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - D Sanchez-Quintana
- University of Extremadura, Department of Anatomy & Cell Biology, Faculty of Medicine , Badajoz , Spain
| | - J Rosell-Ferrer
- Universitat Politècnica de Catalunya, Electronic and Biomedical Instrumentation Group, CIBERCV , Barcelona , Spain
| | - J M Guerra
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - J Cinca
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| |
Collapse
|
12
|
Amoros-Figueras G, Casabella-Ramon S, Moreno-Weidmann Z, Company-Ramon G, Jorge E, Rosell-Ferrer J, Cinca J, Guerra JM. Real-time electrophysiological characterization of acute and chronic radiofrequency ablation lesions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2972] [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
Background
Assessment of lesion formation remains one of the most important goals to guide radiofrequency (RF) procedures in the cardiac electrophysiology laboratory. Cardiac navigation systems use specific algorithms to predict the effective lesion size, but these metrics are based only on ablation parameters and ignore local electric tissue characteristics. [1] Recent studies show that local multiparametric impedance is influenced by the intrinsic structural characteristics of the tissue. [2]
Purpose
This study aimed to assess the ability of local multiparametric impedance to characterize acute and chronic RF ablation lesions in the right atrium of pigs.
Methods
Four anesthetized closed-chest pigs were submitted to two interventions. The first intervention aimed at creating RF ablation lesions (30W, 60s, 55°) in the right atrium using an electrocatheter connected to a conventional cardiac navigation system, while mapping the local multiparametric impedance (LMI), the generator impedance (GI) and the bipolar voltage (BiV). All RF ablation lesions were performed with a stable contact force. Four weeks later, the second intervention aimed at mapping again the previous ablation sites. After the second intervention animals were euthanized and the hearts were removed and processed to identify the presence of fibrosis in the previously ablated lesions (Figure).
Results
We performed 19 ablations (5±2 per animal) with an average contact force of 14.2±4.6g. Four weeks later, 14/19 (74%) ablation lesions were identified as fibrotic points in the explanted heart (Figure 1). These showed decreased acute LMI and BiV values that persisted low after 4 weeks (Table 1). The remaining 5/19 ablations that did not present fibrosis had lower baseline LMI and bipolar values that resulted in lower LMI and BiV drops (Table 1). The absolute drop in LMI between effective and non-effective lesions was around 50%, while GI drop was only 21% (LMI drop @51KHz: From −3.0±1.4° to −1.5±0.3°, T-TEST p<0.05; GI drop: From 12.7±27.6Ω to 10.5±21.3Ω, T-TEST p=0.89).
Conclusion
The local baseline electrical properties of atrial myocardium are directly related to the effectiveness of RF ablation lesions. RF ablation sites that resulted into persistent fibrosis points had larger LMI and BiV values, with higher absolute drops than non-effective lesions. The use of LMI in clinical practice could improve the outcome of the procedures of arrhythmia ablation in the electrophysiology lab.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by grants from ISCI-MINECO (FIS PI21/00392), FEDER, CIBERCV (CB16/11/00276)
Collapse
Affiliation(s)
- G Amoros-Figueras
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - S Casabella-Ramon
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - Z Moreno-Weidmann
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - G Company-Ramon
- Universitat Politècnica de Catalunya, Electronic and Biomedical Instrumentation Group, CIBERCV , Barcelona , Spain
| | - E Jorge
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - J Rosell-Ferrer
- Universitat Politècnica de Catalunya, Electronic and Biomedical Instrumentation Group, CIBERCV , Barcelona , Spain
| | - J Cinca
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - J M Guerra
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| |
Collapse
|
13
|
García-Sánchez T, Amorós-Figueras G, Jorge E, Campos MC, Maor E, Guerra JM, Ivorra A. Parametric Study of Pulsed Field Ablation With Biphasic Waveforms in an In Vivo Heart Model: The Role of Frequency. Circ Arrhythm Electrophysiol 2022; 15:e010992. [PMID: 36178752 DOI: 10.1161/circep.122.010992] [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: 11/16/2022]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel nonthermal cardiac ablation technology based on irreversible electroporation. Unfortunately, the characteristics of the electric field waveforms used in clinical and experimental PFA are not typically reported. This study examines the effect of the frequency of biphasic waveforms and compares biphasic to monophasic waveforms. METHODS A total of 29 Sprague-Dawley rats were treated with PFA using an epicardial monopolar electrode. Biphasic waveforms with three different frequencies, 90, 260, and 450 kHz (10 bursts of 100 µs duration at 500 V or 800 V) and monophasic waveforms (10 pulses of 100 µs duration at 500 V) were studied. Collateral neuromuscular stimulation and temperature increase in the point of application were directly measured. Lesion formation was assessed 3 weeks after treatment by histopathologic analysis. Computer simulations were used to estimate the electric field lethal threshold for each condition. A previous in vitro study was performed to draw a complete characterization of the studied dependencies. RESULTS Morphometric analysis demonstrated a significant association between chronic lesion size and waveform characteristics. For the same voltage level, monophasic waveforms yielded the largest lesions compared with any of the biphasic protocols (P<0.05). Increasing PFA frequency was associated with reduced neuromuscular stimulation but also with reduced ablation efficacy. Maximum absolute temperature increase recorded along a complete treatment was 3 °C. Vascular structures inside the lesions were preserved for all conditions. Computer simulation-based analysis showed that waveform frequency had a graded effect on the lethal electric field threshold, with threshold of 600 V/cm for monophasic waveforms versus 2000 V/cm for biphasic waveforms with a frequency of 450 kHz. CONCLUSIONS Frequency is a major determinant of efficacy in biphasic PFA. Our results highlight the critical need of disclosing waveform characteristics when reporting the results of different PFA systems.
Collapse
Affiliation(s)
- Tomás García-Sánchez
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain. (T.G.-S., A.I.)
| | - Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica - Sant Pau, Universitat Autònoma de Barcelona, Spain (G.A.-F., E.J., J.M.G.)
| | - Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica - Sant Pau, Universitat Autònoma de Barcelona, Spain (G.A.-F., E.J., J.M.G.)
| | - María C Campos
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain (M.C.C.)
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel (E.M.).,Sackler School of Medicine, Tel Aviv University, Israel (E.M.)
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica - Sant Pau, Universitat Autònoma de Barcelona, Spain (G.A.-F., E.J., J.M.G.)
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain. (T.G.-S., A.I.).,Serra Húnter Fellow Programme, Universitat Pompeu Fabra, Barcelona, Spain. (A.I.)
| |
Collapse
|
14
|
Petras A, Moreno Weidmann Z, Echeverría Ferrero M, Leoni M, Guerra JM, Gerardo-Giorda L. Impact of electrode tip shape on catheter performance in cardiac radiofrequency ablation. Heart Rhythm O2 2022; 3:699-705. [PMID: 36589920 PMCID: PMC9795254 DOI: 10.1016/j.hroo.2022.07.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background The role of catheter tip shape on the safety and efficacy of radiofrequency (RF) ablation has been overlooked, although differences have been observed in clinical and research fields. Objective The purpose of this study was to analyze the role of electrode tip shape in RF ablation using a computational model. Methods We simulated 108 RF ablations through a realistic 3-dimensional computational model considering 2 clinically used, open-irrigated catheters (spherical and cylindrical tip), varying contact force (CF), blood flow, and irrigation. Lesions are defined by the 50°C isotherm contour and evaluated by means of width, depth, depth at maximum width, and volume. Ablations are deemed as safe, critical (tissue temperature >90°C), and pop (tissue temperature >100°C). Results Tissue-electrode contact is less for the spherical tip at low CF but the relationship is inverted at high CF. At low CF, the cylindrical tip generates deeper and wider lesions and a 4-fold larger volume. With increasing CF, the lesions generated by the spherical tip become comparable to those generated by the cylindrical tip. The 2 tips feature different safety profiles: CF and power are the main determinants of pops for the spherical tip; power is the main factor for the cylindrical tip; and CF has a marginal effect. The cylindrical tip is more prone to pop generation at higher powers. Saline irrigation and blood flow effect do not depend on tip shape. Conclusion Tip shape determines the performance of ablation catheters and has a major impact on their safety profile. The cylindrical tip shows more predictable behavior in a wide range of CF values.
Collapse
Affiliation(s)
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | | | | | - Jose M. Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain,Address reprint requests and correspondence: Dr Jose M. Guerra, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret 167, 08025 Barcelona, Spain.
| | - Luca Gerardo-Giorda
- RICAM, Austrian Academy of Sciences, Linz, Austria,Institute for Mathematical Methods in Medicine and Data-Based Modelling, Johannes Kepler University, Linz, Austria
| |
Collapse
|
15
|
Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| |
Collapse
|
16
|
Simovic S, Providencia R, Barra S, Kircanski B, Guerra JM, Conte G, Duncker D, Marijon E, Anic A, Boveda S. The use of remote monitoring of cardiac implantable devices during the COVID-19 pandemic: an EHRA physician survey. Europace 2022; 24:473-480. [PMID: 34410364 PMCID: PMC8499732 DOI: 10.1093/europace/euab215] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
It is unclear to what extent the COVID-19 pandemic has influenced the use of remote monitoring (RM) of cardiac implantable electronic devices (CIEDs). The present physician-based European Heart Rhythm Association (EHRA) survey aimed to assess the influence of the COVID-19 pandemic on RM of CIEDs among EHRA members and how it changed the current practice. The survey comprised 27 questions focusing on RM use before and during the pandemic. Questions focused on the impact of COVID-19 on the frequency of in-office visits, data filtering, reasons for initiating in-person visits, underutilization of RM during COVID-19, and RM reimbursement. A total of 160 participants from 28 countries completed the survey. Compared to the pre-pandemic period, there was a significant increase in the use of RM in patients with pacemakers (PMs) and implantable loop recorders (ILRs) during the COVID-19 pandemic (PM 24.2 vs. 39.9%, P = 0.002; ILRs 61.5 vs. 73.5%, P = 0.028), while there was a trend towards higher utilization of RM for cardiac resynchronization therapy-pacemaker (CRT-P) devices during the pandemic (44.5 vs. 55%, P = 0.063). The use of RM with implantable cardioverter-defibrillators (ICDs) and CRT-defibrillator (CRT-D) did not significantly change during the pandemic (ICD 65.2 vs. 69.6%, P = 0.408; CRT-D 65.2 vs. 68.8%, P = 0.513). The frequency of in-office visits was significantly lower during the pandemic (P < 0.001). Nearly two-thirds of participants (57 out of 87 respondents), established new RM connections for CIEDs implanted before the pandemic with 33.3% (n = 29) delivering RM transmitters to the patient's home address, and the remaining 32.1% (n = 28) activating RM connections during an in-office visit. The results of this survey suggest that the crisis caused by COVID-19 has led to a significant increase in the use of RM of CIEDs.
Collapse
Affiliation(s)
- Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Rui Providencia
- St Bartholomew’s Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Bratislav Kircanski
- University Clinical Centre of Serbia, Pacemaker Centre, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eloi Marijon
- University of Paris, Paris, France
- European Georges Pompidou Hospital, Cardiology Department and Cardiovascular Research Center, Paris, France
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
| | - Ante Anic
- Department for Cardiovascular diseases, University Hospital Center Split, Split, Croatia
| | - Serge Boveda
- Institut National de la Sante et de la Recherche Medicale U970, 75908 Paris Cedex 15, France
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
- Universitair Ziekenhuis Brussel—VUB, Heart Rhythm Management Centre, Brussels, Belgium
| |
Collapse
|
17
|
Januszkiewicz Ł, Barra S, Providencia R, Conte G, de Asmundis C, Chun JKR, Farkowski MM, Guerra JM, Marijon E, Boveda S. Long-term quality of life and acceptance of implantable cardioverter-defibrillator therapy: results of the European Heart Rhythm Association survey. Europace 2022; 24:860-867. [PMID: 35167672 DOI: 10.1093/europace/euac011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Implantable cardioverter-defibrillator (ICD) may impact patients’ life significantly. The aim of this survey was to analyse the impact of the ICD on quality of life (QoL) metrics from the patient’s perspective. ‘Living with an ICD’ was a prospective, multicentre study with an online questionnaire submitted to the European Heart Rhythm Association (EHRA) Research Network centres as well as patient associations from 10 European countries; it was filled-in directly and personally by the patients that were invited to participate, with a minimal interaction or influence from the healthcare professionals. Overall, the questionnaire was completed by 1809 patients (624 women, 34.5%). Patients in their 60s and 70s and from Western Europe were the most represented. The median time from first ICD implantation was 5 years (IQR 2–10). Device-related complications were reported by 505 patients (22.4%), including one or more inappropriate shocks (n = 209, 11.6%). Almost half the respondents reported improved QoL, with a more favourable impact for those receiving cardiac resynchronization therapy-defibrillator (CRT-D), and only a 10th experienced a significant decrease in QoL. The occurrence of complications remained a major predictor of deteriorated QoL (odds ratio 2.1, 95% confidence interval 1.4–3.0, P < 0.001). In conclusion, most patients have a globally positive view and acceptance of ICD therapy, reporting preserved to improved QoL after device implantation. Complications, namely inappropriate shocks, affect the expectation of living a normal life post-implant and are associated with a significant decrease in QoL. Our findings also highlight the importance of a detailed informed consent process and the involvement of the patient in the decision-making process.
Collapse
Affiliation(s)
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Health Informatics Research, University College of London, London, UK
| | - Giulio Conte
- Cardiology Department, Fondazione CardiocentroTicino, Lugano, Switzerland
- Universita` della Svizzera Italiana Lugano, Lugano, Switzerland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Michał M Farkowski
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | | | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| |
Collapse
|
18
|
Petras A, Moreno Weidmann Z, Leoni M, Gerardo-Giorda L, Guerra JM. Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model. Front Med Technol 2022; 3:747609. [PMID: 35047958 PMCID: PMC8757782 DOI: 10.3389/fmedt.2021.747609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/26/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: High-power short-duration (HPSD) recently emerged as a new approach to radiofrequency (RF) catheter ablation. However, basic and clinical data supporting its effectiveness and safety is still scarce. Objective: We aim to characterize HPSD with an advanced virtual model, able to assess lesion dimensions and complications in multiple conditions and compare it to standard protocols. Methods: We evaluate, on both atrium and ventricle, three HPSD protocols (70 W/8 s, 80 W/6 s, and 90 W/4 s) through a realistic 3D computational model of power-controlled RF ablation, varying catheter tip design (spherical/cylindrical), contact force (CF), blood flow, and saline irrigation. Lesions are defined by the 50°C isotherm contour. Ablations are deemed safe or complicated by pop (tissue temperature >97°C) or charring (blood temperature >80°C). We compared HPSD with standards protocols (30–40 W/30 s). We analyzed the effect of a second HPSD application. Results: We simulated 432 applications. Most (79%) associated a complication, especially in the atrium. The three HPSD protocols performed similarly in the atrium, while 90 W/4 s appeared the safest in the ventricle. Low irrigation rate led frequently to charring (72%). High-power short-duration lesions were 40–60% shallower and smaller in volume compared to standards, although featuring similar width. A second HPSD application increased lesions to a size comparable to standards. Conclusion: High-power short-duration lesions are smaller in volume and more superficial than standards but comparable in width, which can be advantageous in the atrium. A second application can produce lesions similar to standards in a shorter time. Despite its narrow safety margin, HPSD seems a valuable new clinical approach.
Collapse
Affiliation(s)
- Argyrios Petras
- Johann Radon Institute for Computational and Applied Mathematics (RICAM), Austrian Academy of Sciences, Linz, Austria
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Massimiliano Leoni
- Johann Radon Institute for Computational and Applied Mathematics (RICAM), Austrian Academy of Sciences, Linz, Austria
| | - Luca Gerardo-Giorda
- Johann Radon Institute for Computational and Applied Mathematics (RICAM), Austrian Academy of Sciences, Linz, Austria.,Institute for Mathematical Methods in Medicine and Data-Based Modelling, Johannes Kepler University, Linz, Austria
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Universitat Autónoma de Barcelona, Barcelona, Spain
| |
Collapse
|
19
|
Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
20
|
Arbelo E, Aktaa S, Bollmann A, D'Avila A, Drossart I, Dwight J, Hills MT, Hindricks G, Kusumoto FM, Lane DA, Lau DH, Lettino M, Lip GYH, Lobban T, Pak HN, Potpara T, Saenz LC, Van Gelder IC, Varosy P, Gale CP, Dagres N, Boveda S, Deneke T, Defaye P, Conte G, Lenarczyk R, Providencia R, Guerra JM, Takahashi Y, Pisani C, Nava S, Sarkozy A, Glotzer TV, Martins Oliveira M. Quality indicators for the care and outcomes of adults with atrial fibrillation. Europace 2021; 23:494-495. [PMID: 32860039 DOI: 10.1093/europace/euaa253] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). METHODS AND RESULTS We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. CONCLUSION This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.
Collapse
Affiliation(s)
| | | | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - André D'Avila
- Cardiac Arrhythmia Service, Hospital SOS Cardio, Florianopolis, SC, Brazil; Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France; ESC Patient Forum, Sophia Antipolis, France
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | - Fred M Kusumoto
- Cardiology Department, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Deirdre A Lane
- 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
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maddalena Lettino
- Cardiovascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - 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
| | - Trudie Lobban
- Arrhythmia Alliance/AF Association/STARS, Chipping Norton, UK
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Luis C Saenz
- Fundación Cardio Infantil-Instituto de Cardiología, Bogotá, Colombia
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul Varosy
- Rocky Mountain Regional Veterans Affairs Medical Center and the University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France
| | | | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre RHÖN-KLINIKUM Campus Bad Neustadt, Germany
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Radoslaw Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK and Institute of Health Informatics, University College of London, London, UK
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Yoshihide Takahashi
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Santiago Nava
- Head of Electrocardiology Department, Instituto Nacional de Cardiologia 'Ignacio Chavez', Mexico
| | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Taya V Glotzer
- Hackensack Meridian-Seton Hall School of Medicine, Rutgers New Jersey Medical School; Director of Cardiac Research, Hackensack University Medical Center, Hackensack, USA
| | - Mario Martins Oliveira
- Hospital Santa Marta, Department of Cardiology, Rua Santa Marta, 1167-024 Lisbon, Portugal
| |
Collapse
|
21
|
Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
Collapse
Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| |
Collapse
|
22
|
López-Canoa JN, Couselo-Seijas M, Baluja A, González-Melchor L, Rozados A, Llorente-Cortés V, de Gonzalo-Calvo D, Guerra JM, Vilades D, Leta R, Martínez-Sande JL, García-Seara FJ, Fernández-López XA, González-Juanatey JR, Eiras S, Rodríguez-Mañero M. Sex-related differences of fatty acid-binding protein 4 and leptin levels in atrial fibrillation. Europace 2021; 23:682-690. [PMID: 33319222 DOI: 10.1093/europace/euaa284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/23/2020] [Accepted: 09/07/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Our aim was to study the sex differences in adipokines levels according to AF burden. METHODS AND RESULTS Two independent cohorts of patients were studied: (i) consecutive patients with AF undergoing catheter ablation (n = 217) and (ii) a control group (n = 105). (i) Adipokines, oxidative stress, indirect autonomic markers, and leucocytes mRNA levels were analysed; (ii) correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients; and (iii) logistic regression and random forest model were used to determine predictors of AF recurrence after ablation. Our results showed that: (i) fatty acid-binding protein 4 (FABP4) and leptin levels were higher in women than in men in both cohorts (P < 0.01). In women, FABP4 levels were higher on AF cohort (20 ± 14 control, 29 ± 18 paroxysmal AF and 31 ± 17 ng/mL persistent AF; P < 0.01). In men, leptin levels were lower on AF cohort (22 ± 15 control, 13 ± 16 paroxysmal AF and 13 ± 11 ng/mL persistent AF; P < 0.01). (ii) In female with paroxysmal AF, there was a lower acetylcholinesterase and higher carbonic anhydrase levels with respect to men (P < 0.05). (iii) Adipokines have an important role on discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor of recurrence after ablation (1.067, 95% confidence interval 1-1.14; P = 0.046). CONCLUSION The major finding of the present study is the sex-based differences of FABP4 and leptin levels according to AF burden. These adipokines are associated with oxidative stress, inflammatory and autonomic indirect markers, indicating that they may play a role in AF perpetuation.
Collapse
Affiliation(s)
- J N López-Canoa
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain.,Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Travesía da Choupana s/n, Santiago de Compostela, 15706 A Coruña, Spain
| | - M Couselo-Seijas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Travesía da Choupana s/n, Santiago de Compostela, 15706 A Coruña, Spain
| | - A Baluja
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, University Clinical Hospital of Santiago de Compostela, Spain
| | - L González-Melchor
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain
| | - A Rozados
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Travesía da Choupana s/n, Santiago de Compostela, 15706 A Coruña, Spain
| | - V Llorente-Cortés
- Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - D de Gonzalo-Calvo
- Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), Spain.,Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - J M Guerra
- CIBERCV, Institute of Health Carlos III, Madrid, Spain.,Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M a Claret, Spain
| | - D Vilades
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M a Claret, Spain
| | - R Leta
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M a Claret, Spain
| | - J L Martínez-Sande
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - F J García-Seara
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - X A Fernández-López
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain
| | - J R González-Juanatey
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain.,Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Travesía da Choupana s/n, Santiago de Compostela, 15706 A Coruña, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - S Eiras
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Travesía da Choupana s/n, Santiago de Compostela, 15706 A Coruña, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| | - M Rodríguez-Mañero
- Cardiovascular area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Spain.,Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Travesía da Choupana s/n, Santiago de Compostela, 15706 A Coruña, Spain.,CIBERCV, Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
23
|
Garcia R, Waldmann V, Vanduynhoven P, Nesti M, Jansen de Oliveira Figueiredo M, Narayanan K, Conte G, Guerra JM, Boveda S, Duncker D. Worldwide sedation strategies for atrial fibrillation ablation: current status and evolution over the last decade. Europace 2021; 23:2039-2045. [PMID: 34308973 DOI: 10.1093/europace/euab154] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/29/2023] Open
Abstract
Catheter ablation for atrial fibrillation (AF) has become one of the most common procedures in the electrophysiology lab with rapidly increasing volumes. Peri-procedural anaesthesia for AF ablation varies between centres, from general anaesthesia to deep or conscious sedation. The aim of this survey was to assess current sedation practices for AF ablation worldwide and its evolution over the last decade. Centres regularly performing AF ablation responded to an online survey. A total of 297 centres participated in the survey. Overall, the median (interquartile range) number of AF ablation procedures increased from 91 (43-200) to 200 (74-350) per year (P < 0.001) between 2010 and 2019. The proportion of cryoablation also increased from 17.0% to 33.2% (P < 0.001). In 2019, the most used sedation technique was general anaesthesia (40.5%), followed by conscious sedation (32.0%) and deep sedation (27.5%). Between 2010 and 2019, the proportion of procedures performed under general anaesthesia (+4.4%; P = 0.02) and deep sedation (+4.8%; P < 0.01) increased, whereas the use of conscious sedation decreased (-9.2%; P < 0.001). The most commonly used hypnotic drugs were propofol and midazolam, whereas the most commonly used opioid drugs were remifentanyl and fentanyl. This worldwide survey shows that the number of AF ablation procedures has more than doubled over the last decade and general anaesthesia remains most commonly used. Studies comparing outcomes between different sedation strategies are needed to guide optimal decision-making.
Collapse
Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.,Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021, Poitiers, France
| | - Victor Waldmann
- Department of Cardiology, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Philippe Vanduynhoven
- Department of Cardiology, Arrhythmia Clinic Algemeen Stedelijk Ziekenhuis Aalst, Aalst, Belgium
| | - Martina Nesti
- Department of Cardiology and Neurology, San Donato Hospital, Arezzo, Italy
| | | | - Kumar Narayanan
- Department of Cardiology, Medicover Hospitals, Hyderabad, India
| | - Giulio Conte
- Department of Cardiology, Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Jose M Guerra
- Arrhythmia Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| |
Collapse
|
24
|
Guerra JM, Cardoso NC, Daniel AGT, Onuchic LF, Cogliati B. Prevalence of autosomal dominant polycystic kidney disease in Persian and Persian-related cats in Brazil. BRAZ J BIOL 2021; 81:392-397. [PMID: 32491055 DOI: 10.1590/1519-6984.227131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/21/2020] [Indexed: 11/22/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disease in cats. However, scarce data on its prevalence are available in Brazil. Persian cats and Persian-related breeds were assessed by molecular genotyping for a C to A transversion in exon 29 of PKD1 gene to determine ADPKD prevalence in a Brazilian population. Genomic DNA extracted from peripheral whole blood or oral swabs samples was used to amplify exon 29 of PKD1 gene employing a PCR-RFLP methodology. From a total of 616 animals, 27/537 Persian and 1/17 Himalayan cats showed the single-nucleotide variant (C to A) at position 3284 in exon 29 of feline PKD1. This pathogenic variation has been identified only in heterozygous state. The prevalence of ADPKD in Persian cats and Persian-related breeds was 5.03% and 1.6%, respectively. There was no significant association between feline breed, gender or age with ADPKD prevalence. Of note, the observed ADPKD prevalence in Persian cats and Persian-related breeds in Brazil was lower than the ones reported in other parts of the world. This finding may be related to genetic counseling and consequent selection of ADPKD-free cats for reproduction.
Collapse
Affiliation(s)
- J M Guerra
- Laboratório de Patologia Morfológica e Molecular, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia - FMVZ, Universidade de São Paulo - USP, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, CEP 05508-270, São Paulo, SP, Brasil
| | - N C Cardoso
- Laboratório de Patologia Morfológica e Molecular, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia - FMVZ, Universidade de São Paulo - USP, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, CEP 05508-270, São Paulo, SP, Brasil
| | - A G T Daniel
- Gattos - Clínica Especializada em Medicina Felina, Av. Vereador José Diniz, 3165, Campo Belo, CEP 04603-002, São Paulo, SP, Brasil
| | - L F Onuchic
- Faculdade de Medicina, Universidade de São Paulo - USP, Av. Dr. Arnaldo, 455, Cerqueira César, CEP 01246-903, São Paulo, SP, Brasil
| | - B Cogliati
- Laboratório de Patologia Morfológica e Molecular, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia - FMVZ, Universidade de São Paulo - USP, Av. Prof. Dr. Orlando Marques de Paiva, 87, Cidade Universitária, CEP 05508-270, São Paulo, SP, Brasil
| |
Collapse
|
25
|
Caravaca Perez P, González-Juanatey JR, Nuche J, Guerra JM, Martínez Selles M, Delgado JF. Reply to G. Betts's letter referring to "Serum potassium dynamics during acute heart failure hospitalization". Clin Res Cardiol 2021; 110:606-607. [PMID: 33475832 DOI: 10.1007/s00392-020-01796-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Pedro Caravaca Perez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 de Octubre, Avenida de Andalucía s/n, 28041, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Madrid, Spain
| | - José R González-Juanatey
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Facultad de Medicina, Universidad de Santiago, Santiago de Compostela, Spain
| | - Jorge Nuche
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Jose M Guerra
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Manuel Martínez Selles
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria IiGM, Universidad Europea, Madrid, Spain
| | - Juan F Delgado
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Department of Cardiology, Hospital Universitario 12 de Octubre, Avenida de Andalucía s/n, 28041, Madrid, Spain.
- Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Madrid, Spain.
- Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
| |
Collapse
|
26
|
Amorós-Figueras G, Roselló-Diez E, Sanchez-Quintana D, Casabella-Ramon S, Jorge E, Nevado-Medina J, Arzamendi D, Millán X, Alonso-Martin C, Guerra JM, Cinca J. Changes in Local Atrial Electrograms and Surface ECG Induced by Acute Atrial Myocardial Infarction. Front Physiol 2020; 11:264. [PMID: 32362831 PMCID: PMC7180211 DOI: 10.3389/fphys.2020.00264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2019] [Accepted: 03/09/2020] [Indexed: 12/31/2022] Open
Abstract
Background Atrial coronary branch occlusion is a hardly recognizable clinical entity that can promote atrial fibrillation. The low diagnostic accuracy of the ECG could deal with the characteristics of the ischemia-induced changes in local atrial electrograms, but these have not been described. Objectives We analyzed the effects of selective acute atrial branch occlusion on local myocardial structure, atrial electrograms, and surface ECG in an experimental model close to human cardiac anatomy and electrophysiology. Methods Six anesthetized open-chest anesthetized pigs underwent surgical occlusion of an atrial coronary branch arising from the right coronary artery during 4 h. Atrial electrograms and ECG were simultaneously recorded. One additional pig acted as sham control. In all cases, the hearts were processed for anatomopathological analysis. Results Atrial branch occlusion induced patchy atrial necrosis with sharp border zone. During the first 30 min of occlusion, atrial electrograms showed progressive R wave enlargement (1.8 ± 0.6 mV vs. 2.5 ± 1.1 mV, p < 0.01), delayed local activation times (28.5 ± 8.9 ms vs. 36.1 ± 16.4 ms, p < 0.01), ST segment elevation (-0.3 ± 0.3 mV vs. 1.0 ± 1.0 mV, p < 0.01), and presence of monophasic potentials. Atrial ST segment elevation decreased after 2 h of occlusion. The electrical border zone was ∼1 mm and expanded over time. After 2 h of occlusion, the ECG showed a decrease in P wave amplitude (from 0.09 ± 0.04 mV to 0.05 ± 0.04 mV after 165 min occlusion, p < 0.05) and duration (64.4 ± 8.0 ms vs. 80.9 ± 12.6 ms, p < 0.01). Conclusion Selective atrial branch occlusion induces patchy atrial infarction and characteristic changes in atrial activation, R/S wave, and ST segment that are not discernible at the ECG. Only indirect changes in P wave amplitude and duration were appreciated in advanced stages of acute coronary occlusion.
Collapse
Affiliation(s)
- Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Roselló-Diez
- Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Damian Sanchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Sergi Casabella-Ramon
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Nevado-Medina
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Millán
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Alonso-Martin
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
27
|
Guerra JM, Vilahur G, Bayés de Luna A, Cabrera JA, Martínez-Sellés M, Mendieta G, Baranchuk A, Sánchez-Quintana D. Interatrial block can occur in the absence of left atrial enlargement: New experimental model. Pacing Clin Electrophysiol 2020; 43:427-429. [PMID: 32144785 DOI: 10.1111/pace.13895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
We present the surface electrocardiogram of an open-chest anesthetized healthy adult swine after direct application of ice at the transversus sinus of the pericardium where the Bachmann's region is located. Gradual and transient interatrial block (IAB) in the absence of structural atrial disease is described. This new experimental model demonstrated that IAB is an independent entity from left atrial enlargement.
Collapse
Affiliation(s)
- Jose M Guerra
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Gemma Vilahur
- IR-Hospital Santa Creu i Sant Pau, Cardiovascular Program ICCC, Barcelona, Spain
| | - Antoni Bayés de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Jose Angel Cabrera
- Hospital Universitario Quirón-Madrid, European University of Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto Investigación Biomédica Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Guiomar Mendieta
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Adrián Baranchuk
- Division of Cardiology, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| |
Collapse
|
28
|
Zagrodzky J, Gallagher MM, Leung LWM, Sharkoski T, Santangeli P, Tschabrunn C, Guerra JM, Campos B, MacGregor J, Hayat J, Clark B, Mazur A, Feher M, Arnold M, Metzl M, Nazari J, Kulstad E. Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation. J Vis Exp 2020. [PMID: 32225140 DOI: 10.3791/60733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.
Collapse
Affiliation(s)
| | - Mark M Gallagher
- St George's University Hospitals NHS Foundation Trust, St. George's, University of London
| | - Lisa W M Leung
- St George's University Hospitals NHS Foundation Trust, St. George's, University of London
| | - Tiffany Sharkoski
- Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine
| | | | | | - Jose M Guerra
- Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, CIBERCV
| | - Bieito Campos
- Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, CIBERCV
| | | | - Jamal Hayat
- St George's University Hospitals NHS Foundation Trust, St. George's, University of London
| | | | | | | | | | | | | | - Erik Kulstad
- Department of Emergency Medicine, University of Texas, Southwestern Medical Center;
| |
Collapse
|
29
|
Leung LWM, Gallagher MM, Santangeli P, Tschabrunn C, Guerra JM, Campos B, Hayat J, Atem F, Mickelsen S, Kulstad E. Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2019; 59:347-355. [PMID: 31758504 PMCID: PMC7591442 DOI: 10.1007/s10840-019-00661-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022]
Abstract
Purpose Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation. Methods We searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy. Results A total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high-grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation. Conclusions Esophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.
Collapse
Affiliation(s)
- Lisa WM Leung
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, St. George’s, University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Mark M Gallagher
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, St. George’s, University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Pasquale Santangeli
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, PA 19104 Philadelphia, United States
| | - Cory Tschabrunn
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, PA 19104 Philadelphia, United States
| | - Jose M Guerra
- Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Bieito Campos
- Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Jamal Hayat
- Department of Gastroenterology, St George’s University Hospitals NHS Foundation Trust, St. George’s, University of London, Cranmer Terrace, Tooting, London, SW17 0RE UK
| | - Folefac Atem
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, 75390 Dallas, TX United States
| | - Steven Mickelsen
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, United States
| | - Erik Kulstad
- Department of Emergency Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, 75390 Dallas, TX United States
| |
Collapse
|
30
|
Petras A, Leoni M, Guerra JM, Jansson J, Gerardo-Giorda L. A computational model of open-irrigated radiofrequency catheter ablation accounting for mechanical properties of the cardiac tissue. Int J Numer Method Biomed Eng 2019; 35:e3232. [PMID: 31256443 DOI: 10.1002/cnm.3232] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/27/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
Radiofrequency catheter ablation (RFCA) is an effective treatment for cardiac arrhythmias. Although generally safe, it is not completely exempt from the risk of complications. The great flexibility of computational models can be a major asset in optimizing interventional strategies if they can produce sufficiently precise estimations of the generated lesion for a given ablation protocol. This requires an accurate description of the catheter tip and the cardiac tissue. In particular, the deformation of the tissue under the catheter pressure during the ablation is an important aspect that is overlooked in the existing literature, which resorts to a sharp insertion of the catheter into an undeformed geometry. As the lesion size depends on the power dissipated in the tissue and the latter depends on the percentage of the electrode surface in contact with the tissue itself, the sharp insertion geometry has the tendency to overestimate the lesion obtained, which is a consequence of the tissue temperature rise overestimation. In this paper, we introduce a full 3D computational model that takes into account the tissue elasticity and is able to capture tissue deformation and realistic power dissipation in the tissue. Numerical results in FEniCS-HPC are provided to validate the model against experimental data and to compare the lesions obtained with the new model and with the classical ones featuring a sharp electrode insertion in the tissue.
Collapse
Affiliation(s)
| | - Massimiliano Leoni
- Basque Center for Applied Mathematics, Bilbao, Spain
- Department of Computational Science and Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Johan Jansson
- Basque Center for Applied Mathematics, Bilbao, Spain
- Department of Computational Science and Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | | |
Collapse
|
31
|
Guerra JM, Fernandes NCCA, Réssio RA, Magno JA, Kimura LM, Barbosa JEDR, Bertollo DMB, Taniguchi HH, Hiramoto RM, Motoie G, Tolezano JE, Cogliati B. Evaluation of Cytopathological Techniques for the Diagnosis of Canine Visceral Leishmaniosis with Lymph Node Samples. J Comp Pathol 2019; 172:62-71. [PMID: 31690418 DOI: 10.1016/j.jcpa.2019.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/13/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Abstract
The identification of the parasite in cytological smears of lymph node aspirates is a widely applied technique for the direct diagnosis of Leishmania spp. infection, especially in endemic areas. Although very specific, this method has limited sensitivity, and improving the technique would be highly desirable. This study aimed to evaluate the efficacy of conventional smear cytology (SC), liquid-based cytology (LBC), cell block (CB) stained with haematoxylin and eosin (HE) and immunocytochemistry (ICC), and formalin-fixed paraffin wax-embedded tissue immunohistochemistry (FFPE-IHC) compared with serology and polymerase chain reaction for the diagnosis of canine visceral leishmaniosis (CVL) in lymphoid tissue. The use of a preservative medium and centrifugation for cytological samples reduced the number of unsatisfactory artefacts/background. Moreover, LBC allowed excellent cellular preservation and the application of ancillary techniques, such as CB and ICC. SC was the most accurate morphological diagnostic method (45.0%). CB-ICC alone or associated with SC demonstrated significantly higher sensitivity (70.0% and 72.0%, respectively) when compared with SC alone (34.00%). CB-ICC was found to be more effective in the detection of infected animals with mild clinical signs, similar to FFPE-IHC. The specificity and positive predictive value were similar between all methods. Finally, the detection limit for CB-ICC and SC + CB-ICC was identical (18.46 amastigotes/mm2). Our study suggests that CB-ICC is a promising tool for improvement of the cytopathological diagnosis of CVL and may be applied in routine epidemiological screening.
Collapse
Affiliation(s)
- J M Guerra
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil; Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva, 87, São Paulo, Brazil.
| | - N C C A Fernandes
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil; Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva, 87, São Paulo, Brazil
| | - R A Réssio
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - J A Magno
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - L M Kimura
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - J E de R Barbosa
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - D M B Bertollo
- Centro de Laboratório Regional Instituto Adolfo Lutz São José do Rio Preto, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, Rua Alberto Sufredini Bertoni, 2325, Maceno, São José do Rio Preto, São Paulo, Brazil
| | - H H Taniguchi
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - R M Hiramoto
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - G Motoie
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - J E Tolezano
- Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria do Estado da Saúde de São Paulo, São Paulo, Brazil
| | - B Cogliati
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva, 87, São Paulo, Brazil
| |
Collapse
|
32
|
Amoros-Figueras G, Rosello-Diez E, Sanchez-Quintana D, Casabella-Ramon S, Jorge E, Nevado-Medina J, Arzamendi D, Millan X, Alonso-Martin C, Guerra JM, Cinca J. P1598Electrophysiological and structural characterization of acute atrial myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0357] [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: 11/15/2022] Open
Abstract
Abstract
Background
Atrial myocardial infarction may be a risk for atrial fibrillation. However, the electrophysiological and structural characteristics of the infarcted atrial myocardium are not well known. This study aimed to analyse the changes in local atrial electrograms and myocardial structure in an experimental model of isolated atrial myocardial infarction.
Methods
Five anesthetized, open-chest pigs were submitted to 4 hours of acute atrial myocardial ischemia induced by direct surgical clamping of atrial coronary branches originating from the right coronary artery. In all cases, we recorded simultaneously the 12-lead surface electrocardiogram (ECG) and the epicardial mapping of local atrial electrograms (17 x 12.5 mm patches containing 128 electrodes, with 1 mm inter-electrode distance) in a region close to the occluded branches and in control non-treated atria. The changes in local atrial QRS-ST segment and the amplitude of the P-wave of the ECG were sequentially analysed (Figure). The hearts were removed and processed for anatomopathological examination.
Results
Selective atrial coronary branch occlusion induced a patchy atrial myocardial necrosis with an irregular and abrupt border zone (circled areas in the Figure). During the first 15 min of ischemia, the local atrial electrograms showed increasing R waves, widening of QRS complex, and ST segment elevation leading to monophasic potentials (maximal ST segment at 30 min: from 0.2±0.7 mV to 1.9±1.4 mV, ANOVA p<0.01). This period was followed by a phase of transient electrical recovery characterized by disappearance of monophasic potentials, reduction of ST segment elevation, and recovery of local electrical activation. After 60 min of occlusion, monophasic potentials reappeared and the magnitude of ST segment elevation decreased progressively during the ensuing 3 hours. The spatial transition from areas with monophasic potentials to normal electrograms encompassed 1 or 2 electrodes. The surface ECG showed increased duration of the P-wave (lead II at 3h occlusion: from 73.2±4.5 ms to 88.9±15.5 ms, ANOVA p<0.05) with absence of ST segment changes. Atrial arrhythmias were not observed.
Structural and electrical atrial changes
Conclusion
Selective occlusion of atrial coronary branches induced patchy atrial myocardial necrosis with abrupt anatomical and electrical border zone. The overt QRS and ST segment changes in local atrial electrograms resembled those described in acute ventricular myocardial ischemia, and were associated with widening of the P-wave on the surface ECG. Although acute ischemic arrhythmias were not observed, the atrial structural alterations might set the substrate for re-entrant arrhythmias late after the healing over process.
Acknowledgement/Funding
Supported by grants from ISCI-MINECO (FISPI17/00069), CIBERCV (CB16/11/00276), FEDER and Fundaciό “La Maratό” TV3 (20150830).
Collapse
Affiliation(s)
- G Amoros-Figueras
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - E Rosello-Diez
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - D Sanchez-Quintana
- University of Extremadura, Department of Anatomy & Cell Biology, Faculty of Medicine, Badajoz, Spain
| | - S Casabella-Ramon
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - E Jorge
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - J Nevado-Medina
- University of Extremadura, Department of Anatomy & Cell Biology, Faculty of Medicine, Badajoz, Spain
| | - D Arzamendi
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - X Millan
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - C Alonso-Martin
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - J M Guerra
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| | - J Cinca
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain
| |
Collapse
|
33
|
Petras A, Echeverria Ferrero M, Leoni M, Guerra JM, Jansson J, Gerardo-Giorda L. P2431Stay on the safe side: in-silico assessment of ablation protocols to prevent steam pops during radiofrequency ablation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0764] [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: 11/15/2022] Open
Abstract
Abstract
Background
Steam pops (SP) are among the most serious complications of radiofrequency ablation (RFA) due to its potential to cause myocardial tear or tamponade. SP occur when the tissue overheats, causing its water content to transform into steam and explode. Ablation parameters are critical in order to obtain an optimal lesion size while avoiding the occurrence of SP. However, the interaction between ablation settings and the physical parameters that predispose to SP occurrence during irrigated RFA are not fully understood.
Purpose
To characterize regularly used ablation protocols by means of a computational model, in order to achieve optimal lesion size while avoiding SP occurrence.
Methods
The in-silico evaluation is performed using our previously developed computational irrigated RFA model. Our model takes into account the blood-saline interaction as well as the mechanical deformation of the tissue due to the contact with the catheter tip. We test the effects of applied power and contact force on two catheter tip designs (spherical and cylindrical) and two substrates, simulated human atrium and ventricle, during 30 sec applications. A fixed blood flow and catheter-tip saline irrigation (0.5m/s and 17mL/min, respectively) are considered. We simulate human tissue by using the biophysical, mechanical and physiological properties found in the literature. SP occurrence is predicted when the temperature within the tissue reaches 100°C.
Results
Based on the interaction of power and contact force, four risk maps are constructed encompassing the two catheter-tip designs and the two simulated tissues. The maps allow the identification of those ablation protocols (contact force and delivered power) that can potentially result on SP. They correspond to that area of critical temperature values where the temperature within the tissue reach the established criteria for SP occurrence. We also present the lesion size dimensions of ablation protocols that avoid the formation of steam pops.
Conclusion
Our results indicate that the applied power has a strong impact in the formation of SP for a cylindrical catheter, while a combination of contact force and power is important to avoid risks in the case of the spherical catheter tip. The tissue characteristics do not affect significantly the SP occurrence, in agreement with experimental literature. However, the resulting lesion size appears to be larger in the simulated human atrium in comparison to the simulated human ventricle.
Acknowledgement/Funding
BERC 2018-2021, SEV-2017-0718
Collapse
Affiliation(s)
- A Petras
- BCAM Basque Center for Applied Mathematics, Bilbao, Spain
| | | | - M Leoni
- Royal Institute of Technology, Stockholm, Sweden
| | - J M Guerra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Jansson
- Royal Institute of Technology, Stockholm, Sweden
| | | |
Collapse
|
34
|
Amorós-Figueras G, Jorge E, Raga S, Alonso-Martin C, Rodríguez-Font E, Bazan V, Viñolas X, Cinca J, Guerra JM. Comparison between endocardial and epicardial cardiac resynchronization in an experimental model of non-ischaemic cardiomyopathy. Europace 2019; 20:1209-1216. [PMID: 29016778 DOI: 10.1093/europace/eux212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/31/2017] [Indexed: 12/28/2022] Open
Abstract
Aims Pacing from the left ventricular (LV) endocardium might increase the likelihood of response to cardiac resynchronization therapy. However, experimental and clinical data supporting this assumption are limited and controversial. The aim of this study was to compare the acute response of biventricular pacing from the LV epicardium and endocardium in a swine non-ischaemic cardiomyopathy (NICM) model of dyssynchrony. Methods and results A NICM was induced in six swine by 3 weeks of rapid ventricular pacing. Biventricular stimulation was performed from 16 paired locations in the LV (8 epicardial and 8 endocardial) with two different atrioventricular (80 and 110 ms) intervals and three interventricular (0, +30, -30 ms) delays. The acute response of the aortic blood flow, LV and right ventricular (RV) pressures, LVdP/dtmax and LVdP/dtmin and QRS complex width and QT duration induced by biventricular stimulation were analysed. The haemodynamic and electrical beneficial responses to either LV endocardial or epicardial biventricular pacing were similar (ΔLVdP/dtmax: +7.8 ± 2.2% ENDO vs. +7.3 ± 1.5% EPI, and ΔQRS width: -16.8 ± 1.3% ENDO vs. -17.1 ± 1.9% EPI; P = ns). Pacing from LV basal regions either from the epicardium or endocardium produced better haemodynamic responses as compared with mid or apical LV regions (P < 0.05). The LV regions producing the maximum QRS complex shortening did not correspond to those inducing the best haemodynamic responses (EPI: r2 = 0.013, P = ns; ENDO: r2 = 0.002, P = ns). Conclusion Endocardial LV pacing induced similar haemodynamic changes than pacing from the epicardium. The response to endocardial LV pacing is region dependent as observed in epicardial pacing.
Collapse
Affiliation(s)
- Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Silvia Raga
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Concepcion Alonso-Martin
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Enrique Rodríguez-Font
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Victor Bazan
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Xavier Viñolas
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Juan Cinca
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica - Sant Pau, Universitat Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| |
Collapse
|
35
|
Gregorio AW, Vasconcellos MRA, Enokihara MMSS, Guerra JM, Nonogaki S, Tomimori J. Cutaneous schistosomiasis and leishmaniasis coinfection: a case report. J Eur Acad Dermatol Venereol 2019; 33:1781-1783. [PMID: 30801816 DOI: 10.1111/jdv.15521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The polymorphic clinical presentations of schistosomiasis and leishmaniasis allow their inclusion in the differential diagnoses of several conditions. Although an overlap in distribution of these diseases has been reported in endemic areas, coinfection with cutaneous schistosomiasis and cutaneous leishmaniasis in the same patient is rare. OBJECTIVES We report an unusual case of concomitant cutaneous schistosomiasis and cutaneous leishmaniasis. Actions for the management and diagnosis were proposed. METHODS A patient presented with cutaneous lesions on the abdomen and left elbow. The presence of degenerated ova of Schistosoma mansoni in the skin biopsy led to perform a complementary investigation with immunohistochemical techniques, rectal biopsy and abdominal ultrasonography. After the left elbow lesions had failed to improve after several weeks of standard treatment, a new biopsy was performed and led to diagnosis of another infection. RESULTS The patient lived in an endemic area for two infectious diseases (schistosomiasis and leishmaniasis). Biopsies revealed chronic granulomatous dermatitis. Degenerated S. mansoni eggs were found in the abdominal lesion and in a rectal biopsy specimen. Ultrasonography revealed hepatic involvement. Despite combination treatment with oxamniquine and praziquantel, a cutaneous lesion persisted on the left elbow; a new biopsy revealed amastigote forms of Leishmania. The patient was successfully treated with intramuscular and intralesional meglumine antimoniate. CONCLUSIONS The presence of a similar granulomatous infiltrate in lesions caused by the two different infectious agents led to a delay in the diagnosis of cutaneous leishmaniasis. This report serves as a warning of the unusual possibility of cutaneous schistosomiasis and leishmaniasis coinfection in an endemic area.
Collapse
Affiliation(s)
- A W Gregorio
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - M R A Vasconcellos
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - M M S S Enokihara
- Department of Pathology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - J M Guerra
- Instituto Adolfo Lutz, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
| | - S Nonogaki
- Instituto Adolfo Lutz, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
| | - J Tomimori
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
36
|
Jorge E, Solé-González E, Amorós-Figueras G, Arzamendi D, Guerra JM, Millán X, Vives-Borrás M, Cinca J. Influence of Left Bundle Branch Block on the Electrocardiographic Changes Induced by Acute Coronary Artery Occlusion of Distinct Location and Duration. Front Physiol 2019; 10:82. [PMID: 30809155 PMCID: PMC6379473 DOI: 10.3389/fphys.2019.00082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/25/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Electrocardiographic (ECG) diagnosis of acute myocardial ischemia is hampered in the presence of left bundle branch block (LBBB). Objectives: We analyzed the influence of location and duration of myocardial ischemia on the ECG changes in pigs with LBBB. Methods: LBBB was acutely induced in 14 closed chest anesthetized pigs by local electrical ablation. Thereafter, episodes of 5 min catheter balloon occlusion followed by 10 min reperfusion of the left anterior descending (LAD), left circumflex (LCX), and right (RCA) coronary arteries were done sequentially in 5 pigs. Additionally, a 3-h occlusion of these arteries was performed separately in the other 9 pigs. A 15-lead ECG including leads V7 to V9 was continuously recorded. Results: Ablation induced LBBB showed QRS widening, loss of r wave in V1, and predominant R waves in V2 to V9. After 5 min of ischemia the occluded artery could be identified in all cases: the LAD by R waves and ST elevation in V1–V3; the LCX by both ST segment elevation in II, III, aVF, V7 to V9 and ST segment depression in V1 to V4; and the RCA by ST depression and new S-waves in all precordial leads. Three hours after coronary occlusion, ST segment changes declined progressively and only the LAD occlusion could be reliably recognized. Conclusion: LBBB did not mask the ECG recognition of the occluded coronary artery during the first 60 min of ischemia, but 3 h later only the LAD occlusion could be reliably identified. ST elevation in leads V7 to V9 is specific of LCX occlusion and it could be useful in the diagnosis of acute myocardial ischemia in the presence of LBBB.
Collapse
Affiliation(s)
- Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduard Solé-González
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Millán
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Vives-Borrás
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
37
|
Benitez‐Amaro A, Samouillan V, Jorge E, Dandurand J, Nasarre L, de Gonzalo‐Calvo D, Bornachea O, Amoros‐Figueras G, Lacabanne C, Vilades D, Leta R, Carreras F, Gallardo A, Lerma E, Cinca J, Guerra JM, Llorente‐Cortés V. Identification of new biophysical markers for pathological ventricular remodelling in tachycardia-induced dilated cardiomyopathy. J Cell Mol Med 2018; 22:4197-4208. [PMID: 29921039 PMCID: PMC6111813 DOI: 10.1111/jcmm.13699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/17/2018] [Indexed: 11/28/2022] Open
Abstract
Our aim was to identify biophysical biomarkers of ventricular remodelling in tachycardia-induced dilated cardiomyopathy (DCM). Our study includes healthy controls (N = 7) and DCM pigs (N = 10). Molecular analysis showed global myocardial metabolic abnormalities, some of them related to myocardial hibernation in failing hearts, supporting the translationality of our model to study cardiac remodelling in dilated cardiomyopathy. Histological analysis showed unorganized and agglomerated collagen accumulation in the dilated ventricles and a higher percentage of fibrosis in the right (RV) than in the left (LV) ventricle (P = .016). The Fourier Transform Infrared Spectroscopy (FTIR) 1st and 2nd indicators, which are markers of the myofiber/collagen ratio, were reduced in dilated hearts, with the 1st indicator reduced by 45% and 53% in the RV and LV, respectively, and the 2nd indicator reduced by 25% in the RV. The 3rd FTIR indicator, a marker of the carbohydrate/lipid ratio, was up-regulated in the right and left dilated ventricles but to a greater extent in the RV (2.60-fold vs 1.61-fold, P = .049). Differential scanning calorimetry (DSC) showed a depression of the freezable water melting point in DCM ventricles - indicating structural changes in the tissue architecture - and lower protein stability. Our results suggest that the 1st, 2nd and 3rd FTIR indicators are useful markers of cardiac remodelling. Moreover, the 2nd and 3rd FITR indicators, which are altered to a greater extent in the right ventricle, are associated with greater fibrosis.
Collapse
Affiliation(s)
- Aleyda Benitez‐Amaro
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
| | - Valerie Samouillan
- CIRIMATUniversité de ToulouseUniversité Paul Sabatier, Physique des PolymèresToulouseFrance
| | - Esther Jorge
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Jany Dandurand
- CIRIMATUniversité de ToulouseUniversité Paul Sabatier, Physique des PolymèresToulouseFrance
| | - Laura Nasarre
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - David de Gonzalo‐Calvo
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
- CIBERCVBarcelonaSpain
| | - Olga Bornachea
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
| | - Gerard Amoros‐Figueras
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Colette Lacabanne
- CIRIMATUniversité de ToulouseUniversité Paul Sabatier, Physique des PolymèresToulouseFrance
| | - David Vilades
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Ruben Leta
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Francesc Carreras
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Alberto Gallardo
- Department of PathologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Enrique Lerma
- Department of PathologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Juan Cinca
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Jose M. Guerra
- CIBERCVBarcelonaSpain
- Department of CardiologyHospital de la Santa Creu i Sant PauBiomedical Research Institute Sant Pau (IIB Sant Pau)Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Vicenta Llorente‐Cortés
- Group of Lipids and Cardiovascular PathologyICCC ProgramBiomedical Research Institute Sant Pau (IIB Sant Pau)Hospital de la Santa Creu i Sant PauBarcelonaSpain
- Institute of Biomedical Research of Barcelona (IIBB)Spanish National Research Council (CSIC)BarcelonaSpain
- CIBERCVBarcelonaSpain
| |
Collapse
|
38
|
Sole Gonzalez E, Jorge E, Amoros-Figueras G, Vives-Borras M, Millan X, Arzamendi D, Guerra JM, Cinca J. 2373Time course of the ST-segment changes induced by acute coronary artery occlusion in a model of left bundle branch block in pigs. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2373] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Sole Gonzalez
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, CIBERCV, Barcelona, Spain
| | - E Jorge
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, CIBERCV, Barcelona, Spain
| | - G Amoros-Figueras
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - M Vives-Borras
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - X Millan
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, Barcelona, Spain
| | - D Arzamendi
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, CIBERCV, Barcelona, Spain
| | - J M Guerra
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, CIBERCV, Barcelona, Spain
| | - J Cinca
- Hospital de la Santa Creu i Sant Pau, Cardiology Department, CIBERCV, Barcelona, Spain
| |
Collapse
|
39
|
Amoros-Figueras G, Jorge E, Guerra JM. Is the rapidly paced pig the optimal model for endocardial cardiac resynchronization therapy?—Authors’ reply. Europace 2018; 20:1228-1229. [DOI: 10.1093/europace/eux292] [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)
- Gerard Amoros-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica - Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Ma Claret, Barcelona, Spain
- Centro de Investigación Biomèdica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - Esther Jorge
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica - Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Ma Claret, Barcelona, Spain
- Centro de Investigación Biomèdica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica - Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Ma Claret, Barcelona, Spain
- Centro de Investigación Biomèdica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| |
Collapse
|
40
|
Mayordomo JI, Guerra JM, Guijarro C, García-Prats MD, Gómez A, López-Brea M, González R, Hergueta P, López-Pino MA, Martínez-Tello F. Neoplasms of Unknown Primary Site: A Clinicopathological Study of Autopsied Patients. Tumori 2018; 79:321-4. [PMID: 8116074 DOI: 10.1177/030089169307900507] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 11/17/2022]
Abstract
Background Malignant neoplasms of an unknown primary site (NUPS) remain a diagnostic and therapeutic challenge in clinical practice. With this in mind, we have reviewed all autopsies performed in patients with NUPS in a single institution. Patients and methods By reviewing 1656 autopsies performed on adults in our Institution (1974-1990), 43 cases of NUPS were found. (NUPS was defined as histologically proven malignant tumor for which a primary site could not be found after anamnesis, complete physical examination, chest X-ray and routine chemistries.) Results There were 24 men (56 %) and 19 women. Mean age was 62 years (76 % of patients were aged 40-75). Clinical presentation included general deterioration (73 %), digestive symptoms (58 %), liver enlargement (58 %) abdominal pain (56 %), respiratory symptoms (45 %), ascites (26 %) and node enlargement (16 %). Abnormalities in analysis and image tests were frequent but nonspecific. Median time from admission to death was 42 days (range, 4-135). Pathologic diagnoses at autopsy were: 23 adenocarcinomas (53 %), arising from pancreas (6), biliary tree (6), lung (3), prostate (2), stomach (1), kidney (1) and unknown (4); 3 squamous carcinomas (5 %) (1 renal pelvis, 1 biliary tree, 1 stomach); 5 undifferentiated carcinomas (1 lung, 4 unknown); and 12 miscellaneous tumors (including 3 lymphomas, 3 neuroendocrine tumors, 3 hepatocarcinomas, 2 mesotheliomas and 1 melanoma). There was a tendency towards a metastatic pattern different from that expected from the primary tumor. Image tests were of little usefulness in the search for the primary tumor. Conclusions 1) Adenocarciomas were the most frequent tumor presenting as NUPS, especially from the pancreas and biliary tree. 2) In this series, at least 11 % of patients were amenable to standard systemic therapies (3 lymphomas and 2 prostatic adenocarcinomas) if a correct pathologic diagnosis could have been established when alive. 3) Presenting symptoms and metastatic pattern differed from those expected for the primary neoplasm eventually found. 4) Image tests were often misleading as regards the primary site, although they were useful to quantify the dissemination of the tumor.
Collapse
Affiliation(s)
- J I Mayordomo
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Díaz-Delgado J, Sanches TC, Cirqueira CS, Coimbra AAC, Guerra JM, Olivares V, Di Loretto C, Ressio RA, Iglezias S, Fernandes NCCA, Kanamura C, Groch KR, Catão-Dias JL. Multicentric cutaneous keratoacanthomas in a free-living marmoset (Callithrix sp.). J Med Primatol 2018; 47:205-208. [PMID: 29574930 DOI: 10.1111/jmp.12341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 11/29/2022]
Abstract
Cutaneous neoplasia is common in non-human primates. We describe the gross and microscopic features of multicentric cutaneous keratoacanthomas in a free-living marmoset (Callithrix sp.). Immunohistochemistry for human papillomavirus and herpes simplex virus type I and simplex virus type II was negative. Keratoacanthomas should be included in the differential diagnosis for cutaneous masses in non-human primates.
Collapse
Affiliation(s)
- J Díaz-Delgado
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - T C Sanches
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre (DEPAVE-3), Prefeitura do Municipio de São Paulo, São Paulo, SP, Brazil
| | - C S Cirqueira
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - A A C Coimbra
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre (DEPAVE-3), Prefeitura do Municipio de São Paulo, São Paulo, SP, Brazil
| | - J M Guerra
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - V Olivares
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre (DEPAVE-3), Prefeitura do Municipio de São Paulo, São Paulo, SP, Brazil
| | - C Di Loretto
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - R A Ressio
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - S Iglezias
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - N C C A Fernandes
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - C Kanamura
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - K R Groch
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - J L Catão-Dias
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
42
|
Díaz-Delgado J, Coimbra AAC, Dos Santos-Cirqueira C, Sanches TC, Guerra JM, de Oliveira AS, Di Loretto C, Zwarg T, Ressio R, Rivas L, Sansone M, Nagamori FO, Kanamura C, Gonçalves PS, Fernandes NCCA, Groch KR, Catão-Dias JL. Parotid Salivary Gland Basal Cell Adenocarcinoma in a Big-eared Opossum (Didelphis aurita). J Comp Pathol 2018; 159:21-25. [PMID: 29599001 DOI: 10.1016/j.jcpa.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/30/2017] [Revised: 12/24/2017] [Accepted: 12/27/2017] [Indexed: 11/18/2022]
Abstract
The opossum (family Didelphidae) is a marsupial endemic to the Americas. Apart from the South American short-tailed opossum (Monodelphis domestica) and the Virginia opossum (Didelphis virginiana), there is considerable lack of knowledge about the health and diseases of most opossum species. Among these, the big-eared opossum (Didelphis aurita) is found in Argentina, Brazil and Paraguay. Natural and experimental studies have shown this species to be susceptible to infectious agents with zoonotic potential and the animals may play a role in transmission of such agents. However, neoplasia appears to be uncommon in this species. We describe the gross, microscopical and immunohistochemical features of a parotid salivary gland basal cell adenocarcinoma in a free-living big-eared opossum. This case represents the first report of salivary gland neoplasia in opossums.
Collapse
Affiliation(s)
- J Díaz-Delgado
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva 87, São Paulo, São Paulo, Brazil; Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil.
| | - A A C Coimbra
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre, IV Portão 7A, Av. Quarto Centenário, Parque Ibirapuera, São Paulo, São Paulo, Brazil
| | - C Dos Santos-Cirqueira
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - T C Sanches
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre, IV Portão 7A, Av. Quarto Centenário, Parque Ibirapuera, São Paulo, São Paulo, Brazil
| | - J M Guerra
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva 87, São Paulo, São Paulo, Brazil
| | - A S de Oliveira
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre, IV Portão 7A, Av. Quarto Centenário, Parque Ibirapuera, São Paulo, São Paulo, Brazil
| | - C Di Loretto
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - T Zwarg
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre, IV Portão 7A, Av. Quarto Centenário, Parque Ibirapuera, São Paulo, São Paulo, Brazil
| | - R Ressio
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - L Rivas
- Divisão Técnica de Medicina Veterinária e Manejo da Fauna Silvestre, IV Portão 7A, Av. Quarto Centenário, Parque Ibirapuera, São Paulo, São Paulo, Brazil
| | - M Sansone
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - F O Nagamori
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - C Kanamura
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - P S Gonçalves
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - N C C A Fernandes
- Instituto Adolfo Lutz, Centro de Patologia, Brasil, Av. Dr. Arnaldo, 351 - 7 Andar, Sala 706, Pacaembú, São Paulo, São Paulo, Brazil
| | - K R Groch
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva 87, São Paulo, São Paulo, Brazil
| | - J L Catão-Dias
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Orlando Marques de Paiva 87, São Paulo, São Paulo, Brazil
| |
Collapse
|
43
|
Díaz-Delgado J, Guerra JM, Fernandes NCCA, Gonçalves-Serra E, Minozzo GA, Di Loretto C, Iglezias S, Groch KR, Ressio R, Kanamura C, Catão-Dias JL. Spontaneous pulmonary adenosquamous carcinoma in a free-living black capuchin monkey (Sapajus nigritus). J Med Primatol 2017; 47:120-123. [PMID: 29283438 DOI: 10.1111/jmp.12328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
Abstract
Pulmonary neoplasia is rare among wild New World primates. We report the gross, microscopical, and immunohistochemical features of a primary multicentric pulmonary adenosquamous carcinoma in a free-living black capuchin monkey (Sapajus nigritus). Herein, the spectrum of pulmonary neoplasms in non-human primates is widened and briefly reviewed.
Collapse
Affiliation(s)
- J Díaz-Delgado
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - J M Guerra
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - N C C A Fernandes
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | | | - G A Minozzo
- Laboratório Central de Saúde Pública de Paraná, Paraná, Brazil
| | - C Di Loretto
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - S Iglezias
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - K R Groch
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - R Ressio
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - C Kanamura
- Instituto Adolfo Lutz (IAL), Centro de Patologia, São Paulo, SP, Brazil
| | - J L Catão-Dias
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
44
|
Sánchez-Sarmiento AM, Carvalho VL, Sacristán C, Groch KR, Ressio RA, Fernandes NCCA, Guerra JM, Costa-Silva S, Díaz-Delgado J, Favero CM, Silva NS, Ferreira Neto JS, Meirelles ACO, Catão-Dias JL. Brucellosis in a Clymene dolphin (Stenella clymene) stranded in Brazil. Transbound Emerg Dis 2017; 65:289-291. [PMID: 28816014 DOI: 10.1111/tbed.12696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A M Sánchez-Sarmiento
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - V L Carvalho
- Associação de Pesquisa e Preservação de Ecossistemas Aquáticos-AQUASIS, Caucaia, Ceará, Brazil
| | - C Sacristán
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - K R Groch
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - R A Ressio
- Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil
| | | | - J M Guerra
- Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil
| | - S Costa-Silva
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - J Díaz-Delgado
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil
| | - C M Favero
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - N S Silva
- Laboratório de Zoonoses Bacterianas, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - J S Ferreira Neto
- Laboratório de Zoonoses Bacterianas, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - A C O Meirelles
- Associação de Pesquisa e Preservação de Ecossistemas Aquáticos-AQUASIS, Caucaia, Ceará, Brazil
| | - J L Catão-Dias
- Laboratório de Patologia Comparada de Animais Selvagens, Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
45
|
Andre E, Yaniz-Galende E, Hamilton C, Dusting GJ, Hellen N, Poulet CE, Diez Cunado M, Smits AM, Lowe V, Eckardt D, Du Pre B, Sanz Ruiz R, Moerkamp AT, Tribulova N, Smani T, Liskova YV, Greco S, Guzzolino E, Franco D, Lozano-Velasco E, Knorr M, Pavoine C, Bukowska A, Van Linthout S, Miteva K, Sulzgruber P, Latet SC, Portnychenko A, Cannavo A, Kamilova U, Sagach VF, Santin Y, Octavia Y, Haller PM, Octavia Y, Rubies C, Dei Zotti F, Wong KHK, Gonzalez Miqueo A, Kruithof BPT, Kadur Nagaraju C, Shaposhnikova Y, Songia P, Lindner D, Wilson C, Benzoni P, Fabbri A, Campostrini G, Jorge E, Casini S, Mengarelli I, Nikolov A, Bublikov DS, Kheloufi M, Rubies C, Walker RE, Van Dijk RA, Posthuma JJ, Dumitriu IE, Karshovska E, Sakic A, Alexandru N, Martin-Lorenzo M, Molica F, Taylor RF, Mcarthur L, Crocini C, Matsuyama TA, Mazzoni L, Lin WK, Owen TJ, Scigliano M, Sheehan A, Bezerra Gurgel AR, Bromage DI, Kiss A, Ikeda G, Pickard JMJ, Wirth G, Casos K, Khudiakov A, Nistal JF, Ferrantini C, Park SJ, Di Maggio S, Gentile F, Dini L, Buyandelger B, Larrasa-Alonso J, Schirmer I, Chin SH, Cimiotti D, Martini H, Hohensinner PJ, Garabito M, Zeni F, Licholai S, De Bortoli M, Sivitskaya L, Viczenczova C, Rainer PP, Smith LE, Suna G, Gambardella J, Cozma A, De Gonzalo Calvo D, Scoditti E, Clark BJ, Mansfield C, Eckardt D, Gomez L, Llucia-Valldeperas A, De Pauw A, Porporato P, Bouzin C, Draoui N, Sonveaux P, Balligand JL, Mougenot N, Formicola L, Nadaud S, Dierick F, Hajjar RJ, Marazzi G, Sassoon D, Hulot JS, Zamora VR, Burton FL, Macquaide N, Smith GL, Hernandez D, Sivakumaran P, Millard R, Wong RCB, Pebay A, Shepherd RK, Lim SY, Owen T, Jabbour RJ, Kloc M, Kodagoda T, Denning C, Harding SE, Ramos S, Terracciano C, Gorelik J, Wei K, Bushway P, Ruiz-Lozano P, Mercola M, Moerkamp AT, Vegh AMD, Dronkers E, Lodder K, Van Herwaarden T, Goumans MJ, Pellet-Many C, Zachary I, Noack K, Bosio A, Feyen DAM, Demkes EJ, Dierickx PJ, Doevendans PA, Vos MA, Van Veen AAB, Van Laake LW, Fernandez Santos ME, Suarez Sancho S, Fuentes Arroyo L, Plasencia Martin V, Velasco Sevillano P, Casado Plasencia A, Climent AM, Guillem M, Atienza Fernandez F, Fernandez-Aviles F, Dingenouts CKE, Lodder K, Kruithof BPT, Van Herwaarden T, Vegh AMD, Goumans MJ, Smits AM, Knezl V, Szeiffova Bacova B, Egan Benova T, Viczenczova C, Goncalvesova E, Slezak J, Calderon-Sanchez E, Diaz I, Ordonez A, Salikova SP, Zaccagnini G, Voellenkle C, Sadeghi I, Maimone B, Castelvecchio S, Gaetano C, Menicanti L, Martelli F, Hatcher C, D'aurizio R, Groth M, Baugmart M, Mercatanti A, Russo F, Mariani L, Magliaro C, Pitto L, Lozano-Velasco E, Jodar-Garcia A, Galiano-Torres J, Lopez-Navarrete I, Aranega A, Wagensteen R, Quesada A, Aranega A, Franco D, Finger S, Karbach S, Kossmann S, Muenzel T, Wenzel P, Keck M, Mougenot N, Favier S, Fuand A, Atassi F, Barbier C, Lompre AM, Hulot JS, Nikonova Y, Pluteanu F, Kockskaemper J, Chilukoti RK, Wolke C, Lendeckel U, Gardemann A, Goette A, Miteva K, Pappritz K, Mueller I, El-Shafeey M, Ringe J, Tschoepe C, Pappritz K, El-Shafeey M, Ringe J, Tschoepe C, Van Linthout S, Koller L, Richter B, Blum S, Koprak M, Huelsmann M, Pacher R, Goliasch G, Wojta J, Niessner A, Van Herck PL, Claeys MJ, Haine SE, Lenders GD, Miljoen HP, Segers VF, Vandendriescche TR, Hoymans VY, Vrints CJ, Lapikova-Bryhinska T, Gurianova V, Portnichenko H, Vasylenko M, Zapara Y, Portnichenko V, Liccardo D, Lymperopoulos A, Santangelo M, Leosco D, Koch WJ, Ferrara N, Rengo G, Alieva T, Rasulova Z, Masharipova D, Dorofeyeva NA, Drachuk KO, Sicard P, Yucel Y, Dutaur M, Vindis C, Parini A, Mialet-Perez J, Van Deel ED, De Boer M, De Waard MC, Duncker DJ, Nagel F, Inci M, Santer D, Hallstroem S, Podesser BK, Kararigas G, De Boer M, Kietadisorn R, Swinnen M, Duimel H, Verheyen F, Chrifi I, Brandt MM, Cheng C, Janssens S, Moens AL, Duncker DJ, Batlle M, Dantas AP, Sanz M, Sitges M, Mont L, Guasch E, Lobysheva I, Beauloye C, Balligand JL, Vanhoutte PM, Tang EHC, Beaumont J, Lopez B, Ravassa S, Hermida N, Valencia F, Gomez-Doblas JJ, San Jose G, De Teresa E, Diez J, Van De Merbel AF, Kruithof-De Julio M, Goumans MJ, Claus P, Dries E, Angelo Singh A, Vermeulen K, Roderick HL, Sipido KR, Driesen RB, Ilchenko I, Bobronnikova L, Myasoedova V, Alamanni F, Tremoli E, Poggio P, Becher PM, Gotzhein F, Klingel K, Blankenberg S, Westermann D, Zi M, Cartwright E, Campostrini G, Bonzanni M, Milanesi R, Bucchi A, Baruscotti M, Difrancesco D, Barbuti A, Fantini M, Wilders R, Severi S, Benzoni P, Dell' Era P, Serzanti M, Olesen MS, Muneretto C, Bisleri G, Difrancesco D, Baruscotti M, Bucchi A, Barbuti A, Amoros-Figueras G, Raga S, Campos B, Alonso-Martin C, Rodriguez-Font E, Vinolas X, Cinca J, Guerra JM, Mengarelli I, Schumacher CA, Veldkamp MW, Verkerk AO, Remme CA, Veerman C, Guan K, Stauske M, Tan H, Barc J, Wilde A, Verkerk A, Bezzina C, Tsinlikov I, Tsinlikova I, Nicoloff G, Blazhev A, Garev A, Andrienko AV, Lychev VG, Vorobova EN, Anchugina DA, Vion AC, Hammoutene A, Poisson J, Dupont N, Souyri M, Tedgui A, Codogno P, Boulanger CM, Rautou PE, Dantas AP, Batlle M, Guasch E, Torres M, Montserrat JM, Almendros I, Mont L, Austin CA, Holt CM, Rijs K, Wezel A, Hamming JF, Kolodgie FD, Virmani R, Schaapherder AF, Lindeman JHN, Posma JJN, Van Oerle R, Spronk HMH, Ten Cate H, Dinkla S, Kaski JC, Schober A, Chaabane C, Ambartsumian N, Grigorian M, Bochaton-Piallat ML, Dragan E, Andrei E, Niculescu L, Georgescu A, Gonzalez-Calero L, Maroto AS, Martinez PJ, Heredero A, Aldamiz-Echevarria G, Vivanco F, Alvarez-Llamas G, Meens MJ, Pelli G, Foglia B, Scemes E, Kwak BR, Caldwell JL, Eisner DA, Dibb KM, Trafford AW, Chilton L, Smith GL, Nicklin SA, Coppini R, Ferrantini C, Yan P, Loew LM, Poggesi C, Cerbai E, Pavone FS, Sacconi L, Tanaka H, Ishibashi-Ueda H, Takamatsu T, Coppini R, Ferrantini C, Gentile F, Pioner JM, Santini L, Sartiani L, Bargelli V, Poggesi C, Mugelli A, Cerbai E, Maciejewska M, Bolton EL, Wang Y, O'brien F, Ruas M, Lei M, Sitsapesan R, Galione A, Terrar DA, Smith JG, Garcia D, Barriales-Villa R, Monserrat L, Harding SE, Denning C, Marston SB, Watson S, Tkach S, Faggian G, Terracciano CM, Perbellini F, Eiros Zamora J, Papadaki M, Messer A, Marston S, Gould I, Johnston A, Dunne M, Smith G, Kemi OJ, Pillai M, Davidson SM, Yellon DM, Tratsiakovich Y, Jang J, Gonon AT, Pernow J, Matoba T, Koga J, Egashira K, Burke N, Davidson SM, Yellon DM, Korpisalo P, Hakkarainen H, Laidinen S, Yla-Herttuala S, Ferrer-Curriu G, Perez M, Permanyer E, Blasco-Lucas A, Gracia JM, Castro MA, Barquinero J, Galinanes M, Kostina D, Kostareva A, Malashicheva A, Merino D, Ruiz L, Gomez J, Juarez C, Gil A, Garcia R, Hurle MA, Coppini R, Pioner JM, Gentile F, Mazzoni L, Rossi A, Tesi C, Belardinelli L, Olivotto I, Cerbai E, Mugelli A, Poggesi C, Eun-Ji EJ, Lim BK, Choi DJ, Milano G, Bertolotti M, De Marchis F, Zollo F, Sommariva E, Capogrossi MC, Pompilio G, Bianchi ME, Raucci A, Pioner JM, Coppini R, Scellini B, Tardiff J, Tesi C, Poggesi C, Ferrantini C, Mazzoni L, Sartiani L, Coppini R, Diolaiuti L, Ferrari P, Cerbai E, Mugelli A, Mansfield C, Luther P, Knoell R, Villalba M, Sanchez-Cabo F, Lopez-Olaneta MM, Ortiz-Sanchez P, Garcia-Pavia P, Lara-Pezzi E, Klauke B, Gerdes D, Schulz U, Gummert J, Milting H, Wake E, Kocsis-Fodor G, Brack KE, Ng GA, Kostareva A, Smolina N, Majchrzak M, Moehner D, Wies A, Milting H, Stehle R, Pfitzer G, Muegge A, Jaquet K, Maggiorani D, Lefevre L, Dutaur M, Mialet-Perez J, Parini A, Cussac D, Douin-Echinard V, Ebenbauer B, Kaun C, Prager M, Wojta J, Rega-Kaun G, Costa G, Onetti Y, Jimenez-Altayo F, Vila E, Dantas AP, Milano G, Bertolotti M, Scopece A, Piacentini L, Bianchi ME, Capogrossi MC, Pompilio G, Colombo G, Raucci A, Blaz M, Kapelak B, Sanak M, Bauce B, Calore C, Lorenzon A, Calore M, Poloni G, Mazzotti E, Rigato I, Daliento L, Basso C, Thiene G, Melacini P, Corrado D, Rampazzo A, Danilenko NG, Vaikhanskaya TG, Davydenko OG, Szeiffova Bacova B, Kura B, Egan Benova T, Yin CH, Kukreja R, Slezak J, Tribulova N, Lee DI, Sorge M, Glabe C, Paolocci N, Guarnieri C, Tomaselli GF, Kass DA, Van Eyk JE, Agnetti G, Cordwell SJ, White MY, Wojakowski W, Lynch M, Barallobre-Barreiro J, Yin X, Mayr U, White S, Jahingiri M, Hill J, Mayr M, Sorriento D, Ciccarelli M, Fiordelisi A, Campiglia P, Trimarco B, Iaccarino G, Sitar Taut AV, Schiau S, Orasan O, Halloumi W, Negrean V, Zdrenghea D, Pop D, Van Der Meer RW, Rijzewijk LJ, Smit JWA, Revuelta-Lopez E, Nasarre L, Escola-Gil JC, Lamb HJ, Llorente-Cortes V, Pellegrino M, Massaro M, Carluccio MA, Calabriso N, Wabitsch M, Storelli C, De Caterina R, Church SJ, Callagy S, Begley P, Kureishy N, Mcharg S, Bishop PN, Unwin RD, Cooper GJS, Mawad D, Perbellini F, Tonkin J, Bello SO, Simonotto JD, Lyon AR, Stevens MM, Terracciano CM, Harding SE, Kernbach M, Czichowski V, Bosio A, Fuentes L, Hernandez-Redondo I, Guillem MS, Fernandez ME, Sanz R, Atienza F, Climent AM, Fernandez-Aviles F, Soler-Botija C, Prat-Vidal C, Galvez-Monton C, Roura S, Perea-Gil I, Bragos R, Bayes-Genis A. Poster session 1Cell growth, differentiation and stem cells - Heart72Understanding the metabolism of cardiac progenitor cells: a first step towards controlling their proliferation and differentiation?73Expression of pw1/peg3 identifies a new cardiac adult stem cell population involved in post-myocardial infarction remodeling74Long-term stimulation of iPS-derived cardiomyocytes using optogenetic techniques to promote phenotypic changes in E-C coupling75Benefits of electrical stimulation on differentiation and maturation of cardiomyocytes from human induced pluripotent stem cells76Constitutive beta-adrenoceptor-mediated cAMP production controls spontaneous automaticity of human induced pluripotent stem cell-derived cardiomyocytes77Formation and stability of T-tubules in cardiomyocytes78Identification of miRNAs promoting human cardiomyocyte proliferation by regulating Hippo pathway79A direct comparison of foetal to adult epicardial cell activation reveals distinct differences relevant for the post-injury response80Role of neuropilins in zebrafish heart regeneration81Highly efficient immunomagnetic purification of cardiomyocytes derived from human pluripotent stem cells82Cardiac progenitor cells posses a molecular circadian clock and display large 24-hour oscillations in proliferation and stress tolerance83Influence of sirolimus and everolimus on bone marrow-derived mesenchymal stem cell biology84Endoglin is important for epicardial behaviour following cardiac injuryCell death and apoptosis - Heart87Ultrastructural alterations reflecting Ca2+ handling and cell-to-cell coupling disorders precede occurrence of severe arrhythmias in intact animal heart88Urocortin-1 promotes cardioprotection through ERK1/2 and EPAC pathways: role in apoptosis and necrosis89Expression p38 MAPK and Cas-3 in myocardium LV of rats with experimental heart failure at melatonin and enalapril introductionTranscriptional control and RNA species - Heart92Accumulation of beta-amyloid 1-40 in HF patients: the role of lncRNA BACE1-AS93Role of miR-182 in zebrafish and mouse models of Holt-Oram syndrome94Mir-27 distinctly regulates muscle-enriched transcription factors and growth factors in cardiac and skeletal muscle cells95AF risk factors impair PITX2 expression leading to Wnt-microRNA-ion channel remodelingCytokines and cellular inflammation - Heart98Post-infarct survival depends on the interplay of monocytes, neutrophils and interferon gamma in a mouse model of myocardial Infarction99Inflammatory cd11b/c cells play a protective role in compensated cardiac hypertrophy by promoting an orai3-related pro-survival signal100Anti-inflammatory effects of endothelin receptor blockade in the atrial tissue of spontaneously hypertensive rats101Mesenchymal stromal cells reduce NLRP3 inflammasome activity in Coxsackievirus B3-induced myocarditis102Mesenchymal stromal cells modulate monocytes trafficking in Coxsackievirus B3-induced myocarditis103The impact of regulatory T lymphocytes on long-term mortality in patients with chronic heart failure104Temporal dynamics of dendritic cells after ST-elevation myocardial infarction relate with improvement of myocardial functionGrowth factors and neurohormones - Heart107Preconditioning of hypertrophied heart: miR-1 and IGF-1 crosstalk108Modulation of catecholamine secretion from human adrenal chromaffin cells by manipulation of G protein-coupled receptor kinase-2 activity109Evaluation of cyclic adenosin-3,5- monophosphate and neurohormones in patients with chronic heart failureNitric oxide and reactive oxygen species - Heart112Hydrogen sulfide donor inhibits oxidative and nitrosative stress, cardiohemodynamics disturbances and restores cNOS coupling in old rats113Role and mechanisms of action of aldehydes produced by monoamine oxidase A in cardiomyocyte death and heart failure114Exercise training has contrasting effects in myocardial infarction and pressure-overload due to different endothelial nitric oxide synthase regulation115S-Nitroso Human Serum Albumin dose-dependently leads to vasodilation and alters reactive hyperaemia in coronary arteries of an isolated mouse heart model116Modulating endothelial nitric oxide synthase with folic acid attenuates doxorubicin-induced cardiomyopathy119Effects of long-term very high intensity exercise on aortic structure and function in an animal model120Electron paramagnetic resonance spectroscopy quantification of nitrosylated hemoglobin (HbNO) as an index of vascular nitric oxide bioavailability in vivo121Deletion of repressor activator protein 1 impairs acetylcholine-induced relaxation due to production of reactive oxygen speciesExtracellular matrix and fibrosis - Heart124MicroRNA-19b is associated with myocardial collagen cross-linking in patients with severe aortic stenosis. Potential usefulness as a circulating biomarker125A new ex vivo model to study cardiac fibrosis126Heterogeneity of fibrosis and fibroblast differentiation in the left ventricle after myocardial infarction127Effect of carbohydrate metabolism degree compensation to the level of galectin-3 changes in hypertensive patients with chronic heart failure and type 2 diabetes mellitus128Statin paradox in association with calcification of bicuspid aortic valve interstitial cells129Cardiac function remains impaired despite reversible cardiac fibrosis after healed experimental viral myocarditisIon channels, ion exchangers and cellular electrophysiology - Heart132Identifying a novel role for PMCA1 (Atp2b1) in heart rhythm instability133Mutations of the caveolin-3 gene as a predisposing factor for cardiac arrhythmias134The human sinoatrial node action potential: time for a computational model135iPSC-derived cardiomyocytes as a model to dissect ion current alterations of genetic atrial fibrillation136Postextrasystolic potentiation in healthy and diseased hearts: effects of the site of origin and coupling interval of the preceding extrasystole137Absence of Nav1.8-based (late) sodium current in rabbit cardiomyocytes and human iPSC-CMs138hiPSC-derived cardiomyocytes from Brugada Syndrome patients without identified mutations do not exhibit cellular electrophysiological abnormalitiesMicrocirculation141Atherogenic indices, collagen type IV turnover and the development of microvascular complications- study in diabetics with arterial hypertension142Changes in the microvasculature and blood viscosity in women with rheumatoid arthritis, hypercholesterolemia and hypertensionAtherosclerosis145Shear stress regulates endothelial autophagy: consequences on endothelial senescence and atherogenesis146Obstructive sleep apnea causes aortic remodeling in a chronic murine model147Aortic perivascular adipose tissue displays an aged phenotype in early and late atherosclerosis in ApoE-/- mice148A systematic evaluation of the cellular innate immune response during the process of human atherosclerosis149Inhibition of Coagulation factor Xa increases plaque stability and attenuates the onset and progression of atherosclerotic plaque in apolipoprotein e-deficient mice150Regulatory CD4+ T cells from patients with atherosclerosis display pro-inflammatory skewing and enhanced suppression function151Hypoxia-inducible factor (HIF)-1alpha regulates macrophage energy metabolism by mediating miRNAs152Extracellular S100A4 is a key player of smooth muscle cell phenotypic transition: implications in atherosclerosis153Microparticles of healthy origins improve atherosclerosis-associated endothelial progenitor cell dysfunction via microRNA transfer154Arterial remodeling and metabolism impairment in early atherosclerosis155Role of pannexin1 in atherosclerotic plaque formationCalcium fluxes and excitation-contraction coupling158Amphiphysin II induces tubule formation in cardiac cells159Interleukin 1 beta regulation of connexin 43 in cardiac fibroblasts and the effects of adult cardiac myocyte:fibroblast co-culture on myocyte contraction160T-tubular electrical defects contribute to blunted beta-adrenergic response in heart failure161Beat-to-beat variability of intracellular Ca2+ dynamics of Purkinje cells in the infarct border zone of the mouse heart revealed by rapid-scanning confocal microscopy162The efficacy of late sodium current blockers in hypertrophic cardiomyopathy is dependent on genotype: a study on transgenic mouse models with different mutations163Synthesis of cADPR and NAADP by intracellular CD38 in heart: role in inotropic and arrhythmogenic effects of beta-adrenoceptor signalingContractile apparatus166Towards an engineered heart tissue model of HCM using hiPSC expressing the ACTC E99K mutation167Diastolic mechanical load delays structural and functional deterioration of ultrathin adult heart slices in culture168Structural investigation of the cardiac troponin complex by molecular dynamics169Exercise training restores myocardial and oxidative skeletal muscle function from myocardial infarction heart failure ratsOxygen sensing, ischaemia and reperfusion172A novel antibody specific to full-length stromal derived factor-1 alpha reveals that remote conditioning induces its cleavage by endothelial dipeptidyl peptidase 4173Attenuation of myocardial and vascular arginase activity by vagal nerve stimulation via a mechanism involving alpha-7 nicotinic receptor during cardiac ischemia and reperfusion174Novel nanoparticle-mediated medicine for myocardial ischemia-reperfusion injury simultaneously targeting mitochondrial injury and myocardial inflammation175Acetylcholine plays a key role in myocardial ischaemic preconditioning via recruitment of intrinsic cardiac ganglia176The role of nitric oxide and VEGFR-2 signaling in post ischemic revascularization and muscle recovery in aged hypercholesterolemic mice177Efficacy of ischemic preconditioning to protect the human myocardium: the role of clinical conditions and treatmentsCardiomyopathies and fibrosis180Plakophilin-2 haploinsufficiency leads to impaired canonical Wnt signaling in ARVC patient181Improved technique for customized, easier, safer and more reliable transverse aortic arch banding and debanding in mice as a model of pressure overload hypertrophy182Late sodium current inhibitors for the treatment of inducible obstruction and diastolic dysfunction in hypertrophic cardiomyopathy: a study on human myocardium183Angiotensin II receptor antagonist fimasartan has protective role of left ventricular fibrosis and remodeling in the rat ischemic heart184Role of High-Mobility Group Box 1 (HMGB1) redox state on cardiac fibroblasts activities and heart function after myocardial infarction185Atrial remodeling in hypertrophic cardiomyopathy: insights from mouse models carrying different mutations in cTnT186Electrophysiological abnormalities in ventricular cardiomyocytes from a Maine Coon cat with hypertrophic cardiomyopathy: effects of ranolazine187ZBTB17 is a novel cardiomyopathy candidate gene and regulates autophagy in the heart188Inhibition of SRSF4 in cardiomyocytes induces left ventricular hypertrophy189Molecular characterization of a novel cardiomyopathy related desmin frame shift mutation190Autonomic characterisation of electro-mechanical remodeling in an in-vitro leporine model of heart failure191Modulation of Ca2+-regulatory function by three novel mutations in TNNI3 associated with severe infant restrictive cardiomyopathyAging194The aging impact on cardiac mesenchymal like stromal cells (S+P+)195Reversal of premature aging markers after bariatric surgery196Sex-associated differences in vascular remodeling during aging: role of renin-angiotensin system197Role of the receptor for advanced glycation end-products (RAGE) in age dependent left ventricle dysfunctionsGenetics and epigenetics200hsa-miR-21-5p as a key factor in aortic remodeling during aneurysm formation201Co-inheritance of mutations associated with arrhythmogenic and hypertrophic cardiomyopathy in two Italian families202Lamin a/c hot spot codon 190: form various amino acid substitutions to clinical effects203Treatment with aspirin and atorvastatin attenuate cardiac injury induced by rat chest irradiation: Implication of myocardial miR-1, miR-21, connexin-43 and PKCGenomics, proteomics, metabolomics, lipidomics and glycomics206Differential phosphorylation of desmin at serines 27 and 31 drives the accumulation of preamyloid oligomers in heart failure207Potential role of kinase Akt2 in the reduced recovery of type 2 diabetic hearts subjected to ischemia / reperfusion injury208A proteomics comparison of extracellular matrix remodelling in porcine coronary arteries upon stent implantationMetabolism, diabetes mellitus and obesity211Targeting grk2 as therapeutic strategy for cancer associated to diabetes212Effects of salbutamol on large arterial stiffness in patients with metabolic syndrome213Circulating microRNA-1 and microRNA-133a: potential biomarkers of myocardial steatosis in type 2 diabetes mellitus214Anti-inflammatory nutrigenomic effects of hydroxytyrosol in human adipocytes - protective mechanisms of mediterranean diets in obesity-related inflammation215Alterations in the metal content of different cardiac regions within a rat model of diabetic cardiomyopathyTissue engineering218A novel conductive patch for application in cardiac tissue engineering219Establishment of a simplified and improved workflow from neonatal heart dissociation to cardiomyocyte purification and characterization220Effects of flexible substrate on cardiomyocytes cell culture221Mechanical stretching on cardiac adipose progenitors upregulates sarcomere-related genes. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
46
|
Alonso-Martín C, Rodríguez-Font E, Guerra JM, Viñolas X. High-Density Mapping of Counterclockwise to Clockwise Typical Atrial Flutter: Visualization of the Conduction Gap. J Cardiovasc Electrophysiol 2016; 27:1349-1350. [PMID: 27245474 DOI: 10.1111/jce.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 05/16/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Concepción Alonso-Martín
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca HSCSP-IIB Sant Pau, Barcelona, Spain
| | - Enrique Rodríguez-Font
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca HSCSP-IIB Sant Pau, Barcelona, Spain
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca HSCSP-IIB Sant Pau, Barcelona, Spain
| | - Xavier Viñolas
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca HSCSP-IIB Sant Pau, Barcelona, Spain
| |
Collapse
|
47
|
González-Suárez A, Berjano E, Guerra JM, Gerardo-Giorda L. Computational Modeling of Open-Irrigated Electrodes for Radiofrequency Cardiac Ablation Including Blood Motion-Saline Flow Interaction. PLoS One 2016; 11:e0150356. [PMID: 26938638 PMCID: PMC4777505 DOI: 10.1371/journal.pone.0150356] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 09/15/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) is a routine treatment for cardiac arrhythmias. During RFCA, the electrode-tissue interface temperature should be kept below 80 °C to avoid thrombus formation. Open-irrigated electrodes facilitate power delivery while keeping low temperatures around the catheter. No computational model of an open-irrigated electrode in endocardial RFCA accounting for both the saline irrigation flow and the blood motion in the cardiac chamber has been proposed yet. We present the first computational model including both effects at once. The model has been validated against existing experimental results. Computational results showed that the surface lesion width and blood temperature are affected by both the electrode design and the irrigation flow rate. Smaller surface lesion widths and blood temperatures are obtained with higher irrigation flow rate, while the lesion depth is not affected by changing the irrigation flow rate. Larger lesions are obtained with increasing power and the electrode-tissue contact. Also, larger lesions are obtained when electrode is placed horizontally. Overall, the computational findings are in close agreement with previous experimental results providing an excellent tool for future catheter research.
Collapse
Affiliation(s)
- Ana González-Suárez
- BCAM - Basque Center for Applied Mathematics, Bilbao, Basque Country, Spain
- * E-mail:
| | - Enrique Berjano
- Biomedical Synergy, Electronic Engineering Department, Universitat Politècnica de València, València, Spain
| | - Jose M. Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | |
Collapse
|
48
|
Fernandes NCCA, Guerra JM, Réssio RA, Wasques DG, Etlinger-Colonelli D, Lorente S, Nogueira E, Dagli MLZ. Liquid-based cytology and cell block immunocytochemistry in veterinary medicine: comparison with standard cytology for the evaluation of canine lymphoid samples. Vet Comp Oncol 2015; 14 Suppl 1:107-16. [PMID: 25665030 DOI: 10.1111/vco.12137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/27/2014] [Accepted: 11/30/2014] [Indexed: 12/22/2022]
Abstract
Liquid-based Cytology (LBC) consists of immediate wet cell fixation with automated slide preparation. We applied LBC, cell block (CB) and immunocytochemistry to diagnose canine lymphoma and compare results with conventional cytology. Samples from enlarged lymph nodes of 18 dogs were collected and fixed in preservative solution for automated slide preparation (LBC), CB inclusion and immunophenotyping. Two CB techniques were tested: fixed sediment method (FSM) and agar method (AM). Anti-CD79a, anti-Pax5, anti-CD3 and anti-Ki67 were used in immunocytochemistry. LBC smears showed better nuclear and nucleolar definition, without cell superposition, but presented smaller cell size and worse cytoplasmic definition. FSM showed consistent cellular groups and were employed for immunocytochemistry, while AM CBs presented sparse groups of lymphocytes, with compromised analysis. Anti-Pax-5 allowed B-cell identification, both in reactive and neoplastic lymph nodes. Our preliminary report suggests that LBC and FSM together may be promising tools to improve lymphoma diagnosis through fine-needle aspiration.
Collapse
Affiliation(s)
| | - J M Guerra
- Centro de Patologia, Instituto Adolfo Lutz, São Paulo, Brasil
| | - R A Réssio
- Centro de Patologia, Instituto Adolfo Lutz, São Paulo, Brasil
| | | | | | - S Lorente
- Centro de Patologia, Instituto Adolfo Lutz, São Paulo, Brasil
| | - E Nogueira
- Centro de Patologia, Instituto Adolfo Lutz, São Paulo, Brasil
| | - M L Z Dagli
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brasil
| |
Collapse
|
49
|
Brugaletta S, Cola C, Martin-Yuste V, Vilahur G, Oriol J, Padro T, Guerra JM, Borras R, Badimon L, Sabate M. Qualitative and quantitative accuracy of ultrasound-based virtual histology for detection of necrotic core in human coronary arteries. Int J Cardiovasc Imaging 2014; 30:469-76. [DOI: 10.1007/s10554-014-0372-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/15/2014] [Indexed: 01/15/2023]
|
50
|
Alonso-Martín C, Rodríguez Font E, Guerra JM, Viñolas Prat X. Pulmonary vein isolation in cases of difficult catheter placement: a new pacing maneuver to demonstrate complete isolation of the veins. Heart Rhythm 2013; 10:1289-92. [PMID: 23623799 DOI: 10.1016/j.hrthm.2013.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Received: 03/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pulmonary vein electrical isolation is the main goal of atrial fibrillation ablation. To ensure electrical isolation of the pulmonary veins, entrance and exit block should be demonstrated. However, this is sometimes challenging due to the complex anatomy of the pulmonary vein area and the anatomical variations that may preclude the correct position of the commonly used circular multielectrode catheter inside the veins. OBJECTIVE To describe a new pacing maneuver useful to demonstrate complete isolation of ipsilateral veins in cases of difficult catheter placement. METHODS Three representative cases illustrate the usefulness of the maneuver either at the right or left pulmonary veins. RESULTS After the circumferential ablation of ipsilateral veins, the circular catheter is positioned in one vein and the ablation catheter in the other ipsilateral vein. When local capture in one vein can be demonstrated while pacing from the other vein and no conduction to the atria is observed, isolation of both veins can be assured. CONCLUSION This novel maneuver might be of help in assessing complete isolation of the pulmonary veins in cases of difficult circular catheter placement.
Collapse
Affiliation(s)
- Concepción Alonso-Martín
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | | | | |
Collapse
|