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Creta A, Venier S, Tampakis K, Providencia R, Sunny J, Defaye P, Earley MJ, Finlay M, Hunter RJ, Lambiase PD, Papageorgiou N, Schilling RJ, Sporton S, Andrikopoulos G, Deschamps E, Albenque JP, Cardin C, Combes N, Combes S, Vinolas X, Moreno-Weidmann Z, Huang T, Eichenlaub M, Müller-Edenborn B, Arentz T, Jadidi AS, Boveda S. Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study. Front Cardiovasc Med 2023; 10:1110165. [PMID: 37051067 PMCID: PMC10083273 DOI: 10.3389/fcvm.2023.1110165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Outcomes of catheter ablation for non-paroxysmal atrial fibrillation (AF) remain suboptimal. Non-invasive stratification of patients based on the presence of atrial cardiomyopathy (ACM) could allow to identify the best responders to pulmonary vein isolation (PVI). Methods Observational multicentre retrospective study in patients undergoing cryoballoon-PVI for non-paroxysmal AF. The duration of amplified P-wave (APW) was measured from a digitally recorded 12-lead electrocardiogram during the procedure. If patients were in AF, direct-current cardioversion was performed to allow APW measurement in sinus rhythm. An APW cut-off of 150 ms was used to identify patients with significant ACM. We assessed freedom from arrhythmia recurrence at long-term follow-up in patients with APW ≥ 150 ms vs. APW < 150 ms. Results We included 295 patients (mean age 62.3 ± 10.6), of whom 193 (65.4%) suffered from persistent AF and the remaining 102 (34.6%) from long-standing persistent AF. One-hundred-forty-two patients (50.2%) experienced arrhythmia recurrence during a mean follow-up of 793 ± 604 days. Patients with APW ≥ 150 ms had a significantly higher recurrence rate post ablation compared to those with APW < 150 ms (57.0% vs. 41.6%; log-rank p < 0.001). On a multivariable Cox-regression analysis, APW≥150 ms was the only independent predictor of arrhythmia recurrence post ablation (HR 2.03 CI95% 1.28-3.21; p = 0.002). Conclusion APW duration predicts arrhythmia recurrence post cryoballoon-PVI in persistent and long-standing persistent AF. An APW cut-off of 150 ms allows to identify patients with significant ACM who have worse outcomes post PVI. Analysis of APW represents an easy, non-invasive and highly reproducible diagnostic tool which allows to identify patients who are the most likely to benefit from PVI-only approach.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Sandrine Venier
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | - Konstantinos Tampakis
- Electrophysiology & Pacing Department, Henry Dunant Hospital Center, Athens, Greece
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Juno Sunny
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | - Mark J. Earley
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Ross J. Hunter
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | | | - Simon Sporton
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - George Andrikopoulos
- Electrophysiology & Pacing Department, Henry Dunant Hospital Center, Athens, Greece
| | - Elodie Deschamps
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | | | | | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Xavier Vinolas
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Taiyuan Huang
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Björn Müller-Edenborn
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Amir S. Jadidi
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Serge Boveda
- Département de Rythmologie, Clinique Pasteur, Toulose, France
- Correspondence: Serge Boveda
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Müller-Edenborn B, Moreno-Weidmann Z, Venier S, Defaye P, Park CI, Guerra J, Alonso-Martín C, Bazan V, Vinolas X, Rodriguez-Font E, Garcia BC, Boveda S, Combes S, Albenque JP, Guy-Moyat B, Trenk D, Eichenlaub M, Chen J, Lehrmann H, Neumann FJ, Arentz T, Jadidi A. Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau européen de traîtement d'arrhythmies cardiaques)-group. Clin Res Cardiol 2021; 111:1018-1027. [PMID: 34854991 PMCID: PMC9424172 DOI: 10.1007/s00392-021-01973-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Aims Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a scoring system based entirely on easily available clinical parameters to predict FAM and ablation-success in everyday care. Methods In this multicenter, prospective study, a new risk stratification model termed AF-SCORE was derived in 220 patients undergoing high-density left-atrial(LA) voltage-mapping to quantify FAM. AF-SCORE was validated for FAM in an external mapping-validation cohort (n = 220) and for success following pulmonary vein isolation (PVI)-only (without adjunctive left- or right atrial ablations) in an external outcome-validation cohort (n = 518). Results FAM was rare in patients < 60 years (5.4%), but increased with ageing and affected 40.4% (59/146) of patients ≥ 60 years. Sex and AF-phenotype had additional predictive value in older patients and remained associated with FAM in multivariate models (odds ratio [OR] 6.194, p < 0.0001 for ≥ 60 years; OR 2.863, p < 0.0001 for female sex; OR 41.309, p < 0.0001 for AF-persistency). Additional clinical or diagnostic variables did not improve the model. AF-SCORE (+ 1 point for age ≥ 60 years and additional points for female sex [+ 1] and AF-persistency [+ 2]) showed good discrimination to detect FAM (c-statistic 0.792) and predicted arrhythmia-freedom following PVI (74.3%, 54.7% and 45.5% for AF-SCORE ≤ 2, 3 and 4, respectively, and hazard ratio [HR] 1.994 for AF-SCORE = 3 and HR 2.866 for AF-SCORE = 4, p < 0.001). Conclusions Age, sex and AF-phenotype are the main determinants for the development of FAM. A low AF-SCORE ≤ 2 is found in paroxysmal AF-patients of any age and younger patients with persistent AF irrespective of sex, and associated with favorable outcomes of PVI-only. Freedom from arrhythmia remains unsatisfactory with AF-SCORE ≥ 3 as found in older patients, particularly females, with persistent AF, and future studies investigating adjunctive atrial ablations to PVI-only should focus on these groups of patients. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01973-1.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany. .,Department of Cardiology, Julius-Hospital, Würzburg, Germany.
| | - Zoraida Moreno-Weidmann
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.,Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Sandrine Venier
- Department of Cardiology, University Hospital Grenoble, Grenoble, France
| | - Pascale Defaye
- Department of Cardiology, University Hospital Grenoble, Grenoble, France
| | - Chan-Il Park
- Department of Cardiology, Clinique de la Tour, Geneva, Switzerland
| | - José Guerra
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Concepcion Alonso-Martín
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Victor Bazan
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Xavier Vinolas
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Enrique Rodriguez-Font
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Bieito Campos Garcia
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | | | - Benoit Guy-Moyat
- Department of Cardiology, University Hospital Limoges, Limoges, France
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, Section for Pharmacology, Heart Center, University of Freiburg, Bad Krozingen, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Juan Chen
- Department of Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, Heart Center, University of Freiburg, Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.
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3
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Briongos Figuero S, Garcia Alberola A, Rubio J, Segura JM, Rodriguez A, Peinado R, Alzueta J, Martinez Ferrer JB, Vinolas X, Munoz Aguilera R, Perez ML. Long-term outcomes among a cohort of 4296 implantable cardioverter-defibrillator patients: insights from the UMBRELLA study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0345] [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
Large observational real-world studies describing modern implantable cardioverter-defibrillator (ICD) populations with long-term follow-up are lacking.
Purpose
To assess the incidence of arrhythmias in a cohort of contemporary patients undergoing ICD implant from 2005 and 2017 and to analyze the arrhythmic risk and mortality according to their clinical profiles.
Methods
UMBRELLA (NTC01561144) is a prospective, multicentre, nationwide study of ICD patients followed by remote monitoring. All device information was automatically stored through the remote monitoring system and a blinded review of all the stored arrhythmic episodes was performed. The study outcomes were first appropriate ICD therapy and all-cause death.
Results
The study population consisted of 4296 patients (61.9±12.9 years, ischaemic cardiomyopathy (ICM): n=2150, dilated cardiomyopathy (DCM): n=1166, valvular heart disease (VHD): n=119, hypertrophic cardiomyopathy (HCM): n=294, arrhythmogenic right ventricular cardiomyopathy (ARVC): n=71, Brugada syndrome (BS): n=143, long QT syndrome (LQTS): n=43, and adult congenital heart disease (ACHD): n=60)). Primary prevention (PP) was the main indication (n=2758).
During a mean follow-up of 46.6±27.3 months, 16,067 episodes of sustained ventricular arrhythmia (SVA) occurred in 1344 patients. Appropriate ICD therapy was delivered to 85.7% (n=13,767) episodes of SVA in 1173 patients (27.3% of population). A higher risk of first appropriate ICD therapy was observed in VHD (HR: 1.94, 95% CI: 1.43–2.62), ARVC (HR: 1.84, 95% CI: 1.28–2.66), ICM (HR: 1.51, 95% CI: 1.29–1.78), and DCM (HR: 1.28, 95% CI: 1.07–1.53) whereas patients with HCM (HR: 0.72, 95% CI: 0.54–0.96) and BS (HR: 0.25, 95% CI: 0.14–0.45) were at significantly lower risk (Figure 1A). In multivariate analysis (Table 1), age, gender, atrial fibrillation (AF), secondary prevention, LVEF ≤35%, and QRS width emerged as clinical predictors of appropriate ICD therapy, whereas CRT-D correlated with lower risk. An independently higher risk was found in DCM, VHD, and ARVC, and a lower risk in BS patients.
At follow-up, 590 deaths (13.4% of population) were reported. Patients with ICM (HR 3.90, 95% CI: 2.58–5.90), DCM (HR 3.33, CI 95%: 2.18–5.10), and VHD (HR 3.97, CI 95%: 2.25–6.99) had worse prognoses and it was significantly better in BS patients (HR 0.11, 95% CI: 0.01–0.67, p=0.017) (Figure 1B). In multivariate analysis, age, gender, AF, renal failure, diabetes and reduced LVEF, emerged as independent predictors of all-cause death (Table 1).
Conclusions
Irrespective of the aetiology, contemporary ICD patients with an arrhythmic substrate derived from left ventricular systolic dysfunction had a similar risk of ICD life-saving interventions and death.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
| | | | - J Rubio
- University Hospital Clinic of Valladolid, Valladolid, Spain
| | - J M Segura
- University Hospital Reina Sofia, Cordoba, Spain
| | - A Rodriguez
- University Hospital of the Canaries, Santa Cruz de Tenerife, Spain
| | - R Peinado
- University Hospital La Paz, Madrid, Spain
| | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Munoz Aguilera
- Public Hospital of Vallecas - Hospital Infanta Leonor, Madrid, Spain
| | - M L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
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4
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Briongos Figuero S, Estevez A, Perez M, Martinez Ferrer J, Garcia E, Vinolas X, Arenal A, Alzueta J, Munoz Aguilera R. Single- vs dual-chamber ICDs to prevent from inappropriate shocks: the debate is still alive. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0686] [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: 11/12/2022] Open
Abstract
Abstract
Background
The efficacy of dual-chamber implantable cardioverter defibrillators (ICDs) in preventing from inappropriate shocks (IS) is still a matter of debate.
Purpose
To compare the risk of IS among single- and dual-chamber ICDs in a cohort of heart failure (HF) patients carrying a prophylactic device. We aimed to focus on the relationship between programming and discriminators, and the risk of IS in a large cohort.
Methods
All HF patients with left ventricle ejection fraction <35% undergoing a prophylactic ICD-only implant were collected from the multicentre, prospective and nationwide UMBRELLA study. ICD programming was performed according to regular clinical practice at each site and. ICD setting and arrhythmic events occurring during the study period were automatically stored through the remote monitoring system. An experts committee analysed in a blinded manner all electrograms coming from the arrhythmic events.
Results
From 2006 to 2015, 782 patients implanted with an ICD were analysed (537 patients (68.7%) with single-chamber ICDs and 245 patients (31.3%) with dual-chamber ICDs). During a mean follow-up of 4.35±2 years, 109 IS were delivered in 49 patients. IS occurred in 7.8% (n=42) of patients carrying single-chamber ICDs and in 2.9% (n=7) of dual-chamber carriers (p=0.001). A propensity score matched analysis was performed. The matched cohort was composed by 110 well-balanced (regarding baseline characteristics and programming) patients. In the weighted sample, dual-chamber ICDs were related to lower rates of IS (Figure 1) as compared to single-chamber devices (0.9% vs. 11.8%, p≤0.001).
Among programming the following ICD settings correlated to lower risk of IS: ≥30 of 40 intervals detection within ventricular fibrillation (VF) zone (HR=0.47; p=0.018), a programmed ATP-capable zone enabled through VF zone (HR=0.54; p=0.038), morphology discriminator (Wavelet®) (HR=0.42; p=0.032), and the specific dual-chamber discriminator (PR Logic®) (HR=0.28; p=0.004). After multivariable Cox regression analysis including clinical variables and device settings, PR Logic® discriminator was the only programming parameter independently related to a lower risk of IS (HR=0.18, CI 0.06–0.48, p=0.001).
Conclusions
In our nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were associated with a lower risk of IS. ICDs equipped with PR Logic® discriminator might be useful to prevent from IS.
Funding Acknowledgement
Type of funding sources: None. Programming in the matched populationFigure 1
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Affiliation(s)
| | - A Estevez
- Public Hospital of Vallecas - Hospital Infanta Leonor, Madrid, Spain
| | - M.L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | | | - E Garcia
- Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
| | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | - R Munoz Aguilera
- Public Hospital of Vallecas - Hospital Infanta Leonor, Madrid, Spain
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5
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Ferre-Vallverdu M, Ligero C, Vidal-Perez R, Martinez-Rubio A, Vinolas X, Alegret JM. Improvement in Atrial Fibrillation-Related Symptoms After Cardioversion: Role of NYHA Functional Class and Maintenance of Sinus Rhythm. Clin Interv Aging 2021; 16:739-745. [PMID: 33953552 PMCID: PMC8092854 DOI: 10.2147/cia.s305619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The European Heart Rhythm Association (EHRA) score is a proven and validated tool for assessing the symptoms of atrial fibrillation (AF). Little is known about the variables related to this score and how it changes after cardioversion. Methods We analyzed 744 patients undergoing elective cardioversion in whom AF-related symptoms were assessed at baseline and after 6 months of follow-up using the EHRA score. We assessed the association between the EHRA score and other clinical and echocardiographic variables at baseline and after 6 months of follow-up. Results At 6 months of follow-up, we observed a reduction in the EHRA score in 50% and worsening in 2.8% of patients who remained in sinus rhythm (SR) compared with 34.6% and 11.3%, respectively, of patients with AF episodes (p<0.0001). Patients who maintained SR at 6 months were less symptomatic than those with AF (EHRA score 1.13 ± 0.35 vs 1.42 ± 0.59; p<0.0001). The independent predictors for reduction in the EHRA score after cardioversion were NYHA ≥II at baseline and maintenance of SR (p<0.0001). Conclusion The greatest improvement in AF-related symptoms was in patients who remained in SR at 6 months after cardioversion and in patients with worse NYHA functional class at baseline.
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Affiliation(s)
- Maria Ferre-Vallverdu
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Carmen Ligero
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
| | - Rafael Vidal-Perez
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Xavier Vinolas
- Department of Cardiology, Hospital de la Sta, Creu i St Pau, Barcelona, Spain
| | - Josep M Alegret
- Department of Cardiology, Hospital Universitari de Sant Joan.,Institut d'Investigació Sanitària Pere Virgili (IISPV).,Department of Medicine and Surgery of the University Rovira i Virgili; Reus, Spain
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6
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Philippon F, O'Hara GE, Champagne J, Hohnloser SH, Glikson M, Neuzner J, Mabo P, Vinolas X, Kautzner J, Gadler F, Lashevsky N, Connolly SJ, Liu YY, Healey JS. Rate, Time Course, and Predictors of Implantable Cardioverter Defibrillator Infections: An Analysis From the SIMPLE Trial. CJC Open 2020; 2:354-359. [PMID: 32995720 PMCID: PMC7499364 DOI: 10.1016/j.cjco.2020.04.008] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background The number of implantable cardioverter defibrillator (ICD) infections is increasing due to an increased number of ICD implants, higher-risk patients, and more frequent replacement procedures, which carry a higher risk of infection. Reducing the morbidity, mortality, and cost of ICD-related infections requires an understanding of the current rate of this complication and its predictors. Methods The Shock Implant Evaluation Trial (SIMPLE) trial randomized 2500 ICD recipients to defibrillation testing or not. Over an average of 3.1 years, patients were seen every 6 months and examined for evidence of ICD infection, which was defined as requiring device removal and/or intravenous antibiotics. Results Within 24 months, 21 patients (0.8%) developed infection. Fourteen patients (67%) with infection presented within 30 days, 20 patients by 12 months, and only 1 patient beyond 12 months. Univariate analysis demonstrated that patients with primary electrical disorders (3 patients, P = 0.009) and those with a secondary prevention indication (13 patients, P = 0.0009) were more likely to develop infection. Among the 2.2% of patients who developed an ICD wound hematoma, 10.4% developed an infection. Among the 8.3% of patients requiring an ICD reintervention, 1.9% developed an infection. Conclusions This cohort of ICD recipients at high-volume centres have a low risk of device-related infection. However; strategies to reduce wound hematoma and the need for ICD reintervention could further reduce the rate of infection.
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Affiliation(s)
- François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Gilles E O'Hara
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Jean Champagne
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | | | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Noa Lashevsky
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Yan Y Liu
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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7
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Briongos Figuero S, Estevez A, Perez ML, Martinez-Ferrer JB, Garcia E, Vinolas X, Arenal A, Alzueta JB, Basterra N, Lozano I, Munoz-Aguilera R. P5425Prognostic value of NYHA functional class in heart failure patients undergoing primary prevention implantable cardioverter defibrillator therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0382] [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
NYHA functional class (FC) is used for selection of heart failure (HF) patients who are candidates to primary prevention (PP) implantable cardioverter defibrillator (ICD) therapy. However, FC is subjectively estimated and concerns about its real prognostic value are still present in this setting.
Purpose
To compare whether mortality and arrhythmic risk are different, in a cohort of HF patients undergoing PP ICD-only implant, according to their FC.
Methods
All HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD-only implant were collected from the UMBRELLA nationwide registry (2006–2015). The sample was divided into three groups: no symptoms (NYHA I), mildly symptomatic patients (NYHA II) and severely symptomatic (NYHA III) patients. Outcomes were studied as follow: all-cause death, cardiovascular mortality and arrhythmia free survival (surrogate marker of sudden cardiac death) defined as survival free of first appropriate ICD therapy delivered in ventricular fibrillation (VF) window. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.
Results
Six hundred and twenty one patients were identified (61.1±11.4 years, 87.3% male). Distribution of study groups was as follow: 101 patients in NYHA I; 411 in NYHA II; and 109 in NYHA III. More symptomatic patients were older and had higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD). Higher rates of optimal medical treatment were present among study groups (beta-blockers: 92.1%; ACEI or ARB: 86.8%; aldosterone antagonists: 60.2%). After a median follow-up of 4.2 years (IQR, 2.7–5.7 years) 126 patients died (event rate: 20.3%). All-cause mortality was higher in patients with worse FC (13.9% vs. 18.3% vs. 32.9% for NYHA I, II and III respectively; p<0.001, log-rank test). Seventy-eight out of 126 deaths were related to cardiovascular causes (overall event rate: 12.6%). Cardiovascular mortality risk was also higher in more symptomatic patients (6.9% vs. 11% vs. 23.9% for NYHA I, II and III respectively; p<0.001, log-rank test). One hundred and seventeen patients received afirst appropriate ICD therapy (19.4%). Arrhythmia free survival was not different among study groups (20.8% vs. 18.7% vs. 20.8% for NYHA I, II and III, respectively; p=0.495, log-rank test). Cumulative incidence curves for the three outcomes are shown in Figure 1. After multivariate analysis, worse NYHA class independently predicted cardiovascular mortality but not all-cause death. Moreover, diabetes, AF and CKD strongly predicted both all-cause and cardiovascular mortality.
Figure 1
Conclusions
In HF patients, prophylactic ICD seems to be useful in preventing death due to life threatening arrhythmias, regardless of the baseline FC. Nevertheless, the combination of NYHA class with other comorbidities may be useful to select those ICD candidates who obtain less survival benefit.
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Affiliation(s)
| | - A Estevez
- University Hospital Infanta Leonor, Madrid, Spain
| | - M L Perez
- University Hospital Complex A Coruña, A Coruna, Spain
| | | | - E Garcia
- Hospital of Meixoeiro, Vigo, Spain
| | - X Vinolas
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
| | - J B Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - I Lozano
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
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8
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Neuzner J, Hohnloser SH, Kutyifa V, Glikson M, Dietze T, Mabo P, Vinolas X, Kautzner J, O'Hara G, Lawo T, Brachmann J, VanErven L, Gadler F, Appl U, Wang J, Connolly SJ, Healey JS. Effectiveness of single- vs dual-coil implantable defibrillator leads: An observational analysis from the SIMPLE study. J Cardiovasc Electrophysiol 2019; 30:1078-1085. [PMID: 30945798 DOI: 10.1111/jce.13943] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/08/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Dual-coil leads (DC-leads) were the standard of choice since the first nonthoracotomy implantable cardioverter/defibrillator (ICD). We used contemporary data to determine if DC-leads offer any advantage over single-coil leads (SC-leads), in terms of defibrillation efficacy, safety, clinical outcome, and complication rates. METHODS AND RESULTS In the Shockless IMPLant Evaluation study, 2500 patients received a first implanted ICD and were randomized to implantation with or without defibrillation testing. Two thousand and four hundred seventy-five patients received SC-coil or DC-coil leads (SC-leads in 1025/2475 patients; 41.4%). In patients who underwent defibrillation testing (n = 1204), patients with both lead types were equally likely to achieve an adequate defibrillation safety margin (88.8% vs 91.2%; P = 0.16). There was no overall effect of lead type on the primary study endpoint of "failed appropriate shock or arrhythmic death" (adjusted HR 1.18; 95% CI, 0.86-1.62; P = 0.300), and on all-cause mortality (SC-leads: 5.34%/year; DC-leads: 5.48%/year; adjusted HR 1.16; 95% CI, 0.94-1.43; P = 0.168). However, among patients without prior heart failure (HF), and SC-leads had a significantly higher risk of failed appropriate shock or arrhythmic death (adjusted HR 7.02; 95% CI, 2.41-20.5). There were no differences in complication rates. CONCLUSION In this nonrandomized evaluation, there was no overall difference in defibrillation efficacy, safety, outcome, and complication rates between SC-leads and DC-leads. However, DC-leads were associated with a reduction in the composite of failed appropriate shock or arrhythmic death in the subgroup of non-HF patients. Considering riskier future lead extraction with DC-leads, SC-leads appears to be preferable in the majority of patients.
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Affiliation(s)
| | - Stefan H Hohnloser
- Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Valentina Kutyifa
- Semmelweis University, Budapest, Hungary.,University of Rochester Medical Center, Rochester, New York
| | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Gilles O'Hara
- Institute Universitaire de Cardiologie et de Pneumologie de, Quebec, QC, Canada
| | - Thomas Lawo
- Elisabeth Krankenhaus, Recklinghausen, Germany
| | | | | | | | - Ursula Appl
- Boston Scientific, Minneapolis, Minnesota.,Boston Scientific, Brussels, Belgium
| | - Jia Wang
- Population Health Research Institute, Hamilton, Canada
| | | | - Jeff S Healey
- Population Health Research Institute, Hamilton, Canada.,Mc Master University, Hamilton, Canada
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9
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Sandhu RK, Quadros KK, Liu YY, Glikson M, Kutyifa V, Mabo P, Hohnloser S, O'Hara G, VanErven L, Neuzner J, Kautzner J, Gadler F, Vinolas X, Appl U, Connolly SJ, Healey JS. Sedation strategies for defibrillation threshold testing: safety outcomes with anaesthesiologist compared to proceduralist-directed sedation: an analysis from the SIMPLE study. Europace 2018; 20:1798-1803. [PMID: 29878102 DOI: 10.1093/europace/euy114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/19/2018] [Indexed: 11/12/2022] Open
Abstract
Aims No standard practice exists with respect to anaesthesiologist-directed sedation (ADS) vs. sedation by proceduralist (PDS) for defibrillation threshold (DT) testing. We aimed to evaluate adverse events and safety outcomes with ADS vs. PDS for DT testing. Methods and results A post hoc analysis of the Shockless Implant Evaluation (SIMPLE) study was performed among the 1242 patients who had DT testing (624 ADS and 618 PDS). We evaluated both intraoperative and in-hospital adverse composite events and two safety composite outcomes at 30-days of the main trial. Propensity score adjusted models were used to compute odds ratio (OR) and 95% confidence interval (CI) to evaluate the association between adverse and safety outcomes with method of sedation and independent predictors for use of ADS. Compared to PDS, patients who received ADS were younger (62 ± 12 years vs. 64 ± 12 years, P = 0.01), had lower ejection fraction (left ventricular ejection fraction 0.31 ± 13 vs. 0.33 ± 13, P = 0.03), were more likely to receive inhalational anaesthesia, propofol, or narcotics (P < 0.001, respectively) and receive an arterial line (43% vs. 8%, P = <0.0001). Independent predictors for ADS sedation were presence of coronary artery disease (OR 1.69, 95% CI 1.0-2.72; P = 0.03) and hypertrophic cardiomyopathy (OR 2.64, 95% CI 1.19-5.85; P = 0.02). Anaesthesiologist directed sedation had higher intraoperative adverse events (2.2% vs. 0.5%; OR 4.47, 95% CI 1.25-16.0; P = 0.02) and higher primary safety outcomes at 30 days (8.2% vs. 4.9%; OR 1.72 95% CI 1.06-2.80; P = 0.03) and no difference in other outcomes compared to PDS. Conclusion Proceduralist-directed sedation is safe, however, this could be result of selection bias. Further research is needed.
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Affiliation(s)
- Roopinder K Sandhu
- Mazankowski Alberta Heart Institute, University of Alberta, 8440-112 Street, 2C2 WMC Edmonton, AB, Canada
| | - Kenneth K Quadros
- Mazankowski Alberta Heart Institute, University of Alberta, 8440-112 Street, 2C2 WMC Edmonton, AB, Canada
| | - Yan Yun Liu
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Gilles O'Hara
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | - Ursula Appl
- Boston Scientific, Minneapolis, MN, USA.,Boston Scientific, Brussels, Belgium
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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10
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Briongos Figuero S, Estevez A, Sanchez A, Perez ML, Martinez-Ferrer JB, Garcia E, Vinolas X, Arenal A, Alzueta J, Basterra N, Rodriguez A, Fernandez-Lozano I, Munoz-Aguilera R. P3453Survival and arrhythmic mortality among ischemic and non-ischemic heart failure patients undergoing ICD-only therapy for primary prevention strategy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3453] [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: 11/12/2022] Open
Affiliation(s)
| | - A Estevez
- University Hospital Infanta Leonor, Madrid, Spain
| | - A Sanchez
- University Hospital Infanta Leonor, Madrid, Spain
| | - M L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | | | - E Garcia
- Hospital of Meixoeiro, Vigo, Spain
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
| | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - A Rodriguez
- University Hospital of the Canaries, Santa Cruz de Tenerife, Spain
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11
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Cozzolino P, Ambrosio G, Bassand JP, Cate HT, Cools F, Darius H, Fitzmaurice DA, Haas S, Leheuzey JY, Agnelli G, Rosenkvist M, Stepinska J, Vinolas X, Mantovani LG, Kakkar AK. P2889The economic burden attributable to atrial fibrillation in nine European countries: perspectives from the GARFIELD-AF registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2889] [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)
| | - G Ambrosio
- University of Perugia School of Medicine, Perugia, Italy
| | - J.-P Bassand
- Thrombosis Research Institute, London, UK & University of Besançon, Besancon, France
| | - H T Cate
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - F Cools
- AZ KLINA Cardiology, Brasschaat, Belgium
| | - H Darius
- Vivantes Neukoelln Medical Center, Berlin, Germany
| | - D A Fitzmaurice
- University of Warwick Medical School, Coventry, United Kingdom
| | - S Haas
- Formerly Department of Medicine, Technical University of Munich, Munich, Germany
| | - J.-Y Leheuzey
- Georges Pompidou Hospital, René Descartes University, Paris, France
| | - G Agnelli
- Azienda Ospedaliera di Perugia Medicina Interna e Vascolare Stroke Unit, Perugia, Italy
| | - M Rosenkvist
- Södersjukhuset, vo Kardiologi Karolinska Institutet, Institutionen för klinisk forskning och utb, Stockholm, Sweden
| | | | - X Vinolas
- Hospital Santa Creu y San Pau Servicio de Cardiologia, Barcelona, Spain
| | | | - A K Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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12
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Masiero S, Connolly SJ, Birnie D, Neuzner J, Hohnloser SH, Vinolas X, Kautzner J, O'Hara G, VanErven L, Gadler F, Wang J, Mabo P, Glikson M, Kutyifa V, Wright DJ, Essebag V, Healey JS. Wound haematoma following defibrillator implantation: incidence and predictors in the Shockless Implant Evaluation (SIMPLE) trial. Europace 2018; 19:1002-1006. [PMID: 27353323 DOI: 10.1093/europace/euw116] [Citation(s) in RCA: 10] [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: 02/15/2016] [Accepted: 04/04/2016] [Indexed: 01/18/2023] Open
Abstract
Aims Pocket haematoma is a common complication after defibrillator [implantable cardioverter defibrillator (ICD)] implantation, which is not only painful, but also increases the risk of device-related infection, and possibly embolic events. The present study seeks to evaluate the rate and predictors of clinically significant pocket haematoma. Methods and results This study included 2500 patients receiving an ICD in the SIMPLE trial. A clinically significant pocket haematoma was defined as a haematoma that required re-operation or interruption of oral anticoagulation (OAC) therapy. Clinically significant pocket haematoma occurred in 56 of 2500 patients (2.2%) of which 6 (10.7%) developed device-related infection. Patients who developed pocket haematoma were older (mean age 67.6 ± 8.8 years vs. 62.7 ± 11.6 years, P < 0.001), were more likely to have permanent atrial fibrillation (30.4 vs. 6.7%, P < 0.001) and a history of stroke (17.9 vs. 6.7%, P = 0.004), or were more likely to receive peri-operative OAC (50.0 vs. 28.4%, P < 0.001), unfractionated heparin (16.1 vs. 5.2%, P = 0.003), or low-molecular-weight heparin (37.5 vs. 17.5%, P < 0.001). Independent predictors of wound haematoma on multivariable analysis included the use of heparin bridging (OR 2.65, 95% CI 1.48-4.73, P = 0.001), sub-pectoral location of ICD (OR 2.00, 95% CI 1.12-3.57, P =0.020), previous stroke (OR 2.47, 95% CI 1.20-5.10, P = 0.015), an upgrade from permanent pacemaker (OR 2.52, 95% CI 1.07-5.94, P = 0.035), and older age (OR 1.03, 95% CI 1.00-1.06, P = 0.049). Conclusion Pocket haematoma remains an important complication of ICD implantation and is associated with a high risk of infection. Independent predictors of pocket haematoma include heparin bridging, prior stroke, sub-pectoral placement of ICD, older age, and upgrade from a pacemaker.
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Affiliation(s)
- Simona Masiero
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2.,Clinica di Cardiologia, Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, CanadaL8L 2X2
| | - David Birnie
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, CanadaK1Y 4W7
| | - Jörg Neuzner
- Klinikum Kassel, 43, Mönchebergstraße 41, 34125 Kassel, Germany
| | - Stefan H Hohnloser
- J.W. Goethe University, Theodor-W.-Adorno-Platz 6, 60323 Frankfurt am Main, Germany
| | - Xavier Vinolas
- Hospital de Santa Creu i Sant Pau, Carrer de Sant Quintí 89, 08026 Barcelona, Spain
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 140 21 Prague 4-Krc, Czech Republic
| | - Gilles O'Hara
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC, CanadaG1V 4G5
| | - Lieselot VanErven
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Fredrik Gadler
- Karolinska Institute, Solnavägen 1, 171 77 Stockholm, Sweden
| | - Jia Wang
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, CanadaL8L 2X2
| | - Philippe Mabo
- Centre Hospitalier Universitaire, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Michael Glikson
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Tel Aviv, Israel
| | - Valentina Kutyifa
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - David J Wright
- Institute of Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool, Merseyside L14 3PE, UK
| | - Vidal Essebag
- McGill University, 845 Rue Sherbrooke O, Montrèal, QC, CanadaH3A 0G4
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, CanadaL8L 2X2
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13
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Loughlin G, Avila P, Martinez-Ferrer JB, Alzueta J, Vinolas X, Brugada J, Arizon JM, Fernandez-Lozano I, García-Campo E, Basterra N, Fernandez De La Concha J, Arenal A. Association of cardiac resynchronization therapy with the incidence of appropriate implantable cardiac defibrillator therapies in ischaemic and non-ischaemic cardiomyopathy. Europace 2018; 19:1818-1825. [PMID: 28339565 DOI: 10.1093/europace/euw303] [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: 11/23/2015] [Accepted: 08/30/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we compared the incidence of AICDT use in four groups of patients: patients with ischaemic cardiomyopathy vs. non-ischaemic dilated cardiomyopathy (NIDC) and patients implanted with an ICD vs. CRT-ICD. Methods and results We analysed 689 consecutive patients (mean follow-up 37 ± 16 months) included in the Umbrella registry, a multicentre prospective registry including patients implanted with ICD or CRT-ICD devices with remote monitoring capabilities in 48 Spanish Hospitals. The primary outcome was the time to first AICDT. Despite a worse clinical risk profile, NIDC patients receiving a CRT-ICD had a lower cumulative probability of first AICDT use at 2 years compared with patients implanted with an ICD [24.7 vs. 41.6%, hazard ratio (HR): 0.49, P = 0.003]; on the other hand, there were no significant differences in the incidence of first AICDT use at 2 years in ischaemic patients (22.6 vs. 21.9%, P = NS). Multivariate analysis confirmed the association of CRT with lower AICDT rates amongst NIDC patients (Adjusted HR: 0.55, CI 95% 0.35-0.87). Conclusions These data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class.
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Affiliation(s)
- Gerard Loughlin
- Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Pablo Avila
- Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Dr. Esquerdo 46, 28007 Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Angel Arenal
- Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Dr. Esquerdo 46, 28007 Madrid, Spain
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14
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Bisbal Van Bylen F, Alarcon F, Ferrero A, Gonzalez-Ferrer JJ, Alonso C, Pachon M, Tizon H, Cabanas-Grandio P, Sanchez M, Teis A, Ruiz-Granell R, Perez-Villacastin J, Vinolas X, Arias MA, Mont L. 1014Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicenter LAGO-AF Study. Europace 2018. [DOI: 10.1093/europace/euy015.563] [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)
| | - F Alarcon
- University of Barcelona, Arrhythmia Unit, Hospital Clínic, Barcelona, Spain
| | - A Ferrero
- University Hospital Clinic of Valencia, Valencia, Spain
| | | | - C Alonso
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Pachon
- Hospital Virgen de la Salud, Toledo, Spain
| | - H Tizon
- Hospital del Mar, Barcelona, Spain
| | | | - M Sanchez
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Teis
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | | | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M A Arias
- Hospital Virgen de la Salud, Toledo, Spain
| | - L Mont
- University of Barcelona, Arrhythmia Unit, Hospital Clínic, Barcelona, Spain
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15
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Moreno Weidmann ZL, Jadidi A, Bazan Gelizo V, Park C, Combes S, Vinolas X, Chen J, Mueller-Edenborn B, Arentz T. P1199Role of electrocardiographic parameters to detect differente degrees of atrial fibrosis. Insights of the Substrate AF Study. Europace 2018. [DOI: 10.1093/europace/euy015.681] [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)
- Z L Moreno Weidmann
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - V Bazan Gelizo
- Hospital de la Santa Creu i Sant Pau, Electrophysiology, Barcelona, Spain
| | - C Park
- La Tour Hospital, Electrophysiology, Geneva, Switzerland
| | - S Combes
- Clinic Pasteur of Toulouse, Electrophysiology, Toulouse, France
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Electrophysiology, Barcelona, Spain
| | - J Chen
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
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16
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Vamos M, Healey JS, Wang J, Connolly SJ, Mabo P, Van Erven L, Kautzner J, Glikson M, Neuzner J, O'Hara G, Vinolas X, Gadler F, Hohnloser SH. Implantable cardioverter–defibrillator therapy in hypertrophic cardiomyopathy: A SIMPLE substudy. Heart Rhythm 2018; 15:386-392. [DOI: 10.1016/j.hrthm.2017.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 11/29/2022]
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17
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Bazal P, Navarro AM, Basterra N, Perez L, Alzueta J, Martinez Ferrer JB, Mazuelos F, Garcia A, Vinolas X, Porro R, Fernandez De La Concha J, Arenal A. P443Primary Prevention Implantable Cardioverter Defibrillator (ICD): Should sex influence their indication? Europace 2018. [DOI: 10.1093/europace/euy015.253] [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: 11/13/2022] Open
Affiliation(s)
- P Bazal
- Hospital de Navarra, Cardiology, Pamplona, Spain
| | - A M Navarro
- Hospital de Navarra, Cardiology, Pamplona, Spain
| | - N Basterra
- Hospital de Navarra, Cardiology, Pamplona, Spain
| | - L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - F Mazuelos
- University Hospital Reina Sofia, Cordoba, Spain
| | - A Garcia
- Hospital Clínico Univeristario Virgen de la Arrixaca, Murcia, Spain
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Porro
- Hospital San Pedro de Alcantara, Caceres, Spain
| | | | - A Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
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18
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Bisbal Van Bylen F, Mont L, Ferrero A, Gonzalez-Ferrer JJ, Alonso C, Pachon M, Valles E, Cabanas-Grandio P, Fernandez-Lozano I, Benito E, Sarrias A, Ruiz-Granell R, Perez-Villacastin J, Vinolas X, Arias MA. 529Diagnostic-to-ablation Time in Atrial Fibrillation: A modifiable factor relevant to clinical outcome. Europace 2018. [DOI: 10.1093/europace/euy015.296] [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: 11/13/2022] Open
Affiliation(s)
| | - L Mont
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Ferrero
- University Hospital Clinic of Valencia, Valencia, Spain
| | | | - C Alonso
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Pachon
- Hospital Virgen de la Salud, Toledo, Spain
| | - E Valles
- Hospital del Mar, Barcelona, Spain
| | | | | | - E Benito
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Sarrias
- Germans Trias i Pujol University Hospital, Badalona, Spain
| | | | | | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M A Arias
- Hospital Virgen de la Salud, Toledo, Spain
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Gunturiz Beltran C, Bertomeu Gonzalez V, Moreno Arribas J, Perez L, Martinez Ferrer JB, Alzueta J, Arcocha MF, Arenal A, Vinolas X, Alvarez M, Anguera I, Porro R, Castillo Castillo J, Bellver A, Mont L. P874Analysis of efficacy of event discrimination algorithm added to standard programming strategies based on cycle length and detection intervals in implantable defibrillator. Europace 2018. [DOI: 10.1093/europace/euy015.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - J Moreno Arribas
- University Hospital San Juan de Alicante, Cardiology, Alicante, Spain
| | - L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | | | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - A Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Alvarez
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - I Anguera
- University Hospital of Bellvitge, Barcelona, Spain
| | - R Porro
- Hospital San Pedro de Alcantara, Caceres, Spain
| | | | - A Bellver
- Hospital General de Castellón, Castellon, Spain
| | - L Mont
- Hospital Clinic de Barcelona, Barcelona, Spain
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Gunturiz Beltran C, Bertomeu Gonzalez V, Moreno Arribas J, Perez L, Martinez Ferrer JB, Alzueta J, Arcocha MF, Arenal A, Vinolas X, Alvarez M, Anguera I, Porro R, Castillo Castillo J, Bellver A, Mont L. P1228Individual discriminators contribution to the reduction of inappropriate therapies in implantable defibrillators. Europace 2018. [DOI: 10.1093/europace/euy015.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - J Moreno Arribas
- University Hospital San Juan de Alicante, Cardiology, Alicante, Spain
| | - L Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | | | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - A Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Alvarez
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - I Anguera
- University Hospital of Bellvitge, Barcelona, Spain
| | - R Porro
- Hospital San Pedro de Alcantara, Caceres, Spain
| | | | - A Bellver
- Hospital General de Castellón, Castellon, Spain
| | - L Mont
- Hospital Clinic de Barcelona, Barcelona, Spain
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Moreno Weidmann ZL, Jadidi A, Bazan Gelizo V, Park C, Combes S, Vinolas X, Chen J, Espinosa H, Mueller-Edenborn B, Arentz T. P340Identification of clinical risk factors and biological markers associated with development of atrial low voltage substrate predisposing to atrial fibrillation. Substrate-AF-Study. Europace 2018. [DOI: 10.1093/europace/euy015.151] [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)
- Z L Moreno Weidmann
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - V Bazan Gelizo
- Hospital de la Santa Creu i Sant Pau, Electrophysiology, Barcelona, Spain
| | - C Park
- La Tour Hospital, Electrophysiology, Geneva, Switzerland
| | - S Combes
- Clinic Pasteur of Toulouse, Electrophysiology, Toulouse, France
| | - X Vinolas
- Hospital de la Santa Creu i Sant Pau, Electrophysiology, Barcelona, Spain
| | - J Chen
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - H Espinosa
- Hospital de la Santa Creu i Sant Pau, Electrophysiology, Barcelona, Spain
| | - B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Electrophysiology, Bad Krozingen, Germany
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Quadros K, Sandhu R, Connolly S, Glikson M, Kutyifa V, Mabo P, Hohnloser S, O’Hara G, VanErven L, Neuzner J, Gadler F, Vinolas X, Appl U, Healey J. SAFETY OUTCOMES WITH ANESTHESIOLOGIST DIRECTED SEDATION COMPARED TO NON-ANESTHESIOLOGIST FOR DEFIBRILLATION THRESHOLD TESTING. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gunturiz Beltran C, Bertomeu-Gonzalez V, Moreno-Arribas J, Perez L, Martinez-Ferrer J, Alzueta J, Arcocha M, Arenal A, Vinolas X, Alvarez M, Anguera I, Porro R, Castillo-Castillo J, Cordero A, Bertomeu-Martinez V. 3875Discriminators algorithm integrated into implantable defibrillator: diagnostic capacity analysis and impact in the reduction of inappropriate therapies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3875] [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: 11/12/2022] Open
Affiliation(s)
| | | | - J. Moreno-Arribas
- University Hospital San Juan de Alicante, Cardiology, Alicante, Spain
| | - L. Perez
- University Hospital Complex A Coruña, A Coruña, Spain
| | | | - J. Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | - A. Arenal
- University Hospital Gregorio Maranon, Madrid, Spain
| | - X. Vinolas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M. Alvarez
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - I. Anguera
- University Hospital of Bellvitge, Barcelona, Spain
| | - R. Porro
- Hospital San Pedro de Alcantara, Caceres, Spain
| | | | - A. Cordero
- University Hospital San Juan de Alicante, Cardiology, Alicante, Spain
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Briongos Figuero S, Sanchez A, Estevez A, Perez ML, Martinez-Ferrer JB, Garcia E, Vinolas X, Arenal A, Alzueta J, Basterra N, Rodriguez A, Fernandez-Lozano I, Munoz-Aguilera R. P1741Arrhythmic risk among ischemic and non-ischemic heart failure patients with narrow QRS: insigths from the umbrella registry. Europace 2017. [DOI: 10.1093/ehjci/eux161.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cozar-Leon R, Bastos P, Perez L, Alzueta J, Martinez-Ferrer JB, Arizon JM, Fernandez-Lozano I, Vinolas X, Jimenez J, Fernandez De La Concha J, Garcia Campo E, Ruiz-Duthil AD, Diaz-Infante E. P1738Incidence and risk factors for the development of fast ventricular tachycardia in recipients of implantable cardioverter defibrillators. Europace 2017. [DOI: 10.1093/ehjci/eux161.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Briongos Figuero S, Sanchez A, Estevez A, Perez ML, Martinez Ferre JB, Garcia E, Vinolas X, Arenal A, Alzueta J, Basterra N, Rodriguez A, Lozano I, Munoz-Aguilera R. P1744Inappropriate therapies in primary prevention ICD patients with narrow QRS: dual or single chamber ICD? The question remains. Europace 2017. [DOI: 10.1093/ehjci/eux161.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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
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Amit G, Wang J, Connolly SJ, Glikson M, Hohnloser S, Wright DJ, Brachmann J, Defaye P, Neuzner J, Mabo P, Vanerven L, Vinolas X, O'Hara G, Kautzner J, Appl U, Gadler F, Stein K, Konstantino Y, Healey JS. Apical versus Non-Apical Lead: Is ICD Lead Position Important for Successful Defibrillation? J Cardiovasc Electrophysiol 2016; 27:581-6. [PMID: 26888558 DOI: 10.1111/jce.12952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/22/2015] [Revised: 12/25/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We aim to compare the acute and long-term success of defibrillation between non-apical and apical ICD lead position. METHODS AND RESULTS The position of the ventricular lead was recorded by the implanting physician for 2,475 of 2,500 subjects in the Shockless IMPLant Evaluation (SIMPLE) trial, and subjects were grouped accordingly as non-apical or apical. The success of intra-operative defibrillation testing and of subsequent clinical shocks were compared. Propensity scoring was used to adjust for the impact of differences in baseline variables between these groups. There were 541 leads that were implanted at a non-apical position (21.9%). Patients implanted with a non-apical lead had a higher rate of secondary prevention indication. Non-apical location resulted in a lower mean R-wave amplitude (14.0 vs. 15.2, P < 0.001), lower mean pacing impedance (662 ohm vs. 728 ohm, P < 0.001), and higher mean pacing threshold (0.70 V vs. 0.66 V, P = 0.01). Single-coil leads and cardiac resynchronization devices were used more often in non-apical implants. The success of intra-operative defibrillation was similar between propensity score matched groups (89%). Over a mean follow-up of 3 years, there were no significant differences in the yearly rates of appropriate shock (5.5% vs. 5.4%, P = 0.98), failed appropriate first shock (0.9% vs. 1.0%, P = 0.66), or the composite of failed shock or arrhythmic death (2.8% vs. 2.3% P = 0.35) according to lead location. CONCLUSION We did not detect any reduction in the ICD efficacy at the time of implant or during follow-up in patients receiving a non-apical RV lead.
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Affiliation(s)
- Guy Amit
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jia Wang
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | | | | | | | | | - Gilles O'Hara
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ursula Appl
- Boston Scientific, Minneapolis, Minnesota, USA.,Boston Scientific, Brussels, Belgium
| | | | - Kenneth Stein
- Boston Scientific, Minneapolis, Minnesota, USA.,Boston Scientific, Brussels, Belgium
| | | | - Jeff S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Vamos M, Healey JS, Wang J, Duray GZ, Connolly SJ, van Erven L, Vinolas X, Neuzner J, Glikson M, Hohnloser SH. Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes: Insights from the SIMPLE trial. Heart Rhythm 2015; 13:504-10. [PMID: 26569461 DOI: 10.1016/j.hrthm.2015.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Shockless IMPLant Evaluation trial randomized 2500 patients receiving a first implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator device to have either defibrillation testing (DT) or no DT. It demonstrated that DT did not improve shock efficacy or reduce mortality. OBJECTIVE This prospective substudy evaluated the effect of DT on postoperative troponin levels and their predictive value for total and arrhythmic mortality. METHODS Troponin levels were measured between 6 and 24 hours after ICD implantation in 2200 of 2500 patients. RESULTS A postoperative serum troponin level above the upper limit of normal (ULN) was more common in patients undergoing DT (n = 509 [46.4%]) than in those not subjected to DT (n = 456 [41.3%]; P = .02). After excluding patients with known preoperative troponin levels above the ULN, consistent findings were observed (42.1% vs 37.5%; P = .04). During a mean follow-up of 3.1 ± 1.0 years, the annual mortality rate was increased in patients with postoperative troponin levels above the ULN (adjusted hazard ratio [HR] 1.43; 95% confidence interval [CI] 1.15-1.76; P = .001) irrespective of DT or no DT. Likewise, patients with elevated troponin levels had a significantly higher risk of arrhythmic death (adjusted HR 1.80; 95% CI 1.23-2.63; P = .002). The rate of first appropriate ICD shock (adjusted HR 0.89; 95% CI 0.71-1.12; P = .32) or failed appropriate shock (adjusted HR 1.02; 95% CI 0.59-1.76; P = .95) was similar in patients with or without troponin elevation. CONCLUSION DT at the time of ICD implantation is associated with increased troponin levels, indicating subclinical myocardial injury caused by the procedure. Elevated troponin levels but not DT seem to predict clinical outcomes in ICD recipients.
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Affiliation(s)
- Mate Vamos
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt Am Main, Germany
| | - Jeff S Healey
- McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton, Canada
| | - Gabor Z Duray
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | | | | | | | | | | | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt Am Main, Germany.
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Healey JS, Hohnloser SH, Glikson M, Neuzner J, Mabo P, Vinolas X, Kautzner J, O'Hara G, VanErven L, Gadler F, Pogue J, Appl U, Gilkerson J, Pochet T, Stein KM, Merkely B, Chrolavicius S, Meeks B, Foldesi C, Thibault B, Connolly SJ. Cardioverter defibrillator implantation without induction of ventricular fibrillation: a single-blind, non-inferiority, randomised controlled trial (SIMPLE). Lancet 2015; 385:785-91. [PMID: 25715991 DOI: 10.1016/s0140-6736(14)61903-6] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Defibrillation testing by induction and termination of ventricular fibrillation is widely done at the time of implantation of implantable cardioverter defibrillators (ICDs). We aimed to compare the efficacy and safety of ICD implantation without defibrillation testing versus the standard of ICD implantation with defibrillation testing. METHODS In this single-blind, randomised, multicentre, non-inferiority trial (Shockless IMPLant Evaluation [SIMPLE]), we recruited patients aged older than 18 years receiving their first ICD for standard indications at 85 hospitals in 18 countries worldwide. Exclusion criteria included pregnancy, awaiting transplantation, particpation in another randomised trial, unavailability for follow-up, or if it was expected that the ICD would have to be implanted on the right-hand side of the chest. Patients undergoing initial implantation of a Boston Scientific ICD were randomly assigned (1:1) using a computer-generated sequence to have either defibrillation testing (testing group) or not (no-testing group). We used random block sizes to conceal treatment allocation from the patients, and randomisation was stratified by clinical centre. Our primary efficacy analysis tested the intention-to-treat population for non-inferiority of no-testing versus testing by use of a composite outcome of arrhythmic death or failed appropriate shock (ie, a shock that did not terminate a spontaneous episode of ventricular tachycardia or fibrillation). The non-inferiority margin was a hazard ratio (HR) of 1·5 calculated from a proportional hazards model with no-testing versus testing as the only covariate; if the upper bound of the 95% CI was less than 1·5, we concluded that ICD insertion without testing was non-inferior to ICD with testing. We examined safety with two, 30 day, adverse event outcome clusters. The trial is registered with ClinicalTrials.gov, number NCT00800384. FINDINGS Between Jan 13, 2009, and April 4, 2011, of 2500 eligible patients, 1253 were randomly assigned to defibrillation testing and 1247 to no-testing, and followed up for a mean of 3·1 years (SD 1·0). The primary outcome of arrhythmic death or failed appropriate shock occurred in fewer patients (90 [7% per year]) in the no-testing group than patients who did receive it (104 [8% per year]; HR 0·86, 95% CI 0·65-1·14; pnon-inferiority <0·0001). The first safety composite outcome occurred in 69 (5·6%) of 1236 patients with no-testing and in 81 (6·5%) of 1242 patients with defibrillation testing, p=0·33. The second, pre-specified safety composite outcome, which included only events most likely to be directly caused by testing, occurred in 3·2% of patients with no-testing and in 4·5% with defibrillation testing, p=0·08. Heart failure needing intravenous treatment with inotropes or diuretics was the most common adverse event (in 20 [2%] of 1236 patients in the no-testing group vs 28 [2%] of 1242 patients in the testing group, p=0·25). INTERPRETATION Routine defibrillation testing at the time of ICD implantation is generally well tolerated, but does not improve shock efficacy or reduce arrhythmic death. FUNDING Boston Scientific and the Heart and Stroke Foundation (Ontario Provincial office).
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Affiliation(s)
- Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
| | | | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Gilles O'Hara
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | | | | | - Janice Pogue
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Ursula Appl
- Boston Scientific, Minneapolis MN, USA, and Brussels, Belgium
| | - Jim Gilkerson
- Boston Scientific, Minneapolis MN, USA, and Brussels, Belgium
| | - Thierry Pochet
- Boston Scientific, Minneapolis MN, USA, and Brussels, Belgium
| | - Kenneth M Stein
- Boston Scientific, Minneapolis MN, USA, and Brussels, Belgium
| | - Bela Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Susan Chrolavicius
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Brandi Meeks
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Csaba Foldesi
- Gottsegen National Institute of Cardiology, Budapest, Hungary
| | | | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Delgado H, Mitroi C, Martinez-Ferrer J, Vinolas X, Alzueta J, Basterra N, Fernandez-De-La-Concha J, Garcia E, Perez-Villacastin J, Fernandez Lozano I. Bundle branch block and QRS width in ICD patients. Morphology is more important than length. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1385] [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: 11/13/2022] Open
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Dores H, Ferreira R, Cardiga R, Araujo I, Marques F, Leitao A, Fonseca C, Ceia F, Alegret Colome JM, Vinolas X, Martinez JG, Pachon N, Crespo F, Freire F, Gonzalez Ruiz J, Garcia Sacristan JF, Deering TF, Epstein A, Goldman D, Greeberg S, Dalal Y, Castellant P, Vinsonneau U, Vinsonneau A, Valls-Bertault V, Desvignes O, Fatemi M, Etienne Y, Blanc JJ, Heidarsdottir R, Indridason OS, Arnar DO, Torfason B, Palsson R, Edvardsson V, Gottskalksson G, Skuladottir GV, Guglin M, Chen R, Curtis AB. Abstracts: Associated risk in atrial fibrillation patients. Europace 2009. [DOI: 10.1093/europace/euq251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Homs E, Marti V, Laguna P, Guindo J, Vinolas X, Caminal P, Elosua R, de Luna AB. A16-5 Automatic measurement of corrected qt interval in holter ECG as a marker of life-threatening arrhythmias in postmyocardial infarction patients. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b25] [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: 11/16/2022] Open
Affiliation(s)
- E. Homs
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - V. Marti
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - P. Laguna
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - J. Guindo
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - X. Vinolas
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - P. Caminal
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - R. Elosua
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
| | - A. Bayes de Luna
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau, Barcelona, Spain
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Homs E, Marti V, Laguna P, Guindo J, Vinolas X, Caminal P, Elosua R, de Luna AB. P-433 Dynamic behavior of QTC interval measured in holter ecg in postmyocardial infarction patients: Evidence of a circadian pattern of peaks of QTC lenghtening. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b168-b] [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: 11/15/2022] Open
Affiliation(s)
- E. Homs
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - V. Marti
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - P. Laguna
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - J. Guindo
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - X. Vinolas
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - P. Caminal
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - R. Elosua
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
| | - A. Bayes de Luna
- Cardiology Department, Hospital De La Santa Creu I De Sant Pau
,
Barcelona, Spain
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Vinolas X, Alegret J, Rodriguez E, Sabate X. P-290 Electrical cardioversion for persistent atrial fibrillation: Results of “estudi cardioversio electrica a catalunya”. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b134-c] [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: 11/29/2022] Open
Affiliation(s)
- X. Vinolas
- Cardiologia.Hospital Sant Pau.
Barcelona.Spain
| | | | | | - X. Sabate
- Cardiologia.Hospital Sant Pau.
Barcelona.Spain
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Sztajzel JM, Vinolas X, Sobral J, Dumaresq L, Boveda S, Torner P, Oter R, Luna AB. Heart Rate Variability Early After Successful Radiofrequency Catheter Ablation of Left- and Right-Sided Accessory Pathways and After Selective Ablation of the Slow Pathway. Ann Noninvasive Electrocardiol 1997. [DOI: 10.1111/j.1542-474x.1997.tb00201.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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