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Osca J, Francisco-Pascual J, Martínez-Basterra J, Martínez JG, Reis H, Oliveira M, Campos B, Balaguer J, Rubio J, Pavón-Jiménez R, Hernández J, Ormaetxe JM, Zamorano JL, Santamaría P, Alzueta J. Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III. Eur J Clin Invest 2023; 53:e13935. [PMID: 36504276 DOI: 10.1111/eci.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
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Affiliation(s)
- Joaquín Osca
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Jaume Francisco-Pascual
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | | | | | | | | | - Bieito Campos
- Hospital Universitari Arnau de Vilanova de Lleida, Barcelona, Spain
| | - Javier Balaguer
- Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Julio Hernández
- Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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2
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Calvo D, Salinas L, Martínez-Camblor P, García-Iglesias D, Alzueta J, Rodríguez A, Romero R, Viñolas X, Fernández-Lozano I, Anguera I, Villacastín J, Bodegas A, Fontenla A, Jalife J, Berenfeld O. Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases. Europace 2022; 24:1788-1799. [PMID: 35851611 PMCID: PMC10112842 DOI: 10.1093/europace/euac107] [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: 03/05/2021] [Accepted: 06/09/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans. METHODS AND RESULTS Fifty-eight self-terminated and 173 shock-terminated episodes of spontaneously initiated PVT/VF recorded by Medtronic implanted cardiac defibrillators (ICDs) in 87 patients with various cardiac pathologies were analyzed by short fast Fourier transform of shifting segments to determine the dynamics of dominant frequency (DF) and regularity index (RI). The progression in the intensity of DF and RI accumulations further quantified the time course of spectral characteristics of the episodes. Episodes of self-terminated PVT/VF lasted 8.6 s [95% confidence interval (CI): 8.1-9.1] and shock-terminated lasted 13.9 s (13.6-14.3) (P < 0.001). Recordings from patients with primarily electrical pathologies displayed higher DF and RI values than those from patients with primarily structural pathologies (P < 0.05) independently of ventricular function or antiarrhythmic drug therapy. Regardless of the underlying pathology, the average DF and RI intensities were lower in self-terminated than shock-terminated episodes [DF: 3.67 (4.04-4.58) vs. 4.32 (3.46-3.93) Hz, P < 0.001; RI: 0.53 (0.48-0.56) vs. 0.63 (0.60-0.65), P < 0.001]. In a multivariate analysis controlled by the type of pathology and clinical variables, regularity remained an independent predictor of self-termination [hazard ratio: 0.954 (0.928-0.980)]. Receiver operating characteristic (ROC) curve analysis of DF and RI intensities demonstrated increased predictability for self-termination in time with 95% CI above the 0.5 cut-off limit at about t = 8.6 s and t = 6.95 s, respectively. CONCLUSION Consistent with the notion that fast organized sources maintain PVT/VF in humans, reduction of frequency and regularity correlates with early self-termination. Our findings might help generate ICD methods aiming to reduce inappropriate shock deliveries.
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Affiliation(s)
- David Calvo
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. Roma, s/n; 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Lucia Salinas
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA
| | | | - Daniel García-Iglesias
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. Roma, s/n; 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Javier Alzueta
- Arrhythmia Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | - Anibal Rodríguez
- Arrhythmia Unit, Hospital Universitario de Canarias, Canarias, Spain
| | - Rafael Romero
- Arrhythmia Unit, Hospital Universitario Ntra Señora de la Candelaria, Canarias, Spain
| | | | | | | | | | | | | | - José Jalife
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA.,Cardiac Arrhythmia Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, USA
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Castro V, Toquero J, Pérez L, Orruño J, Alzueta J, Viñolas X, Álvarez L, Anguera I, Fernández I. Factores predictores de aparición de fibrilación auricular en pacientes con miocardiopatía dilatada. RCCAR 2022. [DOI: 10.24875/rccar.m21000096] [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: 11/17/2022] Open
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4
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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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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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Lillo-Castellano JM, González-Ferrer JJ, Marina-Breysse M, Martínez-Ferrer JB, Pérez-Álvarez L, Alzueta J, Martínez JG, Rodríguez A, Rodríguez-Pérez JC, Anguera I, Viñolas X, García-Alberola A, Quintanilla JG, Alfonso-Almazán JM, García J, Borrego L, Cañadas-Godoy V, Pérez-Castellano N, Pérez-Villacastín J, Jiménez-Díaz J, Jalife J, Filgueiras-Rama D. Personalized monitoring of electrical remodelling during atrial fibrillation progression via remote transmissions from implantable devices. Europace 2021; 22:704-715. [PMID: 31840163 PMCID: PMC7203636 DOI: 10.1093/europace/euz331] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/05/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
Aims Atrial electrical remodelling (AER) is a transitional period associated with the progression and long-term maintenance of atrial fibrillation (AF). We aimed to study the progression of AER in individual patients with implantable devices and AF episodes. Methods and results Observational multicentre study (51 centres) including 4618 patients with implantable cardioverter-defibrillator +/−resynchronization therapy (ICD/CRT-D) and 352 patients (2 centres) with pacemakers (median follow-up: 3.4 years). Atrial activation rate (AAR) was quantified as the frequency of the dominant peak in the signal spectrum of AF episodes with atrial bipolar electrograms. Patients with complete progression of AER, from paroxysmal AF episodes to electrically remodelled persistent AF, were used to depict patient-specific AER slopes. A total of 34 712 AF tracings from 830 patients (87 with pacemakers) were suitable for the study. Complete progression of AER was documented in 216 patients (16 with pacemakers). Patients with persistent AF after completion of AER showed ∼30% faster AAR than patients with paroxysmal AF. The slope of AAR changes during AF progression revealed patient-specific patterns that correlated with the time-to-completion of AER (R2 = 0.85). Pacemaker patients were older than patients with ICD/CRT-Ds (78.3 vs. 67.2 year olds, respectively, P < 0.001) and had a shorter median time-to-completion of AER (24.9 vs. 93.5 days, respectively, P = 0.016). Remote transmissions in patients with ICD/CRT-D devices enabled the estimation of the time-to-completion of AER using the predicted slope of AAR changes from initiation to completion of electrical remodelling (R2 = 0.45). Conclusion The AF progression shows patient-specific patterns of AER, which can be estimated using available remote-monitoring technology.
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Affiliation(s)
- José María Lillo-Castellano
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Marina-Breysse
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Agencia Española de Protección de la Salud en el Deporte (AEPSAD), Madrid. Spain
| | | | - Luisa Pérez-Álvarez
- Department of Cardiology, Hospital Hospital Universitario de A Coruña, La Coruña, Spain
| | - Javier Alzueta
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan Gabriel Martínez
- Department of Cardiology, Hospital General Universitario de Alicante, ISABIAL-FISABIO, Alicante, Spain
| | - Aníbal Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Ignasi Anguera
- Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Xavier Viñolas
- Department of Cardiology, Hospital Santa Creu i san Pau, Barcelona, Spain
| | | | - Jorge G Quintanilla
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Manuel Alfonso-Almazán
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Javier García
- Department of Cardiology, Hospital Universitario de Getafe, Madrid, Spain
| | - Luis Borrego
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Jiménez-Díaz
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - José Jalife
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiac Arrhythmia Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - David Filgueiras-Rama
- Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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7
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Loughlin G, Datino T, Arenal Á, Ruiz-Granell R, Sánchez-Gómez JM, Pérez L, Martínez-Ferrer J, Alzueta J, Pérez-Lorente F, Viñolas X, Fidalgo Andrés ML, Fernández de la Concha J. Predictores e impacto de la adopción de programación basada en la evidencia en la incidencia de terapias del desfibrilador automático implantable. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Loughlin G, Datino T, Arenal Á, Ruiz-Granell R, Sánchez-Gómez JM, Pérez L, Martínez-Ferrer J, Alzueta J, Pérez-Lorente F, Viñolas X, Fidalgo Andrés ML, Fernández de la Concha J. Predictors of adoption and impact of evidence-based programming on the incidence of implantable cardioverter-defibrillator therapies. Rev Esp Cardiol (Engl Ed) 2021; 74:296-302. [PMID: 32773348 DOI: 10.1016/j.rec.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES The ADVANCE III trial showed that a delayed-detection strategy reduces implantable cardioverter-defibrillator (ICD) therapies. Here, we describe the adherence to and predictors of ADVANCE adoption and compare ICD therapy rates between patients with and without ADVANCE programming. METHODS This observational retrospective study analyzed patients implanted with Medtronic ICDs included from 2005 to 2016 in a Spanish national multicenter registry (UMBRELLA database; ClinicalTrials.gov, NCT01561144). Changes in ADVANCE programming adoption were described in relation to a) publication of the ADVANCE trial, b) implementation of an "ADVANCE awareness" campaign, and c) publication of an expert consensus statement. Multivariate logistic regression identified predictors of adoption. Therapy incidence rates were compared between groups by estimating the adjusted incidence rate ratio (aIRR) using negative binomial regression. RESULTS A total of 3528 patients were included. An ADVANCE strategy was used in 20% overall and in 44% at the end of the study. ADVANCE III adoption increased after trial publication, with less growth after an "ADVANCE awareness" campaign and after expert consensus statement publication. Predictors of ADVANCE adoption were as follows: ICD device with a nominal number of intervals to detect 30/40 (aOR, 4.4; 95%CI, 3.5-5.4), implantation by an electrophysiologist (aOR, 1.7; 95%CI, 1.4-2.2), and secondary prevention (aOR, 3.2; 95%CI, 2.6-3.9). Dual-chamber ICDs (aOR, 0.6; 95%CI, 0.5-0.8) and cardiac resynchronization-defibrillators (aOR, 0.5; 95%CI, 0.4-0.7) were associated with lower adoption. ADVANCE programming was associated with reduced total therapy burden (aIRR, 0.77; 95%CI, 0.69-0.86) and fewer inappropriate shocks (aIRR, 0.66; 95%CI, 0.52-0.85). CONCLUSIONS ADVANCE adoption remains modest and can be improved through evidence-driven selection of nominal ICD settings. ADVANCE programming is associated with reduced therapy rates in real-world ICD recipients.
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Affiliation(s)
- Gerard Loughlin
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Tomás Datino
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ángel Arenal
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ricardo Ruiz-Granell
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Luisa Pérez
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Javier Alzueta
- Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | | | - Xavier Viñolas
- Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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9
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Briongos-Figuero S, García-Alberola A, Rubio J, Segura JM, Rodríguez A, Peinado R, Alzueta J, Martínez-Ferrer JB, Viñolas X, Fernández de la Concha J, Anguera I, Martín M, Cerdá L, Pérez L. Long-Term Outcomes Among a Nationwide Cohort of Patients Using an Implantable Cardioverter-Defibrillator: UMBRELLA Study Final Results. J Am Heart Assoc 2020; 10:e018108. [PMID: 33356406 PMCID: PMC7955463 DOI: 10.1161/jaha.120.018108] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
Background Large‐scale studies describing modern populations using an implantable cardioverter‐defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real‐world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29–1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07–1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43–2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54–0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14–0.45) showed a lower risk. All‐cause death was 13.4% at follow‐up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58–5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18–5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25–6.99) had the worst prognoses. Delayed high‐rate detection was enabled in 39.7% of patients, and single‐zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow‐up was low (6%) and did not differ among type of ICD but was lower in SmartShock‐capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure–related disorders had a similar risk of ICD life‐saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NTC01561144.
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Affiliation(s)
- Sem Briongos-Figuero
- Hospital Universitario Infanta Leonor Madrid Spain.,Universidad Complutense de Madrid Madrid Spain
| | | | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid Valladolid Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria Málaga Spain
| | | | | | | | | | | | | | - Luisa Pérez
- Complexo Hospitalario Universitario de A Coruña A Coruña Spain
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Diaz Exposito A, Ruiz Salas A, Medina C, Barrera A, Alzueta J, Gomez Doblas J. Threshold stability using active fixation LV lead. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The proper functioning of the CRT devices depends on the correct positioning of the electrodes, sometimes being compromised by the absence of suitable epicardial veins, leads instability or unacceptable high thresholds, among other. In 2017, a novel quadripolar active fixation LV lead was released with an innovative helical mechanism that expands to attach the lead within the vessel.
Objectives
Study the impact of the active fixation LV lead on threshold stability and dislocations.
Methods
We included 127 consecutive patients undergoing CRT between September 2017 to December 2019 in one hospital. They were randomly assigned: 62p active fixation VI leads vs 65p standard VI leads. LV thresholds, capture losses and dislocations were collected at standard pacing checks (1 week, 2 months, 6 months).
Results
The mean age of the sample was 73,9±8,4 years. 75% patients were male and 48,4% suffered ischemic cardiomyopathy. The two groups were similar according to this variables. 5 (7.7%) dislocations were reported in the control group against 2 (3.2%) in the active fixation group (n.s). The mean threshold (V) at the moment of the implant was 1,4 in the active fixation vs 1,41 in the standard LV leads; at the first visit 1,55 vs 1,99; at two months 1,59 vs 2,13 and at six months 1,74 vs 2,48.
The threshold stability is shown in Figure 1.
Conclusions
– The active fixation LV lead provides higher threshold stability than the conventional one.
– There is a non-significant tendency to reduce dislocations.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Ruiz Salas
- University Hospital Virgen de la Victoria, Malaga, Spain
| | - C Medina
- University Hospital Virgen de la Victoria, Malaga, Spain
| | - A Barrera
- University Hospital Virgen de la Victoria, Malaga, Spain
| | - J Alzueta
- University Hospital Virgen de la Victoria, Malaga, Spain
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11
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Calvo D, Picazo M, García-Iglesias D, Pérez D, Rubín J, Martínez-Ferrer JB, Rodríguez A, Viñolas X, Alzueta J, Basterra N, Morís C. The clinical impact of untreated slow ventricular tachycardia in patients carrying implantable cardiac defibrillators. J Interv Card Electrophysiol 2020; 62:103-111. [PMID: 32965615 DOI: 10.1007/s10840-020-00877-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. METHODS AND RESULTS From the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes of slow VT were observed in 97 patients. Untreated slow VT (n = 93) had longer duration (23.7 min, CI95%: 10-39), compared with episodes treated effectively by anti-tachycardia pacing (ATP; n = 527; 0.32 min, IC95%: 0.22-0, 48) or shock (n = 39; 1 min, CI95%: 0.8-1.2). Despite of longer duration, the time to the first contact with the medical services was similar to those episodes treated by ATP (50 days [CI95%: 45-55] vs. 41 days [CI95%: 39-44]). However, both were significantly longer than the time observed in episodes treated with shock (10 days, CI95%: 6-15). This tendency was maintained with successive interrogations of the device (2nd and 3rd). There were no significant differences in mortality during follow-up (48 ± 16 months), neither other adverse outcomes, between patients who presented untreated slow TV and those who did not (log-rank p = 0.28). In a Cox regression analysis, the variable "presenting untreated episodes of slow VT" was not able to predict mortality. However, being in sinus rhythm (vs. atrial fibrillation, OR: 0.31, p = 0.009), narrower QRS (OR: 1.036, p = 0.037) and diabetes (OR 4.673, p = 0.049) appropriately predict survival. CONCLUSIONS Untreated slow VT does not significantly worsen patient prognosis. Our results support the limitation of therapies to ATP only, thus avoiding therapies that have been associated with increased risk of morbidity and mortality.
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Affiliation(s)
- David Calvo
- Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Av. Roma, s/n, 33011, Oviedo, Asturias, Spain.
| | | | - Daniel García-Iglesias
- Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Av. Roma, s/n, 33011, Oviedo, Asturias, Spain
| | - Diego Pérez
- Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Av. Roma, s/n, 33011, Oviedo, Asturias, Spain
| | - José Rubín
- Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Av. Roma, s/n, 33011, Oviedo, Asturias, Spain
| | | | | | | | - Javier Alzueta
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | - César Morís
- Arrhythmia Unit; Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Av. Roma, s/n, 33011, Oviedo, Asturias, Spain
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Dallaglio PD, di Marco A, Moreno Weidmann Z, Perez L, Alzueta J, García-Alberola A, Fernandez-Lozano I, Díaz-Infante E, Rodriguez A, Basterra N, Calvo D, Rodriguez Garcia M, Aceña M, Anguera I. Antitachycardia pacing for shock prevention in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Heart Rhythm 2020; 17:1084-1091. [PMID: 32113896 DOI: 10.1016/j.hrthm.2020.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden death due to ventricular arrhythmias (VAs). The implantable cardioverter-defibrillator (ICD) is a well-established therapy for treatment of VA. Monomorphic ventricular tachycardias (MVTs) are frequent in HCM patients and suitable for antitachycardia pacing (ATP) termination. OBJECTIVE The purpose of this study was to describe ventricular tachycardia (VT) characteristics in a population of HCM patients with ICD and to study the effectiveness and safety of ATP for MVT. METHODS Data were obtained from the multicenter prospective observational UMBRELLA trial, which included all patients with HCM and ICD followed by the CareLink Monitoring System. All episodes of VA were collected and analyzed. ATP effectiveness and safety were described, and factors related to ATP effectiveness were studied with generalized estimating equation (GEE) models. RESULTS Among 251 patients followed for 47 months, 67 (26.7%) were implanted as secondary prevention. Fifty-six patients presented 326 episodes of VA (286 [87%] MVT). Mean cycle length was 312 ± 64 ms. Among 264 MVTs that received ICD therapy, 202 (76.5%) were ATP terminated. The first ATP burst was effective in 169 episodes (68.4%), and overall effectiveness of the first or second ATP burst was 73.8%. Multivariate GEE-adjusted analysis showed 2 variables related to ATP effectiveness: programming fast VT zone On vs Off (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.5-5.2; P = .03) and programming ≥2 ATP bursts vs 1 burst only (OR 1.6; 95% CI 1.2-3.4; P = .04; and OR 2.9; 95% CI 1.8-6.3; P = .02; respectively). CONCLUSION MVT is the predominant VA in HCM patients with ICD. ATP is highly effective in terminating the majority of MVTs, and its proved effectiveness should guide device selection and programming in order to avoid unnecessary high-energy shocks.
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Affiliation(s)
| | - Andrea di Marco
- Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | | | - Luisa Perez
- Heart Disease Institute, University Hospital of A Coruña, A Coruña, Spain
| | - Javier Alzueta
- Heart Disease Institute, "Virgen de la Victoria" University Hospital, Málaga, Spain
| | | | | | - Ernesto Díaz-Infante
- Heart Disease Institute "Virgen de la Macarena" University Hospital, Sevilla, Spain
| | | | - Nuria Basterra
- Heart Disease Institute, Hospital de Navarra, Pamplona, Spain
| | - David Calvo
- Hospital Universitario Central de Asturias, Asturias, Spain
| | | | - Marta Aceña
- Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Ignasi Anguera
- Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
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13
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Briongos-Figuero S, Estévez A, Pérez ML, Martínez-Ferrer JB, García E, Viñolas X, Arenal Á, Alzueta J, Muñoz-Aguilera R. Prognostic role of NYHA class in heart failure patients undergoing primary prevention ICD therapy. ESC Heart Fail 2019; 7:279-283. [PMID: 31823514 PMCID: PMC7083467 DOI: 10.1002/ehf2.12548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/06/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Concerns about the prognostic value of NYHA functional class (FC) in heart failure (HF) patients carrying a prophylactic implantable cardioverter defibrillator (ICD) are still present. We aimed to compare whether mortality and arrhythmic risk were different, in a cohort of HF patients undergoing ICD‐only implant, according to their FC. Methods and results HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD‐only implant were collected from a multicentre nationwide registry (2006–2015). Six hundred and twenty‐one patients were identified (101 patients in NYHA I; 411 in NYHA II; 109 in NYHA III). After a mean follow‐up of 4.4 years (±2.1), 126 patients died (20.3%). All‐cause mortality risk was higher in symptomatic patients: 13.9% in NYHA I patients, 18.3% in NYHA II patients (HR: 1.8, 95% CI 1.1–3.2), and 32.9% in NYHA III patients (HR: 3.9, 95% CI 2.1–7.3). Seventy‐eight out of all deaths were due to cardiovascular causes (12.6%). Cardiovascular mortality risk was also higher in symptomatic patients: 6.9% in NYHA I patients, 11% in NYHA II patients (HR: 2.2, 95% CI 1.1–4.9), and 23.9% in NYHA III (HR: 5.5, 95% CI 2.4–12.7). One hundred and seventeen patients received a first appropriate ICD therapy (19.4%). Arrhythmia free survival did not differ among study groups [20.8% in NYHA I patients, 18.7% in NYHA II (HR: 1.1, 95% CI 0.6–1.7) and 20.8% in NYHA III patients (HR: 1.3, 95% CI 0.7–2.5)]. NYHA class independently predicted cardiovascular mortality (NYHA III vs. NYHA I: HR, 4.7; 95% CI, 1.7–12.8, P = 0.002; NYHA II vs. NYHA I: HR, 2.1, 95% CI, 1.0–5.6, P = 0.05) but not all‐cause death (NYHA III vs. NYHA I: HR: 1.8, 95% CI 0.8–3.9, P = 0.11; NYHA II vs. NYHA I: HR, 1.1, 95% CI 0.6–2.2, P = 0.71;). Atrial fibrillation, chronic kidney disease, and diabetes emerged as predictors of both all‐cause death [(HR: 1.8, 95% CI 1.2–2.8, P = 0.005), (HR: 2.2, 95% CI 1.4–3.4, P < 0.001), (HR: 2.0, 95% CI 1.3–3.1, P = 0.001), respectively] and cardiovascular mortality [(HR: 1.8, 95% CI 1.1–3.1, P = 0.02), (HR: 3.1, 95% CI 1.8–5.4, P < 0.001), (HR: 1.7, 95% CI 1.1–3, P = 0.032), respectively]. Conclusions Mortality in HF patients undergoing prophylactic ICD implantation was higher in symptomatic patients. NYHA functional class along with other comorbidities might be helpful to identify a subgroup of ICD carriers with poorer prognosis and higher risk of cardiovascular death.
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Affiliation(s)
- Sem Briongos-Figuero
- Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - Alvaro Estévez
- Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - M Luisa Pérez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Enrique García
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Ángel Arenal
- Hospital Universitario Gregorio Marañón, Madrid, Spain
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14
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Briongos-Figuero S, Estévez A, Luisa Pérez M, Martínez-Ferrer JB, García E, Viñolas X, Arenal Á, Alzueta J, Basterra N, Rodríguez A, Lozano I, Muñoz-Aguilera R. Survival and arrhythmic risk among ischemic and non-ischemic heart failure patients with prophylactic implantable cardioverter defibrillator only therapy: A propensity score-matched analysis. Int J Cardiol 2019; 274:163-169. [PMID: 30206014 DOI: 10.1016/j.ijcard.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/18/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Concerns about the efficacy of prophylactic ICD in non-ischemic cardiomyopathy (NICM) heart failure (HF) patients are still present. We aimed to assess whether survival and arrhythmic risk were different among ischemic cardiomyopathy (ICM) and NICM ICD-only patients, along with specific predictors for mortality. METHODS HF patients undergoing ICD-only implant were extracted from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts. RESULTS 782 patients (556 ICM; 226 NICM) were recruited: mean ejection fraction of 26.6%; 83.4% in NYHA class II-III; mean QRS duration of 108.9 ms (only 14.9% with QRS > 130 ms). After 4.35 years of mean follow-up, all-cause mortality rate was 4.2%/year. In propensity-score (PS) analysis no survival differences between ICM and NICM subgroups appeared (mortality rates: 19.4% vs. 20%, p = 0.375). Age (hazard ratio [HR] = 1.02, p = 0.009), diabetes (HR = 2.61, p ≤ 0.001), chronic obstructive pulmonary disease (HR = 2.13, p = 0.002), and previous HF (HR = 2.28, p = 0.027) correlated with increased mortality for the entire population, however atrial fibrillation (AF) (HR = 2.68, p = 0.002) and chronic kidney disease (HR = 3.74, p ≤ 0.001) emerged as specific predictors in NICM patients. At follow-up, 134 patients (17.1%) were delivered a first appropriate ICD therapy (5.1%/year) without significant differences between ICM and NICM patients in the PS analysis (17.6% vs. 15.8%, p = 0.968). ICD shocks were associated with a higher mortality (HR = 2.88, p < 0.001) but longer detection windows (HR = 0.57, p = 0.042) correlated with fewer appropriate therapies. CONCLUSIONS Mortality and arrhythmia free survival is similar among ICM and NICM HF patients undergoing ICD-only implant for primary prevention strategy.
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Affiliation(s)
| | | | - M Luisa Pérez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Enrique García
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Ángel Arenal
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Aníbal Rodríguez
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Ruiz Salas A, Peña Hernández J, Medina Palomo C, Barrera Cordero A, Cabrera Bueno F, García Pinilla JM, Guijarro A, Morcillo-Hidalgo L, Jiménez Navarro M, Gómez Doblas JJ, de Teresa E, Alzueta J. Rentabilidad del estudio genético mediante técnicas de next-generation sequencing masiva de pacientes con miocardiopatía arritmogénica de alto riesgo. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.11.007] [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: 10/18/2022]
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Ruiz Salas A, Peña Hernández J, Medina Palomo C, Barrera Cordero A, Cabrera Bueno F, García Pinilla JM, Guijarro A, Morcillo-Hidalgo L, Jiménez Navarro M, Gómez Doblas JJ, de Teresa E, Alzueta J. Usefulness of Genetic Study by Next-generation Sequencing in High-risk Arrhythmogenic Cardiomyopathy. Rev Esp Cardiol (Engl Ed) 2018; 71:1018-1026. [PMID: 29606362 DOI: 10.1016/j.rec.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/06/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by progressive fibrofatty replacement of predominantly right ventricular myocardium. This cardiomyopathy is a frequent cause of sudden cardiac death in young people and athletes. The aim of our study was to determine the incidence of pathological or likely pathological desmosomal mutations in patients with high-risk definite ARVC. METHODS This was an observational, retrospective cohort study, which included 36 patients diagnosed with high-risk ARVC in our hospital between January 1998 and January 2015. Genetic analysis was performed using next-generation sequencing. RESULTS Most patients were male (28 patients, 78%) with a mean age at diagnosis of 45 ± 18 years. A pathogenic or probably pathogenic desmosomal mutation was detected in 26 of the 35 index cases (74%): 5 nonsense, 14 frameshift, 1 splice, and 6 missense. Novel mutations were found in 15 patients (71%). The presence or absence of desmosomal mutations causing the disease and the type of mutation were not associated with specific electrocardiographic, clinical, arrhythmic, anatomic, or prognostic characteristics. CONCLUSIONS The incidence of pathological or likely pathological desmosomal mutations in ARVC is very high, with most mutations causing truncation. The presence of desmosomal mutations was not associated with prognosis.
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Affiliation(s)
- Amalio Ruiz Salas
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
| | - José Peña Hernández
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Carmen Medina Palomo
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Alberto Barrera Cordero
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Fernando Cabrera Bueno
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - José Manuel García Pinilla
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Ana Guijarro
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Luis Morcillo-Hidalgo
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Manuel Jiménez Navarro
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Juan José Gómez Doblas
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Eduardo de Teresa
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Javier Alzueta
- Unidad de Gestión Clínica (UGC) del Corazón, CIBER Cardiovascular, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
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Dallaglio PD, Anguera I, Martínez Ferrer JB, Pérez L, Viñolas X, Porres JM, Fontenla A, Alzueta J, Martínez JG, Rodríguez A, Basterra N, Sabaté X. Taquicardias ventriculares rápidas en pacientes con desfibrilador implantable: reducción de choques mediante terapia antitaquicárdica antes y durante la carga. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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18
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Ruiz Salas A, Barrera Cordero A, Navarro‐Arce I, Jiménez Navarro M, García Pinilla JM, Cabrera Bueno F, Abdeselam‐Mohamed N, Morcillo‐Hidalgo L, Gómez Doblas JJ, Teresa E, Alzueta J. Impact of dynamic physical exercise on high‐risk definite arrhythmogenic right ventricular cardiomyopathy. J Cardiovasc Electrophysiol 2018; 29:1523-1529. [DOI: 10.1111/jce.13704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Amalio Ruiz Salas
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Alberto Barrera Cordero
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Isabel Navarro‐Arce
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Manuel Jiménez Navarro
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - José Manuel García Pinilla
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Fernando Cabrera Bueno
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Nasiba Abdeselam‐Mohamed
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Luis Morcillo‐Hidalgo
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Juan José Gómez Doblas
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Eduardo Teresa
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Javier Alzueta
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
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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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20
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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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21
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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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22
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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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23
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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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Dallaglio PD, Anguera I, Martínez Ferrer JB, Pérez L, Viñolas X, Porres JM, Fontenla A, Alzueta J, Martínez JG, Rodríguez A, Basterra N, Sabaté X. Shock Reduction With Antitachycardia Pacing Before and During Charging for Fast Ventricular Tachycardias in Patients With Implantable Defibrillators. Rev Esp Cardiol (Engl Ed) 2017; 71:709-717. [PMID: 29242102 DOI: 10.1016/j.rec.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator are susceptible to antitachycardia pacing (ATP) termination. Some manufacturers allow programming 2 ATP bursts: before charging (BC) and during (DC) charging. The aim of this study was to describe the safety and effectiveness of ATP BC and DC for fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator in daily clinical practice. METHODS Data proceeded from the multicenter UMBRELLA trial, including implantable cardioverter-defibrillator patients followed up by the CareLink monitoring system. Fast ventricular tachycardias in the ventricular fibrillation zone until a cycle length of 200ms with ATP BC and/or ATP DC were included. RESULTS We reviewed 542 episodes in 240 patients. Two ATP bursts (BC/DC) were programmed in 291 episodes (53.7%, 87 patients), while 251 episodes (46.3%, 153 patients) had 1 ATP burst only DC. The number of episodes terminated by 1 ATP DC was 139, representing 55.4% effectiveness (generalized estimating equation-adjusted 60.4%). There were 256 episodes terminated by 1 or 2 ATP (BC/DC), representing 88% effectiveness (generalized estimating equation-adjusted 79.3%); the OR for ATP effectiveness BC/DC vs DC was 2.5, 95%CI, 1.5-4.1; P <.001. Shocked episodes were 112 (45%) for ATP DC vs 35 (12%) for ATP BC/DC, representing an absolute reduction of 73%. The mean shocked episode duration was 16seconds for ATP DC vs 19seconds for ATP BC/DC (P=.07). CONCLUSIONS The ATP DC in the ventricular fibrillation zone for fast ventricular tachycardia is moderately effective. Adding an ATP burst BC increases the overall effectiveness, reduces the need for shocks, and does not prolong episode duration.
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Affiliation(s)
- Paolo Domenico Dallaglio
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ignasi Anguera
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luisa Pérez
- Servicio de Cardiología, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Xavier Viñolas
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Manuel Porres
- Servicio de Cardiología, Hospital Universitario de Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - Adolfo Fontenla
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Alzueta
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan Gabriel Martínez
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Aníbal Rodríguez
- Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Nuria Basterra
- Servicio de Cardiología, Hospital de Navarra, Pamplona, Navarra, Spain
| | - Xavier Sabaté
- Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Alzueta J, Fernández-Lozano I. Registro Español de Desfibrilador Automático Implantable. XIII Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2016). Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Alzueta J, Fernández-Lozano I. Spanish Implantable Cardioverter-defibrillator Registry. 13th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2016). ACTA ACUST UNITED AC 2017; 70:960-970. [PMID: 28923417 DOI: 10.1016/j.rec.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES To report the findings of the Spanish Implantable Cardioverter-defibrillator Registry for 2016 compiled by the Electrophysiology and Arrhythmias Section of the Spanish Society of Cardiology. METHODS Prospective data were voluntarily recorded on a data collection form and send to the Spanish Society of Cardiology by each implantation team. RESULTS Overall, 5673 device implantations were reported, representing 85% of the estimated total number of implantations. The reported implantation rate was 122 per million population and the estimated total implantation rate was 143 per million. The proportion of first implantations was 66.8%. Data were received from 177 hospitals (8 more than in 2015). Most implantable cardioverter-defibrillator recipients were men (81.9%). The mean age was 62.7 ± 13.4 years. Most patients had severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent underlying cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Indications for primary prevention accounted for 62% of first implantations. Overall, 81.2% of devices were implanted by cardiac electrophysiologists. CONCLUSIONS The 2016 Spanish Implantable Cardioverter-defibrillator Registry includes information on 85% of the devices implanted in Spain. The total number of device implantations increased in comparison with the last few years. The percentage of implantations for primary prevention also increased in comparison with the previous year.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/therapy
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/epidemiology
- Cardiomyopathy, Dilated/physiopathology
- Child
- Defibrillators, Implantable/statistics & numerical data
- Female
- Humans
- Male
- Middle Aged
- Myocardial Ischemia/complications
- Myocardial Ischemia/epidemiology
- Myocardial Ischemia/physiopathology
- Prospective Studies
- Prosthesis Failure
- Registries
- Spain/epidemiology
- Stroke Volume/physiology
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
- Young Adult
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Affiliation(s)
- Javier Alzueta
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain.
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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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Ruiz Salas A, Robles Mezcua A, Medina Palomo C, Pena Hernandez JL, Barrera Cordero A, De Teresa E, Alzueta J. P1599High incidence of desmosomic mutations on high risk arrhythmogenic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux158.225] [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: 11/13/2022] Open
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Mendez Zurita F, Alonso M C, Martinez Ferrer J, Fernandez Lozano I, Rodriguez A, Diaz Infante E, Garcia Arberola A, Villuenda R, Alzueta J, Villacastin J, Arizon JM, Vinolas Prat X. P955Clinical characteristics predisposing to appropiate ventricular therapy in patients with implanted cardioverter-defibrilator for primary prevention of sudden cardiac death. Europace 2017. [DOI: 10.1093/ehjci/eux151.137] [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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Alonso-Martin C, Mendez F, Martinez Ferrer J, Fernandez Lozano I, Rodriguez A, Diaz Infante E, Garcia Alberola A, Villuendas R, Alzueta J, Villacastin J, Arizon JM, Vinolas J. P1020Evolving profile of atrial fibrillation in patients with dilated cardiomyopathy and ICD implantation during remote follow-up. Europace 2017. [DOI: 10.1093/ehjci/eux151.201] [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: 11/13/2022] Open
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Ruiz Salas A, Medina Palomo C, Robles Mezcua A, Barrera Cordero A, Pena Hernandez JL, Gomez Doblas JJ, De Teresa E, Alzueta J. P454Impact of dynamic physical exercise on the progression of arrhythmogenic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux141.177] [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: 11/13/2022] Open
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35
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Cozar-Leon R, Ruiz-Duthil AD, Perez L, Alzueta J, Martinez-Ferrer JB, Arizon JM, Fernandez-Lozano I, Vinolas J, Jimenez J, Fernandez De La Concha J, Garcia Campo E, Bastos P, Diaz-Infante E. P1737Incidence and risk factors for the development of slow ventricular tachycardia in recipients of implantable cardioverter defibrillators. Europace 2017. [DOI: 10.1093/ehjci/eux161.047] [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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Alzueta J, Fernández-Lozano I, Barrera A. Registro Español de Desfibrilador Automático Implantable. XII Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2015). Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Alzueta J, Fernández-Lozano I, Barrera A. Spanish Implantable Cardioverter-defibrillator Registry. Twelfth Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2015). ACTA ACUST UNITED AC 2016; 69:1168-1179. [PMID: 27818148 DOI: 10.1016/j.rec.2016.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/05/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2015, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology. METHODS Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology. RESULTS The number of reported implantations was 5465 (85% of the estimated total number of implantations). The implantation rate was 118 per million population while the estimated rate was 138. First implantations comprised 71.8%. Data were obtained from 169 hospitals (7 more than in 2014). Most implantations (82.7%) were performed in men. The mean patient age was 62.8±13.3 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association function class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.2%. Electrophysiologists performed 79.6% of the implantations. CONCLUSIONS The 2015 Spanish Implantable Cardioverter-defibrillator Registry received information on 85% of the implantations performed in Spain. The number of implantations has grown from previous years. The percentage of implantations for primary prevention indications has slightly decreased from the previous registry.
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Affiliation(s)
- Javier Alzueta
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain.
| | | | - Alberto Barrera
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain
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Lillo-Castellano JM, Marina-Breysse M, Gómez-Gallanti A, Martínez-Ferrer JB, Alzueta J, Pérez-Álvarez L, Alberola A, Fernández-Lozano I, Rodríguez A, Porro R, Anguera I, Fontenla A, González-Ferrer JJ, Cañadas-Godoy V, Pérez-Castellano N, Garófalo D, Salvador-Montañés Ó, Calvo CJ, Quintanilla JG, Peinado R, Mora-Jiménez I, Pérez-Villacastín J, Rojo-Álvarez JL, Filgueiras-Rama D. Safety threshold of R-wave amplitudes in patients with implantable cardioverter defibrillator. Heart 2016; 102:1662-70. [PMID: 27296239 DOI: 10.1136/heartjnl-2016-309295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 01/08/2016] [Accepted: 05/08/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE A safety threshold for baseline rhythm R-wave amplitudes during follow-up of implantable cardioverter defibrillators (ICD) has not been established. We aimed to analyse the amplitude distribution and undersensing rate during spontaneous episodes of ventricular fibrillation (VF), and define a safety amplitude threshold for baseline R-waves. METHODS Data were obtained from an observational multicentre registry conducted at 48 centres in Spain. Baseline R-wave amplitudes and VF events were prospectively registered by remote monitoring. Signal processing algorithms were used to compare amplitudes of baseline R-waves with VF R-waves. All undersensed R-waves after the blanking period (120 ms) were manually marked. RESULTS We studied 2507 patients from August 2011 to September 2014, which yielded 229 VF episodes (cycle length 189.6±29.1 ms) from 83 patients that were suitable for R-wave comparisons (follow-up 2.7±2.6 years). The majority (77.6%) of VF R-waves (n=13953) showed lower amplitudes than the reference baseline R-wave. The decrease in VF amplitude was progressively attenuated among subgroups of baseline R-wave amplitude (≥17; ≥12 to <17; ≥7 to <12; ≥2.2 to <7 mV) from the highest to the lowest: median deviations -51.2% to +22.4%, respectively (p=0.027). There were no significant differences in undersensing rates of VF R-waves among subgroups. Both the normalised histogram distribution and the undersensing risk function obtained from the ≥2.2 to <7 mV subgroup enabled the prediction that baseline R-wave amplitudes ≤2.5 mV (interquartile range: 2.3-2.8 mV) may lead to ≥25% of undersensed VF R-waves. CONCLUSIONS Baseline R-wave amplitudes ≤2.5 mV during follow-up of patients with ICDs may lead to high risk of delayed detection of VF. TRIAL REGISTRATION NUMBER NCT01561144; results.
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Affiliation(s)
- J M Lillo-Castellano
- Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Manuel Marina-Breysse
- Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain
| | | | | | - Javier Alzueta
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Arcadi Alberola
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Anibal Rodríguez
- Department of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Rosa Porro
- Department of Cardiology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Ignacio Anguera
- Department of Cardiology, Hospital de Bellvitge, Barcelona, Spain
| | - Adolfo Fontenla
- Department of Cardiology, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - Daniel Garófalo
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Conrado J Calvo
- Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Electrical Engineering, Universitat Politècnica de Valencia, Valencia, Spain
| | - Jorge G Quintanilla
- Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Inmaculada Mora-Jiménez
- Department of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - J L Rojo-Álvarez
- Department of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - David Filgueiras-Rama
- Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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Fontenla A, Martínez-Ferrer JB, Alzueta J, Viñolas X, García-Alberola A, Brugada J, Peinado R, Sancho-Tello MJ, Cano A, Fernández-Lozano I. Incidence of arrhythmias in a large cohort of patients with current implantable cardioverter-defibrillators in Spain: results from the UMBRELLA Registry. Europace 2015; 18:1726-1734. [PMID: 26705555 DOI: 10.1093/europace/euv393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 07/02/2015] [Accepted: 10/31/2015] [Indexed: 01/06/2023] Open
Abstract
AIMS The benefit of implantable cardioverter-defibrillators (ICDs) in patients at risk of sudden death has been established in randomized clinical trials (RCTs) using the ICD models available at the time. However, observational large-scale data on the incidence of arrhythmias in up-to-date ICDs implanted according to the current guidelines are scarce. The aim was to assess the incidence of arrhythmias in a large, current ICD population based on a blinded peer review of the detected episodes. METHODS AND RESULTS UMBRELLA is a multicentre, observational registry of ICD patients followed by remote monitoring. Stored episodes were classified by a blinded committee of experts. Subgroup analyses were based on clinical profiles established by previous pivotal RCTs of ICDs. Of 1514 enrolled patients, 605 (39.9%) patients had 5951 episodes after 26 ± 17 months follow-up, being 3353 of them (56.3%) sustained ventricular arrhythmias (SVA), and 13.2% of SVA were self-terminated. Appropriate and inappropriate shocks occurred in 11.6 and 5% of patients, respectively. The 3 years cumulative incidence of SVA was 25% (95% CI: 21-28%) in primary prevention patients and 41% (95% CI: 36-47%) in secondary prevention patients (P < 0.001). Male gender, secondary prevention, and atrial fibrillation as basal rhythm were significantly related to a higher incidence of SVA. CONCLUSION This real-world analysis suggests that modern ICD patients have a low rate of appropriate and inappropriate shocks. The risk of SVA in secondary prevention patients is less than what has been reported in RCTs.
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Affiliation(s)
- Adolfo Fontenla
- University Hospital 12 de Octubre, Av de Córodoba sn, 28041, Madrid, Spain
| | - Jose B Martínez-Ferrer
- University Hospital of Araba, Calle Jose itxotegi sn, 01009, Vitoria-Gasteiz, Alava, Spain
| | - Javier Alzueta
- University Hospital Virgen de las Victoria, Campus de Teatinos sn, 29010 Malaga, Spain
| | - Xavier Viñolas
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quinti, 89, 08026 Barcelona, Spain
| | | | - Josep Brugada
- Hospital Clìnic i Provincial, Carrer Villarroel, 170, 08036 Barcelona, Spain
| | - Rafael Peinado
- University Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | | | - Alicia Cano
- Cardiac and Vascular Group, Medtronic Iberica, Calle Maria de Portugal, 9, 28050 Madrid, Spain
| | - Ignacio Fernández-Lozano
- University Hospital Puerta de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
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Bertomeu-González V, Moreno-Arribas J, Castillo-Castillo J, Martínez-Ferrer J, Viñolas X, Rodríguez A, Díaz-Infante E, Fernández-Lozano I, Alzueta J, Fontenla A. Etiology and Programming Effects on Shock Efficacy in ICD Recipients. Pacing Clin Electrophysiol 2015; 39:73-80. [PMID: 26450114 DOI: 10.1111/pace.12765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/20/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to assess the efficacy of high-energy shocks to restore rhythm and predictors of success in patients with sustained ventricular arrhythmias and implantable cardioverter defibrillator (ICD). METHODS AND RESULTS Data from 162 patients included in the UMBRELLA study that experienced one or more episodes of ventricular tachycardia (VT) for which ICD shocks of at least 30 Joules were delivered (appropriate high-energy shocks) were analyzed. In total, 456 ventricular arrhythmia episodes were registered. Forty four episodes (9.6%) from 39 patients (24%) had at least one ineffective high-energy shock delivered. Hypertrophic cardiomyopathy was more frequent among patients with unsuccessful shocks (10.3% vs 2.4%). Patients with ineffective shocks had higher proportion of sustained monomorphic ventricular arrhythmias (86.4%; the other 13.6% were sustained polymorphic and ventricular fibrillation [VF]) compared with patients with all their shocks effective (62.9%, P = 0.02). No statistical differences were found between groups in time from detection to the high-energy shock delivery, in tachycardia cycle length, or in antitachycardia pacing, but patients with ineffective high-energy shocks had higher proportion of previously ineffective low-energy shock (9.1% vs 0.5%, P = 0.01). CONCLUSION We found a substantial rate of ineffective high-energy shocks for the treatment of VT or VF in patients with ICD. High-energy shock efficacy seems to be reduced by hypertrophic cardiomyopathy and by the administration of previous low-energy shocks.
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Affiliation(s)
| | - José Moreno-Arribas
- Hospital Universitario de San Juan, Universidad Miguel Hernandez, Alicante, Spain
| | | | | | | | - Aníbal Rodríguez
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | - Javier Alzueta
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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Alzueta J, Asso A, Quesada A. Spanish Implantable Cardioverter-defibrillator Registry. Eleventh Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2014). ACTA ACUST UNITED AC 2015; 68:996-1007. [PMID: 26443122 DOI: 10.1016/j.rec.2015.07.004] [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: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2014, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology. METHODS Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology. RESULTS The number of reported implantations was 4911 (82% of the estimated total number of implantations). The implantation rate was 106 per million population while the estimated rate was 128. First implantations comprised 72.2%. Data were obtained from 162 hospitals (8 more than in 2013). Most implantations (82%) were performed in men. The mean patient age was 61.8±13.7 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.5%. Electrophysiologists performed 85.6% of the implantations. CONCLUSIONS The 2014 Spanish Implantable Cardioverter-defibrillator Registry received information on 82% of the implantations performed in Spain. The number of implantations has increased from previous years and the percentage of implantations for primary prevention indications has increased from the previous year.
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Affiliation(s)
- Javier Alzueta
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain.
| | - Antonio Asso
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain
| | - Aurelio Quesada
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain
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Anguera I, Dallaglio P, Martínez-Ferrer J, Rodríguez A, Alzueta J, Pérez-Villacastín J, Porres JM, Viñolas X, Fontenla A, Fernández-Lozano I, García-Alberola A, Sabaté X. Shock Reduction With Multiple Bursts of Antitachycardia Pacing Therapies to Treat Fast Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter Defibrillators: A Multicenter Study. J Cardiovasc Electrophysiol 2015; 26:774-82. [PMID: 25916814 DOI: 10.1111/jce.12699] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/05/2015] [Revised: 03/17/2015] [Accepted: 03/27/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION An empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter-defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst. METHODS AND RESULTS We analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250-320 milliseconds) before shock therapy. Over a mean follow-up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high-energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7-6.8, P = 0.001) was an independent predictor of ATP effectiveness. CONCLUSION This study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks.
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Affiliation(s)
- Ignasi Anguera
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Paolo Dallaglio
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | | | - Aníbal Rodríguez
- Cardiology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Javier Alzueta
- Cardiology Department, Hospital Vírgen de la Victoria, Málaga, Spain
| | | | - José Manuel Porres
- Cardiology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | - Xavier Viñolas
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Adolfo Fontenla
- Cardiology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Xavier Sabaté
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge University Hospital, Barcelona, Spain
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Ruiz-Salas A, García-Pinilla JM, Cabrera-Bueno F, Fernández-Pastor J, Peña-Hernández J, Medina-Palomo C, Barrera-Cordero A, De Teresa E, Alzueta J. Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator. Europace 2015; 18:773-7. [PMID: 25855675 DOI: 10.1093/europace/euv079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/05/2015] [Indexed: 01/29/2023] Open
Abstract
AIMS Hypertrophic cardiomyopathy is one of the main causes of sudden death in young people. Recent clinical practice guidelines include a risk prediction model for sudden death (HCM Risk-SCD), which facilitates the decision of whether to implant a defibrillator. The aim of our study was to ascertain the percentage of events in our series of primary prevention implantable cardioverter-defibrillator recipients with hypertrophic cardiomyopathy and whether HCM Risk-SCD predicts the onset of arrhythmic events. METHODS AND RESULTS This was an observational, retrospective cohort study, which included 48 primary prevention defibrillator recipient patients with HCM. We compiled their demographic and clinical characteristics, estimated 5-year risk using HCM Risk-SCD, and collected the documentation on arrhythmias during follow-up. The majority was male (66.7%) and mean age at implantation was 44.44 ± 14.46 years. Non-sustained ventricular tachycardia was the most prevalent risk factor (66.67%), followed by a family history of sudden death (47.92%). Mean HCM Risk-SCD was 6.15 ± 5.01%. HCM Risk-SCD was the only factor independently associated with the onset of ventricular tachyarrhythmia, above any other classic risk factor or association [odds ratio = 1.46 (95% confidence interval 1.051-2.013); P = 0.02]. None of the 11 patients estimated as low risk using HCM Risk-SCD suffered any appropriate events (P < 0.05). CONCLUSIONS During an average follow-up of 4 years, 16.67% presented appropriate events (4.16%/year). HCM Risk-SCD predicted the onset of events more suitably than classic risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Cabrera-Bueno F, Medina-Palomo C, Ruiz-Salas A, Flores A, Rodríguez-Losada N, Barrera A, Jiménez-Navarro M, Alzueta J. Serum levels of interleukin-2 predict the recurrence of atrial fibrillation after pulmonary vein ablation. Cytokine 2015; 73:74-8. [PMID: 25743240 DOI: 10.1016/j.cyto.2015.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/16/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
AIMS Interleukin-2 has a significant antitumor activity in some types of cancer, and has been associated with the development of atrial fibrillation (AF). In addition, IL-2 serum levels in recent onset AF have been related with pharmaceutical cardioversion outcomes. We evaluated the hypothesis that a relationship exists between inflammation and the outcome of catheter ablation of AF. METHODS We studied 44 patients with paroxysmal AF who underwent catheter ablation. Patients with structural heart disease, coronary artery or valve disease, active inflammatory disease, known or suspected neoplasm, endocrinopathies, or exposure to anti-inflammatory drugs were excluded. All study participants underwent evaluation with a standardized protocol, including echocardiography, and cytokine levels of interleukin-2, interleukin-4, interleukin-6, interleukin-10, tumour necrosis factor-alpha, and gamma-interferon determination before procedure. Clinical and electrocardiographic follow-up were performed with Holter-ECG at 3, 6 and 12months in order to know if sinus rhythm was maintained. RESULTS After catheter ablation of the 44 patients included (53±10years, 27.3% female), all patients returned to sinus rhythm. During the first year of follow-up seven patients (15.9%) experienced recurrence of AF. The demographics, clinical and echocardiographic features, and pharmacological treatments of these patients were similar to those who maintained sinus rhythm. The only independent factor predictive of recurrence of AF was an elevated level of IL-2 (OR 1.18, 95% CI 1.12-1.38). CONCLUSIONS High serum levels of interleukin-2, a pro-inflammatory non-vascular cytokine, are associated with the recurrence of AF in patients undergoing catheter ablation.
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Affiliation(s)
- Fernando Cabrera-Bueno
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain.
| | - Carmen Medina-Palomo
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
| | - Amalio Ruiz-Salas
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
| | - Ana Flores
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
| | - Noela Rodríguez-Losada
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
| | - Alberto Barrera
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
| | - Manuel Jiménez-Navarro
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
| | - Javier Alzueta
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria de Málaga, IMIBA (Instituto de Investigación Biomédica de Málaga), Universidad de Málaga, Spain
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Ruiz-Salas A, Barrera-Cordero A, Viñolas X, Sola NB, Álvarez LP, Olalla JJ, Brugada J, Alzueta J. Usefulness of antitachycardia pacing in arrhythmogenic right ventricular dysplasia/cardiomyopathy. Int J Cardiol 2015; 181:172-3. [DOI: 10.1016/j.ijcard.2014.11.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/22/2014] [Indexed: 01/05/2023]
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Fontenla A, López Gil M, Martínez Ferrer J, Alzueta J, Fernández Lozano I, Viñolas X, Rodríguez A, Fernández de la Concha J, Anguera I, Arribas F. Perfil clínico e incidencia de arritmias ventriculares de los pacientes sometidos a recambio de generador de desfibrilador en España. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fontenla A, López Gil M, Martínez Ferrer J, Alzueta J, Fernández Lozano I, Viñolas X, Rodríguez A, Fernández de la Concha J, Anguera I, Arribas F. Clinical profile and incidence of ventricular arrhythmia in patients undergoing defibrillator generator replacement in Spain. ACTA ACUST UNITED AC 2014; 67:986-92. [PMID: 25432708 DOI: 10.1016/j.rec.2014.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/17/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Implantable cardioverter-defibrillators reduce mortality in some patients with heart disease. Battery replacement is a frequent occurrence in clinical practice and is required in up to 30% of implants. The benefit/risk ratio of defibrillators varies over time and should be reevaluated at the time of replacement. The aim of this study was to determine the clinical characteristics and incidence of defibrillator therapies in patients who underwent generator replacement. METHODS This multicenter retrospective study involved patients from the UMBRELLA national registry who underwent replacement due to defibrillator battery depletion. The incidence of ventricular arrhythmias was determined via remote monitoring. Risk factors for sustained ventricular arrhythmia after replacement were analyzed. RESULTS A total of 354 patients were included (mean age [standard deviation], 61.8 [14.5] years; men, 80%; secondary prevention, 42%; ventricular arrhythmias in the explanted generator, 62%). After a 25-month follow-up, 70 patients (20%) received appropriate therapies and 8 (2.3%) received inappropriate discharges. Male sex, structural heart disease, heart failure, and the absence of resynchronization were independent predictors of ventricular arrhythmia occurrence. CONCLUSIONS One-fifth of patients had appropriate defibrillator therapies in the first 2 years after generator replacement. Determination of the factors associated with arrhythmia occurrence after replacement may be useful to optimize implantable cardioverter-defibrillator treatment.
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Affiliation(s)
- Adolfo Fontenla
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - María López Gil
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Martínez Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Araba, Vitoria, Álava, Spain
| | - Javier Alzueta
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Ignacio Fernández Lozano
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Xavier Viñolas
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aníbal Rodríguez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Canarias, Sta. Cruz de Tenerife, Spain
| | | | - Ignasi Anguera
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Arribas
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Alzueta J, Pedrote A, Fernández Lozano I. Registro Español de Desfibrilador Automático Implantable. X Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2013). Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alzueta J, Pedrote A, Fernández Lozano I. Spanish Implantable Cardioverter-defibrillator Registry. Tenth Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2013). Rev Esp Cardiol (Engl Ed) 2014; 67:936-947. [PMID: 25280887 DOI: 10.1016/j.rec.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/07/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES To present the findings of the Spanish Implantable Cardioverter-defibrillator Registry for 2013 compiled by the Electrophysiology and Arrhythmias Section of the Spanish Society of Cardiology. METHODS Prospective data were voluntarily recorded on a data collection form and sent to the Spanish Society of Cardiology by each implantation team. RESULTS Overall, 4772 device implantations were reported, representing 85% of the estimated total number of implantations. The reported implantation rate was 102 per million population and the estimated total implantation rate was 120 per million. The proportion of first implantations was 68.8%. Data were received from 154 hospitals (4 fewer than in 2012). Most implantable cardioverter-defibrillator recipients were men (83.3%). The mean age was 62.5 (13.4) years. Most patients had severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent underlying cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Indications for primary prevention accounted for 53.0% of first implantations, consolidating the decrease first observed in 2012. Overall, 79.8% of devices were implanted by cardiac electrophysiologists. CONCLUSIONS The 2013 Spanish Implantable Cardioverter-defibrillator Registry includes information on 85% of the devices implanted in Spain. The total number of implantations increased compared with the previous 2 years. The percentage of implantations for primary prevention indications decreased compared with the previous year.
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Affiliation(s)
- Javier Alzueta
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain.
| | - Alonso Pedrote
- Sección de Electrofisiología y Arritmias, Sociedad Española de Cardiología, Madrid, Spain
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Stockburger M, Gómez-Doblas JJ, Lamas G, Alzueta J, Fernández-Lozano I, Cobo E, Wiegand U, de la Concha JF, Navarro X, Navarro-López F, de Teresa E. Preventing ventricular dysfunction in pacemaker patients without advanced heart failure: results from a multicentre international randomized trial (PREVENT-HF). Eur J Heart Fail 2014; 13:633-41. [DOI: 10.1093/eurjhf/hfr041] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [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)
- Martin Stockburger
- Charité - Universitaetsmedizin Berlin, Experimental and Clinical Research Center (ECRC) Campus Berlin-Buch & Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie; Campus Mitte, Charitéplatz 1, 10117; Berlin Germany
| | - Juan José Gómez-Doblas
- Hospital Clínico Virgen de la Victoria; Campus Universitario Teatinos; 29010 Málaga Spain
| | - Gervasio Lamas
- Division of Cardiology; Mount Sinai Medical Center, Columbia University; FL 33140 USA
| | - Javier Alzueta
- Hospital Clínico Virgen de la Victoria; Campus Universitario Teatinos; 29010 Málaga Spain
| | | | - Erik Cobo
- Universidad Politécnica de Catalunya; C/ Pau Gargallo, 5 08028 Barcelona Spain
| | - Uwe Wiegand
- Universitaetsklinikum Schleswig-Holstein; Campus Luebeck, Ratzeburger Allee 160 23538 Luebeck Germany
| | | | - Xavier Navarro
- Medtronic Ibérica, S.A., C/ María de Portugal, 11; Madrid Spain
| | - Francisco Navarro-López
- Hospital Clínic i Provincial de Barcelona, Universidad de Barcelona; Villaroel 170 Barcelona Spain
| | - Eduardo de Teresa
- Hospital Clínico Virgen de la Victoria; Campus Universitario Teatinos; 29010 Málaga Spain
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