Alfonso Macías Gallego

Registro Español de Ablación con Catéter. XI Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2011)

INTRODUCTION AND OBJECTIVES The findings of the 2011 Spanish Catheter Ablation Registry are presented. METHODS Data were collected in two ways: retrospectively using a standardized questionnaire, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS Sixty-six Spanish centers voluntarily contributed data to the survey. Some 9662 ablation procedures were analyzed, averaging 146 (104) per center. The three main conditions treated were atrioventricular nodal reentrant tachycardia (n=2537; 26%), typical atrial flutter (n=2205; 23%) and accessory pathways (n=1813; 19%). Atrial fibrillation was the fourth most common substrate treated (n=1535; 16%) and showed a slight increase over figures for 2010. Ventricular arrhythmia ablation has increased considerably. The overall success rate was 94%; major complications occurred in 2.2% and overall mortality was 0.04%. CONCLUSIONS Data from the 2011 registry show a continued increase in the number of ablations performed with a generally high success rate and few complications. The use of complex substrate ablation continues to grow.

Registro Español de Ablación con Catéter. X Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2010)

INTRODUCTION AND OBJECTIVES The findings of the 2010 Spanish Catheter Ablation Registry are presented. METHODS Data were collected in two ways: retrospectively using a standardized questionnaire, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS Fifty-seven Spanish centers voluntarily contributed data to the survey. A total of 8762 ablation procedures was analyzed, averaging 154 (97) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2321; 27%), typical atrial flutter (n=1839; 22%), and accessory pathways (n=1738; 20%). Atrial fibrillation was the fourth most common condition treated (n=1309; 15%), and reflects mild growth. The overall success rate was 94%, major complications occurred in 1.7%, and the overall mortality rate was 0.06%. CONCLUSIONS Data from the 2010 registry show that the number of ablations carried out continued to increase and exceeded 8700 ablations for the second time. In addition, they show, in general, a higher success rate and a lower number of complications. Again, cavotricuspid isthmus ablation for typical atrial flutter was the second most common condition treated. The number of catheter ablations carried out for ventricular arrhythmias in Spain is growing compared to the previous year.

Spanish Catheter Ablation Registry. 8th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2008)

INTRODUCTION AND OBJECTIVES This article reports the findings of the 2008 Spanish Catheter Ablation Registry, as compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias. METHODS As in previous years, data were collected in two ways: retrospectively using a standard questionnaire sent to electrophysiology laboratories by the Working Group on Electrophysiology and Arrhythmias, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS Fifty five Spanish centers contributed data voluntarily. In total, 7741 ablations were analyzed, averaging 141+/-97 per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2302; 31%), typical atrial flutter (n=1720; 22%) and accessory pathways (n=1658; 21%). The fourth most common condition was atrial fibrillation (n=829; 11%), which accounted for 18% more procedures than in 2007. Overall, the success rate was 93%, major complications occurred in 1.7%, and the mortality rate was 0.03%. CONCLUSIONS Registry data for 2008 show that the number of ablations carried out continues to increase, and has exceeded 7000 for the second time. In general, the success rate was high and there were few complications. Typical atrial flutter, requiring cavotricuspid isthmus ablation, has become the second most frequently treated condition. A moderate steady increase in the number of ablations for atrial fibrillation was also observed.

Doble respuesta nodal incesante y fibrilación auricular paroxística

Atrial fibrillation can be triggered by rapid atrial rhythms, including intranodal tachycardia. We present the recordings of a male patient with paroxysmal atrial fibrillation referred for pulmonary vein ablation following failure of various antiarrhythmic drug treatments (bisoprolol, flecainide, and amiodarone). The initial study showed two QRS complexes with a single p wave. A double nodal pathway was suspected and later confirmed, which led to a change in the therapeutic strategy. This phenomenon is an electrophysiological manifestation of the double nodal pathway, but it is an uncommon finding because detection requires a large difference in the conduction times between the two pathways. The baseline electrocardiogram (ECG) findings (Fig. 1) were interpreted as supraventricular bigeminism. However, the electrophysiologic study showed that it was actually a spontaneous repetitive double nodal response that triggered runs of tachycardia (Fig. 2A) and atrial fibrillation. The atrial activation occurred through both nodal pathways simultaneously, but at differing conduction velocities (Figure 2B), sometimes with posterior retrograde conduction by the fast pathway, which perpetuated it (Figs. 2A, 2C, and 3). Following ablation of the slow nodal pathway, the double response and runs of tachycardia disappeared (Fig. 2D) and a continuous, decreasing AV and VA conduction pattern was seen. During follow-up, the patient remained asymptomatic, with stable sinus rhythm and no antiarrhythmic treatment. No recurrence was documented on Holter ECG at 3, 6, or 12 months. Distal CS

Spanish Catheter Ablation Registry. Seventh official report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2007).

INTRODUCTION AND OBJECTIVES This article reports the findings of the 2007 Spanish Catheter Ablation Registry, as compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias. METHODS As in previous years, data were collected in two ways: retrospectively using a standard questionnaire sent to electrophysiology laboratories by the Working Group on Electrophysiology and Arrhythmias, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS Fifty Spanish centers contributed data voluntarily. In total, 7062 ablations were analyzed, averaging 141 (82) per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2068, 30%), typical atrial flutter (n=1701, 24%) and accessory pathways (n=1624, 23%). A steady increase in both the absolute number of cavotricuspid isthmus ablations for typical atrial flutter and in the relative frequency of this procedure was observed, such that it has overtaken accessory pathway ablation to became the second most common form of treatment. The fourth most common condition was atrial fibrillation (n=659, 9%), which accounted for 22% more procedures than in 2006. Overall, the success rate was 92%, major complications occurred in 1.7%, and the mortality rate was 0.04%. CONCLUSIONS Registry data for 2007 show that the number of ablations carried out continues to increase, and has exceeded 7000 for the first time. In general, the success rate was high and there were few complications. Typical atrial flutter, requiring cavotricuspid isthmus ablation, has become the second most frequently treated condition. A moderate steady increase in the number of ablations for atrial fibrillation was also observed.