Concepción Alonso

Comentarios a la guía de práctica clínica de la ESC para el tratamiento de las enfermedades cardiovasculares durante el embarazo. Una visión crítica desde la cardiología española

doi: 10.1016/j.rec.2011.12.002 Along the lines of the new philosophy regarding clinical practice guidelines established by the Executive Committee of the Sociedad Española de Cardiología (SEC: Spanish Society of Cardiology), described and explained in an article recently published in Revista Española de Cardiología (REC),1 a document has been drafted to provide the framework for the discussion of the most important and novel aspects of the guidelines for the treatment of cardiovascular diseases during pregnancy, issued by the European Society of Cardiology (ESC) and endorsed by other European scientific societies.2 In the Spanish cardiology setting, the clinical practice recommendations concerning the subject of heart disease and pregnancy were set forth in the document “Guías de práctica clínica de la Sociedad Española de Cardiología en la gestante con cardiopatía” (Practice Guidelines of the Spanish Society of Cardiology for the Management of Cardiac Disease in Pregnancy), published in 2000,3 and the Sociedad Española de Ginecología y Obstetricia (Spanish Society of Gynecology and Obstetrics) designed a protocol for heart diseases and pregnancy (available at www.prosego.com). More recently, valuable contributions have appeared in our scientific literature,4,5 but there has been a need for an update of guidelines encompassing the body of knowledge that has been consolidated over the past decade. METHODS

Nonfluoroscopic Catheter Ablation. Results From a Prospective Multicenter Registry

INTRODUCTION AND OBJECTIVES Nonfluoroscopic catheter ablation is feasible in most procedures. The aim of our registry was to evaluate the safety and feasibility of a zero-fluoroscopic approach to catheter ablation in several Spanish centers. METHODS Eleven centers prospectively included a minimum of 20 patients. Patients with an arrhythmic substrate deemed suitable by the operator for a zero-fluoroscopic approach throughout the procedure were recruited. Patients with intracardiac devices were not included. Attending electrophysiologists, fellows, and resident physicians participated in each procedure, as in usual care. RESULTS The study included 247 patients. Ablation was performed in 235 patients (95.2%). In 2 patients, who were not included in the analysis, fluoroscopy was performed as the first-line treatment. The arrhythmic substrate was located in the right chambers in most of the procedures (231 of 233 [99.15%]). Fluoroscopy was used in 24 procedures (10.3%). Catheter ablation was successful in 96.4% of the procedures and severe complications occurred in 2 patients (0.85%). Two variables were related to the need for fluoroscopy: the performing center (minimum 0% vs maximum 30.3%; P=.001) and procedural failure (13% vs 2.4%; P<.05). CONCLUSIONS The Spanish multicenter registry reveals that a zero-fluoroscopic approach is feasible in most right-sided catheter ablation procedures. Randomized trials are necessary to confirm the safety of this approach. The need for fluoroscopy was related to procedural failure, with significant differences among performing centers.

Effects of thrombolysis in the evolution of right bundle-branch block complicating an acute anterior myocardial infarction.

Introduction — There is scant information about the effects of thrombolysis in the evolution of right bundle-branch block (RBBB) in the setting of acute anterior myocardial infarction.The aim of this study has been to analyse these effects and its impact on prognosis. Methods —We studied 54 patients who presented a RBBB related to an acute anterior myocardial infarction.We defined two groups: those who received thrombolytic treatment and those who did not.We analysed the evolution of RBBB (transience, moment of onset, moment of disappearance) and its relationship with in-hospital mortality.Twenty-one patients (39%) received thrombolytic treatment (group T) and 33 patients (61%) (group NT) did not. Results — The incidence of late appearance (> 6 h) of RBBB was less frequent in group T compared with group NT (10% vs. 33%, p = 0.04). The incidence of transient block was similar in the two groups (57% vs. 45%, p ns). However, early disappearance of RBBB (in < 6 hours) was more common in group T than in group NT (33% vs. 9%, p = 0.04). Mortality was higher in patients with RBBB present at 24 h after admission) than in those with RBBB resolved in less than 24 hours (in group NT, 55% vs. 8%, p = 0.02 and in group T 50% vs. 0%, p = 0.02, respectively). Conclusions — Thrombolysis seems to influence the moment of onset and disappearance of RBBB by promoting its early disappearance and avoiding its late appearance.Disappearance of RBBB is associated with a better prognosis.

Spanish Catheter Ablation Registry. 17th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2017)

INTRODUCTION AND OBJECTIVES This report describes the findings of the 2017 Spanish Catheter Ablation Registry. METHODS Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. RESULTS A total of 15 284 ablation procedures were performed by 98 institutions (the highest number of ablations and institutions historically reported in this registry), with a mean of 156±126 and a median of 136 procedures per center. For the first time, the most frequently treated ablation target was atrial fibrillation (n=3457; 22.6%), followed by cavotricuspid isthmus (n=3449; 22.5%) and atrioventricular nodal re-entrant tachycardia (n=3429; 22.4%). The overall success rate was 87%. The rate of major complications was 2.6%, and the mortality rate was 0.09%. The percentage of procedures performed without fluoroscopic support increased to 6% of all ablations, and 2.3% of all ablations were performed in pediatric patients. CONCLUSIONS The Spanish Ablation Catheter Registry systematically and uninterruptedly collects data on the ablation procedures performed in Spain, revealing that both the number of ablations and the number of centers performing them has progressively increased, while maintaining a high success rate and a low percentage of complications.

Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study

Aims Left atrial (LA) remodelling is a key determinant of atrial fibrillation (AF) ablation outcome. Optimal methods to assess this process are scarce. LA sphericity is a shape-based parameter shown to be independently associated to procedural success. In a multicentre study, we aimed to test the feasibility of assessing LA sphericity and evaluate its capability to predict procedural outcomes. Methods and results This study included consecutive patients undergoing first AF ablation during 2013. A 3D model of the LA chamber, excluding pulmonary veins and LA appendage, was used to quantify LA volume (LAV) and LA sphericity (≥82.1% was considered spherical LA). In total, 243 patients were included across 9 centres (71% men, aged 56 ± 10 years, 44% with hypertension and 76% CHA2DS2-VASc ≤ 1). Most patients had paroxysmal AF (66%) and underwent radiofrequency ablation (60%). Mean LA diameter (LAD), LAV, and LA sphericity were 42 ± 6 mm, 100 ± 33 mL, and 82.6 ± 3.5%, respectively. Adjusted Cox models identified paroxysmal AF [hazard ratio (HR 0.54, P = 0.032)] and LA sphericity (HR 1.87, P = 0.035) as independent predictors for AF recurrence. A combined clinical-imaging score [Left Atrial Geometry and Outcome (LAGO)] including five items (AF phenotype, structural heart disease, CHA2DS2-VASc ≤ 1, LAD, and LA sphericity) classified patients at low (≤2 points) and high risk (≥3 points) of procedural failure (35% vs. 82% recurrence at 3-year follow-up, respectively; HR 3.10, P < 0.001). Conclusion In this multicentre, real-life cohort, LA sphericity and AF phenotype were the strongest predictors of AF ablation outcome after adjustment for covariates. The LAGO score was easy to implement, identified high risk of procedural failure, and could help select optimal candidates. Clinical Trial Registration Information NCT02373982 (http://clinicaltrials.gov/ct2/show/NCT02373982).

Sustitución valvular urgente en la endocarditis infecciosa: evolución hospitalaria y a largo plazo. Análisis de 45 pacientes

Fundamento Definir en nuestro medio la evolucion de los pacientes afectados de endocarditisinfecciosa que requieren una sustitucion valvular urgente. Pacientes Y Metodos Analizamos 45 pacientes consecutivos que requirieron sustitucion valvulardurante el ingreso hospitalario por endocarditis infecciosa, 32 correspondieron a endocarditissobre valvula nativa, 7 a protesica precoz y 6 a protesica tardia. Se ha realizado un seguimientoa largo plazo clinico y ecocardiografico. Resultados En 39 casos, la sustitucion valvular debio realizarse antes de finalizar el tratamientoantibiotico. Las principales indicaciones fueron insuficiencia cardiaca refractaria (24 pacientes)y shock (11 pacientes). La mortalidad global fue del 24%: 19% en endocarditis sobre valvulanativa, 43% en protesica precoz y 33% en protesica tardia. La primera causa de muertefue el shock septico (46%). Se han seguido 31 de los 4 supervivientes durante una media de 65 (DE 49) meses, registrandose 2 recidivas y 6 fallecimientos (1 muerte subita y 2 por endocarditis). El 72% de los pacientespresenta una clase I de la NYHA. Se detecto una dehiscencia significativa en el 17%(38% en el grupo con endocarditis protesica). Conclusiones La sustitucion valvular urgente en la endocarditis infecciosa es una situacion gravey con elevada mortalidad. El pronostico a largo plazo es aceptable, aunque algunos pacientespresentaron dehiscencias significativas, especialmente en endocarditis protesicas.