Ernesto Díaz-Infante

Electrocardiographic Optimization of Interventricular Delay in Cardiac Resynchronization Therapy: A Simple Method to Optimize the Device

Introduction: Echocardiography is widely used to optimize CRT programming, but it is time‐consuming. This study aimed to correlate the optimal interventricular pacing (V‐V) interval obtained by echo with the optimal V‐V interval obtained by a simpler method based on the surface ECG.

Registro Español de Ablación con Catéter. VI Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2006)

Introduccion y objetivos Se detallan los resultados del Registro Nacional de Ablacion del ano 2006, elaborado por la Seccion de Electrofisiologia y Arritmias de la Sociedad Espanola de Cardiologia. Metodos Al igual que en anteriores registros, la recogida de datos se llevo a cabo mediante dos sistemas: bien de forma retrospectiva con la cumplimentacion de un cuestionario que fue enviado desde la Seccion de Electrofisiologia y Arritmias a los laboratorios de electrofisiologia, bien prospectivamente mediante una base de datos comun. La eleccion de una u otra fue voluntaria por parte de cada uno de los centros. Resultados En el envio de datos participaron de forma voluntaria 48 centros. El numero total de procedimientos de ablacion analizado fue 6.568, con una media de 139 ± 75 procedimientos por centro. Como en registros previos, los 3 sustratos abordados con mas frecuencia fueron la taquicardia intranodular (n = 1.881; 28%), las vias accesorias (n = 1.628; 25%) y la ablacion del istmo cavotricuspideo (n = 1.507; 23%). El cuarto sustrato abordado (n = 540; 8%) fue la ablacion de fibrilacion auricular. El porcentaje general de exito fue del 92,2%; el de complicaciones mayores, del 1,4%, y el de mortalidad, del 0,015%. Conclusiones En el registro del ano 2006 se mantiene una linea de continuidad ascendente en el numero de ablaciones realizadas, con mas de 6.500 procedimientos registrados, una elevada tasa de exito y un numero bajo de complicaciones. La ablacion de fibrilacion auricular supone ya el cuarto sustrato mas frecuentemente abordado en las unidades de arritmias de nuestro pais.

Spanish Catheter Ablation Registry. Sixth Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2006)

Introduction and objectives The findings of the 2006 Spanish Catheter Ablation Registry compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias are presented. Methods As in previous years, data were collected in 2 ways: retrospectively using a standardized 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 Forty-eight Spanish centers contributed data voluntarily. A total of 6568 ablation procedures were recorded, averaging 139(75) per center. As in previous reports, the 3 most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=1881, 28%), accessory pathways (n=1628, 25%), and typical atrial flutter (n=1507, 23%). Atrial fibrillation was the fourth most common condition treated (n=540, 8%). The overall success rate was 92.2%, major complications occurred in 1.4%, and the mortality rate was 0.015%. Conclusions In 2006, the number of ablation procedures recorded in the Spanish Catheter Ablation Registry continued to grow, with more than 6500 procedures now being registered. The success rate increased and there were fewer complications. Atrial fibrillation remains the fourth most common condition treated by catheter ablation at Spanish arrhythmia units.

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. IX Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2009)

Introduccion y objetivos Se detallan los resultados del Registro Nacional de Ablacion del ano 2009. Metodos La recogida de datos se llevo a cabo mediante dos sistemas: de forma retrospectiva con la cumplimentacion de un cuestionario y de forma prospectiva a traves de una base de datos comun. La eleccion de uno u otro por cada centro fue voluntaria. Resultados Se recogieron datos de 59 centros. El numero total de procedimientos de ablacion fue 8.546, con una media de 145 ± 101 procedimientos. Los tres sustratos abordados con mas frecuencia fueron la taquicardia intranodal (n = 2.341; 27%), la ablacion del istmo cavotricuspideo (n = 1.859; 21,7%) y las vias accesorias (n = 1.758; 20,5%). El cuarto sustrato abordado (n = 1.188; 14%) fue la ablacion de fibrilacion auricular, que mostro un incremento del 44% con respecto al registro del ano 2008. La tasa general de exito fue del 93%; la de complicaciones mayores, del 1,9% y la de mortalidad, del 0,046%. Conclusiones En el registro del ano 2009 se mantiene una linea de continuidad ascendente en el numero de ablaciones realizadas, se supera por primera vez los 8.000 procedimientos y, en lineas generales, se observa una elevada tasa de exito y un numero de complicaciones bajo. La ablacion del istmo cavotricuspideo como tratamiento del aleteo auricular tipico continua como el segundo sustrato mas frecuentemente abordado. Se observa un mayor incremento en el numero de procedimientos de ablacion de fibrilacion auricular con respecto a anos anteriores.

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.

Influencia de la cardiopatía subyacente en la respuesta a la terapia de resincronización cardiaca

INTRODUCTION AND OBJECTIVES Little is known about how responses to cardiac resynchronization therapy (CRT) are affected by the nature of the underlying cardiopathy. The aim of this study was to investigate how cardiopathy etiology influences the effect of CRT on reverse left ventricular remodeling. METHODS The study included 106 patients with left ventricular systolic dysfunction and left bundle branch block (LBBB) who were receiving CRT. Clinical and echocardiographic investigations were performed at baseline before implantation and at 6 and 12 month follow-up to determine left ventricular diameter, volume and systolic function, and to quantify mitral regurgitation. RESULTS During follow-up, it was observed that CRT reduced left ventricular volume and diameter, increased left ventricular ejection fraction (LVEF), and reduced mitral regurgitation severity irrespective of the etiology of the cardiopathy. In patients with ischemic dilated cardiomyopathy, LVEF increased by 34% and end-diastolic and end-systolic volumes decreased by 4% and 12%, respectively; in those with idiopathic dilated cardiomyopathy, LVEF increased by 38% and end-diastolic and end-systolic volumes decreased by 13% and 19%, respectively (P=NS for ischemic vs. non-ischemic disease). Nor were differences observed between the groups in clinical outcome: 74% of the ischemic group responded compared with 62% of the non-ischemic group (P=NS). CONCLUSIONS At 12-month follow-up, patients with left ventricular systolic dysfunction and LBBB treated by CRT showed clinical improvements and demonstrated reverse ventricular remodeling, irrespective of the etiology of their cardiopathy.Introduccion y objetivos La influencia del tipo de cardiopatia en la respuesta a la terapia de resincronizacion cardiaca (TRC) es poco conocida. El objetivo de este estudio fue analizar el efecto de la TRC en el remodelado, en funcion de la etiologia de la cardiopatia subyacente. Metodos Se incluyo a 106 pacientes con disfuncion sistolica del ventriculo izquierdo (VI) y bloqueo de rama izquierda del haz de His (BRIHH) tratados con TRC. Se les realizo una evaluacion clinica y ecocardiografica para estudiar los diametros, los volumenes y la funcion sistolica del VI y cuantificar la insuficiencia mitral, antes del implante y a los 6 y los 12 meses de seguimiento. Resultados La TRC indujo en el seguimiento una reduccion de los volumenes y diametros ventriculares, aumento la fraccion de eyeccion (FE) y se redujo la insuficiencia mitral independientemente de la etiologia de la cardiopatia: los pacientes isquemicos (MCD-CI) incrementaron la FE del VI (FEVI) un 34% y los volumenes telediastolico y telesistolico se redujeron en el 4 y el 12% frente a un incremento de la FE del 38% y una reduccion de volumenes del 13 y el 19% en los pacientes con miocardiopatia dilatada idiopatica (MCD) (sin diferencia significativa entre MCD-CI y MCD). Tampoco se encontraron diferencias en el numero de respondedores clinicos: el 74% en los pacientes con MCD-CI y el 62% de los portadores de una MCD (sin diferencia significativa). Conclusiones A los 12 meses de seguimiento, los pacientes con disfuncion sistolica del VI y BRIHH tratados con TRC presentaron mejoria clinica y un remodelado ventricular inverso independientemente de la etiologia de su cardiopatia.

Electrodo de desfibrilación Sprint Fidelis: experiencia de nueve centros en España

INTRODUCTION AND OBJECTIVES Sprint Fidelis defibrillation leads are prone to early failure. Most of the reported series come from a single institution. This paper describes the clinical experience in nine Spanish hospitals. METHODS Clinical, implant, and follow-up data of all patients with a Sprint Fidelis lead were analyzed. All cases of lead failure were identified, medium-term lead survival was calculated, and possible predictors for lead failure were determined. RESULTS In total, 378 leads in 376 patients were studied. The mean age (male 85.7%) was 64.9 ± 13.6 years. The majority of patients (59.8%) had ischemic heart disease. Mean left ventricular ejection fraction was 33.4% ± 14.5%. Left subclavian vein puncture was used in 74.8%. During a mean follow-up of 30.9 ± 14 months, 16 lead failures have occurred, with a lead survival of 96.1% at 36 months after implantation. Eleven of 16 lead failures were caused by failure of pace/sense conductors, 3 by defects in the high-voltage conductor, and 2 by defects in both types of conductors. A less depressed left ventricular ejection fraction was associated with an increased probability of lead failure (42.4% ± 16% vs. 33% ± 14.3%; P =.011). Three hospitals presented a rate of lead failure higher than 10%; the rate was less than 5% in the remaining 6 hospitals. CONCLUSIONS In this multicenter series of 378 leads, the 3-year estimated survival was higher than that reported in prior series. Clinical presentation of lead failures was similar to that reported previously. Left ventricular ejection fraction and hospital of implantation were variables associated to lead failure.

Long-term prognosis of patients with life-threatening ventricular arrhythmias induced by coronary artery spasm

Aims Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.

Predictors of Lack of Clinical Improvement at Mid-Term Follow-up With Cardiac Resynchronization Therapy

INTRODUCTION About 30% of all patients do not respond to cardiac resynchronization therapy for heart failure. The objective of the study was to analyze the variables that may predict the lack of response. PATIENTS AND METHOD We analyzed the results in a series of 63 patients who received cardiac resynchronization with a biventricular device. Clinical and left ventricular function parameters were evaluated at the beginning of the study and at 6 months. Responders were defined as those who were alive, had not received a heart transplant, and who achieved more than a 10% increase in distance in the 6-minute walking test. RESULTS Mean age was 68.3 (8) years, 51 patients (81%) were men, and NYHA functional class was III-IV in 79.4%. Mean left ventricular ejection fraction was 22.4% (6)%, QRS width was 177 (25) ms, and 77.8% were in sinus rhythm. Almost half (46%, n=29) had ischemic heart disease. At 6-month follow-up, 69.8% of the patients were responders. Ischemic heart disease, sustained monomorphic ventricular tachycardia and a degree of mitral regurgitation >II/IV before implantation were associated with lack of response. No association was found for any of the other baseline variables. Logistic regression analysis identified all three of the aforementioned variables as independent predictors of lack of response: ischemic heart disease OR=4.8, 95% CI, 1.2-18.3, P=.023; ventricular tachycardia OR=8.7, 95% CI, 1.8-41.3, P=.007; and mitral regurgitation OR=8.03, 95% CI, 1.7-37.1, P=.008. CONCLUSION The likelihood of responding to resynchronization therapy is lower in patients with ischemic heart disease, significant mitral regurgitation, or sustained monomorphic ventricular tachycardia.