Francisco G. Cosio

EHRA Expert Consensus Statement on the management of cardiovascular implantable electronic devices in patients nearing end of life or requesting withdrawal of therapy

The purpose of this Consensus Statement is to focus on implantable cardioverter-defibrillator (ICD) deactivation in patients with irreversible or terminal illness. This statement summarizes the opinions of the Task Force members, convened by the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS), based on ethical and legal principles, as well as their own clinical, scientific, and technical experience. It is directed to all healthcare professionals who treat patients with implanted ICDs, nearing end of life, in order to improve the patient dying process. This statement is not intended to recommend or promote device deactivation. Rather, the ultimate judgement regarding this procedure must be made by the patient (or in special conditions by his/her legal representative) after careful communication about the deactivations consequences, respecting his/her autonomy and clarifying that he/she has a legal and ethical right to refuse it. Obviously, the physician asked to deactivate the ICD and the industry representative asked to assist can conscientiously object to and refuse to perform device deactivation.

European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE)

This is an executive summary of the full consensus document on the management of supraventricular tachycardia (SVT) patients, published in Europace . The consensus document was prepared by a Task Force from the European Heart Rhythm Association (EHRA) with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). It summarizes current developments in the field, and provides recommendations for the management of patients with SVT based on the principles of evidence-based medicine, with focus on new advances since the last ESC guidelines.1 It does not cover atrial fibrillation (AF), which is the subject of a separate clinical guideline. The process for evidence review has been described in the full document. Consensus statements are evidence-based and derived primarily from published …

Contemporary Management of Atrial Fibrillation: What Can Clinical Registries Tell Us About Stroke Prevention and Current Therapeutic Approaches?

Atrial fibrillation (AF) is a global health problem. The condition brings an increased risk of stroke, systemic embolism, and heart failure (HF) and is associated with impaired quality of life, frequent hospitalizations, and mortality.[1][1] Observational studies have been the main source of

Bachmann block pattern resulting from inexcitable areas peripheral to the Bachmann's bundle: controversial name or concept?

The electrocardiographic (ECG) P-wave pattern, >120 ms, and bimodal (±) in inferior leads has been attributed to Bachmanns bundle block. We have mapped left atrial (LA) activation in a patient with mild mitral stenosis, displaying this pattern, and with history …

Atrial Flutter, Typical and Atypical: A Review

Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava-tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

Executive Summary: European Heart Rhythm Association Consensus Document on the Management of Supraventricular Arrhythmias: Endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE)

This paper is an executive summary of the full European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, published in Europace. It summarises developments in the field and provides recommendations for patient management, with particular emphasis on new advances since the previous European Society of Cardiology guidelines. The EHRA consensus document is available to read in full at http://europace.oxfordjournals.org.

Cicatrices mesocárdicas como sustrato de taquicardia ventricular en pacientes con tamaño y función ventricular normales

Image of the week Mesocardiac scars as the substrate of ventricular tachycardia in patients with normal ventricular size and function Cicatrices mesocárdicas como sustrato de taquicardia ventricular en pacientes con tamaño y función ventricular normales Natalia Lorenzo , Francisco J. Toledano, Francisco García Cosío a Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain b Servicio de Cardiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain

When and Why Is a Patient with a Brugada Sign in the ECG at Risk

When some 20 years ago the Brugada brothers described the association of life-threatening ventricular arrhythmias with an electrocardiographic (ECG) pattern of RSR’ and ST segment elevation in the right precordial leads, in the absence of detectable structural heart disease, they opened a new window to the understanding and the hope of primary prevention of sudden death, particularly in the (apparently) healthy young.1 Controversy arose early, as some groups attributed the pattern to a form of right ventricular (RV) dysplasia,2 but soon the “Brugada Syndrome” (BS) was recognized as an entity, and this has stimulated a great surge of research into the electrophysiologic and genetic mechanisms. Since then it has become evident that BS is probably not a single entity and there is continuing controversy on its pathogenesis, diagnostic criteria and evaluation of risk of sudden death, particularly in asymptomatic patients.3 In this perspective, some authors have preferred to use the term “Brugada Sign.”4 Initially, the mechanism of ST segment elevation was attributed to repolarization abnormalities linked to the Ito current that would cause dispersion of membrane potentials and phase 2 reentry,5 a hypothesis supported mainly by studies of an arterially perfused wedge preparation of the canine RV6 and monophasic action potential recordings in 3 patients.7 The observation that quinidine can be effective to control arrhythmias in some patients with BS was attributed to its Ito blocking effect.8 But clinical evidence progressively accumulated pointing at depolarization abnormalities in the form of abnormal conduction in the right ventricular outflow tract (RVOT) as the probable cause of both ST elevation and arrhythmias. Late potentials are often recorded by signal averaged ECG9-11 and by direct recordings from the RVOT epicardium12 and their presence has been related to arrhythmia inducibility13 and prognosis.14,15 Electron beam computed tomography16 and magnetic resonance imaging17 may disclose RV morphological and functional abnormalities that may relate to the origin of ventricular ectopic beats. Histological and electrophysiologic studies of an explanted heart of a patient with BS, a mutation of the SCN5A Na+ channel, and intractable arrhythmias, disclosed local slow conduction related to areas of fibrosis in the RVOT.18 More recently,