Ignacio García Bolao

Comparison of benefits and mortality in cardiac resynchronization therapy in patients with atrial fibrillation versus patients in sinus rhythm (Results of the Spanish Atrial Fibrillation and Resynchronization [SPARE] Study).

The efficacy of cardiac resynchronization therapy (CRT) in patients with atrial fibrillation (AF) and the need for atrioventricular junction ablation in these patients is controversial. The aim of the study was to analyze CRT results in patients with permanent AF. A total of 470 consecutive patients who underwent CRT in 6 centers were included in this study. Of these patients, 126 (27%) had permanent AF. Patients were evaluated at baseline and 12 months. No difference was found in the magnitude of improvement experienced by patients with AF compared with those in sinus rhythm (SR) with respect to quality of life, distance in 6-minute walking test, and left ventricular reverse remodeling. Despite the beneficial effects of CRT, death from refractory heart failure at 12 months was higher in patients with AF (17 of 126; 13.5%) than those in SR (14/344; 4.1%; p <0,001). Furthermore, permanent AF was an independent predictive factor for mortality from refractory heart failure (hazard ratio 5.4, 95% confidence interval 1.9 to 15.1). In conclusion, patients with AF treated with CRT who survived at the 12-month follow-up had the same functional improvement and remodeling as those in SR. However, AF was an independent risk factor for mortality from heart failure after CRT implantation.

Radiofrequency Ablation of Anteroseptal, Para-Hisian, and Mid-Septal Accessory Pathways Using a Simplified Femoral Approach

Feasibility of RF ablation using a simplified two‐catheter technique from a femoral approach was studied in 97 consecutive patients with a manifest or concealed accessory pathway located at the anteroseptal, mid‐septal, and para‐Hisian areas. BF was applied at the site with the shortest V‐delta interval or the earliest retrograde atrial activation during orthodromic tachycardia or right ventricular pacing. Ablation was initially successful in 88 of’97 patients (91 %). Success rate was 94% (16/17) for anteroseptal. 94% (39/43] for para‐Hisian, and 89% (33/37) for mid‐septal accessory pathways, without differences between manifest and concealed pathways for any of the locations. Mean number of BF pulses was 8 ± 5 for anteroseptal, 6 ± 6 for mid‐septal, and 12 ± 13 for para‐Hisian accessory pathways. Two patients (2%) required implantation of a permanent pacemaker for complete A V block. At a mean follow‐up of 27 ± 14 months, four patients with previous manifest preexcitation experienced resumption of intermittent preexcitation, but only one required a second successful procedure for recurrence of palpitations. RF ablation can be used effectively and without impairment of normal AV conduction in the majority of patients with anteroseptal, para‐Hisian, and mid‐septal accessory pathways using a simplified two‐catheter technique from a femoral approach.

Cardiac resynchronization therapy in patients with permanent atrial fibrillation. Is it mandatory to ablate the atrioventricular junction to obtain a good response

Current guidelines recommend atrioventricular junction (AVJ) ablation in patients with atrial fibrillation (AF) treated with cardiac resynchronization therapy (CRT). Our study compared the CRT response of patients in sinus rhythm (SR) vs. AF.

Criteria for the Management of Technological Assets in Cardiovascular Imaging

Adequate, updated and functional technology is essential in cardiology. In Spain, the economic scenario has strongly impacted technology renewal programs and obsolescence is a growing problem. The current report attempts to describe the current situation and the conditions that must concur to update, replace or adopt new technologies in the field of cardiology.