José Luis Martínez Sande

Diferencias en la calidad de vida en pacientes con flutter auricular tipico sometidos a ablacion del istmo cavotricuspideo

INTRODUCTION AND OBJECTIVES The aim of the study was to assess and measure health-related quality of life (HRQoL) changes in patients with typical atrial flutter following catheter ablation. The outcome was standardized and normalized to the Spanish population adjusted by age and sex. METHODS Ninety-five consecutive patients who had undergone cavotricuspid isthmus ablation were included. The SF-36 questionnaire was self-administered before the procedure and at 1-year follow-up. We used the effect size and the standardized response mean as measures of responsiveness to quantify the change in HRQoL and the minimum clinically important difference to assess the smallest difference in score that patients perceived as beneficial. RESULTS Of the 95 patients initially included, 88 completed the 1-year follow-up. We observed a large improvement (effect size ≥0.8) on the physical functioning, role-physical , general health, and vitality scales and on the physical component summary. We detected a moderate improvement (effect size ≥0.5) on the role-emotional, social functioning, and mental health scales and on the mental component summary. On all scales except bodily pain and social activity, the improvement was clinically perceived by patients. CONCLUSIONS A clinically significant improvement in HRQoL measures was found in patients with typical atrial flutter who underwent cavotricuspid isthmus catheter ablation.

Failure of hybrid therapy for the prevention of long-term recurrence of atrial fibrillation

OBJECTIVES To determine the long-term effectiveness of hybrid therapy in the control of atrial fibrillation (AF) as well as the differences in clinical outcomes between patients with antiarrhythmic drug atrial flutter (AAD-AFl), those with coexistent AFl and AF, and isolated AFl. METHODS Four hundred eight patients who consecutively underwent cavotricuspid isthmus (CTI) ablation between 1998 and 2010 were followed for 5.9 years. Twenty-seven patients had AAD-AF1 (Group 1): they had AF but not AFl at baseline but on AAD therapy they showed typical AFl. They underwent CTI ablation and continued with AAD therapy, 96 patients had coexistent AF1 and AF at baseline (Group 2) and continued with AAD therapy at the discretion of their cardiologists and 284 patients had isolated AFl (Group 3). RESULTS AF recurred in the majority of the AAD-AF1 patients (74%, incident density rate (IDR): 19.1/100 person-years). This incidence rate was similar to the recurrence rate of AF in patients with coexistent AFl and AF (59%, IDR: 19.2/100 person-years). The patients in Group 1 had a similar IDR of stroke as Group 2 and a slightly higher rate than Group 3. There were no significant differences in the IDR for death among Groups 1, 2 and 3. CONCLUSIONS Hybrid therapy was not effective for long-term control of AF. The clinical outcomes (AF, stroke and death) were similar for AAD-AF1 patients and patients with coexistent AF and AFl.

Long-term improvement of QT dispersion is unaffected by short-term changes in blood pressure during treatment of systemic hypertension with enalapril.

Background: We report the reduction of QT and QTc dispersion in patients treated for 7 years with enalapril for systemic hypertension with left ventricular (LV) hypertrophy. We assess the correlation between QT dispersion and LV mass during this period and at the end of an 8‐week period of suspension of enalapril treatment after 5 years.

RETRACTED ARTICLE: Long-term mortality prediction of CHA2DS2VASc and HATCH scores in a cohort of patients with typical atrial flutter

The Editors-in-Chief retract the above-mentioned article per the Committee on Publication Ethics (COPE) guidelines on redundant publication. The editors have examined and discussed this case of redundant publication and followed the guidelines from the Committee on Publication Ethics (COPE) to address this issue. The overlap between the above-mentioned article and International Journal of Cardiology 199 (2015) 426–428 was deemed substantial, and the editors decided that the publication of two separate articles of this study is redundant and unnecessary. The Editors-in-Chief take issues of research and publication misconduct seriously in order to preserve the integrity of the academic record. The online version of this article contains the full text of the retracted article as electronic supplementary material.

Cardiac resynchronization therapy response in heart failure patients with different subtypes of true left bundle branch block

PurposeLeft bundle branch block (LBBB) configuration has been described as a predictor of response to cardiac resynchronization therapy (CRT). We investigated whether different subtypes of true LBBB configuration could help select patients with better response and clinical outcome.MethodsThis retrospective study included 198 consecutive LBBB patients implanted with a CRT. True LBBB was defined using the Strauss and the Predict study criteria. Echocardiographic response was evaluated by the reduction in left ventricular end-systolic volume (LVESV) and the increase in left ventricular ejection fraction (LVEF). Clinical response was defined as an improvement in one category of the NYHA functional class.ResultsPatients with true LBBB had a greater improvement in both LVESV reduction (median = − 27.6%, interquartile range = [− 4.9, − 50.1]) and LVEF increase (median 10.8 ± 10) than those with non-true LBBB (− 19.7%, [16.7, − 48.0]) p = 0.04 and 5.1 ± 10, p = 0.03, respectively. No differences were exhibited between true LBBB Strauss group (− 26.7%, [− 11.0, − 46.9]) and true LBBB Predict group (− 26.6%, [− 15.9, − 39.4]). There were no statistically significant differences in the percentage of patients with clinical response, assessed by NYHA improvement, among all groups. In the Cox model for death, age, ischemic etiology, and ΔLVESV were independent predictors of mortality. True LBBB (Strauss + Predict) patients had a trend towards lower mortality than non-true LBBB [HR = 0.55, 95% CI = (0.22–1.15)], p = 0.08. In the Cox model for HF hospitalization, age, sex male, prior LVEF, and ΔLVESV were independent predictors. True LBBB (Strauss + Predict) patients had a significantly lower risk of developing HF hospitalization than those with non-true LBBB [0.45 (0.21–0.90)], p = 0.029.ConclusionsPatients with true LBBB, either Strauss or Predict criteria, had greater echocardiographic response and lower incidence of HF hospitalization than non-true LBBB when implanted with CRT.

Upgrade a estimulación tri-ventricular desde estimulación biventricular en un paciente no respondedor a terapia de resincronización cardíaca en fibrilación auricular. ¿Una alternativa terapéutica viable?

La terapia de resincronización cardíaca (TRC) se ha convertido en uno de los tratamientos con más éxito en los últimos años en pacientes con insuficiencia cardíaca. Sin embargo, aproximadamente un tercio de los pacientes no responden a esta terapia. Presentamos el caso de un paciente de 82 años portador de marcapasos definitivo bicameral en 1994 por disfunción sinusal. El ECG en el momento del implante muestra un ritmo sinusal a 40 lpm con QRS de 85 ms y eje normal. En fibrilación auricular (FA) permanente desde 1998. En 2005 se diagnostica de miocardiopatía dilatada con depresión de la función sistólica del ventrículo izquierdo (VI) (FEVI: 29%) e insuficiencia mitral moderada. Se optimiza el tratamiento farmacológico y se realiza un cateterismo cardíaco que descarta enfermedad coronaria. El porcentaje de estimulación del ventrículo derecho (VD) es del 65%. El paciente está estable, en clase funcional II de la New York Heart Association (NYHA) hasta 2011 en que se indica un Upgrade a estimulación biventricular por empeoramiento funcional, implantándose un electrodo Medtronic Attain Ability ® 4196 en una vena posterolateral en posición medio-apical en oblicua anterior derecha (OAD) y en posición 4 h en oblicua anterior izquierda (OAI). La posición más apical del electrodo del VI se debe a la inestabilidad del electrodo en una posición más basal de la vena posterolateral. Se optimiza el intervalo VI-VD a −30 ms, según media de integral velocidad tiempo en tracto de salida del VI. Se objetiva una reducción m l y t I (89%). El paciente no mejora en su situación funcional. n enero de 2016 ingresa por IC. Se documenta una insufiiencia mitral severa excéntrica, disfunción sistólica del VI evera y asincronía intraventricular izquierda (FEVI: 25%). El orcentaje de estimulación del VI es del 99%, el umbral de stimulación es 1.0 V a 0.5 ms, y solamente destaca la posiión medio-apical del electrodo del VI como causa de la no espuesta a la TRC. Se discuten las opciones terapéuticas que incluyen la xtracción del electrodo del VI y reimplante en una vena nterior, implante de un dispositivo de cierre mitral perutáneo y la realización de un Upgrade a estimulación ri-ventricular, y se define la región anterolateral basal como bjetivo del nuevo electrodo de estimulación del VI. Debido la dificultad de garantizar la estimulación percutánea del I, tras la extracción de un electrodo, que ha permaneido en el interior del seno coronario 5 años, se decide por a opción de estimulación tri-ventricular. Como el paciente stá en FA se utiliza el puerto auricular para el nuevo elecrodo del VI. En marzo de 2016 se implanta un electrodo VI Medtronic ttain Ability ® plus 4296 en vena anterolateral en posición h en OAI, en posición basal en OAD (fig. 2A y 2B) con dibujo xplicativo de la posición de los electrodos (fig. 2C). El geneador es un Medtronic VIVA ® CRT-P en modo de estimulación DDR, AV estimulado y sensado es 30 ms (valor menor proramable de AV en este modelo). El cegamiento ventricular ostestimulación auricular es de 30 ms para detección venricular bipolar (valor no programable). No se observa con sta programación inhibición de estimulación ventricular ni a activación de la estimulación ventricular de seguridad que levaría a un AV no deseado. El QRS es de 155 ms (fig. 1). A los 3 meses de seguimiento, el paciente está en clase uncional II de la NYHA, con reducción de los volúmenes el VI, mejoría en la FEVI hasta el 33%, y de la asincronía ecánica del VI y reducción de la insuficiencia mitral por la isminución de la asincronía interpapilar (fig. 2D y E).

Is HATCH score a reliable predictor of atrial fibrillation after cavotricuspid isthmus ablation for typical atrial flutter

Objective We determined the effectiveness of the HATCH score in patients with typical atrial flutter (AFl) undergoing cavotricuspid isthmus (CTI) ablation to predict long-term atrial fibrillation (AF). Methods We conducted an observational retrospective single-center cohort study including all patients admitted to our hospital for a CTI ablation between 1998 and 2010. The patients were divided into four categories: 1) new-onset AF (no prior AF and AF during follow-up (FU)); 2) old AF (prior AF and no AF during FU); 3) prior and post AF (AF prior and post CTI ablation); and 4) no AF. Results Four hundred and eight patients were included. In patients without prior AF, the hazard ratio (HR) for new-onset AF during FU was 0.98 (CI 95%: 0.65–1.50; p = 0.95) and 1.00 (CI 95%: 0.57–1.77; p = 0.98) for HATCH ≥ 2 and HATCH ≥ 3, respectively. In patients with prior AF, the HR for AF was 1.41 (CI 95%: 0.87–2.28; p = 0.17) and 1.79 (CI 95%: 0.96–3.35; p = 0.06), for HATCH ≥ 2 and HATCH ≥ 3, respectively. Left atrial enlargement was positively correlated with the occurrence of AF during FU, especially in the subgroup without prior AF, which had a HR of 2.44 (CI 95%: 1.35–4.40; p = 0.003), a HR of 2.88 (CI 95%: 1.36–6.10; p = 0.006) and a HR of 3.68 (CI 95%: 1.71–7.94; p = 0.001), for slight, moderate and severely dilated left atrial dimension, respectively, compared with a normal value. Conclusions HATCH score did not predict AF in patients with typical AFl who underwent CTI ablation. Basal left atrium dimension could help predict new-onset AF.