Publications by authors named "Fontenla Adolfo"

42 Publications

Do we have a new drug for heart rate control in patients with permanent atrial fibrillation? Response.

Rev Esp Cardiol (Engl Ed) 2020 12 14;73(12):1083-1084. Epub 2020 Oct 14.

Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.

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http://dx.doi.org/10.1016/j.rec.2020.08.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556276PMC
December 2020

[Do we have a new drug for heart rate control in patients with permanent atrial fibrillation? Response].

Rev Esp Cardiol 2020 Dec 9;73(12):1083-1084. Epub 2020 Sep 9.

Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, España.

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http://dx.doi.org/10.1016/j.recesp.2020.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480786PMC
December 2020

Wolff Parkinson white pattern in Danon disease: When preexcitation is not what it seems.

J Electrocardiol 2020 Sep - Oct;62:161-164. Epub 2020 Sep 1.

Division of pediatric cardiology, Hospital General de Albacete, Albacete, Spain.

Danondisease is a rare genetic disorder with an X-linked dominant inheritance affecting both skeletal and cardiac muscle. Its characteristic cardiac phenotype consists on a severe, non-obstructive and concentric hypertrophic cardiomyopathy (HCM) usually associated with a Wolff-Parkinson-White (WPW) type preexcitation pattern. Whether this corresponds to the presence of an AV or another type of accessory pathways, such as fasciculoventricular pathways (FVP) remains controversial in the literature. However, we describe the case of a teenager with Danon disease and preexcitation who develops a first degree AV block without any change in his QRS morphology, fact that favors the hypothesis of the presence of a FVP. This finding has important clinical implications in the management and prognosis of these complex patients. The absence of an AV accessory pathway decreases their risk of potential SCD in the context of a fast atrial arrhythmia and their chances of having a reentrant AV tachycardia.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.08.020DOI Listing
September 2020

First experience in Spain of cardiac contractility modulation. A new alternative for patients with heart failure.

Rev Esp Cardiol (Engl Ed) 2020 Oct 6;73(10):855-857. Epub 2020 May 6.

Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, CIBERCV, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2020.04.003DOI Listing
October 2020

Ivabradine for chronic heart rate control in persistent atrial fibrillation. Design of the BRAKE-AF project.

Rev Esp Cardiol (Engl Ed) 2020 May 17;73(5):368-375. Epub 2019 Oct 17.

Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

Introduction And Objectives: Ivabradine is an inhibitor of the If channel, the main determinant of the pacemaker function of the sinus node. The drug has been approved for the treatment of angina and heart failure. There is some evidence of its role as an inhibitor of atrial-ventricular node (AVN) conduction. The aim of the BRAKE-AF project is to assess ivabradine use for rate control in atrial fibrillation (AF).

Methods: A multicenter, randomized, parallel, open-label, noninferiority phase III clinical trial will be conducted to compare ivabradine vs digoxin in 232 patients with uncontrolled permanent AF despite beta-blockers or calcium channel blockers. The primary efficacy endpoint is the reduction in daytime heart rate measured by 24-hour Holter monitoring at 3 months. This clinical trial will be supported by an electrophysiological study of the effect of ivabradine on the action potential of the human AVN. To do this, an experimental model will be used with Chinese hamster ovarium cells transfected with the DNA encoding the expression of the t channels involved in this action potential and recording of the ionic currents with patch clamp techniques.

Results: New data will be obtained on the effect of ivabradine on the human AVN and its safety and efficacy in patients with permanent AF.

Conclusions: The results of the BRAKE-AF project might allow inclusion of ivabradine within the limited arsenal of drugs currently available for rate control in AF.

Clinical Trial Registration: http://www.clinicaltrials.gov. Identifier: NCT03718273.
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http://dx.doi.org/10.1016/j.rec.2019.09.004DOI Listing
May 2020

Subcutaneous implantable cardioverter defibrillators in patients with left ventricular assist devices: case report and comprehensive review.

Eur Heart J Case Rep 2019 Jun;3(2)

Cardiac Electrophysiology & Arrhythmia Unit, Cardiology Department, 12 de Octubre University Hospital, Avda de Córdoba s/n, Madrid, Spain.

Background: Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, many of whom have been or will be implanted with an implantable cardioverter defibrillator (ICD). Interaction between both devices is a matter of concern. Subcutaneous ICD (S-ICD) obtains its signals through subcutaneous vectors, which poses special challenges with regards to adequate performance following LVAD implantation.

Case Summary: We describe the case of a 24-year-old man implanted with an S-ICD because of idiopathic dilated cardiomyopathy, severe biventricular dysfunction, and self-limiting sustained ventricular tachycardias. After the implantation of a HeartMate 3™ (Left Ventricular Assist System, Abbott) several months later, the S-ICD became useless because of inappropriate sensing due to electromagnetic interference and attenuation of QRS voltage.

Discussion: We reviewed the reported cases in PubMed about the concomitant use of S-ICD and LVAD. Seven case reports about the performance of S-ICD in patients with an LVAD were identified, with discordant results. From these articles, we analyse the potential causes for these differing results. Pump location and operating rates in LVAD, as well as changes in the subcutaneous-electrocardiogram detected by the S-ICD after LVAD implantation are related to sensing disturbances when used in the same patient.
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http://dx.doi.org/10.1093/ehjcr/ytz057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601396PMC
June 2019

Response to ECG, July 2019.

Rev Esp Cardiol (Engl Ed) 2019 Aug;72(8):676

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2018.07.016DOI Listing
August 2019

ECG, July 2019.

Rev Esp Cardiol (Engl Ed) 2019 Jul;72(7):580

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2018.07.017DOI Listing
July 2019

Spanish Results of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II).

Rev Esp Cardiol (Engl Ed) 2019 Dec 29;72(12):1020-1030. Epub 2019 Mar 29.

Stavanger University Hospital, Stavanger, Norway; Institute of Internal Medicine, University of Bergen, Bergen, Norway.

Introduction And Objectives: We describe the results for Spain of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II) and compare them with those of the other participating countries.

Methods: We included patients undergoing CRT device implantation between October 2015 and December 2016 in 36 participating Spanish centers. We registered the patients' baseline characteristics, implant procedure data, and short-term follow-up information until hospital discharge.

Results: Implant success was achieved in 95.9%. The median [interquartile range] annual implantation rate by center was significantly lower in Spain than in the other participating countries: 30 implants/y [21-50] vs 55 implants/y [33-100]; P=.00003. In Spanish centers, there was a lower proportion of patients ≥ 75 years (27.9% vs 32.4%; P=.0071), a higher proportion in New York Heart Association functional class II (46.9% vs 36.9%; P <.00001), and a higher percentage with electrocardiographic criteria of left bundle branch block (82.9% vs 74.6%; P <.00001). The mean length of hospital stay was significantly lower in Spanish centers (5.8±8.5 days vs 6.4±11.6; P <.00001). Spanish patients were more likely to receive a quadripolar LV lead (74% vs 56%; P <.00001) and to be followed up by remote monitoring (55.8% vs 27.7%; P <.00001).

Conclusions: The CRT-Survey II shows that, compared with other participating countries, fewer patients in Spain aged ≥ 75 years received a CRT device, while more patients were in New York Heart Association functional class II and had left bundle branch block. In addition, the length of hospital stay was shorter, and there was greater use of quadripolar LV leads and remote CRT monitoring.
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http://dx.doi.org/10.1016/j.rec.2019.02.003DOI Listing
December 2019

Multiple ICD shocks in a patient with dilated cardiomyopathy: What is the mechanism?

J Cardiovasc Electrophysiol 2019 05 3;30(5):781-784. Epub 2019 Feb 3.

Department of Cardiology, Cardiac Electrophysiology Unit, University Hospital 12 de Octubre, Madrid, Spain.

We present the case of a 45-year-old male patient with dilated cardiomyopathy who suffers from multiple implantable cardioverter defibrillator (ICD) shocks. The analysis of the ICD tracing and the electrophysiological study allows to conclude that bundle branch re-entrant tachycardia is the most likely diagnosis, even in absence of conduction abnormalities in his basal electrocardiography.
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http://dx.doi.org/10.1111/jce.13862DOI Listing
May 2019

Electroanatomical delimitation of recipient atrium in heart transplantation.

Europace 2019 Feb;21(2):346

Cardiology Department, University Hospital 12 de Octubre, Avenida de Cordoba SN, Madrid, Spain.

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http://dx.doi.org/10.1093/europace/euy258DOI Listing
February 2019

Entrapment of "PV-Tracker" guidewire in the pulmonary veins during atrial fibrillation ablation with PVAC Gold.

Pacing Clin Electrophysiol 2018 11 6;41(11):1572-1574. Epub 2018 Aug 6.

Hospital Universitario 12 de Octubre, Madrid, Spain.

We report the entrapment of Pulmonary Vein Ablation Catheter (Medtronic, Minneapolis, MN, USA) and its guidewire within the right pulmonary veins in two patients. The catheters could be retrieved without complications but they were disabled in both cases. This nondescribed incident should be recognized by PVAC users since it may be a source of potential severe complications during pulmonary vein isolation procedures.
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http://dx.doi.org/10.1111/pace.13451DOI Listing
November 2018

Electrocardiographic changes and conduction disturbances after transfemoral aortic valve implantation with Edwards Sapien 3 prosthesis.

J Electrocardiol 2018 May - Jun;51(3):416-421. Epub 2018 Feb 20.

Clinical Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain.

Objectives: The aim of this study is to describe electrocardiographic changes and conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: 76 patients who underwent TAVI using Edwards Sapien 3 prosthesis were included, comparing electrocardiographic registries at admission, post-procedure and before discharge.

Results: Patients after TAVI presented a longer PR interval, a wider QRS, and a longer corrected QT, with a left deviation of QRS axis and T waves; reversible changes that tended to correct in the following days after TAVI. Complete atrioventricular block incidence was 2.9%. New-onset left bundle branch block (LBBB) incidence was 39%, although solved in almost half of patients before discharge.

Conclusions: TAVI was associated with different reversible electrocardiographic changes that suggest a transient impact on the conduction system. One of every five patients presented permanent LBBB after valve implant.
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http://dx.doi.org/10.1016/j.jelectrocard.2018.02.009DOI Listing
March 2019

Shock Reduction With Antitachycardia Pacing Before and During Charging for Fast Ventricular Tachycardias in Patients With Implantable Defibrillators.

Rev Esp Cardiol (Engl Ed) 2018 Sep 11;71(9):709-717. Epub 2017 Dec 11.

Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.

Introduction And Objectives: Fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator are susceptible to antitachycardia pacing (ATP) termination. Some manufacturers allow programming 2 ATP bursts: before charging (BC) and during (DC) charging. The aim of this study was to describe the safety and effectiveness of ATP BC and DC for fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator in daily clinical practice.

Methods: Data proceeded from the multicenter UMBRELLA trial, including implantable cardioverter-defibrillator patients followed up by the CareLink monitoring system. Fast ventricular tachycardias in the ventricular fibrillation zone until a cycle length of 200ms with ATP BC and/or ATP DC were included.

Results: We reviewed 542 episodes in 240 patients. Two ATP bursts (BC/DC) were programmed in 291 episodes (53.7%, 87 patients), while 251 episodes (46.3%, 153 patients) had 1 ATP burst only DC. The number of episodes terminated by 1 ATP DC was 139, representing 55.4% effectiveness (generalized estimating equation-adjusted 60.4%). There were 256 episodes terminated by 1 or 2 ATP (BC/DC), representing 88% effectiveness (generalized estimating equation-adjusted 79.3%); the OR for ATP effectiveness BC/DC vs DC was 2.5, 95%CI, 1.5-4.1; P <.001. Shocked episodes were 112 (45%) for ATP DC vs 35 (12%) for ATP BC/DC, representing an absolute reduction of 73%. The mean shocked episode duration was 16seconds for ATP DC vs 19seconds for ATP BC/DC (P=.07).

Conclusions: The ATP DC in the ventricular fibrillation zone for fast ventricular tachycardia is moderately effective. Adding an ATP burst BC increases the overall effectiveness, reduces the need for shocks, and does not prolong episode duration.
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http://dx.doi.org/10.1016/j.rec.2017.11.003DOI Listing
September 2018

Super-response to cardiac resynchronization therapy may predict late phrenic nerve stimulation.

Europace 2018 09;20(9):1498-1505

Cardiac Electrophysiology Unit, Department of Cardiology, Hospital Doce de Octubre, Avenida de Córdoba, s/n, Madrid, Spain.

Aims: Changes in the anatomical relationship between left phrenic nerve and coronary veins may occur due to the reverse remodelling observed in super-responders to cardiac resynchronization therapy (CRT) and might be the underlying mechanism in patients developing late-onset phrenic nerve stimulation (PNS) without evidence of lead dislodgement (LD). In this study, we sought to evaluate the role of super-response (SR) to CRT as a potential predictor of late-onset PNS.

Methods And Results: Consecutive patients implanted with a left ventricular (LV) lead in a single centre were retrospectively analysed. Phrenic nerve stimulation was classified as 'early' when it occurred within 3 months of implantation and 'late' for occurrences thereafter. 'Late' PNS was considered related to LD (LD-PNS) when LV threshold differed by > 1 V or impedance >250 Ω from baseline values or in case of radiological displacement. Cases not meeting the former criteria were classified as 'non-LD-PNS'. Super-response was defined as a decrease ≥30% of the left ventricluar end-systolic volume at 1-year echocardiography. At 32 ± 7 months follow-up, PNS occurred in 20 of 139 patients. Late non-LD-PNS incidence was significantly higher in the SR group (8/61; 13.1%) when compared with the non-SR (1/78; 1.3%) (P = 0.010). Super-response remained the only predictor of non-LD-PNS at multivariate analysis (odds ratio: 11.62, 95% confidence interval 1.41-95.68, P = 0.023).

Conclusion: Incidence of late non-LD-PNS is higher among SR to CRT, suggesting a potential role of the changes in the anatomical relationship between left phrenic nerve and coronary veins.
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http://dx.doi.org/10.1093/europace/eux311DOI Listing
September 2018

Pacemapping guided by defibrillator electrograms for ventricular tachycardia ablation in a patient with ARVD/C.

J Cardiovasc Electrophysiol 2018 02 9;29(2):336. Epub 2017 Nov 9.

Hospital Universitario, Madrid, Spain.

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http://dx.doi.org/10.1111/jce.13366DOI Listing
February 2018

Spanish Catheter Ablation Registry. 16th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2016).

Rev Esp Cardiol (Engl Ed) 2017 Nov 20;70(11):971-982. Epub 2017 Sep 20.

Unidad de Arritmias, Hospital Universitario de Alicante, Alicante, Spain.

Introduction And Objectives: This report describes the findings of the 2016 Spanish Catheter Ablation Registry.

Methods: Data were retrospectively collected by means of a standardized questionnaire completed by each of the participating centers.

Results: Data were collected from 83 centers. A total of 13 482 ablation procedures were performed (the highest historically reported in this registry), with a mean of 162.4 ± 116 and a median of 136 procedures per center. The most frequently treated ablation targets were atrioventricular nodal re-entrant tachycardia (n = 3058; 22.7%), atrial fibrillation (n = 2953; 21.9%), and cavotricuspid isthmus (n = 2892; 21.4%). There was a peak in ablation procedures for atrial fibrillation, which, for the first time in this registry, became the second most treated substrate. After exclusion of atrial fibrillation and ventricular tachycardia with underlying heart disease, the overall success rate was 86%. The rate of major complications was 2.3%, and the mortality rate was 0.05%. In all, 2.7% of the ablations were performed in pediatric patients.

Conclusions: The Spanish Catheter Ablation Registry systematically and uninterruptedly records the ablation procedures performed in Spain, showing a progressive rise in the number of ablations performed, with a high success rate and a low percentage of complications.
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http://dx.doi.org/10.1016/j.rec.2017.07.012DOI Listing
November 2017

Ivabradine as an Atrioventricular Node Modulator. Promise or Reality? Response.

Rev Esp Cardiol (Engl Ed) 2017 11 8;70(11):1024. Epub 2017 Jul 8.

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2017.06.013DOI Listing
November 2017

Ivabradine as an Alternative to AV Node Ablation in a Patient With Permanent Atrial Fibrillation.

Rev Esp Cardiol (Engl Ed) 2017 Nov 15;70(11):1019-1020. Epub 2017 May 15.

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2017.04.018DOI Listing
November 2017

Incidence of arrhythmias in a large cohort of patients with current implantable cardioverter-defibrillators in Spain: results from the UMBRELLA Registry.

Europace 2016 Nov 24;18(11):1726-1734. Epub 2015 Dec 24.

University Hospital Puerta de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain.

Aims: The benefit of implantable cardioverter-defibrillators (ICDs) in patients at risk of sudden death has been established in randomized clinical trials (RCTs) using the ICD models available at the time. However, observational large-scale data on the incidence of arrhythmias in up-to-date ICDs implanted according to the current guidelines are scarce. The aim was to assess the incidence of arrhythmias in a large, current ICD population based on a blinded peer review of the detected episodes.

Methods And Results: UMBRELLA is a multicentre, observational registry of ICD patients followed by remote monitoring. Stored episodes were classified by a blinded committee of experts. Subgroup analyses were based on clinical profiles established by previous pivotal RCTs of ICDs. Of 1514 enrolled patients, 605 (39.9%) patients had 5951 episodes after 26 ± 17 months follow-up, being 3353 of them (56.3%) sustained ventricular arrhythmias (SVA), and 13.2% of SVA were self-terminated. Appropriate and inappropriate shocks occurred in 11.6 and 5% of patients, respectively. The 3 years cumulative incidence of SVA was 25% (95% CI: 21-28%) in primary prevention patients and 41% (95% CI: 36-47%) in secondary prevention patients (P < 0.001). Male gender, secondary prevention, and atrial fibrillation as basal rhythm were significantly related to a higher incidence of SVA.

Conclusion: This real-world analysis suggests that modern ICD patients have a low rate of appropriate and inappropriate shocks. The risk of SVA in secondary prevention patients is less than what has been reported in RCTs.
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http://dx.doi.org/10.1093/europace/euv393DOI Listing
November 2016

Spanish Catheter Ablation Registry. 15th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2015).

Rev Esp Cardiol (Engl Ed) 2016 Nov 28;69(11):1061-1070. Epub 2016 Sep 28.

Unidad de Arritmias, Hospital Universitario de Burgos, Burgos, Spain.

Introduction And Objectives: This report presents the findings of the 2015 Spanish Catheter Ablation Registry.

Methods: For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database.

Results: Data were collected from 82 centers. A total of 12 863 ablation procedures were performed, for a mean of 157±119 and a median of 138 procedures per center. The ablation target most frequently treated was cavotricuspid isthmus (n=2992 [23.2%]), followed by atrioventricular nodal reentrant tachycardia (n=2966 [23%]) and atrial fibrillation (n=2640 [20.5%]). There were fewer ablation procedures for atrial tachycardia, idiopathic ventricular tachycardia and accessory pathways, while those for ventricular tachycardia in ischemic cardiomyopathy remained steady. The overall success rate, excluding atrial fibrillation and ventricular tachycardia in cardiomyopathy, was 87.5%, the rate of major complications was 2%, and the mortality rate was 0.08%.

Conclusions: The 2015 registry is the first to show a slight reduction in the number of centers sending in their results and in the total number of ablation procedures performed. The most frequently treated substrate was the cavotricuspid isthmus. There was also a slight decrease in the success rate. The complications and mortality rates remained low.
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http://dx.doi.org/10.1016/j.rec.2016.06.009DOI Listing
November 2016

Late Phrenic Nerve Stimulation in a Super-responder to Cardiac Resynchronization Therapy. The Toll of Success?

Rev Esp Cardiol (Engl Ed) 2016 Sep 12;69(9):868-70. Epub 2016 Jul 12.

Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.04.035DOI Listing
September 2016

Safety threshold of R-wave amplitudes in patients with implantable cardioverter defibrillator.

Heart 2016 10 13;102(20):1662-70. Epub 2016 Jun 13.

Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.

Objective: A safety threshold for baseline rhythm R-wave amplitudes during follow-up of implantable cardioverter defibrillators (ICD) has not been established. We aimed to analyse the amplitude distribution and undersensing rate during spontaneous episodes of ventricular fibrillation (VF), and define a safety amplitude threshold for baseline R-waves.

Methods: Data were obtained from an observational multicentre registry conducted at 48 centres in Spain. Baseline R-wave amplitudes and VF events were prospectively registered by remote monitoring. Signal processing algorithms were used to compare amplitudes of baseline R-waves with VF R-waves. All undersensed R-waves after the blanking period (120 ms) were manually marked.

Results: We studied 2507 patients from August 2011 to September 2014, which yielded 229 VF episodes (cycle length 189.6±29.1 ms) from 83 patients that were suitable for R-wave comparisons (follow-up 2.7±2.6 years). The majority (77.6%) of VF R-waves (n=13953) showed lower amplitudes than the reference baseline R-wave. The decrease in VF amplitude was progressively attenuated among subgroups of baseline R-wave amplitude (≥17; ≥12 to <17; ≥7 to <12; ≥2.2 to <7 mV) from the highest to the lowest: median deviations -51.2% to +22.4%, respectively (p=0.027). There were no significant differences in undersensing rates of VF R-waves among subgroups. Both the normalised histogram distribution and the undersensing risk function obtained from the ≥2.2 to <7 mV subgroup enabled the prediction that baseline R-wave amplitudes ≤2.5 mV (interquartile range: 2.3-2.8 mV) may lead to ≥25% of undersensed VF R-waves.

Conclusions: Baseline R-wave amplitudes ≤2.5 mV during follow-up of patients with ICDs may lead to high risk of delayed detection of VF.

Trial Registration Number: NCT01561144; results.
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http://dx.doi.org/10.1136/heartjnl-2016-309295DOI Listing
October 2016

Change in the Grade of Preexcitation and Progressive Prolongation of S-Delta Interval.

J Cardiovasc Electrophysiol 2016 Nov 22;27(11):1356-1359. Epub 2016 Jun 22.

Cardiac Electrophysiology Section, Cardiology Department, Hospital Doce de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1111/jce.13021DOI Listing
November 2016

The Usefulness of Vernakalant in Maintaining Sinus Rhythm During Ablation Procedures.

Rev Esp Cardiol (Engl Ed) 2016 Jul 24;69(7):708-9. Epub 2016 May 24.

Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.03.017DOI Listing
July 2016

Intracardiac drifting iceberg: a worrisome incident during cryoablation.

Europace 2016 Sep 22;18(9):1351. Epub 2016 Mar 22.

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Av de Córdoba s/n. 28041, Madrid, España.

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http://dx.doi.org/10.1093/europace/euw041DOI Listing
September 2016

Atrial Rate-Responsive Pacing and Incidence of Sustained Atrial Arrhythmias in Patients with Implantable Cardioverter Defibrillators.

Pacing Clin Electrophysiol 2016 Jun 22;39(6):548-56. Epub 2016 Apr 22.

Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain.

Background: Atrial rate-responsive pacing (RRP) has proved to be safe in pacemaker recipients with chronotropic incompetence. Although RRP is available in all current implantable cardioverter defibrillators (ICDs), the outcomes of this pacing mode in ICD patients are unknown. The aim is to evaluate the relationship between atrial RRP and atrial arrhythmias in ICD recipients.

Methods: Dual-chamber and triple-chamber ICD patients were included in this multicenter cohort study. Patients with permanent atrial fibrillation (AF) or VVI pacing mode were excluded. The number and duration of atrial tachycardia (AT)/AF episodes were assessed.

Results: Data from 415 patients and 80,707 AT/AF episodes (median duration: 0.4 hours) were collected after a 21.3 ± 14.1-month follow-up. Atrial RRP was programmed in 90 (21.7%) patients and was associated with a higher atrial pacing percentage in the overall study population (51.2 ± 33.8% vs 18.4 ± 25.7%, P < 0.001) and to a higher ventricular pacing percentage among dual-chamber devices (22.3 ± 37.6% vs 9.3 ± 25%, P < 0.001). Independent factors associated with sustained AT/AF episodes (>23 hours) were previous AF (odds ratio [OR]: 7.98; 95% confidence interval [CI]: 4.11-15.47; P < 0.001) and atrial RRP (OR: 3.58; 95% CI: 1.82-7.03; P < 0.001). RRP was related to a lower sustained AT/AF episodes-free survival both in patients with a history of AF (43% vs 70%, P = 0.035) and without a history of AF (82% vs 97%, P = 0.004) at 2 years.

Conclusions: Atrial RRP in ICD patients was related to a higher incidence of sustained atrial arrhythmias. This pacing mode may have an atrial proarrhythmic effect on ICD patients, especially among those with a history of AF.
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http://dx.doi.org/10.1111/pace.12856DOI Listing
June 2016

Phrenic paralysis during cardiac electronic device implantation: incidence, causes and clinical course.

Europace 2016 Oct 29;18(10):1561-1564. Epub 2016 Jan 29.

Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Avda de Córdoba, s/n., Madrid 28041, Spain.

Aims: Phrenic paralysis is a known complication of central venous catheterization, but it is not listed as a complication related to cardiac implantable electronic device (CIED) implants. The aim of this study is to describe the incidence, causes, clinical picture, and management of phrenic paralysis occurring in this scenario.

Methods And Results: We retrospectively analysed data from our CIED implantation database and identified those patients who suffered phrenic paralysis during the implantation procedure. Four of 891 patients (subclavian puncture in 626) developed phrenic paralysis during pacemaker or defibrillator implant procedures. Severe respiratory failure needing ventilatory support occurred in two, being the phrenic paralysis transient in all of the cases.

Conclusions: Transient phrenic paralysis may occur during CIED implantation probably related to the infiltration of local anaesthesia in the subclavian area. Mechanism, prevention, and management are discussed.
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http://dx.doi.org/10.1093/europace/euv423DOI Listing
October 2016

Syncopes in a Patient With a History of Radiotherapy: The Importance of a Comprehensive Assessment of Cardiac Involvement.

Rev Esp Cardiol (Engl Ed) 2016 Mar 15;69(3):352. Epub 2016 Jan 15.

Unidad de Arritmias, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.10.007DOI Listing
March 2016

Left Free Wall Accessory Pathway Ablation in the Presence of a Mechanical Mitral Prosthesis.

J Cardiovasc Electrophysiol 2016 06 20;27(6):759-60. Epub 2016 Jan 20.

Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España.

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http://dx.doi.org/10.1111/jce.12889DOI Listing
June 2016