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Introduction: His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are novel techniques that have demonstrated their efficacy in patients needing right ventricular pacing and in candidates for resynchronization therapy. The purpose of this study was to compare acute and short-term outcomes between HBP and LBBAP. Methods: Retrospective review of the success rate and change in QRS duration obtained by HBP and LBBAP in patients requiring anti-bradycardia pacing or cardiac resynchronization, evaluating the complications and pacing parameters at implantation and at 3 months. Results. The study included 90 procedures (46 HBP and 44 LBBAP) in 87 patients. Success was achieved in 77 procedures (85.6%): 37 (80.4%) in the HBP group and 40 (90.9%) in the LBBAP group (P = .23). Paced QRS duration was shorter in the LBBAP patients (109 ± 8 vs. 117 ± 19 ms; P

BACKGROUND Frequent premature ventricular complexes (PVCs) are common after a myocardial infarction (MI), but data on PVC ablation in this population are limited. OBJECTIVE The purpose of this study was to analyze data on PVC ablation in post-MI patients. METHODS Three hundred thirty-two patients with frequent PVCs and left ventricular (LV) dysfunction were prospectively studied. Data from 67 patients (20%; age 63 +/- 10 years; 65 men [93%]) with previous MI were compared with the remaining 265 patients. RESULTS PVCs in post-MI patients originate predominantly from the LV (92% LV vs 6% right ventricle [RV]; P

The treatment of patients with bifascicular block (BFB) and syncope in the absence of structural heart disease (SHD) is not well defined. The objective of our study is to compare pacemaker empirical implantation with the use of electrophysiological studies (EPS). This is a prospective cohort study that included 77 patients with unexplained cardiogenic syncope and BFB without structural heart disease between 1997 and 2012. Two groups: 36 patients received empirical pacemakers (Group A) and 41 underwent EPS (Group B) to guide their treatment. The incidence of syncope recurrence and atrioventricular block was lower in group A. Mortality and complication rates were similar between both groups. Multivariate analysis demonstrated a higher number of events (combined endpoint) in group B. Our study shows that treatment according to EPS does not improve the results of a treatment strategy based on empirical pacemaker.

A mechanical tricuspid valve makes it difficult to implant a transvenous endocardial lead in the right ventricle, necessitating pacing by alternative nonphysiological methods such as implanting an epicardial lead and pacing through the coronary sinus. Permanent His-bundle pacing is an increasingly

There is a consensus that patients with complete atrioventricular (AV) block accompanied by significant ventricular systolic dysfunction (before or after monoventricular pacing) benefit from cardiac resynchronization therapy (CRT). However, there are cases in which effective resynchronization is particularly difficult to achieve, generally owing to anatomic or vein-access problems. Up to now, the alternative therapy in these especially difficult cases has been the epicardial approach. We present His-bundle pacing (HBP) for the first time as a clinically effective alternative in a case that was complicated by dextrocardia and persistent right superior vena cava and required CRT because of systolic dysfunction in the presence of complete AV block.

Resumen Los feocromocitomas son tumores neuroendocrinos secretores de catecolaminas. La reseccion es un procedimiento quirurgico de alto riesgo debido al peligro de crisis hipertensivas, arritmias malignas y fallo multiorganico, por lo que requiere una preparacion farmacologica previa. Presentamos el caso de un varon de 69 anos que fue intervenido quirurgicamente desconociendose que presentaba un paraganglioma extraadrenal, y durante la intervencion y el postoperatorio tuvo episodios de taquicardia ventricular y crisis hipertensivas.

Resumen Introduccion y objetivos Analizar el valor pronostico de la hipoxemia nocturna, evaluada mediante pulsioximetria nocturna portatil, en pacientes ingresados por insuficiencia cardiaca y su relacion con la mortalidad y el reingreso hospitalario. Metodos Incluimos a 38 pacientes ingresados de manera consecutiva en nuestra unidad con el diagnostico de insuficiencia cardiaca descompensada. La pulsioximetria se considero positiva para hipoxemia cuando se registraron mas de 10 desaturaciones a la hora durante el sueno. Se realizo seguimiento durante 30,3 (desviacion estandar [DE] 14,2) meses, el objetivo principal fue un endpoint combinado de mortalidad por cualquier causa y reingreso por insuficiencia cardiaca. Resultados La edad media fue de 70,7 (DE 10,7) anos; el 63,3% eran varones. La pulsioximetria fue considerada positiva para hipoxemia en 27 (71%) pacientes. Los pacientes con una pulsioximetria positiva presentaron con mayor frecuencia el endpoint combinado (9.1% [1] vs. 61,5% [16]; p = 0,003). Tras el analisis multivariable, la hipoxemia nocturna continuo estando relacionada con el endpoint combinado (HR = 8,37; 1,19-68,4; p = 0,03). Discusion Los pacientes ingresados por insuficiencia cardiaca e hipoxemia nocturna medida con pulsioximetro portatil presentan un riesgo aumentado de reingreso y muerte.

Introduction and objectives Nonischemic sudden cardiac death (SCD) is predominantly caused by cardiomyopathies and channelopathies. There are many diagnostic tests, including some complex techniques. Our aim was to analyze the diagnostic yield of a systematic diagnostic protocol in a specialized unit. Methods The study included 56 families with at least 1 index case of SCD (resuscitated or not). Survivors were studied with electrocardiogram, advanced cardiac imaging, exercise testing, familial study, genetic testing and, in some cases, pharmacological testing. Families with deceased probands were studied using the postmortem findings, familial evaluation, and molecular autopsy with next-generation sequencing (NGS). Results A positive diagnosis was obtained in 80.4% of the cases, with no differences between survivors and nonsurvivors ( P = .53). Cardiac channelopathies were more prevalent among survivors than nonsurvivors (66.6% vs 40%, P = .03). Among the 30 deceased probands, the definitive diagnosis was given by autopsy in 7. A diagnosis of cardiomyopathy tended to be associated with a higher event rate in the family. Genetic testing with NGS was performed in 42 index cases, with a positive result in 28 (66.6%), with no differences between survivors and nonsurvivors ( P = .21). Conclusions There is a strong likelihood of reaching a diagnosis in SCD after a rigorous protocol, with a more prevalent diagnosis of channelopathy among survivors and a worse familial prognosis in cardiomyopathies. Genetic testing with NGS is useful and its value is increasing with respect to the Sanger method.

Resumen Introduccion y objetivos La muerte subita cardiaca (MSC) de origen no isquemico esta causada predominantemente por miocardiopatias y canalopatias. La bateria de test diagnosticos es amplia e incluye pruebas complejas. El objetivo de nuestro estudio es analizar la rentabilidad diagnostica del estudio etiologico sistematizado de la MSC. Metodos Se estudio a 56 familias con al menos 1 caso indice con MSC (reanimada o no). En los supervivientes se exploro con electrocardiograma, imagen cardiaca avanzada, ergometria, estudio familiar, estudio genetico y, puntualmente, test farmacologicos. En los fallecidos se examino la necropsia, asi como la autopsia molecular con next generation sequencing (NGS), junto con estudio clinico familiar. Resultados El diagnostico se alcanzo en el 80,4% de los casos, sin diferencias entre supervivientes y fallecidos (p = 0,53). Entre los supervivientes, el diagnostico de canalopatia fue mas frecuente que entre los fallecidos (el 66,6 frente al 40%; p = 0,03). De los 30 sujetos fallecidos, en 7 la autopsia aporto un hallazgo concluyente. El diagnostico de miocardiopatia tendia a asociarse con mayor tasa de eventos en la familia. El test genetico con NGS se realizo en 42 de los casos; se obtuvo resultado positivo en 28 (66,6%), sin diferencias entre supervivientes y fallecidos (p = 0,21). Conclusiones La probabilidad de alcanzar el diagnostico en la MSC tras un protocolo exhaustivo es alta, con mayor prevalencia de canalopatias en los supervivientes y un aparente peor pronostico en las miocardiopatias. El test genetico mediante NGS muestra utilidad en casos de MSC e incrementa la rentabilidad respecto al estudio con Sanger.

Resumen Introduccion y objetivos La ablacion con cateter sin guia fluoroscopica es factible en la mayoria de los casos. El objetivo de nuestro registro es evaluar la factibilidad y la seguridad de la ablacion no guiada por fluoroscopia en varios centros espanoles. Metodos Once hospitales incluyeron prospectivamente a, al menos, 20 pacientes afectados de un sustrato arritmico cuyo procedimiento de ablacion, a juicio de cada operador, se podia abordar sin fluoroscopia durante todo el procedimiento. No se incluyo a pacientes portadores de dispositivos intracardiacos. Electrofisiologos de plantilla, becarios y residentes participaron en cada procedimiento de forma habitual. Resultados Se incluyo a un total de 247 pacientes (n = 247). Se realizo ablacion en 235 casos (95,2%), y en 2 casos que no se incluyeron en el analisis la fluoroscopia se utilizo como primera intencion. En el 99,15% (231/233) de los procedimientos analizados el sustrato arritmico abordado se localizaba en cavidades derechas. Se requirio fluoroscopia en 24 (10,3%), se obtuvo exito en el 96,4% de los procedimientos y hubo complicaciones graves en 2 pacientes (0,85%). Las variables relacionadas con la necesidad de fluoroscopia fueron el centro realizador (maximo, 33,3%; minimo, 0; p = 0,001) y el fracaso del procedimiento (el 13 frente al 2,4%; p Conclusiones El registro multicentrico muestra que la ablacion sin escopia de sustratos localizados en cavidades derechas es factible en la mayoria de los procedimientos. Se necesitan estudios aleatorizados para confirmar su seguridad. La necesidad de fluoroscopia es mayor en los procedimientos sin exito y es variable en los centros realizadores.

Introduction and objectives Nonfluoroscopic catheter ablation is feasible in most procedures. The aim of our registry was to evaluate the safety and feasibility of a zero-fluoroscopic approach to catheter ablation in several Spanish centers. Methods Eleven centers prospectively included a minimum of 20 patients. Patients with an arrhythmic substrate deemed suitable by the operator for a zero-fluoroscopic approach throughout the procedure were recruited. Patients with intracardiac devices were not included. Attending electrophysiologists, fellows, and resident physicians participated in each procedure, as in usual care. Results The study included 247 patients. Ablation was performed in 235 patients (95.2%). In 2 patients, who were not included in the analysis, fluoroscopy was performed as the first-line treatment. The arrhythmic substrate was located in the right chambers in most of the procedures (231 of 233 [99.15%]). Fluoroscopy was used in 24 procedures (10.3%). Catheter ablation was successful in 96.4% of the procedures and severe complications occurred in 2 patients (0.85%). Two variables were related to the need for fluoroscopy: the performing center (minimum 0% vs maximum 30.3%; P = .001) and procedural failure (13% vs 2.4%; P Conclusions The Spanish multicenter registry reveals that a zero-fluoroscopic approach is feasible in most right-sided catheter ablation procedures. Randomized trials are necessary to confirm the safety of this approach. The need for fluoroscopy was related to procedural failure, with significant differences among performing centers.

Background The Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored. Objective This study aims to assess the effectiveness of a remotely provided Mediterranean diet–based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF). Methods The PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the Mediterranean diet enriched with extra virgin olive oil (EVOO) on the prevention of atrial tachyarrhythmia recurrence after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (Mediterranean diet enriched with EVOO) or a control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with provision of dietary recommendations, and participants had access to a web page, a mobile app, and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, Mediterranean diet classroom, and Your personal experience. At baseline and at 1-year and 2-year follow-up, the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire were collected by a dietitian by phone. Results A total of 720 subjects were randomized (365 to the intervention group, 355 to the control group). Up to September 2020, 560 subjects completed the first year (560/574, retention rate 95.6%) and 304 completed the second year (304/322, retention rate 94.4%) of the intervention. After 24 months of follow-up, increased adherence to the Mediterranean diet was observed in both groups, but the improvement was significantly higher in the intervention group than in the control group (net between-group difference: 1.8 points in the MEDAS questionnaire (95% CI 1.4-2.2; P Conclusions The remote nutritional intervention using a website and phone calls seems to be effective in increasing adherence to the Mediterranean diet pattern among AF patients treated with catheter ablation. Trial Registration ClinicalTrials.gov NCT03053843; https://www.clinicaltrials.gov/ct2/show/NCT03053843

ObjectivesSARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients.DesignWe evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 hours after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors.ResultsWe included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404–433), and after treatment QTc was prolonged to 423 ms (405–438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14,1 %) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation.ConclusionsAmbulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.What is already known about this subject?Treatment for COVID 19 with empirical drugs hydroxicloroquine, azitromycin and protease inhibitors affects ventricular repolarization by prolonging the QT interval in a variable degree basing upon heterogeneous studiesWhat does this study add?Not critically ill patients with COVID 19 develop a non relevant QT interval prolongation, leading to a modest arrhythmic risk increase, overall in patients with normal basal ECGHow might this impact on clinical practice?Our findings are significant as ECG monitoring of COVID 19 patients is costly and difficult. Ambulatory and stable patients with normal basal ECG might nor benefit from QT assessment afeter treatment initiation

Aims Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a life-threatening entity with a highly heterogeneous genetic background. Cardiac magnetic resonance (CMR) imaging can identify fibrofatty scar by late gadolinium enhancement (LGE). Our aim is to investigate genotype–phenotype correlation in ARVC/D mutation carriers, focusing on CMR-LGE and myocardial fibrosis patterns. Methods and results A cohort of 44 genotyped patients, 33 with definite and 11 with borderline ARVC/D diagnosis, was characterized using CMR and divided into groups according to their genetic condition (desmosomal, non-desmosomal mutation, or negative). We collected information on cardiac volumes and function, as well as LGE pattern and extension. In addition, available ventricular myocardium samples from patients with pathogenic gene mutations were histopathologically analysed. Half of the patients were women, with a mean age of 41.6 ± 17.5 years. Next-generation sequencing identified a potential pathogenic mutation in 71.4% of the probands. The phenotype varied according to genetic status, with non-desmosomal male patients showing lower left ventricular (LV) systolic function. LV fibrosis was similar between groups, but distribution in non-desmosomal patients was frequently located at the posterolateral LV wall; a characteristic LV subepicardial circumferential LGE pattern was significantly associated with ARVC/D caused by desmin mutation. Histological analysis showed increased fibrillar connective tissue and intercellular space in all the samples. Conclusion Desmosomal and non-desmosomal mutation carriers showed different morphofunctional features but similar LV LGE presence. DES mutation carriers can be identified by a specific and extensive LV subepicardial circumferential LGE pattern. Further studies should investigate the specificity of LGE in ARVC/D.

Aims Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular systolic dysfunction. We aimed to investigate the influence of the baseline QRS in the response after PVC ablation in patients with depressed left ventricular ejection fraction (LVEF). Methods and results Two hundred and fifteen [59 ± 13 years old, 152 (71%) men] consecutive patients with left ventricular (LV) systolic dysfunction and frequent PVCs referred for ablation were included and followed-up for 12 months. Echocardiographic response was defined as an improvement of at least five absolute points in LVEF. Clinical, electrocardiogram, and electrophysiological characteristics were analysed. Mean baseline QRS duration was 110 ms [97–140]. Premature ventricular complex burden significantly decreased after ablation from 23% [16–33] at baseline to 1% [0–8] at 12 months, P 130 ms. Conclusions In patients with LV systolic dysfunction, intrinsic QRS duration is inversely related to the probability and the degree of echocardiographic response after frequent PVC ablation. Patients with a QRS duration >130 ms at baseline have the poorer response after ablation.

Resumen Las taquicardias supraventriculares en gestantes afectan tanto a la madre como al feto, estando el tratamiento farmacologico condicionado por el propio embarazo. En casos recidivantes, la ablacion es una alternativa, mas aun si se realiza sin escopia. Aportamos el caso de una gestante de 31 semanas que se somete a estudio electrofisiologico ayudados por un sistema de navegacion no fluoroscopico, al presentar dichas taquicardias de forma recidivante a pesar del tratamiento. Durante el estudio se comprueba la presencia de una via accesoria oculta izquierda, y se realiza su mapeo y ablacion por via retroaortica de forma exitosa, unicamente tras 6 s de escopia precisos para evitar lesionar el cayado aortico. Este caso resalta el uso de navegadores 3D para realizar procedimientos de cero o minima escopia.

Resumen El desfibrilador automatico implantable ha demostrado mejorar la supervivencia en pacientes con cardiopatia estructural, pero no esta exento de riesgos, por lo que la seleccion de los pacientes y la programacion del dispositivo es fundamental para maximizar el beneficio y minimizar los riesgos.

Aims Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population. Methods and results Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24–84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P Conclusion In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up.

Short QT Syndrome (SQTS) is a very rare cardiac channelopathy that leads to an abbreviated QTc interval and sudden cardiac death (SCD). It is a genetically heterogeneous entity, with only 25 % of cases identified as having a pathogenic mutation in genes encoding mainly for plasma membrane ion

Resumen Introduccion y objetivos La heredabilidad y la penetrancia familiar de los trastornos causantes de la parada cardiaca en ausencia de cardiopatia aparente es desconocida. Nuestro objetivo es describir los hallazgos clinicos y los medios para alcanzar el diagnostico en una muestra de familiares de probandos con parada cardiaca en ausencia de cardiopatia aparente. Material y metodos Estudiamos a familiares de primer a tercer grado de pacientes afectados por parada cardiaca de origen incierto. En todos se realizo electrocardiograma y ecocardiograma transtoracico. En los casos con diagnostico cierto en el probando, se realizo ademas estudio dirigido en funcion del mismo para desenmascarar la enfermedad. Resultados Se incluyo a 88 sujetos pertenecientes a 35 familias (media de 2,5 familiares por caso indice, con una edad media de 38,4 anos y 52,8% varones). El 55,6% fueron familiares de primer grado y el resto de segundo y tercer grado. En 18 de los 35 casos indice se alcanzo un diagnostico final. Se obtuvo un diagnostico positivo en 19 familiares (21,5%) consistentes en sindrome de Brugada (10 casos), sindrome de QT largo (3 casos), taquicardia ventricular catecolaminergica polimorfica (5 casos) y un caso de posible Sindrome de QT corto. En 4 familias, el diagnostico del probando se alcanzo exclusivamente mediante el estudio familiar. Conclusiones La prevalencia de canalopatias cardiacas entre los familiares de probandos con parada cardiaca de origen incierto fue alta, con frecuente necesidad de test de desenmascaramiento y genetico para logar un diagnostico cierto.

Premature ventricular complex (PVC) ablation has been shown to improve left ventricular ejection fraction (LVEF) and New York Heart Association functional class in patients with left ventricular dysfunction. Both are considered key variables in predicting risk of sudden cardiac death.The objective of this study was to assess whether ablation might remove the primary prevention (PP) implantable cardioverter-defibrillator (ICD) indication in patients with frequent PVC.Sixty-six consecutive patients with PP-ICD indication and frequent PVC [33 (50%) men; mean age 53 ± 13 years; 11 (17%) with ischemic heart disease] underwent PVC ablation. The ICD was withheld and the indication was reevaluated at 6 and 12 months.LVEF progressively improved from 28% ± 4% at baseline to 42% ± 12% at 12 months (P.001). New York Heart Association functional class improved from 2 patients with NYHA functional class I (3%) at baseline to 35 (53%) at 12 months (P.001). The brain natriuretic peptide level decreased from 246 ± 187 to 176 ± 380 pg/mL (P = .004). The PP-ICD indication was removed in 42 patients (64%) during follow-up, from 38 (92%) of them at 6 months, showing an independent association with baseline PVC burden and successful sustained ablation. In patients with successful sustained ablation, a cutoff value of 13% PVC burden had a sensitivity of 100% and a specificity of 93% (area under the curve 99%) for removing ICD indication postablation. No sudden cardiac deaths or malignant ventricular arrhythmias were observed.In patients with frequent PVC and PP-ICD indication, ablation improves LVEF and, in most cases, allows removal of the indication. Withholding the ICD and reevaluating within 6 months of ablation seems to be a safe and appropriate strategy.

Resumen Introduccion y objetivos Existen muy pocos estudios que hayan analizado el valor diagnostico y pronostico del electrocardiograma en la miocardiopatia no compactada. Nuestro objetivo es evaluar sus caracteristicas en dicha enfermedad, establecer su relacion con la disfuncion ventricular izquierda y eventos clinicos mayores como insuficiencia cardiaca. Metodos Los electrocardiogramas de 20 pacientes con criterios ecocardiograficos y clinicos de miocardiopatia no compactada y de un grupo control de 20 sujetos sanos fueron analizados de forma ciega por un unico observador. Resultados El 85% de los electrocardiogramas en sujetos afectos resulto anormal. Se constato mayor duracion de los intervalos QRS y QT corregida con respecto a los controles. Los pacientes con fraccion de eyeccion ventricular menor o igual al 35% mostraron un QRS mas ancho y un QT corregido mas largo. Conclusiones La mayoria de los afectados tienen electrocardiogramas patologicos en la poblacion analizada. La prolongacion del intervalo QRS y la duracion del intervalo QT corregido parecen asociarse con disfuncion ventricular izquierda e insuficiencia cardiaca.

Introduction and objectives To analyze the prognostic value of nocturnal hypoxaemia measured with portable nocturnal pulse-oximetry in patients hospitalized due to heart failure and its relation to mortality and hospital readmission. Methods We included 38 patients who were admitted consecutively to our unit with the diagnosis of decompensated heart failure. Pulse-oximetry was considered positive for hypoxaemia when more than 10 desaturations per hour were recorded during sleep. Follow-up was performed for 30.3 (standard deviation [SD] 14.2) months, the main objective being a combined endpoint of all-cause mortality and hospital readmission due to heart failure. Results The average age was 70.7 (SD 10.7) years, 63.3% were males. Pulse-oximetry was considered positive for hypoxaemia in 27 (71%) patients. Patients with positive pulse-oximetry had the most frequent endpoint (9.1% [1] vs. 61.5% [16], p = 0.003). After multivariate analysis, continuous nocturnal hypoxaemia was related to the combined endpoint (HR = 8.37, 1.19–68.4, p = 0.03). Discussion Patients hospitalized for heart failure and nocturnal hypoxaemia measured with portable pulse-oximeter have an increased risk of hospital readmission and death.

Julio Plaza-Díaz is part of the “UGR Plan Propio de Investigación 2016” and the “Excellence actions: Unit of Excellence on Exercise and Health (UCEES), University of Granada”. We are grateful to Belen Vazquez-Gonzalez for assistance with the illustration service., The importance of gut microbiota in health and disease is being highlighted by numerous research groups worldwide. Atherosclerosis, the leading cause of heart disease and stroke, is responsible for about 50% of all cardiovascular deaths. Recently, gut dysbiosis has been identified as a remarkable factor to be considered in the pathogenesis of cardiovascular diseases (CVDs). In this review, we briefly discuss how external factors such as dietary and physical activity habits influence host-microbiota and atherogenesis, the potential mechanisms of the influence of gut microbiota in host blood pressure and the alterations in the prevalence of those bacterial genera affecting vascular tone and the development of hypertension. We will also be examining the microbiota as a therapeutic target in the prevention of CVDs and the beneficial mechanisms of probiotic administration related to cardiovascular risks. All these new insights might lead to novel analysis and CVD therapeutics based on the microbiota.

Background Empiric circumferential pulmonary vein isolation (CPVI) has become the therapy of choice for drug-refractory atrial fibrillation (AF). Although results are suboptimal, it is unknown whether mechanistically-based strategies targeting AF drivers are superior. Objectives This study sought to determine the efficacy and safety of localized high-frequency source ablation (HFSA) compared with CPVI in patients with drug-refractory AF. Methods This prospective, multicenter, single-blinded study of 232 patients (age 53 ± 10 years, 186 males) randomized those with paroxysmal AF (n = 115) to CPVI or HFSA-only (noninferiority design) and those with persistent AF (n = 117) to CPVI or a combined ablation approach (CPVI + HFSA, superiority design). The primary endpoint was freedom from AF at 6 months post-first ablation procedure. Secondary endpoints included freedom from atrial tachyarrhythmias (AT) at 6 and 12 months, periprocedural complications, overall adverse events, and quality of life. Results In paroxysmal AF, HFSA failed to achieve noninferiority at 6 months after a single procedure but, after redo procedures, was noninferior to CPVI at 12 months for freedom from AF and AF/AT. Serious adverse events were significantly reduced in the HFSA group versus CPVI patients (p = 0.02). In persistent AF, there were no significant differences between treatment groups for primary and secondary endpoints, but CPVI + HFSA trended toward more serious adverse events. Conclusions In paroxysmal AF, HFSA failed to achieve noninferiority at 6 months but was noninferior to CPVI at 1 year in achieving freedom of AF/AT and a lower incidence of severe adverse events. In persistent AF, CPVI + HFSA offered no incremental value. (Radiofrequency Ablation of Drivers of Atrial Fibrillation [RADAR-AF]; NCT00674401 )

Background Electroanatomical mapping systems have reduced the amount of fluoroscopy required to ablate the cavotricuspid isthmus. The aims of this study are to evaluate the feasibility and safety of a zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system (Biosense Webster, Diamond Bar, CA, USA) and to compare the results of this approach with those of the zero-fluoroscopy approach using the Ensite-NavX™ system (St. Jude Medical, St. Paul, MN, USA). Methods Twenty consecutive procedures guided by the Carto®3 system (Group A) were compared with two case-control groups matched from 146 procedures guided with the Ensite-NavX™ system. Group B consisted of 20 matched procedures from the first 50 procedures performed in the electrophysiology unit, and Group C consisted of 20 matched procedures from the last 50 procedures. Acute success (bidirectional block), complications, and recurrences were analyzed. The procedure times were also compared. Results There were no differences in the rates of acute success (95%, 100%, and 100%, respectively), complications (0%, 5%, and 0%), and recurrences (5.2%, 0%, and 5%) in the three groups. A zero-fluoroscopy approach was attempted in all procedures, and electroanatomical mapping made it possible to successfully avoid fluoroscopy in 90% of the procedures in Group A, 85% in B, and 95% in C. The total procedure time was shorter in Group C. The fluoroscopy and radiofrequency times were not different. Conclusions A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system is feasible in most procedures. This approach has similar results to the zero-fluoroscopy approach using the Ensite-NavX™ system.

OBJECTIVES: The PREDIMAR (Prevention of arrythmias with Mediterranean diet -MedDiet-) trial is an ongoing randomized, parallel, multicenter study in Spain that began in 2017. The aim of this trial was to assess the effectiveness of a remote nutrition intervention in reducing the rate of atrial fibrillation (AF) relapses after ablation. Here, we compare 1-year changes in diet and other lifestyle factors between the intervention and control group. METHODS: As of December 2018, 149 out of 484 recruited participants had completed the 1-yr follow-up visit. Among them, 77 received a remote intervention by a dietitian and 72 received the usual clinical care (controls). Adherence to the MedDiet was measured using a validated 14-point Mediterranean diet Adherence Score (MEDAS). Lifestyle was measured using a 7-point Healthy Lifestyle Score (HLS): physical activity, BMI, Mediterranean diet score, moderate alcohol consumption, TV watching, napping, and time spent with friends. Mean differences between baseline and 1-yr follow-up within and between groups were calculated with Student's t-test for statistical significance. RESULTS: One-year changes in MEDAS were significantly better within the intervention group (2.48 pts. 95%CI:1.97–2.99) but not within the control group (0.29 pts. 95%CI: −0.21–0.79). We observed a significant increase in MEDAS in the intervention group compared to the control group (2.19 pts. 95%CI: −2.90–1.48). After 1-yr follow-up, participants in the intervention group significantly increased their consumption of fruits, vegetables, legumes, olive oil, fish, nuts, carbohydrates, fiber, and fat, by increasing MUFA and PUFA (all P

Resumen Introduccion y objetivos Las canalopatias cardiacas son trastornos geneticos que pueden causar muerte subita. Entre ellas se encuentran el sindrome de QT largo y el sindrome de Brugada. Ambos se diagnostican segun unos criterios previamente publicados. Nuestro objetivo es evaluar la sensibilidad de esos criterios en una serie consecutiva de sujetos portadores de mutacion patogenica para sindrome de QT largo y sindrome de Brugada. Metodos Se incluyo a 15 familias y 31 sujetos portadores de mutaciones con alta probabilidad patogenica de sindrome de QT largo o sindrome de Brugada. Realizamos estudio clinico y electrocardiografico para analizar el cumplimiento de los criterios diagnosticos. El estudio estadistico se realizo con el programa estadistico SPSS 17.0. Resultados El 48,3% de los sujetos cumplian criterios de alta probabilidad de sindrome de QT largo o sindrome de Brugada. Entre la poblacion con mutacion para sindrome de QT largo, solo 10 de 21 sujetos mostraron un indice de Schwartz ≥ 4. Tanto la mediana de la puntuacion de Schwartz como el intervalo QTc fueron menores en familiares que en probandos. En la poblacion con mutacion para sindrome de Brugada, el 60% no cumplia los criterios diagnosticos vigentes, algo que fue mas frecuente en familiares. El test farmacologico con epinefrina y flecainida ayudo a establecer el diagnostico en dos familias portadoras de mutacion con fenotipo negativo. Conclusiones Los criterios diagnosticos actuales para sindrome de QT largo y sindrome de Brugada tuvieron baja sensibilidad en nuestra muestra de portadores geneticos. El test genetico apoyado por tests farmacologicos puede incrementar la sensibilidad diagnostica, especialmente en familiares asintomaticos.

BACKGROUND Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction. OBJECTIVE The purpose of this study was to identify the clinical pattern of patients having a "pure PVC-induced" cardiomyopathy at presentation. METHODS This prospective multicenter study included 155 consecutive patients (age 55612 years, 96 men [62%], 23% +/- 12% mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation and followed up for at least 12 months. Patients with a previously diagnosed structural heart disease (50 [32%]) and those without complete PVC abolition during follow-up who did not normalize LV ejection fraction (LVEF) (24 [15%]) were excluded from the analysis. RESULTS Of the remaining 81 patients, 41 (51%) had a successful sustained ablation, did not have normalized LVEF, and were classified as having PVC-worsened nonischemic cardiomyopathy, and 40 (49%) who had normalized LVEF were considered as having pure PVC-induced cardiomyopathy. The latter group had higher baseline PVC burden (27% +/- 12% vs 12% +/- 8%; P < .001), smaller LV end-diastolic diameter (58 +/- 5 mmvs 60 +/- 6 mm; P=.05), and shorter Kintrinsic QRS (105 +/- 12 vs 129 +/- 24 ms; P130 ms, baseline PVC burden 63 mm. CONCLUSION Almost half of patients with frequent PVCs and low LVEF of unknown origin normalize LVEF after sustained PVC abolition, and these patients can be identified before ablation.

Background Calmodulin 1, 2 and 3 (CALM) mutations have been found to cause cardiac arrest in children at a very early age. The underlying aetiology described is long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT) and idiopathic ventricular fibrillation (IVF). Little phenotypical data about CALM2 mutations is available. Objectives The aim of this paper is to describe the clinical manifestations of the Asn98Ser mutation in CALM2 in two unrelated children in southern Spain with apparently unexplained cardiac arrest/death. Methods Two unrelated children aged 4 and 7, who were born to healthy parents, were studied. Both presented with sudden cardiac arrest. The first was resuscitated after a VF episode, and the second died suddenly. In both cases the baseline QTc interval was within normal limits. Peripheral blood DNA was available to perform targeted gene sequencing. Results The surviving 4-year-old girl had a positive epinephrine test for LQTS, and polymorphic ventricular ectopic beats were seen on a previous 24-hour Holter recording from the deceased 7-year-old boy, suggestive of a possible underlying CPVT phenotype. A p.Asn98Ser mutation in CALM2 was detected in both cases. This affected a highly conserved across species residue, and the location in the protein was adjacent to critical calcium binding loops in the calmodulin carboxyl-terminal domain, predicting a high pathogenic effect. Conclusions Human calmodulin 2 mutation p.Asn98Ser is associated with sudden cardiac death in childhood with a variable clinical penetrance. Our results provide new phenotypical information about clinical behaviour of this mutation.