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1. Differences in ventricular tachycardia inducibility in patients with Tetralogy of Fallot depending on the clinical indication for the electrophysiologic study

Author

B Miranda Barrios, A Santos Ortega, I Ferreira Gonzalez, V Gonzalez Fernandez, L Dos Subira, B Gordon Ramirez, P Jordan Marchite, A Pijuan Domenech, N Rivas Gandara, J Cantalapiedra Romero, J Francisco Pascual, B Carbonell Prat, L Herrador Galindo, B Benito, and J Perez Rodon

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Cardiology, Electrophysiologic study, Medicine, In patient, Cardiology and Cardiovascular Medicine, business, Ventricular tachycardia, medicine.disease, Tetralogy of Fallot
Abstract

Introduction The arrhythmic risk stratification of patients with repaired Tetralogy of Fallot (TOF) is still controversial. The performance of an electrophysiologic (EP) study before pulmonary valve replacement (PVR), regardless of patient's risk factors, is an extended practice in some centers that is not recommended in current guidelines. The aim of our study was to explore the differences in ventricular tachycardia (VT) inducibility in patients with TOF during programmed ventricular stimulation (PVS) depending on the clinical indication. Methods All patients with repaired TOF who underwent an EP study with PVS between January 2001 and October 2020 were included. EP studies performed in the context of ventricular or supraventricular tachycardia ablations that had been previously diagnosed were excluded. We defined two clinical scenarios for performing the EP study: pre-PVR (performed previous to pulmonary valve replacement) or diagnostic EP study (performed due to high risk symptoms which included palpitations, syncope or presyncope). Baseline clinical information, electrocardiogram, echocardiogram and cardiac MRI parameters were retrospective recorded. Results A total of 139 EP studies with PVS were included; 87 in the pre-PVR group and 52 in the diagnostic EP study group. There was a greater incidence of palpitations, syncope and presyncope in the “Diagnostic EP study” group. Moreover, there were statistical significant differences in right ventricle dimensions and function between groups. The repair surgical approach was similar in both groups. It was detected a statistical significant difference in VT induction between the pre-PVR group and the diagnostic indicated group (16,1% vs 34,6%, p=0,012). Conclusions Differences in VT induction are observed during PVS performing in TOF patients depending on the clinical indication. Symptomatology is an important parameter that must be taken into account in order to decide whether to perform an EP study in this population. Funding Acknowledgement Type of funding sources: None.

Published
2021
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2. Are there sex differences in patients with syncope and bundle branch block?

Author

Begoña Benito, J Perez Rodon, A Moya Mitjans, A Sambola Ayala, I Ferreira Gonzalez, A Santos Ortega, M Maymi Ballesteros, G Oristrell Santamaria, M Bach Oller, I Roca Luque, J Francisco Pascual, J Cantalapiedra Romero, N Rivas Gandara, C Badia Molins, and Julio Maldonado

Subjects
medicine.medical_specialty, Bundle branch block, biology, business.industry, Internal medicine, Cardiology, Syncope (genus), Medicine, In patient, Cardiology and Cardiovascular Medicine, business, medicine.disease, biology.organism_classification
Abstract

Background In the last years a substantial effort has been made to improve the understanding of the sex-differences in cardiovascular disease. However, no studies have examined differences in presentation and outcomes between men and women presenting with syncope and bundle branch block (BBB). Aim To determinate if there are sex-specific differences in the characteristics and outcomes of syncope in patients with BBB Methods Cohort study carried out in a tertiary hospital that is a reference center for syncope from January 2008 to February 2021. Patients (p.) with BBB and syncope of unknown origin after the initial evaluation without direct indication of an ICD were included. They were managed according to the current ESC guidelines. All patients underwent to an EPS and an ILR was implanted if it was not diagnostic. Results 374p. were included (75±1 y. o; 135 (36%) female). Mean follow up was 2.3±1.6 y.o. No differences in baseline characteristics where found comparing both groups, except that LBBB was more prevalent in female and RBBB in male (Figure 1A). EPS and ILR diagnostic yield was 44%/44% respectively in females and 50% /40% in males (p=ns). However, basal HV interval in EPS was significant shorter in females (Figure 2A). In the multivariate analyses female sex was associated with a significant lower risk of AV block (Figure 1B), and with a trend of less need of a pacemaker implantation (PM) (53% in females, 60% in males) (Log-rank 0.1) (Figure 2B). No significant differences in recurrences neither in mortality rate were found. Conclusions Female patients with syncope and BBB have lower risk of AV block compared to males, and only half of them required a pacemaker implantation. A strategy of direct PM implantation should be avoided, specially in woman. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Published
2021
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3. Evaluation of ventricular tachycardia inducibility after implementation of a standardized programmed ventricular stimulation protocol in patients with repaired Tetralogy of Fallot

Author

N Rivas Ganadara, B Miranda Barrio, J Francisco Pascual, J Maldonado, A Santos Ortega, V Gonzalez Fernandez, J Perez Rodon, L Herrador Galindo, B Benito, I Ferreira Gonzalez, A Pijuan Domenech, J Cantalapiedra Romero, L Dos Subira, B Gordon Ramirez, and M Bach Oller

Subjects
medicine.medical_specialty, business.industry, Internal medicine, cardiovascular system, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, Ventricular tachycardia, medicine.disease, business, Tetralogy of Fallot, Ventricular stimulation
Abstract

Introduction The electrophysiologic (EP) evaluation with programmed electrical stimulation (PVS) is generally recommended in patients with repaired Tetralogy of Fallot and additional risk factors for sudden cardiac death. Nevertheless, different PVS protocols have been described. The aim of our study was to evaluate the differences in ventricular tachycardia (VT) inducibility of patients with TOF after the implementation of a standard PVS protocol in the EP laboratory of a Congenital Heart Disease reference center. Methods All patients with repaired TOF who underwent an EP study with PVS between January 2001 and October 2020 were included. The new standardized PVS protocol was performed in 2 ventricular sites (apex and outflow tract) with 3 drive trains (cycle lengths 400, 500 and 600ms) and up to 3 extrastimuli. In absence of VT induction, the protocol was repeated under isoprenaline infusion. This new protocol was implemented since January 2012. Non protocolized PVS studies before 2012 were defined as “Non-standardized”. Baseline clinical information about symptoms and previous arrhythmias was recorded as well as electrocardiogram, echocardiogram and cardiac MRI parameters. Finally, the follow-up events (ICD implantation, sudden cardiac death, global mortality, arrythmias and ICD therapies) were also retrospective recorded. Results A total of 154 EP studies with PVS were performed in 128 patients with repaired TOF. 31 of them were performed before the 1st January 2012 (non-standardized PVS) and 112 were performed with the new standardized protocol. The median follow-up was 6,5 years. Both groups had similar baseline characteristics except LVEF and RVEF, that were lower in the “Non-standardized PVS” group. There were no differences between the ventricular tachycardia inducibility of both protocols (22,3% vs 33,3%; p=0,162). The risk factors for VT inducibility were the QRS length (184,46ms vs 169,34 ms; p=0,038), the RVEF (36,25% vs 43,79; p=0,0007), the presence of ventricular ectopia (VE) (38,5% vs 20,0%; p=0,024) and previous VT (35,9% vs 13,9%; p=0,003). VT induction during EP study was related with ICD implantation (71,8% vs 21,7%, p≤0,001), VT (30,8% vs 20%, p Conclusions The implementation of a standardized and more complete PVS protocol in patients with repaired TOF has not shown differences in the experience of our center. The risk factors for VT inducibility were the QRS length, the RVEF, the presence of ventricular ectopia and previous VT, which have also been reported as risk factors for sudden cardiac death in previous studies. The presence of VT induction entailed more ICD implantation and more arrythmias at follow-up. Funding Acknowledgement Type of funding sources: None.

Published
2021
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4. First Vs Recurrent Syncope In Patients With Structural Heart Disease Or Bundle Branch Block

Author

I Ferreira Gonzalez, J Francisco Pascual, J Cantalapiedra Romero, J Maldonado, A Santos Ortega, Ignasi Roca, Begoña Benito, J Perez Rodon, P Jordan Marchite, L Herrador Galindo, and N Rivas Gandara

Subjects
Bradycardia, medicine.medical_specialty, Univariate analysis, Bundle branch block, Heart disease, biology, business.industry, Syncope (genus), medicine.disease, biology.organism_classification, Physiology (medical), Internal medicine, medicine, Cardiology, In patient, Patient evaluation, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrioventricular block
Abstract

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Vall d"Hebron - Vall d"Hebron Institut de Recerca. CIBERCV BACKGROUND Patients with structural heart disease (SHD) or bundle branch block (BBB) are at high risk of having an arrhythmic syncope (AS). In patients with recurrent syncope episodes (RSE) complete work-up including electrophysiological study (EPS) and/or implantation of a loop recorder (ILR) is recommended, however patients with their first episode may also be at risk of an AS. AIM To determinate if the patients with SHD or BBB with a single syncope episode (SSE) are at high risk of having an AS and compare it with patients with recurrent episodes (RSE). METHODS Cohort study carried out in a tertiary hospital that is a reference centre for syncope. From January 2008 to August 2020 patients with SHD or BBB with syncope of unknown origin after the initial evaluation and without direct indication of an ICD were included. They were managed according the current ESC guidelines. RESULTS 417patients were included (74 ±11 y. o; 39% female). Mean follow up was 2.5 ±1 y. 223 patients were diagnosed from an AS [113 (53%) in SSE group and 110 (54%) in RSE group, p = 0.9], 210 were due to bradyarrhythmia (AV block or sinus arrest). No differences in baseline characteristics where found comparing both groups, except that BBB was slightly more prevalent in patients with RSE (81% vs 90%, p = 0.01) (FIGURE- PANEL A). Risk of AS was 53% in patients with SE and 54% (p = 0.9). RSE were not associated with an increased risk of AS in univariate analyses (OR 1.01 IC95% 0.7-1.5) neither in the multivariate (FIGURE- PANEL B). EPS and ILR diagnostic yield was 45% / 32% respectively in SSE group and 44% / 33% in RSE group (p = 0.8) (FIGURE - PANEL C). After appropriate treatment, recurrence syncope rate was 10% in SSE group and 9% in RSE group (p = 0.8). No significant differences in mortality rate were found. CONCLUSIONS Patients with SHD or BBB and single syncope episode are at a high risk of having AS, and similar to those with RSE. EPS and ILR offer a similar diagnostic yield in both groups. Complete syncope work-up must be recommended in these patients despite having had only a single episode. Abstract Figure

Published
2021
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5. Mechanical-electrical interaction of the right ventricle in patients with repaired tetralogy of fallot: the next step towards resynchronization in congenital heart disease

Author

B Gordon Ramirez, A Santos Ortega, B Miranda Barrio, J Francisco Pascual, J Perez Rodon, J Rodriguez Garcia, I Ferreira Gonzalez, B Benito Villabriga, L Dos Subira, A Pijuan Domenech, M Subirana Domenech, and N Rivas Gandara

Subjects
medicine.medical_specialty, Heart disease, business.industry, medicine.disease, medicine.anatomical_structure, Ventricle, Internal medicine, Electrical interaction, medicine, Cardiology, In patient, Cardiology and Cardiovascular Medicine, business, Tetralogy of Fallot
Abstract

Introduction Patients with repaired tetralogy of Fallot (rTF) and severe pulmonary regurgitation frequently progress to dilation and dysfunction of the right ventricle (RV). It has been documented in the literature that there is a correlation between the duration of the QRS in the surface electrocardiogram and the hemodynamic parameters of the RV of these patients, suggesting the presence of a mechanical-electrical interaction. Purpose To determine if there is an association between the contraction delay in certain areas of the RV measured in M-mode echocardiography and the delay in electrical activation measured in the electroanatomic map (EAM) of RV in patients with rTF. Methods Unicentric and observational study of all patients with rTF undergoing EAM, echocardiography with study of RV asynchrony and cardiac magnetic resonance imaging (MRI). Activation delay in the antero-basal area and in the RV outflow tract (RVOT) in the EAM were both analysed (Figure 1A). The shortening delay in the same areas in M-mode echocardiography was also evaluated (Figure 1B, C). MRI data regarding volume and ejection fraction was also collected. Results 64 patients were included (36.7±10.6 years, 65% men). The mean total activation time of the RV (RV-TAT) was 127.3±42.4 ms. Activation mapping showed a recurrent pattern with beginning in the interventricular septum and ending in RV antero-basal region and/or RVOT. A linear positive correlation was observed between RV-TAT and the activation delay in both regions analysed (ρ=0.60 and ρ=0.52, respectively; p Conclusions There is a mechanical-electrical interaction in the RV of patients with rTF, with a negative correlation between the activation delay and RVEF and between mechanical and electrical activation delay in specific anatomical regions (regional mechanical-electrical interaction). These results may guide future studies on resynchronization in this heart disease. Figure 1. EAM and echocardiographic measures Funding Acknowledgement Type of funding source: None

Published
2020
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6. Late gadolinium-enhanced cardiac magnetic resonance in repaired tetralogy of Fallot: characterization of the right ventricular arrhythmogenic substrate

Author

M Subirana Domenech, I Ferreira Gonzalez, A Santos Ortega, H Cuellar Calabria, B Benito Villabriga, N Rivas Gandara, B Gordon Ramirez, J Francisco Pascual, J Rodriguez Garcia, G Pascual Gonzalez, L Dos Subira, J Perez Rodon, A Pijuan Domenech, F Valente, and B Miranda Barrio

Subjects
medicine.medical_specialty, business.industry, Gadolinium, chemistry.chemical_element, medicine.disease, Arrhythmogenic substrate, chemistry, Internal medicine, Cardiology, Medicine, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Cardiac magnetic resonance, Tetralogy of Fallot
Abstract

Introduction Ventricular arrhythmias are one of the main causes of morbidity and mortality in patients with repaired tetralogy of fallot (rTF). These life-threatening arrhythmias are related to specific isthmuses of viable tissue between areas of scar and/or valve rings of the right ventricle (RV) that have been already described in the literature. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) has proven useful in characterizing the arrhythmogenic substrate in several heart diseases. Nevertheless, LGE-CMR evidence in patients with rTF is scarce. Purpose To compare the characterization of the ventricular arrhythmogenic substrate by means of LGE-CMR and electroanatomic mapping (EAM) of the right ventricle (RV) in patients with rTF. Methods Unicentric and observational study of consecutive patients with rTF who underwent LGE-CMR performed with 1.5T equipment and RV high-density voltage map, performed with multipolar catheter and completed with contact force-sensing catheter. The LGE-CMR segmentation was performed with dedicated software. The extent (area and percentage) and location of the dense scar (defined as Results Eight patients were included (45.7±10.4 years; 50% male). The extent of the scar was 20.7±13.6 cm2 (15.1±9.3%) by EAM and 21.7±8.8 cm2 (11.8±7.6%) by LGE-CMR. There was an absolute correlation regarding the location of the dense scar and the distribution of the isthmuses of viable tissue. The quantification of the dense scar evidenced a positive linear correlation between both techniques (area correlation: ρ = 0.71, p=0.047; percentage correlation: ρ = 0.88; p=0.004). The average time spent for the segmentation of the LGE-CMR with the dedicated software was 19.9±3.0 minutes. Conclusions Characterization of the RV arrhythmogenic substrate in patients with rTF with LGE-CMR is feasible. An absolute association regarding the location of the dense scar and the distribution of the isthmuses of viable tissue was observed when compared to the RV high-density EAM. In the same way, a statistically significant linear correlation in the quantification of the dense scar between both techniques was documented. LGE-CMR and EAM of two patients with rTF Funding Acknowledgement Type of funding source: None

Published
2020
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7. P921Feasibility of multipoint, high-definition mapping with grid cathether of SVTs in patients with D-Transposition of the great arteries treated with atrial switch surgery

Author

L Dos Subira, M T Subirana, J Rodriguez Garcia, A Pijuan, N Rivas Gandara, R Escalona Silva, Víctor M. González, S I Llerena Butron, I Ferreira Gonzalez, Begoña Benito, J Perez Rodon, B. Miranda, A Santos Ortega, and J Francisco Pascual

Subjects
medicine.medical_specialty, Great arteries, business.industry, Physiology (medical), medicine, Transposition (telecommunications), High definition, In patient, Cardiology and Cardiovascular Medicine, business, Surgery, Atrial switch
Abstract

Introduction Patients with D-transposition of the great arteries (TGA) treated with Senning or Mustard surgery develop supraventricular tachycardias (SVTs) that require treatment with ablation. The use of multipoint, high-density, wavefront-activation-orientation independent mapping catheters hasn’t been reported in literature. Purpose To describe the feasibility of using a specific mapping catheter in SVTs in this set of patients. Methods Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent EP study and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint (16 equidistant electrodes along 4 splines), with magnetic sensor, wavefront-activation-orientation independent catheter, in a third level hospital since April 2018 until May 2019, with medium-term follow-up. Results A total of 8 EPS (electrophysiologic studies) were performed in 7 patients (clinical data in Table 1). One patient had a tachycardia recurrence, accounting for a second EPS. The pulmonary venous atrium (PVA) was mapped in all procedures, whereas the systemic venous atrium (SVA) was mapped only in 75% of them, A total of 15 EA maps were obtained, with a ratio of 1.9 maps/patient, and an average of 20 375 ± 13 045 total points per patient. In all cases, PVA mapping was performed via retrograde transaortic approach, without transbaffle puncture. Tachycardia was induced in 5 out of 8 procedures, obtaining 6 different tachycardias (4 CTI dependent macro-reentry: 3 w/anticlockwise activation; 1 localized re-entry in SVA; 1 focal AT in SVA). No arrhythmia was induced in the other 3 procedures, however, in a patient with a previous CTI ablation, evidence of a gap in the ablation line on the voltage map was found. Ablation was performed with an irrigated, contact force, 3.5 mm catheter in 6 of the 8 procedures (75%). A retrograde transaortic approach was used in 3 of CTI dependent macro-reentries (75%). In one patient (who underwent two procedures) ablation was performed through a baffle leak. We report an acute success rate of ablation of 100%, and a recurrence rate of 20% on medium-term follow up. There were no major complications; nonetheless, one patient with history of morbid obesity had a minor vascular complication on the femoral puncture site treated medically. Conclusions it’s feasible and safe to use this new mapping catheter in patients with history of atrial switch surgery, both via retrograde and anterograde approach on the PVA and SVA respectively. The most frequent tachycardia observed in this study was anticlockwise CTI-dependent atrial flutter. Abstract Figure. Patient characteristics

Published
2020
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8. 1326Identification of arrhythmic isthmus in patients with transposition of the great arteries treated with atrial switch surgery using a new high-definition wavefront-activation-orientation grid catheter

Author

L Dos Subira, B Miranda Barrio, I Ferreira Gonzalez, V Gonzalez Fernandez, F Roses Noguer, S I Llerena Butron, M T Subirana, A Pijuan Domenech, J Rodriguez Garcia, J Francisco Pascual, Begoña Benito, J Perez Rodon, N Rivas Gandara, and A Santos Ortega

Subjects
Wavefront, medicine.medical_specialty, business.industry, Transposition (telecommunications), Atrial switch, Surgery, Catheter, Orientation (mental), Great arteries, Physiology (medical), medicine, High definition, In patient, Cardiology and Cardiovascular Medicine, business
Abstract

INTRODUCTION Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have several atrial scars that predispose them to develop atrial tachycardias (AT). Identification of scar zones and possible arrhythmic isthmus in voltage mapping will help to guide the ablation. AIM To describe the feasibility of using a specific mapping catheter to identify possible arrhythmic isthmus in this set of patients. METHODS Prospective observational study in patients with history of SVT and atrial switch surgery, that underwent electrophysiologic study (EP) and electroanatomic (EA) mapping with a new 8Fr deflectable, multipoint wavefront-activation-orientation independent Grid catheter, in a third level hospital since April 2018 until May 2019, with medium-term follow-up. RESULTS A total of 8 EPs were performed in 7 patients (3 (57%) Female, median age 35 ± 6,3 y.o.). Figure 1A shows the localization and percentage of scar identified in both atria. A total of 6 AT were induced. In this, an arrhythmogenic isthmus was identified and, in all patients, at least one non-arrhytmogenic isthmus was documented. Figure 1B shows anatomical and electrophysiological characteristics of the isthmus. Arrhythmogenic isthmus had slower conduction velocity than non-arrhytmogenic ( mean 0,44m/s (IQI 0,17-0,62) vs 1,05 m/s (IQI 0,86-1,39) p = 0.008) and fractionated potentials were detected more frequently (100% vs 50% p = 0.089) CONCLUSION EA mapping with a new a multipoint, high-definition, Grid Cather is feasible and allows the identification and electrophysiological characterization of arrhythmogenic and non-arrhytmogenic isthmus in patients with TGA treated with atrial switch surgery. Abstract Figure 1

Published
2020
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9. P6569Additive value of evaluating patients with syncope by an implantable loop recorder: diagnosis of subclinical atrial fibrillation

Author

B Benito Villabriga, A Olivella San Emeterio, N Rivas Gandara, S I Llerena Butron, I Ferreira Gonzalez, J Perez Rodon, J Rodriguez Garcia, A Santos Ortega, David Garcia-Dorado, and J Francisco Pascual

Subjects
medicine.medical_specialty, biology, business.industry, Syncope (genus), Atrial fibrillation, biology.organism_classification, medicine.disease, Internal medicine, Ischemic stroke, Implantable loop recorder, Cardiology, medicine, Cardiology and Cardiovascular Medicine, business, Value (mathematics), Ambulatory electrocardiography, Subclinical infection
Abstract

Background Few information exists about the additive value of implantable loop recorders (ILR) for the diagnosis of subclinical atrial fibrillation or flutter (AF) in patients (p) studied for syncope and its therapeutic and prognostic implications. Purpose To evaluate the burden of new onset AF diagnosed by ILR in patients studied for syncope and its therapeutic and prognostic implications. Methods We conducted an observational cohort study in a tertiary center. From April 2014 to January 2019, 355 ILR were implanted in patients with syncope according the ESC syncope guidelines. We excluded the ones with previous known AF and younger than 18 years old (yo), with a final cohort of 197 patients. All of them were therefore followed in outpatient clinic and treated according to current clinical guidelines. New AF diagnosis and consequent therapeutic changes and related clinical events were recorded. Results Of 197p, 38 had a first episode of AF (19.29%), with a mean AF burden of 4.19%, and a median of 0.15%. The incidence rate of AF detection was 10.67patients/year (p-y), with higher incidence among patients older than 65 yo (14.17p-y vs 5.27p-y, p Kaplan Meier survival from AF Conclusions New onset AF is frequent in patients with ILR implanted for syncope, especially among those older of 65 yo, with the vast majority consisting in short paroxysms. Following AF detection, generally OAC are initiated.

Published
2019
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10. P6635Clinical and electrocardiographic predictors of arrhythmic syncope in patients with severe aortic stenosis

Author

Y Belahnech Pujol, G Oristrell Santamaria, David Garcia-Dorado, S Llerena, A Moya Mitjans, A Santos Ortega, V. Serra Garcia, J Perez Rodon, Y Cossio Gil, J Francisco Pascual, N Rivas Gandara, I. Roca Luque, and E Rodenas Alesina

Subjects
medicine.medical_specialty, Stenosis, biology, business.industry, Internal medicine, medicine, Cardiology, Syncope (genus), In patient, Cardiology and Cardiovascular Medicine, medicine.disease, business, biology.organism_classification
Published
2018
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11. P435Axillary access for ICD-CRT implantation: a new era of no acute complications? Observational study of 483 leads

Author

J Francisco Pascual, H Tornos Millet, J Rodriguez Garcia, G Pascual Gonzalez, A Aguilar Palacios, I Roca Luque, J Perez Rodon, M Riera Musach, N Rivas Gandara, T Soriano Colome, A Santos Ortega, A. Moya Mitjans, S I Llerena Butron, D. Garcia Dorado, and B Gordon Ramirez

Subjects
medicine.medical_specialty, business.industry, Physiology (medical), medicine, Observational study, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2018
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12. Rapid Fire Abstract session: usefulness of CT and radionuclide imaging in different clinical scenarios378Improving the cost-effectiveness of chest pain investigations using single photon emission computed tomography379Is autonomic nervous dysfunction severity associated to less benefit from cardiac resynchronization therapy?380Validation of stress Thallium-201/Rest Technetium-99m sequential dual isotope high-speed myocardial perfusion imaging against fractional flow reserve for the detection of the extent of ischemia.381Nuclear imaging to predict adverse events in heart failure patients382Autonomic nervous system modulation in patients with heart failure and resynchronization after high intensity interval training383Long-term prediction of cardiac events using low-dose coronary ct angiography with prospective triggering384Left atrial appendage sizing for percutaneous occlusion with Amplatzer cardiac plug: a multimodality imaging approach385Evaluation of PAPVR using cardiac CT or MR imaging in patients with Turner syndrome

Author

AT Van Den Hoven, X Iriart, O F Clerc, A Abreu, J Limeres Freire, G Barone-Rochette, P Rio, J Lagan, M Meah, J Hasleton, J Mcshane, R Trent, V Santos, H Santa-Clara, L Oliveira, M Martins Oliveira, P Silva Cunha, L Moura Branco, M Mota Carmo, R Cruz Ferreira, FZ Zoreka, A Calizzano, E Vautrin, JL Quesada, A Broisat, L Riou, JP Baguet, D Fagret, C Ghezzi, J Rodriguez, G Oristrell, X Quiroga, N Pizzi, J Perez-Rodon, E Galve, S Aguade, H Santa Clara, M Oliveira, P Cunha, G Portugal, R Ferreira, B P Kaufmann, M Possner, R Liga, J Vontobel, F Mikulicic, C Graeni, D C Benz, P A Kaufmann, R R Buechel, W Selmi, Z Jalal, JB Thambo, RG Saru-Chelu, AL Duijnhouwer, IM Van Hagen, and JW Roos-Hesselink

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine
Published
2015
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13. P1015Systematic use of an external loop recorder to evaluate patients with palpitations: a cost-benefit study

Author

N Rivas Gandara, J Francisco Pascual, J Perez Rodon, A Santos Ortega, L. Mila Pascual, G. Martin, A Moya Mitjans, I. Roca Luque, and D. Garcia-Dorado

Subjects
business.industry, Physiology (medical), Palpitations, Medicine, Cost benefit, Medical emergency, medicine.symptom, Cardiology and Cardiovascular Medicine, business, medicine.disease, Loop recorder
Published
2017
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15. Recurrences at long-term follow-up after flutter ablation in patients with congenital heart disease: types and predictors

Author

J. Casaldaliga, M T Subirana, I Roca Luque, N Rivas Gandara, J. Francisco, D. Garcia Dorado, L. Dos, A Pijuan Domenech, J Perez Rodon, and A. Moya Mitjans

Subjects
Tachycardia, medicine.medical_specialty, Heart disease, business.industry, medicine.medical_treatment, Cardiac arrhythmia, Atrial fibrillation, medicine.disease, Ablation, Surgery, Great arteries, Internal medicine, cardiovascular system, Cardiology, Medicine, Sinus rhythm, cardiovascular diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Tetralogy of Fallot
Abstract

Ablation of intra-atrial reentrant tachycardia (IART), either isthmus-dependent (CTI-F) or scar-related flutter (SC-F) can be a challenging procedure in patients with congenital heart disease (CHD). Few data is published about long-term follow-up (FU) and predictors of recurrence. We describe ablation success, type and predictors of recurrences in a tertiary care hospital. Methods: Between 1999 an 2012 we performed 81 flutter ablation procedures (RF) in 58 patients (age 34,1±15,5 years, mean 1,39 procedures per patient, flutter type: 50% CTI-F, 20.7% SC-F and 29,3% CTI-F and SC-F) with surgically repaired CHD. The most frequent CHD was transposition of great arteries (TGA, 17p, 29%) with atrial switch procedure, repaired atrial septal defect (11pt.,19%) and Tetralogy of Fallot (11pt., 19%). Cardiac history (specially arrhythmia burden), imaging and RF procedure details were analysed. Results: After a FU of more than 3 years (38.09±34,4 months), 76.4% of the patients were in sinus rhythm (23 pts. with more than one procedure). The most frequent arrhythmia in the recurrences was a flutter different than the one that was ablated (44%), followed by the same kind of flutter (40%) and atrial fibrillation (AFib, 16%). Predictors of any kind of arrhythmia recurrence at the end of FU were: acute RF failure (45.5% vs. 15%, p=0.08), QRS width >120 ms (21.2 vs. 0%, p=0.05), number of arrhythmia episodes before RF (1.7±1.38 vs. 0.82±1.05 months, p=0.019) and time between the first arrhythmia and RF procedure (RF Delay) (80.41±106 vs. 25.69±42 months, p=0.009). Previous Afib (80 vs. 42.2%, p=0.04) and SC-F (76.5 vs. 36.8%, p=0.009) were specific predictors of recurrence after a single procedure but were not related with overall recurrence at the end of FU. Predictors of recurrence of the same arrhythmia after a single procedure were: previous Afib (40 vs. 15.5%, p=0.09), acute RF failure (50 vs. 13.5%, p=0.021) and RF delay (97.8±115.7 months vs. 22.5±31.6 months, p=0.005). None of the parameters related with echocardiogram neither with the RF procedure were predictors of recurrence. Conclusions: Despite the complexity and cardiac disease progression, after a flutter ablation procedure a high proportion of CHD patients maintain sinus rhythm after long-term FU. Parameters related not only with acute success but also with arrhythmia burden and with not aggressive treatment at the beginning of arrhythmia appearance were predictors of recurrence during FU. Our data suggests that an early invasive arrhythmia treatment in these patients could decrease the recurrences, but more studies are needed in this field.

Published
2013
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16. Poster Session 2

Author

T. Andersson, A. Magnusson, I.- L. Bryngelsson, O. Frobert, K. M. Henriksson, N. Edvardsson, D. Poci, M. Polovina, T. Potpara, M. Licina, N. Mujovic, A. Kocijancic, D. Simic, M. C. Ostojic, R. A. Providencia, A. Botelho, J. Trigo, J. Nascimento, N. Quintal, P. Mota, A. M. Leitao-Marques, R. F. Bosch, W. Kirch, L. Rosin, S. N. Willich, D. Pittrow, H. Bonnemeier, M. C. Valenza, L. Martin, T. Munoz Casaubon, G. Valenza, M. Botella, M. Serrano, B. Valenza, I. Cabrera, K. Anderson, B. S. Benzaquen, N. Koziolova, J. Nikonova, Y. Shilova, D. Scherr, S. Narayan, M. Wright, D. Krummen, A. Jadidi, P. Jais, M. Haissaguerre, M. Hocini, R. Hunter, Y. Liu, Y. Lu, W. Wang, R. J. Schilling, S. Bernstein, B. Wong, R. Rooke, C. Vasquez, R. Shah, S. Rosenberg, L. Chinitz, G. Morley, M. Bashir Choudhary, F. Holmqvist, J. Carlson, H.- J. Nilsson, P. G. Platonov, A. S. Jadidi, H. Cochet, S. Miyazaki, A. J. Shah, N. Marrouche, N. Calvo, M. Nadal, D. Andreu, D. Tamborero, F. E. Diaz, A. Berruezo, J. Brugada, L. Mont, S. Fichtner, G. Hessling, H. L. Estner, C. Jilek, T. Reents, S. Ammar, J. Wu, I. Deisenhofer, H. Nakanishi, K. Kashiwase, A. Hirata, M. Wada, Y. Ueda, J. Skoda, P. Neuzil, J. Popelova, J. Petru, L. Sediva, V. Y. Reddy, L. Uldry, A. Forclaz, N. Virag, J.- M. Vesin, L. Kappenberger, R. Sehra, C. Briggs, W.- J. Rappel, M. Janotka, M. Chovanec, K. Yamashiro, K. Takami, Y. Sakamoto, K. Satoh, T. Suzuki, H. Nakagawa, A. Romanov, E. Pokushalov, S. Artemenko, V. Shabanov, I. Stenin, D. Elesin, A. Turov, A. Yakubov, M. Hioki, S. Matsuo, K. Ito, R. Narui, S. Yamashita, K. Sugimoto, M. Yoshimura, T. Yamane, L. Di Biase, J. D. Gallinghouse, K. Rajappan, J. Kautzner, A. Dello Russo, C. Tondo, F. Lorgat, A. Natale, O. Balta, K. Buenz, M. Paessler, H. Anders, M. Horlitz, T. Deneke, L. Lickfett, I. Liberman, M. Linhart, R. Andrie, E. Mittmann-Braun, F. Stockigt, G. Nickenig, J. Schrickel, R. Tilz, A. Rillig, B. Feige, A. Metzner, A. Fuernkranz, A. Burchard, E. Wissner, F. Ouyang, T. R. Betts, M. A. Jones, K. C. K. Wong, N. Qureshi, Y. Bashir, G. Corbucci, D. Losik, V. Selina, M. A. Crandall, C. Daniels, E. Daoud, S. Kalbfleisch, H. Yamaji, T. Murakami, H. Kawamura, M. Murakami, K. Hina, S. Kusachi, G. Dakos, V. Vassilikos, S. Paraskevaidis, A. Mantziari, S. Theophylogiannakos, I. Chouvarda, I. Chatzizisis, I. Styliadis, T. Kimura, K. Fukumoto, N. Nishiyama, Y. Aizawa, Y. Fukuda, T. Sato, S. Miyoshi, S. Takatsuki, A. J. Navarrete Casas, I. Ali, F. C. Conte, M. Moran, B. G. Graham, O. Kalejs, R. Lacis, P. Stradins, A. Koris, I. Putnins, M. Vikmane, A. Lejnieks, A. Erglis, A. Estrada, A. Perez Silva, S. Castrejon, D. Doiny, J. L. Merino, A. Baranchuk, I. Greiss, C. S. Simpson, H. Abdollah, D. P. Redfearn, M. Buys-Topart, R. Nitzsche, B. Thibault, S. Kathan, C. Kolb, S. Reif, S. Schade, J. Taggeselle, A. Frey, A. Birkenhagen, S. Kohler, M. Schmidt, O. Cano Perez, F. Buendia, B. Igual, J. M. Osca, J. M. Sanchez, M. J. Sancho-Tello, J. M. Olague, A. Salvador, J. M. Tolosana, J. Fernandez-Armenta, M. Matas, M. C. Barbarin, M. Habibovic, K. C. Van Den Broek, D. A. M. J. Theuns, L. Jordaens, M. Alings, P. H. Van Der Voort, S. S. Pedersen, G. Pupita, S. Molini, M. Brambatti, A. Capucci, S. Molodykh, E. M. Idov, O. V. Belyaev, L. Segreti, E. Soldati, G. Zucchelli, A. Di Cori, S. Viani, L. Paperini, R. De Lucia, M. G. Bongiorni, L. Binner, M. Taborsky, D. Bello, H. Heuer, B. Ramza, I. Jenniskens, W. B. Johnson, M. S. Silvetti, L. Rava', M. S. Russo, C. Di Mambro, A. Ammirati, G. Gimigliano, M. Prosperi, F. Drago, A. R. Santos, B. Picarra, P. Semedo, P. Dionisio, R. Matos, M. Leitao, A. Jacinto, M. Trinca, P. Mazzone, G. Ciconte, A. Marzi, G. Paglino, P. Vergara, N. Sora, S. Gulletta, P. Della Bella, P. Koppitz, A. Fach, S. Hobbiesiefken, E. Fiehn, R. Hambrecht, J. Sperzel, M. Jung, J. Schmitt, D. Pajitnev, H. Burger, G. Goebel, W. Ehrlich, T. Walther, T. Ziegelhoeffer, V. Vancura, D. Wichterle, V. Melenovsky, M. Glikson, G. Goldenberg, A. Segev, D. Dvir, J. Kuzniec, A. Finkelstein, I. Hay, V. Guetta, W. K. Choo, S. Gupta, R. Kirkfeldt, J. Johansen, E. Nohr, M. Moller, P. Arnsbo, J. Nielsen, M. Banha, P. Stojanov, S. Raspopovic, D. Vasic, D. Savic, G. Nikcevic, V. Jovanovic, P. Defaye, B. Mondesert, A. Mbaye, R. Cassagneau, V. Gagniere, J. Jacon, V. Sanfins, H. R. Reis, J. N. Nobre, V. M. Martins, L. D. Duarte, C. M. Morais, J. C. Conceicao, M. Hero, J. L. Rey, A. Ducharme, C. Simpson, C. Stuglin, L. Blier, M. Senaratne, Y. Khaykin, A. Pinter, A. Mlynarska, R. Mlynarski, M. Sosnowski, J. Wilczek, C. Iorgulescu, S. Bogdan, D. Constantinescu, C. Caldararu, M. Dorobantu, A. Radu, R.- G. Vatasescu, S. Yusu, T. Ikeda, H. Mera, Y. Miwa, A. Abe, M. Miyakoshi, T. Tsukada, H. Yoshino, V. Nayar, P. Cantelon, A. Rawling, M. R. D. Belham, P. J. Pugh, J. Osca Asensi, O. Cano, D. Tejada, B. Munoz, M. Rodriguez, J. Olague, L. Wecke, A. Van Hunnik, T. Thompson, L. Di Carlo, M. Zdeblick, A. Auricchio, F. Prinzen, A. Doltra Magarolas, B. Bijnens, E. Silva, D. Penela, M. Sitges, P. Ofman, L. Navaravong, J. Leng, A. Peralta, P. Hoffmeister, R. Levine, J. Cook, M. Stoenescu, M. E. Tettamanti, A. Revilla Orodea, J. Lopez Diaz, L. De La Fuente Galan, R. Arnold, E. Garcia Moran, J. A. San Roman Calvar, I. Gomez Salvador, K. Nakamura, M. Takami, T. Keida, A. Mesato, S. Higa, M. Shimabukuro, H. Masuzaki, R. Proietti, A. Sagone, G. Domenichini, H. Burri, C. Valzania, M. Biffi, H. Sunthorn, G. Gavaruzzi, H. Foulkes, G. Boriani, S. Koh, W. Hou, J. Snell, J. Poore, N. Dalal, G. Bornzin, A. Kloppe, D. Mijic, H. Bogossian, I. Ninios, M. Zarse, B. Lemke, L. Guedon-Moreau, C. Kouakam, D. Klug, C. Marquie, F. Ziglio, S. Kacet, H. Mohamed Fereig Hamed, A. M. A. L. Hamdy, A. H. M. E. D. Abd El Aziz, M. R. V. A. T. Nabih, R. E. H. A. B. Hamdy, A. Yaminisaharif, G. H. Davoudi, A. Kasemisaeid, S. Sadeghian, A. Vasheghani Farahani, P. Yazdanifard, A. Shafiee, C. Alonso, C. Grimard, G. Jauvert, A. Lazarus, L. L. Mont, J. Ortiz-Perez, T. Caralt, J. Escudero, F. Perez, K. M. Griffith, R. Ferreyra, P. Urena, M. Demas, C. Muratore, H. Mazzetti, J. Guardado, M. Fernandes, V. H. Pereira, F. Canario-Almeida, F. Ferreira, B. Rodrigues, J. Almeida, A. Sokal, E. Jedrzejczyk, R. Lenarczyk, S. Pluta, O. Kowalski, P. Pruszkowska, A. Swiatkowski, Z. Kalarus, M. Heinke, B. Ismer, H. Kuehnert, T. Heinke, R. Surber, N. Osypka, D. Prochnau, H. R. Figulla, S. Iacopino, M. Landolina, A. Proclemer, L. Padeletti, V. Calvi, A. Pierantozzi, P. Di Stefano, A. Bauer, F. Bode, F. Le Gal, J. C. Deharo, M. Delay, J. Clementy, M. Kawamura, Y. Munetsugu, K. Tanno, Y. Kobayashi, D. Cannom, J. Hosoda, T. Ishikawa, K. Andoh, M. Nobuyoshi, S. Fujii, S. Shizuta, T. Isshiki, M. A. Castel, F. Perez-Villa, B. Vidal, P. Pruszkowska-Skrzep, M. Szulik, T. Kukulski, L. Gianfranchi, K. Bettiol, F. Pacchioni, P. Alboni, R. Abu Sham'a, J. Buber, E. Nof, R. Kuperstein, M. Feinberg, D. Luria, M. Eldar, K. Parks, J. R. Stone, J. P. Singh, E. Hatzinikolaou-Kotsakou, M. Kotsakou, T. H. Beleveslis, G. Moschos, E. Reppas, P. Latsios, K. Tsakiridis, A. Kazemisaeid, G. Davoodi, A. Yamini Sharif, M. Sheikhvatan, M. Toniolo, G. Zanotto, A. Rossi, L. Tomasi, C. Vassanelli, H. Versteeg, P. M. C. Mommersteeg, G. Vergara, J. Blauer, R. Ranjan, S. Vijayakumar, E. Kholmovski, N. Volland, R. Macleod, L. E. Aguinaga Arrascue, A. Bravo, P. Garcia Freire, P. Gallardo, E. Hasbani, J. Dantur, R. Quintana, P. P. Adragao, D. Cavaco, L. Parreira, K. Reis Santos, P. Carmo, R. Miranda, S. Marcelino, D. Cabrita, P. Sommer, T. Gaspar, S. Rolf, A. Arya, C. Piorkowski, G. Hindricks, E. Valles Gras, V. Bazan, L. Portillo, F. Suarez, J. Bruguera, J. Marti, Y. Huo, S. Richter, R. Schoenbauer, N. Rivas, J. Casaldaliga, I. Roca, L. Dos, J. Perez-Rodon, A. Pijuan, D. Garcia-Dorado, A. Moya, H. B. Carter, A. Garg, J. Hegrenes, H. J. Sih, L. R. Teplitsky, K. Kuroki, H. Tada, Y. Seo, T. Ishizu, M. Igawa, Y. Sekiguchi, K. Kuga, K. Aonuma, C. Rodriguez A, J. Mejias, P. Hidalgo, J. A. Hidalgo L, M. Orczykowski, P. Derejko, F. Walczak, E. Szufladowicz, P. Urbanek, R. Bodalski, K. Bieganowska, L. Szumowski, P. Peichl, R. Cihak, I. Skalsky, P. Kubus, P. Vit, L. Zaoral, R. A. Gebauer, M. Fiala, J. Janousek, K. Hiroshima, M. Goya, M. Ohe, K. Hayashi, Y. Makihara, M. Nagashima, Y. An, M. Schloesser, T. Lawrenz, D. Meyer Zu Vilsendorf, C. Strunk-Mueller, C. Stellbrink, J. Papagiannis, D. Avramidis, C. Kokkinakis, G. Kirvassilis, G. Eidelman, A. Arenal, T. Datino, F. Atienza, E. Gonzalez Torrecilla, A. Miracle, J. Hernandez, F. Fernandez Aviles, E. Ene, P. Insulander, H. Bastani, F. Braunschweig, N. Drca, G. Kenneback, J. Schwieler, J. Tapanainen, M. Jensen-Urstad, B. Andrea, E. M. A. Andrea, W. M. Maciel, L. S. Siqueira, R. C. Cosenza, F. M. Mittidieri, S. F. Farah, J. A. Atie, E. Kanoupakis, E. Kallergis, H. Mavrakis, C. Goudis, I. Saloustros, N. Malliaraki, G. Chlouverakis, P. Vardas, J. L. Bonnes, J. Jaspers Focks, S. W. Westra, M. A. Brouwer, J. L. R. M. Smeets, G. Inama, C. Pedrinazzi, F. Oliva, M. Senni, M. Zoni Berisso, S. Mostov, M. Haim, R. Nevzorov, D. Hasadi, B. Starsberg, A. Porter, J. Kuschyk, A. Schoene, F. Streitner, C. G. Veltmann, R. Schimpf, M. Borggrefe, U. Luesebrink, A. Gardiwal, H. Oswald, T. Koenig, D. Duncker, G. Klein, R. Bastiaenen, V. Batchvarov, O. Atty, J. H. Cheng, E. R. Behr, M. M. Gallagher, A. H. Starrenburg, K. Kraaier, M. F. Scholten, J. Van Der Palen, S. Adhya, L. A. Smith, T. Zhao, C. Bannister, R. H. Kamdar, M. Martinelli, S. Siqueira, R. Greco, S. A. D. Nishioka, A. A. A. Pedrosa, R. Alkmim-Teixeira, G. L. Peixoto, R. Costa, J. C. Nielsen, P. T. Mortensen, J. B. Johansen, W. Kwasniewski, A. Filipecki, D. Urbanczyk-Swic, W. Orszulak, M. Trusz - Gluza, J. Jimenez-Candil, J. Morinigo, C. Ledesma, C. Martin-Luengo, T. Vogtmann, M. Gomer, S. Stiller, V. Kuehlkamp, G. Zach, S. Loescher, S. Kespohl, G. Baumann, J. D. Snell, N. Korsun, J. R. Snell, B. Morley, R. Bharmi, Y. Nabutovsky, M. Mollerus, L. Naslund, A. Meyer, M. Lipinski, B. Libey, K. Dornfeld, A. Martin, M. Gallego, M. K. De Bie, J. B. Van Rees, C. J. Borleffs, J. Thijssen, J. W. Jukema, M. J. Schalij, L. Van Erven, E. T. Van Der Velde, T. A. Witteman, H. Foeken, T. Szili-Torok, F. Akca, K. Caliskan, F. Ten Cate, M. Michels, D. C. Cozma, L. Petrescu, C. Mornos, S. I. Dragulescu, J. A. Groeneweg, B. K. Velthuis, M. G. P. J. Cox, P. Loh, D. Dooijes, M. J. Cramer, J. M. T. De Bakker, R. N. W. Hauer, S. D. Park, S. H. Shin, S. I. Woo, J. Kwan, K. S. Park, D. H. Kim, A. Iorio, L. Vitali Serdoz, F. Brun, E. Daleffe, M. Zecchin, M. Dal Ferro, S. Santangelo, G. F. Sinagra, S. Ouali, R. Hammemi, S. Hammas, S. Kacem, R. Gribaa, E. Neffeti, F. Remedi, E. Boughzela, P. Korantzopoulos, K. Letsas, Z. Christogiannis, K. Kalantzi, A. Ntorkos, J. Goudevenos, P. W. X. Foley, L. Yung, E. Barnes, M. Kikuchi, H. Ito, F. Miyoshi, R. Pecini, J. M. Marott, G. B. Jensen, J. Theilade, T. Mine, T. Kodani, T. Masuyama, I. M. Mozos, C. Serban, C. Costea, L. Susan, P. Barthel, A. Mueller, M. Malik, G. Schmidt, O. Karakurt, H. Kilic, D. R. Munevver Sari, D. Mroczek-Czernecka, A. Z. Pietrucha, A. Borowiec, M. Wnuk, I. Bzukala, O. Kruszelnicka, E. Konduracka, J. Nessler, Y. Kikuchi, A. Meireles, C. Gomes, D. Anjo, C. Roque, A. Pinheiro Vieira, V. Lagarto, A. Hipolito Reis, S. Torres, L. Miller, G. Vedrenne, E. Bruguiere, A. Redheuil, T. Lavergne, J. Y. Le Heuzey, E. Mousseaux, A. Hersi, K. Alhabib, H. Alfaleh, K. Sulaiman, W. Almahmeed, J. Alsuwidi, H. Amin, A. Almotarreb, H. W. K. Pang, K. Michael, E. J. Pereira, P. W. Munt, M. F. Fitzpatrick, A. S. Revishvili, G. Simonyan, T. Dzhordzhikiya, O. Sopov, V. Kalinin, E. T. Locati, A. M. Vecchi, G. Cattafi, A. Sachero, M. Lunati, S. Sayah, A. Alizadeh, N. Nazari, M. Hekmat, M. Moradi, M. Zeighami, H. Ghanji, K. Suzuki, M. Takagi, K. Maeda, H. Tatsumi, P. Vieira, H. Reis, A. Toth, H. Vago, P. Takacs, E. Edes, A. Marki, G. Y. Balazs, K. Huttl, B. Merkely, F. Lainis, M. M. Buckley, E. J. Johns, C. M. Seifer, L. Daba, K. Liebrecht, W. Piwowarska, J. Toquero Ramos, E. Perez Pereira, C. Mitroi, V. Castro Urda, J. M. Fernandez Villanueva, A. Corona Figueroa, L. Hernandez Reina, I. Fernandez Lozano, A. Bartoletti, P. Bocconcelli, S. Giuli, R. Massa, C. Svetlich, G. Tarsi, F. Tronconi, E. Vitale, P. Stryjewski, M. Wegrzynowska, A. Lousinha, J. Labandeiro, E. Antunes, S. Silva, S. Alves, A. Timoteo, M. Oliveira, R. Cruz Ferreira, and J. Jedrzejczyk-Spaho

Subjects
medicine.medical_specialty, Voltage-dependent calcium channel, business.industry, medicine.drug_class, Umbilical artery, 030204 cardiovascular system & hematology, Cyclase, 3. Good health, Low testosterone levels, 03 medical and health sciences, 0302 clinical medicine, Bkca channel, Endocrinology, Physiology (medical), Internal medicine, medicine.artery, Natriuretic peptide, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Ionic Channels
Abstract

Inthelastdecadesseveralinvestigatorshavesuggestedtheassociationofandrogenswithhypertension. Recently, some studies have shown that the incidence of cardiovascular diseases is increased in men with low testosterone levels, suggesting a protective role of androgens. Hypertension is one of the mostcommonproblemsinpregnancythatcomplicates5-10 %ofpregnancies.Anincreaseofmorbidity wasobservedinbabiesfrompregnantwomenwithhypertension.However,thepathogenesisremains unclearandthislimitstheabilitytopreventandtreatthispathology.Thebeneficialeffectsofandrogens for vascular system are associated with their ability to cause vasorelaxation. Inhuman vessels, this non genomiceffectofandrogensappeartobeduetoactivationoflargeconductancecalcium-activatedpotassiumchannels(BKCa)andvoltagegatedpotassiumchannels(KV)whichisinducedbycGMPincrease andaconsequentactivationofcGMP-dependentproteinkinase(PKG).Ontheotherhand,thegenomic effects of androgens concerning ionic channels are almost unknown. Our previous studies suggested that androgens increase the expression of BKCa channels and decrease expression of L-type calcium channels (LTCC). The aim of this work was to analyze the genomic effects of androgens on theexpressionofotherproteinsinvolvedintheregulationofvascularcontractility,suchassolubleguanylate cyclase (sGC), the natriuretic peptide receptor-A (NPRA) and PKG. This study also aimed to compare the expression levels of these proteins in human umbilical artery (HUA) from normotensive andhypertensivepregnantwomen.ToachievethesegoalsrealtimePCRwasperformedusingsmooth

Published
2011
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17. Poster Session 4

Author

H. Tada, H. Yamasaki, Y. Sekiguchi, M. Igarashi, K. Kuroki, T. Machino, K. Yoshida, K. Aonuma, F. R. Heinzel, H. Forstner, P. Lercher, E. Bisping, B. Rotman, F. M. Fruhwald, B. M. Pieske, R. Dabrowski, I. Kowalik, A. Borowiec, E. Smolis-Bak, A. Trybuch, C. Sosnowski, H. Szwed, M. A. Baturova, A. Lindgren, Y. V. Shubik, B. Olsson, P. G. Platonov, K. C. Van Den Broek, J. Denollet, J. Widdershoven, N. Kupper, R. Allam, R. A. G. A. B. Allam, W. A. G. D. Y. Galal, H. A. Y. A. M. El-Damnhoury, A. Y. M. A. N. Mortada, J. Jimenez-Candil, A. Martin, J. Hernandez, F. Martin, M. Gallego, C. Martin-Luengo, J. G. Quintanilla, J. Moreno Planas, R. Molina-Morua, T. Archondo, M. J. Garcia-Torrent, N. Perez-Castellano, C. Macaya, J. Perez-Villacastin, J. Saiz, C. Tobon, J. F. Rodriguez, F. Hornero, J. M. Ferrero, K. Ito, T. Date, M. Kawai, M. Hioki, R. Narui, S. Matsuo, M. Yoshimura, T. Yamane, N. Tabatabaei, G. Lin, B. D. Powell, R. Smairat, J. F. Glockner, P. A. Brady, S. Fichtner, U. Czudnochowsky, H. Estner, T. Reents, C. Jilek, S. Ammar, G. Hessling, I. Deisenhofer, D. C. Shah, J. Kautzner, N. Saoudi, C. Herrera, P. Jais, G. Hindricks, P. Neuzil, K. H. Kuck, K. C. K. Wong, M. Jones, N. Qureshi, A. Muthumala, T. R. Betts, Y. Bashir, K. Rajappan, T. Vogtmann, M. Wagner, J. Schurig, P. Hein, B. Hamm, G. Baumann, A. Lembcke, B. Saad, C. Slater, L. A. Oliveira, R. Elias, A. Camiletti, D. Moura, P. Maldonado, L. E. Camanho, A. Bulava, J. Hanis, D. Sitek, A. Novotny, W. B. Chik, T. W. Lim, H. K. Choon, V. A. See, R. Mccall, L. Thomas, D. L. Ross, S. P. Thomas, J. Chen, A. De Bortoli, O. Rossvoll, P. I. Hoff, E. Solheim, L. Z. Sun, P. Schuster, O. J. Ohm, A. V. Ardashev, E. Zhelyakov, M. S. Rybachenko, A. V. Konev, Y. U. N. Belenkov, M. Gunawardene, K. R. J. Chun, B. Schulte-Hahn, V. Windhorst, M. Kulikoglu, B. Nowak, B. Schmidt, G. A. Albina, R. S. Rivera, F. Scazzuso, R. L. Laino, G. A. Giniger, E. Arbelo, N. Calvo, D. Tamborero, D. Andreu, R. Borras, A. Berruezo, J. Brugada, L. Mont, L. Stefan, M. Eisenberger, E. Celentano, P. Peytchev, O. Bodea, P. Geelen, T. De Potter, M. M. Oliveira, N. Silva, P. S. Cunha, J. Feliciano, A. Lousinha, A. Toste, S. Santos, R. C. Ferreira, H. Matsuda, T. Harada, K. Soejima, Y. Ishikawa, K. Mizukoshi, T. Sasaki, K. Mizuno, F. Miyake, P. P. Adragao, D. Cavaco, R. Miranda, M. Santos, F. Morgado, K. Reis Santos, R. Candeias, S. Marcelino, F. Zoppo, G. Grandolino, F. Zerbo, E. Bertaglia, S. M. Schlueter, O. Grebe, E. G. Vester, A. L. Miracle Blanco, A. Arenal Maiz, F. Atienza Fernandez, T. Datino Romaniega, E. Gonzalez Torrecilla, G. Eidelman, J. Hernandez Hernandez, F. Fernandez Aviles, K. Fukumoto, S. Takatsuki, T. Kimura, N. Nishiyama, Y. Aizawa, T. Sato, S. Miyoshi, K. Fukuda, B. Richter, M. Gwechenberger, A. Socas, G. Zorn, S. Albinni, M. Marx, J. Wojta, H. Goessinger, T. Deneke, O. Balta, M. Paesler, K. Buenz, H. Anders, M. Horlitz, A. Muegge, D.- I. Shin, K. Natsuyama, K. M. Yamaguchi, Y. N. Nishida, J. Kosiuk, K. Bode, A. Arya, C. Piorkowski, T. Gaspar, P. Sommer, A. Bollmann, D. Wichterle, P. Peichl, J. Simek, S. Havranek, V. Bulkova, R. Cihak, A. Jurado Roman, R. Salguero Bodes, M. Lopez Gil, A. Fontenla Cerezuela, M. De Riva Silva, F. Arribas Ynsaurriaga, A. I. Fernandez Herranz, S. De Dios Perez, A. S. Revishvili, M. Dishekov, Z. Tembotova, S. Barsamyan, D. Vaccari, C. Alvarenga, I. Jesus, J. Layher, A. Takahashi, N. Singh, P. Siot, J. P. Elkaim, I. Savelieva, L. Mcclelland, A. Lovegrove, S. Jones, J. Camm, A. F. Folino, R. Breda, P. Calzavara, J. Comisso, F. Borghetti, S. Iliceto, G. Buja, R. Mlynarski, A. Mlynarska, M. Sosnowski, J. Wilczek, P. Mabo, G. Carrault, P. Bordachar, A. Makdissi, L. Duchemin, C. Alonso, G. Neri, G. Masaro, S. Vittadello, A. Gardin, A. Barbetta, F. Di Gregorio, E. Sciaraffia, M. R. Ginks, J. S. Gustafsson, M. C. Hollmark, C. A. Rinaldi, C. Blomstrom Lundqvist, S. Brusich, D. Tomasic, B. Ferek-Petric, Z. Mavric, A. Kutarski, B. Malecka, A. Kolodzinska, M. Grabowski, E. V. Dovellini, L. Giurlani, G. Cerisano, N. Carrabba, R. Valenti, D. Antoniucci, G. Opolski, G. Tomassoni, J. Baker, R. Corbisiero, D. Martin, I. Niazi, R. Sheppard, J. Sperzel, K. Gutleben, J. Petru, L. Sediva, J. Skoda, P. Mazzone, G. Ciconte, P. Vergara, A. Marzi, G. Paglino, N. Sora, S. Gulletta, P. Della Bella, R. Pietura, M. Czajkowski, N. Cabanelas, V. P. Martins, M. Alves, F. X. Valente, L. Marta, A. Francisco, R. Silva, G. Ferreira Da Silva, Y. Huo, F. Holmqvist, J. Carlson, U. Wetzel, P. Platonov, E. Nof, R. Abu Shama, R. Kuperstein, M. S. Feinberg, M. Eldar, M. Glikson, D. Luria, P. Kubus, O. Materna, R. A. Gebauer, T. Matejka, R. Gebauer, T. Tlaskal, J. Janousek, A. Muessigbrodt, S. Richter, M. Stockburger, S. Boveda, P. Defaye, P. Stancak Branislav, G. Kaliska, M. Rolando, J. Moreno, M.- A. G. Ohlow, B. Lauer, B. Buchter, M. Schreiber, J. C. Geller, J. E. Val-Mejias, S. Ouali, S. Azzez, S. Kacem, H. Ben Salem, S. Hammas, E. Neffeti, F. Remedi, E. Boughzela, H. Miyazaki, S. Miyanaga, K. Shibayama, M. Tokuda, T. Kudo, B. Coppola, R. E. N. Shehada, P. Costandi, J. Healey, S. H. Hohnloser, M. R. Gold, A. Capucci, I. C. Van Gelder, M. Carlson, C. P. Lau, S. J. Connolly, M. D. Bogaard, G. E. Leenders, B. Maskara, A. E. Tuinenburg, P. Loh, R. N. Hauer, P. A. Doevendans, M. Meine, B. Thibault, M. Dubuc, E. Karst, K. Ryu, P. Paiement, T. Farazi, V. Puetz, C. Berndt, J. Buchholz, A. Dorszewski, C. Mornos, D. Cozma, A. Ionac, L. Petrescu, A. Mornos, S. Pescariu, M. Benser, G. Roscoe, S. De Jong, G. Roberts, P. Boileau, A. Rec, C. Folman, A. Morttada, M. Abd El Kader, R. Samir, R. Roushdy, S. Khaled, M. Abo El Maaty, B. Van Gelder, P. Houthuizen, F. A. Bracke, J. Osca Asensi, D. Tejada, J. M. Sanchez, B. Munoz, O. Cano, M. Rodriguez, M. J. Sancho-Tello, J. Olague, W. Hou, S. Rosenberg, S. Koh, J. Poore, J. Snell, M. Yang, D. Nirav, G. Bornzin, T. Deering, D. Dan, A. C. Wickliffe, S. Cazeau, K. Karimzadeh, S. Mukerji, C. Loghin, B. Kantharia, M. A. Jones, J. Lamba, C. S. Simpson, D. P. Redfearn, K. A. Michael, M. Fitzpatrick, A. Baranchuk, M. Heinke, B. Ismer, H. Kuehnert, R. Surber, A. M. Haltenberger, D. Prochnau, H. R. Figulla, N. Delarche, O. Bizeau, P. Couderc, A. Chapelet, W. Amara, A. Lazarus, S. Krupickova, C. J. M. Van Deursen, M. Strik, K. Vernooy, A. Van Hunnik, M. Kuiper, H. J. G. M. Crijns, F. W. Prinzen, N. Islam, D. Gras, W. Abraham, L. Calo, U. Birgersdotter-Green, C. Clyne, J. Herre, N. Klein, O. Kowalski, R. Lenarczyk, P. Pruszkowska, A. Sokal, T. Kukulski, T. Zielinska, S. Pluta, Z. Kalarus, J. O. Schwab, M. Gasparini, F. Anselme, J. Clementy, M. Santini, J. Martinez Ferrer, V. Burrone, E. Santi, R. Nevzorov, A. Porter, J. Kusniec, G. Golovchiner, T. Ben-Gal, B. Strasberg, M. Haim, R. Rordorf, S. Savastano, A. Sanzo, A. Vicentini, B. Petracci, M. De Amici, L. Striuli, M. Landolina, J. M. Tolosana, A. M. Martin, A. Hernandez-Madrid, A. Macias, I. Fernandez-Lozano, J. Osca, A. Quesada, Y. Noguchi, S. Shahrzad, N. Karim Soleiman, A. Tavoosi, S. Taban, Z. Emkanjoo, M. Fukunaga, M. Goya, K. Hiroshima, M. Ohe, K. Hayashi, M. Iwabuchi, H. Nosaka, M. Nobuyoshi, D. Doiny, A. Perez-Silva, S. Castrejon Castrejon, A. Estrada, M. Ortega, J. L. Lopez-Sendon, J. L. Merino, F. J. Garcia Fernandez, R. Gallardo, M. Pachon, J. Almendral, J. Martin, D. Yahya, B. Al-Mogheer, S. Gouda, E. Eweis, M. El Ramly, A. Abdelwahab, W. Kassenberg, F. H. M. Wittkampf, I. E. Hof, J. H. Heijden, K. G. E. J. Neven, R. N. W. Hauer, F. Baratto, E. Bignami, F. Pappalardo, G. Maccabelli, D. Nicolotti, A. Zangrillo, M. Nagashima, Y. An, A. Okreglicki, C. Russouw, R. Tilz, Y. Yoshiga, S. Mathew, A. Fuernkranz, A. Rillig, E. Wissner, F. Ouyang, A. De Sisti, J. Tonet, F. Gueffaf, F. Touil, P. Aouate, F. Hidden-Lucet, H. Makimoto, K. Satomi, Y. Yamada, H. Okamura, T. Noda, W. Shimizu, N. Aihara, S. Kamakura, A. Perez Silva, S. Castrejon, M. Gonzalez Vasserot, J. Senges, J. Brachmann, D. Andresen, E. Hoffmann, B. Schumacher, S. Willems, B. Springer, C. Kolb, F. Akca, T. Bauernfeind, N. M. S. De Groot, B. Schwagten, M. Witsenburg, L. Jordaens, T. Szili-Torok, Y. Hata, R. Nakagami, T. Watanabe, A. Sato, H. Watanabe, T. Kabutoya, T. Mituhashi, D. A. M. J. Theuns, T. Smith, S. S. Pedersen, L. Dabiri-Abkenari, M. W. Prull, S. Unverricht, A. Bittlinsky, H. Wirdemann, B. Sasko, S. Wirdeier, H. J. Trappe, E. Zorio Grima, J. Rueda, P. Medina, T. Jaijo, T. Sevilla, M. A. Arnau, A. Salvador, A. H. Starrenburg, K. Kraaier, M. F. Scholten, J. Van Der Palen, S. De Haan, J. Commandeur, K. De Boer, A. M. Beek, A. C. Van Rossum, C. P. Allaart, P. Berne, J. M. Porres, J. A. Arnaiz, R. Brugada, S. Man, A. C. Maan, J. Thijssen, E. E. Van Der Wall, M. J. Schalij, L. Burattini, R. Burattini, C. A. Swenne, A. Bonny, I. Ditah, F. Larrazet, R. Frank, G. Fontaine, P. H. Van Der Voort, M. Alings, A. Shimane, K. Okajima, G. Kanda, K. Yokoi, S. Yamada, Y. Taniguchi, T. Hayashi, T. Kajiya, M. C. Santos, J. Wright, J. Betts, R. Denman, L. Dominguez-Perez, M. A. Arias Palomares, J. Toquero, E. Diaz-Infante, L. Tercedor, I. Valverde, A. Napp, S. Joosten, D. Stunder, M. Zink, N. Marx, P. Schauerte, J. Silny, M. E. Trucco, M. Arce, J. Palazzolo, F. Femenia, J. M. Glad, S. J. Szymkiewicz, J. Fernandez-Armenta, O. Camara, L. L. Mont, E. Diaz, E. Silva, A. Frangi, B. Brembilla-Perrot, F. Laporte, J. Morinigo, C. Ledesma, C. Hadid, M. Ortiz, C. Wolpert, E. Cobo, X. Navarro, F. Arribas, Y. Miki, S. Naitoh, K. Kumagai, K. Goto, K. Kaseno, S. Oshima, K. Taniguchi, S. Rivera, G. Albina, A. Klein, R. Laino, V. Sammartino, A. Giniger, M. Muggenthaler, H. Raju, M. Papadakis, N. Chandra, R. Bastiaenen, E. R. Behr, S. Sharma, N. Samniah, Y. Radezishvsky, H. Omari, U. Rosenschein, A. R. Perez Riera, M. Ferreira, W. M. Hopman, W. F. Mcintyre, A. R. Baranchuk, W. Wongcharoen, K. Keanprasit, A. Phrommintikul, R. Chaiwarith, A. Yagishita, H. Hachiya, T. Nakamura, Y. Tanaka, K. Higuchi, M. Kawabata, K. Hirao, M. Isobe, V. Stoickov, S. Ilic, M. Deljanin Ilic, P. Aagaard, A. Sahlen, L. Bergfeldt, F. Braunschweig, A. Sousa, A. Lebreiro, C. Sousa, S. Oliveira, A. S. Correia, I. Rangel, J. Freitas, M. J. Maciel, E. Asensio Lafuente, A. A. C. Aguilera, M. A. C. C. Corral, K. L. M. C. Mendoza, P. E. N. D. Nava, A. L. R. C. Rendon, L. V. C. Villegas, L. C. M. Castillo, R. Schaerf, R. Develle, C. Oliver, P. Y. Zinzius, R. A. Providencia, A. Botelho, J. Trigo, J. Nascimento, N. Quintal, P. Mota, A. M. Leitao-Marques, J. Borbola, P. Abraham, C. S. Foldesi, A. Kardos, S. Almeida, M. B. Santos, R. Quaresma, F. B. Morgado, P. Adragao, M. Fatemi, R. Didier, G. Le Gal, Y. Etienne, Y. Jobic, M. Gilard, J. Boschat, J. Mansourati, M. Zubaid, W. Rashed, A. Alsheikh-Ali, W. Almahmeed, A. Shehab, K. Sulaiman, N. Asaad, H. Amin, L. V. A. Boersma, M. Swaans, M. Post, B. Rensing, K. Jarverud, M. Broome, K. Noren, T. Svensson, S. Hjelm, M. Hollmark, A. Bjorling, K. Maeda, M. Takagi, K. Suzuki, H. Tatsumi, M. Yoshiyama, E. Simeonidou, C. Michalakeas, S. Kastellanos, C. Varounis, A. Nikolopoulou, C. Koniari, M. Anastasiou-Nana, T. Furukawa, R. Maggi, C. Bertolone, D. Fontana, M. Brignole, A. Z. Pietrucha, M. Wnuk, I. Bzukala, D. Mroczek-Czernecka, E. Konduracka, O. Kruszelnicka, W. Piwowarska, J. Nessler, N. Edvardsson, G. Rieger, C. Garutti, N. Linker, C. Jorge, J. Silva Marques, A. Veiga, J. Cruz, M. J. Correia, J. Sousa, G. Miltenberger-Miltenyi, A. Nunes Diogo, D. Matic, I. Mrdovic, G. Stankovic, M. Asanin, N. Antonijevic, M. Matic, N. Kocev, Z. Vasiljevic, M. A. Ramirez-Marrero, B. Perez-Villardon, J. L. Delgado-Prieto, M. Jimenez-Navarro, E. De Teresa-Galvan, M. De Mora-Martin, K. Sztefko, A. Malek, N. De Groot, T. Shalganov, M. Schalij, N. Rivas, J. Casaldaliga, I. Roca, A. Pijuan, J. Perez-Rodon, L. Dos, D. Garcia-Dorado, A. Moya, A.- E. Baruteau, A. Behaghel, S. Chatel, J. J. Schott, J. C. Daubert, H. Le Marec, V. Probst, J. Navarro-Manchon, P. Molina, B. Igual, M. Bermejo, J. Giner, V. J. A. Bourgonje, M. A. Vos, S. Ozdemir, N. Doisne, M. A. G. Van Der Heyden, A. A. B. Van Veen, K. Sipido, G. Antoons, P. I. Altieri, N. Escobales, M. Crespo, H. L. Banchs, L. Sciarra, R. Bloise, G. Allocca, E. Marras, E. Lioy, P. Delise, S. Priori, and L. Calo'

Subjects
medicine.medical_specialty, business.industry, Physiology (medical), Internal medicine, Diastole, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

spectively), (p

Published
2011
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18. Syncope, conduction disturbance, and negative electrophysiological test: Predictive factors and risk score to predict pacemaker implantation during follow-up.

Author

Roca-Luque I, Francisco-Pascual J, Oristrell G, Rodríguez-García J, Santos-Ortega A, Martin-Sanchez G, Rivas-Gandara N, Perez-Rodon J, Ferreira-Gonzalez I, García-Dorado D, and Moya-Mitjans A

Subjects
Aged, False Negative Reactions, Female, Follow-Up Studies, Heart Conduction System physiopathology, Heart Conduction System surgery, Humans, Male, Predictive Value of Tests, Prognosis, Atrioventricular Block etiology, Atrioventricular Block physiopathology, Atrioventricular Block prevention & control, Bundle-Branch Block diagnosis, Bundle-Branch Block physiopathology, Bundle-Branch Block surgery, Cardiac Pacing, Artificial methods, Cardiac Pacing, Artificial statistics & numerical data, Electrophysiologic Techniques, Cardiac methods, Electrophysiologic Techniques, Cardiac standards, Pacemaker, Artificial statistics & numerical data, Risk Assessment methods, Risk Assessment statistics & numerical data, Syncope diagnosis, Syncope etiology, Syncope prevention & control
Abstract

Background: Patients with syncope and bundle branch block (BBB) are at risk for atrioventricular block (AVB). Electrophysiological study (EPS) can help in identifying patients at higher risk for AVB, but the false-negative rate is remarkable. Few data on the predictors of the need for pacemaker implantation during follow-up have been reported., Objective: The purpose of this study was to analyze the rate of patients who need pacemaker implantation after negative EPS and predictive factors., Methods: A single-center prospective study of 159 consecutive patients (73.9 ± 12.1 years; male 64.9%) with syncope and BBB (January 2012-December 2016) and negative EPS was conducted. An implantable loop recorder was implanted., Results: After 27.9 ± 10.8 months of follow-up, 39 patients (24.8%) underwent pacemaker implantation because of bradyarrhythmia. In the univariate analysis, bifascicular (right BBB + left fascicular block) block, bifascicular block + long PR interval, conduction disturbance different from isolated right BBB, HV ≥60 ms, and HV ≥70 ms after class I drug challenge were predictors of pacemaker implantation. In the multivariate analysis, only bifascicular block (hazard ratio 2.5; 95% confidence interval 1.4-4.8; P = .04) and HV interval ≥60 ms (hazard ratio 3.5; 95% confidence interval 1.8-6.2; P <.001) were statistically significant. A risk score according to the multivariate model identified 3 levels of pacemaker implantation rate (13.5%, 32.7%, and 66.7%; P <.001). No death or severe trauma related to bradyarrhythmia occurred., Conclusion: The strategy of an implantable loop recorder in patients with syncope and BBB is safe after negative EPS, but some patients might need pacemaker implantation during follow-up. A risk score based on HV ≥60 ms and bifascicular block can be useful in identifying patients at risk for advanced AVB after negative EPS., (Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Published
2019
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19. Flecainide Versus Procainamide in Electrophysiological Study in Patients With Syncope and Wide QRS Duration.

Author

Roca-Luque I, Francisco-Pasqual J, Oristrell G, Rodríguez-García J, Santos-Ortega A, Martin-Sanchez G, Rivas-Gandara N, Perez-Rodon J, Ferreira-Gonzalez I, García-Dorado D, and Moya-Mitjans A

Subjects
Aged, Aged, 80 and over, Bundle-Branch Block diagnosis, Bundle-Branch Block physiopathology, Female, Flecainide therapeutic use, Heart Conduction System drug effects, Humans, Male, Middle Aged, Procainamide therapeutic use, Electrocardiography drug effects, Electrophysiologic Techniques, Cardiac methods, Flecainide pharmacology, Procainamide pharmacology, Syncope diagnosis, Syncope physiopathology
Abstract

Objectives: This study sought to compare the differences between procainamide and flecainide to stress the His-Purkinje system during electrophysiological study (EPS) in patients with syncope and bundle branch block (BBB)., Background: Patients with syncope and BBB are at risk of developing atrioventricular block. EPS is recommended including class I drug challenge to unmask His-Purkinje disease in cases with baseline normal His-ventricular interval. There is little data on differences between different class I drugs., Methods: This was a prospective study of all consecutive patients undergoing EPS for syncope and BBB at a single center (January 1, 2012 to June 30, 2017). Of those patients with negative baseline EPS, 2 cohorts were compared: group A (historical cohort: procainamide) and group B (flecainide)., Results: During the study, 271 patients (age 73.9 ± 12.1 years, 64.9% male, QRS duration: 139.4 ± 13.9 ms) underwent EPS. In 166, baseline EPS was negative and class I drug challenge was performed (90 procainamide, 76 flecainide). The final value and percentage increase in the His-ventricular interval (76 ± 16 ms vs. 64 ± 10 ms and 22.5 ± 6.2% vs. 11.8 ± 5.3%; p < 0.001) and diagnostic yield (14.5% vs. 7.8%, p = 0.04) were higher with flecainide. No differences were found in baseline characteristics. During follow-up (25.8 ± 6.3 months), 39 patients (24.8%) with negative EPS (19.2% with flecainide vs. 30.1% with procainamide: relative risk: 5.1; 95% confidence interval: 2.6 to 10.2; p < 0. 001) received a pacemaker., Conclusions: Flecainide has a higher diagnostic yield than does procainamide in patients with BBB, syncope, and negative baseline EPS due to a greater increase of the His-ventricular interval. Additionally, there is a lesser need for pacemaker implantation in patients in whom the class I drug test using flecainide was negative., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2019
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20. Predictors of positive electrophysiological study in patients with syncope and bundle branch block: PR interval and type of conduction disturbance.

Author

Roca-Luque I, Oristrell G, Francisco-Pasqual J, Rodríguez-García J, Santos-Ortega A, Martin-Sanchez G, Rivas-Gandara N, Perez-Rodon J, Ferreira-Gonzalez I, García-Dorado D, and Moya-Mitjans A

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Bundle-Branch Block physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Syncope physiopathology, Young Adult, Bundle-Branch Block diagnosis, Electrocardiography methods, Heart Conduction System physiopathology, Syncope diagnosis
Abstract

Background: Electrophysiological study (EPS) is indicated in patients with syncope and bundle branch block (BBB). Data about predictors of positive EPS in these patients is scarce., Objective: To assess clinical and electrocardiographic (ECG) predictors of positive EPS in patients with syncope and BBB., Methods: Observational single-center study that included all consecutive patients with syncope and BBB that underwent EPS from January 2011 to June 2017. Results of EPS were considered positive according to current ESC syncope guidelines., Results: During study period, 271 patients were included (64.9% male, age: 73.9 ± 12.2 years, number of syncopal episodes: 2.4 ± 2.5, LVEF: 56.1 ± 9.9%). Type of BBB: RBBB + LAFB/LPFB in 39.8%, isolated LBBB in 38.7% and isolated RBBB in 18.5% of the patients. Duration of QRS and PR interval were 141.9 ± 16.7 and 182.8 ± 52.2 milliseconds. EPS was positive in 41.7% of the patients. In multivariate analysis, conduction disturbance pattern and long PR interval (OR 8.6; 2.9-25; P < 0.0001) were predictors of positive EPS. Conduction disturbance patterns related with positive EPS were: BBB different than isolated RBBB (OR 15.2; 2.2-23.4; P = 0.005), LBBB or RBBB+long PR + left fascicular block (OR 4.5; 1.06-20.01; P < 0.042), and RBBB+left fascicular block compared with LBBB (OR 4.8; 1.2-16.7; P = 0.025). Clinical factors and syncope characteristics were not related with EPS result., Conclusions: Diagnostic yield of EPS in patients with syncope and BBB is moderate (41%). Type of conduction disturbance pattern and PR interval are associated with the electrophysiological (EP) test result. Patients with LBBB or bifascicular block have the highest rate of positive EP test. Long PR interval increases the proportion of positive EPS in all conduction disturbance patterns., (© 2018 Wiley Periodicals, Inc.)

Published
2018
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23. Narrow complex tachycardia with irregular ventricular and atrial intervals: what is the mechanism?

Author

Sarrias-Merce A, Moya-Mitjans A, Rivas-Gandara N, Perez-Rodon J, Roca-Luque I, and Garcia-Dorado D

Subjects
Chronic Disease, Diagnosis, Differential, Female, Humans, Middle Aged, Recurrence, Atrioventricular Block complications, Atrioventricular Block diagnosis, Electrocardiography methods, Tachycardia, Atrioventricular Nodal Reentry complications, Tachycardia, Atrioventricular Nodal Reentry diagnosis
Published
2013
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24. Overview of the contribution of recent clinical trials to advancement of syncope management.

Author

Moya A, Rivas N, and Perez-Rodon J

Subjects
Cardiac Pacing, Artificial, Cardiovascular Agents therapeutic use, Equipment Design, Evidence-Based Medicine, Fluid Therapy, Heart Block complications, Heart Block diagnosis, Heart Block physiopathology, Humans, Muscle Contraction, Pacemaker, Artificial, Physical Therapy Modalities, Posture, Predictive Value of Tests, Recurrence, Risk Assessment, Risk Factors, Syncope, Vasovagal diagnosis, Syncope, Vasovagal etiology, Syncope, Vasovagal physiopathology, Treatment Outcome, Clinical Trials as Topic, Heart Block therapy, Syncope, Vasovagal therapy
Abstract

In this communication we review those trials that have contributed in recent years to improving our knowledge on the management (diagnosis and treatment) of syncope. In this regard, most recent trials focus on vasovagal syncope (VVS) and consequently these will be the focus of this manuscript. In essence, from a diagnostic perspective the ISSUE studies demonstrate the value of insertable loop recorders (ILR), while in terms of treatment, in the case of VVS current data strongly support use of non-pharmacologic treatment as a primary approach. There is no clear evidence supporting pharmacologic treatment with the possible exception of midodrine. Further, the most recent ISSUE trials suggest that in older very symptomatic patients with VVS in whom an asystole has been documented during spontaneous episode or possibly after ATP administration, implantation of a permanent pacemaker (PPM) can be effective. Which pacing or programming mode will be the more beneficial has not been completely clarified. Management of other forms of neurally-mediated syncope (e.g., carotid sinus syndrome) or other causes of syncope has not been addressed by clinical trials. In those cases, direction is provided by older evidence, the vast majority of which is based on observational reports or small non-randomized patient series., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Published
2013
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25. Incremental pacing for the diagnosis of complete cavotricuspid isthmus block during radiofrequency ablation of atrial flutter.

Author

Bazan V, Martí-Almor J, Perez-Rodon J, Bruguera J, Gerstenfeld EP, Callans DJ, and Marchlinski FE

Subjects
Aged, Atrial Flutter diagnosis, Female, Humans, Male, Reproducibility of Results, Sensitivity and Specificity, Tricuspid Valve, Vena Cava, Inferior, Atrial Flutter complications, Atrial Flutter surgery, Cardiac Pacing, Artificial methods, Catheter Ablation adverse effects, Heart Block diagnosis, Heart Block etiology
Abstract

Background: Complete conduction block of the cavotricuspid isthmus (CTI) reduces atrial flutter recurrences after ablation. Incremental rapid pacing may distinguish slow conduction from complete CTI conduction block., Methods and Results: Fifty-two patients (67 +/- 9 years) undergoing 55 CTI ablation procedures were included. With ablation, double potentials (DPs) separated by an isoelectric line of > or =30 ms were obtained. Incremental atrial pacing (600-250 ms) was performed from coronary sinus (CS) and low lateral right atrium (LLRA). A <20 ms increase in the DPs distance during incremental pacing was indexed as complete CTI block. In 8 patients, an initial <20 ms DPs distance increase was noted; direct complete isthmus block was suggested and no additional ablation performed. In the remaining, the CTI line was remapped for conduction gaps and additional radiofrequency energy pulses applied. Complete block, as indexed by incremental pacing, occurred in 46 of 55 procedures, with one flutter recurrence (follow-up 8 +/- 2 months): DPs interval variation of 116 +/- 20 to 123 +/- 20 ms (CS), P = 0.21; and 122 +/- 25 to 135 +/- 35 ms (LLRA), P = 0.17. The remaining 9 patients (persistent rate-dependent DPs increase) presented 3 flutter recurrences, P = 0.01: DP distance from 127 +/- 15 to 161 +/- 18 ms (CS), P < 0.001; and 114 +/- 24 to 142 +/- 10 ms (LLRA), P = 0.007., Conclusion: Incremental pacing distinguishes complete CTI block from persistent conduction. Such identification, accompanied by additional ablation to achieve block, should minimize flutter recurrences after ablative therapy.

Published
2010
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