Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert.

INTRODUCTION AND OBJECTIVES: The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts. METHODS: The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol. RESULTS: We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001). CONCLUSIONS: A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.

Remote heart failure management using the HeartLogic algorithm. RE-HEART registry.

INTRODUCTION AND OBJECTIVES: HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry. METHODS: We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively). RESULTS: We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P <.001). CONCLUSIONS: The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.

Two-Year Follow-up in Atrial Fibrillation Patients Referred for Catheter Ablation of the Atrioventricular Node.

INTRODUCTION: At the present time there is still concern regarding the long-term deleterious effects of right ventricular apical pacing in patients referred for auriculoventricular node ablation (AVNA). Furthermore, scarce information is available regarding differences in the follow up according to the baseline cardiopathy and predictors associated with a worse outcome. METHODS: 104 consecutives patients referred for AVNA were retrospectively analyzed. Patients included were seen in the outpatient clinic at 6, 12 and 24 months post ablation (mean follow-up 24 ± 2 months). An echocardiogram two years after the procedure was obtained in 68 patients. Three categories were done according to the change in the left ventricular function (LVEF) (increase, decrease or absence of change, defined as less than 10% variation in either LVEF). RESULTS: After two years of follow up there was a decrease in the rate of hospital admission (from 0.9 admission/year to 0.35, p<0.001), an increase in the functional status in at least one NYHA class in 58 patients, and an increase in the global LVEF (from 48.9% to 54,1%; p<0.001). Valvular replacement and LVEF less than 50% were independently associated with a decrease in the LVEF. Regarding safety issues, one patient who presented a polymorphic ventricular tachycardia (Torsade de pointes) 60 minutes after the ablation. CONCLUSIONS: AVNA results in a decrease in hospital admission rates and an improvement in functional status. Baseline LVEF < 50% and mitral valvulopathy were multivariate predictor of LVEF decline, hence, it is our belief that, in this particular population, the "ablate and pace" strategy is not the most suitable option, and or maybe a biventricular pacemaker should be implanted or an AF ablation reconsidered." Finally, although it is a safe procedure and rate of complications were low, there is a potential risk of fatal complications.

Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012).

INTRODUCTION AND OBJECTIVES: This article presents the findings of the 2012 Spanish Catheter Ablation Registry. METHODS: Data were collected in 2 ways: retrospectively using a standardized questionnaire, and prospectively using a central database. Each participating center selected its own preferred method of data collection. RESULTS: Seventy-four Spanish centers voluntarily contributed data to the survey. A total of 11 042 ablation procedures were analyzed, averaging 149 (103) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2842; 25.7%), cavotricuspid isthmus (n=2485; 23%), and accessory pathways (n=1999; 18%). Atrial fibrillation was the fourth most common substrate treated (n=1852; 17%), representing a slight increase. The number of ventricular arrhythmia ablation procedures was similar to that of 2011, but there was a decrease in procedures for ventricular tachycardia associated with postinfarction scarring. The overall success rate was 94.9%, major complications occurred in 1.9%, and the overall mortality rate was 0.04%. CONCLUSIONS: Data from the 2012 registry show that the number of ablations performed continued to increase. Overall, they also show a high success rate and a low number of complications. Ablation of complex substrates continued to increase, particularly in the case of atrial fibrillation.

Spanish Catheter Ablation Registry. 11th official report of the Spanish Society of Cardiology Working Group on electrophysiology and arrhythmias (2011).

INTRODUCTION AND OBJECTIVES: The findings of the 2011 Spanish Catheter Ablation Registry are presented. METHODS: Data were collected in two ways: retrospectively using a standardized questionnaire, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS: Sixty-six Spanish centers voluntarily contributed data to the survey. Some 9662 ablation procedures were analyzed, averaging 146 (104) per center. The three main conditions treated were atrioventricular nodal reentrant tachycardia (n=2537; 26%), typical atrial flutter (n=2205; 23%) and accessory pathways (n=1813; 19%). Atrial fibrillation was the fourth most common substrate treated (n=1535; 16%) and showed a slight increase over figures for 2010. Ventricular arrhythmia ablation has increased considerably. The overall success rate was 94%; major complications occurred in 2.2% and overall mortality was 0.04%. CONCLUSIONS: Data from the 2011 registry show a continued increase in the number of ablations performed with a generally high success rate and few complications. The use of complex substrate ablation continues to grow.

[Spanish catheter ablation registry. 10th official report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2010)]. / Registro Español de Ablación con Catéter. X Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2010).

INTRODUCTION AND OBJECTIVES: The findings of the 2010 Spanish Catheter Ablation Registry are presented. METHODS: Data were collected in two ways: retrospectively using a standardized questionnaire, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS: Fifty-seven Spanish centers voluntarily contributed data to the survey. A total of 8762 ablation procedures was analyzed, averaging 154 (97) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2321; 27%), typical atrial flutter (n=1839; 22%), and accessory pathways (n=1738; 20%). Atrial fibrillation was the fourth most common condition treated (n=1309; 15%), and reflects mild growth. The overall success rate was 94%, major complications occurred in 1.7%, and the overall mortality rate was 0.06%. CONCLUSIONS: Data from the 2010 registry show that the number of ablations carried out continued to increase and exceeded 8700 ablations for the second time. In addition, they show, in general, a higher success rate and a lower number of complications. Again, cavotricuspid isthmus ablation for typical atrial flutter was the second most common condition treated. The number of catheter ablations carried out for ventricular arrhythmias in Spain is growing compared to the previous year.

Spanish Catheter Ablation Registry. 9th Report of the Spanish Society Of Cardiology Working Group on Electrophysiology and Arrhythmias (2009).

INTRODUCTION AND OBJECTIVES: This article reports the findings of the 2009 Spanish national Catheter Ablation Registry. METHODS: Data were collected in two ways: retrospectively using a standard questionnaire and prospectively from a central database. Each center chose its own preferred method of data collection. RESULTS: Data were collected from 59 centers. The total number of ablation procedures carried out was 8546, giving a mean of 145 ± 101 procedures per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n = 2341; 27%), typical atrial flutter (n = 1859; 21.7%) and accessory pathways (n = 1758; 20.5%). The fourth most common condition was atrial fibrillation (n = 1188; 14%), the number of which has grown by 44% since the 2008 registry. The overall success rate was 93%, major complications occurred in 1.9%, and the mortality rate was 0.046%. CONCLUSIONS: Data from the 2009 registry show that the number of ablations carried out continued to increase and exceeded 8000 for the first time. In addition, they show, in general, a higher success rate and a lower number of complications. Cavotricuspid isthmus ablation, as treatment for typical atrial flutter, continued to be the second most common procedure. There was a substantial increase in the number of catheter ablations performed for atrial fibrillation compared with previous years.

Spanish Catheter Ablation Registry. 8th official report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2008).

INTRODUCTION AND OBJECTIVES: This article reports the findings of the 2008 Spanish Catheter Ablation Registry, as compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias. METHODS: As in previous years, data were collected in two ways: retrospectively using a standard questionnaire sent to electrophysiology laboratories by the Working Group on Electrophysiology and Arrhythmias, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS: Fifty five Spanish centers contributed data voluntarily. In total, 7741 ablations were analyzed, averaging 141+/-97 per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2302; 31%), typical atrial flutter (n=1720; 22%) and accessory pathways (n=1658; 21%). The fourth most common condition was atrial fibrillation (n=829; 11%), which accounted for 18% more procedures than in 2007. Overall, the success rate was 93%, major complications occurred in 1.7%, and the mortality rate was 0.03%. CONCLUSIONS: Registry data for 2008 show that the number of ablations carried out continues to increase, and has exceeded 7000 for the second time. In general, the success rate was high and there were few complications. Typical atrial flutter, requiring cavotricuspid isthmus ablation, has become the second most frequently treated condition. A moderate steady increase in the number of ablations for atrial fibrillation was also observed.

[Spanish catheter ablation registry. Sixth official report of the Spanish Society of Cardiology Working group on Electrophysiology and Arrhythmias (2006)]. / Registro Español de Ablación con Catéter. VI Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2006).

INTRODUCTION AND OBJECTIVES: The findings of the 2006 Spanish Catheter Ablation Registry compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias are presented. METHODS: As in previous years, data were collected in two ways: retrospectively using a standardized questionnaire sent to electrophysiology laboratories by the Working Group on Electrophysiology and Arrhythmias, and prospectively from a central database. Each participating center selected its own preferred method of data collection. RESULTS: Forty-eight Spanish centers contributed data voluntarily. A total of 6568 ablation procedures were recorded, averaging 139+/-75 per center. As in previous reports, the three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=1881, 28%), accessory pathways (n=1628, 25%), and typical atrial flutter (n=1507, 23%). Atrial fibrillation was the fourth most common condition treated (n=540, 8%). The overall success rate was 92.2%, major complications occurred in 1.4%, and the mortality rate was 0.015%. CONCLUSIONS: In 2006, the number of ablation procedures recorded in the Spanish Catheter Ablation Registry continued to grow, with more than 6500 procedures now being registered. The success rate increased and there were fewer complications. Atrial fibrillation remains the fourth most common condition treated by catheter ablation at Spanish arrhythmia units.