RESUMEN
BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
Asunto(s)
Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Humanos , Estudios Prospectivos , Función Ventricular Izquierda/fisiología , Volumen Sistólico/fisiología , Resultado del Tratamiento , Dispositivos de Terapia de Resincronización CardíacaAsunto(s)
Desfibriladores Implantables , Marcapaso Artificial , Corazón , Humanos , Extremidad SuperiorRESUMEN
Background Large-scale studies describing modern populations using an implantable cardioverter-defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real-world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29-1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07-1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43-2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54-0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14-0.45) showed a lower risk. All-cause death was 13.4% at follow-up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58-5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18-5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25-6.99) had the worst prognoses. Delayed high-rate detection was enabled in 39.7% of patients, and single-zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow-up was low (6%) and did not differ among type of ICD but was lower in SmartShock-capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure-related disorders had a similar risk of ICD life-saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NTC01561144.
Asunto(s)
Desfibriladores Implantables , Cardioversión Eléctrica , Taquicardia Ventricular , Estudios de Cohortes , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/clasificación , Desfibriladores Implantables/estadística & datos numéricos , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/métodos , Cardioversión Eléctrica/estadística & datos numéricos , Análisis de Falla de Equipo , Femenino , Cardiopatías/clasificación , Cardiopatías/complicaciones , Cardiopatías/mortalidad , Cardiopatías/terapia , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Necesidades , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/estadística & datos numéricos , Medición de Riesgo , España/epidemiología , Análisis de Supervivencia , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/terapiaAsunto(s)
Estimulación Cardíaca Artificial/efectos adversos , Sistema de Conducción Cardíaco/fisiopatología , Frecuencia Cardíaca , Síndrome de QT Prolongado/terapia , Marcapaso Artificial , Taquicardia Ventricular/etiología , Complejos Prematuros Ventriculares/etiología , Potenciales de Acción , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/prevención & control , Electrocardiografía , Humanos , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/fisiopatología , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Resultado del Tratamiento , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/fisiopatología , Complejos Prematuros Ventriculares/terapiaRESUMEN
BACKGROUND: We describe the feasibility of monitoring with a Textile Wearable Holter (TWH) in patients included in Crypto AF registry. METHODS: We monitored cryptogenic stroke patients from stroke onset (<3days) continuously during 28days. We employed a TWH composed by a garment and a recorder. We compared two garments (Lead and Vest) to assess rate of undiagnosed Atrial Fibrillation (AF) detection, monitoring compliance, comfortability (1 to 5 points), skin lesions, and time analyzed. We describe the timing of AF detection in three periods (0-3, 4-15 and 16-28days). RESULTS: The rate of undiagnosed AF detection with TWH was 21.9% (32 out of 146 patients who completed the monitoring). Global time compliance was 90% of the time expected (583/644h). The level of comfortability was 4 points (IQR 3-5). We detected reversible skin lesions in 5.47% (8/146). The comfortability was similar but time compliance (in hours) was longer in Vest group 591 (IQR [521-639]) vs. Lead 566 (IQR [397-620]) (p=0.025). Also, time analyzed was more prolonged in Vest group 497 (IQR [419-557]) vs. Lead (336h (IQR [140-520]) (p=0.001)). The incidence of AF increases from 5.6% (at 3days) to 17.5% (at 15th day) and up to 20.9% (at 28th day). The percentage of AF episodes detected only in each period was 12.5% (0-3days); 21.7% (4-15days) and 19% (16-28days). CONCLUSIONS: 28days Holter monitoring from the acute phase of the stroke was feasible with TWH. Following our protocol, only five patients were needed to screen to detected one case of AF.
Asunto(s)
Fibrilación Atrial/diagnóstico , Electrocardiografía Ambulatoria/métodos , Sistema de Registros , Accidente Cerebrovascular/diagnóstico , Textiles , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/fisiopatología , Electrocardiografía Ambulatoria/instrumentación , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Accidente Cerebrovascular/fisiopatologíaAsunto(s)
Antiarrítmicos/efectos adversos , Bloqueo Atrioventricular/tratamiento farmacológico , Cardiomiopatía Hipertrófica/complicaciones , Electrocardiografía , Sistema de Conducción Cardíaco/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Propafenona/efectos adversos , Potenciales de Acción , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/fisiopatología , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasAsunto(s)
Diagnóstico por Imagen/métodos , Endocarditis Bacteriana , Marcapaso Artificial/efectos adversos , Infecciones Relacionadas con Prótesis , Bacterias/aislamiento & purificación , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/etiología , Salud Global , Humanos , Incidencia , Marcapaso Artificial/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiologíaRESUMEN
BACKGROUND: Different types of ventricular arrhythmias (monomorphic ventricular tachycardia [VT], polymorphic VT, or ventricular fibrillation) can be detected by implantable cardiac defibrillators (ICDs) in fast VT zone. The efficacy of antitachycardia pacing (ATP) depends on the type of the treated arrhythmia. We hypothesized that an automatic algorithm based on morphological affinity of ICD far-field electrograms during tachycardia can predict ATP success and the need of shock. METHODS: The algorithm was evaluated on ventricular arrhythmias recorded in CareLink ICD remote monitoring system (Medtronic Inc., Minneapolis, MN, USA). Patients were selected if first ATP programmed was a burst of eight pulses at 88% coupling interval and if a far-field electrogram was available. The algorithm calculated a stability coefficient (SC) for all their stored ATP-treated fast ventricular arrhythmia (VA) episodes (LC 200-300 ms), analyzing the morphology homogeneity of the last eight recorded far-field electrograms before ventricular arrhythmias detection. RESULTS: Inclusion criteria were fulfilled by 717 patients from 29 centers. Three hundred and twenty fast VA were recorded in 103 patients. A higher SC was observed in episodes terminated with the first-ATP (0.78 [0.72-0.84] vs 0.74 [0.60-0.84]; P = 0.006). These differences were especially marked among the 62 episodes of very fast VA (CL ≤250 ms) (0.77 [0.74-0.85] vs 0.64 [0.51-0.8]; P = 0.006). In the multivariate analysis, a SC > 70% was independently associated with a higher likelihood of first-ATP success (odds ratio [OR] = 2.5; [95% confidence interval (CI) = 1.4-4.5], P = 0.001) and a lower need of shock (OR = 0.37; [95% CI = 0.2-0.7], P = 0.002). CONCLUSION: This automatic algorithm (stability coefficient) shows that ATP therapy response can be predicted in fast ventricular arrhythmias through morphology evaluation.
Asunto(s)
Algoritmos , Técnicas Electrofisiológicas Cardíacas/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/prevención & control , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/prevención & control , Estimulación Cardíaca Artificial , Desfibriladores Implantables , Diagnóstico por Computador/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , España , Terapia Asistida por Computador/métodos , Resultado del TratamientoRESUMEN
CASE REPORT: A 20 year-old woman was submitted to resection of an ependymome of the fourth ventricle. After surgery the patient began to refer diplopia and oscillopsia. WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia), vertical nystagmus and skew deviation were diagnosed. DISCUSSION: WEBINO syndrome is considered a special form of bilateral internuclear ophthalmoplegia. It is characterized by bilateral absence of adduction, nystagmic abduction of both eyes, convergence deficiency and frequently exotropia. Ischemic, demyelinating and infectious etiologies have been described, but to our knowledge this is the first report of a postsurgical form of this syndrome.