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Background: The benefit of prophylactic implantable cardioverter defibrillators (ICDs) in patients with severe systolic dysfunction of non-ischemic origin is still unclear, and the identification of patients at risk for sudden cardiac death remains a major challenge. Aims/Methods: We retrospectively reviewed all consecutive patients with non-ischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify the predictors of appropriate ICD therapies (anti-tachycardia pacing [ATP] and/or shocks) in this cohort of patients. Results: A total of 224 patients were included. After a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD therapies. Patients with appropriate ICD therapies were more frequently men (87% vs. 69%, p = 0.006), of younger age (59 years, (53-65) vs. 64 years, (57-70); p = 0.02), showed more right bundle branch blocks (RBBBs) (15% vs. 4%, p = 0.007) and less left bundle branch blocks (LBBBs) (26% vs. 47%, p = 0.005) in the ECG, and had higher left ventricular end-diastolic (100 mL/m2, (90-117) vs. 86, (71-110); p = 0.011) and systolic volumes (72 mL/m2, (59-87) vs. 61, (47-81), p = 0.05). In a multivariate competing-risks regression analysis, RBBB (HR 2.26, CI 95% 1.02-4.98, p = 0.043) was identified as an independent predictor of appropriate ICD therapies. Conclusion: RBBBs may help to identify patients with NICM at high risk of ventricular arrhythmias and requiring ICD intervention.
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BACKGROUND: Risk stratification in Brugada syndrome (BrS) remains controversial. In this respect, the role of the electrophysiology study (EPS) has been a subject of debate. In some centers, it is common practice to use an implantable loop recorder (ILR) after a negative EPS to help in risk stratification. However, the diagnostic value of this approach has never been specifically addressed. OBJECTIVE: The aim of this study was to describe the baseline characteristics and the main findings of a diagnostic workup strategy with an ILR after a negative EPS in BrS. METHODS: We conducted a retrospective international registry including patients with BrS and negative EPS (ie, noninducible ventricular tachycardia or ventricular fibrillation) before ILR monitoring. RESULTS: The study included 65 patients from 8 referral hospitals in The Netherlands, Spain, and the United Kingdom (mean age, 39 ± 16 years; 72% male). The main indication for ILR monitoring was unexplained syncope/presyncope (66.2%). During a median follow-up of 39.0 months (Q1 25.0-Q3 47.6 months), 18 patients (27.7%) experienced 21 arrhythmic events (AEs). None of the patients died during follow-up. Bradyarrhythmias were the most common finding (47.6%), followed by atrial tachyarrhythmias (38.1%). Only 3 patients presented with ventricular arrhythmias. AEs were considered incidental in 12 patients (66.7%). In 11 patients (61.1%), AEs led to specific changes in treatment. CONCLUSION: The use of ILR after a negative EPS in BrS is a safe strategy that reflected the high negative predictive value of EPS for ventricular arrhythmia in this syndrome. In addition, it allowed the detection of AEs in a significant proportion of patients, with therapeutic implications in most of them.
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Síndrome de Brugada , Sistema de Registros , Humanos , Masculino , Femenino , Síndrome de Brugada/fisiopatología , Síndrome de Brugada/diagnóstico , Adulto , Estudios Retrospectivos , Electrocardiografía Ambulatoria/métodos , Electrocardiografía Ambulatoria/instrumentación , Técnicas Electrofisiológicas Cardíacas/métodos , Persona de Mediana Edad , Estudios de Seguimiento , Medición de Riesgo/métodosRESUMEN
Resumen Introducción: en los procedimientos de extracción de electrodos, la vía femoral se usa cuando la vía superior ha fracasado. Objetivo: describir la incidencia, el éxito, las complicaciones y los predictores de uso de la vía femoral. Métodos: se realizó un análisis de la incidencia del uso de la vía femoral y los factores predictores en pacientes a quienes se les realizó extracción de electrodos entre noviembre de 2011 y noviembre de 2017. Resultados: se incluyeron 85 pacientes, con edad media de 62,36 ± 11,15 años. El 38,9% de los dispositivos eran marcapasos. Se extrajeron 135 electrodos, 59,3% de fijación pasiva. La mediana de tiempo desde el implante fue de 102 (60-174) meses. Se empleó la ruta femoral en el 25,9% de los procedimientos. Se obtuvo éxito clínico en el 92,9% de los pacientes. La extracción no fue exitosa en el 22,7% de los procedimientos cuando se usó la vía femoral, en comparación con el 1,6% cuando se usó la vía superior (p 0,004). La extracción no fue completa en el 36,4% de los procedimientos cuando se empleó la vía femoral en comparación con el 9,5% por vía superior (p 0,007). Los factores que predijeron el empleo de la ruta femoral fueron la presencia de electrodos de fijación pasiva [OR IC 95% 13,69 (3,06-62,5) p 0,001] y el tiempo desde el implante del electrodo [OR IC 95% por cada 10 meses 1,04 (1,00-1,09) p 0,044]. Conclusiones: se empleó la ruta femoral en el 25,9% de los procedimientos. No fue eficaz en el 22,7% de las intervenciones. Los factores que predijeron su utilización fueron la presencia de electrodos de fijación pasiva y el tiempo desde el implante del electrodo.
Abstract Introduction: The femoral route is used in electrode removal procedures when the upper route has failed. Objective: To describe the incidence, success rate, complications and predictive factors for the use of the femoral route. Methods: An analysis was performed on the incidence of use of the femoral route and the predictive factors in patients in whom electrode removal was carried out between November 2011 and November 2017. Results: The study included 85 patients with a mean age of 62.36 ± 11.5 years. Pacemakers made up 38.9% of the devices. A total of 135 electrodes, 59.3% of passive fixation, were removed. The median time since the implant was 102 (60-174) months. The femoral route was used in 25.9% of the procedures. Clinical success was achieved in 92.9% of the patients. The removal was not successful in 22.7% of the procedures when the femoral route was used, compared to 1.6% when the upper route was used (P = .004). The removal was not completed in 36.4% of the procedures when the femoral route was used, compared to 9.5% with the upper route (P = .007). The factors that predicted the use of the femoral route were the presence of passive-fixation electrodes (OR = 13.69: 95% CI; 3.06 - 62.5, P = .001), and the time since the electrodes were implanted (OR = 1.04, 95% CI; 1.00 - 1.09, P = .044, for every 10 months). Conclusions: The femoral route was employed in 25.9% of the procedures. It was not effective in 22.7% of the interventions. The factors that predicted its use were the presence of passive-fixation electrodes and the time since the electrode implant.
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Humanos , Masculino , Persona de Mediana Edad , Electrodos , Vena Femoral , Incidencia , Equipos y SuministrosRESUMEN
Resumen Objetivo: El bloqueo interauricular (BIA) es una entidad asociada con un mayor riesgo de presentar fibrilación auricular (FA), constituyendo el denominado síndrome de Bayés. El objetivo de nuestro estudio fue definir la prevalencia de BIA en pacientes menores de 65 años sometidos a cirugía cardiaca y determinar si existe una asociación entre la presencia de BIA y la aparición de FA postoperatoria. Método: Se incluyeron un total de 207 pacientes. Se definió BIA parcial como onda P > 120 ms. Se definió BIA avanzado como onda P > 120 ms con morfología bifásica en derivaciones inferiores. Se determinó la frecuencia de aparición de FA postoperatoria y se realizó un análisis comparativo entre los pacientes que presentaron y los que no presentaron esta arritmia. Resultados: La prevalencia de BIA fue del 78.3% (parcial, 66.2%; avanzado, 12.1%). La frecuencia de aparición de FA fue del 28.5% de forma global, siendo mayor en los pacientes con BIA avanzado (44%) comparado con pacientes con BIA parcial (27.7%) y sin BIA (24.4%). Los pacientes que presentaron FA fueron significativamente mayores, con niveles más elevados de NTproBNP y presentaron mayor prevalencia de dilatación auricular y de patología tiroidea. El análisis multivariable demostró una asociación independiente entre BIA avanzado y FA postoperatoria. Conclusiones: El BIA es una entidad frecuente en pacientes sometidos a cirugía cardiaca. En nuestro estudio, el BIA avanzado se asocia de forma independiente con una mayor frecuencia de FA postoperatoria en pacientes menores de 65 años sometidos a cirugía cardiaca.
Abstract Objective: Interatrial block (IAB) is a well-known entity that is associated with an increased risk of atrial fibrillation (AF). This association is called Bayes' syndrome. The aim of our study was to define the prevalence of IAB among patients younger than 65 years undergoing cardiac surgery and determine whether there is an association between the presence of interatrial conduction delay and postoperative atrial fibrillation (POAF). Method: A total of 207 patients were enrolled. Partial IAB was defined as P-wave > 120 ms. Advanced IAB was defined as P-wave > 120 ms + biphasic morphology in the inferior leads. Ocurrence of POAF was assessed and a comparative analysis was conducted between patients that did and did not develop AF. Results: IAB prevalence was 78.3% (partial 66.2%, advanced 12.1%). POAF occurred in 28.5% of all patients, and was more frequent among patients with advanced IAB (44%) compared to 27.7% and 24.4% of POAF among patients with partial IAB and without IAB, respectively. Patients who developed POAF were significantly older, had significantly higher NTproBNP, higher prevalence of atrial enlargement and thyroid disease. After multivariate analysis, advanced IAB was found to be independently associated with POAF. Conclusions: IAB is a frequent finding among patients undergoing cardiac surgery. According to our results, advanced IAB is independently associated with POAF in younger patients (< 65 years) undergoing cardiac surgery.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Fibrilación Atrial/epidemiología , Bloqueo Interauricular/epidemiología , Procedimientos Quirúrgicos Cardíacos/métodos , Fragmentos de Péptidos/sangre , Fibrilación Atrial/etiología , Prevalencia , Análisis Multivariante , Factores de Edad , Péptido Natriurético Encefálico/sangreRESUMEN
Introducción: Un elevado porcentaje de pacientes no responde a la resincronización. La captura anódica izquierda mediante estimulación a alto voltaje, permite una estimulación multipunto que podría aumentar la tasa de respondedores. Objetivo: Evaluar la viabilidad y eficacia hemodinámica aguda de estimulación a alto voltaje mediante el uso del electrodo cuadripolar Quartet 1458Q®. Métodos: Se incluyeron 18 pacientes consecutivos, con electrodo cuadripolar, en quienes se confirmó captura en el modo deseado mediante monitorización electrocardiográfica. Se compararon las diferencias hemodinámicas agudas de captura anódica (electrodos 1-cátodo- y 4-ánodo, máximo voltaje y anchura), biventricular y ventricular derecha. Mediante el Task Force Monitor, se hizo análisis hemodinámico agudo de presión arterial sistólica, diastólica y media, volumen latido e índice, gasto cardiaco e índice. Para cada variable se analizó el valor máximo, mínimo y promedio, durante fases estables de diez minutos. Resultados: Se analizaron 18 pacientes (5 mujeres-27,8%), con edad media de 67,2 anos Ë (37-81); 33% con fibrilación auricular permanente y 39% con cardiopatía isquémica (sólo 5,6% ambas). La estimulación anódica aumentó significativamente el volumen latido e índice, así como el gasto cardiaco e índice en comparación con el modo biventricular [76,21 vs. 71,04 ml (p = 0,014); 40,67 vs. 37,88 ml/m2 (p = 0,018); 5,29 vs. 4,89 l/min (p = 0,007); 2,86 vs. 2,65 l/min/m2 (p = 0,007), respectivamente]. En el análisis por subgrupos, se concentró el beneficio en los pacientes en ritmo sinusal. Conclusión: La estimulación multipunto mediante captura anódica a través de un electrodo cuadripolar es factible, demostrándose así diferencias significativas en el volumen latido y gasto cardiaco, aunque limitado a la población en ritmo sinusal. © 2015 Sociedad Colombiana de Cardiolog´ia y Cirug´ia Cardiovascular. Publicado por Elsevier Espana, Ë S.L.U. Este es un art´iculo Open Access bajo la CC BY-NC-ND licencia (http:// creativecommons.org/licencias/by-nc-nd/4.0/).
Introduction: A high percentage of patients does not respond to resynchronization. Left anodal capture by means of high-voltage stimulation allows a multipoint stimulation that could increase the responders rate. Objetive: To assess viability and acute hemodynamic effectiveness of high voltage stimulation using the quadripolar lead Quartet 1458Q®. Methods: 18 consecutive patients with quadripolar lead were included. The capture was con- firmed by means of electrocardiographic monitoring. Acute hemodynamic differences of anodal capture were compared (lead 1-cathode and 4-anode, maximum voltage and width), biventricular and right ventricular. Using the Task Force Monitor an acute hemodynamic analysis of systolic, diastolic and average blood pressure, stroke volume and index, cardiac output and index was conducted. For each variable the maximum, minimum and average values were reached during ten minute stable phases. Results: 18 patients (5 women - 27.8%) were analyzed, with an average age of 67.2 years (37- 81); 33% with permanent atrial fibrillation and 39% with ischemic cardiopathology (only 5.6% with both). Anodal stimulation significantly raised the stroke volume and index, as well as the cardiac output and index compared to the biventricular mode [76.21 vs. 71.04 ml (p = 0.014); 40.67 vs. 37.88 ml/m2 (p = 0.018); 5.29 vs. 4.89 l/min (p = 0.007); 2.86 vs. 2.65 l/min/m2 (p = 0.007), respectively]. Subgroup analysis focused on the benefit for patients in sinus rhythm. Conclusion: Multipoint stimulation by means of anodal capture using a quadripolar lead is possible. This further proves significant improvement in the stroke volume and cardiac output, though limited to the population in sinus rhythm. © 2015 Sociedad Colombiana de Cardiolog´ia y Cirug´ia Cardiovascular. Published by Elsevier Espana, Ë S.L.U. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)..