Conduction system pacing and atrioventricular node ablation in heart failure: The PACE-FIB study design.

AIMS: Atrial fibrillation (AF) worsens the prognosis of patients with heart failure (HF). Successful treatments are still very scarce for those with permanent AF and preserved (HFpEF) or mildly reduced (HFmrEF) ejection fraction. In this study, the long-term benefits and safety profile of heart rate regularization through left-bundle branch pacing (LBBP) and atrioventricular node ablation (AVNA) will be explored in comparison with pharmacological rate-control strategy. METHODS AND RESULTS: The PACE-FIB trial is a multicentre, prospective, open-label, randomized (1:1) clinical study that will take place between March 2022 and February 2027. A total of 334 patients with HFpEF/HFmrEF and permanent AF will receive either LBBP followed by AVNA (intervention arm) or optimal pharmacological treatment for heart rate control according to European guideline recommendations (control arm). All patients will be followed up for a minimum of 36 months. The primary outcome measure will be the composite of all-cause mortality, HF hospitalization, and worsening HF at 36 months. Other secondary efficacy and safety outcome measures such as echocardiographic parameters, functional status, and treatment-related adverse events, among others, will be analysed too. CONCLUSION: LBBP is a promising stimulation mode that may foster the clinical benefit of heart rate regularization through AV node ablation compared with pharmacological rate control. This is the first randomized trial specifically addressing the long-term efficacy and safety of this pace-and-ablate strategy in patients with HFpEF/HFmrEF and permanent AF.

Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

BACKGROUND: Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA. METHODS: A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built. RESULTS: Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan-Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4-75.8%) in the Prior-CB, and 89.2% (95% CI 73.6-95.9%) in the Prior-RF group (p = 0.002). Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05-6.79). CONCLUSIONS: Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991.

Clinical guide for the diagnosis and follow-up of myotonic dystrophy type 1, MD1 or Steinert's disease. / Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert.

BACKGROUND AND OBJECTIVES: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. MATERIAL AND METHODS: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. RECOMMENDATIONS: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. CONCLUSION: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up.

[Clinical characteristics, epidemiology and prognosis of acute coronary syndrome without ST-segment elevation and angiographically normal coronary arteries]. / Características clínicas, epidemiología y pronóstico del síndrome coronario agudo sin elevación del segmento ST con coronarias sanas.

BACKGROUND AND OBJECTIVE: It has been estimated that up to 12% of patients with acute myocardial infarction do not present coronary atherosclerotic disease demonstrable with angiographic studies. We assessed the clinical characteristics and prognosis of acute coronary syndrome without ST-segment elevation with angiographically normal coronary arteries. PATIENTS AND METHOD: Comparative retrospective analysis of 58 consecutive patients with this diagnosis and a sample (n = 59) with lesions in angiographic studies, analyzing demographic characteristics, analytical parameters, electrocardiogram, ventricular function and prognosis. RESULTS: The group represented 19% of the totality of acute coronary syndromes, showing a lower prevalence rates of hypercholesterolemia, diabetes mellitus and no record of ischemic heart disease (p = 0.043 to p = 0.005). The presence of regional wall motion abnormalities was significantly higher in the group with angiographic lesions (76.3% vs 41.4%; p < 0.01). In-hospital mortality rate showed a non significant trend toward to be lower in the group with normal angiogram (1.7% vs 8.4%). CONCLUSIONS: The absence of significant coronary artery disease in acute coronary syndrome without ST-segment elevation is not infrequent and was related to a lower cardiovascular risk profile and the absence of regional wall motion abnormalities showing a trend toward better in-hospital prognosis.

Functional assessment of coronary artery disease by intravascular ultrasound and computational fluid dynamics simulation.

Clinical trials have shown that functional assessment of coronary stenosis by fractional flow reserve (FFR) improves clinical outcomes. Intravascular ultrasound (IVUS) complements conventional angiography, and is a powerful tool to assess atherosclerotic plaques and to guide percutaneous coronary intervention (PCI). Computational fluid dynamics (CFD) simulation represents a novel method for the functional assessment of coronary flow. A CFD simulation can be calculated from the data normally acquired by IVUS images. A case of coronary heart disease studied with FFR and IVUS, before and after PCI, is presented. A three-dimensional model was constructed based on IVUS images, to which CFD was applied. A discussion of the literature concerning the clinical utility of CFD simulation is provided.

[Spanish Implantable Cardioverter-Defibrillator Registry. Fourth Official Report of the Spanish Society of Cardiology Working Group on Implantable Cardioverter-Defibrillators (2007)]. / Registro Español de Desfibrilador Automático Implantable. IV Informe Oficial del Grupo de Trabajo de Desfibrilador Automático Implantable de la Sociedad Española de Cardiología (2007).

INTRODUCTION AND OBJECTIVES: This article presents the 2007 findings of the Spanish Implantable Cardioverter-Defibrillator (ICD) Registry, established by the Working Group on Implantable Cardioverter-Defibrillators, Electrophysiology and Arrhythmia Section, Spanish Society of Cardiology. METHODS: The Spanish Society of Cardiology received prospective data recorded on a single-page questionnaire on 96.6% of device implantations. RESULTS: Overall, 3,291 implantations were reported (90.1% of the estimated total). The reported implantation rate was 72.8 per million inhabitants, and 77.1% were first implantations. The majority of ICDs were implanted in males (mean age, 61 [12] years) in functional class II with severe or moderate-to-severe left ventricular dysfunction. The most frequent form of heart disease was ischemic heart disease, followed by dilated cardiomyopathy. Indications for primary prevention remained unchanged relative to the previous year and now account for half of all first implantations, with an increasing number of patients with dilated cardiomyopathy. The number of ICDs incorporating cardiac resynchronization therapy has increased slightly and now comprises 30.1% of the total. Around 70% of ICD implantations were performed in an electrophysiology laboratory by a cardiac electrophysiologist. The incidence of complications was very low. CONCLUSIONS: The 2007 Spanish Implantable Cardioverter-Defibrillator Registry contains data on more than 90% of all ICD implantations performed in Spain, thereby confirming that it has become increasingly representative in recent years. The number of implantations has continued to grow, though the proportion carried out for primary prevention has stabilized at around 50%.