Neutralizing Autoantibodies to Type I IFNs in >10% of Patients with Severe COVID-19 Pneumonia Hospitalized in Madrid, Spain.

BACKGROUND: In a recent study, autoantibodies neutralizing type I interferons (IFNs) were present in at least 10% of cases of critical COVID-19 pneumonia. These autoantibodies neutralized most type I IFNs but rarely IFN-beta. OBJECTIVES: We aimed to define the prevalence of autoantibodies neutralizing type I IFN in a cohort of patients with severe COVID-19 pneumonia treated with IFN-beta-1b during hospitalization and to analyze their impact on various clinical variables and outcomes. METHODS: We analyzed stored serum/plasma samples and clinical data of COVID-19 patients treated subcutaneously with IFN-beta-1b from March to May 2020, at the Infanta Leonor University Hospital in Madrid, Spain. RESULTS: The cohort comprised 47 COVID-19 patients with severe pneumonia, 16 of whom (34%) had a critical progression requiring ICU admission. The median age was 71 years, with 28 men (58.6%). Type I IFN-alpha- and omega-neutralizing autoantibodies were found in 5 of 47 patients with severe pneumonia or critical disease (10.6%), while they were not found in any of the 118 asymptomatic controls (p = 0.0016). The autoantibodies did not neutralize IFN-beta. No demographic, comorbidity, or clinical differences were seen between individuals with or without autoantibodies. We found a significant correlation between the presence of neutralizing autoantibodies and higher C-reactive protein levels (p = 5.10e-03) and lower lymphocyte counts (p = 1.80e-02). No significant association with response to IFN-beta-1b therapy (p = 0.34) was found. Survival analysis suggested that neutralizing autoantibodies may increase the risk of death (4/5, 80% vs 12/42, 28.5%). CONCLUSION: Autoantibodies neutralizing type I IFN underlie severe/critical COVID-19 stages in at least 10% of cases, correlate with increased C-RP and lower lymphocyte counts, and confer a trend towards increased risk of death. Subcutaneous IFN-beta treatment of hospitalized patients did not seem to improve clinical outcome. Studies of earlier, ambulatory IFN-beta treatment are warranted.

The RITHMI study: diagnostic ability of a heart rhythm monitor for automatic detection of atrial fibrillation.

INTRODUCTION AND OBJECTIVES: Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist device designed for automatic AF detection. METHODS: RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram. RESULTS: The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98). CONCLUSIONS: This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.

Aortic thrombus in patients with severe COVID-19: review of three cases.

Coronavirus disease 2019 (COVID-19) could predispose to both venous and arterial thromboembolism, in an exaggerated immune response to the virus, especially in severe patients. Even though aortic clots are a rare entity, the pro-coagulant nature of COVID-19 is associated with thrombosis in atypical locations and should be considered in patients with severe abnormalities in coagulation parameters. We describe a series of three cases of aortic thrombi diagnosed by computerized tomography (CT) angiography in patients with confirmed SARS-CoV-2 infection.

Spanish Pacemaker Registry. Ninth official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2011).

INTRODUCTION AND OBJECTIVES: To describe the results of the analysis of pacemaker implantations reported to the Spanish Pacemaker Registry in 2011, with particular reference to the population distribution and the selection of pacing modes. METHODS: Information provided by the European Pacemaker Patient Identification Card was processed using a purpose-built computer application. RESULTS: Data from 115 hospitals were analyzed, totaling 13,373 cards, representing an estimated 38% of implantations. The number of pacemaker generators and resynchronization devices implanted was 738 and 56.2 units per million population, respectively. The mean age of the patients who received a device was 76.7 years. Overall, 57.2% of first implantations and 56.5% of replacements were performed in men. Most implantations (38.7%) and generator replacements (41.9%) were performed in patients aged between 80 and 89 years. Of the pacemaker leads used, 99.7% were bipolar and 63% used an active fixation system. Overall, 20% of the patients with atrioventricular block or sick sinus syndrome were paced in VVI/R mode despite being in sinus rhythm. CONCLUSIONS: With respect to previous years, the use of conventional pacemakers remained stable and the implantation of resynchronization devices has increased. The number of implantation procedures continues to be higher in men and in younger patients. Age and the degree of blockage remain as factors influencing the appropriate choice of pacing mode.

Ischemic time as a predictor of physical recovery in the first months after heart transplantation.

Functional results after heart transplantation range from modest to spectacular improvement. Little is known about factors to predict functional result. This study aimed to identify these factors. We present a prospective study including all consecutive transplant recipients (n = 55) in a two-year period whose survival was greater than two months. Perioperative, donor, and recipient issues were systematically analyzed. Exercise capacity was assessed by symptom-limited treadmill exercise testing two months after transplantation. Exercise capacity was classified as satisfactory or poor depending on achieving or not 4.5 METs (metabolic equivalents), respectively. Thirty-three patients (60%) showed a good exercise capacity (>4.5 METs), whereas the remaining twenty-two patients (40%) were unable to exceed this threshold. The variables which correlated with exercise capacity in univariate analysis were recipient age, inotropic treatment, ischemic time, ventricular assist device, etiology, urgent transplant, and INTERMACS score. Among them only recipient age and ischemic time were proved to be correlated with exercise capacity in the multiple regression analysis. Thus, younger patients and those who had received an organ with shorter ischemic time showed greater exercise capacity after transplant. These findings strengthen the trend toward reducing ischemic time as much as possible to improve both survival and clinical recovery.

Cross-sectional study of cardiac resynchronization therapy in Spain. Indications, implant techniques, optimization and follow-up.

INTRODUCTION AND OBJECTIVES: A cross-sectional study of cardiac resynchronization therapy use in Spain was performed to analyze problems with indications, implantation, and patient follow-up. METHODS: Spanish cardiac resynchronization therapy implanter centers were identified, then the department members were surveyed and the data were recorded by each implantation team. RESULTS: Eighty-eight implanter centers were identified; of these, 85 (96.6%) answered the survey. A total of 2147 device implantations were reported, comprising 85.6% of the overall number of 2518 implantations estimated by the European Confederation of Medical Suppliers Associations for the same period. The reported implantation rate was 46 per million inhabitants versus an estimated implantation rate of 51 per million (European average, 131). Cardiac resynchronization therapy devices accounted for 84% of implantations, and upgrades to previously implanted devices, 16%. The majority of cardiac resynchronization therapy devices were implanted in men (70.7%). The mean age was 68 (12) years, and the mean left ventricular ejection fraction was 26.4% (5%). Most patients (67%) were in New York Heart Association functional class III. The group of patients for whom cardiac resynchronization therapy was indicated according to the latest update of the guidelines was significant: 17.3% among New York Heart Association class II patients and more than 21.6% among patients with atrial fibrillation. In all, electrophysiologists accounted for 73.8% of implanters, followed by surgeons, accounting for 21.4%. CONCLUSIONS: The latest update of the guidelines is being progressively implemented in Spain, according to data obtained in patients in New York Heart Association class II or with atrial fibrillation. Nevertheless, the number of cardiac resynchronization therapy device implants is still well below the European average.

[Clinical factors and biomarkers associated with subclinical atherosclerosis in the human immunodeficiency virus infection]. / Factores clínicos y biomarcadores asociados a lesión vascular subclínica en la infección por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: HIV-infected patients present accelerated cardiovascular disease (CVD) and CVD is among the most important causes of mortality in this population. We aimed to identify biomarkers and clinical factors associated with subclinical atherosclerosis in HIV-infected patients. PATIENTS AND METHODS: Carotid intima-media thickness (cIMT) and cardiovascular biomarkers were measured in 235 HIV-infected patients. Individuals with a cIMT ≥ 75th percentile or plaque were classified as having subclinical atherosclerosis and compared with patients without subclinical atherosclerosis. RESULTS: Age was 46 (11) years old. Mean cIMT was 0.58 (0.13)mm. Sixty-five (27.8%) patients had subclinical atherosclerosis. These subjects had more frequently lipodystrophy (OR:2.7; CI95%:1.4-4.9), immunosuppression (OR:2.5; CI95%:1.1-5.8), longer time to HIV diagnosis (≥ p50 [10 years], OR:1.4; CI95%:1.1-2.9), longer exposure to nucleoside analogues (≥ p50 [132 months], OR:3.2; CI95%:1.7-6) and to protease inhibitors (≥ p50 [24 months], OR:2.2; CI95%:1.1-3.6). They also showed higher levels of several biomarkers such as NT-proBNP (≥ p75 [72.6 pg/ml], OR:2.0; CI95%:1-4.1) and albumin/creatinine urine ratio (≥ p50 [5mg/g], OR:3.8; CI95%:1.3-11). After the multivariate analysis, subclinical atherosclerosis was associated with age (OR:6.6; CI95%:2.2-19.5; P=.001), a longer time to HIV diagnosis (OR:3.1; CI95%:1.0-11.0; P=.044) and immunosuppression (OR:2.8; CI95%:1-8.3; P=.048). CONCLUSIONS: Among HIV-infected patients, time to HIV diagnosis and immunosuppression were independently associated with subclinical atherosclerosis. Patients with subclinical atherosclerosis showed increased levels of vascular damage biomarkers, especially albumin/creatinine urine ratio and NT-proBNP.

[Advances in cardiac pacing]. / Novedades en estimulación cardiaca.

This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.

[Spanish pacemaker registry. Eighth official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2010)]. / Registro Español de Marcapasos. VIII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2010).

INTRODUCTION AND OBJECTIVES: Our aim is to describe the analysis of the pacemaker implants and replacements reported to the Spanish Pacemaker Registry in 2010, with special reference to the selection of pacing modes. METHODS: Data collection was based on the information provided by the European Pacemaker Patient Identification Card, which was processed using a specially designed computer application. RESULTS: Information was received from 101 hospitals, covering a total of 11 648 cards. An estimated 738 pacemaker generators per million population were placed in 2010. The number of pacemaker implantations is higher and the mean age of the recipients lower among men. Overall, 95.5% of the pacemaker leads used were bipolar, 56% employed an active fixation system, and 60% were placed in atrium. The most common electrocardiographic indication was atrioventricular block, followed by sick sinus syndrome. Twenty-four percent of the patients with atrioventricular block and 25.6% of those with sick sinus syndrome are being paced in VVI/R mode (12% of the patients in each group are aged 80 years or under). Cardiac resynchronization device implantation has reached the level of 47 units per million population, 25.7% of which are not associated with implantable cardioverter defibrillators. CONCLUSIONS: The upward trend in the use of pacemaker generators continues. The pacemaker leads used are predominantly bipolar, and the majority are active fixation leads. Age remains a factor in the choice of the appropriate pacing mode for the different types of heart disease. This choice could be improved in more than 20% of the cases of pacemaker implantation.

[Progress in cardiac pacing]. / Avances en estimulación cardiaca.

This article contains a discussion of the most recent developments in cardiac resynchronization therapy, of the feasibility of performing magnetic resonance imaging in patients with cardiac pacemakers, and of the current and future status of leadless pacing. Finally, the most significant scientific articles published in the last year are reviewed.

Spanish Pacemaker Registry. Seventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2009).

INTRODUCTION AND OBJECTIVES: This article describes the finding of an analysis of all pacemaker implants reported to the Spanish Pacemaker Registry in 2009. Particular attention is paid to patients' demographic characteristics and to the pacing modes selected for various electrocardiographic indications. METHODS: The information provided by the European Pacemaker Identification Card was analyzed using a specially developed computer program. RESULTS: Data were received from 106 centers, covering a total of 11,939 cards and corresponding to 35% of all pacemakers implanted. The average age of patients receiving pacemakers was 76.6 years. Overall, 58.4% of pacemakers were implanted in men. The largest number of electrocardiographic indications for a pacemaker was for third-degree atrioventricular block, which comprised 56% of all atrioventricular blocks. The VVIR pacing mode was used for 24.0% of patients with sick sinus syndrome and 23.5% with atrioventricular block. Over 50% of leads employed an active fixation system, and 65% were placed in the atrium. CONCLUSIONS: The trend of increasing pacemaker use continued in 2009, reaching 729 units per million population. Pacemaker implantation was more frequent in males, who received them at a slightly younger age than women. Age was a more significant determinant of inappropriate pacing mode selection than electrocardiographic abnormalities. Active fixation of pacemaker leads was used in more than 50% of cases.

[Progress in cardiac pacing]. / Novedades en estimulación cardiaca.

This review discusses the utility and current status of remote monitoring in patients with cardiac devices in Spain, the different anticoagulation strategies used during device implantation, the surgical replacement and maintenance of pacemakers and defibrillators, and the present and future importance of impedance sensors in cardiac pacing and heart failure management. Finally, there is a summary of the most relevant scientific articles published in the last year.

Spanish pacemaker registry. 6th official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2008).

INTRODUCTION AND OBJECTIVES: This article describes the findings of an analysis of data on pacemaker implantations and replacements reported to the Spanish Pacemaker Registry during 2008. METHODS: The data came primarily from information recorded on European Pacemaker Patient Identification Cards. RESULTS: Data were received from 116 hospital units, which submitted a total of 11,855 identification cards representing 36.3% of all pacemakers implanted. There was a marked increase in the number of pacemaker units used, which rose to a rate of 708.3 per million inhabitants. The frequency of pacemaker implantation increased and the mean age of male patients decreased. The largest number of implantations were carried out in patients in their 70s, who comprised 39.1% of the total. The most frequent electrocardiographic indication was atrioventricular block. With regard to pacing leads, active fixation leads were used in the atrium in 59.3% of cases and in the ventricle in 37.9% of cases. There was an improvement in the choice of pacing mode, with age being a determining factor. For example, in sick sinus syndrome, the VVI/R mode was used in a 29% of patients aged over 80 years compared with 14% of those aged under 80 years. CONCLUSIONS: Age was found to be one factor influencing the selection of the most appropriate pacing mode. Active fixation leads were used more often, reaching 44.5% of leads implanted. Atrioventricular pacing was used in a greater percentage of cases than in any other time period covered by the pacemaker registry.

[Progress in cardiac pacing]. / Novedades en estimulación cardiaca.

This review article summarizes the fundamental principles of radiological protection for interventional cardiologists. In addition, the scientific articles on cardiac pacing that have had the greatest impact in the last year are also summarized. Two cardiac pacing techniques are described: His-bundle pacing and cardiac contractility modulation.

Pacemaker malfunction or non-physiological ventricular pacing?

Pacemaker manufacturers have developed new algorithms to preserve intrinsic conduction in order to reduce unnecessary stimulation and looking for physiological pacing. This case report highlights some of the new challenges related to these algorithms which include possible ECG misinterpretations and inaccurate programming leading to potential negative consequences.

[Spanish Pacemaker Registry. Fourth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Stimulation (2006)]. / Registro Español de Marcapasos. IV Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2006).

INTRODUCTION AND OBJECTIVES: The aim of this report was to describe the results of an analysis of the data on pacemaker implantations reported to the Spanish Pacemaker Registry during 2006. Special emphasis was placed on sociodemographic characteristics and on the pacing modes implemented for different electrocardiographic indications. METHODS: The data collected comprised all the information recorded with the European Pacemaker Patient Identification Card. Special software was used for the analysis. RESULTS: Information was received from 105 centers and involved a total of 10,401 cards. It represented 35% of all pacemakers implanted during 2006. The majority of implantations (57.5%) were performed in males, and this applied to all age decades, except the 90s. The average age of patients who received a first implant was 75 years. Atrioventricular block accounted for the greatest number of electrocardiographic indications. Some 25% of patients with sinus node disease received VVI/R pacing despite remaining in sinus rhythm. In addition, 1.5% of implanted devices provided cardiac pacing for ventricular resynchronization, and did not have an associated defibrillator function. Almost all the leads used were bipolar, with only 0.6% being unipolar. In addition, 35.2% of leads were active-fixation leads, while 24.3% of generator used throughout the year were for pulse generator replacement. Some 2.4% of generator replacements were due to erosion or infection. CONCLUSIONS: The number of pacemaker implantations and the incidence of conduction disturbance were both greater in males. Correspondingly, first implantations were carried out at a slightly younger age in males. The age decade during which the greatest number of pacemaker implantations was carried out was the 70s, followed by the 80s. Age was one of the factors that influenced the suitability of the pacing mode. In a significant percentage of patients, the pacing mode was inappropriate. The use of active-fixation electrodes continues to increase.

[Current topics (2005) in cardiac pacing]. / Temas de actualidad en estimulación cardíaca 2005.

Currently, three areas of active development in cardiac pacing are of particular interest to clinical cardiologists. Biventricular pacing is now considered a type-I indication for adjuvant treatment in advanced and refractory heart failure. Consequently, some changes in everyday clinical practice will be seen when patients with end-stage heart failure start to receive resynchronization therapy. Secondly, the Cardiac Pacing Working Group of the Spanish Society of Cardiology has developed a national consensus document on sleep apnea and cardiac rhythm abnormalities. It appears that a novel way of tackling the current growing epidemic could be to use permanent cardiac pacing in an attempt to modify the cardiac rhythm alterations, mainly bradyarrhythmias, related to sleep apnea. Finally, promising developments are taking place in systems designed to reduce the unwanted right ventricular stimulation sometimes observed with antibradycardia pacing modalities. These new systems are expected to minimize significantly the well-known deleterious hemodynamic effects sometimes seen in our patients.