Impact of face masks during the treadmill exercise tests. / Impacto del uso de la mascarilla durante la realización de la prueba de esfuerzo en tapiz rodante.

INTRODUCTION AND OBJECTIVE: There is little literature on the use of face masks in a treadmill test (TMT) during the COVID-19 pandemic. The objective of this study is to analyze the impact of face masks during a TMT performed during the prepandemic (without face mask) and postpandemic (with face mask) era. METHODS: Retrospective observational unicentric study of patients undergoing TMT. The inclusion criterion were being over 16years old and having performed at least one TMT in the prepandemic and postpandemic period. RESULTS: One thousand six hundred fifty-five patients were included in the study. Nine hundred thirty-five (56.5%) were men and 720 (43.5%) women. The mean age was 57.3±14.9 and the mean follow-up time was 15.4 months. Fifty-three percent patients had arterial hypertension, 20% dyslipidemia, 12% diabetes mellitus, 8% smoking habit, 19% personal history of ischemic heart disease, 5% COPD, 8% bronchial asthma, and 8% atrial fibrillation. In almost all the variables studied in PE, including the appearance of ventricular arrhythmias, no significant differences were found, neither by age nor sex, except for the existence of a very slight decrease in exercise capacity with mask use in older patients (>65years). CONCLUSIONS: The use of surgical or FFP2 face masks during the TMT did not affect functional capacity, blood pressure, heart rate, or increased ventricular arrhythmias.

Recomendaciones para el ejercicio físico en deportistas con cardiopatías familiares (segunda parte) / Recommendations for physical exercise in athletes with inherited heart diseases (second part)

La seguridad de la actividad física y deportiva en pacientes con cardiopatías familiares aún no está bien establecida. Las recomendaciones sobre el ejercicio físico en estos pacientes suele ser bastante restrictiva sin que haya clara evidencia para ello, a pesar de que el deporte haya demostrado importantes beneficios cardiovasculares. La participación en deportes en los adultos con cardiopatías familiares se considera un territorio relativamente poco conocido y muchos clínicos se encuentran con dificultades en el asesoramiento a sus pacientes. El desarrollo de la medicina actual ha supuesto una mejoría significativa en el estudio de las cardiopatías familiares, así como en su diagnóstico precoz y tratamiento. Asimismo, los estudios genéticos han supuestos un pilar fundamental en el seguimiento de estas cardiopatías, guiando de manera más adecuada la actitud terapéutica que debemos seguir. Hasta hace poco tiempo, los pacientes que presentan dichas cardiopatías han sido descalificados de manera frecuente de los deportes competitivos y en muchas ocasiones, se recomienda el cese completo de la actividad física, incluido el deporte tipo recreacional. Sin embargo, las recomendaciones actuales son menos restrictivas, insistiendo en individualizar los diferentes casos en función del tipo de patología, del tipo de actividad física realizada, si éstos presentan la enfermedad o son únicamente portadores de mutaciones genéticas causales, etc. Las investigaciones actuales se centran fundamentalmente en la seguridad de la actividad física en pacientes con cardiopatías familiares, y el temor a que la práctica de actividad física a nivel competitivo pueda aumentar significativamente el riesgo de eventos adversos, especialmente de eventos arrítmicos y muerte súbita. En esta revisión, analizamos numerosos estudios y las guías de práctica clínica, con el fin de establecer las recomendaciones de actividad física, así como sus restricciones en función de los diferentes tipos de cardiopatías familiares

The safety of physical activity and sports in patients with inherited heart disease is not well established. The recommendations on physical exercise in these patients are usually quite restrictive without clear evidence for this, despite the fact that sport has shown important cardiovascular benefits. Participation in sports in adults with inherited heart disease is considered a relatively little known territory and many clinicians find it difficult to advise their patients. The development of current medicine has meant a significant improvement in the study of inherited heart diseases, as well as in their early diagnosis and treatment. In addition, genetic studies have assumed a fundamental aspect in the follow-up of these heart diseases, guiding more appropriately the therapeutic attitude that we must follow. Until recently, patients with such heart disease have been frequently disqualified from competitive sports, and in many cases, complete cessation of physical activity, including recreational sport, is recommended. However, current recommendations are less restrictive, insisting on individualizing the different cases depending on the type of pathology, the type of physical activity performed, whether they present the disease or are only carriers of causal genetic mutations, etc. Current research focuses primarily on the safety of physical activity in patients with inherited heart disease and the fear that the practice of competitive physical activity can significantly increase the risk of adverse events, especially arrhythmic events and sudden death. In this review, we analyzed numerous studies and clinical practice guidelines, in order to establish the recommendations of physical activity, as well as their restrictions depending on the different types of inherited heart disease

Recomendaciones para el ejercicio físico en deportistas con cardiopatías familiares (primera parte) / Recommendations for physical exercise in athletes with inherited heart diseases (first part)

La seguridad de la actividad física y deportiva en pacientes con cardiopatías familiares aún no está bien establecida. Las recomendaciones sobre el ejercicio físico en estos pacientes suele ser bastante restrictiva sin que haya clara evidencia para ello, a pesar de que el deporte haya demostrado importantes beneficios cardiovasculares. La participación en deportes en los adultos con cardiopatías familiares se considera un territorio relativamente poco conocido y muchos clínicos se encuentran con dificultades en el asesoramiento a sus pacientes. El desarrollo de la medicina actual ha supuesto una mejoría significativa en el estudio de las cardiopatías familiares, así como en su diagnóstico precoz y tratamiento. Asimismo, los estudios genéticos han supuestos un pilar fundamental en el seguimiento de estas cardiopatías, guiando de manera más adecuada la actitud terapéutica que debemos seguir. Hasta hace poco tiempo, los pacientes que presentan dichas cardiopatías han sido descalificados de manera frecuente de los deportes competitivos y en muchas ocasiones, se recomienda el cese completo de la actividad física, incluido el deporte tipo recreacional. Sin embargo, las recomendaciones actuales son menos restrictivas, insistiendo en individualizar los diferentes casos en función del tipo de patología, del tipo de actividad física realizada, si éstos presentan la enfermedad o son únicamente portadores de mutaciones genéticas causales, etc. Las investigaciones actuales se centran fundamentalmente en la seguridad de la actividad física en pacientes con cardiopatías familiares, y el temor a que la práctica de actividad física a nivel competitivo pueda aumentar significativamente el riesgo de eventos adversos, especialmente de eventos arrítmicos y muerte súbita. En esta revisión, analizamos numerosos estudios y las guías de práctica clínica, con el fin de establecer las recomendaciones de actividad física, así como sus restricciones en función de los diferentes tipos de cardiopatías familiares

The safety of physical activity and sports in patients with inherited heart disease is not well established. The recommendations on physical exercise in these patients are usually quite restrictive without clear evidence for this, despite the fact that sport has shown important cardiovascular benefits. Participation in sports in adults with inherited heart disease is considered a relatively little known territory and many clinicians find it difficult to advise their patients. The development of current medicine has meant a significant improvement in the study of inherited heart diseases, as well as in their early diagnosis and treatment. In addition, genetic studies have assumed a fundamental aspect in the follow-up of these heart diseases, guiding more appropriately the therapeutic attitude that we must follow. Until recently, patients with such heart disease have been frequently disqualified from competitive sports, and in many cases, complete cessation of physical activity, including recreational sport, is recommended. However, current recommendations are less restrictive, insisting on individualizing the different cases depending on the type of pathology, the type of physical activity performed, whether they present the disease or are only carriers of causal genetic mutations, etc. Current research focuses primarily on the safety of physical activity in patients with inherited heart disease and the fear that the practice of competitive physical activity can significantly increase the risk of adverse events, especially arrhythmic events and sudden death. In this review, we analyzed numerous studies and clinical practice guidelines, in order to establish the recommendations of physical activity, as well as their restrictions depending on the different types of inherited heart disease

La flecainida reduce las arritmias ventriculares en pacientes con taquicardia ventricular polimórfica catecolaminérgica genotipo RyR2 positivo / Flecainide reduces ventricular arrhythmias in patients with genotype RyR2-positive catecholaminergic polymorphic ventricular tachycardia

Introducción y objetivos: La taquicardia ventricular polimórfica catecolaminérgica (TVPC) es una enfermedad hereditaria caracterizada por arritmias ventriculares (AV) polimórficas o bidireccionales desencadenadas por estrés físico o emocional en jóvenes con corazón estructuralmente normal. El pilar del tratamiento son los bloqueadores beta y recientemente se ha incorporado la flecainida al arsenal terapéutico. El objetivo de este trabajo es exponer nuestra experiencia con su uso. Métodos: De un total de 174 pacientes pertenecientes a 7 familias afectadas de TVPC con genotipo positivo, se analizó a los que tomaron flecainida. Se valoraron la indicación, los efectos secundarios, la dosificación, los eventos clínicos, las AV y la ventana arrítmica en las pruebas de esfuerzo y las descargas del desfibrilador automático (DAI). Resultados: Recibieron flecainida 18 pacientes (10,4%); 17 en combinación con bloqueadores beta y 1 como tratamiento único por intolerancia al bloqueador beta. Ningún paciente sufrió efectos secundarios. La indicación fue la persistencia de AV complejas en la prueba de esfuerzo en 13 pacientes (72,2%) y descargas frecuentes del DAI en los otros 5 (27,8%). En el 66,7% de la familia 1, la puntuación cuantitativa de AV en la prueba de esfuerzo se redujo más de un 50% (32,76 ± 84,06 frente a 74,38 ± 153,86 lpm; p = 0,018). La ventana arrítmica fue menor (5,8 ± 11,9 frente a 19,69 ± 21,27 lpm; p = 0,007) y 4 de los 5 pacientes con descargas apropiadas del DAI no sufrieron más descargas. Conclusiones: En pacientes con TVPC, la flecainida reduce los eventos clínicos, las AV, la ventana arrítmica y las descargas del DAI y los pacientes la toleran bien (AU)

Introduction and objectives: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disease characterized by polymorphic or bidirectional ventricular arrhythmias (VA) triggered by physical or emotional stress in young people with a structurally normal heart. Beta-blockers are the cornerstone of treatment, while flecainide has recently been incorporated into the therapeutic arsenal. The aim of this study was to report our experience with this drug. Methods: The cohort included 174 genotype-positive CPVT-patients from 7 families. We collected data from patients who were receiving flecainide and analyzed the indications, adverse effects and dosage, clinical events, VA and arrhythmic window during exercise testing, and implantable cardioverter-defibrillator (ICD) shocks during follow-up. Results: Eighteen patients (10.4%) received flecainide; 17 patients in combination with beta-blockers, and 1 patient as monotherapy due to beta-blocker intolerance. None of the patients presented side effects. In 13 patients (72.2%) the indication was the persistence of exercise-induced VA and in 5 patients (27.7%) persistent ICD-shocks, despite on beta-blockers. After flecainide initiation, the exercise-induced VA quantitative score was reduced by more than 50% in 66.7% of the members of family 1 (32.76 ± 84.06 vs 74.38 ± 153.86; P = .018). The arrhythmic window was reduced (5.8 ± 11.9 bpm vs 19.69 ± 21.27 bpm; P = .007), and 4 of 5 patients with appropriate ICD shocks experienced no further shocks in the follow-up. Conclusions: In CPVT-patients flecainide reduces clinical events, exercise-induced VA, the arrhythmic window, and ICD shocks, with good tolerance (AU)

Flecainide Reduces Ventricular Arrhythmias in Patients With Genotype RyR2-positive Catecholaminergic Polymorphic Ventricular Tachycardia.

INTRODUCTION AND OBJECTIVES: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disease characterized by polymorphic or bidirectional ventricular arrhythmias (VA) triggered by physical or emotional stress in young people with a structurally normal heart. Beta-blockers are the cornerstone of treatment, while flecainide has recently been incorporated into the therapeutic arsenal. The aim of this study was to report our experience with this drug. METHODS: The cohort included 174 genotype-positive CPVT-patients from 7 families. We collected data from patients who were receiving flecainide and analyzed the indications, adverse effects and dosage, clinical events, VA and arrhythmic window during exercise testing, and implantable cardioverter-defibrillator (ICD) shocks during follow-up. RESULTS: Eighteen patients (10.4%) received flecainide; 17 patients in combination with beta-blockers, and 1 patient as monotherapy due to beta-blocker intolerance. None of the patients presented side effects. In 13 patients (72.2%) the indication was the persistence of exercise-induced VA and in 5 patients (27.7%) persistent ICD-shocks, despite on beta-blockers. After flecainide initiation, the exercise-induced VA quantitative score was reduced by more than 50% in 66.7% of the members of family 1 (32.76 ± 84.06 vs 74.38 ± 153.86; P = .018). The arrhythmic window was reduced (5.8 ± 11.9 bpm vs 19.69 ± 21.27 bpm; P = .007), and 4 of 5 patients with appropriate ICD shocks experienced no further shocks in the follow-up. CONCLUSIONS: In CPVT-patients flecainide reduces clinical events, exercise-induced VA, the arrhythmic window, and ICD shocks, with good tolerance.

Economic evaluations of implantable cardioverter defibrillators: a systematic review.

The aim of this paper was to review the cost-effectiveness studies of implantable cardioverter defibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD). A systematic review of the literature published in English or Spanish was performed by electronically searching MEDLINE and MEDLINE in process, EMBASE, NHS-EED, and EconLit. Some keywords were implantable cardioverter defibrillator, heart failure, heart arrest, myocardial infarction, arrhythmias, syncope, sudden death. Selection criteria were the following: (1) full economic evaluations published after 1995, model-based studies or alongside clinical trials (2) that explored the cost-effectiveness of ICD with or without associated treatment compared with placebo or best medical treatment, (3) in adult patients for primary or secondary prevention of SCD because of ventricular arrhythmias. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. The methodological quality of the studies was assessed and a narrative synthesis was prepared. In total, 24 studies were included: seven studies on secondary prevention and 18 studies on primary prevention. Seven studies were performed in Europe. For secondary prevention, the results showed that the ICD is considered cost-effective in patients with more risk. For primary prevention, the cost-effectiveness of ICD has been widely studied, but uncertainty about its cost-effectiveness remains. The cost-effectiveness ratios vary between studies depending on the patient characteristics, methodology, perspective, and national settings. Among the European studies, the conclusions are varied, where the ICD is considered cost-effective or not dependent on the study.