Resultados en España de la encuesta de la Sociedad Europea de Cardiología sobre terapia de resincronización cardiaca (CRT-Survey II) / Spanish results of the Second European Cardiac resynchronization therapy survey (CRT-Survey II)

Introducción y objetivos: Se describen los resultados en España de la segunda encuesta de la Sociedad Europea de Cardiología sobre terapia de resincronización cardiaca (CRT-Survey II) y se comparan con los de los demás países participantes. Métodos: Pacientes a los que se implantó un dispositivo de terapia de resincronización cardiaca entre octubre de 2015 y diciembre de 2016 en 36 centros participantes. Se recogieron datos sobre las características basales de los pacientes y del implante, y un seguimiento a corto plazo hasta el alta hospitalaria. Resultados: La tasa de éxito del implante fue del 95,9%. La mediana [intervalo intercuartílico] de implantes anuales/centro en España fue significativamente menor que en los demás países participantes: 30 [21-50] frente a 55 [33-100] implantes/año (p=0,00003). En los centros españoles hubo una menor proporción de pacientes de edad ≥ 75 años (el 27,9 frente al 32,4%; p=0,0071), una mayor proporción de pacientes en clase funcional II de la New York Heart Association (el 46,9 frente al 36,9%; p <0,00001) y un mayor porcentaje de pacientes con criterios electrocardiográficos de bloqueo de rama izquierda (el 82,9 frente al 74,6%; p <0,00001). La media de la estancia hospitalaria fue menor en los centros españoles (5,8+/-8,5 frente a 6,4+/-11,6; p <0,00001) y una mayor proporción de pacientes recibieron un cable de ventrículo izquierdo cuadripolar (el 74 frente al 56%; p <0,00001) y fueron seguidos a distancia (el 55,8 frente al 27,7%; p <0,00001). Conclusiones: La encuesta CRT-Survey II muestra que en España hay una menor proporción de pacientes de 75 o más años que reciben un dispositivo de terapia de resincronización cardiaca, una mayor proporción de pacientes en clase funcional II de la New York Heart Association, con bloqueo completo de la rama izquierda del haz de His y con seguimiento a distancia, con estancias hospitalarias significativamente menores

Introduction and objectives: We describe the results for Spain of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II) and compare them with those of the other participating countries. Methods: We included patients undergoing CRT device implantation between October 2015 and December 2016 in 36 participating Spanish centers. We registered the patients' baseline characteristics, implant procedure data, and short-term follow-up information until hospital discharge. Results: Implant success was achieved in 95.9%. The median [interquartile range] annual implantation rate by center was significantly lower in Spain than in the other participating countries: 30 implants/y [21-50] vs 55 implants/y [33-100]; P=.00003. In Spanish centers, there was a lower proportion of patients ≥ 75 years (27.9% vs 32.4%; P=.0071), a higher proportion in NYHA class II (46.9% vs 36.9%, P <.00001), and a higher percentage with electrocardiographic criteria of left bundle branch block (82.9% vs 74.6%; P <.00001). The mean length of hospital stay was significantly lower in Spanish centers (5.8+/-8.5 days vs 6.4+/-11.6; P <.00001). Spanish patients were more likely to receive a quadripolar LV lead (74% vs 56%, P <.00001) and to be followed up by remote monitoring (55.8% vs 27.7%; P <.00001). Conclusions: The CRT-Survey II shows that, compared with other participating countries, fewer patients in Spain aged ≥ 75 years received a CRT device, while more patients were in New York Heart Association functional class II and had left bundle branch block. In addition, the length of hospital stay was shorter, and there was greater use of quadripolar LV leads and remote CRT monitoring

Colchicina administrada en el primer episodio de pericarditis aguda idiopática: estudio multicéntrico abierto y aleatorizado / Colchicine administered in the first episode of acute idiopathic pericarditis: a randomized multicenter open-label study

Introducción y objetivos: Se dispone de poca información sobre el beneficio real de la administración de colchicina en el primer episodio de pericarditis aguda idiopática (PAI). El objetivo principal del presente estudio es evaluar la eficacia real de la colchicina en pacientes con PAI que no toman corticoides. Métodos: Estudio multicéntrico abierto y aleatorizado. Se aleatorizó en 2 grupos a los pacientes con un primer episodio de PAI (no secundario a lesión cardiaca o enfermedad del tejido conectivo): A, con tratamiento antiinflamatorio convencional más colchicina durante 3 meses, y B, con tratamiento antiinflamatorio convencional solamente. Ningún paciente tomaba corticoides. El objetivo primario del estudio fue la aparición de episodios recurrentes de pericarditis. El objetivo secundario fue el tiempo hasta la primera recurrencia. El seguimiento fue de 24 meses. Resultados: Se aleatorizó a 110 pacientes (el 83,6% varones; media de edad, 44+/-18,3 años) a los grupos A (59 pacientes) y B (51 pacientes). No se encontraron diferencias entre ambos grupos en las características basales, las características clínicas del episodio índice o el tipo de tratamiento antiinflamatorio administrado. Completaron el seguimiento 102 pacientes (92,7%). No se encontraron diferencias entre los grupos en la tasa de pericarditis recurrente (12 pacientes [10,9%]; grupo A frente a grupo B, el 13,5 frente al 7,8%; p=0,34). El tiempo hasta la primera recurrencia (9,6+/-9.0 frente a 8,3+/-10,5 meses; p=0,80) no fue diferente entre los grupos. Conclusiones: En pacientes con un primer episodio de PAI que no habían tomado corticoides, no parece que la adición de colchicina al tratamiento antiinflamatorio convencional reduzca la tasa de recurrencias. Registro de ensayos clínicos: URL: https://www.clinicaltrialsregister.eu. Identificador: EudraCT 2009-011258-16

Introduction and objectives: There is a paucity of information about the real benefit of colchicine administration in the first episode of acute idiopathic pericarditis (AIP). The main objective of the present study was to assess the real efficacy of colchicine in patients with AIP who did not receive corticosteroids. Methods: Randomized multicenter open-label study. Patients with a first episode of AIP (not secondary to cardiac injury or connective tissue disease) were randomized into 2 groups: group A received conventional anti-inflammatory treatment plus colchicine for 3 months, and group B received conventional anti-inflammatory treatment only. None of the patients received corticosteroids. The primary endpoint was the appearance of recurrent episodes of pericarditis. The secondary endpoint was the time to first recurrence. Follow-up was extended to 24 months. Results: A total of 110 patients (83.6% men, age 44+/-18.3 years) were randomized to group A (n=59) and group B (n=51). No differences were found in baseline demographics or in the clinical features of the index episode or in the type of anti-inflammatory treatment administered in both groups. The follow-up was completed by 102 patients (92.7%). No differences were found in the rate of recurrent pericarditis between groups (12 patients [10.9%]; group A vs group B, 13.5% vs 7.8%; P=.34). The time to first recurrence (group A vs group B, 9.6+/-9.0 vs 8.3+/-10.5 months; P=.80) did not differ between groups. Conclusions: Among patients with a first episode of AIP who had not received corticosteroids, the addition of colchicine to conventional anti-inflammatory treatment does not seem to reduce the recurrence rate. Clinical trial registration: URL: https://www.clinicaltrialsregister.eu. Identifier: EudraCT 2009-011258-16

Spanish Results of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II).

INTRODUCTION AND OBJECTIVES: We describe the results for Spain of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II) and compare them with those of the other participating countries. METHODS: We included patients undergoing CRT device implantation between October 2015 and December 2016 in 36 participating Spanish centers. We registered the patients' baseline characteristics, implant procedure data, and short-term follow-up information until hospital discharge. RESULTS: Implant success was achieved in 95.9%. The median [interquartile range] annual implantation rate by center was significantly lower in Spain than in the other participating countries: 30 implants/y [21-50] vs 55 implants/y [33-100]; P=.00003. In Spanish centers, there was a lower proportion of patients ≥ 75 years (27.9% vs 32.4%; P=.0071), a higher proportion in New York Heart Association functional class II (46.9% vs 36.9%; P <.00001), and a higher percentage with electrocardiographic criteria of left bundle branch block (82.9% vs 74.6%; P <.00001). The mean length of hospital stay was significantly lower in Spanish centers (5.8±8.5 days vs 6.4±11.6; P <.00001). Spanish patients were more likely to receive a quadripolar LV lead (74% vs 56%; P <.00001) and to be followed up by remote monitoring (55.8% vs 27.7%; P <.00001). CONCLUSIONS: The CRT-Survey II shows that, compared with other participating countries, fewer patients in Spain aged ≥ 75 years received a CRT device, while more patients were in New York Heart Association functional class II and had left bundle branch block. In addition, the length of hospital stay was shorter, and there was greater use of quadripolar LV leads and remote CRT monitoring.

Colchicine Administered in the First Episode of Acute Idiopathic Pericarditis: A Randomized Multicenter Open-label Study.

INTRODUCTION AND OBJECTIVES: There is a paucity of information about the real benefit of colchicine administration in the first episode of acute idiopathic pericarditis (AIP). The main objective of the present study was to assess the real efficacy of colchicine in patients with AIP who did not receive corticosteroids. METHODS: Randomized multicenter open-label study. Patients with a first episode of AIP (not secondary to cardiac injury or connective tissue disease) were randomized into 2 groups: group A received conventional anti-inflammatory treatment plus colchicine for 3 months, and group B received conventional anti-inflammatory treatment only. None of the patients received corticosteroids. The primary endpoint was the appearance of recurrent episodes of pericarditis. The secondary endpoint was the time to first recurrence. Follow-up was extended to 24 months. RESULTS: A total of 110 patients (83.6% men, age 44±18.3 years) were randomized to group A (n=59) and group B (n=51). No differences were found in baseline demographics or in the clinical features of the index episode or in the type of anti-inflammatory treatment administered in both groups. The follow-up was completed by 102 patients (92.7%). No differences were found in the rate of recurrent pericarditis between groups (12 patients [10.9%]; group A vs group B, 13.5% vs 7.8%; P=.34). The time to first recurrence (group A vs group B, 9.6±9.0 vs 8.3±10.5 months; P=.80) did not differ between groups. CONCLUSIONS: Among patients with a first episode of AIP who had not received corticosteroids, the addition of colchicine to conventional anti-inflammatory treatment does not seem to reduce the recurrence rate. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrialsregister.eu. Identifier: EudraCT 2009-011258-16.

Marcadores angiográficos negativos en la intervención coronaria percutánea de las oclusiones totales crónicas / Negative angiographic markers in percutaneous coronary intervention of chronic total occlusions

Resumen Objetivos: El objetivo de este estudio es evaluar variables angiográficas predictivas negativas y la presencia de la rama lateral en la proximidad de la capa distal de la oclusión en el resultado de la intervención coronaria percutánea de las oclusiones totales crónicas. Método: Las variables angiográficas potencialmente negativas fueron evaluadas retrospectivamente en 156 oclusiones totales crónicas sometidas a intervención coronaria percutánea. Se utilizó regresión logística binaria con una finalidad predictiva para identificar un modelo de variables que en su conjunto puedan predecir satisfactoriamente el resultado negativo de la intervención. Resultados: Las variables asociadas de forma independiente al fracaso de procedimiento fueron la enfermedad multivaso (odds ratio = 5,12; intervalo de confianza del 95%, 1,94-13,5; P = 0.001), la presencia de muñón ambiguo (odds ratio = 5,08; IC intervalo de confianza del 95%, 2,22- 11,63; P < 0.001), longitud de la oclusión ≥20 mm (odds ratio = 3,7; IC intervalo de confianza del 95%, 1,37-9,97; P = 0.01) y la localización ostial de la oclusión (odds ratio = 6,53; intervalo de confianza del 95%, 1,67-25,63; P = 0.007). La rama lateral en la proximidad de la capa distal no permaneció en el modelo predictivo. Conclusión: La enfermedad multivaso, muñón ambiguo, una longitud ≥20 mm y la localización ostial son factores independientes y predictivos de un resultado desfavorable de la angioplastia. La rama lateral en la capa distal de la oclusión no se asoció al fracaso de la intervención. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Objective: The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. Methods: Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. Results: Variables independently associated with the procedural failure were multivessel disease (odds ratio = 5.12; 95% confidence interval (CI); 1.94-13.5; P = .001), ambiguous stump presence (odds ratio = 5.08; 95% CI; 2.22-11.63 P < .001), occlusion length ≥20 mm (odds ratio = 3.7; 95% CI; 1.37-9.97 P = .01), and ostial location (odds ratio = 6.53; 95% CI; 1.67-25.63; P = .007). Side branch at distal cap proximity did not remain in the predictive model. Conclusions: Multivessel disease, ambiguous stump, a length ≥20 mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

[Negative angiographic markers in percutaneous coronary intervention of chronic total occlusions]. / Marcadores angiográficos negativos en la intervención coronaria percutánea de las oclusiones totales crónicas.

OBJECTIVE: The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. METHODS: Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. RESULTS: Variables independently associated with the procedural failure were multivessel disease (odds ratio=5.12; 95% confidence interval (CI); 1.94-13.5; P=.001), ambiguous stump presence (odds ratio=5.08; 95% CI; 2.22-11.63 P<.001), occlusion length ≥20mm (odds ratio=3.7; 95% CI; 1.37-9.97 P=.01), and ostial location (odds ratio=6.53; 95% CI; 1.67-25.63; P=.007). Side branch at distal cap proximity did not remain in the predictive model. CONCLUSIONS: Multivessel disease, ambiguous stump, a length ≥20mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure.

Percutaneous retrieval of a port-a-cath using a pigtail catheter combined with snaring technique.

We present a case of a 63-year-old woman who underwent chemotherapy for breast cancer through a port-a-cath inserted in left subclavian vein. The device was withdrawn one year later due to jugular vein thrombosis plus dysfunction of the device. A few years later a chest X-ray for scrutinizing dyspnea showed a catheter located in right heart chambers. Percutaneous retrieval via right subclavian vein was planned. Both catheter ends were impacted against heart structures and were not free to be easily captured by a snare. By using a pig-tail catheter we were able to seize the catheters loop portion and pull it back slightly. Once the catheter ends became free we seized one of the catheter's distal ends with a snare and successfully externalised it.

Estado actual del tratamiento de resincronización cardiaca en Cataluña: resultados del estudio prospectivo multicéntrico TRC-CAT / Status of cardiac resynchronization therapy in Catalonia, Spain: Results of the prospective multicentric study TRC-CAT

Introducción y objetivos: Los resultados del tratamiento de resincronización cardiaca (TRC) han sido extensamente publicados. Sin embargo, hay datos limitados en poblaciones no seleccionadas. El objetivo del estudio fue analizar la eficacia y la seguridad del TRC en Cataluña. Métodos: Se analizó prospectivamente una serie de pacientes consecutivos a los que se les implantó durante un año un dispositivo de TRC en 7 hospitales universitarios de Cataluña, los cuales representan el 90% del total de dispositivos implantados. Se definió como remodelado ecocardiográfico inverso el aumento de 5 puntos de la fracción de eyección del ventrículo izquierdo, y respondedores clínicos los pacientes que a los 12 meses habían aumentado > 10% la distancia recorrida en la prueba de caminar 6 minutos o un punto la clase de laNew York Heart Association. El seguimiento de los pacientes fue por un año y se analizaron los ingresos hospitalarios y la mortalidad. Resultados: De los 200 pacientes incluidos en el estudio, el 99% cumplía las indicaciones de las guías clínicas actuales de TRC y el 68% recibió TRC con desfibrilador automático implantable. La tasa de complicaciones fue del 12,5%. Durante el seguimiento 16 pacientes (8%) murieron. El 52% (104) de la población fue respondedor clínico y un 62% (124) presentó remodelado ecocardiográfico. En comparación con el año previo al implante los ingresos hospitalarios se redujeron un 82%, lo que resultó en una diferencia estadísticamente significativa (p < 0,001). Conclusiones: En una población no seleccionada de Cataluña observamos que el TRC fue eficaz y redujo el número de hospitalizaciones (AU)

Introduction and objectives: Results of cardiac resynchronization therapy (CRT) have been extensively published. However, there is limited data in unselected populations. The objective of the study was to analyse the efficacy and safety of CRT in Catalonia. Methods: A prospective study was performed of consecutive patients implanted with CRT over one year in 7 university hospitals in Catalonia, representing 90% of the implanted patients. Echocardiographic reverse remodelling was defined as 5 points improvement in left ventricular ejection fraction and clinical responders were defined as patients with an increase > 10% of six-minute walk test or one point of New York Heart Association functional class at 12 months. Patients were followed up for one year and hospital admissions and mortality were analyzed. Results: Of the 200 patients included in the study, 99% met the indications of the current CRT clinical guidelines and 68% received CRT with implantable cardioverter-defibrillator. The rate of complications was 12.5%. During follow-up 16 patients (8%) died. Fifty-two percent (104) of the population was considered to respond clinically and 62% (124) presented improved echocardiographic parameters. Compared to the year prior to implant, hospital admissions decreased by 82% (P < .001). Conclusions: In an unselected population of Catalonia, we observe that CRT was effective and decreased the number of hospital admissions (AU)

[Status of cardiac resynchronization therapy in Catalonia, Spain: Results of the prospective multicentric study TRC-CAT]. / Estado actual del tratamiento de resincronización cardiaca en Cataluña: resultados del estudio prospectivo multicéntrico TRC-CAT.

INTRODUCTION AND OBJECTIVES: Results of cardiac resynchronization therapy (CRT) have been extensively published. However, there is limited data in unselected populations. The objective of the study was to analyse the efficacy and safety of CRT in Catalonia. METHODS: A prospective study was performed of consecutive patients implanted with CRT over one year in 7 university hospitals in Catalonia, representing 90% of the implanted patients. Echocardiographic reverse remodelling was defined as 5 points improvement in left ventricular ejection fraction and clinical responders were defined as patients with an increase>10% of six-minute walk test or one point of New York Heart Association functional class at 12 months. Patients were followed up for one year and hospital admissions and mortality were analyzed. RESULTS: Of the 200 patients included in the study, 99% met the indications of the current CRT clinical guidelines and 68% received CRT with implantable cardioverter-defibrillator. The rate of complications was 12.5%. During follow-up 16 patients (8%) died. Fifty-two percent (104) of the population was considered to respond clinically and 62% (124) presented improved echocardiographic parameters. Compared to the year prior to implant, hospital admissions decreased by 82% (P<.001). CONCLUSIONS: In an unselected population of Catalonia, we observe that CRT was effective and decreased the number of hospital admissions.

Una técnica poco habitual en el diagnóstico de síndrome de apnea del sueño / An unusual diagnostic technique of obstructive sleep apnoea syndrome

No disponible

Holter implantable subcutáneo: una nueva herramienta en el diagnóstico del ictus criptogénico / Implantable loop recorder: a new tool in the diagnosis of cryptogenic stroke

No disponible

Pacemaker clinic: an opportunity to detect silent atrial fibrillation and improve antithrombotic treatment.

AIMS: The prevalence of atrial fibrillation (AF) in patients with pacemakers is high, and often passes unnoticed. Our aim was to assess the use of antithrombotic treatment in this group of patients. METHODS AND RESULTS: All patients who came to our institution to have their pacemakers checked during the year 2008 were included in this study. The atrial activity was assessed by slowing down the paced frequency if necessary, and by the analysis of atrial electrograms in atrial-based pacemakers. The appropriateness of the antithrombotic treatment was evaluated by a cardiologist. Out of 585 patients, 216 (36.9%) displayed AF at some point during the 5.5-year monitoring period (1.5-11), although only 58 (9.9%) displayed it at the time of the implant. Of these 216, 58% were men, with an average age of 80 years (76-86 years). The pacemaker was implanted in response to an atrioventricular block (AVB) in 46.3% of the cases, sinoatrial node disorder in 24.1% of the cases, and slow AF in 25.9% of the cases. The CHADS2 score was 0 points in 4.2% (9) of the cases, 1 point in 19% (41) of the cases, and ≥ 2 points in 77% (173) of the cases. Despite this, only 58.3% of the cases received anticoagulant treatment. The existence of arrhythmia at the time of implantation [odds ratio (OR) = 4.25; 95% confidence interval (95% CI), 1.72-10.51; P = 0.002] and the implantation of a pacemaker with atrioventricular synchronization (OR = 13.23; 95% CI, 2.89-60.56; P = 0.001) were associated with the use of anticoagulant treatment in those cases with CHADS2>2. CONCLUSION: Atrial fibrillation is common in patients fitted with pacemakers. Despite the high risk of embolism, an underuse of anticoagulant treatment was observed.

Desensibilización rápida al ácido acetilsalicílico en pacientes con intolerancia a AINE afectos de síndrome coronario agudo / No disponible

No disponible