A manual synchronous low energy shock impedance as a predictor of successful defibrillation testing during subcutaneous ICD implantation.

BACKGROUND: Guidelines recommend defibrillation testing (DFT) during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Implant position, patient characteristics and device factors, such as shock impedance, influence defibrillation success. To evaluate the shock impedance, a manual synchronous 10J shock (low energy synchronous shock [LESS]) can be delivered, without the need to induce ventricular fibrillation (VF). OBJECTIVE: To compare LESS and DFT impedance values and to evaluate the diagnostic accuracy of LESS impedance for predicting a successful DFT during S-ICD implantation. METHODS: Consecutive S-ICD implantations were included. Shock impedances were compared by paired t-tests. Univariate analysis was performed to investigate factors associated with successful DFT. A prediction model of successful DFT based on LESS impedance was assessed by logistic regression. Receiver operating characteristic (ROC) curve, area under the ROC curve and the Hosmer-Lemeshow tests were used to evaluate the accuracy of LESS impedance. RESULTS: Sixty patients were included (52 ± 14 years; 69% male). LESS and DFT impedance values were highly correlated (r2 = 0.97, p < .01). Patients with a failed first shock had higher body mass index (BMI) (30 ± 3 vs. 25.7 ± 4.3, p = .014), higher mean LESS (120 ± 35Ω vs. 86. ± 23Ω, p = .0013) and DFT impedance (122 ± 33Ω vs. 87 ± 24Ω, p = .0013). ROC analysis showed that LESS impedance had a good diagnostic performance in predicting a successful conversion test (AUC 84% [95% CI: 0.72-0.92]) with a cutoff value of <94Ω to identify a successful DFT (sensitivity 71%, specificity 73%). CONCLUSION: LESS impedance values without the need to induce VF can intraoperatively predict a successful DFT.

Cardiac Magnetic Resonance and Ventricular Arrhythmia Risk Assessment in Chronic Ischemic Cardiomyopathy: An Unmet Need?

Ischemic cardiomyopathy (ICM) constitutes a major public health issue, directly involved in the prevalence and incidence of heart failure, ventricular arrhythmias (VA) and sudden cardiac death (SCD). Severe impairment of left ventricular ejection fraction (LVEF) is considered a high-risk marker for SCD, conditioning the criteria that determine an implantable cardiac defibrillator (ICD) placement in primary prevention according to current clinical guidelines. However, its sensitivity and specificity values for the prediction of SCD in ICM may not be highest. Myocardial characterization using cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) sequences has made it possible to answer clinically relevant questions that are currently not assessable with LVEF alone. There is growing scientific evidence in favor of the relationship between fibrosis evaluated with CMR and the appearance of VA/SCD in patients with ICM. This evidence should make us contemplate a more realistic clinical value of LVEF in our daily clinical decision-making.

Morphology and COI barcodes reveal four new species in the lycieus group of Calisto (Lepidoptera, Nymphalidae, Satyrinae).

The predominantly Greater Antillean endemic genus Calisto Hübner, 1823 is highly diversified on several islands being more species rich on Hispaniola. We conducted expeditions during five years in the Dominican Republic resulting in new findings related with lyceius species group. Material belonging to this group was examined following the traditional morphological characters employed in genus taxonomy, and the COI barcode sequences obtained were analyzed through different approaches: Neighbor Joining clustering, ABGD, Maximum Likelihood (ML), and Bayesian Inference (BI). Analysis yielded 12 groups representing putative species: eight corresponding to previously named ones and four new species which are described in the present work: C. mariposa sp. nov., C. azua sp. nov., C. victori sp. nov., and C. samana sp. nov. The results also confirmed a single taxonomic entity within C. pulchella Lathy and the conspecific nature of C. franciscoi Gali and C. hendersoni. A dichotomic key for identification of species within the group is also given. Both phylogenetic reconstruction methods (ML and BI) employing molecular data achieved similar results with the relationships among the majority of taxa being supported by some ecological and morphological features. The exceptions were C. zangis Fabricius, C. raburni Gali, and C. pulchella, grouped together in a weakly supported clade. These species possess a highly differentiated adult and immature morphology which indicates an earlier divergence.

Spanish Implantable Cardioverter-defibrillator Registry. Eleventh Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2014).

INTRODUCTION AND OBJECTIVES: We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2014, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology. METHODS: Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology. RESULTS: The number of reported implantations was 4911 (82% of the estimated total number of implantations). The implantation rate was 106 per million population while the estimated rate was 128. First implantations comprised 72.2%. Data were obtained from 162 hospitals (8 more than in 2013). Most implantations (82%) were performed in men. The mean patient age was 61.8±13.7 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.5%. Electrophysiologists performed 85.6% of the implantations. CONCLUSIONS: The 2014 Spanish Implantable Cardioverter-defibrillator Registry received information on 82% of the implantations performed in Spain. The number of implantations has increased from previous years and the percentage of implantations for primary prevention indications has increased from the previous year.

Selección de lo mejor del año 2016 en aritmología clínica / Selection of the best of 2016 in clinical arrhythmology

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Registro Español de Desfibrilador Automático Implantable. XI Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2014) / Spanish Implantable Cardioverter-defibrillator Registry. Eleventh Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2014)

Introducción y objetivos. Se presentan los resultados del Registro Español de Desfibrilador Automático Implantable de 2014, elaborado por la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología. Métodos. Se envió de forma prospectiva a la Sociedad Española de Cardiología la hoja de recogida de datos cumplimentada voluntariamente por cada equipo implantador. Resultados. El número de implantes comunicados fue 4.911 (el 82% del total de implantes estimado). La tasa de implantes fue 106 por millón de habitantes y la estimada, 128. Los primoimplantes fueron el 72,2%. Se obtuvieron datos de 162 hospitales (8 más que en 2013). La mayoría de los implantes (82%) se realizaron en varones. La media de edad fue 61,8 ± 13,7 años. La mayoría de los pacientes presentaban una disfunción ventricular grave o grave-moderada y clase funcional II de la New York Heart Association. La cardiopatía más frecuente fue la isquémica, seguida de la dilatada. Las indicaciones por prevención primaria han sido el 58,5%. Los implantes realizados por electrofisiólogos fueron el 85,6%. Conclusiones. El Registro Español de Desfibrilador Automático Implantable de 2014 recoge información del 82% de los implantes realizados en España. El número de implantes ha crecido respecto a los datos de los últimos años. El porcentaje de indicación por prevención primaria ha aumentado con respecto al registro anterior (AU)

Introduction and objectives. We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2014, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology. Methods. Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology. Results. The number of reported implantations was 4911 (82% of the estimated total number of implantations). The implantation rate was 106 per million population while the estimated rate was 128. First implantations comprised 72.2%. Data were obtained from 162 hospitals (8 more than in 2013). Most implantations (82%) were performed in men. The mean patient age was 61.8 ± 13.7 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.5%. Electrophysiologists performed 85.6% of the implantations. Conclusions. The 2014 Spanish Implantable Cardioverter-defibrillator Registry received information on 82% of the implantations performed in Spain. The number of implantations has increased from previous years and the percentage of implantations for primary prevention indications has increased from the previous year (AU)

Clinical effectiveness of antiarrhythmic treatment after electrical cardioversion in patients without structural heart disease.

INTRODUCTION AND OBJECTIVES: The aim was to investigate the clinical effectiveness of using antiarrhythmic drugs after electrical cardioversion in patients without structural heart disease, including their effect on the maintenance of sinus rhythm. METHODS: In total, 528 patients with persistent atrial fibrillation but without significant structural heart disease who underwent successful electrical cardioversion at 96 Spanish hospitals were followed up for 1 year. Patients were assessed at 1, 3, 6 and 12 months. The use and effectiveness of antiarrhythmic drugs for preventing the recurrence of persistent atrial fibrillation was evaluated. RESULTS: Some 80% of patients were receiving antiarrhythmic drugs at discharge, most frequently amiodarone. No specific clinical factor was associated with greater use of antiarrhythmics. Overall, 37% of patients were in sinus rhythm at all follow-up assessments. At the 1-year assessment, 59% of patients who remained in sinus rhythm were still taking antiarrhythmic drugs. Multivariate Cox regression analysis identified weight (hazard ratio [HR]=1.01 per kg; P=.04) and no antiarrhythmic treatment (HR=1.59; P=.001) as being independently associated with the recurrence of persistent atrial fibrillation. Amiodarone tended to be better than other antiarrhythmic drugs. CONCLUSIONS: In routine clinical practice, the large majority of patients without structural heart disease received antiarrhythmic drugs, most frequently amiodarone, after successful electrical cardioversion. Drug use was the principal factor associated with the maintenance of sinus rhythm at 1 year.

Utilidad en la práctica clínica del tratamiento antiarrítmico tras cardioversión eléctrica en pacientes sin cardiopatía estructural / Clinical effectiveness of antiarrhythmic treatment after electrical cardioversion in patients without structural heart disease

Introducción y objetivos. Conocer en la práctica clínica el uso de antiarrítmicos tras cardioversión eléctrica en pacientes sin cardiopatía y su repercusión en el mantenimiento del ritmo sinusal. Métodos. Se realizó un seguimiento a un año de 528 pacientes con fibrilación auricular persistente sin cardiopatía significativa tras una cardioversión eléctrica efectiva en 96 hospitales españoles, con controles clínicos 1, 3, 6 y 12 meses después. Se analizó el uso y la utilidad de los fármacos antiarrítmicos en la prevención de recurrencias de fibrilación auricular persistente. Resultados. Se trató al alta con fármacos antiarrítmicos al 80% de los pacientes, y el más utilizado fue la amiodarona. Ningún factor clínico se relacionó con un mayor uso de antiarrítmicos. El 37% de los pacientes siguió en ritmo sinusal en todos los controles. En el control a los 12 meses, se mantuvo el tratamiento antiarrítmico al 59% de los pacientes que seguían en ritmo sinusal. En el análisis multivariable de la regresión de Cox, el peso (hazard ratio [HR] por cada kilo = 1,01; p = 0,04) y la ausencia de tratamiento antiarrítmico (HR = 1,59; p = 0,001) fueron factores independientes relacionados con la recurrencia de fibrilación auricular persistente. La amiodarona tendía a ser superior a los otros antiarrítmicos. Conclusiones. En la práctica clínica habitual, tras una cardioversión eléctrica efectiva, la gran mayoría de los pacientes sin cardiopatía estructural recibe fármacos antiarrítmicos, especialmente amiodarona, que es el principal factor relacionado con el mantenimiento del ritmo sinusal 1 año más tarde (AU)

Introduction and objectives. The aim was to investigate the clinical effectiveness of using antiarrhythmic drugs after electrical cardioversion in patients without structural heart disease, including their effect on the maintenance of sinus rhythm. Methods. In total, 528 patients with persistent atrial fibrillation but without significant structural heart disease who underwent successful electrical cardioversion at 96 Spanish hospitals were followed up for 1 year. Patients were assessed at 1, 3, 6 and 12 months. The use and effectiveness of antiarrhythmic drugs for preventing the recurrence of persistent atrial fibrillation was evaluated. Results. Some 80% of patients were receiving antiarrhythmic drugs at discharge, most frequently amiodarone. No specific clinical factor was associated with greater use of antiarrhythmics. Overall, 37% of patients were in sinus rhythm at all follow-up assessments. At the 1-year assessment, 59% of patients who remained in sinus rhythm were still taking antiarrhythmic drugs. Multivariate Cox regression analysis identified weight (hazard ratio [HR]=1.01 per kg; P=.04) and no antiarrhythmic treatment (HR=1.59; P=.001) as being independently associated with the recurrence of persistent atrial fibrillation. Amiodarone tended to be better than other antiarrhythmic drugs. Conclusions. In routine clinical practice, the large majority of patients without structural heart disease received antiarrhythmic drugs, most frequently amiodarone, after successful electrical cardioversion. Drug use was the principal factor associated with the maintenance of sinus rhythm at 1 year (AU)

Muerte súbita cardíaca extrahospitalaria y desfibrilación precoz / Sudden cardiac death and early defibrillation

Dado que la mayoría de las víctimas de muerte súbita no tienen síntomas antes de la misma y no presentan factores que permitan su identificación como poblaciones de alto riesgo antes del evento, es importante la mejora de los sistemas de resucitación cardiopulmonar extrahospitalaria con el objetivo de conseguir una mayor supervivencia de estos pacientes. En este sentido, una desfibrilación precoz dentro de una eficaz aplicación de la cadena de supervivencia que incluya un rápido reconocimiento de la víctima, una llegada inmediata de personal entrenado que aplique de forma precoz las maniobras de resucitación cardiopulmonar y la posibilidad de llevar a cabo un soporte vital avanzado con prontitud asegurarían una mayor supervivencia de las víctimas de muerte súbita cardíaca. Numerosos estudios han demostrado la enorme importancia de la desfibrilación precoz en pacientes que han presentado una parada cardíaca por fibrilación ventricular. El predictor más importante de supervivencia en estos casos es el tiempo que transcurre hasta la desfibrilación eléctrica, de tal modo que a medida que éste se prolonga, disminuye rápidamente la supervivencia medida al alta hospitalaria. En este sentido, la desfibrilación externa automática ha demostrado, en múltiples estudios, la reducción del tiempo hasta la desfibrilación y la mejoría de la supervivencia. Por estas razones, los sistemas de acceso a la desfibrilación pública, que permiten a personal no médico el empleo de desfibriladores externos automáticos, han cobrado mucho entusiasmo en un número cada vez mayor de países, ciudades o compañías. En la actualidad se está investigando la eficacia de la desfibrilación externa automática llevada a cabo por cualquier persona de una comunidad (no necesariamente un 'primer auxiliador'), aunque esta mayor liberalización de uso, si demuestra ser eficaz, debería acompañarse de medidas legales que la avalen y de una adecuada educación sanitaria, probablemente en los años de educación secundaria (AU)

Guías de práctica clínica de la Sociedad Española de Cardiología sobre requerimientos y equipamiento en electrofisiología / Guidelines of the Spanish Society of Cardiology on Requirements and Equipment in Electrophysiology

La evolución, tanto cualitativa como cuantitativa, experimentada por la electrofisiología en los últimos años ha llevado a la necesidad de crear unidades específicas dedicadas al manejo de los pacientes con arritmias cardíacas. En estas guías se consideran las necesidades materiales y humanas mínimas con las que debe contar una unidad de arritmias (AU)