10 results on '"Rafael, Jiménez-Arjona"'
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2. Cardiac Resynchronization Therapy Response Is Equalized in Men and Women by Electrical Optimization
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Emilce Trucco, José María Tolosana, Roger Borràs, Francisco Alarcón, Rodolfo San Antonio, Ivo Roca-Luque, Elena Arbelo, Eduard Guasch, Rafael Jiménez-Arjona, María Ángeles Castel, Niraj Varma, Paz Garre, Marta Sitges, Margarida Pujol-López, Ada Doltra, and Lluís Mont
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Degree (temperature) ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,PR interval ,business - Abstract
Objectives This study hypothesized that the shorter intrinsic PR interval observed in women allows a greater degree of fusion with intrinsic conduction, achieving a shorter QRS interval du...
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- 2021
3. PO-03-008 CORRECTION OF DYSSYNCHRONY BY CONDUCTION SYSTEM PACING: RESULTS OF LEVEL-AT TRIAL
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Margarida Pujol Lopez, Cora Garcia-Ribas, Rafael Jiménez Arjona, Roger Borràs Amoraga, Paz Garre Anguera de Sojo, Eduard Guasch, Elisenda Ferró Lozano, Mireia Niebla Bellido, Esther Carro fernandez, J. Baptiste Guichard, Andreu Porta-Sanchez, Ivo Roca-Luque, María-Angeles Castel, Elena Arbelo, Marta Sitges, Josep Brugada Terradellas, JOSE MARIA TOLOSANA, Adelina Doltra, and Lluis Mont
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
4. Septal flash correction with His-Purkinje pacing predicts echocardiographic response in resynchronization therapy
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Margarida Pujol‐López, Rafael Jiménez Arjona, Eduard Guasch, Adelina Doltra, Roger Borràs, Ivo Roca Luque, María Ángeles Castel, Paz Garre, Elisenda Ferró, Mireia Niebla, Esther Carro, Elena Arbelo, Marta Sitges, José M. Tolosana, and Lluís Mont
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Heart Failure ,Heart Ventricles ,Cardiac Pacing, Artificial ,Stroke Volume ,General Medicine ,Ventricular Function, Left ,Cardiac Resynchronization Therapy ,Ventricular Dysfunction, Left ,Treatment Outcome ,Echocardiography ,Physiology (medical) ,Humans ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Grant of the Catalan Society of Cardiology, 2019; Research Grant Josep Font 2019, Hospital Clínic de Barcelona His-Purkinje conduction system pacing (HPCSP) has been proposed as an alternative to cardiac resynchronization therapy (CRT); however, no predictors of echocardiographic response have been described. Septal flash (SF) is a marker of intraventricular dyssynchrony. Methods The study aimed to analyze whether HPCSP corrects SF in patients with CRT indication, and if correction of SF predicts echocardiographic response. Prospective observational study (n=30). Left ventricular ejection fraction (LVEF) was measured with echocardiography at baseline and at 6-month follow-up. Echocardiographic response was defined as increase in 5 points LVEF. ECG Imaging was performed in 2 patients to validate ventricular activation shortening and to study the basal and HPCSP activation pattern. Results HPCSP shortened QRS duration by 48±21ms and SF was significantly decreased (baseline 3.6±2.2mm vs HPCSP 1.5±1.5mm p1.5mm had 81% sensitivity and 80% specificity to predict echocardiographic response (area under curve 0.86, p=0.019). Conclusion HPCSP improves intraventricular dyssynchrony and results in 64% echocardiographic responders at 6-month follow-up. Dyssynchrony improvement with SF correction may predict echocardiographic response at 6-month follow-up (Fig.2.).
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- 2022
5. Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block
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Margarida Pujol‐López, Rafael Jiménez Arjona, Eduard Guasch, Roger Borràs, Adelina Doltra, Sara Vázquez‐Calvo, Ivo Roca‐Luque, Paz Garre, Elisenda Ferró, Mireia Niebla, Esther Carro, Jose L. Puente, Laura Uribe, Eric Invers, Maria Ángeles Castel, Elena Arbelo, Marta Sitges, Lluís Mont, and José M. Tolosana
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Cardiac Resynchronization Therapy ,Heart Failure ,Bundle of His ,Treatment Outcome ,Cardiac Conduction System Disease ,Cardiac Pacing, Artificial ,Ventricular Dysfunction ,Humans ,Stroke Volume ,General Medicine ,Cardiology and Cardiovascular Medicine ,Atrioventricular Block ,Ventricular Function, Left - Abstract
It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT.Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up.HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02).HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
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- 2022
6. CI-569-04 SEPTAL FLASH CORRECTION WITH HIS-PURKINJE PACING PREDICTS ECHOCARDIOGRAPHIC RESPONSE IN RESYNCHRONIZATION THERAPY
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Margarida Pujol Lopez, Rafael Jiménez Arjona, Eduard Guasch, Adelina Doltra, Roger Borràs Amoraga, Ivo Roca-Luque, María-Angeles Castel, Paz Garre Anguera de Sojo, Elisenda Ferró Lozano, Mireia Niebla Bellido, Esther Carro fernandez, Elena Arbelo, Marta Sitges, JOSE MARIA TOLOSANA, and Lluis Mont
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
7. Cardiac Resynchronization Therapy Response Is Equalized in Men and Women by Electrical Optimization: PR Matters
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Margarida, Pujol-López, José María, Tolosana, Eduard, Guasch, Emilce, Trucco, Rafael, Jiménez-Arjona, Roger, Borràs, Paz, Garre, Rodolfo, San Antonio, Ada, Doltra, Ivo, Roca-Luque, Elena, Arbelo, Francisco, Alarcón, María Ángeles, Castel, Marta, Sitges, Niraj, Varma, and Lluís, Mont
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Cardiac Resynchronization Therapy ,Heart Failure ,Male ,Heart Rate ,Humans ,Female ,Cardiac Resynchronization Therapy Devices ,Retrospective Studies - Abstract
This study hypothesized that the shorter intrinsic PR interval observed in women allows a greater degree of fusion with intrinsic conduction, achieving a shorter QRS interval duration and, thus, a better response.Women benefit more from cardiac resynchronization therapy (CRT) than men. However, the reason for this difference remains elusive.A cohort of 180 patients included in the BEST (Fusion based optimization in resynchronization therapy [ECG Optimization of CRT: Evaluation of Mid-Term Response]; NCT01439529) study were retrospectively analyzed. Patients were initially randomized to either nonoptimized CRT (NON-OPT group; n = 89) or electrocardiographically optimized CRT based on the fusion-optimized intervals (FOI) method (FOI group; n = 91). Echocardiographic response was defined as a15% decrease in left ventricular end-systolic volume at the 12-month follow-up.The basal PR interval was shorter in women as compared to men. In the NON-OPT group, CRT resulted in a shorter paced QRS interval in women than in men (134 ± 21 ms vs. 151 ± 21 ms, respectively; p = 0.003, 95% confidence interval [CI]: -27 to -5.6) and better response in women than in men: 70.4% vs. 46.4%, respectively (odds ratio: 0.37; p = 0.04; 95% CI: 0.14 to 0.97). There were no differences in paced QRS interval duration (126 ± 13 ms vs. 129 ± 17 ms; p = 0.47) or response between women and men in the FOI group (68% vs. 70.5%; odds ratio: 1.12; p = 0.82; 95% CI: 0.41 to 3.07). FOI extended the atrioventricular interval to obtain the best fusion; the atrioventricular intervals tended to require greater extension in men than in women (22 ± 33 ms vs. 8 ± 28 ms, respectively; p = 0.07).Women had a shorter PR interval, which was associated with a shorter QRS interval and better response to CRT. The difference in QRS interval duration and response between men and women did not persist when CRT was optimized using fusion with intrinsic conduction (FOI programming).
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- 2020
8. Single-Point Left Ventricular Pacing Optimized by ECG Results in Better Resynchronization than Multipoint Pacing
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Maria S. Guillem, Felipe Atienza, Francisco Alarcón, Rodolfo San Antonio, Marta Sitges, Alejandro Liberos, Luis Mont Girbau, Eduard Guasch, Omar Trotta, Ana Gonzalez-Ascaso, Roger Borràs, Rafael Jiménez-Arjona, Paz Garre, Andreu M. Climent, Margarida Pujol-López, Adelina Doltra, Ivo Roca-Luque, José María Tolosana, Josep Brugada, Elena Arbelo, Francisco Fernández-Avilés, and Levio Quinto
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Ventricular pacing ,QRS complex ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Electrocardiographic imaging ,medicine ,Cardiology ,cardiovascular diseases ,Single point ,Reverse remodeling ,business - Abstract
Background: Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods: This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results: The SPP-FOI method achieved greater QRS shortening than MPP (-56±16 vs. -42±17 ms, P
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- 2020
9. 45Improving the optimization of cardiac resynchronization therapy: Does multipoint left ventricular pacing shorten the paced-QRS duration compared to the fusion-optimized intervals method?
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Levio Quinto, Adelina Doltra, Rafael Jiménez-Arjona, Omar Trotta, F Alarcon, R San Antonio, M Sanchez, Paz Garre, José María Tolosana, Ivo Roca-Luque, Eduard Guasch, J. Brugada, Luis Mont, Margarida Pujol-López, and Elena Arbelo
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medicine.medical_specialty ,QRS complex ,business.industry ,Physiology (medical) ,medicine.medical_treatment ,Internal medicine ,Cardiac resynchronization therapy ,medicine ,Cardiology ,Ventricular pacing ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements Cardiac Pacing Scholarship from the Spanish Society of Cardiology (SEC) Background Electrocardiogram-based optimization of cardiac resynchronization therapy (CRT) using the fusion-optimized intervals (FOI) method has demonstrated to improve both acute hemodynamic response and left ventricle (LV) reverse remodeling compared to nominal programming of CRT. FOI optimizes the atrioventricular (AV) and ventriculo-ventricular (VV) intervals to achieve the shortest paced-QRS duration. The recent development of multipoint pacing (MPP) enables the activation of the LV from 2 locations, also shortening the QRS duration compared to conventional biventricular pacing. Purpose To determine if MPP reduces the paced-QRS duration compared to FOI optimization. Methods This prospective clinical study included 25 consecutive patients who successfully received a CRT with MPP pacing capability. All patients were in sinus rhythm and had an PR interval below 250 ms. The QRS duration was measured with a 12-lead digital electrocardiography (screen speed of 200 mm/s) at baseline and using 3 different configurations: MPP, FOI and a combined FOI-MPP strategy. In MPP, the intervals were (based on previous studies): 1) AV 130 ms, 2) Right ventricular (RV)-LV2 (Δ1) 5 ms, and 3) LV1-LV2 (Δ2) 5 ms. In FOI, AV and VV intervals were optimized to achieve fusion between intrinsic conduction and biventricular pacing. In FOI-MPP, the Δ2 was set at 5 ms, while AV and Δ1 intervals were optimized using the FOI method. The CRT device was programmed with the configuration that achieved a greater paced-QRS shortening. After 45 days, battery life was estimated. Results Mean age was 65 ± 10 years, 20 were men (80%) and baseline QRS duration was 177 ± 17 ms. The FOI method bested nominal MPP (QRS shortened by 58 ± 16 ms vs 43 ± 16 ms, respectively, p = 0.002). Adding MPP to the narrowest QRS by FOI did not result in further shortening (FOI: 58 ± 16 ms vs FOI-MPP: 59 ± 13 ms, p = 0.81). The final configuration was FOI method alone in most cases (n = 16, 64%) and FOI-MPP in all others (n = 9, 36%; figure). In total, 10 out of 25 patients (40%) were not candidates to MPP due to: 1) pacing thresholds exceeding 3.5 V/0.4 ms at the distal or proximal electrode (8, 32%), and 2) phrenic stimulation (2, 8%). Estimated battery longevity was longer in patients receiving FOI as compared to MPP (8.3 ± 2.1 years vs. 6.2 ± 2.2 years, p = 0.04). Conclusion In CRT, the FOI method is not improved by coupling with MPP. Up to 40% of patients are not candidates for MPP due to high thresholds or phrenic stimulation. The use of MPP in unselected patients would result in a decrease of battery longevity, without any additional benefit over FOI. Abstract Figure.
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- 2020
10. Aneurisma aislado del seno de Valsalva no coronariano
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Rafael Jiménez-Arjona, Purificación Holgado-Carballo, María Victoria García-Ruiz, and Víctor Manuel Becerra-Muñoz
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Cardiology and Cardiovascular Medicine - Published
- 2020
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