198 results on '"E. Arbelo"'
Search Results
2. Visualizing Lucas's Hamiltonian Paths Through the Associahedron 1-Skeleton (Media Exposition).
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Kacey Thien-Huu La, Jose E. Arbelo, and Christopher J. Tralie
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- 2024
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3. The DOPE Distance is SIC: A Stable, Informative, and Computable Metric on Time Series And Ordered Merge Trees.
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Christopher J. Tralie, Zachary Schlamowitz, Jose E. Arbelo, Antonio I. Delgado, Charley Kirk, and Nicholas A. Scoville
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- 2022
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4. Stepwise application of ECG and electrogram based criteria to ensure left bundle branch pacing
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M Pujol-Lopez, E Ferro, R Borras, P Garre, E Guasch, M Niebla, E Carro, I Roca-Luque, J B Guichard, L Uribe, E Arbelo, A Porta-Sanchez, M Sitges, J M Tolosana, and L Mont
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): MPL received the Catalan Society of Cardiology Research Grant in 2019 and 2020 (Catalonia, Spain); the Josep Font Grant (2019-2022) from Hospital Clínic Barcelona (Catalonia, Spain). Background Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing. However, lack of a systematic stepwise application of the left bundle branch (LBB) capture criteria complicates implantation. Objective To define a stepwise application of LBBP capture criteria that will simplify implantation and ensure LBB capture. Methods A cohort of 24 patients from the LEVEL-AT trial who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG and electrogram based criteria to predict accurate LBB capture were analyzed. A two-step approach was developed to ensure LBB capture. The gold standard used to confirm LBB capture was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Results Twenty-two (91.6%) patients showed LBBP capture on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120ms) resulted in 95% sensitivity and 100% specificity to predict LBB capture, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R Conclusions Stepwise application of ECG and electrogram criteria ensured an accurate assessment of left conduction system capture.
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- 2023
5. Local conduction velocities determined by non-invasive electrocardiographic imaging predict arrhythmia-free survival after pulmonary vein isolation
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E Invers-Rubio, I Hernandez-Romero, J Reventos-Presmanes, E Ferro, R Borras, J B Guichard, M S Guillem, A M Climent, J M Tolosana, I Roca-Luque, E Arbelo, A Porta-Sanchez, E Guasch, L Mont, and T F Althoff
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union's Horizon Research and Innovation Programme under the Marie-Sklodowska Curie Grant Agreement No. 860974 Background Recurrence rates after atrial fibrillation (AF) ablation are still unsatisfactory. As catheter ablation is primarily targeting pulmonary vein (PV) ectopic activity, it is not surprising that extra-PV arrythmogenic substrate is a key determinant of arrhythmia recurrence. Against this background, several studies have proposed assessment of extra-PV substrate in terms of atrial fibrosis or locally reduced conduction velocities (CV) to guide treatment. However, to date no non-invasive method directly assessing electrical arrhythmogenic substrate has been established in clinical practice, and treatment decisions are commonly based on crude surrogates like AF type or left atrial size. Here we establish and validate a novel non-invasive method based on electrocardiographic imaging (ECGi) to determine atrial arrhythmogenic substrate in terms of reduced local CVs and its predictive value regarding arrhythmia recurrence after PVI. Methods and results 52 consecutive patients scheduled for AF ablation (PVI-only) and 19 healthy controls were prospectively included and received ECGi to assess left and right atrial arrhythmogenic substrate. This ECGi-based method uses 64 electrodes placed on the torso. Subsequently, a 3D model of the torso is acquired as an anatomical reference using a 3D reconstruction camera. A personalised 3D atrial geometry is then derived from a database of human atria using an artificial intelligence-based algorithm. Finally, unipolar surface electrograms are projected onto the cardiac geometry and local CVs are estimated. Mean ECGi-determined atrial CVs were significantly lower in AF patients than in healthy controls, both in a global analysis (1.45±0.15 m/s vs. 1.64±0.15 m/s; p A ROC analysis revealed that a cut-off for this variable of 0.72 m/s best discriminates PVI responders from non-responders: patients with a mean CV >0.72 m/s in all atrial regions showed a 6-months arrhythmia-free survival of 90.9%, whereas patients with one or more atrial regions with a mean CV Conclusion This was the first study to investigate local atrial CV non-invasively and to validate their predictive value regarding outcome after PVI. The absence of ECGi-determined areas of slow conduction well discriminated PVI responders from non-responders. Such non-invasive assessment of electrical arrhythmogenic substrate may guide treatment strategies and be an important step towards personalised AF therapy.
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- 2023
6. Non-invasive electrocardiographic imaging for the characterization of complex atrial tachyarrhythmias
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J Reventos-Presmanes, E Invers-Rubio, E Ferro, R Borras, M Regany, M S Guillem, E Guasch, J M Tolosana, I Roca-Luque, A Porta-Sanchez, E Arbelo, T Althoff, A M Climent, L Mont, and J B Guichard
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by the European Union NextGenerationEU/PRTR. Background – The non-invasive characterization of complex atrial tachyarrhythmias, including atrial flutter (AFL) and focal atrial tachycardia (AT) is challenging. Conventional 12-lead electrocardiogram (ECG) faces several limitations. Planning a precise and preprocedural strategy for complex tachyarrhythmias catheter ablation (CA) is not easy. Purpose To evaluate the diagnostic capacity of a novel electrocardiographic imaging (ECGI) system that does not require previous CT/MRI thoracic imaging. Methods – 42 patients (27 males, CHA2DS2-VASc score 2±1, LVEF 54.5 ± 11.0 % and LA area 31.3 ± 7.0 cm2) undergoing CA for focal AT or AFL were prospectively included in the study. A preprocedural ECGI was managed based on a 64-electrode vest, a torso reconstruction using a 3D real-time acquisition camera, and an artificial intelligence-based method to estimate the patient atrial geometry. The differential diagnostic capacities of non-invasive 12-lead ECG and ECGI were assessed compared with endocavity electroanatomical mapping (EAM) regarding three endpoints: 1) the identification of the involved atrial cavity, 2) the mechanism (focal/micro-reentry or macro-reentry), and (3) the ablation target site defined as the area where the earliest activation was located for focal/micro re-entrant arrhythmias, and the precise anatomical pathway for macro re-entrant tachyarrhythmias. Regarding the ECG, the three endpoints were assessed based on validated algorithms by 2 different observers blinded from the diagnosis. Results – 48 atrial tachyarrhythmias of which 59.5% occurred in the context of a history of CA were evaluated. The non-invasive characterization of complex atrial arrhythmias using this novel ECGI system was possible in 94% of the cases (Figure A): directly for 36 arrhythmias and after decreasing ventricular response using vagal maneuvers for 9. ECGI obtained global accuracy to identify the involved atrial cavity of 91.7%, the mechanism of 89.6%, and the ablation target of 83.3%. In challenging cases, such as in patients with history of CA for AF (n = 27) and in patients without a final diagnosis of counterclockwise typical AFL (n=38) the diagnosis capacity of ECGI is consistent compared to the whole study population. The ECGI diagnostic capacity significantly outclassed the ECG one regarding the identification of the involved cavity (p Conclusions (Figure B) – This novel non-invasive ECGI system that does not require CT/MRI thoracic imaging accurately characterizes complex atrial tachyarrhythmia and outclasses ECG, the current noninvasive diagnostic tool of reference.
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- 2023
7. Evolution of deceleration zones during VT ablation and relation with cardiac magnetic resonance
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S Vazquez-Calvo, P Garre, E Ferro, P Falzone, L Uribe, J B Guichard, J T Ortiz-Perez, E Guasch, E Arbelo, J M Tolosana, L Mont, A Porta-Sanchez, J Brugada, and I Roca-Luque
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: None. Background A new functional mapping strategy based on targeting deceleration zones (DZs) has become one of the most commonly used strategies within the armamentarium of substrate-based ablation methods for ventricular tachycardia (VT) in patients with structural heart disease. The classic conduction channels detected by voltage mapping can be accurately determined by cardiac magnetic resonance (CMR). Objectives To analyze the evolution of DZs during ablation and their correlation with CMR. Methods Forty-two consecutive patients with scar-related VT undergoing ablation after CMR (October 2018-December 2020) were included (medium age 65.3±11.8 years; 94.7% male; 73.7% ischemic heart disease). Baseline DZs and their evolution in isochronal late activation remaps were analyzed. A comparison between DZs and CMR conducting channels (CMR-CCs) was realized. Patients were prospectively followed for VT recurrence for one year. Results Overall, 95 DZs were analyzed, 93.68% of which were correlated with CMR-CCs: 44.8% located in the middle segment and 55.2% located in the entrance/exit of the channel. Remapping was performed in 91.7% of patients (1remap: 33.3%, 2remaps: 55.6% and 3remaps: 2.8%). Regarding the evolution of DZs, 72.2% disappeared after the first ablation set, with 14.13% not ablated at the end of the procedure. A total of 32.5% of DZs in remaps correlated with a CMR-CCs already detected, and 17.5% were associated with an unmasked CMR-CCs. One-year VT recurrence was 22.9%. Conclusions DZs are highly correlated with CMR-CCs. In addition, remapping can lead to the identification of hidden substrate initially not identified by electroanatomic mapping but detected by CMR.
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- 2023
8. Noninvasive stratification of ventricular substrate by electrocardiographic imaging
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J Reventos-Presmanes, I Hernandez-Romero, E Invers-Rubio, E Ferro, P Garre, R Borras, J M Tolosana, E Guasch, E Arbelo, A Porta-Sanchez, S Vazquez, J B Guichard, A M Climent, L Mont, and I Roca-Luque
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Abnormalities of cardiac activation and conduction velocity (CV) are known pro-arrhythmogenic factors. Electrocardiographic imaging (ECGI) is presented as a non-invasive tool for arrhythmogenic substrate analysis. However, electrocardiographic features such propagation activation patterns, and CV are unknown in healthy subjects. In this study, ECGI technology has been evaluated for ventricular tissue stratification in patients with and without structural heart disease. Methods Nineteen patients were included in the study. The healthy ventricles group (Panel A) included 10 patients (8 males, 57 ± 6 years, NYHA = I and LVEF 61 ± 5 %) with normal baseline QRS and normal values of ventricular morphology, function and perfusion assessed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). The structural heart disease group (Panel B) included 9 patients (9 males, 66±6 years, NYHA 2±1 and LVEF 26±5%) with ischemic cardiomyopathy (ICM) confirmed by LGE-CMR and indication for ablation due to ventricular tachycardia. For each patient, fibrotic areas were identified by ventricular segmentation of the LGE-CMR and ventricles were regionalized in 16 regions. Epicardial electrograms were noninvasively reconstructed by ECGI, late activation time (LAT) and CV maps were calculated to study electrocardiographic features. Results – Ventricles with fibrosis secondary to ICM revealed heterogenous activation patters and higher activation time distribution compared to healthy ventricles (120 ms vs 80 ms; p Conclusions ECGI can noninvasively identify fibrotic tissue by analysing ventricular activation and CV patterns. ECGI could be a potential early tool to identify patients at risk of sudden cardiac death.
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- 2023
9. Impact of cardiac magnetic resonance channels to localize deceleration zones during VT ablation
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S Vazquez-Calvo, P Garre, E Ferro, J B Guichard, P Falzone, E Arbelo, J M Tolosana, E Guasch, L Mont, A Porta-Sanchez, J Brugada, J T Ortiz-Perez, and I Roca-Luque
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: None. Background Cardiac magnetic resonance has demonstrated to accurately identify voltage conduction channels and it is nowadays an important tool to analyze the arrhythmic substrate, to predict ventricular tachycardia (VT) events and to aid VT ablation. The characteristics of CMR channels (CMR-CCs) that predicts the presence of deceleration zone (DZ) have not been explored. Methods Forty-four consecutive patients with scar-related VT undergoing ablation after CMR (October 2018-July 2021) were included (medium age 64.8±11.6 years; 95.5% male; 70.5% ischemic heart disease, mean ejection fraction of 32.3±7.8). Characteristics of CMR-CCs were analyzed and correlation with DZs both in baseline maps and remaps were performed. Patients were prospectively followed for VT recurrence for one year. Results Overall, 129 automatically detected CMR-CCs were analyzed (2.89±1.83 per patient; length: 52.72±65.44mm (0.18–376.73), CC mass: 1.76±2.46grams (0.01–14.59); protectedness 19.02±24.51% (0.01–143.51)). Overall, 73.6% of CMR-CCs were associated with a DZ: 58.1% CMR-CCs in baseline map and 15.5% with a DZs not observed initially but in remaps. The univariate analysis showed that channels associated with DZs were longer (61.83±73.43 vs. 29.96±32.55, OR 1.01, p0.004), with higher border zone mass (2.02±2.75 vs. 1.09±1.44, OR 1.28, p0.031) and more protectedness (21.90±27.23 vs. 11.46±14.20, OR1.02, p0.036). VT recurrence after one-year follow up was 21.95%. Conclusions Pre ablation CMR can accurately identify channels that correlates with DZs that could be targets for ablation, especially those CMR-CCs with higher length, border zone mass and protectedness. Additionally, some channels not related with DZ in the first map have a clear DZ after abolishing the first region of slow conduction, suggesting a very useful role of CMR to detect potential DZs.
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- 2023
10. Cardiac injury before and after COVID-19. A longitudinal MRI study
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J E Gonzalez, A Doltra, R J Perea, P Lapena, C Garcia-Ribas, J Reventos, G Caixal, J M Tolosana, E Guasch, I Roca-Luque, E Arbelo, M Sitges, S Prat, L Mont, and T F Althoff
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Cardiology and Cardiovascular Medicine - Abstract
Background Recent MRI-based studies have raised great concern about frequent cardiac involvement even in mild or asymptomatic COVID-19. However, while signs of myocardial injury were found in large proportions of patients after COVID-19, all studies published to date lack baseline imaging and are therefore unable to discriminate between pre-existing and COVID-19-induced injury. Purpose In this longitudinal study, we aimed to assess the true cardiac impact of COVID-19 based on pre- and post-COVID-19 late gadolinium enhancement (LGE)-MRI. Methods A prospective registry of patients with serial LGE-MRIs was screened for patients with documented SARS-COV-2 infection after cardiac LGE-MRI. Eligible patients then received a post-COVID-19 LGE-MRI using the same scanner and sequence as in the pre-COVID-19 MRI. Inversion recovery prepared T1-weighted gradient echo sequences were acquired in sinus rhythm using ECG gating and a free-breathing 3D navigator, 15–20 minutes after administering an intravenous bolus of 0.2 mmol/kg of gadobutrol. A TI scout sequence was used in order to determine the optimal TI that nullified the left ventricular myocardial signal. The presence of LGE was independently assessed qualitatively by two experienced investigators blinded to patient information. For quantitative analyses a 3D-reconstruction of the left ventricle was performed using ADAS-3D software. LGE was then automatically quantified based on a prespecified signal intensity threshold of ≥3 SD above the mean of a remote non-enhanced myocardial region. Results Pre- and post-COVID LGE-MRI from 31 patients with cardiovascular risk factors that had recovered from mild to moderate COVID-19 (23% hospitalised) were analysed. At a median of 5 months post-COVID-19, LGE-lesions indicative of myocardial injury were encountered in 15 out of 31 patients (48%), which is in line with previous reports. However, intraindividual comparison with the pre-COVID-19 MRI reveiled all of these lesions as pre-existing and thus not COVID-19-related. Quantitative analysis detected no increase in the size of individual LGE-lesions, nor in the global left ventricular LGE-extent. There was no difference in any functional or structural parameter between pre- and post-COVID-19 MRI. Conclusion This longitudinal study in a cohort of patients considered at high risk of cardiac involvement, did not find any evidence for COVID-19-induced myocardial injury. The complete absence of de novo LGE lesions in this cohort is reassuring and indicates that cardiac sequelae of COVID-19 are rare and certainly not as common as previously suggested. Funding Acknowledgement Type of funding sources: None.
- Published
- 2022
11. Non-invasive assessment of pulmonary vein isolation durability using late gadolinium enhancement MRI
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D Padilla, E Ferro, S Prat, A Doltra, R J Perea, J M Tolosana, E Arbelo, E Guasch, I Roca, M Sitges, J Brugada, L Mont, and T F Althoff
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Cardiology and Cardiovascular Medicine - Abstract
Background Electrical reconnection of pulmonary veins (PV) is considered an important determinant of recurrent atrial fibrillation (AF) after PV isolation (PVI). However, it requires an invasive repeat procedure to assess durability of PVI. Against this background, in most centers clinically relevant AF recurrences almost automatically trigger repeat ablation procedures aiming at PV re-isolation. However, technological and procedural advances have substantially improved efficacy of catheter ablation. As a result it is increasingly common that all four PVs are found isolated in those repeat procedures. Thus, as ablation of extra-PV targets has failed to show benefit in large randomized trials, more and more often these highly invasive procedures are being performed only to confirm durable PVI. To date, late gadolinium enhancement (LGE)-MRI is the only non-invasive method to assess ablation lesions. However, its predictive value regarding PVI durability has not been systematically determined. Purpose Here we aim to define the ability of LGE-MRI to rule out PV reconnection and its potential to guide patient selection for repeat ablation procedures. Methods This study was based on our prospective registry where all patients receive an LGE-MRI before and after AF ablation. All patients that had undergone a repeat invasive procedure after an initial PVI-only ablation were included, and the ability of LGE-MRI to determine PVI durability was analysed using invasive mapping as a reference. Gradient echo MR sequences were acquired in sinus rhythm and 3D-reconstruction of left atrium and PVs performed using ADAS-3D software. LGE was quantified based on the signal intensity ratio of each voxel relative to the blood pool, applying a previously validated threshold of >1.2 to define LGE indicative of ablation-induced scarring. LGE discontinuations of >3 mm were considered indicative of PV reconnection. For validation, PVI durability was determined invasively based on local bipolar electrograms. Results A total of 142 patients and 284 PV pairs were analysed. LGE-MRI displayed LGE-discontinuations suggestive of PV reconnection in 210 PV pairs (74%). According to invasive mapping, LGE-MRI predicted PV reconnection with high sensitivity (89%), whereas specificity was somewhat lower (48%). Of note, a complete circumferential LGE-lesion reliably ruled out electrical reconnection of the respective PV pair with a negative predictive value of 94.5%. In the patient-based analyses 11% of the patients displayed complete LGE-lesion sets encircling all 4 PVs. None of these patients showed electrical PV reconnection in the invasive repeat procedure. Conclusion Although not frequently encountered, continuous LGE lesions encircling all 4 PVs reliably rule out PV reconnection. Thus, LGE-MRI has the potential to guide treatment decisions in patients with AF recurrences and may help to avoid unnecessary repeat procedures with all their associated risks and costs. Funding Acknowledgement Type of funding sources: None.
- Published
- 2022
12. Adolescent with Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria
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M. García, K. Kestler, A. Rodríguez, G. García-Donas, N. Dominguez, E. Arbelo, M.A. Portero, and C. Muñiz
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Cancer Research ,Pediatrics ,medicine.medical_specialty ,Oncology ,business.industry ,Paroxysmal nocturnal hemoglobinuria ,medicine ,Hematology ,Aplastic anemia ,medicine.disease ,business - Published
- 2017
13. 1011Ablation Strategies for different types of atrial fibrillation in Europe - Results of the EORP Atrial Fibrillation Ablation Long-Term Registry
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B Schmidt, J Brugada, E Arbelo, C Laroche, S Bayramova, M Bertini, K Letsas, L Pison, E Pokushalov, D Romanov, D Scherr, R Tilz, A Maggioni, and N Dagres
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2018
14. 198In Hospital and 12-month Follow-up Outcome from the ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry: Gender Differences
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M Grecu, N Dagres, J Brugada, C Laroche, I C Van Gelder, R Cihak, L Jordaens, J M Rubio Campal, A P Maggioni, E Pokushalov, J Kautzner, L Tavazzi, C Blomstrom Lundqvist, and E Arbelo
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2018
15. Personalized voltage maps guided by cardiac magnetic resonance in the era of high-density mapping.
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Vázquez-Calvo S, Garre P, Ferró E, Sánchez-Somonte P, Guichard JB, Falzone PV, Guasch E, Porta-Sánchez A, Tolosana JM, Borras R, Arbelo E, Ortiz-Pérez JT, Prats S, Perea RJ, Brugada J, Mont L, and Roca-Luque I
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- Humans, Male, Female, Aged, Catheter Ablation methods, Heart Conduction System physiopathology, Middle Aged, Body Surface Potential Mapping methods, Electrophysiologic Techniques, Cardiac methods, Tachycardia, Ventricular physiopathology, Tachycardia, Ventricular diagnosis, Magnetic Resonance Imaging, Cine methods
- Abstract
Background: Voltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5-1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high-density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) has been proven to be related with VT., Objective: The purpose of this study was to analyze the diagnostic yield of a personalized voltage map using CMR to guide the adjustment of voltage thresholds., Methods: All consecutive patients with scar-related VT undergoing ablation after CMR (from October 2018 to December 2020) were included. First, personalized CMR-guided voltage thresholds were defined systematically according to the distribution of the scar and channels. Second, to validate these new thresholds, a comparison with standard thresholds (0.5-1.5 mV) was performed. Tissue characteristics of areas identified as deceleration zones (DZs) were recorded for each pair of thresholds. In addition, the relation of VT circuits with voltage channels was analyzed for both maps., Results: Thirty-two patients were included [mean age 66.6 ± 11.2 years; 25 (78.1%) ischemic cardiomyopathy]. Overall, 52 DZs were observed: 44.2% were identified as border zone tissue with standard cutoffs vs 75.0% using personalized voltage thresholds (P = .003). Of the 31 VT isthmuses detected, only 35.5% correlated with a voltage channel with standard thresholds vs 74.2% using adjusted thresholds (P = .005). Adjusted cutoff bipolar voltages that better matched CMR images were 0.51 ± 0.32 and 1.79 ± 0.71 mV with high interindividual variability (from 0.14-1.68 to 0.7-3.21 mV)., Conclusion: Personalized voltage CMR-guided personalized voltage maps enable a better identification of the substrate with a higher correlation with both DZs and VT isthmuses than do conventional voltage maps using fixed thresholds., Competing Interests: Disclosures Drs Mont and Brugada report activities as a consultant, lecturer, and advisory board member for Abbott Medical, Boston Scientific, Biosense Webster, Medtronic, and Biotronik. They are also shareholders of ADAS 3D Medical. Drs Roca-Luque, Tolosana, and Porta-Sánchez report activities as a consultant and lecturer for Biosense Webster, Medtronic, Boston Scientific, and Abbott Medical. All other authors report that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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16. Longitudinal comparison of dyssynchrony correction and 'strain' improvement by conduction system pacing: LEVEL-AT trial secondary findings.
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Pujol-López M, Jiménez-Arjona R, Garcia-Ribas C, Borràs R, Guasch E, Regany-Closa M, Graterol FR, Niebla M, Carro E, Roca-Luque I, Guichard JB, Castel MÁ, Arbelo E, Porta-Sánchez A, Brugada J, Sitges M, Tolosana JM, Doltra A, and Mont L
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- Humans, Female, Male, Aged, Middle Aged, Treatment Outcome, Echocardiography, Heart Failure therapy, Heart Failure physiopathology, Heart Failure diagnostic imaging, Stroke Volume physiology, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left therapy, Ventricular Dysfunction, Left physiopathology, Longitudinal Studies, Follow-Up Studies, Cardiac Resynchronization Therapy methods
- Abstract
Aims: Longitudinal dyssynchrony correction and 'strain' improvement by comparable cardiac resynchronization therapy (CRT) techniques is unreported. Our purpose was to compare echocardiographic dyssynchrony correction and 'strain' improvement by conduction system pacing (CSP) vs. biventricular pacing (BiVP) as a marker of contractility improvement during 1-year follow-up., Methods and Results: A treatment-received analysis was performed in patients included in the LEVEL-AT trial (NCT04054895), randomized to CSP or BiVP, and evaluated at baseline (ON and OFF programming) and at 6 and 12 months (n = 69, 32% women). Analysis included intraventricular (septal flash), interventricular (difference between left and right ventricular outflow times), and atrioventricular (diastolic filling time) dyssynchrony and 'strain' parameters [septal rebound, global longitudinal 'strain' (GLS), LBBB pattern, and mechanical dispersion). Baseline left ventricular ejection fraction (LVEF) was 27.5 ± 7%, and LV end-systolic volume (LVESV) was 138 ± 77 mL, without differences between groups. Longitudinal analysis showed LVEF and LVESV improvement (P < 0.001), without between-group differences. At 12-month follow-up, adjusted mean LVEF was 46% with CSP (95% CI 42.2 and 49.3%) vs. 43% with BiVP (95% CI 39.6 and 45.8%), (P = 0.31), and LVESV was 80 mL (95% CI 55.3 and 104.5 mL) vs. 100 mL (95% CI 78.7 and 121.6 mL), respectively (P = 0.66). Longitudinal analysis showed a significant improvement of all dyssynchrony parameters and GLS over time (P < 0.001), without differences between groups. Baseline GLS significantly correlated with LVEF and LVESV at 12-month follow-up., Conclusion: CSP and BiVP provided similar dyssynchrony and 'strain' correction over time. Baseline global longitudinal 'strain' predicted ventricular remodelling at 12-month follow-up., Competing Interests: Conflict of interest: M.P.-L. has received speaker honoraria from Medtronic. J.M.T. has received honoraria as a lecturer and consultant from Abbott, Boston Scientific, and Medtronic. L.M. has received unrestricted research grants, fellowship programme support, and honoraria as a lecturer and consultant from Abbott, Biotronik, Boston Scientific, Livanova, and Medtronic; he holds stock in Galgo Medical and Corify. I.R.-L. has received honoraria as a lecturer and consultant from Abbott and Biosense Webster. M.S. has received consultant fees and speaker honoraria from Abbott, Medtronic, General Electric, and Edwards Lifesciences. M.A.C. has received speaker honoraria from Boston Scientific, Abbott, and Microport. E.A. has received speaker honoraria from Biosense Webster and Bayer. A.P.-S. has received honoraria as a lecturer and consultant from Biosense Webster, Abbott, and Boston Scientific. All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2024
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17. The European Society of Cardiology quality indicators in atrial fibrillation in centers of excellence in Spain: the SEC-EXCELENTE FA registry.
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Ruiz Ortiz M, Arbello Laínez E, Roldán Rabadán I, Marín F, Pérez Cabeza A, Marzoa Rivas R, Peinado Peinado R, Valle Alberca A, Ibáñez Criado A, Valle Muñoz A, Osca Asensi J, Del Río Lechuga A, Elola Somoza FJ, Anguita Sánchez M, Ruiz Ortiz M, Peinado Peinado R, Arbelo Laínez E, Valle Alberca A, Ibáñez Criado A, Valle Muñoz A, Osca Asensi J, Río Lechuga AD, and Pérez Cabeza AI
- Abstract
Introduction and Objectives: By 2022, 9 centers had been accredited by the Spanish Society of Cardiology for the atrial fibrillation (AF) process. Our objective was to evaluate the performance of these centers based on the quality indicators (QIs) proposed by the European Society of Cardiology (ESC) in 2020., Methods: Adults with AF who were attended in the cardiology departments of participating centers during the second week of May 2019 were included in a retrospective registry (n=797, age 72±11 years, 60% male). Key ESC QIs were assessed., Results: CHA
2 DS2 -VASc, HAS-BLED scores, and serum creatinine levels were documented in 24.9%, 6.1%, and 96.2% of patients, respectively. Anticoagulation was appropriately prescribed in 90.6% of high-risk patients according to the CHA2 DS2 -VASc score, but was inappropriately prescribed in 57.8% of low-risk patients. Among all patients, 84.1% received high-quality anticoagulation. Inappropriate antiarrhythmic drugs were prescribed in 7.2% of patients with permanent AF, 2.9% of those with structural heart disease, and 0.0% of those with end-stage kidney disease. Catheter ablation was offered to 70% of patients with symptomatic paroxysmal or persistent AF after the failure or intolerance of 1 antiarrhythmic drug. All modifiable risk factors were documented in 59.3% of patients. Rates of all-cause mortality, ischemic stroke or transient ischemic attack, and major bleeding were 8.1, 0.8, and 2.56 per 100 patients/y, respectively. QIs for anticoagulation and outcomes were similar between general cardiology and tertiary referral centers., Conclusions: Although accredited centers in Spain demonstrated good performance in many of the ESC QIs for AF, there remains room for improvement. These data could serve as a starting point for enhancing the quality of care in this population., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2024
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18. Clinical and economic impact of first-line or drug-naïve catheter ablation and delayed second-line catheter ablation for atrial fibrillation using a patient-level simulation model.
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Arbelo E, Ponti R, Cohen L, Pastor L, Costa G, Hempel M, and Grima D
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Aims: To determine the clinical and economic implications of first-line or drug-naïve catheter ablation compared to antiarrhythmic drugs (AADs), or shorter AADs-to-Ablation time (AAT) in atrial fibrillation (AF) patients in France and Italy, using a patient level-simulation model., Materials and Methods: A patient-level simulation model was used to simulate clinical pathways for AF patients using published data and expert opinion. The probabilities of adverse events (AEs) were dependent on treatment and/or disease status. Analysis 1 compared scenarios of treating 0%, 25%, 50%, 75% or 100% of patients with first-line ablation and the remainder with AADs. In Analysis 2, scenarios compared the impact of delaying transition to second-line ablation by 1 or 2 years., Results: Over 10 years, increasing first-line ablation from 0% to 100% (versus AAD treatment) decreased stroke by 12%, HF hospitalization by 29%, and cardioversions by 45% in both countries. As the rate of first-line ablation increased from 0% to 100%, the overall 10-year per-patient costs increased from €13,034 to €14,450 in Italy and from €11,944 to €16,942 in France. For both countries, the scenario with no delay in second-line ablation had fewer AEs compared to the scenarios where ablation was delayed after AAD failure. Increasing rates of first-line or drug-naïve catheter ablation, and shorter AAT, resulted in higher cumulative controlled patient years on rhythm control therapy., Limitations: The model includes assumptions based on the best available clinical data, which may differ from real-world results, however, sensitivity analyses were included to combat parameter ambiguity. Additionally, the model represents a payer perspective and does not include societal costs, providing a conservative approach., Conclusion: Increased first-line or drug-naïve catheter ablation, and shorter AAT, could increase the proportion of patients with controlled AF and reduce AEs, offsetting the small investment required in total AF costs over 10 years in Italy and France.
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- 2024
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19. Regional conduction velocities determined by noninvasive mapping are associated with arrhythmia-free survival after atrial fibrillation ablation.
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Invers-Rubio E, Hernández-Romero I, Reventos-Presmanes J, Ferro E, Guichard JB, Regany-Closa M, Pellicer-Sendra B, Borras R, Prat-Gonzalez S, Tolosana JM, Porta-Sanchez A, Arbelo E, Guasch E, Sitges M, Brugada J, Guillem MS, Roca-Luque I, Climent AM, Mont L, and Althoff TF
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- Humans, Male, Female, Middle Aged, Prospective Studies, Electrocardiography, Heart Atria physiopathology, Heart Atria diagnostic imaging, Follow-Up Studies, Magnetic Resonance Imaging, Cine methods, Recurrence, Aged, Body Surface Potential Mapping methods, Electrophysiologic Techniques, Cardiac methods, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Catheter Ablation methods, Heart Conduction System physiopathology, Pulmonary Veins surgery, Pulmonary Veins physiopathology, Pulmonary Veins diagnostic imaging
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Background: Atrial arrhythmogenic substrate is a key determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI), and reduced conduction velocities have been linked to adverse outcome. However, a noninvasive method to assess such electrophysiologic substrate is not available to date., Objective: This study aimed to noninvasively assess regional conduction velocities and their association with arrhythmia-free survival after PVI., Methods: A consecutive 52 patients scheduled for AF ablation (PVI only) and 19 healthy controls were prospectively included and received electrocardiographic imaging (ECGi) to noninvasively determine regional atrial conduction velocities in sinus rhythm. A novel ECGi technology obviating the need of additional computed tomography or cardiac magnetic resonance imaging was applied and validated by invasive mapping., Results: Mean ECGi-determined atrial conduction velocities were significantly lower in AF patients than in healthy controls (1.45 ± 0.15 m/s vs 1.64 ± 0.15 m/s; P < .0001). Differences were particularly pronounced in a regional analysis considering only the segment with the lowest average conduction velocity in each patient (0.8 ± 0.22 m/s vs 1.08 ± 0.26 m/s; P < .0001). This average conduction velocity of the "slowest" segment was independently associated with arrhythmia recurrence and better discriminated between PVI responders and nonresponders than previously proposed predictors, including left atrial size and late gadolinium enhancement (magnetic resonance imaging). Patients without slow-conduction areas (mean conduction velocity <0.78 m/s) showed significantly higher 12-month arrhythmia-free survival than those with 1 or more slow-conduction areas (88.9% vs 48.0%; P = .002)., Conclusion: This is the first study to investigate regional atrial conduction velocities noninvasively. The absence of ECGi-determined slow-conduction areas well discriminates PVI responders from nonresponders. Such noninvasive assessment of electrical arrhythmogenic substrate may guide treatment strategies and be a step toward personalized AF therapy., Competing Interests: Disclosures Dr Till Althoff has received research grants for investigator-initiated trials from Biosense Webster and honoraria as consultant from Corify Care. Prof Lluís Mont has received honoraria as a lecturer and consultant and has received research grants from Abbott Medical, Biosense Webster, Boston Scientific, and Medtronic; he is a shareholder of Galgo Medical SL and Corify Care. Drs Andreu Climent and María S. Guillem are co-founders of Corify Care and receive honoraria from the company. Dr Ismael Hernández is co-founder of Corify Care. Jana Reventos is employed by Corify Care. Drs Ivo Roca-Luque, Jose M. Tolosana, and Andreu Porta-Sanchez received honoraria as consultants for Biosense Webster, Boston Scientific, and Medtronic. Dr Jean-Baptiste Guichard reports honoraria as a consultant from Microport CRM and as lecturer from Microport CRM and Abbott and an unrestricted grant support for a fellowship from Abbott Laboratories., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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20. A narrative review of inherited arrhythmogenic syndromes in young population: role of genetic diagnosis in exercise recommendations.
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Sarquella-Brugada G, Martínez-Barrios E, Cesar S, Toro R, Cruzalegui J, Greco A, Díez-Escuté N, Cerralbo P, Chipa F, Arbelo E, Diez-López C, Grazioli G, Balderrábano N, and Campuzano O
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Sudden cardiac death is a rare but socially devastating event, especially if occurs in young people. Usually, this unexpected lethal event occurs during or just after exercise. One of the leading causes of sudden cardiac death is inherited arrhythmogenic syndromes, a group of genetic entities characterised by incomplete penetrance and variable expressivity. Exercise can be the trigger for malignant arrhythmias and even syncope in population with a genetic predisposition, being sudden cardiac death as the first symptom. Due to genetic origin, family members must be clinically assessed and genetically analysed after diagnosis or suspected diagnosis of a cardiac channelopathy. Early identification and adoption of personalised preventive measures is crucial to reduce risk of arrhythmias and avoid new lethal episodes. Despite exercise being recommended by the global population due to its beneficial effects on health, particular recommendations for these patients should be adopted considering the sport practised, level of demand, age, gender, arrhythmogenic syndrome diagnosed but also genetic diagnosis. Our review focuses on the role of genetic background in sudden cardiac death during exercise in child and young population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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21. Disease phenotypes in adult patients with suspected undifferentiated autoinflammatory diseases and PFAPA syndrome: Clinical and therapeutic implications.
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Gómez-Caverzaschi V, Yagüe J, Espinosa G, Mayordomo-Bofill I, Bedón-Galarza R, Araújo O, Pelegrín L, Arbelo E, Morales X, Balagué O, Figueras-Nart I, Mascaró JM, Fuertes I, Giavedoni P, Muxí A, Alobid I, Vilaseca I, Cervera R, Aróstegui JI, Mensa-Vilaró A, and Hernández-Rodríguez J
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- Humans, Adult, Female, Male, Retrospective Studies, Fever drug therapy, Fever diagnosis, Young Adult, Middle Aged, Colchicine therapeutic use, Syndrome, Adolescent, Phenotype, Stomatitis, Aphthous diagnosis, Stomatitis, Aphthous drug therapy, Pharyngitis drug therapy, Pharyngitis diagnosis, Lymphadenitis diagnosis, Lymphadenitis drug therapy, Hereditary Autoinflammatory Diseases diagnosis, Hereditary Autoinflammatory Diseases drug therapy, Hereditary Autoinflammatory Diseases genetics
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Background: Undifferentiated autoinflammatory diseases are characterized by recurrent or persistent fever, usually combined with other inflammatory manifestations, and negative or inconclusive genetic studies for monogenic autoinflammatory disorders., Aims: To define and characterize disease phenotypes in adult patients diagnosed in an adult reference center with undifferentiated autoinflammatory diseases, and to analyze the efficacy of the drugs used in order to provide practical diagnostic and therapeutic recommendations., Methods: Retrospective study (2015-2022) of patients with undifferentiated autoinflammatory diseases among all patients visited in our reference center. Demographic, clinical, laboratory features and detailed therapeutic information was collected., Results: Of the 334 patients with a suspected autoinflammatory disease, 134 (40%) patients (61% women) were initially diagnosed with undifferentiated autoinflammatory diseases. Mean age at disease onset and at diagnosis was 28.7 and 37.7 years, respectively. In 90 (67.2%) patients, symptoms started during adulthood. Forty-four (32.8%) patients met diagnostic/classification criteria for adult periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. In the remaining patients, four additional phenotypes were differentiated according to the predominant manifestations: a) Predominantly fever phenotype (n = 18; 13.4%); b) Predominantly abdominal/pleuritic pain phenotype (n = 9; 6.7%); c) Predominantly pericarditis phenotype (n = 18; 13.4%), and d) Complex syndrome phenotype (n = 45; 33.6%). Prednisone (mainly on demand), colchicine and anakinra were the drugs commonly used. Overall, complete responses were achieved with prednisone in 41.3%, colchicine in 40.2%, and anakinra in 58.3% of patients in whom they were used. By phenotypes, prednisone on demand was more effective in adult PFAPA syndrome and colchicine in patients with the abdominal/pleuritic pain pattern and PFAPA syndrome. Patients with complex syndrome achieved complete responses with prednisone (21.9%), colchicine (25.7%) and anakinra (44.4%), and were the group more often requiring additional immunosuppressive drugs., Conclusions: The analysis of the largest single-center series of adult patients with undifferentiated autoinflammatory diseases identified and characterized different disease phenotypes and their therapeutic approaches. This study is expected to contribute to increase the awareness of physicians for an early identification of these conditions, and to provide the best known therapeutic options., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: José Hernández-Rodríguez reports financial support was provided by Hospital Clínic de Barcelona. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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22. Predictors of failed left bundle branch pacing implant in heart failure with reduced ejection fraction: Importance of left ventricular diameter and QRS morphology.
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Graterol FR, Pujol-López M, Borràs R, Ayala B, Uribe L, Guasch E, Regany-Closa M, Niebla M, Carro E, Guichard JB, Castel MÁ, Arbelo E, Porta-Sánchez A, Sitges M, Brugada J, Roca-Luque I, Doltra A, Mont L, and Tolosana JM
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Background: Left bundle branch pacing (LBBP) is considered an alternative to cardiac resynchronization therapy (CRT). However, LBBP is not suitable for all patients with heart failure., Objective: The aim of our study was to identify predictors of unsuccessful LBBP implantation in CRT candidates., Methods: A cohort of consecutive patients with indications for CRT were included. Clinical, echocardiographic, and electrocardiographic variables were prospectively recorded., Results: A total of 187 patients were included in the analysis. LBBP implantation was successful in 152 of 187 patients (81.2%) and failed in 35 of 187 patients (18.7%). The causes of unsuccessful implantation were unsatisfactory paced QRS morphology (28 of 35 [80%]), inability to screw the helix (4 of 35 [11.4%]), lead instability (2 of 35 [5.7%]), and high pacing thresholds (1 of 35 [2.8%]). The left ventricular end-diastolic diameter (LVEDD), non-LBBB (left bundle branch block) QRS morphology, and QRS width were predictors of failed implantation according to the univariate analysis. According to the multivariate regression analysis, LVEDD (odds ratio 1.31 per 5-mm increase; 95% confidence interval 1.05-1.63 per 5-mm increase; P = .02) and non-LBBB (odds ratio 3.07; 95% confidence interval 1.08-8.72; P = .03) were found to be independent predictors of unsuccessful LBBP implantation. An LVEDD of 60 mm has 60% sensitivity and 71% specificity for predicting LBBP implant failure., Conclusion: When LBBP was used as CRT, LVEDD and non-LBBB QRS morphology predicted unsuccessful implantation. Non-LBBB triples the likelihood of failed implantation independent of LVEDD. Caution should be taken when considering these parameters to plan the best pacing strategy for patients., Competing Interests: Disclosures Dr Pujol-López has received speaker honoraria from Medtronic. Dr Tolosana has received honoraria as a lecturer and consultant from Abbott, Boston Scientific, and Medtronic. Dr Mont has received unrestricted research grants, fellowship program support, and honoraria as a lecturer and consultant from Abbott, Biotronik, Boston Scientific, LivaNova, and Medtronic; he holds stock in Galgo Medical and Corify. Dr Roca-Luque has received honoraria as a lecturer and consultant from Abbott and Biosense Webster. Dr Sitges has received consultant fees and speaker honoraria from Abbott, Medtronic, General Electric, and Edwards Lifesciences. Dr Castel has received speaker honoraria from Boston Scientific, Abbott, and MicroPort. Dr Arbelo has received speaker honoraria from Biosense Webster and Bayer. Dr Porta-Sánchez has received honoraria as a lecturer and consultant from Biosense Webster, Abbott, and Boston Scientific. Dr Guichard has received honoraria as a consultant from MicroPort CRM, honoraria as a lecturer from MicroPort CRM and Abbott, and unrestricted grant support for a fellowship from Abbott. The remaining authors declare that they have no conflicts of interest., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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23. Implantable loop recorders in patients with Brugada syndrome: the BruLoop study.
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Bergonti M, Sacher F, Arbelo E, Crotti L, Sabbag A, Casella M, Saenen J, Rossi A, Monaco C, Pannone L, Compagnucci P, Russo V, Heller E, Santoro A, Berne P, Bisignani A, Baldi E, Van Leuven O, Migliore F, Marcon L, Dagradi F, Sfondrini I, Landra F, Comune A, Cespón-Fernández M, Nesti M, Santoro F, Magnocavallo M, Vicentini A, Conti S, Ribatti V, Brugada P, de Asmundis C, Brugada J, Tondo C, Schwartz PJ, Haissaguerre M, Auricchio A, and Conte G
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- Female, Humans, Male, Middle Aged, Arrhythmias, Cardiac complications, Arrhythmias, Cardiac diagnosis, Electrocardiography methods, Electrocardiography, Ambulatory methods, Adult, Brugada Syndrome complications, Brugada Syndrome diagnosis, Brugada Syndrome therapy, Defibrillators, Implantable, Pacemaker, Artificial
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Background and Aims: Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to assess the precise arrhythmic cause of syncopal episodes., Methods: A total of 370 patients with BrS and ILRs (mean age 43.5 ± 15.9, 33.8% female, 74.1% symptomatic) from 18 international centers were included. Patients were followed with continuous rhythm monitoring for a median follow-up of 3 years., Results: During follow-up, an arrhythmic event was recorded in 30.7% of symptomatic patients [18.6% atrial arrhythmias (AAs), 10.2% bradyarrhythmias (BAs), and 7.3% ventricular arrhythmias (VAs)]. In patients with recurrent syncope, the aetiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs, and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of a pacemaker in 2.5%, and a cardioverter-defibrillator in 8%. At multivariate analysis, the presence of symptoms [hazard ratio (HR) 2.5, P = .001] and age >50 years (HR 1.7, P = .016) were independent predictors of arrhythmic events, while inducibility of ventricular fibrillation at the electrophysiological study (HR 9.0, P < .001) was a predictor of VAs., Conclusions: ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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24. The 2023 ESC guidelines for the management of cardiomyopathies: the 10 commandments.
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Kaski JP and Arbelo E
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- Humans, Practice Guidelines as Topic, Cardiomyopathies diagnosis, Cardiomyopathies therapy
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- 2024
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25. Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference.
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Linz D, Andrade JG, Arbelo E, Boriani G, Breithardt G, Camm AJ, Caso V, Nielsen JC, De Melis M, De Potter T, Dichtl W, Diederichsen SZ, Dobrev D, Doll N, Duncker D, Dworatzek E, Eckardt L, Eisert C, Fabritz L, Farkowski M, Filgueiras-Rama D, Goette A, Guasch E, Hack G, Hatem S, Haeusler KG, Healey JS, Heidbuechel H, Hijazi Z, Hofmeister LH, Hove-Madsen L, Huebner T, Kääb S, Kotecha D, Malaczynska-Rajpold K, Merino JL, Metzner A, Mont L, Ng GA, Oeff M, Parwani AS, Puererfellner H, Ravens U, Rienstra M, Sanders P, Scherr D, Schnabel R, Schotten U, Sohns C, Steinbeck G, Steven D, Toennis T, Tzeis S, van Gelder IC, van Leerdam RH, Vernooy K, Wadhwa M, Wakili R, Willems S, Witt H, Zeemering S, and Kirchhof P
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- Humans, Risk, Hemorrhage, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Stroke etiology, Stroke prevention & control
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Aims: Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA)., Methods and Results: Eighty-three international experts met in Münster for 2 days in September 2023. Key findings are as follows: (i) Active rhythm management should be part of the default initial treatment for all suitable patients with AF. (ii) Patients with device-detected AF have a low burden of AF and a low risk of stroke. Anticoagulation prevents some strokes and also increases major but non-lethal bleeding. (iii) More research is needed to improve stroke risk prediction in patients with AF, especially in those with a low AF burden. Biomolecules, genetics, and imaging can support this. (iv) The presence of AF should trigger systematic workup and comprehensive treatment of concomitant cardiovascular conditions. (v) Machine learning algorithms have been used to improve detection or likely development of AF. Cooperation between clinicians and data scientists is needed to leverage the potential of data science applications for patients with AF., Conclusions: Patients with AF and a low arrhythmia burden have a lower risk of stroke and other cardiovascular events than those with a high arrhythmia burden. Combining active rhythm control, anticoagulation, rate control, and therapy of concomitant cardiovascular conditions can improve the lives of patients with AF., Competing Interests: Conflict of interest The 9th AFNET/EHRA consensus conference was partially supported by the European Union MAESTRIA project (grant agreement 965286) to AFNET. The following participants and authors are employees of companies active in cardiovascular health as indicated in their affiliations: M.D.M., E.D., C.E., G.H., L.H.H., T.H., R.H.v.L., M.W., and H.W. P.K. was partially supported by the European Union AFFECT-AF (grant agreement 847770) and MAESTRIA (grant agreement 965286), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, grant numbers DZHK FKZ 81X2800182, 81Z0710116, and 81Z0710110), German Research Foundation (Ki 509167694), and Leducq Foundation. He receives research support for basic, translational, and clinical research projects from several drug and device companies active in AF and has received honoraria from several such companies in the past, but not in the last 3 years. He is listed as an inventor on two issued patents held by the University of Hamburg (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). J.G.A. was partially supported by the Canadian Arrhythmia Network and the Michael Smith Foundation for Health Research, Baylis Medical. He receives consulting fees/honoraria from Bayer, BMS/Pfizer Alliance, Servier, and Medtronic Inc. E.A. receives consulting fees/honoraria from Biosense Webster and Bayer. G.B. receives consulting fees/honoraria from Bayer, BMS, Boston Scientific, Daiichi Sankyo, Sanofi, and Janssen. A.J.C. receives consulting fees/honoraria from Bayer, Pfizer/BMS, Daiichi Sankyo, Menarini, Sanofi, Boston Scientific, Biosense Webster, Abbott, Acesion Pharma, Huya Bio, and Milestone. V.C. receives consulting fees/honoraria from Bayer, Boehringer Ingelheim, and Ever Pharma (paid to the institution of employment). W.D. receives consulting fees/honoraria from Reata and research grants from MicroPort, Boston Scientific, and Abbott. S.Z.D. receives consulting fees from BMS/Pfizer, Cortrium, and Acesion Pharma and speaker fees from MS/Pfizer and Bayer. He is listed as a medical advisor for Vital Beats. Dobromir D. receives consulting fees/honoraria from Elsevier, Springer Healthcare Ltd, and Daiichi Sankyo and research grants as follows: four NIH grants (partially) from Baylor College of Medicine, Houston; one NIH grant from UC Davis, one NIH grant from the University of Minnesota, and one EU-Project H2020. David D. receives consulting fees/honoraria from Abbott, Astra Zeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, BMS/Pfizer, CVRx, Medtronic, MicroPort, and Zoll and research grants from Roche, CVRx, and Zoll. L.E. has received lecture fees from various companies in AF in the past but none related to the present work. L.F. receives consulting fees/honoraria from Roche (paid to the institution of employment). She is currently employed at the UKE and previously at the University of Birmingham. She was partially supported by the European Union AFFECT-EU (grant agreement 847770), MAESTRIA (grant agreement 965286), CATCH ME (grant agreement 633196), and the British Heart Foundation (AA/18/2/3218). D.F.-R. receives research grants from Abbott. He is listed as an inventor on two issued patents: EP3636147A1 (method for the identification of cardiac fibrillation drivers and/or the footprint of rotational activations) and PCT/EP2022/071364 (system and method of assessment of electromechanical remodelling). A.G. receives consulting fees/honoraria from Daiichi Sankyo, Bayer, BMS/Pfizer, Medtronic, Abbott, and Boston Scientific and was partially supported by the European Union MAESTRIA (grant agreement 965286). K.G.H. receives consulting fees/honoraria from Abbott, Alexion, Amarin, Astra Zeneca, Bayer Healthcare, Biotronik, Boehringer Ingelheim, Boston Scientific, BMS/Pfizer, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Novaris, Portola, Premier Research, Sanofi, SUN Pharma, and W. L. Gore and Associates. J.S.H. receives speaking fees from BMS/Pfizer, Bayer, Servier, and Boston Scientific and consulting fees from Bayer and Boston Scientific. He receives research grants from BMS/Pfizer, Servier, Novartis, Boston Scientific, and Medtronic. H.H. receives lecture and consulting fees from Bayer, Biotronik, BMS/Pfizer, Daiichi Sankyo, Milestone Pharmaceuticals, Centrix India, C.T.I. Germany, ESC, Medscape, and Springer Healthcare Ltd. He receives research grants (paid to the institution of employment, University of Antwerp and/or University of Hasselt) from Abbott, Bayer, Biosense Webster, Boston Scientific, Daiichi Sankyo, Fibricheck/Qompium, Medtronic, and BMS/Pfizer. Z.H. receives consulting fees/honoraria from Boehringer Ingelheim, BMS/Pfizer, and Roche Diagnostics. He was partially supported by The Swedish Society for Medical Research (S17-0133), Hjärt-Lungfonden (The Swedish Heart-Lung Foundation, 20200722), and the institution he is currently employed at (Uppsala University Hospital). L.H.-M. receives research grants from the Spanish Ministry of Science and Innovation (PID2020-116927RB-C21) and Fondo Europeo de Desarrollo Regional (FEDER). D.K. receives consulting fees/honoraria from Bayer, Amomed, and Protherics Medicines Development. He receives research grants from the National Institute for Health Research (NIHR CDF-2015-08-074 RAE-AF; NIHR130280 DaRe2THINK; NIHR13274 D2T-NeuroVascular; and NIHR203326 Biomedical Research Centre), the British Heart Foundation (PG/17/55/33087, AA/182/3218, and FS/CDRF/21/21032), the EU/EFPIA Innovative Medicines Initiative (BigData@Heart 116074), EU Horizon and UKRI (HYPERMARKER 101095480) UK National Health Service—Data for R&D-Subnational Secure Data Environment programme, UK Department for Business, Energy Industrial Strategy Regulators Pioneer Fund, the Cook & Wolstenholme Charitable Trust, and the European Society of Cardiology supported by educational grants from Boehringer Ingelheim, BMS/Pfizer, Alliance, Bayer, Daiichi Sankyo, Boston Scientific, the NIHR/University of Oxford Biomedical Research Centre, and the British Hear Foundation, the University of Birmingham Accelerator Award (STEEER-AF). J.L.M. receives consulting fees/honoraria from Biotronik, Medtronic, MicroPort, and Milestone Pharmaceuticals. A.M. receives consulting fees/honoraria from Medtronic, Biosense Webster, and Boston Scientific and lecture fees from Medtronic, Boston Scientific, Biosense Webster, BMS, and Bayer. L.M. receives consulting fees/honoraria from Abbott, Medtronic, Boston Scientific, and Johnson & Johnson. G.A.N. receives lecture fees from AliveCor, consultant fees from Biosense Webster, and research grants from Abbott and Biosense Webster. H.P. receives consulting fees/honoraria from Abbott, Boston Scientific, Biosense Webster, Medtronic, Daiichi Sankyo, Bayer, and Pfizer. P.S. receives consulting fees/honoraria from Medtronic, Boston Scientific, Abbott, CathRx, and PaceMate (paid to the institution of employment). He is currently employed at the University of Adelaide, which receives research grants from Medtronic, Boston Scientific, and Becton-Dickenson. R.B.S. receives consulting fees/honoraria from BMS/Pfizer. She was partially supported by the European Union Horizon 2020 research and innovation programme (grant agreement 648131 and 847770), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, grant numbers 81Z1710103 and 81Z0710114), German Ministry of Research and Education (BMBF 01ZX1408A), ERACoSysMed3 (031L0239), Wolfgang Seefried project funding German Heart Foundation. U.S. receives consulting fees/honoraria from University Svizzerra Italiana, Stanford, and Johnson & Johnson and research grants from the European Union, Dutch Heart Foundation, Roche, and EP Solution. He is a shareholder of YourRhythmics B.V. T.T. receives consulting fees/honoraria from Boston Scientific and Medtronic. I.C.v.G. receives consulting fees/honoraria from Bayer (paid to the institution of employment). She is currently employed at the University of Groningen. K.V. receives consulting fees/honoraria from Abbott, Philips, Medtronic, Biosense Webster, and Boston Scientific and research grants from Medtronic and Biosense Webster. R.W. receives consulting fees/honoraria from Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Boston Scientific, Biotronik, Abiomed, and Zoll and a research grant from Boston Scientific, BMS/Pfizer, and Abiomed. S.W. receives consulting fees/honoraria from Boehringer Ingelheim, Boston Scientific, Abbott, and Bayer Vital and a research grant from Boston Scientific. All remaining authors (G.B., J.C.N., T.D.P., N.D., M.F., E.G., S.H., S.K., D.L., K.M.-R., M.O., A.S.P., U.R., M.R., D.S., C.S., G.S., D.S., S.T., R.H.v.L., and S.Z.) have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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26. Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol.
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Espinosa T, Farrus A, Venturas M, Cano A, Vazquez-Calvo S, Pujol-Lopez M, Eulogio-Valenzuela F, Guichard JB, Falzone PV, Graterol FR, Freixa X, Tolosana JM, Guasch E, Porta-Sanchez A, Arbelo E, Brugada J, Sitges M, Mont L, Roca-Luque I, and Althoff TF
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- Humans, Patient Discharge, Stroke Volume, Aftercare, Ventricular Function, Left, Retrospective Studies, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery
- Abstract
Aims: Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol., Methods and Results: As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff., Conclusion: Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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27. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society.
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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N, Peichl P, Frontera A, Tzeis S, Merino JL, Soejima K, de Chillou C, Tung R, Eckardt L, Maury P, Hlivak P, Tereshchenko LG, Kojodjojo P, and Atié J
- Subjects
- Humans, Risk Factors, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac therapy, Incidence, Asia epidemiology, Heart Failure complications, Defibrillators, Implantable, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular therapy, Tachycardia, Ventricular complications
- Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA., Competing Interests: Conflict of interest: Radosław Lenarczyk – nothing to declare, Katja Zeppenfeld – nothing to declare, Jacob Tfelt-Hansen – support received by himself or his institution related to this work - John and Birte Meyer Family Foundation, any other financial support: Johnson and Johnson, Microport, Cytokinetics and Leo Pharma, Frank R. Heinzel – nothing to declare, Thomas Deneke speaker honoraria- Biotronik, Abbott, Biosense Webster, voted member German Cardiology Society leadership team, Elena Ene - travel and proctorship honoraria from Johnson&Johnson, Christian Meyer - Abbott: speaker, Biotronik: consultant, Biosense Webster: consultant, Boston Scientific: consultant, speaker, Arthur Wilde - Associate editor Heart Rhythm, Chair DSMB LEAP trial (unpaid), Member scientific advisory board ARMGO & ThryvTherapeutics (unpaid), Elena Arbelo - Consulting for Bayer and Biosense Webster, Ewa Jędrzejczyk-Patej – nothing to declare, Avi Sabbag – nothing to declare, Markus Stühlinger - speaker honoraria (Biotronik, Medtronic), Luigi di Biase - consultant for Biosense Webster, Stereoataxis and I-Rhythm, has received speaker honoraria/travel from Biosense Webster, St. Jude Medical (now Abbott), Boston Scientific, Medtronic, Biotronik, Atricure, Baylis and Zoll, Marmar Vaseghi – grants NIH R01HL1706262, NIH R01HL148190, honorarium for educational speaking/courses/seminars from Zoll Inc. Medtronic Inc. and Biosense Webster Inc., minor stock in NeuCures Inc, Ohad Ziv – nothing to declare, William-Fernando Bautista-Vargas – nothing to declare, Saurabh Kumar – nothing to declare, Narayanan Namboodiri – nothing to declare, Benhur Davi Henz – nothing to declare, Jose Montero Cabezas - Shockwave Inc- research funding, Penumbra Inc- speaker fees, Nikolaos Dagres – nothing to declare, Peichl Petr – Astra Zeneca, Promed, Abbott, Medtronic, Biotronik, Biosense Webster: speaker fees, consultancy, Frontera Antonio – Abbott, Boston Scientific, Biosense Webster: speaker fees, consultancy, Tzeis Stylianos – Bayer, Pfizer: speaker fees, consultancy, Merino Jose Luis – Sanofi Aventis, Microport, Medtronic, Milestone Pharmaceutical, Biotronik, Zoll Medical: speaker fees, consultancy, Bayer: travel and meeting support, Daiichi Sankyo : Clinical Trial participation, Principal investigator, Milestone : Clinical trial participation, Principal investigator, Abbott : Fellow support, Principal investigator, Medtronic : Fellow support, Principal investigator, Soejima Kyoko – Abbott, Daiichi Sankyo, Medtronic, Johnson and Johnson: speaker fees, consultancy, de Chillou Christian – Abbott, Boston Scientific, Biosense Webster: speaker fees, consultancy, Tung Roderick – Biotronik, Medtronic, Abbott: speaker fees, consultancy, Eckardt Lars - nothing to declare, Maury Philippe - nothing to declare, Hlivak Peter – Pfizer, Boehringer-Ingelheim, Bayer, Novo-Nordisk: speaker fees, consultancy, Tereshchenko Larisa - nothing to declare, Kojodjojo Pipin - nothing to declare Atie Jacob - Johnson & Johnson: speaker fees, consultancy, Boston Scientific: travel and meeting support., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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28. Implementing a New Algorithm for Reinterpretation of Ambiguous Variants in Genetic Dilated Cardiomyopathy.
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Pérez-Serra A, Toro R, Martinez-Barrios E, Iglesias A, Fernandez-Falgueras A, Alcalde M, Coll M, Puigmulé M, Del Olmo B, Picó F, Lopez L, Arbelo E, Cesar S, Llano CT, Mangas A, Brugada J, Sarquella-Brugada G, Brugada R, and Campuzano O
- Subjects
- Humans, Algorithms, Gene Frequency, Cardiomyopathy, Dilated genetics, Heart Failure
- Abstract
Dilated cardiomyopathy is a heterogeneous entity that leads to heart failure and malignant arrhythmias. Nearly 50% of cases are inherited; therefore, genetic analysis is crucial to unravel the cause and for the early identification of carriers at risk. A large number of variants remain classified as ambiguous, impeding an actionable clinical translation. Our goal was to perform a comprehensive update of variants previously classified with an ambiguous role, applying a new algorithm of already available tools. In a cohort of 65 cases diagnosed with dilated cardiomyopathy, a total of 125 genetic variants were classified as ambiguous. Our reanalysis resulted in the reclassification of 12% of variants from an unknown to likely benign or likely pathogenic role, due to improved population frequencies. For all the remaining ambiguous variants, we used our algorithm; 60.9% showed a potential but not confirmed deleterious role, and 24.5% showed a potential benign role. Periodically updating the population frequencies is a cheap and fast action, making it possible to clarify the role of ambiguous variants. Here, we perform a comprehensive reanalysis to help to clarify the role of most of ambiguous variants. Our specific algorithms facilitate genetic interpretation in dilated cardiomyopathy.
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- 2024
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29. Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe.
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Carrick RT, De Marco C, Gasperetti A, Bosman LP, Gourraud JB, Trancuccio A, Mazzanti A, Murray B, Pendleton C, Tichnell C, Tandri H, Zeppenfeld K, Wilde AAM, Davies B, Seifer C, Roberts JD, Healey JS, MacIntyre C, Alqarawi W, Tadros R, Cutler MJ, Targetti M, Calò L, Vitali F, Bertini M, Compagnucci P, Casella M, Dello Russo A, Cappelletto C, De Luca A, Stolfo D, Duru F, Jensen HK, Svensson A, Dahlberg P, Hasselberg NE, Di Marco A, Jordà P, Arbelo E, Moreno Weidmann Z, Borowiec K, Delinière A, Biernacka EK, van Tintelen JP, Platonov PG, Olivotto I, Saguner AM, Haugaa KH, Cox M, Tondo C, Merlo M, Krahn AD, Te Riele ASJM, Wu KC, Calkins H, James CA, and Cadrin-Tourigny J
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- Humans, Retrospective Studies, Arrhythmias, Cardiac epidemiology, Arrhythmias, Cardiac therapy, Arrhythmias, Cardiac etiology, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac prevention & control, Death, Sudden, Cardiac etiology, Risk Factors, North America epidemiology, Europe epidemiology, Defibrillators, Implantable adverse effects, Arrhythmogenic Right Ventricular Dysplasia complications, Arrhythmogenic Right Ventricular Dysplasia epidemiology, Arrhythmogenic Right Ventricular Dysplasia therapy
- Abstract
Background and Aims: Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC., Methods: This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (<10%/5 years), intermediate- (10%-25%/5 years), and high-risk (>25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed., Results: One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans., Conclusions: North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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30. Non-invasive detection of slow conduction with cardiac magnetic resonance imaging for ventricular tachycardia ablation.
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Vázquez-Calvo S, Mas Casanovas J, Garre P, Sánchez-Somonte P, Falzone PV, Uribe L, Guasch E, Tolosana JM, Borras R, Figueras I Ventura RM, Arbelo E, Ortiz-Pérez JT, Prats S, Perea RJ, Brugada J, Mont L, Porta-Sanchez A, and Roca-Luque I
- Subjects
- Humans, Male, Middle Aged, Aged, Female, Magnetic Resonance Imaging methods, Myocardium pathology, Heart Rate physiology, Arrhythmias, Cardiac, Cicatrix pathology, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular surgery, Catheter Ablation methods
- Abstract
Aims: Non-invasive myocardial scar characterization with cardiac magnetic resonance (CMR) has been shown to accurately identify conduction channels and can be an important aid for ventricular tachycardia (VT) ablation. A new mapping method based on targeting deceleration zones (DZs) has become one of the most commonly used strategies for VT ablation procedures. The aim of the study was to analyse the capability of CMR to identify DZs and to find predictors of arrhythmogenicity in CMR channels., Methods and Results: Forty-four consecutive patients with structural heart disease and VT undergoing ablation after CMR at a single centre (October 2018 to July 2021) were included (mean age, 64.8 ± 11.6 years; 95.5% male; 70.5% with ischaemic heart disease; a mean ejection fraction of 32.3 ± 7.8%). The characteristics of CMR channels were analysed, and correlations with DZs detected during isochronal late activation mapping in both baseline maps and remaps were determined. Overall, 109 automatically detected CMR channels were analysed (2.48 ± 1.15 per patient; length, 57.91 ± 63.07 mm; conducting channel mass, 2.06 ± 2.67 g; protectedness, 21.44 ± 25.39 mm). Overall, 76.1% of CMR channels were associated with a DZ. A univariate analysis showed that channels associated with DZs were longer [67.81 ± 68.45 vs. 26.31 ± 21.25 mm, odds ratio (OR) 1.03, P = 0.010], with a higher border zone (BZ) mass (2.41 ± 2.91 vs. 0.87 ± 0.86 g, OR 2.46, P = 0.011) and greater protectedness (24.97 ± 27.72 vs. 10.19 ± 9.52 mm, OR 1.08, P = 0.021)., Conclusion: Non-invasive detection of targets for VT ablation is possible with CMR. Deceleration zones found during electroanatomical mapping accurately correlate with CMR channels, especially those with increased length, BZ mass, and protectedness., Competing Interests: Conflict of interest: L.M. and J.B. report activities as consultants, lecturers, and advisory board members for Abbott Medical, Boston Scientific, Biosense Webster, Medtronic, and Biotronik. They are also shareholders of Galgo Medical, S.L. I.R.-L., J.M.T., and A.P.-S. report activities as consultants and lecturers for Biosense Webster, Medtronic, Boston Scientific, and Abbott Medical. J.M.C. is currently an Abbott employee. R.M.F.V. is currently an ADAS 3D employee. All other authors report that they have no relationships relevant to the contents of this paper to disclose., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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31. Post-Ablation cardiac Magnetic resonance to assess Ventricular Tachycardia recurrence (PAM-VT study).
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Roca-Luque I, Vázquez-Calvo S, Garre P, Ortiz-Perez JT, Prat-Gonzalez S, Sanchez-Somonte P, Ferro E, Quinto L, Alarcón F, Althoff T, Perea RJ, Figueras I Ventura RM, Guasch E, Tolosana JM, Lorenzatti D, Morr-Verenzuela CI, Porta-Sanchez A, Arbelo E, Sitges M, Brugada J, and Mont L
- Subjects
- Humans, Male, Middle Aged, Aged, Female, Myocardium pathology, Contrast Media, Magnetic Resonance Imaging, Cine methods, Cicatrix pathology, Prospective Studies, Gadolinium, Magnetic Resonance Imaging methods, Magnetic Resonance Spectroscopy, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular surgery, Tachycardia, Ventricular pathology, Catheter Ablation
- Abstract
Aims: Conducting channels (CCs) detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related to ventricular tachycardia (VT). The aim of this work was to study the ability of post-ablation LGE-CMR to evaluate ablation lesions., Methods and Results: This is a prospective study of consecutive patients referred for a scar-related VT ablation. LGE-CMR was performed 6-12 months prior to ablation and 3-6 months after ablation. Scar characteristics of pre- and post-ablation LGE-CMR were compared. During the study period (March 2019-April 2021), 61 consecutive patients underwent scar-related VT ablation after LGE-CMR. Overall, 12 patients were excluded (4 had poor-quality LGE-CMR, 2 died before post-ablation LGE-CMR, and 6 underwent post-ablation LGE-CMR 12 months after ablation). Finally, 49 patients (age: 65.5 ± 9.8 years, 97.9% male, left ventricular ejection fraction: 34.8 ± 10.4%, 87.7% ischaemic cardiomyopathy) were included. Post-ablation LGE-CMR showed a decrease in the number (3.34 ± 1.03 vs. 1.6 ± 0.2; P < 0.0001) and mass (8.45 ± 1.3 vs. 3.5 ± 0.6 g; P < 0.001) of CCs. Arrhythmogenic CCs disappeared in 74.4% of patients. Dark core was detected in 75.5% of patients, and its presence was not related to CC reduction (52.2 ± 7.4% vs. 40.8 ± 10.6%, P = 0.57). VT recurrence after one year follow-up was 16.3%. The presence of two or more channels in the post-ablation LGE-CMR was a predictor of VT recurrence (31.82% vs. 0%, P = 0.0038) with a sensibility of 100% and specificity of 61% (area under the curve 0.82). In the same line, a reduction of CCs < 55% had sensibility of 100% and specificity of 61% (area under the curve 0.83) to predict VT recurrence., Conclusion: Post-ablation LGE-CMR is feasible, and a reduction in the number of CCs is related with lower risk of VT recurrence. The dark core was not present in all patients. A decrease in VT substrate was also observed in patients without a dark core area in the post-ablation LGE-CMR., Competing Interests: Conflict of interest: L.M. and J.B. report activities as a consultant, lecturer, and advisory board member for Abbott Medical, Boston Scientific, Biosense Webster, Medtronic, and Biotronik. They are also shareholders of Adas3D Medical S.L. I.R.-L. and A.P.-S. have served as a consultant for Biosense Webster, Medtronic, Boston Scientific, and Abbott Medical. M.S. reports activities as a consultant, lecturer, advisory board member, and grant recipient for Abbott Medical, Edwards Lifesciences, Sanofi, General Electric, and Medtronic. All other authors report that they have no relationships relevant to the contents of this paper to disclose., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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32. Combined Area of Left and Right Atria May Outperform Atrial Volumes as a Predictor of Recurrences after Ablation in Patients with Persistent Atrial Fibrillation-A Pilot Study.
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Mărgulescu AD, Mas-Lladó C, Prat-Gonzàlez S, Perea RJ, Borras R, Benito E, Alarcón F, Guasch E, Tolosana JM, Arbelo E, Sitges M, Brugada J, and Mont L
- Subjects
- Male, Humans, Female, Pilot Projects, Heart Atria diagnostic imaging, Heart Ventricles, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Atrial Appendage
- Abstract
Background and Objectives : Left atrial (LA) remodelling and dilatation predicts atrial fibrillation (AF) recurrences after catheter ablation. However, whether right atrial (RA) remodelling and dilatation predicts AF recurrences after ablation has not been fully evaluated. Materials and Methods : This is an observational study of 85 consecutive patients (aged 57 ± 9 years; 70 [82%] men) who underwent cardiac magnetic resonance before first catheter ablation for AF (40 [47.1%] persistent AF). Four-chamber cine-sequence was selected to measure LA and RA area, and ventricular end-systolic image phase to obtain atrial 3D volumes. The effect of different variables on event-free survival was investigated using the Cox proportional hazards model. Results : In patients with persistent AF, combined LA and RA area indexed to body surface area (AILA + RA) predicted AF recurrences (HR = 1.08, 95% CI 1.00-1.17, p = 0.048). An AILA + RA cut-off value of 26.7 cm
2 /m2 had 72% sensitivity and 73% specificity for predicting recurrences in patients with persistent AF. In this group, 65% of patients with AILA + RA > 26.7 cm2 /m2 experienced AF recurrence within 2 years of follow-up (median follow-up 11 months), compared to 25% of patients with AILA + RA ≤ 26.7 cm2 /m2 (HR 4.28, 95% CI 1.50-12.22; p = 0.007). Indices of LA and RA dilatation did not predict AF recurrences in patients with paroxysmal AF. Atrial 3D volumes did not predict AF recurrences after ablation. Conclusions : In this pilot study, the simple measurement of AILA + RA may predict recurrences after ablation of persistent AF, and may outperform measurements of atrial volumes. In paroxysmal AF, atrial dilatation did not predict recurrences. Further studies on the role of RA and LA remodelling are needed.- Published
- 2024
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33. Clinical Management of Brugada Syndrome: Commentary From the Experts.
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Cutler MJ, Eckhardt LL, Kaufman ES, Arbelo E, Behr ER, Brugada P, Cerrone M, Crotti L, deAsmundis C, Gollob MH, Horie M, Huang DT, Krahn AD, London B, Lubitz SA, Mackall JA, Nademanee K, Perez MV, Probst V, Roden DM, Sacher F, Sarquella-Brugada G, Scheinman MM, Shimizu W, Shoemaker B, Sy RW, Watanabe A, and Wilde AAM
- Subjects
- Humans, Electrocardiography, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Consensus, Brugada Syndrome diagnosis, Brugada Syndrome therapy, Heart Arrest diagnosis, Heart Arrest therapy
- Abstract
Although there is consensus on the management of patients with Brugada Syndrome with high risk for sudden cardiac arrest, asymptomatic or intermediate-risk patients present clinical management challenges. This document explores the management opinions of experts throughout the world for patients with Brugada Syndrome who do not fit guideline recommendations. Four real-world clinical scenarios were presented with commentary from small expert groups for each case. All authors voted on case-specific questions to evaluate the level of consensus among the entire group in nuanced diagnostic and management decisions relevant to each case. Points of agreement, points of controversy, and gaps in knowledge are highlighted., Competing Interests: Disclosures Dr Lubitz is a full-time employee of Novartis Institutes of BioMedical Research as of July 18, 2022. Dr Lubitz previously received sponsored research support from Bristol Myers Squibb, Pfizer, Boehringer Ingelheim, Fitbit, Medtronic, Premier, and IBM and has consulted for Bristol Myers Squibb, Pfizer, Blackstone Life Sciences, and Invitae.
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- 2024
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34. [2023 ESC Guidelines for the management of cardiomyopathies].
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, and Kaski JP
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- Humans, Electrocardiography, Cardiomyopathies therapy
- Published
- 2023
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35. Emergency department management of atrial fibrillation: 2023 consensus from the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Cardiology (SEC), and the Spanish Society of Thrombosis and Hemostasis (SETH).
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Martín A, Calvo D, Llamas P, Roldán V, Cózar R, Fernández de Simón A, Ávila P, Del Arco C, Arbelo E, Piñera P, and Coll-Vinent B
- Subjects
- Humans, Quality of Life, Emergency Service, Hospital, Cluster Analysis, Health Personnel, Hospitals, Workplace Violence, Atrial Fibrillation drug therapy
- Abstract
Objectives: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia managed in emergency departments, and the already high prevalence of this arrhythmia is increasing in Spain. This serious condition associated with increased mortality and morbidity has a negative impact on patient quality of life and the functioning of the health care system. The management of AF requires consideration of diverse clinical variables and a large number of possible therapeutic approaches, justifying action plans to coordinate the work of several medical specialties in the interest of providing appropriate care and optimizing resources. This consensus statement brings together recommendations for emergency department management of AF based on available evidence adapted to special circumstances. The statement was drafted by a multidisciplinary team of specialists from the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Cardiology (SEC), and the Spanish Society of Thrombosis and Hemostasis (SETH). Strategies for stroke prophylaxis, measures to bring heart rate and heart rhythm under control, and related diagnostic and logistic issues are discussed in detail.
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- 2023
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36. Athletes and suspected catecholaminergic polymorphic ventricular tachycardia: Awareness and current knowledge.
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Mascia G, Brugada J, Arbelo E, and Porto I
- Abstract
Introduction: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a cardiac inherited arrhythmogenic disease potentially leading to sudden cardiac death that is determined by electrical instability exacerbated by acute adrenergic tone., Methods and Results: Despite its life-threatening nature, CPVT remains potentially unnoticed since diagnosis may be difficult especially in apparently healthy athletes. This review summarizes current knowledge and shortcomings of CPVT, focusing on genetics, arrhythmic mechanisms, sport preparticipation screening, and current recommendations., Conclusions: The paper captures the importance of CPVT athletes regarding the necessity of risk stratification, as well as the importance of maintaining a healthy lifestyle., (© 2023 Wiley Periodicals LLC.)
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- 2023
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37. Placing patient-reported outcomes at the centre of cardiovascular clinical practice: implications for quality of care and management.
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Moons P, Norekvål TM, Arbelo E, Borregaard B, Casadei B, Cosyns B, Cowie MR, Fitzsimons D, Fraser AG, Jaarsma T, Kirchhof P, Mauri J, Mindham R, Sanders J, Schiele F, Torbica A, and Zwisler AD
- Subjects
- Humans, Patient Reported Outcome Measures, Quality of Life
- Abstract
Patient-reported outcomes (PROs) provide important insights into patients' own perspectives about their health and medical condition, and there is evidence that their use can lead to improvements in the quality of care and to better-informed clinical decisions. Their application in cardiovascular populations has grown over the past decades. This statement describes what PROs are, and it provides an inventory of disease-specific and domain-specific PROs that have been developed for cardiovascular populations. International standards and quality indices have been published, which can guide the selection of PROs for clinical practice and in clinical trials and research; patients as well as experts in psychometrics should be involved in choosing which are most appropriate. Collaborations are needed to define criteria for using PROs to guide regulatory decisions, and the utility of PROs for comparing and monitoring the quality of care and for allocating resources should be evaluated. New sources for recording PROs include wearable digital health devices, medical registries, and electronic health record. Advice is given for the optimal use of PROs in shared clinical decision-making in cardiovascular medicine, and concerning future directions for their wider application., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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38. Magnetic resonance detection of advanced atrial cardiomyopathy increases the risk for atypical atrial flutter occurrence following atrial fibrillation ablation.
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Ferró E, Pérez N, Althoff T, Guasch E, Prat S, Doltra A, Borrás R, Tolosana JM, Arbelo E, Sitges M, Porta-Sánchez A, Roca-Luque I, Mont L, and Guichard JB
- Subjects
- Humans, Contrast Media, Gadolinium, Magnetic Resonance Imaging, Heart Atria diagnostic imaging, Heart Atria surgery, Magnetic Resonance Spectroscopy, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Atrial Flutter diagnostic imaging, Atrial Flutter surgery, Cardiomyopathies complications, Cardiomyopathies diagnostic imaging, Catheter Ablation adverse effects
- Abstract
Aims: Recurrence of arrhythmia after catheter ablation of atrial fibrillation (AF) in the form of atypical atrial flutter (AFL) is common among a significant number of patients and often requires redo ablation with limited success rates. Identifying patients at high risk of AFL after AF ablation could aid in patient selection and personalized ablation approach. The study aims to assess the relationship between pre-existing atrial cardiomyopathy and the occurrence of AFL following AF ablation., Methods and Results: We analysed a cohort of 1007 consecutive AF patients who underwent catheter ablation and were included in a prospective registry. Patients who did not have baseline cardiac magnetic resonance imaging and late gadolinium enhancement (LGE-CMR) or did not experience any recurrences were excluded. A total of 166 patients were included gathering 56 patients who underwent re-ablation due to AFL recurrences and 110 patients who underwent re-ablation due to AF recurrences (P = 0.11). A multiparametric assessment of atrial cardiomyopathy was based on basal LGE-CMR, including left atrial (LA) volume, LA sphericity, and global and segmental LA fibrosis using semiautomated post-processing software. Out of the initial cohort of 1007 patients, AFL and AF occurred in 56 and 110 patients, respectively. An age higher than 65 [odds ratio (OR) = 5.6, 95% confidence interval (CI): 2.2-14.4], the number of previous ablations (OR = 3.0, 95% CI: 1.2-7.8), and the management of ablation lines in the index procedure (OR = 2.5, 95% CI: 1.0-6.3) were independently associated with AFL occurrence. Furthermore, several characteristics assessed by LGE-CMR were identified as independent predictors of AFL recurrence after the index ablation for AF, such as enhanced LA sphericity (OR = 1.3, 95% CI: 1.1-1.6), LA global fibrosis (OR = 1.03, 95% CI: 1.01-1.07), and increased fibrosis in the lateral wall (OR = 1.03, 95% CI: 1.01-1.04)., Conclusion: Advanced atrial cardiomyopathy assessed by LGE-CMR, such as increased LA sphericity, global LA fibrosis, and fibrosis in the lateral wall, is independently associated with arrhythmia recurrence in the form of AFL following AF ablation., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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39. Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing.
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Pujol-López M, Ferró E, Borràs R, Garre P, Guasch E, Jiménez-Arjona R, Garcia-Ribas C, Doltra A, Niebla M, Carro E, Roca-Luque I, Guichard JB, Puente JL, Uribe L, Vázquez-Calvo S, Castel MÁ, Arbelo E, Porta-Sánchez A, Sitges M, Tolosana JM, and Mont L
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- Humans, Bundle-Branch Block diagnosis, Bundle-Branch Block therapy, Cardiac Pacing, Artificial methods, Electrocardiography methods, Heart Conduction System, Treatment Outcome, Bundle of His, Cardiac Resynchronization Therapy methods
- Abstract
Aims: To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking., Methods and Results: A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R <80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP., Conclusion: Stepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract)., Competing Interests: Conflict of interest: M.P.L. has received speaker honoraria from Medtronic. J.M.T. has received honoraria as a lecturer and consultant from Abbott, Boston Scientific, and Medtronic. L.M. has received unrestricted research grants, fellowship program support, and honoraria as a lecturer and consultant from Abbott, Biotronik, Boston Scientific, Livanova, and Medtronic; he holds stock in Galgo Medical and Corify. I.R.L. has received honoraria as a lecturer and consultant from Abbott and Biosense Webster. M.S. has received consultant fees and speaker honoraria from Abbott, Medtronic, General Electric, and Edwards Lifesciences. E.F. is an employee of Medtronic. M.A.C. has received speaker honoraria from Boston Scientific, Abbott and Microport. E.A. has received speaker honoraria from Biosense Webster and Bayer. A.P.S. has received honoraria as a lecturer and consultant from Biosense Webster, Abbott, Boston Scientific. All remaining authors have declared no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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40. Evolution of Deceleration Zones During Ventricular Tachycardia Ablation and Relation With Cardiac Magnetic Resonance.
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Vázquez-Calvo S, Casanovas JM, Garre P, Ferró E, Sánchez-Somonte P, Quinto L, Guasch E, Porta-Sanchez A, Tolosana JM, Borras R, Arbelo E, Ortiz-Pérez JT, Brugada J, Mont L, and Roca-Luque I
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- Humans, Male, Middle Aged, Aged, Female, Magnetic Resonance Imaging, Heart, Magnetic Resonance Spectroscopy, Deceleration, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular surgery
- Abstract
Background: A new functional mapping strategy based on targeting deceleration zones (DZs) has become one of the most commonly used strategies within the armamentarium of substrate-based ablation methods for ventricular tachycardia (VT) in patients with structural heart disease. The classic conduction channels detected by voltage mapping can be accurately determined by cardiac magnetic resonance (CMR)., Objectives: The purpose of this study was to analyze the evolution of DZs during ablation and their correlation with CMR., Methods: Forty-two consecutive patients with scar-related VT undergoing ablation after CMR in Hospital Clinic (October 2018-December 2020) were included (median age 65.3 ± 11.8 years; 94.7% male; 73.7% ischemic heart disease). Baseline DZs and their evolution in isochronal late activation remaps were analyzed. A comparison between DZs and CMR conducting channels (CMR-CCs) was realized. Patients were prospectively followed for VT recurrence for 1 year., Results: Overall, 95 DZs were analyzed, 93.68% of which were correlated with CMR-CCs: 44.8% located in the middle segment and 55.2% located in the entrance/exit of the channel. Remapping was performed in 91.7% of patients (1 remap: 33.3%, 2 remaps: 55.6%, and 3 remaps: 2.8%). Regarding the evolution of DZs, 72.2% disappeared after the first ablation set, with 14.13% not ablated at the end of the procedure. A total of 32.5% of DZs in remaps correlated with a CMR-CCs already detected, and 17.5% were associated with an unmasked CMR-CCs. One-year VT recurrence was 22.9%., Conclusions: DZs are highly correlated with CMR-CCs. In addition, remapping can lead to the identification of hidden substrate initially not identified by electroanatomic mapping but detected by CMR., Competing Interests: Funding Support and Author Disclosures This study was supported by Emile Letang Grand of Hospital Clinic de Barcelona/Instituto de Salud Carlos III (ISCIII) PI20/00693/CB16/11/00354, co-funded by the European Union. Drs Mont and Brugada are consultants, lecturers, and advisory board members for Abbott Medical, Boston Scientific, Biosense Webster, Medtronic, and Biotronik; and shareholders of ADAS3D Medical, S.L. Drs Roca-Luque, Tolosana, and Porta-Sanchez are consultants and lecturers for Biosense Webster, Medtronic, Boston Scientific, and Abbott Medical. Judit Mas Casanovas is currently an Abbott employee. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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41. Sex differences in long QT syndrome.
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Díez-Escuté N, Arbelo E, Martínez-Barrios E, Cerralbo P, Cesar S, Cruzalegui J, Chipa F, Fiol V, Zschaeck I, Hernández C, Campuzano O, and Sarquella-Brugada G
- Abstract
Long QT Syndrome (LQTS) is a rare, inherited channelopathy characterized by cardiac repolarization dysfunction, leading to a prolonged rate-corrected QT interval in patients who are at risk for malignant ventricular tachyarrhythmias, syncope, and even sudden cardiac death. A complex genetic origin, variable expressivity as well as incomplete penetrance make the diagnosis a clinical challenge. In the last 10 years, there has been a continuous improvement in diagnostic and personalized treatment options. Therefore, several factors such as sex, age diagnosis, QTc interval, and genetic background may contribute to risk stratification of patients, but it still currently remains as a main challenge in LQTS. It is widely accepted that sex is a risk factor itself for some arrhythmias. Female sex has been suggested as a risk factor in the development of malignant arrhythmias associated with LQTS. The existing differences between the sexes are only manifested after puberty, being the hormones the main inducers of arrhythmias. Despite the increased risk in females, no more than 10% of the available publications on LQTS include sex-related data concerning the risk of malignant arrhythmias in females. Therein, the relevance of our review data update concerning women and LQTS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Díez-Escuté, Arbelo, Martinez Barrios, Cerralbo, Cesar, Cruzalegui, Chipa, Fiol, Zschaeck, Hernández, Campuzano and Sarquella-Brugada.)
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- 2023
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42. Cardiac Injury Before and After COVID-19: A Longitudinal Cardiac Magnetic Resonance Study.
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González JE, Doltra A, Perea RJ, Lapeña P, Garcia-Ribas C, Reventos J, Caixal G, Tolosana JM, Guasch E, Roca-Luque I, Arbelo E, Sitges M, Prat-Gonzalez S, Mont L, and Althoff TF
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- Humans, Predictive Value of Tests, Heart, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, COVID-19, Heart Injuries
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- 2023
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43. Scar conducting channel characterization to predict arrhythmogenicity during ventricular tachycardia ablation.
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Sanchez-Somonte P, Garre P, Vázquez-Calvo S, Quinto L, Borràs R, Prat S, Ortiz-Perez JT, Steghöfer M, Figueras I Ventura RM, Guasch E, Tolosana JM, Arbelo E, Brugada J, Sitges M, Mont L, and Roca-Luque I
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- Humans, Male, Middle Aged, Aged, Female, Cicatrix etiology, Cicatrix complications, Contrast Media, Gadolinium, Myocardium pathology, Magnetic Resonance Imaging methods, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular etiology, Tachycardia, Ventricular surgery, Catheter Ablation adverse effects
- Abstract
Aims: Heterogeneous tissue channels (HTCs) detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related to ventricular arrhythmias, but there are few published data about their arrhythmogenic characteristics., Methods and Results: We enrolled 34 consecutive patients with ischaemic and non-ischaemic cardiomyopathy who were referred for ventricular tachycardia (VT) ablation. LGE-CMR was performed prior to ablation, and the HTCs were analyzed. Arrhythmogenic HTCs linked to induced VT were identified during the VT ablation procedure. The characteristics of arrhythmogenic HTCs were compared with those of non-arrhythmogenic HTCs. Three patients were excluded due to low-quality LGE-CMR images. A total of 87 HTCs were identified on LGE-CMR in 31 patients (age:63.8 ± 12.3 years; 96.8% male; left ventricular ejection fraction: 36.1 ± 10.7%). Of the 87 HTCs, only 31 were considered arrhythmogenic because of their relation to a VT isthmus. The HTCs related to a VT isthmus were longer [64.6 ± 49.4 vs. 32.9 ± 26.6 mm; OR: 1.02; 95% CI: (1.01-1.04); P < 0.001] and had greater mass [2.5 ± 2.2 vs. 1.2 ± 1.2 grams; OR: 1.62; 95% CI: (1.18-2.21); P < 0.001], a higher degree of protectedness [26.19 ± 19.2 vs. 10.74 ± 8.4; OR 1.09; 95% CI: (1.04-1.14); P < 0.001], higher transmurality [number of wall layers with CCs: 3.8 ± 2.4 vs. 2.4 ± 2.0; OR: 1.31; 95% CI: (1.07-1.60); P = 0.008] and more ramifications [3.8 ± 2.0 vs. 2.7 ± 1.1; OR: 1.59; 95% CI: (1.15-2.19); P = 0.002] than non-arrhythmogenic HTCs. Multivariate logistic regression analysis revealed that protectedness was the strongest predictor of arrhythmogenicity., Conclusion: The protectedness of an HTC identified by LGE-CMR is strongly related to its arrhythmogenicity during VT ablation., Competing Interests: Conflict of interest: I.R.L. and J.M.T. have served as consultants for Boston Scientific and Abbott Medical.L.M. and J.B. report activities as consultants, lecturers, and advisory board members for Abbott Medical, Boston Scientific, Biosense Webster, Medtronic, and Biotronik. They are also shareholders of Galgo Medical, S.L. M.S and R.FV work for ADAS3D Medical S.L. All other authors declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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44. Electrocardiographic findings in patients with arrhythmogenic cardiomyopathy and right bundle branch block ventricular tachycardia.
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Laredo M, Tovia-Brodie O, Milman A, Michowitz Y, Roudijk RW, Peretto G, Badenco N, Te Riele ASJM, Sala S, Duthoit G, Arbelo E, Ninni S, Gasperetti A, van Tintelen JP, Paglino G, Waintraub X, Andorin A, Peichl P, Bosman LP, Calo L, Giustetto C, Radinovic A, Jorda P, Casado-Arroyo R, Zorio E, Bermúdez-Jiménez FJ, Behr ER, Havranek S, Tfelt-Hansen J, Sacher F, Hermida JS, Nof E, Casella M, Kautzner J, Lacroix D, Brugada J, Duru F, Bella PD, Gandjbakhch E, Hauer R, and Belhassen B
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- Humans, Bundle-Branch Block, Heart Ventricles, Electrocardiography, Tachycardia, Ventricular etiology, Tachycardia, Ventricular complications, Cardiomyopathies complications, Cardiomyopathies diagnosis
- Abstract
Aims: Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data., Methods and Results: From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available. Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV., Conclusions: In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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45. Quantification of right atrial fibrosis by cardiac magnetic resonance: verification of the method to standardize thresholds.
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Gunturiz-Beltrán C, Borràs R, Alarcón F, Garre P, Figueras I Ventura RM, Benito EM, Caixal G, Althoff TF, Tolosana JM, Arbelo E, Roca-Luque I, Prat-González S, Perea RJ, Brugada J, Sitges M, Guasch E, and Mont L
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- Humans, Cicatrix pathology, Cicatrix surgery, Contrast Media, Heart Atria pathology, Magnetic Resonance Imaging methods, Fibrosis, Gadolinium, Magnetic Resonance Spectroscopy, Atrial Fibrillation surgery, Catheter Ablation methods
- Abstract
Introduction and Objectives: Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) allows noninvasive detection of left atrial fibrosis in patients with atrial fibrillation (AF). However, whether the same methodology can be used in the right atrium (RA) remains unknown. Our aim was to define a standardized threshold to characterize RA fibrosis in LGE-CMR., Methods: A 3 Tesla LGE-CMR was performed in 53 individuals; the RA was segmented, and the image intensity ratio (IIR) calculated for the RA wall using 1 557 767 IIR pixels (40 994±10 693 per patient). The upper limit of normality of the IIR (mean IIR+2 standard deviations) was estimated in healthy volunteers (n=9), and patients who had undergone previous typical atrial flutter ablation (n=9) were used to establish the dense scar threshold. Paroxysmal and persistent AF patients (n=10 each) were used for validation. IIR values were correlated with a high-density bipolar voltage map in 15 patients undergoing AF ablation., Results: The upper normality limit (total fibrosis threshold) in healthy volunteers was set at an IIR = 1.21. In the postablation group, 60% of the maximum IIR pixel (dense fibrosis threshold) was calculated as IIR = 1.29. Endocardial bipolar voltage showed a weak but significant correlation with IIR. The overall accuracy between the electroanatomical map and LGE-CMR to characterize fibrosis was 56%., Conclusions: An IIR > 1.21 was determined to be the threshold for the detection of right atrial fibrosis, while an IIR > 1.29 differentiates interstitial fibrosis from dense scar. Despite differences between the left and right atria, fibrosis could be assessed with LGE-CMR using similar thresholds in both chambers., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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46. Reevaluation of ambiguous genetic variants in sudden unexplained deaths of a young cohort.
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Martinez-Barrios E, Sarquella-Brugada G, Perez-Serra A, Fernandez-Falgueras A, Cesar S, Alcalde M, Coll M, Puigmulé M, Iglesias A, Ferrer-Costa C, Del Olmo B, Picó F, Lopez L, Fiol V, Cruzalegui J, Hernandez C, Arbelo E, Díez-Escuté N, Cerralbo P, Grassi S, Oliva A, Toro R, Brugada J, Brugada R, and Campuzano O
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- Humans, Mutation, Gene Frequency, Autopsy, Death, Sudden, Cardiac etiology, Death, Sudden etiology, Arrhythmias, Cardiac
- Abstract
Sudden death cases in the young population remain without a conclusive cause of decease in almost 40% of cases. In these situations, cardiac arrhythmia of genetic origin is suspected as the most plausible cause of death. Molecular autopsy may reveal a genetic defect in up to 20% of families. Most than 80% of rare variants remain classified with an ambiguous role, impeding a useful clinical translation. Our aim was to update rare variants originally classified as of unknown significance to clarify their role. Our cohort included fifty-one post-mortem samples of young cases who died suddenly and without a definite cause of death. Five years ago, molecular autopsy identified at least one rare genetic alteration classified then as ambiguous following the American College of Medical Genetics and Genomics' recommendations. We have reclassified the same rare variants including novel data. About 10% of ambiguous variants change to benign/likely benign mainly because of improved population frequencies. Excluding cases who died before one year of age, almost 21% of rare ambiguous variants change to benign/likely benign. This fact makes it important to discard these rare variants as a cause of sudden unexplained death, avoiding anxiety in relatives' carriers. Twenty-five percent of the remaining variants show a tendency to suspicious deleterious role, highlighting clinical follow-up of carriers. Periodical reclassification of rare variants originally classified as ambiguous is crucial, at least updating frequencies every 5 years. This action aids to increase accuracy to enable and conclude a cause of death as well as translation into the clinic., (© 2023. The Author(s).)
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- 2023
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47. Non-invasive assessment of pulmonary vein isolation durability using late gadolinium enhancement magnetic resonance imaging.
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Padilla-Cueto D, Ferro E, Garre P, Prat S, Guichard JB, Perea RJ, Tolosana JM, Guasch E, Arbelo E, Porta-Sanchéz A, Roca-Luque I, Sitges M, Brugada J, Mont L, and Althoff TF
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- Humans, Contrast Media, Gadolinium, Treatment Outcome, Magnetic Resonance Imaging, Recurrence, Pulmonary Veins diagnostic imaging, Pulmonary Veins surgery, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods
- Abstract
Aims: Electrical reconnection of pulmonary veins (PVs) is considered an important determinant of recurrent atrial fibrillation (AF) after pulmonary vein isolation (PVI). To date, AF recurrences almost automatically trigger invasive repeat procedures, required to assess PVI durability. With recent technical advances, it is becoming increasingly common to find all PVs isolated in those repeat procedures. Thus, as ablation of extra-PV targets has failed to show benefit in randomized trials, more and more often these highly invasive procedures are performed only to rule out PV reconnection. Here we aim to define the ability of late gadolinium enhancement (LGE)-magnetic resonance imaging (MRI) to rule out PV reconnection non-invasively., Methods and Results: This study is based on a prospective registry in which all patients receive an LGE-MRI after AF ablation. Included were all patients that-after an initial PVI and post-ablation LGE-MRI-underwent an invasive repeat procedure, which served as a reference to determine the predictive value of non-invasive lesion assessment by LGE-MRI.: 152 patients and 304 PV pairs were analysed. LGE-MRI predicted electrical PV reconnection with high sensitivity (98.9%) but rather low specificity (55.6%). Of note, LGE lesions without discontinuation ruled out reconnection of the respective PV pair with a negative predictive value of 96.9%, and patients with complete LGE lesion sets encircling all PVs were highly unlikely to show any PV reconnection (negative predictive value: 94.4%)., Conclusion: LGE-MRI has the potential to guide selection of appropriate candidates and planning of the ablation strategy for repeat procedures and may help to identify patients that will not benefit from a redo-procedure if no ablation of extra-PV targets is intended., Competing Interests: Conflict of interest: T.F.A. has received research grants for investigator-initiated trials from Biosense Webster. L.M. has received honoraria as a lecturer and consultant and has received research grants from Abbott Medical, Biosense Webster, Boston Scientific, and Medtronic. He is a shareholder of Galgo Medical SL. M.S. has received grants, consulting honoria and speakers’ fees from General Electric, Edwards Lifesciences, Abbott Medical, and Medtronic. J.-B.G. has received an unrestricted fellowship grant from Abbott Medical. All remaining authors have declared no conflicts of interest., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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48. AFA-Recur: an ESC EORP AFA-LT registry machine-learning web calculator predicting atrial fibrillation recurrence after ablation.
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Saglietto A, Gaita F, Blomstrom-Lundqvist C, Arbelo E, Dagres N, Brugada J, Maggioni AP, Tavazzi L, Kautzner J, De Ferrari GM, and Anselmino M
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- Humans, Registries, Machine Learning, Recurrence, Risk Factors, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods
- Abstract
Aims: Atrial fibrillation (AF) recurrence during the first year after catheter ablation remains common. Patient-specific prediction of arrhythmic recurrence would improve patient selection, and, potentially, avoid futile interventions. Available prediction algorithms, however, achieve unsatisfactory performance. Aim of the present study was to derive from ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry (AFA-LT) a machine-learning scoring system based on pre-procedural, easily accessible clinical variables to predict the probability of 1-year arrhythmic recurrence after catheter ablation., Methods and Results: Patients were randomly split into a training (80%) and a testing cohort (20%). Four different supervised machine-learning models (decision tree, random forest, AdaBoost, and k-nearest neighbour) were developed on the training cohort and hyperparameters were tuned using 10-fold cross validation. The model with the best discriminative performance on the testing cohort (area under the curve-AUC) was selected and underwent further optimization, including re-calibration. A total of 3128 patients were included. The random forest model showed the best performance on the testing cohort; a 19-variable version achieved good discriminative performance [AUC 0.721, 95% confidence interval (CI) 0.680-0.764], outperforming existing scores (e.g. APPLE score: AUC 0.557, 95% CI 0.506-0.607). Platt scaling was used to calibrate the model. The final calibrated model was implemented in a web calculator, freely available at http://afarec.hpc4ai.unito.it/., Conclusion: AFA-Recur, a machine-learning-based probability score predicting 1-year risk of recurrent atrial arrhythmia after AF ablation, achieved good predictive performance, significantly better than currently available tools. The calculator, freely available online, allows patient-specific predictions, favouring tailored therapeutic approaches for the individual patient., Competing Interests: Conflict of interest: M.A. is consultant for Biosense Webster and Boston Scientific, proctor for Medtronic, and received educational support from Abbott., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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49. European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
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Aktaa S, Tzeis S, Gale CP, Ackerman MJ, Arbelo E, Behr ER, Crotti L, d'Avila A, de Chillou C, Deneke T, Figueiredo M, Friede T, Leclercq C, Merino JL, Semsarian C, Verstrael A, Zeppenfeld K, Tfelt-Hansen J, and Reichlin T
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- Humans, Arrhythmias, Cardiac complications, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac therapy, Death, Sudden, Cardiac prevention & control, Quality Indicators, Health Care, Cardiology
- Abstract
To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of care for the management of patients with VA and the prevention of SCD: (i) structural framework, (ii) screening and diagnosis, (iii) risk stratification, (iv) patient education and lifestyle modification, (v) pharmacological treatment, (vi) device therapy, (vii) catheter ablation, and (viii) outcomes, which included 17 main and 4 secondary QIs across these domains. Following a standardized methodology, we developed 21 QIs for the management of patients with VA and the prevention of SCD. The implementation of these QIs will improve the care and outcomes of patients with VA and contribute to the prevention of SCD., Competing Interests: Conflict of interest: M.J.A. is a consultant for Abbott, Boston Scientific, Bristol Myers Squibb, Daichii Sankyo, Invitae, LQT Therapeutics, and Medtronic. M.J.A. and/or Mayo Clinic are involved in an equity/intellectual property/royalty relationship with AliveCor, Anumana, ARMGO Pharma, Pfizer, and UpToDate. However, none of these entities were involved in this study. T.D. receives from InHeart—Speaker honoraria, personal (< 5.000€), Siemens—Speaker Honoraria, institutional (< 5.000€), Biotronik—Educational Course Director, personal (< 10.000€), Abbott—Speaker honoraria, personal (< 5.000€) and Boston Scientific—Adverse events committee, personal (< 5.000€). CPG Chair of the Data Science Group of EuroHeart, Deputy Editor of EHJ Quality of Care and Clinical Outcomes. Unrelated to the present work: Research grants from Abbott, BMS, BHF, Horizon 2020, NIHR; speaker’s honoraria from AstraZeneca, Raisio Group, Wondr Medical; Consulting from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Ely-Lilly, Menarini, Vifor outside the submitted work., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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50. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference.
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Schnabel RB, Marinelli EA, Arbelo E, Boriani G, Boveda S, Buckley CM, Camm AJ, Casadei B, Chua W, Dagres N, de Melis M, Desteghe L, Diederichsen SZ, Duncker D, Eckardt L, Eisert C, Engler D, Fabritz L, Freedman B, Gillet L, Goette A, Guasch E, Svendsen JH, Hatem SN, Haeusler KG, Healey JS, Heidbuchel H, Hindricks G, Hobbs FDR, Hübner T, Kotecha D, Krekler M, Leclercq C, Lewalter T, Lin H, Linz D, Lip GYH, Løchen ML, Lucassen W, Malaczynska-Rajpold K, Massberg S, Merino JL, Meyer R, Mont L, Myers MC, Neubeck L, Niiranen T, Oeff M, Oldgren J, Potpara TS, Psaroudakis G, Pürerfellner H, Ravens U, Rienstra M, Rivard L, Scherr D, Schotten U, Shah D, Sinner MF, Smolnik R, Steinbeck G, Steven D, Svennberg E, Thomas D, True Hills M, van Gelder IC, Vardar B, Palà E, Wakili R, Wegscheider K, Wieloch M, Willems S, Witt H, Ziegler A, Daniel Zink M, and Kirchhof P
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- Humans, Artificial Intelligence, Early Diagnosis, Consensus, Cognition, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Stroke prevention & control
- Abstract
Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI., Competing Interests: Conflict of interest: RBS has received lecture fees and advisory board fees from BMS/Pfizer outside this work and has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme under the grant agreement No 648131, from the European Union's Horizon 2020 research and innovation programme under the grant agreement No 847770 (AFFECT-EU) and German Center for Cardiovascular Research (DZHK e.V.) (8121710103); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239).EAM is employee of Daiichi Sankyo Europe GmbH producing and marketing an oral anticoagulant (edoxaban). EA has received consulting / speaker fees for Biosense Webster. GB has received speaker's fees of small amount from Boston, Bayer, Daiichi, Boehringer. SB is consultant for Medtronic, Boston Scientific, Microport, and Zoll. JC has received consulting fees / honoraria fees from Acesion, Allergan, Alta Thera, Arca, lncarda, Menarini, Milestone, Sanofi, Bayer, Daiichi Sankyo, Pfizer, Abbott, Biosense Webster, Biotronik, Boston Scientific, Lilly, Medtronic, Johnson and Johnson. BC has received in kind contribution for research Support from iRhythm. WC has received advisory board fees for Roche Diagnostics AG. MDM is employee of Medtronic. SZB has received fees as member of Advisory Board in Bristol Myers Squibb-Pfizer. DD has received fees from Abbott, Astra Zenica, Bayer, Bosten Scientific, Bristol Myers Squibb-Pfizer, Medtonic, Zoll. LE has received lecture Honoria from Medtronic, Biotronik, Boston Scientific, Boehringer Ingelheim, Daiichy Sankyo, Bayer, MMS, Pfizer, Sanofi and received research grants from DFG and DGK. CE is employee of Preventicus GmbH. LF has received institutional research grants and non-financial support from European Union, DFG, British Heart Foundation, Medical Research Council (UK), NIHR, and several biomedical companies. The Institute of Cardiovascular Research, University of Birmingham, has received an Accelerator Award by the British Heart Foundation M/18/2/34218. LF is listed as inventor of two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). BF receiving fees from Bristol-Myers Squibb and Pfizer Alliance, Bayer, Daiichi Sankyo, Omron. (largely speaker fees and travel support for speaking at session or official satellites of large international/continental society meetings) and investigator-initiated research grants to the institution from Bristol-Myers and Squibb and Pfizer Alliance and Ownership / Employee of Nil. LG and AZ are employees of Roche Diagnostics International Ltd. AG has received funding from Daiichi Sankyo, Astra Zenica, Bayer, Bristol Myers Squibb-Pfizer, Viola, Medtonic, Berlin Charitè. JHS has received Advisory board fees in Medtronic and Speaker fee from Medtronic. KGH has received fees from Abbott, Alexion, AMARIN, AstraZeneca, Bayer, Biotronik, Boehringer Ingelheim, Bristol-Myers-Squibb, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Pfizer, Premier Research, SUN Pharma and W. L. Gare & Associates and Research Grants from Bayer Vital, Sanofi-Aventis. JSH received fees from Boston Scientific, Servier, Bayer, Myokardia, Bristol-Myers-Squibb, Pfizer, and research grants from Medtronic, Boston Scientific, Bristol-Myers-Squibb, Abbott. HH has received lecture and consultancy fees from Abbott, Biotronik, Bristol-Myers-Squibb- Pfizer, Medscape, Daiichi Sankyo, Springer Healthcare Ltd and receive un conditional research grants through the Univerity of Antwerp and/or University of Hasselt from Abbott, Bayer, Biotronik, Biosense-Webster, Fibrickeck/Qompium, Medtronic, Bristol-Myers-Squibb- Pfizer, Boston Scientific, Daiichi Sankyo and Boehringer Ingelheim. RH has received speacker fees from BI, Bayer and Bristol-Myers-Squibb- Pfizer and AZ. TH is CEO of Preventicus GmbH. DK has received funding from Bayer, AtriCure, Protherics Medicines Development and Myokardia and Research grant from rants from the National Institute for Health Research (NIHR CDF-2015-08-074 RATE-AF; NIHR HTA-130280 DaRe2THINK; NIHR EME- 132974 D2T-NV), the British Heart Foundation (PG/17/55/33087 and AA/18/2/34218), EU/EFPIA IMI (BigData@Heart 116074),the European Society of Cardiology supported by educationalgrants from Boehringer Ingelheim/BMS-Pfizer Alliance/Bayer/Daiichi Sankyo/Boston Scientific, the NIHR/the University of Ox- ford Biomedical Research Centre, and British Heart Foundation/ the University of Birmingham Accelerator Award (STEEER-AF NCT04396418), Amomed Pharma, and IRCCS San Raffaele/Menarini (beta-blockers in Heart Failure Collaborative Group NCT0083244). MK is employee of Bristol-Myers and Squibb. CL has received fees from medtonic, Boston Scientific, Biotronik and Bristol-Myers and Squibb- Pfizer and research grants from Rennes Univerity, Metronik, Biotonik and Boston Scientific. DL has received research grant for EHRA-PATHS, NovoNordisk Young Investigator Award. MLL has received lecture fees from Bristol-Myers and Squibb and research grant from H2020 AFFECT-EU (grant No. 847770). SM has received research grant from Daiichi Sankyo (EPDAURUS IIT) and Bristol-Myers and Squibb (APPROACH ACS AF IIT). JLM has received Abbott, Boston Scientific, Biotronik, Boehringer Ingelheim, Sanofi, Microport and received research grants from Medtronic, Abbott, Microport, Biosense. RM is employee of Medtronic. LM is Stockholder for Galgomedical and Corify and receiving consuting fees from Abbott, Biosense-Webster, Bosten Scientific, Medtronik and receiving research grants from Abbott, Biosense-Webster, Bosten Scientific, Medtronik. LN has received consulting fees from Bristol-Myers and Squibb- Pfizer. GP is employee of Bayer AG. HP has received consulting fees from Abbott, Biosense-Webster, Bosten Scientific, Medtronik and receiving research grants from Abbott, Bayer, Biosense-Webster, Bosten Scientific, Medtronik, Bristol-Myers and Squibb- Pfizer. MR has received consulting fees for Medtonic, Arca BiopharmaInc, Roche and received research grants from Dutch Heart Foundation: RACE V, RED-CVD, CVON-AI, DECISION studies; grant from SJM/Abbott to institution: VIP-HF study; Grant for Medtronic to institution: Cryoballoon AF registry/biobank study. The other authors declare that there is no conflict of interest.LR has received research grants from Canadian Insititute of Health research and Byer Inc. U.S. received consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited, (United Kingdom), Bayer Healthcare (Germany). U.S. is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht and Research grant from the Dutch Heart Foundation (CVON RACE V, CVON2014–09) European Union's Horizon 2020 Research and Innovation Program granted to MS under the Marie Sklodowska-Curie grant agreement #813716 (TRAIN-HEART Innovative Training Network), and various other programs of the European Union granted to US (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network – grant #860974; CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly – grant #633196; MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation – grant #965286; REPAIR: Restoring cardiac mechanical function by polymeric artificial muscular tissue – grant #952166). DS has received consultation fees from Biosense Webster, Abbott, Boston Scientific, Consultant with stock option: SentiAR, Arga Medtech. RS is employee of Daiichi Sankyo Europe GmbH. DS has received consultation fees from Boston Scientific, Abbott and Research grant from Biosense Webster. ES has received lecture fees from Bayer, Bristol-Myers and Squibb- Pfizer, Boehringer Ingelheim, Johnson & Johnson, Merck Sharp & Dohme and Sanofi. DT has received lecture fees from Bayer Vital, Bristol-Myers and Squibb- Pfizer, Daiichi Sankyo, Medtonic, Zoll CMS, Sanofi, St. Jude Medical and research grant from Daiichi Sankyo. MTH is employee/owner of American Foundation of women's Health /StopAfib.org and employee/owner of True Hills Inc.. BV is employee of Bayer AG. RW has received consultation fees from Boston Scientific, Biotronic, Pfizer, Daiichi Sankyo, Bayer, Adagio Medical and Research grant from Bristol-Myers and Squibb- Pfizer, Boston Scientific. CW has received consulation fees from Biotronik, Boston Scientific, Novartis and research grant from BMBF, AFNET, DZHK, Biotronik. MW is employee and shareholder of Sanofi. SW has received Consulting fees from Boston Scientific, Abbott, Bayer, Bristol-Myers and Squibb- Pfizer, Boehringer Ingelheim and research grant from Boston Scientific. HW is employee and stockholder of Pfizer Germany. MDZ has received advisory and speaker fee from Bristol-Myers and Squibb- Pfizer. PK reports grants and non-financial support from BMBF (German Ministry of Education and Research), grants from Sanofi and Abbott, grants and non-financial support from EHRA (European Heart Rhythm Association), and grants from German Heart Foundation and DZHK (German Center for Cardiovascular Research), during the conduct of the study, and grants from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and non-financial support from German Centre for Heart Research, outside the submitted work; in addition, P.K. has a patent Atrial Fibrillation Therapy WO 2015140571 issued to University of Birmingham and a patent Markers for Atrial Fibrillation WO 2016012783 issued to University of Birmingham., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.)
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