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1. Primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator in elderly patients: results of a Spanish multicentre study

Author

Expósito V, Rodríguez-Mañero M, González-Enríquez S, Arias MA, Sánchez-Gómez JM, Andrés La Huerta A, Bertomeu-González V, Arce-León Á, Barrio-López MT, Arguedas-Jiménez H, Seara JG, and Rodriguez-Entem F

Subjects
Cardiac resynchronization therapy, Primary prevention, Elderly, Survival, Implantable cardioverter-defibrillator
Abstract

Currently, there continues to be a lack of evidence regarding outcomes associated with device-based therapy for ventricular arrhythmias in elderly patients, even more in primary-prevention indications. We aimed to describe the follow-up in terms of efficacy and safety of implantable cardioverter-defibrillator (ICD) therapy in a large cohort of elderly patients. Retrospective multicentre study performed in 15 Spanish hospitals. Consecutive patients referred for ICD implantation before 2011 were included. One hundred and sixty-two of 1174 patients (13.8%) a parts per thousand yen75 years were considered as 'elderly'. When compared with those patients < 75, this subgroup presented more co-morbid conditions, including hypertension, chronic obstructive pulmonary disease , and renal failure, and more previous hospitalizations due to heart failure (HF). During a mean follow-up of 104.4 +/- 3.3 months, 162 patients (14%) died, 120 in the younger age (12.4%), and 42 (24.4%) in the elderly. Kaplan-Meier analysis showed an increased probability of death with increasing age (17, 24, 28, and 69% at 12, 24, 48, and 60 months of follow-up in the elderly group). There was neither difference regarding the rate of appropriate nor inappropriate ICD intervention. In a real-world scenario, elderly patients comprise similar to 15% of ICD implantations for primary prevention of sudden cardiac death (SCD). Although the rate of appropriate therapy is similar between groups, the benefit of ICD is attenuated for a major increase in mortality risk among those patients a parts per thousand yen75 years at the moment of device implantation.

Published
2016

2. A Remote Nutritional Intervention to Change the Dietary Habits of Patients Undergoing Ablation of Atrial Fibrillation: Randomized Controlled Trial.

Author

Goni L, de la O V, Barrio-López MT, Ramos P, Tercedor L, Ibañez-Criado JL, Castellanos E, Ibañez Criado A, Macias Ruiz R, García-Bolao I, Almendral J, Martínez-González MÁ, and Ruiz-Canela M

Subjects
Diet, Mediterranean, Female, Humans, Male, Nutrition Assessment, Risk Factors, Secondary Prevention, Atrial Fibrillation diet therapy, Feeding Behavior physiology
Abstract

Background: The Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored., Objective: This study aims to assess the effectiveness of a remotely provided Mediterranean diet-based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF)., Methods: The PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the Mediterranean diet enriched with extra virgin olive oil (EVOO) on the prevention of atrial tachyarrhythmia recurrence after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (Mediterranean diet enriched with EVOO) or a control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with provision of dietary recommendations, and participants had access to a web page, a mobile app, and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, Mediterranean diet classroom, and Your personal experience. At baseline and at 1-year and 2-year follow-up, the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire were collected by a dietitian by phone., Results: A total of 720 subjects were randomized (365 to the intervention group, 355 to the control group). Up to September 2020, 560 subjects completed the first year (560/574, retention rate 95.6%) and 304 completed the second year (304/322, retention rate 94.4%) of the intervention. After 24 months of follow-up, increased adherence to the Mediterranean diet was observed in both groups, but the improvement was significantly higher in the intervention group than in the control group (net between-group difference: 1.8 points in the MEDAS questionnaire (95% CI 1.4-2.2; P<.001). Compared with the control group, the Mediterranean diet intervention group showed a significant increase in the consumption of fruits (P<.001), olive oil (P<.001), whole grain cereals (P=.002), pulses (P<.001), nuts (P<.001), white fish (P<.001), fatty fish (P<.001), and white meat (P=.007), and a significant reduction in refined cereals (P<.001), red and processed meat (P<.001), and sweets (P<.001) at 2 years of intervention. In terms of nutrients, the intervention group significantly increased their intake of omega-3 (P<.001) and fiber (P<.001), and they decreased their intake of carbohydrates (P=.02) and saturated fatty acids (P<.001) compared with the control group., Conclusions: The remote nutritional intervention using a website and phone calls seems to be effective in increasing adherence to the Mediterranean diet pattern among AF patients treated with catheter ablation., Trial Registration: ClinicalTrials.gov NCT03053843; https://www.clinicaltrials.gov/ct2/show/NCT03053843., (©Leticia Goni, Víctor de la O, M Teresa Barrio-López, Pablo Ramos, Luis Tercedor, Jose Luis Ibañez-Criado, Eduardo Castellanos, Alicia Ibañez Criado, Rosa Macias Ruiz, Ignacio García-Bolao, Jesus Almendral, Miguel Ángel Martínez-González, Miguel Ruiz-Canela. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.12.2020.)

Published
2020
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3. Iatrogenic atrial septal defect and aortoatrial fistula in a patient with endovascular prosthesis in the inferior vena cava.

Author

Barrio-López MT, Martín-Trenor A, Mastrobuoni S, and Gavira-Gómez JJ

Subjects
Aortic Diseases diagnostic imaging, Aortic Diseases surgery, Carcinoma, Hepatocellular surgery, Fistula diagnostic imaging, Fistula surgery, Foreign-Body Migration diagnostic imaging, Foreign-Body Migration surgery, Heart Atria diagnostic imaging, Heart Atria surgery, Heart Diseases diagnostic imaging, Heart Diseases surgery, Heart Septum diagnostic imaging, Heart Septum surgery, Hepatic Veins, Humans, Iatrogenic Disease, Liver Cirrhosis surgery, Liver Neoplasms surgery, Male, Middle Aged, Postoperative Complications diagnostic imaging, Postoperative Complications surgery, Ultrasonography, Vena Cava, Inferior, Aortic Diseases etiology, Endovascular Procedures instrumentation, Fistula etiology, Foreign-Body Migration etiology, Heart Atria injuries, Heart Diseases etiology, Heart Septum injuries, Liver Transplantation, Postoperative Complications etiology, Stents adverse effects
Abstract

Percutaneous procedures and endovascular prostheses are becoming increasingly frequent, replacing classic interventions, and new complications are now appearing. We report the case of a liver transplant patient with a stenosis in the anastomosis of the suprahepatic veins to inferior vena cava, treated by self-expanding prosthesis, who developed an aorto-right atrial fistula and an atrial septal defect. Open heart surgery was performed to correct the defects. Transthoracic echocardiogram 1 year later revealed no evidence of residual shunt., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2012
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