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2. Reference for Electrocardiographic Imaging-Based T-Wave Alternans Estimation

Author

Estela Sanchez-Carballo, Francisco Manuel Melgarejo-Meseguer, Ramya Vijayakumar, Juan Jose Sanchez-Munoz, Arcadi Garcia-Alberola, Yoram Rudy, and Jose Luis Rojo-Alvarez

Subjects
Bootstrap resampling, electrocardiographic imaging, reference, spatial-temporal study, T-wave alternans, T-wave segmentation, Electrical engineering. Electronics. Nuclear engineering, TK1-9971
Abstract

Sudden cardiac death causes multiple deaths annually, and T-wave alternans are a reliable predictor of this fatal event. Detecting alternans is crucial for reducing disease incidence, and electrocardiographic imaging is a promising tool, providing spatial-temporal insights. The absence of references and segmentation methods specific to these data may complicate progress in the field. Therefore, this work aimed to develop a reference for evaluating estimation methods. Initially, a novel T-wave segmentation procedure specific to these data was introduced and compared with a commonly used method. Subsequently, a reference for assessing alternans estimation methods was created by integrating alternans into epicardial signals through a spatial-temporal Gaussian function. Finally, a bootstrap-based classifier for detecting alternans was developed. Results underscored the superiority of the novel T-wave segmentation procedure, with the lowest 95% confidence interval being $[16.57~\mu V, 18.80~\mu V]$ , indicating significant disparities between the two segmentation methodologies. Furthermore, the generated reference demonstrated the distinguishability of T-wave alternans with an amplitude of approximately $55~\mu V$ from noise. Additionally, the classifier exhibited consistency with previous findings, demonstrating its ability to detect alternans with amplitudes around $50~\mu V$ . In conclusion, this study provides a spatial-temporal reference for proper evaluation of estimation methods, contributing to establishing a gold standard.

Published
2024
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3. Exploring Cardiac Rhythms and Improving ECG Beat Classification Through Latent Spaces

Author

Alba Vadillo-Valderrama, Jacobo Chaquet-Ulldemolins, Rebeca Goya-Esteban, Raul P. Caulier-Cisterna, Juan Jose Sanchez-Munoz, Arcadi Garcia-Alberola, and Jose Luis Rojo-Alvarez

Subjects
Electrocardiography, machine learning, unsupervised learning, neural networks, dimensionality reduction, manifold learning, Electrical engineering. Electronics. Nuclear engineering, TK1-9971
Abstract

In recent years, a wide variety of Machine Learning (ML) algorithms, including Deep Learning (DL) methods, have been proposed for electrocardiogram (ECG) beat classification. However, accurately discerning ECG beat types faces challenges due to noise interference and inherent imbalances among different classes. Moreover, understanding mathematical models enclosed by black-box learning systems is an issue today. Our study employed a manifold learning algorithm capable of mapping high-dimensional data into a latent space to conduct a comprehensive analysis within a neural network learning framework. This approach involved the following studies: 1) examining the intermediate high-dimensional latent space in simple architectures by studying its projection into a visualizable latent space; 2) exploring the influence of class imbalance on the configuration of the latent space; 3) evaluating and analysing the compensatory effects of employing diverse DL architectures, such as modified autoencoders and Generative Adversarial Networks (GANs), specifically in generating data augmentation through synthetic beats. The experimental results demonstrated the effectiveness of our methodology in mitigating noise and addressing inter-class imbalance, notably enhancing the diagnostic Area Under the ROC Curve (AUC) in ECG signal analysis. Implementation of GAN data augmentation techniques resulted in a 2% improvement, elevating the AUC from 0,9332 to 0,9520 in the biclass dataset. Similarly, the AUC values increased by 2%, from 0,9020 to 0,9223, for the multiclass dataset. These findings highlight the impact of appropriate data augmentation techniques on AUC improvement. Furthermore, visualizing latent spaces during beat classifier design significantly contributes to developing solid and principled multiclass beat-discriminating systems.

Published
2024
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4. Symptom burden guiding invasive electrophysiological study in paroxysmal supraventricular tachycardia: The believe SVT registry

Author

Rodriguez Muñoz, Daniel, Ramos Jimenez, Javier, Marco Del Castillo, Álvaro, Lozano Granero, Cristina, García Alberola, Arcadio, Jiménez Sánchez, Diego, Guntúriz Beltrán, Clara, Ramos Ruiz, Pablo, Arias, Miguel Ángel, Di Nubila, Bruna, Betancur, Andrés, González Torrecilla, Esteban, Dallaglio, Paolo, Alonso Fernández, Pau, Ayala More, Hebert David, Calero, Sofía, Lumia, Giuseppe, Salgado Aranda, Ricardo, Lázaro Rivera, Carla, Rodríguez Mañero, Moisés, Syed, Ahsan, Arribas Ynsaurriaga, Fernando, and Salguero-Bodes, Rafael

Published
2024
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7. Differential Beat Accuracy for ECG Family Classification Using Machine Learning

Author

Alba Vadillo-Valderrama, Rebeca Goya-Esteban, Raul P. Caulier-Cisterna, Arcadi Garcia-Alberola, and Jose Luis Rojo-Alvarez

Subjects
Machine learning, ECG morphology, MIT-BIH database, family beats, differential confusion matrix, differential beat accuracy, Electrical engineering. Electronics. Nuclear engineering, TK1-9971
Abstract

Holter systems record the electrocardiogram (ECG), which is used to identify beat families according to their origin and severity. Many systems have been proposed using signal conditioning and machine learning (ML) classification algorithms for beat family recognition. However, the design stage of these systems does not always consider the impact that tuning the intermediate blocks has on the beat family classification and the overall accuracy. We propose to use a new index based on the confusion matrices and bootstrap resampling to summarize the global performance for all family beats, so-called differential beat accuracy (DBA), which is obtained as the total number of beats correctly classified in each class minus the total number of beats incorrectly classified. We addressed the sensitivity of the different subblocks when creating a simple beat family classifier consisting of signal preprocessing blocks and a simple k-Nearest Neighbors classifier. The MIT-BIH Arrhythmia database was used for this purpose, following existing literature on the field. We benchmarked two implementations, one for biclass classification (supraventricular vs. non-supraventricular origin) and another for multiclass beat labeling. The usual preprocessing stages were scrutinized with the DBA to evaluate their impact on the quality of the complete ML system, such as signal detrending and filtering, beat balancing, or inter-beat distance. With the support of the DBA, our methodology was able to detect significant differences in terms of some of the options in the algorithm design. For instance, balancing the number of beats in each class for training significantly improved the classification accuracy of the minority classes at 3.22% for the multiclass dataset but not for the biclass dataset. Also, accuracy improved significantly by about 6% for the biclass regrouping without data normalization, whereas overall accuracy improved significantly by about 7% for the multiclass regrouping with data normalization. In addition, the analysis of the statistical dispersion of confusion matrices showed that this database should be considered with caution when training ML-based family classifiers. We can conclude that the proposed DBA can provide us with statistically principled criteria for designing ML-based classifiers and reducing their bias in strongly unbalanced beat family datasets.

Published
2022
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13. Spanish Catheter Ablation Registry. 18th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2018)

Author

Almendral-Garrote, Jesús, Alonso-Fernández, Pau, Alonso-Martín, Concepción, Alvarenga-Recalde, Nelson María, Álvarez-Acosta, Luis, Álvarez-López, Miguel, Anguera-Camos, Ignasi, Arana-Rueda, Eduardo, Arcocha-Torres, María Fe, Arias-Palomares, Miguel Ángel, Asso-Abadía, Antonio, Ballesteros-Derbenti, Gabriel Alejandro, Barrera-Cordero, Alberto, Benezet-Mazuecos, Juan, Bodegas-Cañas, Andrés I., Brugada-Terradellas, Josep, Cabadés-Rumbeu, Claudia, Cabanas-Grandío, María del Pilar, Cabrera-Gómez, Sandra, Cano-Calabria, Lucas R., del Castillo-Arrojo, Silvia, Castro-Urda, Víctor, Cózar-León, Rocío, Díaz-Infante, Ernesto, Durán-Guerrero, Juan Manuel, Elices-Teja, Juliana, Expósito-Pineda, María del Carmen, Fernández-Gómez, Juan Manuel, Ferrer-Hita, Julio Jesús, Fidalgo-Andrés, María Luisa, Fontenla-Cerezuela, Adolfo, García-Alberola, Arcadio, García-Bolao, J. Ignacio, García-Cuenca, Enrique, García-Fernández, Francisco Javier, Gil-Ortega, Ignacio, Gómez-Pulido, Federico, Grande-Ingelmo, Juan Manuel, Guasch-i-Casany, Eduard, Guerra-Ramos, José M., Heras-Herreros, Santiago, Hernández-Afonso, Julio, Herreros-Guilarte, Benito, Hidalgo-Olivares, Víctor Manuel, Ibáñez-Criado, Alicia, Ibáñez-Criado, José Luis, Ibars-Campaña, Sonia, Jáuregui-Abularach, Miguel Eduardo, Jiménez-Candil, F. Javier, Jiménez-Díaz, Javier, Jiménez-López, Jesús I., Lázaro-Rivera, Carla, Lozano-Herrera, José Miguel, Macías-Gallego, Alfonso, Magnani-Ragamato, Santiago, Martínez-Basterra, Javier, Martínez-Brotons, Ángel, Martínez-Sande, José Luis, Martín-Sánchez, Gabriel, Matías-Francés, Roberto, Merino-Llorens, José Luis, Mont-Girbau, Josep Lluis, Moreno-Arribas, José, Moreno-Planas, Javier, Moya-i-Mitjans, Ángel, Ortega-Molina, Marta, Osca-Asensi, Joaquín, Pastor-Fuentes, Agustín, Pavón-Jiménez, Ricardo, Peinado-Peinado, Rafael, Pérez-Álvarez, Luisa, Pérez-Castellano, Nicasio, Porro-Fernández, Rosa, Porta-Sánchez, Andreu, Punti-Sala, Jordi, Quesada-Dorador, Aurelio, Rivas-Gándara, Nuria, Rodrigo-Trallero, Gonzalo, Rodríguez-Entem, Felipe José, Rodríguez-Pérez, Juan Carlos, Romero-Garrido, Rafael, Rubín-López, José Manuel, Rubio-Caballero, José Amador, Rubio-Campal, José Manuel, Rubio-Sanz, Jerónimo, Ruiz-Hernández, Pablo M., Salgado-Aranda, Ricardo, Sánchez-Gómez, Juan Miguel, Sarquella-Brugada, Georgia, Sarrias-Mercé, Axel, Segura-Saint-Gerons, Jose María, Segura-Villalobos, Federico, Valverde-André, Irene, Ibáñez Criado, José Luis, Quesada, Aurelio, and Cózar, Rocío

Published
2019
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14. Registro Español de Ablación con Catéter. XVIII Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2018)

Author

Almendral-Garrote, Jesús, Alonso-Fernández, Pau, Alonso-Martín, Concepción, Alvarenga-Recalde, Nelson María, Álvarez-Acosta, Luis, Álvarez-López, Miguel, Anguera-Camos, Ignasi, Arana-Rueda, Eduardo, Arcocha-Torres, María Fe, Arias-Palomares, Miguel Ángel, Asso-Abadía, Antonio, Ballesteros-Derbenti, Gabriel Alejandro, Barrera-Cordero, Alberto, Benezet-Mazuecos, Juan, Bodegas-Cañas, Andrés I., Brugada-Terradellas, Josep, Cabadés-Rumbeu, Claudia, Cabanas-Grandío, María del Pilar, Cabrera-Gómez, Sandra, Cano-Calabria, Lucas R., del Castillo-Arrojo, Silvia, Castro-Urda, Víctor, Cózar-León, Rocío, Díaz-Infante, Ernesto, Durán-Guerrero, Juan Manuel, Elices-Teja, Juliana, Expósito-Pineda, María del Carmen, Fernández-Gómez, Juan Manuel, Ferrer-Hita, Julio Jesús, Fidalgo-Andrés, María Luisa, Fontenla-Cerezuela, Adolfo, García-Alberola, Arcadio, García-Bolao, J. Ignacio, García-Cuenca, Enrique, García-Fernández, Francisco Javier, Gil-Ortega, Ignacio, Gómez-Pulido, Federico, Grande-Ingelmo, Juan Manuel, Guasch-i-Casany, Eduard, Guerra-Ramos, José M., Heras-Herreros, Santiago, Hernández-Afonso, Julio, Herreros-Guilarte, Benito, Hidalgo-Olivares, Víctor Manuel, Ibáñez-Criado, Alicia, Ibáñez-Criado, José Luis, Ibars-Campaña, Sonia, Jáuregui-Abularach, Miguel Eduardo, Jiménez-Candil, F. Javier, Jiménez-Díaz, Javier, Jiménez-López, Jesús I., Lázaro-Rivera, Carla, Lozano-Herrera, José Miguel, Macías-Gallego, Alfonso, Magnani-Ragamato, Santiago, Martínez-Basterra, Javier, Martínez-Brotons, Ángel, Martínez-Sande, José Luis, Martín-Sánchez, Gabriel, Matías-Francés, Roberto, Merino-Llorens, José Luis, Mont-Girbau, Josep Lluis, Moreno-Arribas, José, Moreno-Planas, Javier, Moya-i-Mitjans, Ángel, Ortega-Molina, Marta, Osca-Asensi, Joaquín, Pastor-Fuentes, Agustín, Pavón-Jiménez, Ricardo, Peinado-Peinado, Rafael, Pérez-Álvarez, Luisa, Pérez-Castellano, Nicasio, Porro-Fernández, Rosa, Porta-Sánchez, Andreu, Punti-Sala, Jordi, Quesada-Dorador, Aurelio, Rivas-Gándara, Nuria, Rodrigo-Trallero, Gonzalo, Rodríguez-Entem, Felipe José, Rodríguez-Pérez, Juan Carlos, Romero-Garrido, Rafael, Rubín-López, José Manuel, Rubio-Caballero, José Amador, Rubio-Campal, José Manuel, Rubio-Sanz, Jerónimo, Ruiz-Hernández, Pablo M., Salgado-Aranda, Ricardo, Sánchez-Gómez, Juan Miguel, Sarquella-Brugada, Georgia, Sarrias-Mercé, Axel, Segura-Saint-Gerons, Jose María, Segura-Villalobos, Federico, Valverde-André, Irene, Ibáñez Criado, José Luis, Quesada, Aurelio, and Cózar, Rocío

Published
2019
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17. Spanish Catheter Ablation Registry. 17th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2017)

Author

Álvarez-López, Miguel, Almendral, Jesús, Alonso, Concepción, Alonso-Fernández, Pau, Alvaralenga, Nelson, Álvarez-Acosta, Luis, Anguera, Ignasi, Arcocha, María Fe, Arias, Miguel Ángel, Asso, Antonio, Barrera-Cordero, Alberto, Ballesteros, Gabriel, Benezet-Mazuecos, Juan, Bodegas-Cañas, Andrés, Brugada, Josep, Cabadés Lucas Cano-Calabria, Claudia, Caballero-Dorta, Eduardo, Cabanas-Grandío, Pilar, Cabrera, Sandra, Castro, Víctor, Cózar, Rocío, Díaz-Infante, Ernesto, Doblado, Manuel, Elices, Juliana, Expósito-Pineda, María del Carmen, Fernández-Gómez, Juan Manuel, Fidalgo, María Luisa, Fontenla, Adolfo, García-Fernández, F. Javier, García-Alberola, Arcadio, Gil-Ortega, Ignacio, Gómez-Pulido, Federico, González-Vasserot, Mar, Grande, Ángel, Guerra-Ramos, José M., Hernández-Afonso, Julio, Heras-Herreros, Santiago, Hidalgo-Olivares, Víctor Manuel, Ibáñez-Criado, José Luis, Ibáñez-Criado, Alicia, Ibars, Sonia, Jauregui, Miguel, Jiménez, Jesús, Jiménez-Díaz, Javier, Jiménez-Candil, Javier, Lázaro-Rivera, Carla, Mazuelos, Francisco, Magnani, Santiago, Martínez-Basterra, Javier, Macías, Alfonso, Martínez-Brotons, Ángel, Martínez-Sande, José Luis, Matía-Francés, Roberto, Moriña, Pablo, Moya, Ángel, Mont, Lluis, Moreno-Arribas, José, Moreno-Planas, Javier, Navarro-Manchón, Josep, Ortega-Molina, Marta, Osca, Joaquín, Pastor, Agustín, Pavón-Jiménez, Ricardo, Pedrote, Alonso, Peinado, Rafael, Pérez-Álvarez, Luisa, Pérez-Castellano, Nicasio, Pindado, Javier, Porro-Fernández, Rosa, Punti-Sala, Jordi, Quesada, Aurelio, Rivas-Gándara, Nuria, Rodrigo-Trallero, Gonzalo, Roca, Ivo, Rodríguez-Entem, Felipe, Rodríguez-Pérez, Juan Carlos, Rodríguez-Font, Enrique, Ruiz-Hernández, Pablo, Rubín, José Manuel, Rubio-Campal, José Manuel, Rubio-Caballero, Amador, Rubio-Sanz, Jerónimo, Salgado-Aranda, Ricardo, Sarrias, Axel, Sarquella-Brugada, Georgia, Esteban-Paul, Elena, Segura, Federico, Ibáñez Criado, José Luis, and Quesada Dorador, Aurelio

Published
2018
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18. Registro Español de Ablación con Catéter. XVII Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2017)

Author

Álvarez-López, Miguel, Almendral, Jesús, Alonso, Concepción, Alonso-Fernández, Pau, Alvaralenga, Nelson, Álvarez-Acosta, Luis, Anguera, Ignasi, Arcocha, María Fe, Arias, Miguel Ángel, Asso, Antonio, Barrera-Cordero, Alberto, Ballesteros, Gabriel, Benezet-Mazuecos, Juan, Bodegas-Cañas, Andrés, Brugada, Josep, Cano-Calabria, Claudia Cabadés Lucas, Caballero-Dorta, Eduardo, Cabanas-Grandío, Pilar, Cabrera, Sandra, Castro, Víctor, Cózar, Rocío, Díaz-Infante, Ernesto, Doblado, Manuel, Elices, Juliana, Expósito-Pineda, María del Carmen, Fernández-Gómez, Juan Manuel, Fidalgo, María Luisa, Fontenla, Adolfo, García-Fernández, F. Javier, García-Alberola, Arcadio, Gil-Ortega, Ignacio, Gómez-Pulido, Federico, González-Vasserot, Mar, Grande, Ángel, Guerra-Ramos, José M., Hernández-Afonso, Julio, Heras-Herreros, Santiago, Hidalgo-Olivares, Víctor Manuel, Ibáñez-Criado, José Luis, Ibáñez-Criado, Alicia, Ibars, Sonia, Jauregui, Miguel, Jiménez, Jesús, Jiménez-Díaz, Javier, Jiménez-Candil, Javier, Lázaro-Rivera, Carla, Mazuelos, Francisco, Magnani, Santiago, Martínez-Basterra, Javier, Macías, Alfonso, Martínez-Brotons, Ángel, Martínez-Sande, José Luis, Matía-Francés, Roberto, Moriña, Pablo, Moya, Ángel, Mont, Lluis, Moreno-Arribas, José, Moreno-Planas, Javier, Navarro-Manchón, Josep, Ortega-Molina, Marta, Osca, Joaquín, Pastor, Agustín, Pavón-Jiménez, Ricardo, Pedrote, Alonso, Peinado, Rafael, Pérez-Álvarez, Luisa, Pérez-Castellano, Nicasio, Pindado, Javier, Porro-Fernández, Rosa, Punti-Sala, Jordi, Quesada, Aurelio, Rivas-Gándara, Nuria, Rodrigo-Trallero, Gonzalo, Roca, Ivo, Rodríguez-Entem, Felipe, Rodríguez-Pérez, Juan Carlos, Rodríguez-Font, Enrique, Ruiz-Hernández, Pablo, Rubín, José Manuel, Rubio-Campal, José Manuel, Rubio-Caballero, Amador, Salgado-Aranda, Jerónimo Rubio-Sanz, Ricardo, Sarrias, Axel, Sarquella-Brugada, Georgia, Esteban-Paul, Elena, Segura, Federico, Ibáñez Criado, José Luis, and Quesada Dorador, Aurelio

Published
2018
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20. A Support Vector Laplacian Distance Kernel Approach to the Inverse Problem in Intracardiac Electrophysiology

Author

Caulier-Cisterna, Raúl, Sanromán-Junquera, Margarita, Rojo-Álvarez, José Luis, García-Alberola, Arcadio, Magjarevic, Ratko, Editor-in-chief, Ładyżyński, Piotr, Series editor, Ibrahim, Fatimah, Series editor, Lacković, Igor, Series editor, Rock, Emilio Sacristan, Series editor, Kyriacou, Efthyvoulos, editor, Christofides, Stelios, editor, and Pattichis, Constantinos S., editor

Published
2016
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21. Influence of Normalization on the Analysis of Electroanatomical Maps with Manifold Harmonics

Author

Sanromán-Junquera, Margarita, Mora-Jiménez, Inmaculada, García-Alberola, Arcadio, Caamaño-Fernández, Antonio, Rojo-Álvarez, José Luis, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Ortuño, Francisco, editor, and Rojas, Ignacio, editor

Published
2016
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22. Value of the “Standing Test” in the Diagnosis and Evaluation of Beta-blocker Therapy Response in Long QT Syndrome

Author

Muñoz-Esparza, Carmen, Zorio, Esther, Domingo Valero, Diana, Peñafiel-Verdú, Pablo, Sánchez-Muñoz, Juan J., García-Molina, Esperanza, Sabater, María, Navarro, Marina, San-Román, Irene, Pérez, Inmaculada, Santos, Juan J., Cabañas-Perianes, Valentín, Valdés, Mariano, Pascual, Domingo, García-Alberola, Arcadio, and Gimeno Blanes, Juan R.

Published
2017
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23. Valor del «test de bipedestación» en el diagnóstico y la evaluación de la respuesta al tratamiento con bloqueadores beta en el síndrome de QT largo

Author

Muñoz-Esparza, Carmen, Zorio, Esther, Domingo Valero, Diana, Peñafiel-Verdú, Pablo, Sánchez-Muñoz, Juan J., García-Molina, Esperanza, Sabater, María, Navarro, Marina, San-Román, Irene, Pérez, Inmaculada, Santos, Juan J., Cabañas-Perianes, Valentín, Valdés, Mariano, Pascual, Domingo, García-Alberola, Arcadio, and Gimeno Blanes, Juan R.

Published
2017
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27. Repercusiones en la posología de los anticoagulantes orales no antagonistas de la vitamina K por las variaciones de la función renal de los pacientes con fibrilación auricular e insuficiencia cardiaca aguda reciente

Author

Andreu-Cayuelas, José M., Pastor-Pérez, Francisco J., Puche, Carmen M., Mateo-Martínez, Alicia, García-Alberola, Arcadio, Flores-Blanco, Pedro J., Valdés, Mariano, Lip, Gregory Y.H., Roldán, Vanessa, and Manzano-Fernández, Sergio

Published
2016
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30. Generalization and Regularization for Inverse Cardiac Estimators

Author

Melgarejo-Meseguer, Francisco M., primary, Everss-Villalba, Estrella, additional, Gutierrez-Fernandez-Calvillo, Miriam, additional, Munoz-Romero, Sergio, additional, Gimeno-Blanes, Francisco-Javier, additional, Garcia-Alberola, Arcadi, additional, and Rojo-Alvarez, Jose-Luis, additional

Published
2022
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34. Phenotypic characteristics of patients with arrhythmogenic left ventricular cardiomyopathy and sustained ventricular tachycardias

Author

JJ Sanchez Munoz, C Munoz Esparza, P Penafiel Verdu, J Gonzalez Alarcon, LA Polo Garcia, JR Gimeno Blanes, and A Garcia Alberola

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: None. Introduction The Padua criteria proposed for the diagnostic approach to Arrhythmogenic Cardiomyopathy (AMC) introduced new diagnostic criteria to recognize patients with a phenotype of the left ventricular variants of AMC (ALVC). Unlike ARVC, the arrhythmogenicity of this left phenotype has not yet been established. Objectives This study aims to analyze the phenotypic characteristics in a group of patients with ALVC and ventricular arrhythmias (VA). Methods Thirty-seven related patients with ALVC and VA were included and these were evaluated at the Inherited Cardiac Disease Unit of a Tertiary Hospital. Results Between 2000 and 2021, a total of 207 patients were diagnosed with ALVC. Thirty-seven patients (18%) presented VA; 25 ( 67%) sustained ventricular tachycardia (SVT), 10 ( 27 %) non sustained ventricular tachycardia (NSVT) and 2 ventricular fibrillation (VF). Eighteen 18/37 (49%) biventricular and 19/37 (51%) dominant . Twenty-five, 67 % male, aged 41.8 ± 13.4 years. A genetic study was performed in 36 ( 97%), and the pathogenic mutations were identified in desmoplakin in eighteen, plakophilin-2, desmoglein-2 and phospholamb in three, titin and filamine in two; desmin, plakoglobin and lamin A in one. There was one variant of uncertain significance in desmocollin-2, desmoplakin and titin. A low amplitude QRS voltages (LAQRS) in limb leads was present in 14/33 patients . Inverted T waves in right (V1-V3) in 4/33 patients and in left precordial (V4-V6) were present in 9/33 patients. The average left ventricular ejection fraction (LVEF) was 41%± 14 and myocardial fibrosis evidenced by contrast-enhanced CMR as LGE was presented in 22 patients. Ventricular arrhythmias with a right bundle branch block (RBBB) morphology were most frequent (7/12 ), denoting the origin from LV. All VT with LBBB morphology appeared in biventricular cases (5/12). Reverse pattern break was present in three patients. EAM showed bipolar or unipolar endocardial scar left ventricle in 6/10 and bipolar or unipolar endocardial scar right ventricle in 3/10 patients. Epicardial scar was present in 4 patients ( 3 LV, 2 RV). An implantable cardioverted defibrillator (ICD) therapy was performed in 25 patients for primary or secondary prevention of sudden death. Heart transplantation was carried out for three patients. Conclusions A substancial number of patients with ALVC have presented ventricular arrhythmias. Ventricular arrhythmias with a right bundle branch block (RBBB) morphology were the most frequent. All of VT with LBBB morphology appeared in biventricular cases. The mutation in DSP was the most prevalent in patients with ALVC and VT. Patients with ALVC and VA are characterized by a ventricular function that is not significantly impaired; however, fibrosis in LGE is widespread.

Published
2022
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38. Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

Author

Alvarez-Ortega, C, primary, Solorzano, C, additional, Barrera, A, additional, Toquero, J, additional, Martinez-Alday, JD, additional, Grande, C, additional, Rodriguez, A, additional, Garcia-Alberola, A, additional, Perez, L, additional, Ferrero, A, additional, Hernandez, J, additional, Cozar, R, additional, Cano, O, additional, Trucco, E, additional, and Peinado, R, additional

Published
2022
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44. Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study.

Author

Metzner, Andreas, Straube, Florian, Tilz, Roland R., Kuniss, Malte, Noelker, Georg, Tebbenjohanns, Juergen, Andresen, Dietrich, Wieneke, Heinrich, Stellbrink, Christoph, Franke, Jennifer, Dorwarth, Uwe, Carion, Phuong Lien, Holbrook, Reece, Hochadel, Matthias, Senges, Jochen, Hoffmann, Ellen, Kuck, Karl-Heinz, Wu, L. Q., Garcia-Alberola, A., and Massa, T.

Subjects
CATHETER ablation, DISCRETE event simulation, ATRIAL flutter, ELECTROPHYSIOLOGY, ATRIAL fibrillation, COHORT analysis
Abstract

Background: Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA). Methods: The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other. Results: The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively). Conclusion: CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011). [ABSTRACT FROM AUTHOR]

Published
2023
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49. Efficacy of left bundle branch area pacing in patients with indication for cardiac resynchronization therapy

Author

Elvira Ruiz, G, primary, Penafiel-Verdu, P, additional, Munoz-Esparza, C, additional, Martinez-Sanchez, J, additional, Sanchez-Munoz, J J, additional, Garcia-Almagro, F, additional, Salar-Alcaraz, M, additional, Pastor-Perez, F J, additional, Fernandez-Villa, N, additional, Veas-Porlan, M, additional, Martinez-Herrera, M, additional, Vazquez-Andres, D J, additional, Jimenez-Aceituna, A, additional, Pascual-Figal, D A, additional, and Garcia-Alberola, A, additional

Published
2021
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50. Impact of programming in a large cohort of implantable cardioverter-defibrillator patients with long-term follow-up: findings from the UMBRELLA study

Author

Briongos Figuero, S, primary, Garcia Alberola, A, additional, Rubio, J B, additional, Segura, J M, additional, Rodriguez, A, additional, Peinado, R, additional, Alzueta, J, additional, Martinez Ferrer, J B, additional, Vinolas, X, additional, Munoz-Aguilera, R, additional, and Perez, M L, additional

Published
2021
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