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This article presents the data corresponding to implantable cardioverter-defibrillator (ICD) implantations in Spain in 2021.The data were drawn from implanting centers, which voluntarily completed a data collection sheet during the procedure.In 2021, 7496 implant data sheets were received, compared with 7743 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 96.8% of the devices implanted in Spain. Data completion ranged from 99.9% for "name of implanting hospital" to 8.9% for "implanting hospital". In 2021, 199 hospitals participated in the registry, exceeding the figures of previous years, with around 170 participating hospitals. The total rate of registered implants was 158/million inhabitants (163 according to Eucomed), making 2021 the year with the highest activity. However, the registry continues to show significant differences among the various autonomous communities and the lowest implantation rate of all the European countries participating in Eucomed.The Spanish implantable cardioverter-defibrillator registry for 2021 recorded an increase in the number of ICD implantations, reflecting the recovery of hospital activity after the initial impact of the COVID-19 pandemic in 2020. Although the total number of implants has increased in Spain, figures are still much lower than the European Union average, with differences persisting among Spanish autonomous communities.

Adequate measurement of the QT interval is of clinical importance in order to identify patients at higher risk for ventricular arrhythmias. Previous studies have described different methods to estimate baseline QT in patients with left bundle branch block (LBBB). However, the evidence regarding the assessment of the QT in patients with right bundle branch block (RBBB) is scarce.To analyze the feasibility and reliability of the different formulae described for LBBB in the estimation of the baseline QT in the presence of RBBB.We performed an observational study including patients who underwent electrophysiology study and/or ablation. Two types of RBBB were considered: 1) pacing-induced and 2) transient true RBBB. QRS, JT and QT intervals were measured during baseline and RBBB. Estimated QTc was calculated using LBBB formulae: Bogossian, Rautaharju, Tabatabaei, Tang-Rabkin, Yankelson, Wang. Linear correlation and intraclass correlation coefficients (ICC) were used to assess the reliability of these formulae for the estimation of baseline QTc.We finally included a total of 100 patients. Correlations between baseline and estimated QTc were strong (R 0.7) for all the formulae except for Tabatabaei. Yankelson and Wang showed the highest reliability (ICC = 0.775 and 0.727, respectively). Yankelson appeared to be the most accurate formula, with a mean estimated QTc closest to baseline values.Previously described formulae for LBBB exhibited marked differences regarding reliability in the estimation of the QTc interval in the presence of RBBB. According to our results, Yankelson showed the most consistent and accurate agreement in this setting.

Resumen Introduccion y objetivos Se presentan los datos correspondientes a los implantes de desfibrilador automatico implantable (DAI) en Espana durante el ano 2020. Metodos Los datos provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos. Resultados En 2020 se recibieron 7.056 hojas de implante, frente a las 7.106 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations), lo que implica que se han recogido datos del 99% de los dispositivos implantados en Espana. La cumplimentacion oscilo entre el 99,8% en el campo «nombre del hospital implantador» y el 2,6% en la variable «hospital de referencia». Los hospitales que realizaron implantes de DAI y participaron en el registro fueron 173, un numero similar al del ano 2019 (172). La tasa total de implantes registrados fue 149/millon de habitantes (150 segun Eucomed), lo que muestra una ligera disminucion de los implantes en Espana en 2020 como consecuencia del impacto de la pandemia de la COVID-19. Esta reduccion observada ha sido desigual entre las diferentes comunidades autonomas. Conclusiones El Registro Espanol de Desfibrilador Automatico Implantable del ano 2020 recoge una mejora en la tasa de implantes comunicados y una reduccion del numero de implantes de DAI, lo que reflejaria la reduccion de la actividad hospitalaria no relacionada con el tratamiento del paciente con COVID-19. De forma similar a los anos previos, el numero total de implantes en Espana sigue siendo muy inferior a la media de la Union Europea, con un aumento en las diferencias entre las comunidades autonomas espanolas.

La fibrilación auricular aumenta hasta en 5 veces el riesgo de ictus. Los ictus cardioembólicos habitualmente son más graves y tienen altas tasas de recurrencias y discapacidad permanente en comparación con los ictus de otras etiologías. En consecuencia, la reducción del riesgo de ictus mediante una adecuada anticoagulación es uno de los principales objetivos en el tratamiento de los pacientes con fibrilación auricular. Los antagonistas de la vitamina K han sido ampliamente superados por los anticoagulantes orales de acción directa, ya que tanto los resultados de los ensayos clínicos como los de los estudios de práctica clínica y, últimamente, estudios poblacionales han demostrado que los anticoagulantes orales de acción directa tienen mayores eficacia (menos ictus y muerte) y seguridad (menos hemorragias intracraneales) que los antagonistas de la vitamina K. Además, durante la pandemia de COVID-19, el empleo preferente de anticoagulantes orales de acción directa frente a los antagonistas de la vitamina K constituye una estrategia clave para garantizar una calidad óptima de la anticoagulación y una mejor protección del paciente contra el SARS-CoV-2, al no precisarse control de la razón internacional normalizada.

Pulmonary vein (PV) isolation is a well-established rhythm control therapy in atrial fibrillation (AF). Currently, there is no consensus on which ablation technique to use for the first procedure, cryoballoon (CB) or radiofrequency (RF). A retrospective cohort study was conducted on 1055 patients who underwent a first ablation, to assess both techniques based on the need for reablation. Patients with CB (n = 557) and RF (n = 498) ablations were clinically characterized and the need for reablation during a 30-month follow-up was used as the primary endpoint. Independent variables were analyzed to identify potential predictors. The need for reablation was significantly lower in the CB group than in the RF group (hazard ratio = 0.45 and 95% confident interval = 0.32–0.61; p < 0.001); in both paroxysmal and persistent AF, using a full-adjusted regression Cox model by age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, severe obstructive sleep apnea, dilated left atrium, persistent AF and early recurrence. RF ablation, dilated left atrium, persistent AF and early recurrence were identified as independent predictors of reablation. In addition, the CB-redo subgroup had a lower PV reconnection than the RF-redo subgroup. In conclusion, CB ablation suggests a reduction in the need for reablation and lower PV reconnection during the follow-up than RF ablation.

Background Current evidence suggests that Brugada syndrome (BrS), far from being a purely electrical condition, is associated with subtle mechanical abnormalities primarily affecting the right ventricle (RV). We aimed to characterize RV function in BrS and investigate the echocardiographic profile of patients with arrhythmic events, with a special focus on parameters of RV dyssynchrony using speckle-tracking echocardiography (STE). Methods An echocardiogram was performed in 71 BrS patients and 25 healthy controls. STE was performed to assess regional and global RV mechanics, including RV outflow tract shortening (RVOTS). RVOT contraction time was considered to calculate the modified RV mechanical dispersion (RVMDm). Arrhythmic events were prospectively evaluated in the BrS cohort. Results Compared to controls, BrS patients showed subtle contractile abnormalities, including impaired RV longitudinal strain, higher RV index of myocardial performance (RIMP) and lower RVOTS. BrS patients also exhibited a greater contraction delay between the lateral and the septal aspect of the RV. After a median follow-up of 7.3 year (IQR 5.2–10.8), 6 patients presented malignant arrhythmic events. RIMP >0.50, RVOTS 42 ms showed high sensitivity for the identification of BrS patients with arrhythmic events during follow-up. Conclusions Subtle RV mechanical abnormalities were present in BrS patients. RIMP and RVOTS, a novel STE-derived parameter, were found to be sensitive markers of arrhythmic events. Adding the RVOT contraction time to the analysis of RVMD may help identify patients at higher risk, reflecting the importance of the RVOT mechanical substrate in the assessment of the arrhythmic risk in BrS.

Resumen La fibrilacion auricular aumenta de manera marcada el riesgo de ictus. Multiples ensayos clinicos y estudios en practica clinica han demostrado que el tratamiento anticoagulante disminuye el riesgo de complicaciones tromboembolicas. Para este tratamiento, los anticoagulantes orales de accion directa (ACOD) ofrecen un mejor perfil de eficacia y seguridad que los antagonistas de la vitamina K. Estudios realizados en paises de nuestro entorno han objetivado en los ultimos anos una reduccion en la incidencia de ictus isquemico, lo que podria estar en relacion con una mayor prescripcion de anticoagulantes orales, sobre todo ACOD. En Espana hay muy poca informacion sobre este tema. Sin embargo, los datos disponibles indican que parece que tambien la mayor prescripcion de anticoagulantes orales, sobre todo ACOD, se asociaria con una significativa reduccion de las incidencias tanto de ictus isquemico como de hemorragias intracraneales. En consecuencia, se deberia recomendar un mayor empleo de los ACOD para los pacientes con fibrilacion auricular, lo que contribuiria no solo a reducir la incidencia de ictus isquemico y de hemorragias intracraneales, sino tambien la carga economica que esto conlleva.

We present the first reported case of extraction of a ventricular lead placed in the left bundle branch area with a double-loop design snare via the femoral approach without any complication. It was a 4-month-old lead whose extraction was not possible only with a conventional stylet via an implant vein approach, so we want to show that complete procedural success is possible.

Resumen: Introducción: en los procedimientos de extracción de electrodos, la vía femoral se usa cuando la vía superior ha fracasado. Objetivo: describir la incidencia, el éxito, las complicaciones y los predictores de uso de la vía femoral. Métodos: se realizó un análisis de la incidencia del uso de la vía femoral y los factores predictores en pacientes a quienes se les realizó extracción de electrodos entre noviembre de 2011 y noviembre de 2017. Resultados: se incluyeron 85 pacientes, con edad media de 62,36 ± 11,15 años. El 38,9% de los dispositivos eran marcapasos. Se extrajeron 135 electrodos, 59,3% de fijación pasiva. La mediana de tiempo desde el implante fue de 102 (60-174) meses. Se empleó la ruta femoral en el 25,9% de los procedimientos. Se obtuvo éxito clínico en el 92,9% de los pacientes. La extracción no fue exitosa en el 22,7% de los procedimientos cuando se usó la vía femoral, en comparación con el 1,6% cuando se usó la vía superior (p 0,004). La extracción no fue completa en el 36,4% de los procedimientos cuando se empleó la vía femoral en comparación con el 9,5% por vía superior (p 0,007).Los factores que predijeron el empleo de la ruta femoral fueron la presencia de electrodos de fijación pasiva [OR IC 95% 13,69 (3,06-62,5) p 0,001] y el tiempo desde el implante del electrodo [OR IC 95% por cada 10 meses 1,04 (1,00-1,09) p 0,044]. Conclusiones: se empleó la ruta femoral en el 25,9% de los procedimientos. No fue eficaz en el 22,7% de las intervenciones. Los factores que predijeron su utilización fueron la presencia de electrodos de fijación pasiva y el tiempo desde el implante del electrodo. Abstract: Introduction: The femoral route is used in electrode removal procedures when the upper route has failed. Objective: To describe the incidence, success rate, complications and predictive factors for the use of the femoral route. Methods: An analysis was performed on the incidence of use of the femoral route and the predictive factors in patients in whom electrode removal was carried out between November 2011 and November 2017. Results: The study included 85 patients with a mean age of 62.36 ± 11.5 years. Pacemakers made up 38.9% of the devices. A total of 135 electrodes, 59.3% of passive fixation, were removed. The median time since the implant was 102 (60-174) months. The femoral route was used in 25.9% of the procedures. Clinical success was achieved in 92.9% of the patients. The removal was not successful in 22.7% of the procedures when the femoral route was used, compared to 1.6% when the upper route was used (P = .004). The removal was not completed in 36.4% of the procedures when the femoral route was used, compared to 9.5% with the upper route (P = .007).The factors that predicted the use of the femoral route were the presence of passive-fixation electrodes (OR = 13.69: 95% CI; 3.06 – 62.5, P = .001), and the time since the electrodes were implanted (OR = 1.04, 95% CI; 1.00 – 1.09, P = .044, for every 10 months). Conclusions: The femoral route was employed in 25.9% of the procedures. It was not effective in 22.7% of the interventions. The factors that predicted its use were the presence of passive-fixation electrodes and the time since the electrode implant.

Background Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden death due to ventricular arrhythmias (VAs). The implantable cardioverter–defibrillator (ICD) is a well-established therapy for treatment of VA. Monomorphic ventricular tachycardias (MVTs) are frequent in HCM patients and suitable for antitachycardia pacing (ATP) termination. Objective The purpose of this study was to describe ventricular tachycardia (VT) characteristics in a population of HCM patients with ICD and to study the effectiveness and safety of ATP for MVT. Methods Data were obtained from the multicenter prospective observational UMBRELLA trial, which included all patients with HCM and ICD followed by the CareLink Monitoring System. All episodes of VA were collected and analyzed. ATP effectiveness and safety were described, and factors related to ATP effectiveness were studied with generalized estimating equation (GEE) models. Results Among 251 patients followed for 47 months, 67 (26.7%) were implanted as secondary prevention. Fifty-six patients presented 326 episodes of VA (286 [87%] MVT). Mean cycle length was 312 ± 64 ms. Among 264 MVTs that received ICD therapy, 202 (76.5%) were ATP terminated. The first ATP burst was effective in 169 episodes (68.4%), and overall effectiveness of the first or second ATP burst was 73.8%. Multivariate GEE-adjusted analysis showed 2 variables related to ATP effectiveness: programming fast VT zone On vs Off (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.5–5.2; P = .03) and programming ≥2 ATP bursts vs 1 burst only (OR 1.6; 95% CI 1.2–3.4; P = .04; and OR 2.9; 95% CI 1.8–6.3; P = .02; respectively). Conclusion MVT is the predominant VA in HCM patients with ICD. ATP is highly effective in terminating the majority of MVTs, and its proved effectiveness should guide device selection and programming in order to avoid unnecessary high-energy shocks.

INTRODUCTION AND OBJECTIVES: Equal opportunities to access technical advances with recognized clinical value should be a priority of the publicly-funded health system. We analyzed variability among all the Spanish autonomous communities in the use of cardiovascular techniques with an established indication and its relationship with economic indicators, burden of disease, and hospital mortality. METHODS: The activity registries of various Associations of the Spanish Society of Cardiology from 2011 to 2019 were analyzed for coronary angiography, overall percutaneous coronary intervention (PCI), primary PCI, implantable cardioverter-defibrillators (ICD), cardiac resynchronization therapy, and transcatheter aortic valve replacement (TAVR). Economic indices (gross domestic product and per capita health care expenditure) were obtained from public sources and data on attendance rates and mortality from the Resources and Quality in Cardiology (RECALCAR) reports of the Spanish Society of Cardiology. We analyzed the coefficient of variation for activity and the correlation of activity with regional economic indices, attendance rates, and risk-adjusted rates of in-hospital mortality. RESULTS: We identified wide variability in the use of technologies, especially for primary PCI (18%), ICD (22%), cardiac resynchronization therapy (36%), and TAVR (42%). A certain correlation with attendance rates was seen only for overall PCI and ICD. In general, no significant correlation was found between the use of the techniques and the economic indices of wealth and expenditure. The correlation with in-hospital mortality showed no significant results, although this was the analysis with the greatest limitations because the impact of these techniques on survival is exerted more in the mid- and long-term. CONCLUSIONS: The results of this study, despite its inherent limitations, show marked variability between autonomous communities in the use of cardiovascular technologies, which is not explained by economic differences or by hospital attendance rates due to the corresponding diseases.

Introduction Previous studies have found sex differences in implantable cardiac defibrillator (ICD) implantation counseling, especially in primary prevention. Possible explanations to this phenomenon have been described: under-representation of women in clinical trials, patient's preferences, lower overall sudden cardiac death risk in women compared to men, higher prevalence of non-ischemic dilated cardiomyopathy (DCM) in women and better response to cardiac resynchronization therapy in this population. Nevertheless, this gap appears to narrow in most recent registries. Purpose Our aim is to asses if there is still sex discrimination in ICD counseling by comparing ICD implantation between men and women. Methods A single-centre retrospective registry of 160 patients with a reduced left ventricle ejection fraction (LVEF ≤35%) found in a routine transthoracic echocardiogram (TTE) from January 2019 to June 2020. Inclusion and exclusion flow chart is described in Picture 1. Data collected included demographic, clinical and echocardiographic characteristics. Date of heart disease diagnosis, earliest date of LVEF ≤35% diagnosis (with TTE or cardiac magnetic resonance) and date of death when applicable were recorded. Cardiac resynchronization devices with ICD function were also considered for the analysis. In ICD carriers, implantation date and type of prevention for indication were collected. ICD implants and deaths up to December 31, 2020 were included for the analysis. Results Basal characteristics are described in Picture 2. The mean age was 67.5 years and 24.4% of the population were women. Ischemic etiology was the most frequent etiology in the overall population and in the male group. In women, DCM was the most common etiology. Sixty-eight patients carried an ICD. No significant differences between both sexes, neither globally nor according to the implant indication (primary vs. secondary prevention) were observed. In the subgroup analysis of patients with ICD, there were no significant differences in the number of devices between men and women, neither in ischemic or non-ischemic etiology. In primary prevention, there was a non-significant trend towards earlier implantation of the device in women (1.4 years vs 3.4 years, p=0.008) since the diagnosis of LVEF ≤35%. In patients without ICD (n=92), the mean age was significantly higher (72.5 years vs. 60.8 years, p Conclusions Despite under representation of women in pur population, we could not find differences in ICD implantation decision based on gender, even considering differences in underlying cardiomyopathy. There was no delay in implantation depending on sex, and even the trend was towards earlier implantation in women. Funding Acknowledgement Type of funding sources: None. Inclusion and exclusion flow chartBasal characteristics

Sudden cardiac arrest (SCA) is an uncommon but devastating event among young adults. While inherited cardiomyopathies and channelopathies represent an important proportion of sudden deaths, coronary artery disease remains a significant contributor in this age group. ECG findings are essential to guide the first steps of diagnostic work‐up of SCA, but sometimes can overlap between different etiologies. In this article we present a 16‐year‐old female who experienced SCA during vigorous swimming whose ECG was compatible with long QT syndrome. However, evaluation of the coronary anatomy provided the diagnosis of Kawasaki disease., Sudden cardiac arrest is uncommon among young adults. Inherited cardiomyopathies and channelopathies are the most frequently identified cardiac etiologies. However, assessment of coronary artery anatomy is mandatory in order to rule out coronary artery anomalies.

Resumen Introduccion y objetivos Se describen los resultados en Espana de la segunda encuesta de la Sociedad Europea de Cardiologia sobre terapia de resincronizacion cardiaca (CRT-Survey II) y se comparan con los de los demas paises participantes. Metodos Pacientes a los que se implanto un dispositivo de terapia de resincronizacion cardiaca entre octubre de 2015 y diciembre de 2016 en 36 centros participantes. Se recogieron datos sobre las caracteristicas basales de los pacientes y del implante, y un seguimiento a corto plazo hasta el alta hospitalaria. Resultados La tasa de exito del implante fue del 95,9%. La mediana [intervalo intercuartilico] de implantes anuales/centro en Espana fue significativamente menor que en los demas paises participantes: 30 [21-50] frente a 55 [33-100] implantes/ano (p = 0,00003). En los centros espanoles hubo una menor proporcion de pacientes de edad ≥ 75 anos (el 27,9 frente al 32,4%; p = 0,0071), una mayor proporcion de pacientes en clase funcional II de la New York Heart Association (el 46,9 frente al 36,9%; p Conclusiones La encuesta CRT-Survey II muestra que en Espana hay una menor proporcion de pacientes de 75 o mas anos que reciben un dispositivo de terapia de resincronizacion cardiaca, una mayor proporcion de pacientes en clase funcional II de la New York Heart Association, con bloqueo completo de la rama izquierda del haz de His y con seguimiento a distancia, con estancias hospitalarias significativamente menores.

Resumen Introduccion y objetivos La Sociedad Espanola de Cardiologia/Fundacion Espanola del Corazon (SEC/FEC) realiza convocatorias anuales de becas para proyectos de investigacion cardiovascular. El objetivo es analizar la evolucion de estas inversiones y la produccion cientifica derivada en el periodo 2007-2012. Metodos Se ha realizado una busqueda de las publicaciones financiadas por SEC/FEC, segun los siguientes criterios de inclusion: publicacion en revista indexada en MEDLINE o EMBASE, fecha de publicacion posterior a la de la ayuda, estar firmadas por el investigador principal de la ayuda y reconocer la financiacion SEC/FEC. Se analizo el factor impacto y las citas posteriores de los articulos (Web of Science). Resultados Se han otorgado 235 becas (39/ano) con una dotacion de 3.854.300 euros (642.383 euros/ano), el 37% a mujeres. Hay 122 publicaciones derivadas de 88 proyectos (37%) de investigacion financiados SEC/FEC. Estas publicaciones han recibido hasta octubre de 2017 un total de 2.258 citas en estudios posteriores en la Web of Science, con una media de 18,5 y una mediana de 8 citas/estudio. Conclusiones Las becas concedidas por la SEC/FEC han crecido en numero y cuantia media en el periodo analizado, a pesar de la crisis economica. Las mujeres acceden a ellas en igualdad de condiciones que los varones. El impacto bibliometrico de los proyectos financiados es aceptable, aunque deben hacerse esfuerzos para mejorarlo.

Significant mitral regurgitation (MR) may be present in up to half of patients with heart failure (HF) and it is associated with adverse cardiac remodeling and myocardial stretch. These are potential triggers for ventricular arrhythmias (VA) in patients with HF, and therefore MR may enhance electrical ventricular vulnerability. Our aim was to evaluate VA burden before and after percutaneous mitral valve repair (PMVR) in patients with implantable cardiac devices. We conducted a prospective registry of all consecutive patients (n = 34, age 69.0 ± 12.2 years, 77% male) with significant functional mitral regurgitation (FMR) who underwent MitraClip implantation in 2 centers between June 2014 and July 2018. VA burden was defined as the total number of events during device follow-up before and after PMVR. Among patients presenting VA during follow-up before or after PMVR, device success at hospital discharge was related to a significant reduction in the incidence of Nonsustained ventricular tachycardia (VT, p = 0.002) and any sustained VT or rapid VT/ventricular fibrillation (p = 0.034). Regarding implantable cardiac defibrillator (ICD) therapies, successful PMVR was related to a reduction in incidence of either antitachycardia pacing or appropriate shocks (p = 0.045) and in the occurrence of any defibrillation shocks (p = 0.045). Overall, effective repair lead to a significant reduction in the VA burden, with a significant decrease in the occurrence of any VA (p = 0.004) and any ICD therapies (p = 0.045). In conclusion, device success after PMVR was related to a reduction in overall arrhythmic burden and ICD therapies in our cohort.

Resumen Introduccion y objetivos El uso de dispositivos cardiacos implantables (DCI) se ha expandido en los ultimos anos. La infeccion relacionada con estos dispositivos es una de las principales complicaciones y se asocia con grandes morbilidad, mortalidad y costes. El objetivo del estudio es construir una puntuacion predictiva del riesgo de infeccion del DCI. Metodos Se diseno un estudio retrospectivo de casos y controles anidado. Tanto los casos como los controles pertenecian a una cohorte que incluia a todos los pacientes sometidos a un procedimiento relacionado con un DCI entre enero de 2009 y diciembre de 2015. Los casos se definieron como pacientes con infeccion, y se selecciono aleatoriamente a 3 controles de la cohorte por cada caso incluido. Resultados Durante el periodo de estudio, se realizaron 2.323 procedimientos. Se identificaron en total 33 infecciones relacionadas con el DCI. Se selecciono como controles a 99 pacientes. Se identificaron como factores de riesgo independientes el indice de Charlson (OR = 1,33; IC95%, 1,07-1,67), la anticoagulacion oral (OR = 3,51; IC95%, 1,44-8,54), la revision o el reemplazo de un dispositivo anterior (OR = 2,75; IC95%, 1,12-6,71) y la presencia de mas de 2 cables (OR = 3,42; IC95%, 1,25-9,37). Se genero una escala de riesgo predictivo y se denomino CIED-AI (indice de Charlson, mas de 2 cables/electrodos, revision/reemplazo del dispositivo, anticoagulacion oral, infeccion previa). Esta puntuacion presento un area bajo la curva receiver operating characteristic de 0,79 (IC95%, 0,71-0,88). Conclusiones La puntuacion CIED-AI puede ayudar a identificar a los pacientes con mayor riesgo de infeccion que serian candidatos a medidas de prevencion intensivas.

Resumen Introduccion y objetivos La cardioversion es la terapia inicial de la estrategia de control del ritmo en muchos pacientes con fibrilacion auricular (FA) persistente. Sin embargo, la informacion disponible sobre la cardioversion y sus resultados en Espana son escasos. Este trabajo tiene por objetivo analizar las caracteristicas y resultados de la cardioversion de la FA en nuestro pais. Metodos Es un estudio observacional, trasversal y multicentrico, realizado en servicios de urgencias y servicios de cardiologia de todo el territorio nacional que recoge las practicas y resultados durante el ano 2017. Resultados Participaron un total de 73 servicios, 44 servicios de cardiologia (60%) y 29 servicios de urgencias. Se realizaron 10.949 cardioversiones, de las cuales 6.671 (61%) se realizaron en los servicios de cardiologia y 4.278 (39%) en los de urgencias. Un total de 2.385 (22%) pacientes recibieron la cardioversion el mismo dia (2.091 en los servicios de urgencias), 602 (5%) pacientes entre 2 y 5 dias, 1.784 (16%) entre 5 dias y 3 semanas, 5.049 (46%) entre 3 semanas y 2 meses y 1.103 (10%) mas de 2 meses despues del diagnostico de FA. El uso de anticoagulantes orales directos se asocio a una cardioversion mas precoz. El 84% de los pacientes tratados con anticoagulantes de accion directa tuvieron una cardioversion efectiva, frente al 72% de los pacientes que recibieron antagonistas de la vitamina K (p Conclusiones El registro ENCARFA aporta un reflejo de la situacion actual de la cardioversion de la FA y sus resultados en Espana.

Objective: Cardiac amyloid infiltration can lead to systolic heart failure (HF) or to conduction disorders (CD). Patients with transthyretin (ATTR) amyloidosis are particularly exposed. We ...

En este documento se ofrece evidencia sobre los aspectos macroeconomicos mas importantes de la politica fiscal en Colombia. En primer lugar, sobre su papel en la estabilizacion del ciclo economico en el corto plazo y sobre otros asuntos relacionados con la estabilizacion, como los impactos macro de la incertidumbre ocasionada por los cambios recurrentes en la tributacion y la interrelacion entre la politica fiscal y la politica monetaria. En segundo lugar, se evalua la sostenibilidad de la deuda publica y el espacio fiscal disponible en la economia, factores que son cruciales para conocer el margen de discrecionalidad del gobierno en el mediano y largo plazo. Los hallazgos del trabajo contribuiran al debate sobre el manejo futuro de la politica macroeconomica. En el frente fiscal, las acciones deberian encaminarse a alcanzar el doble objetivo de la sostenibilidad de la deuda publica y de estabilizar el ciclo economico. Sobre esta ultima cuestion, no se registran avances significativos a pesar de la regla fiscal estructural adoptada en 2011.

Aims This trial aimed to evaluate the safety and efficiency of a common and simplified protocol for the surveillance of cardiac implantable electronic devices based on remote monitoring (RM) in patients with pacemakers (PMs) and implantable cardiac defibrillators (ICDs) for at least 24 months. Methods and results The RM-ALONE is a multicentre prospective trial that randomly assigned 445 patients in two groups, both followed by RM: the home monitoring-only (HMo) based on RM + remote interrogations (RIs) every 6 months and the HM + IO that adds in-office evaluations every 6 months to RM. Four hundred and forty-five patients were enrolled in the study, 294 PMs and 151 ICDs recipients. In the HMo group, 20% of patients experienced ≥1 major adverse cardiac event (MACE) vs. 19.5% in HM + IO group (P = 0.006 for non-inferiority). The proportion of patients with a PM/ICD who experienced ≥1 MACE was 15.2/29.3% in HMo group and 16.1/26.3% in HM + IO group (hazard ratio 0.95/1.15, 95% confidence interval 0.53–1.70/0.62–2.10). There were 789 in-office evaluations (136 in the HMo and 653 in the HM + IO; P Conclusion The RM-ALONE protocol common for ICD and PM surveillance, consisting of RM + RI every 6 months has proven safe and efficient in reducing hospital visits and staff workload.

Funding Acknowledgements Type of funding sources: None. Introduction The most frequent complications of atrial fibrillation (AF) ablation procedures are those related to the vascular access site, which are associated with increased morbidity and length of hospital stay. Purpose: To assess the safety and efficacy of venous access site closure with a suture-mediated vascular closure device (SVD), as well as the feasibility of early mobilization and same-day discharge protocol after AF ablation procedures. Methods: We conducted a retrospective analysis of all consecutive AF ablation patients in whom a SVD was employed to achieve hemostasis after each venous puncture. The ablation was performed under conscious sedation, using 7 to 12-F introducer sheaths. Anticoagulation was uninterrupted but for the last dose prior to the procedure. Intraprocedural heparin was not reversed. Groin ultrasound was performed in the first 10 patients with adequate SVD deployment. Three conditions were required for the same-day discharge protocol application: 1) uncomplicated procedure, 2) successful SVD deployment and 3) adequate recovery. Recovery followed a three-phase protocol: bed rest (two hours), sitting (one hour) and ambulation. Follow-up included phone call and clinical examination. Patients were offered contact to the electrophysiologist if needed. Results: 63 ablation procedures with SVD closure were performed from May 2019 to October 2020, with a total of 132 access sites analysed. Patient characteristics are shown in the table. The SVD was successfully deployed in 125 (94.7%) and hemostasis immediately achieved. In the remaining 5.3%, failure was attributed to a deficient technique, which missed to advance the knot to the vein. First 10 patients were ultrasound evaluated 24 hours later (no early discharge), showing total absence of complications. 35 subsequent patients (55.6% of the remaining 53) were discharged the same day without ultrasound control. The remaining 18 stayed overnight for reasons not related to the access site (hemodynamic surveillance, initiation of antiarrhythmic drugs or loss of phrenic capture), allowing in any case early mobilization (three hours after the procedure). Mean follow-up was 272 ± 160 days, with no adverse events recorded. Conclusion: SVD are safe and effective in achieving rapid hemostasis, making the early mobilization and same-day discharge protocol after AF ablation feasible in selected patients. Age 63 (57-71) Male 46 (73%) Body mass index (kg/m²) 27,5 (24,2-31,6) Previous anticoagulation- Vitamin K antagonist- Direct oral anticoagulation 50 (79,4%)14 (28%)36 (72%)

Aims To determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans. Methods and results Fifty-eight self-terminated and 173 shock-terminated episodes of spontaneously initiated PVT/VF recorded by Medtronic implanted cardiac defibrillators (ICDs) in 87 patients with various cardiac pathologies were analyzed by short fast Fourier transform of shifting segments to determine the dynamics of dominant frequency (DF) and regularity index (RI). The progression in the intensity of DF and RI accumulations further quantified the time course of spectral characteristics of the episodes. Episodes of self-terminated PVT/VF lasted 8.6 s [95% confidence interval (CI): 8.1–9.1] and shock-terminated lasted 13.9 s (13.6–14.3) (P < 0.001). Recordings from patients with primarily electrical pathologies displayed higher DF and RI values than those from patients with primarily structural pathologies (P < 0.05) independently of ventricular function or antiarrhythmic drug therapy. Regardless of the underlying pathology, the average DF and RI intensities were lower in self-terminated than shock-terminated episodes [DF: 3.67 (4.04–4.58) vs. 4.32 (3.46–3.93) Hz, P < 0.001; RI: 0.53 (0.48–0.56) vs. 0.63 (0.60–0.65), P < 0.001]. In a multivariate analysis controlled by the type of pathology and clinical variables, regularity remained an independent predictor of self-termination [hazard ratio: 0.954 (0.928–0.980)]. Receiver operating characteristic (ROC) curve analysis of DF and RI intensities demonstrated increased predictability for self-termination in time with 95% CI above the 0.5 cut-off limit at about t = 8.6 s and t = 6.95 s, respectively. Conclusion Consistent with the notion that fast organized sources maintain PVT/VF in humans, reduction of frequency and regularity correlates with early self-termination. Our findings might help generate ICD methods aiming to reduce inappropriate shock deliveries.

Introduction and objectives: We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2020. Methods: The data in this registry were drawn from implantation centers, which voluntarily completed a data collection sheet. Results: In 2020, 7056 implant sheets were received compared with 7106 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 99% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.8% for the field ``name of the implanting hospital'' to 2.6% for the variable ``referral hospital''. A total of 173 hospitals performed ICD implants and participated in the registry, which is a similar figure to that in 2019 (n=172). The total rate of registered implants was 149/million inhabitants (150 according to Eucomed), revealing a slight reduction in implants in Spain in 2020 as a result of the impact of the COVID-19 pandemic. This reduction was uneven among the autonomous communities. Conclusions: The Spanish Implantable Cardioverter Defibrillator Registry for 2020 shows an improvement in the rate of implants reported and a reduction in the number of ICD implants, which likely reflects the decrease in hospital activity not related to the treatment of COVID-19 infection. Similar to previous years, the total number of implants in Spain is still much lower than the average for the European Union, with an increase in the differences between Spanish autonomous communities. (C) 2021 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Background Large‐scale studies describing modern populations using an implantable cardioverter‐defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real‐world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29–1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07–1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43–2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54–0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14–0.45) showed a lower risk. All‐cause death was 13.4% at follow‐up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58–5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18–5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25–6.99) had the worst prognoses. Delayed high‐rate detection was enabled in 39.7% of patients, and single‐zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow‐up was low (6%) and did not differ among type of ICD but was lower in SmartShock‐capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure–related disorders had a similar risk of ICD life‐saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NTC01561144.

Implantable cardiac defibrillator (ICD) is the only definitive therapy for prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM). Conventional transvenous ICDs can provide cardiac pacing unlike new subcutaneous ICD, but the usefulness of cardiac pacing in HCM patients is not well defined. We sought to assess the usefulness of ICD pacing in HCM. We retrospectively analyzed 93 HCM patients who had undergone ICD implantation at our center. Usefulness of pacing was defined as follows: 1) need of pacing due to bradycardia or AV conduction disturbances, 2) improvement of LV outflow tract obstruction by sequential AV pacing, 3) need for CRT pacing, or 4) successful antitachycardia pacing without a subsequent shock. Independent predictors of useful pacing were investigated by multivariable analysis. During a mean follow-up of 91.3 ± 5.5 months, 43 patients (46.2%) reached the composite endpoint. Independent predictors of pacing usefulness were older age (HR 1.36; 95%CI: 1.088–1.709; p=0.007) and NYHA functional class ≥ II (HR 2.15; 95%CI: 1.083–4.301; p=0.029). Twenty-eight (30.1%) patients had appropriate ICD interventions, triggered by a monomorphic ventricular tachycardia (MVT) in 22 of them (78.5%). In 17 individuals with MVT (77%), antitachycardia pacing successfully treated MVT. In our HCM series of patients with ICD, 46% of individuals benefitted from cardiac pacing. MVT were documented in nearly 80% of the patients with ventricular arrhythmias and antitachycardia pacing successfully treated them in 77% of cases.

OBJECTIVE Anxiety is often present among patients with atrial fibrillation (AF). This condition has been associated with greater symptom severity and worse quality of life in these patients. However, the influence of anxiety on the risk of AF recurrence is not well known. We aimed to define the level of anxiety in patients with persistent AF undergoing elective cardioversion (EC) and determine whether there is an association between anxiety and the risk of early AF recurrence after EC. METHODS Anxiety was measured before EC using the State-Trait Anxiety Inventory. Early AF recurrence was assessed with a control electrocardiogram at 30-day follow-up. RESULTS We included 107 patients undergoing effective EC. Early AF recurrence was diagnosed in 40 patients (37.4%). Compared with those who remained in sinus rhythm, individuals with early AF recurrence had significantly higher levels of trait anxiety (23.1 [10.4] versus 17.9 [9.5]; p = .013) and larger left atrial volume index (45.8 [12.3] versus 37.9 [13.3] ml/m; p = .004). Both variables remained independently associated with early AF recurrence after multivariate analysis. A predictive model including trait anxiety score >20 and left atrial volume index >41 ml/m showed acceptable accuracy for the diagnosis of early AF recurrence (area under the curve = 0.733; 95% confidence interval = 0.634-0.832; p < .001). CONCLUSIONS Our study shows that trait anxiety is an independent risk factor for early AF recurrence after EC. Further studies are warranted to assess the beneficial role of anxiety-reducing strategies on the outcomes of patients with AF.

Introduction and objectives We present the data corresponding to implantable cardioverter-defibrillator (ICD) implants in Spain in 2019. Methods The data were drawn from implant centers voluntarily completing a data collection sheet. Results In 2019, 7003 implant sheets were received compared with the 7389 reported by Eucomed (European Confederation of Medical Suppliers Associations), indicating that data were collected from 94.8% of the devices implanted in Spain. Completion of the implant sheet ranged from 99.7% in the field “name of the implanting hospital” to 17.8% in the variable “reference hospital”. In 2019, 172 hospitals performed ICD implants and participated in the registry, a figure similar to that of 2018 (173). The total rate of registered implants was 149/million inhabitants; the rate reported by Eucomed was 157. Although this value represents the highest in the historical series, it is still much lower than the average rate of ICD implants in Europe (303). Conclusions The Spanish Implantable Cardioverter-Defibrillator Registry for 2019 reflects a growth in the number of ICD implants and is the year with the highest number of ICD implants in Spain. However, similar to previous years, the total number of implants in Spain is still much lower than the European Union average, with substantial differences between Spanish autonomous communities.