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Resumen Introduccion y objetivos HeartLogic es un algoritmo multiparametrico incorporado a desfibriladores automaticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociacion entre alertas y eventos clinicos bajo un protocolo de seguimiento comun en un registro multicentrico. Metodos Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activacion de HeartLogic, segun practica local y un protocolo comun respectivamente). Resultados Se incluyo a 288 pacientes en 15 centros. En fase 1, tras una media de observacion de 10 meses, hubo 73 alertas (0,72 alertas/paciente-ano), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/ano-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/ano-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/ano-paciente. Fuera del estado de alerta solo hubo una hospitalizacion y una descompensacion menor. La mayoria de las alertas (el 82% en fase 2 y el 81% en fase 3; p = 0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de el (7.378 frente a 1.210 pg/ml; p Conclusiones El indice HeartLogic se asocio con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitio detectar y actuar a distancia con seguridad sobre las alertas.

INTRODUCTION AND OBJECTIVES: This article reports the results of the 2020 Spanish Catheter Ablation Registry, a year marked by the SARS-CoV-2 pandemic. METHODS: Data were collected retrospectively through completion and return of a specific form by the participating centers. RESULTS: Data from 97 centers (67 public, 30 private) were analyzed. A total of 15 169 ablation procedures were reported with a mean of 155 ± 117 and a median [interquartile range] of 115 [62-227]. Because of the SARS-CoV-2 pandemic, both procedures and participating centers markedly decreased (-3380 procedures, -18%) and there were 5 centers less than in 2019. The most common procedure continued to be atrial fibrillation ablation (4513; 30%), well ahead of the remaining substrates, followed by ablation of the cavotricuspid isthmus (3188; 21%), and intranodal re-entry tachycardia (2808; 18%). Ablation of these 3 substrates continued to form the bulk of the procedures. The total success rate was slightly lower than in previous years (88%) with a similar complication rate (n = 309; 2%) and mortality (n = 7; 0.04%). A total of 243 procedures were performed in pediatric patients (1.6%). CONCLUSIONS: The Spanish Catheter Ablation Registry systematically and continuously reflects the national trajectory, which, in 2020, was markedly affected by the SARS-CoV-2 pandemic. Although slightly lower than in previous years, the success rate remained high, with a low complication rate.

Introduction and objectives: This article reports the results of the 2020 Spanish Catheter Ablation Registry, a year marked by the SARS-CoV-2 pandemic. Methods: Data were collected retrospectively through completion and return of a specific form by the participating centers. Results: Data from 97 centers (67 public, 30 private) were analyzed. A total of 15 169 ablation procedures were reported with a mean of 155 117 and a median [interquartile range] of 115 [62-227]. Because of the SARS-CoV-2 pandemic, both procedures and participating centers markedly decreased ( 3380 procedures, 18%) and there were 5 centers less than in 2019. The most common procedure continued to be atrial fibrillation ablation (4513; 30%), well ahead of the remaining substrates, followed by ablation of the cavotricuspid isthmus (3188; 21%), and intranodal re-entry tachycardia (2808; 18%). Ablation of these 3 substrates continued to form the bulk of the procedures. The total success rate was slightly lower than in previous years (88%) with a similar complication rate (n = 309; 2%) and mortality (n = 7; 0.04%). A total of 243 procedures were performed in pediatric patients (1.6%).Conclusions: The Spanish Catheter Ablation Registry systematically and continuously reflects the national trajectory, which, in 2020, was markedly affected by the SARS-CoV-2 pandemic. Although slightly lower than in previous years, the success rate remained high, with a low complication rate. C 2021 Sociedad Espan ̃ola de Cardiologı ́a. Published by Elsevier Espan ̃a, S.L.U. All rights reserved. Introducción y objetivos Se describen los resultados del Registro Español de Ablación con Catéter de 2020, año marcado por la pandemia por SARS-CoV-2. Métodos La recogida de datos fue restrospectiva mediante la cumplimentación y envío de un formulario específico por los centros participantes. Resultados Se analizaron los datos de 97 centros (67 públicos, 30 privados). Se comunicaron 15.169 procedimientos de ablación (media, 155 ± 117; mediana, 115 [62-227]). La pandemia de SARS-CoV-2 ha condicionado una disminución notable tanto de los procedimientos (–3.380 casos, –18%) como de los centros participantes (5 menos que en 2019). La ablación de FA sigue siendo el procedimiento más frecuente (4.513; 30%), a distancia de los demás sustratos; junto con la ablación del ICT (3.188; 21%) y la taquicardia por reentrada intranodular (2.808; 18%), son los 3 sustratos más abordados. La tasa total de éxito reportada es discretamente inferior a las de años previos (88%), con similares tasas de complicaciones (309; 2%) y mortalidad (7; 0,04%). Se realizaron 243 procedimientos en pacientes pediátricos (1,6%). Conclusiones El Registro Español de Ablación con Catéter recoge de manera sistemática e ininterrumpida la trayectoria nacional, que este año se ha visto notablemente marcada por la pandemia por SARS-CoV-2. Aunque discretamente inferior a las años previos, la tasa de éxito sigue siendo alta, con una baja tasa de complicaciones.

Introduction and objectives: This report presents the findings of the 2018 Spanish Catheter Ablation Registry. Methods: Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. Results: Data sent by 100 centers were analyzed, with a total number of 16,566 ablation procedures performed (the highest historically reported in this registry) for a mean of 165.5 ± 127.9 and a median of 119 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n = 4234; 25.6%), atrioventricular nodal re-entrant tachycardia (n = 3525; 21.3%) and cavotricuspid isthmus (n = 3425; 20.7%). A new peak was observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was 91%. The rate of major complications was 2.2%, and the mortality rate was 0.04%. A total of 2.1% of the ablations were performed in pediatric patients. Conclusions: The Spanish Catheter Ablation Registry systematically and continuously enrolls the ablation procedures performed in Spain, showing a progressive increase in the number of ablations over the years, with a high success rate and low percentage of complications.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Inc. Introduction Catheter ablation of atrial fibrillation, both cryoablation and radiofrequency pulmonary vein isolation, have demonstrated to be safe and effective techniques for treating symptomatic atrial fibrillation as a first procedure. However, about one in three patients may face a redo procedure due to AF recurrence. The most suitable technique for redo is unknown. Purpose The aim of this study is to assess the efficacy of cryoballoon AF ablation as a redo technique in patients with prior cryoballoon or radiofrequency AF ablation. Methods We analyzed a nation-wide real-world cryoablation registry (RECABA) and compared patients who were referred for a first cryoballoon AF ablation procedure with those who had previously undergone cryoballoon or radiofrequency pulmonary vein isolation. The primary endpoint was AF recurrence during the first year after a 3-month blanking period. We performed survival analysis and built univariate and multivariate cox regression models. Results From 1742 patients, 1625 had a 12-month follow-up visit. 1551 (95.45%) underwent a first cryoballoon ablation, whereas 33 (2.03%) had a previous CB ablation performed and 41 (2.52%) a previous RF ablation. Mean age was 58.6 ±10.4 years and 511 (31.5%) were women. 463 (28.5%) had persistent atrial fibrillation and there were no major clinical differences between groups. Prior-CB group had a higher share of veins without electrogram visualization, with a median of 100% (IQR 75%-100%), compared to prior-RF group (median 67%, IQR 25%-75%) and first procedure group (median 25%, IQR 0%-50%). Kruskal-Wallis test Chi2=54.35, p 12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 78.5% (95% CI 76.2% - 80.7%) in the first procedure group, 61.0% (95% CI 41.4% - 75.8%) in the prior-CB and 89.2% (95% CI 73.6% - 95.9%) in the prior-RF group. Log-rank test Chi2=17.49, p Multivariate cox regression analysis pointed female sex, persistent AF, and prior-CB ablation as independent predictors of AF recurrence. The adjusted HR for AF recurrence of prior-CB ablation vs first-CB ablation was 3.13 (95% CI 1.82 -5.40) and for prior-RF vs first CB-ablation was 1.01 (95% CI 0.51 – 1.97). Conclusion Repeat cryoballoon AF ablation shows higher rates of AF recurrences compared to first CB procedures or after prior RF ablation. These data suggest that patients with AF recurrence after CB-ablation have worse arrhythmic outcomes and may benefit from other ablation techniques after a recurrence.

Telemonitoring through multiple variables measured on cardiac devices has the potential to improve the follow-up of patients with heart failure. The HeartLogic algorithm (Boston Scientific), implemented in some implantable cardiac defibrillators and cardiac resynchronisation therapy, allows monitoring of the nocturnal heart rate, respiratory movements, thoracic impedance, physical activity and the intensity of heart tones, with the aim of predicting major clinical events. Although HeartLogic has demonstrated high sensitivity for the detection of heart failure decompensations, its effects on hospitalisation and mortality in randomised clinical trials has not yet been corroborated. This review details how the HeartLogic algorithm works, compiles available evidence from clinical studies, and discusses its application in daily clinical practice.

Cryoablation is safe and effective for the treatment of atrial fibrillation (AF) in controlled clinical trials, but contemporary real-world usage and outcomes are limited. The Report of the Spanish Cryoballoon Ablation Registry (RECABA) was designed to evaluate acute and 12-month outcomes of cryoballoon ablation for the treatment of AF in Spain. Patients from 27 Spanish centers were prospectively enrolled. Patients were treated with cryoballoon ablation and managed according to standard of care protocols at each center. The primary endpoint was ≥ 30 s freedom from AF at 12-month after a 3-month blanking period. Secondary endpoints included a description of patient characteristics, cryoablation procedural strategy and safety, and predictors of efficacy. In total, 1742 patients (71.4% PAF, 68.8% male, mean age 58.02 ± 10.40 years, 76.1% overweight or obese, CHA2DS2-VASc index 1.40 ± 1.28) were enrolled. Patients received 7.2 ± 2.67 cryo-applications. PV potentials could be detected in 61% of the PVs during ablation, with a mean time to block of 52.9 ± 37.02 s. Acute PVI was observed in 97% of PVs with 75.8% isolated with the first cryo-application. Mean procedural time was 113 ± 41 min. Acute complications occurred in 4.4% of the cases. With follow-up in 1628 patients, AF-free survival was 78.5% (PAF: 80.6% vs PersAF 73.3%; p ClinicalTrials.gov number: NCT02785991.

HeartLogic is a multiparametric algorithm incorporated into implantable cardioverter-defibrillators (ICD). The associated alerts predict impending heart failure (HF) decompensations. Our objective was to analyze the association between alerts and clinical events and to describe the implementation of a protocol for remote management in a multicenter registry.We evaluated study phase 1 (the investigators were blinded to the alert state) and phases 2 and 3 (after HeartLogic activation, managed as per local practice and with a standardized protocol, respectively).We included 288 patients from 15 centers. In phase 1, the median observation period was 10 months and there were 73 alerts (0.72 alerts/patient-y), with 8 hospitalizations and 2 emergency room admissions for HF (0.10 events/patient-y). There were no HF hospitalizations outside the alert period. In the active phases, the median follow-up was 16 (95%CI, 15-22) months and there were 277 alerts (0.89 alerts/patient-y); 33 were associated with HF hospitalizations or HF death (n=6), 46 with minor decompensations, and 78 with other events. The unexplained alert rate was 0.39 alerts/patient-y. Outside the alert state, there was only 1 HF hospitalization and 1 minor HF decompensation. Most alerts (82% in phase 2 and 81% in phase 3; P=.861) were remotely managed. The median NT-proBNP value was higher within than outside the alert state (7378 vs 1210 pg/mL; P.001).The HeartLogic index was frequently associated with HF-related events and other clinically relevant situations, with a low rate of unexplained events. A standardized protocol allowed alerts to be safely and remotely detected and appropriate action to be taken on them.

Background Cryoablation is safe and effective for the treatment of atrial fibrillation (AF) in controlled clinical trials, but contemporary real-world usage and outcomes are limited. Objectives The Report of the Spanish Cryoballoon Ablation Registry (RECABA) was designed to evaluate acute and 12-month outcomes of cryoballoon ablation for the treatment of AF in Spain. Methods Patients from 27 Spanish centers were prospectively enrolled. Patients were treated with cryoballoon ablation and managed according to standard of care protocols at each center. Theprimary endpoint was ≥ 30 sec freedom from AF at 12-mo after a 3-mo blanking period. Secondary endpoints included a description of patient characteristics, cryoablation procedural strategy and safety, and predictors of efficacy. Results In total, 1742 patients (71.4% PAF, 68.8% male, mean age 58.02 ± 10.40 years, 76.1% overweight or obese, CHA2DS2-VASc index 1.40 ± 1.28) were enrolled. Patients received 7.2 ± 2.67 cryoapplications. PV potentials could be detected in 61% of the PVs during ablation, with a mean time to block of 52.9 ± 37.02 seconds. Acute PVI was observed in 97% of PVs with 75.8% isolated with the first cryoapplication. Mean procedural time was 113 ± 41 minutes. Acute complications occurred in 4.4% of the cases21. With follow-up in 1628 patients, AF-free survival was 78.5% (PAF: 80.6% vs PersAF 73.3%; p

Resumen Introduccion y objetivos Se describen los resultados del Registro Espanol de Ablacion correspondientes al ano 2019. Metodos La recogida de datos ha sido retrospectiva mediante la cumplimentacion de un formulario de recogida de datos por cada uno de los centros participantes. Resultados Se han analizado los datos enviados por 102 centros, con un total de 18.549 procedimientos de ablacion (el mayor de este registro) y con una media de 181,9 ± 137,0 y una mediana de 144,5 procedimientos por centro. Se consolida la ablacion de fibrilacion auricular como el sustrato abordado con mas frecuencia (n = 5.164; 27,8%), que aumenta la distancia respecto al resto de sustratos. El segundo sustrato es el istmo cavotricuspideo (n = 3.925; 21,1%) y el tercero, la taquicardia por reentrada intranodular (n = 3.768; 20,3%), desbancada del segundo puesto por aquel. La tasa total de exito fue de nuevo del 91%; la de complicaciones mayores, del 1,9% y la mortalidad, del 0,03%. Se consolida el uso de navegadores (el 44,5% del total de procedimientos) y de los cateteres con tecnologia de contacto en la fibrilacion auricular (84,8%) y la taquicardia ventricular (90%). El 1,5% de las ablaciones se realizaron en pacientes pediatricos. Conclusiones El Registro Espanol de Ablacion recoge de manera sistematica sin interrupcion los procedimientos de ablacion realizados en Espana, y permite observar a lo largo de los anos un aumento progresivo del numero de ablaciones manteniendo una alta tasa de exito y unos porcentajes bajos de complicaciones.

Resumen Introduccion y objetivos Se describen los resultados del Registro Espanol de Ablacion con Cateter correspondientes al ano 2017. Metodos La recogida de datos se llevo a cabo de forma retrospectiva con la cumplimentacion de un formulario de recogida de datos de cada uno de los centros participantes. Resultados El numero total de procedimientos de ablacion fue de 15.284 realizados en 98 centros (mayor numero de centros y de procedimientos de ablacion comunicados historicamente en este registro) con una media de 156 ± 126 y una mediana de 136 procedimientos. El sustrato abordado con mas frecuencia ha sido por primera vez en el registro la fibrilacion auricular (n = 3.457; 22,6%), seguida del istmo cavotricuspideo (n = 3.449; 22,5%) y la taquicardia intranodular (n = 3.429; 22,4%). La tasa total de exito fue del 87%; la de complicaciones mayores, del 2,6% y la mortalidad, del 0,09%. Se ha producido un aumento de los procedimientos realizados sin apoyo de fluoroscopia hasta suponer un 6% del total de las ablaciones. Un 2,3% de las ablaciones se realizo en pacientes pediatricos. Conclusiones El Registro Espanol de Ablacion con Cateter recoge sistematica e ininterrumpidamente los procedimientos de ablacion realizados en Espana, y esto nos ha permitido observar un aumento progresivo del numero de ablaciones y de centros que las realizan manteniendo una tasa de exito elevada y unos porcentajes de complicaciones bajos.

Resumen Describimos el caso de un paciente de 72 anos portador de DAI en prevencion primaria por una miocardiopatia dilatada de origen isquemico con sobresensado de onda T en relacion con el desarrollo de un trastorno de conduccion intraventricular (bloqueo de rama derecha), que provoco terapias inapropiadas del dispositivo, y posteriormente inhibicion de la estimulacion debida al sobresensado tras aparicion de bloqueo AV completo. Ponemos de manifiesto la importancia de esta situacion y el conocimiento de cada una de las opciones de programabilidad o algoritmos que ofrece cada fabricante para enfrentarnos a este fenomeno.

Introduction and objectives: This report describes the findings of the 2017 Spanish Catheter Ablation Registry. Methods: Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. Results: A total of 15 284 ablation procedures were performed by 98 institutions (the highest number of ablations and institutions historically reported in this registry), with a mean of 156 ± 126 and a median of 136 procedures per center. For the first time, the most frequently treated ablation target was atrial fibrillation (n = 3457; 22.6%), followed by cavotricuspid isthmus (n = 3449; 22.5%) and atrioventricular nodal re-entrant tachycardia (n = 3429; 22.4%). The overall success rate was 87%. The rate of major complications was 2.6%, and the mortality rate was 0.09%. The percentage of procedures performed without fluoroscopic support increased to 6% of all ablations, and 2.3% of all ablations were performed in pediatric patients. Conclusions: The Spanish Ablation Catheter Registry systematically and uninterruptedly collects data on the ablation procedures performed in Spain, revealing that both the number of ablations and the number of centers performing them has progressively increased, while maintaining a high success rate and a low percentage of complications.

Resumen Introduccion y objetivos La heredabilidad y la penetrancia familiar de los trastornos causantes de la parada cardiaca en ausencia de cardiopatia aparente es desconocida. Nuestro objetivo es describir los hallazgos clinicos y los medios para alcanzar el diagnostico en una muestra de familiares de probandos con parada cardiaca en ausencia de cardiopatia aparente. Material y metodos Estudiamos a familiares de primer a tercer grado de pacientes afectados por parada cardiaca de origen incierto. En todos se realizo electrocardiograma y ecocardiograma transtoracico. En los casos con diagnostico cierto en el probando, se realizo ademas estudio dirigido en funcion del mismo para desenmascarar la enfermedad. Resultados Se incluyo a 88 sujetos pertenecientes a 35 familias (media de 2,5 familiares por caso indice, con una edad media de 38,4 anos y 52,8% varones). El 55,6% fueron familiares de primer grado y el resto de segundo y tercer grado. En 18 de los 35 casos indice se alcanzo un diagnostico final. Se obtuvo un diagnostico positivo en 19 familiares (21,5%) consistentes en sindrome de Brugada (10 casos), sindrome de QT largo (3 casos), taquicardia ventricular catecolaminergica polimorfica (5 casos) y un caso de posible Sindrome de QT corto. En 4 familias, el diagnostico del probando se alcanzo exclusivamente mediante el estudio familiar. Conclusiones La prevalencia de canalopatias cardiacas entre los familiares de probandos con parada cardiaca de origen incierto fue alta, con frecuente necesidad de test de desenmascaramiento y genetico para logar un diagnostico cierto.

Resumen La extrasistolia ventricular originada en el tracto de salida de ventriculo derecho puede tener una respuesta pobre a farmacos y ser compleja de ablacionar mediante un sistema convencional con guia fluoroscopica debido a la dificultad en la inducibilidad. Describimos la ablacion de extrasistolia ventricular de dificil inducibilidad originada en el tracto de salida de ventriculo derecho, mediante un sistema de cartografia sin contacto. Se realizo ablacion de cinco focos extrasistolicos originados en tracto de salida de ventriculo derecho en una serie prospectiva de 4 pacientes. Los pacientes presentaban pobre calidad de vida y falta de respuesta a antiarritmicos. Se realizo una media de tres aplicaciones de radiofrecuencia por foco, con un tiempo medio de aplicacion de 113 ± 15 s. Se obtuvo un 100% de exito agudo y no hubo complicaciones. En un seguimiento medio de 30 ± 16 meses, los pacientes se mantienen asintomaticos sin tratamiento farmacologico. El sistema de cartografia sin contacto permite una alta eficacia en la eliminacion de extrasistolias ventriculares aisladas de dificil inducibilidad.

A B S T R A C T Premature ventricular contractions originating in the right ventricular outflow tract may respond poorly to pharmacological treatment, and ablation using conventional fluoroscopically-guided systems may be complicated by the difficulty in inducing arrhythmias. We describe the use of a non-contact mapping system to ablate difficult-to-induce premature ventricular contractions originating in the right ventricular outflow tract. Five premature ventricular contractions sites in the right ventricular outflow tract were ablated in a prospective series of 4 patients. Patients had a poor quality of life and had not responded to antiarrhythmic drugs. A mean of 3 radiofrequency pulses per site was applied and mean application time was 113 � 15 s. We achieved a 100% acute success rate and there were no complications. Patients were asymptomatic without drug therapy after a mean of 30 � 16 months of follow-up. The noncontact mapping system is highly effective in eliminating difficult to induce, isolated premature ventricular contractions.

Introduccion y objetivos Se presentan los resultados del Registro Espanol de Desfibrilador Automatico Implantable de 2007 elaborado por el Grupo de Trabajo de Desfibrilador Automatico Implantable de la Seccion de Electrofisiologia y Arritmias de la Sociedad Espanola de Cardiologia. Metodos Se envio a la Sociedad Espanola de Cardiologia la hoja de recogida de datos de forma prospective en el 96,6% de los implantes. Resultados El numero de implantes comunicados fue 3.291 (el 90,1% del total estimado). El numero de implantes por millon de habitantes comunicados fue 72,8. La cantidad de primoimplantes fue del 77,1%. La mayor parte se implanto en varones con una media ± desviacion estandar de edad de 61 ± 12 anos, con disfuncion VI severa o moderada a severa y en clase funcional II. La cardiopatia mas frecuente fue la isquemica, seguida de la dilatada. Las indicaciones por prevencion primaria se han estabilizado con respecto al ano previo y constituyen la mitad de los primoimplantes, con un incremento en pacientes con miocardiopatia dilatada. Ha aumentado ligeramenteel numero de desfibriladores automaticos implantables con terapia de resincronizacion cardiaca, el 30,1% del total. En torno al 70% de los implantes se realizo en el laboratorio de electrofisiologia y por electrofisiologos. La incidencia de complicaciones fue muy baja. Conclusiones El Registro Espanol de Desfibrilador Automatico Implantable del ano 2007 recoge informacion de mas del 90% de los implantes de desfibrilador automatico implantable que se realizan en Espana, apoyando su representatividad creciente en los ultimos anos. El numero de implantes ha continuado aumentando, aunque se ha estabilizado la proporcion de indicaciones por prevencion primaria en torno al 50%.

Introduction and objectives This article describes the findings of the 2009 Spanish Implantable Cardioverter-Defibrillator (ICD) Registry compiled by the Working Group on Implantable Cardioverter-Defibrillators of the Spanish Society of Cardiology’s Electrophysiology and Arrhythmias Section. Methods Each implantation team voluntarily sent prospective data recorded on a single-page document to the Spanish Society of Cardiology. Results In total, 4108 device implantations were reported, which comprised 88.6% of the estimated total number of implantations carried out. The number of implants reported corresponded to 89 per million population and the estimated total number was 100.2 per million. The proportion of first implantations among those reported was 71.3%. Data were received from 134 centers, 17 more than in 2008. There continued to be significant regional variations between the various Spanish autonomous regions. The highest implantation rate (81%) was in men (mean age 62 years) who had severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most common heart condition was ischemic heart disease, followed by dilated cardiomyopathy. Indications for primary prevention accounted for 55.9% of first implantations; this figure was lower than the previous year's for the first time since 2003. The most significant increase observed was in patients with ischemic heart disease. Conclusions The 2009 Spanish ICD registry included data on almost 89% of all ICD implantations performed in the country. Although the number of implantations has continued to increase, it still remains far from the European average. The percentage of implantations performed for primary prevention was observed to have stabilized.

Unexplained cardiac arrest (UCA) can be caused by low-penetrance genetic disorders. The aim of this cross-sectional study is to assess the usefulness of a new diagnostic protocol: Thirty-five patients were recruited from 9 Spanish centers. Electrocardiogram, echocardiogram, and coronary catheterization were used to rule out electrical or structural heart disease in all subjects. Patients underwent pharmacologic tests with epinephrine and flecainide, followed by assessment of family members using electrocardiogram and echocardiogram, and next-generation genetic sequencing to analyze 126 genes if all the other test results were negative. A firm diagnosis of channelopathy required phenotypic proof of the condition in unmasking tests, the presence of a pathogenic variant consistent with the phenotype observed, and/or co-segregation of the mutation found in a family member's phenotype. A firm diagnosis was made in 18 cases. The diagnoses were 7 Brugada syndrome, 5 catecholaminergic polymorphic ventricular tachycardia, 3 long QT syndrome, 2 early repolarization syndrome, and 1 short QT syndrome. Pharmacologic testing was the most frequent method of diagnosis. In 5 cases, the diagnosis was made based on positive genetic testing without phenotypic alterations. In conclusion, this sequential diagnostic protocol allows diagnoses to be made in approximately half of the UCA cases. These diagnoses are low clinical penetrance channelopathies. If interpreted carefully, genetic tests can be a useful tool for diagnosing UCA without a phenotype. (C) 2015 Elsevier Inc. All rights reserved.

ObjectivesThis study was designed to determine the effectiveness of a protocol for rapid intravenous hydration to prevent contrast-induced nephropathy (CIN) in patients undergoing emergency percutaneous coronary intervention (PCI).BackgroundContrast-induced nephropathy frequently complicates PCI, resulting in prolonged hospitalization and increased in-hospital and long-term morbidity and mortality. Little is known regarding prevention of CIN in patients undergoing urgent PCI.MethodsWe conducted a prospective, controlled, randomized, single-center trial in 111 consecutive patients with acute coronary syndrome undergoing emergency PCI. As part of the hydration therapy, 56 patients (group A) received an infusion of sodium bicarbonate plus N-acetylcysteine (N-AC) started just before contrast injection and continued for 12 h after PCI. The remaining 55 patients (group B) received the standard hydration protocol consisting of intravenous isotonic saline for 12 h after PCI. In both groups, 2 doses of oral N-AC were administered the next day.ResultsThe 2 groups were similar with respect to age, gender, diabetes mellitus, and baseline serum creatinine. A serum creatinine concentration >0.5 mg/dl from baseline after emergency PCI was observed in 1 patient in group A (1.8%) and in 12 patients in group B (21.8%; p < 0.001). Acute anuric renal failure was observed in 1 patient (1.8%) in group A and in 7 patients (12.7%) in group B (p = 0.032).ConclusionsRapid intravenous hydration with sodium bicarbonate plus N-AC before contrast injection is effective and safe in the prevention of CIN in patients undergoing emergency PCI.

AIMS: The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analyse how centres assess in routine clinical practice the success of the procedure and to evaluate the success rate and long-term safety/complications.METHODS AND RESULTS: Seventy-two centres in 10 European countries were asked to enrol 20 consecutive patients undergoing a first AFib ablation procedure. A web-based case report form captured information on pre-procedural, procedural, and 1-year follow-up data. Between October 2010 and May 2011, 1410 patients were included and 1391 underwent an AFib ablation (98.7%). A total of 1300 patients (93.5%) completed a follow-up control 367 ± 42 days after the procedure. Arrhythmia documentation was done by an electrocardiogram in 76%, Holter-monitoring in 52%, transtelephonic monitoring in 8%, and/or implanted systems in 4.5%. Over 50% became asymptomatic. Twenty-one per cent were re-admitted due to post-ablation arrhythmias. Success without antiarrhythmic drugs was achieved in 40.7% of patients (43.7% in paroxysmal AF; 30.2% in persistent AF; 36.7% in long-lasting persistent AF). A second ablation was required in 18% of the cases and 43.4% were under antiarrhythmic treatment. Thirty-three patients (2.5%) suffered an adverse event, 272 (21%) experienced a left atrial tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause).CONCLUSION: The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib in a real-world setting. The methods used to assess the success of the procedure appeared at least suboptimal. Even in this context, the 12-month success rate appears to be somewhat lower to the one reported clinical trials.