
Eduard GuaschHospital Clínic de Barcelona; IDIBAPS August Pi i Sunyer Biomedical Research Institute · Arrhythmia Unit - Cardiology Department
Eduard Guasch
MD, PhD
About
303
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Introduction
Skills and Expertise
Additional affiliations
January 2010 - August 2012
June 2008 - December 2009
Publications
Publications (303)
BACKGROUND
Transcriptional dysregulation, possibly affected by genetic variation, contributes to disease development. Due to dissimilarities in development, function, and remodeling during disease progression, transcriptional differences between the left atrial (LA) and right atrial (RA) may provide insight into diseases such as atrial fibrillation...
One of the main limitations of conventional absorption-based X-ray micro-computed tomography imaging of biological samples is the low inherent X-ray contrast of soft tissue. To overcome this limitation, the use of ethanol as contrast agent has been proposed to enhance image contrast of soft tissues through dehydration. Some authors have shown that...
Efficient personalized ablation strategies for treating atrial arrhythmias remain challenging. Discrepancies in identifying arrhythmogenic areas using characterization methods, such as late gadolinium enhanced magnetic resonance imaging (LGE-MRI) and electroanatomical mapping, require a comparative analysis of local impedance (LI) and LGE-MRI data....
Background/Introduction
Atrial fibrillation (AF) is a prevalent condition that can lead to a decrease in quality of life and frequent re-hospitalizations. Some data suggest that integrated care nurse-led may blunt these consequences in unselected patients with AF, but not all studies support this. While AF ablation is becoming a cornerstone treatme...
Background and Aims
In patients with atrial fibrillation (AF), recurrent AF and sinus rhythm during follow-up are determined by interactions between cardiovascular disease processes and rhythm control therapy. Predictors of attaining sinus rhythm at follow-up are not well known.
Methods
To quantify the interaction between cardiovascular disease pr...
Aims
To describe the rationale, design, delivery and baseline characteristics of STEEER-AF (Stroke prevention and rhythm control Treatment: Evaluation of an Educational programme of the European Society of Cardiology [ESC] in a cluster-Randomised trial in patients with Atrial Fibrillation).
Methods & Results
STEEER-AF is a pragmatic trial designed...
Background
Left bundle branch pacing (LBBP) has emerged as a promising alternative technique for cardiac resynchronization therapy (CRT). ECG imaging (ECGI) may provide an accurate assessment of electrical resynchronization using real-time maps during LBBP implant.
Purpose
To evaluate the usefulness of ECGI to guide LBBP implant, by analyzing the...
Introduction
Implantable cardioverter-defibrillator (ICD) therapy plays a pivotal role in the management of patient’s survivors of life-threatening ventricular arrhythmias (secondary prevention). Risk of recurrence may be related to presence of myocardial scar and its components (including core mass, border zone (BZ) mass, and BZ channels) assessed...
Background
Catheter ablation is an effective atrial fibrillation (AF) therapy, but a complex, resource-intensive procedure. Same-day discharge (SDD) reduces utilization of health care resources including personell and hospital beds, and may help to accommodate the increasing demand for AF ablation. However, besides structural adaptations, SDD requi...
Background
Atrial arrythmogenic substrate is a key determinant of arrhythmia recurrence after pulmonary vein isolation (PVI), and reduced conduction velocities have been linked to adverse outcome. However, a non-invasive method to assess such electrical substrate is not available to date.
Purpose
We have developed and validated a non-invasive mapp...
Background
Novel concepts for pulmonary vein isolation (PVI) like pulsed field ablation (PFA) or high power-short duration ablation (HPSD) promise favourable profiles of safety and efficacy. However, clinical comparisons of ablation lesion quality are lacking.
Purpose
To systematically investigate lesion characteristics of novel ablation concepts,...
Background
The validation of bidirectional cavotricuspid isthmus (CTI) block following catheter ablation for typical atrial flutter (AFL) involves endocavitary manoeuvres using multiple catheters. The diagnostic capacity of electrocardiographic imaging (ECGi) as a non-invasive tool to confirm bidirectional CTI block may simplify the procedure but i...
Background
Fibrosis is a hallmark of atrial fibrillation (AF) arrhythmogenic substrate, and the extent of atrial fibrosis, as determined by late gadolinium enhancement (LGE)-MRI, predicts AF recurrence after ablation. However, ablation fundamentally alters the individual composition of fibrotic tissue, and inhomogeneous ablation lesions may constit...
Background
A partial delineation of targets for ventricular tachycardia (VT) ablation may contribute to a suboptimal success rate. Abnormal electrograms (EGMs) with low-voltage near-field components might be concealed within high-amplitude far-field signals. Our hypothesis posited that acquiring functional mapping after double ventricular extrastim...
Background
Left bundle branch pacing (LBBP) is considered an alternative to cardiac resynchronization therapy (CRT). However, LBBP is not suitable for all heart failure patients.
Purpose
The aim of our study was to identify predictors of unsuccessful LBBP implantation in CRT candidates.
Methods
A cohort of consecutive patients with indications fo...
Background
Left bundle branch pacing (LBBP) may prevent right ventricular (RV) pacing-induced dyssynchrony (DYS). Nowadays, real-time assessment of DYS correction is indirectly measured with QRS narrowing. Non-invasive ECG imaging (ECGI) technique may provide an evaluation of electrical resynchronization based on quantitative assessment of ventricu...
Background
The ablation of ventricular tachycardias (VT) presents significant challenges due to the complex and time-consuming approaches involved in identifying arrhythmogenic regions. Combining non-invasive electrocardiographic imaging (ECGI) with endocardial mapping could potentially enhance the efficacy of interventions.
Objective
To evaluate...
Background
The decision to perform a high-risk endo-epicardial approach for VT ablation is controversial and mostly based on previous endocardial failure or very specific etiologies. We systematically evaluated the 3D distribution of the automatically-detected conducting channels by CMR with the aim of assessing whether tissue thickness in those ar...
Aims
Longitudinal dyssynchrony correction and ‘strain’ improvement by comparable cardiac resynchronization therapy (CRT) techniques is unreported. Our purpose was to compare echocardiographic dyssynchrony correction and ‘strain’ improvement by conduction system pacing (CSP) vs. biventricular pacing (BiVP) as a marker of contractility improvement du...
Aims
Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a st...
Aims
Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial...
TRPV4 channels, which respond to mechanical activation by permeating Ca2+ into the cell, may play a pivotal role in cardiac remodeling during cardiac overload. Our study aimed to investigate TRPV4 involvement in pathological and physiological remodeling through Ca2+-dependent signaling. TRPV4 expression was assessed in heart failure (HF) models, in...
Background
Noninvasive myocardial scar characterization with cardiac magnetic resonance (CMR) has been shown to accurately identify conduction channels and can be an important aid for ventricular tachycardia (VT) ablation. A new mapping method based on targeting deceleration zones (DZs) has become one of the most commonly used strategies for VT abl...
Background and Objectives: Left atrial (LA) remodelling and dilatation predicts atrial fibrillation (AF) recurrences after catheter ablation. However, whether right atrial (RA) remodelling and dilatation predicts AF recurrences after ablation has not been fully evaluated. Materials and Methods: This is an observational study of 85 consecutive patie...
Background
Atrial cardiomyopathy (atCM) is an emerging prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy, and capillary density are hallmarks of atCM. The contribution of etiological factors and atrial fibrillation (AF) to the development of differential atCM phenotypes has not been quantified. This study a...
Introduction
The U-shaped relationship between exercise load and atrial fibrillation (AF) risk, where moderate exercise is protective but strenuous training increases the risk of AF, is currently well accepted (1, 2). Clinical and experimental data suggest that atrial fibrosis and parasympathetic tone (PT) enhancement may underlie the excess risk o...
Background
Durable pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Technological advances like ablation index-guided RF ablation and second generation cryoballoon have substantially improved lesion durability, but PV reconnection remains a key determinant of AF recurrences.
Purpose
We aimed to compare RF abl...
Aims
Conducting channels (CCs) detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related to ventricular tachycardia (VT). The aim of this work was to study the ability of postablation LGE-CMR to evaluate ablation lesions.
Methods
This is a prospective study of consecutive patients referred for a scar-related VT ablat...
Early detection of atrial fibrillation (AF) enables initiation of anticoagulation and early rhythm control therapy to reduce stroke, cardiovascular death, and heart failure. In a cross-sectional, observational study, we aimed to identify a combination of circulating biomolecules reflecting different biological processes to detect prevalent AF in pa...
Aims
Recurrence of arrhythmia after catheter ablation of atrial fibrillation (AF) in the form of atypical atrial flutter (AFL) is common among a significant number of patients and often requires redo ablation with limited success rates. Identifying patients at high risk of AFL after AF ablation could aid in patient selection and personalized ablati...
Although the benefits of moderate exercise in patients at high cardiovascular risk are well established, the effects of strenuous exercise remain unknown. We aimed to study the impact of strenuous exercise in a very high cardiovascular risk model. Nephrectomized aged Zucker obese rats were trained at a moderate (MOD) or high (INT) intensity or were...
Aims:
To define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking.
Methods and res...
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): MPL received the Catalan Society of Cardiology Research Grant in 2019 and 2020 (Catalonia, Spain); the Josep Font Grant (2019-2022) from Hospital Clínic Barcelona (Catalonia, Spain).
Background
Left bundle branch pacing (LBBP) has emerged as an alterna...
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Catalan Society of Cardiology; Asociación del Ritmo Cardiaco (Spanish Society of Cardiology).
Background
Correction of dyssynchrony measured with echo strain, in conduction system pacing (CSP) vs biventricular pacing (BIVP) has not been reported.
Obje...
Funding Acknowledgements
Type of funding sources: None.
Background
A new functional mapping strategy based on targeting deceleration zones (DZs) has become one of the most commonly used strategies within the armamentarium of substrate-based ablation methods for ventricular tachycardia (VT) in patients with structural heart disease. The classic con...
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac magnetic resonance has demonstrated to accurately identify voltage conduction channels and it is nowadays an important tool to analyze the arrhythmic substrate, to predict ventricular tachycardia (VT) events and to aid VT ablation. The characteristics of CMR channels (CMR-C...
Funding Acknowledgements
Type of funding sources: None.
Introduction
Abnormalities of cardiac activation and conduction velocity (CV) are known pro-arrhythmogenic factors. Electrocardiographic imaging (ECGI) is presented as a non-invasive tool for arrhythmogenic substrate analysis. However, electrocardiographic features such propagation activation...
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly
Background
We recently demonstrated that in human atria, endomysial fibrosis causes conduction disturbances during atrial fibrillation (A...
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly
Background
Atrial cardiomyopathy is emerging as independent prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocy...
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by the European Union NextGenerationEU/PRTR.
Background
– The non-invasive characterization of complex atrial tachyarrhythmias, including atrial flutter (AFL) and focal atrial tachycardia (AT) is challenging. Conventional...
Funding Acknowledgements
Type of funding sources: None.
Background
Radiofrequency ablation (RF) is a well-established treatment for of premature ventricular complexes (PVCs) It is not uncommon to perform radiofrequency ablation of PVCs arising from epicardial/intramural localization, in particular those arising from the LV summit and aortic sinuse...
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union's Horizon Research and Innovation Programme under the Marie-Sklodowska Curie Grant Agreement No. 860974
Background
Recurrence rates after atrial fibrillation (AF) ablation are still unsat...
Purpose
The atrial fibrillation (AF) substrate can be characterized by left atrium (LA) fibrosis assessed by delayed-enhancement cardiac magnetic resonance (CMR), potentially guiding therapeutic strategies and predicting outcomes in patients with AF undergoing the catheter ablation (CA) procedure. Two-dimensional speckle tracking echocardiography (...
Background: Atrial cardiomyopathy (AtCM) is emerging as an independent prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy, and capillary density are histological hallmarks of atCM. The contribution of etiological factors and atrial fibrillation (AF) to the development of differential atCM phenotypes has not...
Background:
A new functional mapping strategy based on targeting deceleration zones (DZs) has become one of the most commonly used strategies within the armamentarium of substrate-based ablation methods for ventricular tachycardia (VT) in patients with structural heart disease. The classic conduction channels detected by voltage mapping can be acc...
Aims
Heterogeneous tissue channels (HTCs) detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related to ventricular arrhythmias, but there are few published data about their arrhythmogenic characteristics.
Methods and results
We enrolled 34 consecutive patients with ischaemic and non-ischaemic cardiomyopathy who were...
Aims
With recurrence rates up to 50% after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF), predictive tools to improve patient selection are needed. Patient selection based on left atrial late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been proposed previously (UTAH-classification). However, this...
Most cells release extracellular vesicles (EVs) that can be detected circulating in blood. We and others have shown that the microRNA contents of these vesicles induce transcriptomic changes in acceptor cells, contributing to the adjustment of metabolic homeostasis in response to environmental demands. Here, we explore the potential for modulating...
Objective
Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known.
Design
The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in older adults case finding study (Smart in...
An increased burden of premature atrial contractions (PACs) has long been considered a benign phenomenon. However, strong evidence of their involvement in the occurrence of atrial fibrillation (AF), ischemic stroke, and excess mortality suggests the need for management. The central question to be resolved is whether increased ectopic atrial rhythm...
The consequences of extremely intense long‐term exercise for brain health remain unknown. We studied the effects of strenuous exercise on brain structure and function, its dose‒response relationship, and mechanisms in a rat model of endurance training. Five‐week‐old male Wistar rats were assigned to moderate (MOD) or intense (INT) exercise or a sed...
Background
Left atrial structural remodeling contributes to the arrhythmogenic substrate of atrial fibrillation (AF), but the role of the right atrium (RA) remains unknown. Our aims were to comprehensively characterize right atrial structural remodeling in AF and identify right atrial parameters predicting recurrences after ablation.
Methods and R...
Background
Electrical reconnection of pulmonary veins (PV) is considered an important determinant of recurrent atrial fibrillation (AF) after PV isolation (PVI). However, it requires an invasive repeat procedure to assess durability of PVI. Against this background, in most centers clinically relevant AF recurrences almost automatically trigger repe...
Background
Recent MRI-based studies have raised great concern about frequent cardiac involvement even in mild or asymptomatic COVID-19. However, while signs of myocardial injury were found in large proportions of patients after COVID-19, all studies published to date lack baseline imaging and are therefore unable to discriminate between pre-existin...
Introduction
Compelling evidence supports that regular moderate exercise has a positive impact on cardiovascular disease (CVD) incidence and prognosis [1]. Nevertheless, emerging clinician and experimental data in healthy individuals suggests that long-term, high-intensity endurance exercise might increase vascular stiffness and enhance coronary ca...
Resumen
Introducción y objetivos
La resonancia magnética cardiaca con realce tardío de gadolinio (RMC-RTG) permite la detección no invasiva de la fibrosis auricular izquierda en pacientes con fibrilación auricular (FA). Sin embargo, se desconoce si se puede utilizar la misma metodología en la aurícula derecha (AD). Nuestro objetivo fue definir un...
Background
Conduction system pacing (CSP) has emerged as an alternative to biventricular pacing (BiVP). Randomized studies comparing both therapies are scarce and do not include left bundle branch pacing.
Objectives
This study aims to compare ventricular resynchronization achieved by CSP vs BiVP in patients with cardiac resynchronization therapy i...