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Publications
Publications (114)
Background
Recent studies suggest that slow conduction velocity (CV) areas are associated with the perpetuation of AF and its recurrence after ablation. Electrocardiographic imaging (ECGI) provides beat-to-beat reconstruction of atrial electrical propagation non-invasively from body surface signals, offering real-time insights.
Objective
This stud...
Background
Precise, non-invasive localization of Premature Ventricular Contractions (PVCs) is challenging with current 12-lead ECG methods, which often lack accuracy. Catheter ablation, while effective, requires lengthy procedures to identify ectopic origins, raising costs and patient risk. Imageless Electrocardiographic Imaging (ECGI) could overco...
Background
Distinguishing atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT) presents a diagnostic challenge, with clinical and electrocardiogram (ECG) features playing a crucial role in differential diagnosis.
Purpose
The aim of this study was to devise and validate a predictive alg...
Background
It has been suggested that antiarrhythmic drugs (AAD) are less effective and safe in slow ventricular tachycardia (VT) due to their effect on conduction velocity, which could stabilize reentry. Conversely, catheter ablation aims to disrupt the VT circuit. Because of the distinct mechanisms of action of AAD and catheter ablation on the VT...
Atrial fibrillation (AF), the most common arrhythmia, is associated with increased morbidity, mortality, and healthcare costs. Evidence indicates that rhythm control offers superior cardiovascular outcomes compared to rate control, especially when initiated early after the diagnosis of AF. Catheter ablation remains the single best therapy for AF; h...
Background
The mechanisms responsible for atrial fibrillation (AF) are not yet fully understood and treatment strategies remain suboptimal. Electrocardiographic imaging (ECGi) could provide new insights into the arrhythmogenic substrate’s characterization.
Objective
To validate a novel imageless ECGi technique against electroanatomical mapping (EA...
Background
The acquisition of electroanatomical (EA) maps in clinical electrophysiology procedures typically depends on locating intracardiac mapping catheters through magnetic triangulation with external patches placed on the patient's skin. However, this configuration is hampered by shifts in the reference system if the patient moves or if the se...
Objective
The presence of cannon A waves, the so called “frog sign”, has traditionally been considered diagnostic of atrioventricular nodal re‐entrant tachycardia (AVNRT). Nevertheless, it has never been systematically evaluated. The aim of this study is to assess the independent diagnostic utility of cannon A waves in the differential diagnosis of...
Introduction and objectives:
There is limited evidence regarding the use of subcutaneous implantable cardioverter-defibrillators (S-ICD) in pediatric patients. The aim of this study was to determine the incidence of complications in these patients at our center, according to the type of ICD and patient size.
Methods:
We included all patients age...
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia managed in emergency departments, and the already high prevalence of this arrhythmia is increasing in Spain. This serious condition associated with increased mortality and morbidity has a negative impact on patient quality of life and the functioning of the health care system. The...
Background and aims
Bayesian analyses can provide additional insights into the results of clinical trials, aiding in the decision-making process. We analyzed the SURVIVE-VT trial using Bayesian survival models.
Methods
The SURVIVE-VT trial randomized patients with ischemic cardiomyopathy and monomorphic ventricular tachycardia (VT) to catheter abl...
Background
Life expectancies for patients with congenital heart disease (CHD) have dramatically increased in recent years, accompanied by a rise in atrial fibrillation (AF) prevalence. Data on AF ablation strategy and outcomes are limited in CHD.
Purpose
We aimed to investigate the characteristics of CHD patients presenting for AF ablation and the...
Introduction:
Ablation of atrial fibrillation (AF) is usually not considered in patients with rheumatic mitral stenosis (RMS). We analyzed the results of a combined procedure of AF ablation and percutaneous balloon mitral commissurotomy (PBMC).
Methods:
We prospectively included 22 patients with severe RMS to undergo a combined PBMC+AF ablation...
Background
The differential diagnosis between orthodromic atrioventricular reentry tachycardia (AVRT) and atypical AV nodal reentrant tachycardia (aAVNRT) is sometimes challenging. We hypothesize that aAVNRTs have more variability in the retrograde conduction time at tachycardia onset than AVRTs.Methods
We aimed to assess the variability in retrogr...
Background
Data on atrial fibrillation (AF) ablation and outcomes are limited in patients with congenital heart disease (CHD). We aimed to investigate the characteristics of patients with CHD presenting for AF ablation and their outcomes.
Methods
A multicenter, retrospective analysis was performed of patients with CHD undergoing AF ablation betwee...
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular ejection fraction (LVEF) is at present the main parameter used to guide the implantation of cardioverter-defibrillators (ICD) in patients with ischaemic cardiomyopathy. However, LVEF alone is a poor predictor of ventricular arrhythmias (VA) and sudden cardiac death...
Background
Identifying driving and initiating areas in persistent atrial fibrillation (AF) might contribute to better understanding AF and improve the ablation treatment. However, their correct identification still requires visual inspection or heavy signal processing algorithms that sometimes distort the electrograms (EGMs) information. In this li...
Background
In patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), catheter ablation and antiarrhythmic drugs (AADs) reduce ICD shocks, but the most effective approach remains uncertain.
Objectives
This trial compares the efficacy and safety of catheter ablation vs AAD as first-line therapy in ICD patients wit...
Background: Structural and post-ablation gender differences are reported in atrial fibrillation (AF). We analyzed the gender differences in structural remodeling and AF mechanisms in patients with persistent/long-lasting AF who underwent wide area circumferential pulmonary vein isolation (WACPVI).
Materials and Methods: Ultra-high-density mapping...
Resumen Introducción y objetivos: El tratamiento de la fibrilación auricular (FA) sigue siendo subóptimo, con escaso éxito en los procedimientos de ablación de las venas pulmonares (AVP) en pacientes con FA persistente. Los mecanismos de mantenimiento de la FA siguen siendo objeto de debate. Los eventos de actividad rotacional (AR), rotores, pueden...
Resumen Introducción y objetivos: El «signo de la rana», definido como la presencia de latidos prominentes, rápidos y regulares a nivel de la vena yugular interna, se ha asociado tradicionalmente con la taquicardia intranodular (TRIN). El presente estudio pretende validar su utilidad en el diagnóstico diferencial de los dos grupos principales taqui...
Background/Introduction
Several ECG signs have been proposed to discern the focal origin of ventricular outflow tract arrhythmias with a transition ≥V3. Their independent predictive value is unclear.
Purpose
The aim of the study is to establish a predictive model of independent ECG parameters to obtain an acute success in right-sided catheter abla...
Introduction
Treatment of atrial fibrillation (AF) remains sub-optimal, with low success in pulmonary vein isolation (PVI) ablation procedures in long-standing-persistent AF patients. The maintenance mechanisms of AF are still under debate. Rotational activity (RA) events, also known as rotors, may play a role in perpetuating AF. The characterisati...
Objective:
The role of age in clinical characteristics and catheter ablation outcomes of atrioventricular nodal re-entrant tachycardia (AVNRT) or orthodromic atrioventricular re-entrant tachycardia (AVRT) has been assessed in retrospective studies categorising age by arbitrary cut-offs, but contemporary analyses of age-related trends are lacking....
Simple Summary
Atrial fibrillation is a type of arrhythmia that occurs when the electrical activity of the heart in the atrium is not coordinated, and its consequences can be lethal. The driving source that initiates this chaotic activity can be located anywhere in the atrium, but most frequently appears in certain areas such as the pulmonary veins...
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Supported in part by the Instituto de Salud Carlos III (PI16/01123, DTS16/0160, PI17/010559, PI17/01106 and PI20/01618); Spanish Ministry of Science and Innovation (CIRBER CV); and cofound by FEDER: Fondo Europeo de Desarrollo Regional. EITHealth...
The increasing prevalence of AF in a growing population of adults with congenital heart disease (CHD) poses new challenges to clinicians involved in the management of these patients. Distinctive underlying anatomies, unique physiological aspects, a high diversity of corrective surgeries and associated comorbidities can complicate clinical decision-...
Introduction and objectives
The development of complete AV block and the need for pacemaker implantation (PM) is the most frequent complication after Transaortic valve replacement (TAVR). In other PM clinical contexts, a higher percentage of ventricular stimulation has been associated with worse prognosis. The objective was to study the existence o...
Introduction
Chronic Atrial stretch is an important determinant for atrial fibrillation (AF) in patients with rheumatic mitral stenosis (RMS).
Purpose
We analysed the effect of balloon mitral commissurotomy (BMC) plus atrial fibrillation ablation on the long-term occurrence of AF as compared to isolated BMC.
Methods
We prospectively included 20 p...
Introducción y objetivos:
La tormenta eléctrica (TE) se caracteriza por episodios repetidos de taquicardia ventricular o fibrilación ventricular relacionados con mal pronóstico a corto y largo plazos. El objetivo fue evaluar la prevalencia, resultados y supervivencia de los pacientes sometidos a tratamiento intervencionista por TE en un centro de r...
Objectives
To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual’s characteristics, to guide primary prevention strat...
A 32‐year‐old woman without relevant clinical antecedents presented with a crisis of paroxysmal tachycardic palpitations. A 12‐lead electrocardiogram (ECG) showed a regular tachycardia with a QRS duration of 120 ms, a right bundle branch block pattern and a frontal plane QRS axis of −90° (Figure 1. Top).
This article is protected by copyright. All...
Introduction and objectives
To assess the structure of health care delivery and the clinical characteristics of adults with congenital heart disease (ACHD) attending specialized centers in Spain.
Methods
A survey was conducted among 32 Spanish centers in 2014. The centers were classified into 2 levels based on their resources. In 2017, a clinical...
Resumen
Introducción y objetivos
Analizar la estructura asistencial y las características clínicas de las cardiopatías congénitas del adulto en España.
Métodos
En 2014 se realizó una encuesta entre 32 centros que se clasificaron como nivel 1 o 2 en función de su estructura asistencial. En 2017 se realizó un registro clínico de todos los pacientes...
Introduction and objectives
Atrial tachycardia (AT) is a major late complication in congenital heart disease (CHD) after surgery. These arrhythmias arise between areas of anatomical barriers or in fibrotic tissue/scars. In our study we examined the clinical predictors of AT.
Methods
A retrospective study of cases and controls in adult patients wit...
We describe two consecutive adult males with incessant dual AV nodal non‐re‐entrant tachycardia and associated severe cardiomyopathy. After invasive diagnosis, this is the first published report showing the successful outcome of this rare tachycardia with effective cryoablation. Cryothermal lesions in the roof of the proximal coronary sinus and rig...
Background
Risk models for primary prevention strategies in adult congenital heart disease (ACHD) must incorporate the heterogeneous risk for sudden cardiac death (SCD) and life-threatening ventricular arrhythmias (LTVA) as stratified by underlying lesion.
Objectives
To determine lesion-specific risk for SCD and LTVA in ACHD.
Methods
We analyzed...
Objectives:
The purpose of this study was to assess the safety and efficacy of cryoablation for perinodal substrates in patients with congenital heart disease (CHD) and a displaced atrioventricular (AV) conduction system or an AV conduction system location that was difficult to predict.
Background:
Catheter ablation for perinodal arrhythmias in...
Introduction and objectives:
Catheter ablation has become the treatment of choice in an increasing number of arrhythmias in children and adolescents. There is still limited evidence of its use at a national level in Spain. The aim was to describe the characteristics and results of a modern monocentric series form a referral tertiary care centre....
Aims
Tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal re-entry (AVNRT) require careful electrophysiologic evaluation for differential diagnosis. We aim to describe the differential behaviour of local ventriculo-atrial (VA) intervals which predicts the tachycardia mechanism.
Methods and results
The local VA...
Resumen
Introducción y objetivos
La ablación con catéter es un método para tratar arritmias en población pediátrica indicada en un creciente número de casos. Hay poca evidencia sobre la experiencia en estos procedimientos en España. El objetivo es describir las características y los resultados de una serie contemporánea de un hospital terciario de...
Aims
Radiofrequency ablation (RFA) of septal accessory pathways (APs) is associated with a significant rate of first procedure failures and complications. Cryoablation is an alternative energy source but there are no studies comparing both ablation techniques. We aimed to systematically review the literature and compare the efficacy and safety of c...
Background— Atrial tachycardias (AT) are a significant source of morbidity in adults with congenital heart disease (CHD). This study evaluates the incidence and clinical predictors of AT in a cohort of patients with CHD.
Methods and Results — We included 3,311 adults (median age at entry 22.6 years, 50.6% males) with CHD (49% simple, 39% moderate a...
Background
The impact of gender and aging on relative survival and causes of death in adults with congenital heart disease (ACHD) are not well known.
Methods
Single center observational longitudinal study of 3311 consecutive ACHD (50.5% males) followed up to 25 years. Patients were divided by the age at last follow-up into three groups: <40, 40–65...
Sudden death of presumed arrhythmic etiology is a leading cause of mortality in adults with congenital heart disease. Anticipated benefits of the implantable cardioverter-defibrillator (ICD) must be weighed against high complication rates. Without robust evidence from randomized trials, caregivers face difficult decisions in selecting appropriate c...
Aims:
To examine factors related to excess mortality in a cohort of adults with congenital heart disease (CHD).
Methods and results:
We conducted a survival analysis using prospective data of 3311 adults with CHD [50.5% males, median age at entry 22.5 years (IQR 18-39), median follow-up time 10.5 years (IQR: 4.4-18)]. Survival status of each pat...
A 75-year-old man was admitted due to an electrical storm with appropriate recurrent implantable cardioverter defibrillator (ICD) discharges. The patient had had an extensive anterolateral myocardial infarction with associated severe left ventricular dysfunction 10 years earlier (left ventricular ejection fraction, 25%), and an ICD was placed 9 yea...
Aims
Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we c...
Sudden death of presumed arrhythmic etiology is the leading cause of mortality in adults with tetralogy of Fallot.
To assess the impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot.
Adults with repaired tetralogy of Fallot were randomized in a 2:1 ratio to an open-label trial of standard care versus 12 weeks of superv...
Background:
Shone complex consists of a constellation of left-sided, usually obstructive, cardiac lesions, including supravalvar mitral ring, parachute mitral valve, subaortic stenosis, and aortic coarctation. Incomplete Shone complex consists of a mitral valve anomaly associated with lesions involving the subaortic region, aortic valve, or thorac...
Introduction: Post myocardial infarction (MI) patients are at risk of scar related ventricular tachycardia (VT).
Hypothesis: Stem cell therapy reduces post-MI scar size, potentially leading to a reduction in the risk of ventricular arrhythmias (VA).
Methods: A post-MI scar model of VT was created by transient occlusion of the mid left anterior desc...
-Differential diagnosis between tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal reentry (AVNRT) can be challenging. We hypothesized that an immediate versus delayed pace-related advancement of the atrial electrogram, once the local septal parahisian ventricular electrogram (SVE) has been advanced, may help...
-Ventricular fibrillation (VF) has been proposed to be maintained by localized high-frequency sources. We tested whether spectral-phase analysis of the precordial ECG enabled identification of periodic activation patterns generated by such sources.
-Precordial ECGs were recorded from 15 Ischemic Cardiomyopathy (IC) and 15 Brugada Syndrome (BrS type...
Objectives:
The aim of this study was to determine if noninvasive measurement of scar by contrast-enhanced magnetic resonance imaging (MRI)-based signal intensity (SI) mapping predicts ventricular tachycardia (VT) recurrence after endocardial ablation.
Background:
Scar extension on voltage mapping predicts VT recurrence after ablation procedures...
Current indications for implantable cardioverter defibrillators (ICDs) in patients with channelopathies and cardiomyopathies of non-ischemic origin are mainly based on non-randomized evidence. In patients with nonischemic dilated cardiomyopathy (NIDCM) there is a tendency towards a beneficial effect on total mortality of ICD therapy in patients wit...
Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators.MethodsA retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of in...
Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators.MethodsA retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of in...
Medical and surgical breakthroughs in the care of children born with heart defects have generated a growing population of adult survivors and spawned a new subspecialty of cardiology: adult congenital heart disease. The prevalence of adult congenital heart disease is escalating at a rampant rate, outpacing the relatively static prevalence of pediat...
Endo-epicardial substrate ablation reduces ventricular tachycardia (VT) recurrences, however not all patients in whom the epicardium is explored have VT substrate. Contrast-enhanced magnetic resonance imaging (ceMRI) is used to characterize VT substrate after myocardial infarction.
To determine if epicardial VT substrate can be identified noninvasi...
Background
Endo-epicardial substrate ablation reduces ventricular tachycardia (VT) recurrences, however not all patients in whom the epicardium is explored have VT substrate. Contrast-enhanced magnetic resonance imaging (ceMRI) is used to characterize VT substrate after myocardial infarction.
Objective
To determine if epicardial VT substrate can b...
Radiofrequency ablation (RFCA) of septal accessory pathway (SAPs) locations is associated with a significant rate of first procedure failures and complications. Several single-center studies suggest that cryothermal ablation might be a safer alternative. The purpose of our study was to systematically review the available literature, including the n...
