Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert.

Introduction And Objectives: The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts.

Methods: The algorithm was activated in HF patients at 19 Spanish centers.

An annotation-independent algorithm based on electrogram characteristics to guide the identification of ventricular tachycardia isthmuses in patients with structural heart disease.

Background: Criteria such as electrograms voltage or late potentials have been largely utilized in the past to help identify areas of substrate maps that are within the ventricular tachycardia (VT) isthmus; yet their specificity and positive predictive value are quite low. The Lumipoint fractionation tool of the Rhythmia system illuminates regions with fractionated electrograms irrespective of their timing and annotation. We aimed to ascertain whether the use of this tool can rapidly identify areas within VT isthmuses from substrate maps.

Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC study.

Introduction And Objectives: Transthyretin cardiac amyloidosis (ATTR-CA) patients often have atrial fibrillation and increased bleeding/thrombogenic risks. We aimed to evaluate outcomes of left atrial appendage closure (LAAC) compared with patients without a known diagnosis of CA.

Methods: Comparison at long-term of patients diagnosed with ATTR-CA who underwent LAAC between 2009 and 2020 and those without a known diagnosis of CA.

A Fibrosis Biomarker Early Predicts Cardiotoxicity Due to Anthracycline-Based Breast Cancer Chemotherapy.

Anthracycline-based cancer chemotherapy (ACC) causes myocardial fibrosis, a lesion contributing to left ventricular dysfunction (LVD). We investigated whether the procollagen-derived type-I C-terminal-propeptide (PICP): (1) associates with subclinical LVD (sLVD) at 3-months after ACC (3m-post-ACC); (2) predicts cardiotoxicity 1-year after ACC (12m-post-ACC) in breast cancer patients (BC-patients); and (3) associates with LVD in ACC-induced heart failure patients (ACC-HF-patients). Echocardiography, serum PICP and biomarkers of cardiomyocyte damage were assessed in two independent cohorts of BC-patients: CUN (n = 87) at baseline, post-ACC, and 3m and 12m (n = 65)-post-ACC; and HULAFE (n = 70) at baseline, 3m and 12m-post-ACC.

Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation.

Objectives: This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures.

Background: A radiofrequency catheter measuring LI has been shown to be effective for performing PVI in patients with paroxysmal atrial fibrillation. Previous analysis has demonstrated LI drop to be predictive of pulmonary vein segment conduction block during an atrial fibrillation ablation procedure.

Targeted ablation of residual pulmonary vein potentials in atrial fibrillation ablation through ultra-high-density mapping: Insights from the CHARISMA registry.

Introduction: Low-voltage activity beyond pulmonary veins (PVs) may contribute to the failure of ablation of atrial fibrillation (AF) in the long term. We aimed to assess the presence of gaps (PVG) and residual potential (residual antral potential [RAP]) within the antral scar by means of an ultra-high-density mapping (UHDM) system.

Methods: We studied consecutive patients from the CHARISMA registry who were undergoing AF ablation and had complete characterization of residual PV antral activity.

Improved procedural workflow for catheter ablation of paroxysmal AF with high-density mapping system and advanced technology: Rationale and study design of a multicenter international study.

Background: The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions.

Remote heart failure management using the HeartLogic algorithm. RE-HEART registry.

Introduction And Objectives: 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.

Antithrombotic therapy and clinical outcomes at 1 year in the Spanish cohort of the EORP-AF Long-term General Registry.

Background: Atrial fibrillation (AF) increases the risk of thromboembolism. We investigate the efficacy and safety of oral anticoagulation (OAC) therapy and explored the number needed to treat for net effect (NNTnet) of OAC in the Spanish cohort of the EURObservational Research Programme-AF (EORP-AF) Long-term General Registry.

Methods: The EORP-AF General Registry is a prospective, multicentre registry conducted in ESC countries, including consecutive AF patients.

Characterization of atrial fibrillation in real-world patients: testing the 4S-AF scheme in the Spanish and French cohorts of the EORP-AF Long-Term General Registry.

Aims: The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] has recently been described as a novel approach to in-depth characterization of AF. We aim to determine if the 4S-AF scheme would be useful for AF characterization and provides prognostic information in real-world AF patients.

Methods And Results: The Spanish and French cohorts of the EORP-AF Long-Term General Registry were included.

Local catheter impedance drop during pulmonary vein isolation predicts acute conduction block in patients with paroxysmal atrial fibrillation: initial results of the LOCALIZE clinical trial.

Aims: Radiofrequency ablation creates irreversible cardiac damage through resistive heating and this temperature change results in a generator impedance drop. Evaluation of a novel local impedance (LI) technology measured exclusively at the tip of the ablation catheter found that larger LI drops were indicative of more effective lesion formation. We aimed to evaluate whether LI drop is associated with conduction block in patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI).

Economic evaluation of an ultra-high density mapping system compared to non-ultra-high density mapping systems for radiofrequency catheter ablation procedures in patients with atrial fibrillation.

Purpose: Advanced non-fluoroscopic mapping systems for radiofrequency ablation (RFA) have shown to be an effective treatment of atrial fibrillation. This study analyzes the resource usage and subsequent costs associated with the implementation of an ultra-high density mapping system (UHDMS) compared to non-ultra-high density mapping systems (NUHDMS).

Methods: This retrospective observational study included 120 patients (18 years or older) with paroxysmal or persistent atrial fibrillation who underwent RFA for de novo pulmonary vein isolation guided either by an UHDMS (n=63) or NUHDMS (n=57) for their index procedure.

Real-world outcomes in cardiac resynchronization therapy patients: design and baseline demographics of the SMART- Registry.

Aims: The SMART (Strategic MAnagement to optimize response to cardiac Resynchronization Therapy) Registry was designed to assess real-world outcomes for patients receiving a cardiac resynchronization therapy defibrillator (CRT-D) and to better understand which programming and optimization techniques are used and how effective they are.

Methods And Results: The SMART Registry is a global, multicentre, prospective, observational, post-market CRT-D registry with a planned enrolment of 2000 subjects from a maximum of 200 sites in Europe, North America, and Asia-Pacific region. Each subject will be followed up for a minimum of 12 months.

Impact of anticoagulation strategy after left atrial appendage occlusion in patients requiring direct current cardioversion.

Introduction: Current guidelines recommend adequate anticoagulation for at least 3 weeks pre- and 4 weeks post-direct current cardioversion (DCCV) to reduce thrombo-embolic risk in patients with atrial fibrillation (AF) lasting greater than 48 h. No specific recommendations exist for DCCV in patients that have undergone left atrial appendage occlusion (LAAO), many of whom are ineligible for anticoagulation. This study aims to observe the efficacy and safety of DCCV post-LAAO in everyday clinical practice.

Long-term prognosis of women with Brugada syndrome and electrophysiological study.

Background: A male predominance in Brugada syndrome (BrS) has been widely reported, but scarce information on female patients with BrS is available.

Objective: The purpose of this study was to investigate the clinical characteristics and long-term prognosis of women with BrS.

Methods: A multicenter retrospective study of patients diagnosed with BrS and previous electrophysiological study (EPS) was performed.

A Remote Nutritional Intervention to Change the Dietary Habits of Patients Undergoing Ablation of Atrial Fibrillation: Randomized Controlled Trial.

Background: The Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored.

Objective: This study aims to assess the effectiveness of a remotely provided Mediterranean diet-based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF).

Remote operation for non-fluoroscopic navigation of complex tachycardias.

Purpose: Remote system operation technology was developed and applied to a non-fluoroscopic navigation system in order to overcome Spanish mobility restrictions caused by Covid-19 pandemic infection and subsequently used routinely.

Methods And Results: Fifty consecutive complex ablations were performed in different days using this technology. All these procedures were assisted remotely with the only intervention of a field clinical specialist located at his home who took full control of the navigation system (keyboard, mouse, and screen) and had bidirectional real-time audio/video feedback with the operating physician.

Is the mid-diastolic isthmus always the best ablation target for re-entrant atrial tachycardias?

Aims: We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry.

Methods: A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs.