Primary results of the Spanish Cryoballoon Ablation Registry: acute and long-term outcomes of the RECABA study

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 < 0.001). Left atrium enlargement, female sex, non-PAF, and early recurrence were independent predictors of AF recurrence (p < 0.05). RECABA provides detailed insight into current dosing practices and demonstrates cryoablation is safe and effective in real-world use

Symbolic Recurrence Analysis of RR Interval to Detect Atrial Fibrillation

Atrial fibrillation (AF) is a sustained cardiac arrhythmia associated with stroke, heart failure, and related health conditions. Though easily diagnosed upon presentation in a clinical setting, the transient and/or intermittent emergence of AF episodes present diagnostic and clinical monitoring challenges that would ideally be met with automated ambulatory monitoring and detection. Current approaches to address these needs, commonly available both in smartphone applications and dedicated technologies, combine electrocardiogram (ECG) sensors with predictive algorithms to detect AF. These methods typically require extensive preprocessing, preliminary signal analysis, and the integration of a wide and complex array of features for the detection of AF events, and are consequently vulnerable to over-fitting. In this paper, we introduce the application of symbolic recurrence quantification analysis (SRQA) for the study of ECG signals and detection of AF events, which requires minimal pre-processing and allows the construction of highly accurate predictive algorithms from relatively few features. In addition, this approach is robust against commonly-encountered signal processing challenges that are expected in ambulatory monitoring contexts, including noisy and non-stationary data. We demonstrate the application of this method to yield a highly accurate predictive algorithm, which at optimal threshold values is 97.9% sensitive, 97.6% specific, and 97.7% accurate in classifying AF signals. To confirm the robust generalizability of this approach, we further evaluated its performance in the implementation of a 10-fold cross-validation paradigm, yielding 97.4% accuracy. In sum, these findings emphasize the robust utility of SRQA for the analysis of ECG signals and detection of AF. To the best of our knowledge, the proposed model is the first to incorporate symbolic analysis for AF beat detection.This research was funded by projects AIM, ref. TEC2016-76465-C2-1-R (AEI/FEDER, UE), e-DIVITA, ref.20509/PDC/18 (Proof of Concept, 2018) and it is the result of the activity performed under the program Groups of Excellence of the Region of Murcia (Spain), the Fundación Séneca, Science and Technology Agency of the region of Murcia project under grant 19884/GERM/15 and ATENTO, ref. 20889/PI/18. All remaining errors are our responsibility

Tres semanas de docencia virtual en la Universidad de Murcia (I): Experiencias en Medicina y Odontología

Presentamos un resumen de las actividades que algunos de los profesores de la Facultad de Medicina de Murcia han llevado a cabo durante las 3 semanas previas a las vacaciones de primavera. Durante este tiempo, debido a la pandemia provocada por la COVID-19, la docencia presencial tuvo que ser sustituída por actividades en línea o virtuales, a causa de la implantación del estado de alarma en España que motivó el cierre completo de las Universidades desde el 13 de marzo de 2020. Las experiencias son de Traumatología, Matemáticas, Medicina Legal, Medicina del Sistema Cardiovascular, Periodoncia y Odontología Preventiva y Comunitaria

Time to –30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation

Background: Freezing rate of second-generation cryoballoon (CB) is a biophysical parameter that could assist pulmonary vein isolation. The aim of this study is to assess freezing rate (time to reach –30°C ([TT-30C]) as an early predictor of acute pulmonary vein isolation using the CB. Methods: Biophysical data from CB freeze applications within a multicenter, nation-wide CB ablation registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein isolation with time to isolation in under 60 s (SA-TTI&lt;60) as achieving durable vein isolation in under 60 s. Logistic regressions were performed and predictive models were built for the data set. Results: 12,488 CB applications from 1,733 atrial fibrillation (AF) ablation procedures were included within 27 centers from a Spanish CB AF ablation registry. SA was achieved in 6,349 of 9,178 (69.2%) total freeze applications, and SA-TTI&lt;60 was obtained in 2,673 of 4,784 (55.9%) freezes and electrogram monitoring was present. TT-30C was shorter in the SA group (33.4 ± 9.2 vs 39.3 ± 12.1 s; p &lt; 0.001) and SA-TTI&lt;60 group (31.8 ± 7.6 vs. 38.5 ± 11.5 s; p &lt; 0.001). Also, a 10 s increase in TT-30C was associated with a 41% reduction in the odds for an SA (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.56–0.63) and a 57% reduction in the odds for achieving SA-TTI&lt;60 (OR 0.43; 95% CI 0.39–0.49), when corrected for electrogram visualization, vein position, and application order. Conclusions: Time to reach –30°C is an early predictor of the quality of a CB application and can be used to guide the ablation procedure even in the absence of electrogram monitoring.

Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

Background: Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA. Methods: A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built. Results: Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4–75.8%) in the Prior-CB, and 89.2% (95% CI 73.6–95.9%) in the Prior-RF group (p = 0.002).  Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05–6.79). Conclusions: Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991

Estudio de la variabilidad de la frecuencia cardíaca en diversas cardiopatías / Arcadio García Alberola ; director Mariano Valdés Chávarri.

Tesis-Universidad de Murcia.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-669

Registro Español de Ablación con Catéter. V Informe Oficial (2005)

Se detallan los resultados (éxito y complicaciones) del Registro Español de Ablación del año 2005, elaborado por la Sección de Electrofisiología y Arritmias. Métodos: La recogida de datos, como en registros anteriores, se llevó a cabo mediante dos sistemas: de forma retrospectiva con la cumplimentación de un cuestionario que fue enviado desde la Sección de Electrofisiología y Arritmias a los laboratorios de electrofisiología, y de forma prospectiva a través de una base de datos común. La elección de una u otra fue voluntaria por parte de cada uno de los centros. Resultados: En el envío de datos participaron 47 centros. El número de procedimientos de ablación analizado fue de 6.162, con una media de 131 ± 88 procedimientos/centro. Como en registros previos, los tres sustratos abordados con más frecuencia fueron la taquicardia intranodal (n = 1.792; 29%), las vías accesorias (n = 1.591; 26%) y la ablación del istmo cavotricuspídeo (n = 1.378; 22%). El cuarto sustrato abordado (n = 480; 8%) fue la ablación de fibrilación auricular. El porcentaje global de éxito fue del 93%, el de complicaciones mayores, del 1,05%, y el de mortalidad del 0,03%. Conclusiones: Con un número de procedimientos de ablación superior a 6.000 y con la participación más numerosa de centros de todo el Estado, el Registro Español de Ablación con Catéter aumenta su representatividad y su valor como referencia. El número de procedimientos de ablación de fibrilación auricular se incrementa progresivamente en nuestro país

Efecto del verapamil sobre variabilidad de la frecuencia cardíaca, potenciales tardíos y dispersión del QT en el infarto agudo de miocardio / Eduardo Pinar Bermúdez ; directores Mariano Valdés Chávarri, Arcadio García Alberola.

Tesis-Universidad de Murcia.MEDICINA ESPINARDO. DEPOSITO. MU-Tesis 538.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M.-1593