Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice

Background: The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines. Methods: The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010. Results: We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA >= II and left ventricular ejection fraction <30%. We observed a reduction in the number of ECV performed in 16 of the 27 (67%) participating hospitals. However, there was an increase of 14% in the number of procedures performed in tertiary hospitals, and was related to the increasing use of ECV as a bridge to AF ablation. Considering the initial number of patients treated with ECV, the rate of sinus rhythm at 3 months was almost unchanged (58% in 2003 vs. 57% in 2010; p = 0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs. Conclusions: Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes

Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice

Abstract Background The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines. Methods The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010. Results We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA ≥ II and left ventricular ejection fraction vs. 57% in 2010; p = 0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs. Conclusions Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes.</p

Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice

Background: The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines. Methods: The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010. Results: We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA >= II and left ventricular ejection fraction <30%. We observed a reduction in the number of ECV performed in 16 of the 27 (67%) participating hospitals. However, there was an increase of 14% in the number of procedures performed in tertiary hospitals, and was related to the increasing use of ECV as a bridge to AF ablation. Considering the initial number of patients treated with ECV, the rate of sinus rhythm at 3 months was almost unchanged (58% in 2003 vs. 57% in 2010; p = 0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs. Conclusions: Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes

Marcapasos temporales: utilización actual y complicaciones

Introducción y objetivo. Los marcapasos temporales (MT) permiten el tratamiento urgente de pacientes con bradiarritmias severas. Se los utiliza en las situaciones urgentes y con frecuencia en ancianos con estado general deteriorado, inestabilidad hemodinámica y escasa colaboración. El objetivo es revisar los MT implantados en nuestro centro en los últimos 6 años y analizar sus indicaciones, incidencia y tipo de complicaciones. Pacientes y método. Se han analizado las variables clínicas significativas, la indicación, la vía de acceso, el seguimiento, las complicaciones y los días de mantenimiento del MT. Resultados. Se implantó un total de 568 MT y se pudo revisar 530 casos (edad, 74,8 ± 11 años). Las indicaciones para su implantación fueron: bloqueo auriculoventricular sintomático (51%) y profiláctico por recambio de generador (14,7%), bloqueo en la fase aguda del infarto (12,6%), bradiarritmia por intoxicación medicamentosa (12,2%), enfermedad del nodo sinusal (7,5%) e intervalo QT largo o taquicardia ventricular (2,5%). Se colocaron por la vena femoral en el 99% de los casos. La duración del MT fue de 4,2 días (rango, 1-31 días). Requirieron un marcapasos definitivo 369 pacientes (69,6%). En cuanto a las complicaciones, se produjo el fallecimiento de 34 pacientes (6,4%), aunque sólo en 3 fue atribuible al MT. En 98 pacientes (18,5%) se observaron otras complicaciones severas, entre ellas, disfunción del MT en 48 pacientes (9%) por movilización del electrocatéter. Conclusiones. Los MT se emplean con frecuencia en ancianos con bradiarritmia extrema y, en ocasiones, infarto agudo de miocardio. Las complicaciones graves son frecuentes (22%) y se puede producir desde un hematoma femoral hasta un taponamiento cardíaco o incluso la muerte (6%). En un 9% de los casos, el electrodo debe ser recolocado por fallo del sensado o de la captura ventricular

Image_2_Electrophysiological effects of adipose graft transposition procedure (AGTP) on the post-myocardial infarction scar: A multimodal characterization of arrhythmogenic substrate.JPEG

ObjectiveTo assess the arrhythmic safety profile of the adipose graft transposition procedure (AGTP) and its electrophysiological effects on post-myocardial infarction (MI) scar.BackgroundMyocardial repair is a promising treatment for patients with MI. The AGTP is a cardiac reparative therapy that reduces infarct size and improves cardiac function. The impact of AGTP on arrhythmogenesis has not been addressed.MethodsMI was induced in 20 swine. Contrast-enhanced magnetic resonance (ce-MRI), electrophysiological study (EPS), and left-ventricular endocardial high-density mapping were performed 15 days post-MI. Animals were randomized 1:1 to AGTP or sham-surgery group and monitored with ECG-Holter. Repeat EPS, endocardial mapping, and ce-MRI were performed 30 days post-intervention. Myocardial SERCA2, Connexin-43 (Cx43), Ryanodine receptor-2 (RyR2), and cardiac troponin-I (cTnI) gene and protein expression were evaluated.ResultsThe AGTP group showed a significant reduction of the total infarct scar, border zone and dense scar mass by ce-MRI (p = 0.04), and a decreased total scar and border zone area in bipolar voltage mapping (p ConclusionAGTP is a safe reparative therapy in terms of arrhythmic risk and provides additional protective effect against adverse electrophysiological remodeling in ischemic heart disease.</p