Papers by ESTEBAN GONZALEZ TORRECILLA
Revista Española de Cardiología, 2015
Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on... more Introduction: the results of surgical procedures in cardiac surgery depend, to a great extent, on the quality of post-operative care. The complexity of the evolution of these patients requires attention from specialized personnel and a differentiated support structure. Objectives: to characterize patients in the postoperative period of cardiac surgery and to describe the main postoperative complications. Methods: we conducted a cross-sectional descriptive study of cases operated and received in the postoperative period of cardiac surgery at the Hospital Provincial Universitario Cardiocentro “Ernesto Guevara” during 2018. Results: 161 cardiac surgery patients were received in the postoperative period; 70.8% were male and most of them were between 45 and 54 years old (32.3%); valve surgery was performed on 49.1%; 16.1% of the total patients were ventilated for more than 48 hours and many were complicated by nosocomial pneumonia (11.8%) and there was a very low frequency of post-operat...
European Heart Journal, 2015
Class of recommendation Level of evidence Class Relevance Data source. Reliability and difficulty... more Class of recommendation Level of evidence Class Relevance Data source. Reliability and difficulty to obtain Auditable Level Evidence 1 † Mayor outcomes (usual outcomes in clinical trials) † Data available in all hospitals by law (e.g. minimal health care database) † Obligatory registries † Data public, available on file † Obligatory registries A † Self-evident † Level A in ESC/AHA-ACC guidelines † Recommendations of regulatory agencies 2 † Outcome surrogates † Class I in guidelines other than major outcomes in clinical trials † Voluntary registries including all patients † Difficult to obtain; may be unreliable † Voluntary disclosures † Difficult to audit B † Level B in guidelines 3 † Class , I in guidelines † Opinions
Revista Española de Cardiología (English Edition), 2015
Cardiology practice requires complex organization that impacts overall outcomes and may differ su... more Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.
Revista Española de Cardiología (English Edition), 2020
Comments on the 2019 ESC guidelines on supraventricular tachycardia Comentarios a la guía ESC 201... more Comments on the 2019 ESC guidelines on supraventricular tachycardia Comentarios a la guía ESC 2019 sobre taquicardia supraventricular SEC Working Group for the 2019 ESC guidelines on supraventricular tachycardia, Expert Reviewers for the 2019 ESC guidelines on supraventricular tachycardia, SEC Guidelines CommitteeÂ
IJC Heart & Vasculature, 2020
Introduction and objectives: The development of complete AV block and the need for pacemaker impl... more 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 of predictors of PM dependence. Methods: We identified 96 consecutive patients who had received a PM post-TAVR (all Core-Valve). We retrospectively analyzed this cohort with the aim of identifying predictors of a high and very high percentage of ventricular pacing (VP), PM dependency and survival. Results: The mean age was 82.3 years, with a mean logistic EuroSCORE of 17.1, 53% were women and 12% of patients had LVEF < 50%. The indication was complete AV block in 40.5%, and LBBB in 59.5%. Mean survival was 62.7 months, IQR [54.4-71]. The only independent predictor of mortality was the pre-TAVR logistic Euro-SCORE (RR = 1,026, p = 0.033), but not LVEF < 50%, VP > 50%, VP > 85% or PM dependence. In 73 patients PM rhythm was documented at the end of follow-up. Of these, 14 (19.2%) were considered dependent, and 37 (50.7%) presented VP > 50%. The post-TAVR complete AV block recovery rate was 67.8%. In multivariate analysis, female sex (HR = 5.6, p = 0.005), and indication of complete AV block vs. LBBB (HR = 15.7, p = 0.017) were independently associated with PM dependency. Conclusions: Female sex and indication due to complete AV block were independent predictors of PM dependency during follow up. In our series of patients with mostly normal LVEF, a high percentage of stimulation does not influence prognosis.
Circulation Issn 0009 7322 2013 11 Vol 128 N 22, Nov 1, 2013
Circulation, Oct 31, 2007
Cardiology journal, Jan 2, 2014
Ventricular fibrillation is routinely induced during implantable-cardioverter defibrillator inser... more Ventricular fibrillation is routinely induced during implantable-cardioverter defibrillator insertion to assess defibrillator performance, but this strategy is experiencing a progressive decline. We aimed to assess the efficacy of defibrillator therapies and long-term outcome in a cohort of patients that underwent defibrillator implantation with and without defibrillation testing. Retrospective observational series of consecutive patients undergoing initial defibrillator insertion or generator replacement. We registered 1) spontaneous ventricular arrhythmias incidence and therapy efficacy; and 2) mortality. A total of 545 patients underwent defibrillator implantation (111 with and 434 without defibrillation testing). After 19 (9-31) months of follow-up, the death rate per observation year (4% vs. 4%; p=0.91) and the rate of patients with defibrillator-treated ventricular arrhythmic events per observation year (with test: 10% vs. without test: 12%; p=0.46) were similar. The generaliz...
Revista Española de Cardiología, 1997
Reviews on Recent Clinical Trials, 2012
Although clinical trials evaluating therapy with implantable cardioverter defibrillators (ICD) ha... more Although clinical trials evaluating therapy with implantable cardioverter defibrillators (ICD) have had clear limitations, there are few interventions in which multiple trial settings over a long period have consistently produced a 20% to 30% reduction in total mortality in patients with left ventricular dysfunction. Substantial differences between the Guidelines on ICD implantation have resulted and the number of patients actually implanted following these recommendations remains relatively low. As well as this, different reasons have been proposed to explain why randomized trials of ICD versus control subjects implanted early after myocardial infarction do not show survival benefit. Moreover, many factors in addition to ejection fraction (EF) do influence the prognosis of patients with coronary disease. However, there are few tools to use this information to guide clinical decisions. Recent years have seen an ongoing debate on the further risk stratification of patients who will benefit most from ICD implantation and a combination of a few readily available clinical variables indicating advanced disease and comorbid conditions identifies ICD patients at high risk. In addition, the role of these devices in patients with nonischemic cardiomyopathies, in older patients and females, for prevention of sudden cardiac death (SCD), has long been debated. This review aims to summarize these criticisms and to refine the current indications of ICD implantation in patients with moderate-severe left ventricular dysfunction.
Journal of the American College of Cardiology, 1990
Journal of the American College of Cardiology, 1990
, spa-m we hew pedorii fxmnafy shw (CS) mapp'@~ wing fiered (Soami %earW (0.m k!!) udpohf leads f... more , spa-m we hew pedorii fxmnafy shw (CS) mapp'@~ wing fiered (Soami %earW (0.m k!!) udpohf leads from a 4 or olmdmmii circm movement tachycardii (CMT) dufhg 9x9 elecaophydokgk study (EPS). We have l&W&d 3 types of fast spikes between th8 major atrial and veWicular elsctrograms in the bipolar CB leads, that could ba taken for K potentials, Type 1: sphsarterttk3majorabialdeAectmduringsinusrhythafKiatrial pacing (5 Pts). Type 2 spikes hmediiety precedii the onset of the majorrarial~bnduingCMT(29~).Ty~3:~~iesaitheendob (29Pts).Only3Ptshadnotspik6sofany were eduded to represenl K potenGak in lackdrelatbnbatweenth8preaenceand apikeS were due to activation delays under each electrode or dierent fmQm8fWon patterns d tha atrlal elactrograms recorded by each pole. We met ubfh to exclude that type 3 spikes were K ptenlials in anty
Journal of the American College of Cardiology, 2011
Background: Electrograms with delayed isolated component (E-IDC) and conduction channels (CC) ide... more Background: Electrograms with delayed isolated component (E-IDC) and conduction channels (CC) identified by voltage mapping are the critical isthmus of most SMVT. We hypothesized that ablation of all E-IDC and CC during sinus rhythm is a safe and effective ablation strategy. The purpose of this study was to determine the long-term efficacy and to identify the success predictor of substrate based ablation of sustained monomorphic ventricular tachycardias (SMVT) in patients with myocardial infarction. Methods: We analyzed 60 patients (age 67±9, LVEF: 30±11%) with chronic myocardial infarction who underwent substrate based VT ablation (SBVTA). Electroanatomic maps were obtained to measure the scar (≤1,5 mV) and dense scar ((≤ ,5 mV) and to delimit the scar borders. The targets of SBVTA were all E-IDC and CC of the scar tissue. Results: Ablation targeted E-IDC and CC in 95% and 75% of patients, in 5 % the ablation targeted multicomponent electrogram from the scar border where pace-mapping reproduced VT morphology. The ablation area was 14±10 cm 2, no major life-threatening complications/incessant VT were observed after the procedure. During a median follow-up of 35 months 57% of patients remained free of VT recurrences. Patients with an above-median dense scar extension (25 cm 2) were at higher risk for VT recurrence compared with those with a below-median (65% versus 24%, p<0.0001, median follow-up 31 vs. 39 months, p: 0.1). Multivariable analysis showed that scar extension was the only predictors of VT recurrence (p<0.004). Conclusion: In patients with a prior MI SBVTA is safe and effective, the extent of dense scar provides incremental prognostic value post MI smvt recurrence
Journal of the American College of Cardiology, 1991
Previous studies on atrioventricular nodal reentrant tachycardia (AVNR) have noted occasional pts... more Previous studies on atrioventricular nodal reentrant tachycardia (AVNR) have noted occasional pts with longer ventrfculoatrial intervals and unusual properties. Described here are 6 pts with AVER using slow pathways for both the antegrade and retrograde limbs. All were women 35-18 years old, and AVNR was refractory to or worsened with verapamil. The average cycle length of AVNR was 469 f 89 q s (mean + sd, range 383-590
Journal of the American College of Cardiology, 2004
Journal of Electrocardiology, 2004
Severe bradyarrythmias remain as an important cause for hospital urgent admission and these patie... more Severe bradyarrythmias remain as an important cause for hospital urgent admission and these patients can suffer potentially lethal complications (such as ventricular fibrillation [VF] and Torsades de Pointes [TdP]) between hospital admission and final therapy. Incidence and predictors of these tachyarrhythmias have not been well established. We retrospectively studied all consecutive patients (N ϭ 243, age 75 Ϯ 10 years; 47% men) admitted to the emergency department of a general hospital between January 1998 and July 2000 for symptomatic bradyarrhythmia. Concomitant therapy included diuretics (25%), digitalis (10%), beta-blockers (10%), amiodarone (2%), and verapamil or diltiazem (8%). Syncope was the most frequent symptom at admission (54%). The most prevalent inclusion bradyarrhythmia was Նsecond-degree AV block (82%). Eleven patients (4.5%) presented VF or TdP. Univariate predictors for these complications were previous amiodarone or diuretic intake, presentation as syncope, low serum potassium level, and longer QTc at admission. Multivariate analysis with logistic regression showed only therapy with diuretics and/or amiodarone and QTc at admission as significant predictors for TdP or VF development. Incidence of VF or TdP in patients admitted for symptomatic bradyarrhythmia is relatively important. A prolonged QTc interval and/or therapy with amiodarone or diuretics can predict their presentation.
Journal of Cardiovascular Electrophysiology, 2002
Pace Mapping for Accessory Pathways. Introduction: Radiofrequency (RF) ablation of accessory path... more Pace Mapping for Accessory Pathways. Introduction: Radiofrequency (RF) ablation of accessory pathways (APs) is often a time-consuming procedure, mainly because conventional criteria have modest accuracy. Thus, additional mapping criteria are desirable. Our hypothesis was that comparison of paced atrial activation sequences with that obtained during orthodromic AV reentrant tachycardia might be useful for locating the atrial insertion of single APs. Methods and Results: The study included 15 patients with a single AP referred for ablation. Analysis of the atrial activation sequence was simpli ed by measuring the activation time (AT) that elapsed between two atrial reference points placed next to the AV annulus on either side of the area containing the AP. Ablation was guided by conventional criteria. Before each RF delivery, a short pacing train was delivered from the ablation catheter and, after veri cation of atrial capture, the AT was compared with the AT obtained during orthodromic tachycardia. Fifty sites of RF delivery were appropriate for analysis. The multivariate model with the highest predictive power included a deviation of AT between pacing and tachycardia <5 msec (P < 0.001), a local AV ratio >1 (P 5 0.04), and stability of the local electrogram (P 5 0.05). The combination of all these criteria predicted a successful application with high sensitivity, speci city, and positive predictive value (92%, 86%, and 71% respectively). To validate the method prospectively, 10 additional consecutive patients underwent an AP ablation procedure guided by these criteria. Conclusion: This technique seems to be highly accurate in selecting the atrial site for RF ablation of single APs.
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Papers by ESTEBAN GONZALEZ TORRECILLA