Papers by Miguel A. Arias
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 12, 2015
Currently, there continues to be a lack of evidence regarding outcomes associated with device-bas... more Currently, there continues to be a lack of evidence regarding outcomes associated with device-based therapy for ventricular arrhythmias in elderly patients, even more in primary-prevention indications. We aimed to describe the follow-up in terms of efficacy and safety of implantable cardioverter-defibrillator (ICD) therapy in a large cohort of elderly patients. Retrospective multicentre study performed in 15 Spanish hospitals. Consecutive patients referred for ICD implantation before 2011 were included. One hundred and sixty-two of 1174 patients (13.8%) ≥75 years were considered as 'elderly'. When compared with those patients <75, this subgroup presented more co-morbid conditions, including hypertension, chronic obstructive pulmonary disease , and renal failure, and more previous hospitalizations due to heart failure (HF). During a mean follow-up of 104.4 ± 3.3 months, 162 patients (14%) died, 120 in the younger age (12.4%), and 42 (24.4%) in the elderly. Kaplan-Meier ana...
Pacing and Clinical Electrophysiology, 2015
We thank Tian et al. for the interest in our recent paper on the performance of the SA-VA differe... more We thank Tian et al. for the interest in our recent paper on the performance of the SA-VA difference to distinguish orthodromic reentrant tachycardia (OT) from atrioventricular nodal reentrant tachycardia (AVNRT).(1) We fully agree with the authors that the diagnostic performance for the SA-VA difference might not be as good, as presented in our work,(1) for left free wall accessory pathways (AP) as compared to septal APs, given the larger distance from the pacing site (right ventricular apex) to the reentry circuit in the former. Indeed, reanalyzing our data, excluding left free wall APs, the SA-VA difference was able to distinguish OT from AVNRT in all instances. Unfortunately, in our study the number of anterior and anterolateral APs was fairly small,(1) for which no meaningful conclusions can be made with regards to this subset of patients. Nonetheless, it should be noted that the same applies for other pacing maneuvers, which also differentiates AVNRT from OT based on the proximity of the reentry circuit to the pacing catheter. For example, in the study by González-Torrecilla et al.(2) the corrected post paced interval - tachycardia cycle length (PPI-TCL) was significantly shorter for septal APs when compared to free wall APs and 1 patient with a free wall AP presented a corrected PPI-TCL long enough to be incorrectly classified as AVNRT. Similarly, analyzing resetting during or after the transition zone of ventricular overdrive pacing in order to distinguish AVNRT from OT,(3) there have been reports of OT through a left lateral AP resetting after the transition zone leading to an erroneous diagnosis of AVNRT.(4) This article is protected by copyright. All rights reserved.
Heart Rhythm, 2015
Isolated cases of monomorphic ventricular tachycardia (MVT) in patients with Brugada syndrome (Br... more Isolated cases of monomorphic ventricular tachycardia (MVT) in patients with Brugada syndrome (BrS) have been reported. We aimed to describe the incidence and characteristics of MVT in a cohort of BrS patients who had received an implantable cardioverter defibrillator (ICD). Data from 834 BrS patients with an ICD in 15 tertiary hospitals between 1993 and 2014 were included. Mean age was 45.3 ± 13.9; 200 patients (24%) were women. During a mean follow-up of 69.4 ± 54.3 months, 114 patients (13.7%) experienced at least one appropriate ICD intervention, with MVT recorded in 35 patients (4.2%) (sensitive to antitachycardia pacing in 15 (42,8%)). Only QRS width was an independent predictor of MVT in the overall population. Specifically, 6 patients presented with right ventricular outflow tract tachycardia (RVOT) (successfully ablated from the endocardium in 4 and epi + endocardial ablation in one), two patients with MVT arising from the left ventricle (LV) (one successfully ablated in the supra lateral mitral annulus) and two patients with bundle branch reentry VT (BBRVT). Significant structural heart disease was ruled out by echocardiography and/or CMR. In this retrospective study, 4.2% of the patients with BrS implanted with an ICD presented with MVT confirmed as arising from the RVOT in 6, the LV in 2 and BBRVT in 2. Endocardial +/- epicardial ablation was successful in 80% of these cases. These data imply that the occurrence of MVT should not rule out the possibility of BrS. This finding may also be relevant for ICD model selection and programming.
International Journal of Cardiology, 2015
ICDs have been demonstrated to be highly effective in the primary prevention of sudden death, but... more ICDs have been demonstrated to be highly effective in the primary prevention of sudden death, but inappropriate shocks (IS) occur frequently and represent one of the most important adverse effects of ICDs. The aim of this study was to analyze IS and identify the clinical predictors and prognostic implications of ISs in a real-world primary prevention ICD population. This multicenter retrospective study was performed in 13 centers with experience in the field of ICD implantation (at least 30 per year) and ICD follow-up in Spain. All consecutive patients who underwent ICD implantation for primary prevention between January 2008 and May 2014 were included. One-thousand-sixteen patients were included, and 4 (0.39%) were lost to follow-up. Two-hundred-seventeen (21.4%) patients suffered from shock; 69 (6.8%) of these patients experienced IS, and 154 (15.4%) experienced appropriate shocks (AS). Age (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;65years, hazard ratio (HR) 2.588 [95% CI 1.282-5.225]; p=0.008), history of atrial fibrillation (HR 2.252 [95% CI 1.230-4.115]; p=0.009), non-ischemic myocardiopathy (HR 2.258 [95% CI 1.090-4.479]; p=0.028), and cardiac resynchronization therapy (HR 0.385 [95% CI 0.200-0.740]; p=0.004) were identified as IS predictors in a multivariate analysis. IS was not associated with rehospitalization due to heart failure, myocardial infarction, cardiovascular mortality or all-cause mortality. This analysis of our national registry identified the independent IS predictors of age, atrial fibrillation history and cardiac resynchronization therapy and suggests that ISs are not linked to poorer clinical endpoints.
JAMA, 2006
... Nevertheless, Kwatra raises an interesting hypothesis that should be assessed in future trial... more ... Nevertheless, Kwatra raises an interesting hypothesis that should be assessed in future trials. ... JAMA. 2004;291:1720-1729. 2. Daoud EG, Strickberger A, Man KC, et al. Preoperative amiodarone as prophy-laxis against atrial fibrillation after heart surgery. N Engl J Med. ...
International Journal of Cardiology, 2008
We report a case of a patient with recurrent episodes of supraventricular tachycardia in which a ... more We report a case of a patient with recurrent episodes of supraventricular tachycardia in which a concealed left-posterior accessory pathway-mediated orthodromic tachycardia was reproducibly induced during the EP study. Two interesting and very unusual electrophysiological phenomenon were observed at the same time during the ablation procedure of the accessory pathway: 1- Automaticity of the regular accessory atrioventricular pathway; 2- Emergence of manifest preexcitation following radiofrequency application exclusively during the automatic accessory pathway-mediated rhythm.
Revista Espanola De Cardiologia, Nov 28, 2011
QRS before resynchronization present a higher response rate to therapy although an adequate cut-o... more QRS before resynchronization present a higher response rate to therapy although an adequate cut-off point has not yet been achieved; however, the degree of QRS narrowing in the implant 5,6 is probably more important for prognosis than the actual duration of the baseline complex. Our findings support those results and underscore the importance of adequate left ventricular lead placement during implantation, as well as accurate programming to obtain the narrowest paced QRS possible.
Pacing and clinical electrophysiology : PACE, Jan 14, 2015
Ventricular overdrive pacing (VOP) produces reset during the transition zone (TZ) of QRS fusion i... more Ventricular overdrive pacing (VOP) produces reset during the transition zone (TZ) of QRS fusion in orthodromic reentrant tachycardia (ORT) and after the TZ in atrioventricular nodal reentrant tachycardia (AVNRT), and this represents a simple diagnostic maneuver to differentiate the 2 tachycardia mechanisms. The purpose of this study was to determine whether the number of beats with reset in the TZ predicts accessory pathway (AP) location in ORT. We retrospectively reviewed 57 patients with ORT (21 left-sided AP, 20 septal AP, and 16 right-sided AP) and 20 patients with AVNRT (19 typical AVNRT and 1 atypical AVNRT) who underwent VOP from the right ventricular apex. We analyzed the number of beats with reset during or after the TZ, demonstrated by fixed ventricular stimulus-atrial (SA) interval during VOP. The overall mean tachycardia cycle length [CL] minus VOP CL was 22.6±7.5 ms with no statistical difference between the groups (P = 0.480). The mean number of beats in the TZ with fi...
Pacing and Clinical Electrophysiology, 2015
The SA-VA difference represents a simple diagnostic maneuver to distinguish between atrioventricu... more The SA-VA difference represents a simple diagnostic maneuver to distinguish between atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reentrant tachycardia (ORT) during electrophysiology study. However, its usefulness has largely been studied in selected patient subgroups. The purpose of this study was to evaluate the performance of the SA-VA difference against commonly used diagnostic maneuvers in a large cohort of consecutive patients. Consecutive patients with inducible supraventricular tachycardia and successful entrainment through pacing trains from right ventricular apex during an electrophysiological study were included. Atrial tachycardias were excluded. The following intervals were calculated for each patients: SA-VA difference; his potential and atrial electrogram during entrainment minus his potential and atrial electrogram during tachycardia; and the corrected return cycle. A total of 456 patients fulfilled the inclusion criteria, of which electrophysiological study revealed 265 typical AVNRT, 38 atypical AVNRT, 54 and 108 ORT through a septal and free-wall accessory pathway, respectively. An SA-VA difference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;99 ms identified AVNRT in all patients with sensitivity, specificity, positive and negative predictive values of 97.7%, 96.9%, 98.3%, and 95.7%, respectively. This study confirms the high ability to distinguish AVNRT from ORT using the SA-VA difference, not only in selected patient subgroups, but as whole when a cutoff of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;99 ms is used. This article is protected by copyright. All rights reserved.
Pacing and Clinical Electrophysiology, 2015
ABSTRACT A 33-year-old woman with a history of symptomatic nonischemic dilated cardiomyopathy, se... more ABSTRACT A 33-year-old woman with a history of symptomatic nonischemic dilated cardiomyopathy, severe left ventricular systolic dysfunction and left bundle branch block underwent implantation of a cardiac resynchronization therapy device with a defibrillator indicated as primary prevention (Promote Quadra CRT-D model 3239-40Q; St. Jude Medical [SJM], Sylmar, CA, USA) in 2012. Three years later, during a scheduled follow-up visit, the patient was found asymptomatic and was taking ramipril 10 mg, carvedilol 25 mg and spironolactone 25 mg. Device interrogation revealed parameters within normal limits including stable P- and R-wave sensing, pacing thresholds and pacing and shock impedance, as well as ventriculoatrial (VA) conduction present at pacing threshold testing. There were no recorded ventricular tachyarrhythmia events however, 24 automatic mode switch (AMS) episodes were observed since the last device interrogation 6 months ago. Antibradycardia settings were programmed DDDR between 60 and 150 ppm, paced and sensed atrioventricular intervals (AVI) 160 and 100 ms, and biventricular pacing with left ventricular first at 20 ms. Other main device programming parameters are summarized in Table 1. Unexpectedly none of the AMS episodes revealed any atrial tachyarrhythmia, all displaying synchronous atrial- biventricular pacing (AP-BP) at the sensor indicated rate (SIR) with associated short coupled atrial pace (AP)-atrial refractory (AR; marked with a vertical line on the marker channel) events (Figure 1). Why did the mode switch occur? Is it due to device malfunction? This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Pacing and clinical electrophysiology : PACE, Jan 8, 2015
A 65-year-old man with a long history of short runs of rapid palpitations and no documentation of... more A 65-year-old man with a long history of short runs of rapid palpitations and no documentation of tachycardia, was scheduled for an electrophysiology study. Echocardiogram was normal and he received no antiarrhythmic therapy at the time. Baseline 12-lead electrocardiogram (ECG) showed sinus rhythm with a short PR interval and a delta wave consistent with ventricular preexcitation through a midseptal accessory pathway (AP) (fig. 1). This article is protected by copyright. All rights reserved.
Revista Española de Cardiología, 2013
La fibrilació n auricular (FA) es la arritmia sostenida má s comú n en la prá ctica clínica y es ... more La fibrilació n auricular (FA) es la arritmia sostenida má s comú n en la prá ctica clínica y es la causa de un tercio de las hospitalizaciones por arritmias cardiacas 1 . Dichas hospitalizaciones siguen en aumento debido al envejecimiento de la població n, la mayor prevalencia de las enfermedades cró nicas cardiovasculares y la mayor detecció n de la arritmia mediante dispositivos de monitorizació n ambulatoria de toda índole. Por otro lado, el síndrome de apnea-hipopnea obstructiva del sueñ o (SAHOS), caracterizada por la repetició n durante el sueñ o de obstrucciones de la vía aé rea superior, asociada a síntomas debidos a un sueñ o no reparador, es una enfermedad infradiagnosticada que afecta aproximadamente al 5% de la població n general 2 . El índice de apneas-hipopneas (IAH) es el nú mero de obstrucciones totales o parciales de la vía aé rea por hora de sueñ o, y es el principal pará metro en un estudio de sueñ o para diagnosticar y cuantificar la gravedad del SAHOS. Así, un IAH > 4 se considera patoló gico, y el SAHOS se considera leve cuando el IAH está entre 5 y 14, moderado entre 15 y 30 y grave cuando es > 30. Ademá s de su elevada prevalencia en pacientes con distintas formas de enfermedad cardiovascular, el SAHOS se asocia a una sustancial morbilidad y mortalidad, fundamentalmente de causa cardiovascular 2 . Se estima que dos tercios de los pacientes con FA puedan tener tambié n SAHOS. La idea de que el SAHOS pueda ser origen de FA es atractiva, pero el hecho de que ambas entidades compartan muchos factores de riesgo y comorbilidades, tales como la edad, la obesidad, el sexo masculino, la hipertensió n arterial, la enfermedad coronaria o la insuficiencia cardiaca 2 , dificulta establecer claramente una relació n causal independiente entre ambas.
Journal of Cardiovascular Electrophysiology, 2015
CASE SUMMARY A 58-year-old man with a history of ischemic cardiomyopathy with healed inferolatera... more CASE SUMMARY A 58-year-old man with a history of ischemic cardiomyopathy with healed inferolateral myocardial infarction, mild left ventricular systolic dysfunction, who had previously received a single-chamber implantable cardiac defibrillator as secondary prevention, was admitted to the cardiology ward with palpitations and shortness of breath. He was on clopidogrel 75 mg, bisoprolol 7,5 mg, olmesartan 40 mg, amlodipine 10mg, hidroclorothiazide 12,5 mg, amiodarone 200mg and atorvastatin 80 mg. This article is protected by copyright. All rights reserved.
Revista Española de Cardiología (English Edition), 2004
Introduction. The ablation of ventricular tachycardia is limited by a number of factors that redu... more Introduction. The ablation of ventricular tachycardia is limited by a number of factors that reduce the effectiveness of this intervention in patients with structural heart disease compared to other types of arrhythmia. Recent years have seen the development of several nonfluoroscopic navigation techniques that facilitate the mapping of complex arrhythmogenic substrates. One such technique, the LocaLisa system, has not previously been tested for the ablation of ventricular tachycardia.
Revista Española de Cardiología (English Edition), 2009
We present the case of a 34-year-old male with no structural cardiopathy, referred for an electro... more We present the case of a 34-year-old male with no structural cardiopathy, referred for an electrophysiological study due to a history of several years' evolution of paroxysmal supraventricular tachycardia. The baseline ECG was normal. The study was carried out with 3 tetrapolar catheters for ...
Revista Española de Cardiología, 2013
Revista Española de Cardiología (English Edition), 2013
A 72-year-old man was hospitalized for congestive heart failure and had a favorable response to t... more A 72-year-old man was hospitalized for congestive heart failure and had a favorable response to the intensive medical treatment received. The patient had a history of ischemic heart disease with chronic anterior infarction of several years' duration and three-vessel ...
Revista Española de Cardiología, 2008
En el excelente artículo de Zamora et al 1 se pone de manifiesto el fenómeno de la paradoja de la... more En el excelente artículo de Zamora et al 1 se pone de manifiesto el fenómeno de la paradoja de la obesidad en los pacientes con insuficiencia cardiaca, en este caso en una población de pacientes con insuficiencia cardiaca en seguimiento ambulatorio y que han seguido un adecuado tratamiento contemporáneo de la insuficiencia cardiaca.
Revista Española de Cardiología, 2011
Revista Española de Cardiología (English Edition), 2007
Heart failure (HF) and sleep-disordered breathing are conditions highly prevalent in the general ... more Heart failure (HF) and sleep-disordered breathing are conditions highly prevalent in the general population that often co-exist in the same patient. Epidemiological and pathophysiological studies indicate that there may be a causal link between sleep-disordered breathing and HF with either left ventricular systolic dysfunction or preserved ejection fraction. The presence of sleep-disordered breathing in HF patients expose the cardiovascular system to intermittent hypoxia, sympathetic activation, and increased preload and afterload and they trigger several inflammatory, oxidative and neurohumoral mechanisms that may precipitate the progression of the disease. Although there are no available data to indicate that treating sleep-disordered breathing in HF patients reduce cardiac mortality, several studies demonstrate a significant improvement in structural and functional cardiovascular parameters. This review focuses on the clinical and epidemiological bases, the pathophysiological mechanisms and the therapeutic implications between HF and sleep apnea-hypopnea syndromes.
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Papers by Miguel A. Arias