Personalized monitoring of electrical remodelling during atrial fibrillation progression via remote transmissions from implantable devices
Por:
Lillo-Castellano, JM, Gonzalez-Ferrer, JJ, Marina-Breysse, M, Martinez-Ferrer, JB, Perez-Alvarez, L, Alzueta, J, Martinez, JG, Rodriguez, A, Rodriguez-Perez, JC, Anguera, I, Vinolas, X, Garcia-Alberola, A, Quintanilla, JG, Alfonso-Almazan, JM, Garcia, J, Borrego, L, Canadas-Godoy, V, Perez-Castellano, N, Perez-Villacastin, J, Jimenez-Diaz, J, Jalife, J, Filgiras-Rama, D
Publicada:
1 may 2020
Resumen:
Aims Atrial electrical remodelling (AER) is a transitional period associated with the progression and long-term maintenance of atrial fibrillation (AF). We aimed to study the progression of AER in individual patients with implantable devices and AF episodes.
Methods and results Observational multicentre study (51 centres) including 4618 patients with implantable cardioverter-defibrillator +/-resynchronization therapy (ICD/CRT-D) and 352 patients (2 centres) with pacemakers (median follow-up: 3.4 years). Atrial activation rate (AAR) was quantified as the frequency of the dominant peak in the signal spectrum of AF episodes with atrial bipolar etectrograms. Patients with complete progression of AER, from paroxysmal AF episodes to electrically remodelled persistent AF, were used to depict patient-specific AER slopes. A total of 34 712 AF tracings from 830 patients (87 with pacemakers) were suitable for the study. Complete progression of AER was documented in 216 patients (16 with pacemakers). Patients with persistent AF after completion of AER showed , similar to 30% faster AAR than patients with paroxysmal AF. The slope of AAR changes during AF progression revealed patient-specific patterns that correlated with the time-to-completion of AER (R-2 = 0.85). Pacemaker patients were older than patients with ICD/CRT-Ds (78.3 vs. 67.2 year olds, respectively, P< 0.001) and had a shorter median time-to-completion of AER (24.9 vs. 93.5 days, respectively, P = 0.016). Remote transmissions in patients with ICD/CRT-D devices enabled the estimation of the time-to-completion of AER using the predicted slope of AAR changes from initiation to completion of electrical remodelling (R-2 = 0.45).
Conclusions The AF progression shows patient-specific patterns of AER, which can be estimated using available remote-monitoring technology.
Filiaciones:
Lillo-Castellano, JM:
Ctr Nacl Invest Cardiovasc CNIC, Adv Dev Arrhythmia Mech & Therapy Lab, Myocardial Pathophysiol Area, Madrid, Spain
Fdn Interhospitalaria Invest Cardiovasc FIC, Madrid, Spain
Gonzalez-Ferrer, JJ:
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Marina-Breysse, M:
Ctr Nacl Invest Cardiovasc CNIC, Adv Dev Arrhythmia Mech & Therapy Lab, Myocardial Pathophysiol Area, Madrid, Spain
Agencia Espanola Protecc Salud Deporte AEPSAD, Madrid, Spain
Martinez-Ferrer, JB:
Hosp Univ Araba, Dept Cardiol, Vitoria, Spain
Perez-Alvarez, L:
Hosp Hosp Univ A Coruna, Dept Cardiol, La Coruna, Spain
Alzueta, J:
Hosp Univ Virgen de la Victoria, Dept Cardiol, Malaga, Spain
Martinez, JG:
Hosp Gen Univ Alicante, Dept Cardiol, ISABIAL FISABIO, Alicante, Spain
Rodriguez, A:
Hosp Univ Canarias, Dept Cardiol, Santa Cruz De Tenerife, Spain
Rodriguez-Perez, JC:
Hosp Insular Gran Canaria, Dept Cardiol, Las Palmas Gran Canaria, Spain
Anguera, I:
Hosp Univ Bellvitge, Dept Cardiol, Barcelona, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Barcelona, Spain
Garcia-Alberola, A:
Hosp Univ Virgen de la Arrixaca, Dept Cardiol, IMIB, Murcia, Spain
Quintanilla, JG:
Ctr Nacl Invest Cardiovasc CNIC, Adv Dev Arrhythmia Mech & Therapy Lab, Myocardial Pathophysiol Area, Madrid, Spain
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Alfonso-Almazan, JM:
Ctr Nacl Invest Cardiovasc CNIC, Adv Dev Arrhythmia Mech & Therapy Lab, Myocardial Pathophysiol Area, Madrid, Spain
Garcia, J:
Hosp Univ Getafe, Dept Cardiol, Madrid, Spain
Borrego, L:
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Canadas-Godoy, V:
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Perez-Castellano, N:
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Perez-Villacastin, J:
Fdn Interhospitalaria Invest Cardiovasc FIC, Madrid, Spain
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Jimenez-Diaz, J:
Hosp Gen Univ Ciudad Real, Dept Cardiol, Ciudad Real, Spain
Jalife, J:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Ctr Nacl Invest Cardiovasc CNIC, Cardiac Arrhythmia Lab, Myocardial Pathophysiol Area, Madrid, Spain
Filgiras-Rama, D:
Ctr Nacl Invest Cardiovasc CNIC, Adv Dev Arrhythmia Mech & Therapy Lab, Myocardial Pathophysiol Area, Madrid, Spain
Hosp Clin San Carlos IdISSC, Inst Invest Sanitaria, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
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