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Article: Redefining QRS transition to confirm left bundle branch capture during left bundle branch area pacing.

Briongos-Figuero, Sem / Estévez Paniagua, Álvaro / Sánchez Hernández, Ana / Muñoz-Aguilera, Roberto

2023 Volume 10, Page(s) 1217133

Abstract: Background: QRS transition criteria during dynamic manoeuvers are the gold-standard for non-invasive confirmation of left bundle branch (LBB) capture, but they are seen in <50% of LBB area pacing (LBBAP) procedures.: Objective: We hypothesized that ... ...

Abstract	Background: QRS transition criteria during dynamic manoeuvers are the gold-standard for non-invasive confirmation of left bundle branch (LBB) capture, but they are seen in <50% of LBB area pacing (LBBAP) procedures. Objective: We hypothesized that transition from left ventricular septal pacing (LVSP) to LBB pacing (LBBP), when observed during lead penetration into the deep interventricular septum (IVS) with interrupted pacemapping, can suggest LBB capture. Methods: QRS transition during lead screwing-in was defined as shortening of paced V6-R wave peak time (RWPT) by ≥10 ms from LVSP to non-selective LBBP (ns-LBBP) obtained during mid to deep septal lead progression at the same target area, between two consecutive pacing manoeuvres. ECG-based criteria were used to compared LVSP and ns-LBBP morphologies obtained by interrupted pacemapping. Results: Sixty patients with demonstrated transition from LVSP to ns-LBBP during dynamic manoeuvers were compared to 44 patients with the same transition during lead screwing-in. Average shortening in paced V6-RWPT was similar among study groups (17.3 ± 6.8 ms vs. 18.8 ± 4.9 ms for transition during dynamic manoeuvres and lead screwing-in, respectively; Conclusions: During LBBAP procedure, QRS transition from LVSP to ns-LBBP can be observed as the lead penetrates deep into the IVS with interrupted pacemapping. Shortening of at least 10 ms in paced V6-RWPT may serve as marker of LBB capture.
Language	English
Publishing date	2023-07-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1217133
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Article ; Online: Combination of current and new electrocardiographic-based criteria: a novel score for the discrimination of left bundle branch capture.

Briongos-Figuero, Sem / Estévez-Paniagua, Álvaro / Sánchez-Hernández, Ana / Muñoz-Aguilera, Roberto

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

2023 Volume 25, Issue 3, Page(s) 1051–1059

Abstract: Aims: Most of the criteria used to diagnose direct capture of the left bundle branch (LBB) have never been validated in an external sample. We hypothesized that lead aVL might add relevant information, and the combination of several electrocardiograph ( ... ...

Abstract	Aims: Most of the criteria used to diagnose direct capture of the left bundle branch (LBB) have never been validated in an external sample. We hypothesized that lead aVL might add relevant information, and the combination of several electrocardiograph (ECG)-based criteria might discriminate better LBB capture from left ventricular septal (LVS) capture, than each criterion separately. Methods and results: Single-centre study involving all consecutive patients who received LBB area pacing. LBB capture was defined according to QRS morphology transition criteria during decremental pacing. Multivariate logistic regression analysis was performed to develop a predictive score for LBB capture. A total of 71 patients with confirmed LBB capture were analysed. The optimal cut-off values of R wave peak time (RWPT) in lead V6 (V6-RWPT) and V6-V1 interpeak interval for the discrimination of LBB capture were <83 ms and ≥33 ms, respectively. The RWPT in lead aVL (aVL-RWPT) showed a good discrimination power for the differential diagnosis of LBB capture and LVS capture. The optimal value for aVL-RWPT was 79 ms [sensitivity (SN) and specificity (SP) of 71.2% and 88.4%, respectively]. A new score, with a good diagnostic performance (area under the curve of 0.976), was constructed gathering the information from V6-RWPT, aVL-RWPT, and V6-V1 interpeak interval. The optimal score of 3 points showed a SN and SP of 89.2% and 100%, respectively for the differentiation of LBB capture. Conclusions: ECG-based criteria are useful to confirm the capture of the LBB. The combination of V6-RWPT, aVL-RWPT, and V6-V1 interpeak interval values demonstrated better diagnostic performance than isolated measurements.
MeSH term(s)	Humans ; Heart Conduction System ; Electrocardiography/methods ; Ventricular Septum ; Sensitivity and Specificity ; Bundle of His ; Cardiac Pacing, Artificial
Language	English
Publishing date	2023-05-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euac276
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Article ; Online: Optimizing atrial sensing parameters in leadless pacemakers: Atrioventricular synchrony achievement in the real world.

Briongos-Figuero, Sem / Estévez-Paniagua, Álvaro / Sánchez Hernández, Ana / Jiménez, Silvia / Gómez-Mariscal, Eloy / Abad Motos, Ane / Muñoz-Aguilera, Roberto

Heart rhythm

2022 Volume 19, Issue 12, Page(s) 2011–2018

Abstract: Background: Performance of the leadless pacemaker capable of atrioventricular (AV) synchronous pacing in de novo patients warrants further investigation.: Objective: The aims of this study were to assess what programming changes are needed to achieve ...

Abstract	Background: Performance of the leadless pacemaker capable of atrioventricular (AV) synchronous pacing in de novo patients warrants further investigation. Objective: The aims of this study were to assess what programming changes are needed to achieve proper atrial tracking and to study the percentage of AV synchrony (AVS) the device can provide under real-world conditions. Methods: Consecutive patients undergoing Micra AV implantation between June 2020 and November 2021 were studied. Reprogramming of atrial sensing parameters during follow-up was performed by following device counters. AVS was studied with an ambulatory 24-hour Holter monitor and automatically analyzed by an electrocardiogram delineation system. The primary end point was AVS ≥85% of total cardiac cycles during 24-hour Holter electrocardiogram monitoring. Results: Thirty-one patients who remained in VDD mode were studied, and all of them required manual reprogramming. The automatic A3 window end was deactivated, and a fixed and short value was set in all patients throughout follow-up. AVS significantly increased from 68.7% ± 14.7% at 24-hour follow-up to 83.9% ± 7.4% at 1-month visit (P = .001). At 1-month visit, shorter A3 window end time (P = .019), higher A4 threshold (P = .011), and deactivation of the automatic A3 window (P = .054) were independently related to higher AVS. A total of 2,291,953 Holter-recorded cardiac cycles were analyzed. Median AVS during 24-hour daily activities was 87.6% (interquartile range 84.5%-90.6%). Twenty of 26 patients (79.6%) reached AVS ≥85% of cardiac cycles. Conclusion: High rates of AVS can be achieved in real-world patients undergoing leadless pacing. Manual reprogramming of the atrial sensing parameters is essential to optimize mechanically sensed atrial tracking.
MeSH term(s)	Humans ; Heart Block ; Pacemaker, Artificial ; Heart Atria ; Electrocardiography, Ambulatory ; Electrocardiography ; Cardiac Pacing, Artificial
Language	English
Publishing date	2022-08-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2022.08.007
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Zs.A 6278: Show issues

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Article ; Online: Atrial mechanical contraction and ambulatory atrioventricular synchrony: Predictors from the OPTIVALL study.

Briongos-Figuero, Sem / Estévez Paniagua, Álvaro / Sánchez Hernández, Ana / Jiménez Loeches, Silvia / Gómez Mariscal, Eloy / Vaqueriza Cubillo, David / Muñoz-Aguilera, Roberto

Journal of cardiovascular electrophysiology

2023 Volume 34, Issue 9, Page(s) 1904–1913

Abstract: Introduction: The role that preprocedural factors have on atrioventricular synchrony (AVS) provided by leadless pacemakers requires investigation.: Methods and results: We aimed to assess the correlation between mitral inflow echocardiographic ... ...

Abstract	Introduction: The role that preprocedural factors have on atrioventricular synchrony (AVS) provided by leadless pacemakers requires investigation. Methods and results: We aimed to assess the correlation between mitral inflow echocardiographic parameters and p-wave morphology with the accelerometer A4 signal amplitude. We also sought to identify clinical and echocardiographic predictors of optimal ambulatory AVS (≥85% of cardiac cycles). Forty-three patients undergoing Micra AV implant from June 2020 to March 2023 were prospectively enrolled. Baseline echocardiogram and 12-lead resting ECG were performed. Device follow-up was scheduled at 24 h, 1, 3, and 6 months and yearly after the implant. Ambulatory AVS was studied with a 24 h Holter monitor performed at 3 months follow-up in 35 patients who remained in VDD mode. A4 signal amplitude at 1 month correlated to peak A wave velocity (r = .376; p = .024) at echocardiogram, but no relationship was found with peak A' wave velocity, E/A, or E'/A' ratio. P-wave amplitude in lead I and aVF correlated to A4 signal amplitude at 1- and 3-months follow-up, respectively. Median AVS during 24 h of daily activities was 85.6 ± 7.6% and remained stable up to 100 bpm. Twenty-three out of 35 patients (65.7%) reached optimal ambulatory AVS. There was no association between mitral inflow echocardiographic parameters and optimal AVS. Diabetes (OR: 0.05, 95% CI: 0.01-0.47; p = .009) and chronic obstructive pulmonary disease (COPD) (OR: 0.06, 95% CI: 0.01-0.63; p = .019) strongly predicted ambulatory AVS <85%. Conclusions: Diabetes and COPD should be considered when selecting candidates for Micra AV. Measurements of pulsed wave Doppler mitral inflow do not systematically reflect the behavior of the A4 signal amplitude.
MeSH term(s)	Humans ; Atrial Fibrillation ; Heart Atria ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Pacemaker, Artificial ; Cardiac Pacing, Artificial/methods
Language	English
Publishing date	2023-07-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.16016
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Zs.A 2863: Show issues

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Article ; Online: Tailored electrocardiographic-based criteria for different pacing locations within the left bundle branch.

Briongos-Figuero, Sem / Estévez-Paniagua, Álvaro / Sánchez-Hernández, Ana / Heredero-Palomo, Delia / Sánchez-López, Elena / Luna-Cabadas, Arantxa / Tapia-Martínez, Manuel / Muñoz-Aguilera, Roberto

Heart rhythm

2023 Volume 21, Issue 1, Page(s) 54–63

Abstract: Background: Electrocardiographic (ECG)-based criteria are used to confirm left bundle branch (LBB) pacing (LBBP), but current cutoff values have never been validated for different pacing locations.: Objective: The purpose of this study was to ... ...

Abstract	Background: Electrocardiographic (ECG)-based criteria are used to confirm left bundle branch (LBB) pacing (LBBP), but current cutoff values have never been validated for different pacing locations. Objective: The purpose of this study was to describe diagnostic performance of V6-R wave peak time (RWPT), V6-V1 interpeak interval, and aVL-RWPT for different pacing sites within the LBB and to determine 100% specific values for each criterion at each pacing location. Methods: Consecutive patients with confirmed LBBP were selected. Population was divided into subgroups based on the site of pacing: left bundle trunk pacing (LBTP), left septal fascicular pacing (LSFP), left posterior fascicular pacing (LPFP), and left anterior fascicular pacing (LAFP). Results: A total of 147 patients with unequivocal LBB capture were analyzed. Left fascicular pacing was more frequently achieved (82.8%) than LBTP (17.2%). Diagnostic performance of V6-RWPT, V6-V1 interpeak interval, and aVL-RWPT for discrimination of LBBP was good in all subgroups. V6-RWPT cutoff values with 100% specificity (SP) for LBBP discrimination were 75 ms in LBTP, 68 ms in LPFP, 81 ms in LAFP, and 79.5 ms in LSFP. V6-V1 interpeak interval cutoff values with 100% SP for LBBP discrimination were 35.5 ms in LBTP, 53.5 ms in LPFP, 41 ms in LAFP, and 46 ms in LSFP. In LAFP, aVL-RWPT cutoff value with 100% SP for LBBP discrimination was 68 ms, but was 74 ms in LBTP, 74.5 ms in LSFP, and 73.5 ms in LPFP. Conclusions: Tailored ECG-based criteria might be useful to confirm LBBP at different pacing locations within the LBB.
MeSH term(s)	Humans ; Bundle of His ; Bundle-Branch Block/diagnosis ; Bundle-Branch Block/therapy ; Cardiac Pacing, Artificial ; Heart Conduction System ; Electrocardiography
Language	English
Publishing date	2023-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2023.09.015
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Article ; Online: Infección por SARS-CoV-2: un factor predisponente para síndrome coronario agudo.

de Cortina Camarero, Cristina / Gómez Mariscal, Eloy / Espejo Bares, Victoria / Núñez Garcia, Alberto / Muñoz Aguilera, Roberto / Botas Rodriguez, Javier

Medicina clinica

2021 Volume 157, Issue 3, Page(s) 114–117

Abstract: Introduction: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during ...

Title translation	SARS-CoV-2 infection: A predisposing factor for acute coronary syndrome.
Abstract	Introduction: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019. Methods: Observational multicenter cohort study of 3,108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied. Results: The incidence of ACS in COVID-19 patients was 3.31 ‰, significantly higher than in the 2019 period, 1.01 ‰ (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high. Conclusions: Severe COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis.
MeSH term(s)	Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/epidemiology ; COVID-19 ; Causality ; Cohort Studies ; Hospitalization ; Humans
Language	Spanish
Publishing date	2021-01-28
Publishing country	Spain
Document type	Case Reports ; Multicenter Study ; Observational Study
ZDB-ID	411607-0
ISSN	1578-8989 ; 0025-7753
ISSN (online)	1578-8989
ISSN	0025-7753
DOI	10.1016/j.medcli.2021.01.004
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Article ; Online: SARS-CoV-2 infection: A predisposing factor for acute coronary syndrome.

de Cortina Camarero, Cristina / Gómez Mariscal, Eloy / Espejo Bares, Victoria / Núñez Garcia, Alberto / Muñoz Aguilera, Roberto / Botas Rodriguez, Javier

Medicina clinica (English ed.)

2021 Volume 157, Issue 3, Page(s) 114–117

Abstract	Introduction: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019. Methods: Observational multicenter cohort study of 3.108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied. Results: The incidence of ACS in COVID-19 patients was 3.31‰, significantly higher than in the 2019 period, 1.01‰ (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high. Conclusions: Severe COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis.
Language	English
Publishing date	2021-07-06
Publishing country	Spain
Document type	Case Reports
ISSN	2387-0206
ISSN (online)	2387-0206
DOI	10.1016/j.medcle.2021.01.012
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Article ; Online: Leadless atrioventricular synchronous pacing: a validation pilot study with Holter monitoring.

Briongos Figuero, Sem / Estévez Paniagua, Álvaro / Sánchez Hernández, Ana / Abad-Motos, Ane / Ruiz, Alicia / Muñoz-Aguilera, Roberto

Revista espanola de cardiologia (English ed.)

2021 Volume 74, Issue 11, Page(s) 992–993

MeSH term(s)	Cardiac Pacing, Artificial ; Electrocardiography, Ambulatory ; Equipment Design ; Humans ; Pacemaker, Artificial ; Pilot Projects
Language	Spanish
Publishing date	2021-06-29
Publishing country	Spain
Document type	Case Reports
ZDB-ID	2592481-3
ISSN	1885-5857 ; 1885-5857
ISSN (online)	1885-5857
ISSN	1885-5857
DOI	10.1016/j.rec.2021.06.004
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Article ; Online: Patient satisfaction with remote monitoring of cardiac implantable electronic devices: the VALIOSA questionnaire.

Ruiz Díaz, Miguel A / Egea García, Marta / Muñoz Aguilera, Roberto / Viñolas Prat, Xavier / Silvestre García, Jorge / Álvarez Orozco, María / Martínez Ferrer, José

BMC health services research

2020 Volume 20, Issue 1, Page(s) 354

Abstract: Background: Remote monitoring of cardiac implantable electronic devices (CIEDs) has demonstrated substantial benefits. Treatment guidelines have therefore endorsed its use and is being increasingly adopted in the clinical setting, but the level of ... ...

Abstract	Background: Remote monitoring of cardiac implantable electronic devices (CIEDs) has demonstrated substantial benefits. Treatment guidelines have therefore endorsed its use and is being increasingly adopted in the clinical setting, but the level of satisfaction they convey remains still unknown. We developed and validated a questionnaire to measure patient satisfaction with remote monitoring using Medtronic CareLink® Network and assessed its internal reliability and dimensional validity. Methods: After a thorough literature review, cognitive debriefing of 18 patients, and an expert panel discussion, a 30-item instrument was proposed and grouped into 5 dimensions (items): 1- Information on cardiac condition (3), 2- Device convenience (3), 3- Transmission process (6), 4- Satisfaction with medical monitoring (8), and 5- General opinions (10). Correlation with the visual analog scale (VAS), overall health related quality of life (HRQoL) measured by the EuroQoL-5D accompanied by the VAS as well as with the Medical Outcomes Study (MOS) SF-36 were assessed. Psychometric properties, exploratory factor analysis and a second order confirmatory factor analysis (a hierarchical CFA with a general common factor explaining the relations between the first order common factors, See Figure 1) were estimated. Models were assessed based on item loading size, sign and statistical significance, and goodness-of-fit statistics. Results: A total of 186 patients (77% male) with a mean age of 66.03 (SD = 13.94) years were assessed. 48% had implantable cardioverter-defibrillators, 24% had pacemakers, and 29% had cardiac resynchronization therapy devices. An overall Cronbach's α = 0.893 was achieved, with acceptable reliabilities for isolated dimensions. Correlations with corresponding VAS scales were meaningful and significant (p < 0.01). The second order factor solution yielded good goodness-of-fit indexes (χ Conclusions: The 30-item questionnaire showed good reliability and validity to assess satisfaction with remote monitoring in patients with CIEDs.
MeSH term(s)	Aged ; Cardiac Resynchronization Therapy Devices ; Defibrillators, Implantable ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic/methods ; Pacemaker, Artificial ; Patient Satisfaction/statistics & numerical data ; Psychometrics ; Quality of Life ; Remote Sensing Technology ; Reproducibility of Results ; Surveys and Questionnaires
Language	English
Publishing date	2020-04-25
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-020-05216-3
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Article: Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain.

González-Juanatey, Carlos / Anguita-Sánchez, Manuel / Barrios, Vivencio / Núñez-Gil, Iván / Gómez-Doblas, Juan José / García-Moll, Xavier / Lafuente-Gormaz, Carlos / Rollán-Gómez, María Jesús / Peral-Disdier, Vicente / Martínez-Dolz, Luis / Rodríguez-Santamarta, Miguel / Viñolas-Prat, Xavier / Soriano-Colomé, Toni / Muñoz-Aguilera, Roberto / Plaza, Ignacio / Curcio-Ruigómez, Alejandro / Orts-Soler, Ernesto / Segovia-Cubero, Javier / Fanjul, Víctor /

Marín-Corral, Judith / Cequier, Ángel / Savana Research Group

Journal of clinical medicine

2023 Volume 12, Issue 16

Abstract: Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical ... ...

Abstract	Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead
Language	English
Publishing date	2023-08-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12165218
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