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Prof. Josep Brugada
During the year 2005 new information has become available concerning issues in arrythmology. This article presents a summary of the most relevant ones, in the opinion of the author, presented at the ESC annual meeting in Stockholm.
Epidemiological, clinical and pathological characteristics of sudden death in the Mediterranean area were analysed in M. Subirana's EULALIA project. A total of 121 SD victims were studied, 100 men (54 ± 15 years) and 21 women (60 ± 11 years). A cardiovascular disease was documented in 109 (90%), non cardiovascular in 6 (5%), and no pathological findings in 6 (5%). However the most relevant finding was the presence of coronary artery disease in only 55% of the patients and cardiac hypertrophy in about 50% of patients, much lower than expected in similar populations from other areas of the world. These findings might suggest a different profile in sudden death victims depending on their geographical origin.
Survival from out of hospital cardiac arrest was compared in patients receiving rapid defibrillation with an automatic external defibrillator with patients receiving late or no defibrillation in a study from C. Barret. A total of 103 cardiac arrest in public places were analysed. In 90 cases no on site EAD was available, and survival in this group was 4,4%. In 13 cases a public access EAD was available. Survival was 54% in this group. The results are quite evident and reinforce the idea that public access defibrillation is the most effective means to improving survival from SCD in public places.
Brouwer, presented the SOFA study, a study on the effects of Omega-3 fatty acids in ventricular arrhythmias in ICD patients. A total of 546 patients with an ICD were randomised to fish oil (276 patients) and placebo oil (276 patients). The study was parallel, double-blind, randomised and 2 g/day fish oil provided ± 900 mg n-3 fatty acids equivalent to about 3-4 fish meals per week. After one year follow-up no differences were observed in terms of time to first VT or VF episode or time to survival. Unfortunately the study was negative for the effects of fish oil in improving ventricular arrhythmias in this high risk population.
Genetically determined arrhythmias has been a focus of interest also during 2005. C. Wolpert, A. Leenhardt, J. Hoobs and A. Sarkozy presented different aspects on catecholaminergic polymorphic ventricular tachycardias, short QT syndrome, long QT syndrome and Brugada syndrome. Risk stratification, and new genetic defects were presented. Our knowledge in this field grows every year and we are now able to recognise most cases using the ECG as a major tool.
Many presentations related to the Euro Heart survey on atrial fibrillation. More than 5000 patients were collected around Europe to analyse different aspects of atrial fibrillation and its management. Probably one of the more interesting issues was the finding that population at high risk of stroke are less protected with oral anticoagulation than medium or low risk population (probably related to age, and fair of the phycisian to bleeding problems in this older age group).
E. Kozluk presented the results of EURAFA, the European atrial fibrillation registry. This study reviewed the results of AF ablation in medium size centers in Europe. A total of 476 patients were analyzed. In 59 cases a second procedure was needed. Acute success was documented in 92% of cases, but 42% recurred. Acute complications occurred in 5% of patients and life threatening complications in 1,8%. This study shows the results a physician might expect from an ablation procedure in standard centres in Europe.
A significant number of studies related to resynchronisation therapy were presented. A. Auricchio presented a multicenter study on long term benefits of CRT. A total of 1298 patients with a mean EF of 25% were studied. At 2 and 5 years follow-up, 92 and 56% of patients respectively were free of events (death, need for assist device or heart transplant), suggesting a highly significant benefit in this population. M. Gasparini and I. Fernandez-Lozano presented the beneficial effects of biventricular pacing in narrow QRS complex patients and in patients presenting with right bundle branch block, suggesting a widening in the indications of this therapy.
Finally, S. Ernst presented the feasibility of catheter ablation of AV nodal reentrant tachycardias using a remote navigation system without the need for fluoroscopic image. The results were very encouraging and suggested that in the future we might not need to use standard Rx sources to perform RF ablation.
The full presentation and slides are available for download here.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
Josep Brugada, Chairman of the Thorax Institute, Hospital Clínic, University of Barcelona, Spain firstname.lastname@example.org