Biomedical subjects

Arcadi García-Alberola

Publications and source records attributed to Arcadi García-Alberola.

4 recordsLinked to original sources

PubMed2006

Alternative explanations to the differences of femoral and brachial saline contrast injections for echocardiographic detection of patent foramen ovale.

Patent foramen ovale (PFO) of the interatrial septum is a cardiac foetal remnant, which frequent persistence in adulthood has important implications in a variety of clinical conditions. Echographic diagnosis of PFO is based on detection of interatrial shunt by means of contrast microbubbles identification after venous injection of a first-generation echographic contrast agent. Current recommendations propose venous femoral injection of contrast for enhanced echographic detection of PFO instead of venous brachial administration, as femoral injection has been shown to have higher sensitivity for PFO detection. Inferior vena cava inflow directed toward interatrial septum has been considered the explanation for increased sensitivity of femoral delivery of contrast. In the present paper, it is hypothesised that the main determinants of these differences between injection sites are technical factors related to right atrial contrast opacification and proper transient right atrial pressure rise, rather than intraatrial flow streaming. Effects of inferior vena cava inflow stream, although significant during foetal life, would be negligible after birth. Rationale and evidence, basis for further research, and practical implications leading to a simpler and safer routine technique for echographic detection of PFO are presented and discussed.

Brachial Artery↗

PubMed2004

Acute and long-term outcome of transvenous cryoablation of midseptal and parahissian accessory pathways in patients at high risk of atrioventricular block during radiofrequency ablation.

The ability of transvenous cryothermal catheter ablation to create reversible lesions (cryomapping) and to avoid catheter dislodgment (cryoadherence) has been shown to be safe and highly effective in elimination of atrioventricular nodal reentrant tachycardia. In addition, cryoablation may be useful in the management of perinodal accessory pathways, but its efficacy and safety in patients at high risk of atrioventricular block during radiofrequency catheter ablation is unknown. This study prospectively evaluated the efficacy and safety of cryoablation in patients with midseptal and parahissian accessory pathways.

Adolescent↗

PubMed2002

Automatic discrimination between supraventricular and ventricular tachycardia using a multilayer perceptron in implantable cardioverter defibrillators.

The morphological analysis of implantable cardioverter defibrillator (ICD) stored electrograms (EGM) using a multilayer perceptron (MLP) has been proposed for discrimination between supraventricular and ventricular arrhythmias. However, a reliable estimation of the accuracy of MLP methods is lacking. The aim of the study was to compare the morphology and spectrum-based MLP with more conventional morphology-based algorithms in a large series of ICD-stored episodes of arrhythmia. One set of ICD-stored electrograms was used for control and training purposes and a second one, consisting of spontaneous episodes in patients with dual chamber ICDs, for validation of the MLP performance. The correlation waveform analysis (CWA) and the EGM width criterion were compared with MLP methods. Bootstrap resampling techniques were used to extract the relevant information in the MLP training. The morphology-based MLP achieved better discrimination than any other method, with areas under the receiver operating characteristic (ROC) curve (tolerance intervals): 0.96 (0.81, 0.96) for MLP, 0.91 (0.77, 0.94) for CWA, and 0.68 (0.49, 0.78) for EGM width in the validation set. A specificity of 73.0% was obtained at 95% sensitivity, compared with 38.1% and 55.1% using CWA and EGM width criteria, respectively. In contrast, the generalization capabilities of spectral-based MLP methods are poor, showing a lower area under the ROC curve in the validation set. Time-domain MLP techniques may be useful for the morphological analysis of the intracardiac EGM signal stored by ICD devices. When properly trained and validated, these methods perform better than other commonly used morphological criteria for discrimination between supraventricular and ventricular arrhythmias.

Algorithms↗

PubMed2002

Brugada-like electrocardiographic pattern induced by fever.

The Brugada syndrome is characterized by a peculiar ST-segment elevation in the right precordial leads and the propensity to develop ventricular arrhythmias. Mutations in a cardiac sodium channel gene have been linked to this syndrome and some experimental data suggest that the dysfunction of the mutated channel can be temperature sensitive. This report describes a patient in whom a typical Brugada ECG pattern developed in relation to fever but could not be reproduced at normal temperature on administration offlecainide. This case suggests that in some patients a Brugada-like ECG may only manifest during a febrile state.

Aged↗