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Lluís Mont

Publications and source records attributed to Lluís Mont.

At least 19 recordsLinked to original sources
PubMed2006

Relation of response to cardiac resynchronization therapy to left ventricular reverse remodeling.

Cardiac resynchronization therapy (CRT) reverses left ventricular (LV) remodeling in patients with congestive heart failure. However, the mechanisms leading to the clinical response to CRT remain unclear. The aim of this study was to analyze whether patients who improve clinically have greater LV reverse remodeling than nonresponders after a 12-month follow-up period. The sample comprised 64 consecutive patients with heart failure, complete left bundle branch block, and LV ejection fractions (EFs) < or =35% who were treated with CRT. Doppler echocardiographic scans were taken just before and immediately after the implantation of the pacemakers and at 6- and 12-month follow-up examinations. LV diameters, volumes, and EFs were compared. Responders were defined as those patients who were alive without cardiac transplantation and with > or =10% improvement in the 6-minute walking test after 1 year of follow-up. There were no clinical differences at baseline between responders and nonresponders. At 6- and 12-month follow-up, LV dimensions decreased significantly in responders but did not change in nonresponders. Furthermore, LVEFs improved only in responders. In conclusion, patients who clinically respond to CRT have greater LV reverse remodeling than nonresponders after 6 and 12 months of follow-up. The effect of CRT on LV remodeling may explain, at least in part, the clinical benefit of this therapy.

Aged↗
PubMed2005

Sport practice and the risk of lone atrial fibrillation: a case-control study.

BACKGROUND: Lone atrial fibrillation (LAF) is characterized by the presence of atrial fibrillation in the absence of structural heart disease or other identifiable cause of arrhythmia. In a recent study, we reported sport practice to be more frequent in LAF patients than in the general population. The aim of the study was to determine the association between sport practice and the prevalence of LAF in men. METHODS: An age-matched case-control study was designed. Cases were identified from consecutive patients who attended an outpatient clinic; 51 men with LAF were included, 20 of them with vagal characteristics. Controls were selected from the general population (n=109). A questionnaire to assess former and current sport practice and the number of lifetime hours of sport practice was administered. Conditional logistic regression was used for statistical analysis. RESULTS: The proportion of patients with LAF who reported current sport practice (31%) was higher than that observed in controls (14%). In the logistic regression, current practice of sport was associated with a higher prevalence of LAF (OR=3.13; 95% CI: 1.39-7.05). The practice of more than 1500 lifetime hours of sport appears to be the threshold for the observed association. Current practice of sport with a lifetime practice greater than 1500 h was associated with LAF (OR=2.87; 95% CI: 1.20-6.91). CONCLUSION: In men, the combination of current and prolonged lifetime sport practice is associated with higher risk of LAF.

Adult↗
PubMed2005

Predictors of lack of response to resynchronization therapy.

About 30% of patients treated with cardiac resynchronization therapy (CRT) do not respond to treatment. The aim of this study was to identify clinical predictors of lack of improvement in patients receiving CRT. From 197 consecutive patients scheduled to receive CRT, 143 fulfilled the inclusion criteria. Mean age was 68 +/- 7 years and 79% were men. Heart failure was due to ischemic heart disease in 49 patients (34%). Mean QRS duration was 165 +/- 26 ms, and left ventricular ejection fraction was 27 +/- 7%. Nonresponder patients were defined as those who died of heart failure, underwent heart transplantation, or did not increase the distance walked in 6 minutes >10%. At 6-month follow-up, there were 28 nonresponders (20%). Among nonresponders, 2 patients received a heart transplantation and 9 patients died of heart failure. In logistic regression analysis, independent predictors of lack of response to CRT were ischemic heart disease (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.2 to 7; p = 0.023), severe mitral regurgitation (OR 3.5, 95% CI 1.3 to 9; p = 0.014), and left ventricular end-diastolic diameter > or =75 mm (OR 3.1, 95% CI 1.1 to 8; p = 0.026). Patients with these 3 predictors had a probability response of 27%.

Aged↗
PubMed2004

Value of the implantable loop recorder for the management of patients with unexplained syncope.

AIM: Recurrent syncope often remains unexplained despite extensive multidisciplinary screening. The implantable loop recorder (ILR) may be a tool to define the cardiac arrhythmias underlying syncope. METHODS AND RESULTS: The study population consisted of 43 consecutive patients with unexplained syncope who underwent extensive cardiological screening and were followed with an ILR. During follow-up, 5 patients had only presyncope, 4 had palpitations, and 15 had a true recurrence of syncope. In all patients with palpitations, 3 with presyncope, and 7 with a recurrence of syncope, the ILR excluded arrhythmias. In the patients with a true recurrence, 1 had symptomatic paroxysmal atrial fibrillation (PAF) treated with drugs, 1 had polymorphic ventricular tachycardia (VT) and received an implantable cardioverter defibrillator (ICD), and 7 had asystole and received a pacemaker. Two patients with presyncope received a pacemaker for Mobitz II block and PAF with brady-tachycardia syndrome. One asymptomatic patient received a pacemaker for significant nocturnal asystole recorded by ILR. Abnormalities in the cardiac screening were observed both in patients with and without syncope, but none of these had a predictive value. CONCLUSION: The ILR is a valuable and effective tool to establish an arrhythmic cause for unexplained syncope. The results of head-up tilt testing (HUTT) and electrophysiological study (EPS) are neither sufficiently sensitive nor specific enough in this patient group.

Adolescent↗
PubMed2004

Radiofrequency catheter ablation for arrhythmic storm in patients with an implantable cardioverter defibrillator.

The aim of the study was to analyze the usefulness of RFA in controlling arrhythmic storm due to hemodynamically stable VT in a cohort of patients with an ICD and to evaluate the incidence of arrhythmic storm among patients with an ICD. A group of 13 (3%) of 403 consecutive ICD recipients were submitted to RFA of VT during an arrhythmic storm. Two additional patients were referred from other institutions. Standard criteria were used for VT endocardial ablation. A transcatheter epicardial approach was required in three patients. A total of 18 procedures were performed in 15 patients. A mean of 13.2 +/- 9.7 pulses of RF were delivered. Clinical tachycardia was successfully ablated in 12 (80%) patients. One patient died in incessant VT, 1 patient underwent heart transplant, and 1 was treated with direct current ablation. During a mean follow-up of 12 +/- 17 months, only two patients suffered a single episode of VT. Arrhythmic storm requiring VT ablation was uncommon among patients with an ICD and occurred late after ICD implantation. The arrhythmic episode was successfully controlled in the majority of patients with endocardial or epicardial RFA.

Adolescent↗
PubMed2004

Short head-up tilt test potentiated with oral nitroglycerine: comparison with a conventional test using isoproterenol.

Conventional tilt test protocols are time consuming and there is no consensus regarding the optimal duration of the test and the provocative drug to be used. This study evaluated the diagnostic power of a short nitroglycerine test against a conventional isoproterenol protocol. A cohort of 128 patients with unexplained syncope was studied. A group of 64 consecutive patients were tilted with a short nitroglycerine test consisting of a passive phase of 15 minutes and if this proved negative, 400 microg of sublingual nitroglycerin spray for a further 15 minutes. The control group consisted of 64 patients tilted with a conventional isoproterenol protocol with a passive phase of 30 minutes and a drug-challenge phase of 20 minutes. In the nitroglycerine protocol 39 (60.9%) patients showed a positive response versus 27(42.2%) in the isoproterenol group (P = 0.034). The duration of the protocol was 23.2 +/- 7.2 minutes in the nitroglycerine group versus 41.1 +/- 15.5 minutes with isoproterenol (P = 0.001). The time until syncope was 18.87 +/- 6.1 versus 29 +/- 18, respectively (P = 0.002). For evaluating unexplained syncope the short tilt test protocol with nitroglycerine is less time consuming, easier to perform, and has a higher rate of positive response than a conventional isoproterenol protocol.

Female↗
PubMed2004

[Predictors of lack of clinical improvement at mid-term follow-up with cardiac resynchronization therapy].

INTRODUCTION: About 30% of all patients do not respond to cardiac resynchronization therapy for heart failure. The objective of the study was to analyze the variables that may predict the lack of response. PATIENTS AND METHOD: We analyzed the results in a series of 63 patients who received cardiac resynchronization with a biventricular device. Clinical and left ventricular function parameters were evaluated at the beginning of the study and at 6 months. Responders were defined as those who were alive, had not received a heart transplant, and who achieved more than a 10% increase in distance in the 6-minute walking test. RESULTS: Mean age was 68.3 (8) years, 51 patients (81%) were men, and NYHA functional class was III-IV in 79.4%. Mean left ventricular ejection fraction was 22.4% (6)%, QRS width was 177 (25) ms, and 77.8% were in sinus rhythm. Almost half (46%, n=29) had ischemic heart disease. At 6-month follow-up, 69.8% of the patients were responders. Ischemic heart disease, sustained monomorphic ventricular tachycardia and a degree of mitral regurgitation >II/IV before implantation were associated with lack of response. No association was found for any of the other baseline variables. Logistic regression analysis identified all three of the aforementioned variables as independent predictors of lack of response: ischemic heart disease OR=4.8, 95% CI, 1.2-18.3, P=.023; ventricular tachycardia OR=8.7, 95% CI, 1.8-41.3, P=.007; and mitral regurgitation OR=8.03, 95% CI, 1.7-37.1, P=.008. CONCLUSION: The likelihood of responding to resynchronization therapy is lower in patients with ischemic heart disease, significant mitral regurgitation, or sustained monomorphic ventricular tachycardia.

Aged↗
PubMed2003

Comparison of effectiveness of implantable cardioverter defibrillator in patients with idiopathic dilated cardiomyopathy versus those with proved coronary heart disease.

This study analyzes the effectiveness of the implantable cardioverter defibrillator in a group of 40 consecutive patients with idiopathic dilated cardiomyopathy and sustained ventricular arrhythmia; these patients were compared with a control group of 80 consecutive patients with proved coronary artery disease. There were no differences in the type and probability of recurrences at follow-up. Most recurrences were due to sustained monomorphic ventricular tachycardia, and the efficacy of the defibrillator in treating the arrhythmia was the same in both groups.

Aged↗
PubMed2003

[Radiofrequency ablation in the treatment of focal atrial fibrillation using circumferential mapping and segmentary disconnection of pulmonary veins].

INTRODUCTION: The treatment of paroxysmal atrial fibrillation in patients without structural heart disease using radiofrequency ablation of pulmonary veins is a recently developed procedure with a good clinical success rate, although there have only been a few published series. We analyzed our results with this technique. METHOD: The procedure was performed in 33 highly symptomatic patients with focal atrial fibrillation that had probably originated in the pulmonary veins. The electrophysiological study was carried out with a decapolar catheter inserted by transeptal catheterization. Ablation was performed using a 4-mm catheter and directed to the segments of the ostium of pulmonary veins where venous potentials with greatest precocity were recorded. Subsequent radiofrecuency applications were performed until pulmonary vein disconnection was achieved. RESULTS: Venous electrical activity was recorded in 59 of 115 pulmonary veins that were mapped (58 were disconnected). During a median follow-up of 180 days, 8 patients recurred and only 2 of these continue with repeat episodes. The success rate at short term was 74.2% and at mid-term was 93.5%. Nineteen patients continue to receive antiarrhythmic treatment innefective before the procedure. Two patients showed complications related to catheter manipulation during tansseptal catheterization, probably due to air embolism, that was resolved spontaneously without consequences. No patient showed pulmonary stenosis. CONCLUSIONS: Teatment of focal atrial fibrillation using circumferential mapping and radiofrecuency application in segments of the ostium of pulmonary veins is a highly effective procedure in selected patients and has potentially severe although infrequent complications.

Atrial Fibrillation↗
PubMed2003

[Consensus document for the management of patients with atrial fibrillation in hospital emergency departments].

Atrial fibrillation (AF) is the most prevalent arrhythmia in hospital emergency departments and is a serious disease associated with a twofold increase in morbidity and a high mortality rate. However, the management of AF in this scenario is variable and frequently inadequate. This is probably a consequence of the diverse clinical aspects and therapeutic options to consider in the management of patients with AF. Therefore, implementation of specific, coordinated management strategies by the different care providers involved is needed to improve the quality of care and optimize the use of human and material resources. This document presents the guidelines recommended by the Spanish Society of Cardiology (SEC) and the Spanish Society of Emergency Medicine (SEMES) for the management of AF in hospital emergency departments. These guidelines are based on published scientific evidence and are applicable to most emergency departments in Spain. Specific management strategies are proposed for the conversion and maintenance of sinus rhythm, heart rate control during AF, prophylaxis for thrombi and emboli, and hospital admission and discharge protocols.

Atrial Fibrillation↗
PubMed2003

Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery.

OBJECTIVE: Anorexia nervosa is a life-threatening condition, with significant risk for death due to cardiac complications. The objective of this study was to analyze the cardiac involvement in anorexia nervosa and to study the reversibility of cardiac abnormalities. METHOD: Thirty-one consecutive adolescents (aged 12 to 17 years) with a diagnosis of anorexia nervosa were evaluated from January 1998 to January 1999 at the Hospital Clínic (University of Barcelona, Catalonia, Spain). An electrocardiogram, an echocardiogram, a 24-hour Holter recording with heart rate variability, an exercise test, and a tilt test were performed at initial examination and after refeeding (3 to 18 months later). RESULTS: The basal body mass index was 15.2 +/- 2 kg/m2. Sinus bradycardia was found in 35% of patients, 93% showed a decreased left ventricular mass, and 70% had a diminished thickness of cardiac walls. The Holter recordings showed nocturnal bradycardia in 60% with an increased heart rate variability. After refeeding, a significant decrease in QT interval (p <.05) and QT dispersion (p <.01) was observed. Echocardiograms showed an increase in cardiac diameters (p <.01), left ventricular mass (p <.001), and cardiac output (p <.001). There was also an improvement in the exercise capacity (p <.05) and a normalization of the heart rate and heart rate variability (p <.05). CONCLUSION: Cardiac structural and functional abnormalities provoked by anorexia nervosa are reversible in young adolescents after refeeding.

Adolescent↗