University Hospital Brussels Brussels

Brussels, Belgium

University Hospital Brussels Brussels

Brussels, Belgium
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Rodriguez-Manero M.,University Hospital Brussels Brussels | Bertomeu-Gonzalez V.,Hospital Universitario Of San Juan | Cordero A.,Hospital Universitario Of San Juan | Moreno-Arribas J.,Hospital Universitario Of San Juan | And 7 more authors.
Revista Portuguesa de Cardiologia | Year: 2013

Aim: We sought to define trends in AF prevalence and its medical management using recent data based on data from two cross-sectional studies performed in a European country in 1999 and 2009. Methods: CARDIOTENS 1999 and CARDIOTENS 2009 were two observational, cross-sectional, multicenter studies. Patients were recruited in from primary care and cardiology outpatient clinics. A total of 32 051 and 25 137 subjects were analyzed in the two studies, 1540 and 1524 of them, respectively, diagnosed with AF. Results: Over the course of the study period there was an increase in the prevalence of AF (from 4.8% to 6.1%), mainly due to the higher prevalence of AF in patients aged over 70 years (24.7% vs. 37.1%). Furthermore, patients with AF had a higher prevalence of hypertension (64.9% vs. 87.0%), diabetes (19.0% vs. 37.4%), heart failure (30.8% vs. 34.8%), coronary artery disease (23.0% vs. 25.8%) and previous stroke (1.5% vs. 8.9%). An overall increase in prescription of antithrombotic/antiplatelet therapy was observed (33.0% vs. 62.7% and 31.0% vs. 38.2% respectively); the difference observed in 1999 between prescription of oral anticoagulation by general practitioners and cardiologists was not seen in the later study. Differences in prescription of angiotensin-converting enzyme inhibitors (28.0% vs. 40.7%), angiotensin receptor blockers (10.0% vs. 40.0%), beta-blockers (14.0% vs. 41.5%) and calcium channel blockers (21.0% vs. 34.9%) were also identified. Conclusions: The number of patients with AF and a higher risk for thromboembolic events increased over the last 10 years. More aggressive antithrombotic treatment has been observed, especially in older patients. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved.


PubMed | University Hospital Brussels Brussels and University of Navarra
Type: Journal Article | Journal: Journal of atrial fibrillation | Year: 2016

At the present time there is still concern regarding the long-term deleterious effects of right ventricular apical pacing in patients referred for auriculoventricular node ablation (AVNA). Furthermore, scarce information is available regarding differences in the follow up according to the baseline cardiopathy and predictors associated with a worse outcome.104 consecutives patients referred for AVNA were retrospectively analyzed. Patients included were seen in the outpatient clinic at 6, 12 and 24 months post ablation (mean follow-up 24 2 months). An echocardiogram two years after the procedure was obtained in 68 patients. Three categories were done according to the change in the left ventricular function (LVEF) (increase, decrease or absence of change, defined as less than 10% variation in either LVEF).After two years of follow up there was a decrease in the rate of hospital admission (from 0.9 admission/year to 0.35, p<0.001), an increase in the functional status in at least one NYHA class in 58 patients, and an increase in the global LVEF (from 48.9% to 54,1%; p<0.001). Valvular replacement and LVEF less than 50% were independently associated with a decrease in the LVEF. Regarding safety issues, one patient who presented a polymorphic ventricular tachycardia (Torsade de pointes) 60 minutes after the ablation.AVNA results in a decrease in hospital admission rates and an improvement in functional status. Baseline LVEF < 50% and mitral valvulopathy were multivariate predictor of LVEF decline, hence, it is our belief that, in this particular population, the ablate and pace strategy is not the most suitable option, and or maybe a biventricular pacemaker should be implanted or an AF ablation reconsidered. Finally, although it is a safe procedure and rate of complications were low, there is a potential risk of fatal complications.


Rodriguez-Manero M.,University Hospital Brussels Brussels | Cordero A.,Hospital Universitario Of San Juan | Bertomeu-Gonzalez V.,Hospital Universitario Of San Juan | Moreno-Arribas J.,Hospital Universitario Of San Juan | And 7 more authors.
Revista Espanola de Cardiologia | Year: 2011

Introduction and objectives: The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the 'low', 'moderate', and 'high' risk categories. The objective of this study was to determine the impact of the new scheme CHA 2DS 2-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists. Methods: Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period. Results: Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS 2 score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA 2DS 2-VASc score: 14.4% were aged 75 years or older (CHA 2DS 2-VASc = 2). Of those younger than 75, 42.3% had a CHA 2DS 2-VASc = 2; 23.7% CHA 2DS 2-VASc = 3, and 1.1% CHA 2DS 2-VASc = 4. This means that the 85.1% of the patients with a CHADS 2 score <2 and no contraindications are indicated for OAC. Conclusions: The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation. Full English text available from: www.revespcardiol.org © 2011 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved. 15.


PubMed | University Hospital Brussels Brussels
Type: Journal Article | Journal: Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2013

We sought to define trends in AF prevalence and its medical management using recent data based on data from two cross-sectional studies performed in a European country in 1999 and 2009.CARDIOTENS 1999 and CARDIOTENS 2009 were two observational, cross-sectional, multicenter studies. Patients were recruited in from primary care and cardiology outpatient clinics. A total of 32 051 and 25 137 subjects were analyzed in the two studies, 1540 and 1524 of them, respectively, diagnosed with AF.Over the course of the study period there was an increase in the prevalence of AF (from 4.8% to 6.1%), mainly due to the higher prevalence of AF in patients aged over 70 years (24.7% vs. 37.1%). Furthermore, patients with AF had a higher prevalence of hypertension (64.9% vs. 87.0%), diabetes (19.0% vs. 37.4%), heart failure (30.8% vs. 34.8%), coronary artery disease (23.0% vs. 25.8%) and previous stroke (1.5% vs. 8.9%). An overall increase in prescription of antithrombotic/antiplatelet therapy was observed (33.0% vs. 62.7% and 31.0% vs. 38.2% respectively); the difference observed in 1999 between prescription of oral anticoagulation by general practitioners and cardiologists was not seen in the later study. Differences in prescription of angiotensin-converting enzyme inhibitors (28.0% vs. 40.7%), angiotensin receptor blockers (10.0% vs. 40.0%), beta-blockers (14.0% vs. 41.5%) and calcium channel blockers (21.0% vs. 34.9%) were also identified.The number of patients with AF and a higher risk for thromboembolic events increased over the last 10 years. More aggressive antithrombotic treatment has been observed, especially in older patients.

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