Papers by Juan Carlos Diaz
Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) pat... more Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods and Results: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005)....
Cardiac Electrophysiology, 2020
Multiple macroreentry circuits can coexist after previous cardiac surgery. Most of them are cause... more Multiple macroreentry circuits can coexist after previous cardiac surgery. Most of them are caused by post-procedural scar tissue, but it is also common to find “CTI-dependent circuit atrial flutter”.
Circulation, 2017
Background: Interatrial conduction block (IACB) is mainly considered to be an electric abnormalit... more Background: Interatrial conduction block (IACB) is mainly considered to be an electric abnormality of the Bachmann bundle that delays activation of the left atrium. IACB is manifest on a surface el...
EP Europace, 2020
AimsLeft atrial appendage electrical isolation (LAAEI) has been shown to improve freedom from all... more AimsLeft atrial appendage electrical isolation (LAAEI) has been shown to improve freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal atrial fibrillation (AF). The aim of this study is to investigate the long-term efficacy and safety outcomes of LAAEI in patients with non-paroxysmal AF undergoing catheter ablation.Methods and resultsA systematic review of Medline, Cochrane, and Embase was performed for clinical studies evaluating the benefit of LAAEI in non-paroxysmal AF. Nine studies with a total of 2336 patients were included (mean age: 65 ± 9 years, 63% male). All studies included patients with persistent AF, long-standing persistent AF, or both. At a mean follow-up of 40.5 months, patients who underwent LAAEI had significantly higher freedom from all-atrial arrhythmia recurrence than patients who underwent standard ablation alone [69.3% vs. 46.4%; risk ratio (RR) 0.54; 95% confidence interval (CI) 0.42–0.69; P < 0.0001]. A 46% relative risk reduction ...
Non-pulmonary veins triggers improve the rate of freedom of AF. Most of them can be targeted with... more Non-pulmonary veins triggers improve the rate of freedom of AF. Most of them can be targeted with focal ablation.
Journal of Cardiovascular Electrophysiology, 2021
Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac... more Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead‐related complications. Currently, objective data on TLE in Latin America is lacking.
Cardiac Electrophysiology Clinics, 2020
This paper presents experimental data concerning combustion characteristics of full-scale biomass... more This paper presents experimental data concerning combustion characteristics of full-scale biomass-fired bubbling fluidized bed (BFB) steam boiler with a thermal output of 31 MW. The purpose of the experimental measurements is to show how the values of selected combustion parameters vary in reality depending on measurement position. Experimentation involves specifically a determination of combustion gas temperature and concentration of gas species i.e. O 2 , CO 2 , CO and NO X at different positions in the furnace and the flue gas trains. Character of results from the furnace indicates the intermediate stage of thermochemical reactions. Increased levels of CO close to the wall have been found, this may be indicating reducing atmosphere and thereby increased corrosion risk. Results from flue gas trains demonstrate that behavior there is related to the fluid dynamics and heat transfer, the temperature is too low for further combustion reactions. Results show great variations among measured values of all measurands depending on a distance along the line from the wall to the center of the boiler. The measurements from permanently installed fixed sensors are not giving value representing average conditions, but overall profiles can be correlated to online measurements from fixed sensors.
Heart Rhythm, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Arrhythmia & Electrophysiology Review, 2019
Brugada syndrome (BrS) is one of the most common causes of sudden cardiac death in normal structu... more Brugada syndrome (BrS) is one of the most common causes of sudden cardiac death in normal structural heart individuals. First characterised in 1992, the global prevalence of BrS is unclear, with estimates placing it at around 0.05% and presenting most frequently in southeast Asian countries. This review aims to summarise the development in the understanding of BrS and, importantly, progress in its management, underpinned by knowledge regarding its genetics and molecular mechanisms. It also provides update on risk stratification and promising new therapies for BrS, including epicardial ablation. Future studies are required to increase understanding of the pathogenesis of this disease and to guide clinical practice.
Heart Rhythm, 2018
Background: The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) vent... more Background: The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs) is challenging as activation mapping can reveal similar activation times suggesting an intramural origin. Objective: We sought to assess whether in patients with intramural VAs and with multiple early activation sites (AS), sequential ablation of all the early AS could improve acute and long term outcomes. Methods: A total of 116 patients undergoing ablation for symptomatic LVOT VAs were enrolled in this study. Thirty-nine patients (34%) were referred for a redo procedure, whereas the remaining presented for a first procedure. Mapping was performed manually in 86 cases (74%) and with a magnetic robotic system (Stereotaxis) in the remainder of the cases. Results: Out of the 116 patients, 15 (13%) were found to have multiple sites of equally early AS.. In patients with multiple early AS, the mean pre-QRS activation time was significantly less when compared to patients with a single early site (-26 ± 3 msec vs-38 ± 6 msec p < 0.005). Sequential ablation of all the early AS was possible in 14 patients (93%), resulting in complete arrhythmia suppression. After a mean follow up of 21±5 months, all patients with successful ablation of all multiple early AS remained free from clinical VAs. Conclusions: Intramural LVOT VAs manifesting with multiple early AS require ablation at all sites to achieve acute and long-term success, particularly if none of the early sites is greater than-30 ms pre-QRS.
HeartRhythm Case Reports, 2018
HeartRhythm case reports, 2018
JACC. Clinical electrophysiology, 2018
This was a meta-analysis of published studies to examine the impact of early referral on outcomes... more This was a meta-analysis of published studies to examine the impact of early referral on outcomes after catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease. Patients are frequently referred for VT ablation after failure of antiarrhythmic drugs to control VT. Some studies have suggested that early referral might confer better outcomes. An electronic search was performed using major databases. The primary outcomes were long-term VT recurrence and total mortality. Secondary outcomes were acute procedural success and acute complications. Three studies were included with a total of 980 patients (mean age 64 ± 12 years, 71% males). Mean follow-up was 29 ± 27 months. Early referral for VT ablation was associated with decreased VT recurrence and acute complications compared with late referral (relative risk: 0.69 [95% confidence interval: 0.58 to 0.82], p < 0.0001 and relative risk: 0.50 [95% confidence interval: 0.27 to 0.93], p = 0.03, respectiv...
Arrhythmia & electrophysiology review, 2018
Atrial fibrillation remains the most common arrhythmia worldwide, with pulmonary vein isolation (... more Atrial fibrillation remains the most common arrhythmia worldwide, with pulmonary vein isolation (PVI) being an essential component in the treatment of this arrhythmia. In view of the close proximity of the oesophagus with the posterior wall of the left atrium, oesophageal injury prevention has become a major concern during PVI procedures. Oesophageal changes varying from erythema to fistulas have been reported, with atrio-oesophageal fistulas being the most feared as they are associated with major morbidity and mortality. This review article provides a detailed description of the risk factors associated with oesophageal injury during ablation, along with an overview of the currently available techniques to prevent oesophageal injury. We expect that this state of the art review will deliver the tools to help electrophysiologists prevent potential oesophageal injuries, as well as increase the focus on research areas in which evidence is lacking.
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Papers by Juan Carlos Diaz