Ramos, P. (Pablo)
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- A remote nutritional intervention to change the dietary habits of patients undergoing ablation of atrial fibrillation: randomized controlled trial(JMIR Publications, 2020) Martinez-Gonzalez, M.A. (Miguel Ángel); Castellanos, E. (Eduardo); Macias-Ruiz, R. (Rosa); Almendral, J. (Jesús); Barrio-Lopez, M.T. (Maria T.); Ibáñez-Criado, A. (Alicia); Goñi-Mateos, L. (Leticia); Tercedor, L. (Luis); Ruiz-Canela, M. (Miguel); Garcia-Bolao, I. (Ignacio); De-la-O-Pascual, V. (Víctor); Ramos, P. (Pablo); Ibáñez-Criado, J.L. (José Luis)Background: The Prevention With Mediterranean Diet (PREDIMED) trial supported the effectiveness of a nutritional intervention conducted by a dietitian to prevent cardiovascular disease. However, the effect of a remote intervention to follow the Mediterranean diet has been less explored. Objective: This study aims to assess the effectiveness of a remotely provided Mediterranean diet–based nutritional intervention in obtaining favorable dietary changes in the context of a secondary prevention trial of atrial fibrillation (AF). Methods: The PREvention of recurrent arrhythmias with Mediterranean diet (PREDIMAR) study is a 2-year multicenter, randomized, controlled, single-blinded trial to assess the effect of the Mediterranean diet enriched with extra virgin olive oil (EVOO) on the prevention of atrial tachyarrhythmia recurrence after catheter ablation. Participants in sinus rhythm after ablation were randomly assigned to an intervention group (Mediterranean diet enriched with EVOO) or a control group (usual clinical care). The remote nutritional intervention included phone contacts (1 per 3 months) and web-based interventions with provision of dietary recommendations, and participants had access to a web page, a mobile app, and printed resources. The information is divided into 6 areas: Recommended foods, Menus, News and Online resources, Practical tips, Mediterranean diet classroom, and Your personal experience. At baseline and at 1-year and 2-year follow-up, the 14-item Mediterranean Diet Adherence Screener (MEDAS) questionnaire and a semiquantitative food frequency questionnaire were collected by a dietitian by phone.
- Combination of Circulating Type I Collagen-Related Biomarkers Is Associated With Atrial Fibrillation(2019) Moreno, M.U. (María Ujué); Querejeta, R. (Ramón); Ravassa, S. (Susana); Gonzalez, A. (Arantxa); Ballesteros, G. (Gabriel); Garcia-Bolao, I. (Ignacio); Bragard, J. (Jean); López, B. (Begoña); Vives, E. (Enrique); Ramos, P. (Pablo); Diez, J. (Javier)Background A combination of circulating biomarkers associated with excessive myocardial collagen type-I cross-linking or CCL+ (i.e., decreased carboxy-terminal telopeptide of collagen type-I to matrix metalloproteinase-1 ratio) and with excessive myocardial collagen type-I deposition or CD+ (i.e., increased carboxy-terminal propeptide of procollagen type-I) has been described in heart failure (HF) patients and associates with poor outcomes. Objectives The purpose of this study was to investigate whether the CCL+CD+ combination of biomarkers associates with atrial fibrillation (AF). Methods Biomarkers were analyzed in serum samples from 242 HF patients (study 1) and 150 patients referred for AF ablation (study 2). Patients were classified into 3 groups (CCL−CD−, CCL+CD− or CCL−CD+, and CCL+CD+) in accordance to biomarker threshold values. Left atrial electroanatomic high-density mapping was performed in 71 patients from study 2. Results In study 1, 53.7% patients had AF at baseline and 19.6% developed AF (median follow-up 5.5 years). Adjusted odds and hazard ratios associated with baseline and new-onset AF, respectively, were both ≥3.3 (p ≤ 0.050) in CCL+CD+ patients compared with CCL−CD− patients, with nonsignificant changes in the other group. In study 2, 29.3% patients had AF recurrence during 1-year post-ablation. The adjusted hazard ratio for AF recurrence was 3.4 (p = 0.008) in CCL+CD+ patients compared with CCL−CD− patients, with nonsignificant changes in the other group. The CCL+CD+ combination added incremental predictive value over relevant covariables. CCL+CD+ patients exhibited lower left atrial voltage than the remaining patients (p = 0.005). Conclusions A combination of circulating biomarkers reflecting excessive myocardial collagen type-I cross-linking and deposition is associated with higher AF prevalence, incidence, and recurrence after ablation.
- Association of left atrium voltage amplitude and distribution with the risk of atrial fibrillation recurrence and evolution after pulmonary vein isolation: An ultrahigh-density mapping study(2019) Moreno, M.U. (María Ujué); Ravassa, S. (Susana); Wise, B. (Bernardo); Gonzalez, A. (Arantxa); Ballesteros, G. (Gabriel); Garcia-Bolao, I. (Ignacio); Bragard, J. (Jean); López, B. (Begoña); Vives, E. (Enrique); Ramos, P. (Pablo); Diez, J. (Javier); Neglia, R. (Renzo)Introduction Ultrahigh-density-voltage mapping (uHDVM) is a new tool that can add new insights into the pathophysiology of atrial fibrillation (AF). The aim of this study was to evaluate the performance of uHDVM in predicting postablation AF recurrence (AFR). Methods and Results We included 98 consecutive patients undergoing pulmonary vein isolation for AF (40.8% persistent) using an uHDVM system and followed for 1 year. The left atrium (LA) mean voltage (Vm) and the Vslope (slope of the voltage histogram calculated by linear interpolation, with the relative frequency on the vertical axis and the bipolar potential on the horizontal axis) were calculated from 12 567 ± 5486 points per map. Patients with AFR (N = 29) had lower Vm and higher Vslope as compared with patients without AFR (N = 69). Receiver operating characteristic curves identified Vm as the strongest predictor of AFR, with a higher incidence of AFR in patients with Vm 0.758 mV (57.6%) or lower than patients with Vm higher than 0.758 mV (15.4%; P < .0001). Among patients with Vm higher than 0.758 mV, patients with Vslope 0.637 or higher exhibited higher (P = .043) AFR incidence (31.3%) than patients with Vslope lower than 0.637 (10.2%). This classification showed incremental predictive value over relevant covariables. Vm values were lower and Vslope values were higher in patients that progressed from paroxysmal to persistent AF. Patients with Vslope 0.637 or higher had a 14.2% incidence of postablation atypical atrial flutter, whereas patients with Vslope lower than 0.637 did not present this outcome. Conclusions The risk of AFR, atrial flutter, and progression from paroxysmal to persistent AF can be detected by quantitative analysis of LA uHDVM identifying diverse patterns of atrial substrate alterations.