Person:
Pérez Villacastín Domínguez, Julián

First Name

Julián

Last Name

Pérez Villacastín Domínguez

URI

https://hdl.handle.net/20.500.14352/79096

Affiliation

Universidad Complutense de Madrid

Faculty / Institute

Medicina

Department

Medicina

Area

Medicina

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Now showing 1 - 10 of 22

Coronary angiography in patients without ST-segment elevation following out-of-hospital cardiac arrest. COUPE clinical trial
(2023) Viana Tejedor, Ana Teresa; Martínez-Sellés D Oliveira Soares, Manuel; Fernández Ortiz, Antonio Ignacio; Pérez Villacastín Domínguez, Julián
El papel de la coronariografía urgente y angioplastia, si procede, en los pacientes con parada cardiaca extrahospitalaria (PCEH) recuperada que no presentan elevación del segmento ST es controvertido. Nuestro objetivo fue evaluar si la coronariografía urgente y la angioplastia mejoran la supervivencia con buen pronóstico neurológico en esta población. En este ensayo clínico multicéntrico, aleatorizado, abierto, incluimos 69 pacientes supervivientes a una PCEH sin elevación del ST y se aleatorizaron a recibir una coronariografía urgente (CU) o diferida (CD). El objetivo primario de eficacia fue el combinado de supervivencia hospitalaria libre de dependencia. El objetivo de seguridad fue un compuesto de eventos cardiacos mayores, incluyendo muerte, reinfarto, sangrado y arritmias ventriculares. Resultados: Se incluyó a 66 pacientes en el análisis primario (95,7%). La supervivencia hospitalaria fue 62,5% en el grupo CU y 58,8% en el grupo CD (HR = 0,96; IC95%, 0,45-2,09; p = 0,93). La supervivencia hospitalaria con buen pronóstico neurológico fue 59,4% en el grupo CU y 52,9% en el grupo CD (HR = 1,29; IC95%, 0,60-2,73; p = 0,4986). No se encontraron diferencias en los objetivos secundarios, salvo por la incidencia de fracaso renal agudo, que fue más frecuente en el grupo CU (15,6 frente a 0%, p = 0,002) y de infecciones, más prevalentes en el grupo CD (46,9 frente a 73,5%, p = 0,003). Conclusiones: En este estudio aleatorizado de pacientes con una PCEH sin elevación del ST, una coronariografía urgente no fue beneficiosa en términos de supervivencia con buen pronóstico neurológico comparada con una coronariografía diferida.
Mechanistic Approaches to Detect, Target, and Ablate the Drivers of Atrial Fibrillation
(Circulation: Arrhythmia and Electrophysiology, 2016) Quintanilla, Jorge G.; Pérez Villacastín Domínguez, Julián; Pérez Castellano, Nicasio; Pandit, Sandeep V.; Berenfeld, Omer; Jalife, José; Filgueiras Rama, David
Selection of the Best of 2016 in Catheter Ablation
(Revista española de cardiología, 2011) Filgueiras-Rama, David; Bogun, Frank; Morady, Fred; Jalife, José; Pérez Castellano, Nicasio; Pérez Villacastín Domínguez, Julián
KATP channel opening accelerates and stabilizes rotors in a swine heart model of ventricular fibrillation
(Cardiovascular Research, 2023) Quintanilla, Jorge G.; Moreno, Javier; Archondo, Tamara; Pérez Castellano, Nicasio; Usandizaga, Elena; García Torrent, María Jesús; Molina Morúa, Roberto; González, Pablo; Rodríguez Bobada, Cruz; Macaya Miguel, Carlos; Pérez Villacastín Domínguez, Julián
Aims The mechanisms underlying ventricular fibrillation (VF) are still disputed. Recent studies have highlighted the role of KATP-channels. We hypothesized that, under certain conditions, VF can be driven by stable and epicardially detectable rotors in large hearts. To test our hypothesis, we used a swine model of accelerated VF by opening KATP-channels with cromakalim. Methods and results Optical mapping, spectral analysis, and phase singularity tracking were performed in eight perfused swine hearts during VF. Pseudo-bipolar electrograms were computed. KATP-channel opening almost doubled the maximum dominant frequency (14.3 ± 2.2 vs. 26.5 ± 2.8 Hz, P < 0.001) and increased the maximum regularity index (0.82 ± 0.05 vs. 0.94 ± 0.04, P < 0.001), the density of rotors (2.0 ± 1.4 vs. 16.0 ± 7.0 rotors/cm2×s, P < 0.001), and their maximum lifespans (medians: 368 vs. ≥3410 ms, P < 0.001). Persistent rotors (≥1 movie = 3410 ms) were found in all hearts after cromakalim (mostly coinciding with the fastest and highest organized areas), but they were not epicardially visible at baseline VF. A ‘beat phenomenon’ ruled by inter-domain frequency gradients was observed in all hearts after cromakalim. Acceleration of VF did not reveal any significant regional preponderance. Complex fractionated electrograms were not found in areas near persistent rotors. Conclusion Upon KATP-channel opening, VF consisted of rapid and highly organized domains mainly due to stationary rotors, surrounded by poorly organized areas. A ‘beat phenomenon’ due to the quasi-periodic onset of drifting rotors was observed. These findings demonstrate the feasibility of a VF driven by stable rotors in hearts whose size is similar to the human heart. Our model also showed that complex fractionation does not seem to localize stationary rotors.
Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status
(International Journal of Cardiology, 2015) Filgueiras Rama, David; Pérez Castellano, Nicasio; Pérez Villacastín Domínguez, Julián; Quintanilla, Jorge G.; Millet, José
Background Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. Methods Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive model was developed in a retrospective cohort (n = 32; September 2006–September 2011, 48.5 ± 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011–July 2013, 5 ± 1.8 months of follow-up). Results FNP was present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p < 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity = 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic ≥ 0.89. Conclusions A spectral analysis-based model reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest.
Errors in pulmonary vein identification and ostia location in the absence of pulmonary vein imaging
(Heart Rhythm, 2005) Pérez Castellano, Nicasio; Pérez Villacastín Domínguez, Julián; Moreno Planas, Javier; Rodríguez Bernal, Aníbal; Moreno, Mauricio; Conde, Asunción; Morales, Ricardo; Macaya Miguel, Carlos
Background: A key point in atrial fibrillation (AF) ablation is the ability to identify the pulmonary vein (PVs) and locate their ostia. Objectives: The purpose of this study was to assess the error margin of PV identification and ostia location in the absence of previous PV imaging. Methods: This study was performed in patients referred for catheter ablation of AF. PVs were reconstructed before ablation using the CARTO system. The operator tagged the superior and inferior edges of the PV ostia before and after examining the corresponding PV angiograms. The distances between the tagged PV ostia were measured using CARTO software. Results: A total of 105 location estimations of 54 PVs were analyzed. The location of PV ostia without angiography deviated from the angiographic PV ostia by a median of 13 mm (95% confidence interval = 11-14 mm; P < .0001). In 84 of the 105 estimations (80%), wrong tagging was performed inside the PV. A multiple logistic regression revealed that, at sites displaying PV potentials, the left atrial potential amplitude was an independent predictor of location at the angiographic PV ostium (odds ratio 24 [95% confidence interval = 3.7-227] per 1-mV increase). Receiver operator characteristic analysis set the optimal cutoff level at 0.7 mV. Use of this criterion improved the accuracy of PV ostium location by 4 mm (95% confidence interval = 1-6 mm; P = .005). Conclusion: Attempts at PV identification and ostia location in the absence of previous PV imaging are subject to a broad error margin
Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement
(Journal of Clinical Medicine, 2023) Alberto de Agustín, José; Pozo Osinalde, Eduardo; Olmos, Carmen; Mahia Casado, Patricia; Marcos Alberca, Pedro; Luaces Méndez, María; Gómez de Diego, José Juan; Nombela Franco, Luis; Jiménez Quevedo, Pilar; Tirado Conte, Gabriela; Collado Yurrita, Luis Rodolfo; Fernández Ortiz, Antonio Ignacio; Pérez Villacastín Domínguez, Julián
This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and “valve in valve” procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.
Pathological effects of pulmonary vein beta-radiation in a swine model
(Journal of Cardiovascular Electrophysiology, 2006) Pérez Castellano, Nicasio; Pérez Villacastín Domínguez, Julián; Aragoncillo Ballesteros, Paloma; Fantidis, Panayotis; Sabaté, Manel; García Torrent, María Jesús; Prieto Martín, Carlos; Corral, José M.; Moreno, Javier; Fernández Ortiz, Antonio Ignacio; Vaño Carruana, Eliseo; Macaya Miguel, Carlos
Introduction: Atrial fibrillation (AF) may be triggered by ectopic beats originating in sleeves of atrial myocardium entering the pulmonary veins (PVs). PV isolation by means of circumferential ostial or atrial radiofrequency ablation is an effective but also a difficult and long procedure, requiring extensive applications that can have serious potential complications. Our objective was to examine pathological effects of PV β-radiation, particularly the ability to destroy PV myocardial sleeves without inducing PV stenosis and other unwanted effects, in order to establish its potential feasibility for the treatment of AF. Methods and Results: Ten minipigs were studied. A phosphorus-32 source wire centered within a 2.5-mm diameter balloon catheter (Galileo® III Intravascular Radiotherapy System, Guidant, Santa Clara, CA, USA) was used to deliver β-radiation to the superior wall of the right PV trunk. Pathological analysis was performed either immediately after ablation (2 pigs) or 81 ± 27 days later (8 pigs). Acute effects of PV β-radiation consisted of endothelial denudation covered by white thrombus, elastic lamina disruption, and PV sleeve necrosis. Late effects consisted of mild focal neointimal hyperplasia that reduced the PV luminal area by only 1.3 ± 1.8%, elastic lamina thickening, and PV sleeve fibrosis. Four of these 8 PVs were completely re-endothelized. Lesions were transmural in 6 of 10 radiated PVs and segmental, involving 28 ± 7% of the right PV perimeter. Conclusion: Intravascular β-radiation can induce transmural necrosis and fibrosis of PV myocardial sleeves without PV stenosis and other unwanted effects, which supports a potential usefulness of this energy source in the treatment of AF.
Epicardial Connections Between the Pulmonary Veins and Left Atrium: Relevance for Atrial Fibrillation Ablation
(Journal of Cardiovascular Electrophysiology, 2011) Pérez Castellano, Nicasio; Pérez Villacastín Domínguez, Julián; Salinas, Jorge; Vega, Mercedes; Moreno, Javier; Doblado, Manuel; Ruiz, Eduardo; Macaya Miguel, Carlos
Epicardial Connections Between PVs and the LA. Introduction: Some observations support the existence of epicardial connections (ECs) between ipsilateral pulmonary veins (vein to vein ECs [VVECs]), and we have observed venoatrial ECs inserted at distance from the pulmonary vein ostium (vein to atrium ECs [VAECs]). Our aim was to determine the prevalence of ECs and their relevance for pulmonary vein isolation. Methods and Results: We studied 100 consecutive patients with drug-refractory atrial fibrillation who underwent ostial pulmonary vein isolation by cooled radiofrequency catheter ablation. A VVEC was identified if pulmonary vein pacing activated the ipsilateral vein before the atrium, requiring ablation of both venous ostia to isolate either pulmonary vein. A VAEC was identified if pacing produced atrial breakthrough located at distance from the venous ostium, requiring extraostial ablation to isolate the pulmonary vein. Patients with ECs (20%) were younger (P = 0.02) and had a higher prevalence of structural heart disease (P = 0.01) than patients without ECs. VVECs and VAECs were identified in 32 pulmonary veins (10%) and VAECs in 10 veins (3%). Veins with ECs had a higher rate of early recurrence of conduction following isolation (29% vs 11%; P = 0.01). Conclusion: Twenty percent of patients with atrial fibrillation had ECs resistant to ostial ablation in one or more pulmonary veins. Isolating veins with ECs may require a different ablation approach. These connections are associated with an increased rate of early recurrence of conduction.
Effect of Primary Care Center Characteristics, Healthcare Worker Vaccination Status and Patient Economic Setting on Patient Influenza Vaccination Coverage Rates
(Vaccines, 2023) Bengoa Terrero, C; Bas Villalobos, M; Pastor Rodríguez-Moñino, A; Lasheras Carbajo, MD; Pérez Villacastín Domínguez, Julián; García Torrent, María Jesús; Sánchez del Hoyo, R; Bengoa San Sebastian, E; García Lledó, A
Background: Reaching the public health organizations targets of influenza vaccination in at-risk patient groups remains a challenge worldwide. Recognizing the relationship between the healthcare system characteristics and the economic environment of the population with vaccination uptake can be of great importance to improve. Methods: Several characteristics were correlated in this retrospective ecological study with data from 6.8 million citizens, 15,812 healthcare workers across 258 primary care health centers, and average income by area of the care center in Spain. Results: No correlation between HCW vaccination status and patient vaccination was found. A weak negative significant correlation between the size of the population the care center covers and their vaccination status did exist (6 mo.–59 yr., r = 0.19, p = 0.002; 60–64 yr., r = 0.23, p < 0.001; ≥65 yr., r = 0.23, p ≥ 0.001). The primary care centers with fewer HCWs had better uptake in the at-risk groups in the age groups of 60–64 yr. (r = 0.20, p = 0.002) and ≥65 (r = 0.023, p ≥ 0.001). A negative correlation was found regarding workload in the 6 mo.–59 yr. age group (r = 0.18, p = 0.004), which showed the at-risk groups that lived in the most economically deprived areas were more likely to be vaccinated. Conclusions: This study reveals that the confounding variables that determine influenza vaccination in a population and in HCWs are complex. Future influenza campaigns should address these especially considering the possibility of combining influenza and SARS-CoV-2 vaccines each year.