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Da Costa A, Benali K. Leadless pacemaker: The revolution is underway. Trends Cardiovasc Med 2024:S1050-1738(24)00029-X. [PMID: 38555030 DOI: 10.1016/j.tcm.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Antoine Da Costa
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France.
| | - Karim Benali
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France
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2
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Vial M, Hean V, Da Costa A, Camdessanché JP, Garnier P, Guichard JB. Implications of atrial cardiomyopathy in the incidence of cardioembolic events in patients with cryptogenic stroke. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00105-1. [PMID: 38555068 DOI: 10.1016/j.rec.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Marine Vial
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Virginie Hean
- Department of Neurology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France; Laboratoire Sainbiose, University Jean Monnet, Saint-Étienne, France
| | - Jean-Philippe Camdessanché
- Department of Neurology, University Hospital of Saint-Étienne, Saint-Étienne, France; Institut NeuroMyoGène, University Claude Bernard, Lyon, France
| | - Pierre Garnier
- Department of Neurology, University Hospital of Saint-Étienne, Saint-Étienne, France; Laboratoire Sainbiose, University Jean Monnet, Saint-Étienne, France
| | - Jean-Baptiste Guichard
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France; Laboratoire Sainbiose, University Jean Monnet, Saint-Étienne, France; Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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3
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Benali K, Vlachos K, Reddy VY, Verma A, Chun J, Andrade J, Macle L, Da Costa A, Jaïs P, Hocini M. Pulsed field ablation for atrial fibrillation in real-life settings: Efficacy, safety, and lesion durability in patients with recurrences. Heart Rhythm 2024:S1547-5271(24)00127-9. [PMID: 38341122 DOI: 10.1016/j.hrthm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Jean-Monnet University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France.
| | - Konstantinos Vlachos
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France
| | - Vivek Y Reddy
- Department of Cardiology, Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, New York
| | - Atul Verma
- Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julian Chun
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias (FAFA), Frankfurt, Germany
| | - Jason Andrade
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, Jean-Monnet University, Saint-Etienne, France
| | - Pierre Jaïs
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France
| | - Mélèze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France
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4
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Hauguel-Moreau M, Guedeney P, Dauphin C, Auffret V, Marijon E, Aldebert P, Clerc JM, Beygui F, Elbaz M, Khalil WA, Da Costa A, Macia JC, Elhadad S, Cayla G, Brugier D, Silvain J, Hammoudi N, Duthoit G, Vicaut E, Montalescot G. Flecainide to prevent atrial arrhythmia after patent foramen ovale closure Rationale and design of the randomized AFLOAT study. Eur Heart J Cardiovasc Pharmacother 2024:pvad100. [PMID: 38216511 DOI: 10.1093/ehjcvp/pvad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN The Assessment of Flecainide to Lower the patent foramen Ovale closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release dose) for 6 months (Group 1), Flecainide (150 mg per day in a single sustained-release dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analyzed as a secondary objective of the study. CONCLUSION AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. Clinical trial registration: NCT05213104 (clinicaltrials.gov).
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Affiliation(s)
- Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, INSERM U1018, CESP, ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital (AP-HP), Boulogne, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Claire Dauphin
- Department of Cardiology and Cardiovascular Diseases, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Vincent Auffret
- University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | | | - Jean-Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Farzin Beygui
- CHU de la Côte de Nacre, Département de Cardiologie, Caen, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Wissam Abi Khalil
- Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, Angers, France
| | - Antoine Da Costa
- Service de cardiologie, hôpital Nord, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France
| | - Jean-Christophe Macia
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, Montpellier 5, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, Jossigny, France
| | - Guillaume Cayla
- Cardiology department, Nimes university Hospital, Montpellier University, ACTION group, Nimes, France
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Duthoit
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hopital Lariboisière, (APHP), Université Paris-Diderot Paris 7, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Benali K, Zei PC, Lloyd M, Kautzner J, Guenancia C, Ninni S, Rigal L, Simon A, Bellec J, Vlachos K, Sacher F, Hammache N, Sellal JM, de Crevoisier R, Da Costa A, Martins R. One-year mortality and causes of death after stereotactic radiation therapy for refractory ventricular arrhythmias: A systematic review and pooled analysis. Trends Cardiovasc Med 2024:S1050-1738(23)00122-6. [PMID: 38191005 DOI: 10.1016/j.tcm.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/25/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
Patients treated with cardiac stereotactic body radiation therapy (radioablation) for refractory ventricular arrhythmias are patients with advanced structural heart disease and significant comorbidities. However, data regarding 1-year mortality after the procedure are scarce. This systematic review and pooled analysis aimed at determining 1-year mortality after cardiac radioablation for refractory ventricular arrhythmias and investigating leading causes of death in this population. MEDLINE/EMBASE databases were searched up to January 2023 for studies including patients undergoing cardiac radioablation for the treatment of refractory ventricular arrhythmias. Quality of included trials was assessed using the NIH Tool for Case Series Studies (PROSPERO CRD42022379713). A total of 1,151 references were retrieved and evaluated for relevance. Data were extracted from 16 studies, with a total of 157 patients undergoing cardiac radioablation for refractory ventricular arrhythmias. Pooled 1-year mortality was 32 % (95 %CI: 23-41), with almost half of the deaths occurring within three months after treatment. Among the 157 patients, 46 died within the year following cardiac radioablation. Worsening heart failure appeared to be the leading cause of death (52 %), although non-cardiac mortality remained substantial (41 %) in this population. Age≥70yo was associated with a significantly higher 12-month all-cause mortality (p<0.022). Neither target volume size nor radiotherapy device appeared to be associated with 1-year mortality (p = 0.465 and p = 0.199, respectively). About one-third of patients undergoing cardiac stereotactic body radiation therapy for refractory ventricular arrhythmias die within the first year after the procedure. Worsening heart failure appears to be the leading cause of death in this population.
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Affiliation(s)
- Karim Benali
- Section of Cardiac Electrophysiology, Saint-Etienne University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; INSERM-LTSI, U1099 Rennes, France.
| | - Paul C Zei
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, United States
| | - Michael Lloyd
- Section of Cardiac Electrophysiology, Emory University, Atlanta, United States
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Charles Guenancia
- Section of Cardiac Electrophysiology, Dijon University, Dijon, France
| | - Sandro Ninni
- Heart and Lung Institute, Lille University, Lille, France
| | | | | | - Julien Bellec
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Frederic Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Nefissa Hammache
- Section of Cardiac Electrophysiology, Nancy University, Nancy, France
| | - Jean-Marc Sellal
- Section of Cardiac Electrophysiology, Nancy University, Nancy, France
| | | | - Antoine Da Costa
- Section of Cardiac Electrophysiology, Saint-Etienne University, Saint-Etienne, France
| | - Raphael Martins
- INSERM-LTSI, U1099 Rennes, France; Section of Cardiac Electrophysiology, Rennes University, Rennes, France
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Benali K, Lloyd MS, Petrosyan A, Rigal L, Quivrin M, Bessieres I, Vlachos K, Hammache N, Bellec J, Simon A, Laurent G, Higgins K, Garnier F, de Crevoisier R, Martins R, Da Costa A, Guenancia C. Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices. J Cardiovasc Electrophysiol 2024; 35:206-213. [PMID: 38018417 DOI: 10.1111/jce.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
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Affiliation(s)
- Karim Benali
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- LTSI-UMR 1099, Rennes, France
| | - Michael S Lloyd
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andranik Petrosyan
- Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Louis Rigal
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Magali Quivrin
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Igor Bessieres
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Nefissa Hammache
- Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
| | - Julien Bellec
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
| | - Antoine Simon
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Gabriel Laurent
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Fabien Garnier
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | | | - Raphaël Martins
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
| | - Antoine Da Costa
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Charles Guenancia
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
- PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
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7
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Milhem A, Anselme F, Da Costa A, Abbey S, Mansourati J, Bader H, Winum PF, Badenco N, Maury P, Dompnier A, Shah D, Johner N, Taieb J, Bertrand J, Tréguer F, Amelot M, Ingrand P, Allix-Béguec C. ATE Score Diagnostic Accuracy for Predicting the Absence of Intra-Atrial Thrombi Before AF Ablation. JACC Clin Electrophysiol 2023; 9:2550-2557. [PMID: 37804261 DOI: 10.1016/j.jacep.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND In a preliminary study in patients hospitalized for catheter ablation of atrial fibrillation (AF), the atrial thrombus exclusion (ATE) score (stroke, hypertension, heart failure, and D-dimers >270 ng/mL) was developed to rule out the diagnosis of intra-atrial thrombus, with a negative predictive value (NPV) of 100%, and to avoid performing transesophageal echocardiography (TEE). OBJECTIVES The present study was designed to prospectively confirm the NPV of the ATE score in an independent population. METHODS Consecutive patients hospitalized for catheter ablation of AF or left atrial tachycardia (LAT) were prospectively enrolled in a multicenter study. D-dimer levels were measured within 48 hours before ablation. An ATE score of 0 was considered predictive of no thrombus. TEE was routinely performed at the beginning or just before the ablation procedure. The primary endpoint was the presence of atrial thrombus diagnosed by TEE. RESULTS The analysis included 3,072 patients (53.3% paroxysmal AF, 36.7% persistent AF, and 10% LAT). A thrombus was detected in 29 patients (0.94%; 95% CI: 0.63%-1.35%), all on appropriate anticoagulant therapy. An ATE score of 0 was observed in 818 patients (26.6%), and the sensitivity, specificity, positive predictive value, and NPV were 93.1%, 26.8%, 1.2%, and 99.8%, respectively. Follow-up of the 2 false negative patients revealed the persistence of chronic organized thrombi. CONCLUSIONS In patients hospitalized for catheter ablation of AF or LAT, the ATE score identifies a population at very low risk for atrial thrombus. In consultation with the patient, the cardiologist may consider not performing a preoperative TEE in case of an ATE score of 0.
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Affiliation(s)
- Antoine Milhem
- Department of Cardiology, CH la Rochelle, La Rochelle, France.
| | | | - Antoine Da Costa
- Department of Cardiology, CHU Saint-Etienne, Saint-Etienne, France
| | - Sélim Abbey
- Department of Cardiology, Nouvelles Cliniques Nantaises, Groupe Confluent, Nantes, France
| | | | | | | | - Nicolas Badenco
- Department of Cardiology, APHP, Hôpital Pitié Salpêtrière, Paris, France; Sorbonne Université, INSERM, UMRS 1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Philippe Maury
- Department of Cardiology, CHU Toulouse, Toulouse, France
| | | | - Dipen Shah
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Nicolas Johner
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Jérôme Taieb
- Department of Cardiology, CH Pays d'Aix, Aix-en-Provence, France
| | - Julien Bertrand
- Department of Cardiology, CHR Metz-Thionville, Ars-Laquenexy, France
| | | | | | - Pierre Ingrand
- Epidemiology and Biostatistics, INSERM CIC 1402, Université de Poitiers, CHU Poitiers, Poitiers, France
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8
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Benali K, Khairy P, Hammache N, Petzl A, Da Costa A, Verma A, Andrade JG, Macle L. Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol 2023; 81:2089-2099. [PMID: 37225362 DOI: 10.1016/j.jacc.2023.03.418] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design. OBJECTIVES The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends. METHODS MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273). RESULTS A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. CONCLUSIONS Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.
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Affiliation(s)
- Karim Benali
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Saint-Etienne University, Saint-Etienne, France; INSERM-LTSI, U1099, Rennes, France. https://twitter.com/KarimBenali42
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Adrian Petzl
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada. https://twitter.com/atulverma_md
| | - Jason G Andrade
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada. https://twitter.com/DrJasonAndrade
| | - Laurent Macle
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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9
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Tilz RR, Schmidt V, Pürerfellner H, Maury P, Chun KJ, Martinek M, Sohns C, Schmidt B, Mandel F, Gandjbakhch E, Laredo M, Gunawardene MA, Willems S, Beiert T, Borlich M, Iden L, Füting A, Spittler R, Gaspar T, Richter S, Schade A, Kuniss M, Neumann T, Francke A, Wunderlich C, Shin DI, Grosse Meininghaus D, Foresti M, Bonsels M, Reek D, Wiegand U, Bauer A, Metzner A, Eckardt L, Popescu SȘ, Krahnefeld O, Sticherling C, Kühne M, Nguyen DQ, Roten L, Saguner AM, Linz D, van der Voort P, Mulder BA, Vijgen J, Almorad A, Guenancia C, Fauchier L, Boveda S, De Greef Y, Da Costa A, Jais P, Derval N, Milhem A, Jesel L, Garcia R, Poty H, Khoueiry Z, Seitz J, Laborderie J, Mechulan A, Brigadeau F, Zhao A, Saludas Y, Piot O, Ahluwalia N, Martin C, Chen J, Antolic B, Leventopoulos G, Özcan EE, Yorgun H, Cay S, Yalin K, Botros MS, Mahmoud AT, Jędrzejczyk-Patej E, Inaba O, Okumura K, Ejima K, Khakpour H, Boyle N, Catanzaro JN, Reddy V, Mohanty S, Natale A, Blessberger H, Yang B, Stevens I, Sommer P, Veltmann C, Steven D, Vogler J, Kuck KH, Merino JL, Keelani A, Heeger CH. A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study. Eur Heart J 2023:7123667. [PMID: 37062040 DOI: 10.1093/eurheartj/ehad250] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/25/2023] [Accepted: 04/14/2023] [Indexed: 04/17/2023] Open
Abstract
AIMS Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management and outcome are sparse. METHODS AND RESULTS This international multicenter registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553,729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed at 214 centers in 35 countries. In 78 centers 138 patients (0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (p<0.0001)) were diagnosed with an oesophageal fistula. Periprocedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8%, and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) (odds ratio 7.463 (2.414, 23.072) p<0.001). CONCLUSIONS Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.
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Affiliation(s)
- Roland Richard Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Schmidt
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | | | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Kr Julian Chun
- MVZ CCB am Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | | | - Christian Sohns
- Kliniken für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Boris Schmidt
- MVZ CCB am Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Estelle Gandjbakhch
- Sorbonne Université, APHP, Pitié Salpêtrière University Hospital, Cardiology Institute, Paris, France
| | - Mikael Laredo
- APHP, Pitié Salpêtrière University Hospital, Cardiology Institute, Paris, France
| | | | - Stephan Willems
- Klinik für Kardiologie und Internistische Intensivmedizin, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Thomas Beiert
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Martin Borlich
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Schleswig-Holstein, Germany
| | - Leon Iden
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Bad Segeberg, Schleswig-Holstein, Germany
| | - Anna Füting
- Dept. of Electrophysiology, Alfred Krupp Hospital, EssenGermany
- Dept. Of Medicine, Witten/Herdecke University, Witten, Germany
| | - Raphael Spittler
- Department of Cardiology II/Electrophysiology, Center for Cardiology, University Hospital Mainz, Germany
| | - Thomas Gaspar
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Germany
| | - Sergio Richter
- Department of Internal and Cardiovascular Medicine, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Germany
| | - Anja Schade
- Department of Interventional Electrophysiology, Helios Hospital Erfurt, Erfurt, Germany
| | - Malte Kuniss
- Dept. of Cardiology Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Neumann
- Dept. of Cardiology Kerckhoff Heart Center, Bad Nauheim, Germany
| | | | | | - Dong-In Shin
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | | | - Mike Foresti
- Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Marc Bonsels
- Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - David Reek
- University Hospital Augsburg, Department of Cardiology, Augsburg, Germany
| | - Uwe Wiegand
- Sana-Klinikum Remscheid GmbH, Akademisches Lehrkrankenhaus der Universität zu Köln, Remscheid, Germany
| | - Alexander Bauer
- Diak-Klinikum Schwäbisch Hall und Klinikum Crailsheim, Schwäbisch Hall, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum, Klinik für Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Germany
| | - Sorin Ștefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | | | | | - Michael Kühne
- Deaprtment of Cardiology, University Hospital Basel, Switzerland
| | | | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johan Vijgen
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Serge Boveda
- Cardiology - Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Y De Greef
- Department of Cardiology, ZNA Heart Centre, Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Pierre Jais
- CHU Bordeaux, Univ. Bordeaux, IHU LIRYC ANR-10-IAHU-04, France
| | - Nicolas Derval
- CHU Bordeaux, Univ. Bordeaux, IHU LIRYC ANR-10-IAHU-04, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nikhil Ahluwalia
- Barts Heart Centre, Barts Health NHS Trust, London, UK
- Wiliam Harvey Heart Centre, Queen Mary University of London, UK
| | | | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Bor Antolic
- Department of Cardiology, University Medical Center Ljubljana, Slovenia
| | | | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, Izmir, Turkey
| | - Hikmet Yorgun
- Hacettepe University, Department of Cardiology, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Yuksek Ihtisas Cardiovascular Building, Ankara City Hospital, Ankara, Turkey
| | - Kivanc Yalin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Maichel Sobhy Botros
- Department of critical care medicine, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ahmed Taher Mahmoud
- Department of critical care medicine, Faculty of medicine, Cairo University, Cairo, Egypt
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Los Angeles, USA
| | - J N Catanzaro
- University of Florida Health, Jacksonville, Florida, USA
| | - Vivek Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- International Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Irene Stevens
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Philipp Sommer
- Kliniken für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Daniel Steven
- Department for Electrophysiology, Heart Center University Cologne, Cologne, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - José Luis Merino
- La Paz University Hospital, Universidad Autónoma de Madrid, Idipaz, Madrid, Spain
| | - Ahmad Keelani
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
| | - Christian-H Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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10
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Benali K, Barré V, Hermida A, Galand V, Milhem A, Philibert S, Boveda S, Bars C, Anselme F, Maille B, André C, Behaghel A, Moubarak G, Clémenty N, Da Costa A, Arnaud M, Venier S, Sebag F, Jésel-Morel L, Sagnard A, Champ-Rigot L, Dang D, Guy-Moyat B, Abbey S, Garcia R, Césari O, Badenco N, Lepillier A, Ninni S, Boulé S, Maury P, Algalarrondo V, Bakouboula B, Mansourati J, Lesaffre F, Lagrange P, Bouzeman A, Muresan L, Bacquelin R, Bortone A, Bun SS, Pavin D, Macle L, Martins RP. Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study. Circ Arrhythm Electrophysiol 2023; 16:e011354. [PMID: 36802906 DOI: 10.1161/circep.122.011354] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; P=0.006). CONCLUSIONS In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
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Affiliation(s)
- Karim Benali
- CHU Saint Etienne, University of Rennes, INSERM, LTSI -UMR 1099, Rennes (K.B.)
| | - Valentin Barré
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | - Vincent Galand
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | | | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse (S.B.)
| | | | | | | | | | | | | | | | | | | | | | - Frédéric Sebag
- Rythmologie, Institut Mutualiste Montsouris, Paris (F.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Babé Bakouboula
- Institut Cardiovasculaire de Strasbourg, Clinique RHENA (B.B.)
| | | | | | | | | | | | | | | | | | - Dominique Pavin
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Canada (L.M.)
| | - Raphaël P Martins
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
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11
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Laredo M, Duthoit G, Sacher F, Anselme F, Audinet C, Bessière F, Bordachar P, Bouzeman A, Boveda S, Bun SS, Chassignolle M, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Extramiana F, Fauchier L, Hermida A, Gandjbakhch E, Garcia R, Gourraud JB, Guenancia C, Guy-Moyat B, Irles D, Iserin L, Jourda F, Koutbi L, Labombarda F, Ladouceur M, Lagrange P, Lellouche N, Mansourati J, Marquié C, Martins R, Massoulié G, Mathiron A, Maury P, Messali A, Milhem A, Mondoly P, Nguyen C, Ninni S, Pasquié JL, Pierre B, Pujadas P, Sellal JM, Thambo JB, Walton C, Winum P, Zakine C, Zhao A, Jouven X, Combes N, Marijon E, Waldmann V. Rapid ventricular tachycardia in patients with tetralogy of Fallot and implantable cardioverter-defibrillator: Insights from the DAI-T4F nationwide registry. Heart Rhythm 2023; 20:252-260. [PMID: 36309156 DOI: 10.1016/j.hrthm.2022.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In repaired tetralogy of Fallot (TOF), little is known about characteristics of patients with rapid ventricular tachycardia (VT). Also, whether patients with a first episode of nonrapid VT may subsequently develop rapid VT or ventricular fibrillation (VF) has not been addressed. OBJECTIVES The objectives of this study were to compare patients with rapid VT/VF with those with nonrapid VT and to assess the evolution of VT cycle lengths (VTCLs) overtime. METHODS Data were analyzed from a nationwide registry including all patients with TOF and implantable cardioverter-defibrillator (ICD) since 2000. Patients with ≥1 VT episode with VTCL ≤250 ms (240 beats/min) formed the rapid VT/VF group. RESULTS Of 144 patients (mean age 42.0 ± 12.7 years; 104 [72%] men), 61 (42%) had at least 1 VT/VF episode, including 28 patients with rapid VT/VF (46%), during a median follow-up of 6.3 years (interquartile range 2.2-10.3 years). Compared with patients in the nonrapid VT group, those in the rapid VT/VF group were significantly younger at ICD implantation (35.2 ± 12.6 years vs 41.5 ± 11.2 years; P = .04), had more frequently a history of cardiac arrest (8 [29%] vs 2 [6%]; P = .02), less frequently a history of atrial arrhythmia (11 [42%] vs 22 [69%]; P = .004), and higher right ventricular ejection fraction (43.3% ± 10.3% vs 36.6% ± 11.2%; P = .04). The median VTCL of VT/VF episodes was 325 ms (interquartile range 235-429 ms). None of the patients with a first documented nonrapid VT episode had rapid VT/VF during follow-up. CONCLUSION Patients with TOF and rapid VT/VF had distinct clinical characteristics. The relatively low variation of VTCL over time suggests a room for catheter ablation without a backup ICD in selected patients with well-tolerated VT.
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Affiliation(s)
- Mikael Laredo
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Guillaume Duthoit
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Frédéric Sacher
- LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | | | | | | | | | - Morgane Chassignolle
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Gaël Clerici
- Saint Pierre University Hospital, La Réunion, France
| | | | | | | | | | | | | | | | | | - Estelle Gandjbakhch
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | | | | | | | | | | | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | - Magalie Ladouceur
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Jouven
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| | | | - Eloi Marijon
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France.
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12
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Massoullié G, Ploux S, Souteyrand G, Mondoly P, Pereira B, Amabile N, Jean F, Irles D, Mansourati J, Combaret N, Mechulan A, Badoz M, Da Costa A, Defaye P, Motreff P, Clerfond G, Bordachar P, Eschalier R. Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study. Heart Rhythm 2023; 20:699-706. [PMID: 36646235 DOI: 10.1016/j.hrthm.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block. OBJECTIVES The objectives of this study were to determine the incidence of AV block in such a population and to assess the performance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR). METHODS This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recipients (mean age 82.3 ± 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for >24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval ≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring. RESULTS A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P < .001). In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2-4.8; P = .010). CONCLUSION New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pierre Mondoly
- Federation of Cardiology, University Hospital Rangueil, Toulouse cedex, France
| | - Bruno Pereira
- Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Frédéric Jean
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Alexis Mechulan
- Ramsay Générale de Santé, Hôpital Privé de Clairval, Marseille, France
| | - Marc Badoz
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
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Guichard JB, Guasch E, Roche F, Da Costa A, Mont L. Premature atrial contractions: A predictor of atrial fibrillation and a relevant marker of atrial cardiomyopathy. Front Physiol 2022; 13:971691. [PMID: 36353376 PMCID: PMC9638131 DOI: 10.3389/fphys.2022.971691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/14/2022] [Indexed: 09/08/2023] Open
Abstract
An increased burden of premature atrial contractions (PACs) has long been considered a benign phenomenon. However, strong evidence of their involvement in the occurrence of atrial fibrillation (AF), ischemic stroke, and excess mortality suggests the need for management. The central question to be resolved is whether increased ectopic atrial rhythm is only a predictor of AF or whether it is a marker of atrial cardiomyopathy and therefore of ischemic stroke. After reviewing the pathophysiology of PACs and its impact on patient prognosis, this mini-review proposes to 1) detail the physiological and clinical elements linking PACs and AF, 2) present the evidence in favor of supraventricular ectopic activity as a marker of cardiomyopathy, and 3) outline the current limitations of this concept and the potential future clinical implications.
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Affiliation(s)
- Jean-Baptiste Guichard
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Eduard Guasch
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Frederic Roche
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
- Sainbiose, DVH, Inserm U1059, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Lluís Mont
- Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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14
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Waldmann V, Bouzeman A, Duthoit G, Koutbi L, Bessière F, Labombarda F, Marquié C, Gourraud JB, Mondoly P, Sellal JM, Bordachar P, Hermida A, Al Arnaout A, Anselme F, Audinet C, Bernard Y, Boveda S, Bun SS, Chassignolle M, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Garcia R, Guenancia C, Guy-Moyat B, Halimi F, Irles D, Iserin L, Jourda F, Ladouceur M, Lagrange P, Laredo M, Mansourati J, Massoulié G, Mathiron A, Maury P, Messali A, Narayanan K, Nguyen C, Ninni S, Perier MC, Pierre B, Pujadas P, Sacher F, Sagnol P, Sharifzadehgan A, Walton C, Winum P, Zakine C, Fauchier L, Martins R, Pasquié JL, Thambo JB, Jouven X, Combes N, Marijon E. Sex Differences in Outcomes of Tetralogy of Fallot Patients With Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol 2022; 8:1304-1314. [DOI: 10.1016/j.jacep.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
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15
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Weizman O, Marijon E, Narayanan K, Boveda S, Defaye P, Martins R, Deharo JC, Laurent G, Klug D, Sadoul N, Hocini M, Mansencal N, Anselme F, Da Costa A, Maury P, Ferrières J, Schiele F, Simon T, Danchin N. Incidence, Characteristics, and Outcomes of Ventricular Fibrillation Complicating Acute Myocardial Infarction in Women Admitted Alive in the Hospital. J Am Heart Assoc 2022; 11:e025959. [PMID: 36017613 PMCID: PMC9496428 DOI: 10.1161/jaha.122.025959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Little data are available in women presenting with ventricular fibrillation (VF) in the setting of acute myocardial infarction (AMI). We assessed frequency, predictors of VF, and outcomes, with a special focus on women compared with men. Methods and Results Data were analyzed from the FAST‐MI (French Registry of Acute ST‐Elevation or Non‐ST‐Elevation Myocardial Infarction) program, which prospectively included 14 406 patients admitted to French cardiac intensive care units ≤48 hours from AMI onset between 1995 and 2015 (mean age, 66±14 years; 72% men; mean left ventricular ejection fraction, 52±12%; 59% with ST‐segment–elevation myocardial infarction). A total of 359 patients developed VF during AMI, including 81 women (2.0% of 4091 women) and 278 men (2.7% of 10 315 men, P=0.02). ST‐segment–elevation myocardial infarction (odds ratio [OR], 2.29 [95% CI, 1.75–2.99]; P<0.001) was independently associated with the onset of VF during AMI. In contrast, female sex (OR, 0.73 [95% CI, 0.56–0.95]; P=0.02), hypertension (OR, 0.75 [95% CI, 0.60–0.94]; P=0.01), and prior myocardial infarction (OR, 0.69 [95% CI, 0.50–0.96]; P=0.03) were protective factors. Women were less likely to have cardiac intervention than men (percutaneous coronary intervention during hospitalization 48.1% versus 66.9%, respectively; P=0.04) with a higher 1‐year mortality in women compared with men (50.6% versus 37.4%, respectively; P=0.03), including increased in‐hospital mortality (42.0% versus 32.7%, respectively; P=0.12). After adjustment, female sex was no longer associated with a worse 1‐year mortality (adjusted hazard ratio, 1.10 [95% CI, 0.75–1.61]; P=0.63). Conclusions Women have lower risk of developing VF during AMI compared with men. However, they are less likely to receive cardiac interventions than men, possibly contributing to missed opportunities of improved outcomes.
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Affiliation(s)
- Orianne Weizman
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Faculté de Médecine Université de Lorraine Vandœuvre-lès-Nancy France
| | - Eloi Marijon
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Cardiology Department AP-HP, European Georges Pompidou Hospital Paris France
| | | | - Serge Boveda
- Cardiology Department Clinique Pasteur Toulouse France
| | - Pascal Defaye
- Cardiology Department CHU Grenoble La Tronche France
| | | | | | | | - Didier Klug
- Cardiology Department CHU Lille Lille France
| | | | - Meleze Hocini
- Cardiology Department Institut de Rythmologie-Hopital Cardiologique, CHU Bordeaux Pessac France
| | - Nicolas Mansencal
- Cardiology Department AP-HP Hopital Ambroise Paré Boulogne Bilancourt France
| | | | - Antoine Da Costa
- Cardiology Department CHU Saint Etienne Saint Priez en Jarez France
| | - Philippe Maury
- Cardiology Department Rangueil University Hospital Toulouse France
| | - Jean Ferrières
- Cardiology Department Rangueil University Hospital Toulouse France
| | - François Schiele
- Cardiology Department University Hospital Jean Minjoz Besançon France
| | - Tabassome Simon
- Clinical Research Unit Saint-Antoine Hospital AP-HP Paris France
| | - Nicolas Danchin
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Cardiology Department AP-HP, European Georges Pompidou Hospital Paris France
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16
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Kamakura T, Gourraud JB, Clementy N, Maury P, Mansourati J, Klug D, Da Costa A, Pasquie JL, Mabo P, Chavernac P, Laurent G, Defaye P, Laborderie J, Leenhardt A, Sadoul N, Deharo JC, Giraudeau C, Quentin A, Jesel L, Thollet A, Tixier R, Derval N, Haissaguerre M, Probst V, Sacher F. Outcome of Patients with Early Repolarization Pattern and Syncope. Heart Rhythm 2022; 19:1306-1314. [PMID: 35395407 DOI: 10.1016/j.hrthm.2022.03.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Syncope in patients with an early repolarization (ER) pattern presents a challenge for clinicians as it has been identified as an indicator of a higher risk of life-threatening ventricular arrhythmias (VAs). OBJECTIVE This study aimed to analyze the outcome of patients with an ER pattern and syncope, and to evaluate the factors predictive of VAs. METHODS Over a period of 5 years, we enrolled 143 patients with an ER pattern and syncope in a multicenter prospective registry. RESULTS Following the initial examinations, 97 patients (67.8%) were implanted with a device allowing electrocardiogram monitoring, including 84 with an implantable loop recorder. During a mean follow-up of 68 ± 34 months, we documented 16 arrhythmias presumably responsible for syncope (5 VAs, 10 bradycardias, and 1 supraventricular tachycardia). Additionally, recurrent syncope not associated with electrocardiogram documentation occurred in 16 patients (11.2%). The cause of syncope was identified in 23 of 97 (23.8%) patients with a monitoring device. The 5-year incidence of VAs and arrhythmic events presumably responsible for syncope was 4.9% and 11.0%, respectively. Patients who developed VAs showed no prodromes or specific triggers at the time of syncope. Neither the presence of a family history of sudden cardiac death nor the previously reported high-risk electrocardiographic parameters differed between patients with and without VAs. CONCLUSIONS VAs occurred in 4.9% of patients with an ER pattern and syncope. Device implantation based on detailed history taking seems to be a reasonable strategy. Previously reported high-risk electrocardiographic patterns did not identify patients with VAs.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Jean-Baptiste Gourraud
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Nicolas Clementy
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Didier Klug
- Department of Electrophysiology, Lille University Hospital, Lille, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, France
| | - Jean-Luc Pasquie
- Department of Cardiology and PhyMedExp, Université Montpellier, INSERM, CNRS, CHRU Montpellier University Hospital, France
| | - Philippe Mabo
- Department of Cardiology, Rennes University Hospital, France
| | | | | | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital, France
| | | | | | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, France
| | | | | | - Anne Quentin
- Department of Cardiology, Centre Hospitalier de Saint Brieuc, France
| | - Laurence Jesel
- Department of Cardiology, Strasbourg University Hospital, France
| | - Aurelie Thollet
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Michel Haissaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Vincent Probst
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France.
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17
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Guichard JB, Anselme F, Defaye P, Mansourati J, Pavin D, Pasquié JL, Saludas Y, Barthélémy JC, Roche F, Laporte S, Chapelle C, Garcin A, Romeyer C, Isaaz K, Da Costa A. Prevention of Atrial Fibrillation After Atrial Flutter Ablation With Ramipril (from the PREFACE Study). Am J Cardiol 2022; 162:73-79. [PMID: 34728062 DOI: 10.1016/j.amjcard.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/01/2022]
Abstract
The clinical efficacy of the inhibitors of the renin-angiotensin-aldosterone system (RAAS) as an upstream therapy for atrial fibrillation (AF) prevention is controversial. No study has itemized so far the role of RAAS inhibitors in AF prevention after atrial flutter (AFL) ablation. This trial aims to investigate the effect of ramipril compared with placebo on AF occurrence in patients hospitalized for AFL ablation without structural heart disease. The Prevention of Atrial Fibrillation by Inhibition Conversion Enzyme (ICE) After Radiofrequency Ablation of Atrial Flutter (PREFACE) trial was a prospective, multicenter, randomized, double-blind, double-dummy trial depicting the AF occurrence during a 12-month follow-up as the primary end point. A total of 198 patients hospitalized for AFL ablation were enrolled in the trial and randomized to placebo or ramipril 5 mg/day. Patients were followed up during 1 year after AFL ablation using 1-week Holter electrocardiogram at 3, 6, 9, and 12 months. The intention-to-treat population encompassed 97 patients in the ramipril group and 101 patients in the placebo group. The primary end point, such as AF occurrence during the 1-year follow-up, was not different between the 2 groups (p = 0.96). Secondary end points, including the occurrence of supraventricular arrhythmia (p = 0.50), heart failure, stroke, and death, were not different between the 2 groups. Safety outcome parameters, including serious adverse events leading to treatment disruption (p = 0.10), hypotension, impairment of renal function, and elevated serum potassium level, also were not different between the 2 groups. In conclusion, RAAS inhibition using ramipril does not reduce AF occurrence in patients facing AFL ablation during the 1-year follow-up.
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18
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Waldmann V, Bouzeman A, Duthoit G, Koutbi L, Bessiere F, Labombarda F, Marquié C, Gourraud JB, Mondoly P, Sellal JM, Bordachar P, Hermida A, Anselme F, Asselin A, Audinet C, Bernard Y, Bru P, Sithikun Bun S, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Garcia R, Guenancia C, Guy-Moyat B, Halimi F, Irles D, Iserin L, Jourda F, Ladouceur M, Lagrange P, Laredo M, Mansourati J, Massoulié G, Mathiron A, Maury P, Messali A, Narayanan K, Nguyen C, Ninni S, Perier MC, Pierre B, Pujadas P, Sacher F, Sagnol P, Sharifzadehgan A, Walton C, Winum P, Zakine C, Fauchier L, Martins R, Pasquié JL, Thambo JB, Jouven X, Combes N, Marijon E. Long-term follow-up of patients with tetralogy of fallot and implantable cardioverter defibrillator–The DAI-T4F nationwide registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Benali K, Da Costa A, Macle L, Hammache N, Galand V, Romeyer C, Guichard JB, Leclercq C, Pavin D, Martins R. Distance between the descending aorta and the left inferior pulmonary vein as a determinant of biophysical parameters during paroxysmal atrial fibrillation cryoablation. J Cardiovasc Electrophysiol 2021; 32:2943-2952. [PMID: 34455655 DOI: 10.1111/jce.15234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The distance from the descending aorta (DA) to the posterior wall of the left atrium (LA) is variable. We aimed to determine whether the proximity between the DA and the left inferior pulmonary vein (LIPV) ostium has an impact on biophysical parameters and cryoballoon (CB) ablation efficacy during LIPV freezing. METHODS Patients referred for CB-ablation of atrial fibrillation (AF) in two high-volume centers were included. Cryoablation data were collected prospectively for each patient. The anatomical relationships between the LIPV and the DA (distance LIPV ostium-DA, presence of an aortic imprint on the posterior aspect of the LIPV) were then retrospectively analysed on the LA computed tomography scans realized before AF ablation. RESULTS A total of 350 patients were included (70% men, 59.7 ± 11.5 years). The decrease in the Ostium-DA distance was significantly correlated to the increase in the time-to-isolation (TTI) (r = -.31; p = .036), with less negative temperature (r = -.11; p = .045). Similarly, the presence of an aortic imprint on the LIPV was associated with a longer TTI (p < .001). The analysis of redo procedures data shows a trend toward the presence of shorter ostium-DA distances (15.3 ± 3.29 vs. 18.1 ± 4.99, p = .15) and more frequent aortic imprints (63.6% vs. 47.5%, p = .34) in patients with LIPV reconnection as opposed to patients without reconnection in the LIPV. CONCLUSION Our findings indicated that the DA seems to have a "radiator" effect influencing LIPV cryoablation parameters during CB-ablation. Additional studies will be needed to elucidate whether this biophysical influence has a clinical impact in LIPVs reconnections.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France.,University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Montreal, Canada
| | - Nefissa Hammache
- University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre lès-Nancy, France
| | - Vincent Galand
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Cécile Romeyer
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Jean Baptiste Guichard
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | | | - Dominique Pavin
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Raphaël Martins
- Department of Cardiology, Rennes University Hospital, Rennes, France.,University of Rennes, CHU Rennes, INSERM-LTSI, U1099, Rennes, France
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20
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Alonso C, Marquie C, Defaye P, Clementy N, Mondoly P, Sadoul N, Boveda S, Hidden-Lucet F, Dompnier A, Da Costa A, Marijon E, Leclercq C, Caudron G, Piot O, Deharo JC. FRAGILE: FRench Attitude reGistry in case of ICD LEad replacement. Europace 2021; 23:389-394. [PMID: 33257986 DOI: 10.1093/europace/euaa290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups. METHODS AND RESULTS Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient's age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications. CONCLUSION In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient's age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
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Affiliation(s)
- Christine Alonso
- CMC Ambroise Paré, 25-27 bd Victor Hugo, 92200 Neuilly-sur-Seine, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord Saint-Denis, France
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21
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Garcia R, Combes N, Defaye P, Narayanan K, Guedon-Moreau L, Boveda S, Blangy H, Bouet J, Briand F, Chevalier P, Cottin Y, Da Costa A, Degand B, Deharo JC, Eschalier R, Extramiana F, Goralski M, Guy-Moyat B, Guyomar Y, Hermida JS, Jourda F, Lellouche N, Mahfoud M, Manenti V, Mansourati J, Martin A, Pasquié JL, Ritter P, Rollin A, Tibi T, Yalioua A, Gras D, Sadoul N, Piot O, Leclercq C, Marijon E. Wearable cardioverter-defibrillator in patients with a transient risk of sudden cardiac death: the WEARIT-France cohort study. Europace 2021; 23:73-81. [PMID: 33257972 PMCID: PMC7842091 DOI: 10.1093/europace/euaa268] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Aims We aimed to provide contemporary real-world data on wearable cardioverter-defibrillator (WCD) use, not only in terms of effectiveness and safety but also compliance and acceptability. Methods and results Across 88 French centres, the WEARIT-France study enrolled retrospectively patients who used the WCD between May 2014 and December 2016, and prospectively all patients equipped for WCD therapy between January 2017 and March 2018. All patients received systematic education session through a standardized programme across France at the time of initiation of WCD therapy and were systematically enrolled in the LifeVest Network remote services. Overall, 1157 patients were included (mean age 60 ± 12 years, 16% women; 46% prospectively): 82.1% with ischaemic cardiomyopathy, 10.3% after implantable cardioverter-defibrillator explant, and 7.6% before heart transplantation. Median WCD usage period was 62 (37–97) days. Median daily wear time of WCD was 23.4 (22.2–23.8) h. In multivariate analysis, younger age was associated with lower compliance [adjusted odds ratio (OR) 0.97, 95% confidence interval (CI) 0.95–0.99, P < 0.01]. A total of 18 participants (1.6%) received at least one appropriate shock, giving an incidence of appropriate therapy of 7.2 per 100 patient-years. Patient-response button allowed the shock to be aborted in 35.7% of well-tolerated sustained ventricular arrhythmias and in 95.4% of inappropriate ventricular arrhythmia detection, finally resulting in an inappropriate therapy in eight patients (0.7%). Conclusion Our real-life findings reinforce previous studies on the efficacy and safety of the WCD in the setting of transient high-risk group in selected patients. Moreover, they emphasize the fact that when prescribed appropriately, in concert with adequate patient education and dedicated follow-up using specific remote monitoring system, compliance with WCD is high and the device well-tolerated by the patient.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, 86021 Poitiers, France.,Univ Poitiers, 86000 Poitiers, France
| | - Nicolas Combes
- Department of Cardiology, Pasteur Clinic, 33000 Toulouse, France
| | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital, 38043 Grenoble, France
| | - Kumar Narayanan
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Medicover Hospitals, Hyderabad, India
| | | | - Serge Boveda
- Department of Cardiology, Pasteur Clinic, 33000 Toulouse, France
| | - Hugues Blangy
- Department of Cardiology, Nancy University Hospital, 54500 Vandoeuvre-Lès-Nancy, France
| | - Jérôme Bouet
- Department of Cardiology, Hospital Center of Aix, 13080 Aix En Provence, France
| | - Florent Briand
- Department of Cardiology, Besançon University Hospital, 25000 Besançon, France
| | | | - Yves Cottin
- Department of Cardiology, Dijon University Hospital, 28000 Dijon, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, 42000 Saint-Étienne, France
| | - Bruno Degand
- Department of Cardiology, Poitiers University Hospital, 86021 Poitiers, France
| | - Jean-Claude Deharo
- Department of Cardiology, University Hospital La Timone, 13000 Marseille, France
| | - Romain Eschalier
- Department of Cardiology Clermont-Ferrand University Hospital, 63000 Clermont Ferrand, France
| | - Fabrice Extramiana
- Department of Cardiology, Bichat Hospital - Claude Bernard, 75877 Paris, France
| | - Marc Goralski
- Department of Cardiology, General Hospital of Oréans, 45000 Orléans, France
| | - Benoit Guy-Moyat
- Department of Cardiology, Limoges University Hospital, 87000 Limoges, France
| | - Yves Guyomar
- Department of Cardiology, Hospital Center Saint Philibert, 59160 Lomme, France
| | | | - François Jourda
- Department of Cardiology, General Hospital of Auxerre, 89000 Auxerre, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital Henri Mondor, 94000 Creteil, France
| | - Mohanad Mahfoud
- Department of Cardiology, Hospital Center Sud Francilien, 91100 Corbeil Essonnes, France
| | - Vladimir Manenti
- Department of Cardiology, Jacques Cartier Institute, 91300 Massy, France
| | - Jacques Mansourati
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Angéline Martin
- Department of Cardiology, Fontaine Clinic, 21121 Fontaine-Lès-Dijon, France
| | - Jean-Luc Pasquié
- Department of Cardiology, Montpellier University Hospital, 34000 Montpellier, France
| | - Philippe Ritter
- Department of Cardiology, Bordeaux University Hospital, 33600 Pessac, France
| | - Anne Rollin
- Department of Cardiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Thierry Tibi
- Department of Cardiology, General Hospital of Cannes, 06150 Cannes, France
| | - Arab Yalioua
- Department of Cardiology, General Hospital of Angoulême, 16000 Angoulême, France
| | - Daniel Gras
- Department of Cardiology, Hopital privé du Confluent, 44000 Nantes, France
| | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, 54500 Vandoeuvre-Lès-Nancy, France
| | - Olivier Piot
- Department of Cardiology, Cardiology Center of Nord, 93200 Saint Denis, France
| | | | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France
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22
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Yvorel C, Da Costa A, Lerebours C, Guichard JB, Viallon G, Romeyer C, Ferreira T, Benali K, Isaaz K. Comparison of clockwise and counterclockwise right atrial flutter using high-resolution mapping and automated velocity measurements. J Cardiovasc Electrophysiol 2021; 32:2127-2139. [PMID: 34041809 DOI: 10.1111/jce.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. OBJECTIVES We sought to compare CW and CCW CTI-dependent AFL in pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system and we mathematically developed a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. METHODS AND RESULTS Thirty-three pts were recruited. The mean age was 71 ± 13 years old. The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p = .7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. 4/10 [40%]; p = .9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. 6/10 [60%]; p = .9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p = .2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28 ± 10 cm/s; n = 8), and the velocities were similarly altered between both groups (26 ± 10 [4/22] vs. 29.8 ± 11 cm/s [4/11]; p = .6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20 cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. CONCLUSION The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions.
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Affiliation(s)
- Cedric Yvorel
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Chloe Lerebours
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Jean B Guichard
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Gregory Viallon
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Cécile Romeyer
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Thomas Ferreira
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Karim Benali
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Karl Isaaz
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
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23
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Ferreira T, Da Costa A, Cerisier A, Vidal N, Guichard JB, Romeyer C, Barthelemy JC, Isaaz K. Predictors of high-degree conduction disturbances and pacemaker implantation after transcatheter aortic valve replacement: Prognostic role of the electrophysiological study. Pacing Clin Electrophysiol 2021; 44:843-855. [PMID: 33742449 DOI: 10.1111/pace.14225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/27/2021] [Accepted: 03/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Predictors of high-degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) are recognized, but the electrophysiological study's (EPS) role is still a subject to debate. The objective of our study was to determine factors associated with PPM implantation including the potential role of EPS before and/or after TAVR. METHODS AND RESULTS Seventy four consecutive patients (pts) were included and 21 pts (28.4%) received a PPM during the immediate postoperative follow-ups (until Day 5): HAVB in 15 pts (71.4%), prophylactic implantation due to a documented increased HV interval ≥ 95-100 ms plus LBBB in 2 pts (9.5%), a high-degree HV block evidenced at the EPS plus LBBB in 3 pts (14.3%) and one additional patient was implanted for AV-block in presence of AFib (4.8%). In the multivariate model 1 including parameters before TAVR, both prosthesis diameter and PR lengthening remained significantly associated with PPM as well RBBB. In the multivariate model 2 including parameters after TAVR, only HV remained significantly associated with the risk of PPM (OR = 1.15 (1.05-1.26), p = .004). When all the significant variables in models 1 and 2 were analyzed together in model 3, only HV after TAVR remained significantly associated with an increased risk of PPM. CONCLUSIONS In this prospective observational study, it was revealed that a Day 4-5 EPS is likely to more precisely stratify the risk of PPM implantation regarding its ability to discover asymptomatic severe infra-hisian conduction disturbances particularly in presence of LBBB. Multivariate analysis confirmed the prognostic value of HV alteration.
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Affiliation(s)
- Thomas Ferreira
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Alexis Cerisier
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Nicolas Vidal
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | | | - Cécile Romeyer
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | | | - Karl Isaaz
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
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24
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Guichard JB, Naud P, Xiong F, Qi X, L'Heureux N, Hiram R, Tardif JC, Cartier R, Da Costa A, Nattel S. Comparison of Atrial Remodeling Caused by Sustained Atrial Flutter Versus Atrial Fibrillation. J Am Coll Cardiol 2021; 76:374-388. [PMID: 32703507 DOI: 10.1016/j.jacc.2020.05.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atrial flutter (AFL) and atrial fibrillation (AF) are associated with AF-promoting atrial remodeling, but no experimental studies have addressed remodeling with sustained AFL. OBJECTIVES This study aimed to define the atrial remodeling caused by sustained atrial flutter (AFL) and/or atrial fibrillation (AF). METHODS Intercaval radiofrequency lesions created a substrate for sustained isthmus-dependent AFL, confirmed by endocavity mapping. Four groups (6 dogs per group) were followed for 3 weeks: sustained AFL; sustained AF (600 beats/min atrial tachypacing); AF superimposed on an AFL substrate (AF+AFLs); sinus rhythm (SR) with an AFL substrate (SR+AFLs; control group). All dogs had atrioventricular-node ablation and ventricular pacemakers at 80 beats/min to control ventricular rate. RESULTS Monitoring confirmed spontaneous AFL maintenance >99% of the time in dogs with AFL. At terminal open-chest study, left-atrial (LA) effective refractory period was reduced similarly with AFL, AF+AFLs and AF, while AF vulnerability to extrastimuli increased in parallel. Induced AF duration increased significantly in AF+AFLs and AF, but not AFL. Dogs with AF+AFLs had shorter cycle lengths and substantial irregularity versus dogs with AFL. LA volume increased in AF+AFLs and AF, but not dogs with AFL, versus SR+AFLs. Optical mapping showed significant conduction slowing in AF+AFLs and AF but not AFL, paralleling atrial fibrosis and collagen-gene upregulation. Left-ventricular function did not change in any group. Transcriptomic analysis revealed substantial dysregulation of inflammatory and extracellular matrix-signaling pathways with AF and AF+ALs but not AFL. CONCLUSIONS Sustained AFL causes atrial repolarization changes like those in AF but, unlike AF or AF+AFLs, does not induce structural remodeling. These results provide novel insights into AFL-induced remodeling and suggest that early intervention may be important to prevent irreversible fibrosis when AF intervenes in a patient with AFL.
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Affiliation(s)
- Jean-Baptiste Guichard
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada; Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France
| | - Patrice Naud
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Feng Xiong
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Xiaoyan Qi
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Nathalie L'Heureux
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Roddy Hiram
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Jean-Claude Tardif
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Raymond Cartier
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France
| | - Stanley Nattel
- Department of Medicine and Research Center Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada; Department of Pharmacology and Therapeutics, McGill University Montréal, Montréal, Québec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany; IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France.
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25
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Delinière A, Baranchuk A, Giai J, Bessiere F, Maucort-Boulch D, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum PF, Taieb J, Bouet J, Fauvernier M, Rosianu H, Carabelli A, Duband B, Chevalier P. Prediction of ventricular arrhythmias in patients with a spontaneous Brugada type 1 pattern: the key is in the electrocardiogram. Europace 2020; 21:1400-1409. [PMID: 31177270 DOI: 10.1093/europace/euz156] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/15/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS There is currently no reliable tool to quantify the risks of ventricular fibrillation or sudden cardiac arrest (VF/SCA) in patients with spontaneous Brugada type 1 pattern (BrT1). Previous studies showed that electrocardiographic (ECG) markers of depolarization or repolarization disorders might indicate elevated risk. We aimed to design a VF/SCA risk prediction model based on ECG analyses for adult patients with spontaneous BrT1. METHODS AND RESULTS This retrospective multicentre international study analysed ECG data from 115 patients (mean age 45.1 ± 12.8 years, 105 males) with spontaneous BrT1. Of these, 45 patients had experienced VF/SCA and 70 patients did not experience VF/SCA. Among 10 ECG markers, a univariate analysis showed significant associations between VF/SCA and maximum corrected Tpeak-Tend intervals ≥100 ms in precordial leads (LMaxTpec) (P < 0.001), BrT1 in a peripheral lead (pT1) (P = 0.004), early repolarization in inferolateral leads (ER) (P < 0.001), and QRS duration ≥120 ms in lead V2 (P = 0.002). The Cox multivariate analysis revealed four predictors of VF/SCA: the LMaxTpec [hazard ratio (HR) 8.3, 95% confidence interval (CI) 2.4-28.5; P < 0.001], LMaxTpec + ER (HR 14.9, 95% CI 4.2-53.1; P < 0.001), LMaxTpec + pT1 (HR 17.2, 95% CI 4.1-72; P < 0.001), and LMaxTpec + pT1 + ER (HR 23.5, 95% CI 6-93; P < 0.001). Our multidimensional penalized spline model predicted the 1-year risk of VF/SCA, based on age and these markers. CONCLUSION LMaxTpec and its association with pT1 and/or ER indicated elevated VF/SCA risk in adult patients with spontaneous BrT1. We successfully developed a simple risk prediction model based on age and these ECG markers.
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Affiliation(s)
- Antoine Delinière
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| | | | - Joris Giai
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Francis Bessiere
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Pascal Defaye
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Dan Dobreanu
- Department of Physiology, University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania
| | - Alina Scridon
- Department of Physiology, University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania
| | - Antoine Da Costa
- Pôle Cardiovasculaire, CHU de Saint-Etienne, Saint-Etienne, France
| | | | - Claude Kouakam
- Unité de Rythmologie, Hôpital Cardiologique, CHU de Lille, Lille, France
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Extramiana
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Antoine Leenhardt
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Haran Burri
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Genève, Suisse
| | | | - Jérôme Taieb
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Jérôme Bouet
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Mathieu Fauvernier
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Horia Rosianu
- Department of Cardiology, Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Adrien Carabelli
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Benjamin Duband
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Chevalier
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
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26
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Delinière A, Baranchuk A, Bessière F, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum PF, Taieb J, Bouet J, Rosianu H, Chevalier P. Prognostic significance of a low T/R ratio in Brugada syndrome. J Electrocardiol 2020; 63:6-11. [PMID: 33011474 DOI: 10.1016/j.jelectrocard.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prognostic value of a low T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients (pts) with a spontaneous type-1 Brugada pattern (SBT1). BACKGROUND Abnormalities of myocardial repolarization may play a key role in the initiation of ventricular fibrillation (VF) in Brugada syndrome (BrS). Recent studies have shown that the height of the T waves and the T/R ratio are inversely proportional to sudden cardiac arrest (SCA) risk in early repolarization syndrome and hypertrophic cardiomyopathy. METHODS In an international retrospective study, we reviewed 115 pts. (105 males, 91.3%). 45 had VF and/or SCA (38.7 ± 11.5 years old, all males), while 70 (49.3 ± 12.0 years, 10 women) remained free of ventricular arrhythmia. 6 ECG markers plus the T/R ratio in leads V5 & II were studied. RESULTS The T/R ratio among leads II & V5 was significantly lower in the VF/SCA group (0.24 [0.14; 0.38]vs. 0.34 [0.24; 0.45]; p = 0.006). 44.4% of pts. in the VF/SCA group had a lowest T/R ratio among leads II & V5 ≤ 0.17 compared to 11.4% in the non-VF/SCA group (p < 0.001). In multivariate analysis, a lowest T/R ratio among leads II & V5 ≤ 0.17 was independently associated with VF/SCA (OR 6.10, 95% CI 1.92-19.40; p = 0.002). Type 1 Brugada pattern in the peripheral leads (OR 10.78) and early repolarization (OR 3.60) were other independent markers of VF/SCA. CONCLUSION A low T/R ratio among leads II & V5 is an independent marker for VF/SCA risk in patients with type-1 Brugada pattern.
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Affiliation(s)
- Antoine Delinière
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France
| | | | - Francis Bessière
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France
| | - Pascal Defaye
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Dan Dobreanu
- University of Medicine and Pharmacy of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Antoine Da Costa
- Pôle Cardiovasculaire, CHU de Saint-Etienne, Saint-Etienne, France
| | | | - Claude Kouakam
- Unité de Rythmologie, Hôpital Cardiologique, CHU de Lille, Lille, France
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Extramiana
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Antoine Leenhardt
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Haran Burri
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Genève, Suisse, Switzerland
| | | | - Jérôme Taieb
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Jérôme Bouet
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Horia Rosianu
- Department of Cardiology, Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Philippe Chevalier
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France.
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27
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Galves R, Da Costa A, Pierrard R, Bayard G, Guichard JB, Isaaz K. Impact of β-blocker therapy on right ventricular function in heart failure patients with reduced ejection fraction. A prospective evaluation. Echocardiography 2020; 37:1392-1398. [PMID: 32815195 DOI: 10.1111/echo.14813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Beta-blocker (β-blocker) therapy has been shown to improve mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Although the physiological action mechanisms of β-blockers are well described, their effects on right ventricular (RV) function have not been prospectively studied. OBJECTIVE This prospective study aimed to (a) evaluate whether β-blocker therapy impacts RV remodeling based on echo parameters and (b) determine the predictive echo factors of β-blocker therapy response. METHODS From September 2017 to September 2018, HF patients were prospectively enrolled using CIBIS criteria: Class II, III, or IV HF; left ventricular ejection fraction (LVEF) of ≤40%; hospitalized for HF within the previous 12 months. Echo evaluation was performed before initiating β-blocker therapy and 3 months after optimal dose adjustment. Based on previous studies, patients with (absolute) LVEF ≥ 5% improvement were considered significant β-blocker therapy responders. RESULTS Overall, 40 patients (pts) completed the study, characterized as follows by age: 70 ± 10 years; gender: 10 women; cardiomyopathy etiology: idiopathic in 24 and ischemic in 16; NYHA Class: II in 22 and III in 10; LVEF: 32 ± 5%; and NTProBNP: 2665 ± 2400 pg/mL. The final population comprised 32 pts (79%), with eight (21%) excluded: two because of β-blocker therapy intolerance, one lost to follow-up, and five withdrew from the study. Under β-blocker therapy, several echo parameters significantly improved: LVEF from 31.7 ± 9 to 40.5 ± 9 (P < .0001); LV end-diastolic volume (EDV) from 154 ± 54 to 143 ± 45 mL (P = .06); LV end-systolic volume (ESV) from 107 ± 49 to 88 ± 37 mL (P = .0006); LV ES from 46 ± 11 to 64 ± 13 mL (P = .008); LV end-diastolic diameter (EDD) from 57 ± 9 to 54 ± 6 mm (P = .04); LV end-systolic diameter (ESD) from 48 ± 10 to 44 ± 7 mm (P = .007); and right ventricular systolic pressure (RV SP) from 39 ± 10 to 32 ± 8 mm Hg (P = .0001). Significant modifications were observed in terms of RV echo parameters: right ventricular (RV) size decreased from 30 ± 4 to 27 ± 5 mm (P = .03), while RV systolic function significantly improved based on tricuspid annular plane systolic excursion (TAPSE) (16.5 ± 4 vs. 19 ± 4 mm; 0.0006); DTI-derived tricuspid lateral annular systolic velocity wave (S') (10 ± 2 vs. 11.3 ± 3 cm/s; P = .03); and RIMP (Tei index) (0.5 ± 0.1 vs 0.46 ± 0.1; P = .04). RV 2D fractional area change (%) did not significantly differ despite a clear improvement tendency (35 ± 6 vs. 37 ± 4%; P = .1). No significant modifications were observed concerning LV diastolic parameters. Overall, β-blocker echo responders (n = 23/32; 72%) exhibited the same left and right echo parameters. No echo variables predicted the β-blocker response. CONCLUSIONS In HFrEF pts, β-blocker therapy significantly improves LV and RV systolic remodeling. Accordingly, β-blocker therapy could be applied as soon as possible in HFrEF patients with right ventricular dysfunction so as to limit RV remodeling.
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Affiliation(s)
- Rémi Galves
- Division of Cardiology CHU Saint Etienne, Jean Monnet University, Saint-Etienne, France
| | - Antoine Da Costa
- Division of Cardiology CHU Saint Etienne, Jean Monnet University, Saint-Etienne, France
| | - Romain Pierrard
- Division of Cardiology CHU Saint Etienne, Jean Monnet University, Saint-Etienne, France
| | - Geoffrey Bayard
- Division of Cardiology CHU Saint Etienne, Jean Monnet University, Saint-Etienne, France
| | | | - Karl Isaaz
- Division of Cardiology CHU Saint Etienne, Jean Monnet University, Saint-Etienne, France
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Massoullié G, Moubarak G, Thomas O, Da Costa A, Roger V, Justo J, Mechulan A, Eschalier R, Silberbauer J, Andronache M. Initial multicenter experience with a new high-density coloring module: impact for complex atrial arrhythmias interpretation. J Interv Card Electrophysiol 2020; 60:313-319. [PMID: 32621214 DOI: 10.1007/s10840-020-00802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-density automated mapping of complex atrial tachycardias (ATs) requires accurate assessment of activation maps. A new local activation display module (HD coloring, Biosense Webster®) provides higher map resolution, a better delineation of potential block reducing color interpolation, and a new propagation display. We evaluated the accuracy of a dedicated local activation display compared with standard algorithm. METHODS High-density maps from 10 AT were collected with a multipolar catheter and were displayed with standard activation or HD coloring. Six expert operators retrospectively analyzed activation maps and were asked to define (1) the tachycardia mechanism, (2) ablation target, and (3) level of difficulty to interpret those maps. RESULTS Using HD coloring, operators were able to reach a correct diagnosis in 93% vs. 63%, p < 0.05 compared to standard activation maps. Time to diagnosis was shorter 1.9 ± 1.0 min vs. 3.9 ± 2.1 min, p < 0.05. Confidence level would have allowed ablation without necessity for entrainment maneuvers in 87% vs. 53%, p < 0.05. Operators would have needed to remap or proceed with multiple entrainments in 3% vs. 13% of cases, p < 0.05. Finally, ablation strategy was more accurately identified in 97% vs. 67%, p < 0.05. CONCLUSION Activation mapping with the new HD coloring module allowed a more accurate, reliable, and faster interpretation of complex ATs mechanisms compared to standard activation maps.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, ISIT-CaVITI, 58 rue Montalembert, 63000 CHU, Clermont-Ferrand, France.
| | - Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Thomas
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | | | | | | | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, ISIT-CaVITI, 58 rue Montalembert, 63000 CHU, Clermont-Ferrand, France
| | | | - Marius Andronache
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, ISIT-CaVITI, 58 rue Montalembert, 63000 CHU, Clermont-Ferrand, France
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Tajiri K, Guichard JB, Qi X, Xiong F, Naud P, Tardif JC, Costa AD, Aonuma K, Nattel S. An N-/L-type calcium channel blocker, cilnidipine, suppresses autonomic, electrical, and structural remodelling associated with atrial fibrillation. Cardiovasc Res 2020; 115:1975-1985. [PMID: 31119260 DOI: 10.1093/cvr/cvz136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/18/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Autonomic dysfunction can promote atrial fibrillation (AF) and results from AF-related remodelling. N-type Ca2+-channels (NTCCs) at sympathetic nerve terminals mediate Ca2+-entry that triggers neurotransmitter release. AF-associated remodelling plays an important role in AF pathophysiology but the effects of NTCC inhibition on such remodelling is unknown. Here, we investigated the ability of a clinically available Ca2+-channel blocker (CCB) with NTCC-blocking activity to suppress the arrhythmogenic effects of AF-promoting remodelling in dogs. METHODS AND RESULTS Mongrel dogs were kept in AF by right atrial tachypacing at 600 bpm. Four groups were studied under short-term AF (7 days): (i) Shams, instrumented but without tachypacing (n = 5); (ii) a placebo group, tachypaced while receiving placebo (n = 6); (iii) a control tachypacing group receiving nifedipine (10 mg orally twice-daily; n = 5), an L-type CCB; and (iv) a cilnidipine group, subjected to tachypacing and treatment with cilnidipine (10 mg orally twice-daily; n = 7), an N-/L-type CCB. With cilnidipine therapy, dogs with 1-week AF showed significantly reduced autonomic changes reflected by heart rate variability (decreases in RMSSD and pNN50) and plasma norepinephrine concentrations. In addition, cilnidipine-treated dogs had decreased extracellular matrix gene expression vs. nifedipine-dogs. As in previous work, atrial fibrosis had not yet developed after 1-week AF, so three additional groups were studied under longer-term AF (21 days): (i) Shams, instrumented without tachypacing or drug therapy (n = 8); (ii) a placebo group, tachypaced while receiving placebo (n = 8); (iii) a cilnidipine group, subjected to tachypacing during treatment with cilnidipine (10 mg twice-daily; n = 8). Cilnidipine attenuated 3-week AF effects on AF duration and atrial conduction, and suppressed AF-induced increases in fibrous-tissue content, decreases in connexin-43 expression and reductions in sodium-channel expression. CONCLUSIONS Cilnidipine, a commercially available NTCC-blocking drug, prevents AF-induced autonomic, electrical and structural remodelling, along with associated AF promotion.
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Affiliation(s)
- Kazuko Tajiri
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Jean-Baptiste Guichard
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada.,Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France
| | - Xiaoyan Qi
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada
| | - Feng Xiong
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada
| | - Patrice Naud
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Belanger St E, Montreal, Quebec, Canada.,Department of Pharmacology and Therapeutics, McGill University, Promenade Sir-William-Osler, Montreal, Quebec, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstr. 55, Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Avenue du Haut Lévêque, Pessac, Bordeaux, France
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Abstract
BACKGROUND In New Caledonia, a South Pacific archipelago whose inhabitants comprise Melanesians, Europeans/whites, Wallisians, Futunans, Polynesians, and Asians, the prevalence of rheumatic heart disease (RHD) is 0.9% to 1% at ages 9 and 10. It could be higher at the age of 16, but this remains to be verified. METHODS AND RESULTS A total of 1530 Melanesian, Métis, white, Wallisian, Futunan, Polynesian, and Asian adolescents benefited from a transthoracic echocardiogram. Definite or borderline RHD, nonrheumatic valve lesions, congenital heart defects, family and personal history of acute rheumatic fever, and socioeconomic factors were collected. The prevalence of cardiac abnormalities was 8.1%, made up of 4.1% RHD including 2.4% definite and 1.7% borderline RHD, 1.7% nonrheumatic valve lesions, and 2.3% congenital anomalies. In whites and Asians, there were no cases of RHD. RHD was higher in the Wallisian, Futunan, and Polynesian group (7.6%) when compared with Melanesians (5.3%) and Métis (2.9%). The number of nonrheumatic valve lesions was not statistically different in the different ethnicities. The prevalence of RHD was higher in adolescents with a personal history of acute rheumatic fever, in those living in overcrowded conditions, and in those whose parents were unemployed or had low‐income occupations, such as the farmers or manual workers. CONCLUSIONS RHD was 4 times higher in adolescents at age 16 than at ages 9 and 10 (4.1% versus 0.9%–1%). No cases of RHD were observed in whites and Asians. The determining factors were history of acute rheumatic fever and socioeconomic factors.
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Affiliation(s)
- Jean-Claude Chatard
- Inter-University Laboratory of Human Movement Science Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France.,Directorate of Health and Social Affairs Noumea New Caledonia
| | - Thomas Dubois
- Department of Cardiology Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France.,Directorate of Health and Social Affairs Noumea New Caledonia
| | - Florian Espinosa
- Department of Cardiology Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France
| | | | | | | | - Antoine Da Costa
- Department of Cardiology Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France
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31
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van Rosmalen F, Delhaas T, Dagres N, Arbelo E, Blomström-Lundqvist C, Crijns HJGM, Da Costa A, Pytkowski M, Sharikov N, Laroche C, Tavazzi L, Brugada J, Pison L. Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry. J Interv Card Electrophysiol 2020; 60:395-406. [PMID: 32356163 PMCID: PMC8134287 DOI: 10.1007/s10840-020-00744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
Background Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety. Methods The registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared. Results Adenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991). Conclusions The use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.
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Affiliation(s)
- Frank van Rosmalen
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Antoine Da Costa
- C.H.U. de Saint Etienne, Hôpital Nord, Saint-Priest-en-Jarez, France
| | - Mariusz Pytkowski
- Heart Rhythm Division of the 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warszawa, Poland
| | - Nikita Sharikov
- Department of Surgical Treatment of Complex Rhythm Disturbances and Electro-cardio-stimulation, District Clinical Hospital, Khanty-Mansiysk, Autonomous Okrug-Yugra, Russia
| | - Cécile Laroche
- EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology, Sophia Antipolis, France
| | - Luigi Tavazzi
- GVM Care and Research, E.S., Maria Cecilia Hospital, Cotignola, Italy
| | - Joseph Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.
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Mery B, Fouilloux A, Rowinski E, Catella-Chatron J, Guichard JB, Da Costa A, Tinquaut F, Magné N, Bertoletti L. Cardiovascular disease events within 5 years after a diagnosis of breast cancer. BMC Cancer 2020; 20:337. [PMID: 32398106 PMCID: PMC7216603 DOI: 10.1186/s12885-020-06838-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Concern for cardiovascular disease (particularly atrial fibrillation-AF) among women with breast cancer is becoming a major issue. We aimed at determining the incidence of cardiovascular disease events (AF, arterial and cardiac events, venous-thromboembolism-VTE) in patients diagnosed with breast cancer, and assessing potential risk factors. METHODS We reviewed medical records of all patients diagnosed with breast cancer from 2010 to 2011 in our cancer center. Baseline characteristics of patients and tumors were collected. The main outcome was the occurrence of cardiovascular disease events (AF, VTE, arterial and cardiac events) during the 5-years follow-up. RESULTS Among the 682 breast cancer patients, 22 (3.2%) patients had a history of atrial fibrillation. Thirty-four patients (5%) presented at least one cardiovascular disease event, leading to a cumulative incidence of 5.8% events at 5-years ([3.8-7.7] CI 95%), with most of them occurring in the first 2 years. AF cumulative incidence was 1.1% ([0.1-2.1] CI 95%). Factors associated with the occurrence of cardiovascular disease events (including AF) were an overexpression of HER-2 (HR 2.6 [1.21-5.56] p < 0.011), UICC-stage III tumors or more (HR 5.47 [2.78-10.76] p < 0.001) and pre-existing cardiovascular risk factors (HR 2.91 [1.36-6.23] p < 0.004). CONCLUSION The incidence of cardiovascular disease events was 5.8% ([3.8-7.7] CI 95%), with HER-2 over-expression, UICC-stage III tumors or more and pre-existing cardiovascular diseases being associated with them. These findings call for the development of preventive strategies in patients diagnosed with breast cancer.
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Affiliation(s)
- Benoîte Mery
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 SAINT PRIEST EN JAREZ, France
| | - Antoine Fouilloux
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 SAINT PRIEST EN JAREZ, France
| | - Elise Rowinski
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 SAINT PRIEST EN JAREZ, France
| | - Judith Catella-Chatron
- Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Fabien Tinquaut
- Public Health Department, Lucien Neuwirth Cancer Institute, St Priest en Jarez, France
| | - N. Magné
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, St Priest en Jarez, France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
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Rosier L, Zouaghi A, Barré V, Martins R, Probst V, Marijon E, Sadoul N, Chauveau S, Da Costa A, Badoz M, Peyrol M, Barraud J, Massoullie G, Eschalier R, Espinosa M, Lesaffre F, Garcia R, Degand B, Noël A, Mansourati J, Extramiana F, Algalarrondo V, Devilliers H, Cottin Y, Gandjbakhch E, Guenancia C. High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis. J Clin Med 2020; 9:jcm9030848. [PMID: 32244983 PMCID: PMC7141537 DOI: 10.3390/jcm9030848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan–Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.
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Affiliation(s)
- Laurent Rosier
- Cardiology Department, Dijon Bourgogne University Hospital, 21000 Dijon, France; (L.R.); (Y.C.)
| | - Amir Zouaghi
- Cardiology Department, Hôpitaux Universitaires Pitié Salpêtrière, APHP, 75013 Paris, France; (A.Z.); (E.G.)
| | - Valentin Barré
- Cardiology Department, University Hospital, 35000 Rennes, France; (V.B.); (R.M.)
| | - Raphaël Martins
- Cardiology Department, University Hospital, 35000 Rennes, France; (V.B.); (R.M.)
| | - Vincent Probst
- Institut du thorax, Service de Cardiologie and INSERM 1087, 44000 Nantes, France;
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital and Paris Descartes University, 75015 Paris, France;
| | - Nicolas Sadoul
- Cardiology Department, University Hospital, 54511 Nancy, France
| | - Samuel Chauveau
- Cardiology Department, University Hospital Louis Pradel, 69500 Lyon, France;
| | - Antoine Da Costa
- Cardiology Department, University Hospital, 42055 Saint-Etienne, France;
| | - Marc Badoz
- Cardiology Department, University Hospital, 25030 Besançon, France;
| | - Michael Peyrol
- Aix-Marseille University, Assistance Publique–Hôpitaux de Marseille (APHM), Department of Cardiology, Nord Hospital, 13000 Marseille, France; (M.P.); (J.B.)
| | - Jérémie Barraud
- Aix-Marseille University, Assistance Publique–Hôpitaux de Marseille (APHM), Department of Cardiology, Nord Hospital, 13000 Marseille, France; (M.P.); (J.B.)
| | - Grégoire Massoullie
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.M.); (R.E.)
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.M.); (R.E.)
| | - Madeline Espinosa
- Cardiology Department, University Hospital, 51100 Reims, France; (M.E.); (F.L.)
| | - François Lesaffre
- Cardiology Department, University Hospital, 51100 Reims, France; (M.E.); (F.L.)
| | - Rodrigue Garcia
- CHU Poitiers, Centre Cardiovasculaire, 86000 Poitiers, France; (R.G.) ; (B.D.)
| | - Bruno Degand
- CHU Poitiers, Centre Cardiovasculaire, 86000 Poitiers, France; (R.G.) ; (B.D.)
| | - Antoine Noël
- Cardiology Department, University Hospital, 29200 Brest, France; (A.N.); (J.M.)
| | - Jacques Mansourati
- Cardiology Department, University Hospital, 29200 Brest, France; (A.N.); (J.M.)
| | - Fabrice Extramiana
- Department of Cardiology, Bichat Claude Bernard Hospital, University Paris Diderot, 75018 Paris, France; (F.E.); (V.A.)
| | - Vincent Algalarrondo
- Department of Cardiology, Bichat Claude Bernard Hospital, University Paris Diderot, 75018 Paris, France; (F.E.); (V.A.)
| | - Hervé Devilliers
- Internal Medicine 2 Department, Dijon Bourgogne University Hospital, 21000 Dijon, France;
| | - Yves Cottin
- Cardiology Department, Dijon Bourgogne University Hospital, 21000 Dijon, France; (L.R.); (Y.C.)
- PEC 2, Univ. Bourgogne Franche–Comté, 21000 Dijon, France
| | - Estelle Gandjbakhch
- Cardiology Department, Hôpitaux Universitaires Pitié Salpêtrière, APHP, 75013 Paris, France; (A.Z.); (E.G.)
| | - Charles Guenancia
- Cardiology Department, Dijon Bourgogne University Hospital, 21000 Dijon, France; (L.R.); (Y.C.)
- PEC 2, Univ. Bourgogne Franche–Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380293536; Fax: +33-380293879
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Guichard JB, Xiong F, Qi XY, L'Heureux N, Hiram R, Xiao J, Naud P, Tardif JC, Da Costa A, Nattel S. Role of atrial arrhythmia and ventricular response in atrial fibrillation induced atrial remodelling. Cardiovasc Res 2020; 117:462-471. [PMID: 31977017 DOI: 10.1093/cvr/cvaa007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/13/2019] [Accepted: 01/17/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS No studies have assessed the specific contributions of atrial fibrillation (AF)-related atrial vs. associated ventricular arrhythmia to remodelling. This study assessed the roles of atrial arrhythmia vs. high ventricular rate in AF-associated remodelling. METHODS AND RESULTS Four primary dog-groups (12/group) were subjected to 3-week pacing: 600-b.p.m. atrial tachypacing maintaining AF [AF w/o- atrioventricular block (AVB)]; atrial tachypacing with atrioventricular-node ablation (AF+AVB) and ventricular-demand pacing (80 b.p.m.); 160-b.p.m. ventricular-tachypacing (V160) reproducing the response rate during AF; and sinus rhythm with AVB/ventricular-pacing at 80-b.p.m. (control group). At terminal study, left-atrial (LA) effective refractory period (ERP) was reduced equally in both AF groups (w/o-AVB and AF+AVB). AF-inducibility was increased strongly in AF groups (w/o-AVB and AF+AVB) and modestly in V160. AF duration was significantly increased in AF w/o-AVB but not in AF+AVB or V160. Conduction velocity was decreased in AF w/o-AVB, to a greater extent than in AF+AVB and V160. Atrial fibrous-tissue content was increased in AF w/o-AVB, AF+AVB and V160, with collagen-gene up-regulation only in AF w/o-AVB. Connexin43 gene expression was reduced only in AF w/o-AVB. An additional group of 240-b.p.m. ventricular tachypacing dogs (VTP240; to induce heart failure) was studied: vs. other tachypaced groups, VTP240 caused greater fibrosis, but no change in LA-ERP or AF-inducibility. VTP240 also increased AF duration, strongly decreased left ventricular ejection fraction, and was the only group with LA natriuretic-peptide activation. CONCLUSION The atrial tachyarrhythmia and rapid ventricular response during AF produce distinct atrial remodelling; both contribute to the arrhythmogenic substrate, providing new insights into AF-related remodelling and novel considerations for ventricular rate-control.
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Affiliation(s)
- Jean-Baptiste Guichard
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada.,Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne 42000, France
| | - Feng Xiong
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Xiao-Yan Qi
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Nathalie L'Heureux
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Roddy Hiram
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Jiening Xiao
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Patrice Naud
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Jean-Claude Tardif
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Antoine Da Costa
- Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne 42000, France
| | - Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada.,Department of Pharmacology and Therapeutics, McGill University Montreal, Montreal, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
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Galand V, Linde C, Lellouche N, Mansourati J, Deharo JC, Sagnol P, Da Costa A, Horvilleur J, Defaye P, Boveda S, Steinbach M, Bru P, Rumeau P, Beard T, Younsi S, Dickstein K, Normand C, Leclercq C. The European Society of Cardiology Cardiac Resynchronization Therapy Survey II: A comparison of cardiac resynchronization therapy implantation practice in Europe and France. Arch Cardiovasc Dis 2019; 112:713-722. [PMID: 31706879 DOI: 10.1016/j.acvd.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The first European Cardiac Resynchronization Therapy (CRT) Survey, conducted in 2008-2009, showed considerable variations in guideline adherence and implantation practice. A second prospective survey (CRT Survey II) was then performed to describe contemporary clinical practice regarding CRT among 42 European countries. AIM To compare the characteristics of French CRT recipients with the overall European population of CRT Survey II. METHODS Demographic and procedural data from French centres recruiting all consecutive patients undergoing either de novo CRT implantation or an upgrade to a CRT system were collected and compared with data from the European population. RESULTS A total of 11,088 patients were enrolled in CRT Survey II, 754 of whom were recruited in France. French patients were older (44.7% aged≥75 years vs 31.1% in the European group), had less severe heart failure symptoms, a higher baseline left ventricular ejection fraction and fewer co-morbidities. Additionally, French patients had a shorter intrinsic QRS duration (19.1% had a QRS<130ms vs 12.3% in the European cohort). Successful implantation rates were similar, but procedural and fluoroscopy times were shorter in France. French patients were more likely to receive a CRT pacemaker than European patients overall. Of note, antibiotic prophylaxis was reported to be administered less frequently in France, and a higher rate of early device-related infection was observed. Importantly, French patients were less likely to receive optimal drugs for treating heart failure at hospital discharge. CONCLUSION This study highlights contemporary clinical practice in France, and describes substantial differences in patient selection, implantation procedure and outcomes compared with the other European countries participating in CRT Survey II.
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Affiliation(s)
- Vincent Galand
- LTSI-UMR 1099, Rennes University, CHU de Rennes, 35000 Rennes, France
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institute, 17176 Stockholm, Sweden
| | | | | | | | - Pascal Sagnol
- Department of Cardiology, centre hospitalier William-Morey, 71321 Chalon-sur-Saône, France
| | - Antoine Da Costa
- Department of Cardiology, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
| | - Jerome Horvilleur
- Department of Cardiology, Paris South Cardiovascular Institute, 91300 Massy, France
| | - Pascal Defaye
- Department of Cardiology, Michallon Hospital, CHU Grenoble Alpes, 38700 La Tronche, France
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Mathieu Steinbach
- Department of Cardiology, centre hositalier de Haguenau, 67500 Haguenau, France
| | - Paul Bru
- Department of Cardiologie, centre hositalier de La Rochelle, 17019 La Rochelle, France
| | - Philippe Rumeau
- Department of Cardiology, centre hositalier de Albi, 81000 Albi, France
| | - Thierry Beard
- Department of Cardiology, Ormeau Polyclinic, 65000 Tarbes, France
| | - Salem Younsi
- Department of Cardiology, Antoine-Béclère Hospital, 92140 Clamart, France
| | - Kenneth Dickstein
- Cardiology Division, Stavanger University Hospital, 4011 Stavanger, Norway; Institute of Internal Medicine, University of Bergen, 5021 Bergen, Norway
| | - Camilla Normand
- Cardiology Division, Stavanger University Hospital, 4011 Stavanger, Norway; Institute of Internal Medicine, University of Bergen, 5021 Bergen, Norway
| | - Christophe Leclercq
- Department of Cardiology and Vascular Diseases, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
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Isaaz K, Balichard S, Gerbay A, Haber B, Bouchou G, Terreaux J, Cerisier A, Da Costa A. TCT-589 Role of the Position of the Pressure Guidewire Sensor Distal to the Coronary Artery Stenosis on Fractional Flow Reserve Measurements. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bayard G, Da Costa A, Pierrard R, Roméyer-Bouchard C, Guichard JB, Isaaz K. Impact of sacubitril/valsartan on echo parameters in heart failure patients with reduced ejection fraction a prospective evaluation. Int J Cardiol Heart Vasc 2019; 25:100418. [PMID: 31517034 PMCID: PMC6728827 DOI: 10.1016/j.ijcha.2019.100418] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
Background Sacubitril/valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Although the physiological action mechanisms of sacubitril/valsartan are well described, its effects on left ventricular (LV) remodelling and other echocardiographic (echo) parameters have not been prospectively studied. Objective The aim of this prospective study was to: McMurray et al. (2012) [1] evaluate if sacubitril/valsartan impacts LV remodelling based on echo parameters; Ponikowski et al. (2016) [2] identify the predictive factors of sacubitril/valsartan response or intolerance. Methods From May 2017 to September 2018, 52 HF patients were prospectively enrolled using PARADIGM-HF criteria: Class II, III, or IV HF; ejection fraction (EF) of 40% or less; hospitalized for HF within the previous 12 months. Echo evaluation was performed before initiating sacubitril/valsartan and 3 months after optimal dose adjustment. Based on previous studies, patients with (absolute) improvement in left ventricular ejection fraction (LVEF) ≥ 5% were considered significant sacubitril/valsartan responders. Results The 52 patients completing the study were characterized by age: 70 ± 10 years; gender: 11women; aetiology: idiopathic in 20 and ischaemic in 32; NYHA Class: II in 17 and III in 35; LVEF: 32 ± 5%; NTProBNP: 1805 ± 1914 pg/mL. The final population comprised 41 pts (79%), as 11 (21%) did not tolerate sacubitril/valsartan therapy. Under sacubitril/valsartan, several echo parameters significantly improved: LVEF from 32.6 ± 5 to 36 ± 6% (p < 0.0001); LVES volume from 117 ± 40 to 108 ± 46 mL (p = 0.0051); SEV from 59 ± 12 to 64 ± 13 (p = 0.0061); LVEDD from 60 ± 4 to 57 ± 5 mm (p = 0.0002); mean right ventricular systolic pressure (RVSP) from 39 ± 10 to 32 ± 8 (p = 0.0001). No significant modifications were observed concerning LV diastolic parameters or RV echo parameters. Sacubitril/valsartan echo responders (n = 18/41; 42%) had less severe LV remodelling, as shown by LVEDV: 144 ± 37 vs. 193 ± 47 mL, p = 0.0009; LVESV: 96 ± 28 vs. 133 ± 42 mL; p = 0.003; LVTDD: 61 ± 4 vs. 57 ± 5 mm; p = 0.02; significant mitral regurgitation: 6/18 (33%) vs. 16/23 (69%), p = 0.02; no diastolic LV or RV parameters impacted sacubitril/valsartan response. Predictors of sacubitril/valsartan intolerance were baseline creatinine level: 137 ± 99 vs. 100 ± 24, p = 0.03; LVEF: 29 ± 6 vs. 33 ± 5%; p = 0.04. Conclusions In HFrEF patients, sacubitril/valsartan significantly improves LV systolic remodelling, without any significant effects on LV diastolic or RV systolic echo parameters. Sacubitril/valsartan responders exhibit both less severe LV remodelling and less significant mitral regurgitation. Accordingly, sacubitril/valsartan could be used as soon as possible in HFrEF patients in order to limit LV remodelling, while precluding non-response or intolerance.
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Affiliation(s)
- Geoffrey Bayard
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Romain Pierrard
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | | | | | - Karl Isaaz
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
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Amara W, Garcia R, Mansourati J, Taieb J, Gandjbackh E, Dompnier A, Gorka H, Zannad-Bahe N, Da Costa A, Sacher F, Jourda F, Fromentin S, Cheggour S, Georger F, Ramonatxco A, Milhem A. HEPARIN AND LOW-MOLECULAR-WEIGHT HEPARIN SWITCH ASSOCIATED WITH AN INCREASE IN BLEEDING COMPLICATIONS IN PATIENTS ON APIXABAN UNDERGOING CATHETER ABLATION: THE AMPER ABLATION STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Milhem A, Ingrand P, Tréguer F, Cesari O, Da Costa A, Pavin D, Rivat P, Badenco N, Abbey S, Zannad N, Winum PF, Mansourati J, Maury P, Bader H, Savouré A, Sacher F, Andronache M, Allix-Béguec C, De Chillou C, Anselme F, Al Arnaout A, Amara W, Amelot M, Bars C, Becoulet L, Bru P, Chevalier P, Darmon JP, Deharo JC, Dompnier A, Duplantier-Duchene C, Extramiana F, Faugier JP, Guenancia C, Horvilleur J, Jourda F, Laurent G, Lellouche N, Magnin Poull I, Piot O, Roux A, Saludas Y, Seitz J, Taieb J. Exclusion of Intra-Atrial Thrombus Diagnosis Using D-Dimer Assay Before Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2019; 5:223-230. [DOI: 10.1016/j.jacep.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/20/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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Barra S, Providência R, Boveda S, Duehmke R, Narayanan K, Chow AW, Piot O, Klug D, Defaye P, Gras D, Deharo JC, Milliez P, Da Costa A, Mondoly P, Gonzalez-Panizo J, Leclercq C, Heck P, Virdee M, Sadoul N, Le Heuzey JY, Marijon E. Device complications with addition of defibrillation to cardiac resynchronisation therapy for primary prevention. Heart 2018. [PMID: 29540431 DOI: 10.1136/heartjnl-2017-312546] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In patients indicated for cardiac resynchronisation therapy (CRT), the choice between a CRT-pacemaker (CRT-P) versus defibrillator (CRT-D) remains controversial and indications in this setting have not been well delineated. Apart from inappropriate therapies, which are inherent to the presence of a defibrillator, whether adding defibrillator to CRT in the primary prevention setting impacts risk of other acute and late device-related complications has not been well studied and may bear relevance for device selection. METHODS Observational multicentre European cohort study of 3008 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias, undergoing CRT implantation with (CRT-D, n=1785) or without (CRT-P, n=1223) defibrillator. Using propensity score and competing risk analyses, we assessed the risk of significant device-related complications requiring surgical reintervention. Inappropriate shocks were not considered except those due to lead malfunction requiring lead revision. RESULTS Acute complications occurred in 148 patients (4.9%), without significant difference between groups, even after considering potential confounders (OR=1.20, 95% CI 0.72 to 2.00, p=0.47). During a mean follow-up of 41.4±29 months, late complications occurred in 475 patients, giving an annual incidence rate of 26 (95% CI 9 to 43) and 15 (95% CI 6 to 24) per 1000 patient-years in CRT-D and CRT-P patients, respectively. CRT-D was independently associated with increased occurrence of late complications (HR=1.68, 95% CI 1.27 to 2.23, p=0.001). In particular, when compared with CRT-P, CRT-D was associated with an increased risk of device-related infection (HR 2.10, 95% CI 1.18 to 3.45, p=0.004). Acute complications did not predict overall late complications, but predicted device-related infection (HR 2.85, 95% CI 1.71 to 4.56, p<0.001). CONCLUSIONS Compared with CRT-P, CRT-D is associated with a similar risk of periprocedural complications but increased risk of long-term complications, mainly infection. This needs to be considered in the decision of implanting CRT with or without a defibrillator.
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Affiliation(s)
- Sérgio Barra
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Rudolf Duehmke
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Kumar Narayanan
- Cardiovascular Epidemiology, Paris Cardiovascular Research Center, Paris, France.,Cardiology Department, MaxCure Hospitals, Hyderabad, India
| | | | - Olivier Piot
- Cardiology Department, Centre Cardiologique du Nord, St Denis, France
| | - Didier Klug
- Cardiology Department, Lille University Hospital, Lille, France
| | - Pascal Defaye
- Cardiology Department, Grenoble University Hospital, Grenoble, France
| | - Daniel Gras
- Cardiology Department, Nouvelles Cliniques Nantaises, Nantes, France
| | | | - Paul Milliez
- Cardiology Department, Caen University Hospital, Caen, France
| | - Antoine Da Costa
- Cardiology Department, St Etienne University Hospital, St Etienne, France
| | - Pierre Mondoly
- Cardiology Department, Toulouse University Hospital, Toulouse, France
| | | | | | - Patrick Heck
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Munmohan Virdee
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicolas Sadoul
- Cardiology Department, Nancy University Hospital, Nancy, France
| | - Jean-Yves Le Heuzey
- Paris Descartes University, Paris, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Eloi Marijon
- Cardiovascular Epidemiology, Paris Cardiovascular Research Center, Paris, France.,Paris Descartes University, Paris, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
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Da Costa A, Munier S, Mercier B, Tardy B, Ferec C, Isaaz K, Blanc JJ, Mansourati J. Prevalence of Factor V Leiden in Patients with Myocardial Infarction and Normal Coronary Angiography. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613927] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryFactor V Leiden is associated with an increased risk of venous thrombosis and myocardial infarction in young women, but not in men in this latter case. The aim of this study was to evaluate the prevalence of this mutation in patients with myocardial infarction but normal coronary angiography.We compared 3 groups of patients: one group consisted of 107 patients with premature myocardial infarction but no significant coronary artery stenosis; another group of 244 patients with myocardial infarction and significant coronary artery stenosis; a third group of 400 healthy controls.Factor V Leiden was found in 13 patients (12.1%) who had a myocardial infarction without significant coronary artery stenosis, 11 patients (4.5%) who had a myocardial infarction with significant coronary artery stenosis (p = 0.01) and in 20 controls (5%) (p = 0.01). Odds ratio associated with factor V Leiden were respectively 2.93 (CI95 : 1.18-7.31) and 2.63 (CI95 : 1.19-5.78) when we compared myocardial infarction patients without significant coronary artery stenosis to controls or to patients with significant coronary artery stenosis.In myocardial infarction patients without significant coronary artery stenosis, prevalence of factor V Leiden is significantly higher than in controls. This new finding supports the hypothesis that thrombosis plays a key role in this selected situation.
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Mery B, Guichard JB, Guy JB, Vallard A, Barthelemy JC, Da Costa A, Magné N, Bertoletti L. Atrial fibrillation in cancer patients: Hindsight, insight and foresight. Int J Cardiol 2017; 240:196-202. [DOI: 10.1016/j.ijcard.2017.03.132] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/21/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
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Da Costa A, Guichard JB, Maillard N, Romeyer-Bouchard C, Gerbay A, Isaaz K. Substantial superiority of Niobe ES over Niobe II system in remote-controlled magnetic pulmonary vein isolation. Int J Cardiol 2017; 230:319-323. [DOI: 10.1016/j.ijcard.2016.12.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/12/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
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Da Costa A, Axiotis A, Romeyer-Bouchard C, Abdellaoui L, Afif Z, Guichard JB, Gerbay A, Isaaz K. Transcatheter leadless cardiac pacing. Int J Cardiol 2017; 227:122-126. [DOI: 10.1016/j.ijcard.2016.11.196] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022]
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Isaaz K, Gerbay A, Terreaux J, Khamis H, Tammam K, Richard L, Cerisier A, Lamaud M, Da Costa A. Restenosis after percutaneous coronary intervention for coronary chronic total occlusion. The central role of an optimized immediate post-procedural angiographic result. Int J Cardiol 2016; 224:343-347. [PMID: 27681251 DOI: 10.1016/j.ijcard.2016.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/24/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Karl Isaaz
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France.
| | - Antoine Gerbay
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Jérémy Terreaux
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Hazem Khamis
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Khalid Tammam
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Laure Richard
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Alexis Cerisier
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Michel Lamaud
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, University of Saint Etienne, Saint Etienne, France
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Eschalier R, Ploux S, Pereira B, Clémenty N, Da Costa A, Defaye P, Garrigue S, Gourraud JB, Gras D, Guy-Moyat B, Leclercq C, Mondoly P, Bordachar P. Assessment of cardiac resynchronisation therapy in patients with wide QRS and non-specific intraventricular conduction delay: rationale and design of the multicentre randomised NICD-CRT study. BMJ Open 2016; 6:e012383. [PMID: 27836874 PMCID: PMC5129079 DOI: 10.1136/bmjopen-2016-012383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cardiac resynchronisation therapy (CRT) was initially developed to treat patients with left bundle branch block (LBBB). However, many patients with heart failure have a widened QRS but neither left-BBB nor right-BBB; this is called non-specific intraventricular conduction delay (NICD). It is unclear whether CRT is effective in this subgroup of patients. METHODS AND ANALYSIS The NICD-CRT study is a prospective, double-blind, randomised (1:1), parallel-arm, multicentre trial comparing the effects of CRT in patients with heart failure, a reduced left ventricular ejection fraction (LVEF <35%) and NICD, who have been implanted with a device (CRT-pacemaker or CRT-defibrillator) that has or has not been activated. Enrolment began on 15 July 2015 and should finish within 3 years; 40 patients have already been randomised and 11 centres have agreed to participate. The primary end point is the comparison of the proportion of patients improved, unchanged or worsened over the subsequent 12 months. 100 patients per group are required to demonstrate a difference between groups with a statistical power of 90%, a type I error of 0.05% (two-sided) and a loss to follow-up of 10%. This trial will add substantially to the modest amount of existing data on CRT in patients with NICD and should reduce uncertainty for guidelines and clinical practice when added to the pool of current information. ETHICS AND DISSEMINATION Local ethics committee authorisations have been obtained since May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. TRIAL REGISTRATION NUMBER NCT02454439; pre-results.
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Affiliation(s)
- Romain Eschalier
- Cardiology Department, Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics unit (Clinical Research and Innovation Direction), Clermont-Ferrand, France
| | - Nicolas Clémenty
- Cardiology Department, Trousseau Hospital, François-Rabelais University, Tours, France
| | | | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | | | | | - Daniel Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | - Benoît Guy-Moyat
- Cardiology Department, Limoges University Hospital, Limoges, France
| | - Christophe Leclercq
- Department of Cardiology and Vascular Disease, Pontchaillou Hospital, Rennes, France
| | - Pierre Mondoly
- Federation of Cardiology, University Hospital Rangueil, Toulouse cedex 09, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
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Massoullié G, Bordachar P, Irles D, Caussin C, Da Costa A, Defaye P, Jean F, Mechulan A, Mondoly P, Souteyrand G, Pereira B, Ploux S, Eschalier R. Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB-TAVI Study. BMJ Open 2016; 6:e010485. [PMID: 27797979 PMCID: PMC5093384 DOI: 10.1136/bmjopen-2015-010485] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. METHOD AND ANALYSIS The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His-ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV <70 ms) will be implanted with a loop recorder device with remote monitoring of cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and implanted device follow-up will also be performed at 3, 6 and 12 months. The primary objective is to assess the efficacy and safety of a decisional algorithm based on electrophysiological study and remote monitoring of CIEDs in the prediction of high-grade conduction disturbances in patients with LBBB after TAVI. The primary end point is to compare the incidence (rate and time to onset) of high-grade conduction disturbances in patients with LBBB after TAVI between the two groups at 12 months. Given the proportion of high-grade conduction disturbances (20-40%), a sample of 200 subjects will allow a margin of error of 6-7%. The LBBB-TAVI Study has been in an active recruiting phase since September 2015 (21 patients already included). ETHICS AND DISSEMINATION Local ethics committee authorisation was obtained in May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. TRIAL REGISTRATION NUMBER NCT02482844; Pre-results.
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Affiliation(s)
- Grégoire Massoullié
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Didier Irles
- Cardiology Department, CH Annecy Genèvois, Pringy, France
| | | | | | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | - Frédéric Jean
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexis Mechulan
- Ramsay Générale de Santé, Hôpital Privé de Clairval, Marseille, France
| | - Pierre Mondoly
- Federation of Cardiology, University Hospital Rangueil, Toulouse cedex, France
| | - Géraud Souteyrand
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics unit (Clinical Research and Innovation Direction), Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Romain Eschalier
- Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
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48
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Abstract
Radiofrequency treatment represents the first choice of treatment for arrhythmias, in particular complex arrhythmias and especially atrial fibrillation, due to the greater benefit/risk ratio compared to antiarrhythmic drugs. However, complex arrhythmias such as atrial fibrillation require long procedures with additional risks such as X-ray exposure or serious complications such as tamponade. Given this context, the treatment of arrhythmias using robotic magnetic navigation entails a technique well suited to complex arrhythmias on account of its efficacy, reliability, significant reduction in X-ray exposure for both patient and operator, as well as a very low risk of perforation. As ongoing developments will likely improve results and procedure times, this technology will become one of the most modern technologies for treating arrhythmias. Based on the literature, this review summarizes the advantages and limitations of robotic magnetic navigation for ablation of human arrhythmias.
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Affiliation(s)
- Antoine Da Costa
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Jean Baptiste Guichard
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Cécile Roméyer-Bouchard
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Antoine Gerbay
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Karl Isaaz
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
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Boriani G, Da Costa A, Quesada A, Ricci RP, Favale S, Boscolo G, Clementy N, Amori V, Mangoni di S. Stefano L, Burri H. Effects of remote monitoring on clinical outcomes and use of healthcare resources in heart failure patients with biventricular defibrillators: results of the MORE-CARE multicentre randomized controlled trial. Eur J Heart Fail 2016; 19:416-425. [DOI: 10.1002/ejhf.626] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Giuseppe Boriani
- University of Modena and Reggio Emilia; Policlinico di Modena; Modena Italy
- University of Bologna; S. Orsola-Malpighi University Hospital; Bologna Italy
| | | | | | | | | | | | | | | | | | - Haran Burri
- University Hospital of Geneva; Geneva Switzerland
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50
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Da Costa A, Romeyer-Bouchard C, Guichard JB, Gerbay A, Isaaz K. Is the new Micra-leadless pacemaker entirely safe? Int J Cardiol 2016; 212:97-9. [DOI: 10.1016/j.ijcard.2016.03.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
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