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Teiger E, Eschalier R, Amabile N, Rioufol G, Ducrocq G, Garot P, Lepillier A, Bille J, Elbaz M, Defaye P, Audureau E, Le Corvoisier P. Left atrial appendage closure in very elderly patients in the French National Registry. Heart 2024; 110:245-253. [PMID: 37813560 DOI: 10.1136/heartjnl-2023-322871] [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: 04/23/2023] [Accepted: 08/19/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients. METHODS A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups <80 years and ≥80 years. RESULTS Among the 1053 patients included, median age was 79.7 (73.6-84.3) years; 512 patients (48.6%) were aged ≥80 years. Procedure-related serious adverse events were non-significantly more common in octogenarians (7.0% vs 4.4% in patients aged <80 years, respectively; p=0.07). Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events during the study was similar in both groups (3.0 vs 3.1/100 patient-years; p=0.85). By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p<0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19). CONCLUSION Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events after LAAC in this age group was similar to that in patients aged <80 years. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03434015).
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Affiliation(s)
- Emmanuel Teiger
- Department of Cardiology, APHP, Henri Mondor University Hospital, Créteil, France
- Clinical Investigation Center 1430 and U955-IMRB team 3, Ecole Nationale Vétérinaire d'Alfort, UPEC, INSERM, Créteil, France
| | - Romain Eschalier
- Cardiology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Lyon Cardiovascular Hospital, Bron Cedex, France
- CARMEN INSERM 1060, INSERM, Bron, France
| | - Gregory Ducrocq
- Department of Cardiology, FACT (French Alliance for Cardiovascular Trials), DHU-FIRE, Bichat-Claude Bernard University Hospital, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Ramsay-Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Jacques Bille
- Cardiology Department, Saint Joseph Hospital, Marseille, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Pascal Defaye
- Department of Rhythmology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Etienne Audureau
- AP-HP, Department of Public Health, Henri Mondor University Hospital, Creteil, France
- Equipe CEpiA, INSERM, UPEC, U955-IMRB, Créteil, France
| | - Philippe Le Corvoisier
- Clinical Investigation Center 1430, APHP, Groupe Hospitalier Henri Mondor, Creteil, France
- Clinical Investigation Center 1430 and U955-IMRB team 3, INSERM, Créteil, France
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Lepillier A, Maggio R, De Sanctis V, Malacrida M, Stabile G, Zakine C, Champ-Rigot L, Anselmino M, Segreti L, Dell’Era G, Garnier F, Mascia G, Pandozi C, Dello Russo A, Scaglione M, Cosaro G, Ferraro A, Paziaud O, Maglia G, Solimene F. Insight into contact force local impedance technology for predicting effective pulmonary vein isolation. Front Cardiovasc Med 2023; 10:1169037. [PMID: 37476572 PMCID: PMC10354239 DOI: 10.3389/fcvm.2023.1169037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created. Objective We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry. Methods A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included. Results In all, 13,891 radiofrequency (RF) applications of ≥3 s duration were assessed. The first-pass PV isolation rate was 93.3%. A total of 80 PV gaps were detected. At successful ablation spots, baseline LI and absolute LI drop were larger than at PV gap spots (161.4 ± 19 Ω vs. 153.0 ± 13 Ω, p < 0.0001 for baseline LI; 22.1 ± 9 Ω vs. 14.4 ± 5 Ω, p < 0.0001 for LI drop). On the basis of Receiver operating characteristic curve analysis, the ideal LI drop, which predicted successful ablation, was >21 Ω at anterior sites and >18 Ω at posterior sites. There was a non-linear association between the magnitude of LI drop and contact-force (CF) (r = 0.14, 95% CI: 0.13-0.16, p < 0.0001) whereas both CF and LI drop were inversely related with delivery time (DT) (-0.22, -0.23 to -0.20, p < 0.0001 for CF; -0.27, -0.29 to -0.26, p < 0.0001 for LI drop). Conclusion An LI drop >21 Ω at anterior sites and >18 Ω at posterior sites predicts successful ablation. A higher CF was associated with an increased likelihood of ideal LI drop. The combination of good CF and adequate LI drop allows a significant reduction in RF DT. Clinical trial registration http://clinicaltrials.gov/, identifier: NCT03793998.
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Affiliation(s)
| | | | | | | | | | | | | | - Matteo Anselmino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gabriele Dell’Era
- Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy
| | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | | | - Francesco Solimene
- Department of Cardiac Electrophysiology and Arrhythmology, Clinica Montevergine, Mercogliano, Italy
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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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Seitz J, Durdez TM, Albenque JP, Pisapia A, Gitenay E, Durand C, Monteau J, Moubarak G, Théodore G, Lepillier A, Zhao A, Bremondy M, Maluski A, Cauchemez B, Combes S, Guyomar Y, Heuls S, Thomas O, Penaranda G, Siame S, Appetiti A, Milpied P, Bars C, Kalifa J. Artificial intelligence software standardizes electrogram-based ablation outcome for persistent atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2250-2260. [PMID: 35989543 PMCID: PMC9826214 DOI: 10.1111/jce.15657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Multiple groups have reported on the usefulness of ablating in atrial regions exhibiting abnormal electrograms during atrial fibrillation (AF). Still, previous studies have suggested that ablation outcomes are highly operator- and center-dependent. This study sought to evaluate a novel machine learning software algorithm named VX1 (Volta Medical), trained to adjudicate multipolar electrogram dispersion. METHODS This study was a prospective, multicentric, nonrandomized study conducted to assess the feasibility of generating VX1 dispersion maps. In 85 patients, 8 centers, and 17 operators, we compared the acute and long-term outcomes after ablation in regions exhibiting dispersion between primary and satellite centers. We also compared outcomes to a control group in which dispersion-guided ablation was performed visually by trained operators. RESULTS The study population included 29% of long-standing persistent AF. AF termination occurred in 92% and 83% of the patients in primary and satellite centers, respectively, p = 0.31. The average rate of freedom from documented AF, with or without antiarrhythmic drugs (AADs), was 86% after a single procedure, and 89% after an average of 1.3 procedures per patient (p = 0.4). The rate of freedom from any documented atrial arrhythmia, with or without AADs, was 54% and 73% after a single or an average of 1.3 procedures per patient, respectively (p < 0.001). No statistically significant differences between outcomes of the primary versus satellite centers were observed for one (p = 0.8) or multiple procedures (p = 0.4), or between outcomes of the entire study population versus the control group (p > 0.2). Interestingly, intraprocedural AF termination and type of recurrent arrhythmia (i.e., AF vs. AT) appear to be predictors of the subsequent clinical course. CONCLUSION VX1, an expertise-based artificial intelligence software solution, allowed for robust center-to-center standardization of acute and long-term ablation outcomes after electrogram-based ablation.
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Waintraub X, Sauve R, Vedrenne G, Amet D, Gras M, Degand B, Moini C, Duthoit G, Laredo M, Badenco N, Lesaffre F, Lepillier A, Hidden Lucet F, Hermida A, Gandjbakhch E. Endocardial ablation of ventricular tachycardia ablation in arrhythmogenic right ventricular cardiomyopathy aiming epicardial late potential abolition. Europace 2022. [DOI: 10.1093/europace/euac053.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation is frequently needed to treat ventricular tachycardia (VT) in ARVC patients. Ablation aiming non-inducibility (NI) and late potential (LP) abolition has been shown to be effective1. Simultaneous endo-epicardial mapping demonstrate epicardial involvement in most VT2. However epicardial fat and vicinity of coronary artery may prevent effective epicardial ablation.
Aims
(a) evaluate endocardial-only ablation guided by epicardial late-potential recording (EA-ELP) to achieve LP abolition (LPA) and NI; (b) measure ablation-index(AI) values allowing epicardial LP suppression by endocardial ablation, as a surrogate for transmurality.
Methods
From 2019 to 2021 the authors (XW, EG) evaluated EA-ELP in ARVC patients patient referred for ablation. Our ablation protocol was previously described3. Endo and epicardial voltage mapping of the right ventricle (RV) were performed in sinus rhythm using 0.5-1.5 mV threshlods for endocardial scar and 0.5-1 mV for the epicardial. All LP were manually tagged. Programmed ventricular stimulation (PVS) was performed till S4 from the RV apex and other sites, all inducible tolerated VT were mapped. Endocardial ablation was performed with an irrigated tip catheter positioned in front of epi-LP recorded by a multi-electrode catheter aiming to eliminate or delay epi-LP as a surrogate for transmurality. For each lesion fulfilling the «transmurality criteria», the AI values were recorded. Remap was performed to validate LPA and NI was tested. Patient follow-up (FU) rely on telemonitoring in ICD-carriers and holter/exercise test for the others.
Results
11 patients were enrolled (9M/2F, mean age 45 years), 9 for VT recurrence (3 redo) and 2 for de novo VT. The median ICD therapy before ablation was 5/patient (mean 1.7). The clinical VT originated from the RV outflow tract (RVOT) in 5 patients, peritricuspid (PT) in 2, RV free wall (RFW) in 4. Substrate were more extended in the epicardium compared to the endocardium: epi-LP and scar surfaces were 42.5 cm2/118 cm2 versus 24.5 cm2/25.5 cm2 for the endocardium. In one patient, additional epicardial lesion was necessary to achieve LPA. The mean ablation duration was 3377 s. Remap showed LPA in all patients and PVS was negative in all (not tested in one due to hemodynamic instability). One patient presented retrosternal hematoma after ablation with spontaneous favorable outcome. Endocardial AI values allowing epi-LP abolition were 595 for the inferior wall, 625 in the RVOT, 604 for PT and 639 for RFW. During a mean FU of 12 months (median 16.5 mths), only one patient had VT recurrence.
Conclusion
Based on this case-series, EA-ELP appeared as a safe and effective method to treat VT in ARVC. EA-ELP ablation allowed VT suppression in 91 % of patients after an mean FU of 12 mths. The RV endocardial AI needed to suppress epi-LP ranged was between 595-639 and could be used as surrogate for transmurality in ARVC.
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Affiliation(s)
- X Waintraub
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - R Sauve
- Biosense Webster, Paris, France
| | - G Vedrenne
- Saint Joseph Hospital, Arrhythmia Unit, Paris, France
| | - D Amet
- European Hospital Georges Pompidou, Paris, France
| | - M Gras
- La Miletrie University Hospital Centre, Poitiers, France
| | - B Degand
- La Miletrie University Hospital Centre, Poitiers, France
| | - C Moini
- JACQUES CARTIER PRIVATE HOSPITAL, Massy, France
| | - G Duthoit
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - M Laredo
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - N Badenco
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - F Lesaffre
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - F Hidden Lucet
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - A Hermida
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - E Gandjbakhch
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
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Sebag FA, Garot P, Galea R, de Backer O, Lepillier A, De Meesteer A, Hildick-Smith D, Armero S, Moubarak G, Ducrocq G, Eschalier R, Aminian A, Sauguet A, Lellouche N, Mahmoudi K, Räber L, Amabile N. Left atrial appendage closure for thrombus trapping: the international, multicentre TRAPEUR registry. EUROINTERVENTION 2022; 18:50-57. [PMID: 34794937 PMCID: PMC9903160 DOI: 10.4244/eij-d-21-00713] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the presence of a thrombus contraindicates left atrial appendage closure procedure (LAAC), a previous study reported the feasibility of the thrombus trapping procedure (TTP) technique to overcome this limitation. AIMS This study aimed to analyse the short-term outcomes in a series of patients who underwent LAAC using the TTP (TTP-LAAC). METHODS This retrospective series included patients who underwent TTP-LAAC between January 2018 and May 2020 in 13 European centres. Device choice, pre-interventional work-up and post-discharge antithrombotic therapy regimens were left to the discretion of the operators. The primary endpoint was the 30-day occurrence of stroke, systemic embolism or cardiovascular death. RESULTS During the study period, a total of 1,918 patients underwent LAAC. A thrombus was identified in 71 cases but completely disappeared in 24 patients before procedure. TTP-LAAC was finally performed in 53 cases (3%). Thrombi were identified ahead of the actual day of implantation in 47 patients (87%) and were mostly limited in size (50 cases with extension <50% of the LAA surface). The Amplatzer Amulet and WATCHMAN FLX occluders were implanted in 44 and 9 patients, respectively. A single deployment approach was applied in 70% and a cerebral embolic protection system was used in 9% of the patients. The overall success rate was 100%. Small pericardial effusion without tamponade was observed in 6% of the cases. Patients were discharged with 72% under antiplatelet therapy and 10% under short-term oral anticoagulation. The primary endpoint occurred in one patient. CONCLUSIONS TTP-LAAC might be used in a minority of LAAC procedures but appears to be feasible and safe in the short-term, in select cases.
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Affiliation(s)
- Frederic A. Sebag
- Service de Cardiologie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud (ICPS), Ramsay Santé, Massy, France
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Ole de Backer
- Department of Cardiology, Rigshospital, Copenhagen, Denmark
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | | | - David Hildick-Smith
- Cardiology Department, Royal Sussex Cardiac Centre, Brighton, United Kingdom
| | | | | | - Gregory Ducrocq
- Department of Cardiology, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Romain Eschalier
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Adel Aminian
- Department of Cardiology, C.H.U. de Charleroi, Charleroi, Belgium
| | | | | | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
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Lepillier A, Strisciuglio T, De Ruvo E, Scaglione M, Anselmino M, Sebag FA, Pecora D, Gallagher MM, Rillo M, Viola G, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, De Simone A, Bertaglia E, Solimene F, Stabile G. Impact of ablation index settings on pulmonary vein reconnection. J Interv Card Electrophysiol 2021; 63:133-142. [PMID: 33570717 DOI: 10.1007/s10840-021-00944-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/13/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
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Affiliation(s)
- A Lepillier
- Centre Cardiologique du Nord, St Denis, Paris, France
| | - T Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,University of Naples Federico II, Naples, Italy
| | | | | | - M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F A Sebag
- Institut Mutualiste Montsouris, Paris, France
| | - D Pecora
- Fondazione Poliambulanza, Brescia, Italy
| | | | - M Rillo
- Casa di Cura Villa Verde, Taranto, Italy
| | - G Viola
- Ospedale San Francesco, Nuoro, Italy
| | - E Pisanò
- Ospedale Vito Fazzi, Lecce, Italy
| | - S Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | - A Pani
- Ospedale di Lecco, Lecco, Italy
| | | | - G Sgarito
- A.R.N.A.S. Civico Cristina Benfratelli, Palermo, Italy
| | - A De Simone
- Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy
| | - E Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - F Solimene
- Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy. .,Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. .,Anthea Hospital, Bari, Italy.
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8
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Lepillier A, Solimene F, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Stabile G. Reproducibility of pulmonary vein isolation guided by the ablation index: One-year outcome of the AIR registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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Lepillier A, Copie X, Escande W, Niro M, Piot O, Paziaud O. Impact of low voltage areas in sinus rhythm for the ablation of persistent atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.201] [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: 10/22/2022]
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10
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Constantin V, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Deharo J, Defaye P, Montalescot G, Fauchier L, Mansourati J. Does left atrial appendage morphology have any impact on the results of percutaneous closure? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2658] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Transcatheter left atrial appendage (LAA) occlusion is an alternative treatment in patients with atrial fibrillation (AF), high CHADSVASC Score and a contra-indication to anticoagulants. This retrospective cohort study aims to evaluate the impact of LLA morphology on procedure outcomes.
Methods
Patients from eight French centers who underwent left atrial appendage occlusion from February 2012 to January 2017 were included in this retrospective cohort study. LLA morphology was described by preoperative cardiac computed tomography (CT). Clinical data and Transoesophageal echocardiography (TEE) or CT results were collected during follow-up.
Results
Among 469 included patients, LAA morphologies were described in 215 cases 45.8%), 150 patients (70%) were implanted with Watchman devices, 57 (26%) with Amplatzer devices and 8 procedures (4%) failed. LAA Morphology was Chicken Wing (34%), Windsock (45%), cauliflower (18%) and 3% had another morphology including Cactus.
There was no difference in patient characteristics between the different morphology groups. Mean follow-up was 9.6±11 months, during which 190 patients underwent LAA imaging (TEE in 171 and CT in 19 patients). There was no significant difference in the failure rate (p=0.72), duration of the procedure (p=0.065), peri-device leak (p=0.83) device-related thrombus (p=0.96) and the occurrence of stroke (p=1) during follow-up.
Conclusion
LLA morphology did not influence complication occurrence after occlusion in this cohort.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Cinaud
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - F Brigadeau
- CHRU De Lille - Institut Coeur-Poumons, Lille, France
| | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - B Pierre
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - J.C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| | - G Montalescot
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - L Fauchier
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - J Mansourati
- University Hospital of Brest and Université de Bretagne Occidentale, Cardioloy and ORPHY (EA4324), Brest, France
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11
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Sebag FA, Simeon É, Moubarak G, Zhao A, Villejoubert O, Darondel JM, Vedrenne G, Lepillier A, Jorrot P, Mouhoub Y, Bouzeman A, Hamon D, Lellouche N, Mignot N. Definition of success criteria for ablation of typical right atrial flutter with a single-catheter approach: A pilot study. Arch Cardiovasc Dis 2020; 113:791-796. [PMID: 33051170 DOI: 10.1016/j.acvd.2020.05.021] [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: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The success rate of cavotricuspid isthmus ablation to treat right common flutter is high (up to 95%), but needs bidirectional block confirmation, requiring two or three catheters. AIM To describe a new pacing technique using a single catheter to ablate and confirm cavotricuspid isthmus block with differential PR interval measurements. METHODS We included 61 patients from five centres, who were referred for cavotricuspid isthmus ablation. All patients had cavotricuspid isthmus ablation, and the cavotricuspid isthmus block was confirmed by differential pacing using two or three catheters. The new method consisted of measuring the PR interval on the surface electrocardiogram using pacing from the tip of the ablation catheter on the lateral side (lateral delay) and the septal side (coronary sinus ostium) of the cavotricuspid isthmus line (difference=delta PR interval), before and after cavotricuspid isthmus ablation. We analysed the value of the delta PR interval in predicting bidirectional cavotricuspid isthmus block as confirmed by standard methods. RESULTS Among our patient population (mean age 63±12 years), 39 patients were ablated during sinus rhythm, and 22 during common flutter. Cavotricuspid isthmus block was achieved in all patients but one. Lateral delay and delta PR interval increased significantly after validation of cavotricuspid isthmus block (257±42 vs. 318±50ms and 32±23 vs. 96±22ms, respectively; P<0.0001). A delta PR interval cut-off of ≥70ms had 100% sensitivity and specificity to predict bidirectional cavotricuspid isthmus block. CONCLUSIONS A single-catheter ablation approach to performing cavotricuspid isthmus line based on surface electrocardiogram PR interval measurement is feasible. After ablation, cavotricuspid isthmus block was systematically obtained when the delta PR interval was>70ms.
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Affiliation(s)
- Frédéric A Sebag
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France.
| | - Édouard Simeon
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - Ghassan Moubarak
- Centre médico-chirurgicale Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Alexandre Zhao
- Centre médico-chirurgicale Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | | | - Jean-Marc Darondel
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | | | | | - Pierre Jorrot
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - Yamina Mouhoub
- Service de cardiologie, hôpital Saint-Joseph, 75014 Paris, France
| | | | - David Hamon
- Service de cardiologie, hôpital Henri-Mondor, 94010 Créteil, France
| | | | - Nicolas Mignot
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
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12
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Sebag F, Galea R, Lepillier A, Moubarak G, Darmon A, Raber L, Amabile N. TCT CONNECT-444 Feasibility and Safety of Left Atrial Appendage (LAA) Occlusion in Presence of LAA Thrombus: The TRAPEUR Registry (Thrombus Trapping European Registry). J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.472] [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: 11/25/2022]
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13
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Duthoit G, Silvain J, Marijon E, Ducrocq G, Lepillier A, Frere C, Dimby SF, Popovic B, Lellouche N, Martin-Toutain I, Spaulding C, Brochet E, Attias D, Mansourati J, Lorgis L, Klug D, Zannad N, Hauguel-Moreau M, Braik N, Deltour S, Ceccaldi A, Wang H, Hammoudi N, Brugier D, Vicaut E, Juliard JM, Montalescot G. Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure. Circ Cardiovasc Interv 2020; 13:e008481. [DOI: 10.1161/circinterventions.119.008481] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background:
Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC.
Methods:
ADRIFT (Assessment of Dual Antiplatelet Therapy Versus Rivaroxaban in Atrial Fibrillation Patients Treated With Left Atrial Appendage Closure) is a multicenter, phase IIb study, which randomized 105 patients after successful LAAC to either rivaroxaban 10 mg (R
10
, n=37), rivaroxaban 15 mg (R
15
, n=35), or DAPT with aspirin 75 mg and clopidogrel 75 mg (n=33). The primary end point was thrombin generation (prothrombin fragments 1+2) measured 2 to 4 hours after drug intake, 10 days after treatment initiation. Thrombin-antithrombin complex, D-dimers, rivaroxaban concentrations were also measured at 10 days and 3 months. Clinical end points were evaluated at 3-month follow-up.
Results:
The primary end point was reduced with R
10
(179 pmol/L [interquartile range (IQR), 129–273],
P
<0.0001) and R
15
(163 pmol/L [IQR, 112–231],
P
<0.0001) as compared with DAPT (322 pmol/L [IQR, 218–528]). We observed no significant reduction of the primary end point between R
10
and R
15
while rivaroxaban concentrations increased significantly from 184 ng/mL (IQR, 127–290) with R
10
to 274 ng/mL (IQR, 192–377) with R
15
,
P
<0.0001. Thrombin-antithrombin complex and D-dimers were numerically lower with both rivaroxaban doses than with DAPT. These findings were all confirmed at 3 months. The clinical end points were not different between groups. A device thrombosis was noted in 2 patients assigned to DAPT.
Conclusions:
Thrombin generation measured after LAAC was lower in patients treated by reduced rivaroxaban doses than DAPT, supporting an alternative to the antithrombotic regimens currently used after LAAC and deserves further evaluation in larger studies.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03273322.
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Affiliation(s)
- Guillaume Duthoit
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Eloi Marijon
- European Georges Pompidou Hospital, APHP; Paris Descartes University, INSERM U 970, France (E.M., C.S.)
| | - Grégory Ducrocq
- Département de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L., D.A.)
| | - Corinne Frere
- Sorbonne Université, Department of Haematology Biologic, APHP Pitié-Salpêtrière Hospital; INSERM UMRS 1166, Institute of Cardiometabolism And Nutrition, Paris, France (C.F., I.M.-T.)
| | - Solohaja-Faniaha Dimby
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, France (S.-F.D., E.V.)
| | - Batric Popovic
- Université de Lorraine, Département de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France (B.P.)
| | - Nicolas Lellouche
- Département de Cardiologie, CHU Henri Mondor, Créteil, France (N.L.)
| | - Isabelle Martin-Toutain
- Sorbonne Université, Department of Haematology Biologic, APHP Pitié-Salpêtrière Hospital; INSERM UMRS 1166, Institute of Cardiometabolism And Nutrition, Paris, France (C.F., I.M.-T.)
| | - Christian Spaulding
- European Georges Pompidou Hospital, APHP; Paris Descartes University, INSERM U 970, France (E.M., C.S.)
| | - Eric Brochet
- Département de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)
| | - David Attias
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L., D.A.)
| | - Jacques Mansourati
- Département de Cardiologie, CHRU Brest, Université de Bretagne Occidentale, EA 4324 (J.M.)
| | - Luc Lorgis
- Department of Cardiology, Laboratory of Cerebro-Vascular Pathophysiology and epidemiology (PEC2) EA 7460, University of Burgundy, Dijon, France (L.L.)
| | - Didier Klug
- Univ. Lille CHU Lille, F-59000 Lille, France (D.K.)
| | - Noura Zannad
- Département de Cardiologie, CHR Metz-Thionville, France (N.Z.)
| | - Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, Department of Cardiology, Ambroise Paré Hospital (AP-HP), INSERM U-1018, Boulogne, France (M.H.-M.)
| | - Nassim Braik
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Sandrine Deltour
- Sorbonne Université, Urgences Cerebro-Vasculaires Pitié-Salpêtrière Hospital (AP-HP), INSERM UMR U-942, Paris, France (S.D.)
| | - Alexandre Ceccaldi
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Hui Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China (H.W.)
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, France (S.-F.D., E.V.)
| | - Jean-Michel Juliard
- Département de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)
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14
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Lepillier A, Copie X, Escande W, Niro M, Paziaud O, Piot O. P1021Low incidence of atrial tachycardia following ablation of low voltage areas in sinus rhythm for persistent atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
. Background: Dedicated ablation strategies for persistent atrial fibrillation (AF) have shown a limited success rate with frequent atrial tachycardia (AT) occurrence. Recent studies suggest that atrial arrhythmogenic sites are related to tissular heterogeneities and increased fibrosis can be identified as reduced bipolar voltage areas.
. Purpose: Targeting low voltage areas (LVA) in addition to PVI may represent an efficient strategy for the ablation of persistent AF, and may limit the risk of AT recurrence.
. Methods: We prospectively included consecutive patients with symptomatic persistent AF. The ablation strategy consisted of the following steps: circumferential pulmonary vein isolation (CPVI), Sinus rhythm restoration by electrical cardioversion, voltage map performed in sinus rhythm. Complementary RFA was guided by low voltage areas (0.2-0.4 mV). Success was defined as freedom from AF/ atrial flutter or atrial arrhythmia at 12 months or more.
. Results: 101 patients (mean age: 62.5 +/- 10.4 years, men 73%) were included with persistent AF or long standing AF (7%). Procedure time was: 154 ± 25 min and fluoroscopy time: 184 ± 90 sec. Time of RFA was 44.7 +/- 12 min. Mean LA volume was 182 +/- 38 mL. LVA were found in 50 patients (49.5%). The distribution of these areas was: 30 anterior wall 29.7%), 21 septum (20.7%), 19 roof (18.8%), 5 inferior (4.9%), 11 left appendage (10.8%), 6 posterior (5.9%), 3 mitral isthmus (3%). RF ablation was realized for all LVA and homogenisation was attempt. After a single procedure at a mean FU of 12 months, 72.3% of patients were free of symptomatic AF. 27 patients had recurrence of atrial AF: 7 permanent, 15 persistent and 5 paroxysmal AF. Predictive factors of recurrence of AF were: long standing persistent AF, large left atrial volume (> 205 mL), shorts AF cycle length (< 168 ms) and reduce LEVF (< 45%). Atrial tachycardia occurred in 5 patients (4,9%). Mechanisms of AT were: typical cavo-tricuspid flutter in one patient, peri-mitral flutter in 2 patients, and atrial focal tachycardia (close to pulmonary veins) in 2 patients.
. Conclusion: These results suggest that PVI with complementary RF ablation guided on low voltage areas is an efficient strategy for symptomatic persistent AF, and reduce the recurrence of AT following this ablation strategy.
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Affiliation(s)
| | - X Copie
- Centre Cardiologique du Nord, Paris, France
| | - W Escande
- Centre Cardiologique du Nord, Paris, France
| | - M Niro
- LARREY - UNIVERSITY HOSPITAL CENTRE OF ANGERS, cardiology, Angers, France
| | - O Paziaud
- Centre Cardiologique du Nord, Paris, France
| | - O Piot
- Centre Cardiologique du Nord, Paris, France
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15
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Stabile G, Lepillier A, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Viola G, Rossi L, De Santis V, Landolina M, Castro A, Grimaldi M, Badenco N, Del Greco M, De Simone A, Pisanò E, Abbey S, Lamberti F, Pani A, Zucchelli G, Sgarito G, Dugo D, Bertaglia E, Strisciuglio T, Solimene F. Reproducibility of pulmonary vein isolation guided by the ablation index: 1-year outcome of the AIR registry. J Cardiovasc Electrophysiol 2020; 31:1694-1701. [PMID: 32369225 DOI: 10.1111/jce.14531] [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: 03/26/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ablation index (AI) is a new lesion quality marker that has been demonstrated to allow a high single-procedure arrhythmia-free survival in single-center studies. This prospective, multi-center study was designed to evaluate the reproducibility of pulmonary vein (PV) isolation guided by the AI. METHODS A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV isolation and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330-450 or 380-500 at anterior wall or posterior wall, respectively). RESULTS At 12 months a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%; P = .039). There was no difference in the rate of AF recurrence among the four study groups (4.5% in group ST330-450, 12.2% in group ST 380-500, 14.9% in group STSF330-450, 9.4% in group STSF380-500; P = .083). Recurrence was also similar between patients treated with a ST (8%) or STSF catheter (12.1%; P = .2), and within patients targeting an AI settings of 330 to 450 (10.9%) or 380 to 500 (10.3%; P = .64). In patients with paroxysmal AF, there was no difference (P = .12) in the 1-year freedom from AF recurrence among 14 operators that performed ≥10 ablation procedure. CONCLUSIONS An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of 1-year freedom from AF recurrence, irrespective of the ablation catheters, AI settings, and operator.
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Affiliation(s)
- Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Clinica San Michele, Maddaloni, Caserta, Italy.,Anthea Hospital, Bari, Italy
| | | | | | | | - Matteo Anselmino
- Department of Medical Sciences, A. O. U. Citta della Salute e della Scienza di Torino, University of Turin, Italy
| | | | | | | | | | | | - Luca Rossi
- Ospedale Civili Guglielmo da Saliceto, Piacenza, Italy
| | | | | | | | - Massimo Grimaldi
- Ospedale Regionale Miulli, Acquaviva delle Fonti, Metropolitan City of Bari, Italy
| | | | | | | | | | - Salim Abbey
- Hôpital Privé Du Confluent (HPCN), Nantes, France
| | | | | | | | | | - Daniela Dugo
- AUO Policlinico Vittorio Emanuele, Catania, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padua, Italy
| | - Teresa Strisciuglio
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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16
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Fauchier L, Bisson A, Cinaud A, Brigadeau F, Lepillier A, Jacon P, Gras D, Klug D, Guedeney P, Pierre B, Mansourati J, Piot O, Montalescot G, Deharo JC, Defaye P. P999Major adverse events with percutaneous left atrial appendage closure in patients with atrial fibrillation in real life setting. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Transcatheter left atrial appendage (LAA) closure is an alternative strategy for stroke prevention in atrial fibrillation (AF) patients with an inacceptable risk of bleeding with oral anticoagulation (OAC). A better characterization of major adverse clinical events after LAA closure in daily practice is still needed.
Methods
We analysed data from all AF patients treated with Watchman or Amplatzer LAA closure according to European guidelines in 8 French cardiology departments. Antithrombotic management was decided for each patient on an individual basis. A Cox regression model was used for multivariable analysis of major adverse events. Yearly rate of ischemic stroke during follow-up was calculated and compared to that expected for a same risk score population. Yearly rate of bleeding was extrapolated from that reported with the HASBLED score.
Results
A total of 469 consecutive AF patients (299 males, 74.9±8.9 years old, mean CHA2DS2-VASc score 4.5±1.4, HASBLED score 3.7±1.0) received LAA closure from March 2012 to January 2017. There were 272 Watchman devices (58%) and 197 ACP devices (42%) implanted. At discharge, 36% received a single anti platelet therapy (APT), 23% received dual APT, 29% received OAC and no APT, 5% received OAC plus APT and 8% received no antithrombotic therapy. Mean follow up was 11.4 months (median 7, interquartile 3–22 months) during which 70 major adverse events (19 ischemic strokes, 18 major haemorrhages and 33 deaths) were recorded in 69 patients. The annual rate of ischemic stroke was 3.96%, which translates into a 13% relative risk reduction (95% CI −59 to 52%) as compared with the calculated stroke rate for similar CHA2DS2-VASc score after adjustment for exposure to APT and OAC. The annual rate of major bleeding in the study was 3.75%, which corresponds to a 48% relative risk reduction (95% CI 9 to 70%) as compared with the rate that would have been expected based on a comparable HAS-BLED score. Yearly rate of mortality was 7.4% (2.5 to 3 fold higher than in previous randomized trials) and the rate of non-cardiovascular death was 82%. None of the baseline characteristics was predictive of major adverse events, neither in univariate nor in multivariable analysis, which highlights the difficulty in identifying a risk of unfavourable outcome with simple tools.
Conclusions
AF patients treated with LAA closure may have a lower risk of stroke and bleeding events compared to their theoretical risk. However, our findings indicate that a high rate of major adverse events is observed in these patients during follow-up. This questions the suggested cost-effectiveness of the procedure (with models based on previous trials) for a real-life perspective. A better identification of patients with a relevant benefit of LAA closure is needed among those with long-term anticoagulation contraindication, both for an optimal management of each patient on an individual basis and for a global perspective with limited healthcare resources.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | - D Klug
- Hospital of Lille, Lille, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - B Pierre
- University Hospital of Grenoble, Grenoble, France
| | | | - O Piot
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
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Ciobotaru V, Combes N, Iriart X, Marijon E, Hascoet S, Nguyen A, Ternacle J, Defaye P, Jacon P, Lepillier A, Thambo JB, Teiger E, Cheneau E, Commeau P, Elbaz M. P2436Preliminary data from “LAA-Print French registry”: a large national multi-centric prospective registry evaluating a new preoperative approach based on 3Dprinted simulation in LAAC procedures. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Left atrial appendage closure (LAAC) is an alternative to OAC in patients with contra indication to OAC and AF. But LAAC may be at risk, especially in frail patients.
There are no imaging criteria to asses individual procedural risk.
Furthermore, procedural factors (double curve catheter alignment) are hard to predict
3D-printing simulation has capability to integrate all anatomical and procedural parameters and has demonstrated improvements in LAAC device sizing in a pilot study
Aim
To demonstrate efficiency of 3D-printing simulation to predict LAAC procedural risk (failure, long procedure time, pericardial effusion or others serious adverse events (SAES) or inappropriate implantations)
Methods
Open study: Prospective and Consecutive.
Recruiting 150 patients in 16 centres (of 300 patients expected).
Start: Jan 18th, 2018.
Study Completion: Nov 1st, 2019.
ClinicalTrials ID: NCT03330210.
1. Cardiac CT prior to LAAC.
2. Industrial manufacture, laser sintering, of 3D-printed models including the whole LA cavity including interatrial thin septum and vena cava (using material TPU with adequat elasticity: shore 50).
3. LAAC Simulation based on 3Dprinted models using specific sheaths and prosthesis.
Prior to LAAC procedure each operator asses a risk score for procedural failure (low/moderate/high) based on real 3D printed LAAC simulation taking into account: trans-septal puncture site/sheath alignment with LAA ostium/device deployment and stability.
4. LAAC procedure TEE guided.
5. CT or TEE control M3 or M6.
Procedural outcomes according to risk Sc Low risk (N=63) Moderate risk (N=50) High risk (N=37) p<0.05 vs High risk Failure 1 (1.6%) 1 (2%) 10 (27%) * Recaptures ≥2 4 (6%) 5 (10%) 12 (32%) * Prosthesis ≥2 2 (3%) 1 (2%) 9 (24%) * Inappropriate implantation 0 6 (12%) 7 (19%) * SAES 2 (3%) 6 (12%) 12 (32%) * Pericardial effusion (pericardiocentesis) 2 (3%) 1 (2%) 4 (11%) * Haemorrhage (≥2 points) 0 2 (4%) 5 (13%) * Coronary syndrome 0 0 4 (11%) * Time (intra left atrium) min 21±10 29±16 50±25 * *p<0.05 vs High risk group according to prospective risk score.
LAAC simulation on 3D printed model
Conclusion
3D printing simulation accurately stratifies the risk of procedure according to LA anatomy. 3D printing may guide the procedure through verification of the transseptal puncture site and/or using a specific catheter shape and device. In case of high risk, a careful assessment of risk/benefice ratio is mandatory
Acknowledgement/Funding
AG2RFondation and Boston Scientific
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Affiliation(s)
- V Ciobotaru
- Hopital Prive Les Franciscaines, Nimes, France
| | - N Combes
- Clinic Pasteur, Toulouse, France
| | - X Iriart
- Hospital Haut Leveque, Cardiology, Bordeaux-Pessac, France
| | - E Marijon
- Hôpital Européen Georges Pompidou- Université Paris Descartes, Cardiology, Paris, France
| | - S Hascoet
- Surgical Centre Marie Lannelongue, Cardiology, Le Plessis Robinson, France
| | - A Nguyen
- University Hospital Henri Mondor, Cardiology, Creteil, France
| | - J Ternacle
- University Hospital Henri Mondor, Cardiology, Creteil, France
| | - P Defaye
- University Hospital of Grenoble, Cardiology, Grenoble, France
| | - P Jacon
- University Hospital of Grenoble, Cardiology, Grenoble, France
| | - A Lepillier
- Centre Cardiologique du Nord, Cardiology, Saint Denis, France
| | - J B Thambo
- Hospital Haut Leveque, Cardiology, Bordeaux-Pessac, France
| | - E Teiger
- University Hospital Henri Mondor, Cardiology, Creteil, France
| | - E Cheneau
- Hopital Prive Clairval, Cardiology, Marseille, France
| | - P Commeau
- Polyclinique Les Fleurs, Cardiology, Ollioules, France
| | - M Elbaz
- Toulouse Rangueil University Hospital (CHU), Cardiology, Toulouse, France
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Fauchier L, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Gras D, Mansourati J, Deharo JC, Montalescot G, Defaye P. Major Adverse Events With Percutaneous Left Atrial Appendage Closure in Patients With Atrial Fibrillation. J Am Coll Cardiol 2019; 73:2638-2640. [PMID: 31118155 DOI: 10.1016/j.jacc.2019.03.468] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 10/26/2022]
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Solimene F, Lepillier A, Ruvo E, Scaglione M, Anselmino M, Sebag FA, Pecora D, Gallagher MM, Rillo M, Viola G, Rossi L, Santis V, Landolina M, Castro A, Grimaldi M, Badenco N, Del Greco M, Simone A, Bertaglia E, Stabile G. Reproducibility of acute pulmonary vein isolation guided by the ablation index. Pacing Clin Electrophysiol 2019; 42:874-881. [DOI: 10.1111/pace.13710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/16/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Luca Rossi
- Ospedale Civili Guglielmo da Saliceto Piacenza Italy
| | | | | | | | | | | | | | | | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular SciencesUniversity of Padova Italy
| | - Giuseppe Stabile
- Clinica Montevergine Mercogliano (AV) Italy
- Clinica San Michele Maddaloni (CE) Italy
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Fauchier L, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Gras D, Mansourati J, Deharo JC, Montalescot G, Defaye P. Left Atrial Appendage Closure in Atrial Fibrillation. J Am Coll Cardiol 2018; 72:2806-2807. [DOI: 10.1016/j.jacc.2018.08.2196] [Citation(s) in RCA: 6] [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: 07/31/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
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Fauchier L, Cinaud A, Brigadeau F, Guedeney P, Jacon P, Mansourati J, Deharo JC, Franceschi F, Pierre B, Klug D, Lepillier A, Piot O, Gras D, Montalescot G, Defaye P. P4809Possible benefits of left atrial appendage closure for stroke prevention in patients with atrial fibrillation in real life setting. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4809] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - F Franceschi
- Hospital La Timone of Marseille, Marseille, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Klug
- Cardiology Hospital of Lille, Lille, France
| | - A Lepillier
- Centre Cardiologique du Nord, Saint Denis, France
| | - O Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - P Defaye
- University Hospital of Grenoble, Grenoble, France
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Teiger E, Thambo JB, Defaye P, Hermida JS, Abbey S, Klug D, Juliard JM, Pasquie JL, Rioufol G, Lepillier A, Elbaz M, Horvilleur J, Brenot P, Pierre B, Le Corvoisier P, Amabile N, Andronache M, Anselme F, Armero S, Aubry P, Audureau E, Babuty D, Bakouboula B, Bars C, Baruteau AE, Bille J, Bonnet JL, Brigadeau F, Brochet E, Bun SS, Cailla G, Cesari O, Champagnac D, Chevalier P, Combes N, Comet B, Commeau P, Dearo JC, Dompnier A, Farah B, Garot P, Gras D, Giraudeau C, Granier M, Guerin P, Iriart X, Jalal Z, Jesel-Morel L, Jeu A, Kamtchueng P, Lellouche N, Meneveau N, Nighoghossian N, Otmani A, Pelliere R, Pillière R, Pons M, Popovic B, Pujadas P, Rossi R, Roux A, Saludas Y, Spaulding C, Statiev V, Ternacle J, Traulle S, Winum PF. Percutaneous Left Atrial Appendage Closure Is a Reasonable Option for Patients With Atrial Fibrillation at High Risk for Cerebrovascular Events. Circ Cardiovasc Interv 2018. [DOI: 10.1161/circinterventions.117.005841] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background—
Percutaneous left atrial appendage (LAA) closure is an emerging option for patients with atrial fibrillation at high risk for cerebrovascular events. The multicenter FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to assess LAA closure outcomes in everyday practice.
Methods and Results—
Four hundred thirty-six patients referred from April 2013 to September 2015 to 33 French interventional cardiology centers for percutaneous LAA closure were included prospectively in the FLAAC registry. Mean age was 75.4±0.4 years. The stroke risk was high (mean CHA
2
DS
2
–VASc score, 4.5±0.1) and most patients had experienced clinically significant bleeding (HAS-BLED score, 3.1±0.05). The device used was Amplatzer LAA occluder in 58% and the Watchman device in 42% of the patients. The procedural success rate was 98.4%. Median postprocedure follow-up was 12.0 (11.8–12.0) months and a single patient was lost to follow-up. During the periprocedural and subsequent follow-up period, procedure-related severe adverse events occurred in 21 (4.9%) and 10 (2.3%) patients, respectively. One-year cumulative incidences of ischemic stroke and cerebral hemorrhage were 2.9% (1.6–5.0) and 1.5% (0.7–3.2), respectively. Overall, 1-year mortality was 9.3% (6.9–12.5) with 7 of the 39 deaths related or possibly related to the device or procedure.
Conclusions—
This nationwide prospective registry shows that, in the French population, LAA closure is mainly used in patients with high comorbidity rates and a poor prognosis. LAA closure in such patients seems reasonable to decrease the stroke rate. The overall health status of these patients should be taken into account during the preprocedural evaluation process.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02252861.
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Affiliation(s)
- Emmanuel Teiger
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Jean-Benoit Thambo
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Pascal Defaye
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Jean-Sylvain Hermida
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Sélim Abbey
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Didier Klug
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Jean-Michel Juliard
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Jean-Luc Pasquie
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Gilles Rioufol
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Antoine Lepillier
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Meyer Elbaz
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Jerome Horvilleur
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Philippe Brenot
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Bertrand Pierre
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
| | - Philippe Le Corvoisier
- From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.)
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Fauchier L, Cinaud A, Lepillier A, Brigadeau F, Jacon P, Pierre B, Paziaud O, Franceschi F, Mansourati J, Klug D, Piot O, Gras D, Montalescot G, Deharo JC, Defaye P. 201Left atrial appendage closure for stroke prevention in patients with atrial fibrillation: the difficult task of estimating the possible benefit in real life setting. Europace 2018. [DOI: 10.1093/europace/euy015.050] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Lepillier
- Centre Cardiologique du Nord, Saint Denis, France
| | | | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - O Paziaud
- Centre Cardiologique du Nord, Saint Denis, France
| | - F Franceschi
- Hospital La Timone of Marseille, Marseille, France
| | | | - D Klug
- Cardiology Hospital of Lille, Lille, France
| | - O Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
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Fauchier L, Cinaud A, Brigadeau F, Pierre B, Lepillier A, Paziaud O, Fatemi M, Jacon P, Abbey S, Franceschi F, Klug D, Mansourati J, Deharo J, Gras D, Defaye P. P4562Predictors of cardiovascular events in patients with atrial fibrillation after left atrial appendage closure for stroke prevention in a multicenter analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4562] [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: 11/14/2022] Open
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Fauchier L, Cinaud A, Brigadeau F, Pierre B, Lepillier A, Paziaud O, Fatemi M, Jacon P, Abbey S, Franceschi F, Klug D, Mansourati J, Deharo J, Gras D, Defaye P. 5718Incidence, predictors and prognosis of thrombus formation on device in patients with atrial fibrillation after left atrial appendage occlusion for stroke prevention in a multicenter analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5718] [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: 11/14/2022] Open
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Lepillier A, Copie X, Piot O, Lascault G, Paziaud O. 136-18: A 5 Years experience of PVAC Duty-Cycled Phased RF Ablation of atrial fibrillation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i94a] [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: 11/13/2022] Open
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Lepillier A, Copie X, Paziaud O, Lascault G, Piot O. 0455: Success rates of a multipolar ablation irrigated catheter for paroxysmal atrial fibrillation: a single center experience. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30207-5] [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: 10/22/2022]
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Ashrafpoor G, Andréoletti L, Bruneval P, Macron L, Azarine A, Lepillier A, Danchin N, Mousseaux E, Redheuil A. Fulminant human herpesvirus 6 myocarditis in an immunocompetent adult: role of cardiac magnetic resonance in a multidisciplinary approach. Circulation 2014; 128:e445-7. [PMID: 24297820 DOI: 10.1161/circulationaha.113.001801] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Golmehr Ashrafpoor
- Departments of Cardiovascular Imaging (G.A., L.M., A.A., E.M.,), Pathology (P.B.), and Cardiology (A.L., N.D.), Hôpital Européen George Pompidou, Université Paris Descartes, Paris, France; Medical and Molecular Virology Unit and EA-4684 (CardioVir), University Hospital and Medical School, Reims, France (L.A.); and the Department of Cardiovascular Imaging, Pitié Salpêtrière Hospital, Pierre et Marie Curie University, INSERM U678 and ICAN Imaging Core Lab, Paris, France (A.R.)
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Lepillier A, Otmani A, Waintraub X, Ollitrault J, Le Heuzey J, Lavergne T. Temporary transvenous VDD pacing as a bridge to permanent pacemaker implantation in patients with sepsis and haemodynamically significant atrioventricular block. Europace 2012; 14:981-5. [DOI: 10.1093/europace/eur403] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bensimhon L, Lavergne T, Hugonnet F, Mainardi JL, Latremouille C, Maunoury C, Lepillier A, Le Heuzey JY, Faraggi M. Whole body [(18) F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: a preliminary prospective study. Clin Microbiol Infect 2010; 17:836-44. [PMID: 20636421 DOI: 10.1111/j.1469-0691.2010.03312.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We studied the potential use of [(18) F]fluorodeoxyglucose ((18) F-FDG) whole body positron emission tomography (PET)-computed tomography for the diagnosis of device infection and extension of infection. Twenty-one patients with suspected device infection were prospectively included and compared with 14 controls free of infection. (18) F-FDG uptake on the box and on the leads was visually and quantitatively interpreted (using the maximal standard uptake value). The final diagnosis was obtained either from bacteriological data after device culture (n = 11) or by a 6-month follow-up according to modified Duke's criteria (n = 10). Ten patients finally showed infection on bacteriological study (n = 8) or during follow-up (n = 2). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 80%, 100%, 100% and 84.6% on patient-based analysis (presence or absence of infection). They were 100%, 100%, 100% and 100% for boxes, but only 60%, 100%, 100% and 73% for leads. Quantitative analysis could be useful for boxes but not for leads, for which the presence of a mild hot spot was the best criterion of infection. The four false negatives on leads received antibiotics for longer than the six true positives (20 ± 7.2 vs. 3.2 ± 2.3 days, p <0.01). Although the study was not designed for this purpose, management could have been modified by PET results in six of 21 patients. (18) F-FDG PET imaging may be useful for the diagnosis of device infection, and could impact on clinical management. Interpretation of negative cases should be performed with caution if patients have received antibiotics.
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Affiliation(s)
- L Bensimhon
- Department of Nuclear Medicine, Hôpital Européen Georges Pompidou-Paris, Paris Descartes University, Paris, France.
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Durand E, Delos A, Chaib A, Lepillier A, Beretti S, Collin M, Coeuret JF, Schachtel M, Le Heuzey JY, Desnos M, Danchin N. Performance assessment of a chest pain unit: Preliminary 2-year experience in the European Georges Pompidou Hospital. Arch Cardiovasc Dis 2009; 102:803-9. [DOI: 10.1016/j.acvd.2009.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/18/2009] [Accepted: 09/25/2009] [Indexed: 11/30/2022]
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Le Heuzey JY, Marijon E, Otmani A, Lepillier A, Waintraub X, Lavergne T, Pornin M. [Perspectives in cardiology: evidence of efficacy in atrial fibrillation and hopes in acute coronary syndrome]. ACTA ACUST UNITED AC 2009; 28:S34-8. [PMID: 19875004 DOI: 10.1016/s0750-7658(09)72463-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
New antithrombotic drugs, antithrombin or anti Xa, will probably be very useful in cardiology. Two directions are interesting: in one hand atrial fibrillation, in which the unmet need concern drugs as effective as vitamine K antagonists but easier to use. On the other hand, in acute coronary syndrome the situation is different, there are many antithrombotic drugs available but there is still a place for innovative drugs which could provide a gain in terms of efficacy, but the hemorrhagic risk must remain acceptable. In atrial fibrillation, the RELY trial, performed in 18,113 patients has demonstrated, as compared to warfarin, a non inferiority of dabigatran at the dose of 110 mg BID and a superiority of dabigatran at 150 mg BID with a reduction of 34% of the primary endpoint, i.e.stroke and systemic embolism.
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Affiliation(s)
- J-Y Le Heuzey
- Service de Cardiologie A et Rythmologie, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Lepillier A, Chaib A, Bougouin W, Joffre J, Durand E, Salvi S, Bruneval P, Danchin N. [Case report and review of a voluminous right atrial myxoma revealed by heart failure]. Ann Cardiol Angeiol (Paris) 2009; 59:37-9. [PMID: 19875096 DOI: 10.1016/j.ancard.2009.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 09/26/2009] [Indexed: 11/18/2022]
Abstract
Right atrial myxoma is a rare disease and its clinical presentation is not specific. The usual mode of revelation is heart failure. The most frequent complications are pulmonary embolism and atrioventricular valve obstruction by the tumor. A 49-year-old woman was admitted to intensive care unit for heart failure. The echocardiogram showed a voluminous right atrial myxoma, appending to the interatrial septum. Its surgical excision under extracorporeal circulation was successfully performed. Histology confirmed the final diagnosis of myxoma. No complication was observed at 6 months follow-up.
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Affiliation(s)
- A Lepillier
- Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, Paris, France.
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Otmani A, Trinquart L, Marijon E, Lavergne T, Waintraub X, Lepillier A, Chatellier G, Le Heuzey JY. Rates and predictors of appropriate implantable cardioverter-defibrillator therapy delivery: results from the EVADEF cohort study. Am Heart J 2009; 158:230-237.e1. [PMID: 19619699 DOI: 10.1016/j.ahj.2009.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 05/13/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND The implantable cardioverter defibrillator (ICD) is the therapy of choice in patients at risk for sudden cardiac death in both primary and secondary prevention indication. There are no recent data concerning the delivery rate and etiology of appropriate ICD therapies in routine medical care. METHODS The EVADEF study was a French multicenter, prospective, observational cohort study of ICD patients with a 2-year follow-up. Every 6 months we recorded patients' survival status and evaluated appropriate ICD therapies-antitachycardia pacing or shocks. Causes of ICD activation were also recorded from among ventricular tachycardia (VT), fast VT and ventricular fibrillation (VF). RESULTS From 2001 to 2003, 2296 unselected patients were implanted and followed until 2005. During a mean follow-up of 20.5 months, 274 deaths occurred. In 2009 patients with cardiopathy, 22 patients per 100 person-years had at least one appropriate therapy. Twenty-four and 11 patients per 100 person-years had at least one therapy in secondary and primary prevention, respectively. Age >65 years, left ventricular ejection fraction <30% and secondary prevention were independently associated with appropriate therapy. Besides, 5 patients per 100 person-years had at least 1 episode of life-threatening arrhythmia (fast VT or VF). Left ventricular ejection fraction <30% and secondary prevention were independently associated with life-threatening arrhythmia. In 287 patients without cardiopathy, the rate of appropriate therapy was twice as less, whereas the rate of life-threatening arrhythmia was similar. CONCLUSION Over a 24-month follow-up, the rate of appropriate therapy was substantial while few patients had life-threatening arrhythmia. Appropriate therapies and life-threatening arrhythmia were more frequent in patients with secondary prevention indication.
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Danchin N, Carda R, Chaib A, Lepillier A, Durand E. Optimizing outcomes in patients with STEMI: mortality, bleeding, door-to-balloon times, and guidelines: the approach to regional systems for STEMI care: defining the ideal approach to reperfusion therapy based on recent trials. Eur Heart J Suppl 2009. [DOI: 10.1093/eurheartj/sup007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Le Heuzey JY, Marijon É, Otmani A, Lepillier A, Waintraub X, Lavergne T, Pornin M. Traiter la fibrillation atriale dans l’insuffisance cardiaque. Therapie 2009; 64:115-9. [DOI: 10.2515/therapie/2009011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Le Heuzey JY, Marijon E, Chachoua K, Waintraub X, Lepillier A, Otmani A, Lavergne T, Pornin M. Pathophysiology of atrial fibrillation: insights into the renin-angiotensin system. Arch Cardiovasc Dis 2008; 101:787-91. [PMID: 19059574 DOI: 10.1016/j.acvd.2008.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/19/2008] [Accepted: 09/21/2008] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atrial fibrillation is, to date, a major problem of public health with an important cost in the health care system. DISCUSSION The therapeutic strategies for atrial fibrillation are complex and their outcomes have been disappointing globally. New ablative techniques have brought important advances but the patient's profile has to be taken into account in the choice of the therapeutic strategies. The renin-angiotensin system plays a major role in the phenomena of remodelling following the onset of atrial fibrillation. CONCLUSION Drugs blocking the renin-angiotensin system can have a real place in the treatment of atrial fibrillation, not only to maintain sinus rhythm but primarily to prevent cardiovascular accidents in these patients with atrial fibrillation and in some cases to prevent the occurrence of atrial fibrillation, for example in hypertensive patients.
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Affiliation(s)
- Jean-Yves Le Heuzey
- Service de cardiologie A et rythmologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Le Heuzey JY, Otmani A, Marijon E, Waintraub X, Lepillier A, Chachoua K, Lavergne T, Pornin M. Fibrillation atriale : le plus fréquent des troubles du rythme. Presse Med 2008; 37:821-6. [DOI: 10.1016/j.lpm.2007.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 09/17/2007] [Accepted: 09/24/2007] [Indexed: 11/16/2022] Open
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