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Delinière A, Bessière F, Placide L, Pasquié JL, Haddad C, Tirel S, Mokhtar H, Morel E, Gardey K, Dulac A, Ditac G, Sacher F, Denjoy I, Chevalier P. Wearable electrocardiogram devices in patients with congenital long QT syndrome: The SMART-QT study. Arch Cardiovasc Dis 2024:S1875-2136(24)00054-8. [PMID: 38704288 DOI: 10.1016/j.acvd.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND In patients with congenital long QT syndrome (LQTS), the risk of ventricular arrhythmia is correlated with the duration of the corrected QT interval and the changes in the ST-T wave pattern on the 12-lead surface electrocardiogram (12L-ECG). Remote monitoring of these variables could be useful. AIM To evaluate the abilities of two wearable electrocardiogram devices (Apple Watch and KardiaMobile 6L) to provide reliable electrocardiograms in terms of corrected QT interval and ST-T wave patterns in patients with LQTS. METHODS In a prospective multicentre study (ClinicalTrials.gov identifier: NCT04728100), a 12L-ECG, a 6-lead KardiaMobile 6L electrocardiogram and two single-lead Apple Watch electrocardiograms were recorded in patients with LQTS. The corrected QT interval and ST-T wave patterns were evaluated manually. RESULTS Overall, 98 patients with LQTS were included; 12.2% were children and 92.8% had a pathogenic variant in an LQTS gene. The main genotypes were LQTS type 1 (40.8%), LQTS type 2 (36.7%) and LQTS type 3 (7.1%); rarer genotypes were also represented. When comparing the ST-T wave patterns obtained with the 12L-ECG, the level of agreement was moderate with the Apple Watch (k=0.593) and substantial with the KardiaMobile 6L (k=0.651). Regarding the corrected QT interval, the correlation with 12L-ECG was strong for the Apple Watch (r=0.703 in lead II) and moderate for the KardiaMobile 6L (r=0.593). There was a slight overestimation of corrected QT interval with the Apple Watch and a subtle underestimation with the KardiaMobile 6L. CONCLUSIONS In patients with LQTS, the corrected QT interval and ST-T wave patterns obtained with the Apple Watch and the KardiaMobile 6L correlated with the 12L-ECG. Although wearable electrocardiogram devices cannot replace the 12L-ECG for the follow-up of these patients, they could be interesting additional monitoring tools.
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Affiliation(s)
- Antoine Delinière
- National Reference Centre for Inherited Arrhythmia of Lyon (CERA), Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France; Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon-1, MeLiS, CNRS UMR 5284, INSERM U1314, Institut NeuroMyoGène, 69008 Lyon, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Francis Bessière
- Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France; Paediatric and Congenital Heart Disease Medico-Surgical Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon-1, LabTau, Inserm, 69003 Lyon, France
| | - Leslie Placide
- Service de Cardiologie, Centre de Compétence des Troubles du Rythme Cardiaque d'Origine Héréditaire, Hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier, France
| | - Jean-Luc Pasquié
- Service de Cardiologie, Centre de Compétence des Troubles du Rythme Cardiaque d'Origine Héréditaire, Hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 34295 Montpellier, France; CNRS UMR9214, Inserm U1046, PHYMEDEXP, Université de Montpellier, 34295 Montpellier, France
| | - Christelle Haddad
- Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Solenn Tirel
- National Reference Centre for Inherited Arrhythmia of Lyon (CERA), Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Hajira Mokhtar
- National Reference Centre for Inherited Arrhythmia of Lyon (CERA), Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Elodie Morel
- National Reference Centre for Inherited Arrhythmia of Lyon (CERA), Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Kevin Gardey
- Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Arnaud Dulac
- Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Geoffroy Ditac
- Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Frédéric Sacher
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Institut LIRYC, Centre de référence des MAladies RYthmiques héréditaire (CMARY), Bordeaux University Hospital, 33000 Bordeaux, France; Université de Bordeaux, Inserm, CRCTB, U1045, 33000 Bordeaux, France
| | - Isabelle Denjoy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Service de Cardiologie, Centre de Référence des Troubles du Rythme Cardiaque d'Origine Héréditaire, Hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France
| | - Philippe Chevalier
- National Reference Centre for Inherited Arrhythmia of Lyon (CERA), Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France; Electrophysiology Unit, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon-1, MeLiS, CNRS UMR 5284, INSERM U1314, Institut NeuroMyoGène, 69008 Lyon, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart).
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Waldmann V, Bessière F, Gardey K, Bakloul M, Belli E, Bonnet D, Chaussade AS, Cohen S, Delasnerie H, Dib N, Di Filippo S, Dulac A, Hascoët S, Henaine R, Iserin L, Karsenty C, Ladouceur M, Legendre A, Malekzadeh-Milani S, Mostefa Kara M, Radojevic J, Ratsimandresy M, Marijon E, Maltret A, Khairy P, Combes N. Systematic Electrophysiological Study Prior to Pulmonary Valve Replacement in Tetralogy of Fallot: A Prospective Multicenter Study. Circ Arrhythm Electrophysiol 2023:e011745. [PMID: 37170812 DOI: 10.1161/circep.122.011745] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Ventricular arrhythmias and sudden death are recognized complications in tetralogy of Fallot. Electrophysiological studies (EPS) before pulmonary valve replacement (PVR), the most common reintervention in tetralogy of Fallot, could potentially inform therapy to improve arrhythmic outcomes. METHODS A prospective multicenter study was conducted to systematically assess EPS with programmed ventricular stimulation in patients with tetralogy of Fallot referred for PVR from January 2020 to December 2021. A standardized stimulation protocol was used across all centers. RESULTS A total of 120 patients were enrolled, mean age 39.2±14.5 years, 53.3% males. Sustained ventricular tachycardia was induced in 27 (22.5%) patients. When identifiable, the critical isthmus most commonly implicated (ie, in 90.0%) was between the ventricular septal defect patch and pulmonary annulus. Factors independently associated with inducible ventricular tachycardia were history of atrial arrhythmia (OR, 8.56 [95% CI, 2.43-34.73]) and pulmonary annulus diameter >26 mm (OR, 5.05 [95% CI, 1.47-21.69]). The EPS led to a substantial change in management in 23 (19.2%) cases: 18 (15.0%) had catheter ablation, 3 (2.5%) surgical cryoablation during PVR, and 9 (7.5%) defibrillator implantation. Repeat EPS 5.1 (4.8-6.2) months after PVR was negative in 8 of 9 (88.9%) patients. No patient experienced a sustained ventricular arrhythmia during 13 (6.1-20.1) months of follow-up. CONCLUSIONS Systematically performing programmed ventricular stimulation in patients with tetralogy of Fallot referred for PVR yields a high rate of inducible ventricular tachycardia and carries the potential to alter management. It remains to be determined whether a standardized treatment approach based on the results of EPS will translate into improved outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04205461.
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Affiliation(s)
- Victor Waldmann
- Université Paris Cité, Inserm, PARCC, France (V.W., D.B., M.L., E.M.)
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.)
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, France (V.W., D.B., A.L., S.M.-M.)
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France (V.W., E.M.)
| | - Francis Bessière
- Université Paris Cité, Inserm, PARCC, France (V.W., D.B., M.L., E.M.)
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.)
| | - Kevin Gardey
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.)
| | - Mohamed Bakloul
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.)
| | - Emre Belli
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.)
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, France (V.W., D.B., A.L., S.M.-M.)
| | - Anne-Solène Chaussade
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.)
| | - Sarah Cohen
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.)
| | - Hubert Delasnerie
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, Le Kremlin-Bicêtre, France (S.C.)
| | - Nabil Dib
- Pasteur Clinic, Toulouse, France (H.D., C.K., M.R., N.C.)
| | - Sylvie Di Filippo
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.)
| | - Arnaud Dulac
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.)
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.)
| | - Roland Henaine
- Louis Pradel Hospital, Hospices Civils de Lyon, Université Lyon 1 Claude Bernard, France (F.B., K.G., M.B., S.D.F., A.D., R.H.)
| | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.)
| | - Clément Karsenty
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, Le Kremlin-Bicêtre, France (S.C.)
| | - Magalie Ladouceur
- Université Paris Cité, Inserm, PARCC, France (V.W., D.B., M.L., E.M.)
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.)
| | - Antoine Legendre
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.)
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, France (V.W., D.B., A.L., S.M.-M.)
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, APHP, France (V.W., D.B., A.L., S.M.-M.)
| | - Mansour Mostefa Kara
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, France (V.M., A.-S.C., L.I., M.L., A.L., M.M.K.)
| | - Jelena Radojevic
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.)
| | | | - Eloi Marijon
- Université Paris Cité, Inserm, PARCC, France (V.W., D.B., M.L., E.M.)
- Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France (V.W., E.M.)
| | - Alice Maltret
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.)
| | - Paul Khairy
- Pasteur Clinic, Toulouse, France (H.D., C.K., M.R., N.C.)
| | - Nicolas Combes
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France (E.B., S.C., S.H., J.R., A.M., N.C.)
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, Le Kremlin-Bicêtre, France (S.C.)
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Ditac G, Cottinet PJ, Quyen Le M, Grinberg D, Duchateau J, Gardey K, Dulac A, Delinière A, Haddad C, Boussuge-Roze J, Sacher F, Jaïs P, Chevalier P, Bessière F. Carbon footprint of atrial fibrillation catheter ablation. Europace 2023; 25:331-340. [PMID: 36107465 PMCID: PMC10103577 DOI: 10.1093/europace/euac160] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Climate change represents the biggest global health threat of the 21st century. Health care system is itself a large contributor to greenhouse gas (GHG) emissions. In cardiology, atrial fibrillation (AF) catheter ablation is an increasing activity using numerous non-reusable materials that could contribute to GHG emission. Determining a detailed carbon footprint analysis of an AF catheter ablation procedure allows the identification of the main polluting sources that give opportunities for reduction of environmental impact. To assess the carbon footprint of AF catheter ablation procedure. To determine priority actions to decrease pollution. METHODS AND RESULTS An eco-audit method used to predict the GHG emission of an AF catheter ablation procedure was investigated. Two workstations were considered including surgery and anaesthesia. In the operating room, every waste produced by single-use medical devices, pharmaceutical drugs, and energy consumption during intervention were evaluated. All analyses were limited to the operating room. Thirty procedures were analysed over a period of 8 weeks: 18 pulmonary veins isolation RF ablations, 7 complex RF procedures including PVI, roof and mitral isthmus lines, ethanol infusion of the Marshall vein and cavo tricuspid isthmus line, and 5 pulmonary vein isolation with cryoballoon. The mean emission during AF catheter ablation procedures was 76.9 kg of carbon dioxide equivalent (CO2-e). The operating field accounted for 75.4% of the carbon footprint, while only 24.6% for the anaesthesia workstation. On one hand, material production and manufacturing were the most polluting phases of product life cycle which, respectively, represented 71.3% (54.8 kg of CO2-e) and 17.0% (13.1 kg of CO2-e) of total pollution. On the other hand, transport contributed in 10.6% (8.1 kg of CO2-e), while product use resulted in 1.1% (0.9 kg of CO2-e) of GHG production. Electrophysiology catheters were demonstrated to be the main contributors of environmental impact with 29.9 kg of CO2-e (i.e. 38.8%). Three dimensional mapping system and electrocardiogram patches were accounting for 6.8 kg of CO2-e (i.e. 8.8% of total). CONCLUSION AF catheter ablation involves a mean of 76.9 kg of CO2-e. With an estimated 600 000 annual worldwide procedures, the environmental impact of AF catheter ablation activity is estimated equal to 125 tons of CO2 emission each day. It represents an equivalent of 700 000 km of car ride every day. Electrophysiology catheters and patches are the main contributors of the carbon footprint. The focus must be on reducing, reusing, and recycling these items to limit the impact of AF ablation on the environment. A road map of steps to implement in different time frames is proposed.
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Affiliation(s)
- Geoffroy Ditac
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Pierre-Jean Cottinet
- INSA-Lyon, LGEF, Université de Lyon, 20 Av. Albert Einstein, 69100 Villeurbanne, France
| | - Minh Quyen Le
- INSA-Lyon, LGEF, Université de Lyon, 20 Av. Albert Einstein, 69100 Villeurbanne, France
| | - Daniel Grinberg
- Department of Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Josselin Duchateau
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Kévin Gardey
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Arnaud Dulac
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Antoine Delinière
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Christelle Haddad
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Julie Boussuge-Roze
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Frédéric Sacher
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Pierre Jaïs
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Philippe Chevalier
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Francis Bessière
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
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Rajinthan P, Gardey K, Boccalini S, Si-Mohammed S, Dulac A, Berger C, Placide L, Delinière A, Mewton N, Chevalier P, Bessière F. CMR - Late gadolinium enhancement characteristics associated with monomorphic ventricular arrhythmia in patients with non-ischemic cardiomyopathy. Indian Pacing Electrophysiol J 2022; 22:225-230. [PMID: 35931352 PMCID: PMC9463474 DOI: 10.1016/j.ipej.2022.07.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Priyanka Rajinthan
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Kevin Gardey
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Sara Boccalini
- Radiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue Du Doyen Lépine, 69394 LYON Cedex 03, Hospices Civils de Lyon, France
| | - Salim Si-Mohammed
- Radiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue Du Doyen Lépine, 69394 LYON Cedex 03, Hospices Civils de Lyon, France; Creatis, UMR CNRS 5220, INSERM U 1044, Université Claude Bernard Lyon 1, France
| | - Arnaud Dulac
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Clothilde Berger
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Leslie Placide
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Antoine Delinière
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Nathan Mewton
- Centre d'investigation Clinique, Hôpital Cardiologique Louis Pradel, 28 Avenue Du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Philippe Chevalier
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Francis Bessière
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France; LabTau, INSERM U 1032, Université Claude Bernard Lyon 1, France.
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5
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Jacquemart E, Bessière F, Combes N, Ladouceur M, Iserin L, Gardey K, Henaine R, Dulac A, Cohen S, Belli E, Jannot AS, Chevalier P, Ly R, Clavier S, Legendre A, Petit J, Maltret A, Di Filippo S, Hascoët S, Marijon E, Waldmann V. Incidence, Risk Factors, and Outcomes of Atrial Arrhythmias in Adult Patients With Atrioventricular Septal Defect. JACC Clin Electrophysiol 2022; 8:331-340. [PMID: 35331427 DOI: 10.1016/j.jacep.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to assess the incidence, associated factors, and outcomes of atrial arrhythmias in adults with atrioventricular septal defect (AVSD). BACKGROUND Data regarding atrial arrhythmias in adults with AVSD are particularly scarce. METHODS Data were analyzed from a multicentric cohort of adult patients with AVSD. Lifetime cumulative incidences of atrial arrhythmias were studied. Multiple logistic regression models were used to identify risk factors. RESULTS A total of 391 patients (61.6% women) were enrolled with a mean age of 36.3 ± 16.3 years and a mean follow-up of 17.3 ± 14.2 years after initial surgical repair. Overall, 98 patients (25.1%) developed at least 1 episode of atrial arrhythmia at a mean age of 39.2 ± 17.2 years. The mean ages of patients at first episode of intra-atrial re-entrant tachycardia (IART)/ focal atrial tachycardia (FAT) and atrial fibrillation were 33.7 ± 15.3 and 44.3 ± 16.5 years, respectively. The lifetime risks for developing atrial arrhythmia to ages 20, 40, and 60 years were 3.7%, 17.8%, and 55.3%, respectively. IART/FAT was the leading arrhythmia until the age of 45, then atrial fibrillation surpassed IART/FAT. Age (odds ratio [OR]: 1.4; 95% confidence interval [CI]: 1.2-1.6), number of cardiac surgeries (OR: 4.1; 95% CI: 2.5-6.9), left atrial dilatation (OR: 3.1; 95% CI: 1.4-6.8), right atrial dilatation (OR: 4.1; 95% CI: 1.7-10.3), and moderate or severe left atrioventricular valve regurgitation (OR: 3.7; 95% CI: 1.2-11.7) were independently associated with a higher risk of atrial arrhythmias, whereas the type of AVSD and the age at repair were not. The occurrence of atrial arrhythmias was associated with pacemaker implantation (41.8% vs. 8.5%; P < 0.001), heart failure (24.5% vs. 1.0%; P < 0.001), and cerebrovascular accidents (11.2% vs. 3.4%; P = 0.007). CONCLUSIONS The lifetime risk of atrial arrhythmias in patients with AVSD is considerable with more than half of patients developing ≥1 atrial arrhythmia by the age of 60 and is associated with a significant morbidity. The risk in partial/intermediate AVSD is as high as in complete AVSD and is not impacted by age at repair.
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Affiliation(s)
- Etienne Jacquemart
- Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France
| | | | - Nicolas Combes
- Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France; Pasteur Clinic, Toulouse, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | - Sarah Cohen
- Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France
| | - Emre Belli
- Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France
| | - Anne-Sophie Jannot
- Department of Medical Informatics and Public Health, European Georges Pompidou Hospital, Paris, France
| | | | - Reaksmei Ly
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | - Sandra Clavier
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | - Antoine Legendre
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | - Jérôme Petit
- Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France
| | - Alice Maltret
- Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France
| | | | - Sébastien Hascoët
- Marie Lannelongue Hospital, Department of Pediatric Cardiology and Congenital Heart Diseases, Centre de Référence Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint Joseph, Paris-Saclay University, Inserm UMR999, Le Plessis-Robinson, France
| | - Eloi Marijon
- Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France
| | - Victor Waldmann
- Electrophysiology Section, European Georges Pompidou Hospital, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Université de Paris, Inserm, Paris Cardiovascular Research Centre, Paris, France.
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Hayek A, Gardey K, Dulac A, Bessiere F, Chevalier P. Atrial arrhythmia in a patient after bicaval heart transplantation: Evidence for recipient-to-donor conduction. HeartRhythm Case Rep 2019; 6:11-14. [PMID: 31956494 PMCID: PMC6962723 DOI: 10.1016/j.hrcr.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ahmad Hayek
- Service de Rythmologie, Hôpital cardiologique Louis Pradel, Université de Lyon, Lyon, France
| | - Kevin Gardey
- Service de Rythmologie, Hôpital cardiologique Louis Pradel, Université de Lyon, Lyon, France
| | - Arnaud Dulac
- Service de Rythmologie, Hôpital cardiologique Louis Pradel, Université de Lyon, Lyon, France
| | - Francis Bessiere
- Service de Rythmologie, Hôpital cardiologique Louis Pradel, Université de Lyon, Lyon, France
| | - Philippe Chevalier
- Service de Rythmologie, Hôpital cardiologique Louis Pradel, Université de Lyon, Lyon, France
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Chauveau S, Le Vavasseur O, Morel E, Dulac A, Chevalier P. Flecainide is a safe and effective treatment for pre-excited atrial fibrillation rapidly conducted to the ventricle in pregnant women: a case series. Eur Heart J Case Rep 2019; 3:5522158. [PMID: 31449645 PMCID: PMC6601159 DOI: 10.1093/ehjcr/ytz066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 06/10/2019] [Indexed: 11/14/2022]
Abstract
Background Pregnancy is associated with an increased incidence of cardiac arrhythmias likely due to hormonal, haemodynamic, and autonomic changes. Yet, there is little data available regarding the efficacy and safety of anti-arrhythmic agents to prevent pre-excited atrial fibrillation (AF) in pregnant women. Case summary We report on three pregnant women who developed AF rapidly conducted to the ventricle through an overt accessory pathway as the first manifestation of Wolff–Parkinson–White syndrome. Discussion All patients were treated with flecainide with neither arrhythmias recurrence nor adverse events of the treatment. Mechanisms of action and clinical efficacy of flecainide are discussed.
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Affiliation(s)
- Samuel Chauveau
- Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, 26 Avenue du Doyen jean Lépine, Lyon, France.,Lyon Reference Center for Inherited Arrhythmias, Louis Pradel Cardiovascular Hospital, 28 avenue Doyen Lépine, Bron, France
| | - Olivier Le Vavasseur
- Department of Cardiology, Northwest Hospital, Gleizé, France Hospital, 39 Plateau d'Ouilly Gleizé, Gleize, France
| | - Elodie Morel
- Lyon Reference Center for Inherited Arrhythmias, Louis Pradel Cardiovascular Hospital, 28 avenue Doyen Lépine, Bron, France
| | - Arnaud Dulac
- Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, 26 Avenue du Doyen jean Lépine, Lyon, France
| | - Philippe Chevalier
- Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, 26 Avenue du Doyen jean Lépine, Lyon, France.,Lyon Reference Center for Inherited Arrhythmias, Louis Pradel Cardiovascular Hospital, 28 avenue Doyen Lépine, Bron, France
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8
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Chauveau S, Dulac A, Sebbag L, Morel E, Chevalier P. Additional coronary sinus shocking lead as rescue therapy after multiple internal and external defibrillation failures. Clin Case Rep 2017; 5:923-926. [PMID: 28588840 PMCID: PMC5458032 DOI: 10.1002/ccr3.968] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/26/2016] [Accepted: 03/19/2017] [Indexed: 11/10/2022] Open
Abstract
High defibrillation threshold (DFT) and defibrillation failure can lead to intractable ventricular arrhythmias. Additional coronary sinus coil is an effective strategy to achieve marked reduction in DFT. However, physicians should retain this might prevent future coronary sinus lead placement in case the patient would develop complete left bundle branch block.
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Affiliation(s)
- Samuel Chauveau
- Department of Rhythmology; Hospices civils de Lyon; Louis Pradel Cardiovascular Hospital; Lyon France
- Lyon Reference Center for inherited Arrhythmias; Louis Pradel Cardiovascular Hospital; Lyon France
| | - Arnaud Dulac
- Department of Rhythmology; Hospices civils de Lyon; Louis Pradel Cardiovascular Hospital; Lyon France
- Lyon Reference Center for inherited Arrhythmias; Louis Pradel Cardiovascular Hospital; Lyon France
| | - Laurent Sebbag
- Heart Transplant Department; Louis Pradel Cardiovascular Hospital; Lyon France
| | - Elodie Morel
- Lyon Reference Center for inherited Arrhythmias; Louis Pradel Cardiovascular Hospital; Lyon France
| | - Philippe Chevalier
- Department of Rhythmology; Hospices civils de Lyon; Louis Pradel Cardiovascular Hospital; Lyon France
- Lyon Reference Center for inherited Arrhythmias; Louis Pradel Cardiovascular Hospital; Lyon France
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Loron S, Dulac A, Jegaden O, Ferry T. Large vegetation in a 60-year-old man with Enterococcus faecalis cardiac implantable electronic device infection. BMJ Case Rep 2014; 2014:bcr-2014-206907. [PMID: 25293687 DOI: 10.1136/bcr-2014-206907] [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: 11/04/2022] Open
Affiliation(s)
- Sandrine Loron
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Dulac
- Université Claude Bernard Lyon 1, Lyon, France Service de Cardiologie, Unité 50, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Olivier Jegaden
- Université Claude Bernard Lyon 1, Lyon, France Service de Chirurgie Cardiaque, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Lyon, France Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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Dulac A, Sarrazin J, Nault I, O'Hara G, Philippon F, Molin F, Blier L, Champagne J. COMPARISON OF PULMONARY VEIN ISOLATION USING THE FIRST-GENERATION ARCTIC FRONT CRYOBALLOON VERSUS THE MOST RECENT ARCTIC FRONT ADVANCE CRYOBALLOON FOR PAROXYSMAL ATRIAL FIBRILLATION. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.519] [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: 10/24/2022] Open
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Bochaton T, Hugon E, Bejan-Angoulvant T, Quijano E, Ivanes F, Dulac A, Ducher L, André-Fouët X, Angoulvant D. 043 Does routine measurement of ankle brachial index ameliorates the assessment of coronary risk level in patients with known or suspected coronary artery disease. The ABICARD study. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70045-8] [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: 10/19/2022]
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Noël Y, Lehembre N, Dulac A, Clavaud MC. Comparaison des cinétiques de coagulation enzymatique et mixte du lait. Influence du calcium. ACTA ACUST UNITED AC 1989. [DOI: 10.1051/lait:1989632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dorne R, Rigaud A, Salle M, Belat C, Woillez E, Dulac A. [Peroperative hemodynamic study during the surgical excision of a nasopharyngeal angiofibroma, performed with intentional normovolemic hemodilution]. Ann Fr Anesth Reanim 1982; 1:539-41. [PMID: 6307083 DOI: 10.1016/s0750-7658(82)80099-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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