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Didier R, Garnier L, Duloquin G, Meloux A, Sagnard A, Graber M, Dogon G, Benali K, Pommier T, Laurent G, Vergely C, Bejot Y, Guenancia C. Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study. Stroke Vasc Neurol 2024; 9:165-173. [PMID: 37429637 DOI: 10.1136/svn-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS). METHODS Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission. RESULTS A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029). CONCLUSION AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations. TRIAL REGISTRATION NUMBER NCT03570060.
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Affiliation(s)
| | - Lucie Garnier
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | | | | | - Mathilde Graber
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | | | - Karim Benali
- Cardiology, CHU Saint Etienne, Saint Etienne, France
| | - Thibaut Pommier
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | - Gabriel Laurent
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | | | - Yannick Bejot
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | - Charles Guenancia
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
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Petzl A, Benali K, Mbolamena N, Dyrda K, Rivard L, Seidl S, Martins R, Martinek M, Pürerfellner H, Aguilar M. Patient-specific quantification of cardiorespiratory motion for cardiac stereotactic radioablation treatment planning. Heart Rhythm O2 2024; 5:234-242. [PMID: 38690147 PMCID: PMC11056453 DOI: 10.1016/j.hroo.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background Cardiac radioablation is a new treatment for patients with refractory ventricular tachycardia (VT). The target for cardiac radioablation is subject to cardiorespiratory motion (CRM), the heart's movement with breathing and cardiac contraction. Data regarding the magnitude of target CRM are limited but are highly important for treatment planning. Objectives The study sought to assess CRM amplitude by using ablation catheter geometrical data. Methods Electroanatomic mapping data of patients undergoing catheter ablation for VT at 3 academic centers were exported. The spatial position of the ablation catheter as a function of time while in contact with endocardium was analyzed and used to quantify CRM. Results Forty-four patients with ischemic and nonischemic cardiomyopathy and VT contributed 1364 ablation lesions to the analysis. Average cardiac and respiratory excursion were 1.62 ± 1.21 mm and 12.12 ± 4.10 mm, respectively. The average ratio of respiratory to cardiac motion was approximately 11:1. CRM was greatest along the craniocaudal axis (9.66 ± 4.00 mm). Regional variations with respect to respiratory and cardiac motion were observed: basal segments had smaller displacements vs midventricular and apical segments. Patient characteristics (previous cardiac surgery, height, weight, body mass index, and left ventricular ejection fraction) had a statistically significant, albeit clinically moderate, impact on CRM. Conclusion CRM is primarily determined by respiratory displacement and is modulated by the location of the target and the patient's biometric characteristics. The patient-specific quantification of CRM may allow to decrease treatment volume and reduce radiation exposure of surrounding organs at risk while delivering the therapeutic dose to the target.
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Affiliation(s)
- Adrian Petzl
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Karim Benali
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital, France
| | - Nicolas Mbolamena
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Katia Dyrda
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Léna Rivard
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Sebastian Seidl
- Department of Internal Medicine 2/Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Raphaël Martins
- Department of Cardiac Electrophysiology, Rennes University Hospital, France
| | - Martin Martinek
- Department of Internal Medicine 2/Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Helmut Pürerfellner
- Department of Internal Medicine 2/Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Martin Aguilar
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
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Da Costa A, Benali K. Leadless pacemaker: The revolution is underway. Trends Cardiovasc Med 2024:S1050-1738(24)00029-X. [PMID: 38555030 DOI: 10.1016/j.tcm.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Antoine Da Costa
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France.
| | - Karim Benali
- From the Division of Cardiology, Jean Monnet University (ADC), Saint-Etienne, France
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Benali K, Monaco C, Duchateau J, Sacher F, Haïssaguerre M. Malignant Purkinje Ectopy Induced by Atrial Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00179-8. [PMID: 38613546 DOI: 10.1016/j.jacep.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Karim Benali
- Cardiac Arrhythmia Department, Saint-Etienne University Hospital, Jean Monnet University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France.
| | - Cinzia Monaco
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis, Belgium
| | - Josselin Duchateau
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France
| | - Frederic Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France; Inherited Arrhythmic Disease Center, Bordeaux University Hospital, Bordeaux, France
| | - Michel Haïssaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France
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Benali K, Vlachos K, Reddy VY, Verma A, Chun J, Andrade J, Macle L, Da Costa A, Jaïs P, Hocini M. Pulsed field ablation for atrial fibrillation in real-life settings: Efficacy, safety, and lesion durability in patients with recurrences. Heart Rhythm 2024:S1547-5271(24)00127-9. [PMID: 38341122 DOI: 10.1016/j.hrthm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Jean-Monnet University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France.
| | - Konstantinos Vlachos
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France
| | - Vivek Y Reddy
- Department of Cardiology, Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, New York
| | - Atul Verma
- Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julian Chun
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias (FAFA), Frankfurt, Germany
| | - Jason Andrade
- Department of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, Jean-Monnet University, Saint-Etienne, France
| | - Pierre Jaïs
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France
| | - Mélèze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Department of Cardiology, Haut-Lévèque University Hospital, Bordeaux, France
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Benali K, Zei PC, Lloyd M, Kautzner J, Guenancia C, Ninni S, Rigal L, Simon A, Bellec J, Vlachos K, Sacher F, Hammache N, Sellal JM, de Crevoisier R, Da Costa A, Martins R. One-year mortality and causes of death after stereotactic radiation therapy for refractory ventricular arrhythmias: A systematic review and pooled analysis. Trends Cardiovasc Med 2024:S1050-1738(23)00122-6. [PMID: 38191005 DOI: 10.1016/j.tcm.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/25/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
Patients treated with cardiac stereotactic body radiation therapy (radioablation) for refractory ventricular arrhythmias are patients with advanced structural heart disease and significant comorbidities. However, data regarding 1-year mortality after the procedure are scarce. This systematic review and pooled analysis aimed at determining 1-year mortality after cardiac radioablation for refractory ventricular arrhythmias and investigating leading causes of death in this population. MEDLINE/EMBASE databases were searched up to January 2023 for studies including patients undergoing cardiac radioablation for the treatment of refractory ventricular arrhythmias. Quality of included trials was assessed using the NIH Tool for Case Series Studies (PROSPERO CRD42022379713). A total of 1,151 references were retrieved and evaluated for relevance. Data were extracted from 16 studies, with a total of 157 patients undergoing cardiac radioablation for refractory ventricular arrhythmias. Pooled 1-year mortality was 32 % (95 %CI: 23-41), with almost half of the deaths occurring within three months after treatment. Among the 157 patients, 46 died within the year following cardiac radioablation. Worsening heart failure appeared to be the leading cause of death (52 %), although non-cardiac mortality remained substantial (41 %) in this population. Age≥70yo was associated with a significantly higher 12-month all-cause mortality (p<0.022). Neither target volume size nor radiotherapy device appeared to be associated with 1-year mortality (p = 0.465 and p = 0.199, respectively). About one-third of patients undergoing cardiac stereotactic body radiation therapy for refractory ventricular arrhythmias die within the first year after the procedure. Worsening heart failure appears to be the leading cause of death in this population.
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Affiliation(s)
- Karim Benali
- Section of Cardiac Electrophysiology, Saint-Etienne University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; INSERM-LTSI, U1099 Rennes, France.
| | - Paul C Zei
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, United States
| | - Michael Lloyd
- Section of Cardiac Electrophysiology, Emory University, Atlanta, United States
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Charles Guenancia
- Section of Cardiac Electrophysiology, Dijon University, Dijon, France
| | - Sandro Ninni
- Heart and Lung Institute, Lille University, Lille, France
| | | | | | - Julien Bellec
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Frederic Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Nefissa Hammache
- Section of Cardiac Electrophysiology, Nancy University, Nancy, France
| | - Jean-Marc Sellal
- Section of Cardiac Electrophysiology, Nancy University, Nancy, France
| | | | - Antoine Da Costa
- Section of Cardiac Electrophysiology, Saint-Etienne University, Saint-Etienne, France
| | - Raphael Martins
- INSERM-LTSI, U1099 Rennes, France; Section of Cardiac Electrophysiology, Rennes University, Rennes, France
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Grygorowicz C, Benali K, Serzian G, Mouhat B, Duloquin G, Pommier T, Didier R, Laurent G, Béjot Y, Maille B, Vuillier F, Badoz M, Guenancia C. Value of HAVOC and Brown ESUS-AF scores for atrial fibrillation on implantable cardiac monitors after embolic stroke of undetermined source. J Stroke Cerebrovasc Dis 2024; 33:107451. [PMID: 37995501 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Up to 20 % of ischemic strokes are associated with overt atrial fibrillation (AF). Furthermore, silent AF was detected by an implantable cardiac monitor (ICM) in 1 in 3 cryptogenic strokes in the CRYSTAL AF study. An ESC position paper has suggested a HAVOC score ≥ 4 or a Brown ESUS-AF score ≥ 2 as criteria for ICM implantation after cryptogenic stroke, but neither of these criteria has been developed or validated in ICM populations. We assessed the performance of HAVOC and Brown ESUS-AF scores in a cohort of ICM patients implanted after embolic stroke of undetermined source (ESUS). METHODS All patients implanted with an ICM for ESUS between February 2016 and February 2022 at two French University Hospitals were retrospectively included. Demographic data, cardiovascular risk factors, and clinical and biological data were collected after a review of electronic medical records. HAVOC and Brown ESUS-AF scores were calculated for all patients. FINDINGS Among the 384 patients included, 106 (27 %) developed AF during a mean follow-up of 33 months. The scores performances for predicting AF during follow-up were: HAVOC= AUC: 68.5 %, C-Index: 0.662, and Brown ESUS-AF=AUC: 72.9 %, C-index 0.712. Compared with the CHA2DS2-VASc score, only the Brown ESUS-AF score showed significant improvement in NRI/IDI. Furthermore, classifying patients according to the suggested HAVOC and Brown ESUS-AF thresholds, only 24 % and 31 % of the cohort, respectively, would have received an ICM, and 58 (55 %) and 47 (44 %) of the AF patients, respectively, would not have been implanted with an ICM. CONCLUSION HAVOC and Brown ESUS-AF scores showed close and moderate performance in predicting AF on ICM after cryptogenic stroke, with a significant lack of sensitivity. Specific risk scores should be developed and validated in large ICM cohorts.
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Affiliation(s)
| | - Karim Benali
- Cardiology Department, University Hospital, Saint-Etienne, France
| | | | - Basile Mouhat
- Cardiology Department, University Hospital, Besançon, France
| | - Gauthier Duloquin
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France; Neurology Department, University Hospital, Dijon, France
| | - Thibaut Pommier
- Cardiology Department, University Hospital, Dijon, France; PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Romain Didier
- Cardiology Department, University Hospital, Dijon, France; PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Gabriel Laurent
- Cardiology Department, University Hospital, Dijon, France; PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Yannick Béjot
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France; Neurology Department, University Hospital, Dijon, France
| | - Baptiste Maille
- Cardiology Department, University Hospital, Marseille, France
| | | | - Marc Badoz
- Cardiology Department, University Hospital, Besançon, France
| | - Charles Guenancia
- Cardiology Department, University Hospital, Dijon, France; PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France.
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Grifoni G, Haissaguerre M, Bongiorni MG, Benali K, Soldati E, Zucchelli G. Short-coupled Purkinje ectopy inducible by pharmacological and hyperventilation tests. HeartRhythm Case Rep 2024; 10:68-71. [PMID: 38264118 PMCID: PMC10801065 DOI: 10.1016/j.hrcr.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Gino Grifoni
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Michel Haissaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, and Bordeaux University Hospital, Bordeaux, France
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Karim Benali
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, and Bordeaux University Hospital, Bordeaux, France
- CHU Saint Etienne, University of Rennes, Rennes, France
| | - Ezio Soldati
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
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Benali K, Lloyd MS, Petrosyan A, Rigal L, Quivrin M, Bessieres I, Vlachos K, Hammache N, Bellec J, Simon A, Laurent G, Higgins K, Garnier F, de Crevoisier R, Martins R, Da Costa A, Guenancia C. Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices. J Cardiovasc Electrophysiol 2024; 35:206-213. [PMID: 38018417 DOI: 10.1111/jce.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
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Affiliation(s)
- Karim Benali
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- LTSI-UMR 1099, Rennes, France
| | - Michael S Lloyd
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andranik Petrosyan
- Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Louis Rigal
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Magali Quivrin
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Igor Bessieres
- Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Nefissa Hammache
- Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
| | - Julien Bellec
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
| | - Antoine Simon
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
| | - Gabriel Laurent
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Fabien Garnier
- Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
| | | | - Raphaël Martins
- Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
- Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
| | - Antoine Da Costa
- Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - Charles Guenancia
- Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
- PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
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Komatsu Y, Nogami A, Hocini M, Morita H, Sato N, Marijon E, Arentz T, Yli-Mäyry S, Onishi Y, Kowase S, Duchateau J, Benali K, Takase T, Hosaka Y, Takei A, Nakajima I, Kawamura M, Inden Y, Ieda M, Aonuma K, Haïssaguerre M. Triggers of Ventricular Fibrillation in Patients With Inferolateral J-Wave Syndrome. JACC Clin Electrophysiol 2024; 10:1-12. [PMID: 37855774 DOI: 10.1016/j.jacep.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/05/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There are few data on ventricular fibrillation (VF) initiation in patients with inferolateral J waves. OBJECTIVES This multicenter study investigated the characteristics of triggers initiating spontaneous VF in inferolateral J-wave syndrome. METHODS A total of 31 patients (age 37 ± 14 years, 24 male) with spontaneous VF episodes associated with inferolateral J waves were evaluated to determine the origin and characteristics of triggers. The J-wave pattern was recorded in inferior leads in 11 patients, lateral leads in 3, and inferolateral leads in 17. RESULTS The VF triggers (n = 37) exhibited varying QRS durations (176 ± 21 milliseconds, range 119-219 milliseconds) and coupling intervals (339 ± 46 milliseconds, range 250-508 milliseconds) with a right (70%) or left (30%) bundle branch block (BBB) pattern. Trigger patterns were associated with J-wave location: left BBB triggers with inferior J waves and right BBB triggers with lateral J waves. Electrophysiologic study was performed for 22 VF triggers in 19 patients. They originated from the left or right Purkinje system in 6 and from the ventricular myocardium in 10 and were undetermined in 6. Purkinje vs myocardial triggers showed distinct electrocardiographic characteristics in coupling interval and QRS-complex duration and morphology. Abnormal epicardial substrate associated with fragmented electrograms was identified in 9 patients, with triggers originating from the same region in 7 patients. Catheter ablation resulted in VF suppression in 15 patients (79%). CONCLUSIONS VF initiation in inferolateral J-wave syndrome is associated with significant individual heterogeneity in trigger characteristics. Myocardial triggers have electrocardiographic features distinct from Purkinje triggers, and their origin often colocalizes with an abnormal epicardial substrate.
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Affiliation(s)
- Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mélèze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuyuki Sato
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Eloi Marijon
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Thomas Arentz
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sinikka Yli-Mäyry
- Heart Hospital, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Yoshimi Onishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Karim Benali
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Tetsuro Takase
- Department of Cardiology, Ayase Heart Hospital, Tokyo, Japan
| | - Yukio Hosaka
- Department of Cardiovascular Medicine, Niigata City General Hospital, Niigata, Japan
| | - Asumi Takei
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Mitsuharu Kawamura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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11
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Rigal L, Benali K, Barré V, Bougault M, Bellec J, Crevoisier RD, Martins R, Simon A. Multimodal fusion workflow for target delineation in cardiac radioablation of ventricular tachycardia. Med Phys 2024; 51:292-305. [PMID: 37455674 DOI: 10.1002/mp.16613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Cardiac radioablation (CR) is an innovative treatment to ablate cardiac arrythmia sources by radiation therapy. CR target delineation is a challenging task requiring the exploitation of highly different imaging modalities, including cardiac electro-anatomical mapping (EAM). PURPOSE In this work, a data integration process is proposed to alleviate the tediousness of CR target delineation by generating a fused representation of the heart, including all the information of interest resulting from the analysis and registration of electro-anatomical data, PET scan and planning computed tomography (CT) scan. The proposed process was evaluated by cardiologists during delineation trials. METHODS The data processing pipeline was composed of the following steps. The cardiac structures of interest were segmented from cardiac CT scans using a deep learning method. The EAM data was registered to the cardiac CT scan using a point cloud based registration method. The PET scan was registered using rigid image registration. The EAM and PET information, as well as the myocardium thickness, were projected on the surface of the 3D mesh of the left ventricle. The target was identified by delineating a path on this surface that was further projected to the thickness of the myocardium to create the target volume. This process was evaluated by comparison with a standard slice-by-slice delineation with mental EAM registration. Four cardiologists delineated targets for three patients using both methods. The variability of target volumes, and the ease of use of the proposed method, were evaluated. RESULTS All cardiologists reported being more confident and efficient using the proposed method. The inter-clinician variability in delineated target volume was systematically lower with the proposed method (average dice score of 0.62 vs. 0.32 with a classical method). Delineation times were also improved. CONCLUSIONS A data integration process was proposed and evaluated to fuse images of interest for CR target delineation. It effectively reduces the tediousness of CR target delineation, while improving inter-clinician agreement on target volumes. This study is still to be confirmed by including more clinicians and patient data to the experiments.
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Affiliation(s)
- Louis Rigal
- Univ Rennes, CHU Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Rennes, France
| | - Karim Benali
- Univ Rennes, CHU Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Rennes, France
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Valentin Barré
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Mathilde Bougault
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Julien Bellec
- Department of Cardiology, Rennes University Hospital, Rennes, France
- Medical Physics Department, CLCC Eugène Marquis, Rennes, France
| | - Renaud De Crevoisier
- Univ Rennes, CHU Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Rennes, France
| | - Raphaël Martins
- Univ Rennes, CHU Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Rennes, France
| | - Antoine Simon
- Univ Rennes, CHU Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Rennes, France
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12
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Duchateau J, Krisai P, Charton J, Benali K, Cheniti G, Surget E, Sacher F, Hocini M, Haïssaguerre M. How to perform Purkinje tissue ablation for the treatment of idiopathic VF. Heart Rhythm 2023; 20:1408-1413. [PMID: 37468026 DOI: 10.1016/j.hrthm.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Josselin Duchateau
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
| | - Philipp Krisai
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Charton
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Karim Benali
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Elodie Surget
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
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13
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Martins RP, Hamel-Bougault M, Bessière F, Pozzi M, Extramiana F, Brouk Z, Guenancia C, Sagnard A, Ninni S, Goemine C, Defaye P, Boignard A, Maille B, Gariboldi V, Baudinaud P, Martin AC, Champ-Rigot L, Blanchart K, Sellal JM, De Chillou C, Dyrda K, Jesel-Morel L, Kindo M, Chaumont C, Anselme F, Delmas C, Maury P, Arnaud M, Flecher E, Benali K. Heart transplantation as a rescue strategy for patients with refractory electrical storm. Eur Heart J Acute Cardiovasc Care 2023; 12:571-581. [PMID: 37319361 DOI: 10.1093/ehjacc/zuad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
AIMS Heart transplantation (HT) can be proposed as a therapeutic strategy for patients with severe refractory electrical storm (ES). Data in the literature are scarce and based on case reports. We aimed at determining the characteristics and survival of patients transplanted for refractory ES. METHODS AND RESULTS Patients registered on HT waiting list during the following days after ES and eventually transplanted, from 2010 to 2021, were retrospectively included in 11 French centres. The primary endpoint was in-hospital mortality. Forty-five patients were included [82% men; 55.0 (47.8-59.3) years old; 42.2% and 26.7% non-ischaemic dilated or ischaemic cardiomyopathies, respectively]. Among them, 42 (93.3%) received amiodarone, 29 received (64.4%) beta blockers, 19 (42.2%) required deep sedation, 22 had (48.9%) mechanical circulatory support, and 9 (20.0%) had radiofrequency catheter ablation. Twenty-two patients (62%) were in cardiogenic shock. Inscription on wait list and transplantation occurred 3.0 (1.0-5.0) days and 9.0 (4.0-14.0) days after ES onset, respectively. After transplantation, 20 patients (44.4%) needed immediate haemodynamic support by extracorporeal membrane oxygenation (ECMO). In-hospital mortality rate was 28.9%. Predictors of in-hospital mortality were serum creatinine/urea levels, need for immediate post-operative ECMO support, post-operative complications, and surgical re-interventions. One-year survival was 68.9%. CONCLUSION Electrical storm is a rare indication of HT but may be lifesaving in those patients presenting intractable arrhythmias despite usual care. Most patients can be safely discharged from hospital, although post-operative mortality remains substantial in this context of emergency transplantation. Larger studies are warranted to precisely determine those patients at higher risk of in-hospital mortality.
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Affiliation(s)
- Raphael P Martins
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
| | - Mathilde Hamel-Bougault
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
| | - Francis Bessière
- Service de Cardiologie, Hôpital Louis Pradel, CHU de Lyon, Lyon, France
| | - Matteo Pozzi
- Service de Cardiologie, Hôpital Louis Pradel, CHU de Lyon, Lyon, France
| | | | - Zohra Brouk
- Service de Cardiologie, Hôpital Bichat, AP-HP, Paris, France
| | | | | | - Sandro Ninni
- Service de Cardiologie, Service de Cardiologie, CHU de Lille, Lille, France
| | - Céline Goemine
- Service de Cardiologie, Service de Cardiologie, CHU de Lille, Lille, France
| | - Pascal Defaye
- Service de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Aude Boignard
- Service de Cardiologie, CHU de Grenoble, Grenoble, France
| | | | - Vlad Gariboldi
- Service de Cardiologie, CHU La Timone, Marseille, France
| | - Pierre Baudinaud
- Service de Cardiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Anne-Céline Martin
- Service de Cardiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | | | | | | | - Katia Dyrda
- Institut de Cardiologie de Montréal, Montréal, Canada
| | | | - Michel Kindo
- Service de Cardiologie, CHU de Strasbourg, Strasbourg, France
| | | | | | - Clément Delmas
- Service de Cardiologie, CHU de Toulouse, Toulouse, France
| | - Philippe Maury
- Service de Cardiologie, CHU de Toulouse, Toulouse, France
| | - Marine Arnaud
- Service de Cardiologie, Institut du Thorax, Nantes, France
| | - Erwan Flecher
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
| | - Karim Benali
- Service de Cardiologie, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, CVHU de Rennes, 2 rue Henri Le Guilloux, F-35000 Rennes, France
- Service de Cardiologie, CHU de Saint-Etienne, Saint-Etienne, France
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14
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Benali K, Khairy P, Hammache N, Petzl A, Da Costa A, Verma A, Andrade JG, Macle L. Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol 2023; 81:2089-2099. [PMID: 37225362 DOI: 10.1016/j.jacc.2023.03.418] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design. OBJECTIVES The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends. METHODS MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273). RESULTS A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. CONCLUSIONS Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.
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Affiliation(s)
- Karim Benali
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Saint-Etienne University, Saint-Etienne, France; INSERM-LTSI, U1099, Rennes, France. https://twitter.com/KarimBenali42
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Adrian Petzl
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada. https://twitter.com/atulverma_md
| | - Jason G Andrade
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada. https://twitter.com/DrJasonAndrade
| | - Laurent Macle
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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15
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Vô C, Bartoletti S, Benali K, Gonzalez CM, Mondésert B, Gagnon MH, Dyrda K, Fourier A, Khairy P. Robotic magnetic-guided catheter ablation in patients with congenital heart disease: a systematic review and pooled analysis. Expert Rev Cardiovasc Ther 2023; 21:227-236. [PMID: 36852632 DOI: 10.1080/14779072.2023.2184798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Robotic magnetic navigation (RMN) has emerged as a potential solution to overcome challenges associated with catheter ablation of arrhythmias in patients with congenital heart disease (CHD). OBJECTIVES To assess safety and efficacy of RMNguided catheter ablation in patients with CHD. DESIGN AND METHODS A systematic review and pooled analysis was conducted on patients with CHD who underwent RMNguided catheter ablation. Random effects models were used to generate pooled estimates with the inverse variance method used for weighting studies. RESULTS Twentyfour nonoverlapping records included 167 patients with CHD, mean age 36.5 years, 44.6% female. Type of CHD was simple in 27 (16.2%), moderate in 32 (19.2%), and complex in 106 (63.5%). A total of 202 procedures targeted 260 arrhythmias, the most common being macroreentrant atrial circuits. The mean procedural duration was 207.5 minutes, with a mean fluoroscopy time of 12.1 minutes. The pooled acute success rate was 89.2% [95% CI (77.8%, 97.4%)]. Freedom from arrhythmia recurrence was 84.5% [95% CI (72.5%, 94.0%)] over a mean follow-up of 24.3 months. The procedural complication rate was 3.5% with no complication attributable to RMN technology. CONCLUSION RMN-guided ablation appears to be safe and effective across a variety of arrhythmia substrates and types of CHD.
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Affiliation(s)
- Christophe Vô
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Stefano Bartoletti
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Karim Benali
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Cardiology, Saint-Etienne University Hospital Center, SaintEtienne, France
| | - Cecilia M Gonzalez
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Gagnon
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Katia Dyrda
- Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Anne Fourier
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Division of Electrophysiology, Department of Pediatric Cardiology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montreal, Québec, Canada.,Electrophysiology Service, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
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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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Benali K, Barre V, Hermida A, 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, Jesel L, Macle L, Martins R. Atrial fibrillation recurrences despite durable pulmonary vein isolation: Characteristics, management and outcomes, the PARTY-PVI study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.177] [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: 12/31/2022]
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18
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Garnier L, Duloquin G, Meloux A, Sagnard A, Pommier T, Graber M, Dogon G, Benali K, Didier R, Bejot Y, Vergely C, Guenancia C. Multimodal approach for the prediction of atrial fibrillation detected after stroke: SAFAS study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.176] [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: 12/31/2022]
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Benali K, Hamel-Bougault M, Bessière F, Extramiana F, Guenancia C, Ninni S, Defaye P, Maille B, Baudinaud P, Champ-Rigot L, Sellal JM, Jesel L, Anselme F, Delmas C, Galand V, Flécher E, Martins R. Heart transplantation as a rescue strategy for patients with refractory electrical storm. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.173] [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: 12/31/2022]
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Rigal L, Bellec J, Hervouin A, Lederlin M, De Crevoisier R, Benali K, Martins R, Simon A. Motion discrepancies between cardiac target and ICD lead, and their impact on target volume for cardiac radioablation. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.182] [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: 12/31/2022]
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Rigal L, Simon A, Benali K, Hamel-Bougault M, Barre V, Bellec J, Lederlin M, De Crevoisier R, Martins R. A novel data integration workflow for target delineation in cardiac radioablation. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.204] [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: 12/31/2022]
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Eshagh D, Mageau A, Benali K, Alexandra J, Mutuon P, Papo T, Sacre K. Hypermétabolisme vasculaire persistent en TEP-TDM 18FDG et risque de rechute chez les patients pris en charge pour une artérite à cellules géantes. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.116] [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: 12/12/2022]
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23
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Braillon A, Bernard A, Leclercq T, Duloquin G, Pommier T, Benali K, Comby PO, Loffroy R, Midulla M, Ricolfi F, Béjot Y, Guenancia C. Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke. Eur Stroke J 2022; 8:175-182. [PMID: 37021162 PMCID: PMC10069180 DOI: 10.1177/23969873221138197] [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] [Received: 09/02/2022] [Accepted: 10/21/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Atrial fibrillation (AF) is one of the most common causes of ischemic stroke. It is essential to target patients at highest risk of AF detected after stroke (AFDAS), who should benefit from a prolonged rhythm screening strategy. Cardiac-CT angiography (CCTA) was added to the stroke protocol used in our institution in 2018. We sought to assess, for AFDAS, the predictive value of atrial cardiopathy markers by a CCTA performed on admission for acute ischemic stroke. Patients and Methods: From November 2018 to October 2019, consecutive stroke patients with no history of AF were included. Let atrial volume (LAV), epicardial adipose tissue (EAT) attenuation and volume, and LAA characteristics were measured on CCTA. The primary endpoint was the presence of AFDAS at follow-up, diagnosed by continuous electrocardiographic monitoring, long-term external Holter monitoring during hospital stay, or implantable cardiac monitor (ICM). Results: Sixty of the 247 included patients developed AFDAS. Multivariable analysis shows independent predictors of AFDAS: age >80 years (HR 2.46; 95%CI (1.23–4.92), p = 0.011), indexed LAV >45 mL/m2 (HR 2.58; 95%CI (1.19–5.62), p = 0.017), EAT attenuation > −85HU (HR 2.16; 95%CI (1.13–4.15), p = 0.021) and LAA thrombus (HR 2.50; 95%CI (1.06–5.93), p = 0.037). Added consecutively to AFDAS prediction AS5F score (combining age and NIHSS >5), these markers had an incrementally better predictive value compared with the global Chi2 of the initial model ( p = 0.001, 0.035, and 0.015 respectively). Discussion and conclusion: Adding CCTA to the acute stroke protocol to assess markers of atrial cardiopathy associated with AFDAS may help to better stratify the AF screening strategy, including the use of an ICM.
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Affiliation(s)
| | | | | | | | - Thibaut Pommier
- Cardiology Department, University Hospital, Dijon, France
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Karim Benali
- Cardiology Department, University Hospital, Dijon, France
| | | | | | - Marco Midulla
- Radiology Department, University Hospital, Dijon, France
| | | | - Yannick Béjot
- Neurology Department, University Hospital, Dijon, France
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
| | - Charles Guenancia
- Cardiology Department, University Hospital, Dijon, France
- PEC2 EA7460, University of Burgundy and Franche-Comté, Dijon, France
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Benali K, Lai VD, Hammache N, Magnin-Poull I, de Chillou C, Sellal JM. Impact of pulmonary veins anatomy on the outcomes of radiofrequency ablation for paroxysmal atrial fibrillation in the era of contact force-sensing ablation catheters. J Interv Card Electrophysiol 2022; 66:931-940. [PMID: 36251129 DOI: 10.1007/s10840-022-01393-9] [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: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pulmonary vein (PV) isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF). PVI durability is influenced by many factors including PVs anatomy. Data regarding the influence of PVs anatomical variations on the outcomes of PAF ablation in the era of contact force-sensing ablation catheters are scarce and contradictory. METHODS Consecutive patients referred to our center for a first ablation of PAF using radiofrequency (RF) were included. PVs anatomy was classified into 3 groups: typical anatomy (4 distinct veins), left common ostium (LCO), and right accessory PV (RAPV). The primary outcome was recurrence of atrial arrhythmia episode during a 12-month follow-up after ablation. RESULTS Two hundred twenty-three patients were included (mean age 58.4 ± 10.8 years and 70.9% male). Among this cohort, 141 patients (63.2%) had typical PV anatomy, 53 (23.8%) had a LCO, and 29 (13.0%) had a RAPV. The existence of a RAPV was not associated with a higher rate of AF recurrences (22 (14.3%) vs. 7 (10.1%), p = 0.519). After multivariate analysis, the presence of an LCO did not appear to be associated with the AF recurrence rate at 12 months (OR = 1.69, 95%CI 0.95-2.49, p = 0.098). Maintenance of antiarrhythmic drugs after ablation was the only factor independently associated with a decreased risk of AF recurrence at 12 months (OR = 0.76, 95%CI 0.60-0.97, p = 0.046). CONCLUSION This study suggests that the presence of an LCO or a RAPV is not associated with a higher rate of AF recurrence at 12 months after radiofrequency PVI using contact force-sensing catheters in PAF patients.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, CHU de Saint-Etienne, 42270, Saint-Priest-En-Jarez, France. .,INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.
| | - Van Duc Lai
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Nefissa Hammache
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Isabelle Magnin-Poull
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Christian de Chillou
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
| | - Jean-Marc Sellal
- INSERM-IADI, U1254, F-54500, Vandœuvre lès-Nancy, France.,Department of Cardiology, CHRU de Nancy, 54500, Vandœuvre lès-Nancy, France
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Benali K, Guenancia C, Martins RP. Letter by Benali et al Regarding Article, "Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial". Circulation 2022; 146:e69-e70. [PMID: 35969649 DOI: 10.1161/circulationaha.122.060400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Karim Benali
- Saint-Etienne University Hospital, Department of Cardiology, Saint-Priest-En-Jarez, France (K.B.)
- INSERM-IADI, U947, Vandœuvre Lès-Nancy, France (K.B.)
- INSERM-LTSI, U1099, Rennes, France (K.B., R.P.M.)
| | - Charles Guenancia
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Université de Bourgogne Franche-Comté, Dijon, France (C.G.)
- Dijon University Hospital, Department of Cardiology, France (C.G.)
| | - Raphaël P Martins
- Rennes University Hospital, Department of Cardiology, France (R.P.M.)
- INSERM-LTSI, U1099, Rennes, France (K.B., R.P.M.)
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Garnier L, Duloquin G, Meloux A, Benali K, Sagnard A, Graber M, Dogon G, Didier R, Pommier T, Vergely C, Béjot Y, Guenancia C. Multimodal Approach for the Prediction of Atrial Fibrillation Detected After Stroke: SAFAS Study. Front Cardiovasc Med 2022; 9:949213. [PMID: 35911547 PMCID: PMC9326228 DOI: 10.3389/fcvm.2022.949213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntensive screening for atrial fibrillation (AF) has led to a better recognition of this cause in stroke patients. However, it is currently debated whether AF Detected After Stroke (AFDAS) has the same pathophysiology and embolic risk as prior-to-stroke AF. We thus aimed to systematically approach AFDAS using a multimodal approach combining clinical, imaging, biological and electrocardiographic markers.MethodsPatients without previously known AF admitted to the Dijon University Hospital (France) stroke unit for acute ischemic stroke were prospectively enrolled. The primary endpoint was the presence of AFDAS at 6 months, diagnosed through admission ECG, continuous electrocardiographic monitoring, long-term external Holter during the hospital stay, or implantable cardiac monitor if clinically indicated after discharge.ResultsOf the 240 included patients, 77 (32%) developed AFDAS. Compared with sinus rhythm patients, those developing AFDAS were older, more often women and less often active smokers. AFDAS patients had higher blood levels of NT-proBNP, osteoprotegerin, galectin-3, GDF-15 and ST2, as well as increased left atrial indexed volume and lower left ventricular ejection fraction. After multivariable analysis, galectin-3 ≧ 9 ng/ml [OR 3.10; 95% CI (1.03–9.254), p = 0.042], NT-proBNP ≧ 290 pg/ml [OR 3.950; 95% CI (1.754–8.892, p = 0.001], OPG ≥ 887 pg/ml [OR 2.338; 95% CI (1.015–5.620), p = 0.046) and LAVI ≥ 33.5 ml/m2 [OR 2.982; 95% CI (1.342–6.625), p = 0.007] were independently associated with AFDAS.ConclusionA multimodal approach combining imaging, electrocardiography and original biological markers resulted in good predictive models for AFDAS. These results also suggest that AFDAS is probably related to an underlying atrial cardiopathy.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03570060].
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Affiliation(s)
- Lucie Garnier
- Department of Neurology, University Hospital, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Gauthier Duloquin
- Department of Neurology, University Hospital, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Alexandre Meloux
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Karim Benali
- Department of Cardiology, University Hospital, Dijon, France
| | - Audrey Sagnard
- Department of Cardiology, University Hospital, Dijon, France
| | - Mathilde Graber
- Department of Neurology, University Hospital, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Geoffrey Dogon
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Romain Didier
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
- Department of Cardiology, University Hospital, Dijon, France
| | - Thibaut Pommier
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
- Department of Cardiology, University Hospital, Dijon, France
| | - Catherine Vergely
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Yannick Béjot
- Department of Neurology, University Hospital, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
| | - Charles Guenancia
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France
- Department of Cardiology, University Hospital, Dijon, France
- *Correspondence: Charles Guenancia,
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Guenancia C, Supple G, Sellal JM, Magnin-Poull I, Benali K, Hammache N, Echivard M, Marchlinski F, de Chillou C. How to use pace mapping for ventricular tachycardia ablation in post-infarct patients. J Cardiovasc Electrophysiol 2022; 33:1801-1809. [PMID: 35665562 PMCID: PMC9543459 DOI: 10.1111/jce.15586] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/15/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
We aim to describe the technical aspects of pace mapping (PM), as well as the two typical patterns of pacing correlation maps during ventricular tachycardia (VT) ablation. The first main pattern is focal, with a gradual and eccentric decrease of the QRS correlation from the area with the best PM correlation. This focal pattern may be associated with two clinical situations: (1) with some endocardial points showing a good correlation compared to VT morphology: true endocardial exit of VT or endocardial breakthrough of either an intramural or an epicardial circuit; (2) without any endocardial points showing a good correlation compared to VT morphology: the VT may originate from the other ventricle, but the presence of an intramural or an epicardial circuit should be considered in patients with a structural heart disease. The second pattern is the presence of PM points exhibiting a good correlation close to other PM points showing a poor correlation compared to VT morphology: this abrupt change in paced QRS morphology over a short distance indicates divergence of activation wavefronts between these sites and suggests the presence of a slow conduction channel: the VT isthmus.
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Affiliation(s)
- Charles Guenancia
- Cardiology Department, University Hospital, Dijon, France.,PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France.,Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France.,INSERM-IADI U1254, Vandœuvre lès-Nancy, France
| | - Gregory Supple
- Division of Cardiovascular Medicine, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jean-Marc Sellal
- Division of Cardiovascular Medicine, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France
| | - Isabelle Magnin-Poull
- Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France
| | - Karim Benali
- Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France.,INSERM-IADI U1254, Vandœuvre lès-Nancy, France
| | - Nefissa Hammache
- Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France.,INSERM-IADI U1254, Vandœuvre lès-Nancy, France
| | - Mathieu Echivard
- Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France
| | - Francis Marchlinski
- Division of Cardiovascular Medicine, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian de Chillou
- Département de Cardiologie, Centre Hospitalier Universitaire (CHU de Nancy), Vandœuvre lès-Nancy, France.,INSERM-IADI U1254, Vandœuvre lès-Nancy, France
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Casadepax-Soulet C, Crestani B, Benali K, Forien M, Ebstein E, Juge PA, Dieudé P, Ottaviani S. POS1397 USEFULNESS OF 18F-FDG PET/CT FOR POLYMYALGIA RHEUMATICA DIAGNOSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPolymyalgia rheumatica (PMR) is an inflammatory disorder affecting elderly people. The diagnosis is based on clinical and imaging findings such as ultrasonography. The interest of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) in PMR is increasing. However, its exact place in the diagnosis or management of PMR patients remains unclear.ObjectivesWe aimed to describe the utility 18F-FDG PET/CT for PMR diagnosis.MethodsWe performed an observational retrospective study of patients with new onset of PMR having a 18F-FDG PET/CT. Diagnosis of PMR was done according to ACR/EULAR 2012 classification criteria. A control group, including patients with sarcoidosis, neoplasia or infection, was also analyzed. The following sites were assessed for the presence of hypermetabolism (SUVmax ≥ 2): shoulders, acromioclavicular and sternoclaviculaire joints, hips, symphysis pubis, ischial tuberosities, great trochanters, cervical and lumbar interspinous process and large vessels. The number of hypermetabolic sites (0-18), the median SUVmax and the highest SUVmax were analyzed.ResultsA total of 85 PMR patients (60% of female, mean age 70.7 years) and 75 controls (51% of female, mean age 65 years) were analyzed. Among PMR patients, hypermetabolism was mostly observed in shoulders (93%), hips (91%), great trochanters (87%), ischial tuberosities (89%) and lumber interspinous process (71%). Large vessel vasculitis was only observed in 7% of PMR patients. In comparison to control patients, PMR had higher number of hypermetabolic sites (11.3 ±3.3 vs. 0.85 ±1.1, p<0.001), and mean SUVmax score (3.9 ±0.8 vs. 2.7 ±0.4, p<0.001). After adjustment to age, the number of hypermetabolic sites (OR 2.57 [1.84; 4.51], p<0.001) and the mean SUVmax were associated with the diagnosis of PMR (OR 1.49 [1.30; 1.78], p<0.001). Among PMR patients, the C-reactive protein (CRP) levels were correlated with the mean SUVmax (r=0.38, p<0.001), the number of hypermetabolic sites (r=0.34, p<0.01) and the highest SUVmax (r=0.38, p<0.001).Conclusion18F-FDG PET/CT appears to be a sensitive imaging for PMR. The number of hypermetabolic sites and the man SUVmax are correlated with CRP levels and PMR diagnosis.Disclosure of InterestsNone declared
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Martins RP, Benali K, Galand V, Behar N, Daubert JC, Mabo P, Leclercq C, Pavin D. Ablation of multifocal premature ventricular contractions using automated pace-mapping software. Rev Port Cardiol 2022; 41:653-662. [DOI: 10.1016/j.repc.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/08/2021] [Accepted: 05/02/2021] [Indexed: 10/18/2022] Open
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Benali K, Rigal L, Simon A, Bellec J, Jaïs P, Kamakura T, Robinson CG, Cuculich P, De Crevoisier R, Martins RP. Correlation between radiation dose and myocardial remodeling after stereotactic radiation therapy for ventricular tachycardia: First assessment of dose-effect relationship in human. Heart Rhythm 2022; 19:1559-1560. [DOI: 10.1016/j.hrthm.2022.04.017] [Citation(s) in RCA: 2] [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: 01/24/2022] [Revised: 03/18/2022] [Accepted: 04/19/2022] [Indexed: 11/28/2022]
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Bellec J, Rigal L, Hervouin A, Martins R, Lederlin M, Jaksic N, Castelli J, Benali K, de Crevoisier R, Simon A. Cardiac radioablation for ventricular tachycardia: Which approach for incorporating cardiorespiratory motions into the planning target volume? Phys Med 2022; 95:16-24. [DOI: 10.1016/j.ejmp.2022.01.004] [Citation(s) in RCA: 2] [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: 10/10/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022] Open
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Benali K, Galand V, Martins R. A Man in His 60s With Severe Heart Failure and Incessant Ventricular Arrhythmias. JAMA Cardiol 2022; 7:e214401. [PMID: 35019959 DOI: 10.1001/jamacardio.2021.4401] [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: 11/14/2022]
Affiliation(s)
- Karim Benali
- Saint-Etienne University Hospital, Department of Cardiology, Saint-Priest-En-Jarez, France.,INSERM-IADI, U947, Vandœuvre lès-Nancy, France
| | - Vincent Galand
- Rennes University Hospital, Department of Cardiology, Rennes, France.,INSERM-LTSI, U1099, Rennes, France
| | - Raphaël Martins
- Rennes University Hospital, Department of Cardiology, Rennes, France.,INSERM-LTSI, U1099, Rennes, France
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Benali K, Hammache N, Sellal JM, Mazen E, de Chillou C. Catheter knot around the mitral valve apparatus: An exceptional complication of remote magnetic navigation. J Cardiovasc Electrophysiol 2021; 33:137-139. [PMID: 34897865 DOI: 10.1111/jce.15313] [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: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
Remote magnetic navigation (RMN) is as safe and effective as manual navigation for catheter ablation of ventricular arrhythmias. This case is the first description of a soft-tip ablation catheter entrapment in the mitral valve apparatus during an RMN ablation procedure. The tight knot created by the catheter around a mitral valve chordae required surgical removal. This complication, which has never been reported before, highlights the need for closer fluoroscopic monitoring when performing catheter loops inside the ventricles when using the RMN system.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France.,INSERM-IADI, U947, Vandœuvre-lès-Nancy, France
| | - Nefissa Hammache
- INSERM-IADI, U947, Vandœuvre-lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Jean-Marc Sellal
- INSERM-IADI, U947, Vandœuvre-lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Elfarra Mazen
- Department of Cardiovascular Surgery and Heart Transplantations, Nancy University Hospital, France
| | - Christian de Chillou
- INSERM-IADI, U947, Vandœuvre-lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
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Yvorel C, Da Costa A, Lerebours C, Guichard JB, Viallon G, Ferreira T, Romeyer C, Benali K, Isaaz K. Comparison of clockwise and counterclockwise right atrial flutter using high-resolution mapping. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0329] [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: 11/14/2022] Open
Abstract
Abstract
Background
To the best of our knowledge, few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. Objectives. Accordingly, our prospective cohort study, sought to compare CW and CCW CTI-dependent AFL in preselected pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system. The study also aimed to mathematically develop a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities.
Methods and results
Between October 2019 and July 2020, 33 patients were recruited. The mean age was 71±13 years old. No difference was found concerning clinical variables between CCW AFL and CW AFL or regarding left ventricular ejection fraction (LVEF) (55.5±10 vs. 56.6±12; p=0.76). The AFL cycle length was very similar (248±20 vs. 252±28 ms; p=0.6). The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p=0.7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. (4/10 [40%]); p=0.9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. (6/10 [60%]) (p=.9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p=0.2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28±10cm/s; n=8),and the velocities were similarly altered between both groups (26±10 [4/22] vs. 29.8±11cm/s [4/11]; p=0.6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. The only differences between CW and CCW AFL concerned activation patterns.
Conclusions
The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Yvorel
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - A Da Costa
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - C Lerebours
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - J B Guichard
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - G Viallon
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - T Ferreira
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - C Romeyer
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - K Benali
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - K Isaaz
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
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Lajili O, Mahjoub F, Benali K, Benamor N, Rachdi R, Berriche O, Jamoussi H. Association entre le diabète de type 2 et la stéatose hépatique non alcoolique chez des patients obèses Tunisiens. Annales d'Endocrinologie 2021. [DOI: 10.1016/j.ando.2021.08.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martins RP, Maille B, Bessière F, Benali K, Guenancia C, Algalarrondo V, Gourraud JB, Baudinaud P, De Chillou C, Maury P, Sacher F, Galand V. Left Ventricular Assist Device Implantation As a Bailout Strategy for the Management of Refractory Electrical Storm and Cardiogenic Shock. Circ Arrhythm Electrophysiol 2021; 14:e009853. [PMID: 34565166 DOI: 10.1161/circep.121.009853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raphaël P Martins
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes (R.P.M., K.B., V.G.)
| | - Baptiste Maille
- Department of Cardiology and Cardiac Surgery, La Timone Hospital, Marseille (B.M.)
| | | | - Karim Benali
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes (R.P.M., K.B., V.G.)
| | | | | | | | - Pierre Baudinaud
- Department of Cardiology, European Georges Pompidou Hospital, Paris (P.B.)
| | | | | | - Frédéric Sacher
- Department of cardiac pacing and electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac- Bordeaux, France (F.S.)
| | - Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes (R.P.M., K.B., V.G.)
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Benali K, Da Costa A, Macle L, Hammache N, Galand V, Romeyer C, Guichard JB, Leclercq C, Pavin D, Martins R. Distance between the descending aorta and the left inferior pulmonary vein as a determinant of biophysical parameters during paroxysmal atrial fibrillation cryoablation. J Cardiovasc Electrophysiol 2021; 32:2943-2952. [PMID: 34455655 DOI: 10.1111/jce.15234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The distance from the descending aorta (DA) to the posterior wall of the left atrium (LA) is variable. We aimed to determine whether the proximity between the DA and the left inferior pulmonary vein (LIPV) ostium has an impact on biophysical parameters and cryoballoon (CB) ablation efficacy during LIPV freezing. METHODS Patients referred for CB-ablation of atrial fibrillation (AF) in two high-volume centers were included. Cryoablation data were collected prospectively for each patient. The anatomical relationships between the LIPV and the DA (distance LIPV ostium-DA, presence of an aortic imprint on the posterior aspect of the LIPV) were then retrospectively analysed on the LA computed tomography scans realized before AF ablation. RESULTS A total of 350 patients were included (70% men, 59.7 ± 11.5 years). The decrease in the Ostium-DA distance was significantly correlated to the increase in the time-to-isolation (TTI) (r = -.31; p = .036), with less negative temperature (r = -.11; p = .045). Similarly, the presence of an aortic imprint on the LIPV was associated with a longer TTI (p < .001). The analysis of redo procedures data shows a trend toward the presence of shorter ostium-DA distances (15.3 ± 3.29 vs. 18.1 ± 4.99, p = .15) and more frequent aortic imprints (63.6% vs. 47.5%, p = .34) in patients with LIPV reconnection as opposed to patients without reconnection in the LIPV. CONCLUSION Our findings indicated that the DA seems to have a "radiator" effect influencing LIPV cryoablation parameters during CB-ablation. Additional studies will be needed to elucidate whether this biophysical influence has a clinical impact in LIPVs reconnections.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France.,University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Montreal, Canada
| | - Nefissa Hammache
- University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre lès-Nancy, France
| | - Vincent Galand
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Cécile Romeyer
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Jean Baptiste Guichard
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | | | - Dominique Pavin
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Raphaël Martins
- Department of Cardiology, Rennes University Hospital, Rennes, France.,University of Rennes, CHU Rennes, INSERM-LTSI, U1099, Rennes, France
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Benali K, Hammache N, Guenancia C, de Chillou C. Mechanism of ventricular tachycardia in a patient with double-outlet left ventricle. J Cardiovasc Electrophysiol 2021; 32:3099-3102. [PMID: 34455656 DOI: 10.1111/jce.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/01/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
We report the case of ventricular tachycardia (VT) ablation procedure in a patient with history of surgically repaired double-outlet left ventricle. The electrophysiology procedure revealed a re-entry pattern between the right-ventricle to main-pulmonary-artery conduit and the tricuspid annulus. The re-entrant mechanism was most likely promoted by a fibrous remodeling of this area, related to the surgical repair. This case is the first to describe a re-entry mechanism between fixed anatomical barriers in a repaired right ventricle of a double-outlet left ventricle. A pace mapping technique was used to highlight the VT isthmus.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France.,INSERM-IADI, U947, Vandœuvre-lès-Nancy, France
| | - Nefissa Hammache
- INSERM-IADI, U947, Vandœuvre-lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
| | - Charles Guenancia
- INSERM-IADI, U947, Vandœuvre-lès-Nancy, France.,Department of Cardiology, Dijon University Hospital, Dijon, France
| | - Christian de Chillou
- INSERM-IADI, U947, Vandœuvre-lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
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Yvorel C, Da Costa A, Lerebours C, Guichard JB, Viallon G, Romeyer C, Ferreira T, Benali K, Isaaz K. Comparison of clockwise and counterclockwise right atrial flutter using high-resolution mapping and automated velocity measurements. J Cardiovasc Electrophysiol 2021; 32:2127-2139. [PMID: 34041809 DOI: 10.1111/jce.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. OBJECTIVES We sought to compare CW and CCW CTI-dependent AFL in pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system and we mathematically developed a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. METHODS AND RESULTS Thirty-three pts were recruited. The mean age was 71 ± 13 years old. The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p = .7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. 4/10 [40%]; p = .9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. 6/10 [60%]; p = .9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p = .2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28 ± 10 cm/s; n = 8), and the velocities were similarly altered between both groups (26 ± 10 [4/22] vs. 29.8 ± 11 cm/s [4/11]; p = .6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20 cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. CONCLUSION The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions.
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Affiliation(s)
- Cedric Yvorel
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Chloe Lerebours
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Jean B Guichard
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Gregory Viallon
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Cécile Romeyer
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Thomas Ferreira
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Karim Benali
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | - Karl Isaaz
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
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Suzat A, Da Costa A, Guichard JB, Pierrard ROMAIN, Benali K, Yvorel C, Bayard G, Isaaz K. Is transesophageal echocardiogram mandatory for patients undergoing ablation for right atrial flutter with uninterrupted anticoagulants? A prospective single registry. Europace 2021. [DOI: 10.1093/europace/euab116.267] [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. Limited data exist regarding the prevalence of left atrial appendage (LAA) thrombi and spontaneous echocardiographic contrast (SEC) in patients with atrial flutter (AFL). Objectives. Our prospective single-center observational study sought to evaluate the prevalence of LAA thrombi in patients referred for AFL ablation, compared to those requiring atrial fibrillation (AFib) ablation during the same time period, as well as to determine the predictive factors of LAA thrombi in terms of arrhythmia etiology. Methods and Results. From July 2019 to August 2020, 321 consecutive patients who were referred for either AFib ablation (n = 229) or AFL ablation (n = 92) were included in the study, with a thrombus detected by transesophageal echocardiography (TEE) in 3.22% (12/321). Prior to ablation under anticoagulants, the percentage of thrombi was similar between patients referred for AFL ablation and those referred for AFib ablation (5.4% [n = 5/92] vs. 3.1% [n = 7/229]; p = 0.3). In the overall population, patients with LAA thrombi had a higher CHA²DS²-VASc score (3 ± 2 vs. 2 ± 1.5; p = 0.048) and a higher presence of valvular prothesis (25% vs. 4.9%; p = 0.003), with relevant left atrial remodeling more often observed, such as demonstrated by a higher left atrium (LA) volume (57 ± 19 vs. 46 ± 17 ml/m²; p = 0.04), a lower LAA velocity (0.41 ± 0.3 vs. 0.55 ± 0.2; p = 0.04) and a more severe LAA echo contrast (83.3% vs. 3.2%; p <0.0001). In the subset of patients with right AFL, patients with LAA thrombi had a higher CHA²DS²-VASc score (4.4 ± 1 vs. 2.5 ± 1.5; p = 0.008), had more often hypertension (100% vs. 53%; p = 0.04) and more often diabetes mellitus (60% vs. 18.4%; p = 0.03), and a more severe LAA echo contrast (80% vs. 5.7%; p <0.0001). Predictive factors of atrial thrombi evaluated by crude odds ratios were the presence of valvular prosthesis (OR = 6.53; [1.60, 26.65] ; p = 0.009), the CHA²DS²-VASc score (OR = 1.41 [0.99, 2.01] ; p = 0.05), the LAA velocity (cm/s) (OR = 0.03; [0.001, 0.79]; p = 0.04) and presence of severe LAA contrast (OR = 188 ; [35.32, 1002.02] ; <0.0001) rather than the atrial arrhythmia itself. Conclusions. Patients referred for ablation with right AFL have a similar risk of LAA thrombi, compared to those with AFib. The risk of LAA thrombi is better related to the presence of valvular prosthesis, CHA²DS²-VASc score and LA remodelling than the atrial arrhythmia itself. Accordingly, TEE should be recommended before right AFL ablation, especially in case of a valvular prosthesis, high CHA²DS²-VASc score or LA alteration.
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Affiliation(s)
- A Suzat
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - A Da Costa
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - JB Guichard
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - ROMAIN Pierrard
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - K Benali
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - C Yvorel
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - G Bayard
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
| | - K Isaaz
- University of Saint-Etienne - Jean Monnet, Department of Cardiology, Saint-Etienne, France
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Bellec J, Simon A, Benali K, Jaksic N, Caille P, Lederlin M, Lafond C, de Crevoisier R, Martins R. Cardiac stereotactic body radiation therapy for refractory ventricular tachycardia: Impact of cardiac and respiratory movement on the target volume definition. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.206] [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: 11/28/2022]
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Dulin M, Pasi N, Benali K, Chauveheid M, Dossier A, Goulenok T, Roriz M, Papo T, Sacré K. Tuberculose myocardique : analyse rétrospective de 6 cas. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.289] [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: 11/26/2022]
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Champion L, Culine S, Desgranchamps F, Benali K, Verine J, Daugas E. Metastatic Renal Cell Carcinoma in a Renal Allograft: A Sustained Complete Remission After Stimulated Rejection. Am J Transplant 2017; 17:1125-1128. [PMID: 27931087 DOI: 10.1111/ajt.14151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/04/2016] [Accepted: 11/22/2016] [Indexed: 01/25/2023]
Abstract
We report the case of a 40-year-old woman who recovered from a diffuse metastatic renal cell carcinoma that developed from a kidney allograft. She was successfully treated by the induction of tumor rejection. Immunosuppression was discontinued, and transplant nephrectomy was deliberately delayed based on the expectation that the tumor mass would trigger the alloimmune response, which was stimulated with pegylated interferon-α-2a. Three years later, the patient remained in complete remission. Despite this severe context, the present case shows that the poor prognosis of allograft metastatic renal cell carcinoma could be dramatically reversed by taking advantage of the donor tumor origin to actively induce a specific alloimmune rejection of the tumor.
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Affiliation(s)
- L Champion
- Department of Nephrology, AP-HP, DHU FIRE, Bichat Hospital, Paris, France
| | - S Culine
- Department of Medical Oncology, APHP, Saint Louis Hospital, Paris, France
| | - F Desgranchamps
- Department of Urology, APHP, Saint Louis Hospital, Paris, France
| | - K Benali
- Department of Nuclear Medicine, AP-HP, Bichat Hospital, Paris, France
| | - J Verine
- Department of Pathology, AP-HP, Saint Louis Hospital, Paris, France
| | - E Daugas
- Department of Nephrology, AP-HP, DHU FIRE, Bichat Hospital, Paris, France
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Mageau A, Rigolet A, Benali K, Ladjeroud S, Maisonobe T, Mahe I, Papo T, Sacré K. Hypercalcémie maligne révélant une granulomatose musculaire floride isolée : une entité différente de la sarcoïdose ? Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.138] [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: 11/28/2022]
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Lariviere D, Benali K, Coustet B, Pasi N, Alexandra JF, Dieude P, Papo T, Sacre K. FRI0520 Comparison of 18F-Fluoro-Deoxyglucose Positron Emission Tomography and Computed Tomography Angiography for The Diagnosis of Giant Cell Arteritis: A Prospective, Case-Control Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2651] [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: 11/04/2022]
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Lehlimi M, Fadil F, Ferram N, Benali K, Hammoumi Z, Habzi A, Sbai H, Benomar S. [Gastric pneumatosis complicated by a neonatal digestive occlusion]. Arch Pediatr 2013; 20:979-81. [PMID: 23876441 DOI: 10.1016/j.arcped.2013.06.007] [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] [Received: 09/13/2012] [Revised: 01/28/2013] [Accepted: 06/07/2013] [Indexed: 11/17/2022]
Abstract
Gastric pneumatosis is a rare pathology. Its occurrence in the neonatal period requires looking for ulcerative-necrotizing enterocolitis in a context of prematurity or an underlying surgical obstacle. We report a case of gastric pneumatosis at a newborn child born at term, admitted on the third day of life for neonatal occlusion with a flat stomach. The abdomen without preparation showed substantial gastric distension with aspects of gastric pneumatosis and embellishes with images showing a double gastric bubble. The surgical exploration showed gastric pneumatosis, complete duodenal atresia located at the level of the second duodenal portion, and an annular pancreas. Progression was favorable after duodenostomy.
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Affiliation(s)
- M Lehlimi
- Service de néonatologie et de réanimation néonatale, hôpital A. Harouchi, CHU Ibn Rochd, Casablanca, Maroc.
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Anderson M, Smedira N, Samuels L, Madani M, Naka Y, Acker M, Hout M, Benali K. Use of the AB5000™ Ventricular Assist Device in Cardiogenic Shock After Acute Myocardial Infarction. Ann Thorac Surg 2010; 90:706-12. [DOI: 10.1016/j.athoracsur.2010.03.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 03/18/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
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Dixon SR, Henriques JPS, Mauri L, Sjauw K, Civitello A, Kar B, Loyalka P, Resnic FS, Teirstein P, Makkar R, Palacios IF, Collins M, Moses J, Benali K, O'Neill WW. A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (The PROTECT I Trial): initial U.S. experience. JACC Cardiovasc Interv 2009; 2:91-6. [PMID: 19463408 DOI: 10.1016/j.jcin.2008.11.005] [Citation(s) in RCA: 266] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 11/09/2008] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We sought to evaluate the safety and feasibility of the Impella 2.5 system (Abiomed Inc., Danvers, Massachusetts) in patients undergoing high-risk percutaneous coronary intervention (PCI). BACKGROUND The Impella 2.5 is a miniaturized percutaneous cardiac assist device, which provides up to 2.5 l/min forward flow from the left ventricle into the systemic circulation. METHODS In a prospective, multicenter study, 20 patients underwent high-risk PCI with minimally invasive circulatory support employing the Impella 2.5 system. All patients had poor left ventricular function (ejection fraction <or=35%) and underwent PCI on an unprotected left main coronary artery or last patent coronary conduit. Patients with recent ST-segment elevation myocardial infarction or cardiogenic shock were excluded. The primary safety end point was the incidence of major adverse cardiac events at 30 days. The primary efficacy end point was freedom from hemodynamic compromise during PCI (defined as a decrease in mean arterial pressure below 60 mm Hg for >10 min). RESULTS The Impella 2.5 device was implanted successfully in all patients. The mean duration of circulatory support was 1.7 +/- 0.6 h (range: 0.4 to 2.5 h). Mean pump flow during PCI was 2.2 +/- 0.3 l/min. At 30 days, the incidence of major adverse cardiac events was 20% (2 patients had a periprocedural myocardial infarction; 2 patients died at days 12 and 14). There was no evidence of aortic valve injury, cardiac perforation, or limb ischemia. Two patients (10%) developed mild, transient hemolysis without clinical sequelae. None of the patients developed hemodynamic compromise during PCI. CONCLUSIONS The Impella 2.5 system is safe, easy to implant, and provides excellent hemodynamic support during high-risk PCI. (The PROTECT I Trial; NCT00534859).
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Anderson MB, Gratz E, Wong RK, Benali K, Kung RTV. Improving outcomes in patients with ventricular assist devices transferred from outlying to tertiary care hospitals. J Extra Corpor Technol 2007; 39:43-8. [PMID: 17486873 PMCID: PMC4680681] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In this retrospective study, the implant course and outcome of patients with ventricular assist devices (VADs) transferred from outlying "spoke" hospitals and converted nonsurgically to a device designed for ambulation at tertiary care "hub" hospitals are evaluated. Factors affecting the crucial decision to transfer and to convert devices have not previously been characterized. Data from 50 patients at 26 US hub institutions were voluntarily submitted to a VAD data registry at ABIOMED, between December 2003 and December 2005. The patients were transferred from 40 spokes on the BVS 5000 Blood Pump and converted to the AB5000 Ventricle (both ABIOMED) at hubs. Comparisons were made on implant indications, time-course, and end-organ function at the time of conversion between surviving patients and patients that had died. Patients who were transferred and converted had a survival to recovery or to next therapy rate of 42%. Eighteen of the surviving patients were still alive 30 days after the explant: 61% were weaned, 33% were transplanted, and 5.6% received a destination device. Average implant-to-transfer time was 1.5 vs. 2.0 days for 30-day survivors and expired patients, respectively, whereas support time from transfer to conversion was 4.8 vs. 4 days, respectively. At the time of device conversion, a total bilirubin below a threshold level of 3.5 mg/dL was predictive of 30-day survival (n = 26, p = .03, odds ratio = 2.73, 95% confidence interval: 1.22-6.16). Patients who survived 30 days were supported longer than those who died (35 vs. 21.1 days, p = .026). At least 18 patients recovered sufficiently on the AB5000 Ventricle to tolerate extubation and 11 patients were able to ambulate. Liver function after implant both at the spoke and before conversion at the hub may be a good indicator of patient survivability. Patients transferred from the BVS 5000 Blood Pump benefited from easy, safe conversion to the AB5000 Ventricle, which provided them with additional support time and afforded the opportunity to recover native heart function.
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Affiliation(s)
- Mark B Anderson
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
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Bensaad D, Bactarzi T, Zoughaileche D, Benali K. P11 - Épidémiologie de l’asthme dans la wilaya de Annaba, Algérie. Rev Epidemiol Sante Publique 2005. [DOI: 10.1016/s0398-7620(05)84639-5] [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: 11/16/2022] Open
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