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Denis C, Clerfond G, Chalard A, Riocreux C, Pereira B, Lamallem O, Guizani T, Catalan PA, Boudias A, Jean F, Bouchant-Pioche M, Abu-Alrub S, Combaret N, Souteyrand G, Motreff P, Jabaudon M, Futier E, Massoullie G, Eschalier R. Safety and Efficacy of Mini-invasive left atrial appendage closure : a propensity score analysis. Can J Cardiol 2024:S0828-282X(24)00289-7. [PMID: 38570114 DOI: 10.1016/j.cjca.2024.03.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Left atrial appendage closure (LAAC) for stroke prevention is validated in patients with non-valvular atrial fibrillation (NVAF) contraindicated to oral anticoagulation. General anesthesia (GA) is often used for procedural guidance by trans-oesophageal echocardiography (TEE); however, its use may be challenging in some patients. The aim of the study was to evaluate the safety and the mid-term efficacy of a mini-invasive LAAC strategy using micro-TEE under procedural sedation. METHODS Comparison by propensity score of two cohorts of consecutive patients who underwent LAAC: standard TEE-guided LAAC (3D-TEE under GA) and, mini-invasive LAAC strategy (micro-TEE under procedural sedation). The primary endpoint was a composite of embolic or bleeding events, significant per-procedural complication, and cardiovascular deaths within 3 months after LAAC. RESULTS In total, 432 patients were included (78.7±8 years old, 32.4% of women, CHA2DS2VASC score:4.9±1.1); 127 patients underwent mini-invasive LAAC strategy and were compared to 305 patients standard TEE-guided LAAC. The mini-invasive strategy was acheived in 122/127 (96.1%) planned patients. The primary endpoint occurred in 11.2% of patients from the mini-invasive LAAC strategy group and in 10.3% of patients from the standard TEE group (absolute difference = 0.9%[-6.4; 4.5], hazard-ratio=1.11[0.56; 2.19], p=0.76). Procedural times, fluoroscopy duration and hospital stays were shorter in the mini-invasive LAAC strategy group (p<0.001). CONCLUSIONS The mini-invasive LAAC strategy is safe and effective compared to the standard TEE-guided LAAC strategy. A mini-invasive LAAC strategy may also be an important tool to help physicians to treat more patients as LAAC indications evolve in the future.
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Affiliation(s)
- Catherine Denis
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Aurélie Chalard
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Clément Riocreux
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ouarda Lamallem
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Taieb Guizani
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Antoine Boudias
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Frédéric Jean
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marion Bouchant-Pioche
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Saer Abu-Alrub
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France
| | - Grégoire Massoullie
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.
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Hermida A, Ader F, Millat G, Jedraszak G, Maury P, Cador R, Catalan PA, Clerici G, Combes N, De Groote P, Dupin-Deguine D, Eschalier R, Faivre L, Garcia P, Guillon B, Janin A, Kugener B, Lackmy M, Laredo M, Le Guillou X, Lesaffre F, Lucron H, Milhem A, Nadeau G, Nguyen K, Palmyre A, Perdreau E, Picard F, Rebotier N, Richard P, Rooryck C, Seitz J, Verloes A, Vernier A, Winum P, Yabeta GAD, Bouchot O, Chevalier P, Charron P, Gandjbakhch E. NEXN Gene in Cardiomyopathies and Sudden Cardiac Deaths: Prevalence, Phenotypic Expression, and Prognosis. Circ Genom Precis Med 2024; 17:e004285. [PMID: 38059363 DOI: 10.1161/circgen.123.004285] [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] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Few clinical data are available on NEXN mutation carriers, and the gene's involvement in cardiomyopathies or sudden death has not been fully established. Our objectives were to assess the prevalence of putative pathogenic variants in NEXN and to describe the phenotype and prognosis of patients carrying the variants. METHODS DNA samples from consecutive patients with cardiomyopathy or sudden cardiac death/sudden infant death syndrome/idiopathic ventricular fibrillation were sequenced with a custom panel of genes. Index cases carrying at least one putative pathogenic variant in the NEXN gene were selected. RESULTS Of the 9516 index patients sequenced, 31 were carriers of a putative pathogenic variant in NEXN only, including 2 with double variants and 29 with a single variant. Of the 29 unrelated probands with a single variant (16 males; median age at diagnosis, 32.0 [26.0-49.0] years), 21 presented with dilated cardiomyopathy (prevalence, 0.33%), and 3 presented with hypertrophic cardiomyopathy (prevalence, 0.14%). Three patients had idiopathic ventricular fibrillation, and there were 2 cases of sudden infant death syndrome (prevalence, 0.46%). For patients with dilated cardiomyopathy, the median left ventricle ejection fraction was 37.5% (26.25-50.0) at diagnosis and improved with treatment in 13 (61.9%). Over a median follow-up period of 6.0 years, we recorded 3 severe arrhythmic events and 2 severe hemodynamic events. CONCLUSIONS Putative pathogenic NEXN variants were mainly associated with dilated cardiomyopathy; in these individuals, the prognosis appeared to be relatively good. However, severe and early onset phenotypes were also observed-especially in patients with double NEXN variants. We also detected NEXN variants in patients with hypertrophic cardiomyopathy and sudden infant death syndrome/idiopathic ventricular fibrillation, although a causal link could not be established.
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Affiliation(s)
- Alexis Hermida
- Cardiology, Arrhythmia, and Cardiac Stimulation Service (A.H.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
| | - Flavie Ader
- Unité Pédagogique de Biochimie, Département des Sciences Biologiques et Médicales, UFR de Pharmacie-Faculté de Santé, Université Paris Cité (F.A.)
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | - Gilles Millat
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | - Guillaume Jedraszak
- Molecular Genetics Laboratory (G.J.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
| | | | - Romain Cador
- Service de Cardiologie, Hôpital Saint Joseph, Paris (R.C.)
| | | | - Gaël Clerici
- Service de Cardiologie, Centre hospitalier universitaire, Saint Pierre, La Réunion (G.C.)
| | - Nicolas Combes
- Service de Cardiologie, Clinique Pasteur, Toulouse (N.C.)
| | - Pascal De Groote
- France CHU Lille, Service de Cardiologie & Inserm U1167, Institut Pasteur de Lille (P.D.G.)
| | | | | | | | - Patricia Garcia
- Unité Mort Inattendue du Nourrisson, Hôpital de la Conception, APHM, Marseille (P.G.)
| | | | - Alexandre Janin
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | | | - Marylin Lackmy
- Unité de Génétique Clinique, CHU de Guadeloupe, Pointe à Pitre (M. Lackmy)
| | - Mikael Laredo
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | | | - Hugues Lucron
- Service de Cardiologie pédiatrique, CHU Martinique, Fort-de-France (H.L.)
| | | | - Gwenaël Nadeau
- Service de génétique clinique CH Métropole Savoie, Chambéry (G.N.)
| | | | - Aurélien Palmyre
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Elodie Perdreau
- Département médico chirurgical de cardiologie pédiatrique (E.P.), Hôpital Louis Pradel, HCL, Lyon
| | - François Picard
- Service de Cardiologie, Hôpital Cardiologique Haut Leveque, Bordeaux (F.P.)
| | | | - Pascale Richard
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | - Julien Seitz
- Service de Cardiologie, Hôpital Saint Joseph, Marseille (J.S.)
| | - Alain Verloes
- Departement de génétique, Hôpital Robert Debré, APHP (A. Verloes)
| | | | | | - Grace-A-Dieu Yabeta
- Service de Cardiologie, CH Ouest Guyane, Saint-Laurent-du-Maroni (G.-A.-D.Y.)
| | - Océane Bouchot
- Service de Cardiologie, CH Annecy Genevois, Annecy, France (O.B.)
| | | | - Philippe Charron
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Estelle Gandjbakhch
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
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Teiger E, Eschalier R, Amabile N, Rioufol G, Ducrocq G, Garot P, Lepillier A, Bille J, Elbaz M, Defaye P, Audureau E, Le Corvoisier P. Left atrial appendage closure in very elderly patients in the French National Registry. Heart 2024; 110:245-253. [PMID: 37813560 DOI: 10.1136/heartjnl-2023-322871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/19/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients. METHODS A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups <80 years and ≥80 years. RESULTS Among the 1053 patients included, median age was 79.7 (73.6-84.3) years; 512 patients (48.6%) were aged ≥80 years. Procedure-related serious adverse events were non-significantly more common in octogenarians (7.0% vs 4.4% in patients aged <80 years, respectively; p=0.07). Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events during the study was similar in both groups (3.0 vs 3.1/100 patient-years; p=0.85). By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p<0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19). CONCLUSION Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events after LAAC in this age group was similar to that in patients aged <80 years. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03434015).
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Affiliation(s)
- Emmanuel Teiger
- Department of Cardiology, APHP, Henri Mondor University Hospital, Créteil, France
- Clinical Investigation Center 1430 and U955-IMRB team 3, Ecole Nationale Vétérinaire d'Alfort, UPEC, INSERM, Créteil, France
| | - Romain Eschalier
- Cardiology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Lyon Cardiovascular Hospital, Bron Cedex, France
- CARMEN INSERM 1060, INSERM, Bron, France
| | - Gregory Ducrocq
- Department of Cardiology, FACT (French Alliance for Cardiovascular Trials), DHU-FIRE, Bichat-Claude Bernard University Hospital, Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Ramsay-Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Jacques Bille
- Cardiology Department, Saint Joseph Hospital, Marseille, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Pascal Defaye
- Department of Rhythmology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Etienne Audureau
- AP-HP, Department of Public Health, Henri Mondor University Hospital, Creteil, France
- Equipe CEpiA, INSERM, UPEC, U955-IMRB, Créteil, France
| | - Philippe Le Corvoisier
- Clinical Investigation Center 1430, APHP, Groupe Hospitalier Henri Mondor, Creteil, France
- Clinical Investigation Center 1430 and U955-IMRB team 3, INSERM, Créteil, France
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Abu-Alrub S, Strik M, Huntjens P, Haïssaguerre M, Eschalier R, Bordachar P, Ploux S. Current Role of Electrocardiographic Imaging in Patient Selection for Cardiac Resynchronization Therapy. J Cardiovasc Dev Dis 2024; 11:24. [PMID: 38248894 PMCID: PMC10816019 DOI: 10.3390/jcdd11010024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Cardiac resynchronization therapy (CRT) is a recognized therapy for heart failure with altered ejection fraction and abnormal left ventricular activation time. Since the introduction of the therapy, a 30% rate of non-responders is observed and unchanged. The 12-lead ECG remains the only recommended tool for patient selection to CRT. The 12-lead ECG is, however, limited in its inability to provide a precise pattern of regional electrical activity. Electrocardiographic imaging (ECGi) provides a non-invasive detailed mapping of cardiac activation and therefore appears as a promising tool for CRT candidates. The non-invasive ventricular activation maps acquired by ECGi have been primarily explored for the diagnosis and guidance of therapy in patients with atrial or ventricular tachyarrhythmia. However, the accuracy of the system in this field is lacking and needs further improvement before considering a clinical application. On the other hand, its use for patient selection for CRT is encouraging. In this review, we introduce the technical considerations and we describe how ECGi can precisely characterize ventricular activation, especially in patients with left bundle branch block, thus identifying the electrical substrate responsive to CRT.
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Affiliation(s)
- Saer Abu-Alrub
- Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Marc Strik
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Peter Huntjens
- Division of Cardiology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Michel Haïssaguerre
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Romain Eschalier
- Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (Centre Hospitalier Universitaire), 33600 Pessac-Bordeaux, France; (M.S.); (S.P.); (P.B.); (M.H.)
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
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Ploux S, Strik M, Ramirez FD, Buliard S, Chauvel R, Dos Santos P, Haïssaguerre M, Jobbé‐Duval A, Picard F, Riocreux C, Eschalier R, Bordachar P. Remote management of worsening heart failure to avoid hospitalization in a real-world setting. ESC Heart Fail 2023; 10:3637-3645. [PMID: 37797957 PMCID: PMC10682851 DOI: 10.1002/ehf2.14553] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
AIMS From a patient and health system perspective, managing worsening heart failure (WHF) as an outpatient has become a priority. Remote management allows early detection of WHF, enabling timely intervention with the aim of preventing hospitalization. The objective of the study was to evaluate the feasibility and safety of remotely managing WHF events using a multiparametric platform. METHODS AND RESULTS All patients enrolled in the heart failure remote management programme of the Bordeaux University Hospital Telemedicine Center between 1 January and 31 December 2021 were included in the study. Follow-up data were collected until 1 March 2022. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II symptoms and an elevated B-type natriuretic peptide (BNP > 100 pg/mL or N-terminal-pro-BNP > 1000 pg/mL). Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. In total, 161 patients (71 ± 11 years old, 79% male) were followed for a mean of 291 ± 66 days with a mean adherence to the remote monitoring system of 80 ± 20%. Over this period, 52 (32.3%) patients had 105 WHF events, of which 66 (63%) were successfully managed remotely, the remaining requiring hospitalization. Freedom from WHF events and hospitalization at 300 days were 66% and 85%, respectively (P < 0.001 for the difference). Increased level of BNP was associated with an increased risk of WHF event [hazard ratio (HR) per unit increase in BNP: 1.001; 95% confidence interval (CI) 1-1.002; P = 0.001] and hospitalization (HR 1.002; 95% CI 1.002-1.003; P = 0.002). A decrease in the level of glomerular filtration rate was associated with an increased risk of hospitalization (HR per unit decrease in estimated glomerular filtration rate: 0.946; 95% CI 0.906-0.989; P = 0.014). WHF event recurrence and (re)hospitalization rates at 1-month were similar among patients managed remotely (18% and 12%, respectively) and those requiring hospitalization (21% and 10%, respectively). Iatrogenic complications occurred more often during hospitalization than remote management (26% vs. 3%, P < 0.001). CONCLUSIONS Our study suggests that remote management of WHF events based on a multiparametric approach led by a telemedical centre is feasible and safe. Adopting such a strategy for patients with chronic HF could reduce HF-related hospitalizations with expected benefits for patients, care providers, and health care systems.
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Affiliation(s)
- Sylvain Ploux
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Marc Strik
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - F. Daniel Ramirez
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Samuel Buliard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Rémi Chauvel
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Pierre Dos Santos
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Michel Haïssaguerre
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Antoine Jobbé‐Duval
- Department of Heart Failure and Transplant‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de LyonLyonFrance
| | - François Picard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Clément Riocreux
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Romain Eschalier
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Pierre Bordachar
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
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Bennes O, Souteyrand G, Cambier S, Motreff P, Riocreux C, Eljezi V, Lahaye C, Eschalier R, Innorta A, Combaret N. Transfemoral versus trans-subclavian access in transcatheter aortic valve implantation using self-expandable valve: A propensity-matched comparison. Arch Cardiovasc Dis 2023; 116:555-562. [PMID: 37940389 DOI: 10.1016/j.acvd.2023.09.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation is unfeasible for 10-15% of patients using the conventional transfemoral approach. Other alternative approaches, such as the subclavian approach, have emerged, with no clear recommendation indicating the superiority of one technique over another. AIM To compare the 1-month mortality and postprocedural outcomes of patients undergoing transcatheter aortic valve implantation using a self-expandable valve via transfemoral and subclavian access. METHODS This was a retrospective single-centre study including 1496 patients who underwent transcatheter aortic valve implantation between January 2016 and December 2020 at Clermont-Ferrand University Hospital, France. Propensity score matching was used to compare transfemoral and subclavian access. RESULTS After building two propensity score-matched groups of 221 patients each with either access route (total n=442), baseline characteristics were similar. The procedure duration was significantly longer in the subclavian access group (53 [45-64] versus 60 [51-72] minutes; P<0.001), but with a lower amount of contrast agent (138 [118-165] versus 123 [105-150] mL; P<0.001), fluoroscopy time (11.2 [9-14] versus 9.9 [7-12] minutes; P<0.001) and radiation dose (397 [264-620] versus 321 [217-485] mGy; P<0.001). No significant difference was observed concerning 1-month mortality (odds ratio 1.62, 95% confidence interval 0.52-5.03; P=0.39) or periprocedural complications. Follow-up at 1 year confirmed no difference in longer-term mortality (hazard ratio 0.78, 95% confidence interval 0.52-5.03; P=0.43). CONCLUSIONS The subclavian approach provides similar results to the transfemoral approach in terms of mortality, efficacy and safety; it is a reasonable and effective alternative when the reference transfemoral approach is impossible or seems complex.
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Affiliation(s)
- Olivier Bennes
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France.
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Sébastien Cambier
- Delegation to Clinical Research and Innovation, Biostatistics Unit, CHU Clermont-Ferrand, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Clément Riocreux
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Vedat Eljezi
- Department of Perioperative Medicine, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Clément Lahaye
- Department of Geriatrics, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Andréa Innorta
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, CNRS, Clermont-Auvergne University, 63000 Clermont-Ferrand, France
| | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Auvergne University, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
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7
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Strik M, Ploux S, Eschalier R, Mondoly P, Fontagne L, Ramirez FD, Haïssaguerre M, Bordachar P. T-Wave Oversensing with Contemporary Implantable Cardioverter-Defibrillators. J Cardiovasc Dev Dis 2023; 10:430. [PMID: 37887877 PMCID: PMC10607450 DOI: 10.3390/jcdd10100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) need to reliably detect ventricular tachycardia (VT) and ventricular fibrillation (VF) while avoiding T-wave oversensing (TWOS), which is associated with a risk of inappropriate therapies. The incidence of TWOS with endovascular ICDs appears to differ between manufacturers. OBJECTIVES We aimed to evaluate the incidence and clinical consequences of TWOS with contemporary Medtronic and Boston Scientific ICDs. METHODS Consecutive patients implanted with a recent Medtronic or Boston Scientific ICD and remotely monitored at three French centers were included. All transmitted EGMs labelled as VF, VT, non-sustained VT (NSVT), or ventricular oversensing (Medtronic) were screened for TWOS. RESULTS Among 7589 transmitted episodes from 674 patients with a Boston Scientific ICD, we did not identify a single case of TWOS. Among 16,790 transmitted episodes from 1733 patients with a Medtronic ICD, we identified 60 patients (3.4%) with at least one episode of TWOS. In 46 patients, TWOS was intermittent (NSVT episodes). In the remaining 14 patients, TWOS resulted in 60 sustained episodes (completed counters). No inappropriate therapies were delivered in 12 of these patients because no therapies were programmed (in monitor zones, 11 episodes) or because therapies were inhibited by the morphology discriminator (Wavelet, 19 episodes) or by the anti-TWOS algorithm (26 episodes). Two patients received inappropriate therapies due to TWOS (0.1% of patients with Medtronic ICDs). CONCLUSION On review of 24,379 transmitted episodes from 2407 patients with endovascular ICDs, we found no case of TWOS with Boston Scientific devices, whereas TWOS was not uncommon with Medtronic devices. However, the risk of inappropriate therapy with Medtronic ICDs was very low (0.1%) due to the often intermittent nature of this phenomenon, the morphology discriminator, and the anti-TWOS algorithm.
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Affiliation(s)
- Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, F-33600 Bordeaux, France
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, F-33600 Bordeaux, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France
| | - Leslie Fontagne
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, F-33600 Bordeaux, France
| | - F. Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, F-33600 Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, F-33600 Bordeaux, France
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Monzo L, Huttin O, Ferreira JP, Lamiral Z, Bozec E, Beaumont M, Micard E, Baudry G, Marie PY, Eschalier R, Rossignol P, Zannad F, Girerd N. Role of aldosterone in mid- and long-term left ventricular remodelling after acute myocardial infarction: The REMI study. Eur J Heart Fail 2023; 25:1742-1752. [PMID: 37530453 DOI: 10.1002/ejhf.2986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 08/03/2023] Open
Abstract
AIMS Whether aldosterone levels after myocardial infarction (MI) are associated with mid- and long-term left ventricular (LV) remodelling in the era of systematic use of renin-angiotensin system inhibitors is uncertain. We prospectively investigated the relationship between aldosterone levels and mid- and long-term LV remodelling in patients with acute MI. METHODS AND RESULTS Plasma aldosterone was measured in 119 patients successfully treated by primary percutaneous coronary angioplasty for a first acute ST-elevation MI (STEMI) 2-4 days after the acute event. LV volumes were assessed by cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) in the same timeframe and 6 months later. LV assessment was repeated by TTE 3-9 years after MI (n = 80). The median aldosterone level at baseline was 23.1 [16.8; 33.1] pg/ml. In the multivariable model, higher post-MI aldosterone concentration was significantly associated with more pronounced increase in LV end-diastolic volume index (TTE: β ± standard error [SE]: 0.113 ± 0.046, p = 0.015; CMR: β ± SE: 0.098 ± 0.040, p = 0.015) and LV end-systolic volume index (TTE: β ± SE: 0.083 ± 0.030, p = 0.008; CMR: β ± SE: 0.064 ± 0.032, p = 0.048) at 6-month follow-up, regardless of the method of assessment. This result was consistent also in patients with a LV ejection fraction (LVEF) >40%. The association between baseline plasma aldosterone and adverse LV remodelling did not persist at the 3-9-year follow-up evaluation. CONCLUSION Aldosterone concentration in the acute phase was associated with adverse LV remodelling in the medium term, even in the subgroup of patients with LVEF >40%, suggesting a potential role of the mineralocorticoid system in post-MI adverse remodelling. Plasma aldosterone was no longer associated with LV remodelling in the long term (NCT01109225).
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Affiliation(s)
- Luca Monzo
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Olivier Huttin
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - João Pedro Ferreira
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Zohra Lamiral
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Erwan Bozec
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Marine Beaumont
- Centre d'Investigations Cliniques IADI U947, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - Emilien Micard
- Centre d'Investigations Cliniques IADI U947, Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - Guillaume Baudry
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Pierre-Yves Marie
- CHRU-Nancy, Université de Lorraine, Nuclear Medicine & Nancyclotep Imaging Platform, Nancy, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
- Department of Medicine and Nephrology-Hemodialysis, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, La Colle, Monaco
| | - Faiez Zannad
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
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9
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Strik M, Sacristan B, Bordachar P, Duchateau J, Eschalier R, Mondoly P, Laborderie J, Gassa N, Zemzemi N, Laborde M, Garrido J, Matencio Perabla C, Jimenez-Perez G, Camara O, Haïssaguerre M, Dubois R, Ploux S. Artificial intelligence for detection of ventricular oversensing: Machine learning approaches for noise detection within nonsustained ventricular tachycardia episodes remotely transmitted by pacemakers and implantable cardioverter-defibrillators. Heart Rhythm 2023; 20:1378-1384. [PMID: 37406873 DOI: 10.1016/j.hrthm.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) increasingly automatically record and remotely transmit nonsustained ventricular tachycardia (NSVT) episodes, which may reveal ventricular oversensing. OBJECTIVES We aimed to develop and validate a machine learning algorithm that accurately classifies NSVT episodes transmitted by PMs and ICDs in order to lighten health care workload burden and improve patient safety. METHODS PMs or ICDs (Boston Scientific, St Paul, MN) from 4 French hospitals with ≥1 transmitted NSVT episode were split into 3 subgroups: training set, validation set, and test set. Each NSVT episode was labeled as either physiological or nonphysiological. Four machine learning algorithms-2DTF-CNN, 2D-DenseNet, 2DTF-VGG, and 1D-AgResNet-were developed using training and validation data sets. Accuracies of the classifiers were compared with an analysis of the remote monitoring team of the Bordeaux University Hospital using F2 scores (favoring sensitivity over predictive positive value) using an independent test set. RESULTS A total of 807 devices transmitted 10,471 NSVT recordings (82% ICD; 18% PM), of which 87 devices (10.8%) transmitted 544 NSVT recordings with nonphysiological signals. The classification by the remote monitoring team resulted in an F2 score of 0.932 (sensitivity 95%; specificity 99%) The 4 machine learning algorithms showed high and comparable F2 scores (2DTF-CNN: 0.914; 2D-DenseNet: 0.906; 2DTF-VGG: 0.863; 1D-AgResNet: 0.791), and only 1D-AgResNet had significantly different labeling from that of the remote monitoring team. CONCLUSION Machine learning algorithms were accurate in detecting nonphysiological signals within electrograms transmitted by PMs and ICDs. An artificial intelligence approach may render remote monitoring less resourceful and improve patient safety.
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Affiliation(s)
- Marc Strik
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France.
| | - Benjamin Sacristan
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Josselin Duchateau
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Narimane Gassa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Nejib Zemzemi
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Maxime Laborde
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | | | | | | | | | - Michel Haïssaguerre
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, Pessac- Bordeaux, France
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10
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Waldmann V, Marquié C, Bessière F, Perrot D, Anselme F, Badenco N, Barra S, Bertaux G, Blangy H, Bordachar P, Boveda S, Chauvin M, Clémenty N, Clerici G, Combes N, Defaye P, Deharo JC, Durand P, Duthoit G, Eschalier R, Fauchier L, Garcia R, Geoffroy O, Gitenay E, Gourraud JB, Guenancia C, Iserin L, Jacon P, Jesel-Morel L, Kerkouri F, Klug D, Koutbi L, Labombarda F, Ladouceur M, Laurent G, Leclercq C, Maille B, Maltret A, Massoulié G, Mondoly P, Ninni S, Ollitrault P, Pasquié JL, Pierre B, Pujadas P, Champ-Rigot L, Sacher F, Sadoul N, Schatz A, Winum P, Milliez PU, Probst V, Marijon E. Subcutaneous Implantable Cardioverter-Defibrillators in Patients With Congenital Heart Disease. J Am Coll Cardiol 2023; 82:590-599. [PMID: 37558371 DOI: 10.1016/j.jacc.2023.05.057] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Very few data have been published on the use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD). OBJECTIVES The aim of this study was to analyze outcomes associated with S-ICDs in patients with CHD. METHODS This nationwide French cohort including all patients with an S-ICD was initiated in 2020 by the French Institute of Health and Medical Research. Characteristics at implantation and outcomes were analyzed in patients with CHD. RESULTS From October 12, 2012, to December 31, 2019, among 4,924 patients receiving an S-ICD implant in 150 centers, 101 (2.1%) had CHD. Tetralogy of Fallot, univentricular heart, and dextro-transposition of the great arteries represented almost one-half of the population. Patients with CHD were significantly younger (age 37.1 ± 15.4 years vs 50.1 ± 14.9 years; P < 0.001), more frequently female (37.6% vs 23.0%; P < 0.001), more likely to receive an S-ICD for secondary prevention (72.3% vs 35.9%; P < 0.001), and less likely to have severe systolic dysfunction of the systemic ventricle (28.1% vs 53.1%; P < 0.001). Over a mean follow-up period of 1.9 years, 16 (15.8%) patients with CHD received at least 1 appropriate shock, with all shocks successfully terminating the ventricular arrhythmia. The crude risk of appropriate S-ICD shock was twice as high in patients with CHD compared with non-CHD patients (annual incidences of 9.0% vs 4.4%; HR: 2.1; 95% CI: 1.3-3.4); however, this association was no longer significant after propensity matching (especially considering S-ICD indication, P = 0.12). The burden of all complications (HR: 1.2; 95% CI: 0.7-2.1; P = 0.4) and inappropriate shocks (HR: 0.9; 95% CI: 0.4-2.0; P = 0.9) was comparable in both groups. CONCLUSIONS In this nationwide study, patients with CHD represented 2% of all S-ICD implantations. Our findings emphasize the effectiveness and safety of S-ICD in this particularly high-risk population. (S-ICD French Cohort Study [HONEST]; NCT05302115).
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Affiliation(s)
- Victor Waldmann
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Pediatric and Congenital Medico-Surgical Unit, Necker Hospital, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France.
| | | | - Francis Bessière
- Université de Lyon, INSERM LabTau, Lyon, France; Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - David Perrot
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | - Sergio Barra
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | | | | | | | | | - Michel Chauvin
- ICS HENA Strasbourg, Strasbourg, France; Clinique de l'Orangerie, Strasbourg, France
| | | | | | | | | | - Jean-Claude Deharo
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France and Aix Marseille Université, C2VN, Marseille, France
| | - Philippe Durand
- Centre Médico-Chirurgical Arnault Tzanck, St Laurent du Var, France
| | | | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France, and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | | | - Rodrigue Garcia
- Cardiology Department, University Hospital of Poitiers, Poitiers, France; Centre d'Investigations Cliniques 1402, University Hospital of Poitiers, Poitiers, France
| | | | | | | | | | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | - Fawzi Kerkouri
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; University Hospital of Brest, Brest, France
| | | | - Linda Koutbi
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France and Aix Marseille Université, C2VN, Marseille, France
| | | | - Magalie Ladouceur
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | - Baptiste Maille
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France and Aix Marseille Université, C2VN, Marseille, France
| | - Alice Maltret
- Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Grégoire Massoulié
- Cardiology Department, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France, and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | | | | | | | - Jean-Luc Pasquié
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHRU de Montpellier, France
| | | | | | | | | | | | | | | | | | | | - Eloi Marijon
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Pediatric and Congenital Medico-Surgical Unit, Necker Hospital, Paris, France
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11
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Aminian A, Leduc N, Freixa X, Swaans MJ, Ben Yedder M, Maarse M, Sanchis L, Cepas-Guillen P, Cruz-González I, Blanco-Fernandez F, Eschalier R, Boersma LVA. Left Atrial Appendage Occlusion Under Miniaturized Transesophageal Echocardiographic Guidance and Conscious Sedation: Multicenter European Experience. JACC Cardiovasc Interv 2023; 16:1889-1898. [PMID: 37587597 DOI: 10.1016/j.jcin.2023.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/29/2023] [Accepted: 06/13/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) procedures are widely guided by standard transesophageal echocardiography (TEE) probes, requiring general anesthesia in most patients. The use of miniaturized TEE probes allows for LAAO guidance under local anesthesia and offers an attractive imaging alternative to standard TEE probes. OBJECTIVES The aim of this study was to assess the safety and efficacy of miniaturized TEE probes for procedural guidance of LAAO. METHODS Multicenter retrospective observational study of LAAO procedures performed under miniaturized TEE guidance and conscious sedation. The primary efficacy endpoint was technical success. The secondary efficacy endpoint was procedural success (technical success without major periprocedural complications). The safety outcome was a composite of major periprocedural complications. RESULTS A total of 546 consecutive LAAO procedures were performed in 5 European centers. Technical success was achieved in 534 (98.0%) patients. Sixteen major periprocedural complications occurred in 15 (2.9%) patients, yielding a procedural success rate of 97.0%. Conversion to general anesthesia was required in 4 (0.7%) patients. Short-term imaging follow-up was available in 422 patients with an incidence of major (>5 mm) TEE-detected residual leaks of 0.7%, complete LAA occlusion of 82.2% on cardiac computed tomography, and device-related thrombus of 5%. As compared with procedural 2-dimensional imaging for device sizing, preprocedural assessment by 3-dimensional imaging resulted in improved technical success (100% vs 95.0%; P < 0.001). CONCLUSIONS LAAO under conscious sedation and miniaturized TEE guidance is safe and feasible with a high rate of technical success and a low rate of periprocedural complications.
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Affiliation(s)
- Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
| | - Nina Leduc
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Mohamed Ben Yedder
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Moniek Maarse
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Ignacio Cruz-González
- Instituto de Investigación Biomédica de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, University Hospital Salamanca, Salamanca, Spain
| | - Fabian Blanco-Fernandez
- Instituto de Investigación Biomédica de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, University Hospital Salamanca, Salamanca, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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12
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Laredo M, Duthoit G, Sacher F, Anselme F, Audinet C, Bessière F, Bordachar P, Bouzeman A, Boveda S, Bun SS, Chassignolle M, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Extramiana F, Fauchier L, Hermida A, Gandjbakhch E, Garcia R, Gourraud JB, Guenancia C, Guy-Moyat B, Irles D, Iserin L, Jourda F, Koutbi L, Labombarda F, Ladouceur M, Lagrange P, Lellouche N, Mansourati J, Marquié C, Martins R, Massoulié G, Mathiron A, Maury P, Messali A, Milhem A, Mondoly P, Nguyen C, Ninni S, Pasquié JL, Pierre B, Pujadas P, Sellal JM, Thambo JB, Walton C, Winum P, Zakine C, Zhao A, Jouven X, Combes N, Marijon E, Waldmann V. Rapid ventricular tachycardia in patients with tetralogy of Fallot and implantable cardioverter-defibrillator: Insights from the DAI-T4F nationwide registry. Heart Rhythm 2023; 20:252-260. [PMID: 36309156 DOI: 10.1016/j.hrthm.2022.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In repaired tetralogy of Fallot (TOF), little is known about characteristics of patients with rapid ventricular tachycardia (VT). Also, whether patients with a first episode of nonrapid VT may subsequently develop rapid VT or ventricular fibrillation (VF) has not been addressed. OBJECTIVES The objectives of this study were to compare patients with rapid VT/VF with those with nonrapid VT and to assess the evolution of VT cycle lengths (VTCLs) overtime. METHODS Data were analyzed from a nationwide registry including all patients with TOF and implantable cardioverter-defibrillator (ICD) since 2000. Patients with ≥1 VT episode with VTCL ≤250 ms (240 beats/min) formed the rapid VT/VF group. RESULTS Of 144 patients (mean age 42.0 ± 12.7 years; 104 [72%] men), 61 (42%) had at least 1 VT/VF episode, including 28 patients with rapid VT/VF (46%), during a median follow-up of 6.3 years (interquartile range 2.2-10.3 years). Compared with patients in the nonrapid VT group, those in the rapid VT/VF group were significantly younger at ICD implantation (35.2 ± 12.6 years vs 41.5 ± 11.2 years; P = .04), had more frequently a history of cardiac arrest (8 [29%] vs 2 [6%]; P = .02), less frequently a history of atrial arrhythmia (11 [42%] vs 22 [69%]; P = .004), and higher right ventricular ejection fraction (43.3% ± 10.3% vs 36.6% ± 11.2%; P = .04). The median VTCL of VT/VF episodes was 325 ms (interquartile range 235-429 ms). None of the patients with a first documented nonrapid VT episode had rapid VT/VF during follow-up. CONCLUSION Patients with TOF and rapid VT/VF had distinct clinical characteristics. The relatively low variation of VTCL over time suggests a room for catheter ablation without a backup ICD in selected patients with well-tolerated VT.
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Affiliation(s)
- Mikael Laredo
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Guillaume Duthoit
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Frédéric Sacher
- LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | | | | | | | | | - Morgane Chassignolle
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Gaël Clerici
- Saint Pierre University Hospital, La Réunion, France
| | | | | | | | | | | | | | | | | | - Estelle Gandjbakhch
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | | | | | | | | | | | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | - Magalie Ladouceur
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Jouven
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| | | | - Eloi Marijon
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France.
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13
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Lau DH, Pierre B, Cabanas P, Martens E, Bisignani G, Hofer D, Berruezo A, Eschalier R, Mansourati J, Gaspar T, Sanfins VM, Erglis A, Hain A, Papaioannou G, Cuneo A, Tscholl V, Schrader J, Deneke T. Diagnostic yield of an insertable cardiac monitor in a large patient population. Heart Rhythm O2 2023; 4:97-102. [PMID: 36873314 PMCID: PMC9975005 DOI: 10.1016/j.hroo.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are increasingly used for cardiac rhythm diagnosis with expanding indications. Little has been reported about their use and efficacy. Objective The study sought to evaluate the clinical utility of a novel ICM (Biotronik BIOMONITOR III) including the time to diagnosis in unselected patients with different ICM indications. Methods Patients from 2 prospective clinical studies were included to determine the diagnostic yield of the ICM. The primary endpoint was time to clinical diagnosis per implant indication or to the first change in atrial fibrillation (AF) therapy. Results A total of 632 patients were included with a mean follow-up of 233 ± 168 days. Of 384 patients with (pre)syncope, 34.2% had a diagnosis at 1 year. The most frequent therapy was permanent pacemaker implantation. Of 133 patients with cryptogenic stroke, 16.6% had an AF diagnosis at 1 year, resulting in oral anticoagulation. Of 49 patients with an indication for AF monitoring, 41.0% had a relevant change in AF therapy based on ICM data at 1 year. Of 66 patients with other indications, 35.4% received a rhythm diagnosis at 1 year. Moreover, 6.5% of the cohort had additional diagnoses: 26 of 384 patients with syncope, 8 of 133 patients with cryptogenic stroke, and 7 of 49 patients with AF monitoring. Conclusion In a large unselected patient population with heterogeneous ICM indications, the primary endpoint of rhythm diagnosis was achieved in ∼1 in 4, and additional clinically relevant findings was achieved in 6.5% of patients at short-term follow-up.
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Affiliation(s)
- Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, Australia
| | - Bertrand Pierre
- Department of Cardiology, Tours University Hospital, Chambray-lès-Tours, France
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Berruezo
- Department of Cardiology, Teknon Heart Institute, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | - Andrejs Erglis
- Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | | | - Alessandro Cuneo
- Department of Cardiology, Krankenhaus Maria-Hilf Stadtlohn, Stadtlohn, Germany
| | - Verena Tscholl
- Department of Cardiology, Charité Universitaetsmedizin, Campus Mitte, Berlin, Germany
| | - Jürgen Schrader
- Department of Cardiology, Biotronik SE & Co.KG, Berlin, Germany
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Saale, Germany
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14
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Strik M, Clementy N, Mondoly P, Eschalier R, Ramirez FD, Racine HP, Haïssaguerre M, Ritter P, Ploux S, Bordachar P. Implantation of a leadless pacemaker in young adults. J Cardiovasc Electrophysiol 2023; 34:412-417. [PMID: 36583963 DOI: 10.1111/jce.15796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 12/31/2022]
Abstract
AIMS Leadless pacing has emerged as an alternative to conventional transvenous pacemakers to mitigate the risks of pocket- and lead-related complications but its use remains controversial in young adults mostly because experience in this patient population is limited. We sought to examine the feasibility and safety of implanting leadless single chamber pacemakers in young adults. METHODS This multicenter, retrospective, observational study sought to evaluate the safety, efficacy, and electrical performance of the Micra VR Transcatheter Pacemaker System (Medtronic) in patients between 18 and 40 years who underwent implantation of a leadless pacemaker for any indication at the university medical centers of Bordeaux, Clermont-Ferrand, Toulouse, and Tours (France), between 2015 and 2021. The primary safety endpoint was freedom from system-related or procedure-related major complications at 6 months. The primary efficacy endpoint was the combination of a low (≤2 V) and stable (increase within 1.5 V) pacing capture threshold at 6 months. RESULTS Leadless pacemaker implantation was successful in all 35 patients. At 6 months, safety endpoint was met for 35 (100%) and efficacy endpoint for 34 (97%) patients. During a follow-up of 26 ± 15 months (range: 6-60 months), Safety endpoint remained 100% and efficacy endpoint was 94%. Leadless pacemaker retrieval was not required in any patient. Approximately one-third of patients (n = 13, 37%) had >40% ventricular pacing burdens at 1 year, including all 10 patients with a complete AV block but also 3 patients with normal AV conduction during implantation. One patient reported symptoms of pacemaker syndrome which was confirmed using Holter recording and successfully treated using reprogramming. CONCLUSION In this observational study, leadless pacemakers demonstrated favorable short- and intermediate-term safety and effectiveness in young adults.
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Affiliation(s)
- Marc Strik
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Clementy
- Department of Cardiology, University Hospital Trousseau, Tours, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Epidemiology Department, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Hugo-Pierre Racine
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Service de Cardiologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Québec, Canada
| | - Michel Haïssaguerre
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Philippe Ritter
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Sylvain Ploux
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Pierre Bordachar
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
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15
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Massoullié G, Ploux S, Souteyrand G, Mondoly P, Pereira B, Amabile N, Jean F, Irles D, Mansourati J, Combaret N, Mechulan A, Badoz M, Da Costa A, Defaye P, Motreff P, Clerfond G, Bordachar P, Eschalier R. Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study. Heart Rhythm 2023; 20:699-706. [PMID: 36646235 DOI: 10.1016/j.hrthm.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block. OBJECTIVES The objectives of this study were to determine the incidence of AV block in such a population and to assess the performance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR). METHODS This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recipients (mean age 82.3 ± 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for >24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval ≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring. RESULTS A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P < .001). In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2-4.8; P = .010). CONCLUSION New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pierre Mondoly
- Federation of Cardiology, University Hospital Rangueil, Toulouse cedex, France
| | - Bruno Pereira
- Biostatistics Unit (Clinical Research and Innovation Direction), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Frédéric Jean
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Nicolas Combaret
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Alexis Mechulan
- Ramsay Générale de Santé, Hôpital Privé de Clairval, Marseille, France
| | - Marc Badoz
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
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16
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Roberts PR, Clémenty N, Mondoly P, Winter S, Bordachar P, Sharman D, Jung W, Eschalier R, Theis C, Defaye P, Anderson C, Pol A, Butler K, Garweg C. A leadless pacemaker in the real-world setting: Patient profile and performance over time. J Arrhythm 2023; 39:1-9. [PMID: 36733321 PMCID: PMC9885317 DOI: 10.1002/joa3.12811] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023] Open
Abstract
Background While prior Micra trials demonstrated a high implant success rate and favorable safety and efficacy results, changes in implant populations and safety over time is not well studied. The objective of this analysis was to report the performance of Micra in European and Middle Eastern patients and compare to the Micra Investigational Device Exemption (IDE) and Micra Post Approval Registry (PAR) studies. Methods The prospective, single-arm Micra Acute Performance European and Middle Eastern (MAP EMEA) registry was designed to further study the performance of Micra in patients from EMEA. The primary endpoint was to characterize acute (30-day) major complications. Electrical performance was analyzed. The major complication rate through 12 months was compared with the IDE and PAR studies. Results The MAP EMEA cohort (n = 928 patients) had an implant success rate of 99.9% and were followed for an average of 9.7 ± 6.5 months. Compared to prior studies, MAP EMEA patients were more likely to have undergone dialysis and have a condition which precluded the use of a transvenous pacemaker (p < .001). Within 30 days of implantation, the MAP EMEA cohort had a major complication rate of 2.59%. Mean pacing thresholds were low and stable through 12 months (0.61 ± 0.40 V at 0.24 ms at implant and 12 months). Through 12 months post-implantation, the major complication rate for MAP EMEA was not significantly different from IDE (p = .56) or PAR (p = .79). Conclusion Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and low complication rate, in-line with prior reports.
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Affiliation(s)
- Paul R. Roberts
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | | | - Pierre Mondoly
- Centre Hospitalier Universitaire de ToulouseToulouseFrance
| | | | | | | | - Werner Jung
- Schwarzwald‐Baar Klinikum Villingen‐SchwenningenVillingen‐SchwenningenGermany
| | - Romain Eschalier
- Université Clermont Auvergne and Cardiology Department, CHU Clermont‐Ferrand, CNRSSIGMA Clermont, Institut PascalClermont‐FerrandFrance
| | | | - Pascal Defaye
- Centre Hospitalier Universitaire de GrenobleLa TroncheFrance
| | | | - Aimée Pol
- Medtronic Bakken Research CenterMaastrichtThe Netherlands
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17
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Bisignani G, De Bonis S, Pierre B, Lau DH, Hofer D, Sanfins VM, Hain A, Cabanas P, Martens E, Berruezo A, Eschalier R, Milliez P, Lüsebrink U, Mansourati J, Papaioannou G, Giacopelli D, Gargaro A, Ploux S. Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety. Front Cardiovasc Med 2023; 10:1148052. [PMID: 37025684 PMCID: PMC10071510 DOI: 10.3389/fcvm.2023.1148052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background Fat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m2] and normal-weight controls (BMI <30 kg/m2) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM. Materials and methods Patients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61-90 and days 1-90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls. Results The average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P < 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups. Conclusion Although increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was >0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220.
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Affiliation(s)
- Giovanni Bisignani
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
- Correspondence: Giovanni Bisignani
| | - Silvana De Bonis
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
| | | | - Dennis H. Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daniel Hofer
- Department of Cardiology, UniversitätsspitalZürich, Zurich, Switzerland
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira—Guimarães, Guimarães, Portugal
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Department of Cardiology, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Antonio Berruezo
- Department of Cardiology, Centro Médico Teknon, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont Ferrand, France
| | - Paul Milliez
- Department of Cardiology, Le Centre Hospitalier Universitaire de Caen CHRU Caen, Caen, France
| | - Ulrich Lüsebrink
- Department of Cardiology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany
| | | | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Milano, Italy
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
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Carime NA, Cottenet J, Clerfond G, Eschalier R, Quilliot D, Eicher J, Joly B, Quantin C. Correction: Impact of nutritional status on heart failure mortality: a retrospective cohort study. Nutr J 2022; 21:61. [PMID: 36171593 PMCID: PMC9520937 DOI: 10.1186/s12937-022-00811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nafz Abdoul Carime
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France;, University of Bourgogne Franche-Comté, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France;, University of Bourgogne Franche-Comté, Dijon, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand,, France and F-CRIN, INI-CRCT, Nancy, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand,, France and F-CRIN, INI-CRCT, Nancy, France
| | - Didier Quilliot
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 1 Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France; Nutritional Assistance Department, University Hospital of Nancy, University of Lorraine, Vandoeuvre‑lès‑Nancy, France
| | | | - Bertrand Joly
- CHPCB Paray-le-Monial General Hospital, Paray‑le‑Monial, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France;, University of Bourgogne Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Combaret N, d'Ostrevy N, Innorta A, Motreff P, Eschalier R, Clerfond G, Pereira B, Souteyrand G. Emergency bailout surgery saves lives in high-risk patients with complications after TAVR. J Card Surg 2022; 37:3477-3484. [PMID: 36124420 DOI: 10.1111/jocs.16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With the expansion of the indication for transcatheter aortic valve implantation (TAVR), the value of access to on-site emergency heart surgery at performing centers needs to be assessed. AIMS To evaluate postoperative mortality after surgical rescue post-TAVR, in a population at high surgical risk. METHODS Retrospective analysis of a cohort of patients included in the France-TAVI registry who had undergone TAVR with the latest generation valves between January 2017 and February 2020. RESULTS Among the 968 patients undergoing TAVR, 6 patients (0.62%) were identified as candidates for surgery: 3 in the peri-operative context and 3 during hospitalization. Four subjects were managed in a salvage situation, two due to tamponade, one due to aortic dissection, and one due to aortic annulus rupture. One patient died of a delayed aortic annulus rupture and one patient presented a right coronary occlusion which was medically treated. All patients who underwent emergency surgery were discharged alive from the hospital. CONCLUSIONS In TAVR patients initially contraindicated for surgery, emergency bailout surgery could be performed successfully with all patients discharged alive. Access to on-site heart surgery represents a life-saving resource for TAVR centers.
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Affiliation(s)
- Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Nicolas d'Ostrevy
- Department of Cardiac Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Andrea Innorta
- Department of Cardiac Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Pascal Motreff
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Romain Eschalier
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Géraud Souteyrand
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
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Waldmann V, Bouzeman A, Duthoit G, Koutbi L, Bessière F, Labombarda F, Marquié C, Gourraud JB, Mondoly P, Sellal JM, Bordachar P, Hermida A, Al Arnaout A, Anselme F, Audinet C, Bernard Y, Boveda S, Bun SS, Chassignolle M, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Garcia R, Guenancia C, Guy-Moyat B, Halimi F, Irles D, Iserin L, Jourda F, Ladouceur M, Lagrange P, Laredo M, Mansourati J, Massoulié G, Mathiron A, Maury P, Messali A, Narayanan K, Nguyen C, Ninni S, Perier MC, Pierre B, Pujadas P, Sacher F, Sagnol P, Sharifzadehgan A, Walton C, Winum P, Zakine C, Fauchier L, Martins R, Pasquié JL, Thambo JB, Jouven X, Combes N, Marijon E. Sex Differences in Outcomes of Tetralogy of Fallot Patients With Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol 2022; 8:1304-1314. [DOI: 10.1016/j.jacep.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
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21
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Blanquet M, Massoulié G, Boirie Y, Guiguet-Auclair C, Mulliez A, Anker S, Boiteux MCD, Jean F, Combaret N, Souteyrand G, Riocreux C, Pereira B, Motreff P, Rossignol P, Clerfond G, Eschalier R. Handgrip strength to screen early-onset sarcopenia in heart failure. Clin Nutr ESPEN 2022; 50:183-190. [DOI: 10.1016/j.clnesp.2022.05.019] [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: 12/16/2021] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022]
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22
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Sebag FA, Garot P, Galea R, de Backer O, Lepillier A, De Meesteer A, Hildick-Smith D, Armero S, Moubarak G, Ducrocq G, Eschalier R, Aminian A, Sauguet A, Lellouche N, Mahmoudi K, Räber L, Amabile N. Left atrial appendage closure for thrombus trapping: the international, multicentre TRAPEUR registry. EUROINTERVENTION 2022; 18:50-57. [PMID: 34794937 PMCID: PMC9903160 DOI: 10.4244/eij-d-21-00713] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the presence of a thrombus contraindicates left atrial appendage closure procedure (LAAC), a previous study reported the feasibility of the thrombus trapping procedure (TTP) technique to overcome this limitation. AIMS This study aimed to analyse the short-term outcomes in a series of patients who underwent LAAC using the TTP (TTP-LAAC). METHODS This retrospective series included patients who underwent TTP-LAAC between January 2018 and May 2020 in 13 European centres. Device choice, pre-interventional work-up and post-discharge antithrombotic therapy regimens were left to the discretion of the operators. The primary endpoint was the 30-day occurrence of stroke, systemic embolism or cardiovascular death. RESULTS During the study period, a total of 1,918 patients underwent LAAC. A thrombus was identified in 71 cases but completely disappeared in 24 patients before procedure. TTP-LAAC was finally performed in 53 cases (3%). Thrombi were identified ahead of the actual day of implantation in 47 patients (87%) and were mostly limited in size (50 cases with extension <50% of the LAA surface). The Amplatzer Amulet and WATCHMAN FLX occluders were implanted in 44 and 9 patients, respectively. A single deployment approach was applied in 70% and a cerebral embolic protection system was used in 9% of the patients. The overall success rate was 100%. Small pericardial effusion without tamponade was observed in 6% of the cases. Patients were discharged with 72% under antiplatelet therapy and 10% under short-term oral anticoagulation. The primary endpoint occurred in one patient. CONCLUSIONS TTP-LAAC might be used in a minority of LAAC procedures but appears to be feasible and safe in the short-term, in select cases.
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Affiliation(s)
- Frederic A. Sebag
- Service de Cardiologie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud (ICPS), Ramsay Santé, Massy, France
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Ole de Backer
- Department of Cardiology, Rigshospital, Copenhagen, Denmark
| | - Antoine Lepillier
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | | | - David Hildick-Smith
- Cardiology Department, Royal Sussex Cardiac Centre, Brighton, United Kingdom
| | | | | | - Gregory Ducrocq
- Department of Cardiology, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Romain Eschalier
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Adel Aminian
- Department of Cardiology, C.H.U. de Charleroi, Charleroi, Belgium
| | | | | | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
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Klein C, Finat L, Abbey S, Eschalier R, Fossati F, Lazarus A, Marijon E, Pasquié JL, Ploux S, Salerno F, Williatte L, Gras D, Sacher F, Taieb J, Boveda S, Guédon-Moreau L. Remote monitoring for cardiac implantable electronic devices: A practical guide. Arch Cardiovasc Dis 2022; 115:406-407. [DOI: 10.1016/j.acvd.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
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BOUCHANT-PIOCHE M, MASSOULLIE G, pereira B, Boudias A, Jean F, Abu-Alrub S, Catalan PA, Motreff P, CLERFOND G, Souteyrand G, Eschalier R. PO-618-01 IMPACT OF PR INTERVAL PROLONGATION ON THE RISK OF HIGH GRADE CONDUCTIVE DISORDERS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cha YM, Ali-Ahmed F, MONDOLY PIERRE, Al-Smadi Al-Shehri FM, DEFAYE PASCAL, CLEMENTY N, Martinez-Sande JL, marquie C, Eschalier R, Roberts PR, El-Chami MF, Piccini JP, Stromberg K, Fagan DH, Garweg C. PO-619-01 SAFETY AND FEASIBILITY OF LEADLESS PACEMAKER IMPLANTATION VIA A LEFT FEMORAL VEIN APPROACH: EXPERIENCE WITH THE MICRA TRANSCATHETER PACEMAKER. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abdoul Carime N, Cottenet J, Clerfond G, Eschalier R, Quilliot D, Eicher JC, Joly B, Quantin C. Impact of nutritional status on heart failure mortality: a retrospective cohort study. Nutr J 2022; 21:2. [PMID: 34991613 PMCID: PMC8734339 DOI: 10.1186/s12937-021-00753-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/21/2021] [Indexed: 12/19/2022] Open
Abstract
Background Chronic heart failure (CHF) is one of the most common causes of mortality in industrialized countries despite regular therapeutic advances. Numerous factors influence mortality in CHF patients, including nutritional status. It is known that malnutrition is a risk factor for mortality, whereas obesity may play a protective role, a phenomenon dubbed the “obesity paradox”. However, the effect of the obesity-malnutrition association on mortality has not been previously studied for CHF. Our aim was to study the effect of nutritional status on overall mortality in CHF patients. Methods This retrospective, multicenter study was based on a French nationwide database (PMSI). We included all CHF patients aged ≥18 years admitted to all public and private hospitals between 2012 and 2016 and performed a survival analysis over 1 to 4 years of follow-up. Results Malnutrition led to a significant decrease in life expectancy in CHF patients when compared with normal nutritional status (aHR=1.16 [1.14-1.18] at one year and aHR=1.04 [1.004-1.08] at four years), obese, and obese-malnutrition groups. In contrast, obesity led to a significant increase in life expectancy compared with normal nutritional status (aHR=0.75 [0.73-0.78] at one year and aHR=0.85 [0.81-0.90] at four years), malnutrition, and obese-malnutrition groups. The mortality rate was similar in patients presenting both malnutrition and obesity and patients with normal nutritional status. Conclusions Our results indicate that the protective effect on mortality observed in obese CHF patients seems to be linked to fat massincrease. Furthermore, malnourished obese and normal nutritional status patients had similar mortality rates. Further studies should be conducted to confirm our results and to explore the physiopathological mechanisms behind these effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00753-x.
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Affiliation(s)
- Nafiz Abdoul Carime
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France and F-CRIN, INI-CRCT, Nancy, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France and F-CRIN, INI-CRCT, Nancy, France
| | - Didier Quilliot
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 1 Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France; Nutritional Assistance Department, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - Bertrand Joly
- CHPCB Paray-le-Monial General Hospital, Paray-le-Monial, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Massoullié G, Ploux S, Mondoly P, Souteyrand G, Pereira B, Jean F, Amabile N, Irles D, Mansourati J, Combaret N, Mechulan X, Badoz M, Da Costa A, Defaye P, Clerfond G, Bordachar P, Eschalier R. Occurrence of high-grade conduction disorder after the onset of left bundle branch block in post-TAVI. The French multicenter LBBB-TAVI study. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.170] [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: 11/29/2022]
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Logeart D, Berthelot E, Bihry N, Eschalier R, Salvat M, Garcon P, Eicher JC, Cohen A, Tartiere JM, Samadi A, Donal E, deGroote P, Mewton N, Mansencal N, Raphael P, Ghanem N, Seronde MF, Chavelas C, Rosamel Y, Beauvais F, Kevorkian JP, Diallo A, Vicaut E, Isnard R. Early and short-term intensive management after discharge for patients hospitalized with acute heart failure: a randomized study (ECAD-HF). Eur J Heart Fail 2021; 24:219-226. [PMID: 34628697 DOI: 10.1002/ejhf.2357] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/06/2021] [Revised: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Hospitalization for acute heart failure (HF) is followed by a vulnerable time with increased risk of readmission or death, thus requiring particular attention after discharge. In this study, we examined the impact of intensive, early follow-up among patients at high readmission risk at discharge after treatment for acute HF. METHODS AND RESULTS Hospitalized acute HF patients were included with at least one of the following: previous acute HF < 6 months, systolic blood pressure ≤ 110 mmHg, creatininaemia ≥ 180 µmol/L, or B-type natriuretic peptide ≥ 350 pg/mL or N-terminal pro B-type natriuretic peptide ≥ 2200 pg/mL. Patients were randomized to either optimized care and education with serial consultations with HF specialist and dietician during the first 2-3 weeks, or to standard post-discharge care according to guidelines. The primary endpoint was all-cause death or first unplanned hospitalization during 6-month follow-up. Among 482 randomized patients (median age 77 and median left ventricular ejection fraction 35%), 224 were hospitalized or died. In the intensive group, loop diuretics (46%), beta-blockers (49%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (39%) and mineralocorticoid receptor antagonists (47%) were titrated. No difference was observed between groups for the primary endpoint (hazard ratio 0.97; 95% confidence interval 0.74-1.26), nor for mortality at 6 or 12 months or unplanned HF rehospitalization. Additionally, no difference between groups according to age, previous HF and left ventricular ejection fraction was found. CONCLUSIONS In high-risk HF, intensive follow-up early post-discharge did not improve outcomes. This vulnerable post-discharge time requires further studies to clarify useful transitional care services.
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Affiliation(s)
- Damien Logeart
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | | | | | | | | | | | | | - Ariel Cohen
- Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Nicolas Mansencal
- Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | - Yann Rosamel
- Hôpital Sud-Francilien, Corbeil-Essonnes, France
| | - Florence Beauvais
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Abdourahmane Diallo
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Vicaut
- Hôpital Lariboisière Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Richard Isnard
- Hôpital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Ploux S, Strik M, Abu-Alrub S, Ramirez FD, Buliard S, Marchand H, Picard F, Eschalier R, Haïssaguerre M, Bordachar P. Remote monitoring of patients with heart failure during the first national lockdown for COVID-19 in France. European Heart Journal - Digital Health 2021; 2:487-493. [PMID: 37115642 PMCID: PMC8135567 DOI: 10.1093/ehjdh/ztab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
Background Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19. Aims To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring. Methods Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization. Results The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely. Conclusions The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring. lay summary The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.
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Affiliation(s)
- Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Saer Abu-Alrub
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- Cardiology Department, Clermont Université, Université d’Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, H-3406, Ottawa, ON K1Y 4W7, Canada
| | - Samuel Buliard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
| | - Hugo Marchand
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
| | - François Picard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
| | - Romain Eschalier
- Cardiology Department, Clermont Université, Université d’Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Electrophysiology and Pacing Department, F-33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
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30
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Abstract
Exactly two decades have elapsed since pacemakers first provided automatic remote monitoring. This innovation has been well received by patients. However, there is still a widely held perception that remote monitoring of pacemakers is non-essential, despite the very similar gains that are achieved compared with remote monitoring of implantable cardioverter defibrillators. Reducing in-office evaluations and overall staff workload is important when these resources are stretched to their limits. The early detection ability provided by remote monitoring facilitates device management (extending battery longevity) and the ability to exercise vigilance over recalled components. Clinical complications, such as arrhythmic events, are also detected earlier. Remote monitoring has been shown to produce similar reductions in the risk of all-cause hospitalization and death for pacemakers and implantable cardioverter defibrillators in a mega-cohort observational study. This review is an evidence-based plea for the recognition and systematic implementation of remote monitoring for pacemakers.
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Affiliation(s)
- Sylvain Ploux
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France.
| | - Marc Strik
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France
| | - Niraj Varma
- Cleveland Clinic, 44195 Cleveland, Ohio, USA
| | - Romain Eschalier
- UMR6284, Cardio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), Clermont Université, Université d'Auvergne, 63001 Clermont-Ferrand, France; Cardiology department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Pierre Bordachar
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, 33600 Pessac, France; Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), 33600 Pessac, France
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31
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Baudry G, Nesseler N, Flecher E, Vincentelli A, Goeminne C, Delmas C, Porterie J, Nubret K, Pernot M, Kindo M, Hoang Minh T, Rouvière P, Gaudard P, Michel M, Senage T, Boignard A, Chavanon O, Para M, Verdonk C, Pelcé E, Gariboldi V, Anselme F, Litzler PY, Blanchart K, Babatasi G, Bielefeld M, Bouchot O, Hamon D, Lellouche N, Bailleul X, Genet T, Eschalier R, d'Ostrevy N, Bories MC, Akar RA, Blangy H, Vanhuyse F, Obadia JF, Galand V, Pozzi M. Characteristics and outcome of ambulatory heart failure patients receiving a left ventricular assist device. ESC Heart Fail 2021; 8:5159-5167. [PMID: 34494391 PMCID: PMC8712824 DOI: 10.1002/ehf2.13592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/12/2021] [Accepted: 08/19/2021] [Indexed: 02/04/2023] Open
Abstract
Aims Despite regularly updated guidelines, there is still a delay in referral of advanced heart failure patients to mechanical circulatory support and transplant centres. We aimed to analyse characteristics and outcome of non‐inotrope‐dependent patients implanted with a left ventricular assist device (LVAD). Methods and results The ASSIST‐ICD registry collected LVAD data in 19 centres in France between February 2006 and December 2016. We used data of patients in Interagency Registry for Mechanically Assisted Circulatory Support Classes 4–7. The primary endpoint was survival analysis. Predictors of mortality were searched with multivariable analyses. A total of 303 patients (mean age 61.0 ± 9.9 years, male sex 86.8%) were included in the present analysis. Ischaemic cardiomyopathy was the leading heart failure aetiology (64%), and bridge to transplantation was the main implantation strategy (56.1%). The overall likelihood of being alive while on LVAD support or having a transplant at 1, 2, 3, and 5 years was 66%, 61.7%, 58.7%, and 55.1%, respectively. Age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.00–1.05; P = 0.02], a concomitant procedure (HR 2.32, 95% CI 1.52–3.53; P < 0.0001), and temporary mechanical right ventricular support during LVAD implantation (HR 2.94, 95% CI 1.49–5.77; P = 0.002) were the only independent variables associated with mortality. Heart failure medications before or after LVAD implantation were not associated with survival. Conclusion Ambulatory heart failure patients displayed unsatisfactory survival rates after LVAD implantation. A better selection of patients who can benefit from LVAD may help improving outcomes.
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Affiliation(s)
- Guillaume Baudry
- Heart Failure Unit, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | | | - Erwan Flecher
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Céline Goeminne
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Clément Delmas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean Porterie
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Karine Nubret
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Mathieu Pernot
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Kindo
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Tam Hoang Minh
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Rouvière
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Thomas Senage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Marylou Para
- Department of Cardiac Surgery and Cardiology, Bichat-Hospital, Paris, France
| | - Constance Verdonk
- Department of Cardiac Surgery and Cardiology, Bichat-Hospital, Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Frederic Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, Dijon, France
| | - David Hamon
- Department of Cardiology, AP-HP CHU Henri Mondor, Créteil, France
| | | | - Xavier Bailleul
- Cardiac Surgery Department and Cardiology Department, Cardiac Intensive Care Unit, Tours University Hospital, Tours, France
| | - Thibaud Genet
- Cardiac Surgery Department and Cardiology Department, Cardiac Intensive Care Unit, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology and Cardiac Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas d'Ostrevy
- Cardiology and Cardiac Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Cécile Bories
- Cardiology and Cardiac Surgery Department, European Georges Pompidou Hospital, Paris, France
| | - Ramzi Abi Akar
- Cardiology and Cardiac Surgery Department, European Georges Pompidou Hospital, Paris, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Jean François Obadia
- Department of Cardiology and Cardiac Surgery, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Matteo Pozzi
- Department of Cardiology and Cardiac Surgery, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
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32
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Waldmann V, Bouzeman A, Duthoit G, Koutbi L, Bessiere F, Labombarda F, Marquié C, Gourraud JB, Mondoly P, Sellal JM, Bordachar P, Hermida A, Anselme F, Asselin A, Audinet C, Bernard Y, Bru P, Sithikun Bun S, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Garcia R, Guenancia C, Guy-Moyat B, Halimi F, Irles D, Iserin L, Jourda F, Ladouceur M, Lagrange P, Laredo M, Mansourati J, Massoulié G, Mathiron A, Maury P, Messali A, Narayanan K, Nguyen C, Ninni S, Perier MC, Pierre B, Pujadas P, Sacher F, Sagnol P, Sharifzadehgan A, Walton C, Winum P, Zakine C, Fauchier L, Martins R, Pasquié JL, Thambo JB, Jouven X, Combes N, Marijon E. Long-term follow-up of patients with tetralogy of fallot and implantable cardioverter defibrillator–The DAI-T4F nationwide registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Endamena GB, Temgoua MN, Chanseaume S, Hilic E, Camus L, Chanseaume A, Mischie A, Kane K, Diallo N, Assi S, Eschalier R. When COVID-19 delays the management of an urgent heart condition: A rare case of a spontaneous dissection of two coronary arteries. Clin Case Rep 2021; 9:e04708. [PMID: 34484755 PMCID: PMC8405420 DOI: 10.1002/ccr3.4708] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Some severe life-threatening conditions could be misdiagnosed during the current COVID-19 pandemic.
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Affiliation(s)
| | - Mazou Ngou Temgoua
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
- Department of Internal Medicine and SpecialitiesFaculty of Medicine and Biomedical SciencesYaoundéCameroon
| | | | - Enver Hilic
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Lise Camus
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | | | | | - Karamoko Kane
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Nouhoun Diallo
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Sami Assi
- Cardiology UnitCenter Hospital of MonluçonMonluçonFrance
| | - Romain Eschalier
- Department of CardiologyClermont‐Ferrand University HospitalClermont‐FerrandFrance
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34
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Garcia R, Combes N, Defaye P, Narayanan K, Guedon-Moreau L, Boveda S, Blangy H, Bouet J, Briand F, Chevalier P, Cottin Y, Da Costa A, Degand B, Deharo JC, Eschalier R, Extramiana F, Goralski M, Guy-Moyat B, Guyomar Y, Hermida JS, Jourda F, Lellouche N, Mahfoud M, Manenti V, Mansourati J, Martin A, Pasquié JL, Ritter P, Rollin A, Tibi T, Yalioua A, Gras D, Sadoul N, Piot O, Leclercq C, Marijon E. Wearable cardioverter-defibrillator in patients with a transient risk of sudden cardiac death: the WEARIT-France cohort study. Europace 2021; 23:73-81. [PMID: 33257972 PMCID: PMC7842091 DOI: 10.1093/europace/euaa268] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Aims We aimed to provide contemporary real-world data on wearable cardioverter-defibrillator (WCD) use, not only in terms of effectiveness and safety but also compliance and acceptability. Methods and results Across 88 French centres, the WEARIT-France study enrolled retrospectively patients who used the WCD between May 2014 and December 2016, and prospectively all patients equipped for WCD therapy between January 2017 and March 2018. All patients received systematic education session through a standardized programme across France at the time of initiation of WCD therapy and were systematically enrolled in the LifeVest Network remote services. Overall, 1157 patients were included (mean age 60 ± 12 years, 16% women; 46% prospectively): 82.1% with ischaemic cardiomyopathy, 10.3% after implantable cardioverter-defibrillator explant, and 7.6% before heart transplantation. Median WCD usage period was 62 (37–97) days. Median daily wear time of WCD was 23.4 (22.2–23.8) h. In multivariate analysis, younger age was associated with lower compliance [adjusted odds ratio (OR) 0.97, 95% confidence interval (CI) 0.95–0.99, P < 0.01]. A total of 18 participants (1.6%) received at least one appropriate shock, giving an incidence of appropriate therapy of 7.2 per 100 patient-years. Patient-response button allowed the shock to be aborted in 35.7% of well-tolerated sustained ventricular arrhythmias and in 95.4% of inappropriate ventricular arrhythmia detection, finally resulting in an inappropriate therapy in eight patients (0.7%). Conclusion Our real-life findings reinforce previous studies on the efficacy and safety of the WCD in the setting of transient high-risk group in selected patients. Moreover, they emphasize the fact that when prescribed appropriately, in concert with adequate patient education and dedicated follow-up using specific remote monitoring system, compliance with WCD is high and the device well-tolerated by the patient.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, 86021 Poitiers, France.,Univ Poitiers, 86000 Poitiers, France
| | - Nicolas Combes
- Department of Cardiology, Pasteur Clinic, 33000 Toulouse, France
| | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital, 38043 Grenoble, France
| | - Kumar Narayanan
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,Cardiology Department, Medicover Hospitals, Hyderabad, India
| | | | - Serge Boveda
- Department of Cardiology, Pasteur Clinic, 33000 Toulouse, France
| | - Hugues Blangy
- Department of Cardiology, Nancy University Hospital, 54500 Vandoeuvre-Lès-Nancy, France
| | - Jérôme Bouet
- Department of Cardiology, Hospital Center of Aix, 13080 Aix En Provence, France
| | - Florent Briand
- Department of Cardiology, Besançon University Hospital, 25000 Besançon, France
| | | | - Yves Cottin
- Department of Cardiology, Dijon University Hospital, 28000 Dijon, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, 42000 Saint-Étienne, France
| | - Bruno Degand
- Department of Cardiology, Poitiers University Hospital, 86021 Poitiers, France
| | - Jean-Claude Deharo
- Department of Cardiology, University Hospital La Timone, 13000 Marseille, France
| | - Romain Eschalier
- Department of Cardiology Clermont-Ferrand University Hospital, 63000 Clermont Ferrand, France
| | - Fabrice Extramiana
- Department of Cardiology, Bichat Hospital - Claude Bernard, 75877 Paris, France
| | - Marc Goralski
- Department of Cardiology, General Hospital of Oréans, 45000 Orléans, France
| | - Benoit Guy-Moyat
- Department of Cardiology, Limoges University Hospital, 87000 Limoges, France
| | - Yves Guyomar
- Department of Cardiology, Hospital Center Saint Philibert, 59160 Lomme, France
| | | | - François Jourda
- Department of Cardiology, General Hospital of Auxerre, 89000 Auxerre, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital Henri Mondor, 94000 Creteil, France
| | - Mohanad Mahfoud
- Department of Cardiology, Hospital Center Sud Francilien, 91100 Corbeil Essonnes, France
| | - Vladimir Manenti
- Department of Cardiology, Jacques Cartier Institute, 91300 Massy, France
| | - Jacques Mansourati
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Angéline Martin
- Department of Cardiology, Fontaine Clinic, 21121 Fontaine-Lès-Dijon, France
| | - Jean-Luc Pasquié
- Department of Cardiology, Montpellier University Hospital, 34000 Montpellier, France
| | - Philippe Ritter
- Department of Cardiology, Bordeaux University Hospital, 33600 Pessac, France
| | - Anne Rollin
- Department of Cardiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Thierry Tibi
- Department of Cardiology, General Hospital of Cannes, 06150 Cannes, France
| | - Arab Yalioua
- Department of Cardiology, General Hospital of Angoulême, 16000 Angoulême, France
| | - Daniel Gras
- Department of Cardiology, Hopital privé du Confluent, 44000 Nantes, France
| | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, 54500 Vandoeuvre-Lès-Nancy, France
| | - Olivier Piot
- Department of Cardiology, Cardiology Center of Nord, 93200 Saint Denis, France
| | | | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, 75015 Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France
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35
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Clementy N, Coelho R, Veltmann C, Marijon E, Tolosana J, Galand V, Ploux S, Eschalier R, Simeon E, Blessberger H, Mueller-Leisse J, Pujol-Lopez M, Martins R, Ritter P, Steinwender C, Babuty D. Leadless pacemakers in critically ill patients requiring prolonged cardiac pacing: A multicenter international study. J Cardiovasc Electrophysiol 2021; 32:2522-2527. [PMID: 34270153 DOI: 10.1111/jce.15175] [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: 02/24/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Temporary transvenous pacing in critically ill patients requiring prolonged cardiac pacing is associated with a high risk of complications. We sought to evaluate the safety and efficacy of self-contained intracardiac leadless pacemaker (LPM) implantation in this population. METHODS AND RESULTS Consecutive patients implanted with a Micra LPM during the hospitalization in an intensive care unit were retrospectively included. Inclusion criteria were: more than or equal to 1 supracaval central venous line, or a ventilation tube, or intravenous antibiotic therapy for ongoing sepsis or bacteremia. Patients with a history of the previous implantation of a pacemaker were excluded. Out of 1016 patients implanted with an LPM, 99 met the inclusion criteria. Mean age was 75 years and Charlson comorbidity index 7. LPM implantation was successfully performed in 98% of cases, with a perioperative complication rate of 5%, mainly cardiac injuries. In-hospital mortality rate was 6%. No late (>30 days) device-related complication occurred, especially no infection. CONCLUSIONS LPM appears as an acceptable alternative to conventional temporary transvenous pacing in selected critically ill patients requiring prolonged cardiac pacing, especially regarding the risk of infection.
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Affiliation(s)
- Nicolas Clementy
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Roxane Coelho
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - José Tolosana
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Vincent Galand
- Department of Cardiology, University Hospital Pontchaillou, Rennes, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Edouard Simeon
- Department of Electrophysiology, Private Hospital Institute Mutualiste Montsouris, Paris, France
| | | | - Johanna Mueller-Leisse
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Raphaël Martins
- Department of Cardiology, University Hospital Pontchaillou, Rennes, France
| | - Philippe Ritter
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France
| | | | - Dominique Babuty
- Department of Cardiology, University Hospital of Tours, Tours, France
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36
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Garweg C, Clementy N, Mondoloy P, Winter S, Bordachar P, Sharman D, Jung W, Eschalier R, Theis C, Defaye P, Anderson C, Pol A, Roberts PR. A leadless pacemaker in the real-world setting: Patient profile and performance over time. Europace 2021. [DOI: 10.1093/europace/euab116.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.
OnBehalf
Micra Acute Performance EMEA Investigators
Background
The first in-man implant of the Micra leadless pacemaker occurred in December 2013. While prior trials demonstrated a high implant success rate and favorable safety and efficacy results; whether the patient population and outcomes have changed over time is not well studied.
Purpose
To characterize the evolution of patient profile and outcomes for patients receiving a leadless pacemaker through the pre-market and post-market environment.
Methods
Patients undergoing a Micra leadless pacemaker implant attempt from the initial Micra Investigational Device Exemption [IDE] and current Micra studies (Micra post-approval registry [PAR], Micra acute performance [MAP] study) were analyzed. Patient characteristics and pericardial effusions regardless of severity were summarized.
Results
The 3466 patients included in the analysis underwent a Micra implant attempt and were enrolled during consecutive timeframes: patients from the Micra IDE study (n = 726) underwent a Micra implant attempt from 2013-2015, patients from the PAR (n = 1814) from 2015-2018, and patients from Micra MAP cohort (n = 926) from 2018 – 2020. Implant success was >99.0% in all 3 studies. Median age ranged from 78 – 79 years among the 3 studies without significant difference. There were more patients requiring dialysis in the MAP cohort compared to the PAR or IDE cohorts (10.3%, 7.9%, and 3.9%, respectively; P < 0.001), but fewer patients with congestive heart failure (8.3%, 13.1%, and 18.0%; P < 0.001). Pacing indication was significantly different between the studies, with fewer patients in MAP having an indication of bradyarrhythmia associated with atrial fibrillation (AF) and more having an indication associated with atrioventricular block without AF (P < 0.001). The number of patients considered to be precluded for a transvenous pacemaker implant increased significantly from the initial IDE study to the PAR and MAP studies (6.2%, 23.9%, and 44.1%, respectively, P < 0.001). Implant site placement was mostly apical for the IDE but shifted to mostly septal placement in the PAR and MAP (septal placement: 33.3%, 64.0%, and 79.5%, respectively). The rate of pericardial effusion regardless of severity was 1.79% (n = 13) in the IDE, 0.83% (n = 15) in the PAR, and 0.97% (n = 9) in MAP (figure). Mean pacing thresholds among MAP EMEA patients were low (0.61 ± 0.40V) at implant and remained stable through 12 months (0.62 +/- 0.41V).
Conclusion
Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and a low perforation rate, in-line with prior reports. Abstract Figure. Pericardial effusion rate by study
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Affiliation(s)
- C Garweg
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - N Clementy
- Centre Hospitalier Régional Universitaire de Tours, France, Tours, France
| | - P Mondoloy
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - S Winter
- St. Vinzenz Hospital (Köln), Cologne, Germany
| | - P Bordachar
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - D Sharman
- Northampton General Hospital (Cliftonville), Cliftonville, Northampton, United Kingdom of Great Britain & Northern Ireland
| | - W Jung
- Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - R Eschalier
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Theis
- Robert Bosch Hospital, Stuttgart, Germany
| | | | - C Anderson
- Medtronic, Mounds View, United States of America
| | - A Pol
- Bakken Research Center, Maastricht, Netherlands (The)
| | - PR Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
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37
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Andronache M, Pastorcici A, Massoulie G, Blendea D, Boudias A, Catalan PA, Jean F, Dauphin C, Eschalier R, Costea A, Rosu R, Cismaru G, Puiu M, Souteyrand G, Motreff P. Achieving acute mitral isthmus block with catheter ablation with vein of marshall ethanol infusion. Europace 2021. [DOI: 10.1093/europace/euab116.177] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Achieving bidirectional mitral isthmus block during radiofrequency (RF) ablation for persistent atrial fibrillation (AF) is still challenging. The conventional ablation method involves RF applications on the endocardial aspect of the Mitral Isthmus (MI), and for a majority of patients, in the distal coronary sinus (CS).
Purpose
We have evaluated the acute success of obtaining mitral isthmus block by adding another epicardial component using ethanol infusion in the vein of Marshall (EIVOM) in addition to endocardial MI and epicardial CS ablation.
Methods
We studied 121 patients (pts.) with a mean age of 65 years (range 40-83) 73% men; 119 with longstanding persistent AF (98%) and 2 with perimitral flutter (2%). The mean duration of AF was 53 months (12-244 months). In the majority of patients, additional endocardial (on the ventricular aspect of the MI) and/or epicardial (distal CS) (RF) ablation was performed in order to achieve MIB. The ablation procedure was performed under general anesthesia (GA) for 81 pts (67%). EIVOM was perform with a mean 6 ml ethanol (range 2-10ml)
Results
Bidirectional MIB was obtained in 114 pts. (94,2%). The 7 patients without MIB were scheduled for another ablation procedure (4 pts under GA during the first procedure). The average RF delivery time to block was 160 seconds (range 42-480 seconds) for the endocardial MI RF ablation (point-by-point application with a power of 50W and an Ablation Index of 450-500, contact force 10-20g) and 156 seconds (range 55-438) for the epicardial MI RF ablation (applications with a power of 20W). Bidirectional endocardial and epicardial MIB was confirmed by conventional pacing maneuvers performed in sinus rhythm. No major complications were observed. The parameters associated with failure for MIB were AF duration, Left Atrial dilatation >200 ml, MI thickness (epicardial endocardial distance on the CARTO maps >15mm).
Conclusion
Ethanol infusion in the vein of Marshall is a safe approach and is associated with a higher success rate of obtaining acute bidirectional endocardial and epicardial mitral isthmus block when compared with the conventional method. Abstract Figure. Bloc Mitral Endo; Bloc Mitral Epi;
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Affiliation(s)
- M Andronache
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - A Pastorcici
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - G Massoulie
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - D Blendea
- County Emergency Clinical Hospital, Cluj Napoca, Romania
| | - A Boudias
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - PA Catalan
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - F Jean
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - C Dauphin
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - R Eschalier
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - A Costea
- University of Cincinnati, Cincinnati, United States of America
| | - R Rosu
- CARDIOTEAM MONZAARES HOSPITAL, Cluj Napoca, Romania
| | - G Cismaru
- CARDIOTEAM MONZAARES HOSPITAL, Cluj Napoca, Romania
| | - M Puiu
- CARDIOTEAM MONZAARES HOSPITAL, Cluj Napoca, Romania
| | - G Souteyrand
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - P Motreff
- University Hospital Gabriel Montpied, Clermont-Ferrand, France
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Chen E, Nesseler N, Martins RP, Goéminne C, Vincentelli A, Delmas C, Porterie J, Nubret K, Pernot M, Kindo M, Hoang Minh T, Gaudard P, Rouvière P, Michel M, Sénage T, Boignard A, Chavanon O, Verdonk C, Para M, Pelcé E, Gariboldi V, Pozzi M, Baudry G, Litzler PY, Anselme F, Blanchart K, Babatasi G, Garnier F, Bielefeld M, Radu C, Lellouche N, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Bories MC, Baudinaud P, Vanhuyse F, Blangy H, Leclercq C, Flécher E, Galand V. Comparison of Outcomes and Mortality in Patients Having Left Ventricular Assist Device Implanted Early -vs- Late After Diagnosis of Cardiomyopathy. Am J Cardiol 2021; 146:82-88. [PMID: 33549526 DOI: 10.1016/j.amjcard.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/22/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
LVAD implantation in patients with a recently diagnosed cardiomyopathy has been poorly investigated. This work aims at describing the characteristics and outcomes of patients receiving a LVAD within 30 days following the diagnosis of cardiomyopathy. Patients from the ASSIST-ICD study was divided into recently and remotely diagnosed cardiomyopathy based on the time from initial diagnosis of cardiomyopathy to LVAD implantation using the cut point of 30 days. The primary end point of the study was all-cause mortality at 30-day and during follow-up. A total of 652 patients were included and followed during a median time of 9.1 (2.5 to 22.1) months. In this population, 117 (17.9%) had a recently diagnosed cardiomyopathy and had LVAD implantation after a median time of 15.0 (9.0 to 24.0) days following the diagnosis. This group of patients was significantly younger, with more ischemic cardiomyopathy, more sudden cardiac arrest (SCA) events at the time of the diagnosis and were more likely to receive temporary mechanical support before LVAD compared with the remotely diagnosed group. Postoperative in-hospital survival was similar in groups, but recently diagnosed patients had a better long-term survival after hospital discharge. SCA before LVAD and any cardiac surgery combined with LVAD implantation were identified as 2 independent predictors of postoperative mortality in recently diagnosed patients. In conclusion, rescue LVAD implantation for recently diagnosed severe cardiomyopathy is common in clinical practice. Such patients experience a relatively low postoperative mortality and have a better long-term survival compared with remotely diagnosed patients.
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Affiliation(s)
- Elisabeth Chen
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Nicolas Nesseler
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | | | - Céline Goéminne
- CHU Lille, Institut Coeur-Poumons, Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Lille, France
| | - André Vincentelli
- CHU Lille, Institut Coeur-Poumons, Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Lille, France
| | - Clément Delmas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean Porterie
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Karine Nubret
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Mathieu Pernot
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Michel Kindo
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Tam Hoang Minh
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
| | - Philippe Rouvière
- Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and cardiac surgery, Bichat-Hospital, Paris, France
| | - Marylou Para
- Department of Cardiology and cardiac surgery, Bichat-Hospital, Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Guillaume Baudry
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, France
| | - Fabien Garnier
- Department of Cardiology and cardiac surgery, University Hospital, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and cardiac surgery, University Hospital, Dijon, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Thibaud Genet
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- CHU Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France
| | | | - Pierre Baudinaud
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | | | - Erwan Flécher
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Galand
- Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France.
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Abu-Alrub S, Strik M, Huntjens P, Ramirez FD, Potse M, Cochet H, Marchand H, Buliard S, Eschalier R, Haïssaguerre M, Bordachar P, Ploux S. Left-axis deviation in patients with nonischemic heart failure and left bundle branch block is a purely electrical phenomenon. Heart Rhythm 2021; 18:1352-1360. [PMID: 33831543 DOI: 10.1016/j.hrthm.2021.03.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/18/2020] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Possible mechanisms of left-axis deviation (LAD) in the setting of left bundle branch block (LBBB) include differences in cardiac electrophysiology, structure, or anatomic axis. OBJECTIVE The purpose of this study was to clarify the mechanism(s) responsible for LAD in patients with LBBB. METHODS Twenty-nine patients with nonischemic cardiomyopathies and LBBB underwent noninvasive electrocardiographic imaging (ECGi), cardiac computed tomography, and magnetic resonance imaging in order to define ventricular electrical activation, characterize cardiac structure, and determine the cardiac anatomic axis. RESULTS Sixteen patients had a normal QRS axis (NA) (mean axis 8° ± 23°), whereas 13 patients had LAD (mean axis -48° ± 13°; P <.001). Total activation times were longer in the LAD group (112 ± 25 ms vs 91 ± 14 ms; P = .01) due to delayed activation of the basal anterolateral region (107 ± 10 ms vs 81 ± 17 ms; P <.001). Left ventricular (LV) activation in patients with LAD was from apex to base, in contrast to a circumferential pattern of activation in patients with NA. Apex-to-base delay was longer in the LA group (95 ± 13 ms vs 64 ± 21 ms; P <.001) and correlated with QRS frontal axis (R2 = 0.67; P <.001). Both groups were comparable with regard to LV end-diastolic volume (295 ± 84 mL vs LAD 310 ± 91 mL; P = .69), LV mass (177 ± 33 g vs LAD 180 ± 37 g; P = .83), and anatomic axis. CONCLUSION LAD in LBBB appears to be due to electrophysiological abnormalities rather than structural factors or cardiac anatomic axis.
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Affiliation(s)
- Saer Abu-Alrub
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Marc Strik
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Peter Huntjens
- Division of Cardiology, Washington University, St. Louis, Missouri
| | - F Daniel Ramirez
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Mark Potse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Hubert Cochet
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Hugo Marchand
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Samuel Buliard
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Haïssaguerre
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
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40
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Irles D, Salerno F, Cassagneau R, Eschalier R, Maupain C, Dupuis JM, Mansourati J, Guedon L, Marijon E, Frey P. Evolution of high-grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode-that minimizes ventricular pacing-activated. J Cardiovasc Electrophysiol 2021; 32:1376-1384. [PMID: 33625762 DOI: 10.1111/jce.14970] [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: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. We sought to identify factors associated with late (occurring ≥7 days after the procedure) high-grade atrioventricular blocks after TAVI, based on specific pacemaker memory data. METHODS AND RESULTS STIM-TAVI (NCT03338582) was a prospective, multicentre, observational study that enrolled all patients (from November 2015 to January 2017) implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of centrally adjudicated late high-grade atrioventricular blocks during the year after TAVI. Among 197 patients, 138 (70.1%) had ≥1 late high-grade atrioventricular block. Whereas oversizing (p = .005), high-grade atrioventricular block during TAVI (p < .001), and early (within 6 days) high-grade atrioventricular block (p < .001) were associated with occurrence of late high-grade atrioventricular block, self-expanding prothesis (p = .88), prior right bundle branch block (p = .45), low implantation (p = .06), and new or wider left bundle branch block and lengthening of PR interval (p = .24) were not. In multivariable analysis, only post-TAVI early high-grade atrioventricular block remained associated with late high-grade atrioventricular blocks (Days 0-1: odds ratio [OR], 3.25; 95% confidence interval [CI], 1.57-6.74; p = .001; Days 2-6: OR, 4.13; 95% CI, 2.06-8.31; p < .001), whereas other conventionally used predictors were not. CONCLUSION One-third of pacemaker-implanted patients do not experience late high-grade atrioventricular block. Our findings suggest that post-TAVI early high-grade atrioventricular block is the main factor associated with occurrence of late high-grade atrioventricular blocks.
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Affiliation(s)
- Didier Irles
- Department of Cardiology, Hospital of Annecy, Pringy, France
| | - Fiorella Salerno
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Massy, France
| | | | - Romain Eschalier
- Department of Cardiology, University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - Carole Maupain
- Department of Cardiology, Hospital Pitié-Salpêtrière, Paris, France
| | - Jean-Marc Dupuis
- Department of Cardiology, University Hospital of Angers, Angers, France
| | | | - Laurence Guedon
- Department of Cardiology, Regional University Hospital of Lille, Lille, France
| | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Pierre Frey
- Department of Cardiology, Hospital of Annecy, Pringy, France
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Massoullié G, Boyer B, Sapin V, Jean F, Andronache M, Peoc'h M, Clerfond G, Eschalier R. Sudden cardiac death risk in contact sports increased by myocarditis: a case series. Eur Heart J Case Rep 2021; 5:ytab054. [PMID: 34113757 PMCID: PMC8185879 DOI: 10.1093/ehjcr/ytab054] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/15/2020] [Accepted: 10/25/2020] [Indexed: 01/02/2023]
Abstract
Background Myocarditis is a known cause of sudden cardiac death of the athlete. The impact of direct chest trauma in at-risk sports or activities in patients with a history of myocarditis has never been demonstrated or studied. We report herein two cases of life-threatening ventricular arrhythmia secondary to non-penetrating blunt chest trauma while playing contact sports. Case summary The first patient, a 26-year-old man described a brief loss of consciousness after having received blunt impact to the chest (typical intensity) while playing a rugby match. The loss of consciousness was total and proceeded by rapid and regular palpitations. He had a history of viral myocarditis 10 years prior with a fibrotic sequalae in the inferolateral wall on cardiac magnetic resonance imaging (left ventricular ejection fraction 71%). Right apical ventricular pacing induced a sustained monomorphic ventricular tachycardia reproducing the patient's symptoms. A subcutaneous implantable cardioverter-defibrillator was implanted. The second patient is a 22-year-old professional rugby player with no known notable history. During a match, a direct blow to the chest wall was followed by a cardiac arrest. A ventricular fibrillation was cardioverted to pulseless electrical activity. Patient died despite cardiopulmonary resuscitation. An autopsy identified a myocardial sequela of fibrosis with no acute inflammatory remodelling compatible with a previous myocarditis. Discussion Myocarditis may increase the risk of life-threatening ventricular arrhythmias caused by blunt impact to the chest, particularly in contact sports. Screening and prevention measures should be considered to reduce this risk.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Baptiste Boyer
- Institute of Legal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Frédéric Jean
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France
| | - Marius Andronache
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | | | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.,INI-CRCT F-CRIN, Nancy, France For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Rue Montalembert, 63000 Clermont-Ferrand, France.,Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.,INI-CRCT F-CRIN, Nancy, France For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast
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Temgoua MN, Chanseaume S, Hilic E, Karamoko K, Tochie JN, Beyina G, Camus L, Chanseaume A, Alexandru M, Benfreha K, Diallo N, Eschalier R. Paroxysmal atrial fibrillation associated with a moderate form of COVID-19 in a middle-aged man with low cardiovascular risk factor: More still needs to be done in this topic. Clin Case Rep 2021; 9:1986-1990. [PMID: 33821191 PMCID: PMC8013679 DOI: 10.1002/ccr3.3923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 01/02/2023] Open
Abstract
Strict monitoring of the heart rhythm in patients with COVID‐19 even nonsevere case and patient with low cardiovascular risk factors is very important to prevent fatal outcomes.
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Affiliation(s)
- Mazou Ngou Temgoua
- Cardiology Unit Center Hospital of Monluçon Monluçon France.,Department of Internal Medicine and Specialities Faculty of Medicine and Biomedical Sciences Yaoundé Cameroon
| | | | - Enver Hilic
- Cardiology Unit Center Hospital of Monluçon Monluçon France
| | - Kane Karamoko
- Cardiology Unit Center Hospital of Monluçon Monluçon France
| | - Joel Noutakdie Tochie
- Department of Anaesthesiology and Critical Care Medicine Faculty of Medicine and Biomedical Sciences Yaoundé Cameroon
| | - Gislain Beyina
- Cardiology Unit Center Hospital of Monluçon Monluçon France
| | - Lise Camus
- Cardiology Unit Center Hospital of Monluçon Monluçon France
| | | | | | | | - Nouhoun Diallo
- Cardiology Unit Center Hospital of Monluçon Monluçon France
| | - Romain Eschalier
- Department of Cardiology Clermont-Ferrand University Hospital Clermont-Ferrand France
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43
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Delinière A, Baranchuk A, Giai J, Bessiere F, Maucort-Boulch D, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum PF, Taieb J, Bouet J, Fauvernier M, Rosianu H, Carabelli A, Duband B, Chevalier P. Prediction of ventricular arrhythmias in patients with a spontaneous Brugada type 1 pattern: the key is in the electrocardiogram. Europace 2020; 21:1400-1409. [PMID: 31177270 DOI: 10.1093/europace/euz156] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/15/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS There is currently no reliable tool to quantify the risks of ventricular fibrillation or sudden cardiac arrest (VF/SCA) in patients with spontaneous Brugada type 1 pattern (BrT1). Previous studies showed that electrocardiographic (ECG) markers of depolarization or repolarization disorders might indicate elevated risk. We aimed to design a VF/SCA risk prediction model based on ECG analyses for adult patients with spontaneous BrT1. METHODS AND RESULTS This retrospective multicentre international study analysed ECG data from 115 patients (mean age 45.1 ± 12.8 years, 105 males) with spontaneous BrT1. Of these, 45 patients had experienced VF/SCA and 70 patients did not experience VF/SCA. Among 10 ECG markers, a univariate analysis showed significant associations between VF/SCA and maximum corrected Tpeak-Tend intervals ≥100 ms in precordial leads (LMaxTpec) (P < 0.001), BrT1 in a peripheral lead (pT1) (P = 0.004), early repolarization in inferolateral leads (ER) (P < 0.001), and QRS duration ≥120 ms in lead V2 (P = 0.002). The Cox multivariate analysis revealed four predictors of VF/SCA: the LMaxTpec [hazard ratio (HR) 8.3, 95% confidence interval (CI) 2.4-28.5; P < 0.001], LMaxTpec + ER (HR 14.9, 95% CI 4.2-53.1; P < 0.001), LMaxTpec + pT1 (HR 17.2, 95% CI 4.1-72; P < 0.001), and LMaxTpec + pT1 + ER (HR 23.5, 95% CI 6-93; P < 0.001). Our multidimensional penalized spline model predicted the 1-year risk of VF/SCA, based on age and these markers. CONCLUSION LMaxTpec and its association with pT1 and/or ER indicated elevated VF/SCA risk in adult patients with spontaneous BrT1. We successfully developed a simple risk prediction model based on age and these ECG markers.
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Affiliation(s)
- Antoine Delinière
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| | | | - Joris Giai
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Francis Bessiere
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Pascal Defaye
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Dan Dobreanu
- Department of Physiology, University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania
| | - Alina Scridon
- Department of Physiology, University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania
| | - Antoine Da Costa
- Pôle Cardiovasculaire, CHU de Saint-Etienne, Saint-Etienne, France
| | | | - Claude Kouakam
- Unité de Rythmologie, Hôpital Cardiologique, CHU de Lille, Lille, France
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Extramiana
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Antoine Leenhardt
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Haran Burri
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Genève, Suisse
| | | | - Jérôme Taieb
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Jérôme Bouet
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Mathieu Fauvernier
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Horia Rosianu
- Department of Cardiology, Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Adrien Carabelli
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Benjamin Duband
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Chevalier
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
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Ferreira JP, Rossello X, Eschalier R, McMurray JJV, Pocock S, Girerd N, Rossignol P, Pitt B, Zannad F. MRAs in Elderly HF Patients: Individual Patient-Data Meta-Analysis of RALES, EMPHASIS-HF, and TOPCAT. JACC Heart Fail 2020; 7:1012-1021. [PMID: 31779922 DOI: 10.1016/j.jchf.2019.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to assess the effect of MRA treatment (vs. placebo) in older patients (≥75 years of age) compared with younger patients (<75 years of age) with heart failure (HF). BACKGROUND Mineralocorticoid receptor antagonists (MRAs) have been shown to reduce morbidity and mortality in patients with HF with reduced ejection fraction (HFrEF) and in a subset of patients with HF with preserved EF (HFpEF). Notwithstanding, MRAs are underused, especially in the elderly. Pooling the individual patient data (IPD) provided more statistical power with which to assess the efficacy and safety of MRA treatment in this subpopulation. METHODS An IPD meta-analysis was performed using Cox proportional hazards models stratified by trial. A total of 1,756 patients (853 randomized to placebo and 903 to MRA) ≥75 years of age, along with 4,411 patients (2,242 randomized to placebo and 2,169 to MRA) <75 years of age were included. The primary outcome was a composite of death from cardiovascular causes or hospitalization for HF. RESULTS The treatment groups were well balanced. Patients ≥75 years of age or older and those 80 years of age, 61% were male, 30% had diabetes, and the mean estimated glomerular filtration rate 59 ml/min. The primary outcome occurred in 331 patients (38.8%) in the placebo group versus 281 (31.1%) in the MRA group (hazard ratio: 0.74; 95% confidence interval: 0.63 to 0.86; p < 0.001; and the heterogeneity p value [heterogeneity p = Cochran's Q p value of treatment effect by study interaction] was 0.52). Cardiovascular death and all-cause death were also reduced by MRAs without significant between-trial or age (younger vs. older) heterogeneity. Worsening renal function and hyperkalemia occurred more frequently in patients taking MRAs (vs. placebo). Compared to younger patients, worsening renal function (but not hyperkalemia) was found more frequently in the elderly. CONCLUSIONS MRAs reduced morbidity and mortality in elderly patients with HF, a beneficial effect that is more marked in patients with HFrEF but homogenous across HFrEF and HFpEF. Implementation of measures that increase MRA treatment in this population are warranted.
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Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine, Centre d'Investigation Clinique-Plurithématique INSERM 1433, and Cardiovascular and Renal Clinical Trialists, INSERM U1116, CHRU Nancy Brabois, Nancy, France.
| | - Xavier Rossello
- Department of Cardiology, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Department of Cardiology, CIBER de enfermedades Cardio Vasculares, Madrid, Spain
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Stuart Pocock
- Department of Cardiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigation Clinique-Plurithématique INSERM 1433, and Cardiovascular and Renal Clinical Trialists, INSERM U1116, CHRU Nancy Brabois, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigation Clinique-Plurithématique INSERM 1433, and Cardiovascular and Renal Clinical Trialists, INSERM U1116, CHRU Nancy Brabois, Nancy, France
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Faiez Zannad
- Université de Lorraine, Centre d'Investigation Clinique-Plurithématique INSERM 1433, and Cardiovascular and Renal Clinical Trialists, INSERM U1116, CHRU Nancy Brabois, Nancy, France
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Delinière A, Baranchuk A, Bessière F, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum PF, Taieb J, Bouet J, Rosianu H, Chevalier P. Prognostic significance of a low T/R ratio in Brugada syndrome. J Electrocardiol 2020; 63:6-11. [PMID: 33011474 DOI: 10.1016/j.jelectrocard.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prognostic value of a low T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients (pts) with a spontaneous type-1 Brugada pattern (SBT1). BACKGROUND Abnormalities of myocardial repolarization may play a key role in the initiation of ventricular fibrillation (VF) in Brugada syndrome (BrS). Recent studies have shown that the height of the T waves and the T/R ratio are inversely proportional to sudden cardiac arrest (SCA) risk in early repolarization syndrome and hypertrophic cardiomyopathy. METHODS In an international retrospective study, we reviewed 115 pts. (105 males, 91.3%). 45 had VF and/or SCA (38.7 ± 11.5 years old, all males), while 70 (49.3 ± 12.0 years, 10 women) remained free of ventricular arrhythmia. 6 ECG markers plus the T/R ratio in leads V5 & II were studied. RESULTS The T/R ratio among leads II & V5 was significantly lower in the VF/SCA group (0.24 [0.14; 0.38]vs. 0.34 [0.24; 0.45]; p = 0.006). 44.4% of pts. in the VF/SCA group had a lowest T/R ratio among leads II & V5 ≤ 0.17 compared to 11.4% in the non-VF/SCA group (p < 0.001). In multivariate analysis, a lowest T/R ratio among leads II & V5 ≤ 0.17 was independently associated with VF/SCA (OR 6.10, 95% CI 1.92-19.40; p = 0.002). Type 1 Brugada pattern in the peripheral leads (OR 10.78) and early repolarization (OR 3.60) were other independent markers of VF/SCA. CONCLUSION A low T/R ratio among leads II & V5 is an independent marker for VF/SCA risk in patients with type-1 Brugada pattern.
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Affiliation(s)
- Antoine Delinière
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France
| | | | - Francis Bessière
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France
| | - Pascal Defaye
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Dan Dobreanu
- University of Medicine and Pharmacy of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Antoine Da Costa
- Pôle Cardiovasculaire, CHU de Saint-Etienne, Saint-Etienne, France
| | | | - Claude Kouakam
- Unité de Rythmologie, Hôpital Cardiologique, CHU de Lille, Lille, France
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Extramiana
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Antoine Leenhardt
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Haran Burri
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Genève, Suisse, Switzerland
| | | | - Jérôme Taieb
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Jérôme Bouet
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Horia Rosianu
- Department of Cardiology, Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Philippe Chevalier
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France.
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46
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Delinière A, Baranchuk A, Bessiere F, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum P, Taieb J, Bouet J, Rosianu H, Chevalier P. Low T/R ratio in inferolateral leads: A new ECG marker of sudden cardiac arrest in patients with a spontaneous type 1 Brugada pattern. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Galand V, Flécher E, Chabanne C, Lelong B, Goéminne C, Vincentelli A, Delmas C, Dambrin C, Nubret K, Pernot M, Kindo M, Hoang Minh T, Gaudard P, Frapier JM, Michel M, Sénage T, Boignard A, Chavanon O, Verdonk C, Para M, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Litlzer PY, Anselme F, Babatasi G, Plane AF, Garnier F, Bielefeld M, Hamon D, Radu C, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Bories MC, Marijon E, Vanhuyse F, Blangy H, Leclercq C, Martins RP. Septuagenarian population has similar survival and outcomes to younger patients after left ventricular assist device implantation. Arch Cardiovasc Dis 2020; 113:701-709. [PMID: 32952086 DOI: 10.1016/j.acvd.2020.05.018] [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: 03/06/2020] [Revised: 03/20/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation may be an attractive alternative therapeutic option for elderly patients with heart failure who are ineligible for heart transplantation. AIM We aimed to describe the characteristics and outcomes of elderly patients (i.e. aged≥70 years) receiving an LVAD. METHODS This observational study was conducted in 19 centres between 2006 and 2016. Patients were divided into two groups-younger (aged<70 years) and elderly (aged≥70 years), based on age at time of LVAD implantation. RESULTS A total of 652 patients were included in the final analysis, and 74 patients (11.3%) were aged≥70 years at the time of LVAD implantation (maximal age 77.6 years). The proportion of elderly patients receiving an LVAD each year was constant, with a median of 10.6% (interquartile range 8.0-15.4%) per year, and all were implanted as destination therapy. Elderly and younger patients had similar durations of hospitalization in intensive care units and total lengths of hospital stays. Both age groups experienced similar rates of LVAD-related complications (i.e. stroke, bleeding, driveline infection and LVAD exchange), and the occurrence of LVAD complications did not impact survival in the elderly group compared with the younger group. Lastly, when compared with younger patients implanted as destination therapy, the elderly group also exhibited similar mid-term survival. CONCLUSION This work strongly suggests that selected elderly adults can be scheduled for LVAD implantation.
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Affiliation(s)
- Vincent Galand
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Erwan Flécher
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Céline Chabanne
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Bernard Lelong
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Céline Goéminne
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Institut Coeur-Poumons, CHU de Lille, 59000 Lille, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Institut Coeur-Poumons, CHU de Lille, 59000 Lille, France
| | | | | | - Karine Nubret
- LIRYC Institute, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, 33600 Pessac, France
| | - Mathieu Pernot
- LIRYC Institute, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, 33600 Pessac, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Philippe Gaudard
- Department of Anaesthesiology, Critical Care Medicine and Cardiac Surgery, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, PhyMedExp, INSERM, CNRS, 34090 Montpellier, France
| | - Jean Marc Frapier
- Department of Anaesthesiology, Critical Care Medicine and Cardiac Surgery, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, PhyMedExp, INSERM, CNRS, 34090 Montpellier, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, 44093 Nantes, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, 44093 Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, Hôpital Albert Michallon, CHU de Grenoble, 38700 La Tronche, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, Hôpital Albert Michallon, CHU de Grenoble, 38700 La Tronche, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Hôpital Bichat, 75018 Paris, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Hôpital Bichat, 75018 Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, Hôpital de la Timone, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Hôpital de la Timone, 13005 Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, Hôpital Cardio-Vasculaire Louis Pradel, 69500 Bron, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Hôpital Cardio-Vasculaire Louis Pradel, 69500 Bron, France
| | - Pierre Yves Litlzer
- Department of Cardiology and Cardiovascular Surgery, Hôpital Charles Nicolle, 76000 Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hôpital Charles Nicolle, 76000 Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, Université de Caen and CHU de Caen, 14000 Caen, France
| | - Anne Flore Plane
- Department of Cardiology and Cardiac Surgery, Université de Caen and CHU de Caen, 14000 Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, CHU de Dijon, 21000 Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, CHU de Dijon, 21000 Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, Hôpital Henri Mondor, AP-HP, 94010 Créteil, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, Hôpital Henri Mondor, AP-HP, 94010 Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, CHRU de Tours, 37000 Tours, France
| | - Thibaud Genet
- Department of Cardiology and Cardiac Surgery, CHRU de Tours, 37000 Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie-Cécile Bories
- Cardiology Department, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Eloi Marijon
- Cardiology Department, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Christophe Leclercq
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Raphaël P Martins
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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Galand V, Leclercq C, Bourenane H, Boulé S, Vincentelli A, Maury P, Mondoly P, Picard F, Welté N, Kindo M, Cardi T, Pasquié JL, Gaudard P, Gourraud JB, Probst V, Defaye P, Boignard A, Para M, Algalarrondo V, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Anselme F, Litzler PY, Blanchart K, Babatasi G, Garnier F, Bielefeld M, Hamon D, Lellouche N, Bourguignon T, Pierre B, Eschalier R, D'Ostrevy N, Varlet E, Marijon E, Blangy H, Sadoul N, Flécher E, Martins RP. Implantable cardiac defibrillator leads dysfunction after LVAD implantation. Pacing Clin Electrophysiol 2020; 43:1309-1317. [PMID: 32627211 DOI: 10.1111/pace.14004] [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] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) lead dysfunction has been reported after left ventricular assist device (LVAD) implantation in limited single-center studies. We aimed at describing and characterizing the incidence of ICD lead parameters dysfunction after LVAD implantation. METHODS Among the 652 patients enrolled in the ASSIST-ICD study, only patients with an ICD prior to LVAD were included (n = 401). ICD lead parameters dysfunction following LVAD implantation is defined as follows: (a) >50% decrease in sensing threshold, (b) pacing lead impedance increase/decrease by >100Ω, and (c) >50% increase in pacing threshold. RESULTS One hundred twenty-two patients with an ICD prior to LVAD had available ICD interrogation reports prior and after LVAD. A total of 67 (55%) patients exhibited at least one significant lead dysfunction: 17 (15%) exhibited >50% decrease in right ventricular (RV) sensing, 51 (42%) had >100 Ω increase/decrease in RV pacing impedance, and 24 (20%) experienced >50% increase in RV pacing threshold. A total of 52 patients experienced ventricular arrhythmia during follow-up and all were successfully detected and treated by the device. All lead dysfunction could be managed conservatively. CONCLUSION More than 50% of LVAD-recipients may experience >1 significant change in lead parameters but none had severe clinical consequences.
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Affiliation(s)
- Vincent Galand
- CHU Rennes, INSERM, University of Rennes, Rennes, France
| | | | | | - Stéphane Boulé
- Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Philippe Maury
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Mondoly
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Picard
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Nicolas Welté
- Hôpital Cardiologique du Haut-Lévêque, LIRYC institute, Université Bordeaux, Bordeaux, France
| | - Michel Kindo
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Thomas Cardi
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
| | | | - Vincent Probst
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Pascal Defaye
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | | | - Edeline Pelcé
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Katrien Blanchart
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital, Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Bertrand Pierre
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emilie Varlet
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Nicolas Sadoul
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Erwan Flécher
- CHU Rennes, INSERM, University of Rennes, Rennes, France
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Massoullié G, Moubarak G, Thomas O, Da Costa A, Roger V, Justo J, Mechulan A, Eschalier R, Silberbauer J, Andronache M. Initial multicenter experience with a new high-density coloring module: impact for complex atrial arrhythmias interpretation. J Interv Card Electrophysiol 2020; 60:313-319. [PMID: 32621214 DOI: 10.1007/s10840-020-00802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-density automated mapping of complex atrial tachycardias (ATs) requires accurate assessment of activation maps. A new local activation display module (HD coloring, Biosense Webster®) provides higher map resolution, a better delineation of potential block reducing color interpolation, and a new propagation display. We evaluated the accuracy of a dedicated local activation display compared with standard algorithm. METHODS High-density maps from 10 AT were collected with a multipolar catheter and were displayed with standard activation or HD coloring. Six expert operators retrospectively analyzed activation maps and were asked to define (1) the tachycardia mechanism, (2) ablation target, and (3) level of difficulty to interpret those maps. RESULTS Using HD coloring, operators were able to reach a correct diagnosis in 93% vs. 63%, p < 0.05 compared to standard activation maps. Time to diagnosis was shorter 1.9 ± 1.0 min vs. 3.9 ± 2.1 min, p < 0.05. Confidence level would have allowed ablation without necessity for entrainment maneuvers in 87% vs. 53%, p < 0.05. Operators would have needed to remap or proceed with multiple entrainments in 3% vs. 13% of cases, p < 0.05. Finally, ablation strategy was more accurately identified in 97% vs. 67%, p < 0.05. CONCLUSION Activation mapping with the new HD coloring module allowed a more accurate, reliable, and faster interpretation of complex ATs mechanisms compared to standard activation maps.
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Affiliation(s)
- Grégoire Massoullié
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, ISIT-CaVITI, 58 rue Montalembert, 63000 CHU, Clermont-Ferrand, France.
| | - Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Thomas
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Antoine Da Costa
- Division of Cardiology, Jean Monnet University, Saint-Etienne, France
| | | | | | | | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, ISIT-CaVITI, 58 rue Montalembert, 63000 CHU, Clermont-Ferrand, France
| | | | - Marius Andronache
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, ISIT-CaVITI, 58 rue Montalembert, 63000 CHU, Clermont-Ferrand, France
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Cataldi C, Andronache M, Eschalier R, Jean F, Bosle R, Farhat M, Massoullie G. P957Characteristics of atrial tachycardia after mitral surgey via biatrial trans-septal approach using high density mapping system. Europace 2020. [DOI: 10.1093/europace/euaa162.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The biatrial trans-septal approach (BTSa) ameliorates mitral valve (MV) exposure in difficult cases when routine left atriotomy doesnt"t allow it. Main steps are an oblique incision on the right atrium (RA), reaching medially the right pulmonary veins (PV), a septal incision from the fossa ovalis, extended up to reach the first incision, then on the left atrium (LA).
Purpose
We aim to study the arrhythmic burden in this post-surgical context, focusing on atrial tachycardia (AT), to investigate the complexity of several possible circuits.
Methods
All patients (>18yo) with previous MV surgery via BTSa for MV repair or replacement, who underwent ablation of AT from January 2017 to September 2019, were enrolled. Patients ablated for persistent or paroxysmal AF, or with AF during the index procedure were excluded. Patients with associated surgery on other valves or congenital defects, coronary, surgical or percutaneous rhythm interventions weren’t excluded. Electroanatomical mapping was created using 2 different high-density mapping system. Substrate and activation map and radio-frequency (RF) ablation (25-50W, Ablation Index target 400) were realized. Cartographies were analysed to evaluate AT re-entry circuit, critical isthmus (CI) location and characterization, atrial vulnerability. Procedural outcomes (AT termination, sinus rhythm (SR) restoration, anti-arrhythmic drugs (AAD) withdrawal), and peri-procedural complications were also evaluated.
Results
We enrolled 49 patients (median age 57 ± 15), finding a maximum of 5 AT per procedure (2 ± 1). A total of 112 AT were mapped: the majority (72%) were persistent AT, 8,2% common atrial flutter. Cycle length was 314 ± 74 msec, with proximal-distal activation of coronary sinus (78%). A multiple re-entry circuit was observed in 70% of index AT. We identified 152 critical isthmus (maximum 5 per procedure). Only 27,9% of our patients had a single CI; CTI was the most frequent one (n = 37), envolved in 33% of all AT, while BTS scars altogether were envolved in 65% AT. A complete AT circuit was mapped in the RA, the LA and both atria in respectively 49%, 11,5% and 39%AT. The distribution of CIs is shown in figure 1. Biatrial and left AT leads to superior procedure, RF and fluoroscopy duration (p <0,05). SR was restored in 93,4%of patients, requiring a DC shock in 4 cases. Immediate AAD withdrawal was achieved after 41%procedures. No pericardial, oesophageal, vascular or phrenic complication occurred. 4 pace-maker implantations were realized because of 3 interatrial, 2 AV block and a sinus node dysfunction.
Conclusions
AT occurring after a BTSa have a high prevalence of multiple re-entry circuits with multiple critical isthmus. Ablation in this context is feasible and safe but often requires a left atrial access. Mapping of both atria should be considered to identify critical isthmus and tailored ablation strategy.
Abstract Figure 1. Critical Isthmus Distribution
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Affiliation(s)
- C Cataldi
- University Hospital of Padova, Padua, Italy
| | - M Andronache
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - R Eschalier
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - F Jean
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - R Bosle
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - M Farhat
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
| | - G Massoullie
- University Hospital Gabriel Montpied, Cardiology, Clermont-Ferrand, France
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