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Wahbi K, Bassez G, Duchateau J, Salort-Campana E, Vicart S, Desaphy JF, Labombarda F, Sellal JM, Deharo JC. Expert opinion on mexiletine treatment in adult patients with myotonic dystrophy. Arch Cardiovasc Dis 2024:S1875-2136(24)00059-7. [PMID: 38677940 DOI: 10.1016/j.acvd.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
In France, mexiletine - a class I antiarrhythmic drug - can be prescribed for the symptomatic treatment of myotonia of the skeletal muscles in adult patients with myotonic dystrophy under a compassionate use programme. Mexiletine is used according to its summary of product characteristics, which describes its use for myotonia treatment in adult patients with non-dystrophic myotonia, a different neuromuscular condition without cardiac involvement. A cardiac assessment is required prior to initiation and throughout treatment due to potential proarrhythmic effects. The presence of conduction system disease, the most common cardiac manifestation of myotonic dystrophy, mandates repeated cardiac evaluations in patients with this condition, and becomes even more important when they are given mexiletine. A group of experts, including three neurologists and five cardiologists from French neuromuscular reference centres, were involved in a task force to develop a treatment algorithm to guide mexiletine use in myotonic dystrophy. The recommendations are based on data from a literature review of the safety of mexiletine-treated patients with myotonic dystrophy, the compassionate use protocol for mexiletine and the personal clinical experience of the experts. The main conclusion of the expert group is that, although existing safety data in mexiletine-treated patients with myotonic dystrophy are reassuring, cardiac assessments should be reinforced in such patients compared with mexiletine-treated patients with non-dystrophic myotonia. This expert opinion to guide mexiletine treatment in patients with myotonic dystrophy should help to reduce the risk of severe adverse events and facilitate interactions between specialists involved in the routine care of patients with myotonic dystrophy.
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Affiliation(s)
- Karim Wahbi
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Île-de-France, Cardiology Department, Cochin Hospital, AP-HP, Paris Cité University, 75014 Paris, France; Paris Cardiovascular Research Centre (PARCC), Inserm Unit 970, Georges-Pompidou European Hospital, 75015 Paris, France.
| | - Guillaume Bassez
- Constitutive Reference Centre for Neuromuscular Diseases, Neuro-Myology Department, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France
| | - Josselin Duchateau
- Department of Cardiology, Electrophysiology and Cardiac Pacing, Haut l'Evêque Cardiology Hospital, CHU de Bordeaux, 33604 Pessac, France
| | - Emmanuelle Salort-Campana
- Reference Centre for Neuromuscular Diseases PACA/Réunion/Rhône Alpes, La Timone Hospital, CHU de Marseille, AP-HM, 13385 Marseille, France; FILNEMUS, Neuromuscular Rare Diseases Healthcare Professional Network, La Timone Hospital, CHU de Marseille, AP-HM, 13385 Marseille, France
| | - Savine Vicart
- Muscle Channelopathies Reference Centre, Neuro-Myology Department, Pitié-Salpêtrière University Hospital, AP-HP, Inserm UMR 974, Institute of Myology, Sorbonne University, 75013 Paris, France
| | - Jean-François Desaphy
- Department of Precision and Regenerative Medicine and Ionian Area, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Fabien Labombarda
- Cardiology Department, CHU de Caen, UR 4650, UNICAEN, 14000 Caen, France
| | | | - Jean-Claude Deharo
- Cardiology Department, La Timone Hospital, CHU de Marseille, AP-HM, 13385 Marseille, France; C2VN, Aix-Marseille Université, 13005 Marseille, France
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Benali K, Monaco C, Duchateau J, Sacher F, Haïssaguerre M. Malignant Purkinje Ectopy Induced by Atrial Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00179-8. [PMID: 38613546 DOI: 10.1016/j.jacep.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Karim Benali
- Cardiac Arrhythmia Department, Saint-Etienne University Hospital, Jean Monnet University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France.
| | - Cinzia Monaco
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis, Belgium
| | - Josselin Duchateau
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France
| | - Frederic Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France; Inherited Arrhythmic Disease Center, Bordeaux University Hospital, Bordeaux, France
| | - Michel Haïssaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; Cardiac Arrhythmia Department, Bordeaux University Hospital, INSERM, Bordeaux, France
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Sacher F, Bacquelin R, Bessiere F, Ditac G, Duchateau J, Ait-Said M, Boveda S, Extramiana F, Delsarte L, Fauchier L, Gandjbakhch E, Garcia R, Klug D, Lellouche N, Marijon E, Martins R, Maury P, Mette C, Piot O, Taieb J, Defaye P. Position paper on sustainability in cardiac pacing and electrophysiology from the Working Group of Cardiac Pacing and Electrophysiology of the French Society of Cardiology. Arch Cardiovasc Dis 2024; 117:224-231. [PMID: 38302391 DOI: 10.1016/j.acvd.2023.11.016] [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: 10/09/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice. Reprocessing of single-use medical devices has emerged as a potential solution to mitigate the environmental impact of electrophysiology procedures, while also offering economic advantages. However, reprocessing remains unauthorized in certain countries. In regions where it is possible, stringent regulatory standards must be adhered to, to ensure patient safety. It is essential that healthcare professionals, policymakers and manufacturers collaborate to drive innovation, explore sustainable practices and ensure that patient care remains uncompromised in the face of environmental challenges. Ambitious national/international programmes of disease prevention should be the cornerstone of the strategy. It is equally vital to implement immediate actions, as delineated in this position paper, to bring about tangible change quickly.
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Affiliation(s)
- Frédéric Sacher
- Cardiac Arrhythmia Department, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U 1045, IHU Liryc, CRCTB, université de Bordeaux, 33000 Bordeaux, France.
| | | | - Francis Bessiere
- Hospices civils de Lyon, hôpital cardiovasculaire Louis-Pradel, 69500 Bron, France; Inserm, LabTau U1032, université Claude-Bernard Lyon 1, 69003 Lyon, France
| | - Geoffroy Ditac
- Hospices civils de Lyon, hôpital cardiovasculaire Louis-Pradel, 69500 Bron, France
| | - Josselin Duchateau
- Cardiac Arrhythmia Department, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U 1045, IHU Liryc, CRCTB, université de Bordeaux, 33000 Bordeaux, France
| | | | - Serge Boveda
- Heart Rhythm Management Department, clinique Pasteur, 31076 Toulouse, France; Vrije Universiteit Brussel (VUB), 1090 Jette, Brussels, Belgium; Inserm U970, 75908 Paris, France
| | - Fabrice Extramiana
- Cardiologie, université Paris Cité, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Laura Delsarte
- Service de cardiologie, CHU de Montpellier, 34295 Montpellier, France
| | - Laurent Fauchier
- Service de cardiologie, CHU de Trousseau, 37170 Chambray-lès-Tours, France; Faculté de médecine, université François-Rabelais, 37032 Tours, France
| | - Estelle Gandjbakhch
- Cardiology Department, ICAN, Sorbonne université, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France
| | - Rodrigue Garcia
- Cardiology Department, entre d'investigation CIC14-02, CHU de Poitiers, 86000 Poitiers, France
| | - Didier Klug
- Service de cardiologie, CHU de Lille, 59000 Lille, France
| | - Nicolas Lellouche
- Service de cardiologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Eloi Marijon
- Service de cardiologie, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Raphael Martins
- Inserm, LTSI - UMR 1099, CHU de Rennes, université de Rennes, 35000 Rennes, France
| | - Philipe Maury
- Unité Inserm U 1048, Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France
| | - Carole Mette
- Centre cardiologique du Nord Saint-Denis, 93207 Saint-Denis, France
| | - Olivier Piot
- Centre cardiologique du Nord Saint-Denis, 93207 Saint-Denis, France
| | - Jerome Taieb
- Service de cardiologie, centre hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | - Pascal Defaye
- Cardiology Department, Grenoble-Alpes University, University Hospital, 38043 Grenoble, France
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Bouyer B, Derval N, Pambrun T, Tixier R, Arnaud M, Buliard S, Chauvel R, Marchand H, Bouteiller X, Vlachos K, Ascione C, Yokoyama M, Kowalewski C, Hocini M, Jaïs P, Sacher F, Haïssaguerre M, Duchateau J. Local VA index for the differential diagnosis of supraventricular tachycardia. Heart Rhythm 2024:S1547-5271(24)00096-1. [PMID: 38286245 DOI: 10.1016/j.hrthm.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Differentiating between atypical atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reciprocating tachycardia utilizing a septal accessory pathway is a complex challenge. OBJECTIVE The purpose of this study was to describe the "local VA index," a straightforward method based on signals from the coronary sinus catheter, to distinguish between these arrhythmias during tachycardia and entrainment. The ventriculoatrial (VA) interval on the coronary sinus catheter is measured during tachycardia and entrainment, at the site of earliest atrial activity. The difference between these 2 situations defines the "local VA index." We also propose a mechanism to clarify the limitations of historical pacing maneuvers, such as postpacing interval minus tachycardia cycle length (PPI-TCL) and stimulus-atrial interval minus ventriculoatrial interval (SA-VA), by examining nodal decrement and intraventricular conduction delay. METHODS In a retrospective study of 75 patients referred for supraventricular tachycardia evaluation, 37 were diagnosed with atrioventricular reentrant tachycardia (AVRT) with orthodromic reciprocating tachycardia, and 38 with AVNRT (27 typical, 11 atypical). RESULTS In comparison to AVRT patients, AVNRT patients exhibited longer PPI-TCL (176 ± 47 ms vs 113 ± 42 ms; P <.01) and SA-VA (138 ± 47 ms vs 64 ± 28 ms; P <.01). The AVRT group had mean local VA index of -1 ± 13 ms, whereas the AVNRT group had a significantly longer index of 91 ± 46 ms (P <.01). An optimal threshold for differentiation was a local VA index of 40 ms. Importantly, there was no significant correlation between pacing cycle length and nodal decrement as well as intraventricular delay related to pathway location. This interindividual variability might explain misleading interpretations of PPI-TCL and SA-VA. CONCLUSION This novel approach is advantageous because of its simplicity and effectiveness, requiring only 2 diagnostic catheters. A local VA interval difference <40 ms provides a clear distinction for AVRT.
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Affiliation(s)
- Benjamin Bouyer
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
| | - Nicolas Derval
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Marine Arnaud
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Samuel Buliard
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Hugo Marchand
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Xavier Bouteiller
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Ciro Ascione
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Masaaki Yokoyama
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Christopher Kowalewski
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
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Komatsu Y, Nogami A, Hocini M, Morita H, Sato N, Marijon E, Arentz T, Yli-Mäyry S, Onishi Y, Kowase S, Duchateau J, Benali K, Takase T, Hosaka Y, Takei A, Nakajima I, Kawamura M, Inden Y, Ieda M, Aonuma K, Haïssaguerre M. Triggers of Ventricular Fibrillation in Patients With Inferolateral J-Wave Syndrome. JACC Clin Electrophysiol 2024; 10:1-12. [PMID: 37855774 DOI: 10.1016/j.jacep.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There are few data on ventricular fibrillation (VF) initiation in patients with inferolateral J waves. OBJECTIVES This multicenter study investigated the characteristics of triggers initiating spontaneous VF in inferolateral J-wave syndrome. METHODS A total of 31 patients (age 37 ± 14 years, 24 male) with spontaneous VF episodes associated with inferolateral J waves were evaluated to determine the origin and characteristics of triggers. The J-wave pattern was recorded in inferior leads in 11 patients, lateral leads in 3, and inferolateral leads in 17. RESULTS The VF triggers (n = 37) exhibited varying QRS durations (176 ± 21 milliseconds, range 119-219 milliseconds) and coupling intervals (339 ± 46 milliseconds, range 250-508 milliseconds) with a right (70%) or left (30%) bundle branch block (BBB) pattern. Trigger patterns were associated with J-wave location: left BBB triggers with inferior J waves and right BBB triggers with lateral J waves. Electrophysiologic study was performed for 22 VF triggers in 19 patients. They originated from the left or right Purkinje system in 6 and from the ventricular myocardium in 10 and were undetermined in 6. Purkinje vs myocardial triggers showed distinct electrocardiographic characteristics in coupling interval and QRS-complex duration and morphology. Abnormal epicardial substrate associated with fragmented electrograms was identified in 9 patients, with triggers originating from the same region in 7 patients. Catheter ablation resulted in VF suppression in 15 patients (79%). CONCLUSIONS VF initiation in inferolateral J-wave syndrome is associated with significant individual heterogeneity in trigger characteristics. Myocardial triggers have electrocardiographic features distinct from Purkinje triggers, and their origin often colocalizes with an abnormal epicardial substrate.
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Affiliation(s)
- Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mélèze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuyuki Sato
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
| | - Eloi Marijon
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Thomas Arentz
- Arrhythmia Division, Clinic for Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sinikka Yli-Mäyry
- Heart Hospital, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Yoshimi Onishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Karim Benali
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Tetsuro Takase
- Department of Cardiology, Ayase Heart Hospital, Tokyo, Japan
| | - Yukio Hosaka
- Department of Cardiovascular Medicine, Niigata City General Hospital, Niigata, Japan
| | - Asumi Takei
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ikutaro Nakajima
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Mitsuharu Kawamura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Cabanis P, Magat J, Rodriguez-Padilla J, Ramlugun G, Yon M, Bihan-Poudec Y, Pallares-Lupon N, Vaillant F, Pasdois P, Jais P, Dos-Santos P, Constantin M, Benoist D, Pourtau L, Dubes V, Rogier J, Labrousse L, Haissaguerre M, Bernus O, Quesson B, Walton R, Duchateau J, Vigmond E, Ozenne V. Cardiac structure discontinuities revealed by ex-vivo microstructural characterization. A focus on the basal inferoseptal left ventricle region. J Cardiovasc Magn Reson 2023; 25:78. [PMID: 38093273 PMCID: PMC10720182 DOI: 10.1186/s12968-023-00989-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND While the microstructure of the left ventricle (LV) has been largely described, only a few studies investigated the right ventricular insertion point (RVIP). It was accepted that the aggregate cardiomyocytes organization was much more complex due to the intersection of the ventricular cavities but a precise structural characterization in the human heart was lacking even if clinical phenotypes related to right ventricular wall stress or arrhythmia were observed in this region. METHODS MRI-derived anatomical imaging (150 µm3) and diffusion tensor imaging (600 µm3) were performed in large mammalian whole hearts (human: N = 5, sheep: N = 5). Fractional anisotropy, aggregate cardiomyocytes orientations and tractography were compared within both species. Aggregate cardiomyocytes orientation on one ex-vivo sheep whole heart was then computed using structure tensor imaging (STI) from 21 µm isotropic acquisition acquired with micro computed tomography (MicroCT) imaging. Macroscopic and histological examination were performed. Lastly, experimental cardiomyocytes orientation distribution was then compared to the usual rule-based model using electrophysiological (EP) modeling. Electrical activity was modeled with the monodomain formulation. RESULTS The RVIP at the level of the inferior ventricular septum presented a unique arrangement of aggregate cardiomyocytes. An abrupt, mid-myocardial change in cardiomyocytes orientation was observed, delimiting a triangle-shaped region, present in both sheep and human hearts. FA's histogram distribution (mean ± std: 0.29 ± 0.06) of the identified region as well as the main dimension (22.2 mm ± 5.6 mm) was found homogeneous across samples and species. Averaged volume is 0.34 cm3 ± 0.15 cm3. Both local activation time (LAT) and morphology of pseudo-ECGs were strongly impacted with delayed LAT and change in peak-to-peak amplitude in the simulated wedge model. CONCLUSION The study was the first to describe the 3D cardiomyocytes architecture of the basal inferoseptal left ventricle region in human hearts and identify the presence of a well-organized aggregate cardiomyocytes arrangement and cardiac structural discontinuities. The results might offer a better appreciation of clinical phenotypes like RVIP-late gadolinium enhancement or uncommon idiopathic ventricular arrhythmias (VA) originating from this region.
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Affiliation(s)
- Pierre Cabanis
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, Bordeaux, France.
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.
- Centre de Résonance Magnétique des Systèmes Biologiques, 2 Rue Dr Hoffmann Martinot, 33000, Bordeaux, France.
| | - Julie Magat
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, Bordeaux, France
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Centre de Résonance Magnétique des Systèmes Biologiques, 2 Rue Dr Hoffmann Martinot, 33000, Bordeaux, France
| | | | - Girish Ramlugun
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Maxime Yon
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Yann Bihan-Poudec
- Centre de Neuroscience Cognitive, CNRS, Université Claude Bernard Lyon I, Villeurbanne, France
| | - Nestor Pallares-Lupon
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Fanny Vaillant
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Philippe Pasdois
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Jais
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Pierre Dos-Santos
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Marion Constantin
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - David Benoist
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Line Pourtau
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Virginie Dubes
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Julien Rogier
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Louis Labrousse
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Michel Haissaguerre
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Olivier Bernus
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Bruno Quesson
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, Bordeaux, France
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Centre de Résonance Magnétique des Systèmes Biologiques, 2 Rue Dr Hoffmann Martinot, 33000, Bordeaux, France
| | - Richard Walton
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Josselin Duchateau
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Cardiology Department, Bordeaux University Hospital (CHU), Pessac, France
| | - Edward Vigmond
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- CNRS, IMB, UMR5251, Talence, France
| | - Valéry Ozenne
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, Bordeaux, France
- Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Centre de Résonance Magnétique des Systèmes Biologiques, 2 Rue Dr Hoffmann Martinot, 33000, Bordeaux, France
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7
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Cedilnik N, Pop M, Duchateau J, Sacher F, Jaïs P, Cochet H, Sermesant M. Efficient Patient-Specific Simulations of Ventricular Tachycardia Based on Computed Tomography-Defined Wall Thickness Heterogeneity. JACC Clin Electrophysiol 2023; 9:2507-2519. [PMID: 37804259 DOI: 10.1016/j.jacep.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Electrophysiological mapping of ventricular tachycardia (VT) is tedious and poorly reproducible. Substrate analysis on imaging cannot explicitly display VT circuits. OBJECTIVES This study sought to introduce a computed tomography-based model personalization approach, allowing for the simulation of postinfarction VT in a clinically compatible time frame. METHODS In 10 patients (age 65 ± 11 years, 9 male) referred for post-VT ablation, computed tomography-derived wall thickness maps were registered to 25 electroanatomical maps (sinus rhythm, paced, and VT). The relationship between wall thickness and electrophysiological characteristics (activation-recovery interval) was analyzed. Wall thickness was then employed to parameterize a fast and tractable organ-scale wave propagation model. Pacing protocols were simulated from multiple sites to test VT induction in silico. In silico VTs were compared to VT circuits mapped clinically. RESULTS Clinically, 6 different VTs could be induced with detailed maps in 9 patients. The proposed model allowed for fast simulation (median: 6 min/pacing site). Simulations of steady pacing (600 milliseconds) from 100 different sites/patient never triggered any arrhythmia. Applying S1-S2 or S1-S2-S3 induction schemes allowed for the induction of in silico VTs in the 9 of 10 patients who were clinically inducible. The patient who was not inducible clinically was also noninducible in silico. A total of 42 different VTs were simulated (4.2 ± 2 per patient). Six in silico VTs matched a VT circuit mapped clinically. CONCLUSIONS The proposed framework allows for personalized simulations in a matter of hours. In 6 of 9 patients, simulations show re-entrant patterns matching intracardiac recordings.
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Affiliation(s)
- Nicolas Cedilnik
- Université Côte d'Azur, Epione, Inria, Sophia-Antipolis, France; Institut Hospitalo-Universitaire Liryc, Bordeaux, France.
| | - Mihaela Pop
- Université Côte d'Azur, Epione, Inria, Sophia-Antipolis, France
| | - Josselin Duchateau
- Institut Hospitalo-Universitaire Liryc, Bordeaux, France; Cardiac Pacing and Electrophysiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Sacher
- Institut Hospitalo-Universitaire Liryc, Bordeaux, France; Cardiac Pacing and Electrophysiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jaïs
- Institut Hospitalo-Universitaire Liryc, Bordeaux, France; Cardiac Pacing and Electrophysiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Hubert Cochet
- Institut Hospitalo-Universitaire Liryc, Bordeaux, France; Radiology Department, Bordeaux University Hospital, Bordeaux, France
| | - Maxime Sermesant
- Université Côte d'Azur, Epione, Inria, Sophia-Antipolis, France; Institut Hospitalo-Universitaire Liryc, Bordeaux, France
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8
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Nakatani Y, Takigawa M, Ramirez FD, Nakashima T, André C, Goujeau C, Carapezzi A, Anzai T, Krisai P, Takagi T, Kamakura T, Konstantinos V, Cheniti G, Tixier R, Welte N, Chauvel R, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Electrophysiologic Determinants of Isoelectric Intervals on Surface Electrocardiograms During Atrial Tachycardia: Insights From High-Density Mapping. JACC Clin Electrophysiol 2023; 9:2054-2066. [PMID: 37715740 DOI: 10.1016/j.jacep.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Substrate abnormalities can alter atrial activation during atrial tachycardias (ATs) thereby influencing AT-wave morphology on the surface electrocardiogram. OBJECTIVES This study sought to identify determinants of isoelectric intervals during ATs with complex atrial activation patterns. METHODS High-density activation maps of 126 ATs were studied. To assess the impact of the activated atrial surface on the presence of isoelectric intervals, this study measured the minimum activated area throughout the AT cycle, defined as the smallest activated area within a 50-millisecond period, by using signal processing algorithms (LUMIPOINT). RESULTS ATs with isoelectric intervals (P-wave ATs) included 23 macro-re-entrant ATs (40%), 26 localized-re-entrant ATs (46%), and 8 focal ATs (14%), whereas those without included 46 macro-re-entrant ATs (67%), 21 localized-re-entrant ATs (30%), and 2 focal ATs (3%). Multivariable regression identified smaller minimum activated area and larger very low voltage area as independent predictors of P-wave ATs (OR: 0.732; 95% CI: 0.644-0.831; P < 0.001; and OR: 1.042; 95% CI: 1.006-1.080; P = 0.023, respectively). The minimum activated area with the cutoff value of 10 cm2 provided the highest predictive accuracy for P-wave ATs with sensitivity, specificity, and positive and negative predictive values of 96%, 97%, 97%, and 95%, respectively. In re-entrant ATs, smaller minimum activated area was associated with lower minimum conduction velocity within the circuit and fewer areas of delayed conduction outside of the circuit (standardized β: 0.524; 95% CI: 0.373-0.675; P < 0.001; and standardized β: 0.353; 95% CI: 0.198-0.508; P < 0.001, respectively). CONCLUSIONS Reduced atrial activation area and voltage were associated with isoelectric intervals during ATs.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France.
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | | | - Tatsuhiko Anzai
- Department of Biostatistics, M and D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Vlachos Konstantinos
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Nicolas Welte
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; IHU LIRYC-Centre Hospitalier Universitaire Bordeaux, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale U1045, Pessac, France
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9
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Cheniti G, Haissaguerre M, Dina C, Kamakura T, Duchateau J, Sacher F, Racine HP, Surget E, Simonet F, Gourraud JB, Sridi S, Cochet H, Andre C, Bouyer B, Chauvel R, Tixier R, Derval N, Pambrun T, Dubois R, Jais P, Nademanee K, Redon R, Schott JJ, Probst V, Hocini M, Barc J, Bernus O. Left Ventricular Abnormal Substrate in Brugada Syndrome. JACC Clin Electrophysiol 2023; 9:2041-2051. [PMID: 37480873 DOI: 10.1016/j.jacep.2023.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Slow-conductive structural abnormalities located in the epicardium of the right ventricle (RV) underlie Brugada syndrome (BrS). The extent of such substrate in the left ventricle (LV) has not been investigated. OBJECTIVES This study sought to characterize the extent of epicardial substrate abnormalities in BrS. METHODS We evaluated 22 consecutive patients (mean age 46 ± 11 years, 21 male) referred for recurrent ventricular arrhythmias (mean 10 ± 13 episodes) in the setting of BrS. The patients underwent clinical investigations and wide genetic screening to identify SCN5A mutations and common risk variants. High-density biventricular epicardial mapping was performed to detect prolonged (>70 ms) fragmented electrograms, indicating abnormal substrate area. RESULTS All patients presented with abnormal substrate in the epicardial anterior RV (27 ± 11 cm2). Abnormal substrate was also identified on the LV epicardium in 10 patients (45%), 9 at baseline and 1 after ajmaline infusion, covering 15 ± 11 cm2. Of these, 4 had severe LV fascicular blocks. Patients with LV substrate had a longer history of arrhythmia (11.4 ± 6.7 years vs 4.3 ± 4.3 years; P = 0.003), longer PR (217 ± 24 ms vs 171 ± 14 ms; P < 0.001) and HV (60 ± 12 ms vs 46 ± 5 ms; P = 0.005) intervals, and abnormal substrate also extending into the inferior RV (100% vs 33%; P = 0.001). SCN5A mutation was present in 70% of patients with LV substrate (vs 25%; P = 0.035). SCN5A BrS patients with recurrent ventricular arrhythmias present a higher polygenic risk score compared with a nonselected BrS population (median of differences: -0.86; 95% CI: -1.48 to -0.27; P = 0.02). CONCLUSIONS A subset of patients with BrS present an abnormal substrate extending onto the LV epicardium and inferior RV that is associated with SCN5A mutations and multigenic variants.
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Affiliation(s)
- Ghassen Cheniti
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France.
| | - Michel Haissaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Tsukasa Kamakura
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Hugo-Pierre Racine
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Elodie Surget
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Floriane Simonet
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Baptiste Gourraud
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Soumaya Sridi
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Hubert Cochet
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Clementine Andre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Benjamin Bouyer
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Remi Chauvel
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Romain Tixier
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Thomas Pambrun
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Remi Dubois
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | | | - Richard Redon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Vincent Probst
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Meleze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Julien Barc
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Olivier Bernus
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
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10
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Duchateau J, Krisai P, Charton J, Benali K, Cheniti G, Surget E, Sacher F, Hocini M, Haïssaguerre M. How to perform Purkinje tissue ablation for the treatment of idiopathic VF. Heart Rhythm 2023; 20:1408-1413. [PMID: 37468026 DOI: 10.1016/j.hrthm.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Josselin Duchateau
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
| | - Philipp Krisai
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Charton
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Karim Benali
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Elodie Surget
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
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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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Nakatani Y, Ramirez FD, Takigawa M, Nakashima T, André C, Goujeau C, Krisai P, Takagi T, Kamakura T, Vlachos K, Carapezzi A, Cheniti G, Tixier R, Welte N, Chauvel R, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Abnormal Atrial Potentials Recorded During Sinus Rhythm or Pacing Represent Substrates for Reentrant Atrial Tachycardia. Circ Arrhythm Electrophysiol 2023; 16:e012241. [PMID: 37728002 DOI: 10.1161/circep.123.012241] [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: 12/10/2022] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Abnormal atrial potentials (AAPs) recorded during sinus rhythm/atrial pacing may indicate areas of slow conduction capable of supporting reentrant atrial tachycardia (AT). Therefore, we sought to examine the relationship between AAPs and AT circuits. METHODS One hundred twenty-three reentrant ATs in 104 patients were analyzed. AAPs, consisting of fragmented potentials and split potentials, were assessed using the Rhythmia LUMIPOINT algorithm. RESULTS There was 93±13% overlap between areas with AAPs during sinus rhythm/atrial pacing and areas of slow conduction along the reentry circuit during AT. The cumulative area of AAPs was smaller in patients with localized-reentrant ATs compared with anatomic macro-reentrant ATs (20.0 [14.6-30.5] versus 28.9 [21.8-35.6] cm2; P=0.021). Patients with perimitral ATs had larger areas of AAPs on the lateral wall whereas patients with roof-dependent ATs had larger areas of AAPs on the roof and posterior wall (P≤0.018 for all comparisons). The patchy scar that was associated with localized-reentrant AT exhibited a larger area of AAPs at its periphery than the scar that did not participate in localized-reentrant AT (3.1 [2.4-4.5] versus 1.0 [0.7-1.6] cm2; P<0.001). CONCLUSIONS AAPs recorded during sinus rhythm/atrial pacing are associated with areas of slow conduction during reentrant AT. The burden and distribution of AAPs may provide actionable insights into AT circuit features, including in cases in which ATs are difficult to map.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
- Division of Cardiology, University of Ottawa Heart Institute, Canada (F.D.R.)
- School of Epidemiology and Public Health, University of Ottawa, Canada (F.D.R.)
| | - Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Konstantinos Vlachos
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | | | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Nicolas Welte
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre, P.J.)
- IHU LIRYC - CHU Bordeaux, France (Y.N., F.D.R., M.T., T.N., C.A., C.G., P.K., T.T., T.K., V.K., G.C., R.T., N.W., R.C., J.D., T.P., N.D., F.S., M. Hocini, M. Haïssaguerre. P.J.)
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Ascione C, Kowalewski C, Bergonti M, Yokoyama M, Monaco C, Bouyer B, Chauvel R, Arnaud M, Buliard S, Tixier R, Vlachos K, Krisai P, Kamakura T, Takagi T, Duchateau J, Pambrun T, Derval N, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. Omnipolar versus bipolar mapping to guide ventricular tachycardia ablation. Heart Rhythm 2023; 20:1370-1377. [PMID: 37414109 DOI: 10.1016/j.hrthm.2023.06.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Omnipolar technology (OT) was recently proposed to generate electroanatomic voltage maps with orientation-independent electrograms. We describe the first cohort of patients undergoing ventricular tachycardia (VT) ablation guided by OT. OBJECTIVE The purpose of this study was to compare omnipolar and bipolar high-density maps with regard to voltage amplitude, late potential (LP) annotation, and isochronal late activation mapping distribution. METHODS A total of 24 patients (16 [66%] ischemic cardiomyopathy and 12 [50%] redo cases) underwent VT ablation under OT guidance. Twenty-seven sinus rhythm substrate maps and 10 VT activation maps were analyzed. Omnipolar and bipolar (HD Wave Solution algorithm, Abbott, Abbott Park, IL) voltages were compared. Areas of LPs were correlated with the VT isthmus areas, and late electrogram misannotation was evaluated. Deceleration zones based on isochronal late activation maps were analyzed by 2 blinded operators and compared to the VT isthmuses. RESULTS OT maps had higher point density (13.8 points/cm2 vs 8.0 points/cm2). Omnipolar points had 7.1% higher voltages than bipolar points within areas of dense scar and border zone. The number of misannotated points was significantly lower for OT maps (6.8% vs 21.9%; P = .01), showing comparable sensitivity (53% vs 59%) but higher specificity (79% vs 63%). The sensitivity and specificity of detection of the VT isthmus in the deceleration zones were, respectively, 75% and 65% for OT and 35% and 55% for bipolar mapping. At 8.4 months, 71% freedom from VT recurrence was achieved. CONCLUSION OT is a valuable tool for guiding VT ablation, providing more accurate identification of LPs and isochronal crowding due to slightly higher voltages.
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Affiliation(s)
- Ciro Ascione
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France.
| | - Christopher Kowalewski
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Marco Bergonti
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Masaaki Yokoyama
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Cinzia Monaco
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Benjamin Bouyer
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Rémi Chauvel
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Marine Arnaud
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Samuel Buliard
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Romain Tixier
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Konstantinos Vlachos
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Philipp Krisai
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Tsukasa Kamakura
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Takamitsu Takagi
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Josselin Duchateau
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Thomas Pambrun
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Nicolas Derval
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Mélèze Hocini
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Michel Haïssaguerre
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Pierre Jaïs
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
| | - Frederic Sacher
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; CHU de Bordeaux, Cardiac arrhythmia department, INSERM, U 1045, Bordeaux, France
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14
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Takigawa M, Kamakura T, Martin C, Derval N, Cheniti G, Duchateau J, Pambrun T, Sacher F, Cochet H, Hocini M, Negishi M, Yamamoto T, Ikenouchi T, Goto K, Shigeta T, Nishimura T, Tao S, Miyazaki S, Goya M, Sasano T, Haissaguierre M, Jais P. Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias. Europace 2023; 25:euad195. [PMID: 37428890 PMCID: PMC10403248 DOI: 10.1093/europace/euad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
AIMS Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping. OBJECTIVE We examined if the information gathered from the cycle length (CL) of the tachycardia can help predict the AT-mechanism and its localization. METHODS One hundred and thirty-eight activation maps of ATs including eight focal-ATs, 94 macroreentrant-ATs, and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, the CL-respiration correlation was analysed by the RhythmiaTM system. : Both MCL and mCL were significantly shorter in macroreentrant-ATs [MCL = 288 (253-348) ms, P = 0.0001; mCL = 283 (243-341) ms, P = 0.0012], and also shorter in localized-ATs [MCL = 314 (261-349) ms, P = 0.0016; mCL = 295 (248-340) ms, P = 0.0047] compared to focal-ATs [MCL = 506 (421-555) ms, mCL = 427 (347-508) ms]. An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated re-entrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the re-entrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of re-entrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%). CONCLUSION Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Claire Martin
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- Cardiology Department, Royal Papworth Hospital, Cambridge CB2 0AY, UK
- Department of Medicine, Cambridge University, Cambridge CB2 0QQ, UK
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Miho Negishi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Takatoshi Shigeta
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Masahiko Goya
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo
| | - Michel Haissaguierre
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France
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15
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Takigawa M, Sacher F, Martin C, Cheniti G, Duchateau J, Pambrun T, Derval N, Cochet H, Hocini M, Yamamoto T, Nishimura T, Tao S, Miyazaki S, Goya M, Sasano T, Haissaguierre M, Jais P. Impact of filter configurations on bipolar EGMs: An optimal filter setting for identifying VT substrates. J Cardiovasc Electrophysiol 2023; 34:1708-1717. [PMID: 37431258 DOI: 10.1111/jce.15997] [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: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND The impact of filtering on bipolar electrograms (EGMs) has not been systematically examined. We tried to clarify the optimal filter configuration for ventricular tachycardia (VT) ablation. METHODS Fifteen patients with VT were included. Eight different filter configurations were prospectively created for the distal bipoles of the ablation catheter: 1.0-250, 10-250, 100-250, 30-50, 30-100, 30-250, 30-500, and 30-1000 Hz. Pre-ablation stable EGMs with good contact (contact force > 10 g) were analyzed. Baseline fluctuation, baseline noise, bipolar peak-to-peak voltage, and presence of local abnormal ventricular activity (LAVA) were compared between different filter configurations. RESULTS In total, 2276 EGMs with multiple bipolar configurations in 246 sites in scar and border areas were analyzed. Baseline fluctuation was only observed in the high-pass filter of (HPF) ≤ 10 Hz (p < .001). Noise level was lowest at 30-50 Hz (0.018 [0.012-0.029] mV), increased as the low-pass filter (LPF) extended, and was highest at 30-1000 Hz (0.047 [0.041-0.061] mV) (p < .001). Conversely, the HPF did not affect the noise level at ≤30 Hz. As the HPF extended to 100 Hz, bipolar voltages significantly decreased (p < .001), but were not affected when the LPF was extended to ≥100 Hz. LAVAs were most frequently detected at 30-250 Hz (207/246; 84.2%) and 30-500 Hz (208/246; 84.6%), followed by 30-1000 Hz (205/246; 83.3%), but frequently missed at LPF ≤ 100 Hz or HPF ≤ 10 Hz (p < .001). A 50-Hz notch-filter reduced the bipolar voltage by 43.9% and LAVA-detection by 34.5% (p < .0001). CONCLUSION Bipolar EGMs are strongly affected by filter settings in scar/border areas. In all, 30-250 or 30-500 Hz may be the best configuration, minimizing the baseline fluctuation, baseline noise, and detecting LAVAs. Not applying the 50-Hz notch filter may be beneficial to avoid missing VT substrate.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Claire Martin
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- Royal Papworth Hospital, Cambridge, UK
- Department of Medicine, Cambridge University, Cambridge, UK
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Michel Haissaguierre
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
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16
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Haissaguerre M, Duchateau J, Laredo M, Lavergne T, Winum PF, Cheniti G, Waintraub X, Samson S, Surget E, Tixier R, Sacher F, Marijon E, Bernus O, Gandjbakhch E. Inducibility of Short-Coupled Purkinje Ectopy by Pharmacological Tests in Patients With Spontaneous Short-Coupled Idiopathic Ventricular Fibrillation. Circulation 2023; 148:70-72. [PMID: 37399260 DOI: 10.1161/circulationaha.122.063578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Michel Haissaguerre
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France (M.H., F.S., O.B.)
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
| | - Josselin Duchateau
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
| | - Mikael Laredo
- Cardiology Institute, Pitié-Salpetriere, AP-HP, Sorbonne Université, Paris, France (M.L., X.W., E.G.)
| | - Thomas Lavergne
- Cardiology Department, European Hospital Georges Pompidou, AP-HP, Paris University, France (T.L., E.M.)
| | - Pierre F Winum
- Cardiology Department, University Hospital, CHU Nimes, France (P.F.W.)
| | - Ghassen Cheniti
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
| | - Xavier Waintraub
- Cardiology Institute, Pitié-Salpetriere, AP-HP, Sorbonne Université, Paris, France (M.L., X.W., E.G.)
| | | | - Elodie Surget
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
| | - Romain Tixier
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
| | - Frederic Sacher
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France (M.H., F.S., O.B.)
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
- Inherited Arrhythmic Disease Center, Haut-Leveque Hospital, CHU Bordeaux, France (F.S.)
| | - Eloi Marijon
- Cardiology Department, European Hospital Georges Pompidou, AP-HP, Paris University, France (T.L., E.M.)
| | - Olivier Bernus
- Université de Bordeaux, CRCTB U1045, Inserm, France (M.H., J.D., G.C., E.S., F.S., O.B.)
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France (M.H., F.S., O.B.)
- Cardiac Electrophysiology and Stimulation Department, Bordeaux University Hospital, France (M.H., R.T., F.S., O.B.)
| | - Estelle Gandjbakhch
- Cardiology Institute, Pitié-Salpetriere, AP-HP, Sorbonne Université, Paris, France (M.L., X.W., E.G.)
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17
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Takigawa M, Martin CA, Yamamoto T, Nakatani Y, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Nishimura T, Tao S, Miyazaki S, Goya M, Haïssaguerre M, Sasano T, Jaïs P. Demonstration of the discrepancy between AT-wave morphology on 12-lead ECG and AT mechanism in scar-related AT. Pacing Clin Electrophysiol 2023; 46:515-518. [PMID: 36690018 DOI: 10.1111/pace.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/17/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
The 12-lead electrocardiogram (ECG) is a fundamental modality to help determine the mechanism and the localization of atrial tachycardias (ATs). Although macroreentrant ATs and focal ATs typically show F-waves and discrete P-waves respectively on the 12-lead ECG, this is not universally the case in scar-related ATs.1, We present three cases clearly showing the discrepancy between the AT morphology on the 12-lead ECG and the AT-mechanism.
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Affiliation(s)
- Masateru Takigawa
- Tokyo Medical and Dental University, Tokyo, Japan
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | | | - Yosuke Nakatani
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Thomas Pambrun
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Susumu Tao
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | - Pierre Jaïs
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
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18
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Bouyer B, Jalal Z, Daniel Ramirez F, Derval N, Iriart X, Duchateau J, Roubertie F, Tafer N, Tixier R, Pambrun T, Cheniti G, Ascione C, Yokoyama M, Kowalewski C, Buliard S, Chauvel R, Arnaud M, Hocini M, Haïssaguerre M, Jaïs P, Cochet H, Thambo JB, Sacher F. Electrophysiological study prior to planned pulmonary valve replacement in patients with repaired tetralogy of Fallot. J Cardiovasc Electrophysiol 2023; 34:1395-1404. [PMID: 37232426 DOI: 10.1111/jce.15940] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
AIM Ventricular arrhythmias (VAs) are the most common cause of death in patients with repaired Tetralogy of Fallot (rTOF). However, risk stratifying remains challenging. We examined outcomes following programmed ventricular stimulation (PVS) with or without subsequent ablation in patients with rTOF planned for pulmonary valve replacement (PVR). METHODS We included all consecutive patients with rTOF referred to our institution from 2010 to 2018 aged ≥18 years for PVR. Right ventricular (RV) voltage maps were acquired and PVS was performed from two different sites at baseline, and if non-inducible under isoproterenol. Catheter and/or surgical ablation was performed when patients were inducible or when slow conduction was present in anatomical isthmuses (AIs). Postablation PVS was undertaken to guide implantable cardioverter-defibrillator (ICD) implantation. RESULTS Seventy-seven patients (36.2 ± 14.3 years old, 71% male) were included. Eighteen were inducible. In 28 patients (17 inducible, 11 non-inducible but with slow conduction) ablation was performed. Five had catheter ablation, surgical cryoablation in 9, both techniques in 14. ICDs were implanted in five patients. During a follow-up of 74 ± 40 months, no sudden cardiac death occurred. Three patients experienced sustained VAs, all were inducible during the initial EP study. Two of them had an ICD (low ejection fraction for one and important risk factor for arrhythmia for the second). No VAs were reported in the non-inducible group (p < .001). CONCLUSION Preoperative EPS can help identifying patients with rTOF at risk for VAs, providing an opportunity for targeted ablation and may improve decision-making regarding ICD implantation.
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Affiliation(s)
- Benjamin Bouyer
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Zakaria Jalal
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France
| | | | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Xavier Iriart
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - François Roubertie
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Nadir Tafer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Ciro Ascione
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Masaaki Yokoyama
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Christopher Kowalewski
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Samuel Buliard
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Marine Arnaud
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Radiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Jean-Benoit Thambo
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
- Department of Congenital Heart Disease, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
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19
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Kowalewski C, Ascione C, Nuñez-Garcia M, Ly B, Sermesant M, Bustin A, Sridi S, Bouteiller X, Yokoyama M, Vlachos K, Monaco C, Bouyer B, Buliard S, Arnaud M, Tixier R, Chauvel R, Derval N, Pambrun T, Duchateau J, Bordachar P, Hocini M, Hindricks G, Haïssaguerre M, Sacher F, Jais P, Cochet H. Advanced Imaging Integration for Catheter Ablation of Ventricular Tachycardia. Curr Cardiol Rep 2023; 25:535-542. [PMID: 37115434 DOI: 10.1007/s11886-023-01872-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Imaging plays a crucial role in the therapy of ventricular tachycardia (VT). We offer an overview of the different methods and provide information on their use in a clinical setting. RECENT FINDINGS The use of imaging in VT has progressed recently. Intracardiac echography facilitates catheter navigation and the targeting of moving intracardiac structures. Integration of pre-procedural CT or MRI allows for targeting the VT substrate, with major expected impact on VT ablation efficacy and efficiency. Advances in computational modeling may further enhance the performance of imaging, giving access to pre-operative simulation of VT. These advances in non-invasive diagnosis are increasingly being coupled with non-invasive approaches for therapy delivery. This review highlights the latest research on the use of imaging in VT procedures. Image-based strategies are progressively shifting from using images as an adjunct tool to electrophysiological techniques, to an integration of imaging as a central element of the treatment strategy.
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Affiliation(s)
- Christopher Kowalewski
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
| | - Ciro Ascione
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marta Nuñez-Garcia
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Buntheng Ly
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Maxime Sermesant
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Aurélien Bustin
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Soumaya Sridi
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Xavier Bouteiller
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masaaki Yokoyama
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Cinzia Monaco
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Benjamin Bouyer
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Samuel Buliard
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marine Arnaud
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Gerhard Hindricks
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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20
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Surget E, Duchateau J, Marchant J, Maury P, Walton R, Lavergne T, Gandjbakhch E, Leenhardt A, Extramiana F, Haïssaguerre M. Idiopathic ventricular fibrillation associated with long-coupled Purkinje ectopy. J Cardiovasc Electrophysiol 2023; 34:615-623. [PMID: 36748854 DOI: 10.1111/jce.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Idiopathic ventricular fibrillation (IVF) is mainly associated with and triggered by short-coupled (R-on-T) ventricular ectopics. However, little is known about the risk of VF associated with long-coupled premature ventricular complexes (LCPVCs). OBJECTIVE To examine the prevalence and characteristics of IVF patients presenting with LCPVCs. METHODS Consecutive patients with IVF and PVCs from five arrhythmia referral centers were reviewed. We included patients presenting LCPVCs, defined as PVCs falling after the end of the T wave, with a normal QTc interval. We evaluated demographics, medical history, and clinical circumstances associated with PVCs and VF episodes. The origin of PVCs was determined by invasive mapping. RESULTS Seventy-nine patients with IVF were reviewed. Among them, 12 (15.2%) met the inclusion criteria (8 women, age 36 ± 14 years). Eleven patients had documented LCPVCs initiating repetitive PVCs or sustained VF, whereas 1 had only documented isolated PVCs. In 10 of 12 patients, PVCs were recorded showing both long and short coupling intervals of 418 ± 46 and 304 ± 33 ms, respectively. Mapping showed that PVCs originated from the left Purkinje in 10 patients, from the right Purkinje in 1 patient, and both in 1 patient. Compared to other patients from the initial cohort, IVF with LCPVCs was associated with a left-sided origin of PVCs (92% in long-coupled IVF vs. 46% of left Purkinje PVCs in short-coupled IVF, p = .004). CONCLUSION Long-coupled fascicular PVCs, traditionally recognized as benign, can be associated with IVF in a subset of patients. They can induce IVF by themselves or in association with short-coupled PVCs.
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Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - James Marchant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Philippe Maury
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Thomas Lavergne
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Estelle Gandjbakhch
- Institute of Cardiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Antoine Leenhardt
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Fabrice Extramiana
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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21
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Ditac G, Cottinet PJ, Quyen Le M, Grinberg D, Duchateau J, Gardey K, Dulac A, Delinière A, Haddad C, Boussuge-Roze J, Sacher F, Jaïs P, Chevalier P, Bessière F. Carbon footprint of atrial fibrillation catheter ablation. Europace 2023; 25:331-340. [PMID: 36107465 PMCID: PMC10103577 DOI: 10.1093/europace/euac160] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Climate change represents the biggest global health threat of the 21st century. Health care system is itself a large contributor to greenhouse gas (GHG) emissions. In cardiology, atrial fibrillation (AF) catheter ablation is an increasing activity using numerous non-reusable materials that could contribute to GHG emission. Determining a detailed carbon footprint analysis of an AF catheter ablation procedure allows the identification of the main polluting sources that give opportunities for reduction of environmental impact. To assess the carbon footprint of AF catheter ablation procedure. To determine priority actions to decrease pollution. METHODS AND RESULTS An eco-audit method used to predict the GHG emission of an AF catheter ablation procedure was investigated. Two workstations were considered including surgery and anaesthesia. In the operating room, every waste produced by single-use medical devices, pharmaceutical drugs, and energy consumption during intervention were evaluated. All analyses were limited to the operating room. Thirty procedures were analysed over a period of 8 weeks: 18 pulmonary veins isolation RF ablations, 7 complex RF procedures including PVI, roof and mitral isthmus lines, ethanol infusion of the Marshall vein and cavo tricuspid isthmus line, and 5 pulmonary vein isolation with cryoballoon. The mean emission during AF catheter ablation procedures was 76.9 kg of carbon dioxide equivalent (CO2-e). The operating field accounted for 75.4% of the carbon footprint, while only 24.6% for the anaesthesia workstation. On one hand, material production and manufacturing were the most polluting phases of product life cycle which, respectively, represented 71.3% (54.8 kg of CO2-e) and 17.0% (13.1 kg of CO2-e) of total pollution. On the other hand, transport contributed in 10.6% (8.1 kg of CO2-e), while product use resulted in 1.1% (0.9 kg of CO2-e) of GHG production. Electrophysiology catheters were demonstrated to be the main contributors of environmental impact with 29.9 kg of CO2-e (i.e. 38.8%). Three dimensional mapping system and electrocardiogram patches were accounting for 6.8 kg of CO2-e (i.e. 8.8% of total). CONCLUSION AF catheter ablation involves a mean of 76.9 kg of CO2-e. With an estimated 600 000 annual worldwide procedures, the environmental impact of AF catheter ablation activity is estimated equal to 125 tons of CO2 emission each day. It represents an equivalent of 700 000 km of car ride every day. Electrophysiology catheters and patches are the main contributors of the carbon footprint. The focus must be on reducing, reusing, and recycling these items to limit the impact of AF ablation on the environment. A road map of steps to implement in different time frames is proposed.
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Affiliation(s)
- Geoffroy Ditac
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Pierre-Jean Cottinet
- INSA-Lyon, LGEF, Université de Lyon, 20 Av. Albert Einstein, 69100 Villeurbanne, France
| | - Minh Quyen Le
- INSA-Lyon, LGEF, Université de Lyon, 20 Av. Albert Einstein, 69100 Villeurbanne, France
| | - Daniel Grinberg
- Department of Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Josselin Duchateau
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Kévin Gardey
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Arnaud Dulac
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Antoine Delinière
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Christelle Haddad
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Julie Boussuge-Roze
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Frédéric Sacher
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Pierre Jaïs
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Philippe Chevalier
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Francis Bessière
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
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22
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Bonnin T, Roumegou P, Sridi S, Mahida S, Bustin A, Duchateau J, Tixier R, Derval N, Pambrun T, Chniti G, Takagi T, Kamakura T, Krisai P, Andre C, Chauvel R, Hocini M, Haissaguerre M, Jais P, Cochet H, Sacher F. Prevalence and risk factors of cardiac thrombus prior to ventricular tachycardia catheter ablation in structural heart disease. Europace 2023; 25:487-495. [PMID: 36355748 PMCID: PMC10103557 DOI: 10.1093/europace/euac156] [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: 02/03/2022] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Assess prevalence, risk factors, and management of patients with intra-cardiac thrombus referred for scar-related ventricular tachycardia (VT) ablation. METHODS AND RESULTS Consecutive VT ablation referrals between January 2015 and December 2019 were reviewed (n = 618). Patients referred for de novo, scar-related VT ablation who underwent pre-procedure cardiac computed tomography (cCT) were included. We included 401 patients [61 ± 14 years; 364 male; left ventricular ejection fraction (LVEF) 40 ± 13%]; 45 patients (11%) had cardiac thrombi on cCT at 49 sites [29 LV; eight left atrial appendage (LAA); eight right ventricle (RV); four right atrial appendage]. Nine patients had pulmonary emboli. Overall predictors of cardiac thrombus included LV aneurysm [odds ratio (OR): 6.6, 95%, confidence interval (CI): 3.1-14.3], LVEF < 40% (OR: 3.3, CI: 1.5-7.3), altered RV ejection fraction (OR: 2.3, CI: 1.1-4.6), and electrical storm (OR: 2.9, CI: 1.4-6.1). Thrombus location-specific analysis identified LV aneurysm (OR: 10.9, CI: 4.3-27.7) and LVEF < 40% (OR: 9.6, CI: 2.6-35.8) as predictors of LV thrombus and arrhythmogenic right ventricular cardiomyopathy (OR: 10.6, CI: 1.2-98.4) as a predictor for RV thrombus. Left atrial appendage thrombi exclusively occurred in patients with atrial fibrillation. Ventricular tachycardia ablation was finally performed in 363 including 7 (16%) patients with thrombus but refractory electrical storm. These seven patients had tailored ablation with no embolic complications. Only one (0.3%) ablation-related embolic event occurred in the entire cohort. CONCLUSION Cardiac thrombus can be identified in 11% of patients referred for scar-related VT ablation. These findings underscore the importance of systematic thrombus screening to minimize embolic risk.
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Affiliation(s)
- Thomas Bonnin
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Pierre Roumegou
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Soumaya Sridi
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France.,Department of Radiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Saagar Mahida
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Aurélien Bustin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France.,Department of Radiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Ghassen Chniti
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Clementine Andre
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Meleze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Michel Haissaguerre
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France.,Department of Radiology, Bordeaux University Hospital (CHU), Bordeaux, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Hopital cardiologique du Haut-Leveque, Bordeaux University Hospital (CHU), 33604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, University Bordeaux, F-33600 Bordeaux, France
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Michot A, Zalta M, Pinsolle V, Pélissier P, Casoli V, Dannepond A, Duchateau J, Delgove A. Use of Near-infrared spectroscopy (NIRS) for monitoring free flaps. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.576] [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: 02/25/2023]
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Boussuge-Roze J, Duchateau J, Bessiere F, Sacher F, Jaïs P. Author Correction: Environmental sustainability in cardiology: reducing the carbon footprint of the catheterization laboratory. Nat Rev Cardiol 2023; 20:138. [PMID: 36604488 DOI: 10.1038/s41569-023-00831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Julie Boussuge-Roze
- Electrophysiology and Heart Modelling Institute, IHU Liryc, Université de Bordeaux, INSERM CRCTB U1045, Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Heart Modelling Institute, IHU Liryc, Université de Bordeaux, INSERM CRCTB U1045, Pessac, France.,Department of Electrophysiology and Cardiac Stimulation, CHU de Bordeaux, Bordeaux, France
| | - Francis Bessiere
- Department of Electrophysiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France.,Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - Frederic Sacher
- Electrophysiology and Heart Modelling Institute, IHU Liryc, Université de Bordeaux, INSERM CRCTB U1045, Pessac, France.,Department of Electrophysiology and Cardiac Stimulation, CHU de Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology and Heart Modelling Institute, IHU Liryc, Université de Bordeaux, INSERM CRCTB U1045, Pessac, France. .,Department of Electrophysiology and Cardiac Stimulation, CHU de Bordeaux, Bordeaux, France.
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Tixier R, Duchateau J, Derval N, Pambrun T, Bouyer B, Chauvel R, Buliard S, André C, Strik M, Ploux S, Bordachar P, Hocini M, Jaïs P, Haissaguerre M, Sacher F. Retrospective single center experience use of propofol for general anesthesia in Brugada patients. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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26
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Takagi T, Derval N, Duchateau J, Chauvel R, Tixier R, Marchand H, Bouyer B, André C, Kamakura T, Krisai P, Ascione C, Balbo C, Cheniti G, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication. Heart Rhythm 2023; 20:14-21. [PMID: 36115541 DOI: 10.1016/j.hrthm.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce. OBJECTIVE The purpose of this study was to evaluate the impact of gaps within such a lesion set. METHODS We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg). RESULTS Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05). CONCLUSION Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
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Affiliation(s)
- Takamitsu Takagi
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France.
| | - Nicolas Derval
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Hugo Marchand
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Benjamin Bouyer
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Philipp Krisai
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ciro Ascione
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Conrado Balbo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
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Charton J, Tixier R, Sacher F, Hocini M, Haissaguerre M, Duchateau J. Stepwise Ablation Strategy for Post-myocardial infarction ventricular fibrillation: from Arrhythmia Suppression to Ablation. HeartRhythm Case Rep 2022; 9:133-137. [PMID: 36970384 PMCID: PMC10030304 DOI: 10.1016/j.hrcr.2022.10.021] [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: 11/11/2022] Open
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Ascione C, Benabou L, Hocini M, Jaïs P, Haïssaguerre M, Duchateau J. Cardioneuroablation: Don't underestimate the posteromedial left atrial ganglionated plexus. HeartRhythm Case Rep 2022; 9:67-69. [PMID: 36860755 PMCID: PMC9968900 DOI: 10.1016/j.hrcr.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ciro Ascione
- Address reprint requests and correspondence: Dr Ciro Ascione, Division of Cardiac Electrophysiology, CHU de Bordeaux, Av. Magellan, 33604 Pessac, France.
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Haissaguerre M, Cheniti G, Nademanee K, Sacher F, Duchateau J, Coronel R, Vigmond E, Boukens BJ, Bernus O. Dependence of epicardial T-wave on local activation voltage in Brugada syndrome. Heart Rhythm 2022; 19:1686-1688. [DOI: 10.1016/j.hrthm.2022.05.036] [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: 04/06/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022]
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Kamakura T, André C, Duchateau J, Nakashima T, Nakatani Y, Takagi T, Krisai P, Ascione C, Balbo C, Tixier R, Chauvel R, Cheniti G, Kusano K, Cochet H, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Derval N, Pambrun T. Distribution of atrial low voltage induced by vein of Marshall ethanol infusion. J Cardiovasc Electrophysiol 2022; 33:1687-1693. [PMID: 35637606 DOI: 10.1111/jce.15573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion. METHODS AND RESULTS The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients. CONCLUSION VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France.,Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ciro Ascione
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Conrado Balbo
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Arnaud Denis
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
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Krisai P, Hocini M, Derval N, Pambrun T, Constantin M, Earl R, Duchateau J, Sacher F, Haïssaguerre M, Jaïs P. A Novel Balloon-Based Catheter for Venous Ethanol Ablation. JACC Clin Electrophysiol 2022; 8:1157-1159. [DOI: 10.1016/j.jacep.2022.04.004] [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: 01/06/2022] [Revised: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
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Sacher F, TIXIER R, Duchateau J, Bouyer B, CHENITI G, Marchand H, Pambrun T, DERVAL N, Kamakura T, Balbo CP, Krisai P, Ascione C, Cochet H, Hocini M, Haissaguerre M, Jais P. PO-717-08 UNUSUAL LETHAL COMPLICATION DURING SCAR-RELATED VT ABLATION: A CASE OF DRY TAMPONADE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nakashima T, Pambrun T, Vlachos K, Goujeau C, André C, Krisai P, Daniel Ramirez F, Pintican G, Kamakura T, Takagi T, Nakatani Y, Surget E, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Strategy for Repeat Procedures in Patients with Persistent Atrial Fibrillation: Systematic Linear Ablation with Adjunctive Ethanol Infusion into the Vein of Marshall versus Electrophysiology‐Guided Ablation. J Cardiovasc Electrophysiol 2022; 33:1116-1124. [DOI: 10.1111/jce.15472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - F. Daniel Ramirez
- CHU Bordeaux, IHU Lyric, Univ. BordeauxFrance
- Division of Cardiology, University of Ottawa Heart InstituteOttawaOntarioCanada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Jaïs
- CHU Bordeaux, IHU Lyric, Univ. BordeauxFrance
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Nakatani Y, Nuñez-Garcia M, Cheniti G, Sridi-Cheniti S, Bustin A, Jia S, Goujeau C, André C, Nakashima T, Krisai P, Takagi T, Kamakura T, Derval N, Duchateau J, Pambrun T, Chauvel R, Sacher F, Hocini M, Haïssaguerre M, Sermesant M, Jais P, Cochet H. Preoperative Personalization of Atrial Fibrillation Ablation Strategy to Prevent Esophageal Injury: Impact of Changes in Esophageal Position. J Cardiovasc Electrophysiol 2022; 33:908-916. [PMID: 35274776 DOI: 10.1111/jce.15447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Due to changes in esophageal position, preoperative assessment of the esophageal location may not mitigate the risk of esophageal injury in catheter ablation for atrial fibrillation (AF). This study aimed to assess esophageal motion and its impact on AF ablation strategies. METHODS AND RESULTS Ninety-seven AF patients underwent 2 computed tomography (CT) scans. The area at risk of esophageal injury (AAR) was defined as the left atrial surface ≤3 mm from the esophagus. On CT1, ablation lines were drawn blinded to the esophageal location to create 3 ablation sets: individual pulmonary vein isolation (PVI), wide antral circumferential ablation (WACA), and WACA with linear ablation (WACA+L). Thereafter, ablation lines for WACA and WACA+L were personalized to avoid the AAR. Rigid registration was performed to align CT1 onto CT2, and the relationship between ablation lines and the AAR on CT2 was analyzed. The esophagus moved by 3.6 [2.7 to 5.5] mm. The AAR on CT2 was 8.6 ± 3.3 cm2 , with 77% overlapping that on CT1. High body mass index was associated with the AAR mismatch (standardized β 0.382, P <0.001). Without personalization, AARs on ablation lines for individual PVI, WACA, and WACA+L were 0 [0-0.4], 0.8 [0.5-1.2], 1.7 [1.2-2.0] cm2 . Despite the esophageal position change, the personalization of ablation lines for WACA and WACA+L reduced the AAR on lines to 0 [0-0.5] and 0.7 [0.3-1.0] cm2 (P <0.001 for both). CONCLUSION The personalization of ablation lines based on a preoperative CT reduced ablation to the AAR despite changes in esophageal position. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Marta Nuñez-Garcia
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Soumaya Sridi-Cheniti
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Aurélien Bustin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Shuman Jia
- INRIA Epione research team, Sophia Antipolis, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Clementine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Maxime Sermesant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,INRIA Epione research team, Sophia Antipolis, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France.,Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
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35
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Barc J, Tadros R, Glinge C, Chiang DY, Jouni M, Simonet F, Jurgens SJ, Baudic M, Nicastro M, Potet F, Offerhaus JA, Walsh R, Choi SH, Verkerk AO, Mizusawa Y, Anys S, Minois D, Arnaud M, Duchateau J, Wijeyeratne YD, Muir A, Papadakis M, Castelletti S, Torchio M, Ortuño CG, Lacunza J, Giachino DF, Cerrato N, Martins RP, Campuzano O, Van Dooren S, Thollet A, Kyndt F, Mazzanti A, Clémenty N, Bisson A, Corveleyn A, Stallmeyer B, Dittmann S, Saenen J, Noël A, Honarbakhsh S, Rudic B, Marzak H, Rowe MK, Federspiel C, Le Page S, Placide L, Milhem A, Barajas-Martinez H, Beckmann BM, Krapels IP, Steinfurt J, Winkel BG, Jabbari R, Shoemaker MB, Boukens BJ, Škorić-Milosavljević D, Bikker H, Manevy FC, Lichtner P, Ribasés M, Meitinger T, Müller-Nurasyid M, Veldink JH, van den Berg LH, Van Damme P, Cusi D, Lanzani C, Rigade S, Charpentier E, Baron E, Bonnaud S, Lecointe S, Donnart A, Le Marec H, Chatel S, Karakachoff M, Bézieau S, London B, Tfelt-Hansen J, Roden D, Odening KE, Cerrone M, Chinitz LA, Volders PG, van de Berg MP, Laurent G, Faivre L, Antzelevitch C, Kääb S, Arnaout AA, Dupuis JM, Pasquie JL, Billon O, Roberts JD, Jesel L, Borggrefe M, Lambiase PD, Mansourati J, Loeys B, Leenhardt A, Guicheney P, Maury P, Schulze-Bahr E, Robyns T, Breckpot J, Babuty D, Priori SG, Napolitano C, de Asmundis C, Brugada P, Brugada R, Arbelo E, Brugada J, Mabo P, Behar N, Giustetto C, Molina MS, Gimeno JR, Hasdemir C, Schwartz PJ, Crotti L, McKeown PP, Sharma S, Behr ER, Haissaguerre M, Sacher F, Rooryck C, Tan HL, Remme CA, Postema PG, Delmar M, Ellinor PT, Lubitz SA, Gourraud JB, Tanck MW, George AL, MacRae CA, Burridge PW, Dina C, Probst V, Wilde AA, Schott JJ, Redon R, Bezzina CR. Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility. Nat Genet 2022; 54:232-239. [PMID: 35210625 DOI: 10.1038/s41588-021-01007-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/13/2021] [Indexed: 12/19/2022]
Abstract
Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel NaV1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on NaV1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings.
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Affiliation(s)
- Julien Barc
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France. .,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, .
| | - Rafik Tadros
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charlotte Glinge
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David Y Chiang
- Medicine, Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariam Jouni
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Floriane Simonet
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Sean J Jurgens
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Manon Baudic
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Michele Nicastro
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Franck Potet
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joost A Offerhaus
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roddy Walsh
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Arie O Verkerk
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Yuka Mizusawa
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Soraya Anys
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Damien Minois
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Marine Arnaud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Alison Muir
- Cardiology, Belfast Health and Social Care Trust and Queen's University Belfast, Belfast, UK
| | - Michael Papadakis
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Silvia Castelletti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Margherita Torchio
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy
| | - Cristina Gil Ortuño
- Cardiogenetic, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia, Spain
| | - Javier Lacunza
- Cardiology, Unidad de Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Daniela F Giachino
- Clinical and Biological Sciences, Medical Genetics, University of Torino, Orbassano, Italy.,Medical Genetics, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Natascia Cerrato
- Medical Sciences, Cardiology, University of Torino, Torino, Italy
| | - Raphaël P Martins
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain.,Medical Science Department, University of Girona, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clinic, University of Barcelona-IDIBAPS, Barcelona, Spain
| | - Sonia Van Dooren
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Centre for Medical Genetics, research group Reproduction and Genetics, research cluster Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Aurélie Thollet
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Florence Kyndt
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | | | - Anniek Corveleyn
- Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Birgit Stallmeyer
- University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Sven Dittmann
- University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Johan Saenen
- Cardiology, Electrophysiology - Cardiogenetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium
| | - Antoine Noël
- Department of Cardiology, University Hospital of Brest, Brest, France
| | | | - Boris Rudic
- Department 1st of Medicine, Cardiology, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Halim Marzak
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | - Matthew K Rowe
- Medicine, Cardiology, Western University, London, Ontario, Canada
| | - Claire Federspiel
- Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche sur Yon, France
| | | | - Leslie Placide
- Department of Cardiology, CHU Montpellier, Montpellier, France
| | - Antoine Milhem
- Department of Cardiology, CH La Rochelle, La Rochelle, France
| | | | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,University Hospital of the Johann Wolfgang Goethe University Frankfurt, Institute of Legal Medicine, Frankfurt, Germany
| | - Ingrid P Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johannes Steinfurt
- Department of Cardiology and Angiology I, Heart Center, University Freiburg, Freiburg, Germany
| | - Bo Gregers Winkel
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Reza Jabbari
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Moore B Shoemaker
- Medicine, Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bas J Boukens
- Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Doris Škorić-Milosavljević
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hennie Bikker
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Genome Diagnostics Laboratory, Clinical Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Federico C Manevy
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Marta Ribasés
- Psychiatric Genetics Unit, Institute Vall d'Hebron Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,IBE, LMU Munich, Munich, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Department of Internal Medicine I (Cardiology), Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | | | - Jan H Veldink
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philip Van Damme
- Neurology Department University Hospital Leuven, Neuroscience Department KU Leuven, Center for Brain & Disease Research VIB, Leuven, Belgium
| | - Daniele Cusi
- Scientific Unit, Bio4Dreams - Business Nursery for Life Sciences, Milan, Italy
| | - Chiara Lanzani
- Nephrology, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Milan, Italy
| | - Sidwell Rigade
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Eric Charpentier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Estelle Baron
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphanie Bonnaud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Simon Lecointe
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Audrey Donnart
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Hervé Le Marec
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphanie Chatel
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Matilde Karakachoff
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphane Bézieau
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Barry London
- Department of Internal Medicine, Division of Cardiovascular Medicine, Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan Roden
- Medicine, Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Medicine, Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Medicine, Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University Freiburg, Freiburg, Germany.,Department of Cardiology, Translational Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marina Cerrone
- Medicine, Leon H. Charney Division of Cardiology, Heart Rhythm Center and Cardiovascular Genetics Program, New York University School of Medicine, New York, NY, USA
| | - Larry A Chinitz
- Medicine, Leon H. Charney Division of Cardiology, Heart Rhythm Center and Cardiovascular Genetics Program, New York University School of Medicine, New York, NY, USA
| | - Paul G Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten P van de Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gabriel Laurent
- Cardiology Department, ImVia lab team IFTIM, University Hospital Dijon, Dijon, France
| | | | | | - Stefan Kääb
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partnersite Munich, Munich, Germany
| | | | | | - Jean-Luc Pasquie
- Department of Cardiology, CNRS UMR9214 - Inserm U1046 - PHYMEDEXP, Université de Montpellier et CHU Montpellier, Montpellier, France
| | - Olivier Billon
- Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche sur Yon, France
| | - Jason D Roberts
- Medicine, Cardiology, Western University, London, Ontario, Canada
| | - Laurence Jesel
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France.,INSERM 1260 - Regenerative Nanomedecine, University of Strasbourg, Strasbourg, France
| | - Martin Borggrefe
- Department 1st of Medicine, Cardiology, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Pier D Lambiase
- Cardiology, Medicine, Barts Heart Centre, London, UK.,Institute of Cardiovasculr Science, UCL, Population Health, UCL, London, UK
| | | | - Bart Loeys
- Center for Medical Genetics, Cardiogenetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Cardiology, Hopital Bichat, Paris, France
| | - Pascale Guicheney
- Sorbonne Université, Paris, France.,UMR_S1166, Faculté de médecine, Sorbonne Université, INSERM, Paris, France
| | - Philippe Maury
- Service de cardiologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Eric Schulze-Bahr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | | | - Silvia G Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Carlo Napolitano
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Carlo de Asmundis
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis, Brussel-Vrije Universiteit Brussel, ERN Heart Guard Center, Brussels, Belgium.,IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ramon Brugada
- Hospital Trueta, CiberCV, University of Girona, IDIBGI, Girona, Spain, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Philippe Mabo
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Nathalie Behar
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Carla Giustetto
- Medical Sciences, Cardiology, University of Torino, Torino, Italy
| | - Maria Sabater Molina
- Cardiogenetic, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia, Spain
| | - Juan R Gimeno
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Cardiology, Unidad de Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Bornova, Turkey
| | - Peter J Schwartz
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy
| | - Lia Crotti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pascal P McKeown
- Cardiology, Belfast Health and Social Care Trust and Queen's University Belfast, Belfast, UK
| | - Sanjay Sharma
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Caroline Rooryck
- CHU Bordeaux, Service de Génétique Médicale, Bordeaux, France.,Université de Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), INSERM U1211, Bordeaux, France
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Carol A Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Delmar
- Medicine, Cardiology, New York University School of Medicine, New York, NY, USA
| | - Patrick T Ellinor
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Steven A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Jean-Baptiste Gourraud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Michael W Tanck
- Clinical Epidemiology, Biostatistics and Bioinformatics, Clinical Methods and Public Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Calum A MacRae
- Medicine, Cardiovascular Medicine, Genetics and Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul W Burridge
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian Dina
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Arthur A Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Jacques Schott
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Richard Redon
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Connie R Bezzina
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, . .,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Takagi T, Derval N, Pambrun T, Nakatani Y, André C, Ramirez FD, Nakashima T, Krisai P, Kamakura T, Pineau X, Tixier R, Chauvel R, Cheniti G, Duchateau J, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Optimized Computed Tomography Acquisition Protocol for Ethanol Infusion Into the Vein of Marshall. JACC Clin Electrophysiol 2022; 8:168-178. [PMID: 35210073 DOI: 10.1016/j.jacep.2021.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study sought to introduce a computed tomography (CT) protocol for optimal planning of vein of Marshall (VOM) catheterization. BACKGROUND Ethanol infusion into the VOM (Et-VOM) is increasingly used in atrial fibrillation ablation. METHODS Preprocedural CT was performed with either a conventional (conv-CT; n = 132) or an optimized CT protocol (VOM-CT; n = 126) designed for obtaining on a single image both left atrial and coronary sinus (CS) enhancement. The detection rate and anatomical features of the CT-derived VOM were analyzed and the utility of VOM-CT protocol was assessed by comparing the procedural data. RESULTS VOM was detected in 35% in conv-CT versus 63% in VOM-CT (P < 0.001). The VOM-CT protocol did not impair the assessment of left atrial anatomy and appendage patency. In VOM-CT, the detection of the VOM was related to body mass index and width of epicardial space on posterior wall. Mean distance between CS ostium and VOM was 36 ± 7 mm. Mean VOM diameter was 1.6 ± 0.3 mm. On the CS circumference, the VOM emerged superiorly in 68% and postero-superiorly in 32%. Ethanol infusion into the VOM was attempted in 165 patients (77 conv-CT, 70 VOM-CT, and 18 without-CT). After registration in CARTO, the VOM segmented on CT matched its location on venography in all cases. As compared with conv-CT and without-CT, procedures guided by VOM-CT showed significantly shorter radiation time, shorter procedure time, lower amount of the contrast medium, and fewer contrast injections to obtain VOM catheterization. CONCLUSIONS The proposed CT protocol allows for improved visualization of the VOM, translating into easier VOM catheterization.
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Affiliation(s)
- Takamitsu Takagi
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France.
| | - Nicolas Derval
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Clémentine André
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Xavier Pineau
- Département de Cardiovascular Imaging, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Romain Tixier
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
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Krisai P, Cheniti G, Takagi T, Kamakura T, Surget E, André C, Duchateau J, Pambrun T, Derval N, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Sex differences in ventricular arrhythmia: epidemiology, pathophysiology and catheter ablation. Rev Cardiovasc Med 2022; 23:14. [DOI: 10.31083/j.rcm2301014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/06/2022] Open
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38
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Pambrun T, Derval N, Duchateau J, Ramirez FD, Chauvel R, Tixier R, Marchand H, Bouyer B, Welte N, André C, Nakashima T, Nakatani Y, Kamakura T, Takagi T, Krisai P, Ascione C, Balbo C, Cheniti G, Vlachos K, Bourier F, Takigawa M, Kitamura T, Frontera A, Meo M, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. Sinus node exit, crista terminalis conduction, interatrial connection and wavefront collision: key features of human atrial activation in sinus rhythm. Heart Rhythm 2022; 19:701-709. [PMID: 35033665 DOI: 10.1016/j.hrthm.2022.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND An understanding of normal atrial activation during sinus rhythm can inform catheter ablation strategies to avoid deleterious impacts of ablation lesions on atrial conduction and mechanics. OBJECTIVE To describe how the sinus node impulse originates, propagates, and collides in right and left atria with normal voltage. METHODS Fifty consecutive patients undergoing catheter ablation of atrial fibrillation with endocardial atrial voltage > 0.5 mV during high-density 3D-mapping were studied. RESULTS Sinus node exits varied between patients along a lateral oblique arc extending from the anterior aspect of the superior vena cava (SVC) to the mid-posterior wall of the right atrium (RA). Conduction slowing or block at one of the smooth components that faces the crista terminalis was observed in 54% of cases, including complete block at the SVC musculature and the systemic venous sinus in 6% of cases. Depending on these two key features of RA activation, interatrial conduction was mediated by the Bachmann bundle (64%) and posterior bundles (54%), with an overlap of the resulting LA breakthrough location. Wavefront collision was consistently observed at three sites: the septal aspect of the cavotricuspid isthmus; and the lower aspects of the dome and of the mitral isthmus. CONCLUSION During sinus rhythm, atrial activation occurs via distinct sequences mediated by a complex interaction of anatomic factors.
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Affiliation(s)
- Thomas Pambrun
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France.
| | - Nicolas Derval
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - F Daniel Ramirez
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Rémi Chauvel
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Hugo Marchand
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Benjamin Bouyer
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Nicolas Welte
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Clémentine André
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Takashi Nakashima
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Yosuke Nakatani
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Takamitsu Takagi
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Philipp Krisai
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Ciro Ascione
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Conrado Balbo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Félix Bourier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Masateru Takigawa
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Takeshi Kitamura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Antonio Frontera
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Marianna Meo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux. L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, France
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Surget E, Duchateau J, Lavergne T, Ramirez FD, Cheniti G, Haissaguerre M. Long-term freedom from ventricular fibrillation despite persistent Purkinje ectopy after catheter ablation. HeartRhythm Case Rep 2022; 8:259-263. [PMID: 35497479 PMCID: PMC9039102 DOI: 10.1016/j.hrcr.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Thomas Lavergne
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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40
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Haissaguerre M, Cheniti G, Hocini M, Sacher F, Ramirez FD, Cochet H, Bear L, Tixier R, Duchateau J, Walton R, Surget E, Kamakura T, Marchand H, Derval N, Bordachar P, Ploux S, Takagi T, Pambrun T, Jais P, Labrousse L, Strik M, Ashikaga H, Calkins H, Vigmond E, Nademanee K, Bernus O, Dubois R. OUP accepted manuscript. Eur Heart J 2022; 43:1234-1247. [PMID: 35134898 PMCID: PMC8934691 DOI: 10.1093/eurheartj/ehab893] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/25/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Mapping data of human ventricular fibrillation (VF) are limited. We performed detailed mapping of the activities underlying the onset of VF and targeted ablation in patients with structural cardiac abnormalities. Methods and results We evaluated 54 patients (50 ± 16 years) with VF in the setting of ischaemic (n = 15), hypertrophic (n = 8) or dilated cardiomyopathy (n = 12), or Brugada syndrome (n = 19). Ventricular fibrillation was mapped using body-surface mapping to identify driver (reentrant and focal) areas and invasive Purkinje mapping. Purkinje drivers were defined as Purkinje activities faster than the local ventricular rate. Structural substrate was delineated by electrogram criteria and by imaging. Catheter ablation was performed in 41 patients with recurrent VF. Sixty-one episodes of spontaneous (n = 10) or induced (n = 51) VF were mapped. Ventricular fibrillation was organized for the initial 5.0 ± 3.4 s, exhibiting large wavefronts with similar cycle lengths (CLs) across both ventricles (197 ± 23 vs. 196 ± 22 ms, P = 0.9). Most drivers (81%) originated from areas associated with the structural substrate. The Purkinje system was implicated as a trigger or driver in 43% of patients with cardiomyopathy. The transition to disorganized VF was associated with the acceleration of initial reentrant activities (CL shortening from 187 ± 17 to 175 ± 20 ms, P < 0.001), then spatial dissemination of drivers. Purkinje and substrate ablation resulted in the reduction of VF recurrences from a pre-procedural median of seven episodes [interquartile range (IQR) 4–16] to 0 episode (IQR 0–2) (P < 0.001) at 56 ± 30 months. Conclusions The onset of human VF is sustained by activities originating from Purkinje and structural substrate, before spreading throughout the ventricles to establish disorganized VF. Targeted ablation results in effective reduction of VF burden. Key question The initial phase of human ventricular fibrillation (VF) is critical as it involves the primary activities leading to sustained VF and arrhythmic sudden death. The origin of such activities is unknown. Key finding Body-surface mapping shows that most drivers (≈80%) during the initial VF phase originate from electrophysiologically defined structural substrates. Repetitive Purkinje activities can be elicited by programmed stimulation and are implicated as drivers in 37% of cardiomyopathy patients. Take-home message The onset of human VF is mostly associated with activities from the Purkinje network and structural substrate, before spreading throughout the ventricles to establish sustained VF. Targeted ablation reduces or eliminates VF recurrence.
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Affiliation(s)
| | - Ghassen Cheniti
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Meleze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - F. Daniel Ramirez
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Hubert Cochet
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Laura Bear
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Romain Tixier
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Rick Walton
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Elodie Surget
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Tsukasa Kamakura
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Hugo Marchand
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Pierre Bordachar
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Sylvain Ploux
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Takamitsu Takagi
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Thomas Pambrun
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Louis Labrousse
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Mark Strik
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Hiroshi Ashikaga
- Arrhythmia Service, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Hugh Calkins
- Arrhythmia Service, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA
| | - Ed Vigmond
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, IMB, U1045 Pessac, France
| | | | - Olivier Bernus
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
| | - Remi Dubois
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Univ Bordeaux, CRCTB, Inserm, U1045 Pessac, France
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Krisai P, Duchateau J, Cheniti G, Takagi T, Kamakura T, Ramirez FD, Pambrun T, Derval N, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Radiofrequency ablation of ventricular fibrillation. Heart Rhythm 2021; 18:2016-2017. [PMID: 34752260 DOI: 10.1016/j.hrthm.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Philipp Krisai
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France.
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Krisai P, Cheniti G, Kamakura T, Takagi T, André C, Ramirez FD, Nakatani Y, Nakashima T, Tixier R, Chauvel R, Pillois X, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Catheter Ablation for Atrial Fibrillation in Hyperthyroid Patients. Circ Arrhythm Electrophysiol 2021; 14:e010200. [PMID: 34693719 DOI: 10.1161/circep.121.010200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philipp Krisai
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Xavier Pillois
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit and L'Institut de rythmologie et modélisation cardiaque (LIRYC), Centre hospitalier universitaire de Bordeaux, Bordeaux-Pessac, France
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Letsas KP, Vlachos K, Conte G, Efremidis M, Nakashima T, Duchateau J, Bazoukis G, Frontera A, Mililis P, Tse G, Cheniti G, Takigawa M, Pambrun T, Prappa E, Sacher F, Derval N, Sideris A, Auricchio A, Jais P, Haissaguerre M, Hocini M. Right ventricular outflow tract electroanatomical abnormalities in asymptomatic and high-risk symptomatic patients with Brugada syndrome: Evidence for a new risk stratification tool? J Cardiovasc Electrophysiol 2021; 32:2997-3007. [PMID: 34596938 DOI: 10.1111/jce.15262] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Microstructural abnormalities at the epicardium of the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Endocardial unipolar electroanatomical mapping allows the identification of epicardial abnormalities. We evaluated the clinical implications of an abnormal endocardial substrate as perceived by high-density electroanatomical mapping (HDEAM) in patients with BrS. METHODS Fourteen high-risk BrS patients with aborted sudden cardiac death (SCD) (12 males, mean age: 41.9 ± 11.8 years) underwent combined endocardial-epicardial HDEAM of the right ventricle/RVOT, while 40 asymptomatic patients (33 males, mean age: 42 ± 10.7 years) underwent endocardial HDEAM. Based on combined endocardial-epicardial procedures, endocardial HDEAM was considered abnormal in the presence of low voltage areas (LVAs) more than 1 cm2 with bipolar signals less than 1 mV and unipolar signals less than 5.3 mV. Programmed ventricular stimulation (PVS) was performed in all patients. RESULTS The endocardial unipolar LVAs were colocalized with epicardial bipolar LVAs (p = .0027). Patients with aborted SCD exhibited significantly wider endocardial unipolar (p < .01) and bipolar LVAs (p < .01) compared with asymptomatic individuals. A substrate size of unipolar LVAs more than 14.5 cm2 (area under the curve [AUC]: 0.92, p < .001] and bipolar LVAs more than 3.68 cm2 (AUC: 0.82, p = .001) distinguished symptomatic from asymptomatic patients. Patients with ventricular fibrillation inducibility (23/54) demonstrated broader endocardial unipolar (p < .001) and bipolar LVAs (p < .001) than noninducible patients. The presence of unipolar LVAs more than 13.5 cm2 (AUC: 0.95, p < .001) and bipolar LVAs more than 2.97 cm2 (AUC: 0.78, p < .001) predicted a positive PVS. CONCLUSION Extensive endocardial electroanatomical abnormalities identify high-risk patients with BrS. Endocardial HDEAM may allow risk stratification of asymptomatic patients referred for PVS.
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Affiliation(s)
- Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.,Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | | | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Takashi Nakashima
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Antonio Frontera
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Panagiotis Mililis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Gary Tse
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Efstathia Prappa
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Antonios Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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Takigawa M, Kitamura T, Basu S, Bartal M, Martin CA, Martin R, Cheniti G, Vlachos K, Pillois X, Frontera A, Massoullié G, Thompson N, Bourier F, Lam A, Duchateau J, Pambrun T, Denis A, Derval N, Cochet H, Haïssaguerre M, Sacher F, Hocini M, Jaïs P. Effect of electrode size and spacing on electrograms: Optimized electrode configuration for near-field electrogram characterization. Heart Rhythm 2021; 19:102-112. [PMID: 34534699 DOI: 10.1016/j.hrthm.2021.09.011] [Citation(s) in RCA: 12] [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: 01/01/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Detailed effects of electrode size on electrograms (EGMs) have not been systematically examined. OBJECTIVES We aimed to elucidate the effect of electrode size on EGMs and investigate an optimal configuration of electrode size and interelectrode spacing for gap detection and far-field reduction. METHODS This study included 8 sheep in which probes with different electrode size and interelectrode spacing were epicardially placed on healthy, fatty, and lesion tissues for measurements. Between 3 electrode sizes (0.1 mm/0.2 mm/0.5 mm) with 3 mm spacing. As indices of capability in gap detection and far-field reduction, in different electrode sizes (0.1 mm/0.2 mm/0.5 mm) and interelectrode spacing (0.1 mm/0.2 mm/0.3 mm/0.5 mm/3 mm) and the optimized electrode size and interelectrode spacing were determined. Compared between PentaRay and the optimal probe determined in study 2. RESULTS Study 1 demonstrated that unipolar voltage and the duration of EGMs increased as the electrode size increased in any tissue (P < .001). Bipolar EGMs had the same tendency in healthy/fat tissues, but not in lesions. Study 2 showed that significantly higher gap to lesion volume ratio and healthy to fat tissue voltage ratio were provided by a smaller electrode (0.2 mm or 0.3 mm electrode) and smaller spacing (0.1 mm spacing), but 0.3 mm electrode/0.1 mm spacing provided a larger bipolar voltage (P < .05). Study 3 demonstrated that 0.3 mm electrode/0.1 mm spacing provided less deflection with more discrete EGMs (P < .0001) with longer and more reproducible AF cycle length (P < .0001) compared to PentaRay. CONCLUSION Electrode size affects both unipolar and bipolar EGMs. Catheters with microelectrodes and very small interelectrode spacing may be superior in gap detection and far-field reduction. Importantly, this electrode configuration could dramatically reduce artifactual complex fractionated atrial electrograms and may open a new era for AF mapping.
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Affiliation(s)
- Masateru Takigawa
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takeshi Kitamura
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | | | - Claire A Martin
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France; Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ruairidh Martin
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Ghassen Cheniti
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - Xavier Pillois
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Antonio Frontera
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | | | - Felix Bourier
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Anna Lam
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - Thomas Pambrun
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Arnaud Denis
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Nicolas Derval
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - Frederic Sacher
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- CHU Bordeaux, IHU LIRYC, Université de Bordeaux, Bordeaux, France
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Hocini M, Ramirez FD, Szumowski Ł, Maury P, Cheniti G, Duchateau J, Pambrun T, Derval N, Sacher F, Cochet H, Jaïs P, Haïssaguerre M. Purkinje triggers of ventricular fibrillation in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2021; 32:2987-2994. [PMID: 34453363 DOI: 10.1111/jce.15231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/04/2021] [Accepted: 07/25/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ventricular fibrillation (VF) is the main mechanism of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). The origin of VF and the success of catheter ablation to eliminate recurrent episodes in this population are poorly understood. METHODS AND RESULTS From 2010 to 2014, five patients with HCM (age 21 ± 9 years, three female) underwent invasive electrophysiological studies and ablation at our center after resuscitation from recurrent (9 ± 7) episodes of VF. Ventricular premature beats (VPBs), seen to initiate VF in certain cases, were recorded noninvasively before the ablation procedure. Postprocedural computed tomography (CT) was performed to correlate ablation sites with myocardial hypertrophy in three patients. Outcomes were assessed by clinical follow-up and implantable cardioverter-defibrillator interrogations. VPB triggers were localized invasively to the distal left Purkinje conduction system (left posterior fascicle [2], left anterior fascicle [1], and both fascicles [2]). All targeted VF triggers were successfully eliminated by radiofrequency ablation in the left ventricle. Among patients with postablation CT imaging, 93 ± 12% of ablation sites corresponded to hypertrophied segments. Over 50 ± 38 months, four of five patients were free from primary VF without antiarrhythmic drug therapy. One patient who had 13 episodes of VF before ablation had a single recurrence. CONCLUSION In our study of patients with HCM and recurrent VF, VF was not initiated from the myocardium but rather from Purkinje arborization. These sources colocalized with the hypertrophic substrate, suggesting electromechanical interaction. Focal ablation at these sites was associated with a marked reduction in VF burden.
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Affiliation(s)
- Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Łukasz Szumowski
- Department of Cardiac Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France.,Unité INSERM U 1048, Toulouse, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Hubert Cochet
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.,L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Bordeaux-Pessac, France
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Vlachos K, Efremidis M, Derval N, Martin CA, Takigawa M, Bazoukis G, Frontera A, Gkalapis C, Duchateau J, Nakashima T, Letsas KP, Mililis P, Pambrun T, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Kitamura T, Cheniti G, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation. Europace 2021; 23:1052-1062. [PMID: 33564832 DOI: 10.1093/europace/euaa394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS An incomplete understanding of the mechanism of atrial tachycardia (AT) is a major determinant of ablation failure. We systematically evaluated the mechanisms of AT using ultra-high-resolution mapping in a large cohort of patients. METHODS AND RESULTS We included 107 consecutive patients (mean age: 65.7 ± 9.2 years, males: 81 patients) with documented endocardial gap-related AT after left atrial ablation for persistent atrial fibrillation (AF). We analysed the mechanism of 134 AT (94 macro-re-entries and 40 localized re-entries) using high-resolution activation mapping in combination with high-density voltage and entrainment mapping. Voltage in the conducting channels may be extremely low, even <0.1 mV (0.14 ± 0.095 mV, 51 of 134 AT, 41%), and almost always <0.5 mV (0.03-0.5 mV, 133 of 134 AT, 99.3%). The use of multipolar Orion, HDGrid, and Pentaray catheters improved our accuracy in delineating ultra-low-voltage areas critical for maintenance of the circuit of endocardial gap-related AT. Conventional ablation catheters often do not detect any signal (noise level) even using adequate contact force, and only multipolar catheters of small electrodes and shorter interelectrode space can detect clear fractionated low-amplitude and high frequency signals, critical for re-entry maintenance. We performed a diagnosis in 112 out of 134 AT (83.6%) using only activation mapping and in 134 out of 134 AT (100%) using the combination of activation and entrainment mapping. CONCLUSION High-resolution activation mapping in combination with high-density voltage and entrainment mapping is the ideal strategy to delineate the critical part of the circuit in endocardial gap-related re-entrant AT after AF ablation.
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Affiliation(s)
- Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Claire A Martin
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France.,Department of Electrophysiology-Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Charis Gkalapis
- Department of Electrophysiology-Cardiology, Klinikum Vest, Recklinghausen, Germany.,Department of Cardiology, Akademisches Lehrkrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Panagiotis Mililis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Felix Bourier
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Clémentine André
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Philipp Krisai
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Pessac Cedex, France
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Nakashima T, Duchateau J, Vlachos K, Pambrun T, Jaïs P, Derval N. Partial participation of the coronary sinus owing to longitudinal dissociation during peri-mitral atrial flutter. Europace 2021; 23:957. [PMID: 32974653 DOI: 10.1093/europace/euaa282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Takashi Nakashima
- Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), LIRYC, University of Bordeaux, CHU de Bordeaux, Avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Josselin Duchateau
- Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), LIRYC, University of Bordeaux, CHU de Bordeaux, Avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), LIRYC, University of Bordeaux, CHU de Bordeaux, Avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Thomas Pambrun
- Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), LIRYC, University of Bordeaux, CHU de Bordeaux, Avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Pierre Jaïs
- Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), LIRYC, University of Bordeaux, CHU de Bordeaux, Avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Nicolas Derval
- Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), LIRYC, University of Bordeaux, CHU de Bordeaux, Avenue de Magellan, 33604 Bordeaux-Pessac, France
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Das M, Luik A, Shepherd E, Sulkin M, Laughner J, Oesterlein T, Duffy E, Meyer C, Jais P, Duchateau J, Yue A, Ullah W, Ramos P, García-Bolao I. Local catheter impedance drop during pulmonary vein isolation predicts acute conduction block in patients with paroxysmal atrial fibrillation: initial results of the LOCALIZE clinical trial. Europace 2021; 23:1042-1051. [PMID: 33550380 PMCID: PMC8286855 DOI: 10.1093/europace/euab004] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 07/21/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022] Open
Abstract
Aims Radiofrequency ablation creates irreversible cardiac damage through resistive heating and this temperature change results in a generator impedance drop. Evaluation of a novel local impedance (LI) technology measured exclusively at the tip of the ablation catheter found that larger LI drops were indicative of more effective lesion formation. We aimed to evaluate whether LI drop is associated with conduction block in patients with paroxysmal atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI). Methods and results Sixty patients underwent LI-blinded de novo PVI using a point-by-point ablation workflow. Pulmonary vein rings were divided into 16 anatomical segments. After a 20-min waiting period, gaps were identified on electroanatomic maps. Median LI drop within segments with inter-lesion distance ≤6 mm was calculated offline. The diagnostic accuracy of LI drop for predicting segment block was assessed using receiver operating characteristic analysis. For segments with inter-lesion distance ≤6 mm, acutely blocked segments had a significantly larger LI drop [19.8 (14.1–27.1) Ω] compared with segments with gaps [10.6 (7.8–14.7) Ω, P < 0.001). In view of left atrial wall thickness differences, the association between LI drop and block was further evaluated for anterior/roof and posterior/inferior segments. The optimal LI cut-off value for anterior/roof segments was 16.1 Ω (positive predictive value for block: 96.3%) and for posterior/inferior segments was 12.3 Ω (positive predictive value for block: 98.1%) where inter-lesion distances were ≤6 mm. Conclusion The magnitude of LI drop was predictive of acute PVI segment conduction block in patients with paroxysmal AF. The thinner posterior wall required smaller LI drops for block compared with the thicker anterior wall.
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Affiliation(s)
- Moloy Das
- Department of Cardiology, Freeman Road Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Ewen Shepherd
- Department of Cardiology, Freeman Road Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Matthew Sulkin
- Boston Scientific Corp., Electrophysiology Department, St. Paul, MN, USA
| | - Jacob Laughner
- Boston Scientific Corp., Electrophysiology Department, St. Paul, MN, USA
| | - Tobias Oesterlein
- Boston Scientific Corp., Electrophysiology Department, St. Paul, MN, USA
| | - Elizabeth Duffy
- Boston Scientific Corp., Electrophysiology Department, St. Paul, MN, USA
| | - Christian Meyer
- Department of Cardiology, University Heart Center, University Hospital Hamburg, Hamburg, Germany
| | - Pierre Jais
- L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Hôpital Cardiologique du Haut-Lévèque, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Hôpital Cardiologique du Haut-Lévèque, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Arthur Yue
- Department of Cardiology, University Hospital Southampton, Southampton, UK
| | - Waqas Ullah
- Department of Cardiology, University Hospital Southampton, Southampton, UK
| | - Pablo Ramos
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Ignacio García-Bolao
- Department of Cardiology and Cardiovascular Surgery, Clìnica Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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Ramirez FD, Pambrun T, Duchateau J, Nédellec C, Nakashima T, Nakatani Y, Krisai P, Vlachos KG, André C, Goujeau C, Kamakura T, Takagi T, Cheniti G, Chauvel R, Tixier R, Welte N, Sacher F, Hocini M, Haissaguerre M, Jais P, Derval N. B-PO03-074 COMPARATIVE ANALYSIS OF THE MARSHALL-PLAN AND DRIVER-GUIDED ABLATION WITH ARRHYTHMIA TERMINATION AS PROCEDURAL ENDPOINT IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.549] [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: 11/26/2022]
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50
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Krisai P, Cheniti G, Kamakura T, Takagi T, Andre C, Daniel Ramirez F, Nakatani Y, Nakashima T, Tixier R, Xavier Pillois RC, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haissaguerre M, Jais P. B-PO03-084 CATHETER ABLATION FOR ATRIAL FIBRILLATION IN HYPERTHYROID PATIENTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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