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Willems S, Khairy P, Andrade JG, Hoffmann BA, Levesque S, Verma A, Weerasooriya R, Novak P, Arentz T, Deisenhofer I, Rostock T, Steven D, Rivard L, Guerra PG, Dyrda K, Mondesert B, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S, Macle L. Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.115.003909. [PMID: 27516462 DOI: 10.1161/circep.115.003909] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 07/18/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Early recurrences (ERs) of atrial tachyarrhythmia are common after catheter ablation of atrial fibrillation. A 3-month blanking period is recommended by current guidelines. This study sought to investigate the significance of ER during the first 3 months post ablation in predicting late recurrences and determine whether it varies according to timing. METHODS AND RESULTS A total of 401 patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation were followed for 12 months with transtelephonic monitoring in the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial. Patients with atrial tachyarrhythmia ≥30 s within the 3-month blanking period were stratified according to the timing of ER. A total of 179 patients (44.6%) experienced their last episode of ER during the first (n=53), second (n=44), or third (n=82) month of the 3-month blanking period. One-year freedom from symptomatic atrial tachyarrhythmia was 77.2% in patients without ER compared with 62.6%, 36.4%, and 7.8% in patients with ER 1, 2, and 3 months post ablation, respectively (P<0.0001). Receiver operating curve analyses revealed a strong correlation between the timing of ER and late recurrence (area under the curve 0.82, P<0.0001). Corresponding hazard ratios for ER during the first, second, and third months were 1.84, 4.45, and 9.64, respectively. CONCLUSIONS This study validates the use of a blanking period after catheter ablation for paroxysmal atrial fibrillation but calls into question the 90-day cut-off value. In particular, >90% of patients with ER during the third month post ablation experience late recurrence by 1 year. However, pending further study, repeat ablation before 90 days cannot be routinely advocated. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980.
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Audoubert M, Ostiguy G, Nguyen DH, Plante M, Dubuc M, Guerra P, Khairy P, Macle L, Mondesert B, Rivard L, Talajic M, Thibault B, Roy D, Dyrda K. P1504Resistance of the medtronic micra leadless pacemaker to 60 hz electrical fields. Europace 2017. [DOI: 10.1093/ehjci/eux158.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thibault B, Richer LP, Mcspadden L, Ryu P, Dyrda K, Rivard L, Guerra PG, Khairy P, Macle L, Mondesert B, Roy D, Talajic M, Finnerty V, Gregoire J, Harel F. P381Retrospective registration can provide good concordance between perfusion data from 3D nuclear imaging and electrophysiological data from EnSite Velocity mapping system. Europace 2017. [DOI: 10.1093/ehjci/eux141.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bessiere F, Dubuc M, Andrade J, Shohoudi A, Sirois M, Mondesert B, Dyrda K, Rivard L, Macle L, Guerra P, Thibault B, Talajic M, Roy D, Khairy P. P250Focal transcatheter cryoablation: is a four-minute application still required? Europace 2017. [DOI: 10.1093/ehjci/eux171.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Venier S, Khairy P, Thibault B, Rivard L. Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber. HeartRhythm Case Rep 2017; 2:379-383. [PMID: 28491715 PMCID: PMC5419942 DOI: 10.1016/j.hrcr.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Bessière F, Dubuc M, Andrade J, Shohoudi A, Sirois MG, Mondésert B, Dyrda K, Rivard L, Macle L, Guerra PG, Thibault B, Talajic M, Roy D, Khairy P. Focal Transcatheter Cryoablation: Is a Four-Minute Application Still Required? J Cardiovasc Electrophysiol 2017; 28:559-563. [PMID: 28233925 DOI: 10.1111/jce.13193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/10/2017] [Accepted: 01/30/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The standard 4-minute application time for transcatheter cryoablation was determined in the 1990s when the system employed less potent chlorofluorocarbon refrigerants. The current refrigerant, nitrous oxide, generates substantially colder temperatures, with a faster cooling rate. METHODS AND RESULTS We conducted a preclinical study on 32 mongrel dogs with stratified randomization of right atrial, right ventricular, and left ventricular chambers to 2-minute versus 4-minute application times using 8-mm electrode tip cryocatheters (Freezor Max, Medtronic CryoCath LP, Montreal, Canada). Animals were sacrificed one month after the procedure. Three-dimensional morphometric analyses were conducted in a blinded fashion. A total of 193 identified ablation lesions were processed for histological analyses, 102 with 2-minute applications and 91 with 4-minute applications. Ablation lesion surface area (167.8 ± 21.6 mm2 vs. 194.3 ± 22.6 mm2 , P = 0.40), maximum depth (4.4 ± 0.2 mm vs. 4.5 ± 0.2 mm, P = 0.71), and volume (125.7 ± 69.5 mm3 vs. 141.0 ± 83.5 mm3 , P = 0.25) were similar between groups. Overall, 90.2% of ablation lesions in the right atrium were transmural, 45.6% in the right ventricle, and 2.4% in the left ventricle, with no differences between 2-minute and 4-minute application times (P = 0.55). Thrombus was detected on the endocardial surface of 0.0% and 3.3% of ablation lesions created with 2-minute and 4-minute application times, respectively (P = 0.10). CONCLUSION Single 2-minute and 4-minute application times result in catheter ablation lesions of similar size using the modern cryoablation system with nitrous oxide as a refrigerant. While these findings suggest the potential to reduce the standard 4-minute application time, further studies are required to compare clinical efficacy.
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Rivard L, Andrade J. Innovative Approaches to Arrhythmic Storm: The Growing Role of Interventional Procedures. Can J Cardiol 2017; 33:44-50. [DOI: 10.1016/j.cjca.2016.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/09/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022] Open
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Rivard L, Roux A, Nault I, Champagne J, Roux JF, Tadros R, Talajic M, Cadrin-Tourigny J, Shohoudi A, Mondésert B, Roy D, Macle L, Andrade J, Dyrda K, Dubuc M, Guerra PG, Sarrazin JF, Thibault B, Khairy P. Predictors of Ventricular Arrhythmias and Sudden Death in a Québec Cohort With Brugada Syndrome. Can J Cardiol 2016; 32:1355.e1-1355.e7. [DOI: 10.1016/j.cjca.2016.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/23/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022] Open
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Audoubert M, Ostiguy G, Nguyen D, Plante M, Dubuc M, Guerra P, Khairy P, Macle L, Mondesert B, Rivard L, Talajic M, Thibault B, Roy D, Dyrda K. RESISTANCE OF THE SUBCUTANEOUS INTERNAL CARDIOVERTER DEFIBRILLATOR TO 60 HZ ELECTRIC FIELDS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Russo J, Nery P, Ha A, Healey J, Rivard L, Friedrich M, Gula L, Wisenberg G, deKemp R, Chakraborty S, Hruczkowski T, Quinn R, Dwivedi G, Beanlands R, Birnie D. SENSITIVITY AND SPECIFICITY OF CHEST IMAGING FOR SCREENING OF SARCOIDOSIS IN PATIENTS WITH CARDIAC PRESENTATIONS: INSIGHTS FROM THE CHASM-CS REGISTRY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, Thibault B, Rivard L, Gula L, Leong-Sit P, Essebag V, Nery PB, Tung SK, Raymond JM, Sterns LD, Veenhuyzen GD, Healey JS, Redfearn D, Roux JF, Tang ASL. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med 2016; 375:111-21. [PMID: 27149033 DOI: 10.1056/nejmoa1513614] [Citation(s) in RCA: 525] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recurrent ventricular tachycardia among survivors of myocardial infarction with an implantable cardioverter-defibrillator (ICD) is frequent despite antiarrhythmic drug therapy. The most effective approach to management of this problem is uncertain. METHODS We conducted a multicenter, randomized, controlled trial involving patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite the use of antiarrhythmic drugs. Patients were randomly assigned to receive either catheter ablation (ablation group) with continuation of baseline antiarrhythmic medications or escalated antiarrhythmic drug therapy (escalated-therapy group). In the escalated-therapy group, amiodarone was initiated if another agent had been used previously. The dose of amiodarone was increased if it had been less than 300 mg per day or mexiletine was added if the dose was already at least 300 mg per day. The primary outcome was a composite of death, three or more documented episodes of ventricular tachycardia within 24 hours (ventricular tachycardia storm), or appropriate ICD shock. RESULTS Of the 259 patients who were enrolled, 132 were assigned to the ablation group and 127 to the escalated-therapy group. During a mean (±SD) of 27.9±17.1 months of follow-up, the primary outcome occurred in 59.1% of patients in the ablation group and 68.5% of those in the escalated-therapy group (hazard ratio in the ablation group, 0.72; 95% confidence interval, 0.53 to 0.98; P=0.04). There was no significant between-group difference in mortality. There were two cardiac perforations and three cases of major bleeding in the ablation group and two deaths from pulmonary toxic effects and one from hepatic dysfunction in the escalated-therapy group. CONCLUSIONS In patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite antiarrhythmic drug therapy, there was a significantly lower rate of the composite primary outcome of death, ventricular tachycardia storm, or appropriate ICD shock among patients undergoing catheter ablation than among those receiving an escalation in antiarrhythmic drug therapy. (Funded by the Canadian Institutes of Health Research and others; VANISH ClinicalTrials.gov number, NCT00905853.).
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Laplante L, Allard C, Rivard L, Khairy P. Weighing the evidence for weight loss as a therapeutic strategy for atrial fibrillation. Expert Rev Cardiovasc Ther 2016; 14:877-9. [DOI: 10.1080/14779072.2016.1199274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Thibault B, Mondesert B, Dyrda K, Dubuc M, Khairy P, Guerra PG, Rivard L, Roy D, Talajic M, Macle L. 109-02: Resynchronization therapy implant procedures with a novel sensor-based electromagnetic tracking system (Mediguide™): more than just reduction in radiation exposure. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i85b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dyrda K, Roy D, Leduc H, Talajic M, Stevenson LW, Guerra PG, Andrade J, Dubuc M, Macle L, Thibault B, Rivard L, Khairy P. Treatment Failure With Rhythm and Rate Control Strategies in Patients With Atrial Fibrillation and Congestive Heart Failure: An AF-CHF Substudy. J Cardiovasc Electrophysiol 2015; 26:1327-32. [PMID: 26332293 DOI: 10.1111/jce.12828] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rate and rhythm control strategies for atrial fibrillation (AF) are not always effective or well tolerated in patients with congestive heart failure (CHF). We assessed reasons for treatment failure, associated characteristics, and effects on survival. METHODS AND RESULTS A total of 1,376 patients enrolled in the AF-CHF trial were followed for 37 ± 19 months, 206 (15.0%) of whom failed initial therapy leading to crossover. Rhythm control was abandoned more frequently than rate control (21.0% vs. 9.1%, P < 0.0001). Crossovers from rhythm to rate control were driven by inefficacy, whereas worsening heart failure was the most common reason to crossover from rate to rhythm control. In multivariate analyses, failure of rhythm control was associated with female sex, higher serum creatinine, functional class III or IV symptoms, lack of digoxin, and oral anticoagulation. Factors independently associated with failure of rate control were paroxysmal (vs. persistent) AF, statin therapy, and presence of an implantable cardioverter-defibrillator. Crossovers were not associated with cardiovascular mortality (hazard ratio [HR] 1.11 from rhythm to rate control; 95% confidence interval [95% CI, 0.73-1.73]; P = 0.6069; HR 1.29 from rate to rhythm control; 95% CI, 0.73-2.25; P = 0.3793) or all-cause mortality (HR 1.16 from rhythm to rate control, 95% CI [0.79-1.72], P = 0.4444; HR 1.15 from rate to rhythm control, 95% [0.69, 1.91], P = 0.5873). CONCLUSIONS Rhythm control is abandoned more frequently than rate control in patients with AF and CHF. The most common reasons for treatment failure are inefficacy for rhythm control and worsening heart failure for rate control. Changing strategies does not impact survival.
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Venier S, Andrade J, Dubuc M, Dyrda K, Guerra P, Khairy P, Mondésert B, Rivard L, Roy D, Talajic M, Thibault B, Malliet N, Gomes S, Tadros R, Macle L. CONTACT FORCE-GUIDED VERSUS CONTACT FORCE-BLINDED CATHETER ABLATION OF TYPICAL ATRIAL FLUTTER: A PROSPECTIVE STUDY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dyrda K, Nguyen D, Thibault B, Khairy P, Venier S, Talajic M, Dubuc M, Macle L, Mondesert B, Guerra P, Rivard L, Plante M, Ostiguy G. INTERFERENCE RESISTANCE OF PACEMAKERS AND DEFIBRILLATORS TO 60 HZ ELECTRIC FIELDS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Venier S, Millette C, Khairy P, Andrade J, Dubuc M, Guerra P, Dyrda K, Macle L, Mondésert B, Rivard L, Roy D, Talajic M, Gomes S, Malliet N, Tadros R, Thibault B. DEFIBRILLATION TESTING FOR RIGHT SIDED IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD). Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Thibault B, Mondésert B, Dubuc M, Venier S, Palazzolo J, Casteigt B, Ascoeta S, Dyrda K, Guerra P, Khairy P, Rivard L, Roy D, Talajic M, Macle L. IT IS POSSIBLE TO REDUCE EXPOSURE TO IONIZING RADIATION BY > 90% DURING CARDIAC RESYNCHRONIZATION THERAPY IMPLANT PROCEDURES IN THE EP LAB: THE MONTRÉAL HEART INSTITUTE EXPERIENCE WITH LOW-DOSE FLUOROSCOPY SETTINGS AND MEDIGUIDE. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T, Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet 2015. [PMID: 26211828 DOI: 10.1016/s0140-6736(15)60026-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation. METHODS We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980. FINDINGS Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry. INTERPRETATION Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice. FUNDING Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).
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Tadros R, Cadrin-Tourigny J, Abadir S, Rivard L, Nattel S, Talajic M, Khairy P. Pharmacotherapy for inherited arrhythmia syndromes: mechanistic basis, clinical trial evidence and practical application. Expert Rev Cardiovasc Ther 2015; 13:769-82. [DOI: 10.1586/14779072.2015.1049156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cadrin-Tourigny J, Tadros R, Talajic M, Rivard L, Abadir S, Khairy P. Risk stratification for sudden death in arrhythmogenic right ventricular cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 13:653-64. [DOI: 10.1586/14779072.2015.1043891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rivard L, Schram G, Asgar A, Khairy P, Andrade JG, Bonan R, Dubuc M, Guerra PG, Ibrahim R, Macle L, Roy D, Talajic M, Dyrda K, Shohoudi A, le polain de Waroux JB, Thibault B. Electrocardiographic and electrophysiological predictors of atrioventricular block after transcatheter aortic valve replacement. Heart Rhythm 2015; 12:321-9. [DOI: 10.1016/j.hrthm.2014.10.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Indexed: 10/24/2022]
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Tremblay-Gravel M, Khairy P, Roy D, Leduc H, Wyse DG, Cadrin-Tourigny J, Macle L, Dubuc M, Andrade J, Rivard L, Guerra PG, Thibault B, Ahmed A, Talajic M, Guertin MC, White M. Systolic blood pressure and mortality in patients with atrial fibrillation and heart failure: insights from the AFFIRM and AF-CHF studies. Eur J Heart Fail 2014; 16:1168-74. [PMID: 25296634 DOI: 10.1002/ejhf.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/07/2014] [Accepted: 08/15/2014] [Indexed: 11/11/2022] Open
Abstract
AIMS To investigate the association between baseline systolic blood pressure levels and mortality in patients with AF with or without LV dysfunction. Hypertension leads to cardiovascular disease but, in specific groups, low blood pressure has been associated with a paradoxical increase in mortality. In patients with AF and heart failure, the relationship between blood pressure and death remains largely unknown. METHODS AND RESULTS We conducted a post-hoc combined analysis on pooled data from AFFIRM and AF-CHF trials and assessed the relationship between baseline systolic blood pressure (SBP) and mortality and hospitalizations. Patients were classified according to LVEF (>40%, ≤40%) and baseline SBP (<120 mmHg, 120-140 mmHg, >140 mmHg). A total of 5436 patients with non-permanent AF were followed for 41 ± 16 months. In patients with LVEF >40%, baseline SBP was not related to mortality using multivariate Cox regression analyses to adjust for baseline differences (P = 0.563). In contrast, in patients with LVEF ≤40% (n = 1980), SBP <120 mmHg and SBP >140 mmHg were both associated with a significant increase in total mortality compared with SBP 120-140 mmHg [hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.41-2.17; and HR 1.40, 95% CI 1.04-1.90, respectively]. Hospitalizations were unrelated to SBP regardless of LVEF. CONCLUSIONS Mortality is modulated by baseline SBP levels in patients with AF and depressed EF but not in patients with normal EF. Targeted therapy of AF patients based on SBP merits further prospective investigation.
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Malliet N, Dahdah N, Khairy P, Rivard L, Talajic M, Fournier A. ELECTROCARDIOGRAPHIC DATA AND RHYTMIC EVENTS IN A PEDIATRIC COHORT OF MYOTONIC DYSTROPHY 1: A LONG TERM FOLLOW-UP STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mondésert B, Talajic M, Macle L, Andrade J, Dyrda K, Dubuc M, Roy D, Guerra P, Thibault B, Khairy P, Schram G, Rivard L. ROLE OF REVASCULARIZATION AND ELECTROPHYSIOLOGICAL TESTING IN PATIENTS WITH SUSTAINED VENTRICULAR ARRHYTHMIAS IN CHRONIC CORONARY ARTERY DISEASE (CAD) AND NEAR NORMAL LEFT VENTRICULAR (LV) FUNCTION: LONG-TERM FOLLOW-UP OF 274 PATIENTS. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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