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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Morgat C, Denjoy I, Fressart V, Badilini F, Vaglio M, Messali A, Maison-Blanche P, Leenhardt A, Extramiana F. ECG descriptors of ventricular repolarization are associated with cardiac events in a gene-specific manner in long QT syndrome patients. Europace 2022. [DOI: 10.1093/europace/euac053.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Assistance Publiques Hôpitaux de Paris (APHP)
Background
Congenital long QT syndrome (LQTS) is still associated with syncope and a risk of sudden cardiac death despite the dramatic reduction in mortality associated with beta-blocker therapy. Current risk stratification tools are imperfect.
Objective
To assess the contribution of automated scalar ECG descriptors of ventricular repolarization for arrrhythmic risk stratification in genotyped LQTS patients.
Methods
Patients with genotyped type 1, 2 or 3 LQTS with at least 1 digital ECG recording have been included in the study. History at diagnosis, and follow-up data were collected. Cardiac events included syncope, aborted cardiac arrest, appropriate implantable cardioverter-defibrillator therapy in VF zone, and sudden death.
ECG were analyzed using the BRAVO algorithm embedded in the CalECG software, version 4.1.0. QT interval duration was manually checked but ECG descriptors of Ventricular Repolarization were fully automatic.
Multivariate cox regression analysis were performed to identify parameters associated with cardiac events.
Results
467 patients (58% female, median age at diagnosis=25, LQT1,2,3 54%, 39%, 7%) were followed-up during 15.2±9.2 years. Rate of cardiac event was 1.2/100 patients-year before diagnosis and 0.9/100 patients-year during follow-up.
QTc duration was associated with the occurrence of cardiac events in the whole study population (HR=1.01 95%CI 1.0-1.01, p=0.03). Ventricular repolarization parameters associated with cardiac events were different according to LQTS type. Cardiac events were associated with increased time to accumulate 50% of T-wave energy (HR=1.53 95%CI 1.04-2.26, p=0.03) in LQT1 but with a decrease in T-wave slopes (ascending slope HR=0.63 95%CI 0.17-0.75, p<0.01) in type 2 LQTS patients. QTc duration was not independently associated with cardiac events in genotype specific multivariate models.
Conclusions
T-wave morphology parameters are associated with cardiac events in a gene-specific manner. Change in T-wave symmetry and T-wave flattening are associated with cardiac events in type 1 and type 2 LQTS respectively. The descriptors of ventricular repolarization are promising parameters or risk stratification beyond QTc duration in LQTS patients.
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Affiliation(s)
- C Morgat
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - I Denjoy
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - V Fressart
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - F Badilini
- University of California San Francisco, San Francisco, United States of America
| | - M Vaglio
- University of Rochester, Rochester, United States of America
| | - A Messali
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - P Maison-Blanche
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly sur Seine, France
| | - A Leenhardt
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - F Extramiana
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
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Peltenburg P, Lieve K, Van Der Werf C, Wilde A, Brugada R, Till J, Ackerman M, Probst V, Haugaa K, Swan H, Kammeraad J, Horie M, Sanatani S, Schwartz P, Leenhardt A. Atenolol is not effective in reducing ventricular arrhythmia severity on exercise stress test in patients with catecholaminergic polymorphic ventricular tachycardia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for malignant ventricular arrhythmias during exercise and emotions which may lead to sudden cardiac death. Beta-blockers (BB) are the mainstay of therapy in patients with CPVT, but studies comparing the efficacy of different types of BB are scarce. Our objective was to determine the efficacy of different types of BB in reducing the ventricular arrhythmia (VA) severity on exercise stress test (EST) in patients with CPVT.
Data was derived from the International CPVT Registry, a large retrospective cohort study. We included patients who had an EST before (pre-EST) and after start of BB (post-EST). We divided the cohort into five groups based on the first prescribed BB and compared pre-EST and post-EST.
We included 428 patients (median age 18.5 [11.7–39.6] years, 240 (56.%) female), 155 (36.2%) probands) of whom 38 (8.9%) used atenolol, 131 (30.6%) bisoprolol, 82 (19.2%) metoprolol, 124 (29.0%) nadolol and 53 (12.4%) propranolol. Sex and history of aborted cardiac arrest were similar in all groups. The age at start of BB differed (p<0,001): patients using bisoprolol were oldest (35.0 [15.7–35.3]) while patients using propranolol were youngest (12.3 [8.8–24.9]). Median daily BB dose in mg/kg was: 1.0 [0.8–2.3] for atenolol, 0.06 [0.05–0.10] for bisoprolol, 0.9 [0.6–1.5] for metoprolol, 1.1 [0.9–1.6] for nadolol and 1.5 [1.1–2.8] for propranolol. Resting heart rate on pre-EST and post-EST was similar in all groups. Patients using metoprolol had a significantly higher maximum heart rate post-EST compared to nadolol and propranolol (161±18 vs 136±19 and 130±22 bpm, p=0,002 and p=0,001, respectively). The VA severity decreased significantly after BB (147 (37.9%) (non-sustained) ventricular tachycardia ((NS)VT) and 120 (30.9%) no or isolated ventricular premature beat (iVPB) pre-EST vs 46 (11.4%) (NS)VT and 184 (45.7%) iVPB post-EST, p<0,001). Examining the different groups, the VA severity decreased significantly after BB in all but atenolol (13 (40.6%) (NS)VT and 8 (25.0%) iVPB pre-EST vs 9 (25.0%) (NS)VT and 15 (41.7%) iVPB post-EST, p=0,103).
Based on these results we conclude that all beta-blockers except atenolol are effective in reducing the VA severity on EST in patients with CPVT.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): E-Rare Joint Transnational Call for Proposals 2015 “Improving Diagnosis and Treatment of Catecholaminergic Polymorphic Ventricular Tachycardia: Integrating Clinical and Basic Science”
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Affiliation(s)
- P Peltenburg
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K.V.V Lieve
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - C Van Der Werf
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - A.A.M Wilde
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | | | - J Till
- Royal Brompton Hospital, London, United Kingdom
| | - M.J Ackerman
- Mayo Clinic, Rochester, United States of America
| | - V Probst
- Institut du Thorax, Nantes, France
| | - K Haugaa
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Swan
- Helsinki University Hospital, Helsinki, Finland
| | - J.A.E Kammeraad
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M Horie
- Shiga University of Medical Science, Otsu, Japan
| | - S Sanatani
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - P Schwartz
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - A Leenhardt
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
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Delinière A, Baranchuk A, Bessiere F, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum P, Taieb J, Bouet J, Rosianu H, Chevalier P. Low T/R ratio in inferolateral leads: A new ECG marker of sudden cardiac arrest in patients with a spontaneous type 1 Brugada pattern. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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5
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Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X, Adnet F, Agostinucci JM, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Benhamou D, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Crahes M, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Dhonneur G, Diehl JL, Dinanian S, Domanski L, Dreyfuss D, Duboc D, Dubois-Rande JL, Dumas F, Empana JP, Extramiana F, Fartoukh M, Fieux F, Gabbas M, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Hidden Lucet F, Jabre P, Jacob L, Joseph L, Jost D, Jouven X, Karam N, Kassim H, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt CE, Maltret A, Mansencal N, Mansouri N, Marijon E, Marty J, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira JP, Monnet X, Narayanan K, Ngoyi N, Perier MC, Piot O, Pirracchio R, Plaisance P, Plu I, Raux M, Revaux F, Ricard JD, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharifzadehgan A, Sideris G, Spaulding C, Teboul JL, Timsit JF, Tourtier JP, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2019; 41:1961-1971. [DOI: 10.1093/eurheartj/ehz753] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/26/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.
Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).
Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.
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Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Pierre Carli
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Romain Pirracchio
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Surgical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicolas Deye
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Medical ICU, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Georgios Sideris
- Cardiology Department, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Brigade de Sapeurs Pompiers de Paris (BSPP), 1 Place Jules Renard, 75017 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
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Probst V, Clerici G, Babuty D, Badenco N, Marquie C, Leenhardt A, Maury P, Blangy H, Deharo JC, Tfelt-Hansen J, Rudic B, Behar N, Mansourati J, Sacher F, Gourraud JB. P2279First clinical evaluation of subcutaneous implantable cardiac defibrillator in Brugada patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of SCD. While Subcutaneous ICD (S-ICD) is a seductive approach to treat these patients, questions raised on the risk of inappropriate shock in this specific population.
Objective
The aim of this study was to evaluate the safety and the effectiveness of the S-ICD in BrS patients.
Methods
We prospectively enrolled 112 BrS patients implanted with S-ICD in 17 European centers. During the screening at least 2 vectors must be suitable but it was not necessary to check for the suitability of the ECG during sodium channel blocker or exercise test. S-ICD indications follow the current guidelines.
Results
Mean age of patients was 45±13 years, with 95 (85%) males. Implantation was performed in 91 (83%) patients for primary prevention and in 18 (16%) patients for secondary prevention. There is an indication of ICD replacement for 16 patients (14%): 13 lead defect (81%), 1 infection (6%) and 2 ICD end of life (13%). In this cohort, 57 patients (51%) had spontaneous type I BrS, 60 patients (55%) were symptomatic: 10 resuscitated SCD (17%) and 48 (83%) syncope.
Implantation was performed under general anesthesia in 79 patients (71%). The mean operation time was 56±19 min. The lead was placed at the left side of the sternum in 102 patients (92%) and at the right side in 9 (8%). Sensing configuration was the primary vector for 46 patients (41%), secondary vector for 57 (51%) and alternative vector for 9 (8%). No complications occurred during implantation.
During a mean follow-up of 15.6 months (0–39 months), 6 patients (5%) had at least one appropriate shock (n=9). The rate of appropriate shock was 4.5%/y. All the VF episodes were successfully treated with the first shock. One patient had VF ablation for recurrent VF. Among the 6 patients who received an appropriate shock, 3 (50%) were implanted for secondary prevention and 3 (50%) were implanted for primary prevention including 2 patients with a history of syncope and one asymptomatic patient.
Twelve patients (11%) had at least one inappropriate shock (n=22) including 2 patients with respectively 8 and 4 inappropriate shocks due to T-wave oversensing. With the SMART pass system the first patient had no more inappropriate shock for now 2 years. The rate of inappropriate shock was 9%/y. One patient died of myocardial infarction.
Five patients (4%) were hospitalized for complications (4 pocket or scar infections and 1 electrode failure).
Conclusion
Our initial experience showed that S-ICD is efficient to treat VF episode in BrS patients. In this population, the rate of inappropriate shock was 9%/y. In view of these results, S-ICD implantation seems to be efficient to protect BrS patients against SCD.
Acknowledgement/Funding
Investigator-Sponsored Research program, Boston Scientific
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Affiliation(s)
- V Probst
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - G Clerici
- Reunion Regional University Hospital, Saint Pierre, Réunion
| | - D Babuty
- University Hospital of Tours, Tours, France
| | - N Badenco
- Hospital Pitie-Salpetriere, Paris, France
| | | | - A Leenhardt
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Maury
- University Hospital of Toulouse, Toulouse, France
| | - H Blangy
- University Hospital of Nancy, Nancy, France
| | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B Rudic
- University Medical Centre of Mannheim, Mannheim, Germany
| | - N Behar
- University Hospital of Rennes, Rennes, France
| | | | - F Sacher
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J B Gourraud
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
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7
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Probst V, Clerici G, Babuty D, Badenco N, Marquie C, Leenhardt A, Maury P, Blangy H, Deharo JL, Tfelt-Hansen J, Rudic B, Behar N, Mansourati J, Sacher F, Gourraud JB. 3298First clinical evaluation of subcutaneous implantable cardiac defibrillator in brugada patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Probst
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
| | - G Clerici
- Reunion Regional University Hospital, Saint Pierre, Reunion
| | - D Babuty
- University Hospital of Tours, Tours, France
| | - N Badenco
- Hospital Pitie-Salpetriere, Paris, France
| | - C Marquie
- Lille University Hospital, Lille, France
| | - A Leenhardt
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Maury
- University Hospital of Toulouse, Toulouse, France
| | - H Blangy
- University Hospital of Nancy, Nancy, France
| | - J L Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B Rudic
- University Medical Centre of Mannheim, Mannheim, Germany
| | - N Behar
- University Hospital of Rennes, Rennes, France
| | | | - F Sacher
- University Hospital of Bordeaux - Hospital Haut Leveque, Departement of Cardiology, Bordeaux-Pessac, France
| | - J B Gourraud
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec, Nantes, France
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8
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Blancard M, Debbiche A, Kato K, Cardin C, Guichard S, Gandjbakhch E, Haissaguerre M, Extramania F, Hocini M, Geoffroy O, Leenhardt A, Guicheney P, Rougier J. A loss-of-function CACNA1C variant, p.T1787M, associated with risk of ventricular fibrillation in Africans. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Milman A, Probst V, Nam GB, Brugada P, Brugada J, Kusano KF, Takagi M, Priori SG, Delise P, Gaita F, Corrado D, Leenhardt A, Veltmann C, Hirao K, Belhassen B. P401Clinical predictors of time-to-first appropriate implantable cardioverter-defibrillator discharge in high-risk patients with Brugada syndrome implanted prophylactically: analysis of 246 patients from. Europace 2017. [DOI: 10.1093/ehjci/eux141.126] [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: 11/14/2022] Open
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10
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Stordeur B, Gandjbakhch E, Marijon E, Lellouche N, Algalarrondo A, Varlet E, Messali A, Leenhardt A, Extramiana F. Outcome after aborted cardiac arrest related to ventricular arrhythmias. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30498-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Stordeur B, Gandjbakhch E, Marijon E, Lellouche N, Algalarrondo V, Varlet E, Messali A, Leenhardt A, Extramiana F. Cause of aborted cardiac arrest in patients implanted with a defibrillator in secondary prevention. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30417-2] [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: 11/27/2022]
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12
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Arbelo E, Brugada J, Hindricks G, Maggioni AP, Tavazzi L, Vardas P, Laroche C, Anselme F, Inama G, Jais P, Kalarus Z, Kautzner J, Lewalter T, Mairesse GH, Perez-Villacastin J, Riahi S, Taborsky M, Theodorakis G, Trines SA, Brugada J, Arbelo E, Hindriks G, Maggioni AP, Morgan J, Tavazzi L, Vardas P, Alonso A, Ferrari R, Komajda M, Tavazzi L, Wood D, Vardas P, Brugada J, Mairesse G, Taborsky M, Kautzner J, Lewalter T, Riahi S, Jais P, Anselme F, Theodorakis G, Inama G, Trines S, Kalarus Z, Villacastin JP, Maggioni AP, Manini M, Gracia G, Laroche C, Missiamenou V, Taylor C, Konte M, Fiorucci E, Lefrancq EF, Glémot M, McNeill PA, Bois T, Heidbüchel H, Nuyens D, Boland J, Dinraths V, Herzet JM, Hoffer E, Malmendier D, Massoz M, Pourbaix S, Ballant E, Blommaert D, Deceuninck O, Dormal F, Xhaet O, De Potter T, Geelen P, Derycker K, Duytschaever M, Tavernier R, Vandekerckhove Y, Vankats D, Bulava A, Hanis J, Sitek D, Blahova M, Cihak R, Hanyasova L, Jansova H, Peichl P, Tanzerova M, Wichterle D, Duda J, Haman L, Parizek P, Coling L, Neuzil P, Petru J, Sediva L, Skoda J, Chovancik J, Fiala M, Neuwirth R, Karlsdottir A, Pehrson S, Gerdes C, Jensen H, Lukac P, Nielsen JC, Hansen J, Johannessen A, Hansen PS, Pedersen A, Heath F, Hjortshoj S, Thogersen A, Da Costa A, Martel I, Romeyer-Bouchard C, Sadki N, Schmid A, Haissaguerre M, Hocini M, Knecht S, Sacher F, Ait Said M, Cauchemez B, Ledoux F, Thomas O, Cebron JP, Decarsin N, Gras D, Hervouet S, Durand C, Durand-Dubief A, Poty H, Babuty D, Pierre B, Albenque JP, Boveda S, Combes N, Mas R, Hermida JS, Kubala M, Godin B, Savouré A, Soublin Y, Defaye P, Jacon P, Brigadeau F, Corbut S, Flament-Balzola F, Kacet S, Klug D, Lacroix D, Copie X, Gilles L, Hocine Z, Paziaud O, Piot O, Crocq C, Kaballu G, Le Moal V, Lotton P, Mabo P, Pavin D, Andronache M, De Chillou C, Magnin-Poull I, Deharo JC, Durand C, Franceschi F, Peyrouse E, Prevot S, Etchegoin M, Extramiana F, Leenhardt A, Messali A, Heine T, Schneider A, Winter N, Brachmann J, Ritscher G, Schertel-Gruenler B, Simon H, Sinha AM, Turschner O, Wystrach A, Stemberg M, Kuck KH, Metzner A, Tilz R, Wissner E, Heitmann K, Willems S, Andresen D, Mueller S, Volkmer M, Schmidt B, Kostopoulou A, Livanis E, Voudris V, Efremidis M, Letsas K, Tsikrikas S, Christoforatou E, Ioannidis P, Katsivas A, Kourouklis S, Andrikopoulos G, Rassias I, Tzeis S, Dakos G, Paraskevaidis S, Stavropoulos G, Theofilogiannakos E, Vassilikos V, Bongiorni M, Zucchelli G, Raviele A, Themistoclakis S, Pratola C, Tritto M, Della Bella P, Mazzone P, Moltrasio M, Tondo C, Calo L, De Luca L, Guarracini F, Lioy E, Dozza L, Frigoli E, Giannelli L, Pappone C, Saviano M, Schiavina G, Vicedomini G, De Ponti R, Doni LA, Marazzi R, Salerno-Uriarte J, Tamborini C, Anselmino M, Ferraris F, Gaita F, Bertaglia E, Brandolino G, Zoppo F, De Groot N, Janse P, Jordaens L, Pison L, Roos C, Van Gelder I, Manusama R, Meijer A, Van der Voort P, Trines S, Compier MG, Kazmierczak J, Kornacewicz-Jach Z, Wielusinski M, Baran J, Kulakowski P, Dzidowski M, Fuglewicz A, Nowak K, Pruszkowska-Skrzep P, Wozniak A, Nowak S, Trusz-Gluza M, Almendral J, Atienza F, Castellanos E, De Diego C, Ortiz M, Moreno Planas J, Perez Castellano N, Benezet J, Farre Muncharaz J, Rubio Campal J, Hernandez Madrid A, Matia R, Arana E, Pedrote A, Cozar R, Peinado R, Valverde I, Arbelo E, Berruezo A, Calvo N, Guiu E, Husseini S, Mont Girbau L. The Atrial Fibrillation Ablation Pilot Study: an European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Eur Heart J 2014; 35:1466-78. [DOI: 10.1093/eurheartj/ehu001] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elena Arbelo
- Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain
| | | | - Aldo P. Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia – Antipolis, France
| | - Luigi Tavazzi
- GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia – Antipolis, France
| | - Frédéric Anselme
- Service De Cardiologie, Hôpital Charles Nicolle, Rouen Cedex, France
| | | | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
| | - Zbigniew Kalarus
- Department of Cardiology, Silesian Academy of Medicine, Zabrze, Poland
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | | | | | - Sam Riahi
- AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Milos Taborsky
- Internal Cardiology Department, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | - Serge A. Trines
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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Leenhardt A, Defaye P, Mouton E, Delay M, Delarche N, Dupuis JM, Bizeau O, Mabo P, Cheggour S, Babuty D. First inappropriate implantable cardioverter defibrillator therapy is often due to inaccurate device programming: analysis of the French OPERA registry. Europace 2012; 14:1465-74. [DOI: 10.1093/europace/eus144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Leenhardt A, Messali A, Labbé JP, Denjoy I, Dejode P, Maison-Blanche P, Kedra A, Extramiana F. Les post-dépolarisations. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Extramiana F, Messali A, Labbé JP, Maison-Blanche P, Denjoy I, De Jode P, Kedra A, Leenhardt A. Les réentrées. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Segouin C, Leenhardt A, Dozol A, Duteil C, Barbier V, Cohen-Solal A. Comment identifier et valoriser un transfert d’activité ? Application à une activité de cardiologie. Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Lubinski A, Bissinger A, Boersma L, Leenhardt A, Merkely B, Oto A, Proclemer A, Brugada J, Vardas PE, Wolpert C. Determinants of geographic variations in implantation of cardiac defibrillators in the European Society of Cardiology member countries--data from the European Heart Rhythm Association White Book. Europace 2011; 13:654-62. [DOI: 10.1093/europace/eur066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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18
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Extramiana F, Tatar C, Maison-Blanche P, Denjoy I, Messali A, Dejode P, Iserin F, Leenhardt A. Beat-to-beat T-wave amplitude variability in the long QT syndrome. Europace 2011. [DOI: 10.1093/europace/euq498] [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: 11/14/2022] Open
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19
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Abstract
Atrial fibrillation (AF) is the most frequent cardiac arrhythmia and its prevalence rises with age. AF may cause stroke and heart failure but the relationship between AF and mortality is less clear. It is difficult to determine if cardiovascular events in patients with AF are attributable to the arrhythmia itself or if they are merely related to the comorbidities frequently associated with AF. Review of the literature suggests that lone AF (without structural heart disease), a rare clinical entity except in young patients, is not an independent risk factor for mortality. On the other hand, if illnesses usually associated with AF are present (hypertension, heart failure...), AF has a negative impact on outcome in terms of survival and morbidity. Current antiarrhythmic medications have not shown reduction in mortality of AF patients, but new agents and catheter ablation are promising paths to explore in order to decrease AF burden.
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Affiliation(s)
- G Moubarak
- Service de Cardiologie, Centre de Référence Maladies Cardiaques Héréditaires, Université Paris 7, Hôpital Lariboisière, France.
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Leenhardt A, Messali A, Denjoy I, Dejode P, Maison-Blanche P, Ben Halima M, Kedra A, Extramiana F. Des recommandations à la pratique quotidienne en rythmologie. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Alkmim Teixeira R, Martinelli Filho M, Borba E, Bonfa E, Nishioka S, Pedrosa A, Costa R, Sosa E, Foley PWX, Muhyaldeen S, Chalil S, Smith REA, Sanderson JE, Leyva F, Pentimalli F, Visram N, Sala D, Sagone A, Lerecouvreux M, Probst V, Sacher F, Leenhardt A, Sadoul N, Le Heuzey JY, Carlioz R, Blanc JJ, Pernencar S, Morais J, De Ponti R, Marazzi R, Zoli L, Caravati F, Salerno-Uriarte JA, Dixen U, Lamberts M, Skielboe AK, Dalsgaard J, Stender S, Jensen GB, Nageh MF, Kim JJ, Yao J, Khairallah FS, Hamati F, Perress D, Schneider A, Alonso J, Gupta M, Hegazy R, Lotfy W, Ammar R, Fattouh A, Kyriakou P, Kyriakou P, Bostanitis I, Zafiris A, Makridis I, Bountonas G, Raptopoulou-Gigi M, Kloppe A, Thiere A, Mijic D, Zarse M, Lemke B, Kaba RA, Lyne JC, Markides V, Wong T, Ernst S, Mabo P, Abbey S, Tassin A, Cebron JP, Solnon A, Dupuis JM, Zorio Grima E, Cano Perez O, Navarro Manchon J, Rodriguez Diez S, Rueda Soriano J, Osca Asensi J, Sancho Tello De Carranza MJ, Salvador Sanz A. FLASH SESSION ORAL & POSTER PRESENTATION. Europace 2009. [DOI: 10.1093/europace/euq199] [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: 11/14/2022] Open
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22
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Mabo P, Leenhardt A, Jaillon P, Kacet S, Aubin F, Denjoy I, Le Heuzey JY. [Management of atrial fibrillation in France: the observational FACTUEL study]. Ann Cardiol Angeiol (Paris) 2009; 58:151-158. [PMID: 19477433 DOI: 10.1016/j.ancard.2009.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 01/23/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To describe the management of patients with atrial fibrillation (AF) and to study consistency with guidelines on management of AF. PATIENTS AND METHODS Observational study on a random sample of cardiologists from a French national database. Each cardiologist had to recruit the first five patients meeting inclusion criteria (patients diagnosed with AF between January 2004 and one month before inclusion and accepting the collection of their medical data). RESULTS Between December 2006 and January 2207, 1789 patients aged 71 on average have been recruited by 481 cardiologists. Fifty-one percent were diagnosed with paroxysmal, 15% with persistent and 33% with permanent AF. Restoration of sinus rhythm was preferred in forms considered as paroxysmal or persistent forms whereas control of the ventricular rate was more frequent in AF considered as permanent. Overall, therapeutic guidelines are applied in practice, despite a frequent use of amiodarone in patients with no associated heart disease. Prevention of thromboembolism was observed in 88% of the patients. CONCLUSIONS FACTUEL is the biggest observational study on AF ever conducted in France. The therapeutic strategies used by the cardiologists are consistent with the objectives of preventing thromboembolism and controlling heart rhythm and/or rate. In most cases, the treatment used is consistent with the therapeutic guidelines.
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Affiliation(s)
- P Mabo
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Hôpital Pontchaillou, Rennes, France.
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23
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Extramiana F, Messali A, Leenhardt A. Cryoablation for curing reciprocating tachycardia: take the good and leave the bad. Arch Cardiovasc Dis 2008; 101:137-8. [PMID: 18477938 DOI: 10.1016/s1875-2136(08)71793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Denjoy I, Lupoglazoff JM, Villain E, Vaksmann G, Godart F, Lucet V, Leenhardt A, Guicheney P, Schwartz P. [The Jervell and Lange-Nielsen syndrome. Natural history, molecular basis and clinical outcome]. Arch Mal Coeur Vaiss 2007; 100:359-64. [PMID: 17646758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED Data on the Jervell and Lange-Nielsen syndrome (JLN), the long QT syndrome (LQTS) variant associated with deafness and caused by homozygous or compound heterozygous mutations on the KCNQ1 or on the KCNE1 genes encoding the IKs current, are still largely based on case reports. We analyzed data from 186 JLN patients obtained from the literature (31%) and from individual physicians (69%). Most patients (86%) had cardiac events and 50% were symptomatic already by age 3. Their QTc was markedly prolonged (557 +/- 65 ms). Most of the arrhythmic events (95%) were triggered by emotions or exercise. Females are at lower risk for cardiac arrest and sudden death (CA/SD). A QTc>550 ms and history of syncope during the first year of life are independent predictors of subsequent CA/SD. Most mutations (90.5%) are on the KCNQ1 gene; mutations on the KCNE1 gene are associated with a more benign course. beta-blockers have only partial efficacy as 51% of the patients had events despite therapy and 29% had CA/SD. CONCLUSIONS JLN syndrome is a most severe variant of LQTS, with a very early onset, major QTc prolongation, and is not well responsive to beta-blockers. Subgroups at relatively lower risk for CA/SD are identifiable and include females, patients with a QTc pound550 ms, without events in the first year of life, and with mutations on KCNE1. Early therapy with ICDs has to be considered.
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Affiliation(s)
- I Denjoy
- Service de cardiologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris.
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Leenhardt A. [The best of arrhythmia in 2006]. Arch Mal Coeur Vaiss 2007; 100 Spec No 1:79-83. [PMID: 17405569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Even though the year 2006 did not bring any major publication reporting therapeutic trials in the field of arrhythmia, it has been marked by the publication of important international guidelines on atrial fibrillation (AF), the treatment of ventricular arrhythmia and the prevention of sudden death, as well as studies on AF ablation, the external automatic defibrillator, the risk factors of ventricular fibrillation in the acute phase of myocardial infarction, and genetic aspects of the arrhythmogenic right ventricular dysplasia.
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Affiliation(s)
- A Leenhardt
- Service de cardiologie, hôpital Lariboisière, 2 rue Ambroise-Paré, 75475 Paris.
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27
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Milliez P, Haggui A, Maltret A, Leenhardt A. [Recommendations for sports participation in patients with arrhythmia]. Arch Mal Coeur Vaiss 2006; 99:992-1002. [PMID: 17181039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nowadays, sports are a wonderful mean for social success, and the high-level athlete is the symbol of a perfect hygiene of life. Despite this, the occurrence of unexplained sudden death (SD) is not exceptional, especially during training and competition. In this context, it is important to intensify medical controls for these athletes, especially in a very early phase, in order to detect subjects at risk. In case of detection of a cardiac disease prone to cardiovascular or arrhythmic event, the practice of any high-level sportive activity or even any sustained sportive activity must be forbidden without hesitation, with the aim of protecting these subjects. Even though a total interdiction of sports practice can be a tough decision to be accepted, it should prevail on the dramatic consequences of sudden death. Physicians' responsibility issues in the screening and management of competition or leisure-time sportsmen are of high importance since in case of sudden death, the physician and the medical community liabilities can be considered. As a consequence, the medical community set up recommendations on the screening, treatment and even interdiction of sportive activity for athletes, which should also be applied to leisure-time sportsmen. In the first part of this article, the different causes (especially the arrhythmia-related) of sudden death occurring in sportsmen are reviewed. In the second part, the recommendations on practice of high-level sports in case of arrhythmia or genetic arrhythmic cardiac disease are summarized.
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Affiliation(s)
- P Milliez
- Service de cardiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris.
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28
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Leenhardt A, Extramiana F. [Ablation of atrial fibrillation: by who, where and at what cost?]. Arch Mal Coeur Vaiss 2006; 99:769-70. [PMID: 17067092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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29
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Chauvin M, Cazeau S, Frank R, Leenhardt A, Clémenty J, Barnay C, Djiane P, Salvador M, Boveda S, Defaye P. [Recommendations from the French Cardiology Society concerning the competence, performance and the environment required for the implantation and surveillance of pacemakers]. Arch Mal Coeur Vaiss 2006; 99:275-8. [PMID: 16733993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- M Chauvin
- Service de Cardiologie, CHU de Hautepierre, 67098 Strasbourg
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30
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Leenhardt A, Extramiana F, Milliez P, Meddane M, Haggui A, Cauchemez B. [Value and limitations of programmed ventricular stimulation]. Arch Mal Coeur Vaiss 2005; 98 Spec No 5:6-14. [PMID: 16433237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The electrocardiogramme and methods of prolonged ECG recording are sufficient for diagnosing most cardiac arrhythmias. They also provide some prognostic information and allow evaluation and follow-up of treatment. However, in some situations, endocavitary electrophysiological investigations are required when the diagnosis is uncertain, that more prognostic information is required or interventional techniques (endocavitary ablation) are envisaged. The aim of this report is to summarise the value and limitations of programmed ventricular stimulation. Many of its indications have been abandoned in terms of rhythm stratification in the face of more robust parameters, in particular the left ventricular ejection fraction. However, it retains a potential utility in terms of prognosis in arrhythmogenic right ventricular dysplasia, the Brugada syndrome and operated Tetralogy of Fallot. In any event, it is important to remember that studies resulting in diagnostic or therapeutic recommendations were performed with strict protocols of stimulation in selected patients and that these recommendations can only be applied when the evaluation protocols are respected. The indications of programmed ventricular stimulation will increase in the therapeutic field with the development of new techniques of 3D mapping, new systems of catheter guiding which should extend the indications of endocavitary ablation.
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Affiliation(s)
- A Leenhardt
- Service de cardiologie, hôpital Lariboisière,2, rue Ambroise Paré, 75475 Paris.
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31
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Extramiana F, Maison-Blanche P, Haggui A, Milliez P, Cauchemez B, Beaufils P, Leenhardt A. [Primary anomalies of ventricular repolarisation]. Arch Mal Coeur Vaiss 2005; 98 Spec No 5:21-6. [PMID: 16433239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The duration of repolarisation is the main determinant of the refractory period and therefore plays a major electrophysiological role. Ventricular repolarisation can be influenced or modified by very many extrinsic factors responsible for so-called secondary changes or anomalies. On the contrary, primary anomalies of ventricular repolarisation correspond to intrinsic anomalies of ionic conduction which in turn affect repolarisation. Primary anomalies of ventricular repolarisation are the consequences of vascular disease, which is the origin of both electrocardiographic anomalies and rhythm disorders, and which can result in sudden death from ventricular fibrillation. Three clinical syndromes correspond with these definitions: long QT syndrome, short QT syndrome, and Brugada syndrome. Much of the experimental work seems to show that arrhythmogenic action results mostly from an increase in the heterogeneity of the refractory periods, whether this involves a prolonged, short or even normal repolarisation time. The various experimental models also give a better understanding of the repolarisation changes observed on the electrocardiogram. Knowledge of the mechanisms responsible for arrhythmias due to primary anomalies of ventricular repolarisation could provide a model for secondary anomalies.
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Affiliation(s)
- F Extramiana
- Service de cardiologie, hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris 10.
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32
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Abstract
During these last years, several therapeutic strategies trials have been performed in atrial fibrillation: the goal was to compare the rhythm control strategy (restoration and maintenance of sinus rhythm) to the rate control strategy (slowing of heart rate in atrial fibrillation). The most important of these different trials is the AFFIRM study. The main conclusion of this trial is that rate control can be chosen in first intention and not only in case of failure of the rhythm control strategy. These results can not be applied to 2 categories of patients: on one hand patients with heart failure and on the other hand young patients without cardiopathy in whom the strategy of rhythm control and sinus rhythm maintenance, mainly by class I antiarrhythmic drugs, remains the better choice.
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Affiliation(s)
- J Y Le Heuzey
- Service de cardiologie A, hôpital Européen-Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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33
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Extramiana F, Maison-Blanche P, Badilini E, Beaufils P, Leenhardt A. 67 Individual QT/RR relationship: average stability over time does not rule out an individual residual variability implication for the assessment of drug effect on the QT interval. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.14-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- F. Extramiana
- Lariboisi re Hospital, Cardiology Dept., Paris, France
| | | | | | - P. Beaufils
- Lariboisi re Hospital, Cardiology, Paris, France
| | - A. Leenhardt
- Lariboisi re Hospital, Cardiology, Paris, France
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Extramiana F, Denjoy I, Neyroud N, Guicheney P, Beaufils P, Leenhardt A, Maison-Blanche P. 807 Heart rate influences on repolarization duration and morphology in symptomatic and asymptomatic KCNQ1 mutation carriers. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.186-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- F. Extramiana
- Lariboisi re Hospital, Cardiology Dept., Paris, France
| | - I. Denjoy
- Lariboisiere hospital, cardiology, Paris, France
| | - N. Neyroud
- Groupe Hospitalier Piti -Salp tri re, INSERM U582 — Institut de Myologie, Paris, France
| | - P. Guicheney
- Groupe Hospitalier Piti -Salp tri re, INSERM U582 — Institut de Myologie, Paris, France
| | - P. Beaufils
- Lariboisiere hospital, cardiology, Paris, France
| | - A. Leenhardt
- Lariboisiere hospital, cardiology, Paris, France
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35
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Lerecouvreux M, Leenhardt A, Cl menty J, Le Marec H, Franck R, Blanc J, Le Heuzey J, Carlioz R. 274 Collective Observatory of BRugadA syndrome (COBRA): a French national multicenter survey. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.66-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - J. Cl menty
- CHU Haut L v que, Cardiology, Bordeaux, France
| | | | - R. Franck
- CHU Piti -Salp tri re, Cardiology, Paris, France
| | - J.J. Blanc
- CHU la Cavale Blanche, Cardiology, Brest, France
| | - J.Y. Le Heuzey
- H pital Europ en Georges Pompidou, Cardiology, Paris, France
| | - R. Carlioz
- H pital Sainte Anne, Cardiology, Toulon, France
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36
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Denjoy I, Postma A, Lupoglazoff JM, Vaksman G, Kamblock J, Leenhardt A, Wilde AA, Guicheney P. [Catecholinergic ventricular tachycardia in children]. Arch Mal Coeur Vaiss 2005; 98:506-12. [PMID: 15966600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Catecholinergic ventricular tachycardia is an adrenergic induced polymorphic ventricular arrhythmia. It occurs in infancy and is responsible for syncope and sudden death in the absence of any morphological cardiac abnormality. Without treatment the mortality in catecholinergic ventricular tachycardia is very high. We report genetic and clinical data from 25 cases of catecholinergic ventricular tachycardia referred with syncope (n=19) or resuscitated sudden death during exercise (n=6). A family history from the 25 families identified 41 apparent subjects considered as being clinically affected, with an average age of 30 +/- 10 years (11 to 62 years). Analysis of the RyR2 gene showed mutations in 13 of the 25 cases and in 39 of apparent subjects. With betablocker treatment (nadolol: 1.6 +/- 0.15 mg/kg), 96% of patients remained asymptomatic over an average follow-up of between 7.5 +/- 1.5 years, although some of them continued to display polymorphic ventricular extrasystoles on exercise. Nevertheless, 12% of the cases suffered sudden death or further syncope during follow-up. An automatic defibrillator was implanted in 2 patients who had a RyR2 mutation. High dose betablockers are effective in preventing serious rhythm disturbance in children. In adolescence, implanting an automatic defibrillator should be discussed in cases with a history of syncope or resuscitated sudden death. We confirm the importance of genetic studies in these families at high risk of sudden death.
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Affiliation(s)
- I Denjoy
- Cardiologie pédiatrique, hôpital Robert Debré, Paris.
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37
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Milliez P, Seitz J, Haggui A, Courteaux C, Obioha-Ngwu O, Josephson ME, Leenhardt A. [Comparison between three-dimensional electro-anatomical mapping and conventional mapping in the ablation of atrial tachycardias]. Arch Mal Coeur Vaiss 2005; 98:281-7. [PMID: 15881842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In atrial tachycardias, catheter ablation using conventional mapping system is associated with high immediate success and low recurrence. Three-dimensional electroanatomical mapping system combined to catheter ablation of atrial tachycardias has reached, in small uncontroled series, success rates of 100%. However, limited data are available about rates of recurrence or complication using this approach. In order to compare both mapping systems, we have conducted a study of 65 consecutive patients (36 women and 29 men) that underwent both electrophysiologic study and catheter ablation for suspected atrial tachycardias. Pre-existing heart disease was noted in 43%, hypertension in 32% and a history of atrial fibrillation of flutter in 52%. Catheter ablation guided by conventional mapping was undertaken in 44 patients and by three-dimensional electroanatomical mapping in 21. Successful ablation was performed in 68% of patients with conventional mapping and in 90% with three-dimensional electroanatomical mapping. No complication and recurrence were observed with the latter approach, while 5 patients had a recurrence and 2 had immediate complication with conventional mapping. Catheter ablation of atrial tachycardias combined with three-dimensional electroanatomical mapping appeared to be effective and safe, however, conventional mapping system still remains a reliable approach that must be considered as the first choice for atrial tachycardias ablation.
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Affiliation(s)
- P Milliez
- Harvard Thorndike Electrophysiology Institute, Beath Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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38
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Leenhardt A, Extramiana F, Milliez P, Meddane M, Haggui A, Cauchemez B. [Ventricular extrasystoles]. Arch Mal Coeur Vaiss 2004; 97 Spec No 4:7-12. [PMID: 15714885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Ventricular extrasystoles result from premature excitation of the heart from a site beyond the bifurcation of the bundle of His, at the level of the conductive tissue or myocardial cells. In practice they represent a daily problem for cardiologists due to their frequent occurrence. They can be detected in symptomatic patients and also in asymptomatic subjects, for example during routine health checks. It is therefore important to distinguish benign ventricular extrasystoles from those which are potentially serious, so that a useless or even dangerous treatment is not undertaken and severe anxiety is not caused in patients who have become 'medicalised'. The decision about treatment is only made following electrocardiographic and echographic clinical investigation, with the presence of cardiopathy being one of the major deciding factors.
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Affiliation(s)
- A Leenhardt
- Service de cardiologie, hôpital Lariboisière, Paris.
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39
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Leenhardt A, Chauvin M. [New concepts in electrophysiology and cardiac pacing]. Arch Mal Coeur Vaiss 2004; 97:1047. [PMID: 15609904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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40
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Extramiana F, Maison-Blanche P, Denjoy I, Milliez P, Cauchemez B, Beaufils P, Leenhardt A. [Recent concepts of the Brugada syndrome, the long QT syndrome and adrenergic ventricular tachycardias]. Arch Mal Coeur Vaiss 2004; 97:1135-40. [PMID: 15609917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The clinical syndromes responsible for sudden death have benefited from spectacular advances in recent years. The authors propose a brief review of the genetic, electrophysiological, physiopathological and clinical characteristics of the long QT syndrome, Brugada's syndrome, adrenergic ventricular tachycardias and the short QT syndrome. The initial concept of one gene responsible for one pathology has uncovered new zones of complexity within diseases considered to be monogenetic in origin. These new findings have impacted on diagnostic and therapeutic strategies of these conditions. However, the assessment of the arrhythmic risk and the choice of treatment in individual cases still remain almost exclusively the domain of clinical judgement. Similarly, the better understanding of the mechanisms of the arrhythmias in these syndromes has opened up new specific therapeutic approaches which require validation by clinical trial.
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Affiliation(s)
- F Extramiana
- Service de cardiologie, hôpital Lariboisière, Paris.
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41
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Chauvin M, Frank R, Le Heuzey JY, Barnay C, Cazeau S, Djiane P, Guenoun M, Leenhardt A, Mabo P, Sadoul N. [Recommendations on the implantation and surveillance of implantable defibrillators]. Arch Mal Coeur Vaiss 2004; 97:915-9. [PMID: 15521486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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42
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Lévy S, Boccara G, Dotto P, Brembillat-Perrot B, Leenhardt A, Avierinos JF, Somody E, Dubieff D, Fatemi M. [A multicentre trial of the diagnostic value and cost of electrocardiography in symptoms suggesting arrhythmia with a new event recorder with transtelephonic transmission]. Arch Mal Coeur Vaiss 2004; 97:108-12. [PMID: 15032409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Events recorders are used for electrocardiographic documentation of symptoms of arrhythmia too sporadic and short lasting to be recorded by 24 hour Holter monitoring. However, there are no French studies comparing the value and cost of event recorders with conventional diagnostic methods. Recently, a new telediagnostic device has become available in France leading to an assessment of the technique. The aim of this study was to determine the value of this event recorder and the cost of diagnostic ECG in the assessment of presumed arrhythmic symptoms such as palpitations or rare tachycardia (<3 episodes per week) of short duration, compared with conventional techniques. Fifty-eight patients with these criteria were randomised, 30 to Survcard (Group I) and 28 to conventional diagnostic methods (Group II). The patients were comparable with respect to age, sex distribution, type of symptoms and associated cardiac disease. The ECG diagnosis of the symptoms was established in 20 cases (66.6%) of patients in Group I in 17 +/- 16 days, and in 14 cases (50.0%) of Group II in 23 +/- 28 days. The difference between the two groups was not statistically significant. The cost of a positive diagnosis for Group I (Survcard) varied from 0 to 228.47 Euro with an average of 71.22 +/- 117.02 Euro. The cost of positive diagnosis in Group II varied from 76.80 to 2340.41 Euro with an average of 480.39 +/- 797.41 Euro. In conclusion, this study showed that the percentage of patients with a positive diagnosis was comparable in the two groups but that the cost was 6 times higher in the group investigated by conventional methods than in the Survcard group because of more costly medical intervention.
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Affiliation(s)
- S Lévy
- Travail des services de cardiologie, l'hôpital Nord, Marseille.
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43
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Milliez P, Deangelis N, Rucker-Martin C, Leenhardt A, Beaufils P, Delcayre C, Hatem S. P-268 Regression of the arrhythmogenic remodeling of left atria with treatment of heart failure in rat. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b129-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- P. Milliez
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
| | - N. Deangelis
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
| | - C. Rucker-Martin
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
| | - A. Leenhardt
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
| | - P. Beaufils
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
| | - C. Delcayre
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
| | - S. Hatem
- Inserm U 572, Inserm U 460, Lariboisiere Hospital and Bichat Hospital
,
Paris, France
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44
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Hermida J, Jandaud S, Mizon F, Rey J, Leenhardt A, Cauchemez B, Denjoy I, Milliez P, Coumel. P-234 Decreased nocturnal standard deviation of averaged NN intervals: An independent marker to identify patients at risk in the Brugada Syndrome. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b121-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | | | - F. Mizon
- University Hospital
,
Amiens, France
| | - J.L. Rey
- University Hospital
,
Amiens, France
| | | | | | - I. Denjoy
- Lariboisiere Hospital
,
Paris, France
| | | | - Coumel
- Lariboisiere Hospital
,
Paris, France
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45
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Leenhardt A, Extramiana F, Milliez P, Denjoy I, Thomas O, Meddane M, Dejode P, Cauchemez B. [Bidirectional ventricular tachycardias]. Arch Mal Coeur Vaiss 2003; 96 Spec No 7:27-31. [PMID: 15272518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Bidirectional tachycardias are rare arrhythmias. Nevertheless in the sixties and seventies these arrhythmias prompted much work relating to their mechanism. Discussions about the supposed supra-ventricular origin of certain bidirectional tachycardias essentially rested on presumptive arguments based on electrocardiographic analysis. All the electrophysiological investigations which could be performed in tachycardia showed a ventricular origin. The current hypotheses concerning the electrophysiological mechanism favour non-unifocal mechanisms as well as a very diverse aetiology: an automatic focus, or the triggered activities being associated with alternating conduction, or re-entry between the left hemibranches. Although the classic context is of excess digitalis with advanced cardiopathy, readily in atrial fibrillation with a poor prognosis as a corollary, the most recent description of catecholergic ventricular tachycardias with the very characteristic appearance of bidirectional tachycardias justifies updating the understanding of these unusual tachycardias.
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Affiliation(s)
- A Leenhardt
- Service de cardiologie, hôpital Lariboisière, Paris.
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46
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Milliez P, Cosson S, Courteaux C, Obioha-Ngwu O, Richardson A, Josephson M, Beaufils P, Leenhardt A. [Characteristic electrocardiographic procedures of isthmic-dependent atrial flutter; influence of clinical and echocardiographic procedures]. Arch Mal Coeur Vaiss 2003; 96:615-21. [PMID: 12868342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The appearance of the F waves on the ECG is considered to be related to the type of circuit of the anti-clockwise flutters and the clockwise isthmic-dependant flutters. In the authors' experience, the usual ECG description of these two types of flutter is not always observed. This study was undertaken to analyse the different appearances of anti-clockwise and clockwise flutters and to try and explain the reasons for these differences. Over a 4 year period, 139 patients with an ECG of atrial flutter required electro-physiological studies and echocardiography of the 156 flutters analysed: 130 were anti-clockwise and 26 clockwise. Three types of anti-clockwise flutter were observed: type 1 with exclusively negative F waves in the inferior leads: type 2 and 3 with negative F waves in the inferior leads and a small (type 2) or large (type 3) positive terminal components. The types 2 and 3 were associated with a higher incidence of left atrial dilatation, cardiac disease and atrial fibrillation than type 1. Two types of clockwise flutter were observed: type 1 with positive notched F waves in the inferior leads with a return to the iso-electric line and type 2 with wide F waves in the inferior leads with two components, predominantly positive and negative, without return to the iso-electric line. There are different ECG appearances of anti-clockwise and clockwise flutter which seem to be correlated with structural cardiac abnormalities. The anti-clockwise flutters with a positive terminal component of the F waves in the inferior leads corresponds to a subgroup with a high probability of cardiac disease and left atrial dilatation.
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Affiliation(s)
- P Milliez
- Service de cardiologie, hôpital Lariboisiere, 2, rue Ambroise Paré, 75010 Paris.
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47
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Cosson S, Kévorkian JP, Roux O, Fressonnet R, Leenhardt A, Beaufils P. [Left superior vena cava: a simple diagnosis by transthoracic echocardiography. A case report]. Ann Cardiol Angeiol (Paris) 2003; 52:194-7. [PMID: 12938575 DOI: 10.1016/s0003-3928(03)00045-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persistent left superior vena cava is an anomaly of the systemic venous return occurring in 0.5% of the general population. We report the case of a patient with an incidental diagnosis made during a dyspnea while he had chronic pulmonary disease. The diagnosis was suspected by the presence of a markedly dilated coronary sinus and confirmed by a simple contrast injection into the left antecubital vein. Transesophageal echocardiography and magnetic resonance imaging confirmed the existence of 2 superior vena cava with the left superior vena cava draining into the coronary sinus. This congenital anomaly is of minimal hemodynamic significance when isolated. The diagnosis can be useful for placement of central catheters from left superior approach.
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Affiliation(s)
- S Cosson
- Service de cardiologie du Professeur Beaufils, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris, France.
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Leenhardt A, Hamdaoui B, Di Fusco S, Extramiana F, Meddane M, Denjoy I, Milliez P, Dejode P, Cauchemez B. [Brugada syndrome]. Arch Mal Coeur Vaiss 2003; 96 Spec No 4:30-7. [PMID: 12852283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The Brugada syndrome is characterised clinically by the occurrence of syncope or sudden death due to ventricular arrhythmias in patients with structurally normal hearts and electrocardiographic signs of right bundle branch block and ST elevation in the right precordial leads (V1 to V3). The transmission of the condition is autosomal dominant with variable penetration. Mutations have been identified in a gene coding for the alpha sub-unity of the sodium channel (SCN5A) on chromosome 3 in only 30% of cases. This mutation is responsible for a reduction of the density of the sodium current and explains the aggravation of the electrocardiographic anomalies by antiarrhythmic drugs which block the sodium channels. The prognosis is poor in symptomatic patients and depends on the prevention of sudden death by the implantation of an automatic defibrillator. The therapeutic decision is much more difficult in asymptomatic patients without a family history. The authors propose a decisional algorithm. The management may have to be modified in the months or years to come depending on advances in the understanding of this syndrome.
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Affiliation(s)
- A Leenhardt
- Service de cardiologie, hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris
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Thomas O, Extramiana F, Milliez P, Cauchemez B, Coumel P, Leenhardt A. [Indications for implantable automatic defibrillators: critical analysis]. Arch Mal Coeur Vaiss 2003; 96 Spec No 4:54-61. [PMID: 12852286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The implantable automatic defibrillator (IAD), invented in 1980, has revolutionised the management of patients with malignant ventricular arrhythmias resistant to medical treatment or ablation procedures. The number of devices implanted continues to increase in the industrialised countries and, based on the results of clinical trials, the indications for IAD are now well codified and increase as new clinical studies are published. However, the absolute number of implantations in France remains low (about 1200 to 2000, about 20 per million population) for a number of reasons: cost of IAD, absence of reimbursement by the health service which has restrained the implantation to public hospitals, and information of cardiologists for whom IAD may seem to be reserved for a few exceptional cases. Several factors suggest that the number of implantations will increase in the near future. First of all, the procedures of implantation have become much more simple due mainly to technical improvements. Then, the results of recent studies have validated prophylactic implantations of these devices in primary prevention in the post-infarction period (MADIT, MUSTT, MADIT II studies) and have demonstrated the superiority of IAD over antiarrhythmic drug therapy in terms of global survival in patients with severe ventricular arrhythmias (AVID, CIDS, CASH studies).
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Affiliation(s)
- O Thomas
- Service de cardiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris
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Charlier P, Cochand-Priollet B, Polivka M, Goldgran-Tolédano D, Leenhardt A. [Chloroquine cardiomyopathy revealed by complete atrio-ventricular block. A case report]. Arch Mal Coeur Vaiss 2002; 95:833-7. [PMID: 12407800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
We describe a rare case of chloroquine cardiomyopathy occurring during long term (7 years) treatment for rheumatoid polyarthritis in a 42 year old woman. There was an isolated acute severe conduction defect, which is particularly rare. Histological study with the electron microscope allowed confirmation of this diagnosis. We report here the secondary cardiological effects of this frequently used synthetic antimalarial.
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Affiliation(s)
- P Charlier
- Service de cardiologie, hôpital Lariboisière
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