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El-Chami MF, Garweg C, Clementy N, Al-Samadi F, Iacopino S, Martinez-Sande JL, Roberts PR, Tondo C, Johansen JB, Vinolas-Prat X, Cha YM, Grubman E, Bordachar P, Stromberg K, Fagan DH, Piccini JP. Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry. Eur Heart J 2024; 45:1241-1251. [PMID: 38426911 PMCID: PMC10998730 DOI: 10.1093/eurheartj/ehae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Prior reports have demonstrated a favourable safety and efficacy profile of the Micra leadless pacemaker over mid-term follow-up; however, long-term outcomes in real-world clinical practice remain unknown. Updated performance of the Micra VR leadless pacemaker through five years from the worldwide post-approval registry (PAR) was assessed. METHODS All Micra PAR patients undergoing implant attempts were included. Endpoints included system- or procedure-related major complications and system revision rate for any cause through 60 months post-implant. Rates were compared through 36 months post-implant to a reference dataset of 2667 transvenous pacemaker patients using Fine-Gray competing risk models. RESULTS 1809 patients were enrolled between July 2015 and March 2018 and underwent implant attempts from 179 centres in 23 countries with a median follow-up period of 51.1 months (IQR: 21.6-64.2). The major complication rate at 60 months was 4.5% [95% confidence interval (CI): 3.6%-5.5%] and was 4.1% at 36 months, which was significantly lower than the 8.5% rate observed for transvenous systems (HR: .47, 95% CI: .36-.61; P < .001). The all-cause system revision rate at 60 months was 4.9% (95% CI: 3.9%-6.1%). System revisions among Micra patients were mostly for device upgrades (41.2%) or elevated thresholds (30.6%). There were no Micra removals due to infection noted over the duration of follow-up. At 36 months, the system revision rate was significantly lower with Micra vs. transvenous systems (3.2% vs. 6.6%, P < .001). CONCLUSIONS Long-term outcomes with the Micra leadless pacemaker continue to demonstrate low rates of major complications and system revisions and an extremely low incidence of infection.
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Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Christophe Garweg
- Department of Cardiovascular Sciences, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Regional Universitaire de Tours—Hopital Trousseau, Tours, France
| | - Faisal Al-Samadi
- Department of Medicine, King Salman Heart Center—King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saverio Iacopino
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Jose Luis Martinez-Sande
- Arrhythmia Unit, Cardiology Service, University Clinical Hospital of Santiago de Compostela, CIBER-CV, IDIS, Santiago de Compostela, Spain
| | - Paul R Roberts
- Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Claudio Tondo
- Monzino Cardiac Center, IRCCS, Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | | | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Grubman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital, Pessac-Bordeaux, France
| | | | | | - Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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De Pooter J, Bulava A, Gras D, Timmer S, Chin-Pang Chan G, Clementy N, Pathak RK, Healy S, Lüsebrink U, Zanon F. Utility of a guiding catheter for conduction system pacing: An early multicenter experience. Heart Rhythm O2 2024; 5:8-16. [PMID: 38312208 PMCID: PMC10837172 DOI: 10.1016/j.hroo.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Conduction system pacing (CSP), either as His bundle pacing (HBP) or as left bundle branch area pacing (LBBAP), may be superior to right ventricular apical or septal pacing. Objective The study sought to present acute results for a new guiding catheter (Biotronik Selectra 3D) designed for CSP implantations of a retractable screw-in lead (Biotronik Solia S). Methods The primary endpoint of the prospective, international nonrandomized BIO|MASTER.Selectra 3D study was freedom from catheter-related serious adverse device effects (SADEs) within 1 week of lead implantation. Results Of 157 enrolled patients, CSP was achieved in 147 (93.6%) patients. No SADEs occurred within 7 days. LBBAP was achieved in 82 patients (45 as crossover from an HBP attempt) and HBP in 65 (44.2%) patients. In centers considering both HBP and LBBAP, the CSP implantation success approached 99%. Successful CSP implantations lasted on average ∼50 minutes (fluoroscopy ∼6 minutes). Most procedures (87.9%) needed only 1 catheter, even after switch from HBP to LBBAP. The catheter's handling was rated largely positive. In patients without bundle branch block, mean QRS duration increased from 106 ms (intrinsic) to 122 ms (CSP) (P = .001). In patients with bundle branch block, mean QRS duration decreased from 151 ms (intrinsic) to 137 ms (CSP) (P = .004). Conclusion The Selectra 3D catheter is a valuable tool for HBP and LBBAP implantations of the stylet-supported pacemaker leads. When implanters considered both HBP and LBBAP, the success rate was ∼99%. Flexibility to change between different approaches may be advisable in heterogeneous and challenging areas, such as CSP implantations.
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Affiliation(s)
| | - Alan Bulava
- České Budějovice Hospital, Faculty of Health and Social Sciences, Cardiology, University of South Bohemia, České Budějovice, Czech Republic
| | - Daniel Gras
- Hôpital Privé du Confluent, Cardiology, Nantes, France
| | - Stefan Timmer
- Noordwest Ziekenhuisgroep, Cardiology, Alkmaar, the Netherlands
| | | | - Nicolas Clementy
- Centre Hospitalier Régional Universitaire de Tours, Cardiology, Chambray-lès-Tours, France
| | - Rajeev K Pathak
- Canberra Heart Rhythm, Australian National University, Cardiology, Garran, Australian Capital Territory, Australia
| | - Stewart Healy
- Monash Medical Centre, Cardiology, Melbourne, Victoria, Australia
| | - Ulrich Lüsebrink
- Universitätsklinikum Gießen und Marburg, Kardiologie, Marburg, Germany
| | - Francesco Zanon
- Santa Maria della Misericordia, Arrhythmia and Electrophysiology Unit, Rovigo, Italy
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Perino AC, Wang PJ, Lloyd M, Zanon F, Fujiu K, Osman F, Briongos-Figuero S, Sato T, Aksu T, Jastrzebski M, Sideris S, Rao P, Boczar K, Yuan-Ning X, Wu M, Namboodiri N, Garcia R, Kataria V, De Pooter J, Przibille O, Gehi AK, Cano O, Katsouras G, Cai B, Astheimer K, Tanawuttiwat T, Datino T, Rizkallah J, Alasti M, Feld G, Barrio-Lopez MT, Gilmore M, Conti S, Yanagisawa S, Indik JH, Zou J, Saha SA, Rodriguez-Munoz D, Chang KC, Lebedev DS, Leal MA, Haeberlin A, Forno ARJD, Orlov M, Frutos M, Cabanas-Grandio P, Lyne J, Leyva F, Tolosana JM, Ollitrault P, Vergara P, Balla C, Devabhaktuni SR, Forleo G, Letsas KP, Verma A, Moak JP, Shelke AB, Curila K, Cronin EM, Futyma P, Wan EY, Lazzerini PE, Bisbal F, Casella M, Turitto G, Rosenthal L, Bunch TJ, Baszko A, Clementy N, Cha YM, Chen HC, Galand V, Schaller R, Jarman JWE, Harada M, Wei Y, Kusano K, Schmidt C, Hurtado MAA, Naksuk N, Hoshiyama T, Kancharla K, Iida Y, Mizobuchi M, Morin DP, Cay S, Paglino G, Dahme T, Agarwal S, Vijayaraman P, Sharma PS. Worldwide survey on implantation of and outcomes for conduction system pacing with His bundle and left bundle branch area pacing leads. J Interv Card Electrophysiol 2023; 66:1589-1600. [PMID: 36607529 PMCID: PMC9817436 DOI: 10.1007/s10840-022-01417-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p < 0.0001). CONCLUSION In conclusion, CSP lead implantation has been broadly adopted but has yet to become the default approach at most surveyed institutions. As the indications and data for CSP continue to evolve, strategies to educate and promote CSP lead implantation at institutions without CSP lead implantation experience would be necessary.
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Affiliation(s)
- Alexander C Perino
- Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Paul J Wang
- Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | | | - Francesco Zanon
- Santa Maria Della Misericordia General Hospital, Perugia, Italy
| | | | | | | | | | - Tolga Aksu
- Yeditepe University Hospital, Istanbul, Turkey
| | | | | | - Praveen Rao
- Baylor University Medical Center, Dallas, USA
| | | | - Xu Yuan-Ning
- West China Hospital, Sichuan University, Chengdu, China
| | - Michael Wu
- Lifespan Cardiovascular Institute, Brown University, Providence, USA
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | | | - Anil K Gehi
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Oscar Cano
- Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Binni Cai
- Xiamen Cardiovascular Hospital, Xiamen, China
| | | | | | - Tomas Datino
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | | | - Gregory Feld
- University of California San Diego Health System, San Diego, USA
| | | | | | | | | | - Julia H Indik
- University of Arizona College of Medicine, Tucson, USA
| | - Jiangang Zou
- First Affiliated Hospital of Nanjing Medical University, Jiangsu Provincial Hospital, Nanjing, China
| | | | | | - Kuan-Cheng Chang
- School of Medicine, China Medical University, Taichung, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - Dmitry S Lebedev
- National Medical Research Center. VA Almazov, Saint Petersburg, Russia
| | - Miguel A Leal
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | | | | | | | - Manuel Frutos
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Francisco Leyva
- Aston University, Birmingham, UK
- Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Cristina Balla
- Azienda Ospedaliero Universitaria Di Ferrara, Cona, Italy
| | | | | | | | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Canada
| | | | | | - Karol Curila
- Cardiocenter, 3Rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Edmond M Cronin
- Lewis Katz School of Medicine at, Temple University, Philadelphia, USA
| | - Piotr Futyma
- Medical College, University of Rzeszów, Rzeszów, Poland
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | | | - Pietro Enea Lazzerini
- University of Siena, Siena, Italy
- Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Felipe Bisbal
- University Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Gioia Turitto
- New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | | | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, USA
| | - Artur Baszko
- Poznań University of Medical Sciences, Poznań, Poland
| | | | | | | | | | - Robert Schaller
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | | | | | - Yong Wei
- Shanghai General Hospital, Shanghai, China
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | - Yoji Iida
- Kobari General Hospital, Noda, Japan
| | | | | | | | | | - Tillman Dahme
- Universitätsklinikum Ulm (Ulm University Medical Center), Ulm, Germany
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Lenormand T, Abou Khalil K, Bodin A, Babuty D, Bisson A, Clementy N. Comparison of first- and second-generation leadless pacemakers in patients with sinus rhythm and complete atrioventricular block. J Cardiovasc Electrophysiol 2023; 34:1730-1737. [PMID: 37354448 DOI: 10.1111/jce.15981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The efficacy and safety of leadless cardiac pacemakers (LPMs) as an alternative to conventional transvenous cardiac pacing have been largely reported. The first generation of the MicraTM transcatheter pacing system (VR; Medtronic) was able to provide single-chamber VVI(R) pacing mode only, with a potential risk of pacemaker syndrome in sinus rhythm patients. A second-generation system (AV) now provides atrioventricular synchrony through atrial mechanical (Am) sensing capability (VDD mode). OBJECTIVE We sought to compare VR and AV systems in sinus rhythm patients with chronic ventricular pacing (Vp) for complete atrioventricular block. METHODS All consecutive patients implanted with an LPM in our department for complete atrioventricular block were retrospectively screened. Patients with atrial fibrillation, sinus dysfunction, or Vp burden <20% at 1 month postimplantation were excluded. Patients were systematically followed with a visit at 1 month, and then at least once a year. RESULTS A total of 93 patients-45 VR (2015-2020) and 48 AV (2020-2021)-were included. VR and AV patients had similar baseline characteristics, except for VR patients being older (80 ± 8 vs. 77 ± 9 years, p = 0.049). The mean Vp burden was 77% in the VR and 82% in the AV group (p = 0.38). In AV patients, the median AV synchronous beats rate was 78%, with 65% having a >66% rate. An E/A ratio <1.2 as measured on echocardiography was the only independent predictor of accurate atrial mechanical tracking (p = 0.01). One-year survival rate was similar in both groups. Five patients in the VR and 0 in the AV group eventually developed pacemaker syndrome within 1 year post-implantation (p = 0.02). CONCLUSION In sinus rhythm patients with chronic Vp for complete atrioventricular block implanted with an LPM, the atrial mechanical sensing algorithm allowed significant atrioventricular synchrony in most patients and was associated with no occurrence of-otherwise rare-pacemaker syndrome.
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Affiliation(s)
| | | | - Alexandre Bodin
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Dominique Babuty
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Arnaud Bisson
- Department of Cardiology, University Hospital of Tours, Tours, France
- Department of Cardiology, Hospital Center of Orléans, Orléans, France
| | - Nicolas Clementy
- Cardiology Department, Clinique du Millénaire, Montpellier, France
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5
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Lenormand T, Abou Khalil K, Bodin A, Babuty D, Bisson A, Clementy N. Leadless cardiac pacing: Results from a large single-centre experience. Arch Cardiovasc Dis 2023; 116:316-323. [PMID: 37236828 DOI: 10.1016/j.acvd.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The efficacy and safety of leadless cardiac pacing as an alternative to conventional transvenous cardiac pacing in selected patients have been widely reported. AIM To report the experience of a high-volume implantation centre with older and new generations of leadless pacemakers. METHODS This retrospective observational study included the first consecutive 400 patients who underwent implantation of a leadless pacemaker in our centre. Complications and electrical parameters were evaluated during follow-up, comparing patients implanted with first-generation (Micra™ VR) and second-generation (Micra™ AV) leadless pacemakers (Medtronic, Minneapolis, MN, USA). Data were collected by a review of medical files. RESULTS Among 400 procedures, there were 328 Micra™ VR pacemakers and 72 Micra™ AV pacemakers implanted, followed for a median of 16 months (694 patient-years). The mean age was 77 years and both groups had a high burden of co-morbidities. Implantation success rate was 99.5%. A total of 87.5% of patients were discharged the day after the procedure. The pacing threshold remained stable and<2V in 96.5% of all patients. The perioperative complication rate at 30 days was 3.5%. Outcomes were similar between the two groups. CONCLUSION Leadless cardiac pacing is a safe and efficient alternative to conventional transvenous cardiac pacing.
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Affiliation(s)
- Thibault Lenormand
- Department of Cardiology, Tours University Hospital, 37000 Tours, France.
| | - Kassem Abou Khalil
- Department of Cardiology, Tours University Hospital, 37000 Tours, France
| | - Alexandre Bodin
- Department of Cardiology, Tours University Hospital, 37000 Tours, France
| | - Dominique Babuty
- Department of Cardiology, Tours University Hospital, 37000 Tours, France
| | - Arnaud Bisson
- Department of Cardiology, Tours University Hospital, 37000 Tours, France; Department of Cardiology, Orléans Hospital Centre, 45000 Orléans, France
| | - Nicolas Clementy
- Cardiology Department, Clinique du Millénaire, 34000 Montpellier, France
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Bisson A, Fawzy AM, El-Bouri W, Angoulvant D, Lip GYH, Fauchier L, Clementy N. Clinical Phenotypes and Atrial Fibrillation Recurrences after Catheter Ablation: An Unsupervised Cluster Analysis. Curr Probl Cardiol 2023; 48:101732. [PMID: 37003451 DOI: 10.1016/j.cpcardiol.2023.101732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Catheter ablation (CA) is a well-established treatment of atrial fibrillation (AF). Data-driven cluster analysis is able to better distinguish prognostically-relevant phenotype clusters among patients with AF. We performed a hierarchical cluster analysis in a cohort of AF patients undergoing a first CA and evaluate associations between identified clusters and recurrences of arrhythmia following ablation. The study included 209 AF patients treated with CA. 3 clusters with distinct characteristics were identified. Recurrences at one year occurred in 27.2% in Cluster 1, 43.2% in Cluster 2 and 60.9% in Cluster 3 (p<0.0001). Cluster classification was independently associated with arrhythmia recurrences (HR 1.58, 95% CI 1.01-2.49, p=0.046) after adjustment for age, CHA2DS2-VASc score, left atrial volume, type of atrial fibrillation and ejection fraction. To concluded, cluster analysis identified three statistically-driven groups among AF patients treated with CA with different risks for arrhythmia recurrences.
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Affiliation(s)
- Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France; Service de Cardiologie, Centre Hospitalier Régional Universitaire d'Orléans, Orléans, France; EA4245, Transplantation Immunité Inflammation, Université de Tours, Tours, France; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Ameenathul M Fawzy
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Wahbi El-Bouri
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France; EA4245, Transplantation Immunité Inflammation, Université de Tours, Tours, France
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Clinique du Millénaire, Montpellier, France
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7
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Strik M, Clementy N, Mondoly P, Eschalier R, Ramirez FD, Racine HP, Haïssaguerre M, Ritter P, Ploux S, Bordachar P. Implantation of a leadless pacemaker in young adults. J Cardiovasc Electrophysiol 2023; 34:412-417. [PMID: 36583963 DOI: 10.1111/jce.15796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 12/31/2022]
Abstract
AIMS Leadless pacing has emerged as an alternative to conventional transvenous pacemakers to mitigate the risks of pocket- and lead-related complications but its use remains controversial in young adults mostly because experience in this patient population is limited. We sought to examine the feasibility and safety of implanting leadless single chamber pacemakers in young adults. METHODS This multicenter, retrospective, observational study sought to evaluate the safety, efficacy, and electrical performance of the Micra VR Transcatheter Pacemaker System (Medtronic) in patients between 18 and 40 years who underwent implantation of a leadless pacemaker for any indication at the university medical centers of Bordeaux, Clermont-Ferrand, Toulouse, and Tours (France), between 2015 and 2021. The primary safety endpoint was freedom from system-related or procedure-related major complications at 6 months. The primary efficacy endpoint was the combination of a low (≤2 V) and stable (increase within 1.5 V) pacing capture threshold at 6 months. RESULTS Leadless pacemaker implantation was successful in all 35 patients. At 6 months, safety endpoint was met for 35 (100%) and efficacy endpoint for 34 (97%) patients. During a follow-up of 26 ± 15 months (range: 6-60 months), Safety endpoint remained 100% and efficacy endpoint was 94%. Leadless pacemaker retrieval was not required in any patient. Approximately one-third of patients (n = 13, 37%) had >40% ventricular pacing burdens at 1 year, including all 10 patients with a complete AV block but also 3 patients with normal AV conduction during implantation. One patient reported symptoms of pacemaker syndrome which was confirmed using Holter recording and successfully treated using reprogramming. CONCLUSION In this observational study, leadless pacemakers demonstrated favorable short- and intermediate-term safety and effectiveness in young adults.
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Affiliation(s)
- Marc Strik
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Clementy
- Department of Cardiology, University Hospital Trousseau, Tours, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Epidemiology Department, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Hugo-Pierre Racine
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Service de Cardiologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Québec, Canada
| | - Michel Haïssaguerre
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Philippe Ritter
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Sylvain Ploux
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Pierre Bordachar
- Cardiac Electrophysiology and Pacing Department, Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.,Signal Analysis Unit, IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
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Gourraud J, Le Diffon T, Mansourati J, Clementy N, Thollet A, Rajalu A, Cotard V, Kyndt F, Martins R, Sacher F, Probst V. Characteristics and prognosis of the catecholamine induced QT prolongation syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.370] [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
We have recently demonstrated association of unexplained sudden cardiac arrest (SCA) with inheritance of catecholamine induced QT prolongation (CIQTP).
Objective
We here aim to describe incidence, characteristics and prognosis of this new syndrome in young patients with unexplained SCA or their relatives.
Methods
We reviewed the medical screening of all consecutive patients or their first-degree relatives explore from 2015 after the occurrence of a SCA before age 45. Structural heart disease or inherited arrhythmia diseases were excluded. A mental stress test was performed, as previously described, for each family members. All families with a positive mental stress were included in the study. Genetic screening was performed in at least one positive patient per family using targeted sequencing on a panel of 109 genes associated with inherited arrhythmias and cardiomyopathies.
Results
Among 456 patients screened (24 after SCA, 432 for familial screening) of 153 families, we identified 10 families (6.5%) with a catecholamine induced QT prolongation. No mutation was identified in these families. One hundred and ten patients were screened in CIQTP families. Thirty-four patients (30.9%) presented a CIQTP (mean age 42±20 yo, 64.7% of women). Five (14.7%) patients presented with previous symptoms (including 4 syncope and 1 SCA).
Two patients (5.9%) were implanted with an ICD and eleven (32.3%) were treated with beta blocker therapy mainly because of QT prolongation >500 ms after mental stress test or previous symptoms.
After a 3.6±1.8 years of follow up, no sudden cardiac death nor syncope occurred on beta blocker therapy except for one patient implanted with an ICD after a SCA. Under beta blocker treatment the patient was asymptomatic for 5 years. After a suddenly stop of the beta blocker treatment, the patient underwent VF. For 3 years now the patient is asymptomatic under beta blocker treatment.
Conclusions
In our experience, CIQTP families represent 6.5% of cases of unexplained SCD and suggest systematic screening with a mental stress test for family screening after the occurrence of a SCA. Beta blocker therapy is very efficient to reduce the risk of SCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | - N Clementy
- University Hospital of Tours , Tours , France
| | - A Thollet
- Institut du Thorax , Nantes , France
| | - A Rajalu
- Institut du Thorax , Nantes , France
| | - V Cotard
- Institut du Thorax , Nantes , France
| | - F Kyndt
- Institut du Thorax , Nantes , France
| | - R Martins
- University Hospital of Rennes - Hospital Pontchaillou, Department of Cardiology and Vascular Disease , Rennes , France
| | - F Sacher
- University Hospital of Bordeaux , Bordeaux , France
| | - V Probst
- Institut du Thorax , Nantes , France
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9
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Clementy N, Bodin A, Ah-Fat V, Babuty D, Bisson A. Dual-chamber ICD for left bundle branch area pacing: the cardiac resynchronization and arrhythmia sensing via the left bundle (cross-left) pilot study. J Interv Card Electrophysiol 2022; 66:905-912. [PMID: 35970951 DOI: 10.1007/s10840-022-01342-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) has emerged as a promising technique to deliver cardiac resynchronization therapy (CRT). However, safety and efficacy of ventricular arrhythmia sensing via the left bundle in implantable cardioverter-defibrillator (ICD) recipients remain unclear. We sought to evaluate the feasibility of a single LBBAP lead connected to a dual-chamber ICD in patients indicated with a CRT-D implantation. METHODS The CROSS-LEFT pilot study prospectively included 10 consecutive patients with a reduced ejection fraction and a complete left bundle branch block, indicated with a prophylactic CRT-D. A DF-1 lead was implanted at the right ventricular (RV) apex, and an LBBAP lead through the interventricular septum. Ventricular fibrillation was induced at implantation in both conventional (RV) and left bundle branch area sensing configurations. The latter was the final sensing configuration, and patients were implanted with a dual-chamber DF-1 ICD connected to the atrial lead (RA port), the LBBAP lead (RV IS-1 port), and the defibrillation lead (RV DF-1 port), the IS-1 pin being capped. Atrioventricular delay was optimized to ensure fusion between LBBAP and native conduction from the right bundle. Patients were followed during 6 months. RESULTS No difference between both configurations was observed regarding R-wave sensing in sinus rhythm (p = 0.22), ventricular fibrillation median interval detection (p = 1.00), or total induced episode duration (p = 0.78). LBBAP resulted in a significant reduction of median QRS width from 164 to 126 ms (p = 0.002). Median ventricular sensing significantly improved from 9.7 at implantation to 18.8 mV at 6 months (p = 0.01). Median LVEF also significantly improved from 29 to 44% at 6 months (p = 0.002). CONCLUSION Ventricular arrhythmia sensing and defibrillation can be performed via a single LBBAP lead connected to a dual-chamber ICD, and is associated with significant electromechanical reverse remodeling. CLINICAL TRIAL REGISTRATION NUMBER NCT05102227 In patients presenting with left bundle branch block and left ventricular systolic dysfunction, a left bundle branch area pacing lead connected to a DF-1 dual-chamber implantable cardioverter-defibrillator provides safe ventricular arrhythmia sensing and efficient electro-mechanical resynchronization.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France.
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Vincent Ah-Fat
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et Faculté de Médecine, Université de Tours, EA7505, Tours, France
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10
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Davydoff C, Andorin A, Minois D, Arnaud M, Minier M, Sacher F, Martins R, Clementy N, Gourraud JB, Probst V. Does sports participation increase risk in patients with long QT syndrome? Results from a large French cohort. Europace 2022; 24:1675-1683. [PMID: 35951747 DOI: 10.1093/europace/euac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Sports practice, especially in competition, is usually restrained in patients diagnosed with long QT syndrome (LQTS). Although data are scarce, a low incidence of cardiac arrhythmic events (CAEs) during sports practice is reported. We aim to evaluate the incidence of CAE during sports practice in LQTS patients. METHODS AND RESULTS All consecutive patients above 18 years of age diagnosed with LQTS and prospectively followed at the referral centre for inherited arrhythmia syndrome received a survey to retrospectively assess their sports practice prior to and after the diagnosis of LQTS. Two hundred and forty-six patients were included (57% females). The median age was 43 years, and the median QTc was 457 ms (428; 482). Patients reported a total of 4092 years [1376 (34%) after diagnosis] of sports practice: 2905 (77%) [1138 (39%) after diagnosis] years of leisure practice and 1187 (23%) [238 (20%) after diagnosis] years of competitive practice. One hundred and eighty (73%) patients practiced sport prior to the diagnosis of LQTS and 170 (69%) after. Prior to the diagnosis, four (2%) patients presented a CAE during leisure sports practice and one during competition. After diagnosis, only one patient presented a CAE, appropriately treated by an implantable cardioverter defibrillator discharge, in the context of beta-blocker non-compliance. The CAE event rate was 0.0007 events/year in the 1376 years of total sports practice after the diagnosis of LQTS. CONCLUSION After the diagnosis of LQTS, the occurrence of CAE is very low during sports practice, even in competitive practice. There was no CAE in patients properly treated with beta-blocker therapy with good compliance.
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Affiliation(s)
- Caroline Davydoff
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Antoine Andorin
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Damien Minois
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Marine Arnaud
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Mathilde Minier
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | | | - Raphael Martins
- Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Vincent Probst
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
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11
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Bodin A, Clementy N, Bisson A, Pierre B, Herbert J, Babuty D, Fauchier L. Leadless or Conventional Transvenous Ventricular Permanent Pacemakers: A Nationwide Matched Control Study. J Am Heart Assoc 2022; 11:e025339. [PMID: 35929449 PMCID: PMC9496294 DOI: 10.1161/jaha.122.025339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Leadless ventricular permanent pacemakers (leadless VVI or LPM) were designed to reduce lead‐related complications of conventional VVI pacemakers (CPM). The aim of our study was to assess and compare real‐life clinical outcomes within the first 30 days and during a midterm follow‐up with the 2 techniques. Methods and Results This French longitudinal cohort study was based on the national hospitalization database. All adults (age ≥18 years) hospitalized in French hospitals from January 1, 2017 to September 1, 2020, who underwent a first LPM or CPM were included. The study included 40 828 patients with CPM and 1487 with LPM. After propensity score matching 1344 patients with CPM were matched 1:1 with patients treated with LPM. Patients with LPM had a lower rate of all‐cause and cardiovascular death within the 30 days after implantation. During subsequent follow‐up (mean: 8.6±10.5 months), risk of all‐cause death in the unmatched population was significantly higher in the LPM group than in the CPM group, whereas risk of cardiovascular death and of endocarditis was not significantly different. After matching on all baseline characteristics including comorbidities (mean follow‐up 6.2±8.7 months), all‐cause death, cardiovascular death, and infective endocarditis were not statistically different in the 2 groups. Conclusions Patients treated with leadless VVI pacemakers had better clinical outcomes in the first month compared with the patients treated with conventional VVI pacing. During a midterm follow‐up, risk of all‐cause death, cardiovascular death, and endocarditis in patients treated with leadless VVI pacemaker was not statistically different after propensity score matching.
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Affiliation(s)
- Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France
| | - Bertrand Pierre
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France.,Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et EA7505 Faculté de Médecine, Université François Rabelais Tours France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais Tours France
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12
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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13
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Kottmaier M, Inaba O, Phillips K, Adsett M, Hayes J, Gkalapis C, Lengauer S, Clementy N, Bailey C, Kaneko S. Initial experience using a novel algorithm to calculate omnipolar electrograms using a high-density grid-style catheter. Europace 2022. [DOI: 10.1093/europace/euac053.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
A novel mapping algorithm recently became available in Europe and select countries in the Asia Pacific region. EnSite Omnipolar Technology (OT) utilizes the Advisor HD Grid Mapping Catheter, Sensor Enabled (HD Grid) to calculate electrograms in 360 degrees from two bipolar and three unipolar electrograms acquired from a triangular set of three electrodes. This software also enables calculation of wavefront characteristics including maximum voltage, activation direction and wave speed. Procedural characteristics and clinical utilization of this novel software have not yet been reported.
Purpose
To examine the clinical utility and procedural characteristics associated with the use of this novel mapping algorithm among participating centers.
Methods
Acute procedural data were prospectively collected in 386 cases at 52 centers utilizing the newly approved mapping software in the initial phases of commercialization in Europe and the Asia Pacific region. Procedural characteristics recorded included indication for mapping/ablation, navigation mode, mapping reference, and maps and tools used to diagnose/locate ablation targets.
Results
A total of 14 indications for mapping and ablation were represented including AF, atypical flutter, and VT (Table 1). VoXel (magnetic primary) navigation mode was used in most cases (n=325, 84%). The CS catheter was used as the map reference in 280 cases (73%). A variety of workflows were used with OT to diagnose and locate ablation targets including voltage maps (n=275, 71%), LAT maps (n=226, 59%), OT activation vectors (n=124, 32%), propagation maps (n=94, 24%), and sparkle maps (n=69, 18%); note: total exceeds 100%, multiple workflows per case observed. EnSite LiveView Dynamic Display (LiveView) was used in 129 cases (33%) to diagnose and locate ablation targets, including 28 (22%) where OT activation vectors were used with LiveView. Several benefits of OT were reported including rapid identification of ablation target(s) (n=133, 35%), higher point density (n=82, 21%), better signals (n=69, 18%), and improved procedure efficiency (n=48, 12%).
Conclusion(s)
Initial experience with this novel mapping software in Europe and the Asia-Pacific region illustrated utility in a variety of arrhythmias to diagnose and locate ablation targets. The use of OT provided several benefits including rapid identification of ablation targets and higher point density, however further examination of its impact on procedural efficiencies and acute outcomes is likely warranted.
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Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Munich, Germany
| | - O Inaba
- Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - K Phillips
- Greenslopes Private Hospital, Brisbane, Australia
| | - M Adsett
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - J Hayes
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - S Lengauer
- German Heart Center of Munich, Munich, Germany
| | - N Clementy
- University Hospital of Tours, Tours, France
| | - C Bailey
- Abbott, St. Paul, United States of America
| | - S Kaneko
- Toyota Kosei Hospital, Toyota, Japan
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BAPTISTE GOURRAUD JEAN, Mansourati J, Clementy N, PROBST VINCENT, Martins R, Sacher F, PROBST VINCENT. PO-625-06 CHARACTERISTICS AND PROGNOSIS OF THE CATECHOLAMINE INDUCED QT PROLONGATION SYNDROME. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Maille B, Bodin A, Bisson A, Herbert J, Pierre B, Clementy N, Klein V, Franceschi F, Deharo JC, Fauchier L. Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the CRT-D Futility score. Heart 2022; 108:1186-1193. [PMID: 35410895 DOI: 10.1136/heartjnl-2021-320532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score. METHODS Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010-2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. RESULTS Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included-as main predictors of futility-older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%). CONCLUSIONS The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.
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Affiliation(s)
- Baptiste Maille
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France .,C2VN, Aix-Marseille University, Marseille, France
| | - Alexandre Bodin
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Arnaud Bisson
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Julien Herbert
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Bertrand Pierre
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Nicolas Clementy
- Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Victor Klein
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Frédéric Franceschi
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France.,C2VN, Aix-Marseille University, Marseille, France
| | - Jean-Claude Deharo
- Cardiology, Assistance Publique Hopitaux de Marseille, Marseille, France.,C2VN, Aix-Marseille University, Marseille, France
| | - Laurent Fauchier
- Cardiology, Trousseau University Hospital, Tours, France.,François Rabelais University, Tours, France
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16
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Kamakura T, Gourraud JB, Clementy N, Maury P, Mansourati J, Klug D, Da Costa A, Pasquie JL, Mabo P, Chavernac P, Laurent G, Defaye P, Laborderie J, Leenhardt A, Sadoul N, Deharo JC, Giraudeau C, Quentin A, Jesel L, Thollet A, Tixier R, Derval N, Haissaguerre M, Probst V, Sacher F. Outcome of Patients with Early Repolarization Pattern and Syncope. Heart Rhythm 2022; 19:1306-1314. [PMID: 35395407 DOI: 10.1016/j.hrthm.2022.03.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Syncope in patients with an early repolarization (ER) pattern presents a challenge for clinicians as it has been identified as an indicator of a higher risk of life-threatening ventricular arrhythmias (VAs). OBJECTIVE This study aimed to analyze the outcome of patients with an ER pattern and syncope, and to evaluate the factors predictive of VAs. METHODS Over a period of 5 years, we enrolled 143 patients with an ER pattern and syncope in a multicenter prospective registry. RESULTS Following the initial examinations, 97 patients (67.8%) were implanted with a device allowing electrocardiogram monitoring, including 84 with an implantable loop recorder. During a mean follow-up of 68 ± 34 months, we documented 16 arrhythmias presumably responsible for syncope (5 VAs, 10 bradycardias, and 1 supraventricular tachycardia). Additionally, recurrent syncope not associated with electrocardiogram documentation occurred in 16 patients (11.2%). The cause of syncope was identified in 23 of 97 (23.8%) patients with a monitoring device. The 5-year incidence of VAs and arrhythmic events presumably responsible for syncope was 4.9% and 11.0%, respectively. Patients who developed VAs showed no prodromes or specific triggers at the time of syncope. Neither the presence of a family history of sudden cardiac death nor the previously reported high-risk electrocardiographic parameters differed between patients with and without VAs. CONCLUSIONS VAs occurred in 4.9% of patients with an ER pattern and syncope. Device implantation based on detailed history taking seems to be a reasonable strategy. Previously reported high-risk electrocardiographic patterns did not identify patients with VAs.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Jean-Baptiste Gourraud
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Nicolas Clementy
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Didier Klug
- Department of Electrophysiology, Lille University Hospital, Lille, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, France
| | - Jean-Luc Pasquie
- Department of Cardiology and PhyMedExp, Université Montpellier, INSERM, CNRS, CHRU Montpellier University Hospital, France
| | - Philippe Mabo
- Department of Cardiology, Rennes University Hospital, France
| | | | | | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital, France
| | | | | | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, France
| | | | | | - Anne Quentin
- Department of Cardiology, Centre Hospitalier de Saint Brieuc, France
| | - Laurence Jesel
- Department of Cardiology, Strasbourg University Hospital, France
| | - Aurelie Thollet
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Michel Haissaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Vincent Probst
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France.
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17
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Lenormand T, Bisson A, Bodin A, Babuty D, Clementy N. Left Purkinje premature ventricular complexes following left bundle branch area pacing. HeartRhythm Case Rep 2022; 8:445-448. [PMID: 35774209 PMCID: PMC9237351 DOI: 10.1016/j.hrcr.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Nasarre M, Clementy N, Bodin A, Babuty D, Bisson A. Physiological pacing with a DF-1 single chamber defibrillator in a patient with permanent atrial fibrillation and heart block: a case report. J Cardiovasc Electrophysiol 2022; 33:1067-1069. [PMID: 35229391 DOI: 10.1111/jce.15429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
We report a case report of a 68-year-old man with chemotherapy-induced cardiomyopathy and uncontrolled permanent atrial fibrillation. CRT implantation and atrioventricular junction ablation was planned. DF-1 single chamber defibrillator was connected to lead's defibrillation and a lead destinated to left bundle branch area pacing. This system leads to reduce costs by one third, improve battery longevity and provide a more physiological pacing. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mathieu Nasarre
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Nicolas Clementy
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Alexandre Bodin
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Dominique Babuty
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Arnaud Bisson
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France.,Cardiology Department, Centre Hospitalier Régional d'Orléans, Orléans, France
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19
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Clementy N, Pineaud G, Bisson A, Babuty D. Atrioventricular Nodal Reentrant Tachycardia Ablation Using Mini-Electrode Recordings. J Clin Med 2022; 11:jcm11010282. [PMID: 35012022 PMCID: PMC8746187 DOI: 10.3390/jcm11010282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Catheter ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia (AVNRT) is mainly performed using anatomical landmarks. We sought to see whether a new ablation catheter equipped with mini-electrodes may facilitate the mapping of slow pathway potentials for AVNRT ablation. We prospectively included patients referred for AVNRT in our center. Mapping and ablation were performed using an irrigated catheter equipped with 3 insulated mini-electrodes on the distal tip. Thirteen consecutive patients were included (85% female, median age 46 years). Slow pathway potentials could be identified in 77% of cases on mini-electrode bipolar tracings, versus 15% on conventional bipolar tracings (p = 0.0009). At the end of the procedure, double potentials on the ablation line were identified in all patients, only on mini-electrode bipolar tracings. Following ablation, an interval separating double potentials in sinus rhythm ≥15% of baseline tachycardia cycle length was associated with non-inducibility in all patients (p < 0.0001). No recurrence occurred during 1 year of follow-up. The use of mini-electrodes may help target slow pathway potentials during AVNRT ablation. Identification of sufficiently split double potentials on the ablation line might represent an electrophysiological endpoint in these patients.
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20
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Spiesser P, Bisson A, Bodin A, Herbert J, Pierre B, Clementy N, Babuty D, Fauchier L. Long-term clinical outcomes in patients after catheter ablation for atrial fibrillation or atrioventricular node ablation: A French nationwide cohort study. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Ma I, Genet T, Clementy N, Bisson A, Herbert J, Semaan C, Bouteau J, Angoulvant D, Ivanes F, Fauchier L. Outcomes in patients with acute myocardial infarction and history of illicit drug use: a French nationwide analysis. Eur Heart J Acute Cardiovasc Care 2021; 10:1027-1037. [PMID: 34453835 DOI: 10.1093/ehjacc/zuab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
AIMS Several reports suggest that illicit drug use may be a major cause of acute myocardial infarction (AMI) independently of smoking habits and associated with a poorer prognosis. The aim of our study was to evaluate the impact of illicit drug use on (i) the risk of AMI and (ii) its prognosis. METHODS AND RESULTS This French longitudinal cohort study was based on the administrative hospital-discharge database from the entire population. First, we collected data for all patients admitted in hospital in 2013 with at least 5 years of follow-up to identify potential predictors of AMI. In a second phase, we collected data for all patients admitted with AMI from January 2010 to December 2018. We identified patients with a history of illicit drug use (cannabis, cocaine, or opioid). These patients were matched with patients without illicit drug use to assess their prognosis. In 2013, 3 381 472 patients were hospitalized with a mean follow-up of 4.7 ± 1.8 years. In multivariable analysis, among all drugs under evaluation, only cannabis use was significantly associated with a higher risk of AMI [HR 1.32 (95% CI 1.09-1.59), P = 0.004]. Between January 2010 and December 2018, we then identified 738 899 AMI patients. Among these patients, 3827 (0.5%) had a known history of illicit drug use. These patients were younger, most often male and had less comorbidities. After 1:1 propensity score matching, during a mean follow-up of 1.9 ± 2.3 years, there was no significant difference between patients without illicit drug use and patients with illicit drug use regarding all-cause death, cardiovascular death, stroke, or heart failure. CONCLUSION In a large and systematic nationwide analysis, cannabis use was an independent risk factor for the incidence of AMI. However, the prognosis of illicit drug users presenting with AMI was similar to patients without illicit drug use.
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Affiliation(s)
- Iris Ma
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Thibaud Genet
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
| | - Nicolas Clementy
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Arnaud Bisson
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Julien Herbert
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
| | - Carl Semaan
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Jérémie Bouteau
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Denis Angoulvant
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Fabrice Ivanes
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
| | - Laurent Fauchier
- Service de cardiologie, CHU Trousseau, 37044 Tours, France
- Université de Tours, EA7505, 37044 Tours, France
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22
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Fischer K, Lellouche N, Damy T, Martins R, Clementy N, Bisson A, Lesaffre F, Espinosa M, Garcia R, Degand B, Serzian G, Jourda F, Huttin O, Guichard JB, Devilliers H, Eicher JC, Laurent G, Guenancia C. Cardiovascular outcomes after cardiac resynchronization therapy in cardiac amyloidosis. ESC Heart Fail 2021; 9:740-750. [PMID: 34734471 PMCID: PMC8787999 DOI: 10.1002/ehf2.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 12/03/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) is highly effective in dilated cardiomyopathy (DCM) patients with impaired left ventricular ejection fraction (LVEF) and left bundle block branch. In cardiac amyloidosis (CA) patients, left ventricular dysfunction and conduction defects are common, but the potential of CRT to improve cardiac remodelling and survival in this particular setting remains undefined. We investigated cardiovascular outcomes in CA patients after CRT implantation in terms of CRT echocardiographic response and major cardiovascular events (MACEs). Methods and results Our retrospective study included 47 CA patients implanted with CRT devices from January 2012 to February 2020, in nine French university hospitals (77 ± 6 years old, baseline LVEF 30 ± 8%) compared with propensity‐matched (1:1 for age, LVEF at implantation, and CRT indication) DCM patients with a CRT device. CA patients had lower rates of CRT response (absolute delta LVEF ≥ 10%) compared with DCM patients (36% vs. 70%, P = 0.002). After multivariate Cox analysis, CA was independently associated with MACE (hospitalization for heart failure/cardiovascular death) [hazard ratio (HR) 3.73, 95% confidence interval (CI) 1.85–7.54, P < 0.001], along with the absence of CRT response (HR 3.01, 95% CI 1.56–5.79, P = 0.001). The presence of echocardiographic CRT response (absolute delta LVEF ≥ 10%) was the only predictive factor of MACE‐free survival in CA patients (HR 0.36, 95% CI 0.15–0.86, P = 0.002). Conclusion Compared with a matched cohort of DCM patients, CA patients had a lower rate of CRT response and consequently a worse cardiovascular prognosis after CRT implantation. However, CRT could be beneficial even in CA patients given that CRT response was associated with better cardiac outcomes in this population.
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Affiliation(s)
- Kilian Fischer
- Department of Cardiology, Dijon University Hospital, 14 rue Paul Gaffarel, Dijon, 21079, France
| | - Nicolas Lellouche
- Department of Cardiology, Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU-ATVB, Inserm U955, University Hospital Henri Mondor, Créteil, France
| | - Thibaud Damy
- Department of Cardiology, Referral Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU-ATVB, Inserm U955, University Hospital Henri Mondor, Créteil, France
| | - Raphaël Martins
- Department of Cardiology, Pontchaillou Hospital, Rennes, France
| | - Nicolas Clementy
- Department of Cardiology, Tours University Hospital, Tours, France
| | - Arnaud Bisson
- Department of Cardiology, Tours University Hospital, Tours, France
| | | | | | - Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, Poitiers, France
| | - Bruno Degand
- Department of Cardiology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Serzian
- Department of Cardiology, Regional University Hospital Jean Minjoz, Besançon, France
| | | | - Olivier Huttin
- Department of Cardiology, Nancy University Hospital, Nancy, France
| | | | | | - Jean-Christophe Eicher
- Department of Cardiology, Dijon University Hospital, 14 rue Paul Gaffarel, Dijon, 21079, France
| | - Gabriel Laurent
- Department of Cardiology, Dijon University Hospital, 14 rue Paul Gaffarel, Dijon, 21079, France
| | - Charles Guenancia
- Department of Cardiology, Dijon University Hospital, 14 rue Paul Gaffarel, Dijon, 21079, France.,EA 7460, University of Burgundy, Dijon, France
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23
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El-Chami MF, Garweg C, Iacopino S, Al-Samadi F, Martinez-Sande JL, Tondo C, Johansen JB, Prat XV, Piccini JP, Cha YM, Grubman E, Bordachar P, Roberts PR, Soejima K, Stromberg K, Fagan DH, Clementy N. Leadless Pacemaker Implant, Anticoagulation Status, and Outcomes: Results From The Micra Transcatheter Pacing System Post-Approval Registry. Heart Rhythm 2021; 19:228-234. [PMID: 34757189 DOI: 10.1016/j.hrthm.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Early results from the Micra investigational trial and Micra post-approval registry (PAR) demonstrated excellent safety and device performance; however, outcomes based upon anticoagulation status at implant have not been evaluated. OBJECTIVE To report implant characteristics, perforation rate and vascular related events based upon perioperative oral anticoagulation (AC) strategy in patients undergoing Micra implant. METHODS We compared procedure characteristics, major complications, and vascular events, including pericardial effusion, stratified by any AE (including major complications, minor complications and observations) or major complication only according to AC status in the Micra PAR. RESULTS Among 1795 patients with AC status available, 585 were not on AC, 795 had AC interrupted, and 415 had AC continued during Micra implant. Non-AC patients tended to be younger, with less history of AF and COPD, and more history of dialysis than interrupted and continued patients. The implant success rate was similar for all groups (99.1%-99.8%). Through 30 days post implant, the overall major complication rate was 3.1% for the non-AC group, 2.6% for the interrupted group, and 1.5% for the continued group. The combined rate for any vascular or pericardial effusion AE did not differ significantly between AC strategies (6.5%, 4.8%, and 3.6% respectively). CONCLUSION Implant of Micra appears to be safe and feasible regardless of an interrupted or continued peri-procedural oral anticoagulation strategy, with no increased risk of perforation rate or vascular complications.
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Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia.
| | | | - Saverio Iacopino
- Electrophysiology Unit, Arrhythmology Department, Maria Cecelia Hospital, Cotignola, Italy
| | - Faisal Al-Samadi
- King Salman Heart Center - King Fahad Medical City, Riyadh, Saudi Arabia
| | - Jose Luis Martinez-Sande
- Unidad de Arritmias, Servicio de Cardiologia, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Claudio Tondo
- Monzino Cardiac Center, IRCCS, Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | | | | | - Jonathan P Piccini
- Electrophysiology Section, Duke Center for Atrial Fibrillation, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Eric Grubman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, Bordeaux, France
| | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Régional Universitaire de Tours - Hôpital Trousseau, Tours, France
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Fauchier L, Bisson A, Bodin A, Spiesser P, Clementy N, Pierre B, Babuty D, Lip G. Are the results of the RATE-AF trial reproducible in daily practice? Clinical outcomes with digoxin vs beta-blocker for heart rate control in permanent atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0495] [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: 11/13/2022] Open
Abstract
Abstract
Background
There is little evidence to support selection of heart rate control therapy in patients with permanent atrial fibrillation (AF), in particular those with coexisting heart failure. In the recent RATE-AF trial that included patients with permanent AF and symptoms of heart failure, treatment with low-dose digoxin or bisoprolol did not result in statistically significant difference in quality of life at 6 months. The purpose of the study was to analyse whether the clinical outcomes may differ among unselected patients with permanent AF treated with digoxin or beta-blocker seen in daily practice.
Methods
All patients with atrial fibrillation (AF) seen in an academic institution were identified in a database. We examined the clinical course of 8962 consecutive patients with AF seen over a 10-year period. The adverse outcomes were investigated during follow-up and we identified the causes of death. Among them 1,787 patients had the RATE-AF criteria of inclusion (permanent AF, age ≥60 and NYHA ≥2), of whom 512 patients (29%) were treated with beta-blocker alone, 425 (24%) were treated with digoxin alone and 237 (13%) were treated with both a beta-blocker and digoxin. Outcomes in patients treated with beta-blocker alone or digoxin alone were compared after 1:1 propensity-score matching.
Results
After propensity score matching, 270 patients treated with beta-blocker were matched 1:1 with 270 patients treated with digoxin. In these patients (age 79±8 years, CHA2DS2VASc score 4.0±1.3), 125 deaths were recorded during a follow-up of 2.2±2.7 years (median 1.1, interquartile 0.1–3.5 years, yearly rate of death 10.4%) including 72 cardiovascular deaths (yearly rate 6.0%). Major clinical events (all-cause death, myocardial infarction, ischemic stroke or major bleeding) were recorded in 192 patients (yearly rate 19.1%). In this matched analysis, risk was not statistically significant in the 2 groups for all-cause death (HR 0.95, 95% CI 0.67–1.35 for beta-blocker use vs digoxin use), cardiovascular death (HR 1.23, 95% CI 0.77–1.96 for beta-blocker use vs digoxin use) or major clinical events (HR 0.98, 95% CI 0.74–1.31 for beta-blocker use vs digoxin use).
Conclusion
Our analysis included more patients and had a longer follow-up than in the RATE-AF trial, resulting in a 10-fold higher number of clinical events. We found that among patients with permanent AF and symptoms of HF, there was no statistically significant difference in the risk of all-cause death, cardiovascular mortality and major clinical events between those treated with digoxin or beta-blocker. Concerns regarding the use of digoxin, such as the narrow therapeutic window and drug interactions, were not issues resulting in worse clinically relevant cardiovascular outcomes with the approach used in the current study.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P.H Spiesser
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - G.Y.H Lip
- City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom
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25
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Garweg C, Bordachar P, Boveda S, Roberts P, Johansen J, Iacopino S, Clementy N, Winter S, Anderson C, Butler K, El-Chami M. Real-world experience on the safety and effectiveness of Micra TPS in patients with pre-existing in situ CIEDs. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0614] [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: 11/12/2022] Open
Abstract
Abstract
Background
The Micra pre-market study showed that the Micra transcatheter pacing system could be safely implanted in patients with pacing indications. Patients with pre-existing cardiac implantable electronic devices (CIED) were excluded from this clinical trial; however, this group of patients might benefit from a leadless pacemaker especially when a lead fails or after incidence of system-related infections.
Objective
To determine the outcome of patients with a pre-existing CIED or lead that remains in situ at the time of Micra implant attempt.
Methods
Patients who had a pre-existing CIED and/or lead at the time of Micra implantation attempt were identified from the Micra Post-Approval Registry and Micra Acute Performance studies. Baseline characteristics were summarized, and a Fine-Gray competing risk model was used to compare risk for major complication through 24 months for patients with and without a pre-existing CIED.
Results
Of the 2323 patients included in the analysis, 111 patients had a pre-existing CIED or lead at the time of Micra implantation attempt that remained in situ. Types of pre-existing devices included 81 pacemakers (45 single chamber, 32 dual chamber, 4 of unknown type), 10 ICDs (2 single chamber, 2 dual chamber, 6 unknown type), 10 CRT devices (6 CRT-P, 4 CRT-D), 3 generators of unknown type, and 7 patients had only leads remaining. Patients with pre-existing devices were younger and less likely to have a pacing indication of bradyarrhythmia with atrial fibrillation compared to patients without pre-existing devices (p<0.001 for both). Patients with prior devices were more likely to have a condition precluding implant of a transvenous pacemaker (67.6% vs. 21.3%, p<0.001). The presence of a pre-existing CIED did not impact the outcome of the Micra TPS implant procedure: implant success was >99% for both cohorts. Mean follow-up duration was 21.2±14.3 months (range 0–56) for pre-existing devices patients and 23.3±15.8 months (range 0–62) for other patients. The rate of major complications through 24 months was 1.8% for patients with and 3.8% for patients without prior devices (p=0.36). There were no major complications related to device malfunction or device-device interaction. There were 6 system revisions in 4 patients with preexisting devices and 52 revisions in 51 patients without preexisting devices. Pacing thresholds for patients with and without prior devices were similar at implant (0.72 and 0.63, respectively; p=0.31) and remained stable through 12 months.
Conclusion
Micra can be safely and successfully implanted in patients with a pre-existing CIED remaining in situ. It should be considered a treatment option for patients in whom CIED extraction may be deemed high risk.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Risk of major complications
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Affiliation(s)
- C Garweg
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - P Bordachar
- University Hospital of Bordeaux, Bordeaux, France
| | - S Boveda
- Clinic Pasteur, Toulouse, France
| | - P.R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - N Clementy
- University Hospital of Tours, Tours, France
| | - S Winter
- St. Vinzenz-Hospital, Cologne, Germany
| | - C Anderson
- Medtronic, Mounds View, United States of America
| | - K Butler
- Medtronic, Mounds View, United States of America
| | - M.F El-Chami
- Emory University Hospital, Atlanta, United States of America
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26
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Fauchier L, Bodin A, Bisson A, Herbert J, Spiesser P, Ah-Fat V, Pierre B, Clementy N, Babuty D. Benefits for clinical outcomes associated with dual-chamber pacing versus ventricular pacing in patients with sinus-node dysfunction: a nationwide matched control study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0600] [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
Introduction
Evidence from randomized trials suggests that, in patients with sinus-node dysfunction (SND), physiologic pacing (dual-chamber, DDD) may be superior to single-chamber (ventricular, VVI) pacing because it is associated with lower risks of atrial fibrillation and stroke, better exercise capacity and lower risk of pacemaker syndrome. However, benefits on mortality and risk of heart failure have not been demonstrated and these issues have not been fully evaluated in large “real life” analyses. The aim of our study was to assess and compare clinical outcomes within the first 30 days and during a longer-term follow-up with the two types of pacing at a nationwide level for patients with SND.
Methods
Using the administrative hospital database in France 2010–2020, 52,974 patients with SND were included in the analysis: 4,069 patients had VVI pacing and 48,905 had DDD pacing. Patients with leadless VVI pacemakers were excluded of the analysis. After propensity score matching 2,213 patients with VVI pacemaker were matched 1:1 with 2,213 patients treated with DDD pacemaker.
Results
In the matched analysis, patients with DDD pacemakers had a lower rate of all-cause (hazard ratio HR 0.711, 95% CI 0.61–0.828) and cardiovascular death (HR 0.628, 95% CI 0.48–0.818) within the 30 days after implantation. There were no significant differences for incidence of tamponade (HR 0.666, 95% CI 0.11–3.992), pneumothorax (HR 1.000, 95% CI 0.32–3.105), hemothorax (HR 0.800, 95% CI 0.21–2.982), major bleeding (HR 0.824, 95% CI 0.68–1.005) and transfusion (HR 1.016, 95% CI 0.83–1.243). During subsequent follow-up (mean: 3.0±2.8 years), risk of all-cause death in the matched population was significantly lower in the DDD group than in the VVI pacemaker group (HR 0.683, 95% CI 0.60–0.784). Patients with SND treated DDD pacemakers also had a lower risk of cardiovascular death (HR 0.569, 95% CI 0.44–0.732), new-onset atrial fibrillation (HR 0.638, 95% CI 0.58–0.706), ischemic stroke (HR 0.685, 95% CI 0.53–0.887) and hospitalization for heart failure (HR 0.758, 95% CI 0.68–0.850) than those treated VVI pacemakers, whilst risk of endocarditis was not significantly different (HR 0.986, 95% CI 0.50–1.951).
Conclusion
Patients with SND treated with DDD pacemakers had better clinical outcomes compared to those treated with VVI pacemakers. DDD pacing was associated with lower risks of death, cardiovascular death, new-onset atrial fibrillation, ischemic stroke, hospitalization for heart failure. DDD pacing was neither associated with a higher risk of complication on the short-term nor of endocarditis on the longer-term.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P.H Spiesser
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - V Ah-Fat
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Spiesser P, Bisson A, Bodin A, Herbert J, Pierre B, Clementy N, Babuty D, Fauchier L. Long-term clinical outcomes in patients after catheter ablation for atrial fibrillation or atrioventricular node ablation: a French nationwide cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0491] [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: 11/13/2022] Open
Abstract
Abstract
Background
Catheter ablation of atrial fibrillation (AF) has become a therapy of choice to treat symptomatic AF in current practice. As an alternative, atrioventricular node (AVN) ablation is an older but efficient procedure to control ventricular rate.
Purpose
To assess long-term clinical outcomes of AF ablation and AVN ablation in large cohort of patients with AF and to compare these two procedures.
Methods
This French multicentric retrospective study enrolled all patients hospitalized with a primary or secondary diagnosis of AF from 1st January 2010 to 31st December 2019, using an administrative hospital-discharge database. Clinical outcomes were analyzed in overall population and in propensity-matched samples.
Results
During follow-up (mean [SD] 2.0 [2.2], median [IQR] 1.0 [0.1–3.3] years), 2,438,015 patients were analysed (No ablation 2,360,833, AF ablation 62,490 and AVN ablation 14,692). Compared to patients treated without ablation, incidence of all-cause death was lower in patients treated with AF ablation (hazard ratio (HR) 0.272, 95% confidence interval (CI) 0.259–0.287, p<0.0001) or AVN ablation (HR 0.762, 95% CI 0.734–0.791, p<0.0001). After propensity-score matching, in patients treated with AF ablation, incidence of all-cause death (HR 0.662, 95% CI 0.557–0.788, p<0.0001), cardiovascular death (HR 0.617, 95% CI 0.471–0.807, p<0.0001) and hospitalization for heart failure (HF) (HR 0.732, 95% CI 0.620–0.865, p<0.0001) were lower compared to patients treated with AVN ablation, unlike incidence of ischemic stroke (HR 1.447, 95% CI 1.122–1.865, p<0.0001).
Conclusion
AF ablation and AVN ablation may be associated with better survival compared to non-invasive strategy. Compared to AVN ablation, AF ablation is associated with lower risk of all-cause death, cardiovascular death and hospitalization for HF, but higher incidence of ischemic stroke.
Funding Acknowledgement
Type of funding sources: None. Baseline characteristics matched cohortMain results
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Affiliation(s)
- P Spiesser
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - A Bisson
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - A Bodin
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - J Herbert
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - B Pierre
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - N Clementy
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - D Babuty
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
| | - L Fauchier
- Regional University Hospital Centre Trousseau - Chambray, Chambray Les Tours, France
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Bodin A, Clementy N, Bisson A, Pierre B, Herbert J, Babuty D, Fauchier L. Conventional transvenous or leadless ventricular permanent pacemakers: post-operative complications and mid-term follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0611] [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
Introduction/Background
Leadless ventricular permanent pacemakers (leadless VVI, LPM) were designed to reduce lead-related complications of conventional VVI pacemakers (CPM).
Purpose
The aim of our study was to assess and compare real-life clinical outcomes within the first 30 days and during a mid-term follow-up with the two techniques at a nationwide level.
Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals From January 1, 2017 to September 1, 2020, who underwent a first LPM or CPM implantation were included. Importantly, patients with dual chamber pacemaker were not included in our study.
Results
Of 42,315 patients included in the cohort, 40,828 patients (96%) had a CPM and 1,487 had a LPM. Using propensity score, 1,344 patients with CPM were adequately matched in a 1:1 fashion with LPM patients.
Clinical outcomes at day 30
In the unmatched population, within the 30 days after implantation, patients with LPM had a lower rate of all-cause mortality (OR: 0.635, 95% CI: 0.527–0.765, p<0.0001) and from a cardiovascular cause (OR: 0.568, 95% CI: 0.405–0.797, p=0.001). They also had lower rates of major bleeding and need for transfusion. There was no significant difference between groups regarding tamponade, pneumothorax or hemothorax.
In the matched population, LPM implantation was still significantly associated with a lower rate of all-cause death (OR: 0.583, 95% CI: 0.456–0.744, p<0.0001), cardiovascular death (OR: 0.413, 95% CI: 0.271–0.629, p<0.0001), major bleeding (OR: 0.523, 95% CI: 0.348–0.786, p=0.002) or transfusion (OR: 0.481, 95% CI: 0.296–0.780, p<0.0001). However, tamponade, pneumothorax or hemothorax were not significantly different between the two groups.
Clinical outcomes during mid-term follow-up
In the unmatched patients, mean follow-up was 8.6±10.5 months. Annual incidence of all-cause death was high in both groups, and significantly higher in the LPM group than in CPM group (31%/year vs. 20%/year, p<0.0001) with a HR of 1.519 (95% CI: 1.296–1.780). Cardiovascular death was not significantly different between groups. Infective endocarditis was higher in the LPM group than in the CPM group with a HR of 2.108 (95% CI: 1.119–3.973).
In the matched patients, mean follow-up was 6.2±8.7 months. All-cause death, cardiovascular death and infective endocarditis were not significantly different between groups.
Conclusion
Mortality is high among unselected patients implanted with ventricular permanent pacemakers, whether leadless or conventional pacemaker are used.
Implantation of leadless pacemakers seems to be a safe procedure in this high-risk population, with better outcomes at 1 month.
Mid-term outcomes appear relatively similar in LPM and CPM patients.
Funding Acknowledgement
Type of funding sources: None. Central illustration
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Affiliation(s)
- A Bodin
- University Hospital of Tours, Cardiology, Tours, France
| | - N Clementy
- University Hospital of Tours, Cardiology, Tours, France
| | - A Bisson
- University Hospital of Tours, Cardiology, Tours, France
| | - B Pierre
- University Hospital of Tours, Cardiology, Tours, France
| | - J Herbert
- University Hospital of Tours, Cardiology, Tours, France
| | - D Babuty
- University Hospital of Tours, Cardiology, Tours, France
| | - L Fauchier
- University Hospital of Tours, Cardiology, Tours, France
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Fauchier L, Bisson A, Bodin A, Herbert J, Spiesser PH, Pierre B, Clementy N, Babuty D, Bernard A, Lip GYH. All-cause mortality and cardiovascular death in 52091 patients with hypertrophic cardiomyopathy. A nationwide cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1735] [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: 11/12/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) have high risk of death related to cardiovascular (CV) death. Improvements in risk stratification are needed to help identify those HCM patients at higher risk of all-cause death and cardiovascular death.
Methods
This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adultshospitalized with isolated HCM. The overall sample of 52,091 patients was randomly partitioned into derivation (n=26,067) and validation (n=26,024) populations. A logistic regression model was used to construct HCM death and CV-death scores in the derivation sample, which were compared to the Charlson index, Frailty index and CHA2DS2VASc scores using c-indexes and calibration analysis.
Results
In 52,091 patients with isolated HCM, 12,676 (24.0%) died during follow-up of 3.0±2.8 years (median 2.3, interquartile range 0.4–5.0). Rate of all-cause death was 8.10%/year (7.96–8.24) and was 2.76%/year (2.68–2.84) for CV death.Independent predictors of CV death in HCM were older age, diabetes mellitus, heart failure, history of pulmonary edema, atrial fibrillation, ventricular tachycardia or fibrillation, ischemic stroke, while smoking and poor nutrition were associated with better survival (all p<0.05). In addition to these, male sex, vascular disease, alcohol related diagnoses, kidney disease, lung disease, liver disease anemia and cancer were independent predictors of all-cause death. In the derivation cohort, c-indexes for the HCM death score were 0.720 (0.713–0.727) for all-cause death and 0.695 (0.685–0.705) for CV death. For the HCM CV-death score, c-indexes were 0.679 (0.671–0.686) for all-cause death and 0.723 (0.712–0.733) for CV death. Performances were very similar in the validation cohort. Both scores had good calibrations. Charlson and Frailty indexes however had a better clinical usefulness than the HCM death score and HCM CV-death scores for predicting all-cause death. Decision curve analysis for CV death demonstrated that the HCM CV-death score had the best clinical usefulness of all the tested risk scores.
Conclusion
HCM patients have a high risk of all-cause and CV mortality. Independent predictors of CV-mortality in HCM were used to derive and validate a simple risk prediction model (French HCM CV-mortality score) which performed better than clinical scores, Charlson Index and Frailty Index; showing the best clinical usefulness, with good calibration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P H Spiesser
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - G Y H Lip
- City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom
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Bodin A, Clementy N, Bisson A, Pierre B, Herbert J, Babuty D, Fauchier L. Single-chamber transvenous and subcutaneous defibrillators: clinical outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0670] [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: 11/13/2022] Open
Abstract
Abstract
Introduction/Background
By using an entirely extra-thoracic lead placement, subcutaneous implantable cardioverter–defibrillators (S-ICD) were designed to avoid lead-related complications of single-chamber transvenous implantable cardioverter-defibrillators (VVI ICD).
Purpose
Our objective was to assess and compare outcomes following first VVI ICD or S-ICD implantation in an exhaustive nationwide matched cohort.
Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals From January 1, 2010 to September 1, 2020, who underwent a VVI ICD or S-ICD implantation were included. Patients with a previous pacemaker or ICD or with a history of infective endocarditis were excluded.
Results
21,667 patients were included in the cohort, 19,493 patients had a transvenous VVI ICD and 2,174 had a subcutaneous ICD.
Mean follow-up was 28.8±31.8 months. S-ICD patients was associated with higher rate of all-cause death (HR: 1.684, 95% CI: 1.309–2.165, p<0.001). There were no significant differences in cardiovascular death (HR: 1.092, 95% CI: 0.697–1.711, p=0.70) and infective endocarditis (HR: 0.354, 95% CI: 0.067–1.433, p=0.15) between the two groups
Using propensity score, 1,582 patients with VVI ICD were matched 1:1 with S-ICD patients. Mean follow-up was 4.5±7.2 months. In the matched analysis, there were no significant differences in all-cause death (HR: 1.090, 95% CI: 0.728–1.633, p=0.68) and cardiovascular death (HR: 1.167, 95% CI: 0.603–2.260, p=0.65) between the two groups. A trend toward a lower risk of infective endocarditis in the S-ICD group was also observed without reaching significance (HR: 0.219, 95% CI: 0.047–1.017, p=0.053).
A sensitivty analysis in patients with coronary artery disease in the matched cohort was performed. 1,024 patients had a VVI ICD and 977 had a S-ICD. Same trends were observed without significant differences in all-cause death (HR: 0.966, 95% CI: 0.605–1.543, p=0.88) and cardiovascular death (HR: 1.307, 95% CI: 0.610–2.799, p=0.49).
Conclusion
Our nationwide study highlighted a higher risk of all-cause death in patients treated with subcutaneous which however was not statistically significant after propensity score matching. No differences regarding cardiovascular mortality was found. An interesting trend toward diminution of infective endocarditis was also observed without reaching significancy.
Funding Acknowledgement
Type of funding sources: None. Baseline characteristicsCardiovascular death
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Affiliation(s)
- A Bodin
- University Hospital of Tours, Cardiology, Tours, France
| | - N Clementy
- University Hospital of Tours, Cardiology, Tours, France
| | - A Bisson
- University Hospital of Tours, Cardiology, Tours, France
| | - B Pierre
- University Hospital of Tours, Cardiology, Tours, France
| | - J Herbert
- University Hospital of Tours, Cardiology, Tours, France
| | - D Babuty
- University Hospital of Tours, Cardiology, Tours, France
| | - L Fauchier
- University Hospital of Tours, Cardiology, Tours, France
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Fauchier L, Bisson A, Bodin A, Herbert J, Spiesser P, Pierre B, Clementy N, Bernard A, Babuty D, Lip GYH. Ischemic Stroke in Patients With Hypertrophic Cardiomyopathy According to Presence or Absence of Atrial Fibrillation. Stroke 2021; 53:497-504. [PMID: 34601900 DOI: 10.1161/strokeaha.121.034213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Patients with hypertrophic cardiomyopathy (HCM) have high risk of ischemic stroke (IS), especially if atrial fibrillation (AF) is present. Improvements in risk stratification are needed to help identify those patients with HCM at higher risk of stroke, whether AF is present or not. METHODS This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adults hospitalized with isolated HCM. A logistic regression model was used to construct a French HCM score, which was compared with the HCM Risk-CVA and CHA2DS2-VASc scores using c-indexes and calibration analysis. RESULTS In 32 206 patients with isolated HCM, 12 498 (38.8%) had AF, and 2489 (7.7%) sustained an IS during follow-up. AF in patients with HCM was independently associated with a higher risk for death (hazard ratio, 1.129 [95% CI, 1.088-1.172]), cardiovascular death (hazard ratio, 1.254 [95% CI, 1.177-1.337]), IS (hazard ratio, 1.210 [95% CI, 1.111-1.317]), and other major cardiovascular events. Independent predictors of IS in HCM were older age, heart failure, AF, prior IS, smoking and poor nutrition (all P<0.05). For the HCM Risk-CVA score, CHA2DS2-VASc score and a French HCM score, all c-indexes were 0.65 to 0.70, with good calibration. Among patients with AF, the CHA2DS2-VASc score had marginal improvement over the HCM Risk-CVA score but was less predictive compared with the French HCM score (P=0.001). In patients without AF, both HCM Risk-CVA score and the French HCM score had significantly better prediction compared with CHA2DS2-VASc (both P<0.0001). Decision curve analysis demonstrated that the French HCM score had the best clinical usefulness of the 3 tested risk scores. CONCLUSIONS Patients with HCM have a high prevalence of AF and a significant risk of IS, and the presence of AF in patients with HCM was independently associated with worse outcomes. A simple French HCM score shows good prediction of IS in patients with HCM and clinical usefulness, with good calibration.
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Affiliation(s)
- Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.).,Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (J.H.)
| | - Pascal Spiesser
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Bertrand Pierre
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Anne Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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Alonso C, Marquie C, Defaye P, Clementy N, Mondoly P, Sadoul N, Boveda S, Hidden-Lucet F, Dompnier A, Da Costa A, Marijon E, Leclercq C, Caudron G, Piot O, Deharo JC. FRAGILE: FRench Attitude reGistry in case of ICD LEad replacement. Europace 2021; 23:389-394. [PMID: 33257986 DOI: 10.1093/europace/euaa290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups. METHODS AND RESULTS Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient's age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications. CONCLUSION In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient's age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
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Affiliation(s)
- Christine Alonso
- CMC Ambroise Paré, 25-27 bd Victor Hugo, 92200 Neuilly-sur-Seine, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord Saint-Denis, France
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Bisson A, Bodin A, Clementy N. His bundle pacing implantable cardiac defibrillator with defibrillation lead placement in the middle cardiac vein: a case report. Europace 2021; 23:633. [PMID: 33320953 DOI: 10.1093/europace/euaa296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
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Clementy N, Coelho R, Veltmann C, Marijon E, Tolosana J, Galand V, Ploux S, Eschalier R, Simeon E, Blessberger H, Mueller-Leisse J, Pujol-Lopez M, Martins R, Ritter P, Steinwender C, Babuty D. Leadless pacemakers in critically ill patients requiring prolonged cardiac pacing: A multicenter international study. J Cardiovasc Electrophysiol 2021; 32:2522-2527. [PMID: 34270153 DOI: 10.1111/jce.15175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Temporary transvenous pacing in critically ill patients requiring prolonged cardiac pacing is associated with a high risk of complications. We sought to evaluate the safety and efficacy of self-contained intracardiac leadless pacemaker (LPM) implantation in this population. METHODS AND RESULTS Consecutive patients implanted with a Micra LPM during the hospitalization in an intensive care unit were retrospectively included. Inclusion criteria were: more than or equal to 1 supracaval central venous line, or a ventilation tube, or intravenous antibiotic therapy for ongoing sepsis or bacteremia. Patients with a history of the previous implantation of a pacemaker were excluded. Out of 1016 patients implanted with an LPM, 99 met the inclusion criteria. Mean age was 75 years and Charlson comorbidity index 7. LPM implantation was successfully performed in 98% of cases, with a perioperative complication rate of 5%, mainly cardiac injuries. In-hospital mortality rate was 6%. No late (>30 days) device-related complication occurred, especially no infection. CONCLUSIONS LPM appears as an acceptable alternative to conventional temporary transvenous pacing in selected critically ill patients requiring prolonged cardiac pacing, especially regarding the risk of infection.
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Affiliation(s)
- Nicolas Clementy
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Roxane Coelho
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - José Tolosana
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Vincent Galand
- Department of Cardiology, University Hospital Pontchaillou, Rennes, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Romain Eschalier
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Edouard Simeon
- Department of Electrophysiology, Private Hospital Institute Mutualiste Montsouris, Paris, France
| | | | - Johanna Mueller-Leisse
- Department of Cardiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Raphaël Martins
- Department of Cardiology, University Hospital Pontchaillou, Rennes, France
| | - Philippe Ritter
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France
| | | | - Dominique Babuty
- Department of Cardiology, University Hospital of Tours, Tours, France
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Clementy N, Bisson A, Bodin A, Herbert J, Lacour T, Etienne CS, Pierre B, Deharo P, Babuty D, Fauchier L. Outcomes associated with pacemaker implantation following transcatheter aortic valve replacement: A nationwide cohort study. Heart Rhythm 2021; 18:2027-2032. [PMID: 34147701 DOI: 10.1016/j.hrthm.2021.06.1175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conduction abnormalities following transcatheter aortic valve replacement (TAVR) often may require permanent pacemaker implantation (PPM). OBJECTIVE The purpose of this study was to evaluate outcomes associated with PPM after a TAVR procedure in a large, nationwide-level population. METHODS Based on the administrative hospital discharge database, the incidence of all-cause death, cardiovascular death, and hospitalization for heart failure (HF) were retrospectively collected, based on the presence or absence of PPM, in the first 30 days following all TAVRs in France from 2010 to 2019. RESULTS Among 520,662 patients hospitalized for aortic stenosis, 49,201 were treated with TAVR. A total of 29,422 patients had follow-up ≥6 months (median 1.7 years), 22% already had PPM at baseline, and 22% underwent PPM within the first 30 days post-TAVR. Adjusted hazard ratios for the combined risk of all-cause death and hospitalization for HF, during the whole follow-up, were higher in both patients with a previous PPM and in those implanted within 30 days (hazard ratio [95% confidence interval] 1.12 [1.07-1.17] and 1.11 [1.06-1.16], respectively). CONCLUSION PPM at baseline and within 30 days post-TAVR are independently associated with higher mortality and HF hospitalization during follow-up.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France.
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, Tours, France
| | - Thibaud Lacour
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Bertrand Pierre
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Pierre Deharo
- Département de Cardiologie, Centre Hospitalier Universitaire Timone, Marseille, France, INSERM, INRA, C2VN, Marseille, France et Faculté de Médecine, Université Aix-Marseille, Marseille, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, Tours, France
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Probst V, Goronflot T, Anys S, Tixier R, Briand J, Berthome P, Geoffroy O, Clementy N, Mansourati J, Jesel L, Dupuis JM, Bru P, Kyndt F, Wargny M, Guyomarch B, Thollet A, Mabo P, Gourraud PA, Behar N, Sacher F, Gourraud JB. Robustness and relevance of predictive score in sudden cardiac death for patients with Brugada syndrome. Eur Heart J 2021; 42:1687-1695. [PMID: 33289793 DOI: 10.1093/eurheartj/ehaa763] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/10/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Risk stratification of sudden cardiac arrest (SCA) in Brugada syndrome (Brs) remains the main challenge for physicians. Several scores have been suggested to improve risk stratification but never replicated. We aim to investigate the accuracy of the Brs risk scores. METHODS AND RESULTS A total of 1613 patients [mean age 45 ± 15 years, 69% male, 323 (20%) symptomatic] were prospectively enrolled from 1993 to 2016 in a multicentric database. All data described in the risk score were double reviewed for the study. Among them, all patients were evaluated with Shanghai score and 461 (29%) with Sieira score. After a mean follow-up of 6.5 ± 4.7 years, an arrhythmic event occurred in 75 (5%) patients including 16 SCA, 11 symptomatic ventricular arrhythmia, and 48 appropriate therapies. Predictive capacity of the Shanghai score (n = 1613) and the Sieira (n = 461) score was, respectively, estimated by an area under the curve of 0.73 (0.67-0.79) and 0.71 (0.61-0.81). Considering Sieira score, the event rate at 10 years was significantly higher with a score of 5 (26.4%) than with a score of 0 (0.9%) or 1 (1.1%) (P < 0.01). No statistical difference was found in intermediate-risk patients (score 2-4). The Shanghai score does not allow to better stratify the risk of SCA. CONCLUSIONS In the largest cohort of Brs patient ever described, risk scores do not allow stratifying the risk of arrhythmic event in intermediate-risk patient.
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Affiliation(s)
- Vincent Probst
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Thomas Goronflot
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, Nantes, France
| | - Soraya Anys
- l'institut du thorax, Service de cardiologie, CHU Nantes, France
| | - Romain Tixier
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Jean Briand
- Service de Cardiologie, CHU de Rennes, Rennes, France
| | - Pauline Berthome
- l'institut du thorax, Service de cardiologie, CHU Nantes, France
| | - Olivier Geoffroy
- Service de Cardiologie, CHU La Réunion, Saint-Denis de la Réunion, France
| | | | | | - Laurence Jesel
- Service de Cardiologie, CHRU Strasbourg, Strasbourg, France
| | | | - Paul Bru
- Service de Cardiologie, CH La Rochelle, La Rochelle, France
| | - Florence Kyndt
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, Nantes, France
| | - Béatrice Guyomarch
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Aurélie Thollet
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Philippe Mabo
- Service de Cardiologie, CHU de Rennes, Rennes, France
| | - Pierre-Antoine Gourraud
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, Nantes, France
| | | | - Frédéric Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
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Fauchier L, Bisson A, Bodin A, Spiesser P, Pierre B, Clementy N, Babuty D. Season of birth and cardiovascular mortality in atrial fibrillation: a population-based cohort study. Europace 2021. [DOI: 10.1093/europace/euab116.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Month and season of birth may be indicators for a variety of prenatal and early postnatal exposures and they have been associated with life expectancy in adulthood. It is suggested that people born in the autumn on the northern hemisphere live longer than those born during the spring or summer, who may have an increase in cardiovascular disease specific mortality. Only few studies have followed populations longitudinally and no study has investigated the relation between season of birth and mortality in patients with established cardiac conditions.
Methods. All patients with atrial fibrillation (AF) seen in an academic institution were identified in a database. We examined the clinical course of 8962 consecutive patients with AF seen over a 10-year period. The adverse outcomes were investigated during follow-up and we identified the causes of death. The relation between season of birth (autumn, winter, spring and summer) and mortality risk was assessed using Cox proportional hazard regression models using autumn as the reference. Analyses were also made separately for men and women.
Results. In these 8962 patients (age 70 ± 10 years, CHA2DS2VASc score 3.1 ± 1.7), 1253 deaths were recorded during a follow-up of 2.5 ± 3.0 years (median 1.2, interquartile 4.3 years, yearly rate of death 5.5%) and 97% of causes of death were identified. Cardiovascular deaths accounted for 54% and 43% for non-cardiovascular. The three main causes of death were heart failure (29%), infection (18%) and cancer (12%).
Season of birth was a significant predictor of cardiovascular mortality (overall p = 0.0006). The lowest mortality was seen for people born in autumn or winter and the highest mortality in those born in spring and summer. This was mainly related to a higher cardiovascular mortality in males (hazard ratio [HR] 1.46, 95%CI 1.10-1.93, p = 0.009 for males born in spring and HR 1.44, 95%CI 1.08-1.91, p = 0.01 for those born in summer when compared to males born in autumn as the reference) while this effect was not seen in women. In a model adjusted for age, CHA2DS2VASc score, HASBLED score, cardiovascular risk factors, other comorbidities, AF pattern, antithrombotic use and other cardiovascular drugs use, a higher cardiovascular mortality was still seen in males born in spring (adjusted HR 1.43, 95%CI 1.05-1.96, p = 0.03) or in summer (adjusted HR 1.46, 95%CI 1.07-1.99, p = 0.02) when compared to those born in autumn while this was not seen in women.
Conclusion. Birth in spring or summer is associated with a higher risk of cardiovascular mortality in male AF patients. Further studies should aim at clarifying the mechanisms behind this association, which would support the so-called fetal origins hypothesis.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P Spiesser
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Garweg C, Clementy N, Mondoloy P, Winter S, Bordachar P, Sharman D, Jung W, Eschalier R, Theis C, Defaye P, Anderson C, Pol A, Roberts PR. A leadless pacemaker in the real-world setting: Patient profile and performance over time. Europace 2021. [DOI: 10.1093/europace/euab116.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.
OnBehalf
Micra Acute Performance EMEA Investigators
Background
The first in-man implant of the Micra leadless pacemaker occurred in December 2013. While prior trials demonstrated a high implant success rate and favorable safety and efficacy results; whether the patient population and outcomes have changed over time is not well studied.
Purpose
To characterize the evolution of patient profile and outcomes for patients receiving a leadless pacemaker through the pre-market and post-market environment.
Methods
Patients undergoing a Micra leadless pacemaker implant attempt from the initial Micra Investigational Device Exemption [IDE] and current Micra studies (Micra post-approval registry [PAR], Micra acute performance [MAP] study) were analyzed. Patient characteristics and pericardial effusions regardless of severity were summarized.
Results
The 3466 patients included in the analysis underwent a Micra implant attempt and were enrolled during consecutive timeframes: patients from the Micra IDE study (n = 726) underwent a Micra implant attempt from 2013-2015, patients from the PAR (n = 1814) from 2015-2018, and patients from Micra MAP cohort (n = 926) from 2018 – 2020. Implant success was >99.0% in all 3 studies. Median age ranged from 78 – 79 years among the 3 studies without significant difference. There were more patients requiring dialysis in the MAP cohort compared to the PAR or IDE cohorts (10.3%, 7.9%, and 3.9%, respectively; P < 0.001), but fewer patients with congestive heart failure (8.3%, 13.1%, and 18.0%; P < 0.001). Pacing indication was significantly different between the studies, with fewer patients in MAP having an indication of bradyarrhythmia associated with atrial fibrillation (AF) and more having an indication associated with atrioventricular block without AF (P < 0.001). The number of patients considered to be precluded for a transvenous pacemaker implant increased significantly from the initial IDE study to the PAR and MAP studies (6.2%, 23.9%, and 44.1%, respectively, P < 0.001). Implant site placement was mostly apical for the IDE but shifted to mostly septal placement in the PAR and MAP (septal placement: 33.3%, 64.0%, and 79.5%, respectively). The rate of pericardial effusion regardless of severity was 1.79% (n = 13) in the IDE, 0.83% (n = 15) in the PAR, and 0.97% (n = 9) in MAP (figure). Mean pacing thresholds among MAP EMEA patients were low (0.61 ± 0.40V) at implant and remained stable through 12 months (0.62 +/- 0.41V).
Conclusion
Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and a low perforation rate, in-line with prior reports. Abstract Figure. Pericardial effusion rate by study
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Affiliation(s)
- C Garweg
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - N Clementy
- Centre Hospitalier Régional Universitaire de Tours, France, Tours, France
| | - P Mondoloy
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - S Winter
- St. Vinzenz Hospital (Köln), Cologne, Germany
| | - P Bordachar
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - D Sharman
- Northampton General Hospital (Cliftonville), Cliftonville, Northampton, United Kingdom of Great Britain & Northern Ireland
| | - W Jung
- Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - R Eschalier
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Theis
- Robert Bosch Hospital, Stuttgart, Germany
| | | | - C Anderson
- Medtronic, Mounds View, United States of America
| | - A Pol
- Bakken Research Center, Maastricht, Netherlands (The)
| | - PR Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
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Bodin A, Bisson A, Pierre B, Herbert J, Clementy N, Babuty D, Fauchier L. Subcutaneous and single-chamber transvenous defibrillators: a nationwide matched control study. Europace 2021. [DOI: 10.1093/europace/euab116.425] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction / Background
Subcutaneous implantable cardioverter–defibrillators (S-ICD) was designed to avoid complications of single-chamber transvenous implantable cardioverter-defibrillators (VVI ICD) by using an entirely extra-thoracic placement.
Purpose
Our objective was to compare outcomes following first VVI ICD or S-ICD implantation in an exhaustive nationwide matched cohort.
Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals From January 1, 2010 to September 1, 2020, who underwent a VVI ICD or S-ICD implantation were included. Patients with a previous pacemaker or ICD or with a history of infective endocarditis were excluded. Multivariable analyses for clinical outcomes during the whole follow-up in the groups of interests were performed using a Cox model with all baseline characteristics and reporting hazard ratio. Owing to the non-randomized nature of the study, and considering for significant differences in baseline characteristics, propensity-score matching was also used to control for potential confounders of the treatment outcome relationship.
Results
21,667 patients were included in the cohort, 19,493 patients had a transvenous VVI ICD and 2,174 had a subcutaneous ICD. Mean age was 61.2 ± 13.2 years in the VVI ICD group and 52.3 ± 17.5 years in the S-ICD goup. Coronary artery disease was present in 71.6% of patients with a VVI ICD and 48.2% of patients with a S-ICD. Mean follow-up was 28.8 ± 31.8 months. S-ICD patients had a significant higher rate of all-cause death (HR: 1.684, 95%CI: 1.309-2.165, p < 0.001). There were no significant differences in cardiovascular death (HR: 1.092, 95%CI: 0.697-1.711, p = 0.70) and infective endocarditis (HR: 0.354, 95%CI: 0.067-1.433, p = 0.15) between the two groups
Using propensity score, 1,582 patients with VVI ICD were matched 1:1 with S-ICD patients. Mean follow-up was 4.5 ± 7.2 months. In the matched analysis, there were no significant differences in all-cause death (HR: 1.090, 95%CI: 0.728-1.633, p = 0.68) and cardiovascular death (HR: 1.167, 95%CI: 0.603-2.260, p = 0.65) between the two groups. A trend toward a lower risk of infective endocarditis in the S-ICD group was also observed without reaching significance (HR : 0.219, 95%CI: 0.047-1.017, p = 0.053). A sensitivity analysis in patients with coronary artery disease in the matched cohort was performed. Same trends were observed without significant differences in all-cause death and cardiovascular death.
Conclusion
Our nationwide study highlighted a higher risk of all-cause death in patients treated with subcutaneous which however was not statistically significant after propensity score matching. No differences regarding cardiovascular mortality was found. An interesting trend toward diminution of infective endocarditis was also observed without reaching significancy.
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Affiliation(s)
- A Bodin
- University Hospital of Tours, Cardiology, Tours, France
| | - A Bisson
- University Hospital of Tours, Cardiology, Tours, France
| | - B Pierre
- University Hospital of Tours, Cardiology, Tours, France
| | - J Herbert
- University Hospital of Tours, Cardiology, Tours, France
| | - N Clementy
- University Hospital of Tours, Cardiology, Tours, France
| | - D Babuty
- University Hospital of Tours, Cardiology, Tours, France
| | - L Fauchier
- University Hospital of Tours, Cardiology, Tours, France
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Bisson A, Bodin A, Babuty D, Clementy N. Left bundle area pacing, an elegant alternative in failed cardiac resynchronization therapy implantation: A case report. J Electrocardiol 2021; 67:31-32. [PMID: 34022468 DOI: 10.1016/j.jelectrocard.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/14/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
Left ventricular lead placement for cardiac resynchronization therapy may be challenging or even impossible. Left bundle area pacing has emerged as an interesting alternative method in case of failed implantation.
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Affiliation(s)
- Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
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Clementy N, Bodin A, Bisson A, Teixeira-Gomes AP, Roger S, Angoulvant D, Labas V, Babuty D. The Defibrillation Conundrum: New Insights into the Mechanisms of Shock-Related Myocardial Injury Sustained from a Life-Saving Therapy. Int J Mol Sci 2021; 22:ijms22095003. [PMID: 34066832 PMCID: PMC8125879 DOI: 10.3390/ijms22095003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Implantable cardiac defibrillators (ICDs) are recommended to prevent the risk of sudden cardiac death. However, shocks are associated with an increased mortality with a dose response effect, and a strategy of reducing electrical therapy burden improves the prognosis of implanted patients. We review the mechanisms of defibrillation and its consequences, including cell damage, metabolic remodeling, calcium metabolism anomalies, and inflammatory and pro-fibrotic remodeling. Electrical shocks do save lives, but also promote myocardial stunning, heart failure, and pro-arrhythmic effects as seen in electrical storms. Limiting unnecessary implantations and therapies and proposing new methods of defibrillation in the future are recommended.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
- Correspondence: ; Tel.: +33-247-474-687; Fax: +33-247-475-919
| | - Alexandre Bodin
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Ana-Paula Teixeira-Gomes
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Sebastien Roger
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Denis Angoulvant
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Valérie Labas
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Dominique Babuty
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
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Jacobs M, Bisson A, Bodin A, Babuty D, Niro M, Clementy N. Leadless cardiac pacemaker implantation in patient with active tricuspid endocarditis. Europace 2021; 23:1794. [PMID: 33961045 DOI: 10.1093/europace/euab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/20/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mathieu Jacobs
- Department of Cardiology, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Arnaud Bisson
- Department of Cardiology, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Alexandre Bodin
- Department of Cardiology, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Dominique Babuty
- Department of Cardiology, Trousseau Hospital, University of Tours, 37044 Tours, France
| | - Marjorie Niro
- Department of Cardiology, CHU Angers, Angers, France
| | - Nicolas Clementy
- Department of Cardiology, Trousseau Hospital, University of Tours, 37044 Tours, France
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Clementy N, Bensaid R, Bouteau J, Fedida J, Kiavue Y, Socie P, Ackermann R, Goralski M, Fauchier L, Bernard A, Angoulvant D, Babuty D. The IC-D score for predicting prophylactic cardioverter-defibrillator implantation following acute myocardial infarction. Pacing Clin Electrophysiol 2021; 44:973-979. [PMID: 33846979 DOI: 10.1111/pace.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A reduced left ventricular ejection fraction (LVEF) ≤35% ≥6 weeks following an acute myocardial infarction (MI) may indicate prophylactic implantation of a cardioverter-defibrillator (ICD). We sought to find predictors of absence of significant left ventricular (LV) remodeling post-MI. METHODS All consecutive patients hospitalized for acute MI with an LVEF ≤35% at discharge in our institution from 2010 were retrospectively included. Patients were assigned to two groups according to the persistence of an LVEF ≤35% (ICD+) or a recovery >35% (ICD-). Logistic regression was performed to build a predictive score, which was then externally validated. RESULTS Among a total of 1533 consecutive MI patients, 150 met inclusion criteria, 53 (35%) in the ICD+ group and 97 in the ICD group. After multivariable analyses, an LVEF ≤25% at discharge (adjusted OR 6.23 [2.47 to 17.0], p < .0001) and a CPK peak at the MI acute phase >4600 UI/L (adjusted OR 9.99 [4.27 to 25.3], p < .0001) both independently predicted non-recovery at 6 weeks. The IC-D (Increased Cpk-LV Dysfunction) score predicted persistent LVEF ≤35% with areas under curve of 0.83 and 0.73, in the study population and in a multicenter validation cohort of 150 patients, respectively (p < .0001). CONCLUSIONS The association of a severely reduced LVEF and a major release of myocardial necrosis biomarkers at the acute phase of MI predict unfavorable remodeling, and prophylactic ICD implantation.
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Affiliation(s)
- Nicolas Clementy
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Reda Bensaid
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Jérémie Bouteau
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Joël Fedida
- Cardiology Department, Bicêtre Hospital, Kremlin-Bicêtre, France
| | - Yoann Kiavue
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Pierre Socie
- Cardiology Department, Chartres Louis Pasteur Hospital, Le Coudray, France
| | - Romain Ackermann
- Cardiology Department, Orleans La Source Hospital, Orleans, France
| | - Marc Goralski
- Cardiology Department, Orleans La Source Hospital, Orleans, France
| | - Laurent Fauchier
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Anne Bernard
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Denis Angoulvant
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
| | - Dominique Babuty
- Cardiology Department, Trousseau Hospital, University of Tours, Tours, France
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44
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El-Chami MF, Shinn T, Bansal S, Martinez-Sande JL, Clementy N, Augostini R, Ravindran B, Sagi V, Ramanna H, Garweg C, Roberts PR, Soejima K, Stromberg K, Fagan DH, Zuniga N, Piccini JP. Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker. J Cardiovasc Electrophysiol 2021; 32:832-841. [PMID: 33428248 PMCID: PMC7986103 DOI: 10.1111/jce.14881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/19/2020] [Accepted: 01/02/2021] [Indexed: 12/01/2022]
Abstract
Background The feasibility and outcomes of concomitant atrioventricular node ablation (AVNA) and leadless pacemaker implant are not well studied. We report outcomes in patients undergoing Micra implant with concomitant AVNA. Methods Patients undergoing AVNA at the time of Micra implant from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post‐Approval Registry (PAR) were included in the analysis and compared to Micra patients without AVNA. Baseline characteristics, acute and follow‐up outcomes, and electrical performance were compared between patients with and without AVNA during the follow‐up period. Results A total of 192 patients (mean age 77.4 ± 8.9 years, 72% female) underwent AVNA at the time of Micra implant and were followed for 20.4 ± 15.6 months. AVNA patients were older, more frequently female, and tended to have more co‐morbid conditions compared with non‐AVNA patients (N = 2616). Implant was successful in 191 of 192 patients (99.5%). The mean pacing threshold at implant was 0.58 ± 0.35 V and remained stable during follow‐up. Major complications within 30 days occurred more frequently in AVNA patients than non‐AVNA patients (7.3% vs. 2.0%, p < .001). The risk of major complications through 36‐months was higher in AVNA patients (hazard ratio: 3.81, 95% confidence interval: 2.33–6.23, p < .001). Intermittent loss of capture occurred in three AVNA patients (1.6%), all were within 30 days of implant and required system revision. There were no device macrodislodgements or unexpected device malfunctions. Conclusion Concomitant AVN ablation and leadless pacemaker implant is feasible. Pacing thresholds are stable over time. However, patient comorbidities and the risk of major complications are higher in patients undergoing AVNA.
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Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia, USA
| | | | | | - Jose L Martinez-Sande
- Unidad de Arritmias, Servicio de Cardiología, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Régional Universitaire de Tours - Hôpital Trousseau, Tours, France
| | - Ralph Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Venkata Sagi
- Baptist Heart Specialists, Baptist Medical Center, Jacksonville, Florida, USA
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hauge, The Netherlands
| | - Christophe Garweg
- Department of Cardiovascular Sciences, Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | | | | | | | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
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45
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Bodin A, Labas V, Bisson A, Teixeira-Gomes AP, Blasco H, Tomas D, Combes-Soia L, Marcelo P, Miquelestorena-Standley E, Baron C, Angoulvant D, Babuty D, Clementy N. Acute pathophysiological myocardial changes following intra-cardiac electrical shocks using a proteomic approach in a sheep model. Sci Rep 2020; 10:20252. [PMID: 33219330 PMCID: PMC7679418 DOI: 10.1038/s41598-020-77346-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICD) are meant to fight life-threatening ventricular arrhythmias and reduce overall mortality. Ironically, life-saving shocks themselves have been shown to be independently associated with an increased mortality. We sought to identify myocardial changes at the protein level immediately after ICD electrical shocks using a proteomic approach. ICD were surgically implanted in 10 individuals of a healthy male sheep model: a control group (N = 5) without any shock delivery and a shock group (N = 5) with the delivery of 5 consecutive shocks at 41 J. Myocardial tissue samples were collected at the right-ventricle apex near to the lead coil and at the right ventricle basal free wall region. Global quantitative proteomics experiments on myocardial tissue samples were performed using mass spectrometry techniques. Proteome was significantly modified after electrical shock and several mechanisms were associated: protein, DNA and membrane damages due to extreme physical conditions induced by ICD-shock but also due to regulated cell death; metabolic remodeling; oxidative stress; calcium dysregulation; inflammation and fibrosis. These proteome modifications were seen in myocardium both “near” and “far” from electrical shock region. N-term acetylated troponin C was an interesting tissular biomarker, significantly decreased after electrical shock in the “far” region (AUC: 0.93). Our data support an acute shock-induced myocardial tissue injury which might be involved in acute paradoxical deleterious effects such as heart failure and ventricular arrhythmias.
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Affiliation(s)
- Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France. .,INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.
| | - Valérie Labas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Hélène Blasco
- Imagerie Et Cerveau - UMR 1253, Université de Tours, Tours, France
| | - Daniel Tomas
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Lucie Combes-Soia
- INRAE, CNRS, IFCE, UMR PRC, Université de Tours, 37380, Nouzilly, France.,INRAE, CHU de Tours, Plate-Forme de Chirurgie Et D'Imagerie Pour La Recherche Et L'Enseignement, Université de Tours, 37380, Nouzilly, France
| | - Paulo Marcelo
- Plate-Forme ICAP, Centre Universitaire de Recherche en Santé, Université de Picardie Jules Verne, 80054, Amiens, France
| | | | - Christophe Baron
- Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.,Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.,Transplantation, Immunologie et Inflammation T2i - EA 4245, Université de Tours, Tours, France
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46
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Fauchier L, Bisson A, Bodin A, Herbert J, Clementy N, Pierre B, Angoulvant D, Hanon O, Babuty D, Lip G. Prediction of mortality and mode of death by clinical risk score systems in 2.6 million patients with atrial fibrillation: a nationwide analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0501] [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: 11/12/2022] Open
Abstract
Abstract
Atrial fibrillation (AF) is associated with a higher mortality, but modes of death may vary and their respective predictors have been insufficiently defined. Charlson comorbidity index (CCI) is a tool to quantify multimorbidity and a strong estimator of mortality. The quantifiable frailty phenotype is also predictive of mortality and disability and claims data can be used to classify individuals as frail and non-frail using the Claims-based Frailty Index (CFI). We evaluated whether these tools may help to predict mortality and the different modes of death in AF.
Methods
Based on the France nationwide administrative hospital-discharge database, we collected information for all AF patients treated between 2010 and 2019 in France. Adverse outcomes were investigated during follow-up. CHA2DS2VASc score, CCI and CFI were calculated for each patient.
Results
Among 2,641,626 patients with AF, 670,541 patients died during a follow-up of 2.0±2.3 years (median 1.1) (yearly rate 12.6%, 30.3% cardiovascular and 69.7% non-cardiovascular deaths). Death occurred more often in patients with higher CHA2DS2VASc, CCI and CFI scores. CCI was a better predictor of total mortality than CFI and CHA2DS2VASc score (see C-statistics in table); however, the CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and CFI. By contrast, CCI was a better predictor of non-cardiovascular mortality than CFI and CHA2DS2VASc score. The optimal predictive performances were better for non-cardiovascular death than for cardiovascular death.
Conclusion
Multimorbidity assessed with CCI demonstrated better performances in predicting total mortality and non-cardiovascular mortality than CHA2DS2VASc score and Frailty assessed with CFI in AF patients. By contrast, CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and CFI in these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - O Hanon
- Hospital Broca of Paris, Paris, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - G Lip
- City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom
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47
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Fauchier L, Bodin A, Bisson A, Herbert J, Lacour T, Saint Etienne C, Clerc J, Quilliet L, Semaan K, Ivanes F, Pierre B, Deharo P, Babuty D, Clementy N. Outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0719] [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
Conduction abnormalities leading to permanent pacemaker (PPM) implantation are common complications following transcatheter aortic valve replacement (TAVR). Whether PPM implantation placement is associated with adverse outcomes is unclear. The purpose of this study was to evaluate the incidence, predictors, and clinical outcomes of PPI following TAVR.
Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with TAVR between 2010 and 2019 in France.
Results
A total of 49,201 patients with aortic stenosis treated with transcatheter aortic valve replacement (TAVR) using the balloon-expandable (BE) Edwards SAPIEN valve or the self-expanding (SE) Medtronic CoreValve were found in the database. Among them, 10,019 (20.4%) had prior PPM implantation, including 476 (4.8%) treated with cardiac resynchronization therapy (CRT). New PPM implantation was required within 30 days of TAVR in 11,010 patients (22.4%), which varied among those receiving self-expanding valves (24.7%) versus balloon-expanding valves (20.9%). There were 349/10,010 patients (3.1%) treated with cardiac resynchronization therapy (CRT) within 30 days following TAVR. In a multivariable analysis comprising 38 variables (including among others underlying conduction disorders, Euroscore 2, Charlson comorbidity index, frailty score and type of implanted valve), prior PPM implantation was associated with an increased risk of all-cause death (adjusted hazard ratio [HR]: 1.10 95% CI 1.04–1.16). New PPM implantation was associated with even higher risk of mortality (adjusted HR: 1.21 95% CI 1.15–1.28). By contrast, previous CRT was associated with a lower risk of death during follow-up (adjusted HR: 0.78 95% CI 0.63–0.96), while PPM with CRT within 30 days of TAVR was not associated with a different risk of death (adjusted HR: 1.00 95% CI 0.80–1.24). Prior PPM and new PPM implantation were also associated with an increased risk of rehospitalization for heart failure (adjusted HR: 1.26 95% CI 1.19–1.32 and 1.18 95% CI 1.12–1.24, respectively). Previous CRT was associated with a non-significant lower risk of rehospitalization for heart failure (adjusted HR: 0.92 95% CI 0.77–1.09).
Conclusions
Both previous PPM and early PPM implantation following TAVR are commonly seen in patients treated with TAVR, and they are associated with a higher risk of death and rehospitalisation for heart failure when compared to patients with no PPM. The fact that CRT when implanted before TAVR was associated with a better survival may deserve consideration when elaborating future optimal approaches for management of conduction disturbances in patients treated with TAVR.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J.M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - K Semaan
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P Deharo
- APHM La Timone Hospital, Marseille, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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48
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Fauchier L, Bisson A, Bodin A, Herbert J, Clementy N, Pierre B, Angoulvant D, Hanon O, Babuty D, Lip G. Bleeding risks with frailty and multimorbidity in patients with atrial fibrillation. A nationwide analysis of 1.4 million subjects. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty and multimorbidity are common in patients with atrial fibrillation (AF). The quantifiable frailty phenotype has been validated as predictive of mortality and disability, and patients can be categorised as frail and non-frail using the Claims-based Frailty Index (CFI). The Charlson comorbidity index (CCI) is a tool to quantify multimorbidity and also a strong estimator of mortality. We evaluated whether frailty and multimorbidity are associated with the risk of major bleeding in patients with AF.
Methods
Based on the administrative hospital-discharge database, we collected information for all patients with AF between 2010 and 2019 in France. CCI and CFI were calculated for each patient, and their associated risks of bleeding compared to 4 bleeding risk scores (HAS-BLED, HEMORR2HAGES, ATRIA and ORBIT). The analysis focused on patients with events or with at least one year of follow-up. Predictive abilities of the scores were compared in the whole population, and then separately in the subgroup of elderly patients (>75 yo).
Results
Among 1,372,567 patients with AF, 131,535 major bleeding events were recorded during a follow-up of 3.5±2.1 years (median 3.1, IQR 1.8–4.9) (yearly rate 2.7%). Bleeding occurred more commonly in patients with higher HAS-BLED, ATRIA, CCI and CFI scores. Those with high frailty and multimorbidity had markedly higher yearly incidences of bleeding events of 13.0% and 14.7%, respectively (vs low frailty and multimorbidity: 4.3%% and 4.1%, respectively; p<0.001). The 4 bleeding risk scores significantly had lower c-statistics than CCI and CFI for predicting major bleeding (table). In elderly patients (n=853,833), the c-statistics were all lower than in the whole population and were lower for the 4 scores than for the CCI and CFI scores (0.463, 0.473, 0.443, 0.445, 0.622 and 0.620 for HAS-BLED, ATRIA, ORBIT, HEMORR2HAGES, CCI and CFI, respectively).
Conclusion
Multimorbidity and frailty, respectively assessed with CCI and CFI, demonstrated statistically better performances in predicting major bleeding than the 4 established bleeding risk scores in AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - O Hanon
- Hospital Broca of Paris, Paris, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - G Lip
- City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom
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49
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Garweg C, Iacopino S, El-Chami M, Veltmann C, Clementy N, Grubman E, Johansen J, Knops R, Schalij M, Piccini J, Soejima K, Stromberg K, Fagan D, Roberts P. Leadless pacemaker implant in patients with a history of open heart surgery: experience with the Micra transcatheter pacemaker. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0773] [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: 11/15/2022] Open
Abstract
Abstract
Background
The Micra transcatheter pacemaker has demonstrated a favorable safety and efficacy profile relative to transvenous pacing. Patients with a history of open heart surgery have a higher risk of complications with transvenous pacemakers during follow-up. The experience with leadless pacemakers among a large cohort of patients with a history of open heart surgery has not been reported.
Objective
To report outcomes in patients with a history of open heart surgery undergoing Micra implant.
Methods
Patients undergoing Micra implant from the Micra Transcatheter Pacing Post-Approval Registry (PAR) were included in the analysis. Baseline and procedural characteristics, major complications, and electrical performance were compared among patients with vs. without history of cardiac surgery.
Results
A total of 331 out of 1815 (18.2%) patients had a history of open heart surgery, underwent Micra implant, and were followed for 19.4±10.4 months. The mean age was 74.6±13.5 years, 40% were female. The most common cardiac surgery was aortic valve surgery (71%) followed by mitral valve surgery (39%). Patients with prior open-heart surgery were more likely to have contraindications to transvenous pacing, were more likely to be on oral anticoagulants, and had more co-morbidities including atrial fibrillation, heart failure, and coronary artery disease (all p<0.005). Implantation was successful in 327 of 331 patients (98.8%) with a median procedure time of 29 minutes. Mean pacing capture thresholds (PCTs) at implant were 0.66±0.51V and remained stable through follow-up. There were 11 major complications in 10 cardiac surgery patients, with no device or procedure-related infections reported. The major complication rate was 3.1% (Figure) and was not significantly different than that of patients without a history of open heart surgery (HR: 0.85, P=0.640). There was 1 cardiac perforation (with no intervention required) in the open heart surgery group (0.3%) and there were 14 cardiac perforations (0.94%, P=0.332) in the non-open heart surgery group of which 10 required intervention.
Conclusion
The Micra transcatheter pacemaker can be safely implanted in patients with a history of open heart surgery, with a similar long-term safety profile to patients without a history of open heart surgery. Importantly, there were no device-related infections reported in either group.
Risk of Major Complication
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic, Inc.
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Affiliation(s)
- C Garweg
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - M.F El-Chami
- Emory University, Atlanta, United States of America
| | - C Veltmann
- Hannover Medical School, Hannover, Germany
| | - N Clementy
- University Hospital of Tours, Tours, France
| | - E Grubman
- Yale University, New Haven, United States of America
| | | | - R Knops
- Academic Medical Center, Amsterdam, Netherlands (The)
| | - M.J Schalij
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J.P Piccini
- Duke University Medical Center, Durham, United States of America
| | - K Soejima
- Kyorin University School of Medicine, Tokyo, Japan
| | - K Stromberg
- Medtronic, Mounds View, United States of America
| | - D.H Fagan
- Medtronic, Mounds View, United States of America
| | - P.R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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50
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Fauchier L, Bisson A, Bodin A, Herbert J, Genet T, Ma I, Ivanes F, Clementy N, Pierre B, Babuty D, Angoulvant D, Danchin N. Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0514] [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: 11/12/2022] Open
Abstract
Abstract
Background
In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate.
Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up.
Results
Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded.
Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49).
Conclusion
In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Genet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - I Ma
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Danchin
- Hopital Europeen Georges Pompidou- University Paris Descartes, Paris, France
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