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Brembilla-Perrot B, Vincent J, Olivier A, Bozec E, Girerd N, Sellal JM. Does the age of evaluation change the long-term follow-up of untreated pre-excitation syndrome? J Electrocardiol 2018; 51:792-797. [PMID: 30177314 DOI: 10.1016/j.jelectrocard.2018.06.009] [Citation(s) in RCA: 2] [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: 03/01/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to high rates of ablation at the time of diagnostic EP study, follow-up of the natural history of untreated pre-excitation syndrome has become difficult. We present patients in which such data is available and study the effect of initial age on the evolution. METHODS In this retrospective review, 126 patients, 47 aged ≤19 years, 79 aged more than>19 underwent 2 similar electrophysiological studies (EPS) within 1 to 25 years of one another (8.8 ± 6.8) for occurrence of symptoms or new evaluation. First EPS was indicated for syncope (10), atrioventricular re-entrant tachycardias (AVRT) (58), atrial fibrillation (AF) (5), spontaneous PS-related adverse event (7) or asymptomatic PS (46). RESULTS Clinical data remained unchanged in 76 patients (60.3%). AVRT symptom was more frequently unchanged than other symptoms. Electrophysiological data remained unchanged in 105 patients (82%), but signs of initial malignant signs were variable with a disappearance in 53.5% of patients. At EPS1, AF induction was rarer in patients ≤19 years. Syncope had a low predictive value of malignant form. AVRT induction at EPS1 was not predictive of AVRT occurrence. Maximal rate over accessory pathway increased, but unexpected changes could occur. After multivariate analysis, data of first EPS were limited for the prediction of AVRT or adverse event; effect of age was not significant. CONCLUSIONS Clinical data remained unchanged in 60.3% of patients and electrophysiological data in 82%. Initial age of evaluation did not change the modifications. Electrophysiological signs associated with sudden death varied over time. Clinical AVRT was inconstantly related to inducible AVRT (78.5%).
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Affiliation(s)
| | | | | | - Erwan Bozec
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, Institut Lorrain du Cœur et des Vaisseaux, Nancy University Hospital, Nancy, France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, Institut Lorrain du Cœur et des Vaisseaux, Nancy University Hospital, Nancy, France
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Brembilla-Perrot B, Girerd N, Sellal JM. Unresolved questions associated with the management of ventricular preexcitation syndrome. Pacing Clin Electrophysiol 2018; 41:839-844. [PMID: 29754436 DOI: 10.1111/pace.13367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Many recent recommendations concern the management of preexcitation syndrome. In clinical practice, they are sometimes difficult to use. The purpose of the authors was to discuss the main problems associated with this management. Three problems are encountered: (1) the reality of the absence of symptoms or the interpretation of atypical symptoms, (2) the electrocardiographic diagnosis of preexcitation syndrome that can be missed, and (3) the exact electrophysiological protocol and its interpretation used for the evaluation of the prognosis. Because of significant progress largely related to the development of curative treatment, it seems easy to propose ablation in many patients despite the related risks of invasive studies and to minimize the invasive risk by only performing ablation for patients with at-risk pathways. However, there is a low risk of spontaneous events in truly asymptomatic patients and the indication of accessory pathway ablation should be discussed case by case.
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Affiliation(s)
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, Nancy University Hospital, Nancy, France
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Brembilla-Perrot B, Sellal JM, Olivier A, Villemin T, Beurrier D, Vincent J, Manenti V, de Chillou C, Bozec E, Girerd N. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years. PLoS One 2018; 13:e0187895. [PMID: 29304037 PMCID: PMC5755731 DOI: 10.1371/journal.pone.0187895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
AIM To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes. METHODS Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation. RESULTS Among 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70-97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41-2.62, p<0.001), conduction disturbances (OR = 11.27, 5.89-21.50, p<0.001), history of AF (OR = 2.18, 1.22-3.90, p = 0.009) and erroneous diagnosis at baseline (OR = 9.14, 5.93-14.09, p<0.001) as well as high rates of procedural complications (OR = 2.13, 1.19-3.81, p = 0.01) and ablation failure (OR = 1.68, 1.08-2.62, p = 0.02). In contrast, age ≥70 was not significantly associated with a higher risk of AF in multivariable analysis. CONCLUSIONS A sizeable proportion of patients with inducible SVT without pre-excitation syndromes are elderly. These patients exhibit higher risks of erroneous tachycardia diagnosis prior to EPS as well as failure and/or complication of ablation, but similar risk of SVT recurrence. These results support performing transesophageal EPS in most patients and intracardiac EPS in selected patients. EPS may furthermore prove useful in elderly patients with regular tachycardia, mainly by avoiding treatment based on an erroneous diagnosis.
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Affiliation(s)
| | - Jean Marc Sellal
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Arnaud Olivier
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Thibaut Villemin
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Daniel Beurrier
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Julie Vincent
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Vladimir Manenti
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Christian de Chillou
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Erwan Bozec
- INSERM, Centre d’Investigations Cliniques 1433, Nancy, France
- INSERM, Unité 1116, Nancy, France
- Faculté de médecine, Université de Lorraine, Nancy, France
- CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
| | - Nicolas Girerd
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- INSERM, Centre d’Investigations Cliniques 1433, Nancy, France
- INSERM, Unité 1116, Nancy, France
- Faculté de médecine, Université de Lorraine, Nancy, France
- CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
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Brembilla-Perrot B, Olivier A, Villemin T, Vincent J, Manenti V, Beurrier D, de la Chaise AT, Selton O, Louis P, de Chillou C, Sellal JM. Prediction of atrial fibrillation in patients with supraventricular tachyarrhythmias treated with catheter ablation or not. Classical scores are not useful. Int J Cardiol 2016; 220:102-6. [DOI: 10.1016/j.ijcard.2016.06.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/04/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
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Brembilla-Perrot B, Sellal JM, Olivier A, Villemin T, Moulin-Zinsch A, Beurrier D, Lethor JP, Marçon F, DE Chillou C, Felblinger J, Vincent J. Evolution of Clinical and Electrophysiological Data in Children with a Preexcitation Syndrome. Pacing Clin Electrophysiol 2016; 39:951-8. [PMID: 27448170 DOI: 10.1111/pace.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/30/2016] [Accepted: 07/17/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND With ablation, the follow-up of preexcitation syndrome now is difficult to assess. The purpose was to collect data of children with a preexcitation syndrome studied on two separate occasions within a minimal interval of 1 year. METHODS This is a retrospective chart review of 47 children initially aged 12 ± 4 years, who underwent two or more invasive electrophysiological studies (EPS) within 1-25 years of one another (6.3 ± 4.8) for occurrence of symptoms or new evaluation. RESULTS Among initially symptomatic children (n = 25), four (19%) became asymptomatic and one presented life-threatening arrhythmia. Among asymptomatic children (n = 22), five became symptomatic (22.7%). Anterograde conduction disappeared in seven of 23 children with initially long accessory pathway-effective refractory period, but four of six had still induced atrioventricular reentrant tachycardia (AVRT). AVRT was induced at second EPS in three of 13 asymptomatic preexcitation syndrome with negative initial EPS. There were no spontaneous adverse events in the five children with criteria of malignancy at initial EPS; signs of malignancy disappeared in two. At multivariate analysis, AVRT at initial EPS was the only independent factor of symptomatic AVRT during follow-up. Absence of induced AVRT at initial EPS was the only factor of absence of symptoms and a negative study at the second EPS. CONCLUSIONS There were no significant changes of data in children after 6.3 ± 4.8 years of follow-up. Most children with spontaneous/inducible AVRTs at initial EPS had still inducible AVRT at second EPS. Induced AF conducted with high rate has a relatively low prognostic value for the prediction of adverse events.
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Affiliation(s)
| | - Jean-Marc Sellal
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Arnaud Olivier
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Thibaut Villemin
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Anne Moulin-Zinsch
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Daniel Beurrier
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Jean-Paul Lethor
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - François Marçon
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | | | | | - Julie Vincent
- Adult and Paediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
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Brembilla-Perrot B, Olivier A, Sellal JM, Manenti V, Brembilla A, Villemin T, Admant P, Beurrier D, Bozec E, Girerd N. Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period. BMJ Open 2016; 6:e010520. [PMID: 27188807 PMCID: PMC4874160 DOI: 10.1136/bmjopen-2015-010520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS. SETTING Single-centre retrospective study of patient files. PARTICIPANTS In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary. PRIMARY AND SECONDARY OUTCOME MEASURES Occurrence of atrial fibrillation (AF) or procedure-induced adverse event. RESULTS Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01). CONCLUSIONS In this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly patients, the decision for EPS and AP ablation should be discussed in light of their suspected higher risk of events and ablation complications. However, these findings should be further validated in future prospective multicentre studies.
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Affiliation(s)
| | - Arnaud Olivier
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Jean-Marc Sellal
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Vladimir Manenti
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Alice Brembilla
- Department of Epidemiology, CHU of Besançon, Besançon, France
| | - Thibaut Villemin
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | | | - Daniel Beurrier
- Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Erwan Bozec
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, Vandoeuvre-lès-Nancy, France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, Vandoeuvre-lès-Nancy, France
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Brembilla-Perrot B, Huttin O, Olivier A, Sellal JM, Villemin T, Manenti V, Moulin-Zinsch A, Marçon F, Simon G, Andronache M, Beurrier D, de Chillou C, Girerd N. Age-related location of manifest accessory pathway and clinical consequences. Indian Pacing Electrophysiol J 2016; 15:227-35. [PMID: 27134439 PMCID: PMC4834439 DOI: 10.1016/j.ipej.2016.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/30/2022] Open
Abstract
BACKGROUND Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location. METHODS Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients. RESULTS AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP, <0.0001 for PSAP). Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients. Malignant forms at EPS were more frequent in patients with LLAP than in patients with ASAP (0.002) or PSAP (0.001). Similar data were noted when AP location was confirmed at intracardiac EPS. Among untreated patients, poorly-tolerated arrhythmia occurred in patients with LLAP (3) or PSAP (6). Failures of ablation were more frequent for AS or RL AP than for LL or PS AP. CONCLUSIONS AS and RLAP location in pre-excitation syndrome was more frequent in young patients. Maximal rate conducted over AP was lower than in other locations. Absence of poorly-tolerated arrhythmias during follow-up and higher risk of ablation failure should be taken into account for indications of AP ablation in children with few symptoms.
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Affiliation(s)
| | - Olivier Huttin
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Arnaud Olivier
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Jean Marc Sellal
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Thibaut Villemin
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Vladimir Manenti
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Anne Moulin-Zinsch
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - François Marçon
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Gauthier Simon
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Marius Andronache
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Daniel Beurrier
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | | | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France
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Brembilla-Perrot B, Ferreira JP, Manenti V, Sellal JM, Olivier A, Villemin T, Beurrier D, De Chillou C, Louis P, Brembilla A, Juillière Y, Girerd N. Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation. Eur J Heart Fail 2016; 18:394-401. [DOI: 10.1002/ejhf.482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/14/2015] [Accepted: 12/05/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433; Université de Lorraine; CHRU de Nancy and F-CRIN INI-CRCT Nancy France
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine; University of Porto; Porto Portugal
| | - Vladimir Manenti
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Jean Marc Sellal
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Arnaud Olivier
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Thibaut Villemin
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Daniel Beurrier
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Christian De Chillou
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Pierre Louis
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | | | - Yves Juillière
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433; Université de Lorraine; CHRU de Nancy and F-CRIN INI-CRCT Nancy France
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Sellal JM, Manenti V, Olivier A, Villemin T, Chillou CD, Girerd N, Brembilla-Perrot B. 0082: Is it really possible to predict adverse event in patients with a preex-citation syndrome? Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brembilla-Perrot B, Sellal JM, Olivier A, Villemin T, Manenti V, Brembilla A, Rizk J, Chillou CD, Moulin-Zinsch A, Marçon F, Girerd N. Electrophysiological study generally is negative in patients <40years suspected of supraventricular tachycardia but also complaining of chest pain and/or syncope. Int J Cardiol 2016; 203:1109-13. [PMID: 26646383 DOI: 10.1016/j.ijcard.2015.11.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/14/2015] [Indexed: 11/26/2022]
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Brembilla-Perrot B, Bénichou M, Brembilla A, Bozec E, Dorlet S, Sellal JM, Olivier A, Manenti V, Villemin T, Beurrier D, Moulin-Zinsch A, De Chillou C, Girerd N. AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events. Int J Cardiol 2015; 199:84-9. [DOI: 10.1016/j.ijcard.2015.07.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/26/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022]
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Dorlet S, Brembilla-Perrot B. 0049: Long-term follow- up of AV conduction disturbances after slow pathway ablation in patients with AV node reentrant tachycardia. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brembilla-Perrot B, Moulin-Zinsch A, Louis Cloez J, Paul Lethor J, Nrecaj-Jager C, Tisserant A, Marchal C, Ferderspiel C, Marçon F. 0164: Evolution of preexcitation syndrome in children. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vincent J, Brembilla-Perrot B. 0048: A long accessory pathway refractory period measured by oesophageal atrial stimulation is always associated with a benign form of preexcitation syndrome. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brembilla-Perrot B, Mielczarek M, Lalevee C, Vincent J, Olivier A, Manenti V, Sellal JM, Beurrier D, Villemin T, Moulin-Zinsch A, Marçon F. 0035: Unpredictable long-term follow-up of untreated preexcitation syndrome. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71696-4] [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: 11/24/2022]
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Brembilla-Perrot B, Brembilla A, Moulin-Zinsch A, Sellal JM, Olivier A, Manenti V, Villemin T, Lethor JP, Taihï S, Rizk J, Rodermann M, Marçon F, Girerd N. Factors of negativity of electrophysiological study in children and teenagers complaining of tachycardia and prognostic significance. Pediatr Cardiol 2015; 36:64-70. [PMID: 25070388 DOI: 10.1007/s00246-014-0965-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
When non-invasive studies remain negative, the diagnosis of unexplained tachycardia in the young is a dilemma. The purpose of the study was to determine the factors of negativity of transesophageal electrophysiological study (EPS) in children/teenagers complaining of tachycardia and the prognostic value. Two hundred and seventy-three children with a normal ECG in sinus rhythm, aged from 6 to 19 years (15 ± 3), complained of tachycardia. Transesophageal EPS consisted of atrial stimulation in control state and after isoproterenol. Supraventricular tachycardia (SVT) was induced in 149 patients (group I) and EPS remained negative in 124 (group II). Age did not differ (15 ± 3 vs 15 ± 3). Female gender and familial history of SVT were as frequent in group I (47, 11%) than in group II (55%, p = 0.15; 7%;p = 0.2). Feeling of dizziness/syncope with tachycardia was less frequent in group I (12%) than in group II (48%) (p < 0.0001). Feeling of chest pain with tachycardia was less frequent in group I (2%) than in group II (28%) (p < 0.0001). The presence of non-cardiac disease was less frequent in group I (1.3%) than in group II (6.4%) (p < 0.025). Patients with negative study remained free of SVT after a follow-up of 3.5 ± 3 years, but one had a complete AV block. In children with apparently normal ECG in sinus rhythm, who complained of tachycardia clinical history (association with syncope, chest pain, or the presence of another disease) can predict negativity of EPS with a relatively high accuracy; EPS may not be necessary. In very symptomatic patients, transesophageal EPS, which is inexpensive and non-invasive, might be performed to stop investigations.
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Brembilla-Perrot B, Sellal JM, Olivier A, Manenti V, Beurrier D, de Chillou C, Villemin T, Girerd N. Recurrences of symptoms after AV node re-entrant tachycardia ablation: a clinical arrhythmia risk score to assess putative underlying cause. Int J Cardiol 2014; 179:292-6. [PMID: 25464467 DOI: 10.1016/j.ijcard.2014.11.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 07/25/2014] [Revised: 09/22/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE OF THE RESEARCH To identify clinical factors associated with the probability for each arrhythmic mechanism causing recurring symptoms after atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. Slow pathway radiofrequency ablation is used to treat AVNRT. After ablation, recurrence of symptoms due to AVNRT or other arrhythmias can occur. RESULTS We studied 835 patients successfully treated with AVNRT ablation. Variables associated with each specific arrhythmia underlying symptom recurrence were studied by logistic regression. During a mean follow-up of 2.2 ± 2 years, 136 (16%) patients had a recurrence of symptoms. Following invasive and non-invasive studies, symptoms were mostly attributed to sinus tachycardia, recurrence of AVNRT and atrial arrhythmias (respectively 4.7%, 5.2% and 6.1%). Older age and history of atrial fibrillation were associated with a markedly increased risk of symptom recurrence due to atrial arrhythmias (OR=15.58, 7.09-35.22, p<0.001) whereas younger age was associated with a higher risk of sinus tachycardia. A simple 3-item clinical score based on age categories and atrial fibrillation history efficiently predicted atrial arrhythmia (C-Index=0.82, 0.75-0.89) and sinus tachycardia (C-Index=0.83, 0.75-0.90). 8.3% of patients with scores=0 had atrial arrhythmias whereas 100% of patients with scores ≥4 had atrial arrhythmias. CONCLUSIONS While recurrence of symptoms after successful AVNRT ablation is relatively frequent (16%), true AVNRT recurrence accounts for only 1/3 of these recurrences. A simple clinical score based on age and history of atrial fibrillation enables efficient risk stratification for symptom recurrence attributable to atrial arrhythmias and inappropriate sinus tachycardia.
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Affiliation(s)
| | - Jean-Marc Sellal
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Arnaud Olivier
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Vladimir Manenti
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Daniel Beurrier
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | | | - Thibaut Villemin
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France
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Jacquet C, Brembilla-Perrot B, Marc Sellal JM, Mohamed S, Terrier de la Chaise A, Kaminsky P. Troubles du rythme et intolérance musculaire à l’effort chez un adulte jeune révélant une laminopathie. Rev Med Interne 2014; 35:617-20. [DOI: 10.1016/j.revmed.2014.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 04/02/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
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Brembilla-Perrot B, Sellal JM, Olivier A, Manenti V, Beurrier D, Al Jouma B, Andronache M, de Chillou C, Girerd N, Villemin T. A case series of patients with poorly-tolerated arrhythmias related to a preexcitation syndrome and presenting with atypical ECG. Int J Cardiol 2014; 174:348-54. [PMID: 24794061 DOI: 10.1016/j.ijcard.2014.04.114] [Citation(s) in RCA: 3] [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: 02/18/2014] [Revised: 03/25/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED The aim of study was to report different and unusual patterns of preexcitation syndrome (PS) noted in patients referred for studied for poorly-tolerated arrhythmias and their frequency. Electrophysiologic study (EPS) is an easy means to identify a patient with PS at risk of serious events. However the main basis for this diagnosis is the ECG which associates short PR interval and widening of QRS complex with a delta wave. METHODS ECGs of 861 patients in whom PS related to an atrioventricular accessory pathway (AP) was identified at electrophysiological study (EPS), were studied. RESULTS The most frequent unusual presentation (9.6%) was the PS presenting with a normal or near normal ECG, noted preferentially for left lateral AP and rarely for posteroseptal or right lateral location. More exceptional (0.1%) was the presence of a long PR interval, which did not exclude a rapid conduction over AP. The association of a complete AV block with symptomatic tachycardias was exceptional (0.3%) and was shown related to a rapid conduction over AP after isoproterenol. Most of the presented patients were at high-risk at EPS. CONCLUSION The diagnosis of PS is not always evident and symptoms should draw attention to minor abnormalities and lead to enlarge indications of EPS, only means to confirm or not PS.
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Affiliation(s)
| | - Jean Marc Sellal
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Arnaud Olivier
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Vladimir Manenti
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Daniel Beurrier
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Bassam Al Jouma
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Marius Andronache
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Christian de Chillou
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Nicolas Girerd
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
| | - Thibaut Villemin
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France
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Brembilla-Perrot B, Huttin O, Azman B, Sellal JM, Schwartz J, Olivier A, Blangy H, Sadoul N. Influence of the mode of management of acute myocardial infarction on the inducibility of ventricular tachyarrhythmias with programmed ventricular stimulation after myocardial infarction. Isr Med Assoc J 2014; 16:352-357. [PMID: 25058996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Programmed ventricular stimulation (PVS) is a technique for screening patients at risk for ventricular tachycardia (VT) after myocardial infarction (MI), but the results might be difficult to interpret. OBJECTIVES To investigate the results of PVS after MI, according to date of completion. METHODS PVS results were interpreted according to the mode of MI management in 801 asymptomatic patients: 301 (group I) during the period 1982-1989, 315 (group II) during 1990-1999, and 185 (group III) during 2000-2010. The periods were chosen based on changes in MI management. Angiotensin-converting enzyme (ACE) inhibitors had been given since 1990; primary angioplasty was performed routinely since 2000. The PVS protocol was the same throughout the whole study period. RESULTS Group III was older (61 +/- 11 years) than groups I (56 +/- 11) and II (58 +/- 11) (P < 0.002). Left ventricular ejection fraction (LVEF) was lower in group III (36.5 +/- 11%) than in groups I (44 +/- 15) and II (41 +/- 12) (P < 0.000). Monomorphic VT < 270 beats/min was induced as frequently in group III (28%) as in group II (22.5%) but more frequently than in group I (20%) (P < 0.03). Ventricular fibrillation and flutter (VF) was induced less frequently in group III (14%) than in groups I (28%) (P < 0.0004) and II (30%) (P < 0.0000). Low left ventricular ejection fraction (LVEF) and date of inclusion (before/after 2000) were predictors of VT or VF induction on multivariate analysis. CONCLUSIONS Induction of non-specific arrhythmias (ventricular flutter and fibrillation) was less frequent than before 2000, despite the indication of PVS in patients with lower LVEF. This decrease could be due to the increased use of systematic primary angioplasty for MI since 2000.
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Federspiel C, Brembilla-Perrot B. Prevalence, causes of reappearance of symptoms or preexcitation syndrome after ablation of accessory pathway and management. Ann Cardiol Angeiol (Paris) 2014; 63:89-94. [PMID: 24613003 DOI: 10.1016/j.ancard.2014.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/03/2014] [Indexed: 06/03/2023]
Abstract
AIM The purpose of the study was to look for the prevalence, significance and management of preexcitation syndrome (PS) or symptoms reappearance after accessory pathway (AP) ablation. AP ablation actually is the first treatment of PS. METHODS Successful AP ablation was performed in 261 patients; reappearance of symptoms or PS on ECG occurred in 47 patients (18%) from 20minutes to several years. Their data were compared with remaining patients. RESULTS Recurrences were more frequent in patients with spontaneous malignant form (34 vs. 21%), in congenital heart disease (4.2 vs. 0%) (P<0.002), in case of complication (11 vs. 2%) (P<0.007) and of a longer duration of applications (304±209 vs. 188±182sec) (P<0.019). Forty percent of patients had the same symptoms and electrophysiological data as before ablation. Twenty-four percent had an improvement of symptoms and/or electrophysiological data. However, 3 initially asymptomatic patients became symptomatic after ablation. Twenty-six percent had another AP or another rhythm disorder. We recommend transesophageal electrophysiological study for the control because only 40% of patients required second ablation. CONCLUSIONS Reappearance of symptoms or a PS on ECG after AP ablation was not rare (18%) and was inconsistently associated with the reappearance of all initial AP electrophysiological properties. Only 40% of patients required a second AP ablation. Another arrhythmia was possible. Non-invasive second evaluation should be preferred. However, asymptomatic patients before ablation could become symptomatic.
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Affiliation(s)
- C Federspiel
- Cardiology, CHU of Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - B Brembilla-Perrot
- Cardiology, CHU of Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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de Chillou C, Groben L, Magnin-Poull I, Andronache M, Abbas MM, Zhang N, Abdelaal A, Ammar S, Sellal JM, Schwartz J, Brembilla-Perrot B, Aliot E, Marchlinski FE. Localizing the critical isthmus of postinfarct ventricular tachycardia: The value of pace-mapping during sinus rhythm. Heart Rhythm 2014; 11:175-81. [DOI: 10.1016/j.hrthm.2013.10.042] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Indexed: 11/27/2022]
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Pauriah M, Cismaru G, Sellal JM, Chillou CD, Brembilla-Perrot B. Is isoproterenol really required during electrophysiological study in patients with Wolff-Parkinson-White syndrome? J Electrocardiol 2013; 46:686-92. [PMID: 23313385 DOI: 10.1016/j.jelectrocard.2012.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Indexed: 11/26/2022]
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Brembilla-Perrot B, Schwartz J, Huttin O, Frikha Z, Sellal JM, Sadoul N, Blangy H, Olivier A, Louis S, Kaminsky P. Atrial flutter or fibrillation is the most frequent and life-threatening arrhythmia in myotonic dystrophy. Pacing Clin Electrophysiol 2013; 37:329-35. [PMID: 24117873 DOI: 10.1111/pace.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/09/2013] [Accepted: 07/18/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Several arrhythmias were reported in myotonic dystrophy (MD). OBJECTIVES To evaluate the prevalence of atrial fibrillation (AF) and atrial flutter (AFL) in MD and the clinical consequences. METHODS One hundred sixty-one patients, mean age 41 ± 14 years, were referred for a type 1 MD. All patients were asymptomatic except four patients and followed during 5 ± 4 years. Electrocardiogram (ECG), echocardiography assessing left ventricular ejection fraction, and Holter monitoring were obtained and repeated. RESULTS Twenty-seven patients (17%) presented sustained (>1 hour) AF (n = 15) or AFL (n = 12); two of them presented syncope-related 1/1 AFL. In one of them, 16 years of age, cardiac defibrillator was implanted for a diagnosis of ventricular tachycardia, but the true diagnosis was established after inappropriate shocks. AFL ablation was performed in five patients, but four developed AF. The other seven patients with AFL developed AF. During the follow-up, 22 patients died (14%) from cardiac and respiratory failure; eight patients with AF/AFL died (30%) while only 14 without AF/AFL died (10%; P < 0.01). Univariate analysis indicated that age >40 years (death: 48 ± 14 vs 40 ± 8 in alive patients), abnormal ECG, and occurrence of AF/AFL were significant factors of death. At multivariate analysis, AF at ECG (odds ratio: 3.12) and age >40 (odds ratio: 3.14) were the sole independent variables predicting death. CONCLUSIONS AF and AFL were frequent in MD and increased mortality. AFL could present as 1/1 AFL with a poor tolerance and a risk of misdiagnosis despite frequent conduction disturbances. This arrhythmia could explain wide QRS tachycardia occurring in MD and interpreted as VT.
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Brembilla-Perrot B, Moulin-Zinsch A, Sellal JM, Schwartz J, Olivier A, Zinzius PY, De Chillou C, Beurrier D, Rodermann M, Goudote G, Al Amoura H, Terrier de la Chaise A, Lemoine J, Rizk J, Lethor JP, Anne Tisserand JL, Taïhi S, Marçon F. Impact of transesophageal electrophysiologic study to elucidate the mechanism of arrhythmia on children with supraventricular tachycardia and no preexcitation. Pediatr Cardiol 2013; 34:1695-702. [PMID: 23609066 DOI: 10.1007/s00246-013-0703-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
An electrophysiologic study (EPS) of children and teenagers with paroxysmal supraventricular tachycardia (SVT) and normal electrocardiography (ECG) in sinus rhythm was evaluated. Generally, EPS is performed only before paroxysmal SVT ablation in these patients. In this study, 140 patients (mean age, 15 ± 3 years) with normal ECG in sinus rhythm were studied for SVT by a transesophageal route in baseline state and after isoproterenol. Idiopathic left or right ventricular tachycardia was diagnosed in four patients (3 %). Anterograde conduction over an atrioventricular (AV) left lateral (n = 10) or septal (n = 9) accessory pathway (AP) was noted in 19 patients (13.5 %) at atrial pacing. Orthodromic AV reentrant tachycardia (AVRT) was induced in these children. Five of the patients had a high rate conducted over AP (>240 bpm in baseline state or >290 bpm after isoproterenol). Two of the patients (a 10-year-old girl with well-tolerated SVT and a 17-year-old with syncope-related SVT) had the criteria for a malignant form with the induction of atrial fibrillation conducted over AP at a rate exceeding 290 bpm in baseline state. Of the 140 patients, 74 (53 %) had typical AV node reentrant tachycardia (AVNRT), nine had atypical AVNRT (6 %), 1 had atrial tachycardia (0.7 %), and 33 (23.5 %) had AVRT related to a concealed AP with only retrograde conduction. Electrophysiologic study is recommended for children with paroxysmal SVT and normal ECG in sinus rhythm. The data are helpful for guiding the treatment. Ventricular tachycardia or atrial tachycardia can be misdiagnosed. Masked preexcitation syndrome with anterograde conduction through AP was present in 13.5 % of the patients, and 1.4 % had a malignant preexcitation syndrome.
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Brembilla-Perrot B, Huttin O, Manenti V, Benichou M, Sellal J, Zinzius P, Beurrier D, Schwartz J, Laporte F, de Chillou C, Andronache M, Cismaru G, Pauriah M, Selton O, Louis P, Terrier de la Chaise A. Sex-related differences in peri- and post-ablation clinical data for patients with atrial flutter. Int J Cardiol 2013; 168:1951-4. [PMID: 23351790 DOI: 10.1016/j.ijcard.2012.12.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/06/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
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Brembilla-Perrot B, Schwartz J, Frikha Z, Sellal JM, Olivier A, Louis S, Kaminsky P. Misdiagnosis of atrial flutter/fibrillation in myotonic dystrophy and prognosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4949] [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: 11/14/2022] Open
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Brembilla-Perrot B, Manenti V, Sellal JM, Schwartz J, Olivier A, Zinzius PY, Andronache M, De Chillou C, Beurrier D. Is atrioventricular nodal reentrant tachycardia possible in patients with first degree AV block? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5573] [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: 11/12/2022] Open
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Brembilla-Perrot B, Sellal JM, Schwartz J, Olivier A, Beurrier D, Zinzius PY, De Chillou C, Terrier De La Chaise A, Louis P, Selton O. Prevalence of previous history of atrial fibrillation in patients referred for ablation of atrial flutter. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4119] [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: 11/14/2022] Open
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Brembilla-Perrot B, Sellal J, Zinzius P, Schwartz J, Blangy H, Sadoul N. Influence of the time on the prevalence of drug-related resuscitated sudden death during these past 20years. Int J Cardiol 2013; 167:491-4. [DOI: 10.1016/j.ijcard.2012.01.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/04/2012] [Accepted: 01/21/2012] [Indexed: 11/25/2022]
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Brembilla-Perrot B, Pauriah M, Sellal JM, Zinzius PY, Schwartz J, de Chillou C, Cismaru G, Beurrier D, Voilliot D, Selton O, Louis P, Andronache M, Nosu R, de la Chaise AT. Incidence and prognostic significance of spontaneous and inducible antidromic tachycardia. Europace 2013; 15:871-876. [PMID: 23148120 DOI: 10.1093/europace/eus354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 09/25/2023] Open
Abstract
AIMS Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT). METHODS AND RESULTS Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol. Antidromic tachycardia was induced in 63 patients (8%). Clinical and electrophysiological data were compared with those of 744 patients without ADT. Patients with and without ADT were similar in term of age (33 ± 18 vs. 34 ± 17), male gender (68 vs. 61%), clinical presentation with spontaneous atrioventricular reentrant tachycardia (AVRT) (35 vs. 42%), atrial fibrillation (AF) (3 vs. 3%), syncope (16 vs. 12%). In patients with induced ADT, asymptomatic patients were less frequent (24 vs. 37%; <0.04), spontaneous ADT and spontaneous malignant form more frequent (8 vs. 0.5%; <0.001) (16 vs. 6%; <0.002). Left lateral accessory pathway (AP) location was more frequent (51 vs. 36%; P < 0.022), septal location less frequent (40 vs. 56%; P < 0.01). And 1/1 conduction through AP was more rapid. Orthodromic AVRT induction was as frequent (55.5 vs. 55%), but AF induction (41 vs. 24%; P < 0.002) and electrophysiological malignant form were more frequent (22 vs. 12%; P < 0.02). The follow-up was similar; four deaths and three spontaneous malignant forms occurred in patients without ADT. When population was divided based on age (<20/≥20 years), the older group was less likely to have criteria for malignant form. CONCLUSION Antidromic tachycardia induction is rare in pre-excitation syndrome and generally is associated with spontaneous or electrophysiological malignant form, but clinical outcome does not differ.
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Khachab H, Brembilla-Perrot B. Prevalence of atrial fibrillation in patients with history of paroxysmal supraventricular tachycardia. Int J Cardiol 2013; 166:221-4. [DOI: 10.1016/j.ijcard.2011.10.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/06/2011] [Accepted: 10/18/2011] [Indexed: 11/25/2022]
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Pauriah M, Cismaru G, Magnin-Poull I, Andronache M, Sellal JM, Schwartz J, Brembilla-Perrot B, Sadoul N, Aliot E, de Chillou C. A Stepwise Approach to the Management of Postinfarct Ventricular Tachycardia Using Catheter Ablation as the First-Line Treatment. Circ Arrhythm Electrophysiol 2013; 6:351-6. [PMID: 23512203 DOI: 10.1161/circep.113.000261] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maheshwar Pauriah
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Gabriel Cismaru
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Isabelle Magnin-Poull
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Marius Andronache
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Jean-Marc Sellal
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Jérôme Schwartz
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Béatrice Brembilla-Perrot
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Nicolas Sadoul
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Etienne Aliot
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Christian de Chillou
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
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Brembilla-Perrot B, Moejezi RV, Zinzius PY, Jarmouni S, Schwartz J, Beurrier D, Sellal JM, Nossier I, Muresan L, Andronache M, Moisei R, Selton O, Louis P, de la Chaise AT. Missing diagnosis of preexcitation syndrome on ECG: clinical and electrophysiological significance. Int J Cardiol 2013; 163:288-293. [PMID: 21704397 DOI: 10.1016/j.ijcard.2011.06.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/20/2011] [Accepted: 06/06/2011] [Indexed: 11/25/2022]
Abstract
UNLABELLED Electrocardiographic criteria of preexcitation syndrome are sometimes not visible on ECG in sinus rhythm (SR). The purpose of the study was to evaluate the significance of unapparent preexcitation syndrome in SR, when overt conduction through accessory pathway (AP) was noted at atrial pacing. METHODS Anterograde conduction through atrioventricular AP was identified at electrophysiological study (EPS) in 712 patients, studied for tachycardia (n=316), syncope (n=89) or life-threatening arrhythmia (n=55) or asymptomatic preexcitation syndrome (n=252). ECG in SR at the time of EPS was analysed. RESULTS 78 patients (11%) (group I) had a normal ECG in SR and anterograde conduction over AP at atrial pacing; 634 (group II) had overt preexcitation in SR. Group I was as frequently asymptomatic (35%) as group II (35%), had as frequently tachycardias, syncope or life-threatening arrhythmia as group II (43, 5, 2% vs 43, 13, 8%). AP was more frequently left lateral in group I (57%) than in group II (36%)(p<0.001). AV re-entrant tachycardia, atrial fibrillation (AF), antidromic tachycardia were induced as frequently in group I (54, 18, 10%) as in group II (54, 27, 7%). Malignant forms (induced AF with RR intervals between preexcited beats <250ms in control state or <200ms after isoproterenol) were as frequent in group I (11.5%) as II (14%). CONCLUSIONS The frequency of unapparent preexcitation syndrome represents 11% of our population with anterograde conduction through an AP and could be underestimated. The risk to have a malignant form is as high as in patients with overt preexcitation syndrome in SR.
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Affiliation(s)
| | | | - Pierre Yves Zinzius
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Soumaya Jarmouni
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Jérôme Schwartz
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Daniel Beurrier
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Jean Marc Sellal
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Ibrahim Nossier
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Lucian Muresan
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Marius Andronache
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Radou Moisei
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Olivier Selton
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Pierre Louis
- Department of cardiology, University Hospital of Brabois, Vandoeuvre, France
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Brembilla-Perrot B, Zinsch AM, Sellal JM, Zinzius PY, Schwartz J, Beurrier D, DE Chillou C, Godenir JP, Lethor JP, Marchal C, Cloez JL, Pauriah M, Nosu R, Andronache M, Marçon F. Age-related prognosis of syncope associated with a preexcitation syndrome. Pacing Clin Electrophysiol 2013; 36:803-10. [PMID: 23438091 DOI: 10.1111/pace.12110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/03/2013] [Accepted: 01/03/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syncope in Wolff-Parkinson-White syndrome (WPW) is without relationship with WPW or reveals a poorly tolerated arrhythmia. Electrophysiologic study (EPS) is recommended. The purpose of the study was to evaluate the influence of the patient's age on the causes and prognosis of syncope. METHODS A total of 98 patients, mean age 35 ± 18 years, with WPW were admitted for syncope. Note that 29 were aged between 9 and 19 years (mean 15 ± 3) (children and teenagers/group I), 45 between 20 and 49 years (mean 34 ± 8) (adults/group II), and 24 between 50 and 70 years (mean 60 ± 8) (elderly/group III). EPS consisted of atrial pacing and programmed atrial stimulation in control state and after isoproterenol. RESULTS Potentially malignant form (rapid conduction in accessory pathway >240 beats/min in control state or >300 beats/min after isoproterenol and atrial fibrillation [AF] induction) was more frequent in group I (34%) than in groups II (7%) (P < 0.002) and III (0%) (P < 0.001). Orthodromic atrioventricular reentrant tachycardia (AVRT) and AF were induced as frequently in groups I (59, 34%), II (47, 15.5%), and III (54, 17%). AVRT was induced in all but one patient with malignant form. EPS was as frequently negative in groups I (27.5%), II (44%), and III (37.5%). Natural follow-up (mean 8 ± 6 years) indicated a favorable prognosis, only related to AVRT induction. Induced AF was without significance. CONCLUSIONS Data in syncope and WPW syndrome depended on age: electrophysiological malignant form was frequent in children/teenagers, rare in adults, and absent in elderly. AVRT, the main cause of syncope, was as frequent in all ranges of age. AF's induction alone had no significance. Final prognosis was favorable.
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Cismaru G, Brembilla-Perrot B, Pauriah M, Zinzius PY, Sellal JM, Schwartz J, Sadoul N. Cycle length characteristics differentiating non-sustained from self-terminating ventricular fibrillation in Brugada syndrome. Europace 2013; 15:1313-8. [PMID: 23419658 DOI: 10.1093/europace/eut023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/15/2022] Open
Abstract
AIMS Limited information is available on self-terminating (ST) ventricular fibrillation (VF). Understanding spontaneous fluctuations in VF cycle length (CL) is required to identify arrhythmia that will stop before shock. Using Brugada syndrome (BS) as a model, the purpose of the study was to compare ST-VF and VF terminated by electrical shock and to look for spontaneous fluctuations in ventricular CL. METHODS AND RESULTS Occurrence of ST-VF and VF was studied in 53 patients with 46 VF episodes: (i) spontaneously, (ii) during defibrillation threshold testing, (iii) during programmed ventricular stimulation (PVS). Fifteen presented ST-VF (average duration 25 s): 11 during PVS, 1 during defibrillation threshold testing, and 3 spontaneously (at device interrogation). Self-terminating ventricular fibrillation was compared with 31 VFs terminated by electrical shock. Mean ventricular CL was longer (192.5 ± 22 vs. 149 ± 19 ms) (P < 0.0001) and CL became longer or did not change in ST-VF (187 ± 28 vs. 200 ± 25 ms) (first vs. last CL)(NS) in contrast with progressively shorter CL in electrical shock-terminated VF (177 ± 14.5 vs. 139 ± 12 ms) (first vs. last CL before electrical shock) (P < 0.0001). Ventricular fibrillation had more CL variability (average 16.4 ± 6.5 ms) for the first 50 beats than ST-VF (average 4.08 ± 2) (P < 0.0001). Cycle length range for the first 50 beats was 9.6 ± 1 ms for ST-VF and 44 ± 15 for VF (P < 0.002). CONCLUSION Self-terminating ventricular fibrillation in BS was not rare (28%). Ventricular CL was longer and progressively increased or did not change in ST-VF compared with electrical shock-terminating VF. Cycle length variability and CL range could differentiate VF and ST-VF within the first 50 beats. These parameters should be considered in the algorithms for VF detection and termination.
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Affiliation(s)
- Gabriel Cismaru
- Cardiology, CHU de Brabois, 54500 Vandoeuvre les Nancy, France
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Brembilla-Perrot B, Delobelle J, Sellal JM, Zinzius PY, Schwartz J, Pauriah M, Cismaru G, Rizk J, De Chillou C, Beurrier D, Louis P, Selton O, De La Chaise AT. 199: Prevalence and significance of stroke among patients with paroxysmal supraventricular tachycardia. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kaminsky P, Brembilla-Perrot B, Pruna L, Poussel M, Chenuel B. Age, conduction defects and restrictive lung disease independently predict cardiac events and death in myotonic dystrophy. Int J Cardiol 2013; 162:172-8. [DOI: 10.1016/j.ijcard.2011.05.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 02/14/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
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Brembilla-Perrot B, Schwartz J, Sellal JM, Louis S, Pauriah M, Cismaru G, Kaminsky P. 143: Standard deviation of the mean RR intervals measurement, a simple non invasive method to evaluate the prognosis of patients with myotonic dystrophy. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brembilla-Perrot B, Benichou M, Sellal JM, Zinzius PY, Sellal JM, Schwartz J, Moulin-Zinsch A, Cismaru G, Pauriah M, De Chillou C, De La Chaise AT, Selton O, Beurrier D, Louis P, Marçon F. 206: Isoproterenol infusion is more frequently required for the induction of atrioventricular node reentrant tachycardia than for the induction of atrioventricular reentrant tachycardia. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Huttin O, Frikha Z, Brembilla-Perrot B, Sellal JM, Mandry D, Aliot E, Juilliere Y, Sadoul N, Selton-Suty C. Acute myocarditis presenting with ventricular arrhythmias: the role of CMR in the differential diagnosis of ARVD. Intern Med 2013; 52:1915-8. [PMID: 23994982 DOI: 10.2169/internalmedicine.52.0462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present the findings of the case of a 23-year-old man who was hospitalized for ventricular tachycardia (VT) with no previous history of cardiac disease or any family history of sudden death. Based on the clinical features as well as the echographic and MRI results, the patient was diagnosed with both acute viral myocarditis and arythmogenic right ventricular dysplasia (ARVD). The patient underwent implantation of an automatic cardioverter defibrillator. There was no recurrent VT during the 24 month follow-up. This case demonstrates the link between ARVD and myocarditis, and highlights the importance of conducting an RV assessment through a cardiac magnetic resonance (CMR) study in the context of arrhythmia and myocarditis.
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Affiliation(s)
- Olivier Huttin
- Department of Cardiology, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
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Brembilla-Perrot B, Moulin-Zinsch A, Sellal JM, Schwartz J, Zinzius PY, Pauriah M, Cismaru G, Beurrier D, De Chillou C, Louis P, Selton O, Terrier De La Chaise A, Marçon F. 302: Familial atrioventricular node reentrant tachycardias. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brembilla-Perrot B, Benichou M, Sellal JM, Zinzius PY, Schwartz J, Manenti V, Beurrier D, Cismaru G, Pauriah M, Louis P, De Chillou C, Selton O, De La Chaise AT. 209: Incidence of atrial fibrillation in patients with atrial flutter before and after ablation according to the nature of associated heart disease. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brembilla-Perrot B, Benichou M, Sellal JM, Manenti V, Zinzius PY, Beurrier D, Louis P, Sellal JM, Pauriah M, Cismaru G, De Chillou C, Selton O, De La Chaise AT. 195: Women with atrial flutter differ from men. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brembilla-Perrot B, Sellal JM, Schwartz J, Zinzius PY, Pauriah M, Cismaru G, Selton O, Louis P, Terrier De La Chaise A, Blangy H, Sadoul N, Juillère Y. 092: Prognosis value of QRS duration in patients with heart disease and syncope. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poussel M, Djaballah K, Laroppe J, Brembilla-Perrot B, Marie PY, Chenuel B. Left ventricle fibrosis associated with nonsustained ventricular tachycardia in an elite athlete: is exercise responsible? A case report. J Athl Train 2012; 47:224-7. [PMID: 22488290 PMCID: PMC3418136 DOI: 10.4085/1062-6050-47.2.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To emphasize the potentially harmful effects of high-intensity exercise on cardiac health and the fine line between physiologic and pathologic adaptation to chronic exercise in the elite athlete. This case also highlights the crucial need for regular evaluation of symptoms that suggest cardiac abnormality in athletes. BACKGROUND Sudden cardiac death (SCD) of young athletes is always a tragedy because they epitomize health. However, chronic, high-intensity exercise sometimes has harmful effects on cardiac health, and pathologic changes, such as myocardial fibrosis, have been observed in endurance athletes. In this case, a highly trained 30-year-old cyclist reported brief palpitations followed by presyncope feeling while exercising. Immediate investigations revealed nonsustained ventricular tachycardia originating from the left ventricle on a stress test associated with myocardial fibrosis of the left ventricle as shown with magnetic resonance imaging. Despite complete cessation of exercise, life-threatening arrhythmia and fibrosis persisted, leading to complete restriction from competition. Differential Diagnosis: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, myocarditis, postmyocarditis, use of drugs and toxic agents, doping, and systemic disease. TREATMENT The arrhythmia could not be treated with catheter ablation procedure or drug suppression. Therefore, the athlete was instructed to withdraw completely from sport participation and to have a medical follow-up twice each year. UNIQUENESS To our knowledge, no other report of left ventricle exercise-induced fibrosis associated with life-threatening arrhythmia in a living young elite athlete exists. Only postmortem evidence supports such myocardial pathologic adaptation to exercise. CONCLUSIONS To prevent SCD in young athletes, careful attention must be paid to exercise-related symptoms that suggest a cardiac abnormality because they more often are linked to life-threatening cardiovascular disease.
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Affiliation(s)
- Mathias Poussel
- Department of Pulmonary Function Testing and Exercise Test, CHU of Nancy, Rue du Morvan, 54500 Vandoeuvre, France.
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Brembilla-Perrot B, Zinzius PY, Sellal JM, Tatar C, Schwartz J, Jarmouni S, Nossier I, Moisei R, Beurrier D, Moulin-Zinsch A, Kazmierczak CO, State S. 237 The management of preexcitation syndrome remains to be improved. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Brembilla-Perrot B, Zinzius PY, Sellal JM, Schwartz J, Jarmouni S, Nossier I, Selton O, Louis P, De La Chaise AT, Blangy H, Sadoul N, Rizk J, Vaugrenard T, Manenti V. 231 Age-related findings of electrophysiological study in patients with heart disease and syncope. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lalevee C, Brembilla-Perrot B. 254 Evolution of symptoms among patients with a preexcitation syndrome. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Manenti V, Brembilla-Perrot B. 226 Atrial flutter-related tachycardiomyopathy. Prevalence and predisposing factors. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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