1
|
Hermida A, Ader F, Millat G, Jedraszak G, Maury P, Cador R, Catalan PA, Clerici G, Combes N, De Groote P, Dupin-Deguine D, Eschalier R, Faivre L, Garcia P, Guillon B, Janin A, Kugener B, Lackmy M, Laredo M, Le Guillou X, Lesaffre F, Lucron H, Milhem A, Nadeau G, Nguyen K, Palmyre A, Perdreau E, Picard F, Rebotier N, Richard P, Rooryck C, Seitz J, Verloes A, Vernier A, Winum P, Yabeta GAD, Bouchot O, Chevalier P, Charron P, Gandjbakhch E. NEXN Gene in Cardiomyopathies and Sudden Cardiac Deaths: Prevalence, Phenotypic Expression, and Prognosis. Circ Genom Precis Med 2024; 17:e004285. [PMID: 38059363 DOI: 10.1161/circgen.123.004285] [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: 06/14/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Few clinical data are available on NEXN mutation carriers, and the gene's involvement in cardiomyopathies or sudden death has not been fully established. Our objectives were to assess the prevalence of putative pathogenic variants in NEXN and to describe the phenotype and prognosis of patients carrying the variants. METHODS DNA samples from consecutive patients with cardiomyopathy or sudden cardiac death/sudden infant death syndrome/idiopathic ventricular fibrillation were sequenced with a custom panel of genes. Index cases carrying at least one putative pathogenic variant in the NEXN gene were selected. RESULTS Of the 9516 index patients sequenced, 31 were carriers of a putative pathogenic variant in NEXN only, including 2 with double variants and 29 with a single variant. Of the 29 unrelated probands with a single variant (16 males; median age at diagnosis, 32.0 [26.0-49.0] years), 21 presented with dilated cardiomyopathy (prevalence, 0.33%), and 3 presented with hypertrophic cardiomyopathy (prevalence, 0.14%). Three patients had idiopathic ventricular fibrillation, and there were 2 cases of sudden infant death syndrome (prevalence, 0.46%). For patients with dilated cardiomyopathy, the median left ventricle ejection fraction was 37.5% (26.25-50.0) at diagnosis and improved with treatment in 13 (61.9%). Over a median follow-up period of 6.0 years, we recorded 3 severe arrhythmic events and 2 severe hemodynamic events. CONCLUSIONS Putative pathogenic NEXN variants were mainly associated with dilated cardiomyopathy; in these individuals, the prognosis appeared to be relatively good. However, severe and early onset phenotypes were also observed-especially in patients with double NEXN variants. We also detected NEXN variants in patients with hypertrophic cardiomyopathy and sudden infant death syndrome/idiopathic ventricular fibrillation, although a causal link could not be established.
Collapse
Affiliation(s)
- Alexis Hermida
- Cardiology, Arrhythmia, and Cardiac Stimulation Service (A.H.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
| | - Flavie Ader
- Unité Pédagogique de Biochimie, Département des Sciences Biologiques et Médicales, UFR de Pharmacie-Faculté de Santé, Université Paris Cité (F.A.)
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | - Gilles Millat
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | - Guillaume Jedraszak
- Molecular Genetics Laboratory (G.J.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
| | | | - Romain Cador
- Service de Cardiologie, Hôpital Saint Joseph, Paris (R.C.)
| | | | - Gaël Clerici
- Service de Cardiologie, Centre hospitalier universitaire, Saint Pierre, La Réunion (G.C.)
| | - Nicolas Combes
- Service de Cardiologie, Clinique Pasteur, Toulouse (N.C.)
| | - Pascal De Groote
- France CHU Lille, Service de Cardiologie & Inserm U1167, Institut Pasteur de Lille (P.D.G.)
| | | | | | | | - Patricia Garcia
- Unité Mort Inattendue du Nourrisson, Hôpital de la Conception, APHM, Marseille (P.G.)
| | | | - Alexandre Janin
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | | | - Marylin Lackmy
- Unité de Génétique Clinique, CHU de Guadeloupe, Pointe à Pitre (M. Lackmy)
| | - Mikael Laredo
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | | | - Hugues Lucron
- Service de Cardiologie pédiatrique, CHU Martinique, Fort-de-France (H.L.)
| | | | - Gwenaël Nadeau
- Service de génétique clinique CH Métropole Savoie, Chambéry (G.N.)
| | | | - Aurélien Palmyre
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Elodie Perdreau
- Département médico chirurgical de cardiologie pédiatrique (E.P.), Hôpital Louis Pradel, HCL, Lyon
| | - François Picard
- Service de Cardiologie, Hôpital Cardiologique Haut Leveque, Bordeaux (F.P.)
| | | | - Pascale Richard
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | - Julien Seitz
- Service de Cardiologie, Hôpital Saint Joseph, Marseille (J.S.)
| | - Alain Verloes
- Departement de génétique, Hôpital Robert Debré, APHP (A. Verloes)
| | | | | | - Grace-A-Dieu Yabeta
- Service de Cardiologie, CH Ouest Guyane, Saint-Laurent-du-Maroni (G.-A.-D.Y.)
| | - Océane Bouchot
- Service de Cardiologie, CH Annecy Genevois, Annecy, France (O.B.)
| | | | - Philippe Charron
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Estelle Gandjbakhch
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| |
Collapse
|
2
|
Théry G, Faroux L, Boyer F, Nazeyrollas P, Chabert JP, Metz D, Lesaffre F. Relationship between Exercise Test Parameters, Device-Delivered Electric Shock and Adverse Clinical Events in Patients with an Implantable Cardioverter Defibrillator for Primary Prevention. J Pers Med 2023; 13:589. [PMID: 37108975 PMCID: PMC10143101 DOI: 10.3390/jpm13040589] [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: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Receiving the first internal electric shock is a turning point for patients with an implantable cardioverter defibrillator (ICD) for primary prevention. However, no study has investigated whether patients who receive a first device-delivered electric shock have a poor prognosis even at the time of ICD implantation. (2) Methods: We retrospectively identified 55 patients with ischemic (n = 31) or dilated (n = 24) cardiomyopathy who underwent ICD implantation for primary prevention with exercise test at the time of implantation. We recorded baseline characteristics, exercise test parameters, and clinical events. (3) Results: After a median follow-up of 5 years, we observed an association between an appropriate device-delivered electric shock, the occurrence of death or heart transplant, and the occurrence of the composite endpoint. There was also a significant relation between a VE/VCO2 slope >35 and the occurrence of the composite endpoint. Conversely, there was no significant association between negative outcomes on the exercise test and the occurrence of a device-delivered electric shock. (4) Conclusions: The exercise test performed at the time of ICD implantation do not predict the occurrence of device-delivered electric shock. The exercise test and the first electric shock are two independent markers of poor prognosis.
Collapse
Affiliation(s)
- Guillaume Théry
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
- Intensive Care Unit, Reims University Hospital, 51100 Reims, France
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | - Fanny Boyer
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | - Pierre Nazeyrollas
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| | - François Lesaffre
- Department of Cardiology, Reims University Hospital, 51100 Reims, France
| |
Collapse
|
3
|
Benali K, Barré V, Hermida A, Galand V, Milhem A, Philibert S, Boveda S, Bars C, Anselme F, Maille B, André C, Behaghel A, Moubarak G, Clémenty N, Da Costa A, Arnaud M, Venier S, Sebag F, Jésel-Morel L, Sagnard A, Champ-Rigot L, Dang D, Guy-Moyat B, Abbey S, Garcia R, Césari O, Badenco N, Lepillier A, Ninni S, Boulé S, Maury P, Algalarrondo V, Bakouboula B, Mansourati J, Lesaffre F, Lagrange P, Bouzeman A, Muresan L, Bacquelin R, Bortone A, Bun SS, Pavin D, Macle L, Martins RP. Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study. Circ Arrhythm Electrophysiol 2023; 16:e011354. [PMID: 36802906 DOI: 10.1161/circep.122.011354] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; P=0.006). CONCLUSIONS In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
Collapse
Affiliation(s)
- Karim Benali
- CHU Saint Etienne, University of Rennes, INSERM, LTSI -UMR 1099, Rennes (K.B.)
| | - Valentin Barré
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | - Vincent Galand
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | | | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse (S.B.)
| | | | | | | | | | | | | | | | | | | | | | - Frédéric Sebag
- Rythmologie, Institut Mutualiste Montsouris, Paris (F.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Babé Bakouboula
- Institut Cardiovasculaire de Strasbourg, Clinique RHENA (B.B.)
| | | | | | | | | | | | | | | | | | - Dominique Pavin
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Canada (L.M.)
| | - Raphaël P Martins
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| |
Collapse
|
4
|
Bouchiat L, Faroux L, Chabert JP, Mauran P, Blanpain T, Metz D, Lesaffre F. Transseptal versus retrograde approach for ablation of left-sided accessory pathways: impact on radiation exposure. J Radiol Prot 2022; 42:031509. [PMID: 35901783 DOI: 10.1088/1361-6498/ac84e5] [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: 05/02/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Management of left-sided accessory pathways (APs) is based on catheter ablation through an antegrade or retrograde approach. Both are safe and effective but are associated with exposure to x-rays; however, recipients of ablation are generally young. We sought to evaluate the impact of the approach chosen on dose-area product (DAP). A total of 95 patients who underwent radiofrequency ablation of a left-sided AP between January 2011 and January 2020 were included. The primary endpoint was the radiation dose received by the patient. Secondary endpoints were procedural success and complication and recurrence rates. The mean age of the study population was 34.3 ± 16.6 years. The antegrade transseptal approach was used in 63.5% of cases. By multivariate analysis, the antegrade transseptal approach was associated with a 53% reduction in DAP (p< 0.001). The radiation dose received was also significantly associated with body mass index and total fluoroscopy time (p< 0.001). There was no significant difference in other secondary endpoints between approaches. The use of an antegrade transseptal approach is associated with a significant reduction in DAP compared with the retrograde approach, and procedural success and complication and recurrence rates are similar.
Collapse
Affiliation(s)
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, Reims, France
- EA3801 HERVI, SFR CAP Santé, Université Reims Champagne Ardenne, Reims, France
| | | | - Pierre Mauran
- Pediatric and Congenital Cardiology Unit, American Memory Hospital, Reims, France
| | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
| | | |
Collapse
|
5
|
Waintraub X, Sauve R, Vedrenne G, Amet D, Gras M, Degand B, Moini C, Duthoit G, Laredo M, Badenco N, Lesaffre F, Lepillier A, Hidden Lucet F, Hermida A, Gandjbakhch E. Endocardial ablation of ventricular tachycardia ablation in arrhythmogenic right ventricular cardiomyopathy aiming epicardial late potential abolition. Europace 2022. [DOI: 10.1093/europace/euac053.382] [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
Catheter ablation is frequently needed to treat ventricular tachycardia (VT) in ARVC patients. Ablation aiming non-inducibility (NI) and late potential (LP) abolition has been shown to be effective1. Simultaneous endo-epicardial mapping demonstrate epicardial involvement in most VT2. However epicardial fat and vicinity of coronary artery may prevent effective epicardial ablation.
Aims
(a) evaluate endocardial-only ablation guided by epicardial late-potential recording (EA-ELP) to achieve LP abolition (LPA) and NI; (b) measure ablation-index(AI) values allowing epicardial LP suppression by endocardial ablation, as a surrogate for transmurality.
Methods
From 2019 to 2021 the authors (XW, EG) evaluated EA-ELP in ARVC patients patient referred for ablation. Our ablation protocol was previously described3. Endo and epicardial voltage mapping of the right ventricle (RV) were performed in sinus rhythm using 0.5-1.5 mV threshlods for endocardial scar and 0.5-1 mV for the epicardial. All LP were manually tagged. Programmed ventricular stimulation (PVS) was performed till S4 from the RV apex and other sites, all inducible tolerated VT were mapped. Endocardial ablation was performed with an irrigated tip catheter positioned in front of epi-LP recorded by a multi-electrode catheter aiming to eliminate or delay epi-LP as a surrogate for transmurality. For each lesion fulfilling the «transmurality criteria», the AI values were recorded. Remap was performed to validate LPA and NI was tested. Patient follow-up (FU) rely on telemonitoring in ICD-carriers and holter/exercise test for the others.
Results
11 patients were enrolled (9M/2F, mean age 45 years), 9 for VT recurrence (3 redo) and 2 for de novo VT. The median ICD therapy before ablation was 5/patient (mean 1.7). The clinical VT originated from the RV outflow tract (RVOT) in 5 patients, peritricuspid (PT) in 2, RV free wall (RFW) in 4. Substrate were more extended in the epicardium compared to the endocardium: epi-LP and scar surfaces were 42.5 cm2/118 cm2 versus 24.5 cm2/25.5 cm2 for the endocardium. In one patient, additional epicardial lesion was necessary to achieve LPA. The mean ablation duration was 3377 s. Remap showed LPA in all patients and PVS was negative in all (not tested in one due to hemodynamic instability). One patient presented retrosternal hematoma after ablation with spontaneous favorable outcome. Endocardial AI values allowing epi-LP abolition were 595 for the inferior wall, 625 in the RVOT, 604 for PT and 639 for RFW. During a mean FU of 12 months (median 16.5 mths), only one patient had VT recurrence.
Conclusion
Based on this case-series, EA-ELP appeared as a safe and effective method to treat VT in ARVC. EA-ELP ablation allowed VT suppression in 91 % of patients after an mean FU of 12 mths. The RV endocardial AI needed to suppress epi-LP ranged was between 595-639 and could be used as surrogate for transmurality in ARVC.
Collapse
Affiliation(s)
- X Waintraub
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - R Sauve
- Biosense Webster, Paris, France
| | - G Vedrenne
- Saint Joseph Hospital, Arrhythmia Unit, Paris, France
| | - D Amet
- European Hospital Georges Pompidou, Paris, France
| | - M Gras
- La Miletrie University Hospital Centre, Poitiers, France
| | - B Degand
- La Miletrie University Hospital Centre, Poitiers, France
| | - C Moini
- JACQUES CARTIER PRIVATE HOSPITAL, Massy, France
| | - G Duthoit
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - M Laredo
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - N Badenco
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - F Lesaffre
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - F Hidden Lucet
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - A Hermida
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| | - E Gandjbakhch
- AP-HP - Hospital Pitie-Salpetriere - Institute of Cardiology, Rhythmology Department, Paris, France
| |
Collapse
|
6
|
Martin V, Witz JF, Gillon F, Najjar D, Quaegebeur P, Benabou A, Hecquet M, Berté E, Lesaffre F, Meersdam M, Auzene D. Low cost 3D printing of metals using filled polymer pellets. HardwareX 2022; 11:e00292. [PMID: 35509947 PMCID: PMC9058854 DOI: 10.1016/j.ohx.2022.e00292] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Nowadays, additive manufacturing of metallic materials is most often carried out using expensive and complex tools that leave the user with limited control and no possibility of modification. In order to make the printing of metal parts more accessible to small structures but also better suited for academic research, the use of a mixture of thermoplastic polymer and metal powder is a good solution as many granular feedstocks already exist for Metal Injection Molding applications. To perform the shaping process, the Fused Granular Fabrication 3D printing technology is set up by diverting the use of a feedstock in the form of pellets that are directly inserted into the print head. This solution, which is less costly, is implemented here by modifying a mid-range printer, the Tool Changer from E3D, and by making the hardware and software adaptations to mount a compact granulates extruder on it, which is also available on the market. The polymer portion present in the green part can then be removed in order to perform the heat treatments that will densify the powder by sintering and give a fully metallic dense object.
Collapse
Affiliation(s)
- Vincent Martin
- Univ. Lille, Arts et Metiers Institute of Technology, Centrale Lille, Junia, ULR 2697 – L2EP Lille, France
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | - Jean-François Witz
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | - Frédéric Gillon
- Univ. Lille, Arts et Metiers Institute of Technology, Centrale Lille, Junia, ULR 2697 – L2EP Lille, France
| | - Denis Najjar
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | - Philippe Quaegebeur
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | - Abdelkader Benabou
- Univ. Lille, Arts et Metiers Institute of Technology, Centrale Lille, Junia, ULR 2697 – L2EP Lille, France
| | - Michel Hecquet
- Univ. Lille, Arts et Metiers Institute of Technology, Centrale Lille, Junia, ULR 2697 – L2EP Lille, France
| | - Emmanuel Berté
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | - François Lesaffre
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | - Matthieu Meersdam
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 – LaMcube – Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, France
| | | |
Collapse
|
7
|
Diallo MN, Mayeur O, Lecomte-Grosbras P, Patrouix L, Witz JF, Lesaffre F, Rubod C, Cosson M, Brieu M. Simulation of the mobility of the pelvic system: influence of fascia between organs. Comput Methods Biomech Biomed Engin 2021; 25:1073-1087. [PMID: 34783611 DOI: 10.1080/10255842.2021.2001460] [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] [Indexed: 10/19/2022]
Abstract
The mobility of pelvic organs is the result of an equilibrium called Pelvic Static characterizing the balance between the properties and geometries of organs, suspensions and support system. Any imbalance in this complex system can cause of pelvic static disorder. Genital prolapse is a common hypermobility pathology which is complex, multi factorial and its surgical management has high rate of complications. The use of 3 D numerical models and simulation enables the role of the various suspension structures to be objectively studied and quantified. Fascias are connective tissues located between organs. Although their role are described as important in various descriptions of pelvic statics, their influence and role has never been quantitatively objectified. This article presents a refine Finite Element (FE) model for a better understanding of biomechanical contribution of inter-organ fascia. The model is built from MRI images of a young volunteer, the mechanical properties derived from literature data to take into account the age of the patient and new experimental results have enabled an order of magnitude of the mechanical properties of the fascias to be defined. The FE results allows to quantify the biomechanical role of the fascia on pelvic mobility quantified by an analysis of dynamic MRI images and a local mapping of the gap between calculated and measured displacements. This improved numerical model integrating the fascias makes it possible to describe pelvic mobilities with a gap of 1 mm between numerical simulations and measurements, whereas without taking them into account this gap locally reaches 20 mm.
Collapse
Affiliation(s)
- Mouhamadou Nassirou Diallo
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Olivier Mayeur
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Pauline Lecomte-Grosbras
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Laurent Patrouix
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Jean François Witz
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - François Lesaffre
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Chrystle Rubod
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Michel Cosson
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Mathias Brieu
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Department of Mechanical Engineering, College Engineering, Computer Science and Technology, California State University, Los Angeles, Long Angeles, CA, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Oudin V, Marcus C, Faroux L, Espinosa M, Metz D, Lesaffre F. Impact of epicardial fat on the duration of radiofrequency energydelivery during catheter ablation of atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF).
Methods
The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI.
Results
From March 2015 to May 2018, 222 patients (45,5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0,0002; p = 0,009 respectively), periatrial (p = 0,003; p = 0,045) and periventricular epicardial fat (p = 0,001; p = 0,012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0,743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35,2 vs 74,5 ± 31,2 ml ; p = 0,192).
Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat maybe a marker, but not an independent factor,of ablation complexity.
Collapse
Affiliation(s)
- V Oudin
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - C Marcus
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - L Faroux
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - M Espinosa
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - D Metz
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| | - F Lesaffre
- HOSPITAL ROBERT DEBRE - UNIVERSITY HOSPITAL CENTRE OF REIMS, Reims, France
| |
Collapse
|
10
|
Oudin V, Marcus C, Faroux L, Espinosa M, Metz D, Lesaffre F. Impact of epicardial fat on the duration of radiofrequency energy delivery during catheter ablation of atrial fibrillation. IJC Heart & Vasculature 2020; 29:100555. [PMID: 32551360 PMCID: PMC7292915 DOI: 10.1016/j.ijcha.2020.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 12/03/2022]
Abstract
Aims This study aimed to determine the impact of the volume of epicardial fat on the duration of radiofrequency (RF) energy delivery during the procedure of ablation of atrial fibrillation (AF). Methods The volume of epicardial fat was measured from spiral computerized tomography scan. The primary endpoint was the duration of RF delivery for pulmonary vein isolation (PVI), and the overall total duration of RF application. Secondary endpoint was conversion of AF to sinus rhythm or organisation of the arrhythmia after PVI. Results From March 2015 to May 2018, 222 patients (45.5% with persistent AF) underwent a first RF catheter ablation procedure for AF. The total duration of RF delivery, and the duration of RF delivery specifically for PVI were significantly associated with higher total volume of epicardial fat (p = 0.0002; p = 0.009 respectively), periatrial (p = 0.003; p = 0.045) and periventricular epicardial fat (p = 0.001; p = 0.012). In multivariate analysis, total epicardial fat volume was not significantly associated with total RF delivery duration (p = 0.743). For patients with arrhythmia at the time of the procedure, patients who achieved conversion or organisation of their arrhythmia after PVI had similar levels of total epicardial fat to those whose arrhythmia persisted (65 ± 35.2 vs 74.5 ± 31.2 ml; p = 0.192). Conclusion We observed a significant relation between total, periatrial, and periventricular epicardial fat, and the duration of RF delivery during ablation of AF. This relation was not significant by multivariate analysis meaning that epicardial fat may be a marker, but not an independent factor, of ablation complexity.
Collapse
|
11
|
Rosier L, Zouaghi A, Barré V, Martins R, Probst V, Marijon E, Sadoul N, Chauveau S, Da Costa A, Badoz M, Peyrol M, Barraud J, Massoullie G, Eschalier R, Espinosa M, Lesaffre F, Garcia R, Degand B, Noël A, Mansourati J, Extramiana F, Algalarrondo V, Devilliers H, Cottin Y, Gandjbakhch E, Guenancia C. High Risk of Sustained Ventricular Arrhythmia Recurrence After Acute Myocarditis. J Clin Med 2020; 9:jcm9030848. [PMID: 32244983 PMCID: PMC7141537 DOI: 10.3390/jcm9030848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/21/2020] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
Acute myocarditis is associated with cardiac arrhythmia in 25% of cases; a third of these arrhythmias are ventricular tachycardia (VT) or ventricular fibrillation (VF). The implantation of a cardiac defibrillator (ICD) following sustained ventricular arrhythmia remains controversial in these patients. We sought to assess the risk of major arrhythmic ventricular events (MAEs) over time in patients implanted with an ICD following sustained VT/VF in the acute phase of myocarditis compared to those implanted for VT/VF occurring on myocarditis sequelae. Our retrospective observational study included patients implanted with an ICD following VT/VF during acute myocarditis or VT/VF on myocarditis sequelae, from 2007 to 2017, in 15 French university hospitals. Over a median follow-up period of 3 years, MAE occurred in 11 (39%) patients of the acute myocarditis group and 24 (60%) patients of the myocarditis sequelae group. Kaplan–Meier MAE rate estimates at one and three years of follow-up were 19% and 45% in the acute group, and 43% and 64% in the sequelae group. Patients who experienced sustained ventricular arrhythmias during acute myocarditis had a very high risk of VT/VF recurrence during follow-up. These results show that the risk of MAE recurrence remains high after resolution of the acute episode.
Collapse
Affiliation(s)
- Laurent Rosier
- Cardiology Department, Dijon Bourgogne University Hospital, 21000 Dijon, France; (L.R.); (Y.C.)
| | - Amir Zouaghi
- Cardiology Department, Hôpitaux Universitaires Pitié Salpêtrière, APHP, 75013 Paris, France; (A.Z.); (E.G.)
| | - Valentin Barré
- Cardiology Department, University Hospital, 35000 Rennes, France; (V.B.); (R.M.)
| | - Raphaël Martins
- Cardiology Department, University Hospital, 35000 Rennes, France; (V.B.); (R.M.)
| | - Vincent Probst
- Institut du thorax, Service de Cardiologie and INSERM 1087, 44000 Nantes, France;
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital and Paris Descartes University, 75015 Paris, France;
| | - Nicolas Sadoul
- Cardiology Department, University Hospital, 54511 Nancy, France
| | - Samuel Chauveau
- Cardiology Department, University Hospital Louis Pradel, 69500 Lyon, France;
| | - Antoine Da Costa
- Cardiology Department, University Hospital, 42055 Saint-Etienne, France;
| | - Marc Badoz
- Cardiology Department, University Hospital, 25030 Besançon, France;
| | - Michael Peyrol
- Aix-Marseille University, Assistance Publique–Hôpitaux de Marseille (APHM), Department of Cardiology, Nord Hospital, 13000 Marseille, France; (M.P.); (J.B.)
| | - Jérémie Barraud
- Aix-Marseille University, Assistance Publique–Hôpitaux de Marseille (APHM), Department of Cardiology, Nord Hospital, 13000 Marseille, France; (M.P.); (J.B.)
| | - Grégoire Massoullie
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.M.); (R.E.)
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France; (G.M.); (R.E.)
| | - Madeline Espinosa
- Cardiology Department, University Hospital, 51100 Reims, France; (M.E.); (F.L.)
| | - François Lesaffre
- Cardiology Department, University Hospital, 51100 Reims, France; (M.E.); (F.L.)
| | - Rodrigue Garcia
- CHU Poitiers, Centre Cardiovasculaire, 86000 Poitiers, France; (R.G.) ; (B.D.)
| | - Bruno Degand
- CHU Poitiers, Centre Cardiovasculaire, 86000 Poitiers, France; (R.G.) ; (B.D.)
| | - Antoine Noël
- Cardiology Department, University Hospital, 29200 Brest, France; (A.N.); (J.M.)
| | - Jacques Mansourati
- Cardiology Department, University Hospital, 29200 Brest, France; (A.N.); (J.M.)
| | - Fabrice Extramiana
- Department of Cardiology, Bichat Claude Bernard Hospital, University Paris Diderot, 75018 Paris, France; (F.E.); (V.A.)
| | - Vincent Algalarrondo
- Department of Cardiology, Bichat Claude Bernard Hospital, University Paris Diderot, 75018 Paris, France; (F.E.); (V.A.)
| | - Hervé Devilliers
- Internal Medicine 2 Department, Dijon Bourgogne University Hospital, 21000 Dijon, France;
| | - Yves Cottin
- Cardiology Department, Dijon Bourgogne University Hospital, 21000 Dijon, France; (L.R.); (Y.C.)
- PEC 2, Univ. Bourgogne Franche–Comté, 21000 Dijon, France
| | - Estelle Gandjbakhch
- Cardiology Department, Hôpitaux Universitaires Pitié Salpêtrière, APHP, 75013 Paris, France; (A.Z.); (E.G.)
| | - Charles Guenancia
- Cardiology Department, Dijon Bourgogne University Hospital, 21000 Dijon, France; (L.R.); (Y.C.)
- PEC 2, Univ. Bourgogne Franche–Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380293536; Fax: +33-380293879
| |
Collapse
|
12
|
Oudin V, Metz D, Marcus C, Faroux L, Lesaffre F. Impact of epicardial fat on the duration of endocavitary radiofrequency during atrial fibrillation ablation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.252] [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]
|
13
|
Faroux L, Lesaffre F, Blanpain T, Mora C, Nazeyrollas P, Metz D. Impact of Obesity on Overall Radiation Exposure for Patients Who Underwent Radiofrequency Ablation of Atrial Fibrillation. Am J Cardiol 2019; 124:1213-1217. [PMID: 31395297 DOI: 10.1016/j.amjcard.2019.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
Patients who underwent radiofrequency ablation of atrial fibrillation are exposed to X-rays not only during the procedure but also during the preprocedural computed tomography. No study has investigated the cumulative effective dose received by patients who underwent atrial fibrillation ablation and identified factors influencing this dose. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent radiofrequency ablation of atrial fibrillation. The secondary objective was to estimate the impact of obesity on this exposure. All patients who underwent a first attempt of radiofrequency ablation of atrial fibrillation in our center over a 21 months period were included. Dosimetric indicators from preprocedural computed tomography and the ablation procedure were collected and converted into an effective dose. A total of 144 radiofrequency ablation of atrial fibrillation were included. The mean cumulative effective dose was 11.4 mSv, and 82% of the dose was from the computed tomography. Obese patients received a dose that was 75% higher than normal-weight patients, and this increase remained significant by multivariate analysis. In conclusion, overall exposure to ionizing radiation for patients who underwent radiofrequency ablation of atrial fibrillation seems acceptable, and the majority of the overall effective dose comes from the computed tomography. Obese patients are exposed to a 75% higher dose than normal-weight patients.
Collapse
|
14
|
Faroux L, Daval C, Lesaffre F, Blanpain T, Chabert JP, Martin A, Guinot M, Luconi N, Espinosa M, Nazeyrollas P, Tourneux C, Metz D. Physicians' exposure to radiation during electrophysiology procedures. J Interv Card Electrophysiol 2019; 55:233-237. [PMID: 31177353 DOI: 10.1007/s10840-019-00568-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/18/2018] [Accepted: 05/19/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no study comparing the level of exposure of physicians during different electrophysiology procedures. We aimed to measure and compare cardiologists' exposure to radiation during different electrophysiology procedures. METHODS The study population comprised all electrophysiology procedures performed over a 6-month period in a large referral centre. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on the operator's left arm. RESULTS In total, 150 electrophysiology procedures were analyzed. Compared with electrophysiology studies (reference category), physician radiation exposure was 3-fold greater during ablation of atrial fibrillation, 9-fold greater during ablation of atrioventricular nodal reentrant tachycardia (AVNRT)/atrioventricular reentrant tachycardia (AVNT), and 10-fold greater during ablation of atrial flutter (p < 0.001). Physician exposure was mainly related to X-ray time (R2 = 0.28). CONCLUSIONS Our study showed significant differences in cardiologists' exposure to ionizing radiation depending on the type of electrophysiology procedure. Atrial flutter and AVNRT/AVNT ablations are the procedures in which operators are most exposed to ionizing radiation.
Collapse
Affiliation(s)
- Laurent Faroux
- Department of Cardiology, Reims University Hospital, Reims, France. .,Service Cardiologie, Hopital Robert Debré, CHU de Reims, Avenue du général Koenig, 51092, Reims, France.
| | - Charline Daval
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | - Thierry Blanpain
- Department of Cardiology, Reims University Hospital, Reims, France.,Department of Radiation Protection, Reims University Hospital, Reims, France
| | | | - Angeline Martin
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Mathias Guinot
- Department of Cardiology, Reims University Hospital, Reims, France
| | - Nicolas Luconi
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | | | - Christophe Tourneux
- Department of Radiation Protection, Reims University Hospital, Reims, France
| | - Damien Metz
- Department of Cardiology, Reims University Hospital, Reims, France
| |
Collapse
|
15
|
Daval C, Faroux L, Lesaffre F, Blanpain T, Chabert JP, Martin A, Guinot M, Luconi N, Espinosa M, Nazeyrollas P, Tourneux C, Metz D. Impact of cardiac resynchronisation therapy on cardiologists' exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators. J Radiol Prot 2019; 39:489-497. [PMID: 30913548 DOI: 10.1088/1361-6498/ab1377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to 'classical' implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator's chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with 'classical' implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R2 = 0.21 during 'classical' implantations and R2 = 0.57 during CRT procedures). Our study shows that cardiologists' exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.
Collapse
Affiliation(s)
- Charline Daval
- Department of Cardiology, Reims University Hospital, Reims, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Hocine A, Belmokhtar K, Bauley K, Jaisson S, Gaha K, Oubaya N, Lesaffre F, Lavaud S, Halin P, Gillery P, Rieu P, Touré F. Serum and Tissue Accumulation of Advanced Glycation End-Products Correlates with Vascular Changes. Perit Dial Int 2016; 35:592-4. [PMID: 26450482 DOI: 10.3747/pdi.2013.00338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | | | | | - Nadia Oubaya
- Clinical Investigation Center, CHU Reims, France
| | | | | | - Pascale Halin
- Division of Nephrology, Manchester Hospital, Charleville Méziéres, France
| | | | - Philippe Rieu
- Division of Nephrology, CHU Reims, France Laboratory of Nephrology, UMR CNRS URCA 7369, CHU Reims, France
| | - Fatouma Touré
- Division of Nephrology, CHU Reims, France Laboratory of Nephrology, UMR CNRS URCA 7369, CHU Reims, France
| |
Collapse
|
17
|
N’Guyen Y, Lesaffre F, Metz D, de Martino S, Jaulhac B, Andréoletti L. No serological evidence for Borrelia burgdorferi sensu lato infection in patients with dilated cardiomyopathy in Northern France. Infect Dis (Lond) 2016; 48:763-4. [DOI: 10.1080/23744235.2016.1193790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Yohan N’Guyen
- Laboratoire de Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, Reims, France
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - François Lesaffre
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Damien Metz
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Sylvie de Martino
- Laboratoire de Bactériologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Benoit Jaulhac
- Laboratoire de Bactériologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Laurent Andréoletti
- Laboratoire de Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, Reims, France
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
18
|
N'Guyen Y, Lesaffre F, Metz D, Tassan S, Saade Y, Boulagnon C, Fornes P, Renois F, Andreoletti L. Enterovirus but not Parvovirus B19 is associated with idiopathic dilated cardiomyopathy and endomyocardial CD3, CD68, or HLA-DR expression. J Med Virol 2016; 89:55-63. [PMID: 27301802 DOI: 10.1002/jmv.24600] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 01/23/2023]
Abstract
We assessed Enterovirus (EV) &Parvovirus B19 (PVB19) genomes and CD3, CD68&HLA-DR detection in dilated cardiomyopathies (DCM). EV&PVB19 genomes and CD3, CD68&HLA-DR were detected by PCR and immunohistochemistry assays in 115 endomyocardial biopsies obtained in 13 idiopathic DCM (iDCM) and 10 explained DCM (eDCM) patients. Results were compared with those of 47 atrial surgical samples (47 surgery controls) and 22 autoptic cardiac samples (11 healthy heart controls) (2008-2014, Reims, France). EV was detected in 23.1% of iDCM patients but not in eDCM and controls (P = 0.003) (viral load 803 copies/μg). PVB19 was detected in 76.9%, 80.0%, 63.6% and 78.2% of iDCM, eDCM, healthy heart and surgery controls (P = 0.99) with a mean viral load of 413, 346, 1,428, and 71 copies/μg. CD3, CD68 or HLA-DR were detected in 100 and 50% of EV and PVB19 "mono-infected" iDCM patients. EV was exclusively detected in iDCM cases in association with CD3, CD68, or HLA-DR indicating that EV could be an etiological cause in a subset of iDCM cases. By contrast the equal frequent detection of PVB19 in iDCM cases and controls without association with CD3, CD68, or HLA-DR suggested that PVB19 could be a bystander in many DCM cases. J. Med. Virol. 89:55-63, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yohan N'Guyen
- Laboratoirede Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, France. .,EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France.
| | - François Lesaffre
- EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France.,Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Damien Metz
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Sophie Tassan
- Service de Cardiologie, Centre hospitalier universitaire de Reims, France
| | - Yves Saade
- Service de Chirurgie Thoracique, Centre hospitalier universitaire de Reims, France
| | - Camille Boulagnon
- Laboratoire d'Anatomie Pathologique, Faculté de médecine, Université de Reims Champagne Ardennes, Reims, France.,Laboratoire d'Anatomie Pathologique, Centre hospitalier universitaire de Reims, France
| | - Paul Fornes
- Laboratoire d'Anatomie Pathologique, Faculté de médecine, Université de Reims Champagne Ardennes, Reims, France.,Laboratoire d'Anatomie Pathologique, Centre hospitalier universitaire de Reims, France
| | - Fanny Renois
- Laboratoirede Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, France.,EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - Laurent Andreoletti
- Laboratoirede Virologie médicale et moléculaire, Centre hospitalier universitaire de Reims, France.,EA-4684 Cardiovir, Faculté de médecine, Université de Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
19
|
Guinot M, Lesaffre F, Nazeyrollas P, Bauley K, Chabert JP, Simone L, Bui HT, Foulon A, Girodet B, Voyez J, Metz D. 0362: Atrial fibrillation after radiofrequency ablation of atrial flutter: prevalence and risk factors. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30204-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: 10/22/2022]
|
20
|
Guinot M, Lesaffre F, Nazeyrollas P, Bauley K, Chabert JP, Bui HT, Simone L, Foulon A, Girodet B, Voyez J, Metz D. 0163: Management of long-term anticoagulant therapy after atrial flutter radiofrequency ablation according to associated atrial fibrillation and CHA2DS2-VASc score. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Monnier A, Lesaffre F, Chabert JP, Nazeyrollas P, Metz D. 0470: Implantable cardioverter defibrillator in primary prevention for chronic heart failure: incidence and predictors of appropriate therapy. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Morch A, Pouseele B, Doucède G, Witz JF, Lesaffre F, Brieu M, Cosson M, Rubod C. Influence of healing time on the mechanical properties of an implanted mesh. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2004-5. [DOI: 10.1080/10255842.2015.1069598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A. Morch
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
- Ecole Centrale de Lille, Villeneuve d’Ascq, France
| | | | - G. Doucède
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Jeanne de Flandres, CHRU, Lille, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| | - J.-F. Witz
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| | - F. Lesaffre
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
- Ecole Centrale de Lille, Villeneuve d’Ascq, France
| | - M. Brieu
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
- Ecole Centrale de Lille, Villeneuve d’Ascq, France
| | - M. Cosson
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Jeanne de Flandres, CHRU, Lille, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| | - C. Rubod
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Jeanne de Flandres, CHRU, Lille, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| |
Collapse
|
23
|
Monnier A, Lesaffre F, Nazeyrollas P, Marchais A. 0334 : Implantable cardioverter defibrillator in primary prevention for chronic heart failure: incidence and predictors of appropriate therapy. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
24
|
Charbonneau A, Akhavi A, Chabert J, Lesaffre F, Metz D, Morville P, Mauran P. Grown-up congenital heart disease: Continuum of care between pediatric and adults cardiologists in Reims University Hospital. Arch Cardiovasc Dis 2014. [DOI: 10.1016/j.acvd.2014.07.032] [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: 11/29/2022]
|
25
|
Lesaffre F, Wynckel A, Nazeyrollas P, Rieu P, Metz D. Echocardiography to predict adverse cardiac and vascular events in patients with severe chronic kidney disease (stage 4): a prospective study. Arch Cardiovasc Dis 2013; 106:220-7. [PMID: 23706368 DOI: 10.1016/j.acvd.2013.01.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/26/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiovascular disease is the primary cause of mortality and morbidity among patients with chronic kidney disease. AIMS To investigate whether echocardiography can predict the occurrence of major cardiovascular events in patients with severe chronic kidney disease. PATIENTS Patients with stable stage 4 chronic kidney disease (estimated glomerular filtration rate 15-29 mL/min/1.73 m(2)) and followed in the nephrology department were included. Clinical, biological, electrocardiographic and echocardiographic data were recorded. Endpoint was defined as fatal or non-fatal cardiovascular event (acute coronary syndrome, acute heart failure, stroke, sustained ventricular arrhythmias, arterial thrombotic events and death). RESULTS We included 71 patients (46 men); mean age 72±14 years. Mean glomerular filtration rate was 21.9±4.8 mL/min/1.73 m(2). Over a mean follow-up of 258±30 days, 18 (25%) patients reached endpoint (death in 7/18). Male sex, blood urea, atrial fibrillation, Sokolow index, left atrial size, pulmonary arterial pressure, indexed left ventricular mass and protodiastolic peak velocity of transmitral Doppler flow were significantly higher whereas left ventricular ejection fraction was significantly lower in these patients. By multivariable analysis, blood urea and left ventricular ejection fraction remained predictive of major cardiovascular event with odds ratios of 1.10 (95% confidence interval 1.02-1.18) and 0.93 (95% confidence interval 0.89-0.97), respectively. The negative predictive value was 95% when left ventricular ejection fraction was>50% with blood urea<15 mmol/L. CONCLUSION Patients with stage 4 chronic kidney disease are at high risk of major cardiovascular events and death. Echocardiographic evaluation is effective in identifying patients at highest risk of adverse cardiac events.
Collapse
Affiliation(s)
- François Lesaffre
- Department of Cardiology and Vascular Diseases, University Hospital, Hôpital Robert-Debré, Reims, France.
| | | | | | | | | |
Collapse
|
26
|
Rio C, Lesaffre F, Nazeyrollas P, Novella JL, Ledon S, Metz D. 196: Impact of frailty and dependence on anticoagulant treatment prescription in older persons with atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71126-1] [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]
|
27
|
Rio C, Lesaffre F, Nazeyrollas P, Novella JL, Tassan-Mangina S, Ledon S, Metz D. 197: Oral anticoagulation therapy in older patients with atrial fibrillation: an evaluation of daily practice with regard to guidelines and scores in a cohort of 142 patients. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71127-3] [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]
|
28
|
Hercé B, Nazeyrollas P, Lesaffre F, Sandras R, Chabert JP, Martin A, Tassan-Mangina S, Bui HT, Metz D. Risk factors for infection of implantable cardiac devices: data from a registry of 2496 patients. Europace 2012; 15:66-70. [PMID: 23097224 DOI: 10.1093/europace/eus284] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS The increased use of implantable cardiac devices has been accompanied by an increase in infection. However, risk factors for infection of implanted devices are poorly documented. We aimed to identify risk factors in patients with long-term follow-up after implantation of cardiac devices. METHODS AND RESULTS Patients with first implantation of a cardiac device in our centre between October 1996 and July 2007 were entered in a registry. Each confirmed infection of the implanted device was matched to two controls for age, sex, and implantation year. We recorded cardiovascular risk factors (hypertension, diabetes), previous history of heart disease, renal failure, antiplatelet or anticoagulant therapy, as well as pre- and post-procedural characteristics (antibiotic prophylaxis, hyperthermia, number of leads, associated interventions, and early complications). During the study period, 2496 patients underwent implantation of a cardiac device; 35 infections were diagnosed (1.2%). Among these, 75% occurred during the first year after implantation. Early non-infectious complication requiring surgical intervention was observed only in patients with infection (9 of 35, P < 0.001). Factors independently associated with infection were diabetes [odds ratio (OR) 3.5, 95% confidence interval (CI) [1.03, 12.97]], underlying heart disease (OR 3.12, 95% CI [1.13; 8.69]), and use of >1 lead (OR 4.07, 95% CI [1.23, 13.47]). These latter two risk factors were also independently associated with occurrence of infection within 1 year of implantation. CONCLUSION Our data show that the presence of diabetes and underlying heart disease are independent risk factors for infection after cardiac device implantation. As regards procedural characteristics, the use of several leads and early re-intervention are associated with a higher infection rate.
Collapse
Affiliation(s)
- Benoit Hercé
- Cardiology Department, University Hospital Reims, Reims, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Leveque N, Boulagnon C, Brasselet C, Lesaffre F, Boutolleau D, Metz D, Fornes P, Andreoletti L. A fatal case of Human Herpesvirus 6 chronic myocarditis in an immunocompetent adult. J Clin Virol 2011; 52:142-5. [DOI: 10.1016/j.jcv.2011.06.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/27/2011] [Accepted: 06/29/2011] [Indexed: 01/15/2023]
|
30
|
Jaussaud R, Servettaz A, Lesaffre F, Garnotel R, Nazeyrollas P. Cardiopathie hypokinétique dilatée curable chez l’adulte : penser à la carnitine ! Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.264] [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]
|