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ABSTRACT: The Brugada syndrome (BrS) can first present with syncope. Class-I antiarrhythmic drug (AAD) test is used to unmask the diagnostic coved-type ECG pattern in case it is not spontaneously present. The aim of the study was to analyze patients with BrS presenting with syncope as first manifestation and compare patients with syncope and a spontaneous coved-type ECG to patients with syncope in whom a class-I AAD test unmasked the disease.
Fifty-eight of 157 probands (36.9%) had syncope as first manifestation of the disease. Twenty-six patients (44.8%, group A) showed a spontaneous coved-type ECG diagnostic for BrS at first presentation. In 32 patients (55.2%, group B) without spontaneous coved-type ECG pattern at first presentation (36% normal ECGs and 19% type-II ECG pattern), a class-I AAD test unmasked the disease. Twenty-one patients of group A and 29 patients of group B underwent implantable cardioverter defibrillator (ICD) implantation. The mean follow up as 9.7 ± 55.7 month. Four patients in group A (15.4%) and 3 patients (9.3%) in group B had appropriate ICD shock delivery due to ventricular fibrillation or ventricular tachycardia (P = NS).
One of 3 patients with BrS presents first with syncope. More than one-third of these patients have a normal ECG at investigation for syncope and the correct diagnosis would have been missed without a class-I AAD test. Patients presenting with syncope are at similar risk irrespective of the presence of a spontaneous coved-type ECG.
Journal of Cardiovascular Electrophysiology 10/2011; 23(3):290-5. · 3.06 Impact Factor
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ABSTRACT: Guidelines have become very important in assisting with decision making in clinical practice. However, few studies have analyzed the level of evidence (LOE) underlying guidelines critically. This study aims to assess the accuracy of the referenced literature that has led to recommendations with a level of evidence A (LOE-A) rating.
The latest updates of the practice guidelines related to arrhythmia posted on the European Society of Cardiology (ESC) web site were analyzed. The referenced literature for LOE-A recommendation was analyzed to reassess the proposed grading scheme for LOE-A. Furthermore, the clearly defined positive (Class I) and negative (Class III) recommendations with correctly referenced LOE-A were assessed. A median of 5.4% of all recommendations per guideline (interquartile range 4.9% to 9.7%) were categorized as LOE-A, but only 3.7% (IQR 3.4% to 4.9%) were accurately referenced as LOE-A. In total, 27 of 698 recommendations (median 1.2% per guideline [IQR 0.95% to 3.7%]) were correctly referenced as Class I or III LOE-A recommendations implying definite evidence-based positive or negative conclusion.
Our findings raise the question of the accuracy of LOE-A in medical guidelines in general and highlight the importance of a critical use of all recommendations. Moreover, they underline the need for improving the guideline-writing process. Further randomized double-blinded and/or crossover-designed studies should focus on areas with a gap in the evidence, such as existing but not yet convincing (LOE-B) or conflicting (Class II) evidence.
Circulation Arrhythmia and Electrophysiology 03/2011; 4(2):202-10. · 6.46 Impact Factor
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ABSTRACT: Although it has been shown that a transseptal (TS) puncture in the electrophysiology laboratory is associated with a high success and a low complication rate, this procedure remains challenging particularly in difficult septum anatomies (aneurismal septum and thick septum) and during repeat TS catheterization. Radiofrequency (RF) electrocautery current delivery through the TS needle has been shown to facilitate the TS puncture. The aim of this study was to verify prospectively the feasibility, safety, and outcome of RF energy delivery associated with the standard TS technique in patients undergoing a challenging TS puncture.
Over a 14-month period, 162 consecutive patients underwent left atrial (LA) arrhythmia ablation in our centre. Among them, we enrolled 18 patients who failed LA access after two TS puncture attempts. In these patients, an RF delivery through TS (RF-TS) needle approach was used to reach the LA. All 18 patients had a successful RF-TS at the first attempt. A transoesophageal echocardiography (TEE) guidance and fluoroscopy views were used in all patients. No acute complications were reported. There have been no clinical sequelae after 10 +/- 4 months of follow-up following the RF-TS approach. Challenging TS punctures were more frequent in repeat LA catheterization when compared with the first LA catheterization, respectively, in 35% (13 of 37) and 4% (5 of 125) of the patients.
Radiofrequency electrocautery delivery associated with the standard TS approach is a safe and reproducible technique to reach the left atrium, using the TEE guidance. This technique is helpful during repeat TS catheterization and in the presence of anatomical atrial septum abnormalities.
Europace 02/2010; 12(5):662-7. · 1.98 Impact Factor
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Lucio Capulzini,
Andrea Sarkozy,
Oscar Semeraro,
Gaetano Paparella,
Gian Battista Chierchia,
Carlo DE Asmundis, Markus Roos,
Yoshinao Yazaki,
Andreas Muller-Burri,
Antonio Sorgente,
Pedro Brugada
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ABSTRACT: We present the case of a 49-year-old woman with atrioventricular nodal re-entrant tachycardia and a severe pectus excavatum. The patient underwent an electrophysiological study and fast pathway ablation. Fast pathway ablation was not done on purpose but accidentally, likely due to the abnormal position of the heart in the chest cavity in this patient suffering from severe pectus excavatum. Some hours after the ablation, the patient developed inappropriate sinus tachycardia (IST), complaining of dyspnea and fatigue. IST has been described as a complication of fast pathway ablation in 10% of the cases. In our case it was not possible to treat IST with beta-blockers due to an important lowering of the blood pressure. Digitalis, given as second choice, was not successful. Ivabradine-the specific sinus node If current inhibitors-was used to successfully lower the heart rate with immediate relief of symptoms. A 24-hour Holter, 10 days later, showed a complete control of the heart rate without any episode of IST. The patient was completely symptom free and able to undertake her normal daily activities without any discomfort. Our case confirms the potential use of ivabradine for indications other than coronary artery disease.
Pacing and Clinical Electrophysiology 10/2009; 33(3):e32-5. · 1.35 Impact Factor
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ABSTRACT: Nowadays, trans-septal (TS) puncture is a relatively safe and straightforward procedure in experienced hands. However, in the presence of a thick, aneurysmatic or extremely elastic fossa ovalis crossing the septum might be challenging. We here describe the use of a novel guidewire that permits easy and safe 'over the wire' TS access during atrial fibrillation ablation.
Europace 05/2009; 11(5):657-9. · 1.98 Impact Factor
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ABSTRACT: In this case report we describe the important role of real-time three-dimensional transesophageal echocardiography guidance in performing double transseptal puncture for atrial fibrillation ablation in a patient who underwent a previous Tirone David intervention.
Journal of Cardiovascular Medicine 05/2009; 10(7):563-4. · 1.51 Impact Factor
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MARKUS ROOS M.D,
ANDREA SARKOZY M.D,
GIAN BATTISTA CHIERCHIA M.D,
PHILIPPE DE WILDE M.D,
ERIC SCHMEDDING M.D,
PEDRO BRUGADA M.D, MARKUS ROOS,
ANDREA SARKOZY,
GIAN BATTISTA CHIERCHIA,
PHILIPPE DE WILDE,
ERIC SCHMEDDING,
PEDRO BRUGADA
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ABSTRACT: Adult-Onset KWD and Arrhythmia. We present a case of a 43-year-old male patient with adult onset of spinal muscular atrophy (SMA). The patient first came to our attention with atrioventricular (AV) block. A dual-chamber pacemaker (DDD-PM) was implanted. Four years later, the PM data log showed occurrence of frequent episodes of nonsustained ventricular tachycardia (NSVT). The episodes progressed in duration and frequency. An electrophysiological study revealed prolonged His-ventricular (HV) interval duration and induction of sustained ventricular tachycardia. The patient was successfully upgraded to a prophylactic dual-chamber cardioverter defibrillator. Our case is the first description of a patient with adult-onset SMA (Kugelberg–Welander disease [KWD]) and malignant ventricular arrhythmias. (J Cardiovasc Electrophysiol, Vol. 20, pp. 342-344, March 2009)
Journal of Cardiovascular Electrophysiology 02/2009; 20(3):342 - 344. · 3.06 Impact Factor
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Kurt Vanhoutte,
Carlo de Asmundis,
Anna Francesconi,
Jurgen Figysl,
Griet Steurs,
Tim Boussy, Markus Roos,
Andreas Mueller,
Lucio Massimo,
Gaetano Paparella,
Kristien Van Caelenberg,
Gian Battista Chierchia,
Andrea Sarkozy,
Pedro Brugada Y Terradellas,
Martin Zizi
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ABSTRACT: Atrial fibrillation (AF) is a frequent chronic dysrythmia with an incidence that increases with age (>40). Because of its medical and socio-economic impacts it is expected to become an increasing burden on most health care systems. AF is a multi-factorial disease for which the identification of subtypes is warranted. Novel approaches based on the broad concepts of systems biology may overcome the blurred notion of normal and pathological phenotype, which is inherent to high throughput molecular arrays analysis. Here we apply an internal contrast algorithm on AF patient data with an analytical focus on potential entry pathways into the disease. We used a RMA (Robust Multichip Average) normalized Affymetrix micro-array data set from 10 AF patients (geo_accession #GSE2240). Four series of probes were selected based on physiopathogenic links with AF entryways: apoptosis (remodeling), MAP kinase (cell remodeling), OXPHOS (ability to sustain hemodynamic workload) and glycolysis (ischemia). Annotated probe lists were polled with Bioconductor packages in R (version 2.7.1). Genetic profile contrasts were analysed with hierarchical clustering and principal component analysis. The analysis revealed distinct patient groups for all probe sets. A substantial part (54% till 67%) of the variance is explained in the first 2 principal components. Genes in PC1/2 with high discriminatory value were selected and analyzed in detail. We aim for reliable molecular stratification of AF. We show that stratification is possible based on physiologically relevant gene sets. Genes with high contrast value are likely to give pathophysiological insight into permanent AF subtypes.
Bioinformation 02/2009; 3(6):275-8.
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ABSTRACT: To assess the incidence of early pulmonary vein (PV) reconnection, characterize the anatomic features of the reconducting veins, and analyse the time course of their recovery in a series of consecutive patients with paroxysmal atrial fibrillation (AF) undergoing ablation with the Arctic Front Cryoballoon.
We prospectively enrolled 26 patients (20 males; age 55.4 +/- 4.1) for circumferential PV cryoballoon isolation for highly symptomatic paroxysmal AF. Following isolation of all veins, we analysed PV potentials in each vein after 30 and 60 min with a circular mapping catheter. After successful electrical isolation of all 104 PV's, recurrence was observed only in three veins (2.8%) after 30 min. Two further cryoballoon applications in each of these veins lead to their isolation. These veins were still electrically disconnected at 60 min. No PV reconnection was observed in any of the other 101 veins (97.1%) at 30 and 60 min.
Cryoballoon ablation of the PV's ostia is a very effective technique to achieve electrical isolation, with a very low rate of early reconnection.
Europace 01/2009; 11(4):445-9. · 1.98 Impact Factor
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ABSTRACT: Transseptal (TS) puncture during atrial fibrillation (AF) ablation is a relatively safe procedure in experienced hands. However, major and minor complications cannot be completely ruled out. Real-time three-dimensional transeosophageal echocardiography (RT 3D TEE) is a novel imaging technology that permits direct visualization of the fossa ovalis in a 3D perspective, thereby sensibly lowering the likelihood of potential adverse effects during TS. In our study, we describe the technique and assess the feasibility, advantages, and safety of this novel imaging method in guiding TS puncture in a series of consecutive patients undergoing AF ablation.
We performed TS puncture guided by RT 3D TEE under general anaesthesia in 24 consecutive patients (16 male, 55.4 +/- 8.1 years) undergoing ablation for drug refractory AF. The fossa ovalis could clearly be seen and easily be distinguished from surrounding anatomical structures in all 24 patients. All punctures required a single attempt to access left atrium. Mean orientation of the needle hub when puncturing was 4.30 o'clock (ranging from 3 o'clock to 6.30 o'clock), and mean distances from the needle tip to the aortic and to the posterior wall were, respectively, 13.5 +/- 7 and 35 +/- 7.3 mm. Total fluoroscopic time was 120.6 +/- 34 s. No major or minor complications were experienced.
Real-time three-dimensional transeosophageal is a very useful tool in guiding TS puncture in patients undergoing AF ablation with the invaluable advantage of the 3D direct visualization of the fossa ovalis. This permits fast and safe transatrial access with a single puncture attempt.
Europace 11/2008; 10(11):1325-8. · 1.98 Impact Factor
