Michel Haïssaguerre

Publications (254)1588.37 Total impact

• Article: Electrical Storm in Idiopathic Ventricular Fibrillation is Associated with Early Repolarization.

  Yoshifusa Aizawa, Masaomi Chinushi, Kanae Hasegawa, Nobu Naiki, Minoru Horie, Yoshiaki Kaneko, Masahiko Kurabayashi, Shogo Ito, Tsutomu Imaizumi, Yoshiyasu Aizawa, Seiji Takatsuki, Kunitake Joo, Masahito Sato, Katsuya Ebe, Yukio Hosaka, Michel Haissaguerre, Keiichi Fukuda
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  ABSTRACT: OBJECTIVE: To characterize patients with idiopathic ventricular fibrillation (IVF) who develop electrical storms (ESs). BACKGROUND: Some IVF patients develop VF storms, but the characteristics of these patients are poorly known. METHODS: A total of 91 IVF patients (86% male) were selected after the exclusion of structural heart diseases, primary electrical diseases and coronary spasm. ECG features were compared between the patients with and without ESs. A VF storm was defined as VF occurring ≥3 times in 24 h and J waves >0.1 mV above the isoelectric line in contiguous leads. RESULTS: Fourteen (15.4%) patients had VF occurring out-of-hospital at night or in the early morning. J waves were more closely associated with VF storms compared to patients without VF storms: 92.9% vs. 27.1% (P<0.0001). VF storms were controlled by intravenous isoproterenol, which attenuated the J wave amplitude. After the subsidence of VF storms, the J waves decreased to the non-diagnostic level during the entire follow-up period. ICD therapy was administered to all patients during follow-up. Quinidine therapy was limited, but the patients on disopyramide (3), bepridil (1) or isoprenaline (1) were free from VF recurrence, while VF recurred in 5 of the 9 patients who were not given antiarrhythmic drugs. CONCLUSIONS: The VF storms in the IVF patients were highly associated with J waves that showed augmentation prior to the VF onset. Isoproterenol was effective in controlling VF and attenuated the J waves which diminished below the diagnostic level during follow up. VF recurred in patients followed without antiarrhythmic agents.
  Journal of the American College of Cardiology 06/2013; · 14.16 Impact Factor
• Source

  Available from: Stephen B Wilton

  Article: Pattern and Timing of the Coronary Sinus Activation to Guide Rapid Diagnosis of Atrial Tachycardia after Atrial Fibrillation Ablation.

  Patrizio Pascale, Ashok J Shah, Laurent Roten, Daniel Scherr, Yuki Komatsu, Amir S Jadidi, Khaled Ramoul, Matthew Daly, Arnaud Denis, Stephen B Wilton, Nicolas Derval, Frédéric Sacher, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs
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  ABSTRACT: BACKGROUND: -Atrial tachycardias (AT) during or after ablation of AF frequently pose a diagnostic challenge. We hypothesized that both the patterns and timing of coronary sinus (CS) activation could facilitate AT mapping. METHODS AND RESULTS: -140 consecutive post-persistent AF ablation patients with sustained AT were investigated by conventional mapping. CS activation pattern was defined as "chevron" or "reverse chevron" when the activations recorded on both the proximal and distal CS dipoles were latest or earliest, respectively. The local activation of mid-CS was timed with reference to Ppeak-Ppeak (P-P) interval in lead V1. A ratio, mid-CS activation time to AT cycle length, was computed. Out of 223 diagnosed ATs, 124 were macroreentrant (56%) and 99 were centrifugal (44%). When CS activation was "chevron"/"reverse chevron" (n = 44, 20%), macroreentries were mostly roof-dependent. With reference to P-P interval, mid-CS activation timing showed specific consistency for peritricuspid and perimitral AT. Proximal to distal CS activation pattern and mid-CS activation at 50-70% of the P-P interval (n = 30, 13%) diagnosed peritricuspid AT with 81% sensitivity and 89% specificity. Distal to proximal CS activation and mid-CS activation at 10-40% of the P-P interval (n = 44, 20%) diagnosed perimitral AT with 88% sensitivity and 75% specificity. CONCLUSIONS: -The analysis of the patterns and timing of CS activation provides a rapid stratification of most likely macroreentrant ATs and points towards the likely origin of centrifugal ATs. It can be included in a stepwise diagnostic approach to rapidly select the most critical mapping maneuvers.
  Circulation Arrhythmia and Electrophysiology 04/2013; · 6.46 Impact Factor
• Article: Noninvasive electrocardiographic mapping to improve patient selection for cardiac resynchronization therapy: Beyond QRS duration and left bundle-branch block morphology.

  Sylvain Ploux, Joost Lumens, Zachary Whinnett, Michel Montaudon, Maria Strom, Charu Ramanathan, Nicolas Derval, Adlane Zemmoura, Arnaud Denis, Maxime De Guillebon, Ashok Shah, Mélèze Hocini, Pierre Jaïs, Philippe Ritter, Michel Haïssaguerre, Bruce L Wilkoff, Pierre Bordachar
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  ABSTRACT: OBJECTIVES: To investigate whether noninvasive electrocardiographic activation mapping (ECM) is a useful method for predicting response to Cardiac Resynchronization Therapy (CRT). BACKGROUND: One third of the patients appear not to respond to CRT when they are selected according to QRS duration. METHODS: We performed ECM in 33 consecutive CRT-candidates (QRS≥120ms). In 18 patients the 12-lead ECG morphology was Left Bundle-Branch Block (LBBB) and in 15 Nonspecific Intraventricular Conduction Disturbance (NICD).Three indices of electrical dyssynchrony were derived from intrinsic maps: right and left ventricular total activation times and ventricular electrical uncoupling (VEU: difference between the LV and RV mean activation times). We assessed the ability of these parameters to predict response, measured using a clinical composite score, after 6 months treatment with CRT. RESULTS: Electrocardiographic maps revealed homogeneous patterns of activation and consistently greater VEU and LV total activation time in patients with LBBB compared to heterogeneous activation sequences and shorter VEU and LV total activation time in NICD patients (VEU: 75±12ms vs. 40±22ms; p<0.001/ LVTAT: 115±21ms vs 91±34ms; p=0.03). LBBB and NICD patients had similar RV total activation times (62±30ms vs 58±26ms; p=0.7). The area under the receiver operating characteristic curve indicated that VEU (AUC: 0.88) was significantly superior to QRS duration (AUC: 0.73) and LVTAT (AUC: 0.72) for predicting CRT response (p<0.05). With a 50ms cut-off value, VEU identified CRT responders with 90% sensitivity and 82% specificity whether LBBB was present or not. CONCLUSION: Ventricular electrical uncoupling measured by electrocardiographic mapping predicted clinical CRT response better than QRS duration or the presence of LBBB.
  Journal of the American College of Cardiology 04/2013; · 14.16 Impact Factor
• Source

  Available from: Stephen B Wilton

  Dataset: Supplementary Appendices

  Nick W F Linton, Stephen B Wilton, Daniel Scherr, Ashok J Shah, Nicolas Derval, Frederic Sacher, Matthew Wright, Meleze Hocini, Mark D O'Neill, Michel Haïssaguerre, Pierre Jaïs
• Article: Regional Myocardial Wall Thinning at Multi-Detector Computed Tomography Correlates to Arrhythmogenic Substrate in Post-Infarction Ventricular Tachycardia: Assessment of Structural and Electrical Substrate.

  Yuki Komatsu, Hubert Cochet, Amir Jadidi, Frédéric Sacher, Ashok Shah, Nicolas Derval, Daniel Scherr, Patrizio Pascale, Laurent Roten, Arnaud Denis, [......], Matthieu Riffaud, Maxime Sermesant, Jatin Relan, Nicholas Ayache, Steven Kim, Michel Montaudon, François Laurent, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs
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  ABSTRACT: BACKGROUND: -A majority of patients undergoing ablation of ventricular tachycardia (VT) have implanted devices precluding substrate imaging with delayed-enhancement magnetic resonance imaging (MRI). Contrast-enhanced multi-detector computed tomography (MDCT) can depict myocardial wall thickness with submillimetric resolution. We evaluated the relationship between regional myocardial wall thinning (WT) imaged by MDCT and arrhythmogenic substrate in post-infarction VT. METHODS AND RESULTS: -We studied 13 consecutive post-infarction patients undergoing MDCT before ablation. MDCT data was integrated with high-density 3D-electroanatomic maps acquired during sinus rhythm (endocardium: 509±291 points/map, epicardium: 716±323 points/map). Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were assessed with regard to the WT. A significant correlation was found between the areas of WT<5mm and endocardial low-voltage (correlation-R=0.82, p=0.001), but no such correlation was found in the epicardium. The WT<5mm area was smaller than the endocardial low-voltage area (54cm2 [Q1-Q3: 46-92] versus 71cm2 [Q1-Q3: 59-124], p=0.001). Among a total of 13,060 electrograms reviewed in the whole study population, 538 LAVA were detected and analyzed. LAVA were located within the WT<5mm (469/538 [87%]) or at its border (100% within 23mm). Very late LAVA (>100ms after QRS complex) were almost exclusively detected within the thinnest area (93% in the WT<3mm). CONCLUSIONS: -Regional myocardial WT correlates to low-voltage regions and distribution of LAVA critical for the generation and maintenance of post-infarction VT. The integration of MDCT WT with 3D-electroanatomic maps can help focus mapping and ablation on the culprit regions, even when MRI is precluded by the presence of implanted devices.
  Circulation Arrhythmia and Electrophysiology 03/2013; · 6.46 Impact Factor
• Article: Comparison of different invasive hemodynamic methods for AV delay optimization in patients with cardiac resynchronization therapy: Implications for clinical trial design and clinical practice.

  Zachary I Whinnett, Darrel P Francis, Arnaud Denis, Keith Willson, Patrizio Pascale, Irene van Geldorp, Maxime De Guillebon, Sylvain Ploux, Kenneth Ellenbogen, Michel Haïssaguerre, Philippe Ritter, Pierre Bordachar
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  ABSTRACT: BACKGROUND: Reproducibility and hemodynamic efficacy of optimization of AV delay (AVD) of cardiac resynchronization therapy (CRT) using invasive LV dp/dtmax are unknown. METHOD AND RESULTS: 25 patients underwent AV delay (AVD) optimisation twice, using continuous left ventricular (LV) dp/dtmax, systolic blood pressure (SBP) and pulse pressure (PP). We compared 4 protocols for comparing dp/dtmax between AV delays: We assessed for dp/dtmax, LVSBP and LVPP, test-retest reproducibility of the optimum. Optimization using immediate absolute dp/dtmax had poor reproducibility (SDD of replicate optima=41ms; R2=0.45) as did delayed absolute (SDD 39ms; R2=0.50). Multiple relative had better reproducibility: SDD 23ms, R2=0.76, and (p<0.01 by F test). Compared with AAI pacing, the hemodynamic increment from CRT, with the nominal AV delay was LVSBP 2% and LVdp/dtmax 5%, while CRT with pre-determined optimal AVD gave 6% and 9% respectively. CONCLUSIONS: Because of inevitable background fluctuations, optimization by absolute dp/dtmax has poor same-day reproducibility, unsuitable for clinical or research purposes. Reproducibility is improved by comparing to a reference AVD and making multiple consecutive measurements. More than 6 measurements would be required for even more precise optimization - and might be advisable for future study designs. With optimal AVD, instead of nominal, the hemodynamic increment of CRT is approximately doubled.
  International journal of cardiology 03/2013; · 7.08 Impact Factor
• Article: Endocardial vs. Epicardial Ventricular Radiofrequency Ablation: Utility of in vivo Contact Force Assessment.

  Frédéric Sacher, Matthew J Wright, Nicolas Derval, Arnaud Denis, Khaled Ramoul, Laurent Roten, Patrizzio Pascale, Pierre Bordachar, Philippe Ritter, Mélèze Hocini, Pierre Dos Santos, Michel Haïssaguerre, Pierre Jaïs
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  ABSTRACT: BACKGROUND: -Contact force (CF) is an important determinant of lesion formation for atrial endocardial radiofrequency (RF) ablation. There are minimal published data on CF and ventricular lesion formation. We studied the impact of CF on lesion formation using an ovine model both endo and epicardially. METHODS AND RESULTS: -Twenty sheep received 160 epicardial and 160 endocardial ventricular RF applications using either a 3.5 mm irrigated-tip catheter (Thermocool, Biosense-Webster, n=160) or a 3.5 irrigated-tip catheter with CF assessment (Tacticath, Endosense, n=160), via percutaneous access. Power was delivered at 30 watts for 60 seconds when either catheter/tissue contact was felt to be good or when CF>10g with Tacticath. Following completion of all lesions acute dimensions were taken at pathology. Identifiable lesion formation from RF application was improved with the aid of CF information, from 78% to 98% on the endocardium (p<0.001) and from 90% to 100% on the epicardium (p=0.02). The mean total force was greater on the endocardium (39±18g vs 21±14g for the epicardium, p<0.001) mainly due to axial force. Despite the Force-Time-Integral being greater endocardially, epicardial lesions were larger (231±182mm(3) vs 209±131mm(3); p=0.02) probably due to the absence of the heat sink effect of the circulating blood and covered a greater area (41±27 vs 29±17mm(2); p=0.03) due to catheter orientation. CONCLUSIONS: -In the absence of CF feedback, 22% of endocardial RF applications that are felt to have good contact didn't result in lesion formation. Epicardial ablation is associated with larger lesions.
  Circulation Arrhythmia and Electrophysiology 02/2013; · 6.46 Impact Factor
• Article: Acute hemodynamic benefits of biventricular and single-site systemic ventricular pacing in patients with a systemic right ventricle.

  Irene E van Geldorp, Pierre Bordachar, Joost Lumens, Maxime de Guillebon, Zachary I Whinnett, Frits W Prinzen, Michel Haïssaguerre, Tammo Delhaas, Jean-Benoît Thambo
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  ABSTRACT: BACKGROUND: Patients treated by atrial redirection surgery (Senning or Mustard procedure) for transposition of the great arteries (TGA), have an important risk for heart failure caused by dysfunction of the systemic RV. Conventional non-systemic ventricular pacing (non-systVP) may even further increase this risk. OBJECTIVE: We investigated the effects of endocardial non-systVP, biventricular pacing (BiVP), and single-site systemic ventricular pacing (systVP) on systolic cardiac pump function in patients with TGA and status post atrial redirection surgery (SenningMustardTGA). METHODS: During clinically indicated catheterization in 9 patients with SenningMustardTGA, endocardial ventricular stimulation (overdrive DDD-mode, 80-90 bpm) was applied with temporary pacing leads at the non-systemic and the systemic ventricle. Acute changes in dP/dt(max) and systolic pressure of the systemic ventricle, as induced by non-systVP, systVP and BiVP compared to reference, were assessed with a pressure wire within the systemic ventricle. Reference was AAI pacing with similar heart rate (n=7), or non-systVP at a lower heart rate than during stimulation at experimental sites (85 vs. 90 bpm; n=2). RESULTS: Systemic dP/dt(max) and systolic ventricular pressure were significantly higher during systVP (+15.6% and +5.1%, respectively) and BiVP (+14.3% and +4.9%, respectively, compared with non-systVP). In 6 out of 7 patients systemic dP/dt(max) was higher during BiVP and systVP than during AAI pacing. CONCLUSIONS: In a population of patients with SenningMustardTGA, acute hemodynamic effects of endocardial systVP and BiVP were significantly and equally better than those of non-systVP. In some patients systVP and BiVP might even be better than ventricular activation by the intrinsic conduction system.
  Heart rhythm: the official journal of the Heart Rhythm Society 01/2013; · 4.56 Impact Factor
• Article: Identification of large families in early repolarization syndrome.

  Jean-Baptiste Gourraud, Solena Le Scouarnec, Frederic Sacher, Stéphanie Chatel, Nicolas Derval, Vincent Portero, Pascal Chavernac, Juan E Sandoval, Philippe Mabo, Richard Redon, Jean-Jacques Schott, Hervé Le Marec, Michel Haïssaguerre, Vincent Probst
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  ABSTRACT: The aim of this study was to identify families affected by early repolarization syndrome (ERS) and to determine the mode of transmission of the disease. Early repolarization (ER) has recently been linked to idiopathic ventricular fibrillation. Familial inheritance of the disease has been suggested but not demonstrated. We screened relatives of 4 families affected by ERS. ER was defined as a distinct J-wave in at least 2 consecutive leads and a 1-mm amplitude above baseline. The Valsalva maneuver was performed in affected and unaffected family members to decrease heart rate and thus increase or reveal an ER pattern. Twenty-two sudden cardiac deaths occurred in the 4 families including 10 before 35 years of age. In the 4 families, the prevalence of ER was 56%, 34%, 61%, and 33% of, respectively, 30, 82, 29, and 30 screened relatives. In these families, transmission of an ER pattern is compatible with an autosomal dominant mode of inheritance. All probands were screened for genes identified in ERS, and no mutation was found. The Valsalva maneuver was performed in 80 relatives, resulting in increased J-wave amplitude for 17 of 20 affected patients and revealing an ER pattern in 17 relatives in whom 5 are obligate transmitters of an ER pattern. ERS can be inherited through autosomal dominant transmission and should be considered a real inherited arrhythmia syndrome. Familial investigation can be facilitated by using the Valsalva maneuver to reveal the electrocardiographic pattern in family members. The prognosis value of this test remains to be assessed.
  Journal of the American College of Cardiology 01/2013; 61(2):164-72. · 14.16 Impact Factor
• Article: Clinical Utility of Adenosine-Infusion test at Repeat Atrial Fibrillation Ablation procedure.

  Shinsuke Miyazaki, Atsushi Kobori, Mélèze Hocini, Ashok J Shah, Yuki Komatsu, Hiroshi Taniguchi, Shigeki Kusa, Takashi Uchiyama, Hiroaki Nakamura, Hitoshi Hachiya, Mitsuaki Isobe, Kenzo Hirao, Michel Haïssaguerre, Atsushi Takahashi, Yoshito Iesaka
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  ABSTRACT: BACKGROUND: The majority of patients with recurrence of arrhythmia after initial atrial fibrillation (AF) ablation procedure have resumption of pulmonary vein (PV) conduction. Adenosine-infusion test after PV isolation (PVI) identifies acute dormant PV conduction at the index procedure. OBJECTIVE: To evaluate the utility of adenosine-infusion test at repeat AF ablation procedure. METHODS: This study included 50 consecutive patients (65 ± 9 years; 38 men), who underwent second ablation procedure for recurrent atrial tachyarrhythmia(s). At the index procedure, which was undertaken for paroxysmal AF, all patients underwent PVI and 48/50 (96%) underwent superior vena cava isolation (SVCI) followed by infusion of adenosine. PV and SVC were re-isolated, if found reconnected, at the start of the second procedure. Adenosine-infusion test was undertaken for all PVs in all patients, thereafter. RESULTS: At the index procedure, adenosine infusion revealed dormant PV conduction in 15/50 (30%) patients. At the second procedure, after 10 ± 10 months, PV and SVC reconnections were observed in 46/50 (92%) and 33/48 (68.8%) patients and they were reisolated. Subsequently, adenosine-infusion test revealed dormant PV conduction in 9/50 (18%) patients including 3/50 (6%), in whom there was no PV reconnection at the start of the procedure. In these 3 patients, transient AF resulted following adenosine-infusion and at mean 8.0 ± 3.4 months, they have been free from any atrial arrhythmia after elimination of dormant PV conduction, alone. CONCLUSION: Adenosine-infusion test reveals dormant thoracic vein conduction associated with arrhythmia recurrence in the chronic phase after initial PV isolation.
  Heart rhythm: the official journal of the Heart Rhythm Society 12/2012; · 4.56 Impact Factor
• Source

  Available from: Stephen B Wilton

  Article: A Practical Criterion for the Rapid Detection of Single-Loop and Double-Loop Reentry Tachycardias.

  Nick W F Linton, Stephen B Wilton, Daniel Scherr, Ashok J Shah, Nicolas Derval, Frederic Sacher, Matthew Wright, Meleze Hocini, Mark D O'Neill, Michel Haïssaguerre, Pierre Jaïs
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  ABSTRACT: INTRODUCTION: Entrainment criteria for the diagnosis of reentrant atrial tachycardia can be difficult to apply and cannot detect double-loop reentry. We sought to develop and clinically test a new criterion for the diagnosis of single- and double-loop reentry. METHODS AND RESULTS: (1) Proposed criterion: after sequential overdrive pacing at 2 different locations and assessing the first ensuing beats of tachycardia, the difference in activation time recorded between 2 appropriate stationary positions changes by 1 or 2 tachycardia cycle lengths; a change of 2 tachycardia cycle lengths usually indicates double-loop reentry rather than only a single-loop. (2) Clinical testing: multiple overdrive pacing maneuvers were undertaken and analyzed in 5 patients with common flutter (single-loop reentry). In total, 23 pairs of overdrive pacing maneuvers were performed using electrodes in the coronary sinus and a distribution of positions in the right atrium. In 22/23 pairs of maneuvers, the change in Activation Difference was within 2.6 ± 12.4 milliseconds of the tachycardia cycle length, confirming single loop reentry. For double-loop reentry, the literature was reviewed and 3 cases of double-loop reentry were identified with sufficient data. In all of these cases, double-loop reentry was detected and also the zone containing the common isthmus was identified. CONCLUSION: The proposed criterion can diagnose single- and double-loop reentry atrial tachycardia using intracardiac recordings from any pair of well separated positions. The criterion does not require precise electrode placement or extensive activation mapping.
  Journal of Cardiovascular Electrophysiology 12/2012; · 3.06 Impact Factor
• Article: Noninvasive Electrocardiomapping Facilitates Previously Failed Ablation of Right Appendage Diverticulum Associated Life-Threatening Accessory Pathway.

  Mélèze Hocini, Ashok J Shah, Hubert Cochet, Philippe Maury, Arnaud Denis, Michel Haïssaguerre
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  ABSTRACT: Electrocardiomapping in Right Atrial Diverticulum and Accessory Pathway. Combination of structural (CT-scan) and functional (3D electrocardiomapping) imaging methods helped successfully accomplish ablation of a life-threatening manifest accessory pathway in association with a complex right atrial anomaly after previous unsuccessful attempts of endo-epicardial ablation guided by the invasive electroanatomic system in an adolescent female. Such a system has a potential to facilitate the ablation procedure and impact its outcome through accurate localization of the arrhythmogenic substrate. (J Cardiovasc Electrophysiol, Vol. pp. 1-3).
  Journal of Cardiovascular Electrophysiology 11/2012; · 3.06 Impact Factor
• Article: Integration of Merged Delayed-Enhanced Magnetic Resonance Imaging and Multidetector Computed Tomography for the Guidance of Ventricular Tachycardia Ablation: A Pilot Study.

  Hubert Cochet, Yuki Komatsu, Frederic Sacher, Amir Sherwan Jadidi, Daniel Scherr, Matthieu Riffaud, Nicolas Derval, Ashok Shah, Laurent Roten, Patrizio Pascale, Jatin Relan, Maxime Sermesant, Nicholas Ayache, Michel Montaudon, François Laurent, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs
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  ABSTRACT: MDCT/MRI Fusion for the Guidance of VT Ablation. Background: Delayed enhancement (DE) MRI can assess the fibrotic substrate of scar-related VT. MDCT has the advantage of inframillimetric spatial resolution and better 3D reconstructions. We sought to evaluate the feasibility and usefulness of integrating merged MDCT/MRI data in 3D-mapping systems for structure-function assessment and multimodal guidance of VT mapping and ablation. Methods: Nine patients, including 3 ischemic cardiomyopathy (ICM), 3 nonischemic cardiomyopathy (NICM), 2 myocarditis, and 1 redo procedure for idiopathic VT, underwent MRI and MDCT before VT ablation. Merged MRI/MDCT data were integrated in 3D-mapping systems and registered to high-density endocardial and epicardial maps. Low-voltage areas (<1.5 mV) and local abnormal ventricular activities (LAVA) during sinus rhythm were correlated to DE at MRI, and wall-thinning (WT) at MDCT. Results: Endocardium and epicardium were mapped with 391 ± 388 and 1098 ± 734 points per map, respectively. Registration of MDCT allowed visualization of coronary arteries during epicardial mapping/ablation. In the idiopathic patient, integration of MRI data identified previously ablated regions. In ICM patients, both DE at MRI and WT at MDCT matched areas of low voltage (overlap 94 ± 6% and 79 ± 5%, respectively). In NICM patients, wall-thinning areas matched areas of low voltage (overlap 63 ± 21%). In patients with myocarditis, subepicardial DE matched areas of epicardial low voltage (overlap 92 ± 12%). A total number of 266 LAVA sites were found in 7/9 patients. All LAVA sites were associated to structural substrate at imaging (90% inside, 100% within 18 mm). Conclusion: The integration of merged MDCT and DEMRI data is feasible and allows combining substrate assessment with high-spatial resolution to better define structure-function relationship in scar-related VT. (J Cardiovasc Electrophysiol, Vol. pp. 1-8).
  Journal of Cardiovascular Electrophysiology 11/2012; · 3.06 Impact Factor
• Article: Prevalence and types of pitfall in the assessment of mitral isthmus linear conduction block.

  Ashok J Shah, Patrizio Pascale, Shinsuke Miyazaki, Xingpeng Liu, Laurent Roten, Nicolas Derval, Amir S Jadidi, Daniel Scherr, Stephen B Wilton, Michala Pedersen, Sebastien Knecht, Frédéric Sacher, Pierre Jaïs, Michel Haïssaguerre, Mélèze Hocini
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  ABSTRACT: Background- To identify and understand clinically encountered pitfalls in the assessment of transmitral conduction block using differential coronary sinus and left atrial appendage pacing techniques in patients with left mitral isthmus linear ablation. Methods and Results- All the available assessments of mitral isthmus block were thoroughly reviewed in 271 mitral isthmus ablation procedures undertaken among 236 patients from October 2008 to April 2011. Bidirectional block was established in 186 of 271 (69%) procedures. Careful evaluation of electrograms recorded on the multipolar coronary sinus and ablation catheters was undertaken to identify and understand the characteristics of pitfall, if any. Pitfall was encountered in 55 of 271 (20%) procedures among 51 patients and categorized into 6 types (types 1, 3, 4, and 5 led to spurious diagnosis of block; types 2 and 6 led to erroneous diagnosis of absence of block). There were 14, 10, 17, 2, 15, and 3 (total=61) cases of pitfall types 1 through 6, respectively. Operator recognized 42 of 61 (69%) pitfalls intraprocedurally. Recognition of types 1 and 5 was difficult because of indiscernible electrograms at usual amplifier settings or presence of slow conduction mimicking block. Conclusions- Every fifth assessment of bidirectional block across mitral isthmus linear lesion using differential coronary sinus and left atrial appendage pacing techniques encounters a pitfall, which can lead to erroneous clinical diagnosis of block or absence of block. Recognition of pitfall during the procedure is feasible and necessitates careful distinction of far-field left atrium from the local coronary sinus electrograms besides appropriate adjustments in catheter position and pacing outputs.
  Circulation Arrhythmia and Electrophysiology 08/2012; 5(5):957-67. · 6.46 Impact Factor
• Article: Current Hot Potatoes in Atrial Fibrillation Ablation.

  Laurent Roten, Nicolas Derval, Patrizio Pascale, Daniel Scherr, Yuki Komatsu, Ashok Shah, Khaled Ramoul, Arnaud Denis, Frédéric Sacher, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs
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  ABSTRACT: Atrial fibrillation (AF) ablation has evolved to the treatment of choice for patients with drug-resistant and symptomatic AF. Pulmonary vein isolation at the ostial or antral level usually is sufficient for treatment of true paroxysmal AF. For persistent AF ablation, drivers and perpetuators outside of the pulmonary veins are responsible for AF maintenance and have to be targeted to achieve satisfying arrhythmia-free success rate. Both complex fractionated atrial electrogram (CFAE) ablation and linear ablation are added to pulmonary vein isolation for persistent AF ablation. Nevertheless, ablation failure and necessity of repeat ablations are still frequent, especially after persistent AF ablation. Pulmonary vein reconduction is the main reason for arrhythmia recurrence after paroxysmal and to a lesser extent after persistent AF ablation. Failure of persistent AF ablation mostly is a consequence of inadequate trigger ablation, substrate modification or incompletely ablated or reconducting linear lesions. In this review we will discuss these points responsible for AF recurrence after ablation and review current possibilities on how to overcome these limitations.
  Current Cardiology Reviews 08/2012;
• Article: Heterogeneous response of J-wave syndromes to beta-adrenergic stimulation.

  Laurent Roten, Nicolas Derval, Frédéric Sacher, Patrizio Pascale, Daniel Scherr, Yuki Komatsu, Khaled Ramoul, Matthew Daly, Arnaud Denis, Ashok J Shah, Mélèze Hocini, Pierre Jaïs, Michel Haïssaguerre
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  ABSTRACT: BACKGROUND: Inferolateral early repolarization (ER) and Brugada syndrome manifest with J waves. Isoproterenol suppresses recurrent ventricular arrhythmias while reducing J waves in both disorders. OBJECTIVE: To characterize the effect of isoproterenol on J waves. METHODS: We analyzed the impact of isoproterenol on J waves in 20 patients with Brugada-type electrocardiogram (Br group) and 38 patients with ER (ER group). RESULTS: In the ER group, J waves were present in inferior leads in 32 patients (84%) and in lateral leads in 23 patients (61%). Isoproterenol increased the heart rate by 75 beats/min in the ER group and by 71 beats/min in the Br group (P = .20). The incidences of persistent (≤0.05-mV decrease), decreased, and normalized J waves (residual J wave ≤0.05 mV) were 20%, 80%, and 0% for Br group patients and 29%, 8%, and 63% for ER group patients, respectively (P <.001). Within the ER group, inferior J waves persisted in 34% of the cases, decreased in 9%, and normalized in 56% whereas lateral J waves always normalized (P <.001). Baseline QRS width was broader in ER group patients with persistent J waves (90 ms vs 80 ms; P = .003) and was unchanged with isoproterenol (90 ms; P = .19), whereas it decreased in the remaining patients (75 ms; P <.001). CONCLUSIONS: J-wave syndromes have distinct regional sensitivity to beta-adrenergic stimulation. J waves may persist in a subset of patients with precordial and inferior J waves but never in lateral location. This heterogeneous response to isoproterenol may indicate distinctive mechanisms for Brugada and ER patterns, including depolarization abnormalities or ion channel sensitivity.
  Heart rhythm: the official journal of the Heart Rhythm Society 08/2012; · 4.56 Impact Factor
• Article: Clinical value of fibrillatory wave amplitude on surface ECG in patients with persistent atrial fibrillation

  Isabelle Nault, Nicolas Lellouche, Seiichiro Matsuo, Sébastien Knecht, Matthew Wright, Kang-Teng Lim, Frederic Sacher, Pyotr Platonov, Antoine Deplagne, Pierre Bordachar, Nicolas Derval, Mark D. O’Neill, George J Klein, Mélèze Hocini, Pierre Jaïs, Jacques Clémenty, Michel Haïssaguerre
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  ABSTRACT: PurposeWe postulated that amplitude of fibrillatory (F)-wave in patients with persistent AF would correlate with clinical characteristics and outcome in patients undergoing catheter ablation for AF. MethodMaximal and mean amplitude of F-waves were measured in V1 and lead II in 90 patients prior to ablation for persistent AF. F-wave amplitudes were correlated to clinical, echocardiographic variables, and outcome. ResultsF-wave ≥ 0.1mV in lead II and V1was correlated with younger age and shorter AF history, and in lead II only was correlated with a smaller left atrium. Higher F-wave amplitude at baseline predicted AF termination during ablation. Maximal amplitude of ≥ 0.07mV predicted AF termination by ablation with 82%/79% sensitivity and 68%/73% specificity in V1/lead II respectively. An association between F-wave amplitude and AF recurrence was observed. Forty-three percent of patients with mean f wave amplitude <0.05 in lead V1 had AF recurrence compared to 12% of those with F-wave ≥ 0.05 (p = 0.004). ConclusionLonger AF duration, older age and larger LA size are associated with fine AF amplitude. High F-wave amplitude predicts procedural termination of arrhyhmia in patients with persistent AF and freedom from AF upon follow-up.
  Journal of Interventional Cardiac Electrophysiology 04/2012; 26(1):11-19. · 1.17 Impact Factor
• Article: Microcanonical processing methodology for ECG and intracardial potential: application to atrial fibrillation

  Oriol Pont, Michel Haïssaguerre, Hussein Yahia, Nicolas Derval, Mélèze Hocini
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  ABSTRACT: Cardiac diseases are the principal cause of human morbidity and mortality in the western world. The electric potential of the heart is a highly complex signal emerging as a result of nontrivial flow conduction, hierarchical structuring and multiple regulation mechanisms. Its proper accurate analysis becomes of crucial importance in order to detect and treat arrhythmias or other abnormal dynamics that could lead to life-threatening conditions. To achieve this, advanced nonlinear processing methods are needed: one example here is the case of recent advances in the Microcanonical Multiscale Formalism. The aim of the present paper is to recapitulate those advances and extend the analyses performed, specially looking at the case of atrial fibrillation. We show that both ECG and intracardial potential signals can be described in a model-free way as a fast dynamics combined with a slow dynamics. Sharp differences in the key parameters of the fast dynamics appear in different regimes of transition between atrial fibrillation and healthy cases. Therefore, this type of analysis could be used for automated early warning, also in the treatment of atrial fibrillation particularly to guide radiofrequency ablation procedures.
  04/2012;
• Article: Syncope in Brugada syndrome patients: prevalence, characteristics, and outcome.

  Frédéric Sacher, Florence Arsac, Stephen B Wilton, Nicolas Derval, Arnaud Denis, Maxime de Guillebon, Khaled Ramoul, Pierre Bordachar, Philippe Ritter, Mélèze Hocini, Jacques Clémenty, Pierre Jaïs, Michel Haïssaguerre
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  ABSTRACT: The report from the 2nd Consensus Committee on BrS suggests that all patients with syncope without a "clear extracardiac cause" should have an implantable cardioverter-defibrillator (ICD). However, a clear extracardiac cause for syncope may be difficult to prove. The purpose of this study was to characterize syncope in patients with Brugada syndrome (BrS). All patients diagnosed with BrS at our institution between 1999 and 2010 were enrolled in a prospective registry. Patients with suspected arrhythmic syncope (group 1) were compared to patients with nonarrhythmic syncope (group 2) and to patients with syncope of doubtful origin (group 3). Of 203 patients with BrS, 57 (28%; 44 male, age 46 ± 12 years) experienced at least 1 syncope. Group 1 consisted of 23 patients, all of whom received an ICD. In group 2 (17 patients), 3 received an ICD because of a positive electrophysiologic study. In group 3 (17 patients), 6 received an implantable loop recorder and 6 received an ICD. After mean follow-up of 65 ± 42 months, 14 patients in group 1 remained asymptomatic, 4 had recurrent syncope, and 6 had appropriate ICD therapy. In group 2, 9 patients remained asymptomatic and 7 had recurrent neurocardiogenic syncope. In group 3, 7 remained asymptomatic and 9 had recurrent syncope. One patient from each group died from a noncardiac cause. In the present study, syncope occurred in 28% of patients with BrS. The ventricular arrhythmia rate was 5.5% per year in group 1. In 30%, the etiology of the syncope was questionable. No sudden cardiac death occurred in groups 2 and 3.
  Heart rhythm: the official journal of the Heart Rhythm Society 04/2012; 9(8):1272-9. · 4.56 Impact Factor
• Article: Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia.

  Pierre Jaïs, Philippe Maury, Paul Khairy, Frédéric Sacher, Isabelle Nault, Yuki Komatsu, Mélèze Hocini, Andrei Forclaz, Amir S Jadidi, Rukshen Weerasooryia, [......], Daniel Scherr, Patrizio Pascale, Laurent Roten, Michala Pederson, Pierre Bordachar, François Laurent, Steven J Kim, Philippe Ritter, Jacques Clementy, Michel Haïssaguerre
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  ABSTRACT: Catheter ablation of ventricular tachycardia (VT) is effective and particularly useful in patients with frequent defibrillator interventions. Various substrate modification techniques have been described for unmappable or hemodynamically intolerable VT. Noninducibility is the most frequently used end point but is associated with significant limitations, so the optimal end point remains unclear. We hypothesized that elimination of local abnormal ventricular activities (LAVAs) during sinus rhythm or ventricular pacing would be a useful and effective end point for substrate-based VT ablation. As an adjunct to this strategy, we used a new high-density mapping catheter and frequently used epicardial mapping. Seventy patients (age, 67±11 years; 7 female) with VT and structurally abnormal ventricle(s) were prospectively enrolled. Conventional mapping was performed in sinus rhythm in all, and a high-density Pentaray mapping catheter was used in the endocardium (n=35) and epicardially. LAVAs were recorded in 67 patients (95.7%; 95% confidence interval, 89.2-98.9). Catheter ablation was performed targeting LAVA with an irrigated-tip catheter placed endocardially via a transseptal or retrograde aortic approach or epicardially via the subxiphoid approach. LAVAs were successfully abolished or dissociated in 47 of 67 patients (70.1%; 95% confidence interval, 58.7-80.1). In multivariate analysis, LAVA elimination was independently associated with a reduction in recurrent VT or death (hazard ratio, 0.49; 95% confidence interval, 0.26-0.95; P=0.035) during long-term follow-up (median, 22 months). LAVAs can be identified in most patients with scar-related VT. Elimination of LAVAs is feasible and safe and is associated with superior survival free from recurrent VT.
  Circulation 04/2012; 125(18):2184-96. · 14.74 Impact Factor