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Introduction
Publications
Publications (502)
Aims
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with a high risk of ventricular arrhythmia (VA). Current guidelines recommend beta-blockers as first-line medical therapy and if ineffective, sotalol or amiodarone. We describe our experience, as a tertiary centre for ARVC, with the effectiveness a...
Introduction
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by progressive fibro-fatty replacement of cardiomyocytes and associated with a high risk of ventricular arrhythmia (VA). Current guidelines recommend beta-blockers as first-line medical therapy and if ineffective, sotalol or amiodarone....
BACKGROUND: Bradycardia-induced torsade de pointes (TdP) tachycardia in patients with spontaneous high-degree atrioventricular block (AVB) is common. The aim of this study was to analyze endocardial recordings during TdP in spontaneous high-degree AVB in humans to better understand the electrophysiological mechanisms underlying this phenomenon. MET...
Background
ECG late depolarization abnormality called epsilon wave (ɛ) is a major diagnostic criterion in ARVC/D patients according to Task Force.
Objectives
As ARVC/D induces progressive right ventricular enlargement, whether or not additional right precordial leads (X1, X2, V3R, V4R) may increase ECG diagnostic sensitivity at rest and/or during...
BACKGROUND: Atrial fibrillation (AF) is the most common atrial arrhythmia in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVD). Considering the histologic changes known in the right ventricular (RV) in ARVD, the aim of the present study was to examine right atrial (RA) pathology in patients with ARVD. METHODS: Histology of RA and RV...
Background
The role and value of electrophysiological study (EPS) for syncope in heart transplant patient has never been analyzed and described in current guidelines.
Purpose
To analyse if EPS was relevant in diagnostic strategy of syncope in heart transplant patient who required permanent pacemaker implantation (PPI).
Methods
Between 1982 and 20...
Arrhythmogenic right ventricular cardiomyopathy/dysplasia
(ARVC/D) was initially recognized as a clinical entity by
Fontaine and Marcus, who evaluated a group of patients
with ventricular tachyarrhythmia from a structurally impaired
right ventricle (RV). Since then, there have been significant
advances in the understanding of the pathophysiology,
m...
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy that can lead to sudden cardiac death and heart failure. Our understanding of its pathophysiology and clinical expressivity is continuously evolving. The diagnosis of ARVC/D remains particularly challenging due to the absence of specific unique diagnos...
Objectives:
The purpose of this study was to identify clinical factors associated with arrhythmic events and sudden cardiac death (SCD), and to evaluate the prognostic value of electrophysiological study (EPS) in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients without implantable cardioverter-defibrillators (ICDs).
Bac...
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) was initially recognized as a clinical entity by Fontaine and Marcus, who evaluated a group of patients with ventricular tachyarrhythmia from a structurally impaired right ventricle (RV). Since then, there have been significant advances in the understanding of the pathophysiology, m...
Background:
Organized atrial arrhythmias (OAAs) are common after orthotopic heart transplantation (OHT). Some controversies remain about their clinical presentation, relationship with atrial anastomosis and electrophysiologic features. The objectives of this retrospective study were to determine the mechanisms of OAAs after OHT and describe the ou...
Background:
Monomorphic ventricular tachycardia (MVT) is common in adults with repaired tetralogy of Fallot (TOF), and is associated with sudden cardiac death. Management of MVT is not defined, and results of catheter ablation (CA) are limited.
Aims:
To evaluate long-term outcomes of MVT CA in repaired TOF.
Methods:
Thirty-four patients (mean...
Background:
Atrioventricular block (AVB) is common after transcatheter aortic valve replacement (TAVR) and permanent pacemaker (PPM) implantation is needed in up to 30% of patients. Main predictors of long term AVB are electrocardiographic. The purpose of this study is to assess the prognostic value of serial HV intervals measured before and after...
A young man presented with a history of myocarditis with palpitations and dizziness. He had implantation of a loop recorder that showed repetitive short episodes of VT. In addition, there were fragmented potentials immediately following the large and sharp electrograms (EGMs) before as well as after episodes of VT suggesting an Epsilon wave. This s...
Background
Cardiac conduction disturbances frequently occurred after transcatheter aortic valve replacement (TAVR), leading to permanent pacemaker (PPM) implantation. The aim is to identify predictive factors of early and late high degree atrioventricular blocks (AVB).
Methods Pacemaker
free patients who underwent TAVR from January 2013 to Decembe...
Background
Radiofrequency catheter ablation (RFCA) is increasingly used in the management of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/D) but it is associated with a high level of recurrences.
Objective
To determine predictors associated with VT recurrence after RFCA in ARVC/D.
Methods
This st...
A temporary pace-maker (TPM) is often used after TAVR due to the risk of atrioventricular block (AVB) in the following days, related to progressive conduction system injuries. However guidelines are unclear as when to safely remove it. Between 2013 and 2014, 195 patients without previous permanent pacemaker, were prospectively followed after TAVR (...
Background
Early and late atrioventricular blocks (AVB) are frequent during trans-aortic valve replacement (TAVR) leading to permanent pacemaker (PPM) implantation.
Whether His Bundle recording (HBR) during and after TAVR can predict AVB remains a matter of debate.
Objective
To correlate HV interval during and after TAVR with early and late AVB oc...
Los pacientes se quejan de palpitaciones cuando perciben sus latidos cardíacos. Esta sintomatología puede ser el reflejo de una gran variedad de enfermedades que van desde trastornos del ritmo, algunos de los cuales son potencialmente mortales, hasta causas psiquiátricas de diversa gravedad. La anamnesis es fundamental para diferenciar los latidos...
The early repolarization (ER) pattern is associated with an increased risk of arrhythmogenic sudden death. However, strategies for risk stratification of patients with the ER pattern are not fully defined.
This study sought to determine the role of electrophysiology studies (EPS) in risk stratification of patients with ER syndrome.
In a multicenter...
Background
Arrhythmogenic right ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic disease predominantly caused by desmosomal gene mutations that account for only ~50% of cases. RYR2 gene mutations usually cause Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) but have been associated with peculiar phenotype named ARVC2.
Object...
Background and objective
Implantation of a cardioverter defibrillator (ICD) is a frequently recommended treatment for symptomatic Brugada syndrome (BrS). However, complications related to the device have been reported.
Methods and results
We assessed the benefit / morbidity ratio of this mode of therapy in a cohort of 34 patients implanted in 3 Fre...
Introduction: Brugada syndrome (BrS) is considered a primary electrical disease. However, morphological abnormalities have been reported and localized arrhythmogenic right ventricular (RV) dysplasia/cardiomyopathy (ARVD/C) may mimic its phenotype, raising the question of an overlap between these two conditions and making difficult the therapeutic m...
We report the first use of a new platform, the Guiraudon Universal Cardiac Introducer (GUCI), in humans for accessing the left atrium for catheter-based ablations in patients with resistant atrial arrhythmias after total cavopulmonary derivation. The GUCI was originally designed for intracardiac access for closed, beating instrumental intracardiac...
In patients needing a pacemaker (PM) for bradycardia indications, the amount of right ventricular (RV) apical pacing has been correlated with atrial fibrillation (AFib) and heart failure (HF) in both DDD and VVI mode. RV pacing was linked with left ventricular (LV) dyssynchrony in almost 50% of patients with PM implantation and atrioventricular (AV...
The origin of 40% of syncope cases remains unknown even after a complete diagnostic workup. Previous studies have suggested that ATP testing has value in selecting successful therapy. This patient-blinded, multicenter, randomized superiority trial tested whether, in patients with syncope of unknown origin, selecting cardiac pacing in those with a p...
A growing body of evidence suggests that the arrhythmogenic substrate underlying Brugada syndrome (BrS) is located in the right ventricular outflow tract (RVOT), and electrophysiological abnormalities recently evidenced most commonly concur in conduction slowing. Also, imaging studies reported wall motion abnormalities of the RVOT in patients with...
Background We studied the relationship between C-reactive protein (CRP) and clinical manifestation of Brugada syndrome. Methods and Results All patients underwent physical examination and detailed cardiac tests. At admission, prior to any intervention, they had blood samples drawn for CRP. Among 54 patients, 37% were symptomatic (17 syncope and 3 a...
Background. Inflammation in the Brugada syndrome (BrS) and its clinical implication have been little studied. Aims. To assess the level of inflammation in BrS patients. Methods. All studied BrS patients underwent blood samples drawn for C-reactive protein (CRP) levels at admission, prior to any invasive intervention. Patients with a previous ICD pl...
I pazienti parlano di palpitazioni quando avvertono i propri battiti cardiaci. Questa sintomatologia può riflettere patologie molto diverse che vanno da disturbi del ritmo, alcuni dei quali possono comportare un rischio vitale, a cause psichiatriche di diversa gravità. La raccolta dell’anamnesi è fondamentale per differenziare i battiti normali, ne...
We report the case of a 30-year-old man with situs inversus totalis, recurrent orthodromic reciprocal tachycardia, and the Wolff-Parkinson-White syndrome. He underwent, in our department, radiofrequency ablation of an accessory pathway (AP) located in the lateral mitral atrioventricular ring. Ablation of the AP was carried out successfully through...
The efficacy of radiofrequency (RF) ablation of an uncommon coronary sinus (CS)-dependent atrial flutter (AFL) was evaluated using conventional electrophysiological criteria in a highly selected subset of patients with typical and atypical AFL.
Fourteen patients with atrial flutter (11 males, mean age 69 ± 9 years) without previous right or left at...
Background. The relationship between C-reactive protein (CRP) elevation and ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is unclear. Methods and Results. In 91 consecutive patients with either ARVD/C with or without VT (cases) or idiopathic right ventricular outflow tract (RVOT) tachycardia (con...
We report the case of a 44-year-old man referred to our institution for suspicion of arrhythmogenic right ventricular (RV) cardiomyopathy. Both familial and personal medical histories were unremarkable, except the notion of a slight unexplored heart murmur during childhood. He decided to undergo a “40s” medical checkup. On presentation to the gener...
Five desmosomal genes have been recently implicated in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) but the clinical impact of genetics remains poorly understood. We wanted to address the potential impact of genotyping.
Direct sequencing of the five genes (JUP, DSP, PKP2, DSG2, and DSC2) was performed in 135 unrelated patients...
Paroxysmal atrial fibrillation (PAF) may remain underdiagnosed after stroke, as suggested by long-duration EKG monitoring. Here we report the sensitivity of transtelephonic EKG monitoring (TTM) for detection of PAF in patients following a recent stroke or TIA and a negative 24-hour Holter.
We analyzed data from 98 consecutive patients with TTM and...
We illustrate a case of persistent inappropriate sinus tachycardia after slow pathway atrio-ventricular (AV) nodal reentrant tachycardia cryoablation, and inadvertent fast pathway lesion with residual first-degree AV block in a 72-year-old man with a small Koch's triangle. At the end of the cryoprocedure, the patient presented with sinus tachycardi...
Although Brugada syndrome (BrS) is a primarily electrical disease leading to conduction slowing, it is now acknowledged that structural alterations of the myocardium are frequently associated. Those two factors, may result in both contraction heterogeneity and remodeling of the right ventricle (RV). Radionuclide angiocardiography (RNA) with phase a...
Los pacientes hablan de palpitaciones cuando sienten sus latidos cardíacos. Este síntoma puede reflejar enfermedades muy variadas, que van desde trastornos del ritmo, algunos con un riesgo vital, hasta causas psiquiátricas de diversa gravedad. La anamnesis es fundamental para diferenciar los latidos normales, en el marco de una distonía neurovegeta...
Management of recurrent ventricular tachycardia (VT) remains difficult. Neither medical treatments nor conventional endocardial radiofrequency (RF) ablation are efficient to prevent some recurrences. In these cases, a percutaneous pericardial approach may be required.
Among all the patients referred to our center between 1998 and 2007 for a VT abla...
We report the case of a 41-year-old man with a diagnosis of sporadic arrhythmogenic right ventricular cardiomyopathy (ARVC). Genetic screening identified the heterozygous missense mutation R49H in the desmoglein-2 gene. The mutation was absent in both parents, and we demonstrated that it was a de novo mutation. To the best of our knowledge, this is...
Our purpose was to evaluate the efficacy of antiarrhythmic drugs (AADs) in recurrent ventricular fibrillation (VF) associated with inferolateral early repolarization pattern on the electrocardiogram.
Although an implantable cardioverter-defibrillator is the treatment of choice, additional AADs may be necessary to prevent frequent episodes of VF and...
Until recently it was generally thought that early repolarization is benign. But a recent article in the NEJM (Haissaguerre et al.) suggests that some persons with early repolarization may be at risk of life-threatening ventricular tachyarrhythmia. Unexplained syncope or sudden death occurs mostly during sleep. However, some cases of cardiac arrest...
The study aimed at evaluating the long-term effects of transient atrioventricular (AV) block on clinical outcomes during atrioventricular nodal re-entrant tachycardia (AVNRT) cryoablation.
In 150 consecutive patients (39 +/- 14 years, ineffective anti-arrhythmic drugs 1.9 +/- 1.3), slow-pathway cryoablation for AVNRT was performed. A 7 Fr 6 mm-tip...
Right ventricular (RV) premature contractions, although generally benign, may represent the first manifestation of arrhythmogenic RV cardiomyopathy. The diagnostic and prognostic value of RV functional abnormalities evidenced by equilibrium radionuclide angiocardiography (ERNA) with multiharmonic Fourier analysis has been validated in patients with...
Pericicatricial right intra-atrial reentrant tachycardias occur frequently in patients who have undergone surgical correction of an interatrial defect.
To characterize the tachycardia circuits using three-dimensional electroanatomical mapping.
Twelve tachycardias were analysed in 11 patients who had undergone surgical correction of an interatrial d...
Summary
Purpose of the study. Pacemakers (PM) or implantable cardioverter-defibrillators (ICD) can be disturbed by magnetic field exposure at work. Based on experimental exposure of volunteers and our experience from in situ case studies, we present an approach to evaluate work safety and the worker’s fitness in such situations.
Method. For the PMs...
Travail pluridisciplinaire sur la compatibilité électromagnétique des implantas actifs en milieu professionnel.
Limited information is available on the efficacy of cryoablation in the coronary venous system in humans. A patient with a lateral accessory pathway was referred to our center after several unsuccessful endocardial and epicardial (within the coronary sinus) attempts using standard radiofrequency energy. Ablation was subsequently performed successfu...
Although all races are concerned with the Brugada syndrome, no case has ever been reported among black Africans. We describe five different cases in this specific group of populations.
In all patients, Brugada syndrome was identified after detailed noninvasive and invasive evaluations. Sex ratio was four males for one female. Convulsive syncope was...
Atrial fibrillation (AF) is associated with impaired functional capacity and quality of life and significant morbidity and mortality. The current management approach fails to maintain stable sinus rhythm (SR) in the majority of patients. For many years, guidelines have recommended antiarrhythmic treatment of a first AF episode only if the AF is poo...
Aims To analyse the follow-up data of implantable cardioverter-defibrillator (ICD) therapy in Brugada syndrome (BS). Methods and results We conducted a retrospective, single centre study of 47 patients (mean age: 44.5 + 15 years) with BS, who underwent primary prophylactic ICD implantation. All patients had baseline spontaneous (23 patients) or dru...
Sudden cardiac death is a major cause of mortality in patients suffering from heart failure and left ventricular dysfunction. Recent trials have shown that ICD implantation improves survival with a 25 to 30 % reduction of the overall mortality for primary or secondary prevention. French updated guidelines for ICD implantation indications published...
Objective: Chronically depressed right ventricular (RV) function presents an unresolved therapeutic challenge. Despite recent advances in medical and surgical therapies, prognosis remains poor and patient’s quality of life and mortality are frequently unacceptable. The aim of this work is to present the surgical technique and long-term results of R...
Within the last several years, transvenous cryo-ablation has become an alternative method to perform ablation of the slow-pathway. This study evaluated the acute and long-term safety and effectiveness of atrio-ventricular nodal re-entrant tachycardia (AVNRT) cryo-ablation.
The first 69 consecutive patients with AVNRT (60 slow-fast, 4 fast-slow, and...
The objective of this study was to evaluate the behaviour of implanted pacemakers in the presence of a 50 Hz magnetic field of a magnitude of 100 μT, the maximum limit value set by European recommendation 1999/519/EC concerning public exposure to electromagnetic fields. The study included 265 patients with implanted pacemakers from different manufa...
The EVADEF registry enrolled 2296 patients implanted with a defibrillator between june 2001 and june 2003 and followed up 24 months. Their main characteristics were the following: their mean age was 60±15 years, they were male in 86 %. Their left ventricular ejection fraction was 38.9 ± 15.9 %. They were in NYHA class I or II for 83.8% of them, in...
The EVADEF registry enrolled 2296 patients implanted with a clefibrillator betweenjune 2001 andjune 2003 and followed up 24 months. Their main characteristics were the following: their mean age was 60 +/- 15 years, they were male in 86 %. Their left ventricular ejection fraction was 38.9 +/- 15.9 %. They were in NYHA class I or II for 83.8% of them...
Antiarrhythmic surgery (ventriculotomy) was used in our institution between 1973 and 1980 to treat 15 patients with Arrhythmogenic Right Ventricular Dysplasia (ARVC/D) who had ventricular tachycardia (VT) resistant to antiarrhythmic drug therapy. When catheter ablative procedures became available, we used fulguration (F) with DC energy shock alone...
Recent advances in molecular biology have led to the proposal of the descriptive term of "right ventricle cardiomopathies" to define a group of diseases affecting the right ventricle. "Arrhythmogenic right ventricular dysplasia", Brugada syndrome and right ventricular outflow tract tachycardia are the most frequent forms of presentation. Several ra...
Although non-ischemic dilated cardiomyopathies (NIDCM) account for a minority of patients enrolled in implantable-cardiovertor-defibrillator (ICD) trials, the relative benefit yield by such devices seems to be the same whatever the etiology of the cardiomyopathy is. This risk reduction is estimated between 20 and 35%, in primary or secondary preven...
Unlabelled:
A survey into the implantation of cardiac pacemakers during 2001 in the Ile-de-France area was carried out by the French National Insurance Medical Service in order to evaluate performance in all centres performing more than 10 primary implantations per year.
Methods and results:
In 2001, 12 centres out of a total of 49 performed les...
Atrial fibrillation is associated with a high risk of thromboembolic complications. Several studies have demonstrated the efficacy of oral anticoagulant therapy, in secondary and primary prevention, superior to anti platelet aggregation agents alone. This efficacy has to be balanced against the hemorrhagic risk, lowest with an INR between 2 and 3....
Background The efficacy of radiofrequency (RF) ablation of an uncommon coronary sinus (CS)-dependent atrial flutter (AFL) was evaluated using conventional electro-physiological criteria in a highly selected subset of patients with typical and atypical AFL. Methods Fourteen patients with atrial flutter (11 males, mean age 69 ± 9 years) without previ...
