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Antiarrhythmic Drug and Ablation of Atrial FlutterIntroduction Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation. Methods and Results A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00–1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42–2.54, P < 0.001) and female gender (OR = 1.77, CI = 1.29–2.42, P < 0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, class I antiarrhythmics and amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15–3.88, P = 0.02 and OR = 1.60, CI = 1.08–2.36, P = 0.02, respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc ≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke. Conclusions AF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.

Electrocardiographic criteria of preexcitation syndrome are sometimes not visible on ECG in sinus rhythm (SR). The purpose of the study was to evaluate the significance of unapparent preexcitation syndrome in SR, when overt conduction through accessory pathway (AP) was noted at atrial pacing. Methods Anterograde conduction through atrioventricular AP was identified at electrophysiological study (EPS) in 712 patients, studied for tachycardia (n=316), syncope (n=89) or life-threatening arrhythmia (n=55) or asymptomatic preexcitation syndrome (n=252). ECG in SR at the time of EPS was analysed. Results 78 patients (11%) (group I) had a normal ECG in SR and anterograde conduction over AP at atrial pacing; 634 (group II) had overt preexcitation in SR. Group I was as frequently asymptomatic (35%) as group II (35%), had as frequently tachycardias, syncope or life-threatening arrhythmia as group II (43, 5, 2% vs 43, 13, 8%). AP was more frequently left lateral in group I (57%) than in group II (36%)(p Conclusions The frequency of unapparent preexcitation syndrome represents 11% of our population with anterograde conduction through an AP and could be underestimated. The risk to have a malignant form is as high as in patients with overt preexcitation syndrome in SR.

International audience; Background: Atrial fibrillation (AF) and other supraventricular tachyarrhythmias (SVTA) [atrial flutter (AFL), atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT) and preexcitation syndrome (PS)] are frequently associated. We assessed the AF occurrence frequency and predictors according to the nature of SVTA and completion of SVTA ablation.Methods and results: 4169 patients were referred for SVTA (typical AVNRT: 1338, AVRT over a concealed accessory pathway: 329, atypical AVNRT: 205, AFL: 1321; PS: 976); mean age was 50±20years; electrophysiological study (EPS) was systematic; patients were followed for a mean duration of 3±4.5years. Ablation of SVTA was performed in 2949 patients (71%) and 1220 patients were not treated or treated with antiarrhythmic drugs. AF developed in 469 patients (11.2%). In the multivariable model, AF prior to ablation, history of AF, nature of SVTA (AFL), and presence of heart disease were associated with a high risk of AF during follow-up. Presence of heart failure, old age, diabetes and vascular disease were not predictive of AF. Ablation was a weak but significant factor of AF prevention. A score based on nature of SVTA, presence of heart disease and history of AF is proposed.Conclusions: AF occurrence in patients with SVTA cannot be predicted by the presence of heart failure, old age, diabetes and vascular disease, but only by the following criteria, presence of heart disease, history of AF and nature of the SVTA (SVTA).

Resume Introduction Le but de cette etude a ete de determiner et de rechercher des facteurs susceptibles d’expliquer la survenue d’une syncope chez des sujets qui avaient des tachycardies jonctionnelles paroxystiques (TJP) et un ECG intercritique normal. Methodes Quatre cent dix-neuf patients âges de dix a 88 ans (47 ± 19) avec un ECG intercritique normal, ont ete recrutes consecutivement pour des TJP. Soixante-dix-huit patients avaient presente au moins un episode de syncope. Ils ont eu une etude electrophysiologique systematique pratiquee par voie transœsophagienne, un echocardiogramme, des manœuvres vagales et un tilt-test dans 25 cas. Resultats L’âge, le sexe, la methode d’induction, le mecanisme de la tachycardie, la frequence moyenne en tachycardie ont ete similaires chez les sujets avec et sans syncope. La syncope a ete attribuee a une reaction vagale a l’arret de la TJP (n = 31), une frequence cardiaque rapide en crise (n = 15), une dysfonction sinusale (n = 6), une ischemie coronaire (n = 5), une crise de tetanie (n = 3), un âge tres avance (n = 3), des causes multiples (n = 3) et chez huit sujets est restee inconnue. Le traitement de la TJP par ablation dans 28 cas a supprime la syncope chez 26 sujets. Conclusion En conclusion, une syncope peut survenir chez 18 % des sujets qui ont une histoire de TJP. Plusieurs mecanismes sont possibles. Les plus frequents sont une ischemie coronaire ou une dysfonction sinusale chez les sujets âges, une reaction vagale ou une frequence cardiaque rapide ou une crise de tetanie chez les patients de tous les âges.

Aims Syncope in Wolff–Parkinson–White (WPW) syndrome may reveal an arrhythmic event or is not WPW syndrome related. The aim of the study is to evaluate the results of electrophysiological study in WPW syndrome according to the presence or not of syncope and the possible causes of syncope. Methods and results Among 518 consecutive patients with diagnosis of WPW syndrome, 71 patients, mean age 34.5+ 17, presented syncope. Transoesophageal electrophysiological study in control state and after isoproterenol infusion was performed in the out-patient clinic. Atrioventricular re-entrant tachycardia (AVRT) was more frequently induced than in asymptomatic patients (n ¼ 38, 53.5%, P , 0.01), less frequently than in those with tachycardia; atrial fibrillation (AF) and/or antidromic tachycardia (ATD) was induced in 28 patients (39%) more frequently (P , 0.05) than in asymptomatic patients or those with tachycardia. The incidence of high-risk form [rapid conduction over accessory pathway (AP) and AF or ATD induction] was higher in syncope group (n ¼ 18, 25%, P , 0.001) than in asymptomatic subjects (8%) or those with tachycardias (7.5%). Maximal rate conducted over AP was similar in patients with and without syncope, and higher in patients with spontaneous AF, but without syncope. Results were not age-related. Conclusion Tachycardia inducibility was higher in patients with syncope than in the asymptomatic group. The incidence of malignant WPW syndrome was higher in patients with syncope than in asymptomatic or symptomatic population, but the maximal rate conducted over AP was not higher and another mechanism could be also implicated in the mechanism of syncope.

Resume La signification de la fibrillation auriculaire (FA) dans la cardiomyopathie dilatee primitive (CMD) reste discutee. Le but de l'etude a ete d'evaluer les donnees cliniques, electrophysiologiques et pronostiques de patients ayant une CMD et une FA permanente en comparaison avec des sujets en rythme sinusal. Methodes Trois cent vingt-trois patients ayant une CMD primitive et une fraction d'ejection du ventricule gauche (FEVG) inferieure a 40 % ont ete hospitalises pour des tachycardies ventriculaires (TV) ( n = 69), des syncopes ( n = 103) ou des TV non soutenues sur l'enregistrement Holter ( n = 151). 65 etaient en FA permanente (groupe I), les autres en rythme sinusal (groupe II). Un enregistrement Holter, une mesure de la FEVG et une etude electrophysiologique ont ete realises. Les patients ont ete suivis pendant 3 ± 2 ans. Resultats Les patients du groupe I sont plus souvent des hommes et sont plus vieux que ceux du groupe II (61 ± 8 vs 52 ± 12 ans). Les syncopes (31 vs 36 %), les TV soutenues spontanees (18 vs 23 %), la FEVG (28 ± 9 vs 29 ± 9 %) et l'induction d'une TV (25 vs 35 %) sont similaires dans les deux groupes. Il n'y a pas de difference significative quant aux risques de mort subite (1,5 vs 5 %), de deces lies a une insuffisance cardiaque (5 vs 7 %) ou de transplantation cardiaque (8 vs 3 %). Conclusion Les patients avec CMD primitive et FA permanente sont plus âges que ceux en rythme sinusal. Les autres donnees cliniques, electrophysiologiques et pronostiques ne sont pas affectees par la FA.

Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation.A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.1 ± 2.7 years. Antiarrhythmic drugs were stopped after ablation in patients with no AF prior to ablation, or continued otherwise. A total of 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be females (OR = 1.35, CI = 1.00-1.83, P = 0.05). After ablation, 260 (23.2%) patients experienced AF. In the multivariable model, AF prior to ablation (OR = 1.90, CI = 1.42-2.54, P0.001) and female gender (OR = 1.77, CI = 1.29-2.42, P0.001) were associated with a higher risk of AF after ablation. In patients without prior AF, class I antiarrhythmics and amiodarone prior to AFL ablation were independently associated with higher risk of AF after ablation (OR = 2.11, CI = 1.15-3.88, P = 0.02 and OR = 1.60, CI = 1.08-2.36, P = 0.02, respectively). In patients who experienced AF after ablation, 201/260 (77.3%) had a CHA2DS2-VASc ≥1. Two patients with AF prior to ablation had a stroke during the follow-up whereas none of the patients without AF prior to ablation had a stroke.AF occurrence after AFL ablation is frequent (20%), especially in patients with a history of AF, in female patients, and in patients treated with class I antiarrythmics/amiodarone prior to AFL. Since most patients who experience AF after AFL ablation have a CHA2DS2-VASc ≥1, the decision to stop anticoagulants after ablation should be considered on an individual basis.

International audience; Sex-related differences were not reported for the atrial flutter (AF). The purpose of the study was to look for the influence of gender on indications, clinical data and long-term results of AFl ablation.METHODS:985 patients, [227 females (23%)] were referred for radiofrequency AFl ablation. Clinical history, echocardiography were collected. Patients were followed from 3 months to 10 years.RESULTS:Age of women and men was similar (65.5 ± 12 vs 64 ± 11.5 years). Underlying heart disease (HD) was as frequent in women as men (77.5 vs 77%), but women had more congenital HD (10 vs 2%;p

International audience; Little is known about the epidemiology of 1:1 atrial flutter (AFL). Our objectives were to determine its prevalence and predisposing conditions.Methods1037 patients aged 16 to 93 years (mean 64 ± 12) were consecutively referred for AFL ablation. 791 had heart disease (HD). Patients admitted with 1/1 AFL were collected. Patients were followed 3 ± 3 years.Results1:1 AFL-related tachycardiomyopathy was found in 85 patients, 59 men (69%) with a mean age of 59 ± 12 years. The prevalence was 8%. They were compared to 952 patients, 741 men (78%, 0.04), with a mean age of 65 ± 12 years (0.002) without 1:1 AFL. Factors favoring 1:1 AFL was the absence of HD (35 vs 23%, 0.006), the history of AF (42 vs 30.5%)(0.025) and the use of class I antiarrhythmic drugs (34 vs 13%)(p < 0.0001), while use of amiodarone or beta blockers was less frequent in patients with 1:1 AFL (5, 3.5%) than in patients without 1:1 AFL (25, 15%) (p < 0.0001, 0.03). The failure of ablation (9.4 vs 11%), ablation-related complications (2.3 vs 1.4%), risk of subsequent atrial fibrillation (AF) (20 vs 24%), risk of AFL recurrences (19 vs 13%) and risk of cardiac death (5 vs 6%) were similar in patients with and without 1:1 AFL.ConclusionsThe prevalence of 1:1 AFL in patients admitted for AFL ablation was 8%. These patients were younger, had less frequent HD, had more frequent history of AF and received more frequently class I antiarrhythmic drugs than patients without 1:1 AFL. Their prognosis was similar to patients without 1:1 AFL.

International audience; AIMS:Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT).METHODS AND RESULTS:Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol. Antidromic tachycardia was induced in 63 patients (8%). Clinical and electrophysiological data were compared with those of 744 patients without ADT. Patients with and without ADT were similar in term of age (33 ± 18 vs. 34 ± 17), male gender (68 vs. 61%), clinical presentation with spontaneous atrioventricular reentrant tachycardia (AVRT) (35 vs. 42%), atrial fibrillation (AF) (3 vs. 3%), syncope (16 vs. 12%). In patients with induced ADT, asymptomatic patients were less frequent (24 vs. 37%

Electrocardiographic criteria of preexcitation syndrome are sometimes not visible on ECG in sinus rhythm (SR). The purpose of the study was to evaluate the significance of unapparent preexcitation syndrome in SR, when overt conduction through accessory pathway (AP) was noted at atrial pacing.Anterograde conduction through atrioventricular AP was identified at electrophysiological study (EPS) in 712 patients, studied for tachycardia (n=316), syncope (n=89) or life-threatening arrhythmia (n=55) or asymptomatic preexcitation syndrome (n=252). ECG in SR at the time of EPS was analysed.78 patients (11%) (group I) had a normal ECG in SR and anterograde conduction over AP at atrial pacing; 634 (group II) had overt preexcitation in SR. Group I was as frequently asymptomatic (35%) as group II (35%), had as frequently tachycardias, syncope or life-threatening arrhythmia as group II (43, 5, 2% vs 43, 13, 8%). AP was more frequently left lateral in group I (57%) than in group II (36%)(p0.001). AV re-entrant tachycardia, atrial fibrillation (AF), antidromic tachycardia were induced as frequently in group I (54, 18, 10%) as in group II (54, 27, 7%). Malignant forms (induced AF with RR intervals between preexcited beats250ms in control state or200ms after isoproterenol) were as frequent in group I (11.5%) as II (14%).The frequency of unapparent preexcitation syndrome represents 11% of our population with anterograde conduction through an AP and could be underestimated. The risk to have a malignant form is as high as in patients with overt preexcitation syndrome in SR.

Multiple factors, in addition to left ventricular ejection fraction (LVEF) influence the risk of mortality in coronary artery disease. The purpose of this study was to evaluate the main causes of syncope after myocardial infarction (MI) and to propose an algorithm of management.356 patients consecutively admitted for syncope and history of MI (1 month), without ventricular tachycardia (VT), underwent echocardiography, Holter monitoring, head-up tilt test, exercise testing, signal-averaged ECG, electrophysiological study (EPS) and evaluation of coronary status. The mean follow-up was 4±2 years.Monomorphic VT, ventricular flutter or fibrillation (VF) and supraventricular tachyarrhythmia were respectively induced at EPS in 87, 63 and 39 patients; conduction disturbances were noted in 23 patients, and 57 patients had several abnormalities. Among the 144 patients with negative EPS, coronary ischaemia was identified in 37 patients, and hypervagotonia in 27 patients. All studies remain negative in 84 patients (23.6%), more frequently women (p0.001). Four patients died suddenly during follow-up. A longer QRS duration, a lower LVEF and grade IVa,b of Lown on Holter ECG were associated with the induction of VT. LVEF40% and VT/VF induction were predictors of cardiac mortality, VT was a predictor of sudden death, and low LVEF and advanced age were predictors of death by heart failure.Myocardial ischaemia, hypervagotonia, conduction abnormalities, ventricular or supraventricular tachyarrhythmias were identified in 76% of patients with syncope after MI. Several factors of syncope were found in 57 patients (16%). Non-invasive rhythmological and systematic coronary status assessment should be recommended in patients with syncope following MI.

Fine-QRS complex tachycardia alternating with wide-QRS complex tachycardia can lead to an erroneous diagnosis of paroxysmal supraventricular tachycardia (SVT) with or without aberrancy. The purpose of the study was to evaluate the incidence and the significance of the association of SVT and ventricular tachycardia (VT) in the same patient. Population 898 patients aged from 11 to 88 years were consecutively admitted for a sustained VT; 818 patients had associated heart disease (history of myocardial infarction 374, idiopathic dilated cardiomyopathy 69, arrhythmogenic right ventricular dysplasia 86, miscellaneous 289) and 80 had no apparent heart disease. Methods Electrophysiological study including programmed atrial and ventricular stimulation, 2D cardiac echocardiography, coronary angiography in patients older than 40 years, right ventricular angiography and cardiac RMI since 2002, were performed in these patients. Results Fifteen patients presented (2%) with either SVT or VT. All SVT's were related to an atrioventricular node reentrant tachycardia (AVNRT). The association of SVT and VT was significantly more frequent in patients without heart disease and with verapamil-sensitive VT (n=6/80, 7.5%)( Conclusion The association of SVT and VT is rare in patients with heart disease except in those with arrhythmogenic right ventricular dysplasia. The association is more frequent in patients without heart disease diagnosis and could be underestimated; fine QRS complex tachycardia alternating with wide QRS complex tachycardia leads generally to the erroneous diagnosis of SVT with or without aberrancy.

Radiofrequency (RF) ablation of typical atrial flutter (AFl) is largely used to restore and maintain a sinus rhythm. Little is known on the risk of a third degree atrioventricular block (AVB). The purpose of the study was to evaluate the incidence and the causes of iatrogenic complete AVB during RF ablation of a typical AFl.PopulationAFl ablation was performed in 763 patients (pts), 606 males, 157 females aged from 18 to 90 years (64±12) with recurrent or bad–tolerated typical AFl; 330 pts had associated significant heart disease (valvular 68, congenital 24, ischemic heart disease 71, dilated cardiomyopathy 43, miscellaneous 78) or chronic pulmonary disease (46).MethodsAFl RF catheter ablation was performed by conventional method with setting a HALO catheter in coronary sinus and using an 8-F quadripolar with an 8 mm-tip electrode catheter; a maximum power of 70 w and a maximum target temperature of 70̊ was used. Obtaining a sinus rhythm and a complete isthmus block was the objective of the procedure.ResultsComplete AVB (1%) was noted when sinus rhythm was restored, in 8 pts aged from 59 to 89 years (73±9) significantly older than other pts (63.5±12) (p

Too often, tachycardias of elderly patients are medically treated without evaluation of their mechanism. The purpose of the study was to look for the influence of age on clinical and electrophysiological data and long-term follow-up of patients with paroxysmal supraventricular tachycardia (SVT).MethodsSVT was induced in 1690 patients, 996 females, mean age 49±19 years referred for regular tachycardia. Clinical history, SVT-related complications, echocardiography, results of electrophysiological study, methods of treatment were collected.Results269 patients with SVT were aged from 70 to 97 years (group I),188 from 70 to 79 (group IA) and 81 from 80 to 97 (group IB). Anticoagulants were prescribed in 23 for an erroneous diagnosis of atrial tachycardia. They were compared to 1421 patients

The management and prognosis of heart diseases (HD) or arrhythmias may depend on the patient gender. The purpose of the study was to look for the influence of gender on the indications and the long-term results of ablation of atrial flutter (AFl).Methods965 patients, 743 males, 222 females (23%), mean age 64 ± 12 years were consecutively referred for radiofrequency ablation of recurrent or poor-tolerated AFL Clinical history, other arrhythmias as atrial fibrillation (AF), data of echocardiography were collected. The patients were followed from 3 months up to 10 years.ResultsWomen tended to be older than men (65.5±12 vs 64±11.5 years) (p< 0.08). Underlying HD was as frequent in women as in men (76%). HD nature differed: women had more congenital HD (10 vs 2%, p

Atrial fibrillation (AF) is a major cause of stroke. AF incidence is increased in Wolff-Parkinson-White syndrome (WPW), represents about 10% of spontaneous arrhythmias and has several mechanisms as the degeneration of atrioventricular reentrant tachycardia (AVRT) into AF, the AF facilitation by the atrial insertion of accessory pathway (AP) or another origin. The purpose of study was to assess the incidence of stroke in patients (pts) who had a preexcitation syndrome.Population707 pts aged from 5 to 85 years (mean 34.5±17) were studied for a WPW: 93 pts had unexplained syncope; 247 pts were asymptomatic; 367 pts had spontaneous tachycardias; among these pts 52 had documented AF. Electrophysiological study (EPS) consisted of atrial pacing and programmed atrial stimulation in control state and if necessary after infusion of isoproterenol. Clinical and electrophysiological data were collected.ResultsStroke was noted in 5 pts (0.7%), 2 women, 3 men aged from 53 to 75 years. They had a normal carotid and transcranial Doppler ultrasonography. One pt had ischemic heart disease and the remaining pts had no heart disease. Their age was significantly older than remaining population (62±9 years vs 34±17) (p

International audience; Introduction: Atrial fibrillation (AF) and atrial flutter (AFL) are frequently associated. The aim of the study was to look for the prevalence of previous history of AF in patients referred for radiofrequency ablation of AFL and the possible causes.Methods: 1061 patients, 819 males, 242 females, mean age 64±12 years were referred for ablation of recurrent or poorly-tolerated typical AFL. Clinical history, previous AF, data of echocardiography, was collected. Patients were followed from 3 months to 10 years (mean 3±3 years). Antiarrhythmic drugs (AAD) were stopped after ablation except in patients with previous AF before ablation.Results: 336 patients had presented at least one episode of sustained AF (>1 min) before AFL ablation (group I). The prevalence of AF in this population was high (32%). These patients were compared to remaining patients without know AF (group II). Ages of group I and II were similar (65±11 vs 64±12 years). They were more frequently females in group I (27%) than in group II (24%) (p

BackgroundPatients with heart disease (HD) and syncope are at high risk of sudden death. Implantable defibrillator (ICD) is recommended in patients with unexplained syncope and left ventricular ejection fraction (LVEF) < 30% or in patients with LVEF >30% and inducible ventricular tachycardia (VT).AimThe purpose of the study was to evaluate the prognostic significance of QRS duration measurement in patients with HD and syncope.Methods528 patients, 89 women and 439 men, mean age 65±12 years, were admitted for syncope. All of them had an HD, either ischemic HD (n=382) or left ventricular impairment of other origin (n=115). Holter monitoring, electrophysiological study and head-up tilt test were systematic. Filtered QRS duration was measured at signal-averaged ECG (Fidelity 2000 of Cardionics) (filter 40 Hz, noise level < 0.6 μV). The patients were followed from 3 months up to 18 years (mean 5 ±4 years).ResultsMean LVEF was 40±14%. Cardiac defibrillator was implanted in 73 patients. 30 patients died suddenly, 75 died from heart failure or were transplanted (n=9). Remaining patients are alive or died from non cardiac death (n= 8). The last group differed from group who died suddenly by an higher LVEF (42±14% vs 32±13) (p< 0.00001) and a shorter QRS duration (125±34 msec vs 144±31) (p< 0.026). They tended to be older (65±12 years vs 61±13) (p

The risk of atrial fibrillation (AF) in patients with paroxysmal supraventricular tachycardia (SVT) is well-known. AF is a cause of embolic event and a risk of stroke in patients with SVT can be expected. The purpose of the study was to assess the prevalence of unexplained stroke in patients presenting with SVT and to look for the risk factors. Methods Electrophysiological study (EPS) was performed in 1379 patients without anterograde conduction through accessory pathway (AP) for SVT. Clinical and electrophysiological data were collected. Results Stroke was noted in 38 patients (group I) (prevalence 2.8%). 1341 patients had no stroke (group II). 1) Clinical data: Group I was older than group II (62±13 vs 49±19 years) (p Conclusions Unexplained stroke was a rare event in patients with paroxysmal SVT (2.8%). Old age, and AF history were the only independent significant factors associated with the history of stroke in these patients. They had a risk of severe adverse events during the follow-up as spontaneous AF (21%) or death (8%). SVT ablation did not reduce the risk of new stroke, spontaneous AF or death.

Supraventricular reentrant tachycardia (SVT) can be due to atrioventricular node reentrant tachycardia (AVNRT) or atrioventricular reentrant tachycardia (AVRT) in a concealed or an overt accessory pathway (AP) in patients with a Wolff-Parkinson-White syndrome (WPW). The purpose of the study was to look for the mode of SVT induction and to correlate the mode of induction with the mechanism of the tachycardia.Methods1818 patients were consecutively referred for a SVT. 438 had a WPW (group I). Remaining patients had a normal ECG. At electrophysiological study (EPS), SVT was related to AVRT in 251 patients (group II), to typical AVNRT in 969 patients (group II) and to atypical AVNRT in 160 patients (group IV). Atrial pacing and programmed atrial stimulation with one and 2 extrastimuli were performed in control state (CS). If SVT was not induced, the protocol was repeated after isoproterenol (0.02 to 1 μg. min-1) infused to increase sinus rate to at least 130bpm.ResultsGroups differed by age and gender: group I was younger than group II (36±17 vs 42±17 years) (p < 0.001). Group II was younger than group III (49±19)(p

Programmed ventricular stimulation (PVS) after myocardial infarction (MI) was used 20 years ago to stratify arrhythmic risks. Recent studies recommend PVS early after MI to detect a risk of ventricular tachycardia (VT) and sudden death (SD). The purpose of the study was to look for the actual prognostic significance of inducible ventricular arrhythmias after MI.MethodsPVS was performed between 1985 and January 2012, from 4 to 8 weeks after acute MI in 808 patients with MI, without syncope or ventricular arrhythmias. LVEF was evaluated by echocardiography. PVS used the same protocol (up to 3 extrastimuli in 2 sites of right ventricle).ResultsMonomorphic VT 265bpm) or fibrillation (VF) in 206 (25%). PVS remained negative in 418 patients (52%). Mean follow-up was 8±6.5 years. Cardiac defibrillator (ICD) was implanted in 83 patients from 1994 (10%). Nineteen patients developed spontaneous sustained VT, 35 died suddenly; 103 died from heart failure or were transplanted (HF); 11 died from a noncardiac cause. Their comparison with patients alive or dying from noncardiac death (n=660) indicated that monomorphic VT induction was the only univariate predictor of SD (37%)(p

Ventricular tachycardia (VT) is considered as the main cause for syncope after myocardial infarction (MI). Multiple other causes have been reported. When left ventricular ejection fraction (LVEF) is low (35%), the implantation of a defibrillator (ICD) is recommended. The mortality of these patients (pts) remains relatively high. The purpose of study was to evaluate the main causes implicated in syncope after MI and the clinical factors associated with the diagnosis.Methods363 pts, 307 men, 56 women, consecutively admitted for syncope and history of MI (> 1 month), without VT underwent echocardiography, Holter monitoring, head-up tilt-test, exercise testing, signal-averaged ECG, electrophysiological study (EPS) and evaluation of coronary status. They were followed 4 ± 2 years.ResultsThe presumed cause of syncope was attributed after EPS to a ventricular arrhythmia in 151 pts (monomorphic VT 88, ventricular flutter or fibrillation (VF) 63), to a supraventricular tachyarrhythmia (SVT) in 39 pts, to conduction disturbances in 24 pts; 57 pts had several electrophysiological abnormalities: 26 had inducible VT or SVT and coronary ischemia; hypervagotonia was noted in 8 pts with induced VT or SVT. In the case of negative EPS, coronary ischemia alone was identified in 41 pts, hypervagotonia in 27pts. All studies were negative and syncope remains unexplained in 86 pts (24%), mainly women (p

Atrial fibrillation (AF) is a major cause of embolic event, but the significance of other arrhythmias remains unknown. The purpose of study was to assess the significance of unexplained stroke in patients who had apparently only supraventricular tachycardia (SVT). Population Unexplained stroke was noted in 26 patients (pts) (group I) admitted for palpitations and electrophysiological study (EPS); they were issued from a population of 1002 pts with normal ECG in sinus rhythm, palpitations or tachycardia and with inducible SVT at EPS; 976 pts had no history of stroke (group II). Methods EPS consisted of atrial pacing and programmed atrial stimulation in control state and if necessary after infusion of isoproterenol. Clinical and electrophysiological data of both groups were studied. Pts with stroke had a normal carotid ultrasound study and transcranial Doppler ultrasonography. Results Pts with unexplained stroke represent 2.5% of population with SVT. They were older than remaining pts without stroke (65±10 vs 50±19 years) (p 0.001). They have more frequently associated heart disease (8/26, 31% vs 37/976, 4%) (p Conclusions Old age, male gender, associated heart disease, and induction of atrial fibrillation were significant factors associated with the history of stroke in pts with SVT. They have a risk of adverse events during the follow-up. However, unexplained stroke was a rare event in patients with paroxysmal SVT, noted in 2.5% of this population.

Familial Wolff-Parkinson-White (WPW) syndrome and gene (PRKAG2) was reported. Rare case reports suggest that genetic factors may play a role in the formation of accessory atrioventricular pathways (AP) and dual AV nodal pathways. In this last case, nothing is known, probably because atrioventricular node re-entrant tachycardia (AVNRT) is associated with a good prognosis. The purpose of study was to look for familial forms of AVNRT.Methods792 patients with a preexcitation syndrome, 251 patients with a normal ECG but with atrioventricular re-entrant tachycardia (AVRT) using a concealed AP and 969 patients with AVNRT were referred in our department. Electrophysiological study (EPS) was performed in all subjects. The familial forms in these groups have been sought. Only patients with documented and/or induced supraventricular tachycardia were retained as having tachycardia.ResultsAmong patients with a preexcitation syndrome, we did not find familial form of preexcitation syndrome. Sister of a young patient who had presented a WPW-related ventricular fibrillation complained of tachycardia, but AVNRT was identified at electrophysiological study (EPS). Two other patients had a family history of unexplained sudden death, but no ECG was recorded before death in these patients. Among patients with AVRT and normal ECG, one familial form was noted (father and daughter) (0.4%). Among patients with AVNRT, 7 families were identified (0.7%): mother and son (n=4), mother and daughter (n=1), brother and sister (n=1), father and daughter (n=1). The frequency of familial AVNRT was significantly higher than in patients with a preexcitation syndrome (p

Ventricular tachycardia (VT) may explain syncope after myocardial infarction (MI) and is in this case is associated with a high risk of sudden death, mainly in association with low left ventricular ejection fraction (LVEF). Programmed ventricular stimulation (PVS) remains the main method to look for VT. The purpose of the study was to look for the changes of the population referred for PVS for unexplained syncope after MI during the last 26 years.Methods346 patients were recruited for unexplained syncope after MI between 1982 and 2008: 76 patients (group I) were studied between 1982 and 1989; 151 patients (group II) were studied between 1990 and 1999 and 119 patients (group III) were studied between 2000 and 2008. ECG and 24 hour Holter monitoring did not indicate a possible cause of syncope. LVEF was evaluated in all patients by echocardiography. PVS was systematic with the same protocol (up to 3 extrastimuli in 2 sites of right ventricle).ResultsClinical and electrophysiological data were similar between groups I and II but differed significantly in group III: age was higher in group III (68±12 years) than in group I (64±11) and II (65±12) (p 270/min) and ventricular fibrillation were less frequently induced in group III (9%) than in group I (26%) and II (19%) (p

Patients (pts) with history of paroxysmal supraventricular tachycardia (PSVT) have a higher risk of atrial fibrillation (AF) than other pts. The purpose of the study was to evaluate the incidence of AF in pts seen for PSVT and to look for the factors of AF.Population1099 pts aged from 5 to 85 years were consecutively studied for spontaneous PSVT that was confirmed by electrophysiological study (EPS). Pts with anterograde conduction through an accessory pathway were excluded.MethodsThe history of spontaneous AF was noted. Clinical factors (age, gender, heart disease) and electrophysiological factors were noted. Pts with and without AF were compared.Results62 pts developed documented paroxysmal or permanent AF or flutter (6%). Several clinical factors were associated with AF: pts were older than 1037 pts without AF (59 ± 13 years vs 50 ± 19, p < 0.0009); they were more frequently men (35/62; 56%) than other pts 383/1037; 37%) (p < 0.002). Associated heart disease (HD) (ischemic, valvular, hypertensive HD) was more frequent in pts with AF (17/62; 27%) than in pts without AF (66/1037; 6%) (p < 0.0000). There were no differences at EPS concerning the mechanism of reentry: typical atrioventricular (AV) node re-entrant tachycardia (AVNRT) was noted in 48/62 pts with AF (77%), 712/1037 pts without AF (69%) (NS); reentry in a concealed accessory pathway (AVRT) was noted in 8 pts with AF (14%) and 191 pts without AF (18%) (NS); atypical AVNRT was noted in 6 pts with AF (10%) and 134 pts without AF (13%) (NS). The induction or the spontaneous occurrence of AF during electrophysiological study was more frequent in pts with AF (17/62; 27%) than in pts without AF (113/1037; 11%) (p < 0.00000).ConclusionsThe incidence of AF was 6% in 1099 consecutive patients who had PSVT. The risk was correlated with the classical factors of AF, the older age, the male gender and the presence of HD. The mechanism of the reentry does not change the incidence of AF but the induction of AF is more frequent than in other patients. Thus, patients with PSVT and with these risk factors should be carefully followed.

Programmed ventricular stimulation (PVS) was proposed after myocardial infarction (MI) more than 25 years ago, but the management of MI has changed during this period. The purpose of the study was to look for the results of systematic PVS after MI according to the period of indication and remaining indications.MethodsPVS was performed between 1982 and march 2010, from 4 to 8 weeks after acute MI in 797 patients (pts) without syncope or ventricular tachycardia (VT) to stratify the risk of arrhythmias: 301 (group I) were studied between 1982 and 1989, 315 (group II) between 1990 and 1999 and 179 (group III) between 2000 and 2010. PVS used the same protocol (up to 3 extrastimuli in 2 sites of right ventricle).ResultsGroup III pts were older (61 ± 10 years) than group I (56 ± 11) and group II pts (58 ± 11) (p 265 b/min) was induced less frequently in group III (8%), than in group II (18%, p

Radiofrequency (RF) ablation is a treatment of choice of typical atrial flutter (AFl). However the risk of atrial fibrillation (AF) is high. Heart disease (HD) presence may modify this risk. The purpose of the study was to look for the role of associated HD on previous history of AF and later occurrence of AF after AFl ablation.Methods965 patients, mean age 64±12, were consecutively referred for ablation of recurrent or poor-tolerated AFL. Clinical history, occurrence of AF, data of echocardiography was collected. Patients were followed from 3 months up to 10 years. Antiarrhythmic drugs were stopped after ablation except in patients with history of AF before ablation.ResultsHD was present in 744 patients (77%): hypertensive disease (HTD) (n=186), ischemic HD (IHD) (n=163), valvular HD (VHD) (n=113), dilated cardiomyopathy (DCM) (n= 87), respiratory failure (resp) (n=84), congenital HD (cong) (n=26), miscellaneous HD (n=59). Prior AF was more frequent in patients without HD (67%) than in patients with HD (26%)(p