178 results on '"Pierre Mondoly"'
Search Results
102. P774Hemodynamics of premature bentricular beats and relation to PVC induced-cardiomyopathy
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Marie Sadron, P. Maury, Anne Rollin, Pierre Mondoly, Benjam Monteil, Sophie Billet, and Olivie Lairez
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Internal medicine ,Cardiomyopathy ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2018
103. 66Value of active periodic electrograms in remote management of pacemaker recipients: The PREMS study
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Arnaud Lazarus, F Victor, J P Elkaim, Benoit Guy-Moyat, C Quaglia, F Pons, S Bayle, and Pierre Mondoly
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business.industry ,law ,Physiology (medical) ,medicine ,Artificial cardiac pacemaker ,Medical emergency ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Remote management ,law.invention - Published
- 2018
104. 223Early post-operative ventricular arrhythmias increase mortality in patient with continuous-flow left ventricular assist device
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Vincent Galand, Stéphane Boulé, Pierre Mondoly, M K Kindo, Christophe Leclercq, R E Eschallier, C V Verdonk, F. Sacher, Frédéric Anselme, Jean-Baptiste Gourraud, Pascal Defaye, Philippe Rouvière, Bertrand Pierre, R Martins, and E. Marijon
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medicine.medical_specialty ,business.industry ,Continuous flow ,Physiology (medical) ,Internal medicine ,Ventricular assist device ,medicine.medical_treatment ,medicine ,Cardiology ,In patient ,Post operative ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
105. P789Prevalence and characteristics of Brugada patients diagnosed during chest pain
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F. Sacher, Anne Rollin, P. Maury, Pierre Mondoly, Marie Sadron, Benjam Monteil, and Fathia Sebai
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Medicine ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Chest pain - Published
- 2018
106. Systemic Sarcoidosis Revealed by Ventricular Tachycardia: Electrocardiography and MRI Correspondence
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Pierre Mondoly, Philippe Maury, Decebal Gabriel Latcu, Valerie Chabbert, Marc Delay, David Labarre, and Alexandre Duparc
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Systemic sarcoidosis ,Magnetic resonance imaging ,General Medicine ,equipment and supplies ,medicine.disease ,Ventricular tachycardia ,Granuloma ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Sarcoidosis ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Electrocardiography - Abstract
We describe a case presenting with ventricular tachycardia as the manifestation leading to the diagnosis of sarcoidosis. The ventricular tachyacardia's origin is correlated with granuloma localization on magnetic resonance imaging.
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- 2007
107. Impact of Substrate-Based Ablation of Ventricular Tachycardia on Cardiac Mortality in Patients With Implantable Cardioverter-Defibrillators
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Yuki, Komatsu, Philippe, Maury, Frédéric, Sacher, Paul, Khairy, Matthew, Daly, Han S, Lim, Stephan, Zellerhoff, Laurence, Jesel, Anne, Rollin, Alexandre, Duparc, Pierre, Mondoly, Valerie, Aurillac-Lavignolle, Ashok, Shah, Arnaud, Denis, Hubert, Cochet, Nicolas, Derval, Mélèze, Hocini, Michel, Haïssaguerre, and Pierre, Jaïs
- Abstract
This study sought to determine if the acute procedural outcome of ventricular tachycardia (VT) substrate ablation is associated with a mortality benefit in patients with implantable cardioverter-defibrillators (ICD).A total of 195 ICD recipients (65 ± 11years) with ischemic or nonischemic dilated cardiomyopathy underwent substrate-based ablation targeting elimination of local abnormal ventricular activities (LAVA). Acute procedural success, which was defined as elimination of all identified LAVA in addition to the lack of VT inducibility, was achieved in 95 (49%) patients. During a median follow-up of 23 months, patients with acute procedure success had a significantly lower incidence of ICD shocks compared to those with ablation failure (8% vs. 30%, P0.001). In multivariate analysis, acute procedural success was associated with a lower risk of VT recurrence (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.18-0.49, P0.001) and all-cause mortality (HR 0.32, 95% CI 0.17-0.60, P0.001). While the impact of ablation success on mortality was not statistically significant in patients with LVEF35% (HR 0.45, 95% CI 0.15-1.34, P = 0.15) and those with NYHA class I/II (HR 0.63, 95% CI 0.29-1.40, P = 0.26), it was marked in patients with LVEF ≤ 35% (HR 0.30, 95% CI 0.14-0.62, P = 0.001) and NYHA class III/IV (HR 0.17, 95% CI 0.05-0.57, P = 0.004).LAVA elimination in addition to VT noninducibility as a procedural outcome for substrate-based ablation is associated with reduced mortality and better VT-free survival during follow-up. This prognostic benefit may be most pronounced in patients with severe heart failure as indicated by severely depressed LV function and NYHA class III/IV symptoms.
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- 2015
108. Premature ventricular contraction-induced cardiomyopathy: Related clinical and electrophysiologic parameters
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Michel Haïssaguerre, Arnaud Denis, Vanina Bongard, Christelle Cardin, Philippe Maury, Didier Carrié, Jurg Schlaepfer, Pierre Mondoly, Frederic Sacher, David Hamon, Etienne Pruvot, Mélèze Hocini, Patrizio Pascale, Nicolas Lellouche, Nicolas Derval, Marie Sadron Blaye-Felice, Alexandre Duparc, Pierre Jaïs, Michel Galinier, and Anne Rollin
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Adult ,Male ,medicine.medical_specialty ,Heart disease ,Population ,Statistics as Topic ,Cardiomyopathy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Tachycardia-induced cardiomyopathy ,Physiology (medical) ,Internal medicine ,medicine ,Palpitations ,Humans ,030212 general & internal medicine ,education ,Coronary sinus ,Aged ,Retrospective Studies ,education.field_of_study ,Ejection fraction ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,Ventricular Premature Complexes ,Cardiology ,Catheter Ablation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies ,Electrophysiologic Techniques, Cardiac - Abstract
Background Factors associated with premature ventricular contraction-induced cardiomyopathy (PVCi-CMP) remain debated. Objective The purpose of this study was to test the correlation of various factors to the presence PVCi-CMP in a large multicenter population. Methods One hundred sixty-eight consecutive patients referred for ablation of frequent premature ventricular contractions (PVCs) were included. Patients were divided into 2 groups: group 1 with suspected PVCi-CMP (96 patients, ejection fraction 38% ± 10%, left ventricular end-diastolic diameter 62 ± 8 mm, with or without additional structural heart disease); and group 2 (control group, 72 patients with normal ejection fraction and left ventricular dimensions). Various clinical and electrophysiologic parameters were compared between groups. Results In univariate analysis, left ventricular origin of PVC, lack of palpitations, long PVC coupling interval, epicardial origin of the focus, long sinus beat QRS duration, male gender, high PVC burden, presence of polymorphic PVCs, high PVC QRS duration, and older age were significantly related to the presence of PVCi-CMP. In multivariate analysis, only lack of palpitations, PVC burden, and epicardial origin remained significantly and independently correlated with the presence of cardiomyopathy. Even if sinus QRS duration or PVC left ventricular origin were also found independently linked to PVCi-CMP in the whole population, they were no longer correlated when patients with additional heart disease were excluded. Conclusion Lack of palpitations, PVC burden, and epicardial origin are independent factors that identify patients prone to developing PVCi-CMP.
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- 2015
109. [Factors Associated with Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients with Non-valvular Atrial Fibrillation]
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Layla, Saliba, Pierre, Mondoly, Alexandre, Duparc, Alessandra, Bura-Rivière, Philippe, Maury, Violaine, Calmels, Brigitte, Sallerin, Atul, Pathak, Jean-Louis, Montastruc, and Haleh, Bagheri
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Aged, 80 and over ,Male ,Vitamin K ,Drug Substitution ,Pyridones ,Administration, Oral ,Anticoagulants ,Hemorrhage ,Comorbidity ,Middle Aged ,Antithrombins ,Dabigatran ,Intracranial Embolism ,Rivaroxaban ,Atrial Fibrillation ,Humans ,Pyrazoles ,Thrombophilia ,Female ,Prospective Studies ,Warfarin ,Practice Patterns, Physicians' ,Platelet Aggregation Inhibitors ,Aged ,Factor Xa Inhibitors - Abstract
Describing the factors associated with direct oral anticoagulants (DOA) prescription in patients with atrial fibrillation (AF).This study was performed in Toulouse on a cohort of patients received in rhythmology consultation, treated with vitamin K antagonists (VKA) or DOA for AF. A multivariate model was performed using logistic regression to describe the factors associated with DOA prescription and secondly, those associated with discontinuation of the anticoagulant.Among the 140 patients included, 96 (66%) were treated with VKA and 48 (34%) with DOA. Recent AF diagnosis (OR 7.52, 95% CI [2.41;23.29], p = 0.001), previous exposure to VKA (OR 17.11, 95% CI [4.48;60.91], p0.001), and no current exposure to anti-platelet agents (APA) (OR 7.69, 95% CI [1.22; 50.00], p = 0.030) were associated to DOA prescription. Discontinuation of the anticoagulant (n=24) was associated to DOA intake (OR 2.71, 95% CI [1.21; 6.08], p = 0.016).DOA are less prescribed than VKA in patients treated with APA. DOA switch to VKA was not systematic in patients diagnosed for a long time. However, international normalized ratio (INR) values were stable in most of patients treated with VKA at the switching to DOA. A more powerful study would confirm the factors associated with DOA prescription.
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- 2014
110. Lack of Correlations between Electrophysiological and Anatomical-Mechanical Atrial Remodeling in Patients with Atrial Fibrillation
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Philippe, Maury, Emilie, Thomson, Anne, Rollin, Mathieu, Berry, Thomas, Cognet, Alexandre, Duparc, Pierre, Mondoly, Mathieu, Gautier, Olivier, Lairez, Simon, Méjean, Pierre, Massabuau, Christelle, Cardin, Stéphane, Combes, Jean-Paul, Albenque, and Nicolas, Combes
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Male ,Treatment Outcome ,Cryotherapy ,Echocardiography ,Radio Waves ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Female ,Atrial Remodeling ,Prospective Studies ,Middle Aged ,Aged - Abstract
Atrial fibrillation (AF) progressively leads to electrical remodeling (ER) and anatomical-mechanical remodeling (AR), whose relationships in humans remain poorly known.ER and AR were compared in patients undergoing percutaneous radiofrequency (RF) ablation for AF. ER was defined by right and left appendage activation rates as a surrogate for atrial refractory periods. AR was approached by left atrial (LA) diameters and area and left atrial appendage (LAA) area and contractile function (mean emptying flow velocity) (LAAFV) before RF ablation. Mean duration between successive LAA contractions was considered as LAA mechanical rate.Forty-one patients (31 men, age: 64 ± 9 years) with paroxysmal (27%), persistent (61%), or long-persistent AF (12%) were prospectively included (ejection fraction: 44 ± 16%). Parameters exploring AR were highly correlated to each other: LA area (28 ± 7 cm(2) ), LAA area (5.7 ± 2.25 cm(2) ), LA transverse (49 ± 7 mm), and anteroposterior diameter (59 ± 13 mm) or LAAFV (29 ± 13 cm/s; P0.05 for each comparison). Parameters exploring ER were also highly correlated: right atrial appendage (RAA; 181 ± 39 ms) and LAA (176 ± 33 ms) activation rates (P0.0001). There was no significant correlation between any ER and AR parameter. Only LAA mechanical rate (174 ± 36 ms) was correlated to LAA or RAA activations rates (P ≤ 0.01).ER and AR are not mutually related, atrial activation rate being not correlated to LA or LAA size or function. Thus, the mechanisms leading to AF-induced atrial remodeling may differ for anatomical and electrophysiological aspects.
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- 2014
111. P1473Long-term efficiency of a novel high density mapping system for ablation of atrial tachycardia
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Benjam Monteil, Philippe Maury, L. Marty, Paul Milliez, Anne Rollin, Laure Champ-Rigot, C. Cardin, Marie Sadron, Pierre Mondoly, Stefano Capellino, and Alexandre Duparc
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,High density ,Ablation ,Term (time) ,Physiology (medical) ,Mapping system ,Internal medicine ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial tachycardia - Published
- 2017
112. Ability of 99m Tc-DPD scintigraphy to predict conduction disorders requiring permanent pacemaker in patients with transthyretin-related cardiac amyloidosis
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Olivier Lairez, S. Pradel, P. Pascal, Didier Carrié, P. Maury, S. Brun, Michel Galinier, Pierre Mondoly, David Ribes, Alexandre Duparc, I. Berry, and G. Victor
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medicine.medical_specialty ,biology ,medicine.diagnostic_test ,Conduction disorders ,business.industry ,Scintigraphy ,Transthyretin ,Cardiac amyloidosis ,Internal medicine ,medicine ,biology.protein ,Cardiology ,In patient ,Radiology ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
113. Hybrid treatment of persistent atrial fibrillation: combined epicardial and endocardial ablation
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C. Cardin, Pierre Mondoly, Bertrand Marcheix, A. Rollin, Alexandre Duparc, E. Grunenwald, and P. Maury
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Persistent atrial fibrillation ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,Ablation ,business ,Surgery - Published
- 2017
114. Sudden Modification in QRS Morphology During Entrainment of Ventricular Tachycardia: What Is the Mechanism?
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Anne Rollin, Philippe Maury, Alexandre Duparc, and Pierre Mondoly
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Male ,Qrs morphology ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Action Potentials ,Catheter ablation ,Ventricular tachycardia ,Electrocardiography ,Recurrence ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,business.industry ,Cardiac Pacing, Artificial ,Reentry ,Middle Aged ,medicine.disease ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Entrainment (chronobiology) ,business - Published
- 2011
115. Atrial Oversensing by an LV Lead during Typical Flutter: The Interest of Electronic Repositioning
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Philippe Maury, Marc Delay, Pierre Mondoly, Talia Chilon, Nicolas Detis, Alexandre Duparc, and Anne Rolin
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Tachycardia ,medicine.medical_specialty ,Cavotricuspid isthmus ,business.industry ,medicine.medical_treatment ,Treatment outcome ,General Medicine ,medicine.disease ,Ablation ,Equipment failure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Flutter ,cardiovascular diseases ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Occurrence of supraventricular tachycardia is a common cause of clinical impairment for patients implanted with CRT devices. We report the case of atrial activity oversensing by the left ventricular (LV) lead during typical flutter, which led to LV pacing inhibition. Temporary reprogramming of the LV detection from standard bipolar to extended bipolar and cavotricuspid isthmus ablation solved this problem.
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- 2011
116. Prevalence of type 1 Brugada ECG pattern after administration of Class 1C drugs in patients with type 1 myotonic dystrophy: Myotonic dystrophy as a part of the Brugada syndrome
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Marie Sadron, Franck Raczka, Marie-Christine Arne-Bes, Philippe Maury, Jean-Marc Davy, Mathieu Audoubert, Jean Luc Pasquié, Alexandre Duparc, Blandine Acket, Pierre Mondoly, Anne Rollin, Marc Delay, Michel Galinier, Xinran Zhao, Christelle Cardin, Pascal Cintas, Didier Carrié, and Ana-Maria Chiriac
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Adult ,Male ,medicine.medical_specialty ,Sudden death ,Myotonic dystrophy ,Electrocardiography ,Physiology (medical) ,Internal medicine ,medicine ,Prevalence ,Humans ,Myotonic Dystrophy ,Prospective Studies ,PR interval ,Flecainide ,Brugada syndrome ,Brugada Syndrome ,Voltage-Gated Sodium Channel Blockers ,Ajmaline ,business.industry ,ST elevation ,Incidence ,fungi ,medicine.disease ,Prognosis ,Defibrillators, Implantable ,Survival Rate ,Death, Sudden, Cardiac ,Ventricular fibrillation ,Cardiology ,Female ,France ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Follow-Up Studies - Abstract
Background Both type 1 myotonic dystrophy (MD1) and Brugada syndrome (BrS) may be complicated by conduction disturbances and sudden death. Spontaneous BrS has been observed in MD1 patients, but the prevalence of drug-induced BrS in MD1 is unknown. Objective The purpose of this study was to prospectively assess the prevalence of type 1 ST elevation as elicited during pharmacologic challenge with Class 1C drugs in a subgroup of MD1 patients and to further establish correlations with ECG and electrophysiologic variables and prognosis. Methods From a group of unselected 270 MD1 patients, ajmaline or flecainide drug challenge was performed in a subgroup of 44 patients (27 men, median age 43 years) with minor depolarization/repolarization abnormalities suggestive of possible BrS. The presence of type 1 ST elevation after drug challenge was correlated to clinical, ECG, and electrophysiologic variables. Results Eight of 44 patients (18%) presented with BrS after drug challenge. BrS was seen more often in men (26% vs 6%, P = .09) and was related to younger age (35 vs 48 years, P = .07). BrS was not correlated to symptoms, baseline ECG, HV interval, results of signal-averaged ECG, or abnormalities on ambulatory recordings. MD1 patients with BrS had longer corrected QT intervals, greater increase in PR interval after drug challenge, and higher rate of inducible ventricular arrhythmias (62% vs 21%, P = .03). Twelve patients were implanted with a pacemaker and 5 with an implantable cardioverter-defibrillator. Significant bradycardia did not occur in any patients, and malignant ventricular arrhythmia never occurred during median 7-year follow-up (except 1 hypokalemia-related ventricular fibrillation). Conclusion BrS is elicited by a Class 1 drug in 18% of MD1 patients presenting with minor depolarization/repolarization abnormalities at baseline, but the finding seems to be devoid of a prognostic role.
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- 2014
117. Radio-frequency ablation as primary management of well-tolerated sustained monomorphic ventricular tachycardia in patients with structural heart disease and left ventricular ejection fraction over 30%
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Michel Haïssaguerre, Christian de Chillou, Katja Zeppenfeld, Marc Delay, Francesca Baratto, Andrei Forclaz, Paolo Della Bella, Mélèze Hocini, Philippe Maury, Jurg Schlaepfer, Marius Andronache, Nicolas Sadoul, Nicolas Derval, Didier Klug, I. Magnin-Poull, Frédéric Bouisset, Roman Brenner, Alexandre Duparc, Anne Rollin, Giuseppe Maccabelli, Etienne Delacrétaz, Pierre Mondoly, Pierre Jaïs, Marcin Gawrysiak, George J. Klein, Etienne Pruvot, François Brigadeau, Frederic Sacher, and Dominique Lacroix
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Population ,Cardiomyopathy ,610 Medicine & health ,Ablation ,Ventricular tachycardia ,Sudden death ,Right ventricular cardiomyopathy ,Young Adult ,Recurrence ,Internal medicine ,Implantable cardioverter defibrillator ,Medicine ,Humans ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,Ejection fraction ,business.industry ,Stroke Volume ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,Arrhythmogenic right ventricular dysplasia ,Defibrillators, Implantable ,Death, Sudden, Cardiac ,Treatment Outcome ,Radio-frequency ,Cardiology ,Catheter Ablation ,Tachycardia, Ventricular ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS: Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a 'back-up' implantable cardioverter-defibrillator (ICD). METHODS AND RESULTS: One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%). CONCLUSION: Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strategy.
- Published
- 2014
118. Detection of T wave beta-to-beat variations prior to ventricular arrythmias onset in ICD-stored intracardiac electrograms: the endocardial T-wave alternans study (ETWAS)
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Philippe, Maury, Chao, Lin, Jean-Luc, Pasquié, Frank, Raczka, Lionel, Beck, Jérôme, Taieb, Corinne, Mailhes, Jean-Yves, Tourneret, Anne, Rollin, Alexandre, Duparc, Pierre, Mondoly, Pierre, Winum, Philippe, Rolland, Francis, Castanié, Benoit, Hallier, CHU Toulouse [Toulouse], Signal et Communications (IRIT-SC), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse 1 Capitole (UT1), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse 1 Capitole (UT1), Université Fédérale Toulouse Midi-Pyrénées, Télécommunications Spatiales et Aéronautiques - Telecommunications for Space ant Aeronautics (TéSA), Laboratoire de recherche coopératif dans les télécommunications spatiales et aéronautiques (TESA), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier du Pays d'Aix, CoMputational imagINg anD viSion (IRIT-MINDS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), St Jude Medical, and St. Jude Medical International, Inc., Zaventem, Belgium
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Adult ,Aged, 80 and over ,Male ,implantable cardioverter defibrillator ,sudden death ,Arrhythmias, Cardiac ,Middle Aged ,intracardiac electrogram ,Defibrillators, Implantable ,Cardiac Conduction System Disease ,Heart Conduction System ,Tachycardia, Ventricular ,cardiovascular system ,Humans ,Female ,[INFO]Computer Science [cs] ,Prospective Studies ,ventricular tachycardia ,Electrophysiologic Techniques, Cardiac ,wave alternans ,Aged ,Brugada Syndrome - Abstract
International audience; Background: The aim of the Endocardial T-Wave Alternans Study was to prospectively assess thepresence of T-wave alternans (TWA) or beat-to-beat repolarization changes on implantable cardioverter-defibrillator (ICD)-stored electrograms (EGMs) immediately preceding the onset of spontaneous ventriculartachycardia (VT) or fibrillation (VF). Methods: Thirty-seven VT/VF episodes were compared to 116 baseline reference EGMs from the same57 patients. A Bayesian model was used to estimate the T-wave waveform in each cardiac beat and a setof 10 parameters was selected to segment each detected T wave. Beat-by-beat differences in each T-waveparameter were computed using the absolute value of the difference between each beat and the followingone. Fisher criterion was used for determining the most discriminant T-wave parameters, then top-Mranked parameters yielding a normalized cumulative Fisher score>95% were selected, and analysis wasapplied on these selected parameters. Simulated TWA EGMs were used to validate the algorithm. Results: In the simulation study, TWA was detectable even in the case of the smallest simulatedalternans of 25μV. In 13 of the 37 episodes (35%) occurring in nine of 16 patients, significant largerbeat-to-beat variations before arrhythmia onset were detected compared to their respective references(median one positive episode per patient). Parameters including the T-wave apex amplitude seem themore discriminant parameters.Conclusions:Detection of beat-by-beat repolarization variations in ICD-stored EGMs is feasible ina significant subset of cases and may be used for predicting the onset of ventricular arrhythmias.
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- 2014
119. Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB–TAVI Study
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Bruno Pereira, Pascal Defaye, Alexis Mechulan, Sylvain Ploux, Antoine Da Costa, Frédéric Jean, Grégoire Massoullié, Didier Irles, Christophe Caussin, Pierre Mondoly, Géraud Souteyrand, Pierre Bordachar, and Romain Eschalier
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Cardiac Catheterization ,Pacemaker, Artificial ,medicine.medical_treatment ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,Intracardiac injection ,Electrocardiography ,Postoperative Complications ,0302 clinical medicine ,Cardiac Conduction System Disease ,Protocol ,Medicine ,030212 general & internal medicine ,remote monitoring ,Cardiac electrophysiology ,Left bundle branch block ,Ethics committee ,Heart ,General Medicine ,Prognosis ,Treatment Outcome ,Research Design ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Algorithms ,Adult ,medicine.medical_specialty ,Transcatheter aortic ,Bundle-Branch Block ,Clinical Decision-Making ,Lower risk ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Internal medicine ,Humans ,Monitoring, Physiologic ,Transcatheter aortic valve implantation ,Percutaneous aortic valve replacement ,business.industry ,medicine.disease ,Electrophysiological Phenomena ,Surgery ,business ,Complication ,cardiac electrophysiology - Abstract
Introduction Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. Method and analysis The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His–ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV
- Published
- 2016
120. Concealed left superior accessory pathway. Distinctive features of retrograde atrial activation and successful ablation using transseptal approach
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Pierre Mondoly, Alexandre Duparc, Alain Graffeille, Anne Rollin, Marc Delay, Philippe Maury, and Aurélien Hébrard
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Male ,Tachycardia ,Bundle of His ,medicine.medical_specialty ,medicine.medical_treatment ,Accessory pathway ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Heart Septum ,Tachycardia, Supraventricular ,medicine ,Humans ,Heart Atria ,Cardiac Surgical Procedures ,Tachycardia, Paroxysmal ,Coronary sinus ,business.industry ,Coronary Sinus ,Middle Aged ,Atrial activation ,Ablation ,Catheter Ablation ,Cardiology ,medicine.symptom ,Left superior ,Cardiology and Cardiovascular Medicine ,business ,Inferior left - Abstract
Concealed left superior accessory pathways are very infrequent and can be difficult to diagnose and ablate. We describe here the case of a patient presenting with reciprocating tachycardia involving superior and inferior left accessory pathways. Left superior accessory pathway was suspected because of the simultaneous retrograde atrial activation at the distal coronary sinus (CS) and His bundle lead and could be successfully ablated using transseptal catheterization.
- Published
- 2009
121. Reverse left septal activation during intermittent left bundle-branch block
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Alexandre Duparc, Pierre Mondoly, Marc Delay, Philippe Maury, Aurélien Hébrard, and Anne Rollin
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medicine.medical_specialty ,business.industry ,Left bundle branch block ,medicine.disease ,Intracardiac injection ,medicine.anatomical_structure ,Internal medicine ,Bundle ,Left bundle branch ,medicine ,Cardiology ,Interventricular septum ,Cardiology and Cardiovascular Medicine ,business - Abstract
Concealed retrograde activation of bundle branch has been often proposed for explaining the persistence of functional rate-dependent bundle-branch block, but direct proof of such a mechanism in man has rarely been demonstrated. We report intracardiac recordings compatible with a reversal of activation of the left basal interventricular septum during intermittent left bundle-branch block. In our case, however, retrograde activation into the left bundle-branch cannot be recordable, probably due to the concealment within the muscular septal activation, even if this may explain the perpetuation of bundle-branch block according to the linking phenomenon.
- Published
- 2009
122. 0379: Premature ventricular beat-induced cardiomyopathy. Characteristics and prognosis factor for recovery after radio-frequency ablation
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Michel Haïssaguerre, Alexandre Duparc, Pierre Mondoly, Anne Rollin, Marc Delay, Nicolas Lellouche, Patrizio Pascale, Nicolas Derval, Frederic Sacher, Pierre Jaïs, Christelle Cardin, Mélèze Hocini, Marie Sadron, and Philippe Maury
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medicine.medical_specialty ,Premature ventricular beats ,business.industry ,medicine.medical_treatment ,Cardiomyopathy ,Diastole ,Beat (acoustics) ,medicine.disease ,Ablation ,QRS complex ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Palpitations ,Cardiology ,Medicine ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine - Abstract
IntroductionFrequent premature ventricular beats (PVB) may induce cardiomyopathy (CM). Characteristics and prognosis factor for recovery after RF ablation remain debated.Methods93 patients (74% men, 58±14 yo) with dilated CM associated with frequent isolated PVB were included. A group of 75 pts undergoing ablation for symptomatic PVB without significant cardiac disease serves as the control group.ResultsEF was 38±10% and left ventricular end diastolic diameter (LVEDD) was 63±8mm. One third have various associated cardiomyopathy.PVB burden was 27±12%. PVB arose from the left ventricle in 96 pts (LVOT 61, mitral 16, apex 7, septal 12) and from the right ventricle in 61 pts (RVOT 58) and multiple in 11. Epicardial ablation in the CS was needed in 25.In multivariate analysis, lack of palpitations (OR 9.09 [3.45-33.33]), VPB number > 20000 (OR 5.40 [1.98-14.70]), left ventricular origin (OR 4.12 [1.53-11.11]), epicardial location (OR 11.00 [1.92-62.50]), VPB right inferior axis (OR 2.31 [0.85-6.27]), baseline QRS width > 100ms (OR 3.66 [1.2810.43]), VPB coupling interval > 500ms (OR 3.11 [1.14-8.55]) and polymorphic VPB (OR 10.40 [1.05-103.05]) were independantly associated with CM compared to controls (p 80% reduction). In these, EF increased (36±9 to 51±12%, p 10% increase in EF. Only a VPB > 2mV (OR 19.2 [1.84-200.00], p=0.01) was independanlty associated with reversal of CM in multivariate analysis.ConclusionMechanisms leading to PVB-induced CM may involve lack of palpitations, a high VPB number, a left ventricular origin, an epicardial location, a VPB right inferior axis, a large baseline QRS duration, a long VPB coupling interval and polymorphic VPB. Reversal of CM after RF ablation may associate a high VPB amplitude and a shorter VPB coupling interval. This may help in selecting patients for RF ablation of suspected VPB-induced CM.
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- 2015
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123. Prevalence and prognostic role of various conduction disturbances in patients with the Brugada syndrome
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Marc Delay, Vanina Bongard, Laurence Jesel, Jean-Marc Davy, Marie Sadron, Pierre Jaïs, Vincent Probst, Nicolas Derval, Frederic Sacher, Franck Raczka, Jean-Baptiste Gourraud, Arnaud Denis, Philippe Maury, Jean-Luc Pasquié, Alexandre Duparc, Anne Rollin, Michel Haïssaguerre, Christelle Cardin, Stéphanie Chatel, Pierre Mondoly, and Mélèze Hocini
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Male ,medicine.medical_specialty ,Asymptomatic ,Sudden death ,Electrocardiography ,Heart Conduction System ,Internal medicine ,Confidence Intervals ,Odds Ratio ,Prevalence ,Medicine ,Humans ,Brugada syndrome ,Brugada Syndrome ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,ST elevation ,Odds ratio ,Right bundle branch block ,Middle Aged ,medicine.disease ,Prognosis ,Survival Rate ,Death, Sudden, Cardiac ,First-degree atrioventricular block ,Cardiology ,Female ,France ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Prevalence and prognostic value of conduction disturbances in patients with the Brugada syndrome (BrS) remains poorly known. Electrocardiograms (ECGs) from 325 patients with BrS (47 ± 13 years, 258 men) with spontaneous (n = 143) or drug-induced (n = 182) type 1 ECG were retrospectively reviewed. Two hundred twenty-six patients (70%) were asymptomatic, 73 patients (22%) presented with unexplained syncope, and 26 patients (8%) presented with sudden death or implantable cardioverter-defibrillator appropriated therapies at diagnosis or during a mean follow-up of 48 ± 34 months. P-wave duration of ≥120 ms was present in 129 patients (40%), first degree atrioventricular block (AVB) in 113 (35%), right bundle branch block (BBB) in 90 (28%), and fascicular block in 52 (16%). Increased P-wave duration, first degree AVB, and right BBB were more often present in patients after drug challenge than in patients with spontaneous type 1 ST elevation. Left BBB was present in 3 patients. SCN5A mutation carriers had longer P-wave duration and longer PR and HV intervals. In multivariate analysis, first degree AVB was independently associated with sudden death or implantable cardioverter-defibrillator appropriated therapies (odds ratio 2.41, 95% confidence interval 1.01 to 5.73, p = 0.046) together with the presence of syncope and spontaneous type 1 ST elevation. In conclusion, conduction disturbances are frequent and sometimes diffuse in patients with BrS. First degree AVB is independently linked to outcome and may be proposed to be used for individual risk stratification.
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- 2013
124. 205: Lack of correlations between electrical and anatomical-mechanical left atrial remodeling in patients with atrial fibrillation
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Mathieu Gauthier, Philippe Maury, Mathieu Berry, Pierre Massabuau, Pierre Mondoly, Alexandre Duparc, Jean Paul Albenque, Thomas Cognet, Nicolas Combes, Brice Arnaudis, Anne Gardères-Rollin, Olivier Lairez, Marc Delay, and Emilie Thomson
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medicine.medical_specialty ,business.industry ,Left atrium ,Atrial fibrillation ,Atrial activation ,medicine.disease ,Amiodarone ,medicine.anatomical_structure ,Left atrial ,Internal medicine ,medicine ,Cardiology ,In patient ,business ,Cardiology and Cardiovascular Medicine ,Rf ablation ,Atrial Remodeling ,medicine.drug - Abstract
IntroductionAtrial fibrillation (AFib) progressively leads to electrical remodeling (ER) and anatomical-mechanical remodeling (AMR) whose relationships remain poorly known.MethodsER and AMR were compared in patients undergoing percutaneous RF ablation for AFib. ER was defined by right and left appendage activation rate (RAAAR and LAAAR) as a surrogate for atrial refractory periods. AMR was approached by left atrium (LA) diameters and area and left atrial appendage (LAA) area and contractile function (mean emptying flow velocity) (LAAFV) as determined during transoesophageal and transthoracic echocardiography performed during AFib the day before or immediately before RF ablation. Mean duration between successive LAA contractions was considered as LAA mechanical rate.Results40 pts with paroxysmal AFib (n=10), persistent AFib (n=25) or long-persistent AFib (n=5) were included (30 men, 64±9 yo, EF 39±14%). 63% were on amiodarone.Parameters exploring AMR were highly correlated to each other: LA area 27±7cm2; LAA area 5.5±2cm2; LA transv 48±14 mm; LA ant-post 58±13 mm; LAA velocity 28±13cm/sec (p
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- 2013
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125. 174: Premature ventricular beat-induced cardiomyopathy Characteristics and prognosis after radio-frequency ablation
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Christelle Cardin, Marc Delay, Philippe Maury, Pierre Mondoly, Alexandre Duparc, Nicolas Dumonteil, Anne Rollin, and Marie Sadron
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medicine.medical_specialty ,Premature ventricular beats ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Cardiomyopathy ,Beat (acoustics) ,Ablation ,medicine.disease ,Nyha class ,Surgery ,Internal medicine ,Left bundle branch ,Cardiology ,Medicine ,business ,Cardiology and Cardiovascular Medicine ,Rf ablation - Abstract
IntroductionFrequent premature ventricular beats (PVB) may induce cardiomyopathy (CM) whose characteristics and underlying mechanisms are poorly knownMethods38 patients (27 men, 57±16yo) with dilated CM associated with frequent isolated PVB suspected to be responsible the CM were ablated between 2005 and 2011. PVB were documented 5 years (n=10) before (unknown in 9). Ejection fraction (EF), left ventricular end-diastolic diameter (LVEDD) and NYHA class were compared before and after radio-frequency ablation. 16 pts with symptomatic PVB without CM serves as the control groupResultsBaseline EF was 39±1%, LVEDD was 61±7mm and mean NYHA class was 1.9±0.8. PVB arose from the RV in 10 pts (RVOT in 7) and from the LV in 28 pts (LVOTt in 10 and coronary cusps in 10)Compared to the control group, daily PVB number was not different in pts with suspected VPB-induced CM (22000±12000 vs 20000±14000, p=ns), as was the presence of PVB left bundle branch pattern (24/38 vs 13/16, p=ns) and gender or age. Pts with suspected PVB-induced CM had more often right axis VPB (31/37 vs 10/16, p=0.08). History of PVB was shorter in controls. Origin of the PVB did not differ between groupsRF ablation completely eliminated PVB in 26 pts (68%), partially in 4 and was inefficient in 8. During a follow up of 19±19 months, EF increased from 39±10 to 52±13% (p=0.003) while LVEDD decrease from 61±7 to 56±7mm (p=0.002) leading to a decrease in NYHA class (1.9±0.8 to 1.4±0.6, p=0.02). Parameters related to the failure of ablation were an older age, a higher NYHA class and a LVOT location of the focus. Parameters related to the lack of reversal of CM in successful ablations, were an older age, a lower baseline EF, but not the length of PVB history.ConclusionRF ablation of frequent PVB may lead to cure or significant improvement in 78% of pts with associated CM. Plausible mechanisms leading to a PVB-induced CM may associate a more longer history of PVB.
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- 2013
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126. 16-81: Prevalence of early repolarisation in children
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Cardin Christelle, Alexandre Duparc, Acar Philippe, Philippe Maury, Pierre Mondoly, Authenac Céline, Hascoet Sebastien, Dulac Yves, and Rollin Anne
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Pediatrics ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
127. 56-18: Use of the Rythmia ™ system for mapping atrial flutter in univentricular heart after Fontan procedure
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Acar Philippe, Capellino Stefano, Philippe Maury, Alexandre Duparc, Rollin Anne, Dulac Yves, Hascoet Sebastien, Blot-Souletie Nathalie, Cardin Christelle, and Pierre Mondoly
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Fontan procedure ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,medicine.medical_treatment ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Atrial flutter ,Univentricular heart - Published
- 2016
128. 16-86: Prevalence and prognosis role of wide QRS and of QRS 'narrower than normal'
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Philippe Maury, Bernard Ruidavet Jean, Cardin Christelle, Ferrieres Jean, Sadron Marie, Lematte Elodie, Rollin Anne, Alexandre Duparc, and Pierre Mondoly
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medicine.medical_specialty ,QRS complex ,business.industry ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
129. 16-56: Sleep Apnea Syndrome in a Multicentric Study on Patients with Device Remote Monitoring System
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Pascal Defaye, Florian Dugenet, Romain Eschalier, Peggy Jacon, Pierre Bordachar, Sandrine Venier, and Pierre Mondoly
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Emergency medicine ,medicine ,Sleep apnea ,Monitoring system ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2016
130. 216-35: Performance of the RYTHMIQ(TM) algorithm to minimize right ventricular pacing: a multicenter study
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Michel Haïssaguerre, Sylvain Ploux, Marc Strik, Frontera Antonio, Kenneth A. Ellenbogen, Romain Eschalier, Pascal Defaye, Philippe Ritter, Pierre Bordachar, and Pierre Mondoly
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medicine.medical_specialty ,Multicenter study ,business.industry ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,Ventricular pacing ,Atrioventricular dissociation ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
131. A randomized study of defibrillator lead implantations in the right ventricular mid-septum versus the apex: the SEPTAL study
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Pascal Defaye, Dominique Babuty, Jean-Pierre Cebron, Philippe Mabo, Frédéric Anselme, Jean-Claude Daubert, Olivier Paziaud, Elisabeth Mouton, Jean Marc Davy, Pierre Mondoly, Aude Tassin, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiac Stimulation and Rhythmology, CHU Grenoble, CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de cardiologie [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Male ,medicine.medical_treatment ,MESH : Aged ,heart failure ,MESH: Logistic Models ,Electrocardiography ,0302 clinical medicine ,MESH: Treatment Outcome ,MESH: Middle Aged ,MESH: Ventricular Septum ,MESH : Electric Countershock ,Cardiac Pacing, Artificial ,Implantable cardioverter-defibrillator ,3. Good health ,Defibrillators, Implantable ,MESH : Electrocardiography ,Ventricular Fibrillation ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Heart Ventricles ,Electric Countershock ,MESH: Cardiac Pacing, Artificial ,Sudden death ,MESH: Defibrillators, Implantable ,Disease-Free Survival ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Physiology (medical) ,Humans ,MESH : Middle Aged ,MESH: Kaplan-Meier Estimate ,Aged ,MESH: Humans ,MESH : Humans ,MESH: Adult ,medicine.disease ,MESH: Single-Blind Method ,MESH : Prosthesis Design ,Logistic Models ,MESH: Disease-Free Survival ,MESH : Heart Ventricles ,Feasibility Studies ,MESH: Tachycardia, Ventricular ,MESH: Heart Ventricles ,MESH: Feasibility Studies ,MESH: Female ,right ventricular apex ,MESH : Logistic Models ,Tachycardia ,implantable cardioverter defibrillator ,Time Factors ,MESH : Single-Blind Method ,MESH: Electric Countershock ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Implantable defibrillator ,MESH : Ventricular Septum ,MESH : Female ,right ventricular mid-septum ,Single-Blind Method ,030212 general & internal medicine ,[ SDV.IB ] Life Sciences [q-bio]/Bioengineering ,MESH: Aged ,leads ,Ejection fraction ,pacing ,medicine.diagnostic_test ,MESH : Adult ,[ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Middle Aged ,MESH: Ventricular Fibrillation ,Treatment Outcome ,MESH : Disease-Free Survival ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Female ,France ,medicine.symptom ,MESH: Prosthesis Design ,MESH : Time Factors ,Adult ,MESH : Feasibility Studies ,MESH : Ventricular Fibrillation ,MESH : Male ,sudden death ,MESH : Treatment Outcome ,Ventricular Septum ,MESH : Tachycardia, Ventricular ,Prosthesis Design ,MESH : Kaplan-Meier Estimate ,medicine ,MESH : France ,business.industry ,MESH: Time Factors ,MESH: Male ,Surgery ,MESH : Cardiac Pacing, Artificial ,MESH: Electrocardiography ,MESH: France ,Heart failure ,Tachycardia, Ventricular ,Implant ,business ,MESH : Defibrillators, Implantable - Abstract
Impact of Recalls on ICD Utilization. Introduction: The study was designed to evaluate the feasibility and performance of right ventricular (RV) mid-septal versus apical implantable defibrillator (ICD) lead placement. Methods and Results: SEPTAL is a randomized, noninferiority trial, which randomly assigned patients to implantation of ICD leads in the RV mid-septum versus apex, with a primary objective of comparing the implant success rate of implant at each site, based on strict electrical predefined criteria. We also compared the (1) pacing lead characteristics, (2) rates of appropriate and inappropriate ICD therapies, and (3) all-cause mortality between the 2 sites at 1 year. The trial enrolled 215 patients (mean age = 59.7 ± 12.4 years, mean LVEF = 34.0 ± 14.2%, 84.2% men), of whom 148 (68.8%) presented with ischemic heart disease. The ICD indication was primary prevention in 117 patients (54.4%). The lead was successfully implanted in 96/107 patients (89.7%) assigned to the RV mid-septum, and in 99/108 (91.7%) assigned to the apex (ns). The 1-year rate of lead-related adverse events was similar in both groups. A total of 8 first inappropriate ICD therapies (7.9%) were delivered in the RV mid-septal group, versus 8 (7.8%) in the apical group (ns), while first appropriate therapies were delivered to 22 (21.4%) and 24 patients (23.8%), respectively (ns). All-cause mortality was 7.9% in the RV mid-septal versus 2.9% in the RV apical group (ns). Conclusion: This study confirmed the technical feasibility and noninferior performance of ICD leads implanted in the RV mid-septum versus the apex. (J Cardiovasc Electrophysiol, Vol. 23, pp. 853-860, August 2012)
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- 2012
132. 236 Per-operative evaluation of adding second left lead on very dilated patients
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Marc Delay, Didier Carrié, Philippe Maury, Mathieu Berry, Anne Rollin, Nicolas Detis, Pierre Mondoly, and Alexandre Duparc
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medicine.medical_specialty ,business.industry ,medicine ,Lead (electronics) ,business ,Cardiology and Cardiovascular Medicine ,Surgery - Published
- 2012
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133. 192 Invasive assessment of atrioventricular conduction changes following transcatheter aortic valve implantation with self-expandable or balloon-expandable prosthesis
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A. Rollin, Alexandre Duparc, Pierre Mondoly, Didier Tchetche, Didier Carrié, P. Maury, Nicolas Dumonteil, Nicolas Boudou, Bertrand Marcheix, Marc Delay, Mathieu Gautier, and Thibault Lhermusier
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medicine.medical_specialty ,Balloon expandable stent ,Transcatheter aortic ,business.industry ,Self expandable ,Internal medicine ,medicine.medical_treatment ,Atrioventricular conduction ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine ,Prosthesis - Published
- 2012
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134. Microvolt T-Wave Alternans in Short QT Syndrome
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Philippe, Maury, Fabrice, Extramiana, Carla, Giustetto, Cristelle, Cardin, Anne, Rollin, Alexandre, Duparc, Pierre, Mondoly, Isabelle, Denjoy, Marc, Delay, Anne, Messali, Antoine, Leenhardt, and Daniele, Marangoni
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Adult ,Male ,short QT syndrome ,T-wave alternans ,sudden cardiac death ,Arrhythmias, Cardiac ,Syndrome ,Statistics, Nonparametric ,Syncope ,Electrocardiography ,Death, Sudden, Cardiac ,Heart Conduction System ,Risk Factors ,Ventricular Fibrillation ,Humans ,Female ,Prospective Studies - Abstract
T-wave alternans (TWA) is an accepted marker of risk for malignant ventricular arrhythmias, for which prognosis value has been established in different populations. Short QT syndrome (SQTS) is a very rare primary electrical disease carrying the risk of ventricular fibrillation. TWA in SQTS has not been evaluated yet.Thirteen patients with SQTS (QT = 308 ± 16 ms, QTc = 329 ± 10 ms, heart rate = 69 ± 8 beats/min) underwent microvolt TWA measurement using spectral analysis. TWA testing was performed using Heartwave II (Cambridge Heart™, Inc., Bedford, MA, USA) during bicycle exercice and classified as negative, positive, or indeterminate according to the published standards for clinical interpretation.Twelve patients were male (mean age 23 ± 5 years). Five were asymptomatic, three presented with aborted sudden cardiac death, and five with unexplained syncope. Six patients belonged to two unrelated families, while familial cases of SQTS were present for two other patients. A familial history of sudden death (SD) was present for seven patients. Ventricular fibrillation was inducible in three patients. Four patients were implanted with an implantable cardioverter-defibrillator and one presented with polymorphic ventricular tachycardia during follow-up. TWA was negative in each but one patient (indeterminate). Maximal negative heart rate was 118 ± 12 beats/min. Patients with previous SD displayed significant shorter QT and higher resting heart rate compared to the remaining cases.TWA testing is negative in 12 of 13 SQTS patients, even in the symptomatic or inducible ones. Measurement of TWA using conventional protocol and criteria for risk stratification in SQTS seems therefore useless.
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- 2012
135. 211 Validation of transmural dispersion of repolarization in a large series of Brugada syndrome patients. Increased Tpeak-Tend interval in Brugada syndrome is independantly related to symptoms or arrhythm
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Jean Luc Pasquié, Marc Delay, Alexandre Duparc, Michel Galinier, Didier Carrié, Vanina Bongard, Philippe Maury, Pierre Jaïs, Pierre Mondoly, Mélèze Hocini, Michel Haïssaguerre, Frederic Sacher, F. Raczka, Anne Rollin, C. Cardin, and Jean-Marc Davy
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medicine.medical_specialty ,business.industry ,Transmural dispersion ,Large series ,medicine.disease ,Internal medicine ,medicine ,Cardiology ,cardiovascular system ,Repolarization ,Interval (graph theory) ,Tpeak tend ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine ,Brugada syndrome - Published
- 2012
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136. 212 Late outcome of radio-frequency ablation for monomorphic sustained Ventricular tachycardia in patients with underlying heart disease without implantation of a defibrillator
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Philippe Maury, Paolo Della Bella, Katja Zeppenfeld, Etienne Delacretaz, Frederic Sacher, Jurg Schlaepfer, Francois Brigadeau, Anne Rollin, Giuseppe Maccabelli, Francesca Baratto, Marcyn Gawrysiak, Roman Brenner, Andrei Forclaz, Alexandre Duparc, Pierre Mondoly, Marc Delay, Meleze Hocini, Pierre Jaïs, and Michel Haïssaguerre
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medicine.medical_specialty ,Heart disease ,business.industry ,medicine.medical_treatment ,Late outcome ,Ablation ,medicine.disease ,Sustained ventricular tachycardia ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine - Published
- 2012
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137. Incessant atrio-ventricular node reentrant tachycardia induced by unapparent dual atrio-ventricular node conduction
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Philippe, Maury, Nicolas, Detis, Alexandre, Duparc, Pierre, Mondoly, Anne, Rollin, and Marc, Delay
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Adult ,Electrocardiography ,Heart Conduction System ,Atrioventricular Node ,Catheter Ablation ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Electrophysiologic Techniques, Cardiac - Abstract
We present the case of a patient with incessant slow-fast atrio-ventricular (AV) node reentrant tachycardia induced by dual AV node conduction with aborted conduction to the ventricles. The unapparent conduction over the slow pathway was suspected here because of spontaneous nodal echoes without QRS complexes occurring during sinus rhythm, manifested as isolated premature atrial beats and which repetitively induced the tachycardia.
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- 2011
138. Atrial oversensing by an LV lead during typical flutter: the interest of electronic repositioning
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Alexandre, Duparc, Pierre, Mondoly, Nicolas, Detis, Talia, Chilon, Anne, Rolin, Philippe, Maury, and Marc, Delay
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Male ,Electrocardiography ,Treatment Outcome ,Atrial Flutter ,Heart Ventricles ,Therapy, Computer-Assisted ,Tachycardia, Supraventricular ,Humans ,Equipment Failure ,Aged ,Electrodes, Implanted - Abstract
Occurrence of supraventricular tachycardia is a common cause of clinical impairment for patients implanted with CRT devices. We report the case of atrial activity oversensing by the left ventricular (LV) lead during typical flutter, which led to LV pacing inhibition. Temporary reprogramming of the LV detection from standard bipolar to extended bipolar and cavotricuspid isthmus ablation solved this problem.
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- 2011
139. 185 T wave alternans in short QT Syndrome
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Anne Rollin, Marc Delay, Alexandre Duparc, Philippe Maury, and Pierre Mondoly
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medicine.medical_specialty ,business.industry ,Short QT syndrome ,T wave alternans ,medicine.disease ,QT interval ,Asymptomatic ,Sudden cardiac death ,Channelopathy ,Internal medicine ,Ventricular fibrillation ,Heart rate ,medicine ,Cardiology ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine - Abstract
Introduction T wave alternans (TWA) is a reliable marker of risk for malignant ventricular arrhythmias whose prognosis value has been established in many populations. Short QT syndrome (SQTS) is a recently described and very rare channelopathy defined by a decrease in repolarisation duration and carrying a risk of ventricular fibrillation. TWA in SQTS has not been evaluated at yet. Methods 6 patients with SQTS (QT 310 ± 16 ms, QTc 329 ± 11 ms) underwent microvolt TWA measurement using spectral analysis. TWA testing was performed using Heartwave II (Cambridge HeartTM) during bicycle exercice and classified as negative, positive or indeterminate according to the published standards for clinical interpretation. Results there were 6 men (mean age 24 ± 2 yo): 4 asymptomatic, 1 with previous sudden cardiac death and 1 with unexplained syncope. 3 patients belonged from the same family. Familial history of SQTS was present in 4 (2 families) and history of unexplained sudden death was found in both families. Ventricular fibrillation was induced in 2 of 5 investigated patients. Two patients were implanted with an ICD without any appropriate therapy during follow-up. No patient was on any medical therapy. Genetic analysis was pending in each but without result at yet. TWA was negative in each patient except in one inducible asymptomatic patient (indeterminate due to too fast heart rate). Maximal negative heart rate was 113 ± 5 bpm. Conclusions Conversely to what is observed in other settings, TWA testing is negative in most SQTS patients even in the symptomatic or inducible ones. This may be explained by the longer diastolic interval according to the restitution curve theory. Measurement of TWA for risk stratification in SQTS is therefore useless.
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- 2011
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140. 174 Infection on cardiac devices. A monocentric prospective study
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Benoit Lepage, Marc Delay, Aurélien Hébrard, M. Metais, S. Malavaud, Didier Carrié, Pierre Mondoly, and Alexandre Duparc
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medicine.medical_specialty ,business.industry ,ICD-10 ,medicine.disease ,Intensive care unit ,Surgery ,law.invention ,Sepsis ,law ,Anesthesia ,Diabetes mellitus ,medicine ,Endocarditis ,Implant ,business ,Prospective cohort study ,Lead (electronics) ,Cardiology and Cardiovascular Medicine - Abstract
PurposeThe infections after cardiac device implantation (CDI) are not well known in the real life because of the multiplicity of the circumstances. This is a monocentric prospective study.Method304 consecutive pts had a CDI in 6 months (feb to aug 2009): male 69% age 70±15 yo. The data of the pts were consecutively collected:type of device (VVI PM 10%, DDD PM 42%, CRT P 7%, VVI ICD 13%, DDD ICD 10%, CRT D 17%) (Primo Implant 73%, Device Replacement 21%, Lead Replacement 8%, Burying 2.3%).components of the NNIS score (N1. Nosocomial Infection Surveillance): −1 duration of the procedure (83±40mn); 7minus;2 ASA score (Am. Soc. Anesth)(asal=4%, asa2=22%, asa3=43%, asa4=30%, asa5=0); −3 surgical site Infection (SSI) Class: Clean wound 73%, fever the days before 6%.the prevention with antibiotic therapy was: – conventional: Cefuroxine 1.5 g 30 mn before and 0.75g each 2hr (93%; 69% timing conformity); – Vancomicyne 1gr 1hr before (3%); previous adjusted therapy (4%).the follow-up was of 3 months.Results7 SSI occurred at 43±36 days (2.3%) for DDD PM = 5, VVI ICD = 1, CRT D = 1. They were 2 endocarditis (for 2 implantations on the other side after an extraction, with the same germ) sepsis = 1 (diabetes), loge infection = 4 (2 after burying). The 7 pts had an extraction of the device and the leads. The risk factors of SSI were anticoagulation (7/7; p
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- 2011
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141. 177 Long term follow-up of patient implanted with ICD before 2000
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Nicolas Detis, P. Maury, Aurélien Hébrard, M Rezai, Alexandre Duparc, Talia Chilon, A. Rollin, Pierre Mondoly, Marc Delay, and Didier Carrié
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education.field_of_study ,medicine.medical_specialty ,Long term follow up ,business.industry ,Population ,medicine.disease ,Cardiac failures ,Surgery ,Internal medicine ,Risk of mortality ,medicine ,Cardiology ,Endocarditis ,Lost to follow-up ,education ,business ,Cardiology and Cardiovascular Medicine ,Survival rate ,Cause of death - Abstract
BackgroundICD is an effective treatment to prevent SCD but very long term follow-up is poorly known.MethodsWe retrospectively studied the 67 patients implanted with an ICD at the University Hospital of Toulouse between 1989 and 1999.ResultsCharacteristics of the population are (number of patients): males: 56, ischemic heart disease (IHD): 42, mean EF 42%, secondary prevention: 62, abdominal implantation: 30, dual chamber devices: 57. Data were complete for 58 patients (mean follow-up: 100 months +/− 103), nine patients were lost to follow up (mean 52 +/− 40 months). Survival rate (of the 58 patients) is respectively 93%, 71% and 48% at 1, 5 and 10 years. Cause of death was cardiac for 10 patients (7 terminal cardiac failures, 2 sudden cardiac deaths and 1 endocarditis), extra cardiac for 7 patients and unknown for 13.Independent factors of global mortality are: age (p = 0.038), IHD (p = 0.035), NYHA>2 (p = 0.0058), EF
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- 2011
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142. Transseptal implantation of a left ventricular pacing lead for an ectopic location of the coronary sinus ostium in the left atrium
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Pierre, Mondoly, Marie-Agnès, Marachet, Pierre, Massabuau, Philippe, Rumeau, Philippe, Maury, Marc, Delay, and Alexandre, Duparc
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Heart Failure ,Male ,Prosthesis Implantation ,Radiography ,Pacemaker, Artificial ,Treatment Outcome ,Coronary Sinus ,Heart Septum ,Humans ,Heart Atria ,Middle Aged ,Electrodes, Implanted - Abstract
Congenital abnormalities of the coronary sinus (CS) are rare but can be responsible for unsuccessful implantation of a cardiac resynchronization therapy device. We report the case of an ectopic drainage of the CS in the left atrium. A left ventricular lead was implanted by the transseptal route.
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- 2010
143. A wide QRS tachycardia in a left univentricular pacing system: what is the mechanism?
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Pierre Mondoly, Aurélien Hébrard, Jean-Thomas Aubert, and Alexandre Duparc
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Bradycardia ,Male ,medicine.medical_specialty ,Pacemaker, Artificial ,Defibrillation ,medicine.medical_treatment ,Heart Ventricles ,Bundle-Branch Block ,Ventricular tachycardia ,Electrocardiography ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Coronary Vein ,Ejection fraction ,Ischemic cardiomyopathy ,Left bundle branch block ,business.industry ,Equipment Design ,Middle Aged ,medicine.disease ,Ventricular fibrillation ,cardiovascular system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Case summary A 55-year-old man was referred to our institution for cardiac resynchronization therapy-defibrillator (CRT-D) implantation. He had suffered severe ischemic cardiomyopathy with low left ventricular (LV) ejection fraction of 20%, left bundle branch block, and New York Heart Association (NYHA) Class III symptoms despite optimal medical treatment. Magnetic resonance imaging showed a large anterior and lateral scar, with preserved tissue in the septal and posterior regions. In April 2009 he underwent CRT-D implantation with a Boston Scientific COGNIS P107 (SaintPaul, Minnesota, USA). The right ventricular (RV) lead (Guidant Endotak Reliance 0185 Saint-Paul, Minnesota, USA) was screwed into the RV apex; the right atrial (RA) lead (Medtronic Capsurefix 5076, Minneapolis, Minnesota, USA) was screwed into the RA appendage; and the LV lead (Medtronic Attain 4194) was positioned in a posterolateral coronary vein (Figure 1). All leads showed normal electrical values: pacing thresholds were 0.7, 0.7, and 0.8 V at 0.4 ms for the RA, RV, and LV leads, respectively; impedances were 597, 636, and 643 , respectively; and signal amplitudes were 5, 11.5, and 4.6 mV, respectively. Defibrillation testing was performed, and a 31-J first shock successfully cardioverted the induced ventricular fibrillation. Bradycardia pacing parameters were mode DDD, lower rate limit 50 bpm, and maximum tracking rate (MTR) 130 bpm. Figure 2 shows 12-lead ECGs recorded during atrioventricular (AV) optimization. It appeared that LV-only pacing mode with paced AV delay of 140 ms and sensed AV delay of 80 ms was the most effective mode for obtaining the
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- 2010
144. Regular narrow QRS tachycardia with apparent atrioventricular dissociation: what is the mechanism?
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Philippe, Maury, Alexandre, Duparc, Pierre, Mondoly, Nicolas, Detis, and Anne, Rollin
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Diagnosis, Differential ,Male ,Electrocardiography ,Tachycardia, Ventricular ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Middle Aged - Published
- 2010
145. Arrhythmia Rounds: Regular Narrow QRS Tachycardia With Apparent Atrioventricular Dissociation: What is the Mechanism?
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Nicolas Detis, Alexandre Duparc, Pierre Mondoly, Anne Rollin, and Philippe Maury
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Tachycardia ,medicine.medical_specialty ,Narrow qrs ,business.industry ,Physiology (medical) ,Internal medicine ,Cardiology ,medicine ,Atrioventricular dissociation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Mechanism (sociology) - Published
- 2010
146. 233 Indication, technique and results of Radio-frequency ablation of premature ventricular beats
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Talia Chilon, Denis Gaty, Elisabeth Somody, Philippe Maury, Philippe Rumeau, Aurélien Hébrard, Alain Graffeille, Alexandre Duparc, Pierre Mondoly, Anne Gardères-Rollin, and Marc Delay
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medicine.medical_specialty ,Electroanatomic mapping ,Premature ventricular beats ,business.industry ,medicine.medical_treatment ,Ablation ,Clinical success ,Surgery ,Internal medicine ,medicine ,Cardiology ,Palpitations ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,Pace mapping ,Isolated cases ,Conventional technique - Abstract
Introduction radio-frequency (RF) ablation of premature ventricular beats (PVB) has been only reported as isolated cases or in short series. Methods 34 successive pts (25 men, 53 ± 18 yo) underwent RF ablation of frequent or symptomatic isolated PVB at our institution from 2005 to 2009. Indication, technique and results were reported. Results 43 RF ablation of PVB was performed for post-ischemic electrical storm in 7 pts (6 men), for symptomatic PVB in 7 (3 men) and for suspected VPB-induced tachycardiomyopathy in 20 (16 men) with 1,2 procedure/pt. RF was performed in each case using pace mapping and activation mapping with conventional technique. RF ablation of PVB during intractable post-ischemic electrical storm was initially successful in each pt but fatal electrical storm recurred in 4 during the following days. PVB were targeted in the left septal Purkinje network. 10 procedures were performed in 7 pts for palpitations or syncope, leading to complete or partial clinical success in 6 (PVB reduction 9400 ± 12200 to 420 ± 610 /24h, NS). 25 procedures were performed for suspected VPB-induced tachycardiomyopathy in 20 pts leading to complete success in 9 pts and to significant decrease in VPB in 5 pts. Mean VPB/24h was 17800 ± 8600 before and 3410 ± 8150 after and 125 ± 230 at 11 ± 6 months follow-up (p=0,0005). EF increase from 41 ± 8 to 53 ± 7% (p Conclusions RF ablation of PVB may be indicated if highly symptomatic, for electrical storm or for suspected tachycardiomyopathy with good although imperfect success rate
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- 2010
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147. 202 Late Outcome of Radio-frequency ablation for monomorphic sustained Ventricular tachycardia in patients with underlying heart disease without implantation of a defibrillator
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Frederic Sacher, Alexandre Duparc, Marc Delay, Michel Haïssaguerre, Isabelle Nault, Philippe Maury, Pierre Mondoly, Aurélien Hébrard, Pierre Jaïs, Mélèze Hocini, and Anne Gardères-Rollin
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medicine.medical_specialty ,Heart disease ,business.industry ,medicine.medical_treatment ,Dilated cardiomyopathy ,Context (language use) ,medicine.disease ,Amiodarone ,Ablation ,Sustained ventricular tachycardia ,Internal medicine ,medicine ,Cardiology ,In patient ,Stage (cooking) ,business ,Cardiology and Cardiovascular Medicine ,medicine.drug - Abstract
IntroductionSustained ventricular tachycardia (VT) in structural heart disease (SHD) is usually an indication for ICD implantation. Whether successful RF ablation of VT in this setting could avoid the need of ICD implantation is unknown.MethodsWe report our initial experience of VT ablation in 27 successive non-implanted pts (22 men, 62±18 yo) presenting with sustained monomorphic VT and SHD. An ICD was not implanted either because of debilitating or end stage extra cardiac pathology, advanced age or because the VT was well tolerated and EF was preserved. Amiodarone failed to control VT in 33% and beta-blockers in 73%.Results33 procedures were performed (1.2/pt). Seventeen pts had ischemic heart disease, four had ARVD, 2 dilated cardiomyopathy, 1 congenital and three had non-categorized SHD. Mean EF was 44±13% (5 pts with EF < 0,35%). The end-point was elimination of post-systolic potentials by RF. VT was inducible in 71% with 1 to 4 different morphology (1.8±1). Acute success was defined by lack of any inducible monomorphic sustained VT and was achieved in 78%. The only complication was an arterial dissection managed with angioplasty. One patient died after 10 days due to intractable heart failure associated with relapse of electrical storm. Patients were discharged on beta-blockers and amiodarone was interrupted except when otherwise indicated. Mean follow-up was 13±9 months. Four patients died from non arrhythmic cardiac or non cardiac causes. There was one late sudden death in a patient with low EF (incomplete procedure due to ongoing vascular complication). VT recurred in 24% without compromise of the vital status. RF ablation was performed in again in 5 pts and VT further recurred in two. Final VT recurrence rate including redo precedures was 12%.ConclusionsRF ablation for VT occurring in pts with SHD without ICD appears relatively safe and efficient and may be considered in some cases when ICD therapy is not desired because of associated morbidity, advanced age or when VT is well tolerated and does not occur in the context of advanced heart disease.
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- 2010
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148. ST-segment changes after direct current external cardioversion for atrial fibrillation. Incidence, characteristics and predictive factors
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Alexandre Duparc, Philippe Rumeau, Michel Galinier, Meyer Elbaz, Pierre Massabuau, Pierre Mondoly, Nicolas Detis, Joelle Fourcade, Philippe Maury, Didier Carrié, Aurélien Hébrard, Marc Delay, and Anne Rollin
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Male ,medicine.medical_treatment ,Electric Countershock ,Cardioversion ,Heart Conduction System ,Predictive Value of Tests ,Atrial Fibrillation ,medicine ,ST segment ,Humans ,Prospective Studies ,Aged ,ST depression ,Ejection fraction ,business.industry ,ST elevation ,Incidence ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Treatment Outcome ,Echocardiography ,Anesthesia ,Shock (circulatory) ,Female ,medicine.symptom ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Incidence, characteristics and predictive factors of transient ST-segment changes after DC shock are poorly known.91 consecutive pts referred for external cardioversion of atrial fibrillation (AF) (61 men, 69±10 yo) were prospectively included. The presence of ST elevation or depression was assessed on 12 lead-ECG immediately after the first DC shock. Correlations with DC shock characteristics (monophasic/biphasic and energy), clinical variables, echocardiographic parameters, biological parameters, medications, anaesthetic drugs as well with morphological features were made.18 and 20 pts underwent 200 J or 300 J monophasic and 53 pts 200 J biphasic DC shocks. We found an incidence of 48% for ST-segment changes: 35% for ST elevation and 13% for ST depression. ST changes did not induce significant cardiac events or alter AF recurrences. ST changes were not related to energy but ST elevation was significantly more often induced by monophasic (76% vs 6%, p0.0001) and ST depression by biphasic DC shocks (26% vs 3%, p=0.01). Using multivariate analysis, independent predictors for ST elevation were the use of monophasic DC shocks, of propofol and increased CRP, while a low ejection fraction and use of biphasic DC shocks were independent predictors of ST depression.ST-segment changes after external cardioversion with DC shock are common, short living and do not carry clinical significance. They are related to the monophasic or biphasic configuration of DC shock, to the use of propofol, to the ejection fraction and to an increased CRP.
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- 2009
149. Surgical catheter ablation of ventricular tachycardia using left thoracotomy in a patient with hindered access to the left ventricle
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Anne Rollin, Bertrand Marcheix, Caroline Paquie, Philippe Maury, Aurélien Hébrard, Marc Delay, Pierre Mondoly, and Alexandre Duparc
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Tachycardia ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Heart Ventricles ,Catheter ablation ,Ventricular tachycardia ,Internal medicine ,medicine ,Humans ,Thoracotomy ,Coronary sinus ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Ventricle ,cardiovascular system ,Cardiology ,Catheter Ablation ,Tachycardia, Ventricular ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
We report the case of a patient presenting with incessant monomorphic ventricular tachycardia resistant to antiarrhythmic drugs, and in whom usual percutaneous vascular or pericardial access to the left ventricle was hindered by mechanical aortic and mitral prosthetic valves. Because an epicardial location was suspected by electrocardiogram features and because access to the target area through the coronary sinus was not possible, we decided to perform a surgically based radiofrequency (RF) ablation. Catheter mapping of the epicardial surface through surgical left lateral thoracotomy in the operating room confirmed the epicardial location of the arrhythmogenic substrate and allowed successful RF ablation of the clinically incessant tachycardia. Combined surgical and electrophysiological approach should therefore be performed when RF ablation is needed in case of unadvisable, difficult, or failed nonsurgical percutaneous access.
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- 2009
150. Reverse left septal activation during intermittent left bundle-branch block: indirect proof for concealed retrograde left bundle-branch activation
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Philippe, Maury, Alexandre, Duparc, Aurélien, Hébrard, Pierre, Mondoly, Anne, Rollin, and Marc, Delay
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Adult ,Electrocardiography ,Heart Conduction System ,Heart Septal Defects ,Bundle-Branch Block ,Humans ,Female ,False Negative Reactions - Abstract
Concealed retrograde activation of bundle branch has been often proposed for explaining the persistence of functional rate-dependent bundle-branch block, but direct proof of such a mechanism in man has rarely been demonstrated. We report intracardiac recordings compatible with a reversal of activation of the left basal interventricular septum during intermittent left bundle-branch block. In our case, however, retrograde activation into the left bundle-branch cannot be recordable, probably due to the concealment within the muscular septal activation, even if this may explain the perpetuation of bundle-branch block according to the linking phenomenon.
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- 2009
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