371 results on '"J. Clémenty"'
Search Results
2. La télécardiologie en France, état des lieux en 2012 et perspectives de développement
- Author
-
L. Guédon-Moreau, S. Kacet, P. Mabo, and J. Clémenty
- Subjects
Health Information Management ,Health Informatics - Abstract
Resume La cardiologie est un domaine ou la telemedecine devrait connaitre un essor rapide. L’application la plus avancee aujourd’hui est le telesuivi des stimulateurs et defibrillateurs cardiaques implantables, permettant de limiter les suivis en face a face au centre d’implantation et d’acceder plus facilement aux donnees memorisees dans la protheses. Apres une phase de validation technologique, des larges etudes prospectives randomisees (TRUST, CONNECT, COMPAS, ECOST, EVATEL) ont demontre la securite d’utilisation du telesuivi sur des criteres durs de morbi-mortalite avec une valeur ajoutee sous la forme d’une reduction du nombre des consultations, d’une detection anticipee des evenements et d’une reduction des therapies inappropriees. Ce nouveau standard de suivi s’integre parfaitement dans la loi francaise sur la telemedecine. Neanmoins, certains obstacles doivent encore etre leves, notamment les aspects financiers de remboursement des actes pour les equipes medicales et de prise en charge d’un service pour les industriels, avant de passer dans la routine. L’acceptation par les patients et la communaute medicale ne devrait pas etre un reel probleme sous reserve de bien definir les objectifs cliniques et les modalites de partage de l’information. D’autres domaines de la cardiologie devraient a moyen terme s’ouvrir a la telemedecine. more...
- Published
- 2012
- Full Text
- View/download PDF
Catalog
3. La mesure de la distensibilité artérielle par la méthode du QKd :un nouveau marqueur vasculaire
- Author
-
J Clémenty, P. Gosse, Joël Constans, and Claude Conri
- Subjects
Physics ,Measurement method ,Arterial pulse ,Arterial disease ,Gastroenterology ,Internal Medicine ,Humanities - Abstract
Resume Introduction. – La distensibilite est la capacite des grosses arteres elastiques a faire varier leur diametre de la diastole a la systole. Lˈune des methodes les plus validees pour la mesurer est la velocite de lˈonde de pouls (VOP), qui peut etre mesuree par divers procedes dont le QKd. Exegese. – Le QKd est lˈintervalle de temps compris entre lˈonde Q de lˈelectrocardiogramme et lˈenregistrement du deuxieme bruit de Korotkoff au niveau de lˈartere humerale, correspondant a la tension arterielle diastolique. Il est mesure par un holter tensionnel et electrocardiographique specifique (normale superieure a 200 ms). La distensibilite arterielle semble interessante pour predire les evenements cardiovasculaires. Il a ete montre que les hypertendus âges avec QKd altere font plus dˈevenements cardiovasculaires que les autres. Le QKd est a lˈetude comme predicteur de la progression des sclerodermies (etude ERAMS). Conclusion. – Le QKd est une methode non invasive et ambulatoire qui couple les mesures de distensibilite et de tension arterielle. more...
- Published
- 2002
- Full Text
- View/download PDF
4. Characteristics of the Ventricular Insertion Sites of Accessory Pathways With Anterograde Decremental Conduction Properties
- Author
-
B Cauchemez, M. Haissaguerre, J Clémenty, F Marcus, F Poquet, P Lauribe, L Gencel, and P Le Metayer
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Bundle-Branch Block ,Catheter ablation ,Bundle of His ,Pre-Excitation, Mahaim-Type ,Electrocardiography ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Atrium (heart) ,Tachycardia, Paroxysmal ,medicine.diagnostic_test ,business.industry ,Cardiac Pacing, Artificial ,Atrioventricular node ,medicine.anatomical_structure ,Ventricle ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Accessory pathways (APs) with anterograde decremental conduction properties referred to as Mahaim fibers have recently been recognized as originating from the right lateral atrium. Little information is available about their distal insertion. The purpose of this study was to determine the different kinds of APs involved and the characteristics of their distal insertion site. Methods and Results Twenty-one patients (mean age, 28±13 years) with reciprocating tachycardia or atrial fibrillation were studied. Right-sided atrial and/or ventricular endocardial mapping during tachycardia identified different types of APs. (1) Seventeen patients had long APs originating from the right lateral atrium and coursing several centimeters to the right ventricle. In 10 patients, the AP terminated in or close to the right bundle-branch system (atriofascicular AP) and in 7, the AP terminated in the anterior right ventricle (atrioventricular AP). Patients with atriofascicular APs had narrower QRS complexes (133±10 versus 165±26 milliseconds, P =.02) and narrower initial r wave in leads V 2 through V 4 during maximal preexcitation than patients with atrioventricular APs. In addition, they had earlier His-bundle and right bundle-branch retrograde activation, ie, shorter V-His (16±5 versus 37±9 milliseconds, P P Conclusions Different types of APs account for tachycardias previously called Mahaim fibers. Long and short atrioventricular APs are observed in 81% and 19%, respectively. Long APs often have a distal arborization and may have either a fascicular or ventricular insertion. Radiofrequency current is more efficient when applied to the AP bundle or AP proximal insertion rather than to the distal insertion in patients with long APs. more...
- Published
- 1995
- Full Text
- View/download PDF
5. [Catheter ablation for atrial fibrillation]
- Author
-
N, Derval, F, Sacher, A, Deplagne, M, Hocini, P, Bordachar, Ph, Ritter, P, Jaïs, J, Clémenty, and M, Haissaguerre
- Subjects
Risk Factors ,Atrial Fibrillation ,Catheter Ablation ,Humans - Abstract
The mainstay of treatment for atrial fibrillation (AF) remains pharmacological, however, catheter ablation, since an early attempt in 1994 has undergone many evolutions up to the present day whereby it has taken an increasing place in the management of this arrhythmia. In paroxysmal AF, the most recent studies report a success rate of more than 80% at 1 year of follow-up after a single procedure (free of symptoms without antiarrhythmic drugs). In persistent AF the technique continues to evolve with a success rates between 70% and 95% even if several long and complex procedures are often needed, which are not without risk, to achieve these results. With constant improvement in this field catheter ablation has become a valuable tool in the management strategy of AF. more...
- Published
- 2010
6. [Identification of candidates for multisite pacing: results and presumed mechanisms of action after five years experience]
- Author
-
S, Reuter, S, Garrigue, P, Bordachar, J, Laborderie, S, Lafitte, F, Sacher, P, Jaïs, R, Roudaut, M, Haïssa guerre, and J, Clémenty
- Subjects
Heart Failure ,Male ,Electrocardiography ,Treatment Outcome ,Patient Selection ,Cardiac Pacing, Artificial ,Humans ,Female ,Middle Aged - Abstract
Biventricular resynchronisation is an additional therapeutic option in the management of refractory heart failure, with a functional and haemodynamic benefit as well as an improved morbidity and mortality. However, the rate of non-responsive patients has prompted a re-think about the presumed mechanisms of action for this procedure. This study aims to identify candidates more successfully. Based on five years experience in this centre, our work confirmed a medium and long term clinical benefit with multisite pacing. Nevertheless, there was evidence of a relative discordance between the functional benefit and the haemodynamic impact in terms of ejection fraction achieved with resynchronisation. While QRS narrowing appears to be a predictive factor for a successful procedure, the ECG alone is not sufficient to select 'unsynchronised' candidates. Statistical analysis reveals that before implantation the independent predictive factors to identify non-responsive patients include the presence of a complication of myocardial infarction and a low grade mitral leak. The limits of the ECG suggest a more mechanical than electrical approach to understanding the mechanisms of action for resynchronisation. Its effectiveness in cases of right bundle branch block confirm the hypothesis of left intra-ventricular conduction defects, not apparent on the surface ECG but accessible through new imaging techniques. Based on the hypothesis of delayed movement of the ventricular walls, the principle of resynchronisation aims to restore homogenous contraction. Echocardiography allows observation of electromechanical delay and opens new perspectives in the future for selecting patients for pacing. Ar more...
- Published
- 2006
7. [Mapping and ablation of malignant ventricular arrhythmias]
- Author
-
M, Hocini, P, Jais, F, Sacher, S, Reuter, J, Clémenty, and M, Haïssaguerre
- Subjects
Heart Neoplasms ,Ventricular Fibrillation ,Catheter Ablation ,Ventricular Dysfunction ,Humans - Abstract
Endocavitary investigations showed that the ventricular extrasystoles originated in the common ventricular myocardium (pulmonary infundibulum) in only 9 cases whereas the majority arose from the Parkinje system either on the anterior wall of the right ventricle or in septal region of the left ventricle. The extrasystoles arising from the Parkinje system and pulmonary infundibulum differed in their duration and polymorphism (128 +/- 18 ms vs 145 +/- 13 ms, p = 0.05; 3.3 +/- 2.7 morphologies vs 1.1 +/- 0.4, p0.001, respectively). During the extrasystoles, the local Pukinje potential preceded the ventricular activation by variable intervals, some of which were very long, up to 150 ms. Seven applications of radiofrequency were delivered on average per patient on the most distal part of the Purkinje system leading to ablation of the specific activation. The clinical results were spectacular: 88% of patients had no further episodes of ventricular fibrillation as demonstrated by analysis of the defibrillator with an average follow-up period of more than 34 months. more...
- Published
- 2006
8. [Catheter ablation of paroxysmal atrial fibrillation]
- Author
-
F, Sacher, P, Jaïs, M, Hocini, S, Reuter, P, Bordachar, S, Garrigue, M, Haïssaguerre, and J, Clémenty
- Subjects
Adult ,Male ,Treatment Outcome ,Pulmonary Veins ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Female ,Middle Aged - Abstract
Catheter ablation techniques for atrial fibrillation have undergone an extensive evolution, starting with linear lesions in the right, then the left atria before being superseded by ablation of triggers, mainly from the pulmonary veins. We investigate the feasibility and results of combined pulmonary vein and linear ablation utilizing a specific linear lesion connecting the lateral mitral annulus to the left inferior pulmonary vein (left isthmus).115 patients (101 M: 54 +/- 9 years) with paroxysmal atrial fibrillation (7 +/- 5 years) resistant to 4 +/- 1.6 anti-arrhythmic drugs were studied. After electrophysiologically guided disconnection of all four pulmonary veins, the left isthmus line was performed with an irrigated tip catheter. Complete linear block was demonstrated during coronary sinus pacing by local mapping looking for widely separated double potentials and confirmed by differential pacing. Mapping and ablation from within the coronary sinus was performed if an epicardial gap was detected after unsuccessful endocardial radiofrequency delivery.100% of pulmonary veins were successfully disconnected and the left isthmus line was complete with bi-directional block in 88% after a mean of 22 +/- 12 min of endocardial radiofrequency delivery in 44 patients. In 58 patients, additional radiofrequency delivery was required from within the coronary sinus for 5 +/- 5 min. After a follow-up of 6.5 +/- 2.6 months and a mean of 1.4 +/- 0.6 procedures/patient, 79% were in stable sinus rhythm without antiarrhythmic drugs.the left isthmus line is feasible and safe and when performed in addition to pulmonary veins isolation can contribute to an increased success rate. more...
- Published
- 2005
9. [Severity of aortic ring abscess complicated by cardiac conduction abnormalities]
- Author
-
P L, Massoure, E, Kéreun, J M, Chevalier, J M, Rigollaud, F, Bire, J, Clémenty, and R, Roudaut
- Subjects
Heart Failure ,Male ,Pacemaker, Artificial ,Fatal Outcome ,Heart Block ,Endocarditis ,Humans ,Middle Aged ,Prognosis ,Severity of Illness Index ,Abscess - Abstract
To determine clinical features, management and prognosis of cardiac conduction abnormalities (CCA) complicating abscessed endocarditis.We have analysed clinical, microbiologic and echocardiographic datas, therapies and outcome of cardiac abscesses complicated by CCA in patient hospitalized between 1995 and 2001 in our centre.Above 35 cardiac abscesses, six men (mean age 62 years) had CCA complicating six aortic ring abscesses (4 on native valve and 2 on prosthetic valve) with four cases of interventricular septal involvement and fistulization. Severe heart failure is present four times, a septic cerebral embolization twice. Streptococcus and Staphylococcus prevail. Complete atrioventricular block (AVB) reveals endocarditis twice and complicates the evolution three times. Trifascicular block (first degree AVB, left anterior fascicular block and complete right bundle branch block) revealed recurrence of endocarditis. Two patients were treated medically: one died quickly (complete AVB pre-mortem), and the other one had favourable issue (paroxystic complete AVB). Four patients had surgery with temporary pacemaker in three cases (one died) then definitive pacemaker in two cases. At 26.5 month (7-50), the four survivors had no recurrence of endocarditis.Severe CCA are classical in aortic ring abscessed endocarditis and associated with increased mortality. Immediate transfert in a dentre with cardiac surgery is necessary. Definitive cardiac pacing can be performed early without leads infection. more...
- Published
- 2005
10. [Outcome of 30 congenital atrio-ventricular blocks]
- Author
-
F, Verdier, M, Jimenez, J M, Chevalier, J B, Thambo, F, Bire, J, Clémenty, and A, Choussat
- Subjects
Adult ,Cardiomyopathy, Dilated ,Male ,Lupus Vulgaris ,Pacemaker, Artificial ,Adolescent ,Prognosis ,Heart Block ,Treatment Outcome ,Risk Factors ,Child, Preschool ,Prenatal Diagnosis ,Humans ,Female ,Child ,Retrospective Studies - Abstract
Congenital isolated atrio-ventricular block (CAVB) is a rare pathology, and its management is still rather poorly described through international literature. Within the service of pediatric cardiology leaded by Pr Choussat and Dr Jimenez (Cardiologic Hospital Haut-Lévêque of Bordeaux), we collected from 1980 to 2003, 30 isolated congenital CAVB, constituting the purpose of this retrospective study. Average follow-up is 14 +/- 8.8 years. None death occurred. CAVB are discovered at an average age of 4.8 years old; 6 cases were diagnosed in utero, half of them were associated with maternal lupus. Twenty patients on 30 were fitted with stimulator at an average age of 8.7 +/- 6.9 years old, due to symptoms or bradycardy. Epicardic fitting in VVI mode represents 65% of first approaches, it is followed by endocavitary way for 81% of cases. Cardiac stimulation does not prevent from dilated cardiomyopathy. Among 30 patients 10 were not fitted with stimulator, half of them presents chronotrop insufficiency during effort. As a conclusion, our patients show a good long-term vital prognosis; although CAVB discovered in utero lead to worse prognosis for children. more...
- Published
- 2005
11. [The place of ablation in the treatment of atrial fibrillation: where are we and where are we going?]
- Author
-
P, Jaïs, M, Hocini, F, Sacher, J, Clémenty, and M, Haïssaguerre
- Subjects
Treatment Outcome ,Patient Selection ,Atrial Fibrillation ,Catheter Ablation ,Drug Resistance ,Humans ,Prognosis ,Anti-Arrhythmia Agents - Abstract
Atrial fibrillation, the most common arrhythmia, is frequently disabling and drug resistant and is associated with significant complications, especially thromboembolic events. Non-pharmacological approaches including surgery and catheter-based ablation have been developed for the most symptomatic patients. These new treatment strategies have dramatically increased our knowledge of the pathophysiology of this arrhythmia but most importantly have demonstrated that atrial fibrillation is curable. Since 1994, 2 different concepts have been used, aiming to modify the substrate responsible for AF maintenance using linear lesions, or to ablate the triggers located from within the pulmonary veins (PV) in about 90% of cases. The vast majority of the laboratories in the world are now using approaches centred on isolation of the PV. These approaches are far from being perfect but good enough to be offered in routine practice to selected patients in experienced centres. The importance of PVs in the initiation of AF has been clearly demonstrated and they also have a possible role in the maintenance of AF. However, the existence of non venous foci or a prominent substrate for AF maintenance limits the success rate to about 70%. As a consequence, a combination of PV isolation and linear lesions is commonly used. This more complex procedure carries a significantly higher success rate however with an increased risk of tamponade. As a consequence, we need to identify which patients will require linear lesions in addition to PV isolation. At the present time, AF ablation is restricted to symptomatic patients who have failed at least 1-2 antiarrhythmic drugs but future technical improvements based on presently applied concepts are likely to widen the indications for ablation therapy of AF. more...
- Published
- 2004
12. Mapping and ablation of ventricular fibrillation
- Author
-
P, Sanders, L F, Hsu, M, Hocini, P, Jaïs, Y, Takahashi, M, Rotter, F, Sacher, J L, Pasquié, T, Arentz, C, Scavée, S, Garrigue, J, Clémenty, and M, Haïssaguerre
- Subjects
Electrocardiography ,Long QT Syndrome ,Patient Selection ,Ventricular Fibrillation ,Myocardial Infarction ,Humans - Abstract
Sudden cardiac death frequently results from ventricular fibrillation (VF). While VF is frequently the eventual mode of death in patients with abnormal ventricular substrates, it has also been described in patients with structurally normally hearts. Until recently, the management of patients who have survived sudden cardiac death has focused on treating the consequences by implantation of a defibrillator. However, such therapy remains restricted in many countries, is associated with a prohibitive cost to the community, and may be a cause of significant morbidity in patients with frequent episodes or storms of arrhythmia. Evidence emerging from the study of fibrillation both in the atria and the ventricle suggests an important role for triggers arising from the Purkinje network or the right ventricular outflow tract in the initiation of VF. Initial experience in patients with idiopathic VF and even those with VF associated with abnormal repolarization syndromes (LQT or Brugada syndrome) or myocardial infarction suggests that long term suppression of recurrent VF may be feasible by the elimination of these triggers. With the development of new mapping and ablation technologies, and greater physician experience, catheter ablation of VF, with the ultimate aim of curing such patients at risks of sudden cardiac death, may not be an unrealistic goal in the future. more...
- Published
- 2004
13. Cardiac Resynchronisation and Haemodynamic Monitoring: the Living-CHF Study
- Author
-
J. Clémenty
- Subjects
medicine.medical_specialty ,business.industry ,Diastole ,Hemodynamics ,Stimulation ,medicine.disease ,Contractility ,medicine.anatomical_structure ,Ventricle ,Heart failure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,business ,Mitral valve regurgitation ,Isovolumetric contraction - Abstract
Since multisite stimulation was first performed in heart failure (HF) [1], a few specific devices have been designed with capabilities for providing separated output control of pacing parameters for the right and left ventricular leads, as well as inter ventricular (VV) sequence programming. So far, there are no haemodynamic sensors to improve understanding of and follow up the effects of biventricular (BiV) stimulation and help in the programming of the resyn-chronisation parameters. In the meantime, Sorin Biomedica has developed the Living-BEST system, which is based on a sensor that is able to measure the amplitude of mechanical vibrations generated by the myocardium during the isovolumetric contraction of ventricles. The peak of endocardial acceleration (PEA) reflects events that produce vibrations that originate mainly in the left ventricle and are transmitted through the cardiac mass [2, 3]. It has been shown that PEA is correlated with contractility indexes, such as dP/dtmax, and is influenced by catecholamine levels. PEA variations are related to the capability of the myocardium to respond to adrenergic stresses. Human experiments [4,5] have shown that PEA variation is greater during exercise with biventricular pacing than compared with to other modes, and it has been suggested that PEA might be used as a marker for selecting the position of ventricular pacing leads that provides the best haemodynamic effect. The version of the Living-BEST system designed specifically for biventricular pacing (Living CHF) has the capability of recording amplitudes and timings of PEA and providing realtime telemetry of the whole endocardial acceleration signal. Secondly, the device has the VV Interval programming feature, which can influence the efficacy of resynchronisation provided by biventricular stimulation. Recent studies [6–13] have been focused on improving understanding of the effects of cardiac resynchronisation therapy. Biventricular stimulation provides a more homogeneous contraction of ventricles, which becomes faster and allows prolongation of the diastolic filling phase. Filling pressures are reduced with the frequent reduction in the mitral valve regurgitation. The most relevant parameter is the aortic pre-ejection interval [14], which has to become shorter to predict the beneficial effect of biventricular stimulation, and also the shortening in the contraction timing of the uncoordinated ventricular segments. In this context the use of a haemodynamic sensor is an interesting possibility as an analytic tool for the evaluation and optimisation of ventricular resynchronisation therapy. more...
- Published
- 2004
- Full Text
- View/download PDF
14. [Radiofrequency ablation of atrial fibrillation]
- Author
-
M, Hocini, P, Jaïs, M, Haïssaguerre, S, Garrigue, P, le Métayer, and J, Clémenty
- Subjects
Adult ,Aged, 80 and over ,Male ,Adolescent ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Female ,Middle Aged ,Aged - Abstract
The possibility of curing patients suffering from paroxysmal atrial fibrillation using a radiofrequency ablation treatment is a major change in the management of this arrhythmia. Pulmonary vein disconnection is efficient and safe after a learning curve of the operator. This pulmonary vein isolation is the first and mandatory step allowing disappearance of atrial fibrillation in 70% of the patients. Modification in fibrillatory substrate using linear lesions increases the rate success to 75% in chronic atrial fibrillation and to 82% in paroxysmal atrial fibrillation. The radiofrequency ablation of atrial fibrillation should be considered as a surgical treatment without an open heart, isolating structures and cutting tissues are technical improvements (new radiofrequency catheters) will probably facilitate in the future. Some comparative studies with medical treatment are currently evaluating their efficacy, safety and respective cost and they may lead to a considerable increase in the number of patients who could benefit from these curative treatments. more...
- Published
- 2003
15. [Sleep apnea and cardiac pacing: mechanisms of action and perspectives]
- Author
-
S, Garrigue, P, Bordier, and J, Clémenty
- Subjects
Sleep Apnea Syndromes ,Cardiac Pacing, Artificial ,Humans - Abstract
In an adult population, the prevalence of sleep apnea is 4% for men and 2% for women. Generally, nasal positive pressure ventilation is the best therapeutic option. To date, and in spite of the possible presence of marked brady-arrhythmias during sleep apnea, there is no recognised indication for Pacemaker implantation. However, recent data show the potential benefit of permanent cardiac stimulation in these patients. Increasing heart rate (using atrial pacing) improves cardiac output, and reduces pulmonary congestion and pulmonary vagal afferent nerves are no longer stimulated. The incidence of central sleep apnea is thereby reduced. Excessive nocturnal vagal tone increases snoring and sleep apnea, because of excessive relaxation of the oropharyngeal muscles. In patients with bradycardia, atrial stimulation may oppose increased vagal tone, by stimulating the sympathetic system or maintaining it at a minimal level. It is therefore possible that cardiac stimulation will become part of the treatment of sleep apnea in patients with documented bradycardia and/or heart failure. more...
- Published
- 2003
16. [What methods are available to assess quality of life of patients fitted with a pacemaker?]
- Author
-
J, Clémenty, O, Vancollie, S, Garrigue, S, Reuter, P, Bordachar, T, Gillet, and E, Safarova
- Subjects
Pacemaker, Artificial ,Surveys and Questionnaires ,Quality of Life ,Humans - Abstract
Quality of life (QOL) measurements are one of the main determinants for indication and technologic choice in permanent cardiac pacing. QOL measurements are obtained using questionnaire application. Questionnaire for QOL has to be reliable, comprehensive, sensitive and specific. Pacing mode and pacemakers algorithms have been evaluated by QOL measurements: VVI vs DDD, DDD vs VVIR, AAI vs DDD, fall back, algorithm.... Survival data and costs are also relevant aspects of cardiac pacing evaluation. more...
- Published
- 2003
17. [Tachycardia-induced cardiomyopathy, unusual and reversible cause of left ventricular dysfunction: report of 9 cases]
- Author
-
G, Quiniou, J M, Chevalier, F, Barbou, F, Bire, and J, Clémenty
- Subjects
Adult ,Male ,Ventricular Dysfunction, Left ,Adolescent ,Tachycardia ,Humans ,Female ,Middle Aged ,Cardiomyopathies ,Child ,Aged ,Follow-Up Studies - Abstract
In this study, 9 cases of tachycardia-induced cardiomyopathy have been reported, with a 7-year follow-up period. The patient population consisted of 5 males and 4 females with a mean age of 41 +/- 18 years (range: 10-70 years). It was difficult to determine the onset of the arrhythmia, due to its frequently asymptomatic course until such time as cardiac insufficiency became apparent (this was the case in 7 patients, while 2 subjects had palpitations). Four cases of AV intranodal reentry tachycardia (3 with an accessory pathway), 2 cases of atrial fibrillation, 1 case of auricular flutter, 1 case of atrial tachycardia and 1 case of ventricular tachycardia were observed. Disappearance of the symptomatology following restoration of sinus rhythm was accompanied by echocardiographically-determined normalization of systolic function on average 5 +/- 4 months post-arrhythmia (range: 1-12 months). Left-ventricular end-diastolic volumes decreased from 60 +/- 5 mm to 51 +/- 4 mm (P0.01), and end-systolic volumes from 50 +/- 7 mm to 35 +/- 4 mm (P0.001), while the left ventricular shortening fraction increased from 17 +/- 5% to 33 +/- 4% (P0.0001). In the differential diagnosis for primary dilated cardiomyopathy, tachycardia-induced cardiomyopathy appears very similar to the former, and only an adequate period of follow-up after the restoration of sinus rhythm can confirm the diagnosis. more...
- Published
- 2003
18. [Placement of an implantable defibrillator via the endocavitary route in a patient presenting with a univentricular heart and a Glenn anastomosis]
- Author
-
F, Casassus, J-B, Thambo, S, Reuter, G, Espil, X, Roques, P, Dos Santos, M, Jimenez, J, Clémenty, and A, Choussat
- Subjects
Prosthesis Implantation ,Treatment Outcome ,Vena Cava, Superior ,Heart Ventricles ,Palliative Care ,Humans ,Arrhythmias, Cardiac ,Female ,Middle Aged ,Defibrillators, Implantable - Abstract
We report the observation of a female 45 year old patient presenting with a post-surgery complex congenital cardiopathy, associated with serious ventricular rhythm disorders necessitating the placement of an implantable defibrillator. The palliative surgery performed (cavo-pulmonary Glenn anastomosis) does not allow the usual access to the right ventricle via the superior vena cava. The different possibilities for defibrillator implantation are discussed. These include associating a surgical approach to introduce the bipolar probe with subcutaneous tunnelling to connect the probe to the box. more...
- Published
- 2002
19. [Role of radiofrequency ablation in atrial fibrillation]
- Author
-
P, Jaïs, M, Haïssaguerre, M, Hocini, D C, Shah, L, Macle, S, Garrigue, Ph, Le Métayer, and J, Clémenty
- Subjects
Treatment Outcome ,Patient Selection ,Atrial Fibrillation ,Catheter Ablation ,Drug Resistance ,Humans ,Anti-Arrhythmia Agents ,Severity of Illness Index - Abstract
Atrial fibrillation is the most frequently encountered arrhythmia in the human species. Its danger is widely appreciated but it remains for certain patients and their practitioners an awkward or even exasperating problem. Only surgery and radiofrequency ablation allow certain patients to be cured. The surgical approach is of course warranted in the case of an otherwise necessary cardiac intervention. In the absence of a surgical indication, endovenous ablation, which is less aggressive, is preferred. The procedure consists of disconnecting the pulmonary veins which "house" 80 to 95% of the foci, together with the ablation of further non-venous foci, which are always difficult to treat. Side effects in experimental centres are rare and 70% of patients are cured, which allows cessation of antiarrhythmic and anticoagulant treatments. The procedure is currently offered to symptomatic patients having had at least one episode every ten days in spite of antiarrhythmics. more...
- Published
- 2002
20. [Measurement of arterial distensibility by the QKd method a new vascular marker]
- Author
-
J, Constans, P, Gosse, C, Conri, and J, Clémenty
- Subjects
Time Factors ,Brachial Artery ,Arteriosclerosis ,Systole ,Age Factors ,Blood Pressure ,Blood Pressure Determination ,Arteries ,Blood Pressure Monitoring, Ambulatory ,Middle Aged ,Elasticity ,Vasodilation ,Electrocardiography ,Auscultation ,Diastole ,Hypertension ,Vascular Capacitance ,Humans ,Vascular Resistance ,Pulse ,Biomarkers ,Aged - Abstract
Distensibility is the ability of large elastic arteries to increase in diameter from diastole to systole. Pulse wave velocity (PWV) is one of the ways to measure this parameter. Several techniques, including QKd, are able to measure PWV.QKd is the time interval between the Q wave on EKG and auscultation of the second Korotkoff's sound at the brachial artery. QKd is measured by a specific apparatus that registers ambulatory blood pressure as well as EKG (normal200 ms). Arterial distensibility seems to be able to predict cardiovascular morbidity and QKd has been demonstrated to predict such morbidity in a sample of elderly hypertensives. Currently the relationship between QKd and prognosis is under investigation in systemic sclerosis (ERAMS study).QKd is a noninvasive ambulatory method that measures arterial distensibility as well as blood pressure. more...
- Published
- 2002
21. [Role of electric stimulation in apnea syndromes]
- Author
-
P, Bordier, S, Garrigue, and J, Clémenty
- Subjects
Sleep Apnea Syndromes ,Humans ,Electric Stimulation - Abstract
The sleep apnoea syndrome is the best known apnoeic syndrome. It is observed in 4% of men and 2% of women. Nasal ventilation with continuous positive pressure is the best treatment for most patients. To date, electrical stimulation has a limited role in its treatment as it is used only when the apnoea requires ventilation by tracheotomy. This electrogenic ventilation requires so-called diaphragmatic stimulators. Although severe bradycardia may occur during sleep apnoea, there is usually no indication for cardiac pacing. However, recent publications have reported an anti-apnoeic effect of permanent atrial pacing. The modes of action remain unclear but these results support other recently reported data concerning the value of pacing in cardiac failure, the high incidence of sleep apnoea in cardiac failure patients and the possibility of diagnosing and monitoring apnoea by minute ventilation sensors. Therefore, there appears to be a field of research for cardiac pacing in apnoea syndromes. The authors review the principal reported data on the indications and possibilities of extra-cardiac and cardiac stimulation in apnoeic syndromes. more...
- Published
- 2002
22. Focal Atrial Fibrillation: The Bordeaux Experience
- Author
-
D. C. Shah, Laurent Macle, M. Hocini, K.-J. Choi, J. Clémenty, M. Haissaguerre, P. Jaï’s, and T. Yamane
- Subjects
medicine.medical_specialty ,business.industry ,Atrial fibrillation ,Reentry ,medicine.disease ,Right atrial ,Catheter ,Left atrial ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,business ,Linear ablation - Abstract
Initial attempts at linear ablation for atrial fibrillation (AF) indicated that creating continuous linear lesions to duplicate surgical atriotomies was difficult, that right atrial lesions alone were safe but ineffective, and that left atrial lesions improved success rates, although at a significant morbidity (including proarrhythmic left atrial reentry) and even mortality cost — but, most importantly perhaps, these studies showed the feasibility of cure by catheter-based techniques in patients with paroxysmal and persistent AF [1–3]. more...
- Published
- 2002
- Full Text
- View/download PDF
23. What Is the Most Accurate and Simple Method to Assess Block Through the Cavotricuspid Isthmus?
- Author
-
J. Clémenty, Laurent Macle, M. Haissaguerre, K.-J. Choi, M. Hocini, T. Yamane, D. C. Shah, and P. Jaï’s
- Subjects
medicine.medical_specialty ,Cavotricuspid isthmus ,business.industry ,medicine.medical_treatment ,Block (permutation group theory) ,Catheter ablation ,medicine.disease ,Progressive refinement ,Typical atrial flutter ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Flutter ,cardiovascular diseases ,business ,Coronary sinus ,Atrial flutter - Abstract
The determining factor in allowing the effective elimination of typical atrial flutter by catheter ablation has clearly been the progressive refinement of procedural endpoints (Table 1). In our own experience, three clear transitions, demarcated by progressive reductions in the recurrence rates for this arrhythmia, have been evident. Beginning with a high recurrence rate when flutter termination and noninducibility were considered sufficient endpoints, the demonstration of cavotricuspid isthmus block based on septal and lateral right atrial activation sequences reduced recurrence rates to about 12%. Further refinement with the routine use of local electrogram-based criteria [1], mapping double potentials supplemented with differential pacing [2], has led to an additional reduction in recurrence rates to < 5%. more...
- Published
- 2002
- Full Text
- View/download PDF
24. What Are the Long-Term Benefits of the Dual-Chamber Rate-Responsive System Driven by Contractility?
- Author
-
G. Gaggini, M. Hocini, J. Clémenty, M. Haissaguerre, S. Garrigue, D. C. Shah, and P. Jaïs
- Subjects
medicine.medical_specialty ,Ventricular lead ,business.industry ,medicine.disease ,Sick sinus syndrome ,Contractility ,Autonomic nervous system ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Heart rate ,medicine ,Cardiology ,Dobutamine ,business ,Closed loop ,medicine.drug - Abstract
Myocardial contractility beat-to-beat evaluation is now possible using an implanted microaccelerometer located on the tip of an endocardial lead in the right ventricle. The signal provided by this device is closely related to right ventricle dp/dt curve. The maximal value of the accelerometer signal, peak of endocardial acceleration (PEA) is correlated with dp/dt max (mm Hg) during dobutamine infusion. Some previous studies have clearly established a direct correlation between right and left ventricle contractility [1–3]. Increased cardiac output during exercise and emotional or psychological stress is mediated by the autonomic nervous system, sympathetic tone increasing myocardial contractility and heart rate [4]. In an individual patient, every PEA value is associated with a heart rate value. These two parameters related by a closed loop algorithm can be used to drive a rate-responsive pacemaker in patients with chronotropic incompetence but normal contractility adaptation during sympathetic stimulation. A DDDR device was provided by Sorin (Italy) Living 1 pacemaker. This works using a specially designed ventricular lead tipped by a microaccelerometer and a standard pacing unipolar electrode. Some studies have demonstrated the efficacy of this pacemaker [5–7]. The aim of this paper is to study the long-term stability of the correlation linking PEA and heart rate variations in implanted patients. more...
- Published
- 2000
- Full Text
- View/download PDF
25. [New data on paroxysmal atrial fibrillation]
- Author
-
P, Jaïs, M, Haïssaguerre, and J, Clémenty
- Subjects
Thromboembolism ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Prognosis - Published
- 1999
26. Atrial fibrillation: role of arrhythmogenic foci
- Author
-
P, Jaïs, D C, Shah, M, Haïssaguerre, M, Hocini, S, Garrigue, and J, Clémenty
- Subjects
Adult ,Male ,Electrocardiography ,Treatment Outcome ,Pulmonary Veins ,Atrial Fibrillation ,Catheter Ablation ,Electrocardiography, Ambulatory ,Humans ,Female ,Middle Aged ,Aged ,Follow-Up Studies - Abstract
Atrial fibrillation, the most common of all sustained cardiac arrhythmias can be cured by Surgical atriotomies or linear RF catheter ablation. We have investigated the role of focal RF ablation in paroxysmal atrial fibrillation.sixteen patients with focal atrial fibrillation (extrasystoles, atrial tachycardia and atrial fibrillation due to the same focus firing irregularly at different rates) and 45 with common AF initiated by extrasystolic foci were included. The ablation site was determined on the basis of earliest bipolar activity relative to a stable atrial electrogram reference or to the P wave onset during atrial fibrillation initiation.All the patients with focal atrial fibrillation were treated with a mean of 5 +/- 4 RF applications delivered on a right atrial site (n = 4) or on a pulmonary venous site (n = 13), (one patient had 2 foci). Sixty nine foci (located in the pulmonary veins in 94%) were identified in the 45 patients with common atrial fibrillation initiated by extrasystoles. They were ablated with a mean of 4.5 +/- 2 RF applications. Using a mean follow up of 8 +/- 6 months, 28/45 (62%) were cured without antiarrhythmic drugs.Pulmonary veins play an important role in paroxysmal atrial fibrillation. They are the most frequent source of focal atrial fibrillation and of initiating foci amenable to RF ablation. more...
- Published
- 1999
27. [Implantable defibrillators. Good cost-effectiveness or supplementary expense to our hospitals?]
- Author
-
S, Lévy, E, Aliot, J, Clémenty, S, Kacet, and P, Coumel
- Subjects
Cost-Benefit Analysis ,Humans ,France ,Hospital Costs ,Defibrillators, Implantable - Published
- 1999
28. Dual chamber rate responsive pacing system driven by contractility: final assessment after 1-year follow-up. The European PEA Clinical Investigation Group
- Author
-
J, Clémenty
- Subjects
Male ,Sick Sinus Syndrome ,Pacemaker, Artificial ,Time Factors ,Cardiac Pacing, Artificial ,Myocardial Contraction ,Electrodes, Implanted ,Heart Block ,Activities of Daily Living ,Electrocardiography, Ambulatory ,Exercise Test ,Humans ,Female ,Aged ,Follow-Up Studies - Abstract
The aim of this study was to assess the long-term performance of a new dual chamber rate responsive pacing system based on the dynamic measurement of the peak endocardial acceleration (PEA) index of cardiac contractility. Seventy patients who participated in the Multicenter European Clinical Evaluation were studied 1 year after implantation by continuously recording the PEA and the heart rate (HR) during exercise stress testing and during 24 hours of usual activities. A complete examination of standard parameters was also performed to assess the pacing/sensing lead characteristics. Statistical comparisons were performed with the data recorded with the same protocol at 1 month after implant for each patient. A linear correlation coefficient was calculated between PEA and sinus rate when the patient showed predominant atrial tracked rhythm. There were no significant differences between PEA values measured at 1 month and 1 year (PEA = 0.41 +/- 0.26 g vs 0.45 +/- 0.29 g at rest and PEA = 1.63 +/- 0.77 g vs 1.72 +/- 0.83 g during peak exercise). The correlation coefficient remained stable (0.67 +/- 0.15 vs 0.65 +/- 0.14 during daily life and 0.74 +/- 0.14 vs 0.77 +/- 0.11 during exercise). The PEA signal detected by the sensor was reliable and stable. No long-term complications or adverse effects were observed, and the lead performance was comparable to that of a standard lead. more...
- Published
- 1998
29. Radiofrequency catheter ablation for AV nodal reentrant tachycardias (AVNRT)
- Author
-
D C, Shah, P, Jaïs, L, Gencel, S, Chouairi, M, Hocini, B, Fischer, J, Clémenty, and M, Haïssaguerre
- Subjects
Treatment Outcome ,Catheter Ablation ,Humans ,Tachycardia, Atrioventricular Nodal Reentry - Abstract
Radiofrequency (RF) catheter ablation is the curative treatment of choice for atrioventricular (AV) nodal reentrant tachycardia (AVNRT). Analogous to the development of surgical techniques, catheter ablation has evolved from AV nodal ablation to selective "fast" and "slow" pathway ablation. "Slow" ablation is now the method of choice because of the lower incidence of associated AV block. Though slow pathway ablation can be achieved with equal success using either the anatomic or the electrogram-guided approach, fewer applications of RF energy are required for the potential-guided technique. more...
- Published
- 1996
30. [Flecainide acetate]
- Author
-
P, Bordier, S, Garrigue, and J, Clémenty
- Subjects
Electrocardiography ,Flecainide ,Dose-Response Relationship, Drug ,Humans ,Anti-Arrhythmia Agents - Abstract
Flecainide acetate is a powerful antiarrhythmic initially used to treat ventricular arrhythmias. Despite an excess mortality in this indication and in the presence of heart disease, flecainide remains a good antiarrhythmic for supraventricular tachycardias in a healthy heart. more...
- Published
- 1996
31. [Endocavitary ablation of nodal reentrant tachycardia]
- Author
-
P, Jaïs, M, Haïssaguerre, L, Gencel, D C, Shah, P, Le Métayer, and J, Clémenty
- Subjects
Bundle of His ,Electrocardiography ,Treatment Outcome ,Recurrence ,Catheter Ablation ,Heart Septum ,Sinoatrial Block ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Follow-Up Studies - Abstract
Atrioventricular nodal reentrant tachycardias which, for a long time, could only be treated medically, may now benefit from catheter ablation. The rapid retrograde pathway was an effective initial target but carried a risk of complete atrioventricular block of about 10%. Nowadays, most operators deliver the radiofrequency energy (endocavitary cautery) to the slow nodal pathway. Different techniques of guidance (anatomical, electrophysiological, rapid potential, slow potential) are associated with high success rates: 90 to 100%. However, experimental studies suggest that the slow potentials arise from transitional cells within the tachycardia circuit (the anatomical substrate of the slow pathway). There is still a risk of complete atrioventricular block (1 to 5%) which should be clearly explained to patients referred for ablation of this constantly benign arrhythmia. more...
- Published
- 1996
32. [Management of nodal reentrant tachycardia with radiofrequency: predictive criteria of success]
- Author
-
P, Jaïs, M, Haïssaguerre, L, Gencel, F, Pocquet, P, Le Metayer, and J, Clémenty
- Subjects
Adult ,Male ,Adolescent ,Cardiac Pacing, Artificial ,Middle Aged ,Prognosis ,Electrocardiography ,Heart Block ,Treatment Outcome ,Recurrence ,Tachycardia, Ectopic Junctional ,Atrioventricular Node ,Catheter Ablation ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female - Abstract
Endocavitary catheter ablation by radiofrequency energy applied on the slow pathway is an effective method of treatment of nodal reentrant tachycardias. The aim of this report was to determine the criteria predictive of success during radiofrequency ablation of the slow pathway guided by the presence of slow potentials. Thirty-five patients (21 women, 14 men, mean age 44 +/- 14 years) with frequent attacks of junctional tachycardia were studied. After confirmation of the diagnosis by electrophysiological investigation, radiofrequency energy was delivered at a site characterised by the presence of slow potentials between the atrial (A) and ventricular (V) potentials. The criteria investigated at each site were: before application: A/V ratio; amplitude of A and V: maximum A/minimum A ratio; amplitude and duration of the A potential; during ablation: radiological stability of the catheter position and occurrence of a junctional rhythm. All 35 patients had successful procedures with no inducible tachycardia at the end of the procedure. The slow pathway was destroyed in 20 cases (57%) with no complication of atrioventricular block. The duration of the A potential was longer in the successful cases (56 +/- 16 vs 48 +/- 14 ms; p = 0.04). The appearance of junctional rhythm and catheter stability during the procedure were predictive of success (79% vs 48%; p = 0.02; 74% vs 43%; p = 0.01). The authors concluded that an ablation site with a long duration A potential and a slow potential is a good target. In addition, ablation should be started when the catheter is radiologically stable and should not be interrupted in the absence of a junctional rhythm. more...
- Published
- 1995
33. [Survival after His bundle ablation for supraventricular arrhythmia. A 10-years experience in 317 consecutive patients]
- Author
-
F, Poquet, J, Clémenty, L, Gencel, and M, Haissaguerre
- Subjects
Adult ,Aged, 80 and over ,Male ,Bundle of His ,Age Factors ,Electric Countershock ,Middle Aged ,Survival Rate ,Treatment Outcome ,Catheter Ablation ,Quality of Life ,Tachycardia, Supraventricular ,Humans ,Female ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
Survival after His bundle ablation for supraventricular arrhythmias was analysed over 10 years (May 1982 to December 1992) in 312 consecutive patients (5 were lost to follow-up): 54 died (17.3%), 13 of sudden death (24%). The survival rates were 94.5% at 1 year (n = 256), 80.1% at 5 years (n = 88), 72.8% at 8 years (n = 20) and 51% at 10 years (n = 4); patients without apparent heart disease had a better prognosis. This series serves as a reference for other techniques of His bundle ablation. more...
- Published
- 1995
34. [Practical experience of specific catheter ablation of atrial flutter in 110 patients]
- Author
-
B, Fischer, M, Haïssaguerre, S, Garrigue, F, Poquet, L, Gencel, and J, Clémenty
- Subjects
Male ,Treatment Outcome ,Atrial Flutter ,Evaluation Studies as Topic ,Recurrence ,Catheter Ablation ,Humans ,Female ,Middle Aged ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
The object of this study was to assess the efficacy and risks of radiofrequency ablation of common atrial flutter and to determine the optimal site of ablation in a large population of patients. Three different methods were used to determine the site of ablation: the first was anatomical and electrophysiological whilst the two others were based essentially on anatomical landmarks for localising the critical zone of the reentry circuit. Recent studies report that radiofrequency ablation is effective in interrupting and preventing recurrences of common atrial flutter both by using anatomical and electrophysiological methods. Nevertheless, a larger series of patients was necessary to establish the efficacy and to determine the optimal site of ablation. A series of 110 consecutive patients with common atrial flutter resistant to antiarrhythmic drugs was studied. The site of ablation of the first 50 patients was determined using both anatomical landmarks and electrophysiological parameters. The anatomical zones were: zone 1, between the septal leaflet of the tricuspid valve and the orifice of the inferior vena cava; zone 2, between the septal leaflet of the tricuspid valve and the ostium of the coronary sinus, and zone 3: between the orifice of the inferior vena cava and the ostium of the coronary sinus. The electrophysiological criterion was an endocavitary auriculogramme occurring during the plateau phase preceding the F wave of the flutter.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1995
35. [Choice of the mode of stimulation after ablation of the bundle of His. Experience based on a retrospective survey of 192 patients]
- Author
-
V, Bernard, J, Clémenty, L, Gencel, F, Poquet, and M, Haïssaguerre
- Subjects
Male ,Bundle of His ,Pacemaker, Artificial ,Time Factors ,Cardiac Pacing, Artificial ,Electrocoagulation ,Humans ,Arrhythmias, Cardiac ,Female ,Middle Aged ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
A retrospective study of 192 patients centered on the outcome of supraventricular arrhythmias after catheter ablation of the atrioventricular junction provided some useful information concerning the choice of pacing mode in these patients. With the exception of atrioventricular bloc after ablation of the rapid nodal pathway where simple DDD pacing is adequate, rate adaptive pacing would seem to be essential. The VVIR mode should be the mode of choice in atrial flutter, permanent atrial fibrillation, poorly controlled atrial fibrillation and paroxysmal atrial fibrillation of elderly subjects (over 70 years) and/or of male sex, and/or complicating advanced cardiac disease (valvular, ischaemic or primary). The DDDR mode (with an algorithm to prevent endless loop tachycardia) is the mode of choice in sinus node dysfunction and/or in young patients (under 60), and/or females and/or in idiopathic arrhythmias and/or when retrograde VA conduction persists. When the pacemaker is replaced, the indication should be reviewed with respect to the outcome of the arrhythmia, which underlines the value of accurate implanted Holter systems. more...
- Published
- 1994
36. [Ventricular fibrillation in Wolff-Parkinson-White syndrome. Predictive factors]
- Author
-
C, Attoyan, M, Haissaguerre, J F, Dartigues, P, Le Métayer, J F, Warin, and J, Clémenty
- Subjects
Adult ,Male ,Electrocardiography ,Death, Sudden, Cardiac ,Adolescent ,Heart Conduction System ,Predictive Value of Tests ,Data Interpretation, Statistical ,Ventricular Fibrillation ,Humans ,Female ,Wolff-Parkinson-White Syndrome ,Retrospective Studies - Abstract
The incidence of sudden death in the Wolff-Parkinson-White (WPW) syndrome is not well documented and probably underestimated. This retrospective study concerned 28 consecutive patients presenting with ventricular fibrillation either spontaneously (20) or during electrophysiological investigation (8) but whose characteristics allowed them to be assimilated into a single group. Their clinical and electrophysiological characteristics were compared with those of 60 consecutive patients with the WPW syndrome who had documented atrial fibrillation (and even reciprocating tachycardia) but never ventricular fibrillation. There were no significant differences between the two groups with respect to the following clinical parameters: sex, duration of symptoms, the type of tachycardia previously recorded, history of syncope and presence of underlying cardiac disease. With respect to the electrophysiological data, there were no differences in the point of anterograde block, the effective anterograde refractory period of the accessory pathway, the effective and functional refractory periods of the right atrium and atrial vulnerability. On the other hand, a significant difference was observed in the age of patients with ventricular fibrillation (29 +/- 13 years vs 36 +/- 12 years; p0.02), the prevalence of multiple accessory pathways (25% vs 7%; p0.04) with a dominant localisation in the postero-septal region (75% vs 47%, p0.026), preexcitation during exercise stress testing and under antiarrhythmic therapy (95% vs 68%, p0.037). The most discriminating parameter was the shorter RR interval during atrial fibrillation (172 +/- 23 ms vs 230 +/- 50 ms, p0.008). Multivariate analysis only showed one independent predictive factor: the minimum preexcited RR interval.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1994
37. La télémédecine en cardiologie
- Author
-
J. Clémenty
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2011
- Full Text
- View/download PDF
38. [Ablation of junctional tachycardia by radiofrequency currents. Experience with 538 patients]
- Author
-
M, Haissaguerre, B, Fischer, P, Le Métayer, P, Egloff, J F, Warin, and J, Clémenty
- Subjects
Adult ,Aged, 80 and over ,Male ,Time Factors ,Adolescent ,Radio Waves ,Middle Aged ,Recurrence ,Tachycardia, Ectopic Junctional ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Child ,Aged ,Follow-Up Studies - Abstract
Junctional tachycardias may be related to intranodal reentry or to the existence of an accessory pathway. All are suitable for radical treatment by radiofrequency current applied either in the perinodal region or at the tricuspid or mitral atrioventricular rings respectively. 176 patients with intranodal reentry were treated by preferential modification of the rapid (8) or slow (167) anterograde pathway of the reentry circuit, with a 99% success rate (1 failure) and without significant complications, in particular atrioventricular block in the case of ablation of the slow pathway. 362 patients with one or more accessory pathways, patent or latent, were treated using the same type of energy. The ablation site was determined on the basis of indirect criteria and/or recording of the specific activity of the accessory pathway. The success rate here was 98%, once again without significant complications with the exception of those inherent to catheterisation procedures. Treatment duration time was 41 +/- 38 min in the treatment of intranodal reentry and 58 +/- 49 when one or more accessory pathways were responsible. X-ray exposure times were 14 +/- 14 min and 23 +/- 21 min respectively. Such results would justify the expectation of widened indications of the method. more...
- Published
- 1993
39. [Study and value of high amplification atrial signal in arterial hypertension]
- Author
-
M N, Dulhoste, P, Dos Santos, G, Cauchi, A, Lemouroux, I, Cheradame, and J, Clémenty
- Subjects
Adult ,Male ,Electrocardiography ,Amplifiers, Electronic ,Atrial Fibrillation ,Hypertension ,Humans ,Female ,Signal Processing, Computer-Assisted ,Middle Aged ,Atrial Function ,Aged - Abstract
The aim is the analysis of the P wave on the signal averaged ECG in 31 pts: 12 control pts (6 M, 6 W, 40 +/- 10 y) 12 HTA (9 M, 3 W, 60 +/- 7 y), 7 pts (5 M, 2W, 48 +/- 7 y) with sustained paroxystic atrial fibrillation (AF) without organic heart disease, without antiarrhythmic drugs. We measured the filtered P wave duration (Ad), the integral of Ad, the root mean square voltage of Ad for the last 10, 20, 30, 40, 60 msec and the duration of P wave on the ECG in lead II (P II) and the echocardiographic dimensions of the atria (LAd). HTA Ad (132 +/- 12 msec)* etcontrol Ad (116 +/- 10 msec) HTA LAd (38 +/- 3 mm) etcontrol LAd (31 +/- 0.7 mm) HTA PII (120 +/- 1.5 mm)* etcontrol PII (88 +/- 10 mm). The difference between HTA Ad (132 +/- 12 msec) and AF Ad (129 +/- 7 msec) is not significant. The linear regression tests don't show correlation between P II and Ad and between LAd and Ad in HTA group. There is a correlation between Ad and LAF in AF group (r = 0.83, p 0.02). HTA RMS 2o (2.2 + 0.6 microV), control RMS 2o (3.9 + 1.8 V) but HTA RMS 2o and AF RMS 2o (2.4 +/- 0.6 microV) are not significantly different and are not correlated with LAd and PII. A long duration of P filtered P wave and a low RMS 2o observed in HTA group and AF group would be a criteria of atrial vulnerability. p0.05. more...
- Published
- 1992
40. [Left ventricular hypertrophy and arrhythmia. An aspect of hypertensive cardiomyopathy]
- Author
-
J, Clémenty, M N, Dulhoste, P, Coste, and A, Gil
- Subjects
Death, Sudden ,Electrocardiography ,Hypertension ,Prevalence ,Humans ,Arrhythmias, Cardiac ,Cardiomegaly ,Ventricular Function, Left - Abstract
Epidemiological data has established a relationship between left ventricular hypertrophy (LVH) and sudden cardiac death. This relationship is independent. The search for ventricular and atrial arrhythmias in hypertensives confirms a greater prevalence of these arrhythmias in patients with LVH. The mechanism of these arrhythmias is multifactorial: ischemia, subendocardial fibrosis, increased sympathetic tone, electrolyte disturbances, age, and hemodynamic changes may be arrhythmogenic substrates both at the ventricular and auricular levels. The relationship between LVH (marker or cause) and the detected arrhythmias remain obscure. The most sensitive markers of severity seem to be the ECG parameters (LVH with overload), echocardiographic mass (greater than + 20%) and septal thickness (greater than 12 mm). The evolution of arrhythmias with regression of LVH is unknown. Respect of electrolyte equilibrium would seem to be the only unquestioned therapeutic intervention. more...
- Published
- 1991
41. [Betablockers and vascular aging]
- Author
-
J, Clémenty, M N, Dulhoste, P, Labbe, P, Bordier, N, Fons, and M C, Lartigue
- Subjects
Aging ,Arteriosclerosis ,Adrenergic beta-Antagonists ,Blood Vessels ,Humans ,Aged - Published
- 1991
42. [Antihypertensive treatment and remission of left ventricular hypertrophy. Critical study]
- Author
-
J, Clémenty, M N, Dulhoste, P, Bordier, M C, Lartigue, and N, Pons
- Subjects
Hypertension ,Animals ,Drug Evaluation ,Humans ,Cardiomegaly ,Antihypertensive Agents - Abstract
Left ventricular hypertrophy which is the adaptive mechanism of the heart to hypertension may become a cardiovascular risk factor independent of the hypertension which induced it: the regression of left ventricular hypertrophy therefore constitutes one of the medium-term objectives of antihypertensive therapy. Some antihypertensive drugs make the left ventricular hypertrophy regress early and permanently: methyldopa, betablockers, converting enzyme inhibitors, calcium antagonists. The reduction of myocardial mass is slight or debatable with diuretics and absent or inconstant with vasodilator therapy. The regression of left ventricular hypertrophy in hypertension raises several problems: the reliability of methods of measurement; inter-individual and inter-drug variations; the beneficial nature of this regression; the preventive effect of regression of left ventricular hypertrophy on cardiovascular complications. In the light of recent trials, early treatment of hypertension may prevent the development of left ventricular hypertrophy. more...
- Published
- 1990
43. Predictive value of electrophysiologic studies during treatment of ventricular tachycardia with the beta-blocking agent nadolol. The Working Group on Arrhythmias of the French Society of Cardiology
- Author
-
J F, Leclercq, A, Leenhardt, H, Lemarec, J, Clémenty, J S, Hermida, C, Sebag, and E, Aliot
- Subjects
Adult ,Electrophysiology ,Male ,Nadolol ,Predictive Value of Tests ,Recurrence ,Tachycardia ,Humans ,Female ,Stroke Volume ,Prospective Studies ,Middle Aged - Abstract
Sixty patients with recurrent inducible sustained ventricular tachycardia were prospectively treated with nadolol (40 or 80 mg/day). Old myocardial infarction was present in 43 patients and dilated cardiomyopathy in 12. In group I (n = 36), nadolol was given alone, whereas in group II (n = 24), previously ineffective treatment with amiodarone was continued in combination with nadolol. Left ventricular ejection fraction was higher in patients in group I (0.40 +/- 0.12) than in group II (0.30 +/- 0.10, p less than 0.01) patients. Electrophysiologic study was repeated after short-term treatment with nadolol, which was continued regardless of the results of this test, according to the scheme of the parallel approach. Recurrence of spontaneous tachycardia or sudden death occurred in 21 patients after 10 +/- 9.2 months; sustained tachycardia was inducible in 19 on nadolol therapy. The remaining 39 patients (of whom 21 had inducible tachycardia while taking the drug) have had no recurrence of tachycardia after 27.8 +/- 9.3 months of follow-up study. Sensitivity, specificity and predictive value of a positive and negative test were 90.5%, 46%, 47.5% and 90%, respectively. The results differ between group I and group II patients, the latter having a high percent of false positive responses. This difference is even more obvious with respect to left ventricular ejection fraction: the predictive value of a positive test was 86% when ejection fraction was greater than 0.40 and 39% when it was less than 0.40.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1990
44. Study of the electrophysiological properties of intravenous bisoprolol in patients with and without coronary artery disease by programmed stimulation
- Author
-
J, Clémenty, R, Samoyeau, P, Coste, and H, Bricaud
- Subjects
Male ,Analysis of Variance ,Chi-Square Distribution ,Adrenergic beta-Antagonists ,Blood Pressure ,Coronary Disease ,Middle Aged ,Electrocardiography ,Heart Rate ,Atrioventricular Node ,Bisoprolol ,Humans ,Female ,Electrophysiologic Techniques, Cardiac ,Infusions, Intravenous ,Aged - Abstract
The objective of this study was to assess the electrophysiological properties of intravenous bisoprolol in patients with and without coronary artery disease (CAD) by programmed stimulation. Sixteen inpatients subjected to an electrophysiological investigation because of dizziness or palpitations were given 10 mg of intravenous bisoprolol after basal measurement and were checked again 15 and 45 min after infusion. Eight patients with CAD (seven males and one female; mean age of 60+/-4 years) and eight patients without CAD (five males and three females; mean age of 59+/-4 years) were investigated after washout of prior antiarrhythmic drugs. For coronary patients, the CAD was documented by a history of myocardial infarction or by a confirmatory coronary arteriography. Main outcome measures were parameters of invasive electrophysiological exploration, with measurement of conduction intervals at rest and during pacing and of refractory periods by means of extrastimulus technique. No significant difference was noted at baseline between the two groups except for CSNRT. After infusion of 10 mg of bisoprolol, with the exception of CSNRT (increased in the group without CAD), no significant differences were noted on comparison between coronary and noncoronary patients. Bisoprolol significantly increased the sinus cycle length, SACT, and FRP of the atria. Regarding atrioventricular nodal conduction, bisoprolol significantly increased the AH 100, ERP, and FRP and significantly decreased the Wenckebach point. In the right ventricle, bisoprolol moderately, but significantly, decreased the corrected QT and induced a small, temporary, significant increase in ERP. Bisoprolol appears to be a very potent beta-blocker that is well tolerated at an intravenous dose of 10 mg. Its depressant effects concern mainly the atrial function and the nodal conduction, without significant differences between the two groups of patients. The decrease in QTc may be a favorable aspect regarding its electrophysiologic tolerance especially in the acute phase of myocardial infarction. more...
- Published
- 1990
45. Infection bactérienne de sonde de pacemaker: 17 observations
- Author
-
P. Jarnier, Joël Constans, Claude Conri, P. Lemetayer, F Jouve, P. Gosse, S. Bakhach, J Clémenty, and P Ansoborlo
- Subjects
Gastroenterology ,Internal Medicine - Published
- 1998
- Full Text
- View/download PDF
46. [Postprandial bidirectional tachycardia]
- Author
-
S, Lévy, J, Hilaire, J, Clémenty, R, Bartolin, P, Besse, and H, Bricaud
- Subjects
Electrocardiography ,Tachycardia ,Humans ,Female ,Aged ,Deglutition - Published
- 1982
47. [Electrophysiological properties of acute intravenous sotalol in man]
- Author
-
J, Clémenty, J F, Falquier, C, Danis, M, Bémurat, M, Dallocchio, and H, Bricaud
- Subjects
Adult ,Male ,Bundle of His ,Time Factors ,Dose-Response Relationship, Drug ,Sotalol ,Middle Aged ,Atrial Function ,Purkinje Fibers ,Heart Conduction System ,Injections, Intravenous ,Humans ,Ventricular Function ,Female ,Aged ,Sinoatrial Node - Abstract
The electrophysiological properties of of 0,6 mg/Kg SOTALOL administered intravenously were studied in 15 subjects aged between 32 and 81 years. The following parameters were recorded: sinus rate (SR), corrected sinus node recovery time (SNRT), sinoatrial conduction time (SACT), PA interval, right atrial effective refractory period (ERP), right atrial functional refractory period (FRP), AH interval at rest, at 100 bpm, Luciani-Wenckebach point (LWP), AV node ERP and FRP, HV interval, His-Purkinje ERP, right ventricular ERP, corrected QT interval. At this dosage, intravenous SOTALOL displays two types of behaviour: --That common to the betablocker drugs: slowing SR by 16%, increasing the AV nodal conduction, increasing the AH interval at rest (5%), at 100 bpm (23%), increasing AV nodal ERP (26%) and FRP (20%), decreasing the LWP (18%). --Other properties: increasing intraatrial PA interval (3%), increasing right atrial ERP (II%), FRP (I7%), increasing right ventricular ERP (8%), increasing His-Purkinje ERP (when measurable) (about 6%), no change in corrected QT interval. At this dosage, SOTALOL exhibits electrophysiological behaviour similar to drugs in Class III (Touboul): those with a "wide electrophysiological spectrum". more...
- Published
- 1981
48. [Vascular risk and renin activity in essential arterial hypertension]
- Author
-
M, Dallocchio, J, Clémenty, A, Choussat, J P, Broustet, and H, Bricaud
- Subjects
Adult ,Heart Failure ,Male ,Cerebrovascular Disorders ,Hypertension ,Renin ,Potassium ,Humans ,Natriuresis ,Female ,Middle Aged ,Prognosis ,Aged - Published
- 1975
49. [Idiopathic auriculo-ventricular block in young patients. Value of stress testing and the atropine test for the localization of the conduction disorder]
- Author
-
S, Lévy, C, Danis, J P, Broustet, J, Clémenty, M, Blanc, R, Gérard, and H, Bricaud
- Subjects
Adult ,Atropine ,Male ,Electrocardiography ,Heart Block ,Adolescent ,Heart Conduction System ,Bundle-Branch Block ,Cardiac Pacing, Artificial ,Exercise Test ,Humans ,Female - Published
- 1982
50. [Functional content of the electrocardiogram of coronary patients]
- Author
-
J P, Colle, J, Clémenty, J, Bonnet, B, Ramanamamonjy, and H, Bricaud
- Subjects
Male ,Electrocardiography ,Arteriosclerosis ,Hemodynamics ,Myocardial Infarction ,Humans ,Coronary Disease ,Female - Abstract
A comparison of the haemodynamic and electrocardiographic data was carried out in 180 coronary patients. All underwent catheterisation and coronary angiography for angina. They were divided into three main groups: 53 patients with coronary atheroma without significant stenosis; 43 patients with at least one coronary stenosis greater than 50%; 84 patients had myocardial infarction with ECG changes of transmural necrosis and coronary thrombosis (or greater than 80% stenosis). Parameters of left ventricular function (LVF), especially ejection fraction (EF), systolic work (LVESW), end diastolic pressure (LVEDP), end diastolic volume (LVEDV), myocardial mass calculated from angiography (LMV) and volumic compliance were analysed in all cases. Each patient had at least 5 ECG recordings analysed by a HP 6 calculator which determined the values of the principal numeric ECG parameters and the means of the 5 recordings. Particular attention was given to the sum of the R waves in the 12 leads (sigma R mV) and Macruz's index (duration of P/PR - P in Lead II). A satisfactory correlation was found overall between sigma R and EF (r = 0,45, p less than 0,001). sigma R was the only ECG variable related to LVF in patients without infarction. In this group of 96 patients, sigma R correlated with LVEDV (r = 0,46, p less than 0,001) with LVM (r = 0,46, p less than 0,001), with LVESW (r = 0,52, p less than 0,001). There was a discordance between angiographically measured LVM and the mass of electrically active myocardium in patients with infarction. sigma R was independent of LVM, LVEDV, and LVESW.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1983
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.