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Introduction: Smartwatch ECGs (SW-ECG) have been identified as a noninvasive solution to assess abnormal heart rhythms, especially atrial arrhythmias (AA) which are related to stroke risk. This study assesses the detection of AA with the Apple Watch and compares the accuracy of two algorithms, the original companion application (ECG 1.0 App) and a novel deep neural network (DNN), in a population typical of an electrophysiology department. Hypothesis/Objective: To determine if a novel DNN can improve the detection of AA on SW-ECGs. Methods: 146 simultaneous pairs of 12-lead ECGs (GE Mac 2000 or Mindray BeneHeart R12) and SW-ECGs have been collected on 144 patients from the electrophysiology department of one tertiary center. 12-lead ECGs were adjudicated by an expert electrophysiologist as 40 AA and 106 not AA and considered as ground truth. The SW-ECGs were processed by the ECG 1.0 App and the DNN in parallel. The proportions of inconclusive diagnoses returned and the performances were assessed and compared. Results: Overall, the ECG 1.0 App yielded inconclusive diagnoses for 25% (37/146) of all SW-ECGs while the DNN reduced that number to 1% (2/146). After excluding SW-ECGs with an inconclusive diagnosis (37/146), the ECG 1.0 App and the DNN had a sensitivity of 62% (95% CI, 55%-70%) and 96% (95% CI, 93%-99%) respectively, and both had a specificity of 95% (95% CI, 92%-99%). Conclusions: A novel DNN improved the performance for the detection of AA. It reduced the burden of inconclusive diagnostics by 24% and improved the sensitivity by 34% with no change in specificity. Routine application of this SW-ECG analysis offers significant promise in arrhythmia diagnosis. Further investigations are needed to assess the classification of atrial arrhythmias more precisely.

Aims Sudden cardiac arrest remains a major complication of acute myocardial infarction (AMI) and is frequently related to ventricular fibrillation (VF). Incidence and impact of VF among patients hospitalized for AMI were evaluated. Methods and results Data from the FAST-MI programme consisting of 5 French nationwide prospective cohort studies between 1995 and 2015 were analysed, totally including 14 423 patients with AMI (66 ± 14 years, 72% males, 59% ST-elevation myocardial infarction). Overall, proportion of patients presenting in-hospital VF decreased from 3.9% in 1995 to 1.8% in 2015 (P < 0.001). One-year mortality decreased from 60.7% to 24.6% (P < 0.001). However, compared with patients who did not develop VF, the over-risk of 1-year mortality associated with VF was stable over time [hazard ratio (HR) 6.78, 95% confidence interval (CI) 5.03–9.14 in 1995 and HR 6.64, 95% CI 4.20–10.49 in 2015, P = 0.52]. This increased mortality in the VF group was mainly related to fatal events occurring prior to hospital discharge, representing 86.2% of 1-year mortality, despite the very low rate of implantable cardioverter defibrillator in the VF group (2.6%). Conclusion This study demonstrates that in-hospital VF incidence and mortality in the setting of AMI have significantly decreased over the past 20 years. Nevertheless, VF remained steadily associated with approximately a 10-fold increased relative risk of in-hospital mortality, without an impact on post-discharge mortality. Beyond long-term cardiac defibrillation strategy, these results emphasize the need to identify in-hospital interventions to further reduce mortality in VF patients. Study registration ClinicalTrials.gov Identifier: NCT00673036, NCT01237418, NCT02566200

Background Atrial flutter-related tachycardiomyopathy (AFL-TCM) is a rare and treatable cause of heart failure. Little is known about its epidemiology and long-term prognosis. Our aims are to determine the prevalence, predictors and outcomes of AFL-TCM. Methods A total of 1269 patients were referred for radiofrequency ablation of AFL between January 1996 and September 2014; 184 had reduced left ventricular ejection fraction (LVEF

International audience; ObjectivesTo jointly study paroxysmal supraventricular tachycardia (SVT)-related adverse events (AE) and ablation-related complications, with specific emphasis on the predictors of SVT-related AE as well as their significance by investigating their association with long-term mortality.Methods1770 patients were included, aged 6 to 97, with either atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic atrioventricular reciprocal tachycardia (AVRT) mediated by concealed accessory pathway, consecutively referred for SVT work-up in a tertiary care center.ResultsSVT-related AE were identified in 339 patients (19%). Major AEs were identified in 23 patients (1%; 15 cardiac arrests or ventricular arrhythmias requiring cardioversion and 8 hemodynamic collapses). Other AE were related to syncope (n = 236), acute coronary syndrome (n = 57) and heart failure/rhythmic cardiomyopathy (n = 21). In multivariable analysis, higher age, heart disease and requirement of isoproterenol to induce SVT were independently associated with a higher risk for SVT-related AE.During follow-up (2.8 ± 3.0 years), death occurred more frequently in patients with SVT-related AE, especially in patients with major adverse events (p < 0.001). In multivariable analysis, major SVT-related AE remained significantly associated with occurrence of death (HR = 6.72, IC = (2.58–17.52), p < 0.001) independently of age and presence of underlying heart disease.Major SVT-related AE in the whole population referred for SVT were more frequent than immediate major ablation complications in patients undergoing SVT ablation (5/1186 vs. 23/1770, p = 0.02).ConclusionsSVT-related AE are independent predictors of mortality and are more frequent than immediate major ablation complications in patients undergoing SVT ablation. The present findings support systematically performing SVT ablation in patients with SVT-related adverse events.

International audience; Background: Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location.Methods: Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients.Results: AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP

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International audience; The aim of study was to report different and unusual patterns of preexcitation syndrome (PS) noted in patients referred for studied for poorly-tolerated arrhythmias and their frequency. Electrophysiologic study (EPS) is an easy means to identify a patient with PS at risk of serious events. However the main basis for this diagnosis is the ECG which associates short PR interval and widening of QRS complex with a delta wave.METHODS:ECGs of 861 patients in whom PS related to an atrioventricular accessory pathway (AP) was identified at electrophysiological study (EPS), were studied.RESULTS:The most frequent unusual presentation (9.6%) was the PS presenting with a normal or near normal ECG, noted preferentially for left lateral AP and rarely for posteroseptal or right lateral location. More exceptional (0.1%) was the presence of a long PR interval, which did not exclude a rapid conduction over AP. The association of a complete AV block with symptomatic tachycardias was exceptional (0.3%) and was shown related to a rapid conduction over AP after isoproterenol. Most of the presented patients were at high-risk at EPS.CONCLUSION:The diagnosis of PS is not always evident and symptoms should draw attention to minor abnormalities and lead to enlarge indications of EPS, only means to confirm or not PS.

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

International audience; Aim: To investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes.Methods: Clinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation.Results: Among 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70-97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41-2.62, p

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

Paroxysmal supraventricular tachycardia (SVT) is considered benign in children if the electrocardiogram in sinus rhythm is normal, but causes anxiety in parents, children and doctors.To report on the clinical and electrophysiological data from children with SVT, their follow-up and management.Overall, 188 children/teenagers (mean age 15±2.8 years) with a normal electrocardiogram in sinus rhythm were studied for SVT, and followed for 2.3±4 years.SVT was poorly tolerated in 30/188 children (16.0%). SVT was related to atrioventricular nodal reentrant tachycardia (AVNRT) (n=133) or atrioventricular reentrant tachycardia (AVRT) over a concealed accessory pathway (n=55; 29.3%). Ablation of the slow pathway (n=66) or the accessory pathway (n=43) was performed without general anaesthesia, 2±3 years after initial evaluation. Failure or refusal to continue occurred in 18/109 (16.5%) children: 7/66 with AVNRT (10.6%), 11/43 with AVRT (25.6%) (P0.001). Symptoms of SVT recurred in 20/91 children (22.0%) with apparently successful ablation: 6/91 (6.6%) had real SVT recurrence; 14/91 (15.4%) had only a sinus tachycardia, more frequent in AVNRT (11/59; 18.6%) than AVRT (3/32; 9.4%) (P0.05). In 13 children treated with an antiarrhythmic drug (AAD), SVT recurred in four; two presented AAD-related syncope. In 66 untreated children, one death was noted after excessive AAD infusion to stop SVT; the others remained asymptomatic or had well-tolerated SVT.At the time of ablation, SVT management remains difficult in children. Indications for ablation are more common in AVRT than in AVNRT, but failures are frequent; 22.0% remained symptomatic after successful ablation, but false recurrences were frequent (15.4%). Without ablation, one third had a spontaneous favourable evolution.

Objectives There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS. Setting Single-centre retrospective study of patient files. Participants In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients

International audience; BACKGROUND:The diagnosis of paroxysmal supraventricular tachycardia (SVT) frequently is a dilemma. Electrophysiological study (EPS) is the only means to evaluate the nature of symptoms when noninvasive studies remain negative. Our objectives were to determine the clinical factors of negativity or positivity of (EPS) in patients suspected of SVT.METHODS:EPS was performed in 2650 patients complaining of tachycardia and suspected of SVT. Transesophageal EPS consisted of programmed atrial stimulation in control state and after isoproterenol. Patients were followed from 1 month to 18 years (2.93 ± 4 years).RESULTS:SVT was induced in 1944 patients, age 48 ± 19.5. EPS remained negative in 706 patients, age 34 ± 17 (p

Purpose of the studyto evaluate the impact of accessory pathway (AP) ablation on the risk of subsequent atrial fibrillation (AF) of patients with a pre-excitation syndrome (PS) and patients with a normal ECG but with AV reentrant tachycardia (AVRT) over a concealed AP.Methods103 patients were studied: 93 patients, mean age 41±16 years, with a PS presented with a well or poorly-tolerated AF (group I). They were issued from a group of 905 patients (10%) with a PS (mean age 34±17 years). Ten patients, mean age 50±21, with a normal ECG in sinus rhythm and with AVRT were referred for AF (group II). They were issued from a group of 303 patients (3%) with AVRT and a normal ECG (mean age 42±18 years). Electrophysiological study was performed in control state and after isoproterenol. Patients were followed from 3 months up to 20 years.ResultsThe incidence of AF at the admission was higher in PS than in patients with concealed AP (p

International audience; PURPOSE OF THE RESEARCH:To identify clinical factors associated with the probability for each arrhythmic mechanism causing recurring symptoms after atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. Slow pathway radiofrequency ablation is used to treat AVNRT. After ablation, recurrence of symptoms due to AVNRT or other arrhythmias can occur.RESULTS:We studied 835 patients successfully treated with AVNRT ablation. Variables associated with each specific arrhythmia underlying symptom recurrence were studied by logistic regression. During a mean follow-up of 2.2 ± 2 years, 136 (16%) patients had a recurrence of symptoms. Following invasive and non-invasive studies, symptoms were mostly attributed to sinus tachycardia, recurrence of AVNRT and atrial arrhythmias (respectively 4.7%, 5.2% and 6.1%). Older age and history of atrial fibrillation were associated with a markedly increased risk of symptom recurrence due to atrial arrhythmias (OR=15.58, 7.09-35.22, p

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When non-invasive studies remain negative, the diagnosis of unexplained tachycardia in the young is a dilemma. The purpose of the study was to determine the factors of negativity of transesophageal electrophysiological study (EPS) in children/teenagers complaining of tachycardia and the prognostic value. Two hundred and seventy-three children with a normal ECG in sinus rhythm, aged from 6 to 19 years (15 ± 3), complained of tachycardia. Transesophageal EPS consisted of atrial stimulation in control state and after isoproterenol. Supraventricular tachycardia (SVT) was induced in 149 patients (group I) and EPS remained negative in 124 (group II). Age did not differ (15 ± 3 vs 15 ± 3). Female gender and familial history of SVT were as frequent in group I (47, 11%) than in group II (55%, p = 0.15; 7%;p = 0.2). Feeling of dizziness/syncope with tachycardia was less frequent in group I (12%) than in group II (48%) (p < 0.0001). Feeling of chest pain with tachycardia was less frequent in group I (2%) than in group II (28%) (p < 0.0001). The presence of non-cardiac disease was less frequent in group I (1.3%) than in group II (6.4%) (p < 0.025). Patients with negative study remained free of SVT after a follow-up of 3.5 ± 3 years, but one had a complete AV block. In children with apparently normal ECG in sinus rhythm, who complained of tachycardia clinical history (association with syncope, chest pain, or the presence of another disease) can predict negativity of EPS with a relatively high accuracy; EPS may not be necessary. In very symptomatic patients, transesophageal EPS, which is inexpensive and non-invasive, might be performed to stop investigations.

Slow pathway radiofrequency (RF) ablation currently is used to treat patients with atrioventricular nodal re-entrant tachycardia (AVNRT). The aim of study was to evaluate the factors explaining the recurrence of symptoms after AVNRT ablation. 881 patients 291 males, 590 females, mean age 52±18

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

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

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

International audience; Purpose of the study: Typical Atrioventricular (AV) Node Re-entrant Tachycardia (AVNRT) occurs in patients with dual AV nodal pathway, a rapid pathway used for retrograde conduction and a slow pathway used for the anterograde conduction. In sinus rhythm the patients have generally the signs of conduction through the rapid pathway with a normal or short PR interval. The purpose of the study was to evaluate the prevalence of patients with 1st degree AV block and with AVNRT and their clinical characteristics.Methods: 1040 patients, 366 males, 665 females were admitted for typical AVNRT. They were aged from 6 to 90 years (mean age 50±19). Initial ECG and clinical data were collected. Electrophysiological study was systematic.Results: Spontaneous 1st degree AV Block (AVB) was rare and noted in 8 patients. The prevalence of the association 1st degree AV Block and AVNRT was 0.8%. AVB was suprahisian in 7 of 8 and infrahisian in one of them. Five patients complained of AVNRT at exercise. Two patients had an ischemic heart disease. Patients with AVB were significantly older (71.5±16 years) than patients without AVB (50±19) (p

Purposeof study to collect history of patients with preexcitation syndrome (PS)-related adverse event (AE) and evaluate their risk factors. Classicaly male sex, multiple accessory pathways (AP) and at electrophysiological study (EPS), refractory period (RP)300 bpm), cause of syncope and requiring cardioversion (17) or drug (58). ECG, Holter monitoring and EPS in control state (CS) and after isoproterenol were performed.ResultsPatients with AE were older than remaining patients (40±8.5 vs 33±17) (p 0.0002). Male gender did not differ significantly (71 vs 61%)(p 0.06). ECG in sinus rhythm was normal or near normal in 20 patients with AE (24%) more frequently than in patients without AE (9%)(p 0.0001). Intermittent PS was seen only in patients without AE. At EPS atrioventricular reentrant tachycardia (AVRT) was induced as frequently in patients with AE as in patients without AE (60% vs 53.5%)(0.22). All other electrophysiological data differ significantly (p 0.0001): maximal rate conducted over AP was more rapid in patients with AE (262±50 bpm vs 183±65 in CS, 302±39 vs 228.5±69 after isoproterenol). AP effective refractory period was shorter in patients with AE (232±34 vs 292±73 in CS, 197±29 vs 232±50ms after isoproterenol); AF was induced more frequently in patients with AE (72 vs 19.5%). Signs of malignancy at EPS were noted in all but 4 patients (sensitivity 95%).ConclusionIf electrophysiological data evaluated in CS and after isoproterenol have high sensitivity (95%) to predict PS-related adverse event, the detection of PS can be difficult. In 20% of patients who presented with an adverse event, the diagnosis of PS was not made because ECG in sinus rhythm was normal.

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

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

IntroductionWe have previously demonstrated that the spatial characteristics (intramural and epicardial components) of MI scar predicts the occurence of monomorphic ventricular tachycardia (MVT) after a myocardial infarction (MI). We studied whether MI scar characteristics, as assessed by magnetic resonance imaging (MRI), was related to the minimum cycle lenght(mCL) of MVT.MethodsWe studied 50 patients (43 men, mean age 60±13 years) with previous MI, cardiac MRI study, primary (n=12) or secondary prevention indication of implantable cardiac defibrillator (ICD) and who experienced MVT. Delayed contrast enhancement (DCE) was used to delineate post-MI scars.ResultsMVT occurred 15±9 years after MI and the mCL was 303±49ms. MRI showed areas with intramural and/or epicardial scar (adjacent to areas showing endocardial or transmural scar) in all patient. Patients were classified depending on the median of the mCL (300ms). There were no statistical differences between the 2 groups for: gender, medication, indication of ICD, history of coronary artery revascularization, infarct location and for the following MRI parameters: left ventricular (LV) ejection fraction, LV end-diastolic volume, LV mass, total myocardial surface, total MI scar surface, transmural, endocardial or epicardial MI scar surface. In patients with a mCL>300ms, there was a trend for older age at first MVT episode (64±2 vs. 57±3 year; p=0.06) and a greater intramural scar surface (5.8±3.7 vs. 2.9±1.6cm2;p=0.002). Age (r=0.32; p=0.02) and intramural scar surface (r=0.47; p

Esophageal electrophysiological study (EPS) is an easy means to evaluate the cause of palpitations in patients with negative Holter monitoring or when cardiac event monitor is not interpretable. The purpose of study was to evaluate the clinical significance and the diagnosis value of inducible atrial tachycardia or fibrillation (AF) by esophageal EPS. Methods Esophageal EPS was performed in 159 patients, 72 males, 87 females, aged from 19 to 89 years (mean 56±16) with a normal ECG in sinus rhythm; 35 patients had presented one episode of documented sustained AF (group I). Remaining 124 patients had no documented AF (group II) and were studied for not documented tachycardia (n=70), not documented tachycardia associated with dizziness/syncope (n=23), unexplained stroke and salvos of AF (n=25), wide-QRS tachycardia suspected of atrial origin (n=6). Atrial pacing and programmed atrial stimulation with 1 and 2 extrastimuli were performed in control state (CS) and after infusion of isoproterenol. Patients were followed from 1 month to 13 years (mean 4±4 years). Results Among group I, AF was induced in 21 patients (60%). Sustained AF was induced in CS (n=50) or after isoproterenol (n= 64) in all group II patients. The follow-up indicated that 7 group I patients (21%) had recurrent AF/atrial flutter requiring ablation, 5 patients with induced AF and 2 with negative EPS (NS). Two group I patients (6%) with induced AF died from a cardiac cause. Among group II, 20 patients (16%) presented documented AF/atrial flutter and 14 of them required an ablation. Five group II patients (4%) died from a cardiac cause. The sensitivity of esophageal EPS to reproduce AF was 60%. Its positive predictive value to predict the occurrence of AF in symptomatic patients without documented AF was 16%. The positive value to predict AF and cardiac death was 24%. Conclusions Despite an average sensitivity for the induction of AF in patients with documented AF, the risk of subsequent AF and/or cardiac death was relatively high in these patients and in symptomatic patients without documented AF but with induced AF. These patients require a careful follow-up.

Atrial fibrillation (AF) and atrial flutter (AFL) are frequently associated. The purpose of the study was to look for the effect of antiarrhythmic drugs (AAD) on the risk of AF occurrence after radiofrequency ablation of AFL. Methods 1121 patients, mean age 64±12 years, were referred for AFL ablation. History, data of echocardiography, antiarrhythmic drug (AAD), were collected. Patients were followed from 3 months to 10 years (mean 2.1±2.7 years). AAD was stopped after ablation except in patients with previous AF before ablation or continued otherwise. Results 857 patients received an AAD (n=637) or a betablocker (n=221). 356 patients (31.7%) had a history of AF prior to AFL ablation. Patients with AF prior to ablation were more likely to be female (OR=1.35, CI=1.00-1.83, p=0.05), more likely to be treated with a class I AAD (45.5% vs 7.7%), isolated or associated with beta-blockers and more likely tended to be treated with Amiodarone (36.5% vs. 31.2%, p=0.08). After ablation, 260 (23.2%) patients experienced AF. In multivariable model, AF prior to ablation (OR=1.90, CI=1.42-2.54, p Conclusions AF occurrence after AFL ablation is frequent (>20%), especially in patients with a history of AF, in female patients, and in patients treated with Class I antiarrhythmics/Amiodarone prior to AFL. The risk was similar in patients treated with class I or III drug. In a patient referred for AFL ablation without known AF before AFL, treated with AAD, the follow-up should be careful because these patients appear at high risk of AF occurrence.

BackgroundAccessory pathway (AP) ablation is currently performed in patients with a preexcitation syndrome (PS); natural follow-up is based on old studies. The purpose of the study was to report data of untreated patients with PS, studied 2 times at least one year of interval.Methods2 baseline electrophysiological study (EPS) were performed within 1 to 25 years of one another (mean 9.5±7) in 104 patients, 58 males, 46 females, aged initially from 4 to 67 y (30±16), with overt PS. First EPS was indicated for syncope (n=10), atrioventricular reentrant tachycardias (AVRT)(n=51), atrial fibrillation (AF)(n=6), spontaneous malignant form (AF conducted at very high rates over AP)(n=4) or for asymptomatic PS (n= 33). The protocol was similar, performed in control state (CS) and after isoproterenol.ResultsAt 2nd EPS, among patients studied for syncope at EPS1, 2 have still syncope, 3 have AVRT, 1 has AF, 3 are asymptomatic. Among patients with AVRT at EPS1, 38 (74.5%) have AVRT, 8 are asymptomatic, 3 had syncope, 3 has AF. Among patients with AF, 2 present with a malignant form, 2 had AVRT, 1 is asymptomatic. Among asymptomatic patients, 3 present with a malignant form, 17 (53%) remain asymptomatic, 7 have AVRT, 4 have syncope, 1 has AF.All AVRT or AF but 1 occurred in patients with inducible AVRT or AF at EPS1.The higher rate conducted by AP was lower in CS and after isoproterenol at EPS2 (166±80bpm, 191±90) than at EPS1 (191±67, 243±67)(p

Paroxysmal supraventricular tachycardia (SVT) documentation is not always easy and in some patients referred for SVT ablation, EPS sometimes remains negative. The purpose of study was to evaluate the follow-up after esophageal EPS for no documented tachycardia. Methods 1569 patients, mean age 42±19.5 years, 637 males, with normal ECG in sinus rhythm, were suspected of SVT. Exercise testing, 24 hour Holter monitoring were normal. Transesophageal EPS consisted of programmed stimulation with 1 and 2 extrastimuli in control state and after isoproterenol. Results EPS remained negative in 594 patients (group I). Atrial fibrillation/tachycardia (AF) was induced in 70 patients (group II), atrioventricular (AV) nodal reentrant tachycardia (AVNRT) or AVRT using a concealed accessory pathway in 887 patients (group III). Group I was younger (34±17 years) than group II (53±16), III (46±20)(p Conclusions Prognosis value esophageal EPS was excellent. A negative study noted in younger patients complaining frequently of dizziness/syncope/ chest pain predicted a favorable prognosis. None of the patients with induced AF had AVNRT/AVRT and this group (older, with HD) had frequently AF during follow-up (20%). Patients with induced AVNRT/AVRT benefit frequently from ablation of their tachycardia.

Introduction The use of implantable cardioverter-defibrillators (ICD) is recommended to prevent sudden cardiac death (SCD) in patients with a reduced (≤30-35%) left ventricular ejection fraction (LVEF) due to previous myocardial infarction (MI). Some patients, however, never receive adequate ICD intervention. We studied whether the characteristics of MI scar, as assessed by magnetic resonance imaging (MRI), could predict the occurrence of ventricular tachycardia (VT). Methods Fifty-one patients (41 men, mean age=59±11 years) with a remote (>6 months) MI and a class I primary prevention indication for ICD implantation underwent a cardiac MRI study before implantation. Delayed contrast enhancement (DCE) was used to delineate post-MI scars.On the basis of manually outlined contours of left ventricular epicardial, endocardial and scar borders, the location and transmural extent of the scar were calculated. Results VT occurred in 15 patients (29%) after a follow-up of 43±24 months. There were no statistical differences between patients who experienced VT and those who did not for demographic data, LVEF, total myocardial and MI surface. At infarct borders, MRI showed areas with intramural and/or epicardial scar in all but one patients. Epicardial scar surface (3.6±0.5 vs. 1.4±0.3 cm2; p=0.0005) and intramural scar surface (4.0±0.6 vs. 1.8±0.4 cm2; p=0.002) were greater in patients with VT. In multivariate analysis, intramural and sub-epicardial scar surface remained significantly associated with the occurrence of VT (respectively: HR, 1.28/1cm2; CI, 1.10 to 1.51; p=0.003 and HR, 1.23/1cm2; CI, 1.01 to 1.51; p=0.04). Patients with intramural scar surface>1.65 cm2 had lower 5 years VT free survival (33.8% vs. 100%; p Conclusion The presence of a critical surface of both intramural and epicardial scars at an infarct border may be key factors for the occurrence of VT after MI. Download : Download full-size image Abstract 0141 - Figure: 3D left ventricular reconstruction

BackgroundReciprocating tachycardia which occurs in patients with a preexcitation syndrome (PS) generally is directly related to the presence of the accessory pathway (AP) and is called atrioventricular re-entrant tachycardia (AVRT). The purpose of the study was to evaluate the incidence of re-entrant tachycardia of other nature among patients with a PS.Methods785 patients with paroxysmal tachycardia were admitted AP ablation, 294 patients with a concealed AP (group I) and 491 patients with a Wolff-Parkinson-White syndrome (WPW) (group II). Programmed atrial stimulation was performed in the control state and if necessary after isoproterenol to induce the clinical tachycardia and determine its mechanism.ResultsAVRT was induced in 760 patients (97%), 282 of group I (96%)and 478 of group II (97%) (NS). Atrioventricular nodal re-entrant tachycardia (AVNRT) was induced in 13 group I patients (4.6%) and 12 group II patients(2.5%) (NS; 0.11). In 9 group I patients (3%) and in 4 group II patients (1%) (p

Typical atrioventricular (AV) node re-entrant tachycardia (AVNRT) occurs in patients with dual AV nodal pathway, a rapid pathway used for retrograde conduction and a slow pathway used for the anterograde conduction. In sinus rhythm, the patients have generally the signs of conduction through the rapid pathway with a normal or short PR interval. The purpose of the study was to evaluate the prevalence of patients with 1st degree AV block and with AVNRT and their clinical characteristics.Methods973 patients, 348 males, 625 females, were admitted for typical AVNRT. They were aged from 6 to 90 years (mean age 50±19). Initial ECG and clinical data were collected. Electrophysiological study was systematic.ResultsSpontaneous 1st degree AV block (AVB) was rare and noted in 7 patients. The prevalence of the association 1st degree AV block and AVNRT was 0.7%. Five patients complained of AVNRT at exercise. Two patients had an ischemic heart disease. Patients with AVB were significantly older (71.5± 16 years) than patients without AVB (50±19)(p

Purpose of the studyto evaluate the role of the mechanism of paroxysmal supraventricular tachycardia (SVT) on the incidence of spontaneous atrial fibrillation (AF). The relation between SVT and AF is well-known but its frequency could depend on the mechanism of SVT.Methods1559 patients, mean age 49±19 years, with SVT and without anterograde conduction over an accessory pathway (AP) were referred for electrophysiological study (EPS), performed in control state and after isoproterenol.ResultsSVT was related to atrioventricular nodal re-entrant tachycardia (AVNRT) in 1262 patients (group I), either typical (n=1180)(group IA) or atypical (n=183)(group IB). In 297 patients SVT was related to atrioventric-ular re-entrant tachycardia (AVRT) due to a concealed AP (group II). At the initial evaluation 47 group I patients (4%)(44 of group IA, 4%, 3 of group IB, 2%), 6 of group II (2%) had presented at least one episode of sustained AF (NS). During follow-up (mean 3±2 years), 97 patients developed AF, 86 of group I (7%)(71 of group IA, 6%, 15 of group IB, 8%),11 of group II (4%). AF risk was higher in group I than in group II (p

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