Philippe Chevalier | Uneversité Claude Bernard Lyon 1 (original) (raw)

Papers by Philippe Chevalier

Research paper thumbnail of Images in cardiology. A threatened paradoxical embolism

Research paper thumbnail of Acquired aortopulmonary fistula in pseudoaneurysm of the aorta six years after a bentall operation

The Journal of Thoracic and Cardiovascular Surgery, 1995

Research paper thumbnail of Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation

European Journal of Cardio-Thoracic Surgery, 2004

Objective: To determine factors predictive of mortality in patients undergoing emergency mitral v... more Objective: To determine factors predictive of mortality in patients undergoing emergency mitral valve surgery in the setting of severe post-infarction regurgitation. Methods: Patients admitted for an acute myocardial infarction who required urgent mitral valve surgery for severe regurgitation were studied. Factors predictive of outcome were analysed. Results: Fifty-five consecutive patients (mean 65^10 years, 37 males) were included. The infarct was inferior in 31 patients, posterior in 10, anterior in 9 and lateral in 5. Thirty-four patients (62%) were in Killip class IV. Peroperative findings confirmed total papillary muscle rupture in 25 patients (posteromedial in 21, anterolateral in 4), and partial rupture in 12 patients (posteromedial in 10, anterolateral in 2). Papillary muscle dysfunction without rupture was responsible for regurgitation in 18 patients (posteromedial in 15, anterolateral in 3). The mitral valve was replaced by a prosthesis in all but 4 patients, who had valvuloplasty. Coronary angiography was done in 32 patients, of whom 18 underwent concomitant coronary artery bypass grafting and 2 balloon angioplasty. Surgery was performed on average 7 days after infarction. Thirteen patients (24%) died during the perioperative period. Absence of coronary revascularisation was significantly associated with increased perioperative mortality (34% vs. 9%, P ¼ 0:02Þ: Of the 42 surviving patients, there were 5 deaths during a mean follow-up of 4.0^3.7 years. Conclusion: In patients with acute post-infarction mitral regurgitation, perioperative mortality is high, but can be improved with concomitant CABG in addition to valve surgery. Long-term outcome of survivors is favourable.

Research paper thumbnail of Long-standing bacteremia and endocarditis caused by Staphylococcus lugdunensis in a patient with an implantable cardioverter defibrillator

Clinical Microbiology and Infection, 1997

Current perspectives on glycopeptidr resistance. Clin Micro-Closrridium dificile toxin A detectio... more Current perspectives on glycopeptidr resistance. Clin Micro-Closrridium dificile toxin A detection on colonies

Research paper thumbnail of Antibiotic Prophylaxis for Permanent Pacemaker Implantation

Circulation, 1998

Background —Infection remains a serious complication after permanent pacemaker implantation. Anti... more Background —Infection remains a serious complication after permanent pacemaker implantation. Antibiotic prophylaxis is frequently prescribed at the time of insertion to reduce its incidence, although results of well-designed, controlled studies are lacking. Methods and Results —We performed a meta-analysis of all available randomized trials to evaluate the effectiveness of antibiotic prophylaxis to reduce infection rates after permanent pacemaker implantation. Reports of trials were identified through a Medline, Embase, Current Contents, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, open or blind trials; (2) patients assigned to a systemic antibiotic group or a control group; (3) end point events related to any infection after pacemaker implantation: wound infection, septicemia, pocket abscess, purulent secretion, right infective endocarditis, inflammatory signs, a positive culture, septic pulmona...

Research paper thumbnail of Role of the Preaxillary Flora in Pacemaker Infections

Circulation, 1998

Background —Infection remains a severe complication after pacemaker implantation. The purpose of ... more Background —Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence. Methods and Results —Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean±SD, 67±15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecula...

Research paper thumbnail of Atrial fibrillation: a left atrial neuro-myopathy?

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Dec 15, 2017

This editorial refers to 'Longitudinal association of shortterm, metronome-paced heart rate varia... more This editorial refers to 'Longitudinal association of shortterm, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year followup: results from the prospective, population-based CARLA cohort' by D. Medenwald et al., on pages 2027-2035.

Research paper thumbnail of Cardiac voltage-sodium channel mutations association with primary electrical diseases: Authors' reply

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 4, 2018

Cardiac voltage-sodium channel mutations association with primary electrical diseases The article... more Cardiac voltage-sodium channel mutations association with primary electrical diseases The article by Moreau et al. 1 published in Europace describing the association between voltage-gated sodium channel mutations and the occurrence of stroke in young patients presented very interesting data. The authors reported that in two unrelated boys stroke and atrial arrhythmias were confirmed. Genetic testing revealed a mutations in the SCN5A gene (p.D1275N, p.E1053K). Certainly, it is important to a knowledge the authors that patients with primary electrical disease including Brugada syndrome (BrS) with mutations of SCN5A gene are associated with atrial arrhythmia. 2-5 Of note, the reported mutation in the second boy has also been reported in BrS patients. 6 Another important finding is that recorded electrocardiograms of patients among the first family were associated with right bundle branch block. Taking all these data together, we are wondering if both families were tested on BrS using sodium channel blocking drugs such as ajmaline. This information may help to stratify this family as atrial arrhythmias in BrS were also described and cerebrovascular events are associated complications. 7

Research paper thumbnail of False positive result of positron emission tomography in a patient with suspected defibrillator system infection

Journal of Cardiology Cases, 2013

The infection of an implanted pacemaker or defibrillator is often difficult to diagnose. Positron... more The infection of an implanted pacemaker or defibrillator is often difficult to diagnose. Positron emission tomography-computerized tomography (PET-CT) has recently been shown to be of great interest in this difficult clinical setting. We report the case of a patient with suspected implantable cardioverterdefibrillator (ICD) infection. Because of 18 F-fluorodeoxyglucose (FDG) uptakes on different portions of the ICD, complete extraction of the ICD generator and lead was performed. Bacteriological samples remained sterile. FDG PET-CT, which appears to be a promising tool for the management of patients with suspected pacemaker/ICD infection, does not have a perfect specificity to detect lead infection, and should not be used alone to diagnose difficult cases of implantable cardiac device infection. <Learning objective: The aim of this case is to bring to light the necessity of specifying the place of PET-CT and its limits for the diagnosis of endocarditis on pacemaker/ICD devices.>

Research paper thumbnail of 0295: Increased intracardiac VEGF and VWF levels revealed low grade inflammatory process and progressive endothelial damage in patients with atrial fibrillation

Archives of Cardiovascular Diseases Supplements, 2015

How to identify a risk for subsequent atrial fibrillation and higher risk of stroke in patients w... more How to identify a risk for subsequent atrial fibrillation and higher risk of stroke in patients with hospitalization related to a cardiac cause? Results: 91 (8%) patients developed new-onset AF. By multivariate analysis, several factors were independently associated with the occurrence of new-onset AF: age (OR(95%CI): 1.06(1.04-1.09); p<0.001), obesity (OR: 2.11; 95% CI 1.22-3.54; p=0.007), LA indexed volume (OR(95% CI): 1.02(1.01-1.04); p=0.016), LVEF<40% (OR(95% CI): 1.91 (1.06-3.46); p=0.032) and severe heart failure on admission (OR(95% CI): 2.46(1.21-5.02); p=0.013). In stratified analysis, we found marked differences in risk factors for AF according to gender. In women, only age (OR (95% CI): 1.07(1.03-1.11); p<0.001) and severe heart failure on admission (OR (95% CI): 4.02(1.38-11.7); p=0.011) were independently associated with AF. In contrast, in men, age (OR(95% CI): 1.07(1.04-1.10); p<0.001), CRP>10mg/l (OR(95% CI): 2.81(1.49-5.28); p=0.001), LA indexed volume (OR(95% CI): 1.03(1.01-1.05); p=0.011) and obesity (OR: 2.50; 95% CI 1.26-4.97; p=0.009) were independent correlates of AF. Conclusion: The present study suggests for the first time that obesity is a major risk factor for the development of AF after AMI, which is specific to men. These findings may have clinical implication for risk stratification in AMI.

Research paper thumbnail of Heart rate reduction with ivabradine protects against ventricular fibrillation during acute ischemia in pigs

Journal of Molecular and Cellular Cardiology, 2007

Research paper thumbnail of Pneumomediastinum after implantable cardiac defibrillator implantation

European Heart Journal, 2010

Research paper thumbnail of Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis

European Heart Journal, 2000

Objective ST-segment elevation in acute pericarditis is believed to be caused by superficial myoc... more Objective ST-segment elevation in acute pericarditis is believed to be caused by superficial myocardial inflammation or epicardial injury. We used cardiac troponin I, a sensitive and specific marker of myocardial injury, to assess myocardial lesions in idiopathic acute pericarditis and its relationship to ST-segment elevation. Patients and Methods Sixty-nine consecutive patients (53 men, 48 17 years) with idiopathic acute pericarditis were included. We used an enzymoimmunoflurometric method to measure serum cardiac troponin I on admission (myocardial infarction threshold was 1•5 ng. ml 1). Results Cardiac troponin I was detectable in 34 patients (49%) and was beyond the 1•5 ng. ml 1 threshold in 15 (22%). Coronary angiography performed in seven of these 15 patients was normal in all of them. ST-segment elevation was observed in 93% of the patients with cardiac troponin I >1•5 ng. ml 1 vs 57% of those without (P<0•01). Sensitivity of ST-segment elevation to detect myocardial injury was 93% and specificity 43%. Patients with a cardiac troponin I increase higher than 1•5 ng. ml 1 were more likely to have had a recent infection (66% vs 31%; P=0•01) and were younger (37 14 vs 52 16 years; P=0•002). There was no significant relationship with other parameters such as pericardial friction rub, fever, PR segment abnormalities, echocardiographic findings or C-reactive protein. Conclusion In patients with idiopathic acute pericarditis, an increase in cardiac troponin I is frequently observed, especially in younger patients and those with a recent infection. Although ST-segment elevation does not reliably indicate myocardial injury, a significant cardiac troponin I increase is only seen in these patients.

Research paper thumbnail of Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients: A Prospective Long-Term Study

Circulation: Cardiovascular Imaging, 2011

Background— Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventricu... more Background— Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventriculography, has shown promising results. We hypothesized that quantifying the cardiac resynchronization reserve, that is, the extent of response to cardiac resynchronization therapy (CRT), by radionuclide imaging could potentially identify patients who are best suited for CRT. Methods and Results— Seventy-four patients ages 64.8±10.1 years were prospectively studied from July 2004 to July 2006, of whom 62.2% and 37.8%, respectively, were in New York Heart Association class 3 and 4. Mean QRS width was 173±25 ms. ECG-gated radionuclide ventriculography to quantify interventricular and intraventricular dyssynchrony was performed at baseline with and without CRT and at the 3-month follow-up visit. Amino-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels were also determined at baseline and at 3 months. During a mean follow-up of 10.1±7.6 months, there were 37 (50%) clinical events that...

Research paper thumbnail of Ropivacaine combined with various anti-arrhythmic drugs results in mild alterations in myocardial contractility in pigs

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2003

Research paper thumbnail of Risk of Sprint Fidelis defibrillator lead failure is highly dependent on age

Archives of Cardiovascular Diseases, 2011

Background.-In 2007, Medtronic Sprint Fidelis defibrillator leads were taken off the market due t... more Background.-In 2007, Medtronic Sprint Fidelis defibrillator leads were taken off the market due to a high rate of lead failure. Current data do not allow for risk stratification of patients with regard to lead failure. Aims.-We sought to determine predictors of Sprint Fidelis lead failure. Methods.-Between 2004 and 2007, 269 Sprint Fidelis leads were implanted in 258 patients in our centre. Variables associated with lead failure were assessed by the Kaplan-Meier method and a Cox survival model. Results.-During a median follow-up of 2.80 years (maximum 5.32), we observed 33 (12.3%) Sprint Fidelis lead failures (5-year survival, 65.6% ± 7.5%). In univariate analysis, age was the only predictor of lead failure (hazard ratio [HR] for 1-year increase 0.97; 95% confidence interval [CI] 0.95-0.99; p = 0.009). Patients aged < 62.5 years (median) had a significantly increased risk of lead failure compared with patients aged > 62.5 years (HR 2.80; CI 1.30-6.02; p = 0.009). Survival without Sprint Fidelis lead failure was 55.6% ± 10.4%) in patients aged < 62.5 years (24/134 leads) vs 78.6% ± 8.8% in patients aged > 62.5 years (9/135 leads). The annual incidence of lead failure in patients aged < 62.5 years was 11.6% ± 4.9% during the fourth year after implantation and 22.9% ± 13.2% during the fifth year.

Research paper thumbnail of In‐Hospital Heart Rate Turbulence and Microvolt T‐Wave Alternans Abnormalities for Prediction of Early Life‐Threatening Ventricular Arrhythmia after Acute Myocardial Infarction

Annals of Noninvasive Electrocardiology, 2013

BackgroundIn the setting of primary prevention, most implantable cardiac defibrillators (ICD) are... more BackgroundIn the setting of primary prevention, most implantable cardiac defibrillators (ICD) are implanted more than 6 months after acute myocardial infarction (AMI). Abnormal heart rate turbulence (HRT) and T‐wave alternans (TWA) are predictors of long‐term sudden cardiac death (SCD). We intended to assess the predictive value of HRT and TWA for early post‐AMI SCD and life‐threatening ventricular arrhythmias (VA).MethodsOne hundred ninety‐nine consecutive patients with AMI were prospectively included (age 61.7 years, LV ejection fraction 45%). One hundred eighty‐three patients (92%) underwent percutaneous coronary intervention. We assessed HRT using turbulence slope (TS), turbulence onset (TO), and TWA on channels 1 and 2 (TWA1 and TWA2) using the modified moving average method. Predictive performance for SCD/VA was assessed by area under the receiver operating curve characteristic (ROC‐AUC).ResultsWithin 6 months after AMI, 2 patients (1%) developed life‐threatening VA and 3 (1.5...

Research paper thumbnail of Muscarinic Receptor Upregulation in Patients With Myocardial Infarction

Circulation: Cardiovascular Imaging, 2009

Background— Despite the major role attributed to myocardial vagal activity in left ventricular ar... more Background— Despite the major role attributed to myocardial vagal activity in left ventricular arrhythmogenesis in chronic myocardial infarction, the impact of infarction on left ventricular muscarinic receptor density remains unknown. Methods and Results— Left ventricular muscarinic receptor density was measured in vivo by positron emission tomography using the specific antagonist [ 11 C]methylquinuclidinyl benzilate ([ 11 C]MQNB) in 11 patients 43�20 days after myocardial infarction and 9 healthy volunteers. The extent of myocardial damage was quantified by delayed contrast-enhanced MRI. Three short-axis slices from each subject were analyzed in matched positron emission tomography and MRI images. A 2-injection positron emission tomography protocol was used; [ 11 C]MQNB time-activity curves were obtained in 6 regions per slice and fitted to a 3-compartment ligand-receptor model. Four classes of myocardial regions were considered: normal (in volunteers); remote, supplied by healthy...

Research paper thumbnail of Spironolactone as a Potential New Treatment to Prevent Arrhythmias in Arrhythmogenic Cardiomyopathy Cell Model

Journal of Personalized Medicine

Arrhythmogenic cardiomyopathy (ACM) is a rare genetic disease associated with ventricular arrhyth... more Arrhythmogenic cardiomyopathy (ACM) is a rare genetic disease associated with ventricular arrhythmias in patients. The occurrence of these arrhythmias is due to direct electrophysiological remodeling of the cardiomyocytes, namely a reduction in the action potential duration (APD) and a disturbance of Ca2+ homeostasis. Interestingly, spironolactone (SP), a mineralocorticoid receptor antagonist, is known to block K+ channels and may reduce arrhythmias. Here, we assess the direct effect of SP and its metabolite canrenoic acid (CA) in cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) of a patient bearing a missense mutation (c.394C>T) in the DSC2 gene coding for desmocollin 2 and for the amino acid replacement of arginine by cysteine at position 132 (R132C). SP and CA corrected the APD in the muted cells (vs. the control) in linking to a normalization of the hERG and KCNQ1 K+ channel currents. In addition, SP and CA had a direct cellular effect on Ca2+ home...

Research paper thumbnail of High-tech catheter ablation : Worth the cost ? Ablation sophistiquée : question de coût ?

MOTS CLÉS Ablation endocavitaire ; Tachycardies ; Robotique ; Arythmies ; Radiofréquence The incr... more MOTS CLÉS Ablation endocavitaire ; Tachycardies ; Robotique ; Arythmies ; Radiofréquence The increased use of catheter ablation for the treatment of patients with arrhythmias has fostered the development of new tools that enhance the safety and efficacy of these procedures [1,2]. After the revolution of three-dimensional (3D) electroanatomical mapping, remote catheter navigation (RCN) is now setting the pace and keeping ‘‘spoiled’’ electrophysiologists in a fascinating era. In most procedures, the systems operate under the supervision of the electrophysiologist, not alone; thus, ‘‘cooperative robotic’’ rather than ‘‘robotic’’ appears to be best suited for describing this technique. Manual control of the ablation catheter can be challenging and is dependent on operator skill and experience as well as cardiac anatomy. Various active catheters have improved physicians’ ability to intervene. All of the catheters can actively select direction in three dimensions and conform to the shape ...

Research paper thumbnail of Images in cardiology. A threatened paradoxical embolism

Research paper thumbnail of Acquired aortopulmonary fistula in pseudoaneurysm of the aorta six years after a bentall operation

The Journal of Thoracic and Cardiovascular Surgery, 1995

Research paper thumbnail of Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation

European Journal of Cardio-Thoracic Surgery, 2004

Objective: To determine factors predictive of mortality in patients undergoing emergency mitral v... more Objective: To determine factors predictive of mortality in patients undergoing emergency mitral valve surgery in the setting of severe post-infarction regurgitation. Methods: Patients admitted for an acute myocardial infarction who required urgent mitral valve surgery for severe regurgitation were studied. Factors predictive of outcome were analysed. Results: Fifty-five consecutive patients (mean 65^10 years, 37 males) were included. The infarct was inferior in 31 patients, posterior in 10, anterior in 9 and lateral in 5. Thirty-four patients (62%) were in Killip class IV. Peroperative findings confirmed total papillary muscle rupture in 25 patients (posteromedial in 21, anterolateral in 4), and partial rupture in 12 patients (posteromedial in 10, anterolateral in 2). Papillary muscle dysfunction without rupture was responsible for regurgitation in 18 patients (posteromedial in 15, anterolateral in 3). The mitral valve was replaced by a prosthesis in all but 4 patients, who had valvuloplasty. Coronary angiography was done in 32 patients, of whom 18 underwent concomitant coronary artery bypass grafting and 2 balloon angioplasty. Surgery was performed on average 7 days after infarction. Thirteen patients (24%) died during the perioperative period. Absence of coronary revascularisation was significantly associated with increased perioperative mortality (34% vs. 9%, P ¼ 0:02Þ: Of the 42 surviving patients, there were 5 deaths during a mean follow-up of 4.0^3.7 years. Conclusion: In patients with acute post-infarction mitral regurgitation, perioperative mortality is high, but can be improved with concomitant CABG in addition to valve surgery. Long-term outcome of survivors is favourable.

Research paper thumbnail of Long-standing bacteremia and endocarditis caused by Staphylococcus lugdunensis in a patient with an implantable cardioverter defibrillator

Clinical Microbiology and Infection, 1997

Current perspectives on glycopeptidr resistance. Clin Micro-Closrridium dificile toxin A detectio... more Current perspectives on glycopeptidr resistance. Clin Micro-Closrridium dificile toxin A detection on colonies

Research paper thumbnail of Antibiotic Prophylaxis for Permanent Pacemaker Implantation

Circulation, 1998

Background —Infection remains a serious complication after permanent pacemaker implantation. Anti... more Background —Infection remains a serious complication after permanent pacemaker implantation. Antibiotic prophylaxis is frequently prescribed at the time of insertion to reduce its incidence, although results of well-designed, controlled studies are lacking. Methods and Results —We performed a meta-analysis of all available randomized trials to evaluate the effectiveness of antibiotic prophylaxis to reduce infection rates after permanent pacemaker implantation. Reports of trials were identified through a Medline, Embase, Current Contents, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, open or blind trials; (2) patients assigned to a systemic antibiotic group or a control group; (3) end point events related to any infection after pacemaker implantation: wound infection, septicemia, pocket abscess, purulent secretion, right infective endocarditis, inflammatory signs, a positive culture, septic pulmona...

Research paper thumbnail of Role of the Preaxillary Flora in Pacemaker Infections

Circulation, 1998

Background —Infection remains a severe complication after pacemaker implantation. The purpose of ... more Background —Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence. Methods and Results —Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean±SD, 67±15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecula...

Research paper thumbnail of Atrial fibrillation: a left atrial neuro-myopathy?

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Dec 15, 2017

This editorial refers to 'Longitudinal association of shortterm, metronome-paced heart rate varia... more This editorial refers to 'Longitudinal association of shortterm, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year followup: results from the prospective, population-based CARLA cohort' by D. Medenwald et al., on pages 2027-2035.

Research paper thumbnail of Cardiac voltage-sodium channel mutations association with primary electrical diseases: Authors' reply

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 4, 2018

Cardiac voltage-sodium channel mutations association with primary electrical diseases The article... more Cardiac voltage-sodium channel mutations association with primary electrical diseases The article by Moreau et al. 1 published in Europace describing the association between voltage-gated sodium channel mutations and the occurrence of stroke in young patients presented very interesting data. The authors reported that in two unrelated boys stroke and atrial arrhythmias were confirmed. Genetic testing revealed a mutations in the SCN5A gene (p.D1275N, p.E1053K). Certainly, it is important to a knowledge the authors that patients with primary electrical disease including Brugada syndrome (BrS) with mutations of SCN5A gene are associated with atrial arrhythmia. 2-5 Of note, the reported mutation in the second boy has also been reported in BrS patients. 6 Another important finding is that recorded electrocardiograms of patients among the first family were associated with right bundle branch block. Taking all these data together, we are wondering if both families were tested on BrS using sodium channel blocking drugs such as ajmaline. This information may help to stratify this family as atrial arrhythmias in BrS were also described and cerebrovascular events are associated complications. 7

Research paper thumbnail of False positive result of positron emission tomography in a patient with suspected defibrillator system infection

Journal of Cardiology Cases, 2013

The infection of an implanted pacemaker or defibrillator is often difficult to diagnose. Positron... more The infection of an implanted pacemaker or defibrillator is often difficult to diagnose. Positron emission tomography-computerized tomography (PET-CT) has recently been shown to be of great interest in this difficult clinical setting. We report the case of a patient with suspected implantable cardioverterdefibrillator (ICD) infection. Because of 18 F-fluorodeoxyglucose (FDG) uptakes on different portions of the ICD, complete extraction of the ICD generator and lead was performed. Bacteriological samples remained sterile. FDG PET-CT, which appears to be a promising tool for the management of patients with suspected pacemaker/ICD infection, does not have a perfect specificity to detect lead infection, and should not be used alone to diagnose difficult cases of implantable cardiac device infection. <Learning objective: The aim of this case is to bring to light the necessity of specifying the place of PET-CT and its limits for the diagnosis of endocarditis on pacemaker/ICD devices.>

Research paper thumbnail of 0295: Increased intracardiac VEGF and VWF levels revealed low grade inflammatory process and progressive endothelial damage in patients with atrial fibrillation

Archives of Cardiovascular Diseases Supplements, 2015

How to identify a risk for subsequent atrial fibrillation and higher risk of stroke in patients w... more How to identify a risk for subsequent atrial fibrillation and higher risk of stroke in patients with hospitalization related to a cardiac cause? Results: 91 (8%) patients developed new-onset AF. By multivariate analysis, several factors were independently associated with the occurrence of new-onset AF: age (OR(95%CI): 1.06(1.04-1.09); p<0.001), obesity (OR: 2.11; 95% CI 1.22-3.54; p=0.007), LA indexed volume (OR(95% CI): 1.02(1.01-1.04); p=0.016), LVEF<40% (OR(95% CI): 1.91 (1.06-3.46); p=0.032) and severe heart failure on admission (OR(95% CI): 2.46(1.21-5.02); p=0.013). In stratified analysis, we found marked differences in risk factors for AF according to gender. In women, only age (OR (95% CI): 1.07(1.03-1.11); p<0.001) and severe heart failure on admission (OR (95% CI): 4.02(1.38-11.7); p=0.011) were independently associated with AF. In contrast, in men, age (OR(95% CI): 1.07(1.04-1.10); p<0.001), CRP>10mg/l (OR(95% CI): 2.81(1.49-5.28); p=0.001), LA indexed volume (OR(95% CI): 1.03(1.01-1.05); p=0.011) and obesity (OR: 2.50; 95% CI 1.26-4.97; p=0.009) were independent correlates of AF. Conclusion: The present study suggests for the first time that obesity is a major risk factor for the development of AF after AMI, which is specific to men. These findings may have clinical implication for risk stratification in AMI.

Research paper thumbnail of Heart rate reduction with ivabradine protects against ventricular fibrillation during acute ischemia in pigs

Journal of Molecular and Cellular Cardiology, 2007

Research paper thumbnail of Pneumomediastinum after implantable cardiac defibrillator implantation

European Heart Journal, 2010

Research paper thumbnail of Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis

European Heart Journal, 2000

Objective ST-segment elevation in acute pericarditis is believed to be caused by superficial myoc... more Objective ST-segment elevation in acute pericarditis is believed to be caused by superficial myocardial inflammation or epicardial injury. We used cardiac troponin I, a sensitive and specific marker of myocardial injury, to assess myocardial lesions in idiopathic acute pericarditis and its relationship to ST-segment elevation. Patients and Methods Sixty-nine consecutive patients (53 men, 48 17 years) with idiopathic acute pericarditis were included. We used an enzymoimmunoflurometric method to measure serum cardiac troponin I on admission (myocardial infarction threshold was 1•5 ng. ml 1). Results Cardiac troponin I was detectable in 34 patients (49%) and was beyond the 1•5 ng. ml 1 threshold in 15 (22%). Coronary angiography performed in seven of these 15 patients was normal in all of them. ST-segment elevation was observed in 93% of the patients with cardiac troponin I >1•5 ng. ml 1 vs 57% of those without (P<0•01). Sensitivity of ST-segment elevation to detect myocardial injury was 93% and specificity 43%. Patients with a cardiac troponin I increase higher than 1•5 ng. ml 1 were more likely to have had a recent infection (66% vs 31%; P=0•01) and were younger (37 14 vs 52 16 years; P=0•002). There was no significant relationship with other parameters such as pericardial friction rub, fever, PR segment abnormalities, echocardiographic findings or C-reactive protein. Conclusion In patients with idiopathic acute pericarditis, an increase in cardiac troponin I is frequently observed, especially in younger patients and those with a recent infection. Although ST-segment elevation does not reliably indicate myocardial injury, a significant cardiac troponin I increase is only seen in these patients.

Research paper thumbnail of Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients: A Prospective Long-Term Study

Circulation: Cardiovascular Imaging, 2011

Background— Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventricu... more Background— Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventriculography, has shown promising results. We hypothesized that quantifying the cardiac resynchronization reserve, that is, the extent of response to cardiac resynchronization therapy (CRT), by radionuclide imaging could potentially identify patients who are best suited for CRT. Methods and Results— Seventy-four patients ages 64.8±10.1 years were prospectively studied from July 2004 to July 2006, of whom 62.2% and 37.8%, respectively, were in New York Heart Association class 3 and 4. Mean QRS width was 173±25 ms. ECG-gated radionuclide ventriculography to quantify interventricular and intraventricular dyssynchrony was performed at baseline with and without CRT and at the 3-month follow-up visit. Amino-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels were also determined at baseline and at 3 months. During a mean follow-up of 10.1±7.6 months, there were 37 (50%) clinical events that...

Research paper thumbnail of Ropivacaine combined with various anti-arrhythmic drugs results in mild alterations in myocardial contractility in pigs

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2003

Research paper thumbnail of Risk of Sprint Fidelis defibrillator lead failure is highly dependent on age

Archives of Cardiovascular Diseases, 2011

Background.-In 2007, Medtronic Sprint Fidelis defibrillator leads were taken off the market due t... more Background.-In 2007, Medtronic Sprint Fidelis defibrillator leads were taken off the market due to a high rate of lead failure. Current data do not allow for risk stratification of patients with regard to lead failure. Aims.-We sought to determine predictors of Sprint Fidelis lead failure. Methods.-Between 2004 and 2007, 269 Sprint Fidelis leads were implanted in 258 patients in our centre. Variables associated with lead failure were assessed by the Kaplan-Meier method and a Cox survival model. Results.-During a median follow-up of 2.80 years (maximum 5.32), we observed 33 (12.3%) Sprint Fidelis lead failures (5-year survival, 65.6% ± 7.5%). In univariate analysis, age was the only predictor of lead failure (hazard ratio [HR] for 1-year increase 0.97; 95% confidence interval [CI] 0.95-0.99; p = 0.009). Patients aged < 62.5 years (median) had a significantly increased risk of lead failure compared with patients aged > 62.5 years (HR 2.80; CI 1.30-6.02; p = 0.009). Survival without Sprint Fidelis lead failure was 55.6% ± 10.4%) in patients aged < 62.5 years (24/134 leads) vs 78.6% ± 8.8% in patients aged > 62.5 years (9/135 leads). The annual incidence of lead failure in patients aged < 62.5 years was 11.6% ± 4.9% during the fourth year after implantation and 22.9% ± 13.2% during the fifth year.

Research paper thumbnail of In‐Hospital Heart Rate Turbulence and Microvolt T‐Wave Alternans Abnormalities for Prediction of Early Life‐Threatening Ventricular Arrhythmia after Acute Myocardial Infarction

Annals of Noninvasive Electrocardiology, 2013

BackgroundIn the setting of primary prevention, most implantable cardiac defibrillators (ICD) are... more BackgroundIn the setting of primary prevention, most implantable cardiac defibrillators (ICD) are implanted more than 6 months after acute myocardial infarction (AMI). Abnormal heart rate turbulence (HRT) and T‐wave alternans (TWA) are predictors of long‐term sudden cardiac death (SCD). We intended to assess the predictive value of HRT and TWA for early post‐AMI SCD and life‐threatening ventricular arrhythmias (VA).MethodsOne hundred ninety‐nine consecutive patients with AMI were prospectively included (age 61.7 years, LV ejection fraction 45%). One hundred eighty‐three patients (92%) underwent percutaneous coronary intervention. We assessed HRT using turbulence slope (TS), turbulence onset (TO), and TWA on channels 1 and 2 (TWA1 and TWA2) using the modified moving average method. Predictive performance for SCD/VA was assessed by area under the receiver operating curve characteristic (ROC‐AUC).ResultsWithin 6 months after AMI, 2 patients (1%) developed life‐threatening VA and 3 (1.5...

Research paper thumbnail of Muscarinic Receptor Upregulation in Patients With Myocardial Infarction

Circulation: Cardiovascular Imaging, 2009

Background— Despite the major role attributed to myocardial vagal activity in left ventricular ar... more Background— Despite the major role attributed to myocardial vagal activity in left ventricular arrhythmogenesis in chronic myocardial infarction, the impact of infarction on left ventricular muscarinic receptor density remains unknown. Methods and Results— Left ventricular muscarinic receptor density was measured in vivo by positron emission tomography using the specific antagonist [ 11 C]methylquinuclidinyl benzilate ([ 11 C]MQNB) in 11 patients 43�20 days after myocardial infarction and 9 healthy volunteers. The extent of myocardial damage was quantified by delayed contrast-enhanced MRI. Three short-axis slices from each subject were analyzed in matched positron emission tomography and MRI images. A 2-injection positron emission tomography protocol was used; [ 11 C]MQNB time-activity curves were obtained in 6 regions per slice and fitted to a 3-compartment ligand-receptor model. Four classes of myocardial regions were considered: normal (in volunteers); remote, supplied by healthy...

Research paper thumbnail of Spironolactone as a Potential New Treatment to Prevent Arrhythmias in Arrhythmogenic Cardiomyopathy Cell Model

Journal of Personalized Medicine

Arrhythmogenic cardiomyopathy (ACM) is a rare genetic disease associated with ventricular arrhyth... more Arrhythmogenic cardiomyopathy (ACM) is a rare genetic disease associated with ventricular arrhythmias in patients. The occurrence of these arrhythmias is due to direct electrophysiological remodeling of the cardiomyocytes, namely a reduction in the action potential duration (APD) and a disturbance of Ca2+ homeostasis. Interestingly, spironolactone (SP), a mineralocorticoid receptor antagonist, is known to block K+ channels and may reduce arrhythmias. Here, we assess the direct effect of SP and its metabolite canrenoic acid (CA) in cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) of a patient bearing a missense mutation (c.394C>T) in the DSC2 gene coding for desmocollin 2 and for the amino acid replacement of arginine by cysteine at position 132 (R132C). SP and CA corrected the APD in the muted cells (vs. the control) in linking to a normalization of the hERG and KCNQ1 K+ channel currents. In addition, SP and CA had a direct cellular effect on Ca2+ home...

Research paper thumbnail of High-tech catheter ablation : Worth the cost ? Ablation sophistiquée : question de coût ?

MOTS CLÉS Ablation endocavitaire ; Tachycardies ; Robotique ; Arythmies ; Radiofréquence The incr... more MOTS CLÉS Ablation endocavitaire ; Tachycardies ; Robotique ; Arythmies ; Radiofréquence The increased use of catheter ablation for the treatment of patients with arrhythmias has fostered the development of new tools that enhance the safety and efficacy of these procedures [1,2]. After the revolution of three-dimensional (3D) electroanatomical mapping, remote catheter navigation (RCN) is now setting the pace and keeping ‘‘spoiled’’ electrophysiologists in a fascinating era. In most procedures, the systems operate under the supervision of the electrophysiologist, not alone; thus, ‘‘cooperative robotic’’ rather than ‘‘robotic’’ appears to be best suited for describing this technique. Manual control of the ablation catheter can be challenging and is dependent on operator skill and experience as well as cardiac anatomy. Various active catheters have improved physicians’ ability to intervene. All of the catheters can actively select direction in three dimensions and conform to the shape ...