Romain Cassagneau - Academia.edu (original) (raw)
Papers by Romain Cassagneau
Eurointervention, Oct 1, 2016
We sought to evaluate the impact of permanent pacemaker (PPM) implantation on two-year mortality ... more We sought to evaluate the impact of permanent pacemaker (PPM) implantation on two-year mortality and one-year left ventricular ejection fraction recovery (∆LVEFR=one-year LVEF-baseline LVEF) after transcatheter aortic valve implantation (TAVI). We pooled patient-level data from four European institutions with significant TAVI volume. Outcomes were compared between patients without PPM (no-PPM), patients with PPM prior to TAVI (old-PPM) and patients with PPM implanted after TAVI (new-PPM). Out of 1,062 patients included in the pooled data set, 783 (73.7%) were in the no-PPM group, 164 (15.4%) in the new-PPM group and 115 (10.8%) in the old-PPM group. All-cause and cardiovascular mortality at two years were similar for patients with no-PPM and new-PPM (adjusted HR 1.11, 95% CI: 0.74-1.67; p=0.62; and adjusted HR 1.16, 95% CI: 0.68-1.98; p=0.59). Conversely, old-PPM was associated with increased risk of both all-cause and cardiovascular mortality vs. no-PPM. By multivariable analysis new-PPM did not affect LVEFR, while old-PPM did. We observed a multiplicative interaction, between new-PPM and post-procedural aortic regurgitation ≥1+ on two-year mortality and one-year LVEFR, with increased risk of death and impaired LVEFR in patients with new-PPM and post-procedural aortic regurgitation (PPAR) ≥1+ (both pinteraction<0.0001). In patients undergoing TAVI, the presence of a PPM at baseline yielded a negative effect on long-term prognosis while new-PPM did not. The combination of new-PPM with PPAR adversely impacts on survival and LV function recovery.
Journal of Cardiovascular Electrophysiology, Mar 4, 2021
The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantat... more The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. We sought to identify factors associated with late (occurring ≥7 days after the procedure) high‐grade atrioventricular blocks after TAVI, based on specific pacemaker memory data.
Cardiology in The Young, Jun 30, 2008
Background: Indications for implantable cardioverter defibrillator (ICD) implantation have expand... more Background: Indications for implantable cardioverter defibrillator (ICD) implantation have expanded considerably in recent years, resulting in steadily growing numbers of ICD recipients worldwide. The aim of this study was to review the overall experience with ICDs in Iceland. Methods: This was a retrospective single centre study set at the University Hospital in Iceland. Data on all ICD implantations in Iceland from the first implantation in 1992 till the end of 2002 was reviewed. Results: Sixty-two patients (71% male) received an ICD during this period. There was an increase in the number of implants by year and the number of new implants in 2001 and 2002 amounted to 56 and 38 per million, respectively. The mean age at implantation was 58 (+/-14) years. Forty patients (65%) had coronary artery disease. The most common indications for ICD implantation were cardiac arrest, 32 (52%) and another 26 (42%) had experienced ventricular tachycardia without cardiac arrest. The most common adverse event was inappropriate shocks. Twenty-eight patients (45%) received therapy from their ICDs, with the majority receiving appropriate therapy. Of the thirteen patients deceased before or during the study period, no case of sudden arrhythmic death was observed. Conclusion: This study shows that the experience with ICDs in Iceland is in most respects similar to other Western countries.
Journal of Cardiovascular Electrophysiology, Jan 7, 2014
ABSTRACT A 40-year-old woman without structural heart disease was referred for non-documented pal... more ABSTRACT A 40-year-old woman without structural heart disease was referred for non-documented palpitations associated with ventricular pre-excitation. The baseline electrocardiogram showed preexcitation suggestive of a posteroseptal accessory pathway (AP). With incremental right atrial pacing, atrioventricular (AV) conduction time over the AP was cycle length dependent (decremental), and maximal preexcitation was observed at pacing cycle length 320 ms (Figure 1). This article is protected by copyright. All rights reserved.
Circulation, Nov 28, 2006
Background-Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of su... more Background-Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome. Methods and Results-All patients (nϭ220, 46Ϯ12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38Ϯ27 months, no patient died and 18 patients (8%) had appropriate device therapy (10Ϯ15 shocks/patient, 26Ϯ33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4Ϯ3 shocks/patient, 21Ϯ20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases. Conclusion-In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of Ͼ3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones. (Circulation.
European Heart Journal, Oct 1, 2019
Journal of Interventional Cardiac Electrophysiology, Mar 16, 2013
Pacing and Clinical Electrophysiology, Nov 11, 2010
Cardiac pacemakers with preerosion are often reimplanted. Preerosion may be caused by an evolving... more Cardiac pacemakers with preerosion are often reimplanted. Preerosion may be caused by an evolving local infectious process affecting the entire pacing system or by mechanical migration of the device causing ischemic necrosis of the skin tissues. We examined the long-term outcome of 33 patients who underwent pocket or scar revision and submuscular reimplantation of cardiac pacemakers in our institution. Before undergoing pocket or scar revision and reimplantation, all patients (1) had negative serial blood cultures, (2) had no vegetation on transesophageal echocardiography, (3) had a normal blood C-reactive protein concentrations, (4) were afebrile, (5) had no cutaneous breakthrough, and (6) presented with preerosion of the pulse generator or granulomatous-like scar abnormality. THE mean follow-up was 37 ± 12 months. Among 16 patients presenting with preerosion associated with signs of local cutaneous inflammation, 62.5% developed an infection of the pacing system requiring later explantation. Of eight patients presenting initially with migration of the pulse generator and mechanical protrusion, none required subsequent explantation of the system. Among nine patients presenting initially with granulomatous-like scar abnormalities, 55.6% underwent explantation of the pacing system during follow-up for management of documented local infection. The reimplantation of pulse generators with preerosion in the presence of local inflammatory manifestations or granulomatous-like changes of the scar is complicated by documented cardiac pacemaker infection in >50% of cases. In these patients, the explantation of the pacing system is recommended before the development of prognostically much more serious spread of infection to the leads and cardiac tissues.
Circulation, Oct 15, 2013
B rugada syndrome (BrS) is an arrhythmogenic disease characterized by an ECG pattern of right bun... more B rugada syndrome (BrS) is an arrhythmogenic disease characterized by an ECG pattern of right bundle-branch block, ST-segment elevation in the right precordial leads, and an increased risk of sudden cardiac arrest (SCA) as a result of polymorphic ventricular tachyarrhythmias or ventricular fibrillation (VF). 1 Whereas the implantable cardioverter-defibrillator (ICD) is considered the main therapy in symptomatic patients, we 2 and others 3-7 have reported Background-Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverterdefibrillator in a large multicenter registry. Methods and Results-A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock. Conclusions-Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramati cally reduce inappropriate shock. However, lead failure remains a major problem in this population.
Archives of Cardiovascular Diseases Supplements, 2012
scale (mean [standard deviation] score 67.1 [18.4] vs 63.2 [18.9]; p<0.001), single index utility... more scale (mean [standard deviation] score 67.1 [18.4] vs 63.2 [18.9]; p<0.001), single index utility score (median 0•78 vs 0•73; p<0.001), or the five dimensions of well-being (p<0.001 for each). Irrespective of AF control, cardiovascular events leading to hospitalization had occurred in 28.1% of patients. Interpretation AF control is not optimal. AF Patients experience frequent symptoms, functional impairment, altered QoL, and cardiovascular events, even when AF is controlled. This highlights the need for improved treatment of AF.
Archives of Cardiovascular Diseases Supplements, 2012
grams of sufentanyl just before epicardial access and that was repeated up to 4 times (20 μg) in ... more grams of sufentanyl just before epicardial access and that was repeated up to 4 times (20 μg) in case of persistent pain and absence of respiratory depression. Blood pressure and O2 saturation were continuously monitored. Results: 74 epicardial VT ablations have been performed in 65 patients (58 M, 58±13yo), 58 (89%) had a structural heart disease with a mean LVEF of 40±15%. 69 were performed under conscious sedation using the above protocol. 5 procedures were performed under GA: 4 because patients had to be sedated for arrhythmic storm before ablation and 1because of respiratory contraindications. Mean midazolam and sufentanyl dosages were 4±1,5 mg and 10±5 μg respectively. RF ablation was performed in 57 procedures with mean epicardial RF duration of 9±11 min for a total procedure time of 243 ±90 min. Because of pericardial bleeding 2 patients were transferred to the operating room and one patient had developed metabolic acidosis but no patient had respiratory failure during the procedure. Conclusion: Epicardial VT ablation can be performed safely under conscious sedation using powerful painkiller such as sufentanyl.
Europace, Jun 28, 2011
We report a case of multiple inappropriate mode switches in a patient with a dual-chamber pacemak... more We report a case of multiple inappropriate mode switches in a patient with a dual-chamber pacemaker, resulting from P-wave double counting due to a double potential on the atrial electrogram. The differential diagnosis of this rarely reported phenomenon is discussed.
Europace, Oct 10, 2012
The prerequisite for cardiac resynchronization therapy (CRT) is ventricular capture, which may be... more The prerequisite for cardiac resynchronization therapy (CRT) is ventricular capture, which may be verified by analysis of the surface electrocardiogram (ECG). Few algorithms exist to diagnose loss of ventricular capture. Methods and results Electrocardiograms from 126 CRT patients were analysed during biventricular (BV), right ventricular (RV), and left ventricular (LV) pacing. An algorithm evaluating QRS narrowing in the limb leads and increasing negativity in lead I to diagnose changes in ventricular capture was devised, prospectively validated, and compared with two existing algorithms. Performance of the algorithm according to ventricular lead position was also assessed. Results Our algorithm had an accuracy of 88% to correctly identify the changes in ventricular capture (either loss or gain of RV or LV capture). The algorithm had a sensitivity of 94% and a specificity of 96% with an accuracy of 96% for identifying loss of LV capture (the most clinically relevant change), and compared favourably with the existing algorithms. Performance of the algorithms was not significantly affected by RV or LV lead position. Conclusion A simple two-step algorithm evaluating QRS width in the limb leads and changes in negativity in lead I can accurately diagnose the lead responsible for intermittent loss of ventricular capture in CRT. This simple tool may be of particular use outside the setting of specialized device clinics.
Canadian Journal of Cardiology, Oct 1, 2013
European Heart Journal, 2019
Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (T... more Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-...
Lead extraction is becoming increasingly common as indications for pacing and ICD insertion expan... more Lead extraction is becoming increasingly common as indications for pacing and ICD insertion expand. Periop management varies between extraction centers, and no clinical guidelines have addressed the need for perioperative anticoagulation. We report a case of massive thrombosis which occurred shortly after laser lead extraction and is undoubtedly related to the trauma of the extraction and ensuing hypercoagulabiilty. Routine post-operative anticoagulation has been advocated as a means to prevent access vein (subclavian) stenosis, but many centres do not employ a routine post-extraction anticoagulation strategy. Pulmonary embolism following lead extraction is a known complication of this procedure and late mortality following lead extraction is a significant and underappreciated problem. We propose that further research attention should be directed at addressing the issue of routine post-extraction anticoagulation.
MOTS CLÉS Syndrome de WolfA 25-year-old man was admitted to hospital for electrophysiological stu... more MOTS CLÉS Syndrome de WolfA 25-year-old man was admitted to hospital for electrophysiological studies for WolfParkinson-White syndrome, discovered during a medical clearance examination to be a professional soccer referee. This athlete had no medical history, reported no symptoms and his physical examination was normal. A 12-lead electrocardiogram revealed the presence of ventricular pre-excitation, a negative delta wave in leads I and aVL, and right bundle branch-type QRS morphology, consistent with a left lateral accessory pathway (Fig. 1), which persisted during peak exercise. Electrophysiological studies confirmed the presence of a left lateral accessory pathway and the induction of atrial fibrillation by rapid atrial pacing, immediately followed by the development of ventricular fibrillation (Fig. 2a, b), requiring the delivery of two consecutive biphasic 200J DC shocks to restore sinus rhythm (Fig. 3a). The patient
Indian Pacing and Electrophysiology Journal, 2014
Pacing and clinical electrophysiology : PACE, 2011
Eurointervention, Oct 1, 2016
We sought to evaluate the impact of permanent pacemaker (PPM) implantation on two-year mortality ... more We sought to evaluate the impact of permanent pacemaker (PPM) implantation on two-year mortality and one-year left ventricular ejection fraction recovery (∆LVEFR=one-year LVEF-baseline LVEF) after transcatheter aortic valve implantation (TAVI). We pooled patient-level data from four European institutions with significant TAVI volume. Outcomes were compared between patients without PPM (no-PPM), patients with PPM prior to TAVI (old-PPM) and patients with PPM implanted after TAVI (new-PPM). Out of 1,062 patients included in the pooled data set, 783 (73.7%) were in the no-PPM group, 164 (15.4%) in the new-PPM group and 115 (10.8%) in the old-PPM group. All-cause and cardiovascular mortality at two years were similar for patients with no-PPM and new-PPM (adjusted HR 1.11, 95% CI: 0.74-1.67; p=0.62; and adjusted HR 1.16, 95% CI: 0.68-1.98; p=0.59). Conversely, old-PPM was associated with increased risk of both all-cause and cardiovascular mortality vs. no-PPM. By multivariable analysis new-PPM did not affect LVEFR, while old-PPM did. We observed a multiplicative interaction, between new-PPM and post-procedural aortic regurgitation ≥1+ on two-year mortality and one-year LVEFR, with increased risk of death and impaired LVEFR in patients with new-PPM and post-procedural aortic regurgitation (PPAR) ≥1+ (both pinteraction&amp;lt;0.0001). In patients undergoing TAVI, the presence of a PPM at baseline yielded a negative effect on long-term prognosis while new-PPM did not. The combination of new-PPM with PPAR adversely impacts on survival and LV function recovery.
Journal of Cardiovascular Electrophysiology, Mar 4, 2021
The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantat... more The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. We sought to identify factors associated with late (occurring ≥7 days after the procedure) high‐grade atrioventricular blocks after TAVI, based on specific pacemaker memory data.
Cardiology in The Young, Jun 30, 2008
Background: Indications for implantable cardioverter defibrillator (ICD) implantation have expand... more Background: Indications for implantable cardioverter defibrillator (ICD) implantation have expanded considerably in recent years, resulting in steadily growing numbers of ICD recipients worldwide. The aim of this study was to review the overall experience with ICDs in Iceland. Methods: This was a retrospective single centre study set at the University Hospital in Iceland. Data on all ICD implantations in Iceland from the first implantation in 1992 till the end of 2002 was reviewed. Results: Sixty-two patients (71% male) received an ICD during this period. There was an increase in the number of implants by year and the number of new implants in 2001 and 2002 amounted to 56 and 38 per million, respectively. The mean age at implantation was 58 (+/-14) years. Forty patients (65%) had coronary artery disease. The most common indications for ICD implantation were cardiac arrest, 32 (52%) and another 26 (42%) had experienced ventricular tachycardia without cardiac arrest. The most common adverse event was inappropriate shocks. Twenty-eight patients (45%) received therapy from their ICDs, with the majority receiving appropriate therapy. Of the thirteen patients deceased before or during the study period, no case of sudden arrhythmic death was observed. Conclusion: This study shows that the experience with ICDs in Iceland is in most respects similar to other Western countries.
Journal of Cardiovascular Electrophysiology, Jan 7, 2014
ABSTRACT A 40-year-old woman without structural heart disease was referred for non-documented pal... more ABSTRACT A 40-year-old woman without structural heart disease was referred for non-documented palpitations associated with ventricular pre-excitation. The baseline electrocardiogram showed preexcitation suggestive of a posteroseptal accessory pathway (AP). With incremental right atrial pacing, atrioventricular (AV) conduction time over the AP was cycle length dependent (decremental), and maximal preexcitation was observed at pacing cycle length 320 ms (Figure 1). This article is protected by copyright. All rights reserved.
Circulation, Nov 28, 2006
Background-Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of su... more Background-Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome. Methods and Results-All patients (nϭ220, 46Ϯ12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38Ϯ27 months, no patient died and 18 patients (8%) had appropriate device therapy (10Ϯ15 shocks/patient, 26Ϯ33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4Ϯ3 shocks/patient, 21Ϯ20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases. Conclusion-In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of Ͼ3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones. (Circulation.
European Heart Journal, Oct 1, 2019
Journal of Interventional Cardiac Electrophysiology, Mar 16, 2013
Pacing and Clinical Electrophysiology, Nov 11, 2010
Cardiac pacemakers with preerosion are often reimplanted. Preerosion may be caused by an evolving... more Cardiac pacemakers with preerosion are often reimplanted. Preerosion may be caused by an evolving local infectious process affecting the entire pacing system or by mechanical migration of the device causing ischemic necrosis of the skin tissues. We examined the long-term outcome of 33 patients who underwent pocket or scar revision and submuscular reimplantation of cardiac pacemakers in our institution. Before undergoing pocket or scar revision and reimplantation, all patients (1) had negative serial blood cultures, (2) had no vegetation on transesophageal echocardiography, (3) had a normal blood C-reactive protein concentrations, (4) were afebrile, (5) had no cutaneous breakthrough, and (6) presented with preerosion of the pulse generator or granulomatous-like scar abnormality. THE mean follow-up was 37 ± 12 months. Among 16 patients presenting with preerosion associated with signs of local cutaneous inflammation, 62.5% developed an infection of the pacing system requiring later explantation. Of eight patients presenting initially with migration of the pulse generator and mechanical protrusion, none required subsequent explantation of the system. Among nine patients presenting initially with granulomatous-like scar abnormalities, 55.6% underwent explantation of the pacing system during follow-up for management of documented local infection. The reimplantation of pulse generators with preerosion in the presence of local inflammatory manifestations or granulomatous-like changes of the scar is complicated by documented cardiac pacemaker infection in &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50% of cases. In these patients, the explantation of the pacing system is recommended before the development of prognostically much more serious spread of infection to the leads and cardiac tissues.
Circulation, Oct 15, 2013
B rugada syndrome (BrS) is an arrhythmogenic disease characterized by an ECG pattern of right bun... more B rugada syndrome (BrS) is an arrhythmogenic disease characterized by an ECG pattern of right bundle-branch block, ST-segment elevation in the right precordial leads, and an increased risk of sudden cardiac arrest (SCA) as a result of polymorphic ventricular tachyarrhythmias or ventricular fibrillation (VF). 1 Whereas the implantable cardioverter-defibrillator (ICD) is considered the main therapy in symptomatic patients, we 2 and others 3-7 have reported Background-Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverterdefibrillator in a large multicenter registry. Methods and Results-A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock. Conclusions-Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramati cally reduce inappropriate shock. However, lead failure remains a major problem in this population.
Archives of Cardiovascular Diseases Supplements, 2012
scale (mean [standard deviation] score 67.1 [18.4] vs 63.2 [18.9]; p<0.001), single index utility... more scale (mean [standard deviation] score 67.1 [18.4] vs 63.2 [18.9]; p<0.001), single index utility score (median 0•78 vs 0•73; p<0.001), or the five dimensions of well-being (p<0.001 for each). Irrespective of AF control, cardiovascular events leading to hospitalization had occurred in 28.1% of patients. Interpretation AF control is not optimal. AF Patients experience frequent symptoms, functional impairment, altered QoL, and cardiovascular events, even when AF is controlled. This highlights the need for improved treatment of AF.
Archives of Cardiovascular Diseases Supplements, 2012
grams of sufentanyl just before epicardial access and that was repeated up to 4 times (20 μg) in ... more grams of sufentanyl just before epicardial access and that was repeated up to 4 times (20 μg) in case of persistent pain and absence of respiratory depression. Blood pressure and O2 saturation were continuously monitored. Results: 74 epicardial VT ablations have been performed in 65 patients (58 M, 58±13yo), 58 (89%) had a structural heart disease with a mean LVEF of 40±15%. 69 were performed under conscious sedation using the above protocol. 5 procedures were performed under GA: 4 because patients had to be sedated for arrhythmic storm before ablation and 1because of respiratory contraindications. Mean midazolam and sufentanyl dosages were 4±1,5 mg and 10±5 μg respectively. RF ablation was performed in 57 procedures with mean epicardial RF duration of 9±11 min for a total procedure time of 243 ±90 min. Because of pericardial bleeding 2 patients were transferred to the operating room and one patient had developed metabolic acidosis but no patient had respiratory failure during the procedure. Conclusion: Epicardial VT ablation can be performed safely under conscious sedation using powerful painkiller such as sufentanyl.
Europace, Jun 28, 2011
We report a case of multiple inappropriate mode switches in a patient with a dual-chamber pacemak... more We report a case of multiple inappropriate mode switches in a patient with a dual-chamber pacemaker, resulting from P-wave double counting due to a double potential on the atrial electrogram. The differential diagnosis of this rarely reported phenomenon is discussed.
Europace, Oct 10, 2012
The prerequisite for cardiac resynchronization therapy (CRT) is ventricular capture, which may be... more The prerequisite for cardiac resynchronization therapy (CRT) is ventricular capture, which may be verified by analysis of the surface electrocardiogram (ECG). Few algorithms exist to diagnose loss of ventricular capture. Methods and results Electrocardiograms from 126 CRT patients were analysed during biventricular (BV), right ventricular (RV), and left ventricular (LV) pacing. An algorithm evaluating QRS narrowing in the limb leads and increasing negativity in lead I to diagnose changes in ventricular capture was devised, prospectively validated, and compared with two existing algorithms. Performance of the algorithm according to ventricular lead position was also assessed. Results Our algorithm had an accuracy of 88% to correctly identify the changes in ventricular capture (either loss or gain of RV or LV capture). The algorithm had a sensitivity of 94% and a specificity of 96% with an accuracy of 96% for identifying loss of LV capture (the most clinically relevant change), and compared favourably with the existing algorithms. Performance of the algorithms was not significantly affected by RV or LV lead position. Conclusion A simple two-step algorithm evaluating QRS width in the limb leads and changes in negativity in lead I can accurately diagnose the lead responsible for intermittent loss of ventricular capture in CRT. This simple tool may be of particular use outside the setting of specialized device clinics.
Canadian Journal of Cardiology, Oct 1, 2013
European Heart Journal, 2019
Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (T... more Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-...
Lead extraction is becoming increasingly common as indications for pacing and ICD insertion expan... more Lead extraction is becoming increasingly common as indications for pacing and ICD insertion expand. Periop management varies between extraction centers, and no clinical guidelines have addressed the need for perioperative anticoagulation. We report a case of massive thrombosis which occurred shortly after laser lead extraction and is undoubtedly related to the trauma of the extraction and ensuing hypercoagulabiilty. Routine post-operative anticoagulation has been advocated as a means to prevent access vein (subclavian) stenosis, but many centres do not employ a routine post-extraction anticoagulation strategy. Pulmonary embolism following lead extraction is a known complication of this procedure and late mortality following lead extraction is a significant and underappreciated problem. We propose that further research attention should be directed at addressing the issue of routine post-extraction anticoagulation.
MOTS CLÉS Syndrome de WolfA 25-year-old man was admitted to hospital for electrophysiological stu... more MOTS CLÉS Syndrome de WolfA 25-year-old man was admitted to hospital for electrophysiological studies for WolfParkinson-White syndrome, discovered during a medical clearance examination to be a professional soccer referee. This athlete had no medical history, reported no symptoms and his physical examination was normal. A 12-lead electrocardiogram revealed the presence of ventricular pre-excitation, a negative delta wave in leads I and aVL, and right bundle branch-type QRS morphology, consistent with a left lateral accessory pathway (Fig. 1), which persisted during peak exercise. Electrophysiological studies confirmed the presence of a left lateral accessory pathway and the induction of atrial fibrillation by rapid atrial pacing, immediately followed by the development of ventricular fibrillation (Fig. 2a, b), requiring the delivery of two consecutive biphasic 200J DC shocks to restore sinus rhythm (Fig. 3a). The patient
Indian Pacing and Electrophysiology Journal, 2014
Pacing and clinical electrophysiology : PACE, 2011