Dissociated pulmonary vein activity after pulmonary vein isolation for paroxysmal atrial fibrillation: a predictor for recurrence?

BACKGROUND: The role of dissociated pulmonary vein (DPV) activity after pulmonary vein isolation (PVI) is still poorly defined. We evaluated electrophysiological features and clinical impact on long-term outcome of DPV activity. METHODS: A total of 243 patients (mean age 63 ± 11 years; 63% males) undergoing PVI for paroxysmal atrial fibrillation (AF) were included. DPV activity was defined as a residual low frequency irregular PV rhythm. Patients were divided into Group 1 (presence of DPV activity; n = 65) or Group 2 (absence of DPV activity; n = 178). RESULTS: Of 936 isolated PVs, 112 PVs (12%) showed DPV activity. DPV activity was observed more frequently in PVs identified as AF triggers (P = 0.026). During follow-up (mean 12 ± 7 months), 15 of 65 patients of Group 1 (23%) and 57 of 178 patients of Group 2 (32%) had an arrhythmia recurrence (P = 0.23). At linear regression analysis, no independent predictor for clinical recurrence was identified. During the repeat ablation, 62 of 72 patients (86%) showed a recovered PV conduction without difference between the 2 groups. Clinically, all patients of Group 1 with PV reconnection (n = 13/15) had a recurrence of paroxysmal AF. In Group 2, 5 of 52 patients with reconnected PV developed non-PV related arrhythmias. CONCLUSION: DPV activity occurred in 12% of PVs after PVI and was observed more frequently in PVs identified as AF triggers. DPV activity was not predictive for AF recurrence during follow-up. PV-left atrium reconnection involving PVs with DPV activity leads to AF.

Ablation of perimitral flutter: acute and long-term success of the modified anterior line.

AIMS: The modified anterior line (MAL) is an alternative to the mitral isthmus (MI) line for the treatment of perimitral atrial flutter (PMFL). We sought to investigate acute and long-term efficacy of this line if routinely used for PMFL. METHODS AND RESULTS: The cohort included 77 consecutive patients who underwent catheter ablation of PMFL. The anterior line was deployed between the anterolateral mitral annulus and the ostium of the left superior pulmonary vein. Perimitral atrial flutter was either the presenting arrhythmia after persistent atrial fibrillation (AF) ablation (Group 1, n = 42, 54.5%), occurring during AF ablation (Group 2, n = 25, 35%) or presenting as primary arrhythmia (Group 3, n = 8, 10%). Acute success was defined as PMFL termination during MAL deployment with demonstration of bidirectional line block. Acute success was achieved in 68 of 77 patients (88%) without difference between the three groups. In five patients an additional MI line was necessary to terminate PMFL and in four patients both lines failed to achieve termination. During follow-up (16 ± 7 months), 38 of 77 (49%) patients underwent a repeat procedure for a recurrent arrhythmia. During reablation, 13 of 38 (34%) patients were identified to have a PMFL recurrence. Persistent MAL block was demonstrated in 22 of 38 (58%) patients during the repeat ablation. CONCLUSION: The MAL is effective for acute and long-term treatment of PMFL. Maintenance of bidirectional MAL block was shown in 58% of patients during a repeat ablation.

Recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation: is repeat pulmonary vein isolation enough? A prospective, randomized trial.

AIMS: In patients with paroxysmal atrial fibrillation (pAF), pulmonary vein isolation (PVI) has become an accepted treatment option with single procedure success rates of 60-80%. A repeat ablation is performed in ∼30% of patients because of arrhythmia recurrence. The strategy for this repeat procedure is not defined. METHODS AND RESULTS: Patients with pAF recurrence after PVI were prospectively randomized and underwent a second ablation procedure with either PVI of all reconnected veins or PVI with an additional left atrial anterior line. Follow-up in our arrhythmia clinic was every 3 months up to 12 months including 7 day Holter monitoring. A total of 77 patients (mean age 63 ± 9 years, 69% males) were included in the analysis. A repeat PVI was performed in 41 patients, PVI + anterior line in 36 patients. After a follow-up of 12 months, 26 of 41 (63%) patients after repeat PVI and 18 of 36 (50%) patients with PVI + anterior line were in stable sinus rhythm off antiarrhythmic medication (P = 0.26). In most patients (12 of 15 patients with PVI and 14 of 18 patients with PVI + anterior line) with an arrhythmia recurrence after the second procedure, the recurring arrhythmia was paroxysmal AF. In 2 of 15 patients of the PVI group and in 4 of 18 patients of the PVI + anterior line group atypical flutter was the reoccurring arrhythmia (P = NS). CONCLUSION: In this prospective randomized trial, patients with a recurrence of paroxysmal AF had no better outcome after repeat PVI + one left atrial line compared with patients with repeat PVI only.

Catheter Ablation of Ventricular Arrhythmias using a Fluoroscopy Image Integration Module.

BACKGROUND: The impact of the CartoUnivu™ technology (Biosense Webster, Diamond Bar, CA, USA) on fluoroscopy exposure compared to a conventional approach using electroanatomical mapping (Carto 3™) was evaluated in patients undergoing radiofrequency ablation for ventricular tachyarrhythmias (VT). METHODS AND RESULTS: We prospectively evaluated 23 patients undergoing VT ablation using the CartoUnivu™ technology. The CartoUnivu™ Module integrates fluoroscopic images and cine loops into the electroanatomical mapping system. As a control group, 23 out of 88 VT patients (ablated using conventional fluoroscopy supplemented by electromagnetic mapping with the Carto 3™ System) were matched for age, gender, body surface area, operator, redo-procedure, presence of coronary artery disease, and left ventricular dysfunction using propensity score matching. A significant reduction in fluoroscopy exposure was observed in the CartoUnivu™ group when compared to the conventional group (10.57 ± 7.93 minutes vs 18.52 ± 11.24 minutes, P_= 0.008; 611 cGy/cm(2) vs 1650 cGy/cm(2) , P = 0.001). In multivariate analysis, the CartoUnivu™ module was an independent predictor of reduced fluoroscopy use. CONCLUSION: This is a report on the clinical application of the CartoUnivu system for VT ablation. CartoUnivu™ markedly reduced fluoroscopy time and dose compared to conventional fluoroscopy/electroanatomical mapping.

Pulmonary vein isolation using new technologies to improve ablation lesion formation: Initial results comparing enhanced catheter tip irrigation (Surround Flow(®)) with contact force measurement (Smarttouch(®)).

INTRODUCTION: Pulmonary vein reconnection after pulmonary vein isolation (PVI) is a significant problem in the treatment of paroxysmal atrial fibrillation (AF). We report about patients who underwent contact force (CF) guided PVI using CF catheter and compared them to patients with PVI using an ablation catheter with enhanced tip irrigation. METHODS: A total of 59 patients were included in the analysis. In 30 patients circumferential PVI was performed using the Thermocool Smarttouch(®) ablation catheter (ST) whereas in 29 patients circumferential PVI using the Thermocool Surround Flow SF(®) ablation catheter (SF) was performed. Patients were compared in regard to procedure time, fluoroscopy time/dose as well as RF-application duration and completeness of PVI. Adverse events (pericardial effusion, PV stenosis, stroke, death) were evaluated. The presence of sinus rhythm off antiarrhythmic medication was assessed during 6 months follow-up using multiple 7 day Holter-ECGs. RESULTS: In both groups, all PVs were isolated without serious adverse events. Procedure time was 2.15 ± 0.5 h (ST) vs. 2.37 ± 1.13 h (SF) (p = 0.19). Duration of RF-applications was 46.6 ± 18 min (ST) and 49.8 ± 19 min (SF) (p = 0.52). Fluoroscopy time was 25.2 ± 13 min (ST) vs. 29 ± 18 min (SF), fluoroscopy dose 2675.6 ± 1658 versus 3038.3 ± 1997 cGym(2) (p = 0.36 and 0.46 respectively). Sinus rhythm off antiarrhythmic medication validated with 7 day Holter ECGs was present in both groups in 72% of patients after 6 months of follow up. CONCLUSION: PVI using the new contact force catheter is safe and effective in patients with paroxysmal AF.

Importance of sinus rhythm as endpoint of persistent atrial fibrillation ablation.

BACKGROUND: The endpoint of persistent atrial fibrillation (AF) ablation is still a matter of debate. The purpose of this study was to evaluate if sinus rhythm (SR) as endpoint of persistent AF ablation has a better long-term outcome compared to atrial tachycardia (AT) or AF at the end of the procedure. METHODS AND RESULTS: Between 2008 and 2011, 191 consecutive patients undergoing de novo catheter ablation for symptomatic persistent and long-standing persistent AF using a sequential ablation approach (including pulmonary vein isolation, ablation of complex fractionated electrograms and linear lesions) were included in the study. According to the result at the end of ablation procedure, patients were classified into 3 groups: patients with termination of AF into SR (Group 1, n = 62), patients with AT undergoing cardioversion (CV) (Group 2, n = 47), or patients with AF undergoing CV (Group 3, n = 82). The primary endpoint was freedom from any atrial tachyarrhythmia off antiarrhythmic drugs at 12 months. At 12 months, estimated proportions of patients free from any arrhythmia recurrence were 42% for Group 1, 13% for Group 2, and 25% for Group 3 (P = 0.002). In a Cox regression analysis only termination into SR was associated with a lower risk of arrhythmia recurrence (HR: 0.62; P = 0.04). CONCLUSION: If SR is achieved as endpoint of persistent and long-standing persistent AF ablation using a sequential ablation approach it is associated with the highest long-term single procedure success rate compared to AT or AF at the end of the procedure.

Prospective assessment of short- and long-term quality of life after ablation for atrial fibrillation.

BACKGROUND: This study prospectively assesses different aspects of short- and long-term quality of life (QoL) after catheter ablation for atrial fibrillation (AF). An analysis of 7 validated generic and tailored questionnaires was performed with regard to the relation of QoL to ablation success. METHODS: The study included 133 patients (74% men, age 57±10) who underwent pulmonary vein isolation ± linear or electrogram-guided substrate modification for AF. QoL was quantitatively assessed at baseline, 3 months after ablation and at a median of 4.3 ± 0.5 years after ablation by the AF severity scale (AFSS), AF symptom checklist (AFSC), WHO-5-Well-Being-Index (WHO), Major Depression Inventory (MDI), Sleep and Vegetative disorder (SV), Vital Exhaustion (VE), and Illness intrusiveness (Ii). RESULTS: QoL was improved significantly 3 months after ablation in all patients (regardless of ablation success or AF type) and stayed significantly improved after a median of 4.3±0.5 years (AFSS, AFSC, WHO, MDI, VE, PE (all P < 0.001), and SV (P = 0.007)). Patients who had a successful ablation improved significantly more than patients with an unsuccessful ablation in the AFSS, AFSC, and MDI questionnaire (delta change from baseline to long-term follow-up P = <0.001, P = <0.001, and P = 0.039, respectively). CONCLUSION: Overall, all patients significantly improved their QoL irrespective of the AF type in all questionnaires 3 months and 4 years after ablation. The increase in QoL was significantly greater in patients who underwent a successful ablation than patients with unsuccessful ablation in the AFSS, AFSC, and MDI questionnaire.

Long-term follow-up after cryoablation for adolescent atrioventricular nodal reentrant tachycardia: recurrence is not predictable.

AIMS: Data about the long-term outcome after cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) in the paediatric population indicate that recurrence rates are higher with cryo than with radiofrequency energy (RF). The purpose of this study was to review our institutional long-term outcome after cryoablation for AVNRT and to seek for predictors of recurrence. METHODS AND RESULTS: Forty-nine patients (28 female, age 14 ± 2.7 years) undergoing slow-pathway modulation or ablation for AVNRT at our institution from 2004 to 2008 were included in the study.  Acute success was obtained in all patients (100%) with a mean procedure time of 164 ± 50 min and a mean fluoroscopy time of 13 ± 8 min. During a follow-up time of 30 ± 1.9 months, AVNRT recurrence occurred in 11/49 patients (22.4%). Age, sex, number of cryomappings or ablations, catheter tip (4 mm vs. 6 mm), or ablation endpoint (slow-pathway ablation vs. modulation) were not predictive for recurrence. In eight patients, reablation using cryo was performed. All these patients remained free of arrhythmia symptoms during a follow-up of 30 ± 8 months following the second procedure. CONCLUSION: Although cryoablation for the treatment for AVNRT in paediatric and adolescent patients is safe and associated with a high acute success rate, AVNRT recurrence occurs in 22% of patients during long-term follow-up without identifiable predictors for recurrence. A second cryoablation procedure leads to a success rate of 100% during long-term follow-up.

Safety of screening procedures with hand-held metal detectors among patients with implanted cardiac rhythm devices: a cross-sectional analysis.

BACKGROUND: Case reports suggest that the hand-held metal detectors used for security screening generate electromagnetic fields that may interfere with pacemaker and implantable cardioverter-defibrillator (ICD) function. OBJECTIVE: To assess changes in function of pacemakers and ICDs after exposure to hand-held metal detectors. DESIGN: Cross-sectional study. SETTING: Two medical centers in Europe. PATIENTS: 388 patients (209 with pacemakers and 179 with ICDs) presenting for routine follow-up of device function between September 2009 and December 2010. MEASUREMENTS: Abnormalities on electrocardiography suggestive of rhythm device malfunction (pacing inhibition, loss of capture, inappropriate mode switch, ventricular oversensing, and spontaneous reprogramming) after 30 seconds of exposure to 2 widely used hand-held metal detectors with a maximal electromagnetic flux density of 6.3 µT. RESULTS: No change in device function, including pacing or sensing abnormalities or device reprogramming, was observed in any patient. LIMITATIONS: The study included a convenience sample of patients, and the number of different device models tested was small. Testing was conducted in 2 clinic settings. CONCLUSION: Hand-held metal detectors did not affect the function of pacemakers or ICDs in this sample. The use of hand-held metal detectors for security screening is probably safe for patients with pacemakers and ICDs, but these findings require confirmation. PRIMARY FUNDING SOURCE: None.

[Protein S, C and antithrombin deficiency: association with myocardial infarction and thromboembolism in the young]. / Déficits en protéine S, C et antithrombine: Association à l'infarctus du myocarde et aux évènements thrombo-emboliques chez le sujet jeune.

BACKGROUND: The pathogenesis of myocardial infarction (MI) in young involves new factors including constitutional or acquired thrombophilia. AIM: To determine in patients ² 50 years, the association between coagulation factors deficiency, myocardial infarction and cardiovascular events during follow-up. METHODS: Protein C (PC), PS and antithrombin (AT) were screened in 50 patients admitted for acute MI and in a healthy control group. Univariate and multivariate analysis were performed using SPSS 11.5 version. RESULTS: PS and PC deficiency were associated to MI (respectively 24% vs 0%, p=0.001 and 14% vs 0%, p=0.016), independently for PC. No AT deficiency was detected in both groups. During followup, PS and C deficiency were predictive for venous thrombosis (p<0.05) and PS deficiency for pulmonary embolism. CONCLUSION: Protein C and S deficiency may play an important role in MI in young and also in thromboembolic complications during follow-up. Nevertheless, therapeutic implications remain controversial.

Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial.

BACKGROUND: Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block. METHODS AND RESULTS: A total of 509 patients underwent slow pathway cryoablation (n=251) or RFCA (n=258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; P=0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; P=0.029). In the cryoablation group, procedure duration was longer (138±54 versus 123±48 minutes; P=0.0012) and more device problems occurred (13 versus 2 patients; P=0.033). Pain perception was lower in the cryoablation group (P<0.001). CONCLUSIONS: Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00196222.

[Cardiac conduction disorders in athletes: diagnosis and management]. / Troubles de la conduction cardiaque chez le sportif : diagnostic et prise en charge.

BACKGROUND: The sino-atrial or atrio-ventricular conduction disturbances are commonly seen in athletes. They are due to predominant effect of the parasympathetic tone. AIM: To describe the physiological cardiac adaptation to physical exercises and to specify the limits of this activity in front of persons with conduction abnormalities. METHODS: Review of literature and lecture of recommendations. RESULTS: conduction disturbances in athletes disappear during physical activities. Their frequency is variously reported in literature. These disorders should be well considered particularly when they are priors to sport practice and need definitive implantable devices. Such decision must be taken after a detailed evaluation of the nature of the physical activity wished and the conduction disturbance type. CONCLUSION: The decision to allow competition should be take after a careful evaluation of the conduction disorder and the type of sport.

Safety of implantable pacemakers and cardioverter defibrillators in the magnetic field of a novel remote magnetic navigation system.

INTRODUCTION: Electromagnetic interference with pacemaker and implantable cardioverter defibrillator (ICD) systems may cause temporary or permanent system malfunction of implanted devices. The aim of this study was to evaluate potential interference of a novel magnetic navigation system with implantable rhythm devices. METHODS: A total of 121 devices (77 pacemakers, 44 ICDs) were exposed to an activated NIOBE II® Magnetic Navigation System (Stereotaxis, St. Louis, MO, USA) at the maximal magnetic field strength of 0.1 Tesla and evaluated in vitro with respect to changes in parameter settings of the device, changes of the battery status/detection of elective replacement indication, or alterations of data stored in the device. RESULTS: A total of 115 out of 121 (95%) devices were free of changes in parameter settings, battery status, and internally stored data after repeated exposition to the electromagnetic field of the remote magnetic navigation system. Interference with the magnetic navigation field was observed in 6 pacemakers, resulting in reprogramming to a power-on-reset mode with or without detection of the elective replacement indication in 5 devices and abnormal variance of battery status in one device. All pacemakers could be reprogrammed to the initial modes and the battery status proved to be normal some minutes after the pacemakers had been removed from the magnetic field. CONCLUSION: Interference of a remote magnetic navigation system (at maximal field strength) with pacemakers and ICDs not connected to leads with antitachycardic detection and therapies turned off is rare. Occurring functional abnormalities could be reprogrammed in our sample. An in vitro study will give information about interference of devices connected to leads.

Very late relapse of atrial fibrillation after pulmonary vein isolation: incidence and results of repeat ablation.

BACKGROUND: There are few data about the incidence of very late (>12 months) arrhythmia relapse after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and about the success rate of repeat ablation procedures in this population. METHODS: All patients treated with PVI for paroxysmal AF were screened in the institution's electrophysiology database. Follow-up data at 1, 3, 6, and 12 months and yearly thereafter including repetitive (7 days or 1 day) Holter electrocardiograms were assessed as well as the technique and success rate of repeat ablations. RESULTS: Overall, 24 of 356 (6.7%) patients experienced their first AF recurrence more than 12 months after PVI. Of these 24 patients, 14 underwent reablation for paroxysmal (11 patients) or persistent AF (three patients). Repeat ablation included re-PVI in all 14 patients (43 of 48 initially isolated PVs with recovered left atrial-PV conduction). Ablation of complex fractionated atrial electrograms or left/right atrial lines was performed in eight patients, including the three patients with persistent AF. During follow-up of 15.1 ± 9 months after the second ablation, 10 of 14 (71%) reablated patients remained in sinus rhythm. CONCLUSIONS: After PVI for paroxysmal AF, very late arrhythmia recurrence occurs in less than 10% of patients. The success rate of the repeat procedure is high.

Does cryopreservation of testicular sperm affect ICSI outcomes in azoospermia ?

OBJECTIVE: To evaluate the outcomes of intracytoplasmic sperm injection (ICSI) cycles when using fresh versus frozen testicular testicular sperm extraction (TESE) samples in non obstructive and obstructive azoospermia in terms of fertilization, cleavage, embryo quality, implantation and clinical pregnancy rates. STUDY DESIGN: A total of one hundred and forty consecutive testicular sperm extraction ICSI cycles were performed at our centre between 2012 and 2018 involving infertile men with obstructive and non-obstructive azoospermia.  Fresh TESE samples were used in 56 consecutive ICSI cycles (group 1) and frozen-thawed TESE sperm samples were used in 84 ICSI cycles (group 2). RESULTS: Our two groups were comparable concerning epidemiologic characteristics. There were no significant differences between the fresh TESE group and the frozen TESE group in the rates of fertilization, embryo cleavage rate, average number of, rate of tops embryos, blastocyst formation rate, implantation rate  and clinical pregnancy rate (32.1% vs. 35.7%; p = 0 ,62). Correlation between clinical pregnancy rate and the type of the injected sperm (motile/ immotile) was not significant (46, 3% vs. 66, 7%; p = 0, 59). CONCLUSIONS: Cryopreservation of testicular sperm seems not to influence ICSI outcomes. Thereby, this alternative is rather efficient in ICSI cycles in azoospermic patients since it may avoid iterative ovarian puncture, especially with non-obstructive azoospermia.

Are the results of electrophysiological study different in patients with a pre-excitation syndrome, with and without syncope?

AIMS: Syncope in Wolff-Parkinson-White (WPW) syndrome may reveal an arrhythmic event or is not WPW syndrome related. The aim of the study is to evaluate the results of electrophysiological study in WPW syndrome according to the presence or not of syncope and the possible causes of syncope. METHODS AND RESULTS: Among 518 consecutive patients with diagnosis of WPW syndrome, 71 patients, mean age 34.5 +/- 17, presented syncope. Transoesophageal electrophysiological study in control state and after isoproterenol infusion was performed in the out-patient clinic. Atrioventricular re-entrant tachycardia (AVRT) was more frequently induced than in asymptomatic patients (n = 38, 53.5%, P < 0.01), less frequently than in those with tachycardia; atrial fibrillation (AF) and/or antidromic tachycardia (ATD) was induced in 28 patients (39%) more frequently (P < 0.05) than in asymptomatic patients or those with tachycardia. The incidence of high-risk form [rapid conduction over accessory pathway (AP) and AF or ATD induction] was higher in syncope group (n = 18, 25%, P < 0.001) than in asymptomatic subjects (8%) or those with tachycardias (7.5%). Maximal rate conducted over AP was similar in patients with and without syncope, and higher in patients with spontaneous AF, but without syncope. Results were not age-related. CONCLUSION: Tachycardia inducibility was higher in patients with syncope than in the asymptomatic group. The incidence of malignant WPW syndrome was higher in patients with syncope than in asymptomatic or symptomatic population, but the maximal rate conducted over AP was not higher and another mechanism could be also implicated in the mechanism of syncope.

Nonischemic dilated cardiomyopathy: results of noninvasive and invasive evaluation in 310 patients and clinical significance of bundle branch block.

BACKGROUND: The survival of patients with idiopathic dilated cardiomyopathy (IDCM) at III and IV stages of New York Heart Association (NYHA) is decreased in those with a bundle branch block (BBB) compared to those without BBB. Less is known on the prognosis of patients at earlier stages of NYHA and who had a left BBB (LBBB) or right BBB (RBBB). We sought to evaluate the prevalence and the clinical significance of LBBB or RBBB in patients with IDCM and classes I and II of NYHA. METHODS: Clinical data, noninvasive, and invasive studies were consecutively collected in 310 patients, with IDCM, followed up to 4.8+/-3.7 years. RESULTS: Seventy-six patients (25%) had LBBB, 21 (7%) had RBBB, and 212 had no BBB. Patients with BBB were older than other patients (P < 0.009). Left ventricular ejection fraction (LVEF) was lower in LBBB than in RBBB and other patients (P < 0.05). Syncope was more frequent in BBB than in absence (P < 0.05). Incidence of spontaneous ventricular tachycardia (VT) and atrial fibrillation, VT induction, total cardiac events, and sudden death were similar in the presence or absence of BBB. Deaths by heart failure and heart transplantations tended to be more frequent in BBB than in absence. CONCLUSIONS: LBBB was present in 25% of patients with IDCM; RBBB was rare. Patients with BBB were older and had more frequent syncope than patients without BBB; LVEF was lower in LBBB than in RBBB or in absence of BBB. BBB did not increase the risk of spontaneous VT, VT induction, or sudden death, and tended to increase deaths by heart failure and the indications of heart transplantation.

[Chronic heart failure: role of Doppler echocardiography in the evaluation of mortality risk]. / Insuffisance cardiaque chronique: place de l'échocardiographie-doppler dans l'évaluation du risque de mortalité.

BACKGROUND: Chronic heart failure (CHF) is a major cause of morbidity and mortality. Despite recent improvements in the management of this condition, the overall prognosis remains poor. Echocardiography is the most useful test in the evaluation of systolic and diastolic function and has also a prognostic value. AIM: The aim of this study is to determine echocardiographic predictors of mortality in patients with CHF. METHODS: We followed 100 patients with a diagnosis of CHF over an average period of 44+/-40.5 months. We compared echocardiographic parameters in survivors and non survivors. RESULTS: Four variables predicted death: LVEF <35% (p=0.001), TDE <150ms (p=0.001), E/A ratio >2 (p=0.05) and E/Ea ratio >10 (p=0.008). CONCLUSION: Doppler echocardiography has a central role in the evaluation of patients with CHF. It provides valuable prognostic information by combination of several parameters.

Two in one is better than one plus one: comparison of adverse events between combining electrophysiological examination and coronary angiography versus performing them consecutively.

PURPOSE: In some patients, both an electrophysiological examination (EPS) and a coronary angiography (CA) are necessary. It might be preferable to choose a combined approach of EPS and CA versus performing them consecutively. The purpose of this study is to evaluate the type and rate of adverse events between both approaches. METHODS: Patients were eligible if they underwent a CA and an EPS in a combined approach or in a time interval of at most 2 months. In all patients, clinical adverse events were recorded. RESULTS: A total of 1184 patients were included. CA and EPS were performed in a combined procedure (comb) in 492 patients, whereas they were performed consecutively in 692 patients (cons). The acute major complication rate was 0.67%, showing no differences between both groups. In the comb 6.9% and in the cons 6.6% of vascular complications were observed (p = 0.20). The rates of AV fistula and hematoma needing transfusion showed a significantly higher rate in the cons group (p = 0.018 and p = 0.045, respectively). In a multivariate logistic regression analysis, age was a significant predictor for groin complications. After propensity matching, AV fistula occurred significantly more often in the cons group (p = 0.002). CONCLUSION: Overall, serious adverse events were rare and there were no differences between the combined approach of EPS and CA and the consecutive approach; however, the occurrence of AV fistula and groin hematoma needing transfusion occurred significantly less in the combined procedure group. Therefore, a combined approach is preferable to a consecutive one.

[Influence of sex on immediate and late results of percutaneous coronary angioplasty]. / Influence du sexe sur les resultats immediats et tardifs de l'angioplastie coronaire percutanee.

Prior studies have reported worse results after percutaneous transluminal coronary angioplasty (PTCA) in women than in men. However, recent data suggest that this difference is less marked. The aim of our study is to evaluate whether the procedural outcome is equal in the two genders. Six hundred and eighty-eight PTCA were studied in 96 consecutive women and 509 men who underwent the procedure in our catheterization laboratory between 1998 and 2004. Women undergoing PTCA were older than men and had a higher incidence of diabetes, hypercholesterolemia and hypertension. Multivessel disease and severe coronary lesions were more frequent in women. The stenting rates, the use of drug eluting stents and of glycoprotein IIbIIIa inhibitors were similar in the two sexes. Procedural success rate was similar in the two groups. No significant differences were found in in-hospital mortality and in the resort to emergency coronary artery bypass grafting (CABG). 14 month after the procedure there were similar rates of death, repeated revascularisation and restenosis have been shown in the two sexes. Even if the baseline characteristics remain worse in women, increased experience of the operators, introduction of new stents and use of glycoprotein IIIbIIa inhibitors have improved the results in patients undergoing PTCA. This improvement has been higher in women than in men leading to the equalization of the outcome in the two sexes.