[New tools for diagnosis and management of arrhythmias]. / Nouveaux outils diagnostiques dans la prise en charge des arythmies.

If we have more and more ECG's tools for the diagnosis of arrhythmias, it is found that these remain largely unknown and mostly underused. If the use of these new tools is increasing by the cardiologist, it remains largely insufficient by non-cardiologists including neurologists or general practitioners. This article explains the main ECG tools available and discusses their respective indications at a time when things are constantly evolving.

[Current limits of the long duration rhythmic holter: A real life study]. / Limites actuelles du holter rythmique de longue durée : une étude vie réelle.

BACKGROUND: Syncope or stroke remain frequently without any explained diagnosis. Long duration holter ECG is an available tool to diagnose arrhythmias. However, this tool is subject to availability of the recorders. AIM: Report a single center experience with long duration holter ECG in clinical practice, in the different cardiology and neurology indications, and to assess the different delays until achievement of a diagnosis. METHODS AND RESULTS: The device (Sorin Spiderflash) was used for 48 patients between January 2018 and June 2018. The holter was applied for a mean duration of 10±4days. The mean age was 55+19 years-old. 20 patients (42%) were explored for a stroke or transient ischemic attack (TIA), 18 (36%) for palpitations, 6 (12%) for syncope and 4 (8%) for evaluation of arrhythmias management. An abnormality has been recorded in 11 (22%) patients and a treatment has been administered in 5 patients (10%). Regarding, the timing of the exam, the mean time between the index event and the indication was 39 days. The mean time between the indication and the availability of the device was 32 days. 16 Days was the mean time for lecture and 23 days was the mean time between the result and the appointment with the cardiologist and neurologist. CONCLUSION: In this registry, the management of patients by non-invasive long duration holter ECG monitoring may be improved regarding the timing of the exams, their lecture and new appointments with the physicians.

[How to manage anticoagulation in atrial fibrillation ablation]. / Comment gérer l'anticoagulation en cas d'ablation de la fibrillation atriale.

There are many randomized trials evaluating non-vitamin K oral anticoagulants (NOAC) in patients with atrial fibrillation ablation. VENTURE AF, RE-CIRCUIT, and recently AXAFA have evaluated the three main NOACs in this indication. Other studies such as ABRIDGE J and AEIOU complemented these results. The management of the anticoagulation in these patients is one of the subjects of the European Society of Cardiology guidelines, as well, as, the EHRA guide recently released. The purpose of this article is to summarize published studies and guidelines.

[Percutaneous closure of persistent ductus arteriosus in low-weight infants]. / La fermeture percutanée du canal artériel persistant chez les enfants de faible poids.

INTRODUCTION: The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg. AIM OF THE STUDY: The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children. PATIENTS AND METHODS: The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed. RESULTS: Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. CONCLUSION: This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.