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Summary Background The relationship between electrical and mechanical indices of cardiac dyssynchronization in systolic heart failure (HF) remains poorly understood. Objectives We examined retrospectively this relationship by using the daily practice tools in cardiology in recipients of cardiac resynchronization therapy (CRT) systems. Methods We studied 119 consecutive patients in sinus rhythm and QRS ≥ 120 ms (mean: 160 ± 17 ms) undergoing CRT device implantation. P wave duration, PR, e PR (end of P wave to QRS onset), QT, RR–QT, JT and QRS axis and morphology were putative predictors of atrioventricular (diastolic filling time [DFT]/RR), interventricular mechanical dyssynchrony (IVMD) and left intraventricular mechanical dyssynchrony (left ventricular pre-ejection interval [PEI] and other measures) assessed by transthoracic echocardiography (TTE). Correlations between TTE and electrocardiographic measurements were examined by linear regression. Results Statistically significant but relatively weak correlations were found between heart rate ( r = −0.5), JT ( r = 0.3), QT ( r = 0.3), RR–QT intervals ( r = 0.5) and DFT/RR, though not with PR and QRS intervals. Weak correlations were found between: (a) QRS ( r = 0.3) and QT interval ( r = 0.3) and (b) IVMD > 40 ms; and between (a) e PR ( r = −0.2), QRS ( r = 0.4), QT interval ( r = 0.3) and (b) LVPEI, though not with other indices of intraventricular dyssynchrony. Conclusions The correlations between electrical and the evaluated mechanical indices of cardiac dyssynchrony were generally weak in heart failure candidates for CRT. These data may help to explain the discordance between electrocardiographic and echocardiographic criteria of ventricular dyssynchrony in predicting the effect of CRT.

International audience; Background Rest echocardiography plays a role in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM). Indeed, left atrial enlargement, severe left ventricle (LV) hypertrophy and rest LV outflow tract (LVOT) gradients ≥50mmHg are sudden cardiac death risk factors as highlighted in recent guidelines. Conversely, exercise echocardiography findings play only a limited role in prognosis evaluations. Therefore, we sought to determine whether exercise induced changes in myocardial and valvular functions could improve HCM risk stratification. Methods and results Consecutive HCM patients with a preserved LV ejection fraction underwent standardized exercise echocardiography (including the assessment of myocardial function, dynamic left intra-ventricular gradient and valvular regurgitations) at baseline and were clinically followed for a median of 29.3 months. The primary endpoint was a composite criterion that included death from any cause, cardiorespiratory arrest, and hospitalization for a cardiovascular event. A total of 126 patients were included. Eighteen patients reached the primary endpoint. According to univariate Cox regression analysis, exercise LVOT gradient ≥50mmHg (HR=3.31, p=0.01) and significant (≥2/4) exercise mitral regurgitation (HR=3.64, p

International audience; Aims Rest echocardiography plays a role in hypertrophic cardiomyopathy (HCM) diagnosis and risk stratification because left atrial enlargement, severe left ventricle (LV) hypertrophy, and rest LV outflow tract (LVOT) gradients ≥50 mmHg are sudden cardiac death risk factors that have been highlighted in recent guidelines. Conversely, the lack of evidence makes that exercise-echocardiography findings play a limited role. In clinical practice, LVOT gradient, but also mitral regurgitation (MR) or pulmonary pressure, seems relevant parameters to look for, during the exercise. Therefore, we sought to determine whether exercise-induced changes in myocardial and valvular functions could improve HCM risk stratification. Methods and results Consecutive primitive HCM patients with a preserved LV ejection fraction underwent standardized exercise echocardiography (including the assessment of myocardial function, dynamic left intraventricular gradient, and valvular regurgitations) at baseline and were clinically followed for a median of 29.3 months. The primary endpoint was a composite criterion that included death from any cause, cardiorespiratory arrest, and hospitalization for a cardiovascular event. A total of 126 patients were included. Eighteen patients reached the primary endpoint. According to univariate Cox regression analysis, exercise LVOT gradient ≥50 mmHg [hazard ratio (HR) = 3.31, P = 0.01] and significant (≥2/4) exercise MR (HR = 3.64, P , 0.01) were associated with the primary endpoint. Patients with significant MR had significantly higher rest and exercise LVOT gradients (P= 0.001 and P= 0.001) and larger left atria volumes (P , 0.001). Conclusion Significant exercise-induced MR appears to significantly impact the prognoses of HCM patients, and it is also associated with higher LVOT rest and exercise gradients,. © The Author 2015.

Summary Background Pulmonary vein (PV) isolation, using cryoballoon or radiofrequency ablation, is the cornerstone therapy for symptomatic paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. One-third of the patients have recurrences, mainly due to PV reconnections. Aims To describe the different locations of reconnection sites in patients who had previously undergone radiofrequency or cryoballoon ablation, and to compare the characteristics of the redo procedures in both instances. Methods Demographic data and characteristics of the initial ablation (cryoballoon or radiofrequency) were collected. Number and localization of reconduction gaps, and redo characteristics were reviewed. Results Seventy-four patients scheduled for a redo ablation of paroxysmal AF were included; 38 had been treated by radiofrequency ablation and 36 by cryoballoon ablation during the first procedure. For the initial ablation, procedural and fluoroscopy times were significantly shorter for cryoballoon ablation (147.8 ± 52.6 min vs. 226.6 ± 64.3 min [ P P = 0.005], respectively). Overall, an identical number of gaps was found during redo procedures of cryoballoon and radiofrequency ablations. However, a significantly higher number of gaps were located in the right superior PV for patients first ablated with radiofrequency (0.9 ± 1.0 vs. 0.5 ± 0.9; P = 0.009). Gap localization displayed different patterns. Although not significant, redo procedures of cryoballoon ablation were slightly shorter and needed shorter durations of radiofrequency to achieve PV isolation. Conclusions During redo procedures, gap localization pattern is different for patients first ablated with cryoballoon or radiofrequency ablation, and right superior PV reconnections occur more frequently after radiofrequency ablation. Redo ablation of a previous cryoballoon ablation appears to be easier.

Introduction The rate of pacemaker(PM) implantations is continuously growing. A large number of nonagenarian patients will be implanted in the future. We aimed at analyzing the outcome after PM implantation in the elderly. Methods Patients aged ≥90 yo referred for PM implantation from 2004 to 2014 were retrospectively included. The primary clinical endpoint was total mortality. Results 113 patients were included (92.6±2.1yo). Five patients (3.5%) had short-term device-related complications (3 pocket hematoma, 1 lead displacement, 1 hemothorax). During the follow-up, 48 patients (42.5%) died. Survival rates were 77.4% (95%CI:67.4-84.7%), 68.7% (95%CI:57.4-77.6%) and 36.4% (95%CI:23.3-49.7%) after 1, 2 and 5 years, respectively. Atrial fibrillation (OR 3.5,95%CI:1.6-7.2) and a cardiomyopathy (OR 2.3,95%CI:1.2-4.4) at the time of implantation were independent predictors of mortality. Conclusion PM implantation in nonagenarians is safe, with a low risk of procedural complications. Download : Download full-size image Figure: Survival for nonagenarians after PM implantation

International audience; The principal role of the left atrium (LA) is to modulate left ventricular filling and cardiovascular performance by functioning as (i) a reservoir for pulmonary venous return during ventricular systole, (ii) a conduit for pulmonary venous return during early ventricular diastole, and (iii) a booster pump that augments ventricular filling during late ventricular diastole. The interplay between these atrial functions and ventricular performance throughout the cardiac cycle is crucial in many pathophysiological conditions.1,2 However, in clinical practice, we do not really assess all of the components of LA function. In fact, quantification of LA function remains challenging. Calculating ejection fraction or atrial ejection force has occasionally been proposed as methods for quantifying LA function, but they are neither routinely used nor recommended in the literature.3 Standard recommendations in the literature propose using LA volume calculated from trans-thoracic 2D echocardiography orthogonal views.3,4 LA size correlates with both LA and left ventricular (LV) function and is a strong predictor of cardiovascular morbidity and death.5 The antero-posterior diameter, calculated with M-mode or 2D echocardiography, is no longer considered to adequately represent the true LA size. For these reasons, the ASE/EACVI joined paper3 …

Background The rate of pacemaker (PM) implantations is continuously growing. A large number of elderly patients is expected to be implanted in the future. We aimed at analyzing the short and long-term outcome after PM replacement in nonagenarians. Methods Patients aged ≥90 yo referred for PM replacement from January 2004 to July 2014 were retrospectively included. The primary clinical endpoint was total mortality. Results 62 patients were included (93.3±2.9yo at the time of PM replacement). During the follow-up, 37 patients (59.7%) died. Survival rates were 84.2% (95%CI:71.8-91.5%), 66.9% (95%CI:51.8-78.2%) and 22.7% (95%CI:10.6-37.7%) after 1, 2 and 5 years, respectively. Atrial fibrillation (OR 2.44, 95%CI:1.07-5.58) and non-physiological pacing, (OR 2.52, 95%CI:1.12-5.65) were independent predictors of mortality. Conclusion PM replacement in nonagenarians is a safe and straightforward procedure. Patients living for a median time of 30 months after the replacement. Download : Download full-size image Figure: Survival for nonagenarians after PM replacement