146 results on '"Thomas Pambrun"'
Search Results
2. Long-term clinical outcome of atrial fibrillation ablation in patients with history of mitral valve surgery
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Alexandre Almorad, Louisa O'Neill, Jean-Yves Wielandts, Kris Gillis, Benjamin De Becker, Yosuke Nakatani, Carlo De Asmundis, Saverio Iacopino, Thomas Pambrun, La Meir Marc, Pierre Jaïs, Michel Haïssaguerre, Mattias Duytschaever, Jean-Baptista Chierchia, Nicolas Derval, and Sébastien Knecht
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atrial fibrillation ,mitral valve surgery ,ablation ,atrial tachyarrhythmias ,antiarrhythmic drugs ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
AimsAtrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery.MethodsSixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2).ResultsAfter the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) (p = 0.3). After 62 (48–84) months of follow-up and 2 (2–2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm (p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs (p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred.ConclusionLong-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm.
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- 2022
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3. Sex differences in ventricular arrhythmia: epidemiology, pathophysiology and catheter ablation
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Philipp Krisai, Ghassen Cheniti, Takamitsu Takagi, Tsukasa Kamakura, Elodie Surget, Clémentine André, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Frédéric Sacher, Pierre Jaïs, Michel Haïssaguerre, and Mélèze Hocini
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ventricular arrhythmia ,ventricular tachycardia ,catheter ablation ,sex difference ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Evidence on sex differences in the pathophysiology and interventional treatment of ventricular arrhythmia in ischemic (ICM) or non-ischemic cardiomyopathies (NICM) is limited. However, women have different etiologies and types of structural heart disease due to sex differences in genetics, proteomics and sex hormones. These differences may influence ventricular electrophysiological parameters and may require different treatment strategies. Considering that women were consistently under-represented in all randomized-controlled trials on VT ablation, the applicability of the study results to female patients is not known. In this article, we review the current knowledge and gaps in evidence about sex differences in the epidemiology, pathophysiology and catheter ablation in patients with ventricular arrhythmias.
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- 2022
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4. Post–Myocardial Infarction Scar With Fat Deposition Shows Specific Electrophysiological Properties and Worse Outcome After Ventricular Tachycardia Ablation
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Ghassen Cheniti, Soumaya Sridi, Frederic Sacher, Arnaud Chaumeil, Xavier Pillois, Masateru Takigawa, Antonio Frontera, Konstantinos Vlachos, Claire A. Martin, Elvis Teijeira, Takeshi Kitamura, Anna Lam, Felix Bourier, Stephane Puyo, Josselin Duchateau, Arnaud Denis, Thomas Pambrun, Remi Chauvel, Nicolas Derval, François Laurent, Michel Montaudon, Meleze Hocini, Michel Haissaguerre, Pierre Jais, and Hubert Cochet
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catheter ablation ,computed tomography ,fat deposition ,myocardial infarction ,ventricular tachycardia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Fat deposition (FD) is part of the healing process after myocardial infarction. The characteristics of FD and its impact on the outcome in patients undergoing ventricular tachycardia (VT) ablation have not been thoroughly studied. Methods and Results We studied consecutive patients undergoing post–myocardial infarction VT ablation with pre‐procedural cardiac computed tomography. FD was defined as intra‐myocardial attenuation ≤ −30 HU on computed tomography. Clinical, anatomical, and post‐procedural outcome was assessed in the overall population. Electrophysiological characteristics were assessed is a subgroup of patients with high‐density electro‐anatomical maps. Sixty‐nine patients were included (66±12 years). FD was detected in 44 (64%) patients. The presence of FD related to scar age (odds ratio [OR]: 1.14 per year; P=0.001) and scar extent (OR: 1.27 per segment; P=0.02). On electro‐anatomical maps, FD was characterized by lower bipolar amplitude (P
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- 2019
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5. Long‐Term Follow‐Up of Idiopathic Ventricular Fibrillation in a Pediatric Population: Clinical Characteristics, Management, and Complications
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Antonio Frontera, Konstantinos Vlachos, Takeshi Kitamura, Saagar Mahida, Xavier Pillois, Gerard Fahy, Christelle Marquie, Riccardo Cappato, Graham Stuart, Pascal Defaye, Juan Pablo Kaski, Joris Ector, Alice Maltret, Patrice Scanu, Jean‐Luc Pasquie, Isabelle Deisenhofer, Ivan Blankoff, Daniel Scherr, Martin Manninger, Yoshifusa Aizawa, Linda Koutbi, Arnaud Denis, Thomas Pambrun, Philippe Ritter, Frederic Sacher, Meleze Hocini, Philippe Maury, Pierre Jaïs, Pierre Bordachar, Michel Haïssaguerre, and Nicolas Derval
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idiopathic ,defibrillator ,ventricular fibrillation ,complications ,ventricular tachycardia ,syncope ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The natural history and long‐term outcome in pediatric patients with idiopathic ventricular fibrillation (IVF) are poorly characterized. We sought to define the clinical characteristics and long‐term outcomes of a pediatric cohort with an initial diagnosis of IVF. Methods and Results Patients were included from an International Registry of IVF (consisting of 496 patients). Inclusion criteria were: (1) VF with no identifiable cause following comprehensive analysis for ischemic, electrical or structural heart disease and (2) age ≤16 years. These included 54 pediatric IVF cases (age 12.7±3.7 years, 59% male) among whom 28 (52%) had a previous history of syncope (median 2 syncopal episodes [interquartile range 1]). Thirty‐six (67%) had VF in situations associated with high adrenergic tone. During a median 109±12 months of follow‐up, 31 patients (57%) had recurrence of ventricular arrhythmias, mainly VF. Two patients developed phenotypic expression of an inherited arrhythmia syndrome during follow‐up (hypertrophic cardiomyopathy and long QT syndrome, respectively). A total of 15 patients had positive genetic testing for inherited arrhythmia syndromes. Ten patients (18%) experienced device‐related complications. Three patients (6%) died, 2 due to VF storm. Conclusions In pediatric patients with IVF, a minority develop a definite clinical phenotype during long‐term follow‐up. Recurrent VF is common in this patient group.
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- 2019
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6. Early Repolarization Syndrome: Diagnostic and Therapeutic Approach
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Felix Bourier, Arnaud Denis, Ghassen Cheniti, Anna Lam, Konstantinos Vlachos, Masateru Takigawa, Takeshi Kitamura, Antonio Frontera, Josselin Duchateau, Thomas Pambrun, Nicolas Klotz, Nicolas Derval, Frédéric Sacher, Pierre Jais, Michel Haissaguerre, and Mélèze Hocini
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early repolarization syndrome ,sudden cardiac death ,J wave ,ICD implantation ,idiopathic ventricular fibrillation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
An early repolarization pattern can be observed in 1% up to 13% of the overall population. Whereas, this pattern was associated with a benign outcome for many years, several more recent studies demonstrated an association between early repolarization and sudden cardiac death, so-called early repolarization syndrome. In early repolarization syndrome patients, current imbalances between epi- and endo-cardial layers result in dispersion of de- and repolarization. As a consequence, J waves or ST segment elevations can be observed on these patients' surface ECGs as manifestations of those current imbalances. Whereas, an early repolarization pattern is relatively frequently found on surface ECGs in the overall population, the majority of individuals presenting with an early repolarization pattern will remain asymptomatic and the isolated presence of an early repolarization pattern does not require further intervention. The mismatch between frequently found early repolarization patterns in the overall population, low incidences of sudden cardiac deaths related to early repolarization syndrome, but fatal, grave consequences in affected patients remains a clinical challenge. More precise tools for risk stratification and identification of this minority of patients, who will experience events, remain a clinical need. This review summarizes the epidemiologic, pathophysiologic and diagnostic background and presents therapeutic options of early repolarization syndrome.
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- 2018
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7. Atrial Fibrillation Mechanisms and Implications for Catheter Ablation
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Ghassen Cheniti, Konstantinos Vlachos, Thomas Pambrun, Darren Hooks, Antonio Frontera, Masateru Takigawa, Felix Bourier, Takeshi Kitamura, Anna Lam, Claire Martin, Carole Dumas-Pommier, Stephane Puyo, Xavier Pillois, Josselin Duchateau, Nicolas Klotz, Arnaud Denis, Nicolas Derval, Pierre Jais, Hubert Cochet, Meleze Hocini, Michel Haissaguerre, and Frederic Sacher
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atrial fibrillation ,reentrant drivers ,catheter ablation ,fibrosis ,mapping ,pulmonary vein ablation ,Physiology ,QP1-981 - Abstract
AF is a heterogeneous rhythm disorder that is related to a wide spectrum of etiologies and has broad clinical presentations. Mechanisms underlying AF are complex and remain incompletely understood despite extensive research. They associate interactions between triggers, substrate and modulators including ionic and anatomic remodeling, genetic predisposition and neuro-humoral contributors. The pulmonary veins play a key role in the pathogenesis of AF and their isolation is associated to high rates of AF freedom in patients with paroxysmal AF. However, ablation of persistent AF remains less effective, mainly limited by the difficulty to identify the sources sustaining AF. Many theories were advanced to explain the perpetuation of this form of AF, ranging from a single localized focal and reentrant source to diffuse bi-atrial multiple wavelets. Translating these mechanisms to the clinical practice remains challenging and limited by the spatio-temporal resolution of the mapping techniques. AF is driven by focal or reentrant activities that are initially clustered in a relatively limited atrial surface then disseminate everywhere in both atria. Evidence for structural remodeling, mainly represented by atrial fibrosis suggests that reentrant activities using anatomical substrate are the key mechanism sustaining AF. These reentries can be endocardial, epicardial, and intramural which makes them less accessible for mapping and for ablation. Subsequently, early interventions before irreversible remodeling are of major importance. Circumferential pulmonary vein isolation remains the cornerstone of the treatment of AF, regardless of the AF form and of the AF duration. No ablation strategy consistently demonstrated superiority to pulmonary vein isolation in preventing long term recurrences of atrial arrhythmias. Further research that allows accurate identification of the mechanisms underlying AF and efficient ablation should improve the results of PsAF ablation.
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- 2018
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8. Noninvasive Assessment of Atrial Fibrillation Complexity in Relation to Ablation Characteristics and Outcome
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Marianna Meo, Thomas Pambrun, Nicolas Derval, Carole Dumas-Pomier, Stéphane Puyo, Josselin Duchâteau, Pierre Jaïs, Mélèze Hocini, Michel Haïssaguerre, and Rémi Dubois
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atrial fibrillation ,catheter ablation ,body surface potential maps ,principal component analysis ,atrial fibrillation complexity ,Physiology ,QP1-981 - Abstract
Background: The use of surface recordings to assess atrial fibrillation (AF) complexity is still limited in clinical practice. We propose a noninvasive tool to quantify AF complexity from body surface potential maps (BSPMs) that could be used to choose patients who are eligible for AF ablation and assess therapy impact.Methods: BSPMs (mean duration: 7 ± 4 s) were recorded with a 252-lead vest in 97 persistent AF patients (80 male, 64 ± 11 years, duration 9.6 ± 10.4 months) before undergoing catheter ablation. Baseline cycle length (CL) was measured in the left atrial appendage. The procedural endpoint was AF termination. The ablation strategy impact was defined in terms of number of regions ablated, radiofrequency delivery time to achieve AF termination, and acute outcome. The atrial fibrillatory wave signal extracted from BSPMs was divided in 0.5-s consecutive segments, each projected on a 3D subspace determined through principal component analysis (PCA) in the current frame. We introduced the nondipolar component index (NDI) that quantifies the fraction of energy retained after subtracting an equivalent PCA dipolar approximation of heart electrical activity. AF complexity was assessed by the NDI averaged over the entire recording and compared to ablation strategy.Results: AF terminated in 77 patients (79%), whose baseline AF CL was 177 ± 40 ms, whereas it was 157 ± 26 ms in patients with unsuccessful ablation outcome (p = 0.0586). Mean radiofrequency emission duration was 35 ± 21 min; 4 ± 2 regions were targeted. Long-lasting AF patients (≥12 months) exhibited higher complexity, with higher NDI values (≥12 months: 0.12 ± 0.04 vs. 180 ms: 0.09 ± 0.03, p < 0.01). More organized AF as measured by lower NDI was associated with successful ablation outcome (termination: 0.10 ± 0.03 vs. no termination: 0.12 ± 0.04, p < 0.01), shorter procedures (
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- 2018
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9. An Automated Platform to Standardize Position in the Left Atrium and Map Electrophysiological Data.
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Marianna Meo, Josselin Duchateau, Jason D. Bayer, Thomas Pambrun, Caroline H. Roney, Edward J. Vigmond, Nicolas Derval, Arnaud Denis, Pierre Jaïs, Mélèze Hocini, Michel Haïssaguerre, and Rémi Dubois
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- 2019
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10. A Posterior Wall Resistant to Electroporation Finally Blocked With Vein of Marshall Ethanol Infusion
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Ciro Ascione, Christopher Kowalewski, Thomas Pambrun, Nicolas Derval, and Pierre Jaïs
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- 2023
11. Advanced Imaging Integration for Catheter Ablation of Ventricular Tachycardia
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Christopher Kowalewski, Ciro Ascione, Marta Nuñez-Garcia, Buntheng Ly, Maxime Sermesant, Aurélien Bustin, Soumaya Sridi, Xavier Bouteiller, Masaaki Yokoyama, Konstantinos Vlachos, Cinzia Monaco, Benjamin Bouyer, Samuel Buliard, Marine Arnaud, Romain Tixier, Remi Chauvel, Nicolas Derval, Thomas Pambrun, Josselin Duchateau, Pierre Bordachar, Mélèze Hocini, Gerhard Hindricks, Michel Haïssaguerre, Frédéric Sacher, Pierre Jais, and Hubert Cochet
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Cardiology and Cardiovascular Medicine - Published
- 2023
12. High-resolution mapping of reentrant atrial tachycardias: Relevance of low bipolar voltage
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F. Daniel Ramirez, Marianna Meo, Corentin Dallet, Philipp Krisai, Konstantinos Vlachos, Antonio Frontera, Masateru Takigawa, Yosuke Nakatani, Takashi Nakashima, Clémentine André, Tsukasa Kamakura, Takamitsu Takagi, Aline Carapezzi, Romain Tixier, Rémi Chauvel, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Frédéric Sacher, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs, Rémi Dubois, and Nicolas Derval
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Bipolar voltage is widely used to characterize the atrial substrate but has been poorly validated, particularly during clinical tachycardias.The purpose of this study was to evaluate the diagnostic performance of voltage thresholds for identifying regions of slow conduction during reentrant atrial tachycardias (ATs).Thirty bipolar voltage and activation maps created during reentrant ATs were analyzed to (1) examine the relationship between voltage amplitude and conduction velocity (CV), (2) measure the diagnostic ability of voltage thresholds to predict CV, and (3) identify determinants of AT circuit dimensions. Voltage amplitude was categorized as "normal" (0.50 mV), "abnormal" (0.05-0.50 mV), or "scar" (0.05 mV); slow conduction was defined as30 cm/s.A total of 266,457 corresponding voltage and CV data points were included for analysis. Voltage and CV were moderately correlated (r = 0.407; P.001). Bipolar voltage predicted regions of slow conduction with an area under the receiver operating characteristic curve of 0.733 (95% confidence interval 0.731-0.735). A threshold of 0.50 mV had 91% sensitivity and 35% specificity for identifying slow conduction, whereas 0.05 mV had 36% sensitivity and 87% specificity, with an optimal voltage threshold of 0.15 mV. Analyses restricted to the AT circuits identified weaker associations between voltage and CV and an optimal voltage threshold of 0.25 mV.Widely used bipolar voltage amplitude thresholds to define "abnormal" and "scar" tissue in the atria are, respectively, sensitive and specific for identifying regions of slow conduction during reentrant ATs. However, overall, the association of voltage with CV is modest. No clinical predictors of AT circuit dimensions were identified.
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- 2023
13. Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication
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Takamitsu Takagi, Nicolas Derval, Josselin Duchateau, Rémi Chauvel, Romain Tixier, Hugo Marchand, Benjamin Bouyer, Clémentine André, Tsukasa Kamakura, Philipp Krisai, Ciro Ascione, Conrado Balbo, Ghassen Cheniti, Arnaud Denis, Frédéric Sacher, Mélèze Hocini, Pierre Jaïs, Michel Haïssaguerre, and Thomas Pambrun
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce.The purpose of this study was to evaluate the impact of gaps within such a lesion set.We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg).Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P.001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05).Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
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- 2023
14. Electrophysiological study prior to planned pulmonary valve replacement in patients with repaired tetralogy of Fallot
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Benjamin Bouyer, Zackaria Jalal, F. Daniel Ramirez, Nicolas Derval, Xavier Iriart, Josselin Duchateau, François Roubertie, Nadir Tafer, Romain Tixier, Thomas Pambrun, Ghassen Cheniti, Ciro Ascione, Masaaki Yokoyama, Christopher Kowalewski, Samuel Buliard, Rémi Chauvel, Marine Arnaud, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs, Hubert Cochet, Jean‐Benoit Thambo, and Frederic Sacher
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
15. Sinus node exit, crista terminalis conduction, interatrial connection, and wavefront collision: Key features of human atrial activation in sinus rhythm
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Thomas Pambrun, Nicolas Derval, Josselin Duchateau, F. Daniel Ramirez, Rémi Chauvel, Romain Tixier, Hugo Marchand, Benjamin Bouyer, Nicolas Welte, Clémentine André, Takashi Nakashima, Yosuke Nakatani, Tsukasa Kamakura, Takamitsu Takagi, Philipp Krisai, Ciro Ascione, Conrado Balbo, Ghassen Cheniti, Konstantinos Vlachos, Félix Bourier, Masateru Takigawa, Takeshi Kitamura, Antonio Frontera, Marianna Meo, Arnaud Denis, Frédéric Sacher, Mélèze Hocini, Pierre Jaïs, and Michel Haïssaguerre
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Vena Cava, Superior ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Heart Atria ,Cardiology and Cardiovascular Medicine ,Sinoatrial Node - Abstract
An understanding of normal atrial activation during sinus rhythm can inform catheter ablation strategies to avoid deleterious impacts of ablation lesions on atrial conduction and mechanics.The purpose of this study was to describe how the sinus node impulse originates, propagates, and collides in right and left atria with normal voltage.Fifty consecutive patients undergoing catheter ablation of atrial fibrillation with endocardial atrial voltage0.5 mV during high-density 3-dimensional mapping were studied.Sinus node exits varied among patients along a lateral oblique arc extending from the anterior aspect of the superior vena cava (SVC) to the mid-posterior wall of the right atrium (RA). Conduction slowing or block at one of the smooth components that faces the crista terminalis was observed in 54% of cases, including complete block at the SVC musculature and systemic venous sinus in 6% of cases. Depending on these 2 key features of RA activation, interatrial conduction was mediated by the Bachmann bundle (64%) and posterior bundles (54%), with an overlap of the resulting left atrial breakthrough location. Wavefront collision was consistently observed at 3 sites: the septal aspect of the cavotricuspid isthmus, and the lower aspects of the dome and of the mitral isthmus.During sinus rhythm, atrial activation occurs via distinct sequences mediated by a complex interaction of anatomic factors.
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- 2022
16. Strategy for repeat procedures in patients with persistent atrial fibrillation: Systematic linear ablation with adjunctive ethanol infusion into the vein of Marshall versus electrophysiology‐guided ablation
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Takashi Nakashima, Thomas Pambrun, Konstantinos Vlachos, Cyril Goujeau, Clémentine André, Philipp Krisai, F. Daniel Ramirez, Gabriela Pintican, Tsukasa Kamakura, Takamitsu Takagi, Yosuke Nakatani, Elodie Surget, Ghassen Cheniti, Romain Tixier, Remi Chauvel, Josselin Duchateau, Frédéric Sacher, Hubert Cochet, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs, and Nicolas Derval
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Male ,Treatment Outcome ,Ethanol ,Pulmonary Veins ,Recurrence ,Tachycardia ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Cardiac Electrophysiology ,Cardiology and Cardiovascular Medicine - Abstract
The optimal strategy after a failed ablation for persistent atrial fibrillation (perAF) is unknown. This study evaluated the value of an anatomically guided strategy using a systematic set of linear lesions with adjunctive ethanol infusion into the vein of Marshall (Et-VOM) in patients referred for second perAF ablation procedures.Patients with perAF who underwent a second procedure were grouped according to the two strategies. The first strategy was an anatomically guided approach using systematic linear ablation with adjunctive Et-VOM, with bidirectional blocks at the posterior mitral isthmus (MI), roof, and cavotricuspid isthmus (CTI) as the procedural endpoint (Group I). The second one was an electrophysiology-guided strategy, with atrial tachyarrhythmia termination as the procedural endpoint (Group II). Arrhythmia behavior during the procedure guided the ablation strategy. Groups I and II consisted of 96 patients (65 ± 9 years; 71 men) and 102 patients (63 ± 10 years; 83 men), respectively. Baseline characteristics were comparable. In Group I, Et-VOM was successfully performed in 91/96 (95%), and procedural endpoint (bidirectional block across all three anatomical lines) was achieved in 89/96 (93%). In Group II, procedural endpoint (atrial tachyarrhythmia termination) was achieved in 80/102 (78%). One-year follow-up demonstrated Group I (21/96 [22%]) experienced less recurrence compared to Group II (38/102 [37%], Log-rank p = .01). This was driven by lower AT recurrence in Group I (Group I: 10/96 [10%] vs. Group II: 29/102 [28%]; p = .002).Anatomically guided strategy with adjunctive Et-VOM is superior to an electrophysiology-guided strategy for second procedures in patients with perAF at 1-year follow-up.
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- 2022
17. Demonstration of the discrepancy between AT‐wave morphology on 12‐lead ECG and AT mechanism in scar‐related AT
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Masateru Takigawa, Claire A. Martin, Tasuku Yamamoto, Yosuke Nakatani, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Frederic Sacher, Meleze Hocini, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki, Masahiko Goya, Michel Haïssaguerre, Tetsuo Sasano, and Pierre Jaïs
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
18. A Novel Balloon-Based Catheter for Venous Ethanol Ablation
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Philipp Krisai, Mélèze Hocini, Nicolas Derval, Thomas Pambrun, Marion Constantin, Robert Earl, Josselin Duchateau, Frédéric Sacher, Michel Haïssaguerre, and Pierre Jaïs
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- 2022
19. Electrogram fractionation during sinus rhythm occurs in normal voltage atrial tissue in patients with atrial fibrillation
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Antonio Frontera, Luca Rosario Limite, Stefano Pagani, Manuela Cireddu, Kostantinos Vlachos, Claire Martin, Masateru Takigawa, Takeshi Kitamura, Felix Bourier, Ghassen Cheniti, Thomas Pambrun, Frederic Sacher, Nicolas Derval, Meleze Hocini, Alfio Quarteroni, Paolo Della Bella, Michel Haissaguerre, and Pierre Jaïs
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Epicardial Mapping ,Male ,sinus rhythm ,box isolation ,slow conduction ,fibrosis ,egm fractionation ,substrate ,General Medicine ,ablation ,Italy ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Computer Simulation ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Introduction Electrogram (EGM) fractionation is often associated with diseased atrial tissue; however, mechanisms for fractionation occurring above an established threshold of 0.5 mV have never been characterized. We sought to investigate during sinus rhythm (SR) the mechanisms underlying bipolar EGM fractionation with high-density mapping in patients with atrial fibrillation (AF). Methods Forty-five patients undergoing AF ablation (73% paroxysmal, 27% persistent) were mapped at high density (18562 +/- 2551 points) during SR (Rhythmia). Only bipolar EGMs with voltages above 0.5 mV were considered for analysis. When fractionation (> 40 ms and >4 deflections) was detected, we classified the mechanisms as slow conduction, wave-front collision, or a pivot point. The relationship between EGM duration and amplitude, and tissue anisotropy and slow conduction, was then studied using a computational model. Results Of the 45 left atria analyzed, 133 sites of EGM fragmentation were identified with voltages above 0.5 mV. The most frequent mechanism (64%) was slow conduction (velocity 0.45 m/s +/- 0.2) with mean EGM voltage of 1.1 +/- 0.5 mV and duration of 54.9 +/- 9.4 ms. Wavefront collision was the second most frequent (19%), characterized by higher voltage (1.6 +/- 0.9 mV) and shorter duration (51.3 +/- 11.3 ms). Pivot points (9%) were associated with the highest degree of fractionation with 70.7 +/- 6.6 ms and 1.8 +/- 1 mV. In 10 sites (8%) fractionation was unexplained. The EGM duration was significantly different among the 3 mechanisms (p = .0351). Conclusion In patients with a history of AF, EGM fractionation can occur at amplitudes > 0.5 mV when in SR in areas often considered not to be diseased tissue. The main mechanism of EGM fractionation is slow conduction, followed by wavefront collision and pivot sites.
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- 2022
20. Effect of electrode size and spacing on electrograms: Optimized electrode configuration for near-field electrogram characterization
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Xavier Pillois, Claire A. Martin, Josselin Duchateau, Masateru Takigawa, Ruairidh Martin, Nathaniel Thompson, Konstantinos Vlachos, Antonio Frontera, Grégoire Massoullié, Takeshi Kitamura, Arnaud Denis, Shubhayu Basu, Mélèze Hocini, Thomas Pambrun, Hubert Cochet, Meir Bar-Tal, Pierre Jaïs, Anna Lam, Ghassen Cheniti, Frederic Sacher, Nicolas Derval, Felix Bourier, and Michel Haïssaguerre
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business.industry ,Near and far field ,Equipment Design ,Gap detection ,Disease Models, Animal ,Microelectrode ,Physiology (medical) ,Electrode ,Catheter Ablation ,Animals ,Medicine ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Electrodes ,Sheep, Domestic ,Biomedical engineering ,Voltage - Abstract
Detailed effects of electrode size on electrograms (EGMs) have not been systematically examined.We aimed to elucidate the effect of electrode size on EGMs and investigate an optimal configuration of electrode size and interelectrode spacing for gap detection and far-field reduction.This study included 8 sheep in which probes with different electrode size and interelectrode spacing were epicardially placed on healthy, fatty, and lesion tissues for measurements. Between 3 electrode sizes (0.1 mm/0.2 mm/0.5 mm) with 3 mm spacing. As indices of capability in gap detection and far-field reduction, in different electrode sizes (0.1 mm/0.2 mm/0.5 mm) and interelectrode spacing (0.1 mm/0.2 mm/0.3 mm/0.5 mm/3 mm) and the optimized electrode size and interelectrode spacing were determined. Compared between PentaRay and the optimal probe determined in study 2.Study 1 demonstrated that unipolar voltage and the duration of EGMs increased as the electrode size increased in any tissue (P.001). Bipolar EGMs had the same tendency in healthy/fat tissues, but not in lesions. Study 2 showed that significantly higher gap to lesion volume ratio and healthy to fat tissue voltage ratio were provided by a smaller electrode (0.2 mm or 0.3 mm electrode) and smaller spacing (0.1 mm spacing), but 0.3 mm electrode/0.1 mm spacing provided a larger bipolar voltage (P.05). Study 3 demonstrated that 0.3 mm electrode/0.1 mm spacing provided less deflection with more discrete EGMs (P .0001) with longer and more reproducible AF cycle length (P .0001) compared to PentaRay.Electrode size affects both unipolar and bipolar EGMs. Catheters with microelectrodes and very small interelectrode spacing may be superior in gap detection and far-field reduction. Importantly, this electrode configuration could dramatically reduce artifactual complex fractionated atrial electrograms and may open a new era for AF mapping.
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- 2022
21. Right ventricular outflow tract electroanatomical abnormalities in asymptomatic and high‐risk symptomatic patients with Brugada syndrome: Evidence for a new risk stratification tool?
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Masateru Takigawa, Antonios Sideris, Thomas Pambrun, Panagiotis Mililis, Gary Tse, Antonio Frontera, George Bazoukis, Efstathia Prappa, Ghassen Cheniti, Konstantinos Vlachos, Josselin Duchateau, Giulio Conte, Mélèze Hocini, Takashi Nakashima, Pierre Jaïs, Konstantinos P. Letsas, Nicolas Derval, Michel Haïssaguerre, Frederic Sacher, Angelo Auricchio, Michael Efremidis, and Clinical sciences
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Brugada Syndrome/diagnosis ,Adult ,Epicardial Mapping ,Male ,medicine.medical_specialty ,Heart Ventricles ,Heart Ventricles/diagnostic imaging ,Risk Assessment ,Asymptomatic ,Sudden cardiac death ,Electrocardiography ,Physiology (medical) ,Internal medicine ,mental disorders ,Humans ,Medicine ,Ventricular outflow tract ,Brugada Syndrome ,Brugada syndrome ,business.industry ,Area under the curve ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Ventricle ,Risk stratification ,Ventricular fibrillation ,cardiovascular system ,Tachycardia, Ventricular ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Endocardium - Abstract
INTRODUCTION: Microstructural abnormalities at the epicardium of the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Endocardial unipolar electroanatomical mapping allows the identification of epicardial abnormalities. We evaluated the clinical implications of an abnormal endocardial substrate as perceived by high-density electroanatomical mapping (HDEAM) in patients with BrS. METHODS: Fourteen high-risk BrS patients with aborted sudden cardiac death (SCD) (12 males, mean age: 41.9 ± 11.8 years) underwent combined endocardial-epicardial HDEAM of the right ventricle/RVOT, while 40 asymptomatic patients (33 males, mean age: 42 ± 10.7 years) underwent endocardial HDEAM. Based on combined endocardial-epicardial procedures, endocardial HDEAM was considered abnormal in the presence of low voltage areas (LVAs) more than 1 cm2 with bipolar signals less than 1 mV and unipolar signals less than 5.3 mV. Programmed ventricular stimulation (PVS) was performed in all patients. RESULTS: The endocardial unipolar LVAs were colocalized with epicardial bipolar LVAs (p = .0027). Patients with aborted SCD exhibited significantly wider endocardial unipolar (p
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- 2021
22. Sex differences in the origin of Purkinje ectopy-initiated idiopathic ventricular fibrillation
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Estelle Gandjbakhch, Josselin Duchateau, Ghassen Cheniti, Elodie Surget, F. Daniel Ramirez, Fabrice Extramiana, Pierre Jaïs, Clémentine André, Yosuke Nakatani, Takashi Nakashima, Antoine Leenhardt, Akihiko Nogami, Philipp Krisai, Mélèze Hocini, Takamitsu Takagi, Olivier Bernus, Tsukasa Kamakura, Frederic Sacher, Françoise Hidden-Lucet, Romain Tixier, Michel Haïssaguerre, Nicolas Welte, Xavier Pillois, Remi Chauvel, Nicolas Derval, Thomas Pambrun, and David Benoist
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Adult ,Male ,medicine.medical_specialty ,Heart Ventricles ,Long QT syndrome ,medicine.medical_treatment ,Magnetic Resonance Imaging, Cine ,Catheter ablation ,Coronary Angiography ,Risk Assessment ,Sudden death ,Purkinje Fibers ,Electrocardiography ,Electrophysiology study ,Sex Factors ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Medical history ,Circadian rhythm ,Sex Distribution ,Retrospective Studies ,Brugada syndrome ,medicine.diagnostic_test ,business.industry ,Incidence ,medicine.disease ,Ventricular Premature Complexes ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Ventricular Fibrillation ,Cardiology ,Female ,France ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Purkinje ectopics (PurkEs) are major triggers of idiopathic ventricular fibrillation (VF). Identifying clinical factors associated with specific PurkE characteristics could yield insights into the mechanisms of Purkinje-mediated arrhythmogenicity. Objective The purpose of this study was to examine the associations of clinical, environmental, and genetic factors with PurkE origin in patients with PurkE-initiated idiopathic VF. Methods Consecutive patients with PurkE-initiated idiopathic VF from 4 arrhythmia referral centers were included. We evaluated demographic characteristics, medical history, clinical circumstances associated with index VF events, and electrophysiological characteristics of PurkEs. An electrophysiology study was performed in most patients to confirm the Purkinje origin. Results Eighty-three patients were included (mean age 38 ± 14 years; 44 [53%] women), of whom 32 had a history of syncope. Forty-four patients had VF at rest. PurkEs originated from the right ventricle (RV) in 41 patients (49%), from the left ventricle (LV) in 36 (44%), and from both ventricles in 6 (7%). Seasonal and circadian distributions of VF episodes were similar according to PurkE origin. The clinical characteristics of patients with RV vs LV PurkE origins were similar, except for sex. RV PurkEs were more frequent in men than in women (76% vs 24%), whereas LV and biventricular PurkEs were more frequent in women (81% vs 19% and 83% vs 17%, respectively) (P Conclusion PurkEs triggering idiopathic VF originate dominantly from the RV in men and from the LV or both ventricles in women, adding to other sex-related arrhythmias such as Brugada syndrome or long QT syndrome. Sex-based factors influencing Purkinje arrhythmogenicity warrant investigation.
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- 2021
23. Purkinje triggers of ventricular fibrillation in patients with hypertrophic cardiomyopathy
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Josselin Duchateau, Nicolas Derval, Thomas Pambrun, Philippe Maury, Michel Haïssaguerre, Łukasz Szumowski, Mélèze Hocini, Pierre Jaïs, Frederic Sacher, Hubert Cochet, F. Daniel Ramirez, and Ghassen Cheniti
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Adult ,medicine.medical_specialty ,Adolescent ,Radiofrequency ablation ,medicine.medical_treatment ,Population ,Catheter ablation ,030204 cardiovascular system & hematology ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,law ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Child ,education ,education.field_of_study ,business.industry ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,Ablation ,medicine.disease ,Ventricular Premature Complexes ,Defibrillators, Implantable ,medicine.anatomical_structure ,Ventricle ,Ventricular Fibrillation ,Ventricular fibrillation ,Catheter Ablation ,Cardiology ,Female ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Ventricular fibrillation (VF) is the main mechanism of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). The origin of VF and the success of catheter ablation to eliminate recurrent episodes in this population are poorly understood. Methods and results From 2010 to 2014, five patients with HCM (age 21 ± 9 years, three female) underwent invasive electrophysiological studies and ablation at our center after resuscitation from recurrent (9 ± 7) episodes of VF. Ventricular premature beats (VPBs), seen to initiate VF in certain cases, were recorded noninvasively before the ablation procedure. Postprocedural computed tomography (CT) was performed to correlate ablation sites with myocardial hypertrophy in three patients. Outcomes were assessed by clinical follow-up and implantable cardioverter-defibrillator interrogations. VPB triggers were localized invasively to the distal left Purkinje conduction system (left posterior fascicle [2], left anterior fascicle [1], and both fascicles [2]). All targeted VF triggers were successfully eliminated by radiofrequency ablation in the left ventricle. Among patients with postablation CT imaging, 93 ± 12% of ablation sites corresponded to hypertrophied segments. Over 50 ± 38 months, four of five patients were free from primary VF without antiarrhythmic drug therapy. One patient who had 13 episodes of VF before ablation had a single recurrence. Conclusion In our study of patients with HCM and recurrent VF, VF was not initiated from the myocardium but rather from Purkinje arborization. These sources colocalized with the hypertrophic substrate, suggesting electromechanical interaction. Focal ablation at these sites was associated with a marked reduction in VF burden.
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- 2021
24. Accuracy of automatic abnormal potential annotation for substrate identification in scar‐related ventricular tachycardia
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Ghassen Cheniti, Philippe Maury, F. Daniel Ramirez, Josselin Duchateau, Remi Chauvel, Takamitsu Takagi, Nicolas Derval, Anne Rollin, Aline Carapezzi, Konstantinos Vlachos, Romain Tixier, Nicolas Welte, Yosuke Nakatani, Thomas Pambrun, Takashi Nakashima, Michel Haïssaguerre, Frederic Sacher, Philipp Krisai, Clémentine André, Pierre Jaïs, Mélèze Hocini, Cyril Goujeau, Tsukasa Kamakura, and Quentin Voglimacci-Stefanopoli
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business.industry ,medicine.medical_treatment ,Pattern recognition ,Catheter ablation ,Ventricular pacing ,Ventricular tachycardia ,medicine.disease ,Annotation ,Manual annotation ,Late potential ,Feature (computer vision) ,Physiology (medical) ,Medicine ,Sinus rhythm ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Ultra-high-density mapping for ventricular tachycardia (VT) is increasingly used. However, manual annotation of local abnormal ventricular activities (LAVAs) is challenging in this setting. Therefore, we assessed the accuracy of the automatic annotation of LAVAs with the Lumipoint algorithm of the Rhythmia system (Boston Scientific). Methods and Results: One hundred consecutive patients undergoing catheter ablation of scar-related VT were studied. Areas with LAVAs and ablation sites were manually annotated during the procedure and compared with automatically annotated areas using the Lumipoint features for detecting late potentials (LP), fragmented potentials (FP), and double potentials (DP). The accuracy of each automatic annotation feature was assessed by re-evaluating local potentials within automatically annotated areas. Automatically annotated areas matched with manually annotated areas in 64 cases (64%), identified an area with LAVAs missed during manual annotation in 15 cases (15%), and did not highlight areas identified with manual annotation in 18 cases (18%). Automatic FP annotation accurately detected LAVAs regardless of the cardiac rhythm or scar location; automatic LP annotation accurately detected LAVAs in sinus rhythm, but was affected by the scar location during ventricular pacing; automatic DP annotation was not affected by the mapping rhythm, but its accuracy was suboptimal when the scar was located on the right ventricle or epicardium. Conclusion: The Lumipoint algorithm was as/more accurate than manual annotation in 79% of patients. FP annotation detected LAVAs most accurately regardless of mapping rhythm and scar location. The accuracy of LP and DP annotations varied depending on mapping rhythm or scar location.
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- 2021
25. Significance of manifest localized staining during ethanol infusion into the vein of Marshall
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Clémentine André, Josselin Duchateau, F. Daniel Ramirez, Takamitsu Takagi, Philipp Krisai, Yosuke Nakatani, Hubert Cochet, Tsukasa Kamakura, Pierre Jaïs, Remi Chauvel, Konstantinos Vlachos, Romain Tixier, Thomas Pambrun, Nicolas Derval, Takashi Nakashima, Ghassen Cheniti, Frederic Sacher, Mélèze Hocini, and Michel Haïssaguerre
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Male ,medicine.medical_specialty ,Venography ,030204 cardiovascular system & hematology ,Pericardial effusion ,03 medical and health sciences ,Pericarditis ,0302 clinical medicine ,Heart Rate ,Recurrence ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Infusions, Intravenous ,Vein ,Retrospective Studies ,Ethanol ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Phlebography ,Middle Aged ,medicine.disease ,3. Good health ,Staining ,medicine.anatomical_structure ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Follow-Up Studies - Abstract
Background Localized staining due to venule injury is attributable to ethanol infusion into the vein of Marshall (Et-VOM). Objective The purpose of this study was to investigate adverse outcomes of localized staining during Et-VOM in patients undergoing ablation for atrial fibrillation. Methods Two hundred four patients (age 64 ± 10 years; 153 male) were sorted based on the aspect of localized staining. Staining of atrial myocardium that spread uniformly along the VOM vascular tree following selective VOM venography was considered normal, in contrast to predominantly localized staining that spread concentrically from a focal point due to vascular injury. Outcomes between the 2 groups were compared. Results Localized staining was observed in 27% of patients. No patients developed clinically significant pericardial effusions during Et-VOM; however, 7 patients developed pericardial effusions on the first postprocedural day (3.6% in patients with vs 3.4% in patients without localized staining). No significant difference was found in achievement of acute mitral isthmus (MI) block (96% vs 98%) and size of the endocardial low-voltage area (8.5 ± 4.1 cm2 vs 9.3 ± 5.3 cm2) in patients with and without localized staining, respectively. Long-term follow-up was not impacted by localized staining. Freedom from recurrent atrial tachyarrhythmias (66% vs 76%) and durability of MI block (57% vs 54%) were not significantly different with and without localized staining. There were no cases of rehospitalization for pericarditis, chronic pericardial effusion, or heart failure. Conclusion In our study, localized staining was frequent but was not associated with clinically relevant impact or disadvantages.
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- 2021
26. Do not forget left ventricle herniation as a rare cause of acute coronary syndrome!
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Mathieu Pernot, Hubert Cochet, Thomas Pambrun, Louis Labrousse, and Edouard Gerbaud
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Cardiology and Cardiovascular Medicine - Published
- 2022
27. PO-04-170 AUTOMATED CT-BASED PREDICTION OF VENTRICULAR ARRHYTHMIA
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Christopher Kowalewski, Ciro Ascione, Marta Nuñez Garcia, Xavier Bouteiller, Buntheng LY, Maxime Sermesant, Masaaki Yokoyama, Josselin Duchateau, Thomas Pambrun, NICOLAS DERVAL, Pierre BORDACHAR, Meleze Hocini, Michel Haissaguerre, Gerhard Hindricks, Frederic Sacher, Hubert Cochet, and Pierre Jais
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
28. Ligament of Marshall ablation for persistent atrial fibrillation
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Antonio Frontera, Takamitsu Takagi, Claire A. Martin, Josselin Duchateau, Takeshi Kitamura, Romain Tixier, Nicolas Welte, F. Daniel Ramirez, Ghassen Cheniti, Michael Efremidis, Michel Haïssaguerre, Masateru Takigawa, Konstantinos Vlachos, Philipp Krisai, Yosuke Nakatani, Tsukasa Kamakura, George Bazoukis, Mélèze Hocini, Takashi Nakashima, Pierre Jaïs, Konstantinos P. Letsas, Remi Chauvel, Nicolas Derval, Thomas Pambrun, Felix Bourier, Clémentine André, and Frederic Sacher
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medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Pulmonary vein ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Vein ,Coronary sinus ,Ligaments ,business.industry ,General Medicine ,Ablation ,medicine.anatomical_structure ,Persistent atrial fibrillation ,Catheter Ablation ,Ligament ,Cardiology ,Mitral isthmus ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
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- 2021
29. Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation (Marshall-PLAN): Prospective, single-center study
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Xavier Pillois, Remi Chauvel, Nicolas Derval, Michel Haïssaguerre, Arnaud Denis, Frederic Sacher, Thomas Pambrun, Josselin Duchateau, F. Daniel Ramirez, Masateru Takigawa, Philipp Krisai, Takeshi Kitamura, Saagar Mahida, Yosuke Nakatani, Mélèze Hocini, Romain Tixier, Clémentine André, and Pierre Jaïs
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Single Center ,Pulmonary vein ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,Prospective Studies ,030212 general & internal medicine ,Vein ,Atrial tachycardia ,Coronary sinus ,business.industry ,Middle Aged ,Ablation ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary Veins ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Beyond pulmonary vein isolation (PVI), the optimal ablation strategy for persistent atrial fibrillation (AF) remains poorly defined. Objective The purpose of this study was to examine a novel comprehensive ablation strategy (Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation [Marshall-PLAN]) strictly based on anatomical considerations. Methods Left atrial (LA) sites were sequentially targeted as follows: (1) coronary sinus and vein of Marshall (CS-VOM) musculature; (2) PVI; and (3) anatomical isthmuses (mitral, roof, and cavotricuspid isthmus [CTI]). The primary endpoint was 12-month freedom from AF/atrial tachycardia (AT). Results Seventy-five consecutive patients were included (age 61 ± 9 years; 10 women; AF duration 9 ± 11 months; mean LA volume 197 ± 43 mL). VOM ethanol infusion was completed in 69 patients (92%). The full Marshall-PLAN lesion set (VOM, PVI, mitral, roof, and CTI with block) was successfully completed in 68 patients (91%). At 12 months, 54 of 75 patients (72%) were free from AF/AT after a single procedure (no antiarrhythmic drugs) in the overall cohort. In the subset of patients with a complete Marshall-PLAN lesion set (n = 68), the single procedure success rate was 79%. After 1 or 2 procedures, 67 of 75 patients (89%) remained free from AF/AT (no antiarrhythmic drugs). After 1 or 2 procedures, VOM ethanol infusion was complete in 72 of 75 patients (96%). Conclusion A novel ablation strategy that systematically targets anatomical atrial structures (VOM ethanol infusion, PVI, and prespecified linear lesions) is feasible, safe, and associated with a high rate of freedom from arrhythmia recurrence at 12 months in patients with persistent AF.
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- 2021
30. Cardioneuroablation: don’t underestimate the posteromedial left atrial ganglionated plexus
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Ciro Ascione, Léa Benabou, Conrado Balbo, Tsukasa Kamakura, Takamitsu Takagi, Philipp Krisai, Romain Tixier, Hugo Marchand, Benjamin Bouyer, Clémentine André, Remi Chauvel, Ghassen Cheniti, Thomas Pambrun, Nicolas Derval, Frederic Sacher, Mélèze Hocini, Claudio Tondo, Pierre Jais, Michel Haissaguerre, and Josselin Duchateau
- Abstract
Introduction Cardioneuroablation (CNA) is a technique used to modulate cardiac parasympathetic tone in patients with sino-atrial (SA) and atrio-ventricular (AV) vagally mediated syncope. We describe the case of a patient who developed AV block after a first procedure of CNA, requiring a second procedure. Case presentation A 47-Year-old man presented with recurrent syncope (daily episodes) associated with high vagal tone conditions. An ECG monitoring showed frequent episodes of sinus bradycardia and sinus arrest, with pauses up to 17 seconds. AV node conduction impairment was never identified. A CNA procedure targeting the right superior and posterior ganglionated plexi (GPs), both from the left and right atrium, was performed with acute success. The subsequent night, repetitive episodes of AV block with normal sinus rate were observed. A second procedure was performed targeting the posteromedial left GP. Follow-up at 4 months showed no recurrent syncopal event and no bradyarrhythmia episode on the implantable loop recorder. Conclusion This case report demonstrates that ablation limited to the right superior and posterior GPs may not be enough for neurocardiogenic syncope and a more systematic approach, extending the ablation to the posteromedial left GP, should be considered.
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- 2022
31. Noninducibility as an Ablation Strategy for Atrial Tachycardia After First-Time Persistent AF Ablation
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Louisa O’Neill, Mattias Duytschaever, Jean-Benoit Le Polain De Waroux, Torsten Konrad, Thomas Rostock, Nicolas Derval, Thomas Pambrun, Anne Rollin, Philippe Maury, and Sebastien Knecht
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Tachycardia, Supraventricular ,Catheter Ablation ,Humans - Published
- 2022
32. 90 vs 50-Watt Radiofrequency Applications for Pulmonary Vein Isolation: Experimental and Clinical Findings
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Agustín Bortone, Jean-Paul Albenque, F. Daniel Ramirez, Michel Haïssaguerre, Stéphane Combes, Marion Constantin, Guillaume Laborie, Guillaume Brault-Noble, Éloi Marijon, Pierre Jaïs, and Thomas Pambrun
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Catheters ,Treatment Outcome ,Pulmonary Veins ,Recurrence ,Swine ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Animals ,Humans ,Heart Atria ,Cardiology and Cardiovascular Medicine - Abstract
Background: Fifty-watt radiofrequency applications have proven to be safe and efficient for pulmonary vein isolation (PVI). However, as PV reconnection still occurs and ablation catheter instability significantly contributes to suboptimal lesion formation, a new ablation catheter capable of delivering 90 W for 4 seconds only has been developed with the aim of improving PVI outcomes. In this setting, we sought to determine whether 90 W applications create transmural lesions without collateral damage experimentally and whether they can safely improve PVI procedures clinically compared with 50 W settings. Methods: Experimentally, individual lesions were created in vivo in the right atrium of 6 swine with 90 W-4 seconds applications using the SmartTouch-SF catheter in a power-controlled mode (3 animals) or the QDOT-MICRO catheter in a temperature-controlled mode (3 animals). Clinically, PVI was performed in a homogenous population of 150 consecutive paroxysmal atrial fibrillation patients using CARTO and the QDOT-MICRO catheter in a temperature-controlled mode (75 patients 50 W-ablation index-guided and 75 patients 90 W-4 seconds). Results: Mostly, (94.9%) experimental lesions were transmural in the thin-walled right atrium of swine. However, collateral damage was observed with both catheters in 17.9% of lesions. Clinically, 90 W procedures had a lower first-pass PVI rate (49% versus 81%, P −4 ) and a higher acute PV reconnection rate (21% versus 5%, P =0.004) than 50 W procedures, whereas total procedural duration (62 versus 66 minutes, P =0.09), 1-year sinus rhythm maintenance (88% versus 90%, P =0.6) and safety (1 tamponade per group) were similar in both groups. Conclusions: Experimentally, using the QDOT-MICRO catheter, 90 W-4 seconds lesions are mostly transmural in the thin-walled right atrium of swine (median depth 1.87 mm) with a moderate lesion diameter of 6.62 mm but retain the potential for collateral damage. Clinically, 90 W-4 seconds applications are associated with a lower first-pass PVI rate and a higher acute PV reconnection rate than 50 W applications but similar safety outcomes and effectiveness at 1 year.
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- 2022
33. Ultralow temperature cryoablation: Safety and efficacy of preclinical atrial and ventricular lesions
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Antonio Frontera, Nicolas Derval, Oliver Bernus, Alexander Babkin, Jerry Cox, Thomas Pambrun, Takeshi Kitamura, F. Daniel Ramirez, Mélèze Hocini, Claire A. Martin, Josselin Duchateau, Michel Haïssaguerre, Rémi Dubois, Felix Bourier, Pierre Jaïs, Arnaud Denis, David Cabrita, Frederic Sacher, Anna Lam, Konstantinos Vlachos, Masateru Takigawa, and Marion Constantin
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medicine.medical_specialty ,Swine ,Heart Ventricles ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cryosurgery ,Intracardiac injection ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Animals ,Heart Atria ,030212 general & internal medicine ,Sheep ,business.industry ,Temperature ,Atrial fibrillation ,Cryoablation ,Ablation ,medicine.disease ,Catheter ,medicine.anatomical_structure ,Pulmonary Veins ,Ventricle ,Catheter Ablation ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Ultralow temperature cyroablation (ULTC) is designed to create focal, linear, and circumferential lesions. The aim of this study was to assess the safety, efficacy, and durability of atrial and ventricular ULTC lesions in preclinical large animal models. Methods and results The ULTC system uses nitrogen near its liquid-vapor critical point to cool 11-cm ablation catheters. The catheter can be shaped to specific anatomies using pre-shaped stylets. ULTC was used in 11 swine and four sheep to create atrial (pulmonary vein isolation and linear ablation) and ventricular lesions. Acute and 90-day success were evaluated by intracardiac mapping and histologic examination. Cryoadherence was observed during all ULTC applications, ensuring catheter stability at target locations. Local electrograms were completely eliminated immediately after the first single-shot ULTC application in 49 of 53 (92.5%) atrial and in 31 of 32 (96.9%) ventricular applications. Lesion depth as measured on histology preparations was 1.96 ± 0.8 mm in atrial and 5.61 ± 2.2 mm in ventricular lesions. In all animals, voltage maps and histology demonstrated transmural and durable lesions without gaps, surrounded by intact collagen fibers without injury to surrounding tissues. Transient coronary spasm could be provoked with endocardial ULTC in the left ventricle in close proximity to a coronary artery. Conclusions ULTC created effective and efficient atrial and ventricular lesions in vivo without procedural complications in two large animal models. ULTC lesions were transmural, contiguous, and durable over 3 months.
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- 2021
34. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation
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Claire A. Martin, Josselin Duchateau, Michel Haïssaguerre, Philipp Krisai, Konstantinos Vlachos, Panagiotis Mililis, Nicolas Derval, Takamitsu Takagi, F. Daniel Ramirez, Charis Gkalapis, Felix Bourier, Takeshi Kitamura, Konstantinos P. Letsas, George Bazoukis, Pierre Jaïs, Thomas Pambrun, Frederic Sacher, Antonio Frontera, Takashi Nakashima, Tsukasa Kamakura, Clémentine André, Yosuke Nakatani, Ghassen Cheniti, Michael Efremidis, Mélèze Hocini, and Masateru Takigawa
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Tachycardia ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,0502 economics and business ,Tachycardia, Supraventricular ,medicine ,Humans ,Heart Atria ,Endocardium ,Atrial tachycardia ,Aged ,business.industry ,05 social sciences ,Atrial fibrillation ,Middle Aged ,Cardiac Ablation ,Ablation ,medicine.disease ,Catheter Ablation ,Cardiology ,050211 marketing ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Entrainment (chronobiology) ,business ,Voltage - Abstract
Aims An incomplete understanding of the mechanism of atrial tachycardia (AT) is a major determinant of ablation failure. We systematically evaluated the mechanisms of AT using ultra-high-resolution mapping in a large cohort of patients. Methods and results We included 107 consecutive patients (mean age: 65.7 ± 9.2 years, males: 81 patients) with documented endocardial gap-related AT after left atrial ablation for persistent atrial fibrillation (AF). We analysed the mechanism of 134 AT (94 macro-re-entries and 40 localized re-entries) using high-resolution activation mapping in combination with high-density voltage and entrainment mapping. Voltage in the conducting channels may be extremely low, even Conclusion High-resolution activation mapping in combination with high-density voltage and entrainment mapping is the ideal strategy to delineate the critical part of the circuit in endocardial gap-related re-entrant AT after AF ablation.
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- 2021
35. Pause‐dependent mitral isthmus conduction block during ablation of the mitral isthmus: What is the mechanism?
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Remi Chauvel, Nicolas Derval, Tsukasa Kamakura, Thomas Pambrun, and Josselin Duchateau
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,030204 cardiovascular system & hematology ,Ablation ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Block (telecommunications) ,Persistent atrial fibrillation ,cardiovascular system ,medicine ,Cardiology ,Mitral isthmus ,cardiovascular diseases ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial tachycardia - Abstract
Mitral isthmus (MI) ablation is commonly performed as an adjunct therapy to pulmonary isolation during the treatment for persistent atrial fibrillation. Confirmation of complete MI block is essential because an incomplete MI block may result in iatrogenic atrial tachycardia. However, there are several pitfalls in the diagnosis of an MI line block. We herein report a case of transient pause-dependent MI block during MI ablation. This article is protected by copyright. All rights reserved.
- Published
- 2020
36. Distribution of atrial low voltage induced by vein of Marshall ethanol infusion
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Tsukasa Kamakura, Clémentine André, Josselin Duchateau, Takashi Nakashima, Yosuke Nakatani, Takamitsu Takagi, Philipp Krisai, Ciro Ascione, Conrado Balbo, Romain Tixier, Rémi Chauvel, Ghassen Cheniti, Kengo Kusano, Hubert Cochet, Arnaud Denis, Frédéric Sacher, Mélèze Hocini, Pierre Jaïs, Michel Haïssaguerre, Nicolas Derval, and Thomas Pambrun
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Ethanol ,Pulmonary Veins ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Heart Atria ,Cardiology and Cardiovascular Medicine - Abstract
Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion.The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients.VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.
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- 2022
37. Evaluation of the QT interval in patients with drug‐induced QT prolongation and torsades de pointes
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Josselin Duchateau, Thomas Pambrun, Takamitsu Takagi, Yosuke Nakatani, Romain Tixier, Nicolas Welte, Konstantinos Vlachos, Philipp Krisai, Ghassen Cheniti, Michel Haïssaguerre, F. Daniel Ramirez, Pierre Jaïs, Tsukasa Kamakura, Takashi Nakashima, Mélèze Hocini, Elodie Surget, Frederic Sacher, Clémentine André, Remi Chauvel, and Nicolas Derval
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medicine.medical_specialty ,ECG Recording Quality ,Long QT syndrome ,Torsades de pointes ,030204 cardiovascular system & hematology ,QT interval ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Torsades de Pointes ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Lead (electronics) ,business.industry ,Drug-induced QT prolongation ,Middle Aged ,medicine.disease ,Ventricular Premature Complexes ,Long QT Syndrome ,Pharmaceutical Preparations ,Cardiology ,Female ,Ecg lead ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Data on the optimal location of the ECG leads for the diagnosis of drug-induced long QT syndrome (diLQTS) with Torsades de Pointes (TdP) are lacking. Methods We systematically reviewed the literature for ECGs of patients with diLQTS and subsequent TdP. We assessed T-wave morphology in each lead and measured the longest QT interval in the limb and chest leads in a standardized fashion. Results Of 84 patients, 61.9% were female and mean age was 58.8 years. QTc was significantly longer in chest versus limb leads (mean (standard deviation) 671 (102) vs 655 (97) ms, p=0.02). Using only limb leads for QT interpretation, 18 (21.4%) ECGs were non-interpretable: 10 (11.9%) due to too flat T-waves, 7 (8.3%) due to frequent, early PVCs and 1 (1.2%) due to too low ECG recording quality. In the chest leads, ECGs were non-interpretable in 9 (10.7%) patients: 6 (7.1%) due to frequent, early PVCs, 1 (1.2%) due to insufficient ECG quality, 2 (2.4%) due to missing chest leads but none due to too flat T-waves. The most common T-wave morphologies in the limb leads were flat (51.0%), broad (14.3%) and late peaking (12.6%) T-waves. Corresponding chest lead morphologies were inverted (35.5%), flat (19.6%) and biphasic (15.2%) T-waves. Conclusions Our results indicate that QT evaluation by limb leads only underestimates the incidence of diLQTS experiencing TdP and favors the screening using both limb and chest lead ECG. This article is protected by copyright. All rights reserved.
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- 2020
38. Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping
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Frederic Sacher, Michel Haïssaguerre, Nathaniel Thompson, Xavier Pillois, Pierre Jaïs, Antonio Frontera, Pierre Bordachar, Darren A. Hooks, Vlachos Konstantinos, Masateru Takigawa, Nicolas Derval, Benjamin Berte, Saagar Mahida, Thomas Pambrun, Arnaud Denis, Mélèze Hocini, Seigo Yamashita, Josselin Duchateau, IHU-LIRYC, CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2, Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], and CCSD, Accord Elsevier
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medicine.medical_specialty ,Radiofrequency ablation ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Context (language use) ,Catheter ablation ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,Atrial Fibrillation ,Tachycardia, Supraventricular ,medicine ,Humans ,In patient ,Heart Atria ,030212 general & internal medicine ,Atrial tachycardia ,business.industry ,Atrial fibrillation ,medicine.disease ,Ablation ,[SDV] Life Sciences [q-bio] ,Catheter ,Treatment Outcome ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,business - Abstract
Objectives This study systematically evaluated mechanisms of atrial tachycardia (AT) by using ultra-high-resolution mapping in a large cohort of patients. Background An incomplete understanding of the mechanism of AT is a major determinant of ablation failure. Methods Consecutive patients with ≥1 AT (excluding cavotricuspid isthmus–dependent flutter) were included. Mapping was performed with a 64-pole mapping catheter. The AT mechanism was defined based on activation mapping and confirmed by entrainment in selected cases. Results A total of 132 patients were included (60 ± 12 years; 31 [23%] female; 111 [84%] previous atrial fibrillation [AF] ablation; 5 [4%] previous left atriotomy). One hundred four (94%) of the 111 post–AF ablation AT patients had substrate-based ablation during the index AF ablation. A total of 214 ATs were mapped, with complete definition of the AT mechanism in 206 (96%). A total of 129 (60%) had anatomic macro re-entry (circuit diameter 44.2 ± 9.6 mm), 57 (27%) had scar-related localized re-entry (circuit diameter 25.8 ± 12.2 mm), and 20 (9%) had focal AT. Fifty-eight (45%) patients had multiple ATs (27 [20%] dual-loop re-entry; 60 [43%] sequential AT) with complex and highly variable transitions between AT circuits. A total of 116 (90%) of 129 macro re-entrant ATs, 56 (98%) of 57 localized AT, and 20 (100%) of 20 focal ATs terminated after radiofrequency ablation. After a mean follow-up of 13 ± 9 months, 57 (46%) patients experienced recurrence of AT. Conclusions Among patients with AT in the context of previous atrial interventions, particularly post–AF ablation patients, multiple complex AT circuits are common. Despite complete delineation of arrhythmia circuits using ultra-high-resolution mapping and high acute ablation success rates, long-term freedom from AT is modest.
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- 2020
39. Acute and mid-term outcome of ethanol infusion of vein of Marshall for the treatment of perimitral flutter
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Yosuke Nakatani, Hubert Cochet, Michel Haïssaguerre, Masateru Takigawa, William Escande, Anna Lam, Mélèze Hocini, Daniel Ramirez, Nathaniel Thompson, Xavier Pillois, Nicolas Derval, Takeshi Kitamura, Arnaud Denis, Frederic Sacher, Li-jun Zeng, Michael Wolf, Clémentine André, Thomas Pambrun, Claire A. Martin, Josselin Duchateau, Felix Bourier, Grégoire Massoullié, Antonio Frontera, Pierre Jaïs, Ghassen Cheniti, Ruairidh Martin, Konstantinos Vlachos, and Takashi Nakashima
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medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Pericardial effusion ,Brain Ischemia ,Physiology (medical) ,Internal medicine ,Infusion Procedure ,Atrial Fibrillation ,Ischaemic stroke ,medicine ,Humans ,Vein ,Atrial tachycardia ,Ethanol ,business.industry ,Ablation ,medicine.disease ,Stroke ,Treatment Outcome ,medicine.anatomical_structure ,Perimitral flutter ,Atrial Flutter ,Catheter Ablation ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims We hypothesized that an epicardial approach using ethanol infusion in the vein of Marshall (EIVOM) may improve the result of ablation for perimitral flutter (PMF). Methods and results We studied 103 consecutive patients with PMF undergoing high-resolution mapping. The first 71 were treated with radiofrequency (RF) ablation alone (RF-group), and the next 32 underwent EIVOM followed by RF on the endocardial and epicardial mitral isthmus (EIVOM/RF-group). Contact force was not measured during ablation. Acute and 1-year outcomes were compared. Flutter termination rates were similar between the RF-group (63/71, 88.7%) and EIVOM/RF-group (31/32, 96.8%, P = 0.27). Atrial tachycardia (AT) terminated with EIVOM alone in 22/32 (68.6%) in the EIVOM/RF-group. Bidirectional block of mitral isthmus was always achieved in the EIVOM/RF-group, but significantly less frequently achieved in the RF-group (62/71, 87.3%; P = 0.05). Median RF duration for AT termination/conversion was shorter [0 (0–6) s in the EIVOM/RF-group than 312 (55–610) s in the RF-group, P Conclusion Ethanol infusion in the vein of Marshall may reduce RF duration required for PMF termination as well as for mitral isthmus block without severe complications, and the mid-term outcome may be improved by this approach.
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- 2020
40. Idiopathic Ventricular Fibrillation
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Josselin Duchateau, Rémi Dubois, Frederic Sacher, Michel Haïssaguerre, Thomas Pambrun, Pierre Jaïs, Thomas Lavergne, Ghassen Cheniti, Elodie Surget, Vincent Probst, Wee Nademanee, Remi Chauvel, Nicolas Derval, Olivier Bernus, E. J. Vigmond, Mélèze Hocini, and Nicolas Welte
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Epicardial Mapping ,medicine.medical_specialty ,Myocarditis ,unexplained death ,ICD, implantable-cardioverter defibrillator ,Purkinje cell ,PVC, premature ventricular contraction ,Disease ,030204 cardiovascular system & hematology ,Sudden death ,Article ,sudden cardiac death ,Sudden cardiac death ,ECG, electrocardiography ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,VT, ventricular tachycardia ,medicine ,Humans ,030212 general & internal medicine ,LV, left ventricular ,Subclinical infection ,IVF, idiopathic ventricular fibrillation ,medicine.diagnostic_test ,business.industry ,BrS, Brugada syndrome ,Arrhythmias, Cardiac ,ventricular fibrillation ,medicine.disease ,3. Good health ,medicine.anatomical_structure ,J-wave syndromes ,SCD, sudden cardiac death ,Ventricular fibrillation ,Cardiology ,CPVT, catecholaminergic polymorphic ventricular tachycardia ,VF, ventricular fibrillation ,RV, right ventricular ,business ,ARVD, arrhythmogenic right ventricular dysplasia - Abstract
Idiopathic ventricular fibrillation is diagnosed in patients who survived a ventricular fibrillation episode without any identifiable structural or electrical cause after extensive investigations. It is a common cause of sudden death in young adults. The study reviews the diagnostic value of systematic investigations and the new insights provided by detailed electrophysiological mapping. Recent studies have shown the high incidence of microstructural cardiomyopathic areas, which act as the substrate of ventricular fibrillation re-entries. These subclinical alterations require high-density endo- and epicardial mapping to be identified using electrogram criteria. Small areas are involved and located individually in various sites (mostly epicardial). Their characteristics suggest a variety of genetic or acquired pathological processes affecting cellular connectivity or tissue structure, such as cardiomyopathies, myocarditis, or fatty infiltration. Purkinje abnormalities manifesting as triggering ectopy or providing a substrate for re-entry represent a second important cause. The documentation of ephemeral Purkinje ectopy requires continuous electrocardiography monitoring for diagnosis. A variety of diseases affecting Purkinje cell function or conduction are potentially at play in their pathogenesis. Comprehensive investigations can therefore allow the great majority of idiopathic ventricular fibrillation to ultimately receive diagnoses of a cardiac disease, likely underlain by a mosaic of pathologies. Precise phenotypic characterization has significant implications for interpretation of genetic variants, the risk assessment, and individual therapy. Future improvements in imaging or electrophysiological methods may hopefully allow the identification of the subjects at risk and the development of primary prevention strategies., Highlights • VF can be unexplained despite extensive investigations, notably in the young. • The use of high-density electrophysiological mapping detects causes in the great majority of victims. • Microstructural cardiomyopathies are the main causes, likely underlain by multiple pathological processes. • The phenotypic characterization of substrate is critical to develop therapy and interpret genetic results., Central Illustration
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- 2020
41. Atrial tachycardia circuits include low voltage area from index atrial fibrillation ablation relationship between RF ablation lesion and AT
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Ghassen Cheniti, Ruairidh Martin, Nicolas Derval, Takeshi Kitamura, Frederic Sacher, Thomas Pambrun, Yosuke Nakatani, Arnaud Denis, Masateru Takigawa, Michel Haïssaguerre, Anna Lam, Felix Bourier, Antonio Frontera, Pierre Jaïs, Claire A. Martin, Josselin Duchateau, Mélèze Hocini, Konstantinos Vlachos, and Hubert Cochet
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medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Tachycardia, Supraventricular ,medicine ,Humans ,030212 general & internal medicine ,Atrial tachycardia ,business.industry ,Atrial fibrillation ,Ablation ,medicine.disease ,Catheter ,Treatment Outcome ,Catheter Ablation ,Cardiology ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Rf ablation ,Low voltage - Abstract
Background No study to date has used high-density mapping to investigate the relationship between prior radiofrequency (RF) lesions for persistent atrial fibrillation (PsAF) ablation and subsequent atrial tachycardias (ATs). Methods From 41 consecutive patients who underwent AT ablation at a second procedure using an ultrahigh-density mapping system, 22 patients (38 ATs) were included as they also had complete maps with a multipolar catheter and three-dimensional (3D) mapping system at the time of the first PsAF ablation procedure. We, therefore, compared voltage maps from the first AF ablation procedure to those from the subsequent AT ablation procedure, as well as the lesion sets used for AF ablation vs the activation patterns in AT during the second procedure. Results In the 38 ATs, 211 of 285 analyzed atrial areas displayed low voltage area (LVA) (74%). Eighteen percent (38/211) existed before the index ablation for AF while 82% (173/211) were newly identified as LVA during the second procedure. Ninety-nine percent (172/173) of the newly developed LVA colocalized with RF lesions delivered for PsAF. Of the 38 ATs, 89.5% (34/38) AT circuits were associated with newly developed LVA due to RF lesions whilst 10.5% (4/38) AT circuits were associated with pre-existing LVA observed at the index procedure. No AT circuit was completely independent from index RF lesions in this series. Conclusions Analysis of detailed 3D electroanatomical mapping demonstrates that most ATs after PsAF ablation are involving LVAs due to index RF lesions.
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- 2020
42. In silico analysis of the relation between conventional and high‐power short‐duration RF ablation settings and resulting lesion metrics
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Konstantinos Vlachos, Arnaud Denis, Thomas Pambrun, Claire A. Martin, Josselin Duchateau, Takeshi Kitamura, Pierre Jaïs, Felix Bourier, Mélèze Hocini, Nicolas Derval, Michel Haïssaguerre, Hubert Cochet, Anna Lam, Antonio Frontera, Frederic Sacher, Ghassen Cheniti, and Masateru Takigawa
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Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cardiac Catheters ,Contact force ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Atrial Fibrillation ,Pressure ,medicine ,Humans ,Computer Simulation ,030212 general & internal medicine ,Short duration ,business.industry ,RF power amplifier ,Models, Cardiovascular ,Ablation ,Power (physics) ,Treatment Outcome ,Pulmonary Veins ,Metric (mathematics) ,Catheter Ablation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Rf ablation ,Biomedical engineering - Abstract
BACKGROUND Use of lesion metric indices is a proposed strategy to support pulmonary vein isolation procedures and these indices show good correlations with lesion sizes. The aim of this in silico study is to provide a detailed analysis of radiofrequency (RF) settings, including high-power short-duration (HPSD) settings, and resulting lesion metric indices. METHODS AND RESULTS A software program was designed which simulated virtual RF ablations. Lesion metric indices (Ablation index: AI, Lesion size index: LSI) were calculated based on underlying RF settings (contact force [CF], power, duration). In series of calculations, the applied settings were varied within defined ranges (CF: 1-80 g, power: 1-60 W, duration: 1-60 seconds). Overall, n = 388 000 virtual ablations were calculated. The resulting lesion metric indices were compared with each other and analyzed in relation to respective RF settings. Increasing contact force from 1 to 10 g resulted in a 4.4-fold LSI value, whilst increasing contact force from 10 to 20g resulted in a 1.5-fold value (P
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- 2020
43. Ultra–High-Density Activation Mapping to Aid Isthmus Identification of Atrial Tachycardias in Congenital Heart Disease
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Arnaud Denis, Philippe Maury, Stephen Murray, Michael Wolf, Antonio Frontera, Pierre Jaïs, Vivienne Ezzat, Nicholas Klotz, Claire A. Martin, Hubert Cochet, Neil Seller, Gregoire Massouillie, Josselin Duchateau, Simon Claridge, Nicolas Combes, Jean-Benoit Thambo, Ewen Shepherd, Felix Bourier, Ghassen Cheniti, Parag R Gajendragadkar, Ruairidh Martin, Simon P. Fynn, Xavier Iriart, David Begley, Patrick M. Heck, Mélèze Hocini, Michel Haïssaguerre, Thomas Pambrun, Richard Snowdon, Frederic Sacher, Martin Lowe, Shohreh Honarbakhsh, Anna Lam, Konstantinos Vlachos, Vinit Sawhney, Nathaniel Thompson, Masateru Takigawa, Arthur M. Yue, Nicolas Derval, and Takeshi Kitamura
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Adult ,Heart Defects, Congenital ,Male ,Tachycardia ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Coronary sinus ,Atrial tachycardia ,Aged ,Tetralogy of Fallot ,Tricuspid valve ,business.industry ,Heart ,Equipment Design ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Great arteries ,Catheter Ablation ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,business - Abstract
Objectives A new electroanatomic mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) using a 64-electrode mapping basket is now available; we systematically assessed its use in complex congenital heart disease (CHD). Background The incidence of atrial arrhythmias post-surgery for CHD is high. Catheter ablation has emerged as an effective treatment, but is hampered by limitations in the mapping system’s ability to accurately define the tachycardia circuit. Methods Mapping and ablation data of 61 patients with CHD (35 males, age 45 ± 14 years) from 8 tertiary centers were reviewed. Results Causes were as follows: Transposition of Great Arteries (atrial switch) (n = 7); univentricular physiology (Fontans) (n = 8); Tetralogy of Fallot (n = 10); atrial septal defect (ASD) repair (n = 15); tricuspid valve (TV) anomalies (n = 10); and other (n = 11). The total number of atrial arrhythmias was 86. Circuits were predominantly around the tricuspid valve (n = 37), atriotomy scar (n = 10), or ASD patch (n = 4). Although the majority of peri-tricuspid circuits were cavo-tricuspid-isthmus dependent (n = 30), they could follow a complex route between the annulus and septal resection, ASD patch, coronary sinus, or atriotomy. Immediate ablation success was achieved in all but 2 cases; with follow-up of 12 ± 8 months, 7 patients had recurrence. Conclusions We demonstrate the feasibility of the basket catheter for mapping complex CHD arrhythmias, including with transbaffle and transhepatic access. Although the circuits often involve predictable anatomic landmarks, the precise critical isthmus is often difficult to predict empirically. Ultra–high-density mapping enables elucidation of circuits in this complex anatomy and allows successful treatment at the isthmus with a minimal lesion set.
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- 2019
44. The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes
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Thomas Pambrun, Clémentine André, Olivier Bernus, Mark Potse, Michel Haïssaguerre, Rémi Dubois, Masa Takigawa, Rick Walton, E. J. Vigmond, Frederic Sacher, Thomas Lavergne, Nicolas Derval, Pierre Jaïs, Josselin Duchateau, Wee Nademanee, and Mélèze Hocini
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,3. Good health ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Ventricular fibrillation ,Cardiology ,Medicine ,Repolarization ,030212 general & internal medicine ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,J wave ,Brugada syndrome - Abstract
Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the occurrence of SCD: (1) localized depolarization abnormalities (due to microstructural myocardial alteration), (2) Purkinje abnormalities manifesting as triggering ectopy and inducible reentry; or (3) repolarization heterogeneities. Each condition may result from a spectrum of pathophysiologic processes with implications for individual therapy.
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- 2019
45. Insights from atrial surface activation throughout atrial tachycardia cycle length: A new mapping tool
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Nathaniel Thompson, Konstantinos Vlachos, Claire A. Martin, Josselin Duchateau, William Escande, Michel Haïssaguerre, Mélèze Hocini, Nicolas Derval, Frederic Sacher, Antonio Frontera, Ghassen Cheniti, Grégoire Massoulié, Michael Wolf, Clémentine André, Anna Lam, Thomas Pambrun, Yosuke Nakatani, Hubert Cochet, Takeshi Kitamura, Felix Bourier, Masateru Takigawa, Li Jun Zeng, Ruairidh Martin, Arnaud Denis, Jean-Rodolphe Roux, and Pierre Jaïs
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Tachycardia, Supraventricular ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Cycle length ,Atrial tachycardia ,business.industry ,Middle Aged ,Atrial activation ,Electrophysiology ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,Software - Abstract
A novel "LUMIPOINT" software in the Rhythmia system (Boston Scientific) displays a histogram of activated area over the entire atrial tachycardia (AT) cycle length (CL) with a normalized score.The purpose of this study was to examine whether the pattern of this global activation histogram (GAH) identified reentrant vs focal AT and whether a decrease in atrial activation area, shown as valleys in the GAH, identifies isthmuses.One hundred eight activation maps of ATs (17 focal, 57 macroreentrant, 21 localized, 13 multiple loop) in 67 patients were reviewed retrospectively with the LUMIPOINT software. The ACTIVATION SEARCH feature highlighted the activated area in a given time period irrespective of the activation map. A 30-ms unit time interval was set, and the GAH patterns and electrophysiological properties of highlighted areas were examined.Focal ATs systematically displayed a plateau with GAH-Score0.1 for at least 30% of the CL. Most reentrant ATs (90/91 [98.9%]) lacked this plateau and displayed activity covering the entire CL, with 2 [1-2] GAH-Valleys per tachycardia. Each GAH-Valley highlighted 1 [1-2] areas in the map. Among 264 highlighted areas, 198 (75.0%) represented slow conduction, 19 (7.2%) lines of block, 27 (10.2%) wavefront collision, 3 (1.1%) unknown, and 17 (6.4%) absence of activation in focal ATs. Practical ablation sites all matched one of the highlighted areas based on GAH-Valleys, and they corresponded better with areas highlighted by GAH-Score ≤0.2 (P.0001).GAH shows focal vs reentrant mechanisms at first glance. Decrease in activated areas (displayed by GAH-Valleys) is mostly due to slow conduction and highlights areas of special interest, with 100% sensitivity for isthmus identification.
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- 2019
46. Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation
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Yosuke, Nakatani, Soumaya, Sridi-Cheniti, Ghassen, Cheniti, F Daniel, Ramirez, Cyril, Goujeau, Clementine, André, Takashi, Nakashima, Charles, Eggert, Christopher, Schneider, Raju, Viswanathan, Philipp, Krisai, Takamitsu, Takagi, Tsukasa, Kamakura, Konstantinos, Vlachos, Nicolas, Derval, Josselin, Duchateau, Thomas, Pambrun, Remi, Chauvel, Vivek Y, Reddy, Michel, Montaudon, François, Laurent, Frederic, Sacher, Mélèze, Hocini, Michel, Haïssaguerre, Pierre, Jaïs, Hubert, Cochet, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Icahn School of Medicine at Mount Sinai [New York] (MSSM), Agence Nationale de la Recherche, European Research Council, ANR-11-EQPX-0030,MUSIC,Plateforme multi-modale d'exploration en cardiologie(2011), ANR-10-IAHU-0004,LIRYC,L'Institut de Rythmologie et modélisation Cardiaque(2010), and European Project: 715093,H2020,ERC-2016-STG,ECSTATIC(2017)
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[SPI]Engineering Sciences [physics] ,Cardiac magnetic resonance ,Pulsed field ablation ,Contrast Media ,Humans ,Gadolinium ,Catheter ablation ,Heart Atria ,Atrial fibrosis ,Fibrosis ,Magnetic Resonance Imaging ,Atrial fibrillation - Abstract
International audience; Pulsed field ablation (PFA), a non-thermal ablative modality, may show different effects on the myocardial tissue compared to thermal ablation. Thus, this study aimed to compare the left atrial (LA) structural and mechanical characteristics after PFA vs. thermal ablation.Cardiac magnetic resonance was performed pre-ablation, acutely (
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- 2021
47. Conduction recovery with Wenckebach periodicity at the mitral isthmus
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Thomas Pambrun, Takamitsu Takagi, Takashi Nakashima, Gabriela Pintican, Nicolas Derval, and Pierre Jaïs
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Tachycardia ,Male ,medicine.medical_specialty ,animal structures ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Arrhythmogenic substrate ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Block (telecommunications) ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Atrioventricular Block ,Aged ,urogenital system ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,Ablation ,Pulmonary Veins ,embryonic structures ,cardiovascular system ,Cardiology ,Mitral Valve ,Mitral isthmus ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Posterior MI ,Atrial flutter - Abstract
A Wenckebach periodicity at the mitral isthmus lesion has rarely been reported. We described a case presenting conduction recovery with Wenckebach periodicity at the mitral isthmus lesion after achieving the posterior mitral isthmus block. These findings demonstrate an early reconnection of mitral isthmus lesion, and an arrhythmogenic substrate that can lead to development of reentrant tachycardia, that is, peri-mitral atrial flutter.
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- 2021
48. Sex differences in ventricular arrhythmia: epidemiology, pathophysiology and catheter ablation
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Philipp Krisai, Ghassen Cheniti, Takamitsu Takagi, Tsukasa Kamakura, Elodie Surget, Clémentine André, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Frédéric Sacher, Pierre Jaïs, Michel Haïssaguerre, and Mélèze Hocini
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Male ,Sex Characteristics ,sex difference ,Arrhythmias, Cardiac ,General Medicine ,Treatment Outcome ,RC666-701 ,Catheter Ablation ,Tachycardia, Ventricular ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Female ,cardiovascular diseases ,ventricular tachycardia ,Cardiology and Cardiovascular Medicine ,Cardiomyopathies ,ventricular arrhythmia ,Randomized Controlled Trials as Topic - Abstract
Evidence on sex differences in the pathophysiology and interventional treatment of ventricular arrhythmia in ischemic (ICM) or non-ischemic cardiomyopathies (NICM) is limited. However, women have different etiologies and types of structural heart disease due to sex differences in genetics, proteomics and sex hormones. These differences may influence ventricular electrophysiological parameters and may require different treatment strategies. Considering that women were consistently under-represented in all randomized-controlled trials on VT ablation, the applicability of the study results to female patients is not known. In this article, we review the current knowledge and gaps in evidence about sex differences in the epidemiology, pathophysiology and catheter ablation in patients with ventricular arrhythmias.
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- 2021
49. Characteristics of macroreentrant atrial tachycardias using an anatomical bypass: Pseudo-focal atrial tachycardia case series
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Josselin Duchateau, Yosuke Nakatani, Mélèze Hocini, Takeshi Kitamura, F. Daniel Ramirez, Michel Haïssaguerre, Takamitsu Takagi, Philipp Krisai, Frederic Sacher, Arnaud Denis, Ghassen Cheniti, Masateru Takigawa, Thomas Pambrun, Tsukasa Kamakura, Remi Chauvel, Nicolas Derval, Pierre Jaïs, Konstantinos Vlachos, Clémentine André, Cyril Goujeau, Takashi Nakashima, and Romain Tixier
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Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Tachycardia, Supraventricular ,Humans ,Fossa ovalis ,Heart Atria ,Vein ,Atrial tachycardia ,Retrospective Studies ,Cardiac Vein ,business.industry ,Ablation ,medicine.anatomical_structure ,Treatment Outcome ,Cardiology ,Catheter Ablation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Focal atrial tachycardia ,business - Abstract
Introduction Human atria comprise distinct layers. One layer can bypass another, and lead to a downstream centrifugal propagation at their interface. We sought to characterize anatomical substrates, electrophysiological properties, and ablation outcomes of "pseudo-focal" atrial tachycardias (ATs), defined as macroreentrant ATs mimicking focal ATs. Methods and results We retrospectively analyzed left atrial ATs showing centrifugal propagation with post-pacing intervals (PPIs) after entrainment pacing suggestive of a macroreentrant mechanism. A total of 22 patients had pseudo-focal ATs consisting of 15 perimitral and 7 roof-dependent flutters. A low-voltage area was consistently found at the collision site and co-localized with distinct anatomical structures like the: (1) coronary sinus-great cardiac vein bundle (27%); (2) vein of Marshall bundle (18%); (3) Bachmann bundle (27%); (4) septopulmonary bundle (18%); and (5) fossa ovalis (9%). The mean missing tachycardia cycle length (TCL) was 65 ± 31 ms (22%) on the endocardial activation map. PPI was 0 [0-15] ms and 0 [0-21] ms longer than TCL at the breakthrough site and the opposite site, respectively. While feasible in 21 pseudo-focal ATs (95%), termination was better achieved by blocking the anatomical isthmus than ablating the breakthrough site [20/21 (95%) vs. 1/5 (20%); p Conclusion Perimitral and roof-dependent flutters with centrifugal propagation are favored by a low-voltage area located at well-identified anatomical structures. Comprehensive entrainment pacing maneuvers are crucial to distinguish pseudo-focal ATs from true focal ATs. Blocking the anatomical isthmus is a better therapeutic option than ablating the breakthrough site. This article is protected by copyright. All rights reserved.
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- 2021
50. Characteristics of Macroreentries Using an Epicardial Bypass: Pseudo-Focal Atrial Tachycardia Case Series
- Author
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Ghassen Cheniti, Arnaud Denis, Ramirez Fd, Takagi T, Clémentine André, Cyril Goujeau, Tsukasa Kamakura, Thomas Pambrun, Romain Tixier, Takashi Nakashima, Josselin Duchateau, Remi Chauvel, Konstantinos Vlachos, Michel Haïssaguerre, Takeshi Kitamura, Mélèze Hocini, Frederic Sacher, Yosuke Nakatani, Pierre Jaïs, Philipp Krisai, Masateru Takigawa, and Nicolas Derval
- Subjects
medicine.medical_specialty ,Text mining ,Series (mathematics) ,business.industry ,Internal medicine ,medicine ,Cardiology ,Focal atrial tachycardia ,business - Abstract
Introduction: Human atria comprise distinct epicardial layers, which can bypass endocardial layers and lead to downstream centrifugal propagation at the “epi-endo” connection. We sought to characterize anatomical substrates, electrophysiological properties, and ablation outcomes of “pseudo-focal” atrial tachycardias (ATs), defined as macroreentrant ATs mimicking focal ATs. Methods and Results: We retrospectively analyzed ATs showing centrifugal propagation with post-pacing intervals (PPIs) after entrainment pacing suggestive of a macroreentry. A total of 26 patients had pseudo-focal ATs consisting of 15 perimitral, 7 roof-dependent, and 5 cavotricuspid isthmus (CTI)-dependent flutters. A low-voltage area was consistently found at the collision site and co-localized with epicardial layers like the: (1) coronary sinus-great cardiac vein bundle (22%); (2) vein of Marshall bundle (15%); (3) Bachmann bundle (22%); (4) septopulmonary bundle (15%); (5) fossa ovalis (7%); and (6) low right atrium (19%). The mean missing tachycardia cycle length (TCL) was 67 ± 29 ms (22%) on the endocardial activation map. PPI was 9 [0-15] ms and 10 [0-20] ms longer than TCL at the breakthrough site and the opposite site, respectively. While feasible in 25 pseudo-focal ATs (93%), termination was better achieved by blocking the anatomical isthmus than ablating the breakthrough site [24/26 (92%) vs. 1/6 (17%); p < 0.001]. Conclusion: Perimitral, roof-dependent, and CTI-dependent flutters with centrifugal propagation are favored by a low-voltage area located at well-identified epicardial bundles. Comprehensive entrainment pacing maneuvers are crucial to distinguish pseudo-focal ATs from true focal ATs. Blocking the anatomical isthmus is a better therapeutic option than ablating the breakthrough site.
- Published
- 2021
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