Publications by authors named "Patrizio Pascale"

80 Publications

Progressive PR Prolongation in an Asymptomatic Man.

JAMA Intern Med 2021 May;181(5):691-692

Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.

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http://dx.doi.org/10.1001/jamainternmed.2020.9216DOI Listing
May 2021

Efficiency of the RADPAD Surgical Cap in Reducing Brain Exposure During Pacemaker and Defibrillator Implantation.

JACC Clin Electrophysiol 2021 02 30;7(2):161-170. Epub 2020 Sep 30.

Department of Cardiology, University Hospital Centre Vaudois, Lausanne, Switzerland. Electronic address:

Objectives: This study sought to investigate the RADPAD No Brainer (Worldwide Innovation and Technologies, Overland Park, Kansas) efficiency in reducing brain exposure to scattered radiation.

Background: Cranial radioprotective caps such as the RADPAD No Brainer are being marketed as devices that significantly reduce operator's brain exposure to scattered radiation. However, the efficiency of the RADPAD No Brainer in reducing brain exposure in clinical practice remains unknown to date.

Methods: Five electrophysiologists performing device implantations over a 2-month period wore the RADPAD cap with 2 strips of 11 thermoluminescent dosimeter pellets covering the front head above and under the shielded cap. Phantom measurements and Monte Carlo simulations were performed to further investigate brain dose distribution.

Results: Our study showed that the right half of the operators' front head was the most exposed region during left subpectoral device implantation; the RADPAD cap attenuated the skin front-head exposure but provided no protection to the brain. The exposure of the anterior part of the brain was decreased by a factor of 4.5 compared with the front-head skin value thanks to the skull. The RADPAD cap worn as a protruding horizontal plane, however, reduced brain exposure by a factor of 1.7 (interquartile range: 1.3 to 1.9).

Conclusions: During device implantation, the RADPAD No Brainer decreased the skin front head exposure but had no impact on brain dose distribution. The RADPAD No Brainer worn as a horizontal plane worn around the neck reduces brain exposure and confirms that the exposure comes from upward scattered radiation.
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http://dx.doi.org/10.1016/j.jacep.2020.08.007DOI Listing
February 2021

Acute chest pain with ST-segment elevation in lead V1-V3: when you hear hoofbeats, also look for zebras.

Clin Res Cardiol 2021 Feb 6. Epub 2021 Feb 6.

School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital Campus, Westminster Bridge Road, London, UK.

ST-segment elevation (STE) in the anterior precordial leads is the hallmark of anterior myocardial infarction. In rare cases, this ECG pattern may be due to isolated infarction of the right ventricle since leads V1-V3 directly overlie the right ventricular free wall. Herein, we aimed to provide clues to recognize and understand this diagnostic pitfall through a series of 4 patients presenting with STE in the anterior leads.
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http://dx.doi.org/10.1007/s00392-021-01803-4DOI Listing
February 2021

[Cardiology].

Rev Med Suisse 2021 Jan;17(723):172-180

Service de cardiologie, CHUV, Université de Lausanne, 1011 Lausanne.

In 2020, new guidelines have been published by the European Society of Cardiology including those on non-ST-segment elevation acute coronary syndromes, atrial fibrillation and adult congenital heart disease. Regarding interventional cardiology, POPular TAVI opens the possibility of anti-platelet monotherapy after transcutaneous aortic valve replacement. EMPEROR-Reduced confirms the importance of SGLT2 inhibitors in the treatment of heart failure with reduced ejection fraction. Within the field of imaging, stress MRI has now become the first-line technique for the screening of coronary artery disease, demonstrating an excellent cost-benefit ratio. Finally, renin-angiotensin-aldosterone inhibitors do not appear to increase the risk of an infection by COVID-19.
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January 2021

First case reported of a Prinzmetal vasospastic angina diagnosed with the help of a smartwatch.

Europace 2020 Dec 30. Epub 2020 Dec 30.

Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Vaud, Switzerland.

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http://dx.doi.org/10.1093/europace/euaa372DOI Listing
December 2020

Uninterrupted vs. interrupted non-vitamin K antagonist oral anticoagulant during atrial fibrillation catheter ablation: expert opinion or true evidence?

Eur Heart J 2020 Dec 9. Epub 2020 Dec 9.

Arrhythmia Unit, National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France.

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http://dx.doi.org/10.1093/eurheartj/ehaa1000DOI Listing
December 2020

The 'double transition': a novel electrocardiogram sign to discriminate posteroseptal accessory pathways ablated from the right endocardium from those requiring a left-sided or epicardial coronary venous approach.

Europace 2020 11;22(11):1703-1711

Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France.

Aims: The precise localization of manifest posteroseptal accessory pathways (APs) often poses diagnostic challenges considering that a small area may encompass AP that may be ablated from the right or left endocardium, or epicardially within the coronary sinus (CS). We sought to explore whether the QRS transition pattern in the precordial lead may help to discriminate the necessary ablation approach.

Methods And Results: Consecutive patients who underwent a successful ablation of a single manifest AP over a 5-year period were included. Standard 12-lead electrocardiograms were reviewed. A total of 273 patients were identified. Mean age was 31 ± 15 years and 62% were male. Of the 110 identified posteroseptal AP, 64 were ablated from the right endocardium, 33 from the left endocardium, and 13 inside the CS. While a normal precordial QRS transition was most often observed, a subset of 33 patients presented an atypical 'double transition' pattern which specifically identified right endocardial AP. The combination of a q wave in V1 with a proportion of the positive QRS component in V1 < V2 > V3, predicted a right endocardial AP with a 100% specificity. In case of a positive QRS sum in V2, this 'double transition' pattern predicted a posteroseptal right endocardial AP with 99.5% specificity and 44% sensitivity. The positive predictive value was 97%. The only false positive was a midseptal AP. In the case of a negative or isoelectric QRS sum in V2, APs were located more laterally on the tricuspid annulus.

Conclusion: The combination of a q wave in V1 with a double QRS transition pattern in the precordial leads is highly specific of a right endocardial AP and rules out the need for CS or left-sided mapping.
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http://dx.doi.org/10.1093/europace/euaa200DOI Listing
November 2020

Stereotactic Radiotherapy for the Management of Refractory Ventricular Tachycardia: Promise and Future Directions.

Front Cardiovasc Med 2020 25;7:108. Epub 2020 Jun 25.

Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Ventricular tachycardia (VT) caused by myocardial scaring bears a significant risk of mortality and morbidity. Antiarrhythmic drug therapy (AAD) and catheter ablation remain the cornerstone of VT management, but both treatments have limited efficacy and potential adverse effects. Stereotactic body radiotherapy (SBRT) is routinely used in oncology to treat non-invasively solid tumors with high precision and efficacy. Recently, this technology has been evaluated for the treatment of VT. This review presents the basic underlying principles, proof of concept, and main results of trials and case series that used SBRT for the treatment of VT refractory to AAD and catheter ablation.
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http://dx.doi.org/10.3389/fcvm.2020.00108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329991PMC
June 2020

[Sinus node dysfunction, Brugada syndrome and long QT syndrome affecting the same patient : when genetics can't make head or tail of it].

Rev Med Suisse 2020 Jun;16(696):1148-1152

Service de cardiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne.

The gene SCN5A encodes the cardiac sodium channel which, through the conduction of Na+ current into the cell, generates the fast upstroke of the action potential of cardiomyocytes. Pathogenic variants of SCN5A have been causally associated to several hereditary cardiac diseases including, among others, Brugada syndrome, congenital long QT syndrome and sinus node dysfunction. Recently, overlap syndromes have been described that are characterized by the simultaneous expression of mixed clinical phenotypes among two or more hereditary cardiac diseases associated to the gene SCN5A (HCD-SCN5A). For this reason, it is time to rethink about HCD-SCN5A as different expressions of the same complex spectrum encompassing multiple clinical phenotypes with pronounced overlaps instead of as distinct clinical entities.
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June 2020

[Cardiology].

Rev Med Suisse 2020 Jan;16(676-7):16-22

Service de cardiologie, Département cœur et vaisseaux, CHUV et Université de Lausanne, 1011 Lausanne.

In 2019, the guidelines on the new entity « chronic coronary syndrome » have been published. They influence importantly the work-up and treatment of patients with stable coronary artery disease. We will also report on publications showing the benefit of percutaneous aortic valve implantation (TAVI) in patients with aortic stenosis and low risk surgical risk. With regard to infectious endocarditis, we elucidate the importance of the vegetation's size for predicting mortality and the prognostic value of the positron emission tomography in predicting septic embolism. We highlight the spectacular results of the DAPA-HF study in patients with heart failure and review publications showing the important role of the detection of myocardial fibrosis and scar by cardiac MRI for risk stratification of sudden cardiac death.
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January 2020

Two to one cavotricuspid isthmus conduction block during coronary sinus pacing: What is the mechanism?

J Cardiovasc Electrophysiol 2020 03 19;31(3):736-738. Epub 2020 Jan 19.

Arrhythmia Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.

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http://dx.doi.org/10.1111/jce.14350DOI Listing
March 2020

Severe and uniform bi-atrial remodeling measured by dominant frequency analysis in persistent atrial fibrillation unresponsive to ablation.

J Interv Card Electrophysiol 2020 Nov 13;59(2):431-440. Epub 2019 Dec 13.

Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Background: High values of ECG and intracardiac dominant frequency (DF) are indicative of significant atrial remodeling in persistent atrial fibrillation (peAF). We hypothesized that patients with peAF unresponsive to ablation display higher ECG and intracardiac DFs than those remaining in sinus rhythm (SR) on the long term.

Methods: Forty consecutive patients underwent stepwise ablation for peAF (sustained duration 19 ± 11 months). Electrograms were recorded before ablation at 13 left atrium (LA) sites and at the right atrial appendage (RAA) and coronary sinus (CS) synchronously to the ECG. DF was defined as the highest peak within the power spectrum.

Results: peAF was terminated within the LA in 28 patients (left-terminated [LT]), whereas 12 patients remaining in AF after ablation (not left-terminated [NLT]) were cardioverted. Over a mean follow-up of 34 ± 14 months, all 12 NLT patients had a recurrence. Of the LT patients, 71% had a recurrence (20/28, LT_Rec), while 29% remained in SR throughout the follow-up (8/28, LT_SR). DF values and correlations between pairs of LA appendage (LAA), RAA, and CS DFs showed distinctive patterns among the subgroups. The NLT subgroup displayed the highest ECG and intracardiac DFs, with strong intragroup homogeneity between pairs of CS and LAA DFs, and to a lesser extent between pairs of CS and RAA DFs. Conversely, the LT_SR subgroup showed the lowest DFs, with significant intragroup heterogeneity between pairs of CS and both LAA and RAA DFs.

Conclusions: Patients with peAF unresponsive to ablation show high surface and intracardiac DFs indicative of severe and uniform bi-atrial remodeling.
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http://dx.doi.org/10.1007/s10840-019-00681-1DOI Listing
November 2020

Interatrial septum dissection and atrial wall hematoma following transseptal puncture: A systematic review of the literature.

Catheter Cardiovasc Interv 2020 08 23;96(2):424-431. Epub 2019 Oct 23.

Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Background: Interatrial septum (IAS) dissection due to transseptal puncture (TSP) is a rare, underreported complication of the procedure. Data on the mechanism, diagnosis, and management of this complication are lacking.

Methods: We conducted a systematic review of all reported cases of IAS dissection with or without associated LA hematoma due to TSP, by thoroughly searching MEDLINE and EMBASE through May 2019.

Results: After screening of n = 882 studies, eight studies with a total of 19 patients addressed the complication of IAS dissection and/or LA hematoma secondary to TSP. Median age was 63 years with a 1:1 male to female ratio. Ablation of atrial fibrillation was the most frequently reported procedure (84%). Diagnosis was established using fluoroscopy with contrast injection (58%), TEE (32%) or intracardiac echocardiography (5%). The mechanism identified involved puncture of the septum secundum portion of the IAS, leading to transient needle passage into the extracardiac space. In the majority of patients, the hematoma remained localized in the IAS and management was conservative with progressive resolution of the hematoma during follow-up (95%). Two patients (11%) required further intervention by either pericardiocentesis or surgical drainage due to hemodynamic instability.

Conclusions: IAS dissection with or without hematoma after TSP remains an underdiagnosed entity. The main mechanism involves lesion to the septum secundum portion of the IAS, resulting in needle passage into the extracardiac space and local bleeding. Although conservative management may be sufficient in the majority of cases, interventional cardiologists should be familiar with this complication and its diagnosis.
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http://dx.doi.org/10.1002/ccd.28554DOI Listing
August 2020

[Management of refractory ventricular tachycardia using stereotactic body radiotherapy].

Rev Med Suisse 2019 May;15(652):1082-1086

Service de cardiologie, CHUV, 1011 Lausanne.

Stereotactic body radiotherapy (SBRT) is routinely used in oncology to treat non-invasively solid tumors with high precision and efficacy. Recently, this technology has been evaluated in the treatment of ventricular tachycardia (VT). This article presents the basic underlying principles, proofs of concept and main results of clinical studies that used SBRT for the treatment of VT.
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May 2019

[The year in cardiology : 2018].

Rev Med Suisse 2019 Jan;15(N° 632-633):27-30

Service de cardiologie, CHUV, 1011 Lausanne.

This review article provides a broad overview of the novelties in cardiology in 2018. Advances in interventional cardiology and cardiovascular prevention, heart failure, electrophysiology and non-invasive cardiovascular imaging have provided important new insights in the pathophysiology, diagnosis and treatment of ischemic and valvular heart disease, heart failure, rhythm disorders and cardiomyopathies. This article provides an overview of the most relevant articles published in 2018.
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January 2019

Prognostic value of pulse pressure after an acute coronary syndrome.

Atherosclerosis 2018 10 20;277:219-226. Epub 2018 Jul 20.

Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. Electronic address:

Background And Aims: Pulse pressure (PP) is a surrogate of aortic stiffness (AS) easily obtainable. The link between AS and cardio-vascular disease is documented, however, data regarding acute coronary syndrome (ACS) patients are scarce and contradictory. We aimed to assess the prognostic value of PP measured at admission, with regard to major adverse outcomes (all-cause mortality, recurrence of MI, and stroke), during the first year following an acute coronary syndrome (ACS).

Methods: The SPUM-ACS project is a prospective cohort study of patients with ACS conducted in 4 Swiss University hospitals. Patients with no PP at admission or with severe clinical heart failure or cardiogenic shock were excluded. Cox regression analyses were performed to determine associations between PP and outcomes (all-cause mortality, recurrence of myocardial infarction (MI), and stroke). Three multivariate Cox regression models were adjusted for hemodynamic, cardiovascular, and non-cardiovascular confounders, added successively.

Results: Of 5635 eligible patients, 5070 met the inclusion criteria. Mean patient age was 63 years (range: 54-72), 79.6% were male, and mean blood pressure and PP were 93.9 ± 15.6 and 54 ± 17 mmHg, respectively. Multivariate analyses confirmed the prognostic significance of PP for each 10-mmHg increase for the composite endpoint, hazard ratio (HR) 1.126 [1.051-1.206], p = 0.001; all-cause mortality, HR1.129 [1.013-1.260], p = 0.029; and recurrence of MI, HR1.206 [1.102-1.320], p < 0.001; but not for stroke, HR1.014[0.853-1.205].

Conclusions: PP measured at admission is a strong, independent prognostic marker predicting mortality and recurrence of MI after ACS. PP should be considered for the management of secondary prevention.
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http://dx.doi.org/10.1016/j.atherosclerosis.2018.07.013DOI Listing
October 2018

Useful Electrocardiographic Features to Help Identify the Mechanism of Atrial Tachycardia Occurring After Persistent Atrial Fibrillation Ablation.

JACC Clin Electrophysiol 2018 01 27;4(1):33-45. Epub 2017 Sep 27.

Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France.

Objectives: The purpose of this study was to describe and identify useful electrocardiographic characteristics to help identify the mechanism of atrial tachycardia (AT) occurring after persistent atrial fibrillation (PsAF) ablation.

Background: Electrocardiographic analysis to help identify the mechanism of AT after PsAF ablation is much limited by the fact that remodeling and ablation alter the normal activation pattern.

Methods: All consecutive patients who underwent mapping and ablation of AT after PsAF ablation were included. Surface P waves were analyzed during higher (>2:1) grades of atrioventricular block.

Results: One hundred ninety-six ATs with visible P waves were identified in 127 patients (macro-re-entry in 57%, centrifugal AT in 43%). One-third displayed low-voltage P waves (≤0.1 mV). An isoelectric line >80 ms was more common in centrifugal compared with macro-re-entrant AT (47% vs. 24%; p < 0.001), but its positive predictive value was limited (60%). A minority of peritricuspid ATs displayed the classic saw-tooth pattern (27% [n = 22]). However, the "precordial transition" (a gradual transition from an upright component in lead V to a negative component with progression across the precordium) remained often observed and specifically identified peritricuspid AT (specificity, 98%; sensitivity, 59%). Only 2 unique features could help identify perimitral AT (n = 60). First, the presence of a negative or negative-positive P-wave in any of leads V to V identified perimitral AT with 97% specificity and 30% sensitivity. Second, a "notched" negative component at the beginning of a positive P-wave in the inferior leads specifically identified clockwise perimitral AT (specificity, 98%; sensitivity, 25%).

Conclusions: Only few unique electrocardiographic characteristics help identify the mechanism of AT after PsAF ablation. Knowledge of these characteristics may aid in planning and performing ablation.
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http://dx.doi.org/10.1016/j.jacep.2017.07.018DOI Listing
January 2018

Circadian variation of ticagrelor-induced platelet inhibition in healthy adulty.

Eur Heart J Cardiovasc Pharmacother 2018 07;4(3):166-171

Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

Aims: The circadian variation of platelet aggregation is well demonstrated. However, whether this has an impact on antiplatelet inhibition therapy is poorly documented. We aimed to observe whether ticagrelor-induced platelet inhibition follows a circadian rhythm.

Methods And Results: The study included 25 healthy volunteers (11 female; 14 male). Blood samples were collected every 4 h. Ticagrelor was added in vitro at a concentration that provided 50% inhibition of the maximum response using the VerifyNow System Platelet Reactivity Test® thus avoiding any bias induced by circadian gastrointestinal absorption. Platelet aggregation testing was subsequently performed using the VerifyNow. Circadian changes in total platelet count, percentage of platelets inhibition, Von Willebrand activity, and volunteers' physiological parameters were analysed by fitting individuals' data to a sine curve with a 24-h period. Volunteers' physiological parameters [heart rate (b.p.m.), systolic/diastolic blood pressure (mmHg), and body temperature (Celsius)] followed a significant mean circadian pattern of 6 b.p.m. (P < 0.001), 5 mmHg/7 mmHg (P < 0.002), and 0.3°C (P < 0.001), respectively. Ticagrelor-induced platelet inhibition was significantly lower at 13:00 (38.4%) than at any other time (45.2%) (P = 0.018). Percentage of inhibited platelets plotted against time followed a circadian rhythm (P < 0.001), with mean minimum/maximum values at 13:00/02:00, respectively. Von Willebrand activity also followed a circadian pattern (P < 0.001), with an amplitude of 12.24% and a maximum activity at 12:00.

Conclusion: Ticagrelor-induced platelet inhibition follows a circadian rhythm, with the lowest mean values achieved at 13:00. These results deserve further studies in patients with coronary artery disease.
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http://dx.doi.org/10.1093/ehjcvp/pvy003DOI Listing
July 2018

Prolonged Asystole After a Loading Dose of Ticagrelor.

Ann Intern Med 2018 04 19;168(8):602-603. Epub 2017 Dec 19.

Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (S.R., O.M., E.P., P.P.).

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http://dx.doi.org/10.7326/L17-0550DOI Listing
April 2018

Circadian rhythm of blood cardiac troponin T concentration.

Clin Res Cardiol 2017 Dec 30;106(12):1026-1032. Epub 2017 Aug 30.

Cardiology Department, Vaudois University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Introduction: High-sensitivity cardiac troponin assays have significantly improved the sensitivity of myocardial infarction detection by using cutoff values and early absolute changes. However, variation in repeated measures also depends on biological variability. This study aimed to assess the potential circadian component of this biological variability.

Methods: 17 healthy volunteers were recruited, and standardized conditions for physical activity, meals, exposure to light and duration of sleep were imposed. Blood samples were collected every 4 h and high-sensitivity troponin T assay with a limit of detection of 3 ng/l and a 99th percentile of 14 ng/l were used. Circadian variations were analyzed using the cosinor method.

Results: Statistically significant circadian variations were observed for body temperature, heart rate, and systolic/diastolic arterial blood pressures (p < 0.01 using both a non-adjusted cosinor model and a gender- and BMI-adjusted cosinor model). The amplitudes of the circadian variations were 18.93, 6, 15.35, and 1.92%, respectively. A statistically significant circadian biological variation of troponin blood concentrations was evidenced (p < 0.01 in both the non-adjusted cosinor model and the gender- and BMI-adjusted cosinor), with an amplitude of 20.5% (average: 4.39 ng/l; amplitude: 0.9 ng/l; peak at 06:00 and nadir at 18:00).

Discussion: This study demonstrates a circadian biological variation in blood troponin concentration in a healthy population. The amplitude of this variation challenges the cutoff value for instant rule-out of the rapid rule-in/rule-out of the recent European guidelines for the management of acute coronary syndromes. These findings deserve further investigation in a population at risk of myocardial infarction.
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http://dx.doi.org/10.1007/s00392-017-1152-8DOI Listing
December 2017

[Cardiology update in 2016].

Rev Med Suisse 2017 Jan;13(544-545):27-32

Service de cardiologie, CHUV, 1011 Lausanne.

In 2016 the European Society of Cardiology (ESC) published new guidelines. These documents update the knowledge in various fields such as atrial fibrillation, heart failure, cardiovascular prevention and dyslipidemia. Of course it is impossible to summarize these guidelines in detail. Nevertheless, we decided to highlight the major modifications, and to emphasize some key points that are especially useful for the primary care physician.
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January 2017

[Paradigm shift in the treatment of atrial fibrillation. The importance of risk factor management].

Rev Med Suisse 2017 May;13(564):1100-1103

Service de cardiologie, CHUV, 1011 Lausanne.

The prevalence of atrial fibrillation (AF) is constantly rising. Different studies have underlined the correlation between AF and modifiable risk factors such as obesity, obstructive sleep apnea, hypertension and sedentary lifestyle. Treatment of these comorbidities could significantly reduce the AF burden and the recurrence rate after cardioversion or ablation. These data should therefore lead to a paradigm shift in the management of AF. A strategy limited to catheter ablation or to the prescription of an antiarrhythmic drug is not sufficient. By analogy to angioplasty in coronary artery disease, the specific management of AF must be combined with the prevention and treatment of risk factors to increase the success rate.
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May 2017

Dormant pulmonary vein conduction before ablation revealed by adenosine: evidence for intermittent venoatrial conduction?

Europace 2017 Apr;19(4):694

Cardiology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Av. du Bugnon 21, 1011 Lausanne, Switzerland.

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http://dx.doi.org/10.1093/europace/euw407DOI Listing
April 2017

A High Baseline Electrographic Organization Level Is Predictive of Successful Termination of Persistent Atrial Fibrillation by Catheter Ablation.

JACC Clin Electrophysiol 2016 Nov 21;2(6):746-755. Epub 2016 Nov 21.

Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. Electronic address:

Objectives: This study sought to investigate whether the level of organization of electrocardiographic (ECG) signals based on novel indexes is predictive of persistent atrial fibrillation (pAF) termination by catheter ablation (CA).

Background: Whether the level of ECG organization in pAF is correlated with the restoration of sinus rhythm by CA remains unknown.

Methods: Thirty consecutive patients who underwent stepwise CA for pAF (sustained duration 19 ± 11 months) were included in the study (derivation cohort). ECG lead V was placed on the patients' back (V) to improve left atrial (LA) recording. Two novel ECG indexes were computed using an adaptive harmonic frequency tracking scheme: 1) the adaptive organization index (AOI), which quantifies the cyclicity of AF harmonic oscillations; and 2) the adaptive phase index (API), which quantifies the phase coupling between the harmonic components. Index cutoff values predictive of procedural AF termination were then tested on a validation cohort of 8 consecutive patients.

Results: In the derivation cohort, CA terminated AF in 21 patients within the LA (70%; left-terminated [LT] group), whereas CA did not terminate AF in 9 patients (30%; non-left-terminated [NLT] group). LT patients displayed a higher ECG organization level at baseline than the NLT patients, with the best separation achieved by AOI and API computed on lead V (area under the curve [AUC] = 0.94 and AUC = 0.88, respectively; p < 0.05) and API on lead V (AUC = 0.83; p < 0.05). Similar results were obtained for both AOI and API in the validation cohort.

Conclusions: Patients in whom pAF terminated within the LA exhibited a higher level of atrial ECG organization, which was suggestive of a limited number of LA drivers than that of patients in whom the pAF could not be terminated by CA.
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http://dx.doi.org/10.1016/j.jacep.2016.05.017DOI Listing
November 2016

Recurrent Asystole After Neostigmine in a Heart Transplant Recipient With End-Stage Renal Disease.

J Cardiothorac Vasc Anesth 2017 04 23;31(2):653-656. Epub 2016 Jun 23.

Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

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http://dx.doi.org/10.1053/j.jvca.2016.06.020DOI Listing
April 2017

Reversal of left ventricular dysfunction after ablation of premature ventricular contractions related parameters, paradoxes and exceptions to the rule.

Int J Cardiol 2016 11 6;222:31-36. Epub 2016 Jul 6.

University Hospital Rangueil Toulouse, France. Electronic address:

Background: Suppression of frequent premature ventricular contractions (PVCs) does not systematically lead to an expected reversal of PVC-induced cardiomyopathy and determinants of left ventricular ejection fraction (LVEF) recovery (reverse remodeling) after ablation remain largely unknown.

Methods: Ninety-six consecutive patients with a suspicion of PVC induced-cardiomyopathy were retrospectively included. Parameters potentially related to reverse remodeling (>10% increase in LVEF) were analyzed in patients w/wo long-term success (decrease in PVC burden >80%).

Results: Over a mean follow-up of 24±21months, long-term ablation success was obtained in 76 patients (79%). In these, reverse remodeling was observed in 63 (83%) (LVEF 39±8 to 56±8%, p<0.0001). In multivariate analysis, only an older age (and marginally a lower PVC QRS amplitude) was independently associated with the lack of reverse remodeling. Only 10 of the 35 patients who initially should have received an ICD for primary prevention remained candidates for implantation after ablation. Lack of reverse remodeling was significantly linked to a higher mortality.

Conclusion: Reverse remodeling was observed in 83% of patients with frequent PVC and unexplained cardiomyopathy undergoing long-term successful ablation of the PVC. A younger age was independently correlated with the occurrence of reverse remodeling.
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http://dx.doi.org/10.1016/j.ijcard.2016.07.005DOI Listing
November 2016

[Cardiology update in 2015].

Rev Med Suisse 2016 Jan;12(500):17-8, 20-2

The present review provides a selected choice of clinical trials and therapeutic advances in the field of cardiology in 2015. A new treatment option in heart failure will become available this year in Switzerland. In interventional cardiology, new trials have been published on the duration of dual antiplatelet therapy, the new stents with bioresorbable scaffold and the long-term results of TAVR in patients who are not surgical candidates or at high surgical risk. RegardingAF the BRIDGE trial provides new evidences to guide the management of patients during warfarin interruption for surgery. Recent publications are changing the paradigm of AF treatment by showing a major impact of the management of cardiometabolic risk factors. Finally, refined criteria for ECG interpretation in athletes have been recently proposed to reduce the burden of false-positive screening.
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January 2016