Publications by authors named "Sébastien Marchandise"

25 Publications

  • Page 1 of 1

Ventricular lead malposition after TAVR causing ischaemic stroke.

Acta Cardiol 2021 Jan 20:1-3. Epub 2021 Jan 20.

Department of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

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http://dx.doi.org/10.1080/00015385.2020.1858249DOI Listing
January 2021

His bundle pacing for newly acquired pacing needs in patients implanted with a subcutaneous implantable cardioverter defibrillator: A feasibility study based on the automated screening score and clinical cases.

J Cardiovasc Electrophysiol 2020 07 29;31(7):1793-1800. Epub 2020 May 29.

Division of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

Introduction: Management of subcutaneous implantable cardioverter defibrillator (S-ICD) patients with newly acquired pacing needs remains problematic. His bundle pacing (HBP) allows for cardiac pacing without significant changes in the QRS morphology. We hypothesized that HBP does not alter S-ICD sensing and functions.

Methods: Twenty consecutive patients were implanted with a HB pacemaker. Among them, 17 demonstrated successful His recruitment and were prospectively screened with the automated screening tool (AST). Results of screenings performed immediately after implant and during follow-up, during intrinsic rhythm and while pacing from all available pacing configurations, were compared using the AST score. Positive-screening tests were defined by greater than or equal to 1 positive vector.

Results: Among the 17 patients successfully implanted (male: 41%; mean age: 73), 13 presented an indication of ventricular pacing and four of cardiac resynchronization. Absolute AST scores during both HBP (all configurations) and intrinsic rhythm were similar (p: NS). Due to left bundle branch block correction, HBP resulted in higher number of positive vectors (AST ≥ 100). AST scores were higher during HBP when compared with right ventricular pacing (RVP) (primary vector: 272 [16; 648] vs 4.6 [0.8; 16.2]; P = .003; secondary vector: 569 [183; 1186] vs 1.5 [0.7; 8.3]; P < .0001; alternate vector: 44 [2;125] vs 4.8 [0.9; 9.3]; P = .02) and resulted in a much higher number of positive vectors. Up to 90% of the patients had a positive-screening test during HBP. This passing rate was higher when compared RVP (17%; P < .0001).

Conclusion: HBP restores normal intrinsic conduction and minimally modifies the surface electrocardiograph and subcutaneous electrograms. When ventricular pacing is needed, HBP might represent an ideal pacing option for patients implanted with a S-ICD.
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http://dx.doi.org/10.1111/jce.14566DOI Listing
July 2020

Feasibility of His-bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement.

J Cardiovasc Electrophysiol 2020 04 5;31(4):813-821. Epub 2020 Feb 5.

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

Background: Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB).

Methods: Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre-TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0-millisecond pulse width.

Results: The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S-HBP and NS-HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow-up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred.

Conclusion: Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR-induced LBBB with acceptable pacing thresholds.
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http://dx.doi.org/10.1111/jce.14371DOI Listing
April 2020

Impact of paced left ventricular dyssynchrony on left ventricular reverse remodeling after cardiac resynchronization therapy.

J Cardiovasc Electrophysiol 2020 02 15;31(2):494-502. Epub 2020 Jan 15.

Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Introduction: We investigated whether pacing-induced electrical dyssynchrony at the time of cardiac resynchronization therapy (CRT) device implantation was associated with chronic CRT response.

Methods And Results: We included a total of 69 consecutive heart failure patients who received a CRT device. Left (LVp-RVs) and right (RVp-LVs) pacing-induced interlead delays were measured intraoperatively and used to determine if there was paced left ventricular (LV) dyssynchrony, defined as present when LVp-RVs is larger than RVp-LVs. CRT response was defined as a reduction in LV end-systolic volume ≥15%, 6 months after implantation. Paced left ventricular dyssynchrony (PLVD) was associated with ischemic cardiomyopathy (ICM) (χ : 8; P = .005) but not with QRS morphology nor with pacing lead positions. In a univariate analysis, PLVD (odds ratio [OR], 6.53; 95% confidence interval [CI], 2.2-18.9; P = .001), atypical left bundle branch block (LBBB) (OR, 3.3; 95% CI, 1.2-9.4; P = .022), and ICM (OR, 5.2; 95% CI, 1.6-17; P = .006) were associated with nonresponse. In a multivariate analysis, both PLVD (OR, 9.74; 95% CI, 2.8-33.9; P < .0001) and atypical LBBB (OR, 5.6; 95% CI, 1.5-20.3; P = .009) were independently associated with nonresponse. Adding PLVD to a model based on QRS morphology provided a significant and meaningful incremental value to predict LV reverse remodeling after CRT (χ to enter: 8; P < .005). Computer simulations corroborate these findings by showing that, while intrinsic electrical dyssynchrony is a prerequisite, the level of pacing-induced dyssynchrony modulates acute CRT response.

Conclusion: In addition to the intrinsic electrical substrate, PLVD is strongly associated with less LV reverse remodeling, demonstrating that measuring the electrical substrate during pacing has additional value for prediction of CRT response in an already well-selected patient population.
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http://dx.doi.org/10.1111/jce.14330DOI Listing
February 2020

Giant right atrial thrombus associated with ICD lead externalized conductors: a case report.

Eur Heart J Case Rep 2018 Jun 4;2(2):yty056. Epub 2018 May 4.

Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate, Brussels, Belgium.

Introduction: Narrow calibre ICD leads are prone to present insulation defects and conductor externalization. Close follow-up of these leads is recommended but as long as their electrical function is maintained, no prophyllactic replacement or extraction is advised. Although the risk of thrombus formation involving externalized conductors has been described, this risk seems considered as negligible compared with the risk of a prophylactic lead extraction. However, when an intracavitar thrombus is identified, the safest therapeutic approach remains undetermined.

Case Presentation: In the present clinical vignette, we describe the case of a giant thrombus developed along the externalized portion of an electrically functional ICD lead. In this case, the thrombus was successfully treated with a systemic oral anticoagulation.

Discussion: This case report supports the concept of a prolonged anticoagulation for both the diagnosis and the long-term treatment of thrombus developed along externalized ICD leads, in particular when the patient prefers to avoid or postpone the risk of a trans-venous lead extraction.
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http://dx.doi.org/10.1093/ehjcr/yty056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176969PMC
June 2018

Interest of waiting time for spontaneous early reconnection after cavotricuspid isthmus ablation: A monocentric randomized trial.

Pacing Clin Electrophysiol 2017 Dec 22;40(12):1440-1445. Epub 2017 Nov 22.

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

Introduction: The aim of this study was to determine the rate of recurrent atrial flutter (AFl) after isolated cavotricuspid isthmus (CTI) ablation and to evaluate the impact of a waiting period with the search for early resumption of the CTI block on the long-term outcome.

Method: Three hundred and nineteen consecutive patients referred for typical AFl ablation were randomly assigned to CTI ablation with continuous reevaluation of the CTI block during 30 minutes and early reablation if needed (waiting time [WT] + group, n  =  155) or to CTI ablation with no waiting period after proven bidirectional CTI block (WT - group, n  =  164). All patients were regularly followed-up.

Result: In the WT+ group, 10 patients (6%) presented a recovery across the CTI (time to recovery: 17 ± 7') and were reablated at the end of the waiting period. After a median follow-up of 21 months, the rate of recurrent AFl was significantly higher in the WT - group as compared to the WT+ group (11.6% [19/164] vs 2.5% [4/155], respectively; P  =  0.007). However, no significant differences in the subsequent rate of AF were observed between the two groups (29% [WT -] vs 32% [WT+], P  =  0.66). During the follow-up, 28 patients from the WT - group underwent a second ablation procedure (16 AFl redo and 12 AF ablation) versus 10 patients form the WT+ group (three AFl redo and seven AF ablation).

Conclusion: Waiting 30 minutes after CTI ablation to check for early resumption and early reablation allows for decreasing significantly the rate of recurrent atrial flutter.
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http://dx.doi.org/10.1111/pace.13207DOI Listing
December 2017

An atypical cause of malignant syncope and sudden cardiac arrest.

Eur Heart J 2016 08 10;37(30):2442. Epub 2016 May 10.

Department of Cardiology, Cliniques Universitaires Saint-Luc, 10, Avenue Hippocrate, Brussels 1200, Belgium.

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http://dx.doi.org/10.1093/eurheartj/ehw194DOI Listing
August 2016

Exercise performance in young patients with complete atrioventricular block: the relevance of synchronous atrioventricular pacing.

Cardiol Young 2016 Aug 22;26(6):1066-71. Epub 2016 Jan 22.

Department of Pediatric Cardiology,Cliniques Universitaires St Luc,Bruxelles,Belgium.

At present, there are many pacing strategies for young patients with complete atrioventricular block. The most frequent policy is to attempt placing a dual-chamber system when possible; however, there is a group of patients that is functioning with a non-synchronous ventricular pacing, raising the question of the ideal timing to upgrade their systems. We investigated the exercise performance of a group of children and young adults with complete atrioventricular block and dual-chamber pacemakers in both single- and dual-chamber pacing modalities. A total of 15 patients performed maximal exercise stress testing after programming the VVIR or DDD modes with 2 hours of interval in a double-blind study protocol. Compared with VVIR pacing, DDD pacing resulted in increase in the peak VO2, longer test duration, major increase in the heart rate achieved during peak exercise, decreased systemic non-invasive arterial blood pressure measured at maximal exercise, higher maximal workload, prolongation of the anaerobic threshold timing, and better self-rated performance perception in all the patients. Synchronous atrioventricular pacing contributes to an increase in both the exercise performance and the performance perception in 100% of the patients. This difference contributes to create a sense of "fitness" with repercussions in the overall health, self-esteem, and life quality, as well as encourages youngster to practice sports. Our experience tends to favour upgrading patients' systems to dual-chamber systems before reaching the adolescent years, even if the centre policy is to prolong as long as possible the epicardial site in order to avoid long years of right ventricular pacing.
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http://dx.doi.org/10.1017/S104795111500178XDOI Listing
August 2016

Unusual cause of transient atrioventricular block during cavotricuspid isthmus ablation for typical right atrial flutter.

Europace 2015 Jul;17(7):1098

Division of Cardiology, Cliniques Universitaires St Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium

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http://dx.doi.org/10.1093/europace/euv200DOI Listing
July 2015

Low contact force and force-time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation.

Europace 2015 Jun 24;17(6):877-83. Epub 2015 Jan 24.

Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.

Aim: After pulmonary vein isolation (PVI), dormant conduction (DC) is present in at least one vein in a substantial number of patients. The present study seeks to determine whether there is a relationship between poor contact forces (CF) and the presence of DC after PVI.

Methods And Results: This prospective, operator-blinded, non-randomized dual-centre trial enrolled 34 consecutive patients with paroxysmal atrial fibrillation who were candidates for PVI. Radiofrequency (RF) energy was delivered by using an irrigated-tip force-sensing ablation catheter (Tacticath, St Jude Medical) at pre-defined target power. The operators were blinded to the CF data at all times. A total of 1476 RF applications were delivered in 743 pre-defined PV segments. For each application, the precise location of the catheter was registered and the following data were extracted from the Tacisys unit: application duration, minimum contact force, maximum contact force, average contact force (CF), and force-time integral (FTI). Sixty minutes after PVI, spontaneous early recovery (ER) of the left atrium (LA) to PV conduction was evaluated. In the absence of ER, the presence of a DC was evaluated by using intravenous adenosine (ATP). In the 34 patients recruited (23 males; mean age: 62 ± 9 years), all PVs were successfully isolated. At the end of the 60 min waiting period, 22 patients demonstrated at least one spontaneous ER or DC under ATP. The mean CF and FTI per PV segment differed significantly among the different veins but the sites of ER and DC were evenly distributed. However, both the minimum, the first and the mean CF and FTI per PV segment were significantly lower in the PV segments presenting either ER or DC as compared with those without ER or DC (mean CF: 4.9 ± 4.8 vs. 12.2 ± 1.65 g and mean FTI: 297 ± 291 vs. 860 ± 81 g s, P < 0.001 for both). Using multivariate analysis, both the mean CF and the FTI per lesion remained significantly associated with the risk of ER or DC. Moreover, a CF < 5 g per PV segment predicted ER+ and DC+ with a sensitivity of 71% and specificity of 82%. In contrast, ER and DC were very unlikely if RF application was performed with a mean CF > 10 g (negative predictive value: 98.7%).

Conclusion: Both a low CF and a low FTI are associated with the ER of the PVI and DC after PVI.
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http://dx.doi.org/10.1093/europace/euu329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447053PMC
June 2015

Asymptomatic late migration of an atrial pacemaker lead into the right lung.

Case Rep Cardiol 2014 12;2014:145917. Epub 2014 Nov 12.

Division of Cardiology, Unit of Electrophysiology and Cardiac Pacing, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.

This report illustrates an unusual case of asymptomatic late cardiac perforation by an atrial pacemaker lead into the right lung. In the present case, the lead was explanted by simple manual traction through the device pocket without any complications.
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http://dx.doi.org/10.1155/2014/145917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244951PMC
December 2014

Evaluation of a new semiautomated external defibrillator technology: a live cases video recording study.

Emerg Med J 2015 Jun 31;32(6):481-5. Epub 2014 Jul 31.

Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.

Aim: To determine the effect of a new automated external defibrillator (AED) system connected by General Packet Radio Service (GPRS) to an external call centre in assisting novices in a sudden cardiac arrest situation.

Method: Prospective, interventional study. Layperson volunteers were first asked to complete a survey about their knowledge and ability to give cardiopulmonary resuscitation (CPR) and use an AED. A simulated cardiac arrest scenario using a CPR manikin was then presented to volunteers. A telephone and semi-AED were available in the same room. The AED was linked to a call centre, which provided real-time information to 'bystanders' and emergency services via GPRS/GPS technology. The scene was videotaped to avoid any interaction with examiners. A standardised check list was used to record correct actions.

Results: 85 volunteers completed questionnaires and were recorded. Mean age was 44±16, and 49% were male; 38 (45%) had prior CPR training or felt comfortable intervening in a sudden cardiac arrest victim; 40% felt they could deliver a shock using an AED. During the scenarios, 56 (66%) of the participants used the AED and 53 (62%) successfully delivered an electrical shock. Mean time to defibrillation was 2 min 29 s. Only 24 (28%) participants dialled the correct emergency response number (112); the live-assisted GPRS AED allowed alerted emergency services in 38 other cases. CPR was initiated in 63 (74%) cases, 26 (31%) times without prompting and 37 (44%) times after prompting by the AED.

Conclusions: Although knowledge of the general population appears to be inadequate with regard to AED locations and recognition, live-assisted devices with GPS-location may improve emergency care.
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http://dx.doi.org/10.1136/emermed-2013-202962DOI Listing
June 2015

Usefulness of tissue Doppler imaging to evaluate pulmonary capillary wedge pressure during exercise in patients with reduced left ventricular ejection fraction.

Am J Cardiol 2014 Jun 3;113(12):2036-44. Epub 2014 Apr 3.

Pôle de recherche cardiovasculaire, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

The early diastolic transmitral velocity/tissue Doppler imaging mitral annular early diastolic velocity (E/e') ratio is used to estimate left ventricular (LV) filling pressures at rest. However, there are only limited data that validate its use during exercise. Accordingly, the aim of this study was to test the ability of E/e' to estimate pulmonary capillary wedge pressure (PCWP) during symptom-limited exercise in patients with LV systolic dysfunction. Forty patients with severe LV dysfunction and heart failure symptoms (54 ± 12 years, 28 men) underwent simultaneous Doppler assessment of E/e' and right-sided cardiac catheterization at rest and during a symptom-limited exercise test, at steady state levels of 30%, 60%, and 90% of their maximal exercise capacity. During exercise, all 40 patients successfully completed stage 1, yielding 40 pairs of data for comparison. Eighteen patients also successfully completed stage 2, and 5 patients also made it through stage 3, yielding 23 additional data pairs. In total, there were thus 63 pairs of data available during exercise. With exercise, heart rate increased from 77 ± 14 to 112 ± 21 beats/min. Septal E/e' at rest correlated well with PCWP at rest (r = 0.75, p <0.01). PCWP at rest also correlated with resting mitral deceleration time (r = 0.32, p <0.01) and with the transmitral E/A ratio (r = 0.74, p <0.01). During exercise, the correlation between septal E/e' and PCWP was weaker (r = 0.57, p <0.01) and was shifted to the right. This rightward shift was observed in patients with both separated or merged E and A velocities. In conclusion, in patients with severe LV dysfunction, although E/e' allows accurate estimation of PCWP at rest, it appears less reliable for estimating LV filing pressure during exercise.
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http://dx.doi.org/10.1016/j.amjcard.2014.03.051DOI Listing
June 2014

Ventricular arrhythmia in a male MS patient on fingolimod.

Acta Neurol Belg 2015 Mar 8;115(1):77-9. Epub 2014 Apr 8.

Neurology Department, Cliniques Universitaires St-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium,

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http://dx.doi.org/10.1007/s13760-014-0297-8DOI Listing
March 2015

Predictive value of the heart rate reserve in patients with permanent atrial fibrillation treated according to a strict rate-control strategy.

Europace 2014 Aug 5;16(8):1125-30. Epub 2014 Mar 5.

Division of Cardiology Unit of rhythmology, Cliniques Universitaires St-Luc, Université catholique de Louvain, 1200 Brussels, Belgium

Aims: Atrial fibrillation (AF) patients treated according to a rate-control strategy seem to have excellent outcomes as long as their ventricular response is kept low. However, the stringency of the rate control to adopt with pharmacologic agents is not clearly defined. In particular, the clinical importance of preserving a heart rate (HR) reserve (HRR) during exercise has not yet been investigated.

Methods And Results: We prospectively analysed the HR response profiles during exercise of 202 patients with permanent AF for whom a strict rate-control strategy was the preferred treatment option. Patients were asked to perform an exercise test on a cycle ergometer until exhaustion. The HRR was defined as the difference between the HR at peak exercise and the resting HR before exercise, divided by the resting HR. Patients were followed-up for at least 24 months or until death or hospitalization for heart failure. The mean resting HR was 80 ± 16 b.p.m. After a median follow-up period of 3 ± 1 years, 31 patients (15.3%) of our initial population (80% male, age 72 ± 12 years) presented either a hospitalization for heart failure (n = 13, 6.4%) or a death (n = 18, 8.9%). Using a univariate analysis, we found that these events correlated with a lower exercise capacity [hazard ratio, HR 0.98, 95% confidence interval, CI (0.96; 0.99), P < 0.001] and a lower HRR [HR 0.30, 95% CI (0.15; 0.60), P < 0.001]. Using a multivariate analysis, both the exercise capacity [HR 0.98, 95% CI (0.97; 0.99), P = 0.008] and the HRR [HR 0.42, 95% CI (0.20-0.87), P = 0.02] remained significantly associated with the outcome. In particular, 4-year survival free from hospitalization for heart failure was better in patients with a preserved HRR (HRR >40%, P < 0.001). No correlation was found between the treatment category (i.e. beta-blockers, calcium channel antagonist, and digoxin) and the HRR.

Conclusion: An impaired HRR in patients with permanent AF treated according to a strict rate-control strategy is associated with an increased risk of hospitalization for heart failure.
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http://dx.doi.org/10.1093/europace/euu033DOI Listing
August 2014

Role of Cardiac Imaging for Catheter-based Left Atrial Appendage Closure.

J Atr Fibrillation 2013 Jun-Jul;6(1):702. Epub 2013 Jun 30.

Division of Cardiology, Cardiovascular Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

Thromboembolic stroke is the most serious complication in patients suffering from Atrial Fibrillation. Atrial thrombi have a predilection to form in the left atrial appendage. Accordingly, oral anticoagulation is recommended for patients with high risk of stroke. However, it is widely underused and problems of compliance are associated with serious risk of bleeding or inefficacy. In these patients with non-valvular atrial fibrillation, percutaneous occlusion of the left atrial appendage might help to reduce the risk of thromboembolism. Cardiac imaging plays a crucial role at all stages of this procedure and trans-esophageal echocardiography represents the current gold-standard for the assessment of the left atrial appendage. Cardiac imaging is mandatory to precisely determine the left atrial appendage anatomy and to select the appropriate size for the device. Finally, real time three-dimension echocardiography is a powerful additional tool that improves the safety profile of the procedure. 3D-transoesophageal echocardiography allows for the accurate assessment of left atrial appendage anatomy and helps determine if it's suitable for device implantation. Finally, it also allows for continuous visualization of all intracardiac devices and catheters during the procedure, and the clear delineation of device positioning in the left atrial appendage.
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http://dx.doi.org/10.4022/jafib.702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153055PMC
June 2013

Automatic external defibrillators in Belgian fitness centres.

Acta Cardiol 2013 Apr;68(2):139-43

Dept. of Cardiology, Cliniques Universitaires Saint Luc, Brussels, Belgium.

Background: The number of fitness centres has increased in Western countries, some proposing specific training programmes (cardiac patients, weight loss or seniors).There is a real risk of cardiovascular events for individuals without cardiovascular evaluation. Fitness centres could represent a place at particularly high risk for sudden cardiac arrest (SCA).

Objective And Methods: In this observational study, we evaluated the number of fitness centres with automatic external defibrillators (AEDs) throughout the French-speaking part of Belgium, their geographic localization, the number of attendees, and the number of SCA reported. Details of AED and SCA were obtained by telephone survey. RESUITS: A total of 51 centres were surveyed. Only 5 (9.8%) had an AED and 68.8% (35/51) of centres had > 1 staff members specifically trained in CPR. Since the opening of these facilities, 5 SCA were reported from 3 centres (5.9%). Only 2 fitness centres had an AED present at the time of the SCA.Two SCA were unwitnessed, and for another 2 victims AED was used without success. Well-conducted CPR (no AED available) resulted in the only survivor of SCA.

Conclusion: The rate of SCA in fitness centres in French-speaking Belgium is comparable to that reported in other countries. AED were available in less than 10% of centres and no CPR trained staff was available in almost one third of the centres.
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http://dx.doi.org/10.1080/ac.68.2.2967270DOI Listing
April 2013

Use of electroanatomic voltage mapping to guide lead implantation in young adults with congenital heart disease.

Acta Cardiol 2012 Aug;67(4):487-9

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

Lead implantation in young adults with congenital heart disease is often problematic due to the reduction in the number of surgical access routes and consequent scar tissue formation related to previous surgery. In such a situation, anatomic and electromagnetic voltage mapping of the heart may be useful to find the optimal implantation site for sensing and pacing activities.
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http://dx.doi.org/10.1080/ac.67.4.2170695DOI Listing
August 2012

A wide QRS complex tachycardia and group beating in a young patient with heart failure: what is the mechanism?

J Cardiovasc Electrophysiol 2013 Feb 7;24(2):231-2. Epub 2012 Aug 7.

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

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http://dx.doi.org/10.1111/j.1540-8167.2012.02411.xDOI Listing
February 2013

Intravenous adenosine to predict conduction recurrence in cavotricuspid isthmus early after ablation of typical atrial flutter: myth or reality?

J Cardiovasc Electrophysiol 2012 Nov 26;23(11):1201-6. Epub 2012 Jun 26.

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

Introduction: Early recovery of conduction (ER) after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl) occurs in approximately 10% of the patients. If not recognized, ER might lead to AFl recurrences. In this study, we hypothesized that intravenous adenosine (iADO) can be used to predict ER in the CTI immediately after RF ablation and distinguish functional block from the complete destruction of the CTI myocardium.

Methods: We prospectively included 68 consecutive patients (age: 65 ± 14 years; male: 78%) referred in our centers for AFl ablation. Immediately after bidirectional isthmus block validation, a bolus of iADO was given during continuous pacing from the proximal coronary sinus. Patients with functional block revealed under iADO (iADO+) and those without (iADO-) were subsequently observed for a 30-minute waiting period (ER-) or until sustained recovery of the conduction through the CTI (ER+).

Results: Seven patients presented a persistent recovery (ER+, 10.3%, mean time to recovery: 14 ± 9 minutes). None of them presented even a transient resumption of conduction under iADO (iADO+: 0). With univariate analysis, we identified a heavy patient weight (>95 kg) as a predictor of ER (sensitivity: 71%).

Conclusions: Adenosine does not predict early recovery in the CTI after linear ablation for atrial flutter. We found that a patient weight over 95 kg predicted early recovery of conduction through the CTI with a sensitivity of 71%.
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http://dx.doi.org/10.1111/j.1540-8167.2012.02384.xDOI Listing
November 2012

Severe acute cardiomyopathy associated with venlafaxine overdose and possible role of CYP2D6 and CYP2C19 polymorphisms.

Clin Toxicol (Phila) 2011 Nov;49(9):865-9

Cliniques St-Luc, Université Catholique de Louvain, Intensive Care, Avenue Hippocrate 10, Brussels, 1200 Belgium.

Introduction: Venlafaxine (VEN) is a serotonin-norepinephrine-dopamine reuptake inhibitor that causes usually a mild cardiotoxicity when ingested in overdose. We report a patient who developed acute heart failure following overdose. As the toxicokinetic data suggested a prolonged metabolism, genetic polymorphisms for cytochrome P450 isoenzymes CYP2D6 and CYP2C19 were also investigated.

Case Report: A 34-year-old woman was admitted to the hospital 10 hours after the ingestion of an 11.25 g overdose of VEN. She was comatose and suffered two self-limited seizures. The electrocardiogram showed diffuse ST segment depression, but normal QRS and QTc duration. The plasma levels on admission were 18,015 and 3,846 ng/ml for VEN and the metabolite O-desmethylvenlafaxine (ODV), respectively. The patient developed severe cardiodepression. The left ventricular shortening fraction was only 9% on echocardiography. The patient was oliguric and required continuous venovenous hemofiltration. The administration of milrinone was required for 12 days, and norepinephrine for 10 days. Left ventricular function recovered. The calculated elimination half-life was 30.8 and 72.2 hours for VEN and ODV, respectively. The patient genotype was CYP2D6*1/*5, the *5 allele corresponding to a complete deletion of CYP2D6 gene.

Conclusions: Severe and sustained cardiotoxicity following VEN overdose may be related to the amount ingested, as well as to the genetic polymorphism for CYP2D6 leading to a delayed elimination of active metabolite.
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http://dx.doi.org/10.3109/15563650.2011.626421DOI Listing
November 2011

Long-term follow-up of DDD and VDD pacing: a prospective non-randomized single-centre comparison of patients with symptomatic atrioventricular block.

Europace 2012 Apr 8;14(4):496-501. Epub 2011 Nov 8.

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Avenue Hippocrate 10-2888, Brussels, Belgium.

Aims: This prospective non-randomized single-centre registry compared clinical outcome, pacing parameters, and long-term survival in patients receiving VDD or DDD pacemaker (PMs) for symptomatic atrioventricular (AV) block.

Methods And Results: Single-lead VDD (n= 166) and DDD (n= 254) PMs were implanted in 420 successive patients with isolated AV block between January 2001 and December 2009. At the end of the follow-up period [median 25 (1-141) months], there was no difference in the incidence of atrial fibrillation [11.2% in the VDD group; 11.4% in the DDD group (P= 0.95)], myocardial infarction [31.1% in the VDD group; 25.2% in the DDD group (P= 0.20)], or dilated cardiomyopathy [9.9% in the VDD group; 8.9% in the DDD group (P= 0.74)]. At last follow-up, 65.9% of the VDD PMs and 89.3% of the DDD PMs were still programmed in their original mode with good atrial sensing. Due to permanent atrial fibrillation, 7.9% patients out of the VDD group had been switched to VVIR mode and 8.7% patients out of the DDD group to VVIR or DDIR mode. The P-wave amplitude was poor (sensed P-wave <0.5 mV) in 19.1% of the VDD PM and 1.6% of the DDD PM (P< 0.001) and 7.1% of the VDD patients and 0.4% of the DDD patients had been switched to VVIR pacing mode due to P-wave undersensing and AV dissociation (P= 0.003). Symptomatic atrial undersensing requiring upgrading was similar in both groups. The overall survival, adjusted for age, was not significantly different in the VDD and the DDD group (log rank: 0.26). Moreover, Cox survival analysis excluded the pacing mode as a significant predictor of mortality [hazard ratio (HR) = 0.79, confidence interval (CI) (0.46-1.35), P= 0.39].

Conclusion: Comparing VDD and DDD pacing, a significantly larger number of VDD-paced patients developed poor atrial signal detection without clinical impact. However, atrial under sensing did not influence the incidence of atrial fibrillation, myocardial infarction, dilated cardiomyopathy, or mortality.
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http://dx.doi.org/10.1093/europace/eur345DOI Listing
April 2012

Left atrial appendage occlusion and pulmonary vein isolation: interest of non-invasive imaging.

Acta Cardiol 2011 Oct;66(5):653-6

Division of Cardiology, Cardiovascular Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.

A 67-year-old woman with paroxysmal atrial fibrillation (AF), not a candidate for anticoagulant therapy, underwent a combined procedure of pulmonary vein isolation (PVI) and occlusion of the left atrial appendage (LAA) with the Amplatzer cardiac plug prosthesis (AGA Medical Corporation, Plymouth, U.S.A.). After PVI, implantation of the Amplatzer cardiac plug was performed under transoesophageal echocardiography guidance after a complete evaluation of the LAA obtained by different imaging techniques. One month later, multidetector computed tomography and transoesophageal echocardiography confirmed proper position of the Amplatzer cardiac plug not interfering with the surrounding structures and the absence of complications resulting from either PVI or LAA closure.
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http://dx.doi.org/10.1080/ac.66.5.2131094DOI Listing
October 2011