Atrial fibrillation and its determinants after radiofrequency ablation of chronic common atrial flutter

Aim. Atrial fibrillation (AFib) is a major clinical issue and its occurrence is the main problem after catheter ablation of atrial flutter. The long-term occurrence of AFib after common atrial flutter ablation is still matter of debate as it may influence the therapeutic approach. So, the aim of our study was to analyze the determinants and the time course of AFib after radiofrequency catheter ablation of chronic common atrial flutter. Methods and Results. 89 consecutive patients (67.5 ± 12.0 yrs) underwent RF ablation of chronic common atrial flutter. 38.2 % had previous history of paroxysmal AFib. 51% had no underlying structural heart disease. Over a mean follow-up of 38 ± 13 months, the occurrence rate of AFib progressively increased up to 32.9% at the end of follow-up. The median occurrence time for AFib was 8 months. AFib occurrence was significantly associated with previous AFib history (P=0.01) but not with the presence of underlying heart disease (P=n.s.). Of particular interest, in our study, AFib never occurred in patients without previous AFib history. Palpitations after chronic common atrial flutter ablation was mostly related to AFib. Conclusion. In conclusion, after chronic common atrial flutter ablation, AFib incidence progressively increased over the follow-up in all patients. Patients with prior AFib history appeared to be a very high risk group. In these patients, closer monitoring is mandatory and the persistent risk of AFib recurrences may justify prolonged anticoagulation policy

Etude de la fonction ventriculaire droite (apport de l'imagerie de déformation myocardique et impact d'une stimulation ventriculaire droite)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Suivi à long terme de l'ablation par radiofréquence des flutters auriculaires

MONTPELLIER-BU Médecine (341722104) / SudocMONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Suivi des patients opérés d'une tétralogie de Fallot (quels indices échocardiographiques de fonction ventriculaire droite?)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Evolution des déformations myocardiques à l'effort dans la cardiomyopathie hypertrophique (une étude en Speckle Tracking Imaging)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Normal Ejection Fraction Is Associated With Severe Left Ventricular Dysfunction as Assessed by Speckle-Tracking Echocardiography: A Multicenter Study.

Background- Low-flow low-gradient (LFLG) is sometimes observed in severe aortic stenosis (AS) despite normal ejection fraction, but its frequency and mechanisms are still debated. We aimed to describe the characteristics of patients with LFLG AS and assess the presence of longitudinal left ventricular dysfunction in these patients. Methods and Results- In a multicenter prospective study, 340 consecutive patients with severe AS and normal ejection fraction were studied. Longitudinal left ventricular function was assessed by 2D-strain and global afterload by valvulo-arterial impedance. Patients were classified according to flow and gradient: low flow was defined as a stroke volume index ≤35 mL/m(2), low gradient as a mean gradient ≤40 mm Hg. Most patients (n=258, 75.9%) presented with high-gradient AS, and 82 patients (24.1%) with low-gradient AS. Among the latter, 52 (15.3%) presented with normal flow and low gradient and 30 (8.8%) with LFLG. As compared with normal flow and low gradient, patients with LFLG had more severe AS (aortic valve area=0.7±0.12 cm(2) versus 0.86±0.14 cm(2)), higher valvulo-arterial impedance (5.5±1.1 versus 4±0.8 mm Hg/mL/m(2)), and worse longitudinal left ventricular function (basal longitudinal strain=-11.6±3.4 versus -14.8±3%; P<0.001 for all). Conclusions- LFLG AS is observed in 9% of patients with severe AS and normal ejection fraction and is associated with high global afterload and reduced longitudinal systolic function. Patients with normal-flow low-gradient AS are more frequent and present with less severe AS, normal afterload, and less severe longitudinal dysfunction. Severe left ventricular longitudinal dysfunction is a new explanation to the concept of LFLG AS

Occurrence of Incomplete Endothelialization Causing Residual Permeability After Left Atrial Appendage Closure.

International audiencePercutaneous left atrial appendage (LAA) occlusion is occasionally incomplete, with residual permeability of the LAA on cardiac computed tomography. The cause for this is unclear. Our objective was to determine if residual permeability was related to incomplete endothelialization

325: Ivabradine and dobutamine associated as a pure inotropic drug in cardiogenic shock?

IntroductionDobutamine remains gold-standard treatment in cardiogenic shock. However, it exacerbates tachycardia, worsening heart failure. Ivabradine, a specific inhibitor of If channel, could reduce this deleterious effect in association with dobutamine in patients with cardiogenic shock.We report the case of a 41-year-old woman admitted in intensive care unit for a severe heart failure with hemodynamic shock. She had no medical history.She suffered from thoracic and epigastric pain and cholecystis was initially diagnosed with an indication of sphincterotomy. However, her clinical status progressively worsened with severe dyspnea and global heart failure requiring appropriate treatment. ECG showed inverted T waves in the lateral leads and echocardiography showed a dilated cardiomyopathy with severe systolic alteration (LVEF: 35%). Coronary angiogram was strictly normal. Finally, no evidence was found on cardiac MRI for ischemic process or myocarditis. She progressively worsened with renal and hepatic dysfunction. Troponin and inflammation markers remained negative. It was necessary to introduce dobutamine and intravenous diuretics but we noticed an initial increase in heart rate concomitantly with blood pressure. We added ivabradine in order to reduce heart rate without effect on blood pressure (fig). Her clinical status improved and dobutamine could be stopped after 5 days and beta-blockers were then introduced.DiscussionHeart rate is a well-known marker of prognosis and tachycardia worsened by dobutamine could be deleterious to evolution of patient with cardiogenic shock. Ivabradine could be helpful in reducing heart rate without effect on blood pressure. However, this drug is indicated in stable heart failure but, to this day, hemodynamic instability is excluded. New prospective studies seem necessary to evaluate this benefit.ConclusionIn cardiogenic shock, association of dobutamine and ivabradine could be interesting to create a pure inotropic drug

083: Medical hypothesis: heart rate on admission and CRP are correlated, in acute pericarditis: a link between heart rate and pericardial inflammation?

IntroductionRest is usually recommended in acute pericarditis, as it could help to lower heart rate (HR) and contribute to limit “mechanical inflammation”. Whether HR on admission could be correlated and perhaps participate to inflammation has not been reported.MethodsBetween March 2007 and February 2010, we conducted a retrospective study on all patients admitted in our center for acute pericarditis. Diagnosis criteria included 2 among the following: typical chest pain, friction rub, pericardial effusion on cardiac echography, or typical ECG findings. Primary endpoint was biology: CRP on admission, on days 1, 2, 3, and especially peak. We evaluated also recurrences and clinical events during hospitalization and at one month.ResultsWe included 73 patients. Median age was 38.0 y (CI 25-75% 28.0-51.0) and median hospitalization duration was 2.0 d (1.5-3.0). 27% of the patients presented pericardial effusion. Heart rate on admission was 88.0 bpm (CI 25-75%: 76.0-100.0) and on discharge 72.0 (65.0-80.0)). Heart rate on admission was significantly correlated with CRP on admission (r=0.34, n=69; p=0.004), CRP peak (r=0.54; n=61; p<0.0001), CRP on discharge (r=0.32; p=0.021) and temperature on admission (r=0.40; n=39; p=0.01). Multivariate analysis showed that HR on admission is associated with an elevated CRP peak, independently of temperature on admission. Fever was scarcely observed (19.5%), and was neither correlated to HR nor CRP, after multivariate analysis.ConclusionIn acute pericarditis, HR on admission is independently correlated with CRP levels. These observations could suggest a link between HR and pericardial inflammation