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

Enseignement de la cardiologie du 2e cycle des études médicales dirigé par informatique (développement d'un cédérom)

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

SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements

International audienc

L’hypertriglycéridémie est-elle athérogène ?

International audienceASCVD reduction is based on LDL reduction, especially by statins. Highly elevated TG could be harmful, especially because of the risk of pancreatitis. Elevation of TG is mainly due to metabolic disorders and diabetes, alcohol intake and overweight. Genetic factors have been clearly identified in the most severe cases. TG have been generally considered as bystanders for cardiovascular diseases (CVD). Both biological and basic research provide strong data suggesting that TG-rich lipoproteins could be involved in the pathophysiology of CVD. Recent epidemiological and genetics studies strongly corroborate the causal role of TG in CVD. This paves the way for new approaches in the management of patients both for primary and secondary prevention.La prévention de la maladie athéroscléreuse est fondée sur la réduction du taux de LDL, particulièrement par l’utilisation de statines. Des taux élevés de triglycérides (TG) peut être dangereuse, en particulier à cause du risque de pancréatite. L’augmentation des TG est principalement liée aux anomalies métaboliques et au diabète, la consommation d’alcool et le surpoids. Des facteurs génétiques ont été identifiés dans les cas les plus sévères. Les TG sont généralement considérés comme des témoins des maladies cardiovasculaires. Les approches biologiques et la recherche fondamentale apportent des démonstrations suggérant que les lipoprotéines riches en TG pourraient être impliquées dans la physiopathologie des maladies cardiovasculaires. Des études épidémiologiques et génétiques récentes confortent puissamment le rôle causal des TG dans les maladies cardiovasculaires. Cela prépare le terrain pour des nouvelles approches thérapeutiques en prévention primaire et secondaire

Vascular complications and bleeding after balloon aortic valvuloplasty performed with or without heparin: HEPAVALVE randomized study

International audienceBackground: Vascular and bleeding events remain the main complications after balloon aortic valvuloplasty (BAV). While BAV is usually performed with per procedural heparin injection, BAV performed without heparin may reduce hemorrhagic events. We aimed to determine whether vascular and bleeding complications may be reduced with BAV performed without heparin.Methods: This randomized, double-blind, placebo-controlled study was conducted from January 2013 to September 2016. Patients were randomly assigned to placebo or intravenous unfractionated heparin (UH) 50 IU/kg bolus during the procedure. The primary endpoint included major vascular, bleeding and ischemic complications (stroke, transient ischemic attack, myocardial infarction) according to VARC-2 criteria.Results: Among 89 randomized patients, 82 completed the study (n = 39 in the UH group and n = 43 in the placebo group). At baseline, diabetes, sex male and renal failure were more frequent in the UH group and peripheral artery disease was more frequent in the placebo group. The primary endpoint was achieved in 7 patients (8.5%), 1 in the placebo group (2.3%) versus 6 in the UH group (15.4%). After adjustment on diabetes, sex, renal failure, peripheral artery disease, percutaneous closure device and chronic obstructive pulmonary disease, UH utilization was associated with a significant risk of major vascular, bleeding and ischemic complications (primary endpoint) (adjOR: 11.9; 95%CI: 1.2-117.2; p = 0.03). Hospitalization length was lower in the placebo group compared to the UH group (p = 0.03).Conclusions: BAV without per procedural UH was associated with a reduction of major VC and bleeding events without increasing the ischemic risk and with a shorter hospitalization length

An hs-TNT Second Peak Associated with High CRP at Day 2 Appears as Potential Biomarkers of Micro-Vascular Occlusion on Magnetic Resonance Imaging after Reperfused ST-Segment Elevation Myocardial Infarction

International audienceMicro-vascular occlusion (MVO) in a myocardial infarction (MI) is associated with an increased risk of heart failure and mortality. Hs-T-troponin has a double peak kinetic after MI. The aim was to determine if this kinetic was correlated to MVO evaluated by cardiac magnetic resonance imaging (MRI) after MI

The origin of Patagonia revealed by Re-Os systematics of mantle xenoliths

We present mineral chemistry and whole rock major, trace, and platinum group element (PGE) concentrations, and Re-Os isotope data for eighteen mantle xenoliths carried to the surface of southern Patagonia (45°–52°S) by Paleocene to Pleistocene alkaline basalts in seven localities scattered widely across southern South America. The new data along with those previously published show that peridotites derived from the lithospheric mantle of the Deseado Massif (DM), southern Patagonia, have compositions indicative of higher degrees of partial melt extraction compared to those from surrounding regions. Re-depletion model ages (TRD) of mantle xenoliths from the DM (n = 20) range from 0.5 to 2.1 Ga, with an average of 1.5 Ga. In contrast, samples from the surrounding areas (n = 39) have a wider range of Re-depletion ages from 0.0 to 2.5 Ga, with an average of 1.0 Ga. Similar geochemical characteristics are recognized between the lithospheric mantle section of the DM and that beneath East Griqualand (∼1.1 Ga), south-eastern Africa, which is related to the Proterozoic Namaqua-Natal Province. The Re-Os systematics of the mantle xenoliths are indicative of Meso to Paleoproterozoic ages for partial melting and stabilization processes of the lithospheric mantle of southern Patagonia, which are considerably older than the crystallization ages obtained for the scarce basement rocks of Patagonia (<0.6 Ga). In addition, published elastic thickness (Te) estimates of southern South America show maximum values on the submerged continental region located between the DM and the Malvinas/Falkland Islands, where Grenville-age metamorphic rocks are exposed. These geochemical and geophysical results suggest that southern Patagonia and the Malvinas/Falkland Islands and plateau constitute an integrated and relatively rigid continental block formed mainly during the Meso to Paleoproterozoic as part of the supercontinent Rodinia. To the north, the formation of the North Patagonian Massif (NPM) seems to be contemporaneous with that of the DM. Nevertheless, its ancient lithospheric mantle and lower crust appear to have been widely eroded and replaced by relatively young convecting mantle, possibly during the Carboniferous collision between the DM and the NPM. The differences between the DM and NPM lithosphere histories apparently controlled the subsequent formation and distribution of Jurassic epithermal Au-Ag deposits.Fil: Schilling, Manuel Enrique. Universidad Austral de Chile. Facultad de Ciencias. Instituto de Ciencias de la Tierra; ChileFil: Carlson, Richard Walter. Carnegie Institution for Science; Estados UnidosFil: Tassara, Andrés. Universidad de Concepción; ChileFil: Conceição, Rommulo Vieira. Universidade Federal do Rio Grande do Sul; BrasilFil: Bertotto, Gustavo Walter. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Vásquez, Manuel. Universidad de Chile. Facultad de Ciencias Físicas y Matemáticas. Departamento de Geología; ChileFil: Muñoz, Daniel. Universidad de Chile. Facultad de Ciencias Físicas y Matemáticas. Departamento de Geología; ChileFil: Jalowitzki, Tiago. Universidade Federal do Rio Grande do Sul; BrasilFil: Gervasoni, Fernanda. Westfalische Wilhelms Universitat; Alemani

Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest

International audienceBackground: Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial.Methods: All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality.Results: Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% (n = 55) of patients, mainly in group 1 (n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 (n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85–25.00]; p = 0.004 and adj. OR = 11.10 [3.70–33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups (n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014).Conclusion: Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders

Prior balloon valvuloplasty versus DIRECT transcatheter Aortic Valve Implantation (DIRECTAVI): study protocol for a randomized controlled trial

Abstract Background Balloon predilatation of the aortic valve has been regarded as an essential step during the transcatheter aortic valve implantation (TAVI) procedure. However, recent evidence has suggested that aortic valvuloplasty may cause complications and that high success rates may be obtained without prior dilatation of the valve. We hypothesize that TAVI performed without predilatation of the aortic valve and using new-generation balloon-expandable transcatheter heart valves is associated with a better net clinical benefit than TAVI performed with predilatation. Methods/design The transcatheter aortic valve implantation without prior balloon dilatation (DIRECTAVI) trial is a randomized controlled open label trial that includes 240 patients randomized to TAVI performed with prior balloon valvuloplasty (control arm) or direct implantation of the valve (test arm). All patients with an indication for TAVI will be included excepting those requiring transapical access. The trial tests the hypothesis that the strategy of direct implantation of the new-generation balloon-expandable SAPIEN 3 valve is noninferior to current medical practice using predilatation of the valve. The primary endpoint assessing efficacy and safety of the procedure consists of immediate procedural success and secondary endpoints include complications at 30-day follow-up (VARC-2 criteria). A subgroup analysis evaluates neurological ischemic events with cerebral MRI imaging (25 patients in each strategy group) performed before and between 1 and 3 days after the procedure. Discussion This prospective randomized study is designed to assess the efficacy and safety of TAVI performed without prior dilatation of the aortic valve using new-generation balloon-expandable transcatheter heart valves. We aim to provide robust evidence of the advantages of this strategy to allow the interventional cardiologist to use it in everyday practice. Trial registration ClinicalTrials.gov identifier: NCT02729519 . Registered on 15 July 2016