2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

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Apport de la technique de topostimulation ventriculaire pour localiser l'isthme des circuits de réentrée des tachycardies ventriculaires post infarctus

Cette étude rétrospective monocentrique porte sur 10 procédures d'ablation par radiofréquence, guidées par cartographie,électro-anatomique, de tachycardies ventriculaires (TV) post infarctus sélectionnées parmi 120 procédures d'ablation réalisées pour cette même indication entre 1998 et 2006 au CHU de Nancy. L'étude a pour but d'évaluer la valeur de la topostimulation ventriculaire gauche (VG) pour identifier, en rythme sinusal, la localisation de l'isthme des circuits de réentrée des TV post-infarctus. La méthodologie consistait à réaliser une cartographie 3D du VG (avec le système de cartographie CARTO®) en rythme sinusal puis en TV. Les sites de topostimulation VG repérés sur la carte en rythme sinusal permettaient de reconstruire une cartographie particulière du VG sur laquelle on pouvait visualiser la concordance morphologique - exprimée en pourcentage de corrélation - entre les ORS de l'ECG de surface, obtenus en différents sites de stimulation ventriculaires, aux ORS de la TV induite. L'analyse statistique montre que les sites de stimulation VG au niveau de la zone de sortie de l'isthme de la TV présentent une excellente concordance morphologique avec les ORS de la TV. La topostimulation permet ainsi de localiser la zone de sortie de l'isthme de la TV avec une très bonne sensibilité (>80%) et une très bonne spécificité (76-83%) pmtr des valeurs seuil de pourcentage de corrélation morphologique >75%. Par contre, la sensibilité, la spécificité et la valeur prédictive positive de la topostimulation sont médiocres pour l'identification de la zone centrale ou la zone d'entrée de l'isthme de la TV. Notre étude suggère que la technique de topostimulation ventriculaire comparative permet de localiser de façon assez précise les zones d'émergence "post-isthmique" des TV post infarctus. A partir de l'identification topographique de ces zones, il nous paraît possible de déduire la localisation de la zone d'entrée et donc de l'isthme des TV post infarctus dans la grande majorité des cas. Cette méthode polytechnique, mêlant topostimulation, cartographie 3D· et comparaison informatisée des signaux électrocardiographiques, paraît prometteuse pour le traitement endocavitaire des TV post infarctus instables. Des études spécifiques sont toutefois nécessaires pour valider cette méthode dans ce contexte.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Is radiofrequency energy a necessary and safe complement to cryotherapy for successful pulmonary vein isolation?

Introduction: Pulmonary vein (PV) isolation is considered the cornerstone of atrial fibrillation (AF) catheter ablation. PV isolation (PVI) by means of cryotherapy has emerged as a promising technique due to both a low thrombogenicity and reduced risk of PV stenosis. The evaluation (need/efficiency/safety) of hybrid therapy (defined as the use of cryotherapy followed by that of radiofrequency energy in a given patient) is the aim of the present study. Methods: Thirty-four consecutive patients (26 men, mean age: 56.7 ± 9.3 years) with symptomatic drug-refractory paroxysmal AF underwent PVI using a balloon-cryotherapy (BCT). A maximum of four cryotherapy applications was applied per PV and disconnection assessed thereafter using a circular LASSO® catheter. When necessary, PV disconnection was then performed using a 4 mm irrigated-tip catheter. All patients underwent CT-scan evaluation before discharge to detect acute PV stenosis. Results: PVI could be achieved in all patients. Mean procedure duration was 230 ± 42 min and mean fluoroscopy time was 52 ± 13 min. Hybrid therapy was needed to achieve PVI in 26 of 34 (76%). With cryoablation solely, PVI was achieved in 90 of 136 (66%) targeted veins, efficacy being higher in superior as compared to inferior PVs (87% vs. 46%, p < 0.001). Besides one patient with permanent right phrenic nerve injury, no other procedure-related complications were observed. After a mean follow-up period of 8 ± 3 months, 28 patients (82%) did not experience AF recurrence (including six patients on antiarrhythmic drugs). Conclusions: Our study suggests that hybrid ablation therapy is necessary in most patients to achieve PV disconnection after a maximum of four blinded applications of balloon-cryotherapy (especially in inferior PVs), with a significant short-term success rate

180 Is it a risk of stroke in Wolff Parkinson White syndrome?

Atrial fibrillation (AF) is a major cause of stroke. AF incidence is increased in Wolff-Parkinson-White syndrome (WPW), represents about 10% of spontaneous arrhythmias and has several mechanisms as the degeneration of atrioventricular reentrant tachycardia (AVRT) into AF, the AF facilitation by the atrial insertion of accessory pathway (AP) or another origin. The purpose of study was to assess the incidence of stroke in patients (pts) who had a preexcitation syndrome.Population707 pts aged from 5 to 85 years (mean 34.5±17) were studied for a WPW: 93 pts had unexplained syncope; 247 pts were asymptomatic; 367 pts had spontaneous tachycardias; among these pts 52 had documented AF. Electrophysiological study (EPS) consisted of atrial pacing and programmed atrial stimulation in control state and if necessary after infusion of isoproterenol. Clinical and electrophysiological data were collected.ResultsStroke was noted in 5 pts (0.7%), 2 women, 3 men aged from 53 to 75 years. They had a normal carotid and transcranial Doppler ultrasonography. One pt had ischemic heart disease and the remaining pts had no heart disease. Their age was significantly older than remaining population (62±9 years vs 34±17) (p<0.0002). Only one pt had spontaneous AF; 51 other pts with spontaneous AF had no stroke. One of 247 was asymptomatic; one pt of 93 had syncope and 2 pts of 315 had spontaneous AVRT. At EPS, one asymptomatic pt had AP with long refractory period and no inducible tachycardia. Two pts with spontaneous tachycardias had only inducible AVRT and the pt with spontaneous AF had inducible antidromic tachycardia and AF. The pt with syncope had only inducible AF. These electrophysiological data did not differ from the remaining population. Anticoagulants were maintained after AP ablation, although the disappearance of arrhythymias.ConclusionsThe risk of stroke in WPW syndrome is very low (0.7%). Only one clinical factor differs significantly from remaining population, the relatively old age (mean 62±9 years). All other clinical factors as sex, associated heart disease, spontaneous symptoms and all electrophysiological data did not differ from remaining population

Major Bleeding of Transjugular Native Kidney Biopsies. A French Nationwide Cohort Study

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2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)

© 2020 European Society of Cardiology. All rights reserved.Atrial fibrillation (AF) poses significant burden to patients, physicians, and healthcare systems globally. Substantial research efforts and resources are being directed towards gaining detailed information about the mechanisms underlying AF, its natural course and effective treatments (see also the ESC Textbook of Cardiovascular Medicine: CardioMed) and new evidence is continuously generated and published. The complexity of AF requires a multifaceted, holistic, and multidisciplinary approach to the management of AF patients, with their active involvement in partnership with clinicians. Streamlining the care of patients with AF in daily clinical practice is a challenging but essential requirement for effective management of AF. In recent years, substantial progress has been made in the detection of AF and its management, and new evidence is timely integrated in this third edition of the ESC guidelines on AF. The 2016 ESC AF Guidelines introduced the concept of the five domains to facilitate an integrated structured approach to AF care and promote consistent, guideline-adherent management for all patients. The Atrial Fibrillation Better Care (ABC) approach in the 2020 ESC AF Guidelines is a continuum of this approach, with the goal to further improve the structured management of AF patients, promote patient values, and finally improve patient outcomes.info:eu-repo/semantics/publishedVersio

2019 ESC guidelines for the management of patients with supraventricular tachycardia : the Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC) : developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC)

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