Tachyarrhythmias in structural heart disease

Ventricular tachyarrhythmias, the major cause of sudden unexpected cardiac arrest, occur specifically in patients with structural heart disease. In general, all types of structural heart disease may lead to chronic heart failure, a severe condition with an additional high risk of atrial- and ventricular tachyarrhythmias. The thesis starts with a general overview (chapter 1) of the epidemiology, pathofysiology, prognosis and therapeutical options of heart failure. In this overview all subjects of study of the following chapters are introduced and explained. Next, attention is focused on clinical ventricular tachyarrhythmias. Chapter 2-5 of this thesis aim at evaluating the diagnostic approach, the therapeutical option of radiofrequency catheter ablation and the risk of recurrences in patients who had presented with a (malignant) ventricular tachyarrhythmia. The second part of this thesis (chapter 6-9) evaluates the effect of cardiac resynchronization therapy -a novel treatment option in patients suffering from heart failure- on the occurrence of atrial- and ventricular tachyarrhythmias. In addition the effect of cardiac resynchroniation therapy on patients with diabetes mellitus is evaluated.LEI Universiteit Leiden(N.B.the sponsors mentioned herebelow contributed only to the printing costs, and have no bearing whatsoever on the contents of this dissertation). Biosense Webster/Johnson & Johnson Medical BV, Guidant Nederland BV, Medtronic BV, St Jude Medical Nederland BV, Biotronik Nederland BV, Boston Scientific Nederland, Bristol-Meyers Squibb BV, Astra Zeneca BV, Boehringer Ingelheim BV, Merck, Sharp & Dohme BV, Scheringh-Plough BV, Siemens Nederland NV, Toshiba Medical Systems Nederland BV, Pfizer BV, Datascope BV, Sanofi-Aventis Netherlands BV and Novartis Pharma BVCardiale disfunctie en ritmestoornisse

Échos des voix, échos des textes. Mélanges en l’honneur de Béatrice Périgot, contributions réunies par Odile Gannier et Véronique Montagne

Conçu comme la continuation d’un dialogue prématurément interrompu, ce volumineux recueil de mélanges rend hommage à Béatrice Périgot, disparue en juin 2009. Par sa dimension mémorielle, l’ouvrage excède les ambitions d’une recension : il débute par une série d’hommages et de témoignages, notamment sous forme de photographies, en l’honneur de l’enseignante, de la chercheuse, de l’amie mais aussi de la mère que fut Béatrice Périgot. Parcours de vie, idéal conversationnel et érudition sont inti..

Patient information portal for congenital aortic and pulmonary valve disease:A stepped-wedge cluster randomised trial

Background In response to an increased need for patient information in congenital heart disease, we previously developed an online, evidence-based information portal for patients with congenital aortic and pulmonary valve disease. To assess its effectiveness, a stepped-wedge cluster randomised trial was conducted. Methods Adult patients and caregivers of paediatric patients with congenital aortic and/or pulmonary valve disease and/or tetralogy of Fallot who visited the outpatient clinic at any of the four participating centres in the Netherlands between 1 March 2016-1 July 2017 were prospectively included. The intervention (information portal) was introduced in the outpatient clinic according to a stepped-wedge randomised design. One month after outpatient clinic visit, each participant completed a questionnaire on disease-specific knowledge, anxiety, depression, mental quality of life, involvement and opinion/attitude concerning patient information and involvement. Results 343 participants were included (221 control, 122 intervention). Cardiac diagnosis (p=0.873), educational level (p=0.153) and sex (p=0.603) were comparable between the two groups. All outcomes were comparable between groups in the intention-to-treat analyses. However, only 51.6% of subjects in the intervention group (n=63) reported actually visiting the portal. Among these subjects (as-treated), disease-specific knowledge (p=0.041) and mental health (p=0.039) were significantly better than in control subjects, while other baseline and outcome variables were comparable. Conclusion Even after being invited by their cardiologists, only half of the participants actually visited the information portal. Only in those participants that actually visited the portal, knowledge of disease and mental health were significantly better. This underlines the importance of effective implementation of online evidence-based patient information portals in clinical practice.Cardiolog

The potential of sodium-glucose cotransporter 2 inhibitors for the treatment of systemic right ventricular failure in adults with congenital heart disease

AimsGiven the compelling evidence on the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the conventional heart failure population, SGLT2i deserve exploration in systemic right ventricular (sRV) failure. The initial experience with dapagliflozin in sRV failure patients is described, with a focus on tolerability and short-term effects on clinical outcomes.Methods and resultsTen patients (70% female, median age 50 years [46.5–52]) with symptomatic sRV failure who received dapagliflozin 10 mg per day on top of optimal medical therapy between 04–2021 and 01–2023 were included. Within 4 weeks, no significant changes in blood pressure, electrolytes, or serum glucose occurred. Creatinine and estimated glomerular filtration rate (eGFR) showed a slight decline (88 ± 17 to 97 ± 23 µmol/L, p = 0.036, and 72 ± 14 vs. 66 ± 16 ml/min/1.73m2, p = 0.020, respectively). At 6 months follow-up (n = 8), median NT-proBNP decreased significantly from 736.6 [589.3–1193.3] to 531.6 [400.8–1018] ng/L (p = 0.012). Creatinine and eGFR recovered to baseline levels. There were no significant changes in echocardiographic systolic sRV or left ventricular function. New York Heart Association class improved significantly in 4 out of 8 patients (p = 0.046), who also showed an improvement in the 6-minute walk test or bicycle exercise test performance. One female patient developed an uncomplicated urinary tract infection. No patients discontinued treatment.ConclusionDapagliflozin was well-tolerated in this small cohort of sRV failure patients. While the early results on the reduction of NT-proBNP and clinical outcome parameters are encouraging, large-scale prospective studies are warranted to thoroughly evaluate the effects of SGLT2i in the growing sRV failure population

"Rencontrer en devisant" : facetious conversation in the bigarré works of the 1580’s (Du Fail, Cholières, Bouchet)

Autour de l’année 1585 paraissent en France des recueils dialogués cultivant l’hybridité formelle et le mélange des tons : les Contes et discours d’Eutrapel de Noël du Fail, les Matinées et les Apresdisnées de Cholières ainsi que les Serées du libraire-imprimeur poitevin Guillaume Bouchet. Exploitant une des potentialités du Décaméron de Boccace, ils mettent l’accent sur la pratique des « devis », c’est-à-dire sur les conversations nouées par des compagnies conteuses. Ces « contes et discours bigarrez » font alterner les bribes de nouvelles, les anecdotes plaisantes et les railleries avec les matières les plus graves, fiches historiques, apophtegmes édifiants et développements juridiques. En un curieux mélange, l’art de « rencontrer » (de dire des bons mots) s’y mêle à l’érudition la plus ostentatoire. Au carrefour de l’histoire des formes littéraires et de la sociabilité, les notions de « facétie » et de « devis » permettent d’interroger la singularité de ces textes, en termes à la fois poétiques et sociaux. Le genre de la facétie humaniste y est de mieux en mieux assimilé, tandis que le dialogue philosophique cède la place à de souples conversations, qui redéfinissent les rapports des plaisanteries aux savoirs. En décrivant les réactions des interlocuteurs, ces textes mènent aussi une réflexion sur la sociabilité et les normes de la civilité. Alors que le royaume est en proie aux guerres civiles, ces conversations facétieuses esquissent des modèles de coexistence originaux, valorisant la liberté de parole, les conflits ludiques et les ententes paradoxales. À la veille du Grand siècle se décide un tournant important de l’histoire de la conversation, entre urbanité et rusticité, politesse et gauloiserie.Dialogued works, hybrid in form and presenting a variety of tone, make their appearance around the year 1585, in the Contes et discours d’Eutrapel by Noël du Fail, Cholières’ Matinées and Apresdisnées, and Serées, by Poitou-native printer and bookseller, Guillaume Bouchet. Inspired by a potentiality offered by Boccaccio’s Decameron, the authors place the accent on the practice known as “devis”, or conversations that are started up in a storytelling mode. These “contes et discours bigarrez” alternate snatches of novellas, pleasant anecdotes and teasing mockery with more serious material, including historical notes, edifying apophthegms and legal developments. In a curious mélange, the art of “rencontrer” (being witty) is offset by showy erudition. At the crossroads of the history of literary forms and sociability, the notions of “facétie” and “devis” enlighten the singularity of these texts, in both poetic and social terms. The genre of humanistic witticism is increasingly integrated, while philosophical dialogue gives way to agile conversation, which redefines the relation between joking and learning. In describing the reactions of the persons addressed, these texts also invite research into the sociability and the civility codes of the day. At a time when the kingdom is rife with civil wars, these facetious or witty conversations are original models for coexistence, where freedom of speech, playful clashes and paradoxical agreements play leading roles. Part urbane, part countrified, between courteous and bawdy, an important turning point in the history of conversation is reached here, on the eve of the Grand Siècle