Ablation par radiofréquence des tachycardies ventriculaires par voie épicardique percutanée (à propos d'une série de 32 patients)

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LE FLUTTER AURICULAIRE A CONDUCTION 1 SUR 1 (ETUDE RETROSPECTIVE A PROPOS DE 16 CAS)

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Suivi à moyen terme de 55 patients ablatés chirurgicalement d'une fibrillation atriale par le système HIFU EPICOR (l'expérience de la Pitié-Salpêtrière 2006-2007)

Le système Epicor (Saint Jude Medical) utilise les ultrasons à haute intensité pour réaliser une ablation circonférentielle de la paroi postérieure de l oreillette gauche par voie chirurgicale, dans le but de traiter la fibrillation atriale.Nous avons étudié rétrospectivement 55 patients ayant bénéficié d une ablation par le système Epicor, par voie épicardique et à cœur battant, cette intervention étant réalisé dans le service de chirurgie cardiaque de l hôpital de la Pitié Salpétrièr entre mars 2006 et septembre 2007. L ancienneté de la fibrillation atriale était comprise entre 1 et 240 mois avec une moyenne de 65 mois. La fibrillation atriale était permanente chez 30 (54%) patients, paroxystique chez 23 (42%) d entre eux et persistante chez 2(4%) patients. Une chirurgie concomitante était réalisée chez 53 (96%) d entre eux. La procédure principale était une chirurgie valvulaire dans 64% des cas, une revascularisation coronaire dans 23% des cas, une chirurgie mixte (valvulaire et coronaire) chez 13% des patients. Outre l ablation par le système Epicor, 29(53%) patients ont eu une ligne mitrale réalisée par une baguette utilisant la même technologie.Aucun décès ni complication lié à la procédure d ablation n a été relevé. Neuf (16%) décès dont deux d origine cardiaque sont survenus au cours du suivi (cinq décès précoces et quatre décès tardifs). La durée moyenne du suivi a été de 10 mois avec un minimum de 3 mois et un maximum de 21 mois. Un patient a été perdu de vue. Au terme du suivi, 56% de la population était en rythme sinusal. 82% des patients du groupe FA paroxystique et 33% du groupe FA chronique étaient en rythme sinusal au terme du suivi. 5 (10%) patient ont bénéficié d un stimulateur cardiaque. Le caractère paroxystique était corrélé à une meilleure efficacité de l ablation (p=0.004)ce registre rétrospectif et monocentrique confirme la sécurité d emploi du système Epicor et procure de bons résultats chez les patients en fibrillation atriale paroxystique, même si l efficacité du système ne peut être quantifiée par cette étude.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Discovery of an Insect Neuroactive Helix Ring Peptide from Ant Venom

International audienceAnts are among the most abundant terrestrial invertebrate predators on Earth. To overwhelm their prey, they employ several remarkable behavioral, physiological, and biochemical innovations, including an effective paralytic venom. Ant venoms are thus cocktails of toxins finely tuned to disrupt the physiological systems of insect prey. They have received little attention yet hold great promise for the discovery of novel insecticidal molecules. To identify insect-neurotoxins from ant venoms, we screened the paralytic activity on blowflies of nine synthetic peptides previously characterized in the venom of Tetramorium bicarinatum. We selected peptide U11, a 34-amino acid peptide, for further insecticidal, structural, and pharmacological experiments. Insecticidal assays revealed that U11 is one of the most paralytic peptides ever reported from ant venoms against blowflies and is also capable of paralyzing honeybees. An NMR spectroscopy of U11 uncovered a unique scaffold, featuring a compact triangular ring helix structure stabilized by a single disulfide bond. Pharmacological assays using Drosophila S2 cells demonstrated that U11 is not cytotoxic, but suggest that it may modulate potassium conductance, which structural data seem to corroborate and will be confirmed in a future extended pharmacological investigation. The results described in this paper demonstrate that ant venom is a promising reservoir for the discovery of neuroactive insecticidal peptides

Risk factors for surgery in stricturing small bowel Crohn's disease: A retrospective cohort study from the GETAID pédiatrique

International audienceAbstract Objectives Previous studies have shown rates of surgical resection of up to 41% in stricturing pediatric Crohn's disease. In this retrospective multicenter study, our aims were to identify clinical risk factors and magnetic resonance enterography (MRE) features of small bowel strictures associated with surgery. Methods Pediatric patients with symptomatic stricturing small bowel CD (defined as obstructive symptoms or proximal dilatation on MRE) confirmed by MRE between 2010 and 2020 were recruited from 12 French tertiary hospitals. Patient characteristics were compared by surgical outcome multivariable Cox regression. Results Fifty‐six patients (61% boys) aged 12.2 ± 2.7 years at diagnosis of CD were included. Median duration of CD before diagnosis of stricture was 11.7 months (interquartile range [IQR]: 25–75: 1.2–29.9). Nineteen (34%) patients had stricturing phenotype (B2) at baseline. Treatments received before stricture diagnosis included MODULEN‐IBD ( n = 31), corticosteroids ( n = 35), antibiotics ( n = 10), anti‐TNF ( n = 27), immunosuppressants ( n = 28). Thirty‐six patients (64%) required surgery, within 4.8 months (IQR: 25–75: 1.8–17.3) after stricture diagnosis. Parameters associated with surgical resection were antibiotic exposure before stricture diagnosis (adjusted odds ratio [aOR]: 15.62 [3.35–72.73], p = 0.0005), Crohn's disease obstructive symptoms score (CDOS) > 4 (aOR: 3.04 [1.15–8.03], p = 0.02) and dilation proximal to stricture >28 mm (aOR: 3.62 [1.17–11.20], p = 0.03). Conclusion In this study, antibiotic treatment before stricture diagnosis, intensity of obstructive symptoms, and diameter of dilation proximal to small bowel stricture on MRE were associated with risk for surgical resection

Position paper concerning the competence, performance and environment required for the practice of ablation in children and in congenital heart disease

International audienc

Stroke prevention in patients with atrial flutter: many questions still unanswered

International audienc

Cohort profile: the ESC EURObservational Research Programme Atrial Fibrillation III (AF III) Registry

International audienceAbstract Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP)-Atrial Fibrillation (AF) III Registry aims to identify contemporary patterns in AF management in clinical practice, assess their compliance with the 2016 ESC AF Guidelines, identify major gaps in guideline implementation, characterize the clinical practice settings associated with good vs. poor guideline implementation and assess and compare the 1-year outcome of guideline-adherent vs. guideline non-adherent management strategies. Methods and results Consecutive adult AF patients (n = 8306) were enrolled between 1 July 2018 and 15 July 2019, and individual patient data were prospectively collected across 192 centres and 31 participating countries during the 3-month enrolment period per centre. The Registry collected baseline and 1-year follow-up data in the eight main domains: patient demographic/enrolment setting, AF diagnosis/characterization, diagnostic assessment, stroke prevention treatments, arrhythmia-directed therapies, integrated AF management, major outcomes (death, non-fatal stroke or systemic embolic event, and non-fatal bleeding event), and the quality of life questionnaire. Conclusion The EORP-AF III Registry is an international, prospective registry of care and outcomes of patients treated for AF, which will provide insights into the contemporary patterns in AF management, ESC AF Guidelines implementation in routine practice and barriers to optimal management of this highly prevalent arrhythmia