Jacques Clémenty

Right and Left Atrial Radiofrequency Catheter Therapy of Paroxysmal Atrial Fibrillation

Ablation of Paroxysmal Atrial Fibrillation. Introduction: (AF), trial fibrillation (AF), the most common arrhythmia, is due to multiple simultaneous wavelets of reentry in the atria. The only available curative treatment is surreal, using atriotomies to compartmentalize the atria. Therefore, we investigated a staged anatomical approach using radiofrequency catheter ablation lines to prevent paroxysmal AF.

Successful Catheter Ablation of Atrial Fibrillation

Catheter Ablation of AF. Introduction: Catheter ablation of a case of incessant atrial fibrillation was attempted using linear right atrial lesions created by sequential applications of radiofrequency energy.

Radiofrequency catheter ablation in unusual mechanisms of atrial fibrillation: report of three cases.

RF Catheter Ablation in AF. Introduction: The purpose of this study was to test the feasibility of radiofrequency (RF) catheter ablation of localized mechanisms of atrial fibrillation (AF).

Catheter Ablation of Chronic Atrial Fibrillation Targeting the Reinitiating Triggers

Trigger Ablation in Chronic AF. Introduction: We assessed the mode of reinitiation of atrial fibrillation (AF) after cardioversion and the efficacy of ablating these foci of reinitiation in patients with chronic AF.

Radiofrequency Catheter Ablation of Common Atrial Flutter in 200 Patients

RF Ablation of Common Atrial Flutter. Introduction: The purpose of this study was to evaluate the efficacy and safety of radiofrequency (RF) catheter ablation of common atrial flutter and to determine the optimum target sites in a large series of patients. Three different approaches were used to target the ablation site. The first used a combined anatomic and electrophysiologic approach, whereas the second and the third approaches relied primarily on anatomic guidelines to target the critical area in the atrial flutter reentrant circuit located in the low right atrium. Background: Recent studies report the efficacy of RF current application in the low right atrial region to interrupt and prevent recurrences of common atrial flutter using either anatomic or electrophysiologic targets. However, larger groups of patients are required to confirm the efficacy of this technique and to specify the target sites.

Pacemaker Endocarditis: Clinical Features and Management of 60 Consecutive Cases

Background: The incidence of endocarditis related to pacemakers is increasing, while the diagnosis and management remain difficult. The objective of this study was to evaluate the clinical features and management of endocarditis after implantation of pacemakers (PM) or cardioverter defibrillators (ICD).

Radiofrequency catheter ablation of accessory pathways: a contemporary review.

RF Catheter Ablation of APs. Catheter ablation techniques are now advocated as the first line of therapy for arrhythmias caused by accessory pathways (APs). The most common energy source is radiofrequency current, but technical characteristics vary. Several parameters can be used to determine the optimal target site: AP potential, AV time, atrial or ventricular insertion site, or unipolar morphology. Specific considerations are needed depending on AP location. Despite the different approaches described, there is no significant difference in the reported success rate, which is over 90%. However, the number of radiofrequency applications needed to achieve ablation appears to differ significantly, with median values from 3 to 8 reported. A combination of criteria related to both timing and direction of the activation wave‐front or use of subthreshold stimulation could improve the accuracy of mapping. In patients with “resistant” APs, different changes in ablation technique must be considered during the procedure to achieve elimination of AP conduction. The incidence of complications in multi‐center reports is close to 4%, with a recurrence rate of 8%. The long‐term safety of catheter ablation requires further study.

Involvement of a Nodofascicular Connection in Supraventricular Tachycardia with VA Dissociation

Nodofascicular Connection in SVT. We present the case of a patient with episodes of supraventricular tachycardia and atrial dissociation that were terminated by either adenosine or verapamil. Involvement of an accessory pathway was shown by ventricular extrastimuli, elicited during His‐bundle refractoriness, that interrupted the tachycardia or advanced the next His potential. The tachycardia circuit was demonstrated to he confined to the nodofascicular region based on the exclusion of surrounding tissues. Atrial activity, including that in the perinodal region, was totally dissociated during tachycardia. The lowest part of the circuit was determined to be located above the Hisian bifurcation, as multiple episodes with either a right or left bundle branch configuration during tachycardia did not modify the HH cycle. The ventricular septum summit was determined not to be involved, as no preexcitation was present during tachycardia or atrial pacing, and the right bundle branch was not part of the circuit. Radiofrequency current applied beneath the tricuspid valve at the His region successfully eliminated the nodofascicular connection with preservation of 1:1 AV conduction. The anatomical substrate underlying the abnormal connection may be either nodofasciculoventricular Mahaim fibers or a duality or dispersion of the nodo‐Hisian conducting system.

Are Women with Severely Symptomatic Brugada Syndrome Different from Men

Introduction: Spontaneous type‐1 ECG has been recognized as a risk factor for sudden cardiac death (SCD) in Brugada syndrome (BrS), but studied populations predominantly consisted of men. We sought to investigate whether a spontaneous type‐1 ECG pattern was also associated in women with severely symptomatic BrS. Other known risk factors were also examined for gender specificity.

Contributions of Advanced Techniques to the Success and Safety of Transvenous Leads Extraction

Purpose: We measured the proportion of intravascular leads, which can be extracted by simple traction versus with newer techniques, and examined the overall safety and success rate of lead extractions.