Jean Eric Wolf

Permanent left atrial pacing therapy may improve symptoms in heart failure patients with preserved ejection fraction and atrial dyssynchrony: a pilot study prior to a national clinical research programme.

Our group has recently shown that in some patients, heart failure with preserved ejection fraction (HFPEF) may be explained by ‘atrial dyssynchrony syndrome’ (ADS) due to interatrial conduction delay (IACD), a short left atrioventricular interval (LAVI), and increased left atrial (LA) stiffness. Our primary objective was to evaluate LA pacing therapy as a new treatment to restore left ventricular active filling in patients with no other known causes for HF than ADS.

Influence of ischemia on heart-rate variability in chronic hemodialysis Patients

Background: Sudden cardiac death occurring in patients with end-stage renal disease (ESRD) may be related to poor autonomic function with a significant decreased heart-rate variability (HRV). In addition, coronary artery disease has a high prevalence in this population and accounts for 50% of deaths. In the present study, relationships between HRV and myocardial ischemic abnormalities revealed by myocardial scintigraphy (MS) were evaluated in 32 chronic hemodialysis patients. Methods: We prospectively studied 32 chronic hemodialysis patients. Each underwent MS and 24 h electrocardiography at baseline for analysis of time and frequency domain the day of dialysis. Three periods were analyzed: during dialysis session, the morning after (nondialytic period), and in a 24 h period. Patients were included in group 1 (seven women, 11 men; mean age: 62 ± 19 years) when MS revealed no ischemia, whereas patients were included in group 2 (seven women, seven men; mean age: 63.1 ± 20 years) when MS revealed ischemic lesions. Results: A student ± test revealed that during the nondialytic period, two important markers of HRV, percentage of delta RR > 50 ms (pNN50) (4.5 ± 4.04 in group 1 versus 1.7 ± 1.4 in group 2), and root mean square of delta RR (rMSSD) (27.7 ± 13.4 versus 19.7 ± 6.8) were significantly reduced in group 2 compared with values in group 1. No significant difference appears between the two groups for standard deviation of normal to normal intervals (SDNN), mean heart rate, and spectral analysis. Conclusion: Patients with ESRD and myocardial ischemia revealed by MS have reduced parasympathetic activity during the nondialytic period. Correlations between parameters of HRV and ischemic lesions revealed by MS have been shown for the first time.

A Randomized Clinical Trial of Continuous Flow Nitrous Oxide and Nalbuphine Infusion for Sedation of Patients During Radiofrequency Atrial Flutter Ablation

Background: In patients with common atrial flutter (CAF), radiofrequency ablation (RFA) causes discomfort. Patients undergoing RFA often feel pain which is difficult to control as the mechanisms are unclear.

Myocardiopathie réversible induite par les médicaments psychotropes À propos d’un cas, revue de la littérature

Resume Un certain nombre de medicaments psychotropes presente un risque de toxicite cardiovasculaire bien demontre. C’est le cas notamment des antidepresseurs tricycliques, des neuroleptiques du type phenothiazine, et du lithium, chacune de ces classes therapeutiques prise individuellement possedant des proprietes electrophysiologiques et myocardiques potentiellement deleteres. Les auteurs rapportent une observation illustrant les effets parfois graves de l’association de ces differentes classes medicamenteuses lorsqu’il existe une pathologie cardiaque preexistante, meme mineure.

A New and Simple Method for Distinguishing Complete from Incomplete Block Through the Cavotricuspid Isthmus

Background: A complete line of block (CLOB) in the cavotricuspid isthmus (CTI) is the endpoint of typical atrial flutter ablation. Before CTI block is obtained, a progressive CTI conduction delay due to an incomplete line of block (InLOB) can be difficult to distinguish from CLOB. The purpose of this study was to assess a new simple approach based on the changes in atrio-ventricular (AV) conduction delays during septal and lateral right atrial pacing, to distinguish a CLOB from an InLOB during typical atrial flutter (AFL) ablation.Methods and Results: Forty patients who presented an InLOB before a CLOB, and a stable (AV) conduction delay at 600 ms cycle length pacing (when in sinus rhythm), during AFL ablation were included in this study. A 24-pole mapping catheter was positioned so that 2 adjacent dipoles bracketed the targeted CTI line of block (LOB), with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. Two pacing sites were lateral (position L1 and L2) and one was septal (position S) to the LOB, with locations L1 and S closest to the LOB. During L1, L2 and S site pacing, the delay between the pacing artefact and the peak of the R wave in a surface ECG (lead II) was measured.We measured the following conduction delays (mean ± SD in ms), during InLOB versus CLOB: (L1 to R) 320.5 ± 68.0 versus 367.0 ± 62.0, p = 0.001; (L2 to R) 333.0 ± 59.0 versus 338.0 ± 62.0, p = 0.663, (S to R) 259.4 ± 51.5 versus 247.1 ± 55.5, p = 0.987. We calculated the following data during an InLOB versus a CLOB: (L1R–L2R) − 12.3 ± 7 versus 20.2 ± 12.7, p = 0.001; (L1R–SR) 51.1 ± 21.5 versus 120.1 ± 16.6, p < 0.05. The sensitivity, specificity, positive and negative predictive values for CLOB with (L1R-SR > 94 ms) and with (L1R-L2R > 0 ms) were respectively; 100%, 98%, 98% and 100%.Conclusions: This study establishes that lateral versus septal right atrial pacing sites combined with the measure of AV conduction delay on a surface ECG can be useful to distinguish a CLOB from an InLOB during AFL ablation.

097 Effects of permanent left atrial pacing in patients with heart failure and preserved ejection fraction

Results: During the study period, 21 patients (15 males) aged between 18 and 40 years old (mean age 33.1±5.6, range 18-39 years) underwent ASA. Among them, 76% were treated with beta-blockers, 33% calcium-channel antagonists and 5% disopyramide. There were 6 patients (29%) with prior pacemaker, 1 patient (5%) with history of sudden death and prior implantable cardioverter-defibrillator (ICD) and 1 patient (5%) with prior myectomy. At baseline, mean New York Heart Association (NYHA) functional class was 2.4±0.5. Mean left ventricular outflow tract (LVOT) peak gradient and septal thickness were 89±37 mmHg and 24.9±5.1 mm, respectively. All procedures were performed with myocardial contrast echocardiography guidance. During ASA, 2.2±0.7 ml of absolute alcohol was injected in 1.4±0.5 septal perforators. Final procedural LVOT peak gradient was 20±16mmHg. Procedural success (defined as immediate LVOT peak gradient reduction >50%) was achieved in 20 patients (95%). There were no major complications. One patient (5%) required a temporary pacemaker for second-degree atrioventricular block. Mean peak CK was 934±468 IU/L. At a mean follow-up of 3.0±2.0 years after the procedure (range 0.3-8.4), repeat ASA was performed in two patients (10%) and a new ICD was needed in 1 patient (5%), while there were no fatalities reported. Mean NYHA class was improved to 1.6±0.7.