Marielle Morissens

Use of a New Non‐Fluoroscopic Three‐Dimensional Mapping System in Type I Atrial Flutter Ablation

We studied 40 patients who underwent cavo‐tricuspid isthmus ablation for typical counterclockwise atrial flutter with cooled tip catheters between 2001 and 2003. Complete bi‐directional isthmus block was created in all patients. A new, three‐dimensional (3D), non‐fluoroscopic mapping system was used in 20 patients (test group), and conventional fluoroscopy in 20 others (conventional group), using anatomic and electrophysiologic criteria in both groups. We measured the total procedure, ablation procedure, and overall fluoroscopy times, and the total number of radiofrequency (RF) applications delivered in the two groups. The overall fluoroscopy time was shorter in the test group (mean 8.8 minutes, range 2–17 minutes) than the conventional group (29.7 minutes, range 12–57 minutes; P < 0.001). Though the overall procedure time was similar in both groups (92.5 ± 28.6 minutes vs 106.5 ± 20.9 minutes; P = 0.067) the ablation duration (25.1 ± 6.6 minutes versus 43.3 ± 19.6 minutes; P = 0.0051) and the total RF applications (10.6 ± 9.4 versus 16.4 ± 9.4; P = 0.044) were smaller in the test group. The use of a new, 3D non‐fluoroscopic mapping system markedly reduced the fluoroscopy exposure during typical atrial flutter ablation. It was also associated with a significant reduction in ablation time and in the number of RF applications. Since atrial flutter ablation is one of the most frequently performed procedures, this system may significantly reduce the overall amount of radiation exposure in high‐volume laboratories.

Left atrial septal pouch thrombus assessed on three-dimensional transoesophageal echocardiography

The left atrial septal pouch (LASP) is an anatomical entity that came to the attention of the medical community in 2010 when Krishnan and Salazar described it as a possible source of embolism. It is formed by the caudal fusion of the area of overlap of the septum primum and the septum secundum. The …

Is There a Potential Benefit to Increased Irrigation Channels During Radiofrequency Ablation? Results From a Two-Center Prospective Randomized Study

Potential Benefit to Increased Irrigation Channels During Radiofrequency Ablation. Introduction: Open irrigation during radiofrequency (RF) application allows a higher power delivery in the setting of temperature‐controlled ablation, without causing blood clots. This study sought to evaluate the clinical value of the additional 6 supplementary channels at the proximal catheter tip compared to a standard irrigated RF catheter with 6 conventional channels present at the distal tip only.

Complicated Forms of Tachycardia-Mediated Cardiomyopathy Associated with Idiopathic Left Ventricular Tachycardia

Idiopathic left ventricular tachycardia is an infrequent form of ventricular tachycardia associated with a structurally normal heart. The prognosis is usually benign; however, sustained cases have been reported. In this report, we describe two cases of persistent idiopathic left ventricular tachycardia complicated by tachycardia‐mediated cardiomyopathy. In the first case, the patient developed a right ventricular thrombus with subsequent pulmonary embolism. In the second case, the patient developed acute pulmonary edema. Both cases were cured by catheter ablation. (PACE 2011; e52–e55)

Cardiogenic shock after nifedipine administration in a pregnant patient: A case report and review of the literature

Abstract We present a case of a 21-year-old Caucasian woman at 27 weeks of pregnancy who was admitted to the obstetric department for pre-term labor. She received 10 mg of nifedipine 4 times in 1 h, according to the internal protocol. Shortly after, she brutally deteriorated with pulmonary edema and hypoxemia requiring transfer to the intensive care unit (ICU) for mechanical ventilation. She finally improved and was successfully extubated after undergoing a percutaneous valvuloplasty of the mitral valve. This case illustrates a severe cardiogenic shock after administration of nifedipine for premature labor in a context of unknown rheumatic mitral stenosis. Nifedipine induces a reflex tachycardia that reduces the diastolic period and thereby precipitates pulmonary edema in case of mitral stenosis. This case emphasizes the fact that this drug may be severely harmful and should never be used before a careful physical examination and echocardiography if valvular heart disease is suspected.

Added value of speckle tracking in the evaluation of cardiac function in patients with sickle cell disease

Speckle tracking echocardiography is a new means of evaluating cardiac function. The principle of speckle tracking is to measure myocardial strain, based on local shortening, lengthening and thickening of the muscles. It has been proposed that the left ventricle global longitudinal strain (LV-GLS) could be a useful tool for the detection of early systolic dysfunction in patients under cardiotoxic chemotherapy (Thavendiranathan et al, 2014). Moreover, the high reproducibility of the LV-GLS represents an advantage over the left ventricle ejection fraction (LVEF) (King et al, 2016; Medvedofsky et al, 2017). Compared to the LVEF, the LV-GLS is less affected by changes in loading conditions, which makes it a potentially useful tool in patients with sickle cell disease (SCD), due to the chronic overload associated with SCD. However, in this population, studies are rare and results are conflicting (Ahmad et al, 2012; Sengupta et al, 2012; Barbosa et al, 2014; Hammoudi et al, 2014). The primary aim of our study was to determine whether the LV-GLS was abnormal in a monocentric population of adults with SCD, compared to a matched population of healthy individuals. The secondary aim was to investigate correlations between the echocardiographic parameters and the biological and clinical evaluations of patients with SCD. The institutional Ethics Committee approved the protocol. All patients provided informed consent. We prospectively included 37 patients with SCD and 34 healthy, ageand sex-matched controls. The patient and control groups were similar in age (31 10 years vs. 32 10 years, respectively). The LVEF was significantly lower in the SCD group than in the control group (Teicholz: 61 8% vs. 67 6%; P = 0 05; Simpson: 61 9% vs. 69 3%; P < 0 05; Table I). However, only one patient had a Simpson LVEF < 50%. The left ventricular (LV) mass and LV end diastolic diameter (LVEDD) were higher in the patient group (LV mass: 107 g/m vs. 70 g/m, P < 0 05 and LVEDD: 53 mm vs. 46 mm; P < 0 05). The myocardial performance index was higher (higher values indicate impaired LV function) in the patient group compared to the control group (0 38 vs. 0 27; P < 0 05). The LV-GLS was significantly lower in the SCD group than in the control group ( 19 4% vs. 22 4%; P < 0 05), and it was abnormal (strain > 18%) in 8 (21%) patients of the SCD group. Diastolic function was abnormal in three SCD patients (8%), but normal in the entire control group. The tricuspid regurgitation velocity was higher in the SCD group than in the control group (2 24 m/s vs. 1 96 m/s, P < 0 05). However, no patient had pulmonary hypertension. The multivariate analysis results (Table II) showed that only the LV-GLS and LVEDD remained significantly different between groups. Among patients with SCD, the mean Hb was 94 g/l (range: 61–122 g/l) and the mean HbF was 12 7% (range: 1– 28 6%). The mean ferritin level was 644 lg/l (range: 13– 7267 lg/l). Iron overload, defined as a ferritin level greater than 1000 lg/l, was observed in five patients. The mean Nterminal pro b-type natriuretic peptide (NTproBNP) level was 154 pg/ml (range 12–1685 pg/ml). The mean patient walking distance was 66% of the predicted value (range: 33–88%).

PREDICTING THE OCCURRENCE OF ATRIAL ARRHYTHMIA AFTER CLOSURE OF AN ATRIAL SEPTAL DEFECT

Alexander Van De Bruaene, MD†, Philip Moons, RN, PhD†, An Belmans, MSc†, Marco C Post, MD, PhD‡, Justin G Luermans, MD‡, Marion Delcroix, MD, PhD†, Agnes Pasquet, MD, PhD*, Julie De Backer, MD, PhD**, Bernard Paelinck, MD, PhD°, Marielle Morissens, MD

Pre-excited or Not Pre-excited?

, Werner Budts, MD, PhD†. †University Hospitals Leuven, Belgium, ‡St Antonius Hospital Nieuwegein, The Netherlands, *University Hospitals St Luc Brussels, Belgium, **Ghent University Hospital, °University Hospital Antwerp, Belgium,

Multidetector 16-slice CT scan evaluation of cavotricuspid isthmus anatomy before radiofrequency ablation.

CHU Brugmann Brussels, Belgium. Background •Atrial arrhtyhmias (AA) are frequent and are associated with morbidity and mortality in patients with congenital heart disease. •Several variables have been shown to be related with atrial arrhythmia after closure of the atrial septal defect (ASD). •Although risk factors that determine the occurrence of late AA drive clinical management, a quantitative event-free prediction tool has not yet been established.

Ultrasound Contrast Quantification for the Diagnosis of Intracardiac Masses.

Figure 1. Twelve-lead ECG before ablation. Case Report An 18-year-old man was referred with a history of paroxysmal palpitations for more than 10 years. The 12-lead electrocardiogram (ECG) recorded during an episode showed a narrow QRS tachycardia. Prior to the electrophysiological study (EPS), two distinct and alternating P-wave morphologies were observed on the ECG monitoring during a sinus rhythm (Fig. 1). One of the