Robert Grolleau

Left Ventricular Lead Insertion Using a Modified Transseptal Catheterization Technique: A Totally Endocardial Approach for Permanent Biventricular Pacing in End-Stage Heart Failure

This article describes a new technique of LV lead insertion, using transseptal catheterization performed through the right internal jugular vein, to obtain a totally endocardial biventricular chronic pacing in end‐stage heart failure. Three patients with QRS widening (> 180 ms) linked to complete left bundle branch block (n = 2) or right ventricular pacing (n = 1) were included in this preliminary study. Catheterization was performed under fluoroscopy and transesophageal echocardiography guidance. Transseptal catheterization was achieved by puncture of the right internal jugular vein at the base of the neck and by using a Brockenbrough needle, the tip curve of which was more curved than the standard model. A flexible long sheath was advanced in the left atrium through the interatrial septum and then a unipolar electrode was placed easily in the LV. The proximal tip of the LV lead was tunneled from the neck to the subclavian area and connected to the ventricular channel of a dual (n = 1) or simple (n = 2) chamber pacemaker. Efficient acute sensing (V wave amplitude = 13 ± 3 mV) and pacing (acute pacing threshold = 0.7 ± 0.4 V) were obtained in the three patients. Early loss of capture occurred in two patients requiring lead replacement. Functional status dramatically improved in all three patients. At 6‐month follow‐up, biventricular pacing was maintained in all patients (mean threshold 1.4 V) who were free of clinical embolic event with oral anticoagulation therapy. This modified technique of jugular transseptal catheterization appears promising for the development of left heart pacing.

Comparison of direct coronary stenting with and without balloon predilatation in patients with stable angina pectoris

The purpose of this study was to compare the effects of stent placement with and without balloon predilatation on duration of the procedure, reduction of procedure-related costs, and clinical outcomes. Although preliminary trials of direct coronary stenting have demonstrated promising results, the lack of randomized studies with long-term follow-up has limited the critical evaluation of the role of direct stenting in the treatment of obstructive coronary artery disease. Between January and September 1999, 338 patients were randomly assigned to either direct stent implantation (DS+; 173 patients) or standard stent implantation with balloon predilatation (DS-; 165 patients). Baseline clinical and angiographic characteristics were similar in the 2 groups. Procedural success was achieved in 98.3% of patients assigned to DS+ and 97.5% of patients assigned to DS- (p = NS), with a crossover rate of 13.9%. Compared with DS-, DS+ conferred a dramatic reduction in procedure-related cost (

Long‐Term Follow‐Up of Biventricular Pacing Using a Totally Endocardial Approach in Patients with End‐Stage Cardiac Failure

956.4 +/-

Ventricular Tachycardia Late After Cardiac Transplantation

352.2 vs

Intrahisian block with wenckebach phenomenon

1,164.6 +/-

Atrial fibrillation and its determinants after radiofrequency ablation of chronic common atrial flutter

383.9, p <0.0001) and duration of the procedure (424.2 +/- 412.1 vs 634.5 +/- 390.1 seconds, p < 0.0001). At 6-month follow-up, the incidence of major adverse cardiac events including death, angina pectoris, myocardial infarction, congestive heart failure, repeat angioplasty, or coronary artery bypass graft surgery was 5.3% in DS+ and 11.4% in DS- (p = NS). Multivariate analysis demonstrated that major adverse cardiac events rates were related to stent length of 10 mm (relative risk [RR] 3.25, 95% confidence intervals [CI] 1.36 to 7.78; p = 0.008), stent diameter of 3 mm (RR 2.69, 95% CI 1.03 to 7.06; p = 0.043), and complex lesion type C (RR 2.83, 95% CI 1.02 to 7.85; p = 0.045). Thus, in selected patients, this prospective randomized study shows the feasibility of DS+ with reduction in procedural cost and length, and without an increase in in-hospital clinical events and major adverse cardiac events at 6-month follow-up.

Original Article Atrial fibrillation and its determinants after radiofrequency ablation of chronic common atrial flutter

Background: Besides standard left ventricular (LV) stimulation via the coronary sinus, a transseptal approach allows left ventricular endocardial stimulation. We report our long‐term observations with biventricular stimulation, using a strictly endocardial system for patients presenting with severe congestive heart failure.

335 Ablation of unmappable post-MI ventricular tachycardia using voltage-map in sinus rhythm

A 65-year-old man presented with 48 hours of palpitations. His ECG on admission demonstrated a broad-complex tachycardia (Figure 1). Eleven years previously he had undergone heterotopic cardiac transplantation for severe ischemic cardiomyopathy. Echocardiography demonstrated a normally contracting donor heart (left ventricular [LV] end-diastolic diameter 41 mm, LV ejection fraction 62%). On the contrary, the native heart showed no …