Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management

Atrioventricular block is classified as congeni- tal if diagnosed in utero, at birth, or within the first month of life. The pathophysiological process is believed to be due to immune-mediated injury of the conduction system, which occurs as a result of transplacental pas- sage of maternal anti-SSA/Ro-SSB/La antibodies. Childhood atrioventricular block is therefore diagnosed between the first month and the 18th year of life. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited progressive car- diac conduction disorders. Indications and techniques of cardiac pacing have also evolved to allow safe perma- nent cardiac pacing in almost all patients, including those with structural heart abnormalities

Hypocalcaemia-induced transient dilated cardiomyopathy in elderly: a case report.

International audienceHypocalcaemia is a rare cause of reversible heart failure. We reported a 76-year-old woman who had a severe systolic heart failure. She had severe hypocalcaemia due to hypoparathyroidism after thyroidectomy. Echocardiography showed a dilated left ventricle with a depressed left ventricular ejection fraction. Serum calcium level was low without other biological abnormalities. After calcium supplementation, heart failure improved rapidly. At 2 months, the calcium level was in a normal range and biventricular systolic and diastolic functions returned to normal

Electromechanical correlates in heart failure patients with a guidelines indication for CRT

L'objectif de l'étude est de mieux comprendre les relations entre activation électrique et asynchronisme mécanique chez les patients insuffisants cardiaques. Méthodes: 119 patients ayant une indication de resynchronisation ont été inclus dans cette étude rétrospective. Les corrélations entre paramètres échographiques et électriques ont été analysées par régression linéaire. Résultats: On observe une corrélation significative entre fréquence cardiaque, JT, QT, RR-QT et temps de remplissage ventriculaire gauche/RR. Une corrélation significative est observée entre QT et QRS et le délai inter-ventriculaire. Une corrélation significative est observée entre P'R, QRS et le délai pré-éjectionel ventriculaire gauche. Conclusion: Ces corrélations faibles conduisent à se poser la question de la validité des critères échographiques utilisés actuellement, et peuvent laisser penser que l'effet bénéfique de la resynchronisation ne résulte pas seulement de la correction des anomalies mécaniquesRENNES1-BU Santé (352382103) / SudocSudocFranceF

New Insights Into Ventricular Interactions During Cardiac Resynchronization∗

International audienceno abstrac

Left atrial function, a new predictor of response to cardiac resynchronization therapy?: Left atrium and resynchronization

International audienceBackground - Cardiac resynchronization therapy (CRT) improves left ventricular (LV) function and induces LV remodeling, and it is an established therapy for advanced heart failure with prolonged QRS duration. One third of patients will not benefit from this invasive therapy. Objective - The purpose of this study was to evaluate whether left atrial (LA) strain imaging (ε) parameters could help in predicting the response in terms of LV reverse remodeling after CRT. Methods - A total of 79 patients who underwent CRT were evaluated with echography before implantation. LA function and LV function were assessed with M-mode, 2-dimensional echocardiography, Doppler, tissue Doppler velocity, and ε. LV reverse remodeling was defined as a >15% reduction in LV end-systolic volume. Results - At 6 months, 54 patients (68%) were responders to CRT. In multivariable logistic regression, LA systolic peak of strain rate (SRA) (odds ratio [OR} 10.5, 95% confidence interval [CI] 1.76-62.1, P = .01), left bundle branch block (OR 6.8, 95% CI 1.06-43.9, P = .04), ischemic cardiomyopathy (OR 3.93, 95% CI 1.07-14.4, P = .04), and LV preejection index (OR 1.03, 95% CI 1.01-1.05, P = .01) were associated with CRT response. With an SRA cutoff of -0.75%, the negative predictive value for predicting CRT response was 0.62. Conclusion - This study demonstrated the possible relevance of assessing LA function before CRT. SRA appeared to be a good predictor of CRT response. Integrating this LA function analysis into the multivariable assessment of patient candidates for CRT should be considered

202: Atrio-ventricular electromechanical correlates in systolic heart failure with wide QRS

BackgroundElectromechanical correlates at the atrio-ventricular (AV) level remain poorly investigated in patients with dyssynchronised systolic heart failure (HF). The aim of the present study was to assess the exact prevalence and the electrical determinants of AV mechanical dyssynchrony in the left heart, in this patient population.MethodsProspective observational study of 49 HF patients with stable sinus rhythm and wide QRS complex (mean: 160±19ms), all scheduled for CRT device implantation. 12% were in NYHA class II, 85% in NYHA class III. Mean PR intervall was 200±40ms, mean LV ejection fraction = 26±5%. Left AV dyssynchrony (LAVD) was definited as LV filling time (LVFT) <40% RR interval on transmitral flow at doppler-echocardiography. PR interval, P wave duration, P'R interval (interval between P wave termination of and QRS onset), QRS duration and QRS morphology (type of bundle branch block) were investigated as possible predictors of LAVD. Correlations between LVFT and ECG intervals were assessed by linear regression.ResultsLAVD was present in 13 patients (26,5). P wave duration, PR interval and QRS morphology had no predictive value for LAVD. In contrast, a significant correlation was observed between LVFT and P'R interval (P<0,005) and QRS duration (p=0,001).ConclusionsEvidence of resting LAVD is observed in 26,5% patients with a CRT guideline indication. QRS duration and the P'R interval but not the PR interval are significant determinants of LAVD. These data may be of practical importance for optimal programming of CRT devices

0346 : Procedural safety and long-term follow-up after pacemaker implantation in nonagenarians

IntroductionThe rate of pacemaker(PM) implantations is continuously growing. A large number of nonagenarian patients will be implanted in the future. We aimed at analyzing the outcome after PM implantation in the elderly.MethodsPatients aged ≥90 yo referred for PM implantation from 2004 to 2014 were retrospectively included. The primary clinical endpoint was total mortality.Results113 patients were included (92.6±2.1yo). Five patients (3.5%) had short-term device-related complications (3 pocket hematoma, 1 lead displacement, 1 hemothorax). During the follow-up, 48 patients (42.5%) died. Survival rates were 77.4% (95%CI:67.4-84.7%), 68.7% (95%CI:57.4-77.6%) and 36.4% (95%CI:23.3-49.7%) after 1, 2 and 5 years, respectively. Atrial fibrillation (OR 3.5,95%CI:1.6-7.2) and a cardiomyopathy (OR 2.3,95%CI:1.2-4.4) at the time of implantation were independent predictors of mortality.ConclusionPM implantation in nonagenarians is safe, with a low risk of procedural complications.Figure: Survival for nonagenarians after PM implantatio

Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation

International audienceBACKGROUND: Compared with the first-generation Arctic Front cryoballoon (ARC-CB), the new Arctic Front Advance cryoballoon (ARC-Adv-CB) increases the efficient CB-tissue contact surface during freezing, which may increase the incidence of phrenic nerve (PN) palsy (PNP). OBJECTIVE: To evaluate the safety and efficacy of paroxysmal atrial fibrillation (AF) ablation with the ARC-Adv-CB as well as the merits of a predictor of PNP. METHODS: AF ablation was performed by using a "single 28-mm big CB" approach. The rate of pulmonary vein (PV) isolation with a first cryoapplication was measured. The distance between the CB and a PN pacing catheter in the superior vena cava was measured to predict PNP during freezing. RESULTS: In 147 patients, PV were isolated with a single cryoapplication in 205 (81.3%) of 252 PV treated with the ARC-CB and in 280 (90.3%) of 310 PV treated with the ARC-Adv-CB (P = .003). The mean time to PV isolation was 52 ± 34 seconds and 40 ± 25 seconds (P < .001) and the temperature at the time of isolation was -36.1 ± 10.3°C and -32.3 ± 10.2°C (P = .001) in the ARC-CB and ARC-Adv-CB groups, respectively. Mean procedure and fluoroscopy durations were significantly shorter in the ARC-Adv-CB group. Transient PNP was observed in 7(10.6%) and 20(24.4%) of the patients treated with the ARC-CB and ARC-Adv-CB, respectively (P = .048). The distance between the lateral edge of the CB and a vertical line through the tip of the pacing catheter accurately predicted PNP (P < .001). CONCLUSIONS: The 28-mm ARC-Adv-CB enabled more efficient ablation of paroxysmal AF and shorter procedures than did the ARC-CB. This higher performance was associated with a higher incidence of PNP, which was predicted by the distance between the CB and the PN

Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up

SummaryBackgroundThe rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8–10years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians.AimsTo analyse the short- and long-term outcomes after device replacement in nonagenarians.MethodsPatients aged≥90years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality.ResultsSixty-two patients were included (mean age 93.3±2.9years at time of pacemaker replacement). Mean procedure duration was 35.7±17.2minutes. Mean hospital stay was 2.2±1.1days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1months (interquartile range, 11.8–39.8months). Survival rates were 84.2% (95% confidence interval [CI] 71.8–91.5%) at 1year, 66.9% (95% CI 51.8–78.2%) at 2years and 22.7% (95% CI 10.6–37.7%) at 5years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1–5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0–4.9) were predictors of mortality.ConclusionsPacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30months afterwards