Showing papers by "Serge Boveda published in 2013"

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

Abstract: Background—Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small nu...

Eye lens radiation exposure to interventional cardiologists: a retrospective assessment of cumulative doses.

Abstract: Radiation dose to the eye lens is a crucial issue for interventional cardiologists (ICs) who are exposed during the procedures they perform. This paper presents a retrospective assessment of the cumulative eye lens doses of ICs enrolled in the O'CLOC study for Occupational Cataracts and Lens Opacities in interventional Cardiology. Information on the workload in the catheterisation laboratory, radiation protection equipment, eye lens dose per procedure and dose reduction factors associated with eye-protective equipment were considered. For the 129 ICs at an average age of 51 who had worked for an average period of 22 years, the estimated cumulative eye lens dose ranged from 25 mSv to more than 1600 mSv; the mean ± SD was 423 ± 359 mSv. After several years of practice, without eye protection, ICs may exceed the new ICRP lifetime eye dose threshold of 500 mSv and be at high risk of developing early radiation-induced cataracts. Radiation protection equipment can reduce these doses and should be used routinely.

Evaluation of left atrial deformation to predict left atrial stasis in patients with non-valvular atrial fibrillation - a pilot-study.

Abstract: Speckle tracking-derived strain and strain rate are recently available parameters to assess left atrial (LA) deformation. We hypothesized that such new parameters could be of interest to evaluate the risk of LA stasis among patients with atrial fibrillation (AF). Single-centre study enrolling all patients with non-valvular AF lasting longer than 48 hours for whom no therapeutic anticoagulation was given in the preceding 3 weeks and who were assessed through transesophageal and transthoracic echocardiogram during a 6 month time interval. LA deformation was assessed by transthoracic echocardiogram through speckle tracking analysis, whereas LA stasis parameters were sought on transesophageal echocardiogram. Among the 82 assessed patients, LA appendage thrombi or sludge were found in 16 (19.5%). A moderate positive correlation was found between peak positive strain rate and maximum emptying velocity (r = 0.589; P <0.001) and peak positive strain rate and maximum filling velocity of the LA appendage (r = 0.651; P <0.001). Peak negative strain rate was also found to be associated with both maximum emptying velocity (r = -0.513; P <0.001) and maximum filling velocity of the LAA (r = -0.552; P <0.001). AF duration, peak negative strain rate and time-to-peak positive strain were independent predictors of LAA thrombi or sludge on multivariate analysis logistic regression. The area under the curve for the estimated probabilities using the obtained logistic regression model was 0.89 (95%CI 0.81-0.96; P <0.001). Our findings suggest that LA mechanical dysfunction assessed through speckle tracking may be of interest to predict LA stasis in the setting of AF.

The History of Cardiac Pacemakers and Defibrillators

Abstract: Cardiac pacing has hugely and rapidly improved in just over 50 years, thanks to advances in electronics, computing, nanotechnology, and medicine. Engineers and physicians are committed to reproducing, as closely as possible, the physiological cardiac cycle and the mechanical activity of the right and left ventricles. The history of the implantable cardioverter defibrillator (ICD) is unique because it relies on the bold project of one man, Mirowski. In 1985, the first implantable cardioverter defibrillator was marketed. This system allowed the ventricle to be paced and provided better detection, which improved the percentage of appropriate shocks. We can imagine that, in the future, progress will continue toward further miniaturization and longevity, but also perhaps the research of new and more compatible biological materials. Research into cardiac pacing and ICDs has been motivated by huge medical and economic issues, and will continue, although we are still amazed by these small but fascinating metal boxes!

The benefit of implantable cardioverter defibrillator programming in MADIT-RIT: more for less?

Abstract: Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy (MADIT-RIT) confirmed the benefit of optimizing the programming of implantable cardioverter defibrillator (ICD) therapy for the reduction of inappropriate therapy and all-cause mortality, with no impact on the incidence of syncope.1 The true effectiveness of this intervention can be better illustrated by estimating the number needed to treat (NNT)2 ( Table 1 ): to avoid one death, 29 patients had to be programmed using high-rate therapy and 43 with delayed therapy, as compared with conventional programming. This means that physicians may start saving lives (see numbers above for NNT) in primary prevention patients more effectively than avoiding inappropriate shocks (NNT of 59–82 patients, according to the treatment arm) by …

Excluding the presence of left atrial thrombus before pulmonary vein isolation: "primum non nocere"!

Abstract: To the Editor, We have read with interest the paper by Floria and colleagues assessing the predictive value of thromboembolic risk scores before an atrial fibrillation (AF) ablation procedure.? In this population of 681 consecutive patients under oral anticoagulation (with a 3 day bridging of low molecular weight heparin before ablation) who underwent a transesophageal echocardiogram (TEE) in the preceding 24 hours, a very low prevalence of thrombus was found: 1.0%. No thrombus were found in the group of 451 patients with a CHA2DS2-VASc score of 0 or 1 and only 1 patient out of 553 with a CHADS2 score of 0 or 1 had a thrombus. In the light of these findings, the authors concluded that “vein isolation could be performed safely without TEE in patients with CHADS2 and CHA2DS2-VASc scores of 0 and 1 ( . . . ) regardless of the type of AF, if they have been on anticoagulation therapy for at least 1 month in a therapeutic range prior to the procedure.” However, we consider that data from this study should be cautiously analyzed since there are studies that do not corroborate it. The 2012 Consensus Statement on Catheter and Surgical Ablation of AF recommends a preprocedural TEE to all patients with AF for 48 hours or longer without anticoagulation at a therapeutic level in the previous 3 weeks.? Still, many centers prefer to perform a TEE or a cardiac CT scan to all patients undergoing ablation of AF, even those in sinus rhythm and effectively anticoagulated. This derives from the fact that even patients with a CHADS2 or a CHA2DS2VASc score of 0,? and a minority of patients therapeutically anticoagulated?,? may develop thrombus or “sludge” in the left atrial appendage. In a recent paper, comprising patients in a similar setting to the investigation of Floria et al., Zoppo and colleagues have shown the occurrence of a left atrial thrombus