Impact of ablation index settings on pulmonary vein reconnection.

PURPOSE: Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS: The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS: Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION: Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.

Whole body [(18) F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: a preliminary prospective study.

We studied the potential use of [(18) F]fluorodeoxyglucose ((18) F-FDG) whole body positron emission tomography (PET)-computed tomography for the diagnosis of device infection and extension of infection. Twenty-one patients with suspected device infection were prospectively included and compared with 14 controls free of infection. (18) F-FDG uptake on the box and on the leads was visually and quantitatively interpreted (using the maximal standard uptake value). The final diagnosis was obtained either from bacteriological data after device culture (n = 11) or by a 6-month follow-up according to modified Duke's criteria (n = 10). Ten patients finally showed infection on bacteriological study (n = 8) or during follow-up (n = 2). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 80%, 100%, 100% and 84.6% on patient-based analysis (presence or absence of infection). They were 100%, 100%, 100% and 100% for boxes, but only 60%, 100%, 100% and 73% for leads. Quantitative analysis could be useful for boxes but not for leads, for which the presence of a mild hot spot was the best criterion of infection. The four false negatives on leads received antibiotics for longer than the six true positives (20 ± 7.2 vs. 3.2 ± 2.3 days, p <0.01). Although the study was not designed for this purpose, management could have been modified by PET results in six of 21 patients. (18) F-FDG PET imaging may be useful for the diagnosis of device infection, and could impact on clinical management. Interpretation of negative cases should be performed with caution if patients have received antibiotics.

[Case report and review of a voluminous right atrial myxoma revealed by heart failure]. / Volumineux myxome de l'oreillette droite révélé par une insuffisance cardiaque congestive.

Right atrial myxoma is a rare disease and its clinical presentation is not specific. The usual mode of revelation is heart failure. The most frequent complications are pulmonary embolism and atrioventricular valve obstruction by the tumor. A 49-year-old woman was admitted to intensive care unit for heart failure. The echocardiogram showed a voluminous right atrial myxoma, appending to the interatrial septum. Its surgical excision under extracorporeal circulation was successfully performed. Histology confirmed the final diagnosis of myxoma. No complication was observed at 6 months follow-up.

[Perspectives in cardiology: evidence of efficacy in atrial fibrillation and hopes in acute coronary syndrome]. / Perspectives en cardiologie : une efficacité démontrée dans la fibrillation atriale, des espoirs dans le syndrome coronaire aigu.

New antithrombotic drugs, antithrombin or anti Xa, will probably be very useful in cardiology. Two directions are interesting: in one hand atrial fibrillation, in which the unmet need concern drugs as effective as vitamine K antagonists but easier to use. On the other hand, in acute coronary syndrome the situation is different, there are many antithrombotic drugs available but there is still a place for innovative drugs which could provide a gain in terms of efficacy, but the hemorrhagic risk must remain acceptable. In atrial fibrillation, the RELY trial, performed in 18,113 patients has demonstrated, as compared to warfarin, a non inferiority of dabigatran at the dose of 110 mg BID and a superiority of dabigatran at 150 mg BID with a reduction of 34% of the primary endpoint, i.e.stroke and systemic embolism.

[Case report and review about radiofrequency catheter ablation in a patient with dilated cardiomyopathy and an implantable cardioverter defibrillator]. / Prise en charge d'une tachycardie ventriculaire récidivante sur cardiopathie non ischémique chez un patient implanté d'un défibrillateur.

The benefit of implantable cardioverter defibrillators (ICD) on total mortality has been demonstrated in primary prevention for heart failure patients, in whom they improve clinical outcomes. However, some of these patients present incessant ventricular tachycardia and receive appropriated shocks and antitachycardia therapy. Radiofrequency catheter ablation is an efficacious method to prevent the occurrence of stable ventricular tachy-arrythmia. We present here, the case of a patient with dilated cardiomyopathy implanted with an ICD in secondary prevention (ventricular tachycardia [VT]). The ICD delivered multiple appropriated shocks for monomorphic VT. A radiofrequency catheter ablation was successfully performed and the patient receives no further shock for the whole 18 months follow-up.