Publications by authors named "Didier Klug"

Article Synopsis
  • Arrhythmic risk stratification in Brugada syndrome is challenging, and this study aimed to evaluate the predictive value of automatically measured ECG parameters from digitized paper ECGs.
  • In a multicenter study involving 301 patients, two ECG parameters (QRS prolongation in lead V1 and S duration on DI) were found to independently predict major cardiac events.
  • The study concluded that automatic ECG analysis could effectively assess risk in Brugada syndrome patients by confirming known parameters and identifying new ones.
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  • SCN5A gene variants are linked to various cardiac electrical disorders, but they can also result in complex phenotypes like overlap syndromes, which haven't been thoroughly studied.
  • The study analyzed DNA from over 13,500 patients with a focus on those carrying pathogenic SCN5A variants, finding that most were tied to well-defined conditions like Brugada syndrome and long QT syndrome.
  • About 19% of the variants were associated with complex phenotypes, and only a small number (8 out of 9,960 patients) showed a potential link to dilated cardiomyopathies (DCM), suggesting it's a rare association.
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Background: Electrical storm (ES) is a life-threatening condition, associated with substantial early and subacute mortality. Catheter ablation (CA) is a well-established therapy for ES. However, data regarding the impact of CA on the short-term and midterm survival of patients admitted for ES remain unclear.

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Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice.

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Background: The efficacy of beta-blocker treatment in type 3 long QT syndrome (LQT3) remains debated.

Objectives: The purpose of this study was to test the hypothesis that beta-blocker use is associated with cardiac events (CEs) in a French cohort of LQT3 patients.

Methods: All patients with a likely pathogenic/pathogenic variant in the SCN5A gene (linked to LQT3) were included and followed-up.

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Article Synopsis
  • Very few studies have explored the effectiveness of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD), which this research aims to address.
  • In a French cohort study of 4,924 patients implanted with an S-ICD, only 101 were found to have CHD, often presenting at a younger age and more often for secondary prevention compared to non-CHD patients.
  • The study found that while patients with CHD had a higher crude risk of receiving appropriate shocks from their S-ICD, this risk was not significant after adjusting for other factors, indicating that complications and inappropriate shocks were similar across both patient groups.
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  • The study looked at two ways to monitor patients with heart devices: using a smartphone app (SM-RM) and a traditional bedside monitor (BM-RM).
  • It found that more patients using the smartphone app stayed enrolled in the monitoring system and sent their data regularly.
  • Overall, patients using the smartphone app did much better at staying connected and sharing their health information compared to those using the bedside monitor.
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Background: A number of epidemiological studies have suggested an association between metabolic dysfunction-associated fatty liver disease (MAFLD) and the incidence of atrial fibrillation (AF). However, the pathogenesis leading to AF in the context of MAFLD remains unclear. We therefore aimed at assessing the impact of MAFLD and liver fibrosis status on left atrium (LA) structure and function.

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Background: Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy for treating refractory ventricular tachycardia (VT) despite optimal medical treatment and catheter ablation. However, data on the use of SBRT in patients with electrical storm (ES) is lacking. The aim of this study was to assess the clinical outcomes associated with SBRT in the context of ES.

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Background Little data are available in women presenting with ventricular fibrillation (VF) in the setting of acute myocardial infarction (AMI). We assessed frequency, predictors of VF, and outcomes, with a special focus on women compared with men. Methods and Results Data were analyzed from the FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program, which prospectively included 14 406 patients admitted to French cardiac intensive care units ≤48 hours from AMI onset between 1995 and 2015 (mean age, 66±14 years; 72% men; mean left ventricular ejection fraction, 52±12%; 59% with ST-segment-elevation myocardial infarction).

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Aims: For assessing predictors of early mortality following hospitalization for electrical storm (ES), only limited data are available. The purpose of this study was to assess the incidence and predictors of early mortality following hospitalization in the intensive care unit (ICU) for ES in a large retrospective study.

Methods And Results: In this retrospective study, we included all patients who were hospitalized for ES from July 2015 to May 2020 in our tertiary centre.

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Cardiovascular diseases, which are the leading global cause of death, should increase by 40% by 2030, reaching close to 24 million deaths worldwide. Atrial fibrillation is the most common heart rhythm disorder, ahead of conduction disturbances and ventricular arrhythmias. Studies estimate that 7.

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Background: Syncope in patients with an early repolarization (ER) pattern presents a challenge for clinicians as it has been identified as an indicator of a higher risk of life-threatening ventricular arrhythmias (VAs).

Objectives: This study aimed to analyze the outcome of patients with an ER pattern and syncope and to evaluate the factors predictive of VAs.

Methods: Over a period of 5 years, we enrolled 143 patients with an ER pattern and syncope in a multicenter prospective registry.

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Catecholaminergic polymorphic ventricular tachycardia (CPVT) is triggered by exercise or acute emotion in patients with normal resting electrocardiogram. The major disease-causing gene is , encoding the cardiac ryanodine receptor (RyR2). We report a novel variant, p.

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Article Synopsis
  • The French LAA closure registry (FLAAC) was designed to evaluate the safety and effectiveness of Left Atrial Appendage (LAA) closure in everyday clinical practice for patients with non-valvular atrial fibrillation (NVAF).
  • In this study involving 816 patients, the annual rate of ischemic stroke/systemic embolism post-procedure was found to be 3.3%, reflecting a significant reduction in risk compared to historical data, although the long-term mortality rate was 10.2%, primarily due to comorbidities.
  • The results indicate that LAA closure is a viable option for NVAF patients, but highlight the need for ongoing multidisciplinary care to address associated health issues.
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Background: Reversion of an implantable cardioverter defibrillator (ICD) to back-up mode degrades the operating capabilities of the device, puts patients at risk and requires rapid intervention by a manufacturer's technician.

Aim: To illustrate the usefulness of remote monitoring of ICDs for the early detection of reversion to back-up mode.

Methods: In our centre, all patients implanted with an ICD, with or without resynchronisation, were offered remote monitoring as soon as the technology became available.

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Ventricular tachycardia has a significant recurrence rate after ablation for several reasons, including inaccessible substrate. A non-invasive technique to ablate any defined areas of myocardium involved in arrhythmogenesis would be a potentially important therapeutic improvement if shown to be safe and effective. Early feasibility studies of single-fraction stereotactic body radiotherapy have demonstrated encouraging results, but rigorous evaluation and follow-up are required.

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As the number of patients with cardiac implantable electronic devices (CIEDs) grows, they are likely to present with issues to diverse groups of physicians. Guideline-adherent management is associated with improved prognosis in patients with CIED infection or lead problems but is insufficiently implemented in practice. The European Heart Rhythm Association (EHRA) with the support of the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery, performed a multinational educational needs assessment study in ESC member countries, directed at physicians who might be confronted with CIED patients with complications.

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Background: Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC.

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Background: Several liver function tests have been identified as predictors of hospitalization for heart failure (HF) and death in patients with chronic HF. The relationship between serum γ-glutamyltranferase (GGT) and albumin (SA) levels with the response to cardiac resynchronization therapy (CRT) has not been reliably determined. The aim of the study was to evaluate the impact of liver function tests on the results of CRT in the elderly.

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Background: In this study we aimed to assess long-term outcomes in subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with structural heart disease by focussing especially on shock incidence, predictors, and associated prognoses.

Methods: In this multicenter registry‒based study, we retrospectively included all patients who underwent S-ICD implantation at 3 tertiary centers. The prognostic impact of S-ICD shock was assessed with a composite outcome that included all-cause death and hospitalisation for heart failure.

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Article Synopsis
  • MRI is now the go-to imaging technique for many diseases, and its usage is on the rise alongside patients with cardiac electronic implantable devices (CEIDs).
  • For years, having a CEID was seen as a no-go for MRI scans; however, advancements have made MR-conditional devices more common, allowing for safer MRI usage in these patients.
  • Despite the progress, risks still exist when conducting MRIs on CEID carriers, necessitating specific programming and monitoring protocols to ensure patient safety during these procedures.
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