Publications by authors named "Stephane Boule"

Background: Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown.

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The spectrum of inherited arrhythmogenic diseases (IADs) includes disorders without overt structural abnormalities (i.e. primary inherited arrhythmia syndromes) and structural heart diseases (i.

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Article Synopsis
  • * Out of 401 patients with an ICD before LVAD, 122 had their ICD checked before and after implantation, with 55% showing significant lead dysfunction, including issues with sensing and pacing.
  • * Despite the lead dysfunction observed, it did not result in severe clinical problems, indicating that management of these issues was effective and conservative.
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  • The study aimed to assess the usage and outcomes of left ventricular assist devices (LVADs) in France from 2007 to 2016 using data from the ASSIST-ICD registry, involving 671 patients across 20 hospitals.
  • The overall survival rates for LVAD support or transplantation were 65.2% at 1 year, steadily decreasing to 47.7% by 5 years, with significant complications such as infections and strokes noted.
  • The findings highlight improved survival outcomes compared to earlier registries, despite patients being older and having more severe conditions, indicating differences in national treatment approaches and patient profiles.
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  • The study investigates the occurrence and impact of early ventricular arrhythmias (VAs) in patients who received left ventricular assist devices (LVAD) post-surgery, focusing on the first 30 days after implantation.
  • Significant predictors of early VAs include a prior history of VAs and undergoing additional surgeries alongside the LVAD procedure, with early VAs notably increasing the risk of death within the first month.
  • Despite early VAs raising the risk of 30-day mortality, they do not affect long-term survival rates in patients who are discharged alive from the hospital.*
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Background: Ventricular arrhythmias (VAs) can occur after continuous flow left ventricular assist device (LVAD) implantation as a single arrhythmic event or as electrical storm (ES) with multiple repetitive VA episodes.

Objective: We aimed at analyzing the incidence, predictors, and clinical impact of ES in LVAD recipients.

Methods: Patients analyzed were those included in the multicenter ASSIST-ICD observational study.

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Background: Left ventricular assist device (LVAD)-associated infections may be life-threatening and impact patients' outcome. We aimed to identify the characteristics, risk factors, and prognosis of LVAD-associated infections.

Methods: Patients included in the ASSIST-ICD study (19 centers) were enrolled.

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Background: An accurate estimation of the risk of life-threatening (LT) ventricular tachyarrhythmia (VTA) in patients with LMNA mutations is crucial to select candidates for implantable cardioverter-defibrillator implantation.

Methods: We included 839 adult patients with LMNA mutations, including 660 from a French nationwide registry in the development sample, and 179 from other countries, referred to 5 tertiary centers for cardiomyopathies, in the validation sample. LTVTA was defined as (1) sudden cardiac death or (2) implantable cardioverter defibrillator-treated or hemodynamically unstable VTA.

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Article Synopsis
  • * Conducted at 19 centers over a decade, the study tracked 659 LVAD recipients, finding that 26.9% experienced late VAs, defined as sustained arrhythmias requiring treatment more than 30 days post-implant.
  • * Researchers identified six key risk factors for late VAs, leading to the development of a "VT-LVAD score" that categorizes patients into risk groups, potentially aiding in decision-making for ICD implantation.
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Background: Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75 years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease.

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Endocardial mapping is typically considered as the first step of VT ablation procedures. Nevertheless, when the electrocardiogram is highly suggestive of an epicardial VT, a minimally invasive procedure performed exclusively via the coronary sinus might be considered. This straightforward approach avoids all potential complications associated with access to the left ventricular endocardium, the aortic root, and the pericardial space.

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Idiopathic epicardial ventricular tachycardias (VTs) account for 9% of idiopathic VTs. The recognition of this entity is important, as a minimally invasive ablation procedure performed exclusively through the coronary sinus branches may be considered, avoiding the potential risks associated with access to the left ventricular endocardium, the aortic root, and the pericardial space. The electrocardiographic features and therapeutic management of this rare form of tachycardia are discussed.

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Aims: Studies assessing radiofrequency ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) report VT recurrences, but have not evaluated the impact of RFA on relevant clinical events during follow-up. We aimed to investigate relevant RFA outcomes in a multicentric registry.

Methods And Results: This study included 49 patients with ARVC (46 with definite diagnosis, 3 with borderline diagnosis according to revised Task Force Criteria) who underwent 92 RFA procedures (83 endocardial, 9 combined endo-epicardial) between 1999-2015.

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We report the case of a 64-year-old woman who was admitted for cardiogenic shock caused by a permanent junctional reciprocating tachycardia. If this incessant and drug-refractory form of tachycardia is a well-known cause of tachycardia-induced cardiomyopathies in infants, its occurrence during adulthood is extremely rare. Catheter ablation is the recommended treatment of this condition.

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Background: Little is known about the long-term outcomes of patients who receive an implantable cardioverter-defibrillator (ICD) for purely secondary prevention indications.

Aims: To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population.

Methods: Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled.

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Aims: Despite increased use of remote monitoring (RM) to follow up implantable cardioverter-defibrillator (ICD) recipients, many patients still receive ICD shocks in the community and present to the emergency department. Our aim was to identify the best predictors of impending shock delivery that can be measured with an ICD and to identify the most appropriate activities to alert physicians to during RM follow-up.

Methods And Results: All patients presenting to our institution for ICD shock, from November 2011 to November 2014, were enrolled in this prospective study.

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Aims: Lead fractures in implantable cardioverter-defibrillator (ICD) patients may cause inappropriate shocks (ISs). An early diagnosis is essential to prevent adverse clinical events. Implantable cardioverter-defibrillator remote monitoring (RM) permits prompt detection of lead fracture.

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Background: Implantable cardioverter-defibrillators (ICDs) are a standard means of sudden cardiac death prevention. Compared with ambulatory visits, remote monitoring (RM) of ICD recipients has improved the quality of health care and spared its resources. Few studies have addressed the organization of RM.

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Background: Remote monitoring (RM) is increasingly used to follow up patients with implantable cardioverter-defibrillators (ICDs). Randomized control trials provide evidence for the benefit of this intervention, but data for RM in daily clinical practice with multiple-brands and unselected patients is lacking.

Aims: To assess the effect of RM on patient management and clinical outcome for recipients of ICDs in daily practice.

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