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Pedro Brugada - One of the best experts on this subject based on the ideXlab platform.
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Malignant Ventricular Arrhythmia in a Case of Adult Onset of Spinal Muscular Atrophy (Kugelberg–Welander Disease)
Journal of cardiovascular electrophysiology, 2008Co-Authors: Markus Roos, Andrea Sarkozy, Gian-battista Chierchia, Philippe De Wilde, Eric Schmedding, Pedro BrugadaAbstract:We present a case of a 43-year-old male patient with adult onset of spinal muscular atrophy (SMA). The patient first came to our attention with atrioventricular (AV) block. A dual-chamber pacemaker (DDD-PM) was implanted. Four years later, the PM data log showed occurrence of frequent episodes of nonsustained ventricular tachycardia (NSVT). The episodes progressed in duration and frequency. An electrophysiological study revealed prolonged His-ventricular (HV) Interval duration and induction of sustained ventricular tachycardia. The patient was successfully upgraded to a prophylactic dual-chamber cardioverter defibrillator. Our case is the first description of a patient with adult-onset SMA (Kugelberg-Welander disease [KWD]) and malignant ventricular arrhythmias.
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natural history of brugada syndrome the prognostic value of programmed electrical stimulation of the heart
Journal of Cardiovascular Electrophysiology, 2003Co-Authors: Pedro Brugada, M Ramon D Brugada, Lluis Mont, M Maximo D Rivero, Peter Geelen, Josep BrugadaAbstract:Introduction: The prognostic value of electrophysiologic studies in individuals with the syndrome of right bundle branch block and ST segment elevation in precordial leads V1 to V3 (Brugada syndrome) remains controversial. Our previous data from 252 individuals with the syndrome suggested that programmed ventricular stimulation had a good overall accuracy to predict events. However, studies from independent investigators questioned our results. We report here the largest population with Brugada syndrome ever studied by programmed electrical stimulation of the heart. Methods and Results: Four hundred forty-three individuals with an ECG diagnostic of Brugada syndrome were studied by programmed electrical stimulation of the heart. The diagnosis was made because of the classic ECG showing a coved-type ST segment elevation in precordial leads V1 to V3. Of the 443 individuals, 180 had developed spontaneous symptoms (syncope or aborted sudden cardiac death) and 263 were asymptomatic at the time the diagnosis was made. The ventricular stimulation protocol included a minimum of two basic pacing cycle lengths with two ventricular premature beats from the right ventricular apex. A sustained ventricular arrhythmia was induced in 217 cases (49%). Symptomatic patients were more frequently inducible [126/180 (70%)] than asymptomatic individuals [91/263 (34%);P = 0.0001 ]. Males were more frequently inducible than females (54% vs 32%,P < 0.0001). Inducible individuals had a longer HV Interval than noninducible patients (50 ± 12 msecvs46 ± 10 msec, P < 0.002). HV Interval and number of premature beats needed to induce VF were not related to outcome. Inducibility was statistically a powerful predictor of arrhythmic events during follow-up. Sixty of 217 inducible patients (28%) had spontaneous ventricular fibrillation compared with 5 of 221 noninducible patients(2%; P = 0.0001). Conclusion: Inducibility of sustained ventricular arrhythmias during programmed ventricular stimulation of the heart is a good predictor of outcome in Brugada syndrome.(J Cardiovasc Electrophysiol, Vol. 14, pp. 455-457, May 2003)
P. Le Prince - One of the best experts on this subject based on the ideXlab platform.
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Respective role of surface electrocardiogram and His bundle recordings to assess the risk of atrioventricular block after transcatheter aortic valve replacement.
International journal of cardiology, 2017Co-Authors: Nicolas Badenco, C. Chong-nguyen, C. Maupain, C. Himbert, G. Duthoit, Xavier Waintraub, Thomas Chastre, E. Gandjbakhch, F. Hidden-lucet, P. Le PrinceAbstract:Abstract Background Atrioventricular block (AVB) is common after transcatheter aortic valve replacement (TAVR) and permanent pacemaker (PPM) implantation is needed in up to 30% of patients. Main predictors of long term AVB are electrocardiographic. The purpose of this study is to assess the prognostic value of serial HV Intervals measured before and after TAVR to shorten the timing of PPM implantation. Methods His bundle recordings were performed before (HV1), immediately after TAVR (HV2) and at day 2 for Edwards Sapien (ES) and 5 for Medtronic CoreValve (CV) (HV3). PPM indications were high degree AVB before day 5 or prolonged HV Interval ≥80ms at the last recording. High degree AVB after discharge was evaluated from the pacemaker memories and ECG at 1 and 6months. Results Data were obtained in 84 patients (33% CV and 67% ES). HV values were not associated with early or late AVB. PPM were implanted in 27 patients (34%) for documented AVB (n=17, 24%), prolonged HV Interval (n=9) or sick sinus syndrome (n=1). Persistent complete AVB during the procedure and postoperative high degree AVB were the only perioperative factors associated with further long term occurrence of high degree AVB (p=0.001 and p Conclusion Pre- and post-operative HV measurements were not correlated with late AVB after TAVR. Perioperative persistent complete AVB and postoperative high degree AVB are the only factors to predict late AVB and should be considered for the decision of PPM implantation.
Josep Brugada - One of the best experts on this subject based on the ideXlab platform.
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natural history of brugada syndrome the prognostic value of programmed electrical stimulation of the heart
Journal of Cardiovascular Electrophysiology, 2003Co-Authors: Pedro Brugada, M Ramon D Brugada, Lluis Mont, M Maximo D Rivero, Peter Geelen, Josep BrugadaAbstract:Introduction: The prognostic value of electrophysiologic studies in individuals with the syndrome of right bundle branch block and ST segment elevation in precordial leads V1 to V3 (Brugada syndrome) remains controversial. Our previous data from 252 individuals with the syndrome suggested that programmed ventricular stimulation had a good overall accuracy to predict events. However, studies from independent investigators questioned our results. We report here the largest population with Brugada syndrome ever studied by programmed electrical stimulation of the heart. Methods and Results: Four hundred forty-three individuals with an ECG diagnostic of Brugada syndrome were studied by programmed electrical stimulation of the heart. The diagnosis was made because of the classic ECG showing a coved-type ST segment elevation in precordial leads V1 to V3. Of the 443 individuals, 180 had developed spontaneous symptoms (syncope or aborted sudden cardiac death) and 263 were asymptomatic at the time the diagnosis was made. The ventricular stimulation protocol included a minimum of two basic pacing cycle lengths with two ventricular premature beats from the right ventricular apex. A sustained ventricular arrhythmia was induced in 217 cases (49%). Symptomatic patients were more frequently inducible [126/180 (70%)] than asymptomatic individuals [91/263 (34%);P = 0.0001 ]. Males were more frequently inducible than females (54% vs 32%,P < 0.0001). Inducible individuals had a longer HV Interval than noninducible patients (50 ± 12 msecvs46 ± 10 msec, P < 0.002). HV Interval and number of premature beats needed to induce VF were not related to outcome. Inducibility was statistically a powerful predictor of arrhythmic events during follow-up. Sixty of 217 inducible patients (28%) had spontaneous ventricular fibrillation compared with 5 of 221 noninducible patients(2%; P = 0.0001). Conclusion: Inducibility of sustained ventricular arrhythmias during programmed ventricular stimulation of the heart is a good predictor of outcome in Brugada syndrome.(J Cardiovasc Electrophysiol, Vol. 14, pp. 455-457, May 2003)
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Ablación por radiofrecuencia de múltiples vías accesorias auriculoventriculares en un paciente con fibrilación auricular sincopal y presencia de fibras fascículo-ventriculares
Revista espanola de cardiologia, 1998Co-Authors: Mariana Valentino, Luis Mont, Luis Aguinaga, Ignacio Anguera, Iciar Eizmendi, Jose Javier Sanchez, Laura Guillamón, Mariona Matas, Josep BrugadaAbstract:Multiple accessory pathways in patients with the Wolff-Parkinson-White syndrome are infrequent and are associated with a higher risk of ventricular fibrillation. We present an exceptional case of a patient with four accessory pathways with anterograde conduction and a fasciculo-ventricular fiber in whom we performed a radiofrequency ablation. A 20 year old healthy male patient was seen at the emergency room after suffering syncope. The electrocardiogram showed atrial fibrillation with wide QRS complex suggestive of preexcitation. The electrophysiologic study demonstrated the presence of four atrio-ventricular accessory pathways with antegrade conduction (left lateral, right posteroseptal, right midseptal and right posterolateral). After ablation of the fourth accessory pathway, the electrocardiogram showed a persistent delta wave with a short HV Interval. Atrial stimulation demonstrated decremental conduction, progressive lengthening of the AH Interval and no modification in the HV Interval nor in the preexcitation pattern, suggestive of the presence of a fasciculo-ventricular fiber. This exceptional case report is demonstrative of the complexity of the Wolff-Parkinson-White syndrome, and the feasibility and efficacy of radiofrequency catheter ablation in a single procedure.
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Reversal of electrophysiologic and hemodynamic effects induced by high dose of bupivacaine by the combination of clonidine and dobutamine in anesthetized dogs.
Anesthesia and analgesia, 1992Co-Authors: J. E. De La Coussaye, B. Bassoul, Josep Brugada, B. Albat, Pascale Peray, J. P. Gagnol, G. Desch, J.j. Eledjam, A. SassineAbstract:The ability of clonidine and dobutamine to correct bupivacaine-induced cardiac electrophysiologic and hemodynamic impairment was evaluated in an experimental electrophysiologic model on closed-chest dogs. Five groups (n = 6) of pentobarbital-anesthetized dogs were given atropine (0.2 mg/kg IV). Group 1 was given a saline solution; all other dogs were given bupivacaine (4 mg/kg IV) over a 10-s period. Group 2 was given only bupivacaine. Group 3 was given clonidine (0.01 mg/kg IV) over a 1-min period. Group 4 was given a dobutamine infusion at 5 micrograms.kg-1.min-1. Group 5 was given the combination of clonidine and dobutamine. Bupivacaine induced bradycardia, prolonged atrioventricular conduction time (PR Interval), atrioventricular node conduction time (AH Interval), His-Purkinje conduction time (HV Interval), and QRS duration. Bupivacaine decreased left ventricular (LV) dP/dt max and increased LV end-diastolic pressure (LVEDP). Clonidine improved QRS duration and HV Interval but enhanced AH Interval, bradycardia, and hemodynamic depression induced by bupivacaine. Dobutamine infusion improved LV dP/dt max but did not modify bupivacaine-induced ventricular electrophysiologic impairment. The combination of clonidine and dobutamine corrected not only the electrophysiologic impairment induced by bupivacaine but also the hemodynamic depression. As the HV Interval and the QRS duration could be correlated with ventricular conduction velocities, we conclude that (a) clonidine reversed the slowing of ventricular conduction velocities induced by bupivacaine, and (b) the combination of clonidine and dobutamine was able to correct the cardiac disturbances induced by bupivacaine in anesthetized dogs.
M Pedro D Brugada - One of the best experts on this subject based on the ideXlab platform.
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malignant ventricular arrhythmia in a case of adult onset of spinal muscular atrophy kugelberg welander disease
Journal of Cardiovascular Electrophysiology, 2009Co-Authors: M Markus D Roos, M Andrea D Sarkozy, M Gianbattista D Chierchia, M Philippe D De Wilde, M Eric D Schmedding, M Pedro D BrugadaAbstract:We present a case of a 43-year-old male patient with adult onset of spinal muscular atrophy (SMA). The patient first came to our attention with atrioventricular (AV) block. A dual-chamber pacemaker (DDD-PM) was implanted. Four years later, the PM data log showed occurrence of frequent episodes of nonsustained ventricular tachycardia (NSVT). The episodes progressed in duration and frequency. An electrophysiological study revealed prolonged His-ventricular (HV) Interval duration and induction of sustained ventricular tachycardia. The patient was successfully upgraded to a prophylactic dual-chamber cardioverter defibrillator. Our case is the first description of a patient with adult-onset SMA (Kugelberg-Welander disease [KWD]) and malignant ventricular arrhythmias.
Laurent Macle - One of the best experts on this subject based on the ideXlab platform.
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electrocardiographic and electrophysiological predictors of atrioventricular block after transcatheter aortic valve replacement
Heart Rhythm, 2015Co-Authors: Lena Rivard, Gernot Schram, Anita W Asgar, Paul Khairy, Jason G Andrade, Raoul Bonan, Marc Dubuc, Peter G Guerra, Reda Ibrahim, Laurent MacleAbstract:Background Electrophysiological predictors of atrioventricular (AV) block after transcatheter aortic valve replacement (TAVR) are unknown. Objective We sought to assess the value of electrophysiology study before and after TAVR. Methods Seventy-five consecutive pacemaker-free patients undergoing TAVR at the Montreal Heart Institute were prospectively studied. Results Eleven patients (14.7%) developed AV block during the index hospitalization and 3 (4.0%) after hospital discharge over a median follow-up of 1.4 years (interquartile range 0.6–2.1 years). AV block developed in 5 of 6 patients with preprocedural right bundle branch block (83.3%), 8 of 30 patients with new-onset left bundle branch block (LBBB; 26.7%), and 1 of 7 patients with preexisting LBBB (14.3%). In multivariate analysis that considered all patients, the delta-HV Interval (HV Interval after TAVR minus HV Interval before TAVR) was the only factor independently associated with AV block. In the subgroup of patients with new-onset LBBB, the postprocedural HV Interval was strongly associated with AV block. By receiver operating characteristic analysis, a delta-HV Interval of ≥13 ms predicted AV block with 100.0% sensitivity and 84.4% specificity and an HV Interval of ≥65 ms predicted AV block with 83.3% sensitivity and 81.6% specificity. In multivariate analysis, the HV Interval after TAVR (hazard ratio 1.073 per ms; 95% confidence Interval 1.029–1.119; P = .001) was also independently associated with all-cause mortality. Conclusion A prolonged delta-HV Interval (≥13 ms) is strongly associated with AV block after TAVR. In patients with new-onset LBBB after TAVR, a postprocedural HV Interval of ≥65 ms is likewise predictive of AV block.
