Browsing by Author "Lellouche, Nicolas"

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    Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes
    (Elsevier, 2017) Hamon, David; Abehsira, Guillaume; Gu, Kai; Liu, Albert; Sadron, Marie Blaye-Felice; Billet, Sophie; Kambur, Thomas; Swid, Mohammed Amer; Boyle, Noel G.; Dandamudi, Gopi; Maury, Philippe; Chen, Minglong; Miller, John M.; Lellouche, Nicolas; Shivkumar, Kalyanam; Bradfield, Jason S.; Department of Medicine, School of Medicine
    Background Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). Conclusion A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.
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    Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures
    (Elsevier, 2021) Makati, Kevin J.; Sood, Nitesh; Lee, Lawrence S.; Yang, Felix; Shults, Christian C.; DeLurgio, David B.; Melichercik, Juraj; Gill, Jaswinder S.; Kaba, Riyaz A.; Ahsan, Syed; Weerasooriya, Rukshen; Joshi, Pragnesh; Lellouche, Nicolas; Blaauw, Yuri; Zannis, Konstantinos; Sebag, Frederic A.; Gauri, Andre; Zembala, Michael O.; Tondo, Claudio; Steinberg, Jonathan S.; Surgery, School of Medicine
    The absence of strategies to consistently and effectively address nonparoxysmal atrial fibrillation by nonpharmacological interventions has represented a long-standing treatment gap. A combined epicardial/endocardial ablation strategy, the hybrid Convergent procedure, was developed in response to this clinical need. A subxiphoid incision is used to access the pericardial space facilitating an epicardial ablation directed at isolation of the posterior wall of the left atrium. This is followed by an endocardial ablation to complete isolation of the pulmonary veins and for additional ablation as needed. Experience gained with the hybrid Convergent procedure during the last decade has led to the development and adoption of strategies to optimize the technique and mitigate risks. Additionally, a surgical and electrophysiology "team" approach including comprehensive training is believed critical to successfully develop the hybrid Convergent program. A recently completed randomized clinical trial indicated that this ablation strategy is superior to an endocardial-only approach for patients with persistent atrial fibrillation. In this review, we propose and describe best practice guidelines for hybrid Convergent ablation on the basis of a combination of published data, author consensus, and expert opinion. A summary of clinical outcomes, emerging evidence, and future perspectives is also given.
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    Usefulness of Doppler Transthoracic Echocardiography for the Diagnosis of Wide-QRS Complex Tachycardia
    (Elsevier, 2023-08) Hamon, David; Moulin, Thibaut; Nicolas, Eroan; Labbé, Jean-Philippe; Ternacle, Julien; Huguet, Raphaelle; Lim, Pascal; Derumeaux, Geneviève; Teiger, Emmanuel; Miller, John M.; Lellouche, Nicolas; Medicine, School of Medicine
    The differential diagnosis of wide–QRS complex tachycardia (WCT) must be assessed between ventricular tachycardia (VT) and supraventricular tachycardia with ventricular aberrancy. Numerous electrocardiographic algorithms have been described but may lack sensitivity or specificity in real-life practice. In this context, additional noninvasive methods are needed in stable patients not requiring urgent defibrillation. Flow and Doppler tissue imaging (DTI) allows real-time visualization of atrial and ventricular mechanical activities. In this proof-of-concept study, we aimed to evaluate the feasibility and performance of Doppler transthoracic echocardiography (TTE) to elucidate atrioventricular (AV) relationship and discriminate VT from supraventricular tachycardia during WCT. The study protocol was approved by a national ethics committee, and all participants gave written inform consent.