AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events

Brembilla‐Perrot, Béatrice; Brembilla, Alice; Bozec, Erwan; Dorlet, Sarah; Sellal, Jean Marc; Olivier, Arnaud; Manenti, Vladimir; Villemin, Thibaut; Beurrier, Daniel; Moulin-Zinsch, Anne; Chillou, Christian de; Girerd, Nicolas

doi:10.1016/j.ijcard.2015.07.048

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…Recurring symptoms are frequent after radiofrequency ablation in several clinical settings. 21 In the present study, the risk of poorly tolerated arrhythmia was also increased in patients ≥60 years (univariable OR=7.69, 1.8 to 32.9, p=0.006). The association of heart disease, increased ventricular stiffness and lower tolerance to high frequency are thought to explain the risk of occurrence of haemodynamically poorly tolerated arrhythmias in elderly patients.…”

Section: Discussionsupporting

confidence: 56%

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period

et al. 2016

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ObjectivesThere are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS.SettingSingle-centre retrospective study of patient files.ParticipantsIn all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary.Primary and secondary outcome measuresOccurrence of atrial fibrillation (AF) or procedure-induced adverse event.ResultsElectrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01).ConclusionsIn this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly patients, the decision for EPS and AP ablation should be discussed in light of their suspected higher risk of events and ablation complications. However, these findings should be further validated in future prospective multicentre studies.

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Section: Discussionsupporting

confidence: 56%

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period

et al. 2016

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“…As expected, clinical signs were often more critical with regard to syncope, heart failure and acute coronary syndromes. Poor tolerance in older patients has been recently reported in other studies [ 14 ]. This poor tolerance is probably explained by a higher rate of cardiac comorbidities such as associated heart disease.…”

Section: Discussionmentioning

confidence: 54%

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years

Brembilla‐Perrot¹,

Sellal²,

Olivier³

et al. 2018

PLoS ONE

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AimTo investigate the influence of increasing age on clinical presentation, treatment and long-term outcome in patients with inducible paroxysmal supraventricular tachycardia (SVT) without pre-excitation syndromes.MethodsClinical and electrophysiological study (EPS) data, as well as long-term clinical outcome (mean follow-up 2.4±4.0 years) were collected in patients referred for regular tachycardia with inducible SVT during EPS without pre-excitation.ResultsAmong 1960 referred patients, 301 patients (15.4%) were aged ≥70 (70–97). In this subset, anticoagulants were prescribed in 49 patients following an erroneous diagnosis of atrial tachycardia and 14 were previously erroneously diagnosed with ventricular tachycardia because of wide QRS. Ablation was performed more frequently in patients ≥70 despite more frequent failure and complications. During follow-up, higher risks of AF, stroke, pacemaker implantation and death were observed in patients ≥70 whereas SVT recurrences were similar in both age groups. In multivariable analysis, age ≥70 was independently associated with higher risks of SVT-related adverse events prior to ablation (OR = 1.93, 1.41–2.62, p<0.001), conduction disturbances (OR = 11.27, 5.89–21.50, p<0.001), history of AF (OR = 2.18, 1.22–3.90, p = 0.009) and erroneous diagnosis at baseline (OR = 9.14, 5.93–14.09, p<0.001) as well as high rates of procedural complications (OR = 2.13, 1.19–3.81, p = 0.01) and ablation failure (OR = 1.68, 1.08–2.62, p = 0.02). In contrast, age ≥70 was not significantly associated with a higher risk of AF in multivariable analysis.ConclusionsA sizeable proportion of patients with inducible SVT without pre-excitation syndromes are elderly. These patients exhibit higher risks of erroneous tachycardia diagnosis prior to EPS as well as failure and/or complication of ablation, but similar risk of SVT recurrence. These results support performing transesophageal EPS in most patients and intracardiac EPS in selected patients. EPS may furthermore prove useful in elderly patients with regular tachycardia, mainly by avoiding treatment based on an erroneous diagnosis.

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“…The retrospective study of patients' files was, as in our previous studies, approved by the Commission Nationale Informatique et Libertés (CNIL), in keeping with French law for single‐centre usual‐care observational studies.…”

Section: Methodsmentioning

confidence: 99%

Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation

Brembilla‐Perrot

Ferreira

Manenti

et al. 2016

European J of Heart Fail

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BackgroundAtrial flutter-related tachycardiomyopathy (AFL-TCM) is a rare and treatable cause of heart failure. Little is known about its epidemiology and long-term prognosis. Our aims are to determine the prevalence, predictors and outcomes of AFL-TCM. Methods and resultsA total of 1269 patients were referred for radiofrequency ablation of AFL between January 1996 and September 2014; 184 had reduced left ventricular ejection fraction (LVEF <40%). At 6 months after AFL ablation, 103 patients (8.1% of the population, 56% of patients with baseline LVEF <40%) had marked LVEF improvement: these were considered to have AFL-TCM. Patients with persisting reduced LVEF were considered to have systolic dysfunction unrelated to AFL. Patients were followed for a median (percentile 25-75 ) of 1.15 (0.4-2.8) years. Patients with AFL-TCM were younger, had lower prevalence of ischaemic cardiomyopathy and used less antiarrhythmic drugs than patients with systolic dysfunction unrelated to AFL. In multivariable analysis, ischemic cardiomyopathy [odds ratio (OR) = 0.32, 95% confidence interval (CI) 0.15-0.68) P = 0.003] and prescription of antiarrhythmic drug before ablation [OR = 0.41, 95% CI 0.20-0.84, P = 0.02] were significantly associated with a lower probability of LVEF improvement during follow-up. Patients with AFL-TCM had similar survival to patients without systolic dysfunction at baseline [hazard ratio (HR) = 0.96 95% CI 0.34-2.65, P = 0.929], whereas patients with systolic dysfunction unrelated to AFL had higher mortality rates compared with patients without systolic dysfunction at baseline [HR = 2.88, 95% CI 1.45-5.72, P = 0.002].

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AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events

Cited by 10 publications

References 23 publications

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period

Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of inducible paroxysmal supraventricular tachycardia without pre-excitation syndromes: A cohort study of 1960 patients included over 25 years

Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation

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