Papers by Estelle Gandjbakhch
Europace, May 24, 2023
Funding Acknowledgements Type of funding sources: None. Background Arrhythmogenic right ventricul... more Funding Acknowledgements Type of funding sources: None. Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibrofatty replacement in the myocardium progressing from the epicardium towards the endocardium and affecting primarily the right ventricle (RV). Little data is available on the distribution of RV electrical abnormalities at the era of epicardial and high-resolution mapping. Purpose To evaluate the extent and distribution of RV epicardial and endocardial low voltage areas and their relationship with ECG abnormalities in ARVC patients. Methods Patients with a definite ARVC diagnosis according to the 2020 Task Force Criteria, who underwent ventricular tachycardia ablation between 2016 and 2022 with a high-density RV 3-dimensional electroanatomic mapping, were included. A custom RV segmentation dividing the RV into 10 segments from endocardial maps was used: anterior and lateral right ventricular outflow tract (RVOT); basal and mid inferior wall; apex; septum; basal anterolateral, basal inferolateral, mid anterolateral and mid inferolateral RV free wall (Figure). A standard definition of electrical scar was used (bipolar voltage ≤0.5 mV), and scar areas were manually delineated. Percentage of scar was defined by the ratio between scar area and the total segment area. ECG abnormal findings, such as epsilon wave and T-wave inversion in precordial leads, were measured before ablation procedure. Results Twenty-nine consecutive definite ARVC patients were included, among whose 24 had epicardial mapping in addition to endocardial mapping. When considering all segments, the epicardial scar (median:70%, interquartile range [IQR] 37-97%) was larger (p<0.0001) than the endocardial scar (9% [IQR] 0-32%). The higher percentage of epicardial scar was found in the basal inferolateral (100% [IQR] 73-100%), basal anterolateral (94% [IQR] 67-100%), RV free wall and lateral RVOT (89% [IQR] 48-100%) segments (Table). Transmural scar was observed mostly in basal inferolateral RV free wall (10 patients, 41%) and basal inferior wall (8 patients, 33%). Patients with major depolarization criteria had a higher percentage of epicardial and endocardial scar as compared to those with no or minor depolarization criteria (respectively 93% [IQR] 59-100% versus 62% [IQR] 28-89%, p<0.0001 and 17% [IQR] 0-42% versus 4% [IQR] 0-23%, p=0.001). There was no significant difference of the percentage of epicardial or endocardial scar in patients with and without major repolarization criteria (respectively 90% [IQR] 49-98% versus 84% [IQR] 43-100%, p=0.91 and 14% [IQR] 11-35% versus 16% [IQR] 0-41%, p=0.73). Conclusion In ARVC, the electrical abnormalities predominate in the basal epicardium. Patients with major depolarization criteria had a higher extent of epicardial and endocardial scar, but there was an association between scar extent and repolarization abnormalities.
Heart Rhythm, May 1, 2022
Archives of Cardiovascular Diseases Supplements, 2017
Pacing and Clinical Electrophysiology, Jul 23, 2018
Diverging channels of activation may be observed in some VT using ultra-high density mapping. We ... more Diverging channels of activation may be observed in some VT using ultra-high density mapping. We present here cases of such diverging activation patterns as observed from 60 consecutive VT activation maps using the Rhythmia system ™. Diverging directions of activation in the same area with "crossroads" or "flyover" pattern can be traced, implying recording of independent multilayer channels. Adaptation of current automated recording by the 3D mapping system is mandatory for better investigating this phenomenon
Radiology, Feb 1, 2023
PurposeTo evaluate a cardiac MRI feature tracking (FT)–derived parameter that combines right vent... more PurposeTo evaluate a cardiac MRI feature tracking (FT)–derived parameter that combines right ventricular (RV) longitudinal and radial motions in detecting arrhythmogenic right ventricular cardiomyopathy (ARVC).Materials and MethodsPatients with ARVC (n = 47; median age, 46 [IQR, 30–52] years; 31 men) were compared with controls (n = 39; median age, 46 [IQR, 33–53] years; 23 men) and separated into two groups based on fulfillment of major structural 2020 International criteria. Cine data from 1.5-T cardiac MRI examinations were analyzed using FT, resulting in conventional strain parameters and a novel composite index named the longitudinal-to-radial strain loop (LRSL). Receiver operating characteristic (ROC) analysis was used to assess diagnostic performance of RV parameters.ResultsVolumetric parameters differed significantly between patients in the major structural criteria group and controls but not between patients in the no major structural criteria group and controls. Patients in the major structural criteria group had significantly lower magnitudes of all FT parameters than controls, including RV basal longitudinal strain, radial motion fraction, circumferential strain, and LRSL (-15.6% ± 6.4 vs -26.7% ± 13.9; -9.6% ± 4.89 vs -13.8% ± 4.7; -6.9% ± 4.6 vs -10.1% ± 3.8; and 217.0 ± 128.9 versus 618.6 ± 356.3, respectively). Only LRSL differed between patients in the no major structural criteria group and controls (359.5 ± 195.8 vs 618.6 ± 356.3; P < .0001). Parameters with the highest area under the ROC curve values for discriminating patients in the no major structural criteria group from controls were LRSL, RV ejection fraction, and RV basal longitudinal strain (0.75, 0.70, and 0.61, respectively).ConclusionA new parameter combining RV longitudinal and radial motions showed good diagnostic performance in ARVC, even in patients without major structural abnormalities.Keywords: Arrhythmogenic Right Ventricular Dysplasia, Strain, Wall Motion Abnormalities, Right Ventricle, MRI, Inherited Cardiomyopathy Supplemental material is available for this article. © RSNA, 2023
European Heart Journal, Oct 1, 2022
Archives of Cardiovascular Diseases Supplements, 2015
]) were independantly associated with CM compared to controls (p<0.05). Over a mean follow-up of ... more ]) were independantly associated with CM compared to controls (p<0.05). Over a mean follow-up of 22±20 months, 79% presented with a significant decrease of VPB (> 80% reduction). In these, EF increased (36±9 to 51±12%, p<0.0001) and LVEDD decreased (62±7 to 56±7mm, p<0.0001). Reversal of CM was defined by > 10% increase in EF. Only a VPB > 2mV (OR 19.2 [1.84-200.00], p=0.01) was independanlty associated with reversal of CM in multivariate analysis. Conclusion: Mechanisms leading to PVB-induced CM may involve lack of palpitations, a high VPB number, a left ventricular origin, an epicardial location, a VPB right inferior axis, a large baseline QRS duration, a long VPB coupling interval and polymorphic VPB. Reversal of CM after RF ablation may associate a high VPB amplitude and a shorter VPB coupling interval. This may help in selecting patients for RF ablation of suspected VPB-induced CM.
Archives of Cardiovascular Diseases, Aug 1, 2016
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are recommended in patients with low ej... more BACKGROUND Implantable cardioverter-defibrillators (ICDs) are recommended in patients with low ejection fraction. However, the survival benefit of ICDs in patients with end-stage heart failure listed for heart transplantation is unclear. AIM To evaluate the ICD benefit on mortality in this population. METHODS Three hundred and eighty consecutive patients listed for heart transplantation between 2005 and 2009 in one tertiary heart transplant centre were enrolled in a retrospective registry; 122 patients received an ICD before or within 3 months after being listed for heart transplantation (ICD group). Predictors of death on the waiting list were assessed by Cox regression. RESULTS Overall, 15.6% of patients died while awaiting heart transplantation. Non-ICD patients presented more often haemodynamic compromise requiring mechanical circulatory support (29.1% vs. 9.8%; P<0.001), and were more likely to die while on the waiting list (19.0% vs. 8.3%; log-rank P=0.001). However, in the multivariable model, ICD did not remain an independent predictor of death. Need for mechanical circulatory support (P<0.001), low ejection fraction (P=0.001) and registration on the regular list (P=0.008) were the only independent predictors of death. Death was mainly caused by haemodynamic compromise (76.3% of deaths), which occurred more frequently in the non-ICD group (14.7% vs. 5.8%; log-rank P=0.002). Unknown/arrhythmic deaths did not differ significantly between the two groups (3.9% vs. 1.7%; log-rank P=0.21). ICD-related complications occurred in 21.4% of patients, mainly as a result of postoperative worsening of heart failure (11.9%). CONCLUSION Haemodynamic failure appears as the main determinant of mortality in patients with end-stage heart failure awaiting heart transplantation. ICD seems to have little benefit on survival in this population.
Journal of the American Heart Association, Nov 6, 2017
Background-Diagnosis of short QT syndrome (SQTS) remains difficult in case of borderline QT value... more Background-Diagnosis of short QT syndrome (SQTS) remains difficult in case of borderline QT values as often found in normal populations. Whether some shortening of refractory periods (RP) may help in differentiating SQTS from normal subjects is unknown. Methods and Results-Atrial and right ventricular RP at the apex and right ventricular outflow tract as determined during standard electrophysiological study were compared between 16 SQTS patients (QTc 324AE24 ms) and 15 controls with similar clinical characteristics (QTc 417AE32 ms). Atrial RP were significantly shorter in SQTS compared with controls at 600-and 500-ms basic cycle lengths. Baseline ventricular RP were significantly shorter in SQTS patients than in controls, both at the apex and right ventricular outflow tract and for any cycle length. Differences remained significant for RP of any subsequent extrastimulus at any cycle length and any pacing site. A cutoff value of baseline RP <200 ms at the right ventricular outflow tract either at 600-or 500ms cycle length had a sensitivity of 86% and a specificity of 100% for the diagnosis of SQTS. Conclusions-Patients with SQTS have shorter ventricular RP than controls, both at baseline during various cycle lengths and after premature extrastimuli. A cutoff value of 200 ms at the right ventricular outflow tract during 600-and 500-ms basic cycle length may help in detecting true SQTS from normal subjects with borderline QT values.
Catheterization and Cardiovascular Interventions, Mar 14, 2018
Objectives: This study aimed to assess the impact of pacemaker mode programming on clinical outco... more Objectives: This study aimed to assess the impact of pacemaker mode programming on clinical outcomes in patients with high-degree atrioventricular conduction disturbance (AVCD) after transcatheter aortic valve implantation (TAVI). Background: Although high-degree AVCD after TAVI can receive pacemaker, recovery of the AVCD is often observed. Specific pacemaker algorithms (AAI-DDD mode switch) are available which favor spontaneous atrioventricular conduction. Methods: Of 1,621 consecutive multi-center TAVI patients, 269 (16.4%) received pacemaker. We retrospectively included 91 patients with persistent high-degree AVCD at hospital discharge. Pacemaker dependency was defined as absence, inadequate intrinsic ventricular rhythm, or ventricular pacing time > 95% on pacemaker interrogation during follow-up. Comparison of heart failure hospitalization and death between conventional DDD (cDDD) and other modes was examined (AAI-DDD and VVI). Results: During a mean follow-up duration of 13 months, the pacemaker dependency rate was 52.8%. Patients with cDDD mode (N 5 36: 40.0%) had significantly more pacemaker dependency. Multivariate analysis showed that cDDD mode was independently associated with pacemaker dependency (odds ratio 5 3.63, P 5 0.03). Moreover, cDDD patients had a significant higher incidence of heart failure hospitalization (Hospitalization: cDDD vs. others 5 45.4% vs. 18.2%, P 5 0.03) and had a higher incidence of mortality (Death: cDDD vs. the others 5 27.0% vs. 4.4%, P 5 0.06). Conclusions: Up to half of patients implanted for high-degree AVCD after TAVI had conduction recovery. Patients with cDDD programming at hospital discharge had more pacemaker dependency and a worse cardiac prognosis. Thus, pacemaker mode should be systematically set to promote spontaneous atrioventricular conduction in patients with pacemaker implantation after TAVI.
American Journal of Human Genetics, Nov 1, 2006
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited myocardial dis... more Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited myocardial disorder associated with arrhythmias, heart failure, and sudden death. To date, mutations in four genes encoding major desmosomal proteins (plakoglobin, desmoplakin, plakophilin-2, and desmoglein-2) have been implicated in the pathogenesis of ARVD/C. We screened 77 probands with ARVD/C for mutations in desmocollin-2 (DSC2), a gene coding for a desmosomal cadherin. Two heterozygous mutations-a deletion and an insertion-were identified in four probands. Both mutations result in frameshifts and premature truncation of the desmocollin-2 protein. For the first time, we have identified mutations in desmocollin-2 in patients with ARVD/C, a finding that is consistent with the hypothesis that ARVD/C is a disease of the desmosome.
European Heart Journal, Nov 1, 2020
Europace, Jun 1, 2020
GPUR The subcutaneous ICD prevents complications of transvenous leads. Its implantation needs a d... more GPUR The subcutaneous ICD prevents complications of transvenous leads. Its implantation needs a defibrillation test. Performing this test increases the time of procedures.. The aim of our study is to describe the experience of subcutaneous ICD of Assitance Publique des Hopitaux de Paris (AP-HP). In a retrospective cohort we included patients who were involved in subcutaneous ICD treatment at the 5 hospitals of AP-HP from December 2012 to April 2018.Analysis used the Kaplan-Meier method and the Mann-Whitney U test. 162 patients were implanted. 76% of implantations were for secondary prevention before 2017, but only 49% after 2017. 126 (77%) tests were successful at first shock, 14 (8.6%) needed a second shock or more, 9 (5.5%) did not have a test. The shock impedance was significantly higher when the shock was not effective at the first test, 82 ohms CI 95% [68; 112] versus 66 ohms CI 95% [64; 70], p <0.05. 6 patients died (3.7%). Late follow up showed 23 (10%) appropriate shocks and 24 inappropriate shocks (11%) mainly due to T wave oversensing (37.5%). This is the first french experience of SICD implantation. Success of defibrillation test was lower than expected. Caracteristics of implantation General anesthesia (%) 162 (100) Procedure time (min) Mean ± SD (median)Range 73± 24 (60)20-165 Cameron Health (%) Generator SQ-RX ® 1010 12 (7.4) Boston Scientific (%) Generator EMBLEM ® A209 100 (61.7) Generator EMBLEM ® A219 44 (27.2) VF time (sec) Mean ± SD (median)Range 16.5± 3.4(15)10-37 Shock Impedance (ohm) Mean ± SD (median) Range 72 ± 12.7 (68) 42-130 Success at 1st shock (%) 126 (77.7) Success at 2nd shock or more (%) 14 (8.6) No test performed (%) 12 (7.4) Implantation caracteristics and defibrillation testing. Impedance was significantly higher in patients without success at first shock : 82 ohms CI 95% [68 ;112] vs 66 ohms CI 95% [64 ;70], p < 0.05. Abstract Figure. Survival without inappropriate shock
European Heart Journal, Oct 1, 2019
Background In arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), implantable car... more Background In arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), implantable cardioverter-defibrillators (ICD) after an episode of sustained monomorphic ventricular tachycardia (MVT) are currently recommended in most situations. However, radiofrequency catheter ablation (RCA) is effective in reducing recurrent VT and whether MVT is a surrogate of sudden cardiac death is debated when other risk factors are lacking. Purpose To report the outcomes of patients with ARVC/D who underwent RCA of well-tolerated MVT without a back-up ICD. Methods Patients with a definite ARVC/D diagnosis according to the 2010 Task Force revised criteria who underwent RCA of well-tolerated MVT at 9 tertiary centers across 5 countries, without an ICD prior to RCA and in the 3 following months were retrospectively included. Patients presenting with syncope or electrical storm, and patients with left ventricular ejection fraction &amp;amp;lt;50% were excluded. Similar patients implanted with an ICD prior or without RCA in the same period served as controls. Results Sixty-five patients [median age 46.1 years, range (19.5–73.8), 75% males] underwent RCA of MVT between 2003 and 2016. Familial history of ARVC/D was found in 11% of patients. Epsilon-waves were present in 19% and T-waves inversion beyond V2 in 43%. A right ventricular (RV) ejection fraction ≤40% or fractional area change ≤33% was found in 14 (25%) patients. Median left ventricular ejection fraction was 61% (50–70). Clinical presentation was palpitations in 81% of patients and near-syncope in 14%. Prior to RCA, patients were on beta-blockers alone in 18%, class I drugs in 37% and amiodarone in 9%, while 15% of patients were free any antiarrhythmic medication. Only 1 patient (2%) had &amp;amp;gt;1 clinical VT morphology. Median VT rate was 180 (110–270). An epicardial approach was used in 31% patients. The clinical VT was inducible in 84% of patients. The median number of targeted RV site was 1 (1–3) (RV outflow tract in 72%). Full acute success defined inability to induce any VT was achieved in 72% of patients. During a median follow-up time of 49 month (1.4–162), there was no death or aborted cardiac arrest. Survival without VT recurrence was estimated at 82%, 71% and 60%, 12-, 36- and 60-months after RCA. No VT recurrence was observed among patient who had undergone an epicardial ablation. Among patients with VT recurrence, 6 (35%) did not receive an ICD, and 14 (70%) underwent redo RCA. An ICD was implanted in 10 patients, including 5 for VT recurrence. Fifty-eight patients constituted the control group, and 64% had appropriate ICD interventions during follow-up. Conclusions Despite a significant rate of VT recurrence, selected patients with ARVC/D who underwent RCA for stable MVT without an ICD did not experience any arrhythmic death. Further prospective studies are mandatory to precise the respective places of ICD and RCA in the management of ARVC/D patients with well-tolerated MVT. Acknowledgement/Funding None
Archives of Cardiovascular Diseases Supplements, Apr 1, 2019
Archives of Cardiovascular Diseases Supplements, 2016
Do implantable cardioverter defibrillators really improve survival of patients listed for heart t... more Do implantable cardioverter defibrillators really improve survival of patients listed for heart transplantation? Xavier Waintraub (1), Estelle Gandjbakhch * (1), Marion Rovani (2), Shaida Varnous (2), Thomas Chastre (2), Carole Maupain (2), Francoise Pousset (2), Guillaume Lebreton (2), Guillaume Duthoit (2), Nicolas Badenco (2), Caroline Himbert (2), Françoise Hidden-Lucet (2), Pascal Leprince (2)
Heart Rhythm, May 1, 2023
JACC: Clinical Electrophysiology, 2023
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Papers by Estelle Gandjbakhch