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Feasibility and safety of cryoballoon ablation for atrial fibrillation inpatients with congenital heart disease

World Journal of Cardiology 2019年第5期11卷 149-158页

作者： Sylvia Abadir Victor Waldmann Katia Dyrda Mikael Laredo Blandine Mondésert Marc Dubuc paul khairy Electrophysiology Service and Adult Congenital Heart Center Montreal Heart Institute Université de Montréal

BACKGROUND The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PV) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time. AIM To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD. METHODS The study population consisted of consecutive patients with CHD and cryoballoon ablation for AF at the Montreal Heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the pulmonary vein. At least one 240-second cryothermal application was performed upon obtaining complete pulmonary vein occlusion. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and then annually. RESULTS Ten patients, median age 57.9 (interquartile range 48.2-61.7) years, 60% female, met inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) *** had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return;aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The pulmonary vein anatomy was normal in 6 (60.0%) patients. Four had left common

关键词： Congenital heart disease Atrial fibrillation Cryoballoon ablation Pulmonary vein isolation Catheter ablation

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Genetic testing in congenital heart disease:A clinical approach

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World Journal of Cardiology 2016年第2期8卷 180-191页

作者： Marie A Chaix Gregor Andelfinger paul khairy Montreal Heart Institute Adult Congenital Center Université de Montréal Sainte-Justine University Hospital Université de Montréal

Congenital heart disease(CHD) is the most common type of birth defect. Traditionally, a polygenic model defined by the interaction of multiple genes and environmental factors was hypothesized to account for different forms of CHD. It is now understood that the contribution of genetics to CHD extends beyond a single unified paradigm. For example, monogenic models and chromosomal abnormalities have been associated with various syndromic and non-syndromic forms of CHD. In such instances, genetic investigation and testing may potentially play an important role in clinical care. A family tree with a detailed phenotypic description serves as the initial screening tool to identify potentially inherited defects and to guide further genetic investigation. The selection of a genetic test is contingent upon the particular diagnostic hypothesis generated by clinical examination. Genetic investigation in CHD may carry the potential to improve prognosis by yielding valuable information with regards to personalized medical care, confidence in the clinical diagnosis, and/or targeted patient followup. Moreover, genetic assessment may serve as a tool to predict recurrence risk, define the pattern of inheritance within a family, and evaluate the need for further family screening. In some circumstances, prenatal or preimplantation genetic screening could identify fetuses or embryos at high risk for CHD. Although genetics may appear to constitute a highly specialized sector of cardiology, basic knowledge regarding inheritance patterns, recurrence risks, and available screening and diagnostic tools, including their strengths and limitations, could assist the treating physician in providing sound counsel.

关键词： Congenital heart disease Genetics Genetic screening Genetic testing

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An early proof-of-concept of cardiac resynchronization therapy

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World Journal of Cardiology 2011年第12期3卷 374-376页

作者： Martial G Bourassa paul khairy Denis Roy Department of Medicine Montreal Heart Institute/Universitéde Montréal

Almost 50 years ago,we published detailed hemodynamic findings in a patient with heart failure and intermittent left bundle branch *** intraventricular conduction was consistently accompanied by an increased duration of left ventricular(LV)isometric contraction,a drop in systolic blood pressure,a rise in heart rate,and a drop in cardiac *** our knowledge,this observation provided the first ever evidence that delayed mechanical LV contraction was associated with deterioration,and return to a normal pre-ejection phase with improvement in LV function.

关键词： Intermittent left bundle branch bock Heart failure Left ventricular dyssynchrony Systolic blood pressure Cardiac output

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