CHRU Lille Lille France

France

CHRU Lille Lille France

France
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Boveda S.,Clinique Pasteur Toulouse France | Narayanan K.,French Institute of Health and Medical Research | Jacob S.,Institute for Radiological Protection and Nuclear Safety | Providencia R.,Clinique Pasteur Toulouse France | And 15 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2017

Temporal Trends Over a Decade of Defibrillator Therapy: Background: Technology and clinical practice surrounding the use of the primary prevention implantable cardioverter defibrillator (ICD) are in a state of constant evolution. The purpose of the study was to test the hypothesis of significant temporal trends in characteristics and outcomes over a decade of ICD therapy. Methods: Between 2002 and 2012, 5,539 consecutive patients (age 62.5 ± 11 years, 84.9% male), with ischemic or nonischemic cardiomyopathy, implanted with a primary prevention ICD from 12 centers in France were included. Information on characteristics and outcomes (including causes of death) were evaluated over a median follow-up of 994 days (466-1,667). Results: In addition to a shift in the type of devices implanted with a significant increase in cardiac resynchronization therapy-defibrillator (CRT-D) over time (43.6 to 60.4%, P = 0.0001), an increase in mean age (from 61.5 ± 11.6 to 63.2 ± 10.9 years, P = 0.0016), proportion of nonischemic cardiomyopathy (31.0 to 44.7%, P <0.0001) and women recipients (11.4 to 15.8%, P = 0.004) was observed. A total of 1,181 patients (22.3%) received ≥1 appropriate therapy, inappropriate therapies occurred in 355 patients (6.7%) and 826 patients (15.2%) died, mainly from cardiovascular causes (49.3%). Annual mortality incidence (5.4% to 4.3%, P = 0.05), as well as incidence of appropriate therapy (10.4% to 7.1%, P = 0.0004), significantly decreased over the decade. By contrast, incidence of ICD-related late (>30 days after implant) complications significantly increased (4.6 to 7.6%, P = 0.003). Conclusion: Our findings demonstrate significant changes in patterns of use and outcomes in primary prevention ICD over the last decade with reductions in mortality and appropriate therapies, counterbalanced by an increase in complications. Journal compilation © 2017 Wiley Periodicals, Inc.


Shankar A.G.,University College London | Roques G.,Reims University Hospital Center | Kirkwood A.A.,University College London | Lambilliotte A.,CHRU Lille Lille France | And 13 more authors.
British Journal of Haematology | Year: 2017

Advanced stage nodular lymphocyte predominant Hodgkin lymphoma (nLPHL) is extremely rare in children and as a consequence, optimal treatment for this group of patients has not been established. Here we retrospectively evaluated the treatments and treatment outcomes of 41 of our patients from the UK and France with advanced stage nLPHL. Most patients received chemotherapy, some with the addition of the anti CD20 antibody rituximab or radiotherapy. Chemotherapy regimens were diverse and followed either classical Hodgkin lymphoma or B non-Hodgkin lymphoma protocols. All 41 patients achieved a complete remission with first line treatment and 40 patients are alive and well in remission. Eight patients subsequently relapsed and 1 patient died of secondary cancer (9 progression-free survival events). The median time to progression for those who progressed was 21 months (5·9-73·8). The median time since last diagnosis is 87·3 months (8·44-179·20). Thirty-six (90%), 30 (75%) and 27 (68%) patients have been in remission for more than 12, 24 and 36 months, respectively. Overall, the use of rituximab combined with multi-agent chemotherapy as first line treatment seems to be a reasonable therapeutic option. © 2017 John Wiley & Sons Ltd.

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