Brussels, Belgium
Brussels, Belgium

Time filter

Source Type

Capulzini L.,Heart Rhythm Management Center | Brugada P.,Heart Rhythm Management Center | Brugada J.,Hospital Clinic Of Barcelona | Brugada R.,University of Girona
Revista Espanola de Cardiologia | Year: 2010

Historically, left ventricular cardiomyopathy and coronary heart disease have been regarded as the main causes of ventricular arrhythmia and sudden cardiac death. However, within last two decades, arrhythmias originating from the right ventricle have begun to attract the attention of the scientific world for a number of reasons. Ventricular arrhythmias originating from the right ventricle usually affect younger patients and can lead to sudden cardiac death. The pathophysiologic mechanism of these arrhythmias is not fully understood, which can leave room for a range of different interpretations. Moreover, the intriguing world of genetics is increasingly being drawn into the pathogenesis, diagnosis and prognosis of some of these arrhythmias. This review considers the pathogenesis, diagnosis and treatment of arrhythmogenic right ventricular cardiomyopathy or dysplasia (ARVD), Brugada syndrome, right ventricular outflow tract ventricular tachycardia, and arrhythmias in the right side of the heart due to congenital heart disease. In addition, because ventricular arrhythmias associated with right ventricular heart diseases such as Brugada syndrome and ARVD can explain up to 10-30% of sudden cardiac deaths in young adults in the general population and an even greater percentage in young athletes, this article contains a brief analysis of screening tests used before participation in sports, life-style modification, and treatment options for athletes affected by these conduction disorders. © 2010 Sociedad Española de Cardiología.


Sarkozy A.,Heart Rhythm Management Center | Sorgente A.,Heart Rhythm Management Center | Boussy T.,Heart Rhythm Management Center | Casado R.,Heart Rhythm Management Center | And 8 more authors.
European Heart Journal | Year: 2011

Aims We sought to investigate the value of a family history of sudden death (SD) in Brugada syndrome (BS). Methods and resultsTwo hundred and eighty consecutive patients (mean age: 41 ± 18 years, 168 males) with diagnostic type I Brugada ECG pattern were included. Sudden death occurred in 69 (43) of 157 families. One hundred and ten SDs were analysed. During follow-up VF (ventricular fibrillation) or SD-free survival rate was not different between patients with or without a family history of SD of a first-degree relative, between patients with or without a family history of multiple SD of a first-degree relative at any age and between patients with or without a family history of SD in first-degree relatives ≤35 years. One patient had family history of SD of two first-degree relative ≤35 years with arrhythmic event during follow-up. In univariate analysis male gender (P 0.01), aborted SD (P < 0.001), syncope (P 0.04), spontaneous type I ECG (P < 0.001), and inducibility during electrophysiological (EP) study (P < 0.001) were associated with worse prognosis. The absence of syncope, aborted SD, spontaneous type I ECG, and inducibility during EP study was associated with a significantly better prognosis (P < 0.001). Conclusion Family history of SD is not predictive for future arrhythmic events even if considering only SD in first-degree relatives or SD in first-degree relatives at a young age. The absence of syncope, aborted SD, spontaneous type I ECG, and inducibility during EP study is associated with a good five-year prognosis. © 2011 The Author.


Conte G.,Heart Rhythm Management Center | Dewals W.,UZ Brussel VUB | Sieira J.,Heart Rhythm Management Center | De Asmundis C.,Heart Rhythm Management Center | And 10 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives The goal of this study was to investigate the clinical features, management, and long-term follow-up of children with drug-induced Brugada syndrome (BS). Background Patients with BS <12 years of age with a spontaneous type I electrocardiogram have a higher risk of arrhythmic events. Data on drug-induced BS in patients <12 years of age are lacking. Methods Among 505 patients with ajmaline-induced BS, subjects ≤12 years of age at the time of diagnosis were considered as children and eligible for this study. Results Forty children (60% male; age 8 ;plusmn& 2.8 years) were included. Twenty-four children (60%) had a family history of sudden death. Two (5%) had a previous episode of aborted sudden death, and 8 (20%) had syncope. Children experienced more frequent episodes of sinus node dysfunction (SND) compared with older subjects (7.5% vs. 1.5%; p = 0.04) and had a comparable incidence of atrial tachyarrhythmias. Children more frequently experienced episodes of ajmaline-induced sustained ventricular arrhythmias (VAs) compared with older patients (10.0% vs. 1.3%; p = 0.005). Twelve children (30%) received an implantable cardioverter-defibrillator (ICD). After a mean follow-up time of 83 ± 51 months, none of the children died suddenly. Spontaneous sustained VAs were documented in 1 child (2%). Among children with ICD, 1 (8%) experienced an appropriate shock, 4 (33%) had inappropriate ICD shocks, and 4 (33%) experienced device-related complications. Conclusions Drug-induced BS is associated with atrial arrhythmias and SND. Children are at higher risk of ajmaline-induced VAs. The rate of device-related complications, leading to lead replacement or inappropriate shocks, is considerable and even higher than with appropriate interventions. Based on these findings, the optimal management of BS in childhood should remain individualized, taking into consideration the patient's clinical history and family's wishes. © 2014 by the American College of Cardiology Foundation.


Conte G.,Heart Rhythm Management Center | Sieira J.,Heart Rhythm Management Center | Ciconte G.,Heart Rhythm Management Center | De Asmundis C.,Heart Rhythm Management Center | And 13 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. Objectives The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Methods Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. Conclusions ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming. © 2015 American College of Cardiology Foundation.


Brugada P.,Heart Rhythm Management Center
Nature Reviews Cardiology | Year: 2016

Brugada syndrome is an inherited disease characterized by an increased risk of sudden cardiac death owing to ventricular arrhythmias in the absence of structural heart disease. Since the first description of the syndrome >20 years ago, considerable advances have been made in our understanding of the underlying mechanisms involved and the strategies to stratify at-risk patients. The development of repolarization–depolarization abnormalities in patients with Brugada syndrome can involve genetic alterations, abnormal neural crest cell migration, improper gap junctional communication, or connexome abnormalities. A common phenotype observed on the electrocardiogram of patients with Brugada syndrome might be the result of different pathophysiological mechanisms. Furthermore, risk stratification of this patient cohort is critical, and although some risk factors for Brugada syndrome have been frequently reported, several others remain unconfirmed. Current clinical guidelines offer recommendations for patients at high risk of developing sudden cardiac death, but the management of those at low risk has not yet been defined. In this Review, we discuss the proposed mechanisms that underlie the development of Brugada syndrome and the current risk stratification and therapeutic options available for these patients. © 2016 Nature Publishing Group, a division of Macmillan Publishers Limited. All Rights Reserved.


Background Cryoballoon ablation (CBA) (Arctic Front, Medtronic, USA) has proven very effective in achieving pulmonary vein isolation (PVI). Different transseptal (TS) puncture sites might influence CBA procedure. The aim of the present study was to analyze the influence of different TS puncture sites (anterior, medial and posterior) on the acute and midterm outcomes of CBA in a series of patients undergoing PVI for drug resistant AF. Methods and results A total 103 patients (78 males, mean age: 57 ± 13 years) formed the study group. Transseptal punctures were performed in the anterior, medial and posterior portion of the FO in 41 (39.8%), 35 (34%) and 27 (26.2%) patients respectively. We found no statistical significant difference between the various sites of TS puncture in 1) the grade of PV occlusion (p = ns), the rate of PV isolation (p = ns), freedom from AF at a mean 12 month follow-up (p = ns) and complication rates (p = ns). Mean grade of occlusion was slightly lower in the RIPV when puncturing in the posterior FO but did not reach statistical significance. Mean procedural and fluoroscopy times were significantly lower when using the inner lumen mapping catheter (ILMC) (Achieve, Medtronic, USA) than the circular mapping catheter (CMC) (Lasso, Biosense Webster, California, USA) (107.24 mn vs 97.74 (p ≤ 0.001) and 25.7 mn vs 19.2 mn (p ≤ 0.001)). Conclusion Different sites of TS puncture on the horizontal axis of the FO (anterior, medial and posterior) did not influence grades of PV occlusion, rates of isolation, mid-term outcome and rates of complications during CB ablation. © 2013 Elsevier Ireland Ltd.


De Asmundis C.,Heart Rhythm Management Center | Brugada P.,Heart Rhythm Management Center
Revista Espanola de Cardiologia Suplementos | Year: 2013

Despite recent progress in the management of cardiovascular disorders generally, and cardiac arrhythmias in particular, sudden cardiac death remains both a problem for the practising clinician and a major public health issue. An estimate for global annual incidence of sudden cardiac death would be in the range of 4 to 5 million cases per year. Information about the causes and mechanisms of the sudden cardiac death syndrome suggests that a specific reduction will require the development of new and multifaceted approaches, including epidemiologic techniques to address risk characteristics specific to the problem; characterisation of triggering events and identification of specific persons at risk for responding adversely to these events; and methods of evaluating outcomes appropriate to the nature of sudden cardiac death. © 2013 Sociedad Española de Cardiología.


Conte G.,Heart Rhythm Management Center | De Asmundis C.,Heart Rhythm Management Center | Sieira J.,Heart Rhythm Management Center | Levinstein M.,Heart Rhythm Management Center | And 8 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2014

Brugada Syndrome in the Elderly Background The clinical course and prognosis of Brugada syndrome (BS) in the elderly is unknown. The purpose of this study was to investigate the clinical characteristics, management, and prognosis of BS in an elderly population. Methods and Results A total of 437 patients with BS were included in this study. Patients were categorized in 2 groups according to the age at the time of diagnosis: <60 years (N = 363) and ≥60 years (N = 74). Moreover, an elderly patients' subgroup analysis was performed between patients with an age between 60 and 70 years (N = 49) and subjects older than 70 years (N = 25). Among elderly patients (50% male, mean age: 67 ± 6 years), family history of sudden death (SD) and induction of sustained ventricular arrhythmias during programmed ventricular stimulation were less frequent as compared to younger patients. Two patients (3%) had a previous episode of aborted SD. Elderly patients with BS presented more frequently with ECG conduction disturbances or previous transient advanced atrioventricular block as compared to younger patients. Of the elderly patients, 42% underwent implantable cardioverter defibrillator implantation and 7% received a pacemaker. After a mean follow-up time of 54 ± 18 months, none of the elderly patients with BS older than 70 years experienced documented life-threating ventricular arrhythmias. Family screening was performed in 58 family members and a BS diagnosis was confirmed in 49%. Conclusion The clinical features and the benign prognosis of BS patients older than 70 years likely identify a lower risk category of patients as compared to younger individuals. The device-guided management in this setting remains individualized and sometimes controversial. Moreover, BS diagnosis in the elderly should not be missed, mainly due to the clinical impact on the family of elderly patients. © 2014 Wiley Periodicals, Inc.


Sorgente A.,Heart Rhythm Management Center | Sarkozy A.,Heart Rhythm Management Center | Brugada P.,Heart Rhythm Management Center
Journal of Cardiovascular Electrophysiology | Year: 2010

J-Wave Disaapearance After an Episode of Ventricular Fibrillation. Early repolarization (ER) abnormalities in the inferior-lateral leads are a matter of intense scientific debate because of their demonstrated association with Brugada syndrome (BS) and idiopathic ventricular fibrillation (VF). To add fuel to the fire, we present a case in which ER abnormalities are associated with BS but in which, more importantly, they were shown to be transient and strictly correlated with an episode of VF. © 2010 Wiley Periodicals, Inc.


Ciconte G.,Heart Rhythm Management Center | De Asmundis C.,Heart Rhythm Management Center | Sieira J.,Heart Rhythm Management Center | Conte G.,Heart Rhythm Management Center | And 10 more authors.
Heart Rhythm | Year: 2015

Background The second-generation cryoballoon (CB-Adv) is effective in achieving pulmonary vein isolation (PVI) with encouraging results. The mid-term clinical efficacy of a single 3-minute freeze, without a routine bonus application, has been recently demonstrated. Objective The purpose of this study was to assess long-term clinical outcome after PVI with the CB-Adv using a single 3-minute application. Methods A total of 143 consecutive patients (93 male [65%], mean age 59.6 ± 12.0 years) with paroxysmal atrial fibrillation (PAF; 113/143 [79%]) or early persistent atrial fibrillation (AF; 30/143 [21%]) underwent PVI using CB-Adv with a single 3-minute freeze. Atrial tachyarrhythmia recurrences were defined as symptomatic or documented episodes >30 seconds. Results After a single freeze, isolation could be reached in 94.1% of all identified pulmonary veins. Complete PVI was successfully achieved with 1.1 ± 0.4 mean freezes. Persistent phrenic nerve palsy occurred in 5 of 143 patients (3.5%). At a mean 12.1 ± 4.4 months of follow-up, after a 3-month blanking period (BP), 80.4% (115/143) were in stable sinus rhythm (93/113 [82.3%] for PAF; 22/30 [73.3%] for early persistent AF). Fifteen patients underwent a second procedure with radiofrequency ablation showing reconnection in 7 of 15 right-sided (46.7%) and 6 of 15 left-sided (40%) pulmonary veins. Relapses during BP (P <.01), time to PVI (P =.02), and longer AF duration (P =.04) were independent predictors of recurrences. Conclusion A single 3-minute freeze is highly effective, determining an atrial tachyarrhythmia freedom of 80.4% at 1-year follow-up. The incidence of persistent phrenic nerve palsy is 3.5%. Relapses during BP, time to PVI, and longer AF duration are predictors of recurrences. Routine use of an "insurance freeze" may not be needed. © 2015 Heart Rhythm Society.

Loading Heart Rhythm Management Center collaborators
Loading Heart Rhythm Management Center collaborators