Biomedical subjects

G Jauvert

Publications and source records attributed to G Jauvert.

4 recordsLinked to original sources

PubMed2004

Cardiac resynchronization therapy.

The first case report introducing the concept of cardiac resynchronisation therapy (CRT) was published less than 10 years ago, opening the way to the development of the first successful non-pharmacological treatment of congestive heart failure (CHF). The now routine implantation of CRT systems is applicable to multitudes of patients as adjunctive therapy in advanced CHF. This technique has transformed the traditional concepts associated with stimulation of the heart, and is now applied not only to restore an appropriate heart rate, but also to change the process of cardiac mechanical activation. Since it must be integrated within a comprehensive and multidisciplinary CHF management program, CRT has changed the practice of experts in the field of cardiac pacing. CRT in the management of CHF was ultimately validated in 2 randomised trials. MUSTIC, the first trial, compared in a single-blind, 3x3 months crossover design active versus inactive biventricular stimulation in a group of patients in sinus rhythm and another group in atrial fibrillation. Both phases of the trial were completed by 48 patients, with significant positive effects conferred by CRT on the distance walked in 6 min and on peak oxygen consumption. The number of hospitalizations for management of CHF was decreased by 2/3 (P<0.05), and 85% of patients preferred the atrio-biventricular over the inactive stimulation mode (P<0.001). These results were amply confirmed by the parallel-design MIRACLE trial. The current indications for CRT, diagnostic tools to assist in its implementation, and limitations of this new therapeutic adjunct are further discussed in this review.

Cardiac Pacing, Artificial↗

PubMed2003

Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study.

Multisite biventricular pacing therapy offers significant clinical improvement in some stimulated patients with electrocardiographic criteria of cardiac dyssynchrony. However, observational data increasingly suggest that patients suffering from congestive heart failure in presence of modest QRS widening may also derive benefit from cardiac resynchronization therapy (CRT), and that some patients can be significantly improved clinically after system implantation despite no apparent change in QRS width. This pilot study explored the value of an echocardiographic model to identify cardiac electromechanical dyssynchrony parameters (EDP) in candidates for CRT, and their potential correction after implantation. The study included 66 consecutive CRT recipients of CRT in NYHA functional class III or IV who had one or more atrioventricular, interventricular or intraventricular dyssynchrony criteria. An immediate improvement was observed in 85% of the population with a partial or total correction of their EDP. However, the modifications in EDP differed considerably between recipients of de novo CRT systems and patients with previously implanted standard pacing systems upgraded with the implantation of a left ventricular lead. EDP measurements appear to identify potential candidates for CRT, and to confirm the success of system implantation.

Atrioventricular Node↗

PubMed2003

[Echocardiographic modelling of cardiac asynchronism: prospective evaluation before and after multisite stimulation].

The evaluation of multisite stimulation with a haemodynamic aim has since its origin clashed with the absence of definition of a simple method of identifying candidates and of evaluation of the effects of treatment. In this pilot work, 66 patients were selected on electromechanical criteria obtained from a desynchronisation model identified from simple echographic parameters. The short term results demonstrate important modifications, differing according to the type of patient undergoing implantation. These results reject the basis of a prospective multicentric study aimed at validating the concept of ventricular resynchronisation.

Arrhythmias, Cardiac↗

PubMed2000

Long-term effects of biatrial synchronous pacing to prevent drug-refractory atrial tachyarrhythmia: a nine-year experience.

INTRODUCTION: Results of previous studies suggest that atrial resynchronization by multisite atrial pacing may contribute to prevention of recurrences in patients with drug-refractory atrial tachyarrhythmias and significant intra-atrial conduction delay. METHODS AND RESULTS: To verify this hypothesis, a prospective noncontrolled study of 86 patients (mean age 66 +/- 10 years) was conducted in a single center between January 1989 and February 1998. Inclusion criteria were P wave duration > or = 120 msec with interatrial conduction time > or = 100 msec, and history of multiple recurrences of atrial tachyarrhythmias (mean 7 +/- 4.8 episodes) evolving in a persistent mode for at least 6 months despite optimized drug treatment (mean 2.7 +/- 1.8 drugs/patient). Patients were chronically implanted with a pacing system that ensured permanent biatrial pacing using two atrial leads, one placed in the high right atrium and the other one into the mid or the distal part of the coronary sinus. P wave duration decreased from a mean value of 187 +/- 29 msec before implant to 106 +/- 14 msec (P < 0.0001) under biatrial pacing. After a 33-month mean follow-up (range 6 to 109), 55 patients (64%) remained in sinus rhythm, including 28 patients (32.6%) without any documented recurrence and 27 patients with one or more recurrences in a paroxysmal or in a persistent form. In these 55 patients, drug treatment was significantly reduced in relation to the preimplantation period (1.4 +/- 0.6 vs 1.7 +/- 0.5 drugs/patient; P = 0.011). The other 31 patients went into chronic atrial arrhythmia after a mean period of 26 months. The only predictive factor of positive response was a spontaneous P wave duration < 160 msec at baseline. CONCLUSION: The results are consistent with a preventive effect of permanent biatrial pacing on recurrent and drug-refractory atrial arrhythmias associated with intra-atrial conduction delay.

Adult↗