Emile Ferrari

University of Nice Sophia Antipolis | UNS · Faculty of Medicine

Background The Virtual Reality Headset (VRH) is a device aiming at improving patient’s comfort by reducing pain and anxiety during medical interventions. Its interest during cardiac implantable electronic devices (CIED) implant procedures has not been studied. Methods We randomized consecutive patients admitted for pacemaker or Implantable Cardiov...

Background Myocardial infarction (MI) is the primary cause of death in subjects with type 2 diabetes (T2D) and their in-hospital mortality after MI is still elevated compared with those without T2D. Therefore, it is of crucial importance to identify possible mechanisms of worse clinical outcomes and mortality in T2D subjects. Monocyte/macrophage-me...

Background/Introduction The optimal Red Blood Cell (RBC) transfusion strategy in patients with acute myocardial infarction (MI) and anemia remains debated. In REALITY, the largest randomized trial to date in this population (n=666), a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of major adverse cardiovasc...

Background Persistent Atrial Fibrillation (PersAF) electrogram-based ablation is complex, and appropriate identification of atrial substrate is critical. Little is known regarding the value of the Average Complex Interval (ACI) feature for PersAF ablation. Objective Using the evolution of AF complexity by sequentially computing AF dominant frequen...

We report the case of a 57‐year‐old female patient with single atrium (SA) complicated with Eisenmenger syndrome, who was referred for highly‐symptomatic persistent atrial fibrillation (AF). The patient was treated with Furosemide, Spironolactone, Rivaroxaban, Bosentan and Tadalafil. Because of symptomatic recurrences under Amiodarone after initial...

Background: Female gender, degree of QT prolongation, and genetic susceptibility are known risk factors for developing torsades de pointes (TdP) during high-grade atrioventricular block (HG-AVB). Our objective was to analyze the prevalence and clinical characteristics of patients presenting with TdP and AVB (TdP [+]) in comparison with non-TdP pat...

Background. Fibrillatory Wave Amplitude (FWA) has been described as a non-invasive marker of atrial fibrillation (AF) complexity, and it predicts catheter ablation outcome. However, the actual determinants of FWA remain incompletely understood. Objective. To assess the respective implications of anatomical atrial substrate and AF spectral character...

Funding Acknowledgements Type of funding sources: None. Background Female gender, degree of QT prolongation and genetic susceptibility are known risk factors for developing torsade de pointe (TdP) during high-degree atrioventricular block (HD-AVB). Objective To analyze the incidence and clinical characteristics of patients presenting with TdP and...

Funding Acknowledgements Type of funding sources: None. Background Axillary vein (AV) puncture, an emerging route for cardiac implantable electronic devices (CIED), can be performed under ultrasounds (US) or fluoroscopic (Fluo) guidance. Objective To compare US to fluroroscopy-guided AV puncture in a multicenter randomized controlled trial. Meth...

Purpose: Balloon Pulmonary Angioplasty (BPA) is a constantly improving technique option for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). To assess pulmonary artery pressures (PAP) and BNP changes immediately after Balloon Pulmonary Angioplasty (BPA) procedures. Methods: We implemented a rigorous protocol for measuring PAP...

Aims The very early management of pulmonary embolism (PE), a part from antithrombotic treatment, has been little studied. Our aim was to compare the effects of diuretic therapy (DT) versus volume expansion (VE) in patients hospitalized for PE with RV dysfunction. Methods and Results We conducted a randomized open-label multicentric study including...

Background: In patients with complete atrioventricular block (AVB), the prevalence and clinical characteristics of patients with pause-dependent AVB (PD-AVB) is not known. Our objective was to assess the prevalence of PD-AVB in a population of patients with complete (or high-grade) AVB. Methods: Twelve-lead electrocardiogram (ECG) and/or telemon...

Aims: Outcomes in pulmonary hypertension (PH) are related to right ventricular (RV) function and remodelling. We hypothesized that changes in RV function and especially area strain (AS) could provide incremental prognostic information compared to the use of baseline data only. We therefore aimed to assess RV function changes between baseline and 6...

Background Pulmonary embolism (PE) is a common life-threatening disease, with mortality related to right ventricular (RV) dysfunction. Aims To investigate the value of 3D global and regional RV strain in patients with acute PE and at 1 month, as compared to a control population. Methods and results We conducted a longitudinal case-control prospec...

Objectives Severity of a first pulmonary embolism (PE) is sometimes proposed as a criterion for prolonging anticoagulant treatment. However, little evidence supports this idea. We attempted to determine the connection between severity of first PE and the risk of recurrence. Participants Patients admitted with PE between 2012 and 2018 and for whom...

Background Radiofrequency (RF) ablation of slow pathway (SP) is usually performed in sinus rhythm while monitoring the occurrence of a slow junctional rhythm (JR). JR although sensitive, is not specific for elimination of SP conduction. Our objective was to prospectively evaluate feasibility and safety of SP elimination using fast atrial rate pacin...

Background: Whether unidirectional conduction block (UB) can be observed after creation of a radiofrequency (RF) line is still debated. Previous studies reported a prevalence of 9 to 33% of UB, but the assessment was performed using a point-by-point recording across the line. Ultra-high-density (UHD) system may bring some new insights on the exact...

Background The fluoroscopic individualized LAO (i-LAO) projection has demonstrated high accuracy for identifying right ventricular (RV) lead positioning, likely by approximating a view along the septal or RV long axes. However, RV and septal anatomical axes have not been studied, and their relation with i-LAO is unknown. We sought to determine RV,...

Background Electrical cardioversion is the first-line rhythm control therapy for symptomatic persistent atrial fibrillation (AF). Contemporary use of biphasic shock waveforms and anterior-posterior positioning of defibrillation electrodes have improved cardioversion efficacy; however, it remains unsuccessful in >10% of patients. Objective The purp...

Background Cardiac injury has been reported in up to 30% of coronavirus disease 2019 (COVID-19) patients. However, cardiac injury is defined mainly by troponin elevation without description of associated structural abnormalities and its time course has not been studied. Research Question What are the ECG and echocardiographic abnormalities as well...

Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID‐19) infection. This characteristic is unusual and seems specific to COVID‐19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complication...

Background: The COVID-19 pandemic has had a profound effect on general health care. We aimed to evaluate the effect of a nationwide lockdown in France on admissions to hospital for acute myocardial infarction, by patient characteristics and regional prevalence of the pandemic. Methods: In this registry study, we collected data from 21 centres pa...

Aims: Right ventricular (RV) function assessment is crucial in congenital heart disease patients, especially in atrial septal defect (ASD) and repaired Tetralogy of Fallot (TOF) patients with pulmonary regurgitation (PR). In this study, we aimed to analyse both 3D RV shape and deformation to better characterize RV function in ASD and TOF-PR. Meth...

Association between Hydroxychloroquine (HCQ) and Azithromycin (AZT) is under evaluation for patients with lower respiratory tract infection (LRTI) caused by the Severe Acute Respiratory Syndrome (SARS‐CoV‐2). Both drugs have a known torsadogenic potential, but sparse data are available concerning QT prolongation induced by this association. Our obj...

Background: Most diseases encountered in the intensive care unit are associated with major stress that can potentially trigger Takotsubo syndrome. Many severe cardiovascular complications are associated with Takotsubo syndrome, yet little is known about Takotsubo syndrome in the intensive care unit. Aims: We sought to determine the incidence of...

INTRODUCTION Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess d...

BACKGROUND Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients. PURPOSE To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-...

Background Direct-current cardioversion (DCC) for atrial fibrillation carries a risk of stroke, probably associated with the temporary atrial stunning following cardioversion. The presence of a cardiac thrombus, usually localized in the left atrial appendage (LAA), is recognized as a clear contra-indication to the cardioversion. However, the presen...

Background The axillary route use for cardiac devices implantation has recently expanded either with fluoroscopy or ultrasounds guidance. Few studies included defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures for ultrasound-guided axillary vein puncture (UGVP). Aims To assess the feasibility/safety of UGVP for co...

Introduction Survival in pulmonary arterial hypertension (PAH) relates to right ventricular (RV) function. Whereas prognosis differs widely between PAH associated with congenital heart disease (CHD) and other causes of PAH, only little is known about differences in RV function. Purpose We aimed at comparing RV function assessed by 3D-speckle-track...

Background Right ventricular (RV) contractile reserve reflects the ability of RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. Purpose To assess different RV contractile reserve evaluation methods in...

Background Whether unidirectional conduction block (UB) can be observed after creation of a radiofrequency (RF) line is still a subject of debate. Previous study reported a prevalence of 9% of UB, but the assessment was performed using a point-by-point recording across the line, which may have artificially increased this UB percentage. Purpose To...

Introduction Atrial fibrillation (AF) is the most common acquired arrhythmia in the intensive care unit (ICU) and is associated with major cardio-vascular complications. However, the association between AF and in-hospital morbi-mortality in ICU remains debated. Furthermore, no prospective study previously assessed long-term outcomes of new-onset AF...

Background Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients. Purpose To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio...

Background: Whether cavotricuspid isthmus (CTI) is a region of conduction slowing during typical flutter has been discussed with conflicting results in the literature. We aimed to evaluate conduction velocity (CV) along the different portions of the typical flutter circuit with a recently proposed method by means of ultra-high resolution (UHR) map...

Since more than a half century, cardiac pacing and defibrillation represent a field in constant evolution, and they have shown some great technological advances from its conception to its methods of insertion. In this review, the recent developments about the accesses for pacemakers and ICD will be described: the axillary and the femoral vein. The...

Background Outcomes in pulmonary hypertension (PH) are related to right ventricular (RV) function and remodeling. We hypothesized that changes in RV function, especially area strain (AS), could provide incremental prognostic data. Purpose To assess global and regional 3D RV function changes between baseline and 6-months visit and evaluate their pr...

Background RV function assessment is crucial in congenital heart disease (CHD) patients, especially in atrial septal defect (ASD) and tetralogy of Fallot (TOF) patients. Indeed, prognosis substantially differs between TOF and ASD and little is known about 3D deformation and shape in RV volume overload. Purpose To assess Right ventricular (RV) remo...

Purpose: Diagnosis of cardiac arrhythmias can be challenging due to their frequent transient nature. Smartphone-based ECG has previously been studied for atrial fibrillation (AF) diagnosis but data is lacking regarding their diagnostic accuracy for other frequent arrhythmias. Thus, this study aims to assess the accuracy of Alivecor smartphone-based...

Background Fluoroscopic criteria have been described for the documentation of septal right ventricular (RV) lead positioning, but their accuracy remains questioned. Methods and resultsConsecutive patients undergoing pacemaker or defibrillator implantation were prospectively included. RV lead was positioned using postero-anterior and left anterior o...

Background: Classical fluoroscopic criteria for the documentation of septal right ventricular (RV) lead positioning have poor accuracy. We sought to evaluate the individualized left anterior oblique (LAO) projection as a novel fluoroscopy criterion. Methods: Consecutive patients undergoing pacemaker or defibrillator implantation were prospective...

This case illustrates the evolution of right ventricular (RV) 3-dimensional (3D) area strain during pregnancy in a patient with repaired Tetralogy of Fallot. The report highlights impairment in RV function with pregnancy, suggesting the importance of prepregnancy RV systolic function assessment, especially using 3D echocardiography.

Aims: Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the RV unique anatomy and structure limit 2D analysis and its regional 3D function has not been studied yet. The aim of this study was to assess the implications of global and regional 3D RV deformation on clinical condition and survival in adults wi...

We report the case of an 82-year-old man presenting with ventricular fibrillation (VF) occurring acutely after atrioventricular node (AVN) ablation. This patient had severe valvular cardiomyopathy, chronic atrial fibrillation (AF), and underwent prior to the AVN ablation a biventricular implantable cardiac defibrillator positioning. The VF was succ...

Background: Adults with Eisenmenger syndrome have a survival advantage over those with idiopathic pulmonary arterial hypertension. Improved survival may result from preservation of right ventricular (RV) function. Aims: To assess left ventricular (LV) and RV remodelling in patients with Eisenmenger syndrome compared to a control population, usin...

Background According to European guidelines, patients with stable coronary disease should undergo moderate-to-vigorous intensity exercise. Intense physical activity may have a negative impact on platelet aggregation and the protective effect of antiplatelet (AP) drugs is not documented. The aim of our study was to assess the effect of aspirin (ASA)...

Background In submassive pulmonary embolism (PE), when a right ventricular (RV) dysfunction (RVD) is present, the benefit of fluid expansion (FE) is questionable. The Franck-Starling law suggests that the reduction of the RV overload may enhances the RV systolic function. Purpose The aim of our study was to compare the effects of a diuretic treatm...

Data on regional variations in the characteristics, management and early outcome of patients admitted with ST-elevation myocardial infarction (STEMI) in France are limited. We used data from the FAST-MI 2010 registry to determine whether regional specificities existed, dividing the French territory into 6 larger geographical regions. Variations in...

An 89-year-old female was referred to the authors' institution for repeating pulmonary edema. Recent transthoracic echocardiography (TTE) showed only a mild mitral regurgitation (MR), but a transient severe reversible functional MR was observed during an episode of respiratory distress. TTE demonstrated the functional nature of the regurgitation wi...

Improved surgical care during the last decades, together with advances in medical management, led to a remarkable increase in survival of patients with congenital heart disease (CHD). However, aging of the CHD population brings new challenges, and loss of follow-up of adolescents and adults with CHD is a major concern. It is crucial to optimize the...

Non-O blood group patients are at higher risk of first episode of venous thromboembolism (VTE). However, only little is known about the risk of recurrence according to the blood group. In this study, we aimed to determine the impact of ABO blood group on VTE recurrence. We prospectively recruited 106 consecutive patients with a first documented epi...

Background Survival is improved in pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) patients and is related to right ventricular (RV) function. In this study we aimed to investigate the prognostic role of RV mechanics in Eisenmenger Syndrome (ES) compared with other causes of PAH using speckle-tracking imaging....

Background Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. Currently, cardiac magnetic resonance (CMR) is the most sensitive method for the diagnosis of CS, however as CMR is being positive relatively late, new imaging methods to improve the early diagnosis of CS are lacking. The aim of this study was to assess the rol...

Background Computed tomography pulmonary angiography (CTPA) is routinely used to diagnose pulmonary embolism (PE). Reflux of contrast medium into the inferior vena cava or hepatic veins (IVC) on CTPA is a simple sign that could help for PE risk stratification. The purpose of this study was therefore to investigate prognosis significance of contrast...

Background Endovascular repair of abdominal aortic anevrysms (AAA) is a well documented option. This approach is usually performed by surgical cut down of the common femoral arteries (CFA). Total percutaneous access for endovascular aortic anevrysm repair (« preclose technique ») has been reported. However high bleeding risk obese patients are stil...

Background Breast cancer is the most frequent female cancer. Treatment of HER2+ tumours evolved with immunotherapy, leading to improved survival. Cardiac toxicity associated to trastuzumab is frequent but reversible in 75% of cases. However, only little is know about the cardiotoxicity of new anti-VEGF antibodies associated to trastuzumab. In this...

Introduction Speckle tracking imaging is a recent technique that can be achieved using either vendor dependent or vendor-independent software. Right ventricular (RV) strain is increasingly used as a prognostic tool in both left and right ventricular diseases. Only little is known regarding the variability of vendor-dependent and - independent speck...

Purpose Pulmonary artery (PA) dilatation is often seen in patients with pulmonary hypertension (PH). The objective of our study was to identify factors associated with PA dilatation and to assess its prognosis significance in group 1 and 4 PH patients. Methods We performed a longitudinal cohort study, including consecutive patients with group 1 and...

Background: Patent foramen ovale (PFO) in pulmonary embolism (PE) is associated with an increased risk of complications. However, little is known about PFO and ischemic stroke prevalence, particularly in acute intermediate-risk PE. In addition, in this context, the so-called "gold standard" method of PFO diagnosis remains unknown. We aimed to eval...

The specific kinetic of copeptin secretion during the course of an acute coronary syndrome (ACS) had poorly been studied, with most studies assessing copeptin levels in the very first hours of chest pain onset and not ACS itself. To overcome this issue, we took advantage of septal embolization technique for hypertrophic obstructive cardiomyopathy (...

We report the case of a middle age patient presenting with Tako-Tsubo cardiomyopathy (TTC) complicated by cardiogenic shock that was successfully handled with milrinone. A 64-year old man presented with cardiogenic shock after benzodiazepine and alcohol intoxication. A slight elevation of troponin and typical left ventricular ballooning without cor...

Patients with pulmonary hypertension must be evaluated using a multimodality approach to ensure a correct diagnosis and basal evaluation as well as a prognostic assessment. Beyond the assessment of pulmonary pressures, the echocardiographical examination allows the evaluation of right ventricular adaptation to elevated afterload. Numbers of variabl...