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Patient care innovations

Liryc conducts many projects aimed at continuously improving and optimising the therapies available to treat heart rhythm disorders for the benefit of patients.

French No. 1 by volume of ablation procedures

Thermoablation of atrial fibrillation.
In the 1990s, Liryc's clinicians identified the sources of atrial fibrillation in the pulmonary veins. This discovery helped to develop a curative treatment for this disorder. It involves cauterising the pulmonary veins with a radiofrequency catheter to isolate these sources of arrhythmia. Other energies have recently become available: Cryotherapy, delivered with a balloon, and within the framework of experimental protocols, electroporation. This treatment has become the standard treatment: to date, more than 400,000 patients benefit from it each year worldwide. Liryc's clinicians hold the largest ablation volume (> 1000 / year) in France, considering that AF ablation represents 75% of the total volume.

 

Treatment of atrial fibrillation by alcoholization of the Marshall's veins
Studies have shown that the Marshall's ligament can be the centre of the heart's electrical dysfunction. It may therefore be a major target beyond the pulmonary veins in the treatment of atrial fibrillation. However, conventional ablation techniques do not ensure its complete destruction: it is in fact positioned on the external face of the atrial wall, and is moreover largely isolated from radiofrequency currents by a sheath of adipose tissue. To overcome this technical limitation, the suppression of the Marshall's ligament and the surrounding ganglia can be achieved by injecting alcohol into the Marshall's vein adjacent to it. At Liryc, this approach is systematically used in cases of persistent AF, in addition to isolating the pulmonary veins and linear lesions (roof and mitral isthmus). This innovative technique has proven to be both effective and safe.

 

Thermoablation of ventricular fibrillation.
Clinicians have also identified the triggers of sudden deaths from ventricular fibrillation. These sources are located in the heart's electrical system, called the Purkinje network. This electrical network of the heart is essential for cardiac contraction and only constitutes 2% of the heart's ventricular mass. The destruction of these sources of arrhythmia by thermoablation represents an innovative and curative approach to ventricular fibrillation to prevent sudden death.

Development of cardiac resynchronization therapy in heart failure

Other clinicians at Liryc have also been involved in the development of cardiac resynchronization therapy in heart failure. This electrical therapy involves implanting pacing leads in the ventricles. It aims to specifically correct electrical desynchronizations in order to harmonise ventricular contraction and ensure better cardiac output.

 

Reference centre for implantation of the Micra© minimally invasive cardiac pacemaker.

In 2014, Dr Philippe Ritter performed the first implantation on a patient in France of the smallest minimally invasive cardiac pacemaker in the world, called Micra® TPS. Nowadays, more than 100 patients have been implanted with the Micra® TPS at CHU de Bordeaux. Overall, CHU de Bordeaux performs around 800 pacemaker/defibrillator implantations per year, or the greatest number of procedures in France.

The minimally invasive pacemakers represent a significant advance in cardiac pacing. The innovative implantation technique and the device's size reduce the procedure time, as well as the patients’ recovery period.

The Micra® TPS is a device whose size is comparable to that of a large tablet or one-tenth of the size of a conventional cardiac pacemaker. It is implanted directly in the heart via a catheter introduced into the femoral vein. It is secured with small tines and delivers electrical impulses that regulate the heart rate by means of an electrode at the end of the device, therefore no longer requiring the use of leads to connect to the heart.

 

At the end of 2015, Philippe Ritter opened a training school “The Micra Academy” at Liryc in partnership with Medtronic. It aims to train French and European cardiologists in its optimal implantation

It is the French leader in remote monitoring

The remote monitoring of implantable cardiac prostheses started in France in 2001 after the implantation of the first remote-monitoring pacemaker in Bordeaux.

 

Data from the cardiac prosthesis are regularly sent by a remote transmitter in the patient’s home and analysed. This monitoring improves patient safety and optimises their follow-up. CHU de Bordeaux, which was a pioneer in the field, is now a leader with an active list of more than 4,800 patients and the greatest number of procedures in France, all specialties combined.

 

State-of-the-art screening

Cardioinsight vest. The cardiology-electrophysiology and cardiac pacing department uses the Cardioinsight vest to improve ablation procedures.

 

It is an electrocardiogram mapping system with 252 non-invasive electrodes. This system combines electrical data collected on the body surface with 3D anatomical data to provide real-time, 3D images of the entire heart’s electrical activity in a single beat.

This jacket quickly identifies the arrhythmia regions and hence a greater speed and accuracy of ablation. 

2018 key figures for the electrophysiology and cardiac pacing department
  • 3,788 stays
  • 5,927 consultations
  • 2,347 procedures (interventional cardiology and cardiac surgical unit)