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Biomedical subjects

E Aliot

Publications and source records attributed to E Aliot.

At least 91 records · Page 5Linked to original sources
PubMed1993

Effects of sotalol and d-sotalol on ventricular tachycardia and fibrillation induced by programmed electrical stimulation.

It is only in the last few years that the broad-spectrum antiarrhythmic properties of sotalol have become increasingly recognized. Racemic sotalol has potent beta-blocking and class III antiarrhythmic properties, and it has been reported that this drug is able to control supraventricular and ventricular arrhythmias. Recently, several studies performed with the d-sotalol isomer, which is almost devoid of the beta-blocking effects compared to the racemate, suggest significant antiarrhythmic efficacy and good tolerance of the dextro-isomer. In this paper we review and discuss the effects of sotalol and d-sotalol in patients with ventricular tachycardia (VT), ventricular fibrillation (VF) or cardiac arrest in whom VT or VF was induced by programmed electrical stimulation (PES).

Adrenergic beta-Antagonists↗
PubMed1993

[Correlation between parameters measured by high amplification ECG and results of programmed ventricular stimulation after myocardial infarct].

The presence of late ventricular potentials and the induction of sustained ventricular tachycardia (SVT) by programmed ventricular stimulation (PVS) after myocardial infarction are markers of the risk of serious ventricular arrhythmias. The authors studied the value of signal averaged electrocardiography (SAECG) compared with induction of SVT by PVS in 118 consecutive patients 4 to 8 weeks after myocardial infarction. In addition to this study population, a control group of 22 patients with spontaneous SVT after myocardial infarction was also considered. Three parameters were measured after averaging 200 QRS complexes: the duration of the filtered QRS complex (QRSd), the duration of signals not exceeding 40 microV (LAS) and the root mean square of the voltage of the last 40 milliseconds (RMS). Abnormal values were defined as: QRSd > or = 120 ms, LAS > or = 39 ms, RMS < or = 20 microV. Patients in the study population were subdivided into 3 groups: Group I (n = 17) inducible SVT; Group II (n = 72) no inducible arrhythmias; Group III (n = 29) induction of sustained ventricular flutter or primary ventricular fibrillation requiring immediate cardioversion. The results showed a good correlation between SAECG and induction of SVT. The sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were as follows: 1) QRSd > 120 ms: Se = 82%, Sp = 80%, PPV = 41%, NPV = 96%; 2) LAS > 39 ms: Se = 59%, Sp = 85%, PPV = 38%, NPV = 92%; 3) RMS < 20 V: Se = 59%, Sp = 88%, PPV = 43%, NPV = 93%.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1993

[Implantable defibrillator using epicardial and endocardial leads. Results of 36 implantations].

The authors report their experience of implantable defibrillators over a 5 year period. Between February 1988 and July 1992, 36 patients (25 men, 11 women, average age 51 +/- 11 years, range 18 +/- 71 years) underwent implantation of an automatic defibrillator with epicardial (n = 13, Group I) or endocardial leads (n = 23, Group II) without patch electrodes (n = 7), with subcutaneous patch electrodes (n = 12) or epicardial patch electrodes (n = 4). Three serious early complications were observed: 2 cardiogenic shocks in Group I, one of which died on Day 1 and one case of infection which required explanation of the defibrillator on Day 23 in Group II. Late complications in Group I included one case of disactivation of the defibrillator, 2 losses of output, one of which required replacement of the defibrillator and 2 increases of threshold treated by implantation of an endocardial lead. In Group II, 2 patients had inappropriate shocks due to overdetection (n = 1) and double counting (n = 1). During an average follow-up period of 28.5 +/- 9 months in group I and 13 +/- 6 months in Group II, 4 patients died, 2 from sudden death. Ninety seven shocks were delivered in 19 patients (56%), 5.1 shocks per patient. In the 17 patients with an antitachycardia function, 14 (82%) developed 947 episodes of VT treated successfully by antitachycardia pacing in 917 cases. This retrospective study confirms the efficacy of implantable defibrillators in the treatment of malignant ventricular arrhythmias. The efficacy of endocardial and epicardial leads seems to be the same but there seems to be a lower immediate mortality and morbidity with the endocardial system.

Adult↗
PubMed1993

[Radiofrequency ablation of Kent's pathways. Apropos of 30 cases].

Radiofrequency catheter ablation is a modern radical treatment of the Wolff-Parkinson-White (WPW) syndrome. The authors report their experience of this method in 30 consecutive patients (12 women, 18 men, mean age 34.2 +/- 13 years, range 14 and 63 years) with the WPW syndrome poorly controlled by antiarrhythmic therapy in 27 out of 30 cases. An average of 10.1 applications (1-33) was necessary to suppress anterograde and retrograde conduction in 26 of the 30 patients during the first session (87% success rate). At the time of effective ablation, the average atrioventricular interval was 41 ms (35-55) and in the two patients with a retrograde Kent bundle, the average ventriculoatrial interval was 72 ms (70 and 75 ms). The average duration of the procedure was 3.5 hours (45 mins to 7 hours) with an average fluoroscopy time of 61.6 minutes (9-182 minutes). There were four complications: one pneumothorax, one subacute femoral arterial obstruction and in two patients with a left Kent bundle, one TIA which regressed within 1 hour and one hemiplegia which regressed in 24 hours. After an average follow-up period of 8.3 months (2-16 months) the 26 patients are asymptomatic without any treatment. Radiofrequency catheter ablation therefore seems to be an effective method with a low morbidity for the radical treatment of symptomatic or high risk WPW syndromes.

Adolescent↗
PubMed1993

[Atrioventricular block induced by radiofrequency: electrophysiological criteria of success].

In a retrospective series of 18 consecutive patients (10 men, average age: 61.6 +/- 9.2 years) who underwent His bundle ablation by radiofrequency current, the authors analyzed the electrophysiological criteria predictive of complete atrioventricular block. A total of 82 radiofrequency bursts were analyzed (average: 4.5 +/- 3.1 bursts/patient) and classified as effective (N = 14, definitive atrioventricular block), ineffective (N = 55, no effect on atrioventricular conduction) or transiently effective procedures (N = 13, reversible Mobitz II atrio-ventricular block). Seven electrophysiological parameters were measured: HV interval, amplitude of atrial (A), Hisian (H) and ventricular (V) potentials, and the A/H, A/V, and V/H ratios before each radiofrequency burst. At the end of the ablation, 14 patients were in complete atrioventricular block and during the following 24 hours, a complete atrioventricular block developed in 3 other patients. The average value of the H potential was comparable in the effective and transiently effective procedures (0.28 +/- 0.20 mV and 0.27 +/- 0.19 mV respectively) and significantly higher than the same parameters in the ineffective group of procedures (0.65 +/- 0.14 mV, p = 0.008). The V/H ratio was progressively greater in effective (5.43 +/- 2.51), transiently effective (8.07 +/- 6.90) and ineffective procedure (14.32 +/- 13.35), p = 0.02; the average value of the A amplitude tended to be higher in the effective procedures (1.03 +/- 0.75 mV) and the transiently effective procedures (0.98 +/- 0.72 mV) than in the ineffective procedures (0.58 +/- 0.79 mV), p = 0.06. On the other hand, the other parameters were comparable in the three groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Primary ventricular fibrillation].

In the absence of autopsy studies, the etiological diagnosis of this form of ventricular fibrillation (VF) depends on the exclusion of cardiac disease by all available invasive and non-invasive diagnostic methods. Primary VF is rare and affects young adults. There are few clinical markers and published electrophysiological data indicates that sustained ventricular tachycardia or VF is unlikely to be induced by programmed ventricular stimulation. The underlying mechanism of the arrhythmia is poorly understood. However, a possible arrhythmogenic substrate has been suggested in small zones of fibrosis within normal Purkinje tissues, as encountered in some minor forms of arrhythmogenic right ventricular dysplasia. Also, the role played by the autonomic nervous system in triggering VF seems to be particularly important. Some described cases resemble curiously "torsades de pointes" with a short coupling interval. The "cardiac" prognosis of resuscitated patients is usually good. However, arrhythmic recurrences are common, and, classically, antiarrhythmic drugs are usually ineffective. The indication for implantation of an automatic defibrillator is therefore justified in patients surviving primary VF. The lack of understanding of this condition is an argument in favour of setting up a French register of patients with primary VF in order to establish its clinical features.

Arrhythmias, Cardiac↗
PubMed1992

Evaluation of bepridil efficacy by electrophysiologic testing in patients with recurrent ventricular tachycardia: comparison of two regimens.

The purpose of the study was to evaluate this effect of different doses of intravenous and oral bepridil on the induction of ventricular tachycardia. Thirty-eight patients underwent electrophysiologic evaluation for recurrent ventricular tachycardia (VT). Sustained monomorphic VT was induced by programmed ventricular stimulation, using up to three extrastimuli in all patients. The effects of intravenous bepridil (2 mg/kg) were evaluated during the initial study. Intravenous bepridil prevented the induction of sustained VT in eight patients (21%). Electrophysiologic study was repeated after oral bepridil. In six patients the study was stopped because of adverse effects or VT recurrence. Thirty-two patients underwent repeat study 7 days later, taking oral bepridil, 500 mg/day (n = 16) or 900/day (n = 16). A dose of 500 mg/day of bepridil prevented the induction of sustained VT in only one patient. A dose of 900 mg/day of bepridil prevented the induction of sustained VT in eight patients. There were no significant clinical adverse effects, except in one patient receiving intravenous bepridil. The response to intravenous bepridil did not predict the response to oral bepridil. The response to intravenous or oral bepridil was not related to the plasma level of bepridil but was related to a higher left ventricular ejection fraction. Eight patients (21%) in whom VTs were noninducible on oral bepridil were discharged on 300 mg/day of bepridil if their initial loading dose was 500 mg/day or on 600 mg/day if their initial loading dose was 900 mg/day. They remained free of VT during a follow-up of at least 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

[Electric stability of the heart after myocardial infarction: role of anti-arrhythmia agents during postinfarction].

Electrical instability of the heart after myocardial infarction threatens surviving patients with sudden death from a severe ventricular arrhythmia. These arrhythmic complications are usually the result of several factors: an arrhythmogenic substrate corresponding to the ischaemic myocardium, a trigger factor (usually a ventricular extrasystole) and other predisposing factors (autonomic nervous system, electrolyte imbalance, activation of the renin-angiotensin system). Risk stratification of electrical instability combines noninvasive (Holter, exercise testing, signal averaged electrocardiography, study of the variability of the heart rate, radionuclide or echocardiographic evaluation of the left ventricular ejection fraction) and invasive investigations (coronary angiography and even programmed ventricular stimulation). The presence of late ventricular potentials, a low ejection fraction and/or a ventricular arrhythmia on Holter monitoring identifies a high risk subgroup. Although the assessment of electrical instability is better than it used to be, pharmacological prevention remains disappointing. Class I antiarrhythmics are ineffective or dangerous. The efficacy of Class III antiarrhythmics is uncertain and only the betablockers seem to have any beneficial effects on this post-infarction electrical instability.

Adrenergic beta-Antagonists↗
PubMed1992

[Ablation of Kent pathways by radiofrequency. An initial study apropos of 3 cases].

This paper reports the initial results of radio-frequency ablation of accessory pathways in 3 consecutive patients with left lateral bundles of Kent and indications for accessory pathway ablation. A modified Polaris catheter was used with a wide distal tip through which the radio-frequency current was delivered by a generator with an intensity of 0.5 Ampères and a potential of 50 Volts, i.e. power of 25 Watts. The appearances of ventricular preexcitation disappeared in all cases and did not reappear during follow-up of 7 to 28 days. These preliminary results are encouraging. Further studies with longer follow-up are required to confirm the safety and efficacy of this new promising technique of ablation.

Adult↗
PubMed1992

[Coronary transluminal angioplasty after 70 years of age. Multivariate analysis of parameters influencing immediate results and long-term prognosis].

Between January 1986 and July 1990, 186 patients over 70 years of age underwent 215 transluminal coronary angioplasties. The patients' characteristics were: 117 men and 69 women; mean age 75.5 +/- 4 years (70-89 years): left ventricular ejection fraction 62 +/- 12%: 40% had previous myocardial infarction; 48% had single vessel disease; 80% had severe angina (19% Class III and 61% Class IV) and 58% of dilated vessels had calcification. In all, 276 vessels (1.3 patient) were dilated: one vessel in 77%, 2 vessels in 18% and 3 or more in 5% of patients. The primary success rate defined as a reduction of the diameter of stenosis below 50% was 81% (174/215 procedures) (85%-215/253 stenosis--in dilatations and 65%-15/23 obstructions--in attempted disobliterations). There were 4 deaths (2.1%), 12 Q wave infarcts (5.5%) and 5 non Q wave infarcts (2.3%), 2 emergency bypass grafts procedures and no cerebrovascular accidents. A multivariate analysis identified two factors which reduced the primary success rate: coronary calcification (p less than 0.02) and a history of previous infarction (p less than 0.02). Three factors were associated with an increased risk of perioperative infarction: the female sex, age greater than 75 years (p less than 0.01) and previous infarction (p less than 0.03). The first 154 patients were followed up for 25 +/- 14 months (8-61 months) without any patients being lost to follow-up. In this period, 16 patients died (11 of cardiac causes), 2 had non-fatal infarction, 13 underwent secondary aortocoronary bypass surgery and 30 patients (20%) developed an angiographic restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Diagnostic value of ventricular stimulation in patients with idiopathic dilated cardiomyopathy.

To assess the response to programmed ventricular stimulation and the clinical outcome, we performed a prospective study in 103 patients with idiopathic dilated cardiomyopathy. The protocol used up to three extrastimuli delivered at two right ventricular sites during sinus rhythm and ventricular pacing at 100 and 150 beats/min and was repeated during infusion of 1 to 4 micrograms/min of isoproterenol. Sustained monomorphic ventricular tachycardia (VT) was induced in 8 of 11 patients with spontaneous sustained VT, in none of 35 patients without significant ventricular arrhythmias during Holter monitoring, and in 9 of 56 patients with salvos of ventricular premature beats. Isoproterenol infusion facilitated the induction of two episodes of sustained VT in patients with spontaneous sustained VT; however, in all but one of the remaining patients, induction of ventricular tachyarrhythmias was not impaired. During the follow-up period there were eight sudden deaths among patients who initially had syncope, inducible sustained VT, or both and three episodes of sustained VT in patients who initially had nonsustained VT but inducible sustained VT. Isoproterenol infusion can be used to safely facilitate induction of ventricular tachyarrhythmias in patients with dilated cardiomyopathy. The induction of sustained VT was associated with a poor prognosis.

Anti-Arrhythmia Agents↗
PubMed1991

Factors determining the occurrence of late potentials on the signal-averaged electrocardiogram after a first myocardial infarction: a multivariate analysis.

To determine the natural history of late potentials on the signal-averaged electrocardiogram (ECG), multivariate analysis was performed in 167 patients (138 men, 29 women) with a first anterior or inferior acute myocardial infarction. Seventy-four patients received thrombolytic therapy; the remaining 93 patients were treated conventionally. All patients underwent coronary angiography, left ventricular ejection fraction determination and signal-averaged ECG recording. Eight variables thought to be correlated with the presence of late potentials were studied; that is, age, infarct location, number of diseased coronary vessels, left ventricular ejection fraction, infarct-related coronary artery patency, treatment received, delay between admission and signal-averaged recording and delay between admission and coronary angiography. Statistical analysis showed that two independent factors (coronary artery occlusion and impaired left ventricular ejection fraction) were highly correlated with the incidence of late potentials. The occurrence of late potentials was multiplied by 5 in case of an occluded infarct-related vessel and by 1.75 each time the left ventricular ejection fraction value decreased by 0.10. This study suggests that coronary artery patency is the most important factor that decrease the rate of late potentials after a first acute myocardial infarction and it occurs independently of infarct location and left ventricular function.

Coronary Angiography↗
PubMed1991

[After a myocardial infarction].

According to the literature and our experience, une expose our conception and our methodology of taking in charge patients after acute myocardial infarction. It is important to evaluate risks based on clinical data and exercise tests. Cardiac rehabilitation is taught of as a number of measures acting on the physical, the psychiatric and the socio-occupational levels, the importance of correcting risk factors and long-term follow-up.

Adaptation, Psychological↗
PubMed1991

[Long-term left atrial stimulation by transesophageal approach in complicated biventricular infarction].

The authors report the value of transoesophageal pacing in a 50 year old patient with acute biventricular infarction and cardiogenic shock who developed sinus node dysfunction, junctional rhythm and retrograde atrial activation. This mode of pacing was used permanently for a 48 hour period at a rate of 80/min (atrial capture with a pacing potential of 12 volts and an impulse duration of 12 ms). The clinical results were spectacular and the procedure was well tolerated. This technique can be instituted at the bedside and should be considered in selected cases of sinus node dysfunction when endocavitary pacing is not possible.

Atrial Function, Left↗
PubMed1991

[Effects of fibrinolysis on late potentials in myocardial infarction].

Late potentials are an index of gravity following myocardial infarction, but there has been little investigation of the effects of fibrinolysis on their incidence. Eighty-two consecutive patients (68 men, 14 women, group men age = 55 +/- 8 years) admitted presenting with a primary infarction and who had received fibrinolytic treatment within the first four hours. Each patient was screened for late potentials, and underwent a coronary artery angiograph and determination of the left ventricular ejaculation fraction (LCEF) following the infarction. The incidence of late potentials was 38% in the patients with an occluded coronary artery (9/24) vs 12% in patients with a permeable artery (7/58) (p less than 0.02). The change in LVEF was greater if reperfusion was not achieved (47 +/- 13% vs 54 +/- 12%, p less than 0.05). This study suggests that following fibrinolysis, the incidence of late potentials is correlated with both an absence of coronary reperfusion and deterioration of left ventricular function.

Adult↗
PubMed1991

[Factors influencing the occurrence of delayed potentials after myocardial infarction. A multivariate study].

Delayed or late potentials after myocardial infarction is a marker of the risk of severe ventricular arrhythmias. We looked for the factors favorising the appearance of these potentials in 208 consecutive patients (172 men, 36 women) admitted to hospital for primary myocardial infarction. Coronary angiography, evaluation of the left ventricular ejection fraction and signal averaged electrocardiography were performed in all patients who were then divided into two groups (Group I: patients with delayed potentials; Group II: patients without delayed potentials). A multivariate analysis of 7 different clinical and paraclinical parameters possibly related to delayed potentials was undertaken. The overall incidence of delayed potentials was 20%. The coronary artery responsible for the infarct was occluded in 79% of patients in Group I and 31% of patients in Group II (p less than 0.00009). The left ventricular ejection fraction was significantly lower in Group I (45.9% vs 54.5%, p less than 0.0002). The incidence of anterior infarcts was 58% in Group I and 37% in Group II (p = 0.008). These 3 factors were independent and correlated with the presence of delayed potentials. The multivariate analysis showed that the major factor was coronary occlusion with presence of delayed potentials multiplied by 6.3, whereas anterior infarction multiplied the risk of delayed potentials by 2.6 and each 10% decrease in LV ejection fraction increased the risk by 1.4.

Action Potentials↗