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Biomedical subjects

F Cherrier

Publications and source records attributed to F Cherrier.

At least 109 records · Page 6Linked to original sources
PubMed1988

[Results of programmed ventricular stimulation in primary dilated cardiomyopathy].

Programmed ventricular stimulation (PVS) has been advocated as being capable of identifying patients with idiopathic non obstructive dilated cardiomyopathy (NOCM) and at high risk of sudden death. We have studied the results of that method in 56 patients aged from 29 to 69 years (mean 53 years) presenting with idiopathic NOCM. The patients were divided into two groups according to the presence or absence of ventricular tachycardia (VT). Group I (controls) comprised 23 patients without documented VT. Group II consisted of 33 patients with documented VT which was sustained in 5 cases. Finally, 7 patients from both groups experienced losses of consciousness. Ventricular stimulation was performed on 2 sites of the right ventricle, using 1 to 3 extrastimuli on 2 imposed cycles. It was repeated under isoprenaline on 25 occasions. PVS induced non sustained ventricular tachycardia (NSVT) in only 2 patients of group I; it reproduced the sustained ventricular tachycardia (SVT) observed in the 5 patients with spontaneous SVT. PVS was negative in 14 of the 28 patients with NSVT; it induced NSVT in 8/28 and SVT in 6/28 (including 4 with more than 280 beats/min). The isoprenaline test failed to induce SVT. 7 patients died suddenly: 3 presented with SVT and 4 had syncopes and NSVT; ventricular stimulation induced SVT in 3 of these 4 patients. It is concluded that induction of sustained VT is uncommon in NOCM, but a history of syncope should prompt a search for SVT. Patients with spontaneous symptomatic NSVT and inducible SVT must be considered at high risk of sudden death.

Adult↗
PubMed1987

[Prognosis of spontaneous occlusions in tight coronary stenosis].

Eighteen out of 408 patients assigned to coronary angioplasty rapidly developed complete obstruction of the vessel to be dilated. The results of a retrospective study of clinical, biochemical, angiographic and/or angio-scintigraphic events in these 18 patients are reported. The interval between the two coronary arteriographies was 67 +/- 66 days. Angina was initially unstable in 9 patients and stable in 6; 3 patients were asymptomatic. Coronary lesions followed the usual distribution pattern: the left anterior descending artery was involved in 11 cases, the circumflex artery in 4 cases and the right coronary artery in 3 cases. Overall, the degree of stenosis was high (86 +/- 7%); Following obstruction the course of the disease was favourable in 11 patients (61%), with complete remission of all symptoms in 5. Six patients remained with unstable angina. Apart from one case of sudden death, none of the patients developed myocardial infarction, as shown by the absence of significant biochemical, electrical and angiographic changes. The importance of pre-existing or newly developed collateral circulation as a good prognosis factor is highlighted.

Adult↗
PubMed1987

[Sudden death during Holter recording. Possible iatrogenic role of cardiovascular drugs. 10 cases].

Ten patients who presented with advanced heart disease and severe ventricular arrhythmia could be considered "at high risk of sudden death" caused by ventricular fibrillation. Yet they died suddenly while under Holter monitoring, and the recordings demonstrated that 4 of these deaths were due to a major disorder of conduction and 6 to ventricular fibrillation. Further analysis of these cases showed that the lethal disturbance of heart rhythm was ascribable to an anti-arrhythmic drug in 5 cases (2 with conduction disorder, 3 with ventricular fibrillation). It would appear that although patients of this kind need anti-arrhythmic drugs, these should be given with caution and in lower doses than in patients with normal left ventricular function.

Adult↗
PubMed1987

Effect of flecainide on left ventricular ejection fraction.

Antiarrhythmic agents may depress cardiac contractility and worsen heart failure. Flecainide is an effective antiarrhythmic drug, but when administered orally in patients with left ventricular (LV) dysfunction, its effect on LV function is unknown. To assess the effects of flecainide on cardiac function, LV ejection fraction (LVEF) was measured by radionuclide ventriculography in 36 patients with LV dysfunction (LVEF less than or equal to 40%), prior to, and 7 days after, drug therapy was initiated. To analyse the possibility of a dose-dependent effect on LVEF, 18 patients received 200 mg day-1 of flecainide and 18 patients with an identical initial LVEF (27 +/- 8 vs 27 +/- 9) (NS) received 300 mg day-1. The study was stopped in 7 patients because of severe cardiac adverse effects; in these patients the LVEF was significantly lower (15 +/- 7) than that of the 29 patients who completed the protocol (27 +/- 8) (P less than 0.01). In patients who completed the protocol, there was no significant change in LVEF either with a daily dosage of flecainide of 200 mg day-1 (27 +/- 8 vs 27 +/- 8) or with 300 mg day-1 (27 +/- 9 vs 28 +/- 13). Thus, in the patients with LV dysfunction studied, oral flecainide did not significantly affect LV function either with a low or with the usual daily dosage. However, in patients with severe impairment of LV function (LVEF less than 30%) flecainide must be used carefully owing to a higher incidence of adverse effects on cardiac rhythm.

Arrhythmias, Cardiac↗
PubMed1987

Inducible multiform ventricular tachycardia in Wolff-Parkinson-White syndrome.

The induction of ventricular tachycardia by ventricular stimulation was investigated in 46 patients with isolated Wolff-Parkinson-White syndrome (10 concealed) and 36 control patients with normal electrocardiograms and conduction systems. None of those studied had spontaneous ventricular arrhythmias or myocardial or valve disease. Single and double ventricular extrastimuli were delivered at 3 cycle lengths (sinus, 600 ms, 400 ms). In the controls ventricular simulation induced one episode (3%) of non-sustained ventricular tachycardia. Ventricular stimulation in patients with Wolff-Parkinson-White syndrome induced two episodes of ventricular fibrillation and 15 episodes of non-sustained multiform ventricular tachycardia (37%). Ventricular arrhythmias were induced only in patients with overt Wolff-Parkinson-White syndrome. In 14 patients the conformation of the electrocardiogram at the start of ventricular tachycardia resembled that of major pre-excitation. The absence of inducible ventricular tachycardia in patients with concealed Wolff-Parkinson-White syndrome suggests that anterograde conduction via an atrioventricular accessory pathway is required to initiate the ventricular arrhythmias: the ventricular tachycardia may be associated with reentry of impulses via atrioventricular connection during the phase of ventricular vulnerability. The similarity between the start of ventricular tachycardia and pre-excitatory complexes may also indicate local reentry into the ventricular area occupied by the bypass tracts. Patients with Wolff-Parkinson-White syndrome and anterograde pre-excitation are more likely to have inducible multiform ventricular tachycardia than individuals without Wolff-Parkinson-White syndrome.

Adolescent↗
PubMed1987

[Prognostic value of a new perfusion index calculated from coronarography].

A new perfusion index was determined from the study of the coronary vascular bed in 8 myocardial territories: upper septal, lower septal, upper anterior, lower anterior, apical, lateral, posterior and inferior. Stenosis of a vessel reduces perfusion in all territories fed by that vessel, downstream of the stenosis. The perfusion index is calculated by adding up the lesions in all 8 territories. In a population of 418 consecutive patients who had undergone coronary arteriography in 1972 and 1973, survival was evaluated according to the perfusion index and to those parameters which classically have the greatest influence on survival. The perfusion index came out as the most important prognostic factor since such parameters as the number of stenotic vessels and ventricular kinetics lose their prognostic value when adjusted to that index. According to the perfusion index, the 8-year prognosis is the same as in subjects without coronary disease when the reduction in overall perfusion does not exceed 40%. With a 40 to 79% reduction the death risk at 8 years is 30% whatever the exact percentage in each individual. When perfusion is reduced by 80% the death risk at 8 years rises to 72%. This perfusion index, easy to determine, provides a better evaluation of prognosis than the conventional parameters.

Adult↗
PubMed1987

[Correlation between late surface potentials and inducible ventricular arrhythmias. Apropos of 115 cases].

Programmed ventricular stimulation and a search for late surface potentials (LP) by means of signal-averaging and quantification by Simson's method were performed in 115 patients divided into five groups: group I (n = 50) with no myocardial infarction (MI) and no clinical or induced ventricular tachycardia (VT); group II (n = 28) with MI and no clinical or induced VT; group III (n = 8) with MI, no clinical VT but induced non sustained VT (NSVT); group IV (n = 19) with MI, no clinical VT but induced sustained VT (SVT); group V (n = 15) with clinical and induced VT. The terminal portion of the averaged signal (AS) was analyzed by three parameters: duration of AS terminal portion less than 40 microvolts (Dur TP), AS amplitude 50 and 40 ms before its end (Amp 50, Amp 40). The presence of TP was defined in two ways: criterion A = Amp 40 less than 25 mcv, criterion B = at least two sub-criteria: Dur TP greater than 40 ms, Amp 50 less than 25 mcv, Amp 40 less than 15 mcv. Compared to groups I and II, the AS of group V was characterized by a prolonged and low amplitude terminal portion (p less than 0.001). Groups III and IV were intermediate. The incidence of TP in groups I to V was 20, 28, 37, 56 and 80% respectively with criterion A, and 4, 4, 0, 28 and 66% respectively with criterion B. The lower incidence of TP in group IV as compared to group V was probably due to the induction of purely artefactual SVT's, notably those with rapid cycle (greater than 270 cps/min) which are remarkable on several accounts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Outcome of 195 patients with Wolff-Parkinson-White syndrome].

Between 1974 and 1984, 207 patients with Wolff-Parkinson-White syndrome (WPW) were admitted to our hospital department; 195 of them were followed up for periods ranging from 1 to 12 years (6 years in children, 3 years and 9 months in adults on average); 160 had undergone electrophysiological exploration. Fifty-seven patients were less than 16 years old: 7 died, including 6 with associated congenital heart disease; an asymptomatic 12-year old girl died suddenly while taking part in a sporting event. The signs of WPW disappeared in 5 out of 10 children under 1 year of age. One hundred and thirty-eight patients were older than 15: 15 of them died, but only 3 deaths were related to WPW: one was consecutive to surgery for WPW and one to fulguration; the third patient died of WPW tachyarrhythmia; the refractory period of his Kent's bundle was short, but his compliance with treatment was irregular. We found no correlation between changes in functional symptoms and Kent's bundle refractory period values; paradoxically, the frequency of attacks and resistance to treatment was higher in cases with long refractory period. On the whole, this series confirms that WPW usually is a benign disease. However, the risk of sudden death, of which it offers an example, indicates that all patients with WPW should be evaluated with at least an exercise test and, depending on its results or on the socio-professional context, an electrophysiological exploration.

Adolescent↗
PubMed1987

[Prognostic value of ventricular tachycardia induced by stimulation in patients without documented tachycardia].

In order to determine the cause of syncopes or disorders of conduction, 584 programmed stimulations using 2 ventricular extrastimuli delivered during an imposed rhythm were performed, between 1981 and 1985, in patients without ventricular tachycardia (VT) proven by Holter recordings. Eighty-seven non-sustained VT (NSVT) (15%), 8 ventricular fibrillations (VF) (1%), 16 ventricular flutters (VF1) (3%) and 23 sustained VT (SVT) (4%) were induced. To appraise the significance of these responses the patients were followed up for a mean period of 2 +/- 1 years. Among the NSVT patients the first 47 were followed up until 1984 and the others, less numerous, until 1985. Patients who responded to stimulation with NSVT had (4.4%) or did not have an underlying cardiopathy; their mean left ventricular ejection fraction (LVEF) was 53.5 +/- 17% (n = 10); 17% died of heart disease, but the disease was related to VT in only one case; 36% of these patients had cardiac symptoms, but only one presented with episodes of NSVT. Patients who responded with VF had a normal (50%) or abnormal heart; their mean LVEF was 52 +/- 19%; one died of heart failure, the others were asymptomatic. All but one of the patients who responded with VF1 had an underlying cardiopathy and a mean LVEF of 38 +/- 19%; 3 died, 2 of heart failure and 1 of sudden death; 13 were asymptomatic. All patients who responded with SVT had an underlying cardiopathy and a mean LVEF of 37 +/- 13%; 7 (30%) died, including 2 sudden deaths; 2 had episodes of VT and 12 were asymptomatic. In summary, an underlying cardiopathy was present in one-half of the patients who responded with NSVT or VF and in all patients who responded with VF1 or SVT. The risk of VT was low (5%) in patients who responded with NSVT, VF or VF1 and was higher (17%) in those who responded with SVT.

Adolescent↗
PubMed1987

[Factors predicting the response to an antiarrhythmic during an electrophysiologic study for ventricular tachycardia].

The purpose of this study was to search for factors correlated with the absence of reinduction of a clinical ventricular tachycardia (VT) by stimulation in patients under anti-arrhythmic treatment. Repeated stimulations were performed in 41 patients with spontaneous VT and sustained, monomorphous ventricular arrhythmia induced by stimulation. The stimulation included 1 or 2 extrastimuli delivered into the right ventricle in sinus rhythm, then in imposed ventricular rhythm (600-400 ms). At least 4 anti-arrhythmic drugs were tested. In 16 patients (group I) of mean age 51 +/- 11 years VT was no longer reinducible under anti-arrhythmic treatment. In 25 patients (group II) of mean age 57 +/- 12 years no anti-arrhythmic drug was able to prevent VT induction. The characteristics of spontaneous and induced VT and of isotopic left ventricular ejection fraction (LVEF) were compared in both groups. The absence of reinduction of VT was obtained more easily in patients with: spontaneous, frequently unsustained VT; VT requiring 2 ventricular extrastimuli delivered in imposed rhythm to be induced; rapid initial induced VT (cycle 233 +/- ms vs 297 +/- 63 ms); less advanced underlying heart disease (LVEF 38 +/- 18 vs 27 +/- 13%). The subsequent history of the patients showed that the absence of reinduction of VT was correlated with a low risk of recurrence of VT (12.5 vs 48%) and with a lower risk of mortality (6% vs 32%) than in patients whose VT was always inducible under anti-arrhythmic treatment.

Adult↗
PubMed1986

[Emergency coronary surgery after transluminal coronary angioplasty].

Twenty-five patients underwent emergency coronary arterial bypass surgery immediately after attempted percutaneous transluminal coronary angioplasty (PTCA). The average time between the onset of PTCA complication and revascularization was 90 min (30-120 min). The surgical indications, the anaesthesia and the perioperative intensive care were analysed. No acute complication was observed during the anaesthesia. Peroperative findings defined two groups: the first "organic" (coronary arterial dissection and/or occlusive coronary thrombi; n = 15), the second "functional" (coronary arterial spasm; n = 10). The rate of perioperative myocardial infarction was significantly higher in the "organic" group. In this group, at the end of the cardiopulmonary bypass, a higher number of patients required circulatory assistance and/or an antiarrhythmic agent, as well inotropic drugs.

Anesthesia, General↗
PubMed1986

[10-year outcome of patients with isolated anterior interventricular stenosis technically accessible to coronary angioplasty].

Between April 1972 and March 1976, 70 patients were found to have an isolated stenosis of the left anterior descending artery at coronary angiography which could have been treated by coronary angioplasty, had the technique been available at that time. A questionnaire was sent to these patients and 65 (93 p. 100) replies were received 9 to 13 years after initial coronary angiography. They provided information about 61 men and 4 women with an average age of 48.1 +/- 8.4 years. Thirty eight patients had undergone surgery and 27 were treated medically, each group having distinct clinical characteristics. The 10 year survival rate was excellent (91 p. 100) and was high in both groups. The quality of life was good: 56 p. 100 claimed to be in good or very good health and 67 p. 100 were improved with respect to their functional state at the time of coronary angiography; only one quarter of these patients had been readmitted to hospital for cardiac problems during the follow up period, and 76 p. 100 of patients in work before the coronary angiography had returned to work. This date illustrates the excellent results of classical medical and surgical management of potential candidates for coronary angioplasty for isolated left anterior descending artery stenosis.

Adult↗
PubMed1986

[Clinical, echocardiographic and evolutive aspects of right atrial thrombosis].

The clinical and echocardiographic features of right atrial thrombi were examined in 9 patients, 5 men and 4 women aged 16 to 86 years. The 2D echocardiographic diagnosis was confirmed at autopsy (4 cases) or by the association of severe recurrent pulmonary embolism (5 cases). Three patients had associated ischaemic heart disease and on patient had dilated cardiomyopathy. The clinical presentation was: acute cor pulmonale (5 cases including 2 patients which biventricular myocardial infarction), chronic post-embolic cor pulmonale (1 case), tricuspid valve obstruction (1 case), general ill health with pyrexia (1 case) and heparin-induced thrombocytopenia (1 case). Predisposing factors included: absence of anticoagulent therapy (7 cases), previous supraventricular arrhythmias (2 cases) and right ventricular failure (6 cases, including 2 of right ventricular infarction). In 2 patients the thrombi were relatively immobile and had a wide base of implantation on the interatrial septum; in 1 patient, multiple thrombi were observed lining the right heart cavities from the inferior vena cava to the pulmonary infundibulum. In the other 6 patients, the thrombi were very mobile with a visible pedicule of implantation (2 cases) or totally free (4 cases). The variable polylobulated appearances, completely irregular whirling motion and intermittent prolapse into the tricuspid valve were characteristic features of the latter 4 cases. They disappeared spontaneously (2 cases) or after fibrinolytic therapy (2 cases) in under 36 hours. Three patients were operated with one postoperative death. The global hospital mortality was 22%. The present occasional detection of right atrial thrombosis will certainly become more common if patients with pulmonary embolism, right ventricular infarction or deep venous thrombosis are systematically examined by 2D echocardiography in the acute phase of their illness.

Adolescent↗
PubMed1986

[Diagnostic value of the isoproterenol test in effort tachycardia].

An isoproterenol test was performed in 69 patients during electrophysiological investigation to assess its diagnostic value in adrenergic supraventricular or ventricular tachycardia. Sixteen control subjects had no symptoms on exercise and routine exercise stress testing did not trigger any hyperexcitability. Sixteen patients had reproducible documented supraventricular tachycardia induced by exercise (13 paroxysmal junctional tachycardias, 3 focal atrial tachycardias). Eight patients had ventricular hyperexcitability related to effort. Twenty-nine patients had supraventricular and/or ventricular hyperexcitability only at rest. Electrophysiological investigations included paired atrial stimulation during sinus rhythm and paced rhythm followed by programmed ventricular stimulation using one and then two extrastimuli delivered during sinus rhythm and paced ventricular rhythm. These stimulation studies were carried out under basal conditions and then during low dose isoproterenol infusion (10 to 40 micrograms) which accelerated the heart rate to 130/mn. Electrophysiological and conduction parameters and the mode of induction of the tachycardia (defined as at least 5 successive echos with a configuration similar to the clinical tachycardia) were studied. We observed an acceleration of anterograde and retrograde conduction and a shortening of the effective atrial and ventricular refractory periods but these changes were found equally in the different groups of patients and were not related to the induction of tachycardias. The induction of paroxysmal junctional tachycardia by isoproterenol was a very sensitive (92%) and specific (100%) diagnostic method. Its diagnostic value was much greater than Holter monitoring (25%) and exercise stress testing (12.5%). Induction of ventricular tachycardia by isoproterenol was also very sensitive (75%) and specific (95%). The diagnostic value was higher than exercise stress testing (71%) and Holter monitoring (62%). Isoproterenol did not affect the induction of spontaneous tachyarrythmias unrelated to effort and even suppressed the triggering of some episodes. In conclusion, the induction by atrial or ventricular pacing or spontaneous supraventricular or ventricular tachycardia during isoproterenol infusion was very specific and correlated with the concept of tachycardia induced by exercise and therefore of adrenergic nature. The sensitivity of this test was excellent in patients with supraventricular tachycardia (95%) and very good in ventricular tachycardia (75%). On the other hand, the changes in the electrophysiological parameters were not specific for a group of patients.

Adolescent↗
PubMed1985

[Apical hypertrophic cardiomyopathy: an element in the continuum of hypertrophic cardiomyopathies].

Fourteen cases of apical hypertrophic cardiomyopathy (i.e. hypertrophy localized to the distal half of the left ventricular wall) are reported. There were 12 men and 2 women aged from 21 to 84 years. Only one of the patients presented, at first consultation, with severe functional symptoms, namely stage IV dyspnoea. ECG tracings were always abnormal, but the classical giant T waves were found in only 7 patients. In the 9 patients who had cardiac catheterization the left ventricular end-diastolic pressure was raised, and angiography showed an "ace of spades" diastolic image of the left ventricle with systolic obliteration of its tip. The distribution of parietal hypertrophy was best studied by two-dimensional echocardiography: the left ventricular apex was affected alone in 7 patients and concomitantly with the adjacent segments of the left or right ventricle in the other 7 patients. A family study showed that 3 patients had a descendant with obstructive cardiomyopathy. At a 4.6 years' follow-up the course of the disease was usually favourable. Apical hypertrophic cardiomyopathy is not a particular entity but one of different possible forms of hypertrophic cardiomyopathy. It seems to be benign in most cases.

Adult↗