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Biomedical subjects

G Faivre

Publications and source records attributed to G Faivre.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Cardiac electrophysiologic effects of prostacyclin in man].

The electrophysiological effects of prostacyclin (PGI2) at increasing doses (2.5, 5 and 10 ng/kg/min) were assessed in 16 patients during classical investigations of sinus node function and atrioventricular conduction and during programmed atrial and right ventricular under basal conditions and during prostacyclin perfusion. Ten patients had normal sinus node function and atrioventricular conduction under basal conditions. Stastistically significant changes were observed during PGI2 perfusion: shortening of the sinus cycle length (p 0.01), decreased intraatrial conduction time (p less than 0.05), reduced atrial functional refractory period (p less than 0.01) and reduced effective and functional refractory periods of the AV node (p less than 0.05), increased anterograde (p less than 0.01) and retrograde (p less than 0.05) Wenckebach point. The changes were dose dependent. No significant changes were observed in sinus node recovery periods of the His Purkinje system. Similar changes were recorded on 4 other patients with various conduction defects. Paired atrial stimulation induced manifestations of hyperexcitability in 5 patients. In 2 patients with normal responses under basal conditions it was possible to induce non-sustained atrial tachycardia during PGI2 administration. In 3 patients with inducible atrial tachycardia under basal conditions, it was still possible to induce the tachycardia after PGI2 but this disappeared in all but one patient with the sick sinus syndrome after the addition of propranolol. The changes in ventricular excitability were studied by a specific protocol in 16 patients. Of the 13 patients without inducible ventricular tachycardia under basal conditions, 4 developed inducible non-sustained ventricular tachycardia after PGI2. Three patients had inducible VT under basal conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Sudden death in mitral valve prolapse. Apropos of 2 cases].

Two cases of sudden death are reported in patients with mitral valve prolapse with mitral insufficiency. Both had significant impairment of left ventricular function. Irreversible ventricular fibrillation occurred in one patient one-half hour preceding a catheterization, whereas the other patient died during sleep. Review of the literature revealed 42 cases of sudden death in patients with prolapse. Occasionally left ventricular dysfunction or medication overdosage can explain or favor development of the terminal arrhythmia, but usually no precipitating factor other than prolapse can be identified. It appears impossible to identify actual subgroups at risk, although sudden death does occur more frequently in patients with a large amount of prolapse of both valves, previous syncopal episodes, and ECG abnormalities at rest. Complex ventricular arrhythmias are also reported, but their predictive importance is difficult to evaluate. Sudden death is a rare complication of mitral prolapse, fact which should conservatively influence indications for further supplementary testing and treatment in these patients.

Adult↗
PubMed1985

[Sudden death in patients wearing pacemakers].

10 to 30 p. cent of patients with cardiac pacemakers die suddenly. In most cases, the cause of death can not be established. Racing of the pacemaker is a rare but definite cause of sudden death. In contrast, failure of the stimulation, which occurs much more frequently, and which is due to failure of the pacemaker or the wire or to an elevation of the threshold of stimulation, rarely causes sudden death because of the development of an idioventricular rhythm, leading to detection of the fault. Competitive rhythms do not appear to be more dangerous than accidental inhibition in sentinel pacemakers; both of these mechanisms can lead to ventricular tachycardia which may degenerate to ventricular fibrillation. Programmable pacemakers have certain advantages and disadvantages, in that the programming may prove to be inappropriate. In most cases, the ventricular fibrillation is spontaneous, occurring in the context of myocardial failure. The extension of the indications for pacemakers is certainly responsible for the relatively high incidence of sudden death.

Death, Sudden↗
PubMed1985

[Apical hypertrophic myocardiopathy. Apropos of 10 cases].

Apical hypertrophic cardiomyopathy is a recently defined subgroup of primary hypertrophic cardiomyopathy. Ten new cases are studied. The electrical features (anomalies of repolarisation) were constant and giant negative T waves were observed in 3 out of 10 cases. Two-dimensional ultrasonography confirmed the diagnosis in every case; the optimal views consisted of 4 cavity scans obtained by the apical approach. When angiography was performed (7 cases out of 10), it confirmed the ultrasonographic findings and was able to eliminate any coronary artery lesions. The patients had a mean age of 48.3 years with a marked male predominance (sex ratio of 0.8) and all of the patients are alive with a mean follow-up of 3.4 years. The functional handicap was moderate (class III: 1 case, class II: 5 cases and class I: 4 cases) and did not progress during the period of follow-up. The family surveys performed revealed that apical hypertrophy can be integrated into the spectrum of segmental hypertrophic cardiomyopathy. In two cases, this survey revealed the coexistence in the same family of segmental hypertrophy with different topography. The long term prognosis of this disease is unknown and the authors consider that the risk of ventricular arrhythmia justifies routine rhythmological evaluation in order to guide subsequent treatment.

Adult↗
PubMed1984

Two-dimensional echocardiographic recognition of aortic valve ring abscess.

2D-echocardiography was performed in 42 consecutive patients with suspected aortic endocarditis who subsequently underwent surgery. On surgery, 12 patients had perivalvular aortic abscesses: in the posterior part of the ring (7) with extension to the aorto-mitral fibrous trigone or pseudo-aneurysm of the aortic wall; in the anterior part of the ring (3), with extension toward the interventricular septum; or with near complete aorto-left ventricular disruption (2). Perivalvular abscess was seen on 2D-echo in 8 patients: echo-free cavity located in the aortic ring, beyond the sigmoid valvulae and sometimes containing necrotic material. In 4 patients, the abscess was not diagnosed on 2D-echo; 2 had small, localized abscesses but the remaining 2 had large abscesses developed around previously implanted mechanical prostheses, which considerably impeded echographic examination. One additional patient with acute aortic regurgitation and fever had an image of posterior abscess, but on surgery, the posterior wall of the aorta appeared inflammatory and oedematous without perivalvular abscess. Accurate topographic diagnosis was made in 6 of the 8 patients, while in 2 the abscess was located more to the left than considered on 2D-echo. Generally, 2D-echo tended to underestimate the importance and extension of the lesions. It is concluded that 2D-echo is helpful to diagnose perivalvular aortic infection.

Abscess↗
PubMed1984

Electrophysiological effects of intravenous prostacyclin in man.

The electrophysiological effects of prostacyclin (PGI2) were studied in 10 normal patients. Programmed stimulation was performed before and after infusion of 2.5, 5, 10 ng kg-1 min-1 of PGI2. Then, 0.2 mg kg-1 of propranolol was added to the higher dose of PGI2. We observed a net decrease of the systolic and diastolic arterial blood pressure beginning with the lowest dose. There was no effect on sinus node recovery time, atrial, His-Purkinje and ventricular effective refractory periods, AH and HV intervals. Atrioventricular (AV) nodal effective and functional refractory periods could be measured in 5 patients and were decreased in all cases. Sinus cycle length and anterograde and retrograde Wenckebach cycle lengths were significantly decreased by PGI2 in a dose dependent manner. The injection of propranolol increased all these values but did not suppress entirely the effects of PGI2. In conclusion, the electrophysiological effects of PGI2 were marked decreases of sinus cycle length and AV nodal refractoriness which may be partly related to enhanced sympathetic activity.

Adult↗
PubMed1984

Significance of supraventricular arrhythmias induced by electrophysiologic studies.

The clinical history and the findings on Holter monitoring of 767 patients (without evidence of ventricular pre-excitation on the ECG) were compared with the results of electrophysiological studies to assess the significance of supraventricular arrhythmias induced by intracardiac study. The studies were undertaken to determine the cause of syncope, conduction disturbances or tachycardia. In 570 patients (group 1) supraventricular arrhythmias were not induced. On Holter monitoring, 36 (6%) had evidence of supraventricular tachycardias, including atrial flutter, atrial fibrillation and paroxysmal junctional tachycardia. In 86 patients (group 2) one atrial extrastimulus induced a paroxysmal junctional tachycardia; 79 (82%) of these patients had had spontaneous supraventricular tachycardia (SVT). In 111 patients (group 3) another type of SVT was induced: The movement of the catheter induced atrial flutter or fibrillation in nine patients, eight (89%) of whom had spontaneous SVT. Atrial pacing at a rate less than 200 bpm induced atrial flutter or fibrillation in 14 patients of whom nine (64%) had SVT. Ventricular pacing induced SVT in 15 patients, of whom 14 (64%) had SVT. An atrial extrastimulus during sinus rhythm induced atrial echoes in 62 patients, 47 (76%) of whom had SVT. The atrial extrastimulus during sinus rhythm induced atrial tachycardia in 11 patients, nine (82%) of whom had SVT.

Adolescent↗
PubMed1984

Effect of adenosine triphosphate on the accessory pathways.

To determine the site of the anterograde and retrograde conduction in the Wolff-Parkinson-White syndrome (WPW), 40 mg of adenosine triphosphate (ATP) was injected during electrophysiological studies in 53 patients with ventricular preexcitation. In 40 cases, the accessory pathway was evident (group 1) and in 13 cases it was concealed (group 2). In 10 cases in group 1, anterograde conduction was abolished with disappearance of the features of preexcitation. In 7 patients of group 1 and in 4 patients of group 2, retrograde conduction in the accessory pathway was prolonged or abolished. These effects were unexpected because ATP is a parasympathomimetic drug. There was a correlation between the Kent effective refractory period (ERP) and the action of ATP. When the drug did not change the anterograde and retrograde conduction in the Kent bundle, the anterograde accessory pathway ERP was always less than 230 ms. When ATP only decreased retrograde conduction in the Kent bundle, anterograde accessory pathway ERP was always more than 280 ms.

Adenosine Triphosphate↗
PubMed1984

[Socio-professional rehabilitation after transluminal coronary angioplasty].

Between April 1980 and October 1982, 109 patients underwent attempted transluminal coronary angioplasty (TCA) with a primary success rate of 71,6% (78 patients). Two patients died of complications of TCA and another one died suddenly 3 months after TCA. The socio-professional rehabilitation of the 106 survivors was studied by questionnaire to which 98 subjects (81 men, 17 women; average age 50,2 +/- 9,2 years) replied. Seventy seven patients were working before their coronary disease and 73 (62 men, 11 women; average age 46,4 +/- 9,1 years) replied to the questionnaire (95%). This constituted the study group, the socio-professional outcome or which was compared to that of 37 active patients who underwent single aorto-coronary bypass surgery during the same period. After TCA, 53 patients (73% returned to work, 48 as full time workers, after an average convalescent period of 4 months. Professional rehabilitation depended mainly on the initial result of TCA: 85% after primary success; 40% after failure (p less than 0,001); in the latter case, the rate of return to work improved if the patients had surgery (58%) rather than medical therapy (125%). Similarly, the average age of re-employed patients was lower (46,1 +/- 7,9 years, compared to 49,3 +/- 6,8 years, p less than 0,05). Finally, the patients returning to work usually claimed to be in good or very good health (72% compared to 30% p less than 001). After single aorto-coronary bypass, only 14 patients (38%) returned to work, 8 full-time, after an average 7 months' convalescence. The duration off work before surgery was related to the incidence of re-employment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Cost of a coronary transluminal angioplasty compared with a single coronary bypass. Economic effects].

The authors discuss the financial incidence of transluminal coronary angioplasty (TCA) compared to isolated coronary bypass surgery (CBS). The study was limited to 1982 (76 cases of TCA) and compares two groups: successful TCA (17 consecutive cases: group I); isolated CBS (18 cases: group II). The following parameters were studied in each group: average length of hospital study, credits received from the Department of Social Security, hospital expenditure. Hospital expenditure was classified under 6 headings: personnel, material, investigations, drugs, hospital costs and administration costs. The results expressed as the mean per patient were: in group I: hospital stay, 10 days; Social Security reimbursement, 10 813 FF; hospital expenditure, 10 586 FF. In group II: hospital stay, 18 days (including 4 days in the ICU); Social Security reimbursement 46 656 FF; hospital expenditure, 28 955 FF. The hospital costs of personnel were relatively small (especially for TCA). The economies realised by reutilising catheters designed for single usage were significant: the use of guide wires, catheters and balloon catheters falls from 1.64, 1.9 and 0.1 per patient to 0.47, 0.53 and 0.05 respectively, a saving of 5 068 FF per TCA and 385 168 FF per year. Compared to costs in the United States (4 773 and 14 952 dollars) TCA and CBS is much cheaper in France.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1984

[Results of the systematic application of ventricular stimulation methods].

This study was undertaken to test the validity of methods of evaluating ventricular tachycardia and in therapeutic surveillance. One hundred and thirty nine patients aged 16 to 84 years, with and without severe ventricular arrhythmias (ventricular tachycardia, VT, and fibrillation, VF) were divided into two groups after clinical, echocardiographic and 24 hour Holter investigations: Group I comprised 26 patients with a least one documented attack of VT or VF; Group II comprised 113 patients without these arrhythmias, who complained of dizziness, syncope, and/or their ECG showed a conduction defect, and so electrophysiological investigation was undertaken. A protocol of ventricular stimulation was undertaken in addition to the usual measurements of conduction times, comprising incremental ventricular stimulation from 100 to 200/min, single and paired extrastimulus in sinus rhythm and during ventricular pacing at rates of 100 and 150/min, the first extrastimulus being programmed 10 ms after the end of the ventricular effective refractory period. Excluding bundle to bundle reentry, the following results were obtained: In Group I: VT was triggered 16 times (61,5 p. 100), and in 4 of these cases VF occurred and required defibrillation. Ten patients had previous myocardial infarction; 5 patients had left ventricular dilatation. In 2 cases runs of 3 or 4 VES were recorded. No arrhythmia could be induced in 8 cases (30,8 p. 100); 5 of these patients had apparently normal hearts. In Group II: VT (greater than 5 VES) was triggered in 22 cases (19,5 p. 100) and in 4 cases this degenerated to VF requiring defibrillation. 11 patients had apparently normal hearts; 6 patients had left ventricular dilatation and 4 patients had previous myocardial infarction. 1 to 4 repetitive VES were observed in 67 cases (59,3 p. 100): the heart was judged to be normal in all patients except those with previous infarction. No correlation was established between the ability to induce VT and age, syncope, or ECG changes (especially bundle branch block). However, a correlation was found between the induction of VT and underlying cardiac disease and the method of induction of VT; in Group II, all episodes of VT were triggered by delivering paired ventricular extrastimuli on a background paced rhythm. These results show that repetitive ventricular responses can easily be triggered and that this has no pathological significance.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study].

The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. Thirty five patients (6.4%) had supraventricular tachycardia (SVT), atrial flutter (AFI), atrial tachycardia (PAT), atrial fibrillation (AF) or PJT. The anterograde Wenckebach point (AV) was over 200/min in 22 cases (4%). In 400 patients the Wenckebach point or the retrograde Mobitz II (VA') point was 170/min in 56 patients (14%). In 28 patients with spontaneous SVT in whom retrograde conduction was studied, 3 had a Wenckebach 200/min (17.7%) and 9 had a Wenckebach point (VA') greater than 170/min (32%). In 86 patients (Group II) paired atrial stimulation induced PJT. Seventy nine patients (91.8%) had PJT : AV was greater than 200/min in 19 cases (22%) and VA was greater than or equal to 170/min in 69 cases (80.2%). In 119 patients (Group III) a supraventricular tachycardia (other than PJT) was induced. Manipulation of the catheter in the atrium led to AF, AFI or PAT in 9 patients. Eight patients had SVT (80.8%), AV was greater than 200/min in one case (11.1%) and VA' greater than or equal to 170/min in 5 of the 7 cases in which it was measured (71.4%). Paired atrial stimulation induced atrial echos in 63 patients; 47 presented spontaneous SVT : AV was greater than 200/min in 7 cases (11.2%) and VA' greater than or equal to 170/min in 23 of the 60 patients investigated (38.3%). Paired atrial extrastimuli triggered AF or PAT in 18 cases : 16 cases (88.8%) had spontaneous SVT. AV was greater than 200/min in 3 cases (16.6%), VA' was greater than or equal to 170/min in 10 of the 17 cases investigated (58.8%) : 11 of these patients also had atrial echos. Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1984

[Long-duration electrocardiographic recording in 33 patients with obstructive cardiomyopathy].

A prospective study of arrhythmias was performed in 33 patients with hypertrophic cardiomyopathy with obstruction by Holter monitoring. The aim of the study was to assess the incidence of "occult" arrhythmias in this condition and to establish a "profile" of high risk patients from clinical, echocardiographic and haemodynamic data. The Holter monitoring demonstrated asymptomatic arrhythmias in 31 of the 33 patients (94%). A supraventricular arrhythmia was detected in 15 cases (45%), including 7 episodes of supraventricular tachycardia (21%). Ventricular arrhythmias were observed in 28 patients (85%), including 5 episodes of ventricular tachycardia (15%). Some patients presented several types of arrhythmia. A number of patients with arrhythmia including short bursts of ventricular tachycardia were asymptomatic during Holter monitoring; conversely, other patients complained of dizziness or syncope but had no arrhythmias. A retrospective study of clinical, echocardiographic and haemodynamic data showed no difference between patients with and patients without arrhythmias. Medium-dose betablocker therapy (propranolol, 110 mg/day) did not seem to protect patients with hypertrophic cardiomyopathy with obstruction from arrhythmias. We conclude that Holter monitoring should form part of the routine evaluation of patients with cardiomyopathy with obstruction, and that potentially dangerous arrhythmias should be treated by anti-arrhythmic agents other than betablockers. This attitude could reduce the incidence of syncope and eventually decrease the risk of sudden death in this condition.

Adult↗
PubMed1984

[Retrospective study of the role of systematic coronarography in patients with heart valve diseases].

The aim of this study was to assess retrospectively the valve of routine coronary angiography in the investigation of patients with valvular heart disease. Between 1978 and 1981, 598 patients over 40 years old underwent left heart catheterisation with routine coronary angiography. In the group with a medical history of angina or infarction (N = 149), there were 49 cases (33%) of severe coronary artery disease (greater than or equal to 70%) and 17 cases of moderate coronary artery disease (11%); of the 49 patients with severe lesions, 2 died after catheterisation, 8 were considered to have too high an operative risk because of their coronary disease and 19 were operated. Valve replacement was associated with a procedure for myocardial revascularisation in 15 cases. In the group without angina (N = 449), severe coronary lesions were much less common (3.6%) and only 5.1% had moderate coronary disease. Severe coronary lesions were found more frequently in certain sub-groups: Stage IV dyspnoea (9%), patients over 65 years of age (11.5%), and coronary calcification (24%). Of the 39 patients without angina and over 50% narrowing on coronary angiography, 17 underwent isolated valve surgery, and 9 underwent combined valvular and coronary surgery (2% of catheterised patients without angina; 3.5% of patients operated without angina. These results show that routine coronary angiography is fully justified in patients with valvular heart disease and a history of angina as vital information is obtained in a high proportion of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Return to work after myocardial infarction].

The working status of 41 men under the age of 60, who developed myocardial infarction while in vocational activity was investigated by means of a questionnaire, 3 years on average after the infarction: 63% had resumed work some time after the disease and 59% were working when the enquiry was made. The ability to resume work cannot be predicted from the patient's medical condition at the time of infarction (location of the infarct, complications during the acute stage, left ventricular ejection fraction). The only unfavourable factors are age and the presence of residual angina or marked post-infarction dyspnoea, although most patients who had not resumed work were fit for employment. Clinicians should be fully aware of the occupational future of patients with coronary artery disease--a future that is particularly at stake in this period of economic crisis in industrial countries.

Disability Evaluation↗
PubMed1983

[Tachycardia and ensuing electrosystole].

The benign or severe nature of a ventricular extrasystole depends on a number of parameters which involve the pathophysiological mechanism of the extrasystole: re-entry, exaggerated normal or abnormal automatism and therefore the presence or absence of an underlying cardiac disease. The prognosis depends directly on the morphology, the number and the characteristics of the arrhythmia. Various investigations are often necessary to evaluate this prognosis, including 24 hour Holter monitoring, stress test and electrophysiological investigations.

Cardiac Complexes, Premature↗