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Biomedical subjects

P Attuel

Publications and source records attributed to P Attuel.

13 recordsLinked to original sources
PubMed1979

Sustained intra-atrial reentrant tachycardia. Electrophysiologic study of 20 cases.

Twenty cases of sustained tachycardia due to intra-atrial reentry were investigated in patients aged 17 to 80 years (mean 47). The average frequency of the tachycardia was 128.6/min (extremes 95 and 180). Three modes of onset of the tachycardia were observed: atrial extra-stimulus (19 times), progressively accelerated atrial pacing (9 times) and atrial escape beat (10 times). The tachycardia was stopped in all cases by a premature stimulation. When spontaneous, the termination was either sudden (10 times) or preceded by a progressive slowing (9 times) or an alternating phenomenon of long-short cycle (13 times). Precise atrial mapping allowed to localize the first atrial depolarization less frequently in the sinus node area (1 case) than in the mean right atrium (21 cases), the low right atrium (2 cases), the interatrial septum (2 cases), and the left atrium (4 cases). The macroscopic size of the reentry circuit was demonstrated in only 3 cases. A junctional reentry was accurately ruled out in all cases thanks to the existence of a second or third-degree AV or VA black, or by studying the sequence of retrograde atrial activation. A true junctional reciprocating tachycardia was associated with the intra-atrial reentry in 2 cases.

Adolescent↗
PubMed1979

[Quantitative evaluation of the efficacy of anti-arrhythmia agents in chronic ventricular arrhythmia].

The authors describe a computer system for the analysis of ventricular arrhythmias and its use in the evaluation of anti-arrhythmic drugs. Provided the arrhythmia is stable, this method allows an estimation of the onset and duration of action of the drug and gives guidelines for the choice of an appropriate drug regimen. Using this system, a comparison can be made between different drugs based on quantification of their efficacy.

Amiodarone↗
PubMed1979

[Technical characteristics of a new computerized system for quantitative evaluation of cardiac arrhythmias (author's transl)].

The ATREC system is designed to carry out at sixty times real time the quantitative evaluation of arrhythmias in 24 hour magnetic tape recordings. A preprocessing unit eliminates the low frequency waves (P and T) and artefacts, and furnishes the computer (Mitra 15/35, 16 K words of core) with information on R-R interval, QRS duration, regular or irregular rhythm, bradycardia or pauses, transient to sustained tachycardia, and ventricular fibrillation. Extrasystoles are analyzed in terms of enlargement, number, coupling interval, bi or trigeminy, doublets or salvos. Trends of mean and extreme cardiac rate, and R-R interval histograms, are also available. The system is also available for ECG real time monitoring of patients in coronary care units. The computer can analyze 8 ECG tracings simultaneously. The ATREC system provides an important aid in the quantification of arrhythmias and improves the evaluation of antiarrhythmic drugs efficacy.

Anti-Arrhythmia Agents↗
PubMed1978

[The atrial arrhythmia syndrome of vagal origin].

Having observed 18 cases, the authors describe a syndrome of recurrent paroxysmal atrial arrhythmia which was very homogeneous from the clinical and ECG point of view. It was usually found in middle aged males, with no demonstrable underlying heart disease, whose disorder of intra-atrial conduction occurred during sinus rhythm. The condition developed slowly over the course of years towards a maximum incidence of several short daily attacks of an arrhythmia which alternated between an atrial fibrillation and atrial flutter. Vagal overactivity is the precipitating cause of these attacks which are usually not completely nocturnal. The condition never progressed to sino-atrial block nor to permanent fibrillation. The beginning of each attack, often heralded by atrial coupling with a long enough interval to cause re-entry, is accompanied by slowing of the sinus rate down to the threshold level. The vagal effect of shortening the action potential and refractory period is recognised to be non-homogeneous in the atrial wall, and suggests a re-entry mechanism rather than hyper-excitability. This would explain the usual resistance of atrial arrhythmias of vagal origin to digitalis, beta blockers and quinidine. Amiodarone alone is usually effective because of the prolongation of the action potential which it causes. In 5 particularly resistant cases a good clinical result was obtained by the insertion of an atrial pacemaker with a fairly rapid rate.

Adrenergic beta-Antagonists↗
PubMed1977

[Romano-Ward syndrome and left stellectomy. General review apropos of a recent case].

A new familial case of the Romano-Ward syndrome in a young girl of 21 years is reported. A progressive worsening of the condition with multiple syncopal attacks, together with difficulty in controlling the patient, lead us to carry out a left stellate ganglionectomy. The operation did not lead to any shortening of the QT interval. It appeared in the end that propranolol was the most effective way of preventing the syncopal attacks.

Adult↗
PubMed1976

'Incessant' tachycardias in Wolff-Parkinson-White syndrome. I: Initiation without antecedent extrasystoles or PR lengthening, with reference to reciprocation after shortening of cycle length.

In 6 patients with the Wolff-Parkinson-White (WPW) syndrome, repetitive, almost continuous (incessant) reciprocating atrioventricular (AV) tachycardia has been shown to arise when the sinus cycle length was shortened to a critical point, at which unidirectional block occurred without the classical feature of PR prolongation. Though this phenomenon superficially resembles an aspect of chronic intranodal reciprocating tachycardia of children, basic differences can be identified. It was encountered more frequently in younger subjects; the only patient over 45 developed the arrhythmia as a complication of therapy. This incessant mechanism may explain some cases in which antiarrhythmic treatment does not control reciprocating tachycardia in the WPW syndrome, but such a mechanism can also occur spontaneously.

Adolescent↗
PubMed1976

'Incessant' tachycardias in Wolff-Parkinson-White syndrome. II: Role of atypical cycle length dependency and nodal-his escape beats in initiating reciprocating tachycardias.

Descriptions of patients with the Wolff-Parkinson-White (WPW) syndrome and reciprocating tachycardia in whom the initiation of the arrhythmia depended neither on the occurrence of premature beats nor on antecedent cycle-length shortening are given. In 5 the occurrence of escape beats in the bundle of His, usually in the presence of sinoatrial disease, activated the tachycardia circuit, but in the other 2 there were unusual mechanisms related to bradycardia-dependent block in the anomalous pathway, and delayed response to shortening of the atrial cycle length, respectively. Careful assessment of such mechanisms is essential for the correct choice of antiarrhythmic prophylactic therapy.

Adult↗
PubMed1976

[Congenital bundle-of-his focal tachycardias. Cooperative study of 7 cases].

The authors described seven cases of supraventricular tachycardia with atrio-ventricular dissociation, associated with the activity of an automatic focus in the bundle of His. These tachycardias, which appear at birth or are discovered at a very young age, appear to be congenital and sometimes familial, and are always isolated, having no associated cardiac abnormality. They give rise to cardiac failure, which is more marked when the rate is high (180-260/mn) and particularly resistant to treatment. The most effective form of treatment is amiodarone, almost always used in combination with digitalis. The anatomical abnormality, which was studied in the first case, is a contricting fibrosis around the main trunk of the bundle of His, and the appearances are reminiscent of those found in conditions of congenital atrio-ventricular block.

Amiodarone↗
PubMed1976

[Treatment of junctional paroxysmal tachycardia, without patent Wolff-Parkinson-White syndrome, by sectioning an accessory Kent-His bundle].

The authors report the case of a patient suffering from a Bouveret's tachycardia without syndrome of Wolff-Parkinson-White. The analysis of the tachycardic spells however showed that during a reciprocal crisis, the circuit went through a left accessory ventriculo-atrial bundle, functioning only in the reverse direction. This accessory bundle was successfully cut by the surgeon, following the procedure of wide atrioventricular desinsertion as described by the authors of Duke University for the surgical treatment of the Wolff-Parkinson-White syndrome.

Adult↗
PubMed1975

[Continuous electrocardiographic recording. Clinical, diagnostic and therapeutic value].

The interest of permanent electrocardiographic recording in ambulatory patients is not restricted to the demonstration of the cardiogenic origin of some functional disturbances. This method provides the proof of the often non fiable character of anamnesis for the diagnosis of arrhythmias. It shows the close relationship between "minor" (extra-systoles) and "major" (tachycardias) arrhythmias, and consequently the prognostic value of the former in relation with the latter. Continuous ECG follow-up affords in the assessment of anti-arrhythmic drugs efficiency a higher safety than that provided by the conventional simple clinical follow-up.

Anti-Arrhythmia Agents↗
PubMed1975

[Paroxysmal junctional tachycardia. Determination of the inferior point of junction of the reentry circuit. Dissociation of the intra-nodal reciprocal rhythms].

Stimulation of the bundle of His and of the uppermost portion of the interventricular septum gives us an opportunity to make a precise study of capture phenomena in patients with paroxysmal nodal tachycardia. According to whether the capture is correctly timed, delayed, or unusually premature, the inferior junction point of the reentry circuit can be located precisely by reference to the H wave and the onset of the R wave. Out of a series of 65 patients, only 30 of whom had a true WPW syndrome, it was shown that 43 cases had a bundle of Kent which ensured retrograde conduction during the tachycardia, and was therefore the seat of a unidirectional block in 13 cases. In 22 cases (33.8%) the diagnosis of WPW syndrome was excluded, but the reentry circuit was nevertheless not of nodal origin. The inferior junction point of the circuit was effectively situated between H and R in 12 cases, and at H in 5. In only 5 cases (7.8%) might there have been a reciprocal intra-nodal rhythm, which should not necessarily be taken as proof of its existence. The validity of the classical criteria in localising the reentry circuit is discussed.

Atrioventricular Node↗