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Biomedical subjects

P Bru

Publications and source records attributed to P Bru.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Arrhythmogenic effects of antidepressive agents demonstrated by programmed ventricular pacing].

Tricyclic antidepressants and phenothiazines have been blamed for increasing the incidence of sudden death. One of their known mechanisms of action in such cases is to induce torsades de pointes by a so-called "quinidine-like" effect. We report the case of a female patient who was rescued from an episode of cardiac arrest which occurred two months after a myocardial infarction. Right ventricular programmed pacing strongly suggested an arrhythmogenic effect to the antidepressant the patient was receiving. This type of treatment seems to be capable of facilitating the induction of a monomorphous ventricular tachycardia which may degenerate into ventricular fibrillation.

Antidepressive Agents, Tricyclic↗
PubMed1989

[Cardioversion by internal electric shock of permanent atrial fibrillation].

A new technique for cardioversion of chronic atrial fibrillation was used in 17 patients whose arrhythmia had resisted all attempts at electrical and pharmacologycal cardioversion. Atrial fibrillation was badly tolerated by all patients despite digitalis administered alone (8 patients) or combined with amiodarone (9 patients). Twelve patients had left atrial dilatation at echocardiography. The 200, 300 or 400 joule electrical shock was delivered between the proximal pole of a quadripolar catheter (cathode) and a back plate (anode). The catheter was positioned at the His bundle recording site then withdrawn into the right atrium. The internal shock restored sinus rhythm in 15 patients (88 p. 100). Transient atrioventricular block (3-315 sec) was observed in 8 patients. Eleven patients were discharged in sinus rhythm. In 4 patients, the atrial fibrillation recurred on day 8 and after 2, 4 and 9 months. A second shock was attempted in two patients and succeeded in one. After a mean follow-up period of 14.8 +/- 8 months (range 2 to 25 months), 8 of the 11 patients successfully cardioverted (72 p. 100) or of the attempted reductions (47 p. 100) were in sinus rhythm. The remaining 9 patients were treated with antiarrhythmic drugs (n = 5) or by his bundle catheter ablation (n = 4). High energy internal shock therefore seems to be an interesting treatment in patients with permanent atrial fibrillation after failure of external electric shock. It enabled 13 of the 17 patients in this series to avoid His bundle catheter ablation indicated by the quasi-impossibility to control the atrial rate and associated symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

High energy transcatheter cardioversion of chronic atrial fibrillation.

A new technique of internal transcatheter cardioversion of chronic atrial fibrillation using high energy shocks (200 to 300 joules) was performed in 10 patients. In all patients, external cardioversion (300 to 400 joules) and pharmacologic therapy failed to restore sinus rhythm. Atrial fibrillation was poorly tolerated despite digitalis therapy alone (five patients) or in combination with amiodarone (five patients). High energy transcatheter cardioversion was performed by pulling back the atrioventricular (AV) junction catheter just inferior to the site of His bundle recording and delivering the shock between a proximal electrode (catheter) and backplate (anode). High energy internal cardioversion restored sinus rhythm in 9 of the 10 patients. However, atrial fibrillation recurred within 3 min in two of them; in the remaining patient, the procedure failed to terminate atrial fibrillation. The only complication observed was transient (3 to 315 s) heart block immediately after shock delivery and this was treated by temporary pacing. Seven patients had sinus rhythm on discharge from the hospital, but in three, recurrent atrial fibrillation appeared at 8 days and 2 and 4 months, respectively. A second attempt of transcatheter cardioversion was performed in two patients and was successful in one patient. With a follow-up ranging from 2 to 11 months, five patients continued to have sinus rhythm. These preliminary results suggest that high energy internal cardioversion may be an alternative to AV junction ablation in selected patients with poorly tolerated chronic atrial fibrillation in whom external cardioversion was unsuccessful.

Adult↗
PubMed1988

Long-term follow-up of atrioventricular junctional transcatheter electrical ablation.

Complete data concerning long-term results of transcatheter electrical ablation of the atrioventricular junction is not available. At the request of the French Cardiac Arrhythmia Working group we undertook an inquiry in October 1983. All centers potentially able to perform such procedures were asked to report their experience. Eight centers have performed one case or more, over a period of 3 years, for a total of 91 patients. The mean follow-up completed in all patients in April 1986 was 12 +/- 10 months. The procedure was indicated for a supraventricular arrhythmia resistant to a mean of 3.9 +/- 1.3 classes of antiarrhythmic agents. Atrial flutter or fibrillation in 54 (59%) and atrioventricular nodal reentry in 17 (18%) were the most common arrhythmias. A mean of 2.6 +/- 2.3 electrical shocks (range 1-14 shocks) with a stored energy of 130-400 joules was delivered during 1-5 sessions. Complete heart block was obtained in 83 patients and persisted at the time of discharge from the hospital in 46 patients (50.5%). The immediate complication (within 24 hours after the procedure) included ventricular fibrillation successfully converted (one patient) and nonsustained ventricular tachycardia (three patients). Late complications included one death 3 days after the procedure, in a patient in whom sustained ventricular tachycardia was documented, nonsustained ventricular tachycardia in two patients, sepsis in three patients and pericardial effusion in one patient. At the time of the follow-up, there were three additional deaths related to sepsis due to pacemaker pocket infection in one patient and to preexisting congestive heart failure in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Electrocardiographic characteristics of the escape rhythm in transient complete atrioventricular block induced by transcatheter electrical ablation of the atrioventricular junction.

The electrocardiographic characteristics of spontaneous escape rhythm during complete heart block induced by transcatheter ablation of the atrioventricular junction was prospectively studied in 21 patients by periodically interrupting temporary pacing. The data derived from 13 of these 21 patients, in whom conduction recurred after the procedure, were analyzed. An escape rhythm was present in 12 patients 8.2 +/- 5.8 minutes after shock delivery at a cycle length of 1985 +/- 974 ms. The escape QRS had a configuration of right bundle branch block with left axis deviation in 9 patients, of right bundle branch block with normal axis in 1, of left bundle branch block with left axis deviation in 1, and 2 distinct morphologies in the remaining patient. After resumption of conduction, the conducted complexes were identical to the escape complexes in six patients, different only in axis in four patients, and different in morphology in two patients. This suggests that in the majority of patients the escape rhythm seen during transient heart block, induced by transcatheter ablation of the atrioventricular junction, presents a right bundle branch morphology with or without a left axis deviation, and most likely originates from an area above, or close to, the site of the anatomical damage.

Adult↗
PubMed1988

[Cardiomuscular lysosomal glycogenosis in adults without known enzyme deficiency. A cause of familial myocardiopathy and lysosomal glycogen overload with normal acid maltase].

An unusual form of familial myocardiopathy is reported. The disease affected siblings entering adulthood and presented as subclinical skeletal muscle and patent cardiac muscle lesions. Quadriceps muscle biopsy performed in a young man who subsequently died of cardial failure revealed excessive lysosomal glycogen storage, as in type II glycogenosis, but biochemistry showed normal enzymatic activity. In a sister with hypertrophic myocardiopathy only leucocytes were examined; they also showed normal enzymatic activity. Other clinical manifestations of this form of familial myocardiopathy are hypoglycaemia and moderate skeletal muscle involvement. At histology, the image is that of Pompe's disease, but the acid maltase level is normal. The condition seems to be transmitted as an autosomal dominant trait.

Adult↗
PubMed1988

[Wolff-Parkinson-White syndrome. Outcome of patients treated with anti-arrhythmia agents from data of electrophysiological examinations].

Seventy-two consecutive patients with electrocardiographic evidence of Wolff-Parkinson-White syndrome underwent electrophysiological study (EPS). Fifty-five of these patients (76 p. 100) had episodes of tachycardia, 11 experienced palpitations or syncopes and 6 were asymptomatic. The decision to prescribe an antiarrhythmic agent was reached on the basis of the patients' symptoms and EPS data. One patient was treated by surgery before the medical treatment was tried; 17 patients were discharged without treatment, 4 were discharged with an episodic and 50 with a preventive antiarrhythmic treatment. Among these 50 patients, 46 (92 p. 100) could be followed up for a mean period of 45.7 +/- 28 months. One died of lung cancer; 43 presented with spontaneous episodes of tachycardia, 4 were able to discontinue treatment at the end of the follow-up period since they had very few symptoms and 2 were lost sight of. Among the 37 patients under antiarrhythmic treatment followed up, 29 (78 p. 100) are well controlled, while 8 (22 p. 100) still present with episodes of tachycardia. A tachycardia-reducing pacemaker was implanted in 5 of these 8 patients. It therefore appears that 78 p. 100 of patients presenting with spontaneous episodes of tachycardia associated with WPW syndrome can be controlled with an antiarrhythmic treatment. This result was obtained after trying at least two types of antiarrhythmic agents in 86 p. 100 of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Cardiac Doppler in the selection of patients for aortic valvuloplasty. Comparison with data of phonomecanograms].

Between December 1986 and August 1987, 34 patients referred for aortic valvuloplasty, undergo before catheterization an ultrasonocardiography with continuous and pulsed Doppler study and a phonocardiography for 22 of them. They all present functional and physical signs of aortic stenosis. The cardiac Doppler enables a positive diagnosis in all patients, while the phonocardiography recordings fail to recognize a tight aortic stenosis. On the other hand, the Doppler enables a diagnosis of severity well correlated with the catheterization (r = 0.88 for maximum instantaneous gradients) in 30 patients: in four patients, the correlation could not be calculated because of technical problems related to the catheterization (2 patients) or the ultrasonic examination (2 patients). From this study, it results that the cardiac Doppler may perfectly select patients who are to undergo an aortic valvuloplasty, unlike phonocardiography.

Adult↗
PubMed1987

Electrophysiologic properties of falipamil (AQA-39)--a new bradycardiac agent.

Falipamil hydrochloride (AQA 39) is a new antiarrhythmic agent structurally related to verapamil. We evaluated the electrophysiologic properties of intravenous falipamil (1.5 mg kg-1 within 20 minutes) in 12 patients. The spontaneous cycle length was significantly (P less than 0.001) prolonged (+79 +/- 59 ms). Atrioventricular conduction was significantly (P less than 0.001) shorter due to AH interval shortening (-17 +/- 14 ms), most probably related to an anticholinergic effect. Similarly, the anterograde Wenckebach point occurred at a significantly (P less than 0.06) higher rate after falipamil (+10 +/- 7 beats min-1). No statistically significant effect was noted on the refractory periods of the AV node, although there was a trend to shortening. The refractoriness of the right atrium and ventricle was significantly prolonged. It is concluded that falipamil is a bradycardiac agent with electrophysiologic properties quite different from those of verapamil and similar to those of class IA antiarrhythmic agents.

Aged↗
PubMed1987

Remote occurrence of high degree heart block following failure of transcatheter AV junctional ablation: incidence and clinical significance.

We report on two patients out of a series of 22 who underwent transcatheter ablation of the atrioventricular (AV) junction. The procedure failed to induce permanent complete heart block in 15 patients, 12 of whom were in sinus rhythm with 1:1 AV conduction before hospital discharge. Of the 12 patients, two (16.6%) were found to be in high degree heart block, one month later. We discuss the mechanism of late occurrence of high degree heart block and we emphasize the need for systematic implantation of permanent ventricular or dual chamber pacemakers, despite failure of transcatheter ablation of the AV junction.

Adult↗
PubMed1987

[Complex ventricular extrasystole. Value of technics of programmed electric stimulation].

The incidence and significance of ventricular arrhythmia induced by programmed electrical stimulation in subjects with complex ventricular ectopy were studied in 46 consecutive subjects: 34 with heart disease, 12 with an apparently normal heart. The procedure consisted of delivering on one spontaneous and 2 imposed rhythms one, two, then three extrastimuli. Significant arrhythmia with more than 6 ventricular complexes was induced in 17 patients (37%), including 6 (13%) with sustained ventricular tachycardia and 11 with unsustained ventricular tachycardia. Induction of ventricular arrhythmia was observed in 12 of the 14 patients with a history of myocardial infarction. At the end of a mean follow-up period of 12 +/- 4 months, there were 2 sudden deaths, and 3 patients had clinically sustained ventricular tachycardia. Clinical ventricular tachycardia occurred in the group of 17 patients inducible during programmed electrical stimulation. The patients who died suddenly belonged to the group of 29 patients without induced ventricular arrhythmia. This study shows a high proportion of significant stimulation-induced arrhythmia in patients who had suffered from myocardial infarction more than 3 months previously and who had complex ventricular ectopy. Owing to the good condition of this group of patients after a mean follow-up of 12 months, we were unable to determine the influence of stimulation-induced arrhythmia on mortality. However, it must be noted that spontaneous sustained tachycardia occurred in the group of patients with significant induced ventricular arrhythmia.

Adult↗
PubMed1987

[Reduction of ventricular tachycardia by programmed electric stimulation. Clinical implications].

The mode of termination by programmed electrical stimulation of sustained ventricular tachycardia (VT) (more than 30 seconds) and induced by stimulation was investigated in 33 patients. In 27 patients (82%) programmed stimulation was possible because VT did not require an immediate electric shock or did not terminate spontaneously, but constant reduction of VT was obtained with one extrasystole in only 1 patient (3%), with two extrasystoles in 5 patients (15%) and by overdrive stimulation in 12 patients (36%). The remaining 15 patients (45%) required an external electric shock either because VT was poorly tolerated clinically, or because stimulation had failed. In 8 of the 27 cases in whom stimulation was attempted (30%), acceleration of VT was observed. A significant correlation was found between the need for electrical shock and the VT cycle length. It is concluded that reduction of VT by programmed electrical stimulation can only be successful in a limited number of patients and carries a significant risk of acceleration. These data must be taken into account when temporary treatment of VT by stimulation is contemplated. They should incite to considerable caution in the use of implantable pacemakers for tachycardia termination.

Adult↗
PubMed1987

[Evaluation of the prognosis of mitral valve prolapse].

It is not easy to evaluate the prognosis of mitral valve prolapse. First of all, a positive diagnosis is difficult: the clinical insufficiencies are ill-compensated by sonocardiography as it is less reliable than expected; the very existence of the "mitral valve prolapse" described by Barlow is being challenged. Secondly, the most severe complications of mitral prolapse are rare, with respect to its frequency. Some complications are currently well defined. Thus, severe mitral insufficiency, leading to valve replacement, affects elderly men more than young women, although the pathological lesions correspond to the same disease. Endocarditis is rare and only occurs when there is an audible murmur. Rhythm disorders are varied, with however, frequent junction tachycardias and a marked influence of catecholamines, which may explain the clinical effectiveness of beta-blockers. Unfortunately, severe complications are not as well known. Thus, the risk of sudden death and cerebral vascular accident cannot be figured out from large statistical studies. Only studies of some so called "risk" sub-groups, should allow a better knowledge of these two complications and a more effective prevention.

Humans↗
PubMed1986

[Sinus dysfunction associated with catecholaminergic ventricular tachycardia. Therapeutic implications].

The presence of resting sinus bradycardia (less than or equal to 45 bpm) with junctional escapes in an 8 year old child with catecholamine induced ventricular tachycardia, raised the problem of an underlying sinus node dysfunction. This was an important consideration bearing in mind the potential risk of the high dose betablocker therapy aggravating the sinus bradycardia. Electrophysiological studies showed pathological sinus node recovery times. Betablocker therapy did not aggravate the bradycardia, even after 6 months' treatment. A review of the literature showed the association of sinus bradycardia and catecholamine-induced ventricular tachycardia to be relatively common (39 p. 100). However, no mention was found of aggravation of this sinus bradycardia by betablocker therapy.

Adrenergic beta-Antagonists↗
PubMed1986

[Indications and results of surgery in native valve infectious endocarditis. Apropos of 104 surgically-treated cases].

From 1972 to 1984, 104 cases of aortic valve infectious endocarditis were treated surgically. The average age of the patients was 40 years and the majority were men (69/104). Forty patients had no previous cardiac disease; 44 patients had documented valvular heart disease, which was unlikely in the remaining 20 patients. There were 16 mitral valve, 55 aortic valve, 1 tricuspid, 30 mitro-aortic, 1 mitro-tricuspid and 1 mitro-aorto-tricuspid valve infections. Aerococcus viridans was isolated in only 4 out of 71 positive cultures: the prevalence of the infecting organisms was otherwise normal (30 staphylococcus, 30 streptococcus, 7 rare organisms). Forty one patients were operated because of haemodynamic deterioration, 13 for resistant infection and 13 for an association of both indications; 37 patients were operated for embolism or threatening vegetations. Eight patients were in functional Class I, 26 in Class II, 52 in Class III and 17 in Class IV. The patients were divided into 4 groups according to the degree of surgical emergency (26 extremely urgent, 26 semi urgent, 32 controlled endocarditis and 20 chronic endocarditis). The actuarial survival rate was 70% at 5 years. Poor prognostic factors were the presence of previous valve disease, the isolation of a staphylococcus and an aortic valve localisation. The degree of emergency and the precise surgical indication did not seem to be important. Most patients at long term were in functional Classes I or II. There was no preferential indication for bioprosthetic or mechanical valve replacement in endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Tricuspid endocarditis with right-left shunt in the atrium].

A case of tricuspid regurgitation due to endocarditis causing a right-to-left shunt through a patent foramen ovale is reported. Tricuspid valve endocarditis occurred after septic abortion and caused valvular regurgitation with dyspnea and cyanosis. The diagnosis was made by echocardiography and the finding of peripheral arterial desaturation, and it was confirmed at surgery. The physiopathology of these right-to-left shunts is the same as that already described during traumatic tricuspid regurgitation: reopening of the foramen ovale by the right atrial dilatation and ventricularisation of right atrial pressures. The presence of a shunt is an indication for surgery.

Abortion, Spontaneous↗
PubMed1986

[Percutaneous electric interruption of normal auriculoventricular conduction. Analysis of French cases].

Since 1982, 85 patients (aged 18 to 81 years) with supraventricular arrhythmias resistant to an average of 3.8 +/- 1.2 classes of antiarrhythmic drugs, 53 of whom had underlying cardiac disease (62.3%), underwent attempted catheter ablation of the normal AV conduction pathway in 8 different French centers. The indication was atrial fibrillation and flutter in 51 cases (60%) and intranodal reentry in 16 cases (18.8%). An average of 2.5 +/- 2.3 electrical shocks of 130 to 400 joules delivered in 1 to 3 sessions successfully induced high degree AV block in 79 patients, present at the time of discharge from hospital in 43 patients (50.5%). There were 3 cases immediately complicated by non-sustained ventricular tachycardia. Late complications (1 day to 1 month) included ventricular tachycardia (2 patients) septicaemia (3 patients) and pericarditis (1 patient). Sixty nine patients were followed up for an average of 12.9 +/- 10.0 months. There was one death from septicaemia due to infection of the pacemaker and two deaths at 5 and 6 months due to cardiac failure which had been present before the procedure. Fifty six patients were asymptomatic (81.1%), 27 with high degree AV block and 29 patients with (N = 19) or without (N = 10) antiarrhythmic therapy. There were 10 failures. This study shows that closed chest interruption of the normal AV conduction pathway is an effective and relatively safe alternative method of treating supraventricular tachycardias resistant to antiarrhythmic therapy.

Adolescent↗