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Biomedical subjects

P Djiane

Publications and source records attributed to P Djiane.

At least 19 recordsLinked to original sources
PubMed2000

Continuous monitoring of an endocardial index of myocardial contractility during head-up tilt test.

BACKGROUND: Previous studies suggest that vigorous myocardial contractions stimulate ventricular mechanoreceptors and lead to vasovagal syncope. We studied an endocardial index of myocardial contractility during the head-up tilt test in vasovagal patients and control patients, and we evaluated the effect of negative inotropic drugs on myocardial contractility and tilt test outcome. METHODS AND RESULTS: We investigated 19 patients with recurrent vasovagal syncope and positive tilt test (group 1) and 11 patients with no syncope and negative tilt test (group 2). Myocardial contractility was continuously measured during a tilt test (60 degrees ) through a microaccelerometer incorporated in the tip of a right ventricular electrode to sense left ventricular contractility. Patients in groups 1 and 2 were evaluated during an unmedicated tilt test, and patients in group 1 were reevaluated during a tilt test with infusion of esmolol (n = 10) or disopyramide (n = 9). During the unmedicated test, patients in group 1 exhibited a significant increase in myocardial contractility immediately on postural change (P <.05), unlike patients in group 2. Patients in group 1 also had a further increase in myocardial contractility before the end of tilt (P <.01). With drug administration, the changes in supine myocardial contractility were nonsignificant and were not related with the outcome of the tilt test (P <.05). CONCLUSIONS: An increase in myocardial contractility is detected by the sensor during the tilt test. The changes induced by the drugs on supine myocardial contractility are minor and not related with the outcome of the head-up tilt test.

Adrenergic beta-Antagonists↗
PubMed2000

His-Purkinje system reentry as a proarrhythmic effect of flecainide.

We report a case of tachycardia due to reentry within the His-Purkinje system (HPS) occurring after introduction of flecainide. The patient presented with a mild mitral regurgitation and normal left ventricular function. He had incomplete left bundle branch block with left-axis deviation. At the electrophysiology study, a prolonged HV interval was observed at baseline, and the tachycardia could be reproduced after ajmaline infusion. Six months after interruption of flecainide, the patient remains free of arrhythmia recurrence. The authors emphasize that proarrhythmic effects of flecainide may include reentry within the HPS in patients with underlying HPS disease.

Administration, Oral↗
PubMed2000

Near fatal electrical storm in a patient equipped with an implantable cardioverter defibrillator for Brugada syndrome.

A patient with Brugada syndrome experienced incessant ventricular fibrillation 7 years after implantation of an ICD. General anesthesia, fast ventricular pacing, bretylium, and atenolol infusion were ineffective; amiodarone infusion was started. After 190 defibrillation shocks over 36 hours, the electrical storm stopped. A multiorgan failure occurred as a complication of the electrical storm and necessitated prolonged reanimation. Thorough cardiac evaluation revealed no structural abnormality and the patient, now on chronic oral amiodarone therapy, remains free of arrhythmia 1 year after the event.

Adult↗
PubMed1999

Quality of life in patients with complete heart block and paroxysmal atrial tachyarrhythmias: a comparison of permanent DDIR versus DDDR pacing with mode switch to DDIR.

A prospective double-blind randomized crossover study was done in 15 patients with complete heart block and intermittent ATs. The pacemaker was randomly programmed to dual chamber inhibited rate responsive pacing (DDIR) and to DDDR with mode switch, for 1 month each. An event recorder was given to the patients and after each period, a QOL questionnaire was obtained. Based on telemetric data, all but two patients had AT during follow-up. The duration and frequency of these episodes were not related to mode settings. AV synchrony was better preserved in DDDR (P < 0.05). Most symptom-related event recordings during DDIR showed loss of AV synchrony; DDDR with mode switch caused symptoms due to tracking of ST. Overall the QOL score was not different between the modes. Fewer somatic complaints were noted during DDDR pacing than during baseline. DDIR stimulation showed no difference. Twelve patients preferred the period of DDDR pacing; one experienced severe symptoms during DDIR. In conclusion, patients with paroxysmal AT, DDDR with mode switch, and DDIR had no influence on the occurrence, nor on the duration of AT episodes. AV synchrony was better preserved in DDDR, which was also associated with fewer somatic complaints compared to the baseline. In DDDR, symptoms were observed when ST was tracked. QOL was comparable, although more patients preferred DDDR.

Adult↗
PubMed1999

[Acute pleurisy revealing post-myocardial infarction syndrome].

We report a case of Dressler's syndrome in which the diagnosis was made following an investigation of pleurisy which the laboratory data revealed as inflammatory. A myocardial infarction which had occurred two months earlier had passed unnoticed. The principal value of this case was to draw attention to the syndrome which may initially be a pleurisy but also clinically the picture may mimic pneumonia, both alone or together may be associated with classical pericarditis. Pleurisy occurs in Dressler's syndrome but it is rarely the presenting diagnosis as the cardiac picture tends to predominate.

Acute Disease↗
PubMed1998

Right- and left-sided interatrial septal aneurysm mimicking atrial tumor and stroke.

We report the cases of two patients with cerebral embolization and interatrial septal aneurysm. Transesophageal echocardiography required for stroke showed right-sided interatrial septal aneurysm in the first patient and left-sided interatrial septal aneurysm in the second. In the two patients, interatrial septal aneurysm was mimicking atrial cystic tumor or abscess. Significant internal carotid artery stenosis was found in the first patient and aortic arch atheroma with mobile components but no patent foramen ovale in the second patient. In the two patients, interatrial septal aneurysm appears to be only an incidental finding and not the true cause of stroke. Furthermore, we discuss the differential diagnoses of atrial masses.

Aged↗
PubMed1998

Giant interatrial septal aneurysm mimicking a right atrial tumor.

We report the case of a patient with a giant interatrial septum aneurysm who was admitted to our hospital for analysis of palpitations. Transthoracic echocardiography was not contributive and cardiac magnetic resonance imaging demonstrated a small interatrial septal aneurysm. In our study, only transesophageal echocardiography provided the correct diagnosis, showing a giant interatrial septal aneurysm protruding far away into the right atrium and mimicking a right atrial cystic tumor.

Diagnosis, Differential↗
PubMed1998

Treatment of malignant primary vasodepressive neurocardiogenic syncope with a rate responsive pacemaker driven by heart contractility.

In a 41-year-old man suffering from frequent syncope, the tilt test reproducibly induced a primary vasodepressive neurocardiogenic syncope. Pharmacotherapy either failed to prevent the syncope induced at the tilt test or was poorly tolerated. In the minutes preceding the syncope, a dramatic increase in heart contractility was sensed by a microaccelerometer located at the tip of a right ventricular pacing electrode. When the tilt test was repeated with the pacemaker programmed in the DDDR mode, high rate dual chamber pacing occurred during the tilt phase and prevented the syncope. Three months after implantation, the patient remains totally symptom free.

Adult↗
PubMed1998

A complication of pacemaker lead extraction: paradoxical embolism of a lead fragment in a leg artery.

Extraction of three chronically implanted pacemaker leads was performed via the implant vein in a 71-year-old man. One of the leads broke in the subclavian scar tissue. The lead fragment migrated into the left peroneotibial trunk artery. Transesophageal echocardiography showed patent foramen ovale associated with right-to-left atrial shunt. This complication of lead extraction is discussed along with the role of echocardiography prior to lead removal.

Aged↗
PubMed1998

A sensor-based evaluation of heart contractility in patients with head-up tilt-induced syncope.

Studies using the head-up tilt test (HUT) suggest that a reflex increase in sympathetic activity resulting in vigorous myocardial contractions precedes neurally-mediated syncope (NMS). The aim of this study was to evaluate heart contractility changes during positive HUT. Ten patients with recurrent NMS and positive HUT were investigated. Before HUT we temporarily placed a standard right ventricular pacing electrode incorporating in its tip a recently developed microaccelerometer (Sorin Biomedica, Italy) that measures the peak endocardial acceleration (PEA) during the isovolumetric phase as an index of heart contractility. PEA potential amplitude, heart rate and mean blood pressure were continuously studied during HUT. Syncope occurred 16.7 +/- 10.3 min after 60 degrees tilt, either at baseline (8 patients) or after sublingual nitrate administration (2 patients). PEA value was stable at 0.62 +/- 0.34 (1G = 9.8 m/sec2) during the supine phase. It slightly increased to 0.72 +/- 0.44 G (p = NS) during the first minutes of 60 degrees tilt and then remained unchanged until a further increase of 71 +/- 79% (range 10 to 266%) as compared to tilt value (p = 0.004) at 2.8 +/- 2.4 min (range 0.25 to 6.5 min) before the syncope in 9 patients. The latter increase was not observed in the patient with dilated cardiomyopathy. In conclusion, a significant increase in heart contractility was observed in 9 patients in the minutes preceding HUT-induced NMS. These changes might be used for driving a rate adaptive pacemaker when cardiac pacing is indicated to prevent NMS.

Electrodes, Implanted↗
PubMed1997

Long-term pacemaker dependency after radiofrequency ablation of the atrioventricular junction.

This prospective study was conducted to determine the percentage of patients with long-term pacemaker dependency after successful radiofrequency ablation of the atrioventricular junction. Abrupt inhibition of the pacemaker was performed 13.5 +/- 8.1 months after ablation in 59 patients. A > or =5-second asystole was considered to indicate pacemaker dependency. Pacemaker dependency was present in 18 patients. Absence of escape rhythm immediately after ablation was strongly associated with a higher incidence of long-term pacemaker dependency. The following variables were not associated with pacemaker dependency: age, presence of cardiac disease, presence of preablation bundle branch block, number of radiofrequency applications, a bilateral approach for ablation, and continuation of antiarrhythmic therapy after ablation. We concluded that (1) long-term pacemaker dependency is present in 30.5% of the patients after successful atrioventricular junction radiofrequency ablation and (2) absence of escape rhythm immediately after ablation predicts long-term pacemaker dependency.

Aged↗
PubMed1997

Clinical electrophysiologic effects of a single high oral dose of amiodarone.

Several recent reports have described the antiarrhythmic effects of a single high oral dose of amiodarone but clinical electrophysiologic effects have not been reported. The present study was performed to assess electrophysiologic effects in 12 patients. After baseline electrophysiologic studies (EPS) patients were administered a single oral dose of 30 mg/kg of amiodarone. EPS was repeated 7.5 +/- 0.5 hours later. Plasma levels of amiodarone and its metabolite desethylamiodarone were determined at the time of the second EPS, Holter monitoring was performed for 24 hours after amiodarone administration. Amiodarone significantly increased the following parameters: corrected QT interval (+4.5%), functional refractory period of the right atrium (+7%); AH interval (+12.3%), effective refractory period of the atrioventricular node (+18.5%), and cycle length of Wenckebach block (+8.4%). These effects were not correlated with plasma levels of amiodarone and desethylamiodarone. Holter monitoring detected no significant bradycardia or arrhythmia. These findings indicate that the effects of a single high oral dose of amiodarone are the same as those known to be induced by acute intravenous administration.

Administration, Oral↗
PubMed1997

[Short and medium-term outcome after radiofrequency ablation of the atrioventricular junction].

The aim of this retrospective study was to assess short and long-term mortality and morbidity after radiofrequency ablation of the atrioventricular junction in patients with supraventricular arrhythmias resistant to treatment. This cooperative series included 91 patients (47 men, mean age 68 +/- 9 years). The arrhythmia was paroxysmal in 56% of cases. The mean duration of symptoms was 67 +/- 61 months and 45 patients (49.4%) were in the NYHA Classes III and IV. An escape rhythm was present in 58 patients with a mean frequency of 39 +/- 9/min. Early complications were observed in 5 patients (venous thromboses, pulmonary embolism, mild pericardial effusion and haemothorax). The hospital mortality was 4 patients (4.4%). Death was of cardiac origin in 1 case (cardiac failure). The mean follow-up of patients was 14.5 +/- 8.6 months. Eleven patients died during this period, 8 of cardiac causes: cardiac failure (3 cases), sudden death (3 cases), thrombosis of a valve prosthesis (1 patient) and major electrolyte disturbances causing loss of stimulation in 1 case. Six patients had recurrences. Long-term morbidity was either related to cardiac pacing (3 cases) or cardiac failure (3 cases). Thirteen patients were in NYHA Classes III or IV at the end of follow-up. The authors conclude that radiofrequency ablation at the atrioventricular junction is an effective method of treating resistant supraventricular arrhythmias. Complications are not frequent but mortality appears to be high, probably due to the presence of advanced cardiac disease in the majority of cases. Sudden death seems to be rare and unrelated to pacing defects.

Adult↗
PubMed1996

[Ventricular extrasystole and arrhythmogenic right ventricular dysplasia. Critical analysis of the diagnostic value of non-invasive tests].

Asymptomatic ventricular extrasystoles were discovered in 2 active sportsmen (32 and 33 years). The cardiology work-up rapidly led to the diagnosis of arrhythmogenic right ventricular dysplasia in one. In the other, the clinical presentation was similar and the initial diagnosis was ventricular extrasystole with a healthy heart. Four years later however, the subject was still asymptomatic but a second evaluation revealed arrhythmogenic right ventricular dysplasia. This delayed diagnosis emphasizes the importance of renewed noninvasive evaluation of patients with asymptomatic ventricular extrasystoles.

Adult↗
PubMed1996

A randomized, single-blind crossover comparison of the effects of chronic DDD and dual sensor VVIR pacing mode on quality-of-life and cardiopulmonary performance in complete heart block.

The aim of this study was to compare DDD and dual sensor VVIR (activity and QT) pacing modes in complete AV block (CAVB). Eighteen patients (14 men and 4 women, aged 70 +/- 6.5 years) implanted with a dual chamber, dual sensor pacemaker for CAVB with normal sinus node chronotropic function were studied. A quality-of-life and cardiovascular symptom questionnaire, and a treadmill exercise test were completed after a period of VVIR and a period of DDD pacing, each lasting 1 month. Overall quality-of-life and cardiovascular symptoms did not significantly differ, though three patients felt discomfort during VVIR mode. There was no significant statistical difference in cardiopulmonary parameters. DDD and VVIR modes yielded the following respective data: maximum heart rate = 105.7 +/- 21.8 beats/minute versus 107.6 +/- 21.6 beats/minute (NS); maximum workload = 60 +/- 33.4 W versus 59.3 +/- 37.8 W (NS); treadmill duration = 10.1 +/- 3.8 minute versus 10.1 +/- 3.6 minute (NS); oxygen consumption at anaerobic threshold = 14.6 +/- 4.1 mL/kg per minute versus 14.9 +/- 4.6 mL/kg per minute (NS); maximum minute ventilation = 49.6 +/- 9L/min versus 46 +/- 12 L/min (NS); and respiratory quotient = 1.08 +/- 0.15 versus 1.08 +/- 0.13 (NS). We conclude that, during a 1-month follow-up period, no difference was found between DDD and dual sensor VVIR (QT and activity) pacing modes in CAVB patients with regard to quality-of-life and cardiopulmonary performance, though a trend toward an increased sense of well being was noted with the DDD mode.

Aged↗
PubMed1996

[Mid-term outcome of escape rhythm after radiofrequency ablation of the atrioventricular junction].

UNLABELLED: Mid-term outcome of the underlying escape rhythm developed after radiofrequency ablation of the atrio-ventricular junction was studied in 50 consecutive patients (28 women and 22 men with a mean age of 66.2 +/- 9.6 years). The escape rhythm was assessed immediately after ablation and after 13.7 +/- 8 months. At the end of ablation: an escape rhythm was present in 38 patients (76%), with a mean rate of 40.7 +/- 9.7 beats/min and a QRS morphology identical to the preablation QRS morphology in 22 patients (58%). At follow-up: an escape rhythm was present in 37 patients (74%), with a slower mean rate of 36.4 +/- 6.8 beats/min (p < 0.05) and an unchanged QRS morphology in 87.5% of the patients. Patients presenting with an escape rhythm at follow-up were more frequently found to have a postablation escape rhythm (p < 0.01). Escape rhythm presence at follow-up was not influenced by age, presence of a cardiac disease, continuation of an antiarrhythmic treatment after ablation, use of a bilateral approach for ablation or number of radiofrequency applications. CONCLUSION: after abrupt inhibition of the stimulation, an escape rhythm was present only in 74% of the patients 13.7 +/- 8 months after atrio-ventricular junction radiofrequency ablation. QRS morphology was identical to the preablation morphology in 57% of the patients.

Aged↗