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Biomedical subjects

R Slama

Publications and source records attributed to R Slama.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Medical treatment of atrial fibrillation in the healthy heart].

Whatever the cause and clinical features, establishing the strategy for the medical treatment of atrial fibrillation, requires three basic steps. First sinus rhythm must be restored, followed by the prescription of antiarrhythmic drugs to prevent recurrence and finally the use of anticoagulants. Obviously the underlying heart disease has a major effect on the patient's tolerance of atrial fibrillation, the risks of peripheral embolism and overall mortality. In patients with "solitary atrial fibrillation" and an apparently normal heart, each step of the treatment must be examined in light of the individual patients clinical situation and the risks of haemorrhage with anticoagulants as well as the risk of lethal ventricular arrhythmia due to the arrhythmogenic effect of class la or 1c antiarrhythmic drugs.

Anti-Arrhythmia Agents↗
PubMed1995

[Functional contribution of inhalation spacers in the treatment of asthma].

The aim of this study is to evaluate the ventilatory gain obtained by using metered dose inhaler (MDI) plus spacer versus MDI alone in 30 asthmatic patients (19 men and 11 women); aged 30 to 70 years old. Initial spirometry showed air flow obstruction. A reversibility test was performed with beta 2 agonists: first with MDI and then, later, with MDI plus spacer. In 27 cases (90%) the improvement of FEVI, referring to its initial value, was significantly better with spacer. This improvement was equal or superior to 20% in 19 patients with spacer versus only 9 patients with MDI. The improvement of FEVI was always better with spacer which ever the ways of expressing the bronchodilating response (referring to initial, predicted or absolute value). in conclusion, since the treatment of asthma is now based on local administration of medications, it is recommended to use spacers not only for children and patients who have coordination problems but more widely specially in severe asthma.

Adult↗
PubMed1994

[Observations on the implantable automatic defibrillator].

Thanks to the fantastic job made by Michel Mirowski, the automatic implantable cardioverter-defibrillator is now an effective treatment for patients with malignant, life-threatening arrhythmias. And in the last ten years, many technical improvements have been made (weight, size, reconfirmation, Holter function, endocardial implantation). But if sudden death has been significantly reduced in implanted patients, the long term global cardiac mortality remains very high in these people. This explains why the indications to implant such an expensive device are difficult to define. Apart from special cases in which the indications (or contraindications) are obvious, many factors must be taken into consideration, including the presentation of the arrhythmia, the results of the programmed ventricular stimulation, and the underlying cardiac disease. The European society of Cardiology has published guidelines for the use of A.I.C.D., but from our own experience in Hospital Lariboisière (Paris, France) we have learned that each case must be discussed; and, if it is possible to suggest some therapeutic orientations, it is yet illusory to believe that decisional algorithms will solve all the problems.

Arrhythmias, Cardiac↗
PubMed1994

[Pericardial constriction caused by epicardial patches of automatic implantable defibrillators. Apropos of 3 cases].

The authors report three cases of pericardial constriction secondary to implantation of an automatic defibrillator. In one case, the pericardial constriction occurred 1 year after implantation and was associated with ascending infection of the patch electrodes from the stimulator; the patient died when the patch electrodes were removed, the infection having eroded the left ventricular wall. In the other two cases, signs of constriction appeared 2 years after implantation. In one of these patients, surgery showed a fibrous pericardial reaction deforming the patch electrodes with a favourable outcome when the electrodes were removed. The other patient refused surgery. In the three cases, the diagnosis was confirmed by right heart catheterisation and ventriculography which showed signs of adiastole and severe deformation of the ventricular contours. Pericardial constriction due to patch electrodes is a potentially serious complication of implantable automatic defibrillators, the prevalence of which may be underestimated. The use of endocavitary or extra-pericardial electrodes should avoid this complication.

Defibrillators, Implantable↗
PubMed1994

[Catheter ablation of atrioventricular nodal reentrant tachycardia].

Electrophysiological data of atrioventricular nodal reentrant tachycardia recensed over the last 40 years in the animal and in man has not resolved the question as to the exact site of the reentry circuit: an exclusively intranodal pathway or a pathway involving part of the atrium? The remarkable efficacy of modern radical therapy of this arrhythmia with preservation of atrioventricular conduction reinforces the concept of reentry involving not only the atrioventricular node but also the juxta nodal atrium and the superior and inferior atrionodal connections. Radical treatment was initially surgical and then by catheter ablation. The technique of specific ablation of the rapid anterior pathway was the first to be described. Its limitation is the relatively high risk (about 10%) of complete atrioventricular block. Very quickly, radiofrequency ablation of the slow posterior pathway became the method of reference. Most patients do not have retrograde conduction in the slow pathway. The pathway is located in sinus rhythm by recording its specific potentials: either the rapid potential described by Jackman et al or the fragmented potential described by Haïssaguerre and Warin. The former is recorded from the posterior septal position anterior to the orifice of the coronary sinus; the second is recorded at the same level but slightly above in the mid septal position. Ablation of the slow pathway can be performed on these purely anatomical criteria. Using these approaches, an immediate success rate of over 90% may be obtained. The recurrence rate is 0 to 5%; that of complete atrioventricular block ranges from 0 to 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Automatic implantable defibrillators: long-term results].

The automatic implantable defibrillator is an essential component of the preventive management of sudden death of patients with malignant ventricular arrhythmias. Though its efficacy in this indication is not contested, the data concerning its influence on global cardiac mortality is more controversial. The elements of this controversy are reviewed. Several prognostic factors are implicated, the principal of which being the patient's haemodynamic status as assessed by objective evaluation of left ventricular function. Prospective randomised studies comparing medical therapy with the automatic implantable defibrillator are under way and should provide a better understanding of its indications in the future.

Arrhythmias, Cardiac↗
PubMed1994

[Right accessory pathways with slow and decremential anterograde conduction. Electrophysiological changes during ablation of the proximal atrial poles].

Right sided accessory pathways with slow and decremential anterograde conduction differ from the anatomical substrates of the nodo-ventricular connections described by Mahaim. The connection may also be atrio-ventricular or atrio-fascicular. The authors report a series of 6 patients (2 men, average age 31 +/- 9 years) with antidromic reciprocating tachycardia implicating accessory pathways with decremential conduction (wide QRS complexes with left bundle branch block) the radiofrequency ablation of which was centered on the proximal atrial pole. The increment of pre-excitation was 75 +/- 18 ms. No nodo-ventricular or nodo-fascicular connections were observed. One patient had an atrio-ventricular connection, the mapping and ablation (5 applications) of which were performed on the annulus, as if it were a bundle of Kent. Five patients had a nodo-fascicular connection which was masked during sinus rhythm. The localisation of the proximal atrial insertion on the tricuspid annulus was initially estimated by studying the superior junction of the circuit and by endocavitary stimulation, and then by recording the M potential (activation of the accessory pathway). This was recorded in 4 patients, either at a specific point on the annulus (lateral or postero-lateral) which was the target of ablation (3 patients, 5 +/- 3 applications) or over a wider region (2 cm) at which ablation failed (1 patient: 13 applications). The site of the increment was determined in 2 patients and was proximal to the M potential. The M potential could not be recorded on the annulus in one patient. In 2 patients, the M potential was also recorded along the side of the pathway on the antero-lateral wall of the right ventricle of the tricuspid valve at its distal pole. In 2 patients, ablation was centered on the distal pole in second intention, near to the terminal part of the right bundle where it was localised in one of the two (18 applications). Finally, ablation was obtained in 5 out of 6 patients. They remain asymptomatic after 12 +/- 7 months follow-up. These cases show that accessory pathways with slow decremential conduction usually behave like a complete conduction pathway with an accessory laterally situated atrioventricular node on the tricuspid, an accessory bundle and a distal insertion which are all accessible to ablation.

Adolescent↗
PubMed1994

[Value of searching ventricular late potentials in patients recovering from ventricular fibrillation].

The prognostic value of ventricular late potentials (VLP) was studied in 38 survivors of ventricular fibrillation (VF) resuscitated after cardiac arrest. Thirty-seven patients had coronary artery disease, 24 within one month of myocardial infarction, and one patient had valvular heart disease. There were 7 deaths within 2 years, including 5 sudden deaths, the average follow-up in the remaining patients being 46 +/- 30 months. Bad prognostic factors included low left ventricular ejection fraction, anterior myocardial infarction, VF occurring after the first 24 hours of myocardial infarction and the presence of VLP. The 2 year mortality rate was 35% in patients with VLP compared with only 5% when they were absent (p < 0.05). The subgroup with the highest risk of death was that of anterior myocardial infarcts with VLP (45% 2 year mortality). The clinical circumstances surrounding VF were important; patients with clinical and electrical signs of ischaemia at the time of VF tended to have a better prognosis than the others, especially in the absence of VLP: in this subgroup of 12 "ischaemic" VFs without VLP the mortality at 2 years was nil, whereas the other 26 patients had a 27% death rate (0.05 < p < 0.10). Programmed ventricular stimulation was only carried out in 14 cases: it showed that the long-term mortality was very high (60%) in patients with VLP and inducible ventricular tachycardia (VT). Therefore, the implantation of an automatic defibrillator device would seem to be justified in patients resuscitated from VF who have both VLP and inducible VT, but of no value in cases of "ischaemic" VF without VLP.

Action Potentials↗
PubMed1994

[Indications for implantable automatic defibrillators].

The automatic implantable defibrillator is an effective therapeutic tool for palliative treatment of severe ventricular arrhythmias. There is a significant reduction in sudden death in implanted patients. However, reliable data on the long term global mortality is not yet available. The indications are difficult to define apart from special cases. A large number of factors has to be taken into consideration: the clinical presentation of the arrhythmia, and the different medical and non-medical therapeutic options. At present, it is not possible to arrive at a consensus on the indications of automatic implantable defibrillators. Therefore, it is illusory to construct decisional algorithms. The authors suggest therapeutic orientations rather than strict clinical indications, based on recommendations published by the working groups on cardiac arrhythmias and pacing of the European Society of Cardiology and on their own personal experience.

Death, Sudden, Cardiac↗
PubMed1993

Diagnostic and prognostic value of coronary arteriography.

Coronarography can be used as a diagnostic test when the clinical evaluation and the non-invasive test are inconclusive, although some conceptual problems remain. In known ischemic heart disease, the estimation of the prognosis is an important factor for the treatment decision, but coronary arteriography does not give a clear picture, and apart from the most severely ill patient, the prognosis usually remains very difficult to evaluate.

Coronary Angiography↗
PubMed1992

Flecainide in quinidine-resistant atrial fibrillation.

Flecainide (100 mg twice daily) was used for prevention of paroxysmal atrial fibrillation (PAF) in 52 patients with frequent symptomatic attacks that were resistant or intolerant to quinidine (600-900 mg/day). Underlying heart disease was present in only 8 cases and left ventricular ejection fraction was always greater than 30%. No patient had had a myocardial infarction. Vagally induced PAF was clinically documented in 35 patients. Amiodarone, previously used and ineffective, was combined with flecainide in 33 patients. After 1-5.8 years of follow-up, complete disappearance of PAF was observed in 38 patients (73%). The success rate was slightly higher in patients with vagally induced PAF (p = 0.07). Extracardiac side effects necessitated withdrawal in only 3 cases. Permanent pacemaker was needed in 7 patients on amiodarone and flecainide because of excessive sinus bradycardia. Two patients, with previously documented atrial flutter, experienced presyncopal episodes of atrial flutter with 1:1 atrioventricular (AV) conduction and wide QRS complex. No death occurred during the follow-up. In this series, quinidine proved to be unsuccessful in 46 patients and it was withdrawn in 6. We concluded that flecainide is efficient and well tolerated for long-term prevention of PAF in patients resistant to quinidine. The possibility of 1:1 AV conduction during atrial flutter may suggest the use of verapamil or beta blockers in combination with flecainide in patients with previously documented atrial flutter.

Amiodarone↗
PubMed1992

Improvement of digital coronary angiography: high resolution processing coupled with a real time functional synchronization procedure.

The use of Digital Subtraction Angiography in coronary applications is restricted by the difficulty in: 1. Obtaining a good resolution of the distal branches. 2. Avoiding, for the purpose of subtraction, the motion artifacts induced by artery and background displacement during the cardiac and respiratory cycles. 3. Preserving the dynamic vascular motion. 4. And storing the digital dynamic information on a permanent support. We used for this study an angiography system, based upon a high resolution 45 MIPS-32 Mbyte image processor, interfaced with a 2.75 Gbyte Winchester drive allowing the real time storage of either 30 frames/s in the 512*512*8 bits matrix or of 7.5 f/s in the 1024*1024*8 bits matrix. To preserve the most important dynamic informations on the basis of the 7.5 f/s maximal storage rate, we developed a synchronization device able to recognize in real time, from chronologic delays derived by using both ECG and Aortic Pressure curves, the functional End-Diastolic (ED) and the End-Systolic (ES) positions, even in the case of heart rates varying during the procedure. The ED and the ES images are stored together with the Mid-Systolic (MS), the 1/3-Diastolic (1/3D) and 2/3-Diastolic (2/3D) images. To establish the validity of this sampling method, which uses a reduced number of frames per cardiac cycle, 7200 coronary injections performed during 450 routine coronary angiographies were compared by two independent observers (A and B), using: first a Digital (D) 5 frames/cycle sequence, and secondly a cine Film (F) 50 frames/s sequence acquired immediately after the corresponding D injection. The D technique resulted in the best image and diagnostic quality, particularly when the F quality was estimated 'fair' or 'poor' by both observers, and in an important reduction on X-Ray doses. The visualisation of the sequential ED, MS, ES, 1/3D and 2/3D frames gives the possibility: 1. of saving the dynamic information, as a regular sample of functional images can be displayed with a cine loop technique. 2. of facilitating cardiac synchronized subtractions. 3. of reducing the amount of frames per cycle, thus allowing an important reduction of X-ray doses and the digital and permanent storage of the most important cardiac cycles.

Angiography, Digital Subtraction↗
PubMed1992

Efficacy of beta-blocking agents in reducing the number of shocks in patients implanted with first-generation automatic defibrillators.

The efficacy of beta-blockers was tested in 11 patients who avoided sudden death as a result of ventricular tachycardia or fibrillation due to coronary artery disease or non-ischaemic underlying heart disease, after implantation of an automatic defibrillator. Ten patients initially tolerated acebutolol despite prior class III or IV heart failure in six cases; nadolol replaced acebutolol in nine cases for long-term therapy. In these 10 patients, periods of treatment with and without beta-blocking agent were available, making possible a crossover comparison, during a follow-up lasting 31.6 +/- 17.8 months. One hundred and ten shocks were delivered: 14 were considered as probably inappropriate and ruled out, leaving the remaining 96 shocks to be analysed. The monthly rate of shocks was lower during beta-blocking treatment: 0.12 +/- 0.24 vs. 1.09 +/- 1.41 (P = 0.03). While taking beta-blockers, only four patients received shocks, compared to 10 (i.e. all cases) not administered beta-blockers (P less than 0.01). Despite the technical limitations of the study, since only a few spontaneous shocks could be documented on ECG recordings, the efficacy of beta-blockers in preventing occurrence of severe ventricular tachyarrhythmias seems likely, and deserves further investigations using new implanted devices with improved memory functions.

Acebutolol↗
PubMed1992

[Pro-arrhythmia effect of pyridostigmine. Apropos of a case].

A coronary patient with myasthenia gravis with a previous myocardial infarction presented with severe ventricular arrhythmias after the replacement of neostigmine by pyridostigmine for the treatment of the myasthenia. These arrhythmias were resistant to antiarrhythmic therapy associating betablockers and amiodarone throughout treatment with pyridostigmine but regressed when this drug was withdrawn. A test of reintroduction of pyridostigmine under medical surveillance led to the reappearance of the ventricular hyperexcitability, so confirming the responsibility of this drug. This would seem to be the first reported case of severe ventricular arrhythmias due to a proarrhythmic effect of pyridostigmine. The possible mechanisms of this effect are discussed.

Coronary Disease↗