Biomedical subjects

S Kacet

Publications and source records attributed to S Kacet.

At least 55 records · Page 3Linked to original sources

PubMed1998

Triple chamber pacemaker for end-stage heart failure in a patient with a previously implanted automatic defibrillator.

A 63-year-old man with an ischemic dilated cardiomyopathy previously implanted with an implantable cardioverter defibrillator (ICD) received a triple chamber pacemaker as an ultimate therapeutic resort for end-stage congestive heart failure. After implant, the tolerance to physical exercise increased and NYHA class decreased from III to II. Echocardiography assessed ventricular contraction resynchronization during DDD biventricular pacing as compared to VVI pacing. No major pacemaker-ICD interaction was noted during testing or follow-up. We conclude that sequential biventricular pacing is feasible in the presence of an ICD.

Cardiac Pacing, Artificial↗

PubMed1998

Differential effects of quinidine, flecainide, and cibenzoline on anisotropic conduction in the isolated porcine heart.

INTRODUCTION: Anisotropic conduction characteristics, expressed as the ratio of conduction velocities in the longitudinal (Vl) and transverse (Vt) fiber directions, may play a role in the mechanism of some ventricular tachycardias and is influenced by pharmacologic interventions. Discrepancies exist among the reported orientation-dependent effects of available Class I antiarrhythmic drugs. The aim of this study was to assess the respective effects of quinidine (Class IA), flecainide (Class IC), and cibenzoline (not subclassified) on the anisotropic conduction of porcine hearts, in corroboration of their effects on ventricular action potentials. METHODS AND RESULTS: We studied the actions of 3 and 10 microM quinidine, 1 and 3 microM flecainide, and 0.3 and 1 microM cibenzoline on Vl and Vt determined from 128 electrograms recorded with a plaque electrode on the anterior left ventricle of isolated perfused hearts (spacing 2.5 mm). Vl and Vt were computed from isochronal maps displaying ellipsoid activation during stimulation from the center of the plaque. The effects on the maximal rate of depolarization (Vmax) of action potentials were obtained from ventricular muscle exposed to the same drugs. Flecainide [1 microM] and cibenzoline [0.3 microM] did not alter Vl and Vt significantly. Quinidine [3 microM] predominantly depressed Vl at rapid pacing rates, but the Vl/Vt ratio was not significantly altered. Quinidine [10 microM] and flecainide [3 microM] reduced Vl and Vt in a frequency-dependent fashion. Conversely, cibenzoline [1 microM] mostly decreased Vl and thus decreased the Vl/Vt ratio and increased the Vl/Vt at all pacing rates. This different effect was not related to a greater depressant effect on Vmax CONCLUSION: Quinidine and flecainide act similarly on the anisotropic pattern of conduction (both drugs increase the Vl/Vt ratio), whereas cibenzoline exerts opposite effects. Orientation-dependent effects are different among Class I antiarrhythmic drugs and may be of importance in their therapeutic efficacy or proarrhythmic potential.

Action Potentials↗

PubMed1998

[Dual-chamber implantable automatic defibrillators. Experiences apropos of 16 cases].

In view of the large number of inappropriate shocks observed in patients with implanted defibrillators, improved detection of ventricular arrhythmias has become a major objective. The addition of an atrial catheter has been proposed to improve discrimination between ventricular and non-ventricular arrhythmias. Besides this function, the additional catheter could be used for DDD pacing without risk of interaction between the pacemaker and defibrillator. The authors report their initial experience in 16 patients implanted with a DDD pacemaker. The indication was resuscitated sudden death (N = 5) or ventricular tachycardia (N = 11). The choice of a DDD defibrillator was justified by a bradycardia (N = 9), haemodynamic factors (N = 4) or supraventricular tachycardia (N = 3). The devices used were the Defender 9001 (ELA Medical SA, France, N = 3), the Ventak AV 1810 and the Ventak AV II DR 1821 (Guidant/CPI, Inc. USA, N = 11 and N = 2 respectively). There were three immediate complications. After 2 to 29 months' follow-up, 5 patients had received appropriate treatment by their devices. Five patients had inappropriate shocks : one patient received a shock triggered by electrical interference, two others had no active sensing algorithme when the shocks were delivered, and the other two had an activated algorithme with 1/1 conduction of a supraventricular arrhythmia. No recurrences were recorded after reprogramming the device. DDD or VDD pacing was permanent in 9 patients and intermittent in 3 others. Seven patients had dilated cardiomyopathy and severe cardiac failure and were clinically improved by dual chamber pacing. In many patients, candidates for a defibrillator, this new generation of devices has improved specificity of arrhythmia detection and cardiac pacing without risk of interaction. The authors propose a classification of the indications for a DDD defibrillator.

Algorithms↗

PubMed1998

[Epidemiology of paroxysmal auricular fibrillation].

The epidemiology of paroxysmal atrial fibrillation (PAF) is poorly known because of the difficulties in setting up trials to study this condition. Its biannual incidence is about 2 per thousand. Its prevalence is 1 to 2% in a population of over 65 years of age. Paroxysmal atrial fibrillation is often asymptomatic. An initial episode of atrial fibrillation may remain a single event in a number of cases. Isolated paroxysmal atrial fibrillation progresses to permanent atrial fibrillation in about 20% of cases, usually if there is underlying cardiac disease. Rheumatic valve disease, cardiac failure, hypertension, previous myocardial infarction and cerebrovascular accidents are often associated with paroxysmal atrial fibrillation. Embolic complications are rare if paroxysmal atrial fibrillation is isolated.

Adult↗

PubMed1997

Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management.

BACKGROUND: Endocarditis related to pacemaker (PM)-lead infection is a rare but serious complication of permanent transvenous pacing. To determine in which situations the diagnosis should be evoked and to determine optimal management, we reviewed our experience with endocarditis related to PM-lead infection. METHODS AND RESULTS: Fifty-two patients were admitted for endocarditis related to PM-lead infection. The presentation was acute in 14 patients, with onset of symptoms in the first 6 weeks after the last procedure on the implant site, and chronic in 38 patients. Fever occurred in 86.5%. Clinical and/or radiological evidences of pulmonary involvement were observed in 38.4%. Pulmonary scintigraphy disclosed pulmonary infarcts in 31.2%. Local complications were found in 51.9%. Elevated C-reactive protein was found in 96.2%. A germ was isolated in 88.4% of patients and was a Staphylococcus in 93.5%. Transthoracic echocardiography demonstrated vegetations in only 23% of patients, whereas transesophageal echocardiography disclosed abnormal appearances on the PM lead in 94%. We systematically tried to ablate all the material. Two techniques were used: percutaneous ablation or surgical removal during extracorporeal circulation. All patients were treated with antibiotics after removal of the infected material. Two patients died before lead removal and 2 after surgical removal; the predischarge mortality was 7.6%, and the overall mortality was 26.9% after a follow-up of 20.1+/-13 months. CONCLUSIONS: The diagnosis of endocarditis related to PM-lead infection should be suspected in the presence of fever, complications, or pulmonary lesions after PM insertion. Transesophageal echocardiography should be performed to look for vegetations. Staphylococci are involved in the majority of these infections. The endocardial system must be entirely removed and appropriate antibiotic therapy pursued for 6 weeks.

Aged↗

PubMed1997

Preliminary clinical experience with the first dual chamber pacemaker defibrillator.

The lack of specificity of VT detection is a significant shortcoming of current ICDs. In a French multicenter study, 18 patients underwent implantation of the Defender 9001 (ELA Medical), an ICD utilizing dual chamber pacing and arrhythmia detection. Over a mean follow-up period of 7.1 +/- 4.5 months, 176 tachycardia episodes recorded in the device memory were analyzed, and physician diagnosis was compared with that by the device. All 122 VT/VF episodes were correctly diagnosed, as were 51 of 53 supraventricular tachyarrhythmias. Two episodes of AF with rapid regular ventricular rates were treated as VT, and a third episode, treated as VT, could not be diagnosed with certainty. A dual chamber pacemaker defibrillator offers improved diagnostic specificity without loss of sensitivity, in addition to the hemodynamic benefit of dual chamber pacing.

Adolescent↗

PubMed1997

Asystolic cardiac arrest during head-up tilt test: incidence and therapeutic implications.

Occasionally, the cardioinhibitory response may be profound during tilt induced syncope. Whether this response is associated with more severe symptoms or predicts a poor response to pharmacotherapy remains controversial. The aim of this study was to characterize patients with vasovagally mediated asystole occurring during head-up tilt test and to evaluate the respective interests of sequential pacing and beta-blockers to treat them. We performed 60 degree tilt testing in 179 consecutive patients with unexplained syncope (91 women and 88 men, age 36.6 +/- 20.1 years). Asystole was defined as a ventricular pause > 5 seconds. All patients with tilt induced asystole received therapy with either beta-blockers or sequential pacing, the efficacy of which was evaluated with serial tilt tests. Of 77 patients with positive tilt test, 10 developed syncope related to asystole (mean duration 11.9 +/- 4.9 s), 2 with spontaneous recovery, and 8 with seizures needing a brief cardiopulmonary resuscitation. When compared with patients without asystole, asystolic patients had more severe symptoms (seizures: 6/10 vs 9/67, P = 0.05, injury 9/10 vs 27/67, P = 0.0048). In the first six patients in whom cardiac pacing was considered, syncope or presyncope still occurred despite atrioventricular pacing at 45 beats/min. Five of these 6 patients, as well as the remaining 4 asystolic patients, were tilted with beta-blockers: 3 patients became tilt-negative; 3 were significantly improved; and 3 did not respond. During follow-up (mean 22.7 +/- 11.7 months) with every patient taking beta-blockers and seven having a permanent pacemaker, no syncopal recurrence was observed. Tilt-induced asystole that may require resuscitative maneuvers occurs especially in patients with a history of seizures or injury. Therapy with beta-blockers in often effective to prevent induction of syncope as well as recurrences.

Adolescent↗

PubMed1997

[Determinants of malignant vasovagal syncopes with asystole disclosed by the tilting test and therapeutic implications].

UNLABELLED: In order to evaluate the determinants of malignant vasovagal syncope with asystole revealed by the tilting test and to determine the possible therapeutic implications, 179 patients (91 women and 88 men, mean age 36.6 +/- 20.1 years) referred for the assessment of unexplained a were studied. The test was performed with a tilt of 60 degrees for 45 minutes. A bolus of isoprenaline (0.02 to 0.08 microgram/kg.min) was injected in the case of a negative passive test. Asystole was defined as a ventricular pause lasting > or = 5 seconds. RESULTS: Ten (13%) of the 77 patients with a positive tilting test experienced a cardio-inhibitory reaction with prolonged asystole lasting an average of 11.9 +/- 4.9 seconds. Compared to the other 67 patients with a positive test, those with asystole were younger (23/9 +/- 14.8 years vs 32.9 +/- 18.5 years, NS) and had a more frequent history of convulsions (6/10 vs 9/67, p = 0.05) during spontaneous episodes and trauma (9/10 vs 27/67, p = 0.005). Implantation of a pacemaker was chosen first-line treatment for the first 6 patients. Their follow-up tilting tests remained positive (pre S = 4, S = 1) despite DDD stimulation of 45 bpm. Five of these patients and the following 4 patients were retested under beta-blockers. In six patients treated with beta-blockers, the clinical symptoms resolved completely (n = 3) or improved (n = 3), in contrast with 3 other patients in whom the tilting test remained positive with recurrence of asystole. The mean follow-up for the 169 patients is 22.7 +/- 11 months and the ten patients with asystole remained totally asymptomatic. CONCLUSION: An asystolic response during the tilting test is characteristic of vasovagal syncope described as malignant. The syndrome essentially affects young patients, with a more frequent history of trauma and convulsions. Beta-blockers appear to be at least as effective as permanent pacemaker to prevent symptoms in this specific subgroup.

Adrenergic beta-Antagonists↗

PubMed1997

[Ventricular fibrillation after radiofrequency ablation of the atrioventricular node].

The authors report the case of a 77 year old patient who underwent radiofrequency ablation of the atrioventricular node for chronic. Invalidating atrial fibrillation, refractory to pharmacological therapy. A single chamber ventricular pacemaker was implanted one week before interruption of AV conduction. Eleven applications (7 on the right and 4 on the left side of the interventricular septum) were required for successful ablation. Four hours later, the patient developed episodes of non-sustained polymorphic ventricular tachycardia and torsades de pointe. These arrhythmias were initiated by long cycle-short cycle sequences and preceded by changes of ventricular repolarisation (prolongation of the spontaneous and paced QTc and JTc intervals). Eight days after ablation, the patient had an episode of ventricular fibrillation reduced by external DC shock. This arrhythmia was also preceded by changes in ventricular repolarisation. This case demonstrates the potential proarrhythmogenic effect of radiofrequency ablation of the AV node with changes in ventricular repolarisation which induces malignant ventricular arrhythmias. The authors suggest an appropriate preventive attitude. The progression in two distinct phases (immediate and late) imposes prolonged arrhythmia monitoring.

Aged↗

PubMed1997

[Value of the tilt-table test in the management of unexplained syncope in children and adolescents].

The value of the tilt test in assessing unexplained syncope in children and adolescents was investigated in 79 patients (41 girls and 38 boys, 12.3 +/- 2.9 years). The test was performed with a tilt of 60 degrees for 45 minutes. A pharmacological provocation with isoprenaline was carried out in negative passive test. The tilt test was considered to be positive in cases of symptomatic falls of the systolic blood pressure with or without bradycardia. Asystole was defined as a ventricular pause > or = 5 seconds. During the investigation, 52 patients (66%) reproduced symptoms related to vasovagal syncope in 45 patients (57%) or panic attack in 7 others (9%). Of the 45 presenting vasovagal syncope, 7 had a cardio-inhibitory reaction with asystole of 11.2 +/- 3.3 seconds. The other responses were vasodepressive in 17 patients and mixed in 21 patients. A comparative study did not reveal any significant difference between patients with a positive or negative test including those with panic attacks. Seventy-five patients were followed up for an average of 32 +/- 22.3 months. Preventive therapy was prescribed in 34 patients because of the frequency or severity of their symptoms. At the end, 10 patients (13%) had at least one recurrence of syncope, 3 in the group with panic attacks, 5 in non-treated patients (irrespective of the result of the tilt test) and only 1 in the group of 23 patients treated with beta-blockers. The authors conclude that with a diagnostic return of 66% in this series, the tilt test seems to be the non-invasive investigation of choice in unexplained syncope in children and adolescents. In addition, true vasovagal syncope can be differentiated from psychogenic.

Adolescent↗

PubMed1997

[VDD mode single electrode cardiac stimulation: indications, results and limitations of the method].

UNLABELLED: Several authors have reported the single atrioventricular (AV) electrode, comprising an atrial dipole floating in the right atrium, to be a system capable of providing results which are just as satisfactory as those of conventional systems (DDD). Between August 1992 and March 1995, a VDD single electrode pacemaker was implanted in 65 patients (mean age: 73 years +/- 17.2). The indication for implantation was isolated high degree AVB with no apparent sinus dysfunction. Four pacemakers were used: Vitatron (n = 24), Intermedics (n = 23), Medico (n = 13), Biotronik (n = 5). Intraoperative atrial endocavitary recording was 1.8 mV +/- 0.74. 17 patients died from a cause unrelated to pacemaker dysfunction. 4 patients were lost to follow-up. The remaining 44 patients were reviewed in our centre with a mean follow-up of 14.5 months +/- 7 months. Seven pacemakers (16%) were reprogrammed in VVI or VVI (R) mode, because of permanent atrial fibrillation in 3 cases, complete loss of atrial reception in 2 cases and late onset sinus dysfunction in 1 case. In the 41 patients in sinus atrial rhythm, the atrioventricular synchronization rate was greater than 90% in 88% of patients, equal to 76.3% in 2.4% of patients and atrioventricular synchronization was impossible in 9.6% of cases. CONCLUSION: The overall results of our preliminary experience of VDD mode single electrode pacemaker are moderate. The poor results essentially concerned patients with paroxysmal atrial arrhythmias prior to pacing.

Adolescent↗

PubMed1996

Late diagnosis of pericardial constriction associated with defibrillator patches and deformation of the left ventricle.

We report a case of pericardial constriction associated with defibrillator patches developing 4.5 years after implantation. This constriction was related to the presence of a large pericardial mass that had developed above the defibrillator patch. This mass, which had a calcified superior border, suggested former hematoma associated with pericardial fibrosis. It induced significant compression of the right ventricle and a dumb-bell deformity of the left ventricle. The hemodynamic picture was of elastic-form constrictive pericarditis. Because of previous cerebral stroke during cardiac surgery, the patient was discharged on pharmacologic treatment after improvement of his functional status. Since removal of epicardial patches is an effective treatment of constriction, constrictive pericarditis should be systematically considered in patients with epicardial patch electrodes and impairment of functional status.

Cardiac Catheterization↗

PubMed1996

[Value of mapping in surgical treatment of ventricular tachycardia].

Surgery may be proposed for patients with a localised aneurysm or akinesia for treatment of monomorphic ventricular tachycardia resistant to antiarrhythmic therapy after myocardial infarction. The multiplicity of tachycardia forms in the same patient, the variability of their mechanism which is not necessarily limited to the subendocardia layers, require mapping to guide the surgeon in the destruction of the anatomical substrates. In a series of 57 ventricular tachycardias recorded in 17 patients with myocardial infarction the authors demonstrated that a system of computerised mapping of the epicardial and endocardial regions optimised the results of this form of surgery. Mapping localised, sometimes at a distance from the scar, classical subendocardial reentry, implicated on occasion the mitral papillary muscle in the mechanism or a tachycardia in cases of inferior or lateral infarction and localised the reentry in the epicardium of the lower layers of the septum. The identification of these "atypical" mechanisms significantly improves the number of patients without inducible arrhythmias after surgery (from 50 to 87% in the authors' experience), without changing the operative mortality. The only really curative approach because of the limitations of catheter ablation, this surgery is a complementary method to implantable defibrillators in the management of post-infarction ventricular tachycardia.

Aged↗

PubMed1996

[Prognostic factors after sustained ventricular fibrillation or tachycardia. A multivariate study apropos of 160 cases].

The authors analysed survival of 160 patients (121 men and 31 women; average age 57.2 +/- 12.5 years; follow-up 29 +/- 20 months) treated for malignant ventricular arrhythmias (sustained ventricular tachycardia, ventricular fibrillation, syncope with inducible ventricular tachycardia). The therapeutic evaluation was frequently invasive (145 patients underwent at least programmed ventricular stimulation, 108 patients underwent full endocavitary electrophysiological studies) and non-pharmacological therapy was widely used (defibrillator n = 44; antiarrhythmic surgery n = 28; ablative procedures n = 19; transplantation n = 7). The following underlying pathologies were observed: ischaemic heart disease n = 120; non-ischaemic left heart disease n = 19; right heart cardiac disease n = 4; and apparently normal hearts n = 17). The average ejection fraction was 40.5 +/- 15.5% and 29 patients were in the NYHA functional classes III or IV. Fifty-five patients had life-threatening arrhythmias whilst receiving amiodarone. At 2 years, the actuarial sudden death rate was 5.9 +/- 2.1% and the actuarial total cardiac mortality rate was 13.1 +/- 2.9%. Univariate analysis showed age, the presence of underlying cardiac disease, the presence of dilated cardiomyopathy, the absence of an invasive approach, the need for basal pacing in electrical cardioversion, the absence of betablocker therapy, a decreased left ventricular ejection fraction and a high NYHA functional class, to be predictive of sudden death. In multivariate analysis, age, the NYHA class for total cardiac mortality and the NYHA class for sudden death, were the only independent predictive factors. The authors conclude that in the era of invasive methods of evaluation and widespread use of non-pharmacological therapeutic methods, the symptomatology of cardiac failure assessed by the NYHA classification remains the most powerful independent prognostic factor after an episode of malignant ventricular arrhythmia.

Actuarial Analysis↗

PubMed1996

[Anxiety disorders and unexplained syncopes of presumed vaso-vagal origin].

The impact of anxiety neurosis on the diagnosis and treatment of patients with unexplained syncope (S) was assessed in 178 patients (91 women and 87 men) with an average age of 36.5 +/- 20 years, presenting with 10.7 +/- 24 episodes of S). None had evidence of underlying cardiac disease apart from 7 patients with mild hypertension. All patients underwent a tilt test (TT) at 60 degrees for 45 minutes. A bolus of isoproterenol was injected intravenously in subjects with negative TT. After the test, the patients were classified according to the presence (n = 38) or absence (n = 140) of anxiety neurosis based on the DSM III-R diagnostic. The TT was positive in 76 patients, 9 of whom had a cardioinhibitory reaction with prolonged asystole. Patients with anxiety had more episodes of S (24 +/- 43 versus 7 +/- 13; p = 0.001), a shorter interval between S (11.5 +/- 23 months versus 12.5 +/- 20 months, p = 0.02) but more negative TT (27/38 versus 75/140; p = 0.05). One hundred and sixty-eight patients were followed up : 10 were lost to follow-up. Preventive treatment was undertaken in 59 patients who were representative of the whole group with respect to age (30 +/- 18 years 39 +/- 21 years : p = 0.004). After an average follow-up of 24.5 +/- 15 months, 26 patients (15%) experienced a recurrence of S. The recurrence rate was identical in patients with positive and negative TT and in treated and untreated cases. On the other hand, recurrence was higher in those with anxiety (12/25 versus 14/117; p = 0.001) who also had less improvement of symptoms (12/15 versus 74/120; p = 0.001). The "anxiety" variable was therefore identified as being the only predictive factor for recurrence of syncope. The authors conclude that in patients referred for investigation of unexplained syncope, some suffer from anxiety neurosis, in whom the TT is usually negative, and have a higher risk of recurrence. They justify a specific therapeutic management.

Adolescent↗

PubMed1995

Determination of left ventricular mass in systemic hypertension: comparison of standard and signal averaged electrocardiography.

OBJECTIVE: To investigate the quantitative relationship, if any, between signal averaged electrocardiographic variables and echocardiographically determined left ventricular mass in hypertensive subjects. DESIGN: Cohort analytic prospective study. SETTING: University hospital. SUBJECTS: 50 hypertensive subjects selected consecutively from inpatients. Patients older than 75 years, with underlying cardiac disease, with inconclusive echocardiograms with bundle branch block, or in atrial fibrillation were excluded. INTERVENTIONS: Antihypertensive therapy involving 41 patients was continued. MAIN OUTCOME MEASURES: Left ventricular mass calculated in accordance with the standards of the Penn convention. Thirteen criteria derived from combinations of signal averaged electrocardiographic X, Y, and Z Frank orthogonal leads, including voltage criteria, duration, and time-voltage integrals of the QRS complex. Four widely used standard electrocardiographic criteria for detection of left ventricular hypertrophy. RESULTS: There was no difference in the values for any of the electrocardiographic variables between patients with (n = 29) and without left ventricular hypertrophy (n = 21). The time-voltage integral of QRS in the horizontal plane was the best signal averaged variable related to left ventricular mass (r = 0.33, P = 0.019); however, the correlation with Rodstein voltage was stronger (r = 0.46, P = 0.0009). A positive correlation was also found between left ventricular indexed mass and Rodstein voltage (r = 0.43, P = 0.0019). Stepwise regression analysis revealed Rodstein voltage as the only predictor of indexed mass (P = 0.0019), and Rodstein voltage (P = 0.0022) and body weight (P = 0.011) as the only independent correlates of left ventricular mass. CONCLUSIONS: The relation between electrocardiographic variables and left ventricular mass or indexed mass is of limited value; signal averaged orthogonal leads do not improve this assessment compared with standard electrocardiographic leads.

Electrocardiography↗

PubMed1995

[Automatic implantable defibrillators. Clinical experience apropos of 45 patients].

The aim of this study was to analyse the efficacy and survival after implantation of an automatic cardioverter-defibrillator.. Forty-five patients including 37 men were followed up for 0 to 51 months. The indications were ventricular fibrillation with no curable cause (n = 27) and sustained resistant or poorly tolerated ventricular tachycardia (n = 17) when programmed ventricular pacing with antiarrhythmic therapy was not applicable or gave poor results. One patient was implanted with this device for torsades de pointes. The underlying cardiac disease was ischaemic in 34 cases, non-ischaemic in 8 cases, and 3 patients had no apparent cardiac disease. Twenty patients were implanted with an epicardial system (group I) and 25 patients with endocardial system (group II). In group II, there was one complete failure of implantation requiring the use of an epicardial system and 2 partial failures requiring an additional epicardial patch electrode. The perioperative mortality was 2/45 (4.4%), both cases being due to permanent arrhythmias. In 5 patients, the minimal effective energy of defibrillation was over 25 Joules at implantation, without any untoward consequences on the clinical outcome. Ten non-fatal complications were observed including two major problems (haemopericardium); there were two cases of late increase of the minimal effective energy of defibrillation requiring the addition of a subcutaneous patch. Twenty-four patient (53%) received at least one appropriate therapy; 14 patients (36%) had at least one inappropriate shock during follow-up. During follow-up, 7 patients died, 6 of a cardiac cause and 3 of an arrhythmic problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[Automatic implantable defibrillator and antiarrhythmic surgery in ischemic cardiopathies. Apropos of 53 cases].

The automatic implantable defibrillator (AID) and antiarrhythmic surgery are the two therapeutic options after failure of catheter ablation and/or antiarrhythmic therapy for sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with coronary artery disease. The authors undertook retrospective study of the characteristics of two groups of patients treated between November 31st 1987 et December 31st 1993 either by AID (28 men and 4 women with an average age of: 56.1 +/- 11.2 years) or by surgery (19 men and 2 women with an average age of: 60.6 +/- 6.8 years). The "surgical" patients differed from "defibrillator" patients in the fewer number of cardiac arrests, a higher proportion of sustained monomorphic VT, better tolerated sustained monomorphic VT (rarely syncopal), fewer early post-infarction arrythmias (< or = 8 weeks), more anterior wall infarction and a higher proportion of aneuvrysms. The perioperative mortality was 6.2% in the "defibrillator" group and nil in the "surgical" group (p = NS). At 2 years, the sudden death rate in the "defibrillator" and "surgical" groups was 7.5% and 0% respectively and total cardiac mortality was 17% and 20% respectively (p = NS). The authors conclude that perioperative mortality and the sudden death rate at 2 years are relatively low in the two groups. However, the total cardiac mortality remains high, largely related to perioperative death and secondary cardiac failure. Nevertheless, compared with defibrillator patients and with identical average ejection fractions, there was no extra mortality due to cardiac failure after antiarrhythmic surgery.

Aged↗