Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors.

Background: In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures.

Prediction of atrial fibrillation in patients with supraventricular tachyarrhythmias treated with catheter ablation or not. Classical scores are not useful.

Background: Atrial fibrillation (AF) and other supraventricular tachyarrhythmias (SVTA) [atrial flutter (AFL), atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT) and preexcitation syndrome (PS)] are frequently associated. We assessed the AF occurrence frequency and predictors according to the nature of SVTA and completion of SVTA ablation.

Methods And Results: 4169 patients were referred for SVTA (typical AVNRT: 1338, AVRT over a concealed accessory pathway: 329, atypical AVNRT: 205, AFL: 1321; PS: 976); mean age was 50±20years; electrophysiological study (EPS) was systematic; patients were followed for a mean duration of 3±4.

Risk of atrial fibrillation after atrial flutter ablation: impact of AF history, gender, and antiarrhythmic drug medication.

Introduction: Atrial fibrillation (AF) and flutter (AFL) are frequently associated. We assessed the frequency and identified the predictors of AF occurrence after AFL ablation.

Methods And Results: A total of 1,121 patients referred for AFL ablation were followed for a mean duration of 2.

Incidence and prognostic significance of spontaneous and inducible antidromic tachycardia.

Aims: Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT).

Methods And Results: Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol.

Missing diagnosis of preexcitation syndrome on ECG: clinical and electrophysiological significance.

Unlabelled: Electrocardiographic criteria of preexcitation syndrome are sometimes not visible on ECG in sinus rhythm (SR). The purpose of the study was to evaluate the significance of unapparent preexcitation syndrome in SR, when overt conduction through accessory pathway (AP) was noted at atrial pacing.

Methods: Anterograde conduction through atrioventricular AP was identified at electrophysiological study (EPS) in 712 patients, studied for tachycardia (n=316), syncope (n=89) or life-threatening arrhythmia (n=55) or asymptomatic preexcitation syndrome (n=252).

Factors likely to affect the long-term results of ventricular stimulation after myocardial infarction.

Background: The results of programmed ventricular stimulation (PVS) may change after myocardial infarction (MI). The objective was to study the factors that could predict the results of a second PVS.

Methods: Left ventricular ejection fraction (LVEF) and QRS duration were determined and PVS performed within 3 to 14 years of one another (mean 7.

Complete atrioventricular block during ablation of atrial flutter.

We report the case of a 51-year-old patient who developed a complete atrioventricular (AV) block during the isthmic radiofrequency catheter ablation of a typical atrial flutter. The cause was an acute occlusion of the segment three of the right coronary artery. His recanalization was associated with the immediate restoration of a normal AV conduction.

Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing.

Objectives: This study evaluated the causes of syncope and the significance and differences in left ventricular (LV) dysfunction, coronary disease, and idiopathic dilated cardiomyopathy (DCM).

Background: Risk stratification of and indications for an automated defibrillator could differ according to the cause of LV dysfunction.

Methods: Electrophysiologic study, including atrial and ventricular programmed stimulation, was performed in 119 patients with coronary disease (group I) and 61 patients with DCM (group II) with an left ventricular ejection fraction (LVEF) <40% and syncope.

Influence of age on atrial fibrillation inducibility.

The prevalence of AF is known to increase in the elderly. Some electrophysiological changes were reported in these patients, but the effects of age on AF inducibility and other electrophysiological signs associated with atrial vulnerability are unknown. The purpose of the study was to evaluate the effects of age on atrial vulnerability and AF induction.

Significance of external cardioversion induced atrial tachyarrhythmias.

External cardioversion is used to stop VT or VF in emergency. Supraventricular tachyarrhythmias are sometimes noted after cardioversion in patients known to be previously in sinus rhythm. The purpose of the study was to evaluate the significance of supraventricular tachyarrhythmias induced by external cardioversion.

Causes and prognosis of cardiac arrest in a population admitted to a general hospital; a diagnostic and therapeutic problem.

Background: The purpose of this study was to determine the causes and the prognosis of consecutive patients resuscitated from cardiac arrest occurring in a general hospital. We assessed 28 females and 94 males (aged 13-82 years) who were resuscitated from cardiac arrest not attributable to acute myocardial infarction. Ventricular fibrillation (VF) was documented in 97.

Value of non-invasive and invasive studies in patients with bundle branch block, syncope and history of myocardial infarction.

Unlabelled: The prognosis of patients with bundle branch block (BBB) and myocardial infarction (MI) is poor, particularly for patients suffering from syncope. The purpose of this study was to investigate the diagnostic value of some techniques for the evaluation of the mechanism of syncope in patients with MI and BBB and their prognosis.

Methods: We prospectively obtained the results of clinical history, 24 h Holter monitoring, left ventricular ejection fraction (LVEF), signal-averaged ECG (SAECG) and programmed ventricular stimulation in 130 patients with syncope, MI and BBB.

Evolution of QRS duration after myocardial infarction: clinical consequences.

Unlabelled: The natural history of late potentials after acute myocardial infarction (AMI) has been studied in the first 2 years following myocardial infarction (MI). The purpose of the study was to assess the influence of some time delays since MI, including a time delay longer than 2 years on signal-averaged ECG (SAECG). SAECG was recorded at 40-Hz high pass filtering in 40 patients 10 days after acute MI (SAECG 1), then repeated 6-12 months later (mean 9 +/- 3 months) (SAECG 2), and then, 2-4 years later (mean 3 +/- 2 years) (SAECG 3).

[The CASS-CHOU study of mesenteric angina. The comparative effects of cassoulet and sauerkraut with sausages].

The goal of study was evaluate in 1,837 consecutive patients the comparative effects of French cassoulet (CASS) and international sauerkraut (CHOU). After procedures of exclusion classical, 8 patients could be evaluated and received in a randomised, doubleblind, crossover protocol an mouth dose of 22.5 g/kg of CASS or CHOU.

Significance and prevalence of inducible atrial tachyarrhythmias in patients undergoing electrophysiologic study for presyncope or syncope.

The purpose of the study was to report the prevalence of inducible supraventricular tachyarrhythmias (SVTA) in 827 consecutive patients aged 17 to 90 years who did not have spontaneous documented SVTA and who had unexplained presyncope and/or syncope. The electrophysiologic study (EPS) included programmed atrial and ventricular stimulation up to two extrastimuli at three cycle lengths, and the study of sino-atrial and AV conduction. The results were as follows.

Programmed ventricular stimulation in survivors of acute myocardial infarction: long-term follow-up.

The prognostic significance of ventricular tachyarrhythmias induced by programmed ventricular stimulation was evaluated in 492 consecutive survivors of acute myocardial infarction (AMI). Holter monitoring, signal-averaged electrocardiogram (ECG) and measurement of left ventricular ejection fraction (EF) were also performed. The protocol used up to 3 extrastimuli.

[Results of systematic programmed ventricular stimulation after myocardial infarction. Which protocol should be recommended?].

The authors report the prognostic value of ventricular arrhythmias induced by routine programmed ventricular stimulation after the acute phase of myocardial infarction. The protocol consisted of two extrastimuli in the first 185 patients and 3 extrastimuli in 308 patients. The use of 3 extrastimuli increased the incidence of inducible sustained monomorphic ventricular tachycardia (VT) < 270/mn, from 17 to 22% and, more importantly, that of ventricular fibrillation from 4 to 17%.

Diagnostic value of ventricular stimulation in patients with idiopathic dilated cardiomyopathy.

To assess the response to programmed ventricular stimulation and the clinical outcome, we performed a prospective study in 103 patients with idiopathic dilated cardiomyopathy. The protocol used up to three extrastimuli delivered at two right ventricular sites during sinus rhythm and ventricular pacing at 100 and 150 beats/min and was repeated during infusion of 1 to 4 micrograms/min of isoproterenol. Sustained monomorphic ventricular tachycardia (VT) was induced in 8 of 11 patients with spontaneous sustained VT, in none of 35 patients without significant ventricular arrhythmias during Holter monitoring, and in 9 of 56 patients with salvos of ventricular premature beats.

Incidence and significance of inducible supraventricular tachyarrhythmias in patients with chronic myocardial infarction.

In order to evaluate the incidence and significance of inducible supra-ventricular (SVTA) in patients with chronic myocardial infarction (MI), the results of systematic programmed atrial stimulation were compared in two groups of patients: 150 patients (group I) without MI or underlying heart disease, studied for syncope or conduction disturbances, 296 patients (group II) studied after an acute Mi (greater than 1 month). None of them had spontaneous SVTA, and 24-h Holter monitoring showed no SVTA. The atrial stimulation programme used one and two extra stimuli delivered during sinus rhythm and atrial pacing (600 ms and 10% less than the sinus cycle length).

The tall R wave in lead V1 in posterior myocardial infarction: a reciprocal sign or a His-Purkinje conduction disturbance?

The significance of the tall R wave in lead V1 with an R/S ratio greater than or equal to 1 in posterior myocardial infarction (PMI) was investigated in 28 patients during programmed electrical stimulation. The patients had been admitted with acute PMI documented by electrocardiogram and proven by enzymatic increase. Electrophysiological study was performed 3 weeks after acute PMI.

Electrophysiological effects of intravenous prostacyclin in man.

The electrophysiological effects of prostacyclin (PGI2) were studied in 10 normal patients. Programmed stimulation was performed before and after infusion of 2.5, 5, 10 ng kg-1 min-1 of PGI2.