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 new diagnostic concept in cardiac pacing for the evaluation of the incidence of atrial arrhythmias. Results of the AIDA study].

An international, prospective, multicentre trial (AIDA) was undertaken from October 1995 to March 1997. The object was to compare the diagnosis of atrial arrhythmias (AA) by the automatic interpretation of the memory functions of dual chamber pacemakers with that of 24 hour Holter monitoring at day 1. The second objective was to assess the incidence and symptomatology of the AA during follow-up at Day 28.

Prevalence of supraventricular arrhythmias from the automated analysis of data stored in the DDD pacemakers of 617 patients: the AIDA study. The AIDA Multicenter Study Group. Automatic Interpretation for Diagnosis Assistance.

The confirmation of the occurrence of supraventricular arrhythmias (SVAs) is possible only if a surface electrocardiogram (ECG) is recorded during an episode, or if SVAs occur during 24 h ambulatory monitoring (Holter). The automatic interpretation of memory functions in DDD pacemakers may be useful in this diagnostic task over longer periods of follow up. This hypothesis was tested in 384 men and 233 women (mean age = 70 +/- 11 years) who had received Chorus 6034/6035, 6234 or 7034 pacemakers (ELA Medical, Montrouge, France) with fall-back function in case of sustained SVAs.

Arrhythmic cardiac arrest due to isolated coronary artery spasm: long-term outcome of seven resuscitated patients.

Objectives: Our aim was to look at the clinical features and long-term follow-up of seven patients without coronary artery disease, who had a history of life-threatening ventricular arrhythmias due to coronary spasm.

Background: Arrhythmic cardiac arrest due to isolated coronary spasm is rare, and there is limited information on the patients affected by this entity alone.

Methods: The seven patients were recruited retrospectively from a cohort of survivors of cardiac arrest.

[A rare cause of inappropriate shocks of an implantable automatic defibrillator. Twiddler syndrome].

The authors report the case of a patient with an automatic defibrillator implanted by an endocavitary approach. The device emitted a series of inappropriate shocks. They were triggered by the detection of myopotentials resulting from lesions of the lead due to Twiddler's syndrome.

[Localised primary lesion of the right pulmonary artery in Takayasu's disease].

Takayasu's disease involves the pulmonary vessels in over 50% of cases. However, primary lesions of the pulmonary arteries are very rare. The authors report the cases of a 34 year-old Caucasian woman presenting with clinical and radiological signs of acute pulmonary embolism, but in whom the pulmonary angiography showed stenotic and occlusive lesions of the right pulmonary artery.

[Left ventricular diastolic function: value of its study with mitral and pulmonary venous Doppler phonocardiography and apexography].

The study of mitral flow and pulmonary venous flow by Doppler provides a non-invasive method of assessing diastolic function. But there are difficulties in differentiating normal pattern from "pseudo-normal" (Appleton Type II) (E/A Mitral > 1). Phonocardiography enables the recording of early (B3) and late (B4) diastolic gallops.

Initial isolated Takayasu's arteritis of the right pulmonary artery: MR appearance.

Takayasu's arteritis involves the pulmonary artery tree in more than 50% of the cases. Initial isolated involvement of the pulmonary artery by Takayasu's arteritis, however, is very rare. We report the case of a 34-year-old white woman who presented a clinical and radiographic pattern that mimicked an acute pulmonary embolism with pulmonary infarction.

[Left ventricular insertion of a permanent pacemaker (radiographic aspect)].

We report a case of inadvertent transarterial permanent pacing of the left ventricule that was not diagnosed on routine chest radiography or ECG. The malposition was diagnosed because of the rupture of the mitral valve cordage 2 months after pacemaker implantation. We emphasize the radiographic appearance of this rare malposition.

[Quantification of aortic insufficiencies. Comparison between Doppler echocardiography and qualitative angiographic methods: apropos of a series of 60 consecutive patients].

Many doppler echocardiographic indices have been described for quantifying aortic regurgitation, posing the problem of the relative value of each. Therefore, the authors assessed the severity of aortic regurgitation in 60 consecutive patients (16 women and 44 men, mean age 56.7 years, range 7 to 84 years) by the four grades of Seller's classification with selective aortography.

[Feasibility and accuracy of pulmonary blood flow measurement by Doppler echocardiography. Apropos of 100 consecutive cases].

One of the main advantages of Doppler echocardiography is the possibility of non-invasive measurement of blood flow at each valvular orifice. This method enables quantification of valvular regurgitation, the measurement of Qp/Qs in cardiac disease with atrial or ventricular shunts, and the interpretation of gradients and functional surface areas in valvular stenosis or prosthesis with respect to the underlying haemodynamics. In each of these application, the measurement of pulmonary blood flow is valuable as the reference blood flow, and even indispensible in cases of shunts.

[Quantification of mitral valve insufficiency by Doppler echocardiography. Correlation with cine-angiography in 60 patients].

Non-invasive quantification of mitral regurgitation remains a clinical problem. The aim of this study was to assess a new methodology of Doppler echocardiographic assessment of the mitral regurgitant fraction. The study included 60 patients (average age 61 years) in sinus rhythm with mitral regurgitation.

[What studies should be done in syncope?].

Fainting (short loss of consciousness) is a frequent reason for a consultation in a general practitioner's or cardiologist's office. Four main causes are recognized commonly: cardial with auriculo-ventricular block and arrhythmias, vascular in particular vaso-vagal syncopes, neurologic and other causes. In 38 to 47% of the patients no etiology is found: these are syncopal attacks of unknown origin.

[Mid-term follow-up after transluminal coronary angioplasty. Clinical results, mortality, morbidity apropos of 500 consecutive procedures].

The aim of this study was evaluation of mid-term results, with a mean follow-up of 23 months (range: 6 months to 6 years), in 449 patients undergoing 500 consecutive angioplasty procedures before 1989. All of these 449 patients underwent primary angioplasty, and not dilatation after restenosis. Data processing of information, based upon a questionnaire filled out by the patient's own cardiologist, enabled 100 per cent follow-up.

[Clinical evaluation after myocardial infarction. Its role, date and methods].

Although global mortality in the year following myocardial infarction is about 10%, this figure varies from less than 1% to more than 50% in some very high risk cases. The principal objective of clinical evaluation during the acute phase is to establish a prognosis and propose a rational strategy for myocardial revascularisation (by bypass grafting or angioplasty) in patients with a poor prognosis. An essential feature of this evaluation is to reduce health care costs and hospital stay to a minimum.

[Quantification by transthoracic Doppler of tricuspid valve insufficiencies].

Various methods are available today for the quantification of regurgitation by transthoracic Doppler. The present review deals with their respective usefulness in tricuspid insufficiency (TI). Despite their contribution in the domain of mitral and aortic insufficiency, precise quantification methods remain of very limited value regarding the tricuspid orifice, and this because of practical difficulties of application.

[Measurement of mitral flow at the extremity of the valves. Validation of a simplified method based on 101 cases].

The measurement of cardiac output at the extremity of the mitral cusps, by Doppler-echocardiography, is of fundamental value, in particular for the evaluation of valve regurgitation. However, it comes up against a theoretical difficulty resulting from constant variation in the surface area of this orifice during diastole. After reviewing the main measurement methods available in the literature, a simplified method based upon the diameter of the ring and calculation of a mean diastolic intercusp distance by TM is suggested.

[Evaluation of cardiac output by Doppler echocardiography. Correlation of aortic, pulmonary and mitral ring flow rates. Study of 103 subjects free of valve leak].

Measurement by Doppler-echocardiography of blood flow rates has the advantage over techniques for the measurement of cardiac output of determining the latter for each valve orifice, and of opening up an approach to the quantification of aortic and mitral regurgitation. This prospective study involving 103 subjects free of any valve leak showed the absence of an significant difference between aortic, pulmonary and mitral ring flow rates in a given individual. Correlations between results obtained at the three measurement sites were: r = 0.

[Evaluation of cardiac output by Doppler echocardiography. Basic principles and practice].

The measurement of cardiac output by the Doppler-echocardiography method is of considerable interest since, in contrast to other available techniques, it offers the possibility of the measurement of output at each valve orifice, thus providing a quantitative approach to valve regurgitation. The 4 basic data items required are: the surface area of the valve orifice, trans-valvular Doppler velocity spectrum, duration of ejection and of filling, and heart rate. A large number of studies have analysed the various investigation techniques and have shown their excellent correlation with reference invasive methods.