[Value and limitations of programmed ventricular stimulation].

The electrocardiogramme and methods of prolonged ECG recording are sufficient for diagnosing most cardiac arrhythmias. They also provide some prognostic information and allow evaluation and follow-up of treatment. However, in some situations, endocavitary electrophysiological investigations are required when the diagnosis is uncertain, that more prognostic information is required or interventional techniques (endocavitary ablation) are envisaged.

[Ventricular extrasystoles].

Ventricular extrasystoles result from premature excitation of the heart from a site beyond the bifurcation of the bundle of His, at the level of the conductive tissue or myocardial cells. In practice they represent a daily problem for cardiologists due to their frequent occurrence. They can be detected in symptomatic patients and also in asymptomatic subjects, for example during routine health checks.

[Bidirectional ventricular tachycardias].

Bidirectional tachycardias are rare arrhythmias. Nevertheless in the sixties and seventies these arrhythmias prompted much work relating to their mechanism. Discussions about the supposed supra-ventricular origin of certain bidirectional tachycardias essentially rested on presumptive arguments based on electrocardiographic analysis.

High-flow perfusion of sheaths for prevention of thromboembolic complications during complex catheter ablation in the left atrium.

Introduction: Mechanisms for thromboembolic complications during complex ablation procedures in left atrium (LA) have not been defined. The aim of this study was to determine the effect of the perfusion rate of the transseptal sheath on the incidence of thromboembolic complications during catheter ablation for atrial fibrillation (AF) or LA macroreentrant tachycardia.

Methods And Results: We analyzed clinical and procedural data from 86 consecutive patients (153 procedures) referred for catheter ablation of AF (74 patients) or LA macroreentrant tachycardia (12 patients).

[Brugada syndrome].

The Brugada syndrome is characterised clinically by the occurrence of syncope or sudden death due to ventricular arrhythmias in patients with structurally normal hearts and electrocardiographic signs of right bundle branch block and ST elevation in the right precordial leads (V1 to V3). The transmission of the condition is autosomal dominant with variable penetration. Mutations have been identified in a gene coding for the alpha sub-unity of the sodium channel (SCN5A) on chromosome 3 in only 30% of cases.

[The value of repeated determinations of brain natriuretic peptide for the diagnosis of unstable angina].

The diagnosis of unstable angina (troponine undetectable) is often difficult in the absence of electrocardiographic changes after suggestive chest pains. The object of this study was to analyse the kinetics of Brain Natiuretic Peptide (BNP) during acute coronary syndromes (ACS) without ST elevation. Plasma BNP was measured every 6 hours for 48 hours in 65 patients admitted for suspicion of ACS without ST elevation and without clinical, radiological or echocardiographic signs of left ventricular dysfunction.

[Mobile right heart thrombus with minimal pulmonary embolism. A case report].

The generalisation of the use of transthoracic echocardiography in the investigation of pulmonary embolism leads to the diagnosis of mobile right heart thrombus in about 5% of cases. A review of the literature shows that this association is mainly observed in clinically severe pulmonary embolism. The presence of a mobile right heart thrombus is associated with a poor prognosis and emergency treatment is based on thrombolytic therapy or surgical embolectomy.

[Localization of isolated atrial involvement of cardiac sarcoidosis].

The authors report the first case of cardiac sarcoidosis involving only the interatrial septum and the atrioventricular node in a 30 year old man with known lymph node sarcoidosis. The diagnosis was suspected after the finding of an apparently innocent 1st degree atrioventricular block and confirmed by transoesophageal echocardiography and by IMATRON computerised tomography. Isolated atrial involvement of sarcoidosis is rare in the absence of any left ventricular disease.

[Legionella myopericarditis].

Cardiac involvement in legionella infection is rare but it is the most common extra-pulmonary complication. It usually takes the form of pericarditis, but a case of legionella myoparicarditis with global left ventricular hypokinesia on echocardiography has been described. The authors report a case of myopericarditis with massive pulmonary oedema and respiratory distress which regressed clinically and on echocardiography with reduction in chamber dilatation and complete recovery of left ventricular function.