Philippe Le Métayer - Academia.edu (original) (raw)
Papers by Philippe Le Métayer
PubMed, Jun 1, 1986
The success rate of catheter ablation, the latest therapeutic method in the treatment of cardiac ... more The success rate of catheter ablation, the latest therapeutic method in the treatment of cardiac arrhythmias, varies according to the precise indication. The best and most logical guarantee of its efficacy is the application of the electrical energy at an anatomical site essential to the arrhythmia. In preexcitation syndromes this site is without doubt the accessory pathway itself rather than its insertions, but this implies the recording of its activation. We recorded the electrical activation of a right sided Kent bundle in three consecutive cases to guide the therapeutic procedure (comparable to the recording of the H potential for his bundle ablation). All patients had paroxysmal atrial fibrillation (minimal RR interval: 175, 150 and 200 ms) and orthodromic reciprocating tachycardia. Two patients had had attacks of ventricular fibrillation. The sites of the Kent bundles were posteroseptal in 2 cases and anterolateral in 1 case. The recording of the electrical activation of the Kent bundle was validated by: the passage (induced or spontaneous) of a preexcited to a normal QRS coincident with the disappearance of the K potential; the exclusion of an atrial or ventricular origin of the electrical activation supposed to be the activation of the Kent bundle; electrical stimulation at the site of the recording of the K potential leading to prolongation of the stimulus-delta wave interval from 10 to 35 ms, with QRS morphology identical to the spontaneous complexes. All 3 patients were clinically cured by catheter ablation at the site of recording of the Kent bundle activation with follow-up periods ranging from 10 to 16 months.(ABSTRACT TRUNCATED AT 250 WORDS)
European Journal of Heart Failure, Jun 1, 2000
source of tumour necrosis factor (TNF) a and the possibility of endotoxin P134/9924 Epidemiology ... more source of tumour necrosis factor (TNF) a and the possibility of endotoxin P134/9924 Epidemiology and impact of intraventricular translocation across the bowel wall during episodes of oedema. conduction delay in heart failure patients Methods: We studied 48 patients (39 male; aged 45.3 (SD 14) years) with severe end stage heart failure requiring implantation of a left ventricular assist device as a bridge to transplantation. Cytokines were measured in all surviving patients preoperatively, at 1 week (n = 46), 40 days (n = 35) and 90 days (n = 26).
PubMed, Mar 1, 1986
68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmi... more 68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmics (quinidine derivatives 52 patients, amiodarone 28 patients, beta-blockers 24 patients) were treated by mouth with propafenone, with a mean postponement of 5.6 +/- 8.5 months (1 day to 33 months). Auricular arrhythmia was observed in 41 patients with the following results: 16 successes among the 24 patients with paroxysmal fibrillation of flutter, 3 successes among the 8 patients with an arrhythmia reduced by cardioversion, and 3 successes among the 9 patients with auricular tachycardia, including 6 systolic tachycardias. Of 8 patients with an intranodal reciprocal rhythm, 7 were treated successfully with propafenone, which acts on the retrograde part of the cycle. Successes were also recorded in 2 out of 3 patients with Wolff-Parkinson-White syndrome. In 19 cases of ventricular tachycardia, propafenone proved to be efficacious in 3 out of 5 cases presenting rapid discharges and in 7 out of 14 patients with continuous arrhythmias, notably those with a catecholaminergic component. Side-effects were digestive (5 patients), cardiac decompensation (3 patients), asthenia and asthma (1 patient) and the transformation of a flutter from 2/1 to 1/1 (1 patient).
PubMed, Jun 1, 1992
Several epidemiological studies have shown decreased cardiovascular mortality and a lower inciden... more Several epidemiological studies have shown decreased cardiovascular mortality and a lower incidence of coronary artery disease in subjects with high dietary intakes of Omega-3 polyunsaturated fatty acids. It has since been shown that Omega-3 fatty acids have a number of beneficial effects in the prevention of atherosclerosis in man: reduction of blood pressure, modifications of lipoprotein metabolism, modifications of haemostasis (increased bleeding time and reduced platelet aggregation), decreased plasma fibrinogen, modifications of the metabolism of arachidonic acid and its derivatives (decreased thromboxane and leukotriene synthesis, increased prostacyclin synthesis). Therefore, Omega-3 polyunsaturated fatty acids have several beneficial effects on the presumed mechanisms of atherogenesis and/or its complications: they could represent an original and seductive solution to the problem of prevention of cardiovascular disease.
Annales De Cardiologie Et D Angeiologie, Aug 1, 2003
ABSTRACT
Chest, Apr 1, 1994
We report the case of a woman treated with urokinase for acute pulmonary embolism with a right-si... more We report the case of a woman treated with urokinase for acute pulmonary embolism with a right-sided heart thrombus. She developed life-threatening acute cor pulmonale which dramatically improved within 4 h with recombinant tissue plasminogen activator (rtPA). We emphasize the clinical interest of rtPA for the treatment of life-threatening pulmonary embolism.
Sang Thrombose Vaisseaux, Jan 12, 1999
Un patient de 71 ans est hospitalise pour des acces febriles recurrents depuis 1 mois et demi, as... more Un patient de 71 ans est hospitalise pour des acces febriles recurrents depuis 1 mois et demi, associes a des douleurs lombaires basses gauches apparues depuis une dizaine de jours. Il a pour antecedent une fibrillation auriculaire lente appareillee par un pacemaker monochambre VVI en decembre 1995. A l'entree dans le service, l'examen [...]
Revue de Médecine Interne, Jun 1, 1999
Revue de Médecine Interne, 1993
Revue de Médecine Interne, Dec 1, 2006
dique est normal. Il existe un tabagisme à 15 paquets/année et une contraception par oestro-proge... more dique est normal. Il existe un tabagisme à 15 paquets/année et une contraception par oestro-progestatifs. Le traitement par héparine entraîne une disparition du thrombus en un mois. Résultats.-Les thrombus flottants aortiques développés sur une aorte en apparence saine sont rares et moins de 100 cas sont rapportés dans la littérature depuis 1981 [2]. Ils concernent le plus souvent la femme jeune, tabagique, traitée par contraceptifs oestro-progestatifs. Dans la plupart des observations l'aorte est décrite comme normale, ce qui n'exclut pas de minimes lésions athéromateuses, comme dans notre observation. Le thrombus siège dans l'aorte abdominale (64 %), l'aorte thoracique descendante (28 %) et l'aorte ascendante (8 %). Le traitement de référence est la thrombectomie chirurgicale, mais quelques observations ont fait état d'une disparition du thrombus par le seul traitement anticoagulant ; les délais habituels sont de six mois, mais dans quelques observations, la disparition du thrombus a été observée après un mois de traitement [1]. Conclusion.-Les thrombus flottants intra-aortiques avec lésions minimes sont rares et concernent le plus souvent la femme jeune tabagique, sous oestro-progestatifs. De minimes plaques d'athérome sont probablement en cause. Le traitement médical est une option thérapeutique efficace permettant d'éviter une chirurgie thoracique lourde. Références
PubMed, Mar 1, 2001
We report the case of a patient with refractory ascitis due to a constrictive pericarditis who un... more We report the case of a patient with refractory ascitis due to a constrictive pericarditis who underwent a liver transplantation with the initial diagnosis of cryptogenic cirrhosis. The cardiac origin was suspected 5 months post surgery when a liver biopsy showed lesions in favor of a post sinusoidal shunt. The diagnosis was confirmed by the increased values of the right intra-ventricular pressures. We discuss the causes of the delay of the diagnosis and, in particular, the difficulty to interpret vascular liver lesions. Such vascular lesions were present on the needle biopsy performed prior to transplantation but wrongly interpreted as cirrhosis.
Thrombosis and Haemostasis, 2001
SummaryWe evaluated two clinical scores for the prediction of deep venous thrombosis (DVT) in hos... more SummaryWe evaluated two clinical scores for the prediction of deep venous thrombosis (DVT) in hospitalized patients (Wells’ and Kahn’s). We included 273 patients referred to the vascular exploration unit for the suspicion of DVT. A clinical questionnaire was filled in by the practitioner and the scores were calculated from this form. 66 of the 273 patients had a DVT. When Wells’ score was 3, a DVT was found by duplex echography in 51% patients ; when the score was 0, a DVT was found in 9%. Kahn’s score was not adapted to this population. We then developed a new simple score (cancer, palsy or plaster immobilization, warmth, superficial venous dilation, unilateral pitting edema, other diagnosis). A DVT was found in 76% patients with a score of 3 and in 11% in those with a score of 0. We therefore propose a 6-item score whose main advantages are simplicity and usefulness in routine practice.
La Revue de Médecine Interne, 2000
Transactions of the Royal Society of Tropical Medicine and Hygiene, 1995
Halofantrine, increasingly ,used for treatment of Plasmodium falciparum malaria, is a normally we... more Halofantrine, increasingly ,used for treatment of Plasmodium falciparum malaria, is a normally well-tolerated amino-alcohol with very few side-effects, but torsades de pointes ventricular tachycardia due to halofantrine has been reported in a few patients with a congenital long QT interval (RomanwWard syndrome). We performed a prospective study of the cardiac effect of halofantrine in 20 patients with 48 h ambulatory electrocardiographic (ECG) monitoring; the halofantrine levels in their serum were also determined. Minimal ECG changes were noted, with lengthening of the QT interval without clinical symptoms. This effect was dosedependent and can be very severe in cases of pre-existing cardiopathy; it also occurs in patients without any pre-existing cardiopathy. In order to reduce the likelihood of such incidents, which are admittedly rare, we suggest performing electrocardiography on all patients before initiating treatment with halofantrine.
European Journal of Medical Genetics, 2011
Europace, 2001
Aims Preliminary studies have shown that peak endocardial acceleration (PEA), measured by a micro... more Aims Preliminary studies have shown that peak endocardial acceleration (PEA), measured by a microaccelerometer at the right ventricular apex, is highly correlated with left ventricular contractility (dp/dt max). Furthermore, changes in PEA are closely correlated with sinus node rate changes during exercise and during pharmacological interventions. Peak endocardial acceleration has, therefore, been used to drive a rate-responsive DDD pacemaker. This study compared the chronotropic performance of such devices implanted in 14 patients suffering from chronotropic incompetence with that observed in 18 control subjects in normal sinus rhythm. Methods and Results Five standardized daily life activities (hall walk, climbing up and down stairs, squatting and hyperventilation) and two types of exercise (Bruce treadmill protocol and bicycle ergometry) were performed in a random order after individual programming of each pacemaker. For each test, a correlation coefficient was calculated between changes in PEA and variations in paced rate, between instantaneous variations in heart rate monitored by telemetry and continuous measurement of heart rate by the pacemaker, and between sensor-driven rate in patients and normal sinus rhythm in controls. The variations in paced heart rate were closely correlated with those observed in subjects with normal sinus rhythm, and proved to be sensitive, specific, rapid and independent of the type of exercise. After optimal programming of the sensor, PEA modulates the heart rate as expected during normal sinus rhythm. Conclusions In this study, a single PEA sensor successfully restored chronotropic response in a population of paced patients with severe chronotropic incompetence. Peak endocardial acceleration can be monitored on a beat-to-beat basis, in parallel with heart rate, and the pacemaker can be accurately programmed with a single exercise test.
Cancer, 1993
Thrombosis of the central veins is one of the most frequent complications of implanted venous acc... more Thrombosis of the central veins is one of the most frequent complications of implanted venous access devices. Among the first cases occurring in our patients, most were associated with left-sided placement of the ports, with catheter tips lying against the external wall in the upper half of the superior vena cava. Some chest radiographs showed lateromediastinal opacities centered on the catheter tip, suggesting a vessel injury. This position allows a narrow contact between the catheter tip and the vessel wall, thus endothelial injuries might result from mechanical and chemical attack. To assess the role of catheter position, we reviewed the routine chest radiographs of 379 patients who received chemotherapy through venous access devices and were followed up at our department between December 1985 and December 1990. Four groups (upper left, upper right, lower left, and lower right) were defined according to the level of the catheter tip (innominate veins or upper half of the vena cava versus lower half of the vena cava or auricula) and to the side of port implantation. Ten patients developed symptomatic venous thrombosis (superior vena cava in 9 patient, left subclavian vein in 1 patient). A strong correlation existed between catheter position and incidence of thrombosis: upper left, 8/28 (28.6%); upper right, 1/33 (3%); lower right, 1/68 (1.5%); and lower left, 0/250. Since 1988, we have insisted on replacement of malpositioned catheters, and we have observed fewer thromboses (2/191 versus 8/188). The current study suggests that patients with left-sided ports and catheter tips lying in the upper part of the vena cava are at high risk for severe thrombotic complications.
La Revue du praticien, Jan 15, 1993
Junctional tachycardias are among the most frequent or paroxysmal supraventricular tachycardias. ... more Junctional tachycardias are among the most frequent or paroxysmal supraventricular tachycardias. They are due to a reentry mechanism and include the so-called nodal reentrant tachycardias as well as tachycardias which imply a patent or hidden accessory pathway. The prognosis of these tachycardias is usually benign, but it can be made unfavourable by repeated attacks or by the presence of an accessory pathway with short anterograde refractory period which exposes the patient to severe arrhythmia. Clinicians are now provided with a therapeutic armentarium that enables them to reduce easily any attack of junctional tachycardia, but also to prevent recurrences. The intracavitary ablation technique by application of radiofrequency currents ensures the radical cure of recurrent or threatening arrhythmias by suppressing the indispensable anatomical substrate of tachycardias.
Annales de cardiologie et d'angéiologie, 1993
Junctional tachycardias may be related to intranodal reentry or to the existence of an accessory ... more Junctional tachycardias may be related to intranodal reentry or to the existence of an accessory pathway. All are suitable for radical treatment by radiofrequency current applied either in the perinodal region or at the tricuspid or mitral atrioventricular rings respectively. 176 patients with intranodal reentry were treated by preferential modification of the rapid (8) or slow (167) anterograde pathway of the reentry circuit, with a 99% success rate (1 failure) and without significant complications, in particular atrioventricular block in the case of ablation of the slow pathway. 362 patients with one or more accessory pathways, patent or latent, were treated using the same type of energy. The ablation site was determined on the basis of indirect criteria and/or recording of the specific activity of the accessory pathway. The success rate here was 98%, once again without significant complications with the exception of those inherent to catheterisation procedures. Treatment duration...
Archives des maladies du coeur et des vaisseaux, 1994
The incidence of sudden death in the Wolff-Parkinson-White (WPW) syndrome is not well documented ... more The incidence of sudden death in the Wolff-Parkinson-White (WPW) syndrome is not well documented and probably underestimated. This retrospective study concerned 28 consecutive patients presenting with ventricular fibrillation either spontaneously (20) or during electrophysiological investigation (8) but whose characteristics allowed them to be assimilated into a single group. Their clinical and electrophysiological characteristics were compared with those of 60 consecutive patients with the WPW syndrome who had documented atrial fibrillation (and even reciprocating tachycardia) but never ventricular fibrillation. There were no significant differences between the two groups with respect to the following clinical parameters: sex, duration of symptoms, the type of tachycardia previously recorded, history of syncope and presence of underlying cardiac disease. With respect to the electrophysiological data, there were no differences in the point of anterograde block, the effective anterog...
PubMed, Jun 1, 1986
The success rate of catheter ablation, the latest therapeutic method in the treatment of cardiac ... more The success rate of catheter ablation, the latest therapeutic method in the treatment of cardiac arrhythmias, varies according to the precise indication. The best and most logical guarantee of its efficacy is the application of the electrical energy at an anatomical site essential to the arrhythmia. In preexcitation syndromes this site is without doubt the accessory pathway itself rather than its insertions, but this implies the recording of its activation. We recorded the electrical activation of a right sided Kent bundle in three consecutive cases to guide the therapeutic procedure (comparable to the recording of the H potential for his bundle ablation). All patients had paroxysmal atrial fibrillation (minimal RR interval: 175, 150 and 200 ms) and orthodromic reciprocating tachycardia. Two patients had had attacks of ventricular fibrillation. The sites of the Kent bundles were posteroseptal in 2 cases and anterolateral in 1 case. The recording of the electrical activation of the Kent bundle was validated by: the passage (induced or spontaneous) of a preexcited to a normal QRS coincident with the disappearance of the K potential; the exclusion of an atrial or ventricular origin of the electrical activation supposed to be the activation of the Kent bundle; electrical stimulation at the site of the recording of the K potential leading to prolongation of the stimulus-delta wave interval from 10 to 35 ms, with QRS morphology identical to the spontaneous complexes. All 3 patients were clinically cured by catheter ablation at the site of recording of the Kent bundle activation with follow-up periods ranging from 10 to 16 months.(ABSTRACT TRUNCATED AT 250 WORDS)
European Journal of Heart Failure, Jun 1, 2000
source of tumour necrosis factor (TNF) a and the possibility of endotoxin P134/9924 Epidemiology ... more source of tumour necrosis factor (TNF) a and the possibility of endotoxin P134/9924 Epidemiology and impact of intraventricular translocation across the bowel wall during episodes of oedema. conduction delay in heart failure patients Methods: We studied 48 patients (39 male; aged 45.3 (SD 14) years) with severe end stage heart failure requiring implantation of a left ventricular assist device as a bridge to transplantation. Cytokines were measured in all surviving patients preoperatively, at 1 week (n = 46), 40 days (n = 35) and 90 days (n = 26).
PubMed, Mar 1, 1986
68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmi... more 68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmics (quinidine derivatives 52 patients, amiodarone 28 patients, beta-blockers 24 patients) were treated by mouth with propafenone, with a mean postponement of 5.6 +/- 8.5 months (1 day to 33 months). Auricular arrhythmia was observed in 41 patients with the following results: 16 successes among the 24 patients with paroxysmal fibrillation of flutter, 3 successes among the 8 patients with an arrhythmia reduced by cardioversion, and 3 successes among the 9 patients with auricular tachycardia, including 6 systolic tachycardias. Of 8 patients with an intranodal reciprocal rhythm, 7 were treated successfully with propafenone, which acts on the retrograde part of the cycle. Successes were also recorded in 2 out of 3 patients with Wolff-Parkinson-White syndrome. In 19 cases of ventricular tachycardia, propafenone proved to be efficacious in 3 out of 5 cases presenting rapid discharges and in 7 out of 14 patients with continuous arrhythmias, notably those with a catecholaminergic component. Side-effects were digestive (5 patients), cardiac decompensation (3 patients), asthenia and asthma (1 patient) and the transformation of a flutter from 2/1 to 1/1 (1 patient).
PubMed, Jun 1, 1992
Several epidemiological studies have shown decreased cardiovascular mortality and a lower inciden... more Several epidemiological studies have shown decreased cardiovascular mortality and a lower incidence of coronary artery disease in subjects with high dietary intakes of Omega-3 polyunsaturated fatty acids. It has since been shown that Omega-3 fatty acids have a number of beneficial effects in the prevention of atherosclerosis in man: reduction of blood pressure, modifications of lipoprotein metabolism, modifications of haemostasis (increased bleeding time and reduced platelet aggregation), decreased plasma fibrinogen, modifications of the metabolism of arachidonic acid and its derivatives (decreased thromboxane and leukotriene synthesis, increased prostacyclin synthesis). Therefore, Omega-3 polyunsaturated fatty acids have several beneficial effects on the presumed mechanisms of atherogenesis and/or its complications: they could represent an original and seductive solution to the problem of prevention of cardiovascular disease.
Annales De Cardiologie Et D Angeiologie, Aug 1, 2003
ABSTRACT
Chest, Apr 1, 1994
We report the case of a woman treated with urokinase for acute pulmonary embolism with a right-si... more We report the case of a woman treated with urokinase for acute pulmonary embolism with a right-sided heart thrombus. She developed life-threatening acute cor pulmonale which dramatically improved within 4 h with recombinant tissue plasminogen activator (rtPA). We emphasize the clinical interest of rtPA for the treatment of life-threatening pulmonary embolism.
Sang Thrombose Vaisseaux, Jan 12, 1999
Un patient de 71 ans est hospitalise pour des acces febriles recurrents depuis 1 mois et demi, as... more Un patient de 71 ans est hospitalise pour des acces febriles recurrents depuis 1 mois et demi, associes a des douleurs lombaires basses gauches apparues depuis une dizaine de jours. Il a pour antecedent une fibrillation auriculaire lente appareillee par un pacemaker monochambre VVI en decembre 1995. A l'entree dans le service, l'examen [...]
Revue de Médecine Interne, Jun 1, 1999
Revue de Médecine Interne, 1993
Revue de Médecine Interne, Dec 1, 2006
dique est normal. Il existe un tabagisme à 15 paquets/année et une contraception par oestro-proge... more dique est normal. Il existe un tabagisme à 15 paquets/année et une contraception par oestro-progestatifs. Le traitement par héparine entraîne une disparition du thrombus en un mois. Résultats.-Les thrombus flottants aortiques développés sur une aorte en apparence saine sont rares et moins de 100 cas sont rapportés dans la littérature depuis 1981 [2]. Ils concernent le plus souvent la femme jeune, tabagique, traitée par contraceptifs oestro-progestatifs. Dans la plupart des observations l'aorte est décrite comme normale, ce qui n'exclut pas de minimes lésions athéromateuses, comme dans notre observation. Le thrombus siège dans l'aorte abdominale (64 %), l'aorte thoracique descendante (28 %) et l'aorte ascendante (8 %). Le traitement de référence est la thrombectomie chirurgicale, mais quelques observations ont fait état d'une disparition du thrombus par le seul traitement anticoagulant ; les délais habituels sont de six mois, mais dans quelques observations, la disparition du thrombus a été observée après un mois de traitement [1]. Conclusion.-Les thrombus flottants intra-aortiques avec lésions minimes sont rares et concernent le plus souvent la femme jeune tabagique, sous oestro-progestatifs. De minimes plaques d'athérome sont probablement en cause. Le traitement médical est une option thérapeutique efficace permettant d'éviter une chirurgie thoracique lourde. Références
PubMed, Mar 1, 2001
We report the case of a patient with refractory ascitis due to a constrictive pericarditis who un... more We report the case of a patient with refractory ascitis due to a constrictive pericarditis who underwent a liver transplantation with the initial diagnosis of cryptogenic cirrhosis. The cardiac origin was suspected 5 months post surgery when a liver biopsy showed lesions in favor of a post sinusoidal shunt. The diagnosis was confirmed by the increased values of the right intra-ventricular pressures. We discuss the causes of the delay of the diagnosis and, in particular, the difficulty to interpret vascular liver lesions. Such vascular lesions were present on the needle biopsy performed prior to transplantation but wrongly interpreted as cirrhosis.
Thrombosis and Haemostasis, 2001
SummaryWe evaluated two clinical scores for the prediction of deep venous thrombosis (DVT) in hos... more SummaryWe evaluated two clinical scores for the prediction of deep venous thrombosis (DVT) in hospitalized patients (Wells’ and Kahn’s). We included 273 patients referred to the vascular exploration unit for the suspicion of DVT. A clinical questionnaire was filled in by the practitioner and the scores were calculated from this form. 66 of the 273 patients had a DVT. When Wells’ score was 3, a DVT was found by duplex echography in 51% patients ; when the score was 0, a DVT was found in 9%. Kahn’s score was not adapted to this population. We then developed a new simple score (cancer, palsy or plaster immobilization, warmth, superficial venous dilation, unilateral pitting edema, other diagnosis). A DVT was found in 76% patients with a score of 3 and in 11% in those with a score of 0. We therefore propose a 6-item score whose main advantages are simplicity and usefulness in routine practice.
La Revue de Médecine Interne, 2000
Transactions of the Royal Society of Tropical Medicine and Hygiene, 1995
Halofantrine, increasingly ,used for treatment of Plasmodium falciparum malaria, is a normally we... more Halofantrine, increasingly ,used for treatment of Plasmodium falciparum malaria, is a normally well-tolerated amino-alcohol with very few side-effects, but torsades de pointes ventricular tachycardia due to halofantrine has been reported in a few patients with a congenital long QT interval (RomanwWard syndrome). We performed a prospective study of the cardiac effect of halofantrine in 20 patients with 48 h ambulatory electrocardiographic (ECG) monitoring; the halofantrine levels in their serum were also determined. Minimal ECG changes were noted, with lengthening of the QT interval without clinical symptoms. This effect was dosedependent and can be very severe in cases of pre-existing cardiopathy; it also occurs in patients without any pre-existing cardiopathy. In order to reduce the likelihood of such incidents, which are admittedly rare, we suggest performing electrocardiography on all patients before initiating treatment with halofantrine.
European Journal of Medical Genetics, 2011
Europace, 2001
Aims Preliminary studies have shown that peak endocardial acceleration (PEA), measured by a micro... more Aims Preliminary studies have shown that peak endocardial acceleration (PEA), measured by a microaccelerometer at the right ventricular apex, is highly correlated with left ventricular contractility (dp/dt max). Furthermore, changes in PEA are closely correlated with sinus node rate changes during exercise and during pharmacological interventions. Peak endocardial acceleration has, therefore, been used to drive a rate-responsive DDD pacemaker. This study compared the chronotropic performance of such devices implanted in 14 patients suffering from chronotropic incompetence with that observed in 18 control subjects in normal sinus rhythm. Methods and Results Five standardized daily life activities (hall walk, climbing up and down stairs, squatting and hyperventilation) and two types of exercise (Bruce treadmill protocol and bicycle ergometry) were performed in a random order after individual programming of each pacemaker. For each test, a correlation coefficient was calculated between changes in PEA and variations in paced rate, between instantaneous variations in heart rate monitored by telemetry and continuous measurement of heart rate by the pacemaker, and between sensor-driven rate in patients and normal sinus rhythm in controls. The variations in paced heart rate were closely correlated with those observed in subjects with normal sinus rhythm, and proved to be sensitive, specific, rapid and independent of the type of exercise. After optimal programming of the sensor, PEA modulates the heart rate as expected during normal sinus rhythm. Conclusions In this study, a single PEA sensor successfully restored chronotropic response in a population of paced patients with severe chronotropic incompetence. Peak endocardial acceleration can be monitored on a beat-to-beat basis, in parallel with heart rate, and the pacemaker can be accurately programmed with a single exercise test.
Cancer, 1993
Thrombosis of the central veins is one of the most frequent complications of implanted venous acc... more Thrombosis of the central veins is one of the most frequent complications of implanted venous access devices. Among the first cases occurring in our patients, most were associated with left-sided placement of the ports, with catheter tips lying against the external wall in the upper half of the superior vena cava. Some chest radiographs showed lateromediastinal opacities centered on the catheter tip, suggesting a vessel injury. This position allows a narrow contact between the catheter tip and the vessel wall, thus endothelial injuries might result from mechanical and chemical attack. To assess the role of catheter position, we reviewed the routine chest radiographs of 379 patients who received chemotherapy through venous access devices and were followed up at our department between December 1985 and December 1990. Four groups (upper left, upper right, lower left, and lower right) were defined according to the level of the catheter tip (innominate veins or upper half of the vena cava versus lower half of the vena cava or auricula) and to the side of port implantation. Ten patients developed symptomatic venous thrombosis (superior vena cava in 9 patient, left subclavian vein in 1 patient). A strong correlation existed between catheter position and incidence of thrombosis: upper left, 8/28 (28.6%); upper right, 1/33 (3%); lower right, 1/68 (1.5%); and lower left, 0/250. Since 1988, we have insisted on replacement of malpositioned catheters, and we have observed fewer thromboses (2/191 versus 8/188). The current study suggests that patients with left-sided ports and catheter tips lying in the upper part of the vena cava are at high risk for severe thrombotic complications.
La Revue du praticien, Jan 15, 1993
Junctional tachycardias are among the most frequent or paroxysmal supraventricular tachycardias. ... more Junctional tachycardias are among the most frequent or paroxysmal supraventricular tachycardias. They are due to a reentry mechanism and include the so-called nodal reentrant tachycardias as well as tachycardias which imply a patent or hidden accessory pathway. The prognosis of these tachycardias is usually benign, but it can be made unfavourable by repeated attacks or by the presence of an accessory pathway with short anterograde refractory period which exposes the patient to severe arrhythmia. Clinicians are now provided with a therapeutic armentarium that enables them to reduce easily any attack of junctional tachycardia, but also to prevent recurrences. The intracavitary ablation technique by application of radiofrequency currents ensures the radical cure of recurrent or threatening arrhythmias by suppressing the indispensable anatomical substrate of tachycardias.
Annales de cardiologie et d'angéiologie, 1993
Junctional tachycardias may be related to intranodal reentry or to the existence of an accessory ... more Junctional tachycardias may be related to intranodal reentry or to the existence of an accessory pathway. All are suitable for radical treatment by radiofrequency current applied either in the perinodal region or at the tricuspid or mitral atrioventricular rings respectively. 176 patients with intranodal reentry were treated by preferential modification of the rapid (8) or slow (167) anterograde pathway of the reentry circuit, with a 99% success rate (1 failure) and without significant complications, in particular atrioventricular block in the case of ablation of the slow pathway. 362 patients with one or more accessory pathways, patent or latent, were treated using the same type of energy. The ablation site was determined on the basis of indirect criteria and/or recording of the specific activity of the accessory pathway. The success rate here was 98%, once again without significant complications with the exception of those inherent to catheterisation procedures. Treatment duration...
Archives des maladies du coeur et des vaisseaux, 1994
The incidence of sudden death in the Wolff-Parkinson-White (WPW) syndrome is not well documented ... more The incidence of sudden death in the Wolff-Parkinson-White (WPW) syndrome is not well documented and probably underestimated. This retrospective study concerned 28 consecutive patients presenting with ventricular fibrillation either spontaneously (20) or during electrophysiological investigation (8) but whose characteristics allowed them to be assimilated into a single group. Their clinical and electrophysiological characteristics were compared with those of 60 consecutive patients with the WPW syndrome who had documented atrial fibrillation (and even reciprocating tachycardia) but never ventricular fibrillation. There were no significant differences between the two groups with respect to the following clinical parameters: sex, duration of symptoms, the type of tachycardia previously recorded, history of syncope and presence of underlying cardiac disease. With respect to the electrophysiological data, there were no differences in the point of anterograde block, the effective anterog...