claude barnay | Aix Marseille, France (original) (raw)
Papers by claude barnay
The online version of this article, along with updated information and services, is located on the
Archives of Cardiovascular Diseases Supplements, 2013
Material and methods: We carried out a multicenter survey in 8 French centers. Each patient recei... more Material and methods: We carried out a multicenter survey in 8 French centers. Each patient received a questionnaire to evaluate his perceptions on information and consent, risks associated with pacemaker implantation and ability to perform various routine activities. Results: We included 185 patients. The mean age was 75.4 + 10.5 years.
Heart, 2010
Danchin, Nicolas; Fauchier, Laurent; Marijon, Eloi; Barnay, Claude; Furber, Alain; Mabo, Philippe... more Danchin, Nicolas; Fauchier, Laurent; Marijon, Eloi; Barnay, Claude; Furber, Alain; Mabo, Philippe; Bernard, Paul; Blanc, Jean-Jacques; Jouven, Xavier; Le Heuzey, Jean-Yves; Charbonnier, Bernard; Ferrières, Jean; Simon, Tabassome.
Archives of Cardiovascular Diseases Supplements, 2011
Ann Cardiol Angeiol, 2005
Archives of Cardiovascular Diseases, 2015
Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening ... more Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening of the heart. TTC can mimic acute myocardial infarction and is associated with a minimal release of myocardial biomarkers in the absence of obstructive coronary artery disease. To provide an extensive description of patients admitted to hospital for TTC throughout France and to study the management and outcomes of these patients. In 14 non-academic hospitals, we collected clinical, electrocardiographic, biological, psychological and therapeutic data in patients with a diagnosis of TTC according to the Mayo Clinic criteria. Of 117 patients, 91.5% were women, mean±SD age was 71.4±12.1 years and the prevalence of risk factors was high (hypertension: 57.9%, dyslipidaemia: 33.0%, diabetes: 11.5%, obesity: 11.5%). The most common initial symptoms were chest pain (80.5%) and dyspnoea (24.1%). A triggering psychological event was detected in 64.3% of patients. ST-segment elevation was found in 41.7% of patients and T-wave inversion in 71.6%. Anterior leads were most frequently associated with ST-segment elevation, whereas T-wave inversion was more commonly associated with lateral leads, and Q-waves with septal leads. The ratio of peak B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) level to peak troponin level was 1.01. No deaths occurred during the hospital phase. After 1 year of follow-up, 3 of 109 (2.8%) patients with available data died, including one cardiovascular death. Rehospitalizations occurred in 17.4% of patients: 2.8% due to acute heart failure and 14.7% due to non-cardiovascular causes. There was no recurrence of TTC. This observational study of TTC included primarily women with atherosclerotic risk factors and mental stress. T-wave inversion was more common than ST-segment elevation. There were few adverse cardiovascular outcomes in these patients after 1-year follow-up.
Archives des maladies du coeur et des vaisseaux
Archives des maladies du coeur et des vaisseaux
The evaluation of sinus function in man rests upon atrial stimulation techniques (rapid atrial st... more The evaluation of sinus function in man rests upon atrial stimulation techniques (rapid atrial stimulation, premature atrial stimulation); in a certain number of cases the results are inconclusive. There are various pharmaco-dynamic tests which can be used in such cases, the aim being to stimulate or depress the function of the sinus, or alternatively to modify the action of the extrinsic nerve supply. A study was carried out of sinus function in a series of 120 patients; pharmaco-dynamic tests were carried out using atropine in 43 cases, glucagon in 9 cases, isoproterinol in 9 cases, ajmaline in 9 cases, and piprofurol in 10 cases. The authors conclude from this study that it is worth adding the atropine test (which suppresses vagal tone), the glucagon test (which causes direct and limited stimulation of the sinus) and a test with an agent with a depressant action on the sinus coupled with a sympathetic-blocking action (such as piprofurol) to the conventional atrial stimulation tests.
La Nouvelle presse médicale
Archives des maladies du coeur et des vaisseaux
Archives des maladies du coeur et des vaisseaux
A consecutive series of 140 patients who presented either with syncope or transient neurological ... more A consecutive series of 140 patients who presented either with syncope or transient neurological deficit of undertermined cause underwent electrophysiological investigation. The patients were classified in 3 groups: Group I comprising 55 patients having presented "true syncope"; Group II comprising 42 patients with "false vertigo"; and Group III comprising 43 patients in whom a transient neurological deficit had been observed. Globally, the investigations were positive in 58 patients (41,4%). Paroxysmal atrioventricular block was recorded in 21 cases (15%), sinus node dysfunction in 34 cases (2,1%). Permanent pacing was instituted in 57 patients. The correlation between the results of electrophysiological investigation and the clinical symptomatology showed a highly significant difference between Groups I and II where the results were positive in 57% cases, and Groupe III where 93% of the investigations were negative.
Archives des maladies du coeur et des vaisseaux
The antiarrhythmic efficiency of quinidine arabogalactan-sulphate (QAGS) and disopyramide were de... more The antiarrhythmic efficiency of quinidine arabogalactan-sulphate (QAGS) and disopyramide were determined in 38 patients showing chronic, stable frequency premature ventricular beats (PVB). The study which was carried out in 4 medical Centers, used a longitudinal cross-over design. After a baseline evaluation which consisted of two 24 hours electrocardiograms, the patients were randomised to one of the two drugs during a period of 6 or 7 days. The drug sequence were followed by a placebo sequence. A 24 hours electrocardiogram was performed at the end of each sequence. The daily doses were equivalent to 660 mg of quinidine base for QAGS and 600 mg for disopyramide. Among the 38 patients who entered in the study, 32 went through each sequence of the test. The average number of PVB was significantly reduced by QAGS and disopyramide (p less than 0.0001). With QAGS 18 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. With disopyramide, 14 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. There was no statistical difference in the overall efficiency of the two drugs. Three patients died, one from myocardial reinfarction, one from ventricular fibrillation; in one other case, the cause of the death remained undetermined. QAGS was better tolerated than disopyramide; adverse effects occurred in 6 patients with QAGS and in 10 with disopyramide. The responsibility of disopyramide in the occurrence of two severe ventricular arrhythmia may be questioned.
Acta cardiologica
To study the diagnostic possibility and the mechanisms involved in sinus node dysfunction, 23 pat... more To study the diagnostic possibility and the mechanisms involved in sinus node dysfunction, 23 patients with sick sinus syndrome were evaluated by the basic electrophysiological method (recovery times, secondary postpacing phases, sinoatrial conduction times) before and after pharmacologic autonomic blockade with i.v. propranolol 0.2 mg/kg and atropine 0.04 mg/kg, and by continuous rhythm monitoring. Patient groups of normal (I) and pathological (II) intrinsic heart rate (IHR) were compared. In group I (no. 15) prolonged recovery time (2/15), postpacing sinoatrial-block (1/15) and chaotic postextrasystolic patterns (5/15) ceased after autonomic blockade; we obtained normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the secondary phase, and a normal intrinsic sinoatrial conduction time. In group II (no. 8) during the control study only 50% of patients had pathological electrophysiological parameters before, and 100% after the drug test (no gradual postpacing return to the intrinsic heart rate, abnormal recovery times, abnormal sinoatrial conduction times or chaotic postextrasystolic patterns). Holter monitoring revealed significant differences between the minimal heart rate during sleeping (group I: 48 +/- 10 bpm, mean +/- SD group II: 32 +/- 4 bpm, probability less than 0.001) as well as in the average sinus cycle length for 24 hours (group I: 848 +/- 88 ms, group II: 1254 +/- 136 ms, P less than 0.001) with a very characteristic histogram. In the patients with pharmacologically and electrophysiologically documented abnormal intrinsic rhythmicity (group II), the first 24 hour Holter monitoring revealed positive ECGs for sinus node dysfunction. In patients with normal intrinsic electrophysiological sinus node properties (group I) repeated continuous rhythm recordings revealed severe sinus bradycardia (1 patient), sinoatrial-block (1 patient), tachybrady syndrome (1 patient) and sinus-arrest (2 patients, up to 29 120 ms in waking period). These findings suggest that 1) IHR is the best and simplest diagnostic method of intrinsic sinus node dysfunction (in patients of abnormal low IHR we found positive electrophysiological and Holter parameters), and 2) in autonomic sinus node dysfunction electrophysiological parameters are essentially negative showing normal intrinsic sinus node function; in these patients systematically repeated Holter monitoring is the most valuable diagnostic method.
Acta cardiologica
In certain cases because of sinus arrhythmia and/or anarchic return and postreturn cycles caused ... more In certain cases because of sinus arrhythmia and/or anarchic return and postreturn cycles caused by premature atrial stimulation, the sinoatrial conduction time cannot be calculated since a chaotic postextrasystolic pattern appears. We examined 49 patients with a history and ECG signs suggesting sinus node dysfunction by programmed extrastimulation method as proposed by Strauss et al. prior to and after pharmacologic autonomic blockade (with propranolol 0.2 mg/kg body weight and atropine sulfate 0.04 mg/kg intravenously). Patients with normal intrinsic heart rate (IHR) (n = 31) showed chaotic postextrasystolic responses in 38%, which in every case could be eliminated by autonomic blockade, resulting in a clear I and II phase with a well estimated intrinsic conduction time. Patients with pathologic IHR (n = 18) gave chaotic responses in 22% which after drug testing increased up to 72%. The chaotic postextrasystolic patterns are to be interpreted as the desynchronization of the sinus potentials, while plateau (phase II) as functional integrity, synchronized activity of the sinus node, dependent on the momentaneous balance of the autonomous tone, and on the integrity of the pacemaker cells. The desynchronized chaotic responses are considered on one hand as a dystonic neurovegetative electrophysiologic characteristic, on the other hand as a primary extrastimulation parameter of the intrinsic sinus node dysfunction.
Archives des maladies du coeur et des vaisseaux
Pacemakers with diagnostic functions have been implanted for several years. The main clinical ind... more Pacemakers with diagnostic functions have been implanted for several years. The main clinical indication for these devices is unexplained syncope. Some reports of the use of diagnostic pacemakers have shown that in patients with unexplained syncope, paroxysmal bradycardia was a common finding after implantation. Until recently, diagnostic functions were only available in VVI pacemakers, which explains the limitations of this type of function in determining the mechanism of the bradycardia. The aim of this study was to assess a new dual-chamber diagnostic pacemaker functioning in the VDI mode. Twenty-three patients were implanted with this type of unit and followed up for an average of 153 days. The number of episodes of bradycardia detected was 6 +/- 10 (median: 3). The interval between the installation of the algorithm and the date of the first episode of bradycardia was 67 +/- 86 days (range: 12-306 days). The mechanisms of the bradycardia were atrioventricular block (6 patients), sinus node dysfunction (6 patients) and blocked atrial bigeminy in 1 patient. These conclusions were drawn from analysis of chains of markers. Bradycardia was recorded during the day or during the day and night in 21 patients; bradycardia was exclusively nocturnal in only 2 patients. The tolerance of the algorithm was good on the whole but 3 patients reported minor symptoms related to the relative bradycardia inherent with this type of algorithm. Four other patients had a VDI pacemaker syndrome which was completely corrected by reprogramming the pacemaker to the standard DDD mode. These new devices represent a technical advance in the field of diagnostic pacemakers.(ABSTRACT TRUNCATED AT 250 WORDS)
Annales de Cardiologie et d Angéiologie
The topographic diagnoses of Kent's bundles obtained from vectorcardiograms with maximum ... more The topographic diagnoses of Kent's bundles obtained from vectorcardiograms with maximum preexcitation in 33 patients (dynamic VCH) were compared with those obtained using Franck's new algorithm. Only three cases disagreed, and the three anteroseptal topographies were identified a posteriori. This simple method therefore shows very satisfactory sensitivity (82%) and provides worthwhile orientation for later investigations.
Archives of Cardiovascular Diseases Supplements, 2015
Annales de cardiologie et d'angéiologie, 2006
QT prolongation is essentially of pharmacologic origin. It is principally linked to a block of th... more QT prolongation is essentially of pharmacologic origin. It is principally linked to a block of the outward potassium current Ikr, with as a consequence a prolongation of the repolarisation causing early after potentials and re-entry. The term "repolarisation reserve" expresses the variable risk of arrhythmia among individuals under the same drug blocking Ikr. This reserve can be altered under various pathologic or genetic conditions. A series of risk factors (bradycar-Torsades de pointes} were described in 1966 by Dessertenne. They are due to a perturbation of ventricular repolarisation causing QT prolongation on surface ECG. Acquired dia, electrolytic disorders, cardiac disease, neurologic disorders, nutrition troubles, female gender) can play a role as well as the metabolic processing of pharmacological agents by Cytochrome P450 and various inhibitors or inductors of this system which can influence the half life of drugs. The list of drugs involved is continuously increa...
Archives des maladies du coeur et des vaisseaux, 2004
Pacing and Clinical Electrophysiology, 1995
LASCAULT, G., ET AL.: Preliminary Evaluation of a Dual Chamber Pacemaker with Bradycardia Diagnos... more LASCAULT, G., ET AL.: Preliminary Evaluation of a Dual Chamber Pacemaker with Bradycardia Diagnostic Functions. Unexplained syncope is the main indication for the implantation of a diagnostic pacemaker. Studies on those implanted have shown that in patients with unexplained syncope, the diagnosis of paroxysmal bradycardia was feasible and reliable. The present study was designed to evaluate a new bradycardia diagnosis algorithm, loaded in a dual chamber pacemaker, in 24 patients considered as candidates for diagnostic pacemakers. During a mean follow-up of 153 days, at least one bradycardia episode was recorded in 13 patients. The mean number of detected bradycardias was 6 and the median was 3. The mean delay between the algorithm activafion and the first bradycardia episode was 67 days. The mechanism of bradycardia was atrioventricular block in 6 patients, sinus node dysfunction in 6 patients, and consecutive blocked atrial premature beats in 1 patient, as indicated by the event markers. In 11 patients bradycardia was recorded during the daytime only or day and night. In two patients the episodes were recorded only at night. Overall, the algorithm was well-tolerated; however, some mild symptoms were observed due to the method of bradycardia determination, allowing bradycardia. Three patients were symptomatic as a direct result of the algorithm operation, and four patients had symptoms related to the single chamber operation of the pacemaker while functioning in the diagnosis mode (VDI). These symptoms were relieved with DDD pacing.
The online version of this article, along with updated information and services, is located on the
Archives of Cardiovascular Diseases Supplements, 2013
Material and methods: We carried out a multicenter survey in 8 French centers. Each patient recei... more Material and methods: We carried out a multicenter survey in 8 French centers. Each patient received a questionnaire to evaluate his perceptions on information and consent, risks associated with pacemaker implantation and ability to perform various routine activities. Results: We included 185 patients. The mean age was 75.4 + 10.5 years.
Heart, 2010
Danchin, Nicolas; Fauchier, Laurent; Marijon, Eloi; Barnay, Claude; Furber, Alain; Mabo, Philippe... more Danchin, Nicolas; Fauchier, Laurent; Marijon, Eloi; Barnay, Claude; Furber, Alain; Mabo, Philippe; Bernard, Paul; Blanc, Jean-Jacques; Jouven, Xavier; Le Heuzey, Jean-Yves; Charbonnier, Bernard; Ferrières, Jean; Simon, Tabassome.
Archives of Cardiovascular Diseases Supplements, 2011
Ann Cardiol Angeiol, 2005
Archives of Cardiovascular Diseases, 2015
Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening ... more Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening of the heart. TTC can mimic acute myocardial infarction and is associated with a minimal release of myocardial biomarkers in the absence of obstructive coronary artery disease. To provide an extensive description of patients admitted to hospital for TTC throughout France and to study the management and outcomes of these patients. In 14 non-academic hospitals, we collected clinical, electrocardiographic, biological, psychological and therapeutic data in patients with a diagnosis of TTC according to the Mayo Clinic criteria. Of 117 patients, 91.5% were women, mean±SD age was 71.4±12.1 years and the prevalence of risk factors was high (hypertension: 57.9%, dyslipidaemia: 33.0%, diabetes: 11.5%, obesity: 11.5%). The most common initial symptoms were chest pain (80.5%) and dyspnoea (24.1%). A triggering psychological event was detected in 64.3% of patients. ST-segment elevation was found in 41.7% of patients and T-wave inversion in 71.6%. Anterior leads were most frequently associated with ST-segment elevation, whereas T-wave inversion was more commonly associated with lateral leads, and Q-waves with septal leads. The ratio of peak B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) level to peak troponin level was 1.01. No deaths occurred during the hospital phase. After 1 year of follow-up, 3 of 109 (2.8%) patients with available data died, including one cardiovascular death. Rehospitalizations occurred in 17.4% of patients: 2.8% due to acute heart failure and 14.7% due to non-cardiovascular causes. There was no recurrence of TTC. This observational study of TTC included primarily women with atherosclerotic risk factors and mental stress. T-wave inversion was more common than ST-segment elevation. There were few adverse cardiovascular outcomes in these patients after 1-year follow-up.
Archives des maladies du coeur et des vaisseaux
Archives des maladies du coeur et des vaisseaux
The evaluation of sinus function in man rests upon atrial stimulation techniques (rapid atrial st... more The evaluation of sinus function in man rests upon atrial stimulation techniques (rapid atrial stimulation, premature atrial stimulation); in a certain number of cases the results are inconclusive. There are various pharmaco-dynamic tests which can be used in such cases, the aim being to stimulate or depress the function of the sinus, or alternatively to modify the action of the extrinsic nerve supply. A study was carried out of sinus function in a series of 120 patients; pharmaco-dynamic tests were carried out using atropine in 43 cases, glucagon in 9 cases, isoproterinol in 9 cases, ajmaline in 9 cases, and piprofurol in 10 cases. The authors conclude from this study that it is worth adding the atropine test (which suppresses vagal tone), the glucagon test (which causes direct and limited stimulation of the sinus) and a test with an agent with a depressant action on the sinus coupled with a sympathetic-blocking action (such as piprofurol) to the conventional atrial stimulation tests.
La Nouvelle presse médicale
Archives des maladies du coeur et des vaisseaux
Archives des maladies du coeur et des vaisseaux
A consecutive series of 140 patients who presented either with syncope or transient neurological ... more A consecutive series of 140 patients who presented either with syncope or transient neurological deficit of undertermined cause underwent electrophysiological investigation. The patients were classified in 3 groups: Group I comprising 55 patients having presented "true syncope"; Group II comprising 42 patients with "false vertigo"; and Group III comprising 43 patients in whom a transient neurological deficit had been observed. Globally, the investigations were positive in 58 patients (41,4%). Paroxysmal atrioventricular block was recorded in 21 cases (15%), sinus node dysfunction in 34 cases (2,1%). Permanent pacing was instituted in 57 patients. The correlation between the results of electrophysiological investigation and the clinical symptomatology showed a highly significant difference between Groups I and II where the results were positive in 57% cases, and Groupe III where 93% of the investigations were negative.
Archives des maladies du coeur et des vaisseaux
The antiarrhythmic efficiency of quinidine arabogalactan-sulphate (QAGS) and disopyramide were de... more The antiarrhythmic efficiency of quinidine arabogalactan-sulphate (QAGS) and disopyramide were determined in 38 patients showing chronic, stable frequency premature ventricular beats (PVB). The study which was carried out in 4 medical Centers, used a longitudinal cross-over design. After a baseline evaluation which consisted of two 24 hours electrocardiograms, the patients were randomised to one of the two drugs during a period of 6 or 7 days. The drug sequence were followed by a placebo sequence. A 24 hours electrocardiogram was performed at the end of each sequence. The daily doses were equivalent to 660 mg of quinidine base for QAGS and 600 mg for disopyramide. Among the 38 patients who entered in the study, 32 went through each sequence of the test. The average number of PVB was significantly reduced by QAGS and disopyramide (p less than 0.0001). With QAGS 18 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. With disopyramide, 14 patients had more than 65 p. 100 reduction of PVB and 12 of them more than 80 p. 100. There was no statistical difference in the overall efficiency of the two drugs. Three patients died, one from myocardial reinfarction, one from ventricular fibrillation; in one other case, the cause of the death remained undetermined. QAGS was better tolerated than disopyramide; adverse effects occurred in 6 patients with QAGS and in 10 with disopyramide. The responsibility of disopyramide in the occurrence of two severe ventricular arrhythmia may be questioned.
Acta cardiologica
To study the diagnostic possibility and the mechanisms involved in sinus node dysfunction, 23 pat... more To study the diagnostic possibility and the mechanisms involved in sinus node dysfunction, 23 patients with sick sinus syndrome were evaluated by the basic electrophysiological method (recovery times, secondary postpacing phases, sinoatrial conduction times) before and after pharmacologic autonomic blockade with i.v. propranolol 0.2 mg/kg and atropine 0.04 mg/kg, and by continuous rhythm monitoring. Patient groups of normal (I) and pathological (II) intrinsic heart rate (IHR) were compared. In group I (no. 15) prolonged recovery time (2/15), postpacing sinoatrial-block (1/15) and chaotic postextrasystolic patterns (5/15) ceased after autonomic blockade; we obtained normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the secondary phase, and a normal intrinsic sinoatrial conduction time. In group II (no. 8) during the control study only 50% of patients had pathological electrophysiological parameters before, and 100% after the drug test (no gradual postpacing return to the intrinsic heart rate, abnormal recovery times, abnormal sinoatrial conduction times or chaotic postextrasystolic patterns). Holter monitoring revealed significant differences between the minimal heart rate during sleeping (group I: 48 +/- 10 bpm, mean +/- SD group II: 32 +/- 4 bpm, probability less than 0.001) as well as in the average sinus cycle length for 24 hours (group I: 848 +/- 88 ms, group II: 1254 +/- 136 ms, P less than 0.001) with a very characteristic histogram. In the patients with pharmacologically and electrophysiologically documented abnormal intrinsic rhythmicity (group II), the first 24 hour Holter monitoring revealed positive ECGs for sinus node dysfunction. In patients with normal intrinsic electrophysiological sinus node properties (group I) repeated continuous rhythm recordings revealed severe sinus bradycardia (1 patient), sinoatrial-block (1 patient), tachybrady syndrome (1 patient) and sinus-arrest (2 patients, up to 29 120 ms in waking period). These findings suggest that 1) IHR is the best and simplest diagnostic method of intrinsic sinus node dysfunction (in patients of abnormal low IHR we found positive electrophysiological and Holter parameters), and 2) in autonomic sinus node dysfunction electrophysiological parameters are essentially negative showing normal intrinsic sinus node function; in these patients systematically repeated Holter monitoring is the most valuable diagnostic method.
Acta cardiologica
In certain cases because of sinus arrhythmia and/or anarchic return and postreturn cycles caused ... more In certain cases because of sinus arrhythmia and/or anarchic return and postreturn cycles caused by premature atrial stimulation, the sinoatrial conduction time cannot be calculated since a chaotic postextrasystolic pattern appears. We examined 49 patients with a history and ECG signs suggesting sinus node dysfunction by programmed extrastimulation method as proposed by Strauss et al. prior to and after pharmacologic autonomic blockade (with propranolol 0.2 mg/kg body weight and atropine sulfate 0.04 mg/kg intravenously). Patients with normal intrinsic heart rate (IHR) (n = 31) showed chaotic postextrasystolic responses in 38%, which in every case could be eliminated by autonomic blockade, resulting in a clear I and II phase with a well estimated intrinsic conduction time. Patients with pathologic IHR (n = 18) gave chaotic responses in 22% which after drug testing increased up to 72%. The chaotic postextrasystolic patterns are to be interpreted as the desynchronization of the sinus potentials, while plateau (phase II) as functional integrity, synchronized activity of the sinus node, dependent on the momentaneous balance of the autonomous tone, and on the integrity of the pacemaker cells. The desynchronized chaotic responses are considered on one hand as a dystonic neurovegetative electrophysiologic characteristic, on the other hand as a primary extrastimulation parameter of the intrinsic sinus node dysfunction.
Archives des maladies du coeur et des vaisseaux
Pacemakers with diagnostic functions have been implanted for several years. The main clinical ind... more Pacemakers with diagnostic functions have been implanted for several years. The main clinical indication for these devices is unexplained syncope. Some reports of the use of diagnostic pacemakers have shown that in patients with unexplained syncope, paroxysmal bradycardia was a common finding after implantation. Until recently, diagnostic functions were only available in VVI pacemakers, which explains the limitations of this type of function in determining the mechanism of the bradycardia. The aim of this study was to assess a new dual-chamber diagnostic pacemaker functioning in the VDI mode. Twenty-three patients were implanted with this type of unit and followed up for an average of 153 days. The number of episodes of bradycardia detected was 6 +/- 10 (median: 3). The interval between the installation of the algorithm and the date of the first episode of bradycardia was 67 +/- 86 days (range: 12-306 days). The mechanisms of the bradycardia were atrioventricular block (6 patients), sinus node dysfunction (6 patients) and blocked atrial bigeminy in 1 patient. These conclusions were drawn from analysis of chains of markers. Bradycardia was recorded during the day or during the day and night in 21 patients; bradycardia was exclusively nocturnal in only 2 patients. The tolerance of the algorithm was good on the whole but 3 patients reported minor symptoms related to the relative bradycardia inherent with this type of algorithm. Four other patients had a VDI pacemaker syndrome which was completely corrected by reprogramming the pacemaker to the standard DDD mode. These new devices represent a technical advance in the field of diagnostic pacemakers.(ABSTRACT TRUNCATED AT 250 WORDS)
Annales de Cardiologie et d Angéiologie
The topographic diagnoses of Kent's bundles obtained from vectorcardiograms with maximum ... more The topographic diagnoses of Kent's bundles obtained from vectorcardiograms with maximum preexcitation in 33 patients (dynamic VCH) were compared with those obtained using Franck's new algorithm. Only three cases disagreed, and the three anteroseptal topographies were identified a posteriori. This simple method therefore shows very satisfactory sensitivity (82%) and provides worthwhile orientation for later investigations.
Archives of Cardiovascular Diseases Supplements, 2015
Annales de cardiologie et d'angéiologie, 2006
QT prolongation is essentially of pharmacologic origin. It is principally linked to a block of th... more QT prolongation is essentially of pharmacologic origin. It is principally linked to a block of the outward potassium current Ikr, with as a consequence a prolongation of the repolarisation causing early after potentials and re-entry. The term "repolarisation reserve" expresses the variable risk of arrhythmia among individuals under the same drug blocking Ikr. This reserve can be altered under various pathologic or genetic conditions. A series of risk factors (bradycar-Torsades de pointes} were described in 1966 by Dessertenne. They are due to a perturbation of ventricular repolarisation causing QT prolongation on surface ECG. Acquired dia, electrolytic disorders, cardiac disease, neurologic disorders, nutrition troubles, female gender) can play a role as well as the metabolic processing of pharmacological agents by Cytochrome P450 and various inhibitors or inductors of this system which can influence the half life of drugs. The list of drugs involved is continuously increa...
Archives des maladies du coeur et des vaisseaux, 2004
Pacing and Clinical Electrophysiology, 1995
LASCAULT, G., ET AL.: Preliminary Evaluation of a Dual Chamber Pacemaker with Bradycardia Diagnos... more LASCAULT, G., ET AL.: Preliminary Evaluation of a Dual Chamber Pacemaker with Bradycardia Diagnostic Functions. Unexplained syncope is the main indication for the implantation of a diagnostic pacemaker. Studies on those implanted have shown that in patients with unexplained syncope, the diagnosis of paroxysmal bradycardia was feasible and reliable. The present study was designed to evaluate a new bradycardia diagnosis algorithm, loaded in a dual chamber pacemaker, in 24 patients considered as candidates for diagnostic pacemakers. During a mean follow-up of 153 days, at least one bradycardia episode was recorded in 13 patients. The mean number of detected bradycardias was 6 and the median was 3. The mean delay between the algorithm activafion and the first bradycardia episode was 67 days. The mechanism of bradycardia was atrioventricular block in 6 patients, sinus node dysfunction in 6 patients, and consecutive blocked atrial premature beats in 1 patient, as indicated by the event markers. In 11 patients bradycardia was recorded during the daytime only or day and night. In two patients the episodes were recorded only at night. Overall, the algorithm was well-tolerated; however, some mild symptoms were observed due to the method of bradycardia determination, allowing bradycardia. Three patients were symptomatic as a direct result of the algorithm operation, and four patients had symptoms related to the single chamber operation of the pacemaker while functioning in the diagnosis mode (VDI). These symptoms were relieved with DDD pacing.