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Biomedical subjects

B Perrot

Publications and source records attributed to B Perrot.

At least 19 recordsLinked to original sources
PubMed1985

[Long-term prognosis of myocardial infarction. Value of Holter monitoring].

The mortality one year after a myocardial infarction varies between 2 and 60% according to the subjects. Thus, there is a group of patients at high risk of sudden death which it is important to be able to define. These patients are characterised by a lesion of the left ventricle with a decrease in the ejection fraction to below 0.40 and the presence of disorders of ventricular excitability on the Holter recording. This examination is able to demonstrate the signs of severity of the extrasystoles by showing an elevated number of ventricular extrasystoles (VEB) (greater than 1%) and the appearance in pairs or in runs. 24 hour Holter monitoring may miss a complex arrhythmia and the increase in the duration of the monitor increase the sensitivity. However, it should be associated with an evaluation of the ejection fraction and possible with invasive investigations such as programmed ventricular stimulation in high risk patients.

Arrhythmias, Cardiac↗
PubMed1985

[Vectorcardiography in inferior infarction associated with left bundle-branch block].

The authors report a series of 13 patients, 8 men and 5 women, with an average age of 68 years (range 39 to 87 years) presenting with documented inferior infarction with anteroseptal extension in 2 cases. These patients developed LBBB (complete in 9 cases, incomplete in 4 cases). This complications occurred in the acute phase in 8 cases and 4 months to 9 years later (average 4,5 years) in the other 5 cases. The block was intermittent in 4 patients and became permanent in all cases. The diagnosis of inferior infarction with LBBB was made by vectorcardiography (VCG) in 5 out of the 13 patients (38,4 p. 100) on the criteria suggested by Starr. 3 of the 8 false negative results were directly related to the block which masked the ECG and VCG signs of inferior infarction. The VCG signs observed were an upwards displacement of the QRS loop with preservation of the superior orientation of the initial forces (5 cases). Atypical appearances of LBBB were observed in 2 cases with a posterior and right-sided shift of the efferent loop following the anterior and left-sided orientations of the initial forces. The sensitivity of the VCG and ECG is mediocre in inferior infarction with LBBB because the block may mask the electrical signs of inferior infarction. The specificity of the VCG could not be assessed because of the mode of selection of the patients and the small number of cases.

Adult↗
PubMed1985

[Diagnostic value of methods of ventricular and auricular stimulation in the evaluation of tachycardia].

The diagnostic value of programmed pacing in the investigation of tachycardia (greater than 5 premature complexes) was studied in 155 patients admitted for evaluation of dizzy attacks and/or tachycardia by determining a relationship between the induction of tachycardia by endocavitary pacing and the presence of spontaneous attacks on ECG and/or 24 hour Holter monitoring. Right atrial and ventricular programmed pacing comprised: an extrastimulus during sinus rhythm (method I), during paced rhythm (method II), 2 extrastimuli during sinus rhythm (method III) and paced rhythm (method IV). The protocol was applied in 20 cases of spontaneous atrial tachycardia (AT) and 40 patients without tachycardia, and in 20 cases of spontaneous sustained ventricular tachycardia (VTS) (Group A), 15 cases of non-sustained ventricular tachycardia (VTNS) (Group B), 20 cases of ventricular doublets or triplets on Holter monitoring (Group C) and 40 patients without ventricular arrhythmias. The following results were obtained: At atrial level, method I was associated with a 75% sensitivity and a 62.5 p. 100 specificity when the triggering of atrial echos was considered. It was difficult to induce AT with methods I, II and III (sensitivity 15, 20 and 45 p. 100 - but they were very specific (greater than 90 p. 100). The induction of echos with methods II, III and IV was very sensitive but not specific and could not be retained as a pathological criterion. Using method IV, only the triggering of sustained AT could be considered to have a good specificity (90 p. 100), but sensitivity remained low (30 p. 100). At ventricular level, more aggressive methods were needed to induce an arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Mitral valve prolapse. Results of electrophysiological studies].

Classically, the frequency of latent left-sided Kent bundles and ventricular tachycardia (VT) is increased in mitral valve prolapse (MVP). To verify this hypothesis, 23 patients with clinical and echocardiographic (M mode and 2D) signs of MVP underwent electrophysiological studies for dizziness or syncope (12 cases) or palpitations (11 cases). In addition to the standard electrophysiological studies, analysis of sinoatrial and atrioventricular conduction, they underwent programmed ventricular pacing (St V2): coupled and then paired St V2 in sinus rhythm and during ventricular pacing (100-150/min) under basal conditions (15 patients), after injection of 2 mg Atropine (6 patients), and 10 micrograms of Isoproterenol (4 patients). These manoeuvres showed that symptoms of dizziness were due to increased vagal tone in 6 cases (associated with paroxysmal nodal tachycardia--PNT--in 3 cases), to sinoatrial block in 2 cases (associated with atrial tachycardia in 1 case), to suprahisian conduction defects in 3 cases (associated with atrial tachycardia in 1 case) and to VT in 1 case. Palpitations were due to VT in 1 case, atrial tachycardia in 1 case and PNT in 9 cases. Our analysis showed a high incidence of PNT (10 cases) with normal inter critical ECG. These arrhythmias were due to intranodal reentry in 7 cases (70%), to a latent left-sided Kent bundle in 2 cases and to a paraseptal Kent bundle in 1 case. These PNT were characterised by induction during exercise (6 cases) and by their association with flutter-type reentry (5 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Sudden death in mitral valve prolapse. Apropos of 2 cases].

Two cases of sudden death are reported in patients with mitral valve prolapse with mitral insufficiency. Both had significant impairment of left ventricular function. Irreversible ventricular fibrillation occurred in one patient one-half hour preceding a catheterization, whereas the other patient died during sleep. Review of the literature revealed 42 cases of sudden death in patients with prolapse. Occasionally left ventricular dysfunction or medication overdosage can explain or favor development of the terminal arrhythmia, but usually no precipitating factor other than prolapse can be identified. It appears impossible to identify actual subgroups at risk, although sudden death does occur more frequently in patients with a large amount of prolapse of both valves, previous syncopal episodes, and ECG abnormalities at rest. Complex ventricular arrhythmias are also reported, but their predictive importance is difficult to evaluate. Sudden death is a rare complication of mitral prolapse, fact which should conservatively influence indications for further supplementary testing and treatment in these patients.

Adult↗
PubMed1984

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. Then, 0.2 mg kg-1 of propranolol was added to the higher dose of PGI2. We observed a net decrease of the systolic and diastolic arterial blood pressure beginning with the lowest dose. There was no effect on sinus node recovery time, atrial, His-Purkinje and ventricular effective refractory periods, AH and HV intervals. Atrioventricular (AV) nodal effective and functional refractory periods could be measured in 5 patients and were decreased in all cases. Sinus cycle length and anterograde and retrograde Wenckebach cycle lengths were significantly decreased by PGI2 in a dose dependent manner. The injection of propranolol increased all these values but did not suppress entirely the effects of PGI2. In conclusion, the electrophysiological effects of PGI2 were marked decreases of sinus cycle length and AV nodal refractoriness which may be partly related to enhanced sympathetic activity.

Adult↗
PubMed1984

Significance of supraventricular arrhythmias induced by electrophysiologic studies.

The clinical history and the findings on Holter monitoring of 767 patients (without evidence of ventricular pre-excitation on the ECG) were compared with the results of electrophysiological studies to assess the significance of supraventricular arrhythmias induced by intracardiac study. The studies were undertaken to determine the cause of syncope, conduction disturbances or tachycardia. In 570 patients (group 1) supraventricular arrhythmias were not induced. On Holter monitoring, 36 (6%) had evidence of supraventricular tachycardias, including atrial flutter, atrial fibrillation and paroxysmal junctional tachycardia. In 86 patients (group 2) one atrial extrastimulus induced a paroxysmal junctional tachycardia; 79 (82%) of these patients had had spontaneous supraventricular tachycardia (SVT). In 111 patients (group 3) another type of SVT was induced: The movement of the catheter induced atrial flutter or fibrillation in nine patients, eight (89%) of whom had spontaneous SVT. Atrial pacing at a rate less than 200 bpm induced atrial flutter or fibrillation in 14 patients of whom nine (64%) had SVT. Ventricular pacing induced SVT in 15 patients, of whom 14 (64%) had SVT. An atrial extrastimulus during sinus rhythm induced atrial echoes in 62 patients, 47 (76%) of whom had SVT. The atrial extrastimulus during sinus rhythm induced atrial tachycardia in 11 patients, nine (82%) of whom had SVT.

Adolescent↗
PubMed1984

Effect of adenosine triphosphate on the accessory pathways.

To determine the site of the anterograde and retrograde conduction in the Wolff-Parkinson-White syndrome (WPW), 40 mg of adenosine triphosphate (ATP) was injected during electrophysiological studies in 53 patients with ventricular preexcitation. In 40 cases, the accessory pathway was evident (group 1) and in 13 cases it was concealed (group 2). In 10 cases in group 1, anterograde conduction was abolished with disappearance of the features of preexcitation. In 7 patients of group 1 and in 4 patients of group 2, retrograde conduction in the accessory pathway was prolonged or abolished. These effects were unexpected because ATP is a parasympathomimetic drug. There was a correlation between the Kent effective refractory period (ERP) and the action of ATP. When the drug did not change the anterograde and retrograde conduction in the Kent bundle, the anterograde accessory pathway ERP was always less than 230 ms. When ATP only decreased retrograde conduction in the Kent bundle, anterograde accessory pathway ERP was always more than 280 ms.

Adenosine Triphosphate↗
PubMed1984

Verapamil: a cause of sudden death in a patient with hypertrophic cardiomyopathy.

Sudden death was recorded by continuous ambulatory electrocardiographic (Holter) monitoring in a 62 year old man with hypertrophic cardiomyopathy and atrial fibrillation, who had been treated for four days with verapamil 360 mg orally. Analysis of the tape showed a third degree atrioventricular block followed by complete asystole. The sudden death could be related to treatment with verapamil.

Atrial Fibrillation↗
PubMed1984

[Results of the systematic application of ventricular stimulation methods].

This study was undertaken to test the validity of methods of evaluating ventricular tachycardia and in therapeutic surveillance. One hundred and thirty nine patients aged 16 to 84 years, with and without severe ventricular arrhythmias (ventricular tachycardia, VT, and fibrillation, VF) were divided into two groups after clinical, echocardiographic and 24 hour Holter investigations: Group I comprised 26 patients with a least one documented attack of VT or VF; Group II comprised 113 patients without these arrhythmias, who complained of dizziness, syncope, and/or their ECG showed a conduction defect, and so electrophysiological investigation was undertaken. A protocol of ventricular stimulation was undertaken in addition to the usual measurements of conduction times, comprising incremental ventricular stimulation from 100 to 200/min, single and paired extrastimulus in sinus rhythm and during ventricular pacing at rates of 100 and 150/min, the first extrastimulus being programmed 10 ms after the end of the ventricular effective refractory period. Excluding bundle to bundle reentry, the following results were obtained: In Group I: VT was triggered 16 times (61,5 p. 100), and in 4 of these cases VF occurred and required defibrillation. Ten patients had previous myocardial infarction; 5 patients had left ventricular dilatation. In 2 cases runs of 3 or 4 VES were recorded. No arrhythmia could be induced in 8 cases (30,8 p. 100); 5 of these patients had apparently normal hearts. In Group II: VT (greater than 5 VES) was triggered in 22 cases (19,5 p. 100) and in 4 cases this degenerated to VF requiring defibrillation. 11 patients had apparently normal hearts; 6 patients had left ventricular dilatation and 4 patients had previous myocardial infarction. 1 to 4 repetitive VES were observed in 67 cases (59,3 p. 100): the heart was judged to be normal in all patients except those with previous infarction. No correlation was established between the ability to induce VT and age, syncope, or ECG changes (especially bundle branch block). However, a correlation was found between the induction of VT and underlying cardiac disease and the method of induction of VT; in Group II, all episodes of VT were triggered by delivering paired ventricular extrastimuli on a background paced rhythm. These results show that repetitive ventricular responses can easily be triggered and that this has no pathological significance.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study].

The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. Thirty five patients (6.4%) had supraventricular tachycardia (SVT), atrial flutter (AFI), atrial tachycardia (PAT), atrial fibrillation (AF) or PJT. The anterograde Wenckebach point (AV) was over 200/min in 22 cases (4%). In 400 patients the Wenckebach point or the retrograde Mobitz II (VA') point was 170/min in 56 patients (14%). In 28 patients with spontaneous SVT in whom retrograde conduction was studied, 3 had a Wenckebach 200/min (17.7%) and 9 had a Wenckebach point (VA') greater than 170/min (32%). In 86 patients (Group II) paired atrial stimulation induced PJT. Seventy nine patients (91.8%) had PJT : AV was greater than 200/min in 19 cases (22%) and VA was greater than or equal to 170/min in 69 cases (80.2%). In 119 patients (Group III) a supraventricular tachycardia (other than PJT) was induced. Manipulation of the catheter in the atrium led to AF, AFI or PAT in 9 patients. Eight patients had SVT (80.8%), AV was greater than 200/min in one case (11.1%) and VA' greater than or equal to 170/min in 5 of the 7 cases in which it was measured (71.4%). Paired atrial stimulation induced atrial echos in 63 patients; 47 presented spontaneous SVT : AV was greater than 200/min in 7 cases (11.2%) and VA' greater than or equal to 170/min in 23 of the 60 patients investigated (38.3%). Paired atrial extrastimuli triggered AF or PAT in 18 cases : 16 cases (88.8%) had spontaneous SVT. AV was greater than 200/min in 3 cases (16.6%), VA' was greater than or equal to 170/min in 10 of the 17 cases investigated (58.8%) : 11 of these patients also had atrial echos. Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1984

[Long-duration electrocardiographic recording in 33 patients with obstructive cardiomyopathy].

A prospective study of arrhythmias was performed in 33 patients with hypertrophic cardiomyopathy with obstruction by Holter monitoring. The aim of the study was to assess the incidence of "occult" arrhythmias in this condition and to establish a "profile" of high risk patients from clinical, echocardiographic and haemodynamic data. The Holter monitoring demonstrated asymptomatic arrhythmias in 31 of the 33 patients (94%). A supraventricular arrhythmia was detected in 15 cases (45%), including 7 episodes of supraventricular tachycardia (21%). Ventricular arrhythmias were observed in 28 patients (85%), including 5 episodes of ventricular tachycardia (15%). Some patients presented several types of arrhythmia. A number of patients with arrhythmia including short bursts of ventricular tachycardia were asymptomatic during Holter monitoring; conversely, other patients complained of dizziness or syncope but had no arrhythmias. A retrospective study of clinical, echocardiographic and haemodynamic data showed no difference between patients with and patients without arrhythmias. Medium-dose betablocker therapy (propranolol, 110 mg/day) did not seem to protect patients with hypertrophic cardiomyopathy with obstruction from arrhythmias. We conclude that Holter monitoring should form part of the routine evaluation of patients with cardiomyopathy with obstruction, and that potentially dangerous arrhythmias should be treated by anti-arrhythmic agents other than betablockers. This attitude could reduce the incidence of syncope and eventually decrease the risk of sudden death in this condition.

Adult↗
PubMed1983

[Tachycardia and ensuing electrosystole].

The benign or severe nature of a ventricular extrasystole depends on a number of parameters which involve the pathophysiological mechanism of the extrasystole: re-entry, exaggerated normal or abnormal automatism and therefore the presence or absence of an underlying cardiac disease. The prognosis depends directly on the morphology, the number and the characteristics of the arrhythmia. Various investigations are often necessary to evaluate this prognosis, including 24 hour Holter monitoring, stress test and electrophysiological investigations.

Cardiac Complexes, Premature↗
PubMed1983

[Natural development of old heart valve disease].

The authors report the natural history of 36 patients with end-stage valvular disease defined by the presence of a functional stage IV and/or a 0.60 and/or dilatation of the LA 90 mm and/or dilatation of the LV 70 mm and/or increase in the systolic PAP 80 mmHg and/or a decrease in the EF of 0.45. 11 patients are alive with a mean survival of 36.8 months (30.5%) and 25 have died after a mean interval of 7.8 months. The prognosis is very poor for aortic valvular disease (14 deaths out of 16 cases), but there were only 3 deaths out of 10 patients with isolated mitral valve disease.

Adult↗
PubMed1983

[Contribution of surgery in advanced valvular diseases].

Technical advances and progress in resuscitation over the last ten years have led to an appreciable improvement in the surgical results of valve replacements. However, it appears that the decision to operate is sometimes difficult in cases of advanced valvular disease. A study of the literature and our own experience lead us believe that despite a significant peri-operative mortality, surgical treatment remains the best form of treatment for these types of valvular disease, whether aortic, mitral or multivalvular. Surgery ensures a longer survival of better quality than does medical treatment. A better understanding of the natural history of valvular disease should enable us to refer those patients to surgeons who will benefit most from a valve replacement.

Heart Valve Diseases↗