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Biomedical subjects

C Barnay

Publications and source records attributed to C Barnay.

At least 55 records · Page 3Linked to original sources
PubMed1982

Electrophysiological classification of normal and pathological sinus node function.

The sympathetic and parasympathetic neurological cardiac effects were blocked with atropine and propranolol. The intrinsic heart rate (IHR) was determined and rapid atrial pacing (RAP) was carried out before and after administration of the drugs. The primary and secondary postpacing parameters were examined in both circumstances. Normal (n = 31) and pathological (n = 20) cases were differentiated on the basis of the IHR. In the secondary phase (PPC 2-10) after autonomic blockade returned to the basic frequency was of exponential character in the great majority of normal IHR cases. Anomalies may appear in both the primary and secondary phases. They are of different types: one of them concerns the recovery time; another electrophysiological anomaly occurs when there is no return to the predrive normal cycle length after pharmacological neurotomy. In the secondary phase there may appear sinoauricular blocks. They may depend on or appear independently of the effect of the vegetative nervous system. The new test allows a physiopathological classification of normal and pathological sinus node function.

Adult↗
PubMed1981

[Sinus node disease - diagnosis and treatment].

The concept of sinus node disease is defined by a group of clinical and electrocardiographic features related to sinus node dysfunction whatever its mechanism; the organicity of the disease can be proven if total or subtotal histological alterations of the sinus node are demonstrated. The most typical symptoms are neurological (syncopes and dizziness). Sinoatrial block, sinus arrest, sinus bradycardia or bradyarrhythmia, and the bradycardia-tachycardia syndrome are the most usual electrocardiographic aspects. The diagnosis is often rendered difficult by the usually intermittent and frequently nonspecific character of the symptoms and of the ECG signs. Holter monitoring is often essential to resolve these difficulties. If the diagnosis remains dubious, the use of electrophysiological methods is necessary: direct recording of the sinus nodal intracardiac potential can now be added to the classical rapid and premature atrial stimulation, possibly complemented by pharmacological tests. Finally, therapeutic indications can be considered after a correct clinical, electrocardiographical and electrophysiological evaluation of the patient. Medical treatment alone is usually ineffective in controlling the attacks of arrhythmia and the neurological episodes. If the sinus nodal dysfunction is obvious and symptomatic, permanent pacing is the treatment of choice. Its short and medium term results are generally excellent, while the long term results, especially with regard to survival of the patients, could be improved by the most recent pacing techniques.

Aged↗
PubMed1981

Wolff-Parkinson-White syndrome: T wave abnormalities during normal pathway conduction.

Forty-five patients with Wolff-Parkinson-White syndrome (WPW) were reviewed. The preexcitation using Boineau's classification was: right anterior (six patients), left lateral (nine patients), right posterior (15 patients) and left posterior (15 patients). Normal pathway conduction was observed to occur either spontaneously or after administration of ajmaline, procainamide, or by eye-ball pressure. Disappearance of preexcitation was associated with T wave abnormalities in 39 patients (86.6%). The orientation of the T spatial vector (SAT), after suppression of the WPW aspect, varied according to the site of ventricular preexcitation. In eight patients with left lateral ventricular preexcitation (LLVP), the frontal T wave axis was between +70 degrees and +120 degrees (mean +92 degrees) and the horizontal T wave axis was located in the left anterior quadrant. In the five patients with right anterior ventricular preexcitation (RAVP), the frontal axis was between + 40 degrees and - 10 degrees (mean + 26 degrees) and the horizontal axis was in the left posterior quadrant. The 26 cases with right posterior ventricular preexcitation (RPVP) and left posterior ventricular preexcitation (LPVP) had a frontal axis between - 10 degrees and - 70 degrees (mean -39 degrees) and the horizontal T wave axis in the left anterior quadrant. This study suggests that the T wave anomalies observed after suppression of the WPW aspect are in direct relation to the localization of the preexcitation according to Boineau's classification. The analogy between the abnormalities of the T wave and those which are observed after right ventricular pacing (VP) or after disappearance of left bundle branch block (LBBB) is discussed.

Adolescent↗
PubMed1980

[Sinus node dysfunction. Clinical outcome and results of cardiac pacing].

112 patients (average age 66 +/- 13 years) with sinus node dysfunction, selected on clinical, electrocardiographic and electrophysiological criteria, were followed up for a period of 3 to 55 months (average: 30,2 months). Permanent cardiac pacing was instituted in 59 patients (52,6 p. 100), and the remaining patients treated medically. 25 patients were lost to follow up (22,3 p. 100: 5 paced, 20 non paced). 16 patients died (14,2 p. 100): mortality was relatively early (average 11,7 months) and higher in patients with pacemakers (15/16); the causes of death were acute heart failure (8 cases), and cerebral vascular accident (3 cases). In the surviving paced patients neurological symptoms completely regressed. In this series, the life expectancy of patients with sinus node dysfunction seemed to depend mainly on the state of their myocardium, but the functional prognosis was clearly improved by cardiac pacing.

Adolescent↗
PubMed1979

[Syncope and transient neurologic deficits of undetermined origin. Clinical and electrophysiological correlations].

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.

Adolescent↗
PubMed1977

[Sinus dysfunction and nodo-hisian conductive disorders. Indication for definitive cardiac stimulation].

A consecutive series of 80 patients has been the object of intracavitary electrophysiological studies, including a study of sinus function and of node/His conduction, before implantation of a definitive cardiac pacemaker. Investigation of the sinus yielded normal or insignificant results in 32 cases. It revealed certain criteria of "major" sinus dysfunction (TRSC 1000 ms; more than compensatory return cycles where there was SAP) in 39 cases, made up of 18/20 in group I (documented evidence of sinus malfunction), 10/14 in group II (sinus bradycardia less than or equal to 55/mn), 9/44 in group III (A-V conduction defects), and 2/2 in group IV (paroxysmal supraventricular tachycardia); criteria of "minor" sinus dysfunction (TRSC between 550 and 1000 ms, TECASA greater than 210 ms) were found in only 9 cases (group I--1; group II--2, group III--6). The association of sinus malfunction with node/His conduction defects was found in 29 cases, the site of the AV block being nodal in 7 cases, intra-His in 2 cases, infra-His in 10 cases, and a combination of nodal and infra-nodal in 10 cases. In 59 cases, the severity of the AV block (40 cases), of the sinus malfunction (17 cases) or of the sinus bradycardia (2 cases) was already obvious, and investigation of the sinus was not critical in determining the indications for a cardiac pacemaker. In 21 cases, however, this investigation was a determining factor, and most especially in 12 cases from group II. Sinus investigation seems to represent, in addition, a valuable indicator for the decision to install a pacemaker in a certain number of litigious cases.

Arrhythmias, Cardiac↗
PubMed1977

[Auricular fibrillation with ventricular tachycardia. Surgical section of a left lateral bundle of Kent].

The authors report the case of a man of 22 years, with no previous cardiac history, in whom a Wolff-Parkinson-White syndrome was discovered during the course of this first episode of atrial fibrillation with a ventricular rate of 300-350/mn; investigation (vecto-cardiogram, intra-cavitory ECG) showed the presence of a short circuit of the Kent type, with a high permeability, and localised in the left lateral position; this was confirmed by pericardial cartography. After the surgical division of the accessory pathway, the electrical phenomenon of pre-excitation disappeared. The current possibilities of operating on cases of a Wolff-Parkinson-White syndrome justify carrying out a scrupulous electrophysiological study of each case, so that any accessory pathway can be precisely localised, and its refractory period determined; thus a pathway of preexcitation localised in the left lateral position, and having a short refractory period leading to a high ventricular rate under atrial fibrillation conditions, constitutes an indication for operation which may be urgent.

Adult↗
PubMed1977

[Effect of a depressant drug on the recovery time of the sinus. Attempt of application to the diagnosis of sinus dysfunctions].

The authors have studied the effect of a depressant drug, 71247 or piprofurol, on the recovery time of the sinoatrial node after rapid electrical stimulation of the atrium (CSRT). 72 patients, divided into three groups, underwent the test: 14 patients with documentary evidence of sinus dysfunction; 48 patients in whom a sinus disorder was suspected, and 10 controls. As a general rule, the sinus recovery time was found to be significantly prolonged in the patients as compared with the controls. The authors have applied this test to the diagnosis of latent sinus dysfunction, categorising three different degress of RESA values: normal (less than or equal to 550 ms), average (between 550 and 1,000 ms), and prolonged (greater than 1,000 ms). In 6 patients from group one and seven from group two, the post-stimulatory pause was normal or average before the test, and prolonged after the injection of 71247; on the other hand the test did not give evidence of any prolongation of the pause in the controls. In this way a dynamic pharmacological test of depression brings and interesting slant on the diagnosis of disorders of the sinus.

Anti-Arrhythmia Agents↗
PubMed1976

[Gap phenomenon and supranormal conduction during intermittent left bundle-branch block].

The mechanism of intermittent bundle branch block, whether spontaneous or as a result of vagal stimulation, can be studied by reference to the known facts of atrial stimulation. Three cases with intermittent left bundle branch block were studied by means of an intracavitary electrode, which allowed the potential of the bundle of His to be measured, and was also used for the extrastimulus method of study. In case 1, in which the block was independent of the cardiac rate, a type 1 "Gap" phenomenon (of nodal origin) was demonstrated; the coupling zone in which the extrastimulus overcame the block was situated in two areas, one being late, and the other earlier in a region where the conduction was normal. In case 2, in which the block was dependent upon the heart rate, the "recovery" of the blocked branch after early coupling of the extrastimulus seemed to be associated with the phenomenon of "supra-normal" conduction. In case 3, in which the block was again dependent upon heart rate, the two phenomena of "Gap" and "suppranormality" seemed to act successively when the coupling of the extrastimulus is decreased progressively. These observations allow us to distinguish two types of intermittent left bundle branch block; one, which is not related to heart rate, is characterised by a prolonged refractory period of the left bundle branch, which becomes progressively shorter as the heart rate increases; the other, which is dependent upon tachycardia, is characterised on the one hand by an increased left bundle branch refractory period which does not shorten as the heart rate increases, and on the other by the phenomenon of supranormal conduction.

Bundle of His↗