PubMed Health⌕ Search

Biomedical subjects

D Beurrier

Publications and source records attributed to D Beurrier.

80 records · Page 5Linked to original sources
PubMed1993

[Results of systematic programmed ventricular stimulation after myocardial infarction. Which protocol should be recommended?].

The authors report the prognostic value of ventricular arrhythmias induced by routine programmed ventricular stimulation after the acute phase of myocardial infarction. The protocol consisted of two extrastimuli in the first 185 patients and 3 extrastimuli in 308 patients. The use of 3 extrastimuli increased the incidence of inducible sustained monomorphic ventricular tachycardia (VT) < 270/mn, from 17 to 22% and, more importantly, that of ventricular fibrillation from 4 to 17%. Induction of ventricular flutter (monomorphic VT > 270/mn) was not increased. A long follow-up period (average 4 +/- 2 years) showed that the risk of VT was increased during the first months after infarction (n = 14), and that, 4 years later, other patients develop VT (n = 6). The risk of serious arrhythmias (VT and sudden death) was significantly higher in patients with inducible VT < 270/mn (20%) than in patients without inducible VT, but it was also higher in patients with inducible ventricular flutter (12.5%). The use of a third extrastimulus has a low positive predictive value for arrhythmic events (10%). This study confirms that the induction of sustained monomorphic VT after myocardial infarction is associated with an increased risk of arrhythmic events but the positive predictive value is relatively low (17%). In view of the risk of inducing non-specific ventricular fibrillation, the authors recommended using a stimulation protocol with only 2 ventricular extrastimuli.

Arrhythmias, Cardiac↗
PubMed1993

[Paroxysmal atrial fibrillation: main cause of syncope in hypertrophic cardiomyopathy].

The aim of this retrospective study was to determine the mechanism of syncope in idiopathic hypertrophic cardiomyopathy (HCM). An electrocardiographic study was undertaken in 43 patients with HCM: 27 (Group I) had a history of syncope and 16 (Group II) had no history of syncope but were investigated for conduction defects (n = 7) or unsustained ventricular tachycardia (VT) (n = 9). The stimulation protocol used programmed atrial pacing with 1 and 2 extrastimuli and ventricular pacing using up to 3 extrastimuli delivered at 2 sites. The following results were obtained: sustained atrial fibrillation (AF) (> 1 min) was induced in 21 patients in Group I (78%), 4 in Group II (25%); VT was induced in 3 patients in Group I (11%), and 3 in Group II (19%); infra-Hisian block was detected in 1 patient in Group I. The mechanism of syncope was elucidated in 23 patients in Group I (85%): one atrioventricular block 1 sinus node dysfunction, 18 atrial fibrillations, 2 associations of AF-VT and 1 VT. The authors conclude that the prevalence of inducible AF was higher in patients with HCA and syncope than in controls and HCM without syncope: this was the only detectable difference in 67% of patients with unexplained syncope. Paroxysmal AF could therefore explain malaise or syncope in up to 2/3 of cases of HCM.

Adult↗
PubMed1993

[Results of high amplification electrocardiogram in primary dilated cardiomyopathy].

Idiopathic dilated cardiomyopathy carries a high risk of sudden death. It is also associated with sustained ventricular tachycardia. A complex ventricular arrhythmia is recorded in 3/4 of cases on Holter monitoring which has a low specificity. The aim of the study was to determine whether signal-averaged electrocardiography could provide a better evaluation of the prognosis of this condition. The results of signal-averaged electrocardiography were compared with those of 24 hour Holter monitoring and of systematic programmed ventricular stimulation in 58 patients with idiopathic dilated cardiomyopathy. Late ventricular potentials were recorded in 13 of the 14 subjects with inducible and usually spontaneous sustained ventricular tachycardia. The sensitivity of the technique for evaluating the risk of sustained VT was therefore good (93%). Late potentials were also recorded in 9 patients with induced ventricular flutter or fibrillation, these patients being symptomatic (dizzy spells). Late potentials were also demonstrated in 14 of the 35 asymptomatic patients without inducible VT, indicating that this non-invasive investigation had a limited specificity (60%). In addition, during follow-up of the patients, the risk of sudden death was difficult to demonstrate. Late potentials were only found in subjects with inducible sustained VT but no in the other cases. In conclusion, signal-averaged electrocardiography seems to be valuable for evaluating the risk of sustained VT in subjects with idiopathic dilated cardiomyopathy and complex ventricular arrhythmias. The detection of the risk of sudden death is probably impossible by this technique.

Adult↗
PubMed1993

[Cardiac arrest reversed: causes and treatments].

The aim of this study was to report the probable mechanism of resuscitated cardiac arrest without acute myocardial infarction. Fifty-seven cases were recensed but the arrest was only documented in 44 subjects. Systematic non-invasive investigations and programmed stimulation showed that the diagnosis of cardiac arrest was probably false in 5 patients and, in the others, that a ventricular arrhythmia was probably the cause (63%). The occurrence of cardiac arrest under antiarrhythmic therapy may reveal an underlying abnormality requiring specific therapy (3/8). The absence of cardiac disease did not exclude the risk of VF (3 cases). When reproducible, ventricular arrhythmias were present during programmed stimulation, the prognosis was good if the arrhythmia could not be induced under antiarrhythmic therapy. It was easier to find an effective treatment for inducible ventricular fibrillation-flutter (13/17) than for inducible ventricular tachycardia (7/17). The prognosis was poor if the arrhythmia was unchanged during programmed stimulation under antiarrhythmic therapy and non-pharmacological treatment was required.

Adolescent↗
PubMed1993

[Incidence of inducible supraventricular tachycardia in dysplasia of the right ventricle].

Arrhythmogenic right ventricular dysplasia (ARVD) is classically associated with ventricular tachycardia and the prevalence of supraventricular tachycardia in this condition is not well known. The aim of this study was to observe the response of 20 patients with ARVD to programmed atrial stimulation and compare it with 150 subjects without cardiac disease or spontaneous supraventricular tachycardia. The protocol used 2 atrial extra-stimuli delivered on 3 paced cycles. Programmed atrial stimulation with 1 extrastimulus was repeated after infusion of 20 to 30 micrograms of Isoproterenol. Sustained supraventricular tachycardia could be induced in 13 patients with ARVD (65%) and 17 control subjects (11%) (p < 0.001). It was not possible to distinguish patients with inducible supraventricular tachycardia from those without inducible arrhythmias by electrophysiologic parameters. Isoproterenol facilitated the induction of VT but not supraventricular tachycardia. Three patients with inducible supraventricular tachycardia developed spontaneous atrial fibrillation. In conclusion, there is a relatively high incidence of inducible supraventricular tachycardia in ARVD: Isoproterenol does not facilitate this tachycardia, contrary to ventricular tachycardia.

Adult↗
PubMed1992

[Vasomotor disorders in the atherosclerotic coronary artery. Are there practical repercussions today?].

The 1980s have brought increasing evidence that coronary vasomotricity has a major role in the pathophysiology of stable angina pectoris. Specifically, it has been shown that mediators such as serotonin have opposite effects on normal and atherosclerotic coronary arteries, resulting in vasodilation and increased coronary blood flow in the former and vasoconstriction with decreased flow in the latter. Other studies have shown that, even in patients with stable angina, coronary vaso-constriction is likely to trigger clinical episodes of angina. In this regard, the adjunction of coronary vasodilator medications to medications reducing myocardial demand might prove useful in patients with stable angina.

Acetylcholine↗
PubMed1990

[Electrophysiologic effects of enoximone].

Most inotropic agents risk aggravating atrial and ventricular hyperexcitability associated with cardiac failure by their catecholergic-like effects. The aim of this study was to evaluate the electrophysiological effects of a powerful inotropic agent, enoximone, and to determine whether it had any arrhythmogenic effects. Endocavitary electrophysiological studies of conduction, induction of supraventricular tachycardia (SVT) by programmed atrial stimulation up to two extrastimuli and induction of ventricular tachycardia by programmed ventricular stimulation using up to 3 extrastimuli were undertaken before and 15 minutes after an injection of 1 mg/kg of enoximone in 10 minutes followed by an infusion of 0.75 mg/kg over 20 minutes. The studies were undertaken in 14 patients with severe cardiac disease (average ejection fraction: 26%): all had complex ventricular arrhythmias on Holter monitoring but only 7 had inducible sustained VT less than 270/mn under basal conditions. The following effects were observed with enoximone: significant shortening of all parameters of conduction; no aggravation of supraventricular excitability; no significant inducible ventricular arrhythmias in subjects without inducible sustained VT under basal conditions; facilitation of induction and acceleration of VT induced in 6 of the 7 patients with inducible sustained VT under basal conditions (VT cycle shortening from 307 +/- 13 to 240 +/- 34 ms). In conclusion, enoximone has no supraventricular arrhythmogenic effects and does not facilitate the induction of ventricular arrhythmias in subjects without inducible sustained VT under basal conditions. However, it can accelerate the VT rhythm in patients who have inducible sustained VT under basal conditions.

Aged↗