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Biomedical subjects

E Aliot

Publications and source records attributed to E Aliot.

At least 37 records · Page 2Linked to original sources
PubMed2002

Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study).

BACKGROUND: In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. METHODS: The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. RESULTS: Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. CONCLUSION: Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.

Adrenergic beta-Antagonists↗
PubMed2002

Catheter ablation using very high frequency current: effects on the atrioventricular junction and ventricular myocardium in sheep.

BACKGROUND: Radiofrequency ablation is currently used in the treatment of various cardiac arrhythmias. However, this technique is limited by impedance rise, leading to coagulum formation and desiccation of tissue. We developed a new generator, providing very high frequency (27 MHz) current, which is in the intermediate range between radiofrequency and microwave energy. The aim of this study was to evaluate the results for catheter ablation of the atrioventricular junction and characteristics of the lesions obtained at ventricular sites. METHODS AND RESULTS: The generator was coupled to a specially designed 7-French coaxial catheter. The study included experiments performed on 10 sheep (Wt. 31- 42 kg). In seven sheep, the catheter was introduced into the femoral vein and advanced across the tricuspid annulus to record the largest possible His electrogram. VHF current was applied for 25 s, with increasing energies. The energy needed to obtain complete atrioventricular (AV) block ranged from 60 to 100 Watts. Six animals were observed for 6 to 21 days. Complete AV block was found to be persistent. In those seven sheep in whom AV junction was ablated and in three additional sheep, the ablation catheter was positioned toward the right ventricular apex using the same approach and into the left ventricle via the femoral artery, and 20 to 90 Watts energy was delivered in order to assess the size of the induced lesions. Side effects included ventricular tachycardia degenerating into ventricular fibrillation in six cases, but the same effect was observed in this animal model with radiofrequency energy. No cardiac perforation was noted. No thrombus was observed at the catheter tip. The size of the lesion ranged from 3 to 45 mm in width and 1 to 15 mm in depth. CONCLUSIONS: Catheter ablation using VHF current is feasible and appears effective in producing stable AV block when applied at the AV junction and results in substantial myocardial lesions. Further studies are needed to define its clinical interest and side effects.

Animals↗
PubMed2002

Task Force on Sudden Cardiac Death, European Society of Cardiology.

The European Society of Cardiology has convened a Task Force on Sudden Cardiac Death in order to provide a comprehensive, educational document on this important topic. The main document has been published in the European Heart Journal in August 2001. The Task Force has now summarized the most important clinical issues on sudden cardiac death and provided tables with recommendations for risk stratification and for prophylaxis of sudden cardiac death. The present recommendations are specifically intended to encourage the development and revision of national guidelines on prevention of sudden cardiac death. The common challenge for cardiologists, physicians of other medical specialties and health professionals throughout Europe is to realize the potential for sudden cardiac death prevention and to contribute to public health efforts to reduce its burden.

Advisory Committees↗
PubMed2002

Acute resumption of conduction in the cavotricuspid isthmus after catheter ablation in patients with common atrial flutter. Real-time evaluation and long-term follow-up.

AIMS: Cavotricuspid isthmus conduction (CIC) is closely associated with the maintenance and recurrence of common atrial flutter (AFL). This study systematically sought to assess the prevalence and characteristics of acute CIC recovery during AFL ablation and to define its predictors and its relationship with the results of long-term follow-up. METHODS AND RESULTS: A total of 124 consecutive patients (105 men, 19 women, mean age 58 +/- 11 years) who underwent successful AFL ablation were included. The procedure endpoint was defined as complete bi-directional CIC block. During an observation period of 30 min, the incidence of CIC restoration was 34.% in patients and 39.8% in applications. It increased with increasing block time and decreased over time during the observation period. Block time in successful burns followed by persistent block was shorter than in those followed by CIC resumption (12 +/- 6 vs 33 +/- 12 s, P<0.0001). A negative correlation between block time and resumption time was found (r = - 0.57, P<0.001). Patients with permanent pacemakers had a higher incidence of acute CIC resumption than those without pacemakers (5/7 vs 29/117, P = 0.007). The AFL recurrence rate was 4.8% during a mean follow-up period of 21 +/- 8 months. Our results suggest that acute CIC resumption may be a potential risk for clinical AFL recurrence during long-term follow-up. CONCLUSIONS: Acute CIC resumption in common AFL ablation varies in terms of incidence and time course. Block time has a predictive value for acute CIC recovery. Observation time can be shortened if block time is short. With longer block time, it is essential to observe for a longer period in order to minimize CIC resumption.

Atrial Flutter↗
PubMed2002

[Immediate and long-term results of radiofrequency ablation of accessory atrioventricular pathways].

The aim of this study was to report the authors' experience of radiofrequency ablation of accessory atrioventricular pathways over a 10 year period (01-91 to 10-00), and the effect of the "learning curve" on the results. The data of 400 patients admitted to primo-ablation of a bundle of Kent was analysed retrospectively. A total of 481 ablations were performed (1.20 per patient). The cumulative global success in the 414 accessory pathways treated was 90.6%. The primary success rate increased from the 1st to the 4th quartile from 68 to 97% (p = 0.0001). The mean duration of fluoroscopy and number of ablation sites decreased from the 1st to the 4th quartile respectively from 47 +/- 27 to 25 +/- 18 minutes (p = 0.0001) and from 8.5 +/- 7.8 to 4.5 +/- 3.8 minutes (p = 0.0001). The average recurrence rate over the four quartiles was 3.6. The overall complication rate was 1.44%. The improved primary success rate from 1991 to 2000 and, in parallel, the reduction of the number of inappropriate ablation sites and fluoroscopy duration are explained not only by the "learning curve" of our centre but also by the benefits of the application of scientific acquisitions (unipolar recordings, criteria for ablation site localisation...) and technical progress (ablation with temperature monitoring...) over this period.

Adult↗
PubMed2002

[Treatment with lepirudin in heparin-induced thrombocytopenia. A case report].

We report the case of a 71 old woman presenting a bilateral massive pulmonary embolism with intraventricular right thrombus complicating heparin induced thrombocytopenia (HIT) persistent after one month of conventional anticoagulant processing. We underline the effectiveness of lepirudin (Refludan) in the curative processing of pulmonary embolism allowing here to avoid a complex surgical thromboembolectomy. We evoke the place of this molecule in the curative therapeutic strategy of HIT with thrombotic phenomena.

Aged↗
PubMed2001

[Prevalence of hyperhidrosis in a population treated by beta-blocker].

INTRODUCTION: Some cases of hyperhidrosis with beta-blocker therapy have been reported in the literature. We studied the prevalence of hyperhidrosis in a population treated by beta-blockers compared with an untreated control group. PATIENTS AND METHODS: Patients attending the cardiologic consultation of the Nancy hospital were included. Past medical history and medication were collected. Interrogation assessed whether the patient felt hyperhidrosis, and defined a hyperhidrosis score. RESULTS: Sixty-five subjects treated by beta-blocker and 100 controls were included. 36.9 p. 100 of treated patients and 38 p. 100 of controls experienced hyperhidrosis (p=0.88). 23.07 and 23 p. 100, respectively, had hyperhidrosis defined by a high score of sweating (p=0.99). Retrospectively, 8 of 24 patients experienced hyperhidrosis after the beginning of beta-blocker therapy. DISCUSSION: We observed the same prevalence of hyperhidrosis in the two groups. However sweat gland innervation involved both cholinergic and adrenergic stimulations. Furthermore, experimental studies showed an increase in sweating on efforts with beta-blocker therapy.

Adrenergic beta-Antagonists↗
PubMed2000

[The best of arrhythmias in 1999].

Recent studies of atrial fibrillation, or rather "atrial fibrillations", have been based on focal atrial fibrillation which seems to be one of the commonest forms of paroxysmal atrial fibrillation. This observation led to the possibility of ablative therapy, usually near the pulmonary veins. Technological advances are awaited before a wider diffusion of this therapy becomes possible. In the field of defibrillation, the MUSTT study demonstrated the value of implantable defibrillators in the prevention of sudden death, in this trial in the case of asymptomatic high risk patients after myocardial infarction, with a decreased ejection fraction and non-sustained ventricular tachycardia. Two large scale randomised controlled trials (MERIT-HF and CIBIS II) have confirmed the value of betablockers in preventing sudden death, in patients with moderate or severe cardiac failure in association with classical treatment by diuretics, ACE inhibitors and digitalis. Similarly, for spironolactone, the RALES study showed a reduced incidence of sudden death in cardiac failure, as its physiopathological modes of action suggested. New techniques of three-dimensional mapping have confirmed their value. Finally, significant progress has been made in the field of genetics of cardiac arrhythmias, indicating that, in years to come, it will be possible to identify most of the genes responsible for conditions predisposing to arrhythmias.

Adrenergic beta-Antagonists↗
PubMed1999

Significant improvement of quality of life following atrioventricular synchronous pacing in patients with hypertrophic obstructive cardiomyopathy. Data from 1 year of follow-up. PIC study group. Pacing In Cardiomyopathy.

AIMS: Atrioventricular synchronous pacing exerts beneficial effects, including reduction of left ventricular outflow tract gradients, in patients with hypertrophic obstructive cardiomyopathy. The Pacing in Cardiomyopathy study was initiated to explore the effects of pacing in a double-blind randomized crossover fashion. The aims were to ascertain the beneficial effects of pacing in a controlled study and to rule out a placebo effect by pacing. This paper deals with the outcome of pacing on quality of life during 1 year of follow-up. METHODS: Quality of life was evaluated with the Karolinska questionnaire, validated for patients paced for bradyarrhythmias and ischaemic heart disease. Drug-refractory patients with hypertrophic obstructive cardiomyopathy were recruited for the study and after a temporary pacing procedure implanted with permanent pacemakers. Patients were randomized to two study arms defining the sequence of pacemaker programming. In one arm the pacemaker was inactive, in the other active. After 3 months the pacemaker was reprogrammed to the alternate mode and a further 3 months followed. After this period subsequent pacemaker programming corresponded to the mode preferred by the patient. A last assessment was made 1 year after baseline examinations. RESULTS: Eighty patients completed the first crossover period and 75 completed the full 1 year of follow-up. Active pacing induced significant quality of life improvements, in the order of 9-44%, regardless of programming sequence. Discontinuation of pacing after a first active period resulted in the return of symptoms. Fourteen patients requested early reprogramming after having been programmed to inactive pacing after a first period of active pacing. Seventy-six patients preferred active pacing after the crossover period. A further 6 months of pacing induced progressive improvement in symptoms already favourably influenced. CONCLUSION: Atrioventricular synchronous pacing has a profound beneficial effect on most domains of quality of life in patients with hypertrophic obstructive cardiomyopathy refractory to drug treatment.

Adult↗
PubMed1999

Accuracy and limitations of published algorithms using the twelve-lead electrocardiogram to localize overt atrioventricular accessory pathways.

INTRODUCTION: The purpose of this study was to evaluate the accuracy and limitations of published algorithms using the 12-lead ECG to localize AV accessory pathways (APs). METHODS AND RESULTS: The 11 relevant algorithms found in the literature (MEDLINE database and major scientific sessions) were tested on a series of 266 consecutive patients who successfully underwent radiofrequency catheter ablation of a single overt AV AP. The positive predictive values (PPV) of the algorithms in applicable patients were significantly lower for algorithms with > 6 accessory location sites (40.6% +/- 10.9% vs 61.2% +/- 8.0%; P < 0.03) and show a tendency for algorithms not relying on delta wave polarity but on QRS polarity only (36.6% +/- 11.2% vs 52.3% +/- 13.1%; P = 0.09). The PPV in applicable patients is related to the AP location (P < 0.001) and ranked from the highest to the lowest as follows: left lateral (mean PPV = 86.3%), posteroseptal (mean PPV = 65.2%), right anteroseptal (mean PPV = 45.2%), and right posterolateral (mean PPV = 23.4%). CONCLUSION: Our study suggests that the accuracy of algorithms relying on the 12-lead ECG depends on AP locations as defined in the algorithms and on the number of AP sites. The accuracy tends to be lower when delta wave polarity is not included in the algorithm's architecture. This should be considered when using these algorithms or when building new ones.

Adolescent↗
PubMed1999

[Evaluation of the risk of sudden death in hypertrophic cardiomyopathy].

Hypertrophic cardiomyopathy (HCM) is defined as primary hypertrophy of the heart muscle, usually the left ventricle which is not dilated. HCM is a relatively common disease with a prevalence estimated at about 1 in 500. It is a complex disease with relatively stereotypical anatomical features but a very variable clinical presentation with a major risk of complication. All forms may be observed from almost asymptomatic hypertrophy to severe familial forms with multiple cases of sudden death. Over the last few years, molecular studies of the genetic abnormalities responsible for HCM have improved our understanding of the clinical variability of this disease. Schematically, HCM is caused by mutation of one of 4 genes which code the proteins of the sarcomere: the gene of the heavy chain of beta-myosin, the gene of cardiac T-troponin, the gene of alpha-tropomyosin and the gene of protein C linked to cardiac myosin. The main problem for clinicians is not making the diagnosis, which is relatively simple by echocardiography, but to assess the risk of complications, especially in adolescents and young adults. Patients over 40 to 45 years of age pose fewer problems as their disease is generally associated with a better prognosis since they have already survived to that age. There are many prognostic factors of sudden death, a reflection of the multifactorial character of sudden death in this disease. Four major risk factors have been identified: a family history of sudden death, abnormal blood pressure changes on exercise, a history of syncope and non-sustained ventricular tachycardia on 24 or 48-hour Holter monitoring. In children and adolescents, only the first three factors may be used, knowing that syncope, though rare, carries a very poor prognosis. On the other hand, in adults up to 40, all 4 factors are valid. Unfortunately, their positive predictive value is relatively poor, all the patients with one of these risk factors not automatically experiencing sudden death. On the other hand, their negative predictive value is excellent. Therefore, a patient with none of these factors has an excellent prognosis and should be allowed to lead a normal life. The risk is considered to be high when 2 or 3 of the factors are associated, theoretically justifying aggressive management (amiodarone? defibrillator?). Finally, there is no established management protocol in cases with a single risk factor. The discovery of mutations causing HCM will probably open up new methods of assessing the risk of sudden death in this disease. It would seem to be possible to assess the impact of the genotype on prognosis. However, this "genetic stratification" remains the realm of top research teams and is not yet accessible routinely in clinical practice.

Adolescent↗