[Indications and surveillance of lignocaine and diphenylhydantoin treatments].
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Biomedical subjects
Publications and source records attributed to G Motté.
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Report of one unhabitual case of reciprocal rhythm with anterograde conduction through James' fibres and retrograde conduction through the normal nodal pathways. The reality of an anterograde nodal short-circuit is indicated by many arguments, and in particular by the presence of a double ventricular response, after induced atrial premature beats reaching the ventricle once by the rapid pathway and the second time by the slow pathway.
A 28-year-old woman, with no previous cardiovascular history, was hospitalized for myocardial infarction complicated by bifascicular block followed by complete atrio-ventricular block with a regressive course. A coronary arteriography performed on the 10th day demonstrated a thrombosis of the anterior interventricular artery, the rest of the coronary network being normal. The influence of a dyslipidaemia and the taking of oral contraceptives was discussed as an aetiology.
Stimulation of the bundle of His and of the uppermost portion of the interventricular septum gives us an opportunity to make a precise study of capture phenomena in patients with paroxysmal nodal tachycardia. According to whether the capture is correctly timed, delayed, or unusually premature, the inferior junction point of the reentry circuit can be located precisely by reference to the H wave and the onset of the R wave. Out of a series of 65 patients, only 30 of whom had a true WPW syndrome, it was shown that 43 cases had a bundle of Kent which ensured retrograde conduction during the tachycardia, and was therefore the seat of a unidirectional block in 13 cases. In 22 cases (33.8%) the diagnosis of WPW syndrome was excluded, but the reentry circuit was nevertheless not of nodal origin. The inferior junction point of the circuit was effectively situated between H and R in 12 cases, and at H in 5. In only 5 cases (7.8%) might there have been a reciprocal intra-nodal rhythm, which should not necessarily be taken as proof of its existence. The validity of the classical criteria in localising the reentry circuit is discussed.
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