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J C Demoulin

Publications and source records attributed to J C Demoulin.

At least 73 records · Page 4Linked to original sources
PubMed1984

Clinical experience with implantable devices for control of tachyarrhythmias.

Pacing is becoming an accepted form of treatment for reentry tachycardias. The different pacing modalities available and experience with a patient-activated antitachycardia pacemaker are presented in this paper. This system has bidirectional communication between pacemaker and pacemaker-activator and between pacemaker and prescription formulator (which is a sophisticated portable stimulator used for non-invasive electrophysiological evaluation of the system). This pacemaker was implanted in 18 patients with drug-resistant tachycardias. Six patients had ventricular tachycardia, 3 had A-V nodal reentrant tachycardia, 4 had the concealed accessory pathway, and 5 had the WPW syndrome. In the 3 months before implantation the mean number of admissions for termination of tachycardia was 2.1 per patient-month. During a follow-up period of 3-26 months only 6 patients were admitted once for termination of tachycardia (0.02 admissions per patient-month). The reasons for admission of these 6 patients were: defective pacemaker activator in 2 patients, inadequate control of tachycardia in 2 patients, inappropriate use of the device in 1, and inadequate intake of medication in 1. All these problems were solved easily. Eight pacemaker activators required reprogramming, which was done in 5 patients on an out-patient basis. The interval scanning mode was used in 9 patients. Nine patients required more than 2 stimuli for reproducible termination. A step-wise increase in number of stimuli was used in 5 patients. This system has proven to be a safe and effective form of treatment of drug-resistant supraventricular and ventricular tachycardias and has resulted in marked improvement of the quality of life of these patients.

Adult↗
PubMed1984

Two-dimensional echocardiographic guiding of endomyocardial biopsy.

Two-dimensional echocardiography provides adequate spatial orientation and anatomic definition. Eighteen consecutive patients undergoing myocardial biopsy had concomitant two-dimensional echocardiography during 22 biopsies of five to six samples each. The transducer was placed at the apex and in the subcostal area and four-chamber views were used. The bioptome was seen entering the right atrium and crossing the tricuspid valve to the right ventricle. The catheter was then manipulated under two-dimensional echocardiography and the tip's position was strictly adapted, using two different classic views before sampling. The success rate in visualizing the forceps and in defining the site of sampling was 100 percent, and no complication was noted. Radiation exposure was largely reduced. Two-dimensional echocardiography to guide endomyocardial biopsy may reduce the risk of perforation by a better anatomic definition of the sampling site. It permits sampling from different ventricular sites or from the same site during serial procedures for monitoring evolution or treatment.

Adult↗
PubMed1983

Right ventricular myocardial infarction diagnosed by 99 m technetium pyrophosphate scintigraphy: clinical course and follow-up.

Out of 178 consecutive patients with acute inferior wall myocardial infarction submitted to technetium-99 m pyrophosphate scintigraphy, 49 (27.5%) were found to have concomitant right ventricular infarction. Gated blood pool scans showed right ventricular abnormalities in 21 out of 26 patients who were submitted to this investigation (right ventricular asynergy: 16 cases; right ventricular dilatation: eight cases; decreased right ventricular ejection fraction: 16 cases). Complications were common in the acute stage. Shock was noted in 19 cases (eight related to bradycardia, three related to relative hypovolaemia and eight instances of true cardiogenic shock). Atrial fibrillation (seven patients), ventricular fibrillation (eight patients) and severe atrioventricular conduction disorders (13 patients) were also frequent. In spite of this, the in-hospital mortality was low: three deaths occurred (6.1%), one from heart failure, two others from posterior septal rupture. All patients were followed up for one year or more. Six additional deaths were noted (three from left cardiac failure, two from recurrent anterior wall infarction and one from massive pulmonary embolism). Clinical assessment, haemodynamic measurements and gated blood pool scans showed significant improvement of right ventricular function with return to normal in those cases with small right ventricular infarcts as judged from technetium-99 m pyrophosphate scintigraphy. In spite of the complications seen in the initial period, patients with a right ventricular infarction have a good overall prognosis and the long-term outcome, primarily determined by the left-sided lesions, is often favourable.

Adult↗
PubMed1983

Natural evolution of atrioventricular conduction in patients with sick sinus syndrome treated by atrial demand pacing. A study of 26 cases.

The authors have followed up 26 patients with sinus node disease who were treated by atrial pacing. The follow-up duration varies between 10 months and 3 years. Assessment of A.V. conduction was performed repeatedly by atrial pacing at increasing rates. Nine patients showed a progressive, sometimes early, deterioration of their A.V. conduction system; five (19%) developed second degree A.V. block of Mobitz type I for pacing rates lower than 100 beats/min. In three of them, the pace-maker had to be replaced by a dual chamber stimulator. Deterioration of A.V. conduction seems to be more frequent in subjects with antecedents of myocardial infarction (4/5) than in others (5/21: p less than 0.05). Deterioration of A.V. conduction is not uncommon among patients with sinus node dysfunction, especially after myocardial infarction. This constitutes a serious limitation to the use of atrial pacing.

Adult↗
PubMed1983

The value of amiodarone for the treatment of unstable angina.

Amiodarone is a potent coronary vasodilator; it has alpha and beta receptor-antagonist activity and is well-known for its marked antiarrhythmic efficacy. This report describes the results of a randomized study of amiodarone in unstable angina. 40 patients (33 male, 7 female; mean age: 55) with unstable angina entered the study. They were randomized into two treatment groups. In group I (20 cases), amiodarone was the first drug applied (during the first 3 days; 1500 mg/24 hours IV + 200 mg orally every 8th hour; from day 4 onwards: 200 mg orally 3 times daily). If, after 8 hours following initiation of treatment, the symptoms were still present or recurred, nifedipine was added at a dose of 10 mg 4 times daily. In case of failure of the combined medical treatment, coronary angiography and, if needed, surgery was performed after 16 hours. In group II (20 cases), nifedipine was given as the first drug and at a dose of 10 mg every 6th hour. If, after 8 hours, this therapy failed, amiodarone was added according to the scheme previously described. In case of failure of the combined therapy, coronary angiography and surgery were performed. In group I, amiodarone was successful within 8 hours in 12 cases. None of the non-responders was improved by the addition of nifedipine. In group II, nifedipine was successful within 8 hours in 6 cases (p = 0.086). Among the 14 non-responders, amiodarone controlled the anginal episodes in 11 instances (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

The left hemiblocks: significance, prognosis and treatment.

This review article is concerned with the concept of left hemiblocks and analyses their significance, prognosis and treatment. It first stresses that the left bundle branch is not sensu stricto a bifascicular structure since it generally is either fanlike, or trifascicular. The anatomical situation, however, remains compatible with the physiological concept of the hemiblocks. The electrocardiographic features of left anterior and posterior hemiblocks are described. A histopathological investigation clearly demonstrates that both are signs of left bundle branch disease, often degenerative in nature and more widely spread than expected from the electrocardiographic terminology. The association of a left hemiblock with right bundle branch block is frequently considered as sign of poor prognosis. This is true in the setting of acute myocardial infarction where it accompanies large infarcts. In chronic cases, the prognosis is primarily influenced by the underlying pathology. Patients with partial bilateral bundle branch block should be investigated and, if needed, paced when they have symptoms, a PR interval which lengthens with the course of time, or signs of cardiomyopathy, or large anterior infarction. Asymptomatic individuals with apparent primary disease of the conducting system are neither studied, nor considered for prophylactic pacing.

Adolescent↗