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Biomedical subjects

J F Leclercq

Publications and source records attributed to J F Leclercq.

At least 19 recordsLinked to original sources
PubMed1992

Flecainide in quinidine-resistant atrial fibrillation.

Flecainide (100 mg twice daily) was used for prevention of paroxysmal atrial fibrillation (PAF) in 52 patients with frequent symptomatic attacks that were resistant or intolerant to quinidine (600-900 mg/day). Underlying heart disease was present in only 8 cases and left ventricular ejection fraction was always greater than 30%. No patient had had a myocardial infarction. Vagally induced PAF was clinically documented in 35 patients. Amiodarone, previously used and ineffective, was combined with flecainide in 33 patients. After 1-5.8 years of follow-up, complete disappearance of PAF was observed in 38 patients (73%). The success rate was slightly higher in patients with vagally induced PAF (p = 0.07). Extracardiac side effects necessitated withdrawal in only 3 cases. Permanent pacemaker was needed in 7 patients on amiodarone and flecainide because of excessive sinus bradycardia. Two patients, with previously documented atrial flutter, experienced presyncopal episodes of atrial flutter with 1:1 atrioventricular (AV) conduction and wide QRS complex. No death occurred during the follow-up. In this series, quinidine proved to be unsuccessful in 46 patients and it was withdrawn in 6. We concluded that flecainide is efficient and well tolerated for long-term prevention of PAF in patients resistant to quinidine. The possibility of 1:1 AV conduction during atrial flutter may suggest the use of verapamil or beta blockers in combination with flecainide in patients with previously documented atrial flutter.

Amiodarone↗
PubMed1992

Efficacy of beta-blocking agents in reducing the number of shocks in patients implanted with first-generation automatic defibrillators.

The efficacy of beta-blockers was tested in 11 patients who avoided sudden death as a result of ventricular tachycardia or fibrillation due to coronary artery disease or non-ischaemic underlying heart disease, after implantation of an automatic defibrillator. Ten patients initially tolerated acebutolol despite prior class III or IV heart failure in six cases; nadolol replaced acebutolol in nine cases for long-term therapy. In these 10 patients, periods of treatment with and without beta-blocking agent were available, making possible a crossover comparison, during a follow-up lasting 31.6 +/- 17.8 months. One hundred and ten shocks were delivered: 14 were considered as probably inappropriate and ruled out, leaving the remaining 96 shocks to be analysed. The monthly rate of shocks was lower during beta-blocking treatment: 0.12 +/- 0.24 vs. 1.09 +/- 1.41 (P = 0.03). While taking beta-blockers, only four patients received shocks, compared to 10 (i.e. all cases) not administered beta-blockers (P less than 0.01). Despite the technical limitations of the study, since only a few spontaneous shocks could be documented on ECG recordings, the efficacy of beta-blockers in preventing occurrence of severe ventricular tachyarrhythmias seems likely, and deserves further investigations using new implanted devices with improved memory functions.

Acebutolol↗
PubMed1992

[Value of signal-averaged electrocardiogram in ventricular arrhythmia without apparent heart disease].

Signal-averaged electrocardiography was performed in 132 subjects with various ventricular arrhythmias without clinically apparent heart disease and compared with the results obtained in a series of 45 normal subjects. The latter enabled definition of the following criteria of normality: QRS duration after averaging < 113 ms; Simson vector of the last 40 ms (RMS40) > or = 17 microV; low amplitude signal duration over 40 microV < 38 ms for a high pass bidirectional filter of 40-300 Hz. Complementary investigations (echo or angiography), performed in all cases, showed underlying abnormalities in 26 patients: 13 right ventricular dysplasias, 7 cardiomyopathies, 3 mitral valve prolapses and 3 minor congenital heart defects. These investigations were normal in the remaining 106 subjects. Of the 26 patients with cardiac disease, 15 had 3 criteria of positivity for late ventricular potentials, 6 had 2 criteria and the other 5 had no criteria of late ventricular potentials. Therefore, 81% of cases with cardiac disease had at least 2 diagnostic criteria of late ventricular potentials whereas only 4% of those without cardiac disease, and in the control group, had criteria of positivity (p < 0.001). Using these criteria, the predictive value of signal-averaged electrocardiography for the detection of underlying cardiac disease was good when 2 criteria are required for diagnosis of late ventricular potentials: sensitivity 81%, specificity 96%; predictive value of a positive test 78%, predictive value of a negative test 97%. Signal-averaged electrocardiography is therefore a good non-invasive method of diagnosing underlying cardiac disease in patients with ventricular arrhythmias without clinically apparent heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Long-term follow-up after sustained monomorphic ventricular tachycardia: Causes, pump failure, and empiric antiarrhythmic therapy that modify survival.

We analyzed the actuarial cardiac mortality rate of 295 consecutive patients with sustained monomorphic ventricular tachycardia who were referred to us between 1978 and 1988. Patients were divided into four groups: group I of 156 patients with coronary disease, group II of 55 patients with nonischemic left ventricular disease, group III of 65 patients with right ventricular disease, and group IV of 19 patients without detectable heart disease. Patients were treated empirically according to a prospective schema: (1) class I antiarrhythmic drugs, (2) in case of recurrence of ventricular tachycardia: amiodarone or beta-blockers, (3) in case of recurrence of ventricular tachycardia: drug combinations or surgery. The mean follow-up duration was 61 +/- 40 months after the first occurrence of ventricular tachycardia, and the clinical outcome was known in 67.5% of patients at 5 years. The actuarial mortality rates were considerably higher in groups I and II compared with those in groups III and IV (p less than 0.01). The mortality rate was slightly higher in group I than in group II (p less than 0.05). In groups I and II, actuarial mortality rate were much higher when left ventricular ejection fraction was less than 0.30 (p less than 0.01). Comparisons between treatments showed no difference in actuarial mortality rates in patients with ventricular tachycardia and left ventricular ejection fraction greater than 0.30.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

Sudden cardiac death, implanted defibrillation, and clinical electrophysiology.

A mere 25 years ago, the technique of external defibrillation became the starting point for the development of clinical electrophysiology by permitting routine use of endocavitary programmed electrical stimulation of the heart without undue risk. Major advances in knowledge of clinical arrhythmias and the understanding of their mechanisms were, thus, permitted. Mirowski's implanted defibrillator also constituted a major breakthrough therapeutically; unfortunately, however, some 10 years later, it has not yet induced similarly hoped for consequences in terms of progressing knowledge concerning lethal arrhythmias, largely due to the absence of Holter functions in the implanted devices. As a result of this, in our opinion, better established therapeutic indications are still needed. The reasons for the present situation, we believe, may be partly technical but are conceptual as well. The key point is that even the clear demonstration of the great practical efficacy of a therapeutic tool does not exempt us from the obligation of determining the mechanisms of this effect.

Arrhythmias, Cardiac↗
PubMed1991

[Implantable automatic defibrillator. Evaluation after 8 years of use].

The thirty nine patients (30 men and 9 women, mean age 49 +/- 14 years) who were implanted with an automatic cardioverter defibrillator (AICD) between October 1982 and April 1990 were reviewed retrospectively. This group included 22 patients with ischaemic cardiomyopathy (55%), 9 primary cardiomyopathies (23%) 5 ventricular tachycardias in patients with normal hearts (13%), 1 case of arrhythmogenic right ventricular dysplasia and two of mitral valve prolapse. The mean ejection fraction for the whole group was 38 +/- 14%. The indication for implantation of the AICD was life-threatening ventricular arrhythmias for which other forms of treatment were either ineffective (29 patients), impossible to assess (9 patients) or poorly tolerated (1 patient). Two patients died during the perioperative period and the follow-up is too short in two other cases. Therefore, 35 patients were studied over an average of 23.7 +/- 16 months. During follow-up, 5 patients died, 3 of progressive cardiac failure and 2 suddenly, one of whom was waiting for a replacement of an exhausted generator. The AICD never functioned in 40% of patients. In addition, it was impossible to determine for the majority of shocks delivered if they had been triggered by a sustained ventricular arrhythmia. Long term tolerance was generally good but two patients developed cardiac constriction induced by the epicardial patch electrodes. The results of this review confirm the efficacy of AICD in preventing sudden death at the expense of a low operative mortality and with good long term tolerance. Quite a large proportion of AICDs never functioned and the interpretation of the delivered shocks remains questionable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Life expectancy after a first attack of sustained monomorphic ventricular tachycardia. Apropos of 295 patients with a follow-up of more than 5 years].

Analysis of actuarial cardiac mortality of 295 patients after a first attack of sustained monomorphic ventricular tachycardia followed up for an average of 5.1 years showed that: the aetiology was the main prognostic factor. Patients with a normal left ventricle had a zero 5 year mortality rate (normal heart) or 3% (arrhythmogenic right ventricular dysplasia) compared with 24% in patients with cardiomyopathy and 40% with myocardial infarction: p less than 0.01. Similar results were obtained if sudden death was considered; in patients with left-ventricular disease, the role of pump function assessed by the ejection fraction was essential: the 5 year mortality was 14.5% (cardiomyopathy) and 30% (myocardial infarction) if this was greater than 0.3 compared to 43% and 51% respectively when less than 0.3 (p less than 0.01); the heart rate of spontaneous ventricular tachycardia and that of tachycardia induced during endocavitary investigation had no influence on the mortality. However, the mortality following a first tachycardia with syncope was higher than that following a well tolerated tachycardia (p less than 0.5 if the ejection fraction less than or equal to 0.3 and p less than 0.001 if greater than 0.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

Flecainide acetate dose-concentration relationship in cardiac arrhythmias: influence of heart failure and amiodarone.

The trough concentration-dose (C/D) ratio of flecainide was prospectively studied in 78 patients with various cardiac arrhythmias. After the removal of two outlier values, no influence of body weight on C/D ratio was evidenced. Coadministration of amiodarone, and, moreover, the presence of heart failure increase the C/D ratio, from 2.01 +/- 0.78 to 2.55 +/- 0.37 and 2.9 +/- 1.19 ng/ml/mg, respectively (p less than 0.001 by two-factor analysis of variance). The presence of both heart failure and amiodarone therapy increases the C/D ratio to 3.88 +/- 1.07 ng/ml/mg. A single loading oral dose (30 mg/kg) of amiodarone increased C/D measured at the sixth hour in nine patients from 2.27 +/- 0.50 to 2.57 +/- 0.73 ng/ml/mg (p less than 0.05). The trough C/D ratio increased more during chronic treatment from 2.03 +/- 0.86 to 2.92 +/- 1.32 ng/ml/mg (p less than 0.05). Thus, a dosage reduction of flecainide (of 50% in some cases) is mandatory, in case of heart failure or the combination with amiodarone therapy, to obtain a plasma level of the drug that is similar to those observed in patients with a normal heart and without amiodarone therapy. The flecainide-amiodarone interaction seems time dependent.

Adult↗
PubMed1990

Predictive value of electrophysiologic studies during treatment of ventricular tachycardia with the beta-blocking agent nadolol. The Working Group on Arrhythmias of the French Society of Cardiology.

Sixty patients with recurrent inducible sustained ventricular tachycardia were prospectively treated with nadolol (40 or 80 mg/day). Old myocardial infarction was present in 43 patients and dilated cardiomyopathy in 12. In group I (n = 36), nadolol was given alone, whereas in group II (n = 24), previously ineffective treatment with amiodarone was continued in combination with nadolol. Left ventricular ejection fraction was higher in patients in group I (0.40 +/- 0.12) than in group II (0.30 +/- 0.10, p less than 0.01) patients. Electrophysiologic study was repeated after short-term treatment with nadolol, which was continued regardless of the results of this test, according to the scheme of the parallel approach. Recurrence of spontaneous tachycardia or sudden death occurred in 21 patients after 10 +/- 9.2 months; sustained tachycardia was inducible in 19 on nadolol therapy. The remaining 39 patients (of whom 21 had inducible tachycardia while taking the drug) have had no recurrence of tachycardia after 27.8 +/- 9.3 months of follow-up study. Sensitivity, specificity and predictive value of a positive and negative test were 90.5%, 46%, 47.5% and 90%, respectively. The results differ between group I and group II patients, the latter having a high percent of false positive responses. This difference is even more obvious with respect to left ventricular ejection fraction: the predictive value of a positive test was 86% when ejection fraction was greater than 0.40 and 39% when it was less than 0.40.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Signal-averaged electrocardiography in right ventricular dysplasia].

The authors report their experience of signal-averaged electrocardiography (SAE) in arrhythmogenic right ventricular dysplasia (ARVD) in a study comparing the results in 40 control subjects, 21 patients with ARVD with episodes of sustained monomorphic ventricular tachycardia (VT) (Group I), 7 patients with ARVD without sustained VT (Group II) and 10 asymptomatic members of the families of patients in Group I (Group III). There were significant differences in the results of SAE in the time domain between the control group and Group I, patients with "classical" ARVD. The RMS 40 (root mean square of the last 40 ms of the QRS complex) was the most sensitive parameter but the specificity was less than the averaged QRS width and the low amplitude signal duration. The results in Group II were more varied, some patients having clearly abnormal SAE and others strictly normal recordings. In Group III, the investigation was normal. Spectral analysis after Fourier transformation did not show significant differences between the 3 groups. A difference was observed between the diffuse and localised forms of ARVD in Groups I and II: the localised forms had a shorter QRS width and low amplitude signal duration than the diffuse forms. Also, there was a relationship in Group I between age and duration of QRS and delayed potential which increased and with the RMS 40 or 50 which decreased. This is an argument in favour of the progressive nature of ARVD with respect to time.

Adult↗
PubMed1990

[Late potentials and arrhythmogenic right ventricular dysplasia].

The authors report on their experience in investigating late potentials (LPs) in arrhythmogenic right ventricular dysplasia (ARVD), by comparing 35 patients with ARVD with 40 control subjects. The values of QRS and RMS40 and the duration of the LP showed a marked difference between the control group and the ARVDs, particularly if sustained VT was present. In this case, 68 per cent of patients were found to have LPs (with at least 2 out of 3 parameters abnormal) versus 50 per cent in the ARVDs without sustained VT and 5 per cent in the controls. There was a difference between the diffuse forms (10 per cent) and the localized forms (25 per cent) of ARVD: the LPs were markedly more obvious in the diffuse forms. Likewise, there was a clear relationship between age and the criteria for LPs in ARVD with sustained VT. This is an argument in favour of the evolutive character of the disease, which could be observed directly in a few cases in which the examinations were repeated over the course of time.

Adult↗
PubMed1989

Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases.

The study of the tapes of ambulatory patients who died while wearing Holter devices allows us to know the terminal electrical events of death in these cases and which are the electrical triggering mechanisms leading to the terminal event. From the evaluation of seven published series with 10 or more cases, we can see that the most frequent causes of sudden death are ventricular tachyarrhythmias (84% of cases) and bradyarrhythmias (16%). VF was the most frequent ventricular tachyarrhythmia, usually secondary to VT. The rest were due to torsades de pointes in patients often without heart disease but who were taking antiarrhythmic drugs. The VT leading to VF was often preceded by sinus tachycardia or new atrial tachyarrhythmia. Only a small percentage of patients presented ischemic ST changes. In patients who died due to bradyarrhythmias, this was more often due to sinus depression than to atrioventricular block.

Arrhythmias, Cardiac↗
PubMed1989

Surgery for the Wolff-Parkinson-White syndrome in 73 consecutive patients: what have we learnt from intraoperative mapping?

Intraoperative epicardial mapping data obtained in 73 consecutive patients operated upon for the Wolff-Parkinson-White syndrome were reviewed. Fifty-six patients had single and 17 patients had multiple accessory pathways. Except for right free wall pathways, all bypass tracts were divided using an endocardial approach. There were 2 operative deaths, 1 of which occurred after a concomitant mitral valve replacement. A total of 78 of the 87 pathways present in the 71 survivors were successfully ablated (90%). All failures occurred in patients with left posterior septal pathways. Epicardial mapping performed prior to bypass was found helpful in identifying multiple distinct accessory pathways which had been missed preoperatively. This occurred in 6 patients and led to appropriate combinations of classic operative approaches which resulted in all of these pathways being successfully divided. Further, by demonstrating that Kent bundles often presented as multiple closely-spaced or arborized accessory pathways, intraoperative mapping led to widening of the margins of surgical dissection, and in particular to an additional left atriotomy in all cases of left posterior septal accessory pathways which resulted in a substantial improvement in our rate of success.

Adolescent↗
PubMed1989

Characteristics, prognosis and treatment of the ventricular arrhythmias of right ventricular dysplasia.

We studied 58 cases of arrhythmogenic right ventricular dysplasia (ARVD). Sustained monomorphic ventricular tachycardia (VT) was present in 50 patients, ventricular fibrillation (VF) in three (two also having VT), and non-sustained VT in the remaining seven. Different morphologies of VT were documented in 24 of the 50 patients with sustained VT. They had a left bundle branch block pattern in 96% of cases, without extreme deviation of the QRS axis, and a QRS relatively narrow and ample. These sustained VTs were triggered by provocative techniques. Holter recordings showed frequent ventricular extrasystoles in the great majority of cases. They were polymorphic in 78%, with runs of VT in 59% of patients. Spontaneous onset of VT occurred during exercise in 60% of cases, preceded by a sinus rate increase when recording was available. This is more frequent in angiographically localized forms of ARVD than in diffuse forms, and tends to disappear during follow-up. Only four cardiac deaths occurred after a follow-up of 8.8 +/- 7.2 years: three by acute heart failure, and only one by recurrent VF. Spontaneous disappearance of VT which became non-inducible was seen in four cases. Single antiarrhythmic drug therapy was judged satisfactory in 21 cases, and combined therapy in 19 other cases. Surgery of fulguration was performed in 17 cases, with 14 successes (nine of them with combined antiarrhythmic therapy). Despite a frequent lack of control of VT by antiarrhythmic drugs, the follow-up of ARVD seems good in patients with sustained VT. Some arguments favour the concept of a diffuse and progressive disease.

Adrenergic beta-Antagonists↗
PubMed1988

Results of electrical fulguration in arrhythmogenic right ventricular disease.

Eleven patients with sustained ventricular tachycardia (VT) refractory to antiarrhythmic drugs due to right ventricular disease shown by angiography underwent fulguration. Seven patients always had VT with the same morphology, and 4 had clinical VT with 2 or 3 different QRS waveforms. Five patients underwent a single fulguration and the other 6 underwent from 2 to 5 procedures; 2 to 14 shocks (mean 6) of 150 to 250 J were used. No serious complications occurred. At 31.5 +/- 9 months of follow-up, the arrhythmia was controlled in 8 patients, with continuation of previously ineffective antiarrhythmic drug therapy in 6 of 8. The number of VT episodes the year before and after fulguration was 0.5 +/- 0.7 vs 3.5 +/- 1.7 (p less than 0.001). There was no statistically significant difference between the success rate and the degree of prematurity of the onset of the local electrogram during VT: -36 +/- 31 ms for successes and -38 +/- 13 ms for failures. In 7 patients with monomorphic VT, there were 6 successes and 1 failure, and in 4 patients with several morphologies of VT, there were 2 successes and 2 failures (1 due to the appearance of a "new" VT). Thus, electrical fulguration of VT in patients with right ventricular disease is safe and most often effective, particularly in patients with monomorphic VT, when combined with antiarrhythmic drugs. In these patients, the usually recommended endocardial mapping criteria for the determination of the optimal fulguration site were not predictive of outcome. Further studies are necessary to better define the optimal site for fulguration.

Adult↗
PubMed1988

[The implantable defibrillator. Long-term clinical results].

Between october, 1982 and december, 1986, 17 patients were implanted with an automatic defibrillator. The thoracic route was used in 6 patients with installation of an epicardial patch and an endocavitary electrode. The subcostal route was used in the remaining 11 patients, with 2 epicardial patches. The device, badly tolerated by 2 of the first 6 patients, created no problem in the 11 patients of the second group. One patient died of pulmonary embolism on the 6th post-operative day. At follow-up, there was no inappropriate triggering of the AID-B: 8 patients had neither arrhythmia nor shock, and 8 received from 2 to 55 shocks with documented arrhythmia. Two patients died suddenly: one after end of life of the device, the other after 3 years, while the device was still working. The implantable defibrillator technique has improved and local complications are now seldom observed. The device is reliable and constitutes an effective weapon against sudden death caused by ventricular arrhythmia.

Adolescent↗
PubMed1988

Respective role of sympathetic tone and of cardiac pauses in the genesis of 62 cases of ventricular fibrillation recorded during Holter monitoring.

Sixty-two Holter recordings of sudden death due to ventricular fibrillation (VF) were analysed by full disclosure and computerized processing. Thirteen sudden deaths were due to torsades de pointes in noncoronary subjects (11/13), related to quinidine-like drugs and/or hypokalaemia: they were always initiated by a long RR cycle due to a post-extrasystolic pause, and announced by a progressive decrease of mean heart rate (from 77.5 +/- 2.5 to 60.6 +/- 2.7 beats min-1, P less than 0.001), in the three preceding hours. The other cases occurred in coronary patients (45/49), with acceleration of ventricular tachycardia (VT), monomorphic in 24 cases, polymorphic in 13, the ventricular rate increasing from 220.6 +/- 55 to 241.5 +/- 69 beats min-1, rather than with primary VF (12 cases). A cardiac pause (RR cycle exceeding 125% of the mean five preceding cycles) was present in 22/49 cases immediately before the onset of VT/VF. The coupling interval of the extrasystole initiating VT/VF was shorter than the shortest value encountered before: 377.6 +/- 94.5 ms vs 421.4 +/- 92.3. The prematurity index (coupling interval/preceding RR cycle ratio) was lower in primary VF than in VT leading to VF. In the last hour preceding VF, ST changes were unusual (five cases), whereas heart rate increased from 82.8 +/- 20 to 92.0 +/- 26.7 beats min-1, (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗