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Biomedical subjects

P Attuel

Publications and source records attributed to P Attuel.

At least 19 recordsLinked to original sources
PubMed1991

[Atrial electrophysiological study of unexplained cerebrovascular disorders].

The aim of this study was to detect possible atrial electrophysiological abnormalities in patients with unexplained embolic cerebrovascular accidents without overt atrial arrhythmias. This group was compared with normal controls and a group of patients with paroxysmal atrial fibrillation. Sixty-six patients were studied: Group I normal controls (N = 20); Group II patients with CVA (N = 26) and Group III, patients with paroxysmal atrial fibrillation (N = 20). Each group was divided into 2 subgroups according to age (over and under 45 years). The following parameters were taken into consideration: parameters correlated to atrial excitability (effective and functional refractory periods, adaptation of these refractory periods, intraatrial conduction--A1 and A2, S1A1, S2A2 intervals--, index of latent vulnerability); provocative testing by the extrastimulus technique; classical indices of atrioventricular conduction and sinus node function. In subjects over 45 years of age, the effective refractory periods were shorter in Group III (214 +/- 33 ms) and II (214 +/- 32 ms) than in the control Group I (248 +/- 21 ms), p less than 0.01. This difference was not apparent in younger patients. Inadaptation of the refractory periods was demonstrated equally in Groups II and III in all ages whilst the control subjects showed normal adaptation, p less than 0.05. Intraatrial A1 and especially A2 conduction was significantly prolonged in Group III (94.5 +/- 24 ms) and II (87 +/- 14 ms) compared with the control group (69 +/- 8 ms), p less than 0.01, especially in younger subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The autonomic nervous system in sudden infant death syndrome. Analysis of heart rate and sinusal variability on Holter monitoring of infants who died].

To evidence abnormality of cardiac control by the autonomic nervous system in the sudden infant death syndrome (SIDS) we retrospectively analysed the Holter recordings and cardiopneumograms of 19 infants (11 boys, 8 girls) of mean +/- SD age 2.3 +/- 1.5 months who had subsequently died of SIDS. Two infants were regarded as normal and the reference diagnoses in the remaining 17 infants were: apparent life threatening event (8), SIDS siblings (8) and prematurity (1). At the time of death the age was 4.2 +/- 2 months. Each of these infants was matched with three control infants in term of postnatal age, gestational age and reference diagnosis, but without SIDS at follow-up of at least one year. Nine hours of Holter recordings (9 p.m. to 6 a.m.) were analysed in term of mean heart rate and sinus oscillations waves. To differentiate between short oscillations of 4 to 6 RR, which are induced by respiration and reflect vagal activity, and long oscillations of 20 to 32 RR, which reflect both neurogenic sympathetic and vagal activity, we used a new method which measures the number and the amplitude in milliseconds of each type of oscillations. The results are expressed as the logarithm of the product of these two variables. Heart rate, correlated to age in both groups, is higher in the deceased infants group (141 +/- 14 mn and 135 +/- 15; p less than 0.05: analysis of covariance with age as an independent variable). Short oscillations, also correlated to age, are lower in the deceased infants group (3.35 +/- 0.59 and 3.65 +/- 0.61; p less than 0.05: analysis of covariance with age).(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmia, Sinus↗
PubMed1988

Long-term follow-up of atrioventricular junctional transcatheter electrical ablation.

Complete data concerning long-term results of transcatheter electrical ablation of the atrioventricular junction is not available. At the request of the French Cardiac Arrhythmia Working group we undertook an inquiry in October 1983. All centers potentially able to perform such procedures were asked to report their experience. Eight centers have performed one case or more, over a period of 3 years, for a total of 91 patients. The mean follow-up completed in all patients in April 1986 was 12 +/- 10 months. The procedure was indicated for a supraventricular arrhythmia resistant to a mean of 3.9 +/- 1.3 classes of antiarrhythmic agents. Atrial flutter or fibrillation in 54 (59%) and atrioventricular nodal reentry in 17 (18%) were the most common arrhythmias. A mean of 2.6 +/- 2.3 electrical shocks (range 1-14 shocks) with a stored energy of 130-400 joules was delivered during 1-5 sessions. Complete heart block was obtained in 83 patients and persisted at the time of discharge from the hospital in 46 patients (50.5%). The immediate complication (within 24 hours after the procedure) included ventricular fibrillation successfully converted (one patient) and nonsustained ventricular tachycardia (three patients). Late complications included one death 3 days after the procedure, in a patient in whom sustained ventricular tachycardia was documented, nonsustained ventricular tachycardia in two patients, sepsis in three patients and pericardial effusion in one patient. At the time of the follow-up, there were three additional deaths related to sepsis due to pacemaker pocket infection in one patient and to preexisting congestive heart failure in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

DDD pacing: an effective treatment modality for recurrent atrial arrhythmias.

We performed atrial EP studies (atrial substrate evaluation) on 10 patients. These patients had evidence of paroxysmal, sustained, recurrent atrial arrhythmias (7 men and 3 women with a mean age of 64 +/- 15 years). All patients combined a brady-tachy syndrome; 7 patients had a sick sinus syndrome (SSS) and 3 patients a typical vagally induced atrial arrhythmia. No anti-arrhythmic drug was allowed in 3 patients with SSS, 1 drug failed in 4 patients and the combination of 2 drugs failed in 3 patients during the first to eighth years prior to pacemaker implantation. Atrial substrate evaluation was feasible in all these patients off anti-arrhythmic therapy and showed important abnormalities of atrial loco-regional conduction parameters and long refractory periods (RP). The remarkable point was, in 7 patients, a paradoxical improvement in intra-atrial conduction delay at rapid pacing rate. The DDD pacing mode was chosen in all patients. No technical problem occurred during implantation. Atrial pacing rate was programmed to be slightly higher than the mean diurnal heart rate calculated on Holter monitoring. After implantation, the mean follow-up period was 18 +/- 25 months with an average of one Holter every 4 months during the first 2 years. The 7 patients who improved intra-atrial conduction at rapid pacing rate were controlled without drugs, 2 patients were controlled with 1 drug, and 1 patient with 2 drugs. Atrial pacing in the DDD mode in a selected group of patients prevents paroxysmal and drug-resistant atrial arrhythmias. Atrial substrate evaluation is a sensitive tool for assuring the long-term benefit of atrial pacing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Importance of atrial electrophysiology in the work-up of cerebral ischemic attacks.

Recent data suggest that a large proportion of ischemic strokes are due to embolic phenomena from the heart. Atrial fibrillation appears to be one of the principal causes of embolization. If electrophysiologic parameters are considered as determining factors, the existence of atrial hypervulnerability in patients with embolic strokes is significant, when arrhythmia has been excluded as an etiology. This study suggests that an aggressive approach to early diagnosis and management through electrophysiologic studies might aid in preventing future neurologic attacks.

Adult↗
PubMed1986

Clinical experience with 910 carbon tip leads: comparison with polished platinum leads.

Since 1980, we have implanted 910 carbon tip leads from three different manufacturers. The pacing thresholds from these leads were compared to those of standard polished platinum electrode configurations. Our major findings are that while acute voltage thresholds are not significantly different, two of the three carbon tip leads that we used in the study have statistically lower chronic thresholds then polished platinum leads (p less than or equal to 0.01).

Carbon↗
PubMed1985

[Idiopathic dilatation of the heart atrium with complete auricular paralysis].

The authors report the case of a patient with idiopathic dilatation of the auricles and complete atrial paralysis associated with absence of excitability of the atrial muscle. Repeated echocardiograms over a period of three months demonstrated dilatation of the auricles and ventricles with the development of mitral and tricuspid incompetence. The role played by the junctional bradycardia in the ventricular dilatation is discussed and the patient was explored haemodynamically with varying rates of ventricular pacing. In view of the improvement in the haemodynamic parameters, a cardiac pacemaker was inserted. After a follow-up of one year, the ventricular chambers have returned to normal and the mitral and tricuspid incompetence has regressed, while the atrial muscle continues to dilate. The patient is currently asymptomatic with no medical treatment.

Adult↗
PubMed1979

Sustained intra-atrial reentrant tachycardia. Electrophysiologic study of 20 cases.

Twenty cases of sustained tachycardia due to intra-atrial reentry were investigated in patients aged 17 to 80 years (mean 47). The average frequency of the tachycardia was 128.6/min (extremes 95 and 180). Three modes of onset of the tachycardia were observed: atrial extra-stimulus (19 times), progressively accelerated atrial pacing (9 times) and atrial escape beat (10 times). The tachycardia was stopped in all cases by a premature stimulation. When spontaneous, the termination was either sudden (10 times) or preceded by a progressive slowing (9 times) or an alternating phenomenon of long-short cycle (13 times). Precise atrial mapping allowed to localize the first atrial depolarization less frequently in the sinus node area (1 case) than in the mean right atrium (21 cases), the low right atrium (2 cases), the interatrial septum (2 cases), and the left atrium (4 cases). The macroscopic size of the reentry circuit was demonstrated in only 3 cases. A junctional reentry was accurately ruled out in all cases thanks to the existence of a second or third-degree AV or VA black, or by studying the sequence of retrograde atrial activation. A true junctional reciprocating tachycardia was associated with the intra-atrial reentry in 2 cases.

Adolescent↗
PubMed1979

[Quantitative evaluation of the efficacy of anti-arrhythmia agents in chronic ventricular arrhythmia].

The authors describe a computer system for the analysis of ventricular arrhythmias and its use in the evaluation of anti-arrhythmic drugs. Provided the arrhythmia is stable, this method allows an estimation of the onset and duration of action of the drug and gives guidelines for the choice of an appropriate drug regimen. Using this system, a comparison can be made between different drugs based on quantification of their efficacy.

Amiodarone↗
PubMed1979

[Technical characteristics of a new computerized system for quantitative evaluation of cardiac arrhythmias (author's transl)].

The ATREC system is designed to carry out at sixty times real time the quantitative evaluation of arrhythmias in 24 hour magnetic tape recordings. A preprocessing unit eliminates the low frequency waves (P and T) and artefacts, and furnishes the computer (Mitra 15/35, 16 K words of core) with information on R-R interval, QRS duration, regular or irregular rhythm, bradycardia or pauses, transient to sustained tachycardia, and ventricular fibrillation. Extrasystoles are analyzed in terms of enlargement, number, coupling interval, bi or trigeminy, doublets or salvos. Trends of mean and extreme cardiac rate, and R-R interval histograms, are also available. The system is also available for ECG real time monitoring of patients in coronary care units. The computer can analyze 8 ECG tracings simultaneously. The ATREC system provides an important aid in the quantification of arrhythmias and improves the evaluation of antiarrhythmic drugs efficacy.

Anti-Arrhythmia Agents↗
PubMed1978

[The atrial arrhythmia syndrome of vagal origin].

Having observed 18 cases, the authors describe a syndrome of recurrent paroxysmal atrial arrhythmia which was very homogeneous from the clinical and ECG point of view. It was usually found in middle aged males, with no demonstrable underlying heart disease, whose disorder of intra-atrial conduction occurred during sinus rhythm. The condition developed slowly over the course of years towards a maximum incidence of several short daily attacks of an arrhythmia which alternated between an atrial fibrillation and atrial flutter. Vagal overactivity is the precipitating cause of these attacks which are usually not completely nocturnal. The condition never progressed to sino-atrial block nor to permanent fibrillation. The beginning of each attack, often heralded by atrial coupling with a long enough interval to cause re-entry, is accompanied by slowing of the sinus rate down to the threshold level. The vagal effect of shortening the action potential and refractory period is recognised to be non-homogeneous in the atrial wall, and suggests a re-entry mechanism rather than hyper-excitability. This would explain the usual resistance of atrial arrhythmias of vagal origin to digitalis, beta blockers and quinidine. Amiodarone alone is usually effective because of the prolongation of the action potential which it causes. In 5 particularly resistant cases a good clinical result was obtained by the insertion of an atrial pacemaker with a fairly rapid rate.

Adrenergic beta-Antagonists↗
PubMed1977

[Romano-Ward syndrome and left stellectomy. General review apropos of a recent case].

A new familial case of the Romano-Ward syndrome in a young girl of 21 years is reported. A progressive worsening of the condition with multiple syncopal attacks, together with difficulty in controlling the patient, lead us to carry out a left stellate ganglionectomy. The operation did not lead to any shortening of the QT interval. It appeared in the end that propranolol was the most effective way of preventing the syncopal attacks.

Adult↗
PubMed1976

'Incessant' tachycardias in Wolff-Parkinson-White syndrome. I: Initiation without antecedent extrasystoles or PR lengthening, with reference to reciprocation after shortening of cycle length.

In 6 patients with the Wolff-Parkinson-White (WPW) syndrome, repetitive, almost continuous (incessant) reciprocating atrioventricular (AV) tachycardia has been shown to arise when the sinus cycle length was shortened to a critical point, at which unidirectional block occurred without the classical feature of PR prolongation. Though this phenomenon superficially resembles an aspect of chronic intranodal reciprocating tachycardia of children, basic differences can be identified. It was encountered more frequently in younger subjects; the only patient over 45 developed the arrhythmia as a complication of therapy. This incessant mechanism may explain some cases in which antiarrhythmic treatment does not control reciprocating tachycardia in the WPW syndrome, but such a mechanism can also occur spontaneously.

Adolescent↗
PubMed1976

'Incessant' tachycardias in Wolff-Parkinson-White syndrome. II: Role of atypical cycle length dependency and nodal-his escape beats in initiating reciprocating tachycardias.

Descriptions of patients with the Wolff-Parkinson-White (WPW) syndrome and reciprocating tachycardia in whom the initiation of the arrhythmia depended neither on the occurrence of premature beats nor on antecedent cycle-length shortening are given. In 5 the occurrence of escape beats in the bundle of His, usually in the presence of sinoatrial disease, activated the tachycardia circuit, but in the other 2 there were unusual mechanisms related to bradycardia-dependent block in the anomalous pathway, and delayed response to shortening of the atrial cycle length, respectively. Careful assessment of such mechanisms is essential for the correct choice of antiarrhythmic prophylactic therapy.

Adult↗
PubMed1976

[Congenital bundle-of-his focal tachycardias. Cooperative study of 7 cases].

The authors described seven cases of supraventricular tachycardia with atrio-ventricular dissociation, associated with the activity of an automatic focus in the bundle of His. These tachycardias, which appear at birth or are discovered at a very young age, appear to be congenital and sometimes familial, and are always isolated, having no associated cardiac abnormality. They give rise to cardiac failure, which is more marked when the rate is high (180-260/mn) and particularly resistant to treatment. The most effective form of treatment is amiodarone, almost always used in combination with digitalis. The anatomical abnormality, which was studied in the first case, is a contricting fibrosis around the main trunk of the bundle of His, and the appearances are reminiscent of those found in conditions of congenital atrio-ventricular block.

Amiodarone↗
PubMed1976

[Treatment of junctional paroxysmal tachycardia, without patent Wolff-Parkinson-White syndrome, by sectioning an accessory Kent-His bundle].

The authors report the case of a patient suffering from a Bouveret's tachycardia without syndrome of Wolff-Parkinson-White. The analysis of the tachycardic spells however showed that during a reciprocal crisis, the circuit went through a left accessory ventriculo-atrial bundle, functioning only in the reverse direction. This accessory bundle was successfully cut by the surgeon, following the procedure of wide atrioventricular desinsertion as described by the authors of Duke University for the surgical treatment of the Wolff-Parkinson-White syndrome.

Adult↗
PubMed1975

[Continuous electrocardiographic recording. Clinical, diagnostic and therapeutic value].

The interest of permanent electrocardiographic recording in ambulatory patients is not restricted to the demonstration of the cardiogenic origin of some functional disturbances. This method provides the proof of the often non fiable character of anamnesis for the diagnosis of arrhythmias. It shows the close relationship between "minor" (extra-systoles) and "major" (tachycardias) arrhythmias, and consequently the prognostic value of the former in relation with the latter. Continuous ECG follow-up affords in the assessment of anti-arrhythmic drugs efficiency a higher safety than that provided by the conventional simple clinical follow-up.

Anti-Arrhythmia Agents↗