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P Mabo

Publications and source records attributed to P Mabo.

At least 19 recordsLinked to original sources
PubMed2006

[Tamponade due to Porphyromonas gingivalis].

A 45 year old man, 10 weeks after angioplasty and endoprosthesis insertion for myocardial infarction, developed tamponade in an infectious context. RNA 16S investigation, using the universal amplification method with ribotyping, detected Porphyromonas gingivalis (a strict anaerobic bacillus associated with peridontitis) in the pericardial fluid. This appears to be the first description of such a clinical scenario, and suggests 5 aetio-pathological mechanisms: fissure syndrome, malignant tamponade, post-infarction pericardial syndrome, endoprosthesis infection and infectious tamponade. We also describe the ribotyping method, which by amplifying DNA coding for RNA 16S allows identification of an increasing number of micro-organisms implicated in infectious pathology.

Anti-Bacterial Agents↗
PubMed2006

[Implantable cardioverter defibrillators in pediatric patients: results in a series of 33 cases].

UNLABELLED: Implantable defibrillator is the recognized treatment of sudden cardiac death. Miniaturization of the devices allows implantation in children. METHODS: This multicentric retrospective study analyzed data of 33 children aged 18 years and less who were implanted from 1990 to 2005. RESULTS: Age of patients are 10 to 18 years, 20 patients were implanted after a resuscitation of sudden death, 10 after a syncope, 2 after a ventricular tachycardia and 1 in a prophylactic way. Tachycardias on primary electrical disease are most frequent (46%). Hypertrophic cardiomyopathy accounts for 22%, DAVD for 14%, congenital cardiopathies for 12%. Seventeen patients received appropriate shocks and 14 patients had inappropriate shocks. There were two unexplained deaths. Five leads fractures and two device infections were noted. CONCLUSION: Implantable defibrillator is an effective treatment for children high-risk of sudden death. Occurrence of inappropriate shocks due to sinusal tachycardia, infections and leads fractures are frequent.

Adolescent↗
PubMed2006

[Pilot study of a strategy combining coronary angioplasty with valvular and/or coronary surgery on the same day].

A strategy combining percutaneous coronary angioplasty followed by valvular and/or coronary surgery was recently proposed as an alternative to the classical surgical only approach. The aim of this study was to assess the feasibility and the results of such a combined strategy with the two procedures performed the same day. The population comprised 34 patients including 17 with valvular disease and revascularisable coronary lesions (15 symptomatic severe aortic stenoses and two acute mitral insufficiencies) plus 17 multitrunk coronary patients without valvular disease but with an indication for revascularisation. Angioplasty was performed several hours prior to surgery and a loading dose of 300mg clopidogrel was administered immediately postoperatively; all patients were on aspirin before the procedure. The average age was 67 +/- 11 years, NYHA class 2.3 +/- 0.7, angina 73%, LVEF 58 +/- 10%. Single coronary artery disease was present in 26%, two vessel disease in 35% and three vessel disease in 39%. The success rate for angioplasty plus stent was 98%. 60 stents were active. Bypasses were exclusively arterial (left or right internal mammary arteries). We observed 4 in-hospital deaths, one of which was due to an infarct and three due to extra-cardiac causes (1 non-cardiogenic acute respiratory distress syndrome, 1 respiratory tract infection and 1 pyelonephritis). Further surgery was necessary in 4 cases: for haemorrhage and one episode of digestive tract haemorrhage. There were no additional deaths, coronary events nor haemorrhage at the end of an average follow-up of 15 +/- 6 months. The results of this combined strategy are encouraging in this population and merit further evaluation in a prospective study.

Aged↗
PubMed2005

[AFFIRM: what we have learned ... and pending issues].

During these last years, several therapeutic strategies trials have been performed in atrial fibrillation: the goal was to compare the rhythm control strategy (restoration and maintenance of sinus rhythm) to the rate control strategy (slowing of heart rate in atrial fibrillation). The most important of these different trials is the AFFIRM study. The main conclusion of this trial is that rate control can be chosen in first intention and not only in case of failure of the rhythm control strategy. These results can not be applied to 2 categories of patients: on one hand patients with heart failure and on the other hand young patients without cardiopathy in whom the strategy of rhythm control and sinus rhythm maintenance, mainly by class I antiarrhythmic drugs, remains the better choice.

Anti-Arrhythmia Agents↗
PubMed2005

[Cardiac arrest outside hospital: initial and subsequent cardiological management].

UNLABELLED: The prognosis of cardiac arrest outside hospital is directly related to the initial management. The aim of this work was to evaluate the characteristics of the initial and subsequent cardiological management of victims of cardiac arrest outside hospital with a retrospective analysis of data from the SAMU 35 (Emergency Medical Service, IIIe et Vilaine region) in the period April 1998 - April 2002. RESULTS: 533 non-traumatic cardiac arrests outside hospital were reported in 532 patients (average age 63 +/- 17, 73% male). The cardiac arrest occurred at home in 77% of cases. The initial cardiac rhythm documented was asystole in 63% of cases, ventricular fibrillation (VF) in 30% ventricular tachycardia (VT) in 1% and electromechanical dissociation in 6%. A cardiac aetiology was presumed in 294 (69%) of the 424 resuscitated patients. Among these, 22% (66/294) were admitted to coronary care units, 11% (31) left hospital alive, 8% (24) with no neurological sequelae. The survival rate for patients with cardiac arrest outside hospital in the presence of a witness and for whom the initial rhythm was VF or VT was 21%. The patient's age (<60 years)[OR: 1.05; CI 95%: 1.02-1.07; p < 0.001], rapid arrival of the SAMU (<10 min) [OR: 5.68; CI 95%: 1.42-22.7; p = 0.01] and resuscitation by the witness (OR: 8.26; CI 95%: 3.28-20.83; p < 0.001) were factors predictive of survival in a multivariate analysis. Coronary heart disease remains the principal cause of cardiac arrest in patients admitted to cardiology units (68%), with a recent coronary thrombosis shown in 40% of patients undergoing angiography (16/40). CONCLUSION: the prognosis of cardiac arrest outside hospital remains bleak, with a mortality of 90%. The survival rate is higher if the initial management is optimal, associated with bystander resuscitation and an immediate emergency service response allowing rapid defibrillation. Diagnosis and management of acute coronary syndrome in a cardiological setting must be integrated into the strategy.

Adolescent↗
PubMed2005

[Factor VIII hyperactivity: an arterio-venous thrombogenic factor. Case report].

Thrombosis is the principal mechanism in vascular pathology, whether cerebral, coronary or peripheral. During the initial stages of infarction, coagulation contributes to vascular occlusion, the haemostatic factors playing a determining role in the development of atherothrombotic lesions. An increase in a coagulation protein, besides any lowering of anticoagulation protein levels, is a risk factor for thrombosis. Among these pro-coagulant factors, the pro-thrombogenic action of factor VIII has without doubt been studied the least. We report the case of a 62 year old patient with a personal and family history of many previous thrombotic episodes, both arterial and venous, in whom factor VIII hyperactivity was discovered after a myocardial infarction. This case underlines the association of the factor VIII complex with thrombosis, and its clinical repercussions, especially the incidence of coronary pathology.

Coronary Thrombosis↗
PubMed2004

Comparative effects of ventricular resynchronization therapy in heart failure patients with or without coronary artery disease.

UNLABELLED: In patients with advanced heart failure, intraventricular conduction delay (IVCD) and left ventricular systolic dysfunction (LVSD), multisite cardiac pacing can be proposed as an additive treatment. The aim of this study was to assess the clinical effectiveness of atrioventricular pacing according to the etiology of LVSD, by comparing the outcome of patients with and without coronary artery disease. Between August 1997 and November 1998, 103 patients were included in the InSync trial and received a biventricular pacemaker and a specifically designed left ventricular pacing lead. Baseline evaluation (12 lead ECG, New York Heart Association Class, quality of life (QOL) and distance walked during the 6 min walk test) was repeated in survival patients at 1, 3, 6 and 12 months after pacemaker implantation. Patients were split in two groups, ischemic (N = 48) and non-ischemic (N = 55), according the result of a recent coronary angiography, the existence of coronary angioplasty or coronary artery bypass or the history of a prior myocardial infarction. RESULTS: The mortality rate was similar in the two groups with a mean 12 months actuarial survival rate of 78%. Nevertheless, the delay between the death and the pacemaker implantation was significantly higher in the non-ischemic group. A significant reduction in QRS duration and a significant improvement in NYHA class (-1.5). QOL score (-50%) and 6 min walking test (+18%) were observed similarly in the two groups. CONCLUSION: This study shows that biventricular pacing improves significantly functional status of patients with LVSD, IVCD and advanced heart failure, regardless the etiology of the cardiomyopathy, ischemic or not, without over-mortality in ischemic patients.

Aged↗
PubMed2004

[The role of cardiac pacing in the treatment of atrial arrhythmias].

The role of cardiac pacing in the treatment of atrial arrhythmias can be analysed from the angle of prevention or treatment in a strategy of rhythm control or heart rate control. From the heart rate control viewpoint, "ablate and place" is a validated method, especially in terms of mortality based on the results of large registers, in cases of uncontrolled ventricular rhythms causing symptoms or left ventricular dysfunction. In a strategy of rhythm control, the theoretical bases of prevention of atrial fibrillation (AF) by atrial pacing are convincing but the clinical results of different prospective clinical trials, though encouraging, do not provide formal proof of the efficacy of preventive pacing. Permanent 100% atrial pacing remains the objective which has led to the development of many algorithms evaluated in the ADOPT, AF Therapy, PIPAF, ATTEST...trials, with contradictory results. The choice of atrial pacing site seems to be a determining factor for the success of the method with better results seemingly with the high or low septal positions. The results of the OASES trial support this hypothesis but they were not confirmed by the ASPECT trial. An interesting observation was made in the PIPAF and a new Danish trial on the deleterious effects of ventricular capture when not required which is the rule in patients paced for brady-tachycardia syndromes. As for the role of anti-tachycardia pacing, the technique remains to be validated. Perhaps, the association of different techniques evaluated--the site of pacing, the prevention algorithms, respect of the ventricular rhythms, reduction by anti-tachycardia stimulation--will provide multifunction devices capable of best managing atrial arrhythmias which do not require "curative" therapy, and in particular, endocavitary ablation. In practice, it is generally when faced with brady-tachycardia syndromes that the question of the preventive role of pacing is raised. The problem is to choose the site of stimulation and the most appropriate pacing device in the light of current knowledge.

Algorithms↗
PubMed2004

[Role of cardiac resynchronisation in the treatment of cardiac failure].

For 10 years cardiac resynchronisation has seen considerable development, as much on the technological side as at the level of its scientific validation. Several prospective studies have shown the functional benefits of cardiac resynchronisation in a selected population of refractory cardiac failure patients with improvement in symptoms, exercise tolerance and quality of life. Equally, cardiac resynchronisation allows a significant reduction in hospital episodes for cardiac failure and also has a beneficial effect on left ventricular inverse remodelling. Finally, the first results of morbidity/mortality trials are very encouraging with a significant reduction in overall mortality at one year in the COMPANION study with the biventricular defibrillator. However, numerous important, unresolved questions remain such as the problem of non-responders and thus patient selection, or such as the place of cardiac resynchronisation in patients with permanent atrial fibrillation. The choice of the type of implantable prosthesis (pacemaker or biventricular defibrillator) and the choice of the mode of pacing (biventricular or solely left ventricular) are still under discussion. New indications for cardiac resynchronisation could be seen next, for example such as the optimisation of stimulation mode in already paced patients or "systematic" biventricular pacing in patients with a conventional indication for pacing..... In 2004, cardiac resynchronisation must be considered as an effective adjuvant therapy in cardiac failure patients refractory to optimal medical treatment with left ventricular dysfunction and intraventricular conduction disorders.

Cardiac Pacing, Artificial↗
PubMed2002

Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation.

BACKGROUND: One third of chronic heart failure patients have major intraventricular conduction and uncoordinated ventricular contraction. Non-controlled studies suggest that biventricular pacing may improve haemodynamics and well-being by reducing ventricular asynchrony. The aim of this trial was to assess the clinical efficacy and safety of this new therapy in patients with chronic atrial fibrillation. METHODS: Fifty nine NYHA class III patients with left ventricular systolic dysfunction, chronic atrial fibrillation, slow ventricular rate necessitating permanent ventricular pacing, and a wide QRS complex (paced width >or=200 ms), were implanted with transvenous biventricular-VVIR pacemakers. This single-blind, randomized, controlled, crossover study compared the patients' parameters, as monitored during two 3-month treatment periods of conventional right-univentricular vs biventricular pacing. The primary end-point was the 6-min walked distance, secondary end-points were peak oxygen uptake, quality-of-life, hospitalizations, patients' preferred study period and mortality. RESULTS: Because of a higher than expected drop-out rate (42%), only 37 patients completed both crossover phases. In the intention-to-treat analysis, we did not observe a significant difference. However, in the patients with effective therapy the mean walked distance increased by 9.3% with biventricular pacing (374+/-108 vs 342+/-103 m in univentricular;P =0.05). Peak oxygen uptake increased by 13% (P=0.04). Hospitalizations decreased by 70% and 85% of the patients preferred the biventricular pacing period (P<0.001). CONCLUSION: As compared with conventional VVIR pacing, effective biventricular pacing seems to improve exercise tolerance in NYHA class III heart failure patients with chronic atrial fibrillation and wide paced-QRS complexes. Further randomized controlled studies are required to definitively validate this therapy in such patients.

Aged↗
PubMed2002

[Medium-term results of multisite biventricular stimulation in severe cardiac failure].

Since its introduction in cardiac failure in 1994, biventricular cardiac stimulation has been widely applied with many clinical trials and the development of new specific technology. The authors present the results observed in the first 125 consecutively implanted patients at the Rennes University Hospital. After a mean follow-up of 22 months, the mortality rate was 40%. The causes of death were sudden death in 42% of patients, progression of cardiac failure in 34% and non-cardiac in 24%. The functional benefits of biventricular cardiac stimulation were seen through significant improvement in HYHA Class, 3.3 +/- 0.5 before implantation to 2.3 +/- 0.8 at the end of follow-up, and by a significant increase of 40% of peak VO2 and of maximal duration of exercise. With the learning curve and development of new technology, the left ventricular catheterisation via a coronary sinus vein, increased from 56% to over 95% during the last two years with an acceptable rate of complications. These results, with the reserve of not being a controlled trial, show the feasibility, safety and efficacy of biventricular cardiac stimulation in terms of functional benefit. Clinical trials are currently underway to assess the impact of this method on morbi-mortality and to assess the concept in association with ventricular defibrillation.

Aged↗
PubMed2002

[Magnetocardiography: principles and potential uses in cardiology].

Magnetocardiography (MCG) is a non-invasive technique of studying cardiac electrophysiology activity. It appears that electric and magnetic measurements are not only complementary but provide independent information. Described over 25 years ago, recent technical progress in the field of supraconductivity has provided MCG with real clinical applications. It is still mostly used in research, but its clinical applications are beginning to develop. The most interesting clinical application of the MCG is certainly its capacity to provide a non-invasive anatomical localisation of the arrhythmogenic substrate or of accessory pathways. Nowadays, however, the accuracy of these localisations needs to be improved. When this has been accomplished, MCG could play a significant role in non-invasive cardiological investigation with well-defined clinical applications.

Arrhythmias, Cardiac↗
PubMed2001

Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects.

BACKGROUND: Biventricular pacing has been proposed as an adjuvant to optimal medical treatment in patients with drug refractory heart failure caused by chronic left ventricular systolic dysfunction and intraventricular conduction delay. OBJECTIVE: To assess the technical feasibility and long term results (over six years) of transverse left ventricular pacing with the lead inserted into a tributary vein of the coronary sinus. SUBJECTS: From August 1994 to February 2000, left ventricular lead implantation was attempted in 116 patients who were eligible for biventricular pacing (mean (SD) age 67 (9) years, New York Heart Association (NYHA) functional class III/IV, left ventricular ejection fraction 22 (6)%, QRS duration 185 (26) ms). RESULTS: The overall implantation success rate was 88% (n = 102). A learning curve was indicated by a progressive increase in success from 61% early on to 98% in the last year. The mean pacing threshold was 1.1 (0.7) V/0.5 ms at the time of implantation and increased slightly up to 1.9 (0.9) V/0.5 ms at the end of the follow up period (15 (13) months). The rate of acute and delayed left ventricular lead dislodgement decreased from 30% in the early years to 11% after 1999. During follow up, 19 patients required reoperation for delayed lead dislodgement or increase in left ventricular pacing threshold (n = 15), phrenic nerve stimulation (n = 3), or infection (n = 3). CONCLUSIONS: Transverse left ventricular pacing through the coronary sinus is feasible and safe. The rate of implantation failure and of lead related problems has decreased greatly with increasing experience and with improvements in the equipment.

Aged↗