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Y Gallais

Publications and source records attributed to Y Gallais.

32 records · Page 2Linked to original sources
PubMed1988

[Endocavitary fulguration in the treatment of cardiac arrhythmia].

Fulguration of the heart cavities seems currently to be a technique of increasing value in the treatment of untractable arrhythmias, of supraventricular junctional or ventricular origin. This study represents the evaluation of our experience with 64 patients, maximum follow-up is 54 months and the minimum follow-up is 7 months. Although the results are quite satisfactory in the fulguration of the bundle of his and in the fulguration of the arrhythmic site inducing ventricular tachycardia, these results are inferior in the Wolff-Parkinson-White syndrome in which fulguration of the coronary sinus seems contraindicated al filter (LEM type), resulting in the death of the patient. It is a true, early (1st week) migration after accurate positioning, opposite L4, and not an incident of insertion.

Adolescent↗
PubMed1987

[Propofol or ketamine in anesthesia of the very old patient. Study of the hemodynamic effects during induction].

The haemodynamic changes following anaesthesia for hip surgery in 16 very old ASA II or III patients (mean age 85.8 +/- 5 years) were studied. Patients were randomly assigned to two groups: group I 1 mg X kg-1 propofol, group II 1.5 mg X kg-1 ketamine. After injection, the patients were left spontaneously breathing oxygen, and were assisted when apneic. Haemodynamic measures with a Swan-Ganz catheter and thermodilution cardiac output calculator were made before and 1, 3, 5, 10 and 15 min after anaesthetic induction. The two groups were similar in age, weight and mean arterial pressure, but statistically different for some haemodynamic parameters (Ppa, Ppw, CI). In group I, arterial pressure fell significantly (-17%) in the first minute and continued to fall (-15%) until the 15th min. Heart rate remained unchanged: right atrial and pulmonary pressures were not changed; cardiac index fell slightly and MVO2 estimated by the triple product fell (-27%) as soon as propofol was infused. There was no clinical sign of cardiac failure. In group II, arterial pressure increased significantly, and heart rate decreased; pulmonary capillary wedge pressure increased (+93% after the 3rd min) and cardiac index was unchanged. The ventricular function curve was shifted to the right, suggesting a decrease in inotropism. Systemic vascular resistances were steady. MVO2 increased twofold, mainly due to the rise in pulmonary capillary wedge pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Treatment of resistant ventricular tachycardia by endocavitary fulguration associated with anti-arrhythmic therapy.

Endocavitary fulgurations were practised in 26 cases of high risk ventricular tachycardia (VT) for which antiarrhythmics including amiodarone and class I antiarrhythmic agents given alone or in combination proved ineffectiveness. Permanent VT was present in nine patients at the time of the fulguration session: three were moribund, and two were unconscious. Included in the series were 10 cases of arrhythmogenic right ventricular dysplasia, nine patients had chronic VT several months after myocardial infarction, four had a non obstructive cardiomyopathy, two were idiopathic and one came after repair of the right ventricular outflow tract. Fulguration succeeded in preventing VT in the 22 patients who survived the initial period of treatment in association with therapeutic antiarrhythmics, in eight cases. Three of the four early deaths were probably related to imperfections in the technique. Two late deaths were due to spontaneous evolution of the disease. The follow-up period ranges from a minimum of 15 to a maximum of 34 months, with an average follow-up of nearly two years. The success rate of fulguration alone or for patients receiving prophylactic antiarrhythmic drugs is 90%. Ten patients required two sessions or more before VT was brought under control.

Adolescent↗
PubMed1986

Treatment of resistant ventricular tachycardia with endocavitary fulguration and antiarrhythmic therapy, compared to antiarrhythmic therapy alone: experience in 111 consecutive cases with a mean follow-up of 18 months.

Endocavitary fulguration was performed in 31 cases of high-risk ventricular tachycardia (VT) for which antiarrhythmics, including Amiodarone and Class-I antiarrhythmic agents, given alone or in combination, proved ineffective. Permanent VT was incessant in nine patients at the time of fulguration: five of these were moribund, and two were unconscious. Included in the series were ten cases of arrhythmogenic right ventricular dysplasia, 13 cases of chronic VT after myocardial infarction, five cases of idiopathic dilated cardiomyopathy, two cases of idiopathic VT, and one case that involved a congenital anomaly. Combined fulguration and antiarrhythmic therapy succeeded in preventing VT in the 27 patients who survived the initial period of treatment. Thirteen patients needed two or more sessions, however, before their VT was brought under control. Three of the four early deaths were probably related to an imperfect technique. Four late deaths were due to spontaneous evolution of the disease. One patient without cardiac failure died suddenly. The follow-up period ranged from a minimum of 13 to a maximum of 34 months, with an average follow-up of nearly 2 years. The success rate for fulguration alone or for antiarrhythmic drugs is about 90%. This group of patients is compared with a group that involved 73 less severe cases treated with drugs. Fulguration appears to be the better form of treatment.

Journal Article↗
PubMed1986

[Anesthesia and surveillance in intracavitary fulguration for radical treatment of ventricular tachycardia].

Endocavitary fulguration, is a new technique to ablate the arrhythmogenic substrate of chronic ventricular tachycardias (VT). This method is used in patients with ventricular tachycardias of varied etiologies. 47 fulgurations in 36 patients with 40 hemodynamic and 12 myocardial metabolic studies are presented. In cardiopathies, the cardiac performance is altered with an ejection fraction of less than 50% and a ventricular function curve which is in Braunwald zone II. Ablation of the arrhythmia was obtained in 63% of cases. Severe complications were observed in 13% of cases, i.e.: low cardiac output, pulmonary oedema and myocardial ischemia. Three patients died from cardiac failure. Ventricular tachycardia was induced to localize the arrhythmogenic foci to be fulgurated. Ventricular tachycardia led to hemodynamic changes with a high pulmonary capillary wedge pressure and low cardiac output (-21%) which was further lowered under general anesthesia (-42%) due to poor response to tachycardia. Endocardial fulguration per se induced severe but transient (less than 5 minutes) hemodynamic changes and was sometimes complicated by myocardial ischemia and conduction disorders. General anesthesia is necessary to perform endocardial fulguration but cannot be induced with a poor hemodynamic state and with high rate ventricular tachy-arrhythmias. Three criteria are used concerning the anesthetic agents: 1) maintainance of cardiac contractility and baro-reflex efficiency; 2) respect of myocardial oxygen balance; 3) maintainance of excitability during mapping of arrhythmogenic foci. Hemodynamic monitoring is necessary to understand and manage complications due to this new type of therapy.

Adult↗
PubMed1985

[Emergency treatment of chronic ventricular tachycardia after myocardial infarction by endocavitary fulguration].

Endocavitary catheter ablation consists of delivering an impulse of 160 to 240 joules via a catheter used for electrophysiological investigation resulting in an electrical discharge which, in addition to its thermal effects may alter the arrhythmogenic substrate mechanically. This method was used in 2 patients with resistant and recurrent VT after myocardial infarction complicated by ventricular aneurysm. Two sessions of catheter ablation were necessary in both patients, but in the second one a single shock was successful in critically ill patients with VT. The first patient has been followed up for 20 months and the second for 13 months. Under prophylactic antiarrhythmic therapy, neither patient has had recurrence of the ventricular arrhythmias which had previously led to their hospitalisation. Catheter ablation is therefore presented as a technique which may be performed in the electro-physiological laboratory and repeated in cases of incomplete efficacy. This method may be used successfully in the treatment of chronic VT after myocardial infarction complicated by ventricular aneurysm.

Aged↗
PubMed1984

[Endocavitary fulguration. A new method of treating arrhythmia?].

Endocavitary diathermy consists of transmitting the energy of a defibrillator shock to the tip of an intracardiac catheter. The circuit is completed via a neutral plate placed under the patient's back. Energies in the order of 200 to 300 joules produce an electric arc at the catheter tip which causes an abrupt variation in pressure and the creation of a shock wave which modifies the myocardial structures directly in contact with the catheter. This method, which was originally used to treat supraventricular arrhythmias by interrupting the conduction in the His bundle, has recently been extended to the treatment of resistant ventricular tachycardia, and has even been used to interrupt the accessory pathway in certain cases of Wolff-Parkinson-White syndrome. The authors report the basic experimental data and the clinical results obtained with this method in the treatment of 20 cases of arrhythmia, especially in various types of ventricular tachycardia. The very promising results obtained, particularly in cases of ventricular tachycardia, suggest that this is a radical method which can be extended to patients unable to support a surgical operation. Although the follow-up period is only short, these results are encouraging. They confirm the basic principle of diathermy in the treatment of supraventricular tachycardia by interruption of the conduction in the His bundle and for the radical treatment of chronic ventricular tachycardia unresponsive to medical treatment. However, a longer follow-up period is required before we can demonstrate the long term effectiveness of this new therapeutic method.

Adolescent↗
PubMed1981

[Suxamethonium. Haemodynamic study in man excepting general anaesthesia (author's transl)].

Haemodynamic effects of suxamethonium IV 1 mg/kg were studied in eight comatose, mechanicaly ventilated, normotensive patients. Drug interference, including atropine was avoid. A transitory but significant increase in heart rate and cardiac output (CO) was observed, respectively + 27 p. cent (p less than 0.02) and + 29 p. cent (p less than 0.025) at the first minute. Right auricular, pulmonary capillary wedge, and pulmonary arterial pressures increased significantly from the first to the eighth minute. Mean arterial blood pressure unsignificantly increased (+ 5 p. cent) wether systemic arterial resistance decreased from - 11 p. cent (p less than 0.02) at the first minute. No arrhythmia occurred throughout the study. In the conditions of this study suxamethonium induces an early and transient increase in CO. Both tachycardia and increased venous return can explain the rise in CO. Such an increase could be due to the transient abdominal hyperpressure, and can be one of the factors which explain the poor tolerance of suxamethonium in patients with heart failure.

Adolescent↗
PubMedDate not supplied

[Endocardial fulguration for the treatment of ventricular tachycardia. Experience with 69 cases].

Between 1983 and 1989, 69 patients underwent endocardial fulguration for drug-resistant VT which had several relapses per month, or were incessant. The etiologies were an old myocardial infarction, (25 cases) arrhythmogenic right ventricular dysplasia, (19 cases) dilated cardiomyocathy, (9 cases) left fascicular tachycardia, (9 cases) 5 right septal idiopathic tachycardia, and 2 congenital heart disease. The ejection fraction ranged between 12 and 30% in 25 cases. VT originated in 32 patients in the right ventricle, 31 in the left, and 6 had fulguration in both ventricles. 41 patients had 1 session, 22 needed 2, 4 had three sessions and 2 had 4. Five patients died during the procedure, four of low output, and three of them before the shocks. One died of tamponade. Two others had tamponade and were successfully drained. Four patients died during the first 3 months of preexisting heart failure without VT relapse. The remaining patients have a mean follow-up of 32 months, ranging from 3 to 72 months. 32 patients are off drug and had no relapse. 23 had early relapses, and are controlled by previously ineffective drugs. However 3 of these had a late sudden death (4, 14 and 22 months). 9 are treated with a combination of drug not tested before. The success rate ranges from 60% in septal VT to 74% in ARVD, 86% in MI and 100% in idiopathic left fascicular VT. The success rate increases with the number of sessiones. Fulguration alone, or combined with pharmacological agents can be considered as an effective therapy for VT, despite that it is neither simple, nor harmless.

Adolescent↗
PubMedDate not supplied

[Fulguration of extrasystolic ventricular focus].

A case is presented of symptomatic premature ventricular contractions refractory to drug therapy with right bundle branch block QRS morphology and left axis deviation in a 68-year-old female without structural heart disease. Endocardial mapping localized the extrasystolic focus at meso-inferoapical region of the left ventricular septum suggesting an origin from the Purkinje network of the left posterior fascicle. Catheter ablation with direct-current energy abolished extrasystolic complexes, without complications. The patient remained asymptomatic over a follow-up of 3 months.

Aged↗
PubMedDate not supplied

[Radiofrequency ablation in ventricular tachycardia: initial experience and evaluation of its limitations].

The purpose of this paper is to report our initial experience with radiofrequency catheter ablation in 21 patients with ventricular tachycardia of different etiologies and to evaluate the causes which play a role in its limitation. The results show a low rate of effectiveness: total clinical success of 43%. Nevertheless there was a high success rate in a specific subsets of patients. The results depends on several factors: the electrophysiologic mechanisms and substrates of the tachycardia, the criteria to localize the critical area perpetuating the arrhythmia and the biophysical aspects of radiofrequency energy. Its usefulness is manifested in ventricular tachycardia with structurally normal heart and it has a limited success in cases with organic heart disease. Improvement of technical aspects and better understanding of the mechanisms of the tachycardia and characteristics of the target site will enhance the results of radiofrequency catheter ablation in ventricular tachycardia.

Adult↗
PubMedDate not supplied

[Transcatheter ablation of atrioventricular accessory pathways. Immediate results and long-term follow-up].

We present the immediate results and follow-up, from our initial serie of patients, where radiofrequency was attempted to ablate atrio-ventricular accessory pathways. Initiation policy included direct current-shocks following every unsuccessful radiofrequency session. Initial ablation success rate with radiofrequency solely was 75% (17/22), same as when direct current-shocks were associated 80% (8/10); but accessory pathway conduction recurrence was present only in this latter (6/10). During follow-up period of 18 to 25 months, from the recurrence group, one patient had spontaneous delta-wave disappearance, and four more required two to three ablation sessions. Permanent elimination with both methods was attained in 91% (20/22 pathways), and all patients remain asymptomatic, and drug free. There were one acute major complication, but no deaths. Because of its superior initial success rate, minor technical requirements, and their economical implications, radiofrequency catheter ablation of accessory pathways is the first choice of treatment. At our institution, direct current-shock remain an alternative method whenever a serious tachycardia prevents radiofrequency treatment.

Adolescent↗
PubMedDate not supplied

[The radiofrequency and the elimination of accessory atrioventricular pathways. The factors related to successful transcatheter ablation].

Some factors related with successful radiofrequency catheter ablation were retrospectively analyzed from the initial patients with WPW syndrome that underwent this therapy. They were 21 patients, and success rate with radiofrequency therapy was 73%. Conventional conduction intervals were obtained from catheter ablation electrograms. Only ventricular activation around Delta-wave onset, and earliest retrograde atrial activation were statistically significant for successful ablation (P < 0.05 both). Inadvertent interruption of AV-His bundle was produced ablating a septal accessory pathway, and no mortality procedure-related was observed. We conclude that radiofrequency catheter ablation of accessory pathways represents nowadays, an effective solution in patients with symptomatic arrhythmias, besides its high success rate and low risks, but different mapping criteria should be considered to attain an efficient elimination of atrioventricular accessory-pathways.

Adolescent↗