[Show abstract][Hide abstract] ABSTRACT: Seventy-four consecutive patients (18 to 55 years) underwent programmed atrial stimulation in the investigation of unexplained ischaemic stroke after a full work-up including transoesophageal echocardiography to exclude abnormalities of the interatrial septum (patent foramen ovale and/or atrial septal aneurysm). The parameters recorded during atrial electrophysiological investigation were: the effective atrial refractory period, loco-regional intra-atrial conduction, the index of latent atrial vulnerability and the inducibility by the extrastimulus technique. Seventy five per cent of patients with a patent foramen ovale and/or an atrial septal aneurysm were inducible compared with only 38% of patients with normal interatrial septa on transoesophageal echocardiography (p = 0.001). Fifty two per cent of patients with an anomaly of the atrial septum had latent atrial vulnerability compared with 26% of those with normal transoesophageal echocardiography (p = 0.02). These results confirm the relationship between atrial septal anomalies and latent atrial vulnerability in unexplained ischaemic stroke of young adults.
No preview · Article · Jan 2001 · Archives des maladies du coeur et des vaisseaux
[Show abstract][Hide abstract] ABSTRACT: Late potentials (LPS) have been shown to be predictive of ventricular tachycardia in coronary artery disease subjects, but the prevalence of LP in the general population is not as well-known. The study included 487 men without a history of cardiovascular disease (aged 50-59) living in Southwestern France. Standard-averaged high resolution electrocardiogram was performed using Butterworth filtering at 40-250 Hz. LPS were defined as two or more of the following criteria: QRS > 114 ms, duration of the low amplitude signals in the terminal portion of QRS > 38 ms, root mean square (RMS) voltage of the last 40 ms < 20 microV. The mean QRS duration was 97 +/- 12 ms (mean +/- SD), duration of the low amplitude signals in the terminal portion of QRS was 32 +/- 10 ms, and RMS voltage in the last 40 ms was 39 +/- 27 microV. Eight percent of subjects (95% confidence interval [CI]: 6%-11%) had a QRS duration > 114 ms; 22% (95% CI: 18%-26%) had a duration of low amplitude signals > 38 ms, and 25% (95% CI: 22%-29%) had RMS voltage in the last 40 ms < 20 microV. Finally, the prevalence of LP was 21% (95% CI: 18%-25%). In conclusion, according to commonly used criteria, the prevalence of LP in this healthy population of middle-aged men is 21%, close to the values found in the literature for myocardial infarction patients. Those findings indicate the need for reconsidering the definition of LPS.
No preview · Article · Jun 2000 · Pacing and Clinical Electrophysiology
[Show abstract][Hide abstract] ABSTRACT: Half of all deaths occurring in patients with heart failure are sudden deaths probably related to a malignant ventricular arrhythmia. The pathophysiological mechanisms of these arrhythmias are unclear, but left ventricular function, hypokalaemia accentuated by diuretics and treatments altering inotropism play a definite role. Because of the diversity of aetiologies generating heart failure, the multiplicity of fatal arrhythmias and the multifactorial origin of these arrhythmias, there is no formal marker for the risk of sudden death in patients with heart failure, at the present time. In addition to the NYHA classification and detection of episodes of syncope, assessment of these patients must be as complete as possible, at least including repeated evaluation of the ejection fraction, Holter ECG monitoring and detection of delayed ventricular potentials.
No preview · Article · May 1999 · Annales de Cardiologie et d Angéiologie