[Atrial flutter ablation: initial experience in a general hospital]. / Ablation de flutter atrial: experience initiale d'un centre hospitalier general.

BACKGROUND: Right atrial flutter has a relatively high incidence. It is often symptomatic and can have a poor outcome particularly in case of thrombo-embolic events. AIM OF STUDY: We evaluate the results of radiofrequency catheter ablation for right atrial flutter since the introduction of this technique inour hospital. METHODS: The 28 first patients referred in our institution for atrial flutter and relevant for cavo-tricuspid isthmus ablation were enrolled. Ablation used a 8 mm tip electrode catheter and one or two conventional diagnostic catheters. The goal of ablation was complete bidirectional isthmus block. RESULTS: The first-line success rate was 96 percent with 4 percent early flutter recurrence. The mean duration of radiofrequency current applications was 652 +/- 409 seconds. No complication was observed. CONCLUSION: This results are comparable with the published data and encourage the development of basic ablation procedures and maintenance of rhythmic competence in general hospital inside medical network.

[Heart valve diseases specific in rheumatoid polyarthritis. Apropos of 2 cases]. / Les cardiopathies valvulaires spécifiques dans la polyarthrite rhumatoïde. A propos de deux observations.

Rheumatoid nodules represent a rare cardiac valvular involvement in rheumatoid arthritis. Patients are usually asymptomatic. We report two cases of such involvement: one presented as a tumour implanted on the mitral valve, with systemic embolisation; the other presented as aortic regurgitation with acute heart failure. Surgical treatment was performed in both cases. Histological examination revealed typical rheumatoid nodules. The authors discuss valvular involvement in rheumatoid arthritis.

[Continuous ambulatory electrocardiographic recordings using the Holter system in the late phase of hospitalization for recent myocardial infarct. Value and limitations studied in a series of 100 patients]. / Enregistrements électrocardiographiques continus en ambulatoire par système Holter en phase tardive d'hospitalisation pour infarctus du myocarde récent. Intérêt et limite à propos d'une série de 100 patients.

Repeated continuous ambulatory electrocardiography by Holter monitoring was performed after early mobilisation post-myocardial infarction in 100 patients, without ventricular extrasystoles on classical ECG. Frequent ventricular arrhythmias were recorded in 58 p. 100 cases, unrelated to the localisation of the infarct. The observation of ventricular arrhythmias in the Coronary Care Unit (CCU) was not related to the occurrence of VEs during Holter monitoring. On the other hand, VEs were less frequent (38 p. 100 compared to 68 p. 100) in patients taking amiodarone or betablockers on transfer from the CCU. The reduced activity of patients during Holter monitoring minimises the frequency of arrhythmias, and 10 p. 100 patients were observed to have VEs only after exercise tolerance testing. These VEs seem to be a bad prognostic factor; the 9 patients who died in this series all presented VEs on ambulatory monitoring (7) or during exercise tolerance testing (2). However the number of patients with triple vessel disease was greater in the group with VEs on ambulatory monitoring (57 p. 100 compared with 13 p. 100). It is difficult to assess the precise role of the VEs amongst the other risk factors of sudden death. This is not a randomised study, but it would appear that long=term amiodarone or betablockers therapy may influence the medium-term prognosis.

[Are stenoses of the common trunk of the left coronary artery at the root of unstable angina?]. / Les sténoses du tronc commun de la coronaire gauche s'individualisent-elles au sein des angors instables?

In a series of 200 cases of unstable angina who have had coronary arteriography carried out, a stenosis of more than 60% of the trunk of the left coronary artery was noted in 40 cases (20%). This sinister site of arteriosclerosis may be suspected in patients presenting with long-standing angina (mean for the group 44 months), an angina which has recently become worse, one which is not responding rapidly to rest and beta-blockers, and in particular one where there has been a previous infarction (50% of cases). Coronary arteriography shows that the lesions were more diffuse and more severe in the group with stenosis of the main trunk. Surgical prognosis becomes worse (31% mortality) because of the risk of vascular complications. Treatment by large doses of Propranolol improves the classically gloomy prognosis of these patients when treated medically.