Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists.

BACKGROUND: The clinical presentation and causes of atrial fibrillation (AF) in the 1990s may differ from AF seen 2 to 3 decades ago. It was the objective of this prospective study to characterize various clinical presentations and underlying conditions of patients with AF observed in general practice in France. METHODS AND RESULTS: The study population comprised 756 patients (19 to 95 years of age) with electrocardiographically documented AF subdivided into paroxysmal (<7 days), chronic (last episode >1 month) and recent onset AF(persistent >7 days and<1 month). Symptoms were present in 670 patients (88.6%). The relative prevalences of paroxysmal, chronic, and recent onset AF were 22.1%, 51.4%, and 26.4%, respectively. Cardiac disorders, present in 534 patients (70.6%), included hypertension (39.4%), coronary artery disease (16.6%), and myocardial diseases (15.3%) as the most common. Rheumatic valvular disease represented a common cause in women (25. 0%) but not in men (8.0%). The paroxysmal group differed by a high percentage of palpitations (79.0%) and a low percentage of underlying heart disease (53.9%). With a mean follow-up of 8.6+/-3.7 months, 28 patients (3.7%) died, including 6 fatal cerebrovascular accidents. Among the 728 patients who survived, congestive heart failure occurred in 30 patients (4.1%), and embolic complications occurred in 13 patients (1.8%). In the paroxysmal AF group, 13 patients (8.0%) developed chronic AF and 51 (31.3%) had AF recurrences. At the time of follow-up, 53 patients (14.3%) from the chronic AF group and 108 patients (55.7%) from the recent onset AF group were in sinus rhythm. CONCLUSIONS: This large-scale study establishes the current demographic profile of out-of-hospital patients with AF and highlights some of the changes that have occurred in the past decades, including a particular shift in cardiac causes toward nonrheumatic AF. This study also demonstrates significant differences between various subsets of AF.

Single radiofrequency application to cure atrioventricular nodal reentry: arguments for the slow pathway origin of the high-low frequency slow potentials.

BACKGROUND: High-low frequency slow potentials are thought to be related to the slow AV pathway conduction. Their use was proposed to guide radiofrequency (RF) ablation of atrioventricular nodal reentrant tachycardia (AVNRT). The present study was designed to determine the prospective value of these high-low frequency slow potentials to guide AVNRT ablation using a single RF application. Single RF application could indeed reduce the size of the lesion created in the viciny of the specialized AV conduction system and shorten the radiation exposure and the overall duration of the procedure. RESULTS: Forty-one patients (14 men, 27 women, 45 +/- 16 years old) with AVNRT underwent slow pathway RF ablation guided by high-low frequency slow potentials. High-low frequency slow potentials were found in all patients along the tricuspid annulus and above the coronary sinus. Ablation was always performed in the posterior part of Koch's triangle. The mean A/V amplitude ratio of the successful site was 0.43 +/- 0.59. In 32 patients (78%) AVNRT was no longer inducible after a single RF application. Procedure and radiation times were 35 +/- 31 and 13 +/- 12 min respectively. Five patients required 2, 3 patients 3, and 1 patient 6 RF applications. The mean number of RF applications was 1.4 +/- 0.9 (median = 1). In the 32 patients who required only one RF application, 24 (75%) had an obvious dual AV nodal pathways with a jump before ablation, which completely disappeared in 18 of them (75%) after ablation. In the 6 remaining patients, who still had a jump after 1 RF application, there was no significant change in either conduction times or refractory periods concerning both the anterograde and retrograde AV conduction. No patient had PR interval purlongation. After a mean follow up of 11 +/- 5 months, recurrence was observed in a single patient who received 2 discontinued RF applications. CONCLUSION: Catheter-mediated ablation of AVNRT using high-low frequency slow potentials to localize the slow AV pathway is feasible and safe. Using this technique, a single RF application was successfull in 78% of patients, and slow pathway characteristics were completely eliminated in 75% of patients. The radiation time and the procedure duration were short. This suggest that, in patients with AVNRT, the choice of an appropriate RF target can reduce procedural duration.

Asystolic cardiac arrest during head-up tilt test: incidence and therapeutic implications.

Occasionally, the cardioinhibitory response may be profound during tilt induced syncope. Whether this response is associated with more severe symptoms or predicts a poor response to pharmacotherapy remains controversial. The aim of this study was to characterize patients with vasovagally mediated asystole occurring during head-up tilt test and to evaluate the respective interests of sequential pacing and beta-blockers to treat them. We performed 60 degree tilt testing in 179 consecutive patients with unexplained syncope (91 women and 88 men, age 36.6 +/- 20.1 years). Asystole was defined as a ventricular pause > 5 seconds. All patients with tilt induced asystole received therapy with either beta-blockers or sequential pacing, the efficacy of which was evaluated with serial tilt tests. Of 77 patients with positive tilt test, 10 developed syncope related to asystole (mean duration 11.9 +/- 4.9 s), 2 with spontaneous recovery, and 8 with seizures needing a brief cardiopulmonary resuscitation. When compared with patients without asystole, asystolic patients had more severe symptoms (seizures: 6/10 vs 9/67, P = 0.05, injury 9/10 vs 27/67, P = 0.0048). In the first six patients in whom cardiac pacing was considered, syncope or presyncope still occurred despite atrioventricular pacing at 45 beats/min. Five of these 6 patients, as well as the remaining 4 asystolic patients, were tilted with beta-blockers: 3 patients became tilt-negative; 3 were significantly improved; and 3 did not respond. During follow-up (mean 22.7 +/- 11.7 months) with every patient taking beta-blockers and seven having a permanent pacemaker, no syncopal recurrence was observed. Tilt-induced asystole that may require resuscitative maneuvers occurs especially in patients with a history of seizures or injury. Therapy with beta-blockers in often effective to prevent induction of syncope as well as recurrences.

Effect of ramipril on heart rate variability in digitalis-treated patients with chronic heart failure.

The aim of this study was to evaluate the effect of an angiotensin-converting enzyme (ACE) inhibitor, ramipril, on heart rate variability in patients with heart failure simultaneously treated with digitalis. This study was a multicentric, randomized, double-blind, placebo-controlled study including 50 patients with chronic heart failure (CHF). All patients were in NYHA functional class II and III. The etiology of CHF was mainly idiopathic dilated cardiomyopathy and ischemic heart disease. After a 4-week placebo run-in period with digoxin and diuretics, patients were randomized to receive additional ramipril or placebo. To assess heart rate variability (HRV) and arrhythmias, 24-hour ECGs were recorded at the end of the placebo run-in period, 8 and 24 weeks after randomization. Spectral analysis of HRV was performed during one diurnal and one nocturnal 5-minute time period. No statistically significant differences in HRV within low-, high-, and total-frequency bands were induced by ramipril in either the diurnal or nocturnal periods, both at 8 and 24 weeks after randomization. Ramipril produced a significant decrease in nonsustained ventricular tachycardia at 24 weeks of treatment (p = 0.01). These results run against previous observations showing an increase in parasympathetic tone with ACE inhibitors in heart failure. The present study thus suggests that the effects of ACE inhibitors in CHF are variable and depend on the patient and concomitant treatment that might influence HRV such as digoxin treatment.

Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management.

BACKGROUND: Endocarditis related to pacemaker (PM)-lead infection is a rare but serious complication of permanent transvenous pacing. To determine in which situations the diagnosis should be evoked and to determine optimal management, we reviewed our experience with endocarditis related to PM-lead infection. METHODS AND RESULTS: Fifty-two patients were admitted for endocarditis related to PM-lead infection. The presentation was acute in 14 patients, with onset of symptoms in the first 6 weeks after the last procedure on the implant site, and chronic in 38 patients. Fever occurred in 86.5%. Clinical and/or radiological evidences of pulmonary involvement were observed in 38.4%. Pulmonary scintigraphy disclosed pulmonary infarcts in 31.2%. Local complications were found in 51.9%. Elevated C-reactive protein was found in 96.2%. A germ was isolated in 88.4% of patients and was a Staphylococcus in 93.5%. Transthoracic echocardiography demonstrated vegetations in only 23% of patients, whereas transesophageal echocardiography disclosed abnormal appearances on the PM lead in 94%. We systematically tried to ablate all the material. Two techniques were used: percutaneous ablation or surgical removal during extracorporeal circulation. All patients were treated with antibiotics after removal of the infected material. Two patients died before lead removal and 2 after surgical removal; the predischarge mortality was 7.6%, and the overall mortality was 26.9% after a follow-up of 20.1+/-13 months. CONCLUSIONS: The diagnosis of endocarditis related to PM-lead infection should be suspected in the presence of fever, complications, or pulmonary lesions after PM insertion. Transesophageal echocardiography should be performed to look for vegetations. Staphylococci are involved in the majority of these infections. The endocardial system must be entirely removed and appropriate antibiotic therapy pursued for 6 weeks.

[Determinants of malignant vasovagal syncopes with asystole disclosed by the tilting test and therapeutic implications]. / Déterminants de syncopes vasovagales malignes avec asystoles révélées par le test d'inclinaison et incidences thérapeutiques.

UNLABELLED: In order to evaluate the determinants of malignant vasovagal syncope with asystole revealed by the tilting test and to determine the possible therapeutic implications, 179 patients (91 women and 88 men, mean age 36.6 +/- 20.1 years) referred for the assessment of unexplained a were studied. The test was performed with a tilt of 60 degrees for 45 minutes. A bolus of isoprenaline (0.02 to 0.08 microgram/kg.min) was injected in the case of a negative passive test. Asystole was defined as a ventricular pause lasting > or = 5 seconds. RESULTS: Ten (13%) of the 77 patients with a positive tilting test experienced a cardio-inhibitory reaction with prolonged asystole lasting an average of 11.9 +/- 4.9 seconds. Compared to the other 67 patients with a positive test, those with asystole were younger (23/9 +/- 14.8 years vs 32.9 +/- 18.5 years, NS) and had a more frequent history of convulsions (6/10 vs 9/67, p = 0.05) during spontaneous episodes and trauma (9/10 vs 27/67, p = 0.005). Implantation of a pacemaker was chosen first-line treatment for the first 6 patients. Their follow-up tilting tests remained positive (pre S = 4, S = 1) despite DDD stimulation of 45 bpm. Five of these patients and the following 4 patients were retested under beta-blockers. In six patients treated with beta-blockers, the clinical symptoms resolved completely (n = 3) or improved (n = 3), in contrast with 3 other patients in whom the tilting test remained positive with recurrence of asystole. The mean follow-up for the 169 patients is 22.7 +/- 11 months and the ten patients with asystole remained totally asymptomatic. CONCLUSION: An asystolic response during the tilting test is characteristic of vasovagal syncope described as malignant. The syndrome essentially affects young patients, with a more frequent history of trauma and convulsions. Beta-blockers appear to be at least as effective as permanent pacemaker to prevent symptoms in this specific subgroup.

[Anxiety disorders and unexplained syncopes of presumed vaso-vagal origin]. / Troubles anxieux et syncopes inexpliquées présumées d'origine vasovagale.

The impact of anxiety neurosis on the diagnosis and treatment of patients with unexplained syncope (S) was assessed in 178 patients (91 women and 87 men) with an average age of 36.5 +/- 20 years, presenting with 10.7 +/- 24 episodes of S). None had evidence of underlying cardiac disease apart from 7 patients with mild hypertension. All patients underwent a tilt test (TT) at 60 degrees for 45 minutes. A bolus of isoproterenol was injected intravenously in subjects with negative TT. After the test, the patients were classified according to the presence (n = 38) or absence (n = 140) of anxiety neurosis based on the DSM III-R diagnostic. The TT was positive in 76 patients, 9 of whom had a cardioinhibitory reaction with prolonged asystole. Patients with anxiety had more episodes of S (24 +/- 43 versus 7 +/- 13; p = 0.001), a shorter interval between S (11.5 +/- 23 months versus 12.5 +/- 20 months, p = 0.02) but more negative TT (27/38 versus 75/140; p = 0.05). One hundred and sixty-eight patients were followed up : 10 were lost to follow-up. Preventive treatment was undertaken in 59 patients who were representative of the whole group with respect to age (30 +/- 18 years 39 +/- 21 years : p = 0.004). After an average follow-up of 24.5 +/- 15 months, 26 patients (15%) experienced a recurrence of S. The recurrence rate was identical in patients with positive and negative TT and in treated and untreated cases. On the other hand, recurrence was higher in those with anxiety (12/25 versus 14/117; p = 0.001) who also had less improvement of symptoms (12/15 versus 74/120; p = 0.001). The "anxiety" variable was therefore identified as being the only predictive factor for recurrence of syncope. The authors conclude that in patients referred for investigation of unexplained syncope, some suffer from anxiety neurosis, in whom the TT is usually negative, and have a higher risk of recurrence. They justify a specific therapeutic management.

Late diagnosis of pericardial constriction associated with defibrillator patches and deformation of the left ventricle.

We report a case of pericardial constriction associated with defibrillator patches developing 4.5 years after implantation. This constriction was related to the presence of a large pericardial mass that had developed above the defibrillator patch. This mass, which had a calcified superior border, suggested former hematoma associated with pericardial fibrosis. It induced significant compression of the right ventricle and a dumb-bell deformity of the left ventricle. The hemodynamic picture was of elastic-form constrictive pericarditis. Because of previous cerebral stroke during cardiac surgery, the patient was discharged on pharmacologic treatment after improvement of his functional status. Since removal of epicardial patches is an effective treatment of constriction, constrictive pericarditis should be systematically considered in patients with epicardial patch electrodes and impairment of functional status.

[Prognostic factors after sustained ventricular fibrillation or tachycardia. A multivariate study apropos of 160 cases]. / Facteurs pronostiques après fibrillation ou tachycardie ventriculaire soutenue. Etude multivariée à propos de 160 observations.

The authors analysed survival of 160 patients (121 men and 31 women; average age 57.2 +/- 12.5 years; follow-up 29 +/- 20 months) treated for malignant ventricular arrhythmias (sustained ventricular tachycardia, ventricular fibrillation, syncope with inducible ventricular tachycardia). The therapeutic evaluation was frequently invasive (145 patients underwent at least programmed ventricular stimulation, 108 patients underwent full endocavitary electrophysiological studies) and non-pharmacological therapy was widely used (defibrillator n = 44; antiarrhythmic surgery n = 28; ablative procedures n = 19; transplantation n = 7). The following underlying pathologies were observed: ischaemic heart disease n = 120; non-ischaemic left heart disease n = 19; right heart cardiac disease n = 4; and apparently normal hearts n = 17). The average ejection fraction was 40.5 +/- 15.5% and 29 patients were in the NYHA functional classes III or IV. Fifty-five patients had life-threatening arrhythmias whilst receiving amiodarone. At 2 years, the actuarial sudden death rate was 5.9 +/- 2.1% and the actuarial total cardiac mortality rate was 13.1 +/- 2.9%. Univariate analysis showed age, the presence of underlying cardiac disease, the presence of dilated cardiomyopathy, the absence of an invasive approach, the need for basal pacing in electrical cardioversion, the absence of betablocker therapy, a decreased left ventricular ejection fraction and a high NYHA functional class, to be predictive of sudden death. In multivariate analysis, age, the NYHA class for total cardiac mortality and the NYHA class for sudden death, were the only independent predictive factors. The authors conclude that in the era of invasive methods of evaluation and widespread use of non-pharmacological therapeutic methods, the symptomatology of cardiac failure assessed by the NYHA classification remains the most powerful independent prognostic factor after an episode of malignant ventricular arrhythmia.

[Value of mapping in surgical treatment of ventricular tachycardia]. / Utilité de la cartographie dans la chirurgie des tachycardies ventriculaires.

Surgery may be proposed for patients with a localised aneurysm or akinesia for treatment of monomorphic ventricular tachycardia resistant to antiarrhythmic therapy after myocardial infarction. The multiplicity of tachycardia forms in the same patient, the variability of their mechanism which is not necessarily limited to the subendocardia layers, require mapping to guide the surgeon in the destruction of the anatomical substrates. In a series of 57 ventricular tachycardias recorded in 17 patients with myocardial infarction the authors demonstrated that a system of computerised mapping of the epicardial and endocardial regions optimised the results of this form of surgery. Mapping localised, sometimes at a distance from the scar, classical subendocardial reentry, implicated on occasion the mitral papillary muscle in the mechanism or a tachycardia in cases of inferior or lateral infarction and localised the reentry in the epicardium of the lower layers of the septum. The identification of these "atypical" mechanisms significantly improves the number of patients without inducible arrhythmias after surgery (from 50 to 87% in the authors' experience), without changing the operative mortality. The only really curative approach because of the limitations of catheter ablation, this surgery is a complementary method to implantable defibrillators in the management of post-infarction ventricular tachycardia.

[Automatic implantable defibrillator and antiarrhythmic surgery in ischemic cardiopathies. Apropos of 53 cases]. / Le défibrillateur automatique implantable et la chirurgie antiarythmique dans les cardiopathies ischémiques. A propos de 53 observations.

The automatic implantable defibrillator (AID) and antiarrhythmic surgery are the two therapeutic options after failure of catheter ablation and/or antiarrhythmic therapy for sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with coronary artery disease. The authors undertook retrospective study of the characteristics of two groups of patients treated between November 31st 1987 et December 31st 1993 either by AID (28 men and 4 women with an average age of: 56.1 +/- 11.2 years) or by surgery (19 men and 2 women with an average age of: 60.6 +/- 6.8 years). The "surgical" patients differed from "defibrillator" patients in the fewer number of cardiac arrests, a higher proportion of sustained monomorphic VT, better tolerated sustained monomorphic VT (rarely syncopal), fewer early post-infarction arrythmias (< or = 8 weeks), more anterior wall infarction and a higher proportion of aneuvrysms. The perioperative mortality was 6.2% in the "defibrillator" group and nil in the "surgical" group (p = NS). At 2 years, the sudden death rate in the "defibrillator" and "surgical" groups was 7.5% and 0% respectively and total cardiac mortality was 17% and 20% respectively (p = NS). The authors conclude that perioperative mortality and the sudden death rate at 2 years are relatively low in the two groups. However, the total cardiac mortality remains high, largely related to perioperative death and secondary cardiac failure. Nevertheless, compared with defibrillator patients and with identical average ejection fractions, there was no extra mortality due to cardiac failure after antiarrhythmic surgery.

[Automatic implantable defibrillators. Clinical experience apropos of 45 patients]. / Le défibrillateur automatique implantable. Expérience clinique á propos de 45 patients.

The aim of this study was to analyse the efficacy and survival after implantation of an automatic cardioverter-defibrillator.. Forty-five patients including 37 men were followed up for 0 to 51 months. The indications were ventricular fibrillation with no curable cause (n = 27) and sustained resistant or poorly tolerated ventricular tachycardia (n = 17) when programmed ventricular pacing with antiarrhythmic therapy was not applicable or gave poor results. One patient was implanted with this device for torsades de pointes. The underlying cardiac disease was ischaemic in 34 cases, non-ischaemic in 8 cases, and 3 patients had no apparent cardiac disease. Twenty patients were implanted with an epicardial system (group I) and 25 patients with endocardial system (group II). In group II, there was one complete failure of implantation requiring the use of an epicardial system and 2 partial failures requiring an additional epicardial patch electrode. The perioperative mortality was 2/45 (4.4%), both cases being due to permanent arrhythmias. In 5 patients, the minimal effective energy of defibrillation was over 25 Joules at implantation, without any untoward consequences on the clinical outcome. Ten non-fatal complications were observed including two major problems (haemopericardium); there were two cases of late increase of the minimal effective energy of defibrillation requiring the addition of a subcutaneous patch. Twenty-four patient (53%) received at least one appropriate therapy; 14 patients (36%) had at least one inappropriate shock during follow-up. During follow-up, 7 patients died, 6 of a cardiac cause and 3 of an arrhythmic problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of left ventricular mass in systemic hypertension: comparison of standard and signal averaged electrocardiography.

OBJECTIVE: To investigate the quantitative relationship, if any, between signal averaged electrocardiographic variables and echocardiographically determined left ventricular mass in hypertensive subjects. DESIGN: Cohort analytic prospective study. SETTING: University hospital. SUBJECTS: 50 hypertensive subjects selected consecutively from inpatients. Patients older than 75 years, with underlying cardiac disease, with inconclusive echocardiograms with bundle branch block, or in atrial fibrillation were excluded. INTERVENTIONS: Antihypertensive therapy involving 41 patients was continued. MAIN OUTCOME MEASURES: Left ventricular mass calculated in accordance with the standards of the Penn convention. Thirteen criteria derived from combinations of signal averaged electrocardiographic X, Y, and Z Frank orthogonal leads, including voltage criteria, duration, and time-voltage integrals of the QRS complex. Four widely used standard electrocardiographic criteria for detection of left ventricular hypertrophy. RESULTS: There was no difference in the values for any of the electrocardiographic variables between patients with (n = 29) and without left ventricular hypertrophy (n = 21). The time-voltage integral of QRS in the horizontal plane was the best signal averaged variable related to left ventricular mass (r = 0.33, P = 0.019); however, the correlation with Rodstein voltage was stronger (r = 0.46, P = 0.0009). A positive correlation was also found between left ventricular indexed mass and Rodstein voltage (r = 0.43, P = 0.0019). Stepwise regression analysis revealed Rodstein voltage as the only predictor of indexed mass (P = 0.0019), and Rodstein voltage (P = 0.0022) and body weight (P = 0.011) as the only independent correlates of left ventricular mass. CONCLUSIONS: The relation between electrocardiographic variables and left ventricular mass or indexed mass is of limited value; signal averaged orthogonal leads do not improve this assessment compared with standard electrocardiographic leads.

[Thromboembolic complications of arrhythmia due to atrial fibrillation]. / Complications thrombo-emboliques de l'arythmie complète par fibrillation auriculaire.

Fifteen per cent of cerebrovascular accidents have a cardiac origin, two thirds of which are due to atrial fibrillation (AF). The Framingham study showed the risk of an ischaemic cerebral event to be increased by 5.6 in AF unrelated to rheumatic heart disease and by 17.5 when AF is associated with valvular heart disease. The risk of embolism is higher in elderly subjects and in those with underlying cardiac disease. Other high risk conditions include hypertension, diabetes, hyperthyroidism and cases with echocardiographic changes: left atrial dilatation, pre-thrombotic state or intra-atrial thrombus, atheroma of the ascending aorta. This stratification of risk should be taken into account when deciding on treatment. Conscious of the importance of the risk of embolism in AF, several authors have undertaken, over the last few years, randomised studies of the prevention of thromboembolic complications of AF: the AFASAK, BAATAF, SPAF and SPINAF trials. All showed the unquestionable efficacy of warfarin, even at low doses, at the price of a haemorrhagic risk of less than 2% per year for severe haemorrhages. A more recent study (SPAF II) confirmed the value of aspirin at the dosage of 325 mg/day which would seem to be a good alternative to anticoagulant therapy when this is contraindicated, although aspirin is less effective. The indications for anticoagulant therapy have become clearer since the publication of these results. Anticoagulant therapy is essential in permanent AF whether or not associated with rheumatic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Direct recording of sinus node potentials using electrode catheter techniques.

Direct recording of sinus node (SN) potentials using electrode catheter techniques is feasible and may be achieved in 50-86% of patients. It takes 15-30 min using commercially available catheters. However, obtaining stable recordings is often difficult, necessitating direct contact of the distal electrode with the endocardial area underlying the sinus node. There is a wide range in sinoatrial (SA) intervals (30-150 ms) obtained, and an overlap exists between patients with normal and abnormal SN function. Consequently, measurement of the SA interval alone may not be a reliable tool for diagnosing SN dysfunction. However, direct SN recordings have a theoretic value, allowing differentiation of disorders of SA conduction from disorders of the impulse generation.

Vasospastic angina without flow-limiting coronary lesions as a cause for aborted sudden death.

Two patients resuscitated from out-of-hospital cardiac arrest were later found to have minor coronary atherosclerosis and no inducible ventricular arrhythmia. Coronary spasm was not elicited during provocative tests but occurred on introduction of the catheter in the right coronary artery and spontaneously recurred after resuscitation, leading to myocardial infarction in one patient. Both patients received an implantable cardioverter defibrillator and subsequent discharges, while receiving calcium antagonists.

[Efficacy and tolerability of sustained-release disopyramide in the treatment of cardiac arrhythmia. Results of a study with 593 patients]. / Efficacité et tolérance du disopyramide à libération prolongée dans le traitement des arythmies cardiaques. Résultats d'une étude portant sur 593 patients.

In the context of an open multicentre study, 593 patients participated in the evaluation of sustained release disopyramide (*) in the treatment of cardiac arrhythmias. One hundred and seventy one (29%) had a ventricular arrhythmia, 382 (64%) a supraventricular arrhythmia and 40 (7%) an atrial and ventricular arrhythmia. Two hundred and seventy patients (46%) had underlying cardiac disease. Disopyramide was administered at the mean daily dose of 462 +/- 95 mg. The effectiveness of treatment was assessed after 3 and 6 months by Holter in the group treated for ventricular arrhythmias, the responder rate was 52.6% at three months and 58.1% at 6 months. It was significantly (p < 0.001) greater in the group treated for supraventricular arrhythmias (71.3% at 3 months and 82.1% at 6 months). The Holter responder rate in patients aged over 65 (70.5% at 6 months) was high and general and cardiac acceptability similar to that in younger patients. Adverse events led to the interruption of treatment in 8.2% of patients. Thus the effectiveness/acceptability ratio of SR disopyramide makes it entirely appropriate for the treatment of cardiac arrhythmias, even in the elderly.

[Efficacy of antihypertensive treatment in the French population. A multicenter survey]. / Efficacité du traitement antihypertenseur dans la population française. Enquête multicentrique.

In order to assess the efficacy of antihypertensive treatment in the population, a study was undertaken in 5 French cities during the commercial fairs of Grenoble, Marseilles, Nice, Toulouse and Lille. The blood pressure was measured according to the WHO recommendations in volunteers. The study included a total of 7107 subjects of both sexes, with 4064 subjects in the 35-64 year age group. The therapeutic efficacy was evaluated in the 791 hypertensive patients who knew their antihypertensive therapy. Taking < 160/95 mmHg as the criterion of efficacy, 52 to 73% of the hypertensive patients were well controlled. However, if the therapeutic objective of normalisation of the blood pressure (BP < 140/90 mmHg) is taken as the criterion of efficacy, only 23 to 29% of the hypertensive patients were controlled whilst their BP remained significantly higher than that of normotensive controls of the same age. The difference in efficacy of antihypertensive therapy between the cities may be explained by the heterogenicity of the populations whereas the treatment did not differ significantly. After adjustment analysis with respect to sex showed that women were better controlled than men whatever the criterion chosen. The group controlled at BP < 160/95 mmHg only differed from the group < 140/90 with respect to the average BP value which was higher before treatment and decreased less with treatment; though this did not achieve statistical significance. In matters of public health, if the ideal blood pressure is taken as < 140/90 mmHg, this study shows that the objective is only attained in one out of four patients in the population studied.