[Current limits of the long duration rhythmic holter: A real life study]. / Limites actuelles du holter rythmique de longue durée : une étude vie réelle.

BACKGROUND: Syncope or stroke remain frequently without any explained diagnosis. Long duration holter ECG is an available tool to diagnose arrhythmias. However, this tool is subject to availability of the recorders. AIM: Report a single center experience with long duration holter ECG in clinical practice, in the different cardiology and neurology indications, and to assess the different delays until achievement of a diagnosis. METHODS AND RESULTS: The device (Sorin Spiderflash) was used for 48 patients between January 2018 and June 2018. The holter was applied for a mean duration of 10±4days. The mean age was 55+19 years-old. 20 patients (42%) were explored for a stroke or transient ischemic attack (TIA), 18 (36%) for palpitations, 6 (12%) for syncope and 4 (8%) for evaluation of arrhythmias management. An abnormality has been recorded in 11 (22%) patients and a treatment has been administered in 5 patients (10%). Regarding, the timing of the exam, the mean time between the index event and the indication was 39 days. The mean time between the indication and the availability of the device was 32 days. 16 Days was the mean time for lecture and 23 days was the mean time between the result and the appointment with the cardiologist and neurologist. CONCLUSION: In this registry, the management of patients by non-invasive long duration holter ECG monitoring may be improved regarding the timing of the exams, their lecture and new appointments with the physicians.

[Asymptomatic Brugada syndrome: From diagnosis to treatment]. / Syndrome de Brugada asymptomatique : diagnostic, pronostic, nouvelles stratégies thérapeutiques.

Brugada syndrome management may be a difficult question. This article reviews diagnosis, prognosis evaluation, current and investigated treatments.

[Platypnea-orthodeoxia syndrome: A case of hypoxemia associated with a patent foramen ovale]. / Platypnée-orthodéoxie: un cas rare d'hypoxémie secondaire d'une réouverture post-traumatique du foramen ovale perméable.

Platypnea-orthodeoxia syndrome is a rare disease characterized by dyspnea and oxygen desaturation in the upright position with improvement in the supine position. We report a case of an 87-year-old woman with a recent history of traumatic hip, spine deformity and vertebral compression fracture, referred due to dyspnea oxygen desaturation. Thoracic tomodensitometry excluded the diagnosis of pulmonary embolism. Transthoracic echocardiography, with intravenous administration of agitated saline contrast solution, revealed the presence of atrial septal defect associated with a right to left shunting and mild enlargement of aortic root. Surgical closure of atrial septal defect resulted in resolution of the syndrome.

[Long term results of patients implanted with CRT-D: Results of a monocentric study]. / Devenir à long terme des patients implantés d'un défibrillateur triple chambre: résultats d'une série monocentrique en centre hospitalier.

Implantable cardiac defibrillators and resynchronization devices (CRT-D) are frequently used for heart failure patients. This is a retrospective study which included 50 patients with a CRT-D. The objective was to evaluate the prevalence of cardiac events (death, hospitalization for acute heart failure, ventricular arrhythmias). During 30-month follow-up, 4 patients (8%) died, 10 patients were hospitalized for acute decompensated heart failure (20%) and 5 patients (10%) presented an appropriate choc for a ventricular arrhythmia. In total, 19 patients presented at least one cardiac event (38%). An improvement in dyspnea was reported in 84% of patients. An improvement of left ventricular ejection fraction (LVEF) was reported in 74% of patients and 12% of them have normalized LVEF. In this study, the majority of patients implanted with a CRT-D presented an improvement of their symptoms. However, residual cardiac events were reported and remain unpredictable.

[Long term results of implantable loop recorder in patients with syncope: results of a French survey]. / Maintien des résultats de suivi à long terme des holters implantables même en cas d'élargissement des indications : résultats d'une étude française.

BACKGROUND AND OBJECTIVE: A first publication of our group demonstrated that implantation of a loop recorder in 30 patients experiencing an unexplained syncope (Medtronic Reveal DX or XT) definitively determined that an arrhythmia was the cause of symptoms in 10 patients (32%). However, we lack the results of a survey evaluating the results of long term follow-up after a loop recorder implantation and the results in case of wider indications of implantation of loop recorders. METHODS AND RESULTS: A device (Medtronic Reveal DX or XT) was implanted in 97 patients between january 2009 and june 2014. During a mean follow-up of 21±19 months, loop recording determined that an arrhythmia was the cause of symptoms in 34 patients (35%). For the management of these arrhythmias, treatments received by patients were a pacemaker implantation in 18 patients (53%), an implantable cardioverter-defibrillator in four patients (12%) and a supraventricular tachycardia ablation (cryo or radiofrequency ablation) in three patients (9%). For nine patients (26%), the arrhythmic events were asymptomatic and didn't justify a specific treatment. The final positive rate of loop monitoring implantation was of 25/97 (26%). The study demonstrated that the positivity of the follow-up was demonstrated after two years of follow-up in 26% of the cases. CONCLUSION: Long-term follow-up of 97 patients implanted by a loop monitor leaded to an interventional rythmology procedure in 26% of the cases. In 26% of patients, loop-monitoring follow-up was positive after a duration of more than two years.

[Double tachycardia: association of an atrial flutter and a fascicular ventricular tachycardia]. / Double tachycardie : association d'un flutter atrial et d'une tachycardie ventriculaire fasciculaire.

Double tachycardia is an uncommon type of tachycardia. We report the case of a 42-year-old patient, admitted in our department for palpitations. Two types of tachycardia, narrow and wide QRS one, have been documented in the moment of palpitations. The electrophysiology study highlights an atrial flutter and a fascicular ventricular tachycardia. The patient had no recurrence of palpitations after atrial flutter ablation and medical treatment by verapamil for his ventricular tachycardia. This is the first published case combining an atrial flutter and a ventricular tachycardia.

[Diagnostic and prognostic value of the head-up tilt test for patients with unexplained syncope: results of a French survey]. / Résultats diagnostiques à court terme et pronostiques à long terme chez des patients avec syncopes inexpliquées : résultats d'un série menée en centre hospitalier.

OBJECTIVE: Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope. METHOD: Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews. RESULTS: A head-up tilt test was realized in 77 patients (47.8±20years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32±11months (range 6-54months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n=5/48; 10%) or a negative head-up tilt test response (n=2/19; 10%). CONCLUSION: The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope.

[Permanent junctional reciprocating tachycardia (Coumel type): a rare but curable form of tachycardia]. / Tachycardie incessante révélant une tachycardie réentrante de type Coumel.

We report the case of a 52 year-old man experiencing recurrent and incessant tachycardias despite antiarrhythmic drugs. Electrophysiological exploration confirmed the diagnosis of permanent junctional reentrant tachycardias (Coumel tachycardia). This tachycardia has been treated successfully by catheter ablation. The mechanisms of this tachycardias are explained.

[Long-term follow-up after implantable loop recorder in patients with syncope: results of a French general hospital survey]. / Suivi à long terme après pose de holter implantable pour syncope: résultats d'un registre mené dans un centre hospitalier.

BACKGROUND AND OBJECTIVE: Despite recent advances in diagnostic procedures, syncope remains unexplained in 15 to 35% of patients. If implantable loop recorder is a validated diagnostic tool for unexplained syncope, results of this strategy are largely issued from randomized studies. We lack the results of surveys. The aim of this study was to report a single center experience with implantable loop recorders, in patients with unexplained syncope. METHODS AND RESULTS: A device (Medtronic Reveal DX or XT) was implanted in 31 patients between January 2009 and January 2012. During a mean follow-up of 10.5±8.5 months, loop recording definitively determined that an arrhythmia was the cause of symptoms in 10 patients (32%). Fourteen patients (45%) experienced syncope or pre-syncope. In eight of the 14 patients with syncope, during follow-up, no arrhythmic diagnosis could be made (one patient has been diagnosed as presenting epilepsy and seven as having hypotensive vasovagal syncope). In six patients, the ILR showed an arrhythmic aetiology. Four other patients presented an abnormal ILR result without symptoms. Diagnosis included sinusal arrest in four patients, bradycardia in one patient, advanced atrioventricular block in two patients, ventricular arrythmias in two patients, and supraventricular tachycardia of 180/min in one patient. Therapy was instituted in all patients, in whom an arrhythmic cause was found except one who refused the therapy (six pacemaker, two implantable cardioverter-defibrillator implantations, and one cryoablation of atrioventricular nodal reentrant tachycardia confirmed by an invasive exploration). CONCLUSION: In this survey, implantable loop recorder implantation led to the diagnosis of an arrhythmic cause in 32% of patients and excluded an arrhythmic cause in 26% of patient with a mean follow-up of 10.5 months.

[Recovered sudden cardiac death associated with an early repolarization syndrome: case analysis and pratical aspects]. / Mort subite récupérée associée à un syndrome de repolarisation précoce: analyse d'un cas et attitude pratique.

In this article, we report the case of a 61-year-old man who presented a cardiac arrest which has been resuscitated successfully. An early repolarization syndrome has been diagnosed by the ECG recorded the first 3 days after admission. This abnormality disappeared after that. The patient received an implantable cardioverter-defibrillator. Practical messages to the clinician concerning early repolarization are provided in this article.

[Antiplatelet agents increase hemorrhagic risk in patients undergoing a cardiac pacemaker or ICD implantation]. / L'implantation des stimulateurs et défibrillateurs cardiaques sous antiagrégants plaquettaires augmente le risque hémorragique.

OBJECTIVES: This study was designed to assess the hypothesis that the implantation or the replacement of a cardiac stimulator or defibrillator in patients receiving antiplatelet agents is associated with an increase of the haemorrhagic risk in comparison with patients not receiving antiplatelet agents (control group). METHODS AND RESULTS: We retrospectively included all the patients undergoing pacemaker or ICD implantation or replacement between January 2007 and May 2010. The primary criterion was the incidence of bleeding complications. In our center, 685 patients were implanted in this period. Two hundred and fourteen (31%) were implanted while taking antiplatelet agents, including 164 (24%) taking aspirin, 31 (4%) taking clopidogrel and 19 (3%) taking the combination aspirin plus clopidogrel, while 471 patients (69%) did not receive antiplatelet agents. The primary criteria was the hemorrhagic complications. Complications were noted in 14 patients out of 471 (3%) not taking antiplatelet agents, in 16 patients out of 214 (7.5%) taking an antiplatelet agent (P=0.004). The complications concerned 13 patients out of 164 taking aspirin (7.9%), one patient out of 31 (3.2%) taking clopidogrel and two patients out of 19 taking the combination aspirin plus clopidogrel (10.5%) (P=0.042 for aspirin vs placebo, NS for all other comparisons). In multivariable analysis, the factors associated with an increase of the heamorrhagic complications were the type of implant (ICD) (OR 3,7; P=0.001) and antiplatelet treatment (OR 2,7; P=0.009). CONCLUSION: Pacemaker and ICD implantation or replacement in patients taking antiplatelet agents are associated with an increase of the hemorrhagic risk.

[Oral anticoagulation doesn't increase hemorrhagic risk in patients undergoing a cardiac pacemaker or defibrillator implantation]. / L'implantation des stimulateurs et défibrillateurs cardiaques sous antivitamines K n'augmente pas le risque hémorragique.

OBJECTIVES: This study was designed to assess the hypothesis that the implantation or the replacement of a cardiac stimulator or defibrillator in patients receiving oral anticoagulants with an INR≥2 doesn't increase the hemorrhagic risk in comparison with patients for whom the treatment has been interrupted temporarily (INR<2) or with patients not receiving anticoagulants (control group). PATIENTS AND RESULTS: We performed a retrospective chart review of bleeding complications in all patients undergoing pacemaker or ICD implantation or replacement between January 2007 and may 2009. In this cohort, 43 patients (10%) were implanted with an INR≥2 while 36 patients (8%) were implanted with an INR<2 and 352 patients (82%) didn't receive anticoagulants. No complication (0/36) has been observed in patients having an INR<2, while 3/43 (7%) complications have been observed in patients with an INR≥2 and 13/352 (3.7%) in patients in the control group (p=0.3093). Duration of the hospital stay was similar in the three groups: 6.2 days in patients with an INR<2, 6.8 days in the group with an INR≥2 and 6.2days in the control group (p=0.686). CONCLUSION: Pacemaker and ICD implantation or replacement without withdrawing of oral anticoagulants and an INR≥2 was not associated with an increase of the hemorrhagic risk.

[Non invasive methylergometrine test should be carried out after cardiac arrest due to coronary spasm?]. / Faut-il faire un test au méthergin non invasif après un arrêt cardiaque par spasme coronaire?

A 59-year-old man was admitted after cardiac arrest with successful reanimation. There was no significant coronary lesion. We conclude to the diagnosis of coronary spasm after the occurrence of a chest pain with anterior ST elevation reversible with intravenous nitrates. One month later, non-invasive methylergometrine test was carried out and complicated by a cardiac arrest due to complete heart block and asystole treated by chest compression, molsidomine and epinephrine. No cardiac event occurred within the following six months. Technique (invasive versus not invasive) and indication of methylergometrine test for the follow-up of severe manifestations of coronary spasm should be better specified in international guidelines.

[Pulmonary hypertension and heart failure: the role of pulmonary vasculature]. / Hypertension pulmonaire et insuffisance cardiaque : le rôle de la vascularisation pulmonaire.

Left heart disease is the most common cause of pulmonary hypertension. Increased left-sided filling pressure leads to passive postcapillary venous hypertension. In some patients, pulmonary vasoconstriction and vascular remodeling may lead to a further increase in pulmonary pressure. When precapillary hypertension component is associated to left heart failure, the elevation of pulmonary pressure is out of proportion with left atrial pressure: transpulmonary gradient greater than 12 mmHg (mean pulmonary pressure -- mean capillary pressure) and pulmonary vascular resistance greater than three Wood units. Precapillary pulmonary hypertension is common in severe systolic heart failure. Before cardiac transplantation, increased pulmonary vascular resistance greater than 3,5 Wood units are reported in 19 to 35% of patients. In those patients vasoreactivity tests are performed with inotropic and/or systemic and/or pulmonary agents to determine the risk of right heart failure after transplantation. There is no pulmonary vascular resistance level above which transplantation is contraindicated. Cardiac assistance may be used before and after transplantation when pulmonary hypertension is severe and not reversible with conventional treatment and/or pulmonary vasodilators. The contribution of precapillary PH in diastolic heart failure is not known but can be significant and lead to disproportionate PH particularly in elderly. The precapillary component of pulmonary hypertension could be a therapeutic target for specific pulmonary vasodilators. Until now pharmacological trials has been disappointing and those medications can be dangerous because of increasing blood flow to the pulmonary capillaries with a risk of pulmonary edema when left sided pressure are still elevated.