[Very long term follow-up after radiofrequency ablation for atrial fibrillation: the Geneva experience]. / Suivi à tres long terme après ablation par radiofréquence de la fibrillation auriculaire: expérience à Genève.

Catheter ablation (CA) has emerged as an increasingly popular treatment option for selected patients with atrial fibrillation (AF) because drugs are frequently limited by side effects and poor effectiveness. However, very little data is available regarding outcomes of CA of AF beyond 5 years. Guidelines' recommendations are not clear regarding long-term oral anticoagulation (OAC) after 2 years. We assessed thromboembolic events (TE) and AF ablation outcomes at very long-term follow-up (> 5 years) after CA. During a mean follow-up of 9 years after CA, 68% patients were in stable sinus rhythm without anti-arrhythmic drugs and the TE event rate was 0.41 per 100 patients/year. Our data suggests that patients post ablation with a high risk for stroke (CHA2DS2-VASc ≥ 2) should however continue OAC treatment.

[New diagnostic tools for arrhythmias]. / Nouveaux outils pour le diagnostic d'arythmies.

Cardiac arrhythmias are common conditions that often manifest themselves intermittently, thus complicating their diagnosis, particularly in the ambulatory setting. Recently, technological advances have facilitated public access to health applications and devices. This article reviews the available technologies and analyses their usefulness for the diagnosis of arrhythmias in the context of everyday clinical practice.

[Early repolarization: when should one worry?]. / Repolarisation précoce: quand s'inquiéter?

Early repolarization of the QRS complex on the surface ECG has long been considered to be a benign finding, but is now recognized as being associated with malignant ventricular arrhythmias and sudden death. This article overviews the literature on this subject, and includes illustrative clinical cases.

[Endurance sports and arythmias]. / Sports d'endurance et arythmies.

Endurance sports can predispose to the occurrence of certain arrhythmias, making them more frequent in athletes than in the general population. Endurance athletes often exhibit electrocardiographic modifications that are difficult to interpret without specific knowledge of the athlete's ECG. Some of these ECG modifications and arrhythmias are benign, however others can be potentially life threatening.

[Remote management of pacemakers and implantable cardioverter defibrillators: an application of telemedicine]. / La télécardiologie pour les stimulateurs cardiaques et les défibrillateurs implantables.

Remote monitoring and follow-up of pacemakers and implantable cardioverter-defibrillator consists of automatic transmission of the data to the cardiologist on a secure website. Many clinical studies have demonstrated the safety of this process and the improvement of patient satisfaction. This strategy allows a reduction in the number of in-office visits, and results in a shorter delay to diagnosis of arrhythmias. A number of studies are ongoing to evaluate the effectiveness of remote monitoring in improving patient outcome.

[Role of cardiac resynchronization therapy for treatment of heart failure]. / Place de la resynchronisation dans le traitement de l'insuffisance cardiaque.

Cardiac resynchronization therapy by a biventricular pacemaker or defibrillator is recommended for treating selected patients with systolic heart failure who are in NYHA class III or IV despite optimal medical therapy, have a left ventricular ejection fraction of < or = 35%, and a QRS width of > or = 120 ms. Improvement in symptoms or ventricular remodelling is observed in 50-80% of patients. In order to improve response to treatment, several strategies are proposed, including patient selection, lead positioning and device optimization.

Hepatopulmonary syndrome increases the postoperative mortality rate following liver transplantation: a prospective study in 90 patients.

Hepatopulmonary syndrome (HPS) is a frequent pulmonary complication of patients with end-stage liver diseases. HPS is diagnosed by hypoxemia and pulmonary vascular dilatation and is an independent risk factor of mortality. Orthotopic liver transplantation (OLT) is the only factor that modifies the natural course of HPS. Once patients with HPS have been transplanted, their long-term survival rate is similar to transplanted patients without HPS. Consequently, HPS is an indication of OLT whatever the severity of hypoxemia. However, besides the favorable long-term survival of HPS patients with OLT, a high postoperative mortality (mostly within 6 months) has been suggested. The aim of our study was to analyze the incidence of HPS and postoperative outcome after OLT in 90 consecutive patients. All patients were prospectively included and had blood gas analysis to detect HPS. Patients with hypoxemia had contrast echocardiography to confirm HPS. Nine patients had HPS with a 50 50 mmHg in all HPS patients transplanted.

Unsuccessful AV nodal ablation in atrial fibrillation: an alternative method to achieve complete heart block.

We report the case of an elderly patient who presented with poorly tolerated episodes of atrial arrhythmia refractory to medical treatment. AV node ablation was identified as the only alternative expected to be efficacious for symptom relief. However, this usually simple intervention failed. The goal of creating a complete AV block was finally achieved through ablation of the anterior fascicle of the His bundle, which represented the only pathway for residual conduction in this patient.

Orthogonal leads for the measurement of QT dispersion: a comparison with conventional leads.

To determine the characteristics of QT interval dispersion using orthogonal ECG leads with high paper speed (100 mm/s) and high voltage gain (10 cm/mV) as compared to conventional 12-lead ECG, we measured the QT dispersion in 57 patients at rest and directly after exercise using these two techniques. The measurements were repeated by the same observer and by an independent observer in 29 patients to assess reproducibility. QT dispersion was found to be significantly lower in orthogonal leads than standard lead tracings (24+/-20 ms versus 44+/-17 ms at rest, P<0.001; 29+/-21 ms versus 53+/-27 ms after exercise, P<0.001, respectively). The intrasubject and interobserver reproducibility was better for the orthogonal lead tracings, making this technique a potentially useful tool for future research.

Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia possibly complicated by clozapine.

OBJECTIVE: To report a case of rhabdomyolysis related to rapid correction of hyponatremia attributable to compulsive drinking of water, possible complicated by clozapine use. CASE SUMMARY: A 42-year-old white man treated with clozapine for schizophrenia was admitted for a generalized seizure. Marked hyponatremia due to psychogenic polydipsia was present. He developed a marked elevation of creatine kinase concentrations after correction of hyponatremia with hyperosmolar sodium solution, without clinical signs of rhabdomyolysis. DISCUSSION: Rhabdomyolysis associated with hyponatremia due to water intoxication has been reported in 17 patients to date. A possible explanation may lie within the framework of the calcium-sodium exchange across the skeletal muscle cell membrane. By increasing muscle cell permeability, clozapine treatment may possibly enhance the destruction of muscle cells. CONCLUSIONS: Hyponatremia due to water intoxication and concurrent use of clozapine should be considered in the differential diagnosis of rhabdomyolysis, especially in the severely psychiatrically disabled population.

Skin changes in chronic lymphatic filariasis.

Seventeen men and 31 women with unilateral lower limb lymphoedema attributed to chronic lymphatic filariasis were examined in the filarial out-patient clinic of the Government General Hospital, Madras, India. Skin changes such as skin fold thickening, hyperkeratosis, hypo- or hypertrichosis, pachydermia, pigmentary changes, chronic ulceration, epidermal and sub-epidermal nodules, and clinical intertrigo were observed and compared between the different lymphoedema grades. These lesions are not specific to chronic lymphatic filariasis, and have been described in other conditions displaying lymphostasis. They are thought to be favoured by secondary infections, which should be dealt with appropriately to prevent the progression of the disease and the onset of elephantiasis.

[The etiology of "malignant catarrhal fever" originating in sheep: serological findings in cattle and sheep with ruminant gamma herpesviruses]. / Zur Atiologie des schaforiginären "bösartigen Katarrhalfiebers": serologische Befunde bei Rindern und Schafen mit Wiederkäuer-Gammaherpesviren.

In the case of the wildebeest-derived form of malignant catarrhal fever (WD-MCF) alcelaphine herpesvirus 1 (AlcHV1) is well established as the cause. However, the etiology of the form of the disease circumstantially associated with sheep (SA-MCF) remains equivocal. A serological relationship has been proposed to exist between the unidentified sheep-associated agent causing SA-MCF and AlcHV1 causing WD-MCF. We attempted to confirm this hypothesis. Using an indirect ELISA we found 94 of 100 cattle (94%) and 80 of 90 sheep (89%) to display antibody to AlcHV1. Nine of 10 cattle with SA-MCF showed elevated antibody titers to AlcHV1 when compared with most other animals. However, these findings were of limited diagnostic value, since similar results were also obtained with sera from healthy cattle. When assayed in the presence of antigens of bovine herpesvirus 4 (BHV4), a virus related to AlcHV1 yet without confirmed pathogenicity, 99 cattle sera (99%) and 85 sheep sera (95%) were observed to react specifically with this virus. Together, the results indicated that most domestic cattle and sheep were infected with viruses that are related to AlcHV1 and BHV4. An etiologically meaningful interpretation of the serologic findings does not seem possible at present.

[The etiology and epidemiology of malignant catarrh--a review]. / Zur Aetiologie und Epidemiologie des bösartigen Katarrhalfiebers--eine Ubersicht.

It is generally accepted that both, the wildebeest-derived malignant catarrhal fever (WD-MCF), and the circumstantially evidenced sheep-associated form of the disease (SA-MCF), may be explained as autoimmune disease of various ruminants, namely cattle and farmed deer. The disease follows infection with related herpesviruses being shed by the respective healthy carrier animals. This has convincingly be shown to apply for WD-MCF (Alcelaphine herpesvirus 1, AlcHV1). SA-MCF, however, remains to be controversial with both respects. In Switzerland, a serological study indicated that a herpesvirus(es) was highly prevalent among cattle and sheep, inducing antibody that cross-react with AlcHV1 and bovine herpesvirus 4 (BHV4). The latter is known as a largely innocuous agent. A relationship can be demonstrated between the presence of MCF in this country and concurrent serological reactions to both viruses. However similar results may be obtained with healthy animals. Healthy cattle and sheep from farms with or without incidences of MCF displayed the same antibody profiles. It is thus not possible to effectuate meaningful diagnostic tests for (SA-)MCF, nor to confirm any relationship between presumed carrier sheep and the appearance of MCF.

[Epileptic seizures in patients with a cerebrovascular infarction]. / Epileptische Anfälle bei Patienten mit zerebrovaskulären Insulten.

In view of the possible occurrence of epileptic manifestations and possible factors predisposing to them, the clinical course of 90 cerebral infarct patients was studied retrospectively and prospectively in a medical rehabilitation department for an average of 29 1/2 months. The following results were obtained: "prodromal" seizures (i.e. those preceding a cerebral insult) were not detectable in any of the study patients. 25 patients (27.7%) suffered epileptic seizures, 1 (1.1%) in the acute insult phase only, 2 (2.2%) in this as well as in the later phase, and 22 (24.4%) in the late phase only. All seizures in the acute insult phase were focal-motor or secondary generalized. Among all 24 patients (26.6%), the latency of late epileptic manifestations ranged from 2 1/2 months to 3 3/4 years and averaged about 12 months. Patients with cortical or cortical-subcortical brain lesions suffered epileptic seizures-as reported in the literature-significantly more frequently than those with exclusively subcortical insults. Based on the features of the focal (motor or psychomotor) seizures and/or interictal focal EEG spikes, there was clear evidence of a focus giving rise to epileptic discharges in the insulted hemisphere in 75% of the patients with late seizures. Under antiepileptic therapy (chiefly with phenytoin), the seizure frequency was slight (not exceeding 2 per year in 3/4 of the patients).