[Comparison between three-dimensional electro-anatomical mapping and conventional mapping in the ablation of atrial tachycardias]. / Comparaison entre la cartographie electro-anatomique tridimensionnelle et la cartographie conventionnelle dans l'ablation des tachycardies atriales.

In atrial tachycardias, catheter ablation using conventional mapping system is associated with high immediate success and low recurrence. Three-dimensional electroanatomical mapping system combined to catheter ablation of atrial tachycardias has reached, in small uncontroled series, success rates of 100%. However, limited data are available about rates of recurrence or complication using this approach. In order to compare both mapping systems, we have conducted a study of 65 consecutive patients (36 women and 29 men) that underwent both electrophysiologic study and catheter ablation for suspected atrial tachycardias. Pre-existing heart disease was noted in 43%, hypertension in 32% and a history of atrial fibrillation of flutter in 52%. Catheter ablation guided by conventional mapping was undertaken in 44 patients and by three-dimensional electroanatomical mapping in 21. Successful ablation was performed in 68% of patients with conventional mapping and in 90% with three-dimensional electroanatomical mapping. No complication and recurrence were observed with the latter approach, while 5 patients had a recurrence and 2 had immediate complication with conventional mapping. Catheter ablation of atrial tachycardias combined with three-dimensional electroanatomical mapping appeared to be effective and safe, however, conventional mapping system still remains a reliable approach that must be considered as the first choice for atrial tachycardias ablation.

[Acute myocardial infarction: what is new?]. / Infarctus du myocarde et thrombolyse: actualités.

Current recommendations on the management of acute myocardial infarction and the use of thrombolysis are reviewed.

[Characteristic electrocardiographic procedures of isthmic-dependent atrial flutter; influence of clinical and echocardiographic procedures]. / Caractéristiques électrocardiographiques des flutters auriculaires isthmiques-dépendants: influence des paramètres cliniques et échocardiographiques.

The appearance of the F waves on the ECG is considered to be related to the type of circuit of the anti-clockwise flutters and the clockwise isthmic-dependant flutters. In the authors' experience, the usual ECG description of these two types of flutter is not always observed. This study was undertaken to analyse the different appearances of anti-clockwise and clockwise flutters and to try and explain the reasons for these differences. Over a 4 year period, 139 patients with an ECG of atrial flutter required electro-physiological studies and echocardiography of the 156 flutters analysed: 130 were anti-clockwise and 26 clockwise. Three types of anti-clockwise flutter were observed: type 1 with exclusively negative F waves in the inferior leads: type 2 and 3 with negative F waves in the inferior leads and a small (type 2) or large (type 3) positive terminal components. The types 2 and 3 were associated with a higher incidence of left atrial dilatation, cardiac disease and atrial fibrillation than type 1. Two types of clockwise flutter were observed: type 1 with positive notched F waves in the inferior leads with a return to the iso-electric line and type 2 with wide F waves in the inferior leads with two components, predominantly positive and negative, without return to the iso-electric line. There are different ECG appearances of anti-clockwise and clockwise flutter which seem to be correlated with structural cardiac abnormalities. The anti-clockwise flutters with a positive terminal component of the F waves in the inferior leads corresponds to a subgroup with a high probability of cardiac disease and left atrial dilatation.