[Results of radiofrequency ablation of the atrioventricular junction in patients with refractory atrial arrhythmia and severe impairment of the left ventricular systolic function]. / Résultats de l'ablation de la jonction auriculoventriculaire par radiofréquence chez des patients en arythmie auriculaire réfractaire présentant une altération sévère de la fonction systolique ventriculaire gauche.

Results of radiofrequency ablation of the atrioventricular junction on functional capacity and left ventricular systolic function were assessed in 8 patients (aged 68 +/- 12 years) with refractory atrial fibrillation and severe left ventricular dysfunction, the mean ejection fraction being 31 +/- 11% (range: 20-48%). A clinical, echocardiographic and angioscintigraphic follow-up was performed 24 hours (basal), 3 and 6 months after the procedure. During follow-up, all patients reported the disappearance of palpitations and tiredness, a significant and early regression of effort dyspnoea from average NYHA Class 3.4 +/- 0.7 to 2.2 +/- 0.4 (M3), (p < 0.01), a decrease in end diastolic echocardiographic dimensions (from 57 +/- 10 to 52 +/- 9 mm (M3); p < 0.05) resulting in an increase in fractional shortening from 26 +/- 7% to 34 +/- 6%; p < 0.05. The isotopic EF increased from 31 +/- 11% to 42 +/- 12% (M3) (p < 0.01), and attained 48 +/- 12% (M6). This study shows that controlling the frequency and regularity of cardiac rhythm by ablation of the atrioventricular junction in patients with refractory AF and left ventricular dysfunction results in functional and haemodynamic improvement, especially when there is no apparent underlying cardiac disease. This suggests that this method should be proposed in all patients with refractory atrial fibrillation and left ventricular dysfunction.

Accuracy and mean duration of different protocols of head-up tilt testing.

Based on the results of our study, > 95% of patients with a positive passive tilt test are also positive during 3 micrograms/min, and especially 5 micrograms/min, isoproterenol tilt test. A proposed time-saving protocol would be to initiate the test with an isoproterenol infusion and to perform a 45-minute passive tilt only in those patients with a positive 5 micrograms/min (an infusion rate reported to have an excessive low specificity) isoproterenol tilt test, and to consider only those with symptoms associated with objective changes during this latter test as "finally positive." An alternative option would be to perform a 45-minute passive tilt only in those patients with a negative 3 micrograms/min isoproterenol tilt test.

[Tachycardia with wide QRS. Limitations of electrocardiographic criteria in patients treated with anti-arrhythmia agents]. / Tachycardies à QRS larges. Limites des critères électrocardiographiques chez les patients sous antiarythmiques.

The diagnosis of ventricular tachycardia is difficult, often requiring endocavitary investigation to obtain proof. Many authors have attempted to define criteria used to distinguish between ventricular tachycardia and supraventricular tachycardia with wide QRS in the surface electrocardiogram. These criteria have been determined in patients not taking antiarrhythmic drugs. The authors report the case of a patient treated with flecainide for atrial fibrillation and hospitalised because of faints and tachycardia with wide complexes. The diagnosis of ventricular tachycardia was justified by surface electrocardiogram but was eliminated by subsequent endocavitary electrophysiological studies. The use of anti-arrhythmic drugs thus limits the applicability of electrocardiographic criteria in cases of tachycardia with wide QRS.

Bilateral chylothorax following jugular catheterization in a woman with complete situs inversus.

The authors report a bilateral chylothorax following a jugular catheterization in a woman with complete inversus situs. The authors discuss the possible mechanisms of chylothorax after central catheterization.

[Determination of variability factors of arterial pressure using 3843 self-measurements of blood pressure in 34 active hypertensives]. / Approche des facteurs de variabilité de la pression artérielle par 3 843 automesures tensionnelles chez 34 hypertendus actifs.

To assess the role of physical activity, stress and treatment on BP variations in working hypertensives we used repeated self measurements of BP which are cheaper and more simple than ambulatory BP measurements but allow for a smaller number of measurements. 34 working hypertensives self measured daily life BP, at home and at workplace, 7 times a day, for at least one week, before and 6 weeks after beta-blockade with metoprolol 200 to 400 mg daily. They used a Spengler SP9 electronic sphygmometer and specified on 4 grades scales their physical activity and stress just before measurement. The time for self measurement of BP was settled according to occupations more than to clocktime. The equipment was standardized at each visit by measuring BP with a mercury manometer then with the electronic sphygmometer. There were no significant differences neither for SBP nor for DBP and the two measures correlate closely (r = 0.91), P = 0.0001). Analysis of variance on SBP exhibits the role of time (p (0.001) and stress (p (0.0001). Physical activity does not interfere (p = 0.19). There is no difference between work days and sundays (p = 0.17). Treatment effect was very strong (p (0.0001) but there was no interaction neither with physical activity nor stress. Analysis of variance on DBP exhibits similar results except that BP on workdays is significantly higher than on sundays (p = 0.03). We conclude that: Repeated self measurement of BP is able to display variation of BP with occupations and stress. Beta-blockade lowers BP but does not interfere with variability.