[Characteristics of the population hospitalized for advanced and terminal heart failure and experiences in palliative caring in the Intensive Care Unit of cardiology]. / Caractéristiques et prise en charge des patients hospitalisés pour insuffisance cardiaque terminale ayant fait l'objet d'une limitation de soins en unité de soins intensifs cardiologiques.

PURPOSE: Advanced heart failure incidence is in progression. Palliative care access remains difficult due to its unpredictable course. The aim of this study was to describe the characteristics of patients admitted in Cardiology Intensive Care Unit for advanced heart failure who received palliative care and compare them to the whole population of acute heart failure hospitalized in the same period. PATIENTS AND METHODS: The patients hospitalized for acute heart failure were retrospectively included from 2009 to 2013. We identified among them those who received palliative care. Specific caring was decided in pluridisciplinary meeting. RESULTS: On 940 patients included, 42 patients (4.5%) receive palliative care. Ischemic heart disease was the main etiology (n=19; 45.2%). Right ventricular dysfunction (n=34; 80.9%) was associated with supra-ventricular arrhythmia (n=28; 66.7%). Twenty-eight patients (57.1%) have died in hospital, 9 (21.4%) were referred to a palliative care unit and 8 (19.1%) was discharged or referred to a rehabilitation center. Time between inclusion and death was 6 days on average. Intra-hospital mortality in control group was 6.8%. CONCLUSION: Palliative care in cardiology is uncommon and has often been too late because of its poor adaptability to advanced heart failure. It is, as consequence, necessary to identify the prognostic factors of these patients in order to propose a personalized care and to adjust the intensity of care ahead of the terminal evolution of heart failure.

[Is atrial fibrillation an independent marker of cardiovascular risk?]. / La fibrillation atriale est-elle un marqueur indépendant de risque cardio-vasculaire?

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia and its prevalence rises with age. AF may cause stroke and heart failure but the relationship between AF and mortality is less clear. It is difficult to determine if cardiovascular events in patients with AF are attributable to the arrhythmia itself or if they are merely related to the comorbidities frequently associated with AF. Review of the literature suggests that lone AF (without structural heart disease), a rare clinical entity except in young patients, is not an independent risk factor for mortality. On the other hand, if illnesses usually associated with AF are present (hypertension, heart failure...), AF has a negative impact on outcome in terms of survival and morbidity. Current antiarrhythmic medications have not shown reduction in mortality of AF patients, but new agents and catheter ablation are promising paths to explore in order to decrease AF burden.

[Cough syncope caused by a possible Chlamydia pneumoniae pneumonia]. / Ictus laryngé au cours d'une possible pneumopathie à Chlamydia pneumoniae.

We report the case of a 61-year-old man who presented with coughing fits followed by sinus pauses and syncope. Cardiac and neurological diagnostic work-up was negative and the patient was considered to have cough syncope. As this occurred within the context of febrile pneumonia, an infectious disease was suspected but diagnostic work-up only revealed an increase of antibodies against Chlamydia pneumoniae. The responsibility of this agent is discussed. Clinical recovery was obtained with the prescription of antitussive medication.

[Pathophysiopathology of atrial fibrillation: applications to treatment]. / Physiopathologie de la fibrillation atriale: applications à la thérapeutique.

The origin and persistence of AF result from a complex interaction between triggers, autonomic nervous system, substrate, and factors involved in atrial remodelling. The pathophysiology of AF differs from one patient to another, but recent advances have helped us to understand more about involved mechanisms and to translate this knowledge into improvements in AF therapy. An illustration is the elimination of triggers within pulmonary veins by means of catheter ablation. Dealing with structural atrial remodelling and atrial fibrosis remains still a great challenge. Solving these problems could help us to develop new approaches to AF prevention and treatment.

[Triple filling plasty in Clagett thoracostomy]. / Triple plastie de comblement d'une thoracostomie de Clagett.

Clagett's thoracostomy is a widely used procedure in the initial treatment of postpneumonectomy empyema. We describe in this paper an original one-step operation of thoracic filling after empyema sterilization. The triple plasty includes an apical thoracoplasty limited to the first 3 ribs, a pedicle flap of the latissimus dorsi transferred inside the thoracic cavity, and an upper translation of the diaphragm to the 4th rib in order to reduce residual pleural space. Three patients were operated and followed up clinically (for 20, 29, and 30 months), and radiologically with a MRI on the 12th month. Complete tissue healing and loss of all residual space was observed in all patients. We therefore recommend the use of this technique rather than thoracic wall coverage procedures.