[Exclusive permanent atrial stimulation. Clinical experience apropos of 65 cases with a follow-up of 1 to 5 years]. / Stimulation auriculaire permanente exclusive. Expérience clinique à propos de 65 observations avec un recul de 1 à 5 ans.

The authors report their experience of permanent exclusive atrial pacing in the treatment of sinus node dysfunction in a series of 65 cases with a follow up of 1 to 5 years (average 37.6 months; 2406 patients months), 41 women and 24 men aged 74 +/- 3 years. Sixty one patients were symptomatic. The diagnosis was made from surface ECG recordings in 54 cases (83 p. 100) and after electrophysiological investigation in 11 cases (16 p. 100). Atrioventricular conduction was carefully evaluated before implantation: PR equal to or less than 200 ms, Wenckebach point equal to or greater than 130/min, absence of ventricular pauses longer than 3,000 ms after carotid sinus massage, HV interval equal to or less than 55 ms [measured in 57 cases (87 p. 100)], negative Ajmaline test in 6 patients with intraventricular conduction defects. Performed J-shaped atrial leads with active (66 p. 100) or passive fixations (34 p. 100) were implanted by an endocavitary approach (right subclavian vein in 60 cases: 92 p. 100). There were 3 cases of early lead displacement and one patient developed an elevated threshold of pacing. There were 5 deaths during the follow-up period (3 of cardiovascular origin). The neurological symptoms disappeared in 93 p. 100 of cases. No cases of cardiac failure were observed after permanent pacing. Fifteen patients had documented supraventricular arrhythmias before implantation; 5 patients continued to have the same paroxysmal or permanent arrhythmias but 10 patients had no further recurrences, 8 with and 2 without antiarrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bepridil in the treatment of supraventricular paroxysmal tachycardias]. / Le bépridil dans le traitement des tachycardies paroxystiques supraventriculaires.

Previous studies have demonstrated the efficacy of bepridil, a new calcium antagonist, in the treatment of ventricular extrasystoles and tachycardia. The electrophysiological properties of bepridil especially the lengthening of the atrial effective refractory period, would also suggest an antiarrhythmic effect at the supraventricular level. This effect was studied on 33 episodes of paroxysmal supraventricular tachycardia (SVT) occurring in 23 patients (6 men and 17 women, mean age 58.1 years; range 18 to 88 years). Bepridil was given intravenously over 5 minutes at a dose of 3 mg/kg. The duration of SVT before administration was less than 1 hour in 10 cases, between 1 and 2 hours in 8 cases and over 2 hours in 15 cases. Sinus rhythm was successfully restored in 25 cases: within 1 to 5 minutes in 19 cases, 6 to 10 minutes in 3 cases and 11 to 30 minutes in 3 cases. In 24 of the 25 cases sinus rhythm was restored without a prolonged pause (over 2 sec) after the termination of SVT; in 3 cases intermediary atrial fibrillation lasting 1, 3 and 9 minutes was observed. There were no side-effects in 26 cases; transient flushing was noted in 5 cases and vagal symptoms in 2 cases. Haemodynamic tolerance judged by blood pressure measurements excellent in all cases. The correlations between plasma concentrations of bepridil and success or failure were poor. In conclusion, bepridil is a valuable alternative to adenosine triphosphate which may induce an exaggerated vagal response and to verapamil whose negative inotropic effects may sometimes be a serious disadvantage in the reduction of paroxysmal SVT.