[Oral flecainide in the treatment of refractory arrhythmias. Long-term follow-up of 98 patients]. / La flécaïnide orale dans le traitement des arythmies rebelles. Suivi à long terme de 98 patients.

Oral flecainide was administered to 98 patients with arrhythmias regarded as resistant to other antiarrhythmic agents: quinidines (82), propafenone (40), beta-blockers (30), amiodarone alone (38) or combined with a class I compound (19). Therapeutic effectiveness was assessed on clinical date, repeated Holter recordings (64 patients), exercise tests (8) and electrophysiological exploration (15). Mean follow-up was 11.7 +/- 11 months; the patients treated have now been followed up for 18.2 +/- 12 months (range: 7-58 months). Fifty-three patients had atrial arrhythmia (fibrillation or flutter in 45, atrial tachycardia in 8). Flecainide was effective in 26 patients (49%) and ineffective in 27 (51%). There was no significant difference in dosage between these 2 groups: 231 +/- 62 mg/day and 265 +/- 61 mg/day respectively. Paroxysms of re-entrant junctional tachycardia were controlled in 6 of the 8 cases observed. Eleven patients presented with Wolff-Parkinson-White syndrome: treatment was successful in the 3 patients with atrial fibrillation and in 8 of the 10 patients with orthodromic reciprocating rhythms. Among 30 patients with episodes of ventricular tachycardia, 9 (30%) responded to flecainide and 21 (70%) failed to respond. Flecainide reduced the repetitive forms by more than 90% in 7/15 patients and suppressed exercise-induced ventricular tachycardia in 2/8 patients. Fifteen out of 18 patients had ventricular tachycardia reproducible by programmed stimulation; under flecainide, the ventricular tachycardia spontaneously recurred in 4 cases, was provoked by stimulation in 5 other cases, was more easily inducible in 3 cases and was not inducible in a sustained manner in the last 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Catheter ablation after the direct electrical recording of the bundle of Kent. Apropos of 3 cases]. / Fulguration après enregistrement électrique direct de la voie de Kent. Résultats préliminaires à propos de 3 cas.

The success rate of catheter ablation, the latest therapeutic method in the treatment of cardiac arrhythmias, varies according to the precise indication. The best and most logical guarantee of its efficacy is the application of the electrical energy at an anatomical site essential to the arrhythmia. In preexcitation syndromes this site is without doubt the accessory pathway itself rather than its insertions, but this implies the recording of its activation. We recorded the electrical activation of a right sided Kent bundle in three consecutive cases to guide the therapeutic procedure (comparable to the recording of the H potential for his bundle ablation). All patients had paroxysmal atrial fibrillation (minimal RR interval: 175, 150 and 200 ms) and orthodromic reciprocating tachycardia. Two patients had had attacks of ventricular fibrillation. The sites of the Kent bundles were posteroseptal in 2 cases and anterolateral in 1 case. The recording of the electrical activation of the Kent bundle was validated by: the passage (induced or spontaneous) of a preexcited to a normal QRS coincident with the disappearance of the K potential; the exclusion of an atrial or ventricular origin of the electrical activation supposed to be the activation of the Kent bundle; electrical stimulation at the site of the recording of the K potential leading to prolongation of the stimulus-delta wave interval from 10 to 35 ms, with QRS morphology identical to the spontaneous complexes. All 3 patients were clinically cured by catheter ablation at the site of recording of the Kent bundle activation with follow-up periods ranging from 10 to 16 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Oral propafenone in refractory arrhythmia. Apropos of 68 patients]. / La propafénone orale dans les arythmies rebelles. A propos de 68 patients.

68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmics (quinidine derivatives 52 patients, amiodarone 28 patients, beta-blockers 24 patients) were treated by mouth with propafenone, with a mean postponement of 5.6 +/- 8.5 months (1 day to 33 months). Auricular arrhythmia was observed in 41 patients with the following results: 16 successes among the 24 patients with paroxysmal fibrillation of flutter, 3 successes among the 8 patients with an arrhythmia reduced by cardioversion, and 3 successes among the 9 patients with auricular tachycardia, including 6 systolic tachycardias. Of 8 patients with an intranodal reciprocal rhythm, 7 were treated successfully with propafenone, which acts on the retrograde part of the cycle. Successes were also recorded in 2 out of 3 patients with Wolff-Parkinson-White syndrome. In 19 cases of ventricular tachycardia, propafenone proved to be efficacious in 3 out of 5 cases presenting rapid discharges and in 7 out of 14 patients with continuous arrhythmias, notably those with a catecholaminergic component. Side-effects were digestive (5 patients), cardiac decompensation (3 patients), asthenia and asthma (1 patient) and the transformation of a flutter from 2/1 to 1/1 (1 patient).