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Resume But de l’etude La bivalirudine, inhibiteur direct de la thrombine, a montre une amelioration du pronostic des syndromes coronariens aigus principalement par une diminution des complications hemorragiques graves. Cette etude observationnelle a evalue l’evolution hospitaliere de patients presentant un infarctus aigu traite en prehospitalier par bivalirudine avant angioplastie primaire. Patients et methodes Nous avons inclus, de juin 2010 a juin 2012, tous les patients avec un infarctus aigu recevant en prehospitalier de la bivalirudine administree en bolus de 0,75 mg/kg suivie d’une perfusion de 1,75 mg/kg par heure jusqu’a l’arrivee en salle de catheterisme et eventuellement poursuivie apres l’angioplastie primaire. Resultats Nous avons inclus 152 patients âges de 57,6 ± 11,6 ans. Une dose de charge de 60 mg de prasugrel a ete donnee en prehospitalier chez 77 % des patients. La coronarographie principalement par voie radiale (77,6 %) precedait une angioplastie reussie dans 97,3 % des cas. La bivalirudine a ete poursuivie apres la procedure dans 81,6 % des cas. L’evolution a ete marquee par deux deces (1,3 %) et deux re-infarctus (1,3 %) dont un lie a la seule thrombose de stent (0,6 %). Les complications hemorragiques graves s’averaient egalement limitees selon la definition Gusto (0,6 %), Timi (0,6 %) ou Horizons-MI (4,6 %). Le risque hemorragique n’apparaissait pas plus important quand la bivalirudine etait maintenue apres l’angioplastie primaire. Conclusion L’administration en prehospitalier de bivalirudine en vue d’une angioplastie primaire apparait efficace et sure sur le risque ischemique et hemorragique lors de la phase hospitaliere.

Resume But de l’etude Ce travail a evalue l’evolution hospitaliere et a long terme de patients fumeurs de moins de 50 ans traites pour un infarctus inferieur a 12 heures par angioplastie coronaire. Patients et methode C’est une etude retrospective avec analyse de survie par methode de Kaplan-Meier chez des patients inclus de decembre 2003 a fevrier 2008. Resultats Nous avons inclus 93 patients âges de 42,8 ± 5,2 ans avec une intoxication tabagique de 27,7 ± 12,7 paquets-annee. Trente et un patients (33,3 %) etaient dyslipidemiques et 36 patients (42,4 %) avaient un antecedent familial de coronaropathie. Trente patients (32,3 %) presentaient un infarctus anterieur et quatre patients (4,4 %) etaient en Killip superieur a 2. Une angioplastie coronaire a retabli un flux TIMI 3 dans le vaisseau coupable dans 96,8 % des cas. Un patient est decede de choc cardiogenique. Avec un suivi de 85 patients sur 20,0 ± 15,6 mois, on observait une survie sans deces de 98,2 % et une survie sans evenement cardiaque de 87,9 % a 24 mois. Soixante-douze patients (85,7 %) prenaient un betabloquant, 81 patients (96,4 %) de l’aspirine, 75 patients (89,3 %) une statine et 64 patients (76,2 %) un inhibiteur de l’enzyme de conversion. Seulement 50 patients (58,8 %) etaient non fumeurs. Conclusion Ainsi, l’evolution hospitaliere et a long terme de l’infarctus du jeune sujet fumeur, traite par angioplastie coronaire, est de bon pronostic. L’adhesion au traitement preventif secondaire est correcte mais il persiste un fort taux d’echec du sevrage tabagique.

Among 10% of all patients presenting with non ST elevation acute coronary syndromes (ACS), coronary angiography do not show non lesions at all (50%) or mild atheromatous stenosis (50%). ACS without angiographic stenosis are more prevalent in female sex and young patients but can be seen in older ones and in men. Pathogenic mechanisms include acute evolution of vulnerable non-significant plaques and endothelial dysfunction. In hospital and mean term prognosis is not as benign as expected. Six months deaths and myocardial infarction incidence is around 6%. Numerous rehospitalizations due to ischemic recurrences are also very often seen. Therefore, such surprising coronary angiograms do not preclude a fair follow-up. These patients need a careful therapeutic strategy.

Resume Cette etude a evalue le pronostic hospitalier de patients octogenaires pris en angioplastie primaire pour un infarctus du myocarde de moins de 12 heures. Le devenir a long terme s'est interesse a la mortalite et a l'evolution sociale a partir des echelles IADL et IADL-E correspondant a l'autonomie physique et au niveau de dependance. Nous avons inclus de 1999 a 2005, 47 patients âges de 83,5 ± 3,2 ans. Une desobstruction de l'artere coupable avec flux TIMI 3 a ete obtenue chez 45 patients (95,7 %). La mortalite hospitaliere etait de 25,5 et de 4,2 % en l'absence de complication hemodynamique. Une analyse multivariee identifiait un score de Killip superieur a 1 comme facteur predictif de mortalite hospitaliere (OR = 8,9 et p = 0,05). Le taux de survie sans deces sur un suivi de 26,3 ± 18,3 mois etait de 82,2 % a 24 mois et de 70,6 % a 48 mois selon la methode de Kaplan-Meier. En analyse multivariee, une absence d'aspirine en sortie d'hospitalisation etait associee a un moins bon taux de survie sans deces (OR = 34,8 et p = 0,04). D'apres l'evolution des scores IADL et IADL-E, les patients jouissaient, avant l'infarctus, d'une excellente autonomie et de bonnes capacites au quotidien qu'ils ont gardees sur le long terme. Ainsi, l'infarctus aigu chez l'octogenaire traite par angioplastie primaire reste greve d'une lourde mortalite sur le court et le long terme mais les survivants conservent une excellente autonomie au quotidien.

Resume Objectif Evaluer les resultats et la faisabilite de la technique de fermeture percutanee des foramens ovals permeables (FOP) avec anevrisme du septum interauriculaire (ASIA) chez des patients jeunes ayant presente un accident neurologique aigu embolique cryptogenique. Patients et methodes Dix-huit patients : 14 accidents vasculaires cerebraux (AVC) et quatre accidents ischemiques transitoires (AIT) avec un FOP large (grade III a l'epreuve de contraste) et un ASIA important (excursion superieure a 15 mm) a l'echographie transœsophagienne (ETO). L'âge moyen est de 48,2 ans : homme 61 %, femmes 39 %. Les patients ont peu de facteur de risque cardiovasculaire (0,83/patient) et 38 % ont presente des accidents neurologiques multiples. La fermeture percutanee est realisee sous anesthesie generale avec ETO et implantation d'une prothese Amplatzer. Un controle ETO est realise six mois apres la fermeture. Resultats Aucune complication perprocedure n'est survenue. Apres 72 heures, un patient a presente une complication majeure : une fistule arterioveineuse femorale necessitant une chirurgie. Cinq patients ont presente une complication mineure : deux hematomes non compliques du Scarpa, deux troubles du rythme supraventriculaire transitoires, un deplacement secondaire minime asymptomatique de prothese sans necessite de chirurgie. Dix-sept patients ont au un controle ETO a six mois : le shunt a disparu pour 95 % des patients, aucun thrombus n'est retrouve. Aucun des 18 patients n'a presente de recidive d'evenement embolique (suivi moyen 19,2 mois). Conclusion La mise en place d'une technique de fermeture des FOP-ASIA est a faible risque et effective.

Resume L’infarctus aigu sur occlusion tardive de stent est une complication reconnue de la brachytherapie endocoronaire. Le risque d’une telle complication n’est cependant pas clairement precise au decours d’une angioplastie conventionnelle. Le but de l’etude a ete de determiner, dans une population de patients ayant fait l’objet d’une angioplastie de l’artere interventriculaire anterieure avec implantation de stent, l’incidence des infarctus aigus par occlusion tardive (> 30 jours apres la procedure initiale) d’une endoprothese et d’en preciser les eventuels facteurs predictifs. Ce travail a inclus 930 angioplasties consecutives de janvier 1999 a decembre 2001 chez 920 patients (667 hommes et 263 femmes) d’un âge moyen de 63 ± 12 ans. L’artere interventriculaire anterieure etait la seule artere dilatee dans 592 procedures (63,6 %). La duree moyenne du suivi a ete de 451 ± 255 jours. Quatorze patients ont presente cette complication a un delai moyen de 135 ± 131 jours soit un taux de survie sans thrombose de stent de 97,6 % a trois ans (methode de Kaplan Meier). La recherche de facteur predictif fait apparaitre un risque significatif de thrombose tardive de stent apres angioplastie de la bifurcation artere interventriculaire anterieure-diagonale (p = 0,01) ou apres endoprothese placee a l’ostium diagonale (p = 0,01) et un risque dependant du nombre de stents dans l’artere interventriculaire anterieure (p = 0,04). Conclusion : l’infarctus aigu par thrombose tardive de stent de l’artere interventriculaire anterieure est une eventualite rare mais possible apres angioplastie conventionnelle. Le risque semble etre lie a la complexite de la procedure et notamment a la refection de la bifurcation artere interventriculaire anterieure-diagonale. Cette observation pourrait inciter a la poursuite de l’association des antiagregants plaquettaires au-dela du premier mois dans ce cas de figure precis.

Resume Objectifs. – A partir d'un registre prospectif multicentrique, nous avons evalue dans trois centres de cardiologie interventionnelle alsaciens non universitaires, la prise en charge et la faisabilite de l'angioplastie coronaire transluminale (ACT) a la phase aigue du syndrome coronaire aigu avec sus-decalage persistant du segment ST (SCA ST+) chez les sujets âges de plus de 75 ans. Methodes. – Nous avons etudie les caracteristiques cliniques et angiographiques des patients âges de plus de 75 ans ainsi que les resultats : les taux de revascularisation et les evenements survenus au decours de l'angioplastie ont ete analyses. Ces donnees ont ete comparees a celles des patients plus jeunes et confrontees aux donnees de la litterature. Resultats. – Sur un total de 1672 patients admis pour un SCA ST+, 342 (soit 20,45 %) sont âges de plus de 75 ans. Ces sujets representent un groupe a haut risque avec une proportion elevee de femmes (50 %), de nombreuses comorbidites (HTA et diabete de type 2) et des atteintes tritronculaires en nombre plus eleve que les sujets plus jeunes. Le taux de mortalite est eleve dans ce sous-groupe de patients et toujours plus severe par rapport aux sujets plus jeunes, mais il reste variable en fonction du profil clinique initial. La mortalite globale des plus de 75 ans est de 20,47 % mais chute a 5,41 % si on exclut les patients en etat de choc, en Killip III et apres mort subite. L'angioplastie est la technique de reperfusion coronaire particulierement indiquee dans la prise en charge du SCA ST+ du sujet âge. C'est une technique efficace en termes de revascularisation, le succes de reperfusion (exclusivement flux TIMI III retenu) reste tres eleve dans cette population, meme s'il est un peu plus faible que chez les patients plus jeunes (93,88 vs 97,18 %). C'est une technique rapidement accessible, sous couvert d'une accessibilite des salles de coronarographie, permettant une reperfusion rapide. Dans la prise en charge des patients âges presentant un SCA ST+, c'est sur le delai avant admission qu'il faut axer nos efforts, les patients âges tardant a appeler les secours en cas de symptomatologie coronarienne. Or plus ce delai est court, meilleur est le pronostic du sujet âge. Conclusion. – L'ACT est la technique de reperfusion indiquee chez les sujets âges en Alsace du fait des particularites de la region : geographique d'une part, avec une proximite des SMUR pour la quasi-totalite de la population alsacienne, et medicale d'autre part, la politique interventionnelle etant acquise dans de nombreuses equipes de cardiologie. En Alsace, la part des personnes âges de plus de 75 ans va sensiblement augmenter, et on peut craindre dans les annees a venir une augmentation du nombre de cas de SCA ST+ du sujet âge. Il faut tenir compte de cette evolution, d'autant plus que cette technique de reperfusion allie de nombreux avantages avec tres peu de complications.

Resume Objectif et methode. – Evaluation de la prise en charge par angioplastie primaire du patient en choc cardiogenique en phase aigue d’infarctus du myocarde dans trois centres alsaciens non universitaires ; suivi hospitalier et a moyen terme pour la periode de 1999 a 2002. Resultats. – Cent quatre-vingt-deux patients etaient inclus. La survie hospitaliere est de 43,96 %. Cent quarante-neuf patients ont ete revascularises par angioplastie, le taux de succes d’angioplastie est de 79,12 %. Les facteurs predictifs de deces en phase hospitaliere sont : l’atteinte tritronculaire, l’âge superieur a 75 ans, le TIMI 0 a l’admission. La survie a moyen terme semble bonne avec 91 % de patients vivant a 24 mois (suivi a cette date sur 28,75 % des patients). Conclusion. – L’angioplastie primaire en phase aigue d’infarctus chez les patients en choc cardiogenique primaire semble l’option therapeutique de choix et permet une meilleure survie hospitaliere et a moyen terme par rapport au traitement conventionnel.

A consecutive series of 746 patients undergoing heart beating myocardial revascularization was reviewed. An average of 2.30 grafts/patients was performed. The rate of mortality in the first 30 postoperative days was 0.28%. Two cases had to be terminated on-pump. We used the inotropic drugs in 0.6% of cases. The postoperative events were: atrial fibrillation (12.6%), myocardial infarction (0.3%). The rate of transfusion was 7.4%. The extubation was performed in the first 24 h postoperatively in 94.7% of cases. The majority of patients (91.3%) left the hospital in the first 8 d postoperatively. Off pump coronary artery bypass grafting gives good result for the most of the patients even for those with multiple vessel disease and high operating risk.

Bivalirudin, a direct thrombin inhibitor, demonstrated an improvement in the prognosis of acute coronary syndromes by a decrease in major bleeding complications. This observational study evaluated inhospital outcome of patients with acute myocardial infarction treated by prehospital bivalirudin before primary angioplasty.We included, from June 2010 to June 2012, all patients with acute myocardial infarction receiving prehospital bivalirudin with bolus of 0.75mg/kg followed by an infusion of 1.75mg/kg per hour until the arrival in the catheterization laboratory. Bivalirudin was possibly continued after primary angioplasty.We included 152 patients aged 57.6±11.6 years. A prehospital 60mg loading dose of prasugrel was given in 77% of patients. Coronary angiography with radial access (77.6%) was performed before a successful angioplasty in 97.3% of cases. The bivalirudin infusion was continued after the procedure in 81.6% of patients. Inhospital outcome showed two deaths (1.3%) and two re-infarctions (1.3%) of which one was related to the single acute stent thrombosis (0.6%). Major bleeding complications were limited irrespective of the Gusto (0.6%), Timi (0.6%) or Horizons-MI (4.6%) classification. Bleeding complications rate was similar when bivalirudin was followed or not after primary angioplasty.The use of bivalirudin in the prehospital setting for primary angioplasty seems to be effective and safe about ischemic and bleeding complications during the inhospital outcome.

Among 10% of all patients presenting with non ST elevation acute coronary syndromes (ACS), coronary angiography do not show non lesions at all (50%) or mild atheromatous stenosis (50%). ACS without angiographic stenosis are more prevalent in female sex and young patients but can be seen in older ones and in men. Pathogenic mechanisms include acute evolution of vulnerable non-significant plaques and endothelial dysfunction. In hospital and mean term prognosis is not as benign as expected. Six months deaths and myocardial infarction incidence is around 6%. Numerous rehospitalizations due to ischemic recurrences are also very often seen. Therefore, such surprising coronary angiograms do not preclude a fair follow-up. These patients need a careful therapeutic strategy.

To evaluate the results and the feasibility of the technique of percutaneous closing of patent foramen oval (PFO) with Atrial Septal Aneurysm (ASA) among young patients having presented a cryptogenic cerebral ischemia.Eighteen patients: 14 cryptogenic stroke and 4 TIA with a broad PFO (rank III) and an important ASA (excursion higher than 15 mm) at transesophageal echocardiography (TEE). The average age is 48.2 years: man 61%, women 39%. The patients have little cardiovascular risk factor (0.83/patient) and 38% presented recurrent thromboembolic events. Percutaneous closing is carried out under general anaesthesia with TEE and Amplatzer devices implantation. A control TEE is carried out 6 months after closing.No complication occurred at the time of the procedures. After 72 hours, one patient presented a major complication: one arteriovenous fistula requiring a surgery. Five patients presented a minor complication: two non complicated femoral hematoma, two atrial arrhytmias and one asymptomatic secondary displacement of the device without need for surgery. Seven-teen patients had TEE at six months: the shunt disappeared for 95% from the patients, no thrombus was found. No recurrent thromboembolic event appeared for the 18 patients (median follow-up 19.2 months).The installation of a technique of percutaneous closing of the PFO+ASA is safe and effective.

Acute myocardial infarction is a rare complication of dobutamine stress echocardiography (DSE). We report the case of a 60-year-old man with moderate apical sequela of a myocardial infarction (MI) which had an inferior MI complicated with cardiogenic shock and circulatory arrest two hours after a positive DSE in that very circulatory topography. Emergency coronarography objectivizes a dissection of the circumflex artery. The patient required a circulatory assistance device. He survived the episode and left the hospital with 50% left ventricular ejection fraction.

This study evaluated the hospital outcome of octogenarian patients treated by primary angioplasty for acute myocardial infarction less than 12 hours. The long-term mortality and social outcome were evaluated, social outcome was based on IADL and IADL-E scales corresponding to physical autonomy and level of dependence. We included from 1999 to 2005 47 old patients of 83.5+/-3.2 years. The reperfusion of the obstructed coronary artery was obtained in 45 patients (95.7%) with TIMI 3 flow. Hospital mortality was 25.5% and 4.2% without hemodynamic complication. A multivariate analysis identified a Killip score1 as predictive factor of hospital mortality (OR=8.9 and p=0.05). The long-term survival without death with a follow-up of 26.3+/-18.3 months was 82.2% at 24 months and 70.6% at 48 months according to the Kaplan-Meier method. In an multivariate analysis, hospitalization exit without aspirine was associated with a higher long term mortality (OR=34.8 and p=0.04). According to the evolution of scores of IADL and IADL-E scales, patients had an excellent autonomy and good capacities before the infarction and they kept them on the long term. Thus octogenarians with acute myocardial infarction treated by primary angioplasty have a high in hospital and long term mortality but the survivors preserve an excellent daily autonomy.

The objective of the study was to assess the frequency of late stent-thrombosis-related acute myocardial infarction in patients with LAD stents. A series of 930 PCI procedures involving LAD stenting were performed in 920 patients (mean age: 63 years, 667 men) from January 1999 to December 2001. Among those 14 patients had late (30 days), thrombosis-related acute myocardial infarction after a mean delay of 135 +/- 131 days. Three-year thrombosis-free survival was 97.6%. By univariate analysis, risk of late thrombosis was associated with LAD-diagonal bifurcation stenting, placement of a stent on the ostium of a diagonal branch and number of stents implanted on the LAD. Patients with these risk factors might be appropriate candidates for long-term combined antiplatelet therapy.

Evaluation of angioplasty for primary cardiogenic shock in acute myocardial infarction in three non-universitary alsacians centres between 1999 and 2002.One hundred and eighty-two patients were included. Hospitalisation survival rate is 43.96% after hospital discharge. One hundred and forty-nine patients were treated by primary angioplasty. Angioplasty is successful in 79.12%. The predictives factors of death are: age75, TIMI = 0 at the admission, three vessels disease. Twenty-four months survival is 91% (follow-up data available on 28.75% of the patients alive at hospital discharge).Angioplasty seems to be the right choice in case of acute myocardial infarction complicated by cardiogenic shock, the results are better than medical treatment at short- and mid-term.

A consecutive series of 746 patients undergoing heart beating myocardial revascularization was reviewed. An average of 2.30 grafts/patients was performed. The rate of mortality in the first 30 postoperative days was 0.28%. Two cases had to be terminated on-pump. We used the inotropic drugs in 0.6% of cases. The postoperative events were: atrial fibrillation (12.6%), myocardial infarction (0.3%). The rate of transfusion was 7.4%. The extubation was performed in the first 24 h postoperatively in 94.7% of cases. The majority of patients (91.3%) left the hospital in the first 8 d postoperatively. Off pump coronary artery bypass grafting gives good result for the most of the patients even for those with multiple vessel disease and high operating risk.

Sinus tachycardia is frequent after cardiac surgery and this tachycardia is probably due to changes of the autonomic nervous system. The objective of this study was to evaluate the changes possibly induced by cardiac surgery, by studying sinus variability (SV) during a 24-hour Holter monitoring. The examination was performed in 28 patients who had undergone cardiac surgery 1 to 6 weeks previously. These patients had no alteration of left ventricular function, or any causes likely to modify SV and they had a normal postoperative course. Their results were compared to those of 4 subjects developing a postoperative complication (1 case of ventricular tachycardia and 3 cases of resuscitated cardiac arrest). The results were also compared to those of 24 age-matched adult controls without heart disease (control group). The study of SV included temporal and spectral analysis of SV with measurement of the standard deviation of normal RR intervals (SD), mean heart rate (HR), percentage of RR intervals differing by more than 50 m/sec from the adjacent interval (pNN50), coefficient of variability (CV) (SD/RR), square root of the differences between successive RR (rMSSD), spectral properties of low frequencies (LF) and high frequencies (HF) and the fractionated spectral property (LF/HF).(see tables, page 151 and 152). An alteration of SV was therefore observed in the surgical group, and lasted 4 to 6 months after surgery. No difference was observed between subjects without cardiac events and those presenting a cardiac event.cardiac surgery decreases all parameters of SV during the first few postoperative months. Certain unexpected cardiac accidents during this period could be explained by these changes.

In order to define the best strategy of prognostic evaluation in relation to patients in heart failure, 415 patients with impaired left ventricular function (ejection fraction40%) were prospectively included, between June 1993 and 1996, in a study comparing the respective value of high amplification ECG and Holter analysis of sinus variability, 308 patients in sinus rhythm and narrow QRS complexes were included. The patients were distributed into 4 groups according to the presence or absence of late potentials and altered sinus variability (group I with 2 normal examinations, group II with late potentials and normal variability, group III without late potentials, but with altered variability and group IV with 2 abnormal examinations). The sudden and overall mortality was significantly greater in groups III (28 and 11%) and IV (28 and 9%) than in group I (7 and 3%) and II (11 and 2%). The presence of potential was unable to identify patients at risk of ventricular tachycardia and sudden death. In another 60 patients with complete branch block, the prognosis was also correlated with the alteration of sinus variability. In conclusion, high amplification ECG correctly evaluated the prognosis of subjects in heart failure. However, analysis of sinus variability should be systematically proposed to detect subjects at high risk of mortality, whether the subject has large or narrow QRS complexes.

Coronary angiography, although now performed extremely frequently, remains an invasive and expensive examination, whose place, as first-line diagnostic method, must be discussed; Its main advantage is to provide a definitive diagnosis of coronary atherosclerosis as well as simple prognostic indicators (single vessel, two-vessel or three-vessel disease; concomitant evaluation of left ventricular function by associated radiological ventriculography). However, it is unable to precisely assess the degree of coronary wall disease and, more importantly, cannot evaluate the functional repercussions of stenosis. Under these conditions, only cases in which myocardial revascularization is expected to provide a definite clinical benefit (presence of frank angina symptoms) probably justify first-line coronary angiography. In all other cases, coronary angiography is a useful examination to provide reference "mapping" of the coronary lesions, but an obvious clinical benefit for the patient cannot be expected from systematic use of this technique. In particular, in such situations, coronary angiography should not be the only element on which the decision to perform myocardial revascularization should be based: the "oculostenotic reflex" must always be avoided.

Since analysis of heart rate variability (HRV) is able to identify subjects at risk of sudden death and as antiarrhythmics can interfere with this prognosis, the objective of this study was to determine whether antiarrhythmics (AA) modified the HRV measured on a 24-hour Holter recording and after rapid ventricular stimulation and whether the initial HRV and its possible modification during treatment with AA were correlated with the results of AA treatment in patients with ventricular tachycardia (sustained VT). The HRV was studied in 50 patients with heart disease and spontaneous sustained VT, reproduced by programmed ventricular stimulation. This analysis was performed at baseline with antiarrhythmic treatment consisting of low-dose beta-blocker and quinidines in 26 patients (group I) or amiodarone in 24 patients (group II). Treatment was effective (i.e. prevented induction of VT) in 9 patients in group I (group la) and 5 patients in group II (group IIa). Treatment was ineffective in the other 17 patients of group I (group Ib) and 19 patients of group II (group IIb). The initial HRV was similar in the patients of groups Ia and Ib or groups IIa and IIb. Temporal analysis did not reveal any significant variation of HRV during AA treatment. In contrast, spectral analysis of HRV and the HRV observed during ventricular stimulation demonstrated a significant reduction of this parameter (p0.05 for groups I and II combined).the initial HRV is not predictive of the results of treatment. Quinidines and amiodarone tend to decrease HRV regardless of the effect of the AA on the prevention of VT.

High-amplification ECG (HA ECG) is now used routinely to evaluate ventricular tachycardia. The effects of 300 to 600 mg quinidine were determined in 26 heart disease patients with spontaneous and inducible ventricular tachycardia. Programmed ventricular stimulation was performed and an HA ECG recorded (40 Hz high-pass filter) before and under treatment. The stimulation became negative under treatment in nine patients (group I), whereas the 17 others had persistent inducible tachycardia (group II). HA ECG tracings were modified in groups I and II, with a QRS duration increase of 7% and 8%, respectively, and RMS 40 decrease of 37% and 29%, and an LAS increase of 16% and 17%. Furthermore, one of the three group I and four of the seven group II patients who had a normal HA ECG tracing before treatment developed HA ECG abnormalities under treatment. An arrhythmia-inducing effect of the treatment was noted in three group II patients; this effect was not detected by HA ECG. In conclusion, changes in HA ECG tracings were seen during quinidine therapy of patients with ventricular tachycardia, and this effect was independent from the effect of antiarrhythmic agents on induction of the ventricular tachycardia. In addition, abnormalities of high-amplification ECG tracings developed in some patients under quinidine therapy. These data suggest that class I antiarrhythmic agents modify high-amplification ECG tracings and that these modifications fail to predict whether the treatment will prove effective.