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Bruton tyrosine kinase (iBTK) inhibitors are effective drugs used in the treatment of various B-cell hemopathies, including ibrutinib; the first generation iBTK for which there is the most data available. Cardiovascular toxicities associated with the use of ibrutinib, including cardiac arrhythmia due to atrial fibrillation and hypertension, quickly emerged as a potential issue with iBTK, and especially from the first clinical trials with this molecule. Other rarer types of cardiovascular toxicities are increasingly described with ibrutinib. More recently, acalabrutinib and zanubrutinib have been developed as 2nd generation iBTK with greater selectivity for the BTK target and with the prospect of less adverse effects due to inhibition of off-target protein kinases. This work represents a brief literature review on cardiovascular toxicities associated with iBTK. [ABSTRACT FROM AUTHOR]

Extra-ocular manifestations of Graves' disease are rare and little known. We here report one of its manifestations: Diamond's triad is defined as the association of exophthalmos, acropachy (<1%) and pretibial myxedema (1.5-2%). It has been rarely found in patients with Graves' disease. We here report the case of a 33-year-old patient with no particular previous history, on follow-up for Graves' disease, complicated by cardiac arrhythmia (atrial fibrillation), treated with synthetic antithyroid drugs followed by total thyroidectomy after cardiac and thyroid stabilization. The patient reported purplish lesions on the anterior face of the legs that had persisted for several years. Clinical examination showed voluminous vascular goiter and vitiligo lesions, associated with bilateral exophthalmos, with Clinical Activity Score < 3 (A) (amended by European Group on Graves' orbitopathy (EUGOGO)), discrete pretibial oedema with purple erythematous patches, painless and firm to palpation, on the anterior face of the legs (B) and pretibial myxedema suggesting pretibial dermopathy (Basedow's disease). The fingers and toes are clubbed in the shape of a drumstick (digital hippocratism) (C, D), suggesting dysthyroid acropathy. Dysthyroid acropathy occurs in less than 1% of patients with Graves' disease but is constantly associated with exophthalmos and pretibial myxedema, thus forming the Diamond Triad, as in the case of our patient. [ABSTRACT FROM AUTHOR]

Especially exposed to frequent cardiovascular events and its related mortality, some cardiovascular therapies of the hemodialyzed population as well as coronary investigations remain controversial. We have collected data and discussed recent trials and guidelines dedicated to this patient subset.

A 16-year-old female presented to the emergency department with complaints of palpitations of two hours duration. She had similar episodes in the past brought on by stress, anger, chocolate, or coffee. The ECG obtained in the course of her medical work-up led to the diagnosis of Wolff-Parkinson-White (WPW) syndrome. The characteristic short PR segment and delta wave are best seen in the lead I rhythm strip. In this rare example, the electrocardiographic morphology alternates between multiple beats of WPW and beats of normal sinus rhythm (A). It is important to recognize the characteristic features of pre-excitation syndromes such as WPW as patients may require treatment with antiarrhythmic drugs and/or radiofrequency ablation. Furthermore, emergency management of tachyarrhythmias in patients with a known history of WPW may differ from those without. However, as demonstrated in this example, such findings may be intermittent thus making an accurate and timely diagnosis challenging. Once it is apparent, proper documentation with copies of the ECG or rhythm strip in the patient record is imperative. In this case, the patient was also provided with a copy of her ECG to show the cardiologist which proved to be important since a repeat ECG at the cardiology clinic later the same day was unremarkable (B).

Linoleic acid (LA) and alpha-linolenic acid (ALA) are precursors of omega-6 and omega-3 fatty acids. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are synthesized from ALA. These fatty acids play important role in various biological functions. The effects of omega-3 on cardiovascular risk factors – such as lipoprotein levels, blood pressure and glycemia – are very modest at standard low doses, significant only for large intakes. Randomized trials have shown that oils enriched in EPA and DHA have an undeniable impact on heart rhythm. Consumers of long-chain fatty acid have lower heart rates than controls. Conversely, patients with established arrhythmias do not appear to benefit from treatment with these fatty acids. The observation of food habits in population cohorts helped to defined the effects of rich in ALA, EPA, DHA on the risk of myocardial infarction, coronary heart disease and sudden death. For ALA the results are inconsistent and appropriate randomized clinical trials are still conclude. The effects of EPA and DHA are better established. The meta-analysis of cohort studies shows that consumption of omega-3 long- chain (EPA-DHA) reduces total mortality, death from cardiac causes, sudden death and possibly stroke. The data from prevention trials with omega-3 long-chain showed a decrease in coronary events, including fatal, in secondary prevention. These results are relatively consistent to believe that EPA and DHA intake reduces the fatal complications of myocardial infarction. Clinical trials in primary prevention are still missing. However, the sum of evidence support the recommendation for consumption of fish, EPA and DHA in patients at high risk of coronary event.

This research proposes a new method to detect R-peaks in electrocardiogram by using the prediction value from adaptive linear neuron (ADALINE) artificial neural network. With this aim, the weights of four input neurons in ADALINE are updated for each encoded ECG vector-segment and the value of an output neuron is compared with the actual ECG followed by applying finite impulse response filter. Our simulated experiments with the MIT-BIH ECG database that represents the long-term recordings from the heart disease patients show that our proposed algorithm can detect R-peaks in ECG data with the accuracy of more than 99%.

Résumé: Nous rapportons le cas d’une adolescente de 14ans ayant présenté une hypokinésie ventriculaire gauche symptomatique dans les suites de la rupture d’une malformation artério-veineuse cérébelleuse. La cardiomyopathie de type tako-tsubo doit être connue des pédiatres, car les circonstances déclenchant l’affection, un facteur émotionnel ou une atteinte du système nerveux central, peuvent se rencontrer dans l’enfance. Elle est responsable d’une dysfonction ventriculaire qui prédomine à l’apex et dans la région médio-ventriculaire gauche, donnant un aspect caractéristique à l’échocardiographie. Un traitement symptomatique peut être transitoirement nécessaire en cas d’hypotension artérielle, de trouble du rythme ou d’insuffisance cardiaque. Son évolution généralement favorable autorise à délivrer une information rassurante et à limiter les explorations étiologiques sur le muscle cardiaque. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: La fibrillation auriculaire multiplie le risque d’AVC par 5. Cette étude observationnelle de 200 patients évalue l’intérêt de la télésurveillance de l’électrocardiogramme (ECG) dans une population à risque Méthode: Le suivi est ambulatoire par la pose quotidienne d’un enregistreur sur une durée moyenne de 11jours et dix heures par jour avec détection d’arythmie et transmission automatique d’ECG. Résultats: Quarante-cinq pour cent hommes et 55 % de femmes, âge moyen de 67ans. Trente-cinq pour cent ont des antécédents d’arythmie traités. Six pour cent ont fait un AVC. Le CHADS2Vasc est de 2,2. On distingue deux groupes : le premier est en rythme sinusal à l’inclusion avec découverte d’une FA pour 31 % d’entre eux et des accès de tachycardies régulières dans 24 %. Le deuxième groupe déjà en arythmie facilite le choix entre contrôle de la fréquence (62 %) ou du rythme (38 %). Traitements: La détection précoce d’épisodes d’arythmie permet d’identifier des patients à risque d’événements aigus et permet un changement rapide et adapté comme les anti-arythmiques passant de 31 à 65 % et sécurise l’utilisation de ces traitements. Le traitement de l’hypertension et de l’insuffisance cardiaque est optimisé dans le même temps. Conclusion: Pour 33 % des patients, la télésurveillance améliore le diagnostic et le traitement de la FA permettant d’ajuster et de sécuriser la thérapeutique délivrée selon le rythme, la fréquence et les temps de conduction. [Copyright &y& Elsevier]

Abstract: Background and objective: Despite recent advances in diagnostic procedures, syncope remains unexplained in 15 to 35% of patients. If implantable loop recorder is a validated diagnostic tool for unexplained syncope, results of this strategy are largely issued from randomized studies. We lack the results of surveys. The aim of this study was to report a single center experience with implantable loop recorders, in patients with unexplained syncope. Methods and results: A device (Medtronic Reveal DX or XT) was implanted in 31 patients between January 2009 and January 2012. During a mean follow-up of 10.5±8.5 months, loop recording definitively determined that an arrhythmia was the cause of symptoms in 10 patients (32%). Fourteen patients (45%) experienced syncope or pre-syncope. In eight of the 14 patients with syncope, during follow-up, no arrhythmic diagnosis could be made (one patient has been diagnosed as presenting epilepsy and seven as having hypotensive vasovagal syncope). In six patients, the ILR showed an arrhythmic aetiology. Four other patients presented an abnormal ILR result without symptoms. Diagnosis included sinusal arrest in four patients, bradycardia in one patient, advanced atrioventricular block in two patients, ventricular arrythmias in two patients, and supraventricular tachycardia of 180/min in one patient. Therapy was instituted in all patients, in whom an arrhythmic cause was found except one who refused the therapy (six pacemaker, two implantable cardioverter-defibrillator implantations, and one cryoablation of atrioventricular nodal reentrant tachycardia confirmed by an invasive exploration). Conclusion: In this survey, implantable loop recorder implantation led to the diagnosis of an arrhythmic cause in 32% of patients and excluded an arrhythmic cause in 26% of patient with a mean follow-up of 10.5 months. [Copyright &y& Elsevier]

Abstract: Type 1 myotonic dystrophy is an autosomal dominant inherited disorder related to the expansion of a trinucleotide (CTG) repeat in the exon 15 in the 3′-untranslated region of the myotonic dystrophy protein kinase (DMPK) gene. Mutant transcripts containing an expanded CUG repeat are retained in nuclear foci and cause numerous dysfunctions by interfering with biogenesis of other mRNAs. Prominent clinical features are progressive muscular weakness and myotonia, which affect skeletal muscles but also white muscles leading to digestive, urinary and obstetrical disorders. Functional prognosis correlates with motor handicap and vital prognosis is linked to cardiac rhythm disturbances and conduction defects due to progressive subendocardial fibrosis, and to complex respiratory dysfunctions, which associate restrictive lung disease, involvement of the central inspiratory pathway, and sleep apnea. Other clinical features are lens opacity, glucose intolerance, metabolic syndrome, several endocrine disorders (gonadal deficiency, hyperparathydoidism), or immunoglobulin deficiency due to immunoglobulin G hypercatabolism. Life expectancy is reduced in myotonic dystrophy, and death is mainly caused by respiratory complications, but also by cardiac arrhythmias. Moreover, an abnormal incidence of tumors has been reported. Therefore, myotonic dystrophy does not only concern neurologists but a multidisciplinary approach is necessary, including at least pneumologist, cardiologist, and physiotherapist. General internists should also be implicated, not only in the initial diagnosis step, but also in the diagnosis of complications and their treatments. [Copyright &y& Elsevier]

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: A 45-year-old man was hospitalized for syncope due to fascicular ventricular tachycardia degenerating into ventricular fibrillation (VF). The electrocardiogram showed an early repolarization syndrome. The arrhythmia was repetitive and disappeared after oral hydroquinidine. An implantable cardioverter-defibrillator (ICD) was implanted; subsequently, the patient was arrhythmia free at 9 months follow-up. [Copyright &y& Elsevier]

Abstract: Aim of the study: In a healthy heart, the mechanoelectric feedback (MEF) process acts as an intrinsic regulatory mechanism of the myocardium which allows the normal cardiac contraction by damping mechanical perturbations in order to generate a new healthy electromechanical situation. However, under certain conditions, the MEF can be a generator of dramatic arrhythmias by inducing local electrical depolarizations as a result of abnormal cardiac tissue deformations, via stretch-activated channels (SACs). Then, these perturbations can propagate in the whole heart and lead to global cardiac dysfunctions. In the present study, we qualitatively investigate the influence of temperature on autonomous electrical activity generated by the MEF. Method: We introduce a one-dimensional time-dependent model containing all the key ingredients that allow accounting for the excitation-contraction coupling, the MEF and the thermoelectric coupling. Results: Our simulations show that an autonomous electrical activity can be induced by cardiac deformations, but only inside a certain temperature interval. In addition, in some cases, the autonomous electrical activity takes place in a periodic way like a pacemaker. We also highlight that some properties of action potentials, generated by the mechanoelectric feedback, are significantly influenced by temperature. Moreover, in the situation where a pacemaker activity occurs, we also show that the period is heavily temperature-dependent. Conclusions: Our qualitative model shows that the temperature is a significant factor with regards to the electromechanical behavior of the heart and more specifically, with regards to the autonomous electrical activity induced by the cardiac tissue deformations. [Copyright &y& Elsevier]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Myotonic dystrophy type 1 (Steinert disease) is an autosomal dominant disease characterized by myotonia and multiorgan damage. This latter is the most frequent of the adult-onset muscular dystrophies. Heart involvement is often associated, including cardiomyopathies, atrioventricular block, atrial and ventricular arrhythmias. [Copyright &y& Elsevier]

Copyright of Journal of Cardiovascular Echography is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Acute agitation occurs in a variety of medical and psychiatric conditions, and the management of agitated, abusive, or violent patients is a common problem in the emergency department. Rapid control of potentially dangerous behaviors by physical restraint and pharmacologic tranquillization is crucial to ensure the safety of the patient and health-care personnel and to allow diagnostic procedures and treatment of the underlying condition. The purpose of this article (the second in a 2-part series) is to review published data on the efficacy and safety of antipsychotic medications currently available for managing situations of this type. Arrhythmias caused by QT-prolonging drugs occur infrequently, and multiple factors are often involved, including concomitant use of other drugs affecting the same pathway (most antipsychotic drugs prolong the QT interval by blocking potassium IKr current in HERG channels of myocardial cells), electrolyte disorders and, possibly, genetic predisposition. Judicious use of typical antipsychotics (mainly haloperidol) and benzodiazepines (mainly lorazepam), given intramuscularly alone or in combination, has proved to be safe and effective for controlling acute motor agitation related to psychiatric illness; cocaine, methamphetamine, and ethanol toxicity; ethanol withdrawal; and other factors. They are still widely used and are particularly useful when limited data are available on the patient''s history of cardiovascular disease, current use of medication, and/or the likelihood of illicit drug or alcohol intoxication; when the diagnosis involves medical comorbidity or intoxication; or when there is no specific treatment (e.g., personality disorders, learning disabilities, mental retardation, organic brain damage). If rapid tranquillization is necessary before a formal diagnosis can be made and there are uncertainties regarding the patient''s medical history, lorazepam is often considered the first-line drug of choice. In patients with primary psychiatric disease, the second-generation atypical antipsychotics, mainly risperidone and olanzapine, were shown to be at least as effective, and possibly safer, than traditional agents. [Copyright &y& Elsevier]

Abstract: Cryoablation is used for definitive treatment of arrhythmias by catheter after a 4min application of a −70°C temperature. There are three main indications of this technique: (1) the treatment for intranodal tachycardia is commonly performed using cryoablation. Success rates are high with no atrio-ventricular block (AVB) risk, (2) the ablation of atrioventricular accessory pathways (Wolf Parkinson-White syndrome), close to His-bundle has a high success rate; the use of a cryo focal catheter avoid AVB risk, (3) the ablation of pulmonary vein potentials with a cryo-balloon in the left atrium for atrial fibrillation. The success rate is high, similar to that achieved with radiofrequency ablation. The cryoballoon procedure is easier to perform because ablation is done in a single step, with a circular application and not point by point. It is well tolerated because it is less painful. There is no risk of pulmonary vein stenosis or esophagus injury. It is less thrombogenic. [Copyright &y& Elsevier]

Abstract: Local anaesthetic toxicity always results from rapid and important increase in their plasma concentrations. Clinically, neurologic and cardiovascular symptoms may occur, especially life-threatening cardiac arrhythmias and cardiac depression. Resuscitating patients from cardiac toxicity was known as difficult, until the introduction of lipid emulsion therapy. From experimental data, at least two mechanisms of action can be proposed, a sink-effect and an improvement of cardiomyocyte metabolism. The present article is a mini-review of the current use of lipid emulsions for the treatment of local anaesthetic cardiac toxicity. The mechanisms of cardiac toxicity and those of lipid emulsion therapy are summarized, and the clinical experience of this therapy and its limits are presented. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and management of PRIS. Data sources: A PubMed® database research in English and French languages published until December 2008. Keywords were propofol, propofol infusion syndrome (PRIS), rhabdomyolysis, heart failure, arrhythmias, metabolic acidosis, brain injury, sedation, intensive care. Data synthesis: PRIS is a rare and potentially lethal complication, especially if there''s no early identification of the syndrome. The physiopathology of PRIS mechanism remains unclear, however a dysfunction of mitochondrial respiratory chain could be involved and potential genetic factor may account. Clinical features consist of arrhythmias, metabolic acidosis, lipemia, rhabdomyolisis, myoglobinuria. PRIS has been described classically in children and adults undergoing a long term infusion with propofol (more than 48hours) at doses higher than 4mg/kg per hour. However, it can be observed with lower doses and after shorter duration of sedation. Steroids, vasopressors and low carbohydrate intake act as triggering factors. Early recognition of the syndrome improve patient''s outcome. Propofol infusion must be avoided in susceptible patients and another sedative agent should be considered. When using prolonged sedation with propofol, arrhythmia and serum triglyceridemia level should be monitored. [Copyright &y& Elsevier]

Abstract: Introduction: The clinical picture of organophosphate poisoning is dominated by respiratory and neurological signs. Cardiac complications are rare, serious and little known by clinicians. Observation: F.B, 17 years, was addressed intubated, at the emergencies after an organosphorus poisoning. At admission, the patient was comatose with a muscarinic syndrome. Her hemodynamic was stable. Chest radiography and ECG of admission were normal. A gastric washing and a treatment by atropine were quickly started. The toxicological analysis of gastric liquid showed presence of malathion. After 20hours, the patient presented a cardiogenic shock. Chest radiography showed signs of acute pulmonary edema and ECG: a circumferential endocardic ischaemia. In spite of vasopressors and positive inotropic treatment, the patient quickly died. The autopsies revealed multiple necrosis of the heart. Discussion: The cardiac symptoms are caused by many mechanisms often associated. The cardiac attack appears primarily by many electrocardiographic modifications: arrhythmias, disturb of repolarisation, conduction''s disorder… On the hemodynamic plan, a circulatory insufficiency is possible. The ventricular arrhythmias, which are not treated by lidocaine or electric cardioversion are treated effectively by injection of isoproterenol and/or ventricular stimulation, and recently by the use of magnesium salts. Conclusion: If the clinical picture of the IOP is dominated by neurological and respiratory signs, it is always necessary to remember the possibility of cardiac complications (early or late) whose pronostic is very often bad. [Copyright &y& Elsevier]

Summary: Aim: Analysis of domestic low-voltage (220–240V) electrical injury in children admitted to a pediatric emergency department to illustrate the low risk of initial or delayed risk of arrhythmia. Material and methods: Retrospective study between 2001 and 2008 analyzing all children aged less than 15 years admitted for a low-voltage electrical injury. The data collected were age, sex, time and circumstances of the accident, time and day of admission, transport modalities, presence of risk factors for arrhythmia (transthoracic current, wet skin, tetany, loss of consciousness or neurological symptoms, and initial EKG abnormalities), injuries, EKG, muscular and/or cardiac enzyme values, progression and complications. For statistical analysis, data were entered in Microsoft Excel tables. Analysis was done with StatView5.1 (SAS Institute®) and Epi Info 6.04fr (VF, ENSP epiconcept®). In the descriptive analysis, the data are presented as mean values with SD, median and range. Results: Forty-eight children were included. The mean annual number of admissions was equal to 6 (range, 3–12). The mean age was 6.2±4.3 years (median, 4.6 years). There was a male predominance: the overall sex ratio was 1.5, i.e., 3 before the age of 2 and 2.6 before the age of 10. The electrical injury occurred after contact with a wire or a connected cord or after the introduction of a metallic object in a wall socket. Ten children had risk factors of arrhythmia (mainly wet skin or thoracic pain). Twenty-nine children suffered from burns to the extremities (digits and hands, 70 %). At admission, 45 children had an EKG performed. The initial EKG was considered abnormal in 8 cases showing: sinusal tachycardia (n =4), incomplete right bundle branch block (n =4), and V1 negative T waves (n =1). The EKG normalized within the first 12h. Hospitalization for cardiac monitoring was required for 18 children. No delayed arrhythmia occurred. In a mean time of 3.5h after the accident, a troponin dosage was given to 15 children and was normal in all cases. One child developed rhabdomyolysis and evolved without needing dialysis. Conclusion: After a low-voltage electrical injury, initial arrhythmia is not frequent, with often a nonspecific and transitory EKG expression; delayed arrhythmia is very rare. Children presenting to the emergency department after such an electrical accident, who are asymptomatic, without any risk factors for arrhythmia (wet skin, tetany, vertical pathway of the current, preexistent cardiological conditions, loss of consciousness) and with a normal initial EKG do not require cardiac monitoring. [Copyright &y& Elsevier]

Abstract: There is a strong prevalence of sleep apnoea syndrome in general population. Cardiac arrhythmia and conduction disturbances during sleep may complicate this syndrome. We report the case of a 73-year-old patient to whom the sleep apnoea syndrome was diagnosed after varied heart blocks during the sleep. A treatment by continuous positive airway pressure (CPAP) permitted to correct these conduction disturbances and to avoid pacemaker implantation. [Copyright &y& Elsevier]

Abstract: Background: Radiofrequency ablation of atrioventricular accessory pathway (AP) which is currently used, remains associated with a risk of complete AV block in the case of anteroseptal (AS) location and its indication remains debatable. The purpose of the study was to evaluate the frequency of AS location in Wolff-Parkinson-White syndrome (WPW) and the clinical and electrophysiological data of these patients. Methods: Electrophysiologic study (EPS) was performed in 503 pts aged from six to 85 years (35±17), 297 men, 206 women, recruited for a patent WPW syndrome. The location of AP was determined on a 12 lead ECG during atrial pacing at maximal preexcitation according to classical criteria. The location was confirmed at EPS. Eleven pts were excluded because the location remained not clearly defined. EPS was indicated for suspected or documented tachycardias (n =264), syncope (n =68) or was systematic in asymptomatic patients (n =171). Results: AS AP location was identified in 34 patients aged eight to 48 years (7%). Their mean age was younger than the age of remaining population (25±13 versus 36±17, p <0.001). According to the age, the prevalence of AS location was significantly higher in children and adolescents (14%) than after 40 years (3%) (p <0.01). There was no AS location among 108 patients aged more than 50 years. The maximal rate conducted over AP was lower in patients with AS location than in other locations either in control state (174±60 per minute versus 197±63per minute) (p <0.01) or after isoproterenol (206±71 versus 248±69) (p <0.01). The number of induced reciprocating tachycardia (47% versus 57.5%), atrial fibrillation (15% versus 21%) and malign forms (12% versus 17%) did not differ significantly in patients with AS location and in other patients. Anterograde conduction disappeared spontaneously in three of six patients followed 8±1.5 years, and significantly increased in two other patients. Conclusions: AS AP location in WPW syndrome was more frequent in children than in adults. The maximal rate conducted over the AP was lower than in other locations. The incidence decreased after 40 years. AS AP location was never noted after 50 years in our population. This disappearance with age should be taken into account for the indications of AS AP ablation. [Copyright &y& Elsevier]

Abstract: The electrical activity in heart is generated in the sinoatrial node and then propagates to the atrial and ventricular tissues. The junctional channels that couple the cardiomyocytes are responsible for this propagation process. These channels are dodecamers of transmembrane proteins of the connexin (Cx) family. Four Cxs – Cx30.2, −40, −43 and −45 – have been demonstrated to be synthesized in the cardiomyocytes. In addition, each of these Cxs has a unique expression pattern in the myocardium. A fruitful approach of the role of these Cxs in the cardiac functions came with the development of transgenic mouse models. It has been shown that Cx43 was mainly involved in influx propagation in the ventricles and that inactivation in the cardiomyocytes of the gene of this Cx predisposed to development of cardiac abnormalities. Cx40 very significantly contributes to the propagation of electrical activity in the atria and the conduction system. Cx45 is essential to coordinate the synchronization of contractile activities of embryonic cardiomyocytes and for the normal progress of cardiogenesis. Finally, Cx30.2 contributes to the slowing of propagation of excitation in the atrioventricular node. These observations enable to better understand the relationships between alteration in Cx expression or gap junction remodelling and arrhythmias in the human heart. [Copyright &y& Elsevier]

Abstract: Aim: This study was designed to describe clinical characteristics and electrophysiologic in patients with asymptomatic Wolff-Parkinson-White syndrome. Methods: From December 2000 to August 2005, a total of 154 patients with accessory pathway-mediated reentry mechanism underwent electrophysiologic studies at Sainte-Marguerite and Timone hospitals in Marseille. Ninety-six patients had WPW syndrome, out of which 78 were symptomatic patients and 18 were asymptomatic. The mean age was 26 years. Sex (masculine) 17. Results: The incidence of intermittent arrhythmia associated with Wolff-Parkinson-White syndrome was lower in 2 patients (11%). There was a higher occurrence of rapid induced tachycardia in 9 patients (50%). However, atrial fibrillation occurred more commonly in 6 (33%) patients. The anterograde accessory pathway effective refractory period (APRP) in patients was much shorter (less than 250 ms [N =16]) 13 patients with accessory pathways were managed by ablation. Conclusion: This study demonstrated the difference in the electrophysiologic characteristics of anterograde accessory pathway and the atrioventricular node in asymptomatic WPW patients, and thus concluded that radiofrequency (RF) catheter ablation is a safe and effective method to manage patients with asymptomatic WPW syndrome. [Copyright &y& Elsevier]

Abstract: Electrical storm is defined as repeated occurrence of severe ventricular arrhythmias requiring multiple cardioversions, two or more or three or more following different studies. The clinical aspect can sometimes be made of multiple, self aggravating, life threatening accesses. There are three main clinical circumstances of occurrence: in patients equipped with intracardiac defibrillators, during the acute phase of myocardial infarction and in Brugada syndrome. 10 to 15% of patients with cardiac defibrillators are subject to electrical storms in a period of two years. The causative arrhythmia is most often ventricular tachycardia than ventricular fibrillation, especially in secondary prevention and if the initial arrhythmias justifying the device was a ventricular tachycardia. Precipitaing factors are present in one third of cases, mainly acute heart failure, ionic disorders and arrhythmogenic drugs. Predictive factors are age, left ventricular ejection fraction<35% and renal insufficiency. Arrhythmia reduction is obtained by electrical shock in 50% of cases, antitachycardi stimulation in 30% and in 20% by association of the two. Treatment, after elimination of inappropriate shocks, is mainly based on beta-blockers and amiodarone, class I antiarrhythmics, lidocaïne or bretylium in some cases, and sedation pushed to general anesthesia in some cases. Radio-frequency ablation and even heart transplantation have been proposed in extreme cases. Quinidine has been proved efficient in cases of Brugada syndrome. [Copyright &y& Elsevier]

Abstract: Objective: The Deep-Breathing (DB) test is of major importance in the evaluation of the vagal response (VR). We applied this test to assess the VR in a group of subjects with functional (neurological, cardiovascular or digestive) symptoms unexplained by standard cardiac examination and to compare it with the VR measured in a group of healthy controls. Patients and methods: The following groups were considered: a C-Group of healthy controls (n =50), and three groups each consisting of 50 symptomatic patients (S1, S2, S3). Subjects in the S1-Group had a postural orthostatic tachycardia syndrome (POTS), while members of the S2-Group had arterial hypertension, and members of S3-Group had neither POTS nor arterial hypertension. The VR was expressed as a percentage variation of RR intervals 100×[(RR max – RR min)/RR min], and was correlated with age and sex in the C-Group before any comparison. Results: In controls the VR was 31.0%±8.2. It was negatively correlated with age (r =−0.42, p =0.003) and there was no significant difference between males (31.2%±5.7) and females (30.9%±9.0) (p =0.12). Compared to the C-Group, the VR was 51.6%±20.4 in the S1-Group (p <0.001), 26.9%±11.3 in the S2-Group (p <0.001), and 47.2%±22.7 in the S3-Group (p <0.001). Conclusion: The VR was independent of sex but was negatively correlated with age. In comparison with healthy controls, it was significantly increased in the patients with POTS and significantly decreased in hypertensives. [Copyright &y& Elsevier]

Abstract: QT prolongation is essentially of pharmacologic origin. It is principally linked to a block of the outward potassium current Ikr, with as a consequence a prolongation of the repolarisation causing early after potentials and re-entry. The term “repolarisation reserve” expresses the variable risk of arrhythmia among individuals under the same drug blocking Ikr. This reserve can the altered under various pathologic or genetic conditions. A series of risk factors (bradycarTorsades de pointes were described in 1966 by Dessertenne. They are due to a perturbation of ventricular repolarisation causing QT prolongation on surface ECG. Acquired dia, electrolytic disorders, cardiac disease, neurologic disorders, nutrition troubles, female gender) can play a role as well as the metabolic processing of pharmacological agents by Cytochrome P450 and various inhibitors or inductors of this system which can influence the half life of drugs. The list of drugs involved is continuously increasing: antiarrhythmics, antihistamines, psychotropics, anti-infectious are the main categories involved. Risk prediction is difficult particularly for non cardiovascular drugs and a low risk incidence. An other risk is to exclude patients from the benefit of an efficient drug for a serious but unfrequent risk, at last an industrial risk for the manufacturer when a drug is withdrawn lately when important quantities of money have already been invested for its development. The diagnosis of torsades is easy on standard ECG although QT measurement and its heart rate variation remain uneasy. The treatment of the arrhythmias is based on heart rate acceleration by Isoprenaline or intravenous pacing and on intravenous administration of magnesium. [Copyright &y& Elsevier]

Abstract: Cardiac tumors are rare in childhood and can be revealed by arrhythmias. We report the observation of an 18-month-old infant who had an episode of ventricular tachycardia (VT) which resulted in a large intramyocardic tumour diagnosis evocating a left ventricular fibroma. A treatment by amiodarone allowed a stable reduction of the VT. The presence of an intracardiac obstruction or uncontrollable arrhythmias would lead to a surgical resection. [Copyright &y& Elsevier]

Abstract: Subject: Transient left ventricular apical ballooning syndrome, knowed as the japanese name of tako-tsubo was recently described and is characterised at the acute period by a large apical dyskinesia of the left ventricule apex. This syndrome usually mimick an acutre coronary syndrome, sometime a cardiac faillure or arrhythmias. We report a typical case of a seventy-seven years old women struck by a tako-tsubo syndrome revelated by an acute chest pain after an emotional stress. The diagnosis was proposed because angiographie didn''t shown any abnormality in spite of a large left ventricular dysfunction at the ventriculography. Topicality: Tako-tsubo syndrome is more and more published due to a better knowledge of this syndrome, specially in the acute coronary syndrome without coronary abnormality. His physiopatology is not well known but is clearly in relation with an acute stress. Several hypothesis are discussed, helped by some experimental animal model. With an excellent prognosis at a middle-course, his discovery allow an adapted take care especialy of the complications. Prospect: The setting up of clinical and electrocardological reliable and well-tried criteria will allowed an early diagnosis to avoid harmful treatment. His specific treatment is not reached by consensus but will develop by a better knownledge of the physiopathology. [Copyright &y& Elsevier]

Abstract: A pharmacoepidemiological cross-sectional observational study was performed among a representative sample of French general practitioners and cardiologists. The aim of this study was to describe the prescription modalities of flecainide acetate, an Ic class antiarrhythmic, and how these modalities match the marketing authorization and the current summary of product characteristics. A total of 941 physicians participated in the study, 496 GPs and 445 cardiologists, and 1116 patients treated with flecainide for more than one month were included. On average, the patients were 68.7-years-old and 54% of them were women. Most of the initial flecainide prescriptions came from cardiologists (96%) and the check-up included an electrocardiogram (98%), a Holter monitoring (56%) and/or an echocardiography (71%). The preferred indication was supraventricular rhythm disorders (95%) and mostly atrial fibrillation (63%). A small proportion of coronary patients (7%) and of patient suffering from cardiac insufficiency (4%) was found. Flecainide was prescribed with a median posology of 150 mg per day, mostly as LP form (64%). Overall, the indications specified in the summary of product characteristics were respected in 90% of the cases, the contraindications in 91% of the cases and the patient follow-up was appropriate in 99% of the cases. In conclusion, the study showed that the prescription''s conditions of flecainide in France complied with the summary of product characteristics data for most of the prescribing physicians with a respect of the indications, contraindications and management recommendations in 84% of the cases. [Copyright &y& Elsevier]

Abstract: Introduction. – Recent progress in molecular biology led to the identification of the genes involved in various cardiac arrhythmias causing syncope and sudden death in young people. Exegesis. – This article briefly describes the clinical features and the genes associated with the congenital long QT syndrome, the short QT syndrome, Brugada''s syndrome, catecholaminergic polymorphic ventricular tachycardias and arrhythmogenic right ventricular dysplasia. Conclusion. – Identification of genetic variations that cause cardiac tachyarrhythmias can help to identify at risk-patients and to propose clinical follow-up and preventive therapy. Further studies are needed to discover other cardiac genetic disorders and to understand cellular mechanisms involved in these diseases. [Copyright &y& Elsevier]

Abstract: Introduction. – In case of an accessory pathway, children are exposed to severe cardiac events including sudden death. Radiofrequency ablation is a standardized procedure, which can be applied to a significant number of children although complications can still potentially occur. In this context, transesophageal evaluation of the accessory pathway evaluation can be discussed. Materials and methods. – Among 140 procedures performed in 19 years, 70 were done for accessory pathway evaluation. The preexcitation was overt in 59 children older than 5 years, which form the basis in this study. Results. – Anterograde refractory period was determined in 88% cases and was found<220 ms in 12 cases justifying an ablation procedure. Conversely, in case of a long refractory period (>250 ms), the ablation procedure was not performed in 8 asymptomatic cases and was postponed in 11/20 mildly symptomatic children. Transesophageal electrophysiologic study seems legitimate in asymptomatic or mildly symptomatic children. Conclusion. – This technique is probably less useful in case of an overt preexcitation and recurrent reciprocating tachycardia requiring long-term antiarrythmic treatment. In this case, endocavitary electrophysiological study eventually followed by an ablation procedure seems the best option. [Copyright &y& Elsevier]

Abstract: Chaotic atrial tachycardia is a rare arrhythmia that has no known etiology and that usually inflicts upon newborn infants. The diagnosis is established using the surface electrocardiogram (ECG) which shows a spectacular polymorphism and irregularity of the atrial electrical activity. Clinical tolerability is variable depending on the ventricular rhythm. Cases that are not well tolerated and cases who do not recover spontaneously require medical treatment which relies mainly on amiodarone and other class IC anti-arrhythmic drugs . There is usually complete recovery during the first few months of life . The authors present the case of a female patient who was diagnosed with chaotic atrial tachycardia with induced cardiomyopathy following birth. She was successfully treated with amiodarone but had several relapses of the arrhythmia upon discontinuation of the drug. Although this observation is classic in its presentation, we consider that it is useful to remember this rare and frequently forgotten syndrome and to report the unique and particular aspects of our case and its evolution. [Copyright &y& Elsevier]

Abstract: Objectives. – This prospective study had for aim to determine the frequency and characteristics of cardiovascular events in the course of tetanus. Patients and methods. – From September to December 2002, we studied all patients over 4 years of age presenting with tetanus without any documented underlying disease. Results. – Thirty cases were included (mean age 36±20 years; sex-ratio 2.3). Seventy-three per cent had a mild-gravity tetanus (stage II of Mollaret) upon admission. One hundred and seventeen ECG were recorded and 93.3% of the patients had more than one abnormality: arrhythmia (24 cases), prolonged QT interval (23 cases), ventricular hypertrophia (17 cases), and atrial hypertrophia (4 cases) especially left (3 cases), failure of AV conduction (3 cases), ST segment depression (3 cases), left and right axis deviation (3 cases), baseline undulation (3 cases) and repolarization disturbances (1 case). All patients had a normal Doppler echocardiographic examination. The mean hospitalization stay was 11.6±1.4 days and complications were noted in 60%; sinus tachycardia in apyrexia (5 cases), instable BP (5 cases), excessive sweatiness in apyrexia (1 case), and access of bradycardia with sudden cardiac arrest (2 cases). 8 patients died (26.7%). Six patients with cardiac autonomic dysfunction died, the case fatality rate being statistically higher in this group (P =0.007). A prolonged QT interval, sinus tachycardia and left ventricular hypertrophia were statistically more frequent at the acute phase of the illness. Conclusion. – The case fatality rate of tetanus is still high, due among others to autonomic dysfunctions. [Copyright &y& Elsevier]

Copyright of EMC-Psychiatrie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Cardiologie-Angeiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 25-year-old man who was known to have Behc¸et’s syndrome and who has no coronary risk factors suffered an acute anterior wall myocardial infarction which was complicated by a ventricular fibrillation. The diagnosis of Behc¸et’s syndrome was based on reccurent thrombophlebitis, genital and oral aphtoses, posterior uveitis, positive pathergy test and HLAB51. About 20 cases of myocardial infarction were reported in the litterature but the etiopathogeny, the causal relationsheep and the treatment are yet unknown. [Copyright &y& Elsevier]

Copyright of EMC-Cardiologie-Angeiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Tachycardia-induced cardiomyopathy is a reversible left ventricular dysfunction caused by cardiac arrhythmia. Because of its reversibility, a correct diagnosis and treatment are necessary. The aim of our study was to precise the diagnostic procedures of the tachycardia-induced cardiomyopathy and to study the left ventricular function after the correction of the arrhythmia.Patients and methods. – A retrospective study done between 1992 and 2001. Children studied were followed-up for: an idiopathic form of cardiomyopathy, in which the etiological research showed a cardiac arrhythmia; a cardiac arrhythmia associated to a cardiomyopathy. An electrocardiogram recorded the cardiac arrhythmia. The left ventricular function was evaluated by an echocardiography before and every month after the correction of the cardiac arrhythmia.Results. – Twelve children were included, ages ranged from 2 months to 15 years (median 11 years). Four patients presented a cardiac insufficiency associated to arrhythmia; three followed-up for an arrhythmia developed a cardiomyopathy; five whose cardiac arrhythmia was not easy to demonstrate had an idiopathic form of cardiomyopathy. The Wilcoxon test showed a significant amelioration (P < 0.01) of the left ventricular function after the correction of the cardiac arrhythmia.Conclusions. – Tachycardia-induced cardiomyopathy in children is curable and the diagnosis is quite difficult. Pediatricians and family doctors should try to look for specific signs of cardiac insufficiency or arrhythmia. Pediatric cardiologists should search a tachycardia-induced cardiomyopathy in every idiopathic form of cardiomyopathy. [Copyright &y& Elsevier]