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Poorly tolerated cardiac rhythm disorders in the newborn are a real emergency requiring early and adequate management. We here report the case of 15-day old newborn with atrial tachycardia associated with acute heart failure requiring electrical cardioversion. [ABSTRACT FROM AUTHOR]

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Copyright of Obésité 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.)

Summary: We report the case of a 3-month-old boy hospitalized with acute bronchiolitis. Respiratory distress was associated with cardiogenic shock caused by chaotic atrial tachycardia. The cause of bronchiolitis was a coronavirus NL63 viral infection, confirmed in nasopharyngeal aspirations. The patient required intensive care including diuretics (furosemide), anti-arrhythmic drugs (amiodarone and digoxin), and inotropic drugs (milrinone and levosimendan) associated with mechanical ventilation. The outcome was favorable in 10days and the sinusal cardiac rhythm was completely restored at discharge. [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: Introduction: Pulmonary embolism is a frequent disorder with a diagnostic approach based on probability estimation. Nevertheless, in some cases, prognosis may be impaired by delayed diagnosis resulting from atypical presenting manifestations. Case report: We report a 37-year-old woman, admitted for a seizure as the presenting manifestation of pulmonary embolism, and review nine additional similar cases reported in the literature since 1945. Seizures were always generalized tonico-clonic in nature without a past medical history of epilepsy in any case. Tachycardia was noted in nine patients over ten. Prognosis was usually severe leading to death by cardiovascular deficiency in 70% of cases. Conclusion: These observations suggest a systematic suspicion of pulmonary embolism in the presence of generalized convulsion with persistent tachycardia after resolution of the episode and no past medical history of seizures. More research is necessary to assess the role of d-dimer testing in these situations. [Copyright &y& Elsevier]

Abstract: Introduction: Radiofrequency ablation of accessory pathways (AP) has become a first-line treatment, except in young children where the indications are discussed because of radiation risks and complications of catheterization. The purpose of the study was to evaluate the indications and results of radiofrequency AP ablation in children and teenagers. Methods: Electrophysiological study (EPS) was performed in 145 patients aged from 5 to 18 years (13.5±3) with a preexcitation syndrome (PS). Results: AP ablation was indicated in 66 children (group 1); others represent the group I. Group I was older and less frequently asymptomatic. All children with a spontaneous malignant form had an ablation. Group 1 has a faster conduction through the AP than group 2. The induction of reentrant tachycardia (RT), atrial fibrillation and the presence of a malignant form is more common in group 1. Failures or reappearances of WPW after ablation were frequent (20, 26%) related to a younger age (15±3 vs 17±4) (<0.05). In group 2, one 18-year-old teenager with untreated RT died before ablation. Asymptomatic children are well with disappearance of PS in two. Medically treated symptomatic children are well. Conclusion: If spontaneous malignant forms, symptoms with drugs or practice of competitive sport are indications of AP ablation, it is recommended to wait for adolescence in other children. [Copyright &y& Elsevier]

Abstract: Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment. [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.)

Summary: A fast heart rate or an irregular ventricular rhythm can produce various degrees of functional impairment and structural remodeling of the ventricle referred to as tachycardia-related cardiomyopathy or tachycardiomyopathy. This form of myocardial dysfunction can be caused by supraventricular or ventricular tachyarrhythmias that are incessant and associated with ventricular rates higher than 120 bpm. It can be reversed with pharmacological or nonpharmacological rate control or arrhythmia reversion. The prevalence of ventricular and supraventricular tachyarrhythmias is high among patients with heart failure. Consequently, in clinical settings, it may be difficult to determine whether a patient with severe ventricular dysfunction and supraventricular tachyarrhythmia associated with a rapid ventricular response is suffering from tachycardiomyopathy or from heart failure complicated by the subsequent development of a supraventricular tachyarrhythmia (e.g. atrial fibrillation). This typical “chicken-or-the-egg” dilemma can be resolved by treating the arrhythmia (pharmacological or nonpharmacological rate and/or rhythm control) and closely monitoring the evolution of the left ventricular dysfunction. Proper management of tachycardiomyopathy requires appropriate decision making, use of both pharmacological and nonpharmacological treatment approaches, and close follow-up. The purpose of this review article is to examine currently available data (experimental and clinical) on this complex clinical entity and on rate-control therapy. [Copyright &y& Elsevier]

Abstract: Multiple mechanisms can explain a tachycardia associated or not with a heart disease. It is important to establish its origin, particularly if advanced heart disease is present, for the treatment. Complete electrophysiological study remains an important means of diagnosis. We report the case of a 39-year old man, who had a dilated cardiomyopathy since the age of 25 years and who complained of tachycardia. These symptoms were shown to be related to atrioventricular nodal re-entrant tachycardia at electrophysiological study and a specific treatment was indicated. [Copyright &y& Elsevier]

Abstract: Cerebral palsy (CP) is a group of disorders of the development of movement and posture, causing activity limitations, that are attributed to nonprogressing disturbances that occurred in the developing fetal or infant brain. The motor abnormalies are often accompagnied by disturbances of sensation, perception, cognition, behavior and/or by a seizure disorder. The prevalence of CP has not decreased in developed countries over the past 30years, despite the widespread use of electronic fetal heart rate monitoring and a 5- to 6-fold increase in the cesarean delivery rate. In the term newborn, CP may be attributed to perinatal asphyxia in case of metabolic acidosis in the cord blood (pH<7,00 and base deficit>12mmol/L), followed by a moderate or severe neonatal encephalopathy within 24hours and a further neurological impairement characterized by spastic quadriplegia and dyskinesia/dystonia. Dating the time of fetal asphyxia during delivery is possible when there are acute catastrophic complications during labor and unexpected acute or progressive fetal heart rate anomalies after a normal admission test, when there is a need for intensive neonatal resuscitation, a multi-organ failure within 72hours of birth and visualization of acute non focal cerebral abnormalities, mainly by early magnetic resonance imaging (MRI). MRI sequences show either a brain-damaged pattern of the central basal ganglia, thalami and posterior limbs of internal capsules with relative cortical sparing, in acute, near-total asphyxial insults manifested by a continuous bradycardia or a pattern of cortical injury in the watershed zones and relative sparing of the central grey matter, in prolonged partial asphyxia, manifested by late or atypical variable decelerations with progressive fetal tachycardia, loss of reactivity and absent fluctuation. Prolongation of either type of asphyxial insult results in more global brain damage. In order to differentiate a CP occurring after perinatal asphyxia from other neurological sequelae in relation with infection, hemorrhage, stroke, malformations, genetic or metabolic diseases, it is essential that a definitive information from the brain by MRI and an extensive histological examination of the placenta are at disposal. [Copyright &y& Elsevier]

Abstract: We report a case of a 55-year-old woman who has a non-compaction of the left ventricular myocardium diagnosed after a cardiac arrest due to a polymorphic ventricular tachycardia. The patient was implanted with a cardioverter-defibrillator. A review of literature of this recently described cardiopathy is done. [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: Neonatal thyrotoxicosis is a rare disease. The goal of this study was to analyse main neonatal symptoms, clinical complications and patient''s care. Material and methods: This retrospective study concerned the newborns admitted with neonatal thyrotoxicosis between 1992 and 2004 in the neonatal department of Bordeaux, Toulouse and Pau hospital. Results: Seven of these patients were included in the study. All of the newborns had permanent tachycardia and 3 of them had respiratory failure. Two patients had potentially lethal clinical complications. The first had goitre with tracheal compression. The second developed global heart failure on his 13th day of life. The onset of antithyroid drug treatment was between the 3rd and the 18th day of life. Mean duration of treatment was 50 days. Occurring complications were neutropenia in 3 patients and hypothyroidism in 1 patient. The children were tracked during their first year, and all had normal growth and normal neurological development. Conclusion: The main prognostic factor is the early onset of antithyroid treatment. In our study, 2 patients had potentially lethal clinical complications. Adequate care depends on early spotting of high-risk newborn. [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: Electrophysiologic study (EPS) frequently is required to assess the prognosis of asymptomatic Wolff-Parkinson-White syndrome (WPW) or to prove the nature of no documented tachycardia. EPS usually is performed by intracardiac route and hospitalization is required. Similar data are given by an EPS performed by oesophageal route during a consultation. The purpose of the study was to evaluate the cost of both techniques in France. Transesophageal EPS was performed during a consultation in 100 patients with asymptomatic WPW syndrome and 100 patients with no heart disease, complaining of no documented tachycardias with abrupt beginning and end, suggesting a paroxysmal junctional re-entrant tachycardia (PJRT). The cost of transesophageal study including isoproterenol infusion is 127.75 euros. The cost of intracardiac EPS is at least 1460 euros, cost of hospitalization during only one day. Results: In patients with WPW syndrome, 15 had a potentially malignant form with the induction of a tachycardia conducted through the accessory pathway at a high rate (>240/min in control state,>300/min with isoproterenol); radiofrequency catheter ablation was indicated in a second time. In the group with no documented tachycardia, PJRT was induced in 30 patients and indication of ablation was discussed. In other 155 patients with either a benign form of WPW syndrome or with a tachycardia unrelated to a PJRT, hospitalization was not required; in these patients, intracardiac study performed during one day of hospitalization would have costed 226,300 Euros. The cost for the esophageal EPS and a similar diagnosis was 19,801 Euros, with a save money of 206,499 Euros. In 45 patients in whom hospitalization was indicated in a second time to perform catheter ablation of the arrhythmia, the cost related to esophageal EPS was 5749 Euros. In the total group, considering the final diagnosis and the need of hospitalization in 45 patients, the save money related to the use of esophageal EPS was 206,499 E–5749 E=200,750 euros. Conclusions: We should take into account the cost studies, when various techniques could be used for a similar diagnosis. There are important differences in the cost of diagnostic methods and it is easy to decrease this cost. [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]

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.)

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]

A clinical case of spontaneous ventricular dysrythmia in a 47-year-old patient scheduled for ankle osteosynthesis is reported. During initial peripheral vein canulation, a spontaneous ventricular tachycardia occurred and disappeared spontaneously in about 3 min. It was decided to proceed with surgery. Thirty minutes after spinal anaesthesia, asystole occurred. Normal sinus rhythm was rapidly restored after basic life support. There was no harmful consequence for the patient. He had a history of repetitive monomorphic ventricular tachycardia (Gallavardin type). The aetiologies of asystole after spinal anaesthesia are well known and will be not discussed in the text. Although the origin of the asystole is unclear in this case, the literature on Gallavardin’s syndrome is reviewed, showing that a prolonged and complex preoperative assessment is not mandatory in this syndrome. [Copyright &y& Elsevier]

The induction of a ventricular tachycardia (VT) after myocardial infarction (MI) is associated with a high risk of VT and sudden death (SD) in asymptomatic patients; the purpose of the study was to know if syncope modifies the results of programmed ventricular stimulation (PVS) and the clinical consequences.Methods. – PVS using two and three extra stimuli delivered in two sites of right ventricle was performed in 1057 patients without spontaneous VT or resuscitated SD at least 1 month after an acute MI; 836 patients (group I) were asymptomatic and were studied for a low ejection fraction or nonsustained VT on Holter monitoring or late potentials; 228 patients (group II) were studied for unexplained syncope. The patients were followed up to 5 years or heart transplantation.Results. – Sustained monomorphic VT (<280 b/min) was induced in 238 group I patients (28%) and 62 group II patients (29%); ventricular flutter (VT > 270 b/min) or ventricular fibrillation (VF) was induced in 245 group I patients (29%) and 42 group II patients (18%) (P < 0.05); PVS was negative in 353 group I patients (42%) and 124 (55%) group II patients (NS). The patients differ by their prognosis; cardiac mortality was 13% in group I patients and 34% in group II patients with inducible VT < 280 b/min (P < 0.01), 4% in group I patients and 13% in group II patients with inducible VF (P < 0.05), 5% in group I patients and 7% in group II patients with negative study (NS). In conclusion, syncope did not change the results of programmed ventricular stimulation after myocardial infarction. However, syncope increased significantly cardiac mortality of patients with inducible ventricular tachycardia, flutter or fibrillation. [Copyright &y& Elsevier]

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]

Pertussis remains in France the first cause of bacterial, infectious death in infant aged 10 days to 2 months. It is especially in this age group that malignant pertussis occurs.Case report. – A 40-day-old infant was admitted in the intensive care unit with symptoms of bronchiolitis along with a 200 bpm permanent tachycardia. He presented a marked leukocytosis with lymphocytosis. On the second day, convulsions and coma occurred, followed rapidly by respiratory failure, with a subsequent deterioration due to the development of severe pulmonary hypertension. Circulatory failure caused the infant’s death on the beginning of the 5th day. Pertussis was confirmed by PCR on nasopharyngeal swab. Intra-familial contamination was most likely.Comments. – Malignant pertussis is characterized by the very young age of patients, permanent tachycardia sine materia, dyspnea with early respiratory failure, frequent neurological symptoms, severe hyperleukocytosis and hyperlymphocytosis, and deep hyponatremia with oliguria and edema. Mortality remains superior to 75% despite the various treatments and life support measures that have been attempted. Adult pertussis, which represents one third of the cases of prolonged cough in this age group, is the main source of contamination of non-immunized young infants. This mode of transmission stresses the importance of the generalization of pertussis vaccine booster in early adolescence, which is recommended in France since 1998. Its extension towards the adult age is under study. [Copyright &y& Elsevier]

Since 1995, a number of studies have established and detailed the mechanisms of electrical and structural atrial remodeling induced by atrial fibrillation. Atrial remodeling involves many cellular components, from ionic channels to connexins. The determination of these mechanisms may help to define a new therapeutic targets of atrial fibrillation, a frequent arrhythmia that remains difficult to treat. Atrial remodeling prevention may lead to limit the evolution of the arrhythmia (early recurrences after reduction, AF secondary to atrial tachycardia, permanent AF, decrease in atrial contractility, sinus dysfunction). Except amiodarone, the usual antiarrhythmic drugs have no effect on atrial remodeling. Calcium channel inhibitors prevent early remodeling but have no effect on prolonged remodeling. Digoxin increases remodeling. Angiotensin II receptor inhibitors have been shown to prevent early AF recurrence after reduction and are very promising in such a direction. Other methods such as the one of antioxidant therapy seem to be promising and could define soon a new antiarrhythmic therapeutic class, the antiremodeling drugs. [Copyright &y& Elsevier]

In children, Wolff-Parkinson-White (WPW) syndrome is often revealed by reentrant tachycardia episodes. Rarely, this syndrome can be the cause of syncope or of sudden death, resulting from rapid conduction of atrial fibrillation to the ventricles through the accessory pathway.Case report – The authors report the case of a child, who had a WPW syndrome diagnosed after birth because of a supraventricular tachycardia and who was later asymptomatic. At ten years of age, he was admitted because of palpitations due to atrial fibrillation and rapid conduction through the accessory pathway.Conclusion – In a child with WPW syndrome, tachycardia with wide and irregular QRS complexes should evoke the involvement of atrial fibrillation, with rapid conduction to the ventricle. Drugs blocking conduction through the atrio-ventricular node are contra-indicated and the condition is an indication for radiofrequency ablation. [Copyright &y& Elsevier]

Postural tachycardia syndrome (PoTS) is a frequent polymorphic clinical syndrome, poorly known and, as a result, underdiagnosed especially in adolescents. It is a form of dysautonomia, but its exact physiopathology remains elusive. It is characterized by heterogeneous symptoms that accompany a disproportionate tachycardia upon the upright position. It can significantly impact adolescents' quality of life. Only a Schellong test is useful to make the diagnosis; however additional testing is frequently performed in order to exclude conditions that may mimic, exacerbate or impact management. Treatment in PoTS is primarily symptomatic. The main goal is to restore the patient's condition as quickly as possible. Its management is multidisciplinary and must involve the parents. The course of the syndrome is sometimes marked by relapses, but the prognosis is mostly favorable., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Résumé: Ce cas clinique traite celui d’un patient de 52ans présentant des tachycardies incessantes persistant malgré un traitement antiarythmique. L’exploration électrophysiologique a révélé une tachycardie réentrante nodale de type Coumel (permanent junctional reciprocating tachycardia [PJRT]) traitée avec succès par ablation. Les mécanismes de cette tachycardie rare sont rappelés. [ABSTRACT FROM AUTHOR]

Abstract: The restoration of patients’ mean arterial pressure after ineffective fluid resuscitation is obtained by vasopressive treatment such as norepinephrine. However, no guidelines exist concerning a norepinephrine infusion method: whether it be the norepinephrine concentration in the syringe, single or double pump administration via a carrier such as an isotonic saline solution, or use of minimized dead-volume extension sets. We present the case of a female patient requiring norepinephrine treatment, who quickly suffers a major haemodynamic incident (a sudden rise in systolic blood pressure above 220mmHg associated with tachycardia up to 189b/min). The main causes of this incident are discussed and infusion parameters considered with a view to developing an optimal infusion method for a drug with a specific therapeutic index. [Copyright &y& Elsevier]

Summary: Accidental intoxications in children are frequent but most of them are without serious consequences. We describe herein the case of a young girl who drank 100mg of a topical hair lotion with minoxidil. On arrival, she had no symptoms except flush on the face and ears. Four and half hours after ingestion, tachycardia appeared with a pulse above 170 beats per min with hypotension at 76/24mmHg. The heart rate remained between 170 and 190 beats per min for 12h and then lowered to between 140 and 160 beats per min. Thirty-six hours after ingestion, the heart beat was at 140 beats per min. Minoxidil is a strong vasodilator used first in the 1970s for severe hypertension. It produces hypotension by direct arteriolar vasodilatation. Only a few cases of minoxidil intoxication have been described in the literature, including only one pediatric case. This young boy had only tachycardia of 160 beats per min for 40h. Most serious cases have been described in adults. They suffered long-lasting tachycardia, hypotension, and ECG changes. Most patients need a bolus of normal saline fluid and some with hemodynamic problems need vasoactive drugs such as dopamine and/or phenylephrine. All patients need to be under medical supervision for a long time because of the product''s very long action. [ABSTRACT FROM AUTHOR]

Summary: Costello syndrome is a rare association of symptoms caused by de novo germline mutations of the HRAS oncogene interfering in the RAS/mitogen-activated protein kinase (MAPK) signal transduction pathway. Mutations in this pathway are also responsible for Noonan syndrome and the related cardiofaciocutaneous syndrome (CFC) as well as LEOPARD syndrome. The 4 syndromes share phenotypic resemblances concerning patients’ morphology but also regarding associated cardiac disease, namely hypertrophic cardiomyopathy, pulmonary stenosis, and atrial septal defect. The electrocardiogram often shows an upper deviation of the QRS axis. Arrhythmias are rare but, if present, are particularly typical of CS. We describe herein two newborn infants with Costello syndrome revealed by atrial tachycardia associated with characteristic morphological and cardiac features of syndromes related to mutations in the RAS/MAPK pathway. [ABSTRACT FROM AUTHOR]

Abstract: Pregabalin is similar in structure to gamma-aminobutyric acid. It is used for neuropathic pain, generalized anxiety disorders and as an adjunct therapy for partial seizures. Tachycardia is a rare side-effect. A 92-year-old patient with a history of paroxystic fibrillation was hospitalised for zoster. She developed a sinusal tachycardia followed by atrial fibrillation and congestive heart failure 15h after a first dose of pregabalin. The imputation was considered as plausible. Even though the mechanism remains unclear, pregabalin might induce tachycardia in predisposed old patients. [Copyright &y& Elsevier]

Abstract: When a hypersensitivity reaction to a drug is diagnosed and the drug is absolutely needed, then desensitization may be indicated. Several desensitization protocols with allopurinol have been described but the procedure is usually carried out over several days. We describe ultra-rush desensitization to allopurinol carried out with success in a 70-year-old man who had experienced urticaria, tachycardia, and syncope a few hours after ingestion of allopurinol. Our protocol allowed us to administer a cumulative dose of 193 mg of allopurinol in 2 1/2 hours on the first day. This was followed by a dose of 200 mg per day for two weeks and then 300 mg per day thereafter. The patient tolerated the desensitization without any adverse reaction. With continued treatment, the patient''s arthritis improved significantly and he had none of the previously noted cutaneous or generalized reactions. Because of its rapidity and simplicity, we suggest that this protocol could have wider use in re-introducing allopurinol after such adverse reactions. [Copyright &y& Elsevier]

In this case report, we rendered a 22-year-old woman with the diagnosis of neurogenic thoracic outlet syndrome. We have evaluated her symptoms of palpitation with Holter monitorization during Roos test before and after surgery where transaxillary first rib resection and scalenectomy were performed. Postoperatively she improved and the tachycardia resolved. We propose that stellate ganglion or postganglionic efferent sympathetic fibers forming the cardiac plexus are exposed to compression while Roos test is being performed. Due to this irritation, there can be an increase in the cardiac sympathetic activity. [Copyright &y& Elsevier]

Rapid atrial transesophageal stimulation is currently used to stop atrial flutter or tachycardia. We report a case complicated of ventricular fibrillation. It is possible to pace the ventricles by transesophageal stimulation in 2–10% of cases. The ventricular stimulation might be dangerous in patients with heart disease. Therefore, transesophageal stimulation must be performed in specialized environment. [Copyright &y& Elsevier]

Catecholaminergic polymorphic ventricular tachycardia is important to be diagnosed as an underlying disease in children with syncope and normal heart, because of its poor prognosis.Case report. – A 3-year-old boy was referred for stress and emotion induced syncope. Primary ventricular arrhythmia, consisting of salvos of bidirectional ventricular tachycardia, was reproducibly induced by physical exertion. The syncopal events and severe arrhythmia disappeared with beta-blocking therapy.Conclusion. – Despite its rare occurrence, catecholaminergic polymorphic ventricular tachycardia is an important cause of stress and emotion induced syncope and sudden death in children. [Copyright &y& Elsevier]

Case report. – During an hospitalization, a ten-day-old newborn infant was treated with ceftriaxone (Rocephine® IV, 390 mg/day) for an infection secondary to the presence of an umbilical catheter.A few minutes after the end of the fifth injection, the infant presented with cyanosis, initially localized at the perfusion site, then generalized, a tachycardia followed by acute circulatory failure with arterial hypotension and finally a multiple organe failure with coagulation, kidney and liver dysfunction. The infant received classical resuscitation treatment and recovered without short term sequelae.The time of onset was in favour of drug-induced accident. A postnatal sensitization during previous injections might have occurred, although the latency of immediate hypersensitivity reactions after a first sensitizing contact is usually longer. A sensitization in utero or via breast feeding was ruled out due to the absence of maternal exposure to ceftriaxone.The absence of urticaria and bronchospasm, and the initial localization of cyanosis were not in favour of a classic allergic disease. An other cause, toxic or infectious cannot be ruled out. [Copyright &y& Elsevier]

The refeeding syndrome (RS) is a consequence of passing from a catabolic state to an anabolic state triggered by renutrition that is followed by a prolonged period of fasting. Often under-diagnosed in the context of malnutrition or multimorbid patients, RS presents itself through nonspecific symptoms (oedema and tachycardia) that can rapidly progress in the first 72 hours into life threatening states. The internationally recognized NICE guidelines estimate the risk of RS and are based on BMI, weight loss and electrolyte levels. Several recent studies have addressed hypophosphatemia as a predominant marker allowing to better estimate refeeding syndrome gravity and risk. Patients who present a risk should have a progressive renutrition with an electrolyte substitution if required., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.