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Purpose: The coronavirus disease 2019 (COVID-19) pandemic reshaped the usual risk: benefit equilibrium that became a trade-off between the infection exposure risk for the patient (and for staff) and the risk associated with delaying or cancelling the nuclear medicine examination. This study aimed at quantifying the impact of the first COVID-19 lockdown in France on nuclear medicine examination volume together with volume of examination cancellation and non-attendance. Methods: We retrospectively assessed the volume of planned examinations from 1 month before to 1 month after the first lockdown in French high-volume nuclear medicine departments (NMD) sharing the same information management system including both university hospitals, UH (n = 7), and cancer centres, CC (n = 2). Results: The study enrolled 31,628 consecutive patients referred for a nuclear medicine examination performed or not (NMEP or NMEnP). The total volume of NMEP significantly dropped by 43.4% between the 4 weeks before and after the starting of the lockdown. The comparison of the percentage of NMEP and NMEnP between UH and CC is significantly different (p < 0.001). The percentage of NMEP during the study was 67.9% in UH vs 84.7% in CC. Percentages of NMEnP in UH and CC were due respectively to cancellation by the patient (14.9 vs 7.4%), cancellation by the NMD (9.5 vs 3.4%), cancellation by the referring physician (5.1 vs 4.4%) and non-attender patients (2.7 vs 0.2%). Conclusion: The study underlines the public health issue caused by COVID-19 above the pandemic itself and should be useful in preparing for potential resource utilisation and staffing requirements. [ABSTRACT FROM AUTHOR]

Study Question: What are the consequences of radioactive iodine (RAI) therapy for testicular function?Summary Answer: A single activity of 3.7 GBq RAI for differentiated thyroid carcinoma (DTC) treatment in young men transiently altered Sertoli cell function and induced sperm chromosomal abnormalities.What Is Known Already: Few studies, mainly retrospective, have reported the potential impacts of RAI on endocrine and exocrine testicular function.Study Design, Size, Duration: A longitudinal prospective multi-center study on testicular function performed in DTC patients before a single 131I ablative activity of 3.7 GBq (V0) and at 3 months (V3) and 13 months (V13) after treatment.Participants/materials, Setting, Methods: Forty male patients, aged 18-55 years, with DTC participated. Hormonal analysis included FSH, LH, testosterone and inhibin B serum levels at V0, V3 and V13. Furthermore, sperm parameters, DNA fragmentation and sperm chromosomal abnormalities were evaluated at each time points. The differences in all parameters, between V0-V3, V0-V13 and V3-V13, were analyzed, using a Wilcoxon test.Main Results and the Role Of Chance: Prior to RAI administration, all patients had normal gonadal function. At V3, a statistically significant increase in FSH levels and a decrease in inhibin B levels were observed and sperm concentration, as well as the percentage of morphologically normal spermatozoa, were significantly decreased (P < 0.0001). These modifications were transient as both sperm concentration and normal morphology rate returned to baseline values at V13. However, at this later time point, FSH and inhibin B levels were still impacted by RAI administration but remained in the normal range. Although no DNA fragmentation was observed at V3 nor V13, our study revealed a statistically significant increase in the number of sperm chromosomal abnormalities both at V3 (P < 0.001) and V13 (P = 0.01).Limitations, Reasons For Caution: Among the 40 patients included in the study, only 24 had all the parameters available at all visits.Wider Implications Of the Findings: Prospective studies with longer term follow up would be helpful to determine whether the chromosome abnormalities persist. These studies would be required before sperm banking should be suggested for all patients. However, sperm preservation for DTC patients who require cumulative radioiodine activities higher than 3.7 GBq should be proposed.Study Funding/competing Interest(s): This study was supported by the Programme Hospitalier de Recherche Clinique, AP-HP (No. P040419). The authors report no conflict of interest in this work.Trial Registration Number: NCT01150318. [ABSTRACT FROM AUTHOR]

Background. Outcomes vary among patients with radioiodine refractory (RR) differentiated thyroid cancer (DTC).The prognostic factors for survival are not well-known, resulting in difficulty in selecting patients for new targeted therapies. We assessed overall survival (OS) and cancer-specific survival (CSS) from RR-DTC to identify prognostic factors associated with survival. Patients and Methods. The data on all cases of metastatic RR-DTC treated in our center from 1990 to 2011 were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method; associated prognostic factors were assessed using Cox's model. Results. Of 153 cases of metastatic DTC, 59% (n =91) met a criterion for RR: that is, 60% (n= 55) had at least 1 metastasis without 131I uptake; 21% (n = 19) had progressive disease (PD) despite 131I; 19% (n= 17) had persistent disease despite a cumulative activity of 131I of ≥600 mCi. After the diagnosis of RR, median OS was 8.9 years (95% confidence interval [CI]: 5.4-NR); median CSS was 9.6 years (95% CI:6.01-NR). In multivariate analyses, PD despite 131I as a criterion for RR disease and the time from initial diagnosis of DTC to diagnosis of RR <3 years were the only independent prognostic factors for poor OS and CSS. Thyroglobulin doubling time (Tg-DT) was assessed in 31 of 91 cases. Among the 11 patients with Tg-DT for <1 year or undetectable Tg, 6 deaths occurred, whereas only 3 died of 20 patients with Tg-DT >1 year or negative Tg-DT. Conclusion. The identification of prognostic factors for decreased survival in RR-DTC may improve the selection of patients for targeted agents. [ABSTRACT FROM AUTHOR]

One of the great challenges of developing sustainable water management is to integrate water and land use issues, and to favor stakeholders’ involvement in the process of designing a solution to the specific issues of water basins. This study aims to help reach these objectives: we present the outcomes of a methodology that aims to design, with stakeholders of a watershed facing quantitative water management issues, alternative agricultural landscapes that they each consider as potential solutions. Our design approach combines (1) facilitation of participatory workshops for designing changes in cropping systems and their spatial distributions at the landscape level with (2) formalization of these alternatives in a GIS. The formalized alternatives provide precise information about fields, farms and areas concerned by the designed changes. We present two sample results of this methodology implemented in a 840 km 2 irrigated landscape located in a water-deficient watershed in southwestern France. We discuss how our design approach may be useful for a wider design-and-assessment methodology involving researchers and stakeholders with conflicting interests. We show that our co-design approach provides fertile ground for the emergence of salient, credible and legitimate change options. [ABSTRACT FROM AUTHOR]

Background: T-wave alternans (TWA) is an accepted marker of risk for malignant ventricular arrhythmias, for which prognosis value has been established in different populations. Short QT syndrome (SQTS) is a very rare primary electrical disease carrying the risk of ventricular fibrillation. TWA in SQTS has not been evaluated yet. Methods: Thirteen patients with SQTS (QT = 308 ± 16 ms, QTc = 329 ± 10 ms, heart rate = 69 ± 8 beats/min) underwent microvolt TWA measurement using spectral analysis. TWA testing was performed using Heartwave II (Cambridge Heart™, Inc., Bedford, MA, USA) during bicycle exercice and classified as negative, positive, or indeterminate according to the published standards for clinical interpretation. Results: Twelve patients were male (mean age 23 ± 5 years). Five were asymptomatic, three presented with aborted sudden cardiac death, and five with unexplained syncope. Six patients belonged to two unrelated families, while familial cases of SQTS were present for two other patients. A familial history of sudden death (SD) was present for seven patients. Ventricular fibrillation was inducible in three patients. Four patients were implanted with an implantable cardioverter-defibrillator and one presented with polymorphic ventricular tachycardia during follow-up. TWA was negative in each but one patient (indeterminate). Maximal negative heart rate was 118 ± 12 beats/min. Patients with previous SD displayed significant shorter QT and higher resting heart rate compared to the remaining cases. Conclusions: TWA testing is negative in 12 of 13 SQTS patients, even in the symptomatic or inducible ones. Measurement of TWA using conventional protocol and criteria for risk stratification in SQTS seems therefore useless. (PACE 2012;35:1413-1419) [ABSTRACT FROM AUTHOR]

To meet sustainability challenges, regional water management and planning require approaches that assess the land-use visions of various stakeholders using their own evaluation criteria. Models and information systems are keystones in such integrated assessment activities. SPACSS (the SPAtial Cropping System Scenarios builder and evaluator) is a modelling solution that aims to help decision-makers evaluate normative land-use scenarios. A prototype of SPACSS was developed to explore concerns raised by a dam-building project in south-western France, specifically the relation between cropping system distribution and water uptake. This paper presents the initial steps of SPACSS development by scientists and agricultural experts and its evaluation by users through alternative scenarios of maize cropping (altering either its precocity or management to reduce irrigation). SPACSS can represent a wide range of land-use scenarios and aggregate impact indicators at several spatial and temporal scales. Although SPACSS served as a solid support for discussions with stakeholders and decision-makers, it needs modifications to represent more realistic, and thus more complex, land-use scenarios. These modifications will make SPACSS potentially valuable for dealing with a variety of issues concerning agricultural landscapes, far beyond the single question of quantitative water management. [ABSTRACT FROM AUTHOR]

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Background: The goal of this study was to provide reference ranges for thyrotropin (TSH) and free thyroxine (fT4) based on data collected from a disease-free sample of French middle-aged adults. Methods: A total of 3218 subjects participating in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) study had measurements for TSH, fT4 and urinary iodine concentrations. Thyroid volume and structure were evaluated using standardized ultrasonography. We selected a disease-free sample which included 2338 subjects (1313 females aged 35–60 years and 1025 males aged 45–60 years) with normal thyroid imaging, no previously reported thyroid disease or use of thyroid medication, and no risk factors for thyroid dysfunction. Distribution of TSH and fT4 was estimated in males and females. Results: The median (central 95% range) TSH serum concentrations for females were 1.79 mU/L (0.29–5.21 mU/L) for ages 35–44 years and 1.98 mU/L (0.27–6.94 mU/L) for ages 45–60 years (p<0.0001, for age). The median (central 95% range) for males 45–60-year-old was 1.63 mU/L (0.28–4.54 mU/L) (p<0.0001, for sex). Sex- and age-specific mean fT4 concentrations did not differ significantly (p=0.06) between males and females and (p=0.08) between female age groups. However, median fT4 concentrations between 45–60-year-old males and females differed (p<0.001). Conclusions: In middle-aged adults, the TSH distribution was associated with gender and, among females, with age. Stratification according to gender and age should be considered when TSH ranges are used in the diagnosis, treatment and monitoring of thyroid disease. Clin Chem Lab Med 2009;47:1497–505. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the management of patients with atrial fibrillation (AF) and to study consistency with guidelines on management of AF. Patients and methods: Observational study on a random sample of cardiologists from a French national database. Each cardiologist had to recruit the first five patients meeting inclusion criteria (patients diagnosed with AF between January 2004 and one month before inclusion and accepting the collection of their medical data). Results: Between December 2006 and January 2207, 1789 patients aged 71 on average have been recruited by 481 cardiologists. Fifty-one percent were diagnosed with paroxysmal, 15% with persistent and 33% with permanent AF. Restoration of sinus rhythm was preferred in forms considered as paroxysmal or persistent forms whereas control of the ventricular rate was more frequent in AF considered as permanent. Overall, therapeutic guidelines are applied in practice, despite a frequent use of amiodarone in patients with no associated heart disease. Prevention of thromboembolism was observed in 88% of the patients. Conclusions: FACTUEL is the biggest observational study on AF ever conducted in France. The therapeutic strategies used by the cardiologists are consistent with the objectives of preventing thromboembolism and controlling heart rhythm and/or rate. In most cases, the treatment used is consistent with the therapeutic guidelines. [Copyright &y& Elsevier]

Bread is one of the most widely consumed staple foods worldwide. White-wheat bread, largely consumed in France, is made from highly refined flour, which leads to a low nutrient density. Due to a highly porous structure and gelatinised starch, it is easily broken down during digestion, leading to a rapid increase of glucose released into the bloodstream. Low glycaemic responses are considered favourable to health, especially against a background of diabetes. Literature reports show that selection of raw material is an essential factor in decreasing the glycaemic index (GI) of white bread. There are two means of decreasing the rate of starch degradation: either (i) slowing gastric emptying rate and/or glucose diffusion–absorption through the intestinal mucosa, which can be achieved by incorporating soluble fibre or organic acid in bread, or (ii) limiting starch accessibility to α-amylase by using high-amylose cereal varieties and/or incorporating intact cereal grains. Studies on cereal products show that preservation of the food structure during digestion seems to be a more important GI-reducing factor than the degree of starch crystallinity or the presence of soluble fibre. Thus, we should look to produce bread with a more compact food structure or higher density, which is the case in leavened wholewheat bread or bread with intact cereal grains. The baking process should also be improved to achieve this goal, by using, for example, a reduced kneading time or less yeast than usual. [ABSTRACT FROM AUTHOR]

Sociology of literature covers two very different types of research, bearing respectively on literature as a consumer product and as an integral part of social reality. With the help of the sociological concepts of her own time and of Montesquieus time, author Madame de Staël undertook to show the original characteristics of the ancient and modern literatures of the north and the south. This article deals with the situation in the U.S., the Federal Republic of Germany and France. The American production of sociological works comprises of numerous notes on literature. Germany has a philosophical and sociological tradition which is directed to a much greater extent towards the sociology of literature. In the "Theory of the Novel," author G. Lukács abandons his Kantian attitude and adopts a Hegelian approach. He regards the novel as the characteristic literary form of a world in which man never feels entirely a part. The part of author Th. W. Adornos's work deals with the sociology of literature which comprises of numerous short essays.

Land managers need spatially explicit information about agricultural practices to address issues that arise from the use of natural resources in agriculture. One main characteristic of agriculture is its great variability in space and time. However, describing the spatial distribution of "cropping systems", i.e. crop sequences and crop management systems at the regional scale, remains a major scientific challenge. This study presents a new, simple and rapid approach to model the spatial distribution of irrigation management practices. It was developed in two large watersheds in southwestern France (about 1500 and 3000 km2). Based on a previous study consisting of 27 farmer interviews in a study area about one-sixth the size of these watersheds, we interviewed 12 key informants who had an integrative vision of the study area and spent only one-fourth as much time collecting and processing the relevant data. One major innovation was to combine knowledge from generic databases and ad-hoc intermediate objects, such as diagrams, tables and maps, to interact with the key informants. These objects helped them focus on specific local information that we had missed and facilitated data processing. Interview results were used to spatially allocate cropping systems formalized as dynamic IF-THEN decision rules. We evaluated our approach by using a cropping system model to simulate irrigation withdrawals over a ten-year period. Its predictions reproduced well annual amounts and inter-annual dynamics of irrigation water withdrawals recorded by the regional Water Agency. This approach, combining diagrams with IF-THEN rules, appears easy to adapt to study other areas and agricultural practices besides irrigation, as well as to manage annual and perennial crops. • Farm surveys to describe cropping systems and their spatial distribution are time consuming. • We developed a faster approach based on key informant interviews. • Key informants provided field-scale indicators driving irrigation and location factors. • Generic databases and existing knowledge were used as intermediate objects. • We evaluated the approach by comparing observed and simulated water withdrawals. [ABSTRACT FROM AUTHOR]

Natural and anthropogenic forcing factors and their changes significantly impact water resources in many river basins around the world. Information on such changes can be derived from fine scale in situ and satellite observations, used in combination with hydrological models. The latter need to account for hydrological changes caused by human activities to correctly estimate the actual water resource. In this study, we consider the catchment area of the Garonne river (in France) to investigate the capabilities of space-based observations and up-to-date hydrological modeling in estimating water resources of a river basin modified by human activities and a changing climate. Using the ISBA-MODCOU and SWAT hydrological models, we find that the water resources of the Garonne basin display a negative climate trend since 1960. The snow component of the two models is validated using the moderate-resolution imaging spectroradiometer snow cover extent climatology. Crop sowing dates based on remote sensing studies are also considered in the validation procedure. Use of this dataset improves the simulated evapotranspiration and river discharge amounts when compared to conventional data. Finally, we investigate the benefit of using the MAELIA multi-agent model that accounts for a realistic agricultural and management scenario. Among other results, we find that changes in crop systems have significant impacts on water uptake for agriculture. This work constitutes a basis for the construction of a future modeling framework of the sociological and hydrological system of the Garonne river region. [ABSTRACT FROM AUTHOR]

Background: Purkinje ectopics (PurkEs) are major triggers of idiopathic ventricular fibrillation (VF). Identifying clinical factors associated with specific PurkE characteristics could yield insights into the mechanisms of Purkinje-mediated arrhythmogenicity., Objective: The purpose of this study was to examine the associations of clinical, environmental, and genetic factors with PurkE origin in patients with PurkE-initiated idiopathic VF., Methods: Consecutive patients with PurkE-initiated idiopathic VF from 4 arrhythmia referral centers were included. We evaluated demographic characteristics, medical history, clinical circumstances associated with index VF events, and electrophysiological characteristics of PurkEs. An electrophysiology study was performed in most patients to confirm the Purkinje origin., Results: Eighty-three patients were included (mean age 38 ± 14 years; 44 [53%] women), of whom 32 had a history of syncope. Forty-four patients had VF at rest. PurkEs originated from the right ventricle (RV) in 41 patients (49%), from the left ventricle (LV) in 36 (44%), and from both ventricles in 6 (7%). Seasonal and circadian distributions of VF episodes were similar according to PurkE origin. The clinical characteristics of patients with RV vs LV PurkE origins were similar, except for sex. RV PurkEs were more frequent in men than in women (76% vs 24%), whereas LV and biventricular PurkEs were more frequent in women (81% vs 19% and 83% vs 17%, respectively) (P < .0001)., Conclusion: PurkEs triggering idiopathic VF originate dominantly from the RV in men and from the LV or both ventricles in women, adding to other sex-related arrhythmias such as Brugada syndrome or long QT syndrome. Sex-based factors influencing Purkinje arrhythmogenicity warrant investigation., (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

The authors explore two heart rhythm troubles described on the occasion of the medical exami- nation of the Italian astronomer Galileo Galilei and the French politician Talleyrand. According to modern scientific knowledge, the pathological context of respectively the 17th and 19th c., and the personal medical history of the patients, some retrospective original and objective diagnoses are proposed.

Aims: This French study was set up to collect perceptions of general practitioners (GPs), cardiologists and patients on anticoagulation therapy with vitamin K antagonists (VKA) in the management of thromboembolic risk in atrial fibrillation (AF)., Method: This is a prospective survey conducted in France, between July 1 and August 7 2011, on a sample defined to obtain a sufficient number of patient files of 133 physicians, divided into 65 cardiologists and 68 GPs., Results: Three hundred and ninety-four patients on VKA and 130 patients not receiving VKA were included in this study. For more than one in three patients, AF was diagnosed incidentally in a medical consultation for another reason. In addition, 15% and 23% of diagnoses of FA were performed after hospitalization for stroke or TIA by cardiologists and GPs, respectively. According to the patient, the doctor contacted first is a GP (52% for the GP vs. 35.5% for the cardiologist), but they state that the diagnosis was made mainly by a cardiologist (63% for the cardiologist vs. 27% for the GP). In 78% of cases, cardiologists are initial prescribers. A CHADS2 score of 0 was found in 23% of patients not receiving VKA and in 11% of patients on VKA. A CHADS2 score superior or equal to 2 is significantly more frequently found in patients with paroxysmal AF. Concerning the monitoring of the patient, GPs ensure mainly monitoring of INR. In terms of compliance, according to doctors, their patients systematically take their treatment in 91% of cases. However, by interviewing patients, 60% of non-compliant patients are considered compliant by their physician., Conclusion: This study has achieved an overview of anticoagulation treatment in AF, in France. The initiation is mainly ensured by the cardiologist and the monitoring by the GP. Assessments between cardiologists and GPs are relatively similar, however, it appears that anticoagulation treatment is under-prescribed for the patients at risk., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Aims: Inappropriate therapy delivered by implantable cardioverter defibrillators (ICDs) remains a challenge. The OPERA registry measured the times to, and studied the determinants of, first appropriate (FAT) and inappropriate (FIT) therapies delivered by single-, dual- and triple-chamber [cardiac resynchronization therapy defibrillator (CRT-D)] ICD., Methods and Results: We entered 636 patients (mean age = 62.0 ± 13.5 years; 88% men) in the registry, of whom 251 received single-, 238 dual-, and 147 triple-chamber ICD, for primary (30.5%) or secondary (69.5%) indications. We measured times to FAT and FIT as a function of multiple clinical characteristics, examined the effects of various algorithm components on the likelihood of FAT and FIT delivery, and searched for predictors of FAT and FIT. Over 22.8 ± 8.8 months of observation, 184 patients (28.9%) received FAT and 70 (11.0%) received FIT. Ventricular tachycardia (VT) was the trigger of 88% of FAT, and supraventricular tachycardia was the trigger of 91% of FIT. The median times to FIT (90 days; range 49-258) and FAT (171 days; 50-363) were similar. The rate of FAT was higher (P <0.001) in patients treated for secondary than primary indications, while that of FIT were similar in both groups. Out of 57 analysable FIT, 27 (47.4%) could have been prevented by fine tuning the device programming like the sustained rate duration or the VT discrimination algorithm., Conclusions: First inappropriate therapy occurred in 11% of 636 ICD recipients followed for ∼2 years. Nearly 50% of FIT could have been prevented by improving device programming.

Objectives: To describe the management of patients with atrial fibrillation (AF) and to study consistency with guidelines on management of AF., Patients and Methods: Observational study on a random sample of cardiologists from a French national database. Each cardiologist had to recruit the first five patients meeting inclusion criteria (patients diagnosed with AF between January 2004 and one month before inclusion and accepting the collection of their medical data)., Results: Between December 2006 and January 2207, 1789 patients aged 71 on average have been recruited by 481 cardiologists. Fifty-one percent were diagnosed with paroxysmal, 15% with persistent and 33% with permanent AF. Restoration of sinus rhythm was preferred in forms considered as paroxysmal or persistent forms whereas control of the ventricular rate was more frequent in AF considered as permanent. Overall, therapeutic guidelines are applied in practice, despite a frequent use of amiodarone in patients with no associated heart disease. Prevention of thromboembolism was observed in 88% of the patients., Conclusions: FACTUEL is the biggest observational study on AF ever conducted in France. The therapeutic strategies used by the cardiologists are consistent with the objectives of preventing thromboembolism and controlling heart rhythm and/or rate. In most cases, the treatment used is consistent with the therapeutic guidelines.

Context: Work-hour restrictions (WHR) were implemented in France in September 2002, forbidding residents to work for 11 hours following a night call. The purpose of this study was to determine residents' perception of the consequences of WHR on their training, well-being and patient care., Design: A self-administered survey was e-mailed to all French cardiology residents (n=413)in June 2007.186 (45%) returned the questionnaire., Results: Most residents reported spending less time in the hospital but did not believe they missed educational experiences. On the contrary they feel more receptive to learning and use some of the extra time out of the hospital for reading medical literature. Overall, WHR do not influence residents' satisfaction with their training (P>0.05). Residents believe that patient care has been unaffected or maybe improved: 75% declare they are less likely to make errors due to fatigue and 58% never cut corners in patient care after their night call. However, residents' perception of their commitment to patient care may not reflect reality: indeed, 78% of residents feel that attendings believe commitment was higher before the implementation of WHR. Finally, residents report that WHR had a positive effect on their well-being, feeling less exhausted and less under pressure. Overall, 83% of residents consider that consequences of WHR are beneficial for the patient., Conclusion: Cardiology residents report that implementation of WHR lead to benefits to their well-being and probably patient care, without negative effects on their education.

Even though the year 2006 did not bring any major publication reporting therapeutic trials in the field of arrhythmia, it has been marked by the publication of important international guidelines on atrial fibrillation (AF), the treatment of ventricular arrhythmia and the prevention of sudden death, as well as studies on AF ablation, the external automatic defibrillator, the risk factors of ventricular fibrillation in the acute phase of myocardial infarction, and genetic aspects of the arrhythmogenic right ventricular dysplasia.

The lack of specificity of VT detection is a significant shortcoming of current ICDs. In a French multicenter study, 18 patients underwent implantation of the Defender 9001 (ELA Medical), an ICD utilizing dual chamber pacing and arrhythmia detection. Over a mean follow-up period of 7.1 +/- 4.5 months, 176 tachycardia episodes recorded in the device memory were analyzed, and physician diagnosis was compared with that by the device. All 122 VT/VF episodes were correctly diagnosed, as were 51 of 53 supraventricular tachyarrhythmias. Two episodes of AF with rapid regular ventricular rates were treated as VT, and a third episode, treated as VT, could not be diagnosed with certainty. A dual chamber pacemaker defibrillator offers improved diagnostic specificity without loss of sensitivity, in addition to the hemodynamic benefit of dual chamber pacing.

Background: Primary ventricular arrhythmias are rarely seen in children. Some of them have a poor prognosis; they should be diagnosed because adequate treatment can prevent sudden death., Population and Methods: Twenty children (11 male, nine female), aged 3 to 16 years (mean: 7.7 +/- 4), with apparently normal hearts and normal QTc intervals were referred for stress or emotion-induced syncope. Primary ventricular arrhythmia, consisting of isolated polymorphic ventricular extrasystoles followed by salvos eventually degenerating into ventricular fibrillation, was reproducibly induced by physical exertion. The syncopal events and "torsades de pointe" disappeared with beta-blocking therapy. A total of four syncopal events and two sudden deaths occurred during a mean follow-up of 8 years, probably due to discontinuation of treatment., Discussion: Fifty-four-cases of stress-induced severe polymorphous ventricular arrhythmia have been reported in the literature. There were four sudden deaths in 37 patients on beta-blocking therapy, and ten sudden deaths in 21 untreated patients., Conclusion: Clinically close to the congenital long QT syndrome, this primary ventricular arrhythmia must be looked for in cases of stress or emotion-induced syncope. The diagnosis relies on Holter monitoring and a stress test. Life-long beta blocker therapy is required.

Incidence and malignant forms of imported Plasmodium falciparum malaria are increasing, and chemoprevention is more and more replaced by stand-by treatment and radical cure in preventing access on return from malaria areas. Halofantrine is recommended for this radical cure: it's an habitually well-tolerated amino-alcohol with very few side-effects. We report three cases of long QT-interval due to halofantine: three different young women coming back from Africa took halofantrine (500 mg (2 tablets) six hourly for three doses on the first and the seventh day) and all presented with syncopal episodes. Serum electrolyte concentrations and echocardiograms were normal. In one case only, a diagnosis of Plasmodium falciparum malaria was made, without severe manifestations, and in the two other cases, treatment was a radical cure. In two cases, several bursts of torsades de pointes ventricular tachycardia due to halofantrine were proven and electrophysiological cardiac tests concluded that they had a congenital long QT-interval/Romano-Ward syndrome). So far halofantrine cardiac toxicity was unknown with single dose of 24 mg/kg/d. This phenomenon can be very severe in case of preexisting cardiopathy. In spite of the rarity on the congenital Romano-Ward syndrome, systematic electrocardiogram is necessary before giving halofantrine.