La mort subite cardiaque

Sudden cardiac death describes the unexpected natural death from cardiac cause within a short time period from the onset of symptoms (usually one hour) in a person without any prior condition that would appear fatal. The mechanism is generally a malignant ventricular arrhythmia (ventricular tachycardia or fibrillation). Sudden death is a major public health problem as it accounts for 3 to 400.000 deaths annually in the United States. Risk factors, physiopathological mechanisms, disease states associated with sudden death, and primary and secondary prevention treatments are reviewed.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Echocardiographic detection of left-sided atrial thrombi in pulmonary embolism

A 43-year-old man suffered a massive pulmonary embolism of the right lung 6 days after a surgical procedure. Echo-Doppler examination disclosed a left atrial thrombus and severe pulmonary hypertension. A right-to-left shunt was documented by angiography. Despite absence of a systemic lytic state after intravenous thrombolysis, the left atrial thrombus disappeared without clinical evidence of systemic embolism, while a right atrial thrombus subsequently appeared without ill effects. Echocardiography in this rare case documented a transient left auricle thrombus due to paradoxical thromboembolization.SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Les syncopes :Évaluation et prise en charge

The optimal management of patients presenting with syncope depends on the aetiology of symptoms. The first step is to differentiate patients without heart disease from others. The clinical history and the examination are the most useful, and in almost half the cases, suggest a presumptive diagnostic. In patients without heart disease, tilt test and autonomic nervous system testing are the investigations with the greatest yield. In patients with heart disease, hemodynamic and electrophysiologic studies are frequently needed. Neurologic investigations are rarely useful and only needed if syncope is associated with focal neurologic manifestations. In some cases implantable ECG loop recorder has proved to be useful. In most of the patients, correlation of symptoms and results of investigations results in appropriate therapeutic strategy.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Secondary prevention after myocardial infarction: Effects of beta blocking agents and calcium antagonists

Therapeutic interventions in patients with myocardial infarction, whether during the first hours after coronary occlusion or several days later, aim to reduce mortality and morbidity by several mechanisms: Prevention of fatal ventricular fibrillation, limitation of infarct size, and inhibition of platelet aggregation are some examples of such mechanisms. Results from early intervention trials with beta blocking agents, particularly from ISIS-I, suggest that 1-year mortality is significantly lower in selected patients randomized to active treatment. Late intervention studies also suggest a significant reduction in coronary mortality and morbidity with beta blockade, particularly when data are pooled. Studies with the calcium channel blockers nifedipine and verapamil were unable to demonstrate any beneficial effects of these drugs on mortality or reinfarction. In this review article, attention will be directed to the most recent information about the preventive value of beta adrenergic blocking drugs and slow calcium channel inhibitors. © 1988 Kluwer Academic Publishers.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Uncommon presentation of a common arrhythmia

This case report demonstrates that atrioventricular and ventricular atrial conduction at rest may be unreliable in assessing the presence of reentrant atrioventricular nodal tachycardia.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe

Robotic-enhanced biventricular resynchronization: An alternative to endovenous cardiac resynchronization therapy in chronic heart failure

Background. Cardiac resynchronization therapy (CRT) by pacing the left and right ventricles is an emerging option for treatment of severe heart failure with ventricular conduction disturbances. Stimulation through a coronary vein is currently the technique of choice to achieve left ventricular (LV) pacing. Unfortunately, this approach carries significant limitations and drawbacks. Therefore we explored robotic-enhanced thoracoscopic implantation of an epicardial lead as an alternative technique to stimulate the LV in cardiac resynchronization therapy. Methods. A total of 15 patients were included in this study. Right (atrial and ventricular) leads were implanted classically through the left subclavian vein. Robotic-enhanced thoracoscopy was then performed to implant the LV epicardial lead. Results. Of the 15 patients, 13 underwent successful endoscopic robotic cardiac resynchronization therapy. Two patients underwent conversion to a small thoracotomy. No perioperative complication occurred in the patients who did not undergo conversion. Acute and chronic LV lead thresholds were satisfactory in all patients, improving over time. All were subjectively and objectively improved at 4 months. As compared with conventional methods, the procedural cost was not significantly affected. Conclusions. Based on this feasibility study, we believe that robotic LV epicardial lead implantation is a valuable option to achieve biventricular resynchronization therapy. It allows for more reproducible acute thresholds for LV pacing and sensing than does the percutaneous approach; enables fine tuning of the LV lead position, thus potentially providing optimal hemodynamic benefit; and avoids the pitfalls and limitations of the endovenous approach. Therefore it deserves further prospective studies to assess its place in the therapeutic armamentarium against heart failure. © 2003 by The Society of Thoracic Surgeons.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Exercise-induced angina alleviated by intracoronary SIN-1

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Hemodynamic effects of SIN-1 in acute left heart failure

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pulmonary vein isolation by robotic-enhanced thoracoscopy for symptomatic paroxysmal atrial fibrillation.

Pulmonary vein isolation (PVI) has been shown to be effective treatment of patients with symptomatic paroxysmal atrial fibrillation (PAF). The percutaneous approach is currently the technique of choice. Unfortunately, this procedure has limitations and complications that lead to fluctuating success rates. We explored an alternative technique of robotic-enhanced, closed-chest PVI with an endoscopic microwave-based catheter.Clinical TrialJournal Articleinfo:eu-repo/semantics/publishe