[Catecholergic ventricular tachycardia. Apropos of a case with associated anomalies of the QTu interval]

The case of a patient presenting syncopal catecholergic ventricular tachycardias associated with abnormalities of the interval QTu is reported. EKG at rest shows a normal or sometimes lengthened repolarization. The least effort or emotion produces a His rhythm accompanied with lengthening of QTu. Three stress tests disclose the caricatural picture of a catecholergic ventricular tachycardia. Treatment with quinidin derivatives causes a constant lengthening of QTu without modifying the profile of the stress test. The patient died suddenly. This case seems to represent an intermediate form between catecholergic ventricular tachycardia and the syndrome of long congenital QT.

[Therapeutic value of a combination of trimetazidine with a calcium inhibitor in the treatment of chronic coronary insufficiency]

This double-blind, placebo-controlled study sought to examine the short-term benefit of adding 60 mg of trimetazidine to the daily therapeutic regimen of 29 male patients with coronary insufficiency who had persistent ST depression on exercise tolerance test (greater than or equal to 1 mm), despite treatment with nifedipine 40 mg per day. As compared with the placebo group, after only 14 days, the patients treated with trimetazidine showed statistically significant increases in the maximum workload level attained before ST depression occurred (31% versus - 6%; P = 0.009), the total work performed (31% versus 2%; P = 0.024) and a significant decrease in the systolic tension time (double product)/workload ratio (-5% versus +11%; P = 0.005). Throughout the study the clinical acceptability was excellent, with no side effects attributable to trimetazidine being recorded. This study shows that the addition of trimetazidine to a calcium antagonist brings a valuable improvement in therapeutic results.

[Catheter ablation after the direct electrical recording of the bundle of Kent. Apropos of 3 cases]

The success rate of catheter ablation, the latest therapeutic method in the treatment of cardiac arrhythmias, varies according to the precise indication. The best and most logical guarantee of its efficacy is the application of the electrical energy at an anatomical site essential to the arrhythmia. In preexcitation syndromes this site is without doubt the accessory pathway itself rather than its insertions, but this implies the recording of its activation. We recorded the electrical activation of a right sided Kent bundle in three consecutive cases to guide the therapeutic procedure (comparable to the recording of the H potential for his bundle ablation). All patients had paroxysmal atrial fibrillation (minimal RR interval: 175, 150 and 200 ms) and orthodromic reciprocating tachycardia. Two patients had had attacks of ventricular fibrillation. The sites of the Kent bundles were posteroseptal in 2 cases and anterolateral in 1 case. The recording of the electrical activation of the Kent bundle was validated by: the passage (induced or spontaneous) of a preexcited to a normal QRS coincident with the disappearance of the K potential; the exclusion of an atrial or ventricular origin of the electrical activation supposed to be the activation of the Kent bundle; electrical stimulation at the site of the recording of the K potential leading to prolongation of the stimulus-delta wave interval from 10 to 35 ms, with QRS morphology identical to the spontaneous complexes. All 3 patients were clinically cured by catheter ablation at the site of recording of the Kent bundle activation with follow-up periods ranging from 10 to 16 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Oral propafenone in refractory arrhythmia. Apropos of 68 patients]

68 patients with rhythmical disorders unresponsive to treatment with one or several antiarrhythmics (quinidine derivatives 52 patients, amiodarone 28 patients, beta-blockers 24 patients) were treated by mouth with propafenone, with a mean postponement of 5.6 +/- 8.5 months (1 day to 33 months). Auricular arrhythmia was observed in 41 patients with the following results: 16 successes among the 24 patients with paroxysmal fibrillation of flutter, 3 successes among the 8 patients with an arrhythmia reduced by cardioversion, and 3 successes among the 9 patients with auricular tachycardia, including 6 systolic tachycardias. Of 8 patients with an intranodal reciprocal rhythm, 7 were treated successfully with propafenone, which acts on the retrograde part of the cycle. Successes were also recorded in 2 out of 3 patients with Wolff-Parkinson-White syndrome. In 19 cases of ventricular tachycardia, propafenone proved to be efficacious in 3 out of 5 cases presenting rapid discharges and in 7 out of 14 patients with continuous arrhythmias, notably those with a catecholaminergic component. Side-effects were digestive (5 patients), cardiac decompensation (3 patients), asthenia and asthma (1 patient) and the transformation of a flutter from 2/1 to 1/1 (1 patient).

[Arrhythmia in relation to acute alcoholic intoxication in the absence of obvious cardiopathy]

Following acute intoxication with alcohol, 8 patients developed 16 episodes of arrhythmia, including 15 supraventricular tachycardias and one torsade de pointe. Seven of the 8 patients were chronically abusing of alcoholic drinks. None of the patients had clinically obvious cardiac pathology nor echocardiographic evidence of myocardiopathy. In 7 of them, however, baseline electrocardiograms disclosed disorders of intra-atrial conduction. The role of the different factors which might determine the occurrence of arrhythmia (notably alcohol, the autonomic nervous system, associated metabolic abnormalities and absorption of medicines) is discussed.