[Evaluation of the normal bioprosthetic Intact aortic valve by Doppler echocardiography]

The Medtronic Intact is a recently commercialized porcine bioprosthesis. Its function and ultrasonic characteristics have not been widely studied. The authors performed a prospective Doppler echocardiographic study of 38 patients with Intact bioprosthesis (n. 19:1, n. 21:10, n. 23:9, n. 25:14, n. 27:3, n. 29:1) implanted in the aortic position and without clinical signs of dysfunction over a period of 8 +/- 5 months after surgery. The following parameters were measured: maximum and mean velocities, maximum and mean transprosthetic pressure gradients, permeability index (PI) or the ratio of subaortic to transprosthetic velocities, and the effective prosthetic surface area (S) calculated using the continuity equation. The PI and S were calculated by two methods, the first using the ratio of maximum velocities (PI1 and S1) and the second using the ratio of the velocity-time integrals (PI2 and S2). The global results were: Vmax 2.65 +/- 0.4 m/s range 1.9 to 3.7 m/s), maximum pressure gradient 29 +/- 9 mmHg (range 15-55 mmHg), mean pressure gradient 16.8 +/- 5.6 mmHg (range 9-32 mmHg), PI1 37.8 +/- 4.5 p. 100 (range 26-48%), PI2 39.1 +/- 5.5 p. 100, S1 1.25 +/- 0.19 cm2 (range 0.96-1.7 cm2) and S2 1.29 cm2 +/- 0.17 cm2. Minimal central prosthetic valve regurgitation was observed in 2 cases (5%). No correlations were found between the size of the prosthesis and blood flow velocities, pressure gradients or permeability indices. On the other hand, a correlation was observed between S and the size of the prosthesis (r = 0.88, p less than 1.10(-6) (S1); r = 0.80, p less than 1.10(-6) (S2)).(ABSTRACT TRUNCATED AT 250 WORDS)

[Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol]

The authors report the case of a 28 year old alcoholic who was admitted to hospital for cardiac failure in 1982 due to a dilated cardiomyopathy. The clinical and paraclinical signs disappeared after cessation of alcohol intake. Three years after abstaining from alcohol, the electrocardiogram, echocardiogram and isotopic ventriculography are normal. This case illustrates the necessity of absolute cessation of alcohol intake in patients with dilated cardiomyopathies.

[Painless myocardial ischemia. Comparison of 2 groups of patients with a positive exercise test after myocardial infarction]

Myocardial ischemia usually presents with chest pain, the characteristics of which are well known. However, anginal pain may be absent during true ischemia, an entity known as painless or silent myocardial ischemia. Does this type of ischemia have special clinical, angiographic or ergometric characteristics after posterior myocardial infarction (MI)? In order to answer this question 183 consecutive patients with recent posterior MI who had undergone coronary angiography and who had positive exercise stress tests on bicycle ergometers were separated into two groups depending on whether they had experienced at least one episode of pain after the acute phase of myocardial infarction or during the exercise stress test (Group S: 83 patients, average age 54 +/- 10 years) or not (Group A: 100 patients, average 54 +/- 8 years). The following parameters were commoner in Group A: cigarette smoking, heart rate and load developed during exercise stress testing provoking electrical signs of ischemia, single vessel disease on coronary angiography, long-term medical treatment. On the other hand, the following parameters were statistically more frequent in Group S: hypercholesterolemia, preinfarction angina, degree of ST depression during exercise testing, reperfusion of the distal vessels of the occluded artery responsible for the infarct by a collateral circulation, triple vessel disease and surgical treatment. However long-term follow-up (average 3 years) shows that mortality and recurrence of MI are similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of the head-up tilt test in the etiologic diagnosis of syncope]

The cause of brief syncopes is discovered in only two-thirds of the cases at most. The purpose of this study was to quantify the value of the head-up tilt test in patients whose syncope remained "causeless" after a "conventional" investigation. Forty-nine patients entered the study on the following criteria: at least one syncope, no conduction disturbances or normal electrophysiological study, physiological response to carotid sinus massage, absence of postural hypotension and assessable tilt test. The head-up tilt test was performed under blood pressure and electrocardiographic monitoring in three stages: dorsal decubitus during 20 min, 60 degrees tilting during 20 min and, if nothing happened, isoprenaline injection. The test was positive (i.e. produced syncope or at least lipothymia) in 12 patients (24.5 per cent). In all cases the loss of consciousness was associated with a deep fall in blood pressure, but prolonged ventricular pause never occurred (2 patients had bradycardia at about 30 beats/min). The head-up tilt test is a non-invasive examination which in one-quarter of the cases provides a diagnosis of vasovagal syncope when no other diagnosis could be made; it reproduces the syncope, which is rarely done by other investigations, and it deserves to be include in the evaluation of unexplained syncopes.

[Left auricular hypertrophy in aortic stenosis in adults]

Left atrial hypertrophy (LAH) was noted from the electrocardiograms of 72 of 98 adult patients (81%) who underwent hemodynamic evaluation of calcified aortostenosis (CAS). The relations between LAH and clinical, echographic and hemodynamic findings are specified. The frequency of LAH was not higher in cases of a history of hypertension, angina pectoris, lipothymia or exercise-induced syncope. In contrast, dyspnea was more frequently associated with LAH (84%) than not (17%). An approximately linear relation was seen between LAH and the mean pulmonary capillary pressure, the mean rate of circumferential decrease (RCF), the coefficient of muscle rigidity (ks of Mirsky), the left ventricular mass (LVM) and the left ventricle-aorta gradient. LAH is, therefore, a frequent sign in patients presenting CAS. Its origin is multifactorial, with a predominance of increased mean capillary pressure in cases of clinical signs of poor safety.

[Left auricular dilatation in calcified aortic stenosis in adults]

Two groups of patients of comparable age, one comprising 12 subjects without detectable cardiac disease and the other comprising 38 patients with calcific aortic stenosis (CAS) underwent clinical, electrocardiographic, echocardiographic and haemodynamic studies to assess the degree and significance of left atrial hypertrophies in CAS. The volume of the left atrium (LA) was globally increased in CAS (maximum volume 68 per cent: 26/38) and LA ejection fraction was decreased in 60 per cent of patients (23/38). However, the maximum volume was only moderately greater than that of normal subjects (+38 per cent). The most specific non-invasive investigation for left atrial assessment is echocardiography. There was a linear relationship between LA angiographic volume and echocardiographic antero-posterior dimension (r = 0.43; p less than 1 x 10(-2)). The duration of the P wave in S2 was a specific (75 per cent) but relatively insensitive (27 per cent) sign of LA dilatation in pure CAS. On the other hand, the Morris index based on the surface of the P terminal force in V1 was quite sensitive (77 per cent) but not very specific (25 per cent). The maximum LA volume was not related to left ventricular volume, the severity of CAS, diastolic indices of compliance or left ventricular mass. However, the minimum LA volume (after atrial systole) was related to left ventricular end diastolic (r = 0.35, p less than 0.05) and end systolic volume (r = 0.34, p less than 0.05). The LA ejection fraction was inversely related to mean pulmonary capillary pressure (r = 0.34, p less than 5 x 10(-2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Calcified aortic valve stenosis in adults. Analysis of supra- and infra-hissian conduction disorders]

The association of intraventricular or atrio-ventricular conductive disorders with a calcified aortic stenosis, is a classical notion demonstrated by the close anatomical relationships between aortic valve and conduction pathways. These conductive disorders have been, for quite some time, analyzed on standard electrocardiograms, but, since a few years, the recording of the bundle of His potential has become the technique of choice. However, studies regarding this subject are few, based on very small and sometimes heterogeneous groups of patients. Sixty six consecutive patients hospitalized for a narrow aortic stenosis have agreed to be subjected, before valve replacement, to a recording of the bundle of His potential. Thirteen of them (19.7%) show a HV interval exceeding 55 ms or a pathological H deflexion (twisted and lasting 35 ms). None of the pre-operative parameters that were analyzed (black-out, left ventricular function, ventriculo-aortic gradient, calculated valvular area, magnitude of valvular and ring calcifications), seem correlated with the increased HV interval. These results cross-check those reported in most of the literature.

Myocardial infarction with normal coronary arteries complicated by rupture of the left ventricular free wall

We report the case of a 73-year-old woman successfully treated for a subacute rupture of the ventricular free wall which occurred on the fourth day after a postero-lateral myocardial infarction. Angiography performed prior to surgical repair revealed the presence of normal coronary arteries. The pathogenetic mechanism of such a happening remains uncertain, but the role of abrupt recanalization must be considered.

[Short loss of consciousness: etiology and diagnostic approach. Results of a prospective study]

Transient loss of consciousness is a frequent reason for hospitalization, but very few prospective studies have been devoted to this topic. Our study involved 150 patients who were admitted for sudden and total loss of consciousness (syncope) with spontaneous return to normality. All patients underwent thorough physical examination, standard laboratory tests, electrocardiography (ECG) and radiography of the chest. Depending on the results of this first evaluation, the patients were investigated for postural hypotension and had carotid sinus massage, electroencephalography (EEG), computerized tomography of the brain, cardiac Holter recording, electrophysiological exploration and, if necessary, other special examinations. The cause of the syncope was found in 93 cases (62 per cent); it was cardiac in 39 cases (bradycardia 25, tachycardia 14), vascular in 20 cases (vagal 14, postural hypotension 6), epileptic "grand mal" type in 32 cases and "miscellaneous" in 2 cases. The syncope occurred in a state of acute drunkenness in 14 cases and was unquestionably due to the absorption of medicines in 6 cases. Clinical findings and ECG or EEG provided the aetiological diagnosis in 82.7 per cent of the patients and the other, sophisticated examinations in 17.3 per cent. These results are similar to those of other prospective studies found in the literature. It may be concluded that the causes of the syncope are only found in about 2 out of 3 cases, that clinical data are all-important in the diagnostic approach and that complementary examinations are either unnecessary or yield little that is not already suggested by clinical examination.

[Congenital atrioventricular block and maternal lupus erythematosus. Histologic discovery of tumor of the atrioventricular node]

A case of congenital atrioventricular block in a newborn whose mother presented with systemic lupus erythematosus (SLE) is reported. Despite intensive care the child died a few hours after birth. Serial sections of the heart could be examined. Histology provided information on the appearance and distribution of the lesions. In particular, the sinus node was small for the child's age, and its supplying artery was found to have a hyperplastic media with adventitial sclerosis; the interatrial and interventricular septa showed subendocardial fibrosis invading the adjacent myocardium. Owing to the scarcity of systematic histopathological examinations, such lesions have seldom been described. In addition, a tumour of the atrioventricular node, known as mesothelioma or hemolymphangioma, was discovered. This case is exceptional in that histopathological findings similar to those described in SLE, though rarely as numerous, were associated with a very rare tumour never hitherto described in such a young patient. The relationship between the two categories of lesions is discussed.

[Hemodynamic effects of intravenous magnesium sulfate in man]

The haemodynamic effects of a single 3 g dose of magnesium sulfate administered by slow (1 min) intravenous injection were evaluated in 16 patients with coronary disease about to be explored by coronary arteriography. The haemodynamic effects were transient, with maximal values at the end of the injection and return to baseline values within less than 3 min. They consisted of peripheral vasodilatation with a decrease in systolic aortic pressure (128 +/- 18 mmHg versus 113 +/- 17 mmHg, p less than 0.05), an increase of cardiac index (3.0 +/- 0.4 versus 3.8 +/- 0.06 1/min/m2, p less than 0.001) and a fall in peripheral arterial resistance (1168 +/- 203 versus 919 +/- 29 dyn/s/cm-5, p less than 0.01). This action was accompanied by a moderate increase in contractility (Vmax) (1.63 +/- 0.34 versus 1.87 +/- 0.47 CIR/s, p less than 0.01) without changes in the relaxation index T (37 +/- 8 versus 67 +/- 9 s-1, NS), but with concomitant increase in heart rate (80 +/- 12 versus 67 +/- 10 beats/min, p less than 1.10(-4]. It is concluded that the haemodynamic effects of magnesium sulfate are moderate and transient and that this substance can be used safely as antiarrhythmic agent, even in case of marked deterioration of the left ventricular function.

[Anti-arrhythmic effects of intravenous magnesium sulfate in paroxysmal supraventricular tachycardia]

The anti-arrhythmic effects of intravenous magnesium sulfate, on bouts of supraventricular tachycardia (SVT) secondary to reentry phenomenon, are evaluated in twelve patients undergoing an electrophysiological testing, because of paroxysmal SVT, the pathway of which is an intranodal reentry (eight patients) or includes an atrio-ventricular accessory route (orthodromic SVT: four patients). At the completion of the basic testing, a stable SVT is induced and an intravenous bolus of 3 grams of magnesium sulfate is administered in three minutes. The length of the SVT cycle is significantly increased from 349 +/- 71 ms to 394 +/- 70 ms (p 0.001). The injection of magnesium relieves the SVT in less than five minutes in three patients (intranodal reentry: two cases; accessory pathway: one case), or an efficacy of 25 p. cent. No incident is reported following administration of the product; but the functional tolerance may be considered as poor, mainly consisting of flushing sensations of brief duration. This study demonstrates the antiarrhythmic properties of intravenous magnesium sulfate during bouts of SVT; however, its efficacy appears moderate at the dose mentioned.

[Radioisotope and ultrasonic diagnosis of a localized form of infarction of the right ventricle]

We are reporting the case of a localized form of right ventricle infarction. The right catheterization, on which the diagnosis usually rests, is completely normal. Cardiac gamma-angiography and bi-dimensional sonography demonstrate, on the contrary, a localized dyskinesis of the inferior wall of the right ventricle which is not dilated and retains its ejection fraction. The failure of right catheterization in the diagnosis of infarction of the right ventricle is usually attributed to hypovolemia or a delay in the performance of the catheterization, which is not the case here. Therefore, this case demonstrates the existence of infarction of the right ventricle without total diastolic or systolic dysfunction, the diagnosis of which may be made with isotopic and sonographic methods.

Constrictive perivenous mesh prosthesis for preservation of vein integrity. Experimental results and application for coronary bypass grafting

Saphenous veins undergo dramatic morphologic changes when used as coronary bypass grafts, and careful preparation of the graft alone is inadequate in preventing these changes. In this study, the use of a constrictive mesh for vein graft was evaluated. Fourteen sheep were subjected to a 5 cm resection of the carotid artery. Six sheep (Group A) received a jugular vein interposition graft, and the other eight sheep (Group B) received a jugular vein graft on which the constrictive mesh had been applied. The diameter of grafts in Group A was 14 +/- 1 mm compared with 7 +/- 0.5 mm for Group B (p = 0.05). The animals were put to death 4 months later. Scanning electron microscopy showed a disruption of the endothelial lining in Group A and a normal endothelium in Group B. Microscopy showed a statistical difference between Groups A and B regarding regularity and thickness of the intimal hyperplasia. Group B showed a moderate and regular intimal thickening and increased vasa vasorum. This indicates that distention and subsequent damage of the vein graft may be minimized by use of a constrictive mesh. Saphenous grafts surrounded by this constrictive mesh were inserted in four patients. Vein diameters were, respectively, 5, 4.3, 3.5, and 3.5 mm before meshing. After insertion in the mesh, vein diameters were 4.3, 3.5, 2.8, and 2.5 mm, respectively. Angiography performed 2 months later showed patent grafts of regular caliber.

[Antiarrhythmic effects of intravenous magnesium sulfate in torsade de pointes. Apropos of 6 cases]

The antiarrhythmic properties of magnesium salts, known for many years, are periodically recalled but rarely used in daily clinical practice. They are usually used in digitalis-induced arrhythmias and are rarely indicated in other conditions; they are often reserved for cases in which a magnesium deficiency is suspected. In 6 cases of torsades de pointes, magnesium sulphate was administered at a dose 1 to 3 g by direct intravenous injection. Although hypokalaemia was a common finding, a low magnesium concentration was only found in one case. The ventricular arrhythmia regressed completely at the end of the injection in 4 cases (one after two injections). One positive but incomplete response was observed in the only case of magnesium deficiency, probably due in retrospect to inadequate dosage. Finally, one patient with very poor ventricular function had recurrence after a good initial response. The diversity of the clinical and biological findings in this series suggests a specific antiarrhythmic action of the magnesium ion, apparently independant of the correction of magnesium deficiency; experimental studies suggest that the mode of action is a direct antagonism of Mg++-K+ and/or Mg++-Ca++. Compared to usual means of treatment of torsades de pointes (isoprenaline infusion or pacing) the advantages of intravenous magnesium sulphate are clear-cut: innocuity, simplicity and rapidity of administration, and almost immediate efficacy.

[Comparison of 2 groups of patients hospitalized at 10 years' interval for recent myocardial infarction]

The aim of this study was to compare two groups of patients admitted consecutively to the Coronary Care Unit in 1972-73 (223 cases) and in 1982-83 (243 cases) for recent myocardial infarction, and followed up for at least 15 days, to try and appreciate the influence of changes in treatment which had taken place during this interval on outcome and mortality. The two groups were comparable with regards to age, sex, time of admission with respect to onset of symptoms, previous vascular disease, and principal coronary risk factors. The clinical presentation of myocardial infarction and its common complications (cardiac failure, arrhythmias) were unchanged at 10 years' interval. The only statistically significant but unexplained difference was the lower proportion of posterior infarctions in 1982-1983 compared to 1972-1973. This decrease was partly due to the increased detection of rudimentary infarcts by more specific enzyme methods. The decrease in the proportion of posterior infarcts probably also explained the lower numbers of atrioventricular blocks. Other differences between the two groups were not statistically significant (slight increase in age, fewer women, lower incidence of cardiac failure). The mortality rate was exactly the same at 20.6%, and the causes of death were identical. The results support those of other rare studies of the same subject showing the lack of effect of recent therapeutic innovations on the majority of patients with myocardial infarction.

[Mitral insufficiency, excluding ruptured papillary muscles, in the acute phase of posterior primary infarction. Anatomical study]

Mitral regurgitation (MR) was demonstrated by water testing valve closure in 23 out 46 cases of patients dying in the 8 days following primary posterior wall infarction due to occlusion of the right coronary or left circumflex arteries (normal valves and chordae; no chronic fibrosis of the papillary muscle). MR was less common with right coronary artery occlusion (14 out of 32; 44%) than with left circumflex occlusion (9 out of 14; 64%). Two anatomical conditions seem to be necessary (all cases but one) for MR to occur: ischaemic necrosis of all or nearly all of the posterior papillary muscle and its base of implantation on the posterior wall. These valvular leaks are usually mild (papillary muscle rupture was excluded) and do not seem to play a major role in the haemodynamic deterioration of these patients, the majority of whom die of irreducible cardiac failure caused by extensive myocardial destruction. The mechanism of the majority of these MR was systolic eversion of the posterior part of the posterior leaflet in the left atrium (6 cases) of the posterior juxtacommissural part of both leaflets (13 cases), of the posterior part of the anterior leaflet (3 cases). Ischaemic destruction of the posterior papillary muscular system and its base of mural implantation (anatomical criteria that we retained) correlated with the occluded artery.

[Median-term clinical development of patients with nonsurgical triple coronary vessel disease]

Patients with angiographic non-surgical triple vessel coronary artery disease are usually considered to have a poor prognosis. We studied the evolution of 110 consecutive patients (mean age of 54.8 years) who underwent coronary angiography between April 1979 and March 1983 and followed up for an average of 24 months after the investigation. There were 10 deaths during the study period, all of "cardiac" causes (5 sudden deaths, 1 cardiac failure and 4 myocardial infarctions). Ninety nine of the 100 survivors at the time the study was closed had a medical treatment (nitrate derivatives, beta-blockers, calcium antagonists, usually associated). The actuarial survival was 94 +/- 2.2% at one year, 87.3 +/- 3.5% at 4 years. The quality of life expressed in terms of angina and breathlessness was good on the whole, as only 16 and 10 patients respectively had Grade III angina and dyspnea at the end of the study. Lack of resources and a follow-up period which was too short to assess the mortality rate meant that we were unable to analyse the factors which influenced the prognosis in this group of patients. These results support those of recent studies showing a mortality rate of patients with angiographic non-surgical triple vessel coronary artery disease that does not exceed 3 to 4% per year; these results seem to have improved over the last twenty years.

[Total obstruction of the anterior interventricular artery without myocardial infarction]

Complete proximal occlusion of the the anterior interventricular artery was associated with the presence (group A: 31 cases) or the absence (group B: 31 cases) of transmural myocardial necrosis in the corresponding territory. The aim of this study was to define the factors which determine the development of permanent myocardial necrosis, on the basis of clinical, electrocardiographic, haemodynamic and angiographic criteria. Group B was characterised by the following features: almost all of the patients (30 out of 31) had unstable angina, for less than 2 months in half of the cases; 67% of cases presented an abnormality of ventricular repolarisation on the resting ECG, usually (54 per cent of cases) in leads V3 to V5, suggestive of isolated sub-pericardial ischaemia in half of these cases; 24 cases presented moderate regional hypokinesia in the anteroapical territory of the LV; the distal AIV artery was more clearly visualised (17 cases had a well perfused AIV artery compared with 6 in group A) and a greater number of patients obtained homocoronary interseptal re-perfusion (8 versus 2) and heterocoronary re-perfusion by distal anastomosis of the AIV artery and the PIV artery by the apex (13 versus 3) (p less than 0.05) than in group A. However, the possibility of surgery was considered to be limited (39%) on the basis of the angiographic criteria. Thus, in group B, a "phantom AIV artery syndrome" can not be distinguished from unstable angina on the basis of the clinical and electrocardiographic profile.(ABSTRACT TRUNCATED AT 250 WORDS)

[Right ventricular function during the convalescence phase of posterior primary infarction]

Right ventricular extension is very common in inferior myocardial infarction and the resulting haemodynamic changes are well documented. The aim of this prospective study was to assess the consequences on regional and global right ventricular function at a distance from the initial episode. The study population included 32 patients (29 men and 3 women; mean age 52.7 +/- 6 years) admitted consecutively to the coronary care unit for acute inferior wall myocardial infarction with right ventricular extension (group A: 14 patients) or without (group B: 18 patients), based on the initial haemodynamic data. All patients underwent right and left cardiac catheterisation with selective biplane right and left ventriculography and coronary angiography, 2.9 +/- 1 months after the acute episode. In group A, there was a normalisation of the haemodynamic changes observed during the acute phase of myocardial infarction, complete occlusion (10 cases) or a significant residual stenosis (3 cases) of the right coronary artery proximal or immediately distal to the right marginal artery and persistence of an alteration of global right ventricular systolic function when compared with group B (increased end systolic volume: RVESV = 43 +/- 11 ml/m2 vs 35 +/- 9 ml/m2, p less than 0.02, and a decreased ejection fraction: RVEF = 49 +/- 7 p. 100 vs 57 +/- 9 p. 100, p less than 0.01, resulting from hypokinesia or akinesia of the right ventricular inferior wall; mean shortening delta R = 11 +/- 6 p. 100 vs 17 +/- 7 p. 100, p less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

Right ventricular function in healed myocardial infarction in man. A cineangiographic assessment

To evaluate the frequency of right ventricular dysfunction following recovery from myocardial infarction (MI) and the relationship of segmental right ventricular (RV) wall motion abnormalities to left ventricular (LV) function or location of coronary arterial stenosis, biplane right and left ventricular cineangiograms were obtained in 100 consecutive patients (4 +/- 3 months post MI). Thirty (group A) had anterior MI and significant stenosis or obstruction of left anterior descending artery (LAD). The remaining 70 patients had inferior MI. They were divided into three groups according to the site of the main coronary stenosis or obstruction and corresponding LV akinesia: right coronary artery (RCA) proximal to the acute marginal artery (RMA), (group B: 32 patients), RCA distal to the RMA (group C: 18 patients), left circumflex artery (LCF), (group D: 18 patients). RV and LV end-diastolic volume index (EDV), end-systolic volume index (ESV), stroke volume (SV) and ejection fraction (EF) have been determined. RV segmental wall motion was assessed in RAO and LAO projection by determining the percentage of systolic shortening (+ delta R) along 11 hemiaxes. Mean axial shortening (delta R) of the RV inferior and free walls were considered. When compared with that in 10 normal subjects, RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV) were increased and RV ejection fraction (RVEF) was lower in patients with anterior or inferior MI. Inferior delta R exhibited comparable sequential changes in the three groups of inferior MI and similar LVEF alteration.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new electrocardiographic technic: voluntary, sequential ambulatory recording]

Voluntary sequential ambulatory electrocardiographic is a new electrocardiographic diagnostic method. The recorder weighs 300 g and measures 156 X 95,5 X 19 mm. The electrodes, which are an integral part of the device, record the cardiac potentials from the hands and chest wall for a programmed interval of 40 or 20 seconds which can be repeated four or eight times. The recordings are in a solid memory and restituted on an electrocardiograph directly using a cable or by telephonic transmission. The bandpass ranges from 50 Hz to 0.05 Hz (analysis of the ST segment). Our experience after several hundreds of recordings shows: - that the recordings obtained are of good quality and perfectly interpretable (even the ST segment) when the patient cooperates satisfactorily; - that the "diagnostic return" is high because the patient only records when he experiences symptoms (the small size of the recorder enables the patient to wear it continuously for periods of several days); - that the need for the patient to play an active role always requires detailed instructions, a condition which sometimes limits the use of this technique (very old or very young patients). These results indicate that voluntary sequential ambulatory electrocardiography is a very promising technique for diagnosing some paroxysmal symptoms (palpitations, episodes of dizziness, chest pain). It does not supplant continuous electrocardiographic recording (Holter method), a more exacting and costly technique, but could significantly reduce its indications.