Showing papers by "Etienne Aliot published in 2003"

ACC/AHA/ESC Guidelines for the Management of Patients with Supraventricular Arrhythmias - Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias)

Abstract: ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary : a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias).

International consensus on nomenclature and classification of atrial fibrillation; a collaborative project of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.

Abstract: Atrial fibrillation (AF) has in recent years been the subject of intense investigation in terms of obtaining a better understanding of its mechanism and improving its management. Despite the advances made, AF remains a challenge for the clinician, and it is uncertain whether these theoretical advances have resulted in a significant improvement in the way the vast majority of patients are managed in general practice. Several reasons may account for this situation. One possible reason is incomplete knowledge of the complex mechanism of this common arrhythmia. Another possible reason is the heterogeneous clinical presentation of the arrhythmia. Still, the numerous publications and clinical trials devoted to AF have dealt with this arrhythmia as if it were a single entity. Furthermore, the abundant terminology used to characterize various subsets of AF and the absence of consistency in the definitions have added to the difficulty in communication.1 Consequently, it has become difficult to compare the results of pharmacologic or nonpharmacologic therapies because different classifications have been used, and the difficulty in characterizing the patient population has not allowed easy or appropriate comparison. The Working Group of Arrhythmia of the European Society of Cardiology (WGA-ESC) and the North American Society of Pacing and Electrophysiology (NASPE) have recognized the need to create a Study Group in an attempt to achieve a consensus on the terminology and classification of AF. This document reports the conclusions reached by this Study Group during a meeting held on June, 13, 2000, and completed by the members soon thereafter. The definitions and classification resulting from this consen-

ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias - Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias)

Abstract: These practice guidelines are intended to assist physicians in clinical decision making by describing a range of generally acceptable approaches for the diagnosis and management of supraventricular arrhythmias. These guidelines attempt to define practices that meet the needs of most patients in most

Update of the guidelines on sudden cardiac death of the European Society of Cardiology.

Abstract: One of the most important challenges forscientific societies responsible for the development of guidelines, is to provide regular update of recommendations when new data become available. The Committee for Practice Guidelines of the ESC has set the goal of producing an update of guidelines every 12–24 months from the publication of the initial document (http://www.escardio.org). The guidelines for the prevention of suddencardiac death (SCD) were published in the August issue of the European Heart Journal in 20011 and the Executive Summary was published in theJanuary issue of Europace.2 In the last 12 months, the release of important data has affected risk stratification and management of patients at riskof dying suddenly. Based on this evidence, the members of the Task Force on SCD of the ESC have decided to revise the original document. Theupdated version of the full document will be published on the ESC website. Here, we review the evidence that has led to the update of two sections: (1) primary prevention of SCD in post-myocardial infarction (MI) and heart failure, and (2) primary prevention of SCD in dilated cardiomyopathy (DCM). The revision of the section of primary prevention of SCD in post-MI and heart failure has been considered appropriate based on the release of the results of the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) trial.3 This study was designed to investigate whether the implantable cardioverter defibrillator (ICD) would be effective in the prevention of all-cause death in patients with …

International consensus on nomenclature and classification of atrial fibrillation: A collaborative project of the Working Group on Arrhythmias and the Working Group of Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.

Abstract: Atrial fibrillation (AF) has in recent years been the subject of intense investigation in terms of obtaining a better understanding of its mechanism and improving its management. Despite the advances made, AF remains a challenge for the clinician, and it is uncertain whether these theoretical advances have resulted in a significant improvement in the way the vast majority of patients are managed in general practice. Several reasons may account for this situation. One possible reason is incomplete knowledge of the complex mechanism of this common arrhythmia. Another possible reason is the heterogeneous clinical presentation of the arrhythmia. Still, the numerous publications and clinical trials devoted to AF have dealt with this arrhythmia as if it were a single entity. Furthermore, the abundant terminology used to characterize various subsets of AF and the absence of consistency in the definitions have added to the difficulty in communication.1 Consequently, it has become difficult to compare the results of pharmacologic or nonpharmacologic therapies because different classifications have been used, and the difficulty in characterizing the patient population has not allowed easy or appropriate comparison. The Working Group of Arrhythmia of the European Society of Cardiology (WGA-ESC) and the North American Society of Pacing and Electrophysiology (NASPE) have recognized the need to create a Study Group in an attempt to achieve a consensus on the terminology and classification of AF. This document reports the conclusions reached by this Study Group during a meeting held on June, 13, 2000, and completed by the members soon thereafter. The definitions and classification resulting from this consen-

Noninvasive quantitation of blood flow turbulence in patients with aortic valve disease using online digital computer analysis of Doppler velocity data

Abstract: Previous experimental studies have demonstrated that aortic valve disease is associated with significant downstream turbulence (T). In this study, we developed a noninvasive method on the basis of Doppler velocity recording for quantitating aortic blood flow T in patients with aortic valve disease. The instantaneous blood velocity at a point in the aorta is equal to the sum of a mean periodic velocity component with a random or turbulent velocity component. According to the ensemble average method, time mean absolute T intensity is the root-mean-square value of turbulent velocity averaged over time and T is better quantitated by the relative T intensity (TIr), which is the ratio of absolute T intensity to the ensemble average velocity averaged over time. We computed TIr in 18 patients with mild to severe aortic stenosis and in 13 healthy volunteers from instantaneous modal velocities of 70 cycle length–matched heart beats recorded in the proximal part of the descending aorta by pulsed Doppler using an ultrasound system with an output port for online digital data transfer into a microcomputer. TIr was greater in patients with aortic valve disease (18.4 ± 5.1%, range 11.2%-28.9%) than in control patients (7.9 ± 1.9%, range 4.8%-9.8%; P = .0001). In patients with aortic valve disease, TIr was better linearly related to the ratio of postvalvular aorta to valvular orifice cross-sectional areas ( r = 0.89, P = .0001) than to other parameters of valve restriction: transvalvular pressure gradient ( r = 0.78, P = .0001); valve area ( r = −0.56, P = .01); and valve resistance ( r = 0.72, P = .0002). Thus, T that can be computed noninvasively from direct digital transfer of Doppler velocity data appears to be linearly related to indices of aortic valve restriction. Our data support the concept of the postvalvular aorta to valvular orifice cross-sectional areas ratio as a new important hemodynamic parameter in patients with aortic valve disease.

Safety of a controlled-release flecainide acetate formulation in the prevention of paroxysmal atrial fibrillation in outpatients

Abstract: Objectives: The cardiac safety of a once-a-day 200mg controlled-release formulation of flecainide acetate in the prevention of paroxysmal atrial fibrillation (PAF) was assessed in outpatients. Material and Methods: The drug was administered for 24 weeks to 227 patients diagnosed with recurrent Paf episodes. Cardiac safety was assessed primarily by the maximum change from baseline in QRS duration. Changes in left ventricular function at echocardiography, incidence of proarrhythmic effects determined from ECG and Holter recordings and cardiovascular adverse events were also taken into account to assess cardiac safety. Efficacy was documented by actuarial methods. Results: Mean maximum QRS increase from baseline was 11.4% ( n = 181); QRS increase was 100ms under treatment. Left ventricular ejection fraction remained within ±20% of baseline for 90% of the patients, increased above 20% for 8.6% and decrease below 30% for 1.4% ( n = 139). Bradycardia (13.2%; n = 129) and ventricular extrasystoles (10.6%; n = 104) were the most frequently identified proarrhythmic effects. Atrio-ventricular block (4.0%), supra-ventricular tachycardia (2.2%), bundle branch block (1.8%) and atrial fibrillation (1.3%) were the most frequent drug-related cardiac adverse events. Estimated treatment success rate was 74% (95% CI: [68%; 80%]) and the incidence of Paf episodes decreased from baseline 28.6% to 11.0% ( P Conclusions: We provided evidence for a good cardiac safety profile of the controlled-release formulation of flecainide acetate and confirmed the effectiveness of the drug in the prevention of PAF recurrences.

Safety and Efficacy of a Dual Chamber Implantable Cardioverter Defibrillator Capable of Slow Ventricular Tachycardia Discrimination

Abstract: New developments in dual chamber implantable cardioverter defibrillators (ICD) have increased the specificity of therapy delivery. This study was performed to examine the performance of an algorithm, focusing on its ability to distinguish slow ventricular tachycardia (VT) from sinus rhythm or supraventricular tachyarrhythmias. The patient population included 77 men and 13 women, 63 ± 11 years old, treated with ICDs after episodes of spontaneous or inducible ventricular tachyarrhythmias. They were randomized to programming of the ICD to a lower limit of VT detection at 128 beats/min (group I, n = 44), versus 153 beats/min II (group II, n = 46). The primary endpoint of the study consisted of comparing the specificity and sensitivity of the algorithm between the two groups of patients. Over a 10.1 ± 3.5 months follow-up, 325 episodes were detected in the Tachy zone in group I, versus 106 in group II. The sensitivity and specificity of the algorithm in group I were 98.8% and 94.4%, respectively, versus 100% and 89% in group II (NS). A single episode of VT at a rate of 132 beats/min was diagnosed as SVT in group I. The sensitivity and specificity of the algorithm for tachycardias <153 beats/min were 97.4% and 94.5%, respectively. Overall VT therapy efficacy was 100% in both groups. The performance of this algorithm in the slow VT zone supports the programming of a long Tachy detection interval to document slow events, and allows to treat slow VT, if necessary, without significant risk of inappropriate interventions for sinus tachycardia. (PACE 2003; 26:2275–2282)

Characteristics and causes of death in 283 patients with implanted defibrillators

Abstract: UNLABELLED The implantable automatic defibrillator has proved its superiority over pharmacological treatments for preventing mortality by serious ventricular arrhythmia. We studied the cause of death in a population of 283 consecutive patients implanted between February 1988 and December 2000 (age at implantation: 58 +/- 14.7 years; extremes: 15-78 years, 45 females, ejection fraction: 0.39 +/- 0.15) and followed up over a median of 25 months (extremes = 1 day-163 months). RESULTS At the end of follow up, 55 patients had died (average age: 62.7 +/- 12.6 years, extremes: 15-79 years, 7 females). All except 2 had a cardiopathy: ischaemic cardiopathy (n = 38, 36 IDDM), dilated cardiomyopathy (n = 14), arrhythmogenic dysplasia of the right ventricle (n = 1). The median interval between implantation and death was 35 months (extremes = 1 day-137 months). The causes of death were the following: cardiac insufficiency (n = 24), refractory arrhythmias (n = 13), other cardiac causes (n = 8), extra-cardiac pathologies (n = 10). The deceased patients had presented an average of 86.6 +/- 23.4 ventricular arrhythmias (extremes = 0-1309) but 18 of them (33%) did not present any during follow up. CONCLUSIONS Cardiac insufficiency is the prime cause of death in refractory arrhythmias; on patient in 4 dies from ventricular arrhythmia, despite the defibrillator and one deceased patient in 3 had no arrhythmia during follow up.

Caractéristiques et causes de décès chez 283 patients implantés d'un défibrillateur automatique

Abstract: Le defibrillateur automatique implantable a prouve sa superiorite sur les traitements pharmacologiques pour prevenir la mortalite par arythmie ventriculaire grave. Nous avons etudie les causes de deces dans une population de 283 patients consecutifs implantes entre fevrier 1988 et decembre 2000 (âge a l'implantation : 58 ± 14,7 ans ; extremes : 15 et 78 ans, 45 femmes, fraction d'ejection : 0,39 ± 0,15) et suivis sur une mediane de 25 mois (extremes : 1 jour et 163 mois). Resultats : au terme du suivi, 55 patients sont decedes (âge moyen : 62,7 ± 12,6 ans ; extremes : 15 et 79 ans ; 7 femmes). Tous, sauf 2, avaient une cardiopathie : cardiopathie ischemique (n = 38 ; 36 IDM), cardiomyopathie dilatee (n = 14), dysplasie arythmogene du ventricule droit (n = 1). La mediane du delai entre l'implantation et le deces etait de 35 mois (extremes : 1 jour et 137 mois). Les causes de deces etaient les suivantes : insuffisance cardiaque (n = 24), arythmies refractaires (n = 13), autres causes cardiaques (n = 8), pathologies extracardiaques (n = 10). Les patients decedes ont fait une moyenne de 86,6 ± 234 arythmies ventriculaires (extremes : 0 et 1 309) mais 18 d'entre eux (33 %) n'en ont eu aucune au cours du suivi. Conclusion : l'insuffisance cardiaque est la premiere cause de deces devant les arythmies refractaires ; un patient sur 4 decede d'arythmie ventriculaire, malgre le defibrillateur et un patient decede sur 3 n'a fait aucune arythmie durant le suivi.

Intérêt des études in vitro de l'immunité des implants cardiaques en environnement électromagnétique basse fréquence

Abstract: L'objet de cet article est de montrer l'apport de l'approche experimentale in vitro, basee sur les regles de base de la compatibilite electromagnetique (CEM), comme outil complementaire aux etudes cliniques. Des resultats peuvent etre obtenus par une approche experimentale in vitro dans des fantomes electromagnetiques associes a un banc de test type de sorte a permettre une comparaison possible entre differentes etudes. Apres avoir decrit le protocole developpe pour les implants cardiaques (stimulateurs et defibrillateurs), des exemples de resultats partiels sont presentes a titre d'illustration.