[Comparative efficacy of amiodarone and propranolol on ventricular arrhythmia in the post-infarction period]. / Efficacité comparée de l'amiodarone et du propranolol sur les arythmies ventriculaires dans les suites d'infarctus du myocarde.

Beta-blockers are known to be effective against post-infarction ventricular arrhythmias and amiodarone has recently been shown to have this property. The purpose of this prospective randomized study was to compare the effects of beta-blockers and amiodarone during the first 6 months following infarction. Nine days after the onset of myocardial infarction, 97 patients were put on either amiodarone (48) or propranolol (49). Holter monitoring was performed on four occasions: on the 7th post-infarction day (baseline), then on the 21st, 90th and 180th days (under treatment). On D7 the two groups were similar in age, sex, risk factors, medical history, characteristics of the infarction and type of arrhythmia. For result analysis purposes the patients were divided into two categories depending on whether their arrhythmia was "moderate" (less than 10 monomorphous and isolated ventricular extrasystoles per hour) or "severe" (at least 10 ventricular extrasystoles per hour, or polymorphous or repetitive ventricular extrasystoles). Concerning the frequency of "severe" arrhythmia, there was no statistical difference between the two treatment groups on D7 (p = 0.53), but differences in favour of amiodarone became increasingly important during the study (p = 0.08 on D21; p = 0.07 on D90; p = 0.04 on D180).(ABSTRACT TRUNCATED AT 250 WORDS)

[Occlusion of a coronary endoprosthesis after a negative stress test]. / Occlusion d'endoprothèse coronaire au décours d'une épreuve d'effort négative.

The frequency of early occlusion of coronary stents has fallen with the use of a powerful association of platelet antiaggregants (ticlopidine and aspirin) in the first month. The authors report the case of coronary stent occlusion after a negative exercise stress test, 11 days after implantation in a centre of cardiac rehabilitation. According to the literature, this type of complication would appear to be rare and related to the small size of the stent and the conditions of implantation (acute phase). It would be useful to compile a registry of complications related to coronary angioplasty during rehabilitation to determine their prevalence and, if necessary, change the protocols of physical training of these patients.

[Acute amiodarone poisoning. Clinical and pharmacokinetic study]. / Intoxication aiguë à l'amiodarone. Etude clinique et pharmacocinétique.

A 73 years old patient, treated with Amiodarone for ventricular tachycardia, ingested 6 000 mg of Amiodarone. This did not induce hemodynamic troubles or aggravation of ventricular arrhythmia. Treatment included a gastric lavage and purging at the third hour. Plasma assay revealed a concentration of 3.69 mg/l at the fourth hour. Their evolution can be described as the sum of two exponentials. The half-life of the first exponential is 4.9 hours ; the half-life of the second one is 544 hours. Amiodarone is an antiarrhythmic agent of high safety.

[Value of provocation tests in the evaluation of the treatment of ventricular tachycardias with amiodarone]. / Intérêt des tests de provocation dans l'appréciation du traitement des tachycardies ventriculaires par l'amiodarone.

The role of provocation tests for the assessment of amiodarone therapy in patients with ventricular tachycardia remains a subject of controversy: recent studies seem to show that the ability to initiate VT in patients on amiodarone is compatible with a good long-term result. Eighteen patients, 16 male and 2 female, average age 56 years, were treated with amiodarone (600 mg/day in 15 cases, and 400 mg/day in 3 cases) and submitted to provocative tests before and after treatment. The mean follow-up period was 14 +/- 4 months. In Group I (5 patients), VT could not be initiated after treatment and there were no relapses of the arrhythmia. In Group II (6 patients), non-sustained VT could be initiated and only one relapse was observed after a close reduction from 600 to 400 mg/day; Group III comprised 5 patients with spontaneous recurrences. An identical VT could be initiated during electrophysiological investigation which served as a basis for selection of an effective antiarrhythmic association. Two patients could not be studied after drug impregnation (1 sudden death, 1 exacerbation of VT). The results of this study show that provocative pacing can be useful in evaluating the efficacy of amiodarone, as in Groups I and II (61% of patients) a favourable prognosis could be predicted in 91% of cases. In cases of therapeutic failure with spontaneous recurrences of VT, the same provocation tests enabled a more effective drug combination to be selected.

[Comparison between amiodarone and disopyramide in the treatment of ventricular extrasystoles]. / Comparaison de l'amiodarone et du disopyramide dans le traitement des extrasystoles ventriculaires.

The authors have compared the anti-arrhythmic activity and tolerance of disopyramide and amiodarone in the treatment of ventricular extrasystoles (VES) by using two quantitative methods of assessment. The stability of the rhythmic disorder was confirmed by two control Holter recordings in 20 patients without treatment, 16 of whom were bearers of an organic cardiopathy. The ventricular extrasystole was greater than 90 VES/hour in 18 patients. After the first control, Holter recording, each patient was treated successively with 400 mg of disopyramide/day in 4 doses for average period of 31 days, then a second Holter control recording without treatment, then 600 mg/day of amiodarone for 8 days followed by a maintenance dose varying from 200 to 400 mg/day: this second period of treatment lasted for an average of 38 days. The reduction of the number of VES was greater than 65 percent (SAMI criterion) in 2 of the 20 patients treated with disopyramide and in 13 of the 20 patients treated with amiodarone. Using the method of variance analysis, disopyramide was found to be efficacious in 5 cases out of 20 and amiodarone in 15 cases out of 20. Both methods indicate that the greater efficacy of amiodarone is statistically significant (p less than 0.01). All of those who did not respond to amiodarone were also non-responders to disopyramide.

Comparison of the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias following myocardial infarction.

The purpose of this prospective randomized trial was to compare the efficacy of propranolol and amiodarone in suppressing ventricular arrhythmias during the first 6 months following myocardial infarction (MI). 97 patients were treated with either amiodarone (n = 48) or propranolol (n = 49) starting on the 9th day following MI. Holter monitoring was carried out on four occasions: on D7, D21, D90 and D180. There was no statistical difference in the incidence of 'major' arrhythmias (an average of at least 10 ventricular premature complexes (VPCs) h-1, multiform or paired VPCs or runs) between the two groups on D7. A significant difference in favour of amiodarone became apparent at D180 (P = 0.04). Patients were also classified according to whether treatment failed or was successful. 'Success' was recorded when arrhythmias remained minor or became minor (less than 10 uniform VPCs h-1) and 'failure' when arrhythmias remained major or became major, or when patients were withdrawn because of side-effects, or lost to follow-up. The difference remained in favour of amiodarone (P = 0.03 at D21; P = 0.05 at D90; P = 0.06 at D180). Evaluation of the percentage reduction in the number of VPCs at D21, D90 or D180 compared with D7 showed superiority of amiodarone at D90 (P less than 0.01) and D180 (P less than 0.04). In this study, the overall effect of amiodarone on ventricular arrhythmias following MI was shown to be superior to that of propranolol.

Progression of digital osteoarthritis: a sequential scintigraphic and radiographic study.

Hand radiographs and scintigraphy were obtained initially and at the 4-year follow-up in 15 patients with symptomatic osteoarthritis (OA) of distal and/or proximal interphalangeal joints. For each joint, a 0-15 score was obtained for the OA radiographic lesions read blind by the same observer. An abnormal isotope retention over a bone reference area was assessed and quantified. The predictive value of scintigraphy for the OA radiographic progression was confirmed and shown to be improved by a second investigation. During the study period, the percentage of radiographic OA joints increased from 66.3 to 76.6%, but joints showing an abnormal scan decreased from 40 to 22.5%. Progression of the OA radiographic score was closely related to scintigraphic changes. The mean difference between the final and initial OA score was -0.08 in joints with two normal scans (N = 115), +0.73 in joints showing a first abnormal and a second normal scan (N = 94) and +1.8 in joints with two abnormal scans (N = 14) or a scan becoming abnormal (N = 47). An abnormal scan appears to represent a transient event, and this event is associated with a period of progression of digital OA. Potentially, anti-OA therapies that suppress joint isotope retention might slow down OA progression. The magnitude of joint isotope retention was positively correlated with the OA radiographic score established at the same time (R = 0.61 and P < 0.001), but showed no predictive value for progression of the latter.