[Sustained ventricular tachycardia: an evaluation of long-term prognosis]. / Tachycardie ventriculaire soutenue: une évaluation du pronostic à long terme.

The authors analysed the clinical and paraclinical variables of 116 patients admitted to the Hôpital Cardiologique de Lyon between 1986 and 1990 with sustained ventricular tachycardia without cardiocirculatory arrest in order to determine the long-term outcome and the prognostic factors of death and recurrence. The average age of the patients was 56 +/- 15 years (mean +/- SD) and 83% were men. The mean ejection fraction was 39 +/- 15%. Sixty-five had previous myocardial infarction (group I); 30 (group II) had dilated cardiomyopathy (n = 21), right ventricular dysplasia (n = 4), hypertrophic cardiomyopathy (n = 2), congenital (n = 2) or valvular (n = 1) heart disease. Group III comprised 21 patients with no apparent cardiac disease or isolated mitral valve prolapse. Brief syncope was reported in 12 cases. The paraclinical investigations showed 46 patients (66%) with at least two criteria of positivity for ventricular late potentials; Holter recording showed doublets or runs of VES in 46% of cases and sustained or non-sustained VT was induced during exercise testing in 16 patients (22%). Programmed ventricular stimulation triggered VT in 85%, 79% and 61% of patients in groups I, II and III respectively. The patients were treated with amiodarone in 65 cases, a betablocker in 25 cases, catheter ablation of the origin of the tachycardia in 12 cases, antiarrhythmic surgery in 6 cases, coronary bypass grafting in 5 cases (with an associated antiarrhythmic procedure in 3 cases). An automatic defibrillator was implanted in 9 patients. The average follow-up period was 32 months (range: 17 days to 65 months).(ABSTRACT TRUNCATED AT 250 WORDS)

[Predictive factors of induction of ventricular arrhythmia under amiodarone]. / Facteurs prédictifs du déclenchement d'une arythmie ventriculaire sous amiodarone.

A good result of electrophysiological investigations under amiodarone therapy distinguishes a low risk group of patients with malignant ventricular arrhythmias. The authors set out to determine the factors predictive of this response in order to identify patients better protected by amiodarone at an earlier stage. Fourty-five patients with an average age of 56 years, were referred for evaluation of severe ventricular arrhythmias, monomorphic ventricular tachycardia being inducible during electrophysiological investigation in all cases before treatment. Amiodarone was prescribed orally at degressive doses. A control electrophysiological study was performed 4 to 6 weeks later. Eighteen patients (40%) were considered to be responders (absence of inducible ventricular arrhythmia or inducible non-sustained tachycardia or tachycardia with a cycle length increased by over 100 ms with respect to the base-line study). The other 27 patients were considered to be non-responders. No clinical or paraclinical parameter was found to distinguish responders from non-responders. The authors conclude that the data obtained before control electrophysiological investigation under amiodarone does not allow prediction of the response to this drug. The search for early prognosis of the efficacy of amiodarone in preventing ventricular arrhythmias therefore requires electrophysiological investigation after impregnation.

[Thrombosis on the mitral valve prosthesis and disseminated cancer: treatment by fibrinolysis]. / Thrombose de prothèse valvulaire mitrale et cancer disséminé: traitement par fibrinolyse.

The authors report the case of a 63-year-old woman with occlusive thrombosis of a mitral valve prosthesis and cardiogenic shock successfully treated by systemic thrombolytic therapy. This treatment was given despite metastatic hepatic and bone breast cancer. This, and other recently reported cases, argues in favour of widening the indication of thrombolysis as treatment of first intention in cases of obstruction of atrioventricular valve prostheses. Nevertheless, the relative safety of surgical treatment and the risk of systemic thromboembolism of thrombolysis, incites caution and reservation of medical therapy for carefully selected patients.

[Hydatid cyst of the heart]. / Kyste hydatique du coeur.

BACKGROUND: We report an unusual localization of a hydatid cyst: the septum interventriculare. CASE REPORT: A 60-year-old algerian man with hypertension was treated for cardiac insufficiency with hypereosinophilia. Cardiac echography showed a round tumor in the septum interventriculare. Serologic tests for hydatidosis were positive. Computed tomography and magnetic resonance imaging were consistent with the diagnostic of hydatid cyst. Surgical treatment was rejected because of severe underlying hypertensive cardiopathy. DISCUSSION: Cardiac hydatidosis is uncommon, but may be revealed by cyst rupture. Treatment requires surgery and associated medical management with albendazole requires further evaluation.