[Coronary artery disease in octogenarians: contribution of coronary angiography and evaluation of therapeutic possibilities]. / Coronaropathie de l'octogénaire: apport de la coronarographie et évaluation des possibilités thérapeutiques.

An increasing number of octogenarians is being referred for coronary angiography with a view to myocardial revascularisation. Based on a retrospective study of 168 octogenarians undergoing coronary angiography between January 1987 and December 1992, the authors reviewed the indications, the risks and therapeutic decisions taken in those patients with significant coronary artery disease. The population studied had acute myocardial ischaemia in 88.7% of cases, a low incidence of previous myocardial infarction and severe extracardiac pathology. Significant coronary lesions were observed in 90% of patients (151) with multiple vessel diseases in 57.8% of cases. The mortality attributed to coronary angioplasty was 0.59% (1 case) and the morbidity was 4.7%. The number of disease vessels did not influence the decision as 75.5% of single vessel, 75% of double vessel and 77.3% of triple vessel disease patients were referred for coronary surgery or angioplasty. Of the patients undergoing a revascularisation procedure (n = 108), those referred for surgery (n = 22) had more severe coronary disease than those referred for angioplasty (p < 0.05). The hospital mortality was high about 8%, irrespective of the therapeutic decision. The 3 year actuarial survival was 70% in the group undergoing myocardial revascularisation (whether by angioplasty or coronary surgery) and 53.6% in subjects treated medically. These results show that coronary angiography in a selected elderly population is possible although the mortality and morbidity should not be underestimated. A high proportion of these patients (72%) is referred for myocardial revascularisation.

[Atrial insertion of accessory pathways in permanent reciprocating junctional tachycardia]. / Insertions auriculaires de la voie accessoire dans la tachycardie jonctionnelle reciproque permanenete.

Permanent reciprocating junctional tachycardia (PRJT) is an uncommon type of Tachycardia, usually associated with a retrogradely conducting accessory pathway situated near to the ostium of the coronary sinus. This study reports the localisation of the site of atrial insertion of the accessory pathway, confirmed by the efficacy of intracardiac catheter ablation. Five patients (4 men), aged 14 to 45, experienced PRTJT at rates of 120 to 150/mn over a period of 2 to 15 years. 4 patients were normal, expected in 2 patients in whom they were 16 and 20%. One of these suffered a thromboembolic complication after pharmacological interruption of the tachycardia. The presence of an accessory pathway with decremential retrograde conduction was confirmed in all cases. Catheter ablation was successful in the medio-septal (2 cases), posteroseptal (1 case), lateral (1 case) and anteroseptal (1 case) regions. Six to 30 applications of 20 to 30 watts of radiofrequency energy were used in the 5 cases. In one case (right lateral accessory pathway), a fulguration procedure was necessary with a cathodic shock of 160 Joules. The AV conduction was preserved and retrograde conduction was normalised in all cases. All patients remained asymptomatic for a period of 10 to 43 months without antiarrhythmic therapy. The ejection fractions of the two patients with left ventricular dysfunction returned to normal. The authors conclude that the accessory pathways of PRJT may be situated in different regions of the right atrium. The efficacy of catheter ablation was 100 % in this form of tachycardia.

[Electrocardiographic evaluation of anti-ischemic effect of verapamil during angioplasty]. / Evaluation électrocardiographique des effets anti-ischémiques du vérapamil en cours d'angioplastie.

The anti-ischemic and cardioprotective effects of various angina drugs have been evaluated during angioplasty. This special situation of transitory regional ischemia was used to test verapami given by intra-coronary injection in 15 patients undergoing balloon dilatation of the left anterior descending artery, suffering from stable angina and with normal left ventricular kinetics. Each patient serving as his own control, parameters indicating oxygen consumption and clinical and electrocardiographic (ST segment changes) markers were measured during two successive inflations. Continuous monitoring of comparative variations between a first inflation without treatment and a second inflation after intra-coronary administration of 1 mg of verapamil revealed, following 60 seconds of ischemia, the absence of any change in heart rate, a moderate fall in mean blood pressure (101.7 as against 96.8 mmHg, p = 0.033) and a notable 60% reduction in the amplitude of maximal ST depression (5.07 +/- 3.08 mm as against 2.07 +/- 1.44 mm, p = 0.0002). These results confirm the anti-ischemic properties of verapamil, the action of which is based upon an indirect peripheral vasodilator model but also on a probable direct cardioprotective effect on anoxic myocardial regions.