[Treatment of chronic ventricular extrasystole by propafenone (600 mg/d) in 2 or 3 daily doses]. / Traitement des extrasystoles ventriculaires chroniques par la propafénone (600 mg/j), en deux ou trois prises journalières.

The efficacy of propafenone by oral route in the treatment of chronic ventricular extrasystoles (VES) was investigated in 14 subjects in the context of a multicenter evaluation carried out double blind and using a crossover sequence. The purpose of this study was to compare the antiarrhythmic efficacy of a dose of 600 mg/d of propafenone randomly divided into two or three subdoses. After carrying out two Holter recordings (< 15 days) the patients presenting with chronic (< or = 100 VES/H) and stable (interindividual variability > or = 30%) ventricular extrasystoles were included. The treatment period consisted of two 8-day courses divided by a placebo period and carried out following a crossover mode. The efficacy of treatment was defined as a reduction in the VES by at least 70% relative to the second Holter during the inclusion period which was used as the reference period. Fourteen patients (57.2 +/- 18.2 years) from eight cardiological centers (eight with heart disease) were included. In general, propafenone at a dose of 600 mg/d bid or tid significantly reduced the total number of VES by about 65%: 15,239 +/- 2,663 VES/24 h (baseline) to 5,238 +/- 2,746 VES/24 h (bid) and 5,765 +/- 2683 VES/24 h (tid); p < 0.0001, with no significant difference between the bid and tid treatments. Individually, 8 patients (57%) responded during the bid treatment, 7 patients (50%) during the tid treatment and 6 patients during both treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

[Efficacy and tolerability of isoptine LP in mild to moderate hypertension. A multicenter study with 50 patients]. / Efficacité et tolérance d'isoptine L.P. dans l'H.T.A. essentielle légère à modérée.

A multicenter open trial involving 50 hypertension patients enabled evaluation of the efficacy and tolerability of Isoptine L.P. (sustained release verapamil) in mild to moderate essential hypertension. Following a 2-week placebo run-in period, patients were given Isoptine L.P. (240 mg/24 h) as a morning dose for 3 months, with a possible dose increase (360 mg/24 h) in case of diastolic blood pressure of 95 mmHg or more at the 30-day evaluation. Blood pressure was measured by mercury sphygmomanometer and, in 20 patients, by a Dinamap type Automatic device. After 3 months of treatment, blood pressure levels in supine and standing position, measured manually and automatically, showed a highly significant decrease, with a mean fall of 18.4 mmHg for systolic (13.7 percent) and 13.2 mmHg diastolic (-14.6 percent). 67 percent of patients were responders after 1 month of treatment and 79 percent at 3 months, including one-fifth at the dose of 360 mg/24 h. Seventeen patients, i.e. 34 percent, reported one or more adverse reactions. Among these, four patients had to stop treatment, twice because of headache and twice for constipation. Adverse events seen most frequently were constipation, headache, tiredness and vomiting. No cardiac adverse events were reported with the exception of one case of atrial premature contractions. The electrocardiogram revealed significant slowing of heart rate, as well as slight prolongation of PR and QT intervals and slight widening of the QRS complex. Tolerability on the basis of laboratory parameters was good.

[Efficacy and tolerance of propafenone in the prevention after a year of recurrent atrial arrhythmia. Results of a multicenter study of 114 patients]. / Efficacité et tolérance de la propafénone dans la prévention à un an des récidives d'arythmies auriculaires. Résultats d'une étude multicentrique sur 114 patients.

One hundred and fourteen patients were included in an open multicenter trial of the prevention of atrial arrhythmias by propafenone and of the tolerability of this anti-arrhythmic agent after a year. The study population was divided into two groups: group I of 45 patients with only runs of arrhythmias and group II of 69 patients with a stable arrhythmia. Patients were seen again after 2 weeks, 3 and 6 months and 1 year. Holter records were obtained routinely in group I and at 6 months in group II. Treatment was stopped for inefficacy in 30 patients (10 of group I, 20 of group II), for intolerance in 10 patients (5 in each group) and for both in 3 patients (1 in group I, 2 in group II). Propafenone was considered to be effective and well tolerated in 55 per cent of patients, this success rate being identical in the two groups. Effectiveness persisted in a stable fashion at 1 year in those patients who responded initially.

[Sustained-released verapamil and ambulatory recording of blood pressure in mild to moderate essential hypertension]. / Vérapamil à libération prolongée et enregistrement ambulatoire de la pression artérielle dans l'hypertension artérielle essentielle légère à modérée.

An open study in 25 patients evaluated the efficacy and safety of Isoptine S.R., in some cases associated with Aldactazine in mild to moderate essential hypertension. After a placebo period of 2 weeks, the patients received sustained release verapamil (240 mg/24 hours) in a single morning dose for 6 months. An increase in the dosage (360 mg/24 hours in two subdoses) could be made during the first month of treatment if the diastolic blood pressure remained greater than or equal to 95 mmHg. If the diastolic blood pressure persisted at these levels at the second monthly assessment, a tablet of Aldactazine was associated. The blood pressure was evaluated by means of conventional clinical determinations and 24-hour ambulatory recordings carried out at the time of inclusion and then after 3 and 6 months of treatment. From the first month of treatment, the casual blood pressure determinations in the supine and standing position fell highly significantly (p less than 0.0001), resulting in a mean reduction of 22.3 mmHg in the systolic blood pressure (-12.6%) and of 17.4 mmHg in the diastolic blood pressure (-17%). The ambulatory recordings of blood pressure also showed a significant reduction in the mean systolic blood pressure over 24 hours (p less than 0.05 at the 3rd month of treatment), in the mean diastolic blood pressure over 24 hours (p less than 0.01) and the mean pressure (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of the efficacy and tolerability of sustained-release verapamil and captopril in mild to moderate essential arterial hypertension]. / Comparaison de l'efficacité et de la tolérance du vérapamil à libération prolongée et du captopril dans l'hypertension artérielle essentielle, légère à modérée.

A randomised, double-blind, double-placebo trial compared the efficacy and safety/acceptability of sustained release verapamil and of captopril in two parallel groups of patients with mild to moderate hypertension. After a 2 week placebo period, 45 patients were randomised into 2 groups, the 1st group (n = 22) given sustained release verapamil (240 mg/24 h) as a single morning dose and the second (n = 23) captopril 25 (50 mg/24 h) as two daily divided doses. Treatment was given for 75 days, with the possibility of a combination of sustained release verapamil + captopril from day 45 onwards if diastolic blood pressure remained at 95 mmHg or more. After 45 days of treatment, the reduction in supine diastolic blood pressure did not differ significantly in the 2 groups (-10.4 mmHg in the sustained release verapamil group and -9.7 mmHg in the captopril), with 68.2 per cent responders to sustained release verapamil and 52.2 per cent in the captopril group. After 75 days of treatment, once again there was no significant difference in efficacy between the two groups: -14 mmHg for diastolic pressure and 80 per cent responders in patients treated with sustained release verapamil, -11.3 mmHg and 62.5 per cent responders in the captopril group. The percentage of responders was 58.3 per cent in the group treated with the combination of sustained release verapamil + captopril from day 45 onwards. The number of patients showing evidence of clinical or electrocardiographic adverse reactions was not significantly different: 20.7 per cent in the sustained release verapamil group and 34.8 per cent in the captopril group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term study of propafenone in severe ventricular extrasystole in elderly subjects]. / Etude à long terme de la propafénone dans l'extrasystolie ventriculaire grave du sujet âgé.

A long-term study of the efficacy and tolerance of propafenone was carried out in cases of severe chronic ventricular extrasystoly in elderly patients (age 70). The patients included presented more than 1,500 ventricular extrasystoles per 24 hours with severe criteria. After the Holter performed upon inclusion, 450 mg/d of propafenone were prescribed (900 mg/d in 4 cases). The Holter tests were then repeated at D8, D30, D60, D180, D360, with possible modification of the dosage. 16 patients were then studied, and the study completed its half of them in one year. The efficacy, evaluated by at least an 83 p. cent decrease of the number of ventricular extrasystoles with disappearance of complex forms, was excellent in 12 out of 16 patients, non-existent or insufficient in 2 patients. The arrhythmia was aggravated in 2 cases. In addition, the efficacy of propafenone was maintained in the 8 patients who responded to the treatment and were followed for one year. A poor tolerance (conduction disorders, aggravated arrhythmia) was noted in 7 patients (44 p. cent of the cases). Conduction disorders were present with a propafenone dosage or on preexisting conduction anomalies. Five deaths occurred during the study, unrelated to the treatment. At a dose of 450 mg/24 h, propafenone is therefore effective, most of the time, effective in the treatment of severe ventricular extrasystoly in elderly patients, with a rather good tolerance, and a long-term efficacy. Higher doses only improve minimally the efficacy and are much less well tolerated.

[Propafenone per os in ventricular arrhythmia]. / Propafénone per os dans les troubles du rythme ventriculaire.

Twenty-one patients presenting ventricular rhythm disorders and admitted to the Intensive Care Unit were treated with oral propafenone at the dosage of 450 to 900 mg/hours. The results of treatment were excellent in 13 cases, average in 2 cases, and nil in 4 cases. Worsening of arrhythmia was observed in 2 cases. Generally the drug was well tolerated, with treatment requiring to be discontinued in 1 case due to gastrointestinal upset and in another case due to broadening of the QRS complex. This study confirms that oral propafenone is well tolerated in ventricular arrhythmias regardless of their etiology.

[Anti-arrhythmia efficacy of propafenone per os in the prevention of paroxysmal supraventricular arrhythmia resistant to class Ia agents]. / Efficacité antiarythmique de la propafénone per os dans la prévention des arythmies paroxystiques supraventriculaires résistantes aux agents de la classe Ia.

The efficacy of orally administered propafenone in the prevention of paroxysmal supraventricular dysrhythmias (atrial fibrillation, atrial tachysystole, reciprocal tachycardia) resistant to Vaughan-Williams class Ia drugs was investigated in 10 patients. Propafenone controlled dysrhythmia very well in 4 out of the ten patients, and satisfactorily in another one at a dosage ranging from 450 to 900 mg/day in 3 or 4 divided doses; this result was documented using continuous 24 hr. Holter ECG monitoring. Among the 5 clinical failures, 1 patient had atrial fibrillation primarily at night, and another poorly tolerated this agent which led to interrupt therapy.

[Verapamil versus propranolol in stable effort angina. Randomized, crossed, double-blind study]. / Vérapamil versus propranolol dans l'angor d'effort stable. Etude randomisée, croisée, en double aveugle.

A randomised, crossover, double-blind study was carried out in sixteen coronary patients with stable effort angina to compare the effects of verapamil (360 mg) and propranolol (120 mg). All the patients received placebo for 2 days, underwent a coronary angiography which confirmed coronary heart disease and were then randomised into two groups to receive an initial treatment of either verapamil or propranolol for three days. The patients then took placebo for 3 days, then the second drug after cross-over also over 3 days. The therapeutic efficacy was assessed by stress testing on a treadmill (Bruce protocol) with automated analysis of the results (Case-Marquette), carried out on the last day of each of the phases with placebo and the test drug. The duration of the stress test increased significantly with propranolol (p less than 0.01) and verapamil (p less than 0.05) with respect to placebo. In comparison with placebo, propranolol and verapamil resulted in a similar decrease in ST segment depression at the time of maximum effort (p less than 0.01). The resting systolic blood pressure decreased with propranolol (p less than 0.02) and verapamil (p less than 0.01), whereas resting diastolic blood pressure only decreased with verapamil (p less than 0.01). Resting heart rate decreased during the propranolol phase (p less than 0.001). The systolic blood pressure at the time of maximum effort decreased especially with propranolol (p less than 0.05), whereas the diastolic blood pressure on exertion decreased during the verapamil phase (p less than 0.01). Heart rate during exertion only showed a significant decrease with propranolol (p less than 0.001) as compared with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

[Eisenmenger's syndrome and pregnancy]. / Syndrome d'Eisenmenger et grossesse.

The consequences of pregnancy, abortion or tubal ligature were studied in 11 women with the Eisenmenger syndrome. Seventeen cases of pregnancy and 7 tubal ligatures were reviewed. In the 4 pregnancies continued of term and preceded by cardiac catheterisation, there were two maternal deaths on the 2nd and 7th day of the postpartum period due to pulmonary embolism confirmed in one case and suspected in the other. A third pregnancy was complicated by cerebral embolism and one case of tubal ligature was complicated by non-fatal pulmonary embolism. These cases were compared with previous reports in the literature to form a total of 42 cases of pregnancy in women with the Eisenmenger syndrome. The pregnancies were characterised by aggravation of dyspnoea and cyanosis in 72.4 p. cent of cases, by documented pulmonary embolism in 7 cases and by toxaemia of pregnancy in 26 p. cent of cases. The global mortality was 36 p. cent and all deaths but one occurred between the time of labour and the 11th postpartum day. Micro pulmonary thromboses were the commonest cause of death. Two mechanisms seem to combine to aggravate the cardiac status at the end of pregnancy and during the initial postpartum period: increased right-to-left shunt due to a rise in pulmonary resistances, due particularly to changes in coagulability favored by pregnancy; increased right-to-left shunt due to a decrease in systemic vascular resistances. A number of poor prognostic factors were identified: decreased oxygen saturation in arterial blood and toxaemia of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)