[Effect of atropine therapy on sudden infant death. A multicenter survey of 7851 children at risk]. / Effet du traitement atropinique sur la mort subite du nourrisson. Enquête multicentrique réunissant 7,851 enfants à risque.

The results of a multicentre inquiry started in 1988 in reference centres of sudden infant death are presented. This study concerns the sudden and unexplained mortality of infants under 1 year of age who were treated with atropinics for an alleged risk of sudden death. The 7,851 infants involved were divided into 2,605 siblings, 1,067 premature babies and 4,179 infants who experienced malaises. Only one of the 2,034 infants treated with atropinics (385 siblings, 435 prematures, 1,214 with malaise) died, as opposed to 27 deaths among the 5,817 infants who where not treated (10 deaths among 2,220 siblings, 6 among 632 premature and 11 among 2,965 infants with malaise); P = 0.005. These results are encouraging, but they suffer from the limitations and biases inherent in all large inquiries. They certainly do not allow us to conclude without reservation that vagal hyperreflectivity is the mechanism responsible for sudden infant death and that atropinics must be systematically given to all infants at risk. Wide and randomized prospective studies are highly desirable in this particular field.

[Esophageal pacing in children. 38 consecutive cases]. / La stimulation oesophagienne chez l'enfant. A propos de 38 cas consécutifs.

On the occasion of a preliminary series of 38 cases, the authors review the esophageal pacing technique and its main indications. On the therapeutic level, the esophageal lead may be successfully used to decrease supraventricular tachycardias due to reentry (typical or atypical flutter, reciprocating nodal tachycardia with or without WPW). As a means of investigation, esophageal pacing is overall useful to diagnose undocumented paroxysmal tachycardia fits (palpitations), to evaluate the refractory stage of an accessory pathway (WPW) or to assess the refractory stage of antiarrhythmia medications. This investigation may also be used to assess the sinusal function, the atrioventricular conduction (Wenckebach point) and the spontaneous rhythm of atrioventricular blocks after pacemaker insertion. Due to the technical improvements achieved, esophageal pacing may be used presently in pediatric units taking care of children with arrhythmias.

[Treatment of reflex vagal hypertonia in infants. Role of diphemanil (apropos of 50 cases)]. / Traitement de l'hypertonie vagale réflexe du nourrisson. Place du diphémanil (à propos de 50 cas).

For a period of 20 months, 50 consecutive infants (mean age: 11 months) were given Diphemanil (atropine like synthetic drug) for reflex symptomatic bradycardia of probable vagal origin. Treatment's results were evaluated with the study of oculo-cardiac reflex (OCR) and Holter monitoring performed before and 3 months after the beginning of Diphemanil. If tolerance was generally good, it was not possible to demonstrate the clinical efficacy of the treatment on the whole group. However, assertive success was seen on individual cases. Holter and OCR data improved statistically. The other therapeutical means aiming at warning possible complications of the hypertonic vagal reflex were reviewed: inserting a cardiac pace-maker does not always prevent sudden death; a nodal sinus surgical selective denervation might be justified in certain exceptional cases, because of the severity of the spontaneous evolution or of the resistance to medical treatment.

[Arrhythmia after atrial correction of transposition of the great vessels. Holter recording study of 123 surgically treated patients]. / Troubles du rythme après corrections atriales des transpositions des gros vaisseaux. Etude par enregistrement Holter de 123 opérés.

Sinus node dysfunction after intra-atrial repair of transposition of the great arteries by a Mustard or Senning procedure is well known. We undertook this study to evaluate the frequency, the nature, the severity and evolution of these dysrhythmias by performing Holter monitoring in 123 children followed up over 5 years; 302 Holter recordings were reviewed. The patients were divided into 3 groups of increasing severity: I = no sinus node dysfunction, II = moderate sinus node dysfunction, III = severe sinus node dysfunction with bradycardia of less than 30/min and/or pauses of over 2000 ms. The association of atrial hyperexcitability was classified in 3 subgroups: A = no extrasystoles, B = at least 4 extrasystoles per 24 hours, C = atrial tachycardia (focal tachycardia or flutter) after the first six postoperative months. There were only 15% of normal recordings (IA) and the majority of children (58%) were classified in the intermediary groups (IB, IIA and IIB). Sinus node dysfunction tended to become more severe with time in nearly 30% of the 69 cases followed up sequentially. The bradycardia tended to become more severe and associated with episodes of atrial tachycardia: the frequency of type B and C increased to 30% in Group I, to 68% in Group II and to 91% in Group III. The attacks were severe, especially in patients with a mediocre postoperative haemodynamic result. This explains the global mortality of 3%, the morbidity of 15% and the pacemaker implantation rate of 12%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Paroxysmal vagal hypertonia in infants. Apropos of 14 cases]. / Hypertonie vagale paroxystique du nourrisson. A propos de 14 observations.

Fourteen infants presenting with unexplained episodes of weakness or fainting were investigated by repeated Holter monitor recordings and oculocardiac reflexes (OCR). The recordings were then compared with those of 10 normal children in order to try to establish the criteria of vagal hyperreflexia. Results of OCR were collated with those of Holter: there was a good correlation between the length of the cardiac arrest on the OCR and the minimal instantaneous frequency and the maximal change of instantaneous frequency recorded on the Holter. The diagnostic difficulties of these vaso-vagal episodes in infants are emphasized. The potential gravity of these episodes and the possible relation with the sudden infant death syndrome are then discussed in the light of these cases.

[Paroxysmal Hisian tachycardia and familial sarcoidosis]. / Tachycardie hisienne en salve et sarcoïdose familiale.

We report a His-bundle tachycardia in a 6 year-old patient without evidence of heart disease. Diagnosis and follow-up were assessed by exercise stress testing and repeated long-term electrocardiographic recording. As sarcoidosis was present in the mother and the aunt, this condition was discussed in this child also. However, since there is no absolute proof for this disease, the hypothesis of an antenatal injury of the bundle of His was discussed: this could be secondary to the transplacental transfer of abnormal maternal antibodies, as frequently observed in women with clinical or biologic evidence of connective tissue disease.

[The mucocutaneous and lymph node syndrome of Kawasaki. 1 case complicated by multiple aneurysms]. / Le syndrome cutanéo-muqueux et ganglionnaire de Kawasaki. A propos d'une observation compliquée d'anévrysmes multiples.

We report in a five month old baby a case of the cutaneomucosal and lymph node syndrome described by Kawasaki, remarkable for the onset of multiple aneurysms involving the coronary and the limb arteries. This syndrome has rarely been observed except in Japan where it seems frequent. Possibly is benign forms, without heart complications, producing a picture of febrile erythema of viral type, have not received sufficient attention. The relationship between Kawasaki's disease and periarteritis nodosa in infants is then discussed. The clinical and pathological existence of the fatal forms seems undoubted, but the generally benign course of Kawasaki's disease contrasts with the severe course of polyarteritis nodosa in infants. It is possible that the usually benign forms of Kawasaki's disease represent only the initial stage of periarteritis nodosa in infants, from which they may recover, and we have only identified until now the severe forms which are rapidly fatal. The etiology of Kawasaki's syndrome, like periateritis nodosa remains unknown.

[Congenital bundle-of-his focal tachycardias. Cooperative study of 7 cases]. / Tachycardies focales hissiennes congénitales. Etude coopérative de sept cas

The authors described seven cases of supraventricular tachycardia with atrio-ventricular dissociation, associated with the activity of an automatic focus in the bundle of His. These tachycardias, which appear at birth or are discovered at a very young age, appear to be congenital and sometimes familial, and are always isolated, having no associated cardiac abnormality. They give rise to cardiac failure, which is more marked when the rate is high (180-260/mn) and particularly resistant to treatment. The most effective form of treatment is amiodarone, almost always used in combination with digitalis. The anatomical abnormality, which was studied in the first case, is a contricting fibrosis around the main trunk of the bundle of His, and the appearances are reminiscent of those found in conditions of congenital atrio-ventricular block.

[Myocardial infarct due to diffuse arteriopathy of the coronary trunk in a 13-year-old child]. / Infarctus du myocarde par artériopathie coronarienne tronculaire diffuse chez un enfant de 13 ans

A case of antero-septal myocardial infarction in a child of 13, presenting as syncopal attacks, is reported. Selective coronary angiography showed severe diffuse lesions of the anterior descending artery and the right coronary artery. Clinical progress was satisfactory over an 18 month follow-up period. The only biochemical abnormality was a raised serum uric acid, the significance of which is discussed.