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Long term follow up of a patient with idiopathic long QT syndrome is described. A 5 year old girl was admitted with attacks of unconsciousness. Epilepsy was diagnosed and the patient was treated with anticonvulsants. During other episodes, ECG study showed torsades de pointes. The patient was treated with beta blockers, stellectomy without success, and later with overdrive pacing. The young woman is now 43 years old and in good health. It is suggested that early overdrive pacing be implanted in young people with symptomatic long QT syndrome.

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The authors report two cases of benign acute pericarditis after the patients received vaccinations against influenza virus. The diagnoses were confirmed by serologic changes and by the findings of 12-lead electrocardiogram and echocardiography. Symptoms and clinical status improved on aspirin therapy. The authors underline the possible mechanisms of this rare complication of influenza vaccination.

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A 71-year-old female with vasovagal near-syncope suffered from paroxysmal second-degree AV block during Holter monitoring. AV block was easily reproduced during head-up tilt test. She was successfully treated with a dual chamber pacemaker. This treatment is unusual and the role of cardiac pacing in patients with vasovagal symptoms is reviewed.

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Electrophysiological testing remains the basic procedure in the assessment of life-threatening sustained ventricular tachycardias (VT). The predictive value of inducible VT depends on the baseline stimulation protocol and probably on some other factors, including automatic balance. We report the cases of four patients, with a history of myocardial infarction, who experienced recurrent episodes of syncope; the clinical aspects of the syncope were suggestive of syncopal VT. With a baseline protocol, electrophysiological testing only allowed the induction of well-tolerated non-sustained VT. Using the same stimulation protocol (rapid ventricular pacing or basal ventricular stimulation with 2 extra-stimuli), monomorphic sustained VT that had the same ECG morphology, as non-sustained VT, could only be induced while low doses of isoproterenol (1-2 micrograms/min) were being administered. In these cases, increased sympathetic tone appears to be prerequisite for a sustained VT reproducing the patients clinical symptoms and discomfort. To conclude, in some patients with recurrent symptoms, including syncope suggestive of ventricular arrhythmia, low-dose infusion of isoproterenol may facilitate the induction of of clinical sustained VT and increase the predictive value of electrophysiological testing. Possible mechanisms of ventricular arrhythmogenesis by isoproterenol are discussed.

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The authors report the case of a 32 year old woman who was shot with a shotgun. Acute inferior wall infarction was detected fortuitously on electrocardiography and coronary angiography showed occlusion of the right coronary artery with lead shot. The single coronary lesion, absence, of other cardiac complications (haemopericardium, cardiac perforation, ...) and the favourable outcome with conservative medical treatment has not been previously reported to the authors' knowledge.

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The authors report the case of a 67-year-old woman, with mitral valve prolapse, for more than 20 years. She recently complained of attacks of syncope and clinical ventricular tachycardia; ventricular fibrillation was induced during programmed stimulation. The patient seemed to be at high risk for sudden cardiac death, and was therefore treated with an automatic implantable defibrillator. The pathophysiology and risk factors of sudden cardiac death in mitral valve prolapse are discussed.

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The authors report the case of a patient with drug-resistant atrial fibrillation, who developed, for more than 2 hours, a well-tolerated attack of palpitations, after taking 500 mg of flecainide acetate. The Holter monitoring demonstrated atrial flutter with 1:1 AV conduction and a ventricular rate at 220 bpm. This atrial pro-arrhythmic effect is rare and the mechanism is discussed.

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The authors report the case of a 68-year-old woman who suffered from an acute massive pulmonary embolism. The common electrocardiographic findings were not observed, but rather an extreme QT prolongation. The patient has been successfully treated by thrombolysis. After a few days, the electrocardiogram normalized. These electrocardiographic changes have not yet been described in the medical literature.

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The congenital complete heart block (CCHB) is a rare affection. In our two centers, in a period of 10 years, 1405 pacemakers were placed and only 10 (0.71%) for CCHB. We review the clinical history, the EKG's, echocardiography and Holter monitoring of these 10 patients. All of them were symptomatic. After pacemaker implantation, symptoms were improved in 90%. No death or other morbidity were observed during the long-term follow-up. So, the clinical outcome of patients with CCHB who underwent prophylactic pacemaker implantation seems to be associated with an excellent prognosis.

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Recent publications have demonstrated that the implantable cardioverter defibrillator (ICD) improves survival in patients with ventricular tachycardia (VT) or fibrillation (VF) by reducing arrhythmic death. We report the case of a patient with a history of an old myocardial infarction and a left ventricular dysfunction, who presented four episodes of syncope associated with a hemodynamically not well tolerated sustained VT, who had easy inductible clinical VT during electrophysiologic study and required an ICD. After a follow-up of 2 months, the patient presents a complete AV block and multiple episodes of torsades de pointes that sometimes degenerate into VF. The ICD delivered 64 adequate and well-tolerated shocks during 10 hours before and during the hospital admission. We programmed a VVI pacing rate at 65 bpm and no more arrhythmia was observed. The left ventricular ejection fraction was not altered afterwards. In conclusion, we experienced the temporary efficacy of the ICD in the treatment of incessant torsades de pointes, without myocardial injury.

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One hundred and twenty-eight patients had a stress test with sestamibi injection and a coronarography within 2 months of the sestamibi study. Sestamibi studies were reconstructed using Hanning 0.65 and Wiener 1.0 filters; the latter improved the results significantly (P < 0.05). Significant correlations were found between sestamibi and coronarography: the sensitivity was 0.967 and the specificity was 0.711. Thus sestamibi is a very good compound, with excellent imaging quality, which is very sensitive for mild defects, even more sensitive than coronarography. Thorough studies of discrepancies show that they could be explained by reductions in coronary flow or myocardial reserve, even when the large epicardial vessels are disease free as occurs in various coronary involvements. A follow-up of positive patients with sestamibi and negative coronarography is absolutely necessary since this group of patients represents a 'risk' group. Moreover, sestamibi single photon emission computed tomographic accuracy is highly dependent on filter choice.

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We report a case of coronary artery spasm induced by 5-fluorouracil. The symptoms occurred during continuous intravenous infusion of the drug, and a coronary spasm was visualized at angiography.

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Fifty-four patients with a symptomatic ventricular arrhythmia underwent two 24-hour electrocardiographic recordings, respectively before and after two to three weeks treatment with mexiletine, at a dose of 200 mg three times a day. According to the reduction in the number of premature beats, the effectiveness of the treatment was similar for patients with heart disease (group A), and for those suffering from an idiopathic arrhythmia (group B). A reduction of more than 80% was observed in 48.1% of the patients, and it was ranging between 50 and 80% in 13% of them. An increase in the number of premature beats was observed in 14.8%. According to the Lown's grading system, the shift from malignant (IV-V) to benign (I-III) grades was significant in group A only. The side effects justified the discontinuation of the treatment for 22.8% of an initial group of 70 patients, but were benign and totally reversible. Thus, mexiletine appears to be effective in the treatment of ventricular arrhythmias, with a relatively high incidence of benign and reversible side effects.

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An early exercise stress test was carried out in 116 patients 8 to 14 days after a myocardial infarction. This test is in good agreement with the late maximal stress test performed 8 weeks after the infarction, both tests being positive together in 86.4% and negative in 84.6% of the cases. Residual coronary insufficiency is present in 41.4% of the patients during the early test, 47.9% after inferior and 30.2% after anterior infarction. With beta blocking therapy, 28.2% of the patients had a positive test, and 48% without this treatment. The sensitivity of the early test is good after inferior infarction but poor after anterior infarction or during beta blocking therapy. A multivessel disease is disclosed by coronary angiography in 78.5% of the patients with a positive early stress test and in 53.3% in cases with a negative test. In the patients with a positive test, mortality at one year is higher (8.7% versus 2.9%). A coronary angiography should be performed relatively precociously in this group of patients.

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The aim of this study was to detect the cardiotoxicity of Adriamycin (ADM) by the evolution of the systolic time intervals (STI). The PEP/LVET ratio represents an easy and reproducible index of myocardial function. The more important this increase, the greater the risk of developing heart failure. A significant correlation exists between the variation of this ratio and the total administered dose, but the correlation coefficient is low. A heart failure may appear for doses of ADM under 500 mg/m2 but it is preceded by an increase of the index. In the absence of a significant modification, the generally admitted maximum dose of 550 mg/m2 may be exceeded. In case of a ratio increase in excess of 0.08 it will be necessary to balance the potential benefits of treatment with the hazards of cardiac failure. The PEP/LVET ratio allows proceeding with the cytostatic treatment in increased security by selecting the patients at high risk for cardiac failure.

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The incidence of ventricular arrhythmias after myocardial infarction was compared in a double blind study of disopyramide (33 patients), aprindine (34 patients) and placebo (31 patients). Total ventricular arrhythmias were less frequent in the aprindine group than in the disopyramide group (P less than 0.05) or than in the combined disopyramide and placebo groups (P less than 0.05). The incidence of life-threatening arrhythmias and of ventricular arrhythmias in high risk patients was also reduced by aprindine compared to disopyramide (P less than 0.001) or placebo (P less than 0.001). It is concluded that aprindine is effective in reducing ventricular arrhythmias and that further investigations on its preventive use after the onset of myocardial infarction are justified.

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