[Predictive factors of the therapeutic result in the prevention of auricular fibrillation. Role of electrophysiological studies].
A population of 50 patients suffering from paroxysmal attacks of atrial fibrillation was studied prospectively to evaluate the prognostic value of 20 variables: 6 clinical variables: sex, age, cardiopathy, number of arrhythmic attacks, "vagal" triggering, failure of class IA antiarrhythmic agents; 3 echocardiographic variables: left ventricular diastolic diameter and percentage of fibre shortening, left atrial diameter; 6 basic electrophysiological data: threshold, refractory periods at 110 and 150/min, modalities of induction of a sustained arrhythmia; 4 results observed with an infusion of flecainide in doses of 2 mg/kg: arrest or persistence of the arrhythmia, whether or not it could be reinduced and value of refractory periods; doses of flecainide administered orally. With a mean +/- SD follow-up period of 7.7 +/- 7.3 months, preventive treatment with flecainide 233 +/- 7 mg failed in 16 patients (32 per cent) and succeeded in 34 patients (68 per cent). Analysis of Kaplan-Meier curves and use of Cox's multidimensional model showed that two electrophysiological data were of prognostic value: atrial effective refractory period, and non-inducibility of the arrhythmia after intravenous administration of flecainide. Thus, the probability of failure increases with the refractory period value and decreases with the non-inducibility of the arrhythmia.
Haissaguerre
M
M
Service de cardiologie, hôpital Saint-André, Bordeaux.
Dulhoste
M N
MN
Commenges
D
D
Salamon
R
R
Lemetayer
P
P
Warin
J F
JF
D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control* / Q000628:therapy; D004594:Electrophysiology; D005069:Evaluation Studies as Topic; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013223:Statistics as Topic
D005424:Flecainide
Eléments prédictifs du résultat thérapeutique dans la prévention des fibrillations auriculaires. Rôle de l'étude électrophysiologique.