ETUDE CRITIQUE DES EXPLORATIONS ENDOCAVITAIRES DANS LE DIAGNOSTIC DES BLOCS AURICULO VENTRICULAIRES PAROXYSTIQUES

Translated title of the contribution: A critical study of endocavitary examinations in the diagnosis of paroxysmal atrioventricular blocks

G. Motte, B. Belhassen, M. Vogel, P. Bellanger, J. J. Welti

Research output: Contribution to journalArticlepeer-review

Abstract

Endocavitary examinations were carried out in 106 patients in sinus rhythm, of whom 35 had a certain chronic atrioventricular block (group 1) and 71 had functional signs compatible with this diagnosis but in whom electrocardiographic proof had not been obtained (group 2). The presence of double His activity was a convincing factor in favour of the diagnosis of a paroxysmal atrioventricular block (truncal site). Equally, the probability of a block was greater the longer the HV interval was in the basal condition. However, a normal HV was not in any way an argument against this diagnosis, since it was found in half the cases of certain paroxysmal atrioventricular block. Right atrial stimulation was of considerable value when it provoked a second degree internodal block with frequencies less than 150 per min, or in particular when it revealed a 'paradoxical' type block (dependent on bradycardia) on extrasystolic stimulation. This method was unfortunately not very sensitive as it was positive in only one third of the group 1 and two of the group 2 patients. As long as the contraindications and the recommendations for administration are respected, an injection of ajmaline appears at present to be the best provocation test; this test was most valuable when it was strongly positive; that is when it indicated either a second or third degree internodal block or a massive lengthening of the HV interval. On the other hand, interpretation of the test is more difficult when the usual criteria of positivity are limited (HV doubling its initial value or reaching 90 ms) and when the test is negative its does not necessarily indicate that surgery is not required. Endocavitary examination thus gives most valuable information in the diagnosis of paroxysmal chronic atrioventricular block: but it has its limitations and the final decision can be taken only on the basis of several arguments, among which those originating from questioning retain a predominant place.

Translated title of the contributionA critical study of endocavitary examinations in the diagnosis of paroxysmal atrioventricular blocks
Original languageFrench
Pages (from-to)557-568
Number of pages12
JournalAnnales de Cardiologie et d'Angeiologie
Volume24
Issue number6
StatePublished - 1975
Externally publishedYes

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