Registro Costarricense de Resincronizadores, Desfibriladores Automáticos y Marcapasos Endovasculares (RECORDAME). I Informe oficial de la Comisión de Electrofisiología de la Asociación Costarricense de Cardiología (2019-2020) / Costa Rican Registry of Resynchronizers, Automatic Defibrillators and Endovascular Pacemakers (RECORDAME). I Official Report of the Electrophysiology Commission of the Costa Rican Cardiology Association (2019-2020)

Resumen Introducción y objetivo: Comunicar el primer informe del del registro nacional de dispositivos de estimulación cardíaca de agosto 2019 a agosto 2020, registro prospectivo de participación voluntaria. Métodos: Se analiza la información registrada, en forma voluntaria, por los centros implantadores con respecto a la población de pacientes a quienes se implantó un marcapaso, un desfibrilador o un resincronizador entre el 22 de agosto de 2019 hasta setiembre de 2020. Resultados: Se registraron un total de 317 procedimientos de marcapasos, por 10 centros implantadores, lo que corresponde a una participación en el registro de un 40%. La tasa de uso de marcapasos de 6,27 x 100 mil habitantes. Un 83% de los marcapasos fueron implantados en centros públicos, un 70% correspondió a dispositivos bicamerales. La edad media de la población fue de 73,7 años. La indicación más frecuente fue el trastorno de conducción AV (70,3%). Los electrodos de fijación activa fueron los más utilizados (97,8%). Un 83,3% de los sistemas implantados tuvieron compatibilidad con resonancia magnética. El uso de marcapasos unicamerales fue más frecuente en pacientes con 80 o más años. Con respecto a la terapia DAI se registraron un total de 63 procedimientos, por 5 centros implantadores, con una participación del 41%. La tasa total de implantes durante el período fue de 1,25 x 100 mil habitantes. La cardiomiopatía dilatada no isquémica fue la cardiopatía más frecuente en la población registrada. Conclusiones: El registro permite conocer la dinámica de procedimientos e indicaciones más usuales para el uso de dispositivos electrónicos cardíacos así como establecer la tasa de uso de las terapias en nuestro país. El porcentaje de participación en el registro puede mejorar. La implantación de dispositivos de estimulación cardíaca es financiada predominantemente por el sistema de seguridad social. La tasa de implantación es baja con respecto a otras regiones.

Abstract Costa Rican Registry of Resynchronizers, Automatic Defibrillators and Endovascular Pacemakers (RECORDAME). I Official Report of the Electrophysiology Commission of the Costa Rican Cardiology Association (2019-2020) Introduction and objective: To communicate the results of the first national registry of cardiac stimulation devices from August 2019 to August 2020. Methods: We analyze the information recorded prospectively, on a voluntary basis, by the implant centers with respect to the population of patients who were implanted with a pacemaker, a defibrillator or a resynchronizer between August 22, 2019 and September 2020. Results: A total of 317 pacemaker procedures were registered from 10 centers participated. Participation was 40% of total procedures reported by companies. The pacemaker implantation rate was 6.27 per hundred thousand. A 83% of pacemakers were implanted in public centers, 70% corresponded to dual chamber devices. Mean age of the population was 73.7 years. Most frequent indication was AV conduction disorder (70.3%). Active fixation electrodes were the most used (97.8%). A 83.3% were MRI conditional. Use of single chamber pacemakers was more frequent in patients aged 80 years or older. Regarding ICD therapy, a total of 63 procedures were registered. from 5 centers, with a participation of 41%. Rate of ICD use was 1.25 per hundred thousand. Non-ischemic dilated cardiomyopathy was the most common heart disease in the recorded population. Conclusions: The registry allowed to know the frequency of procedures and more usual indications as well as to establish the rate of use of therapies in our country. The percentage of participation in the registration can be improved. The implementation of cardiac stimulation devices is predominantly financed by the social security system. The implantation rate is low compared to other regions.

Clinimetric analysis of heart failure in Mexican patients / Análisis clinimétrico de la insuficiencia cardiaca en pacientes mexicanos

Abstract Heart failure (HF) is a syndrome characterized basically by a circulatory deficit to cover the metabolic and energetic demands of the body. This condition has a broad spectrum in its clinical presentation, affects the quality of life significantly, impacts the family/social environment, and generates a great demand for health services. The purpose of this research is to report the situational diagnose of patients with HF in Mexico. We evaluated 292 patients, 70.2% were men. Average age was 56.7 +- 14.3 years. Ischemic heart disease is the main etiology (98 patients, 33.9%) followed by hypertensive (22.6%) and idiopathic (23.3%) heart disease. The associated clinical background was obesity (31.1%), systemic hypertension (36.7%), myocardial infarction (26.4%), and dyslipidemia (15.1%). The most common symptom was stress dyspnea (41.4%) and jugular vein engorgement at physical examination (32.5%). Anemia was observed in 1% of patients. The average left ventricular ejection fraction was 29.2 +- 10.6%. Sinus rhythm was the most frequently detected in 84.9%. 19.9% of patients had an implantable cardioverter-defibrillator or cardiac resynchronization therapy. 13.7% of patients with QRS > 130 ms. In our population, the meta-analysis global group in chronic heart failure risk score calculated was 16.8 +- 5.7 and for EMPHASIS 3.3 +- 1.5. We observed that age at presentation in HF in this analysis is at least 10 years younger than in other reports. The grade of obesity takes relevance in our group. The association of anemia and HF in Mexico is rare.

Resumen La insuficiencia cardiaca es un síndrome caracterizado fundamentalmente por un déficit circulatorio para cubrir las demandas metabólicas y energéticas del organismo. Esta entidad tiene un amplio espectro en su presentación clínica, afecta de manera significativa la calidad de vida, impacta en el entorno familiar/social y genera una gran demanda de los servicios de salud. El propósito de esta investigación es reportar el diagnóstico situacional de pacientes con insuficiencia cardiaca (IC) en México. Evaluamos 292 enfermos, 70.2% eran hombres. Con edad promedio 56.7 +- 14.3 años. La principal etiología es la cardiopatía isquémica (33.9%), seguida de la hipertensiva (22.6%) e idiopática (23.3%). Los antecedentes clínicos asociados fueron: obesidad (31.1%), hipertensión arterial sistémica (36.7%), infarto al miocardio (26.4%) y dislipidemia (15.1%). El síntoma con mayor presentación fue la disnea de esfuerzos (41.4%) y a la exploración física la ingurgitación yugular (32.5%). Se observó anemia en 1% de los enfermos. La fracción de expulsión del ventrículo izquierdo (FEVI) promedio fue de 29.2 + 10.6%. El ritmo sinusal fue el más frecuentemente detectado en 84.9%. El 19.9% de los pacientes tenían instalado un desfibrilador automático implantable (DAI) o tratamiento de resincronización cardiaca (TRC). El 13.7% de los enfermos con QRS mayor de 130 ms. El riesgo (MAGGIC) calculado en nuestro grupo poblacional fue de 16.8 +- 5.7 y para EMPHASIS 3.3 +- 1.5. Observamos que la edad de presentación de la IC en el presente análisis es menor por 10 años en comparación con otros reportes. El grado de obesidad toma relevancia en nuestro grupo. La asociación de anemia e IC en México es poco frecuente.

Unscheduled Emergency Visits after Cardiac Devices Implantation: Comparison between Cardioverter Defibrillators and Cardiac Resynchronization Therapy Devices in less than one year of Follow Up / Consultas Não Programadas em Emergência após Implante de Dispositivos Cardíacos: Comparativo entre Cardiodesfibriladores e Ressincronizadores em Seguimento Inferior a 1 Ano

Abstract Background: The use of Cardiovascular Implantable Electronic Devices (CIED), such as the Implantable Cardioverter Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT), is increasing. The number of leads may vary according to the device. Lead placement in the left ventricle increases surgical time and may be associated with greater morbidity after hospital discharge, an event that is often confused with the underlying disease severity. Objective: To evaluate the rate of unscheduled emergency hospitalizations and death after implantable device surgery stratified by the type of device. Methods: Prospective cohort study of 199 patients submitted to cardiac device implantation. The groups were stratified according to the type of device: ICD group (n = 124) and CRT group (n = 75). Probability estimates were analyzed by the Kaplan-Meier method according to the outcome. A value of p < 0.05 was considered significant in the statistical analyses. Results: Most of the sample comprised male patients (71.9%), with a mean age of 61.1 ± 14.2. Left ventricular ejection fraction was similar between the groups (CRT 37.4 ± 18.1 vs. ICD 39.1 ± 17.0, p = 0.532). The rate of unscheduled visits to the emergency unit related to the device was 4.8% in the ICD group and 10.6% in the CRT group (p = 0.20). The probability of device-related survival of the variable "death" was different between the groups (p = 0.008). Conclusions: Patients after CRT implantation show a higher probability of mortality after surgery at a follow-up of less than 1 year. The rate of unscheduled hospital visits, related or not to the implant, does not differ between the groups.

Resumo Fundamento: O uso de dispositivos cardíacos eletrônicos implantáveis (DCEI) como o cardiodesfibrilador (CDI) e terapia de ressincronização cardíaca (TRC) - é cada vez maior. O número de eletrodos de estimulação e desfibrilação varia de acordo com o dispositivo. A colocação do eletrodo no ventrículo esquerdo aumenta o tempo cirúrgico podendo associar-se a maior morbidade no acompanhamento após alta hospitalar, evento muitas vezes confundível com a gravidade da patologia base. Objetivo: Avaliar a taxa de internação não programada na emergência e óbito após cirurgia de dispositivos implantáveis estratificados pelo tipo de aparelho. Métodos: Estudo de coorte prospectivo analisando 199 pacientes submetidos à implante de dispositivos cardíacos. Os grupos foram divididos de acordo com o tipo de dispositivo: CDI (n = 124) e TRC (n = 75). Estimativas de probabilidades foram analisadas pelo método de Kaplan-Meier de acordo com o desfecho. Valor de p < 0,05 foi considerado significativo nas análises estatísticas. Resultados: A maioria da amostra era do sexo masculino (71,9%) - idade média de 61,1 ± 14,2. A fração de ejeção do ventrículo esquerdo foi similar entre os grupos (TRC 37,4 ± 18,1 vs. CDI 39,1 ± 17,0; p = 0,532). A taxa de visita não programada na emergência relacionada ao dispositivo foi de 4,8% no grupo CDI e de 10,6% no grupo TRC (p = 0,20). A probabilidade de sobrevida relacionada ao dispositivo da variável "óbito" mostrou-se diferente entre os grupos (p = 0,008). Conclusões: Paciente após o implante de TRC apresenta maior probabilidade de mortalidade após o procedimento cirúrgico no seguimento menor que 1 ano. A taxa de visita hospitalar não programada, relacionadas ou não ao implante, não difere entre os grupos.

Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: What has Changed in The Guidelines? / Prevenção de Morte Súbita Cardíaca em Doentes com Miocardiopatia Hipertrófica: O Que Mudou nas Guidelines?

Abstract Background: The new European Society of Cardiology guidelines for hypertrophic cardiomyopathy (HCM) define the estimation of sudden cardiac death (SCD) risk as an integral part of clinical management. An implantable cardioverter defibrillator (ICD) is recommended (class IIa) when the risk is ≥ 6%. Objectives: To compare the SCD risk stratification according to the 2011 and 2014 recommendations for ICD implantation in patients with HCM. Methods: Retrospective study including 105 patients diagnosed with HCM. The indication for ICD was assessed using the 2011 and 2014 guidelines. Statistical analysis was performed using SPSS software version 19.0.0.2®. The tests performed were bilateral, considering the significance level of 5% (p < 0.05). Results: Regarding primary prevention, according to the 2011 ACCF/AHA recommendations, 39.0% of the patients had indication for ICD implantation (level of evidence IIa). Using the 2014 guidelines, only 12.4% of the patients had an indication for ICD implantation. Comparing the two risk stratification models for patients with HCM, we detected a significant reduction in the number of indications for ICD implantation (p < 0.001). Of the 41 patients classified as IIa according to the 2011 recommendations, 68.3% received a different classification according to the 2014 guidelines. Conclusion: Significant differences were found when comparing the SCD risk stratification for ICD implantation in the two guidelines. The current SCD risk score seems to identify many low-risk patients who are not candidates for ICD implantation. The use of this new score results in a significant reduction in the number of ICD implanted.

Resumo Fundamento: As recomendações de miocardiopatia hipertrófica (MCH) da Sociedade Europeia de Cardiologia aconselham a estimativa do risco de morte súbita cardíaca (MSC) como parte da avaliação clínica e decisão de implantação de cardioversor desfibrilador implantável (CDI). Objetivo: Comparar a estratificação de risco de MSC de acordo com as recomendações de 2011 e 2014. Métodos: Estudo retrospectivo de 105 pacientes com diagnóstico de MCH. Avaliou-se a recomendação para implantação de CDI conforme as recomendações de 2011 e 2014. A análise estatística foi realizada usando o software SPSS versão 19.0.0.2®. Os testes realizados foram bilaterais, sendo considerado o nível de significância de 5% (p< 0,05). Resultados: Conforme as recomendações ACCF/AHA 2011, 39,0% dos pacientes tinham indicação para implantação de CDI (nível de evidência classe IIa). Conforme as recomendações de 2014, apenas 12,4% dos pacientes apresentam indicação classe IIa para implantação de CDI. Comparando os dois modelos de estratificação de risco de MSC em MCH, verificou-se uma redução significativa na proporção de pacientes com indicação para implantação de CDI (p < 0,001). Do total de 41 pacientes classificados como IIa segundo as recomendações de 2011, 68,3% deles recebeu uma classificação diferente em 2014. Conclusão: No estudo foram encontradas diferenças significativas quando comparados os métodos de estratificação de risco de MSC para implantação de CDI. O escore de risco atual parece identificar muitos pacientes de baixo risco, que não são candidatos à implantação de CDI. A utilização desse novo escore resulta numa redução significativa do número de CDI implantados.

Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients / Evolução Clínica Pós-Implante de Desfibrilador Cardíaco: Pacientes Chagásicos Versus Isquêmicos

Abstract Background: The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial. Objective: To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD). Methods: Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared. Results: The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups. Conclusion: CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients.

Resumo Fundamento: A evolução do paciente chagásico após implante de cardiodesfibrilador implantável (CDI) é tema ainda controverso. Objetivo: Comparar a evolução clínica pós-implante do CDI em pacientes com cardiopatia chagásica crônica (CCC) e cardiopatia isquêmica (CI). Métodos: Trata-se de um estudo prospectivo histórico de uma população de 153 pacientes portadores de CDI, sendo 65 com CCC e 88 com CI. Os dispositivos foram implantados entre janeiro de 2003 e novembro de 2011, tendo-se comparado a taxa de sobrevida e a sobrevida livre de eventos entre essas populações. Resultados: Os grupos foram similares na predominância do sexo masculino, classe funcional e fração de ejeção. Os pacientes isquêmicos são em média 10 anos mais velhos que os chagásicos (p < 0,05). Os pacientes chagásicos apresentavam escolaridade e renda mensal mais baixa do que os isquêmicos (p < 0,05). Foi demonstrado que o número de terapias apropriadas nos pacientes com CCC é 2,07 vezes maior do que naqueles com CI. A incidência de choque apropriado é maior na CCC (p < 0,05). As taxas de mortalidade anual nos dois grupos foram similares, assim como a incidência de tempestade elétrica. Não houve nenhuma morte súbita nos pacientes com CCC e apenas uma nos pacientes com CI. Não houve diferença estatisticamente significativa no tempo de sobrevida entre os dois grupos (p = 0,720) nem na sobrevida livre de eventos (p = 0,143). Conclusão: A CCC duplica o risco de receber terapias apropriadas em relação à CI, mostrando assim maior complexidade das arritmias nos pacientes chagásicos.

Low educational level but not low income impairs the achievement of cytogenetic remission in chronic myeloid leukemia patients treated with imatinib in Brazil

OBJECTIVES: In Brazil, imatinib mesylate is supplied as the first-line therapy for chronic myeloid leukemia in the chronic phase through the public universal healthcare program, Sistema Único de Saúde (SUS). We studied the socio-demographic factors that influenced therapy success in a population in the northeast region of Brazil. METHODS: Patients with chronic myeloid leukemia from the state of Piauí were treated in only one reference center. Diagnosis was based on WHO 2008 criteria. Risk was assessed by Sokal, Hasford and EUTOS scores. Patients received 400 mg imatinib daily. We studied the influence of the following factors on the achievement of complete cytogenetic response within one year of treatment: age, clinical risk category, time interval between diagnosis and the start of imatinib treatment, geographic distance from the patient's home to the hospital, years of formal education and monthly income. RESULTS: Among 103 patients studied, the median age was 42 years; 65% of the patients had 2-9 years of formal education, and the median monthly income was approximately 100 US$. Imatinib was started in the first year after diagnosis (early chronic phase) in 69 patients. After 12 months of treatment, 68 patients had a complete cytogenetic response. The Hasford score, delay to start imatinib and years of formal education influenced the attainment of a complete cytogenetic response, whereas income and the distance from the home to the healthcare facility did not. CONCLUSION: Patients require additional healthcare information to better understand the importance of long-term oral anticancer treatment and to improve their compliance with the treatment. .

Cardiodesfibriladores implantables. Diecinueve años de experienciaen un centro de nuestro país.Estudio retrospectivo en el seno de una cohorte prospectiva. Supervivencia de pacientes, dispositivos y tiempo libre de eventos en 182 pacientes portadores de cardiodesfibrilador implantable / Implantable defibrillators. Nineteen years of experience a center of our country. A retrospective study within a prospective cohort. Survival of patients, devices and event-free time in 182 patients with implantable cardioverter-defibrillators

Introducción: el desfibrilador automático implantable (DAI) mejora la supervivencia en pacientes con riesgo de muerte súbita cardíaca (MSC). Aunque en nuestro país se utiliza desde hace 19 años, existen escasos datos de seguimiento acerca de su eficacia. Material y método: cohorte prospectiva observacional de 182 pacientes con primoimplante de DAI reclutada en el período2/1993 - 6/2011, que se cerró el 31/6/2012. Edad media: 57 ± 14 años, 83% hombres, 37% fracción de eyección del ventrículo izquierdo (FEVI)<30%, 51% portadores de cardiopatía isquémica y 73% indicación en prevención secundariade MSC. Eventos incidentes considerados: muerte, recambio y primer evento. La probabilidad acumulada de supervivencia se estimó a través de un modelo de Kaplan-Meier (KM), utilizando el SPSS V17.0. Se calcularon las tasas de incidenciaen personas-año-1(IC95%) del primer evento según las respuestas del DAI. Resultados: supervivencia de pacientes: luego de un seguimiento de 988 años-paciente, (mediana: 4 años), la probabilidad de supervivencia (KM, IC95%) al cierre fue de 30% (5%-55%). Vida útil del dispositivo: luego de 619 años-paciente de seguimiento (mediana: 3,7 años), la probabilidad de recambio (KM, IC95%) fue de 2,4% (2%-7%). Supervivencia libre deeventos: luego de 428 años-paciente de seguimiento (mediana: 1,3 años), la probabilidad acumulada libre de primer evento (KM, IC95%) fue de 10% (1%-19%). Tasas de incidencia de choques y terapias antitaquicardia apropiadas 0,20(0,16-0,24) e inapropiados 0,07 (0,04-0,10). Conclusión: el seguimiento prolongado de pacientes portadores de DAI mostró probabilidades de supervivencia de pacientes, vida útil de los dispositivos y tiempo libre de eventos aceptables.

Introduction: Implantable cardioverter defibrillator (ICD) has been reported to improve survival in patients at risk for sudden cardiac death (SCD). There is little follow up data in patients with ICD implant in Uruguay, although it has been used for 19 years already.Methods: A prospective observational cohort of 182 patients with first ICD implant was enrolled between February/1993 and June/2011. The follow up period was closed on 31/06/2012. Clinical characteristics: average age 57 ± 14 years, 83% men, 37% with left ventricular ejection fraction < 30%, coronary artery disease: 51% and secondary prevention ICD implant: 73%. Death, device replacement and first event were considered as end points. Survival curves were calculated by the Kaplan-Meier method (KM), using the SPSS V17.0. Incidence rates of first events were calculated in person-year-1 (IC95%) according to the ICD recorded therapies.Results: Overall survival: after a follow up of 988 years-patient (median: 4 years), the cumulative probability of survival (KM, IC95%) was 30% (% 5-55%). Device’s life time: after a follow up of 619 years-patient (median: 3,7 years) the cumulative probability of replacement (KM, IC95%) was 2,4% (2-7%). Events free survival: after a follow up of 428 years-patient (median: 1,3 years), the cumulative probability of events free survival (KM, IC95%) was 10% (1-19%). The incidence rate of appropriate shocks and antitachycardia therapy was 0,20 (0,16-0,24) and the inappropriate one was 0,07 (0,04-0,10).Conclusion: An acceptable probability of patients survival and device’s life time as well as an acceptable events free survival were observed in this cohort over a long follow up period.

Magnets and implantable cardioverter defibrillators: What's the problem.

A growing number of surgical patients present to the operating room with implantable cardioverter defibrillators (ICD). Peri-operative care of these patients dictates that ICD function be suspended for many surgical procedures to avoid inappropriate, and possibly harmful, ICD therapy triggered by electromagnetic interference (EMI). An alternative to reprogramming the ICD is the use of a magnet to temporarily suspend its function. However, this approach is not without complications. We report a case where magnet use failed to inhibit ICD sensing of EMI, and a shock was delivered to the patient. Measures to decrease EMI, controversies regarding magnet use, and expert recommendations are discussed.

Survey of cardiac rhythm management and device implant patterns in Puerto Rico: analysis of 13.854 cardiac implants

BACKGROUND: Surveys of cardiac pacing and implantable cardiovertor defibrillators (ICD) have been reported since 1969 and 1993 respectively. Increasing costs of medical technology, budget constraints and emergent new clinical indications prompted our committee to conduct the first survey of cardiac rhythm management and device implant patterns in Puerto Rico. METHOD: Clinical and demographic data were obtained for all cardiac devices sold and implanted from 2000 to 2006, through a joint agreement with official representatives of the 2 largest manufacturers and distributors of cardiac pacemakers and ICD in Puerto Rico. RESULTS: 13,854 cardiac devices were implanted from 2000 to 2006. The number of permanent pacemakers (PP) implanted per million population has varied from 430 in the year 2000 to 482 in the year 2006. A significant greater number of males received PP than females (P < .05). Yearly increases in implant rates for cardiac resynchronization therapy (CRT) and ICD were observed, mainly due to new emergent clinical indications, appropriate insurance coverage and availability of implanting electrophysiologists. CONCLUSIONS: Sales figures from PP and ICD manufacturers are a reliable system to calculate and analyze changes in cardiac device implant patterns. The rate of 482 PP per million population positions Puerto Rico as the third largest implant market in North and South America. This finding should be useful to insurance health providers since 76% of the implants are performed in patients over 65 years old. In the year 2006, Puerto Rico was the 10th largest implant market in the world with 67 CRT implanted per million population. A significant greater number of CRT and ICD were implanted in males than females. This gender difference has increased in spite of strict requirements to include more females in clinical trials and intensive, educational and awareness efforts conducted among physicians and patients. A summary of the current guidelines and...

Incidência de choques e qualidade de vida em jovens com cardioversor-desfibrilador implantável / Incidence of shock and quality of life in young patients with implantable cardioverter-defibrillator

OBJETIVOS: Avaliar a incidência e a causa de choques de CDI em crianças e adolescentes e sua repercussão na qualidade de vida (QV). MÉTODOS: De março/1997 a fevereiro/2006, 29 pacientes (15,7±5,4 anos) foram submetidos a implante de CDI. Parada cardiorrespiratória recuperada (41,5 por cento), taquicardia ventricular sustentada (27,6 por cento) e profilaxia primária de morte súbita cardíaca (30,9 por cento) motivaram os implantes. O número de terapias foi avaliado por entrevista e pela telemetria dos CDI. A QV foi avaliada pela aplicação do questionário SF-36 e comparada à de indivíduos saudáveis. Empregou-se o método de Kaplan-Meier para análise da sobrevida livre de choques. RESULTADOS: Após 2,6±1,8 anos de seguimento, 8 (27,6 por cento) pacientes receberam 141 choques apropriados em razão de TV polimórfica (6) ou FV (2), e 11 (37,9 por cento) sofreram 152 choques inapropriados em razão de taquiarritmias supraventriculares (8) ou oversensing (3). A expectativa de sobrevida livre de choques apropriados foi de 74,2 por cento±9,0 após um ano, e de 66,7 por cento±10,7 após três anos. Observou-se diminuição da QV nos aspectos físicos (61,7±28,7), na vitalidade (64,7±19,1), na saúde mental (65,9±22,7) e nos aspectos emocionais (66,7±38,5). Medo e preocupações relacionados ao CDI foram referidos por todos os pacientes. CONCLUSÃO: A despeito da grande eficácia dessa terapêutica, a incidência elevada de choques interferiu na QV e na adaptação ao dispositivo.

OBJECTIVES: To analyze the incidence and causes of ICD therapies in children and young adults and verify their impact on the quality of life (QoL). METHODS: From March/1977 to February/2006, 29 patients (15.7±5.4 years old) were submitted to ICD implants. Aborted cardiac arrest (41.5 percent), sustained ventricular tachycardia (27.6 percent) and primary prophylaxis of sudden cardiac death (30.9 percent) indicated device therapy. The number of therapies was evaluated by interviewing patients and by ICD diagnostic data. The SF-36 questionnaire was used to measure the QoL and the results were compared to healthy population. The expectative of freedom from ICD therapies were estimated by the Kaplan-Meier method. RESULTS: After 2.6±1.8 years follow-up, 8 (27.6 percent) patients received 141 appropriate ICD shocks due to ventricular tachycardia (6) or ventricular fibrillation (2), and 11 (37.9 percent) patients received 152 inappropriate ICD shocks due to supraventricular tachyarrhythmias (8) or oversensing (3). Expectative of freedom from appropriate shocks was 74.2±9.0 percent and 66.7±10.7 percent after one and three years, respectively. Compared to healthy population, QoL decreased in physical function (61.7±28.7), vitality (64.7±19.1), mental health (65.9±22.7) and role-emotional domains (66.7±38.5). All patients referred fear and concern related to ICD use. CONCLUSION: Despite the efficacy of ICD therapies, the high incidence of appropriate and inappropriate shocks interfered in patients' QoL and adaptation to the device.

Casi muerte súbita recuperada tras fibrilación ventricular / Near sudden death recovered to ventricular fibrillation

El síndrome de bloqueo de rama derecha, elevación del segmento ST en las derivaciones V1 a V3 y muerte súbita es una nueva entidad (distinta de otros síndromes, como el síndrome del QT largo o la displasia ventricular derecha), que está determinada por anomalías genéticas que afectan al canal de sodio y se denomina síndrome de Brugada. El único tratamiento que podemos ofrecer a estos pacientes actualmente es un desfibrilador implantable

Pacientes con síncope de etiología desconocida y arritmias ventriculares inducibles tratados con desfibrilador implantable / Patients with syncope of unknown origin and inducible ventricular arrhythmias treated with an implantable defibrillator

La evolución y tratamiento de pacientes con síncope y anomalías cardíacas sin una clara etiología no ha sido bien definido. Muchos pacientes tienen en su evaluación un estudio electrofisiológico. En estas evaluaciones generalmente se encuentran anormalidades del nódulo sinusal, prolongación de los tiempos de conducción o arritmias inducibles, asumiéndose que ésa es la causa del síncope, y según esto se tratan los pacientes. Sin embargo no está bien definido que las taquiarritmias sean la verdadera causa del síncope y que su tratamiento puede prevenir la recurrencia del síncope y la muerte arrítmica. De 320 pacientes consecutivos con síncope de origen no determinado 163 tenían anomalías cardíacas. En 26 de los 163 (16 por ciento) la estimulación eléctrica programada desencadenó arritmias ventriculares sostenidas. En 21 de los 26 pacientes se implantó un desfibrilador automático, formando éstos el grupo de estudio. Todos aquellos con más de un año de seguimiento desde su implante recibieron terapias apropiadas por el dispositivo. Estos datos avalan la práctica del uso del desfibrilador implantable en pacientes con anomalías cardíacas que presentan síncope de origen no conocido y arritmias ventriculares inducibles en el estudio electrofisiológico