ABSTRACT
Los pacientes de la tercera edad están particularmente predispuestos a desarrollar episodios de fibrilación auricular paroxística (FAP), pudiendo ser los cambios que experimenta el miocardio auricular un factor contribuyente a la aparición de este fenómeno con el correr de los años. Por ende, diseñamos este trabajo con la idea de investigar los cambios que se producen en los electrogramas auriculares endocárdicos registrados por medio de un mapeo intraauricular con catéter en pacientes con FAP idiopática en la tercera edad. Realizamos un mapeo endocárdico con catéter de la aurícula derecha en ritmo sinusal en 72 pacientes con FAP idiopática para evaluar la influencia de la edad avanzada en los electrogramas auriculares endocárdicos. Los electrogramas bipolares fueron registrados de 12 sitios de la aurícula derecha, y un electrograma endocárdico auricular anormal fue definido como aquel que posee una duración ≥100 ms, y/o 8 o más deflexiones fragmentadas. Se registraron 864 electrogramas auriculares endocárdicos que fueron analizados cuantitativamente. El número de electrogramas auriculares anormales, así como la máxima duración y el mayor número de deflexiones fragmentadas de los electrogramas auriculares endocárdicos en los pacientes con FAP idiopática tuvo una correlación significativamente positiva con la edad. Se observó que la edad avanzada altera las propiedades electrofisiológicas del miocardio auricular haciéndolo más susceptible a desarrollar episodios de FAP. Estos cambios electrofisiológicos son más extensos conforme aumenta la edad. Existe un aumento progresivo en la extensión de la anormalidad electrofisiológica del miocardio auricular en pacientes de la tercera edad con fibrilación auricular paroxística idiopática.
There is a predisposition to develop paroxysmal atrial fibrillation (PAF) in aging patients,and theatrial musclechangesdue to the aging process could be a contributing factortothedevelopment of this tachyarrhythmia.Thus, we designedthis study to investigate thechangesobserved in the recorded atrial endocardial electrograms by means of an intra-atrial catheter mapping inpatients withidiopathicPAF. We performed an endocardialmapping of the right atrium in 72patientswith idiopathic PAFduring sinus rhythm toevaluate the influence of advancing age on the atrial endocardial electrograms. The bipolarelectrograms were recorded at 12 sites of the right atrium and an abnormal atrialelectrogram was defined as having a duration≥100 ms, and/or eight or more fragmenteddeflections.We recorded 864 atrial endocardial electrograms that were quantitativelyanalyzed. The number of abnormalatrial electrograms, as well asthe wider duration andthe greater number of fragmented deflections of the atrial endocardial electrograms,showed a significantpositive correlation with agingin patients with idiopathic PAF.It wasobserved that aging alters the electrophysiological properties of the atrial muscleincreasing the susceptibility to develop episodes of PAF. These electrophysiologicalchanges aremore extensivein advancing age. There is a progressive increase in theextension of the electrophysiologically altered atrial muscle in aging patients withidiopathicPAF.
Subject(s)
Atrial Fibrillation , MyocardiumABSTRACT
A 57-year-old Japanese-Brazilian man, visiting Japan for only 9 days, was admitted to our hospital due to syncope and frequent ventricular premature beats. He grew up in a rural area of Brazil and moved to Sao Paulo in 1959 when he was 20 years old. We suspected chronic Chagas' heart disease, i.e., dilated cardiomyopathy with apical ventricular aneurysm, right bundle branch block with left anterior fascicular block, and various arrhythmias including supraventricular premature beats, ventricular premature beats and non-sustained ventricular tachycardia because he showed typical echo- and electrocardiographic features of the disease. Coronary arteriograms were normal, and left ventriculogram confirmed the existence of apical ventricular aneurysm. A left ventricle biopsy specimen showed hypertrophic cardiac muscle with mild fibrosis. The diagnosis of chronic Chagas' disease was finally confirmed by the demonstration of Trypanosoma cruzi itself in the blood as well as Trypanosoma cruzi antibodies.
Subject(s)
Chagas Cardiomyopathy/diagnosis , Animals , Antibodies, Protozoan/blood , Brazil/ethnology , Chronic Disease , Electrocardiography , Humans , Japan , Male , Middle Aged , Travel , Trypanosoma cruzi/immunologySubject(s)
Arthroplasty/nursing , Hip Joint/surgery , Joint Prosthesis , Perioperative Nursing , HumansABSTRACT
Analysis has shown that the over-all death rate from renal disease for residents of New York City under 25 years of age has declined from 4.6 per 100,000 in 1950 to 2.3 per 100,000 in 1970. Nephritis and nephrosis was the major disease category accounting for this decrease in deaths. A similar trend was found for the United States as a whole. Other causes of renal disease did not manifest consistent changes in death rates. The decline in deaths from nephritis and nephrosis could not be ascribed solely to changing diagnostic habits or terminology. A possible alternative explanation is a change in the natural history of these diseases. Data of this type might be useful as an index to future trends in the mortality rate from renal diseases and as one basis for projections of potential future needs for dialysis and renal transplantation. Using 1965 data, we estimate the number of such potential candidates in New York City would have been 9 per 1,000,000 for the 5 to 14 year age group and 23 per 1,000,000 for the 15 to 24 year age group. There are significant limitations of projections based on such data. These estimates of potential candidates for chronic dialysis or renal transplantation are the first available for children in the United States.