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1.
Arch. cardiol. Méx ; 93(4): 398-404, Oct.-Dec. 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1527716

RESUMO

Abstract Objective: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. Methods: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. Results: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. Conclusion: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.


Resumen Objetivo: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. Métodos: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. Resultados: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). Conclusiones: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

2.
Arch Cardiol Mex ; 93(4): 398-404, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37972358

RESUMO

OBJECTIVE: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. METHODS: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. RESULTS: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. CONCLUSION: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.


OBJETIVO: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. MÉTODOS: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. RESULTADOS: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). CONCLUSIONES: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.


Assuntos
Fibrilação Atrial , Flutter Atrial , Ablação por Cateter , Marca-Passo Artificial , Humanos , Nó Sinoatrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Estudos Prospectivos , Eletrocardiografia , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/terapia , Fibrilação Atrial/cirurgia , Resultado do Tratamento
3.
Arch Cardiol Mex ; 91(4): 480-484, 2021 Nov 01.
Artigo em Espanhol | MEDLINE | ID: mdl-34491247

RESUMO

MASS syndrome (disorder of connective tissue characterized by involvement of the mitral valve, aorta, skeleton, and skin) is a rare genetic disease with a phenotype similar to that of Marfan syndrome, but with important cardiovascular differences like the absence of aortic root aneurysm and marked mitral affection. We present a case of a patient with MASS syndrome and review the limited literature addressing these differences, and we discuss the impact this information may have in decisions regarding cardiovascular surgery.


El síndrome de MASS (que afecta a: válvula mitral [M], aorta [A], piel [S, skin], sistema musculoesquelético [S, skeletal]) es una rara enfermedad genética con un fenotipo similar al del síndrome de Marfan, pero con diferencias cardiovasculares importantes, como ausencia de afección de la raíz aórtica y marcada afectación mitral. Presentamos el caso de una paciente con síndrome de MASS y revisamos la limitada literatura con respecto a estas diferencias; finalmente discutimos acerca del impacto que pudiera tener esta información con respecto a las decisiones desde el punto de vista de la cirugía cardiovascular.


Assuntos
Síndrome de Marfan , Prolapso da Valva Mitral , Miopia , Dermatopatias , Humanos , Masculino , Síndrome de Marfan/complicações , Prolapso da Valva Mitral/genética , Prolapso da Valva Mitral/cirurgia , Miopia/genética , Miopia/cirurgia , Fenótipo , Dermatopatias/genética , Dermatopatias/cirurgia , Adulto Jovem
4.
Arch Cardiol Mex ; 91(1): 93-99, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33661876

RESUMO

La terapia de resincronización cardiaca mediante estimulación hisiana ha demostrado ser efectiva en pacientes con bloqueo de rama izquierda del haz de His e insuficiencia cardiaca. Paciente masculino, con 47 años de edad, con insuficiencia cardiaca, fracción de expulsión del 17% y miocardio dilatada idiopática, electrocardiograma en ritmo sinusal, bloqueo auriculoventricular de 1.er grado, intervalo PR 400 ms, bloqueo completo de rama derecha del haz de His, bloqueo del fascículo anterior de la rama izquierda del haz de His, duración del QRS 200 ms. Se decidió realizar estimulación selectiva del haz de His. La resincronización cardiaca biventricular convencional en pacientes con presencia de bloqueo completo de la rama derecha del haz de His no está indicada debido a la pobre respuesta al tratamiento. La estimulación hisiana permite reclutar la rama bloqueada y reestablecer la conducción a través de ella, de tal forma que, en ausencia de necrosis, se logre sincronía biventricular. En el caso presentado el reclutamiento de la rama derecha mediante estimulación hisiana se reflejó en el restablecimiento de la sincronía biventricular, medida por rastreo de marcas (speckle tracking) e incremento significativo de la fracción de expulsión del ventrículo izquierdo del 17 al 36.6%, con un incremento absoluto del 19.6%.Cardiac resynchronization therapy has proven to be an effective therapy in patients with left bundle branch block and heart failure. Male, 47 years old, heart failure with a left ventricle ejection fraction of 17%, idiopathic heart failure. ECG with sinus rhythm, 1st degree AV block, PR 400 ms, complete right bundle branch block, anterior hemi-fascicle of the left bundle of His, and QRS duration 200 ms. We decided to perform a selective His bundle pacing. In patients with right bundle branch block the biventricular cardiac resynchronization is not indicated due to low treatment response. His bundle pacing allows recruiting the blocked branch and restoring conduction throughout it, therefore, in the absence of necrosis the biventricular synchrony is achieved. We presented a case of His bundle pacing with recruitment of the right bundle branch, which reestablish biventricular synchrony measured by speckle tracking, and with a significant increase of the left ventricle ejection fraction from 17 to 36.6%, with an absolute increase of 19.6%.


Assuntos
Fascículo Atrioventricular , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Bloqueio de Ramo/complicações , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade
5.
Arch. cardiol. Méx ; 91(1): 93-99, ene.-mar. 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1152865

RESUMO

Resumen La terapia de resincronización cardiaca mediante estimulación hisiana ha demostrado ser efectiva en pacientes con bloqueo de rama izquierda del haz de His e insuficiencia cardiaca. Paciente masculino, con 47 años de edad, con insuficiencia cardiaca, fracción de expulsión del 17% y miocardio dilatada idiopática, electrocardiograma en ritmo sinusal, bloqueo auriculoventricular de 1.er grado, intervalo PR 400 ms, bloqueo completo de rama derecha del haz de His, bloqueo del fascículo anterior de la rama izquierda del haz de His, duración del QRS 200 ms. Se decidió realizar estimulación selectiva del haz de His. La resincronización cardiaca biventricular convencional en pacientes con presencia de bloqueo completo de la rama derecha del haz de His no está indicada debido a la pobre respuesta al tratamiento. La estimulación hisiana permite reclutar la rama bloqueada y reestablecer la conducción a través de ella, de tal forma que, en ausencia de necrosis, se logre sincronía biventricular. En el caso presentado el reclutamiento de la rama derecha mediante estimulación hisiana se reflejó en el restablecimiento de la sincronía biventricular, medida por rastreo de marcas (speckle tracking) e incremento significativo de la fracción de expulsión del ventrículo izquierdo del 17 al 36.6%, con un incremento absoluto del 19.6%.


Abstract Cardiac resynchronization therapy has proven to be an effective therapy in patients with left bundle branch block and heart failure. Male, 47 years old, heart failure with a left ventricle ejection fraction of 17%, idiopathic heart failure. ECG with sinus rhythm, 1st degree AV block, PR 400 ms, complete right bundle branch block, anterior hemi-fascicle of the left bundle of His, and QRS duration 200 ms. We decided to perform a selective His bundle pacing. In patients with right bundle branch block the biventricular cardiac resynchronization is not indicated due to low treatment response. His bundle pacing allows recruiting the blocked branch and restoring conduction throughout it, therefore, in the absence of necrosis the biventricular synchrony is achieved. We presented a case of His bundle pacing with recruitment of the right bundle branch, which reestablish biventricular synchrony measured by speckle tracking, and with a significant increase of the left ventricle ejection fraction from 17 to 36.6%, with an absolute increase of 19.6%.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio de Ramo/terapia , Fascículo Atrioventricular , Terapia de Ressincronização Cardíaca , Bloqueio de Ramo/complicações , Insuficiência Cardíaca/complicações
6.
J Electrocardiol ; 60: 72-76, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32304903

RESUMO

Although most cases of Brugada syndrome have been described in adults, pediatric patients with the disease have been reported since the original article from Josep and Pedro Brugada. Herein is presented the case series of Brugada syndrome in pediatric population of the National Institute of Cardiology Ignacio Chavez. One boy and two adolescent males had palpitations as clinical presentation of the disease. Atrial arrhythmias were documented in two, in the third case there was a high clinical suspicion and quinidine abolished symptoms. The aim of this report is to highlight the importance of performing a detailed clinical history as well as the usefulness of high precordial leads for the diagnosis of this entity.


Assuntos
Síndrome de Brugada , Adolescente , Arritmias Cardíacas , Síndrome de Brugada/diagnóstico , Criança , Morte Súbita Cardíaca , Eletrocardiografia , Humanos , Masculino , Quinidina/uso terapêutico
7.
Case Rep Cardiol ; 2017: 6418070, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29109869

RESUMO

Phrenic nerve injury (PNI) is a rare complication of catheter ablation therapy, most commonly observed in cryoablation of the right side pulmonary veins. We present a case of PNI after radiofrequency catheter ablation that developed acute dyspnea 24 hours after the intervention. Dyspnea is the main symptom of PNI, so the diagnosis should always be suspected if it appears after any type of catheter ablation involving the trajectory of the phrenic nerve. There is no specific treatment for PNI. The only maneuver that has been reported to accelerate the recovery of PNI is early stopping of the ablation therapy.

8.
BMJ Case Rep ; 20142014 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-25404247

RESUMO

We describe two patients with cardiac tumors in the left atrium, which by their association and histopathological lineage, are extremely rare. The clinical, echocardiographic and pathological findings were analysed. The first case was asymptomatic, but in the control studies of colon adenocarcinoma, an intracardiac mass was found by chest computed tomography (CT). A transesophageal 3D (TEE 3D) echocardiogram revealed a left atrial mass attached to the interatrial septum. The mass was surgically removed and histopathologic findings showed myxoma. The second had history of chronic intermittent diarrhea. A thoraco-abdominal CT showed a left atrial mass. The TEE 3D echocardiography reported an intracardiac mass attached to the roof of the left atrium. The mass was surgically removed and the histopathogical findings showed a myxoma, with dystrophic ossification and extramedullary hematopoiesis. TEE 3D echocardiography provides an acceptable morphological characterisation of intracardiac masses, with good correlation with surgery.


Assuntos
Septo Interatrial/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Idoso , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Tomografia Computadorizada por Raios X
9.
Arch. cardiol. Méx ; 83(4): 244-248, oct.-dic. 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-703024

RESUMO

Introduction: Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium. Methods: Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment. Results: The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up. Conclusions: A progressive approach with only one activation/voltage CARTO® map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.


Introducción: La ablación con radiofrecuencia de flutter auricular relacionado con cicatrices posquirúrgicas es compleja. Procedimientos prolongados, con tiempos de fluoroscopia altos y una tasa de recurrencia elevada son problemas habituales. Mostramos un abordaje simple y progresivo basado en un solo mapa de cartografía electroanatómica de la aurícula derecha. Métodos: Se incluyeron 22 pacientes consecutivos con flutter auricular e historia de cirugía cardiaca. Se realizó estudio electrofisiológico para definir la localización del circuito de flutter (derecho o izquierdo) y la participación o no del istmo cavotricuspideo mediante encarrilamiento. Una vez localizado la zona de conducción lenta o critica del circuito, se realizó ablación con radiofrecuencia con catéter de irrigación externa a 30W. Posteriormente se llevó a cabo ablación de todos los circuitos potenciales. Resultados: La cardiopatía más dominante fue la comunicación interauricular. Todas las arritmias se localizaron en la aurícula derecha. El ciclo de flutter fue de 274 ± 31 ms. En solo 40% de los casos se demostró participación del istmo cavotricuspideo. No se observaron recurrencias de la arritmia durante un seguimiento de 13 ± 9.4 meses. Conclusiones: Este abordaje escalonado con un solo mapa CARTO® de activación/voltaje de la aurícula y la ablación de todos los circuitos potenciales es altamente efectivo para el tratamiento de arritmias por macrorreentrada relacionadas con cicatriz posquirúrgica.


Assuntos
Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ablação por Cateter/métodos , Cicatriz/complicações , Cicatriz/cirurgia , Taquicardia/etiologia , Taquicardia/cirurgia , Átrios do Coração
10.
Arch Cardiol Mex ; 83(4): 244-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24286964

RESUMO

INTRODUCTION: Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium. METHODS: Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment. RESULTS: The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up. CONCLUSIONS: A progressive approach with only one activation/voltage CARTO(®) map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.


Assuntos
Ablação por Cateter/métodos , Cicatriz/complicações , Cicatriz/cirurgia , Taquicardia/etiologia , Taquicardia/cirurgia , Adulto , Idoso , Criança , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Arch Cardiol Mex ; 79(3): 212-8, 2009.
Artigo em Espanhol | MEDLINE | ID: mdl-19902669

RESUMO

Idiopathic ventricular tachycardia is identified in 10% of the patients presenting with ventricular tachycardia, and they consist of various subtypes that can originate from different areas, including the aortic cusps which represent 0.7% of the total. Electrocardiographically, these ventricular tachycardias display a left bundle branch block pattern and inferior axis, and although rare, should be considered in the differential diagnosis with tachycardias originating from the septal region of the right ventricular outflow tract, which comprise 80% of the idiopathic ventricular tachycardias. Despite the vicinity of the left coronary artery ostium, radiofrequency catheter ablation can be curative in more than 90% of cases with a low risk (< 1% of serious complication). Therefore, it must be considered first-line therapy in patients who have failed or are intolerant to therapy with antiarrhythmic agents. The aim of this article is to describe the first case reported in Mexico of a successful ablation idiopathic ventricular tachycardia from the aortic sinus cusp in a patient with incessant ventricular tachycardia.


Assuntos
Seio Aórtico , Taquicardia Ventricular , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia
12.
Arch. cardiol. Méx ; 79(3): 212-218, jul.-sept. 2009. ilus
Artigo em Espanhol | LILACS | ID: lil-565619

RESUMO

Idiopathic ventricular tachycardia is identified in 10% of the patients presenting with ventricular tachycardia, and they consist of various subtypes that can originate from different areas, including the aortic cusps which represent 0.7% of the total. Electrocardiographically, these ventricular tachycardias display a left bundle branch block pattern and inferior axis, and although rare, should be considered in the differential diagnosis with tachycardias originating from the septal region of the right ventricular outflow tract, which comprise 80% of the idiopathic ventricular tachycardias. Despite the vicinity of the left coronary artery ostium, radiofrequency catheter ablation can be curative in more than 90% of cases with a low risk (< 1% of serious complication). Therefore, it must be considered first-line therapy in patients who have failed or are intolerant to therapy with antiarrhythmic agents. The aim of this article is to describe the first case reported in Mexico of a successful ablation idiopathic ventricular tachycardia from the aortic sinus cusp in a patient with incessant ventricular tachycardia.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Seio Aórtico , Taquicardia Ventricular , Taquicardia Ventricular , Taquicardia Ventricular
13.
J Cardiovasc Electrophysiol ; 19(5): 550-5, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-17971134

RESUMO

INTRODUCTION: Rhythm disturbances in children with structurally normal hearts are usually associated with abnormalities in cardiac ion channels. The phenotypic expression of these abnormalities ("channelopathies") includes: long and short QT syndromes, Brugada syndrome, congenital sick sinus syndrome, catecholaminergic polymorphic ventricular tachycardia, Lènegre-Lev disease, and/or different degrees of cardiac conduction disease. METHODS: The study group consisted of three male patients with sick sinus syndrome, intraventricular conduction disease, and monomorphic sustained ventricular tachycardia. Clinical data and results of electrocardiography, Holter monitoring, electrophysiology, and echocardiography are described. RESULTS: In all patients, the ECG during sinus rhythm showed right bundle branch block and long QT intervals. First-degree AV block was documented in two subjects, and J point elevation in one. A pacemaker was implanted in all cases due to symptomatic bradycardia (sick sinus syndrome). Atrial tachyarryhthmias were observed in two patients. The common characteristic ventricular arrhythmia was a monomorphic sustained ventricular tachycardia, inducible with ventricular stimulation and sensitive to lidocaine. In one patient, radiofrequency catheter ablation was successfully performed. No structural abnormalities were found in echocardiography in the study group. CONCLUSION: Common clinical and ECG features suggest a common pathophysiology in this group of patients with congenital severe electrical disease.


Assuntos
Bloqueio Atrioventricular/congênito , Bloqueio Atrioventricular/diagnóstico , Síndrome do Nó Sinusal/congênito , Síndrome do Nó Sinusal/diagnóstico , Taquicardia Ventricular/congênito , Taquicardia Ventricular/diagnóstico , Criança , Feminino , Humanos , Lactente , Masculino
14.
Arch. cardiol. Méx ; 77(supl.4): S4-139-S4-143, oct.-dic. 2007. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-568705

RESUMO

In 1992 the radiofrequency ablation program was started, with very good results in patients with supraventricular tachycardias and normal hearts or minimal structural defects. Nevertheless, the results are not as good for the patients with structural defects, that are actually seen more frequently, those are cases with more complex arrhythmias, are patients with cardiac surgery that show a complex arrhythmogenic substrate or patients previously treated with conventional ablation which tachycardia recurs. In these cases, the electroanatomic Carto system has been very useful. RESULTS: In the last two years, 74 procedures with the Carto system were performed, of which 56 have been supraventricular arrhythmias, improving substantially the success rates CONCLUSIONS: The electroanatomical mapping allows the more accurate identification of the arrhythmogenic substrate, achieving better success rates in recurrent tachycardia after conventional ablation, or in cases with more complex arrhythmogenic substrates.


Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ablação por Cateter/métodos , Taquicardia Supraventricular , Eletrofisiologia , Taquicardia Supraventricular/patologia , Taquicardia Supraventricular
15.
Arch Cardiol Mex ; 77 Suppl 4: S4-139-43, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-18938713

RESUMO

UNLABELLED: In 1992 the radiofrequency ablation program was started, with very good results in patients with supraventricular tachycardias and normal hearts or minimal structural defects. Nevertheless, the results are not as good for the patients with structural defects, that are actually seen more frequently, those are cases with more complex arrhythmias, are patients with cardiac surgery that show a complex arrhythmogenic substrate or patients previously treated with conventional ablation which tachycardia recurs. In these cases, the electroanatomic Carto system has been very useful. RESULTS: In the last two years, 74 procedures with the Carto system were performed, of which 56 have been supraventricular arrhythmias, improving substantially the success rates CONCLUSIONS: The electroanatomical mapping allows the more accurate identification of the arrhythmogenic substrate, achieving better success rates in recurrent tachycardia after conventional ablation, or in cases with more complex arrhythmogenic substrates.


Assuntos
Ablação por Cateter/métodos , Taquicardia Supraventricular/cirurgia , Adolescente , Adulto , Criança , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Supraventricular/patologia , Taquicardia Supraventricular/fisiopatologia , Adulto Jovem
16.
Arch Cardiol Mex ; 76 Suppl 2: S196-9, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-17017100

RESUMO

Since the first report of radiofrequency catheter ablation curing atrial fibrillation (AF) nearly a decade ago, numerous techniques have evolved, from linear ablation to modify the reentrant sustrate for AF, to electrical isolation of pulmonary vein to eliminate triggers of AF, to hibrid approaches of circunferential ablation around and between the pulmonary veins and mitral valve annulus to modify both the triggers and sustrate for AF. We describe the electroanatomic mapping system (CARTO, Biosense Webster) and its use in patients undergoing catheter ablation for AF.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Arch. cardiol. Méx ; 76(supl.2): S196-S199, abr.-jun. 2006.
Artigo em Espanhol | LILACS | ID: lil-568821

RESUMO

Since the first report of radiofrequency catheter ablation curing atrial fibrillation (AF) nearly a decade ago, numerous techniques have evolved, from linear ablation to modify the reentrant sustrate for AF, to electrical isolation of pulmonary vein to eliminate triggers of AF, to hibrid approaches of circunferential ablation around and between the pulmonary veins and mitral valve annulus to modify both the triggers and sustrate for AF. We describe the electroanatomic mapping system (CARTO, Biosense Webster) and its use in patients undergoing catheter ablation for AF.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial , Ablação por Cateter/métodos , Fibrilação Atrial/patologia , Fibrilação Atrial , Eletrofisiologia
18.
Gac Med Mex ; 142(1): 43-7, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-16548292

RESUMO

OBJECTIVE: To analyze the results of radiofrequency catheter ablation (RFCA) of the pulmonary veins (PV) in patients with paroxysmal atrial fibrillation (PAF). MATERIAL AND METHODS: We describe 4 patients (38 +/- 12 years, interval 8-52; 11 men) with symptomatic PAF, refractory to antiarrhythmic drugs. Special mapping catheters were used and ablation was performed at the ostium/antrum of those veins with abnormal electrical activity (AEA). RESULTS: AEA in one or more PV was identified in 13 patients (86%); in one patient AEA was also found in the superior vena cava (6.6%). One procedure was complicated by unstable ventricular tachycardia and was notfinished. Success was accomplished in 10, in 5 after the first ablation, in 4 after the second, and in one after a third procedure. One patient had pericarditis with a small pericardial effusion that did not require intervention. CONCLUSIONS: RFCA is a useful and relatively safe procedure for the treatment of PAF and the only one with curative potential. The long-term rate of success (with or without antiarrhythmics) in this series was 71%. These results justify catheter ablation in selected patients with symptomatic PAF unresponsive to medical treatment.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Veias Pulmonares/fisiopatologia , Adolescente , Adulto , Criança , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Gac. méd. Méx ; 142(1): 43-47, ene.-feb. 2006. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-571152

RESUMO

Objetivo: Informar la ablación en las venas pulmonares (VPs) en pacientes con fibrilación auricular paroxística (FAP). Material y métodos: Catorce pacientes (38±12 años [intervalo 8-52, 11 hombres, 3 mujeres) con FAP idiopática, sintomática y refractarios a antiarrítmicos y con estudio electrofisiológico. En 13 se encontró actividad eléctrica anormal (AEA) en VPs mediante catéteres especiales de cartografía y se realizó ablación. Resultados: Se identificó AEA en VP’s (13 pacientes, 86%) y en vena cava superior (un paciente, 6.6%). Un procedimiento fue suspendido por taquicardia ventricular. La ablación fue exitosa en 7 de los 12 pacientes restantes. Los cinco pacientes con ablación inicial fallida fueron llevados a un segundo procedimiento que fue exitoso en dos. En un paciente fue necesario un tercer procedimiento que resultó exitoso. Una paciente tuvo pericarditis con derrame ligero que no requirió drenaje. Conclusión: La ablación de FAP es un procedimiento seguro con una tasa de éxito combinada (con y sin antiarrítmicos) en esta población y a largo plazo, del 71%.


OBJECTIVE: To analyze the results of radiofrequency catheter ablation (RFCA) of the pulmonary veins (PV) in patients with paroxysmal atrial fibrillation (PAF). MATERIAL AND METHODS: We describe 4 patients (38 +/- 12 years, interval 8-52; 11 men) with symptomatic PAF, refractory to antiarrhythmic drugs. Special mapping catheters were used and ablation was performed at the ostium/antrum of those veins with abnormal electrical activity (AEA). RESULTS: AEA in one or more PV was identified in 13 patients (86%); in one patient AEA was also found in the superior vena cava (6.6%). One procedure was complicated by unstable ventricular tachycardia and was notfinished. Success was accomplished in 10, in 5 after the first ablation, in 4 after the second, and in one after a third procedure. One patient had pericarditis with a small pericardial effusion that did not require intervention. CONCLUSIONS: RFCA is a useful and relatively safe procedure for the treatment of PAF and the only one with curative potential. The long-term rate of success (with or without antiarrhythmics) in this series was 71%. These results justify catheter ablation in selected patients with symptomatic PAF unresponsive to medical treatment.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Ablação por Cateter , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Veias Pulmonares/fisiopatologia , Eletrofisiologia
20.
Arch Cardiol Mex ; 74 Suppl 1: S44-9, 2004.
Artigo em Espanhol | MEDLINE | ID: mdl-15216747

RESUMO

The surface ECG constitutes an invaluable tool for the differential diagnosis in those cases in which the QRS complex exceeds the normal duration (120 mseg or more) and a heart rate of 100 bpm or more. Most of the arrhythmias with wide QRS complexes are ventricular in origin, and frequently related to heart disease; nevertheless, in those patients with hemodynamic stability it is frequently misdiagnosed as supraventricular tachycardia. The importance of the surface ECG resides in the fact that the correct diagnosis can be done with high probability when the analysis is orderly made. To be able to perform such an analysis it is necessary to count upon a good quality ECG, besides it is very important if, in addition, a transesophageal record is available to establish the precise relation between the "p" wave and the ventricular activation. There are the traditional morphologic criteria, with their limited usefulness, but the observations of Brugada et al. increased the sensitivity, which can reach up to 98% with a high degree of specificity (96%). The clinical data plus an adequate ECG analysis can lead to the differential diagnosis with a high grade of certainty.


Assuntos
Eletrocardiografia , Taquicardia/diagnóstico , Taquicardia/fisiopatologia , Algoritmos , Diagnóstico Diferencial , Humanos
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