Associated factors with the occurrence of in-hospital cardiac arrest in patients admitted to internal medicine wards for non-cardiovascular causes. / Factores asociados a la ocurrencia de paro cardiaco intrahospitalario en pacientes ingresados en salas de medicina interna por causas no cardiovasculares.

BACKGROUND AND OBJECTIVE: In-hospital cardiac arrest (IHCA) has a low survival rate, so it is essential to recognize the cases with the highest probability of developing it. The aim of this study is to identify factors associated with the occurrence of IHCA. MATERIAL AND METHODS: A single-center case-control study was conducted including 65 patients admitted to internal medicine wards for non-cardiovascular causes who experienced IHCA, matched with 210 admitted controls who did not present with IHCA. RESULTS: The main reason for admission was pneumonia. The most prevalent comorbidity was arterial hypertension. Four characteristics were strongly and independently associated with IHCA presentation, these are electrical left ventricular hypertrophy (LVH) (OR: 13.8; 95% IC: 4.7-40.7), atrial fibrillation (OR: 9.4: 95% CI: 4.3-20.6), the use of drugs with known risk of torsades de pointes (OR: 2.7; 95% CI: 1.3-5.5) and the combination of the categories known risk plus conditional risk (OR: 17.1; 95% CI: 6.7-50.1). The first two detected in the electrocardiogram taken at the time of admission. CONCLUSION: In admitted patients for non-cardiovascular causes, the use of drugs with a known risk of torsades de pointes, as well as the detection of electrical LVH and atrial fibrillation in the initial electrocardiogram, is independently associated with a higher probability of suffering a IHCA.

Características y evolución clínica de pacientes con infarto agudo de miocardio y elevación del segmento ST con y sin bloqueo interauricular

Fundamento resulta novedoso establecer la relación entre bloqueo interauricular e infarto agudo de miocardio con elevación del segmento ST debido a los pocos estudios que abordan el tema. Objetivo evaluar las características y evolución clínica de pacientes con infarto agudo de miocardio con elevación del segmento ST con y sin bloqueo interauricular. Métodos: se realizó un estudio descriptivo y correlacional en unidades de cuidados progresivos del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Se seleccionaron 169 sujetos con diagnóstico de infarto agudo de miocardio con elevación del segmento ST divididos en dos grupos con y sin bloqueo interauricular. Se analizaron como variables demográficas: edad, sexo, color de la piel y entre las clínicas hábitos tóxicos (fumador, exfumador); antecedentes patológicos (infarto de miocardio, angina, enfermedad arterial periférica, hipertensión arterial, diabetes mellitus tipo 2, enfermedad renal crónica; localización del infarto (anterior, inferior, bloqueo de rama izquierda); complicaciones: insuficiencia cardíaca, fibrilación auricular, taquicardia ventricular/fibrilación ventricular, trastornos de conducción aurículo ventricular, complicación mecánica, angina postinfarto, embolismo arterial) y estado al egreso (vivo o fallecido). Resultados el 52,17 % de los pacientes con infarto agudo de miocardio con elevación del segmento ST con bloqueo interauricular desarrollaron insuficiencia cardíaca, vs el 29,45 % de los pacientes sin bloqueo con significación estadística (p = 0.03). La relación entre la ocurrencia o no de complicaciones (así como el estado al egreso) y la presencia o no de bloqueo resultó muy significativa (p=0.01). Conclusiones el análisis minucioso en este contexto, de otros aspectos no habituales como la onda p, debe ser también rutinario, pues la documentación de bloqueo interauricular pudiera relacionarse con el curso clínico de los pacientes.

Foundation: it is novel to establish the relationship between interatrial block and acute myocardial infarction with ST-segment elevation due to the few studies that address the subject. Objective: to evaluate the characteristics and clinical evolution of patients with ST-segment elevation acute myocardial infarction with and without interatrial block. Methods: a descriptive and correlational study was carried out in progressive care units of the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. 169 subjects with a diagnosis of ST-segment elevation myocardial infarction divided into two groups with and without interatrial block were selected. Demographic variables were analyzed: age, sex, skin color and between clinics: toxic habits (smoker, ex-smoker); medical history (myocardial infarction, angina, peripheral arterial disease, arterial hypertension, type 2 diabetes mellitus, chronic kidney disease; infarct location (anterior, inferior, left bundle branch block); complications: heart failure, atrial fibrillation, ventricular tachycardia/ventricular fibrillation, atrioventricular conduction disorders, mechanical complication, post infarction angina, arterial embolism) and discharge status (alive or deceased). Results: 52.17 % of patients with ST-segment elevation myocardial infarction with interatrial block developed heart failure, vs 29.45 % among patients without block with statistical significance (p = 0.03). The relationship between the occurrence or not of complications (as well as the state at discharge) and the presence or not of blockade was highly significant (p=0.01). Conclusions: the detailed analysis, in this context, of the p wave of the electrocardiogram should be routine, since the documentation of interatrial block could be related to the clinical course of the patients.

Would a complete electrophysiological study allow us to make a correct diagnosis? Case report.

BACKGROUND: Oblique course of some left accessory pathways is rare An incomplete electrophysiological study may confuse us between an oblique accessory pathway or the presence of two accessory pathways. The proximity of all atrial and ventricular electrograms, at each pole of the catheter, within the coronary sinus may be a novel finding. CASE PRESENTATION: A 68-year-old woman patient presented arrhythmias with hypotension requiring electrical cardioversion. Her electrocardiogram (ECG) was interpreted as atrial fibrillation by accessory pathway. We performed with the protocol of ablation stablished in our laboratory: two punctures on the right femoral vein with placement of introducers (8F and 7F) by Seldigner technique and one puncture on the left femoral vein (7F). The study was performed with BIOTRONIK technology (Multicath study catheter), a non-deflectable 7F quadripolar catheter with 2 mm tip electrode to record the His electrogram, a non-deflectable decapolar catheter with 5 pairs of coronary sinus (CS) electrodes. Accessory pathway mapping was performed in right and left cavities and within the CS. All electrograms into CS showed short AV from proximal to distal CS. Finally, ablation of two accessory pathway recordings was achieved at two distant epicardial points within the CS. CONCLUSIONS: Ablation at two distant sites, one on the ventricular side and the other on the mitral annulus, suggests the presence of an oblique accessory pathway and at the same time the differential diagnosis of the presence of two accessory pathways. In our point of view according the above, we consider this is a very rare case of oblique AP with epicardial trajectory. The sequence of electrograms (in this case) along the CS has not been seen before in the literature reviewed. It is important, regardless of the urgency, to follow diagnostic and therapeutic protocols in invasive electrophysiology.

El "vetusto" electrocardiograma sigue aportando nuevas variables para la asistencia y educación médicas / The "old" electrocardiogram continues to provide new variables for medical care and education

El descubrimiento de la electrocardiografía marcó un hito para la medicina: ofreció una mejor comprensión de la fisiología cardiovascular, es una herramienta imprescindible para el diagnóstico, evaluación y estratificación pronóstica de casi la totalidad de las enfermedades cardiovasculares, y ha sido un componente insustituible de las investigaciones cardiológicas de la medicina contemporánea. Importantes investigaciones de la cátedra de Cardiología del Hospital Universitario Cardiocentro "Ernesto Guevara" la han tenido como objeto de estudio en consonancia con las directrices del sistema de salud, para su aplicación en la asistencia y la actualización de los programas de la especialidad, los que se han enriquecido con nuevas variables electrocardiográficas denominadas como "no clásicas". Es objetivo de los autores comunicar algunos resultados científicos novedosos de investigaciones relacionadas con este vetusto medio de diagnóstico, los que han sido publicadas en revistas de alto impacto.

The discovery of electrocardiography marked a milestone for medicine: it offered a better understanding of cardiovascular physiology and has been an essential tool for the diagnosis, evaluation, and prognostic stratification of almost all cardiovascular diseases, and it has been an irreplaceable component of cardiology research in contemporary medicine. Important investigations of the Cardiology professorship of the "Ernesto Guevara" University Hospital have had it as an object of study in line with the guidelines of the health system, for its application in assistance and updating of specialty programs, which have been enriched with new electrocardiographic variables called "non-classical". It is the objective of the authors to communicate some novel scientific results of investigations related to this ancient aid of diagnosis, which have been published in high-impact journals.

Uneven vectorial projection is the best explanation for QRS dispersion, not the asynchronic ventricular activation.

BACKGROUND: It is believed that QRS dispersion (QRSd) is caused by asynchrony of ventricular activation, but there are no studies that prove it. OBJECTIVES: To determine the mechanism that best explains QRSd in surface electrocardiogram (ECG). METHODS: Cross-sectional study in 95 consecutive patients (median age: 31.0 years [25-52], female sex: 66.3%) with atrioventricular nodal reentrant tachycardia. All 12 ECG leads were recorded at once, simultaneously with the intracardiac recordings. QRSd was quantified as the difference between maximum (QRSmax) and minimum QRS duration (QRSmin). QRS was measured firstly at a calibration of 20 mm/mV and a sweep speed of 50 mm/s, enhancement 10× (basic measurement [BM]), and after at sweep speed of 150 mm/s, enhancement 80 - 160×. The interventricular dyssynchrony (IVD) was also quantified. RESULTS: QRSmax increased from BM (98 ms [91-103]) to 80× (102 ms [99-108]; p = 0.029) and 160× (104 ms [101.5-110]; p = 0.027). QRSmin, almost equaled the duration of QRSmax at 160× (103 ms [100-108]). With BM, QRSd was 26 ms [22-35] and was reduced 26-fold (p < 0.001) by magnifying the QRS at 160× (1 ms [0-3]). IVD was weakly correlated with QRSd (r = 0.234, p = 0.023), but strongly with the total QRS at 160× (r = 0.676, p < 0.001). CONCLUSION: When QRS complex is narrow, the best explanation for the origin of QRSd on the surface ECG is the unequal projection of the ventricular depolarization vector in the different axis of the leads.

New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies.

OBJECTIVE: Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). SUBJECTS AND METHODS: This was a cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. RESULTS: The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). CONCLUSIONS: Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.

Vectorial theory surpasses the local theory in explaining the origin of P-wave dispersion.

BACKGROUND: Local theory and the vectorial theory are used to explain the origin of P-wave dispersion (PWD). There are no previous studies that analyze both at the same time. OBJECTIVES: We set out to determine the implication of local and vectorial theories in the origin of PWD. METHODS: Cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing electrophysiological study. Inhomogeneous atrial conduction was evaluated by atrial electrogram dispersion in terms of duration (EGMdurdis) and morphology (EGMmorph dis). P-distal coronary sinus interval (P-DCS) was also measured. P-wave was measured twice, firstly at a calibration of 20 mm/mV and a sweep speed of 50 mm/s, enhancement 10× (basic measurement [BM]), and second time at sweep speed of 150 mm/s, enhancement 80-160× (high precision measurement [HPM]). RESULTS: PWD with BM was 48 ms [36-54 ms] while with HPM it was 4 ms [0-10 ms], p < 0.001. With BM, maximum and minimum P- wave duration presented a moderate correlation (r = 0.342; p < 0.001), using HPM it becomes strong (r = 0.750; p < 0.001). In cases with P-DCS < 80 ms (r = 0.965; p < 0.001), but not with P-DCS ≥ 80 ms (r = 0.649; p < 0.001), the previous correlation became almost perfect with HPM. EGMdurdis and EGMmorphdis were weak but significantly correlated with PWD. This correlation became moderate in patients with P-DCS ≥ 80 ms and disappeared in those with P-DCS, using BM and HPM. CONCLUSION: Vectorial theory explains almost entirely the PWD phenomenon. Inhomogeneous conduction could be an additional mechanism to explain PWD, but its contribution is small.

Atrial conduction explains the occurrence of the P-wave dispersion phenomenon, but weakly.

BACKGROUND: P-wave dispersion (PWD) is believed to be caused by inhomogeneous atrial conduction. This statement, however, is based on limited little solid evidence. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. METHODS: Cross-sectional study in 153 patients with accessory pathways and atrioventricular node reentry tachycardia (AVNRT) undergoing an electrophysiological study. Different atrial conduction times were measured and correlated with PWD. RESULTS: Only the interatrial (P-DCS) and left intra-atrial conduction times (ΔDCS-PCS) showed a significant correlation with PWD, but this correlation was weak. Multivariate linear regression analysis determined that both P-DCS (ß = 0.242; P = .008) and ΔDCS-PCS (ß = 0.295; P < .001) are independent predictors of PWD. Performing the multivariate analysis for arrhythmic substrates, it is observed that only ΔDCS-PCS continued to be an independent predictor of PWD. Analysis of the receiver operating characteristic curves showed that regardless of the types of arrhythmic substrates, PWD discriminates significantly, but moderately, to patients with P-DCS and ΔDCS-PCS ≥75 percentile. CONCLUSIONS: Interatrial and intraleft atrial conduction times were directly and significantly correlated with PWD, but only weakly, and were independent predictors of PWD. In general, PWD correctly discriminates patients with high values in interatrial and intraleft atrial conduction times, but moderately. This is maintained in cases with accessory pathways; however, in patients with AVNRT it only does so for intraleft atrial conduction times. Interatrial and intraleft atrial conduction times weakly explains PWD.

Metástasis cardíaca en paciente con cáncer de colon: Informe de un caso / Cardiac metastasis in colon cancer: A case report

RESUMEN Las masas cardíacas constituyen un reto diagnóstico y terapéutico. Muchas veces se descubren casualmente y la evaluación confirma, finalmente, la presencia de un tumor cardíaco. Estos son neoplasias originadas en cualquier capa del corazón y se dividen en primarios y secundarios. Los primarios tienen una incidencia en autopsias de 0,001 - 0,03%, que contrasta con la frecuencia 20-40 veces mayor de los secundarios. Se presenta un paciente de 28 años de edad diagnosticado 1 año antes de adenocarcinoma de colon transverso infiltrante, en quien hace 3 meses se constató metástasis a cadena ganglionar intraabdominal y se realizó tratamiento quirúrgico más quimioterapia. Posteriormente comenzó con taquicardia y acudió a su centro de salud donde se le realizó un ecocardiograma transtorácico que constató una imagen de aspecto tumoral en ventrículo derecho. Por tomografía se demostró una masa tumoral compleja inoperable y el paciente falleció en su hogar, bajo cuidados paliativos, un mes y medio después del egreso.

ABSTRACT Cardiac masses are a diagnostic and therapeutic challenge. They are often found incidentally and assessment eventually confirms the presence of a heart tumor. They are neoplasms that originate in any layer of the heart and are divided into primary and secondary. The primary ones have a 0.001 - 0.03% incidence in autopsies, contrasting with the 20-40 times higher frequency of the secondary ones. We present the case of a 28-year-old patient diagnosed one year before with infiltrating transverse colon adenocarcinoma in whom intra-abdominal lymph node chain metastases were confirmed three months ago, receiving surgical treatment and chemotherapy. Later, he began with tachycardia and presented to his health care center where a transthoracic echocardiogram was performed, which showed a tumor-like image in the right ventricle. The CT-scan showed an unresectable complex tumor mass and the patient died at home, under palliative care, a month or so after discharge.

El nodo sinusal normal: Lo que ahora sabemos / The normal sinus node: What we know now

RESUMEN El nodo sinusal constituye el marcapasos fisiológico del corazón. Diferentes estados fisiopatológicos conducen a una reducción de su función, lo que es llamado en la clínica, disfunción sinusal. Sin embargo, para la mejor comprensión de su estado de enfermedad se requiere dilucidar cómo opera en condiciones normales. Las nuevas evidencias señalan que el automatismo del nodo sinusal se produce por la interacción del reloj de membrana y el reloj de calcio, lo que le confiere un fuerte carácter que lo protege contra fallas de funcionamiento. Se presentan las evidencias actuales sobre la sincronía celular dentro del nodo sinusal, así como la forma de propagación eléctrica y el acoplamiento fuente-sumidero. Además, se describen recientes hallazgos anatómicos e histológicos.

ABSTRACT The sinus node is the physiological pacemaker of the heart. Different pathophysiological conditions lead to a reduction of its function, which is clinically called sinus dysfunction. However, for a better understanding of its disease state, it is necessary to elucidate how it works under normal conditions. New evidences indicate that the automatism of the sinus node is produced by the interaction of the membrane clock and the calcium clock, which gives it a strong character that protects it against malfunctions. Current evidences on cell synchrony within the sinus node are presented, as well as the form of electrical propagation and the source-sink coupling. In addition, recent anatomical and histological findings are described.

Duración de la onda P en las 12 derivaciones del electrocardiograma y su relación con el tiempo de conducción interauricular en pacientes con taquicardias paroxísticas supraventriculares / P wave duration in the 12 leads of the electrocardiogram and its relationship with interatrial conduction time in patients with paroxysmal supraventricular tachycardias

RESUMEN Introducción: Existen algunos estudios que relacionan parámetros de la onda P con diferentes tiempos de conducción auricular, pero no se han realizado teniendo en cuenta a cada derivación del electrocardiograma. Objetivo: Determinar la duración de la onda P (Pdur) en las 12 derivaciones y relacionarlas con el tiempo de conducción interauricular. Método: Estudio de corte transversal en 153 pacientes adultos con diagnóstico confirmado de taquicardia por reentrada intranodal (TRIN) o vías accesorias mediante estudio electrofisiológico invasivo. Resultados: Al comparar la Pdur entre sustratos arrítmicos por cada derivación, no existieron diferencias significativas, excepto en V6. En las derivaciones DII, DIII, aVR, aVF, V1 y de V3-V6 la Pdur se correlacionó con el tiempo de conducción interauricular en ambos sustratos arrítmicos. En el análisis multivariado, la Pdur constituyó un predictor independiente de tiempos de conducción interauricular ≥ 95 percentil, en las derivaciones de cara inferior y en V3, V5 y V6. Se observaron altos valores del área bajo la curva de la Característica Operativa del Receptor en las derivaciones DII (0,950; p<0,001), DIII (0,850; p<0,001) y V5 (0,891; p<0,001). Conclusiones: No existen diferencias por derivación en la Pdur al comparar casos con TRIN y vías accesorias, excepto en V6. La mayoría de las derivaciones se correlacionaron con el tiempo de conducción interauricular. La Pdur fue un predictor independiente de tiempos de conducción interauricular ≥ 95 percentil. La derivación DII presenta la mayor capacidad discriminativa para encontrar valores prolongados del tiempo de conducción interauricular.

ABSTRACT Introduction: Although some studies relate P wave parameters to different atrial conduction times, they do not consider each electrocardiogram lead separately. Objective: To determine the duration of P wave (Pdur) in the 12 leads of the electrocardiogram and relate it to the interatrial conduction time. Method: We conducted a cross-sectional study in 153 adult patients with confirmed diagnosis of atrioventricular nodal reentry tachycardia (AVNRT) or accessory pathways by invasive electrophysiological study. Results: When comparing the Pdur between arrhythmic substrates by each lead, no significant differences were found, except for V6. In leads II, III, aVR, aVF, V1 and V3-V6, Pdur was correlated with the interatrial conduction time in both arrhythmic substrates. In our multivariate analysis, the Pdur was an independent predictor of interatrial conduction times ≥ 95 percentile in inferior wall leads and in V3, V5 and V6. High values of the area under the receiver operating characteristic curve were observed in II (0.950; p<0.001), III (0.850; p<0.001) and V5 (0.891; p<0.001) leads. Conclusions: The Pdur showed no difference by leads when comparing cases with AVNRT and accessory pathways, except for V6. Most of the leads were correlated with the interatrial conduction time; Pdur was an independent predictor of interatrial conduction times ≥ 95 percentile. Lead II has the greatest discriminatory ability to find prolonged values of interatrial conduction time.

Bloqueos interauriculares: diagnóstico y significado clínico / Interatrial blocks: diagnosis and clinical significance

En 1979 Bayés de Luna describió los bloqueos interauriculares (BIA). Siguiendo el mismo principio de clasificación de los bloqueos en otras estructuras del corazón los dividió en primero (BIA parcial), segundo (aberrancia auricular) y tercer grado (BIA avanzado). Recientemente se describieron sus formas atípicas. Se cuenta con evidencias de que los retrasos o bloqueos de la conducción en el haz de Bachmann constituyen la base mecanística de dichos bloqueos. La asociación entre BIA, principalmente los de grado avanzado, y taquiarritmias auriculares ya es ciencia constituida, y es denominado por la comunidad médica como síndrome de Bayés. Los BIA también se asocian a la aparición de infarto cerebral isquémico y recurrencia de fibrilación auricular en varios escenarios. La presente revisión repasa aspectos clásicos y da luz sobre la interpretación de este patrón electrocardiográfico en la práctica clínica

In 1979 Bayés de Luna described interatrial blocks (IAB). Following the same principle of classification of blocks in other structures of the heart, he divided them into first (partial IAB), second (atrial aberrancy) and third degree (advanced IAB). Atypical forms of these blocks were recently described. There is evidence that delays or blocks of conduction in the Bachmann bundle constitute the mechanistic basis of these blocks. The association between IAB, mainly those of advanced grade, and atrial tachyarrhythmias is already constituted science, and is referred to by the medical community as Bayés syndrome. IABs are also associated with the occurrence of ischaemic stroke and recurrence of atrial fibrillation in several scenarios. This review presents classical aspects and sheds light on the interpretation of this electrocardiographic pattern in clinical practice

Interatrial blocks: diagnosis and clinical significance. / Bloqueos interauriculares: diagnóstico y significado clínico.

In 1979 Bayés de Luna described interatrial blocks (IAB). Following the same principle of classification of blocks in other structures of the heart, he divided them into first (partial IAB), second (atrial aberrancy) and third degree (advanced IAB). Atypical forms of these blocks were recently described. There is evidence that delays or blocks of conduction in the Bachmann bundle constitute the mechanistic basis of these blocks. The association between IAB, mainly those of advanced grade, and atrial tachyarrhythmias is already constituted science, and is referred to by the medical community as Bayés syndrome. IABs are also associated with the occurrence of ischaemic stroke and recurrence of atrial fibrillation in several scenarios. This review presents classical aspects and sheds light on the interpretation of this electrocardiographic pattern in clinical practice.

Tpeak-Tend, Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables

Abstract Aim: To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Methods: Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. Results: Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. Conclusions: The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.

Resumen Objetivo: Caracterizar el Tpico-Tfinal, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT en niños y su relación con variables clínicas. Métodos: Estudio transversal en 126 niños entre 9 y 12 años de la escuela Camilo Cienfuegos en Santa Clara, Cuba. Se obtuvieron variables clínicas y antropométricas para determinar su relación con los parámetros electrocardiográficos: el Tpico-Tfinal V5, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT V5. Además, se realizaron pruebas de laboratorio. Resultados: La edad y la presión arterial sistólica se asocian con una mayor probabilidad de tener valores del Tpico-Tfinal/QT V5 ≥75 percentil para ambos sexos (OR: 1.72, IC 95%: 1.02-2.91; p= 0.043), (OR: 1.08, IC 95%: 1.01-1.16; p= 0.017) respectivamente. El índice de masa corporal y la presión arterial sistólica están correlacionados de manera lineal y significativa con el Tpico-Tfinal/QT V5 (r= 0.224; p= 0.012) y (r= 0.220; p= 0.014) respectivamente. Conclusiones: La edad de los pacientes y las cifras de presión arterial sistólica son factores que aumentan la probabilidad de tener valores del percentil Tpico-Tfinal/QT V5 ≥75. Existe correlación lineal significativa entre el Tpico-Tfinal/QT V5 con el índice de masa corporal y la presión arterial sistólica.

Alteraciones electrocardiográficas en pacientes adultos mayores hospitalizados / Electrocardiographic abnormalities in hospitalized elderly patients

RESUMEN Introducción: Como parte del envejecimiento ocurre un incremento de la morbilidad cardiovascular que puede reflejarse en el electrocardiograma, pero no todas las subpoblaciones de adultos mayores han sido estudiadas sistemáticamente. Objetivos: Determinar las principales alteraciones electrocardiográficas que acontecen en pacientes adultos mayores con morbilidades cardiovasculares. Método: Estudio descriptivo, transversal en 148 pacientes ≥ 60 años, con morbilidades cardiovasculares, ingresados en el servicio de Medicina Interna del Hospital Celestino Hernández Robau de Villa Clara. Se determinaron variables electrocardiográficas sugerentes de afectación cardíaca. Resultados: La edad promedio fue 77,4 ± 8,2 años. La fibrilación auricular fue observada en 16,9% de los casos. Existieron alteraciones de la repolarización ventricular en 39,3% de los casos, así como bloqueo de rama izquierda o derecha en 14,4% y 5,4%, respectivamente. Un 24,7% de los pacientes presentaron anormalidad auricular izquierda y 17,8%, prolongación del QT. El mayor número de casos con hipertrofia ventricular izquierda eléctrica se detectó con el criterio R aVL (9 pacientes [10,2%]). Conclusiones: El trastorno del ritmo más frecuente fue la fibrilación auricular. Las alteraciones de la repolarización ventricular prevalecieron sobre las de la despolarización, sin asociación con el sexo o color de piel. El número de casos con anormalidad auricular izquierda, hipertrofia ventricular izquierda y QT largo fue considerable.

ABSTRACT Introduction: Aging causes an increase in cardiovascular morbidity that can be reflected in the electrocardiogram, but not all older adults' subpopulations have been systematically studied. Objectives: To determine the main electrocardiographic alterations that occur in elderly patients with cardiovascular morbidities. Method: Cross-sectional descriptive study in 148 patients ≥ 60 years, with cardiovascular morbidities, admitted to the Internal Medicine service of the "Hospital Celestino Hernández Robau" in Villa Clara. Electrocardiographic variables suggestive of cardiac involvement were identified. Results: The average age was 77.4 ± 8.2 years. Atrial fibrillation was seen in 16.9% of cases. There were alterations of ventricular repolarization in 39.3% of cases, as well as left/right bundle branch block in 14.4% and 5.4% respectively. A 24.7% of patients presented left atrial abnormality and 17.8% QT prolongation. The highest number of cases with electric left ventricular hypertrophy was detected with the R aVL criteria (9 patients [10.2%]). Conclusions: The most frequent rhythm disorder was atrial fibrillation. Alterations of ventricular repolarization prevailed over those of depolarization with no association with sex or skin color. There was a considerable number of cases with left atrial abnormality, left ventricular hypertrophy and long QT.

Mapeo y ablación exitosa, desde el interior de la vena cardíaca magna, de extrasístoles ventriculares originados en el techo (summit) del ventrículo izquierdo / Mapping and successful ablation, from within the great cardiac vein, of premature ventricular contractions originating from the summit of the left ventricle

RESUMEN Se presenta el caso de una paciente de 43 años, con antecedentes de salud aparente, hasta varias semanas previas a su ingreso, cuando comenzó a presentar síncopes precedidos de palpitaciones. Se realizó estudio electrofisiológico y se demostró precocidad en la porción distal del electrodo de registro de seno coronario, que corresponde a la vena cardíaca magna (interventricular anterior) y techo (summit) del ventrículo izquierdo. A pesar del excelente registro precoz se estudiaron estructuras vecinas como el tracto de salida del ventrículo izquierdo en la cúspide coronaria izquierda, aquí el mapeo eléctrico (pace mapping) no fue concordante total. En el sitio de la precocidad obtenida dentro del sistema venoso cardíaco se realizó mapeo concordante 100%, con una precocidad del catéter de ablación de -30 milisegundos. Se decidió ablación con incrementos progresivos de temperatura y potencia con corte de impedancia (termomapping) y se logró el éxito de la ablación sin reproducibilidad de la arritmia y excelente evolución posterior.

ABSTRACT The case of a 43-year-old female patient is presented, with an apparent history of good health, up to several weeks prior to admission, when she began to present syncopes preceded by palpitations. An electrophysiological study was performed and prematurity in the distal portion of the coronary sinus recording electrode was demonstrated, which corresponds to the great cardiac vein (anterior interventricular vein) and summit of the left ventricle. Despite the excellent early registration, neighboring structures were studied, such as the left ventricular outflow tract in the left coronary cusp, here the pace mapping was not totally concordant. At the site of the precocity obtained within the cardiac venous system, a 100% concordant mapping was achieved, with an ablation catheter's precocity of -30 milliseconds. The ablation was decided with progressive increases in temperature and power with thermomapping and the success of the ablation was achieved without reproducibility of the arrhythmia and excellent subsequent evolution.

Tpeak-Tend, Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables.

AIM: To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. METHODS: Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. RESULTS: Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. CONCLUSIONS: The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.

OBJETIVO: Caracterizar el Tpico-Tfinal, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT en niños y su relación con variables clínicas. MÉTODOS: Estudio transversal en 126 niños entre 9 y 12 años de la escuela Camilo Cienfuegos en Santa Clara, Cuba. Se obtuvieron variables clínicas y antropométricas para determinar su relación con los parámetros electrocardiográficos: el Tpico-Tfinal V5, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT V5. Además, se realizaron pruebas de laboratorio. RESULTADOS: La edad y la presión arterial sistólica se asocian con una mayor probabilidad de tener valores del Tpico-Tfinal/QT V5 ≥75 percentil para ambos sexos (OR: 1.72, IC 95%: 1.02-2.91; p= 0.043), (OR: 1.08, IC 95%: 1.01-1.16; p= 0.017) respectivamente. El índice de masa corporal y la presión arterial sistólica están correlacionados de manera lineal y significativa con el Tpico-Tfinal/QT V5 (r= 0.224; p= 0.012) y (r= 0.220; p= 0.014) respectivamente. CONCLUSIONES: La edad de los pacientes y las cifras de presión arterial sistólica son factores que aumentan la probabilidad de tener valores del percentil Tpico-Tfinal/QT V5 ≥75. Existe correlación lineal significativa entre el Tpico-Tfinal/QT V5 con el índice de masa corporal y la presión arterial sistólica.

Atrial fibrillation and cryptogenic stroke. What is the current evidence? Role of electrocardiographic monitoring.

The diagnosis of cryptogenic stroke is made by exclusion. However, current evidence supports the role of atrial fibrillation episodes as a cause of this condition. Prospective data have demonstrated the benefits of long-term electrocardiographic monitoring to identify atrial fibrillation in association with cryptogenic stroke. This aim of this article was to analyze the contemporary evidence for the possible relationship between atrial fibrillation and cryptogenic stroke and the role of continuous electrocardiographic monitoring to clarify this hypothesis.

Levels of uric acid and increased diastolic blood pressure: Risk factors for atrial fibrillation in patients older than 60 years.

OBJECTIVE: To characterize the maximum P-wave duration (Pmax) and P-wave dispersion (PWD) according to blood pressure (BP) and uric acid (UA) levels in geriatric patients. METHOD: An analytical study was performed in 83 patients aged over 60 years treated at the Family Medical Office 5 of the Aracelio Rodríguez Castellón Polyclinic, in Cienfuegos, Cuba between January and December 2015. The sample was divided into two groups (patients with hyperuricemia and patients with normal UA levels). RESULTS: We found a linear and significant correlation between diastolic BP and Pmax in patients with hyperuricemia (r=0.695; p=0.026), but not in patients with normal UA (r=0.048; p=0.757). A linear and significant correlation was demonstrated between diastolic BP and PWD in patients with hyperuricemia (r=0.657; p=0.039), but not in patients with normal UA (r=0.054; p=0.730). CONCLUSION: There is correlation between diastolic BP and Pmax plus PWD in elderly patients with hyperuricemia.