RESUMO
The tachycardia-bradycardia syndrome is the most frequent form of presentation of Sick sinus node syndrome and is commonly characterized by episodes of paroxysmal atrial fibrillation followed by significant pauses, especially in older adult patients. Other frequently associated tachyarrhythmias are atrial tachycardia and atrial flutter. The association between orthodromic tachycardia and significant pauses in these patients is an unusual presentation. We present the case of an older adult with bradycardia-tachycardia syndrome and syncope, who presented with a hidden accessory pathway and who, after successful ablation of it, did not present syncope again.
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BACKGROUND: In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before the massive practice of invasive electrophysiology. PURPOSE: To validate the QRS-Polarity algorithm in a modern cohort of subjects submitted to radiofrequency catheter ablation (RFCA). Our objective was to determinate its global accuracy and its accuracy for parahisian AP. METHODS: We conducted a retrospective analysis of patients with Wolff-Parkinson-White (WPW) syndrome who underwent an electrophysiological study (EPS) and RFCA. We employed the QRS-Polarity algorithm to predict the AP anatomical location and we compared this result with the real anatomic location determined in the EPS. To determine accuracy, the Cohen's kappa coefficient (k) and the Pearson correlation coefficient were used. RESULTS: A total of 364 patients were included (mean age 30 years, 57% male). The global k score was 0.78 and the Pearson's coefficient was 0.90. The accuracy for each zone was also evaluated, the best correlation was for the left lateral AP (k of 0.97). There were 26 patients with a parahisian AP, who showed a great variability in the ECG features. Employing the QRS-Polarity algorithm, 34.6% patients had a correct anatomical location, 42.3% had an adjacent location and only 23% an incorrect location. CONCLUSION: The QRS-Polarity algorithm has a good global accuracy; its precision is high, especially for left lateral AP. This algorithm is also useful for the parahisian AP.
ANTECEDENTES: En 1996 Iturralde y colaboradores publicaron un algoritmo basado en la polaridad del QRS para determinar la ubicación de las vías accesorias (VA), este algoritmo fue desarrollado antes de la práctica masiva de la electrofisiología invasiva. OBJETIVO: Validar el algoritmo de la polaridad del QRS en una cohorte moderna de sujetos sometidos a ablación con catéter por radiofrecuencia (ACRF). Nuestro objetivo fue determinar su precisión global y su precisión para las VA parahisianas. MÉTODOS: Realizamos un análisis retrospectivo de pacientes con síndrome de Wolff-Parkinson-White (WPW) a los que se les realizó estudio electrofisiológico (EEF) y ACRF. Empleamos el algoritmo de la polaridad del QRS para predecir la ubicación anatómica de la VA y comparamos este resultado con la ubicación anatómica real determinada en el EEF. Para determinar la precisión se utilizaron el coeficiente kappa de Cohen (k) y el coeficiente de correlación de Pearson. RESULTADOS: Se incluyeron un total de 364 pacientes (edad media 30 años, 57 % varones). La puntuación k global fue de 0,78 y el coeficiente de Pearson de 0,90. También se evaluó la precisión para cada zona, la mejor correlación fue para las VA laterales izquierdas (k de 0.97). Hubo 26 pacientes con VA parahisianas, que mostraron una gran variabilidad en las características del ECG. Empleando el algoritmo de la polaridad del QRS, el 34,6 % de los pacientes tenía una ubicación anatómica correcta, el 42,3 % tenía una ubicación adyacente y solo el 23 % una ubicación incorrecta. CONCLUSIÓN: El algoritmo de la polaridad del QRS tiene una buena precisión global; su precisión es alta, especialmente para VA lateral izquierdo. Este algoritmo también es útil para la VA parahisiana.
Assuntos
Feixe Acessório Atrioventricular , Ablação por Cateter , Síndrome de Wolff-Parkinson-White , Humanos , Masculino , Adulto , Feminino , Estudos Retrospectivos , Eletrocardiografia , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/cirurgia , Feixe Acessório Atrioventricular/cirurgia , AlgoritmosRESUMO
This guide provides help for medical doctors systematically identifying each commercial brand of pacemakers by thoracic radiography through their electronic components (electrode connectors, logic circuit, and battery); this is crucial for watching the pacemaker after being implanted. We aimed to describe the different cardiac stimulation devices, electrodes, and programming modes more frequently used.
Esta guía propone brindar una ayuda a todos los médicos para la identificación metódica de cada marca comercial de marcapasos por radiografía simple de tórax, por medio de sus componentes electrónicos (conectores de electrodos, circuito lógico y batería), siendo necesario para la interrogación de dispositivos de marcapasos posterior a su implante. Se describirán los diferentes tipos de marcapasos, electrodos y modos de programación más frecuentemente utilizados.
Assuntos
Arritmias Cardíacas , Marca-Passo Artificial , Humanos , Estimulação Cardíaca Artificial , Coração , Sistema de RegistrosRESUMO
Left bundle branch stimulation is a second-line strategy in patients where His bundle stimulation is not optimal. Currently, no cases of left bundle branch stimulation have been reported in patients with diffuse electrical cardiac disease or in the pediatric population.
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Background: The Global Registry of Acute Coronary Events (GRACE) prediction model stratifies patients with non-ST-segment elevation myocardial infarction (NSTEMI). Corrected QT interval (QTc) is not considered in this model. Objective: To evaluate the relationship between the QTc interval and the GRACE score in patients with NSTEMI. Materials and methods: An observational, retrospective study was carried between 2016 and 2019. We included patients with diagnosis of NSTEMI, QTc intervals were calculated with Bazett's formula, and they were classified into 2 groups: a normal QTc interval (<440 ms) and prolonged (≥440 ms). According to the GRACE score they were classified in three ranges: low risk (≤109 points), intermedium (110 - 139 points) and high (≥140 points), we determined if there were a correlation between QTc interval and the GRACE score. Results: A total of 940 patients with a diagnosis of NSTEMI were admitted in our institution, 634 met the inclusion criteria, there were 390 patients with normal QTc interval and 244 with a prolonged QTc interval. Patients with prolonged QTc were older (65.5 vs 61, p=0.001) with a lower proportion of males (71.7% vs 82.8%, p=0.001). An association was found between the GRACE score and the QTC interval, subjects with a normal QTc had a greater proportion of low and intermediate risk than those with a prolonged QTc (p=0.001). Conclusions. In NSTEMI patients, a normal QTc interval (<440 ms) is associated with a GRACE risk score of low or intermediate risk.
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Objective: . To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. Materials and methods: . We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. Results: . Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66-6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08-5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06-5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34-6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR 0.29, IC 95% 0.12-0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48-0.86, p=0.013) were protective factors. Conclusions: . Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it.
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Accelerated idioventricular rhythm has traditionally been recognized as a benign arrhythmia. During an acute myocardial infarction, it is considered a marker of successful reperfusion, though the evidence is controversial. Usually, this arrhythmia is transitory and does not cause hemodynamic compromise; however, its presence may have prognostic value and not necessarily be a benign marker. The recognition of this arrhythmia is always important as well as its recording on a 12-lead electrocardiogram. We present the case of an adult male patient with inferior ST-segment elevation myocardial infarction, who presented accelerated idioventricular rhythm without reperfusion therapy.
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Tetralogy of Fallot (ToF) is one of the most prevalent cyanotic congenital heart disease (CHD). Subsequent to the introduction of surgical repair, long-term outcomes for patients with ToF have improved significantly. Pulmonary atresia with ventricular septal defect (PA-VSD) may be considered as an extreme form of classic ToF. Surgical repair not only corrects the haemodynamic but also creates scars that will be source for ventricular arrhythmias. Patients with tetralogy of Fallot are at risk for ventricular arrhythmias and sudden cardiac death. We present the successful treatment of a 7-years-old child with history of PA-VSD treated by surgical correction and ventricular tachycardia from an unusual anatomic place in the left ventricle summit (LVS), using catheter ablation.
Assuntos
Ablação por Cateter , Cardiopatias Congênitas , Taquicardia Ventricular , Tetralogia de Fallot , Criança , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: The coronavirus disease (COVID-19) pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide. OBJECTIVES: Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center. METHODS: We made a retrospective review of our data base and we compared procedures made in the past 3 years since 2017-2019 with the procedures made in the 2020. We divided the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures and electrophysiological procedures (EP) which included conventional and complex ablations. RESULTS: There was a significant reduction in all the procedures, the average of procedures performed in the last 3 previous years was 467, while in 2020, we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures. There was no statistical difference regarding the CIED related procedures, the average of procedures in the past 3 previous years was 174, and in 2020 we performed 190 procedures (p = 0.46). Regarding the EP, the average of the past 3 previous years was 293, while in 2020, we performed only 129 procedures (p < 0.01). The reduction in the EP was 55.97%. The most affected months were April, May, and June. CONCLUSIONS: The COVID-19 pandemic considerably affected the number of the procedures in our center, reducing it by 33.4%. The reduction of procedures fundamentally affected the ablations, with a reduction of 55.97%. The number of CIED related procedures was not affected.
Assuntos
COVID-19 , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Pandemias , Humanos , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
Wolff Parkinson White Syndrome occurs due to the presence of accessory pathways that abnormally communicate the atria with the ventricles. It is one of the main causes of paroxysmal supraventricular tachycardia in young people and adolescents, in whom the ideal management is catheter ablation. This syndrome can also occur in younger patients such as neonates and infants, where the therapeutic options are different. We present the case of a 47-day-old patient who was admitted to a public pediatric hospital in Peru due to vomiting. Upon admission, she showed a heart rate of 250 beats per minute; wide QRS complex tachycardia was documented; later, on the electrocardiogram in sinus rhythm, signs of pre-excitation were evident.
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Abstract Background: In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before the massive practice of invasive electrophysiology. Purpose: To validate the QRS-Polarity algorithm in a modern cohort of subjects submitted to radiofrequency catheter ablation (RFCA). Our objective was to determinate its global accuracy and its accuracy for parahisian AP. Methods: We conducted a retrospective analysis of patients with Wolff-Parkinson-White (WPW) syndrome who underwent an electrophysiological study (EPS) and RFCA. We employed the QRS-Polarity algorithm to predict the AP anatomical location and we compared this result with the real anatomic location determined in the EPS. To determine accuracy, the Cohen's kappa coefficient (k) and the Pearson correlation coefficient were used. Results: A total of 364 patients were included (mean age 30 years, 57% male). The global k score was 0.78 and the Pearson's coefficient was 0.90. The accuracy for each zone was also evaluated, the best correlation was for the left lateral AP (k of 0.97). There were 26 patients with a parahisian AP, who showed a great variability in the ECG features. Employing the QRS-Polarity algorithm, 34.6% patients had a correct anatomical location, 42.3% had an adjacent location and only 23% an incorrect location. Conclusion: The QRS-Polarity algorithm has a good global accuracy; its precision is high, especially for left lateral AP. This algorithm is also useful for the parahisian AP.
Resumen Antecedentes: En 1996 Iturralde y colaboradores publicaron un algoritmo basado en la polaridad del QRS para determinar la ubicación de las vías accesorias (VA), este algoritmo fue desarrollado antes de la práctica masiva de la electrofisiología invasiva. Objetivo: Validar el algoritmo de la polaridad del QRS en una cohorte moderna de sujetos sometidos a ablación con catéter por radiofrecuencia (ACRF). Nuestro objetivo fue determinar su precisión global y su precisión para las VA parahisianas. Métodos: Realizamos un análisis retrospectivo de pacientes con síndrome de Wolff-Parkinson-White (WPW) a los que se les realizó estudio electrofisiológico (EEF) y ACRF. Empleamos el algoritmo de la polaridad del QRS para predecir la ubicación anatómica de la VA y comparamos este resultado con la ubicación anatómica real determinada en el EEF. Para determinar la precisión se utilizaron el coeficiente kappa de Cohen (k) y el coeficiente de correlación de Pearson. Resultados: Se incluyeron un total de 364 pacientes (edad media 30 años, 57 % varones). La puntuación k global fue de 0,78 y el coeficiente de Pearson de 0,90. También se evaluó la precisión para cada zona, la mejor correlación fue para las VA laterales izquierdas (k de 0.97). Hubo 26 pacientes con VA parahisianas, que mostraron una gran variabilidad en las características del ECG. Empleando el algoritmo de la polaridad del QRS, el 34,6 % de los pacientes tenía una ubicación anatómica correcta, el 42,3 % tenía una ubicación adyacente y solo el 23 % una ubicación incorrecta. Conclusión: El algoritmo de la polaridad del QRS tiene una buena precisión global; su precisión es alta, especialmente para VA lateral izquierdo. Este algoritmo también es útil para la VA parahisiana.