ABSTRACT
We report 67-year-old woman with a sinus node dysfunction and diffuse conduction system disease, with a history of recurrent paroxysmal atrial fibrillation. She was admitted to the Hospital due to palpitations, dizziness, and vertigo, attributing the symptoms to the rhythm disorder described, for which the implantation of a pacemaker was indicated. With a history of tracheal cancer treated with radio and chemotherapy, and chronic steroid therapy for rheumatoid arthritis, she had an important limitation in vascular access for a conventional pacemaker, so, added to a high risk of infection, a decision was made to implant a leadless pacemaker. We discuss the electrocardiographic and clinical manifestations of sinus node disease, its relationship with oncological treatment and the indication for a permanent pacemaker, highlighting the characteristics of this new modality of artificial cardiac stimulation, for a special type of patients.
Subject(s)
Male , Female , Aged , Pacemaker, Artificial , Atrial Fibrillation , Treatment Outcome , ElectrocardiographyABSTRACT
We report a 20-year-old male athlete who while running, presented a sudden death due to ventricular fibrillation. He was successfully rescued by cardiopulmonary resuscitation maneuvers and an automatic external defibrillator. Without evidence of structural heart disease, Brugada syndrome was diagnosed as the cause, after which a subcutaneous implantable cardioverter defibrillator was indicated. We discuss the subject of sudden cardiac death in athletes and its unusual relationship with exercise in this channelopathy.
Subject(s)
Humans , Male , Adult , Young Adult , Cardiopulmonary Resuscitation , Defibrillators, Implantable , Brugada Syndrome/complications , Brugada Syndrome/diagnosis , Arrhythmias, Cardiac , Death, Sudden, Cardiac/etiologyABSTRACT
La taquicardia ventricular del tracto de salida de ventrículo derecho (TVD) es causa del 70 por ciento de las taquicardias ventriculares idiopáticas. Entre octubre de 1995 y agosto de 1997, siete pacientes (4 hombres), con edad promedio de 35 años (6-60), fueron sometidos a estudio electrofisiológico (EEF) y fulguración con radiofrecuencia (FRF) por TVD. El tiempo promedio de evolución de los síntomas fue de 21 meses. Los 7 pacientes tenían palpitaciones y 2 síncope. Ninguno tenía cardiopatía estructural de base y todos habían fracasado el tratamiento farmacológico. Durante el EEF, en tres pacientes la TV se inició espontáneamente, en cuatro con estimulación ventricular e isoproterenol y en uno con estimulación auricular. Para la FRF se avanzó un catéter vía vena femoral derecha, y bajo visión radioscópica, se mapeó el tracto de salida del ventrículo derecho con técnica de pace mapping. La FRF tuvo éxito en los 7 pacientes. Hubo una recidiva a los 92 días, con refulguración exitosa. El promedio de aplicaciones de radiofrecuencia fue de 10 (rango de 1 a 19). El tiempo promedio de laboratorio fue de 4,6 ñ 0,6 horas, con un tiempo de radioscopia de 27 ñ 5 min. No hubo complicaciones ni recidivas de las TVDs. Conclusión: la FRF es una alternativa terapéutica eficaz y segura para pacientes con TVD
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Catheter Ablation/methods , Arrhythmogenic Right Ventricular Dysplasia/surgery , Electrocoagulation/methods , Amiodarone/therapeutic use , Arrhythmogenic Right Ventricular Dysplasia/complications , Electrocardiography/methods , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/etiologyABSTRACT
We report a 41 years old female, previously operated of an atrial septal defect, presenting with a persisting atrial flutter. Sinus node dysfunction became evident during an electrophysiological study at the moment of interrupting the flutter with electrical stimulation. The patient was treated with his bundle ablation and implantation of a definitive pacemaker. After one year of follow up, she is devoid of symptoms
Subject(s)
Humans , Female , Adult , Atrial Flutter/diagnosis , Sick Sinus Syndrome/physiopathology , Atrial Flutter/surgery , Atrial Flutter/etiology , Atrial Flutter/drug therapy , Sick Sinus Syndrome/complications , Sick Sinus Syndrome/diagnosis , Digoxin/therapeutic use , Amiodarone/therapeutic use , Catheter Ablation , Electrocardiography, Ambulatory , Clinical EvolutionABSTRACT
We report a 81 years old female with a severe aortic insufficiency, treated with diuretics and antidepressants admitted due to recurrent syncopal episodes. During the first syncopal episode, an atrioventricular block was detected and an endocavitary demand pacemaker implanted. Two years later, she had a new syncope without evidences of pacemaker failure. The EKG during pacemaker rhythm showed a prolonged QT interval. During hospital monitoring, she presented a self limited polymorphic ventricular tachycardia (Torsade de pointes). Consequently, the pacemaker was programmed at a greater frequency, and the QT interval shortened from 0.73 to 0.56 sec. Thereafter, the patient no longer had tachycardia or syncopal episodes, after one year of follow up
Subject(s)
Humans , Female , Aged , Tachycardia, Ventricular/chemically induced , Syncope/etiology , Long QT Syndrome/complications , Pacemaker, Artificial , Enalapril/adverse effects , Tachycardia, Ventricular/complications , Depressive Disorder/drug therapy , Digoxin/adverse effects , Furosemide/adverse effects , Amitriptyline/adverse effects , Electrocardiography, Ambulatory , Syncope/surgery , Syncope/drug therapy , Long QT Syndrome/diagnosisABSTRACT
The differential diagnosis of tachycardias with a widened QRS complex is a frequent problem that cardiologists and emergency room physicians must face. Ventricular tachycardias, supraventrical tachycardias with aberration of ventricular conduction and supraventricular tachycardias conducted by accessory routes (pre-exited or antidromic) are the three mechanisms that cause tachycardias with a widened QRS complex, whose clinical significance and treatments are different. Recently, intracardiac electrophysiological studies allowed the identification of efficient electrocardigraphic criteria to distinguish each of these mechanisms. Several reports have indicated these criteria based on the careful analysis of the surface electrocardiogram
Subject(s)
Humans , Tachycardia, Supraventricular/diagnosis , Tachycardia, Ventricular/diagnosis , Diagnosis, Differential , Electrocardiography/methodsABSTRACT
A 41 yers old woman with polymyositis-dermatomyositis with cardiac involvement is presented. The patient evolved with congestive heart failure, the electrocardiogram showed a left anterior hemiblock, lack of progression of R waves from V1 to V4 and unespecific ST and T alterations. Echocardiogram and cardiac catheterization showed global ventricular disfunction and pulmonary hypertension. An endomyocardial biopsy performed at the apex of the right ventricle showed mononuclear inflammatory infiltration myocardial fiber degeneration and fibrosis. Initially the patient responded well to diuretic vasodilator and steroid therapy. Posteriorly she developed an atrial flutter that reqquired electrical cardioversion and later died suddenly during the course of an acute pneumonia