Subject(s)
Humans , Aged , Hepatitis, Alcoholic/complications , Heart Failure/diagnosis , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/therapy , Tachycardia, Ventricular/diagnosis , Alcoholism/complications , Amiodarone/therapeutic use , Calcium Channel Blockers , Diagnosis, Differential , Electric Countershock , Electrocardiography , Atrial Flutter/etiology , Procainamide , Procainamide/supply & distribution , Propranolol/therapeutic useABSTRACT
Background: Atrial fibrillation can originate in arrhythmogenic foci coming from the pulmonary veins. Patients with atrial fibrillation, initiated from triggering foci, can be treated with radiofrequency ablation. Aim: To report the results of radiofrequency ablation in patients with focal atrial fibrillation. Patients and methods: Thirteen patients with focal atrial fibrillation (8 male, aged 19 to 60 years old) are reported. Twelve had frequent crises refractory to antiarrhythmic drugs. Two had also flutter and tachycardia. One had a permanent atrial fibrillation lasting five years. Two had ventricular dysfunction and left atrial dilatation. The triggering focus was identified during the electrophysiological study, by the precocity of the potential that initiated the atrial fibrillation. Results: All patients had early atrial extrasystolic beats, isolated or repetitives, that preceded atrial fibrillation. During the electrophysiological study, 18 foci (3 in the right and 15 in the left atrium all in pulmonary veins) were identified. Radiofrequency ablation had immediate success in 11 patients. In 5, a flutter was also ablated. One patient had a sinus dysfunction after the procedure and atrial fibrillation was not eliminated. In this and other patient in whom the procedure failed, a pacemaker was implanted and the atrioventricular node was blocked. In a follow up, ranging from 4 to 31 months, eight patients are asymptomatic and 3 recidivated. No complications have been detected. Conclusions: Patients with focal atrial fibrillation have common clinical and electrocardiographic features. Radiofrequency ablation of the triggering focus is possible and effective in most cases
Subject(s)
Humans , Male , Female , Catheter Ablation/methods , Atrial Fibrillation/diagnosis , Atrial Fibrillation/therapy , Anti-Arrhythmia Agents/therapeutic use , ElectrocardiographyABSTRACT
Distintas formas de terapia están en estudio para pacientes (pts) con fibrilación auricular paroxística (FAP) refractaria. Datos iniciales muestran que lesiones lineales con radiofrecuencia (RF) en aurícula derecha (AD) y aurícula izquierda (AI) puede ser efectiva en controlar la FAP, no obstante la complejidad y riesgos del procedimiento han hecho que algunos autores limiten la RF sólo a AD. En el presente trabajo comunicamos nuestra experiencia en un grupo de 6 pts tratados con RF en AD por FAP recurrente. Material y método: Seis pts (5 hombres, edad x 54 años), 4 de ellos con FAP idiopática y 2 cardiopatía hipertensiva se incluyen en esta experiencia. Cuatro eran pts muy sintomáticos con crisis de FAP 2 a 3 veces por semana, de 1 a 3 días, y refractarios a múltiples drogas. Otros 2 eran sintomáticos por palpitaciones, y se documentó flutter sostenido, y en Holter tenían crisis frecuentes de FAP. En 5 pts en el estudio se indujo muy fácilmente FAP y en otro, eléctricamente muy inestable, no se intentó inducir arritmias. La RF se hizo con un catéter Medtronic, a 70º, con aplicaciones de 20 a 30 seg en el septum interauricular, desde la vena cava superior, pasando por foramen oval, luego ostium de seno coronario y desde allí a la llegada de cava inferior. Además se hizo RF en el istmo cavotricuspideo. Todos recibieron heparina IV durante el procedimiento. Resultado: en 2 pts ablacionados en FAP esta arritmia se convirtió durante la RF. Otros 2 pts requirieron cardioversión y otros 2 se ablacionaron en ritmo sinusal. El n de aplicaciones de RF fue x 24 y el tiempo de Rx x 64,7 min. No hubo complicaciones. En un seguimiento de 4 a 15 m (x 9,5) 2 han tenido una notable mejoría, con crisis cortas, cada 30-90 días, manteniendo la misma terapia que previo a la RF. Los 2 pts que además tenían flutter están asintomáticos y en Holter no tienen arritmias; uno de ellos requirió MP por disfunción sinusal. Los 2 pts restantes no mejoraron post RF. Uno de ellos requirió implante de MP DDD por evolucionar con disfunción sinusal. Conclusión: las lesiones lineales con RF en AD pueden mejorar la evolución de pts con FAP altamente sintomáticos y refractarios a terapia médica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Catheter Ablation/methods , Atrial Fibrillation/therapy , Catheter Ablation/instrumentation , Atrial Flutter/therapy , Electrocardiography, Ambulatory/methods , Atrial Fibrillation/complicationsABSTRACT
A great deal of interest has received atrial fibrillation, the most common arrhythmia in adults, due to its complications and difficulttreatment Its most dreaded complication is atrial thrombi formation with the subsequent risk of embolization There are several reports defining risk factors for embolic complications and the usefulness of anticoagulants for their prevention. We review the state of the art of anticoagulation in atrial fibrillation not associated to rheumatic valvulopathy. We also give tools to assess embolic risk and to determine the anticoagulant choice for the different presentation forms of atrial fibrillation
Subject(s)
Humans , Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Thromboembolism/prevention & control , Warfarin/administration & dosage , Aspirin/administration & dosage , Risk Factors , Primary Prevention/methodsABSTRACT
Most cases of atrial fibrillation are converted with antiarrhyhmic medications or external electric defibrillation. However, in some refractory patients,an internal transcatheter defibrillation must be attempted. We report a 50 years old male with an atrial fibrillation of one year duration that was refractory to pharmacological treatment and in whom external cardioversion was unsuccessful. After the application of a bifasic shock of 10 joules between a cather in the right atrium and another one located at the coronary sinus, the patient was converted to sinus rhythm. At two months of follow up, the patient continues in sinus rhythm
Subject(s)
Humans , Male , Middle Aged , Electric Countershock/methods , Atrial Fibrillation/therapy , Echocardiography , Femoral Vein , Amiodarone/therapeutic use , Cardiac Catheterization/methodsABSTRACT
We measured plasma concentrations of amiodarone and desethylamiodarone by HPLC in 44 outpatients aged 24 to 67 years old (21 male), receiving the drug during at least three months. The drug was indicated for supraventricular arrythmias in 37 patients and ventricular arrhytmias in seven. Plasma concentrations of amiodarone, desethylamiodarone and their ratio were 1.71ñ0.82, 0.85ñ0.42 µg/ml and 2.02 respectively, for a mean daily dose of 223ñ88 mg. In 41 patients, arrhytmias were succesfully treated. These patients received a mean daily dose of 220ñ86 mg and concentrations of amiodarone, desethylamiodarone and their ratio were 1.75ñ0.86, 088ñ0.45 µg/ml and 1.99 respectively. In 3 patients with treatment failure, receiving a daily dose of 257ñ115 mg, these figures were 1.2ñ0.3, 0.5ñ0.1 µg/ml and 2.4 respectively. We conclude that our patients had lower plasma concentrations of desethylamiodarone and higher amiodarone/desethylamiodarone ratios than those reported in other countries
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Arrhythmias, Cardiac/drug therapy , Amiodarone/pharmacokinetics , Amiodarone/blood , Chronic Disease/drug therapyABSTRACT
Nonpharmacological methods are a novel therapeutic option for tachiarrhytmias. Transctheter ablation or surgery can cure many arrhythmias, avoiding the collateral effects of antiarrhythmic drugs. Likewise, implantable defibrillators, have changed life expectancy of patients with high risk arrhythmias or sudden survivors. However, the high cost and sophistication of these methods, preclude their widespread use, thus limiting the number of patients that can be benefited. This article reviews the main nonpharmacological techniques for treatment arrhythmias, their results and complications
Subject(s)
Humans , Tachycardia/therapy , Atrial Flutter/physiopathology , Atrial Flutter/therapy , Surgical Procedures, Operative , Tachycardia, Atrioventricular Nodal Reentry/therapy , Tachycardia, Supraventricular/therapy , Tachycardia, Ventricular/therapy , Defibrillators, Implantable , Catheter Ablation/methodsSubject(s)
Humans , Arrhythmias, Cardiac/diagnosis , Atrial Flutter/diagnosis , Bradycardia/diagnosis , Atrial Fibrillation/diagnosis , Tachycardia/diagnosis , Tachycardia, Paroxysmal/diagnosis , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/etiology , Heart Diseases/diagnosis , Syncope/diagnosisABSTRACT
Se presentan los resultados de los primeros pacientes tratados con radiofrecuencia en el Centro Nacional de Arritmias. Los resultados obtenidos son comparables a los reportes de las más grandes series norteamericanas y europeas. Por ser un centro de referencia, la mayor parte de estos pacientes son de alta complejidad y se incluyen incluso 4 enfermos tratados sin éxito en otro centro y que fueron exitosamente tratados en nuestro hospital. De esta forma, la ablación con radiofrecuencia se presenta como una excelente terapia curativa para la TPSV y TVI refractarias. Su rol en el flutter y taquicardia auricular debe definirse mejor con una mayor casuística, y su utilidad parece ser limitada en la TV secundaria a daño estructural cardíaco. Igualmente, en enfermos con taquiarritmias supraventriculares con alta frecuencia ventricular refractarios a drogas la inducción de BAV completo con RF y modulación de la frecuencia ventricular con un MP es una muy buena alternativa terapéutica
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Catheter Ablation/methods , Reference Standards , Tachycardia/surgery , Atrial Flutter/surgery , Electrocardiography , Follow-Up Studies , Heart Block , Tachycardia, Atrioventricular Nodal Reentry/surgery , Tachycardia, Supraventricular/surgery , Tachycardia, Ventricular/surgery , Tachycardia, Paroxysmal/surgery , Treatment OutcomeABSTRACT
La realización en forma combinada de revascularización coronaria y cirugía de aneurisma de aorta abdominal es una alternativa de manejo quirúrgico para un grupo seleccionado de pacientes portadores de ambas patologías que se está empleando cada vez con mayor frecuencia dado los excelentes resultados reportados. Presentamos en esta oportunidad el primer paciente tratado de esta forma en nuestra institución, el cual evolucionó en forma satisfactoria sin presentar complicaciones post operatorias y analizamos sus indicaciones y beneficios. No obstante que nuestra experiencia es limitada, el caso que presentamos y que las series internacionales están constituídas por no más de 12 pacientes, creemos que esta técnica de cirugía combinada se constituirá en el futuro en una alternativa segura para el manejo de muchos pacientes portadores de ambas patologías