ABSTRACT
Persistent left superior vena cava is the most common venous congenital malformation and is usually asymptomatic. Its presence could increase the difficulty for transvenous lead implantation. We report a 71-year-old woman with an idiopathic dilated cardiomyopathy, atrial fibrillation and heart failure that required biventri-cular resynchronization therapy. During the placement of the device a persistent left superior vena cava was detected. The device was placed without problems and the patient had a satisfactory postoperative evolution.
Subject(s)
Aged , Female , Humans , Atrial Fibrillation/therapy , Cardiac Resynchronization Therapy , Cardiac Resynchronization Therapy Devices , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Vena Cava, Superior/abnormalitiesABSTRACT
We report a 26year old patient who had a single chamber pacemaker implantation one year before. During a routine pre-operative evaluation, pacemaker dysfunction was demonstrated due to sensing and pacing failure, associated to left pectoral muscle rhythmic contraction. Chest X-ray confirmed Twiddler syndrome, in which twisting or rotation of the device inside the pocket results in lead dislodgement and device malfunction.
Subject(s)
Adult , Humans , Male , Cardiac Pacing, Artificial , Equipment Failure , Foreign-Body Migration/complications , Pacemaker, Artificial , Muscle Contraction/physiology , SyndromeABSTRACT
Background: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. Aim: To evaluate CPV in patients with AF submitted to valvular surgery. Patients and Methods: Twenty one patients had simultaneous valvular surgery and CPV, 81 percent of them had permanent AFfor an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60°C for 2 minutes with two 15 mm cryoprobes applied simultaneously. Results: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8 percent (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50 percent of patients were in normal sinus rhythm and 25 percent persisted in AF. The remaining patients were in some type of regular rhythm. Conclusions: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50 percent of the cases, with low morbidity and mortality and little increment in surgical time.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation/surgery , Cardiac Surgical Procedures/methods , Catheter Ablation/methods , Cryosurgery/methods , Pulmonary Veins/surgery , Atrial Fibrillation/mortality , Cardiac Surgical Procedures/mortality , Catheter Ablation/mortality , Follow-Up Studies , Heart Atria/surgery , Heart Valve Prosthesis Implantation , Treatment OutcomeABSTRACT
We report a 59 year-old woman who had recurrent episodes of paroxystic supraventricular tachycardia despite pharmacologic therapy. A previous electrophysiological study (EPS) was done two years earlier without induction of any sustained arrhythmia. A new EPS was performed, during which atrial and ventricular programmed stimulation failed to induce tachycardia, and only by fast ventricular stimulation during intravenous isoproterenol infusion, a typical atrio ventricular nodal reentrant tachycardia (AVNRT) was induced. We successfully ablated the slow nodal pathway. After ablation the tachycardia was not inducible. We comment the occasional difficulties to induce AVNRT and the importance of a complete induction protocol to avoid false negative studies during the EPS.
Subject(s)
Female , Humans , Middle Aged , Cardiac Pacing, Artificial , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Supraventricular/diagnosis , Atrioventricular Node , Diagnosis, Differential , Recurrence , Stimulation, Chemical , Tachycardia, Atrioventricular Nodal Reentry/etiologyABSTRACT
Background: Electrode lead design and materials influence their performance, stability and manipulation characteristics. In our laboratory, we use straight intracardiac, active fixation, steroid eluting leads. These features are shared by three brands of pacemarker distributors. Aim: To compare the short term results of three brands of leads used in our laboratory in patients requiring the implant of a pacemarker of cardioverter. Material and methods: One hundred and four patients (mean age 70 years, 59 males) subjected to a pacemarker or cardioverter implant were studied and followed during the first three months post implant. In these patients, 49 Guidant Flextend® 4087 or 4088, 27 Saint Jude Tendril® 1488T and 10 Medtronic Capsurefix® 5076 leads were implanted in the right atrium and 60 Guidant Flextend® 4087 or 4088, 29 Saint Jude Tendril® 1488T and 19 Medtronic Capsurefix® 5076 leads were implanted in the right ventricle. Results: Implant parameters were adequate for all leads. A sub-acute rise in ventricular stimulation threshold was detected in one Flextrend® lead. Three atrial leads (two Flextend® and one Capsurefix®) and one Capsurefix® ventricular lead experienced an acute displacement. One patient with a Flextend® lead, had a cardiac tamponade caused by an atrial perforation. Conclusions: The three brands of leads tested can be successfully implanted with comparable parameters and without differences in the evolution of patients during the first three months.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac/therapy , Defibrillators, Implantable , Pacemaker, Artificial , Equipment Design , Follow-Up Studies , Retrospective StudiesABSTRACT
Cardiac resynchronization therapy is a non-pharmacological treatment for patients with dilated cardiomyophaty and congestive heart failure. The success of this therapy depends of permanent biventricular stimulation. We report an 84 year-old man, with intermittent loss of biventricular pacemaker stimulation despite having adequate sensing and stimulation thresholds in the right atrium and both ventricles. The problem was solved after correcting some programming parameters.
Subject(s)
Aged, 80 and over , Humans , Male , Cardiac Pacing, Artificial , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Cardiomyopathy, Dilated/physiopathology , Electrocardiography , Equipment Failure , Heart Block/therapyABSTRACT
Background: Since February 2002, Flextend® electrode catheters are used at the Cardiovascular Unit of the Catholic University Clinical Hospital. These transvenous catheters have an IS-1 connector, silicone coating, active fixation and retractile helix with dexamethasone acetate. Aim: To report early and one year results using Flextend® catheters. Material and methods: Retrospective analysis of all patients that received an implant of a Flextend® catheter in the Unit. Results: Forty one Flextend® catheters were implanted in 24 patients, without acute displacement or clinical pericarditis. In 18 electrode catheters located in the right atrium the mean values for p wave, stimulation threshold and impedance at the moment of placement, were 2.9±1.4 mV, 0.8±0.4 V and 522±86 Ohms, respectively. The figures 24 hours after placement were 3.6±2.1 mV, 0.8±0.3 V and 612±69 Ohms, respectively. In 23 electrode catheters in the right ventricle, mean values at the moment of placement for R wave, stimulation threshold and impedance were 11.3±3.6 mV, 0.8±0.2 V and 756±108 Ohms, respectively. The figures 24 hours after placement were 3.6±2.1 mV, 0.8±0.3 V and 612±69 Ohms, respectively. In one patient, the stimulation threshold increased two months after placement and required a new intervention. Conclusions: Flextend® catheters ca be placed successfully with a low rate of complications and stable function parameters on follow up.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Electric Stimulation , Electrodes, Implanted/standards , Pacemaker, Artificial , Technology Assessment, Biomedical , Arrhythmias, Cardiac/therapy , Cardiography, Impedance , Follow-Up Studies , Heart Conduction System , Retrospective Studies , Sensory ThresholdsABSTRACT
Persistent left superior vena cava and absent right superior vena cava is an uncommon anatomical association. This is a challenging situation for permanent pacemaker implantation. We report three patients with this anomaly and a permanent pacemaker successfully implanted through the left superior vena cava and coronary sinus, without acute or chronic complications.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arrhythmia, Sinus/therapy , Cardiac Pacing, Artificial/methods , Pacemaker, Artificial , Tachycardia/therapy , Vena Cava, Superior/abnormalities , Vena Cava, SuperiorABSTRACT
The prevalence of congestive heart failure has increased in the world. Despite advances in pharmacological treatment, some patients have progression of the disease and deterioration of their functional class. In this group of patients cardiac resynchronization therapy has been accepted as a treatment option. However, some patients are non-responders to cardiac resynchronization, and others who respond favorably, will experience reappearance of their symptoms. For these patients, multisite stimulation with the implant of a second electrode in the right ventricle has been published as a new option. We report a 76 year-old woman with a dilated cardiomyopathy, who was treated with resynchronization therapy with good clinical response during two years, but symptoms of congestive heart failure reappeared and her functional class deteriorated to NYHA class IV. She was successfully treated with right ventricular multisite stimulation, with a reduction of symptoms that has lasted during the two months of follow up after the procedure.
Subject(s)
Aged , Female , Humans , Cardiac Pacing, Artificial/methods , Cardiomyopathy, Dilated/therapy , Ventricular Dysfunction, Right/therapy , Cardiomyopathy, Dilated/physiopathology , Disease Progression , Electrocardiography , Treatment Outcome , Ventricular Dysfunction, Right/physiopathologyABSTRACT
Background: The costs of medical care increase along with technological advances. Therefore, highly complex and expensive procedures should be performed in a limited number of institutions. Aim: To report the initial experience on electrophysiological studies performed to beneficiaries of a public health insurance system in Chile (FONASA). Material and methods: An agreement was reached between the Electrophysiology Unit of the Clinical Hospital of the Catholic University and FONASA, to perform electrophysiological studies at a minimal cost, that only considered disposable materials and hospital stay. Thirty patients with supraventricular arrhythmias or ventricular arrhythmias without an associated cardiopathy, were attended using this agreement at the unit. Results: In all treated patients, arrhythmias disappeared. Costs remained within the assigned budget, excepting occasional complementary tests. Conclusions: This pioneering experience demonstrated that it is possible that public health insurance systems can buy complex and expensive procedures to private hospitals.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac/diagnosis , Electrophysiologic Techniques, Cardiac/economics , Insurance, Health/economics , National Health Programs/economics , Arrhythmias, Cardiac/economics , Chile , Electrocoagulation , Follow-Up Studies , Health Benefit Plans, Employee/economics , Health Care Costs , Hospitals, Private , Hospitals, Public , Hospitals, University , Pilot ProjectsABSTRACT
Ventricular tachycardia is one of the most feared complications after surgical repair of Tetralogy of Fallot and it is associated with sudden death. We report a 26 years old female with a history of surgical repair of Tetralogy of Fallot at age of 4 year-old, who developed sustained ventricular tachycardia despite antiarrhythmic drugs. She was successfully treated with radiofrequency catheter ablation. Radiofrequency catheter ablation is a valid treatment for these patients.
Subject(s)
Adult , Female , Humans , Catheter Ablation , Postoperative Complications/surgery , Tachycardia, Ventricular/surgery , Tetralogy of Fallot/surgery , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Electrocardiography , Postoperative Complications/drug therapy , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/etiologyABSTRACT
We report three patients with pre-excitation syndrome that resembled an acute coronary syndrome. A 65 years old woman, consulting in the emergency room for palpitations and retrosternal pain. EKG showed regular tachycardia and ST depression that reverted spontaneously after an episode of vomiting. A subsequent EKG demonstrated a pre-excitation syndrome and the accessory pathway was fulgurated. A 18 years old male presenting with tachycardia and chest pain elicited during exercise. An EKG showed a pre-excitation syndrome and ST segment elevation in V2 and V3. A coronary angiogram was normal. The accessory pathway successfully fulgurated. A 63 years old woman that presented tachycardia while exercising. She was subjected to an electrical cardioversion. An electrophysiological study showed an accessory pathway that was successfully fulgurated.
Subject(s)
Adolescent , Aged , Female , Humans , Male , Middle Aged , Chest Pain/etiology , Heart Conduction System/abnormalities , Pre-Excitation Syndromes/complications , Chest Pain/physiopathology , Electrocardiography , Heart Atria/physiopathology , Heart Conduction System/physiopathology , Heart Ventricles/physiopathology , Myocardium/enzymology , Pre-Excitation Syndromes/physiopathologyABSTRACT
Background: Radiofrequency ablation of the inferior vena cavatricuspid valve isthmus relieves atrial flutter in 95percent of cases. Aim: To evaluate the long term results of radiofrequency ablation of the inferior vena cavatricuspid valve isthmus in atrial flutter. Material and methods: Retrospective review of 86 patients with common atrial flutter, treated with radiofrequency ablation of the isthmus, while in sinus rhythm or flutter. Patients were contacted by telephone for a new clinical and electrocardiographic assessment, three to 40 months after the procedure. Results: Of all the patients treated, five died and five were lost from follow up, thus 76 patients (mean age 56 years, 58 males) were contacted for reassessment. At the moment of the procedure, 51percent had an underlying cardiac disease and 25percent had high blood pressure. All referred palpitations, 25percent had dyspnea, 84percent were receiving antiarrhythmic drugs and 33percent were on oral anticoagulants. Flutter was paroxystic in 83percent and chronic in 17percent. Fulguration was successful in all patients; one patient presented a high grade atrioventricular block as a complication of the procedure. At reassessment, 82percent of patients were in sinus rhythm, 16percent had atrial fibrillation and 2percent, an atypical flutter. Conclusions: Radiofrequency fulguration is a safe and effective treatment of atrial flutter.
Subject(s)
Adult , Male , Humans , Female , Middle Aged , Catheter Ablation , Atrial Flutter/surgery , Atrial Flutter/physiopathology , Electrocardiography , Follow-Up Studies , Vena Cava, Inferior/surgeryABSTRACT
Junctional reciprocating tachycardia is an atrioventricular reentrant tachycardia whose anterograde conduction occurs via the His Purkinje and the retrograde conduction via an accessory pathway with slow conduction. The most common form is incessant tachycardia but a paroxysmal form also exists. We report a 35 years old female with recurrent paroxysmal tachycardia, that underwent electrophysiological evaluation. A left posterolateral accessory pathway was documented. Reciprocating paroxysmal tachycardia was induced by electrical stimulation and a successful pathway ablation was performed (Rev MÚd Chile 2004; 132: 608-13).
Subject(s)
Humans , Adult , Female , Electrophysiology , Tachycardia, Paroxysmal/diagnosis , Tachycardia, Paroxysmal/physiopathology , Arrhythmias, Cardiac , ElectrocardiographyABSTRACT
Radiofrecuency fulguration is the definitive treatment of several supraventricular and ventricular arrythmias. During radiofrecuency application, the conduction in a specific zone is interrupted as a consequence of cellular necrosis and edema. The disappearance of edema, minutes or hours after the procedure, allows the reappearance of conduction and arrythmias. On the other hand, the definitive lesion is larger than the one caused acutely, due to the progression of the scar. We report four patients, in whom there was an apparent failure of the fulguration, since at the end of the procedure there was conduction in the fulgurated zone, the tachycardia was inducible or pre excitation and arrythmias reappeared during the follow up. All four were subjected to a new eletrophysiological study and in all, fulguration had been effective. We conclude that these late effects of fulguration are due to the slow progression of fibrosis, that continues days or weeks after the procedure
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Arrhythmias, Cardiac/surgery , Catheter Ablation/adverse effects , Electrocoagulation/adverse effects , Recurrence , Heart Block , Electroencephalography/methodsABSTRACT
Ventricular tachycardia due to reentry within the bundle branches occurs in the presence of left ventricular dilatation and conduction alterations in the His-Purkinje system. A macro-reentry is formed by the His bundle, left and right bundles and ventricular myocardium. The anatomical substrate of this arrhythmia is ventricular dilatation. However, it may appear in healthy hearts. Alterations of intraventricular conduction are reflected by a prolongation of PR intenval and bundle branch block in the surface EKG and prolongation of HV interval in the endocavitary registry. During tachycardia, His activation precedes ventricular activation. We report three patients aged 55,58 and 78 years old with a dilated cardiomyopathy and ventricular tachycardia due to reentry within the bundle branches. All had a left bundle branch block and a prolonged HV internal. The arrhythmia was induced during the study in two patients. All were subjected to radiofrequency fulguration of the right branch of the His bundle. After fulguration, two remained with a pattern of complete right bundle branch block and one with a complete intermittent AV block. All three are free of arrhythmic events
Subject(s)
Humans , Male , Middle Aged , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/therapy , Catheter Ablation , Electrocardiography/methods , ElectrocoagulationABSTRACT
Background: Accessory pathways are muscular connections between auricles and ventricles, present in different points of mitral and tricuspid annuluses. These pathways participate in 50 percent of Paroxysmal supraventricular tachycardias and the definitive cure of the arrhythmia is their ablation. Aim: To report our experience in patients with right accessory pathways. Patients and methods: 50 consecutive patients treated between 1990 and 1996 are reported. Eight had a history of syncope, two had a diagnosis of Epstein disease and 36 had a pre-excitation in the surface electrocardiogram. Results: Fifty four accessory pathways were identified, since four patients had two pathways. Twenty four pathways were posteroseptal, 15 were lateral, 9 were medioseptal and 6 were anteroseptal. One patient had also a nodal reentry tachycardia. Fulguration was attempted in 39 patients and it was finally successful in 32. Three patients required more than one session. There were six relapses and all were successfully ablated in a second session. A mean of 28 radiofrequency applications were done (range 1- 76), mean laboratory time was 6 hours and mean radioscopy time was 70 min. Four patients had a transient atrioventricular conductor blockade. Conclusions: Radiofrequency ablation of accessory pathways has a high degree of success and a low rate of complications
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Middle Aged , Arrhythmia, Sinus/surgery , Catheter Ablation/methods , Electrocoagulation/methods , Atrial Flutter/physiopathology , Tachycardia, Supraventricular/surgery , Atrial Fibrillation/physiopathology , Tachycardia, Paroxysmal/surgeryABSTRACT
La taquicardia ventricular por reentrada de rama a rama corresponde a un tipo de taquicardia ventricular monomorfa sostenida que se presenta en pacientes con miocardiopatía dilatada y transtornos de conducción del sistema His-Purkinje. Esta taquicardia produce compromiso hemodinámico y hasta un 75 por ciento de los pacientes debuta con síncope o muerte súbita. Con el desarrollo de la electrofisiología se ha comprendido su mecanismo, y la fulguración con radiofrecuencia permite un tratamiento definitivo mediante interrupción de la conducción por la rama derecha. Presentamos el caso clínico de un paciente con miocardiopatía dilatada de origen valvular, quien presentó taquicardia por reentrada de rama a rama y fue sometido a fulguración con radiofrecuencia