A clinical study of hemodynamically significant arrhythmias and QTc interval associated with thrombolysed and non thrombolysed acute myocardial infarction patients

Background: Arrhythmias are a common occurrence in acute myocardial infarction. Objectives of this study the hemodynamically significant arrhythmias and QTc interval in thrombolysed and non thrombolysed acute myocardial infarction patients.Methods: Two hundred patients of AMI were enrolled. ECG and cardiac parameters were examined. Arrhythmias and its various parameters like its incidence, type, frequency associated with site of infarction were recorded in thrombolysed and non thrombolysed patients of AMI.Results: AMI was more prevalent in the males (63.3%) and those with 41-50 years of age. Hypertension (35.7%), smoking (34.2%), and diabetes (23.1%) were the major risk factor. Incidence of AWMI (30.7%) is higher than IWMI (25.1%). Out of 200 subjects 130 were thrombolysed. Arrhythmias was observed in total 164 patients while 36 patients has no documentation of arrhythmias. Mean QTc was prolonged (546.88ms vs 404.33ms) in patients documented with arrhythmia compared with those who has no arrhythmia. Out of all arrhythmias, ventricular tachycardia was seen in 38% cases with 50% mortality and preponderance to antero lateral MI. Sinus Tachycardia was seen in 22% of cases with preponderance to Antero Lateral MI and persistence of Sinus Tachycardia was a prognostic sign, mortality being 12%. Complete Heart Block were seen with IWMI, incidence being 26%. Bundle Branch Block was common in AWMI (31%) than IWMI (10%).Conclusion: Tachyarrhythmias are common with AWMI and bradyarrhythmia’s in IWMI. Reperfusion arrhythmias are a benign phenomenon and good indicator of successful reperfusion.

Registro unicéntrico de ablaciones de taquiarritmias cardíacas en pacientes pediátricos. Seguridad y eficacia / Single-center registry of ablations of arrhythmogenic substrates in pediatric patients. Safety and efficacy

Introducción: Las taquiarritmias en pediatría son uno de las principales motivos cardiológicos de consulta a la guardia. Durante el primer año de vida presentan una significativa morbi-mortalidad, por lo que el tratamiento farmacológico inmediato es fundamental para reducir la misma. Hasta los 3 años existe la posibilidad de curación espontánea en un porcentaje de éstos pacientes. La indicación de procedimientos de ablación durante los primero 4 años de vida se limita a casos refractarios al tratamiento antiarrítmico, dado que cuanto menor peso presenta el paciente, más pequeño es el corazón y más riesgoso es el mismo. Las taquicardias en pacientes con cardiopatía empeora el pronóstico de la misma. A pesar que el tratamiento farmacológico ha permitido el control de la gran mayoría de ellas, en muchos casos se requieren más de una droga antiarrítmica, con mayor exposición a efectos adversos, y en muchos otros se vuelven refractarias. En las últimas 3 décadas se ha desarrollado en forma exponencial el tratamiento de las taquiarritmias por medio de la ablación por radiofrecuencia o por frío (crioablación). Estos procedimientos han permitido obtener la curación de la mayor parte de las taquiarritmias en pediatría. En nuestro trabajo se evaluaron las indicaciones de dichos procedimientos en una población pediátrica, como así también la tasa de éxito, recurrencia, y la morbimortalidad tanto globalmente, como en cada arritmia (AU)

In children, tachyarrhythmias are one of the main reasons for cardiological consultation at the Department of Emergency. In the first year of life, they are associated with significant morbiditymortality and therefore, immediate drug treatment is essential up to 3 years of age. The indication of ablation procedures during the first 4 years of life is limited to patients refractory to antiarrhythmic treatment, since the lower weight of the patient, the smaller the heart and the riskier the intervention. In patients with heart disease, tachycardia worsens the prognosis. Although pharmacological treatment controls the vast majority of tachyarrhythmias, more than one antiarrhythmic drug is often required, leading to greater exposure to adverse effects, and many become refractory. Over the past three decades, treatment of tachyarrhythmias has developed exponentially with the advent of radiofrequency or cold ablation (cryoablation). These procedures have led to the cure of most tachyarrhythmias in children. Our study assessed the indications for these procedures in a pediatric population, as well as the success and recurrence rates, and morbidity both overall and of each arrhythmia episode (AU)

Cardiomiopatía hipertrófica: experiencia de 5 años / Hypertrophic cardiomyopathy: 5 year experience

Resumen Introducción: La cardiomiopatía hipertrófica se define como el engrosamiento de la pared ventricular izquierda que no es explicado por condiciones anormales de la carga y que impone un riesgo de: arritmias, falla cardiaca y muerte súbita. Objetivo: identificar prevalencia, las características clínicas y el tratamiento de los pacientes con cardiomiopatía hipertrófica atendidos en nuestra institución. Materiales y métodos: Se extrajeron y analizaron los registros de pacientes con cardiomiopatías hipertróficas, definiendo las características generales y explorando las diferencias entre subgrupos, todos los contrastes estadísticos asumieron una confianza del 95%. Resultados: Se evaluaron 22 casos de la cardiomiopatía hipertrófica, el sexo femenino aportó el 40,9% del total de los casos, la edad promedio fue 54 años. El 77,27% presentaron insuficiencia mitral, el 63,64% reportaron dolor torácico, el 68,18% se encontraban en tratamiento inhibidor de renina y el 95,45% tenían betabloqueador, el grosor promedio del septum fue del 22,77 mm, la prevalencia de fibrilación auricular fue del 22,7% y la de enfermedad coronaria del 18%. Conclusiones: La prevalencia de la cardiomiopatía hipertrófica en el período 2009-2013 fue del 2,35%, relacionado principalmente con la insuficiencia mitral y tenían antecedente de dolor torácico, la prevalencia de la fibrilación auricular en pacientes con cardiomiopatía hipertrófica en el presente estudio fue del 22,7% y la de enfermedad coronaria del 18%.

Abstract Introduction: Hypertrophic cardiomyopathy is defined as the thickening of the left ventricular wall that is not explained by abnormal loading conditions, imposing a risk for arrhythmias, heart failure and sudden death. We attempt to identify the prevalence, clinical features and treatment of patients with hypertrophic cardiomyopathy assisted within our institution. Material and methods: Records of patients with hypertrophic cardiomyopathy were pulled and analysed, defining general features and exploring differences among subgroups; all statistical contrasts assumed a confidence of 95%. Results: 22 cases of hypertrophic cardiomyopathy were assessed, 40.9% of whom were female, average age was 54. 77.27% showed mitral insufficiency, 63.4% reported chest pain, 68.18% were receiving renin inhibitor therapy and 95.45% were taking beta blockers. Average septum thickness was 22.77 mm, prevalence of atrial fibrillation was 22.7% and coronary disease 18%. Conclusion: Prevalence of hypertrophic cardiomyopathy during the 2009-2013 period was of 2.35%, mostly related to mitral insufficiency and previous history of chest pain; prevalence of atrial fibrillation in patients with hypertrophic cardiomyopathy in our study was of 22.7%,and 28% for coronary disease.

Linfoma primario del corazón: causa poco común de síndrome de falla cardiaca / Primary cardiac lymphoma: an uncommon cause of heart failure

Resumen Objetivo: Describir una causa poco común de síndrome de falla cardiaca aguda como lo es el linfoma primario del corazón. Métodos: Presentación de un caso con antecedentes y cuadro clínico de ingreso, manejo instaurado y desenlace. Resultados y conclusiones: Los tumores cardiacos malignos son bastante infrecuentes, más aún el linfoma cardiaco, por lo que no se considera en el diagnóstico diferencial del médico. Se presenta un nuevo caso en la literatura del linfoma cardiaco manifestado como síndrome de falla cardiaca aguda

Abstract Motivation: To describe an uncommon cause of acute cardiac failure such as primary cardiac lymphoma. Methods: Presentation of a case with medical history and clinical records of admission, established management and outcomes. Results and conclusions: Malignant cardiac tumours are quite infrequent, even more so with cardiac lymphoma, which is why they usually are not taken into consideration by physicians when making a differential diagnosis. A new case of cardiac lymphoma manifesting as acute cardiac failure syndrome is presented in the literature.

Reporte de un caso de fibrilación auricular como manifestación inicial de síndrome de Brugada / Atrial fibrillation as initial feature of Brugada syndrome: a case report

El síndrome de Brugada (SB) es una enfermedad arritmogénica caracterizada por un patrón electrocardiográfico en el que hay una elevación del segmento ST en las derivaciones V1 a V3, y un patrón de bloqueo de la rama derecha. Es una patología poco frecuente en nuestro medio, con mayor prevalencia en países como: el Japón y en el suroeste de Asia. Su etiología es multifactorial y aún es tema de debate. Los diagnósticos diferenciales abarcan: el síndrome coronario agudo, el bloqueo de rama derecha y la pericarditis. A continuación se describe el caso con un patrón electrocardiográfico típico que se manifiesta con síncope y fibrilación auricular.

Brugada syndrome (BS) is an arrhythmogenic condition characterised by an electrocardiographic pattern where there is an elevation of the ST segment in leads V1 to V3, and a right bundle branch block. It is an uncommon condition in our environment, being more prevalent in other areas such as Japan and southwest Asia. Its aetiology is multifactorial and is still under discussion. Differential diagnoses cover acute coronary syndrome, right bundle branch block and pericarditis. We describe a case with a typical electrocardiographic pattern manifesting with syncope and atrial fibrillation.

Crioablación: aplicaciones clínicas en la electrofisiología cardiaca a partir de sus bases biofísicas / Cryoablation: Clinical applications in cardiac electrophysiology from their biophysical bases

Resumen: La crioablación es una energía alternativa a la radiofrecuencia para la ablación de diferentes arritmias, en la que sus propiedades biofísicas únicas ofrecen un perfil de seguridad mayor. Desde su utilización para el tratamiento quirúrgico de diversas arritmias hasta su conceptualización en la técnica transcatéter actual, la crioablación ha probado no solo ser una fuente segura de energía, sino una fuente eficaz a largo plazo. Mientras que la radiofrecuencia ha sido la energía más utilizada para el aislamiento de venas pulmonares en la ablación de fibrilación auricular, los avances tecnológicos con criobalón han logrado simplificar el procedimiento sin sacrificar su eficacia. La crioablación ha sido ampliamente utilizada para arritmias localizadas en sitios de alto riesgo, como la ablación de la taquicardia por reentrada intranodal AV y vías accesorias septales por su nulo riesgo teórico de bloqueo AV completo. Esta revisión tiene la intención de dar a conocer las aplicaciones clínicas de la criotermia a través del entendimiento profundo de sus bases biofísicas.

Abstract: Cryoablation is an energy alternative to radiofrequency for ablation of various arrhythmias, where its unique biophysical properties offer a greater safety profile. Since its first use for the surgical treatment of different arrhythmias until its conceptualization in the current technical transcatheter, cryoablation has proven not to be only a safe source of energy, but also an effective source in the long-term. While the radiofrequency has been the energy most used for isolation of pulmonary veins in atrial fibrillation ablation, technological advances in cryoballon have managed to simplify the procedure without sacrificing its effectiveness. Cryoablation has been widely used for arrhythmias located in high-risk locations, such as the ablation of the atrioventricular nodal reentrant tachycardia and septal accessory pathways, due to its theoretical null risk of complete AV block. This review intends to give the clinical applications of the cryothermy through a thorough understanding of their biophysical basis.

The drug therapy of cardiac arrhythmias / 天津医药

Cardiac arrhythmias are varied and very common. They are usually classified as bradyarrhythmias and tachyarrhythmias, which are treated according to their own common principle separately. There is no long term effective oral drugs that can be used to treat bradyarrhythmias effectively up to now. Pacemaker is still the only effective treatment for it. Now catheter ablation has already applied to almost every kind of tachyarrhythmias, and which is the first choice for treating supraventricular tachycardia and atrial flutter because of the satisfactory result. Most patients with other types of tachyarrhythmias, especially atrial fibrillation and all kinds of premature beats are still given drug therapy. Amiodarone, propafenone, sotalol and mexiletine are common used antiarrhythmic drugs in our country. This article overviewed the principle and the matters need to attention in the drug therapy of cardiac arrhythmias.

Ablación de taquicardia ventricular en displasia arritmogénica del ventrículo derecho / Ablation of tachycardia in arrhythmogenic right ventricular dysplasia

La displasia arritmogénica del ventrículo derecho es una cardiopatía de origen genético, su importancia radica en la capacidad de generar muerte súbita en pacientes en la tercera y cuartadécada de la vida, después de grandes esfuerzos por aumentar la sensibilidad y mejorar la capacidad diagnóstica continúa siendo un importante problema de salud pública. Los desfibriladores implantables han demostrado aumentar la supervivencia de quienes presentan arritmias letales asociadas, sin embargo, debido al carácter progresivo de la enfermedad un interrogante de importancia es cómo tratar a los pacientes con terapias apropiadas y frecuentes de estos dispositivos, la ablación por radiofrecuencia es una respuesta terapéutica seria a este dilema. En la actualidad disponemos de técnicas de ablación que combinan los métodos de la imagen TC cardiaca, la resonancia cardiaca, los mapas electroanatómicos y algunas herramientas de la electrofisiología convencional que permiten realizar ablaciones sin la inducción de arritmias ventriculares de forma sostenida y durante el ritmo sinusal, de modo similar el mejor entendimiento de la patogenia introdujo el uso de técnicas híbridas endo y epicárdica, la suma de cada uno de estos avances ha aumentado la tolerancia durante el procedimiento, ha mejorado los resultados en las etapas agudas postablación y en los seguimientos a mediano plazo, hoy los márgenes de seguridad y eficacia para esta técnica se incrementan, siendo de primera línea en diferentes situaciones de relevancia en esta compleja enfermedad.

Arrhythmogenic right ventricular dysplasia (ARVD) is a genetic disease associated with sudden cardiac death, affecting subjects in the 3rd and 4th decade of life. Despite great efforts made in order to improve its early diagnosis, ARVD remains as a major public health problem in Europe and America. Currently, risk stratification of sudden cardiac death in patients with ARVD remains challenging. Over the last decade implantable defibrillators have been shown to increase survival of patients with structural heart disease and risk factors for sudden cardiac death. However, there is no consensus about how to treat patients with recurrent appropriate implantable defibrillators therapies. Recent studies have shown that radiofrequency ablation is an effective treatment for patients with recurrent episodes of ventricular tachycardia. Specifically, substrate ablation techniques have been shown to be especially useful in the case of ARVD, as these techniques allow performing ablation during sinus rhythm. Additionally, emerging tools as electroanatomic navigation, CT or MRI have provided further knowledge of the pathogenesis of ARVD, allowing the development of novel therapeutic approaches. In this review epidemiologic, pathogenic, diagnostic and therapeutic features of ARVD are discussed, with special focus on the treatment of ventricular arrhythmias associated with ARVD.

Electrocardiograma de superficie en pacientes con dispositivos de estimulación cardíaca / Surface electrocardiogram in patients with cardiac pacing devices

Con el paso del tiempo el número de pacientes portadores de dispositivos de estimulación cardíaca (marcapasos, resincronizadores y desfibriladores) ha aumentado de manera exponencial y ha llevado a que médicos de todas las especialidades tengan mayor exposición a los electrocardiogramas. Conocer el funcionamiento de estos dispositivos es, por tanto, necesario para comprender los cambios que se producen en el electrocardiograma de superficie, identificar los hallazgos normales y reconocer las distintas manifestaciones de la disfunción de estos dispositivos. En este artículo se revisan, de manera clara y concreta, conceptos básicos de diseño, funcionamiento y programación de los dispositivos de estimulación cardíaca, de modo que el lector desarrolle un esquema para la evaluación electrocardiográfica de estos.

Over the last decades, the number of patients with cardiac stimulation devices (including pacemakers, resynchronization devices and automatic implantable cardiac defibrillators) has increased exponentially, exposing an ever increasing number of health professionals from different areas of medicine to their electrocardiograms. Thorough knowledge of proper device function is crucial to understanding electrocardiographic changes induced by cardiac stimulation, identifying normal findings, and recognizing the different manifestations of device malfunction. In this article, basic concepts on device design, programming and proper function will be discussed, allowing the reader to develop an organized step wise approach to interpret the electrocardiogram of patients with cardiac stimulation devices.

Reacción anafiláctica y disfunción sinusal aguda asociada al uso de metoclopramida / Anaphylactic reaction and acute sinus node dysfunction associated with the use of metoclopramide

La disfunción sinusal por metoclopramida es una manifestación adversa poco común. La metoclopramida se usa ampliamente y las complicaciones cardiovasculares son raras. Se presenta un caso correspondiente a un evento adverso a la metoclopramida manifestado como reacción anafiláctica y disfunción sinusal.

Sinus dysfunction due to metoclopramide is a rare adverse event. Metoclopramide is widely used and cardiovascular complications are rare. A case corresponding to an adverse event to metoclopramide manifested as anaphylactic reaction and sinus node dysfunction is presented.

Wolf-parkinson-white Syndrome-current Concepts in Anesthetic Practice.

Wolf-Parkinson-White (WPW) syndrome is a disorder of conduction system of heart caused by presence of an abnormal accessory conduction pathway between the atria and ventricles. It is associated with tachyarrhythmias diagnosed by electrocardiography (ECG). The anesthetic management of these patients is challenging as they are known to develop life threatening arrhythmias. Magnesium sulfate (MgSO4) is a good agent for control of peri-operative dysrhythmias.

Seguimiento de 134 pacientes pediátricos con patrón de Wolff-Parkinson-White: evolución natural e intervención médica* / Follow-up of 134 Pediatric Patients with Wolff-Parkinson-White Pattern: Natural Outcome and Medical Treatment

Objetivos Evaluar la evolución de una población pediátrica con patrón de preexcitación ventricular, presencia de taquicardia supraventricular, fibrilación auricular, cardiopatías, mortalidad e intervención médica. Material y métodos Estudio descriptivo observacional. Se registraron pacientes con preexcitación ventricular en el electrocardiograma desde 1976 a 2011. Todos tenían ecocardiograma, 101 pacientes Holter (75,3%) y 69 (51,5%) ergometría. En pacientes seleccionados se realizó ablación por radiofrecuencia. Los datos se expresaron como media y desviación estándar. Resultados Se incluyeron en el estudio 134 pacientes, 80 varones (59,7%). Edad al diagnóstico: 2 días a 18 años, media 6,5 ± 5 años. Seguimiento clínico: 1 mes a 20 años, media 3,6 ± 3,9 años. Consultaron por taquicardia supraventricular 35 pacientes (26,1%), por preexcitación ventricular 16 pacientes (11,9%) y por otras causas 83 pacientes (61,9%); 76 pacientes (56,7%) evidenciaron vía izquierda, 3 pacientes doble vía; 16 pacientes (11,9%) presentaron taquicardia supraventricular durante el seguimiento. En total, 51 pacientes (38%) tuvieron taquicardia ortodrómica a los 6,3 ± 5,8 años, 10 pacientes en el período neonatal; 38 pacientes (28,3%) recibieron antiarrítmicos. No se observó fibrilación auricular. Veintiocho pacientes (20,9%) presentaron cardiopatía, 9 con taquicardia supraventricular. No hubo variables vinculadas con taquicardia supraventricular. En 43 pacientes (32,1%) se realizó ablación por radiofrecuencia. Un paciente murió súbitamente. Otro paciente falleció en el posoperatorio de cardiopatía. Conclusiones 1) Más del 60% de los pacientes permanecieron asintomáticos. 2) No se registró fibrilación auricular. 3) La tasa de muerte súbita fue del 0,75%. 4) Los pacientes con taquicardia supraventricular no sometidos a ablación evolucionaron bien. 5) No se asociaron variables con taquicardia supraventricular. 6) Las vías múltiples siempre desarrollaron taquicardia supraventricular.

Objectives The aim of the study was to evaluate the outcome of a pediatric population with ventricular preexcitation pattern, supraventricular tachycardia, atrial fibrillation, cardiomyopathies, mortality and medical treatment. Methods From 1976 to 2011, a descriptive observational study was conducted on patients with ventricular preexcitation in the electrocardiogram. All patients underwent an echocardiogram, 101 (75.3%) Holter monitoring, and 69 (51.5%) an ergometric test. Radiofrequency ablation was performed in selected patients. Data were expressed as mean and standard deviation. Results The study population consisted of 134 patients, 80 (59.7%) of whom were male. Age at diagnosis ranged from 2 days to 18 years, with a mean of 6.5±5 years. Clinical follow-up lasted 1 month to 20 years, with a mean of 3.6±3.9 years. Thirty five patients (26.1%) consulted for supraventricular tachycardia, 16 (11.9%) for ventricular preexcitation, and the remaining 83 patients (61.9%) for other abnormalities. Seventy-six patients (56.7%) evidenced left conduction pathway and 3 patients a double conduction pathway. Sixteen patients (11.9%) presented supraventricular tachycardia during follow-up. Overall, 51 patients (38%) had orthodromic tachycardia at 6.3±5.8 years, 10 patients during the neonatal period. Thirty-eight patients (28.3%) received antiarrhythmic drugs. No atrial fibrillation was observed. Twenty-eight patients (20.9%) presented cardiomyopathy, 9 with supraventricular tachycardia. No association was found between supraventricular tachycardia and another variable. Forty-three patients (32.1%) underwent radiofrequency ablation. A patient suffered sudden death and another patient died during the postoperative period of corrective surgery. Conclusions 1) More than 60% of patients remained asymptomatic. 2) No atrial fibrillation was recorded. 3) Sudden death rate was 0.75%. 4) Patients with supraventricular tachycardia not submitted to ablation had a favorable outcome. 5) Supraventricular fibrillation was not associated with any variable. 6) Multiple conduction pathways always developed supraventricular tachycardia.

Effect of radiofrequency catheter ablation for different types of tachyarrhythmias in 1000 children / 中华实用儿科临床杂志

Objective To investigate the success rate,factors associated with recurrence,safety and effect of age on results of radiofrequency catheter ablation(RFCA) for different types of tachyarrhythmias in children.Methods A thousand children diagnosed as tachyarrhythmias underwent electrophysiological study (EPS),with mean age (7.6 ±3.8) years old(0.33-16.50 years old).RFCA methods and results for different kinds of tachyarrhythmias along with recurrence and complications were analyzed.RFCA results for different age groups were compared.Results A thousand children underwent EPS.The number of atrioventricular reentrant tachycardia(AVRT) was 560 (56％),atrioventricular nodal reentrant tachycardia (AVNRT) was 210 (21％),ventricular tachycardia/ventricular premature contraction (VT/PVC) was 159 (15.9％),focal atrial tachycardia (FAT) was 49 (4.9％),and atrial flutter/incisional reentrant atrial tachycardia (AF/IRAT) was 22 (2.2％).Totally 958 children underwent RFCA,among whom success rate was 96.2％ and recurrence rate was 8.1％.EPS performed on recurred cases showed restoration of primary pathway/origin was 5.3％,while appearance of new pathway/origin was 2.8％.Five hundred and thirty-three AVRT cases underwent RFCA,among whom success rate was 98.0％,recurrence rate was 8.4％,restoration of primary pathway was 4.0％,and appearance of new pathway was 4.4％.Success rate of right anterior/mid septal pathway was relatively low (85.3 ％),but its rate of restoration of primary pathway was high (31.0％),as 205 cases of AVNRT underwent RFCA,among whom success rate was 100％,recurrence rate was 5.9％,and restoration of primary origin was 4.9％,while 22 cases of AF/IRAT underwent RFCA,among whom success rate was 95.5％ with no recurrence,46 cases of FAT underwent RFCA,in which success rate was 84.8％ ; success rates for two-dimensional mapping group and three-dimensional mapping combined with cool-tip ablation group were 62.5％ and 96.7％ respectively and the difference was significant (P ＜ 0.05),as 10 cases recurred in which 7 originated from atrial appendages,and these 7 cases were successfully cured by appendectomy,152 cases of VT/PVC underwent RFCA,in which success rate was 89.5％,recurrence rate was 6.6％,restoration of primary origin was 5.9％.There was no difference in success rate between different age groups.The gross success rates and success rates for different types of arrhythmias between early and late periods were not different,while recurrence rates for AVNRT and left anterior pathways in early periods were significantly higher than late periods(P ＜0.05).There were totally 8 cases with complications(0.84％),including 2 cases of complete atrioventricular block and 1 case of anesthetic accident which happened in early period.The other 5 were vascular complications,and there was no death.Conclusions RFCA can be safely used as frontline treatment to cure some kinds of tachyarrhythmias in children with high success rate and low recurrence rate.There is no difference in rates of success,recurrence and complication between younger and older children,while difficulty for procedure increased for the former so that caution should be made for selection of patients.Application of three-dimensional mapping for difficult arrhythmias can increase success rate for ablation.Proficient experience and skillful manipulation are the main factors to avoid complications.

Clinical Study of the Intravenous Amiodarone in Acute Myocardial Infarction with Life-Threatening Refractory Ventricular Tachyarrhythmias

BACKGROUND: Recently, the amiodarone has emerged as a promising antiarrhythmic agent and its efficacy and safety has been widely accepted with many literatures. But there was no general agreement regarding the dosage and indication of intravenous (IV) amiodarone in acute myocardial infarction with life-threatening refractory ventricular tachyarrhythmias. METHOD: From October 1995 through October 1997, we recruited retrospectively 9 patients of acute myocardial infarction who had received IV amiodarone for life-threatening refractory ventricular tachyarrhythmias and analyzed the initial response, adverse effect, and loading dose. RESULTS: 1) Acute efficacy:Eight of 9 patients promptly restored normal sinus rhythm immediately after intravenous amiodarone administration. 2) In-Hospital Mortality:One patients died due to ventricular tachyarrhythmias refractory to aggressive management and 5 in 8 patients who had responded promptly with IV amiodarone discharged alive and other 3 patients died due to cardiogenic shock with normal sinus rhythm. 3) Immediate adverse effects:Five patients experienced immediate adverse effects after IV amiodarone; 3 patients of hypotension, 1 patient of first degree AV block, and the other of Morbitz type 2 AV block. 4) Long term follow-up:Among 5 patients discharged alive, one died as unexpected consequence. Other 4 patients have been still alive without maintenance medication. CONCLUSION: The IV amiodarone for suppression of life-threatening ventricular tachyarrhythmias in patients with acute myocardial infarction seemed to be an effective second-line therapeutic drug and have acceptable adverse effects. In the future, the large scale study regarding the dosage and indication might be warrented.

Padrão de utilização clínica dos digitálicos: necessidade de reavaliação / Clinical Use of Digitalis. Need for Reassessment

Objetivo - Avaliar o padrão de utilização dos digitálicos, indicações de seu emprego e a freqüência de suspensão do fármaco em pacientes hospitalizados. Métodos - Foram estudados os prontuários de todos os pacientes internados nas enfermarias de medicina interna e especialidades médicas do Hospital de Clínicas de Porto Alegre. A coleta de dados foi realizada em 5 dias, sendo 3 no inverno e 2 no verão, mantendo um intervalo de pelo menos 2 semanas entre cada coleta. A presença de insuficiência cardíaca foi avaliada objetivamente através do escore proposto por Carlson e col. Resultados - De um total de 881 pacientes, 114 (13%) faziam uso de digoxina. A idade média ± DP desses pacientes foi de 66 ± 13 anos, sendo que 47% eram do sexo masculino. Dos pacientes que recebiam digoxina, 32% apresentavam escores compatíveis com insuficiência cardíaca definida ou possível; 26% apresentavam fibrilação ou flutter" atrial; 18% tinham insuficiência cardíaca e taquiarritmia supraventricular; e 24% não tinham indicação precisa segundo os critérios deste estudo. Oitenta e cinco por cento dos pacientes faziam uso prévio de digoxina e em 32% desses, a droga foi suspensa durante a internação. Considerando aqueles pacientes sem indicação para usar digitálicos, apenas 44% tiveram o tratamento com digoxina suspenso. Conclusão - De acordo com critérios contemporâneos, um percentual elevado de pacientes internados recebe digoxina sem indicação precisa. Estes dados sugerem que a reavaliação do uso de digitálicos deve ser incorporada à prática médica

Purpose - To evaluate the pattern of utilization of digitalis in an academic hospital. Methods - Clinical files of all patients admitted in medical wards at the Hospital de Clínicas de Porto Alegre were studied. Data were collected during five different days, three in the winter and two in the summer, keeping an interval of at least two weeks between each data collection. Heart failare diagnosis was evaluated objectively by means of a score proposed by Carlson et al. Results - From a total number of 881 patients, 114 (13%) were receiving digoxin. Mean age was 66 ± 13 years and 47% were males. Considering the patients who were taking digoxin, 32% presented scores compatible with definite or possible heart fuilare; 26% had atrial flutter or fibrillation; 18% had heart failare and supraventricular tachyarrhytmias; and in 24% no clear indications were found according to our criteria. Previous use of digoxin was found in 85% of the patients and 32% were withdrawn during the hospitalization. Considering just the patients who had no reason for using digoxin, only 44% had the drug withdrawn. Conclusion - According to current criteria, many hospitalized patients receive digoxin without a definite indication. These data suggest that reassessment of the use of digitalis should be incorporated into clinical practice