ABSTRACT
La disfunción del nódulo sinusal (DNS) es generalmente secundaria a la senescencia del nodo sinusal y del miocardio auricular circundante. Los pacientes con este trastorno son a menudo añosos y en general presentan otras comorbilidades. Los pacientes a menudo buscan atención médica con síntomas de aturdimiento, pre-síncope, síncope y, en pacientes con periodos alternantes de bradicardia y taquicardia, palpitaciones u otros síntomas asociados con una frecuencia cardíaca rápida. Debido a que los síntomas pueden ser de naturaleza variable, inespecíficos y frecuentemente transitorios, a veces puede ser difícil establecer esta relación síntoma-alteración electrocardiográfica. Los hallazgos electrocardiográficos típicos son uno o más episodios de bradicardia sinusal extrema (Rubenstein Tipo I), o pausas sinusales, paro y bloqueo de salida sinoatrial (Rubenstein Tipo II), o episodios de bradicardia y/o pausas alternantes con taquiarritmias auriculares (Rubenstein Tipo III). Las investigaciones basadas en el registro de electrogramas locales auriculares anormalmente prolongados y fraccionados durante el ritmo sinusal y su distribución característica en la aurícula derecha de pacientes con DNS han aportado un conocimiento importante sobre las propiedades electrofisiológicas de la aurícula patológica. El electrograma auricular anormal traduce una conducción auricular irregular, caracterizada por una actividad eléctrica local no homogénea, relacionada con una conducción anisotrópica, no uniforme y retardada a través de un miocardio auricular patológico, en el que se pueden originar arritmias por reentrada. La detección de electrogramas auriculares anormales en la DNS identifica a un grupo de pacientes con vulnerabilidad auricular aumentada y con una incidencia significativamente mayor de episodios espontáneos o inducidos de fibrilación auricular(AU)
Sinus node dysfunction (SND) is often secondary to senescence of the sinus node and surrounding atrial myocardium. Patients with this disorder are frequently elderly and generally have other comorbidities. Patients with SND often seek medical attention with symptoms of lightheadedness, presyncope, syncope, and, in patients with alternating periods of bradycardia and tachycardia, palpitations and/or other symptoms associated with a rapid heart rate. Because symptoms may be variable in nature, nonspecific, and frequently transient, it may be challenging at times to establish this symptom-rhythm relationship. Typical electrocardiographic findings are one or more episodes of extreme sinus bradycardia (Rubenstein type I), or sinus pauses, arrest, and sinoatrial exit block (Rubenstein type II), or alternating bradycardia and atrial tachyarrhythmias (Rubenstein type III). Investigations based on the recording of abnormally prolonged and fractionated local atrial electrograms during sinus rhythm and their characteristic distribution in the right atrium of patients with SND have provided important knowledge about the pathological atrium electrophysiological properties. Abnormal atrial electrogram results in an irregular atrial conduction, characterized by a non-homogeneous local electrical activity, related to an anisotropic, non-uniform and delayed conduction through a pathological atrial myocardium, in which reentry arrhythmias may arise. Abnormal atrial electrograms detection in SND identifies a group of patients with increased atrial vulnerability and a significantly higher incidence of spontaneous or induced episodes of atrial fibrillation(AU)
Subject(s)
Humans , Sick Sinus Syndrome/physiopathology , Electrophysiologic Techniques, Cardiac , Atrial Fibrillation/physiopathology , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/etiologyABSTRACT
A cardiomiopatia não compactada é uma doença congênita, que resulta de falha da compactação do miocárdio na vida embrionária. Nesse processo, há a persistência de trabeculações e recessos profundos, que se comunicam com a cavidade ventricular e geram espessamento do miocárdio em duas camadas distintas. O aspecto clínico dessa doença tanto em crianças como em adultos é muito heterogêneo, variando desde a ausência de sintomas até a tríade composta por insuficiência cardíaca congestiva, arritmias e tromboembolismo sistêmico, porém bradicardias sintomáticas são muito raras. Relatamos o caso de uma paciente com doença do nó sinusal como manifestação inicial de cardiomiopatia não compactada
Noncompaction cardiomyopathy is a congenital disease that results frommyocardial compaction failure in embryonic life. In this process there is the persistence of deep trabeculations and recesses that communicate with the ventricular cavity, resulting in myocardial thickening in two distinct layers. The clinical aspect of this disease in both children and adults is very heterogeneous, ranging from absence of symptomatology to a triad including congestive heart failure, arrhythmias and systemic thromboembolism. However, symptomatic bradycardias are very rare. We report the case of a patient with sinus node disease as the initial manifestation of non-compaction cardiomyopathy
Subject(s)
Humans , Female , Adult , Pacemaker, Artificial , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/therapy , Isolated Noncompaction of the Ventricular Myocardium , Arrhythmias, Cardiac/complications , Sinoatrial Node , Bradycardia/diagnosis , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Prevalence , Heart Defects, Congenital , Heart Failure/complications , Heart VentriclesABSTRACT
Relatam-se dois casos de pacientes portadores de marcapasso definitivo bifocal direito de segurança, totalmente dependentes de estimulação cardíaca artificial. Durante o seguimento, em ambos ocorreu perda da estimulação por um dos cabos-eletrodos ventriculares. A estimulação foi mantida pelo segundo cabo-eletrodo e os pacientes não relataram sintomas. A estimulação cardíaca bifocal deve ser considerada em pacientes altamente dependentes da estimulação artificial ou ainda naqueles submetidos à estimulação cardíaca por via epicárdica...
We describe two cases of patients with right bifocal pacing, totally dependent on cardiac pacing. During follow-up, in both cases occurred exit block of one ventricular lead. The pacing was kept by the other lead and the patients reported no symptoms, showing the value of the bifocal pacing in those patients highly dependent on cardiac pacing or in patients undergoing epicardial pacing...
Subject(s)
Humans , Male , Female , Middle Aged , Atrioventricular Block/diagnosis , Electrodes, Implanted/history , Pacemaker, Artificial/history , Sick Sinus Syndrome/diagnosis , Cardiac Pacing, Artificial/methods , Radiography, Thoracic/methodsABSTRACT
El desplazamiento crónico del catéter ventricular es una complicación infrecuente del implante de marcapasos. Es infrecuente que un catéter desplazado sense y capture en una cámara donde no fue implantado originalmente. Se presenta el caso de un paciente con marcapasos doble cámara en el que el catéter ventricular se desplazó hacia la aurícula derecha. El catéter desplazado permite sensar y capturar la aurícula. El diagnóstico inicial se realizó mediante el análisis deductivo conjunto de los electrogramas en tiempo real y los eventos en los canales de registro ("marker channel"). La radiografía de tórax confirmó el diagnóstico presuntivo.
Chronic ventricular lead dislodgement is an infrequent complication of pacemaker implantation. Occasionally, the dislodged lead may sense and capture a chamber in which the lead was not originally positioned. Intracardiac real time electrograms and channel markers are useful tools for the diagnosis of pacemaker malfunction. We present the case of a patient with a ventricular lead dislodgement into the atrium. The ventricular lead was able to sense and capture the atrium. Initial diagnosis was performed based on the deductive analysis of intracardiac real time electrograms and channel markers and confirmed by chest X-ray.
Subject(s)
Aged , Humans , Male , Cardiac Pacing, Artificial , Electrocardiography/methods , Foreign-Body Migration , Sick Sinus Syndrome/diagnosis , Bradycardia/diagnosis , Electrodes, Implanted , Equipment Failure , Foreign-Body Migration/surgery , ReoperationABSTRACT
La displasia arritmogénica del ventrículo derecho (DAVD) compromete principalmente al ventrículo derecho y debe ser considereada en pacientes jóvenes que presentan síncope, taquicardia ventricular o paro cardíaco y en adultos con insulficiencia cardíaca congestiva. Las alteraciones eléctricas auriculares debidas a DAVD han sido poco descriptas. Informamos el caso de un varón de 60 años con DAVD que durante la evolución presentó enfermedad del nódulo sinusal (tiempo de recuperación del nódulo sinusal de 6113 mseg). Las arritmias auriculares se podrían explica® por el reemplazo gradual de los miocitos auriculares por tejido adiposo.
Subject(s)
Humans , Male , Middle Aged , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Sick Sinus Syndrome/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/complications , Electrocardiography , Heart Ventricles , Magnetic Resonance Imaging , Sick Sinus Syndrome/complications , Syncope/etiologySubject(s)
Humans , Male , Sick Sinus Syndrome/diagnosis , Heart Block/diagnosis , Cardiac Pacing, ArtificialSubject(s)
Humans , Tachycardia, Supraventricular/classification , Atrial Flutter/prevention & control , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/drug therapy , Tachycardia, Sinus/physiopathology , Atrial Premature Complexes/etiology , Anti-Arrhythmia Agents/therapeutic use , Electric Countershock , Atrial Fibrillation/etiology , Atrial Fibrillation/therapyABSTRACT
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 EvolutionSubject(s)
Humans , Arrhythmias, Cardiac/diagnosis , Electrocardiography/methods , Arrhythmias, Cardiac/classification , Arrhythmias, Cardiac/drug therapy , Atrial Flutter/diagnosis , Atrial Fibrillation/diagnosis , Ventricular Fibrillation/diagnosis , Monitoring, Ambulatory , Sick Sinus Syndrome/diagnosis , Wolff-Parkinson-White Syndrome/diagnosis , Tachycardia, Ventricular/classification , Tachycardia, Ventricular/diagnosisABSTRACT
Carbamazepine, a drug used for the treatment of epilepsy and neuralgias, may exert hazardous effects on the cardiac conduction system. We report such a case of symptomatic brady-arrhythmia occurring in a 43-years-old male while on therapy with carbamazepine. Additionally, a literature review is made of previous cases of carbamazepine-induced sinus mode, AV node and His-Purkinje conduction disturbances
Subject(s)
Adult , Humans , Male , Anticonvulsants/adverse effects , Carbamazepine/adverse effects , Sinoatrial Node/drug effects , Anticonvulsants/blood , Carbamazepine/blood , Electrocardiography, Ambulatory/drug effects , Epilepsy/complications , Epilepsy/drug therapy , Sick Sinus Syndrome/chemically induced , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/physiopathology , Sinoatrial Node/physiopathologyABSTRACT
Se presentan 5 (cinco) pacientes estudiados mediante monitoreo electrocardiográfico contínuo (sistema Holter), se mostraron en sus respectivos registros extrasístoles supraventriculares con pausas post-extrasistólicas de más de 2.000 milisegundos (Ms) y PRs normal. Se correlaciona este dato con aumento significativo del Tiempo de recuperación del Nódulo Sinusal corregido (TRNSo), determinado por medio de estudios electrofisiológicos. De la relación directa y permanente observada entre ambos datos, siempre coincidentes, se infiere la importancia que adquiere la medición de la pausa post-extrasistólica auricular en el ECG de Holter para el diagnóstico de la Enfermedad del Nódulo Sinusal (ENS)