First degree heart block with multi-focal atrial ectopics in an adolescent girl due to hypomagnesemia

Nutritional deficiencies are common in adolescent children and include deficiencies of both micro- and macronutrients. Magnesium is an important mineral that is essential for maintenance of numerous electrophysiological and biochemical processes in the body. We report an adolescent girl who developed an episode of syncope with first degree heart block on electrocardiography and run of multifocal atrial ectopics on 24 h holter monitoring. Serum magnesium was found to be low with decreased urinary magnesium excretion. There were no other electrolyte abnormalities. Structural heart disease was ruled out by a normal echocardiogram. The rhythm changes were attributable to nutritional hypomagnesemia and were promptly reversed on correcting the hypomagnesemia

Medium-term outcome of anatomically repaired congenitally corrected transposition: the double switch operation.

BACKGROUND: The double switch operation is emerging as the procedure of choice for congenitally corrected transposition of the great arteries. However, rhythm disturbances in the postoperative period are rarely discussed. METHODS AND RESULTS: Eighteen survivors who underwent corrective surgery for congenitally corrected transposition of the great arteries were followed up. Patients in group I (n=8), who also had a ventricular septal defect and pulmonary stenosis, had undergone the Senning plus Rastelli operation. Patients in group II (n=10), who did not have pulmonary stenosis, had undergone the Senning and arterial switch operation. The patients were followed up by periodical clinical examination, echocardiography and 24-hour Holter monitoring. In group I, follow-up ranged from 24 to 66 months (mean 44 months). There was no late death and all the patients are symptom free. There was no significant atrioventricular valve regurgitation and left ventricular function was normal. There were no rhythm disturbances. In group II, follow-up ranged from 2 to 72 months (mean 48 months). There were 2 late deaths due to atrial tachyarrhythmia and residual pulmonary hypertension 36 and 8 months after the procedure, respectively. One patient had significant mitral regurgitation and required mitral valve replacement. Three patients had recurrent atrial/junctional tachyarrhythmia: one of them was lost to follow-up after 1 year while another died of resistant atrial tachyarrhythmia. The third patient underwent mitral valve replacement for severe mitral regurgitation and developed complete heart block necessitating a permanent pacemaker implantation. CONCLUSIONS: Though good long-term results are obtained following the double switch operation, the problem of atrial arrhythmias still needs to be addressed suitably.

Taquicardia auricular ectópica: fulguración exitosa con radiofrecuencia / Ectopic atrial tachycardia: successfully fulguration with radiofrequency

La taquicardia auricular es una causa de taquicardia paroxística supraventricular que puede originarse en relación a un circuito de reentrada intraauricular o por la existencia de uno o múltiples focos de automatismo anormal. Esta última forma de taquicardia se denomina como taquicardia auricular ectópica (TAE) y se caracteriza porque suele ser resistente a tratamiento antirrítmico y porque en caso de tener carácter incesante puede llevar a insuficiencia cardíaca. En los últimos años se han desarrollado diversas alternativas de tratamiento no farmacológico. En la presente publicación presentamos el caso clínico de una mujer con TAE derecha que fue fulgurada con radiofrecuencia en forma exitosa