Registro de arritmias em pacientes com marcapassos e doença renal crônica de leve a moderada (RYCKE): resultados de um estudo de coorte observacional / Register of arrhythmias in patients with pacemakers and mild to moderate chronic kidney disease (RYCKE): results from an observational cohort study

O presente estudo examinou pacientes submetidos a implante de marcapasso dupla-câmara em decorrência de doença do nó sinusal ou bloqueio atrioventricular de 3o ou 2o graus do tipo 2 na doençarenal crônica em estágios 2, 3 e 4. O estudo teve como objetivo registrar os eventos arrítmicos durante 12 mesesde acompanhamento e comparar a incidência e a gravidade deles nas diferentes fases da doença renal crônica.Método: No total, 305 pacientes foram avaliados a cada 4 meses até 12 meses de acompanhamento. Os eventosarrítmicos foram avaliados em cada visita de acompanhamento. Resultados: Dentro do mesmo grupo de estágio da doença renal crônica não houve diferença entre as causas doença do nó sinusal e bloqueio atrioventricular, a respeito da ocorrência de qualquer arritmia. No entanto, menor incidência de taquicardia atrial/fibrilação atrial foi observada para todas as comparações entre todos os pacientes e os mesmos subgrupos em pacientes no estágio 2 (total: 58%; doença do nó sinusal: 63%; bloqueio atrioventricular: 51%), comparativamente aos estágios 3 (total:87%, P < 0,0001; doença do nó sinusal: 89%, P = 0,0020; bloqueio atrioventricular: 84%, P = 0,0019) e 4 (total: 85%, P < 0,0001; doença do nó sinusal: 81%, P = 0,0409; bloqueio atrioventricular: 90%, P < 0,0001). Em relação à taquicardia ventricular não sustentada/taquicardia ventricular sustentada, foi observada incidência mais elevada para todas as comparações entre todos os pacientes e os mesmos subgrupos em pacientes no estágio 4 (total: 32%; doença do nó sinusal: 16%; bloqueio atrioventricular: 16%), comparativamente aos estágios 3 (total: 11%, P = 0,0007; doença do nó sinusal: 9%, P = 0,0110; bloqueio atrioventricular: 14%, P = 0,0441) e 2 (total: 3%, P < 0,0001; doença do nó sinusal: 3%, P < 0,0001; bloqueio atrioventricular: 4%, P < 0,0001). Conclusão: Nossos resultados sugerem que quanto mais avançado o estágio da doença renal crônica maior a incidência de arritmias malignas...

The present study evaluated patients who had received a dual chamber pacemaker implant due to sinus node disease or 3rd/2nd degree type 2 atrioventricular block in chronic kidney disease stages 2, 3 and 4. The study was aimed at registering arrhythmic events for 12 months of follow-up and comparing their incidence and severity in different stages of chronic kidney disease. Method: Three hundred and five patients were evaluated every 4 months up to 12 months of follow-up. Arrhythmic events were assessed at each follow-up visit. Results: Within the same chronic kidney disease stage group there was no difference between the causes ofsinus node disease and atrioventricular block for the occurrence of any arrhythmia. However, a lower incidence of atrial fibrillation/tachycardia was observed for all comparisons among all patients and the same subgroups in stage 2 patients (total: 58%; sinus node disease: 63%; atrioventricular block: 51%) compared to stages 3 (total: 87%,P < 0.0001; sinus node disease: 89%, P = 0.0020; atrioventricular block: 84%, P = 0.0019) and 4 (total: 85%,P < 0.0001; sinus node disease: 81%, P = 0.0409; atrioventricular block: 90%, P < 0.0001). Regarding nonsustained/ sustained ventricular tachycardia, a higher incidence was observed for all comparisons among all patients and the same subgroups in stage 4 patients (total: 32%; sinus node disease: 16%; atrioventricular block: 16%) compared to stages 3 (total: 11%, P = 0.0007; sinus node disease: 9%, P = 0.0110; atrioventricular block: 14%, P = 0.0441) and 2 (total: 3%, P < 0.0001; sinus node disease: 3%, P < 0.0001; atrioventricular block: 4%,P < 0.0001). Conclusion: Our findings suggest that the more advanced the stage of chronic kidney disease, thegreater the incidence of malignant arrhythmias...

A Case of Sick Sinus Syndrome in a Patient with Systemic Sclerosis / 대한내과학회지

Systemic sclerosis (SSc) is characterized by the presence of microvascular disease and various patterns of cutaneous and parenchymal fibrosis. Manifestation of SSc may occur in numerous tissues and organs and can be particularly problematic when present in the lungs, kidneys or heart. Cardiac involvement in SSc includes pericarditis, myocardial disease, conduction abnormalities, and arrhythmia. Sick sinus syndrome is described as a combination of symptoms (dizziness, confusion, fatigue, syncope and congestive heart failure) caused by sinus node dysfunction and manifested by marked sinus bradycardia, sinoatrial block, or sinus arrest. Sinus node dysfunction is most often seen in the elderly but also, rarely, in systemic amyloidosis and connective tissue disease. Sick sinus syndrome is rarely found in patients with SSc, of which there has been only one case report, according to a review of the literature. Therefore, we report a case of sick sinus syndrome in a 71-year-old female with SSc.

[Study on possible relationship between gastric ulcer and cardiac arrhythmias in the Arab horse and Caspian miniature horse]

Peptic ulcer is a very common disorder in horse race and foals. In the present research possible relationship between gastric ulcer and the prevalence of cardiac arrhythmia were studied in two different horse race. In this respect. 13 Caspian miniature horses and 8 Arab horses were studied. Gastric ulcers and cardiac arrhythmias were diagnosed in 13 horses [62%] and 12[57%] out of 211 horses, respectively. The observed cardiac arrhythmias were sinus tachycardia, sinus bradycardia, sinus arrhythmia, second degree AV block and SA block. There was no significant relationship between gastric ulcer and cardiac arrhythmia in general and between gastric ulcer and each kind of arrhythmia [p>0.005]. Serum calcium, potassium. sodium, magnesium and inorganic phosphorous concentrations were measured in the horses. No significant correlation was seen between serum electrolyte and gastric ulcer or cardiac arrhythmia. Despite lack of significant correlation between cardiac arrhythmia and gastric ulcer, more occurrence for some kinds of arrhythmia in affected horses with gastric ulcer was very interesting and need to be further investigated in future

[Catecholaminergic polymorphic ventricular tachycardia in adult: a case report]

Catecholaminergic polymorphic ventricular tachycardia [CPVT] is a primary electrical myocardial disease characterized by exercise- and stress-related ventricular tachycardia manifested as syncope and sudden death usually in child and teenager and was rarely described in adults. The management includes betablockade, with the use of implantable cardioverter defibrillators if medical treatment is insufficient. Report a new case of CPVT. We report a case of a 43 years old patient in whom CPVT diagnosis was made during his exploration for palpitations occurring with the effort. Registration Holter ECG revealed several episodes of supraventricular tachycardia and episodes of nocturnal sino-atrial block. The patient had an ICD and betablockade treatment. The TVPC in adult can manifest with attenuated symptoms that can be summarized with palpitations with the exertion. The supraventricular arrhythmias and sinus dysfunction may be at the forefront of Electrocardiographic manifestations. The prognosis of this form seems better than the TVPC of the child. Treatment with betablockade appears to be effective but existing dysfunction sinus facilitates decision to implant the ICD

Quinine-induced arrhythmia in a patient with severe malaria.

It was reported that there was a case of severe malaria patient with jaundice who presented with arrhythmia (premature ventricular contraction) while getting quinine infusion was reported. A man, 25 years old, was admitted to hospital with high fever, chill, vomiting, jaundice. The patient was fully conscious, blood pressure 120/80 mmHg, pulse rate 100 x/minute, regular. On admission, laboratory examination showed Plasmodium falciparum (++++), total bilirubin 8.25 mg/dL, conjugated bilirubin 4.36 mg/dL, unconjugated bilirubin 3.89 mg/dL, potassium 3.52 meq/L Patient was diagnosed as severe malaria with jaundice and got quinine infusion in dextrose 5% 500 mg/8 hour. On the second day the patient had vomitus, diarrhea, tinnitus, loss of hearing. After 30 hours of quinine infusion the patient felt palpitation and electrocardiography (ECG) recording showed premature ventricular contraction (PVC) > 5 x/minute, trigemini, constant type--sinoatrial block, positive U wave. He was treated with lidocaine 50 mg intravenously followed by infusion 1500 mg in dextrose 5%/24 hour and potassium aspartate tablet. Quinine infusion was discontinued and changed with sulfate quinine tablets. Three hours later the patient felt better, the frequency of PVC reduced to 4 - 5 x/minute and on the third day ECG was normal, potassium level was 3.34 meq/L. He was discharged on 7th day in good condition. Quinine, like quinidine, is a chincona alkaloid that has anti-arrhythmic property, although it also pro-arrhythmic that can cause various arrhythmias, including severe arrhythmia such as multiple PVC. Administration of parenteral quinine must be done carefully and with good observation because of its pro-arrhythmic effect, especially in older patients who have heart diseases or patients with electrolyte disorder (hypokalemia) which frequently occurs due to vomiting and or diarrhea in malaria cases.

Cardiac Rhythm Disturbance in Sleep Apnea Syndrome: Effect of Nasal Continuous Positive Airway Pressure(nCPAP) Therapy

BACKGROUND AND OBJECTIVES: It has been demonstrated that sleep apnea syndrome predisposes to cardiac rhythm disturbances and cardiovascular risks such as systemic hypertension. This study was conducted to investigate the types and frequency of cardiac arrhythmias which occurred during sleep and the effects of nasal continuous positive airway pressure (nCPAP) therapy in the patients with sleep apnea syndrome. SUBJECTS AND METHODS: The subjects were 197 patients who were referred to the Sleep Research Center of Korea University Medical Center for polysomnography due to snoring and sleep apnea from Jan. 1st 2000 to July 31st 2002. Of the 197 patients, 44 with severe sleep apnea syndrome, whose respiratory disturbance index (RDI) exceeded 40/hr, were enrolled. Their electrograms on polysomnography before and after nCPAP therapy were analyzed. RESULTS: Of the 44 subjects, 32 (72.8%) showed cardiac arrhythmias. The types of arrhythmias were atrial premature beats (APBs, n=17), premature ventricular complexes (PVCs, n=15), sinus bradycardia (heart rate less than 40 per minute, n=6), sinus pause (n=1), and sinoatrial block (n=5). No fatal arrhythmias were identified. Most, 93.2%, of these arrhythmias arose immediately after hypopneic or apneic episodes, and were accompanied by a significant decrease in SaO2, from 91.4% to 84.7% (p<0.05). After nCPAP therapy, these arrhythmias were completely disappeared in 11 patients (34.4%) and diminished in 15 (46.9%). Hypopneic or apneic episodes were preceded by cardiac arrhythmias in only 36.4% with nCPAP (p<0.05 vs. before). CONCLUSION: Cardiac arrhythmias were demonstrated in 72.8% of cases of severe sleep apnea syndrome, which were mostly benign and preceded by hypopneic or apneic episodes. nCPAP therapy decreased the frequency of hypopnea and apnea with elevated arterial O2 saturation, and effectively eliminated cardiac arrhythmias.

Disfunção do nódulo sinusal: do diagnóstico ao implante de marcapasso definitivo' / Sinus nodal dysfunction: from diagnosis to the pacemaker implant

Variações da freqüência cardíaca são normais, dependendo de uma situação de momento, como esforço físico, emoções e tudo que provoque alteração do sistema nervoso autônomo. Contudo, quando uma bradicardia sinusal não consegue manter as necessidades fisiológicas do organismo para cada situação, é considerada como anormal, caracterizando disfunção do nódulo sinusal. Do ponto de vista prático, as disfunções sinusais podem englobar as alterações próprias do nódulo sinusal, os bloqueios sinoatriais, a síndrome bradi-taquicardia e a hipersensibilidade do seio carotídeo. As causas mais comuns são os processos degenerativos crônicos, como a esclerose do sistema excitocondutor, doença isquêmica cardíaca aguda ou crônica, disfunções autonômicas, como na doença de Chagas, e diabete. A avaliação diagnóstica pode ser feita por meio do quadro clínico, que se apresenta com astenia, fraqueza, dispnéia, intolerância ao esforço e/ou episódios de claudicação cerebral, como tonturas, pré-síncope e síncope. Como métodos auxiliares, podem ser utilizados eletrocardiografia, convencional ou de longa duração, como a gravação ambulatorial (Holter), testes farmacológicos com atropina, teste ergométrico e estimulação atrial. O tratamento pode ser feito por meio de fármacos, principalmente as disfunções agudas (fase aguda do infarto do miocárdio, intoxicações exógenas), ou utilizando-se a estimulação cardíaca, temporária ou definitiva. Estimulação cardíaca definitiva ideal é a que estimula exclusivamente o átrio, mas nos casos que demonstram anomalia da condução atrioventricular simultânea há necessidade de emprego de dupla câmara. A evolução a longo prazo costuma ser boa e depende da cardiopatia de base ou do modo inadequado de estimulação cardíaca definitiva, com possibilidades de aparecimento de insuficiência cardíaca e fenômenos tromboembólicos.

Familial Sick Sinus Syndrome

Sick sinus syndrome(SSS) constitutes a spectrum of cardiac arrhythmia, including sinus bradycardia, sinus pause-arrest, sinoatrial block, slow escape rhythm, bradyarrhythmia and tachyarrhythmia. SSS is relatively uncommon in children but its exact incidence is unknown because diagnostic criteria are not uniform and most children with SSS, in general are asymptomatic. SSS may be primary(organic sinus node disease) or secondary(cardiac surgery comprises much of SSS in children and adolescents), but it can hardly be caused by familial relations as well. We reports an occurrence of familial sick sinus syndrome. Mother was diagnosed as SSS, which was presented by symptoms of dizziness and treated by permanent pacemaker(DDD). Also, two daughters revealed SSS with non- compacted cardiomyopathy on neonatal screening and fetal echocardiography respectively. We concluded that familial SSS may occur, so familial screening should be suggested.

Arritmias cardíacas no idoso / Cardiac arrythmias in the elderly

Devido à elevada fraquência com que o aparelho cardiocirculatório é comprometido no indivíduo idoso, as alteraçöes do ritmo cardíaco säo bestante observadas nessa faixa etária. Entre as bradiarritmias temos a doença do nó sinusal, o bloqueio sinoatrial, a hipersensibilidade do seio carotídeo e os bloqueios atrioventriculares. Essas arritmias constituem as principais indicaçöes de implante permanente de marcapasso. As taquiarritmias supraventriculares compreendem a taquuicardia paroxística, o flutter atrial e a fibrilaçäo atrial e podem ser tratadas por drogas, cardioversäo elétrica e, eventualmente, através da eleminaçäo do foco por radiofrequência e cirurgia. As arritmias ventriculares, particularmente a taquicardia ventricular, säo frequêntes em cardiopatas e podem desencandear morte súbita. A terapêutica dessas arritmias se baseia na melhora da disfunçäo hemodinâmica, no emprego de antiarrítmicos, na cardioversäo, no implante de desfibrilador-cardioversor interno e na remoçäo do foco por radiofrequência ou por cirurgia.(au)

[Sino atrial block induced by therapeutic doses of diltiazem: about 3 observations]

We report three observations of Diltiazem intoxication at therapeutic doses with occurence of sino auricular block. The situation evolute favorably for two patients while the thind die. The electro systolic stimulate seems to be justified in case of Diltiazem intoxication

Disfunçäo do nódulo sino-atrial: clínica e terapêutica / Sick sinus syndorme: clinical approach and treatment

Disfunçäo do nódulo sino-atrial é a incapacidade apresentada pelo coraçäo em manter uma frequência adequada às necessidades orgânicas, provocando sintomas, devido ao fluxo snaguineo diminuido. Habitualmente, a reduçäo da frequência cardíaca se manifesta no eletrocardiograma (ECG) como: bradicardia sinusal persistente, bloqueio sino-atrial de 2 grau, pausas ou paradas sinusais passageiras, ritmos de escape passivos, juncionais ou idioventriculares, flutter ou fibrilaçäo atrais com resposta ventricul lenta e síndrome bradicardia-taquicardia. Todos estes distúrbios devem surgir sem a utilizaçäo de agentes farmacológicos bradicardizantes. Os principais sintomas referidos säo: síncopes, pré-síncopes, lipotímias, tonturas, palpitaçöes, insuficiência cardíaca congestiva, edema agudo de pulmäo e agravamento de quadros anginosos. a investigaçäo diagnóstica compreende: história clínica, ECG (em repouso, ambulatorial e de esforço), testes da funçäo autonômica, incluindo a massagem do seio carotídeo e avaliaä dos parâmetros eletrofisiológicos do nódulo sino-atrial. A evoluçäo natural desta enfermidade é lenta e episódica: a bradicardia persiste por períodos prolongados de tempo, até a apariçäo dos sintomas. O prognóstico geralmente é benigno; entretanto podem surgir complicaçöes graves, potencialmente letais: fenômenos embólicos säo comuns, quando exite fibrilaçäo atrial paroxística. A síncope do seio carotídeo é causada por reflexo barorreceptor exagerado, ocasionando assistolias prolongadas, após manobra povocativas mínimas sobre a bifurcaçäo da artéria carótida comum; pode ser subdividida em dois tipos: cardioinibitória e vasodepressora. O uso de fármacos com açäo aceleradora da frequência cardíaca, na disfunçäo do nódulo sino-atrial, näo produz resultados satisfatórios e conduz, precocemente, ao aparecimento de efeitos secundários. Nos casos sintomáticos o tratamento ideal é o implante de marcapasso artificial definitivo: de acordo com as circunstâncias, pode-se utilizar gerador unicameral com eletroo etimulador posicionado em átrio ou dispositivo de dupla câmara, com ou sem modulaçöes de frequencia. Na miocardiopatia chagásica crônica, é relativamente comum a presença de disfunçäo do nódulo sino-atrial, sendo acompanhada, na maioria dos casos por lesöes extensas do sistema de conduçäo; apesar de todas as medidas terapêuticas, farmacológicas ou näo, existe progressäo contínua no comprometimento muscular cardíaco, evoluindo, após ...

Bloqueo sino-atrial durante el tratamiento con amiodarona que ameritó marcapasos temporal / Pacient whith coronary artery disease receiving amiodarone who developd symptomatic synoatrial block and reguired the insertion of a tempory pacemaker

La amiodarona es una agente antiarrítmico potente altamente efectivo en el tratamiento de las arritmias auriculares y ventriculares. A pesar de su eficacia, la amiodarona tiene unas características farmacocinéticas poco usuales debido a su prolongada vida media de eliminación, su tendencia a acumularse en diversos tejidos y no existe un criterio definido para prescribir una dosis exacta basada en concentraciones plasmáticas. Adicionalmente, numerosos efectos adversos e interacción con otras drogas limita la aplicabilidad clínica de la droga. Nosotros precentamos un caso de un paciente con efermedad isquémica coronaria que recibia amiodarona y digoxina para el control de una fibrilación auricular quien desarrolló un bloqueo sino-atrial sintomático que requirió la inserción de un marcapaso temporal

Arritmias infantiles: disociación atrio-ventricular. Bloqueos / Disrhythmias in children: atri-ventricular dissociation heart block

Los autores hacen una revision de las arritmias propias de la infancia, en cuanto a etiología, patogenia, interpretación del ECG, manifestaciones clínicas, bases del tratamiento y prevención