Diagnóstico de las taquiarritmias en el paciente pediátrico / Diagnosis of tachycardias in pediatric patients

Arrythmias in the pediatric patient usually are considered rare; nonetheless, their number is increasing. The paroxistic supraventricular tachycardia is the most frequent symptomatic arrhythmia. The diagnosis is based on electrocardiographic register. There are few diagnostic tools including the Hotter monitoring and loop recorders. Once the tachychardia is detected, a deductive electrocardiographic diagnosis and specific treatment are established.

Incidencia y comportamiento clínico de las arritmias asociadas con cardiopatía congénita y corrección quirúrgica / Incidence and clinical behavior of arrhythmias associated with congenital heart disease and surgical treatment

Congenital heart disease is associated with arrhythmias. Not only the congenital anatomic settings but also the arrhythmogenic substrate related to surgical procedures is associated with the increased incidence of arrhythmias in these patients. In the National Institute of Cardiology, we reviewed retrospectively 128 clinical records of patients subjeted to surgical treatment of congenital heart disease (81 Fontan surgery, 19 with anomalous pulmonary drainage, 19 Fallot tetralogy). The incidence of supraventricular tachycardia was 8.6%, and the bradyarrhythmias were 15% with AV block in different degrees. Permanent pacing was required in 7.8% of the patients. The incidence of arrhythmias in post-surgical patients with congenital heart disease is increasing constantly.

Incidencia y comportamiento clínico de las arritmias en pacientes con corrección quirúrgica de cardiopatías congénitas / Incidence and clinical features of arrhythmias after surgical treatment of congenital heart disease

Congenital heart disease is associated with arrhythmias. Not only the congenital anatomic component but also the greater arrhythmogenic substrate related to surgical procedures is associated with the increased incidence of arrhythmias in these patients. In pediatric cardiology the study of these phenomena is becoming important and one factor associated with it is the longer follow up, which varies depending on the type of heart disease and arrhythmia. With the same impact, there are daily breakthroughs in diagnostic and treatment through pharmacological and interventional means. The incidence of arrhythmias in post-surgical patients with congenital heart disease is in constant increment, and this is related to the constant increment in the procedures, variety and frequency, as well as the long-term survival.

Fibrilación atrial: control del ritmo vs. control de la frecuencia / Atrial fibrillation: rhythm vs. rate control

The atrial fibrillation treatment has been controversial since almost a century. Several studies have been done and there is not a clear therapeutic strategy despite the new technological advances. The disyuntive persist between sinus rhythm control vs. ventricular rate control. The main studies like AFFIRM, RACE, PIAF, PAF2 and STAF have not shown a definitive strategy treatment. Recently, several subgroups have been stablished and variables like life quality and functional state have been included. New therapeutic strategies have resulted. Heart rate control is recommendable for asymptomatic 65 years old patients and older, whereas rhythm control is better for patients with severe symptoms.

Ablación transquirúrgica de vía accesoria atrioventricular en anomalía de Ebstein / Surgical radioerequency catheter ablation of accessory pathways in Ebstein's anomaly

Fueron estudiados 13 pacientes con anomalía de Ebstein con taquicardia por reentrada atrioventricular y al menos una vía accesoria. En 7 pacientes (53.8%) existía una vía accesoria y en 6 pacientes (46.1%) vías múltiples. En 5 pacientes (38.4%) se encontró vía accesoria tipo Mahaim. Un total de 22 vías accesorias fueron identificadas de las cuales 2 (9%) eran ocultas. El 100% se localizaron en el anillo tricuspídeo. Los sitios más frecuentes de ubicación fueron: región lateral derecha con 11 (50%) y postero-septal derecha con 5 (22.7%). Diez pacientes recibieron tratamiento mediante ablación con radiofrecuencia vía transquirúrgica y tres mediante sección quirúrgica. Se obtuvo un éxito de 100%. No se presentaron complicaciones durante los procedimientos. Conclusión: La ablación transquirúrgica de vías accesorias atrioventriculares en pacientes con anomalía de Ebstein es un procedimiento seguro y eficaz.

Thirteen patients with Ebstein anomaly and atrioventricular reentrant tachycardia and at least one accessory pathway were included in this study. One accessory pathway in 7 (53.8%) patients and multiple accessory pathways in 6 (46.1%) were found. Mahaim accessory pathway was observed in 5 (38.4%) patients. A total of 22 accessory pathways was found, 2 (9%) were concealed. In all (100%), the accessory pathways were located in the tricuspid ring. The most frequent regions were right lateral free wall with 11 (50%) and 5 right posteroseptal (22.7%). Ten patients underwent surgical radiofrequency catheter ablation and three subjected to surgical section. We obtained success in 100%. No complications were observed during the procedures. In conclusion, surgical ablation therapy in patients with accessory pathways and Ebstein's anomaly is safe and effective.