Flutter auricular: Resultados inmediatos y alejados de la fulguración con radiofrecuencia del istmo cavo-tricuspídeo / Results of radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus for atrial flutter

Background: Radiofrequency ablation of the inferior vena cavatricuspid valve isthmus relieves atrial flutter in 95percent of cases. Aim: To evaluate the long term results of radiofrequency ablation of the inferior vena cavatricuspid valve isthmus in atrial flutter. Material and methods: Retrospective review of 86 patients with common atrial flutter, treated with radiofrequency ablation of the isthmus, while in sinus rhythm or flutter. Patients were contacted by telephone for a new clinical and electrocardiographic assessment, three to 40 months after the procedure. Results: Of all the patients treated, five died and five were lost from follow up, thus 76 patients (mean age 56 years, 58 males) were contacted for reassessment. At the moment of the procedure, 51percent had an underlying cardiac disease and 25percent had high blood pressure. All referred palpitations, 25percent had dyspnea, 84percent were receiving antiarrhythmic drugs and 33percent were on oral anticoagulants. Flutter was paroxystic in 83percent and chronic in 17percent. Fulguration was successful in all patients; one patient presented a high grade atrioventricular block as a complication of the procedure. At reassessment, 82percent of patients were in sinus rhythm, 16percent had atrial fibrillation and 2percent, an atypical flutter. Conclusions: Radiofrequency fulguration is a safe and effective treatment of atrial flutter.

Ritmo hisiano con fenómeno de Wenckebach retrógrado espontáneo y nodo aurículo-ventricular doble asociado a accidente vascular cerebral / Hissian rhythm with spontaneous retrograde Wenckebach fenomena and dual atrio-ventricular node associated to cerebrovascular accident

El fenómeno de Wenckebach se caracteriza por una prolongación progresiva del intervalo P-R hasta que una onda P es conducida por bloqueo a nivel del nodo aurículo-ventricular. En estudios electrofisiológicos se ha demostrado que la estimulación ventricular puede conducirse hacia las aurículas con prolongación progresiva del intervalo V-A, lo que constituye una especie de Wenckebach retrógrado. Se presenta el caso de una mujer de 70 años que posterior a un infarto parietal izquierdo oclusivo presentó ritmo hisiano con conducción ventrículo-auricular, con fenómeno de Wenckebach retrógrado espontáneo y evidencias electrocardiográficas de doble vía nodal. Este conjunto de anormalidades electrofisiológicas no ha sido publicado previamente