Aneurismas micóticos popliteos bilaterales asociados con endocarditis bacteriana / Bilateral Mycotic Popliteal Aneurysms Associated with Infective Endocarditis

En la era posantibiótica, los aneurismas micóticos en arterias periféricas son una complicación poco frecuente de endocarditis infecciosa. El compromiso de la arteria poplítea es excepcional y más frecuente en hombres. El diagnóstico temprano, utilizando los métodos de imágenes ante una elevada sospecha clínica, tiene implicaciones pronósticas. El tamaño del aneurisma, la presencia de trombosis y el estado general del paciente son factores importantes para decidir un tratamiento oportuno. En esta presentación se describe el caso de un paciente de 48 años con aneurismas poplíteos bilaterales con punto de partida en una endocarditis mitroaórtica por Staphylococcus aureus meticilinorresistente, con embolias sépticas múltiples.

Mycotic aneurysms are a rare complication of infective endocarditis in the post-antibiotic era. The involvement of the popliteal artery is an exception and is more common in men. When the clinical suspicion is high, early diagnosis using image tests has prognostic implications. The aneurysm size, the presence of thrombosis and the patient's general condition are important factors to decide the adequate treatment. We describe the case of a 48-year old male patient with bilateral aneurysms of the popliteal arteries originating from endocarditis of the mitral and aortic valves caused by methicillin-resistant Staphylococcus aureus with multiple septic emboli.

Monitoreo remoto en dispositivos implantables / Remote moitoring and implantable devices

Mechanical assist devices are being used with increasing frequency, for remote monitoring for the care of patients through information received at distance by mean of the technology of telecommunications. The aim of this report was to describe the alerts received from patients implanted with devices with the ability of transmission at distance, in order to evaluate their causes and the therapeutic measures introduced, when in these patients is instituted a permanent remote monitoring instead of a remote follow-up. The role of remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators, is revised.

Ablación por radiofrecuencia de fibrilación auricular paroxística y persistente / Radiofrequency ablation of paroxysmal and persistent atrial fibrillation

La ablación por radiofrecuencia (ARF) es aceptada en la actualidad como tratamiento de la fibrilación auricular (FA) paroxística y persistente. El objetivo del presente trabajo es comparar los resultados de la ablación por radiofrecuencia con diferentes técnicas...

Radiofrequency catheter ablation (RFA) is one of the currently accepted treatments for paroxysmal and persistent atrial fibrillation (AF). Different approaches are currently used. To analyze the results of RFA in patients (pts.) with paroxysmal and persistent AF performing different techniques...

Subsensado de fibrilación ventricular espontánea como causa de muerte súbita en un niño / Undersensing of Spontaneous Ventricular Fibrillation as a Cause of Sudden Death in a Child

Se han comunicado casos aislados de subsensado de fibrilación ventricular por el cardiodesfibrilador implantable. La mayoría de ellos ocurrieron durante la medición de umbrales desfibrilatorios. Se ha sugerido que este tipo de subsensado podría ser una causa potencial de muerte súbita. En esta presentación se describe a un paciente de 4 años con miocardiopatía hipertrófica que sufrió un episodio espontáneo de fibrilación ventricular, con una gran alternancia en la amplitud de los electrogramas ventriculares locales, que fue subsensado y no tratado por el dispositivo y provocó muerte súbita.

In few cases implantable cardiodefibrillators have been reported to undersense ventricular fibrillation, and most of them happened during the measurement of defibrillation thresholds. This type of undersensing has been suggested as a potential cause of sudden death. In this case report we describe a 4-year old boy with hypertrophic myocardiopathy who suffered a spontaneous episode of ventricular fibrillation with a great alternation in the amplitude of local ventricular electrograms. The episode was undersensed by the device and therefore it was not treated, causing the child's death.

Cardiodefibrilador automático implantable: incidencia, causas y predictors de mortalidad. Valor de los registros prospectivos / Implantable automatic cardiodefibrillator: incidence causes and predictors of mortality. Value of the prospective records

The implantable automatic cardiodefibrilator (IACD) has proved to be an effective tool in the prevention of both primary and secondary sudden death. Even so, the mortality of patients receiving an IACD still remains elevated. Recent data, obtained from the secondary analysis of different studies, suggest that the discharges of the deice, between other clinical variables, both electrocardiiographic and ultrasonographic could be associated to a higher mortality, maybe due to a contribution to the progression of the cardiac insufficiency. The aims of this report were to evaluate the incidence of mortality, causes of death and the time since the implantation till the death, to analyze appropriate an inappropriate shocks and other variaables as potential predictors of mortality in patients with IACD. The results obtained in this study are detailed in the article