RESUMO
La taquicardia ventricular monomórfica sostenida (TVMS) es una complicación tardía de la cirugía reparadora de la tetralogía de Fallot y si bien puede ser tratada por técnicas convencionales de ablación por radiofrecuencia, las características de los pacientes hacen que la tasa de éxito de su utilización no supere el 50%. El advenimiento de métodos de cartografía electroanatómica tridimensional favorece una ablación exitosa. En esta presentación se describe el caso de un paciente de 53 años con cirugía previa reparadora de tetralogía de Fallot, a quien le fue colocado un cardiodesfibrilador automático implantable por una TVMS sintomática por síncope. Se decidió indicar una ablación por radiofrecuencia por la presentación de recurrencias a pesar del tratamiento con amiodarona. Asimismo, se describen las técnicas de cartografía electroanatómica tridimensional que, complementando a la electrofisiología convencional, permiten la caracterización correcta de los circuitos arritmogénicos, posibilitando así la abolición de la arritmia mediante radiofrecuencia. A nuestro entender, este es el primer caso publicado en la Argentina de ablación de TVMS en pacientes con cirugía reparadora de tetralogía de Fallot.
Sustained monomorphic ventricular tachycardia (SMVT) is a late complication of corrective surgery for tetralogy of Fallot. The success rate of conventional radiofrequency ablation is <50% due to patients' characteristics. Threedimensional electroanatomic mapping system is associated with favorable outcomes. We describe the case of a 53 year-old male patient with a history of previous corrective surgery for tetralogy of Fallot and an implantable cardioverter defibrillator due to syncope secondary to SMTV. Despite being treated with amiodarone, radiofrequency catheter ablation was indicated due to recurrences. In addition, we describe three-dimensional electroanatomic mapping system as a complement to conventional electrophysiology for an adequate characterization of the arrhythmogenic circuits undergoing radiofrequency catheter ablation. To our understanding, this is the first case published in Argentina of radiofrequency catheter ablation of a SMVT in patients with corrective surgery for tetralogy of Fallot.
RESUMO
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
Assuntos
Humanos , Causas de Morte , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/prevenção & controle , Interpretação Estatística de Dados , Desfibriladores Implantáveis , Seguimentos , Isquemia Miocárdica/patologia , Isquemia Miocárdica/prevenção & controle , Estudos ProspectivosRESUMO
This study aimed to analyze factors affecting the outcome of cardiac operations. A number of variables can affect the autcome of cardiac surgical procedures. The success of a cardiac operation is determined by the successful execution of appropiate management. Cardiac dysfunction during the postoperative period after cardiac surgery is a frequent disorders, causing a more prolonged hospital stay, increasing risk of death and larger costs...We studied the incidence of the different dysfunction of the cardiac rhythm, the involved pathophysiological mechanisms, and the management employed