Como conduzir pacientes assintomáticoscom extrassístoles ventriculares? / How to approach asymptomatic patients with premature ventricular contractions?

As extrassístoles ventriculares (EV) são conhecidas desde o século VII AC, e até o momento existem dúvidas pelos clínicos e mesmo entre grande número de cardiologistas,sobre como abordá-las e consequente terapêutica. Nas últimas décadas surgiram evidências relatadas em trabalhos com grande número de pacientes e em diretrizes devárias sociedades de que as EV em indivíduos sem cardiopatia estrutural, após avaliaçãopor métodos diagnósticos disponíveis, não necessitam de maiores preocupações, já queos riscos de morte se equivalem a uma população normal ou mesmo aos coronarianos com lesões arteriais discretas. Isso equivale a dizer, os assintomáticos não necessitam de nenhum tratamento específico, e se apresentarem sintomas decorrentes da arritmia, apenas terapia com β-bloqueadores e aconselhamento médico. Porém, assintomáticos portadoresde EV com possibilidades de desenvolver quadros clínicos mais severos, devem ter uma abordagem mais criteriosa. Assim, devem submeter-se a avaliação clínica detalhada e talvez emprego de terapia específica, com medicamentos antiarrítmicos e até ablação por cateter, portadores de EV assintomáticos quanto à arritmia, quando esta for frequente– acima de 500 EV por hora – com cardiopatia estrutural, eletrocardiograma com evidênciasde alterações eletrogenéticas, miocardiopatia dilatada e hipertrófica, possibilidade de indução de arritmias ventriculares malignas e fração de ejeção em fase de deterioração...

Premature ventricular contractions (PVC) were first described in the 7th Century BC,but until now, there are doubts among medical professionals, and even among many cardiologists, as to how to address them, or the best conduct for their treatment. In recente decades, evidence has emerged from large clinical trials, and the guidelines of various societies, that PVC in individuals without structural heart disease, after evaluation by the available diagnostic methods, are not a cause for major concern, as the risk of death is equivalent to that of the normal population, or even coronary patients with mild arterial lesions.This means that asymptomatic patients do not require any specific treatment, and if they present symptoms resulting from the arrhythmia, therapy with β-blockers alone, and medical guidance, are advised. However, asymptomatic patients with PVC with the possibility of developing more severe clinical conditions should be more carefully investigated.Patients with asymptomatic PVC in terms of arrhythmia should therefore be submitted to adetailed clinical evaluation, possibly with specific therapy, with antiarrhythmic medications and even catheter ablation, in cases where the arrhythmia is frequent – above 500 PVC per hour – with structural heart disease, electrocardiogram with evidence of electrogenetic alterations, dilated and hypertrophic myocardiopathy, possibility of induction of malignant ventricular arrhythmias, and ejection fraction in the deterioration phase...

Characteristics of Double-Chambered Right Ventricle in Adult Patients

BACKGROUND/AIMS: This study evaluated the clinical features of double-chambered right ventricle (DCRV) in adults. Most cases of DCRV are diagnosed and treated during childhood. Consequently, very few reports include cases in which its clinical characteristics are evident in adults. METHODS: We reviewed the clinical data for 10 adult patients (age > or = 18 years) with DCRV. RESULTS: Electrocardiogram showed right ventricular hypertrophy in 3 DCRV patients. All cases were associated with ventricular septal defect (VSD; 7 for perimembranous, 2 for muscular outlet, and 1 for the subarterial type). Surgical correction was done for 7 DCRV patients all of whom survived operations. Their follow-up echocardiogram showed the pressure gradient in their right ventricle was significantly decreased from 69.4 +/- 17.2 mmHg preoperatively to 10.2 +/- 5.0 mmHg postoperatively (p < 0.05). In the short-term follow-up, there was no significant increase in the pressure gradient in the right ventricle. CONCLUSIONS: There are lots of cases of DCRV that are not diagnosed accurately in adults. In our experience, all DCRV cases had VSD and surgical correction of these cases showed excellent results. Therefore, accurate diagnosis of DCRV is necessary so that DCRV is not overlooked and operations are enabled within an appropriate time.

Displasia arritmogénica del ventrículo derecho: presentación de tres casos / Arrhythmogenic right ventricular dysplasia

La displasia arritmogénica del ventrículo derecho es una afección bien definida con manifestaciones predominantemente arrítmicas. Se analizan los tres casos diagnosticados por nuestro grupo. Estos casos se presentaron como taquicardia ventricular con morfología de bloqueo de rama izquierda, presentando uno de ellos una muerte súbita abortada en la evolución. El electrocardiograma basal y la promediación de señales fueron anormales en dos de los tres casos, al igual que el ecocardiograma. El estudio electrofisiológico logró inducir en los tres pacientes taquicardia ventricular monomorfica sostenida con morfología de bloqueo de rama izquierda. El diagnóstico definitivo se hizo por ventriculografía derecha en dos casos y por resonancia nuclear magnética en el otro. El tratamiento incluyó fármacos antiarrítmicos en los tres casos y la colocación de un cardiodesfibrilador automático en el que sobrevivió a una muerte súbita

Clinical course of isolated ventricular septal defect: an Indian experience.

To define the clinical course of ventricular septal defect, 410 consecutive patients with isolated ventricular septal defect were evaluated over a period of 13 years. Their age ranged from 12 days to 24 years at the time of first visit to the hospital. Patients with less than 2 years follow-up period were excluded. One hundred and fifty seven patients were one year of age or less. The left to right shunt size remained the same in 52.4% of cases. In 34.4% the shunt size decreased, with complete closure of ventricular septal defect in 8.8%. Closure of ventricular septal defect was observed even in patients who had initially presented with large left to right flow, and congestive heart failure in infancy. Right ventricular outflow tract obstruction developed in 8.5% of patients usually between 2 and 10 years of age. Murmur of aortic regurgitation appeared in 8.9% on follow-up. Infective endocarditis developed in 6 cases. The unfortunate complication of Eisemenger's complex was seen in 3 patients; they had not returned for follow up for a long period of time. Hence, our data show that the left to right shunt across the ventricular septal defect decreases in about one-third of patients. However, a regular follow up is essential to prevent development of Eisenmenger's complex and for early detection of other complications like aortic regurgitation and right ventricular outflow tract obstruction.