ABSTRACT
Algorithms used for the differential diagnosis of wide QRS complex tachycardia are extremely important in clinical practice, but they have limitations and should be applied with caution. We describe a case of a patient with positive serology for Chagas disease and normal echocardiogram who presented an episode of wide QRS complex tachycardia. It was initially diagnosed as sustained ventricular tachycardia using the Brugada and Vereckei algorithms and it was sent to the reference service for the implant of a cardioverter defibrillator. However, the clinical history, electrocardiogram in sinus rhythm and the electrophysiological study were fundamental to the correct diagnosis and treatment of a posterolateral atrioventricular accessory pathway.
Subject(s)
Chagas Disease/complications , Electrocardiography , Tachycardia, Ventricular/etiology , Accessory Atrioventricular Bundle , Algorithms , Diagnosis, Differential , Female , Humans , Middle Aged , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Ventricular/diagnosisABSTRACT
BACKGROUND: Clinical independent predictors of inducible sustained ventricular tachycardia (VT) during electrophysiologic study (EPS) are not known in patients with chronic Chagas' heart disease. The purpose of this investigation was to fill this gap. METHODS: The medical charts of 47 patients with a positive serology for Chagas' disease who had undergone EPS between September 2006 and July 2012 at our institution were reviewed. Reasons for the EPS were the presence of unexplained syncope, non-sustained ventricular tachycardia (NSVT) on either resting ECG or 24 h-Holter monitoring as well as a LVEF < 55% and > 35% at echocardiography. A stepwise logistic regression analysis was performed to identify noninvasive predictors of inducible sustained VT/ventricular fibrillation during EPS. RESULTS: On univariate analysis, syncopal episodes (p = 0.04), amiodarone therapy (p < 0.005), diastolic blood pressure (p = 0.03), creatinine serum levels (p < 0.001), potassium serum levels (p < 0.001), and lengthening of the QRS complex (p = 0.03) were associated with inducible sustained VT during EPS. In the multivariate model, amiodarone therapy (p = 0.03; hazard ratio = 10; Wald coefficient = 4.5; 95% confidence interval 1.2 to 85.2) was the only variable retained as independent predictor of inducible sustained VT during EPS. CONCLUSION: Amiodarone therapy was the only independent variable associated with sustained VT inducibility during EPS in patients with chronic Chagas' heart disease.
ABSTRACT
O uso de anticoagulantes para profilaxia de tromboembolismo restringe-se à Fibrilaçãom Atrial (FA) e Flutter Atrial (FLA). FA é a arritmia sustentada mais prevalente nos dias de hoje, com aumento da prevalência de acordo com o aumento da idade. Está associada com maior risco de Insuficiência Cardíaca, mortalidade e Acidente Vascular Encefalico (um em cada cinco), sendo este último associado à maior gravidade, incapacidade e mortalidade do que isquemias cerebrais de outra etiologia. Deste fato, vem a importância de um adequado tratamento antitrombótico a fim de se evitar a cardioembolia. Neste artigo, temos por objetivo indicar os principais fatores de risco para tromboembolismo na FA, as drogas indicadas para profilaxia antitrombótica, incluindo os novos anticoagulantes orais, sua principais indicações, benefícios e riscos, inclusive em situações especiais como cardioversão e ablação de FA.
The use of anticoagulants for thromboembolism prophylaxis is restricted to Atrial Fibrillation (AF) and Atrial Flutter (FLA). Atrial fibrillation is the most prevalent sustained arrhythmia nowadays, with an increasing prevalence during the aging process. It is associated with an increased risk of heart failure, mortality and stroke (one in five), which is associated with greater severity, disability and mortality than with any other etiology of cerebral ischemia. This fact justifies of an adequate antithrombotic treatment in order to avoid thromboembolism. In this article, we aim to outline the main risk factors of thromboembolism in AF, drugs indicated for antithrombotic prophylaxis, including new oral anticoagulant, the main indications, risks and benefits, including special situations such as electrical cardioversion and ablation of AF.
Subject(s)
Humans , Catheter Ablation/adverse effects , Anticoagulants/administration & dosage , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Heart Failure , Thromboembolism/complications , Thromboembolism/therapy , Risk FactorsABSTRACT
O manuseio de pacientes com fibrilação atrial é uma das situações mais corriqueiras na prática diária do cardiologista. Todas as condutas tomadas devem estarbem embasadas cientificamente, para oferecer ao paciente uma terapêutica segura e eficaz. A avaliação detalhada de cada caso é fundamental para que se estabeleça uma conduta terapêutica individualizada ao paciente. A prevenção de fenômenos tromboembólicos e o cuidado para se evitar pró-arritmias são pontos importantes,que contribuem com a redução de complicações graves para o paciente.
