ABSTRACT
Background: The use of implantable cardiac devices in patients with sudden cardiac arrest has contributed to their survival. Aim: To determine the survival rate at 30 days and one year after hospital discharge of patients who had a cardiac arrest with subsequent placement of an implantable cardiac device. Material and Methods: Twenty-three patients older than 18 years who presented sudden extra-institutional or intra-institutional death with subsequent implantation of an implantable cardiac device and whose survival was recorded at 30 days and one year, were included. A univariate analysis was performed. Results: Eighteen patients had an extra institutional cardiac arrest. All patients were discharged alive. We could not ascertain the health status of one patient at follow-up. Twenty-one patients had a Cerebral Performance Category (CPC) of 1 at discharge. One patient died of a stroke within 30 days and one patient died due to an arrhythmic electrical storm one year later. Twenty patients survived at least one year after hospital discharge. Conclusions: Survival at 30 days and one year, was high in patients with sudden death or cardiac arrest who required intracardiac devices.
Subject(s)
Humans , Defibrillators, Implantable , Heart Arrest/therapy , Patient Discharge , Time Factors , Survival Rate , Death, Sudden, Cardiac/etiologyABSTRACT
BACKGROUND: The use of implantable cardiac devices in patients with sudden cardiac arrest has contributed to their survival. AIM: To determine the survival rate at 30 days and one year after hospital discharge of patients who had a cardiac arrest with subsequent placement of an implantable cardiac device. MATERIAL AND METHODS: Twenty-three patients older than 18 years who presented sudden extra-institutional or intra-institutional death with subsequent implantation of an implantable cardiac device and whose survival was recorded at 30 days and one year, were included. A univariate analysis was performed. RESULTS: Eighteen patients had an extra institutional cardiac arrest. All patients were discharged alive. We could not ascertain the health status of one patient at follow-up. Twenty-one patients had a Cerebral Performance Category (CPC) of 1 at discharge. One patient died of a stroke within 30 days and one patient died due to an arrhythmic electrical storm one year later. Twenty patients survived at least one year after hospital discharge. CONCLUSIONS: Survival at 30 days and one year, was high in patients with sudden death or cardiac arrest who required intracardiac devices.
Subject(s)
Defibrillators, Implantable , Heart Arrest , Death, Sudden, Cardiac/etiology , Heart Arrest/therapy , Humans , Patient Discharge , Survival Rate , Time FactorsABSTRACT
BACKGROUND: Differential diagnosis of wide QRS complex tachycardias using the 12-lead ECG may be difficult in many clinical settings. OBJECTIVE: The purpose of this study was to determine the value of ECG lead II, specifically, the duration at its beginning, defined as R-wave peak time (RWPT), in differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with wide QRS complex tachycardia. METHODS: Two hundred eighteen ECGs showing wide QRS complex tachycardias were evaluated. Two cardiologists blinded to the diagnosis measured RWPT duration at lead II (from the isoelectric line to the point of first change in polarity), and results between VT and SVT were compared, with the findings of electrophysiologic study used as the gold standard. RESULTS: One hundred sixty-three VTs had a significantly longer RWPT at DII (76.7 +/- 21.7 ms vs 26.8 +/- 9.5 ms in 55 SVT, P = .00001). Receiver operating characteristic curve identified RWPT > or =50 ms at lead II as having greater specificity and sensitivity in discriminating VT from SVT. Area under the curve was 0.97 (95% confidence interval 0.95-0.99), positive likelihood ratio was 34.8, and kappa coefficient (kappa) was 0.86. Bivariate analysis identified higher age in VT patients (60.7 vs 50.1 years, P < or =.01) and wider QRS complex duration at lead II in VT patients (169.4 vs 128.3 ms, P <.0001). QRS width at DII was not superior to RWPT in diagnosing VT. CONCLUSION: RWPT > or =50 ms at DII is a simple and highly sensitive criterion that discriminates VT from SVT in patients with wide QRS complex tachycardia.
Subject(s)
Electrocardiography , Tachycardia, Supraventricular/diagnosis , Tachycardia, Ventricular/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Heart Conduction System/physiopathology , Humans , Male , Middle Aged , ROC Curve , Sensitivity and Specificity , Tachycardia, Supraventricular/physiopathology , Tachycardia, Ventricular/physiopathology , Young AdultABSTRACT
La prolongación anormal del intervalo QT tiene relevancia por su asociación con inestabilidad eléctrica ventricular, pudiéndose presentar arritmias ventriculares polimórficas en "puntas torcidas". Los síntomas acompañantes de estas arritmias son el síncope, convulsiones o la muerte súbita. Se puede clasificar en síndrome de QT prolongado congénito, el cual se hereda o lo adquiere el individuo de manera esporádica y el síndrome adquirido que se puede presentar asociado a fármacos u otras situaciones clínicas. Presentamos el caso de una mujer de 41 años de edad que desarrolló cambios típicos de síndrome de QT prolongado por isquemia miocárdica y hacemos una breve revisión.
