ABSTRACT
La muerte súbita cardíaca de causa eléctrica en sujetos con corazón "sano", constituye un problema clínico y de salud pública, aún no resuelto. Los objetivos del trabajo fueron: caracterizar pacientes reanimados de un evento de muerte súbita de causa eléctrica y conocer su evolución intervenida en tres años; y estudiar los signos eléctricos premonitorios de muerte súbita. Se estudiaron 42 sujetos, 30 hombres y 12 mujeres, edad promedio 37.7 años, con corazón "sano", por métodos clínicos y paraclínicos. Se consideraron 9 subpoblaciones, en mayor número los síndromes de Brugada y de QT largo y la fibrilación ventricular idiopática. Las arritmias responsables del evento fueron, en primer lugar, la fibrilación ventricular y la torsión de puntas. Existieron signos premonitorios en el 92.8% de los pacientes. Fueron frecuentes las recidivas de las arritmias malignas (71.4%) aunque en la estimulación eléctrica programada, sólo se logró reproducirlas en 4 de 18 pacientes. La fibrilación auricular predominó como arritmia coexistente (19%). En resumen, son frecuentes los signos premonitorios (en especial la fibrilación auricular) y las recidivas de las arritmias malignas aunque su inducibilidad en el laboratorio es pobre. La estratificación de riesgo es muy difícil, por el bajo valor predictivo de los métodos diagnósticos.
Sudden cardiac death due to electrical causes in individuals with no evidence of structural heart disease is an important clinical and public health problem, and it is not yet solved. The objectives of this study were: to characterize patients reanimated from a sudden death event of electrical cause; to know the mediated evolution during a period of three years and to study premonitory electrical signs. 42 individuals were studied, 30 were male and 12 female, mean age 37.7 years, healthy heart, by clinic and paraclinic methods. Nine subpopulations were studied, being Brugada syndrome, long QT syndrome and idiopathic ventricular fibrillation the most frequent. Ventricular fibrillation and twisting of the points were the arrhythmias responsible for most death events. There were premonitory signs in 92.8% and clinical recurrences of life-threatening events in 71.4% but they were induced during programmed electrical stimulation only in 4 of 18 patients. Atrial fibrillation was the most frequent coexistent arrhythmia (19%). In summary, there are frequent premonitory signs (particularly atrial fibrillation), and also malignant arrhythmic recurrences but a poor inducibility at the electrophysiology laboratory. It is very difficult to stratify the risk because of the low predictive value of diagnostic methods.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Arrhythmias, Cardiac/complications , Death, Sudden, Cardiac/etiology , Heart Arrest/etiology , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/drug therapy , Cuba/epidemiology , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Electrocardiography , Electrophysiologic Techniques, Cardiac , Heart Arrest/epidemiology , Heart Arrest/therapy , Risk FactorsABSTRACT
The Brugada syndrome is the most frequent electrical cause of sudden death in patients with structurally normal heart. It is characterized by ST segment elevation in V1-V3 leads, pseudo right bundle branch block and proneness for episodes of life-threatening ventricular cardiac arrhythmias. The aim of this study was to characterize patients with Brugada syndrome identified in Cuba between 1995 and 2001. Fourteen patients with these electrical signs (13 male and 1 female, mean age 42.8) were studied. Seven of them were symptomatic and seven were not. The pharmacological test with sodium channel blockers was very useful (it was positive for all the patients). HV interval was normal. Programmed ventricular stimulation was performed. Ventricular arrhythmia was inducible in 3 symptomatic patients and 2 asymptomatic. All the symptomatic patients and those asymptomatic in whom ventricular arrhythmia was inducible received automatic defibrillators. One clinical recurrence of ventricular arrhythmias was observed. Antiarrhythmic drugs were only used rarely. Clinical history and electrocardiographic tracings were very important to diagnose this syndrome. There were light, transient or masked electrical signs. The treatment of choice is the implantable cardioverter-defibrillator.
