Functional Capacity of Patients with Pacemaker Due to Isolated Congenital Atrioventricular Block / Capacidade Funcional de Portadores de Marca-Passo por Bloqueio Atrioventricular Congênito Isolado

Background: Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation. Objectives: To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling. Methods: This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%. Results: A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0) Conclusions: The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling. .

Fundamento: O bloqueio atrioventricular congênito isolado (BAVCi) é raro e tem múltiplas apresentações clínicas. O remodelamento ventricular pode ocorrer em cerca de 10% dos indivíduos após o implante de marca-passo. Objetivos: Avaliar a capacidade funcional de crianças e adultos jovens com BAVCi e estimulação crônica no ventrículo direito (VD) e pesquisar sua associação com fatores preditores de remodelamento ventricular. Métodos: Estudo transversal em coorte de indivíduos com BAVCi e estimulação no VD há mais de um ano. Os indivíduos foram submetidos a avaliação clínica e ecocardiográfica. A capacidade funcional foi avaliada pelo teste de caminhada de seis minutos. Foram empregados os testes qui-quadrado, exato de Fisher e coeficiente de correlação de Pearson, considerando o nível de significância de 5%. Resultados: De março de 2010 a dezembro de 2013, foram avaliados 61 indivíduos, 67,2% do sexo feminino, com 7-41 anos de idade e uso de MP há 13,5 ± 6,3 anos. O percentual de estimulação ventricular era 97,9 ± 4,1% e a duração do complexo QRS estimulado era de 153,7 ± 19,1 ms. A maioria (95,1%) era assintomática e não utilizava medicamentos. A distância média percorrida de 546,9 ± 76,2 m teve forte correlação com a distância predita (r = 0,907; p = 0,001) e não se associou com os fatores de risco de remodelamento estudados. Conclusões: A capacidade funcional de portadores de BAVTCi com estimulação crônica no VD foi satisfatória e não se correlacionou com os fatores de risco para remodelamento ventricular. .

Functional capacity of patients with pacemaker due to isolated congenital atrioventricular block.

BACKGROUND: Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation. OBJECTIVES: To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling. METHODS: This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%. RESULTS: A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0) CONCLUSIONS: The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.

Distúrbios da condução intraventricular - parte 2 / Intraventricular conduction disturbance - part 2

Na primeira parte desta revisão foram estudados os distúrbios da condução intraventricular, enfocados os bloqueios isolados tronculares e os fasciculares ou divisionais dos ramos direito e esquerdo.Na presente comunicação, enfatiza-se a frequente associação dos bloqueios tronculares com os fascuculares e, ainda, as características especiais dos chamados bloqueios de ramo fases 3 e 4.Especial atenção foi dada para os aspectos eletrocardiográficos diferenciados dos bloqueios focais ou intramurais, baseados em recentes estudos com o emprego do eletrocardiograma de alta resolução (ECGAR) e estudos eletrofisiológicos para a estratificação de risco de taquiarritimias ventriculares graves

[Effects of the combination of nitrogen baths and physical training on physical performance and extrasystole in patients with coronary heart disease with intraventricular blocks]. / Vliianie kombinirovannogo primeneniia fizicheskikh trenirovok i azotnykh vann na fizicheskuiu rabotosposobnost' i ékstrasistoliiu u bol'nykh koronarnoi bolezn'iu serdtsa s vnutrizheludochkovymi blokadami.

99 patients with coronary heart disease (CHD), stable angina pectoris (functional class I-II), intraventricular blocks (IVB) took a course of general artificial nitrogen baths. Of them, 31 patients took the baths alone; 35 patients, in addition, exercised on veloergometer; 33 patients took baths and continued physical training up to 6 months. The results of the treatment were assessed with spiroveloergometry, ambulatory Holter ECG monitoring. Those who took baths and exercised for 6 months benefited from the treatment most as their muscular performance and coronary heart reserve increased; mean daily number of ventricular extrasystoles reduced by 73.3%, supraventricular extrasystoles--by 72.2%; intraventricular conduction was not damaged.

A case of septal Wolff-Parkinson-White syndrome associated with newly developed delta waves due to disappearance of impedance mismatch.

A 65-year-old woman who had shown no delta waves or atrioventricular block when seen in February 1989, suddenly developed advanced atrioventricular block in April 1990. The first electrophysiologic study revealed that atrioventricular block was caused by His ventricular block, and only weak retrograde conduction was documented. A DDD-type permanent pacemaker was implanted. One month after implantation, delta waves developed. The second electrophysiologic study, performed in February 1993, disclosed that a Kent bundle with bidirectional conduction capacity was located at the posterior septum and that the normal conduction system remained blocked at the His ventricular site. The etiology of the newly developed delta waves seems to be the disappearance of impedance mismatch at the ventricular insertion site of the Kent bundle.

Follow-up study of the arrhythmic graduates from the schools under the heart disease program for students in Osaka.

A long term follow-up study of arrhythmic graduates from junior or senior high schools under the Heart Disease Program in Osaka was performed by mailing questionnaires. The age of the total 515 subjects ranged from 20 to 38 years, 26.9 years on an average. From 397 graduates (77%), answers to questionnaires were obtained. We could confirm 92 graduates were alive (18% of total subjects) among the 118 graduates who did not return their answers to the questionnaires. The following is what we could confirm through the present study: The prognoses of simple premature beats, Wenckebach type heart block and complete right bundle branch block are good in young adults. The prognosis of sick sinus syndrome does not warrant an optimistic prognosis even in young adults. The prognosis of WPW syndrome in young adults is not always fair if they have a history of paroxysmal tachycardia. From 95 to 97% of the graduates with arrhythmia as a whole answered that their daily lives are quite similar to those of healthy people. Attitudes toward daily life and medical checks were also studied.

[Problems of rehabilitation during permanent cardiac stimulation]. / Problemi di riabilitazione in corso di elettrostimolazione cardiaca permanente.

The importance of certain features of the classification of diseases of the His system for the purpose of planning and conducting permanent cardiac stimulation (PCE). Stability of the conduction disturbance is essential in classifying low stroke volume syndromes as due to sporadic, frequent or habitual disturbance, and the frequency of stimulation should be geared to that of the syndrome. Rehabilitation during PCE also has its psychological side. Indeed, this almost always surpasses the physical side in importance and is dependent on the patient's job, social and economic standing, and the size of his family, as well as on his own emotional blaance and psychological reactions. About 70% of subjects behave in a normal way (rational acceptance of reality and a correct balance between emotiveness and reason), 20% display anxiety and depression, and the remainder show a typical form of euphoria; in many cases, this is clearly hypomaniacal.