Bloqueo sinoauricular en el postoperatorio inmediato de cirugía de cataratas ¿Casualidad o causalidad? / Sino-auricular block immediately after cataract surgery. Casualty or causality?

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Registro Español de Marcapasos. V Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2007) / Spanish Pacemaker Registry. Fifth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2007)

Introducción y objetivos. En este artículo se presentan los resultados del Registro Español de Marcapasos correspondientes a la actividad realizada en el año 2007, analizándose tanto el tipo de proceso (implantes y recambios) como su distribución poblacional, modos de estimulación y los sistemas de cables-electrodos utilizados. Métodos. La recogida de datos se basa en la información que aporta la Tarjeta Europea del Paciente Portador de Marcapasos, la cual es remitida de forma voluntaria en formato magnético o mediante copia de la tarjeta. Resultados. Se recibió información de 114 centros hospitalarios, con un total de 11.360 tarjetas, que suponen el 36,9% de todos los marcapasos que se estima fueron utilizados. El número de unidades consumidas por millón de habitantes fue 680,4; se aprecia una significativa variación entre las diversas comunidades autónomas, en parte debido al desigual envejecimiento poblacional en ellas. El 25,3% de la actividad referida al registro corresponde a recambios de generadores. La media de edad de los pacientes que reciben su primer implante fue 76,1 años, con diferencias en función del sexo: 75,4 años en varones y 77,1 años en mujeres. La década en la que se objetiva un mayor número de primoimplantes corresponde a los 70 años, con el 40% del total. La frecuencia de primoimplantes fue significativamente superior en los varones (57,9%), por una mayor incidencia en éstos de los trastornos de la conducción; sin embargo, es similar en ambos sexos la enfermedad del nódulo sinusal. Excluidos los pacientes en taquiarritmia auricular, se aprecia que el 26,2% de los pacientes con enfermedad del nódulo sinusal, el 28% de los bloqueos auriculoventriculares y el 28,1% de los trastornos de la conducción intraventricular son estimulados en modo VVI/R. La edad es un factor muy influyente en la selección de este modo. La práctica totalidad de los cables endocárdicos utilizados son bipolares. Se percibe un aumento del porcentaje de los que utilizan un sistema de fijación activo, que supone el 36,5%. La estimulación para la terapia de resincronización ventricular de baja energía se mantiene estable en número total de implantes. Conclusiones. El Registro Español de Marcapasos recoge una muestra prospectiva muy representativa de la estimulación realizada en el año 2007, con un total del 11.360 implantes y recambios. Se objetiva que el sexo del paciente influye en la incidencia de los primoimplantes, que es mayor en los varones y a una edad más temprana debido a una mayor frecuencia de las alteraciones de la conducción en ellos. La edad es un factor influyente en la selección del modo de estimulación en las diversas indicaciones electrocardiográficas que originan el implante. Casi todos los cables utilizados son bipolares, y aumenta evolutivamente el porcentaje de los que utilizan un sistema de fijación activo (AU)

Introduction and objectives. The aim of this article was to report findings from the Spanish Pacemaker Registry on procedures carried out in 2007. The analysis includes details of patients' demographic characteristics, the type of procedure (i.e., implant or replacement), pacing mode, and the electrode and fixation systems used. Methods. The data collected comprised all the information recorded on European Pacemaker Patient Identification Cards, which were submitted voluntarily in either electronic or paper form. Results. The information received from 114 health-care centers included 11 360 cards, which covered 36.9% of all pacemakers thought to be implanted during 2007. Some 680.4 pacemakers were used per million inhabitants. Usage varied significantly between different Spanish autonomous regions, partly due to uneven ageing of the population. Some 25.3% of all procedures were to replace generators. The average age of patients undergoing a first implantation was 76.1 years, with a difference between the sexes: 75.4 years in men and 77.1 years in women. First implantations were carried out most often in patients in their 70s, who comprised 40% of the total, compared with other decades of life. There were more first implantations in men, who accounted for 57.9% of the total, due to a higher incidence of intraventricular conduction disturbance. In contrast, sick sinus syndrome was equally common in both sexes. Leaving aside patients with atrial tachyarrhythmia, it was observed that the VVI/R mode was used in 26.2% of those with sick sinus syndrome, 28% with atrioventricular block and 28.1% with intraventricular conduction disturbance. Age had a great influence on whether this pacing mode was selected. Almost all leads used were bipolar. The percentage using active fixation increased to 36.5%. The percentage of implants involving low-energy cardiac resynchronization therapy remained unchanged. Conclusions. The Spanish Pacemaker Registry received data on a highly representative sample of patients requiring cardiac pacing in 2007, which covered 11 360 device implantations or replacements. It was observed that the incidence of first implantations was influenced by sex, being greater in males, who underwent implantation at a younger age because conduction disturbances were more common. Age was one factor influencing the pacing mode selected for a range of electrocardiographic indications for pacing. Almost all leads implanted were bipolar. The percentage using active fixation continues to increase (AU)

[Early invasive strategy in acute coronary syndromes without persistent ST-segment elevation. Baseline characteristics and in-hospital outcome: Zabrze Registry]. / Obserwacja wewnatrzszpitalna i wyniki leczenia pacjentów z ostrymi zespolami wiencowymi bez przetrwalego uniesienia odcinka ST w osrodku dysponujacym mozliwosciami calodobowego leczenia inwazyjnego. Rejestr Zabrze.

Acute coronary syndromes (ACS) without ST elevation (which include unstable angina [UA] and non ST elevation MI [NSTEMI]) are caused by dynamic changes in the atherosclerotic plaque and coronary blood flow. To determine characteristics, in-hospital outcome and management of patients with ACS without ST elevation. The total of 502 patients were enrolled. Inclusion criteria were: rest angina within the last 24 hours, ST-segment deviation (>0,05 mV), T-wave inversion (>0,1 mV) in at least two leads, positive serum cardiac markers. There were 63,3% of patients with Braunwald's IIIB UA and 6,8% with IIIC UA, 29,9% of patients were diagnosed with NSTEMI. All patients were diagnosed invasively with subsequent revascularization (PCI-73,1% or CABG-16,7%) if apprioppriate. 1,6% of patients underwent PCI and elective CABG and 16,7% of patients were treated conservatively. Overall mortality was 2,98%--PCI subgroup (N = 367) 1,36%, CABG subgroup (N = 84) 8,33% and conservative subgroup (N = 43) 6,07%. Non-fatal myocardial infarction (MI) complicated the hospital course in 0,99%, 0,27%, 3,57%, and 2,32% of patients respectively. 1,4%, 0,54%, 6% and 0% of patients respectively had fatal MI. Early invasive strategy in patients with ACS without ST elevation is efficacious method of treatment.

[Implantation of atrial pacemaker in patients with sinoatrial failure]. / Implantasjon av atriepacemakere ved sinusknutesvikt.

From 1990 to 1997 a total of 42 atrial pacemakers (41 of them rate responsive) were implanted in patients with sick sinus syndrome at Aust-Agder Central Hospital, Arendal, Norway. 22 women and 20 men aged 42-86 years (average 69 years) were treated. Follow-up time was from 1-80 months (average 26 months). Sinusbradycardia and sinoatrial block were diagnosed in 17 patients, whereas 25 patients suffered from tachybrady syndrome. It was not necessary to change the pacemaker in any of the patients. One patient developed a second degree atrioventricular, Wenckebach type block, two patients developed permanent atrial fibrillation after seven and 43 months, respectively, and five patients were treated for paroxysmal atrial fibrillation. Thus, 34 patients had no need of antiarrhythmic treatment in the follow-up period. Although over 30% of patients who need a pacemaker in Norway suffer from sick sinus syndrome, only 8-12% of them are treated with atrial pacemakers. Recent studies have demonstrated that in patients with sick sinus syndrome there is greater improvement in prognosis and quality of life with physiological pacing than with ventricular pacing. Therefore, more patients should be considered for implantation of atrial pacemakers.

When is surgery indicated for the control of supraventricular tachycardia?

The surgical treatment of supraventricular tachycardias, if the experience with the ones caused by Kent bundles is excluded, is only now developing. Recent reports have described eight patients who had ablation, excision, or exclusion of an area of myocardium that contained an automatic focus. One instance of partial atrioventricular node interruption has been reported for correction of an atrioventricular nodal reentry tachycardia. The largest group of patients subjected to a direct operation had interruption of atrioventricular conduction. Twenty-seven patients, most of whom had enhanced atrioventricular nodal conduction, had either His bundle ablation or division. Experiments on the supraventricular conduction system have been outlined; they may point the way to extension of the indications for direct operations for supraventricular tachycardia.