Complete remission with histamine blocker in a patient with intractable hyperadrenergic postural orthostatic tachycardia syndrome secondary to long coronavirus disease syndrome.

The COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), has emerged as a global public health concern and its sequels have barely started to outcrop. A good percentage of patients who suffered from COVID-19 are prone to develop long-COVID or post-COVID condition (PCC), a multisystemic, heterogeneous, chronic disorder. Patients with PCC may experience diverse manifestations, of which cardiovascular and neurological symptoms are among the most frequently reported. Indeed, dysautonomia presented as orthostatic intolerance has gained room following recent reports linking postural orthostatic tachycardia syndrome (POTS) with PCC. Disturbances in heart rate (HR) and blood pressure (BP) during postural changes are the cornerstones of orthostatic intolerance seen in patients suffering from PCC. A subtype of POTS, hyperadrenergic POTS, has been widely studied because of its association with mast cell activation syndrome (MCAS). Although a causative relationship between PCC, hyperadrenergic POTS, and MCAS remains unrevealed, these syndromes can overlap. We want to propose here a correlation produced by a close-loop mechanism with positive feedback established after SARS-CoV-2 infection in a previously healthy young patient.

Cuestionario de reacciones vasovagales a la donación de sangre en una institución de salud / Questionnaire of vasovagal reactions to blood donation in a health institution

Resumen: Objetivo: Identificar mediante un cuestionario de signos y síntomas vasovagales a donadores de sangre, con el fin de registrar los antecedentes que aumentan la probabilidad de presentar reacciones vasovagales. Materiales y Métodos: Se aplico un cuestionario a donadores de sangre, durante tres meses, en el banco de sangre en una institución de salud de tercer nivel. Resultados: El 100% de los donadores respondió negativamente a las preguntas del cuestionario, pero el 1.3% de ellos presentaron reacción vasovagal, siendo el mareo, palidez y náusea el signo y síntomas más frecuentemente mostrados. Al comparar dos grupos con y sin reacción vasovagal pareados por sexo, edad e índice de masa corporal, no hubo diferencias entre ellos. Conclusiones: Los donadores en nuestro país son fundamentalmente de reemplazo, por lo que se debe considerar esta circunstancia además de sus motivaciones, para el diseño de encuestas dirigidas a esta población.

Abstract: Objective: Identify, trough a vasovagal signs and symptoms questionnaire, blood donors in order to record the antecedents that increases the probability of presenting vasovagal reactions. Materials and Methods: A questionnaire was applied to blood donors, for three months, in the blood bank in a third-level health institution. Results: 100% of the donors answered negatively to the questions in the questionnaire, but 1.3% of them presented vasovagal reaction, with dizziness, pallor and nausea being the most frequently shown sing and symptoms. When comparing two groups with and without vasovagal reaction matched by sex, age and body mass index, there were no differences between them. Conclusions: Donors in our country are fundamentally replacement donors, so this circumstance plus their motivations should be considered for the design of surveys aimed at this population.

Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in humans. After successful cardioversion, there is a recurrence of 60% due to atrial remodeling, and it has been shown that the global peak atrial longitudinal strain (GPALS) is decreased in these subjects. The aim of this study was to evaluate the predictive value of GPALS for AF recurrence. A prospective cohort of patients with persistent (PnVAF) and long standing persistent non-valvular AF (LSPnVAF) which underwent electrical cardioversion was evaluated with standard echocardiographic variables and GPALS quantification. The primary endpoint was AF recurrence at 6 months. We included PnVAF (n = 50, aged 68.4 ± 10.2 years, female 46%, lasted AF 6 months) and LSPnVAF (n = 81, aged 66.5 ± 13.1 years, female 36%, lasted AF 18 months). At 6 months there were a 68% of recurrence of AF in PnVAF and 53% in LSPnVAF group. GPALS was lower in recurrence 7.8 ± 2.0% versus 21.2 ± 8.9% (p < 0.001) for PnVAF and 7.3 ± 2.7% versus 20.7 ± 7.6% (p < 0.001) in LSPnVAF. GPALS ≤ 10.75% discriminates recurrence at 6 months with a sensitivity of 85%, specificity 99%, PPV 85%, NPV 90%, LR + 8.5 and LR- 0.17. The independent predictors of recurrence in PnVAF were GPALS ≤ 10.75% HR 8.89 [(2.2-35.7), p < 0.01] meanwhile in LSPnVAF were age HR 1.039 [(1.007-1.071), p = 0.01], and GPALS ≤ 10.75% HR 28.1 [(7.2-109.1), p < 0.001]. In subjects with PnVAF and LSPnVAF with successful electrical cardioversion, GPALS ≤ 10.75% predicts arrhythmia recurrence at 6-month follow-up.

Initial circulatory response to active standing in Parkinson's disease without typical orthostatic hypotension.

UNLABELLED: While the circulatory response to orthostatic stress has been already evaluated in Parkinson's disease patients without typical orthostatic hypotension (PD-TOH), there is an initial response to the upright position which is uniquely associated with active standing (AS). We sought to assess this response and to compare it to that seen in young healthy controls (YHC). METHOD: In 10 PD-TOH patients (8 males, 60 ± 7 years, Hoehn and Yahr ≤ 3) the changes in systolic blood pressure (SBP) and heart rate that occur in the first 30 seconds (sec) of standing were examined. Both parameters were non-invasively and continuously monitored using the volume-clamp method by Peñáz and the Physiocal criteria by Wesseling. The choice of sample points was prompted by the results of previous studies. These sample points were compared to those of 10 YHC (8 males, 32 ± 8 years). RESULTS: The main finding of the present investigation was an increased time between the AS onset and SBP overshoot in PD-TOH group (24 ± 4 vs. 19 ± 3 sec; p<0.05). CONCLUSION: This delay might reflect a prolonged latency in the baroreflex-mediated vascular resistance response, but more studies are needed to confirm this preliminary hypothesis.

Initial circulatory response to active standing in Parkinson's disease without typical orthostatic hypotension / Resposta circulatoria inicial apos ortostatismo ativo na doenca de Parkinson sem hipotensao ortostatica tipica

While the circulatory response to orthostatic stress has been already evaluated in Parkinson's disease patients without typical orthostatic hypotension (PD-TOH), there is an initial response to the upright position which is uniquely associated with active standing (AS). We sought to assess this response and to compare it to that seen in young healthy controls (YHC). Method In 10 PD-TOH patients (8 males, 60±7 years, Hoehn and Yahr ≤3) the changes in systolic blood pressure (SBP) and heart rate that occur in the first 30 seconds (sec) of standing were examined. Both parameters were non-invasively and continuously monitored using the volume-clamp method by Peñáz and the Physiocal criteria by Wesseling. The choice of sample points was prompted by the results of previous studies. These sample points were compared to those of 10 YHC (8 males, 32±8 years). Results The main finding of the present investigation was an increased time between the AS onset and SBP overshoot in PD-TOH group (24±4 vs. 19±3 sec; p<0.05). Conclusion This delay might reflect a prolonged latency in the baroreflex-mediated vascular resistance response, but more studies are needed to confirm this preliminary hypothesis. .

Apesar da resposta circulatória ao estresse ortostático já foi estudada em pacientes com doença de Parkinson sem hipotensão ortostática típica (PD-TOH), não há uma resposta inicial que é exclusivamente associada com o ortostase ativa (AS). Portanto, buscou-se avaliar esta resposta e compará-la à observada em jovens saudáveis (YHC). Método Em 10 PD-TOH pacientes (8 homens, 60±7 anos, Hoehn e Yahr ≤3) as mudanças na pressão arterial sistólica (PAS) e da frequência cardíaca que ocorrem nos primeiros 30 segundos (seg) de pé foram examinados. Ambos parâmetros foram monitorizados continuamente através do método Peňáz e os critérios de Wesseling. Os pontos de amostragem foram escolhidos com base em estudos anteriores. Estes pontos foram comparados com os de 10 YHC (32±8 anos). Resultados O principal achado deste estudo foi o aumento do tempo entre o início de AS e rebote sistólica no grupo PD-TOH (24±4 vs 19±3 seg, p<0,05). Conclusão Este atraso pode refletir uma latência prolongada na resposta da resistência vascular mediado pelo barorreflexo, mas outros estudos são necessários para confirmar esta hipótese preliminar. .

[Clinical guideline for diagnosis and treatment of atrial fibrillation]. / Guía de práctica clínica. Diagnóstico y tratamiento de la fibrilación auricular.

Atrial fibrillation (AF) is associated with long-term increase in the incidence of cerebrovascular disease, heart failure and mortality. The incidence of ischemic stroke in patients with non-valvular atrial fibrillation averages 5 % per year, from two to seven more frequent than in patients without atrial fibrillation (AF). One in six ischemic stroke occurs in patients with AF. The detection and accurate diagnosis and timely therapeutic intervention have shown a decrease in morbidity and mortality associated with this arrhythmia. The above data by themselves justify the development of a management guide and care for these patients. The purpose of this guide is to provide health professionals recommendations based on the best available evidence with the intent to standardize actions: diagnosis and identification of patients with atrial fibrillation; risk stratification and treatment according to the classification of atrial fibrillation; identification of the risk of thromboembolism and its prevention; and treatment guidelines to determine which patient will require to be referred promptly.

Predictores clínicos de tormenta arrítmica en pacientes con cardiomiopatía Chagásica con un desfibrilador automático implantable / Clinical predictors of ventricular arrhythmia storms in Chagas cardiomyopathy patients with implantable defibrillators

OBJECTIVES: To define the predictive factors of electrical storm (ES) in patients with Chronic Chagas Heart Disease (CCh) with an implantable cardioverter defibrillator (ICD). MATERIAL AND METHODS: We retrospectively studied 21 consecutive patients with CCh in whom an ICD was implanted between April 2005 and December 2008, with a mean follow up of 867 days. Patients were classified into two groups according to the presence of electrical storm episodes. We compared baseline characteristics, medical treatment and determinants of ventricular function. P values less than 0.05 were considered statistically significant. RESULTS: Of the 21 patients with CCh there were eight women (37%), mean age 61 years and an EF of 30%. It was noted at least one episode of arrhythmic storm in 9 cases (incidence of 43%). The total number of episodes of arrhythmic storm was 13 and the number of ventricular arrhythmias in each episode of arrhythmic storm was 15.6 (range 3-61). A trigger was identified in only two cases (pulmonary infectious process and decompensation of chronic heart failure). After analyzing the possible predictors of arrhythmic storm was found that a greater percentage of subjects with this complication had an EF <35% (89% vs. 50%, p = 0.01) and NYHA functional class III (66% vs. 8.3%, p = 0.001). In contrast, a lower percentage of subjects with arrhythmic storm were under beta-blocker treatment (55% vs. 100%, p = 0.01). CONCLUSIONS: In subjects with CCh with an ICD, the following variables are predictive of arrhythmic storm: EF <35%, NYHA functional class III-IV and absence of beta-blocker treatment.

[Case report: idiopathic ventricular tachycardia from the aortic sinus cusp]. / Informe de un caso: taquicardia ventricular idiopática en el seno de Valsalva izquierdo.

Idiopathic ventricular tachycardia is identified in 10% of the patients presenting with ventricular tachycardia, and they consist of various subtypes that can originate from different areas, including the aortic cusps which represent 0.7% of the total. Electrocardiographically, these ventricular tachycardias display a left bundle branch block pattern and inferior axis, and although rare, should be considered in the differential diagnosis with tachycardias originating from the septal region of the right ventricular outflow tract, which comprise 80% of the idiopathic ventricular tachycardias. Despite the vicinity of the left coronary artery ostium, radiofrequency catheter ablation can be curative in more than 90% of cases with a low risk (< 1% of serious complication). Therefore, it must be considered first-line therapy in patients who have failed or are intolerant to therapy with antiarrhythmic agents. The aim of this article is to describe the first case reported in Mexico of a successful ablation idiopathic ventricular tachycardia from the aortic sinus cusp in a patient with incessant ventricular tachycardia.

Informe de un caso: taquicardia ventricular idiopática en el seno de Valsalva izquierdo / Case report: idiopathic ventricular tachycardia from the aortic sinus cusp

Idiopathic ventricular tachycardia is identified in 10% of the patients presenting with ventricular tachycardia, and they consist of various subtypes that can originate from different areas, including the aortic cusps which represent 0.7% of the total. Electrocardiographically, these ventricular tachycardias display a left bundle branch block pattern and inferior axis, and although rare, should be considered in the differential diagnosis with tachycardias originating from the septal region of the right ventricular outflow tract, which comprise 80% of the idiopathic ventricular tachycardias. Despite the vicinity of the left coronary artery ostium, radiofrequency catheter ablation can be curative in more than 90% of cases with a low risk (< 1% of serious complication). Therefore, it must be considered first-line therapy in patients who have failed or are intolerant to therapy with antiarrhythmic agents. The aim of this article is to describe the first case reported in Mexico of a successful ablation idiopathic ventricular tachycardia from the aortic sinus cusp in a patient with incessant ventricular tachycardia.

[Clinical predictors of ventricular arrhythmia storms in Chagas cardiomyopathy patients with implantable defibrillators]. / Predictores clínicos de tormenta arrítmica en pacientes con cardiomiopatía Chagásica con un desfibrilador automático implantable.

OBJECTIVES: To define the predictive factors of electrical storm (ES) in patients with Chronic Chagas Heart Disease (CCh) with an implantable cardioverter defibrillator (ICD). MATERIAL AND METHODS: We retrospectively studied 21 consecutive patients with CCh in whom an ICD was implanted between April 2005 and December 2008, with a mean follow up of 867 days. Patients were classified into two groups according to the presence of electrical storm episodes. We compared baseline characteristics, medical treatment and determinants of ventricular function. P values less than 0.05 were considered statistically significant. RESULTS: Of the 21 patients with CCh there were eight women (37%), mean age 61 years and an EF of 30%. It was noted at least one episode of arrhythmic storm in 9 cases (incidence of 43%). The total number of episodes of arrhythmic storm was 13 and the number of ventricular arrhythmias in each episode of arrhythmic storm was 15.6 (range 3-61). A trigger was identified in only two cases (pulmonary infectious process and decompensation of chronic heart failure). After analyzing the possible predictors of arrhythmic storm was found that a greater percentage of subjects with this complication had an EF <35% (89% vs. 50%, p = 0.01) and NYHA functional class III (66% vs. 8.3%, p = 0.001). In contrast, a lower percentage of subjects with arrhythmic storm were under beta-blocker treatment (55% vs. 100%, p = 0.01). CONCLUSIONS: In subjects with CCh with an ICD, the following variables are predictive of arrhythmic storm: EF <35%, NYHA functional class III-IV and absence of beta-blocker treatment.

[Electroanatomic mapping system (CARTO) to perform catheter ablation of atrial fibrillation]. / La cartografía electroanatómica (CARTO) en la ablación de la fibrilación auricular.

Since the first report of radiofrequency catheter ablation curing atrial fibrillation (AF) nearly a decade ago, numerous techniques have evolved, from linear ablation to modify the reentrant sustrate for AF, to electrical isolation of pulmonary vein to eliminate triggers of AF, to hibrid approaches of circunferential ablation around and between the pulmonary veins and mitral valve annulus to modify both the triggers and sustrate for AF. We describe the electroanatomic mapping system (CARTO, Biosense Webster) and its use in patients undergoing catheter ablation for AF.

La cartografía electroanatómica (CARTO) en la ablación de la fibrilación auricular / Electroanatomic mapping system (CARTO) to perform catheter ablation of atrial fibrillation

Since the first report of radiofrequency catheter ablation curing atrial fibrillation (AF) nearly a decade ago, numerous techniques have evolved, from linear ablation to modify the reentrant sustrate for AF, to electrical isolation of pulmonary vein to eliminate triggers of AF, to hibrid approaches of circunferential ablation around and between the pulmonary veins and mitral valve annulus to modify both the triggers and sustrate for AF. We describe the electroanatomic mapping system (CARTO, Biosense Webster) and its use in patients undergoing catheter ablation for AF.

[Electrocardiogram in channel disorders]. / El electrocardiograma en las canalopatías.

The ion channel diseases of the heart are a collection of genetically distinct arrhythmogenic cardiovascular disorders resulting from mutations in fundamental cardiac ion channels that orchestrate the action potential of the human heart. Our understanding of these genetic "channelopathies" has increased dramatically from electrocardiographic depictions of QT prolongations, ST-T alterations and torsades de pointes and clinical descriptions of people experiencing syncope and sudden death to molecular revelations of perfurbed ion channel genes. These exciting molecular breakthroughs have provided new opportunities for translational research with investigations into genotype-phenotype correlations and gene targeted therapies.

Doble taquiarritmia: taquicardia ventricular fascicular anterior izquierda asociada a fibrilación y flutter auriculares. Reporte de un caso / Double tachyarrhythmia: left anterior fasciculare ventricular tachycardial associated to atrial flutter/fibrillation

Se trata de un paciente de 49 años conocido con diagnóstico de miocardiopatía hipertrófica (Hipertrofia septal anterior y lateral asimétrica), e historia de precordialgia asociada a palpitaciones, en quien el electrocardiograma de superficie evidenció la presencia de taquicardia de QRS ancho, con configuración de bloqueo de rama derecha del haz de His (BRDHH) a AQRS F hacia abajo y a la derecha. Fue llevado a estudio electrofisiológico y ablación con radiofrecuencia. El mapeo endocárdico del ventrículo izquierdo durante la taquicardia ventricular identificó la actividad ventricular izquierdo. El potencial de Purkinje se registró en este mismo sitio, precediendo al complejo QRS en 47 mseg. Al estimular este sitio, durante la taquicardia, se observó que el intervalo de la espiga al complejo QRS era similar al del Purkinje-QRS (zona de conducción lenta): sitio donde se realizó ablación con radiofrecuencia, suprimiendo la taquicardia. No se logró inducirla nuevamente con estimulación eléctrica programada. Durante la taquicardia ventricular, se desencadenó un episodio de fibrilación y flutter auricular alternando con la taquicardia ventricular. Después de realizar la ablación de la taquicardia fascicular, se llevó a cabo cardioversión eléctrica para convertir la fibrilación auricular en ritmo sinusal

Infectious endocarditis in pacemaker endocardial leads: Report of three cases / Endocarditis infecciosa en marcapaso endocárdico. Reporte de 3 casos

Se presentan tres casos de endocarditis en cables de marcapasos definitivos y se hace una revisión de la literatura. La ecocardiografía transesofágica permitió diagnosticar las vegetaciones. La infección de los cables del marcapaso es menos común que la infección en el sitio del generador de pulso y tiene mayor morbilidad y mortalidad. Generalmente requiere extirpación quirúrgica de ambos electrodos y de la fuente de poder. Los gérmenes más frecuentemente encontrados son las variedades de Staphylococcus

Trombolisis tardía y estabilidad eléctrica en el infarto agudo del miocardio: importancia del flujo colateral / Late thrombolysis and electrical stability in acute myocardial infarction. Role of the collateral flow

En 249 pacientes con primer infarto del micardio. Grupo 1. Sin trombolítico, n=119; 2. Trombolisis antes de 6 horas, n=80 y grupo 3. Trombolisis entre las 6 y 12 horas, n=50. Se evaluó la presencia de arritmias malignas en el primer año de sobrevida, la variabilidad de la frecuencia cardiaca, el flujo coronario anterógrado (TIMI) y el flujo coronario colateral (1. Pobre: Rentrop, grados 0-2 y 2. Adecuada: Rentrop grado 3). Los grupos 2 y 3 tuvieron mejor flujo TIMI y colateral que el grupo 1 (p<0.001). La banda espectral de alta frecuencia y la relación entre las bandas de baja y alta frecuencia estuvieron más alteradas en el grupo 1 (p<0.05). El análisis de consolidación conjuntiva mostró que los pacientes con TIMI 0-2 y pobre flujo colateral tuvieron mayores epidosios de arritmias malignas que los pacientes con TIMI 0-2 con adecuado flujo colateral (17/138-12.3 por ciento-vs 0/14-0 por ciento-). Los pacientes con TIMI 0-2 y pobre flujo colateral presentaron mayor mortalidad por eventos arrítmicos que los tenían TIMI 3 o TIMI 0-2 con adecuado flujo colateral (x²=7.22, p=0.028), independientemente del tratamiento trombolítico

Parálisis atrial persistente: reporte de 2 casos / Persistent atrial standstill: report of two cases

La parálisis atrial persistente es una rara condición clínica, caracterizada por ausencia de actividad eléctrica y mecánica del atrio, así como la incapacidad de responder a estímulos eléctricos. A partir de la introducción del mapeo intraatrial se logró demostrar la existencia de formas totales y parciales. Se presenta en tres grupos de pacientes: aquéllos con una enfermedad cardiaca de larga evolución, los portadores de algún tipo de distrofia muscular y los con formas aisladas. En la presente revisión se reportan dos casos. Uno, en el que se demostró parálisis atrial total asociado con cardiopatía dilatada. El segundo, con cardiopatía reumática inactiva, en el que se demostró parálisis atrial parcial, que incluyó sólo el tercio apical del atrio derecho. Se presenta el comportamiento clínico y electrofisiológico de ambos pacientes y se hace una revisión de los trabajos recientemente publicados en relación al tema

Ablación con radiofrecuencia en el tratamiento de la taquicardia ventricular / Radiofrequency ablation for the treatment of ventricular tachycardia

Realizamos ablación con catéter de radiofrecuencia (RF) en 14 pacientes consecutivos con taquicardia ventricular (TV), de los cuales 10 tenían corazón sano, uno con cardiopatía isquémica, uno con displasia arritmogénica del ventrículo derecho, uno con miocardiopatía dilatada y uno con cardiopatía congénita compleja. El sitio de origen fue: 10 en el fascículo posterior izquierdo, 3 en el tracto de salida del ventrículo derecho (TSVD), y un paciente con cardiopatía isquémica con sustrato localizado en la punta del ventrículo izquierdo (VI). Todos ellos con TV refractaria a manejo farmacológico, usando un promedio de 2.7 drogas por paciente. Previo estudio electrofisiológico (EEF), se realizó mapeo endocavitario para la localización del sustrato arritmogénico. Posteriormente se pasó a realizar la ablación con RF: se dio un promedio de 15 pulsos, con una energía de 40 W, y el tiempo promedio por sesión fue de 25 segundos. El procedimiento fue exitoso en el 60 por ciento de la TV fasciculares, con una recurrencia del 16 por ciento; de las originadas en el TSVD se obtuvo el 100 por ciento, sin recurrencias. En el paciente isquémico se tuvo éxito primario, sin embargo presentó recurrencia, llevandolo a un segundo intento igualmente exitoso y sin recurrencia al momento. No se tuvo complicaciones mayores en este grupo. Los pacientes no exitosos requirieron nuevamente el uso antiarritmias. El éxito total de la serie es de 71.4 por ciento con 10 por ciento de recurrencias, sin mortalidad