Resultados clínicos de la resincronización ventricular en pacientes con insuficiencia cardíaca severa / Results of intraventricular resynchronization in patients with severe cardiac failure

BACKGROUND: Intraventricular resynchronization with pacemakers is a promising therapy for patients with refractory cardiac failure and intraventricular conductions delay. However its long term effects are not well known. AIM: To report the results of this therapy in patients with cardiac failure. PATIENTS AND METHODS: Fourteen patients (11 male), whose mean age was 68 years, with a severe and refractory cardiac failure, have been treated in our unit using intraventricular resynchronization with pacemakers. Eight had a coronary heart disease and six a dilated myocardiopathy. The pacemaker was implanted transvenously, with conventional stimulation in atrium and right ventricle. The left ventricle was stimulated through an epicardial vein, accessed through the coronary sinus. RESULTS: In one patient the high thresholds did not allow a left ventricular stimulation. In the other 13 patients, a clinical improvement was observed in 11 (85 per cent), that has been sustained for a mean of 8.2 months. The ejection fraction improved form 23.5 to 32.4 per cent (p < 0.001), the 6 min walking test improved from 347 to 437 m (p = 0.003) and the functional capacity changes from 3.3 to 2.7 (p < 0.001). Three patients died during follow up. One was the patient in whom the stimulation failed and two had a sudden death. No complications of the procedure were observed. CONCLUSIONS: In this series, intraventricular resynchronization with pacemakers was effective in 11 of 13 patients, improving functional capacity and ejection fraction. Sudden death could be avoided adding a defibrillator to the pacemaker system.

[Frontal osteosarcoma: a case report]. / Ostéosarcome frontal: à propos d'un cas.

Osteosarcoma is a malignant neoplasm of bone usually affecting long bones. Skull involvement is rare. Primary cranial involvement accounts for less than 3% of all skull neoplasms. We report the imaging findings of a case of osteosarcoma of the frontal bone.

Initial experience with single lead VDD system. Case study.

A single pass lead with dual chamber electrode system, designed for atrial and ventricular sensing and ventricular pacing (VDD), was implanted in a 63-year-old man with a history of syncope and second degree atrioventricular (AV) block. Intact VDD pacing function was confirmed at rest and during treadmill exercise. There were no postoperative complications. A single pass lead system that allows VDD mode pacing in patients with symptomatic AV block and competent sinus node function offers several advantages over traditional two lead dual chamber systems. These advantages include enhanced atrial sensing due to a differentially processed signal reliable for P wave detection and effective for rejection of far field ventricular signals, lowered cost and reduced implant time.

[Detection of viable myocardium by means of stress test with thallium 201: usefulness of delayed imaging]. / Detección de miocardio viable mediante prueba de esfuerzo con Talio 201: utilidad de la imagen tardía.

Delayed imaging may help detect viable myocardium after stress Thallium scintigraphy. In 22 patients who had sustained myocardial infarction we performed a stress Thallium test followed by imaging after 24 hr. Delayed reperfusion was observed in 57% of segments showing no reperfusion at 4 hr, which is similar to findings reported in the literature. We proposed that delayed imaging should be performed in all patients showing perfusion defects at 4 hr. Even though a better image may be obtained using reinjection of Thallium, delayed imaging may be the technique of choice to reduce the cost of the test.

[Intraventricular conduction disorders in acute myocardial infarction: early and late clinical significance]. / Trastornos de conducción intraventricular en infarto agudo del miocardio: significado clínico precoz y tardío.

The prognostic impact of new bundle branch block (BBB) upon the intra hospital course and long-term prognosis of patients with acute myocardial infarction (MI) was studied in 517 consecutive patients with a recent MI: 449 patients did not have BBB (group I) and 69 developed a new BBB (group II). Age and sex were similar in both groups. Incidence of BBB among patients with anterior wall MI was 61% compared to 8% in patients with inferior wall MI (p less than 0.05). The distribution of RBBB, RBBB + left anterior hemiblock and LBBB was 32%, 30% and 38% among 46 patients with anterior wall MI, compared to 28%, 6% and 68% among 18 patients with inferior wall MI (p less than 0.05). The level of peak CK values (2345 vs 1437 IU/l), presence of Killip grade III or IV (56 vs 18%), complete A-V block (24 vs 6%) and mortality (34 vs 9%) were significantly higher in group II (p less than 0.05). Long-term mortality at 1 and 5 years of follow up was 29% and 51% in group II patients, a three fold increase over group I. We conclude that development of new BBB during myocardial infarction is associated with a poor immediate and long term prognosis. This may be related to larger infarcts rather than the conduction defect itself.

[Electrode catheter ablation of the atrioventricular node. Clinical report]. / Electrofulguracion del nodulo auriculoventricular. Caso clinico.

Electrode catheter ablation may be used to treat supraventricular tachyarrhythmias refractory to medical treatment. Initially it was used to treat atrial fibrillation with rapid A-V conduction and later for ablation of para-septal abnormal bundles or ventricular tachycardia foci. A patient with advanced chronic air flow limitation developed atrial fibrillation with rapid ventricular response and heart failure. Drugs and cardioversion failed in controlling the arrhythmia. Partial electrode catheter ablation of the A-V node was followed by a decrease of ventricular rate from 170 to 90 per min associated to an improvement of heart failure.