RESUMO
Non-surgical transpericardial approach for catheter-based epicardial radiofrequency ablation of post-infarction left ventricular tachycardia has been described as an alternative and additive procedure to standard endocardial technique for delivery of radiofrequency energy in difficult situations. We report our initial experience with this approach in three patients of post-infarction recurrent ventricular tachycardia, refactory to multiple antiarrhythmic drugs. Ablation was successful in terminating the tachycardia in two and in modifying the circuit to be amenable for control with single antiarrhythmic drug in one patient. There were no serious acute or long-term complications related to the procedure. Epicardial approach is an effective and safe adjunct to standard endocardial ablative technique for patients of post-infarction ventricular tachycardia.
Assuntos
Ablação por Cateter , Infarto do Miocárdio/complicações , Taquicardia Ventricular/cirurgia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologiaRESUMO
Demonstration of coronary collaterals has been mostly done by coronary angiographic techniques. Coronary collaterals have been demonstrated by transthoracic echocardiography for patients with anomalous origin of coronary arteries from pulmonary artery. Indirect assessment of collaterals to an infarct-related artery has been done using myocardial contrast echocardiography. We describe in this article 3 patients with coronary artery disease in whom coronary collaterals were demonstrated by transthoracic echocardiography before angiography. To our knowledge, coronary collateral demonstration by transthoracic echocardiography before angiography in patients with coronary artery disease has not been previously reported.
Assuntos
Angina Pectoris/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/etiologia , Circulação Colateral , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The congenital form of His bundle tachycardia is an uncommon pediatric arrhythmia. We report the case of a 7-year-old child with tachycardiomyopathy. The incessant arrhythmia, detected in infancy, was resistant to amiodarone and beta-blockers. During electrophysiologic study, the tachycardia converted to sinus rhythm with intravenous adenosine and diltiazem. Subsequently, the child is maintaining sinus rhythm on oral verapamil. Calcium-channel blockers should be considered for the treatment of this arrhythmia, which is often resistant to multiple antiarrhythmic drugs.
Assuntos
Adenosina/uso terapêutico , Antiarrítmicos/uso terapêutico , Fascículo Atrioventricular/anormalidades , Fascículo Atrioventricular/efeitos dos fármacos , Taquicardia Ventricular/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Criança , Diltiazem/uso terapêutico , Resistência a Medicamentos/efeitos dos fármacos , Eletrocardiografia , Feminino , Humanos , Metoprolol/uso terapêutico , Taquicardia Ventricular/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológicoRESUMO
A one-year-old child with a structurally normal heart presented with monomorphic ventricular tachycardia. Electrocardiogram in sinus rhythm showed right bundle branch block with ST segment elevation suggesting a diagnosis of Brugada syndrome. At a later date, when the ST segment was isoelectric. intravenous procainamide caused ST elevation typical of Brugada syndrome.
