39 research outputs found
Avances en el diagnóstico y tratamiento de las arritmias cardíacas
The era of catheter ablation for the treatment of arrhythmias began in 1981 when Dr Scheinman performed the first atrioventricular junction ablation using direct current shocks in a patient with drug refractory atrial fibrillation and an uncontrolled ventricular rate. With the progress of radiofrequency catheter ablation, the range of arrhythmias amenable to catheter ablation and the number of patients that could be treated safely by this procedure expanded enormously. Lastly, although still in an evolutionary phase, catheter ablation to eliminate atrial fibrillation has been demostrated in the past years to be feasible and clinically useful. On the other hand, innovations in technology and pharmacology, and better preventive and diagnostic tools, have provided our patients with an important improvement in their prognosis. The new developments in molecular genetics and biology are likely to change the way we approach a cardiac patient in the future. The diseases are now being deciphered at the most basic level, and the information obtained opens new possibilities not only for better therapeutic and diagnostic measures but also for prevention of the disease
Efecto de la localización del electrodo ventricular izquierdo sobre los parámetros ecocardiográficos de asincronía en pacientes sometidos a terapia de resincronización cardíaca
Introduction and objectives. Cardiac resynchronization
therapy has been shown to be an option in the treatment
of patients with congestive heart failure. The current
indication for this treatment is based on clinical and electrocardiographic
criteria, although echocardiography has
also been shown to be a useful tool for the diagnosis of
ventricular dyssynchrony. The aim of this study was to assess
left ventricular dyssynchrony by echocardiography
and to evaluate the effect of the stimulation site on the
magnitude of resynchronization.
Patients and method. We studied 25 patients with biventricular
stimulation (left ventricular lead located in a lateral
position in 13 patients, and in an anterior position in
12). A complete echo-Doppler evaluation, including left
ventricular ejection fraction, ventricular diameters and parameters
of inter- and intraventricular dyssynchrony, was
performed before implantation and 3 months after the
procedure, with the device connected and disconnected.
Results. Left ventricular ejection fraction increased significantly
from 23.7 (6.5) to 27.8 (5.5) (P=.007) at 3
months. In the group as a whole, biventricular pacing was
associated with a significant decrease in all intraventricular
dyssynchrony parameters (septal-to-lateral wall motion
delay and septal-to-posterior wall motion delay). This decrease
in septal-to-posterior wall motion delay and septalto-
lateral wall motion delay was significantly greater in patients
with the electrode implanted in the lateral position
(58.1 ms vs 118 ms; P=.02) than with the lead in the anterior
position (39.5 ms vs 86.5 ms; P=.04). Three patients,
all with the electrode in an anterior location, were considered
non-responders.
Conclusions. Left lateral free wall stimulation provided
significantly better intraventricular resynchronization compared
to stimulation at an anterior site. Echocardiography
is a useful tool to evaluate changes in intra- and interventricular
synchrony related to the pacing site
High-density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract
The Rhythmia ultrahigh-density mapping system with a specific algorithm
seems to be helpful in identifying the target area to successfully treat multiple
morphologies by catheter ablation in the right ventricular outflow tract RVOT.
Interestingly, the acquisition process seemed to be extremely faster than a standard manual point-by-point premature ventricular contraction (PVC) mapping
Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos
Recent data suggest that biventricular pacing may play
an important role in treating advanced heart failure in the presence of a
significant interventricular and/or intraventricular conduction disorder by
correcting cardiac dysynchrony. In this article, we review the initial technical
and clinical experience with cardiac resynchronization therapy in an
electrophysiology laboratory. METHODS: The first 22 consecutive patients with
severe congestive heart failure, ejection fraction < 0.35, NYHA functional class
III or IV, and QRS duration > 120 ms who were implanted biventricular pacemakers
were studied. Clinical, electrocardiographic, and echocardiographic evaluations
were made before and three months after pacemaker implantation. Acute functional
capacity testing with peak oxygen uptake was measured during biventricular pacing
and during intrinsic rhythm or right ventricular pacing three months after the
implantation procedure. RESULTS: The success rate of pacemaker implantation was
95%. Pre-discharge left ventricular pacing was achieved in 91%, with an average
pacing threshold of 1.53 (1.04) volts. NYHA functional class improved (p = 0.039)
from 3.4 (0.7) to 2.3 (0.78). The rate of hospitalization for heart failure
decreased from an average of 3.12 (0.58) three months before the procedure to
1.38 (0.34) three months after the procedure. Peak oxygen uptake was
significantly greater (p = 0.028) during biventricular pacing: 14.89 (2.1)
ml/min/kg, than during intrinsic rhythm or right ventricular pacing: 12.65 (2.3)
ml/min/kg. CONCLUSIONS: Cardiac resynchronization therapy can be performed safely
and with a high success rate in the electrophysiology laboratory. Biventricular
pacing seems to improve the symptoms of congestive heart failure in patients with
evidence of atrioventricular and/or interventricular/intraventricular
dysynchrony. An acute benefit in peak oxygen uptake was associated with
biventricular pacing after the implantation procedure
Rol de sCD40L en la predicción de súper-respuesta a la terapia de resincronización cardiaca
Background. The aim of this paper is to analyze the role
of the biomarkers Interleukin 6, Tumoral Necrosis Factor α,
sCD40L, high sensitive Troponin T, high sensitive C-Reactive
Protein and Galectin-3 in predicting super response (SR) to
Cardiac Resynchronization Therapy (CRT), as they have not
been studied in this field before.
Methods. Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year.
SR was defined as reduction in LVESV ≥ 30% at one year
follow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed.
Results. 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p=0.04),
suffering from less ischemic cardiomyopathy (13 vs. 63%,
p<0.0001) and lateral (0 vs. 18%, p=0.03), inferior (4 vs.
33%, p=0.01) and posterior infarction (0 vs. 22%, p=0.01);
absence of mitral regurgitation (47% vs. 22%, p=0.04), wider QRS width (157.7±22.9 vs. 140.8±19.2ms, p=0.01), higher concentrations of sCD40L (6.9±5.1 vs. 4.4±3.3 ng/mL,
p=0.02), and left ventricular lead more frequent in lateral
medial position (69 vs. 26%, p=0.002). QRS width, lateral
medial position of the lead and absence of mitral regurgitation were independent predictors of SR. sCD40L showed
a moderate direct correlation with SR (r=0.39, p=0.02) and
with the reduction of LVESV (r=0.44, p=0.02).
Conclusion. sCD40L correlates significantly with SR to CRT.
QRS width, absence of mitral regurgitation and lateral medial position of the lead are independent predictors of SR
in this cohort.Fundamento. Analizar los biomarcadores Interleuquina 6,
factor de necrosis tumoral α, sCD40L, troponina T hipersensible, proteína C-reactiva hipersensible y galectina-3 en la
predicción de súper-respuesta (SR) a la terapia de resincronización cardiaca (TRC), ya que no han sido valorados con
anterioridad.
Material y métodos. Se recopilaron datos clínicos, electrocardiográficos y ecocardiográficos preimplante y al año.
Se definió SR como disminución del VTSVI ≥ 30% al año
de seguimiento. Las muestras sanguíneas fueron extraídas
preimplante. Se realizó regresión logística multivariante y
curvas ROC.
Resultados. Se incluyeron 50 pacientes, 23 (46%) fueron
SR.Las características relacionadas con la SR fueron: ser mujer (35 vs. 11%, p=0,04), sufrir menos cardiopatía isquémica
(13 vs. 63%, p<0,0001) e infarto lateral (0 vs. 18%, p=0,03),
inferior (4 vs. 33%, p=0,01) y posterior (0 vs. 22%, p=0,01); ausencia de insuficiencia mitral (47% vs. 22%, p=0,04), mayor anchura del QRS (157,7±22,9 vs. 140,8±19,2 ms, p=0,01), mayor
concentración de sCD40L (6,9±5,1 vs. 4,4±3,3 ng/mL, p=0,02),
y electrodo ventricular izquierdo más frecuentemente en posición lateral media (69 vs. 26%, p=0,002). El QRS, la posición
lateral media del electrodo y la ausencia de insuficiencia mitral fueron predictores independientes de SR. sCD40L mostró
una correlación moderada directa con SR (r=0,39, p=0,02) y
con la disminución del VTSVI (r=0,44, p=0,02).
Conclusiones. sCD40L se correlaciona significativamente
con SR a la TRC. El QRS, la ausencia de insuficiencia mitral
y la posición lateral media del electrodo son predictores independientes de SR en esta cohorte
Avances en el diagnóstico y tratamiento de las arritmias cardíacas
The era of catheter ablation for the treatment of arrhythmias began in 1981 when Dr Scheinman performed the first atrioventricular junction ablation using direct current shocks in a patient with drug refractory atrial fibrillation and an uncontrolled ventricular rate. With the progress of radiofrequency catheter ablation, the range of arrhythmias amenable to catheter ablation and the number of patients that could be treated safely by this procedure expanded enormously. Lastly, although still in an evolutionary phase, catheter ablation to eliminate atrial fibrillation has been demostrated in the past years to be feasible and clinically useful. On the other hand, innovations in technology and pharmacology, and better preventive and diagnostic tools, have provided our patients with an important improvement in their prognosis. The new developments in molecular genetics and biology are likely to change the way we approach a cardiac patient in the future. The diseases are now being deciphered at the most basic level, and the information obtained opens new possibilities not only for better therapeutic and diagnostic measures but also for prevention of the disease