Utilização do monitor de eventos externo (web-loop) na identificação de sintomas associados a arritmias cardíacas em uma população geral

ObjectiveTo correlate arrhythmic symptoms with the presence of significant arrhythmias through the external event monitoring (web-loop). MethodBetween January and December 2011, the web-loop was connected to 112 patients (46% of them were women, mean age 52±21 years old). Specific arrhythmic symptoms were defined as palpitations, pre-syncope and syncope observed during the monitoring. Supraventricular tachycardia, atrial flutter or fibrillation, ventricular tachycardia, pauses greater than 2 seconds or advanced atrioventricular block were classified as significant arrhythmia. The association between symptoms and significant arrhythmias were analyzed. ResultThe web-loop recorded arrhythmic symptoms in 74 (66%) patients. Of these, in only 14 (19%) patients the association between symptoms and significant cardiac arrhythmia was detected. Moreover, significant arrhythmia was found in 11 (9.8%) asymptomatic patients. There was no association between presence of major symptoms and significant cardiac arrhythmia (OR=0.57, CI95%: 0.21-1.57; p=0.23). ConclusionWe found no association between major symptoms and significant cardiac arrhythmia in patients submitted to event recorder monitoring. Event loop recorder was useful to elucidate cases of palpitations and syncope in symptomatic patients.ObjetivoCorrelacionar sintomas arrítmicos com a presença de arritmias significativas por meio do monitor de eventos externo (web-loop). MétodoEntre janeiro e dezembro de 2011, o web-loop foi instalado em 112 pacientes (46% mulheres, 52±21 anos). Sintomas específicos foram definidos como palpitação, pré-síncope e síncope, presentes durante a monitorização. Arritmia significativa foi definida como taquicardia paroxística supraventricular, flutter e fibrilação atrial, taquicardia ventricular, pausas superiores a 2 segundos ou bloqueio atrioventricular avançado. A associação entre presença de sintomas e arritmias significativas foi avaliada. ResultadoO monitor de eventos registrou sintomas específicos em 74 (66%) pacientes, entretanto a associação entre sintomas específicos e arritmia significativa foi observada em apenas 14 (19%) deles. Em 11 pacientes (9,8%), foi detectada arritmia significativa na ausência de sintomas. Não houve associação entre a presença de sintomas e a detecção de arritmia significativa (OR=0,57, IC95%: 0,21-1,57; p=0,23). ConclusãoEm pacientes monitorizados pelo web-loop, não houve associação entre a presença de sintomas específicos e a detecção de arritmias significativas. O monitor de eventos pode ter importância na elucidação de sintomas de palpitações e síncope dos pacientes.Hospital Israelita Albert EinsteinUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Compound Heterozygous SCN5A Mutations in a Toddler - Are they Associated with a More Severe Phenotype?

Abstract Compound heterozygosity has been described in inherited arrhythmias, and usually associated with a more severe phenotype. Reports of this occurrence in Brugada syndrome patients are still rare. We report a study of genotype-phenotype correlation after the identification of new variants by genetic testing. We describe the case of an affected child with a combination of two different likely pathogenic SCN5A variants, presenting sinus node dysfunction, flutter and atrial fibrillation, prolonged HV interval, spontaneous type 1 Brugada pattern in the prepubescent age and familiar history of sudden death

Myocardial remodeling after experimental acute myocardial infarction in rats: effect of renin-angiotensin-aldosterone system blockade

OBJETIVO: Verificar a ação do lisinopril e do losartan sobre a remodelação miocárdica no infarto experimental em ratos. MÉTODOS: Ratos machos Wistar foram submetidos a infarto e tratados com lisinopril 20 mg/kg/dia (LIS, n=13) ou losartan 20 mg/kg/dia (LOS, n=11), ou mantidos sem tratamento (NT, n=11), por três meses e os resultados comparados com grupo controle (CONT, n=11) de ratos sem infarto. Após a eutanásia, o ventrículo esquerdo foi separado e pesado. Foram medidas a área seccional dos miócitos (AC), fração de colágeno intersticial (CVF) e a hidroxiprolina (HOP) miocárdica. As variáveis foram comparadas pela ANOVA de uma via, para nível de significância de p<0,05. RESULTADOS: O infarto agudo promoveu a hipertrofia do ventrículo esquerdo e os tratamentos com lisinopril e losartam preveniram a hipertrofia quantificada pelo peso do ventrículo esquerdo (LOS=1,06&plusmn; 0,12g, LIS=0,97&plusmn;0,18g, NT=1,26&plusmn;0,17g, CONT=1,02&plusmn; 0,09g; p<0,05), pelo peso de ventrículo esquerdo corrigido pelo peso corporal VE/PC (LOS=2,37&plusmn;0,21mg/g, LIS=2,41&plusmn; 0,38mg/g,NT=2,82&plusmn;0,37mg/g, CONT=2,27&plusmn; 0,15mg/g) e pela medida da AC do ventrículo esquerdo (LOS=210&plusmn;39&micro;², LIS=217&plusmn;35&micro;², NT=256&plusmn;35&micro;², CONT= 158&plusmn;06 &micro;²; p<0,05). O CVF foi significantemente maior no ventrículo esquerdo do grupo infartado e houve prevenção do aumento com os tratamentos (LOS=1,16&plusmn;0,4%, LIS=1,27&plusmn; 0,5%, NT=1,8&plusmn; 0,4%, CONT=0,7&plusmn;0,5%). A HOP foi maior no grupo infartado (NT=6,91&plusmn;2,98mg/g vs. CONT=2,81&plusmn;1,21mg/g) e não alterou com o tratamento. CONCLUSÃO: A remodelação miocárdica pós-infarto é caracterizada por aumento da massa ventricular remanescente e aumento de colágeno intersticial. O bloqueador da enzima conversora da angiotensina e o antagonista seletivo AT1 da angiotensina II previnem a hipertrofia do miócito e a fibrose intersticial.OBJECTIVE: To assess the effect of lisinopril and losartan on myocardial remodeling in experimental infarction in rats. METHODS: Male Wistar rats underwent myocardial infarction and were either treated with lisinopril [20 mg/kg/day (LIS, n=13)] or losartan [20 mg/kg/day (LOS, n=11)], or kept without any treatment (NT, n=11) for 3 months. Their results were compared with those of a control group (CONT, n=11) comprising noninfarcted rats. After euthanasia, the left ventricle was isolated and weighed. The following measurements were taken: the sectional area of myocytes (AC), interstitial collagen fraction (CVF), and myocardial hydroxyproline (HOP). The variables were compared by using 1-way ANOVA, with a significance level of P<0.05. RESULTS: Acute myocardial infarction caused left ventricular hypertrophy. The treatments with lisinopril or losartan could prevent hypertrophy, which was quantified by use of left ventricular weight (LOS=1.06&plusmn;0.12g, LIS=0.97&plusmn;0.18g, NT=1.26&plusmn;0.17g, CONT=1.02&plusmn;0.09g; P<0.05), of left ventricular weight-to-body weight ratio LV/BW (LOS=2.37&plusmn; 0.21mg/g, LIS=2.41&plusmn;0.38mg/g, NT=2.82&plusmn;0.37mg/g, CONT=2.27&plusmn; 0.15mg/g), and of left ventricular AC measure-ment (LOS=210&plusmn;39&micro;², LIS=217&plusmn;35&micro;², NT=256&plusmn;35&micro;², CONT=158&plusmn;06 &micro;²; P<0.05). The CVF was significantly greater in the left ventricle of the infarcted group, and its increase was prevented with treatment (LOS=1.16&plusmn;0.4%, LIS=1.27&plusmn;0.5%, NT=1.8&plusmn; 0.4%, CONT=0.7&plusmn;0.5%). Myocardial hydroxyproline was greater in the infarcted group (NT=6.91&plusmn;2.98mg/g vs. CONT=2.81&plusmn; 1.21mg/g) and did not change with treatment. CONCLUSION: Myocardial remodeling after infarction is characterized by an increase in the remaining ventricular mass and in interstitial collagen. The angiotensin-converting-enzyme blockers and the selective angiotensin II AT1 antagonist prevent hypertrophy of the myocyte and interstitial fibrosis

The use of external event monitoring (web-loop) in the elucidation of symptoms associated with arrhythmias in a general population

<div><p> Objective To correlate arrhythmic symptoms with the presence of significant arrhythmias through the external event monitoring (web-loop). Methods Between January and December 2011, the web-loop was connected to 112 patients (46% of them were women, mean age 52±21 years old). Specific arrhythmic symptoms were defined as palpitations, pre-syncope and syncope observed during the monitoring. Supraventricular tachycardia, atrial flutter or fibrillation, ventricular tachycardia, pauses greater than 2 seconds or advanced atrioventricular block were classified as significant arrhythmia. The association between symptoms and significant arrhythmias were analyzed. Results The web-loop recorded arrhythmic symptoms in 74 (66%) patients. Of these, in only 14 (19%) patients the association between symptoms and significant cardiac arrhythmia was detected. Moreover, significant arrhythmia was found in 11 (9.8%) asymptomatic patients. There was no association between presence of major symptoms and significant cardiac arrhythmia (OR=0.57, CI95%: 0.21-1.57; p=0.23). Conclusion We found no association between major symptoms and significant cardiac arrhythmia in patients submitted to event recorder monitoring. Event loop recorder was useful to elucidate cases of palpitations and syncope in symptomatic patients.</p></div