Guillermo Mora

A Novel Method of Placing Right Ventricular Leads in Patients With Persistent Left Superior Vena Cava Using a Conventional J Stylet

Background Locating pacemaker electrodes can become complicated by congenital abnormalities such as persistent left superior vena cava (LSVC). Objective To evaluate a technique for the implanting of ventricular electrode in patients with persistent LSVC. Materials and Methods The study was carried out from June 2001 to June 2010 involving all patients who were admitted to the Hospital Universitario Mayor, Instituto de Corazon de Bogota and Hospital Universitario Clinica San Rafael (Bogota-Colombia) for implanting pacemakers or cardiac defibrillators. LSVC was diagnosed by fluoroscopic observation (anterior-posterior view) of the course of the stylet. Four steps were followed: 1) Move the electrode with a straight stylet to the right atrium. 2) Change the straight stylet by a conventional J stylet and push the electrode to the lateral or anterolateral wall of the right atrium. 3) Remove the guide 3-5 cm and 4) Push the electrode which crosses the tricuspid valve into the right ventricle and finally deploy the active fixation mechanism. Results A total of 1198 patients were admitted for pacemaker or cardiac defibrillator implant during the 9-year study period, 1114 received a left subclavian venous approach. There were 573 males and 541 females. Persistent LSVC was found in five patients (0.45%) Fluoroscopy time for implanting the ventricular electrode ranged from 60 to 250 seconds, 40 to 92 minutes being taken to complete the whole procedure. Conclusion We present a simple and rapid technique for electrode placement in patients with LSVC using usual J guide and active fixation electrodes with high success.

Tachycardiomyopathy a Rare Manifestation of Left Ventricular Outflow Tract Tachycardia. Treatment with Radiofrequency Catheter Ablation

It is recognized that a type of idiopathic ventricular tachycardia (VT) arises from the left ventricular outflow tract (LVOT). This VT exhibits sustained or nonsustained forms, but also appears as frequent premature ventricular contractions (PVCs) of monomorphic QRS morphology. The prognosis is almost uniformly benign. We describe a patient with tachycardiomyopathy resulting from LVOT VT.

Síncope y escalas de riesgo: ¿qué evidencia se tiene?

Objetivo hacer una revision de las escalas de riesgo existentes para predecir eventos adversos relacionados con sincope. Metodologia se realizo una busqueda de articulos en MEDLINE, EMBASE y Cochrane Database of Systematic Reviews con el uso de las palabras clave relacionadas con reglas de prediccion clinica (algoritmos, analisis multivariado, guias de prediccion clinica, escalas, modelos logisticos, valoracion de riesgo) y sincope. Adicionalmente, se busco literatura con el uso de la estrategia de bola de nieve. Resultados se encontraron nueve escalas que relacionaron el sincope con prediccion de eventos adversos. Se hallaron diferencias en los criterios para definir riesgo, las variables de desenlace, la poblacion estudiada, el uso de una estrategia prospectiva o retrospectiva y el tiempo de seguimiento. Conclusiones aunque existen varias escalas para la definicion de riesgo con el paciente que ingresa por sincope a urgencias, no hay evidencia de que alguna sea superior a otra, tienen poca validez externa y no se han aplicado en nuestro medio.

Características clínicas de pacientes llevados a monitoría externa de eventos

There are a variety of methods that can be used for the evaluation of patients with symptoms suggestive of cardiac arrhythmia; in this regard, external monitoring of events can improve the sensitivity of diagnosis. A descriptive, retrospective and cross-sectional study, which included review of the results of external monitoring of events of 203 patients was performed. The most common reason for requesting external monitoring of events was palpitations in 161 patients (79.3%), followed by syncope in 21 patients (10.3%). The most common diagnosis was normal sinus rhythm with no other abnormalities in 59 patients (29%), followed by sinus tachycardia in 54 (26.6%), ventricular extrasystoles in 24 (11.8%), atrial extrasystoles in 17 (8.3%), non-sustained atrial tachycardia in 12 (5.9%), and less frequently supraventricular tachycardia in 8 (3.94%), non-sustained ventricular tachycardia in 5 patients (2.4%) and interventricular conduction disturbance in 6 (2.9%). This is the first descriptive study of external monitoring of events held in Colombia. From the epidemiological and diagnosis electrocardiographic point of view, the findings are similar to results of previous studies, with the limitations that provides this type of analysis.

Trombosis coronaria en paciente con esclerosis múltiple: a propósito de un caso

Coronary heart disease is the leading cause of death worldwide, described classic risk factors to develop like hypertension and diabetes mellitus, but other entities such as multiple sclerosis (MS) may increase the risk of ischemic heart disease in many patients with incidence 24% higher than in people without MS, which may be due to dysfunction of the autonomic nervous system or to adverse effects of drugs used in this disease. We describe a case of acute myocardial infarction in a patient with MS and review the association of these two diseases.

Cardiología del adulto – Artículo originalCaracterísticas clínicas de pacientes llevados a monitoría externa de eventosClinical characteristics of patients undergoing external monitoring of events

There are a variety of methods that can be used for the evaluation of patients with symptoms suggestive of cardiac arrhythmia; in this regard, external monitoring of events can improve the sensitivity of diagnosis. A descriptive, retrospective and cross-sectional study, which included review of the results of external monitoring of events of 203 patients was performed. The most common reason for requesting external monitoring of events was palpitations in 161 patients (79.3%), followed by syncope in 21 patients (10.3%). The most common diagnosis was normal sinus rhythm with no other abnormalities in 59 patients (29%), followed by sinus tachycardia in 54 (26.6%), ventricular extrasystoles in 24 (11.8%), atrial extrasystoles in 17 (8.3%), non-sustained atrial tachycardia in 12 (5.9%), and less frequently supraventricular tachycardia in 8 (3.94%), non-sustained ventricular tachycardia in 5 patients (2.4%) and interventricular conduction disturbance in 6 (2.9%). This is the first descriptive study of external monitoring of events held in Colombia. From the epidemiological and diagnosis electrocardiographic point of view, the findings are similar to results of previous studies, with the limitations that provides this type of analysis.

Bradicardia y convulsiones: una relación multicausal

La disfuncion del nodo sinusal consiste en una alteracion en la generacion del impulso en el nodo sinusal. Su principal causa es la degeneracion fibrosa del tejido sinusal. Los casos asociados a convulsiones son multicausales y se deben a los efectos cardiodepresores de los anticonvulsivantes o de sus diluyentes; asi mismo se pueden presentar casos de bradicardia y asistolia inducidos por las descargas epilepticas. Se expone el caso de una paciente con status epileptico tratada con fenitoina endovenosa, quien recibia previamente carbamazepina y desarrollo disfuncion del nodo sinusal considerada como un efecto secundario toxico de su medicacion anticonvulsivante.

Descargas inapropiadas por ruido eléctrico como manifestación de pérdida del aislante interno en un paciente con electrodo RIATA

Inappropriate electrical shocks represent 12% of the complications associated with the implanted defi brillator. These are not innocuous and are related to increased mortality. This complication is most often attributed to RIATA electrode, manufactured by St. Jude Medical. The case of a 64 years old male patient who four years after a defi brillator implant (St. Jude Medical electrode RIATA) presented eight inappropriate shocks secondary to extrusion of the electrode wires due to loss of internal insulation, is presented.

Bloqueo aurículo-ventricular familiar progresivo tipo I: descripción clínica de una familia

Se presenta el caso de una familia con bloqueo auriculo-ventricular, que compromete varias generaciones, con herencia mendeliana autosomica dominante, que afecta de manera progresiva el sistema de conduccion cardiaco llevando a sincope y muerte subita en edades tempranas. Esta entidad corresponde al bloqueo familiar cardiaco progresivo tipo I, descrito principalmente en Surafrica. El tratamiento con marcapaso definitivo fue exitoso.