Ricardo Kuniyoshi

Glossopharyngeal Neuralgia Associated with Cardiac Syncope

Glossopharyngeal neuralgia is an uncommon condition that has rarely been described in association with syncope. We report here 2 cases of glossopharyngeal neuralgia in elderly patients. Both were male and underwent temporary pacemaker insertion to prevent syncopal episodes. We discuss the clinical and surgical treatment of glossopharyngeal neuralgia, the role of cardiac stimulation, and the possible physiopathological mechanism of the associated cardiac disturbances.

Electrocardiographic Identification of Mid-Septal Accessory Pathways in Close Proximity to the Atrioventricular Conduction System

In order to identify ECG characteristics of overt midseptal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid‐septal AP, Mean patient age was 31 ± 16 years, and 13 were male. The 40° right anterior oblique view was used to divide the mid‐septal area into 3 zones: 1 (anteriorportion); 2 (intermediate); and 3 (posterior portion). The 12‐lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V2 in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid‐septal AP in close proximity to the AV conduction system.

Effects of cardiac resynchronization therapy on muscle sympathetic nerve activity.

Muscle sympathetic nerve activity (MSNA) is an independent prognostic marker in patients with heart failure (HF). Therefore, its relevance to the treatment of HF patients is unquestionable.

Syncope and complete atrioventricular block related to pulmonary thromboembolism

Hospital Unimed Coracao Vitoria Mailing address: Jorge Elias Neto Rua Alfeu Pereira, 60 Cep 29050-190 Vitoria, ES, Brazil E-mail: eliasj@terra.com.br Received for publication: 1/27/03 Accepted for publication: 2/24/04 English version by Stela Maris Costalonga The co-occurrence of syncope and complete atrioventricular block associated with pulmonary thromboembolism is very rare, and only a few cases have been reported in the literature 4-8. This association was a complicating factor for the initial diagnosis of pulmonary thromboembolism and had clear implications in the outcome of most cases reported 5,7. This study aimed at reporting the case of a patient with this form of presentation and at discussing the clinical, electrocardiographic, pathophysiological, prognostic, and therapeutic aspects of that rare manifestation of pulmonary thromboembolism.

Isolated noncompaction of the myocardium

We report the case of a 42-year-old female with fatigue on exertion and palpitation consequent to the existence of isolated noncompaction of the myocardium. We discuss clinical and familial findings, diagnostic possibilities, and prognostic and therapeutical implications of this rare disorder of endomyocardial morphogenesis.

Relação entre a persistência da condução pela via lenta nodal após ablação de taquicardia por reentrada nodal e a recorrência clínica

PURPOSE: The aim of this study is to verify whether the persistence of conduction over the slow pathway is related to an increased trend for recurrence. METHODS: Recurrence rate was retrospectively analyzed in 126 patients who underwent slow pathway radiofrequency (RF) catheter ablation during a follow-up of 20±12 months. The ablative procedure was interrupted when AVNRT was no longer induced by atrial stimulation after intravenous infusion of isoproterenol. Ninety-eight patients had no evidence of slow pathway whereas 28 patients persisted with AV node jump and atrial echo beat. RESULTS: There were 15 recurrences: 9% of those who had no evidence of slow pathway (9 of 98 patients) and 21% of those with AV node jump and/or atrial echo beat but this difference was not statistically significant. CONCLUSION: As long as AVNRT cannot be induced by atrial pacing and isoproterenol infusion after slow pathway RF catheter ablation, the presence of AV node jump and/or atrial echo beat does not increase the risk of recurrence of AVNRT.PURPOSE The aim of this study is to verify whether the persistence of conduction over the slow pathway is related to an increased trend for recurrence. METHODS Recurrence rate was retrospectively analyzed in 126 patients who underwent slow pathway radiofrequency (RF) catheter ablation during a follow-up of 20 +/- 12 months. The ablative procedure was interrupted when AVNRT was no longer induced by atrial stimulation after intravenous infusion of isoproterenol. Ninety-eight patients had no evidence of slow pathway whereas 28 patients persisted with AV node jump and atrial echo beat. RESULTS There were 15 recurrences: 9% of those who had no evidence of slow pathway (9 of 98 patients) and 21% of those with AV node jump and/or atrial echo beat but this difference was not statistically significant. CONCLUSION As long as AVNRT cannot be induced by atrial pacing and isoproterenol infusion after slow pathway RF catheter ablation, the presence of AV node jump and/or atrial echo beat does not increase the risk of recurrence of AVNRT.OBJETIVO: Verificar se a persistencia de salto nodal relaciona-se a taxa de recorrencia de taquicardia por reentrada nodal (TRN) apos ablacao com radiofrequencia (RF) da via lenta do no atrioventricular. METODOS: Num seguimento de 20±12 meses, foi analisada a recorrencia de TRN em 126 pacientes consecutivos submetidos a ablacao com RF da via lenta nodal. O criterio de interrupcao do procedimento foi a nao reinducao da TRN, apos estimulacao atrial programada, com e sem isoproterenol intravenoso. Ao final do procedimento, 98 pacientes nao apresentavam salto nodal, e em 28 persistia o salto nodal e/ou o eco atrial. RESULTADOS: Houve recorrencia clinica de TRN em 15 (11%) pacientes: 9 no grupo sem salto nodal e/ou eco atrial e em 6 do grupo que persistiu com salto e/ou eco atrial. A recorrencia tendeu a ser maior no 2o grupo (9% vs 21%), mas nao houve significância estatistica entre os resultados (p=0,09). CONCLUSAO: Desde que a TRN nao possa ser induzida apos a infusao de isoproterenol, a recorrencia espontânea da arritmia apos a ablacao por RF da via lenta nodal nao e diferente entre pacientes que persistem ou nao com salto nodal e/ou eco atrial.

Taquicardia ventricular polimórfica durante teste de inclinação na doença de Chagas

1. Especialista em marcapasso, eletrofisiologista da Clínica do Ritmo, Vitória, ES, Brasil. 2. Doutor em Cardiologia, eletrofisiologista da Clínica do Ritmo, Vitória, ES, Brasil. 3. Especialista em Eletrofisiologia, eletrofisiologista da Clínica do Ritmo, Vitória, ES, Brasil. 4. Habilitado em Estimulação Cardíaca Artificial, eletrofisiologista da Clínica do Ritmo, Vitória, ES, Brasil. Correspondência: Jorge Elias Neto Av. Nossa Sra. dos Navegantes, 451/814 – Enseada do Suá Vitória, ES, Brasil – CEP 29050-335 E-mail: jeliasneto@gmail.com Artigo submetido em 8/2016. Artigo publicado em 6/2017. RESUMO Paciente do sexo masculino, de 62 anos de idade, com megacólon chagásico sem manifestações cardíacas, apresentou evento sincopal sem pródromos, sendo submetido a Holter de 24 horas, ecocardiografia, teste ergométrico e cineangiocoronariografia, que se mostraram normais. O estudo eletrofisiológico mostrou ausência de distúrbios de condução e de indução de taquiarritmias. Durante a fase basal do teste de inclinação, o paciente apresentou taquicardia ventricular polimórfica. Foi realizado implante de cardioversor-desfibrilador implantável. Na evolução, apresentou deterioração da função ventricular com início de terapêutica específica. Após sete anos de acompanhamento, observaram-se três episódios de taquicardia ventricular polimórfica adequadamente revertidos pelo cardioversor-desfibrilador implantável. DESCRITORES: Taquicardia Ventricular; Teste da Mesa Inclinada; Doen ça de Chagas; Síncope. ABSTRACT A 62 year-old man with Chagasic megacolon without cardiac manifestations developed a syncope without prodrome and was submitted to 24-hour Holter monitoring, echocardiogram, exercise test and coronary angiography. Electrophysiology tests showed there was no conduction and tachyarrhythmia induction disorders. During the baseline phase of the tilt test, the patient presented a polymorphic ventricular tachycardia. An implantable cardioverter defibrillator was implanted. At the follow-up, the patient presented left ventricular deterioration and specific therapy was started. After seven years of follow-up, three episodes of polymorphic ventricular tachycardia were observed and were successfully converted.

Reprocessing of Medical Products in Electrophysiology

Electrophysiological procedures use high-cost multipolar electrode catheters which can be reprocessed. The reuse thereof has been performed by electrophysiology services in Europe, United States, Latin America and also in our midst. In fact, prior studies have proved that there is an actual cost decrease1,2 and have also attested to the safety and efficacy of such practice,3-12 observing rates of complication and therapeutic results similar to the ones obtained with first-use electrophysiology devices. The growing concern with sustainability and no waste, associated with the efficacy and safety already demonstrated, increasingly stimulate the practice of reprocessing single-use medical devices throughout the world.