Electric therapy for heart failure

The different means for treating congestive heart failure have not yet achieved the improvement in quality of life and the prognosis of people with terminal stage cardiac disease. Some treatment resources, such as cardiac transplant, are only accessible for a selected group of patients. In the last decade, the interest on the role of electromechanic disturbances has grown and has motivated special interest for the use of the pacemaker as a tool for the treatment of congestive heart failure. During this period we have seen an important progress of this kind of treatment and, nowadays, multicenter studies have shown the hemodynamic improvement of the patients treated with this method. Selection of patients for this kind of treatment should be careful; although today it can be known which patients can benefit from this device in the treatment of congestive heart failure.

Follow-up of a group of patients with automatic implantable defibrillator

UNLABELLED The automatic implantable defibrillator (AID) is the treatment of choice for primary and secondary prevention of sudden death. At the Instituto Nacional de Cardiología, since October 1996 until January 2002, 25 patients were implanted with 26 AID. There were 23 men (92%) and the mean age of the whole group, was 51.4 years. Twenty-three patients (92%) presented structural heart disease, the most common was ischemic heart disease in 13 patients (52%), with a mean ejection fraction of 37.8%. One patient without structural heart disease had Brugada Syndrome. The most frequent clinical arrhythmia was ventricular tachycardia in 14 patients (56%). The mean follow-up was of 29.3 months during which a total of 30 events of ventricular arrhythmia were treated through AID; six of them were inappropriate due to paroxismal atrial fibrillation; 10 AID patients (34%) have not applied for therapy. Three patients (12%) of the group died due to congestive heart failure refractory to pharmacologic treatment. CONCLUSION The implant of the AID is a safe and effective measure for primary and secondary prevention of sudden death. World-wide experience evidences, that this kind of device has not modified the mortality rate due to heart failure in these patients, but it has diminished sudden arrhythmic death.

Electrocardiographic changes during stress test in a patient with "Brugada syndrome".

We report a 28 year old man with the Brugada syndrome characterised by an electrocardiographic pattern of a right bundle branch block and an ST segment elevation in the right precordial leads as well as syncope. During an exercise test, we observed a normalization of the ST segment in V2+ while in the postexercise phase, the ST segment elevation in the right leads was established. This is the first case reported of the Brugada syndrome in Mexico, with spontaneous changes on the EKG masked during exercise and apparent during postexercise phase.

The effectiveness and safety of d,l-sotalol in the ambulatory treatment of atrial fibrillation and flutter

Data on short and long term efficacy and safety of d,l sotalol in patients with atrial fibrillation or atrial flutter is limited. The aims of this study were to (1) assess the antiarrhythmic efficacy of d,l sotalol maintaining normal sinus rhythm in patients with refractory atrial fibrillation or flutter, (2) evaluate the efficacy of d,l sotalol in preventing recurrences of paroxysmal atrial fibrillation or flutter, (3) evaluate the control of ventricular rate in patients with paroxysmal or refractory atrial fibrillation or flutter unsuccessfully treated with other antiarrhythmic agents, (4) determine predictors of efficacy (5) assess the safety of d,l sotalol in this setting. Two hundred patients with chronic or paroxysmal atrial fibrillation or atrial flutter or both, who had failed one to six previous antiarrhythmic drug trials were treated with d,l sotalol 80 to 440 mg/day orally. Fifty four percent was female, age 47 +/- 16 years (range 7-79), follow up period 7 +/- 7 months (range 1 to 14 months), 79% of patients had the arrhythmia for more than one year. The atrial fibrillation in 37.5% of patients was chronic and paroxysmal in 23.5. The atrial flutter was chronic in 31% of patients and paroxysmal in 8%. Eighty two percent of patients was in functional class I (NYHA) and 82% had cardiac heart disease: left atrial (LA) size 44 +/- 10 mm, right atrial (RA) size 37 +/- 7 mm and left ventricular ejection fraction (LVEF) 58 +/- 8%. Total success was achieved in 58% of patients (atrial fibrillation 40% and 18% in atrial flutter), partial success in 38% (atrial fibrillation in 18% and 20% in atrial flutter) and 4% of patients failure. It was p < 0.07 when compared total success vs partial success among atrial fibrillation and atrial flutter groups. Patients with cardiac heart disease responded worst (p = 0.10) to the drug than those without it, specially if the heart was dilated. We concluded that d,l sotalol has moderate efficacy to convert and maintain normal sinus rhythm, as well as it acts controlling paroxysmal relapses and ventricular heart rate.

Sudden cardiac death in individuals with normal hearts: an update

Sudden death (SD) is a tragic event and a world-wide health problem. Every year, near 4-5 million people experience SD. SD is defined as the death occurred in 1h after the onset of symptoms in a person without previous signs of fatality. It can be named "recovered SD" when the case received medical attention, cardiac reanimation effective defibrillation or both, surviving the fatal arrhythmia. Cardiac channelopathies are a group of diseases characterized by abnormal ion channel function due to genetic mutations in ion channel genes, providing increased susceptibility to develop cardiac arrhythmias and SD. Usually the death occurs before 40 years of age and in the autopsy the heart is normal. In this review we discuss the main cardiac channelopathies involved in sudden cardiac death along with current management of cases and family members that have experienced such tragic event.

Aspiration Thrombectomy for Treatment of ST-segment Elevation Myocardial Infarction: a Meta-analysis of 26 Randomized Trials in 11 943 Patients.

INTRODUCTION AND OBJECTIVES There is continued debate about the routine use of aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Our aim was to evaluate clinical and procedural outcomes of aspiration thrombectomy-assisted primary percutaneous coronary intervention compared with conventional primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. METHODS We performed a meta-analysis of 26 randomized controlled trials with a total of 11 943 patients. Clinical outcomes were extracted up to maximum follow-up and random effect models were used to assess differences in outcomes. RESULTS We observed no difference in the risk of all-cause death (pooled risk ratio = 0.88; 95% confidence interval, 0.74-1.04; P = .124), reinfarction (pooled risk ratio = 0.85; 95% confidence interval, 0.67-1.08; P = .176), target vessel revascularization (pooled risk ratio = 0.86; 95% confidence interval, 0.73-1.00; P = .052), or definite stent thrombosis (pooled risk ratio = 0.76; 95% confidence interval, 0.49-1.16; P = .202) between the 2 groups at a mean weighted follow-up time of 10.4 months. There were significant reductions in failure to reach Thrombolysis In Myocardial Infarction 3 flow (pooled risk ratio = 0.70; 95% confidence interval, 0.60-0.81; P < .001) or myocardial blush grade 3 (pooled risk ratio = 0.76; 95% confidence interval, 0.65-0.89; P = .001), incomplete ST-segment resolution (pooled risk ratio = 0.72; 95% confidence interval, 0.62-0.84; P < .001), and evidence of distal embolization (pooled risk ratio = 0.61; 95% confidence interval, 0.46-0.81; P = .001) with aspiration thrombectomy but estimates were heterogeneous between trials. CONCLUSIONS Among unselected patients with ST-segment elevation myocardial infarction, aspiration thrombectomy-assisted primary percutaneous coronary intervention does not improve clinical outcomes, despite improved epicardial and myocardial parameters of reperfusion. Full English text available from:www.revespcardiol.org/en.

[Lineage tracing of epicardial cells during development and regeneration].

Tracing the history of individual cells during embryonic morphogenesis in a structure as complex as the cardiovascular system is one of the major challenges of developmental biology. It involves determining the relationships between the various lineages of cells forming an organ at different stages, describing the topological rearrangements tissues undergo during morphogenesis, and characterizing the interactions between cells in different structures. However, despite the great expectations raised in the field of regenerative medicine, only limited progress has been made in using regenerative therapy to repair the cardiovascular system. Recent research has highlighted the role of the epicardium during cardiac regeneration, but it is still unclear whether it is important for molecular signaling or acts as a source of progenitor cells during this process. Consequently, increasing knowledge about the origin, diversification and potential of epicardial cells during development and homeostasis and under pathological conditions is of fundamental importance both for basic research and for the development of effective cellular therapies. The aims of this article were to provide a general overview of the classical techniques used for tracing cell lineages, including their potential and limitations, and to describe novel techniques for studying the origin and differentiation of the epicardium and its role in cardiac regeneration.

Trombolisis en el tromboembolismo de pulmón

Fil: Valdivieso, W.. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Área de Cardiología

MLPA en el estudio de desórdenes genómicos

El término de desórdenes genómicos se utiliza para definir aquellas condiciones que surgen por inestabilidad en la molécula de ADN y, que ocasionan, rearreglos cromosómicos que involucran regiones de uno o varios pares de megabases. Estos rearreglos determinan la pérdida, ganancia o disrupción de genes cuya expresión fenotípica varía de acuerdo a la cantidad de secuencia codificante presente (dosage- sensitive- genes). Estas anormalidades genómicas surgen predominantemente durante eventos de recombinación no alélica entre cromosomas homólogos (NAHR), aunque otros mecanismos también han sido descriptos. Los rearreglos cromosómicos ocurren en puntos de quiebra que concentran regiones inestables de la molécula de ADN como lo son las secuencias repetidas llamadas LCRs (low copy repeats) que sirven como sustrato de recombinación o los sitios palindrómicos ricos en adenina- timina. Entre los desórdenes originados por alteración en la estructura genómica se cita al síndrome de deleción/duplicación 22q11.2, que incluye varios cuadros clínicos con superposición de rasgos fenotípicos. Se estima que la variabilidad clínica en estos pacientes es consecuente con la cantidad de secuencia codificante presente en relación al tamaño de la deleción/ duplicación. El advenimiento de nuevas técnicas moleculares permite actualmente determinar con precisión el segmento delecionado/ duplicado. Una nueva metodología conocida como MLPA (multiplex ligation probe amplification) podría discriminar, para este desorden en particular, cambios en el número de copias genómicas responsables de los diferentes fenotipos. Se considera que la técnica de MLPA es una herramienta de diagnóstico complementaria, con una alta sensibilidad y especificidad en el diagnóstico de desórdenes genómicos, que permite cuantificar microdeleciones/ microduplicaciones no objetivables por otros métodos. Se espera en un futuro que el conocimiento en cuanto a los complejos mecanismos de producción de los diferentes desórdenes genómicos permita definir con claridad la existencia de una relación genotipo- fenotipo que pueda delinear a aquellas entidades con fenotipos intermedios.

Amiodarona : a 50 años de su descubrimiento

Fil: Peñafort, Fernando. Hospital Español de Mendoza. Departamento de Cardiología.