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The case of a 43-year-old female patient is presented, with an apparent history of good health, up to several weeks prior to admission, when she began to present syncopes preceded by palpitations. An electrophysiological study was performed and prematurity in the distal portion of the coronary sinus recording electrode was demonstrated, which corresponds to the great cardiac vein (anterior interventricular vein) and summit of the left ventricle. Despite the excellent early registration, neighboring structures were studied, such as the left ventricular outflow tract in the left coronary cusp, here the pace mapping was not totally concordant. At the site of the precocity obtained within the cardiac venous system, a 100% concordant mapping was achieved, with an ablation catheter’s precocity of -30 milliseconds. The ablation was decided with progressive increases in temperature and power with thermomapping and the success of the ablation was achieved without reproducibility of the arrhythmia and excellent subsequent evolution.

Supraventricular tachycardias in children are the fastest rhythms most frequently reported (70%). Orthodromic tachycardia is that which usually occurs in newborns, and its treatment with amiodarone together with beta blockers has an effectiveness of 63%. However, the combination of antiarrhythmic drugs in children and infants is not recommended because of the proarrhythmic effects. Electrophysiological study and radiofrequency ablation are reserved for older children, where there is less risk of procedures; besides little risk has been reported in children with accessory pathways. The case of an 11-day-old newborn who presented two electrocardiographically different episodes of tachycardia is reported. Those episodes suggested unequal production mechanisms of the arrhythmia, which was difficult to control and needed the combination of three antiarrhythmic drugs for maintaining sinus rhythm.

ResumenIntroducción y objetivos: Existen algoritmos como el de Brugada y Vereckei-2 para el diagnóstico de la taquicardia ventricular, pero no han sido explorados en series específicas de pacientes con taquicardia ventricular idiopática. El propósito de esta investigación no fue otro que identificar en nuestra serie, mediante análisis simple, el esquema de mayor rendimiento diagnóstico de los algoritmos de Brugada y Vereckei-2. Método: Estudio retrospectivo y descriptivo en los 15 pacientes que consecutivamente se presentaron con taquicardia ventricular idiopática, confirmada por estudio electrofisiológico y otras pruebas en el Servicio de Electrofisiología Cardíaca del Cardiocentro "Ernesto Che Guevara" de Santa Clara, Cuba, entre enero 2004 – diciembre 2007. Resultados: Ambos algoritmos diagnosticaron el 100 % de los casos. En pacientes con taquicardia ventricular del tracto de salida del ventrículo derecho, el algoritmo de Brugada, diagnostica el 50 % de los casos en el paso 1, y el 83,3 % combinándolo con el paso 3. El algoritmo de Vereckei-2, en los primeros dos pasos no diagnosticó ninguna taquicardia ventricular del tracto de salida del ventrículo derecho. En las taquicardias ventriculares del tracto de salida del ventrículo derecho fasciculares, el algoritmo de Brugada paso 1, solo diagnostica en el 11,1 % de los casos y ninguno en el paso 2. El algoritmo de Vereckei-2, paso 2, obtiene gran rendimiento diagnóstico para las taquicardias ventriculares fasciculares: 88,9 % de casos. Conclusiones: El algoritmo de Vereckei-2 presenta mayor utilidad en la taquicardia ventricular fascicular, al presentar un elevado rendimiento diagnóstico en un solo paso (el 2). El algoritmo de Brugada a pesar de tener menor rendimiento diagnóstico en un solo paso presenta mayor utilidad en el diagnóstico de taquicardia ventricular del tracto de salida del ventrículo derecho, al combinar los pasos 1 y 3. / AbstractIntroduction and Objectives: There are algorithms such as Brugada and Vereckei-2 for diagnosis of ventricular tachycardia, but they have not been explored in specific series of patients with idiopathic ventricular tachycardia. The purpose of this research was to identify in our series, by simple analysis, the scheme of greater diagnostic performance of the Brugada and Vereckei-2 algorithms. Method: Retrospective and descriptive study in 15 consecutive patients presenting with idiopathic ventricular tachycardia, confirmed by electrophysiological study and other tests at the Cardiac Electrophysiology Service of Cardiocentro "Ernesto Che Guevara" in Santa Clara, Cuba, between January 2004 - December 2007. Results: Both algorithms diagnosed 100% of cases. In patients with right ventricle outflow tract ventricular tachycardia, the Brugada algorithm diagnosed 50% of cases in step 1, and 83.3% combined with Step 3. The Vereckei-2 algorithm in the first two steps did not diagnose any right ventricle outflow tract ventricular tachycardia. In fascicular right ventricle outflow tract ventricular tachycardia, the Brugada algorithm step 1 only diagnosed 11.1% of cases and none in step 2. The Vereckei-2 algorithm, step 2, has a high diagnostic performance for fascicular ventricular tachycardia: 88.9% of cases. Conclusions: The Vereckei-2 algorithm has greater usefulness in fascicular ventricular tachycardia, with a high diagnostic performance in a single step (step 2). Brugada algorithm, despite having lower diagnostic performance in a single step, has greater usefulness in the diagnosis of right ventricle outflow tract ventricular tachycardia by combining steps 1 and 3.

Resumen Presentamos dos pacientes en los que se desarrollaron ondas T negativas que aparecen en el electrocardiograma por la memoria eléctrica cardíaca. Este fenómeno aunque fue descrito hace muchos años es causa de interpretación errónea de ondas T debido a isquemia cardíaca, y puede ser visto en ciertas situaciones clínicas que permiten sospechar su presencia. / Abstract We present two patients in whom negative T waves are developed, and appeared in the electrocardiogram as a result of the electric cardiac memory. Though described many years ago, this phenomenon is the cause for t-wave misinterpretation due to cardiac ischemia. It can be seen in certain clinical situations which lead to suspect its presence.

Introduction and objectives: The success in the treatment of several arrhythmias depends greatly on the use of permanent pacemakers. With the course of time, their uses have been increasing. The objective of this study was to describe the behavior of the implantation of permanent pacemakers in Villa Clara province. Method: A descriptive, longitudinal, prospective and retrospective study was carried out with a group of patients who had pacemakers implanted at the Celestino Hernández Robau Hospital and the Ernesto Che Guevara Hospital in Santa Clara, Villa Clara, from 2004 to 2006. Results: A total of 914 pacemakers were implanted (266 in 2004, 292 in 2005 and 356 in 2006), and 724 of them were a first implantation. Males were 66.3 percent (p = 0,0217); 82,7 percent (756 patients) were over 60 years of age, and 57.8 percent were hospitalized. The principal way of the implantation was the cephalic one (80,5 %), followed by the subclavian one (18.6 %). The atrioventricular blocks caused 60,8 percent of the total of implants (574 patients) and the sick sinus syndrome 31.3 percent (286 patients). The dislocation of the electrodes was the most common complication (22 cases, representing 2,96 %). Conclusions: The patients were mainly elderly people (4:1); there were more pacemakers implanted in men than in women (2:1); the cephalic way was the most common way (4:1); the most common cause of implantation was the atrioventricular block, and the most common immediate complication was the dislocation of the electrode.

Las taquicardias supraventriculares en niños son los ritmos más rápidos que con mayor frecuencia se registran (70 %). La taquicardia ortodrómica es la que se presenta habitualmente en el recién nacido y su tratamiento con amiodarona, en combinación con betabloqueadores, presenta una efectividad de 63 %. Sin embargo, la combinación de fármacos antiarrítmicos en niños y en recién nacidos no es recomendada por los efectos proarrítmicos. El estudio electrofisiológico y la ablación por radiofrecuencia se reserva para niños mayores, donde el riesgo del estudio es menor; además, se ha informado bajo riesgo en niños con presencia de vías accesorias. Se presenta el caso de una recién nacida de 11 días que presentó dos episodios de taquicardias electrocardiográficamente diferentes, que sugieren desiguales mecanismos de producción del trastorno del ritmo, en la cual fue difícil el control de la arritmia y el mantenimiento en ritmo sinusal, para lo cual se necesitó la combinación de tres fármacos antiarrítmicos.

Introducción: En pacientes con insuficiencia cardíaca, el bloqueo de rama izquierda del haz de His constituye un importante marcador de mal pronóstico, en ellos la tera-pia de resincronización puede mejorar la función del ventrículo izquierdo. Objetivo: Describir variables electrocardiográficas asociadas a una mejor respuesta de la resincronización cardíaca. Método: Se estudiaron 19 pacientes, 7 mujeres y 12 hombres con bloqueo de rama izquierda y fracción de eyección ≤ 35 %. Se realizó electrocardiograma antes y des-pués de la terapia de resincronización, medición del QRS en las doce derivaciones y cálculo de su dispersión, se midieron voltajes máximos del QRS, y se realizaron eco-cardiografías antes y después del procedimiento. Resultados: La fracción de eyección se incrementó desde 29,8±4,7 hasta 41,2±10,7 % (p=0.000). La correlación lineal entre fracción de eyección y dispersión del QRS a los seis meses de seguimiento fue significativa (r=0.34 y p=0.02); las mujeres presentaron mayor dispersión del QRS (48,0±24,0 vs. 37,14±13,8 ms; p=0.04). Los voltajes del QRS fueron predominantemente negativos en aVR (-0,52±0,58 vs. 0,28±0,42 mvolt; p=0.032) y positivos en V5 (0,71±1,12 vs. -0,15±1,20 mvolt; p=0.023) para los responde-dores en relación con los no respondedores. Conclusiones: La dispersión del QRS incrementada en el electrocardiograma con blo-queo de rama izquierda y la disminución de la dispersión del QRS posresincronización demostraron correlaciones significativas con la fracción de eyección; además, el es-trechamiento del QRS tras la resincronización fue significativo para los respondedo-res. Los voltajes predominantemente positivos en aVR y negativos en V5, pudieran predecir cuáles pacientes no responderán adecuadamente a la terapia de resincroni-zación cardíaca.

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Supraventricular tachycardias in children are the fastest rhythms most frequently reported (70%). Orthodromic tachycardia is that which usually occurs in newborns, and its treatment with amiodarone together with beta blockers has an effectiveness of 63%. However, the combination of antiarrhythmic drugs in children and infants is not recommended because of the proarrhythmic effects. Electrophysiological study and radiofrequency ablation are reserved for older children, where there is less risk of procedures; besides little risk has been reported in children with accessory pathways. The case of an 11-day-old newborn who presented two electrocardiographically different episodes of tachycardia is reported. Those episodes suggested unequal production mechanisms of the arrhythmia, which was difficult to control and needed the combination of three antiarrhythmic drugs for maintaining sinus rhythm. [ABSTRACT FROM AUTHOR]

Copyright of CorSalud is the property of Cardiocentro Ernesto Che Guevara and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Resumen Introducción y objetivos: La dispersión del intervalo TPICO-TFINAL (Tpeak-Tend) constituye una novedosa variable electrocardiográfica asociada recientemente, al riesgo de arritmias ventriculares malignas en el síndrome de Brugada, pero apenas se ha estudiado en el infarto agudo de miocardio con elevación del segmento ST, por lo que se decidió analizarlo en este contexto. Métodos: Se realizó un estudio de corte transversal donde se compararon los electrocardiogramas de 37 pacientes con infarto con elevación del segmento ST y otros 37, supuestamente sanos con respecto a las variables electrocardiográficas que evalúan la repolarización ventricular. Resultados: Se encontraron diferencias altamente significativas (p

Introduction and objectives: Atrial fibrillation is the most common arrhythmia in adults, with a prevalence of 0.4 percent in the general population. It is the main cause of embolic events and serious hemodynamic alterations, having important clinical, social and economic repercussions. Besides, it is the second most frequent arrhythmia in patients with an accessory pathway. The objective of the study is to characterise atrial fibrillation with anterograde conduction through an accessory pathway. Method: A descriptive, prospective and longitudinal study was carried out in 26 patients who were treated at the Cardiac Electrophysiology Services of the Ernesto Che Guevara Cardiology Hospital in Santa Clara during a year period. The variables related to the prevalence of atrial fibrillation, risk factors, circumstances of appearance, therapeutic options and predictors of sudden death, were studied. Results: It was determined a prevalence 34.2 percent with a predominance of the male gender. The most important risk factor was the existence of previous events of atrial fibrillation in 35 percent of the patients, which appeared most frequently during rest periods. There was a predominance of the left pathways (54 %) and 84 percent of the patients required medication to achieve an acute reversion. Conclusions: Pre-excited atrial fibrillation presents an important prevalence in our environment. There was a predominance of the male gender and the left pathways. The mean RR interval during the pre-excitation was 213 milliseconds and there were minimal RR intervals of less than 170 milliseconds.