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Biomedical subjects

P Iturralde Torres

Publications and source records attributed to P Iturralde Torres.

At least 19 recordsLinked to original sources
PubMedDate not supplied

[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.

Adolescent↗
PubMedDate not supplied

[The familial incidence of accessory atrioventricular pathways (the pre-excitation syndrome)].

Cases of familial preexcitation syndrome represent a specific subgroup of patients that may result from diverse mechanisms: failure in development and genetic predisposition are the main mechanism involved. We determined the prevalence of this syndrome in first degree relatives of patients with proved accessory pathways by electrophysiologic study and compared such prevalence with the general population (0.15%). In five out of 469 patients (1.06%) we found an accessory pathway in one or more member of their family. Only 6 out of 3752 had preexcitation (0.15%); this prevalence was similar to the general population (P = NS). The identification of family members with this syndrome may be incomplete because we only chose for the study symptomatic patients. We did not observed multiple pathways and in one case we found atrial septal defect. Our data demonstrated familial preexcitation in five families suggesting hereditary predisposition.

Adolescent↗
PubMedDate not supplied

[Double tachyarrhythmia: left anterior fascicular ventricular tachycardia associated with atrial flutter and fibrillation. Report of a case].

A patient with episodes of palpitation in whom the electrocardiogram showed a right bundle branch (RBBB) configuration and right axis deviation underwent electrophysiologic study and radiofrequency ablation. Left ventricular endocardial mapping during ventricular tachycardia (VT) identified the earliest ventricular activation in the anterolateral wall of the left ventricle. The fused Purkinje potential was recorded at that site, and preceded the QRS complex by 47 mseg, with pace mapping showing an optimal match between the paced rhythm and the clinical VT. The stimulus to QRS time was equal to the Purkinje potential-QRS time. Several radiofrequency lesions were applied in this region, one of them resulted with termination of the tachycardia. Following delivery of this lesion the ventricular tachycardia couldn't be induced either at baseline or during isoproterenol infusion. During VT, atrial fibrillation and atrial flutter were observed, cardioversion was performed reverting to sinus rhythm.

Atrial Flutter↗
PubMedDate not supplied

Kearns-Sayre syndromes an absolute indication for prophylactic implantation of definitive pacemaker?

Kearns-Sayre syndrome is a mitochondrial cytopathy characterized by chronic progressive external ophthalmoplegia, retinitis pigmentosa and heart block, the last of which determines the survival of these patients. The case of a 23 year old man with Kearns-Sayre syndrome, conduction disturbances and mitral valve prolapse is presented. The characteristics of this syndrome are described and the criteria for prophylactic installation of a pacemaker discussed.

Adult↗
PubMedDate not supplied

[Experience in 1,500 patients undergoing radiofrequency ablation in the treatment of tachycardias].

Several reports have demonstrated that radiofrequency catheter ablation provides effective control of a variety of supraventricular and ventricular tachycardias. This report details the results of radiofrequency catheter ablation in 1500 consecutive patients with a wide variety of supraventricular and ventricular tachycardias treated in the Instituto Nacional de Cardiología "Ignacio Chavez", between April 22, 1992 until December of 1999. Tachycardias were associated with the presence of an accessory pathway in 987 patients (65.8%). Dual accessory pathways were present in 24 patients giving a total of 1,012 accessory pathways. The mechanism of the arrhythmia was atrioventricular nodal reentrant tachycardia in 321 patients (21.4%). Ablation of the reentrant circuit of atrial flutter within the right atrium was attempted in 109 (7.2%) patients and a primary atrial tachycardia in 13 patients (0.8%). Atrioventricular node ablation and permanent pacemaker implantation were performed in 26 patients (1.7%). Finally we performed radiofrequency catheter ablation in 37 (2.4%) patients with ventricular tachycardia. Radiofrequency catheter ablation was successful in 908 of 1012 (89.7%) patients with accessory pathways with a complication rate of 10 (0.98%) and a recurrence rate of 92 (9%). AV nodal reentry was successfully abolished in 319 of 321 patients by selective ablation of the slow pathway in 297/321 (92.5%) patients and the fast pathway in 22/24 (92%) patients. The complication rate of this group was 8/321 (2.4%) with a recurrence rate of 34 patients (10.5%). The reentrant circuit of atrial flutter was ablated successfully in 86 of 109 (76.8%) patients with a recurrence flutter in 14 (12.8%) patients. Five of 13 (38.4%) cases of primary atrial tachycardia were successfully ablated. Complete AV block was achieved in 26 of 26 (100%) patients with atrial fibrillation or flutter treated by AV nodal ablation. The procedure was successful in 28 of 37 (75.6%) patients with fascicular ventricular tachycardia. The results of this series of patients demonstrates the safety and efficacy of radiofrequency ablation for the treatment of a wide variety of taquicardias with high rate of success 1375 of 1500 patients (91.6%), with 142 recurrences (9.4%), 15 complications (1%), and no mortality.

Adolescent↗
PubMedDate not supplied

[Treatment of ventricular tachycardia].

Evaluation and management of postinfarct ventricular tachycardia has changed dramatically in the past two decades. The introduction of the implantable cardioverter defibrillator has played a major role in this change, alternating both, the purpose of the patients evaluation and treatment options. Episodes of sustained ventricular tachycardia can occur in a variety of clinical settings; the most common of which is the patient who has suffered a myocardial infarction. In this paper, I explore the causes and effects of some of these changes and review current strategies, specially the radiofrequency catheter ablation, for the management of the patient with postinfarct ventricular tachycardia.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

[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.

Adult↗
PubMedDate not supplied

[Changes in auriculoventricular conduction due to the effect of ethanol].

Transcoronary ablation of atrioventricular conduction by dehydrated alcohol was attempted in one patient with refractory ectopic atrial tachycardia. Ethanol (1.5 ml) was delivered after selective catheterization of the atrioventricular nodal artery in a patient in whom the artery could be identified by cineangiography. The mean creatine kinase (MB fraction) at four hour to six hour after ablation was 40 U. No electrocardiographic QRS changes was seen. The procedure was successful. The patient is asymptomatic 3 months after procedure. Transcoronary alcohol ablation of atrioventricular conduction should be considered in patients in whom electrical techniques have been unsuccessful.

Adult↗
PubMedDate not supplied

[Pacemakers].

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Electric Countershock↗
PubMedDate not supplied

[A retrospective study for the analysis of collateral effects of amiodarone].

UNLABELLED: We analyzed retrospectively 130 patients treated with amiodarone. They were seen at the Arrhythmias Clinic of this Institute from march 1981 until may 1988 with the purpose of evaluate the frequency of the side effects of the drug. The group of patients consisted of 67 men and 63 women, the mean age was 32 years and they were followed for about 32 months. The average dose of the drug was 1.069 gr per week. All of them had a physical and radiological examination, an ECG and laboratory tests. Besides, 86 patients went through an electrophysiological study at least once. One hundred and eighteen patients had periodical tests for thyroid function. All of the patients had a check up every 3 or 6 months. RESULTS: the response to the drug was good or even excellent in 83% of patients. They did not show electrocardiographic changes of statistic significance (duration of the PR, QRS or QT). The ophthalmologic examination showed corneal deposits in 48% of patients, but in no case there was indication to stop the treatment. Ten patients had a spontaneous regression of these deposits. Alterations of the thyroid function were seen in 33.8% of patients, 14 had hypothyroidism and seven hyperthyroidism, the others simple goitre. In four of these cases the drug was discontinued. Dermatologic lesions were seen in only 4% of patients. Despite the high frequency of side effects the need for stopping the treatment was low, with a high percentage of drug efficacy.

Adult↗
PubMedDate not supplied

[Usefulness of the pre-excitation index to determine the mechanism of supraventricular paroxysmal tachycardia and the location of the anomalous pathway].

To evaluate the preexcitation index in determinate the mechanism of paroxysmal supraventricular tachycardia and localize accessory pathway, fifty nine patients with clinical and electrocardiographic supraventricular tachycardia were analyzed. There were thirty eight patients (64.4%) with orthodromic AV reentry using an accessory pathway for retrograde conduction and 21 patients (35.6%) with typical AV nodal reentrant tachycardia. Preexcitation of the atrium during tachycardia by premature ventricular complex at a time when anterograde His bundle activation was present in 30 o 38 (79%) patients with AV reentry while only 8 of 21 (38%) patients with AV nodal reentry demonstrated preexcitation during tachycardia. There was no significant difference between left and right accessory pathways and in mean tachycardia cycle length between the two groups. However, atrioventricular reentry demonstrated atrial preexcitation during tachycardia more frequently than AV nodal reentry. In conclusion, our findings show that the preexcitation index is a useful method for determinate the mechanism of supraventricular tachycardia and to localize accessory pathways.

Adolescent↗
PubMedDate not supplied

[Wolff-Parkinson-White syndrome with orthodromic supraventricular tachycardia associated with a "hyper-conductor" atrio-ventricular node. A therapeutic challenge].

One case of Wolff-Parkinson-White Syndrome with paroxysmal supraventricular tachycardia related to orthodromic atrioventricular reentry using an accessory pathway for retrograde conduction an a rapidly conducting AV node for anterograde conduction is present. The pharmacological therapy with Digoxin, Propranolol, Quinidine, Disopyramide and Propafenone was not effective. An electrophysiologic study showed a reciprocating tachycardia induced by spontaneous ventricular beats. Both the effective refractory period of the AV node and the anterograde effective refractory period of the accessory pathway were minor or equal to 220 msec which made the control of the arrhythmia difficult. Amiodarone was able to suppress the premature ventricular beats, depress conduction and prolong refractoriness in both, the AV node and accessory pathway to prevent recurrences of atrioventricular reentry. In this patient a false positive test with ajmaline was documented. The electrophysiologic study showed the association of Wolff-Parkinson-White Syndrome with an enhanced atrioventricular nodal-conduction and allowed the selection of an appropriate antiarrhythmic agent.

Adult↗
PubMedDate not supplied

[Sudden death].

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Aged↗
PubMedDate not supplied

[Transtelephonic electrocardiography in Mexico. A report of the first 3434 cases].

The transtelephonic electrocardiographic system started in the 70's and it was used mainly in the study of heart disease, cardiac arrhythmias, syncope and sudden death. This report, include 3434 electrocardiogram (ECG) of patients whom visit the emergency room at the General Hospital and private clinic, using three different forms of transtelephonic monitors. The total population were 1715 males and 1719 females with average age of 52.2 +/- 28.8 years. 26.9% had was present in history of systemic hypertension, non-insulin dependent diabetes 12.3% and myocardial ischemic disease in 5.3%. The main ECG indications were chest pain 38.7%, most of them atypical angina, palpitations in 6.9% and dyspnea in 6.5%. 50.1% of the ECG were abnormal. The most important diagnosis were: tachyarrhythmias (25.2%), intraventricular conduction abnormalities (17.7%), myocardial ischemic disease (16%), and premature ventricular and supraventricular beats (11.6%). We concluded that the transtelephonic electrocardiographic system is a very useful method, and available now in Mexico. We detected a high percentage of electrocardiographic abnormalities, it was possible to give the right diagnosis of arrhythmias, acute myocardial infarction, old infarction, and to evaluate the pacemaker functionality. Finally, it helped to get in brief time the diagnosis and treatment in cases of acute myocardial infarction or severe arrhythmias.

Adult↗