RESUMO
We report a 41 years old female, previously operated of an atrial septal defect, presenting with a persisting atrial flutter. Sinus node dysfunction became evident during an electrophysiological study at the moment of interrupting the flutter with electrical stimulation. The patient was treated with his bundle ablation and implantation of a definitive pacemaker. After one year of follow up, she is devoid of symptoms.
Assuntos
Flutter Atrial/etiologia , Síndrome do Nó Sinusal/complicações , Adulto , Flutter Atrial/diagnóstico , Flutter Atrial/terapia , Doença Crônica , Eletrocardiografia , Feminino , HumanosRESUMO
Normal heart contraction was studied in 20 healthy subjects (14 males and 6 female, mean age 33 years). Rest radioventriculography and phase analysis were used. Ejection fraction was 66 +/- 7% for the LV and 53 +/- 7% for the RV (p < 0.0001). Peak filling rates in the first third of diastole were 1.6 +/- 0.6 EDV/sec for the LV and 0.7 +/- 0.3 EDV/sec for RV (p < 0.0001). Time to peak filling rate normalized for heart rate was 180 +/- 52 ms for the LV and 203 +/- 60 ms for the RV (p = 0.05). Filling fractions were 23 +/- 10% and 9 +/- 3%, respectively (p < 0.0001). Segmental motility was normal in all subjects. Phase analysis revealed faster emptying of the left atrium with phase angles of 171 +/- 13 degrees in the LA and 185 +/- 12 degrees in the RA (p = 0.00007). This difference may be related to faster diastolic events in the left ventricle. Phase angles for the LV and RV were -8.75 +/- 3 and -9.44 +/- 5 degrees, respectively (NS). We conclude that activation occurs earlier in the left atrium, proceeds through the septum and then synchronically over both ventricles.