Assuntos
Síndromes de Pré-Excitação , Humanos , Medição de Risco , Interpretação Estatística de Dados , Síndromes de Pré-Excitação/diagnóstico , Síndromes de Pré-Excitação/fisiopatologia , Fatores de Risco , Morte Súbita Cardíaca/prevenção & controle , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Valor Preditivo dos TestesRESUMO
BACKGROUND: Ventricular pre-excitation is characterized by the presence of atrioventricular accessory pathways, predisposing to arrhythmias. Although it is well established that risk stratification in symptomatic patients should be invasive, there is a lack of evidence of the benefit in asymptomatic. OBJECTIVE: Evaluate ventricular pre-excitation in the electrocardiogram (ECG) as a risk factor for overall mortality in patients of Telehealth Network of Minas Gerais (TNMG), Brazil. METHODS: This observational study was developed with the database of digital ECGs (2010-2017) from TNMG. The electronic cohort was obtained by linking data from ECG exams and those from the national mortality information system. Only the first ECG was considered. Clinical data were self-reported, and ECGs were interpreted manually by cardiologists and automatically by the Glasgow University Interpreter software. Hazard ratio (HR) for mortality was estimated using weighted Cox regression. RESULTS: Nearly 1 665 667 patients were included (median age: 50 [Q1: 34; Q3: 63] years; 41.4% were male). In a mean follow-up of 3.7 years, the overall mortality rate was 3.1%. The prevalence of ventricular pre-excitation was 0.07%. In multivariate analysis, adjusting for sex and age, ventricular pre-excitation was not associated with an increased risk of mortality (HR: 1.41; 95% confidence interval [CI]: 0.56-3.57; p = .47) when compared to the whole sample or to patients with normal ECG (HR: 1.41; 95% CI: 0.53-4.36; p = .43). In a subanalysis on accessory pathway location, there was no evidence of a higher risk of death related to any location. CONCLUSION: Ventricular pre-excitation was not associated with an increased risk of mortality in a primary care cohort.
Assuntos
Feixe Acessório Atrioventricular , Síndromes de Pré-Excitação , Adulto , Arritmias Cardíacas , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Pré-Excitação/diagnóstico , Atenção Primária à SaúdeRESUMO
Resumen: El situs inversus totalis es la inversión congénita completa de órganos torácicos y abdominales. Se presenta el caso de una paciente de 3 años sin antecedentes médicos previos, a quien en atención primaria, y por un cuadro respiratorio agudo, se evidencia el hallazgo de dextrocardia y burbuja gástrica a derecha en la radiografía de tórax, sospechándose situs inversus totalis. Fue derivada a cardiología infantil donde se confirmó el diagnóstico con un ecocardiograma transtorácico, asociado a un hallazgo de preexcitación ventricular en el electrocardiograma. Una vez resuelto el cuadro respiratorio agudo, la paciente se mantiene controlada de manera periódica en atención primaria y por especialista de manera semestral.
Abstract: Situs inversus totalis is the complete congenital inversion of thoracic and abdominal organs. We present the case of a 3-year-old girl with no previous medical history. When seen with an acute respiratory syndrome, dextrocardia and gastric bubble on the right side led to the diagnosis of Situs inversus. She was referred to infant cardiology where the diagnosis was confirmed with a transthoracic echocardiogram. In addition, the electrocardiogram identified the presence of ventricular preexitation. Once the acute respiratory symptoms subsided, the patient remains controlled periodically in primary care and by a specialist every six months. No episodes of tachycardia have been detected.
Assuntos
Humanos , Feminino , Pré-Escolar , Situs Inversus/complicações , Situs Inversus/diagnóstico , Síndromes de Pré-Excitação/complicações , Síndromes de Pré-Excitação/diagnóstico , Radiografia Torácica , Dextrocardia/complicações , Dextrocardia/diagnóstico , EletrocardiografiaRESUMO
RESUMEN La fibrilación auricular por vía accesoria es una peligrosa enfermedad que puede provocar muerte súbita; es poco frecuente y necesita una conducta exacta, mucho más si aparece un patrón de preexcitación ventricular. Se presenta el caso de un adolescente masculino de 17 años de edad y piel blanca, con antecedentes de palpitaciones cortas a esfuerzos moderados y pérdida ocasional del conocimiento de breve duración, sin otra sintomatología asociada. Al momento del ingreso presenta un cuadro de palpitaciones, fatiga, palidez e hipotensión arterial, y en el electrocardiograma se observa una taquicardia con QRS ancho, irregular, con onda delta y frecuencia ventricular rápida, que fue interpretada como fibrilación auricular preexcitada. Se realizó cardioversión eléctrica sincronizada al QRS con 100 julios y se logró restaurar el ritmo sinusal con patrón electrocardiográfico de preexitación ventricular (síndrome de Wolff-Parkinson-White).
ABSTRACT Atrial fibrillation by accessory pathway is a dangerous disease that can cause sudden death, it is rare and it needs a careful management, even more, if a pattern of ventricular pre-excitation appears. The case of a white skin 17-year-old teenager with a history of short palpitations at moderate effort, and occasional loss of consciousness of short duration, without other associated symptoms, is presented. At the moment of admission, he presents palpitations, fatigue, pallor and low blood pressure; in the electrocardiogram a tachycardia with wide, irregular QRS, with delta wave and rapid ventricular rate is observed, which was interpreted as pre-excited atrial fibrillation. Synchronized electrical cardioversion to QRS with 100 joules was performed, and sinus rhythm was restored with electrocardiographic pattern of ventricular pre-excitation (Wolff-Parkinson-White syndrome).
Assuntos
Fibrilação Atrial , Síncope , Síndromes de Pré-Excitação , TaquicardiaRESUMO
El diagnóstico electrocardiográfico correcto de la causa de una taquicardia de complejo QRS ancho (TCA) es fundamental, ya que tanto el manejo, como el pronóstico del paciente, es diferente según su etiología, y define el estudio que debemos realizar. Numerosos criterios y algoritmos han sido descritos para diferenciar el origen de estas taquicardias. Sin embargo, muchos de estos son complejos y difíciles de aplicar para el médico menos experimentado. Esto es particularmente importante en los servicios de emergencia, donde se necesita una definición rápida que permita un manejo agudo apropiado. En la presente revisión analizamos los diferentes mecanismos de las TCA y los principales criterios diagnósticos en el ECG, reforzando, especialmente, aquellos de aplicación rápida y de alto rendimiento diagnóstico.
The correct electrocardiographic diagnosis of the cause of a wide QRS complex tachycardia (WCT) is essential since both management and prognosis of the patient. The correct electrocardiographic diagnosis of the cause of a wide QRS complex tachycardia (WCT) is essential since both management and prognosis is different according to its etiology and defines the study that we should perform. Numerous criteria and algorithms have been described to differentiate the origin of these tachycardias. However, many of these are complex and difficult to apply to the less experienced doctor. This is particularly important in emergency rooms, where a rapid definition is needed to allow proper therapy. In this review we analyze the different mechanisms of WCT and the main EKG diagnostic criteria, emphasizing those which can be applied rapidly and have high diagnostic value.
Assuntos
Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia/diagnóstico , Taquicardia/fisiopatologia , Algoritmos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Síndromes de Pré-Excitação , Bloqueio de Ramo , Taquicardia Ventricular/fisiopatologia , Diagnóstico Diferencial , EletrocardiografiaRESUMO
Down syndrome occurs more frequently in the offsprings of older pregnant women and may be associated with atrioventricular septal defect. This refers to a broad spectrum of malformations characterized by a deficiency of the atrioventricular septum and abnormalities of the atrioventricular valves caused by an abnormal fusion of the superior and inferior endocardial cushions with the midportion of the atrial septum and the muscular portion of the ventricular septum.
Assuntos
Ablação por Cateter/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Síndromes de Pré-Excitação/diagnóstico por imagem , Anormalidades Múltiplas/diagnóstico , Adolescente , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/genética , Síndrome de Down/complicações , Síndrome de Down/genética , Eletrocardiografia/métodos , Feminino , Cardiopatias Congênitas/genética , Cardiopatias Congênitas/cirurgia , Defeitos dos Septos Cardíacos/genética , Humanos , Masculino , Idade Materna , Síndromes de Pré-Excitação/genética , Síndromes de Pré-Excitação/cirurgia , Gravidez , Prognóstico , Vetorcardiografia/métodos , Adulto JovemRESUMO
Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the atriofascicular pathway, long and short decrementally conducting atrioventricular pathways, fasciculoventricular pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.
Assuntos
Feixe Acessório Atrioventricular , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Síndromes de Pré-Excitação/diagnóstico , Pré-Excitação Tipo Mahaim/diagnóstico , Potenciais de Ação , Adenosina/administração & dosagem , Animais , Humanos , Síndromes de Pré-Excitação/fisiopatologia , Pré-Excitação Tipo Mahaim/fisiopatologia , Valor Preditivo dos TestesAssuntos
Fibrilação Atrial/etiologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Lesões Provocadas por Raio/complicações , Síndromes de Pré-Excitação/etiologia , Adulto , Fibrilação Atrial/psicologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Lesões Provocadas por Raio/fisiopatologia , Masculino , Síndromes de Pré-Excitação/fisiopatologia , Síndromes de Pré-Excitação/cirurgiaRESUMO
The electrocardiographic diagnosis of intraventricular conduction disturbances may be hindered by the coexistence of ventricular preexcitation. In fact, the premature depolarization of ventricular myocardium through an accessory pathway tends to conceal any electrocardiographic manifestation of a bundle-branch block. However, there are several conditions favoring the diagnosis of bundle-branch block associated with ventricular preexcitation: intermittency of ventricular preexcitation and/or bundle-branch block, fast atrioventricular (AV) nodal impulse propagation, slow conduction over the accessory pathway or between its ventricular insertion site and the remaining myocardium, and presence of atrioventricular junctional ectopic beats exposing the intraventricular conduction disturbance. This article reexamines the available data on preexcitation in patients with intraventricular blocks and presents clinical examples to emphasize the importance of a thorough examination of the electrocardiogram to attain the correct diagnosis of this association.