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Biomedical subjects

A Fajuri

Publications and source records attributed to A Fajuri.

At least 19 recordsLinked to original sources
PubMed1995

[Arrhythmogenic right ventricular dysplasia. Options of treatment during a 12-year follow-up of a patient].

The replacement of muscle by fibrous and adipose tissue leads to arrhythmogenic right ventricular dysplasia. We report the clinical features and therapeutic options of a 50 years old male with the disease followed during 12 years. The latter included pharmacological therapy, surgical pseudoaneurysmal resection and radiofrequency fulguration of a second arrhythmogenic focus that appeared 10 after the surgical procedure. The patient remained asymptomatic after each therapy, until the disease progressed again. This follow up is one of the longest reported and documents the disease's clinical presentation, evolution and treatment.

Anti-Arrhythmia Agents↗
PubMed1995

[Junctional reciprocating tachycardia: clinical and electrophysiological characteristics, and the role of fulguration in 5 cases].

The permanent form is a variety of junctional reciprocating tachycardia that is refractory to medical treatment. The anterograde arm of the circuit is formed by the His Purkinje bundle and the retrograde conduction is through a slow conduction Accessory Atrioventricular Pathway. We report five patients with this type of arrhythmia, subjected to electrophysiological assessment. Their mean age was 37 years, all suffered from palpitations and several medical treatments had failed. During tachycardia, electrocardiogram had a negative P wave in inferior leads and RP interval was bigger than PR interval. Accessory Pathway were located in the right postero-septal region in three patients, in the left postero-septal region in one and in the left lateral in one. Specific bundle fulguration was successfully attempted in four patients, in whom arrhythmias did not recur without medical treatment.

Adolescent↗
PubMed1995

[Fulguration with radiofrequency of the slow nodal pathway: experience in 30 consecutive cases].

Atrioventricular nodal reentry tachycardia (AVNRT) is one of the most frequent mechanisms of paroxysmal supraventricular tachycardia. In these patients tachycardia is maintained due to anterograde conduction through a slow pathway and retrograde conduction to the atrium via a fast pathway. We present herein our experience in ablation of the slow pathway. Since January 1993, 30 consecutive patients with AVNRT underwent attempted catheter ablation of the slow pathway. Mean age was 35 +/- 3.7 years. All patients had symptomatic tachycardia and six had history of syncope. Electrophysiologic studies revealed AVNRT in all patients, in addition, two patients had a left accessory pathway. Slow pathway ablation was performed with a Mansfield 7 F catheter, guided by both fluoroscopic positioning and endocardial signals. A mean of 13 bursts were applied. In the 30 patients conduction through the slow pathway was interrupted, and thus tachycardia was no longer inducible. Retrograde conduction post ablation was evaluated in 17 of the 30 patients, significant changes were observed in three of them. One patient developed second degree AV block and a permanent pacemaker was implanted. Another patient had recurrence of tachycardia three months post ablation. After a second attempt she is arrhythmia free. Patients have been followed for a mean of 15.7 +/- 2.5 months and are asymptomatic in the absence of antiarrhythmic therapy.

Adolescent↗
PubMed1994

[Hypertrophic cardiomyopathy with two episodes of recuperated sudden death. Report of the first implantable defibrillator cardioverter inserted in Chile].

We report a 29 years old male with a non obstructive hypertrophic cardiomyopathy that survived two episodes of cardiac arrest and with a familiar history of the disease and sudden death. He had an implant of an automatic implantable cardioverter defibrillator by a left anterior thoracotomy with intraoperative electrophysiology. The postoperative outcome was uneventful. After one year of follow up, the patient is in good functional capacity and the implanted device has not performed defibrillations.

Adult↗
PubMed1994

[Radiofrequency fulguration of accessory pathways].

Between August 1991 and August 1993, 75 patients (42 male) with Wolff Parkinson White syndrome (43 concealed) were subjected to radiofrequency ablation of accessory pathways at our institution. 55 had left, 8 postero septal, 2 anteroseptal and 10 right accessory pathways. A retrograde aortic technique with placement of the ablation catheter in close proximity to the mitral annulus was used for most of the patients with left accessory pathways and for some with posteroseptal pathways. The right, anteroseptal and some posteroseptal pathways were ablated using a right heart approach placing the ablation catheter in the tricuspid annulus. Ablation was successful in 61 patients (81%). One subject developed a fatal cardiac tamponade after a transeptal catheterization and was unrelated to the ablation per se. It is concluded that radiofrequency ablation of accessory pathways is a curative procedure for a great majority of patients with Wolf Parkinson White syndrome.

Adolescent↗
PubMed1994

[Primary coronary angioplasty as early reperfusion treatment of acute myocardial infarction].

Between March 1990 and July 1993, 21 patients with an evolving acute myocardial infarction were treated with coronary angioplasty after 2-9 hours of chest pain (mean 3.9). Thirteen had a clinically and electrocardiographically large infarction, including 3 in cardiogenic shock. The dilated arteries were the left anterior descending in 14, the left circumflex in 4 and right coronary artery in 3 patients. With angioplasty successful reperfusion of the infarct area was obtained in 18 patients (86%). The procedure was well tolerated by most patients and the in-hospital mortality rate was 5%.

Aged↗
PubMed1994

[Multiple pathway tachycardias: electrophysiological properties and fulguration of accessory pathways in 2 cases].

We report two patients (male, 35 and female, 28 years old) with recurrent and refractory tachycardias referred for an electrophysiological study. EKG showed left lateral accessory pathway in both, two tachycardias with identical morphology but with different frequency and activation sequence were detected. One was orthodromic with anterograde conduction by the His-Purkinje budle and retrograde by the accessory pathway and the other with slow nodal anterograde conduction. The accessory pathway was first fulgurated with radiofrequency at the third attempt. Posteriorly, a nodal reentry tachycardia was induced in the first patient and in the second, a double nodal pathway was confirmed. In both, the slow pathway was modified using Jackman's technique, after three and four attempts respectively. After these applications, the induction of tachycardia with programmed atrial or ventricular stimulation, with or without isoproterenol, was not possible. It is concluded that radiofrequency fulguration is a reasonable therapeutic alternative for patients with multiple circuit tachycardias.

Adult↗
PubMed1993

[Tilt test: hemodynamic responses in patients with syncope or presyncope of unknown etiology].

The aim of this work was to assess the hemodynamic responses to the tilt test of 51 patients with syncope (n = 31) or presyncope (n = 20) of unknown etiology. A protocol with an inclination of 70 degrees (20 min) with or without isoproterenol (mean dose of 3.6 +/- 0.3 ug/min), was used. Forty five percent of patients had a positive test, 18 with isoproterenol at 70 degrees (group 1A) and 5 without isoproterenol (group 1B); 28 patients had a negative test (group 2). These groups did not differ in age or sex distribution. Basal heart rate was 76.2 +/- 2x'. At the end of the test it was 73.4 +/- 5.7 in group 1A, 78.0 +/- 7.5 in group 1B and 120.4 +/- 3.3 in group 2 (p < 0.01). Systolic blood pressure decreased to 78.1 +/- 4.8 mmHg in group 1A, to 76.2 +/- 9.9 in group 1B and did not decrease in group B (130.0 +/- 5.7 mmHg, p < 0.01). The required dose of isoproterenol was higher in group 1A than in group 2 (4.4 +/- 0.3 vs 3.1 +/- ug/min, p < 0.01). It is concluded that the tilt test reproduced symptoms and accompanying hemodynamic mechanisms in a high proportion of patients with syncope of unknown etiology. This test should be incorporated in the diagnostic workup of these patients.

Adolescent↗
PubMed1993

[Block of the slow pathway of the double atrioventricular node: a new technique for treatment of atrioventricular node reentry tachycardia].

The aim of this work is to summarize the first experience in Chile modifying the slow pathway in patients with tachycardias due to atrio-ventricular node reentry. Until now, the only available treatment was the use of antiarrhythmic drugs. The radiofrequency fulguration or cauterization of part of the atrioventricular node has been reported as a treatment for these arrhythmias. The initial technique fulgurated the rapid pathway with a significant risk of atrioventricular block. The modification of the slow pathway has been recently described. We report two patients, 9 and 45 years old, with a history of recurrent tachycardias, refractory to pharmacological treatment. An electrophysiological study demonstrated that the mechanism of their arrhythmias was a nodal reentry. In the same session one of the mapping catheters was changed by a fulguration one and radiofrequency was applied, using a variation of the technique described by Jackman. In both, the slow pathway was modified or blocked with definitive interruption of the nodal reentry circuit and preservation of atrioventricular conduction.

Catheter Ablation↗
PubMed1993

[Efficacy and secondary effects of chronic treatment with amiodarone].

Long-term therapy with amiodarone has been associated with a high incidence of adverse side effects, that precludes its indication for common cardiac arrhythmias. We have prospectively studied 218 patients (pts), aged 32-87 years, under chronic amiodarone therapy that were followed for 2 years and evaluated for efficacy and adverse side effects. Previous amiodarone treatment ranged from 1 to 135 months. Cardiac arrhythmias were paroxysmal AF (PAF) in 120 pts, sustained VT (SVT) in 36 pts, paroxysmal supraventricular tachycardia (PSVT) in 21 pts, unsustained VT (UVT) in 18 pts and miscellaneous in 23 pts. Amiodarone doses ranged from 500 to 4200 mg per week. Amiodarone was effective in 65% of all patients. No difference was observed between efficacy and type of arrhythmia. Dermatologic toxicity was found in 36%, neurologic toxicity in 23%, thyroid toxicity in 13.4% and pulmonary fibrosis en 2.5% of pts. Amiodarone was discontinued routinely when pulmonary toxicity was present. We conclude that amiodarone therapy is effective in a wide spectrum of arrhythmias. Although drug therapy was associated with a high incidence of adverse side effects, these did not preclude continuation of treatment.

Adult↗
PubMed1992

[Arrhythmogenic dysplasia of the right ventricle: clinical presentation and long-term course].

The clinical findings and follow up in 10 patients with arrhythmogenic dysplasia of the right ventricle were analyzed. Presentation occurred at a mean age of 35 +/- 12(SD) years and all patients presented with ventricular tachycardia and a left bundle branch block pattern. Physical examination was normal. T waves were inverted in right precordial leads in all and late depolarization were seen in 7. Global or segmental dilatation of the right ventricle was shown by echocardiogram in all patients and by right ventricular angiography in 8. After a mean follow up of 6.6 years (+/- 3), 70% had recurrence of ventricular tachycardia in spite of adequate antiarrhythmic therapy. Mortality was only 10%. Surgery was performed in 4 patients. Two patients had focal right ventricular fibrosis and resection lead to cure of arrhythmia.

Adult↗
PubMed1992

[DDD dual chamber pacemakers. Initial experience].

Our preliminary experience with dual-chamber DDD pacemakers is reported. Technological innovations of the device, atrio-ventricular electrode stability and sequential stimulation have contributed to improve the conditions of patients previously submitted to VVI pacemaker implantation. Primary indications for DDD pacemaker implantation in our series included 7 patients with complete atrio-ventricular (A-V) block, 3 with Mobitz type II second-degree A-V block and 2 with sick sinus syndrome. In six of the 12 patients (50%) additional indications included: ventricular tachycardia in 4 patients, atrial fibrillation in one and pacemaker syndrome in one. Other cardiac conditions were diagnosed: dilated cardiomyopathy in 3 patients, ischemic heart disease in 2 patients, valvular heart disease in 2 patients, congenital heart disease in 1 patient and hypertrophic cardiomyopathy in one patient. The implanted pacemakers were: 5 Genesis, 4 Ultra CPI and 3 Versatrax. J-shaped atrial electrodes were used in 8 patients and in 4 instances a screw-in electrode was employed. Improvement of hemodynamic function was achieved by frequent follow up and reprogramming of DDD pacemaker in every patient. While 4 patients died with progressive deterioration of cardiac function, eight patients survived with adequate sequential stimulation. We conclude that DDD pacemakers are reliable and afford symptomatic relief in a broad spectrum of patients.

Adult↗
PubMed1992

[Radiofrequency fulguration in patients with reciprocating tachycardias].

The use of radiofrequency for catheter ablation of accessory pathways and dual AV nodal pathways has been recently introduced. In this paper the results obtained in 5 patients are reported. Three patients had accessory pathways and 2 a dual AV nodal pathway. After a complete electrophysiologic study, a 7F Door Knob catheter coupled to a Radionics radiofrequency generator delivering a maximum of 16 watt at 480 KH was used to ablate the abnormal pathway. Success was obtained in every patient at times varying from 30 sec to 3 min, using 3 to 17 energy deliveries. These results include the first successful ablation of a left lateral bundle with radiofrequency using an energy of only 16 Watt.

Adolescent↗
PubMed1991

[Sudden unexpected nocturnal death: report of a case and review of the literature].

Sudden death usually affects individuals with severe heart disease. A more dramatic phenomenon is the sudden unexpected death of individuals with no evidence of heart disease. It has been described mainly in young healthy males under severe stress. We present a 32 year old man who presented ventricular fibrillation during sleep and was resuscitated by his wife. Recurrent episodes of VF occurred in the following hours. The study, including coronary angiography, revealed a normal heart. Endomyocardial biopsy showed minimal alterations with scarce areas of atrophy and fibrosis. Electrophysiologic evaluation showed an extremely short refractory period of the right ventricle, but the arrhythmia could not be induced by electrical stimulation. An internal cardioverter defibrillator was implanted since the risk of recurrent VF was high. A review of the literature concerning this unusual entity is offered.

Adult↗
PubMed1990

[Wolff-Parkinson-White syndrome: late results of surgical treatment].

We followed 25 patients operated on for Wolff-Parkinson-White syndrome between August 1985 and October 1989. Their mean age was 37 +/- 12 years and arrhythmia had been present for 5 to 30 years. A mean of 3.3 +/- 1.2 antiarrhythmic agents had failed in controlling recurrences. Tachycardia was orthodromic in 21 patients and antidromic in 1, while 3 patients presented rapid atrial fibrillation with hemodynamic deterioration. Drug refractoriness (n = 23) or intolerance (n = 2) were the main surgical indications. The location of accessory pathways was lateral in 19 patients, anteroseptal in 3, posteroseptal in 2, postero lateral in 1 and right lateral in 1 patient. One patient had a double pathway. There was no surgical mortality. After a follow-up period ranging from 1 to 50 months recurrence of arrhythmia was observed in one patient and electrophysiologic evaluation showed persistence of a left lateral pathway in another. The remaining 24 patients are free of symptoms at the end of follow up. Thus, surgical treatment is a curative therapy for most patients with WPW.

Adolescent↗
PubMed1990

[Sudden death in the young adult without demonstrable cardiopathy: the clinical and electrophysiological characteristics in 3 cases].

We report 3 young adult males who developed spontaneous ventricular fibrillation in the absence of demonstrable heart disease. Extensive clinical and electrophysiologic evaluation failed to disclose a cause for the arrhythmia. Antiarrhythmic drugs were empirically used in all patients but 2 of them eventually died. Thus, unexplained ventricular fibrillation without demonstrable heart disease carries a serious short-term prognosis. An implantable cardio-vector-defibrillator may be the therapy of choice in these cases.

Adult↗