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Biomedical subjects

A Fajuri

Publications and source records attributed to A Fajuri.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1989

[Acute cardiac rupture in myocardial infarction. A case report].

A 60 year old woman with a large anterior wall myocardial infarction developed severe hypotension 12 hr after admission to the coronary care unit. X rays showed an enlarged cardiac shadow and echocardiography signs of pericardial effusion. Swan Ganz catheterization revealed severe venous hypertension and no suggestion of ventricular septal rupture. Emergency surgery, initiated with partial cardiopulmonary bypass, showed a 1 cm tear of the anterior wall of the left ventricle, close to the left anterior descending artery. A successful repair was obtained by suture on teflon pledgets. After a difficult postoperative course, the patient was doing well 8 months after surgery.

Electrocardiography↗
PubMed1989

[Serum lipids, HDL2 and HDL3 cholesterol and apolipoproteins A1 and B as predictors of coronary artery disease diagnosed by coronarography].

Serum levels of total, HDL2 and HDL3 cholesterol, triglycerides and apolipoproteins A1 and B were compared in 100 Chilean males with (n = 80) or without (n = 20) coronary artery disease (CAD). The presence and severity of CAD was determined by an angiographic score. Discriminating power, sensitivity, specificity and positive predictive value for CAD were calculated for all variables. As an isolated factor, total cholesterol had the greatest discriminating power (p less than 0.002): 21% of patients with CAD had cholesterol levels below 200 mg/dl while no patient with cholesterol over 275 mg/dl was free of disease. Even though all cases with HDL cholesterol below 25 mg/dl belonged in the CAD group, this factor had no overall discriminating power. Total cholesterol/HDL cholesterol ratio had the greatest discriminating power (p less than 0.001) while total/HDL2 cholesterol had the best positive predictive value.

Adult↗
PubMed1989

[Idiopathic recurrent ventricular tachycardia: role of verapamil in its treatment].

Verapamil is a calcium channel blocker ideally suited for the treatment of A-V nodal reciprocating supraventricular tachycardia. Most types of ventricular tachycardia are refractory to treatment with verapamil since they depend on sodium channels. However, a few cases of recurrent ventricular tachycardia are refractory to Type I antiarrhythmic agents and may respond to verapamil. We report 2 such cases.

Adolescent↗
PubMed1989

[Atrial ectopic tachycardia. A variety of incessant tachycardia].

A 19 year old patient with incessant supraventricular tachycardia was submitted to electrophysiologic study. An ectopic left atrial focus was demonstrated. Intraoperative mapping localized the focus to the upper left atrial quadrant. Successful surgical isolation of the focus was possible. The patient is currently asymptomatic and arrhythmia free.

Electrocardiography↗