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Biomedical subjects

R Peinado

Publications and source records attributed to R Peinado.

32 records · Page 2Linked to original sources
PubMed1996

"Pseudodisappearance" of atrial electrogram during orthodromic tachycardia: new criteria for successful ablation of concealed left-sided accessory pathways.

OBJECTIVES: This study sought to analyze two new criteria along with other known predictors of success of radiofrequency ablation. Background. Although the overall success rate of radiofrequency ablation of accessory pathways is high, the individual predictive value of each of the established criteria is low. METHODS: We prospectively studied the local electrograms obtained before the application of radiofrequency energy in 33 patients with a left-sided concealed accessory pathway successfully ablated. Two new criteria ("pseudodisappearance" during tachycardia of a bipolar atrial electrogram visible during sinus rhythm and the presence of an "atrial notch" in the ascending limb of the unipolar ventricular electrogram during tachycardia) were studied along with other known predictors. Electrograms recorded at a total of 157 sites were analyzed (33 successful applications, 124 failures). RESULTS: Electrogram characteristics that were predictive of success during ablation on the basis of univariate analyses were a pseudodisappearance criterion (p<0.001), the presence of a Kent potential (p<0.005) and the presence of an "atrial notch" (p<0.005). After adjustment for between-patient differences, logistic regression analysis showed that only the "pseudodisappearance" criterion (odds ratio [OR] 7.2, 95% confidence interval [CI] 1.2 to 42.5, p<0.03) and the presence of a Kent potential (OR 2.4, 95% CI 1.01 to 5.79, p<0.05) had independent predictive value. CONCLUSIONS: The pseudodisappearance during tachycardia or ventricular pacing of a bipolar atrial electrogram present during sinus rhythm is associated with a good outcome during radiofrequency ablation of concealed accessory pathways. These observations may help to ablate accessory pathways and to avoid missing appropriate sites for ablation when the atrial activation is not clearly visible at the local electrogram.

Adolescent↗
PubMed1996

Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators.

BACKGROUND: Some patients with an automatic implantable cardioverter-defibrillator (ICD) suffer multiple appropriate, consecutive, high-energy discharges (MCDs) during follow-up. Such events might represent resistant ventricular arrhythmias and might have prognostic significance. METHODS AND RESULTS: Eighty consecutive patients with an ICD were followed up for up to 82 months (mean, 21 +/- 19 months). Thirty-eight patients had survived an out-of-hospital cardiac arrest and 42 had recurrent ventricular tachycardia. During follow-up, 16 patients had MCD (group A), 26 patients had episodes of single appropriate discharges (group B), and 38 patients had no appropriate discharges (group C). Group A patients had worse functional status (P = .001), lower left ventricular ejection fractions (LVEFs) (P = .001), and lower survival rates (log rank, P = .003) than the remaining two groups of patients. Cox analysis showed LVEF (P = .001) to be an independent predictor of MCD. Independent predictors of death or heart transplant were MCD (P = .001), female sex (P = .001), age (P = .001), history of cardiac arrest (P = .003), and functional status (P = .003). The only independent predictor of total mortality was female sex (P = .002). Independent predictors of cardiac death were MCD (P = .007) and female sex (P = .018). Independent predictors of arrhythmic death were age (P = .001), female sex (P = .02), and MCD (P = .023). CONCLUSIONS: In patients with an ICD, the development of MCD is an independent predictor of cardiac and arrhythmic mortality. If this finding is confirmed in larger studies, it may help to identify patients in whom other therapeutic alternatives, ie, heart transplantation, should be considered during follow-up after ICD implantation.

Aged↗
PubMed1996

[Predictive factors of inotropic support in myocardial revascularization surgery].

OBJECTIVES: The use of perioperative inotropics in myocardial revascularization surgery can be considered a marker of ventricular dysfunction, the etiology of which involves a variety of pre- and intraoperative factors. Knowledge of the risk factors and their relative importance can allow them to be modified for improved outcome. This study aims to determine the incidence of and factors that predict the need for inotropic support in order to finalize extracorporeal circulation and in the first 6 hours after myocardial revascularization. PATIENTS AND METHODS: Two hundred forty-two patients who underwent myocardial revascularization were studied retrospectively. The parameters collected were age, sex, NYHA classification, left ventricular telediastolic pressure at baseline and after contrast, ejection fraction, collateral circulation, number of distal anastomoses, time of clamping, time of extracorporeal circulation, need for inotropic support to end extracorporeal circulation and during the first 6 hours after surgery. RESULTS: Inotropics were used in 27.6% of the sample. The need for inotropic support was related to female sex (odds ratio [OR] 3.85 with 95% confidence interval [CI], 1.56-9.49); NYHA class III (OR 2.13 with 95% CI, 1.05-4.32) or IV (OR 10.16 with 95% CI, 3.22-32.13); low injection fraction (OR 2.41 with 95% CI, 1.22-4.76); and prolonged extracorporeal circulation (OR 2.97 with 95% CI, 1.54-5.76). CONCLUSIONS: The independent variables associated with the need for inotropic support during the perioperative period in myocardial revascularization are NYHA functional class III and IV, female sex, low injection fraction and prolonged extracorporeal circulation. New techniques for myocardial protection during extracorporeal circulation, plus adequate peroperative stabilization of patients and shorter time of extracorporeal circulation will probably diminish short term morbidity in revascularization surgery.

Aged↗
PubMed1995

Percutaneous balloon valvuloplasty for concurrent mitral, aortic and tricuspid rheumatic stenosis.

Percutaneous balloon valvuloplasty has been used with good results to treat rheumatic mitral stenosis. However, its use in degenerative aortic stenosis has shown many limitations. There is little information about balloon valvuloplasty in tricuspid and aortic rheumatic stenosis. This article describes two patients with combined rheumatic mitral, aortic and tricuspid stenosis in which triple percutaneous valvuloplasty was performed in a single procedure.

Adult↗
PubMed1994

Identification of concealed posteroseptal Kent pathways by comparison of ventriculoatrial intervals from apical and posterobasal right ventricular sites.

BACKGROUND: The differential diagnosis of supraventricular tachycardia with concentric atrial activation usually requires the inducibility of sustained tachycardia and needs a complex and time-consuming electrophysiological evaluation. To develop a simple test to establish if ventriculoatrial conduction uses a posteroseptal accessory pathway or the normal conduction system, we compared the ventriculoatrial intervals during right ventricular pacing from apical and posterobasal sites. METHODS AND RESULTS: Continuous pacing was performed from an apical and a posterobasal right ventricular site in 34 patients with retrograde conduction over the normal conduction system (group A) and in 22 patients with conduction over a posteroseptal accessory pathway (group B). During apical pacing, ventriculoatrial intervals in group A (176 +/- 40 milliseconds) were not significantly different than those in group B (197 +/- 47 milliseconds, P = NS). During posterobasal pacing, group B patients had significantly shorter ventriculoatrial intervals than group A patients (158 +/- 46 versus 197 +/- 39 milliseconds, P < .01). The difference between the ventriculoatrial interval obtained during apical pacing and that obtained during posterobasal pacing (ventriculoatrial index) discriminated between the two groups without overlapping: It was positive in all group B patients (39 +/- 19; range, +10 to +70 milliseconds) and negative in all except two group A patients (-21 +/- 13; range, -50 to +5 milliseconds; P < .001). CONCLUSIONS: This ventriculoatrial index can identify accurately and in the absence of tachycardia whether concentric retrograde conduction is proceeding over a posteroseptal accessory pathway or over the normal conduction system.

Adult↗
PubMed1993

Treatment of ventricular arrhythmias in patients with hypertrophic cardiomyopathy.

In patients with hypertrophic cardiomyopathy, asymptomatic episodes of non-sustained ventricular tachycardia are frequent and of prognostic significance for sudden cardiac death in adults, particularly in those whose consciousness is impaired. Low-dose amiodarone, found to be beneficial in mildly symptomatic non-sustained ventricular tachycardia, but detrimental in a subgroup with prominent non-arrhythmic symptoms, could be an alternative to an electrophysiological approach in patients with syncope but preserved functional capacity. In cardiac arrest survivors, an electrophysiological approach seems preferable to empiric amiodarone, together with implantation of a defibrillator, at least in those in whom inducible arrhythmias cannot be suppressed.

Amiodarone↗
PubMed1992

[The independent origins of the anterior descending, circumflex and right coronary arteries from the right coronary sinus].

We present a patient with chronic ischaemic cardiac disease and anomalous left anterior descending and circumflex coronary arteries with independent origin from the right Valsalva sinus. Each one had his own ostium and the left anterior descending artery followed an intramyocardial pathway through the interventricular septum whereas the circumflex artery had a retrocardiac pathway. The clinical picture of the patient was related to the presence of atherosclerotic obstructive lesions in right, whose origin and curse were normal, and circumflex coronary arteries. He was treated medically at first but without obtaining complete control therefore he needed surgical treatment which was undertaken without technical difficulties. We reviewed the anomalies of the main coronary arteries, in the origin and course, with its clinical signification, diagnosis and therapeutics topics.

Aged↗
PubMedDate not supplied

[Lipomatous hypertrophy of the interauricular septum, fibrosis of the bundle of His and calcification of the mitral annulus associated with multiple rhythm and conduction disorders. The anatomicoclinical correlations].

We present the case of a 72 years old female with multiple episodes of atrial fibrillation, interatrial block and different degrees of atrioventricular block, that died because of stroke. Postmortem pathologic examination showed a lipomatous hypertrophy of the interatrial septum (previously suspected on echocardiogram), his bundle and right branch degeneration as well as mitral annular calcification extended to conduction system. According to these pathologic findings, rhythm and conduction disturbances are correlated with the two levels (atrial and atrioventricular) where anatomic abnormalities were found.

Aged↗