Diagnóstico cardiaco basado en la probabilidad aplicado a pacientes con marcapasos (original) (raw)

Electrogramas intracardíacos en tiempo real en el diagnóstico de fallas de marcapasos

Medicina-buenos Aires, 2008

Chronic ventricular lead dislodgement is an infrequent complication of pacemaker implantation. Occasionally, the dislodged lead may sense and capture a chamber in which the lead was not originally positioned. Intracardiac real time electrograms and channel markers are useful tools for the diagnosis of pacemaker malfunction. We present the case of a patient with a ventricular lead dislodgement into the atrium. The ventricular lead was able to sense and capture the atrium. Initial diagnosis was performed based on the deductive analysis of intracardiac real time electrograms and channel markers and confirmed by chest X-ray.

Síndrome de marcapasos: una causa subestimada de insuficiencia cardíaca

Resumen La aparición de signos y síntomas de insuficiencia cardíaca (IC) o fibrilación auricular (FA) en pacientes con mar-capasos, particularmente en pacientes añosos y con múltiples co-morbilidades, son atribuidos frecuentemente a mecanismos etiopatogénicos diversos. El síndrome de marcapasos representa una entidad relativamente frecuente, que suele ser subestimada o diagnosticada tardíamente y que afecta la calidad de vida de muchos pacientes con dispositivos. La prevalencia de este síndrome es variable y puede aparecer en pacientes, tanto con marcapasos unicamerales (modo VVI) como en marcapasos bicamerales (modo DDD). Existen fundamentalmente dos meca-nismos principales involucrados en el síndrome de marcapasos: la pérdida de la sincronía aurículo-ventricular y la persistencia de la conducción retrógrada ventrículo-auricular. La elección incorrecta del tipo de dispositivo o la forma de estimulación pueden determinar una mayor morbilidad, por incremento en el desarrollo de FA, stroke o IC. Summary Pacemaker syndrome: an underestimated cause of heart failure Signs and symptoms of heart failure (HF) or atrial fibrillation (AF) in patients with pacemakers, particularly in the elderly with multiple co-morbidities, are often attributed to different pathophysiological mechanisms. Pacemaker syndrome is a relatively common entity, which is usually underestimated or misdiagnosed and can affect the quality of life of many patients with devices. The prevalence of this syndrome is variable and can occur in patients with both unicameral pacemaker (VVI) and dual chamber pacemakers (DDD). There are essentially two main mechanisms involved in the genesis of pacemaker syndrome: loss of atrio-ventricular synchrony and persistence of ventricular-atrial retrograde conduction. The mode of pacing and device model may result in an increased morbidity, by increasing the development of AF, stroke or HF.