The objective of this study was to report the case of a patient with Prinzmetal’s angina who experienced cardiac arrest due to ventricular fibrillation. The patient was successfully resuscitated, and underwent implantation of an implantable cardioverter-defibrillator (ICD) for secondary prevention. Data were collected through a review of medical records, analysis of diagnostic tests, and a literature review. This case highlights the importance of risk stratification and ICD implantation in patients with Prinzmetal’s angina and life-threatening arrhythmic events, ensuring appropriate management and reducing the risk of recurrence.
Introduction: Supervised cardiovascular rehabilitation (SCR) is an essential adjuvant therapy for patients with heart failure. However, the idea that its benefits are restricted to the early stages of heart failure persists in clinical practice. Objective: To describe how SCR positively impacted the functional capacity, functionality, clinical condition and quality of life of a patient with chronic heart failure (CHF) with an implantable cardioverter defibrillator (ICD). Case report: Female, sedentary, 67 years old, hypertensive for 30 years, with an ICD (for seven years), history of coronary artery disease and myocardial infarction, developed dilated ischemic heart failure of functional class III. She was referred by her arrhythmologist to the SRC service. She remained in treatment for seven months. The SRC program consisted of resistance exercises, cyclic exercises, and inspiratory muscle training, adjusted every two months. Results: After the cardiovascular rehabilitation period, we observed a 100% increase in ejection fraction (20% versus 40%), functional capacity (< 5 METs versus 6.8 METs), and quality of life (↑ 47%), as well as a decrease in blood pressure (180/90 versus 130/80 mmHg) and withdrawal of one drug (digoxin). Conclusion: An individualized SRC program can promote clinical and functional benefits and improve the quality of life of patients with chronic heart failure, indicating that not only patients with recent complications or in the early stages of heart failure can benefit from these benefits.
We describe a clinical case of a 20-year-old male who was referred for an exercise stress test, undergoing cardiologic follow-up for 11 years due to episodes of syncope. Shortly after the end of the exercise phase, he presented recurrent episodes of asystole, associated with loss of consciousness, followed by spontaneous recovery.
An 81-year-old woman was referred to Parc Taulí Hospital Universitari with complete atrioventricular block and a dual-chamber pacemaker was implanted. She subsequently presented an episode of ventricular tachycardia that degenerated into ventricular fibrillation requiring cardiopulmonary resuscitation. After review of the device, as well as the electrocardiogram and chest X-ray, displacement of the atrial lead into the right ventricle was confirmed. Contrary to expectations, the ventricular event was not secondary to endocardial irritation by the displaced lead, so the hypothesis of a possible depolarization-repolarization heterogeneity as a cause of the increased arrhythmogenicity was raised.
Introduction: Postoperative atrial fibrillation is the most common sustained arrhythmia after cardiac surgeries that occurs in approximately 30-50% of patients postoperatively. Because of the substantial evidence recommending prophylactic treatment and the lack of clear indications for commencing treatment, this study aimed to develop a new predictive score for atrial fibrillation after cardiac surgery that represents well the pathophysiology of the disease. Methods: This is a retrospective cohort study, involving two public teaching hospitals. The study included 989 adult patients who underwent cardiac surgery, except for heart transplantation or the implantation of a ventricular assist device. Patients with previous atrial fibrillation or those requiring amiodarone were excluded. The variables (age ≥60 years, echocardiographic LA enlargement, inotrope use within 24 hours of surgery, and the need for reoperation) were subjected to univariate analysis of the occurrence of postoperative atrial fibrillation and multivariate analysis using logistic regression. This was then used for developing a risk score. Results: Statistically significant variables in the multivariate analysis were age ≥60 years (P<.001), left atrial enlargement based on echocardiography (P=.025), inotrope use within 24 hours after surgery (P=.002), and the need for reoperation within 24 hours after surgery (P=.016). The score comprises these four variables and has an accuracy of 77% for predicting outcomes. Scores ≥3 were related to a 34% risk of postoperative atrial fibrillation. Conclusions: The proposed score represents the disease pathophysiology well and has good accuracy for predicting the main outcome.
Catheter ablation is the first-line therapy for symptomatic atrioventricular reentrant tachycardia (AVRT). Pseudo-refractory AVRT may stem from misdiagnosis, use of inadequate ablation methods, or the presence of additional concealed or unusual located pathways that initiate or sustain the tachycardia. We present a case of right atrial appendage accessory pathway—a rare and overlooked cause of AVRT—to illustrate the importance of raising suspicion for this condition when standard mapping and ablation around the tricuspid valve annulus fail to eliminate pathway conduction. Furthermore, we present a straightforward, effective approach for localizing the pathway site and safely performing irrigated ablation at the base of the right atrial appendage.
