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Muerte súbita por arritmia sin enfermedad cardíaca manifiesta.

H J Wellens1, R Lemery, J L Smeets

  • 1Department of Cardiology, Academic Hospital Maastricht, University of Limburg, Maastricht, The Netherlands.

Circulation
|January 1, 1992
PubMed
Resumen

La muerte súbita por arritmia puede ocurrir sin enfermedad cardíaca conocida. Las frecuentes arritmias ventriculares que no responden a los medicamentos indican un mal pronóstico, lo que sugiere la necesidad de un registro global de pacientes.

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Área de la Ciencia:

  • Cardiología Cardiología.
  • Electrofisiología y electrofisiología.
  • Muerte cardíaca súbita y súbita.

Sus antecedentes:

  • El colapso circulatorio y la muerte súbita por arritmia pueden ocurrir en individuos sin enfermedad cardíaca aparente.
  • Los mecanismos subyacentes y las estrategias óptimas de gestión de estos eventos siguen sin estar claros.

Objetivo del estudio:

  • Para informar sobre una serie de pacientes que experimentan colapso circulatorio y / o muerte súbita por arritmia.
  • Para investigar las características clínicas, arritmias y resultados en esta cohorte de pacientes.
  • Explorar el significado pronóstico de hallazgos electrofisiológicos específicos y el papel de la terapia antiarrítmica.

Principales métodos:

  • Serie de casos que informan sobre nueve pacientes con episodios de colapso circulatorio.
  • Documentación de las arritmias, incluida la fibrilación ventricular y el aleteo ventricular, durante la reanimación.
  • Evaluación de los frecuentes latidos prematuros ventriculares tempranos y la taquicardia ventricular polimórfica no sostenida.
  • Evaluación de la respuesta a la terapia farmacológica y seguimiento a largo plazo.

Principales resultados:

  • Siete de los nueve pacientes experimentaron fibrilación ventricular documentada; uno tuvo aleteo ventricular.
  • Cuatro pacientes tenían frecuentes latidos prematuros ventriculares tempranos, a menudo con taquicardia ventricular polimórfica no sostenida.
  • La falta de supresión de la actividad ectópica con la terapia farmacológica se asoció con resultados adversos, incluida la muerte súbita y las arritmias recurrentes.
  • Un paciente murió repentinamente después de 21 meses; otros dos tuvieron episodios sintomáticos recurrentes.

Conclusiones:

  • La muerte súbita por arritmia puede ocurrir en ausencia de enfermedad cardíaca manifiesta, siendo las arritmias ventriculares una característica clave.
  • La ectopia ventricular frecuente persistente, particularmente cuando no responde a los medicamentos antiarrítmicos, tiene una implicación pronóstica adversa significativa.
  • Dada la rareza y las incertidumbres, se propone un registro mundial para una mejor comprensión y gestión de estos casos.