S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200001 Riesgo cardiovascular en mujeres Whayne, Jr Thomas F ,Universidad de Kentucky Lexington KY EE.UU 05 2006 2006 8 3 4
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200002 Efectos beneficiosos y perfil de seguridad el Citrato de Sildenafil en pacientes con miocardiopatía Chagásica y otras miocardiopatías Iosa Danel ,Centro privado de diagnostico por imágenes La Cañada Córdoba República Argentina 05 2006 2006 8 5 10

El citrato de sildenafil es un potente donante de oxido nítrico que ha probado ser eficaz para el tratamiento de la disfunción eréctil masculina, pero ha sido contraindicado en pacientes con enfermedades cardiovasculares debido a efectos colaterales graves. El objetivo de este estudio es valorar los efectos cardiovasculares y la seguridad del fármaco en pacientes con miocardiopatías Material y método: Se reclutaron 26 pacientes con miocardiopatías de cualquier origen, excluyendo aquellos con enfermedad arterial coronaria severa y miocardiopatía hipertrófica obstructiva, todos vistos por el autor consecutivamente de marzo a noviembre de 1998. Se valoraron los siguientes 4 parámetros inmediatamente antes y 60 minutos después de una dosis única de 50 mg de citrato de sildenafil. 1. Parámetros electrocardiográficos: ritmo, frecuencia cardiaca, y despolarización/ repolarización ventriculares 2. Presión arterial sistólica y diastólica 3. Función sistólica ventricular izquierda 4. Función diastólica ventricular derecha e izquierda con eco-doppler-color. Resultados: Se estudiaron 26 pacientes con cardioneuromiopatía chagásica crónica, cardioneuromiopatía diabética, cardiomiopatia hipertensiva y/o hipertrófica con o sin insuficiencia cardiaca congestiva concomitante encontrándose: 1) mejoría significativa de la bradicardia basal en pacientes con miocarditis chagásica y enfermedad del nodo sinusal concomitante; 2) reducción significativa de la presión arterial sistólica y diastólica; 3)mejoría significativa de la función sistólica ventricular izquierda en pacientes que la tenían basalmente deprimida y 4) normalización de la función diastólica ventricular izquierda y derecha, tanto en los que presentaban inversión E/A como en los de patrón restrictivo. Conclusión El citrato de sildenafil tiene efectos cardiovasculares potencialmente beneficiosos en pacientes con miocardiopatías, con un perfil de seguridad aceptable.

Introduction and methods: Sildenafil citrate is a potent donor of nitric oxide that has been proven to be effective for the treatment of male erectile dysfunction, however it has been contraindicated in patients with cardiovascular diseases, because of the occurrence of sudden death in some of them. Based on the known vasodilator effect of nitric oxide, effect that could be beneficial for some patients with cardiomyopathies, I carried out this study in order to observe the cardiovascular effects of sildenafil citrate on: 1) heart rate, rhythm and repolarization changes on the ECG; 2) systolic and diastolic arterial blood pressure; 3) left ventricular systolic function and 4) right and left ventricular diastolic function in 26 patients suffering from the following cardiomyopathies: chronic Chagas’s and diabetic cardioneuromyopathies, hypertensive and/or hypertrophic cardiomyopathies with or without chronic congestive heart failure. Results: after a single oral dose of 50 mgs. of sildenafil citrate the following facts were observed: 1) the ECG findings were improved in some patients, and no worsening of the basal ecg was noted in none. Bradiarrhythmia due to sick sinus syndrome of chagasic ethiology disappeared after the use of the study drug. 2) Significant reduction of the systolic and diastolic arterial blood pressures being such reduction very strong in those with basal higher levels 3) Significant improvement in left ventricular systolic function in those patients with poor basal function and 4) Significant normalization of the basal altered diastolic right and left ventricular functions, in those with inverted as well as in those with a restrictive pattern. Conclusion: Sildenafil citrate has potential benefitial cardiovascular effects in patients with myocardiopathies with an acceptable risk profile.

 Goldstein I Lue TF Padma-Nathan H Oral Sildenafil In The Treatment of Erectile Dysfunction N Engl J Med 1998 338 NIH Consensus Conference: Impotence JAMA 1993 270 Iosa D Chronic Chagasic Cardioneuropathy: Pathogenesis And Treatment WHO And Paho Workshop: Chagas´ Disease And The nervous System WHO And Paho Workshop: Chagas´ Disease And The nervous System 1994 Iosa D Dequattro V De-Pink Lee D Plasma norepinephrine In Chagas´Cardioneuromyopathy: A Marker of Progressive Dysautonomia Am Heart J 1989 117 Guzzetti S Iosa D Pecis M Impaired Heart Rate Variability In Patients With Chronic Chagas´ Disease Am Heart J 1991 121 Iosa D Caeiro T Palmero H Abnormal Hyperventilation Test In Chronic Chagas´ Disease J Aut Nerv Syst 1980 2 Palmero H Caeiro T Iosa D The Uniqueness of Chronic Chagas ´Disease Medicina (Buenos Aires) 1980 38 Kolodny RC Kahn CB Goldstein HH Sexual Dysfunction In Diabetic Men Diabetes 1974 23 Feldman HA Goldstein I Hatzichristou DG Impotence And Its Medical And Psychosocial Correlates: Results of The Massachusetts Male Aging Study J Urol 1994 151 Viagra (Sildenafil Citrate) Viagra (Sildenafil Citrate) june 1 99 ^eNew York Pfizer Feenstra J Van Drie-Pierik Rjhm Lacle CF Acute Myocardial Infarction Associated With Sildenafil Lancet 1998 352 Arora RR Timoney M Melilli L Acute Myocardial Infarction After The Use of Sildenafil N Engl J Med 1999 341 Sahn Dj Demaria A Kisslo J Recommendations Regarding Quantitation In M-Mode Echocardiography: Results of A Survey of Echocardiographic Methods Circulation 1978 58 Schiller NB Shah PM Crawford M Recommendations For Quantification of The Left Ventricle By Two-Dimensional Echocardiography J Am Soc Echocardiogr 1989 2 Rakowski H Appleton CP Chan KL Canadian Consensus Recommendations For The Measurement And Reporting of Diastolic Dysfunction By Echocardiography J Am Soc Echocardiogr 1996 9 The Criteria Committee of The new York Heart Association, Disease of The Heart And Blood Vessels. (Nomenclature And Criteria For Diagnosis) The Criteria Committee of The new York Heart Association, Disease of The Heart And Blood Vessels. (Nomenclature And Criteria For Diagnosis) 1973 7 Boston Rosen RC Riley A Wagner G The International Index of Erectile Function (II: A Multidimensional Scale For Assessment of Erectile Dysfunction Urology 1997 49 Arterial Hypertension And Ischaemic Heart Disease. Preventive Aspect Arterial Hypertension And Ischaemic Heart Disease. Preventive Aspect 1962 Ginebra WHO Marmor M Is it okay for men with macular degeneration to take the anti-impotence drug Viagra? Can it accelerate blindness by rupturing blood vessels in the eye? Is it okay for men with macular degeneration to take the anti-impotence drug Viagra? Can it accelerate blindness by rupturing blood vessels in the eye? 2000
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200003 Prevalencia de patrones electrocardiográficos tipo Brugada en un centro de monitoreo cardíaco transtelefónico en El Salvador Abrego Hugo Alberto Suárez Arana Ricardo Sandoval Álvaro E ,Universidad Salvadoreña Alberto Masferrer San Salvador El Salvador ,Universidad de El Salvador San Salvador El Salvador ,Cardiotel de Centroamérica Merliot El Salvador 05 2006 2006 8 13 17

Introducción: Desde que se definieron los criterios que permiten diagnosticar el síndrome de Brugada, se han realizado varios estudios para determinar la prevalencia en el electrocardiograma (ECG) de los pacientes con esta enfermedad. El objetivo de esta investigación fue determinar la prevalencia de los distintos patrones electrocardiográficos tipo Brugada (PETB) en una población con acceso a monitoreo electrocardiográfico transtelefónico en El Salvador. Métodos: Todos los ECGs recibidos desde el 1/1/2002 hasta el 1/12/2004 en un centro de monitoreo transtelefónico fueron analizados por 2 cardiólogos de manera independiente. Los pertenecientes a pacientes a quienes se les diagnosticó enfermedad cardiovascular estructural y los de quienes tomaban fármacos de acción cardiovascular fueron excluidos. Resultados: De un total de 11669 ECGs de igual número de pacientes, algún PETB se encontró en 81 pacientes (0.7%). El promedio de edad de los pacientes fue de 36.4 ± 15.4 años; 64.6% de ellos eran masculinos. En 5 pacientes (6,17%) se encontró el patrón tipo 1, todos estaban asintomáticos y en 1 se colocó un cardiodesfibrilador implantable por tener arritmia ventricular maligna inducible. El patrón tipo 2 fue el más frecuente (59 pacientes, 72,83%) y solo se encontraron 17 pacientes con patrón tipo 3 (20,98%), todos asintomáticos. Conclusión: El electrocardiograma con PETB no es raro en esta población de El Salvador. Hay aproximadamente 1 PETB por cada 144 individuos y 1 caso de PETB tipo 1 por cada 2334 individuos de consulta general.

Aim: Since the diagnostic criteria for the Brugada syndrome were defined, several studies have been made to calculate the electrocardiographic prevalence of this disease. The objective of this study was to define the prevalence of the different Brugada-type patterns in a population with access to transtelephonic electrocardiographic monitoring in El Salvador. Methods: All the electrocardiograms (ECG) received via transtelephonic monitoring at our center between 1/1/2002 and 1/12/2004 were independently analyzed by 2 cardiologists. Results: Alter the exclusion of patients with structural cardiovascular disease, some pattern of Brugada-type ECG was found in 1 patients (0,7%) out of 1166 ECGs from the same number of patients. Average age was 36.4 ± 15.4 years; 64.66 of the patients were male and 35.4% were female. In 5 patients Type 1 pattern was identified (6,17%), none of them had symptoms but an automatic cardioverter defibrillator was implanted in 1 of them because of inducible malignant ventricular arrhytmia. Type 2 was the most frequently found (59 cases, 72,83 and only 17 patients (20,98%) were found to have a Type 3 pattern, all of them were free of symptoms. Conclusion The Brugada-like ECG is not infrequent in this population from El Salvador. There is a Brugada-type pattern for every 144 patients and one case of Type 1 pattern for every 2334 patients of general consultation.

 Síndrome de Brugada Electrocardiografía transtelefónica Desfibrilador Brugada syndrome Transtelephonic electrocardiography Implantable cardioverter-defibrillator Brugada P Brugada J Right Bundle Branch Block, Persistent ST Segment Elevation and Sudden Cardiac Death: a distinct Clinical and Electrocardiographic Syndrome. A Multicenter Report J Am Coll Cardiol 1992 20 Brugada J Brugada R Brugada P Determinants of Sudden Cardiac Death in Individuals with the Electrocardiographic Pattern of Brugada Syndrome and No revious Cardiac Arrest Circulation 2003 108 Surawicz B Brugada Syndrome: Manifest, Concealed, "Asymptomatic", Suspected and "Simulated" J Am Coll Cardiol 2001 38 Brugada J Brugada R Brugada P Determinants of Sudden Cardiac Death in Individuals with the Electrocardiographic Pattern of Brugada Syndrome and No revious Cardiac Arrest Circulation 2003 108 Brugada J Brugada R Antzelevitch C Towbin J Nademanee K Brugada P Long-term follow-up of individuals with the electrocardiographic pattern of right bundle branch block and ST-segment elevation in precordial leads V1 to V3 Circulation 2002 105 Antzelevitch C Brugada P Borgreffe M Brugada syndrome: report of the second consensus conference Heart Rhythm 2005 2 Hisamatsu K Morita H Fukushima KK Evaluation of the Usefulness of Recording the ECG in the Third Intercostal Space and Prevalence of Brugada-Type ECG in Accordance with Recently Established Electrocardiographic Criteria Circ J 2004 68 Cabezón S Errazquin F Pedrote A El Electrocardiograma Convencional Normal con Test de Provocación Farmacológica Negativo No Descarta el Síndrome de Brugada Rev Esp Cardiol 2003 56 Bruns R Witcher T Kirchhof P The Ajmaline Challenge In Brugada Syndrome: Diagnostic Impact, Safety and Recommended Protocol Eur Heart J 2003 24 Sangwatanaroj S Prechawat S Sunsaneewitayakul B New Electrocardiographic Leads and the Procainamide Test for the Detection of the Brugada Sign in Sudden Unexplained Death Syndrome Survivors and their Relatives Eur Heart J 2001 22 Gasparini M Priori SG Mantica M Flecainide Test in Brugada Syndrome: A Reproducible but Risky Tool Pacing Clin Electrophysiol 2003 26 1 Pt 2 Brugada R Use of Intravenous Antiarrhythmics to Identify Concealed Brugada Syndrome Curr Control Trials Cardiovasc.Med 2000 1 Nishizaki M Sakurada H Yamawake N Effects of Glucose-Induced Insulin Secretion on ST Segment Elevation in the Brugada Syndrome J. Cardiovasc. Electrophysiol 2003 14 Guevara-Valdivia ME Iturralde-Torres P De Micheli A Desenmascaramiento del "Síndrome de Brugada" con Propafenona Endovenosa Arch Inst Cardiol Mex 2002 72 1 Namiki T Ogura T Kuwabara Y Kobayashi S Saito T Masuda Y Five- year mortality and clinical characteristics of adult subjects with right bundle branch block with ST elevation Circulation 1995 92 Yamakawa Y Ishikawa T Uchino K Mochida Y Ebina T Sumita S Prevalence of right bundle-bbranch block and right precordial ST-segment elevation (Brugada-type electrocardiogram) in Japanese children Circ J 2004 68 Furuhashi M Uno K Tsuchihashi K Nagahara D Hyakukoku M Ohtomo T Prevalence of asymptomatic ST segment elevation in right precordial leads with right bundle branch block (Brugada- type ST shift) among the general Japanese population Heart 2001 86 Miyasaka Y Tsuji H Yamada K Tokunaga S Saito D Imuro Y Prevalence and mortality of the Brugada-type electrocardiogram in one city in Japan J Am Coll Cardiol 2001 38 Monroe MH Littmann L Two-year case collection of the Brugada syndrome electrocardiogram pattern at a large teaching hospital Clin Cardiol 2000 23 Greer RW Glancy DL Prevalence of the Brugada electrocardiographic pattern at the Medical Center of Louisiana in New Orleans J La State Med Soc 2003 155 Junttila MJ Raatikainen MJ Rarjalainen J Kauma H Kesaniemi A Huikuri HV Prevalence and prognosis of subjects with Brugada-type ECG pattern in a young and middle-aged Finnish population Eur Heart J 2004 25 Priori S Barhanin J Hauer RNW Genetic and Molecular Basis of Cardiac Arrhytmias: Impact on Clinical Management, Parts I & II Circulation 1999 99
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200005 Prevención de la fibrilación auricular en el paciente hipertenso Escobar Cervantes Carlos Calderón Montero Alberto Barrios Alonso Vivencio ,Hospital Ramón y Cajal 05 2006 2006 8 25 30

Un porcentaje importante de pacientes con hipertensión arterial (HTA) tiene además fibrilación auricular (FA) presencia de HTA incrementa el riesgo de tener FA y su presencia empeora el pronóstico de los pacientes con HTA. La posibilidad de que algunos fármacos interfieran con las vías de transducción específicas que facilitan la aparición de FA resulta prometedora. Hasta la fecha, parece que la medida más efectiva es la inhibición del sistema renina- angiotensina- aldosterona mediante la utilización de inhibidores de la enzima convertidora de angiotensina (IECAs) y los antagonistas de los receptores de angiotensina II (ARA II). Esta aproximación se encuentra actualmente bajo una activa investigación. Algunos ensayos clínicos han evaluado la efectividad de estos fármacos en la prevención de FA. Los datos muestran que ambas clases de fármacos, IECAs y ARA II, parecen efectivos en la prevención de FA. Sin embargo, la ausencia de ensayos clínicos aleatorizados y doble ciego específicos, limita su aplicación en los pacientes con FA sin ninguna otra indicación para su uso.

A large percentage of patients with hypertension are affected by atrial fibrillation (AF). The presence of hypertension increases the risk of AF, a condition which in turn aggravates hypertension. The ability of drugs to interfere with specific signal transduction pathways that facilitate the presence of AF in hypertensive patients is promising. To date, the most effective approach appears to be the inhibition of the renin-angiotensin-aaldosterone system with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs). This approach is under active investigation. Several trials have evaluated the effectiveness of these drugs in the prevention of AF. Data show that both, ACEIs and ARBs appear effective to prevent AF. However, a lack of prospective randomized double-blind trials data limits their application in AF patients without another indication for their use.

 fibrilación auricular hipertensión arterial sistema renina-aangiotensina-aldosterona inhibidores de la enzima convertidora de angiotensina y antagonistas de los receptores de angiotensina II atrial fibrillation hypertension renin-angiotensin-aldosterone system angiotensin-converting enzyme inhibitors and angiotensin-II blockers Chobanian AV Bakris GL Black HR Cushman WC Green LA Izzo JL The Seventh Report of the Joint National Committee: on prevention, detection, evaluation, and treatment of high blood pressure JAMA 2003 289 2003 European Society of Hypertension European Society of Cardiology guidelines for the management of arterial hypertension J Hypertens 2003 21 González-Juanatey JR Mazón P Soria F Barrios V Rodríguez-Padial L Bertomeu V Actualización (2003) de las guías de práctica clínica de la Sociedad Española de Cardiología en hipertensión arterial Rev Esp Cardiol 2003 56 Marín R Armario P Banegas JR Campo C de la Sierra A Gorostidi M Guía española de hipertensión arterial 2005 Hipertension 2005 22 ^sSupl 2 MacMahon S Peto R Cutler J Collins R Sorlie P Neaton J Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias Lancet 1990 335 Kannel WB Abbott RD Savage DD McNamara PM Epidemiologic features of chronic atrial fibrillation: the Framingham Study N Engl J Med 1982 306 Verdecchia P Reboldi G Gattobigio R Bentivoglio M Borgioni C Angeli F Atrial fibrillation in hypertension: predictors and outcome Hypertension 2003 41 Hennersdorf MG Strauer BE Arterial hypertension and cardiac arrhythmias J Hypertens 2001 19 Wachtell K Hornestam B Letho M Slotwiner DJ Gerdts E Olsen MH Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study J Am Coll Cardiol 2005 45 Garcia-Acuña JM Gonzalez-Juanatey JR Alegria E Gonzalez I Listerri JL La fibrilación auricular permanente en las enfermedades cardiovasculares en España. Estudio CARDIOTENS 1999 Rev Esp Cardiol 2002 55 Fuster V Ryden LE Asinger RW Cannom DS Crijns J Frye RL ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences J Am Coll Cardiol 2001 38 Goette A Staack T Rocken C Arndt M Geller JC Huth C Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation J Am Coll Cardiol 2000 35 Goette A Arndt M Rocken C Spiess A Staack T Geller JC Regulation of angiotensin II receptor subtypes during atrial fibrillation in humans Circulation 2000 101 Dostal DE Regulation of cardiac collagen: angiotensin and cross-talk with local growth factors Hypertension 2001 37 Li D Shinagawa K Pang L Leung TK Cardin S Wang Z Nattel S Effects of angiotensin-converting enzyme inhibition on the development of the atrial fibrillation substrate in dogs with ventricular tachypacing-induced congestive heart failure Circulation 2001 104 Cardin S Li D Thorin-Trescases N Leung TK Thorin E Nattel S Evolution of the atrial fibrillation substrate in experimental congestive heart failure: angiotensin-dependent and -independent pathways Cardiovasc Res 2003 60 Gonzalez-Juanatey JR Grigorian L Tratamiento de la hipertensión arterial en pacientes con fibrilación auricular. Implicaciones para la práctica clínica Manejo de la fibrilación auricular en el paciente hipertenso Manejo de la fibrilación auricular en el paciente hipertenso 2006 Madrid Sociedad Española de Cardiología Ehrlich JR Hohnloser SH Nattel S Role of angiotensin system and effects of its inhibition in atrial fibrillation: clinical and experimental evidence Eur Heart J 2006 27 Kalus J Coleman CI White CM The impact of suppressing the renin-angiotensin system on atrial fibrillation J Clin Pharmacol 2006 46 L' Allier PL Ducharme A Keller PF Yu H Guertin MC Tardif JC Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation J Am Coll Cardiol 2004 44 Hansson L Lindholm LH Niskanen L Lanke J Hedner T Nicklason A Effect of angiotensinconverting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial Lancet 1999 353 Hansson L Lindholm LH Ekbom T Dahlof B Lanke J Schersten B Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity: the Swedish Trial in Old Patients with Hypertension-2 Study Lancet 1999 354 Wachtell K Lehto M Gerdts E Olsen MH Hornestam B Dahl B Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study J Am Coll Cardiol 2005 45 Devereux RB Palmieri V Liu JE Watchtell K Bella JN Boman K Progressive hypertrophy regression with sustained pressure reduction in hypertension: the Losartan Intervention For Endpoint Reduction study J Hypertens 2002 20 Fogari R Mugellini A Destro M Corradi L Zoppi A Fogari E Losartan and prevention of atrial fibrillation recurrence in hypertensive patients J Cardiovasc Pharmacol 2006 47 Pizzetti F Turazza FM Franzosi MG Barlera S Ledda A Maggioni AP Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data Heart 2001 86 Pedersen OD Bagger H Kober L Torp-Pedersen C Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction Circulation 1999 100 Vermes E Tardif JC Bourassa MG Racine N Levesque S White M Guerra PG Ducharme A Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials Circulation 2003 107 Maggioni AP Latini R Carson PE Singh SN Barlera S Glazer R Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT) Am Heart J 2005 149 Swedberg K Pfeffer M Coen-Solal A Prevention of atrial fibrillation in symptomatic chronic heart failure by candesartan: results from the CHARM study (abstr) J Am Coll Cardiol 2004 43 ^sSuppl A Van Den Berg MP Crijns HJ Van Veldhuisen DJ Griep N De Kam PJ Lie KI Effects of lisinopril in patients with heart failure and chronic atrial fibrillation J Card Fail 1995 1 Murray KT Rottman JN Arbogast PG Shemanski L Primm RK Campbell WB Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM Heart Rhythm 2004 1 Madrid AH Bueno MG Rebollo JM Marin I Pena G Bernal E Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation Circulation 2002 106 Ueng C Tsai TP Yu WC Tsai CF Lin MC Chan C Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study Eur Heart J 2003 24 Healey JS Baranchuk A Crystal E Morillo CA Garfinkle M Yusuf S Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and antengiosin receptor blockers: a meta-analysis J Am Coll Cardiol 2005 45 Julius J Kjeldsen SE Weber M Brunner HR Ekman S Hansson L Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine Lancet 2004 363 Lithell H Hansson L Skoog I Elmfeldt D Hofman A Olofsson B The Study on Cognition and Prognosis in the Elderly (SCOPE) principal results of a randomized double-blind intervention trial J Hypertens 2003 21 Lafuente-Lafuente C Mouly S Longas-Tejero MA Mahe I Bergmann JF Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials Arch Intern Med 2006 166 Teo K Yusuf S Sleight P Anderson C Mookadam F Ramos B Rationale, design, and baseline characteristics of 2 large, simple randomized trials evaluating telmisartan, ramipril and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) Am Heart J 2004 14
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200006 Enfermedad del nodo sinusal en una niña con Enfermedad de Chagas Barboza Arguello María de la Paz Faerron Angel Jorge Calvo Fonseca Nidia Campos Fuentes Erick Villavicencio Rosales Cristina Sánchez Hernández Germana ,Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud ,Caja Costarricense de Segur Social ,INCIENSA ,INCIENSA ,Bióloga ,INCIENSA 05 2006 2006 8 31 34

Se presenta la evolución clínica y serológica de una paciente de once años de edad con Enfermedad de Chagas y afectación miocárdica con enfermedad del nodo sinusal. Se discuten los hallazgos cardiológicos, entomológicos, microbiológicos y antropológicos hechos por un equipo interdisciplinario.

We present herein the clinical and serological evolution of a child aged eleven years old with Chagas disease and myocardial compromise with sinus node disease. Cardiological, entomological, microbiological an anthropological issues of this case are discussed.

 Enfermedad de Chagas enfermedad del nodo sinusal encuesta entomológica Chagas disease sinus node disease enthomologic survey Bonomo Robert A Salata Robert A Behrman R Kliegman R Harbin Ann Tripanosomiasis Americana Nelson, Tratado de Pediatría Nelson, Tratado de Pediatría 1997 I ^eMéxico DF Editorial Interamericana Control of Chagas disease. Report of a WHO Expert Committee. Technical Report Series Control of Chagas disease. Report of a WHO Expert Committee. Technical Report Series 1991 Geneva Zeledón R El Triatoma dimidiata y su relación con la enfermedad de chagas El Triatoma dimidiata y su relación con la enfermedad de chagas 1981 Maguirre JH Of. R Sherloch I Guimaraes AC Sleigh AC Ramos NB Mott E Séller TH Cardiac morbidity and mortality due to Chagas disease: prospective electrocardiographic study of Brazilian community Circulation 1987 19 87 75 Díaz JCP Enfermedad de Chagas, epidemiología, clínica y terapéutica Enfermedad de Chagas, epidemiología, clínica y terapéutica 1984 Buenos Aires Programa de Salud Humana (Ed.) Storino Ruben Milei Jose Enfermedad de Chagas Enfermedad de Chagas 1994 Editorial Mosby Calvo N Zeledón R Barboza MP Sánchez G Navas L Encuesta serológica y entomológica para la Enfermedad de Chagas en Costa Rica, 2001-2002 Boletín INCIENSA 2003 15 33 Elizari MV Chiale PA Tentori Maria Cristina Segura Elsa Hayes David L Pharmacologic treatment of arrhytmias related to Chronic Chagas Heart Disease Arrhytmia management in Chagas Disease Arrhytmia management in Chagas Disease 2000 Futura Publishing Company, INC Mott E Hagstrom JW The pathology lesions of the cardiac autonomic nervous system in chronic Chagas myocarditis Circulation 1965 31 Oliveira JS Tentori Maria Cristina Segura Elsa Hayes David L A natural human model of intrinsic hesrt nervous system denervation: Chagas cardiopathy Arrhytmia management in Chagas Disease Arrhytmia management in Chagas Disease 2000 Futura Publishing Company, INC Serie de Informes Técnicos. Control de la Enfermedad de Chagas. Segundo informe del Comité de Expertos de la OMS Serie de Informes Técnicos. Control de la Enfermedad de Chagas. Segundo informe del Comité de Expertos de la OMS 2002 Ginebra Elizari MV La miocardiopatía chagásica. Perspectiva histórica Medicina (Buenos Aires) 1999 59 ^ssupl. II Tratamiento etiológico de la Enfermedad de Chagas. Conclusiones de una consulta Técnica Tratamiento etiológico de la Enfermedad de Chagas. Conclusiones de una consulta Técnica 1998 Río de Janeiro Fundación Oswaldo Cruz Serie de Informes Técnicos. Control de la Enfermedad de Chagas. Segundo informe del Comité de Expertos de la OMS Serie de Informes Técnicos. Control de la Enfermedad de Chagas. Segundo informe del Comité de Expertos de la OMS 2002 Ginebra
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200007 Masa metástasica intracardíaca en ventrículo derecho en un paciente con antecedente de hepatocarcinoma Mora Tumminelli Limber Solís Blanco Agustín Garita Jiménez Elliot Salazar Vargas Carlos Gonzalez Gatgens Gerardo Cai Chen Daniel ,Caja Costarricense de Seguro Social San José Costa Rica ,C.C.S.S. Cartago Costa Rica ,C.C.S.S. San José Costa Rica ,C.C.S.S. San José Costa Rica 05 2006 2006 8 35 38

Se presenta un paciente hipertenso con antecedente de hepatocarcinoma resecado quirúrgicamente y con quimioterapia asociada. Cinco años después se presenta con disnea de medianos esfuerzos, cardiomegalia en la radiografía de tórax y un soplo cardíaco pandiastólico GII/IV.

We describe the case of a patient with essential hypertension and the antecedent of hepatocarcinoma treated with the combination of surgery and chemotherapy. Five years later he presents dyspnea, cardiomegaly in the chest radiography and a pandiastolic II/IV cardiac murmur.

 hepatocarcinoma masa ventrículo derecho ecocardiograma fístula hepatocarcinoma right ventricle mass echocardiogram phistulae Braunwald E Zipes D Libby P Braunwalds Cardiología Braunwalds Cardiología 2005 6 ^eMéxico DF Inermaericana Hanson EC Cardiac tumors: A current perspective N State Med 1992 92 Santos LE Martínez J Kuri J Hipertensión ventricular derecha severa secundaria a obstrucción metastásica por hepatocarcinoma Arch de Cardiol de México 2005 75 2 Yu Lin T Ming Chiu Yen Chien Ch Metastasis of hepatocellular carcinoma to the heart: a case report and review of the literature Tumori 2004 90 Yu lin T Ming Chiu K Yen Chien Ch Unusual sites of metastatic involvement J Clin Oncol 2004 22 Burke A Virmani R Tumors of the heart and great vessels Tumors of the heart and great vessels 1996 Armed Forces Institute of Pathology Lam KY Dickens P Chan AC Tumors of the heart: a 20- years experience with a review of 12,485 consecutive autopsies Arch Pathol Lab Med 1993 117 10 Vargas J Férez SM Leiva JL Tratado de Cardiología. Sociedad Mexicana de Cardiología Tratado de Cardiología. Sociedad Mexicana de Cardiología 2006 1 Intersistemas, S.A. de C.V Bleiwis MS Georgiou D Brundage BH Detection of intracardiac masses by utrafast computated tomo graphy Am J Card Imaging 1994 19 94 8
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200008 Electrocardiograma del mes Araya Gómez Dra. Vivien ,Centro Cardiológico Integral 05 2006 2006 8 39 39
S1409-414220060002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422006000200004 Variación crónica del umbral de estimulación en pacientes portadores de marcapasos cardiacos Gutiérrez Sotelo Oswaldo ,Universidad de Costa Rica 05 2006 2006 8 19 23

Introducción: El umbral crónico de estimulación (U) en pacientes (Pts) con marcapasos (P) usualmente se determina haciendo mediciones semestrales o anuales. Sin embargo, puede haber variaciones en el U que podrían llevar a pérdida transitoria de captura. Este estudio evaluó el U mediante estimaciones múltiples automáticas llevadas a cabo por el P con el objetivo de evaluar sus variaciones intraindividuales e interindividuales. Material y métodos: Se incluyeron prospectivamente los Pts portadores de P con capacidad de detección automática del U mediante la cual el dispositivo determina automáticamente el U cada 8 horas y promedia los valores encontrados cada 2 días. Una vez concluido el período de seguimiento, se calcularon las diferencias entre U máx y U mín, y entre el U máx promedio y el U mín promedio y la pendiente de la curva de U individual, datos que reflejan la variación del U intraindividual y el U promedio x 2, el U promedio x 2 - U máx y el 2,5 V - U máx, que comparan los hallazgos obtenidos con la práctica usual de duplicar el valor obtenido o programar la salida en 2,5 V. Resultados Se obtuvieron 1569 valores U promedio, máximos y mínimos en 11 Pts (21- 92 años) en un período de seguimiento de 8-19 semanas. La diferencia entre el U máx y mín fue > 1 V en 5 Pts, 1,6 en 2 y > en 3 Pts. En los otros 6 fue v 0, 76 V. Las diferencias entre U promedio máx y mín fueron similares. Las pendientes individuales variaron significativamente en 4 Pts y fue mínima en 7. El U promedio x 2 fue > 2,5 en sólo 2 Pts (4,1 y 2, ). Los demás tuvieron U < 1 V. El U promedio x 2 - U máx fue negativo en 4 Pts y el 2,5 - U máx fue negativo en otros 4, lo que indica que duplicar el U o programar 2,5 - U no garantiza captura todo el tiempo. Conclusión: Existen importantes variaciones intra e interindividuales en el U y puede no ser suficiente duplicar el valor umbral obtenido o establecer 2,5 V como margen de seguridad en algunos Pts.

Introduction: The chronic threshold (CT) in patients (Ps) with cardiac pacemakers (PM) is usually measured every 6 to 12 months. Nevertheless CT could have variations that imply clinical consequences related to "loss of capture". This study evaluated CT by mean of automatic measurements performed by the PM software. The main objective was to assess intra and interindividual variations of CT. Materials and methods: We prospectively included Ps with implanted PM with an automatic capture detection algorithm available in the device. It automatically measures CT every 8 hours and averages those values every 2 days. After the follow-up period, we calculated the difference between max CT and min CT, between mean max CT and mean min CT and the individual U slope, reflecting intraindividual variations, and the mean CT x 2, the mean CTx2 - CT max and 2,5 V - CT max that compares our results with routine programming double CT or 2,5 V as output. Results: We collected 1569 mean CT measurements, max CT and min CT values in 11 Ps (21 - 92 y/o) during a 8-19 weeks follow-up period. The difference between max CT and min CT was > 1 V in 5 Ps, 1,6 in 2 and > 3 in 3 Ps. In the other 6 it was < 0,76 V. The differences between mean max CT and mean min CT were similar. Individual CT slope curves had minimal variations in 7 Ps and exhibited significant variations in 4. Mean CT x 2 was > 2,5 in only 2 Ps (4,1 and 2,7). The other 9 had CT &lt;1 V. Mean CT x 2 - max CT was negative in 4 Ps and 2,5 - max CT was negative in the other 4, indicating that programming double CT or 2,5 V as output is not so safe all the time. Conclusion: There are important intra and interindividual differences in CT and doubling the threshold or to program the output at 2,5 V as a safety margin may not be enough.

 Gregoratos G Abrams J Epstein AE ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to update the 1998 practice guidelines) Circulation 2002 106 Kay GN Ellenbogen KA Word MA Basic concepts of pacing Cardiac pacemakers and ICDs Cardiac pacemakers and ICDs 2002 3 Williston^eVT Blackwell Science Inc Kindermann M Kusch O Frohlig G Markwirth T Schwaab B Schwerdt H Safety and efficiency of pulse charge multiplication for chronic ventricular output programming Pacing Clin Electrophysiol 2001 24 4 Pt 1 Alonso C Savoure A Jauvert G Casset C Ranaivoson H Cazeau S Anselme F Clinical testing of a new pacemaker function to monitor ventricular capture Pacing Clin Electrophysiol 2005 28 ^sSuppl. 1 Kurisu S Inoue I Kawagoe T Ishihara M Shimatani Y Mitsuba N Hata T Nakama Y Kijima Y Kisaka T Documentation of acute increase in ventricular capture threshold after direct current cardioversion with AutoCapture threshold record Pacing Clin Electrophysiol 2005 28 9 Clarke M Liu B Schuller H Binner L Kennergren C Guerola M Weinmann P Ohm OJ Automatic adjustment of pacemaker stimulation output correlated with continuously monitored capture thresholds: a multicenter study. European Microny Study Group Pacing Clin Electrophysiol 1998 21 8 Simeon L Duru F Fluri M Jenzer HR Rahn M Candinas R The impact of automatic threshold tracking on pulse generator longevity in patients with different chronic stimulation thresholds Pacing Clin Electrophysiol 2000 23 11 Pt 2 Schuchert A Meinertz T Low output Programming (LOP) Investigators A randomized study on the effects of pacemaker programming to a lower output on projected pulse generator longevity Pacing Clin Electrophysiol 2001 A ug 24 8 Pt 1 Schwaab B Schwerdt H Heisel A Frohlig G Schieffer H Chronic ventricular pacing using an output amplitude of 1.0 volt Pacing Clin Electrophysiol 1997 20 9 Pt 1 Ribeiro AL Rincon LG Oliveira BG Vinha CR Melatto D Torres AA Barros VC Levine PA Automatic adjustment of pacing output in the clinical setting Am Heart J 2004 147 1 Schuchert A Frese J Stammwitz E Novak M Schleich A Wagner SM Meinertz T Low settings of the ventricular pacing output in patients dependent on a pacemaker: are they really safe? Am Heart J 2002 143 66 Duru F Bauersfeld U Schuller H Candinas R Threshold tracking pacing based on beat by beat evoked response detection: clinical benefits and potential problems J Interv Card Electrophysiol 2000 4 3