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OBJETIVO: Analizar la influencia de la crenoterapia con aguas sulfuradas en la tensión arterial y su relación con la lipoperoxidación. MÉTODO: Estudio clínico prospectivo, realizado en un balneario de aguas sulfuradas, con un grupo homogéneo de 110 voluntarios del Programa de Termalismo Social del IMSERSO, 55 hombres y 55 mujeres, edad media 68,5 años. 49 normo tensos (grupo control) y 61 hipertensos: 42 con tratamiento farmacológico (HTF) y 19 sin él (HNTF). Se determinaron niveles de eliminación urinaria de sustancias reactivas al ácido ti barbitúrico (TBARS), tensión arterial (TA), a la entrada y a la salida del balneario, además de hábitos, condiciones médicas, ingesta de fármacos, radiaciones solares recibidas, vías de administración del tratamiento, edad, sexo, dieta, etc. RESULTADOS: Los niveles urinarios de TBARS antes y después del tratamiento (hombres + mujeres) tanto en el grupo control como en el de hipertensos bajaron con una diferencia estadísticamente significativa (p< 0,05), aunque la disminución de TBARS, fue más manifiesta en hipertensos y sobre todo mujeres. No existió diferencia significativa en la excreción de TBARS, ni antes, ni después del tratamiento, entre el grupo control (normotensos) y el hipertenso. La TA disminuyó (p< 0,01) con el tratamiento. La TA sistólica/TA diastólica (TAS/TAD) del Grupo control (normotensos) disminuyó en 7 y 4 mm Hg, respectivamente; la de los HTF en 10 y 6,5 mmHg y los HNTF en 11 y 12 mmHg, existiendo diferencia significativa en los tres grupos (p< 0,01). La disminución de la TA, también fue más marcada en HNTF, sobre todo en mujeres. CONCLUSIONES: La crenoterapia con aguas sulfuradas, por vía tópica, disminuyó la eliminación de TBARS sobre todo en hipertensos y en mujeres. Igualmente disminuyó la TA en todos los pacientes y voluntarios. No hubo relación entre los valores de TBARS y la TA, independientemente de la edad y sexo (AU)

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INTRODUCTION AND OBJECTIVES: The MAZE procedure was developed as a surgical approach to the management of patients with atrial fibrillation refractory to medical treatment. This study seeks to identify the risk and benefits of adding the MAZE procedure in patients with atrial fibrillation undergoing surgery for underlying organic cardiac disorders. MATERIAL AND METHODS: Since november 1993, we have performed 10 interventions with the MAZE procedure, for the treatment of refractory atrial fibrillation. The indication to perform the technique was systemic embolism in 5 patients, contraindication for the anticoagulant treatment in two cases and no response to antiarrhythmic treatment in 5 cases. Two patients had more than one indication. In all the cases another surgical procedure was performed, 5 replacements of mitral valve, a mitral repair, one tricuspid repair and tree repairs of an atrial septal defect. RESULTS: Soon after surgery 9 patients were in sinus rhythm, and one in atrial fibrillation. Four patients needed atrial pacing during the first days. One patient required a pacemaker due to symptomatic sinus bradycardia. During the first 3 months, 4 patients had episodes of paroxysmal atrial fibrillation and flutter. One patient died suddenly one month after surgery. Seven patients have completed two years of follow-up, and are in stable sinus rhythm, in functional class I and free of antiarrhythmic drugs. All of them have echocardiographic evidence of mechanical activity in both atria. Left atrium had been reduced from 5.3 +/- 0.7 cm to 4.5 +/- 0.7 cm (p < 0.05). No patient has presented new embolic events. CONCLUSIONS: The MAZE procedure is a good choice in selected patients with atrial fibrillation refractory to medical treatment, or a precedent of systemic embolism. However, several problems can complicate the patient's course.

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Knowledge of the clinical and electrophysiological features of certain cardiovascular risk groups, the adaptation and specialization of clinical protocols, the availability of tools to make determinations for use in patient follow-up and to assess the efficacy of the treatments applied, and the proper processing of different parameters can aid in decision making, leading to the application of a given therapeutic approach, and can facilitate the performance of group and multicenter studies. To address these needs, a simple, low-cost, portable ECG processing system has been designed that complements the current techniques for managing patients with ischemic heart disease and nonmalignant ventricular arrhythmias. This system, consisting of an electrocardiograph and a laptop PC, determines the following parameters on the basis of the ECG: incidence of arrhythmia, heart rate variability, QT dispersion, ECG criteria for ventricular hypertrophy and late potentials. Left ventricular ejection fraction and diastolic function (according to Doppler ultrasound) and other basic epidemiological parameters are typed in. Moreover, the system integrates these parameters, which have usually been considered separately, to arrive at second-level indicators with a greater predictive capacity during the long-term follow-up of patients with ischemic heart disease and ventricular arrhythmias, thus providing an idea of the risk of mortality and the onset of arrhythmic events and allowing risk stratification in this patient population. Finally, the system includes a database of all the patients analyzed, with tools that make it possible to follow the course of their disease and to assess the efficacy of the treatments applied.

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Atrial fibrillation is the most frequently found sustained arrhythmia. It increases the risk of thromboembolism and adversely affects cardiac performance because of loss of atrial kick. New surgical treatments of atrial fibrillation have been developed to ablate the origin of abnormal impulses on the atrium. The left atrial isolation and the corridor operation restores the regular rhythm, but do not reduce the risk of thromboembolism because the left atrium may continue to fibrillate. The maze operation has proven to be effective in both converting to sinus rhythm and regaining atrial contractility. However, this method is meticulous and time-consuming and takes more cardiac ischemic time, especially when other cardiac procedures are performed simultaneously.

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Electrophysiological properties were studied in a heterotopic heart transplant model developed in 44 dogs (Group I). Cycle length was 359.5 +/- 55.2 ms in the recipient heart and 500.9 +/- 77.9 ms in the donor heart (P less than 0.001). Sinoatrial conduction time was 38.6 +/- 13.6 ms in the recipient heart and 38.6 +/- 10.4 ms in that of the donor (not significant). The Wenckebach point was 175.4 +/- 31.1 ms in the recipient organ and 214.3 +/- 42.6 ms in the donor heart (P less than 0.001). The retrograde block point was 271.6 +/- 48.0 ms in the recipient heart and 353.6 +/- 47.3 ms in that of the donor (P less than 0.01). The effective antegrade refractory period was 133.4 +/- 28.7 ms in the recipient heart and 167.3 +/- 46.3 ms in the donor organ (P less than 0.001). An epicardial atrial cartography was performed at 44 preset points in both hearts, revealing a normal activation sequence and delays of 36-98 ms (mean 58 ms) in the recipient heart and from 39 to 59 ms (mean 50 ms) in the donor heart (not significant). In another 11 dogs (Group II), the same electrophysiological study was carried out under basal conditions and after pharmacological blockade of the autonomic nervous system with atropine (0.04 mg (kg body weight)-1) and propranolol (0.2 mg (kg body weight)-1). No significant differences were found in any of the parameters studied upon comparison of Group II animals in basal conditions with Group I recipients, and Group II dogs after blockade with Group I donors. These results demonstrate that the differences in automatism, conduction and refractoriness between the donor and recipient hearts are not attributable to differences in the haemodynamic situation or in the anaesthetic technique, but to denervation.

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We compared several electrophysiological variables before and after Mustard and Senning procedures in 14 mongrel dogs and made the following three observations. First, after the Senning operation, the atrial activation in the areas of the anterior and middle internodal tracts is undamaged. After the Mustard procedure, however, conduction through the interatrial septum is practically abolished. Both techniques damage the area of the posterior internodal tract. On the whole, there is greater dispersion of atrial epicardial mapping with the Senning operation. Second, several degrees of depression in the sinus node automatism and intraatrial conduction were observed with both techniques. Third, atrioventricular block in various degrees was observed only after the Mustard procedure. The atrioventricular dissociation observed after the Senning operation was dependent on sinus pacemaker dysfunction only. We think that from the electrophysiological point of view, the Senning procedure is a valid alternative for repair of transposition of the great arteries.

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In a patient with repetitive disabling tachycardias refractory to pharmacologic treatment, the electrophysiologic study suggested the existence of atrioventricular nodal reciprocating tachycardia. During ventricular pacing, endoepicardial mapping of the lower atrium showed the atrial breakthrough point in an area of the lower interatrial septum close to the AV node crista. A selective atriotomy was performed. The postoperative electrophysiologic studies showed absence of ventriculoatrial conduction at several ventricular pacing rates, while antegrade conduction is preserved. The patient remained free of arrhythmias 21 months after surgery, taking no antiarrhythmic drugs.

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The action of 2-3 mg/kg of morphine on the threshold of electrical fibrillation of the ventricle (TVF) in anesthetized dogs has been studied. The basal TVF was 10.5 +/- 4.9 mA, increased to 20.2 +/- 7.7 mA (P 0.005) with the administration of this drug. Comparatively, the effect of morphine on the TVF is similar to that of propranolol and bretilium and more effective than procainamide. The mechanism by which it acts is not well known. Perhaps it is due to a homogenization of refractory periods in the ventricle as well as a possible morphine-catacholamine interaction. Morphine in dosis of 2-3 mg/kg could occupy a place among the antiarrhythmic drugs of choice with antifibrillatory action, with important usefulness in the field of anestesiology of cardiopaths.

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