Raimundo
@cardiovcl.sld.cu
Electrophysiology / Medicine
Cardiovascular Hospital Ernesto Guevara
RESEARCH INTERESTS
Cardiac Arrhythmias
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Raimundo Carmona-Puerta, José Luis Choque-Laura, Elibet Chávez-González, Joel Peñaló-Batista, Marielys del Carmen Martínez-Sánchez, and Elizabeth Lorenzo-Martínez
Elsevier BV
Raimundo Carmona-Puerta, Denise Pérez-Sanchez, Jorge M. Pichardo-Ureña, José L. Rodríguez-Monteagudo, and Elizabeth Lorenzo-Martínez
Informa UK Limited
ABSTRACT Hiatal hernia (HH) is a common disease in the general population. It is often asymptomatic, but if it does present clinical manifestations, these are usually gastrointestinal. Gastroesophageal reflux is the main symptom that accompanies it. Depending on the severity of the hernia, it is classified into several subtypes from I–IV. Especially, IV type (giant HH) can lead to various cardiopulmonary symptoms with several degrees of severity. It is necessary to keep this possibility in mind among the various differential diagnoses that may occur in this clinical setting. The current paper aims to review the literature on classic and novel information on the HH – cardiovascular system relationship. Epidemiological data, physiological aspects of the heart compressed by HH, cardiovascular symptoms, electrocardiographic changes, echocardiographic alterations and clinical implications are discussed. Plain language summary Normally, the stomach and the heart are not in direct contact because they are in different cavities, the thorax and the abdomen, respectively. When part of the stomach moves toward the chest through the diaphragm, we say there is a hiatal hernia (HH). Most of the time the HH symptoms are mild and clearly digestive. In severe cases, surgical repair of the HH is required. Even in these circumstances, digestive symptoms continue to be the most frequent. However, some patients present cardiovascular symptoms and few or no digestive symptoms. This easily creates diagnostic confusion, which leads to incorrect treatments and unnecessary expenses. In extreme cases, as seen in giant HH, the degree of cardiovascular involvement is very serious. There are documented cases that have suffered cardiac arrest, arrhythmias of different types and symptoms like classic acute myocardial infarction. It is required that clinical doctors and surgeons are aware that this complication exists. Only with this in mind can a timely diagnosis be achieved. Some emergency measures have been saving, gastric decompression with a tube being the most important. The main mechanism that explains the serious cardiovascular consequences of giant HH is cardiac compression. The dissemination of this knowledge can help save lives.
Elibet Chávez-González, Raimundo Carmona-Puerta, Fernando Rodríguez-González, Juan Miguel Cruz-Elizundia, and Cynthia Torres-Acosta
Springer Science and Business Media LLC
Abstract Background Oblique course of some left accessory pathways is rare An incomplete electrophysiological study may confuse us between an oblique accessory pathway or the presence of two accessory pathways. The proximity of all atrial and ventricular electrograms, at each pole of the catheter, within the coronary sinus may be a novel finding. Case presentation A 68-year-old woman patient presented arrhythmias with hypotension requiring electrical cardioversion. Her electrocardiogram (ECG) was interpreted as atrial fibrillation by accessory pathway. We performed with the protocol of ablation stablished in our laboratory: two punctures on the right femoral vein with placement of introducers (8F and 7F) by Seldigner technique and one puncture on the left femoral vein (7F). The study was performed with BIOTRONIK technology (Multicath study catheter), a non-deflectable 7F quadripolar catheter with 2 mm tip electrode to record the His electrogram, a non-deflectable decapolar catheter with 5 pairs of coronary sinus (CS) electrodes. Accessory pathway mapping was performed in right and left cavities and within the CS. All electrograms into CS showed short AV from proximal to distal CS. Finally, ablation of two accessory pathway recordings was achieved at two distant epicardial points within the CS. Conclusions Ablation at two distant sites, one on the ventricular side and the other on the mitral annulus, suggests the presence of an oblique accessory pathway and at the same time the differential diagnosis of the presence of two accessory pathways. In our point of view according the above, we consider this is a very rare case of oblique AP with epicardial trajectory. The sequence of electrograms (in this case) along the CS has not been seen before in the literature reviewed. It is important, regardless of the urgency, to follow diagnostic and therapeutic protocols in invasive electrophysiology.
Raimundo Carmona Puerta, Elizabeth Lorenzo Martínez, Ionut Donoiu, and Elibet Chávez González
Wiley
R. Carmona-Puerta and E. Lorenzo-Martínez
Elsevier BV
Raimundo Carmona-Puerta, Elibet Chávez-González, Gustavo Padrón-Peña, Juan Miguel Cruz-Elizundia, Fernando Rodríguez-González, and Elizabeth Lorenzo-Martínez
Elsevier BV
Raimundo Carmona Puerta, Elizabeth Lorenzo Martínez, Magda Alina Rabassa López-Calleja, Gustavo Padrón Peña, Yaniel Castro Torres, Juan Miguel Cruz Elizundia, Fernando Rodríguez González, Luis Ángel García Vázquez, and Elibet Chávez González
S. Karger AG
<b><i>Objective:</i></b> Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). <b><i>Subjects and Methods:</i></b> This was a cross-sectional study in 153 randomly selected patients aged 18–70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. <b><i>Results:</i></b> The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; <i>p</i> &#x3c; 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). <b><i>Conclusions:</i></b> Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.
Raimundo Carmona Puerta, Elizabeth Lorenzo Martínez, Magdalina Rabassa López-Calleja, Gustavo Padrón Peña, Juan Miguel Cruz Elizundia, Fernando Rodríguez González, and Elibet Chávez González
Elsevier BV
BACKGROUND
Local theory and the vectorial theory are used to explain the origin of P-wave dispersion (PWD). There are no previous studies that analyze both at the same time.
OBJECTIVES
We set out to determine the implication of local and vectorial theories in the origin of PWD.
METHODS
Cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing electrophysiological study. Inhomogeneous atrial conduction was evaluated by atrial electrogram dispersion in terms of duration (EGMdurdis) and morphology (EGMmorph dis). P-distal coronary sinus interval (P-DCS) was also measured. P-wave was measured twice, firstly at a calibration of 20 mm/mV and a sweep speed of 50 mm/s, enhancement 10× (basic measurement [BM]), and second time at sweep speed of 150 mm/s, enhancement 80-160× (high precision measurement [HPM]).
RESULTS
PWD with BM was 48 ms [36-54 ms] while with HPM it was 4 ms [0-10 ms], p < 0.001. With BM, maximum and minimum P- wave duration presented a moderate correlation (r = 0.342; p < 0.001), using HPM it becomes strong (r = 0.750; p < 0.001). In cases with P-DCS < 80 ms (r = 0.965; p < 0.001), but not with P-DCS ≥ 80 ms (r = 0.649; p < 0.001), the previous correlation became almost perfect with HPM. EGMdurdis and EGMmorphdis were weak but significantly correlated with PWD. This correlation became moderate in patients with P-DCS ≥ 80 ms and disappeared in those with P-DCS, using BM and HPM.
CONCLUSION
Vectorial theory explains almost entirely the PWD phenomenon. Inhomogeneous conduction could be an additional mechanism to explain PWD, but its contribution is small.
Raimundo Carmona Puerta and Elizabeth Lorenzo Martínez
Elsevier BV
Abstract For years, there has been an increase in cases of atrial fibrillation, reaching alarming levels. This is why intense work is done to find predictors of this arrhythmia. The electrocardiogram has shown to be useful for this purpose, and multiple indices derived from the P wave have been developed. Among the most notable is the P wave dispersion (PWD). It has been verified that PWD can predict the occurrence of paroxysmal atrial fibrillation in the absence of diseases as well as in the context of multiple cardiovascular pathologies or other systems. PWD is considered by most researchers to be the result of inhomogeneous conduction of the atrial electrical impulse, but a vector explanation may play a role in its genesis. The large body of evidence surrounding PWD supports its use in clinical practice.
Raimundo Carmona Puerta, Elibet Chávez González, Magda Alina Rabassa López‐Calleja, Elizabeth Lorenzo Martínez, Juan Miguel Cruz Elizundia, Gustavo Padrón Peña, and Fernando Rodríguez González
Wiley
Raimundo Carmona Puerta
Elsevier BV
In 1979 Bayés de Luna described interatrial blocks (IAB). Following the same principle of classification of blocks in other structures of the heart, he divided them into first (partial IAB), second (atrial aberrancy) and third degree (advanced IAB). Atypical forms of these blocks were recently described. There is evidence that delays or blocks of conduction in the Bachmann bundle constitute the mechanistic basis of these blocks. The association between IAB, mainly those of advanced grade, and atrial tachyarrhythmias is already constituted science, and is referred to by the medical community as Bayés syndrome. IABs are also associated with the occurrence of ischaemic stroke and recurrence of atrial fibrillation in several scenarios. This review presents classical aspects and sheds light on the interpretation of this electrocardiographic pattern in clinical practice.
Yaniel Castro-Torres, Raimundo Carmona-Puerta, Elibet Chávez-González, and Emilio Francisco González-Rodríguez
Universidad del Valle
Aim: To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Methods: Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. Results: Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. Conclusions: The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.
Raimundo Carmona-Puerta and Yaniel Castro-Torres
Wiley
The diagnosis of cryptogenic stroke is made by exclusion. However, current evidence supports the role of atrial fibrillation episodes as a cause of this condition. Prospective data have demonstrated the benefits of long‐term electrocardiographic monitoring to identify atrial fibrillation in association with cryptogenic stroke. This aim of this article was to analyze the contemporary evidence for the possible relationship between atrial fibrillation and cryptogenic stroke and the role of continuous electrocardiographic monitoring to clarify this hypothesis.
Yaniel Castro-Torres, Nabeel Yar Khan, and Raimundo Carmona-Puerta
FapUNIFESP (SciELO)
Summary Objective: To characterize the maximum P-wave duration (Pmax) and P-wave dispersion (PWD) according to blood pressure (BP) and uric acid (UA) levels in geriatric patients. Method: An analytical study was performed in 83 patients aged over 60 years treated at the Family Medical Office 5 of the Aracelio Rodríguez Castellón Polyclinic, in Cienfuegos, Cuba between January and December 2015. The sample was divided into two groups (patients with hyperuricemia and patients with normal UA levels). Results: We found a linear and significant correlation between diastolic BP and Pmax in patients with hyperuricemia (r=0.695; p=0.026), but not in patients with normal UA (r=0.048; p=0.757). A linear and significant correlation was demonstrated between diastolic BP and PWD in patients with hyperuricemia (r=0.657; p=0.039), but not in patients with normal UA (r=0.054; p=0.730). Conclusion: There is correlation between diastolic BP and Pmax plus PWD in elderly patients with hyperuricemia.
Yaniel Castro-Torres, Raimundo Carmona-Puerta, and Luis Castañeda-Carsarvilla
Czech Society of Cardiology
Abstract Introduction Electrocardiographic markers for atrial fibrillation and the relationship with inflammatory markers have not been evaluated in smoker patients with acute myocardial infarction. Material and methods This is a cross-sectional study developed between January 2012 and July 2014 at Hospital Universitario Celestino Hernandez Robau from Santa Clara, Cuba. One hundred fifteen patients were included finally. The sample was divided into two groups (smokers and non-smokers). We obtained clinical and laboratory data and compared electrocardiographic markers for atrial fibrillation in both groups and with inflammatory markers. Results Maximum p wave duration was significantly higher in smoker than non-smoker patients (102 ± 12 vs. 97 ± 9; p = 0,020). Minimum p wave duration and p wave dispersion also are higher in smoker patients but not significantly (61 ± 10 vs. 60 ± 7; p = 0,476 and 41 ± 10 vs. 37 ± 9; p = 0,050). There is a positive and significant linear correlation between neutrophils count and maximum p wave duration in smokers ( r = 0,45; p = 0,004), but not in non-smokers patients ( r = 0,09; p = 0,49). There is a negative correlation between lymphocyte count and maximum p wave duration in smokers ( r = -0,44; p = 0,004) and in non-smoker patients ( r = -0,07; p = 0,62). Conclusion Maximum p wave duration is higher in smoker patients than non-smoker patients during ST-elevation acute myocardial infarction. Neutrophil count is positively associated with maximum p wave duration in smoker patients. Lymphocyte count has a negative association with maximum p wave duration.
Y. Castro-Torres, A. Fleites-Pérez, R. Carmona-Puerta, and R. G. Jiménez-Garrido
Springer Science and Business Media LLC
Chlorthalidone is commonly used for blood pressure control in hypertensive patients. However, it increases sympathetic nervous system activity and insulin resistance. Both conditions are related with an elevated number of complications and worsen patients’ prognosis. Recently has been demonstrated that these adverse effects are avoided with spironolactone administration. Mechanisms to explain increasing sympathetic nervous activity and insulin resistance with chlorthalidone, but not with spironolactone are unclear and under investigation. It should be necessary to continue medical investigation on this field with long-term studies, a larger number of patients and associated comorbidities. The aim should be to establish whether the association of both drugs could be an effective and safety choice to be implemented extensively in clinical practice. That possibility could represent a new alternative for patients’ management.
Yaniel Castro Torres, Anamary Fleites Pérez, Raimundo Carmona Puerta, Marlen Vega Valdez, and Indira Santiestebán Castillo
Elsevier BV
Resumen El deficit de la vitamina D se ha relacionado con el aumento en las cifras de la presion arterial. Un incremento en la actividad del sistema renina-angiotensina-aldosterona, la disfuncion endotelial, las alteraciones en la homeostasis del calcio, el aumento del estres oxidativo y la disminucion en la sintesis de las prostaglandinas parecen ser los principales mecanismos fisiopatologicos involucrados en los pacientes con deficit de la vitamina D y aumento de la presion arterial. El uso de suplementos de la vitamina D para reducir el riesgo o la progresion de la hipertension arterial puede ser una alternativa en los pacientes con bajos niveles de esta vitamina. El deficit de la vitamina D se ha relacionado con el fallo de la terapeutica antihipertensiva y debe continuar evaluandose la efectividad del tratamiento hipotensor en pacientes con bajos niveles de este compuesto
Alejandro Girela
Revista Argentina de Cardiologia
Raimundo Carmona Puerta, Yaniel Castro Torres, Zoila Armada Esmore, César Cáceres Monie, José Estepo, Claudio Higa, Alberto Morales Salinas, Gastón Rodríguez Granillo, Edgardo Schapachnik, Jorge Yanovsky,et al.
Revista Argentina de Cardiologia
Raimundo Carmona Puerta, Yaniel Castro Torres, Zoila Armada Esmore, César Cáceres Monie, José Estepo, Claudio Higa, Alberto Morales Salinas, Gastón Rodríguez Granillo, Edgardo Schapachnik, Jorge Yanovsky,et al.
Revista Argentina de Cardiologia