Nota: Estas diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

Introduction: The septal position is an alternative site for cardiac pacing (CP) that is potentially less harmful to cardiac function. Methods: Patients with Chagas disease without heart failure submitted to permanent pacemaker (PP) implantation at the Clinics Hospital of the Triângulo Mineiro Federal University (UFTM), were selected from February 2009 to February 2010. The parameters analyzed were ventricular remodeling, the degree of electromechanical dyssynchrony (DEM), exercise time and VO2 max during exercise testing (ET) and functional class (NYHA). Echocardiography was performed 24 to 48h following implantation and after one year follow-up. The patients were submitted to ET one month postprocedure and at the end of one year. Results: Thirty patients were included. Patient mean age was 59±13 yearsold. Indication for PP implantation was complete atrioventricular (AV) block in 22 (73.3%) patients and 2 nd degree AV block in the other eight (26.7%). All patients were in NYHA I and no changes occurred in the ET parameters. No variations were detected in echocardiographic remodeling measurements. Intraventricular dyssynchrony was observed in 46.6% of cases and interventricular dyssynchrony in 33.3% of patients after one year. Conclusions: The findings of this work suggest that there is not significant morphological and functional cardiac change following pacemaker implantation in septal position in chagasic patients with normal left ventricular function after one year follow-up. Thus, patients may remain asymptomatic, presenting maintenance of functional capacity and no left ventricular remodeling.

Mid-septum implantation was associated with slower CCC progression, generation of narrower QRS complexes, and lower electromechanical dyssynchrony, suggesting that this pacing site could be less harmful to cardiac function than the inflow tract site in patients with CCC.

Results: Dural Arteriovenous fistulas were found in patients at age ranging from 32-74 years old. They are mostly found at cavernous sinus (40%), transverse-sigmoid sinus (35%) respectively. At these locations patients usually present with headache, exophthalmos and opthalmoparesis (70%, 65%, and 38% respectively) which are resemble with other common neurological diseases. CT brain, MRI or MRA brain were selected to examine in every patients. Average delayed time before definite diagnosis is 1.5 months. Factors involved in delayed diagnosis are unrecognizing symptoms mimicking common neurological diseases (60%), choosing improper neuroimaging (60%) and overlooking subtle abnormalities in those neuroimaging (45%). Conclusions: Keeping in mind that headache, exophthalmos and opthalmoparesis can be presentation of dural arteriovenous fistulas particularly in middle-age to elderly patients and selecting proper initial neuroimaging as well as meticulous interpreting would help to achieve correct diagnosis and be able to start treatment in timely fashion.

Estima-se que até 75% dos pacientes com dispositivos cardíacos eletrônicos implantáveis (DCEIs) terão indicação de exame de ressonância nuclear magnética (RNM) ao longo da vida. Pelas características dos dispositivos, esses foram excluídos historicamente do rol de pacientes considerados elegíveis ao exame.