RESUMO
BACKGROUND: Despite improvement in treatment strategies of atrial fibrillation (AF), a considerable number of patients still experience recurrence of atrial tachyarrhythmia (ATA) following catheter ablation (CA). This study aimed to investigate the prognostic value of left atrial (LA) deformation analysis in a large group of patients undergoing CA for AF. METHODS: This study included 678 patients with AF. Echocardiography including two-dimensional speckle tracking echocardiography (2DSTE) was performed in all patients prior to CA. Logistic regression analysis was used to assess the association between ATA recurrence and LA strain during reservoir phase (LASr), LA strain during contraction phase (LASct), and LA strain during conduit phase (LAScd). RESULTS: During one-year follow-up, 274 (40%) experienced ATA recurrence. Median age of the included study population was 63.2 years (IQR: 55.5, 69.5) and 485 (72%) were male. Patients with recurrence had lower LASr (22.6% vs. 25.1%, p = 0.001) and LASct (10.7% vs. 12.4%, p < 0.001). No difference in LAScd was observed. After adjusting for potential clinical and echocardiographic confounders LASr (OR = 1.04, CI95% [1.01; 1.07], p = 0.015, per 1% decrease) and LASct (OR = 1.06, CI95% [1.02; 1.11], p = 0.007, per 1% decrease) remained independent predictors of recurrence. However, in patients with a normal-sized LA (LA volume index<34 mL/m2), only LASct remained an independent predictor of recurrence (OR = 1.07, CI95% [1.01; 1.12], p = 0.012, per 1% decrease). CONCLUSION: In patients undergoing CA for AF, LA deformation analysis by 2DSTE could be of use in risk stratification in clinical practice regarding ATA recurrence, even in patients with a normal-sized LA.
Assuntos
Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Apêndice Atrial/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Feminino , Átrios do Coração , Humanos , Masculino , Recidiva , Taquicardia/diagnóstico por imagem , Resultado do TratamentoRESUMO
Because of its involvement in a wide variety of cardiovascular, metabolic and behavioural functions, the hypothalamus constitutes a potential target for neuromodulation in a number of treatment-refractory conditions. The precise neural substrates and circuitry subserving these responses, however, are poorly characterized to date. We sought to retrospectively explore the acute sequelae of hypothalamic region deep brain stimulation and characterize their neuroanatomical correlates. To this end we studied-at multiple international centres-58 patients (mean age: 68.5 ± 7.9 years, 26 females) suffering from mild Alzheimer's disease who underwent stimulation of the fornix region between 2007 and 2019. We catalogued the diverse spectrum of acutely induced clinical responses during electrical stimulation and interrogated their neural substrates using volume of tissue activated modelling, voxel-wise mapping, and supervised machine learning techniques. In total 627 acute clinical responses to stimulation-including tachycardia, hypertension, flushing, sweating, warmth, coldness, nausea, phosphenes, and fear-were recorded and catalogued across patients using standard descriptive methods. The most common manifestations during hypothalamic region stimulation were tachycardia (30.9%) and warmth (24.6%) followed by flushing (9.1%) and hypertension (6.9%). Voxel-wise mapping identified distinct, locally separable clusters for all sequelae that could be mapped to specific hypothalamic and extrahypothalamic grey and white matter structures. K-nearest neighbour classification further validated the clinico-anatomical correlates emphasizing the functional importance of identified neural substrates with area under the receiving operating characteristic curves between 0.67 and 0.91. Overall, we were able to localize acute effects of hypothalamic region stimulation to distinct tracts and nuclei within the hypothalamus and the wider diencephalon providing clinico-anatomical insights that may help to guide future neuromodulation work.
Assuntos
Afeto/fisiologia , Sistema Nervoso Autônomo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Cognição/fisiologia , Estimulação Encefálica Profunda/métodos , Hipotálamo/diagnóstico por imagem , Idoso , Sistema Nervoso Autônomo/fisiologia , Temperatura Corporal/fisiologia , Eletrodos Implantados , Feminino , Humanos , Hipotálamo/fisiologia , Hipotálamo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia/diagnóstico por imagem , Taquicardia/fisiopatologiaRESUMO
BACKGROUND: During sepsis, heart rate (HR) reduction could be a therapeutic target, but identification of responders (non-compensatory tachycardia) and non-responders (compensatory for 'fixed' stroke volume [SV]) is challenging. We tested the ability of the difference between systolic and dicrotic pressure (SDPdifference), which reflects the coupling between myocardial contractility and a given afterload, in discriminating the origin of tachycardia. METHODS: In this post hoc analysis of 45 patients with septic shock with persistent tachycardia, we characterised features of haemodynamic response focusing on SDPdifference, classifying patients according to variations in arterial dP/dtmax after 4 h of esmolol administration to maintain HR <95 beats min-1. A cut-off value of 0.9 mm Hg ms-1 was used for group allocation. RESULTS: After reducing HR, arterial dP/dtmax remained above the cut-off in 23 patients, whereas it decreased below the cut-off in 22 patients (from 0.99 [0.37] to 0.63 [0.16] mm Hg ms-1; mean [SD], P<0.001). At baseline, patients with decreased dP/dtmax after esmolol had lower SDPdifference than those with higher dP/dtmax (40 [19] vs 53 [16] mm Hg, respectively; P=0.01). The SDPdifference remained unchanged after esmolol in the higher dP/dtmax group (49 [16] mm Hg), whereas it decreased significantly in patients with lower dP/dtmax (29 [11] mm Hg; P<0.001). In the latter, the HR reduction resulted in a significant cardiac output reduction with unchanged SV, whereas in patients with higher dP/dtmax SV increased (from 48 [12] to 67 [14] ml; P<0.001) with maintained cardiac output. CONCLUSIONS: A decrease in SDPdifference could discriminate between compensatory and non-compensatory tachycardia, revealing a covert loss of myocardial contractility not detected by conventional echocardiographic parameters and deteriorating after HR reduction with esmolol. CLINICAL TRIAL REGISTRATION: NCT02188888.
Assuntos
Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Choque Séptico/fisiopatologia , Taquicardia/fisiopatologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Pressão Arterial , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Norepinefrina/uso terapêutico , Propanolaminas/uso terapêutico , Estudos Prospectivos , Choque Séptico/diagnóstico por imagem , Taquicardia/diagnóstico por imagem , Taquicardia/tratamento farmacológico , Taquicardia/etiologia , Vasoconstritores/uso terapêuticoRESUMO
OBJECTIVE: Focal atrial tachycardia accounts for up to 10-15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia. METHODS: Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study. RESULTS: The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5-18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%). CONCLUSION: The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.
Assuntos
Ablação por Cateter , Taquicardia , Adolescente , Criança , Fluoroscopia , Humanos , Volume Sistólico , Taquicardia/diagnóstico por imagem , Taquicardia/terapia , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Atrioventricular (AV)-nodal-reentrant-tachycardia is a rare association in a patient with persistent left-sided superior vena cava and dilated coronary sinus. There are a few inherent difficulties in ablation in this condition, viz., difficulty in localization of good site for ablation and difficulty in stabilization of the ablation catheter at the designated site, making it difficult to produce transmural lesions and increasing risk of producing AV block. We hereby present a case highlighting the difficulties and possible solutions for them.
Assuntos
Ablação por Cateter/métodos , Seio Coronário/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia/diagnóstico por imagem , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Resultado do Tratamento , Veia Cava Superior/anormalidadesRESUMO
Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.
Assuntos
Aneurisma Coronário/diagnóstico por imagem , Fístula/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Ecocardiografia/métodos , Feminino , Fístula/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Humanos , Recém-Nascido , Gravidez , Diagnóstico Pré-Natal/métodos , Taquicardia/diagnóstico por imagem , Taquicardia/cirurgiaRESUMO
BACKGROUND: Inserting an electrophysiological (EP) catheter into the coronary sinus (CS) via the femoral vein can be difficult and time-consuming in patients with variants of the CS orifice or lumen curve. Our experience with such patients inspired us to develop two new techniques: the Asclepius and Yellow Ribbon techniques. METHODS: Data from a 4-year period were retrieved from records of patients undergoing radiofrequency ablation for paroxysmal supraventricular tachycardia (PSVT) or Wolff-Parkinson-White (WPW) syndrome. Data were analyzed to determine the success and complication rates of conventional and alternative techniques for catheter placement. RESULTS: The success rate of the Asclepius technique was 96.7% (30/31) and that of the Yellow Ribbon technique was 100.0% (7/7). The overall success rate of these two techniques was 97.3% (37/38). CONCLUSIONS: With a high success rate, shorter procedure time, and no complications, the Asclepius and Yellow ribbon techniques may be safe, inexpensive, and effective alternative strategies for EP catheter placement in patients with difficult coronary sinus orifice access.
Assuntos
Catéteres , Seio Coronário/diagnóstico por imagem , Eletrofisiologia/instrumentação , Eletrofisiologia/métodos , Taquicardia/diagnóstico por imagem , Síndrome de Wolff-Parkinson-White/diagnóstico por imagem , Adulto , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia/cirurgia , Taquicardia Paroxística/diagnóstico por imagem , Taquicardia Paroxística/cirurgia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/cirurgiaAssuntos
Arritmias Cardíacas/diagnóstico por imagem , Ecocardiografia/métodos , Diagnóstico Pré-Natal/métodos , Análise Espaço-Temporal , Taquicardia/diagnóstico por imagem , Adulto , Arritmias Cardíacas/embriologia , Feminino , Coração Fetal/diagnóstico por imagem , Humanos , Ilustração Médica , Gravidez , Taquicardia/embriologiaRESUMO
OBJECTIVES: A new electroanatomic mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) using a 64-electrode mapping basket is now available; we systematically assessed its use in complex congenital heart disease (CHD). BACKGROUND: The incidence of atrial arrhythmias post-surgery for CHD is high. Catheter ablation has emerged as an effective treatment, but is hampered by limitations in the mapping system's ability to accurately define the tachycardia circuit. METHODS: Mapping and ablation data of 61 patients with CHD (35 males, age 45 ± 14 years) from 8 tertiary centers were reviewed. RESULTS: Causes were as follows: Transposition of Great Arteries (atrial switch) (n = 7); univentricular physiology (Fontans) (n = 8); Tetralogy of Fallot (n = 10); atrial septal defect (ASD) repair (n = 15); tricuspid valve (TV) anomalies (n = 10); and other (n = 11). The total number of atrial arrhythmias was 86. Circuits were predominantly around the tricuspid valve (n = 37), atriotomy scar (n = 10), or ASD patch (n = 4). Although the majority of peri-tricuspid circuits were cavo-tricuspid-isthmus dependent (n = 30), they could follow a complex route between the annulus and septal resection, ASD patch, coronary sinus, or atriotomy. Immediate ablation success was achieved in all but 2 cases; with follow-up of 12 ± 8 months, 7 patients had recurrence. CONCLUSIONS: We demonstrate the feasibility of the basket catheter for mapping complex CHD arrhythmias, including with transbaffle and transhepatic access. Although the circuits often involve predictable anatomic landmarks, the precise critical isthmus is often difficult to predict empirically. Ultra-high-density mapping enables elucidation of circuits in this complex anatomy and allows successful treatment at the isthmus with a minimal lesion set.
Assuntos
Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Cardiopatias Congênitas , Taquicardia , Adulto , Idoso , Ablação por Cateter/instrumentação , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Desenho de Equipamento , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia/diagnóstico por imagem , Taquicardia/etiologia , Taquicardia/fisiopatologiaRESUMO
Fetal seizure is rarely observed. Investigation of both video-recording of seizures and cardiotocography is crucial for a precise diagnosis. Here, we report a case of fetal seizure, and also show a video-ultrasound recording. A 40-year-old woman was admitted to us due to loss of variability in cardiotocography. Ultrasound repeatedly revealed opisthotonus-like and clonic-seizure-like movements. After the abnormal movement, tachycardia up to 210 bpm (postictal tachycardia) was noted. Ultrasound revealed a nuchal cord. A careful investigation of video-ultrasound recording by an epilepsy specialist led to the confirmation of epileptic seizures. At 364/7 , she vaginally gave birth to an infant with an umbilical artery pH of 7.22. The infant died 30 min after birth. No clear video-recordings associated with fetal seizure were available for cases reported so far in the literature. The video provided in this case may be of use for further analyses.
Assuntos
Doenças Fetais/diagnóstico , Convulsões/diagnóstico , Taquicardia/diagnóstico , Adulto , Eletrocardiografia , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Recém-Nascido , Morte Perinatal , Gravidez , Convulsões/diagnóstico por imagem , Taquicardia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Monitorização UterinaRESUMO
BACKGROUND: Few studies have investigated the prognostic value of cardiac implantable electronic device (CIED)-detection of sleep-disordered breathing (SDB) for risk stratification of cardiovascular events. In the Device-Detected CArdiac Tachyarrhythmic events and Sleep-disordered breathing (DEDiCATES) study, we aim to determine whether device-detected SDB events are associated with increased risk of cardiac arrhythmias or other cardiovascular outcomes. METHODS AND DESIGN: Six-hundred patients (300 patients with low-voltage pacing devices and 300 with high-voltage defibrillator devices) who have dual chamber CIEDs with AP Scan™ function (Boston Scientific Inc., Marlborough, MA, USA) are planned to be enrolled in this study. AP Scan reports the average number of sleep disturbance events per hour per night in the form of a Respiratory Disturbance Index (RDI). The daily RDI values are to be used for quantitative measurement of the severity and burden of SDB. CIED-detected atrial high rate episodes (AHREs) and clinical atrial tachyarrhythmia will be assessed as the primary outcomes over a follow-up period of 2â¯years. Correlations between CIED-detected SDB and AHRE burdens will be analyzed. The secondary outcomes are CIED-detected or clinical ventricular arrhythmic events, stroke, heart failure hospitalization, mortality, and quality of life. CONCLUSION: This study will determine the prognostic value of automated diagnostic function of CIED for SDB, which will help to improve the cardiovascular prognoses of CIED patients by enabling convenient and accurate assessments of SDB events.
Assuntos
Estimulação Cardíaca Artificial/métodos , Desfibriladores Implantáveis , Determinação de Ponto Final/métodos , Síndromes da Apneia do Sono/diagnóstico por imagem , Taquicardia/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial/tendências , Desfibriladores Implantáveis/tendências , Determinação de Ponto Final/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Polissonografia/tendências , Estudos Prospectivos , Síndromes da Apneia do Sono/fisiopatologia , Taquicardia/fisiopatologiaRESUMO
OBJECTIVE: To our knowledge, this is the largest prospective study reporting on maternal heart rate (MHR) levels in laboring women (30 patients), and maternal tachycardia that is a potential risk factor in fetal monitoring confusion. Our objective was to analyze a large population of contiguous laboring patients and to assess the MHR levels attained during the second stage. METHODS: We performed a prospective study that analyzed MHR levels of second-stage laboring patients evaluating numerous predisposing maternal conditions. Univariate and stepwise multivariate logistic regression analysis were performed. RESULTS: A total of 1105 contiguous patients were analyzed and 33.9% had a sustained MHR ≥100; 18.8% had an MHR ≥110; and 9.1% had an MHR ≥120. Multivariate analysis of all potential predisposing maternal conditions did not reveal any specific variable as uniformly significant for predicting maternal tachycardia across all levels of analysis. CONCLUSIONS: The incidence of maternal tachycardia in the second stage of labor is common. We recommend that if the MHR is ≥100 during labor, the simultaneous maternal and fetal heart rate (FHR) monitoring will be used to minimize the potential for fetal monitoring confusion and risking poor fetal outcome if the fetus is in distress.
Assuntos
Frequência Cardíaca Fetal , Frequência Cardíaca , Complicações do Trabalho de Parto/epidemiologia , Taquicardia/epidemiologia , Adulto , Cardiotocografia , Feminino , Humanos , Segunda Fase do Trabalho de Parto/fisiologia , Complicações do Trabalho de Parto/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Taquicardia/diagnóstico por imagem , Ultrassonografia Doppler , Adulto JovemRESUMO
Ventricular (VT) and atrial (AT) tachycardias are some of the most common clinical cardiac arrhythmias. For ablation of tachycardia substrates, two clinical diagnosis methods are used: invasive electroanatomical mapping for an accurate diagnosis using electrograms (EGMs) acquired with intracardiac catheters, and localized on the surface mesh of the studied cavities; and noninvasive electrocardiographic imaging (ECGi) for a global view of the arrhythmia, with EGMs mathematically reconstructed from body surface electrocardiograms using 3-D cardio-thoracic surface meshes obtained from CT-scans. In clinics, VT and AT are diagnosed by studying activation time maps that depict the propagation of the activation wavefront on the cardiac mesh. Nevertheless, slow conduction areas-a well-known proarrhythmic feature for tachycardias-and tachycardia specific propagation patterns are not easily identifiable with these maps. Therefore, local characterization of the activation wavefront propagation can be helpful for improving VT and AT diagnoses. The purpose of this study is to develop a method to locally characterize the activation wavefront propagation for clinical data. For this, a conduction velocity vector field is estimated and analyzed using divergence and curl mathematical operators. The workflow was first validated on a simulated database from computer models, and then applied to a clinical database obtained from ECGi to improve AT diagnosis. The results show the relevancy and the efficacy of the proposed method to guide ablation of tachyarrhythmias.
Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Técnicas de Imagem Cardíaca/métodos , Eletrocardiografia/métodos , Taquicardia/diagnóstico por imagem , Algoritmos , Simulação por Computador , Coração/diagnóstico por imagem , Coração/fisiologia , HumanosRESUMO
PURPOSE: Implantable cardioverter defibrillators (ICDs) can treat life-threatening tachyarrhythmia with high-voltage shocks. The aims were to compare the efficacy of single and dual coil shock vectors in modern ICDs and to identify predictors of shock failure. METHODS: This is a single-center paired randomized study including 216 patients with mixed indications and ICDs from four manufacturers. All patients underwent two implant defibrillation tests using single and dual coil vectors with the test order randomized. Tested shock energy differed slightly between manufacturers because of differences in device programmability: first shock approximately 15 J below maximal output-if failed, second shock approximately 10 J below maximal output-if failed, third shock at maximal output. RESULTS: First shock success rate was 399/432 (92.4%). Comparing single and dual coil vectors, no differences were seen in first shock efficacy (91.7% vs. 93.1%, P = 0.629) or lowest tested succesfully stored energy (27.2 J vs. 27.1 J, P = 0.620). All successive internal shocks failed in 4/432 (0.9%) of inductions requiring external rescue shocks to restore circulation. Multivariate predictors of first shock failure were QRS duration (relative risk 0.81 per 10 ms, P = 0.001), amiodarone treatment (relative risk 3.30, P = 0.003), and body height (relative risk 1.70 per 10 cm, P = 0.019). CONCLUSIONS: Implant defibrillation testing of modern intravenous ICD systems demonstrates high shock efficacy with no difference between single and dual coil vectors.
Assuntos
Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Desenho de Equipamento , Taquicardia/terapia , Idoso , Dinamarca , Cardioversão Elétrica/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Distribuição de Poisson , Valor Preditivo dos Testes , Recidiva , Medição de Risco , Taquicardia/diagnóstico por imagem , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico por imagem , Fibrilação Ventricular/terapiaRESUMO
OBJECTIVES: The association of an abnormal fetal heart rate (FHR) and chromosomal anomalies in the first trimester of pregnancy remains unclear, probably because of the lack of control for known confounding factors. This study was designed to determine whether an increased FHR is an independent risk factor for chromosomal anomalies between 11 and 14 weeks' gestation. METHODS: This cohort study included women who underwent first-trimester genetic screening between 2011 and 2014 at a single institution. A multivariable logistic regression analysis was performed to determine whether an FHR of 170 beats per minute (bpm) or higher, derived from a receiver operating characteristic curve, is an independent risk factor for all chromosomal anomalies while controlling for known confounding factors. P < .05 was considered significant. RESULTS: An FHR of 170 bpm or higher was observed in 7% (228 of 3254), and chromosomal anomalies were present in 1.0% (31 of 3254) of the population. A higher proportion of fetuses with an FHR of 170 bpm or higher had chromosomal anomalies compared to those with an FHR lower than 170 bpm. An FHR of 170 bpm or higher was an independent risk factor for chromosomal anomalies after controlling for known confounding factors. Of note, in the group of fetuses with a nuchal translucency above the 95th percentile, the frequency of chromosomal anomalies was significantly higher among fetuses with an FHR of 170 bpm or higher compared to those with an FHR lower than 170 bpm. CONCLUSIONS: Fetal tachycardia is a risk factor for chromosomal anomalies during first-trimester genetic screening, independent of increased nuchal translucency, nuchal septations, and maternal age.
Assuntos
Transtornos Cromossômicos/complicações , Transtornos Cromossômicos/diagnóstico , Testes Genéticos/métodos , Taquicardia/diagnóstico por imagem , Taquicardia/embriologia , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos de Coortes , Feminino , Coração Fetal/diagnóstico por imagem , Coração Fetal/embriologia , Coração Fetal/fisiopatologia , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos , Fatores de Risco , Taquicardia/complicaçõesAssuntos
Feixe Acessório Atrioventricular , Ablação por Cateter , Taquicardia , Feixe Acessório Atrioventricular/diagnóstico por imagem , Feixe Acessório Atrioventricular/cirurgia , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Taquicardia/diagnóstico por imagem , Taquicardia/cirurgiaRESUMO
PURPOSE: To evaluate the relationship between extension or texture features of late gadolinium enhancement (LGE) and ventricular tachyarrhythmias in hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS: Twenty-three patients with HCM were enrolled in this IRB-approved study. The extension of LGE was determined based on the American Heart Association segments model. Texture analysis was performed for 43 myocardial LGE using an open-access software (MaZda, Technical University of Lodz, Institute of Electronics, Poland). The relationship between the extension or texture features of LGE and ventricular tachyarrhythmias was evaluated using unpaired test and receiver-operating characteristic (ROC) analysis. RESULTS: Six of 23 patients had a history of ventricular tachyarrhythmias, and 16 patients had LGE. All of the 6 patients with the arrhythmias had more than 4 LGE segments and more LGE segments than those without (p < 0.01). Among 4 texture features, entropy LL was the only discriminator between the 2 patient groups (p < 0.01; threshold, 19624; area under the curve [AUC], 0.72). An ROC analysis gave the number of segments showing LGE a better result (AUC, 0.96) for identification of HCM patients with ventricular tachyarrhythmias than the entropy LL of LGE. CONCLUSION: Patients with HCM and a history of ventricular tachyarrhythmias had a wider extension of LGE, and their entropy LL of LGE was significantly lower than those without. The extension of LGE and texture analysis may provide information about LGE related to ventricular tachyarrhythmias in HCM.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Taquicardia/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatia Hipertrófica/complicações , Meios de Contraste , Estudos Transversais , Feminino , Fibrose , Gadolínio , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio , Estudos Retrospectivos , Taquicardia/complicaçõesRESUMO
The His bundle divides into the right bundle branch (RBB) and the more complex left bundle branch (LBB). The latter is typically represented as further dividing into anterior and posterior fascicles, and possibly an additional septal fascicle. This construct raises questions as to why conduction can be preserved in patients with "trifascicular block" and why it sometimes very difficult to ablate fascicular or papillary muscle tachycardias. The answer may be that the LBB is much more complex, variable, and interconnected and that the simple familiar constructs may have obstructed our understanding of conduction and tachycardias. Remarkably, the actual explanatory histopathology has been known for nearly half a century, spearheaded by the work of Demoulin and Kulbertus. One picture is worth a thousand words.