Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 4 de 4
Filtrar
1.
Pacing Clin Electrophysiol ; 42(5): 542-547, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30829416

RESUMO

BACKGROUND: Leadless pacemakers (LPMs) have been shown to have lower postoperative complications than traditional permanent pacemakers but there have been no studies on the outcomes of LPMs in patients with transcatheter heart valve replacements (THVRs). This study determined outcomes of LPMs compared to transvenous single-chamber pacemakers (SCPs) post-THVR. METHODS: This is a retrospective single-center study including 10 patients who received LPMs post-THVR between February 2017 and August 2018 and a comparison group of 23 patients who received SCP post-THVR between July 2008 and August 2018. LPM or SCP was implanted at the discretion of electrophysiologists for atrial fibrillation with slow ventricular response or sinus node dysfunction with need for single-chamber pacing only. RESULTS: LPMs were associated with decreased tricuspid regurgitation (P = 0.04) and decreased blood loss during implantation (7.5 ± 2.5 cc for LPMs vs 16.8 ± 3.2 cc for SCPs, P = 0.03). Five LPM patients had devices positioned in the right ventricular septum as seen on transthoracic echocardiogram. Frequency of ventricular pacing was similar between LPM and SCP groups. In the LPM group, one case was complicated by a pseudoaneurysm and one death was due to noncardiac causes. There was one pneumothorax and one pocket infection in the SCP group. CONCLUSIONS: In this small retrospective study, LPMs were feasible post-THVR and found to perform as well as SCPs, had less intraprocedural blood loss, and were associated with less tricuspid regurgitation. Further, larger studies are required to follow longer-term outcomes and complications.


Assuntos
Estimulação Cardíaca Artificial/métodos , Procedimentos Cirúrgicos Cardíacos , Marca-Passo Artificial , Complicações Pós-Operatórias/prevenção & controle , Substituição da Valva Aórtica Transcateter , Insuficiência da Valva Tricúspide/prevenção & controle , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos
2.
Crit Pathw Cardiol ; 19(3): 105-111, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32324622

RESUMO

The coronavirus disease 2019 crisis is a global pandemic of a novel infectious disease with far-ranging public health implications. With regard to cardiac electrophysiology (EP) services, we discuss the "real-world" challenges and solutions that have been essential for efficient and successful (1) ramping down of standard clinical practice patterns and (2) pivoting of workflow processes to meet the demands of this pandemic. The aims of these recommendations are to outline: (1) essential practical steps to approaching procedures, as well as outpatient and inpatient care of EP patients, with relevant examples, (2) successful strategies to minimize exposure risk to patients and clinical staff while also balancing resource utilization, (3) challenges related to redeployment and restructuring of clinical and support staff, and (4) considerations regarding continued collaboration with clinical and administrative colleagues to implement these changes. While process changes will vary across practices and hospital systems, we believe that these experiences from 4 different EP sections in a large New York City hospital network currently based in the global epicenter of the coronavirus disease 2019 pandemic will prove useful for other EP practices adapting their own practices in preparation for local surges.


Assuntos
Assistência Ambulatorial/tendências , Eletrofisiologia Cardíaca , Infecções por Coronavirus , Reestruturação Hospitalar , Controle de Infecções , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Telemedicina/tendências , Betacoronavirus/isolamento & purificação , COVID-19 , Eletrofisiologia Cardíaca/métodos , Eletrofisiologia Cardíaca/organização & administração , Eletrofisiologia Cardíaca/tendências , Gestão de Mudança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Clínicos/tendências , Reestruturação Hospitalar/métodos , Reestruturação Hospitalar/organização & administração , Hospitalização/tendências , Hospitais Urbanos/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Cidade de Nova Iorque , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2
3.
Sci Transl Med ; 12(536)2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-32213631

RESUMO

Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. The 12-lead electrocardiogram (ECG) is the current noninvasive clinical tool used to diagnose and localize cardiac arrhythmias. However, it has limited accuracy and is subject to operator bias. Here, we present electromechanical wave imaging (EWI), a high-frame rate ultrasound technique that can noninvasively map with high accuracy the electromechanical activation of atrial and ventricular arrhythmias in adult patients. This study evaluates the accuracy of EWI for localization of various arrhythmias in all four chambers of the heart before catheter ablation. Fifty-five patients with an accessory pathway (AP) with Wolff-Parkinson-White (WPW) syndrome, premature ventricular complexes (PVCs), atrial tachycardia (AT), or atrial flutter (AFL) underwent transthoracic EWI and 12-lead ECG. Three-dimensional (3D) rendered EWI isochrones and 12-lead ECG predictions by six electrophysiologists were applied to a standardized segmented cardiac model and subsequently compared to the region of successful ablation on 3D electroanatomical maps generated by invasive catheter mapping. There was significant interobserver variability among 12-lead ECG reads by expert electrophysiologists. EWI correctly predicted 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses [unadjusted for arrhythmia type: odds ratio (OR), 11.8; 95% confidence interval (CI), 2.2 to 63.2; P = 0.004; adjusted for arrhythmia type: OR, 12.1; 95% CI, 2.3 to 63.2; P = 0.003]. This double-blinded clinical study demonstrates that EWI can localize atrial and ventricular arrhythmias including WPW, PVC, AT, and AFL. EWI when used with ECG may allow for improved treatment for patients with arrhythmias.


Assuntos
Arritmias Cardíacas , Ablação por Cateter , Adulto , Arritmias Cardíacas/diagnóstico por imagem , Diagnóstico por Imagem , Eletrocardiografia , Humanos , Ultrassonografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA