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BACKGROUND: The pharmacological therapy of ventricular arrhythmias in patients with unsuccessful or not feasible catheter ablation and contraindication or inefficacy to amiodarone and beta-blockers, is controversial. The present study investigated the effectiveness and tolerability of mexiletine in patients with recurrent ventricular arrhythmias and ischaemic heart disease, when the conventional antiarrhythmic therapy failed. METHODS: We enrolled all consecutive patients with unsuccessful/not feasible catheter ablation and ineffective/contraindicated amiodarone or beta-blockers, which started the mexiletine treatment for refractory ventricular tachycardia (VT) or ventricular fibrillation (VF) between January 2010 and January 2020. The primary endpoint was the total number of VT/VF episodes after the beginning of mexiletine therapy. The 2 secondary endpoints were the overall number of therapies released by implantable cardioverter-defibrillators (ICDs) and the discontinuation of the pharmacological therapy. The events occurring during the mexiletine treatment period were compared with those observed in a matched duration interval before the initiation of therapy. RESULTS: Thirty-four consecutive patients (27 males, 79.4%; mean age 74.0 ± 9.5 years) with ischaemic heart disease were finally analysed. The median of mexiletine treatment was 26.5 months (interquartile range: 18.75-38.25 months). After the mexiletine start, VT/VF episodes and ICD interventions significantly decreased (respectively: 74 vs 33 episodes, p = 0.002; 116 vs 52 interventions, p = 0.02) in comparison with a matched period without mexiletine. Six patients (13.9%) discontinued the treatment because of severe side effects. CONCLUSIONS: The treatment period following the mexiletine start was associated with a significant reduction of ventricular arrhythmias. The rate of side effects requiring dosage reduction or interruption was not neglectable.
Asunto(s)
Amiodarona , Enfermedad de la Arteria Coronaria , Desfibriladores Implantables , Isquemia Miocárdica , Taquicardia Ventricular , Anciano , Anciano de 80 o más Años , Amiodarona/efectos adversos , Antiarrítmicos/uso terapéutico , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/complicaciones , Desfibriladores Implantables/efectos adversos , Femenino , Humanos , Masculino , Mexiletine/uso terapéutico , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Taquicardia Ventricular/etiología , Taquicardia Ventricular/terapia , Fibrilación Ventricular/etiología , Fibrilación Ventricular/terapiaRESUMEN
We have described some unusual findings of radiofrequency interference with ICD functioning during AV nodal ablation, guiding the reader to the possible explanation of the phenomena.
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The COVID-19 post-lockdown period and the subsequent progressive withdrawal of the quarantine measures are currently allowing the gradual resumption of the ordinary clinical activities, which have been suppressed during the COVID-19 pandemic. In this phase, it is crucial to minimize the risk of infection to limit COVID-19-related morbidity and mortality and the number of new cases. Indeed, COVID-19 manifestations may be equivocal, including asymptomatic or mildly symptomatic patients. In order to ensure the safety of patients and healthcare providers, therefore, it is mandatory to stratify the risk of post-COVID-19 pandemic infection during the clinical and instrumental evaluation of cardiac patients, who are at low risk for COVID-19. Here we discuss the most common diagnostic procedures and therapeutic activities, the type of personal protective equipment according to the different tests, the timetable of the different diagnostic examinations, the tele-health services or alternative strategies, and the structural and management requirements, that should be applied to protect patients and healthcare providers in the post-COVID-19 era.
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Control de Enfermedades Transmisibles , Infecciones por Coronavirus/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Cardiopatías , Pandemias/prevención & control , Neumonía Viral/prevención & control , COVID-19 , Infecciones por Coronavirus/transmisión , Cardiopatías/diagnóstico , Cardiopatías/terapia , Humanos , Equipo de Protección Personal , Neumonía Viral/transmisión , Medición de RiesgoRESUMEN
Primary school students (817 apparently healthy 10-year olds) were screened by transthoracic 2-dimensional echocardiography to assess for the prevalence of bicuspid aortic valve. Bicuspid aortic valve was found in 0.5% of cases, with a higher prevalence in males than females (0.75% vs 0.24%), and was significantly associated with aortic root enlargement compared with children who had tricuspid aortic valves.
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Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Niño , Femenino , Humanos , Italia/epidemiología , Masculino , Prevalencia , Estudios Prospectivos , Población Rural/estadística & datos numéricos , UltrasonografíaRESUMEN
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