RESUMO
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Estenose de Veia Pulmonar , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Ablação por Cateter/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hemorragia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Estenose de Veia Pulmonar/etiologia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Metanálise como AssuntoRESUMO
Infective endocarditis (IE) is a life-threatening infection, which has had a notable increase in incidence in recent years. Although Staphylococci or Streptococci are the most common culprit organisms, rarer organisms have also been implicated and associated with a more aggressive disease course. We present a case of Enterobacter cloacae IE affecting the aortic valve in an 82-year-old male with an implantable permanent pacemaker. Our case demonstrates that a prolonged-course of beta-lactam therapy may be an effective, non-invasive management option for IE caused by multidrug-resistant gram-negative organisms.