RESUMO
30 patients (mean age 56 +/- 18 years) suffering from multiple ventricular extrasystoles (VES) of various origin, like ischemic, hypertensive, valvular and congenital cardiopathy, and arrhythmogenic ventricular dysplasia, were treated during 12 days by a daily dose of 900 mg of propafenone (15 cases) or 600 mg of amiodarone (15 cases). The study was randomized and a portable ECG was used for 24 h. At the time of entering into the study (H0) the patients were without any therapy. The mean total number of VES was 16,878 +/- 9,212 in the propafenone group (2,062 +/- 2,342 of them being repetitive) and 19,497 +/- 7,930 in the amiodarone group (2,907 +/- 3,615 of them being repetitive). The difference between the two groups was not statistically significant, even with the use of Holter (H1) ECG monitoring one week later. After 12 days of treatment (H2) a significant decrease in the number of total VES was noted: by 78% with propafenone (76% isolated and 89% repetitive VES) and by 77% with amiodarone (74% isolated and 91% repetitive VES). The difference between the effect of the two drugs was not significative. After 12 days of wash-out (H3) the number of VES returned to initial values with propafenone but not with amiodarone where the values were still decreased after 82 days of wash-out (H4). Both drugs produced significant bradycardia which was more apparent and more spread out during the nyctohemeral with amiodarone. Propafenone affected rather the maximal and diurnal frequencies. No correlation was found between the bradycardic and antiarrhythmic effect. Amiodarone was well tolerated and propafenone produced minor digestive and neurosensory troubles in about half the cases, only in one patient a more pronounced arrhythmogenic effect was observed. In conclusion, the efficacy and the good hemodynamic tolerance of the two drugs was found to be similar in the short-term treatment of chronic, isolated or repetitive VES, irrespective of their etiology.
Assuntos
Amiodarona/uso terapêutico , Complexos Cardíacos Prematuros/tratamento farmacológico , Propafenona/uso terapêutico , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Complexos Cardíacos Prematuros/fisiopatologia , Criança , Doença Crônica , Ritmo Circadiano , Ensaios Clínicos como Assunto , Eletrocardiografia , Feminino , Frequência Cardíaca , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Propafenona/administração & dosagem , Distribuição AleatóriaRESUMO
Propafenone, an antiarrhythmic drug of IC type, was applied to 10 patients with supraventricular tachycardia (SVT) produced by intranodal reentry (group I) and in 14 patients with reentry by an accessory atrioventricular (AV) pathway (group II), 10 of them suffering from orthodromic SVT. Propafenone given intravenously depresses or blocks the antegrade or retrograde conduction in the AV node and in the accessory AV pathway. The same effect is observed with orally given propafenone: 66% of antegrade blocking and 54% of retrograde blocking of the accessory conduction pathway. Intravenously given propafenone reduces within 2 to 3 min by antegrade or retrograde blocking 70% of SVT produced by intranodal reentry and by 85% of SVT produced by reentry by the accessory pathway. After injection it becomes impossible to induce intranodal SVT in 60% of cases and SVT by the accessory pathway reentry in 28% of cases. With oral treatment (600 mg/day) reinduction of intranodal SVT becomes impossible in 66% of cases and of SVT produced by reentry by the accessory pathway in 42% of cases. Long-term oral administration (17 +/- 3.7 months) of the same dose prevents 88% of SVT produced by internodal reentry and 80% of spontaneous SVT produced by reentry by the accessory pathway. Cardiologic tolerance is satisfactory: one case of atrioventricular and intraventricular dysrhythmia is observed. The same holds true for general tolerance: in 2 cases drug administration is discontinued and 11 patients present neurologic and digestive troubles improving after lowering the dosage or increasing the fractionation.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Propafenona/administração & dosagem , Taquicardia por Reentrada no Nó Atrioventricular/tratamento farmacológico , Taquicardia Supraventricular/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/tratamento farmacológico , Administração Oral , Adulto , Idoso , Eletrocardiografia , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
Propafenone (P), a class IC antiarrhythmic drug, was tested intravenously and orally in the curative and preventive treatment of sustained (VTS) and non-sustained (VTNS) ventricular tachycardia. The 16 patients involved included 11 men and 5 women of mean age 49 years. They all had heart disease: ischaemia in 3, right ventricular arrhythmogenic dysplasia in 6, dilated myocardiopathy in 5 and left ventricular aneurysm in 2. Intravenous P in doses of 1.5 mg/kg controlled VT within 2 or 3 minutes on average in 9 out of 12 patients. Following the injection VT could not be reinduced in 2 out of 10 patients; other inductions were harder to obtain or resulted in VTNS instead of VTS (n = 3), or remained unchanged (n = 5). When P was administered orally (mean dose 900 mg) to 14 patients reinduction of VT was no longer possible in 2 cases, more difficult in 1 case, remained unchanged in 7 cases and was easier in 4 cases. Long-term oral therapy at the same dosage level prevented recurrences of VT in 7 out of 14 patients; the drug was discontinued in 2 patients owing to its arrhythmogenic effect on induced VT. The patients were followed up for 5 to 36 months (mean: 16.4 +/- 11.7 months). In this trial the results of long-term treatment could not be predicted from Holter recordings or measurements of plasma levels.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Propafenona/uso terapêutico , Taquicardia/tratamento farmacológico , Administração Oral , Adulto , Idoso , Estimulação Cardíaca Artificial , Feminino , Testes de Função Cardíaca/métodos , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Propafenona/administração & dosagem , Propafenona/sangue , Taquicardia/sangueRESUMO
The authors report 3 cases of acromegaly diagnosed while the patients were in hospital for cardiovascular disease: arterial hypertension in two and hypertrophic myocardiopathy in all three. Coronary arteriography was normal in the 3 patients. The exercise-induced dyspnoea observed in these 3 cases was unexplained by right and left cardiac catheterization results (normal pressures, normal or increased cardiac index). It was most probably related to the myocardial hypertrophy and to abnormalities in diastolic function demonstrated by radioisotopic methods in patients 2 and 3. The degree of myocardial hypertrophy present in these 3 patients seemed to correlate with the size of the pituitary adenoma and the plasma level of growth hormone rather than with the duration or degree of arterial hypertension. After excision of the pituitary adenoma hypertension persisted in 1 case, due to associated adrenal gland hyperplasia, and subsided in the other cases. Abnormalities of diastolic function and dyspnoea are gradually regressing but left ventricular hypertrophy has not significantly decreased after 6 post-operative months.
Assuntos
Acromegalia/complicações , Cardiomiopatia Hipertrófica/etiologia , Hipertensão/etiologia , Acromegalia/fisiopatologia , Adenoma/complicações , Adenoma/fisiopatologia , Idoso , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/fisiopatologiaRESUMO
Flecainide, a Class IC antiarrhythmic agent, was used in 12 patients with an average age of 57 years to treat spontaneous monomorphic sustained ventricular tachycardia (S-VT, n = 9), with a ventricular rhythm of 203 +/- 41 bpm (5 right bundle branch and 4 left bundle branch block pattern) and non-sustained ventricular tachycardia (NS-VT, n = 3). The patients had ischaemic heart disease (n = 5, including 2 cases of aneurysm), idiopathic dilated cardiomyopathy (n = 1), ventricular dysplasia (right, n = 1; left n = 2; biventricular, n = 1). The remaining 2 patients had no overt cardiac disease on coronary angiography. None of the patients had signs of cardiac failure; the left ventricular ejection fraction was 0.49 +/- 0.7. Before treatment, programmed ventricular stimulation (PVS) induced 12 S-VT (214 +/- 41 bpm) which reproduced the clinical VT in 8 out of 10 cases. A second series of electrophysiological studies was performed after an average of 5 weeks treatment with Flecainide 300 mg/day (200-400 mg). It was not possible to induce VT in 2 patients (17% total prevention); NS-VT replaced S-VT in 4 patients (33%); S-VT was less rapid in 5 patients (at least 50 bpm slower) (41%); one patient had S-VT as rapid as before treatment (9%). The 12 patients were prescribed long-term Flecainide therapy. During follow-up there were 4 early (7, 10 and 15 days) and one late recurrence (16 months) (42% failure rate) whilst the other 7 patients had no further attacks of VT (follow-up of 19.1 +/- 5 months) (58% success rate).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Flecainida/uso terapêutico , Taquicardia/tratamento farmacológico , Adulto , Idoso , Estimulação Cardíaca Artificial , Avaliação de Medicamentos , Eletrocardiografia Ambulatorial , Feminino , Flecainida/sangue , Seguimentos , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Volume Sistólico , Taquicardia/epidemiologia , Taquicardia/prevenção & controleRESUMO
Twenty-seven patients (15 men, 12 women; mean age 48.9 years) suffering from ventricular tachycardia (VT) (n = 30) were studied by radionuclide angiocardiography with Fourier phase analysis, both in sinus rhythm and during tachycardia. VT was spontaneous, electrically inducible, sustained, haemodynamically stable and monomorphous, with a mean rate of 174 beats/min (range: 115-260 beats). Heart diseases responsible for VT were: non-obstructive cardiomyopathy (n = 7), hypertrophic cardiomyopathy (n = 1), ischaemic heart disease (n = 5), probable right ventricular arrhythmogenic dysplasia (n = 4), congenital left ventricular aneurysm (n = 2), sequela of myocarditis (n = 2) and aortic valve regurgitation (n = 1); no heart disease was detectable in 5 patients. On surface electrocardiogram there was good concordance between the initial radionuclide site of VT activation and the configuration and electrical axis of QRS. At Fourier phase analysis all 17 VT of the right lag type originated in the left ventricle, arising from the apical septum (n = 7) or lateral segment (n = 2) in case of left axis, from the basal segment (n = 6) or the lateral segment (n = 1) in case of vertical or right axis, and from the middle left septum (n = 1) in case of normal axis. Nine VT of the left lag type originated in the right ventricle, arising from the basal septum or the latero-basal region in case of vertical or right axis (n = 6), from the apical septum or the inferior-apical region in case of left axis (n = 2) and from the middle septum in case of normal axis (n = 1). Four of our patients (3 with coronary disease and 1 with congenital left ventricular aneurysm) had VT of the left lag type and an initial radionuclide site of activation in the middle part of the left septum in case of left axis (n = 2) and in the basal part of that septum in case of right axis (n = 2). Seven patients were operated upon for recurrent VT: 4 had intra-operative mapping which in every case confirmed the results of radionuclide angiocardiography, a method which in the other 3 patients was the only surgeon's guide. Correlations between the site of origin of VT at radionuclide mapping and kinetic abnormalities visualized at radiological angiography and gamma-ray angiocardiography were common in our study. In one of our patients the same lesion gave birth to 2 VT of different morphologies.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Ventrículos do Coração/diagnóstico por imagem , Angiografia Cintilográfica , Taquicardia/diagnóstico por imagem , Adolescente , Adulto , Idoso , Ecocardiografia , Eletrocardiografia , Feminino , Análise de Fourier , Cardiopatias/fisiopatologia , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia/fisiopatologia , TecnécioRESUMO
An electrophysiological study was carried out pre- and postoperatively in 25 patients (children and adults) presenting with an atrial septal defect of the ostium secundum type (OSASD). The purposes of the study were to find out whether early electrophysiological abnormalities were present in children, to compare the results obtained in children and in adults and to evaluate the impact of surgery by comparing preoperative and late postoperative electrophysiological data. Patients were divided into two groups. Group I was composed of 11 children (mean age 8.18 +/- 1.03 years) with a mean pulmonary/systemic blood flow ratio of 2.33 +/- 0.24. Group II comprised 14 adults (mean age 36.79 +/- 4.89 years) with a mean pulmonary/systemic blood flow ratio of 3.42 +/- 0.24. Preoperatively, in group I 55 p. 100 of the patients (6/11) had sinus node dysfunction, 18 p. 100 (2/11) had disturbances of atrioventricular conduction, and none had atrial dysrhythmia. Preoperatively, in group II 43 p. 100 of the patients (6/14) had sinus node dysfunction, 36 p. 100 (5/14) had disturbances of atrioventricular conduction, and 36 p. 100 (5/14) had sustained atrial dysrhythmia (flutter or paroxysmal atrial fibrillation). The frequency of sustained atrial dysrhythmia correlated positively with the patient's age and with the presence of sinus node dysfunction. Following surgical closure of the atrial septal defect, the electrophysiological parameters were not significantly modified in both groups. This study confirmed the presence of early electrophysiological abnormalities of sinus node function and atrioventricular conduction in children with OSASD. The most significant finding in adults was the occurrence of atrial dysrhythmias in the oldest patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Arritmias Cardíacas/fisiopatologia , Comunicação Interatrial/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Eletrocardiografia , Comunicação Interatrial/cirurgia , Hemodinâmica , Humanos , Monitorização Fisiológica , Estudos Prospectivos , Fatores de TempoRESUMO
Flecainide, a new Vaughan-Williams Class Ic anti-arrhythmic agent, was used in 21 patients with an accessory AV conduction pathway which was apparent in 16 cases (WPW syndrome), latent in 1 case and concealed in 4 cases (block in the anterograde direction). Seventeen patients had spontaneous and inducible arrhythmias; 13 supraventricular tachycardias (SVT) due to orthodromic reentry including the accessory AV pathway and 4 atrial arrhythmias. Intravenous flecainide (2 mg/kg over 5 minute period) terminated the 13 cases of SVT in an average of 3 minutes by depressing then blocking retrograde conduction in the accessory pathway and 3 out of 4 cases of atrial arrhythmias. Conduction in the accessory pathway was blocked in the anterograde direction in 75% of cases and depressed in the rest; it was blocked in the retrograde direction in about half the cases and depressed in the rest. Intravenous flecainide completely prevented the induction or arrhythmias in 13 out of 17 patients (76%). Oral flecainide blocked the accessory pathway in the anterograde direction in 68.7%, and in the retrograde direction in 62% of patients, and prevented arrhythmias during provocative testing in 82% of patients (14 out of 17). With an average follow-up of 20.7 +/- 2.6 months with oral doses adapted to body weight and to the response to IV flecainide only one recurrence of atrial fibrillation was observed, a 100% prevention of spontaneous SVT and 94% prevention of all arrhythmias (16 out of 17 cases). The predictive value for the response to oral therapy of the tests of regularisation of SVT by IV flecainide and of the tests of non-provocation of SVT with oral or IV flecainide was excellent (100%). The cardiac tolerance was very good in these 21 patients (17 of whom had no valvular or myocardial lesion). There were 6 minor cases of general intolerance to oral therapy which were not dose related, only 1 of which required interruption of therapy. Flecainide appears one of the best choices for the treatment of preexcitation syndromes and their related arrhythmias at the present time.
Assuntos
Antiarrítmicos/uso terapêutico , Sistema de Condução Cardíaco/efeitos dos fármacos , Piperidinas/uso terapêutico , Taquicardia/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Idoso , Eletrocardiografia , Eletrofisiologia , Feminino , Flecainida , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Vias Neurais/efeitos dos fármacos , Piperidinas/administração & dosagem , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
The aim of this study was to assess the feasibility, safety and efficacy of primary angioplasty in acute myocardial infarction in a cardiology centre of a small urban community without on-site cardiac surgery. During 1995, 50 patients underwent angioplasty for MI in the first 12 hours. The average age was 66.7 +/- 12.6 years. Eighty six per cent of patients had at least one poor prognostic criteria (32% over 75 years of age, 70% anterior wall infarcts, 30% with heart rates > 100 min on admission). The angiographic result was successful in 45 patients (90%). The time between onset of pain and reopening the vessel was 240 +/- 116 min and between admission to the catheter laboratory and reopening 31 +/- 8 min. A coronary stent was implanted in 24 cases (48%) and intra-aortic balloon pumping was necessary in 14 cases (28%). Ischaemia recurred during the hospital phase in 7 cases (14%), 4 of which (8%) were caused by rethrombosis of the dilated artery: in 3 cases, the ischaemia was in another zone. No emergency coronary bypass surgery was required. The hospital mortality was 10%, always in patients over 80 years of age. The average duration of the hospital stay was 5.8 +/- 2.6 days with 15.7 +/- 7.3 days of convalescence. The average global cost was 61850 +/- 20686 F. These results were comparable to previously reported figures and confirm that primary angioplasty in acute infarction is possible and effective with an acceptable risk in a small urban community without on-site cardiac surgery.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , População Urbana , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/economia , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Custos e Análise de Custo , Estudos de Viabilidade , Feminino , França , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Seleção de Pacientes , Estudos Retrospectivos , Terapia Trombolítica , Fatores de Tempo , Resultado do TratamentoRESUMO
The purpose of this study was to evaluate the effectiveness of trans-esophageal atrial stimulation in decreasing atrial flutters. 31 patients, aged between 26 and 86 years, underwent 38 esophageal stimulations between August 1986 and April 1987. Esophageal stimulation was carried out with a device delivering major stimuli (10 to 20 ms) as well as high voltages (10 to 20 volts). A bipolar probe of permanent intracardiac stimulation was placed behind the left atrium, via a trans-esophageal approach under ECG guidance. Stimulations were carried out at a slightly faster rhythm than that of the atrial flutter, for 1 to 30 seconds with a progressive increase of the stimulation frequency (280 to 960 impulses/min) until either a sinus rhythm or an atrial fibrillation was obtained. A sinus rhythm was obtained immediately (21 times out of 38; 55.3%) and at the 24th hour after temporary atrial fibrillation in 8 additional patients (21%). The reduction percentage at 24 hours was therefore 76.3 p. cent. In 6 patients (15.8%), esophageal stimulation failed and in 3 additional patients, after atrial fibrillation, there was either relapse into flutter, or persistence of atrial fibrillation at the 24th hour. Esophageal stimulation was well tolerated in all cases. There were no local or rhythm complications. In conclusion, trans-esophageal atrial stimulation appears to be effective, easy to implement, economical and well tolerated. Its primary use to decrease atrial flutter seems justified, permitting to avoid in 75 p. cent of the time, recourse to intracardiac atrial stimulation or external shock.
Assuntos
Flutter Atrial/terapia , Estimulação Cardíaca Artificial/métodos , Esôfago , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Two cases of MIBG (metaiodobenzylguanidine) scintigraphy are reported: the first case concerns a female patient hospitalized for high blood pressure (HBP) with symptoms evocative of pheochromocytoma. Urinary titration of catecholamines metabolites, which are usually abnormally high, and tomodensitometry permit the visualization of a left adrenal tumor. On the contrary, the MIBG scintigraphy does not show any abnormal fixation. After resection, the pathological examination confirms the diagnosis of pheochromocytoma. The second case concerns a female patient hospitalized for HBP with, on the chest X-Ray, a left postero-inferior density. Serum and urinary catecholamine levels are normal. Tomodensitometry confirms the tumor of the posterior mediastinum and the MIBG scintigraphy demonstrates a focus of thoracic opposite the tumor. After resection, the pathological examination shows an ectopic supernumerary bronchial bud. These two cases illustrate the limitations of MIBG scintigraphy to locate pheochromocytomas. There are false negative (10%) which may be explained by an insufficient uptake of the tracer by the tumor, by an insufficient image formation or by medication interferences. On the contrary, there may be false positives because of histochemical similarities between the chromaffin tissues and certain glandular or neural tumors. Nevertheless, in spite of serious limitations, which we must be aware of, MIBG scintigraphy remains the best primary examination for the location of pheochromocytomas.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Iodobenzenos , Feocromocitoma/diagnóstico por imagem , 3-Iodobenzilguanidina , Adulto , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , CintilografiaRESUMO
INTRODUCTION: Vascular complications at the femoral access site is an important factor of morbidity. The aims of this study were to evaluate the efficacy and safety of the percutaneous closure device (Perclose) during interventional cardiology procedures. PATIENTS AND METHODS: All patients with percutaneous closure of the femoral access site by the Perclose system in 2010 were included. We evaluated the indications of the procedures, the success rate of implantation and the bleeding complications according to antithrombotic therapy used. RESULTS: Three hundred and seventy five patients underwent a percutaneous closure by the Perclose system. Acute coronary syndromes with or without elevation of ST segment were the main indications of procedures (74.9%). The success rate of percutaneous closure of the femoral access site was 97.3%. The rate of minor, moderate, and severe bleeding of the entire cohort according to the GUSTO classification was respectively 4.2%, 0.5% and 1%. Bleeding complications were similar in both groups of patients (2.1% vs 7% P=0.122). In case of unsuccessful deployment of femoral closure devices, the risk of bleeding complications range from 4.3% to 60% (P=0.0000036). CONCLUSION: The use of the Perclose system is associated with a low rate of severe bleeding at the femoral access site. However, the failures of percutaneous closure increase the risk of bleeding complications.
Assuntos
Angioplastia Coronária com Balão , Artéria Femoral/cirurgia , Técnicas Hemostáticas/instrumentação , Punções/efeitos adversos , Dispositivo para Oclusão Septal , Síndrome Coronariana Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/prevenção & controle , Desenho de Equipamento , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Resultado do TratamentoRESUMO
Very late thrombosis occurring after bare-metal stent (BMS) implantation is a rare complication. It differs from very late thrombosis of drug-eluting stents in terms of both frequency and pathophysiological mechanism. We report a case of very late stent thrombosis of a bare-metal stent 10 years after his implantation for treatment of a myocardial infarction. The patient had a new acute coronary syndrome without persistent ST-segment elevation related to bare-metal stent thrombosis. He was treated by thrombo-aspiration and implantation of a new bare-metal stent.
Assuntos
Angioplastia Coronária com Balão , Trombose Coronária/etiologia , Trombose Coronária/terapia , Readmissão do Paciente , Stents/efeitos adversos , Idoso , Humanos , Masculino , Metais , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
AIMS: The drug-eluting stents (DES) reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and its impact on the restenosis rate at 2 years. METHODS: We included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2 years. RESULTS: Four hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at 2 years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9 and 3.7%. CONCLUSION: The use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2 years of follow-up.
Assuntos
Angioplastia Coronária com Balão , Reestenose Coronária/epidemiologia , Estenose Coronária/terapia , Stents Farmacológicos , Idoso , Seguimentos , Fidelidade a Diretrizes , Humanos , Guias de Prática Clínica como Assunto , Fatores de RiscoAssuntos
Serviços Médicos de Emergência , Fidelidade a Diretrizes , Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Terapia TrombolíticaRESUMO
In a series of 83 patients with dilated (DCM) (n = 56) or hypertrophic cardiomyopathies (HCM) (n = 27), were performed 24-hour-Holter monitorings, exercise stress testings, noninvasive recordings of late ventricular potentials (LVP), and programmed ventricular stimulations (PVS) (sinus rhythm and three cycles of stimulation, two extrastimuli, two right ventricle sites) (n = 53), in order to appreciate the frequency of ventricular premature depolarisations (VPDs), to correlate these results with myocardial vulnerability to TV induction, and to compare electrophysiologic and hemodynamic results. Holter monitoring showed that 80% of group A patients had VPDs (75% Lown's grade 3 or over) and 63% in group B (37% greater than or equal to grade 3). LVP were found in 15/56 DCM, and 2/27 HCM; in comparison with a control group of 32 normal subjects, the prevalence of LVP was only significant for DCM group. LVP were more frequent in cases of VPD's greater than or equal to Lown's grade 3 at Holter monitoring in DCM group, (33% versus 7% if VPDs less than or equal to Lown's grade 3) and HCM group (20% versus 0) but the correlation was not significant. Exercise stress testing, conducted only in group B, revealed about 20% of VPDs. PVS provoked ventricular arrhythmia (greater than 5 QRS) in 13 out of 33 cases in group A and in 2 out of 20 cases in group B. There was no significant correlation between the results of these methods of study and those of hemodynamic or echocardiographic explorations except for cardiac index in group A (lower when LVP were present, and VPDs greater than or equal to grade 3 during Holter) and end diastolic diameter (larger when PVS provoked fewer ventricular arrhythmias). In group B, PVS induced monomorphic VT in 2/3 patients with syncopes. Thus: (1) ventricular arrhythmias are frequent in cardiomyopathies but LVP had a significant prevalence only in dilated forms; (2) in DCM monomorphic induced VT reproduce spontaneous crisis, whereas in HCM it is possible to provoke VT in patients with syncopes but without this clinical arrhythmia; (3) in DCM as in HCM, ventricular arrhythmia can be independent from hemodynamic disorders.
Assuntos
Arritmias Cardíacas/etiologia , Estimulação Cardíaca Artificial , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Hipertrófica/complicações , Eletrocardiografia , Monitorização Fisiológica/métodos , Arritmias Cardíacas/diagnóstico , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Processamento de Sinais Assistido por ComputadorRESUMO
For the past few years, a new method for the investigation and treatment of arrhythmias has been used: transoesophageal atrial pacing and recording (TAPR). In the light of 6 cases observed recently, we review the technical aspects and the indications for TAPR. A bipolar stimulation catheter is inserted in the oesophagus and positioned in the area where the atrial wave of greater amplitude is recorded. Atrial stimulation is done with impulses of long duration obtained with a special stimulator. Two cases validated this technique which was effective to correct atrial flutter in a neonate with heart failure resistant to medical treatment as well as in a 5 year-old child. The value of TAPR as a diagnostic tool in cases of tachycardia is discussed in the context of 2 cases: a 5 week-old with wide QRS and a 14 month-old with narrow QRS. Finally, the value of TAPR for monitoring the efficacy of anti-arrhythmia medications is illustrated by 4 cases of supraventricular tachycardia, in whom the optimal dosage of the anti-arrhythmic drug used was determined with the help of TAPR-induced tachycardia. The current literature concerning the technique, indications and results of TAPR are reviewed. This method is likely to take a great importance for the study and treatment of supraventricular arrhythmias in children.