Assuntos
Infecções por Coronavirus/prevenção & controle , Técnicas Eletrofisiológicas Cardíacas/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gestão da Segurança/organização & administração , COVID-19 , Infecções por Coronavirus/epidemiologia , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Feminino , Serviços de Saúde , Humanos , Liderança , Masculino , América do Norte , Saúde Ocupacional , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Sociedades Médicas/organização & administraçãoRESUMO
COVID-19 is a rapidly evolving public health emergency that has largely impacted the provision of healthcare services around the world. The challenge for electrophysiology teams is double; on one side preventing disease spread by limiting all nonessential face-to-face interactions, but at the same time ensuring continued care for patients who need it. These guidelines contain recommendations regarding triaging in order to define what procedures, device checks and clinic visits can be postponed during the pandemic. We also discuss best practices to protect patients and healthcare workers and provide guidance for the management of COVID-19 patients with arrhythmic conditions.
Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Atenção à Saúde , Técnicas Eletrofisiológicas Cardíacas/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Argentina , Arritmias Cardíacas/diagnóstico , Brasil , COVID-19 , Eletrofisiologia Cardíaca/organização & administração , Ablação por Cateter/normas , Colômbia , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/organização & administração , América Latina , Masculino , México , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Gestão da Segurança/normas , Sociedades MédicasRESUMO
In vitro multi-electrode array (MEA) technology is nowadays involved in a wide range of applications beyond neuroscience, such as cardiac electrophysiology and bio-interface studies. However, the cost of commercially available acquisition systems severely limits its adoption outside specialized laboratories with high budget capabilities. Thus, the availability of low-cost methods to acquire signals from MEAs is important to allow research labs worldwide to exploit this technology for an ever-expanding pool of experiments independently from their economic possibilities. Here, we provide a comprehensive toolset to assemble a multifunctional in vitro MEA acquisition system with a total cost 80% lower than standard commercial solutions. We demonstrate the capabilities of this acquisition system by employing it to i) characterize commercial MEA devices by means of electrical impedance measurements ii) record activity from cultures of HL-1 cells extracellularly, and iii) electroporate HL-1 cells through nanostructured MEAs and record intracellular signals.
Assuntos
Técnicas Eletrofisiológicas Cardíacas/instrumentação , Miócitos Cardíacos/fisiologia , Potenciais de Ação/fisiologia , Animais , Linhagem Celular , Análise Custo-Benefício , Técnicas Eletrofisiológicas Cardíacas/economia , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Fenômenos Eletrofisiológicos , Eletroporação , Desenho de Equipamento , Camundongos , Microeletrodos , SoftwareRESUMO
BACKGROUND: Peripartum cardiomyopathy (PPCM) is associated with significant morbidity and mortality. Arrhythmogenic causes of death have been implicated in a significant number of patients. However, there is a dearth of systematic studies evaluating the burden of arrhythmias in PPCM. METHODS: We used the Healthcare Utilization Project, Nationwide Inpatient Sample database (2007-2012) and identified 9841 hospitalizations for women aged ≥18years with a primary diagnosis of PPCM. Frequency of arrhythmias, utilization of electrophysiologic procedures, length of stay, hospitalization costs and outcomes associated with arrhythmias were determined. RESULTS: Mean age was 30.05±6.69years. Arrhythmias were present in 18.7% of hospitalized PPCM cohort. Ventricular tachycardia was the most common arrhythmia and was noted in 4.2%. Approximately 2.2% of cases experienced cardiac arrest. Electrical cardioversion was performed in 0.3%, Catheter ablation in 1.9%, PPM implantation in 3.4% and ICD in 6.8% of hospitalizations for PPCM with arrhythmias. In-hospital mortality was 3-times more frequent in arrhythmia cohort (2.1% vs. 0.7%). Hospitalization costs were significantly higher in PPCM with arrhythmias. Elixhauser comorbidity score (adjusted OR:1.10; 95%CI:1.02-1.18; p=0.016), in-hospital mortality (adjusted OR:2.35; 95%CI:1.38-4.02; p=0.002), cardiogenic shock (adjusted OR:2.61; 95%CI:1.44-4.72; p=0.002), utilization of balloon pump (adjusted OR:13.4; 95%CI: 2.55-70.53; p<0.001), Swan-Ganz catheterization (adjusted OR:3.12; 95%CI:1.21-8.06; p=0.019), and coronary angiography (adjusted OR:1.79; 95%CI:1.19-2.70; p=0.005) were significantly associated with arrhythmias in PPCM. CONCLUSIONS: Arrhythmias were present in 18.7% of PPCM related hospitalizations. Morbidity, in-hospital mortality, length of inpatient stay, hospitalization costs and cardiac procedure utilization were significantly higher in the arrhythmia cohort.
Assuntos
Arritmias Cardíacas , Cardiomiopatias , Cardioversão Elétrica/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas , Parada Cardíaca , Complicações Cardiovasculares na Gravidez , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Bases de Dados Factuais/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/métodos , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Custos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Análise de Sobrevida , Estados Unidos/epidemiologiaRESUMO
AIMS: There has been large variations in the use of invasive electrophysiological therapies in the member countries of the European Society of Cardiology (ESC). The aim of this analysis was to provide comprehensive information on cardiac implantable electronic device (CIED) and catheter ablation therapy trends in the ESC countries over the last five years. METHODS: The European Heart Rhythm Association (EHRA) has collected data on CIED and catheter ablation therapy since 2008. Last year 49 of the 56 ESC member countries provided data for the EHRA White Book. This analysis is based on the current and previous editions of the EHRA White Book. Data on procedure rates together with information on economic aspects, local reimbursement systems and training activities are presented for each ESC country and the five geographical ESC regions. RESULTS: In 2013, the electrophysiological procedure rates per million population were highest in Western Europe followed by the Southern and Northern European countries. The CIED implantation and catheter ablation rate was lowest in the Eastern European and in the non-European ESC countries, respectively. However, in some Eastern European countries with relative low gross domestic product procedure rates exceeded those of some wealthier Western countries, suggesting that economic resources are not the only driver for utilization of arrhythmia therapies. CONCLUSION: These statistics indicate that despite significant improvements, there still is considerable heterogeneity in the availability of arrhythmia therapies across the ESC area. Hopefully, these data will help identify areas for improvement and guide future activities in cardiac arrhythmia management.
Assuntos
Fibrilação Atrial/terapia , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Ablação por Cateter/estatística & dados numéricos , Desfibriladores Implantáveis/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Certificação , Coleta de Dados , Europa (Continente) , Europa Oriental , Produto Interno Bruto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Fatores SocioeconômicosAssuntos
Arritmias Cardíacas/economia , Arritmias Cardíacas/prevenção & controle , Desfibriladores Implantáveis/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Marca-Passo Artificial/economia , Marca-Passo Artificial/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Desfibriladores Implantáveis/economia , Técnicas Eletrofisiológicas Cardíacas/economia , Europa (Continente) , Produto Interno Bruto/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricosRESUMO
The use of implantable cardioverter defibrillator (ICD) in heart failure patients decreases the arrhythmic mortality with the cost of increasing the number of patients to be treated, and microvolt T-wave alternans (MTWA) testing can be used as a good criteria to better select the candidate for such a therapy. This article examines generalities about the mechanism of alternans, definitions of positive, negative, and indeterminate MTWA tests, and factors that can modify these results. We review clinical studies that have found MTWA as a marker of ventricular arrhythmias in patients with heart failure, independent of etiology, ischemic or idiopathic. Microvolt T-wave alternans permits the selection of low risk patients who may not benefit of ICD implantation by standard criteria, due to high negative predictive values in most studies.
Assuntos
Arritmias Cardíacas/diagnóstico , Estimulação Cardíaca Artificial , Desfibriladores Implantáveis , Insuficiência Cardíaca/fisiopatologia , Arritmias Cardíacas/complicações , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/economia , Estimulação Cardíaca Artificial/estatística & dados numéricos , Ensaios Clínicos como Assunto , Desfibriladores Implantáveis/economia , Desfibriladores Implantáveis/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/economia , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Insuficiência Cardíaca/complicações , Humanos , Valor Preditivo dos TestesRESUMO
Sub-Saharan Africa is dominated by diseases of poverty. HIV/AIDS affects 28.5 out of a total of 600 million in the region. South Africa is the only country in sub-Saharan Africa in which implantable cardiovertor defibrillators (ICDs) are implanted (0.8/million in 2001). Only 3 of the 35 new ICDs were implanted in state-funded public hospitals. The pacemaker implantation rate for South Africa was 41/million in 2001. Approximately 20% of the population consume 56% of the health care expenditure, mainly funded by Medical Insurance. A tax-funded state health care system serves the rest of the population, but is concentrated on improving sanitation and primary health care. Diversion of funds from academic tertiary hospitals has reduced specialised services, particularly cardiology and cardiac surgery, and has resulted in an exodus of skilled personnel to the private sector. In the rest of sub-Saharan Africa, tertiary health care is mainly privately funded. Cardiology and cardiac surgery is not widely available. Many countries are crippled by debt and chronic local conflicts. Only one state hospital (Groote Schuur, Cape Town) provides an electrophysiology (EP) service including catheter ablation and ICD implantation, and training in EP, by two electrophysiologists. EP services are available privately in 3 centres. No EP service exists in the rest of sub-Saharan Africa.
Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , África/epidemiologia , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/economia , Atenção à Saúde/economia , Técnicas Eletrofisiológicas Cardíacas/economia , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Humanos , Pobreza/economia , PrevalênciaRESUMO
BACKGROUND: The use of coronary angiography and revascularization is lower than expected among black patients. It is uncertain whether use of other cardiac procedures also varies according to race and ethnicity and whether outcomes are affected. METHODS: We analyzed discharge abstracts from all nonfederal hospitals in California of patients hospitalized for a primary diagnosis of ventricular tachycardia or ventricular fibrillation between 1992 and 1994. We compared mortality rates and use of electrophysiologic study (EPS) and implantable cardioverter-defibrillator (ICD) procedures according to the race and ethnicity of the patient. RESULTS: Among 8713 patients admitted with ventricular tachycardia or ventricular fibrillation, 29% (n = 2508) had a subsequent EPS procedure, and 9% (n = 818) had an ICD implanted. After controlling for potential confounding factors, we found that black patients were significantly less likely than white patients to undergo EPS (odds ratio 0.72, CI 0.56-0.92) or ICD implantation (odds ratio 0.39, CI 0.25-0.60). Blacks discharged alive from the initial hospital admission had higher mortality rates over the next year than white patients, even after controlling for multiple confounding risk factors (risk ratio 1.18, CI 1.03-1.36). The use of EPS and ICD procedures was also significantly affected by several other factors, most notably by on-site procedure availability but also by age, sex, and insurance status. CONCLUSIONS: In a large population of patients hospitalized for ventricular arrhythmia, blacks had significantly lower rates of utilization for EPS and ICD procedures and higher subsequent mortality rates.
Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Revascularização Miocárdica/estatística & dados numéricos , Grupos Raciais , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , População Negra , California/epidemiologia , California/etnologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Análise de Sobrevida , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/mortalidade , Fibrilação Ventricular/epidemiologia , Fibrilação Ventricular/mortalidadeRESUMO
INTRODUCTION: One of the characteristics of the Mahaim fiber is that it possesses a decremental property related to the slow rate of recovery of its excitability similar to that of AV node. The aim of this study was to evaluate the recovery property of the atriofascicular/atrioventricular-type Mahaim fiber and compare it with that of the AV node. METHODS AND RESULTS: Nine patients with a Mahaim fiber were studied; 8 of the patients had atriofascicular/atrioventricular-type fiber. Different models were used to analyze the relationship between conduction time for the Mahaim fiber and the corresponding coupling intervals. The simplest model with the best fit was found to be the linear regression of the natural log of conduction time on corrected coupling intervals. The individual R2 values ranged between 0.43 and 0.98 for the Mahaim fiber and between 0.79 and 0.98 for AV node. The final model chosen for the log transformed data for the Mahaim fiber and for the AV node was the line with parameter estimates defined as a weighted average, over patients, of the corresponding individual line parameters. The weight used for each parameter was the inverse of its variance. The slopes of the lines of the transformed data were not significantly different between the Mahaim fiber and the AV node. Thus, the best fitting curve for the recovery property of the AF-type Mahaim fiber is a simple exponential curve similar to that of the AV node. CONCLUSION: The atriofascicular/atrioventricular-type Mahaim fiber has a quantitative recovery property very similar to that of the AV node.