RESUMO
AIMS: There is increasing evidence that right ventricular (RV) pacing may have detrimental effects by increasing morbidity and mortality for heart failure in implantable cardioverter-defibrillator (ICD) patients. In this study we prospectively tested the hypothesis that cumulative RV pacing increases ventricular tachycardia/ventricular fibrillation (VT/VF) occurrence (primary endpoint) and hospitalization and mortality for heart failure (secondary endpoint) in a predominantly secondary prophylactic ICD patient population. METHODS AND RESULTS: Two hundred and fifty patients were divided into two groups according to the median of cumulative RV pacing (< or =2 vs. >2%) and prospectively followed-up for occurrence of primary and secondary endpoints for 18 +/- 4 months. Established predictors for VT/VF occurrence and heart failure events such as age, left ventricular ejection fraction (EF), QRS duration, history of atrial fibrillation, and NT-proBNP were collected at enrollment. Multivariate Cox regression analysis revealed that cumulative RV pacing > 2% and EF < 40% were independent predictors for VT/VF occurrence and heart failure events. Kaplan-Meier analysis showed that patients with >2% cumulative RV pacing more frequently suffered from VT/VF occurrence and heart failure hospitalization. CONCLUSION: Cumulative RV pacing > 2% and EF < 40% are independent predictors for VT/VF occurrence and mortality and hospitalization for heart failure in predominantly secondary prophylactic ICD patients. Our data show that algorithms capable of reducing cumulative RV pacing should be used more frequently in clinical practice.
Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/fisiopatologia , Taquicardia Ventricular/etiologia , Fibrilação Ventricular/etiologia , Idoso , Algoritmos , Estimulação Cardíaca Artificial/métodos , Estudos de Coortes , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Volume Sistólico , Taquicardia Ventricular/fisiopatologia , Fibrilação Ventricular/fisiopatologiaRESUMO
The case of an 18-year-old polytrauma patient with a complete disruption of the right external iliac artery and a dissection of the left external iliac artery mainly caused by bilateral complex pelvic fractures type C, a subluxated horizontal fracture of the right acetabulum, and a transforaminal sacrum fracture is described.