Asunto(s)
Bradicardia/diagnóstico , Trastorno del Sistema de Conducción Cardíaco/diagnóstico , Agonistas Adrenérgicos beta/uso terapéutico , Algoritmos , Bradicardia/genética , Bradicardia/terapia , Broncodilatadores/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Trastorno del Sistema de Conducción Cardíaco/genética , Trastorno del Sistema de Conducción Cardíaco/terapia , Cardiotónicos/uso terapéutico , Electrocardiografía/métodos , Pruebas Genéticas/métodos , HumanosAsunto(s)
Bradicardia/diagnóstico , Trastorno del Sistema de Conducción Cardíaco/diagnóstico , Antagonistas Adrenérgicos beta/uso terapéutico , Arritmias Cardíacas/etiología , Bradicardia/complicaciones , Bradicardia/epidemiología , Bradicardia/terapia , Trastorno del Sistema de Conducción Cardíaco/complicaciones , Trastorno del Sistema de Conducción Cardíaco/epidemiología , Trastorno del Sistema de Conducción Cardíaco/terapia , Electrocardiografía , Fenómenos Electrofisiológicos , Epilepsia/complicaciones , Cardiopatías/complicaciones , Cardiopatías/congénito , Humanos , Infarto del Miocardio/complicaciones , Calidad de VidaRESUMEN
BACKGROUND: Because as many as 46% of implantable cardioverter defibrillator (ICD) patients experience clinical symptoms of shock anxiety, this randomized controlled study evaluated the efficacy of adapted yoga (vs usual care) in reducing clinical psychosocial risks shown to impact morbidity and mortality in ICD recipients. METHODS: Forty-six participants were randomized to a control group or an 8-week adapted yoga group that followed a standardized protocol with weekly classes and home practice. Medical and psychosocial data were collected at baseline and follow-up, then compared and analyzed. RESULTS: Total shock anxiety decreased for the yoga group and increased for the control group, t(4.43, 36), P < 0.0001, with significant differences between these changes. Similarly, consequential anxiety decreased for the yoga group but increased for the control group t(2.86,36) P = 0.007. Compared to the control, the yoga group had greater overall self-compassion, t(-2.84,37), P = 0.007, and greater mindfulness, t(-2.10,37) P = 0.04, at the end of the study. Exploratory analyses utilizing a linear model (R(2) = 0.98) of observed device-treated ventricular (DTV) events revealed that the expected number of DTV events in the yoga group was significantly lower than in the control group (P < 0.0001). Compared to the control, the yoga group had a 32% lower risk of experiencing device-related firings at end of follow-up. CONCLUSIONS: Our study demonstrated psychosocial benefits from a program of adapted yoga (vs usual care) for ICD recipients. These data support continued research to better understand the role of complementary medicine to address ICD-specific stress in cardiac outcomes.
Asunto(s)
Ansiedad/etiología , Ansiedad/terapia , Desfibriladores Implantables/efectos adversos , Desfibriladores Implantables/psicología , Insuficiencia Cardíaca/prevención & control , Insuficiencia Cardíaca/psicología , Yoga/psicología , Anciano , Ansiedad/psicología , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Resultado del TratamientoRESUMEN
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
RESUMEN
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Asunto(s)
Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Niño , Humanos , Fascículo Atrioventricular , Resultado del Tratamiento , Trastorno del Sistema de Conducción Cardíaco , Terapia de Resincronización Cardíaca/métodos , Insuficiencia Cardíaca/terapia , Electrocardiografía/métodosAsunto(s)
Arritmias Cardíacas/terapia , Estimulación Cardíaca Artificial/métodos , Desfibriladores Implantables/normas , Marcapaso Artificial/normas , Adulto , Cardiomiopatía Hipertrófica/terapia , Niño , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/terapia , Trasplante de Corazón , Humanos , Infarto del Miocardio/complicaciones , Implantación de Prótesis/normas , Síncope/etiologíaRESUMEN
Heart failure continues to affect large populations within the industrialized nations. Previous therapies have been directed at increasing myocardial contractility or decreasing vascular resistance but have not addressed the mechanical dysfunction within certain subpopulations with heart failure. Biventricular pacing has been shown to improve both acute hemodynamic parameters and long-term functional capacity in patients with ventricular dysynchrony and suffering from severe heart failure. From this data, the therapy is indicated for use in patients with depressed ejection fraction, bundle branch block, and either NYHA class III or class IV heart failure, regardless of whether or not there is a separate indication for ICD placement. Recent studies suggest that biventricular pacing may remodel the failing heart. Future studies could expand the previously mentioned indications to patients suffering from mild symptoms of heart failure. This article reviews the current demographics involved within this population, the acute hemodynamic benefits experienced from biventricular pacing, the long term function benefits experienced from the therapy, and other possible benefits from the therapy.
Asunto(s)
Estimulación Cardíaca Artificial , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/terapia , Ensayos Clínicos como Asunto , Desfibriladores Implantables , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Humanos , Marcapaso Artificial , Admisión del Paciente , Selección de Paciente , Volumen Sistólico/fisiología , Disfunción Ventricular/fisiopatología , Disfunción Ventricular/terapia , Remodelación Ventricular/fisiologíaRESUMEN
The following sections detail the medical approach of the three implanters within our group from 75 resynchronization implants as well as the technical field support experience from over 300 resynchronization implants.