Asunto(s)
Amiloidosis/fisiopatología , Fibrilación Atrial/tratamiento farmacológico , Cardiomiopatías/fisiopatología , Inhibidores del Factor Xa/uso terapéutico , Insuficiencia Cardíaca/fisiopatología , Accidente Cerebrovascular/prevención & control , Warfarina/uso terapéutico , Anciano , Anciano de 80 o más Años , Amiloidosis/complicaciones , Anticoagulantes/uso terapéutico , Antitrombinas/uso terapéutico , Fibrilación Atrial/complicaciones , Cardiomiopatías/complicaciones , Dabigatrán/uso terapéutico , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/etiologíaRESUMEN
OBJECTIVES: The goal of this study was to describe short- and long-term outcomes in all patients referred for inappropriate sinus tachycardia ablation, along with the potential complications of the intervention. BACKGROUND: Sinus node (SN) ablation/modification has been proposed for patients refractory to pharmacological therapy. However, available data derive from limited series. METHODS: The electronic databases MEDLINE, Embase, CINAHL, Cochrane, and Scopus were systematically searched (January 1, 1995-December 31, 2015). Studies were screened according to predefined inclusion and exclusion criteria. RESULTS: A total of 153 patients were included. Their mean age was 35.18 ± 10.02 years, and 139 (90.8%) were female. All patients had failed to respond to maximum tolerated doses of pharmacological therapy (3.5 ± 2.4 drugs). Mean baseline heart rates averaged 101.3 ± 16.4 beats/min according to electrocardiography and 104.5 ± 13.5 beats/min according to 24-h Holter monitoring. Two electrophysiological strategies were used, SN ablation and SN modification, with the latter being used more. Procedural acute success (using variably defined pre-determined endpoints) was 88.9%. Consistently, all groups reported high-output pacing from the ablation catheter to confirm absence of phrenic nerve stimulation before radiofrequency delivery. Need of pericardial access varied between 0% and 76.9%. Thirteen patients (8.5%) experienced severe procedural complications, and 15 patients (9.8%) required implantation of a pacemaker. At a mean follow-up interval of 28.1 ± 12.6 months, 86.4% of patients demonstrated successful outcomes. The symptomatic recurrence rate was 19.6%, and 29.8% of patients continued to receive antiarrhythmic drug therapy after procedural intervention. CONCLUSIONS: Inappropriate sinus tachycardia ablation/modification achieves acute success in the vast majority of patients. Complications are fairly common and diverse. However, symptomatic relief decreases substantially over longer follow-up periods, with a corresponding high recurrence rate.
Asunto(s)
Ablación por Catéter/efectos adversos , Técnicas Electrofisiológicas Cardíacas/instrumentación , Taquicardia Sinusal/terapia , Adulto , Antiarrítmicos/uso terapéutico , Mapeo del Potencial de Superficie Corporal , Ablación por Catéter/métodos , Electrocardiografía , Electrocardiografía Ambulatoria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial/normas , Pericardio/anatomía & histología , Nervio Frénico/fisiopatología , Recurrencia , Nodo Sinoatrial/fisiopatología , Taquicardia Sinusal/tratamiento farmacológico , Taquicardia Sinusal/fisiopatología , Resultado del TratamientoRESUMEN
Central nervous system demyelinating processes such as multiple sclerosis and acute disseminated encephalomyelitis constitute a group of diseases not completely understood in their physiopathology. Environmental and toxic insults are thought to play a role in priming autoimmunity. The aim of the present report is to describe a case of acute demyelinating disease with fatal outcome occurring 15 days after oral exposure to herbal extracts.