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1.
Europace ; 20(6): 1001-1009, 2018 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-29016759

RESUMEN

Aims: The Really ProMRI study evaluates magnetic resonance imaging (MRI) access for patients with cardiac implantable electronic devices (CIEDs) as well as the performance of magnetic resonance (MR)-conditional leads when undergoing MRI. Methods and results: Patients either with an MR-conditional pacemaker or implantable defibrillator (ICD) system or with at least a component (device or one or more leads) from an MR-conditional system, were asked to fill in a questionnaire when they were referred to a MR scan. The rate of prescription, denial, or execution of MR examinations was evaluated in a 1-year follow-up visit. In total, 555 patients [median age (interquartile range) 72.2 (62.2-78.6); 72% male] were enrolled, 49% (270) with a pacemaker, 51% (285) with an ICD system. Five-hundred and ten patients completed the follow-up period. A total of 37 MRI referrals were reported in 35 patients, with a consequent event rate of 7.0/100 patient-years (CI, 4.9-9.7). Fourteen were denied, while 23 [66%; (CI, 48-81%)] were performed. The number of patients with MR referrals was not statistically different between pacemaker and ICD groups (21 vs. 14; P = 0.178). The rate of scans performed was higher in the pacemaker subjects (19/23 vs. 4/14, P = 0.003), while it was similar between patients with or without a complete MR-conditional system (19/30 vs. 4/7, P = 0.606). Conclusion: In this study, we reported a 7.0/100 patient-year's event rate of MR prescriptions in CIED patients. Many examinations were denied, despite MR-conditional systems, especially in ICD patients. Regulatory and cultural changes are needed to allow wider access to MR imaging in CIED patients with MR-conditional systems.


Asunto(s)
Desfibriladores Implantables/estadística & datos numéricos , Imagen por Resonancia Magnética , Marcapaso Artificial/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Anciano , Seguridad de Equipos/métodos , Seguridad de Equipos/normas , Femenino , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Cardiopatías/terapia , Humanos , Italia , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos
2.
Europace ; 15(4): 531-40, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23407627

RESUMEN

AIMS: The long-term impact of implantable device-related complications on the patient outcome has not been thoroughly evaluated. The aims of this retrospective, bi-centre study were to analyse the rate and nature of device-related complications requiring surgical revision in a large series of patients undergoing device implantation, elective generator replacement and pacing system upgrade and to systematically assess the impact of such complications on patient outcome and healthcare utilization. METHODS AND RESULTS: Data from 2671 consecutive procedures (1511 device implantations, 1034 elective generator replacements, and 126 pacing system upgrades) performed between January 2006 and March 2011 were retrospectively analysed. The outcome measures recorded were complication-related mortality, number of re-operations, need for complex surgical procedures, number of re-hospitalizations, and additional hospital treatment days. Over a median follow-up of 27 months, the overall rate of complications was 2.8% per procedure-year [9.5% in cardiac resynchronisation therapy (CRT) device implantation, 6.1% in pacing system upgrade, 3.5% in implantable cardioverter defibrillator implantation, 1.7% in pacemaker implantation, and 1.7% in generator replacement). The procedure with the highest risk of complications was CRT device implantation (odds ratio: 6.6; P < 0.001); these complications primarily involved coronary sinus lead dislodgement and device infection. Patients with complications had a significantly higher number of device-related hospitalizations (2.3 ± 0.6 vs. 1.0 ± 0.1; P < 0.001) and hospital treatment days (15.7 ± 25.1 vs. 3.6 ± 1.1; P < 0.001) than those without complications. Device infection was the complication with the greatest negative impact on patient outcome. CONCLUSION: Cardiac resynchronisation therapy implantation was the procedure with the highest risk of complications requiring surgical revision. Complications were associated with substantial clinical consequences and a significant increase in the number and length of hospitalizations.


Asunto(s)
Dispositivos de Terapia de Resincronización Cardíaca , Terapia de Resincronización Cardíaca , Desfibriladores Implantables , Remoción de Dispositivos , Cardioversión Eléctrica/instrumentación , Falla de Equipo , Falla de Prótesis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia de Resincronización Cardíaca/efectos adversos , Terapia de Resincronización Cardíaca/mortalidad , Dispositivos de Terapia de Resincronización Cardíaca/efectos adversos , Distribución de Chi-Cuadrado , Desfibriladores Implantables/efectos adversos , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/mortalidad , Supervivencia sin Enfermedad , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/mortalidad , Femenino , Hematoma/etiología , Hematoma/mortalidad , Hematoma/cirugía , Hospitalización , Humanos , Italia , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/mortalidad , Infecciones Relacionadas con Prótesis/cirugía , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/mortalidad , Infección de la Herida Quirúrgica/cirugía , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
3.
Bull Entomol Res ; 103(3): 278-85, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23448149

RESUMEN

Esterase-based resistance in the peach-potato aphid, Myzus persicae (Sulzer), is generally due to one of two alternative amplified carboxylesterase genes, E4 or FE4 (fast E4). The E4 amplified form is distributed worldwide and it is correlated with a particular translocation between autosomes 1 and 3, whereas the FE4 form, which has hitherto not been found to be associated with chromosomal rearrangements, is typical of the Mediterranean regions. In this study, we present for the first time cytogenetic and molecular data on some M. persicae parthenogenetic lineages, which clearly show a chromosomal A1-3 translocation associated with esterase FE4 genes and unrelated to high levels of esterase-based resistance.


Asunto(s)
Áfidos/enzimología , Carboxilesterasa/genética , Productos Agrícolas/parasitología , Proteínas de Insectos/genética , Resistencia a los Insecticidas/genética , Translocación Genética/genética , Animales , Áfidos/genética , Secuencia de Bases , Análisis Citogenético , Cartilla de ADN/genética , Italia , Datos de Secuencia Molecular , Partenogénesis , Reacción en Cadena en Tiempo Real de la Polimerasa
4.
Int J Surg Case Rep ; 105: 108012, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36966716

RESUMEN

INTRODUCTION: With the spread of the use of implantable loop recorders (ILRs) by cardiologists for outpatient cardiac monitoring, intrathoracic migration represents a rare but possible complication occurring after the placement of these devices. Very few cases of ILRs intrathoracic migration into the pleural cavity have been reported, followed in even fewer cases by surgical removal of the devices, but in none re-implantation was performed. PRESENTATION OF CASE: We report the first case of a patient with a new generation ILR accidentally migrated into the postero-inferior costophrenic recess of the left pleural cavity, successfully removed by uniportal video-assisted thoracic surgery (VATS) and submitted to re-implantation of a new ILR in the same operating session. DISCUSSION: To reduce the risk of ILRs intrathoracic displacement, the insertion technique must be performed in the most suitable part of the chest wall, with the correct incision and angle of penetration, by an expert operator. When migrated into the pleural cavity, surgical removal should be performed to avoid the onset of early and late complications. A mini-invasive surgical approach by uniportal VATS could be considered as the first choice, ensuring a favourable patient outcome. Re-implantation of a new ILR can be safely performed in the same operating session. CONCLUSION: In case of intrathoracic migration of ILRs, early removal by mini-invasive approach is recommended as well as concomitant re-implantation. Beyond periodic monitoring of ILRs by cardiologists, strict radiological follow-up with chest X-ray is advisable after implantation, in order to early identify any abnormalities and correctly manage them.

5.
Europace ; 14(7): 1038-43, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22247273

RESUMEN

AIMS: Closed-loop stimulation (CLS) pacing has shown greater efficacy in preventing the recurrence of vasovagal syncope (VVS) in patients with a cardioinhibitory response to head-up tilt test (HUTT) compared with conventional pacing. Moreover, there is no conclusive evidence to support the superiority of CLS over the conventional algorithms for syncope prevention. This study retrospectively evaluated the effectiveness of CLS pacing compared with dual-chamber pacing with conventional specialized sensing and pacing algorithms for syncope prevention in the prevention of syncope recurrence in patients with refractory VVS and a cardioinhibitory response to HUTT during a long-term follow-up. METHODS AND RESULTS: Forty-one patients (44% male, 53 ± 16 years) with recurrent, refractory VVS (26% with trauma) and a cardioinhibitory response to HUTT who had undergone pacemaker implantation were included in the analysis. Twenty-five patients received a dual-chamber CLS pacemaker (CLS group) and 16 patients received a dual-chamber pacemaker with conventional algorithms for syncope prevention (conventional pacing group): 9 patients with Medtronic rate drop response algorithm and 7 patients with Guidant-Boston Scientific sudden brady response algorithm. During the follow-up (mean 4.4 ± 3.0 years, interquartile range 2.2-7.4 years) one patient (4%) in the CLS group and six (38%) in the conventional pacing group had syncope recurrences (P= 0.016). The Kaplan-Meier actuarial estimate of first recurrence of syncope after 8 years was 4% in the CLS group and 40% in the conventional pacing group (P= 0.010). CONCLUSIONS: The results of this retrospective analysis show that, in order to prevent a recurrence of VVS in patients with a cardioinhibitory response to HUTT, dual-chamber CLS pacing was more effective than dual-chamber pacing with conventional algorithms for syncope prevention in preventing bradycardia-related syncope.


Asunto(s)
Algoritmos , Estimulación Cardíaca Artificial/métodos , Diagnóstico por Computador/métodos , Electrocardiografía/métodos , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/prevención & control , Terapia Asistida por Computador/métodos , Retroalimentación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Método Simple Ciego , Resultado del Tratamiento
6.
Eur J Echocardiogr ; 12(10): 773-81, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21865227

RESUMEN

AIMS: Brugada syndrome (BrS) is an inherited channelopathy that can be characterized by mild right ventricular (RV) abnormalities that are not detectable with conventional echocardiography. The aim of this study was to evaluate the presence of RV abnormalities in BrS patients when compared with controls and a group of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using two-dimensional (2D) strain analysis. METHODS AND RESULTS: We enrolled 25 BrS, 15 ARVD/C patients, and 25 controls. Right and left ventricular dimension and systo-diastolic function were evaluated by conventional echocardiography. Longitudinal systolic strain (sS) peak, systolic and early diastolic strain rate of lateral RV segments were evaluated by 2D speckle tracking analysis. Left ventricle global and segmental strain measures were also evaluated. A reduced basal or mid-RV lateral sS were the parameters mostly associated with both BrS and ARVD/C. In BrS patients the minimum sS observed in these segments was significantly lower than that of controls (-28.9±3.2% vs. -32.3±3.2%, P: 0.002) but significantly greater than that evaluated in ARVD/C patients (-24.6±6.7%, P<0.001 both vs. BrS and controls). No differences were found between the BrS and the control group when left ventricular strain measures were analysed. CONCLUSION: By 2D strain technique it is possible to observe mild abnormalities in RV systolic and diastolic function of BrS patients that are less pronounced than those observed in ARVD/C patients. These results help to better define the phenotypic characteristics of BrS patients and represent the basis for future studies aimed at testing their clinical usefulness in BrS patients.


Asunto(s)
Displasia Ventricular Derecha Arritmogénica/diagnóstico por imagen , Síndrome de Brugada/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Adulto , Displasia Ventricular Derecha Arritmogénica/fisiopatología , Síndrome de Brugada/fisiopatología , Ecocardiografía , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/fisiopatología
7.
Pest Manag Sci ; 74(1): 240-245, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28834586

RESUMEN

BACKGROUND: Pest control in post-harvest food storage represents a great challenge in the sustainable prevention of food losses, and insecticide-treated netting may represent a valid alternative to traditional practices such as the direct application of insecticides. In our work, the efficacy of a permethrin-incorporated net, in combination with polypropylene or jute sacking, was tested for the control of Sitophilus oryzae. Contamination of maize grain by permethrin from the treated netting was also evaluated. RESULTS: A 98% control of S. oryzae was achieved using permethrin-treated netting. Both jute and polypropylene acted as additional barriers, increasing efficacy to 100%. The results also showed the contamination of maize kernel by permethrin released from the treated netting. The concentration of residues in maize kernels increased with increasing temperature; however, use of jute or polypropylene significantly reduced (by 87% to 97%) the concentration of residues transferred to maize kernels. CONCLUSIONS: Permethrin-treated netting provided a high level of efficacy in the post-harvest protection of maize. Several factors influenced permethrin residue concentrations in grains when treated nets are used. Therefore, solutions should be found to prevent contamination of food stored in the bags that are treated with insecticides. © 2017 Society of Chemical Industry.


Asunto(s)
Control de Insectos , Insecticidas , Permetrina , Gorgojos , Zea mays , Animales , Grano Comestible , Femenino , Masculino
8.
Circulation ; 114(5): 368-76, 2006 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-16864729

RESUMEN

BACKGROUND: Brugada syndrome is associated with a high risk of sudden cardiac death and is caused by mutations in the cardiac voltage-gated sodium channel gene. Previously, the R282H-SCN5A mutation in the sodium channel gene was identified in patients with Brugada syndrome. In a family carrying the R282H-SCN5A mutation, an asymptomatic individual had a common H558R-SCN5A polymorphism and the mutation on separate chromosomes. Therefore, we hypothesized that the polymorphism could rescue the mutation. METHODS AND RESULTS: In heterologous cells, expression of the mutation alone did not produce sodium current. However, coexpressing the mutation with the polymorphism produced significantly greater current than coexpressing the mutant with the wild-type gene, demonstrating that the polymorphism rescues the mutation. Using immunocytochemistry, we demonstrated that the R282H-SCN5A construct can traffic to the cell membrane only in the presence of the H558R-SCN5A polymorphism. Using fluorescence resonance energy transfer and protein fragments centered on H558R-SCN5A, we demonstrated that cardiac sodium channels preferentially interact when the polymorphism is expressed on one protein but not the other. CONCLUSIONS: This study suggests a mechanism whereby the Brugada syndrome has incomplete penetrance. More importantly, this study suggests that genetic polymorphisms may be a potential target for future therapies aimed at rescuing specific dysfunctional protein channels.


Asunto(s)
Arritmias Cardíacas/genética , Arritmias Cardíacas/fisiopatología , Proteínas Musculares/genética , Proteínas Musculares/fisiología , Mutación Missense/genética , Polimorfismo de Nucleótido Simple/genética , Canales de Sodio/genética , Canales de Sodio/fisiología , Línea Celular , Membrana Celular/química , Membrana Celular/fisiología , ADN/genética , Muerte Súbita Cardíaca/etiología , Electrofisiología , Femenino , Regulación de la Expresión Génica , Humanos , Inmunohistoquímica , Masculino , Proteínas Musculares/análisis , Mutación Missense/fisiología , Canal de Sodio Activado por Voltaje NAV1.5 , Linaje , Polimorfismo de Nucleótido Simple/fisiología , Proteínas/metabolismo , Factores de Riesgo , Canales de Sodio/análisis , Síndrome
10.
J Am Coll Cardiol ; 45(1): 65-9, 2005 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-15629375

RESUMEN

OBJECTIVES: The aim of this study was to evaluate whether the clinical benefit of cardiac resynchronization therapy (CRT) can be prospectively predicted by means of the baseline evaluation of left ventricular asynchrony. BACKGROUND: The reverse remodeling associated with CRT is more evident in patients with severe heart failure (HF) and left bundle branch block (LBBB) who have left ventricular asynchrony. METHODS: Baseline left ventricular asynchrony was assessed in 60 patients with severe HF and LBBB by calculating the electrocardiographic duration of QRS and the echocardiographic septal-to-posterior wall motion delay (SPWMD). Left ventricular size and left ventricular ejection fraction (LVEF), mitral valve regurgitation, and functional capacity were also evaluated. The progression toward HF (defined as a worsening clinical condition leading to a sustained increase in conventional therapies, hospitalization, cardiac transplantation, and death) was assessed during follow-up, as were the changes in LVEF after six months. RESULTS: During the median follow-up of 14 months, 16 patients experienced HF progression. Univariate analysis showed that ischemic cardiomyopathy, changes in the QRS duration after implantation, and SPWMD significantly correlated with events. At multivariate analysis, a long SPWMD remained significantly associated with a reduced risk of HF progression (hazard ratio: 0.91; 95% confidence interval: 0.83 to 0.99; p <0.05). An improvement in LVEF was observed in 79% of the patients with a baseline SPWMD of > or =130 ms and in 9% of those with an SPWMD of <130 ms (p <0.0001). CONCLUSIONS: Baseline SPWMD is a strong predictor of long-term clinical improvement after CRT in patients with severe HF and LBBB.


Asunto(s)
Bloqueo de Rama/fisiopatología , Bloqueo de Rama/terapia , Estimulación Cardíaca Artificial , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Remodelación Ventricular/fisiología , Anciano , Bloqueo de Rama/diagnóstico por imagen , Cardiomiopatía Dilatada/diagnóstico por imagen , Cardiomiopatía Dilatada/fisiopatología , Cardiomiopatía Dilatada/terapia , Progresión de la Enfermedad , Ecocardiografía Doppler , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Estudios Prospectivos , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen
11.
Eur J Heart Fail ; 8(5): 509-14, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16503416

RESUMEN

OBJECTIVE: To evaluate the role of brain natriuretic peptide (BNP) in predicting the progression of heart failure (HF) after cardiac resynchronization therapy (CRT). BACKGROUND: It has been shown that BNP predicts the prognosis and can guide the treatment of HF. METHODS: We studied 50 consecutive patients (61+/-10 years, 23 male) with HF (8 with ischaemic cardiomyopathy), NYHA class III, left bundle branch block, left ventricular ejection fraction (LVEF) 91.5 pg/ml had 89% sensitivity, 59% specificity, and negative and positive predictive values of 96% and 33%, respectively, for HF progression after 12 months. CONCLUSIONS: HF patients with high BNP values after 1 month of CRT have worse prognosis during follow-up. Therefore, in these patients other therapeutic options should be considered.


Asunto(s)
Estimulación Cardíaca Artificial , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/terapia , Péptido Natriurético Encefálico/sangre , Anciano , Progresión de la Enfermedad , Ecocardiografía Doppler , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Pronóstico , Modelos de Riesgos Proporcionales , Medición de Riesgo , Análisis de Supervivencia , Remodelación Ventricular
12.
J Am Coll Cardiol ; 42(9): 1632-7, 2003 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-14607451

RESUMEN

OBJECTIVES: The aim of this study was to evaluate whether the occurrence of the Brugada Syndrome typical electrocardiogram (ECG) pattern (i.e., right bundle branch block, coved-type ST-segment elevation, and T-wave inversion in the right precordial leads) is characterized by a concomitant lengthening of QT intervals in the right precordial leads. BACKGROUND: It has been suggested that the typical ECG pattern of Brugada syndrome is due to a decreased net inward current during phase 1 of the action potential, which also leads to its prolongation in the right epicardium. METHODS: Thirty-two subjects (19 males) age 37 +/- 15 years with a suspicious baseline ECG, or who were relatives of Brugada syndrome patients, underwent 12-lead ECG before and after the administration of flecainide. RESULTS: The flecainide test was negative in 14 and positive in 18 subjects. After flecainide administration, the positive ECGs were characterized by a greater QT interval corrected for heart rate (QTc) prolongation in the right precordial leads than that in the negative ECGs (78.2 +/- 35.5 ms vs. 22.0 +/- 28.4 ms in V(1) and 107.1 +/- 43.8 ms vs. 26.7 +/- 30.1 ms in V(2); p < 0.01), whereas there was no difference in the QTc prolongation in the left precordial leads (55.2 +/- 25.3 ms vs. 35.1 +/- 28.1 ms in V(5) and 53.1 +/- 32.8 ms vs. 27.3 +/- 22.4 ms in V(6); p = NS). CONCLUSIONS: In accordance with the electrophysiological background, the typical ECG pattern of Brugada syndrome is also characterized by a considerable prolongation of the QT interval in right precordial leads.


Asunto(s)
Bloqueo de Rama/diagnóstico , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Adulto , Antiarrítmicos , Bloqueo de Rama/genética , Bloqueo de Rama/fisiopatología , Femenino , Flecainida , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo Conformacional Retorcido-Simple , Curva ROC , Sensibilidad y Especificidad
13.
Pest Manag Sci ; 71(6): 878-84, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25346186

RESUMEN

BACKGROUND: Pyrethroids have been widely employed in order to control several agricultural pests, including Myzus persicae. Target-site resistance is the main mechanism that confers insensitivity to this class of compounds, and the most common amino acid substitutions are kdr (L1014F) and s-kdr (M918T), but recently another mutation in the s-kdr locus (M918L) has been described in French and Korean populations of M. persicae. RESULTS: Molecular analysis of several Italian populations of M. persicae by pyrosequencing revealed the presence of the new s-kdr mutation (M918L) in different forms. It was found in two different nucleotide polymorphisms (a/t or a/c substitution), in heterozygous or homozygous status, and also in combination with the classic kdr and s-kdr. Bioassays on populations carrying the M918L mutation show that it strongly affects pyrethroid efficacy, particularly of type II pyrethroids such as lambda-cyhalothrin, while it has no effect against DDT. CONCLUSION: This work provides more information about the new s-kdr M918L mutation in M. persicae, describing a more complicated situation arising from the possible combination with the classic L1014F and M918T. Our data open new questions concerning the origin of these new genotypes with different combinations of target-site mutations, and also their possible influence on control strategies.


Asunto(s)
Áfidos/genética , Canales de Sodio Activados por Voltaje/genética , Sustitución de Aminoácidos , Animales , Áfidos/efectos de los fármacos , DDT/farmacología , Resistencia a los Insecticidas , Insecticidas/farmacología , Mutación , Nitrilos/farmacología , Piretrinas/farmacología
14.
J Cardiovasc Med (Hagerstown) ; 16(10): 715-20, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25252037

RESUMEN

BACKGROUND: Despite the fact that magnetic resonance (MR)-conditional pacemaker and lead systems have been introduced more than 5 years ago, it is still not clear whether they have actually facilitated the access of pacemaker patients to this important diagnostic tool. Factors limiting MR scans in daily practice in patients with MR-conditional cardiac implantable electronic device (CIED) systems may be related to organizational, cultural and sometimes legal aspects. The Really ProMRI registry is an ongoing survey designed to assess the annual rate of MR examinations in patients with MR-conditional implants, with either pacemakers or implantable cardioverter defibrillators, and to detect the main factors limiting MRI. METHODS: The primary endpoint of the Really ProMRI registry is to assess the current access to MRI of patients with MR-conditional pacemaker or implantable cardioverter defibrillator systems during normal practice. Data in the literature reported a 17% annual incidence of medical conditions requiring MRI in CIED patients. The Really ProMRI registry has been designed to detect 4.5% absolute difference with an 80% statistical power, by recruiting 600 patients already implanted with MR-conditional CIED implant. Patients will be followed up for 1 year, during which they will be asked to refer any prescription, execution or denial of an MR examination by patient questionnaires and original source documents. CONCLUSION: The ongoing Really ProMRI registry will assess the actual rate of and factors limiting the access to MRI for patients with MR-conditional CIEDs.


Asunto(s)
Desfibriladores Implantables , Fenómenos Electromagnéticos , Imagen por Resonancia Magnética/efectos adversos , Marcapaso Artificial , Corazón/fisiopatología , Humanos , Sistema de Registros , Proyectos de Investigación
15.
Int J Cardiol ; 168(4): 3450-7, 2013 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-23701932

RESUMEN

BACKGROUND: Several previous implantable loop recorder (ILR) studies have shown bradyarrhythmic events requiring a pacemaker implantation in a significant proportion of patients with unexplained syncope (US). The aim of this observational, two-centre, study was to identify the predictive factors for pacemaker implantation in a population of patients receiving an ILR for US with suspected arrhythmic aetiology. METHODS: Fifty-six patients (mean age 68 years, 61% male) with a history of US and negative cardiac and neurological workup, who underwent ILR implantation, were enrolled. After the implantation, a follow-up visit was undertaken after symptomatic events or every 3 months in asymptomatic subjects. The end-point of the study was the detection of a bradyarrhythmia (with or without a syncopal recurrence) requiring pacemaker implantation. RESULTS: After a median ILR observation of 22 months, a clinically significant bradyarrhythmia was detected in 11 patients (20%), of which 9 cases related to syncopal relapses. In the multivariable analysis, three independent predictive factors for pacemaker implantation were identified: an age >75 years (odd ratio [OR]: 29.9; p=0.035); a history of trauma secondary to syncope (OR: 26.8; p=0.039); and the detection of periods of asymptomatic bradycardia, not sufficient to explain the mechanism of syncope, during conventional ECG monitoring (through 24 h Holter or in hospital telemetry), performed before ILR implantation (OR: 24.7; p=0.045). CONCLUSIONS: An advanced age, a history of trauma secondary to syncope, and the detection of periods of asymptomatic bradycardia during conventional ECG monitoring were independent predictive factors for bradyarrhythmias requiring pacemaker implantation in patients receiving an ILR for US.


Asunto(s)
Bradicardia/diagnóstico , Prueba de Esfuerzo/métodos , Examen Neurológico/métodos , Marcapaso Artificial , Síncope/diagnóstico , Anciano , Anciano de 80 o más Años , Bradicardia/fisiopatología , Bradicardia/terapia , Prueba de Esfuerzo/tendencias , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/tendencias , Marcapaso Artificial/tendencias , Valor Predictivo de las Pruebas , Síncope/fisiopatología , Síncope/terapia
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