RESUMEN
Catheter ablation of recurrent atrial arrhythmias following pulmonary vein isolation can be challenging given the complex nature of previously ablated tissue, and managing these already complex cases may be rendered more difficult by the impact of wavefront directionality on mapping catheter orientation, which can make the accurate identification of arrhythmogenic substrate more difficult to achieve. In this report, a 72-year-old man with a history of symptomatic paroxysmal atrial fibrillation and prior pulmonary vein isolation (PVI) underwent repeat ablation. Importantly, this case study demonstrates how a direction-independent high-density mapping catheter (Advisor™ HD Grid; Abbott, Chicago, IL, USA) can identify fractionated low-voltage zones that may be missed when using a standard linear ablation catheter.
RESUMEN
Placental mesenchymal dysplasia is a benign condition that can be confused with a molar pregnancy by ultrasound scanning and gross examination. Conservative management should be considered with a normal-appearing singleton fetus and a cystic-appearing placenta. We present a case of placental mesenchymal dysplasia with a favorable outcome.
Asunto(s)
Mola Hidatiforme/diagnóstico , Mesodermo/diagnóstico por imagen , Enfermedades Placentarias/diagnóstico , Placenta/diagnóstico por imagen , Resultado del Embarazo , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Mesodermo/patología , Placenta/patología , Embarazo , Ultrasonografía , Adulto JovenRESUMEN
An asymptomatic patient with a Teletronics Accufix atrial lead (Teletronics, Englewood, CO, USA) presented for an annual fluoroscopic examination. The examination revealed a retention wire fracture, which occurred 18 years after the initial implantation. Annual fluoroscopic examination of these leads should still be performed.
Asunto(s)
Marcapaso Artificial , Falla de Prótesis , Síndrome del Seno Enfermo/cirugía , Anciano , Remoción de Dispositivos , Electrodos Implantados , Fluoroscopía , Humanos , Masculino , Síndrome del Seno Enfermo/diagnóstico por imagenRESUMEN
Multiple clinical trials support the use of implantable cardioverter-defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure (HF). Unfortunately, several complicating issues have arisen from the universal use of ICDs in HF patients. An estimated 20% to 35% of HF patients who receive an ICD for primary prevention will experience an appropriate shock within 1 to 3 years of implant, and one-third of patients will experience an inappropriate shock. An ICD shock is associated with a 2- to 5-fold increase in mortality, with the most common cause being progressive HF. The median time from initial ICD shock to death ranges from 168 to 294 days depending on HF etiology and the appropriateness of the ICD therapy. Despite this prognosis, current guidelines do not provide a clear stepwise approach to managing these high-risk patients. An ICD shock increases HF event risk and should trigger a thorough evaluation to determine the etiology of the shock and guide subsequent therapeutic interventions. Several combinations of pharmacologic and device-based interventions such as adding amiodarone to baseline beta-blocker therapy, adjusting ICD sensitivity, and employing antitachycardia pacing may reduce future appropriate and inappropriate shocks. Aggressive HF surveillance and management is required after an ICD shock, as the risk of sudden cardiac death is transformed to an increased HF event risk.
Asunto(s)
Insuficiencia Cardíaca/terapia , Antagonistas Adrenérgicos beta/uso terapéutico , Algoritmos , Amiodarona/uso terapéutico , Antiarrítmicos/uso terapéutico , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Progresión de la Enfermedad , Quimioterapia Combinada , Falla de Equipo , Insuficiencia Cardíaca/mortalidad , Humanos , Prevención Primaria , Pronóstico , Calidad de Vida , Prevención Secundaria , Taquicardia Ventricular/terapia , Fibrilación Ventricular/terapiaRESUMEN
PURPOSE: Heart failure (HF) affects five million patients each year with both prevalence and incidence increasing with age. At least 20% of hospital admissions in patients > age 65 are due to HF. Cardiac resynchronization therapy (CRT) has been shown to improve HF symptoms and decrease mortality. However, little data are available which specifically address the effects of CRT in the elderly (>65). METHODS: We performed an analysis of the NYHA III/IV 839 patients randomized in the MIRACLE (n = 470) and MIRACLE-ICD (n = 369) trials. Both included patients with moderate to severe HF, ejection fraction (EF)
Asunto(s)
Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/prevención & control , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/prevención & control , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estimulación Cardíaca Artificial , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: The effects of concomitant amiodarone and haloperidol on Q-Tc interval prolongation were studied. METHODS: All adult patients admitted to a 618-bed tertiary referral teaching hospital between January 1, 2005, and December 31, 2006, who received amiodarone and haloperidol concomitantly were included in this retrospective descriptive analysis. Data collected to assess patients' risk of developing Q-T interval prolongation included age, sex, past medical history, and number of days of concomitant exposure. Data relevant for the assessment of cardiac effects were collected for the time period between 24 hours before and after the administration of haloperidol and included laboratory test values, use of other Q-T interval-prolonging drugs, heart rate, Q-Tc intervals, and clinical documentation of arrhythmia. To determine change in the Q-Tc interval, Q-T and R-R values were recorded using cardiac rhythm strips or electrocardiogram. Nurses' and physicians' records were reviewed to determine if an arrhythmia occurred. Descriptive statistics were used to analyze baseline patient information and Q-Tc interval data. RESULTS: A total of 49 patients met inclusion criteria, yielding 381 distinct amiodarone-haloperidol exposures. During 138 (36.2%) of 381 haloperidol-amiodarone exposures, patients received at least one additional Q-T interval-prolonging drug. When amiodarone-haloperidol exposures were grouped by the number of concomitant Q-T prolonging drugs, no apparent association was detected between longer Q-Tc intervals and an increased number of concomitant Q-T interval-prolonging drugs. CONCLUSION: A small, potentially significant Q-Tc interval prolongation, but not ventricular arrhythmia, was observed in adult patients who received a concomitant administration of amiodarone and haloperidol at a tertiary referral teaching hospital.
Asunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Antipsicóticos/efectos adversos , Haloperidol/efectos adversos , Sistema de Conducción Cardíaco/efectos de los fármacos , Síndrome de QT Prolongado/inducido químicamente , Anciano , Quimioterapia Combinada , Electrocardiografía/efectos de los fármacos , Electrocardiografía/métodos , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Hospitales de Enseñanza , Humanos , Síndrome de QT Prolongado/fisiopatología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
More than 20% of cardiac transplant patients go on to require permanent pacing. We sought to determine the incidence of cardiac pacing in our cardiac transplant population and identify characteristics that may predict which patients will require permanent pacing. We reviewed medical records of cardiac transplant recipients and compared baseline characteristics of patients who received pacemakers with those of patients who did not receive pacemakers. Of 292 patients included in this analysis, 71 (24%) required permanent posttransplant pacing. Use of amiodarone before transplant was associated with a nonsignificant trend toward needing a pacemaker after transplant (P=0.08). Patients undergoing biatrial anastomosis were more likely to require permanent pacing than patients undergoing bicaval anastomosis (P<0.001). Approximately one fourth of cardiac transplant patients require permanent pacing. Surgical technique is a major predictor of who will require permanent pacing after cardiac transplantation.
Asunto(s)
Estimulación Cardíaca Artificial/estadística & datos numéricos , Trasplante de Corazón , Adulto , Anciano , Trasplante de Corazón/efectos adversos , Humanos , Incidencia , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Two female patients undergoing left atrial radiofrequency catheter ablation developed Tako-tsubo cardiomyopathy. This reversible form of left ventricular dysfunction is known to occur under conditions associated with marked sympathetic nervous activation. Radiofrequency catheter ablation in the left atrium can damage autonomic ganglionated plexi, leading to vagal withdrawal, thus resulting in enhanced sympathetic tone. Tako-tsubo cardiomyopathy has not been previously described following radiofrequency catheter ablation.
Asunto(s)
Cardiomiopatías/etiología , Ablación por Catéter/efectos adversos , Atrios Cardíacos/cirugía , Disfunción Ventricular Izquierda/etiología , Anciano , Fibrilación Atrial/cirugía , Cardiomiopatías/diagnóstico , Cardiomiopatías/terapia , Femenino , Humanos , Persona de Mediana Edad , Taquicardia Atrial Ectópica/cirugía , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/terapiaRESUMEN
We report 3 cases of late-onset atrial fibrillation several years after cardiac transplantation, each involving left ventricular systolic dysfunction in the absence of cardiac rejection or cardiac allograft vasculopathy. Although the etiology of late-onset atrial fibrillation in cardiac transplant recipients is not clear, its presence in the absence of cardiac rejection or coronary allograft vasculopathy can result in left ventricular systolic dysfunction, and therefore should be considered in the differential diagnosis of cardiac allograft failure. The onset of atrial fibrillation years after a heart transplant is not necessarily an indication of rejection. Aggressive rate control and restoration of normal sinus rhythm may improve allograft function in such cases.
Asunto(s)
Fibrilación Atrial/complicaciones , Trasplante de Corazón , Complicaciones Posoperatorias , Disfunción Ventricular Izquierda/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
Cardiac resynchronization therapy (CRT) is an established adjunctive treatment for patients with systolic heart failure (HF) and ventricular dyssynchrony. The majority of recipients respond to CRT with improvements in quality of life, New York Heart Association functional class, 6-min walk test, and ventricular function. Management of HF after CRT may include up-titration of neurohormonal blockade and an exercise prescription through cardiac rehabilitation to further improve and sustain clinical outcomes. Diagnostic data provided by the CRT device may help to facilitate and optimize treatment. Initial nonresponder rates remain problematic. We suggest a simple step-by-step management and troubleshooting strategy that integrates device function with advanced HF therapy in patients who do not initially respond to CRT. This algorithm represents a new, comprehensive, collaborative approach between the HF and electrophysiology specialists to further improve and sustain outcomes in the field of CRT.
Asunto(s)
Gasto Cardíaco Bajo/terapia , Estimulación Cardíaca Artificial , Antagonistas Adrenérgicos beta/uso terapéutico , Algoritmos , Gasto Cardíaco Bajo/complicaciones , Gasto Cardíaco Bajo/fisiopatología , Gasto Cardíaco Bajo/rehabilitación , Electrodiagnóstico , Humanos , Neurotransmisores/antagonistas & inhibidores , Marcapaso Artificial , Insuficiencia del Tratamiento , Disfunción Ventricular/etiologíaRESUMEN
OBJECTIVE: The objective of this analysis was to determine if there were differences in ventricular reverse remodeling and 6-month outcome with cardiac resynchronization therapy (CRT) among specific subgroups enrolled in the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study. BACKGROUND: Analysis of major subgroups receiving CRT is important in determining who may be most likely to benefit, since all patients who receive CRT do not demonstrate improvement. METHODS: Differences in response to CRT between subgroups based on baseline echocardiographic parameters, New York Heart Association (NYHA) class, age, gender, beta blocker use, and etiology of heart failure (HF) were analyzed for the clinical end points of the study as well as 6-month HF re-hospitalization or death. RESULTS: The benefit of CRT over control was similar in all subgroups with respect to all clinical endpoints. However, non-ischemic HF patients had greater improvements with CRT compared to ischemic HF patients in left ventricular end diastolic volume (P < 0.001) and ejection fraction (EF) (6.7% increase vs. 3.2% [P < 0.001]). Greater improvements in EF were also seen in those patients with less severe baseline mitral regurgitation (MR) (P < 0.001). Women but not men receiving CRT were more likely to be event-free from first HF hospitalization or death compared to the control group (Hazard Ratio = 0.157). CONCLUSIONS: The benefits of CRT with respect to EF and reverse remodeling were greater in patients with non-ischemic HF and less severe MR. Women may also derive more benefit than men with respect to the occurrence of HF hospitalization or death.
Asunto(s)
Estimulación Cardíaca Artificial , Desfibriladores Implantables , Cardioversión Eléctrica , Insuficiencia Cardíaca/terapia , Remodelación Ventricular/fisiología , Anciano , Análisis de Varianza , Ecocardiografía , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Calidad de Vida , Estadísticas no Paramétricas , Análisis de Supervivencia , Resultado del Tratamiento , Disfunción Ventricular IzquierdaRESUMEN
A retrospective analysis was performed on 52 patients with heart failure to determine the change in beta-blocker therapy after cardiac resynchronization therapy (CRT). After 6 months of CRT, the number of patients receiving beta-blocker therapy increased from 36 to 44, with improved clinical outcomes and larger beta-blocker doses, indicating that these 2 therapies may work together to improve outcomes by allowing the use of larger doses of beta blockers while correcting ventricular dyssynchrony.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Arritmias Cardíacas/terapia , Desfibriladores Implantables , Insuficiencia Cardíaca/tratamiento farmacológico , Anciano , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/diagnóstico , Electrocardiografía , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A novel strategy for rapid chiral method development has been implemented using sample pooling and supercritical fluid chromatography-mass spectrometry (SFC-MS) on four chiral stationary phases, namely Chiralpak AD and AS, and Chiralcel OJ and OD, and eight different modifier concentrations (5 to 40% methanol-0.2% isopropylamine). The screening is performed under an outlet pressure of 110 bar at 35 degrees C, and at a flow-rate of 2.5 ml/min for the initial 20 min and then ramped up to 4 ml/min and held for 4.5 min to elute all solutes from the column. The entire process is fully automated from injection to data processing, and operates unattended for 15 h overnight to obtain optimal chiral separation for multiple compounds. A unique feature of using SFC-MS to monitor chiral synthesis is the negligible interferences from achiral impurities. In addition, with SFC-MS, enantiomeric excess can be determined with much lower detection limits than UV and much shorter analysis times compared to normal-phase/reversed-phase liquid chromatography.