Estudio transversal: Prevalencia de arritmias cardiacas supraventriculares y factores asociados en pacientes adultos atendidos en consulta cardiológica. Hospital José Carrasco Arteaga, Cuenca, 2018 / Cross sectional Study: Prevalence of supraventricular cardiac arrhythmias and associated factors in adult patients seen at the outpatient cardiology service. Hospital José Carrasco Arteaga, Cuenca, 2018.

INTRODUCCIÓN: Las arritmias cardiacas son enfermedades cardiovasculares, causadas por alteraciones en la conducción o formación de estímulos eléctricos. La detección oportuna de estas alteraciones es crucial, pues a largo plazo mejora la calidad de vida de las personas que padecen estas patologías. El objetivo del presente estudio fue determinar la prevalencia de arritmias cardiacas supraventriculares y sus factores asociados en paciente adultos atendidos en la consulta externa de la unidad de cardiología del Hospital José Carrasco Arteaga, Cuenca, 2018. MATERIALES Y MÉTODOS: Se realizó un estudio observacional, transversal, descriptivo y de correlación con una muestra de 608 pacientes mayores de 18 años atendidos en la Institución mencionada que se realizaron electrocardiograma durante el año 2018. Se estudiaron las variables: estado nutricional, hipertensión arterial, diabetes, tabaquismo, medicamentos utilizados; edad y sexo; presencia de arritmia supraventricular. Se utilizó la prueba Chi cuadrado para buscar asociación entre las variables cualitativas; considerando diferencias estadísticamente significativas una p < 0.05. RESULTADOS: De 608 pacientes, el 57.1% fueron mujeres; 61.84% fueron menores de 65 años. El 43.9% tuvo sobrepeso, el 27.6% presentó IMC normal. Las enfermedades crónicas como HTA y Diabetes tuvieron una frecuencia de 44.4% y 16% respectivamente. La prevalencia de las arritmias supraventriculares fue del 3.8%. La fibrilación auricular fue la arritmia supraventricular más frecuente con el 47.8%, seguida de la arritmia sinusal con el 26.08%. Hubo mayor prevalencia de arritmias supraventriculares en el sexo femenino que en el masculino (4.6% vs 2.7%), en los pacientes con sobrepeso u obesidad que en los que tenían IMC normal ( 4.4% vs 2.3%), en los pacientes hipertensos en relación a los que no padecían de hipertensión (5.2% vs 2.7%), en los pacientes usuarios de medicamentos antitiroideos en relación a los que los consumían (50% vs 3.6%); sin embargo no se encontró asociación estadísticamente significativa con ninguna de estas variables. CONCLUSIÓN: La prevalencia de las arritmias supraventriculares fue del 3.8%. La principal de arritmia cardiaca diagnosticada fue la fibrilación auricular seguida de la arritmia sinusal. No se encontró asociación estadísticamente significativa entre la frecuencia de las arritmias supraventriculares y las variables estudiadas.(AU)

BACKGROUND: Cardiac arrhythmias are cardiovascular diseases, caused by disturbances in the initiation or conduction of electrical stimuli. The timely detection of these alterations is crucial, since in the long term it improves the quality of life of people suffering from these pathologies. The aim of this study was to determine the prevalence of supraventricular cardiac arrhythmias and their associated factors in adult patients treated in the outpatient clinic of the cardiology unit of Hospital José Carrasco Arteaga, Cuenca, 2018. METHODS: An observational, cross-sectional, descriptive and correlation study was carried out with a sample of 608 patients older than 18 years, at the mentioned Institution, who underwent electrocardiography during 2018. We studied the variables: nutritional status, arterial hypertension, diabetes, smoking, used drugs; age and sex; presence of supraventricular arrhythmia. We used Chi Square test to search for an association between the qualitative variables; considering statistical significance a p <0.05. RESULTS: of 608 patients, 57.1% were women; 61.84% were under 65 years of age. 43.9% were overweight, 27.6% had normal body mass index (BMI). Chronic diseases such as hypertension and diabetes had a frequency of 44.4% and 16% respectively. The prevalence of supraventricular arrhythmias was 3.8%. Atrial fibrillation was the most frequent supraventricular arrhythmia with 47.8%, followed by sinus arrhythmia with 26.08%. There was a higher prevalence of supraventricular arrhythmias in females than males (4.6% vs 2.7%), in overweight or obese patients than in those with normal BMI (4.4% vs 2.3%), in hypertensive patients than in those who didn't suffer from hypertension ( 5.2% vs 2.7%), in patients who used antithyroid drugs than in those who didn't use them (50% vs 3.6%); however, no statistically significant association was found with any of these variables. CONCLUSION: The prevalence of supraventricular arrhythmias was 3.8%. The most common cardiac arrhythmia was atrial fibrillation followed by sinus arrhythmia. No statistically significant association was found between the frequency of supraventricular arrhythmias and the variables studied.(au)

Cardiovascular Physiotherapy on Respiratory Sinus Arrhythmia of Patients Undergoing Coronary Artery Bypass Grafting

Abstract Introduction: Patients in the postoperative period of coronary artery bypass grafting (CABG) present respiratory and autonomic dysfunctions. In this sense, cardiovascular physiotherapy has been offered as an indispensable differential for the improvement of the prognosis of this population. Heart rate variability is a simple, noninvasive method to analyze autonomic modulation, as well as the accentuation maneuver of respiratory sinus arrhythmia, which demonstrates the parasympathetic autonomic control over the heart. Five patients undergoing cardiac surgery performed a protocol of cardiovascular physiotherapy in the postoperative period and had their data referring to the preoperative period, the 1st and 4th postoperative days analyzed.

Cardiovascular Physiotherapy on Respiratory Sinus Arrhythmia of Patients Undergoing Coronary Artery Bypass Grafting.

INTRODUCTION: Patients in the postoperative period of coronary artery bypass grafting (CABG) present respiratory and autonomic dysfunctions. In this sense, cardiovascular physiotherapy has been offered as an indispensable differential for the improvement of the prognosis of this population. Heart rate variability is a simple, noninvasive method to analyze autonomic modulation, as well as the accentuation maneuver of respiratory sinus arrhythmia, which demonstrates the parasympathetic autonomic control over the heart. Five patients undergoing cardiac surgery performed a protocol of cardiovascular physiotherapy in the postoperative period and had their data referring to the preoperative period, the 1st and 4th postoperative days analyzed.

Variabilidade da frequência cardíaca em diferentes posições corporais e durante MASR em amputado unilateral de membro inferior / Variability of heart beat frequency in different body positions and during MASR in a person with lower member unilateral amputation

A amputação leva a redução da mobilidade e atividade física afetando os sistemas musculoesquelético, respiratório e cardiovascular. Nosso objetivo foi analisar a variabilidade da frequência cardíaca (VFC) em diferentes posições corporais e durante a Manobra de Arritmia Sinusal Respiratória (MASR) em amputados unilaterais de membros inferiores (MMII) protetizados. Estudo transversal, amostra de conveniência, avaliou 07 amputados homens de origem traumática e registradas as variáveis clínicas e VFC nas posições supino, ortostase, sedestação (10 minutos) e durante a MASR (4 minutos). Em repouso os sujeitos apresentam predominância da modulação simpática que se acentua quando assume a posição de ortostase (p = <0.01) e atenuação da complexidade autonômica (p = 0,04). Os amputados não responderam de modo adequado à MASR e observou-se alteração na complexidade da VFC (0,04). Amputados unilaterais de MMII protetizados demonstraram comportamento esperado durante a mudança ativa de postura e respostas adversas à MASR

Amputation causes decrease of mobility and physical activities, affecting the muscle-skeleton, respiratory and cardiovascular systems. Variability of heart frequency (VFC) at different body positions and during Respiratory Sinus Arrhythmia (RSA) was analyzed in people with amputation of unilateral lower members with prosthesis (MMII). Current transversal study, with convenience sample, evaluated seven males with trauma-caused amputations. Clinical variations and VFC were registered with regard to supine position, orthostasis, sedestation (10 min) and during RSA (4 min). The subjects at rest showed a predominance in increasing sympathetic modulation as the orthostatic position is achieved (p = <0.01) and attenuation of autonomic complexity (p = 0.04). People with amputation failed to respond adequately to RSA and alterations were detected in VFC complex (0.04). Unilateral amputated people with prosthesis showed expected behavior during active changes in posture and adverse responses to RSA

Non-Contact, Simple Neonatal Monitoring by Photoplethysmography.

This paper presents non-contact vital sign monitoring in neonates, based on image processing, where a standard color camera captures the plethysmographic signal and the heart and breathing rates are processed and estimated online. It is important that the measurements are taken in a non-invasive manner, which is imperceptible to the patient. Currently, many methods have been proposed for non-contact measurement. However, to the best of the authors' knowledge, it has not been possible to identify methods with low computational costs and a high tolerance to artifacts. With the aim of improving contactless measurement results, the proposed method based on the computer vision technique is enhanced to overcome the mentioned drawbacks. The camera is attached to an incubator in the Neonatal Intensive Care Unit and a single area in the neonate's diaphragm is monitored. Several factors are considered in the stages of image acquisition, as well as in the plethysmographic signal formation, pre-filtering and filtering. The pre-filter step uses numerical analysis techniques to reduce the signal offset. The proposed method decouples the breath rate from the frequency of sinus arrhythmia. This separation makes it possible to analyze independently any cardiac and respiratory dysrhythmias. Nine newborns were monitored with our proposed method. A Bland-Altman analysis of the data shows a close correlation of the heart rates measured with the two approaches (correlation coefficient of 0.94 for heart rate (HR) and 0.86 for breath rate (BR)) with an uncertainty of 4.2 bpm for HR and 4.9 for BR (k = 1). The comparison of our method and another non-contact method considered as a standard independent component analysis (ICA) showed lower central processing unit (CPU) usage for our method (75% less CPU usage).

Análisis de la solicitud de modificación mayor de ivabradina / Analysis of the request for major modification of ivabradine

INTRODUCCIÓN: La insuficiencia cardíaca crónica (ICC) se define como un síndrome clínico caracterizado por disnea fatiga y edema o estertores, lo que provoca una perfusión sistémica inadecuada para alcanzar las demandas metabólicas del organismo. La insuficiencia cardiaca pertenece al grupo de enfermedades cardiovasculares (ECV), estas son la principal causa de muerte en el mundo. Se calcula que en 2012, de las 55.9 millones de muertes en todo el mundo, 17.5 millones de personas (31%) murieron por ECV. En México de acuerdo con la Secretaria de Salud, el 4% de la población adulta y más del 20% de la población mayor de 65 años de edad tiene insuficiencia cardiaca2 . Ivabradina es un fármaco que reduce de manera exclusiva la frecuencia cardíaca (FC), actuando mediante la inhibición selectiva y específica de la corriente funny (lf) del marcapasos cardíaco que controla la despolarización diastólica espontánea en el nodo sinusal y regula la FC. La ivabradina tiene aprobación por la Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS)4 con la indicación de antianginoso para el tratamiento de la ICC. Como coadyuvante al tratamiento base, no de primera línea o monoterapia. Aprobado también por la Food and Drug Association (FDA)5 y European Medicine Agency (EMA)6 para el tratamiento de la insuficiencia cardiaca con combinación de tratamiento estándar incluyendo tratamiento con betabloqueadores o cuando los betabloqueadores están contraindicados o no son tolerados. EVALUACIONES DE TECNOLOGÍAS: La evaluación de tecnologías de la Canadian Agency for Drugs and Technologies in Health (CADTH) (2017) 10, recomienda el tratamiento con ivabradina en pacientes adultos con ICC estable con una FEVI ≤ 35% con clase funcional NYHA II-III que se encuentren con ritmo sinusal y FC ≥ 77 lpm, para reducir la incidencia de mortalidad cardiovascular y hospitalizaciones por agravamiento de la insuficiencia cardiaca, en combinación con la terapia estándar de la ICC. El National Institute for Health and Care Excellence (NICE) (2012) 11, recomienda el uso de ivabradina como una opción para tratar ICC en pacientes con clase funcional NYHA II-IV, con FE ≤ 35% en ritmo sinusal y cuya FC sea ≥ 75 lpm que presenten síntomas a pesar del tratamiento con betabloqueador a dosis máxima tolerada o que son incapaces de tolerar betabloqueador y que tengan manejo con IECA o BRAs y ARM o BRAs. IMPLICACIONES ECONÓMICAS: El uso de ivabradina para el tratamiento de la ICC como coadyuvante a la terapia estándara, no de primera línea o monoterapia, en pacientes con disfunción sistólica, clase II a IV de la NYHA, con ritmo sinusal cuya FC sea ≥ 75 lpm, es una opción dominante (más efectiva y menos costosa) aumentando los años de vida ganados y los años de retraso a la primera hospitalización, respecto a la terapia estándar en un horizonte temporal de 2 años y es una alternativa de tratamiento costo-efectiva en un horizonte temporal de 5 años dentro de los parámetros establecidos en la Guía de Evaluación de Insumos del Consejo de Salubridad General.

Trigeminismo supraventricular em um cão com doença mixomatosa da valva mitral / Supraventricular trigeminy in a dog with myxomatous mitral valve disease

Supraventricular trigeminy is an uncommon cardiac impulse formation disturbance. Detecting and treating cardiac arrhythmias is an important therapeutic goal in cardiology. The aim of this note is to report an occurrence of supraventricular trigeminy in a dog with myxomatous mitral valve disease (MMVD). A 15-year-old intact male mongrel dog weighing 13kg and with a history of heart murmur, cough, dyspnea, and ascites was referred for cardiac evaluation. Echocardiographic findings were consistent with a diagnosis of myxomatous mitral and tricuspid valves disease with a severe hemodynamic compromise. Electrocardiography (ECG) revealed a sinus arrhythmia with isolated supraventricular premature complexes, supraventricular couplets, and periods of supraventricular trigeminy. Previous retrospective and prospective studies that evaluated cardiac arrhythmias in dogs have not reported supraventricular trigeminy. The present report showed that supraventricular trigeminy may occur in dogs with MMVD with severe hemodynamic compromise, probably related to atrial enlargement. In addition, this case reinforces the importance of performing ECG in dogs with MMVD, since it complements the echocardiogram and enables a better therapeutic approach.(AU)

O trigeminismo supraventricular é um distúrbio incomum de formação do impulso elétrico cardíaco. Detectar e tratar arritmias cardíacas são um importante objetivo terapêutico em cardiologia. O objetivo desta nota é relatar a ocorrência de trigeminismo supraventricular em um cão com doença mixomatosa da valva mitral (DMVM). Um cão sem raça definida, macho, inteiro, 15 anos de idade e 13kg foi levado para avaliação cardíaca com um histórico de sopro cardíaco, tosse, dispneia e ascite. Os achados ecocardiográficos foram compatíveis com doença mixomatosa de valvas mitral e tricúspide com comprometimento hemodinâmico severo. A eletrocardiografia (ECG) revelou arritmia sinusal com presença de complexos supraventriculares prematuros isolados, aos pares e períodos de trigeminismo supraventricular. O trigeminismo supraventricular não é relatado em estudos retrospectivos e prospectivos que avaliaram arritmias cardíacas em um grande número de cães. O presente relato evidencia que o trigeminismo supraventricular pode ocorrer em cães com DMVM e comprometimento hemodinâmico severo, provavelmente relacionado à dilatação atrial. Ainda, reforça a importância da realização do ECG em cães com DMVM, complementando as informações ecocardiográficas e possibilitando uma melhor abordagem terapêutica.(AU)

Trigeminismo supraventricular em um cão com doença mixomatosa da valva mitral / Supraventricular trigeminy in a dog with myxomatous mitral valve disease

Supraventricular trigeminy is an uncommon cardiac impulse formation disturbance. Detecting and treating cardiac arrhythmias is an important therapeutic goal in cardiology. The aim of this note is to report an occurrence of supraventricular trigeminy in a dog with myxomatous mitral valve disease (MMVD). A 15-year-old intact male mongrel dog weighing 13kg and with a history of heart murmur, cough, dyspnea, and ascites was referred for cardiac evaluation. Echocardiographic findings were consistent with a diagnosis of myxomatous mitral and tricuspid valves disease with a severe hemodynamic compromise. Electrocardiography (ECG) revealed a sinus arrhythmia with isolated supraventricular premature complexes, supraventricular couplets, and periods of supraventricular trigeminy. Previous retrospective and prospective studies that evaluated cardiac arrhythmias in dogs have not reported supraventricular trigeminy. The present report showed that supraventricular trigeminy may occur in dogs with MMVD with severe hemodynamic compromise, probably related to atrial enlargement. In addition, this case reinforces the importance of performing ECG in dogs with MMVD, since it complements the echocardiogram and enables a better therapeutic approach.

O trigeminismo supraventricular é um distúrbio incomum de formação do impulso elétrico cardíaco. Detectar e tratar arritmias cardíacas são um importante objetivo terapêutico em cardiologia. O objetivo desta nota é relatar a ocorrência de trigeminismo supraventricular em um cão com doença mixomatosa da valva mitral (DMVM). Um cão sem raça definida, macho, inteiro, 15 anos de idade e 13kg foi levado para avaliação cardíaca com um histórico de sopro cardíaco, tosse, dispneia e ascite. Os achados ecocardiográficos foram compatíveis com doença mixomatosa de valvas mitral e tricúspide com comprometimento hemodinâmico severo. A eletrocardiografia (ECG) revelou arritmia sinusal com presença de complexos supraventriculares prematuros isolados, aos pares e períodos de trigeminismo supraventricular. O trigeminismo supraventricular não é relatado em estudos retrospectivos e prospectivos que avaliaram arritmias cardíacas em um grande número de cães. O presente relato evidencia que o trigeminismo supraventricular pode ocorrer em cães com DMVM e comprometimento hemodinâmico severo, provavelmente relacionado à dilatação atrial. Ainda, reforça a importância da realização do ECG em cães com DMVM, complementando as informações ecocardiográficas e possibilitando uma melhor abordagem terapêutica.

Avaliação do desempenho de dois aparelhos automáticos de medida da pressão arterial com ou sem alteração do ritmo cardíaco / Evaluation of the performance of two automatic devices for measurement of blood pressure with or without alteration of heart rhythm

A mortalidade cardiovascular aumenta com a elevação da pressão arterial; sua aferição deve ser precisa e pode ser feita com aparelhos manuais ou automáticos. Estes equipamentos têm seu uso difundido por serem de fácil manuseio e custo acessível. Em decorrência da tecnologia da oscilometria, conceitos devem ser compreendidos e divulgados, entre eles a validação, realizada por meio de protocolos. Diretrizes americanas, brasileiras e outros autores apontam limitações na utilização do método oscilométrico, devido a alterações nos valores pressóricos que podem ser influenciados por rigidez arterial e arritmia cardíaca. Objetivos: Comparar valores de pressão arterial obtidos por dois aparelhos oscilométricos (um detecta arritmia cardíaca, outro não) àqueles obtidos com esfigmomanômetro de mercúrio; descrever o desempenho destes aparelhos. Método: A amostra por conveniência foi composta por 101 voluntários (51 homens e 50 mulheres; 52 com fibrilação atrial e 49 com ritmo cardíaco sinusal) e cada um foi submetido a oito aferições da pressão arterial em ambos os braços. Foram realizadas 808 aferições da pressão arterial, 404 utilizando o método auscultatório concomitantemente por dois observadores, com manômetro de mercúrio, e mais 404 utilizando o método oscilométrico por outro observador. Para medida oscilométrica utilizou-se dois esfigmomanômetros automáticos e para auscultatório um manômetro de mercúrio. Os dados foram coletados por uma equipe de quatro profissionais de saúde devidamente capacitados. Resultados: A coleta de dados ocorreu entre novembro de 2014 e agosto de 2015. Dos 101 participantes, 52 apresentavam fibrilação atrial e 49 ritmo cardíaco sinusal. A média de idade foi 69,57 anos. A circunferência de braço variou entre 21,50 e 41,00 cm. O esfigmomanômetro com recurso de detecção de arritmia cardíaca não exibiu esse sinal em 46,2% das medidas, no entanto houve associação significante entre a aparição deste sinal e o pulso apical irregular, auscultado no início do procedimento. Houve 26 ocorrências de duas tentativas de insuflação, sendo 18 pelo aparelho que detecta arritmia cardíaca e oito com o que não detecta. A concordância entre observadores atingiu um nível adequado. Conclusão: Ambos aparelhos automáticos apresentaram, de modo global, bom desempenho na amostra estudada, o que não diminui a necessidade de submetê-los a estudo de validação em indivíduos com ritmo cardíaco irregular.(AU)

Cardiovascular mortality increases due to high blood pressure; its measurement must be accurate and manual or automatic devices can be used. Such devices have widespread use because they are easy to handle and affordable. Due to the oscillometric technology, concepts must be understood and disclosed, including validation performed by means of protocols. American and Brazilian guidelines, and other authors point out limitations in the use of the oscillometric method, due to changes in blood pressure values which may be influenced by arterial stiffness and cardiac arrhythmia. Objectives: To compare blood pressure values obtained by two oscillometric devices (one detects cardiac arrhythmia, the other does not) to those obtained with mercury sphygmomanometer; to describe the performance of these devices. Methods: This convenience sample consisted of 101 volunteers (51 men and 50 women, 52 with atrial fibrillation and 49 with sinus rhythm) each one was subjected to eight measurements of blood pressure in both arms. It were performed 808 blood pressure measurements, 404 using auscultation with mercury manometer by two observers simultaneously, and 404 using the oscillometric method by another observer. Two automatic sphygmomanometers were used for oscillometric measurement, a mercury manometer for the auscultation. Data were collected by a team of four properly trained health professionals. Results: Data collection took place from November 2014 to August 2015. There were 101 participants, 52 had atrial fibrillation and 49 had sinus rhythm. The average age was 69.57 years. The arm circumference ranged from 21.50 to 41.00 cm. The sphygmomanometer cardiac arrhythmia detector did not show that sign in 46.2% of measures, however there was a significant association between the appearance of this signal and the irregular apical pulse, auscultation at the beginning of the procedure. There were 26 times of two attempts to inflation, 18 by the device that detected cardiac arrhythmia and eight which did not. The agreement among observers reached an appropriate level. Conclusion: Both automatic devices showed, at large, good performance in the sample studied which does not diminish the need to subject them to validation study in patients with irregular heart rhythm.(AU)

Electrocardiographic parameters of the American Miniature Horse: influence of age and sex / Parâmetros eletrocardiográficos de equinos Mini Horse: influência da idade e sexo

The veterinary cardiology has growing importance in equine medicine. There are studies of standardization of electrocardiographic parameters of many races, according to their stature and ability. However, no studies are in the literature with the American Miniature Horse. To evaluate the electrocardiogram (ECG) tracing configuration of this breed at rest and to verify the influence of age and sex on ECG parameters, 203 horses including 143 females and 60 males were divided into four age groups (foals, yearlings, adults and elderly). Electrocardiographic parameters were performed by computerized electrocardiogram (TEB), and the parameters were evaluated in six leads of frontal plane (Lead I, II, III, aVR, aVL and aVF) and base-apex (BA). Heart rates (HR) decreased with increasing age were higher in males than in females. Sinus tachycardia followed by sinus arrhythmia was dominant in both sexes. The cardiac axis was higher in males and ranged between 120° and 150° for foals, 30° and 60° for yearlings and adults, and 60° and 90° for the elderly. The P wave was bifid in several animals. The P-wave amplitude and T-wave duration from lead II and BA were larger in males than in females. The majority of the animals exhibited ST segment depression and a negative T-wave. The most common QRS complex morphology was Qr. Differences were observed between the electrocardiographic tracings of males and females, and age influenced the ECG parameters. Therefore, this study established the ECG patterns for the American Miniature Horse breed and could be used to determine the influence of age and sex on several of the studied variables.(AU)

A cardiologia veterinária possui crescente importância na medicina equina. Existem estudos de padronização dos parâmetros eletrocardiográficos de muitas raças, de acordo com sua estatura e aptidão. No entanto, não há na literatura trabalhos com os equinos da raça Miniature Horse. Os objetivos deste trabalho foram avaliar a configuração do traçado do eletrocardiograma (ECG) em repouso, de equinos desta raça, além de verificar a influência do sexo e da idade sobre os parâmetros eletrocardiográficos desses animais. Foram utilizados 203 equinos desta raça, hígidos, sendo 143 fêmeas e 60 machos, classificados em quatro faixas etárias (potros, sobreanos, adultos e idosos). Os exames eletrocardiográficos foram realizados por eletrocardiograma computadorizado (TEB), e os parâmetros foram avaliados em seis derivações do plano frontal (DI, DII, DIII, aVR, aVL e aVF) e base-ápice (BA). A frequência cardíaca (FC) diminuiu com a progressão da idade, e foi maior nos machos do que nas fêmeas. O ritmo mais comum em ambos os sexos foi taquicardia sinusal, seguido de arritmia sinusal. O eixo cardíaco foi maior nos machos do que nas fêmeas, e nos potros ficou entre 120 e 150o, nos sobreano e adultos permaneceu entre 30 e 60o, e nos idosos entre 60 e 90o. A amplitude da onda P e a duração da onda T foram maiores nos machos do que nas fêmeas na DII e BA. A maioria dos animais apresentou segmento ST infradesnivelado e onda T negativa. A morfologia do complexo QRS mais encontrada em todos os casos foi Qr. Este estudo permitiu estabelecer os padrões eletrocardiográficos para a raça Mini Horse e conseguiu verificar a influência da progressão da idade nas diversas variáveis estudadas, bem como a diferença entre os sexos.(AU)

Electrocardiographic parameters of the American Miniature Horse: influence of age and sex / Parâmetros eletrocardiográficos de equinos Mini Horse: influência da idade e sexo

The veterinary cardiology has growing importance in equine medicine. There are studies of standardization of electrocardiographic parameters of many races, according to their stature and ability. However, no studies are in the literature with the American Miniature Horse. To evaluate the electrocardiogram (ECG) tracing configuration of this breed at rest and to verify the influence of age and sex on ECG parameters, 203 horses including 143 females and 60 males were divided into four age groups (foals, yearlings, adults and elderly). Electrocardiographic parameters were performed by computerized electrocardiogram (TEB), and the parameters were evaluated in six leads of frontal plane (Lead I, II, III, aVR, aVL and aVF) and base-apex (BA). Heart rates (HR) decreased with increasing age were higher in males than in females. Sinus tachycardia followed by sinus arrhythmia was dominant in both sexes. The cardiac axis was higher in males and ranged between 120° and 150° for foals, 30° and 60° for yearlings and adults, and 60° and 90° for the elderly. The P wave was bifid in several animals. The P-wave amplitude and T-wave duration from lead II and BA were larger in males than in females. The majority of the animals exhibited ST segment depression and a negative T-wave. The most common QRS complex morphology was Qr. Differences were observed between the electrocardiographic tracings of males and females, and age influenced the ECG parameters. Therefore, this study established the ECG patterns for the American Miniature Horse breed and could be used to determine the influence of age and sex on several of the studied variables.(AU)

A cardiologia veterinária possui crescente importância na medicina equina. Existem estudos de padronização dos parâmetros eletrocardiográficos de muitas raças, de acordo com sua estatura e aptidão. No entanto, não há na literatura trabalhos com os equinos da raça Miniature Horse. Os objetivos deste trabalho foram avaliar a configuração do traçado do eletrocardiograma (ECG) em repouso, de equinos desta raça, além de verificar a influência do sexo e da idade sobre os parâmetros eletrocardiográficos desses animais. Foram utilizados 203 equinos desta raça, hígidos, sendo 143 fêmeas e 60 machos, classificados em quatro faixas etárias (potros, sobreanos, adultos e idosos). Os exames eletrocardiográficos foram realizados por eletrocardiograma computadorizado (TEB), e os parâmetros foram avaliados em seis derivações do plano frontal (DI, DII, DIII, aVR, aVL e aVF) e base-ápice (BA). A frequência cardíaca (FC) diminuiu com a progressão da idade, e foi maior nos machos do que nas fêmeas. O ritmo mais comum em ambos os sexos foi taquicardia sinusal, seguido de arritmia sinusal. O eixo cardíaco foi maior nos machos do que nas fêmeas, e nos potros ficou entre 120 e 150o, nos sobreano e adultos permaneceu entre 30 e 60o, e nos idosos entre 60 e 90o. A amplitude da onda P e a duração da onda T foram maiores nos machos do que nas fêmeas na DII e BA. A maioria dos animais apresentou segmento ST infradesnivelado e onda T negativa. A morfologia do complexo QRS mais encontrada em todos os casos foi Qr. Este estudo permitiu estabelecer os padrões eletrocardiográficos para a raça Mini Horse e conseguiu verificar a influência da progressão da idade nas diversas variáveis estudadas, bem como a diferença entre os sexos.(AU)

Intervenção em dispositivos cardíacos eletrônicos implantáveis sob uso de anticoagulante oral: experiência inicial / Intervention in cardiac implantable electronic devices in use of oral anticoagulant: initial experience

O manejo de dispositivos cardíacos eletrônicos implantáveis em portadores de arritmias atriais ou outras condições que demandem uso crônico de anticoagulante oral sempre gerou grande conflito nas cirurgias. Este trabalho traz a experiência da realização de intervenções com dispositivos cardíacos eletrônicos implantáveis em serviço especializado em arritmias cardíacas, apresentando resultados similares aos da literatura e que devem mudar paradigmas. Método: Realizamos intervenções desde implante de marcapassos monocamerais até upgrade para marcapassos/ cardiodesfibriladores multissítio em usuários de anticoagulantes orais, incluindo varfarina e os novos anticoagulantes orais ou de ação direta (dabigatrana, rivaroxabana e apixabana). As intervenções foram realizadas por médicos experientes e todos os pacientes foram reexaminados 15 dias após a cirurgia para retirada dos pontos e revisão clínica e do dispositivo. Resultados: Os procedimentos foramrealizados em 20 pacientes, em 5 dos quais foi mantido o uso de anticoagulantes de ação direta. A ocorrência de hematoma na loja se deu em 3 pacientes (INR de 3,4 e 2,63 e outro com apixabana) e todos tiveram boa evolução após conduta expectante sem retirada do anticoagulante oral, com reabsorção completa 30 dias depois.Naqueles em uso de varfarina, o INR médio foi de 2,85, sendo o menor de 2 e o maior, de 4,14. Em nossa série decasos conseguimos reproduzir dados do estudo BRUISE, que demonstrou diferença significativa na ocorrência dehematoma quando se adotou estratégia de intervenção realizando ponte com heparina. Em nossa série, 3 pacientesapresentaram hematoma, sem necessidade de intervenção (somente acompanhamento clínico) e sem aumentar o tempo de internação. Nossa série de casos incluiu os anticoagulantes de ação direta disponíveis no mercado.Conclusão: Este trabalho traz dados similares aos dos grandes estudos...

The management of implantable electronic cardiac devices in patients with atrial arrhythmias or other conditions that require the chronic use of oral anticoagulants has always generated great controversy in surgery. This study reports the experience of performing interventions with implantable electronic cardiac devices in specialized cardiac arrhythmia services with similar results to literature data, which must surely change paradigms. Method: We performed interventions ranging from single-chamber pacemaker implant to upgrade to multisite pacemakers/cardiodefibrillator in patients receiving oral anticoagulants including warfarin and the new oral or direct action anticoagulants (dabigatran, rivaroxaban and apixaban). Experienced surgeons performed the interventions. All of the patients were reexamined 15 days after the surgery to remove stiches,for clinical and device evaluation. Results: We performed procedures in 20 patients; in 5 of them direct oralanticoagulants were maintained. Significant hematomas were observed in 3 patients (INR of 3.4 and 2.63 andanother with apixaban), and all of them had good outcomes after a watchful waiting while maintaining the oralanticoagulant, with complete reabsorption after thirty days. In patients receiving warfarin, mean INR was 2.85, the lowest was 2.0 and the highest 4.14. In our series of cases we reproduced data from BRUISE study, which showed a significant difference in the occurrence of hematoma when the intervention strategy included a “bridge”with heparin. In our series, 3 patients had hematoma, but did not require an intervention (only clinical follow-up)and there was no increase in the length of stay. We used direct action anticoagulants available in the market.Conclusion: Our study provides similar data to major studies...

Retrospective study of pre-anesthetic electrocardiogram examination of 700 dogs conducted at the Veterinary Hospital of UFMG (2013-2014) / Estudo retrospectivo de exames eletrocardiográficos pré-anestésicos em 700 cães realizados no Hospital Veterinário da UFMG (2013-2014)

Pre-operative electrocardiograms performed in 700 dogs were analyzed in order to establish correlation between sex, age, indication for surgery, body condition score, breed and weight. Initially a clinical questionnaire was filled out from each owner, including age, breed, sex, weight, clinical history and surgical indication. Dogs above 6 years of age or those showing any kind of cardiac auscultation disturbances were referred to electrocardiogram (ECG) evaluation. All ECG were performed and analyzed by the same veterinary specialist. Abnormalities at ECG were founnd in 364 of 700 (52%) evaluated dogs, and the most frequent variation was sinus arrhythmia, observed in 293 dogs (25.4%). No significant correlation was found between the electrocardiographic alterations with weight, sex and age of the animals. Therefore ECG should be conducted routinely regardless of age, sex, breed or surgical indication, highlighting its value for determining a safe anesthetic protocol that promotes minimal cardiopulmonary depression and allows rapid post-surgical recovery.(AU)

Foram analisados exames eletrocardiográficos pré-operatórios de 700 cães, com o objetivo de estabelecer correlação entre sexo, idade, indicação cirúrgica, condição corporal, raça e peso. Inicialmente, um questionário clínico foi preenchido por cada proprietário, com informações sobre sexo, raça, sexo, peso, histórico clínico e indicação cirúrgica. Os cães com mais de seis anos de idade e aqueles que apresentavam qualquer tipo de alteração à auscultação cardíaca foram encaminhadas para avaliação por meio de eletrocardiograma (ECG). Todos os ECG foram realizados e analisados pelo mesmo veterinário especialista. As anormalidades ao ECG foram observadas em 364 dos 700 (52%) cães avaliados e a alteração mais frequente foi a arritmia sinusal, observada em 293 (25,4%) cães. Nenhuma correlação significante foi observada entre as alterações eletrocardiográficas com o peso, o sexo e a idade dos animais. Sugere-se, portanto que o exame de ECG seja realizado de forma rotineira, independente de idade, sexo, raça ou indicação cirúrgica, destacando seu valor para a determinação de um protocolo anestésico que promova mínima depressão cardiopulmonar e rápida recuperação pós-cirúrgica.(AU)

Retrospective study of pre-anesthetic electrocardiogram examination of 700 dogs conducted at the veterinary hospital of UFMG (2013-2014) / Estudo retrospectivo de exames eletrocardiográficos pré-anestésicos em 700 cães realizados no hospital veterinário da UFMG (2013-2014)

Pre-operative electrocardiograms performed in 700 dogs were analyzed in order to establish correlation between sex, age, indication for surgery, body condition score, breed and weight. Initially a clinical questionnaire was filled out from each owner, including age, breed, sex, weight, clinical history and surgical indication. Dogs above 6 years of age or those showing any kind of cardiac auscultation disturbances were referred to electrocardiogram (ECG) evaluation. All ECG were performed and analyzed by the same veterinary specialist. Abnormalities at ECG were founnd in 364 of 700 (52%) evaluated dogs, and the most frequent variation was sinus arrhythmia, observed in 293 dogs (25.4%). No significant correlation was found between the electrocardiographic alterations with weight, sex and age of the animals. Therefore ECG should be conducted routinely regardless of age, sex, breed or surgical indication, highlighting its value for determining a safe anesthetic protocol that promotes minimal cardiopulmonary depression and allows rapid post-surgical recovery.

Foram analisados exames eletrocardiográficos pré-operatórios de 700 cães, com o objetivo de estabelecer correlação entre sexo, idade, indicação cirúrgica, condição corporal, raça e peso. Inicialmente, um questionário clínico foi preenchido por cada proprietário, com informações sobre sexo, raça, sexo, peso, histórico clínico e indicação cirúrgica. Os cães com mais de seis anos de idade e aqueles que apresentavam qualquer tipo de alteração à auscultação cardíaca foram encaminhadas para avaliação por meio de eletrocardiograma (ECG). Todos os ECG foram realizados e analisados pelo mesmo veterinário especialista. As anormalidades ao ECG foram observadas em 364 dos 700 (52%) cães avaliados e a alteração mais frequente foi a arritmia sinusal, observada em 293 (25,4%) cães. Nenhuma correlação significante foi observada entre as alterações eletrocardiográficas com o peso, o sexo e a idade dos animais. Sugere-se, portanto que o exame de ECG seja realizado de forma rotineira, independente de idade, sexo, raça ou indicação cirúrgica, destacando seu valor para a determinação de um protocolo anestésico que promova mínima depressão cardiopulmonar e rápida recuperação pós-cirúrgica.

Holter monitoring (24-h electrocardiography) of Holstein calves

Background: Twenty-four h electrocardiographic monitoring is a noninvasive method of assessing cardiac rhythm. Holter monitoring in farm animals can help assessing heart rate variability and its relationship with stress and production. Several authors have reviewed the normal cardiac rhythm of bovines, but there is little information on heart rhythm in calves. The goal of this research is to elucidate which cardiac rhythms may be considered physiological in Holstein calves, from 3 to 6 months old. Materials, Methods & Results: Twenty-four h ambulatory electrocardiography (Holter monitoring) was performed in 10 male Holstein calves, with ages ranging from 3 to 6 months old. The animals came from private farms in São Paulo state and were housed in a semi-open stall during the study. The animals had their hair clipped from the third to the fifth intercostal spaces on both sides of the chest, from the sternal region to the glenohumeral joint, and seven electrodes were positioned in a diagonal configuration. Decoding of the recordings was performed using specialized software and in order to minimize digital mistakes, all of the beats marked as ectopic by the software were manually revised by the authors. Mean heart rate was 83.2 ± 11.06 beats per min (bpm), maximum heart rate was 147.1 ± 11.05 bpm, and minimum heart rate was 53.7 ± 7.45 bpm. In 90% of the calves, normal sinus [...]

Holter monitoring (24-h electrocardiography) of Holstein calves

Background: Twenty-four h electrocardiographic monitoring is a noninvasive method of assessing cardiac rhythm. Holter monitoring in farm animals can help assessing heart rate variability and its relationship with stress and production. Several authors have reviewed the normal cardiac rhythm of bovines, but there is little information on heart rhythm in calves. The goal of this research is to elucidate which cardiac rhythms may be considered physiological in Holstein calves, from 3 to 6 months old. Materials, Methods & Results: Twenty-four h ambulatory electrocardiography (Holter monitoring) was performed in 10 male Holstein calves, with ages ranging from 3 to 6 months old. The animals came from private farms in São Paulo state and were housed in a semi-open stall during the study. The animals had their hair clipped from the third to the fifth intercostal spaces on both sides of the chest, from the sternal region to the glenohumeral joint, and seven electrodes were positioned in a diagonal configuration. Decoding of the recordings was performed using specialized software and in order to minimize digital mistakes, all of the beats marked as ectopic by the software were manually revised by the authors. Mean heart rate was 83.2 ± 11.06 beats per min (bpm), maximum heart rate was 147.1 ± 11.05 bpm, and minimum heart rate was 53.7 ± 7.45 bpm. In 90% of the calves, normal sinus [...](AU)

Surgical Ablation of Atrial Fibrillation Using Energy Sources

ABSTRACT Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery.

Heart rate turbulence analysis in female patients with fibromyalgia.

OBJECTIVE: Fibromyalgia is characterized by diffuse musculoskeletal pain and discomfort. There are several reports regarding autonomic nervous system dysfunction in patients with fibromyalgia. Heart rate turbulence is expressed as ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. Heart rate turbulence has been shown to be an independent and powerful predictor of sudden cardiac death in various cardiac abnormalities. The aim of this study is to determine whether heart rate turbulence is changed in female patients with fibromyalgia compared with healthy controls. METHODS: Thirty-seven female patients (mean age, 40±11 years) with fibromyalgia, and 35 age- and sex-matched healthy female control subjects (mean age, 42±9 years) were included. Twenty-four hours of ambulatory electrocardiography recordings were collected for all subjects, and turbulence onset and turbulence slope values were automatically calculated. RESULTS: The baseline clinical characteristics of the two groups were similar. There were no significant differences in turbulence onset and turbulence slope measures between patients and control subjects (turbulence onset: -1.648±1.568% vs. -1.582±1.436%, p ϝ 0.853; turbulence slope: 12.933±5.693 ms/RR vs. 13.639±2.505 ms/RR, p ϝ 0.508). Although body mass index was negatively correlated with turbulence slope (r ϝ -0.258, p ϝ 0.046), no significant correlation was found between body mass index and turbulence onset (r ϝ 0.228, p ϝ 0.054). CONCLUSION: To the best of our knowledge, this is the first study to evaluate heart rate turbulence in patients with fibromyalgia. It appears that heart rate turbulence parameters reflecting cardiac autonomic activity are not changed in female patients with fibromyalgia.