RESUMO
Introducción y objetivos. En los últimos años se ha asistido a un gran aumento en el número de implantes de dispositivos cardiacos con terapia de resincronización cardiaca. Los beneficios obtenidos con dicha terapia están directamente relacionados con el mantenimiento de la estimulación biventricular continua. Este trabajo analiza la incidencia de pérdida de estimulación biventricular, sus causas, la actitud adoptada y los resultados. Métodos. Se analizaron los datos clínicos y de seguimiento de una serie de pacientes consecutivos de un centro a los que se implantó un dispositivo con terapia de resincronización cardiaca. Resultados. Se estudió a un total de 136 pacientes. Durante un seguimiento medio de 33,4 meses, 45 pacientes (33%) sufrieron pérdida de estimulación biventricular continua. Las causas más frecuentes fueron las taquiarritmias auriculares (21,3%), seguidas de la dislocación de cables (18%) y el fallo de captura del cable de ventrículo izquierdo (13,1%). La pérdida de estimulación biventricular continua fue transitoria y corregible en la mayoría (88,5%) de los casos y ocurrió más precozmente en los casos de dislocación de cables, sobresensado y estimulación extracardiaca. No hubo diferencias significativas de mortalidad entre los grupos de pacientes con y sin pérdida de estimulación biventricular continua (p=0,88). Conclusiones. Pese a los avances técnicos en la terapia de resincronización cardiaca, la pérdida de la estimulación biventricular continua es una situación clínica frecuente pero corregible en la mayoría de los casos. Un seguimiento estrecho de los pacientes y una actitud proactiva garantizan lograr la estimulación biventricular continua en la mayoría de los pacientes (AU)
Introduction and objectives. In recent years, implantation of cardiac resynchronization therapy devices has significantly increased. The benefits of this therapy are directly related to the maintenance of continuous biventricular pacing. This study analyzed the incidence, causes, and outcomes of loss of continuous biventricular pacing, and the approach adopted. Methods. We analyzed the clinical and follow-up data of a series of consecutive patients from a single center who underwent implantation of a cardiac resynchronization therapy device. Results. The study included 136 patients. During a mean follow-up of 33.4 months, loss of continuous biventricular pacing occurred in 45 patients (33%). The most common causes included atrial tachyarrhythmias (21.3%), lead macrodislodgement (18%), and loss of left ventricular capture (13.1%). In most patients (88.5%), loss of continuous biventricular pacing was transient and correctable, and occurred earlier in the follow-up when the cause was lead macrodislodgement, oversensing, or extracardiac stimulation. There were no significant differences in mortality between patients with and without loss of continuous biventricular pacing (P=.88). Conclusions. Despite technical advances in cardiac resynchronization therapy, loss of continuous biventricular pacing is common; however, this loss can usually be corrected. In most patients, continuous biventricular pacing can be ensured by close monitoring and follow-up and a proactive approach (AU)
Assuntos
Humanos , Masculino , Feminino , Terapia de Ressincronização Cardíaca/métodos , Terapia de Ressincronização Cardíaca/tendências , Terapia de Ressincronização Cardíaca , Dispositivos de Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Desfibriladores Implantáveis/tendências , Desfibriladores Implantáveis , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca , Taquicardia/complicações , Taquicardia/diagnóstico , TaquicardiaRESUMO
INTRODUCTION AND OBJECTIVES: In recent years, implantation of cardiac resynchronization therapy devices has significantly increased. The benefits of this therapy are directly related to the maintenance of continuous biventricular pacing. This study analyzed the incidence, causes, and outcomes of loss of continuous biventricular pacing, and the approach adopted. METHODS: We analyzed the clinical and follow-up data of a series of consecutive patients from a single center who underwent implantation of a cardiac resynchronization therapy device. RESULTS: The study included 136 patients. During a mean follow-up of 33.4 months, loss of continuous biventricular pacing occurred in 45 patients (33%). The most common causes included atrial tachyarrhythmias (21.3%), lead macrodislodgement (18%), and loss of left ventricular capture (13.1%). In most patients (88.5%), loss of continuous biventricular pacing was transient and correctable, and occurred earlier in the follow-up when the cause was lead macrodislodgement, oversensing, or extracardiac stimulation. There were no significant differences in mortality between patients with and without loss of continuous biventricular pacing (P=.88). CONCLUSIONS: Despite technical advances in cardiac resynchronization therapy, loss of continuous biventricular pacing is common; however, this loss can usually be corrected. In most patients, continuous biventricular pacing can be ensured by close monitoring and follow-up and a proactive approach.
Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca , Idoso , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudos RetrospectivosRESUMO
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