RESUMO
BACKGROUND: The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF). OBJECTIVE: The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT. METHODS: In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed. RESULTS: Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications. CONCLUSION: VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.
Assuntos
Ablação por Cateter , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/cirurgia , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia , Adulto , Estudos de Coortes , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Complexos Ventriculares Prematuros/diagnósticoAssuntos
Feixe Acessório Atrioventricular/cirurgia , Ablação por Cateter/métodos , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Comunicação Interatrial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVES: Atrial fibrillation (AF) often develops in patients with multiple myeloma following autologous stem cell transplantation (ASCT), but the exact incidence of, and the risk factors for AF have not been described. In this study, we sought to determine the incidence of AF in patients with multiple myeloma undergoing ASCT. METHODS: Patients who received ASCT for multiple myeloma between January 2000 and December 2009 were identified using the ICD-9 codes for multiple myeloma and ASCT, and formed the basis of this report. RESULTS: The study included 278 patients (mean age, 63 ± 9.5 years). A total of 75 (27%) patients developed AF at a mean duration of 14.8 days following ASCT. On multiple regression analysis, baseline renal dysfunction (odds ratio 15.2 [confidence interval 5.08-45.6]), left ventricular systolic dysfunction (9.55 [2.78-32.79]), dilated left atrium on echocardiogram (4.97 [1.8-13.78]), and hypertension (3.6 [1.36-9.52]) were significantly associated with the development of AF after ASCT. The presence of light-chain secretion (0.21 [0.07-0.6]) was associated with a lower incidence of AF. Age, gender, and race were not significantly associated with the development of AF after ASCT. CONCLUSIONS: AF is very frequent in patients with multiple myeloma when they receive ASCT. The presence of abnormal renal function, left ventricular systolic dysfunction, dilated left atrium, or hypertension at baseline identifies patients at high risk of developing AF following ASCT.
Assuntos
Fibrilação Atrial/epidemiologia , Mieloma Múltiplo/cirurgia , Transplante de Células-Tronco/efeitos adversos , Idoso , Arkansas/epidemiologia , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Hipertensão/epidemiologia , Incidência , Rim/fisiopatologia , Nefropatias/epidemiologia , Nefropatias/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/epidemiologia , Razão de Chances , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sístole , Fatores de Tempo , Transplante Autólogo , Ultrassonografia , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Mexiletine is a commonly used Class IB (Vaughan William classification) antiarrhythmic drug. We report a case of mexiletine-induced psychosis that was successfully managed by decreasing the dose and using alternative medications for management of ventricular tachycardia.
RESUMO
OBJECTIVE: To compare global Left Ventricular (LV) systolic function assessment by 16-detector row Computed Tomography (MDCT) with Two-Dimensional Standard Echocardiography (2DSE) in a routine cardiology practice setting and to ascertain the degree of correlation between LV volumes and measurements obtained by 2DSE with those measured by MDCT. METHODS: In 52 patients with suspected coronary artery disease, a contrast enhanced MDCT study was performed using retrospective gating without dose modulation for better endocardial delineation. Eight phases of the cardiac cycle were analyzed to identify the end-diastolic and end-systolic phases. 2DSE was performed on the same day. Left ventricular systolic and diastolic volumes and ejection fraction were calculated in 4-chamber, 2-chamber and biplane (average of the two) views. Endocardial tracing was used to measure ventricular volumes by area length method for CT and Simpson's method for echocardiography. RESULTS: On MDCT, mean LV ejection fraction (LVEF) in 4-chamber, 2-chamber and biplane views were 58.4 +/- 12, 59.3 +/- 12 and 59.7 +/- 12% respectively. On 2DSE, mean LVEF in 4-chamber, 2-chamber and biplane views were 58 +/- 14, 57 +/- 16 and 58 +/- 13% respectively. LVEF correlated best using the biplane views (r = 0.59 and P < 0.01) compared to 2-chamber (r = 0.57 and P < 0.01) and 4-chamber views (r = 0.32 and P = 0.02). Biplane measurement by these two techniques correlated well for LV volumes in both diastole (r = 0.69 and P < 0.01) and systole (r = 0.73 and P < 0.01), although MDCT consistently gave higher values. CONCLUSIONS: MDCT can be a useful tool to measure LVEF while patients are undergoing CT coronary angiography.
Assuntos
Ecocardiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Volume SistólicoRESUMO
Diabetics have a significantly higher incidence of major adverse cardiac events (MACEs) and in-stent restenosis (ISR) than nondiabetics after percutaneous coronary intervention (PCI). Predictors of MACEs and ISR are uncertain in diabetics. In recent studies, microalbuminuria and proliferative retinopathy have been believed to relate to progressive coronary atherosclerosis. We retrospectively studied 191 consecutive patients (mean age 65 +/- 9 years) with diabetes who underwent PCI to determine predictors of ISR and MACEs (defined as cumulative incidence of myocardial infarction, revascularization, or death from cardiovascular cause), with special reference to microalbuminuria and proliferative retinopathy. Of 191 patients, 106 (56%) had a follow-up coronary angiogram at 16 +/- 2 months. Of these 106 patients, 66 (62%) developed ISR. In the multivariate model, microalbuminuria or proliferative retinopathy did not achieve significant association with ISR. Serum high-density lipoprotein cholesterol levels were significantly associated with a lower incidence of ISR (odds ratio [OR] 0.928, 95% confidence interval [CI] 0.876 to 0.983, p = 0.011) and MACEs (OR 0.96, 95% CI 0.931 to 1.000, p = 0.048). Use of drug-eluting stents also had a negative association with ISR (OR 0.171, 95% CI 0.05 to 0.585, p = 0.004). Renal insufficiency was associated with higher MACEs (OR 3.19, 95% CI 1.45 to 7.031, p = 0.0039). In conclusion, serum high-density lipoprotein cholesterol levels were inversely associated with ISR or MACEs.
Assuntos
Angioplastia Coronária com Balão , Reestenose Coronária/etiologia , Diabetes Mellitus Tipo 2/complicações , Stents , Idoso , Albuminúria/complicações , Causas de Morte , HDL-Colesterol/sangue , Angiografia Coronária , Doença das Coronárias/cirurgia , Retinopatia Diabética/complicações , Feminino , Seguimentos , Previsões , Humanos , Masculino , Infarto do Miocárdio/etiologia , Revascularização Miocárdica , Insuficiência Renal/complicações , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Angioplastia Coronária com Balão/métodos , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Isquemia Miocárdica/terapia , Stents/efeitos adversos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/terapia , Teste de Esforço , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/etiologia , Marca-Passo Artificial , Cintilografia , Respiração , Retratamento , Medição de Risco , Resultado do TratamentoRESUMO
Clopidogrel has an established and important role in the management of patients with coronary artery disease after an acute event. It is generally a well-tolerated drug. The major common problem associated with its use is the increased incidence of bleeding complications during or after coronary artery bypass graft surgery when clopidogrel is used within five days before surgery. For this reason, it is recommended to stop clopidogrel at least five days, and preferably one week before surgery.