Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection. / Reprocessamento de Marca-Passos em Países de Língua Portuguesa: Uma Reflexão Clínica.

There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.

Há uma enorme disparidade entre os países de alta renda e outros em termos de acesso a dispositivos médicos cardíacos, como marca-passos e desfibriladores implantáveis. Os custos são uma das principais barreiras ao uso de dispositivos cardíacos nesses países. Existem iniciativas internacionais que visam reduzir essa disparidade, e o reuso de marca-passos tem sido discutido como uma possível alternativa. O conceito de reutilização de marca-passos não é novo; entretanto, estudos recentes têm se mostrado seguros, éticos e eficazes para aqueles que precisam de dispositivos eletrônicos cardíacos implantáveis e não tem como adquiri-los. Parte dos países de língua portuguesa, especialmente na África, precisam de uma resposta imediata que beneficie seus inúmeros pacientes que sofrem de arritmias tratáveis.

Hospital admissions for mitral stenosis in pregnancy in the United States: a thirteen-year analysis.

BACKGROUND: Cardiac conditions are a significant cause of maternal morbidity and mortality, significantly exacerbated during the hemodynamic demands of pregnancy. Mitral stenosis in pregnancy (MSp) is rare in the USA however, it has a high risk for maternal complications. METHODS: We aim to outline the burden of MSp hospitalizations nationally. A retrospective review of HCUP/NIS data from 2002-2014 was conducted. RESULTS: There were 2014 weighted discharges for both pregnancy and mitral stenosis (MS). Patients diagnosed with MS had a more considerable mean cost per discharge than the comparison group. Pulmonary Hypertension (PH), Atrial Arrhythmias (AA), Stroke, and Heart Failure (HF) were respectively reported in 25.71%, 7.14%, 0.95%, and 19.28% of the discharges. Our study identified a low incidence of MS in the US over the 12-year period; no deaths were identified. CONCLUSION: Our results substantiate MSp as a risk factor for PH, AA, HF, and stroke in pregnancy. Even though the mortality is low, it is essential that clinicians be aware of this diagnosis due to higher associated morbidity and costs.

Reprocessamento de Marca-Passos em Países de Língua Portuguesa: Uma Reflexão Clínica / Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection

Resumo Há uma enorme disparidade entre os países de alta renda e outros em termos de acesso a dispositivos médicos cardíacos, como marca-passos e desfibriladores implantáveis. Os custos são uma das principais barreiras ao uso de dispositivos cardíacos nesses países. Existem iniciativas internacionais que visam reduzir essa disparidade, e o reuso de marca-passos tem sido discutido como uma possível alternativa. O conceito de reutilização de marca-passos não é novo; entretanto, estudos recentes têm se mostrado seguros, éticos e eficazes para aqueles que precisam de dispositivos eletrônicos cardíacos implantáveis e não tem como adquiri-los. Parte dos países de língua portuguesa, especialmente na África, precisam de uma resposta imediata que beneficie seus inúmeros pacientes que sofrem de arritmias tratáveis.

Abstract There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.

Cardiac cysticercosis in the setting of colorectal cancer and immunosuppression.

Cysticercosis is a parasitic infection that is caused by the tapeworm Taenia solium and is prevalent in Latin America, southern Africa, and parts of Asia. Cysticercosis normally affects the central nervous system, but rare cases of cardiac cysticercosis have been reported in the literature. We report a case of asymptomatic cardiac cysticercosis in a 54-year-old Afro-Brazilian man with a history of hemicolectomy and chemotherapy, who demonstrated characteristic intramyocardial lesions on transthoracic echocardiogram and cardiac magnetic resonance imaging, and responded well to subsequent treatment with albendazole and prednisone. .

Remote monitoring of pacemakers and defibrillators: Effective and safe in Brazil?

Background: The remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has become a common method of in-home monitoring and follow-up in high-income countries given its effectiveness, safety, convenience, and the possibility of early intervention. However, in Brazil, RM is still underutilized. Objectives: This observational study aims to demonstrate our experience of using RM in Brazil and the predictive factors of RM of CIED follow-up in Brazil. Methods: This was a prospective cohort study of patients with a CIED. Event rates are reported and clinical responses to those findings and outcomes based on the detection of RM. A logistic regression model was performed to identify predictors of more events, with P < .05 for statistical significance. Results: This study evaluated consecutive 119 patients: 30.2% with pacemakers, 42.8% with implantable cardioverter-defibrillator, 22.7% with cardiac resynchronization therapy (CRT) with defibrillator, and 3.3% with CRT with pacemaker. Events were detected in 63.9% of the cases in 29.5 ± 23 months of follow-up. The outcomes found were that 44.5% needed elective evaluation in medical treatment and 23.5% needed immediate evaluation in therapy. Logistic regression analysis showed that the groups with CRT or CRT with defibrillator (75.0%), reduced ejection fraction (76.5%), and New York Heart Association functional class ≥II (75.0%) had the highest RM event rates. Conclusions: RM proved to be effective and safe in the follow-up of patients with CIEDs in Brazil, allowing early interventions and facilitating therapeutic management.

Benign Cardiac Neoplasms in the United States: A Thirteen-Year Review.

Cardiac neoplasms are uncommon tumors. For epidemiological purposes, they can be divided into benign and malignant subtypes, with the former occurring at a significantly higher rate than the latter. Due to their uncommon nature, there are few data-driven studies examining the characteristics and trends of benign cardiac neoplasms. Our retrospective HCUP-NIS data review purports to illuminate some of the trends surrounding benign cardiac neoplasms and their associated co-occurrences. The data consisted of 482,872,274 weighted discharges. There were 45,568 weighted discharges that included a benign cardiac neoplasm. Benign cardiac neoplasms were more often observed in women (64.33%), and the average age was 63.8 years. The most common cardiovascular co-occurrences in patients with benign cardiac neoplasm were atrial tachyarrhythmias (28.93%), heart failure (19.61%), and embolic events such as stroke, myocardial infarct, or pulmonary embolism (19.82%). Other co-occurrences included pulmonary hypertension (7.55%), ventricular arrhythmias (3.23%), and other EKG abnormalities (3.70%). Procedures were numerous in patients with benign cardiac neoplasms. 43% of patients with this diagnosis had some form of cardiac surgery during their hospitalization. Overall, this study found low incidence of benign cardiac neoplasms in the USA during this 13-year study period. However, in the presence of benign cardiac neoplasms, our study showed that cardiovascular co-occurrences are not uncommon and may help to illuminate this otherwise rare diagnosis.

Novel biomarkers in the prognosis of patients with atherosclerotic coronary artery disease.

Biomarkers have a variety of clinical applications in multiple stages of diagnosis and therapy. Troponin T and brain natriuretic peptide are the best-known in the cardiovascular field, but experimental studies have identified new biomarkers with potential clinical value. In this article, novel biomarkers of kidney injury are investigated in the context of their relationship with atherosclerotic coronary disease. This review was carried out through a search in the PubMed database using as keywords each biomarker to be studied with the descriptor (DECS/MeSH) "Myocardial Infarction", and the keywords "coronary" and "cardiovascular", using the Boolean operator "AND". After the selection, 24 articles published between 2003 and 2017 were identified for the review. Eight biomarkers were investigated: neutrophil gelatinase-associated lipocalin (NGAL), fibroblast growth factor 23 (FGF23), tissue inhibitor of metalloproteinase-2 (TIMP-2), syndecan-1, interleukin-6 (IL-6), galectin-3, and the vascular cell adhesion molecules ICAM-1 and VCAM-1. Most identified articles were experimental studies, studies on human subjects having few participants. There are several promising biomarkers in the setting of coronary disease. The main evidence available in the literature suggests that elevated NGAL levels are associated with better prognosis after cardiac arrest and with comorbid kidney injury; elevated FGF23 is associated with coronary artery disease severity; TIMP-2 protects against coronary artery disease; increased expression of syndecan-1 is observed in myocardial infarction (MI) and protects against an exacerbated inflammatory response; IL-6 is associated with atherosclerotic disease and major cardiovascular outcomes; galectin-3 correlates with adverse clinical events post-MI; and elevated ICAM-1/VCAM-1 levels are associated with risk of coronary disease. Further studies are required to better investigate the role of each of these biomarkers in both stable coronary disease and acute coronary syndrome.

Hospital admissions for aortic stenosis in pregnancy in the United States - a thirteen year analysis.

Cardiac disease is still the leading cause of non-pregnancy related maternal morbidity and mortality. Valvular disease is one of the most concerning cardiac conditions in pregnancy. Aortic stenosis (AS) is rare in young populations but deadly complications have been reported in pregnant women. This study is a retrospective review of data from the HCUP-NIS Database from 2002-2014. There were 1108 weighted discharges for both pregnancy and AS. The data contained ten or fewer unweighted discharges with AS in pregnancy that underwent a cardiac intervention: open heart surgery or percutaneous cardiac intervention. Patients who had at least one diagnosis for AS had a greater mean cost per discharge than the comparison groups. No deaths were identified in this group. We found a statistically significant increase in the billing codes for pulmonary hypertension and heart failure. Conditions commonly associated with AS such as atrial arrhythmias, ventricular arrhythmias, diastolic dysfunction, ischemic heart disease and stroke were poorly reported. Our study identified a low incidence of AS and its complications in pregnancy in the USA over our 13-year study period. Even though, the morbidity and mortality are low, it is important that clinicians be aware of this diagnosis due higher costs and risk of complications.

A Rare Case of Non-Prosthetic Aortic Valve Infectious Endocarditis Caused by Achromobacter xylosoxidans.

BACKGROUND Achromobacter xylosoxidans is a ubiquitous environmental gram-negative bacterium, very resistant to antibiotics. Endocarditis caused by these bacteria is extremely rare, with only 20 cases described in the literature to our knowledge. Mortality rates are high, and treatment usually involves a combination of antibiotics and surgery. Nosocomial infections predominate with a strong association between bacteremia and immunosuppression. CASE REPORT A 19-year-old immunocompetent male presented with endocarditis He had interatrial and interventricular communication corrected at age 11 months and aortic coarctation correction at age 10. Initial echocardiogram showed a possible interventricular patch infection, which was later ruled out. He was treated initially for endocarditis with a combination of antibiotics, but because he remained febrile after appropriate antibiotic treatment, surgery was performed. The patient had a favorable outcome after surgery and was asymptomatic on follow-up. CONCLUSIONS Endocarditis caused by A. xylosoxidans is extremely rare. To date, only 20 cases of IT have been reported in the literature, of which only two involved a native valve. Given the scarcity of cases reported, there is no consensus on the best treatment.

Hospital admissions for tuberculous pericarditis in the United States 2002-2014.

Background: Extra pulmonary manifestations of tuberculosis (TB) are rare in developed countries. TB is the main etiology of chronic pericarditis in developing countries, but it's epidemiology is not unknown in the United States. Methods: This retrospective study used the Healthcare Utilization Projects/Nationwide Inpatient Sample (HCUPS/NIS) database from 2002-2014 to evaluate the characteristics, risk factors, trends over time and region of tuberculous pericarditis in the United States. Results: The data during the study period consists of 100,790,900 discharges accounting for 482,872,274 weighted discharges. The data showed 744 weighted discharges with indication of both tuberculosis and pericarditis. A co-ocurrence of TB pericarditis and malignancy or chronic kidney disease was more common than in patients without TB pericarditis. The frequency of co-ocurrence of TB pericarditis and HIV infection, obesity, alcohol abuse and organ transplant was not elevated. Conclusion: TB pericarditis is rare disease in the USA and the classical risk factors for lung tuberculosis may not be associated with TB pericarditis. CKD and malignancy appear to be associated with TB pericarditis, further studies are required to determine causality.

Persistent heart failure following melphalan and fludarabine conditioning.

Advances in chemotherapy and radiotherapy have greatly improved cancer survival, but their side effects can sometimes be more dangerous than the cancer itself. Understanding these risks is especially important when the consequences are as life-threatening as heart failure. Melphalan and fludarabine are drugs used in many chemotherapy regimens and are not usually associated with cardiotoxicity. In this report we present a patient that developed acute heart failure followed by persistent heart failure after conditioning with these drugs following a bone marrow transplant. .

Lead Removal Without Extraction Tools: A Single-Center Experience.

INTRODUCTION: Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure's outcome but have economic implications. OBJECTIVE: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices. METHODS: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes. RESULTS: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases. CONCLUSION: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

Lead removal without extraction tools: a single-center experience

Abstract Introduction: Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure's outcome but have economic implications. Objective: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices. Methods: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes. Results: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases. Conclusion: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

Takayasu arteritis with multiple coronary involvement and early graft relapse.

Coronary artery disease (CAD) due to Takayasu arteritis (TA) is rare. This article reports a case of severe involvement of multiple coronary arteries in a young woman. She was treated with coronary artery bypass grafting and had an early venous graft stenosis despite immunosuppressants. She became asymptomatic one year after a drug-eluting stent placement. This report shows the complexity of the diagnostic and therapeutic approach to TA with complex CAD.