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3.
Pacing Clin Electrophysiol ; 40(5): 527-536, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28244117

RESUMO

BACKGROUND: Remote monitoring (RM) can remotely detect atrial tachyarrhythmias (ATAs). The benefit of RM compared to conventional follow-up in the detection and management of ATA was assessed in recipients of dual-chamber pacemakers. METHODS: The multicenter randomized SETAM study enrolled 595 patients in sinus rhythm with a CHA2 DS2 -VASc score ≥2, without ATA history and untreated with antiarrhythmics and antithrombotics, randomly assigned to RM (RM-ON; n = 291) versus ambulatory follow-up (RM-OFF; n = 304) during 12.8 ± 3.3 months. ATA occurrence, burden, and management were analyzed together with adverse clinical events. RESULTS: Patients were 79 ± 8 years old, 63% men, with a CHA2 DS2 -VASc score of 3.7± 1.2. ATA were detected in 83 patients (28%) in the RM-ON versus 66 (22%) in the RM-OFF group (P = 0.06). The median time between the pacemaker implantation and the first treated ATA was 114 days [44; 241] in the RM-ON versus 224 days [67; 366] in the RM-OFF group (hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.37-0.86; P = 0.01). Therapies for ATA were initiated in 92 patients and the time to treatment of ATA was shortened by 44% in the RM-ON group (HR = 0.565; 95% CI: 0.37-0.86; P = 0.01). Over the last 4 months of follow-up, the mean ATA burden was alleviated by 4 hours/day (18%) in the RM-ON group. The rate of adverse clinical events was similar in both groups. CONCLUSION: Remotely monitored patients were diagnosed and treated earlier for ATA, and subsequently had a lower ATA burden.


Assuntos
Fibrilação Atrial/mortalidade , Fibrilação Atrial/prevenção & controle , Estimulação Cardíaca Artificial/mortalidade , Eletrocardiografia Ambulatorial/estatística & dados numéricos , Taquicardia Atrial Ectópica/mortalidade , Taquicardia Atrial Ectópica/prevenção & controle , Telemedicina/estatística & dados numéricos , Idoso , Fibrilação Atrial/diagnóstico , Estimulação Cardíaca Artificial/estatística & dados numéricos , Efeitos Psicossociais da Doença , Diagnóstico Precoce , Feminino , França/epidemiologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Prevalência , Fatores de Risco , Taxa de Sobrevida , Taquicardia Atrial Ectópica/diagnóstico , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento
4.
Europace ; 18(5): 778-84, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27226497

RESUMO

The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas. Information on antithrombotic therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged ≥66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6 (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88.7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while on chronic antithrombotic therapy varies, with evidence of a disparity between guideline recommendations and practice patterns in Europe. Haemorrhagic complications were significantly less frequent in patients treated with NOACs. Despite this, the incidence of severe pocket haematomas was low.


Assuntos
Anticoagulantes/administração & dosagem , Desfibriladores Implantáveis/efeitos adversos , Hematoma/epidemiologia , Marca-Passo Artificial/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Europa (Continente) , Feminino , Hematoma/etiologia , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/classificação , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Reoperação , Inquéritos e Questionários , Adulto Jovem
5.
Europace ; 18(3): 463-7, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26899998

RESUMO

The purpose of this patient survey was to analyse the knowledge about blood thinning medications relative to gender, age, education, and region of residence in patients with atrial fibrillation (AF). A total of 1147 patients with AF [mean age 66 ± 13 years, 529 (45%) women] from eight European countries responded to this survey. Most patients understood that the indication for anticoagulation therapy was to 'thin the blood', but 8.1% responded that the purpose of the medication was to treat the arrhythmia. Patients with college or university grades reported less frequent deviations from their target INR range compared with those without schooling (2.8% vs. 5.1%, P < 0.05). The awareness of anticoagulation-related risk of bleedings was lowest in patients without schooling (38.5%) and highest in those with college and university education (57.0%), P < 0.05. The same pattern was also observed regarding patient's awareness of non-vitamin K antagonist oral anticoagulants (NOACs): 56.5% of the patients with university education and only 20.5% of those without schooling (P < 0.05) knew about NOACs, indicating that information about new anticoagulation therapies remains well below the target. Bleeding events were statistically less frequent in patients on NOACs compared with vitamin K antagonists. The education level and patients' knowledge have a direct influence on the global management of the anticoagulation.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Pacientes/psicologia , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/complicações , Coagulação Sanguínea/efeitos dos fármacos , Monitoramento de Medicamentos/métodos , Escolaridade , Europa (Continente) , Feminino , Pesquisas sobre Serviços de Saúde , Hemorragia/induzido quimicamente , Humanos , Coeficiente Internacional Normatizado , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Vitamina K/antagonistas & inibidores
6.
Europace ; 18(1): 151-5, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26462697

RESUMO

The purpose of this European Heart Rhythm Association survey was to assess the attitude, level of education, and knowledge concerning oral anticoagulants (OACs) among patients with atrial fibrillation (AF) taking vitamin K antagonists (VKAs), non-VKA oral anticoagulants (NOACs) or antiplatelets. A total of 1147 patients with AF [mean age 66 ± 13 years, 529 (45%) women] from 8 selected European countries responded to this survey. The overall use of OACs and antiplatelets was 77 and 15.3%, respectively. Of the patients taking OACs, 67% were on VKAs, 33% on NOACs, and 17.9% on a combination of OACs and antiplatelets. Among patients on VKAs, 91% correctly stated the target international normalized ratio (INR) level. The proportion of patients on VKA medication who were aware that monthly INR monitoring was required for this treatment and the proportion of patients on NOAC who knew that renal function monitoring at least annually was mandatory for NOACs was 76 and 21%, respectively. An indirect estimation of compliance indicated that 14.5% of patients temporarily discontinued the treatment, and 26.5% of patients reported having missed at least one dose. The survey shows that there is room for improvement regarding education and adherence of patients taking OACs, particularly regarding monitoring requirements for NOACs.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Educação de Pacientes como Assunto/estatística & dados numéricos , Conhecimento do Paciente sobre a Medicação/estatística & dados numéricos , Tromboembolia/prevenção & controle , Administração Oral , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/psicologia , Atitude Frente a Saúde , Autoavaliação Diagnóstica , Europa (Continente)/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Tromboembolia/epidemiologia , Tromboembolia/psicologia , Vitamina K/antagonistas & inibidores
7.
Eur Heart J Suppl ; 18(Suppl D): D1-D6, 2016 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-28533706

RESUMO

Atrial fibrillation (AF) is the most prevalent clinically relevant arrhythmia, affecting millions of individuals in Europe and the USA. Atrial fibrillation increases the risk of stroke; the long-term standard of care for prevention of AF-related stroke is anticoagulation. The use of anticoagulants should be based on the absolute risks of stroke and bleeding and the relative benefit-risk profile of the individual patient. Treatment options include vitamin K antagonists (VKAs) such as warfarin, whose use is long-established but associated with drawbacks, including regular coagulation monitoring requirements and many food and drug interactions. The non-VKA oral anticoagulants are gaining widespread use as alternatives to VKAs, and are supported in treatment guidelines for patients with AF at moderate to high risk of stroke. Adherence to medication is important for the long-term efficacy of any therapy; however, relatively low levels of medication adherence are to be expected in 'real-world' AF patients compared with clinical trials. Experience across several therapy areas, including cardiovascular disease, shows that poor adherence to chronic medication is common. However, simple dosing schedules may be advantageous in this respect, and because long-term outcomes in AF are likely to be influenced by adherence, once-daily dosing has the potential to improve rates of stroke prevention in patients with AF.

8.
Eur Heart J Suppl ; 18(Suppl D): D7-D15, 2016 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-28533707

RESUMO

Oral anticoagulation is the long-term standard of care for preventing stroke in patients with atrial fibrillation (AF). However, anticoagulation is associated with an increased risk of bleeding, such that its use should be based on the absolute risks of stroke and bleeding, and the relative benefit-risk profile of the individual patient. Non-vitamin K antagonist oral anticoagulants, including rivaroxaban, are alternatives to vitamin K antagonists such as warfarin in this setting, and are supported in treatment guidelines as the optimal choice for patients with AF at moderate to high risk of stroke. Rivaroxaban can be given in fixed doses without routine coagulation monitoring, and phase III studies have demonstrated its safety profile and efficacy in patients with non-valvular AF, including the elderly and those with co-morbidities. Moreover, rivaroxaban is administered once daily, which has advantages for optimal patient adherence to medication over the long term. The established efficacy and safety profile of rivaroxaban, together with its convenient once-daily dosing schedule, may contribute to improved patient outcomes and lead to sustained benefits for patients with non-valvular AF at risk of stroke.

9.
Future Cardiol ; 10(6): 699-705, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25495812

RESUMO

AIM: Atrial flutter (AFL) ablation requires optimal periprocedural anticoagulation in order to minimize thromboembolic events/bleeding risk. This study describes the characteristics of patients receiving new oral anticoagulants before AFL ablation and assesses complications. METHODS: This multicenter, retrospective study reports ischemic and hemorrhagic predischarge, postprocedural complications. RESULTS: We evaluated 60 patients (62.3% male; mean age: 69.2 ± 9.7 years; CHA2DS2-VASc score: 2.44 ± 1.46, HAS-BLED score: 1.14 ± 0.7). Twenty-one (35.0%) and 23 patients (38.3%) received twice-daily dabigatran 110 or 150 mg; 16 patients (26.6%) received once-daily rivaroxaban (15 mg [n = 5] or 20 mg [n = 11]). Four cases of postprocedural minor bleeding were reported. CONCLUSION: This is the first study assessing new oral anticoagulants for periprocedural anticoagulation, specifically in patients undergoing AFL ablation. No major bleeding was reported. Further prospective investigation is warranted.


Assuntos
Anticoagulantes/uso terapêutico , Flutter Atrial/terapia , Benzimidazóis/uso terapêutico , Ablação por Cateter , Morfolinas/uso terapêutico , Tiofenos/uso terapêutico , beta-Alanina/análogos & derivados , Administração Oral , Idoso , Dabigatrana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Rivaroxabana , Resultado do Tratamento , beta-Alanina/uso terapêutico
10.
Arch Cardiovasc Dis ; 107(10): 508-18, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25218008

RESUMO

BACKGROUND: Much attention is being paid to the education of and provision of medical information to patients, to optimize their understanding and acceptance of their disease. AIMS: To ascertain the impact of educating recent recipients of an implantable cardioverter defibrillator (ICD) on their perception and acceptance of a home monitoring (HM) system. METHODS: Questionnaire 1, completed one month after ICD implantation, was designed to assess: the quality of patient preparation for HM; patient comprehension of HM; and patient anxiety experienced during its installation. The comprehension questions were assigned a score of -2 for an incorrect answer, +1 for a correct answer and 0 for neither (total score ranging from -40 to +20). Questionnaire 2, completed six months after ICD implantation, assessed patient acceptance of and anxiety about HM. RESULTS: The registry included 571 patients (mean age 63.9±12.8 years; 83% men; 76% of ICDs implanted for primary prevention) followed by HM for 6.2±1.2 months. Questionnaire 1 was completed by 430 (75.3%) patients and questionnaire 2 by 398 (69.7%) patients. Younger patients had a better comprehension of HM than older patients. High-quality training conditions improved the comprehension score, and a positive association was observed between anxiety and acceptance levels and the comprehension score. The 80±20% mean data transmission rate (days of transmission/days of follow-up ratio) was unrelated to the comprehension scores. CONCLUSION: A clear understanding was associated with a higher acceptance of HM, although it was unrelated to the data transmission rate.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/psicologia , Monitorização Fisiológica/métodos , Educação de Pacientes como Assunto , Percepção , Arritmias Cardíacas/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários
12.
Int J Cardiol ; 168(4): 3728-35, 2013 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-23856445

RESUMO

AIM: Reentry circuits of a rare typical atrial flutter (AFL) involving the cavo-tricuspid isthmus (CTI) and proximal coronary sinus (CS) are described based on electrophysiological data and effects of radiofrequency (RF). METHODS AND RESULTS: Twelve patients with ECG-typical AFL in whom entrainment demonstrated that CTI and proximal CS were both part of the circuit were included. Initial RF target was CTI in 8 patients and proximal CS in 4. Success was defined as AFL termination/noninducibility. After CTI ablation, AFL cycle length (CL) increased in all: AFL persisted in 3, while in the other 5 AFL was interrupted but subsequently induced with the same morphology; before induction CTI bi-directional block was validated; success was obtained at the CS, targeting fragmented atrial potentials (APs). In those with first ablation at CS, AFL was interrupted in 3 with no AFL inducibility; in 1 AFL persisted with CL prolongation and was terminated at CTI. Two reentry patterns were identified: in 5 patients the inter-atrial septum as well as the mid-distal CS were outside of the circuit, while the CTI, proximal CS and Bachmann's bundle zone were inside, suggesting a left atrial component; in 1 patient electrophysiological mapping suggested an intra-CS circuit component. RF was successful in all without recurrence. CONCLUSION: Electrophysiological mapping and RF effects suggest a continuum between the CTI and proximal CS in rare cases with ECG-typical AFL. RF inside the proximal CS, targeting fragmented APs, should be considered in any patient in whom CTI ablation failed to interrupt a typical AFL.


Assuntos
Flutter Atrial/fisiopatologia , Ablação por Cateter/métodos , Seio Coronário/fisiopatologia , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Valva Tricúspide/fisiopatologia , Idoso , Flutter Atrial/cirurgia , Seio Coronário/cirurgia , Feminino , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Tricúspide/cirurgia
14.
Presse Med ; 42(4 Pt 1): e96-105, 2013 Apr.
Artigo em Francês | MEDLINE | ID: mdl-23419461

RESUMO

BACKGROUND: Few studies have reported racial differences of electrocardiogram. AIM: To compare clinical and electrocardiographic parameters of black African and white European young adults. MATERIALS AND METHODS: Students from Cameroon (black group) and France (white group) were recruited (ratio 2/1). Resting ECG was recorded in supine position using a numerical electrocardiograph. Participants underwent demographic, clinical and ECG measurements. RESULTS: We included 162 black and 81 white students (68% female), mean age 24±3 years. Longest QRS duration, sinus bradycardia, right bundle branch block and slurred pattern of repolarization were more common in whites (P<0.05) while longest PR interval (P<0.05), QRS microvoltage and positive T wave in lead V1 were more common in blacks (P<0.001). CONCLUSION: Most of ECG patterns are similar in these black and white individuals; particularly repolarization features. Positive T wave in V1 lead and isolated R wave microvoltage in aVL lead are predominant in blacks whereas slurring variant of early repolarization is more frequent in whites.


Assuntos
Grupo com Ancestrais do Continente Africano , Arritmias Cardíacas/etnologia , Eletrocardiografia/classificação , Grupo com Ancestrais do Continente Europeu , Processamento de Sinais Assistido por Computador , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Camarões , Estudos Transversais , Feminino , França , Humanos , Masculino , Valores de Referência , Adulto Jovem
15.
J Interv Card Electrophysiol ; 35(1): 63-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22562357

RESUMO

PURPOSE: A residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump. METHODS: We analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter. Success was defined as AVNRT non-inducibility. Patients with no baseline elicitable jump, no inducible AVNRT, and transient first atrioventricular (AV) block at the last site were excluded. RESULTS: From 371 patients who underwent cryoablation from May 2002 to March 2011, 303 fulfilled the entry criteria (mean age, 41 ± 16; 222 women). Baseline AV nodal effective refractory period (ERP) was 272 ± 57 ms, postprocedural 331 ± 64 (P < 0.001), and the mean of the difference (Δ ERP) 60 ± 41. At the end of the procedure, 64 patients (21 %) had a residual jump, of whom 22 with a single echo. At 12 months follow-up, the actuarial recurrence-free rate was 70.3 % in patients with a residual jump and 86 % in those without (P = 0.01). In patients with a jump, only Δ AV nodal ERP was correlated with recurrence (37 ± 41 vs. 68 ± 47 ms; P < 0.04) while a single echo was not. The actuarial rate of recurrence was 60.8 % in patients with a Δ AV nodal ERP ≤ 30 ms and 18.8 % in those with a Δ AV nodal ERP >30 ms (P < 0.01). CONCLUSIONS: Suppression of slow pathway conduction is the optimal endpoint for AVNRT cryoablation. A residual jump can be tolerated if AV nodal ERP postcryoablation is prolonged >30 ms.


Assuntos
Criocirurgia/métodos , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Adulto , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Recidiva , Medição de Risco , Fatores de Risco , Resultado do Tratamento
16.
Europace ; 14(2): 261-6, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21920912

RESUMO

AIMS: While in radiofrequency ablation for atrioventricular nodal reentry tachycardia (AVNRT) a residual jump and a single echo do not seem to substantially modify long-term results, in cryoablation procedures their effects are still under evaluation. The purpose of this study was to evaluate if a residual jump associated or not with an isolated echo is correlated with outcome. INCLUSION CRITERIA: acute successful slow pathway cryoablation for slow-fast AVNRT. EXCLUSION CRITERIA: use of a 4 mm tip cryocatheter, no baseline elicitable jump or inducible AVNRT, and unwanted persistent first degree atrioventricular (AV) block at the end of the procedure. Cryoablation (-80°C × 4 min) was applied after successful cryomapping. Atrioventricular nodal reentry tachycardia inducibility was checked 30 min later on and off isoproterenol. Acute success was defined as AVNRT non-inducibility. Among 332 patients (pts) who had undergone cryoablation from May 2002 to March 2010 in our institutions, 245 of them fulfilled the entry criteria (173 women, mean age 41 ± 16 years, ineffective drugs 1.3 ± 1.1). A 7-Fr 6-mm tip cryocatheter (CryoCath®) was used in all cases. Baseline AV nodal effective refractory period (ERP) was 271 ± 55 ms, post-procedural ERP 331 ± 60 ms (P< 0.001), and the mean of the difference between baseline and post-procedural ERP 63 ± 38 ms. A/V ratio at successful site was 1 ± 0.4. Forty-four pts (18%) had a residual jump at the end of the procedure, and 14 of them had an associated single echo. Global cryoapplication time was 993 ± 797 s. During a follow-up of 40 ± 10 months, 43 pts (17.5%) had recurrences. At 12 months follow-up, actuarial rate of recurrence-free pts was 85% in the group without residual jump (201 pts), 63.3% with residual jump and no echo (30 pts), and 60.6% with residual jump associated with a single echo (P< 0.003 among groups). Univariate predictors of recurrences were persistence of a residual jump (P< 0.001) and total cryoapplication time (P< 0.02). In a multivariate model, only residual jump was independently correlated with recurrences (P< 0.01). CONCLUSIONS: In patients undergoing AVNRT cryoablation, slow-pathway suppression is correlated with a better outcome. A single echo is associated with a recurrence risk similar to residual jump without echo. It may be suggested that pursuing a procedural endpoint up to slow pathway complete suppression may improve long-term success.


Assuntos
Criocirurgia/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Taquicardia por Reentrada no Nó Atrioventricular/epidemiologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Adulto , Feminino , França/epidemiologia , Humanos , Masculino , Prevalência , Medição de Risco , Fatores de Risco , Resultado do Tratamento
17.
Arch Cardiol Mex ; 80(4): 283-8, 2010 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21169093

RESUMO

Cryoablation is a new method in interventional cardiac electrophysiology for percutaneous catheter ablation of cardiac arrhythmias. Cryothermal mapping enables the functional assessment of a particular site before permanent ablation. In this way, the targeted tissue may be confirmed as safe for ablation. This is useful in high risk ablation, for example, nex to the His bundle or the compact AV node. In the last decade, several studies have been addressed to AV-nodal reentry tachycardia (AVNRT) cryoablation. Current experiences indicate that cryoablation for AV-nodal reentry tachycardia is effective and safe. However, its wide use seems to be somewhat limited by a slightly lower efficacy when compared to radiofrequency. Further studies evaluating long-term success of cryothermal ablation versus radiofrequency are warranted. However, for high-risk ablations, cryoenergy is very helpful and should be systematically used. This article is a review of acute and long-term effects of cryoablation in patients suffering of AV-nodal reentry tachycardia episodes.


Assuntos
Ablação por Cateter , Criocirurgia/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Humanos
18.
Arch. cardiol. Méx ; 80(4): 283-288, oct.-dic. 2010. ilus, tab
Artigo em Inglês | LILACS | ID: lil-632002

RESUMO

Cryoablation is a new method in interventional cardiac electrophysiology for percutaneous catheter ablation of cardiac arrhythmias. Cryothermal mapping enables the functional assessment of a particular site before permanent ablation. In this way, the targeted tissue may be confirmed as safe for ablation. This is useful in high-risk ablation, for example, next to the His bundle or the compact AV node. In the last decade, several studies have been addressed to AV-nodal reentry tachycardia (AVNRT) cryoablation. Current experiences indicate that cryoablation for AV-nodal reentry tachycardia is effective and safe. However, its wide use seems to be somewhat limited by a slightly lower efficacy when compared to radiofrequency. Further studies evaluating long-term success of cryothermal ablation versus radiofrequency are warranted. However, for high-risk ablations, cryoenergy is very helpful and should be systematically used. This article is a review of acute and long-term effects of cryoablation in patients suffering of AV-nodal reentry tachycardia episodes.


La crioablación es un nuevo método en la electrofisiología cardiaca intervensionista para la ablación percutánea de las arritmias cardiacas. El mapeo criotérmico permite la evaluación funcional de un sitio en particular antes de la ablación permanente; de esta manera, el tejido blanco puede confirmarse como seguro para el procedimiento. Esto es útil en la ablación de alto riesgo, por ejemplo, cerca del haz de His o del nodo AV compacto. En la última década, varios estudios se han orientado a la crioablación para la taquicardia de reentrada del nodo AV (TRNAV). Las experiencias actuales indican que la crioablación de la taquicardia de reentrada del nodo AV es efectiva y segura. Sin embargo, la apertura para ampliar su uso está parcialmente limitada por su eficacia ligeramente menor al compararla con el empleo de la radiofrecuencia. Se justifican ensayos clínicos futuros con objeto de evaluar el éxito a largo plazo de la ablación criotérmica en comparación con la radiofrecuencia. Para las ablaciones de alto riesgo, la crioenergía es muy útil y debería ser usada sistemáticamente. Este artículo consiste en una revisión sobre los efectos inmediatos y a largo plazo de la crioablación en pacientes que presentan episodios de taquicardia por reentrada del nodo AV.


Assuntos
Humanos , Ablação por Cateter , Criocirurgia/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia
19.
J Interv Card Electrophysiol ; 29(2): 97-107, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20814733

RESUMO

BACKGROUND: The efficacy of radiofrequency (RF) ablation of an uncommon coronary sinus (CS)-dependent atrial flutter (AFL) was evaluated using conventional electrophysiological criteria in a highly selected subset of patients with typical and atypical AFL. METHODS: Fourteen patients with atrial flutter (11 males, mean age 69 ± 9 years) without previous right or left atrial RF ablation were included. Heart disease was present in eight patients. Baseline ECG suggested typical AFL in 12 patients and atypical AFL in two. Mean AFL cycle length was 324 ± 64 ms at the time of RF ablation in the CS. Lateral right atrium activation was counterclockwise (CCW) in 13 patients and clockwise in one. CS activation was CCW in all. Criteria for CS ablation included the presence of CS mid-diastolic fractionated atrial potentials (APs) associated with concealed entrainment with a postpacing interval within 20 ms. Success was defined as termination of AFL and subsequent noninducibility. RESULTS: The initial target for ablation was the cavotricuspid isthmus (CTI) in 11 patients and the CS with further CTI ablation in three. AP duration at the CS target site was 122 ± 33 ms, spanning 40 ± 12% of the AFL cycle length. CS ablation site was located 1-4 cm from the CS ostium. Ablation was successful in all patients. Mean time to AFL termination during CS ablation was 39 ± 52 s (<20 s in eight patients). No recurrence of ablated arrhythmia occurred during a follow-up of 18 ± 8 months. CONCLUSIONS: The CS musculature is a critical part of some AFL circuits in patients with typical and atypical AFL. AFL can be terminated in patients with CS or CTI/CS AFL reentrant circuits by targeting CS mid-diastolic fragmented APs.


Assuntos
Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Seio Coronário/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Diástole , Feminino , Humanos , Masculino , Resultado do Tratamento
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