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1.
J Interv Card Electrophysiol ; 54(1): 49-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30187250

RESUMO

BACKGROUND: Before subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, the adequacy of sensing is required to be verified through surface ECG screening. Our objective was to determine whether S-ICD can be considered as a supplementary therapy in patients who are receiving biventricular (BIV) pacing. METHODS: We evaluated 48 patients with BIV devices to determine S-ICD candidacy during BIV, left ventricular (LV), right ventricular (RV) pacing, and intrinsic conduction (left bundle branch block-LBBB) by using an automated screening tool. Eligibility was defined by the presence of at least one appropriate vector in the supine and standing positions. RESULTS: Eligibility was verified during BIV pacing in 34 (71%) patients. In patients screened-out, QRS duration was longer (p = 0.035) and ischemic cardiomyopathy was more frequent (p = 0.027). LV-only pacing was associated with a lower passing rate (46%) (p < 0.001 versus BIV). The LBBB QRS morphology during inhibited ventricular pacing was acceptable in 51% of patients. The QRS generated by RV pacing was acceptable in 25% of patients. In patients who passed the screening test during BIV, the QRS was not acceptable in 76% during RV pacing (i.e., accidental loss of LV capture). The concomitant adequacy during inhibited ventricular pacing (i.e., possible intrinsic conduction) was not assessed in 40% of patients. CONCLUSIONS: S-ICD may be a supplemental therapy in the majority of CRT patients. Standard BIV pacing should be preferred to the LV-only pacing mode, as it is more frequently associated with adequacy of S-ICD sensing. Spontaneous LBBB and RV-paced QRS morphologies are frequently inadequate. Therefore, in patients selected for concomitant S-ICD and CRT implantation, accidental loss of LV capture or possible intrinsic conduction must be prevented.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/mortalidade , Terapia de Ressincronização Cardíaca/métodos , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Humanos , Itália , Masculino , Seleção de Pacientes , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento
2.
J Interv Card Electrophysiol ; 52(1): 47-52, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29525913

RESUMO

PURPOSE: The WATCHMAN device for Left Atrial Appendage Occlusion (LAAO) has proven to be an effective alternative to oral anticoagulation (OAC) in patients with atrial fibrillation (AF), and has now been adopted in clinical practice. In the present study, we analyzed the safety and efficacy profile of the LAAO procedure at mid-term follow-up. METHODS: The TRAPS Registry is an observational, multicenter registry involving four Italian centers. Consecutive patients who had undergone LAAO with WATCHMAN device were enrolled. Clinical, demographic, and procedural data were collected at the time of implantation, and follow-up data were collected to assess the clinical outcome. RESULTS: A total of 151 patients were included in the Registry from May 2012 to October 2015. Implantation of the device was successful in 150/151 patients, with no or minimal (< 5 mm) leakage as assessed by peri-procedural transesophageal echo. In the remaining patient, early device embolization was reported, with no sequelae. Overall, intra-procedural events were reported in 5 (3.3%) patients. During a median follow-up of 16 months (25th and 75th percentile, 10-25), 5 patients died of any cause. The annual rate of all-cause stroke was 2.2% (95% CI, 0.7-5.1), the rate of transient ischemic attack was 1.3% (95% CI, 0.3-3.8), and that of major bleeding 0.4% (95% CI, 0.01-2.4). CONCLUSIONS: LAAO for stroke prevention was safely and effectively achieved by implantation of the WATCHMAN device in patients with non-valvular AF. Moreover, regardless of the risk profile of the population, we observed low rates of death and thromboembolic and bleeding events over a median follow-up of 16 months. These findings were obtained in an unselected group of consecutive patients who were variably eligible for chronic OAC therapy.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Sistema de Registros , Dispositivo para Oclusão Septal/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/mortalidade , Estudos de Coortes , Ecocardiografia Transesofagiana/métodos , Feminino , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Segurança do Paciente , Implantação de Prótese/métodos , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
3.
Europace ; 19(9): 1493-1499, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28407139

RESUMO

Aims: Heart failure (HF) patients with implantable cardioverter-defibrillators (ICD) require admissions for disease management and out-patient visits for disease management and assessment of device performance. These admissions place a significant burden on the National Health Service. Remote monitoring (RM) is an effective alternative to frequent hospital visits. The EFFECT study was a multicentre observational investigation aiming to evaluate the clinical effectiveness of RM compared with in-office visits standard management (SM). The present analysis is an economic evaluation of the results of the EFFECT trial. Methods and results: The present analysis considered the direct consumption of healthcare resources over 12-month follow-up. Standard tariffs were applied to hospitalizations, in-office visits and remote device interrogations. Economic comparisons were also carried out by means of propensity score (PS) analysis to take into account the lack of randomization in the study design. The analysis involved 858 patients with ICD or CRT-D. Of these, 401 (47%) were followed up via an SM approach, while 457 (53%) were assigned to RM. The rate of hospitalizations was 0.27/year in the SM group and 0.16/year in the RM group (risk reduction =0.59; P = 0.0004). In the non-adjusted analysis, the annual cost for each patient was €817 in the SM group and €604 in the RM group (P = 0.014). Propensity score analysis, in which 292 RM patients were matched with 292 SM patients, confirmed the results of the non-adjusted analysis (€872 in the SM group vs. €757 in the RM group; P < 0.0001). Conclusion: There is a reduction in direct healthcare costs of RM for HF patients with ICDs, particularly CRT-D, compared with standard monitoring. Clinical Trial Registration: http://clinicaltrials.gov/Identifier, NCT01723865.


Assuntos
Desfibriladores Implantáveis/economia , Cardioversão Elétrica/economia , Custos de Cuidados de Saúde , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Visita a Consultório Médico/economia , Tecnologia de Sensoriamento Remoto/economia , Telemetria/economia , Idoso , Assistência Ambulatorial/economia , Distribuição de Qui-Quadrado , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Custos Hospitalares , Humanos , Itália , Masculino , Modelos Econômicos , Readmissão do Paciente/economia , Valor Preditivo dos Testes , Pontuação de Propensão , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Resultado do Tratamento
4.
Heart Rhythm ; 14(4): 486-492, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27989681

RESUMO

BACKGROUND: Randomized and controlled studies have reported the effect of catheter ablation (CA) for atrial fibrillation (AF) over a follow-up of 12-24 months. OBJECTIVE: We report on the effect of CA plus antiarrhythmic drugs in comparison with antiarrhythmic drugs alone on the maintenance of sinus rhythm over 12-year follow-up. METHODS: We extended the follow-up duration of the 137 patients who were enrolled in the Catheter Ablation for the Cure of Atrial Fibrillation Study between February 1, 2002, and June 30, 2003, and randomized to antiarrhythmic drugs (control group) or antiarrhythmic drugs plus CA (ablation group). The primary end point was time to first symptomatic or asymptomatic recurrence of atrial arrhythmia lasting >30 seconds during follow-up. RESULTS: During follow-up, 19 of 68 (27.9%; 95% confidence interval [CI] 18.7%-39.6%) ablation group patients and 3 of 69 (4.3%; 95% CI 1.49%-12.0%) control group patients did not experience any relapse of atrial tachyarrhythmia (P < .001). The Kaplan-Meier analysis performed to determine the probability of survival free from atrial arrhythmias showed a statistical difference in favor of the ablation group (log-rank, P < .001). The effect of CA was consistent in both patients with paroxysmal AF and those with persistent AF. In the multivariate Cox regression analysis, belonging to the control group (hazard ratio 2.95; 95% CI 1.896-4.726; P < .001) and longer time since first AF episode (hazard ratio 1.004; 95% CI 1.002-1.084; P = .041) were predictors of atrial tachyarrhythmia recurrence. CONCLUSION: In patients with paroxysmal and persistent AF, CA significantly increased time to first recurrence of atrial arrhythmias during 12-year follow-up.


Assuntos
Antiarrítmicos , Ablação por Cateter , Idoso , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Prevenção Secundária/métodos , Prevenção Secundária/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
5.
J Telemed Telecare ; 22(7): 383-90, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26703214

RESUMO

INTRODUCTION: A substantial number of heart failure patients undergoing implantation of implantable cardioverter defibrillators (ICDs) fail to receive beta-blockers, or receive them at a suboptimal dose. Remote monitoring (RM) is becoming the standard means of following up recipients of ICDs. However, the impact of this shift toward remote ICD follow-up on the quality of drug therapy management in current clinical practice is unknown. The present analysis was aimed at investigating the impact of RM on the dose of beta-blockers achieved, and its association with clinical outcome at 12 months. METHODS: Altogether 987 consecutive patients were enrolled and followed up for at least 12 months in 25 Italian centres. RM was adopted by 499 patients. RESULTS: The number of patients receiving beta-blockers at any dose decreased after 12 months (from 403 (81%) to 370 (74%) for the remote arm and from 389 (80%) to 342 (70%) for the standard arm, both p < 0.02). Nonetheless, the number of patients on beta-blockers at the effective dose increased in both arms (from 60 (12%) to 82 (16%) for remote and from 63 (13%) to 98 (20%) for standard arms respectively, both p < 0.05). At multivariate analysis, RM was not associated with an effective dose of beta-blockers at the follow-up evaluation. However, the adoption of RM (p = 0.003) and the achievement of the effective dose of beta-blockers (p = 0.006) were independently and positively associated with an improved outcome. DISCUSSION: In a 'real-world' setting, we did not find an association between RM and the achieved dose of beta-blockers. However, we reported outcome benefits in achieving the effective dose of beta-blockers during follow-up and in adopting RM.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Desfibriladores Implantáveis , Adesão à Medicação , Monitorização Ambulatorial/métodos , Telemedicina , Antagonistas Adrenérgicos beta/administração & dosagem , Idoso , Bisoprolol/administração & dosagem , Bisoprolol/uso terapêutico , Carbazóis/administração & dosagem , Carbazóis/uso terapêutico , Carvedilol , Feminino , Humanos , Masculino , Propanolaminas/administração & dosagem , Propanolaminas/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento
6.
Europace ; 17(8): 1267-75, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25842271

RESUMO

AIMS: Internet-based remote interrogation systems have been shown to reduce emergency department and in-office visits in patients with implantable cardioverter defibrillators (ICDs), resulting in increased efficiency for healthcare providers. Nonetheless, studies sized to demonstrate the impact of remote monitoring on patients' outcome have been lacking. METHODS AND RESULTS: The EFFECT study was a multicentre clinical trial aimed at measuring and comparing the outcome of ICD patients conventionally followed-up by means of in-clinic visits (Standard arm) or by remote monitoring (Remote arm) in the clinical practice of 25 Italian centres. From 2011 to 2013, 987 consecutive patients were enrolled and followed up for at least 12 months. The primary endpoint was the rate of death and cardiovascular hospitalizations. Remote monitoring was adopted by 499 patients. Patients in the Standard and Remote arms did not differ significantly in terms of baseline clinical characteristics, except for a more frequent use of ICD with cardiac resynchronization therapy (CRT-D) in the Remote arm (48 vs. 36%, P < 0.001). One-year rates of the primary combined endpoint were 0.27 events/year for patients in the Standard arm and were 0.15 events/year for those in the Remote arm (incident rate ratio, 0.55; 95% CI, 0.41-0.73; P < 0.001). The endpoint rates in the Standard and Remote arms were 0.27 and 0.08 events/year, respectively, among CRT-D recipients (P < 0.001), and 0.28 vs. 0.21 among ICD patients (P = 0.094). The rates of in-office visits were 1.9 per year in the Standard arm and 1.7 per year in the Remote arm. CONCLUSION: Compared with the standard follow-up through in-office visits, remote monitoring is associated with reduced death and cardiovascular hospitalizations in patients with ICD in clinical practice. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/ Identifier: NCT01723865.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Telemedicina/estatística & dados numéricos , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Itália/epidemiologia , Masculino , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
7.
Pacing Clin Electrophysiol ; 37(6): 697-702, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24665920

RESUMO

BACKGROUND: Atrial fibrillation (AF) relapses, following transcatheter AF ablation, are frequently reported based on patients' symptoms, scheduled electrocardiograms (ECGs), or 24-hour Holter recordings. The aim of this study is to determine the incidence of asymptomatic and symptomatic AF recurrences, using continuous subcutaneous ECG monitoring, in the long-term follow-up of patients with paroxysmal or persistent AF undergoing transcatheter ablation. METHODS AND RESULTS: In total 113 consecutive patients symptomatic for paroxysmal or persistent AF were enrolled. All patients underwent pulmonary vein isolation plus left linear lesions. The insertable cardiac monitor (ICM), subcutaneously implanted during the ablation procedure, recorded the amount of AF per day (daily burden) and per last follow-up period (total AF burden). Based on symptoms and on scheduled 12-lead ECG performed during follow-up, 40 patients (35.4%) suffered AF recurrences. By means of ICM data, however, arrhythmia relapses were recorded within 75 patients (66.3%), of whom 35 (46.7%) were asymptomatic. Patients suffering symptomatic AF recurrences resulted, at univariate analysis, older (66.6 ± 8.4 years vs 61.6 ± 10.7 years) and suffering greater AF burden (88.8 ± 26.9% vs 8.0 ± 8.0%). CONCLUSIONS: AF ablation outcome based on patients' symptoms and/or scheduled ECGs underestimated relapses, as up to half of the patients, during a long-term follow-up, suffer asymptomatic recurrences.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/estatística & dados numéricos , Eletrocardiografia Ambulatorial/estatística & dados numéricos , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Avaliação de Sintomas , Falha de Tratamento , Resultado do Tratamento
8.
Interact J Med Res ; 2(2): e27, 2013 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-24055720

RESUMO

BACKGROUND: Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. OBJECTIVE: The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. METHODS: An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. RESULTS: The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7%) centers, 3 per year in 37/206 (18.0%) centers, and 4 per year in 10/206 (4.9%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5%) centers, and by more than one health care worker in 184/206 (89.3%) centers. There were 137/206 (66.5%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15% for single- and dual-chamber ICD and 20% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). CONCLUSIONS: In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits.

9.
Circ Arrhythm Electrophysiol ; 4(6): 844-50, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21946316

RESUMO

BACKGROUND: The role of pacing sites and atrial electrophysiology on the progression of atrial fibrillation (AF) to the permanent form in patients with sinus node dysfunction (SND) has never been investigated. The aim of the study was to investigate the relationship between atrial electrophysiology and the efficacy of atrial pacing at the low interatrial septum (IAS) or at the right atrial appendage (RAA) to prevent persistent/permanent AF in patients with SND. METHODS AND RESULTS: The Electrophysiology-Guided Pacing Site Selection (EPASS) Study was a prospective, controlled, randomized study. Atrial refractoriness, basal and incremental conduction times from the RAA to the coronary sinus ostium were measured before implantation, and the difference (ΔCTos) was calculated. Patients with ΔCTos ≥ 50 ms (study group) and those with ΔCTos <50 ms (control group) were randomly assigned to RAA or IAS with algorithms for continuous atrial stimulation "on." The primary end point was time to development of permanent or persistent AF within a 2-year follow-up in the study group, IAS versus RAA. Data were analyzed by intention to treat. One hundred two patients (77 ± 7 years, 44 mol/L) were enrolled, 69 (68%) in the study group and 33 (32%) in the control group. Of these, 97 ended the study, respectively, randomly assigned: 29 IAS versus 36 RAA and 18 IAS versus 14 RAA. After a mean follow-up of 15 ± 7 (median, 17) months, 11 (16.6%) patients in the study group met the primary end point: 2 IAS versus 9 RAA (log rank=3.93, P=0.047). CONCLUSIONS: In patients with SND and intra-atrial conduction delay, low IAS pacing was superior to RAA pacing in preventing progression to persistent or permanent AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239226.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/prevenção & controle , Septo Interatrial/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Síndrome do Nó Sinusal/terapia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Progressão da Doença , Feminino , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Prospectivos , Período Refratário Eletrofisiológico , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
11.
Congest Heart Fail ; 15(1): 14-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19187402

RESUMO

Large evidence supports the importance of individualized optimization of cardiac resynchronization therapy in patients with congestive heart failure. The aim of this study was to compare a recently developed intracardiac electrogram (IEGM)-based method with the Doppler echocardiographic (ECHO)-based method to calculate optimal atrioventricular (AV) and interventricular (VV) delays. Ten male patients implanted with a St Jude Medical resynchronization device received AV and VV delay assessment with both the IEGM and the ECHO-based methods. Estimates of the optimal AV and VV delays assessed by the 2 tested methods proved highly comparable. No difference emerged between the IEGM (126.8+/-22.7) and the ECHO (127.3+/-19.8) AV delay values (P=.987). The VV delay suggested by ECHO was highly significantly correlated with the delays calculated by the IEGM method (35+/-27.6 vs 21.31+/-24.31; r(2)=0.78; P<.001). These preliminary data support the evidence that an IEGM based cardiac resynchronization optimization method may be as reliable as a complete ECHO assessment.


Assuntos
Algoritmos , Estimulação Cardíaca Artificial , Ecocardiografia Doppler de Pulso , Insuficiência Cardíaca/terapia , Idoso , Eletrocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Volume Sistólico , Função Ventricular Esquerda
12.
Europace ; 11(4): 533-4, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19112072

RESUMO

Persistence of the left superior vena cava (PLSVC), observed in 0.3% of the general population as established by autopsy, is an anatomic variation particularly relevant when occurring in patients in need of a transvenous pacing. In this report, we describe a hybrid right-left cardiac resynchronization therapy defibrillator implantation approach in a patient with PLSVC. In our experience, the described approach proved feasible and safe, and may be considered an option in case of complex vein anatomy before referring for cardiac surgical implantation of a left ventricular lead.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Veia Cava Superior/anormalidades , Adulto , Ecocardiografia , Humanos , Masculino , Flebografia , Resultado do Tratamento
13.
J Cardiovasc Med (Hagerstown) ; 9(9): 953-6, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18695439

RESUMO

INTRODUCTION: The eterotaxic syndromes encompass two main anatomic pictures: left and right atrial isomerism. They cause a distortion of the atria anatomy that may involve the conduction tissue. The prognosis is related to the severity of the intracardiac-associated defects. CASE REPORT: We describe the case of a patient suffering from asymptomatic 'sinus' bradycardia since childhood, who was referred for pacemaker implantation, in which the diagnosis of left atrial isomerism was made. CONCLUSION: The present paper may provide new insights on the clinical course of arrhythmic disorders, in particular among patients with congenital heart disease.


Assuntos
Arritmia Sinusal/etiologia , Bradicardia/etiologia , Átrios do Coração/anormalidades , Coartação Aórtica/complicações , Coartação Aórtica/cirurgia , Valva Aórtica/cirurgia , Arritmia Sinusal/diagnóstico , Arritmia Sinusal/terapia , Bradicardia/diagnóstico , Bradicardia/terapia , Ecocardiografia , Eletrocardiografia , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Prognóstico , Tomografia Computadorizada por Raios X
14.
Pacing Clin Electrophysiol ; 28(5): 366-71, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15869666

RESUMO

OBJECTIVE: Radiofrequency (RF) ablation at the ostia of the pulmonary veins (PVs) to cure atrial fibrillation (AF) is often followed by early AF recurrence. The aims of this study were to determine the rate of early atrial tachyarrhythmia as recurrence after circumferential anatomical PV ablation; to evaluate whether the early recurrence of atrial tachyarrhythmias correlates with the long-term outcome of ablation; and to identify the predictors of early atrial tachyarrhythmias relapse. METHODS: We studied 143 consecutive patients who underwent circumferential anatomical PV ablation. We defined early atrial tachyarrhythmias relapse as the recurrence of atrial tachyarrhythmias during the first 3 months after RF ablation. RESULTS: After a mean follow-up of 18.7 +/- 7.2 months, 102/143 patients (71%) were deemed responders to ablation. Atrial tachyarrhythmias relapsed during the first 3 months of follow-up in 65/143 (46%) patients. Patients without early atrial tachyarrhythmias relapse had a higher probability of long-term clinical success than patients with early atrial tachyarrhythmias relapse (95% vs 43%, P < 0.0001). However, patients who relapsed within the first month had 45.5% probability of long-term clinical success. On multivariate analysis, the presence of structural heart disease and the lack of a successful anatomical ablation of all targeted PV were significantly and independently correlated with early atrial tachyarrhythmias relapse. CONCLUSION: A delayed cure may be expected in almost 50% of patients in whom atrial tachyarrhythmias relapses within the first month after circumferential anatomical PV ablation. The presence of structural heart disease and the lack of a successful anatomical ablation of all targeted PV predict early atrial tachyarrhythmias recurrence.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Taquicardia/etiologia , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares , Recidiva , Resultado do Tratamento
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