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1.
Herzschrittmacherther Elektrophysiol ; 31(1): 84-90, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31758249

RESUMO

The rising number of catheter ablations of atrial fibrillation increases radiation exposure for both patients and surgeons. Fortunately, this trend is counteracted by the development of measures to reduce total fluoroscopy time using non-fluoroscopic catheter visualization. Since even low-dose radiation can cause serious injury, all options to reduce radiation burden must be utilized (ALARA, "as low as reasonably achievable"). Dose reduction protocols with low-dose settings, which include reduced framerates, pulse duration, detector entrance dose and increased beam hardening, play a decisive role in this regard. This review provides a state-of-the-art summary of non-fluoroscopic catheter visualization and dose reduction protocols for catheter ablation of atrial fibrillation.

2.
J Electrocardiol ; 56: 38-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31255952

RESUMO

BACKGROUND: Left atrial low voltage areas (LVA) are associated with increased recurrence rates of atrial fibrillation (AF) after catheter ablation and can be a potential ablation target during the procedure. Therefore, noninvasive prediction of the presence and the distribution of LVA may help physicians to predict ablation outcomes and to guide antiarrhythmic management. MATERIAL AND METHODS: Seventy-three consecutive patients with atrial fibrillation undergoing first time left atrial ablation for paroxysmal or persistent AF were enrolled. P-wave properties (amplitude and duration) were measured in all limb and precordial leads in pre-interventional sinus rhythm surface ECGs and correlated with total LVA size. LVA were detected via high density low voltage maps of the left atrium in sinus rhythm. LVA were then manually encircled, their total size was calculated and given as a percentage of the total LA surface area. RESULTS: A significant, inverse correlation with LVA size was shown for P-wave amplitude for leads I, II, aVR, aVF, V1, V4, V5 and V6. Additionally, a significant positive correlation between LVA size and P-wave duration was shown for leads V1, V2 and V3. As the strongest correlation was shown for the amplitude in lead I (R = -0.578), this lead was used to find a potential cutoff for LVA prediction. The best cut-off for a P-wave amplitude in lead I to predict severe scarring (defined as LVA size >35%, according to UTAH stadium IV) was 0.062 mV with an area-under-the receiver-operating-characteristic curve of 0.935, a sensitivity of 85% and a specificity of 88%. CONCLUSIONS: P-wave duration and amplitude show significant correlations with LVA size and may be used as a noninvasive tool to predict severe scarring. Amplitudes in lead I smaller than 0.062 mV were found to be predictive of LVA >35%.

3.
Cardiol J ; 26(1): 36-46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29399750

RESUMO

BACKGROUND: Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplainedsyncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. METHODS: One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. RESULTS: The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2-350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). CONCLUSIONS: Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation.


Assuntos
Estimulação Cardíaca Artificial/métodos , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Síncope/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Síncope/fisiopatologia , Síncope/terapia , Fatores de Tempo , Adulto Jovem
4.
Clin Res Cardiol ; 108(5): 465-467, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259106

RESUMO

Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/complicações , Hemoptise/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Hemoptise/diagnóstico , Humanos , Pneumopericárdio/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X
5.
Am J Case Rep ; 19: 1078-1082, 2018 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-30201947

RESUMO

BACKGROUND Following catheter ablation of atrial fibrillation, increased incidence of ventricular arrhythmia has been observed. We report a case of sustained ventricular arrhythmia in a patient who underwent cryoballoon-based pulmonary vein isolation for symptomatic persistent atrial fibrillation. CASE REPORT A 57-year-old patient with dilated cardiomyopathy underwent CB-based pulmonary vein isolation for symptomatic persistent AF. On the day following an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into VT storm. Each arrhythmia was terminated by the ICD that had been implanted for primary prevention. Antiarrhythmic treatment with amiodarone was initiated immediately. The patient remained free from sustained ventricular arrhythmia during follow-up. CONCLUSIONS After pulmonary vein isolation, physicians should be vigilant for ventricular arrhythmia. The influence of atrial autonomic innervation on ventricular electrophysiology is largely unknown.


Assuntos
Fibrilação Atrial/terapia , Criocirurgia/efeitos adversos , Veias Pulmonares/cirurgia , Taquicardia Ventricular/tratamento farmacológico , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Desfibriladores Implantáveis , Humanos , Pessoa de Meia-Idade , Recidiva , Taquicardia Ventricular/etiologia
6.
Circulation ; 137(25): 2730-2740, 2018 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-29915100

RESUMO

BACKGROUND: Postmortem interrogations of cardiac implantable electronic devices (CIEDs), recommended at autopsy in suspected cases of sudden cardiac death, are rarely performed, and data on systematic postmortem CIED analysis in the forensic pathology are missing. The aim of the study was to determine whether nonselective postmortem CIED interrogations and data analysis are useful to the forensic pathologist to determine the cause, mechanism, and time of death and to detect potential CIED-related safety issues. METHODS: From February 2012 to April 2017, all autopsy subjects in the department of forensic medicine at the University Hospital Charité who had a CIED underwent device removal and interrogation. Over the study period, 5368 autopsies were performed. One hundred fifty subjects had in total 151 CIEDs, including 109 pacemakers, 35 defibrillators, and 7 implantable loop recorders. RESULTS: In 40 cases (26.7%) time of death and in 51 cases (34.0%) cause of death could not be determined by forensic autopsy. Of these, CIED interrogation facilitated the determination of time of death in 70.0% of the cases and clarified the cause of death in 60.8%. Device concerns were identified in 9 cases (6.0%), including 3 hardware, 4 programming, and 2 algorithm issues. One CIED was submitted to the manufacturer for a detailed technical analysis. CONCLUSIONS: Our data demonstrate the necessity of systematic postmortem CIED interrogation in forensic medicine to determine the cause and timing of death more accurately. In addition, CIED analysis is an important tool to detect potential CIED-related safety issues.


Assuntos
Autopsia/métodos , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis , Remoção de Dispositivo , Medicina Legal/métodos , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo
8.
Int J Cardiovasc Imaging ; 34(10): 1581-1587, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29799062

RESUMO

The present research evaluated right ventricular (RV) structure, function and mechanics in the cancer patients before initiation of chemo- or radiotherapy, and the association between cancer and decreased RV longitudinal strain. This retrospective investigation included 101 chemo- and radiotherapy-naïve patients with solid cancer and 38 age- and gender-matched controls with similar cardiovascular risk profile. Echocardiographic examination and strain evaluation was performed in all participants. RV structure and RV systolic and diastolic function estimated with conventional echocardiographic parameters were similar between the cancer patients and controls. However, RV global longitudinal strain (- 22.7 ± 2.6% vs. - 21.1 ± 2.4%, p < 0.001) was significantly decreased in the cancer patients than in controls. The same was revealed for RV free wall endocardial (- 33.6 ± 4.3% vs. - 31.4 ± 4.0%, p = 0.006) and mid-myocardial (- 25.2 ± 3.6% vs. - 23.7 ± 3.8%, p = 0.035) longitudinal RV strains, whereas difference was not found in RV free wall epicardial longitudinal strain. The presence of cancer was independently of age, gender, body mass index, left ventricular hypertrophy, diabetes, hypertension and pulmonary pressure associated with reduced RV global longitudinal strain (OR 3.79; 95% CI 2.18-10.92, p < 0.001), as well as with decreased free wall RV longitudinal strain (OR 5.73; 95% CI 3.17-9.85, p < 0.001). RV strain is deteriorated in the chemo- and radiotherapy-naïve cancer patients. Endocardial and mid-myocardial layers are more affected than epicardial strain in the cancer patients. The presence of cancer is independently of other clinical parameters associated with reduced RV longitudinal strain.


Assuntos
Neoplasias/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita/fisiologia , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Estudos Retrospectivos , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico por imagem
9.
Can J Cardiol ; 34(3): 281-287, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29395702

RESUMO

BACKGROUND: We sought to investigate left ventricular (LV) function and mechanics in patients with cancer before they received chemotherapy or radiotherapy, as well as the relationship between cancer and reduced LV multidirectional strain in the whole study population. METHODS: The retrospective study involved 122 chemotherapy- and radiotherapy-naive patients with cancer and 45 age- and sex-matched controls with a cardiovascular risk profile similar to that of the patients with cancer. All the patients underwent echocardiographic examination before introduction of chemotherapy or radiotherapy. RESULTS: LV longitudinal (-19.1% ± 2.1% vs -17.8% ± 3.5%; P = 0.022), circumferential (-22.9% ± 3.5% vs -20.1% ± 4.1%; P < 0.001), and radial (40.5% ± 8.8% vs 35.2% ± 10.7%; P = 0.004) strain was significantly lower in the patients with cancer than in the control group. Endocardial and midmyocardial longitudinal LV strain was significantly reduced in the patients with cancer compared with the controls, whereas epicardial longitudinal strain was similar between these groups. Endocardial, midmyocardial, and epicardial circumferential strain was significantly lower in the chemotherapy- or radiotherapy-naive patients with cancer than in the controls. Cancer was associated with reduced longitudinal (odds ratio [OR], 9.0; 95% confidence interval [CI], 2.20-23.50; P < 0.001), reduced circumferential (OR, 7.1; 95% CI, 3.80-20.40; P < 0.001), and reduced radial strain (OR, 7.2; 95% CI, 3.41-25.10; P < 0.001) independent of age, sex, body mass index, diabetes, and hypertension. CONCLUSIONS: LV mechanics was impaired in the patients with cancer compared with the controls even before initiation of chemotherapy and radiotherapy. Cancer and hypertension were associated with reduced LV multidirectional strain independent of other clinical parameters. The present results indicate that cancer itself potentially induces cardiac remodelling independent of chemotherapy and radiotherapy.


Assuntos
Ecocardiografia/métodos , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Adulto , Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/fisiopatologia , Estudos de Casos e Controles , Quimioterapia Adjuvante , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/mortalidade , Neoplasias/patologia , Variações Dependentes do Observador , Prognóstico , Radioterapia Adjuvante , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Disfunção Ventricular Esquerda/mortalidade , Função Ventricular Esquerda/efeitos dos fármacos , Função Ventricular Esquerda/efeitos da radiação
10.
J Electrocardiol ; 51(2): 170-174, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29174097

RESUMO

BACKGROUND: Propofol is commonly used for procedural sedation in interventional electrophysiology. However, ventricular arrhythmias under Propofol have been reported. Our aim was to investigate ventricular repolarization and incidence of ventricular arrhythmias under Propofol infusion in adults with cardiac arrhythmias. METHODS: QRS, QTcB (Bazett), QTcFri (Fridericia), JTc, measurement of T peak to Tend time (Tp-e) at baseline and under Propofol infusion was performed in 235 patients. Screening for unexpected ventricular arrhythmias was performed in 1165 patients undergoing EP procedures under Propofol. RESULTS: A significant prolongation of Tp-e under Propofol infusion (79.7±17.3 vs. 86.4±22.5ms, p<0.001) and of QTcFri (429.3±35.8 vs. 435.5±36.5, p=0.033) was detected. No significant change of the QTcB interval, JTc interval or QRS duration was observed. One case (0.09%) of ventricular fibrillation during rapid ventricular pacing under Propofol occurred. CONCLUSION: Although transmural dispersion of ventricular repolarisation is increased under Propofol, incidence of malignant ventricular arrhythmias is low. For evaluation of QT interval under Propofol, Fridericia's correction formula should be used rather than Bazett's formula.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/diagnóstico , Hipnóticos e Sedativos/efeitos adversos , Propofol/efeitos adversos , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Europace ; 20(4): 604-607, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28339980

RESUMO

Aims: Despite the use of 3D mapping systems and new developments of non-fluoroscopic options, most centres still rely at least in part on fluoroscopy for catheter visualization during catheter ablations. The purpose of this study was to assess the feasibility of using an ultra-low frame rate and antiscatter grid-less radiation protocol during complex left atrial ablations to minimize radiation exposure for the patient and staff. Methods and results: A total of 150 consecutive patients undergoing left atrial ablations in our hospital were included in the analysis. The procedures were performed between January 2015 and November 2016. Of the included patients 75 (50%) underwent ablation before and 75 (50%) after the ultra-low frame rate (reduced from 4 to 2 FPS) and antiscatter grid-less radiation protocol was established. Procedures performed after the dose reduction protocol was established showed a 64% reduction of the dose area product (630.28 ± 550.96 vs. 226.44 ± 277.44 µGym2, P < 0.001), while fluoroscopy duration (14.22 ± 4.47 vs. 13.62 ± 7.11 min, P = 0.066) and procedural duration (1:48 ± 0:28 vs. 1:53 ± 0:34 min, P = 0.525) were not prolonged. Acute procedural success was achieved in all procedures. Two complications occurred before and one complication after the protocol was established. During four procedures, operators decided to re-introduce the antiscatter grid. This was due to impaired visibility in morbidly obese patients (n = 2) or technically difficult transseptal puncture (n = 2). Conclusion: The use of an ultra low framerate and antiscatter grid-less radiation protocol effectively reduced radiation dose for complex left atrial ablation procedures and lead to very low average patient doses. Reduced image quality did not impair procedural and fluoroscopy duration or acute procedural success.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Átrios do Coração/cirurgia , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Exposição à Radiação/prevenção & controle , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Intervencionista/métodos , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Estudos de Viabilidade , Feminino , Fluoroscopia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Duração da Cirurgia , Segurança do Paciente , Exposição à Radiação/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Espalhamento de Radiação , Fatores de Tempo , Resultado do Tratamento
12.
Acta Cardiol ; : 1-6, 2017 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-29272990

RESUMO

BACKGROUND: Left atrial scarring is recognised as a critical component in the maintenance of atrial fibrillation and is associated with the failure of interventional treatment. Diminished bipolar voltage (LV) has been proposed as a useful tool for left atrial scar quantification. We hypothesised that, due to its anatomic location, signals on the coronary sinus catheter might be used to predict the amount of left atrial low voltage. METHODS AND RESULTS: A total of 124 patients (42% women, average age 66 ± 9 years) were included. Forty-one with paroxysmal and 83 with persistent atrial fibrillation. Left atrial low-voltage (<0.5 mV, measured during sinus rhythm) area size and distribution varied considerably among the included patients (mean: 34.9%; maximum: 94.6%; minimum: 0.4%). Spearman correlation revealed a strong negative correlation between bipolar voltage of the signals on the coronary sinus catheter and the amount of left atrial scarring (R = -0.778, p < .0001). The optimal CS voltage cut off for prediction of left atrial low-voltage size of ≥50% was 1.9 mV with an area-under-the receiver-operating-characteristic (ROC) curve of 0.982, a sensitivity of 97% and a specificity of 98%. CONCLUSIONS: There is a strong negative correlation between the size of left atrial low-voltage areas (LVA) and coronary sinus signal amplitude. With increasing left atrial LVA size, CS signal amplitudes decrease, and vice versa. On the basis of these findings, average CS signal amplitudes of ≤1.9 mV can be used as a predictor for a left atrial low-voltage size of ≥50%.

13.
Pacing Clin Electrophysiol ; 40(12): 1380-1383, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29090490

RESUMO

BACKGROUND AND AIMS: Antiscatter grids improve image contrast by absorbing scattered x-ray beams, although by removing the antiscatter grid patient dose can be reduced as more x-ray beams reach the image receptor. Additionally, there is a trend toward ultra-low frame rates for radiation dose reduction during various electrophysiology procedures. As for most cardiac device implantations (CIED) image quality demands are usually modest, the purpose of this study was to assess the safety and efficacy of an ultra-low frame rate and scatter grid-less radiation protocol. METHODS/RESULTS: A total of 140 patients undergoing CIED implantation between 2014 and 2017 were included in the study. Seventy patients (50%) implanted after implementation of the antiscatter grid-less and ultra-low frame rate protocol were matched to controls before the dose-reduction protocol was established. Forty patients (28.6%) had a one-chamber pacemaker or one-chamber implantable cardioverter defibrillator (ICD) implantation/revision, 60 (42.9%) had a two-chamber pacemaker or two-chamber ICD implantation/revision, and 40 (28.6%) patients had a cardiac resynchronization therapy device implantation/revision. Removing the antiscatter-grid and lowering the frame rate led to a 73% reduction of the overall dose area product (1,206 ± 2,015 vs 324 ± 422 µGym, P < 0.001). Procedural duration (95 ± 51 minutes vs 82 ± 44 minutes, P  =  0.053) and rate of complications were not significantly different between the two groups. CONCLUSION: The use of an ultra-low frame rate and antiscatter grid-less radiation protocol significantly reduced radiation dose for implantation of CIED and led to very low average patient doses, while procedural duration and complication rates did not increase.


Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Implantação de Prótese/métodos , Doses de Radiação , Idoso , Protocolos Clínicos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Espalhamento de Radiação , Cirurgia Assistida por Computador
14.
Scand J Trauma Resusc Emerg Med ; 25(1): 68, 2017 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-28693536

RESUMO

BACKGROUND: The effects of target temperature management (TTM) on the heart aren't thoroughly studied yet. Several studies showed the prolongation of various ECG parameters including Tpeak-Tend-time under TTM. Our study's goal is to evaluate the acute and long-term outcome of these prolongations. METHODS: In this study we included patients with successful resuscitation after cardiac arrest who were admitted to the Charité Virchow Klinikum Berlin or the Heart and Vascular Centre of the Ruhr University Bochum between February 2006 and July 2013 (Berlin) or May 2014 to November 2015 (Bochum). For analysis, one ECG during TTM was recorded after reaching the target temperature (33-34 °C) or in the first 6 h of TTM. If possible, another ECG was taken after TTM. The patients were being followed until February 2016. Primary endpoint was ventricular arrhythmia during TTM, secondary endpoints were death and hospitalization due to cardiovascular diseases during follow-up. RESULTS: One hundred fifty-eight patients were successfully resuscitated in the study period of which 95 patients had usable data (e.g. ECGs without artifacts). During TTM significant changes for different parameters of ventricular de- and repolarization were noted: QRS (103.2 ± 23.7 vs. 95.3 ± 18.1; p = 0.003),QT (405.8 ± 76.4 vs. 373.8 ± 75.0; p = 0.01), QTc (474.9 ± 59.7 vs. 431.0 ± 56.8; p < 0.001), JT (302.8 ± 69.4 vs. 278.5 ± 75.2; p = 0.043), JTc (354.3 ± 60.2 vs. 318.7 ± 59.1; p = 0.001). 13.7% of the patients had ventricular arrhythmias during TTM, however these patients showed no difference regarding their ECG parameters in comparison to those were no ventricular arrhythmias occurred. We were able to follow 69 Patients over an average period of 35 ± 31 months. The 14 (21.5%) patients who died during the follow-up had significant prolongations of the TpTe-time in the ECGs without TTM (103.9 ± 47.2 vs. 75.8 ± 28.6; p = 0.023). CONCLUSION: Our results show a significant prolongation of ventricular repolarization during TH. However, there was no significant difference between the ECG parameters of those who developed a ventricular arrhythmia and those who did not. The temporary prolongation of the repolarization during TTM seems to be less important for the prognosis of the patient. Whereas the prolongation of the repolarization in the basal ECG is associated with a higher mortality in our study.


Assuntos
Arritmias Cardíacas/epidemiologia , Parada Cardíaca/terapia , Hipotermia Induzida , Adulto , Idoso , Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Feminino , Parada Cardíaca/mortalidade , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
15.
Minerva Cardioangiol ; 65(6): 545-552, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28565887

RESUMO

BACKGROUND: Percutaneous left atrial appendage closure (LAAC) and the role of postinterventional anticoagulation often evokes controversy in daily practice. This study aimed to evaluate LAAC in patients with non-rheumatic atrial fibrillation, high thromboembolic risk and contraindications for long-term anticoagulation in a clinical scenario. METHODS: Between 2010-2015, LAAC was attempted in 118 patients (47 women). RESULTS: Devices were successfully implanted in 95% (Watchman™ device: N.=97; Amplatzer™ Cardiac Plug/Amulet: N.=14; Amplatzer PFO Occluder: N.=1). Mean age was 75±8.35 years. Mean HAS-BLED and CHA2DS2VASc scores were 4.3 and 4.9, respectively. Median follow-up was 447 days (IQR: 183-789 days). The primary safety endpoint was defined as major bleeding according to the International Society on Thrombosis and Hemostasis. The combined efficacy endpoint included ischemic strokes, transitory ischemic attacks (TIA) and systemic embolisms. Procedural complication rate was 3.4%. After successful intervention, either a therapy with anticoagulants (N.=62) or dual antiplatelet therapy (DAPT, N.=50) was prescribed temporarily. Medication was reduced if implantation proved satisfying in a 6-week follow-up transesophageal echocardiography, which was the case in 79% of these patients. During follow-up, one patient suffered a TIA (0.6%/year). No other efficacy event was observed. Eleven major bleedings occurred (6.6%/year): one each under DAPT plus phenprocoumon, DAPT plus rivaroxaban, acetylsalicylic acid (ASA) plus rivaroxaban, two under DAPT, two under ASA plus low molecular weight heparin, and four under ASA only. CONCLUSIONS: In the present study, catheter-based LAA occlusion prevented thromboembolisms with high efficacy. Major bleedings were however common in patients with, but also without anticoagulation, independent from time course.


Assuntos
Anticoagulantes/administração & dosagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/terapia , Cateterismo Cardíaco/métodos , Tromboembolia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Contraindicações , Quimioterapia Combinada , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/etiologia , Resultado do Tratamento
16.
Clin Case Rep ; 5(5): 671-674, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28469873

RESUMO

A patient developed a transient first-degree AV block during a radiofrequency ablation of an atrioventricular nodal reentrant tachycardia. Three days later the patient presented with a third-degree AV block. It resolved within 24 h under antiphlogistic therapy. Patient was asymptomatic without necessity for pacemaker implantation at 12 months follow-up.

17.
Pacing Clin Electrophysiol ; 40(7): 788-793, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28548234

RESUMO

BACKGROUND: A considerable amount of patients with typical atrial flutter develop atrial fibrillation after cavotricuspid isthmus (CTI) ablation. No uniform recommendations are available to guide anticoagulation regimes or electrocardiogram (ECG) monitoring strategies after this procedure. METHODS: We conducted a web-based survey in electrophysiology (EP) centers in Germany, Switzerland, and Austria. Responses were received from 47 centers. The survey was designed to investigate variations in management of the following: ablation strategy, oral anticoagulation (OAC) management, and ECG monitoring after successful CTI ablation. RESULTS: More than 55% of the participating centers assume that at least every third patient will develop atrial fibrillation during follow-up. Despite this assumption, most EP experts (81%) would still stop OAC after CTI ablation even in patients with higher CHADS2-VA2SC-score, or even perform CTI in asymptomatic patients with the purpose to stop OAC (52%). Most experts agree that ECG monitoring is necessary during follow-up. A majority still rely on short-term monitoring tools like resting ECGs (7%) or Holter ECGs (43%), while continuous monitoring by implantable loop recorders (10%) are rarely used for postablation OAC management. CONCLUSION: A majority of the centers stop OAC in patients with higher CHADS2-VA2SC-score after CTI ablation. There is evidence that this practice might not be safe and lead to an increased number of ischemic strokes during follow-up. This reflects the need for prospective studies to allow for clear guidelines regarding these issues.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/etiologia , Flutter Atrial/fisiopatologia , Flutter Atrial/cirurgia , Ablação por Cateter/métodos , Eletrocardiografia , Padrões de Prática Médica/estatística & dados numéricos , Administração Oral , Áustria , Feminino , Alemanha , Humanos , Masculino , Veias Pulmonares/cirurgia , Inquéritos e Questionários , Suíça
18.
Clin Cardiol ; 40(4): 230-234, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28333397

RESUMO

BACKGROUND: Obesity is associated with increased complications and potentially worse outcomes for various cardiac interventions. This study analyzed the success rate and complication rates associated with implantation of cardiac implantable electronic devices (CIEDs) in obese patients. HYPOTHESIS: Success rates are lower and complication rates higher in obese patients. METHODS: Consecutive patients undergoing CIED implantation between 2011 and 2015 in our hospital were included. Patients were categorized into obese and nonobese groups according to body mass index (BMI); cutoff was 30 kg/m2 . Patient characteristics, complication rates, procedural duration, and fluoroscopy data were compared between the 2 groups. RESULTS: A total of 965 patients (mean age, 69.0 ± 12.9 years; 67% male) were included. Of these, 249 (25.8%) patients were classified obese and 716 (74.2%) nonobese. Mean BMI was 34.7 ± 4.7 kg/m2 vs 25.1 ± 3.0 kg/m2 , respectively. There was no difference in procedural success rates between the 2 groups (97.2% vs 97.1%, respectively). Major complications were significantly lower in the obese group compared with the nonobese group (11 [4.4%] vs 62 [8.7%]; P < 0.05). Procedural duration and fluoroscopy duration were not different between the 2 groups, but the total dose-area product was significantly higher in obese patients vs nonobese patients (4012 ± 5416 cGcm2 vs 2692 ± 5277 cGcm2 ; P < 0.005). CONCLUSIONS: CIED implantation can be safely and effectively achieved in patients with BMI >30 kg/m2 . However, total radiation dose was significantly higher in the obese group, emphasizing that efforts should be made to reduce radiation exposure in these patients.


Assuntos
Insuficiência Cardíaca/prevenção & controle , Obesidade/epidemiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Índice de Massa Corporal , Comorbidade , Desfibriladores Implantáveis , Feminino , Seguimentos , Alemanha/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Marca-Passo Artificial , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
19.
Pacing Clin Electrophysiol ; 40(5): 585-590, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28240366

RESUMO

BACKGROUND: Patients' satisfaction with invasive procedures largely relies on periprocedural perception of pain and discomfort. The necessity for intraprocedural sedation during catheter ablation of cardiac arrhythmias for technical reasons is widely accepted, but data on patients' experience of pain and satisfaction with the procedural sedation are scarce. We have assessed patients' pain and discomfort during and after the procedure using a standardized questionnaire. METHODS: One hundred seventeen patients who underwent catheter ablation answered a standardized questionnaire on periprocedural perception of pain and discomfort after different anesthetic protocols with propofol/midazolam with and without additional piritramide and ketamine/midazolam. RESULTS: Patients report a high level of satisfaction with periprocedural sedation with 83% judging sedation as good or very good. The majority of patients was unconscious of the whole procedure and did not recollect experiencing pain. Procedural pain was reported by 7.7% of the patients and 16% reported adverse effects, e.g., postprocedural nausea and episodes of headache. CONCLUSION: The results of our study show that deep sedation during catheter ablation of cardiac arrhythmias is generally well tolerated and patients are satisfied with the procedure. Yet, a number of patients reports pain or adverse events. Therefore, studies comparing different sedation strategies should be conducted in order to optimize sedation and analgesia.


Assuntos
Arritmias Cardíacas/psicologia , Arritmias Cardíacas/cirurgia , Catastrofização/psicologia , Ablação por Cateter/psicologia , Sedação Profunda/psicologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/psicologia , Catastrofização/etiologia , Catastrofização/prevenção & controle , Ablação por Cateter/efeitos adversos , Sedação Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Resultado do Tratamento
20.
Herzschrittmacherther Elektrophysiol ; 28(1): 67-69, 2017 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-28185078

RESUMO

If a transfemoral approach for catheter ablation procedures of paroxysmal supraventricular tachycardias is impossible, other access sites have to be considered. We present the case of a 78-year-old woman with an inferior vena cava (IVC) filter with symptomatic episodes of an atrioventricular nodal reentrant tachycardia (AVNRT). We used a combined cubital and axillary vein approach. The tachycardia was successfully ablated within the timeframe needed for conventional ablation.


Assuntos
Veia Axilar/cirurgia , Cateterismo Cardíaco/métodos , Ablação por Cateter/métodos , Cateterismo Periférico/métodos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico por imagem , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Idoso , Veia Axilar/diagnóstico por imagem , Feminino , Humanos , Resultado do Tratamento
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