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1.
Artigo em Inglês | MEDLINE | ID: mdl-32359082

RESUMO

In patients with persistent left superior vena cava (PLSVC), transvenous device implantation for cardiac resynchronization therapy (CRT) may be challenging. We present a complex case with successful, high-density electroanatomic mapping (EAM) guided corrective His bundle pacing (CHBP) following failed CRT upgrade in a patient with PLSVC, congenital heart disease and pacing-associated heart failure. CHBP restored physiological conduction in left bundle branch block with complete conduction block leading to clinical improvement and cardiac remodeling. The presented case supports the growing evidence that EAM guided CHBP may be considered a feasible alternative to conventional CRT when venous anatomy is not favorable for left ventricular lead implantation. This article is protected by copyright. All rights reserved.

2.
Pharmacol Res ; 144: 257-263, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31026503

RESUMO

Quinidine has a very long history as antiarrhythmic medication. The alkaloid has been used in the treatment of almost all cardiac arrhythmias, especially atrial fibrillation, since the early twentieth century. Despite decreases in clinical prescription over the last two decades, mainly due to side effects like pro-arrhythmia, leading to increased mortality and to the availability of newer anti-arrhythmic drugs and catheter ablation, Quinidine remains an invaluable drug in the modern era of antiarrhythmic therapy. We present a review of the pharmacological properties of quinidine and its pivotal therapeutic role in the treatment of life-threatening arrhythmic storms in patients with congenital arrhythmogenic syndromes like Brugada's syndrome, early repolarization syndrome, short QT syndrome and idiopathic ventricular fibrillation.

3.
Artigo em Inglês | MEDLINE | ID: mdl-29897627

RESUMO

BACKGROUND: Currently, several geographies around the world remain underrepresented in medical device trials. The PANORAMA 2 study was designed to assess contemporary region-specific differences in clinical practice patterns of patients with cardiac implantable electronic devices (CIEDs). METHODS: In this prospective, multicenter, observational, multinational study, baseline and implant data of 4,706 patients receiving Medtronic CIEDs (Medtronic plc, Minneapolis, MN, USA; either de novo device implants, replacements, or upgrades) were analyzed, consisting of: 54% implantable pulse generators (IPGs), 20.3% implantable cardiac defibrillators (ICDs), 15% cardiac resynchronization therapy -defibrillators, and 5.1% cardiac resynchronization therapy -pacemakers, from 117 hospitals in 23 countries across four geographical regions between 2012 and 2016. RESULTS: For all device types, in all regions, there were fewer females than males enrolled, and women were less likely to have ischemic cardiomyopathy. Implant procedure duration differed significantly across the geographies for all device types. Subjects from emerging countries, women, and older patients were less likely to receive a magnetic resonance imaging-compatible device. Defibrillation testing differed significantly between the regions. European patients had the highest rates of atrial fibrillation (AF), and the lowest number of implanted single-chamber IPGs. Evaluation of stroke history suggested that the general embolic risk is more strongly associated with stroke than AF. CONCLUSIONS: We provide comprehensive descriptive data on patients receiving Medtronic CIEDs from several geographies, some of which are understudied in randomized controlled trials. We found significant variations in patient characteristics. Several medical decisions appear to be affected by socioeconomic factors. Long-term follow-up data will help evaluate if these variations require adjustments to outcome expectations.

4.
Europace ; 20(suppl_2): ii48-ii55, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29722860

RESUMO

Aims: Oesophagogastroduodenoscopy (OGD) after catheter ablation (CA) of atrial fibrillation (AF) revealed a high rate of procedure related oesophageal lesions. We hypothesized that magnetically guided CA with careful radiofrequency energy titration at the posterior left atrial (LA) wall limits the incidence of oesophageal tissue damage. Methods and results: As a part of the prospective "Remote MAGNetic catheter Ablation for Atrial Fibrillation" (MAGNA-AF) registry, 251 out of 266 consecutive patients underwent OGD after magnetically guided single-CA for AF. All detected pathologies were analysed. Simultaneous pacing and ablation from the tip of the magnetically guided catheter was found to be a safe and feasible method for energy titration. Post-interventional OGD documented midoesophageal tissue damage in four (1.6%) patients. Although a thermal origin of these injuries must be discussed, none of them was located at the anterior oesophageal wall. Risk factors for midoesophageal lesions were female gender and concomitant acetylsalicylic acid (ASA) treatment. Mechanical lesions in 16 patients were attributed to periprocedural transoesophageal echocardiography (TOE). There was no atrio-oesophageal fistula (AOF). Five hundred and one incidental pathologies were found endoscopically, most frequent axial oesophageal herniation (71%), oesophagitis (22%), and gastritis (57%). Conclusion: Magnetically guided CA for AF with careful energy titration at the posterior LA wall and no oesophageal temperature monitoring is not associated with an increased incidence of oesophageal thermal injury. The routine use of periprocedural TOE may cause a low rate of mechanical oesophageal lesions but reliably prevents major complications like transient ischaemic attack, stroke, or cardiac tamponade. An observed high prevalence of upper digestive system inflammation (63%) may further support the recommendation for a routine post-interventional treatment with a proton-pump-inhibitor.


Assuntos
Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Esôfago/lesões , Magnetismo , Tecnologia de Sensoriamento Remoto/efeitos adversos , Cirurgia Assistida por Computador/efeitos adversos , Ferimentos e Lesões/epidemiologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/métodos , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas , Endoscopia Gastrointestinal , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Magnetismo/métodos , Masculino , Prevalência , Recidiva , Sistema de Registros , Tecnologia de Sensoriamento Remoto/métodos , Fatores de Risco , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico
6.
J Neurol Surg A Cent Eur Neurosurg ; 77(1): 73-6, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25915491

RESUMO

We present a case of successful interventional laser-assisted extraction of an endovascularly trapped long-term implanted ventriculoatrial shunt in a patient with shunt-associated septicemia. This approach is based on modified techniques for explantation of pacemaker leads and might be considered an additional option for extraction of otherwise nonremovable trapped endovascular catheters in experienced centers.


Assuntos
Infecções Relacionadas a Cateter/cirurgia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Remoção de Dispositivo/métodos , Terapia a Laser/métodos , Adulto , Antibacterianos/uso terapêutico , Feminino , Átrios do Coração/cirurgia , Humanos , Veias Jugulares/cirurgia , Marca-Passo Artificial , Sepse/etiologia , Resultado do Tratamento , Veia Cava Superior/cirurgia
7.
Herzschrittmacherther Elektrophysiol ; 24(2): 131-5, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23784201

RESUMO

Apart from monitoring shock efficacy, proof of flawless detection of induced ventricular fibrillation (VF) is a decisive argument in favor of implantable cardioverter defibrillator (ICD) testing. On the other hand, it has been observed that undersensing of VF is extremely rare with good sensing of the intrinsic R wave of ≥ 5-7 mV. The case presented here shows limitations in both argumentations: Neither optimal R wave sensing during sinus rhythm nor repeated ICD testing could rule out or predict multiple erroneous detections of clinical VF episodes. This must be taken into consideration in the current discussion on the necessity of defibrillation testing. Further optimization of sensing technology should be a focus in the development of modern ICD systems so as to improve the safety and efficacy of ICD therapy.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Terapia Assistida por Computador/métodos , Falha de Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/prevenção & controle , Criança , Reações Falso-Negativas , Humanos , Masculino
8.
Herzschrittmacherther Elektrophysiol ; 24(2): 125-30, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23744101

RESUMO

AIM: The need for implantable cardioverter-defibrillator (ICD) defibrillation testing (DT) and subsequent intraoperative system modifications is discussed controversially. The study's goal was to prove that consequent abdication of intraoperative DT does not impair defibrillation efficacy and does not increase the rate of postoperative system revisions. METHODS: In a prospective single-center observational study, 609 out of 648 consecutive patients underwent transvenous ICD implantation (left-sided, active can, dual coil lead, and biphasic shock waveform) waiving intraoperative DT. Defibrillation efficacy was validated prior to hospital discharge (PHD) by applying two 10 J safety margin (SM) shocks. RESULTS: Following "schockless" implantation 580 out of 609 patients (95.2 %) met a 10 J SM with default programming. Shock path reversal provided 10 J SM in 13 out of 29 cases with initially failed DT. In four patients (0.7 %) maximum energy shocks were ineffective. There was no morbidity or mortality related to DT. The total rate of surgical ICD revisions was 1.8 %. CONCLUSION: Routine ICD implantation without intraoperative DT does not lead to an increased rate of postoperative system modifications and does not decrease defibrillation efficacy as tested PHD.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Cardioversão Elétrica/mortalidade , Traumatismos por Eletricidade/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/prevenção & controle , Monitorização Intraoperatória/mortalidade , Idoso , Comorbidade , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
9.
Europace ; 13(7): 976-83, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21422022

RESUMO

AIMS: Follow-up of the ever-increasing numbers of patients with implantable cardiac devices places a heavy burden on clinical departments. Device automaticity may alleviate the follow-up burden by minimizing the time for physician involvement. The aim of the prospective, multicentre AUTOMATICITY registry was to examine the performance of a subset of programmed automatic algorithms during patient follow-up and their acceptance by implanting physicians. METHODS AND RESULTS: The clinical use of automatic algorithms from the Insignia pacemakers (PM; Boston Scientific, St Paul, MN, USA) was evaluated: atrial and ventricular AutoSense (sensitivity adjustment), ventricular Automatic Capture (threshold verification and output setting), AutoLifeStyle (sensor settings adjustment). The objective of the study was to assess the reprogramming rates within 12 months of implant, the reasons for reprogramming and relationship to adverse events. A total of 960 patients were enrolled in the study. The proportion of patients free from any algorithm reprogramming at 12 months was 86.1%. A total of 2736 algorithms were activated at enrolment, with 156 (5.7%) being reprogrammed in 115 patients at 12 months for any reason. Forty-nine reprogrammings (1.8%) were unintentional or related to changes in device settings such that the algorithm was no longer available, 33 (1.2%) were due to suspected sensing issues, and 22 (0.8%) were assumed related to the algorithm. The individual 12-month reprogramming-free rates were: ventricular AutoSense 94.3%, Atrial AutoSense 93.3%, AutoLifeStyle 93.9%, and Automatic Capture 95.9%. CONCLUSION: The results of the AUTOMATICITY registry show that automatic measurement of key settings and automatic adjustment to optimal programming is feasible and safe. The simplicity of PM follow-up and avoidance of frequent reprogramming may contribute to a more effective use of hospital time and resources.


Assuntos
Algoritmos , Arritmias Cardíacas/terapia , Marca-Passo Artificial , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/fisiopatologia , China , Europa (Continente) , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
10.
Pacing Clin Electrophysiol ; 34(1): e9-10, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20345621

RESUMO

A 9-year-old girl presented with systemic infection related to a Port-a-Cath system (PAC); therefore, the urgent removal of the PAC was indicated. However, the catheter was trapped and not extractable by conventional means. Using existing comprehensive experience in the removal of pacemaker and implantable cardioverter defibrillator leads, the entrapped PAC was successfully extracted by laser technique, thus avoiding open heart surgery.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/métodos , Terapia a Laser , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Criança , Desfibriladores Implantáveis , Eletrodos Implantados , Feminino , Humanos , Marca-Passo Artificial , Resultado do Tratamento
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