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1.
Arq Bras Cardiol ; 2020 Mar 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32236324

RESUMO

BACKGROUND: Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. OBJECTIVES: To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. METHODS: Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation. RESULTS: Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation. CONCLUSIONS: Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

2.
JACC Clin Electrophysiol ; 6(1): 1-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31971898

RESUMO

Since their introduction >2 decades ago, percutaneous catheter-based epicardial mapping and ablation have become widely adopted by cardiac electrophysiologists around the world. Although epicardial mapping has been used for catheter ablation of a wide variety of cardiac arrhythmias, its most common use is for ablation of intramural and subepicardial substrates that give rise to ventricular tachycardia, particularly in patients with nonischemic cardiomyopathy. As such, the subxiphoid percutaneous epicardial approach has emerged as an important adjunct, and, in some cases, is the preferred strategy in this regard. This review discusses the rationale and indications for epicardial catheter mapping and/or ablation. This paper also reviews the prevalence of epicardial arrhythmias and their electrocardiographic criteria. In addition, it examines the anatomy of the pericardium and commonly used epicardial access techniques, as well as the optimal methodologies for epicardial mapping and ablation and the impact of epicardial fat. Finally, this review discusses the potential of the various complications associated with the percutaneous epicardial approach, in addition to patient-specific risk factors, and potential strategies to mitigate the risk of complications.

3.
Europace ; 22(3): 450-495, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31995197

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31984466

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31960344

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

6.
J Cardiovasc Electrophysiol ; 31(1): 345-359, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31724787

RESUMO

Since its introduction over two decades ago, percutaneous epicardial procedures have become well-adopted by cardiac electrophysiologists, most commonly for catheter ablation of cardiac arrhythmias as well as left atrial appendage closure. The percutaneous epicardial approach has also been utilized for cardiac pacing and drug delivery. But still, its most common usage is for the treatment of intramural and subepicardial substrates that give rise to ventricular tachycardia, particularly in patients with nonischemic cardiomyopathy. In fact, subxiphoid, percutaneous epicardial mapping and ablation have emerged as an important adjunct and in some cases the preferred strategy for characterizing and treating certain types of ventricular arrhythmias. Herein, we will review the indications and rationale for various epicardial procedures. Additionally, we will explore the anatomy of the pericardium as well as the frequently-used epicardial access techniques. We will further examine the optimal approaches and methodologies for epicardial mapping and ablation and the impact of epicardial fat. We will also discuss the epicardial technique for left atrial appendage closure for the purpose of embolic stroke risk reduction. Finally, we will consider the potential for various complications in the setting of epicardial procedures along with their risk factors and discuss strategies to mitigate such adverse events.

7.
Heart Rhythm ; 17(1): e155-e205, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31102616

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

8.
Heart Rhythm ; 17(1): e2-e154, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31085023

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

9.
Int J Hyperthermia ; 36(1): 1168-1177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31752547

RESUMO

Purpose: Although experimental data have suggested that temporary occlusion of the coronary sinus (CS) can facilitate the creation of transmural lesions across the atrial wall (AW) during mitral isthmus radiofrequency (RF) ablation, no computer modeling study has yet been made on the effect of the blood flow inside the epicardial vessels and its stoppage by an occlusion balloon.Methods: Computer simulations using constant power were conducted to study these phenomena by two methods: (1) by setting blood velocity in the CS to zero, which mimics a distal occlusion; and (2) by including a balloon filled with air in the model just below the ablation site, which mimics a proximal occlusion.Results: For short ablations (15 s) and perpendicular electrode/tissue orientation, lesion size was smaller with proximal occlusion compared to distal or no occlusion, regardless of the AW-CS distance (from 0.5 mm to 3.4 mm). For other angulations (0 and 45°) lesion size was almost the same in all cases. For longer ablations (60 s), the internal CS blood flow (no occlusion) considerably reduced lesion size, while stoppage combined with the proximal presence of a balloon produced the largest lesions. This performance was similar for different catheter angulations (0, 45 and 90°). Balloon length (from 10 to 40 mm) was found to be an irrelevant parameter when proximal occlusion was modeled.Conclusions: Using an air-filled balloon to occlude CS facilitates mitral isthmus ablation in long ablations, while proximal occlusion could impede transmural lesions in the case of short ablations (15 s).

10.
Arq Bras Cardiol ; 113(2): 252-257, 2019 07 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31365602

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia worldwide, with significantly associated hospitalizations. Considering its growing incidence, the AF related economic burden to healthcare systems is increasing. Healthcare expenditures might be substantially reduced after AF radiofrequency ablation (AFRA). OBJECTIVE: To compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system. METHODS: We conducted a retrospective cohort study, based on patients' billing information from an administrative database. Eighty-three adult patients who had an AFRA procedure between 2014 and 2015 were included. Healthcare resource utilization related to cardiovascular causes, including ambulatory and hospital care, as well as its costs, were analyzed. A p-value of less than 0.05 was considered statistically significant. RESULTS: Mean follow-up was 14.7 ± 7.1 and 10.7 ± 5.4 months before and after AFRA, respectively. The 1-year AF recurrence-free rate was 83.6%. Before AFRA, median monthly total costs were Brazilian Reais (BRL) 286 (interquartile range [IQR]: 137-766), which decreased by 63.5% (p = 0.001) after the procedure, to BRL 104 (IQR: 57-232). Costs were reduced both in the emergency (by 58.6%, p < 0.001) and outpatient settings (by 56%, p < 0.001); there were no significant differences in the outpatient visits, inpatient elective admissions and elective admission costs before and after AFRA. The monthly median emergency department visits were reduced (p < 0.001). CONCLUSION: In this cohort, overall healthcare costs were reduced by 63.5%. A longer follow-up could be useful to evaluate if long-term cost reduction is maintained.

11.
Arq. bras. cardiol ; 113(2): 252-257, Aug. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1019391

RESUMO

Abstract Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide, with significantly associated hospitalizations. Considering its growing incidence, the AF related economic burden to healthcare systems is increasing. Healthcare expenditures might be substantially reduced after AF radiofrequency ablation (AFRA). Objective: To compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system. Methods: We conducted a retrospective cohort study, based on patients' billing information from an administrative database. Eighty-three adult patients who had an AFRA procedure between 2014 and 2015 were included. Healthcare resource utilization related to cardiovascular causes, including ambulatory and hospital care, as well as its costs, were analyzed. A p-value of less than 0.05 was considered statistically significant. Results: Mean follow-up was 14.7 ± 7.1 and 10.7 ± 5.4 months before and after AFRA, respectively. The 1-year AF recurrence-free rate was 83.6%. Before AFRA, median monthly total costs were Brazilian Reais (BRL) 286 (interquartile range [IQR]: 137-766), which decreased by 63.5% (p = 0.001) after the procedure, to BRL 104 (IQR: 57-232). Costs were reduced both in the emergency (by 58.6%, p < 0.001) and outpatient settings (by 56%, p < 0.001); there were no significant differences in the outpatient visits, inpatient elective admissions and elective admission costs before and after AFRA. The monthly median emergency department visits were reduced (p < 0.001). Conclusion: In this cohort, overall healthcare costs were reduced by 63.5%. A longer follow-up could be useful to evaluate if long-term cost reduction is maintained.


Resumo Fundamento: A fibrilação atrial (FA) é a arritmia mais comum em todo o mundo, com hospitalizações significativamente associadas. Considerando sua crescente incidência, a carga econômica relacionada à FA para os sistemas de saúde está aumentando. Os gastos com saúde podem ser substancialmente reduzidos após a ablação por radiofrequência (ARF). Objetivo: Comparar a utilização de recursos e os custos anteriores e posteriores à ARF em uma coorte de pacientes do sistema de saúde privado brasileiro. Métodos: Foi realizado um estudo de coorte retrospectivo, com base nas informações de cobrança dos pacientes de um banco de dados administrativo. Foram incluídos oitenta e três pacientes adultos que passaram pelo procedimento de ARF entre 2014 e 2015. A utilização de recursos de saúde relacionados às causas cardiovasculares, incluindo atendimento ambulatorial e hospitalar, assim como seus custos, foram analisados. Um valor de p inferior a 0,05 foi considerado estatisticamente significativo. Resultados: O seguimento médio foi de 14,7 ± 7,1 e 10,7 ± 5,4 meses antes e após a ARF, respectivamente. A taxa de FA livre de recidiva em 1 ano foi de 83,6%. Antes da ARF, a mediana dos custos totais mensais foi de R$286,00 (intervalo interquartil [IIQ]: 137-766), com redução de 63,5% (p = 0,001) após o procedimento, para um valor de R$104 (IIQ: 57-232). Os custos foram reduzidos tanto na emergência (em 58,6%, p < 0,001) como no ambiente ambulatorial (em 56%, p < 0,001); não houve diferenças significativas nas consultas ambulatoriais, internações eletivas e custos de internação eletiva antes e depois da ARF. As medianas das consultas mensais no setor de emergência foram reduzidas (p < 0,001). Conclusão: Nesta coorte, os custos gerais com saúde foram reduzidos em 63,5%. Um seguimento mais longo pode ser útil para avaliar se a redução de custos em longo prazo é mantida.

12.
J Arrhythm ; 35(3): 323-484, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31293696

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

13.
J Cardiovasc Electrophysiol ; 30(9): 1537-1548, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172632

RESUMO

INTRODUCTION: The efficacy of endocardial catheter ablation for ventricular tachycardia (VT) can be limited by intramural or epicardial substrates. Adding epicardial mapping and ablation may improve arrhythmia outcomes compared with an endocardial-only approach. METHODS: We performed a systematic review and meta-analysis of studies comparing a strategy of endo-epicardial catheter ablation to an endocardial-only approach for VT. Subanalyses were performed for ischemic and nonischemic cardiomyopathies. RESULTS: A total of 22 studies including 1138 patients were included in the meta-analysis. Of those, 44% underwent an endo-epicardial approach. During intermediate to long-term follow-up (average 7 to 70 months), recurrent VT or appropriate implantable cardioverter defibrillator (ICD) therapies were significantly lower with the endo-epicardial strategy (OR, 0.52; P < .01). All-cause mortality was also lower in this group (OR, 0.50; P = .03). No difference between endo-epicardial and endocardial-only ablation was noted in nonischemic cardiomyopathies. Among 323 patients with ischemic cardiomyopathy, recurrent VT or appropriate ICD therapies was less frequent in the endo-epicardial group (OR, 0.39; P = .01), as was all-cause mortality (OR, 0.38; P = .05). In patients with arrhythmogenic right ventricular cardiomyopathy, recurrent VT or appropriate ICD therapy was also lower in the endo-epicardial group (OR, 0.42; P = .04). CONCLUSION: These results suggest that a strategy of combined endo- and epicardial access for mapping and ablation of VT may provide superior efficacy to an endocardial-only approach in selected patients. Randomized trials are warranted to further investigate this question.

14.
Europace ; 21(8): 1143-1144, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31075787

RESUMO

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

15.
Heart Rhythm ; 16(3): 358-366, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30236610

RESUMO

BACKGROUND: Mortality caused by ventricular arrhythmias (VAs) remains a problem of epidemic proportions. Understanding current trends on admission of VA, patient characteristics, morbidity, mortality, and health care utilization could help us improve allocation of health care resources and risk prediction. OBJECTIVE: The purpose of this study was to investigate clinical outcomes of VA, including ventricular tachycardia (VT), implantable cardioverter-defibrillator (ICD) shocks, and sudden cardiac death (SCD); and to identify predictors of morbidity and mortality, patterns of utilization of ICD and VT ablation, and the impact of such metrics on overall health care utilization. METHODS: From 2010-2015, we identified 290,998 VA hospitalizations, which were stratified into group 1: normal heart; group 2: ischemic heart disease (IHD); group 3: nonischemic heart disease (non-IHD); group 4: ICD shocks; and group 5: SCD (cardiac arrest without ICD shock). RESULTS: The number of admissions for VA decreased during the study period (except for patients with SCD and ICD shock, which increased); in-hospital mortality in patients admitted with VA and SCD increased; utilization of VT ablation in patients with ICD shocks and IHD increased; ICD implantation decreased in non-IHD patients and IHD patients; and admission for SCD was the strongest predictor of in-hospital mortality, followed by patients with non-IHD, patients with ICD shocks, and all patients with a Charlson comorbidity index ≥2. CONCLUSION: We report a decrease in admissions for VA, decreased ICD utilization, a change in pattern of VT ablation utilization, and an increase of in-hospital mortality in SCD patients. Predictors of adverse outcomes identified in our study should be considered when developing risk models for patients undergoing risk assessment for SCD.

17.
J Electrocardiol ; 51(6): 1019-1022, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497723

RESUMO

This is a case report of a patient with painful LBBB Syndrome that responded favorably to His Bundle Pacing. This syndrome is largely under recognized despite 50 reports in the literature over the last 60 years. Both diagnosis and treatment are not well defined and represent a major challenge in patients with this entity. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. We report for the first-time complete resolution of chest pain with His bundle pacing. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with a painful LBBB syndrome.


Assuntos
Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial , Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Esforço Físico
18.
Arq. bras. cardiol ; 111(6): 824-830, Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-973806

RESUMO

Abstract Background: Pulmonary veins (PV) are often the trigger to atrial fibrillation (AF). Occasionally, left PVs converge on a common trunk (LCT) providing a simpler structure for catheter ablation. Objective: To compare the clinical characteristics and outcomes of ablation in paroxysmal atrial fibrillation (PAF) of patients with or without LCT. Methods: Case-control study of patients undergoing first-ever catheter ablation procedure for drug refractory PAF. The information was taken from patients' records by means of a digital collection instrument, and indexed to an online database (Syscardio(r)). Clinical characteristics and procedures were compared between patients with or without LCT (LCT x n-LCT), adopting a level of statistical significance of 5%. The primary endpoint associated with efficacy was lack of atrial arrhythmia over the follow-up time. Results: One hundred and seventy two patients with PAF were included in the study, 30 (17%) LCT and 142 (83%) n-LCT. The clinical characteristics, comorbidities, symptoms scale and risk scores did not differ between the groups. There was AF recurrence in 27% of PAF patients in the n-LCT group and only 10% of patients in the LCT group (OR: 3.4 p: 0.04) after a follow-up of 34 ± 17 months and 26 ± 15 months respectively. Conclusion: Patients with a LCT have a significantly lower recurrence rate when compared to patients without this structure. It is mandatory to report the results of AF catheter ablation as a PV anatomical variation function.


Resumo Fundamento: As veias pulmonares (VP) são frequentemente o local de origem da fibrilação atrial (FA). Ocasionalmente, as VPs esquerdas confluem em um tronco comum (TrCE) proporcionando uma estrutura mais simples para ablação por cateter. Objetivos: Tem-se como objetivo comparar as características clínicas e os resultados da ablação em pacientes portadores de FA paroxística (FAP) com ou sem TrCE. Metódos: Estudo do tipo caso-controle de pacientes submetidos ao primeiro procedimento de ablação por cateter para FAP refratária a drogas antiarrítmicas. As informações foram retiradas dos prontuários dos pacientes por meio de instrumento digital de coleta e indexadas a uma base de dados online (Syscardio(r)). As características clínicas e procedimentos foram comparados entre pacientes com e sem TrCE (TrCE x n-TrCE), sendo adotado nível de significância estatística de 5%. O desfecho primário associado à eficácia foi ausência de arritmia atrial ao longo do seguimento com único procedimento. Resultados: Cento e setenta e dois pacientes foram incluídos no estudo, 30 (17%) TrCE e 142 (83%) n-TrCE. As características clínicas, comorbidades, severidade de sintomas e escores de risco não apresentaram diferença estatística entre os grupos. Houve recorrência da FA em 27% dos pacientes do grupo não-TrCE e em apenas 10% dos pacientes do grupo TrCE (OR: 3,4 p: 0.04) após um seguimento de 34±17 e 26±15 meses respectivamente. Conclusão: Pacientes com TrCE apresentam significativamente menor taxa de recorrência quando comparados a pacientes sem esta estrutura. É imprescindível relatar os resultados da ablação por cateter de FA na vigência de variações anatômicas das VPs.

19.
Arq Bras Cardiol ; 111(6): 824-830, 2018 12.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30365602

RESUMO

BACKGROUND: Pulmonary veins (PV) are often the trigger to atrial fibrillation (AF). Occasionally, left PVs converge on a common trunk (LCT) providing a simpler structure for catheter ablation. OBJECTIVE: To compare the clinical characteristics and outcomes of ablation in paroxysmal atrial fibrillation (PAF) of patients with or without LCT. METHODS: Case-control study of patients undergoing first-ever catheter ablation procedure for drug refractory PAF. The information was taken from patients' records by means of a digital collection instrument, and indexed to an online database (Syscardio(r)). Clinical characteristics and procedures were compared between patients with or without LCT (LCT x n-LCT), adopting a level of statistical significance of 5%. The primary endpoint associated with efficacy was lack of atrial arrhythmia over the follow-up time. RESULTS: One hundred and seventy two patients with PAF were included in the study, 30 (17%) LCT and 142 (83%) n-LCT. The clinical characteristics, comorbidities, symptoms scale and risk scores did not differ between the groups. There was AF recurrence in 27% of PAF patients in the n-LCT group and only 10% of patients in the LCT group (OR: 3.4 p: 0.04) after a follow-up of 34 ± 17 months and 26 ± 15 months respectively. CONCLUSION: Patients with a LCT have a significantly lower recurrence rate when compared to patients without this structure. It is mandatory to report the results of AF catheter ablation as a PV anatomical variation function.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Veias Pulmonares/anatomia & histologia , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , Recidiva , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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