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2.
J Interv Card Electrophysiol ; 52(3): 323-334, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30105429

RESUMO

His bundle pacing (HBP) has recently emerged as a technique to avoid the negative effects of long-term right ventricular apical pacing. In addition to providing physiologic ventricular activation, HBP has been shown to correct underlying conduction abnormalities in certain patients. Although large prospective, randomized clinical trials have not yet been completed, the available observational clinical data support the safety and efficacy of this technique. Here, we review the physiology of the his bundle (HB) as it relates to HBP, describe the current clinical experience, and discuss future directions of this emerging therapy.


Assuntos
Bloqueio Atrioventricular/prevenção & controle , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia , Marca-Passo Artificial , Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Terapia de Ressincronização Cardíaca/métodos , Feminino , Humanos , Masculino , Prognóstico , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
3.
J Cell Mol Med ; 22(4): 2514-2517, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29377565

RESUMO

It is unknown whether fibrosis-associated microRNAs: miR-21, miR-26, miR-29, miR-30 and miR-133a are linked to cardiovascular (CV) outcome. The study evaluated the levels of extracellular matrix (ECM) fibrosis and the prevalence of particular microRNAs in patients with dilated cardiomyopathy (DCM) to investigate any correlation with CV events. METHODS: Seventy DCM patients (48 ± 12 years, EF 24.4 ± 7.4%) underwent right ventricular biopsy. The control group was comprised of 7 patients with CAD who underwent CABG and intraoperative biopsy. MicroRNAs were measured in blood and myocardial tissue via qPCR. The end-point was a combination of CV death and urgent HF hospitalization at the end of 12 months. There were differential levels of circulating and myocardial miR-26 and miR-29 as well as myocardial miR-133a when the DCM and CABG groups were compared. Corresponding circulating and myocardial microRNAs did not correlate with one another. There was no correlation between microRNA and ECM fibrosis. By the end of the 12-month period of the study, CV death had occurred in 6 patients, and a further 19 patients required urgent HF hospitalization. None of the circulating microRNAs was a predictor of the combined end-point; however, myocardial miR-133a was an independent predictor in unadjusted models (HR 1.53; 95% CI 1.14-2.05; P < .004) and adjusted models (HR 1.57; 95% CI 1.14-2.17; P < .005). The best cut-off value for the miR-133a level for the prediction of the combined end-point was 0.74 ΔCq, with an AUC of 0.67. The absence of a correlation between the corresponding circulating and myocardial microRNAs calls into question their cellular source. This study sheds new light on the role of microRNAs in ECM fibrosis in DCM, which warrants further exploration.


Assuntos
Cardiomiopatia Dilatada/genética , Fibrose/genética , Ventrículos do Coração/metabolismo , MicroRNAs/genética , Biomarcadores/sangue , Biópsia , Cardiomiopatia Dilatada/sangue , Cardiomiopatia Dilatada/fisiopatologia , Matriz Extracelular/genética , Feminino , Fibrose/sangue , Fibrose/fisiopatologia , Ventrículos do Coração/patologia , Humanos , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade , Miocárdio/metabolismo , Miocárdio/patologia
4.
Cardiol Res Pract ; 2016: 5191683, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26925288

RESUMO

Background. In a commotio cordis swine model, ventricular fibrillation (VF) can be induced by a ball blow to the chest believed secondary to activation of mechanosensitive ion channels. The purpose of the current study is to evaluate whether stretch induced activation of the L-type calcium channel may cause intracellular calcium overload and underlie the VF in commotio cordis. Method and Results. Anesthetized juvenile swine received 6 chest wall strikes with a 17.9 m/s lacrosse ball timed to the vulnerable period for VF induction. Animals were randomized to IV verapamil (n = 6) or placebo (n = 6). There was no difference in the observed frequency of VF between verapamil (19/26: 73%) and placebo (20/36: 56%) treated animals (p = 0.16). There was also no significant difference in the combined endpoint of VF or nonsustained VF (21/26: 81% in verapamil versus 24/36: 67% in controls, p = 0.22). Conclusions. In this experimental model of commotio cordis, verapamil did not prevent VF induction. Thus, in commotio cordis it is unlikely that stretch activation of the L-type calcium channel with resultant intracellular calcium overload plays a prominent role.

5.
J Interv Card Electrophysiol ; 40(2): 191-205, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24948126

RESUMO

PURPOSE: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death, but patients need to be counseled about potential harms. We summarized the evidence on adverse events from ICDs with a focus on ICD use for primary prevention of sudden cardiac death. METHODS: We searched MEDLINE and Cochrane Central Register of Controlled Trials from 2002 through 2012 for reports of adverse events from ICDs implanted for primary prevention or mixed indications (primary and secondary prevention). Studies had to have ≥500 patients and specify patient numerators and denominators. RESULTS: Data from 35 independent cohorts reported in 53 articles were included. Reports from one registry provided high quality evidence on adverse events during hospitalization for ICD implantation. Adverse events ranged from 2.8 to 3.6%. Serious adverse events ranged from 1.2 to 1.4%. The most frequent serious adverse events were pneumothorax (0.4-0.5%) and cardiac arrest (0.3%). The quality of the evidence for long-term adverse events was low. Frequency of adverse events post-hospitalization was variable, as was follow-up: device-related complications <0.1-6.4% (2-49 months), lead-related complications <0.1-3.9% (1.5-40 months), infection 0.2-3.7% (1.5-49 months), and thrombosis 0.2-2.9% (1.5-49 months). Evidence for inappropriate shock was of moderate quality with 3-21% of patients experiencing at least one inappropriate shock during 1 to 5 years of follow-up. LIMITATIONS: The limitation of the evidence reviewed in this study is low quality evidence for adverse events post-hospitalization. Evidence is predominantly from mixed primary and secondary prevention populations. CONCLUSIONS: In-hospital adverse events after ICD implantation are infrequent. The estimates for long-term adverse events are uncertain. Up to one-fifth of patients receive inappropriate shocks.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/estatística & dados numéricos , Falha de Equipamento/estatística & dados numéricos , Pneumotórax/mortalidade , Infecções Relacionadas à Prótese/mortalidade , Trombose/mortalidade , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida , Falha de Tratamento
6.
Ann Intern Med ; 160(2): 111-21, 2014 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-24592496

RESUMO

BACKGROUND: Previous systematic reviews of implantable cardioverter defibrillators (ICDs) used for primary prevention of sudden cardiac death (SCD) concluded that ICDs are less effective in women and the elderly. PURPOSE: To examine ICD effectiveness for primary prevention of SCD across subgroups by sex, age, New York Heart Association class, left ventricular ejection fraction, heart failure, left bundle branch block, QRS interval, time since myocardial infarction, blood urea nitrogen level, and diabetes. DATA SOURCES: MEDLINE and the Cochrane Central Register of Controlled Trials through 3 September 2013 with no language restriction. STUDY SELECTION: Researchers screened articles for studies comparing ICD versus no ICD for primary prevention. DATA EXTRACTION: Data were extracted about study design, patients, interventions, mortality and SCD outcomes, subgroup characteristics, and subgroup effects. Quality of subgroup analyses was determined by consensus. Relative odds ratios comparing subgroup effects were calculated, and random-effects model meta-analyses were conducted on these ratios. DATA SYNTHESIS: Meta-analysis of 14 studies showed a decrease in deaths and SCDs due to ICD treatment. Ten studies provided subgroup analyses. Nine studies compared ICD versus no ICD, whereas one compared cardiac resynchronization therapy plus a defibrillator versus no ICD. Within-study interaction tests and across-study meta-analyses yielded weak evidence that did not show differences for all-cause mortality in subgroups by sex, age, and QRS interval. The evidence was indeterminate for other evaluated subgroups because of a paucity of data. LIMITATION: Many subgroup analyses were underpowered, which may have resulted in false-negative findings. CONCLUSION: Weak evidence fails to show differences for all-cause mortality in subgroups of sex, age, and QRS interval. Evidence is indeterminate for all-cause mortality in the other subgroups and for SCD. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Prevenção Primária , Fatores Etários , Causas de Morte , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Sexuais
7.
Pulm Med ; 2013: 621736, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23533751

RESUMO

In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient's risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation.

8.
J Interv Card Electrophysiol ; 35(2): 227-34, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22956011

RESUMO

Implantation of implantable cardioverter defibrillators (ICDs) for primary prevention has been shown to significantly reduce mortality in several randomized controlled trials. However, many of these trials have excluded patients on hemodialysis as well as patients with advanced chronic kidney disease (CKD). Whether the benefits of ICD therapy extend to patients with CKD is not clear. This review will examine the relationship between advancing stage of CKD and risk/benefit of ICD placement. Furthermore, we will review the recent evidence for the rates of complications as CKD advances. The intent is to assist the clinician who is considering the risks and benefits of ICD implantation in patients who have significant competing comorbidities and have not been specifically studied in randomized controlled trials.


Assuntos
Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Insuficiência Renal Crônica/complicações , Humanos , Prevenção Primária , Diálise Renal , Insuficiência Renal Crônica/terapia , Fatores de Risco
11.
Heart Rhythm ; 8(4): 555-61, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21146632

RESUMO

BACKGROUND: Stress cardiomyopathy (SCM) is a syndrome of transient ventricular dysfunction triggered by severe emotional or physical stress, likely resulting from catecholamine-mediated myocardial toxicity. Repolarization abnormalities associated with other hyperadrenergic states can cause QT prolongation and lethal arrhythmia including torsades de pointes (TdP). Despite the development of repolarization abnormalities and QT prolongation in SCM, little is known about the risk of ventricular fibrillation (VF) and TdP. OBJECTIVE: The aim of this study was to assess the prevalence and clinical predictors of ventricular arrhythmias in a cohort of patients with SCM. METHODS: Data from a registry of consecutive patients with SCM from 2 institutions were reviewed. Patients who developed VF or TdP were identified. Clinical characteristics and outcomes were analyzed and compared with a control group of patients with SCM without VF/TdP. RESULTS: Of 93 patients with SCM, 8 (8.6%) experienced VF/TdP. Of these 8 patients, 2 presented with VF and were subsequently diagnosed with SCM. Six other patients experienced pause-dependent TdP or VF after SCM diagnosis in the setting of substantial QT prolongation. Prolongation of the corrected QT interval (QTc) was significantly associated with the occurrence of ventricular arrhythmia (odds ratio 1.28 for each 10 ms increase in QTc, 95% confidence interval 1.10 to 1.50). CONCLUSION: SCM can be associated with life-threatening ventricular arrhythmia in over 8% of cases. SCM should be recognized among the causes of acquired long QT syndrome and can be associated with a risk of TdP.


Assuntos
Eletrocardiografia , Síndrome do QT Longo/complicações , Cardiomiopatia de Takotsubo/complicações , Torsades de Pointes/etiologia , Idoso , Feminino , Seguimentos , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Torsades de Pointes/diagnóstico , Torsades de Pointes/epidemiologia
12.
Heart Rhythm ; 7(9): 1346-55, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20659587

RESUMO

BACKGROUND: Recent economic trends influenced by healthcare reform, an aging population, changes in physician reimbursement, and increasing competition will have a significant impact on the electrophysiology workforce. Therefore, there is an important need to obtain information about the EP workforce to assess training of arrhythmic healthcare providers in order the meet the requisite societal need. This report summarizes the data collected by the HRS Workforce Study Task Force in relation to physician workforce issues. OBJECTIVE: The HRS Workforce Study Task Force was charged with conducting a comprehensive study to assess changes in the field of electrophysiology since the last workforce study conducted in 2001 and to identify the population and distribution of professionals who treat patients with heart rhythm disorders. METHODS: A series of comprehensive questionnaires were designed by the HRS Workforce Study Task Force to conduct online surveys with physicians, basic science researchers, and allied professionals. Data collected in the physician survey included: personal demographics and professional profile characteristics such as primary work setting and areas of affiliation; workload characteristics such as hours worked, time spent by activity, workload relative to capacity, competition for patients, volume by specific procedure, sources of referrals, income levels, personal mobility, and anticipated future changes in the respondent's practice. Survey responses were collated and analyzed by the Workforce Study Task Force. RESULTS: Work capacity is expected to increase to offset some of the economic drivers; however, recruitment of new EPs could be challenging and uncertain. Specifically, geographic mobility (>50 miles) appears to be minimal at present overall and unlikely to significantly change for the majority of physicians once they have established themselves in a given community following the completion of their training. Practice time is predominantly spent performing device implantations, device follow-ups and ablations. These activities are being tasked upon younger physicians, thereby suggesting a need for trained allied professionals to assume a greater role in device management. The perception of competition varied by respondent age and geographic location but, in general, was felt to be at least moderate by most respondents. Furthermore, there are concerns that increasing competition may dilute operator experience and potentially lower high quality outcomes if increasing competition leads to lower procedural volumes. CONCLUSION: Based on findings from this study, the task force identified specific workforce (supply) trends and the key drivers of current and future challenges. Although specific areas will require further analysis, overall, the current EP workforce is stable, with the exception of geographic dispersion. However, the workforce must adapt to the key economic drivers (demand) and address future recruitment challenges.


Assuntos
Eletrofisiologia , Pesquisas sobre Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Admissão e Escalonamento de Pessoal/tendências , Médicos/provisão & distribução , Sociedades Médicas , Adulto , Idoso , Canadá , Humanos , Pessoa de Meia-Idade , Estados Unidos , Carga de Trabalho
13.
J Cardiovasc Electrophysiol ; 21(11): 1208-16, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20487117

RESUMO

UNLABELLED: AF Recurrence After RFA: Systematic Review. INTRODUCTION: The relationship between success of radiofrequency ablation for atrial fibrillation (AF) and patient characteristics has not been systematically evaluated. METHODS AND RESULTS: We searched MEDLINE and Cochrane Central Trials Registry databases from 2000 through 2008 for studies reporting preprocedure predictors and AF recurrence after radiofrequency ablation. We extracted multivariable analyses and univariable data on predictors and AF recurrence. Eligible studies were highly heterogeneous, particularly regarding ablation technique and definition of AF recurrence. Among 25 studies with multivariable analyses, two-thirds to 90% of studies found that AF type, ejection fraction, left atrial diameter, structural heart disease, hypertension, and AF symptom duration did not predict AF recurrence (among patients with ejection fraction above 40% and left atrial diameter below about 55 mm). Studies found that gender and age were not predictors (in patients between 40 and 70 years old). Meta-analyses of univariable AF recurrence rates by AF type in 31 studies found that studies were statistically heterogeneous, but that nonparoxysmal AF predicted AF recurrence compared to paroxysmal AF (relative risk 1.59; 95% confidence interval 1.38-1.82; P < 0.001); meta-analyses of persistent or permanent versus paroxysmal AF yielded similar findings. CONCLUSION: Nonparoxysmal AF may be a clinically useful proxy for a combination of confounded variables, none of which alone is an independent predictor of AF recurrence. Evaluation of predictors was limited by exclusion of patients with severe heart disease or at the age extremes; thus, the evidence may not be as applicable to these populations.


Assuntos
Fibrilação Atrial/mortalidade , Fibrilação Atrial/cirurgia , Ablação por Cateter/mortalidade , Avaliação de Resultados em Cuidados de Saúde/métodos , Humanos , Recidiva , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
15.
Ann Intern Med ; 151(3): 191-202, 2009 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-19581635

RESUMO

BACKGROUND: Atrial fibrillation is the most common sustained arrhythmia. Medical treatment often fails to control symptoms. PURPOSE: To compare the benefits and harms of radiofrequency catheter ablation and medical therapy in adults with atrial fibrillation. DATA SOURCES: MEDLINE and the Cochrane Central Register of Controlled Trials (2000 to December 2008) were searched for English-language reports of studies in adults. STUDY SELECTION: 6 independent reviewers screened abstracts to identify longitudinal studies of adults with atrial fibrillation who underwent radiofrequency catheter ablation. Studies reported arrhythmia or other cardiovascular outcomes at least 6 months after ablation or any adverse events. DATA EXTRACTION: Data were extracted by 1 of 4 reviewers and were verified by a cardiac electrophysiologist. Study quality and overall strength of evidence for each question were rated by 2 independent reviewers; disagreements were resolved by consensus. DATA SYNTHESIS: 108 studies met eligibility criteria. Moderate strength of evidence (3 trials; n = 30 to 198) showed that radiofrequency ablation after a failed drug course was more likely than continuation of drug therapy alone to lead to maintained sinus rhythm. Low strength of evidence (4 trials [n = 30 to 137] and 1 retrospective study [n = 1171]) suggested that radiofrequency ablation improved quality of life, promoted avoidance of anticoagulation, and decreased readmission rates compared with medical treatment. Major adverse events occurred in fewer than 5% of patients in most of 84 studies. LIMITATIONS: Study follow-up was generally 12 months or less. Large heterogeneity of applied techniques and reporting of outcomes precluded many definitive conclusions. Reporting of adverse events was poor. Publication and selective reporting biases could not be ruled out. Studies with small samples and studies reported in a language other than English were excluded. CONCLUSION: Radiofrequency catheter ablation is effective for up to 12 months of rhythm control when used as a second-line therapy for atrial fibrillation in relatively young patients with near-intact cardiac function. Longer studies that use primary end points of stroke and mortality are needed.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Adulto , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Insuficiência Cardíaca/epidemiologia , Frequência Cardíaca , Humanos , Readmissão do Paciente , Qualidade de Vida , Acidente Vascular Cerebral/epidemiologia
16.
Heart Rhythm ; 5(8): 1134-41, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18675224

RESUMO

BACKGROUND: Atrial fibrillation catheter ablation is frequently guided by identification of fractionated electrograms, which are thought to be critical for maintenance of the arrhythmia. Objective automated means for identifying fractionation independent of physician interpretation have not been standardized or validated. OBJECTIVE: The purpose of this study was to standardize and validate an automated algorithm to rapidly identify fractionated electrograms for high-density atrial fibrillation fractionation mapping. METHODS: Left and right atrial fractionation maps were generated by EnSite NavX 6.0 software, using standardized ablation catheters in eight patients with atrial fibrillation. Two blinded electrophysiologists interpreted all electrograms as either fractionated or not fractionated. A stepwise approach was used to optimize automated settings to accurately identify fractionation. High-density fractionation maps were generated with a 20-pole mapping catheter in eight other patients. Two blinded electrophysiologists interpreted all electrograms as near field or far field. The algorithm was refined to optimize settings to exclude far-field signals and retain near-field signals. The sampling segment length was adjusted to optimize recording time to ensure reproducibility. RESULTS: Using 1,514 points, the automated software achieved sensitivity of 0.75 and specificity of 0.80 for identification of fractionated electrograms. Using 725 points collected via multipole catheters with optimal automated settings, 94% of near-field fractionated electrograms were accurately identified. A 6-second sampling length was needed for reproducible fractionation measurements. CONCLUSION: Standardized settings of EnSite NavX 6.0 software with 6-second data collection per point can rapidly and accurately generate high-density fractionation maps independent of physician electrogram interpretation. This may allow for an automated, standardized approach to atrial fibrillation fractionated ablation.


Assuntos
Fibrilação Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Endocárdio/patologia , Algoritmos , Fibrilação Atrial/fisiopatologia , Mapeamento Potencial de Superfície Corporal/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
17.
J Interv Card Electrophysiol ; 23(1): 45-9, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18465217

RESUMO

The mechanisms to explain atrial fibrillation (AF) have been widely debated. Although contemporary experimental techniques have provided more insight, hypotheses regarding AF propagation conceived in the early half of the century remain minimally altered and relevant today. Modern mapping technologies have implicated multiwavelet reentry as the electrophysiologic basis to explain AF propagation within the atrial myocardium; however, reentry has also been observed within pulmonary veins and may behave as a focal trigger. The ability to terminate AF by catheter ablation has provided additional clues to explain AF induction and sustenance. The presence of complex fractionated electrograms (CFAE) and subsequent successful CFAE-directed ablation suggest that diseased atrial myocardium is a necessary substrate for AF maintenance. Atrial remodeling creates differential areas of refractory periods and conduction velocity, which, in turn, creates a suitable environment for AF. This review addresses the complex relationship between remodeled atrial myocardium and reentry and explores the role of CFAEs in AF maintenance.


Assuntos
Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas/métodos , Remodelação Ventricular , Fibrilação Atrial/terapia , Mapeamento Potencial de Superfície Corporal , Eletrocardiografia , Humanos , Taquicardia Reciprocante/cirurgia
19.
J Interv Card Electrophysiol ; 16(3): 203-6, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17165133

RESUMO

A 21-year-old woman presented with a pacemaker-associated superior vena cava (SVC) syndrome refractory to medical therapy. In the past, treatment of this condition has involved surgical exploration which is invasive. With the evolution of percutaneous techniques, treatment has included venoplasty and stenting over the pacemaker lead. There is limited experience with a more advanced percutaneous technique in which the lead is extracted by an excimer laser sheath. The extraction is immediately followed by venoplasty and stenting at the site of stenosis with subsequent implantation of a new permanent pacemaker at the previously occluded access site. The patient underwent this procedure which proved to be safe, minimally invasive, and an efficient method of treating SVC syndrome secondary to a single chamber atrial pacemaker.


Assuntos
Cateterismo , Remoção de Dispositivo/métodos , Marca-Passo Artificial/efeitos adversos , Stents , Síndrome da Veia Cava Superior/terapia , Adulto , Veia Ázigos , Veias Braquiocefálicas , Estimulação Cardíaca Artificial , Eletrodos Implantados/efeitos adversos , Feminino , Humanos , Radiografia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia
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