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2.
JACC Clin Electrophysiol ; 6(6): 684-692, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32553219

RESUMO

OBJECTIVES: This study investigated the impact of the type of catheter irrigant used during delivery of radiofrequency ablation. BACKGROUND: The use of half-normal saline (HNS) as an irrigant has been suggested as a method for increasing ablation lesion size but has not been rigorously studied in the beating heart or the use of a low-flow irrigation catheter. METHODS: Sixteen swine underwent left ventricular mapping and ablation using either normal saline (NS) (group 1: n = 9) or half-normal saline (HNS) (group 2: n = 7). All lesions were delivered using identical parameters (40 W with 10-second ramp, 30-second duration, 15 ml/min flow, and 8- to14-g target contact force). An occurrence of steam pop, catheter char, or thrombus was assessed using intracardiac echocardiography and catheter inspection following each application. Lesion depth, width, and area were measured using electronic calibers. RESULTS: A total of 109 lesions were delivered in group 1 and 77 in group 2. There were significantly more steam pops in group 2 (32 of 77 [42%] vs. 24 of 109 [22%], respectively). The frequencies of catheter tip char were similar (group 1: 9 of 109 [8%] vs. group 2: 10 of 77 [13%]; p = 0.29). Lesion depths, widths, and areas also were similar in both groups. CONCLUSIONS: The use of an HNS irrigant using a low-flow open irrigated ablation catheter platform results in more tissue heating due to higher radiofrequency current delivery directed to tissue, but this can lead to higher rate of steam pops. In this in vivo porcine beating-heart model, the use of HNS does not appear to significantly increase lesion size in normal myocardium despite evidence of increased radiofrequency heating.

3.
Card Electrophysiol Clin ; 12(2): 259-264, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32451109

RESUMO

Atrial fibrillation is a leading cause of ischemic stroke. Stroke risk can be reduced with oral anticoagulation. Current guidelines recommend that decisions regarding anticoagulation after ablation be based solely on preprocedural risk. Factors that favor stopping oral anticoagulationafter atrial fibrillation ablation include lower CHA2DS2-VASc score, lesser extent of atrial cardiopathy as defined by atrial size, and fibrosis and higher bleeding risk. More extensive monitoring with insertable cardiac monitors, smart devices, and frequent pulse checks provide greater sensitivity for recurrence. The authors' strategy for managing oral anticoagulation after atrial fibrillation ablation is provided.

4.
Circulation ; 141(19): 1523-1526, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32392102
5.
Heart Rhythm ; 2020 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-32348845

RESUMO

BACKGROUND: Radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) arising from the inaccessible basal region of the left ventricular summit (LVS) is challenging due to proximity to coronary vessels, epicardial fat, and poor radiofrequency (RF) delivery within the distal coronary venous system. OBJECTIVE: The purpose of this study was to describe the outcomes of an anatomic approach to inaccessible LVS-VAs using bipolar radiofrequency (Bi-RFCA) delivered from the anatomically adjacent left pulmonic cusp (LPC) to the opposite left ventricular outflow tract (LVOT). METHODS: Patients from 3 centers who had undergone Bi-RFCA for inaccessible LVS-VAs refractory to conventional RFCA using an anatomic approach targeting the adjacent LPC (reversed U approach) with catheter tip pointing inferiorly within the LPC and LVOT were reviewed. RESULTS: Seven patients (age 59 ± 12 years; 3 women) underwent Bi-RF from the LPC to the LVOT for LVS-VAs after ≥1 failed conventional RFCA. Bi-RFCA (power 36 ± 7 W; duration 333 ± 107 seconds) resulted in VA suppression in 5 of 7 patients. In 2 cases, Bi-RFCA was successfully performed using dextrose 5% in water. No complications occurred. After mean follow-up of 14 ± 6 months, no recurrent VT was documented in 2 of 2 patients with baseline VT. Mean 84% reduction in premature ventricular contraction (PVC) burden (31% ± 13% vs 4% ± 5% PVCs per day; P = .0027) was documented in the other patients. CONCLUSION: In patients with LVS-VAs arising from the inaccessible region and refractory to conventional RFCA, an anatomic approach using Bi-RFCA from the LPC and opposite LVOT is an effective alternative approach.

6.
Cardiovasc Res ; 116(5): 908-915, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31746997

RESUMO

PCSK9 degrades low-density lipoprotein cholesterol (LDL) receptors and subsequently increases serum LDL cholesterol. Clinical trials show that inhibition of PCSK9 efficiently lowers LDL cholesterol levels and reduces cardiovascular events. PCSK9 inhibitors also reduce the extent of atherosclerosis. Recent studies show that PCSK9 is secreted by vascular endothelial cells, smooth muscle cells, and macrophages. PCSK9 induces secretion of pro-inflammatory cytokines in macrophages, liver cells, and in a variety of tissues. PCSK9 regulates toll-like receptor 4 expression and NF-κB activation as well as development of apoptosis and autophagy. PCSK9 also interacts with oxidized-LDL receptor-1 (LOX-1) in a mutually facilitative fashion. These observations suggest that PCSK9 is inter-twined with inflammation with implications in atherosclerosis and its major consequence-myocardial ischaemia. This relationship provides a basis for the use of PCSK9 inhibitors in prevention of atherosclerosis and related clinical events.

7.
Am J Cardiol ; 125(1): 87-91, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31685214

RESUMO

Atrial fibrillation-flutter (AF) has been described in 10% to 24% of patients after heart transplant (HT). Data on AF hospitalizations after HT are limited to single-center experiences. To bridge this gap, we performed an analysis of admissions for AF in HT patients from the National Inpatient Sample (NIS) years 2000 to 2014. All hospitalizations with a primary diagnosis of 427.31 or 427.32 and V42.1 were used to identify hospitalizations with AF and previous HT respectively. Among a total of 211,961 HT related hospitalizations, 1,304 (0.62%) (955 males, 349 females, mean age 59 years, median CHA2DS2Vasc score 2 [Interquartile range 1 to 3]) were admitted with a primary diagnosis AF. Most hospitalizations were nonelective (80.17%). In-hospital mortality was 2.3% and the mean length of stay (LOS) was 3.7 days. Among those patients who were discharged from hospital, 85 % were discharged to home with self-care. Most commonly reported secondary diagnoses included hypertension (57.9%), diabetes (33%), renal failure (31.3%), and congestive heart failure (22%). The event rates for ischemic stroke and gastrointestinal bleeding in the same admission with the AF hospitalization were low (1.2% and 1.2% respectively). Cardioversion was performed in 37% and ablation in 11.2% of admissions. The adjusted median cost of hospitalization was $6478.7 (IQR $3561.8 to $12352.3) and did not change significantly during the study period. AF is a relatively infrequent cause of hospitalization among HT recipients. The number of hospitalizations, ablations, cardioversions, disposition, LOS, and cost of hospitalization for AF remained stable during the study period.


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Transplante de Coração/efeitos adversos , Hospitalização/tendências , Pacientes Internados/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Transplantados/estatística & dados numéricos , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Flutter Atrial/etiologia , Flutter Atrial/terapia , Ablação por Cateter/métodos , Cardioversão Elétrica/métodos , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
8.
Turk Kardiyol Dern Ars ; 47(7): 616-618, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582675

RESUMO

Cardiac implantable electronic devices (CIEDs) are widely used in current practice. Analyzing the electrocardiographic patterns of these devices and having knowledge of artifacts is crucial to appropriate CIED management. A 32-year-old female patient presented at the device clinic for a routine follow-up visit. A dual-chamber pacemaker had been implanted 12 years previously for sinus node dysfunction. An initial 12-lead electrocardiogram (ECG) prompted concern due to a cyclical pattern of multiple, rapid pacing stimulus artifacts. Device interrogation revealed normal overall pacemaker function. Turning the pace gain function of the ECG machine off failed to eliminate the artifact. On review of the past medical history, the patient was found to have a prior diagnosis of congenital central hypoventilation syndrome and pulmonary hypertension, for which she underwent insertion of a diaphragmatic pacemaker. Interrogation of the diaphragmatic pacemaker revealed that the programmed parameters correlated with the frequency of the artifact noted on the ECG. In cardiac pacing, a single stimulus artifact of sufficient threshold can enable myocardial capture. Capturing diaphragmatic pacing, however, requires a train of multiple stimuli above the threshold. Thus, an understanding of the pacing configurations of various electrical devices that can potentially interfere with CIEDs is crucial to appropriate patient management.


Assuntos
Artefatos , Desfibriladores Implantáveis , Diafragma/diagnóstico por imagem , Hipoventilação/congênito , Marca-Passo Artificial , Síndrome do Nó Sinusal/terapia , Apneia do Sono Tipo Central/terapia , Adulto , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Hipoventilação/complicações , Hipoventilação/terapia , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/fisiopatologia , Apneia do Sono Tipo Central/complicações
9.
BMC Res Notes ; 12(1): 398, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300069

RESUMO

OBJECTIVE: Atrial fibrillation (AF) weekend hospitalizations were reported to have poor outcomes compared to weekday hospitalizations. The relatively poor outcomes on the weekends are usually referred to as 'weekend effect'. We aim to understand trends and outcomes among weekend AF hospitalizations. The primary purpose of this study is to evaluate the trends for weekend AF hospitalizations using Nationwide Inpatient Sample 2005-2014. Hospitalizations with AF as the primary diagnosis, in-hospital mortality, length of stay, co-morbidities and cardioversion procedures have been identified using the international classification of diseases 9 codes. RESULTS: Since 2005, the weekend AF hospitalizations increased by 27% (72,216 in 2005 to 92,220 in 2014), mortality decreased by 29% (1.32% in 2005 to 0.94% in 2014), increase in urban teaching hospitalizations by 72% (33.32% in 2005 to 57.64% in 2014), twofold increase in depression and a threefold increase in the prevalence of renal failure were noted over the period of 10 years. After adjusting for significant covariates, weekend hospitalizations were observed to have higher odds of in-hospital mortality OR 1.17 (95% CI 1.108-1.235, P < 0.0001). Weekend AF hospitalizations appear to be associated with higher in-hospital mortality. Opportunities to improve care in weekend AF hospitalizations need to be explored.


Assuntos
Fibrilação Atrial/terapia , Bases de Dados Factuais/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Am Coll Cardiol ; 73(23): 2915-2929, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31196447

RESUMO

BACKGROUND: The efficacy and safety of aspirin for primary prevention of cardiovascular disease (CVD) remain debatable. OBJECTIVES: The purpose of this study was to examine the clinical outcomes with aspirin for primary prevention of CVD after the recent publication of large trials adding >45,000 individuals to the published data. METHODS: Randomized controlled trials comparing clinical outcomes with aspirin versus control for primary prevention with follow-up duration of ≥1 year were included. Efficacy outcomes included all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke, transient ischemic attack (TIA), and major adverse cardiovascular events. Safety outcomes included major bleeding, intracranial bleeding, fatal bleeding, and major gastrointestinal (GI) bleeding. Random effects DerSimonian-Laird risk ratios (RRs) for outcomes were calculated. RESULTS: A total of 15 randomized controlled trials including 165,502 participants (aspirin n = 83,529, control n = 81,973) were available for analysis. Compared with control, aspirin was associated with similar all-cause death (RR: 0.97; 95% confidence interval [CI]: 0.93 to 1.01), CV death (RR: 0.93; 95% CI: 0.86 to 1.00), and non-CV death (RR: 0.98; 95% CI: 0.92 to 1.05), but a lower risk of nonfatal MI (RR: 0.82; 95% CI: 0.72 to 0.94), TIA (RR: 0.79; 95% CI: 0.71 to 0.89), and ischemic stroke (RR: 0.87; 95% CI: 0.79 to 0.95). Aspirin was associated with a higher risk of major bleeding (RR: 1.5; 95% CI: 1.33 to 1.69), intracranial bleeding (RR: 1.32; 95% CI: 1.12 to 1.55), and major GI bleeding (RR: 1.52; 95% CI: 1.34 to 1.73), with similar rates of fatal bleeding (RR: 1.09; 95% CI: 0.78 to 1.55) compared with the control subjects. Total cancer and cancer-related deaths were similar in both groups within the follow-up period of the study. CONCLUSIONS: Aspirin for primary prevention reduces nonfatal ischemic events but significantly increases nonfatal bleeding events.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Hemorragia Gastrointestinal/induzido quimicamente , Prevenção Primária/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Humanos , Prevenção Primária/tendências
11.
J Cardiovasc Pharmacol Ther ; 24(5): 428-434, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31035795

RESUMO

BACKGROUND: Direct oral anticoagulants (DOACs) have been found to be similar or superior to warfarin in reducing ischemic stroke and intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). We sought to examine the anticoagulation prescription patterns in community since the advent of DOACs and also evaluate the outcomes in terms of gastrointestinal (GI) bleeding, ischemic stroke, and ICH in real-world patients with AF receiving anticoagulation. METHODS: This is a retrospective study comprising patients who were newly diagnosed with nonvalvular AF and were prescribed anticoagulants for stroke prevention. Prescription pattern of the anticoagulants based on CHA2DS2Vasc score was studied. Clinical outcomes of GI bleeding, ischemic stroke, and ICH were analyzed using a multivariate logistic regression model. RESULTS: Of the 2362 patients with AF on anticoagulation, 44.7% were prescribed DOACs. Patients with CHA2DS2VASc score of ≥3 received a prescription for warfarin more often than DOACs (P < .001). Multivariate logistic regression analysis revealed that the incidence of GI bleed (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.62-1.35, P = .66) and stroke (OR: 0.77, 95% CI: 0.57-1.05, P = .10) was similar between warfarin and DOAC users. However, there was a trend toward lower ICH in the DOAC group (OR: 0.60, 95% CI: 0.36-1.01, P = .06). CONCLUSIONS: Prescription rate of DOACs for nonvalvular AF has increased significantly, with apixaban being the most commonly used agent. Patients with higher CHA2DS2-VASc score (≥3) are prescribed DOACs less often than warfarin. The reason for this discrepancy is unclear. Given the favorable risk-benefit profile of DOACs, further studies are needed to identify factors that determine anticoagulant selection in patients with AF with high thromboembolic risk.

14.
J Cardiovasc Electrophysiol ; 30(1): 92-101, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30288838

RESUMO

INTRODUCTION: Catheter ablation (CA) has emerged as the preferred modality of treatment for many cardiac arrhythmias. Anatomical sites of ablation are often located in close proximity to coronary arteries. However, the incidence of CA-related coronary injury has not been well studied. We sought to systematically evaluate all cases of CA-related coronary injuries. METHODS AND RESULTS: A PubMed search was conducted from inception until May 1, 2017 using the keywords "coronary artery" and "ablation." We identified 2817 published articles of which 43 articles met our inclusion criteria representing 61 cases of coronary artery injury attributed to CA procedures from 1992 to 2017. Posteroseptal accessory pathway ablation was associated with the highest incidence of coronary injury (35.6% of cases), followed by cavotricuspid isthmus-dependent flutter (19.3%). The right coronary artery was the site of injury in over two-thirds of all reported cases. Coronary injury was detected intraprocedurally in about half of the cases (43.1%), whereas it was a delayed presentation in the other half. Coronary intervention was performed in a third of all cases (32.7%). There were a total of three deaths attributed to coronary artery injury. CONCLUSIONS: Most (91.8%) coronary injuries are a result of anatomic proximity to the site of ablation. Awareness of the relation between coronary artery course and anatomical site of ablation could prevent myocardial damage and improve procedural safety.


Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/efeitos adversos , Vasos Coronários/lesões , Traumatismos Cardíacos/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Adulto , Idoso , Arritmias Cardíacas/mortalidade , Ablação por Cateter/mortalidade , Vasos Coronários/diagnóstico por imagem , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade
15.
Int J Mol Sci ; 19(12)2018 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-30469489

RESUMO

Fish and commercially available fish oil preparations are rich sources of long-chain omega-3 polyunsaturated fatty acids. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the most important fatty acids in fish oil. Following dietary intake, these fatty acids get incorporated into the cell membrane phospholipids throughout the body, especially in the heart and brain. They play an important role in early brain development during infancy, and have also been shown to be of benefit in dementia, depression, and other neuropsychiatric disorders. Early epidemiologic studies show an inverse relationship between fish consumption and the risk of coronary heart disease. This led to the identification of the cardioprotective role of these marine-derived fatty acids. Many experimental studies and some clinical trials have documented the benefits of fish oil supplementation in decreasing the incidence and progression of atherosclerosis, myocardial infarction, heart failure, arrhythmias, and stroke. Possible mechanisms include reduction in triglycerides, alteration in membrane fluidity, modulation of cardiac ion channels, and anti-inflammatory, anti-thrombotic, and anti-arrhythmic effects. Fish oil supplements are generally safe, and the risk of toxicity with methylmercury, an environmental toxin found in fish, is minimal. Current guidelines recommend the consumption of either one to two servings of oily fish per week or daily fish oil supplements (around 1 g of omega-3 polyunsaturated fatty acids per day) in adults. However, recent large-scale studies have failed to demonstrate any benefit of fish oil supplements on cardiovascular outcomes and mortality. Here, we review the different trials that evaluated the role of fish oil in cardiovascular diseases.


Assuntos
Anti-Inflamatórios/uso terapêutico , Cardiotônicos/uso terapêutico , Ácidos Graxos Ômega-3/uso terapêutico , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/farmacologia , Cardiotônicos/administração & dosagem , Cardiotônicos/efeitos adversos , Cardiotônicos/farmacologia , Ensaios Clínicos como Assunto , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/efeitos adversos , Ácidos Graxos Ômega-3/farmacologia , Humanos
16.
Heart Rhythm ; 15(9): 1283-1288, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30170662

RESUMO

BACKGROUND: The role of obstructive sleep apnea (OSA) on the response to cardiac resynchronization therapy (CRT) and all-cause mortality in patients with advanced heart failure (HF) is unknown. OBJECTIVE: We assessed the association between OSA, response to CRT, and all-cause mortality in patients with HF. METHODS: We analyzed records of 548 consecutive patients (mean age 65 ± 13 years; 216 (39%) women; mean follow-up period 76 ± 17 months) who received a CRT-defibrillator device from January 15, 2007 to March 30, 2016 at our tertiary care referral center. RESULTS: A total of 180 patients (33%) had OSA. Fewer patients in the OSA group (109 [61%]) had improvement in left ventricular ejection fraction (EF) than did those in the non-OSA group (253 [69%]) (P = .001). A total of 144 patients (27%) died by the end of follow-up (OSA group: 61 [33%]; non-OSA group 83 [23%]; P < .001). OSA diagnosis was associated with a lower chance of improvement in EF (hazard ratio 0.71; 95% confidence interval 0.60-0.89) and a higher risk of all-cause mortality (hazard ratio 3.7; 95% confidence interval 2.5-6.8). This was true in continuous positive airway pressure-compliant patients and in patients with nonischemic cardiomyopathy. However, among patients with ischemic cardiomyopathy, the chance of improvement in EF and all-cause mortality was similar in patients with OSA and those without OSA. CONCLUSION: OSA is associated with a decreased response to CRT and an increase in all-cause mortality in patients with HF. The differential effect of OSA on CRT response in patients with ischemic cardiomyopathy and nonischemic cardiomyopathy needs further study.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Causas de Morte/tendências , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/mortalidade , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
17.
Turk Kardiyol Dern Ars ; 46(6): 514-515, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30204150
18.
Am J Cardiol ; 122(5): 723-728, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30064860

RESUMO

Fractional flow reserve (FFR) has been shown to improve clinical decision-making for revascularization in intermediate coronary stenosis in native coronary arteries of patients with stable coronary disease. However, its use for saphenous vein graft (SVG) lesions has not been well validated. We sought to determine the prognostic value of deferring intervention in lesions with FFR >0.8 in SVG lesions. Clinical, angiographic, and hemodynamic variables and long-term outcomes were recorded in consecutive patients in whom percutaneous coronary intervention was deferred based on an FFR >0.8 for intermediate native coronary artery or SVG stenosis. Thirty-three patients underwent FFR of SVG lesions and were compared with 532 patients who underwent native vessel FFR during the same period. There were no differences in age (66.6 [interquartile range, IQR 63 to 76] vs 65 years [IQR 61 to 70]; p = 0.12), diabetes (41% vs 50%; p = 0.35), or hypertension (94% vs 97%; p = 0.71). During a median follow-up of 3.2 years (IQR 1.7 to 4.6 years) major adverse cardiac event was significantly higher in SVG group (36% vs 21%; log rank p = 0.01). Similarly, the rate of target vessel failure was significantly higher in the SVG group (27% vs 14%; p = 0.01). Deferred SVG lesions had the worst survival free of target vessel failure compared with deferred native lesions in both patients with and without previous CABG. An SVG lesion was an independent predictor of major adverse cardiac events on Cox proportional hazards analysis (hazard ratio 2.26; confidence interval 1.19, 4.28; p = 0.01). In conclusion, nonischemic FFR carries a significantly worse prognosis in SVG compared with non-SVG lesions. Caution is warranted in utilizing FFR for clinical decision-making in SVG lesions.


Assuntos
Estenose Coronária/cirurgia , Reserva Fracionada de Fluxo Miocárdico , Oclusão de Enxerto Vascular/cirurgia , Veia Safena/transplante , Idoso , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
19.
J Cardiovasc Electrophysiol ; 29(10): 1425-1435, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30016005

RESUMO

BACKGROUND: The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. METHODS AND RESULTS: Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Mechanical complications (5.9%) were the commonest, followed by cardiovascular (3.6%), respiratory failure (2.4%), and pneumothorax (1.5%). Age (≥65 years), female gender (OR, 95% CI; P value) (1.08, 1.03-1.13; 0.001), and the Charlson score ≥3 (1.52, 1.45-1.60; <0.001) were significantly associated with increased mortality/complications. CONCLUSIONS: The overall complication rate in patients undergoing CRT-D has been increasing in the last decade. Age (≥65), female sex, and the Charlson score ≥3 were associated with higher complications. In patients who underwent CRT-D implantation, postoperative complications were associated with significant increases in cost.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/economia , Terapia de Ressincronização Cardíaca/economia , Desfibriladores Implantáveis/economia , Cardioversão Elétrica/economia , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Custos Hospitalares , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Terapia de Ressincronização Cardíaca/tendências , Dispositivos de Terapia de Ressincronização Cardíaca/tendências , Comorbidade , Bases de Dados Factuais , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Cardioversão Elétrica/tendências , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Custos Hospitalares/tendências , Mortalidade Hospitalar , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
20.
Turk Kardiyol Dern Ars ; 46(4): 242-247, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29853691

RESUMO

OBJECTIVE: Wound dehiscence (WD) has been reported as a complication in 0.3% of cardiac implantable electronic device (CIED) procedures. Stapling has not previously been reported as a treatment modality for WD. Presently described is the experience of a single center with WD and its management. METHODS: A retrospective chart review of all patients who underwent CIED implantation between 2009 and 2016, a total of 759 devices, was performed. RESULTS: There were a total of 11 (1.4%) patients with WD. The majority 9/11 patients were female, 5 of 11 (45.5%) had diabetes, and 2 of the 11 patients were immunocompromised due to recent chemotherapy. WD occurred in 6 patients after generator change, in 2 patients after a biventricular device upgrade, in 1 patient after biventricular implantable cardioverter defibrillator (ICD) implantation, in 1 patient after dual-chamber pacemaker implantation, and in 1 patient after subcutaneous ICD implantation. The median time of WD was 6 weeks post procedure (range: 1-20 weeks). In all of the patients, wound stapling was performed under sterile conditions after administering intravenous narcotic analgesics. Eight patients received intravenous antibiotics and all patients received at least 2 weeks of oral antibiotics. Blood cultures were negative in 8/11 (72.7%) patients. However, the wound cultures in 5 patients were positive. The staples were removed in a median of 16 days (range: 9-36 days). All of these patients were successfully treated with stapling and none of the devices required extraction. CONCLUSION: Stapling under sterile conditions may be an acceptable treatment strategy to manage WD after device implantation. This can be performed as an outpatient procedure and can help avoid unnecessary device extraction.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Grampeamento Cirúrgico , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Deiscência da Ferida Operatória/patologia
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