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1.
Acta Clin Croat ; 58(2): 391-393, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31819339

RESUMO

We present a case of a 64-year-old female patient scheduled for implantable cardioverter defibrillator (ICD) implantation due to arrhythmogenic right ventricular cardiomyopathy (ARVC). Dual coil, active fixation ICD lead was introduced through the axillary vein. More than 20 positions were changed in the right ventricle (RV) (outflow tract, high, mid and apical septum, infero-basal, apical and lateral wall). Maximum R wave amplitude was 2 mV with pacing threshold of 0.5 V. Since the sensing was inappropriate, we decided to place the pace/sense lead of the ICD in the coronary sinus. The lead was placed in the basal part of the lateral vein. The pacing threshold was 1.0 V/0.40 ms and R wave was 9 mV. The lead was connected to the ICD sense-pace port and high voltage coils were connected in the usual way. The RV sense-pace lead was capped off. The device sensed an R wave of 7.0 mV 48 hours later. The purpose of this report is to show a possible solution of sensing problems during an ICD implantation in a patient with ARVC.

2.
Sci Rep ; 9(1): 11502, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395917

RESUMO

Diet rich in lipids and hyperlipidaemia increases incidence of atrial premature beats and all supraventricular arrhythmias. The aim of the study was to investigate the prevalence of hyperlipidaemia in patients with AV re-entry tachycardia (AVRT) and AV nodal re-entry tachycardia (AVNRT). We conducted a retrospective, cross-sectional, case-control study that included all consecutive patients for whom AVRT or AVNRT was confirmed during electrophysiology study. Age and gender-matched patients admitted to hospital or outpatient clinic for various reasons were randomly included and served as a control group. Hyperlipidaemia was defined according to 2016 European Society of Cardiology guidelines. A total of 1448 subjects were included: 725 patients with AVRT/AVNRT and 723 controls. AVRT/AVNRT patients had high hyperlipidaemia prevalence, which was significantly higher when compared to the control group (50.1 vs. 35.8%, p < 0.001). AVRT patients, with median age of 37.5 years, had hyperlipidaemia prevalence of 45.7%. In a multivariate analysis, hyperlipidaemia was independently associated with AVRT/AVNRT (OR 2.128, p < 0.001), both with AVNRT (OR 1.878, p < 0.001) and AVRT (OR 2.786, p < 0.001). Hypercholesterolemia was significantly more prevalent in patients with AVNRT and AVRT, while this was not the case for hypertriglyceridemia. There were no differences between the AVRT and AVNRT patients regarding hyperlipidaemia prevalence (51.9 vs. 45.7%, p = 0.801), even though AVRT patients were significantly younger (37.5 vs. 48.5, p < 0.001). In conclusion, this is the first study that investigated hyperlipidaemia prevalence in patients with AVRT or AVNRT. AVRT/AVNRT patients had higher prevalence of hyperlipidaemia and higher total and LDL cholesterol levels.

3.
Acta Clin Croat ; 58(1): 95-102, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363330

RESUMO

The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF <50% after 12 months. The study included 47 patients, median age 59±10 years, 74.5% of them men. Patients who developed systolic dysfunction (LVEF <50%) had significantly higher mean values of cTnT after 24 hours (5.11 vs. 2.82 µg/L, p=0.010) and peak values of CK (3375.5 vs. 1865 U/L, p=0.008). There was no significant relation between hsCRP and development of reduced LVEF (p=0.541). In conclusion, cTnT and CK could serve as long-term predictors of reduced left ventricular systolic function (<50%) in acute STEMI patients with normal systolic function at admission, single-vessel coronary disease and complete revascularization during primary PCI.


Assuntos
Proteína C-Reativa/análise , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo , Troponina T/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Tempo , Função Ventricular Esquerda
4.
Case Rep Cardiol ; 2019: 7979316, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093381

RESUMO

Background: Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary: We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion: There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization.

5.
Nutr Metab Insights ; 12: 1178638819833705, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30923440

RESUMO

Nutritional considerations of many chronic diseases are not fully understood or taken into consideration in everyday clinical practice. Therefore, it is not surprising that high proportion of hospitalized patients with cardiovascular diseases remains underdiagnosed with malnutrition. Malnourished patients have increased risk of poor clinical outcomes, complications rate, prolonged hospital stay, more frequent rehospitalizations, and lower quality of life. The purpose of this review is to recapitulate recent data on nutritional considerations in cardiovascular medicine.

6.
Acta Clin Croat ; 57(2): 383-390, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30431735

RESUMO

Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients.


Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Assistência Perioperatória , Croácia , Humanos
7.
Indian Pacing Electrophysiol J ; 15(5): 245-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-27134441

RESUMO

We report the case of a 46-year old patient in whom an electrophysiology study (EP) was performed due to paroxysmal supraventricular tachycardia documented in 12-lead ECG. During the EP study, supraventricular tachycardia was induced easily and it corresponded to orthodromic AV reentry tachycardia (AVRT) using a concealed left free wall accessory pathway. However, during the study AVRT spontaneously and repeatedly converted to the typical slow-fast AV node reentry tachycardia (AVNRT). Both accessory and AV nodal slow pathways were ablated, due to the finding that both AVRT and AVNRT were independently inducible during the EP study.

8.
Acta Clin Croat ; 53(4): 490-3, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25868319

RESUMO

Patent foramen ovale (PFO) can be found in approximately 25% of adult population. Transcatheter closure of PFO is a potential option in selected patients with PFO. We report a case of a female patient that underwent mapping and catheter ablation of atrial tachycardia and PFO closure in the same procedure.


Assuntos
Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/métodos , Ablação por Cateter/métodos , Forame Oval Patente/cirurgia , Taquicardia Supraventricular/cirurgia , Fibrilação Atrial/etiologia , Feminino , Forame Oval Patente/complicações , Átrios do Coração/patologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
9.
Cardiol Res ; 4(2): 64-67, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28352422

RESUMO

BACKGROUND: Persistent left superior vena cava (LSVC) is a rare congenital venous anomaly that may be found at the time of cardiac device lead insertion. METHODS: In this case series, we present clinical and long-term data of five patients with LSVC who underwent pacemaker (PM) or cardioverter defibrillator (ICD) implantation during the period of 10 years. RESULTS: Left-sided venous approach was used for device implantation in 3 patients with standard PM indications, whereas a right-sided venous approach and an epicardial approach had to be used in 2 patients who needed an ICD and biventricular PM, respectively. In post implantation period of 44 ± 29 months, one patient died due to stroke, one underwent heart transplantation, and 3 had atrial fibrillation. CONCLUSION: The long-term outcome of patients with persistent LSVC and implanted cardiac devices is mostly influenced by the presence of underlying heart disease.

10.
Pacing Clin Electrophysiol ; 35(6): 695-702, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22452373

RESUMO

BACKGROUND: The prognostic significance of development of persistent atrial fibrillation (AF) in patients with atrioventricular (AV) block and dual chamber (DDD) pacemakers has not been separately investigated. We sought to determine whether persistent AF influences clinical outcome in these patients. METHODS: Three hundred-eight consecutive patients with second- or third-degree AV block and implanted a DDD pacemaker were followed for 36 ± 20 months and retrospectively divided into two groups. Thirty-four patients who developed persistent AF formed persistent AF group, and 278 patients who remained free of this arrhythmia control group. Clinical and outcome data of the two groups were compared. The primary outcome was cardiovascular death. RESULTS: The primary outcome occurred more often among the patients in the persistent AF group (6.8% per year) than among those in the control group (2.9% per year; P = 0.028). This difference was primarily because of higher rate of heart failure-related deaths in the persistent AF group (P = 0.009). Secondary outcomes, hospitalization for heart failure and paroxysmal AF episode ≥5 minutes, occurred also more often among the patients in the persistent AF group (P = 0.008 and P < 0.001, respectively), although the risk of nonfatal stroke was similar in both groups (P = 0.628). CONCLUSION: In patients with second- or third-degree AV block and DDD pacemaker, the development of persistent AF is associated with an increased risk of cardiovascular death and heart failure.


Assuntos
Fibrilação Atrial/mortalidade , Fibrilação Atrial/prevenção & controle , Bloqueio Atrioventricular/mortalidade , Bloqueio Atrioventricular/prevenção & controle , Dispositivos de Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Morte Súbita Cardíaca/epidemiologia , Idoso , Doença Crônica , Comorbidade , Croácia/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Medição de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
11.
Croat Med J ; 52(1): 61-7, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21328722

RESUMO

AIM: To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. METHODS: Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average ±standard deviation 23 ± 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. Results. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation. CONCLUSION: In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and intracardial atrial signal amplitude were predictors after 18 months.


Assuntos
Fibrilação Atrial , Bloqueio Atrioventricular/complicações , Eletrocardiografia , Sistema de Condução Cardíaco , Hipertensão/complicações , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Feminino , Seguimentos , Sistema de Condução Cardíaco/patologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Incidência , Masculino , Fatores de Risco
12.
Acta Clin Croat ; 50(4): 609-13, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22649895

RESUMO

While drug eluting stents (DES) are being more widely used in ever more patients receiving DES each day, some new complications may be emerging. Stent fractures and hypersensitivity reactions to stents are among recognized complications that can lead to therapeutic dead end from the interventional cardiologist's point of view. We present a case in which we reached therapeutic dead end with a sirolimus eluting stent, i.e. repetitive stent fractures with diffuse microaneurysms along the implanted DES, possibly due to hypersensitivity reaction to parts of the stent.


Assuntos
Aneurisma Coronário/etiologia , Hipersensibilidade a Drogas/complicações , Stents Farmacológicos/efeitos adversos , Falha de Equipamento , Hipersensibilidade Tardia/complicações , Sirolimo/efeitos adversos , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
13.
Acta Clin Croat ; 49(1): 25-31, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20635581

RESUMO

The aim of this prospective, non-randomized interventional study was to assess electrophysiological effects, efficacy and safety of intravenous propafenone in termination of atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic atrioventricular reentrant tachycardia (AVRT). This single-center study was carried out at Department of Cardiology, Sestre milosrdnice University Hospital in Zagreb, Croatia, between January 1, 2005 and December 31, 2006. Eligibility requirements were fulfilled by a total of 70 patients with AVNRT (n=37) and AVRT (n=33). The intervention consisted of the electrophysiological study aimed at inducing tachycardia, followed by intravenous administration of 2 mg/kg propafenone in both groups. The main outcome measures were safety and efficacy of 2 mg/kg intravenous propafenone in tachycardia termination and re-induction. Out of 37 patients with AVNRT, propafenone managed to terminate it in 28 (75.7%) patients, while tachycardia was not inducible in 25 (67.56%) patients. Out of 33 patients with AVRT, propafenone managed to terminate AVRT in 29 (87.9%) patients, while tachycardia was not inducible in 22 (66.66%) patients. The overall propafenone efficacy in tachycardia termination was 81.42%. No propafenone-related adverse effects were recorded during the study period. Propafenone was found to be a safe and effective anti-arrhythmic drug and can be justifiably administered for AVNRT and AVRT termination. It could be considered as an alternative to adenosine and verapamil.


Assuntos
Antiarrítmicos/administração & dosagem , Propafenona/administração & dosagem , Taquicardia por Reentrada no Nó Atrioventricular/tratamento farmacológico , Adolescente , Adulto , Idoso , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Infusões Intravenosas , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Adulto Jovem
14.
Croat Med J ; 50(5): 449-54, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19839068

RESUMO

AIM: To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. METHODS: Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (> or =50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. RESULTS: Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (> or =80 pg/mL) at 24 hours (P=0.001) and 7 days (P=0.020) after STEMI and successful reperfusion. Patients who had BNP levels > or =80 pg/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P=0.008). CONCLUSION: BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.


Assuntos
Angioplastia Coronária com Balão , Insuficiência Cardíaca Sistólica/sangue , Infarto do Miocárdio/sangue , Peptídeo Natriurético Encefálico/sangue , Biomarcadores/sangue , Croácia , Feminino , Seguimentos , Insuficiência Cardíaca Sistólica/diagnóstico , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/diagnóstico
15.
Coll Antropol ; 33(4): 1129-38, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20102058

RESUMO

Doppler can evaluate renal vascular resistance, and resistance index (RI) highly correlates with blood pressure and renal function in various pathological conditions. Purpose of the study was to measure and compare renal Doppler indices in patients with newly-diagnosed essential hypertension (EH) and in healthy subjects; to determine changes of Doppler indices in patients after six-months monotherapy with either the AT II blocker (valsartane) or calcium channel blocker (niphedipine); to determine which drug has better renoprotective effect. 65 healthy controls were examined, as well as 69 patients with the newly-diagnosed EH, without signs of the target organ damage. Duplex Doppler US of interlobar intrarenal arteries was performed, and RI, acceleration index (AI) and acceleration time (AT) measured. Antihypertensive monotherapy was performed with vaslartane in 34 patients and with niphedipine in 35 patients. Doppler was repeated after the six-months therapy. RI in patients with the 1. stage of EH is significantly higher compared to the controls (p < 0.001), and significantly lower compared to the stage 2. of EH (p < 0.001). The significant decrease of systolic (p < 0.001) and dyastolic blood pressure (BP) (p < 0.001) was noted after the therapy. RI in healthy examinees (RI = 0.59 +/- 0.023) is significantly lower than in EH (RI = 0.66 +/- 0.26) (p < 0.001), while AI is significantly higher (p < 0.001), and AT is significantly lower (p < 0.001). In patients treated with valsartane and those treated with niphedipine, the RIs are significantly lower than before (p < 0.001), while AIs were significantly higher, and ATs were significantly lower after the therapy after the therapy with both drugs. RIs in patients treated with valsartane (RI = 0.615 +/- 0.036) are significantly lower than RIs of patients treated with niphedipine (RI = 0.642 +/- 0.030) (p < 0.01) after therapy. Regression analysis for the predictive values of RI, AT, AI in relation to the age-standardized values of systolic and diastolic BP of healthy examinees and patients with hypertension has demonstrated that RI is the strongest and statistically significant predictor in all groups of examinees. Six-months monotherapy of EH with valsartane or with niphedipine is equally efficient in the decrease of the blood pressure, but valsartane has more favourable effect on kidney. Resistance index measured in intrarenal arteries is the best parameter of Doppler spectrum in the evaluation of the effects of antihypertensive therapy on the kidney.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores dos Canais de Cálcio/farmacologia , Hipertensão Renovascular/prevenção & controle , Hipertensão/tratamento farmacológico , Tetrazóis/farmacologia , Valina/análogos & derivados , Adulto , Croácia , Feminino , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Rim/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Ultrassonografia Doppler Dupla , Valina/farmacologia , Valsartana , Resistência Vascular
16.
Croat Med J ; 46(6): 922-8, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16342345

RESUMO

AIM: To compare ventricular rate responsive (VVIR) pacing with dual chamber rate responsive (DDDR) pacing and antiarrhythmic drugs for the treatment of patients with persistent atrial fibrillation after atrioventricular node ablation. METHODS: One hundred two patients with persistent atrial fibrillation eligible for the atrioventricular node ablation were randomly assigned to the therapy with either VVIR pacemaker (n=52) or DDDR pacemaker and antiarrhythmic drugs (n=50). After ablation, patients in both pacing groups were assigned to take anticoagulant therapy. The primary end point was stroke or death from cardiovascular causes. RESULTS: After a mean follow-up of 26.6+/-9.5 months, there was no difference in the stroke or death rates between patients with VVIR pacing (6 or 5.2% per year) and those with DDDR pacing and antiarrhythmic drugs (6 or 5.9% per year, P=0.930). The observed rates of death from all causes, hospitalization for heart failure, and myocardial ischemia were similar in the two patient groups. There was a significantly lower rate of development of permanent atrial fibrillation in patients with DDDR pacing and antiarrhythmic drugs, with a reduction in absolute risk by 56% and relative risk by 64% (32% vs 88%; P<0.001). CONCLUSION: With respect to cardiovascular death and morbidity, VVIR pacing is not inferior to DDDR pacing and antiarrhythmic drugs for the treatment of patients with persistent atrial fibrillation after atrioventricular node ablation and may be considered as an appropriate therapy for such patients.


Assuntos
Fibrilação Atrial/terapia , Nó Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Ablação por Cateter/efeitos adversos , Ventrículos do Coração/fisiopatologia , Fibrilação Atrial/etiologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Croat Med J ; 46(6): 929-35, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16342346

RESUMO

AIM: To evaluate prospectively the impact of atrioventricular (AV) node ablation and consequent pacing therapy on clinical course in patients with permanent atrial fibrillation and unstable ventricular tachycardia induced by rapid ventricular response. METHODS: One hundred four patients with permanent atrial fibrillation and uncontrolled ventricular rate resistant to drug therapy underwent radiofrequency catheter ablation of the AV node and permanent pacemaker implantation. At baseline examination, 14 of them had unstable ventricular tachycardia induced by rapid ventricular response of atrial fibrillation (ventricular tachycardia group). The remaining 90 patients did not have this type of ventricular tachycardia (control group). After the ablation, all patients were followed-up without antiarrhythmic agents. The primary end point was sudden cardiac death. RESULTS: Before the ablation, patients in ventricular tachycardia group had lower left ventricular ejection fraction (P<0.013), and higher ventricular rate at rest and during daily activities (P<0.001). During the follow up of 20+/-8 months (mean+/-standard deviation), the mortality rate of sudden cardiac death at two years was similar among the two groups (7% vs 5%, P=0.703). The observed cardiac and all-cause mortality were significantly higher in ventricular tachycardia group (21% vs 3.6%, P=0.014; 28.5% vs 4.4%, P=0.038; respectively) due to increased heart failure-related mortality (P=0.013). CONCLUSION: In patients with permanent atrial fibrillation and ventricular tachycardia induced by rapid ventricular response, AV node ablation and pacing therapy have beneficial effect in the elimination of this arrhythmia. It seems that these patients do not need a cardioverter defibrillator therapy.


Assuntos
Fibrilação Atrial/terapia , Nó Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial , Ablação por Cateter , Taquicardia Ventricular/terapia , Fibrilação Atrial/mortalidade , Feminino , Seguimentos , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Volume Sistólico , Taquicardia Ventricular/mortalidade , Fatores de Tempo
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