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2.
J Electrocardiol ; 59: 7-9, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31931468

RESUMO

We report the first case of syncope with a documented asystole in a child triggered by hair grooming. No pathological findings were found, and a 15 s asystole event was recorded in an ambulatory 24 h electrocardiogram while her mother was combing her hair. Syncope by hair grooming is an infrequent type, reported in 162 patients. It is more prevalent in females (84.6% vs. 15.4%) with a mean age in the range of 8.9-12.3 years. The diagnostic is based on clinical history and the most frequent complementary examination is the electrocardiogram. No significant arrythmias or epileptic events have been reported.

4.
Interact Cardiovasc Thorac Surg ; 30(1): 136-143, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31873745

RESUMO

OBJECTIVES: The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. METHODS: Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. RESULTS: Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). CONCLUSIONS: Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.

5.
Eur Heart J ; 40(35): 2953-2961, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31145795

RESUMO

AIMS: In patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), implantable cardioverter-defibrillator (ICD) shocks are sometimes ineffective and may even trigger fatal electrical storms. We assessed the efficacy and complications of ICDs placed in patients with CPVT who presented with a sentinel event of sudden cardiac arrest (SCA) while undiagnosed and therefore untreated. METHODS AND RESULTS: We analysed 136 patients who presented with SCA and in whom CPVT was diagnosed subsequently, leading to the initiation of guideline-directed therapy, including ß-blockers, flecainide, and/or left cardiac sympathetic denervation. An ICD was implanted in 79 patients (58.1%). The primary outcome of the study was sudden cardiac death (SCD). The secondary outcomes were composite outcomes of SCD, SCA, appropriate ICD shocks, and syncope. After a median follow-up of 4.8 years, SCD had occurred in three patients (3.8%) with an ICD and none of the patients without an ICD (P = 0.1). SCD, SCA, or appropriate ICD shocks occurred in 37 patients (46.8%) with an ICD and 9 patients (15.8%) without an ICD (P < 0.0001). Inappropriate ICD shocks occurred in 19 patients (24.7%) and other device-related complications in 22 patients (28.9%). CONCLUSION: In previously undiagnosed patients with CPVT who presented with SCA, an ICD was not associated with improved survival. Instead, the ICD was associated with both a high rate of appropriate ICD shocks and inappropriate ICD shocks along with other device-related complications. Strict adherence to guideline-directed therapy without an ICD may provide adequate protection in these patients without all the potential disadvantages of an ICD.

6.
An. pediatr. (2003. Ed. impr.) ; 90(2): 94-101, feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177220

RESUMO

Introducción: Presentamos el trabajo "situación actual de la organización, recursos y actividad en cardiología pediátrica en España", promovido por la Sociedad Española de Cardiología Pediátrica y Cardiopatía Congénitas. Material y métodos: El estudio se elaboró con los resultados obtenidos de un cuestionario elaborado por la Sociedad Española de Cardiología Pediátrica y Cardiopatía Congénitas, remitido a todos los hospitales del territorio nacional con actividad en cardiología pediátrica. Resultados: Ochenta y seis respondieron el cuestionario, 14 de los cuales disponen de cirugía cardíaca infantil. Los recursos humanos incluyen 190 médicos, 40 cirujanos y 27 MIR. Todos los hospitales disponen de material para el diagnóstico inicial adecuado, y solo los hospitales terciarios disponen de técnicas de diagnóstico específico, cardiología intervencionista y cirugía cardíaca. La atención a los pacientes, en consulta externas y en la hospitalización es realizada o supervisada mayoritariamente por cardiólogos pediátricos. Existe diversidad en los profesionales que realizan las ecocardiografías fetales, ya que en un porcentaje considerable de hospitales sigue siendo realizada en exclusiva por los obstetras. El número de procedimientos diagnósticos y terapéuticos fueron similares al registro previo, con un leve descenso de cirugía cardíaca cerrada y un aumento proporcional de cateterismos terapéuticos. Conclusiones: La cardiología pediátrica en España es realizada por pediatras con formación en cardiología pediátrica mayoritariamente. La mayoría de los centros disponen de medios adecuados de diagnóstico, y solo los hospitales terciarios cuentan con técnicas de diagnóstico específico, cardiología intervencionista y cirugía cardíaca. En futuros estudios, debemos no únicamente cuantificar las técnicas de diagnóstico y tratamiento sino también, aspirar a la cuantificación de resultados clínicos


Introduction: The results are presented on the "current situation of the organisation, resources and activity in paediatric cardiology in Spain". It was promoted by the Spanish Society of Paediatric Cardiology and Congenital Heart disease. Material and methods: An analysis was carried out on the results obtained from a specifically designed questionnaire, prepared by the Spanish Society of Paediatric Cardiology and Congenital Heart disease, that was sent to all hospitals around the country that offer the speciality of paediatric cardiology. Results: A total of 86 questionnaires were obtained, including 14 hospitals that perform cardiac surgery on children. A total of 190 paediatric cardiology consultants, 40 cardiac surgeons, and 27 middle grade doctors performing their paediatric residency (MIR program) were identified. All hospitals had adequate equipment to perform an optimal initial evaluation of any child with a possible cardiac abnormality, but only tertiary centres could perform complex diagnostic procedures, interventional cardiology, and cardiac surgery. In almost all units around the country, paediatric cardiology consultants were responsible for outpatient clinics and hospital admissions, whereas foetal cardiology units were still mainly managed by obstetricians. The number of diagnostic and therapeutic procedures was similar to those reported in the first survey, except for a slight decrease in the total number of closed cardiac surgery procedures, and a proportional increase in the number of therapeutic catheterisations. Conclusions: Paediatric Cardiology in Spain is performed by paediatric cardiology consultants that were trained initially as general paediatricians, and then completed a paediatric cardiology training period. Almost all units have adequate means for diagnosis and treatment. Efforts should be directed to create a national registry that would not only allow a prospective quantification of diagnostic and therapeutic procedures, but also focus on their clinical outcomes


Assuntos
Humanos , Pediatria , Pediatria/organização & administração , Cardiopatias Congênitas/epidemiologia , Registros , Sociedades Médicas/organização & administração , Inquéritos e Questionários , Cardiologistas , Eletrofisiologia
7.
An Pediatr (Barc) ; 90(2): 94-101, 2019 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-29706438

RESUMO

INTRODUCTION: The results are presented on the «current situation of the organisation, resources and activity in paediatric cardiology in Spain¼. It was promoted by the Spanish Society of Paediatric Cardiology and Congenital Heart disease. MATERIAL AND METHODS: An analysis was carried out on the results obtained from a specifically designed questionnaire, prepared by the Spanish Society of Paediatric Cardiology and Congenital Heart disease, that was sent to all hospitals around the country that offer the speciality of paediatric cardiology. RESULTS: A total of 86 questionnaires were obtained, including 14 hospitals that perform cardiac surgery on children. A total of 190 paediatric cardiology consultants, 40 cardiac surgeons, and 27 middle grade doctors performing their paediatric residency (MIR program) were identified. All hospitals had adequate equipment to perform an optimal initial evaluation of any child with a possible cardiac abnormality, but only tertiary centres could perform complex diagnostic procedures, interventional cardiology, and cardiac surgery. In almost all units around the country, paediatric cardiology consultants were responsible for outpatient clinics and hospital admissions, whereas foetal cardiology units were still mainly managed by obstetricians. The number of diagnostic and therapeutic procedures was similar to those reported in the first survey, except for a slight decrease in the total number of closed cardiac surgery procedures, and a proportional increase in the number of therapeutic catheterisations. CONCLUSIONS: Paediatric Cardiology in Spain is performed by paediatric cardiology consultants that were trained initially as general paediatricians, and then completed a paediatric cardiology training period. Almost all units have adequate means for diagnosis and treatment. Efforts should be directed to create a national registry that would not only allow a prospective quantification of diagnostic and therapeutic procedures, but also focus on their clinical outcomes.


Assuntos
Cardiologia/organização & administração , Recursos em Saúde/estatística & dados numéricos , Pediatria/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Cardiologia/educação , Cardiologia/estatística & dados numéricos , Criança , Humanos , Pediatria/educação , Pediatria/estatística & dados numéricos , Sociedades Médicas , Espanha
8.
J Cardiovasc Electrophysiol ; 30(3): 448-456, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30556327

RESUMO

BACKGROUND: Radiofrequency ablation (RF) of ventricular tachycardia (VT) due to intramural foci has a high recurrence rate. Several techniques, such as bipolar ablation, irrigated needle ablation catheter, and retrograde coronary venous ethanol ablation have been suggested. Transarterial coronary ethanol ablation (TCEA) can also be effective. We present a case series of TCEA guided with preprocedural imaging to correlated coronary arteries and the intramural substrate. METHODS AND RESULTS: We present three consecutive patients with previous RF of septal VT (100% male; age, 72.6 ± 11.01 years; two patients with hypertrophic cardiomyopathy, one with mechanical aortic valve prosthesis) that underwent TCEA. Cardiac magnetic resonance was performed in two patients and cardiac CT in all patients. Correlation of septal arteries with intramural substrate was analyzed before the procedure so TCEA was attempted according to this analysis. After last TCEA (6.3 ± 2.08 months) the VT burden was reduced in all patients (sum of all implantable cardioverter-defibrillator therapies [antitachycardia pacing and shock] before and after TCEA, 15.8 ± 3.73 vs 0.97 ± 0.63 therapies/month; P = 0.02). No complications occurred during TCEA. CONCLUSIONS: TCEA completely guided with previous magnetic resonance imaging and computed tomography scan to select the coronary artery in relation to the substrate seems to be feasible as an alternative strategy in cases of intramural VT refractory to RF ablation.

10.
Pediatr. catalan ; 78(4): 145-148, oct.-dic. 2018. ilus, tab
Artigo em Catalão | IBECS | ID: ibc-180199

RESUMO

Introducció: Les arrítmies ventriculars en l'edat pediàtrica poden presentar-se des de formes asimptomàtiques amb extrasístoles ventriculars aïllades fins a formes amb taquicàrdia ventricular sostinguda amb insuficiència i aturada cardíaques. La taquicàrdia ventricular idiopàtica infantil és una de les entitats clíniques dins d'aquest grup, amb unes característiques clíniques i de pronòstic diferenciades, i amb una evolució generalment benigna. Observació clínica: Presentem dos casos clínics neonatals amb taquicàrdia ventricular idiopàtica infantil. Tots dos van debutar en forma de taquicàrdia ventricular ben tolerada hemodinàmicament, però donada la freqüència d'aparició dels episodis es va decidir iniciar tractament antiarrítmic amb propranolol i, posteriorment, flecaïnida. En tots dos casos, al cap de 24-48 hores d'introducció de la flecaïnida es va observar un canvi a ritme sinusal i desaparició dels episodis de taquicàrdia ventricular. En el seguiment posterior no van presentar nous episodis arrítmics. Comentaris: El reconeixement de les característiques clíniques i electrocardiogràfiques és essencial per fer un diagnòstic i un tractament correctes d'aquesta malaltia, així com per establir el diagnòstic diferencial amb altres taquicàrdies ventriculars que presenten un pronòstic pitjor


Introducción: Las arritmias ventriculares en la edad pediátrica pueden presentar desde formas asintomáticas clínicas con extrasístoles ventriculares aisladas hasta formas con taquicardia ventricular sostenida con insuficiencia cardíaca y paro cardíaco. La taquicardia ventricular idiopática infantil es una de las entidades clínicas dentro de este grupo, con unas características clínicas y de pronóstico diferenciadas y con una evolución generalmente benigna. Observación clínica: Presentamos dos casos clínicos neonatales con taquicardia ventricular idiopática infantil. Ambos debutaron en forma de taquicardia ventricular bien tolerada hemodinámicamente, pero dada la frecuencia de aparición de los episodios se decidió iniciar tratamiento antiarrítmico con propranolol y posteriormente flecainida. En ambos casos, a las 24-48 horas de introducción de la flecainida se observa paso a ritmo sinusal y desaparición de los episodios de taquicardia ventricular. En el seguimiento posterior no se observa reaparición de episodios arrítmicos. Comentarios: El reconocimiento de las características clínicas y electrocardiográficas es esencial para la correcta valoración y tratamiento de esta enfermedad, así como para el diagnóstico diferencial con otras taquicardias ventriculares que presentan un peor pronóstico


Introduction: Ventricular arrhythmias in children can present in a wide range of clinical manifestations, varying from patients that are completely asymptomatic with isolated ventricular ectopic beats to more severe forms with sustained ventricular tachycardia, heart failure and cardiac arrest. Infantile idiopathic ventricular tachycardia is one of the clinical entities within this group with different clinical characteristics and prognosis and with a generally benign evolution. Clinical observation: We present two cases of neonatal presentation of infantile idiopathic ventricular tachycardia. Both cases presented in the form of hemodynamically tolerated ventricular tachycardia, but given the frequency of occurrence of the episodes a decision was made to initiate antiarrhythmic treatment with propranolol and subsequently flecainide. In both cases, sinus rhythm and disappearance of episodes of ventricular tachycardia were documented at 24-48 hours of introduction of flecainide. Both patients had a complete resolution, with no recurrence of arrhythmic episodes on subsequent follow-up. Comments: The prompt recognition of the clinical and electrocardiographic characteristics is essential for the correct assessment and treatment of this disease, as well as for the differential diagnosis with other ventricular tachycardias that carry a worse prognosis


Assuntos
Humanos , Feminino , Recém-Nascido , Taquicardia Ventricular/diagnóstico , Eletrocardiografia/métodos , Propranolol/uso terapêutico , Diagnóstico Diferencial , Antiarrítmicos/uso terapêutico , Taquicardia Ventricular/classificação , Diagnóstico Pré-Natal
14.
Am J Cardiol ; 122(4): 672-682, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-30001804

RESUMO

Intra-atrial re-entrant tachycardia (IART) is a severe complication in patients with congenital heart disease (CHD). Cavotricuspid isthmus (CTI)-related IART is the most frequent mechanism. However, due to fibrosis and surgical scars, non-CTI-related IART is frequent. The main objective of this study was to describe the types of IART, circuit locations, and to analyze predictors of CTI versus non-CTI-related IART. This is an observational study that includes all consecutive patients with CHD who underwent a first IART ablation in a single referral tertiary hospital from January 2009 to December 2015 (94 patients; 39.4% women; age: 36.55 ± 14.9 years, 40.4% with highly complex cardiac disease). During the study, 114 IARTs were ablated (1.21 ± 0.41 IARTs per patient). CTI-related IART was the only arrhythmia in 51% (n = 48) of patients; non-CTI-related IART was the only mechanism in 27.7% (n = 26), and 21.3% of patients (n = 20) presented the two types of IART. Severe dilation of the systemic ventricle, absence of severe dilation of the venous atrium, highly complex cardiac defects, and nontypical electrocardiography (ECG) were related to non-CTI-related IART in univariate analysis. In multivariate analysis, nontypical ECG (odds ratio 3.64; 1.01 to 4.9; p = 0.049) and grade III CHD complexity (odds ratio 9.43; 1.44 to 11.7; p = 0.001) were predictors of non-CTI-related IART. In conclusion, in our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% (alone or with concomitant CTI-related IART). High-grade CHD complexity and nontypical ECG were strongly related to non-CTI IART.


Assuntos
Eletrocardiografia/métodos , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Cardiopatias Congênitas/complicações , Frequência Cardíaca/fisiologia , Taquicardia por Reentrada no Nó Sinoatrial/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Sinoatrial/diagnóstico , Taquicardia por Reentrada no Nó Sinoatrial/cirurgia , Adulto Jovem
16.
JACC Clin Electrophysiol ; 4(6): 771-780, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29929671

RESUMO

OBJECTIVES: The aim of this study was to analyze the long-term outcomes after intra-atrial re-entrant tachycardia (IART) ablation in congenital heart disease (CHD). BACKGROUND: IART increases morbidity and mortality in CHD patients. Radiofrequency catheter ablation has evolved into the first-line treatment of this complication. METHODS: This was a prospective, single-center study of all consecutive CHD patients who underwent first ablation for IART from January 2009 to December 2015 (n = 94, 39.4% female, age 36.55 ± 14.9 years, follow-up 44.45 ± 22.7 months). RESULTS: During the study period, 130 procedures were performed (n = 94, 1.21 ± 0.41 IART/patient). In the first procedure, 114 IART were ablated (short-term success 74.66%). Forty-nine percent of the patients whose IART was ablated had non-cavotricuspid isthmus (CTI)-related IART (alone or with concomitant CTI IART). After the first ablation, 54.3% maintained sinus rhythm (SR), 23.9% presented with recurrence of the ablated IART, 14.2% developed new IART, and 7.6% presented with atrial fibrillation (AF). After the second radiofrequency catheter ablation, 78.3% were in SR, 8.7% presented with AF, and 23.0% presented with IART (50% new IART). Multivariate predictors of recurrences were non-CTI IART (hazard ratio [HR]: 5.06; 95% confidence interval [CI]: 1.6 to 15.9; p = 0.006), PR interval >200 ms (HR: 4.02; 95% CI: 1.9 to 11.3; p = 0.009), AF induction (HR: 3.11; 95% CI: 1.1 to 9.1; p = 0.04). and previous AF (HR: 3.08; 95% CI: 1.1 to 9.3; p = 0.04). A risk score according multivariate model identified 3 levels of recurrence risk: 5.8%, 20%, and 58.5% (area under the receiver-operating characteristic curve 0.8 ± 0.03; p < 0.0001). CONCLUSIONS: Ablation of IART in CHD is a challenging procedure, but after ablation in experienced centers, SR can be maintained in 78.3%. Predictors of recurrences are non-CTI-related IART, long PR interval, and previous or induced AF. A risk score based on these factors can be useful for recurrence prediction.


Assuntos
Flutter Atrial , Ablação por Cateter , Cardiopatias Congênitas , Adulto , Flutter Atrial/epidemiologia , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/estatística & dados numéricos , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Adulto Jovem
18.
J Am Heart Assoc ; 7(7)2018 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-29602766

RESUMO

BACKGROUND: Intra-atrial re-entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first-line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD. METHODS AND RESULTS: The observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus-related IART was the only arrhythmia in 51%; non-cavotricuspid isthmus-related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9-17.9; P=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3-18.4; P=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4-17.2; P=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1-21.7; P=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74-0.93, P=0.001). After a mean follow-up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure). CONCLUSIONS: Although ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate-highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).


Assuntos
Fibrilação Atrial/complicações , Flutter Atrial/complicações , Cardiopatias Congênitas/complicações , Ablação por Radiofrequência/efeitos adversos , Taquicardia Supraventricular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Criança , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Falha de Tratamento , Adulto Jovem
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