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1.
J Am Heart Assoc ; 8(15): e012361, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31319747

RESUMO

Background Brugada syndrome and long-QT syndrome may account for at least one third of unexplained sudden cardiac deaths. Dental care in patients with cardiac channelopathies is challenging because of the potential risk of life-threatening events. We hypothesized that the use of local dental anesthesia with lidocaine with and without epinephrine is safe and does not result in life-threatening arrhythmias in patients with channelopathies. Methods and Results We performed a randomized, double-blind pilot trial comparing the use of 2% lidocaine without a vasoconstrictor and with 1:100 000 epinephrine in 2 sessions of restorative dental treatment with a washout period of 7 days (crossover trial). Twenty-eight-hour Holter monitoring was performed, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments were also conducted at 3 time points. Fifty-six dental procedures were performed in 28 patients (18 women, 10 men) with cardiac channelopathies: 16 (57.1%) had long-QT syndrome, and 12 (42.9%) had Brugada syndrome; 11 (39.3%) of patients had an implantable defibrillator. The mean age was 45.9±15.9 years. The maximum heart rate increased after the use of epinephrine during the anesthesia period from 82.1 to 85.8 beats per minute (P=0.008). In patients with long-QT syndrome, the median corrected QT was higher, from 450.1 to 465.4 ms (P=0.009) at the end of anesthesia in patients in whom epinephrine was used. The other measurements showed no statistically significant differences. No life-threatening arrhythmias occurred during dental treatment. Conclusions The use of local dental anesthesia with lidocaine, regardless of the use of a vasoconstrictor, did not result in life-threatening arrhythmias and appears to be safe in stable patients with cardiac channelopathies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03182777.

2.
J Electrocardiol ; 55: 45-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31078108

RESUMO

Brugada phenocopies are Brugada-like ECG patterns induced by reversible clinical conditions. Baranchuk and colleagues characterized this condition in 2012, and since then the phenomenon has been increasingly reported. It has the same pattern classification of Brugada syndrome (i.e., types 1 and 2), but differs substantially regarding etiology and prognosis. Awareness of Brugada phenocopies must be sought to help understanding the mechanisms of ion channel dysfunction and to avoid misdiagnosis and mistreatment of Brugada syndrome.

3.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.91-104.
Monografia em Português | LILACS | ID: biblio-1008935
4.
Front Pharmacol ; 9: 1052, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30298004

RESUMO

Thromboembolic events are associated with high mortality and morbidity indexes. In this context, warfarin is the most widely prescribed oral anticoagulant agent for preventing and treating these events. This medication has a narrow therapeutic range and, consequently, patients usually have difficulty in achieving and maintaining stable target therapeutics. Some studies on the literature about oral anticoagulant management showed that pharmacists could improve the efficiency of anticoagulant therapy. However, the majority of these studies included general patients retrospectively. The aim of this study was to prospectively evaluate a pharmacist's warfarin management in patients with poor quality of anticoagulation therapy (Time in the Therapeutic Range- TTR < 50%). We included 268 patients with atrial fibrillation (AF) and without stable dose of warfarin (TTR < 50%, based on the last three values of International Normalized Ratio-INR). We followed them up for 12 weeks, INR values were evaluated and, when necessary, the dose adjustments were performed. During the first four visits, patient's INR was measured every 7 days. Then, if INR was within the target therapeutic range (INR: 2-3), the patient was asked to return in 30 days. However, if INR was out the therapeutic target, the patient was asked to return in 7 days. Adherence evaluation was measured through questionnaires and by counting the pills taken. Comparison between basal TTR (which was calculated based on the three last INR values before prospective phase) and TTR of 4 weeks (calculated by considering the INR tests from visits 0 to 4, in the prospective phase of the study) and basal TTR and TTR of 12 weeks (calculated based on the INR tests from visits 0 to 12, in the prospective phase of the study) revealed significant statistical differences (0.144 ± 0.010 vs. 0.382 ± 0.016; and 0.144 ± 0.010 vs. 0.543 ± 0.014, p < 0.001, respectively). We also observed that the mean TTR of 1 year before (retrospective phase) was lower than TTR value after 12 weeks of pharmacist-driven treatment (prospective phase) (0.320 ± 0.015; 0.540 ± 0.015, p < 0.001). In conclusion, pharmaceutical care was able to improve TTR values in patients with AF and poor quality of anticoagulation with warfarin.

5.
PLoS One ; 13(5): e0196763, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29723224

RESUMO

AIM: Acute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as QTc dispersion (QTdc) and transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unclear whether breast cancer patients who undergo the ACT chemotherapy regimen of anthracycline (doxorubicin: A), cyclophosphamide (C) and taxane (T) may present with QTc, QTdc and DTpTe prolongation. METHODS: Twenty-three consecutive patients with breast cancer were followed prospectively during ACT chemotherapy and were analyzed according to their QT measurements. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), immediately after the first phase of anthracycline and cyclophosphamide (AC) treatment, and immediately after T treatment. Serum troponin and B-type natriuretic peptide (BNP) levels were also measured. RESULTS: Compared to baseline values, the QTc interval was significantly prolonged after the AC phase (439.7 ± 33.2 ms vs. 472.5 ± 36.3 ms, p = 0.001) and after T treatment (439.7 ± 33.2 ms vs. 467.9 ± 42.6 ms, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0-85.0] vs. 6.0 pg/mL [min-max: 6.0-22.0], p < 0.001) and after T treatment (25.0 pg/mL [min-max: 6.0-80.0] vs. 6.0 pg/mL [min-max: 6.0-22.0], p < 0.001) compared to baseline values. CONCLUSION: In this prospective study of patients with non-metastatic breast cancer who underwent ACT chemotherapy, significant QTc prolongation and an elevation in serum troponin levels were observed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Eletrocardiografia/efeitos dos fármacos , Sistema de Condução Cardíaco/efeitos dos fármacos , Cardiopatias/induzido quimicamente , Paclitaxel/efeitos adversos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias da Mama/sangue , Neoplasias da Mama/fisiopatologia , Cátions/sangue , Ciclofosfamida/administração & dosagem , Ciclofosfamida/farmacologia , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Doxorrubicina/farmacologia , Feminino , Seguimentos , Cardiopatias/sangue , Cardiopatias/fisiopatologia , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Paclitaxel/administração & dosagem , Paclitaxel/farmacologia , Estudos Prospectivos , Troponina I/sangue
6.
J Am Coll Cardiol ; 71(15): 1663-1671, 2018 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-29650123

RESUMO

BACKGROUND: Long QT syndrome (LQTS) is a common inheritable arrhythmogenic disorder, often secondary to mutations in the KCNQ1, KCNH2, and SCN5A genes. The disease is characterized by a prolonged ventricular repolarization (QTc interval) that confers susceptibility to life-threatening arrhythmic events (LAEs). OBJECTIVES: This study sought to create an evidence-based risk stratification scheme to personalize the quantification of the arrhythmic risk in patients with LQTS. METHODS: Data from 1,710 patients with LQTS followed up for a median of 7.1 years (interquartile range [IQR]: 2.7 to 13.4 years) were analyzed to estimate the 5-year risk of LAEs based on QTc duration and genotype and to assess the antiarrhythmic efficacy of beta-blockers. RESULTS: The relationship between QTc duration and risk of events was investigated by comparison of linear and cubic spline models, and the linear model provided the best fit. The 5-year risk of LAEs while patients were off therapy was then calculated in a multivariable Cox model with QTc and genotype considered as independent factors. The estimated risk of LAEs increased by 15% for every 10-ms increment of QTc duration for all genotypes. Intergenotype comparison showed that the risk for patients with LQT2 and LQT3 increased by 130% and 157% at any QTc duration versus patients with LQT1. Analysis of response to beta-blockers showed that only nadolol reduced the arrhythmic risk in all genotypes significantly compared with no therapy (hazard ratio: 0.38; 95% confidence interval: 0.15 to 0.93; p = 0.03). CONCLUSIONS: The study provides an estimator of risk of LAEs in LQTS that allows a granular estimate of 5-year arrhythmic risk and demonstrate the superiority of nadolol in reducing the risk of LAEs in LQTS.

7.
Arq Bras Cardiol ; 109(3 Supl 1): 1-104, 2017 Jan-Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29044300
8.
Arq. bras. cardiol ; 109(3,supl.1): 1-104, Sept. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-887936
9.
Arq Bras Cardiol ; 108(1): 70-73, 2017 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28146213

RESUMO

Compound heterozygosity has been described in inherited arrhythmias, and usually associated with a more severe phenotype. Reports of this occurrence in Brugada syndrome patients are still rare. We report a study of genotype-phenotype correlation after the identification of new variants by genetic testing. We describe the case of an affected child with a combination of two different likely pathogenic SCN5A variants, presenting sinus node dysfunction, flutter and atrial fibrillation, prolonged HV interval, spontaneous type 1 Brugada pattern in the prepubescent age and familiar history of sudden death.


Assuntos
Flutter Atrial/genética , Síndrome de Brugada/genética , Mutação , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Flutter Atrial/fisiopatologia , Síndrome de Brugada/fisiopatologia , Pré-Escolar , Eletrocardiografia , Predisposição Genética para Doença , Heterozigoto , Humanos , Masculino , Linhagem , Fenótipo , Índice de Gravidade de Doença
10.
Arq. bras. cardiol ; 108(1): 70-73, Jan. 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-1038528

RESUMO

Abstract Compound heterozygosity has been described in inherited arrhythmias, and usually associated with a more severe phenotype. Reports of this occurrence in Brugada syndrome patients are still rare. We report a study of genotype-phenotype correlation after the identification of new variants by genetic testing. We describe the case of an affected child with a combination of two different likely pathogenic SCN5A variants, presenting sinus node dysfunction, flutter and atrial fibrillation, prolonged HV interval, spontaneous type 1 Brugada pattern in the prepubescent age and familiar history of sudden death.


Resumo A heterozigose composta é descrita em arritmias hereditárias, geralmente associada a um fenótipo mais grave. Relatos dessa ocorrência em pacientes com síndrome de Brugada ainda são raros. Neste estudo, descrevemos o caso de uma criança com a combinação de duas novas variantes distintas no gene SCN5A, apresentando disfunção do nó sinusal, flutter e fibrilação atrial, intervalo HV prolongado, padrão tipo 1 espontâneo de Brugada na idade pré-puberal e história familiar de morte súbita.

11.
BMC Cardiovasc Disord ; 16(1): 224, 2016 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-27855643

RESUMO

BACKGROUND: Time in therapeutic range (TTR) is a measurement of quality of warfarin therapy and lower TTR values (<50%) are associated with greater risk of thromboembolic and bleeding events. Recently, we developed a pharmacogenetic-based warfarin dosing algorithm specifically calibrated for a Brazilian patient sample. The aims of this study are: to evaluate the impact of a genetic-based algorithm, compared to traditional anticoagulation, in the time to achieve the therapeutic target and in TTR percentage; and to assess the cost-effectiveness of genotype-guided warfarin dosing in a specific cohort of patients with low TTR (<50%) from a tertiary cardiovascular hospital. METHODS/DESIGN: This study is a randomized controlled trial in patients (n = 300) with atrial fibrillation with TTR < 50%, based on the last three INR values. At the first consultation, patients will be randomized into two groups: TA group (traditional anticoagulation) and PA group (pharmacogenetic anticoagulation). For the first group, the physician will adjust the dose according to current INR value and, for the second group, a pharmacogenetic algorithm will be used. At the second, third, fourth and fifth consultations (with an interval of 7 days each) INR will be measured and, if necessary, the dose will be adjusted based on guidelines. Afterwards, patients who are INR stable will begin measuring their INR in 30 day intervals; if the patient's INR is not stable, the patient will return in 7 days for a new measurement of the INR. Outcomes measures will include the time to achieve the therapeutic target and the percentage of TTR at 4 and 12 weeks. In addition, as a secondary end-point, pharmacoeconomic analysis will be carried out. Ethical approval was granted by the Ethics Committee for Medical Research on Human Beings of the Clinical Hospital of the University of São Paulo Medical School. DISCUSSION: This randomized study will include patients with low TTR and it will evaluate whether a population-specific genetic algorithm might be more effective than traditional anticoagulation for a selected group of poorly anticoagulated patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02592980 . Registered on 29 October 2015.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Cálculos da Dosagem de Medicamento , Monitoramento de Medicamentos/métodos , Coeficiente Internacional Normatizado , Farmacogenética , Variantes Farmacogenômicos , Varfarina/administração & dosagem , Algoritmos , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Brasil , Protocolos Clínicos , Humanos , Testes Farmacogenômicos , Valor Preditivo dos Testes , Projetos de Pesquisa , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos
12.
Oncotarget ; 7(34): 54194-54199, 2016 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-27486984

RESUMO

BACKGROUND: Warfarin is the most prescribed oral anticoagulant used for preventing stroke in patients with atrial fibrillation. Time in the therapeutic range (TTR) has been accepted as the best method to evaluate the quality of warfarin therapy. The main aim of the present study was to evaluate the impact of variables on the time in the therapeutic range for warfarin therapy in patients with atrial fibrillation from a referral cardiovascular hospital. METHODS: This retrospective study included 443 patients were included (190 patients with age < 65 years and 253 patients with age ≥65 years) from 2011 to 2014 and TTR was computed according to Rosendaal's method. RESULTS: Patients with age ≥65 years had higher TTR value (67±22%) compared with patients with < 65 years (60±24%) (p = 0.004). In a linear regression model, only age ≥65 years emerged as a significant predictor of greater TTR values. In multivariate logistic regression model, the variable age ≥65 years was associated with higher OR for having a TTR higher than the median value (OR = 2.17, p < 0.001). CONCLUSION: We suggest that the age influenced TTR through greater drug adherence. Strategies for increasing drug adherence might improve quality of warfarin anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Varfarina/uso terapêutico , Fatores Etários , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
13.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.865-885.
Monografia em Português | LILACS | ID: biblio-971573
14.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 25(4): 212-218, out.-dez.2015. ilus
Artigo em Português | LILACS | ID: lil-789233

RESUMO

As arritmias hereditárias são responsáveis por uma proporção significante de mortes cardíacas súbitas em indivíduos jovens aparentemente saudáveis. As canalopatias, como síndrome de Brugada, síndrome do QT longo/curto e taquicardia ventricular polimórfica catecolaminérgica, contribuem com essa incidência e não são marcadas por anomalias estruturais. A cardiomiopatia genética, como cardiomiopatia arritmogênica doventrículo direito e cardiomiopatia hipertrófica, também são causas de morte súbita por arritmia. Novos consensos têm sido publicados para orientar melhor as ferramentas dediagnóstico, os escores de estratificação e o tratamento. Os testes genéticos têm papel importante no diagnóstico, na estratificação de risco e no tratamento de pacientes e de suas famílias. Os avanços da genética molecular nas duas últimas décadas revelaram a base genética subjacente da doença, e podem levar a tratamentos mais personalizados...


Inherited arrhythmias account for a significant proportion of sudden cardiac deaths in apparently healthy and young individuals. Ion channelopathies such as Brugada syndrome, long/short QT syndrome and catecholaminergic polymorphic ventricular tachycardiacontribute to this incidence and are marked by no structural abnormalities. Genetic cardiomyopathy such as Right Ventricular Arrhythmogenic Cardiomyopathy and HypertrophicCardiomyopathy are also causes of arrhythmogenic sudden death. New consensuses are published to better guide the diagnostic tools, stratification scores and treatment. Genetic testing plays somehow an important role in the diagnosis, risk-stratification and treatment of patients and family members. Molecular genetic advances in the last 2 decades have revealed the underlying genetic basis and these may lead to a personalized medicine...


Assuntos
Humanos , Arritmias Cardíacas/genética , Arritmias Cardíacas/terapia , Doenças Genéticas Inatas/terapia , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/genética , Taquicardia Ventricular/genética , Taquicardia Ventricular/terapia , Cardiomiopatia Hipertrófica/terapia , Eletrocardiografia/métodos , Ventrículos do Coração , Propranolol , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Sotalol/administração & dosagem
15.
Arq. bras. cardiol ; 103(6): 468-475, 12/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-732168

RESUMO

Background: Ventricular and supraventricular premature complexes (PC) are frequent and usually symptomatic. According to a previous study, magnesium pidolate (MgP) administration to symptomatic patients can improve the PC density and symptoms. Objective: To assess the late follow-up of that clinical intervention in patients treated with MgP or placebo. Methods: In the first phase of the study, 90 symptomatic and consecutive patients with PC were randomized (double-blind) to receive either MgP or placebo for 30 days. Monthly follow-up visits were conducted for 15 months to assess symptoms and control electrolytes. 24-hour Holter was performed twice, regardless of symptoms, or whenever symptoms were present. In the second phase of the study, relapsing patients, who had received MgP or placebo (crossing-over) in the first phase, were treated with MgP according to the same protocol. Results: Of the 45 patients initially treated with MgP, 17 (37.8%) relapsed during the 15-month follow-up, and the relapse time varied. Relapsing patients treated again had a statistically significant reduction in the PC density of 138.25/hour (p < 0.001). The crossing-over patients reduced it by 247/hour (p < 0.001). Patients who did not relapse, had a low PC frequency (3 PC/hour). Retreated patients had a 76.5% improvement in symptom, and crossing-over patients, 71.4%. Conclusion: Some patients on MgP had relapse of symptoms and PC, indicating that MgP is neither a definitive nor a curative treatment for late follow-up. However, improvement in the PC frequency and symptoms was observed in the second phase of treatment, similar to the response in the first phase of treatment. .


Fundamento: Extrassístoles (ES) ventriculares e supraventriculares são frequentes e muitas vezes sintomáticas. Segundo estudo prévio, a administração de pidolato de magnésio (PMg) a pacientes sintomáticos pode resultar na melhora da densidade das ES e dos sintomas relacionados. Objetivo: Avaliar os resultados dessa intervenção clínica inicial no seguimento tardio de pacientes recebendo PMg ou placebo. Métodos: Noventa pacientes com ES, sintomáticos e consecutivos foram randomizados (duplo-cego) para receber PMg ou placebo por 30 dias. Visitas mensais de seguimento (15 meses) foram realizadas para avaliar a sintomatologia e controlar eletrólitos. O Holter de 24 horas foi realizado sempre que sintomáticos, ou duas vezes, independentemente dos sintomas. Na segunda fase do estudo, os pacientes cujos sintomas recidivassem, seja do grupo PMg ou placebo (crossing over), receberam PMg seguindo-se o mesmo protocolo. Resultados: Dos 45 pacientes que receberam inicialmente o PMg, 17 (37,8%) apresentaram recidiva dos sintomas em tempo variável nos 15 meses. Os pacientes com recidiva e tratados uma segunda vez apresentaram redução estatisticamente significante na densidade de ES de 138,25/hora (p < 0,001). Os pacientes de crossing reduziram em 247/hora (p < 0,001). Nos pacientes que não apresentaram recidiva, a frequência de ES foi baixa (3 ES/hora). A melhora dos sintomas foi de 76,5% nos retratados e de 71,4% nos de crossing. Conclusão: Houve recorrência de sintomas e das ES em alguns pacientes que usaram PMg, deixando claro não ser essa uma forma de tratamento definitivo ou curativo no seguimento tardio. Contudo, houve também melhora na frequência de ES e de sintomas em uma segunda etapa de tratamento, semelhante à resposta na primeira etapa. .


Assuntos
Humanos , Ácido Pirrolidonocarboxílico/administração & dosagem , Complexos Ventriculares Prematuros/tratamento farmacológico , Análise de Variância , Método Duplo-Cego , Eletrocardiografia Ambulatorial , Efeito Placebo , Recidiva , Fatores de Tempo , Resultado do Tratamento
17.
Ann Noninvasive Electrocardiol ; 19(5): 504-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24517421

RESUMO

The association between Brugada syndrome (BS) and ventricular preexcitation is a rare condition, with sporadic cases already reported. We report the case of a 29-year-old man, with palpitation unrelated to physical or emotional stress. The electrocardiogram of the first visit revealed a ventricular preexcitation pattern and an end-conduction delay, with negative T wave in V1 and intraventricular conduction disturbance in V2 (atypical for BS). The typical aspect of BS occurred after introduction of propafenone for the prevention of atrioventricular tachycardia. We discuss the recognition of this rare association, the proarrhythmic effects of some drugs, treatment options, and prognosis.


Assuntos
Síndrome de Brugada/complicações , Síndrome de Wolff-Parkinson-White/complicações , Adulto , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/cirurgia , Ablação por Cateter , Eletrocardiografia , Humanos , Masculino , Prognóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia , Síndrome de Wolff-Parkinson-White/cirurgia
18.
Arq Bras Cardiol ; 102(5 Suppl 1): 1-41, 2014 05.
Artigo em Português | MEDLINE | ID: mdl-27223869
19.
Arq Bras Cardiol ; 103(6): 468-75, 2014 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25590926

RESUMO

BACKGROUND: Ventricular and supraventricular premature complexes (PC) are frequent and usually symptomatic. According to a previous study, magnesium pidolate (MgP) administration to symptomatic patients can improve the PC density and symptoms. OBJECTIVE: To assess the late follow-up of that clinical intervention in patients treated with MgP or placebo. METHODS: In the first phase of the study, 90 symptomatic and consecutive patients with PC were randomized (double-blind) to receive either MgP or placebo for 30 days. Monthly follow-up visits were conducted for 15 months to assess symptoms and control electrolytes. 24-hour Holter was performed twice, regardless of symptoms, or whenever symptoms were present. In the second phase of the study, relapsing patients, who had received MgP or placebo (crossing-over) in the first phase, were treated with MgP according to the same protocol. RESULTS: Of the 45 patients initially treated with MgP, 17 (37.8%) relapsed during the 15-month follow-up, and the relapse time varied. Relapsing patients treated again had a statistically significant reduction in the PC density of 138.25/hour (p < 0.001). The crossing-over patients reduced it by 247/hour (p < 0.001). Patients who did not relapse, had a low PC frequency (3 PC/hour). Retreated patients had a 76.5% improvement in symptom, and crossing-over patients, 71.4%. CONCLUSION: Some patients on MgP had relapse of symptoms and PC, indicating that MgP is neither a definitive nor a curative treatment for late follow-up. However, improvement in the PC frequency and symptoms was observed in the second phase of treatment, similar to the response in the first phase of treatment.


Assuntos
Ácido Pirrolidonocarboxílico/administração & dosagem , Complexos Ventriculares Prematuros/tratamento farmacológico , Análise de Variância , Método Duplo-Cego , Eletrocardiografia Ambulatorial , Humanos , Efeito Placebo , Recidiva , Fatores de Tempo , Resultado do Tratamento
20.
Arq. bras. cardiol ; 98(6): 480-487, jun. 2012. tab
Artigo em Português | LILACS | ID: lil-645359

RESUMO

FUNDAMENTO: As extrassístoles ventriculares e supraventriculares (EV e ESSV) são frequentes e muitas vezes sintomáticas. O íon magnésio (Mg) desempenha um papel importante na fisiologia do potencial de ação transmembrana celular e do ritmo cardíaco. OBJETIVO: Avaliar se a administração do pidolato de magnésio (PMg) em pacientes com EV e ESSV tem desempenho superior ao uso do placebo (P) na melhora dos sintomas e densidade das extrassístoles (DES). MÉTODOS: Estudo duplo-cego, randomizado, com 60 pacientes sintomáticos consecutivos, com mais de 240/EV ou ESSV ao Holter de 24 horas e selecionados para receber P ou PMg. Para avaliar a melhora da sintomatologia, foi feito um questionário categórico e específico de sintomas relacionados às extrassístoles. Após o tratamento, foi considerada significante uma redução de mais de 70% na DES por hora. A dose do PMg foi de 3,0 g/dia por 30 dias, equivalente a 260 mg do elemento Mg. Nenhum paciente tinha cardiopatia estrutural ou insuficiência renal. RESULTADOS: Dos 60 pacientes estudados, 33 eram do sexo feminino (55%). A faixa etária variou de 16 a 70 anos. No grupo PMg, 76,6% dos pacientes tiveram redução maior que 70%, 10% deles maior que 50% e somente 13,4% tiveram redução menor que 50% na DES. No grupo P, 40% dos pacientes tiveram melhora de apenas 30% na frequência de extrassístoles (p < 0,001). A melhora dos sintomas foi alcançada em 93,3% dos pacientes do grupo PMg, comparada com somente 16,7% do grupo P (p < 0,001). CONCLUSÃO: A suplementação de Mg via oral reduziu a DES, resultando em melhora dos sintomas.


BACKGROUND: Premature ventricular and supraventricular complexes (PVC and PsVC) are frequent and often symptomatic. The magnesium (Mg) ion plays a role in the physiology of cell membranes and cardiac rhythm. OBJECTIVE:We evaluated whether the administration of Mg Pidolate (MgP) in patients with PVC and PsVC is superior to placebo (P) in improving symptoms and arrhythmia frequency. METHODS: Randomized double-blind study with 60 consecutive symptomatic patients with more than 240 PVC or PsVC on 24-hour Holter monitoring who were selected to receive placebo or MgP. To evaluate symptom improvement, a categorical and a specific questionnaire for symptoms related to PVC and PsVC was made. Improvement in premature complex density (PCD) per hour was considered significant if percentage reduction was >70% after treatment. The dose of MgP was 3.0 g/day for 30 days, equivalent to 260mg of Mg element. None of the patients had structural heart disease or renal failure. RESULTS: Of the 60 patients, 33 were female (55%). Ages ranged from 16 to 70 years old. In the MgP group, 76.6% of patients had a PCD reduction >70%, 10% of them >50% and only 13.4% <50%. In the P group, 40% showed slight improvement, <30%, in the premature complexes frequency (p < 0.001). Symptom improvement was achieved in 93.3% of patients in the MgP group, compared with only 16.7% in the P group (p < 0.001). CONCLUSION: Oral Mg supplementation decreases PCD, resulting in symptom improvement.


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Complexos Atriais Prematuros/tratamento farmacológico , Ácido Pirrolidonocarboxílico/administração & dosagem , Complexos Ventriculares Prematuros/tratamento farmacológico , Complexos Atriais Prematuros/prevenção & controle , Método Duplo-Cego , Efeito Placebo , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Complexos Ventriculares Prematuros/prevenção & controle
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