Long-Term Remote vs. Conventional Monitoring of Pacemakers: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE OF REVIEW: Remote monitoring (RM) is the standard of care for patients with cardiac implantable electronic devices (CIEDs), particularly pacemakers. However, the long-term outcomes of RM versus conventional monitoring (CM) of pacemakers and its effectiveness in reducing in-office (IO) visits for device reprogramming require elucidation. This systematic review and meta-analysis aimed to compare the RM and CM of pacemakers over a long-term follow-up. RECENT FINDINGS: We systematically searched the PubMed/MEDLINE, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing RM and CM of pacemakers with at least 12 months of follow-up. Binary endpoints were pooled with risk ratios (RRs), whereas continuous outcomes were computed using mean differences (MDs) or standardized MDs (SMDs). Heterogeneity was assessed using I2 statistics. Among the eight included RCTs, 2159 (48.9%) of 4063 patients underwent RM. Follow-up periods ranged from 12 to 24 months. There were no significant between-group differences in all-cause mortality (RR = 1.19; 95% confidence interval [CI], 0.90-1.57; p = 0.22; I2 = 0%), stroke (RR = 0.90; 95% CI, 0.43-1.91; p = 0.79; I2 = 23%), hospitalizations for cardiovascular and/or device-related adverse events (RR = 0.95; 95% CI, 0.75-1.21; p = 0.70; I2 = 0%), and quality of life (SMD = - 0.06; 95% CI, - 0.22 to 0.10; p = 0.473; I2 = 0%). RM was associated with fewer IO visits/patient/year (MD = 0.98; 95% CI, - 1.64 to - 0.33; p = 0.08; I2 = 98%) and higher rates of atrial tachyarrhythmia (ATA) detection (RR = 1.22; 95% CI, 1.01-1.48; p = 0.04; I2 = 0%) than was CM. This meta-analysis suggests that RM of pacemakers leads to higher rates of ATA detection and fewer IO visits/patient/year, without compromising patient safety.

Miocardiopatía hipertrófica en la edad pediátrica. Revisión a propósito de una serie de casos

Introducción: La miocardiopatía hipertrófica (MCH) constituye una enfermedad compleja y variable en cuanto a morfología, fisiopatología, pronóstico y sobrevida. Se caracteriza por una hipertrofia del ventrículo izquierdo, aunque en ocasiones puede ser biventricular o ventricular derecha aislada. En la edad pediátrica predominan las causas no sarcoméricas. La ecocardiografía es el método diagnóstico más utilizado para caracterizar la morfología y repercusión hemodinámica, sin embargo, la resonancia magnética cardíaca (RMC) es de elección por aportar mayores ventajas morfológicas y funcionales. Las pruebas genéticas son de gran importancia en la determinación del diagnóstico etiológico, manejo terapéutico y pronóstico. El tratamiento tiene como objetivo principal mejorar la capacidad funcional y aliviar los síntomas. Los betabloqueantes no vasodilatadores son considerados de primera líneay en algunos casos se puede recurrir a terapias avanzadas como disopiramida o terapia de reducción septal (TRS), uso del cardiodesfibrilador implantable (CDI), y en ocasiones se debe considerar trasplante cardiaco en pacientes con síntomas refractarios al tratamiento médico y en MCH del tipo obstructivo. Materiales y métodos: Estudio observacional, descriptivo, corte transversal. Resultados: Se estudiaron 12 pacientes, desde enero de 2020 a diciembre de 2022, con edades comprendidas desde 5 meses hasta 16 años, diagnosticados con MCH de presentación clínica variable y de distintas etiologías. Conclusión: La MCH de causas no sarcoméricas como los síndromes malformativos y errores innatos del metabolismo son las que tienen peor pronóstico y sobrevida. La finalidad de detectar precozmente la MCH es el inicio temprano de la terapia específica, para así retrasar el compromiso cardiovascular y mejorar la sobrevida.

Introduction: Hypertrophic cardiomyopathy (HCM) is a complex and variable disease in terms of morphology, pathophysiology, prognosis and survival. It is characterized by left ventricular hypertrophy, although it can sometimes be biventricular or isolated right ventricular. In the pediatric population, non-sarcomeric causes predominate. Echocardiography is the most widely used diagnostic method to characterize morphology and hemodynamic repercussions; however, cardiac magnetic resonance imaging (CMR) is preferred because it provides greater morphological and functional advantages. Genetic tests are of great importance in determining the etiological diagnosis, therapeutic management and prognosis. The main objective of the treatment is to improve functional capacity and alleviate symptoms. Non-vasodilator beta-blockers are considered first-line treatment and in some cases advanced therapies such as disopyramide or septal reduction therapy (SRT), use of implantable cardioverter-defibrillator (ICD) can be used; heart transplantation should be considered in patients with symptoms refractory to medical treatment and in HCM of the obstructive type. Materials and methods: This was an observational, descriptive, cross-sectional study. Results: 12 patients were studied, from January 2020 to December 2022, with ages ranging from 5 months to 16 years, diagnosed with HCM of variable clinical presentation and of different etiologies. Conclusion: HCM from non-sarcomeric causes such as malformation syndromes and inborn errors of metabolism have the worst prognosis and survival. The purpose of early detection of HCM is the early initiation of specific therapy, in order to delay cardiovascular compromise and improve survival.

Effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction

SUMMARY BACKGROUND/INTRODUCTION: Heart failure patients with reduced ejection fraction are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes. OBJECTIVE: The effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction patients has not been fully elucidated. The aim of this study was to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients with reduced ejection fraction patients. METHODS: In this retrospective study, 1,639 patients with heart failure patients with reduced ejection fraction were included. Patients were divided into two groups: ivabradine users and nonusers. Patients presenting with ventricular tachycardia, the presence of ventricular extrasystole, and ventricular tachycardia in 24-h rhythm monitoring, appropriate implantable cardioverter-defibrillator shocks, and long-term mortality outcomes were evaluated according to ivabradine use. RESULTS: After adjustment for all possible variables, admission with ventricular tachycardia was three times higher in ivabradine nonusers (95% confidence interval 1.5-10.2). The presence of premature ventricular contractions and ventricular tachycardias in 24-h rhythm Holter monitoring was notably higher in ivabradine nonusers. According to the adjusted model for all variables, 4.1 times more appropriate implantable cardioverter-defibrillator shocks were observed in the ivabradine nonusers than the users (95%CI 1.8-9.6). Long-term mortality did not differ between these groups after adjustment for all covariates. CONCLUSION: The use of ivabradine reduced the appropriate implantable cardioverter-defibrillator discharge in heart failure patients with reduced ejection fraction patients. Ivabradine has potential in the treatment of ventricular arrhythmias in heart failure patients with reduced ejection fraction patients.

Cardiotoxicity of pyrethroids: molecular mechanisms and therapeutic options for acute and long-term toxicity.

Pyrethroids (PY) are synthetic pesticides used in many applications ranging from large-scale agriculture to household maintenance. Their classical mechanisms of action are associated with binding to the sodium channel of insect neurons, disrupting its inactivation, ensuring their use as insecticides. However, PY can also lead to toxicity in vertebrates, including humans. In most toxicological studies, the impact of PY on heart function is neglected. Acute exposure to a high dose of PY causes enhancement of the late sodium current (INaL), which impairs the action potential waveform and can cause severe cardiac arrhythmias. Moreover, long-term, low-dose exposure to PY displays oxidative stress in the heart, which could induce tissue remodeling and impairment. Isolated and preliminary evidence supports that, for acute exposure to PY, an antiarrhythmic therapy with ranolazine (an INaL blocker), can be a promising therapeutic approach. Besides, heart tissue remodeling associated with low doses and long-term exposure to PY seems to benefit from antioxidant therapy. Despite significant leaps in understanding the mechanical details of PY intoxication, currently, few studies are focusing on the heart. In this review, we present what is known and what are the gaps in the field of cardiotoxicity induced by PY.

Evaluation of cardiac-electrophysiological balance according to National Institutes of Health Stroke Scale score at admission and discharge in acute ischemic stroke patients: A pilot study

SUMMARY OBJECTIVE: The main objectives of this investigation were to determine whether there were any relationships between corrected cardiac-electrophysiological balance value and National Institutes of Health Stroke Scale scores at admission and discharge in patients with acute ischemic stroke and to assess whether cardiac-electrophysiological balance value was an independent predictor of high National Institutes of Health Stroke Scale scores (National Institutes of Health Stroke Scale score ≥5). METHODS: In this retrospective and observational study, 231 consecutive adult patients with acute ischemic stroke were evaluated. The cardiac-electrophysiological balance value was obtained by dividing the corrected QT interval by the QRS duration measured from surface electrocardiography. An experienced neurologist used the National Institutes of Health Stroke Scale score to determine the severity of the stroke at the time of admission and before discharge from the neurology care unit. The participants in the study were categorized into two groups: those with minor acute ischemic stroke (National Institutes of Health Stroke Scale score=1-4) and those with moderate-to-severe acute ischemic stroke (National Institutes of Health Stroke Scale scores ≥5). RESULTS: Acute ischemic stroke patients with National Institutes of Health Stroke Scale score ≥5 had higher heart rate, QT, corrected QT interval, T-peak to T-end corrected QT interval, cardiac-electrophysiological balance, and cardiac-electrophysiological balance values compared with those with an National Institutes of Health Stroke Scale score of 1-4. The cardiac-electrophysiological balance value was shown to be independently related to National Institutes of Health Stroke Scale scores ≥5 (OR 1.102, 95%CI 1.036-1.172, p<0.001). There was a moderate correlation between cardiac-electrophysiological balance and National Institutes of Health Stroke Scale scores at admission (r=0.333, p<0.001) and discharge (r=0.329, p<0.001). CONCLUSIONS: The findings of this study demonstrated that the cardiac-electrophysiological balance value was related to National Institutes of Health Stroke Scale scores at admission and discharge. Furthermore, an elevated cardiac-electrophysiological balance value was found to be an independent predictor of National Institutes of Health Stroke Scale score ≥5.

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?

SUMMARY OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

Intervenções de enfermagem no cuidado aos pacientes portadores de arritmias cardíacas / Intervenciones de enfermería en el cuidado de pacientes con arritmia cardíaca / Nursing interventions in the care of patients with heart arrhythmia

Objetivo: as arritmias cardíacas acometem mais de 20 milhões de brasileiros, desse modo, o presente estudo objetiva realizar um levantamento sobre as intervenções de enfermagem diante de um quadro de arritmia em ambiente hospitalar. Método: trata-se de revisão integrativa de literatura de caráter descritivo, realizada entre janeiro e fevereiro de 2022. Por meio de buscas na biblioteca virtual de saúde BVS (Lilacs, Medline, BDEnf, IBECs, PAHO) e Scielo BDenf de artigos publicados nos últimos 5 anos. Resultados: os enfermeiros têm aptidão para identificar anormalidades no ritmo cardíaco. A compreensão das complicações pós-operatórias contribui para a elaboração de um plano de cuidado mais eficaz. As intervenções de enfermagem devem ser pautadas no monitoramento da arritmia, bem como orientação sobre o uso dos antiarrítmicos e esclarecimento de dúvidas sobre a doença. Conclusão: é imprescindível a atuação do enfermeiro na assistência a pacientes com arritmias cardíacas, o qual necessitam monitorar os sinais vitais para determinar o efeito hemodinâmico de tal problema cardíaco, manter uma atitude tranquilizadora e compartilhar informações sobre a patologia e seu tratamento.(AU)

Objective: cardiac arrhythmias affect more than 20 million Brazilians, thus, the present study aims to carry out a survey on nursing interventions in the face of arrhythmia in a hospital environment. Method: Method: this is an integrative literature review of a descriptive nature, carried out between January and February 2022. Through searches in the virtual health library VHL (Lilacs, Medline, BDEnf, IBECs, PAHO) and Scielo. Results: nurses are able to identify heart rhythm abnormalities. Understanding postoperative complications contributes to the development of a more effective care plan. Nursing interventions should be guided by the monitoring of arrhythmia, as well as guidance on the use of antiarrhythmics and clarification of doubts about the disease. Conclusion: it is essential for nurses to assist patients with cardiac arrhythmias, who need to monitor vital signs to determine the hemodynamic effect of such a heart problem, maintain a reassuring attitude and share information about the pathology and its treatment.(AU)

Objetivo: las arritmias cardíacas afectan a más de 20 millones de brasileños, por lo tanto, el presente estudio tiene como objetivo realizar una encuesta sobre las intervenciones de enfermería frente a la arritmia en un ambiente hospitalario. Método: se trata de una revisión integrativa de la literatura de carácter descriptivo, realizada entre enero y febrero de 2022. Mediante búsquedas en la biblioteca virtual en salud BVS (Lilacs, Medline, BDEnf, IBECs, PAHO) y Scielo. Resultados: los enfermeros logran identificar alteraciones del ritmo cardíaco. Comprender las complicaciones posoperatorias contribuye al desarrollo de un plan de atención más eficaz. Las intervenciones de enfermería deben estar guiadas por el seguimiento de la arritmia, así como orientación sobre el uso de antiarrítmicos y aclaración de dudas sobre la enfermedad. Conclusión: es fundamental que los enfermeros ayuden a los pacientes con arritmias cardíacas, que necesitan monitorear los signos vitales para determinar el efecto hemodinámico de tal problema cardíaco, mantener una actitud tranquilizadora y compartir información sobre la patología y su tratamiento.(AU)

Thermal ablation effects on rotors that characterize functional re-entry cardiac arrhythmia.

Thermal ablation is a well-established successful treatment for cardiac arrhythmia, but it still presents limitations that require further studies and developments. In the rotor-driven functional re-entry arrhythmia, tissue heterogeneity results on the generation of spiral/scroll waves and wave break dynamics that may cause dangerous sustainable fibrillation. The selection of the target region to perform thermal ablation to mitigate this type of arrhythmia is challenging, since it considerably affects the local electrophysiology dynamics. This work deals with the numerical simulation of the thermal ablation of a cardiac muscle tissue and its effects on the dynamics of rotor-driven functional re-entry arrhythmia. A non-homogeneous two-dimensional rectangular region is used in the present numerical analysis, where radiofrequency ablation is performed. The electrophysiology problem for the propagation of the action potential in the cardiac tissue is simulated with the Fenton-Karma model. Thermal damage caused to the tissue by the radiofrequency heating is modeled by the Arrhenius equation. The effects of size and position of a heterogeneous region in the original muscle tissue were first analyzed, in order to verify the possible existence of the functional re-entry arrhythmia during the time period considered in the simulations. For each case that exhibited re-entry arrhythmia, six different ablation procedures were analyzed, depending on the position of the radiofrequency electrode and heating time. The obtained results revealed the effects of different model parameters on the existence and possible mitigation of the functional re-entry arrhythmia.

Contributions of the heart rate turbulence method to risk stratification in patients after myocardial infarction: a review.

Coronary artery disease remains an important cause of morbidity and mortality worldwide. The impact of ventricular arrhythmias and impaired cardiac vagal activity on coronary events is one of the most relevant prognostic factors, despite little research being conducted in clinical practice. A simple and cost-effective way to analyze cardiac autonomic regulation is through the heart rate turbulence (HRT) method. Studies have shown that altered HRT, which indicates reduction in the vagal cardiac activity, can identify patients who are at a higher risk of sudden death. Thus, aspects related to the definition, pathophysiological mechanism, conditions that alter the HRT behavior, and the main studies that analyzed the prognostic importance of HRT in patients with ischemic disease were discussed in this review. HRT analysis was proven to be a simple and cost-effective way to assess cardiac autonomic dysfunction by providing complementary information to classic parameters, such as the assessment of ventricular function.

New combined risk score to predict atrial fibrillation after cardiac surgery: COM-AF.

Background and Aims: Atrial fibrillation frequently occurs in the postoperative period of cardiac surgery, associated with an increase in morbidity and mortality. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated ability to predict atrial fibrillation after cardiac surgery (AFCS). The objective is to develop and validate a risk score to predict AFCS from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH models. Methods: We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery in 2010-2016. The primary outcome was the development of new-onset AFCS. The variables of the POAF, CHA2DS2-VASc and HATCH scores were evaluated in a multivariate regression model to determine the predictive impact. Those variables that were independently associated with AFCS were included in the final model. Results: A total of 3113 patients underwent cardiac surgery, of which 21% presented AFCS. The variables included in the new score COM-AF were: age (≥75: 2 points, 65-74: 1 point), heart failure (2 points), female sex (1 point), hypertension (1 point), diabetes (1 point), previous stroke (2 points). For the prediction of AFCS, COM-AF presented an AUC of 0.78 (95% CI 0.76-0.80), the rest of the scores presented lower discrimination ability (P < 0.001): CHA2DS2-VASc AUC 0.76 (95% CI 0.74-0.78), POAF 0.71 (95% CI 0.69-0.73) and HATCH 0.70 (95% CI: 0, 67-0.72). Multivariable analysis demonstrated that COM-AF score was an independent predictor of AFCS: OR 1,91 (IC 95% 1,63-2,23). Conclusion: From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk model system called COM-AF was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations.

[Ablation of cardiac arrhythmias using a three-dimensional electro-anatomical mapping system in the Instituto Nacional Cardiovascular - INCOR]. / Ablación de arritmias cardiacas empleando un sistema de mapeo electroanatómico tridimensional en el Instituto Nacional Cardiovascular - INCOR.

Objective: To describe the initial experience in ablation of cardiac arrhythmias using 3D mapping at the Instituto Nacional Cardiovascular INCOR (Lima, Peru). Methods: A retrospective descriptive study was carried out. During February 2020, data was collected from the medical records of all patients in whom ablation was performed using 3D mapping from July 2017 to December 2019. This procedure was performed in patients with symptomatic arrhythmia refractory to antiarrhythmic therapy. Results: Data were collected from 123 patients (median age: 46 years, 64.2% male), who had a median time of illness of 6 years. Among the arrhythmias treated, 19% had atrial fibrillation, 17.5% atrial tachycardia, 17.5% idiopathic ventricular arrhythmias, 16.6% Wolf Parkinson White syndrome / Atrioventricular reentrant tachycardia, 11.1% ventricular arrhythmias of the His-Purkinje conduction system, 9.5% scar related ventricular tachycardia associated, 6.4% atrial flutter and 2.4% intranodal tachycardia. The median fluoroscopy time was 26 minutes. Ablation was acutely successful in 95.9% of cases, acute complications were observed in 4.8%, and recurrence-free survival during the first year of follow-up was 74%. Conclusions: Our experience in ablation of cardiac arrhythmias using 3D mapping had a high acute success rate, low frequency of complications, and one-year recurrence-free survival of 74 %.

Leocádia e sua passagem pelos infernos / Leocádia and her journey through hell / Leocádia y su paso por los infiernos

Narrativa que percorre o conjunto de atendimentos clínicos vividos por uma dupla, médica e paciente, no Ambulatório de Arritmia durante o processo de tratamento de uma jovem, sem cardiopatia estrutural, com arritmia ventricular complexa, muito sintomática, sem resposta ao tratamento convencional. Utilizou-se abordagem médica ampliada, não convencional, em que o perfil psicoemocional da paciente foi levado em consideração. Por meio de um método cartográfico, buscou-se delinear os percursos trilhados, ressaltando-se os afetos vividos, os impasses, superações e paradas, enquanto vincos de intensidade que marcaram diversos acontecimentos. A paciente obteve reversão das arritmias e dos sintomas após três anos e meio de tratamento e segue sem arritmia após seis anos e meio. Com isso, acreditamos poder colaborar, de forma construtiva, com o questionamento de diversos aspectos das relações clínicas contemporâneas, das dimensões afetivas do adoecer e de processos implicados na construção da saúde. (AU)

arrative depicting the clinical care journey experienced by a doctor and her patient-a young woman with symptomatic ventricular tachycardia, with no structural heart disease, with no response to conventional treatment-at the Arrhythmia Outpatient Clinic. The non-conventional expanded medical approach-where the patient's psychoemotional profile is taken into consideration - was adopted. Through a cartographic method, we aim to trace the paths taken, highlighting feelings, deadlocks, achievements, and stoppage moments as lines of intensity marking several events. The patient reversed her arrhythmia and symptoms after three and a half years of treatment, and remains so after six and a half years. Therefore, we believe we can constructively cooperate with the discussions of several aspects of contemporary clinical relations, affective dimensions of becoming ill, and processes implied in the development of health. (AU)

Narrativa que trascurre por el conjunto de atenciones clínicas vividas por dos personas, una médica y una paciente, en el Ambulatorio de Arritmia, durante el proceso de tratamiento de una joven, sin cardiopatía estructural, con arritmia ventricular compleja, muy sintomática, sin respuesta al tratamiento convencional. Se utilizó el abordaje médico ampliado, no convencional, en el que el perfil psicoemocional de la paciente se llevó en consideración. Por medio de un método cartográfico, se buscó delinear los recorridos seguidos, subrayándose los afectos vividos, los callejones sin salida, las superaciones y las paradas, como marcas de intensidad que señalaron diversos acontecimientos. La paciente tuvo reversión de las arritmias y de los síntomas después de tres años y medio de tratamiento y continúa sin arritmia pasados seis años y medio. De esa forma, creemos que podemos colaborar, de forma constructiva, con el cuestionamiento de diversos aspectos de las relaciones clínicas contemporáneas, de las dimensiones afectivas del enfermarse y de procesos implicados en la construcción de la salud. (AU)

Resultado del tratamiento en pacientes sometidos a ablación percutánea por arritmias supraventriculares en la ciudad de Cuenca, periodo abril 2013- julio 2018 / Treatment outcome of percutaneous ablation in patients with supraventricular arrhythmias in Cuenca, April 2013- July 2018

INTRODUCCIÓN: Las taquicardias supraventriculares son comunes en la práctica clínica, a pesar de tener buen pronóstico, puede afectar significativamente la calidad de vida de los pacientes. El tratamiento médico no da como resultado la ausencia total de la arritmia, por lo que la terapia por ablación se ha convertido en el tratamiento de elección en muchos de los casos por su alto índice de éxito brindando una solución definitiva. El objetivo de este estudio es determinar la frecuencia de presentación de las principales taquicardias supraventriculares, distribuidas por edad y sexo, la frecuencia de éxito de la ablación percutánea y los factores relacionados con el mismo y la frecuencia de las complicaciones presentadas. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo transversal y de correlación, que incluyó 156 con diagnóstico de taquicardia supraventricular y ablacionados en los cinco centros hospitalarios en donde se realizó el procedimiento, basándonos en los registros clínicos de los mismos. RESULTADOS: De los 156 pacientes, 51.9% fueron mujeres y 48.1% hombres, con edades comprendidas entre los 10 y 80 años de edad. Las arritmias reportadas fueron taquicardia de reentrada nodal, taquicardia reentrante auriculoventricular y flutter auricular, de estas la más frecuente fue la taquicardia por reentrada auriculoventricular. El éxito global del tratamiento fue del 93.5%, sin reportar complicaciones, los factores relacionados estudiados no presentaron asociación estadísticamente significativa. CONCLUSIÓN: El tratamiento por ablación tuvo un alto porcentaje de éxito y una tasa nula de complicaciones, esto es un indicador tanto de eficacia como seguridad de este procedimiento.(au)

BACKGROUND: Supraventricular tachycardia is commonly diagnosed in clinical practice, despite having a good prognosis, it can significantly affect the patient's life quality. Pharmacological treatment does not result in the total absence of the arrhythmia, which is why ablation therapy has become the treatment of choice, due to its high success rate, and for offering a definitive solution. The aim of this study was to determine the frequency of each supraventricular tachycardia type, according to age and sex, the rate of success of percutaneous ablation and its related factors, and the frequency of complications due to the procedure. METHODS: A cross-sectional, descriptive, correlational study was conducted, including 156 patients diagnosed with supraventricular tachycardia and ablated, from five hospitals where the procedure was performed, based on their clinical records. RESULTS: From the 156 patients in this study, 51.9% were women and 48.1% men, the age ranged between 10 and 80 years. The most commonly reported arrhythmias were nodal reentrant tachycardia, atrioventricular reentrant tachycardia and atrial flutter, being the atrioventricular reentrant tachycardia the most frequent of all. The global success rate was 93.5%, no complications were reported, and none of the studied factors had significant statistical association with the success rate. CONCLUSION: Ablation treatment had a high success rate, with cero complications in this study, demonstrating the efficacy and safety of the procedure.(au)

Development and Validation of A Simple Clinical Risk Prediction Model for New-Onset Postoperative Atrial Fibrillation After Cardiac Surgery: Nopaf Score.

INTRODUCTION: Postoperative atrial fibrillation (POAFib) occurs in 20 to 40% of patients following cardiac surgery, and is associated with an increased perioperative morbidity and mortality. We aimed to develop and validate a simple clinical risk model for the prediction of POAFib after cardiac surgery. METHODS: An analytical single center retrospective cohort study was conducted, including consecutive patients undergoing cardiac surgery between 2004 and 2017 with POAFib. To create the predictive risk score, a logistic regression model was performed using a random sample of 75% of the population. Coefficients of the model were then converted to a numerical risk score, and three groups were defined: low risk (≤1 point), intermediate risk (2-5 points) and high risk (≥6 points). The score was validated using the remaining 25% of the patients. Discrimination was evaluated through the area under the curve (AUC) ROC, and calibration using the Hosmer-Lemeshow (HL) test, calibration plots, and ratio of expected and observed events (E/O). RESULTS: Six thousand five hundred nine patients underwent cardiac surgery: 52% coronary artery bypass grafting (CABG), 20% valve surgery, 14% combined (CABG and valve surgery) and 12% other. New-onset AF occurred in 1222 patients (18.77%). In the multivariate analysis, age, use of cardiopulmonary bypass pump, severe reduction in left ventricular ejection fraction (LVEF), chronic renal disease and heart failure were independent risk factors for POAFib, while the use of statins was a protective factor. The NOPAF score was calculated by adding points for each independent risk predictor. In the derivation cohort, the AUC was 0.71 (CI95% 0.69-0.72), and in the validation cohort the model also showed good discrimination (AUC 0.67 IC 0.64-0.70) and excellent calibration (HL P = 0.24). The E/O ratio was 1 (CI 95%: 0.89-1.12). According to the risk category, POAFib occurred in 5% of low; 11% of intermediate and 27.7% of high risk patients in the derivation cohort (P <0.001), and 5.7%; 12.6%; and 23.6% in the validation cohort respectively (P <0.001). CONCLUSION: From a large hospitalized population, we developed and validated a simple risk score named NOPAF, based on clinical variables that accurately stratifies the risk of POAFib. This score may help to identify high-risk patients prior to cardiac surgery, in order to strengthen postoperative atrial fibrillation prophylaxis.

Neuropsychological and neuroimaging evidences of cerebral dysfunction in stroke-free patients with atrial fibrillation: A review.

Atrial fibrillation (AF) is the most common heart arrhythmia, with the highest prevalence in the elderly. AF has been correlated with silent lesions and cognitive impairment, even in the absence of stroke. The cognitive impairment in AF represents a risk of functional decline, morbidity, mortality and high costs, constituting a public health problem due to the increasing prevalence of this arrhythmia. Cognitive analysis of patients with AF without stroke has shown poor performance in executive, memory and learning functions. The greater loss occurs in speed processing and performance of instrumental tasks leading to functional dependence. Neuroimaging studies have shown both structural and functional abnormalities in individuals with AF even in the absence of cognitive impairment. The mechanisms related to cognitive impairment and cerebral abnormalities in the AF are still a matter of discussion in the literature and, therefore, how to stop its progression is unknown. We reviewed the recent evidence about AF and dementia in patients without stroke, with special emphasis to the reported profile of cognitive dysfunction and the neuroimaging evidence of brain abnormalities.

Assessment and clinical relevance of the dynamic parameters of ventricular repolarization in patients with grade I left ventricular diastolic dysfunction 1.

Imbalance in ventricular repolarization parameters are related to increased risk of severe arrhythmia and sudden cardiac death. There is limited research regarding markers to detect patients at risk in this early stage. We aimed to assess the influence of grade I left ventricular diastolic dysfunction on repolarization parameters in asymptomatic patients. Ambulatory patients with grade I left ventricular diastolic dysfunction were studied and compared with a control group. We assessed the QT dispersion circadian variation, heart rate variability in the time and frequency domains, and dynamics of QT using a 12-lead Holter. In the diastolic dysfunction group, 8 (30%) patients had QT dispersion > 80 ms. One (3.8%) patient presented premature ventricular complex > 10/h. The comparison between the 2 groups showed that the difference between the standard deviation of normal-to-normal intervals and low frequency power in both groups was statistically significant. We therefore conclude that increased parameters of ventricular repolarization and depressed heart rate variability reflect an imbalance in autonomic responses in patients with grade I left ventricular diastolic dysfunction without cardiovascular symptoms, enabling the identification of patients that are at a higher risk for cardiovascular events.

Reporte de caso: bloqueo del ganglio estrellado para manejo de la tormenta eléctrica / Case report: stellate ganglion blockade for electric storm management

The electric storm is an emergency whose handling is very demanding. Our case report describes a patient with multiple episodes of ventricular tachycardia, refractory to conventional therapy (antiarrhythmics, beta blockers and sedoanalgesia) where the sympathetic activity of the heart seems to play a crucial role. We decided to try as additional therapeutic strategy, the performing of a transient and bilateral blockade of the stellate ganglion under ultrasound guidance, this procedure was carried out at the patient's bed, without complications during the same. The sympathetic modulation allowed us to optimize conventional antiarrhythmic therapy, thus reducing the appearance of malignant arrhythmias.

La tormenta eléctrica es una emergencia cuyo manejo es muy exigente. Nuestro reporte de caso describe a un paciente con múltiples episodios de taquicardia ventricular refractarios a terapia convencional (antiarrítmicos, betabloqueadores y sedoanalgesia) donde la actividad simpática del corazón parece jugar un rol crucial. Decidimos plantear como estrategia terapéutica adicional la realización de un bloqueo transitorio y bilateral del ganglio estrellado bajo guía ecográfica, este procedimiento se realizó en la cama del paciente, sin complicaciones durante el mismo. La modulación simpática nos permitió optimizar la terapia antiarrítmica convencional, logrando así reducir la aparición de arritmias malignas.

Default Mode Network Disruption in Stroke-Free Patients with Atrial Fibrillation.

BACKGROUND: Atrial fibrillation (AF) is a widely accepted risk for causing stroke. However, recent studies show AF as a risk factor for dementia, even without causing stroke. The mechanisms by which dementia develops in stroke-free patients with AF are still poorly understood and the association of AF with abnormal function of brain networks activities, such as the default mode network (DMN), has not been previously studied. We aimed to determine whether, in the absence of stroke and dementia, patients with AF have abnormal resting-state brain networks compared to controls without AF. METHODS: Twenty-one stroke-free patients with AF and 21 age- and sex-matched controls without AF underwent brain functional magnetic resonance imaging acquired at a 3.0 Tesla scanner. During the exam, the subjects were instructed to lie still with eyes closed. At first-level analysis, connectivity of the DMN was obtained for all subjects. Second-level analysis compared the DMN connectivity between AF patients and controls with a general linear model (two-sample t test, p < 0.05, False Discovery Rate corrected, minimum of 50 contiguous voxels). RESULTS: Patients with AF compared with controls showed decreased connectivity in regions of the DMN including the frontal lobe (left medial frontal gyrus, left superior frontal gyrus and anterior cingulate), left angular gyrus, and bilateral precuneus. CONCLUSIONS: Stroke-free patients with AF have evidence of abnormal DMN connectivity. This study adds evidence to the occurrence of cerebral dysfunction in patients with AF.