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2.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(8): 595-601, 2019 Aug 24.
Artigo em Chinês | MEDLINE | ID: mdl-31434429

RESUMO

Objectives: This study explored the relationship between weight control and atrial fibrillation (AF) recurrence after catheter ablation in overweight and obese patients. Methods: We prospectively enrolled consecutive 333 overweight and obese patients aged 28 to 87 years old, who underwent catheter ablation for AF in Beijing Anzhen Hospital between October 2015 and February 2016. Data of patients' characteristics, laboratory examination and treatment were collected at baseline. Each patient was followed up at 3, 6 and 12 months after ablation to collect information on weight, AF recurrence, stroke, major bleeding, hospitalization for cardiovascular reasons and death, etc. Patients were divided into weight controlled group (ΔBMI<-1 kg/m(2)) and weight uncontrolled group (ΔBMI≥-1 kg/m(2)), according to the changes in the most recent exposure BMI before AF recurrence in patients with recurrence or the BMI at 12 months' follow-up in patients without recurrence and the BMI at baseline. Multivariate logistic regression was performed to adjust other known risk factors of AF recurrence and to explore the association between weight control and AF recurrence after catheter ablation. Results: There were 54 patients in weight controlled group and 279 patients in weight uncontrolled group. There were no significant differences in age, gender, education level, left atrial size and history of hypertension between the two groups (all P>0.05). The proportion of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was higher in the weight controlled group (50.0%(27/54) vs. 34.8%(97/279), P=0.034). However, there was no significant difference in the proportion of patients with obesity (33.3% (18/54) vs. 29.7% (83/279)), paroxysmal AF (59.3% (32/54) vs. 56.6% (158/279)) and AF duration less than 5 years (76.9% (40/52) vs. 65.4% (178/272)) between the weight controlled group and the uncontrolled group. During 1-year follow-up after ablation, the recurrence rate of AF was significantly lower in the weight controlled group than that in the weight uncontrolled group (14.8% (8/54) vs. 32.6%(91/279), P=0.009). Multivariable logistic regression analysis shows that weight control is independently associated with a lower postoperative AF recurrence rate (OR=0.40, 95%CI 0.18-0.90, P=0.026). Conclusion: Weight control is strongly associated with a lower AF recurrence rate after catheter ablation in overweight and obese patients.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Obesidade , Sobrepeso , Recidiva , Resultado do Tratamento
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(8): 602-607, 2019 Aug 24.
Artigo em Chinês | MEDLINE | ID: mdl-31434430

RESUMO

Objective: Differences in the activated coagulation time (ACT) during ablation and adequate heparin dosing were observed among atrial fibrillation (AF) patients undergoing AF catheter ablation receiving different anticoagulation therapies and the suitable heparin dosing during ablation among patients treated with different anticoagulation therapies was explored. Methods: Patients who received warfarin (n=100), low-molecular-weight heparin (n=100), dabigatran etexilate (n=98, 110 mg, Bid) and rivaroxaban (n=48, 20 mg, Qd) were included. All of them underwent the first AF ablation during January 2016 to December 2017 and patients with hepatic and renal dysfunction were excluded. Initial bolus heparin (100 U/kg, intravenous) was applied to all patients. Additional heparin dosage was added according to the ACT, which was measured in 15-minute interval to maintain the ACT within 250-350 seconds until the end of ablation. Patient characteristics, ACT and complications were compared among various groups. Results: The baseline general characteristics among patients were similar. The baseline ACTs in the dabigatran groups were significantly longer than those in the rivaroxaban group ((133±36) seconds vs. (113±22) seconds, P<0.05). The 15 min ACT in the warfarin group was longer than in the dabigatran group ((259±56) seconds vs. (243±43) seconds, P<0.05). The 15-minute ACTs were significantly longer in the warfarin ((259±56) seconds) and dabigatran ((243±43) seconds) groups compare with low-molecular-weight heparin group ((224±40) seconds) and rivaroxaban group ((226±32) seconds) (all P<0.05). The same trend was also observed in the rate of reaching ACT goal after initial-standard-dosage of heparin (warfarin (53%, 53/100), dabigatran (45%,44/98), low-molecular-weight heparin (28%,28/100), rivaroxaban (23%,11/48), P<0.05). The 1 hour ACT in the warfarin group ((254±49) seconds) was significantly longer than the other three groups (dabigatran (233±33) seconds, low-molecular-weight heparin (226±34) seconds, rivaroxaban (231±30) seconds, all P<0.01). The rate of reaching ACT goal at 1 hour were significantly higher in the warfarin group (66%,35/53) than in the dabigatran group (41%,18/44), and rivaroxaban group (27%,3/11) (all P<0.05). The total heparin required was significantly higher in rivaroxaban group than in the dabigatran and warfarin groups (all P<0.05). During the perioperative period, no patient exhibited any thromboembolic complications, and only a few minor bleeding complications was observed among patients, which was similar between the four groups (P>0.05). Conclusion: Higher dosage of heparin is required during AF ablation to achieve the satisfactory anticoagulant intensity for AF patients under dabigatran etexilate (110 mg, Bid), low-molecular-weight heparin and rivaroxaban (20 mg, Qd) anticoagulation therapy before AF ablation.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial , Ablação por Cateter , Heparina/uso terapêutico , Fibrilação Atrial/terapia , Benzimidazóis , Dabigatrana , Humanos , Resultado do Tratamento
4.
Med Clin North Am ; 103(5): 835-846, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378329

RESUMO

Atrial fibrillation (AF) is the most common arrhythmia and its management may be organized into risk stratification and/or treatment of heart failure, stroke prevention, and symptom control. At the core of symptom control, treatment is tailored to either allow AF continue with controlled heart rates, so-called rate control, versus restoring and maintaining sinus rhythm or rhythm control. Rate control strategies mainly use rate-modulating medications, whereas rhythm control treatment includes therapy aimed at restoring sinus rhythm, including pharmacologic and direct current cardioversion, as well as maintenance of sinus rhythm, including antiarrhythmic medications and ablation therapy.


Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/terapia , Ablação por Radiofrequência/métodos , Antiarrítmicos/uso terapêutico , Ablação por Cateter/métodos , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Humanos , Medição de Risco
5.
Med Clin North Am ; 103(5): 863-879, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378331

RESUMO

The term paroxysmal supraventricular tachycardia encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each supraventricular tachycardia is important in determining management in the office, at the bedside, and in the electrophysiology laboratory. Paroxysmal supraventricular tachycardias have an abrupt onset and offset, typically initiating and terminating with premature atrial ectopic beats. In the acute setting, both vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter ablation has revolutionized therapy for many supraventricular tachycardias, and newer techniques have significantly improved ablation efficacy and decreased periprocedural complications and procedure times.


Assuntos
Antiarrítmicos/administração & dosagem , Ablação por Cateter/métodos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapia , Eletrocardiografia , Humanos , Taquicardia Supraventricular/fisiopatologia , Resultado do Tratamento
6.
Med Clin North Am ; 103(5): 945-956, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378336

RESUMO

Cardiac defects are the most common congenital defects, accounting for approximately 9 per 1000 births. Patients with structural heart disease related to congenital diseases are prone to develop intrinsic rhythm abnormalities as a result of altered physiology. In addition, they are at an increased risk of developing acquired arrhythmias secondary to the nature of surgical interventions done to improve physiologic function in the setting of these defects. Arrhythmia management and risk stratification pose particularly complex challenges to clinicians managing this population.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Cardiopatias Congênitas/epidemiologia , Fibrilação Atrial/etiologia , Ablação por Cateter , Gerenciamento Clínico , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Marca-Passo Artificial
7.
Medicine (Baltimore) ; 98(32): e16642, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393361

RESUMO

RATIONALE: Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP). PATIENT CONCERNS: A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability. DIAGNOSIS: The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected. INTERVENTIONS: The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring. OUTCOMES: One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal. LESSONS: AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.


Assuntos
Bloqueio de Ramo/cirurgia , Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Ecocardiografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Taquicardia por Reentrada no Nó Atrioventricular/complicações
8.
Kardiologiia ; 59(8): 39-46, 2019 Aug 08.
Artigo em Russo | MEDLINE | ID: mdl-31397228

RESUMO

PURPOSE: to assess cardiac electrophysiological parameters in patients with paroxysmal atrial fibrillation (AF), lone or with concomitant arterial hypertension (AH), and their prognostic significance relative to treatment effectiveness. MATERIALS AND METHODS: We included in this study 184 patients with paroxysmal AF (84 with concomitant AH and 100 with presumed lone AF). Cardiac electrophysiological study was performed in accordance with standardized protocol that included assessment of sinus node recovery time, sinoatrial, intraatrial and interatrial conduction time, and effective refractory periods (ERP) of right and left atria and atrioventricular node. Patients with inducible supraventricular reentrant arrhythmias that could potentially trigger AF underwent catheter radiofrequency ablation of those arrhythmias. Other patients received either antiarrhythmic drug therapy (AAD; n=79) or catheter cryo-ablation (CBA; n=81). Treatment was considered ineffective in case of any symptomatic or asymptomatic AF episode documented by ECG or Holter ECG within 12 months of follow-up. RESULTS: Patients with lone AF compared with those with AH had shorter ERP of the right atrium (219±21 ms vs. 253±44 ms, respectively, p<0.05) and more prominent dispersion of ERP of right and left atria (median 40 ms, interquartile range 10-50 ms vs. median 20 ms, interquartile range 10-22.5 ms, respectively, p<0.05). There was no statistically significant difference in other electrophysiology parameters between the groups. Sustained supraventricular reentrant arrhythmias were induced in 9% (9 of 100) patients with presumed lone AF and in 1.2% (1 of 84) patients with AH (p<0.05). All these arrhythmias were successfully ablated, and patients had no AF recurrence during 12-month follow-up. Among other patient treatment (CBA n=81, AAD n=79) was effective in 64% of those with lone AFib and in 34% - with AH (p<0.05). In multivariate multiple regression analysis, none of electrophysiological parameters could be assumed as a factor associated with the efficacy of CBA or AAD. CONCLUSION: Patients with lone AF had more prominent atrial electrophysiological inhomogeneity compared with patients with concomitant AH. Cardiac electrophysiological parameters had no influence on effectiveness of antiarrhythmic treatment.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Hipertensão , Antiarrítmicos , Átrios do Coração , Humanos
9.
Medicine (Baltimore) ; 98(26): e16279, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261600

RESUMO

Curative treatments for very early-stage hepatocellular carcinoma (HCC), defined as single HCC with a maximum diameter of <2 cm in patients with well-preserved liver function, consist of surgical resection or radiofrequency ablation (RFA). In this retrospective study, we compared the efficacy of both treatments in 154 patients with very early-stage HCCs who underwent resection or RFA as initial therapy and were followed up for a median of 56.8 months. Propensity score matching analysis was also conducted. Overall survival was comparable between treatment groups (median survival time of 143 vs 97 months for resection and RFA, respectively; P = .132). Resection group; however, demonstrated a significantly lower recurrence rate after initial therapy than RFA group (42.3% vs 65.7%; P = .006) with a longer median recurrence-free survival time (66.7 vs 33.8 months; P = .002), which was confirmed even after matching (P = .04). In contrast, the recurrence pattern in advanced-stage (9.6% vs 1.0%; P = .01) or incurable recurrences (19% vs 13%; P = .04) was more frequent following resection than RFA. Recurrent lesions were comparatively more curable in RFA group than in resection group (80% vs 54.5%; P = .02). The recurrence of HCC was independently associated with lower serum albumin level (P = .027), the presence of comorbid diabetes mellitus (P = .010), and RFA (P = .034). In conclusion, in patients with very early-stage HCC, surgical resection has achieved significantly better recurrence-free survival than RFA. A closer follow-up is required after resection.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter , Hepatectomia , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
10.
J Cancer Res Clin Oncol ; 145(9): 2199-2209, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31309302

RESUMO

PURPOSE: Radiofrequency (RF) ablation therapy is of great interest in cancer therapy as it is non-ionizing radiation and can effectively penetrate into the tissue. However, the current RF ablation technique is invasive that requires RF probe insertion into the tissue and generates a non-specific heating. Recently, RF-responsive nanomaterials such as gold nanoparticles (AuNPs) and iron oxide nanoparticles (IONPs) have led to tremendous progress in this area. They have been found to be able to absorb the RF field and induce a localized heating within the target, thereby affording a non-invasive and tumor-specific RF ablation strategy. In the present study, for the first time, we used a hybrid core-shell nanostructure comprising IONPs as the core and AuNPs as the shell (IO@Au) for targeted RF ablation therapy. Due to the magnetic core, the nanohybrid can be directed toward the tumor through a magnet. Moreover, IONPs enable the nanohybrid to be used as a magnetic resonance imaging (MRI) contrast agent. RESULTS: In vitro cytotoxicity experiment showed that the combination of IO@Au and 13.56-MHz RF field significantly reduced the viability of cancer cells. Next, during an in vivo experiment, we demonstrated that magnetically targeting of IO@Au to the tumor and subsequent RF exposure dramatically suppressed the tumor growth. CONCLUSION: Therefore, the integration of targeting, imaging, and therapeutic performances into IO@Au nanohybrid could afford the promise to improve the effectiveness of RF ablation therapy.


Assuntos
Ablação por Cateter/métodos , Compostos Férricos/química , Ouro/química , Hipertermia Induzida/métodos , Nanopartículas de Magnetita/uso terapêutico , Neoplasias/cirurgia , Ablação por Radiofrequência/métodos , Animais , Compostos Férricos/uso terapêutico , Ouro/uso terapêutico , Imagem por Ressonância Magnética/métodos , Nanopartículas de Magnetita/química , Masculino , Nanopartículas Metálicas/química , Nanopartículas Metálicas/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Terapia de Alvo Molecular/métodos , Nanocompostos/química , Nanocompostos/uso terapêutico , Nanoconchas/química , Nanoconchas/uso terapêutico , Neoplasias/patologia , Células Tumorais Cultivadas
11.
Medicina (B Aires) ; 79(3): 197-200, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284254

RESUMO

Functional bundle branch block during a supraventricular tachycardia can be observed with shorter cycle lengths and represent a physiologic response by the specialized intraventricular conduction system to accelerated AV nodal conduction. The present case corresponds to a young patient with exercise induced orthodromic A-V reentrant tachycardia and alternating bundle branch block. This unusual response is explained by the finding obtained during the electrophysiology study. An accelerated AV nodal conduction made the depolarizing wave front reach the bundle branches during their refractory period. Once block in one bundle was stablished, block persisted due to the linking phenomenon that is repetitive retrograde concealed conduction from the contralateral bundle. After catheter ablation of a concealed left-sided accessory A-V pathway, rapid atrial pacing at the same cycle length of the tachycardia reproduced the same aberrancies observed during tachycardia. This response proved that functional bundle branch block is due to the short cycle length and not the presence of an accessory A-V pathway.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Taquicardia Supraventricular/diagnóstico por imagem , Adolescente , Bloqueio de Ramo/etiologia , Ablação por Cateter , Eletrocardiografia , Eletrofisiologia , Sistema de Condução Cardíaco/diagnóstico por imagem , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Taquicardia Supraventricular/complicações
12.
Int Heart J ; 60(4): 812-821, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308323

RESUMO

Pulmonary vein isolation (PVI) of atrial fibrillation (AF) can reduce the AF burden and, potentially, reduce the long-term risk of strokes and death. However, it remains unclear whether anticoagulants can be stopped after PVI because of post-ablation AF recurrence in some patients. This study aimed to investigate the discontinuation rate of anticoagulants and long-term incidence of strokes after PVI.We enrolled 512 consecutive Japanese patients with AF (mean age, 63.4 ± 10.4 years; 123 women; 234 with non-paroxysmal AF; CHADS2 score/CHA2DS2-VASC score, 1.32 ± 1.12/2.21 ± 1.54) who underwent PVI between 2012 and 2015. During a 28.0 ± 17.1 -month follow-up, anticoagulants were terminated in 230 (44.9%) of the 512 patients, AF recurred in 200 (39.1%), and 10 (1.95%) suffered from a stroke. Death occurred in 5 (0.98%) patients. Although the incidence of strokes, by a Kaplan-Meier analysis, was similar, the incidence of death was lower (Hazard ratio 0.37, 95% confidence interval 0.12-0.93, P = 0.041) in the AF ablation group than the control group without ablation after 1:1 propensity score matching (the control data was derived from 2,986 patients in the SAKURA AF Registry, a large-cohort AF registry).Anticoagulants were discontinued in nearly half the patients who underwent AF ablation; of these, 39.1% experienced AF recurrences, 1.95% suffered from strokes, and 0.98% died, but the risk of death after AF ablation appeared to be lower than that in a propensity score-matched control group without ablation during long-term follow-up.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Idoso , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Recidiva , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
13.
Medicine (Baltimore) ; 98(29): e16438, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335698

RESUMO

In many types of surgery, obesity may influence patient selection, prognosis, and/or management. Quantifying the accuracy of the coding of obesity and other prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative healthcare data. This study assessed the validity of obesity diagnoses recorded in insurance claims data in selected surgical populations.This was a retrospective, observational study. Deidentified electronic health record (EHR) and linked administrative claims data were obtained for US patients age ≥20 years who underwent a qualifying surgical procedure (bariatric surgery, total knee arthroplasty [TKA], cardiac ablation, or hernia repair) in 2014Q1-2017Q1 (first = index). Patients' body mass index (BMI) as coded in the claims data (error-prone measure) during the index procedure or 180d pre-index was compared with their measured BMI as recorded in the EHR (criterion standard) to estimate the sensitivity and positive predictive value (PPV) of obesity diagnosis codes.Among patients who underwent bariatric surgery (N = 1422), TKA (N = 8670), cardiac ablation (N = 167), or hernia repair (N = 5450), obesity was present in 98%, 63%, 52%, and 54%, respectively, based on measured BMI. PPVs of obesity diagnosis codes were high: 99.3%, 96.0%, 92.8%, and 94.1% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. The sensitivity of obesity diagnoses was: 99.8%, 46.2%, 41.3%, and 42.3% in bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively. Among false-positive patients diagnosed as obese but with measured BMI <30, the proportion with a BMI ≥28 was 40.0%, 67.6%, 60.7%, and 65.8% for bariatric surgery, TKA, cardiac ablation, and hernia repair, respectively.Our data indicate that obesity is highly prevalent in many surgical populations, obesity diagnosis codes have high PPVs, but also obesity is generally undercoded in claims data. Quantifying the validity of diagnosis codes for obesity and other important prognostic factors is important for the design and interpretation of studies of surgical outcomes based on administrative data. Further research is needed to determine the extent to which undercoding of BMI and obesity can be addressed through the use of proxies that may be better documented in claims data.


Assuntos
Artroplastia do Joelho , Cirurgia Bariátrica , Ablação por Cateter , Codificação Clínica , Herniorrafia , Obesidade/diagnóstico , Adulto , Idoso , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Codificação Clínica/métodos , Codificação Clínica/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Seleção de Pacientes , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos/epidemiologia
14.
Int Heart J ; 60(4): 788-795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31353344

RESUMO

Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Cardiomiopatias/complicações , Átrios do Coração/fisiopatologia , Sarcoidose/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Ablação por Cateter , Ecocardiografia , Eletrocardiografia Ambulatorial , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia
15.
Medicine (Baltimore) ; 98(30): e16150, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348228

RESUMO

We evaluated the post-treatment overall survival (OS) of elderly hepatocellular carcinoma (HCC) patients.The archived records of 10,578 HCC patients registered at the Korean Central Cancer Registry from 2008 through 2014 were retrospectively analyzed. In this registry, we selected Barcelona Clinic Liver Cancer (BCLC) 0, A, or B staged HCC patients (n = 4744) treated by surgical resection (SR), local ablation therapy (LAT), or locoregional therapy (LRT). OSs in nonelderly (<70 years) and elderly (≥70 years) patients were compared after propensity score matching (PSM).In BCLC 0-A staged HCC, the cumulative OS rates of elderly patients were poorer than those of nonelderly patients after PSM (P < .001), but not in those with BCLC stage B (P > .05). In BCLC 0-A staged elderly patients, OS after SR was significantly better than after LAT (P = .005) or LRT (P < .001). In BCLC B staged elderly patients, SR achieved better OS than LRT (P = .006). Multivariable analysis showed that LAT (hazard ratio [HR] 1.52, P = .048) or LRT (HR, 2.01, P < .001) as compared with SR, and large (>3 cm) tumor size (HR1.49, P = .018) were poor predictors of OS for elderly patients with BCLC stage 0-A, and that LRT (HR, 2.64, P = .042) was a poor predictor for those with BCLC stage B.SR provided a better OS rate than LAT or LRT in elderly HCC patients with BCLC stage 0-A, than LRT in those with BCLC stage B. SR should be considered the first therapeutic option even in elderly HCC patients with these stages.


Assuntos
Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Ablação por Cateter/estatística & dados numéricos , Quimioembolização Terapêutica/estatística & dados numéricos , Comorbidade , Feminino , Comportamentos Relacionados com a Saúde , Hepatectomia/estatística & dados numéricos , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Estadiamento de Neoplasias , Pontuação de Propensão , Sistema de Registros , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida , Carga Tumoral
16.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(3): 173-175, 2019 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-31184072

RESUMO

Microwave thermal ablation technology is widely used in the treatment of liver tumors because of its minimal invasiveness and small side effects. The precise control of the thermal dose largely determines the therapeutic effect of microwave thermal ablation. However, the current magnetron-based microwave thermal ablation device has the disadvantages of poor power output stability and high operating voltage. In view of the above problems, this paper selected the microwave solid-state source as the core device of microwave output, and designed a dual-frequency microwave thermal ablation system based on 2 450 MHz and 433 MHz. The system used the power detection circuit to perform PID feedback control on the actual output power of the system. The experimental results show that the maximum output power of the system is less than 1 W. The PID algorithm further enhances the accuracy and stability of the system output power while improving the system security. The dual-frequency microwave thermal ablation system designed in this paper can provide a safe and reliable experimental platform for subsequent research.


Assuntos
Ablação por Cateter , Neoplasias Hepáticas , Ablação por Cateter/instrumentação , Humanos , Neoplasias Hepáticas/terapia , Micro-Ondas , Ablação por Radiofrequência
18.
J Physiol Pharmacol ; 70(1)2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31172970

RESUMO

Atrial fibrillation (AF) is a commonly occurring arrhythmia which significantly reduces patients' quality of life and substantially shortens life expectancy. Although long chain fatty acids (LCFAs) are the basic energy substrates for myocardial metabolism, their excess can result in lipotoxicity, which increases the risk of arrhythmia. Intracellularly, LCFAs are bound by fatty acid biding proteins (FABPs) and this results in low level of free LCFAs in the cytoplasm. Based on this principle, FABPs are considered "safeguards" against overwhelming accumulation of esterified into different bioactive lipid fractions (e.g. ceramide, diacylglycerols) LCFAs. So far, several FABPs have been discovered in humans. Currently, in relation to cardiovascular diseases heart-type fatty acid binding protein (H-FABP) and adipocyte fatty acid binding protein (A-FABP) play significant roles. Nowadays, A-FABP is of great interest for research related with obesity, diabetes and coexisting disorders including cardiovascular diseases. Concomitantly, H-FABP is already well-established marker in the early diagnosis of myocardial infarction. Moreover, FABPs were assigned as a potential biomarker of AF in patients with de novo diagnosed arrhythmia, chronic heart failure (CHF), and in patients undergoing cardiac surgery. Another group of studies where the concentrations of plasma FABPs were analyzed are patients subjected to electrical cardioversion (ECV) and radio-catheter ablation therapy (RFA). It is worth mentioning that, in addition to traditional anti-arrhythmic drugs (AADs) or ECV, ablation techniques are used with good effects. Even though the treatment of arrhythmias is constantly developing, the maintenance of the sinus rhythm (SR) is still a serious problem. Therefore, it is worth looking for a biomarker which is suitable for the patient's treatment qualifications as well as assessing its effectiveness. Thus, the aim of this work is to present current data on the clinical significance of FABPs in terms of the development and treatment of AF.


Assuntos
Fibrilação Atrial/sangue , Proteínas de Ligação a Ácido Graxo/metabolismo , Adipócitos/metabolismo , Animais , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Biomarcadores/sangue , Ablação por Cateter , Cardioversão Elétrica , Insuficiência Cardíaca/sangue , Humanos , Miocárdio/metabolismo
19.
Zhonghua Yi Xue Za Zhi ; 99(23): 1814-1818, 2019 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-31207694

RESUMO

Objective: To assess the feasibility and safety of endovascular denervation (EDN) with a multi-electrode radiofrequency ablation catheter on beagles. Methods: A total of 18 beagles, (10.2±1.1) kg,of either gender,were provided by the Animal Center of Southeast University (SYXK (Su) 2016-0013). They were divided equally into three groups:the instant euthanizing group, the long-term follow-up group and the sham operation group. Beagles in the instant euthanizing group were euthanized immediately after EDN. Beagles in the long-term follow-up group were euthanized three months after EDN. Beagles in the sham operation group underwent sham operation and were euthanized three months later. Blood biochemistry was measured at baseline, and immediately, 15 days, 30 days and 90 days after the surgery. Computerized tomographic (CT) angiography was determined before the surgery and 60 days after the surgery. Digital subtraction angiography (DSA) was determined 90 days after the surgery. Histopathologic analyses were used to identify the changes of arterial wall and neuron cells. Results: Beagles in the long-term follow-up group and the sham operation group all underwent EDN successfully without accidental death. No abdominal aortic perforation and peripheral tissue necrosis were found at Necropsy. No vascular injuries were found by CTA and DSA in each group. There was no statistical difference in hematological analyses, 90 days after the surgery:white blood cell:(12.5±1.5)×10(9)/L vs (13.2±0.7)×10(9)/L, P=0.275; red blood cell:(7.0±0.6)×10(9)/L vs (6.3±0.4)×10(9)/L, P=0.089; total bilirubin:(2.9±0.4) µmol/L vs (3.0±0.6) µmol/L, P=0.681; glutamic-pyruvic transaminase:(40±11) U/L vs (37±6) U/L, P=0.168; glutamic oxalocetie transaminase:(51±11) U/L vs (48±9) U/L, P=0.221; urea nitrogen:(7.2±1.2) mmol/L vs (6.9±0.8) mmol/L, P=0.505; creatinine:(60±9) µmol/L vs (59±9) µmol/L, P=0.81; prothrombin time:(7.2±0.7) s vs (7.0±0.7) s, P=0.719. Histopathological analyses showed that there were hypercellular appearance of nerve bundle and thickened perineurium in EDN groups, while normal perineurium around nerve bundle in the sham operation group. Conclusion: EDN could be applied in beagles safely and feasibly.


Assuntos
Dor do Câncer , Ablação por Cateter , Neoplasias , Angiografia Digital , Animais , Denervação , Cães
20.
Rozhl Chir ; 98(5): 223-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159545

RESUMO

Varicose veins of lower extremities represent a common medical condition with minimally invasive percutaneous endovenous ablation techniques as a treatment of choice. A very rare complication is a catheter migration in the deep venous system. In the literature only 7 cases have been published so far, with only 2 cases with migration to the systemic circulation and heart involvement. In this paper we present an interesting case report from the perspective of a thoracic surgeon with the finding of a laser ablation catheter remnant in the left pleural cavity during thoracoscopic exploration for a spontaneous hemothorax in a 47-year old male patient after collapse. A similar complication affecting the pleural cavity has not been published before. In this paper we discuss possible routes of the cathether migration into the left pleural cavity, impending complications when a part of the catheter is left behind in the body and the means of prevention of these serious potentially fatal complications even after many years following the initial treatment.


Assuntos
Ablação por Cateter , Migração de Corpo Estranho , Hemotórax , Terapia a Laser , Varizes , Migração de Corpo Estranho/complicações , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pelve , Veia Safena , Varizes/terapia
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