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1.
AAPS PharmSciTech ; 20(8): 310, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31520243

RESUMO

The production of 3D-printed dosage forms requires the preparation of high-quality filaments containing an active pharmaceutical ingredient (API). The objective of this research is to prepare filaments containing dronedarone hydrochloride, a drug used in the treatment of cardiac arrhythmias. Filaments and 3D-printed tablets were subjected to characterization methods in order to prove and ensure the stability of the API and preservation of the drug content. Blends containing different proportions of dronedarone hydrochloride (DNR), polyethylene glycol (PEG), and polyvinyl alcohol filament (PVA) were prepared in two forms: as a powder mixture and as a solid dispersion. Thermogravimetric analysis was conducted, and the thermal properties of the components and polymer blends were tested using differential scanning calorimetry. Hot melt extrusion at 170 °C was used to prepare the filaments, and the fused deposition modeling technique was employed to print tablets. Drug release profiles were obtained by in vitro tests. The results indicate that the mixture containing 10 wt.% of polyethylene glycol prepared as a solid dispersion exhibits the most straightforward structure and shows only the slightest deviation from the target filament diameter. The compact structure of the tablet obtained from the filament provides a uniform in vitro drug release over a 24-h period. It also shows the smallest aberration from the expected DNR content in the tablet. The paper demonstrates that a blend containing 10 wt.% of PEG, 10 wt.% of DNR, and 80 wt.% of PVA filament is the most appropriate formula for extrusion and tablet printing.


Assuntos
Antiarrítmicos/administração & dosagem , Arritmias Cardíacas/tratamento farmacológico , Dronedarona/administração & dosagem , Antiarrítmicos/química , Dronedarona/química , Composição de Medicamentos , Liberação Controlada de Fármacos , Polietilenoglicóis , Álcool de Polivinil , Impressão Tridimensional , Solubilidade , Comprimidos
2.
Int Heart J ; 60(5): 1161-1167, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484866

RESUMO

Therapy-resistant ventricular arrhythmias can occur during accidental advanced hypothermic conditions. On the other hand, hypothermic therapy using mild cooling has been successfully accomplished with infrequent ventricular arrhythmia events.To further clarify the therapeutic-resistant arrhythmogenic substrate which develops in hypothermic conditions, an experimental study was performed using a perfusion wedge preparation model of porcine ventricle, and electrophysiological characteristics, inducibility of ventricular arrhythmias, and effects of therapeutic interventions were assessed at 3 target temperatures (37, 32 and 28°C).As the myocardial temperature decreased, myocardial contractions and the number of spontaneous beats deceased. Depolarization (QRS width, stimulus-QRS interval) and repolarization (QT interval, ERP) parameters progressively increased, and dispersion of the ventricular repolarization increased. At 28°C, VF tended to be inducible more frequently (1/11 at 37°C, 1/11 at 32°C, and 5/11 hearts at 28°C), and some VFs at 28°C required greater defibrillation energy to resume basic rhythm.An advanced but not a mild hypothermic condition had an enhanced arrhythmogenic potential in our model. In the advanced hypothermic condition, VF with relatively prolonged F-F intervals and a greater defibrillation energy were occasionally inducible based on the arrhythmogenic substrate characterized as slowed conduction and prolonged repolarization of the ventricle.


Assuntos
Antiarrítmicos/administração & dosagem , Eletrocardiografia/métodos , Hipotermia Induzida/métodos , Fibrilação Ventricular/diagnóstico por imagem , Fibrilação Ventricular/terapia , Análise de Variância , Animais , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Eletrofisiologia Cardíaca/métodos , Modelos Animais de Doenças , Resistência a Medicamentos , Distribuição Aleatória , Medição de Risco , Suínos , Resultado do Tratamento
3.
J Vet Cardiol ; 24: 58-63, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405555

RESUMO

INTRODUCTION: The objective of the present study was to evaluate the pharmacokinetics of a compounded sustained-release procainamide formulation in normal dogs. ANIMALS: Six healthy, purpose-bred mixed-breed dogs participated in the study. METHODS: In phase I, two dogs were administered oral procainamide (30 mg/kg), and plasma was obtained to determine plasma concentration ranges and duration. In phase II, six dogs were administered procainamide (30 mg/kg by mouth every 12 hours) to determine the pharmacokinetics of sustained-release procainamide. Serum procainamide concentration was determined using an immunochemistry assay. RESULTS: No adverse clinical effects were noted in any of the dogs studied. The average maximum serum concentration, average serum concentration, and average minimum serum concentration were 10.17, 7.13, and 3.07 µg/mL, respectively. The average time over a 12-h period during which procainamide concentration exceeded 12 µg/mL was 2.35 h, was between 4 and 12 µg/mL was 7.19 h, and was less than 4 µg/mL was 2.46 h. The average times at maximum concentration and minimum concentration were 18.67 and 12.25 h, respectively. CONCLUSIONS: Administration of sustained-release procainamide twice daily achieved targeted plasma concentrations in most dogs. Evaluation of serum trough concentrations should be considered owing to interanimal variability to confirm that serum concentrations are within the reported therapeutic range for an individual patient.


Assuntos
Antiarrítmicos/farmacocinética , Preparações de Ação Retardada/farmacocinética , Cães/metabolismo , Procainamida/farmacocinética , Administração Oral , Animais , Antiarrítmicos/administração & dosagem , Antiarrítmicos/sangue , Preparações de Ação Retardada/administração & dosagem , Cães/sangue , Feminino , Masculino , Procainamida/administração & dosagem , Procainamida/sangue , Valores de Referência
4.
Medicine (Baltimore) ; 98(34): e16961, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441899

RESUMO

BACKGROUND: Owing to reports of recurrent cardiac events in some catecholaminergic polymorphic ventricular tachycardia (CPVT) patients using ß-blockers, safer alternatives are being investigated. Flecainide is an alternative adjunctive anti-arrhythmic agent known to provide incomplete protection to CPVT patients. METHODS: To investigate the efficacy and tolerability of flecainide, we searched 4 databases for retrospective cohort studies (RCs) and randomized controlled trials (RCTs) investigating the efficacy and safety of flecainide for CPVT patients. Data were extracted and analyzed (risk ratio [RR] or mean difference [MD]) using RevMan software. Seven RCs and 1 RCT (333 CPVT patients; 152 patients treated with flecainide) were identified. RESULTS: Flecainide monotherapy was superior to standard therapy in alleviating the risk of arrhythmic events (RR = 0.46, confidence interval [CI] = [0.38, 0.56], P < .00001) and exercise-induced arrhythmia scores (MD = -0.39, CI = [-0.74, -0.05], P = .03). Combination therapy of flecainide and ß-blockers was superior to ß-blocker monotherapy in reducing the risk of arrhythmic and symptomatic events (RR = 0.29, CI = [0.13, 0.69], P = .005; RR = 0.36, CI = [0.20, 0.62], P = .0003, respectively), peak heart rate (MD = -16.81, CI = [-28.21, -5.41], P = .004), and exercise-induced arrhythmia scores (MD = -1.87, CI = [-2.71, 1.04], P < .0001). Flecainide did not increase the risk of all side effects (RR = 0.76, CI = [0.42, 1.40], P = .38) compared to that with ß-blockers alone. No deaths were reported among patients treated with flecainide. CONCLUSIONS: Flecainide is an effective and safe anti-arrhythmic agent, and its use as a monotherapy might be a good alternative for CPVT patients with ß-blocker intolerance. Combination therapy was superior to ß-blocker monotherapy. More randomized clinical trials are required to explore the long-term efficacy and safety of flecainide in these patients.


Assuntos
Antiarrítmicos/administração & dosagem , Flecainida/administração & dosagem , Taquicardia Ventricular/tratamento farmacológico , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Antiarrítmicos/efeitos adversos , Feminino , Flecainida/efeitos adversos , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
5.
Med Clin North Am ; 103(5): 821-834, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378328

RESUMO

The narrow therapeutic window of antiarrhythmic drugs makes their use clinically challenging. A solid understanding of the mechanisms of arrhythmias and how antiarrhythmics affect these mechanisms is only a preliminary step in their appropriate selection. Clinical factors, side-effect profiles, and proarrhythmic risks are more important than the cellular mechanisms of actions in drug selection and monitoring. This article provides a simplified approach to understanding cellular mechanisms and provides a practical approach to the selection and use of this important class of medications.


Assuntos
Antiarrítmicos/administração & dosagem , Arritmias Cardíacas/tratamento farmacológico , Potenciais de Ação , Antiarrítmicos/efeitos adversos , Arritmias Cardíacas/fisiopatologia , Humanos , Ablação por Radiofrequência , Medição de Risco
6.
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
7.
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
8.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 227-233, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182762

RESUMO

Objetivos: Este estudio analiza el control del ritmo en los servicios de urgencias (SUH) y sus resultados en pacientes con fibrilación auricular (FA) de reciente comienzo, para identificar áreas de mejora en el manejo. Método: Estudio multicéntrico, observacional, prospectivo y transversal desarrollado en 124 SUH representativos del sistema sanitario español basado en el registro HERMES-AF (estrategias de manejo en el servicio de urgencias hospitalario de la FA) del 23 de mayo al 5 de junio de 2011. Se incluyeron pacientes con FA sintomática con menos de 48 h de evolución en los cuales se tomó la decisión de restaurar el ritmo sinusal. Resultados: Se incluyeron 337 pacientes, se optó por cardioversión farmacológica en 311 pacientes (92,3%), y por cardioversión eléctrica en 52 (15%), la mitad de los casos tras fracaso de los fármacos. Se obtuvo ritmo sinusal (RS) en 278 pacientes (82,5%) y el alivio de los síntomas en 297 (94%), con una tasa de efectos adversos del 0,9%, ninguno grave. Amiodarona se asoció de manera independiente a una menor tasa de RS al alta (OR = 0,442; IC 95% 0,238-0,823; p = 0,01), al contrario que la cardioversión eléctrica (OR = 4,0; IC 95% 1,2-13,3; p = 0,024). Los fármacos I-C se asociaron con una mayor proporción de altas en < 6 h (OR 2,6; IC 95% 1,6-4,3; p < 0,001) y amiodarona con más estancias prolongadas de > 24 h (OR 2,7, IC 95% 1,5-4,8; p < 0,003). Conclusiones: En los SUH, la restauración del RS en la FA de reciente comienzo es segura, efectiva y asocia beneficios clínicos para los pacientes. Reemplazar amiodarona por técnicas más efectivas y rápidas como la cardioversión eléctrica o los fármacos I-C es un área de mejora de la calidad asistencial


Objectives: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. Methods: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. Results: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P<.001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P<.003). Conclusions: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardioversão Elétrica/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Ritmo Circadiano/efeitos dos fármacos , Sistema de Registros/normas , Cardioversão Elétrica/tendências , Estudos Prospectivos , Estudos Transversais , Espanha , Antiarrítmicos/administração & dosagem , Sistemas de Saúde/organização & administração
9.
BMJ Case Rep ; 12(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31311787

RESUMO

Andersen-Tawil syndrome (ATS) is an inherited disorder characterised by the triad of ventricular arrhythmias (VAs), periodic paralysis and dysmorphic features. A 31-year-old woman diagnosed with ATS caused by a KCNJ2 mutation (p.R228ins) was urgently admitted to our hospital following an episode of syncope during exercise. Electrocardiography revealed frequent premature ventricular complexes and non-sustained ventricular tachycardias (VTs) with pleomorphic QRS patterns. During the intravenous flecainide test (30 mg), the frequent VAs were inhibited completely. After oral flecainide (100 mg) was started, VAs, except for a brief bigeminy, were suppressed during the exercise test. On 24-hour Holter recordings, the VAs decreased from 50 133 to 13 363 beats/day (-73%). Sustained VT and syncope were not observed during a 3-year follow-up period. Intravenous flecainide challenge test may be useful in predicting the efficacy of oral flecainide treatment for patients with ATS.


Assuntos
Síndrome de Andersen/complicações , Antiarrítmicos/administração & dosagem , Flecainida/administração & dosagem , Complexos Ventriculares Prematuros/etiologia , Administração Intravenosa , Administração Oral , Adulto , Síndrome de Andersen/tratamento farmacológico , Síndrome de Andersen/genética , Síndrome de Andersen/fisiopatologia , Antiarrítmicos/uso terapêutico , Eletrocardiografia , Feminino , Flecainida/uso terapêutico , Humanos , Síncope/etiologia , Síncope/fisiopatologia , Usos Terapêuticos , Resultado do Tratamento , Complexos Ventriculares Prematuros/tratamento farmacológico , Complexos Ventriculares Prematuros/fisiopatologia
10.
AAPS PharmSciTech ; 20(6): 226, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31214813

RESUMO

The objective of the present study was to develop a proliposomal formulation to increase the oral bioavailability of dronedarone hydrochloride (dronedarone HCl) by enhancing solubility, dissolution, and/or intestinal absorption. Proliposomes were prepared by using solvent evaporation method. In this process, different ratios of drug, phospholipids, such as soy phosphatidylcholine (SPC), Phospholipon 90H, hydrogenated egg phosphatidylcholine (HEPC), and dimyristoyl phosphatidylglycerol (DMPG), and cholesterol were used. Physical characterization and in vitro dissolution studies were evaluated for the prepared formulations. In vitro transport across the membrane was carried out using Caco-2 cells. Among all the formulations, the amount of drug released in dissolution was higher with DPF8 formulation (drug:DMPG Na:cholesterol:::1:2:0.2) compared to the pure drug. Also, Caco-2 cell permeability studies resulted in 2.6-fold increase in apparent permeability. Optimized formulation was evaluated in vivo in male Sprague-Dawley rats. After single oral administration of optimized formulation (DPF8), a relative bioavailability of 148.36% was achieved compared to the pure drug. Improved oral bioavailability of dronedarone could be provided by an optimized proliposomal formulation with enhanced solubility, permeability, and oral absorption.


Assuntos
Antiarrítmicos/química , Dronedarona/química , Lipossomos , Administração Oral , Animais , Antiarrítmicos/administração & dosagem , Antiarrítmicos/farmacocinética , Disponibilidade Biológica , Células CACO-2 , Colesterol , Dronedarona/administração & dosagem , Dronedarona/farmacocinética , Portadores de Fármacos , Composição de Medicamentos , Humanos , Masculino , Tamanho da Partícula , Permeabilidade , Fosfolipídeos , Ratos , Ratos Sprague-Dawley , Solubilidade
11.
J Vet Intern Med ; 33(4): 1585-1592, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31222803

RESUMO

BACKGROUND: Typical atrioventricular accessory pathways (APs) are composed of myocardial cells. They provide electrical connections between atria and ventricles separate from the normal conduction system. Accessory pathways can participate in a macroreentrant circuit resulting in orthodromic atrioventricular reciprocating tachycardia (OAVRT). HYPOTHESIS: Because of ultrastructural similarities of typical AP cells to ventricular myocardial cells, we hypothesized lidocaine would be effective in blocking AP conduction, thus terminating OAVRT. ANIMALS: Thirty-two consecutive client-owned dogs presenting with narrow complex tachyarrhythmias were confirmed to have OAVRT by electrophysiologic study (EPS). METHODS: Prospective, nonrandomized, single-arm study with lidocaine administered IV to dogs during OAVRT in 2 mg/kg boluses to a cumulative dose of 8 mg/kg or development of adverse effects. Electrocardiograms were monitored continuously. Subsequent EPS was performed to confirm OAVRT and the absence of other tachycardia mechanisms. RESULTS: Twenty-seven dogs experienced OAVRT cardioversion with lidocaine, before or at the time of adverse effects. Orthodromic atrioventricular reciprocating tachycardia in 5 dogs did not cardiovert before adverse effects, precluding additional dosing. Median total lidocaine dose for cardioversion was 2 mg/kg (interquartile range, 2-5.5 mg/kg). Dogs with right free wall APs had a significantly higher rate of cardioversion than did dogs with right posteroseptal APs. CONCLUSIONS AND CLINICAL IMPORTANCE: Lidocaine successfully cardioverted OAVRT in 84.4% of dogs in our study before adverse effects precluded additional dosing. In 5 dogs with dose limited by adverse effects, it is unknown whether cardioversion would have occurred at a higher cumulative dose.


Assuntos
Antiarrítmicos/farmacologia , Doenças do Cão/tratamento farmacológico , Lidocaína/farmacologia , Taquicardia Reciprocante/veterinária , Animais , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/veterinária , Cães , Feminino , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Estudos Prospectivos , Taquicardia Reciprocante/tratamento farmacológico
13.
Med Arch ; 73(1): 19-22, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31097854

RESUMO

Introduction: Postoperative Atrial Fibrillation (POAF) is associated with a higher rate of postoperative complications and mortality, as well as with longer hospitalization and increased treatment costs. We have designed and performed a randomized, trial of pharmacological prophylaxis in which the event of interest is POAF. Aim: The aim of this study is to reduce the risk of postoperative, complications associated with this arrhythmia. Methods: We included 240 stable patients with a coronary heart disease, who were referred to elective surgical revascularization of the myocardium. The patients were assigned into three groups of 80 patients each: group A (BB, beta blocker, comparator), group B (BB+ Amiodarone) and group C (BB + Rosuvastatin). The goal was to establish whether intervention by combination therapy was more useful than a comparator. Results: An event of interest (POAF) has occurred in 66 of the total 240 patients. Number of new POAF cases is the lowest in Group B, 14 (17.5%) compared to 25 (31.25%) new cases in the comparator group, and 27 new cases (33.75%) in group C. Absolute risk reduction was 13.75%, ≈14% less POAF in group B compared to comparator. Relative risk reduction was 56% (RR 0.56, p = 0.04). Number Needed to Treat was 7.27. In group C, 33.75% of patients developed POAF. Absolute risk was insignificantly higher in group C (2.5%, NS) compared to the comparator .The number needed to harm was high, 40. Conclusion: The results of our research show that prophylaxis of POAF with combined therapy BB + Amiodarone was the most efficient one.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/prevenção & controle , Revascularização Miocárdica/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Rosuvastatina Cálcica/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/etiologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , Complicações Pós-Operatórias/etiologia , Rosuvastatina Cálcica/administração & dosagem
14.
Expert Opin Drug Saf ; 18(6): 537-547, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31117845

RESUMO

Introduction: Nicorandil may exert cardioprotective effects in ischemic heart disease. However, its efficacy in combination with early reperfusion is uncertain. The authors performed a meta-analysis of the short- and long-term clinical outcomes of nicorandil administration at the time of primary percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI). Methods: PubMed, MEDLINE, Embase, and the Cochrane Library databases were systematically searched for eligible randomized controlled studies. The primary endpoint was major adverse cardiovascular events (MACE), both in-hospital and post-discharge. The secondary endpoint was the incidence of no-reflow phenomenon. Results: Ten studies were included (n = 1105). Mean patient age was 63.0 ± 10.0 years; 76.6% of patients were male. Compared with controls who received primary PCI, combined nicorandil/primary PCI significantly reduced in-hospital MACE (pooled odds ratio [OR] 0.16; 95% confidence interval [CI] 0.09-0.27), follow-up MACE (pooled OR 0.53; 95% CI 0.37-0.75), and total MACE (pooled OR 0.27; 95% CI 0.15-0.49). The combined treatment also reduced the incidence of no-reflow phenomenon (pooled OR 0.34; 95% CI 0.23-0.50). Conclusion: Nicorandil administration at the time of primary PCI is associated with reduced MACE (both short- and long-term) and no-reflow phenomenon in patients with STEMI.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Nicorandil/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Animais , Antiarrítmicos/administração & dosagem , Cardiotônicos/administração & dosagem , Doenças Cardiovasculares/epidemiologia , Terapia Combinada , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/epidemiologia , Fenômeno de não Refluxo/prevenção & controle , Intervenção Coronária Percutânea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
15.
Minerva Cardioangiol ; 67(4): 272-279, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31115243

RESUMO

BACKGROUND: Transcatheter ablation (Abl) of atrial fibrillation (AF) is regarded as the best therapeutic solution for severely symptomatic patients, in whom at least one antiarrhythmic drug has been tested. METHODS: In the present retrospective study, 175 cases of paroxysmal, persistent or long-lasting persistent AF have been gathered, and grouped depending on therapeutic approach: Abl, isolated or followed by chronic use of antiarrhythmics (N.=74), drug treatment for rate control strategy (N.=60), and drug treatment for rhythm control strategy (N.=41). The effects respectively exerted by the three treatment modalities on the primary endpoint, namely a composite of death, disabling stroke, severe bleeding and cardiac arrest, have been compared through a median follow-up of 20 months (interquartile range: 18-24 months) using the Cox proportional-hazards regression analysis. Further exposure variables were hypertension, the A-P diameter of the left atrium, the left ventricular ejection fraction and AF relapses. RESULTS: The rhythm control strategy and AF recurrences during the follow-up were associated with increased risk of the primary composite endpoint as documented by the Cox model (for the former, hazard ratio [HR]: 3.3159; 95% CI: 1.5415 to 7.1329; P=0.0023; for the latter, HR: 1.0448; 95% CI: 1.0020 to 1.0895; P=0.0410). Even hypertension was associated with an increased risk (HR: 1.1040; 95% CI: 1.0112 to 1.9662; P=0.0477). On the contrary, a rate control strategy predicted a decreased risk of experiencing the primary endpoint (HR: 0.0711; 95% CI: 0.0135 to 0.3738; P=0.0019) while Abl did not exert a statistically significant effect on the same outcome. CONCLUSIONS: AF ablation is able to decrease the arrhythmic episodes but does not offer a statistically significant protection against the composite of death, disabling stroke, severe bleeding and cardiac arrest in the mid-term follow-up.


Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Acidente Vascular Cerebral/epidemiologia , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Função Ventricular Esquerda
16.
J Clin Pharm Ther ; 44(5): 693-700, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30989702

RESUMO

WHAT IS KNOWN AND OBJECTIVE: There is limited guidance on how to transition critically ill patients from intravenous (IV) to oral (PO) amiodarone. The objective of this study was to assess the impact of IV and PO amiodarone overlap on short-term tachyarrhythmia recurrence and adverse hemodynamic outcomes in the intensive care unit. METHODS: This is a retrospective, single-center analysis of critically ill adults who were treated with IV amiodarone for a supraventricular arrhythmia with rapid ventricular rate (RVR) and transitioned to PO amiodarone while inpatient. Patients were excluded if rate control was not achieved prior to the PO transition. Receipt of concomitant IV and PO therapy for ≤2 hours was considered no overlap (NOV) and >2 hours was considered overlap (OV). Tachyarrhythmia recurrence and adverse hemodynamic events were compared between groups. RESULTS: A total of 90 patients (45 NOV, 45 OV) were included in the analysis. The median overlap duration was 0.1 (-1.3 to 1.2) hours in the NOV arm and 4 (2.6-6.1) hours in the OV arm. Recurrence of RVR occurred in 9 (20%) patients in each arm (P = 1.0). The median time from IV discontinuation to return of tachyarrhythmia was 10.5 hours. There were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Hypotension occurred in 13% and 20% (P = 0.369) and bradycardia in 9% and 13% (P = 0.502) of patients in the NOV and OV arms, respectively. WHAT IS NEW AND CONCLUSION: Providing IV and PO overlap of amiodarone for a median of 4 hours did not decrease the rate of early tachyarrhythmia recurrence. Future studies are warranted to evaluate the impact of alternative amiodarone dosing strategies on breakthrough tachyarrhythmia.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Estado Terminal , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Intravenosas/métodos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taquicardia/tratamento farmacológico
17.
Am J Emerg Med ; 37(7): 1340-1345, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31027937

RESUMO

The evaluation and treatment of wide QRS-complex tachycardia remains a challenge, and mismanagement is quite common. Diagnostic aids such as wide-complex tachycardia algorithms perform poorly in the real-life setting. The purpose of this review is to offer a simple clinical-electrocardiographic approach for the initial evaluation and management of the adult patient with stable wide-complex tachycardia that does not require recollection of complex guidelines or algorithms.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/diagnóstico , Administração Intravenosa , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/complicações , Diagnóstico Diferencial , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Taquicardia/complicações , Síndrome de Wolff-Parkinson-White/complicações
18.
Am J Ther ; 26(4): e469-e480, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30946044

RESUMO

BACKGROUND: The optimal management for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators (ICDs) offers a challenge with no set guidelines regarding which therapy offers a best safety and efficacy profile. STUDY QUESTION: Which therapeutic strategy, among antiarrhythmic drugs and catheter ablation (CA), offers the most effective and safe approach in patients with ICDs? DATA SOURCES: Randomized controlled trials (RCTs) comparing the efficacy and safety of antiarrhythmic drugs or CA against a placebo group. RCTs were identified from a comprehensive search in PubMed, Embase, and Cochrane library. STUDY DESIGN: Our outcomes of interest were reductions in appropriate ICD shocks, inappropriate ICD shocks, and overall mortality. We used the event rates in both groups, and then using a frequentist approach employing a graph theory methodology, we constructed a network meta-analysis model. RESULTS: Fourteen RCTs with 3815 participants and 6 different interventions treatments were included in our network meta-analysis. The most effective treatment for the prevention of recurrent ventricular tachycardia after ICD is amiodarone followed by CA. Amiodarone is most effective in the reduction of appropriate and inappropriate ICD shocks with an odds ratio (OR) of 0.29 [95% confidence interval (CI), 0.11-0.74] and 0.15 (95% CI, 0.04-0.60), respectively. CA was effective in the reduction of appropriate ICD shocks (OR, 0.41; 95% CI, 0.20-0.87), whereas sotalol was effective in the reduction of inappropriate ICD shocks (OR, 0.46; 95% CI, 0.22-0.95). There was no significant reduction in the overall mortality from any therapy. There was a trend of increased mortality associated with amiodarone therapy (OR, 2.40; 95% CI, 0.92-6.26). CONCLUSIONS: Amiodarone remains the most efficacious therapy for the reduction of appropriate and inappropriate shocks in patients with ICD. No therapy resulted in mortality reduction, but amiodarone showed a trend toward increased mortality.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca/prevenção & controle , Prevenção Secundária/métodos , Taquicardia Ventricular/prevenção & controle , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/métodos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Humanos , Meta-Análise em Rede , Recidiva , Taquicardia Ventricular/complicações , Taquicardia Ventricular/mortalidade , Resultado do Tratamento
19.
Int J Cardiovasc Imaging ; 35(9): 1549-1555, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30941564

RESUMO

The transient left atrial appendage (LAA) dysfunction after electrical cardioversion (CV), which is called as LAA-stunning, was found to be an important etiology of thrombus formation. The aim of the present study was to investigate the risk factors of LAA-stunning. This study included 134 patients who underwent catheter ablation for non-paroxysmal, non-valvular, and symptomatic atrial fibrillation (AF). Internal-CV was performed, and LAA emptying fraction (LAA-EF) was assessed using LAA-angiogram before and just after CV. LAA-stunning (defined as 10% reduction of LAA-EF after CV) was observed in 45/134 patients (34%). Patients in LAA-stunning group had longer duration of AF prior to CV, higher brain natriuretic peptide (BNP), higher prevalence of patients taking calcium blocker, larger left atrial (LA) diameter, elevated E wave, and larger LA volume than those in non LAA-stunning group. Multivariate analysis showed that longer duration of AF prior to CV (p = 0.015, OR 1.033 for 1 month extend, 95% CI 1.006-1.073) and elevated BNP (p = 0.038, OR 1.041 for each 10 pg/mL increase, 95% CI 1.001-1.009) were associated with LAA-stunning. In addition, all patients were divided into four groups based on the combination between duration of AF prior to CV and BNP; group 1 (low BNP/short-lasting AF), group 2 (high BNP/short-lasting AF), group 3 (low BNP/long-lasting AF), and group 4 (high BNP/long-lasting AF). The rate of LAA-stunning was the highest in the group 4 (55.6%). Elevated BNP and long duration of AF were associated with LAA stunning after electrical cardioversion.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/terapia , Função do Átrio Esquerdo , Cardioversão Elétrica/efeitos adversos , Miocárdio Atordoado/etiologia , Idoso , Antiarrítmicos/administração & dosagem , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Bloqueadores dos Canais de Cálcio/administração & dosagem , Esquema de Medicação , Ecocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio Atordoado/diagnóstico por imagem , Miocárdio Atordoado/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
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