Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 57.665
Filtrar
1.
Med Clin North Am ; 103(5): 767-774, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378323

RESUMO

This article represents an overview of the basic concepts of cardiac electrophysiology. This relatively new field became a subspecialty of cardiology in the mid-1990s due to the rapid development of equipment that allowed the study and cure of cardiac arrhythmias percutaneously. Simultaneously, technology provided the field with percutaneous cardiac implantable electronic devices designed to protect patients from life-threatening bradyarrhythmias and tachyarrhythmias. Recently, the field has focused on the ablative treatment of atrial fibrillation, the most common arrhythmia facing an aging population, and the diagnosis and management of many inherited arrhythmias through advances in understanding of their genetic cause.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Eletrocardiografia , Fenômenos Eletrofisiológicos , Humanos , Marca-Passo Artificial , Ablação por Radiofrequência
2.
Med Clin North Am ; 103(5): 785-791, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378325

RESUMO

Palpitation is common. It is often accompanied by dizziness, lightheadedness, near syncope, and even syncope. It may be difficult to confirm a diagnosis in patients with infrequent symptoms. Several tools are available to document arrhythmias in the workup of a patient with palpitation, including 24-hour Holter monitoring, 30-day external continuous monitoring, and implantable loop recorders. A number of private companies are now able to empower patients to monitor heart rates and even give accurate rhythm strips. This article reviews the current data on how to make the diagnosis and which tools to use in the primary care setting.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial , Humanos , Avaliação de Sintomas , Fatores de Tempo
3.
Med Clin North Am ; 103(5): 793-807, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378326

RESUMO

Cardiac arrhythmia is a common cause of syncope. The prompt identification of arrhythmic syncope has diagnostic and prognostic implications. In this article, an approach to identifying and managing arrhythmic syncope is discussed, including key findings from the history, physical examination, electrocardiogram, role of risk stratification, use of supplemental investigations, and treatment.


Assuntos
Arritmias Cardíacas/diagnóstico , Síncope/etiologia , Arritmias Cardíacas/complicações , Eletrocardiografia , Humanos , Exame Físico , Prognóstico , Síncope/epidemiologia
4.
Med Clin North Am ; 103(5): 809-820, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378327

RESUMO

With recent advances in genetic diagnostics, many inherited diseases, which can cause life-threatening arrhythmias, are being better characterized. Many of these diseases are caused by genetic disorders that affect the function of the ion channels that regulate the action potential or the function of important cardiac muscle regulatory proteins. This article summarizes the diseases that we have learned about, such as the long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. The article examines the diagnosis, genetic screening of patients and their relatives, management, and referral to a specialist for further therapy.


Assuntos
Arritmias Cardíacas/congênito , Canalopatias/diagnóstico , Morte Súbita Cardíaca/etiologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Canalopatias/complicações , Humanos , Prognóstico , Avaliação de Sintomas
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.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 368-373, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1012344

RESUMO

Cardiopulmonary exercise testing is widely used in the evaluation of patients with left ventricular dysfunction, and some of these patients have an implantable cardioverter-defibrillator (ICD). However, this test presents specific challenges because of the susceptibility to ventricular arrhythmias during maximal levels of exercise. Objective: To evaluate the safety of cardiopulmonary exercise testing in patients with ICD. Methods: The study included patients with ICD who underwent cardiopulmonary exercise testing between 2007 and 2015. The tests were completed once the electronic devices were programmed. The maximum allowed heart rate reached during exercise was 10 beats below the first therapy zone programmed. Results: The study included 69 patients with mean age 53.7 ± 10.8 years, including 68% men. Exercise time was 8.7±2.3 minutes, with peak oxygen consumption of 13.3 ± 4.3 ml.kg-1.min-1. Peak heart rate was 62.9 ± 13.4% of the maximum rate predicted, with all patients taking specific medication. Ventricular arrhythmia was observed in 29% of the patients, and paired ventricular extrasystoles, ventricular bigeminism or non-sustained ventricular tachycardia were observed in only 14.5% of the patients. There was no sustained ventricular arrhythmia resulting in ICD therapy or other complications, such as inappropriate therapies. The frequency of severe events was 0%, 95% CI (0 - 5.2%). Conclusion: In the sample of patients evaluated, the cardiopulmonary exercise testing was shown to be safe during its performance in a hospital setting, following the safety standards


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Desfibriladores Implantáveis , Teste de Esforço/métodos , Consumo de Oxigênio , Arritmias Cardíacas , Doenças Cardiovasculares , Índice de Massa Corporal , Morte Súbita Cardíaca , Eletrocardiografia/métodos , Frequência Cardíaca
7.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(2): 86-101, ago. 2019. ilus, tab
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1008711

RESUMO

La fibrilación auricular (FA) es la arritmia sostenida más frecuente que puede presentarse en una amplia variedad de condiciones clínicas. A pesar de los progresos en el tratamiento de los pacientes con FA, esta arritmia sigue siendo una de las más importantes causas de accidente cerebrovascular, insuficiencia cardiaca, muerte súbita y morbilidad cardiovascular en todo el mundo. El objetivo del tratamiento con fármacos antiarrítmicos es mejorar los síntomas relacionados con la FA, y buscar un equilibrio entre la carga sintomática, la posibilidad de reacciones farmacológicas adversas y las preferencias del paciente. El control de la frecuencia cardiaca a corto y largo plazo se puede lograr con bloqueadores beta, digoxina, bloqueadores de los canales del calcio o tratamiento combinado. Si bien otros fármacos antiarrítmicos de clase III también tienen un efecto limitador de la frecuencia, solo deben emplearse para el control del ritmo cardiaco. Restaurar y mantener el ritmo sinusal también es una parte integral del tratamiento de la FA. Los fármacos antiarrítmicos de clase III duplican la tasa de pacientes en ritmo sinusal. El tratamiento para el control del ritmo está indicado para mejorar los síntomas de los pacientes con FA que siguen sintomáticos a pesar del tratamiento adecuado para el control de la frecuencia cardiaca. La combinación de antiarrítmicos que prolongan el intervalo QT no se debe emplear para el control del ritmo cardiaco en la FA(AU)


Atrial fibrillation (AF) is the most frequent sustained arrhythmia that can occur in a wide variety of clinical conditions. Despite progress in the treatment of patients with AF, this arrhythmia remains one of the most important causes of stroke, heart failure, sudden death and cardiovascular morbidity worldwide. The aim of treatment with antiarrhythmic drugs is to improve the symptoms related to AF, and to look for a balance between the symptomatic load, the possibility of adverse pharmacological reactions and the patient preferences. The short and long term heart rate control can be achieved with beta blockers, digoxin, calcium channel blockers or combination therapy. Although other class III antiarrhythmic drugs also have a frequency-limiting effect, they should only be used for the control of heart rhythm. Restoring and maintaining sinus rhythm is also an integral part of the treatment of AF. Class III antiarrhythmic drugs double the rate of patients who maintain their sinus rhythm. Treatment for rhythm control is indicated to improve the symptoms of patients with AF who remain symptomatic despite adequate treatment for heart rate control. The combination of antiarrhythmics that prolong the QT interval should not be used to control heart rhythm in AF(AU)


Assuntos
Arritmias Cardíacas , Fibrilação Atrial , Tratamento Farmacológico
8.
Stud Health Technol Inform ; 264: 55-59, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437884

RESUMO

When dealing with electrocardiography (ECG) the main focus relies on the classification of the heart's electric activity and deep learning has been proving its value over the years classifying the heartbeats, exhibiting great performance when doing so. Following these assumptions, we propose a deep learning model based on a ResNet architecture with convolutional 1D layers to classify the beats into one of the 4 classes: normal, atrial premature contraction, premature ventricular contraction and others. Experimental results with MIT-BIH Arrhythmia Database confirmed that the model is able to perform well, obtaining an accuracy of 96% when using stochastic gradient descent (SGD) and 83% when using adaptive moment estimation (Adam), SGD also obtained F1-scores over 90% for the four classes proposed. A larger dataset was created and tested as unforeseen data for the trained model, proving that new tests should be done to improve the accuracy of it.


Assuntos
Eletrocardiografia , Processamento de Sinais Assistido por Computador , Algoritmos , Arritmias Cardíacas , Bases de Dados Factuais , Frequência Cardíaca , Humanos
10.
Methodist Debakey Cardiovasc J ; 15(2): 105-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384373

RESUMO

Patients with a functionally univentricular heart who have had an atriopulmonary Fontan are at risk for atrial dilatation, atrial arrhythmias, and progressive circulatory failure. Between 1994 and 2018, we performed 149 Fontan conversions with arrhythmia surgery and epicardial pacemaker placement at Ann & Robert H. Lurie Children's Hospital of Chicago. This operation converts the atriopulmonary Fontan to an extracardiac Fontan that improves hemodynamics and controls the atrial arrhythmias. Operative mortality during that time was 2%, and freedom from death or heart transplant at 10 years is 84%. For properly selected patients, Fontan conversion improves both survival and quality of life. Patients with an atriopulmonary Fontan constitute an eroding population, as they face many comorbidities and have a decreased life expectancy without treatment; therefore, all patients with an atriopulmonary Fontan should be evaluated for this procedure.


Assuntos
Arritmias Cardíacas/cirurgia , Cardiomegalia/cirurgia , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Cardiomegalia/etiologia , Cardiomegalia/mortalidade , Cardiomegalia/fisiopatologia , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Intervalo Livre de Progressão , Reoperação , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
16.
Kyobu Geka ; 72(4): 275-281, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31266913

RESUMO

Total cavopulmonary connection (TCPC) conversion prevents late complications after the atrio-pulmonary-Fontan procedure. However, the outcomes and effects of TCPC conversion are not fully known. We performed TCPC conversion in 31 patients (2004~2017). Concomitantly, we performed anti-arrhythmia surgery in 28 patients( 90%), atrioventricular valve surgery in 4, and pacemaker implantation in 2. There were no perioperative deaths, but one late death occurred due to protein-losing gastroenteropathy. Five-year survival was 96.8%. Eleven patients were readmitted for various reasons, including arrhythmia in 7 and heart failure in 1. The 5-year cardiac event-free rate was 67.7%. The cardiac index was significantly improved:1.58 l/min/m2 before to 3.57 l/min/m2 after surgery ( p=0.0075). Surgical and midterm outcomes of TCPC conversion were favorable. In the perioperative and late periods, therapeutic intervention was usually for atrial arrhythmia. This study demonstrated that TCPC conversion is an effective therapeutic procedure.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Antiarrítmicos , Arritmias Cardíacas , Cardiopatias Congênitas/cirurgia , Humanos , Artéria Pulmonar
17.
Medicine (Baltimore) ; 98(29): e16554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335738

RESUMO

BACKGROUND: The benefits of fenestration for patients undergoing Fontan procedure seem controversial at early and late postoperative stages. OBJECTIVE: We aimed to compare the outcomes between the fenestrated and non-fenestrated Fontan procedures. METHODS: Studies comparing the fenestrated and non-fenestrated Fontan procedures were identified by searching the PubMed, EMBASE, and Cochrane Library databases until July 2018. The assessed variables included postoperative oxygen saturation (SaO2), pulmonary artery pressure, mortality, cardiopulmonary bypass (CPB) time, ventilation time, intensive care unit stay, hospital stay, chest tube duration, protein-losing enteropathy, arrhythmia, and other follow-up outcomes including reintervention, stroke/thrombosis, and peak oxygen consumption. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis stratified by early and late outcomes was performed. RESULTS: A total of 1929 Fontan patients from 14 studies were included. The early postoperative SaO2 was lower with fenestration than without fenestration (MD -2.52, 95% CI -4.16 to -0.87, P <.05); however, the late postoperative SaO2 showed no difference between the 2 approaches. The CPB time was shorter without fenestration than with fenestration (MD 10.72, 95% CI 2.54-18.9, P <.05); however, the incidence of arrhythmia was lower with fenestration than without fenestration (OR 0.43, 95% CI 0.25-0.75, P <.05). Other variables showed no significant differences between the 2 approaches in Fontan patients. CONCLUSION: Fenestration appears to result in a lower incidence of arrhythmia but with a longer CPB time and lower early SaO2. Other outcomes are comparable between the 2 approaches.


Assuntos
Técnica de Fontan/métodos , Arritmias Cardíacas/etiologia , Ponte Cardiopulmonar , Cuidados Críticos , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Humanos , Tempo de Internação , Oxigênio/sangue , Consumo de Oxigênio , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Respiração Artificial
18.
World J Pediatr Congenit Heart Surg ; 10(4): 440-445, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307294

RESUMO

BACKGROUND: Dexmedetomidine has been suggested as an arrhythmia prophylactic agent after surgery for congenital heart disease due to its heart rate lowering effect, though studies are conflicting. We sought to study the effect of dexmedetomidine in infants that are at highest risk for arrhythmias. METHODS: Retrospective cohort study of infants less than six months of age undergoing cardiopulmonary bypass for congenital heart disease. The arrhythmia incidence in the first 48 hours after surgery in infants receiving dexmedetomidine for sedation was compared to those that did not receive dexmedetomidine. RESULTS: A total of 309 patients were included, 206 patients who did not receive dexmedetomidine and 103 patients who did. The incidence of tachyarrhythmias was similar between the non-DEX group and the DEX group (19% vs 15%, P = .34). When adjusted for baseline differences, the non-DEX group did not have an increased risk of postoperative tachyarrhythmias (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 0.5-3.8). The non-DEX group had an increased need for treatment for arrhythmias (18% vs 8%, P = .012). The three lesions with baseline higher risk for arrhythmias (tetralogy of Fallot, transposition of the great arteries, and complete atrioventricular canal) had an increased incidence of tachyarrhythmias in the non-DEX group (34% vs 6%, P = .027). This risk was not significant in multivariate analysis (OR: 2.5, 95% CI: 0.4-15.5). CONCLUSIONS: High-risk infants had decreased incidence of tachyarrhythmias when receiving dexmedetomidine, though this was not significant after accounting for baseline differences between groups.


Assuntos
Arritmias Cardíacas/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Dexmedetomidina/uso terapêutico , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Razão de Chances , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Kardiologiia ; 59(7): 5-10, 2019 Jul 18.
Artigo em Russo | MEDLINE | ID: mdl-31322083

RESUMO

AIM: to analyze the quality of completion medical certificates of death (MCD) of residents of the Tula region, in which in 2017 acute and subsequent myocardial infarction (MI) was listed as the underlying cause of death (UCD) or as multiple causes of death (MC). MATERIALS AND METHODS: From the electronic database (DB) of MCD of residents of Tula region for 2017 we selected all MSD in which MI was written down irrespective of a section of MCD. A total of 689 MSD (43.8% men and 56.2% women) were analyzed. RESULTS: Mean age of the deceased was 72.6±11.3 years (men 67.25±0.62; women 76.7±9.8; p<0.001). Multimorbid pathology was registered in 31.5% of the deceased. In 77.9% of cases myocardial infarction was selected as the UCD and in 22.1% - as a complication of other diseases. Among registered MI complications were hemotamponade (24.5%), cardiogenic shock (3.6%), ventricular fibrillation (0.3%), heart failure (50.2%). Complications of MI were not listed in 3.9% of MCD. Analysis of MCD showed that their completion did not comply with established ICD-10 rules and recommendations of Ministry of Health of RF; all lines were filled out only in 1% of completed MCD. Also, problems of determining the initial cause of death when myocardial infarction occurred in the presence of multimorbid pathology were revealed. CONCLUSION: Mortality analysis using solely UCD leads to decreasing mortality rates from MI, and unsatisfactory quality of filling the MCD decreases the ability to identify MC, that prevents the correction of priorities in the organization of medical care. The revealed problems of coding causes of death require urgent solutions from the professional community of cardiologists, pathologists, and the Ministry of Health.


Assuntos
Insuficiência Cardíaca , Infarto do Miocárdio , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas , Causas de Morte , Atestado de Óbito , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico
20.
Kardiologiia ; 59(7): 26-30, 2019 Jul 19.
Artigo em Russo | MEDLINE | ID: mdl-31322086

RESUMO

Ischemic heart disease (IHD) is often accompanied by cardiac rhythm disturbances particularly ventricular arrhythmias (VA) and their appearance in both chronic and acute forms of IHD is usually regarded as dangerous signal requiring the use of antiarrhythmic drugs. An important addition to hemodynamic therapy can be considered the use of cytoprotective drugs that improve the energy potential of cardiomyocytes. The purpose of this work is to study the comparative evaluation of the Mildronate effectiveness in patients with IHD and VA. METHODS: Under dynamic observation were 147 patients with IHD and VA (Lown II-IV functional class). The diagnosis of angina pectoris was confirmed by clinical, exercise bicycle ergometry, Holter ECG monitoring, and echocardiography data. Holter ECG monitoring was used for recording VA, heart rate, episodes of ST-segment depression. The levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol were determined. All patients were randomly divided into 2 groups. The first group (81 patients) received standard antianginal and antiarrhythmic therapy plus meldonium for 2 months. The second (control) group (66 patients) received standard antianginal and antiarrhythmic therapy only. Statistical analysis of the data was carried out using the statistical package SPSS 13.0. RESULTS: A comparative analysis of the results showed that the use of meldonium in combination with basic therapy significantly improved clinical condition and quality of life indicators, increased exercise tolerance and improved systolic and diastolic dysfunction in patients with IHD and VA. The positive effect of meldonium on LDLC levels was observed. Moreover, the combination of basic antianginal and antiarrhythmic therapy and meldonium in patients with ischemic genesis VA promoted significant reduction of ischemic episodes and decrease of VA, in particular allorhythmia. CONCLUSION: Results of this study suggest that the use of meldonium in patients with IHD and VA helps to optimize myocardial energy metabolism in conditions of ischemia and reperfusion.


Assuntos
Arritmias Cardíacas , Qualidade de Vida , Eletrocardiografia Ambulatorial , Humanos , Metilidrazinas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA