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1.
Pan Afr Med J ; 35: 4, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32117520

RESUMO

Intensive and prolonged practice of sport can lead to cardiovascular and electrocardiographic changes. The purpose of this study was to describe the electrocardiographic changes in some young black Senegalese players practicing competitive basketball. We conducted a prospective descriptive analysis of surface electrocardiogram (ECG) findings related to young Senegalese Black players practicing competitive basketball. The study involved 40 young basketball players, 20 girls and 20 boys, whose average age was 17 ± 0.86 years (ranging from 17 to 19 years) and 15 ± 1.56 years (ranging from 13 to 18 years) respectively. Heart rate was lower among boys, 59 beats ± 9 beats (ranging from 42 to 85) than among girls 73 beats/ min ± 11 beats (ranging from 50 to 95) (p = 0.0004). The following features have been observed: repolarization abnormalities such as T-wave inversion V1-V4 in 3 cases (7.5%), right ventricular hypertrophy in 1 case (2.5%), right axis deviation (QRS axis) in 1 case (2.5%). Intensive and prolonged practice of basketball leads to electrocardiographic changes in the young black Senegalese players.


Assuntos
Arritmias Cardíacas/epidemiologia , Basquetebol , Eletrocardiografia , Frequência Cardíaca/fisiologia , Adolescente , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Senegal , Adulto Jovem
2.
J Cardiovasc Med (Hagerstown) ; 20(11): 731-744, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31567632

RESUMO

: There is a growing interest in the study of the mechanisms of heart and brain interactions with the aim to improve the management of high-impact cardiac rhythm disorders, first of all atrial fibrillation. However, there are several topics to which the scientific interests of cardiologists and neurologists converge constituting the basis for enhancing the development of neuro-arrhythmology. This multidisciplinary field should cover a wide spectrum of diseases, even beyond the classical framework corresponding to stroke and atrial fibrillation and include the complex issues of seizures as well as loss of consciousness and syncope. The implications of a more focused interaction between neurologists and cardiologists in the field of neuro-arrhythmology should include in perspective the institution of research networks specifically devoted to investigate 'from bench to bedside' the complex pathophysiological links of the abovementioned diseases, with involvement of scientists in the field of biochemistry, genetics, molecular medicine, physiology, pathology and bioengineering. An investment in the field could have important implications in the perspectives of a more personalized approach to patients and diseases, in the context of 'precision'medicine. Large datasets and electronic medical records, with the approach typical of 'big data' could enhance the possibility of new findings with potentially important clinical implications. Finally, the interaction between neurologists and cardiologists involved in arrythmia management should have some organizational implications, with new models of healthcare delivery based on multidisciplinary assistance, similarly to that applied in the case of syncope units.


Assuntos
Arritmias Cardíacas/fisiopatologia , Encéfalo/fisiopatologia , Cardiologia , Transtornos Cerebrovasculares/fisiopatologia , Frequência Cardíaca , Coração/inervação , Neurologia , Convulsões/fisiopatologia , Animais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/terapia , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Prognóstico , Fatores de Risco , Convulsões/diagnóstico , Convulsões/epidemiologia , Convulsões/terapia
3.
Cardiol Clin ; 37(4): 459-468, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587787

RESUMO

Multiple cancer therapies are associated with cardiac arrhythmias through a variety of pathophysiologic mechanisms. Atrial fibrillation and atrial flutter are common during cancer therapy but should rarely limit continued delivery of therapy. Ventricular arrhythmias are not common during cancer therapy and are more often secondary to other cardiac pathologies. QT interval monitoring is recommended for some agents, although it is often not a reliable predictor of ventricular arrhythmias. Bradyarrhythmias are common and rarely require intervention, but special attention must be paid to heart block in checkpoint inhibitor therapy.


Assuntos
Antineoplásicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Cardiologia , Oncologia , Neoplasias/tratamento farmacológico , Arritmias Cardíacas/epidemiologia , Comorbidade , Saúde Global , Humanos , Neoplasias/epidemiologia
4.
Niger J Clin Pract ; 22(10): 1349-1355, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607723

RESUMO

Objective: The objective of the this study is to document the existence of statistically significant differences between parameters of heart rate variability (HRV) and heart rate turbulence (HRT), determined in women with overt hyperthyroidism (hT), compared to controls and to highlight their correlations with the level of thyroid hormones and the incidence of arrhythmias. Methods: We studied the HRV in time and frequency domain, and the HRT in a group of 113 women with overt hT, without other cardiovascular risk factors or comorbidities, admitted to the endocrinology clinic of our hospital, between 2012 and 2016. Depending on the severity and duration of hT and levels of thyroid hormones, the patients were assigned to three groups: mild and moderate forms, severe hT with thyrotoxicosis and persistent cases with a relapse of hT. We performed 24 h Holter monitoring in all patients. Results: HRV parameters in time domain (TD) were significantly depressed in patients comparing to controls. All patients had abnormal, positive values of turbulence onset (TO) with significant statistically differences (P < 0.0001) comparing to controls. Although positive, the values of turbulence slope (TS) decreased according to the severity of hT. Conclusion: Patients with hT had depressed values of HRV parameters in TD, correlated with the severity of the thyroid disease and with the incidence of arrhythmias. All patients presented pathological values of TO. TS values were positive, but lower compared to controls.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia Ambulatorial/métodos , Frequência Cardíaca/fisiologia , Hipertireoidismo/complicações , Hormônios Tireóideos/sangue , Adulto , Arritmias Cardíacas/epidemiologia , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Feminino , Humanos , Hipertireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
5.
Rev Esp Cardiol (Engl Ed) ; 72(11): 944-953, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31631049

RESUMO

INTRODUCTION AND OBJECTIVES: This report describes the result of the analysis of the implanted pacemakers reported to the Spanish Pacemaker Registry in 2018. METHODS: The analysis is based on the information provided by the European Pacemaker Identification Card and supplier-reported data on the overall number of implanted pacemakers. RESULTS: Information was received from 90 hospitals, with a total of 12 148 cards, representing 31% of the estimated activity. Use of conventional and resynchronization pacemakers was 825 and 77 units per million people, respectively. The mean age of the patients receiving an implant was 78.3 years, and 54% of the devices were implanted in people aged> 80 years. A total of 77.1% were first implants and 21.6% corresponded to generator exchanges. Bicameral sequential pacing was the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7% of those with atrioventricular block, despite being in sinus rhythm. CONCLUSIONS: The total consumption of pacemaker generators in Spain increased by 1.2% compared with 2017, mainly due to an 8.7% increase in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex.


Assuntos
Arritmias Cardíacas/terapia , Cardiologia , Marca-Passo Artificial/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Espanha/epidemiologia
6.
Heart Surg Forum ; 22(5): E385-E389, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31596717

RESUMO

BACKGROUND: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications. METHODS: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more than 75% and hemodynamic significant stenosis of the left main artery. Exclusion criteria were patients with urgent and previous cardiac surgery and patients with myocardial infarction and stroke in the past one month. We monitored preoperative (ejection fraction, coronarography status), operative (number of grafts, on-pump or off-pump technique) and postoperative (extubation, unit care and hospital stay, bleeding and reoperation) details and complications (myocardial infarction, neurological events, inotropic agents and transfusion requiry, infection, arrhythmic complication, renal failure, mortality). RESULTS: Postoperative complications were observed in 18 (29.9%) patients. Two patients (2.3%) had postoperative stroke and one patient (1.2%) had transient ischemic attack (TIA). Previous stroke was a predictor for increased postoperative neurological events (P < .05). Intrahospital mortality was 8.1%. CONCLUSION: Simultaneous CEA and CABG were performed with low rates of stroke and TIA. Previous stroke was identified as a predictor for increased postoperative neurological complications.


Assuntos
Estenose das Carótidas/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Estenose das Carótidas/complicações , Causas de Morte , Comorbidade , Estenose Coronária/complicações , Feminino , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Masculino , Mediastinite/epidemiologia , Mediastinite/etiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
7.
Emerg Med J ; 36(10): 635-638, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31551305

RESUMO

A shortcut review was carried out to establish the incidence of arrhythmia after prescription of a fluoroquinolone antibiotic. 332 papers were found using the reported searches, of which 14 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that the incidence of arrhythmia after prescription of a fluoroquinolone antibiotic is low (<3%), but estimates are imprecise.


Assuntos
Antibacterianos/efeitos adversos , Arritmias Cardíacas/epidemiologia , Infecções Bacterianas/tratamento farmacológico , Fluoroquinolonas/efeitos adversos , Adulto , Idoso , Arritmias Cardíacas/induzido quimicamente , Medicina de Emergência Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Incidência
9.
Int J Sports Med ; 40(13): 856-862, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505701

RESUMO

Several studies report neurological complications such as brain injury induced by ischemia or edema following exhaustive endurance sport. We aimed to detect the frequency of acute brain lesions after a marathon race. In the prospective observational Berlin Beat of Running study, 110 experienced endurance athletes underwent 3-Tesla brain MRI exams 2-3 days prior and within 2 days after a marathon run. MRI results were compared to an age- and sex-matched control group of 68 non-athletes, including the "Age-Related White Matter Changes" (ARWMC) scale to assess white matter lesions (WML) in the brain. 108 athletes (median age 48 years, 24% female, 8% with hypertension; 0% with diabetes) completed the race. No athlete reported neurological deficits, but a single acute ischemic lesion was detected in diffusion-weighted MRI after the race in one athlete. No other acute brain lesions compared to prior MRI were found. An ARWMC score ≥4 was found in 15% of athletes and 12% of non-athletic controls (p=0.7). Chronic ischemic lesions were not found in athletes but in four controls (6%) (p=0.02). In conclusion, acute ischemic brain lesions may be found in endurance runners. Every seventh endurance athlete and every ninth control showed evidence for substantial white matter lesions.


Assuntos
Comportamento Competitivo/fisiologia , Resistência Física/fisiologia , Corrida/fisiologia , Substância Branca/diagnóstico por imagem , Adulto , Arritmias Cardíacas/epidemiologia , Berlim/epidemiologia , Isquemia Encefálica/epidemiologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Pan Afr Med J ; 33: 114, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489092

RESUMO

Introduction: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. Methods: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. Results: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. Conclusion: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.


Assuntos
Arritmias Cardíacas/diagnóstico , Atletas , Cardiopatias/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Arritmias Cardíacas/epidemiologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Morte Súbita/prevenção & controle , Ecocardiografia , Eletrocardiografia/métodos , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Estudos Retrospectivos , Esportes , Inquéritos e Questionários , Adulto Jovem
11.
Med Arch ; 73(2): 72-75, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391690

RESUMO

Introduction: The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients. Aim: To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages. Patients and methods: The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration. Results: Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs alone (n = 9), as analyzed by a two-tailed t-test, p = 0.577. Conclusion: Use of selective BBs in the treatment of cardiovascular comorbidity in patients with COPD represents a far better choice of pharmacological approach in the treatment of patients diagnosed with COPD GOLD II (moderate) stage.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Arritmias Cardíacas/epidemiologia , Bisoprolol/uso terapêutico , Estudos de Casos e Controles , Digoxina/uso terapêutico , Progressão da Doença , Volume Expiratório Forçado , Humanos , Metoprolol/uso terapêutico , Nebivolol/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Índice de Gravidade de Doença , Verapamil/uso terapêutico , Capacidade Vital
12.
Braz J Cardiovasc Surg ; 34(4): 444-450, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454198

RESUMO

OBJECTIVES: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. METHODS: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. RESULTS: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. CONCLUSION: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.


Assuntos
Arritmias Cardíacas/etiologia , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Transtornos Relacionados ao Uso de Opioides/complicações , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Pressão Sanguínea , Pressão Venosa Central , Epinefrina/efeitos adversos , Feminino , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Adulto Jovem
13.
Cardiol Young ; 29(8): 1072-1077, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31287035

RESUMO

OBJECTIVE: To report on the first 5 years of establishment of fetal echocardiographic services at the Jordan University Hospital with emphasis on diagnosis and outcome. METHODS: A retrospective chart review was conducted on all fetal echocardiographic studies performed between January 2011 and December 2015. Data collected included maternal demographics, referral indications, fetal cardiac diagnosis, correlation to post-natal diagnosis, outcome of pregnancy including pre-mature delivery and perinatal mortality. Basic statistical analysis was performed including demographic analysis, and calculation of fetal echocardiographic sensitivity and specificity. RESULTS: A total of 208 fetuses underwent fetal echocardiographic evaluation at a mean gestational age of 26.5 (±5) weeks. The most common referral indication was a suspicion of CHD during the obstetric ultrasound (44.2%), followed by cardiac dysfunction (18.2%), and a family history of CHD (14.9%). Fetal echocardiography showed CHD in 71 fetuses (34%), heart failure in 26 (12.5%), arrhythmia in 9 (4.3%), and intracardiac masses in 2. In the remaining 100 fetuses (48%), fetal echocardiography showed normal evaluation. For detecting CHD, fetal echocardiography had a sensitivity and specificity of 91.7% and 95.4%, respectively. Perinatal mortality including termination of pregnancy, intrauterine fetal death, and neonatal mortality was highest in heart failure (77%), and was 41% for CHD. CONCLUSION: The fetal cardiac diagnostic services at the Jordan University Hospital have encouraging initial results with a relatively high sensitivity and specificity. The services further positively impacted the quality of counselling offered and facilitated pre- and post-natal management.


Assuntos
Arritmias Cardíacas/diagnóstico , Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Insuficiência Cardíaca/diagnóstico , Nascimento Prematuro/epidemiologia , Adulto , Arritmias Cardíacas/epidemiologia , Países em Desenvolvimento , Ecocardiografia , Feminino , Coração Fetal/anormalidades , Idade Gestacional , Cardiopatias Congênitas/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hospitais Universitários , Humanos , Recém-Nascido , Jordânia/epidemiologia , Masculino , Mortalidade Perinatal , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal , Adulto Jovem
14.
Clin Drug Investig ; 39(11): 1057-1066, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31325111

RESUMO

BACKGROUND AND OBJECTIVE: Risk-minimization measures (RMM), including label revisions were implemented in Europe for domperidone because of evidence of increased incidence of cardiac arrhythmia and sudden cardiac death. In accordance with the guideline on good pharmacovigilance practices, the European Medicines Agency Pharmacovigilance Risk Assessment Committee requested to conduct two studies to evaluate the effectiveness of these risk minimization measures. METHODS: In Belgium, France, Germany, Spain, and the UK, surveys were conducted to assess physicians' knowledge on the updated domperidone labeling information, and a drug-utilization study (DUS) was conducted using healthcare databases to assess domperidone prescribing patterns before and after the RMM. Four DUS sensitivity analyses (scenarios) evaluated uncertainty regarding domperidone treatment duration and indication. RESULTS: Among 1805 physicians participating in the survey, most were aware of the approved indication (nausea and vomiting, 80%), treatment duration (≤ 7 days, 70%), and maximum adult daily dose (10 mg three times daily, 84%). Only 33% selected the on-label indication from a list of indications for which they would prescribe domperidone. Awareness was low for medications contraindicated for concomitant use (26%) and contraindicated conditions (4%). In the DUS, under the optimistic scenario, a large improvement in labeling compliance from pre- to post-implementation period was observed in France (27% vs. 69%), while Belgium, Germany, Spain, and the UK showed small improvements (< 10%). In the other scenarios, there was little to no improvement in compliance with the revised labeling from the pre- to post-implementation periods in most countries. CONCLUSIONS: The survey findings documented that most physicians in all five countries were aware of the main aspects of the revised labeling. Results of the DUS were inconclusive regarding the effect of the RMM and compliance with the revised labeling for all countries except France.


Assuntos
Antieméticos/uso terapêutico , Domperidona/uso terapêutico , Rotulagem de Medicamentos/normas , Uso de Medicamentos/normas , Médicos/normas , Adulto , Antieméticos/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/prevenção & controle , Doença do Sistema de Condução Cardíaco/induzido quimicamente , Doença do Sistema de Condução Cardíaco/epidemiologia , Doença do Sistema de Condução Cardíaco/prevenção & controle , Estudos Transversais , Morte Súbita Cardíaca/etiologia , Domperidona/efeitos adversos , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Náusea/epidemiologia , Estudos Retrospectivos , Medição de Risco , Inquéritos e Questionários , Vômito/tratamento farmacológico , Vômito/epidemiologia
15.
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
16.
Am J Cardiol ; 124(4): 545-553, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31208702

RESUMO

Congestion is associated with adverse outcomes in heart failure (HF) patients. We characterized congestion in patients hospitalized for HF and examined the association between congestion severity at admission and postdischarge outcomes. Using the OPTIMIZE-HF registry linked to Medicare claims, we analyzed patients ≥65 years old hospitalized for HF from 2003 to 2004. Congestion severity was measured using a 15-point scale that scores dyspnea, orthopnea, fatigue, jugular venous pressure, rales, and edema. Patient characteristics and outcomes were described by congestion strata. Proportional hazards models were fit to examine associations between congestion and 1-year outcomes. Congestion scores for the 24,724 patients ranged from 0 to 14, with a median of 5 (Q1, Q3: 3, 7). At baseline, patients with the highest scores (≥7) had the highest rates of recent HF hospitalizations, EF ≤40%, and co-morbidities, including arrhythmias, diabetes mellitus, and renal insufficiency. Adjusting for patient characteristics, a 3-point congestion score increase was positively associated with mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03, 1.09), all-cause rehospitalization (HR 1.02, 95% CI 1.00, 1.04), and HF rehospitalization (HR 1.09, 95% CI 1.06, 1.12), but not emergency department visits (HR 0.99, 95% CI 0.97, 1.01). In conclusion, for patients hospitalized with HF, congestion was associated with rehospitalization and mortality.


Assuntos
Dispneia/epidemiologia , Edema/epidemiologia , Fadiga/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Dispneia/etiologia , Edema/etiologia , Serviço Hospitalar de Emergência , Fadiga/etiologia , Feminino , Insuficiência Cardíaca/complicações , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Veias Jugulares , Masculino , Mortalidade , Postura , Prognóstico , Modelos de Riscos Proporcionais , Insuficiência Renal/epidemiologia , Sons Respiratórios/etiologia , Índice de Gravidade de Doença , Pressão Venosa
17.
Med. infant ; 26(2): 123-129, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1015231

RESUMO

Introducción: Las taquiarritmias en pediatría son uno de las principales motivos cardiológicos de consulta a la guardia. Durante el primer año de vida presentan una significativa morbi-mortalidad, por lo que el tratamiento farmacológico inmediato es fundamental para reducir la misma. Hasta los 3 años existe la posibilidad de curación espontánea en un porcentaje de éstos pacientes. La indicación de procedimientos de ablación durante los primero 4 años de vida se limita a casos refractarios al tratamiento antiarrítmico, dado que cuanto menor peso presenta el paciente, más pequeño es el corazón y más riesgoso es el mismo. Las taquicardias en pacientes con cardiopatía empeora el pronóstico de la misma. A pesar que el tratamiento farmacológico ha permitido el control de la gran mayoría de ellas, en muchos casos se requieren más de una droga antiarrítmica, con mayor exposición a efectos adversos, y en muchos otros se vuelven refractarias. En las últimas 3 décadas se ha desarrollado en forma exponencial el tratamiento de las taquiarritmias por medio de la ablación por radiofrecuencia o por frío (crioablación). Estos procedimientos han permitido obtener la curación de la mayor parte de las taquiarritmias en pediatría. En nuestro trabajo se evaluaron las indicaciones de dichos procedimientos en una población pediátrica, como así también la tasa de éxito, recurrencia, y la morbimortalidad tanto globalmente, como en cada arritmia (AU)


In children, tachyarrhythmias are one of the main reasons for cardiological consultation at the Department of Emergency. In the first year of life, they are associated with significant morbiditymortality and therefore, immediate drug treatment is essential up to 3 years of age. The indication of ablation procedures during the first 4 years of life is limited to patients refractory to antiarrhythmic treatment, since the lower weight of the patient, the smaller the heart and the riskier the intervention. In patients with heart disease, tachycardia worsens the prognosis. Although pharmacological treatment controls the vast majority of tachyarrhythmias, more than one antiarrhythmic drug is often required, leading to greater exposure to adverse effects, and many become refractory. Over the past three decades, treatment of tachyarrhythmias has developed exponentially with the advent of radiofrequency or cold ablation (cryoablation). These procedures have led to the cure of most tachyarrhythmias in children. Our study assessed the indications for these procedures in a pediatric population, as well as the success and recurrence rates, and morbidity both overall and of each arrhythmia episode (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Arritmias Cardíacas/epidemiologia , Taquicardia/epidemiologia , Registros , Criocirurgia , /métodos , Arritmias Cardíacas/cirurgia , Arritmias Cardíacas/diagnóstico , Taquicardia/cirurgia , Taquicardia/diagnóstico , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
18.
J Med Econ ; 22(8): 814-817, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31038380

RESUMO

Aims: This study aimed to examine the long-term clinical and economic burden of adults with congenital heart disease (ACHD) in Hong Kong. Methods: It retrospectively analyzed 336 consecutive ACHD patients who attended the Adult Congenital Heart Clinic between January 1, 2009 and December 31, 2014. Direct medical costs and clinical outcomes over the 5 years were calculated and documented. The economic evaluation was from the hospital's perspective. Results: The median age of ACHD patients was 47 (31-62) years old, with female predominance (61.5%). Ventricular and atrial septal defects accounted for 70% and severe ACHD for 10% of the study cohort. The prevalence of arrhythmia and heart failure increased with the complexity of CHD. The total mean annual cost for managing each ACHD patient was USD 2,913. The annual cost of management of simple ACHD was USD 2,638 vs complex ACHD (USD 6,425) (p = 0.013). Conclusions: This study demonstrated severe ACHD patients accounted for higher cardiovascular morbidities in arrhythmias and heart failure with a higher cost of management.


Assuntos
Cardiopatias Congênitas/epidemiologia , Insuficiência Cardíaca/economia , Adulto , Idoso , Arritmias Cardíacas/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Cardiopatias Congênitas/economia , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos
19.
J Cardiovasc Magn Reson ; 21(1): 26, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046780

RESUMO

BACKGROUND: Conduction disease and arrhythmias represent a major cause of mortality in myotonic muscular dystrophy type 1 (MMD1). Permanent pacemaker (PPM) implantation is the cornerstone of therapy to reduce cardiovascular mortality in MMD1. Cardiovascular magnetic resonance (CMR) studies demonstrate a high prevalence of myocardial fibrosis in MMD1, however the association between CMR myocardial fibrosis with late gadolinium enhancement (CMR-LGE) and surface conduction abnormality is not well established in MMD1. We investigated whether myocardial fibrosis by CMR-LGE is associated with surface conduction abnormalities meeting criteria for PPM implantation according to current guidelines in a cohort of patients with genetically confirmed MMD1. METHODS: Patients with genetically confirmed MMD1 were retrospectively evaluated. 12-lead electrocardiography (ECG) performed within 6 months of CMR was necessary for inclusion. The severity and extent of MMD1 was quantified using a validated Muscular Impairment Rating Scale (MIRS). Based on current guidelines for device-based therapy of cardiac rhythm abnormalities, we defined surface conduction abnormality as the presence of ECG alterations meeting criteria for PPM implant (class I or II indications): PR interval > 200 ms (type I atrioventricular (AV) block) and/or mono or bifascicular block (QRS > 120 ms), or evidence of advanced AV block. Balanced steady-state free precession sequences (bSSFP) were used for assessment of left ventricular (LV) volumes and ejection fraction. MOdified Look-Locker Inversion Recovery (MOLLI) acquisition schemes were used to acquire T1 maps. Patients' charts were reviewed up to 12 months post-CMR for occurrence of PPM implantation. RESULTS: Fifty-two patients (38% male, 41 ± 14 years) were included. Overall, 31 (60%) patients had a surface conduction abnormality and 22 (42%) demonstrated midwall myocardial fibrosis by CMR-LGE. After a median of 57 days from CMR exam, 15 patients (29%) underwent PPM implantation. Subjects with vs. without surface conduction abnormality had significantly longer disease length (15.5 vs. 7.8 years, p = 0.015) and higher disease severity on the MIRS scale (p = 0.041). High prevalence of myocardial fibrosis by CMR-LGE was detected in subjects with and without surface conduction abnormality with no significant difference between the two cohorts (42% vs. 43%, p = 0.999). By multivariate logistic regression analysis, disease length was the only independent variable associated with surface conduction abnormality (OR 1.071, 95%CI 1.003-1.144, p = 0.040); while CMR-LGE was not associated with conduction abnormality (ρ = - 0.009, p = 0.949). CONCLUSIONS: Myocardial fibrosis by CMR-LGE is highly prevalent in MMD1 but not related to surface conduction abnormality meeting current guideline criteria for PPM implantation .


Assuntos
Arritmias Cardíacas/epidemiologia , Cardiomiopatias/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Distrofia Miotônica/epidemiologia , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Cardiomiopatias/epidemiologia , Cardiomiopatias/patologia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/genética , Ohio/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco
20.
Am J Cardiol ; 124(1): 44-50, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31047651

RESUMO

Influenza is associated with an increased risk of cardiovascular events. Influenza's association with ventricular arrhythmias (VAs) has not been adequately studied. We investigated the relation of seasonal influenza activity with the incidence of VAs requiring therapy in patients with an implantable cardiac defibrillator or cardiac resynchronization therapy defibrillator. We retrospectively studied 163,831 patients with an implantable cardiac defibrillator or cardiac resynchronization therapy defibrillator who were enrolled in the Abbott Medical Merlin.net remote-monitoring network between January 2009 and December 2015. We used cross-correlation to assess the temporal relationship between influenza activity and the incidence of VAs requiring shock or antitachycardia pacing (ATP). We used a generalized linear model to test the possible effect of seasonal influenza activity on the occurrence of VAs requiring shock or ATP treatment, after adjustment for within-patient effects, age, gender, device type, and calendar year. We found a significant correlation between influenza activity and the incidence of VAs requiring shock or ATP treatment. The multivariate generalized linear model showed that during high influenza activity, patients were more likely to have a VA treated with shock (odds ratio = 1.06, p < 0.001) or ATP (odds ratio = 1.06, p < 0.0001). The impact of high influenza activity was most prominent during the years 2014 and 2015. We conclude that high influenza activity is associated with increased risk of VAs requiring therapy.


Assuntos
Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Influenza Humana/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Adulto Jovem
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