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1.
Nat Rev Cardiol ; 17(1): 22-36, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31249403

RESUMO

Conventional right ventricular (RV) pacing, particularly RV apical pacing, can have deleterious effects on cardiac function. Long-term RV apical pacing has been associated with increased risk of atrial fibrillation, hospitalization for heart failure, pacing-induced cardiomyopathy and associated death. His bundle pacing (HBP) results in physiological ventricular activation and has generated tremendous research interest and enthusiasm. By stimulating the His-Purkinje network directly, HBP results in synchronized ventricular activation, which might translate into improved clinical outcomes compared with dyssynchronous ventricular activation with RV apical pacing. HBP can also overcome bundle branch block patterns, and data are accumulating on the benefit of HBP for cardiac resynchronization therapy. In this Review, we summarize the anatomy of the His bundle and early clinical observations, implantation techniques and available outcome data associated with permanent HBP. We also highlight the challenges with HBP and the need for additional tools and more randomized data before widespread application of permanent HBP.


Assuntos
Arritmias Cardíacas/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/tendências , Insuficiência Cardíaca/terapia , Potenciais de Ação , Animais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/mortalidade , Difusão de Inovações , Previsões , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Fatores de Risco , Resultado do Tratamento
2.
Pol Merkur Lekarski ; 47(280): 153-156, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31760399

RESUMO

Cardiac arrhythmias are common in patients with various types of muscular dystrophies. The pathophysiological mechanisms of arrhythmias are complex and related to direct involvement of the conduction system and to the development of cardiomyopathy. The occurrence of atrio-ventricular conduction abnormalities and ventricular arrhythmias are associated with increased risk of sudden cardiac death. The threshold for device therapy ( cardiac pacemaker, implantable cardioverter defibrillator) is relatively low according to current guidelines due to the risk of rapid progression of the disease. Atrial arrhythmias carry high risk of stroke and anticoagulation should be considered even in young patients without coexisting risk factors for stroke as estimated by the CHA2DS2-VASc score. Patients with muscular dystrophies should be under regular cardiology follow up even in the absence of symptoms. Early detection of cardiac involvement is crucial. The management of patients with muscular dystrophies requires disease-specific and multidisciplinary approach due to the multi-organ involvement.


Assuntos
Arritmias Cardíacas , Desfibriladores Implantáveis , Distrofias Musculares , Arritmias Cardíacas/complicações , Arritmias Cardíacas/terapia , Morte Súbita Cardíaca , Sistema de Condução Cardíaco , Humanos , Distrofias Musculares/complicações
3.
Rev Esp Cardiol (Engl Ed) ; 72(12): 1054-1064, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31727564

RESUMO

INTRODUCTION AND OBJECTIVES: This article presents the data corresponding to automated implantable cardioverter-defibrillator (ICD) implants in Spain reported to the Spanish Registry in 2018. METHODS: The data in this registry include both primary implants and generator replacements and were gathered from a data collection sheet voluntarily completed by implantation centers. RESULTS: In 2018, 6421 implant sheets were received compared with 7077 reported by Eucomed (European Confederation of Medical Suppliers Associations). This represents data on 90.7% of the devices implanted in Spain. Compliance ranged between 99.6% for the field "name of the implanting hospital" and 12.4% for "population of residence". A total of 173 hospitals reported their data to the registry, representing a slight decrease compared with hospitals participating in 2017 (n=181). CONCLUSIONS: After the reduction in ICD implants in 2017, the number of implants increased in 2018, with the highest number of ICDs implanted in Spain. The total number of implants remains much lower than the European Union average, with substantial differences between autonomous communities.


Assuntos
Arritmias Cardíacas/terapia , Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Eletrofisiologia/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Coleta de Dados , Feminino , Humanos , Masculino , Estudos Retrospectivos , Espanha
5.
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
6.
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
7.
Medicine (Baltimore) ; 98(37): e17107, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517843

RESUMO

BACKGROUND: Percutaneous mechanical circulatory support devices (pMCSDs) are increasingly used on the assumption (but without solid proof) that their use will improve prognosis. A meta-analysis was undertaken according to the PRISMA guidelines to evaluate the benefits of pMCSDs in patients undergoing high-risk percutaneous coronary intervention (hr-PCI). METHODS: We searched PubMed, EMbase, Cochrane Library, Clinical Trial.gov, and other databases to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for 30-day and 6-month all-cause mortality rates, reinfarction, and other adverse events using a random effect model. RESULTS: Sixteen randomized controlled trials (RCTs) were included in this study. In the pooled analysis, intra-aortic balloon pump (IABP) was not associated with a decrease in 30-day and 6-month all-cause mortality (RR 1.01 95% CI 0.61-1.66; RR 0.88 95% CI 0.66-1.17), reinfarction (RR 0.89 95% CI 0.69-1.14), stroke/transient ischemic attack (TIA) (RR 1.75 95% CI 0.47-6.42), heart failure (HF) (RR 0.54 95% CI 0.11-2.66), repeat revascularization (RR 0.73 95% CI 0.25-2.10), embolization (RR 3.00 95% CI 0.13-71.61), or arrhythmia (RR 2.81 95% CI 0.30-26.11). Compared with IABP, left ventricular assist devices (LVADs) were not associated with a decrease in 30-day and 6-month all-cause mortality (RR 0.96 95% CI 0.71-1.29; RR 1.23 95% CI 0.88-1.72), reinfarction (RR 0.98 95% CI 0.68-1.42), stroke/TIA (RR 0.45 95% CI 0.1-1.95), acute kidney injury (AKI) (RR 0.83 95% CI 0.38-1.80), or arrhythmia (RR 1.52 95% CI 0.71-3.27), but LVADs were associated with a decrease in repeat revascularization (RR 0.26 95% CI 0.08-0.83). However, LVADs significantly increased the risk of bleeding compared with IABP (RR 2.85 95% CI 1.72-4.73). CONCLUSIONS: Neither LVADs nor IABP improves short or long-term survival in hr-PCI patients. LVADs are more likely to reduce repeat revascularization after PCI, but to increase the risk of bleeding events than IABP.


Assuntos
Coração Auxiliar/normas , Balão Intra-Aórtico/normas , Intervenção Coronária Percutânea/métodos , Arritmias Cardíacas/terapia , Embolização Terapêutica/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar/estatística & dados numéricos , Humanos , Balão Intra-Aórtico/métodos , Balão Intra-Aórtico/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
8.
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
9.
Cardiol Young ; 29(10): 1313-1316, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475646

RESUMO

Transvenous pacemaker implantation for sinus node dysfunction in patients with Fontan palliation presents the difficulty of finding suitable pacing tissue and the potential of causing vascular obstruction in a low-flow circuit. We describe a patient who underwent electro-anatomic voltage mapping to guide a transvenous single chamber lead within her Fontan baffle. This highlights the use of advanced mapping technologies for pacemaker implantation in complex cyanotic heart disease.


Assuntos
Arritmias Cardíacas/terapia , Mapeamento Potencial de Superfície Corporal/métodos , Cardiopatias Congênitas/cirurgia , Marca-Passo Artificial , Nó Sinoatrial/fisiopatologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Técnica de Fontan , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Adulto Jovem
10.
Expert Rev Cardiovasc Ther ; 17(10): 699-706, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31483168

RESUMO

Introduction: Leadless pacemakers (LPs) are the latest advancement in the field of pacing. Experience from pivotal trials and post-marketing studies has proven the feasibility and safety of these devices. The LPs obviate the need of pulse generator pocket and leads, which translates into lower incidence of lead related complications and pocket related infections. This review will summarize the existing literature on the LPs, specifically indications; implant procedure, unique situations and long- term follow up.Areas covered: This review will summarize the results of published pivotal trials. Several multicenter studies where LP was used in the unique situations such as during concomitant AV node ablation and across bioprosthetic valve will also be discussed. An extensive search using PUBMED was performed to identify the relevant articles.Expert commentary: The use of LPs is expanding and the published results a preferential use of such devices for patients who need single ventricle pacing. Additionally, the use of these devices in several unique situations such as patients with inferior vena cava filters, bioprosthetic tricuspid valves and concomitant atrio-ventricular nodal (AV) ablation has also been shown to be safe.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Humanos
11.
Eur J Radiol ; 118: 96-100, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439265

RESUMO

PURPOSE: Low-field magnetic resonance imaging (MRI), i.e. MRI with a static magnetic field strength <0.5 T, has been reported to be safe in patients with pacemakers, however there are no data about the safety of low-field MRI in patients with implantable cardioverter defibrillators (ICD) and/or cardiac resynchronization therapy (CRT). We aimed to investigate the safety and diagnostic efficiency of routine low-field MRI in patients with different devices for cardiac rhythm management (i.e. pacemakers and ICD, including devices with CRT). METHOD: MRI scans of 446 regions of interest were evaluated with field strength of 0.2 T in 338 patients (62% male; age at MRI scan 76.1 ± 9.2 years; time since device implantation 4.1 ± 3.2 years) with cardiac rhythm management devices (298 pacemakers, 25 ICD, 8 CRT-ICD, and 7 CRT pacemakers). This analysis included 62 pacemaker-dependent patients (18.3%), 52 patients with 1.5-Tesla-MR conditional pacemakers (15.4%) and 13 patients with abandoned leads (3.9%). RESULTS: Except for one examination, which was interrupted because of recurrent severe nausea, all MRI scans could be analyzed efficiently. No induction of arrhythmia or inhibition of pacemaker function occurred. Compared to the device interrogation before MRI, there were no significant changes in battery voltage, pacing capture threshold, sensing of intrinsic ECG, lead impedance, as well as shock impedance in ICD devices after completed examination. CONCLUSIONS: Low-field MRI examinations (0.2 T) were efficient and safe regarding clinical and technical complications in patients with devices for cardiac rhythm management, even in case of pacemaker-dependency or the presence of abandoned leads.


Assuntos
Desfibriladores Implantáveis , Imagem por Ressonância Magnética/efeitos adversos , Marca-Passo Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/terapia , Segurança de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Adulto Jovem
12.
Scand Cardiovasc J ; 53(6): 323-328, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31407601

RESUMO

Objectives. The aim of the study was to assess the long-term influence of catheter ablation (CA) of different arrhythmias on cardiovascular implantable electronic devices (CIED) endocardial leads durability. Design. This was a retrospective case-control study. Ablation protocols and in- or outpatient medical records were reviewed to identify and extract data on adult patients with CIED undergoing a CA. A cohort of patients with hypertrophic cardiomyopathy and implantable cardioverter-defibrillators (ICD) served as a historical control group. The primary endpoint was the diagnosis of lead damage defined as permanent loss of proper function demanding replacement or removal. Results. Among 145 patients n = 177 catheter ablations were performed. Patients' mean age was 66.4 ± 10.5, 66.1% had an ICD or ICD with cardiac resynchronization function (CRT-D), 18.1% had >1 CA. During median 812 days [IQR 381-1588] of follow-up, there were 11 (6.2%) cases of lead damage in the examined and 13 cases (13%) in the control group, p = 0.054. None of the technical aspects of the CA (indication, type of catheter, transseptal sheath) influenced the primary outcome. Both the number of leads and observation time after CA were significantly related to the risk of endocardial lead damage. Conclusion. This study did not find any significant influence of CA on the long-term durability of CIED endocardial leads. Reported risk factors were consistent with general population of CIED patients.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Marca-Passo Artificial , Falha de Prótese , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
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
14.
Med Clin North Am ; 103(5): xv-xvi, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31378337
16.
Clin Cardiol ; 42(10): 866-872, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31317573

RESUMO

BACKGROUND: Implantable cardioverter defibrillator (ICD) was implemented into clinical routine more than 20 years ago. Since then, ICD therapy became standard therapy for primary and secondary prevention of sudden cardiac death in clinical practice. OBJECTIVES: Aim of the study was to evaluate the benefit-harm profile of contemporary primary prophylactic ICD therapy. METHODS: A total of 1222 consecutive patients of a prospective single-center ICD-registry were analyzed who underwent primary prophylactic ICD implantation between 2000 and 2017. Patients were divided into two groups according to the implantation year: 2010-2017 (group 1, n = 579) and 2000-2009 (group 2, n = 643). RESULTS: The rate of estimated appropriate ICD therapy after 8 years was 51% in the 2000s and 42% in the 2010s (P < .001). The complication rate changed slightly from 53% to 47% (P = .005). This decline was mainly driven by the reduction of inappropriate ICD shocks (30% vs 14%, P < .001) whereas the rate of ICD shock lead malfunction and device/ lead infection remained unchanged over time. Nonischemic cardiomyopathy was an independent predictor for ICD complications without benefit of ICD therapy (HR 1.37, 95% CI 1.07-1.77). CONCLUSION: The ICD therapy rate for ventricular arrhythmias in patients with primary prophylactic ICD implantation is decreasing over the last two decades. Complication rate remains high due to an unchanged rate of ICD shock malfunctions and device infections. Nonischemic cardiomyopathy is an independent predictor for ICD complications without benefit of ICD therapy in primary prophylactic ICD-therapy.


Assuntos
Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Prevenção Primária/métodos , Sistema de Registros , Medição de Risco/métodos , Arritmias Cardíacas/complicações , Arritmias Cardíacas/mortalidade , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
18.
Expert Rev Med Devices ; 16(9): 821-828, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31348864

RESUMO

Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters. Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation. Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous. Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators' majority want to disposition all kind of leads, although quadripolar leads are the favorites.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis , Eletrônica Médica , Marca-Passo Artificial , Feminino , Geografia , Átrios do Coração/patologia , Ventrículos do Coração/patologia , Humanos , Itália , Inquéritos e Questionários
19.
Crit Care Nurs Clin North Am ; 31(3): 315-328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351553

RESUMO

This article discusses the anatomy and physiology of tetralogy of Fallot (TOF) and TOF variants. Indications for surgical repair, morbidity/mortalities, and surgical repair techniques are also reviewed. The article concludes with review of common postoperative complications and management strategies for arrhythmias, right ventricular dysfunction, low cardiac output, and residual defects.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/terapia , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Arritmias Cardíacas/terapia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Enfermagem de Cuidados Críticos , Humanos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Tetralogia de Fallot/mortalidade , Fatores de Tempo , Disfunção Ventricular Direita/terapia
20.
Artigo em Português | LILACS | ID: biblio-1023043

RESUMO

Os maiores avanços no tratamento das arritmias cardíacas, que geraram propostas de mudança e/ou incorporação de novas tecnologias de tratamento medicamentoso ou intervencionista, referem-se à fibrilação atrial, arritmia sustentada mais frequente na prática clínica, razão pela qual demos maior ênfase a essa análise. Os últimos estudos que têm proporcionado revisões, atualizações e perspectivas das principais diretrizes mundiais são os que envolvem as comparações dos esquemas de combinações de anticoagulação e antiagregação plaquetária em pacientes com fibrilação atrial no contexto da doença arterial coronariana com intervenção planejada ou imediata, bem como os que envolvem a estratégia de ablação por cateteres com opção no início do tratamento da fibrilação atrial nos pacientes com insuficiência cardíaca com fração de ejeção reduzida


The greatest advances in the treatment of cardiac arrhythmias, which have led to proposals of change and/or the incorporation of new drug or intervention treatment technologies, relate to atrial fibrillation, the most common sustained arrhythmia in medical practice, which is why we have placed more emphasis on it in this analysis. The latest studies to have revised, updated, and offered new perspectives on the principal global guidelines are those that involve comparisons of regimens that combine anticoagulation and antiaggregation of platelets in patients with atrial fibrillation within the context of coronary artery disease with planned or immediate intervention, as well of those that involve a catheter ablation strategy as an option at the beginning of treatment for atrial fibrillation in patients with heart failure with reduced ejection fraction


Assuntos
Humanos , Masculino , Feminino , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Fibrilação Atrial , Varfarina/uso terapêutico , Doença da Artéria Coronariana , Stents , Aspirina/uso terapêutico , Guias como Assunto/normas , Ablação por Cateter/métodos , Hemorragia , Anticoagulantes
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