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1.
Zhonghua Er Ke Za Zhi ; 58(2): 107-112, 2020 Feb 02.
Artigo em Chinês | MEDLINE | ID: mdl-32102146

RESUMO

Objective: To explore the safety and effectiveness of left bundle branch area pacing (LBBAP) in children. Methods: Clinical data, pacing electrocardiogram and parameters of 6 patients (5 females and 1 male) who underwent permanent pacemaker implantation and LBBAP from January to June 2019 in the Department of Pediatric Cardiology of Anzhen Hospital were retrospectively analyzed. Results: The weight of the 6 patients aged between 9 and 14 years ranged from 26 to 48 kg. Five patients were diagnosed with third degree atrioventricular block, and 1 patient was diagnosed with cardiac dysfunction after right ventricular apical pacing. Cardiac function decreased in one patient and remained normal in the other five patients. Left ventricular end diastolic diameter (LVEDD) Z score was 1.85±0.65. V(1) lead showed changes like right bundle branch block in pacing electrocardiogram. No significant difference was found regarding QRS wave duration ((95±13) ms vs. (111±20) ms, t=-1.610, P>0.05) between preoperation and postoperation. Pacing threshold was (0.85±0.26) V. The sensing threshold was (15.0±4.3) mV and the impedance was (717±72) Ω. P potential was recorded in 3 cases. The earliest left ventricular local activation time was (56±5) ms and remained stable at different output voltages. Postoperative echocardiography revealed that the electrodes were located near the endocardium of the left ventricular septum. No complications such as myocardial perforation and electrode dislocation occurred during follow-up. The pacing threshold, sensing threshold and impedance were (0.60±0.09)V, (16.1±3.9)mV, (662±78)Ω respectively at 3 months after operation. The patient with low left ventricular ejection fraction (LVEF) recovered to normal on the 3 rd day after LBBAP (45% vs. 57%). The LVEDD Z score decreased to (1.1±0.3) at 3 months after operation and was significantly lower than that before operation (t=2.38, P<0.05). Conclusions: LBBAP in children can achieve narrow QRS pacing andphysiological pacing with stablepacing parameters. It can improve left ventricular enlargement caused by long-term bradycardia, and cardiac dysfunction and cardiac enlargement caused by long-term right ventricular apical pacing quickly and effectively.LBBAP is safe and feasible for older children in the near future. However, the long term potential risks of LBBAP need further observation and study.


Assuntos
Bloqueio Atrioventricular/cirurgia , Bloqueio de Ramo/fisiopatologia , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Função Ventricular Esquerda/fisiologia , Adulto , Bloqueio de Ramo/diagnóstico por imagem , Criança , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Septo Interventricular
2.
J Med Econ ; 22(10): 1088-1095, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31464176

RESUMO

Aims: The Biventricular vs Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (BLOCK-HF) demonstrated that biventricular (BiV) pacing resulted in better clinical and structural outcomes compared to right ventricular (RV) pacing in patients with atrioventricular (AV) block and reduced left ventricular ejection fraction (LVEF; ≤50%). This study investigated the cost-effectiveness of BiV vs RV pacing in the patient population enrolled in the BLOCK-HF trial. Methods: All-cause mortality, New York Heart Association (NYHA) Class distribution over time, and NYHA-specific heart failure (HF)-related healthcare utilization rates were predicted using statistical models based on BLOCK-HF patient data. A proportion-in-state model calculated cost-effectiveness from the Medicare payer perspective. Results: The predicted patient survival was 6.78 years with RV and 7.52 years with BiV pacing, a 10.9% increase over lifetime. BiV pacing resulted in 0.41 more quality-adjusted life years (QALYs) compared to RV pacing, at an additional cost of $12,537. The "base-case" incremental cost-effectiveness ratio (ICER) was $30,860/QALY gained. Within the clinical sub-groups, the highest observed ICER was $43,687 (NYHA Class I). Patients receiving combined BiV pacing and defibrillation (BiV-D) devices were projected to benefit more (0.84 years gained) than BiV pacemaker (BiV-P) recipients (0.49 years gained), compared to dual-chamber pacemakers. Conclusions: BiV pacing in AV block patients improves survival and attenuates HF progression compared to RV pacing. ICERs were consistently below the US acceptability threshold ($50,000/QALY). From a US Medicare perspective, the additional up-front cost associated with offering BiV pacing to the BLOCK-HF patient population appears justified.


Assuntos
Terapia de Ressincronização Cardíaca/economia , Análise Custo-Benefício , Insuficiência Cardíaca/cirurgia , Bloqueio Atrioventricular/cirurgia , Método Duplo-Cego , Feminino , Política de Saúde , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , New York , Marca-Passo Artificial , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Função Ventricular
3.
Braz J Cardiovasc Surg ; 34(3): 344-351, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310474

RESUMO

OBJECTIVES: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). METHODS: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients' median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. RESULTS: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. CONCLUSION: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.


Assuntos
Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/normas , Adolescente , Adulto , Angiografia/métodos , Insuficiência da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Ecocardiografia/métodos , Desenho de Equipamento , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Lactente , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023735

RESUMO

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease beyond the age of 3 months. Complete heart block (CHB) is rare but a serious sequalae post-repair of TOF. We present a case of an 18-month-old child who developed late CHB after around 1 year of the corrective surgery of the congenital anomaly. On the regular follow-up visit, the patient assessment was unremarkable. However, there was bradycardia, 55 beats/min. The ECG showed complete atrioventricular dissociation. Echocardiogram was done and demonstrated severe tricuspid regurgitation (TR). The patient required a permanent pacemaker and he is currently well. We are presenting this case as a late unexpected CHB, with a possibility of progressive right-side dilatation as a contributing factor to CHB due to severe TR.


Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/cirurgia , Tetralogia de Fallot/complicações , Assistência ao Convalescente , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Ecocardiografia/métodos , Eletrocardiografia , Humanos , Lactente , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Fatores Desencadeantes , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/cirurgia , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
5.
An. sist. sanit. Navar ; 42(1): 93-96, ene.-abr. 2019.
Artigo em Espanhol | IBECS | ID: ibc-183053

RESUMO

La cirugía de pared abdominal alta puede requerir anestesia general pero en los pacientes con alto riesgo de vía aérea difícil y de complicaciones respiratorias es de elección la anestesia local o regional. La anestesia espinal usada habitualmente (isobara o hiperbara) puede comprometer la función respiratoria al bloquear la metámera T6 o superiores. La anestesia espinal hipobara (AEH) a dosis bajas (3,6 cc de bupivacaína hipobara al 0,1% y 0,2 cc de fentanilo al 0,005%) consigue una analgesia suficiente con mínimo bloqueo motor. Exponemos el caso de un paciente con una hernia supraumbilical de gran tamaño, con alto riesgo de vía aérea difícil y de complicaciones respiratorias, al que se le aplicó AEH. El paciente no refirió dolor ni disnea durante la intervención, por lo que la AEH a dosis bajas es una opción a tener en cuenta en la cirugía de pared abdominal alta, pese a no haber sido descrita para este uso


High abdominal wall surgery may require general anesthesia but, in patients with high risk of difficult airway and respiratory complications, local or regional anesthesia is the choice whenever possible. Spinal anesthesia usually used (both isobaric and hyperbaric) could compromise the respiratory function due to blockade of the T6 metamere or higher. Hypobaric spinal anesthesia (HSA) at low doses (3.6 cc of 0.1% hypobaric bupivacaine plus 0.2 cc of 0.005% fentanyl) achieves sufficient analgesia with minimal motor blockade. We present the case of a patient with a large supraumbilical hernia with high risk of difficult airway and respiratory complications, who went through HSA. The patient did not report pain or dyspnea during the surgical procedure thus, HSA at low doses is an option to be taken into account in high abdominal wall surgery despite not having been described for this use


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hérnia Ventral/cirurgia , Raquianestesia/métodos , Transtornos Respiratórios/complicações , Bupivacaína/administração & dosagem , Manuseio das Vias Aéreas/métodos , Complicações Intraoperatórias , Hérnia Umbilical/cirurgia , Obesidade Abdominal/complicações , Bloqueio Atrioventricular/cirurgia , Marca-Passo Artificial
6.
Intern Med ; 58(14): 2041-2044, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30918200

RESUMO

An 84-year-old man presented with syncope. Prior to admission, ambulatory electrocardiogram had demonstrated non-sustained ventricular tachycardia. Echocardiography showed severe aortic stenosis. He was also diagnosed with hypertrophic cardiomyopathy (HCM) by cardiac magnetic resonance (CMR) showing remarkable inhomogeneous left ventricular hypertrophy and extensive late gadolinium enhancement (LGE) in the lesions at the upper border and right-ventricular side of the basal-mid septal wall. Finally, he showed complete atrioventricular (AV) block followed by a long pause and syncope several times after admission. In this case with several possible causes of syncope, the CMR findings suggested a clue concerning the etiology of his syncope: complete AV block in HCM.


Assuntos
Bloqueio Atrioventricular/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Imagem Cinética por Ressonância Magnética/métodos , Marca-Passo Artificial , Síncope/complicações , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica , Bloqueio Atrioventricular/cirurgia , Meios de Contraste , Eletrocardiografia Ambulatorial/métodos , Fibrose/cirurgia , Gadolínio DTPA , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Miocárdio/patologia , Síncope/cirurgia , Resultado do Tratamento
7.
Heart Lung Circ ; 28(7): 1127-1133, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30064922

RESUMO

BACKGROUND: Open surgical implantation of epicardial leads in neonates and infants remains the first option of treatment. We reviewed the long-term outcomes after epicardial pacemaker implantation in neonates and infants. METHODS: From 1989 to 2016, 48 patients (16 neonates) underwent pacemaker implantation within the first year of life. Their median age and weight were 66.5days (range: 0∼319 days), and 4.2kg (range: 1.9∼9.3kg), respectively, at the time of first pacemaker implantation. The indications for pacemaker implantation were postoperative or congenital atrioventricular block, sinus node dysfunction, and/or myocarditis-induced atrioventricular block. Forty-six (46) unipolar epicardial leads (non-steroid-eluting: 22; steroid-eluting: 24) and two bipolar leads (steroid-eluting) were inserted using a median sternotomy or subxiphoid approach. RESULTS: The mean follow-up duration was 8.5±7.9years. The most commonly used generator mode at first implantation was VVI (n=24, 50.0%). Eleven (11) generator mode changes from the initial VVI or VVIR to dual-chamber pacing were made at a mean of 7.0±6.2years after the first implantation for better inter-chamber synchrony and ventricular function. Freedom from reoperation for generator change after the first implantation was 95.3, 70.6, and 21.9% at 1, 5, and 10 years. Eighteen (18) lead malfunction events (34.1%) were detected. Freedom from reoperation for lead change was 97.8, 76.2, and 46.3% at 1, 5, and 10 years. The lead replacement rate was significantly higher in patients with non-steroid-eluting than steroid-eluting leads (p=0.045). CONCLUSIONS: Neonates and infants require more frequent changes in pacemaker generator and leads than the older population. The use of steroid-eluting leads increased lead longevity and reduced the need for surgical re-interventions.


Assuntos
Bloqueio Atrioventricular/cirurgia , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Pericárdio/cirurgia , Reoperação , Síndrome do Nó Sinusal/cirurgia , Bloqueio Atrioventricular/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pericárdio/fisiopatologia , Síndrome do Nó Sinusal/fisiopatologia
8.
Am J Cardiol ; 123(2): 297-305, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30401486

RESUMO

Transcatheter aortic valve implantation (TAVI) often causes intraventricular conduction abnormalities (ICA), particularly left bundle branch block (LBBB) and advanced atrioventricular block, requiring pacemaker implantation (PMI). However, the relation between ICA and clinical outcomes after TAVI with balloon-expandable valves remains unclear, particularly in the Asian population. This retrospective study included all patients who underwent TAVI with balloon-expandable valves from October 2013 to September 2016. We defined ICA as new onset of complete LBBB (CLBBB) or PMI within 2 weeks after TAVI. We divided the patients into 2 groups: those with and without ICA (new-ICA and no-ICA groups) and we assessed 1-year outcome. Two hundred one consecutive patients underwent TAVI using balloon-expandable valves (mean age, 84.8 ± 5.7 years; women, 64%). ICA occurred in 47 patients (23%), 37 patients (18%) developed CLBBB, and 34 patients recovered from CLBBB within 1 year after TAVI. Ten patients (5%) who developed symptomatic bradycardia required PMI within 2 weeks after TAVI. At 30 days after PMI, 7 patients already had a very low ventricular pacing rate, and 6 patients who recovered from bradycardia needed pacing at 1 year. Patients with ICA tended to have high 1-year all-cause mortality, but there was no significant difference between the 2 groups (12% vs 7%, p = 0.15). In conclusion, ICA occurred in 23% of patients after TAVI with balloon-expandable valves, and approximately 90% of them recovered from ICA during the follow-up. There was no significant difference in 1-year all-cause mortality between the new-ICA and no-ICA groups.


Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/etiologia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/cirurgia , Bradicardia/etiologia , Bradicardia/cirurgia , Eletrocardiografia , Feminino , Humanos , Japão , Masculino , Marca-Passo Artificial , Estudos Retrospectivos
9.
Rev. esp. cardiol. (Ed. impr.) ; 71(12): 1059-1068, dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179012

RESUMO

Introducción y objetivos: Se describen e interpretan los datos del Registro Español de Marcapasos referentes a la actividad de estimulación cardiaca llevada a cabo en España en 2017. Métodos: Se analiza la información aportada por la Tarjeta Europea del Paciente Portador de Marcapasos y la información remitida por la industria sobre el número total de dispositivos implantados. Resultados: Se recibe información de 106 centros implantadores, con un total de 12.672 tarjetas europeas, el 32,1% de la actividad total estimada. La tasa de implante de generadores de marcapasos convencionales es de 820 unidades/millón y la de terapia de resincronización cardiaca de baja energía, 26 unidades/millón. Se implantan 333 marcapasos sin cables. La media de edad al implante es 77,9 años, la mayoría en varones (58,5%). Se utilizan mayoritariamente electrodos bipolares y de fijación activa, y tan solo un 20% son compatibles con resonancia magnética. El bloqueo auriculoventricular es la alteración electrocardiográfica más frecuente. A pesar del predominio de la estimulación secuencial bicameral (55%), hasta un 21,8% de los pacientes en ritmo sinusal reciben un marcapasos VVI/R. Los pacientes mayores de 80 años son los que menos se benefician de la estimulación fisiológica y de la terapia de resincronización cardiaca de baja energía. Conclusiones: El consumo total de generadores de marcapasos en España se mantiene en cifras similares a las de 2016. La edad es el principal factor que condiciona el modo de estimulación, que podría optimizarse en cerca del 22% de los pacientes. Continúa en ascenso la implantación del marcapasos sin cables


Introduction and objectives: This report describes the data reported to the Spanish Pacemaker Registry concerning the activity in cardiac pacing in 2017 in Spain. Methods: The analysis is based on the data obtained from the European Pacemaker Identification Card and the information reported by supplier companies related to global number of implanted pacemakers. Results: Information was received from 106 hospitals, with a total of 12672 cards, representing the 32.1% of the total pacing activity. Conventional pacemaker and resynchronization pacemaker rate was 820 units/million and 26 units/million inhabitants respectively. A total of 333 leadless pacemakers were implanted. The mean age was 77.9 years, predominantly men (58.5%). Most electrodes were bipolar, with active fixation and only 20% had magnetic resonance protection. Atrioventricular block was the most common electrocardiographic disturb. Most patients received bicameral sequential pacing although single chamber VVIR pacing was used in up to 21.8% of patients. Patients older than 80 years benefited less from physiological pacing and resynchronization therapy. Conclusions: Total use of pacemaker generators remains stable with respect to 2016. Age is the main factor that influences pacing mode selection, which could be improved in around 22% of patients. Leadless pacing continues to rise


Assuntos
Humanos , Bloqueio Atrioventricular/epidemiologia , Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Marca-Passo Artificial/estatística & dados numéricos , Registros de Doenças/estatística & dados numéricos , Arritmias Cardíacas/terapia , Estudos Retrospectivos , Isquemia Miocárdica/epidemiologia , Bloqueio Atrioventricular/cirurgia , Fibrilação Atrial/cirurgia , Flutter Atrial/cirurgia , Arritmias Cardíacas/epidemiologia
10.
Cardiol Young ; 28(12): 1487-1488, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30326976

RESUMO

Cardiac conduction disease affects patients with Kearns-Sayre syndrome. We report a young asymptomatic patient with Kearns-Sayre syndrome with abnormal conduction on electrocardiogram and Holter monitor, although not advanced atrioventricular block. She underwent prophylactic pacemaker placement, and rapidly developed complete atrioventricular block, which resulted in 100% ventricular pacing. It may be reasonable to consider prophylactic pacemaker implantation in patients with Kearns-Sayre syndrome with evidence of cardiac conduction disease even without overt atrioventricular block given its unpredictable progression to complete atrioventricular block.


Assuntos
Bloqueio Atrioventricular , Síndrome de Kearns-Sayre/complicações , Marca-Passo Artificial , Procedimentos Cirúrgicos Profiláticos , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/prevenção & controle , Bloqueio Atrioventricular/cirurgia , Doença do Sistema de Condução Cardíaco/complicações , Doença do Sistema de Condução Cardíaco/cirurgia , Criança , Progressão da Doença , Eletrocardiografia , Feminino , Humanos
12.
Turk Kardiyol Dern Ars ; 46(6): 494-500, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30204141

RESUMO

Increased parasympathetic tone may cause symptomatic functional atrioventricular block (AVB) and necessitate pacemaker implantation. In these patients, where there is no structural damage to the conduction system, removal of the vagal activity using radiofrequency ablation seems to be a theoretically rational approach. Several methods have been used to determine suitable areas for vagal ganglia ablation. The aim of this report was to describe a new method to detect parasympathetic innervation sites without the need to use additional equipment or extend procedure time. A 51-year-old man was referred to the clinic for implantation of a permanent pacemaker because of symptomatic second-degree AVB and recurrent syncope. The functional nature of the AVB and a supra-Hisian location were verified with standard electrocardiography, Holter recordings, atropine sulfate test, and a standard electrophysiological study. Using conventional recordings, the electrograms were divided into 3 subgroups and sites demonstrating a fractionated pattern were targeted. All of the fractionated electrogram sites considered suitable for usual ganglion settlement were ablated. Biatrial ablation was initiated from the left atrial side. During left atrial ablation, the intrinsic basic cycle length of sinus node accelerated to 800 milliseconds despite AVB persistence. Subsequently, 1:1 atrioventricular conduction was achieved when ablation was applied around the coronary sinus ostium. The patient was completely asymptomatic, experiencing no episodes of dizziness or syncope, and was taking no medications at the end of 9 months of follow-up. In conclusion, electroanatomically guided vagal ganglia ablation may be a good alternative to pacemaker implantation in well-selected patients with functional AVB.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Nervo Vago/cirurgia , Bloqueio Atrioventricular/cirurgia , Ablação por Cateter , Diagnóstico Diferencial , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial
13.
Pacing Clin Electrophysiol ; 41(9): 1266-1267, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29893417

RESUMO

Transcatheter aortic valve implantation (TAVI) has become an established treatment option for aortic valve stenosis in patients with a high risk for conventional surgical valve replacement. A well-known complication is the development of conduction abnormalities. In the case of a new third-degree atrioventricular block, the complication can be life-threatening and permanent pacing is needed. Often these patients have a venous sheath placed in the jugular vein for the perioperative period. We report a case of inadvertent dislodgement of a permanent pacemaker lead after removal of a preoperatively placed venous sheath in a TAVI patient.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Remoção de Dispositivo/efeitos adversos , Eletrodos Implantados/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Ecocardiografia , Humanos , Doença Iatrogênica , Masculino
14.
Artigo em Inglês | MEDLINE | ID: mdl-29614795

RESUMO

Background: The biological behaviour and clinical significance of mercury toxicity vary according to its chemical structure. Mercury differs in its degree of toxicity and in its effects on the nervous, digestive and immune systems as well as on organs such as the lungs, kidneys, skin, eyes and heart. Human exposure occurs mainly through inhalation of elemental mercury vapours during industrial and artisanal processes such as artisanal and small-scale gold mining. Case presentation: A 52-years-old female, housewife, with a body mass index of 25.3 kg/cm², without smoking or alcohol habits or any important clinical or chronic cardiovascular history, was admitted to the emergency room due to probable accidental poisoning by butane gas. Clinical manifestations with a headache, dizziness, cough, and dyspnoea of medium to small efforts. An initial physical exploration with Glasgow scored at 15, with arrhythmic heart sounds, pulmonary fields with bilateral subcrepitant rales and right basal predominance. Electrocardiographic findings were as follows: a cardiac frequency of 50 beats per minute and atrioventricular dissociation. Laboratory parameters were: white blood cells at 15.8 × 108/L; aspartate aminotransferase at 38 U/L; lactate dehydrogenase at 1288 U/L; creatine-kinase at 115 U/L; CK-MB fraction at 28 U/L; and other biochemical parameters were within the reference values. A radiographic evaluation showed flow cephalization, diffuse bilateral infiltrates with right basal predominance. In addition, the patient presented data of low secondary expenditure to third-degree atrioventricular (AV) block for which the placement of a transvenous pacemaker was decided, substantially improving the haemodynamic parameters. Subsequently, after a family interrogation, the diagnosis of mercury inhalation poisoning was established. An initial detection of mercury concentration (Hg(0)) was carried out, reporting 243.5 µg/L. In view of this new evidence, mercury chelation therapy with intravenous calcium disodium ethylenediamine tetraacetic acid (CaNa2·EDTA) was initiated. After 8-days of hospital stay, she presented a favourable evolution with both clinical and radiological improvements, so that the mechanical ventilation progressed to extubating. Subsequently, she was referred for cardiology because of her persistent 3rd-degree atrioventricular block, deciding to place a definitive bicameral pacemaker. The patient was discharged from the hospital 14 days after admission due to clinical improvements with mercury plasma levels at 5 µmol/L and a heart rhythm from the pacemaker. Conclusions: We show evidence that acute exposure to elemental mercury can affect the heart rhythm, including a complete atrioventricular blockage.


Assuntos
Bloqueio Atrioventricular/etiologia , Intoxicação por Mercúrio/complicações , Bloqueio Atrioventricular/cirurgia , Feminino , Humanos , Mercúrio/análise , Pessoa de Meia-Idade , Marca-Passo Artificial
15.
Am J Cardiol ; 121(11): 1373-1379, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29580630

RESUMO

In patients with unexplained cardiomyopathy, electroanatomical mapping can identify abnormal tissue to target during electrophysiology-guided endomyocardial biopsy (EP-guided EMB). The objective of this study is to determine whether catheter ablation performed in the same setting as EP-guided EMB increases procedural risk. Sixty-seven patients (mean age 54.4 ± 13.8, 57% male) undergoing EP-guided EMB were included. Radiofrequency catheter ablation was performed in 17 patients (25%) for ventricular arrhythmias and in 2 (3%) for typical atrial flutter. Femoral arterial access was obtained in 90% ablation patients and 40% biopsy-only patients; vascular access complications were more common in the ablation group than in the EMB-only group (p = 0.02). There were no significant differences in rate of tricuspid regurgitation, thromboembolism, or pericardial effusion, whether procedural anticoagulation was used. In conclusion, catheter ablation and procedural anticoagulation can be combined with EP-guided EMB with an increased risk of vascular access complications, but no significant increase in intracardiac complications.


Assuntos
Arritmias Cardíacas/patologia , Biópsia/métodos , Cardiomiopatias/patologia , Ablação por Cateter/métodos , Endocárdio/patologia , Miocardite/patologia , Miocárdio/patologia , Sarcoidose/patologia , Adulto , Idoso , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/cirurgia , Flutter Atrial/etiologia , Flutter Atrial/patologia , Flutter Atrial/cirurgia , Bloqueio Atrioventricular/patologia , Bloqueio Atrioventricular/cirurgia , Cardiomiopatias/complicações , Técnicas Eletrofisiológicas Cardíacas , Endocárdio/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Complicações Pós-Operatórias/epidemiologia , Sarcoidose/complicações , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/patologia , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/patologia , Complexos Ventriculares Prematuros/cirurgia
16.
Am J Med Sci ; 355(3): 252-265, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29549928

RESUMO

Enhanced parasympathetic tone may cause sinus bradycardia or pauses, transient or permanent atrioventricular block, with resultant vasovagal syncope. A substantial portion of these patients may be highly symptomatic and refractory to the conventional therapies and may require cardiac pacemaker implantation. Cardioneuroablation is a little known technique for management of patients with excessive vagal activation based on radiofrequency catheter ablation of main parasympathetic autonomic ganglia around the heart. Due to complicated inclusion criteria, ganglia detection methods, and ablation endpoints, routine usage of the procedure cannot be recommended at this time. In this comprehensive review, we aimed to discuss all aspects of cardioneuroablation procedure in bradyarrhythmias.


Assuntos
Bloqueio Atrioventricular/cirurgia , Bradicardia/cirurgia , Ablação por Cateter/métodos , Gânglios Parassimpáticos/cirurgia , Parassimpatectomia/métodos , Síndrome do Nó Sinusal/cirurgia , Síncope Vasovagal/cirurgia , Coração/inervação , Humanos
18.
Pediatr Cardiol ; 39(3): 637-639, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29435607

RESUMO

We describe a 17-year-old female who presented with 3 weeks of abdominal pain, exercise intolerance, and an episode of altered mental status found to have marked first-degree atrioventricular block. Exercise stress test and cardiac catheterization demonstrated pseudo-pacemaker syndrome, and a permanent pacemaker was placed. Following placement, she has resolution of symptoms and markedly improved exercise tolerance.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/cirurgia , Cateterismo Cardíaco , Marca-Passo Artificial , Adolescente , Eletrocardiografia , Teste de Esforço , Tolerância ao Exercício , Feminino , Humanos , Complicações Pós-Operatórias
20.
Clin Res Cardiol ; 107(1): 60-69, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28963581

RESUMO

AIMS: Approximately every fifth patient undergoing transcatheter aortic valve implantation (TAVI) requires a permanent pacemaker (PPM) after the procedure. The aim of this study was to analyse predictors of atrioventricular block III° (AVBIII) persistence with concurrent PPM dependency after TAVI. METHODS AND RESULTS: Between 2010 and 2015 a total of 1198 patients underwent TAVI at the Kerckhoff Heart and Thorax Center, Germany. After exclusion of patients with prior PPM (n = 173) 14.7% (n = 176) of the patients underwent PPM implantation after the procedure. Independent predictors of PPM implantation were pre-existing right bundle branch block (RBBB, p < 0.001) and implantation of a CoreValve prosthesis (p < 0.001). A subgroup of patients with a newly implanted PPM (n = 102) were followed-up for a median of 73 (IQR 62-85) days. The leading indication for PPM implantation was AVBIII in 74.5% (76/102). Of these patients only 22.4% (17/76) had persistent AVBIII at follow-up. Predictors of AVBIII persistence were prior RBBB (p = 0.04), postdilatation (p = 0.006) and higher mean aortic valve gradient prior to implantation (p = 0.013). PPMs were implanted earlier in patients with persisting AVBIII [1 day (IQR0-2.5) vs. 4 days (IQR2-7); p < 0.001]. Early PPM implantation after TAVI was the only independent predictor of persistent AVBIII [OR 1.36 (95% 1.05-1.75); p = 0.02]. CONCLUSION: The long-term persistence of AVBIII is generally low after TAVI. Therefore, it may be wise to postpone the indication for PPM implantation for a couple of days. The only predictors of a lack of recovery of the AVB are prior RBBB, higher mean aortic valve gradients and postdilatation of the prosthesis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Feminino , Alemanha , Humanos , Masculino , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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