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1.
Int Heart J ; 62(5): 988-996, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34544968

RESUMO

In this study, we aimed to investigate the time course of new-onset complete atrioventricular block (CAVB) and its reversibility after transcatheter aortic valve implantation (TAVI). We analyzed 206 consecutive patients without baseline CAVB who underwent successful TAVI. The incidence of new-onset CAVB was determined to be 12.6% (26/206). Among these patients, 14 recovered from CAVB within 2 weeks (6.8%, 14/206), while the remaining 12 (5.8%, 12/206) underwent permanent pacemaker (PPM) insertion. Among the 12 patients who received the PPM, 4 were able to recover from CAVB within 4 months. Thus, only 8 among 206 patients (3.8%) showed persistent CAVB. Early-onset CAVB on the day of the procedure was the strongest predictor of PPM implantation (OR = 127). The electrocardiographic changes that occurred after TAVI were mostly recovered after 1 month. The most critical procedural factor that predicts CAVB and PPM insertion is the deep implantation (>4 mm) of a big valve (oversizing index >5.9%). In conclusion, the incidence of CAVB after TAVI was estimated to be at 12.6%. Two-thirds of these patients recovered from CAVB within 3 days, resulting in a final rate of persistent CAVB of 4%. To prevent CAVB, we have to implant an appropriate valve type with an optimal size and depth.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Eletrocardiografia/métodos , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Incidência , Síndrome do QT Longo , Masculino , Marca-Passo Artificial/efeitos adversos , Valor Preditivo dos Testes , Recuperação de Função Fisiológica/fisiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/instrumentação
2.
Int Heart J ; 62(5): 1012-1018, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34544981

RESUMO

High-degree atrioventricular block (HAVB) or complete heart block (CHB) is a common complication associated with transcatheter aortic valve replacement (TAVR). However, some patients with HAVB/CHB recover with time. The results of electrophysiological studies (EPSs) using permanent pacemaker implantation (PPI) in patients with suspicious HAVB/CHB are considered controversial.This study aimed to evaluate whether HAVB/CHB induction at the bedside using a temporary pacemaker can predict recurrence in patients who had recovered from HAVB/CHB after TAVR.We enrolled a total of 11 patients who had recovered from HAVB/CHB and evaluated their electrophysiology using right ventricular pacing and/or procainamide administration.HAVB/CHB induction was positive. Three patients tested positive for HAVB/CHB, whereas 8 tested negative. The ejection fraction and the interval between HAVB/CHB onset and EPS were found to be significant. HAVB/CHB positive patients underwent PPI. A patient with a balloon-expandable valve tested positive just before recovery of CHB, but tested negative 5 days later and was included in the negative group. The 4 patients who tested negative received a cardiovascular implantable electric device (CIED). We observed HAVB/CHB in 2 patients who had previously tested positive after 3 months. Among those who tested negative, those with CIED had no HAVB/CHB, and others showed neither HAVB/CHB on electrocardiogram nor experienced syncope or sudden death.Our EPS revealed that HAVB/CHB induction may predict HAVB/CHB recurrence after TAVR. Valve type and EPS timing may affect the results.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/induzido quimicamente , Bloqueio Atrioventricular/terapia , Eletrofisiologia Cardíaca/estatística & dados numéricos , Próteses Valvulares Cardíacas/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/administração & dosagem , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Eletrofisiologia Cardíaca/tendências , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Marca-Passo Artificial/efeitos adversos , Testes Imediatos/tendências , Valor Preditivo dos Testes , Procainamida/administração & dosagem , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
3.
Am J Physiol Heart Circ Physiol ; 321(3): H569-H576, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34355987

RESUMO

Ventricular arrhythmias, consisting of single ectopic beats (sEB), multiple EB (mEB), and torsades de pointes (TdP, defined as ≥5 beats with QRS vector twisting around isoelectric line) can be induced in the anesthetized chronic atrioventricular block (CAVB) dog by dofetilide (IKr blocker). The interplay between temporal dispersion of repolarization, quantified as short-term variability (STV), and spatial dispersion of repolarization (SDR) in the initiation and perpetuation of these arrhythmias remains unclear. Five inducible (≥3 TdPs/10 min) CAVB dogs underwent one mapping experiment and were observed for 10 min from the start of dofetilide infusion (0.025 mg/kg, 5 min). An intracardiac decapolar electrogram (EGM) catheter and 30 intramural cardiac needles in the left ventricle (LV) were introduced. STVARI was derived from 31 consecutive activation recovery intervals (ARIs) on the intracardiac EGM, using the formula: [Formula: see text]. The mean SDR3D in the LV was determined as the three-dimensional repolarization time differences between the intramural cardiac needles. Moments of measurement included baseline (BL) and after dofetilide infusion before first 1) sEB (occurrence at 100 ± 35 s), 2) mEB (224 ± 96 s), and 3) non-self-terminating TdP (454 ± 298 s). STVARI increased from 2.15 ± 0.32 ms at BL to 3.73 ± 0.99 ms* before the first sEB and remained increased without further significant progression to mEB (4.41 ± 0.45 ms*) and TdP (5.07 ± 0.84 ms*) (*P < 0.05 compared with BL). SDR3D did not change from 31 ± 11 ms at BL to 43 ± 13 ms before sEB but increased significantly before mEB (68 ± 7 ms*) and to TdP (86 ± 9 ms*+) (+P < 0.05 compared with sEB). An increase in STV contributes to the initiation of sEB, whereas an increase in SDR is important for the perpetuation of non-self-terminating TdPs.NEW & NOTEWORTHY This study compared two well-established electrophysiological parameters, being temporal and spatial dispersion of repolarization, and provided new insights into their interplay in the arrhythmogenesis of torsades de pointes arrhythmias. Although it confirmed that an increase in temporal dispersion of repolarization contributes to the initiation of single ectopic beats, it showed that an increase in spatial dispersion of repolarization is important for the perpetuation of non-self-terminating torsades de pointes arrhythmias.


Assuntos
Bloqueio Atrioventricular/fisiopatologia , Modelos Cardiovasculares , Torsades de Pointes/fisiopatologia , Potenciais de Ação , Animais , Bloqueio Atrioventricular/complicações , Cães , Feminino , Masculino , Tempo de Reação , Torsades de Pointes/etiologia
5.
Am Heart J ; 241: 83-86, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34302751

RESUMO

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Assuntos
Assistência ao Convalescente , COVID-19/fisiopatologia , Cardiopatias/diagnóstico , Encaminhamento e Consulta , Adolescente , Assistência Ambulatorial , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/etiologia , Bradicardia/fisiopatologia , COVID-19/complicações , Cardiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Dispneia/fisiopatologia , Ecocardiografia , Eletrocardiografia , Fadiga/fisiopatologia , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/diagnóstico , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Ciência da Implementação , Masculino , Pediatria , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Índice de Gravidade de Doença , Síncope/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia , Adulto Jovem
6.
BMC Cardiovasc Disord ; 21(1): 289, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116630

RESUMO

BACKGROUND: Nationwide data on the prevalence of atrioventricular (AV) block are currently unavailable in China. Thus, we aimed to assess the prevalence and risk factors of AV block among Chinese health examination adults. METHODS: A total of 15,181,402 participants aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent an electrocardiogram as a part of routine health examination in 2018 were analyzed. AV block was diagnosed by physicians using 12-lead electrocardiogram. Overall and stratified prevalence (by age, sex, and city size) of all, first-, second- and third-degree AV block were calculated. Multivariable logistic regression analyses were performed to explore risk factors associated with AV block. RESULTS: AV block was observed in 88,842 participants, including 86,153 with first-degree, 2249 with second-degree and 440 with third-degree AV block. The age- and sex-standardized prevalence rate [95% confidence interval (CI)] of all, first-, second- and third-degree AV block were 7.06‰ (7.01-7.11), 6.84‰ (6.79-6.89), 0.18‰ (0.17-0.18) and 0.04‰ (0.03-0.04) respectively. After multivariable adjustment, the risk of AV block was positively associated with older age, being male, lower heart rate, higher body mass index, hypertension, diabetes and low high-density lipoprotein cholesterol. High total cholesterol was associated with a lower risk of AV block. CONCLUSION: First-degree AV block is relatively common while severe AV block is rare in health examination adults. Besides, AV block was highly prevalent among the elderly. The risk of AV block was associated with older age, being male and metabolic factors.


Assuntos
Bloqueio Atrioventricular/epidemiologia , Prevalência , Adolescente , Adulto , Fatores Etários , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , China/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Eletrocardiografia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
7.
J Am Heart Assoc ; 10(10): e020033, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33960210

RESUMO

Background The temporal incidence of high-grade atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) is uncertain. As a result, periprocedural monitoring and pacing strategies remain controversial. This study aimed to describe the temporal incidence of initial episode of HAVB stratified by pre- and post-TAVR conduction and identify predictors of delayed events. Methods and Results Consecutive patients undergoing TAVR at a single center between February 2012 and June 2019 were retrospectively assessed for HAVB within 30 days. Patients with prior aortic valve replacement, permanent pacemaker (PPM), or conversion to surgical replacement were excluded. Multivariable logistic regression was performed to assess predictors of delayed HAVB (initial event >24 hours post-TAVR). A total of 953 patients were included in this study. HAVB occurred in 153 (16.1%). After exclusion of those with prophylactic PPM placed post-TAVR, the incidence of delayed HAVB was 33/882 (3.7%). Variables independently associated with delayed HAVB included baseline first-degree atrioventricular block or right bundle-branch block, self-expanding valve, and new left bundle-branch block. Forty patients had intraprocedural transient HAVB, including 16 who developed HAVB recurrence and 6 who had PPM implantation without recurrence. PPM was placed for HAVB in 130 (13.6%) (self-expanding valve, 23.7% versus balloon-expandable valve, 11.9%; P<0.001). Eight (0.8%) patients died by 30 days, including 1 unexplained without PPM present. Conclusions Delayed HAVB occurs with higher frequency in patients with baseline first-degree atrioventricular block or right bundle-branch block, new left bundle-branch block, and self-expanding valve. These findings provide insight into optimal monitoring and pacing strategies based on periprocedural ECG findings.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/epidemiologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Minnesota/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Gestão de Riscos
8.
Theranostics ; 11(8): 3948-3960, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33664872

RESUMO

Background: Pacemaker implantation is currently used in patients with symptomatic bradycardia. Since a pacemaker is a lifetime therapeutic device, its energy consumption contributes to battery exhaustion, along with its voltage stimulation resulting in local fibrosis and greater resistance, which are all detrimental to patients. The possible resolution for those clinical issues is an injection of a conductive hydrogel, poly-3-amino-4-methoxybenzoic acid-gelatin (PAMB-G), to reduce the myocardial threshold voltage for pacemaker stimulation. Methods: PAMB-G is synthesized by covalently linking PAMB to gelatin, and its conductivity is measured using two-point resistivity. Rat hearts are injected with gelatin or PAMB-G, and pacing threshold is evaluated using electrocardiogram and cardiac optical mapping. Results: PAMB-G conductivity is 13 times greater than in gelatin. The ex vivo model shows that PAMB-G significantly enhances cardiac tissue stimulation. Injection of PAMB-G into the stimulating electrode location at the myocardium has a 4 times greater reduction of pacing threshold voltage, compared with electrode-only or gelatin-injected tissues. Multi-electrode array mapping reveals that the cardiac conduction velocity of PAMB-G group is significantly faster than the non- or gelatin-injection groups. PAMB-G also reduces pacing threshold voltage in an adenosine-induced atrial-ventricular block rat model. Conclusion: PAMB-G hydrogel reduces cardiac pacing threshold voltage, which is able to enhance pacemaker efficacy.


Assuntos
Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial , Animais , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Materiais Biocompatíveis/administração & dosagem , Modelos Animais de Doenças , Condutividade Elétrica , Estimulação Elétrica/métodos , Eletrocardiografia , Eletrodos Implantados , Gelatina/administração & dosagem , Humanos , Hidrogéis/administração & dosagem , Hidrogéis/síntese química , Éteres de Hidroxibenzoatos/administração & dosagem , Éteres de Hidroxibenzoatos/síntese química , Éteres de Hidroxibenzoatos/química , Técnicas In Vitro , Injeções , Teste de Materiais , Medicina de Precisão , Ratos , Ratos Sprague-Dawley
10.
J Am Heart Assoc ; 10(7): e019429, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33779244

RESUMO

Background Limited clinical evidence and literature are available about the potential impact of sex on permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI). The aim of this work was to evaluate the relationship between sexes and atrioventricular conduction disturbances requiring PPI after TAVI. Methods and Results Data were obtained from 46 studies from PubMed reporting information about the impact of patient sex on PPI after TAVI. Total proportions with 95% Cls were reported. Funnel plot and Egger test were used for estimation of publication bias. The primary end point was 30-day or in-hospital PPI after TAVI, with odds ratios and 95% CIs extracted. A total of 70 313 patients were included, with a cumulative proportion of 51.5% of women (35 691 patients; 95% CI, 50.2-52.7). The proportion of women undergoing TAVI dropped significantly over time (P<0.0001). The cumulative PPI rate was 15.6% (95% CI, 13.3-18.3). The cumulative rate of PPI in women was 14.9% (95% CI, 12.6-17.6), lower than in men (16.6%; 95% CI, 14.2-19.4). The risk for post-TAVI PPI was lower in women (odds ratio, 0.90; 95% CI, 0.84-0.96 [P=0.0022]). By meta-regression analysis, age (P=0.874) and ventricular function (P=0.302) were not significantly associated with PPI among the sexes. Balloon-expandable TAVI significantly decrease the advantage of women for PPI, approaching the same rate as in men (P=0.0061). Conclusions Female sex is associated with a reduced rate of PPI after TAVI, without influence of age or ventricular function. Balloon-expandable devices attenuate this advantage in favor of women. Additional investigations are warranted to elucidate sex-based differences in developing conduction disturbances after TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/terapia , Eletrocardiografia , Marca-Passo Artificial/estatística & dados numéricos , Estenose da Valva Aórtica/complicações , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/fisiopatologia , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Sexuais , Substituição da Valva Aórtica Transcateter
13.
Am J Cardiol ; 149: 78-85, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33753040

RESUMO

Conduction disturbances remain common following transcatheter aortic valve implantation (TAVI). Aside from high-degree atrioventricular block (HAVB), their optimal management remains elusive. Invasive electrophysiological studies (EPS) may help stratify patients at low or high risk of HAVB allowing for an early discharge or permanent pacemaker (PPM) implantation among patients with conduction disturbances. We evaluated the safety and diagnostic performances of an EPS-guided PPM implantation strategy among TAVI recipients with conduction disturbances not representing absolute indications for PPM. All patients who underwent TAVI at a single expert center from June 2017 to July 2020 who underwent an EPS during the index hospitalization were included in the present study. False negative outcomes were defined as patients discharged without PPM implantation who required PPM for HAVB within 6 months of the initial EPS. False positive outcomes were defined as patients discharged with a PPM with a ventricular pacing percentage <1% at follow-up. A total of 78 patients were included (median age 83.5, 39% female), among whom 35 patients (45%) received a PPM following EPS. The sensitivity, specificity, positive and negative predictive values of the EPS-guided PPM implantation strategy were 100%, 89.6%, 81.5%, and 100%, respectively. Six patients suffered a mechanical HAVB during EPS and received a PPM. These 6 patients showed PPM dependency at follow-up. In conclusion, an EPS-guided PPM implantation strategy for managing post-TAVI conduction disturbances appears effective to identify patients who can be safely discharged without PPM implantation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Complicações Pós-Operatórias/terapia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Doença do Sistema de Condução Cardíaco/fisiopatologia , Doença do Sistema de Condução Cardíaco/terapia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/fisiopatologia , Implantação de Prótese/métodos , Resultado do Tratamento
14.
BMC Cardiovasc Disord ; 21(1): 112, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627074

RESUMO

BACKGROUND: HB pacing is a promising approach to achieve physiological pacing, but its efficacy and long-term effects require further validation. In current study, we deemed to investigate the effect of the His bundle pacing (HBP) lead location on pacing parameters. METHODS: 2D echocardiography imaging was performed after successful implantation, according to which the patients were divided into groups A (whose His lead tips were at the atrial side) and B (whose His lead tips were at the ventricular side). The capture thresholds, sensing values, and H-V intervals between the two groups were compared. RESULTS: Thirteen patients were in group A and 16 patients were in group B. The average capture thresholds during, 1 month, and 1 year after operation were 1.20 ± 0.34, 0.69 ± 0.29, and 0.92 ± 0.80 V/0.5 ms for group A and 1.14 ± 0.43, 0.81 ± 0.39, and 0.98 ± 0.59 V/0.5 ms for group B, respectively. The difference between the two groups was not significant. The threshold values in both groups decreased significantly in 1 month and slightly increased in 1 year. The sensing values of group A were 1.87 ± 0.82, 1.95 ± 0.76, and 1.88 ± 0.75 mV, while those of group B were 4.53 ± 1.37, 4.69 ± 1.38, and 4.59 ± 1.42 mV. The difference among the three time points was not significant. However, the sensing values in group A were consistently significantly lower than those in group B. The HV interval in group A was significantly longer than that in group B. CONCLUSIONS: The implantation site of HBP leads has a significant effect on sensing values for that His leads crossing the tricuspid annulus toward the ventricle are associated with higher sensing values, compared to a more proximal location. Meanwhile, lead location has no evident effect on capture thresholds that is improved significantly shortly after operation.


Assuntos
Fibrilação Atrial/terapia , Bloqueio Atrioventricular/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial , Frequência Cardíaca , Marca-Passo Artificial , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , China , Desenho de Equipamento , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
15.
Int Heart J ; 62(1): 57-64, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455981

RESUMO

Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB) after TV surgery and determine whether atrioventricular conduction recovers within time.We investigated pre/intra- and postoperative predictors of AVB in patients who underwent tricuspid valve surgery (not only isolated TV surgery) at our institution between 2004 and 2017. Patients who had pacemakers prior to surgery were excluded.One year after surgery, 5.8% of the surviving cohort had received a pacemaker due to AVB. In the complete follow-up time, 33 out of 505 patients required pacemaker implantation because of AVB. Of the 37 patients who presented to the intensive care unit postoperatively with AVB III, 14 (38%) underwent pacemaker implantation for AVB, and 20 (54%) did not require a pacemaker. AVB III at ICU admission was identified as a predictor of pacemaker implantation (OR: 9.7, CI: 3.8-24.5, P < 0.001). TV endocarditis was also identified as a predictor (OR: 12.4, CI: 3.3-46.3, P < 0.001). Eleven out of 32 patients (34%) with tricuspid endocarditis required a pacemaker for AVB. The mean ventricular pacing burden within the first 5 years after pacemaker implantation was 79%.The issue of AVB after TV surgery is significant. Both the initial rhythm after surgery and etiology of the tricuspid disease can help predict pacemaker requirement. Within the first 5 years after surgery, the ventricular pacing burden remains high without relevant rhythm recovery.


Assuntos
Bloqueio Atrioventricular/etiologia , Endocardite/complicações , Marca-Passo Artificial/estatística & dados numéricos , Valva Tricúspide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/cirurgia , Intervalo Livre de Doença , Endocardite/cirurgia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/patologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia
16.
Europace ; 23(3): 451-455, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33432349

RESUMO

AIMS: The novel coronavirus SARS-CoV-2 has shown the potential to significantly affect the cardiovascular system. Cardiac arrhythmias are commonly reported complications in COVID-19 hospitalized patients. METHODS AND RESULTS: While tachyarrhythmias seem most common, we describe four cases of COVID-19 patients who developed a transient high-degree atrioventricular (AV) block during the course of their hospitalization. All four patients who developed a high-degree AV block during their hospitalization with COVID-19 did not require permanent pacing. CONCLUSION: Similarly to most AV blocks associated with infectious organisms and given its transient nature, this case series suggests that conservative management strategies should be preferred in COVID-19 patients who develop complete heart block.


Assuntos
Bloqueio Atrioventricular/etiologia , Nó Atrioventricular/fisiopatologia , COVID-19/complicações , Frequência Cardíaca , Hospitalização , Potenciais de Ação , Adulto , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , COVID-19/diagnóstico , COVID-19/terapia , Tratamento Conservador , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
17.
Am Heart J ; 231: 73-81, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33098810

RESUMO

Congenitally corrected transposition of the great arteries (ccTGA) is associated with various types of arrhythmia, including supraventricular tachycardia (SVT) and complete atrioventricular block (cAVB). Our study aims to characterize the arrhythmia burden, associated risk factors, arrhythmia mechanisms, and the long-term follow-up results in patients with ccTGA in a large Asian cohort. METHODS: We enrolled 104 patients (43 women and 61 men) diagnosed with ccTGA at our institution. The mean age at last follow-up was 20.8 years. RESULTS: For 40 patients (38%) with tachyarrhythmia, paroxysmal SVT (PSVT) and atrial arrhythmia were observed in 17 (16%) and 27 (26%) patients, respectively, with 4 patients (4%) having both types of SVT. The 20-year and 30-year SVT-free survival rates were 68% and 54%, respectively. Seven patients (7%) developed cAVB: 2 (2%) developed spontaneously, and the other 5 (5%) was surgically complicated (surgical risk of cAVB: 7%, all associated with ventricular septal defect repair surgery). PSVT was mostly associated with accessory pathways (5/9) but also related to twin atrioventricular nodal reentry tachycardia (3/9) and atrioventricular nodal reentry tachycardia (1/9). Most of the accessory pathways were located at tricuspid valve (9/10). Catheter ablation successfully eliminated all PSVT substrates (10/10) and most of the atrial arrhythmia substrates (3/5), with low recurrence rate. CONCLUSIONS: The arrhythmia burden in patients with ccTGA is high and increases over time. However, cAVB incidence was relatively low and kept stationary in this Asian cohort. The mechanisms of SVT are complicated and can be controlled through catheter ablation.


Assuntos
Arritmias Cardíacas/fisiopatologia , Transposição Congênita Corrigida de Grandes Artérias/fisiopatologia , Adolescente , Adulto , Idoso , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/cirurgia , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/mortalidade , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/cirurgia , Criança , Pré-Escolar , Transposição Congênita Corrigida de Grandes Artérias/epidemiologia , Transposição Congênita Corrigida de Grandes Artérias/mortalidade , Transposição Congênita Corrigida de Grandes Artérias/cirurgia , Eletrocardiografia , Feminino , Seguimentos , Comunicação Interventricular/cirurgia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida , Taquicardia por Reentrada no Nó Atrioventricular/epidemiologia , Taquicardia por Reentrada no Nó Atrioventricular/mortalidade , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/epidemiologia , Taquicardia Supraventricular/mortalidade , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Taiwan , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Cardiovasc Interv Ther ; 36(2): 246-255, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32418052

RESUMO

Data on the accurate onset date and serial changes of the complete atrioventricular block (CAVB) after transcatheter aortic valve implantation (TAVI) are limited. This study aimed to assess the incidence, timing, and potential recovery of CAVB following TAVI. Total 696 patients who underwent TAVI were enrolled. Acute CAVB was evaluated within 24 h; delayed CAVB was evaluated 24 h after TAVI. Recovered CAVB was defined as ventricular pacing < 1% during the follow-up or transit block without the need for permanent pacemaker implantation (PMI). The other patients with CAVB were categorized as continued CAVB. Clinical differences between the recovered and continued CAVB groups were evaluated, and the predictive factors of continued CAVB were assessed. The incidence rates of CAVB, acute CAVB, and delayed CAVB were 6.9% (48/696), 4.6% (32/696), and 2.3% (16/696), respectively. Overall, 47.9% (23/48) of patients had recovered CAVB, which was more prevalent in the acute CAVB group than in the delayed CAVB group [59.4% (19/32) vs. 25.0% (4/16), p = 0.025]. CAVB recovery occurred within 24 h (61.0%, 14/23) and after 24 h (39.0%, 9/23). Before CAVB recovery, 21.7% (5/23) of patients had already undergone PMI. A pre-existing complete right bundle branch block (CRBBB) was the only independent predictive factor of continued CAVB (odds ratio 4.51, 95% confidence interval 1.03-19.6, p = 0.045). In conclusion, a pre-existing CRBBB and the timing and prolonged duration of CAVB may be used in risk stratification to determine the appropriateness of early discharge, optimal PMI date, and PMI indication.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/epidemiologia , Marca-Passo Artificial , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Sistema de Registros , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Incidência , Japão/epidemiologia , Masculino , Complicações Pós-Operatórias/terapia
20.
Can J Cardiol ; 37(2): 329-338, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32428620

RESUMO

BACKGROUND: Left bundle branch area pacing (LBBaP) is accepted as a physiological form of pacing; however, it is complex and usually requires an expensive electrophysiological recording system. METHODS: A simplified approach ("9-partition method") was explored to perform LBBaP. In this method, a right anterior oblique 30° fluoroscopic image of the ventricle was divided into 9 sections ("3 × 3" partitions). From May 2018 to February 2019, we enrolled 51 consecutive patients who underwent pacemaker implantation. The patients were nonrandomly allocated to either the conventional LBBaP (c-LBBaP) group or simplified LBBaP (s-LBBaP) group. RESULTS: The mean age was 68.53 ± 11.90 years, and 32 (62.7%) patients were male. The overall success rate was 90.2% (46/51). Compared with the c-LBBaP group, the s-LBBaP group had a significantly lower total procedure duration (91.57 ± 19.51 minutes vs 70.68 ± 13.26 minutes; P < 0.001) and fluoroscopy duration (16.52 ± 5.34 minutes vs 10.54 ± 3.13 minutes; P < 0.001). The time from the 3830 lead and sheath passage through the tricuspid valve to an acceptable initial fixation site (4.69 ± 1.61 minutes vs 2.75 ± 1.04 minutes; P < 0.001) and the time to the left bundle branch lead being implanted successfully (11.78 ± 3.00 minutes vs 7.67 ± 2.45 minutes; P < 0.001) for the c-LBBaP vs s-LBBaP groups, respectively, were significantly different. After 3 months, there were no significant differences in the capture threshold, R wave amplitude, impedance, or QRS duration between the groups. CONCLUSIONS: Compared with the c-LBBaP approach, our simplified 9-partition method was faster and did not require an expensive electrophysiological recording system.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/métodos , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Dispositivos de Terapia de Ressincronização Cardíaca , China/epidemiologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Marca-Passo Artificial , Ajuste de Prótese , Implantação de Prótese/métodos , Estudos Retrospectivos , Septo Interventricular , Simplificação do Trabalho
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