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1.
Medicine (Baltimore) ; 98(44): e17833, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689871

RESUMO

RATIONALE: Acute myocarditis complicated with complete atrioventricular block (CAVB) is rare in clinical scenario. We report an uncommon case of myocarditis complicated with permanent CAVB caused by Escherichia coli (E coli) bacteremia. PATIENT CONCERNS: A 77-year-old woman presented at the emergency department with chest pain, dizziness, nausea, and cold sweats of 1-day duration. She had histories of type 2 diabetes mellitus, hyperlipidemia, and chronic kidney disease with regular medical therapy. DIAGNOSIS: Both blood and urine cultures were positive for E coli. Regional inferior wall motion abnormalities on echocardiography, unexplained life-threatening arrhythmias, newly abnormal electrocardiogram, elevated cardiac troponins, and healthy coronary arteries on angiography were consistent with E coli-induced myocarditis. INTERVENTIONS: The patient received implantation of a dual-chamber pacemaker because of irreversible CAVB. OUTCOMES: The patient was discharged on day 8 and remained asymptomatic at 15 months of follow-up, with ST-segment normalization and normal left ventricular function. LESSONS: This extremely rare case of E coli-induced myocarditis masquerading as acute STEMI and with permanent CAVB sequelae, highlights the importance of sensitivity to non-ischemia etiologies of ST-segment elevation and the potential impact of E coli sepsis on the cardiac conduction system.


Assuntos
Bloqueio Atrioventricular/microbiologia , Bacteriemia/complicações , Infecções por Escherichia coli/complicações , Miocardite/microbiologia , Doença Aguda , Idoso , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Feminino , Humanos
2.
Tidsskr Nor Laegeforen ; 139(16)2019 11 05.
Artigo em Norueguês | MEDLINE | ID: mdl-31686471

RESUMO

BACKGROUND: Periventricular nodular heterotopia (PNH) is an embryonal neuronal migration disturbance of the brain. The condition is rare and genetically heterogeneous, often caused by mutations in the FLNA gene. The most common symptoms are epileptic seizures. PNH is often associated with other conditions such as cardiovascular abnormalities. CASE PRESENTATION: A young man was admitted to hospital after a first episode of loss of consciousness. The patient was in normal general condition upon admission, and the clinical examination revealed no abnormalities. However, cerebral imaging performed upon admittance showed PNH, while an extended cardiac examination revealed atrioventricular block with the indication for a pacemaker. After pacemaker implantation and introduction of antiepileptic drug therapy, the patient has been free of symptoms. INTERPRETATION: PNH is a condition that needs multidisciplinary assessments.


Assuntos
Heterotopia Nodular Periventricular , Adulto , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/terapia , Eletrocardiografia , Humanos , Masculino , Heterotopia Nodular Periventricular/complicações , Heterotopia Nodular Periventricular/diagnóstico por imagem , Heterotopia Nodular Periventricular/terapia , Tomografia Computadorizada por Raios X , Inconsciência/etiologia , Adulto Jovem
3.
Rev Port Cir Cardiotorac Vasc ; 26(2): 139-141, 2019.
Artigo em Português | MEDLINE | ID: mdl-31476815

RESUMO

Persistant left superior vena cava is a rare systemic venous anomaly that can be associated with agenesis of the right superior vena cava. It is usually assymptomatic and discovered incidentally during surgery or other procedures. The authors present the case of a 72-year-old male submitted to an aortic valve replacement surgery. After sternotomy, persistant left superior vena cava and absence of the right superior vena cava were identified. The patient developed complete atrioventricular block after surgery, requiring the implantation of a definitive cardiac pacemaker through the brachiocephalic vein and coronary sinus. This case highlights and ilustrates the clinical implications of the described systemic venous anomalies, discussing the necessary management both in the perioperative and intraoperative periods.


Assuntos
Valva Aórtica/cirurgia , Bloqueio Atrioventricular/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Malformações Vasculares/complicações , Veia Cava Superior/anormalidades , Idoso , Bloqueio Atrioventricular/etiologia , Estimulação Cardíaca Artificial , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino
4.
J Pak Med Assoc ; 69(8): 1119-1123, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431764

RESUMO

OBJECTIVE: To share the experience of a minimally invasive technique in the implantation of a dual chamber permanent pacemaker in paediatric population. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients aged up to 16 years who underwent epicardial dual chamber permanent pacemaker insertion via xiphisternal incision between April 2011 and August 2016. Demographic data included age, weight and gender of the patient. Indications for pacemaker insertion, electrocardiography findings, concomitant cardiac procedures and procedural complications were reviewed. Pacemaker thresholds and impedance at the time of implantation and throughout the course of follow-up were extracted from the clinical data. RESULTS: Of the 10 patients, 5(50%) were males and 5(50%)were females. The overall mean age was 3.4}3.8 years (range: 1 month - 13 years). The mean weight at the time of operation was 11.4}6.8 kg (range: 4.3-27kg). Indications for permanent pacemaker insertion included postoperative advanced or complete atrioventricular block in 7(70%) and complete congenital heart block in 3(30%). There was no reported morbidity. CONCLUSIONS: Dual chamber permanent pacemaker insertion via xiphisternal incision was found to be of benefit to the patients and the surgeons alike.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Bloqueio Cardíaco/congênito , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Marca-Passo Artificial , Implantação de Prótese/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Bloqueio Cardíaco/terapia , Humanos , Lactente , Recém-Nascido , Masculino
5.
J Card Surg ; 34(9): 877-879, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31269268

RESUMO

A 57-year old male with a dual-chamber pacemaker and 40-year history of hemodialysis and autoinflammatory disease developed a large, 35 × 35 mm intracardiac vegetation on the right ventricular pacing lead. As this mass was large enough to occlude the tricuspid valve orifice, transvenous lead extraction was deemed unsuitable. Instead, an urgent surgical extraction of the whole pacemaker system, including leads and vegetation, was conducted under cardiopulmonary bypass. In light of a high risk of recurrent blood infection, a new dual-chamber pacing system was then immediately re-established using epicardial pacing leads on the right atrium and ventricle instead of transvenous electrodes. This case of a rare, giant intracardiac lead vegetation lacked most known causal factors, except for renal failure, but a possibly immunosuppressed cardiac microenvironment due to long-term steroid therapy may have been an important influencing factor.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/métodos , Ponte Cardiopulmonar/métodos , Remoção de Dispositivo/métodos , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Infecções Estafilocócicas/cirurgia , Ecocardiografia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/microbiologia , Pericárdio , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Reimplante/métodos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificação
6.
BMJ Case Rep ; 12(7)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300602

RESUMO

We report a case of a 74-year-old man who developed myocarditis complicated by atrioventricular (AV) block following two doses of nivolumab for the treatment of non-small cell lung cancer. A diagnosis of drug-induced acute myocarditis with complete AV block was considered on the basis of elevated troponin, new onset left ventricular (LV) systolic dysfunction, absence of acute myocardial infarction and some findings suggestive of myocarditis on cardiac magnetic resonance. The patient was commenced on glucocorticoids, perindopril and carvedilol. AV block and LV dysfunction persisted despite 2 weeks of treatment. He ultimately became hypotensive which prompted an implantation of a cardiac resynchronisation therapy pacemaker. Follow-up echocardiogram at 6 weeks showed resolution of LV systolic dysfunction. However, he continued to have AV block.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Bloqueio Atrioventricular/induzido quimicamente , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Miocardite/induzido quimicamente , Nivolumabe/efeitos adversos , Troponina/efeitos dos fármacos , Idoso , Antineoplásicos Imunológicos/administração & dosagem , Bloqueio Atrioventricular/terapia , Ecocardiografia , Humanos , Masculino , Miocardite/terapia , Nivolumabe/administração & dosagem , Marca-Passo Artificial , Resultado do Tratamento
9.
Circ Arrhythm Electrophysiol ; 12(6): e007415, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31113233

RESUMO

Background His-bundle pacing (HBP) is a physiological form of pacing. Although high capture thresholds are common, few predictors of low HBP threshold have been determined. We aimed to identify electrophysiological predictors. Methods Fifty-one patients (53% with atrioventricular block) underwent HBP for bradycardia with an intrinsic QRS duration of <120 ms. Attempts to anchor the HBP lead were guided by unipolar His-bundle electrograms (HB EGMs) recorded with an electrophysiology recording system. Patients were followed-up for >6 months. Results In total, 153 attempts at anchoring the HBP lead were made, of which, 45 achieved acceptable HBP thresholds (≤2.5 V at 1 ms). The amplitude of negative deflection in HB EGM and the selective HBP form at fixation were independently associated with achieving an acceptable threshold. A negative amplitude of ≥0.060 mV in HB EGM was determined as the optimal value for identifying the acceptable threshold. This deep negative HB EGM was recorded with an HBP threshold of 1.4±1.3 V (in 34 attempts), significantly lower than that of positive HB EGM without deep negative deflection (2.8±1.3 V, in 31 trials; or >5 V, in 38 trials). The permanent HBP lead remained with deep negative (≥0.060 mV) or positive HB EGMs in 28 and 14 patients, respectively, and with positive or negative HB injury current in 19 and 23 patients, respectively. During follow-up, increased HBP threshold of >1 V was significantly more prevalent in the positive HB EGM group. The HBP thresholds of deep negative HB EGM and HB injury current, but not of the selective HBP group, were significantly lower than the other subgroups during follow-up. Conclusions Deep negative HB EGM at fixation was associated with an excellent short-term HBP threshold, similar to HB injury current. Analysis of unipolar HB EGM postfixation may enable prediction of permanent HBP threshold.


Assuntos
Potenciais de Ação , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/terapia , Bradicardia/diagnóstico , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
BMC Cardiovasc Disord ; 19(1): 100, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035937

RESUMO

BACKGROUND: Persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly. Permanent pacemaker implantation (PPI) in patients with PLSVC can be challenging because of the venous anomalies. We reported a case series of patients with PLSVC who underwent PPI with double active fixation leads. METHODS: From January 2012 to July 2016, 9 patients (three male and six females, mean age 68 ± 11 years) with PLSVC who received a dual-chamber pacemaker with double active fixation leads were enrolled retrospectively in this observational study. The indications for pacemaker implantation were symptomatic third-degree atrioventricular block in one and sick sinus syndrome in eight patients. RESULTS: PPI were implanted successfully in all 9 patients. Successful positioning of the ventricular leads at the right ventricular outflow tract (RVOT) septum with a "C" shaped stylet was achieved in 7 patients (77.8%). In the remaining two cases, the ventricular leads were placed in the right ventricular apex and the inferior free wall of the sub-tricuspid annulus. The atrial leads were placed at the lateral wall of the right atrium in all patients. Procedure time and fluoroscopy time were 85.3 ± 11.3 min and 4.5 ± 1.1 min respectively. During a mean follow-up of 4 years, no complications were observed and pacing parameters did not change significantly. CONCLUSION: PPI through PLSVC may be technically feasible, safe, and effective. Double active fixation leads may be standard for patients with PLSVC and most of the ventricular leads could be placed at the RVOT septum.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Implantação de Prótese/instrumentação , Síndrome do Nó Sinusal/terapia , Veia Cava Superior/anormalidades , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/fisiopatologia , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem
11.
Interv Cardiol Clin ; 8(3): 301-312, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31078186

RESUMO

Mitral annular calcification (MAC) is a fibrous, degenerative calcification of the mitral valve. It is associated with endocarditis, coronary artery disease, valvular heart disease, and congestive heart failure. Patients with severe MAC associated with mitral valve disease are considered poor candidates for traditional surgery. The current available outcomes data of transcatheter mitral valve replacement (TMVR) in severe MAC were limited by high rates of serious complications and subsequent high short-term and midterm mortality. This review article describes the procedural complications, clinical outcomes, and optimal patient selection for TMVR in patients with severe MAC.


Assuntos
Estenose da Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/patologia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Calcinose , Cateterismo Cardíaco/métodos , Ecocardiografia/métodos , Evolução Fatal , Feminino , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/patologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Valva Mitral/patologia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/patologia , Marca-Passo Artificial , Desenho de Prótese , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/etiologia
12.
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
13.
Medicine (Baltimore) ; 98(17): e15211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027067

RESUMO

RATIONALE: Patients with situs inversus totalis (SIT) and complete atrioventricular (AV) block are extremely rare, and only few cases have been reported up to now. Due to the rarity of such condition and its anatomical complexity, we reported this case as a reference for obstetricians, providing valuable insights into potential clinical treatment. PATIENT CONCERNS: We reported a case of 30-year-old patient with complete AV block, and her heart rate was only about 45 beats per minute. DIAGNOSES: The patient was diagnosed with term delivery with SIT and complete AV block. INTERVENTIONS: A temporary pacemaker (TPM) was implanted before cesarean section (CS) because of complete AV block. OUTCOMES: CS was performed successfully after the implantation of a TPM. The heart rate remained stable, and the 24-hour blood loss was limited. LESSONS: This study presents a complex heart disease case which needed more frequent antenatal examination and restriction of physical activity. To reduce the risk of pregnancy, basic disease needed to be cured before pregnancy. Our findings could provide guidance for future clinical studies.


Assuntos
Bloqueio Atrioventricular/terapia , Cesárea , Dextrocardia/terapia , Marca-Passo Artificial , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Bloqueio Atrioventricular/complicações , Dextrocardia/complicações , Feminino , Humanos , Recém-Nascido , Gravidez
15.
J Am Coll Cardiol ; 73(13): 1673-1687, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30947921

RESUMO

BACKGROUND: Right ventricular (RV) pacing-induced cardiomyopathy (PICM) occurs in ∼30% of patients with RV leads. This study evaluated the long-term effects of restoring antegrade conduction with a biological pacemaker in a porcine model of RV PICM. OBJECTIVES: The goal of this study was to determine if antegrade biological pacing can attenuate RV PICM. METHODS: In pigs with complete atrioventricular (AV) block, transcription factor T-box 18 (TBX18) was injected into the His bundle region in either of 2 experimental protocols: protocol A sought to prevent PICM, and protocol B sought to reverse PICM. In protocol A, we injected adenoviral vectors expressing TBX18 (or the reporter construct green fluorescent protein) after AV node ablation, and observed the animals for 8 weeks. In protocol B, PICM was established by using AV node ablation and 4 weeks of electronic RV pacing, at which point TBX18 was injected into the His bundle region. RESULTS: In protocol A, TBX18 biological pacing led to superior chronotropic support (62.4 ± 3 beats/min vs. 50.4 ± 0.4 beats/min; p = 0.01), lower backup pacemaker utilization (45 ± 2.6% vs. 94.6 ± 1.4%; p = 0.001), and greater ejection fraction (58.5 ± 1.3% vs. 46.7 ± 2%; p = 0.001). In protocol B, full-blown RV PICM was evident 4 weeks after complete AV block in both groups; subsequent intervention led to higher mean heart rate (56 ± 2 beats/min vs. 50.1 ± 0.4 beats/min; p = 0.05), less backup pacemaker utilization (53 ± 8.2% vs. 95 ± 1.6%; p = 0.003), and a greater ejection fraction (61.7 ± 1.3% vs. 49 ± 1.6%; p = 0.0003) in TBX18-injected animals versus control animals. CONCLUSIONS: In a preclinical model, pacemaker-induced cardiomyopathy can be prevented, and reversed, by restoring antegrade conduction with TBX18 biological pacing.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Cardiomiopatias/prevenção & controle , Terapia Genética , Proteínas com Domínio T/uso terapêutico , Animais , Relógios Biológicos , Cardiomiopatias/etiologia , Suínos
16.
J Thorac Cardiovasc Surg ; 157(3): 1168-1177.e2, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30917883

RESUMO

OBJECTIVES: Our primary aims were to describe the contemporary epidemiology of postoperative high-grade atrioventricular block (AVB), the timing of recovery and permanent pacemaker (PPM) placement, and to determine predictors for development of and recovery from AVB. METHODS: Patients who underwent congenital heart surgery from August 2014 to June 2017 were analyzed for AVB using the Pediatric Cardiac Critical Care Consortium registry. Predictors of AVB with or without PPM were identified using multinomial logistic regression. We used these predictors to model the probability of PPM for the subgroup of patients with intraoperative complete AVB. RESULTS: We analyzed 15,901 surgical hospitalizations; 422 (2.7%) were complicated by AVB and 162 (1.0%) patients underwent PPM placement. In patients with transient AVB, 50% resolved by 2 days, and 94% resolved by 10 days. In patients who received a PPM, 50% were placed by 8 days and 62% were placed by 10 days. Independent risk factors associated with PPM compared with resolution of AVB were longer duration of cardiopulmonary bypass (relative risk ratio, 1.04; P = .023) and a high-risk operation (relative risk ratio, 2.59; P < .001). Among patients with complete AVB originating in the operating room, those with the highest predicted probability of PPM had a PPM placed only 77% of the time. CONCLUSIONS: In this cohort, postoperative AVB complicated almost 3% of congenital heart surgery cases and 1% of patients underwent PPM placement. Because almost all patients (94%) with transient AVB had resolution by 10 days, our results suggest there is limited benefit to delaying PPM placement beyond that time frame.


Assuntos
Bloqueio Atrioventricular/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Adolescente , Adulto , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Recuperação de Função Fisiológica , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
Int Heart J ; 60(2): 457-461, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799381

RESUMO

Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal "jailed" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.


Assuntos
Angioplastia Coronária com Balão/métodos , Bloqueio Atrioventricular , Estimulação Cardíaca Artificial/métodos , Oclusão Coronária , Vasos Coronários , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Oclusão Coronária/diagnóstico , Oclusão Coronária/etiologia , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Remoção de Dispositivo/métodos , Septos Cardíacos , Humanos , Masculino , Marca-Passo Artificial , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recuperação de Função Fisiológica , Resultado do Tratamento
19.
Pacing Clin Electrophysiol ; 42(4): 395-399, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30653690

RESUMO

BACKGROUND: Leadless pacing is generally performed from a femoral approach. However, the femoral route is not always available. Until now, data regarding implantation using a jugular approach other than a single-case report were lacking. METHODS: The case records of all patients who underwent internal jugular venous (IJV) leadless pacemaker implantation (Micra, Medtronic, Dublin, Ireland) at our center were analyzed retrospectively. RESULTS: Nineteen patients underwent IJV leadless pacemaker implantation, nine females, mean age of 77.5 ±9.6  years; permanent atrial fibrillation in all patients with normal left ventricular ejection fraction. Implant indication was atrioventricular conduction disturbance in 10, pre-AV node ablation in seven, and replacement of a conventional VVI pacemaker in two (infection in one and lead malfunction in the other). The device was positioned at the superior septum in seven patients, apicoseptal in seven patients, and midseptal in five patients. In 12 patients, a sufficient device position was obtained at the first attempt, in three at the second, in one at the third, in one at the fourth, and in two at the sixth attempt. The mean pacing threshold was 0.56 ± 0.39V at 0.24-ms pulse width, sensed amplitude was 9.1 ± 3.2 mV, mean fluoroscopy duration was 3.1 ± 1.6 min. There were no vascular or other complications. At follow-up, electrical parameters remained stable in 18 of 19 patients. CONCLUSION: Although experience is minimal, we suggest that the IJV approach is safe and may be considered in patients where the femoral approach is contraindicated.


Assuntos
Fibrilação Atrial/cirurgia , Bloqueio Atrioventricular/terapia , Ablação por Cateter/métodos , Veias Jugulares , Marca-Passo Artificial , Idoso , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/fisiopatologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Reoperação , Estudos Retrospectivos
20.
Echocardiography ; 36(3): 609-612, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30677173

RESUMO

Myocarditis is a common cause for acute heart failure in the pediatric population. Various imaging modalities have evolved over the past 3 decades in order to noninvasively image the myocardium in this patient population. These include standard 2-dimensional echocardiographic imaging, tissue Doppler imaging, and magnetic resonance imaging of the heart. More recently, myocardial speckle tracking also known as strain imaging has been utilized to assess regional wall motion abnormalities with increasing accuracy. We report a case of acute myocarditis in a teenage female in whom progression of myocardial strain findings correlated with the rapidly evolving clinical course of the patient.


Assuntos
Coração/diagnóstico por imagem , Coração/fisiopatologia , Miocardite/complicações , Miocardite/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Doença Aguda , Adolescente , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Cardiotônicos/uso terapêutico , Progressão da Doença , Ecocardiografia , Epinefrina/uso terapêutico , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Imagem por Ressonância Magnética , Milrinona/uso terapêutico , Miocardite/terapia , Marca-Passo Artificial , Disfunção Ventricular Esquerda/terapia
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