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1.
Medicine (Baltimore) ; 97(46): e13226, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431601

RESUMO

RATIONALE: Complete heart block (CHB) is a common clinical manifestation. Systemic sclerosis (SSc) is a rare etiology of CHB that has not received enough attention. Whether pacemaker implantation is required remains inconclusive, especially when patients have no symptoms or mild symptoms of CHB. PATIENT CONCERNS: In this study, we report the case of a 48-year-old Chinese male who suffers from SSc and CHB. DIAGNOSE: The patient was previously diagnosed with left anterior hemiblock (LAHB) and right bundle block with normal heart function. CHB was observed on a regular follow-up electrocardiogram (ECG) examination 1 month before his hospitalization. INTERVENTIONS: A permanent dual chamber pacemaker was implanted. OUTCOMES: The patient responded well to pacemaker implantation treatment, and his exertional dyspnea disappeared. LESSONS: The occurrence of heart block associated with SSc often appears concealed. The case highlights the importance of regular follow-up of a patient with SSc. Pacemaker implantation might be unavoidable if CHB is secondary to SSc, even if it is asymptomatic.


Assuntos
Bloqueio Cardíaco/etiologia , Escleroderma Sistêmico/complicações , Bloqueio Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Resultado do Tratamento
2.
JACC Clin Electrophysiol ; 4(10): 1289-1297, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30336874

RESUMO

OBJECTIVES: This study sought to determine the long-term effect of dual-site ventricular pacing (i.e., cardiac resynchronization therapy [CRT]) versus single-site pacing in patients with Fontan physiology and high-grade atrioventricular block (AVB). BACKGROUND: Chronic single-site ventricular pacing in Fontan patients is associated with significant morbidity and mortality. METHODS: The study conducted a retrospective review of all Fontan patients with high-grade AVB who received pacemakers at a single institution between 1990 and 2016 with follow-up of 12 months or greater. The primary study outcome was a composite of death or heart transplantation. RESULTS: Nineteen patients received CRT devices and 43 patients received single-site ventricular pacemakers (SVPMs), with a median follow-up of 4.9 years (range 1.1 to 11.3 years) and 10.4 years (range 1.1 to 26.8 years), respectively. One (5.3%) CRT patient and 11 (25.6%) SVPM patients reached the composite endpoint of death or transplant (odds ratio: 0.16; 95% confidence interval: 0.02 to 1.36; p = 0.09). Kaplan-Meier analysis showed similar rates of freedom from death or transplant between the 2 study groups over a 5-year follow-up period (p = 0.08). The proportion of SVPM patients with abnormal ventricular systolic function before device implantation (9.5%) and at follow-up (33.3%) significantly increased (p=0.009). The CRT cohort had less change in their ventricular function (42.1% before device implant, 36.8% at follow-up; p = 1.00); however, a Kaplan-Meier analysis over a 5-year follow-up period found no difference in the presence of abnormal ventricular systolic function between groups (p = 0.27). CONCLUSIONS: There was no significant difference in long-term outcomes between Fontan patients who were single- or dual-site paced for high-grade AVB.


Assuntos
Terapia de Ressincronização Cardíaca , Técnica de Fontan , Adolescente , Adulto , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/métodos , Terapia de Ressincronização Cardíaca/mortalidade , Criança , Pré-Escolar , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/métodos , Técnica de Fontan/mortalidade , Bloqueio Cardíaco/fisiopatologia , Bloqueio Cardíaco/cirurgia , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Adulto Jovem
5.
Interact Cardiovasc Thorac Surg ; 27(2): 182-185, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29522104

RESUMO

OBJECTIVES: In patients undergoing cardiac surgical procedures, pulmonary vein isolation may be easily accomplished, and it is important to achieve bidirectional conduction block across created lesions. The primary aim of this study was to assess the risk of pulmonary vein stenosis (PVS) after multiple applications of epicardial bipolar radiofrequency energy. METHODS: Thirty-five consecutive patients who were referred for off-pump coronary revascularization with concomitant pulmonary vein isolation and left atrial appendage occlusion were prospectively included in the study. The ablation protocol provided 8 standard epicardial applications of bipolar energy with additional applications until the acute bidirectional conduction block was achieved. Three to 6 months after surgery, patients underwent computed tomography to assess PVS. RESULTS: In all patients, bidirectional conduction block was achieved across the created lesions. In 31 (89%) patients, conduction block was accomplished after the standard 8 energy applications on each side. In 4 (11%) patients, additional applications of energy were needed. All patients had computed tomography (128 total pulmonary veins) scans, which showed no evidence of PVS. CONCLUSIONS: Multiple applications of bipolar radiofrequency energy during off-pump epicardial pulmonary vein isolation did not lead to PVS. Creating bidirectional conduction block using multiple energy applications through created lesions is feasible in all patients using the ablation protocol described.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Estenose de Veia Pulmonar/etiologia , Idoso , Fibrilação Atrial/complicações , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Doença da Artéria Coronariana/complicações , Feminino , Átrios do Coração/cirurgia , Bloqueio Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/cirurgia , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Fatores de Risco , Estenose de Veia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Int J Cardiol ; 249: 220-225, 2017 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-28888481

RESUMO

BACKGROUND: Length of lines of conduction block (CB) during sinus rhythm (SR) at Bachmann's bundle (BB) is associated with atrial fibrillation (AF). However, it is unknown whether extensiveness of CB at BB represents CB elsewhere in the atria. We aim to investigate during SR 1) the spatial distribution and extensiveness of CB 2) whether there is a predilection site for CB and 3) the association between CB and incidence of post-operative AF. METHODS: During SR, epicardial mapping of the right atrium (RA), BB and left atrium was performed in 209 patients with coronary artery disease. The amount of conduction delay (CD, Δlocal activation time ≥7ms) and CB (Δ≥12ms) was quantified as % of the mapping area. Atrial regions were compared to identify potential predilection sites for CD/CB. Correlations between CD/CB and clinical characteristics were tested. RESULTS: Areas with CD or CB were present in all patients, overall prevalence was respectively 1.4(0.2-4.0) % and 1.3(0.1-4.3) %. Extensiveness and spatial distribution of CD/CB varied considerably, however occurred mainly at the superior intercaval RA. Of all clinicalcharacteristics, CD/CB only correlated weakly with age and diabetes (P<0.05). A 1% increase in CD or CB caused a 1.1-1.5ms prolongation of the activation time (P<0.001). There was no correlation between CD/CB and post-operative AF. CONCLUSION: CD/CB during SR in CABG patients with electrically non-remodeled atria show considerable intra-atrial, but also inter-individual variation. Despite these differences, a predilection site is present at the superior intercaval RA. Extensiveness of CB at the superior intercaval RA or BB does not reflect CB elsewhere in the atria and is not associated with post-operative AF.


Assuntos
Doença do Sistema de Condução Cardíaco/diagnóstico , Doença do Sistema de Condução Cardíaco/fisiopatologia , Mapeamento Epicárdico/métodos , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Idoso , Doença do Sistema de Condução Cardíaco/cirurgia , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/fisiopatologia , Bloqueio Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Arq Bras Cardiol ; 109(4): 331-339, 2017 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28876373

RESUMO

BACKGROUND: Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). OBJECTIVE: This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. METHODS: Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. RESULTS: All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. CONCLUSION: Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.


Assuntos
Estimulação Cardíaca Artificial/métodos , Bloqueio Cardíaco/congênito , Marca-Passo Artificial , Eletrodos Implantados , Desenho de Equipamento , Feminino , Seguimentos , Bloqueio Cardíaco/cirurgia , Humanos , Recém-Nascido , Complicações Intraoperatórias , Masculino , Ilustração Médica , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Complicações Pós-Operatórias , Radiografia Torácica , Reprodutibilidade dos Testes , Resultado do Tratamento
9.
Pediatr Cardiol ; 38(6): 1305-1308, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28512719

RESUMO

Congenital complete atrioventricular block (CCAVB) is a rare condition with an incidence of 1 of 20,000 live births. Hypoplastic left heart syndrome (HLHS) occurs more frequently than CCAVB and occurs in 1 of 5000 live births. HLHS in association with CCAVB is exceedingly rare. In this report, we describe a rare case of HLHS and CCAVB diagnosed in utero. Postnatal diagnosis, management and outcome are presented as well as review of the medical literature.


Assuntos
Bloqueio Cardíaco/congênito , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Adulto , Procedimentos Cirúrgicos Cardiovasculares , Feminino , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/cirurgia , Transplante de Coração , Humanos , Síndrome do Coração Esquerdo Hipoplásico/complicações , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Cuidados Paliativos , Ultrassonografia Pré-Natal
12.
Tex Heart Inst J ; 43(6): 546-549, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28100981

RESUMO

Isolated left subclavian artery is one of the rarer aortic arch anomalies. It has been associated with other congenital heart diseases, typically tetralogy of Fallot, double-outlet right ventricle, and atrial and ventricular septal defects. Its significant clinical implications include a left-to-right shunt from the vertebrobasilar system, which causes pulmonary overcirculation and subclavian steal. We present an unusual case of a premature infant who was diagnosed prenatally with congenital complete atrioventricular block and tricuspid atresia and was found to have an isolated left subclavian artery postnatally. The patient underwent implantation of a permanent single-chamber epicardial pacing system. To our knowledge, this combination of lesions has not been reported-and in our case, it influenced our surgical planning.


Assuntos
Anormalidades Múltiplas , Bloqueio Atrioventricular/congênito , Bloqueio Cardíaco/congênito , Artéria Subclávia/anormalidades , Atresia Tricúspide/complicações , Malformações Vasculares/complicações , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/cirurgia , Estimulação Cardíaca Artificial , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Desenho de Equipamento , Feminino , Técnica de Fontan , Idade Gestacional , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Marca-Passo Artificial , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Reimplante , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento , Atresia Tricúspide/diagnóstico por imagem , Atresia Tricúspide/cirurgia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/cirurgia
13.
BMJ Case Rep ; 20152015 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-26404545

RESUMO

A 71-year-old man was referred to a rapid access chest pain clinic by his general practitioner. He presented with a 6-month history of twice weekly central chest pain lasting 2-3 min with walking and exertion, relieved with rest or co-codamol tablets. After initial investigations and a positive myoview scan, he was listed for an elective coronary angiogram. Unfortunately, the procedure was abandoned due to unclear course of the guide wire and a possible aberrant aortic course. Further non-invasive tests were arranged to clarify the anatomy of the vessels. After getting a clear idea of the aberrancies, coronary angiogram was replanned, and the patient underwent successful angiography with angioplasty to one of the coronary arteries, without any complications.


Assuntos
Angioplastia/métodos , Dor no Peito/etiologia , Angiografia Coronária , Vasos Coronários/patologia , Bloqueio Cardíaco/diagnóstico , Acetaminofen , Idoso , Codeína , Combinação de Medicamentos , Bloqueio Cardíaco/fisiopatologia , Bloqueio Cardíaco/cirurgia , Humanos , Masculino , Resultado do Tratamento
14.
Autoimmun Rev ; 14(12): 1154-60, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26284740

RESUMO

BACKGROUND: Cardiac neonatal lupus syndrome is due to anti-SSA or SSB antibodies and mainly includes congenital heart block (CHB) and dilated cardiomyopathy (DCM). Its optimal management is still debated. We report a large series of autoimmune high degree CHB. METHODS: Inclusion criteria in this retrospective study were fetuses or neonates with high-degree CHB associated with maternal anti-SSA/SSB antibodies. RESULTS: 214 CHB were included: 202 detected in utero at a median term of 23 weeks' gestation (WG) [range 16 to 39 WG] and 12 neonatal cases diagnosed at a median age of 0 days [range birth to 8 days]. The 214 cases of CHB included 202 (94.4%) third-degree CHB, 8 (3.7%) second-degree CHB, and 4 (1.9%) intermittent CHB. In multivariate analysis, the factors associated with feto-neonatal deaths (15.7%) were hydrops (p<0.001; hazard ratio [HR] 12.4 [95% confidence interval (95%CI) 4.7-32.7]) and prematurity (p=0.002; HR 17.1 [95%CI 2.8-103.1]). During a median follow-up of 7 years [birth to 36 years], 148 of 187 children born alive (79.1%) had a pacemaker, 35 (18.8%, one missing data) had DCM, and 22 (11.8%) died. In multivariate analysis, factors associated with child death were in utero DCM (p=0.0157; HR 6.37 [95%CI: 1.25-32.44]), postnatal DCM (p<0.0001; HR 227.58[95%CI: 24.33-2128.46]) and pacemaker implantation (p=0.0035; HR 0.11[95%CI: 0.02-0.51]). The use of fluorinated steroids was neither associated with survival nor with regression of 2nd degree CHB. CONCLUSION: In this second largest series of CHB, we confirm some of the previous results. We were unable to find data supporting the routine use of in utero fluorinated steroids.


Assuntos
Bloqueio Cardíaco/congênito , Lúpus Eritematoso Sistêmico/congênito , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/imunologia , Bloqueio Cardíaco/cirurgia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Marca-Passo Artificial , Implantação de Prótese , Resultado do Tratamento
18.
Blood Coagul Fibrinolysis ; 26(8): 959-60, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26192113

RESUMO

An 85-year-old man with persistent atrial flutter (AFL) with slow ventricular rate of 44/min, causing fatigue and presyncope, was referred for urgent treatment. In spite of thromboembolic risk scale value 4, he had not been treated with anticoagulants because of high risk of bleeding. The decision was made to perform urgent catheter ablation to interrupt and cure AFL. Intracardiac echocardiography probe was placed in the pulmonary artery and visualized left atrial appendage free from thrombus with its proper function. Heparin was administered and AFL stopped during energy application. Intracardiac echocardiography showed immediate thrombus formation in left atrial appendage owing to complete atrial standstill and no retrograde conduction during hemodynamically effective escape nodal rhythm. This case report shows that in patients with sinus node disease effective ablation of AFL with escape rhythm without retrograde conduction to the atria may result in complete 'electrically induced' atrial standstill and immediate thrombus formation.


Assuntos
Flutter Atrial/diagnóstico por imagem , Síndrome de Brugada/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Flutter Atrial/complicações , Flutter Atrial/tratamento farmacológico , Flutter Atrial/cirurgia , Síndrome de Brugada/complicações , Síndrome de Brugada/tratamento farmacológico , Síndrome de Brugada/cirurgia , Doença do Sistema de Condução Cardíaco , Cardiomiopatias/sangue , Cardiomiopatias/complicações , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/cirurgia , Ablação por Cateter , Ecocardiografia Transesofagiana , Fadiga/fisiopatologia , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/tratamento farmacológico , Doenças Genéticas Inatas/cirurgia , Átrios do Coração/anormalidades , Átrios do Coração/cirurgia , Bloqueio Cardíaco/sangue , Bloqueio Cardíaco/complicações , Bloqueio Cardíaco/tratamento farmacológico , Bloqueio Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/metabolismo , Ventrículos do Coração/patologia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Síncope/fisiopatologia , Trombose/complicações , Trombose/tratamento farmacológico , Trombose/cirurgia , Varfarina/uso terapêutico
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