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2.
Am J Cardiol ; 125(1): 107-113, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31732136

RESUMO

The objective of this study was to determine the long-term (>1 year) electrocardiographic (ECG) and clinical outcomes of patients without significant changes in their electrocardiogram after transcatheter aortic valve implantation (TAVI; including patients with pre-existing ECG abnormalities). Among 772 consecutive patients who underwent TAVI in our institution, 397 patients (51%) without new ECG changes were included. TAVI patients were divided into 2 groups according to the presence of pre-existing ECG-conduction disturbances (ECG-CD: 140 patients, non-ECG-CD: 257 patients). Clinical follow-up (median: 35 [22 to 57] months) was complete in all patients but 5 (1.2%), and ECG data were available in 291 patients (84.3% of patients at risk) at a median of 29 (20 to 50) months. In the non-ECG-CD group, most patients (79.8%) remained without significant ECG changes at follow-up, and 16.9% developed first-degree atrioventricular block and/or bundle branch block over time. The rate of permanent pacemaker (PPM) implantation at follow-up was 3.5% (1.1%/year) in the non-ECG-CD group versus 15.7% (5.5%/year) in the ECG-CD group (p <0.001). The presence of pre-existing CD was an independent predictor of PPM at follow-up (hazard ratio [HR] 4.67, 95% confidence interval [CI] 2.15 to 10.16, p <0.001). The ECG-CD group exhibited a higher risk of heart failure hospitalization (non-ECG-CD: 25%, ECG-CD: 29%, log-rank p = 0.01), but not mortality (non-ECG-CD: 50%, ECG-CD: 46%, log-rank p = 0.60) at 5-year follow-up. In conclusion, the ECG remained unchanged in most TAVI recipients without new postprocedural CD. Pre-existing ECG-CD was associated with an increased risk of PPM and heart failure hospitalization at long-term follow-up. These results provide reassuring data in the era of TAVI expanding toward candidates with a longer life expectancy, and highlight the importance of a closer follow-up of those patients with pre-existing ECG-CDs.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/complicações , Bloqueio de Ramo/complicações , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Ann Cardiol Angeiol (Paris) ; 68(6): 443-449, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31668339

RESUMO

Transcatheter aortic valve implantation (TAVI) is currently becoming the treatment of choice for patients with calcific aortic stenosis. Despite several technical improvements, the incidence of conduction disturbances has not diminished and remains TAVI's major complication. These disturbances include the occurrence of left bundle branch block and/or high-grade atrioventricular block often requiring pacemaker implantation. The proximity of the aortic valve to the conduction system (conduction pathways) accounts for the occurrence of these complications. Several factors have been identified as carrying a high risk of conduction disturbances like the presence of pre-existing right bundle branch block, the type of valve implanted, the volume of aortic and mitral calcifications, the size of the annulus and the depth of valve implantation. Left bundle branch block is the most frequent post TAVI conduction disturbance. Whereas the therapeutic strategy for persistent complete atrioventricular block is simple, it becomes complex in the presence of fluctuating changes in PR interval and left bundle branch block duration. The QRS width threshold value (150-160 ms) indicative of the need for pacemaker implantation is still being debated. Although there are currently no recommendations regarding the management of these conduction disturbances, the extension of TAVI indications to patient at low surgical risk calls for a standardization of our practice. However, a decision algorithm was recently proposed by a group of experts composed of interventional cardiologists, electrophysiologists and cardiac surgeons. There are still uncertainties about the appropriate timing of pacemaker implantation and the management of new onset left bundle branch block.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Calcinose/cirurgia , Bloqueio Cardíaco/etiologia , Complicações Pós-Operatórias/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Algoritmos , Valva Aórtica/anatomia & histologia , Valva Aórtica/cirurgia , Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/cirurgia , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Sistema de Condução Cardíaco/anatomia & histologia , Sistema de Condução Cardíaco/fisiopatologia , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/patologia , Marca-Passo Artificial
4.
Indian Heart J ; 71(3): 229-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543195

RESUMO

BACKGROUND/AIM: Despite the well-established benefits of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with left ventricular ejection fraction (LVEF) ≤35%, many patients with less reduced EF remain refractory to optimized medical treatment and at high risk of morbidity and mortality. The objective of the study is to evaluate the effects of CRT in optimally treated patients with New York Heart Association (NYHA) classes II-IV, LVEF of 36-45%, and left bundle branch (LBBB), including clinical, structural and biochemical response. METHODS: A selected group of HF patients have been implanted with CRT-P devices and were followed up for 6 months at 4, 12 and 24 weeks. Clinical assessment included NYHA class, quality of life and 6-min walk distance (6 MWD) test. Echocardiographic assessment included LV dimensions and function and left atrial volume. Serum N-terminal pro b-type natriuretic peptide (NT-ProBNP) was measured at the same intervals. RESULTS: This prospective single center study included 23 patients. NYHA functional class significantly improved after CRT-P (p < 0.0001), associated with improvement in QOL (p < 0.0001) and 6 MWD, which increased, from 145.7 ± 20.1 m to 219.5 ± 42.2 m (p < 0.0001). Mean QRS duration showed significant shortening from 164.4 ± 13.2 ms to 126.4 ± 13.6 ms (p < 0.0001). CRT induced reverse remodeling with reduction in both left ventricular end diastolic diameter (LVEDD) from 68.95 ± 5.05 mm to 62.8 ± 4.47 mm, p = 0.0002 and left ventricular end systolic diameter (LVESD) from 54.1 ± 4.5 mm to 46.5 ± 4.1 mm, p < 0.0001, and significant increase in LVEF (from 40.3 ± 2.8 to 48.3 ± 4.2 mm, p < 0.0001). The biochemical response to CRT showed significant reduction in serum NT-ProBNP from 1025.6 ± 363.1 pg/ml to 594.9 ± 263.5 pg/ml (p < 0.0001). CONCLUSIONS: Symptomatic HF patients on maximal optimized medical treatment who have LBBB and baseline LVEF 35-45% appeared to derive significant clinical and structural benefit from CRT.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Idoso , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Dispositivos de Terapia de Ressincronização Cardíaca , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia
6.
Int Heart J ; 60(5): 1196-1200, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484862

RESUMO

Malignant arrhythmia is a fast cardiac arrhythmia that can lead to a hemodynamic abnormality within a short time, most of which is ventricular tachycardia or ventricular fibrillation (VF), which should be managed in time. Both organic and nonorganic cardiac diseases have the potential to cause malignant arrhythmia. We report a noteworthy case of malignant arrhythmia in a teenager during exercise. Transthoracic echocardiography, cardiac magnetic resonance (CMR), electrophysiological study, magnetic resonance imaging of the brain, electroencephalography, chest X-ray, and blood tests were all normal. Twelve-lead electrocardiography showed incomplete right bundle branch block (IRBBB). Two heterozygous missense variants of the desmocollin-2 gene (DSC2, c.G2446A/p.V816M) and desmoplakin gene (DSP, c.G3620A/p.R1207K) were detected in the peripheral blood of this teenager and his father by genetic testing, which encoded a desmosomal protein that was related to arrhythmogenic right ventricular cardiomyopathy (ARVC). In these two rare variants, DSC2 V816M has been reported but uncertain significance, whereas DSP R1207K is never reported. Therefore, the two site variants in DSC2 and DSP genes are likely to become a new research focus for diagnosis and treatment of ARVC in the future. Meanwhile, this report emphasizes that, in addition to a standard set of laboratory tests and examinations, genetic testing may be useful for analyzing the causes of malignant arrhythmia.


Assuntos
Arritmias Cardíacas/etiologia , Bloqueio de Ramo/genética , Desmocolinas/genética , Eletrocardiografia/métodos , Predisposição Genética para Doença , Adolescente , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/genética , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Ecocardiografia/métodos , Testes Genéticos/métodos , Humanos , Masculino , Linhagem , Prognóstico , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença
7.
Medicine (Baltimore) ; 98(32): e16642, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393361

RESUMO

RATIONALE: Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP). PATIENT CONCERNS: A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability. DIAGNOSIS: The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected. INTERVENTIONS: The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring. OUTCOMES: One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal. LESSONS: AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.


Assuntos
Bloqueio de Ramo/cirurgia , Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Ecocardiografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Taquicardia por Reentrada no Nó Atrioventricular/complicações
8.
Am J Emerg Med ; 37(10): 1992.e1-1992.e3, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31387810

RESUMO

Emergency department presentations of syncope can vary from benign to life-threatening etiologies. Older patients are at increased risk of cardiac causes of syncope. Ventricular standstill is a rare phenomenon that can manifest as syncope and must be correctly identified and promptly treated to prevent sudden cardiac arrest. We report the case of a 70-year old man with dizziness and convulsive syncope whose initial ECG showed a right bundle branch block, but then developed ventricular standstill and intermittent high-grade AV block while still in the ED. He was transferred to the ICU and underwent pacemaker implantation. A high index of suspicion for dysrhythmias should be maintained for any patient presenting to the ED with high-risk syncope.


Assuntos
Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo/diagnóstico , Serviços Médicos de Emergência , Síncope/etiologia , Idoso , Arritmias Cardíacas/complicações , Arritmias Cardíacas/fisiopatologia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Humanos , Masculino , Marca-Passo Artificial , Síncope/diagnóstico por imagem , Síncope/fisiopatologia , Resultado do Tratamento
9.
Expert Rev Med Devices ; 16(7): 589-602, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31172837

RESUMO

INTRODUCTION: Transcatheter aortic replacement (TAVR) has revolutionized the treatment of aortic stenosis during the last years. Despite improvements in transcatheter heart valve systems, the rate of conduction disturbances after TAVR, particularly new-onset left bundle branch block (new-onset LBBB), has not decreased over time. AREAS COVERED: Overview of the current data regarding new-onset LBBB post-TAVR focusing on clinical outcomes. EXPERT OPINION: New-onset LBBB remains the most common complication after TAVR, occurring in 6-77% of cases with the use of newer generation transcatheter valve systems. The most consistent factor determining new-onset LBBB post-TAVR has been prosthesis implantation depth. The potential evolution to high degree atrioventricular block (HAVB) and the chronic effect on left ventricular ejection fraction (LVEF) may impact the clinical outcomes in this subset of patients. New-onset LBBB has been associated with an increased risk of PPM after TAVR. Conversely, inconsistent results have been reported regarding the impact of LBBB on hospitalization for heart failure and mortality. Current data do not support an indication for 'prophylactic' PPM in all new-onset LBBB patients. However, a specific subset of patients (those with either a very long PR or wide QRS) may benefit from a PPM to prevent HAVB or sudden death.


Assuntos
Bloqueio de Ramo/complicações , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Sistema de Condução Cardíaco/patologia , Insuficiência Cardíaca/complicações , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
10.
Yonsei Med J ; 60(5): 423-428, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31016903

RESUMO

PURPOSE: We aimed to examine associations between right bundle branch block (RBBB) following heart transplantation (HT) and graft rejection. MATERIALS AND METHODS: We investigated 51 patients who underwent endomyocardial biopsies, electrocardiogram, right-side cardiac catheterization, and echocardiography at 1 month and 1 year after HT. We classified patients into four groups according to the development of RBBB, based on electrocardiogram at 1 month and 1 year: 1) sustained RBBB, 2) disappeared RBBB, 3) newly developed RBBB, and 4) sustained non-RBBB. The RBBB was defined as an RSR' pattern in V1 with a QRS duration ≥100 ms on electrocardiogram. RESULTS: The newly developed RBBB group (n=13, 25.5%) had a higher rate of new onset graft rejection (from grade 0 to grade ≥1R, 30.8% vs. 10.0% vs. 21.4%, p=0.042) at 1 year, compared with sustained RBBB (n=10, 19.6%) and sustained non-RBBB group (n=28, 54.9%). In contrast, the incidence of resolved graft rejection (from grade ≥1R to grade 0) was higher in the sustained RBBB group than the newly developed RBBB and sustained non-RBBB groups (70.0% vs. 7.7% vs. 25.0%, p=0.042). Left atrial volume index was significantly higher in the newly developed RBBB group than the sustained RBBB and sustained non-RBBB groups (60.6±25.9 mL/m² vs. 36.0±11.0 mL/m² vs. 38.4±18.1 mL/m², p=0.003). CONCLUSION: Close monitoring for new development of RBBB at 1 year after HT, which was associated with a higher incidence of new onset graft rejection, may be helpful to identify high risk patients for graft rejection.


Assuntos
Bloqueio de Ramo/complicações , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/imunologia , Transplante de Coração/efeitos adversos , Adulto , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Ecocardiografia , Eletrocardiografia , Feminino , Rejeição de Enxerto/diagnóstico por imagem , Rejeição de Enxerto/fisiopatologia , Hemodinâmica , Humanos , Masculino
13.
J Hypertens ; 37(3): 629-635, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30676480

RESUMO

BACKGROUND: Previous work has demonstrated that treatment of hypertensive patients with the angiotensin-converting enzyme inhibitor lisinopril was associated with a reduced incidence of a composite conduction system disease endpoint and also left bundle branch block (LBBB) compared with chlorthalidone therapy. The relationship of incident conduction system disease to angiotensin receptor blocker therapy has not been examined. METHODS: Risk of new right (RBBB) or LBBB in relation to losartan-based vs. atenolol-based treatment was assessed in 8342 hypertensive patients without baseline RBBB or LBBB. Risk of incident intraventricular conduction delay (IVCD), defined as new QRS duration at least 110 ms was assessed in the 7110 patient subset who also had baseline QRS duration less than 110 ms. QRS duration and BBB were determined on in-study ECGs done at 6 months, 1 year and then yearly. RESULTS: During 4.8 ±â€Š1.0 years follow-up, 459 patients developed new LBBB (5.5%), 184 (2.2) new RBBB and 1173 (16.5%) a new IVCD. In univariate Cox analyses, losartan-based treatment was not associated with a significantly reduced risk of either new LBBB (hazard ratio 0.95, 95% CI 0.79-1.14, P = 0.583) or RBBB (hazard ratio 1.02, 95% CI 0.76-1.36, P = 0.903), but resulted in a 15% lower risk of new IVCD (hazard ratio 0.85, 95% CI 0.76-0.95, P = 0.005). In a multivariable Cox model that adjusted for other statistically significant predictors of incident IVCD in this population (age, sex, race, history of ischemic heart disease, MI, heart failure, diabetes or atrial fibrillation, prior antihypertensive treatment, baseline total and HDL cholesterol, serum glucose and creatinine and baseline QRS duration as standard covariates and incident MI and on-treatment systolic and diastolic pressure, BMI and Cornell voltage as time-dependent covariates), losartan treatment remained associated with a 13% lower risk of new IVCD (hazard ratio 0.87, 95% CI 0.77-0.98, P = 0.021). CONCLUSION: Incident IVCD, but not BBB, is significantly reduced by losartan-based treatment. Further study is warranted to assess the potential differential impact of this therapy on QRS prolongation vs. development of more discrete conduction system block. CLINICAL TRIALS REGISTRATION: .


Assuntos
Anti-Hipertensivos/uso terapêutico , Bloqueio de Ramo , Clortalidona/uso terapêutico , Hipertensão , Lisinopril/uso terapêutico , Bloqueio de Ramo/complicações , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/prevenção & controle , Eletrocardiografia , Sistema de Condução Cardíaco/fisiologia , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia
14.
Blood Press ; 28(2): 84-92, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30698038

RESUMO

AIMS: We aimed to investigate whether left bundle branch block (LBBB) is related to new-onset left ventricle (LV) wall motion abnormalities during treatment in hypertensive patients with electrocardiographic (ECG) defined left ventricular hypertrophy (LVH). METHODS AND RESULTS: 960 patients with essential hypertension and ECG-LVH participating in the LIFE Echo Sub-study were investigated at baseline and annually with echocardiography, during randomized antihypertensive therapy. After excluding patients with LV wall motion abnormalities at baseline and patients developing new-onset LBBB during study time, we investigated 784 patients. The participants with (n = 32) and without (n = 752) LBBB were similar regarding most baseline variables. Logistic regression models controlling for LV mass index, Framingham risk score, and randomized treatment assignment were used to assess the odds ratio of developing new-onset abnormal LV wall motion on annual follow-up echocardiograms. The likelihood of developing new global LV wall motion abnormalities in patients with LBBB was not higher compared to those without LBBB except at year 5 (p = .002). The likelihood of developing new segmental LV wall motion abnormalities in patients with LBBB was however higher compared to patients without LBBB after 1 year (OR = 3.1, 95% CI = 0.7-14.2, p = .173); 2 years (OR = 6.9, 2.1-22.4, p = .003); 3 years (OR = 5.3, 2.0-14.3, p < .001), 4 years (OR = 4.0, 1.6-10.3, p = .003 and 5 years (OR = 4.1, 1.0-16.2, p = .394) of treatment. CONCLUSION: Among patients with ECG-LVH, undergoing antihypertensive treatment, the presence of LBBB independently identifies individuals with ∼3- to 7-fold greater odds of developing new segmental abnormal LV wall motion. These findings suggest that LBBB may be a marker for progressive myocardial disease.


Assuntos
Bloqueio de Ramo/complicações , Ventrículos do Coração/fisiopatologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/diagnóstico , Idoso , Anti-Hipertensivos/uso terapêutico , Cardiomiopatias , Progressão da Doença , Ecocardiografia , Eletrocardiografia , Feminino , Ventrículos do Coração/patologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prognóstico
15.
J Electrocardiol ; 52: 39-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30476637

RESUMO

BACKGROUND: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.


Assuntos
Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Idoso , Algoritmos , Bloqueio de Ramo/epidemiologia , Dinamarca/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Sensibilidade e Especificidade
16.
Trends Cardiovasc Med ; 29(6): 335-342, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30401603

RESUMO

The impact of left bundle branch block (LBBB) on cardiac mechanical function ranges from minimal effect in some patients to marked reduction in left ventricular (LV) systolic function in others. It appears that this variability in part reflects differences in anatomical location of the bundle block. In most patients with LBBB and congestive heart failure, however, there is associated cardiac disease such as cardiomyopathies or coronary artery disease which contributes to LV dysfunction. The mechanism of harmful effect of LBBB on cardiac function is in-coordinated ventricular contractions which result in LV contractile inefficiency. Septal contribution to LV systolic function is lost or attenuated and an excessive workload is placed on the LV free wall which responds with remodeling and in some cases it decompensates. The magnitude of the contractile inefficiency depends on the extent of electrical conduction delay and degree of associated heart disease. Another mechanism, which in many patients contributes to cardiac dysfunction in LBBB, is mitral regurgitation due to in-coordinated contractions of the papillary muscles and altered mitral valve function due to LV remodeling. Potentially, reduced LV filling time due to prolonged LV systole may contribute to cardiac dysfunction, but there is limited knowledge about the clinical importance of this mechanism. In LBBB there is typically reduced septal perfusion, probably not as a sign of ischemia, but reflecting physiologic autoregulation of coronary flow in response to reduced septal work that reduces metabolic demand. Future studies should explore how current insights into mechanisms of cardiac mechanical effects of LBBB can be incorporated into decision algorithms for selection of patients for cardiac resynchronization therapy, as well as how to manage patients with LBBB and preserved LV function.


Assuntos
Bloqueio de Ramo/complicações , Insuficiência Cardíaca/etiologia , Insuficiência da Valva Mitral/etiologia , Disfunção Ventricular Esquerda/etiologia , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Animais , Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Tomada de Decisão Clínica , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/terapia , Seleção de Pacientes , Prognóstico , Medição de Risco , Fatores de Risco , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia , Função Ventricular Esquerda , Remodelação Ventricular
17.
Ann Noninvasive Electrocardiol ; 24(2): e12594, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30117721

RESUMO

Myocardial bridges are a congenital anomaly in which a segment of the coronary artery takes a "tunneled" intramuscular course. Few reports have associated myocardial bridges with left-ventricular dysfunction in patients with ischemia. Intermittent left bundle branch block is a conduction disturbance that has been described to be associated with myocardial bridges and cardiac memory. This study reports unusual associations of multiple myocardial bridges, angina, left-ventricular dysfunction, intermittent left bundle branch block, and cardiac memory.


Assuntos
Angina Estável/diagnóstico , Angina Estável/tratamento farmacológico , Bloqueio de Ramo/diagnóstico por imagem , Eletrocardiografia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Antagonistas Adrenérgicos beta/uso terapêutico , Angina Estável/etiologia , Aspirina/administração & dosagem , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Cardiotônicos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Ecocardiografia , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Ponte Miocárdica/complicações , Ponte Miocárdica/diagnóstico por imagem , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia
18.
J Vasc Access ; 20(2): 217-221, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29984628

RESUMO

Internal jugular venous catheters are widely used for hemodialysis as permanent vascular access in patients with severe peripheral vascular disease or transiently for acute hemodialysis. The Seldinger technique is the most widely used technique in catheter insertion. The guidewire-related complications are rare but sometimes it has significant morbidity and mortality. In this case report, we have a patient who developed asystole during catheter insertion which required transvenous pacemaker insertion.


Assuntos
Bloqueio de Ramo/complicações , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Parada Cardíaca/etiologia , Veias Jugulares , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Estimulação Cardíaca Artificial , Reanimação Cardiopulmonar , Cateterismo Venoso Central/instrumentação , Eletrocardiografia , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Marca-Passo Artificial , Resultado do Tratamento
19.
JACC Cardiovasc Imaging ; 12(6): 967-977, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29361486

RESUMO

OBJECTIVES: This study sought to investigate the hypothesis that patients with left bundle branch block (LBBB) are hypersensitive to elevated afterload. BACKGROUND: Epidemiological data suggest that LBBB can provoke heart failure in patients with hypertension. METHODS: In 11 asymptomatic patients with isolated LBBB and 11 age-matched control subjects, left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were measured by echocardiography. Systolic arterial pressure was increased by combining pneumatic extremity constrictors and handgrip exercise. To obtain more insight into mechanisms of afterload response, 8 anesthetized dogs with left ventricular (LV) micromanometer and dimension crystals were studied during acutely induced LBBB and aortic constriction. Regional myocardial work was assessed by LV pressure-dimension analysis. RESULTS: Consistent with normal afterload dependency, elevation of systolic arterial pressure by 38 ± 12 mm Hg moderately reduced LVEF from 60 ± 4% to 54 ± 6% (p < 0.01) in control subjects. In LBBB patients, however, a similar blood pressure increase caused substantially larger reduction in LVEF (p < 0.01), from 56 ± 6% to 42 ± 7% (p < 0.01). There were similar findings for GLS. In the dog model, aortic constriction abolished septal shortening (p < 0.02), and septal work decreased to negative values (p < 0.01). Therefore, during elevated systolic pressure, the septum made no contribution to global LV work, as indicated by net negative work, and instead absorbed energy from work done by the LV lateral wall. CONCLUSIONS: Moderate elevation of arterial pressure caused marked reductions in LVEF and GLS in patients with LBBB. This reflects a cardiodepressive effect of elevated afterload in the dyssynchronous ventricle and was attributed to loss of septal function.


Assuntos
Pressão Arterial , Bloqueio de Ramo/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Hipertensão/fisiopatologia , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Idoso , Animais , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico por imagem , Estudos de Casos e Controles , Modelos Animais de Doenças , Cães , Ecocardiografia Doppler , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia
20.
Heart ; 105(2): 137-143, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30093543

RESUMO

OBJECTIVES: His bundle pacing (HBP) can potentially correct left bundle branch block (LBBB). We aimed to assess the efficacy of HBP to correct LBBB and long-term clinical outcomes with HBP in patients with heart failure (HF). METHODS: This is an observational study of patients with HF with typical LBBB who were indicated for pacing therapy and were consecutively enrolled from one centre. Permanent HBP leads were implanted if the LBBB correction threshold was <3.5V/0.5 ms or 3.0 V/1.0 ms. Pacing parameters, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and New York Heart Association (NYHA) Class were assessed during follow-up. RESULTS: In 74 enrolled patients (69.6±9.2 years and 43 men), LBBB correction was acutely achieved in 72 (97.3%) patients, and 56 (75.7%) patients received permanent HBP (pHBP) while 18 patients did not receive permanent HBP (non-permanent HBP), due to no LBBB correction (n=2), high LBBB correction thresholds (n=10) and fixation failure (n=6). The median follow-up period of pHBP was 37.1 (range 15.0-48.7) months. Thirty patients with pHBP had completed 3-year follow-up, with LVEF increased from baseline 32.4±8.9% to 55.9±10.7% (p<0.001), LVESV decreased from a baseline of 137.9±64.1 mL to 52.4±32.6 mL (p<0.001) and NYHA Class improvement from baseline 2.73±0.58 to 1.03±0.18 (p<0.001). LBBB correction threshold remained stable with acute threshold of 2.13±1.19 V/0.5 ms to 2.29±0.92 V/0.5 ms at 3-year follow-up (p>0.05). CONCLUSIONS: pHBP improved LVEF, LVESV and NYHA Class in patients with HF with typical LBBB.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia , Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Idoso , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Cateterismo Cardíaco , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
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