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1.
Medicine (Baltimore) ; 100(11): e25190, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726011

RESUMO

RATIONALE: The prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position. PATIENT CONCERN: Electrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position. DIAGNOSIS: Twelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II. INTERVENTION: Nitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted. OUTCOME: Surgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea. LESSON: The prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.


Assuntos
Anestesia Geral/efeitos adversos , Bloqueio de Ramo/etiologia , Complicações Intraoperatórias/etiologia , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Anestesia Geral/métodos , Humanos , Masculino , Pessoa de Meia-Idade
2.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370998

RESUMO

Coronary artery fistulas are abnormal vascular conduits, rarely related to atrioventricular conduction abnormalities. We report the case of a 52-year-old woman who presented with dyspnoea on exertion. Her ECG revealed advanced atrioventricular block and left bundle branch block. CT scans confirmed two fistulas, from the conus branch of right coronary artery and from the left anterior descending coronary artery, into the pulmonary artery. The patient underwent pacemaker implantation. To date, only nine patients with different degrees of heart blocks associated with coronary artery fistulas have been reported. Herein, we review and summarise previously reported cases of different degrees of heart blocks associated with coronary artery fistulas.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Bloqueio de Ramo/diagnóstico , Anomalias dos Vasos Coronários/complicações , Fístula/complicações , Marca-Passo Artificial , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/terapia , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Teste de Esforço/métodos , Feminino , Fístula/diagnóstico , Humanos , Pessoa de Meia-Idade , Tecnécio Tc 99m Sestamibi/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
3.
Am J Cardiol ; 128: 140-146, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650908

RESUMO

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized infiltrative cardiomyopathy in which conduction system disease is common. The aim of our study was to define the incidence and prevalence of high-grade atrioventricular (AV) block requiring pacemaker implantation in our quaternary referral center. This was a single-center retrospective cohort study of 369 consecutive patients with ATTR-CA who underwent 12-lead electrocardiogram at the time of ATTR-CA diagnosis. During a mean follow-up of 28 months, serial ECGs and the electronic medical record were examined for the development of high-grade AV block and pacemaker implantation. Wild-type ATTR-CA (wtATTR-CA) was diagnosed in 261 patients and 108 had hereditary ATTR-CA (hATTR-CA). A total of 35 (9.5%) had high-grade AV block requiring pacemaker implantation at the time of diagnosis of ATTR-CA. The most common conduction abnormalities evident on the baseline ECG were a wide QRS complex, present in 51% with wtATTR-CA and 48% with hATTR-CA (p = 0.62), followed by first-degree AV block, which was present in 49% with wtATTR-CA and 43% with hATTR-CA (p = 0.31). During follow-up, high-grade AV block developed in 10% of those with hATTR-CA and 12% of patients with wtATTR-CA (p = 0.64). On multivariable models, high-grade AV block was not significantly associated with increased mortality. More advanced ATTR-CA stage and a history of obstructive coronary artery disease were associated with increased mortality on multivariable models. In conclusion, the incidence and prevalence of high-grade AV block is high in patients with ATTR-CA. Patients with ATTR-CA require close monitoring during follow-up for the development of conduction system disease.


Assuntos
Neuropatias Amiloides Familiares/fisiopatologia , Bloqueio Atrioventricular/epidemiologia , Cardiomiopatias/fisiopatologia , Mortalidade , Idoso , Idoso de 80 Anos ou mais , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/genética , Amiloidose/complicações , Amiloidose/fisiopatologia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/etiologia , Estimulação Cardíaca Artificial , Cardiomiopatias/complicações , Cardiomiopatias/genética , Estudos de Coortes , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mutação , Marca-Passo Artificial , Pré-Albumina/genética , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome do Nó Sinusal/epidemiologia , Síndrome do Nó Sinusal/etiologia
4.
Circ Arrhythm Electrophysiol ; 13(7): e008210, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32538136

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) improves heart failure outcomes but has significant nonresponse rates, highlighting limitations in ECG selection criteria: QRS duration (QRSd) ≥150 ms and subjective labeling of left bundle branch block (LBBB). We explored unsupervised machine learning of ECG waveforms to identify CRT subgroups that may differentiate outcomes beyond QRSd and LBBB. METHODS: We retrospectively analyzed 946 CRT patients with conduction delay. Principal component analysis (PCA) dimensionality reduction obtained a 2-dimensional representation of preCRT 12-lead QRS waveforms. k-means clustering of the 2-dimensional PCA representation of 12-lead QRS waveforms identified 2 patient subgroups (QRS PCA groups). Vectorcardiographic QRS area was also calculated. We examined following 2 primary outcomes: (1) composite end point of death, left ventricular assist device, or heart transplant, and (2) degree of echocardiographic left ventricular ejection fraction (LVEF) change after CRT. RESULTS: Compared with QRS PCA Group 2 (n=425), Group 1 (n=521) had lower risk for reaching the composite end point (HR, 0.44 [95% CI, 0.38-0.53]; P<0.001) and experienced greater mean LVEF improvement (11.1±11.7% versus 4.8±9.7%; P<0.001), even among patients with LBBB with QRSd ≥150 ms (HR, 0.42 [95% CI, 0.30-0.57]; P<0.001; mean LVEF change 12.5±11.8% versus 7.3±8.1%; P=0.001). QRS area also stratified outcomes but had significant differences from QRS PCA groups. A stratification scheme combining QRS area and QRS PCA group identified patients with LBBB with similar outcomes to non-LBBB patients (HR, 1.32 [95% CI, 0.93-1.62]; difference in mean LVEF change: 0.8% [95% CI, -2.1% to 3.7%]). The stratification scheme also identified patients with LBBB with QRSd <150 ms with comparable outcomes to patients with LBBB with QRSd ≥150 ms (HR, 0.93 [95% CI, 0.67-1.29]; difference in mean LVEF change: -0.2% [95% CI, -2.7% to 3.0%]). CONCLUSIONS: Unsupervised machine learning of ECG waveforms identified CRT subgroups with relevance beyond LBBB and QRSd. This method may assist in objective classification of bundle branch block morphology in CRT.


Assuntos
Terapia de Ressincronização Cardíaca , Diagnóstico por Computador , Eletrocardiografia , Insuficiência Cardíaca/terapia , Processamento de Sinais Assistido por Computador , Aprendizado de Máquina não Supervisionado , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
5.
Am Heart J ; 227: 11-18, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32425198

RESUMO

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. Patients with cardiovascular risk factors or established cardiovascular disease are more likely to experience severe or critical COVID-19 illness and myocardial injury is a key extra-pulmonary manifestation. These patients frequently present with ST-elevation on an electrocardiogram (ECG) due to multiple etiologies including obstructive, non-obstructive, and/or angiographically normal coronary arteries. The incidence of ST-elevation myocardial infarction (STEMI) mimics in COVID-19-positive hospitalized patients, and the association with morbidity and mortality is unknown. Understanding the natural history and appropriate management of COVID-19 patients presenting with ST elevation is essential to inform patient management decisions and protect healthcare workers. Methods: The Society for Cardiovascular Angiography and Interventions (SCAI) and The Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council have collaborated to create a multi-center observational registry, NACMI. This registry will enroll confirmed COVID-19 patients and persons under investigation (PUI) with new ST-segment elevation or new onset left bundle branch block (LBBB) on the ECG with clinical suspicion of myocardial ischemia. We will compare demographics, clinical findings, outcomes and management of these patients with a historical control group of over 15,000 consecutive STEMI activation patients from the Midwest STEMI Consortium using propensity matching. The primary clinical outcome will be in- hospital major adverse cardiovascular events (MACE) defined as composite of all-cause mortality, stroke, recurrent MI, and repeat unplanned revascularization in COVID-19 confirmed or PUI. Secondary outcomes will include the following: reporting of etiologies of ST Elevation; cardiovascular mortality due to myocardial infarction, cardiac arrest and /or shock; individual components of the primary outcome; composite primary outcome at 1 year; as well as ECG and angiographic characteristics. Conclusion: The multicenter NACMI registry will collect data regarding ST elevation on ECG in COVID-19 patients to determine the etiology and associated clinical outcomes. The collaboration and speed with which this registry has been created, refined, and promoted serves as a template for future research endeavors.


Assuntos
Betacoronavirus , Bloqueio de Ramo/epidemiologia , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Pneumonia Viral/epidemiologia , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Bloqueio de Ramo/etiologia , Causas de Morte , Infecções por Coronavirus/complicações , Coleta de Dados/métodos , Eletrocardiografia , Humanos , Isquemia Miocárdica/epidemiologia , Pandemias , Pneumonia Viral/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
7.
Open Heart ; 7(1): e001199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32153792

RESUMO

Objectives: The physiological determinants of left ventricular (LV) mechanical dispersion (MD) are not fully explored. We aimed to investigate the impact of afterload reduction and changes in ventricular conduction on LV MD after transcatheter aortic valve implantation (TAVI). Methods: Patients with severe aortic stenosis (AS) were examined in a prospective, repeated measures observational cohort study before and after an uncomplicated transfemoral TAVI in a single tertiary centre. LV MD was assessed by speckle tracking echocardiography. Valvulo-arterial impedance (ZVA) was used as a measure of global afterload. Results: We included 140 consecutive patients (83±8 years old, 49% women, logistic EuroSCORE 16±10) with severe AS (valve area 0.7±0.2 cm2, mean transvalvular gradient 54±18 mm Hg) and a relatively preserved LV ejection fraction (52%±11%). After TAVI, we observed favourable changes in transvalvular gradients and ZVA in all patients. Compared with baseline, postprocedural MD was significantly lower in 108 patients with unchanged ventricular conduction (55±17 ms vs 51±17 ms, p=0.02) and higher in 28 patients with TAVI-induced left bundle branch block (51±13 ms vs 62±19 ms, p≤0.001). During 22±9 months observation, 22 patients died. Postprocedural MD was associated with mortality in a univariate Cox regression model (HR=1.24 (1.01-1.52), p<0.04, per 10 ms increase). Conclusions: Isolated afterload reduction was associated with reduction of MD, while concomitant impairment of ventricular conduction resulted in a more pronounced MD after TAVI, indicating that loading conditions and conduction should be considered when evaluating MD. A pronounced postprocedural LV MD was associated with mortality.


Assuntos
Potenciais de Ação , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bloqueio de Ramo/etiologia , Frequência Cardíaca , Substituição da Valva Aórtica Transcateter/efeitos adversos , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/mortalidade , Bloqueio de Ramo/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia
10.
Circ J ; 84(2): 269-276, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31902829

RESUMO

BACKGROUND: Cardiac conduction disturbance (CD) is the most frequent complication following transcatheter aortic valve replacement (TAVR). This study examined whether the anatomy of the membranous septum (MS) could provide useful information about the risk of CD following TAVR with a balloon-expandable valve (BEV).Methods and Results:Among 132 consecutive patients, 106 (mean age, 85.6±5.1 years; 75 females) were included in the study. Using preoperative CT and angiography, MS length and implantation depth (ID) were assessed. The MS length minus the prosthesis ID was calculated (∆MSID). Correlation between CD, defined as new-onset left-bundle branch block (LBBB) or the need for permanent pacemaker (PPM) within 1 week after the procedure, and MS length were evaluated. A total of 19 patients (18%) developed CD following TAVR. MS length was significantly shorter in these patients than in those without CD (5.3±1.3 vs. 6.6±1.4; P<0.001), and was the important predictor of CD (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.27-0.69, P<0.001). When considering the pre- and postprocedural parameters, the ∆MSID was smaller in patients with CD (-1.7±1.5 vs. 0.8±1.9, P<0.001), and emerged as the important predictor of CD (OR: 0.47, 95% CI: 0.33-0.69, P<0.001). CONCLUSIONS: Short MS is associated with an increased risk of CD after TAVR with BEV.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valvuloplastia com Balão/efeitos adversos , Bloqueio de Ramo/etiologia , Angiografia por Tomografia Computadorizada , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Septo Interventricular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Septo Interventricular/fisiopatologia
11.
J Korean Med Sci ; 35: e11, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31920017

RESUMO

BACKGROUND: An implantable loop recorder (ILR) is an effective tool for diagnosing unexplained syncope (US). We examined the diagnostic utility of an ILR in detecting arrhythmic causes of US and determining which clinical factors are associated with pacemaker (PM) implantation. METHODS: This retrospective, multicenter, observational study was conducted from February 2006 to April 2018 at 11 hospitals in Korea. Eligible patients with recurrent US received an ILR to diagnose recurrent syncope and document arrhythmia. RESULTS: A total of 173 US patients (mean age, 67.6 ± 16.5 years; 107 men [61.8%]) who received an ILR after a negative conventional workup were enrolled. During a mean follow-up of 9.4 ± 11.1 months, 52 patients (30.1%) had recurrent syncope, and syncope-correlated arrhythmia was confirmed in 34 patients (19.7%). The ILR analysis showed sinus node dysfunction in 24 patients (70.6%), supraventricular tachyarrhythmia in 4 (11.8%), ventricular arrhythmia in 4 (11.8%), and sudden atrioventricular block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In a Cox regression analysis, history of paroxysmal atrial fibrillation (PAF) (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.33-4.12; P < 0.01) and any bundle branch block (BBB) (HR, 2.52; 95% CI, 1.09-5.85; P = 0.03) were significantly associated with PM implantation. CONCLUSION: ILR is useful for detecting syncope-correlated arrhythmia in patients with US. The risk of PM is high in US patients with a history of PAF and any BBB.


Assuntos
Eletrocardiografia Ambulatorial/métodos , Marca-Passo Artificial , Síncope/terapia , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Eletrocardiografia Ambulatorial/instrumentação , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Modelos de Riscos Proporcionais , Recidiva , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Síncope/complicações , Síncope/patologia
12.
Heart Lung ; 49(2): 198-201, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31248624

RESUMO

INTRODUCTION: Acute electrocardiogram abnormalities are common in patients afflicted with pulmonary embolism (PE). Rarely, a patient with acute pulmonary embolism and electrocardiogram changes may have an underlying conduction abnormality that complicates their course. CASE PRESENTATION: We describe a patient with known history of left bundle branch block who presented with acute PE and developed a right bundle branch block, which devolved into complete third degree heart block without ventricular escape rhythm and led to concomitant hemodynamic compromise. DISCUSSION: Given the rarity of this clinical scenario, we call for clinicians to be aware of PE-associated conduction pathology as well as the possibility that malignant cardiac conduction blocks may occur in the setting of PE particularly if the patient is known to have underlying conduction system disease. We emphasize the importance of continuous telemetry monitoring in patients presenting with PE as these types of arrhythmic complications and hemodynamic decompensation has been observed.


Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/etiologia , Embolia Pulmonar/fisiopatologia , Doença Aguda , Idoso , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Hemodinâmica , Humanos , Masculino
14.
Am Heart J ; 218: 128-132, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806088

RESUMO

New-onset left bundle branch block (N-LBBB) after transcatheter aortic valve replacement (TAVR) is a challenging clinical dilemma. In our single-center study, 60 out of 172 patients who underwent permanent pacemaker implantation (PPM) after TAVR had N-LBBB (34.9%). At a median follow-up duration of 357 days (IQR, 178; 560 days), two patients (3.5%) were completely pacemaker-dependent, and four others (7%) were partially dependent. Twelve patients (24%) recovered conduction in their left bundle at a median follow-up duration of 5 weeks (IQR, 4; 14 weeks). Due to the lack of clinical predictors of pacemaker dependency, active surveillance is warranted and may be an alternative to permanent pacemaker implantation.


Assuntos
Bloqueio de Ramo/terapia , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Implantação de Prótese/estatística & dados numéricos , Recuperação de Função Fisiológica , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Resultado do Tratamento
15.
RMD Open ; 5(2): e001053, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31798955

RESUMO

Objectives: To describe electrocardiographic (ECG) development in patients with ankylosing spondylitis (AS) and identify associations between baseline characteristics and cardiac conduction disturbances (CCD) at 5-year follow-up. Methods: In a longitudinal cohort study, 172 patients (54% men, mean age (SD) of 50 (13) years at baseline) with AS underwent ECG, physical examination, questionnaires and laboratory testing at baseline and at 5-year follow-up. Descriptive statistics and univariate and age- and sex-adjusted logistic regression analyses were used. CCD included both atrioventricular and intraventricular blocks. Results: Twenty-three of the 172 patients (13.4%) had a CCD at follow-up. Eight patients had developed a new CCD and eight had normalised their ECG. In the age- and sex-adjusted analyses, CCD at baseline (OR 24.8, 95% CI 7.3 to 84.5), male sex (OR 6.4, 95% CI 2.0 to 20.8), history of anterior uveitis (OR 4.4, 95% CI 1.3 to 14.5), higher ASDAS-CRP (OR 2.3, 95% CI 1.3 to 4.0), greater waist circumference (OR 1.3, 95% CI 1.1 to 1.6, per 5 cm), and medication with antiplatelets (OR 7.0, 95% CI 1.5 to 31.8) and beta-blockers (OR 3.4, 95% CI 1.0 to 11.5) were associated with a CCD at follow-up. Higher age and longer symptom duration were highly correlated and were both associated with a CCD at follow-up. Conclusions: The presence of CCD in AS is in part dynamic and associated with both AS and non-AS characteristics. Our results suggest that patients especially prone to present with CCDs are older men with a previous CCD, longer symptom duration, higher AS disease activity, a history of anterior uveitis and medication reflecting cardiovascular disease.


Assuntos
Bloqueio Atrioventricular/epidemiologia , Bloqueio de Ramo/epidemiologia , Espondilite Anquilosante/complicações , Adulto , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Progressão da Doença , Eletrocardiografia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Espondilite Anquilosante/diagnóstico , Inquéritos e Questionários/estatística & dados numéricos
16.
Circ Cardiovasc Interv ; 12(12): e007635, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31833417

RESUMO

BACKGROUND: Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR. METHODS: This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up. RESULTS: Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days. CONCLUSIONS: In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/diagnóstico , Nó Atrioventricular/fisiopatologia , Bloqueio de Ramo/diagnóstico , Eletrocardiografia Ambulatorial , Frequência Cardíaca , Tecnologia de Sensoriamento Remoto , Substituição da Valva Aórtica Transcateter/efeitos adversos , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Masculino , Minnesota , Valor Preditivo dos Testes , Estudos Prospectivos , Tecnologia de Sensoriamento Remoto/instrumentação , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Heart Surg Forum ; 22(5): E331-E339, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31596707

RESUMO

BACKGROUND: Although the use of transcatheter aortic valve replacement (TAVR) has recently become an attractive strategy in prohibitive surgical high-risk patients undergoing aortic valve replacement (AVR), the most appropriate treatment option in patients with an intermediate- to high-risk profile- whether conventional surgery (SAVR) or TAVR-has been widely debated. METHODS: One hundred and forty-three consecutive patients with intermediate to high risk were prospectively enrolled and selected to undergo SAVR (Group 1 [G1], n = 63) or TAVR (Group 2 [G2], n = 80) following a multidisciplinary evaluation including frailty, anatomy, and degree of atherosclerotic disease of the aorta/peripheral vessels. The mean logistic EuroSCORE (G1 = 20.11 ± 7.144 versus G2 = 23.33 ± 8.97; P = .022), STS score (G1 = 5.722 ± 1.309 versus G2 = 5.958 ± 1.689; P = .347), and preoperative demographics such as sex, left ventricular ejection fraction (LVEF),  body mass index (BMI), peripheral vascular disease, diabetes, atrial fibrillation, renal impairment and syncope were similar. Of note, chronic obstructive pulmonary disease was more frequent in TAVR patients (G2 [46.2%] versus G1 [19.0%]; P = .001), whereas pulmonary hypertension was more frequent in SAVR group (G1 [47.6%] versus G2 [17.5%]; P = .000). The SAVR was performed with either a mechanical or tissue valve; meanwhile, TAVR was performed with either Core valve prosthesis or Edwards-Sapiens XT valve. RESULTS: SAVR group showed higher incidence of some postoperative complications compared to TAVR, namely, postoperative bleeding (4.8% versus 0.0%; P = .048), tamponade (4.8% versus 0.0%; P = .048) and postoperative atrial fibrillation (34.9% versus 10.0%; P = .000), whereas TAVR group had a higher incidence of other sets of postoperative complications, namely, left bundle branch block (58.8% versus 4.8%; P = .000), need for permanent pacemaker implantation (25.0% versus 1.6%; P = .000) and peripheral vascular complications (15.0% versus 0.0%; P = .001). On the contrary, when the two groups were compared they did not show any significant difference regarding anemia requiring more than two units of blood transfusion, postoperative renal failure, stroke, myocardial infarction, and hospital mortality. P = .534, .873, .258, .373 and .072 respectively. Hospital mortality was similar among the two groups (G1 = 0% versus G2 = 5%; P = .072). At the 24-month follow-up, overall mortality, major adverse cardiac and cerebrovascular events were comparable between the two groups but prosthetic regurgitation was better in SAVR group (G2 = 8 patients [10.0%] versus G1 = 1 patient [1.6%] in SAVR group; P = .040). CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Bloqueio de Ramo/etiologia , Tamponamento Cardíaco/etiologia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Hipertensão Pulmonar/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Hemorragia Pós-Operatória/etiologia , Desenho de Prótese , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
18.
Am J Cardiol ; 124(11): 1770-1774, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586533

RESUMO

Patients with type 1 myotonic dystrophy show reduced left ventricular systolic function in the presence of left bundle branch block due to electromechanical dys-synchrony. Our prospective study tracked a cohort of 64 type 1 myotonic dystrophy patients that demonstrated a high burden of atrial and ventricular arrhythmias and conduction delays. Of these patients, 12 (19%) patients had left bundle branch block, which was associated with reduced left ventricular systolic function. Eight of these patients received cardiac resynchronization therapy devices resulting in reduction of median QRS complex duration from 173 to 166 ms (p = 0.04), and improvement in median left ventricular ejection fraction from 37% to 46% (p = 0.007). In conclusion, cardiac resynchronization therapy device therapy is both feasible and effective in treating advanced cardiac disease in this vulnerable group of patients by improving left ventricular function.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/tendências , Eletrocardiografia , Distrofia Miotônica/complicações , Disfunção Ventricular Esquerda/terapia , Função Ventricular Esquerda/fisiologia , Adulto , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico/fisiologia , Sístole , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia
20.
Eur Heart J ; 40(27): 2218-2227, 2019 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-31505615

RESUMO

AIMS: Transcatheter aortic valve replacement (TAVR) is now an established therapy for intermediate-risk surgical candidates with symptomatic, severe aortic stenosis. The clinical impact of new-onset left bundle branch block (LBBB) after TAVR remains controversial and has not been studied in intermediate-risk patients. We therefore sought to analyse outcomes associated with new LBBB in a large cohort of intermediate-risk patients treated with TAVR. METHODS AND RESULTS: A total of 2043 patients underwent TAVR in the PARTNER II trial and S3 intermediate-risk registry and survived to hospital discharge. Patients were excluded from the current analysis due to baseline conduction disturbances, pre-existing permanent pacemaker (PPM), and new PPM during the index hospitalization. Clinical outcomes at 2 years were compared between patients with and without persistent, new-onset LBBB at hospital discharge, and multivariable analysis was performed to identify predictors of mortality. Among 1179 intermediate-risk patients, new-onset LBBB at discharge occurred in 179 patients (15.2%). Patients with new LBBB were similar to those without except for more frequent diabetes and more frequent treatment with SAPIEN 3 vs. SAPIEN XT. At 2 years, new LBBB was associated with increased rates of all-cause mortality (19.3% vs. 10.8%, P = 0.002), cardiovascular mortality (16.2% vs. 6.5%, P < 0.001), rehospitalization, and new PPM implantation. By multivariable analysis, new LBBB remained an independent predictor of 2-year all-cause [hazard ratio (HR) 1.98, 95% confidence interval (95% CI) 1.33, 2.96; P < 0.001] and cardiovascular (HR 2.66 95% CI 1.67, 4.24; P < 0.001) mortality. New LBBB was also associated with worse left ventricular systolic function at 1 and 2-year follow-up. CONCLUSIONS: In a large cohort of intermediate-risk patients from the PARTNER II trial and registry, persistent, new-onset LBBB occurred in 15.2% of patients without baseline conduction disturbances or pacemaker. New LBBB was associated with adverse clinical outcomes at 2 years, including all-cause and cardiovascular mortality, rehospitalization, new pacemaker implantation, and worsened left ventricular systolic function. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov #NCT01314313 and NCT03222128.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/etiologia , Complicações Pós-Operatórias/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Medição de Risco , Resultado do Tratamento
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