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1.
Ter Arkh ; 91(4): 83-89, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094481

RESUMO

AIM: To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. MATERIALS AND METHODS: Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). RESULTS: ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). CONCLUSION: The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.


Assuntos
Bloqueio de Ramo/diagnóstico , Eletrocardiografia/métodos , Taquicardia/diagnóstico , Adulto , Idoso , Bloqueio de Ramo/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Taquicardia/fisiopatologia
2.
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
3.
Einstein (Sao Paulo) ; 17(2): eAO4539, 2019 Apr 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942280

RESUMO

OBJECTIVE: To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. METHODS: Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. RESULTS: Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. CONCLUSION: Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.


Assuntos
Eletrocardiografia , Espondilartrite/tratamento farmacológico , Espondilartrite/fisiopatologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Estudos de Casos e Controles , Feminino , Antígeno HLA-B27/análise , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Estudos Retrospectivos , Espondilartrite/epidemiologia , Espondilartrite/imunologia , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
4.
BMJ Case Rep ; 12(3)2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30850566

RESUMO

We present a case of constrictive pericarditis with concomitant blood and bone marrow appearances of chronic myelomonocytic leukaemia (CMML). Despite surgical treatment with pericardiectomy, the patient deteriorated into multiorgan failure. Pericardial histology disclosed a typical inflammatory picture with no evidence of monocytic or malignant infiltrate. Following intensive collaboration between cardiologists, haematologists and rheumatologists via daily email exchanges, a diagnosis was reached of autoinflammatory constrictive pericarditis with a non-infiltrative coexisting CMML. The key to achieving a rapid and sustained response was a trial of high-dose steroids followed by intravenous immunoglobulins. This achieved restoration of cardiac function, resolution of symptoms and near normalisation of inflammatory markers. A diagnosis of concurrent CMML was confirmed at 3 months. The patient remains well, taking colchicine and steroids.


Assuntos
Doenças Hereditárias Autoinflamatórias/diagnóstico , Leucemia Mielomonocítica Crônica/complicações , Pericardiectomia/métodos , Pericardite Constritiva/patologia , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Diagnóstico Diferencial , Doenças Hereditárias Autoinflamatórias/patologia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/tratamento farmacológico , Pericardite Constritiva/cirurgia , Resultado do Tratamento
5.
Cardiol Young ; 29(3): 435-438, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30681047

RESUMO

The NLRP1-associated autoinflammation with arthritis and dyskeratosis syndrome is a rare novel autoinflammatory disorder. Cardiac involvement has not been previously reported. We present a 12-year-old girl with NLRP1-associated autoinflammation with arthritis and dyskeratosis syndrome who was diagnosed with severely impaired left ventricular function and complete left bundle branch block during an exacerbation of the disease. Cardiac dysfunction proved to be rapidly reversible after initiation of high-dose methylprednisolone.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas Reguladoras de Apoptose/genética , Artrite Juvenil/complicações , Bloqueio de Ramo/etiologia , Disceratose Congênita/complicações , Doenças Hereditárias Autoinflamatórias/complicações , Mutação , Disfunção Ventricular Esquerda/etnologia , Artrite Juvenil/genética , Artrite Juvenil/imunologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Criança , Disceratose Congênita/genética , Ecocardiografia , Eletrocardiografia , Feminino , Doenças Hereditárias Autoinflamatórias/genética , Doenças Hereditárias Autoinflamatórias/imunologia , Humanos , Síndrome , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
6.
Int J Cardiol ; 274: 88-92, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30454724

RESUMO

BACKGROUND: Ventricular septal defects (VSDs) generally have benign long-term prognoses, but recent studies have indicated increased pulmonary vascular resistance. A potential tool for monitoring pulmonary artery pressure is heart rate variability, and therefore, the aim of this study was to assess heart rate variability in adults with a surgically repaired or unrepaired VSD. METHODS: In a long-term, follow-up study, three groups were included; VSD-patients operated in early childhood, patients with an open VSD, and controls. For each patient, 24-hour Holter monitoring was performed and heart rate variability was assessed. RESULTS: In total, 30 participants with a surgically closed VSD, 30 participants with an unrepaired VSD, and 36 controls were included. In the closed VSD group, there was a higher proportion of participants, who had low sNN50 (p = 0.005) and low sNN6% (p = 0.017) than in the other two groups. Similar differences were found when sNN50 was divided into increases and decreases (p = 0.007 and p = 0.005, respectively) as well as sNN6% (p = 0.014 and p = 0.014, respectively). Lastly, there was a higher proportion of patients in the closed VSD group with low rMSSD than in the other two groups (p = 0.005). For the closed VSD group, the proportion of participants with low total sNN50 (p = 0.046) and low total sNN6% (p = 0.046) were higher among participants with a complete right bundle branch block (RBBB) than among participants with no or an incomplete RBBB. CONCLUSIONS: Adults who had surgical VSD closure in early childhood had impaired heart rate variability and, particularly, participants with complete RBBB had lower heart rate variability.


Assuntos
Bloqueio de Ramo/etiologia , Procedimentos Cirúrgicos Cardíacos , Eletrocardiografia Ambulatorial/métodos , Frequência Cardíaca/fisiologia , Comunicação Interventricular/cirurgia , Adolescente , Adulto , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Criança , Pré-Escolar , Estudos Cross-Over , Método Duplo-Cego , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/fisiopatologia , Humanos , Lactente , Masculino , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
7.
Comput Math Methods Med ; 2018: 4253928, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30538769

RESUMO

Two case reports showed that the combination of CRT and LVAD benefits the end-stage heart failure patients with prolonged QRS interval significantly. In one of the reports, the patient had the LVAD removed due to the recovery of the heart function. However, the quantification of the combined devices has yet to be conducted. This study aimed at computationally predicting the effects of CRT-only or combined with LVAD on electromechanical behaviour in the failing ventricle with left bundle branch blocked (LBBB) and right bundle branch blocked (RBBB) conditions. The subjects are normal sinus rhythm, LBBB, RBBB, LBBB with CRT-only, RBBB with CRT-only, LBBB with CRT + LVAD, and RBBB with CRT + LVAD. The results showed that the CRT-only shortened the total electrical activation time (EAT) in the LBBB and RBBB conditions by 20.2% and 17.1%, respectively. The CRT-only reduced the total mechanical activation time (MAT) and electromechanical delay (EMD) of the ventricle under LBBB by 21.3% and 10.1%, respectively. Furthermore, the CRT-only reduced the contractile adenosine triphosphate (ATP) consumption by 5%, increased left ventricular (LV) pressure by 6%, and enhanced cardiac output (CO) by 0.2 L/min under LBBB condition. However, CRT-only barely affects the ventricle under RBBB condition. Under the LBBB condition, CRT + LVAD increased LV pressure and CO by 10.5% and by 0.9 L/min, respectively. CRT + LVAD reduced ATP consumption by 15%, shortened the MAT by 23.4%, and shortened the EMD by 15.2%. In conclusion, we computationally predicted and quantified that the CRT + LVAD implementation is superior to CRT-only implementation particularly in HF with LBBB condition.


Assuntos
Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Coração Auxiliar , Fenômenos Biomecânicos , Bloqueio de Ramo/patologia , Terapia Combinada , Simulação por Computador , Fenômenos Eletrofisiológicos , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Imagem Tridimensional , Conceitos Matemáticos , Modelos Cardiovasculares
8.
Clin Cardiol ; 41(8): 1097-1102, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29920728

RESUMO

Rate-related left bundle branch block (LBBB) is a well-studied phenomenon. Cardiac memory is another physiologic phenomenon in which T-wave abnormalities occur in the absence of ischemia. The association between these 2 phenomena has been described in several case reports. A literature review was performed through Ovid and PubMed, where at total of 93 cases of rate-related LBBB were identified. Cases were reviewed, and data were collected on rates of appearance and disappearance as well as the presence or absence of cardiac memory. There is some overlap in the rate at which LBBB appears. Cardiac memory is associated with rate-related LBBB in several cases, but its true prevalence is unknown. Cardiac memory is a phenomenon that is well described in the literature but is often underrecognized in clinical practice. As a consequence of overlooking this phenomenon and not including cardiac memory in the differential when T-wave abnormalities are observed, patients may be subjected to unnecessary invasive diagnostic testing.


Assuntos
Bradicardia/fisiopatologia , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Bradicardia/complicações , Bloqueio de Ramo/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
9.
Int J Cardiol ; 261: 119-129, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29657035

RESUMO

Cardiac resynchronization therapy (CRT) was proposed around 20 years ago, and its clinical use rapidly moved from pioneering experiences to randomized controlled trials (RCT). Since 2002 recommendations for CRT have been included in international consensus guidelines that even in an early phase recommended CRT as an effective treatment for improving symptoms, reducing hospitalizations and mortality in well-selected patients with wide QRS, left ventricular dysfunction and moderate to severe heart failure (NYHA classes III-IV), on optimal medical therapy. Subsequently the indications were extended to mild (NYHA class II) heart failure (associated with left ventricular dysfunction and wide QRS) and more recently also to appropriately selected patients with conventional indications for pacing having a left ventricular ejection fraction of 50% or less and NYHA class I-III. While all the guidelines strongly recommend CRT in case of LBBB with QRS duration >150 ms, lower strength of recommendations, with some heterogeneity, appears when QRS duration is 130-150 ms, especially if not associated with LBBB. Of note, according to recent guidelines, CRT is not recommended in case of QRS duration <130 ms, which is now the lower limit for candidacy to CRT, differently from the 120 ms limit used before. Despite consensus guidelines, many data indicate that CRT is still underused, with great heterogeneity in its implementation, both in North America and Europe, thus requiring a more organized patient referral.


Assuntos
Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/normas , Terapia de Ressincronização Cardíaca/tendências , Consenso , Guias de Prática Clínica como Assunto/normas , Bloqueio de Ramo/fisiopatologia , Europa (Continente)/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Fatores de Tempo , Estados Unidos/epidemiologia
11.
Clin Cardiol ; 41(3): 360-365, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29574887

RESUMO

BACKGROUND: Current guidelines support exercise stress echocardiography (ESE) for evaluation of suspected obstructive coronary artery disease (OCAD) in ambulant patients with left bundle branch block (LBBB). Data regarding the diagnostic utility of ESE in patients with LBBB are limited. HYPOTHESIS: We hypothesized that the diagnostic performance of ESE for the assessment of suspected OCAD is reduced in the context of LBBB. METHODS: We studied 191 consecutive patients with resting LBBB undergoing ESE for the investigation of suspected OCAD between 2008 and 2015 at our center. The studies were categorized as inconclusive, normal, or abnormal. Patients with an abnormal response were subcategorized as regional ischemic response or globally abnormal. RESULTS: Eighty-two patients (43%) demonstrated a normal left ventricular contractile response (LVCR) to exercise; 92 (48%) developed an abnormal LVCR to exercise, including 70 patients with globally abnormal and 22 patients with regional ischemic responses. Of the patients with abnormal responses, 62 patients had anatomic imaging, only 29 of whom had significant OCAD, conferring an overall specificity of ESE for significant OCAD of 21% and accuracy of 52%. Of patients who developed a regionally abnormal response, 89% had significant OCAD. CONCLUSIONS: For patients with LBBB who develop a globally abnormal LVCR during ESE, the specificity of ESE for reliably excluding significant OCAD is significantly reduced. ESE appears to be a suboptimal test for the evaluation of OCAD in patients with resting LBBB, as about 50% of patients will have an abnormal response, the majority due to globally abnormal contraction where OCAD cannot be reliably diagnosed. Alternative testing should be considered for the investigation of suspected OCAD in patients with resting LBBB.


Assuntos
Bloqueio de Ramo/complicações , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia sob Estresse/métodos , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Eletrocardiografia , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
12.
Int J Cardiol ; 257: 84-91, 2018 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-29506744

RESUMO

BACKGROUND: Female patients are underrepresented in cardiac resynchronization therapy (CRT) trials, although they show better CRT response compared to males and at shorter QRS durations. We hypothesized that differences in left bundle branch block (LBBB) characteristics and mechanical dyssynchrony might explain this gender disparity. METHODS: Patients presenting with true LBBB-morphology (including mid-QRS notching) on surface electrocardiograms (ECG) were selected. LBBB QRS duration (QRSDLBBB) was measured automatically on the ECG. Left ventricular dimensions were assessed by two-dimensional echocardiography. Mechanical dyssynchrony was assessed by the presence of septal flash (SF) on echocardiography. RESULTS: The study enrolled 1037 patients (428 females). Female LBBB patients had smaller QRSDLBBB compared to male LBBB patients (142 [22]ms versus 156 [24]ms, p<0.001). In a multivariate analysis, sex and left ventricular end-diastolic diameter (LVEDD) were independent predictors of QRSDLBBB. QRSDLBBB can be corrected for sex and LVEDD using a simplified formula: corrected-QRSDLBBB=QRSDLBBB+0.5×(50-LVEDD)-10 (if male). SF was more prevalent in females compared to males (60% versus 43%, p<0.001). Women revealed significantly more SF in narrow QRSDLBBB groups compared to men: 65% versus 13% (p<0.001) with QRSDLBBB 120-129ms, 66% versus 18% (p<0.001) with QRSDLBBB 130-139ms and 63% versus 31% (p<0.001) with QRSDLBBB 140-149ms. At QRSDLBBB>150ms, there were no differences in SF prevalence between females and males. CONCLUSION: Female patients show true LBBB morphology at shorter QRSD and have more frequent mechanical dyssynchrony at shorter QRSD compared to males. This might explain the better CRT response rates at shorter QRSD in females.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Caracteres Sexuais , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Congenit Heart Dis ; 13(3): 419-427, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29431296

RESUMO

OBJECTIVE: This study evaluates the ability of experienced pediatric electrophysiologists (EPs) to reliably classify incomplete right bundle branch block (IRBBB) and assesses its clinical utility as an isolated ECG finding in a group of healthy outpatient children without prior cardiac evaluation. DESIGN: We performed a retrospective analysis of all electrocardiographic and echocardiographic records at Boston Children's Hospital between January 1, 2005, and December 31, 2014. Echocardiographic diagnoses were identified if registered between the date of the index electrocardiogram and the ensuing year. A selected subset of 473 ECGs was subsequently reanalyzed in a blinded manner by six pediatric EPs to determine the consistency with which the finding of IRBBB could be assigned. RESULTS: Of the 331 278 ECGs registered in the BCH database, 32 127 (9.7%) met inclusion criteria and were analyzed for the prevalence of isolated right bundle conduction disturbance findings. The mean age was 12.1 ± 4.0 years, and the population was 49% male. Of the 32 127 ECGs, 72.5% were coded normal, 3.0% were coded IRBBB, and 0.5% were coded complete right bundle branch block (CRBBB). A total of 7.3% of patients coded as normal had an ensuing echocardiogram, compared to 12.5% coded IRBBB. Echo findings were recorded in 0.1% of normal and 0.2% of IRBBB. Patients with ASD-secundum type were no more likely to have isolated IRBBB on previous ECG than the general population (2.5% vs 3.0%). Analysis of inter-reader variability in ECG findings and conduction disturbance identification was high (range of IRBBB prevalence 1-20% among readers). Reinterpretation of ECGs using explicit diagnostic criteria did not demonstrate consistent discrimination of IRBBB and Normal ECGs. CONCLUSIONS: IRBBB is not uncommon in a healthy school age population and is observed to have high inter-reader variability. It was associated with increased use of echocardiographic exam but was not associated with increased rate of echocardiographic findings when compared with rates for normal ECGs.


Assuntos
Bloqueio de Ramo/fisiopatologia , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Monitorização Fisiológica/métodos , Adolescente , Boston/epidemiologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/epidemiologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Prevalência , Estudos Retrospectivos
14.
PLoS One ; 13(1): e0190518, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29304097

RESUMO

BACKGROUND: Duchenne muscular dystrophy (DMD) is an inherited myogenic disorder due to mutations in the dystrophin gene on chromosome Xp21.1. We designed this study to determine the prevalence of left bundle branch block (LBBB), whether there is a relationship between LBBB and genetic pattern, and to assess predictive factors for acute cardiac events and mortality in adult DMD patients. METHODS: We reviewed the charts of DMD followed at the Home Mechanical Ventilation Unit of the Raymond Poincare University Hospital. RESULTS: A total of 121 patients, aged from 18 to 41 years have been included in our study. Median vital capacity (VC) was 12% [7; 19.5] of predicted. Almost all patients were on home mechanical ventilation (95%). LBBB was present in 15 patients (13%); among them, 10 disclosed exonic deletions. After a median follow up of 6 years, 21 patients (17%) experienced acute heart failure (AHF), 7 patients (6%) supraventricular arrhythmia, 3 patients (2.4%) ventricular tachycardia, 4 patients (3%) significant electrical disturbances. LBBB was significantly associated with cardiac events (OR = 12.7; 95%CI [3.78-42.7]; p <0.0001) and mortality (OR = 4.4; 95%CI [1.44-13.7]; p 0.009). Presence of residual dystrophin protein was not associated with significant less cardiac events. Age and LVEF were also predictive factors for cardiac events and mortality. CONCLUSION: LBBB is relatively frequent in DMD and is a major predictive factor for cardiac events and mortality. Presence of residual dystrophin protein was not associated with a lower incidence of cardiac events.


Assuntos
Bloqueio de Ramo/fisiopatologia , Predisposição Genética para Doença , Distrofia Muscular de Duchenne/complicações , Adulto , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/genética , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Estudos Retrospectivos , Adulto Jovem
15.
Am J Med Sci ; 355(1): 44-47, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29289261

RESUMO

BACKGROUND: Recently, the R-wave peak time (RWPT) at lead II was reported to be a helpful and simple tool for differentiating wide QRS complex tachycardias with a RWPT ≥ 50ms for ventricular tachycardia diagnosis. Our previous study showed that the duration of RWPT at lead II in adults was ≈29ms. However, the effects of ventricular premature beats (VPBs), bundle branch block (BBB) or left anterior fascicular block (LAFB) on RWPT at lead II remain unknown. METHODS: The study was conducted in the First Affiliated Hospital of Shantou University Medical College in Southern China. Adults with VPBs, BBB or LAFB were included. RWPT at lead II was determined. RESULTS: Compared with the control groups, the right BBB, LAFB, RWPT were longer in groups with left BBB and VPBs. Compared with the group with left BBB, the group with VPBs had a significantly longer RWPT at lead II (54.20 ± 18.52 versus 84.76 ± 16.38ms, P < 0.01). CONCLUSION: Our study showed that there is a significant difference in the RWPT at lead II between groups with left BBB, ventricular premature beat, right BBB and LAFB. A RWPT of 50ms may be optimal to differentiate between ventricular tachycardia and supraventricular tachycardia with right left BBB and LAFB, but not with left BBB.


Assuntos
Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia , Adulto , Idoso , Bloqueio de Ramo/epidemiologia , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Taquicardia Ventricular/epidemiologia , Fatores de Tempo , Complexos Ventriculares Prematuros/epidemiologia
16.
Heart Rhythm ; 15(3): 460-468, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29107697

RESUMO

His bundle pacing (HBP) prevents ventricular dyssynchrony and its long-term consequences by preserving normal electrical activation of the ventricles. Since the original description of permanent HBP in 2000, the adoption of HBP has increased over the past several years. However, the reporting of procedural and clinical outcomes to date is not uniform. This article is a collaboration between several implanters with significant experience in HBP to establish a uniform set of definitions encompassing the different forms of HBP as well as define a standardized approach to gathering data end points to ensure consistency in reported outcomes.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/normas , Eletrocardiografia , Guias de Prática Clínica como Assunto , Bloqueio de Ramo/fisiopatologia , Humanos , Estudos Multicêntricos como Assunto
17.
Europace ; 20(2): 323-328, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28371908

RESUMO

Aims: Right bundle branch block is associated with right ventricular (RV) electromechanical dyssynchrony, which may contribute to acute haemodynamic impairment after repair of tetralogy of Fallot (ToF). We sought to evaluate the effects of RV resynchronization on haemodynamics and tissue oxygenation during the first 24 h after surgery. Methods and results: Arterial pressures, cardiac output, and tissue oxygenation were measured in 28 consecutive patients (median age 10.1 months) during baseline sinus rhythm with right bundle branch block and after RV resynchronization by atrial-triggered RV free wall pacing in complete fusion with spontaneous activation. Studied variables were compared in a crossover design in four 5-min intervals (baseline rhythm and stimulation, 2x each). Resynchronization reduced the QRS complex duration from median 110 to 70 ms (P < 0.001), increased significantly median arterial systolic, mean and pulse pressure, cardiac index, left ventricular maximum +dP/dT and decreased central venous pressure (P < 0.001 for all). Both cerebral and renal oxygenation improved (P < 0.001). Eleven of the 28 patients showed a clinically highly significant resynchronization effect defined as an increase in arterial pulse pressure of ≥ 10%. The q-RV interval (expressed as % of QRS duration) at the RV pacing site during baseline rhythm was the only predictor of resynchronization effect. Conclusions: RV resynchronization carried short-term improvement of haemodynamics in children early after surgery for ToF and might be a useful non-pharmacologic adjunct to the management of haemodynamically compromised patients. Resynchronization effect was maximized when pacing from area of the latest RV activation.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Procedimentos Cirúrgicos Cardíacos , Hemodinâmica , Tetralogia de Fallot/cirurgia , Função Ventricular Direita , Fatores Etários , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Humanos , Lactente , Recuperação de Função Fisiológica , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
Artigo em Inglês | MEDLINE | ID: mdl-28557338

RESUMO

AIM: Optimization of coronary sinus (CS) lead position to the latest activated left ventricular (LV) area is important to increase cardiac resynchronization therapy (CRT) response. We aimed to detect the relationship between coronary sinus lead delay index (CSDI) and echocardiographic, electrocardiographic response to CRT treatment. METHODS: We prospectively included 137 consecutive patients with heart failure (HF) diagnosis, QRS ≥ 120 ms, left bundle branch block (LBBB), New York Heart Association score (NYHA) II-IV, LV ejection fraction (LVEF) <35% and scheduled for CRT (84 male, 53 female; mean age 65.1 ± 10.1 years). Echocardiographic CRT response was defined as ≥15% reduction in LV end-systolic volume (LVESV). CS lead sensing delay was calculated as the time interval from the onset of surface QRS wave to the onset of depolarization wave recorded from the CS lead by using the CS pacing lead as a bipolar electrode. CSDI was calculated by dividing the CS lead sensing delay by the QRS duration. RESULTS: LVESV reduction was associated with baseline QRS width (r = .257, p = .002), QRS narrowing (r = .396, p < .001), CSDI (r = .357, p < .001), and NT-proBNP (r = -0.213, p = .022) in bivariate analysis. In logistic regression analysis, CSDI was found to be only independent parameter for predicting significant LVESV reduction (Beta = 0.318, p < .001). CSDI was also found to be significantly associated with LVEF increase (r = .244, p = .004) and QRS narrowing (r = .178, p = .046). CONCLUSION: CSDI may be used as a marker to predict the favorable response to CRT. It may be useful to integrate CSDI to CRT implantation procedure in order to minimize nonresponders.


Assuntos
Terapia de Ressincronização Cardíaca , Seio Coronário/fisiopatologia , Ecocardiografia , Eletrocardiografia , Cardiopatias/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Seio Coronário/diagnóstico por imagem , Feminino , Cardiopatias/diagnóstico , Cardiopatias/diagnóstico por imagem , Cardiopatias/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
19.
Echocardiography ; 35(2): 148-152, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29178366

RESUMO

AIMS: Left bundle branch block (LBBB) causes a dyssynchronized contraction of left ventricle. This is a kind of regional wall-motion abnormality and measuring left ventricular ejection fraction (LVEF) by two-dimensional (2D) echocardiography could be less reliable in this particular condition. Our aim was to evaluate the role of dyssynchrony index (SDI), measured by three-dimensional (3D) echocardiography, in assessment of LVEF and left ventricular volumes accurately in patients with LBBB. METHODS AND RESULTS: In this case-control study, we included 52 of 64 enrolled participants (twelve participants with poor image quality were excluded) with LBBB and normal LVEF or nonischemic cardiomyopathy. Left ventricular ejection fraction (LVEF) and left ventricular volumes were assessed by 2D (modified Simpson's rule) and 3D (four beats full volume analysis) echocardiography and the impact of SDI on results were evaluated. In patients with SDI ≥6%, LVEF measurements were significantly different (46.00% [29.50-52.50] vs 37.60% [24.70-45.15], P < .001) between 2D and 3D echocardiography, respectively. In patients with SDI < 6%, there were no significant differences between two modalities in terms of LVEF measurements (54.50% [49.00-59.00] vs 54.25% [40.00-58.25], P = .193). LV diastolic volumes were not significantly different while systolic volumes were underestimated by 2D echocardiography, and this finding was more pronounced when SDI ≥ 6%. CONCLUSION: In patients with LBBB and high SDI (≥6%), LVEF values were overestimated and systolic volumes were underestimated by 2D echocardiography compared to 3D echocardiography.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/fisiopatologia , Ecocardiografia Tridimensional/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Bloqueio de Ramo/complicações , Estudos de Casos e Controles , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/complicações
20.
Heart Lung Circ ; 27(3): 291-300, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29097067

RESUMO

Cardiac resynchronisation therapy (CRT) is a cornerstone in the contemporary management of heart failure. The most effective way of predicting response to this therapy remains electrocardiographic (ECG) criteria of electromechanical dyssynchrony. The left bundle branch block (LBBB) pattern is currently the most robust ECG criterion in predicting improvement in symptoms and reduction in mortality. However, recent studies using three-dimensional (3D) mapping and cardiac magnetic resonance imaging (CMR) have demonstrated heterogeneous left ventricular activation patterns in patients with LBBB. This has led to intense debate on the activation pattern of "true LBBB" and resulted in the proposal of stricter criteria for defining LBBB. This review will focus on the definitions and implications of LBBB in the CRT era. At a minimum, the use of stricter ECG criteria appears warranted, and adjunctive pre-implant imaging or mapping may further identify patient-specific electrophysiological patterns that determine response to CRT.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Função Ventricular Esquerda/fisiologia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Prognóstico
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