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1.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 335-340, oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184123

RESUMO

Objetivo. Analizar la seguridad de la cardioversión de la fibrilación auricular (FA) de reciente comienzo realizada en un servicio de urgencias hospitalario (SUH). Método. Estudio observacional, retrospectivo y analítico en un SUH. Se recogieron de forma consecutiva los episodios de FA de menos de 48 horas de evolución y hemodinámicamente estables, en los que se realizó una cardioversión urgente (CVU) y los episodios derivados para valorar cardioversión programada ambulatoria (CVP). La variable de resultado fue la presencia de eventos embólicos (EE) o hemorrágicos (EH) a los 90 días. Resultados. Se analizaron 718 cardioversiones en 570 pacientes. La edad media fue de 64 años (DE 13,5). Se realizaron 479 (66,7%) CVU y 239 (33,3%) CVP. Se recogieron un total de 11 (1,5%) eventos: dos EE (0,3%) y 9 EH (1,3%). Todos los EH fueron hemorragias menores. No se encontraron diferencias estadísticamente significativas entre ambos grupos. Conclusión. La CVU de la FA de reciente comienzo en los SUH es una estrategia segura


Objective. To analyze the safety of electric cardioversion performed for recent-onset atrial fibrillation in a hospital emergency department. Methods. Observational retrospective analysis of consecutive emergency department cases of atrial fibrillation of less than 48 hours’ duration in hemodynamically stable patients. All included cases were either treated with emergency electric cardioversion or referred for evaluation and scheduling of outpatient cardioversion. The outcome variable was the occurrence of a thromboembolic or hemorrhagic event within 90 days. Results. A total of 718 cardioversions in 570 patients were analyzed. The mean (SD) age of the patients was 64 (13.5) years. Four hundred seventy-nine emergency cardioversions (66.7%) and 239 (33.3%) scheduled cardioversions were performed. Eleven adverse events (1.5% of the cohort) occurred: 2 were thromboembolic events (0.3%) and 9 were hemorrhagic (1.3%). All bleeds were minor. There were no statistically significant differences in the rate of adverse events between the emergency and scheduled cardioversion groups. Conclusion. Emergency cardioversion for recent-onset atrial fibrillation is safe


Assuntos
Humanos , Pessoa de Meia-Idade , Cardioversão Elétrica/instrumentação , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Cardioversão Elétrica/métodos , Cardioversão Elétrica/tendências , Segurança do Paciente , Estudos de Coortes , Estudos Retrospectivos , Análise Multivariada
3.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 227-233, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182762

RESUMO

Objetivos: Este estudio analiza el control del ritmo en los servicios de urgencias (SUH) y sus resultados en pacientes con fibrilación auricular (FA) de reciente comienzo, para identificar áreas de mejora en el manejo. Método: Estudio multicéntrico, observacional, prospectivo y transversal desarrollado en 124 SUH representativos del sistema sanitario español basado en el registro HERMES-AF (estrategias de manejo en el servicio de urgencias hospitalario de la FA) del 23 de mayo al 5 de junio de 2011. Se incluyeron pacientes con FA sintomática con menos de 48 h de evolución en los cuales se tomó la decisión de restaurar el ritmo sinusal. Resultados: Se incluyeron 337 pacientes, se optó por cardioversión farmacológica en 311 pacientes (92,3%), y por cardioversión eléctrica en 52 (15%), la mitad de los casos tras fracaso de los fármacos. Se obtuvo ritmo sinusal (RS) en 278 pacientes (82,5%) y el alivio de los síntomas en 297 (94%), con una tasa de efectos adversos del 0,9%, ninguno grave. Amiodarona se asoció de manera independiente a una menor tasa de RS al alta (OR = 0,442; IC 95% 0,238-0,823; p = 0,01), al contrario que la cardioversión eléctrica (OR = 4,0; IC 95% 1,2-13,3; p = 0,024). Los fármacos I-C se asociaron con una mayor proporción de altas en < 6 h (OR 2,6; IC 95% 1,6-4,3; p < 0,001) y amiodarona con más estancias prolongadas de > 24 h (OR 2,7, IC 95% 1,5-4,8; p < 0,003). Conclusiones: En los SUH, la restauración del RS en la FA de reciente comienzo es segura, efectiva y asocia beneficios clínicos para los pacientes. Reemplazar amiodarona por técnicas más efectivas y rápidas como la cardioversión eléctrica o los fármacos I-C es un área de mejora de la calidad asistencial


Objectives: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. Methods: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. Results: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P<.001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P<.003). Conclusions: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardioversão Elétrica/métodos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Serviços Médicos de Emergência , Ritmo Circadiano/efeitos dos fármacos , Sistema de Registros/normas , Cardioversão Elétrica/tendências , Estudos Prospectivos , Estudos Transversais , Espanha , Antiarrítmicos/administração & dosagem , Sistemas de Saúde/organização & administração
4.
J Cardiovasc Med (Hagerstown) ; 20(8): 531-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259858

RESUMO

AIMS: The aim of this survey was to assess the management and organization of cardiac implantable electronic device (CIED) replacement in Italy. METHODS: A questionnaire consisting of 24 questions on organizational aspects and on the peri-procedural management of anticoagulant therapies and antibiotic prophylaxis was sent via the Internet to 154 Italian arrhythmia centers. RESULTS: A total of 103 out of 154 centers completed the questionnaire (67% response rate). In 43% of the centers, the procedures were performed under day-case admission, in 40% under ordinary admission, and in 17% under either day-case or ordinary admission. The most frequent reason (66%) for choosing ordinary admission rather than day-case admission was to obtain full reimbursement. Although warfarin therapy was continued in 73% of the centers, nonvitamin K oral anticoagulants were discontinued, without bridging, 24 h or less prior to replacement procedures in 88%. Prophylactic antibiotic therapy was systematically administered in all centers; in 97%, the first antibiotic dose was administered 1-2 h prior to procedures. Local antibacterial envelopes were also used in 43% of the centers in patients with a higher risk of device infection. CONCLUSION: This survey provides a representative picture of how CIED replacements are organized and managed in current Italian clinical practice. The choice of the type of hospitalization (short versus ordinary) was more often motivated by economic reasons (reimbursement of the procedure) than by clinical and organizational factors. Peri-procedural management of anticoagulation and prophylactic antibiotic therapy was consistent with current scientific evidence.


Assuntos
Antibioticoprofilaxia/tendências , Anticoagulantes/administração & dosagem , Estimulação Cardíaca Artificial/tendências , Desfibriladores Implantáveis/tendências , Remoção de Dispositivo/tendências , Cardioversão Elétrica/tendências , Marca-Passo Artificial/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Ambulatórios , Estimulação Cardíaca Artificial/economia , Desfibriladores Implantáveis/economia , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/economia , Esquema de Medicação , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Custos de Cuidados de Saúde , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Tempo de Internação , Marca-Passo Artificial/economia , Admissão do Paciente , Padrões de Prática Médica/economia , Falha de Prótese , Fatores de Tempo , Resultado do Tratamento
6.
Int J Cardiol ; 278: 133-136, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30522886

RESUMO

BACKGROUND: Observational data suggest that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) can reduce the risk of recurrent atrial fibrillation (AF) post-direct current cardioversion (DCCV) or catheter ablation. METHODS: We conducted a study of adult patients with AF and sleep apnea, stratified by age and gender, who underwent successful DCCV to sinus rhythm, and who were randomized to receive PAP or usual care. Those with sleepiness, significant cardiac or respiratory disease were excluded. Patients were followed for ≤1 year. Primary outcome assessed was time to AF recurrence. Secondary outcomes included sleepiness and quality of life measured using the Epworth Sleepiness Scale (ESS) and Functional Outcome of Sleep Questionnaire (FOSQ) respectively. RESULTS: Of 1757 patients that were screened, 34 underwent polysomnography for this study, 25 of whom had an apnea-hypopnea index (AHI) >5/h. Twelve were randomized to PAP therapy and 13 to usual care. All eligible patients were found to have OSA. There were no differences in body mass index, blood pressure, ejection fraction, AHI, or nocturnal oxygen parameters between intervention and control groups (all p > 0.05). AF recurred in 25% of patients in the PAP and control groups, at 129.0 ±â€¯166.5 versus 109.3 ±â€¯73.2 days respectively, p = 0.98; there were no differences in ESS (5.8 ±â€¯2.6 versus 5.7 ±â€¯2.3; p = 0.17) or FOSQ (18.3 ±â€¯1.5 versus 17.5 ±â€¯1.9; p = 0.26) at follow-up. CONCLUSIONS: This is the first randomized controlled trial assessing the impact of treatment of OSA on recurrence of AF post-DCCV, and did not detect a difference between those treated with PAP versus usual care. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, identifier number: NCT00263757.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Pressão Positiva Contínua nas Vias Aéreas/tendências , Cardioversão Elétrica/tendências , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Idoso , Fibrilação Atrial/fisiopatologia , Eletrocardiografia/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/tendências , Recidiva , Apneia Obstrutiva do Sono/fisiopatologia
7.
Circ Cardiovasc Qual Outcomes ; 11(12): e004763, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30562069

RESUMO

BACKGROUND: Little is known about real-world facility-level preferences for cardiac resynchronization therapy devices with (CRT-D) and without (CRT-P) defibrillator backup. We quantify this variation at the facility level and exploit this variation to compare outcomes of patients receiving these 2 devices. METHODS AND RESULTS: Claims data from fee-for-service Medicare beneficiaries were used to identify new CRT-P and CRT-D implants, 2006 to 2012. We modeled factors associated with receipt of each device, and compared mortality, hospitalizations, and reoperations for patients receiving each using both logistic regression and instrumental variable analysis to account for confounding. Among 71 459 device recipients (CRT-P, 11 925; CRT-D, 59 534; 31% women), CRT-P recipients were older, more likely to be women, and had more comorbidities. Variation in device selection among facilities was substantial: After adjustment for patient characteristics, the odds of receiving a CRT-P (versus CRT-D) device were 7.6× higher for a patient treated at a facility in the highest CRT-P use quartile versus a facility in the lowest CRT-P use quartile. Logistic modeling suggested a survival advantage for CRT-D devices but with falsification end points indicating residual confounding. By contrast, in the instrumental variable analysis using facility variability as the proposed instrument, clinical characteristics and falsification end points were well balanced, and 1-year mortality in patients who received CRT-P versus CRT-D implants did not differ, while CRT-P patients had a lower probability of hospitalizations and reoperations in the year following implant. CONCLUSIONS: CRT-P versus CRT-D selection varies substantially among facilities, adjusted for clinical factors. After instrumental variable adjustment for clinical covariates and facility preference, survival was no different between the devices. Therefore, CRT-P may be preferred for Medicare beneficiaries considering new CRT implantation.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/tendências , Terapia de Ressincronização Cardíaca/tendências , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/tendências , Disparidades em Assistência à Saúde/tendências , Insuficiência Cardíaca/terapia , Padrões de Prática Médica/tendências , Demandas Administrativas em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Tomada de Decisão Clínica , Bases de Dados Factuais , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/mortalidade , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Medicare , Seleção de Pacientes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
9.
Circ Arrhythm Electrophysiol ; 11(9): e006542, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30354291

RESUMO

Background Implantable cardioverter defibrillators (ICDs) are an important part of therapy for many patients, yet there is little data on population characteristics, complications, or system survival in pediatric patients. Methods A retrospective review of ICD recipients in the National Cardiovascular Data Registry ICD Registry was performed from 2010 to 2016. Patient characteristics and complications between pediatric (≤21 years) and adult populations (>21 years) were compared. Variables associated with complications and early device interventions within the pediatric cohort were evaluated using multivariate modeling. Results There were 562 209 total ICD implants, of which 3461 occurred in the pediatric cohort. Among the pediatric patients, 60% of implants were for primary prevention, and nonischemic cardiomyopathy was the most common underlying disease (60%). Over time, there was an increasing trend of both primary and secondary prevention ICD implantations ( P<0.05). Compared with adults, pediatric patients were more likely to have structural heart disease, hypertrophic cardiomyopathy, and channelopathy, and to receive a single-chamber device (all P<0.001). There was no difference in inhospital complications between the adult and pediatric cohorts (2.4% versus 2.6%, P=0.3). However, among the pediatric patients, lower weight, Ebstein anomaly, worse New York Heart Association class, dual chamber, and cardiac resynchronization therapy-defibrillator were associated with greater risk of complications. Although reintervention for generator replacement or upgrade was more common in adults, the time to reintervention was shorter in the pediatric cohort. Conclusions We observed an increasing trend in ICD device implantation among pediatric patients. The pediatric cohort had similar inhospital complication rates compared with adults but had a shorter time to reintervention.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Prevenção Primária/instrumentação , Prevenção Secundária/instrumentação , Adolescente , Fatores Etários , Criança , Pré-Escolar , Morte Súbita Cardíaca/epidemiologia , Desfibriladores Implantáveis/tendências , Remoção de Dispositivo , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Cardioversão Elétrica/tendências , Feminino , Humanos , Masculino , Prevenção Primária/tendências , Falha de Prótese , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Prevenção Secundária/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Cardiovasc Electrophysiol ; 29(11): 1540-1547, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30168227

RESUMO

INTRODUCTION: Life expectancy of less than 1 year is usually a contraindication for implantable cardioverter defibrillator (ICD) implantation. The aim was to identify patients at risk of death during the first year after implantation. METHODS AND RESULTS: Data were derived from a prospective Israeli ICD Registry. Two groups of patients were compared, those who died and those who were alive 1 year after ICD implantation. Factors associated with 1-year mortality were identified on a derivation cohort. A risk score was established and validated. A total of 2617 patients have completed 1 year of follow-up after ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Age greater than 75 years (hazard ratio [HR], 2.7; 95% confidence interval [95% CI], 1.6 to 4.4), atrial fibrillation (AF; HR, 1.9; 95% CI, 1.12 to 3.17), chronic lung disease (HR, 2.0; 95% CI, 1.1 to 3.76), anemia (HR, 2.3; 95% CI, 1.3 to 3.93) and chronic renal failure (CRF; HR, 3.4; 95% CI, 1.74 to 6.6) were independent risk factors for 1-year mortality. We propose a simple AAACC ("triple A double C") score for prediction of 1-year mortality after ICD implantation: Age greater than 75 years (3 points(pts)), anemia (2 pts), AF (1 pt), CRF (3 pts) and chronic lung disease (1 pt). Mortality risk increased with rising number of points (from 1% with 0 pts to 12.5% with >4 pts). The risk score was evaluated with receiver operating characteristic curve and the area under the curve of the validation curve is 0.71 (95% CI, 0.66 to 0.76). CONCLUSIONS: Age greater than 75, AF, chronic lung disease, anemia, and CRF were independent risk factors for 1-year mortality. AAACC risk score identifies patients at high risk of death during 1 year after ICD implantation.


Assuntos
Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/mortalidade , Cardioversão Elétrica/tendências , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Análise de Dados , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco
11.
Int J Cardiol ; 272: 113-117, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30072150

RESUMO

BACKGROUND: Early recurrence of atrial fibrillation (AF) is common following a successful electrical cardioversion (ECV). The purpose of this study was to investigate the hypothesis that AF recurrence is related to atrial electrical inhomogeneity, which may influence the P wave characteristics. METHODS: Two hundred ninety-one consecutive persistent AF patients who underwent ECV were enrolled, and evaluated for AF recurrences one month after the ECV. Patients with open-heart surgery, a history of catheter ablation, and an unsuccessful ECV were excluded. The P wave duration, dispersion and P wave morphology were evaluated by 12­lead ECGs 30 min after the ECV. RESULTS: In total, 141 patients were investigated. One month after the ECV, 60 (43%) patients maintained sinus rhythm. The advanced interatrial block (aIAB; P wave duration >120 ms and biphasic P waves in the inferior leads) (Hazard ratio [HR], 4.51; 95% confidence interval [CI] 1.45-14.01, P = 0.009), P wave dispersion (HR, 1.06; 95%CI 1.02-1.09, P = 0.001), and duration of AF per month (HR, 1.03; 95%CI 1.01-1.04, P = 0.004) were independent predictors of AF recurrence. An aIAB was not associated with structural parameters such as the left atrial volume index or right atrial area. There were no differences in the serum BNP level and frequency of administering anti-arrhythmic drugs between the patients with and without recurrence. CONCLUSIONS: The risk of AF recurrence after the ECV can be predicted by the P wave characteristics. A longer P wave dispersion and the duration of AF also had a tendency for recurrence.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Cardioversão Elétrica/tendências , Eletrocardiografia/tendências , Bloqueio Interatrial/diagnóstico por imagem , Bloqueio Interatrial/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia/tendências , Cardioversão Elétrica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do Tratamento
12.
Int J Cardiol ; 272: 179-184, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30121177

RESUMO

OBJECTIVES: To evaluate the effectiveness of wearable cardioverter defibrillator (WCD) use in protecting patients from sudden cardiac arrest (SCA) while they were treated in nonhospital settings until re-implantation of an Implantable cardioverter-defibrillator (ICD) was feasible. We sought to determine whether the WCD could be successfully utilized long term (≥1 year) after ICD extraction in patients at continued risk of SCD in which ICD re-implantation was not practical. BACKGROUND: ICDs have proven to improve mortality in patients for both secondary and primary prevention of SCA. Increased ICD implantation in older patients with comorbid conditions has resulted in higher rates of cardiac device infections. Currently, a wearable cardioverter defibrillator (WCD) is an alternative management for SCA prevention in specific cases. METHODS: This a retrospective analysis based on consecutive WCD patients who underwent ICD explant due to device-related infections or mechanical reasons between April 2007 and July 2014. A total of 102 patients were identified from the national database maintained by ZOLL (Pittsburgh, PA, USA). We analyzed the reason for WCD use, demographic information, device data, compliance and duration of WCD use, detected arrhythmias and therapies, and reason for discontinuing WCD use. RESULTS: In these long term WCD users, average length of WCD use was 638 ±â€¯361 days. Nine patients (8.8%) had a sustained ventricular arrhythmia that was successfully resuscitated by the WCD. Six patients (5.8%) experienced inappropriate shocks. Two patients (1.9%) died of asystole events while wearing the WCD and an additional 10 patients died while not monitored by the WCD. Thirty-nine patients (38.2%) ended WCD use when a new ICD was implanted and 15 patients (14.7%) were still wearing the WCD at the time of analysis. CONCLUSIONS: We found that extending use of the WCD to ≥1 year is a safe and effective alternative treatment for patients with explanted ICDs who are not pacemaker dependent.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores/tendências , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/tendências , Dispositivos Eletrônicos Vestíveis/tendências , Adulto , Idoso , Desfibriladores/normas , Cardioversão Elétrica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Dispositivos Eletrônicos Vestíveis/normas
14.
J Cardiovasc Electrophysiol ; 29(10): 1425-1435, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30016005

RESUMO

BACKGROUND: The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. METHODS AND RESULTS: Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Mechanical complications (5.9%) were the commonest, followed by cardiovascular (3.6%), respiratory failure (2.4%), and pneumothorax (1.5%). Age (≥65 years), female gender (OR, 95% CI; P value) (1.08, 1.03-1.13; 0.001), and the Charlson score ≥3 (1.52, 1.45-1.60; <0.001) were significantly associated with increased mortality/complications. CONCLUSIONS: The overall complication rate in patients undergoing CRT-D has been increasing in the last decade. Age (≥65), female sex, and the Charlson score ≥3 were associated with higher complications. In patients who underwent CRT-D implantation, postoperative complications were associated with significant increases in cost.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/economia , Terapia de Ressincronização Cardíaca/economia , Desfibriladores Implantáveis/economia , Cardioversão Elétrica/economia , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Custos Hospitalares , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Terapia de Ressincronização Cardíaca/tendências , Dispositivos de Terapia de Ressincronização Cardíaca/tendências , Comorbidade , Bases de Dados Factuais , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Cardioversão Elétrica/tendências , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Custos Hospitalares/tendências , Mortalidade Hospitalar , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
15.
Int J Cardiol ; 272: 123-129, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30049498

RESUMO

BACKGROUND: Atrial fibrillation (AF) care should strive for more informed, involved and empowered patients. However, few effective educational programs are available. The aim of this study was to evaluate the effectiveness of an online tailored education platform to inform AF patients undergoing a direct current cardioversion (DCC) or a pulmonary vein isolation (PVI). METHODS: 120 AF patients requiring DCC or PVI were allocated to an online education group (n = 35), a standard care group despite having online access (n = 36; randomized with group 1), and a group without a computer/tablet/smartphone receiving standard care (n = 49). The Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ), supplemented with procedure-specific questions, had to be completed 1-3 weeks before hospitalization, at hospitalization, and 6 and/or 12 weeks post-procedurally. RESULTS: Major AF-related and procedure-related knowledge gaps were shown. The online tailored education group scored significantly better at hospitalization compared to baseline (P = 0.001). This knowledge increase was retained after 6 (P = 0.010) and 12 (P < 0.001) weeks. In the online standard care group there was no change in knowledge from planning till hospitalization (P = 1.000), although knowledge was improved 6 weeks post-procedurally (P = 0.010). Knowledge did not improve in the group without computer/tablet/smartphone at any time (P = 0.248). Most patients indicated that the platform was easy to use (87.9%), understandable (97.0%), and 72.7% indicated that an online platform was their preferred way to receive future AF-related information. CONCLUSIONS: Tailored online education is an effective strategy to improve AF- and procedure-related knowledge with lasting effects up to 12 weeks post-procedurally. The platform was positively evaluated by patients.


Assuntos
Fibrilação Atrial/terapia , Instrução por Computador/métodos , Cardioversão Elétrica/métodos , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Veias Pulmonares , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Instrução por Computador/tendências , Cardioversão Elétrica/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/tendências , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
16.
Europace ; 20(7): 1218-1224, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29762683

RESUMO

The aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess peri-procedural practices, implantation techniques, and short-term procedure-related complications associated with implantation of subcutaneous implantable cardioverter-defibrillator (S-ICD) or transvenous implantable cardioverter-defibrillator (TV-ICD), across tertiary European electrophysiology centres. An internet-based electronic questionnaire concerning implantation settings, peri-procedural routines, techniques, personnel, complications, and patient outcomes was sent to the centres routinely implanting both TV-ICDs and S-ICDs. The centres were requested to prospectively include consecutive patients implanted with either TV-ICD or S-ICD during the 8-week enrolment period. Overall, 20 centres from 6 countries enrolled 429 consecutive patients. Subcutaneous implantable cardioverter-defibrillators (20%) compared with TV-ICD were implanted mainly under general anaesthesia (72% vs. 14%), in the surgical operation room settings (69% vs. 43%), with more frequent prophylactic antibiotic administration (82% vs. 91%), and post-implant defibrillation testing (85% vs. 7%, all P < 0.05). Feasibility (implantation duration of 45 min) and short-term complication rates (4%) were comparable for S-ICDs and TV-ICDs, but the spectrum of complications varied, despite different baseline characteristics of patients undergoing the S-ICD vs. TV-ICD implantation. This EHRA snapshot survey provides important insights into the implantable cardioverter-defibrillator implantation routines and patient outcomes. Our study showed differences between the S-ICD and TV-ICD implantation routines with respect to implantation settings, peri-procedural management, and pre-defined procedural endpoints. However, the comparable duration of S-ICD or TV-ICD implantation and similar rates of peri-procedural complications indicate that both devices can be routinely used in clinical practice.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/tendências , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Europa (Continente)/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Desenho de Prótese , Resultado do Tratamento , Adulto Jovem
17.
J Am Heart Assoc ; 7(10)2018 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-29748177

RESUMO

BACKGROUND: The transvenous implantable cardioverter-defibrillator (ICD) lead is the most common source of complications in a traditional ICD system. This investigation aims to determine the incidence, predictors, and costs associated with these complications using a large insurance database. METHODS AND RESULTS: Data from the OptumLabs™ Data Warehouse, which include diagnosis, physician and procedure codes, and claims from patient hospitalizations, were analyzed. Patients with a de novo ICD or cardiac resynchronization therapy defibrillator implanted from January 1, 2003, through June 30, 2015, were included; those who did not have continuous coverage beginning 1 year before implantation were excluded, resulting in 40 837 patients followed up over an average of 2.3±2.1 years. Patients were followed up until they had the procedure or their last active date in the database. Of 20 580 device procedures, 2165 (5.3%) and 771 (1.9%) had mechanical and infectious complications, respectively. The 5-year rate of freedom from mechanical complication was 92.0% and 89.3% for ICDs and cardiac resynchronization therapy defibrillators, respectively. Infectious complications were more likely in patients with a history of atrial fibrillation, diabetes mellitus, and renal disease, and the risk increased with subsequent device procedures. Younger age, female sex, lack of comorbidities, and implantations between 2003 and 2008 were associated with more mechanical complications. CONCLUSIONS: Incidence of mechanical and infectious complications of transvenous ICD leads over long-term follow-up is much higher in the real world than in clinical studies. In our study cohort, 1 of 4 transvenous ICD leads had mechanical complications when followed up to 10 years. The high rate of reintervention leads to additional complications.


Assuntos
Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/tendências , Falha de Prótese/tendências , Infecções Relacionadas à Prótese/epidemiologia , Demandas Administrativas em Assistência à Saúde , Idoso , Data Warehousing , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/economia , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
18.
J Cardiovasc Electrophysiol ; 29(7): 1010-1016, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29626366

RESUMO

INTRODUCTION: Experience with the subcutaneous implantable cardioverter-defibrillator (S-ICD) is expanding rapidly. However, data on long-term performance or complications related to elective generator replacement are lacking. METHODS: Follow-up (FU) data of all patients implanted between December 2008 and April 2011 were collected. Complications were defined as those requiring surgical intervention. Kaplan-Meier estimates for complication and shock rates, with corresponding 95% confidence intervals (CI), were calculated. RESULTS: One hundred and eighteen patients were included. Median FU was 6.1 years (IQR 5.6-6.5 years). Short-term complication rate (0-30 days) was 3% (CI 0-6%). Long-term complication rate at 6 years was 19% (CI 12-26%), corresponding with an annual complication rate of 3%. One patient in this cohort developed a need for a transvenous ICD (TV-ICD) in order to provide pacing for bradycardia (1%). Six patients were implanted with a TV-ICD after experiencing an S-ICD complication for which extraction was necessary. In total, 10 S-ICDs were extracted; none resulted in a complication. Eight patients had a nonsystemic ICD-related infection and no lead failures were observed. The majority, 68 (58%) patients, received an elective generator replacement. Two patients had a complication related to generator replacement (3%). Battery longevity was 5.6 years (IQR 5.2-6.1). Appropriate and inappropriate shock rates of 6-year estimates were 17% (CI 9-25%) and 21% (CI 15-27%), respectively. CONCLUSIONS: This cohort represents the longest follow-up to date and shows a low annual complication rate without lead failures or systemic infections. Battery longevity of the first S-ICD generation results in relative early generator replacement procedures.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/tendências , Adulto , Estudos de Coortes , Desfibriladores Implantáveis/normas , Cardioversão Elétrica/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tela Subcutânea/cirurgia , Fatores de Tempo , Resultado do Tratamento
20.
Int J Cardiol ; 258: 133-137, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29544919

RESUMO

BACKGROUND: Post-procedural recovery following sub-cutaneous ICD (S-ICD) implantation is feared to be more painful and to require more prolonged hospital admission. The purpose of this study was to compare peri-procedural and short clinical outcomes of the S-ICD vs. the Transvenous ICD (TV-ICD). METHODS: We conducted a single-center cross-sectional study including all consecutive patients who underwent S-ICD implantation by the same operator since January 2016 and a gender and age-matched control group with all single chamber TV-ICD implanted patients over a contemporary time period. RESULTS: Thirty-one patients (sex ratio 1/5; mean age 58.7±13.2years) with S-ICD were compared to 31 matched TV-ICD patients. Duration of the implant procedure was significantly longer for the S-ICD (58.0±24.4min vs 41.7±20.8min TV-ICD, p<0.01). Mean fluoroscopy time for the TV-ICD was 3.5±3.6min vs 0.1±0.01min for all S-ICD patients (p<0.01). Requirement of on-demand analgesia administration, and duration of hospitalization (1.5days for both groups; p=NS) were similar in the two groups. No peri-procedural events were reported, and after a mean follow-up of 6months, the only complication was a pocket infection requiring reintervention in the TV-ICD group. CONCLUSIONS: The S-ICD appears to be as effective and safe as the conventional single chamber TV-ICD. Duration of hospital admission and need of on-demand analgesia are also comparable for S-ICD patients.


Assuntos
Analgesia/tendências , Anestesia Geral/tendências , Desfibriladores Implantáveis/tendências , Cardioversão Elétrica/tendências , Admissão do Paciente/tendências , Idoso , Estudos Transversais , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tela Subcutânea , Fatores de Tempo , Resultado do Tratamento
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