Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.846
Filtrar
1.
Nursing ; 50(2): 24-29, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31904617

RESUMO

Historically, MRI was contraindicated in patients with cardiovascular implantable electronic devices because the devices' metallic components made this imaging study unsafe. Advances over the last decade have now made MRI safe for many of these patients. This article examines the risks of MRI technology for this patient population and reviews recent guidelines from the Heart Rhythm Society.


Assuntos
Desfibriladores Implantáveis , Imagem por Ressonância Magnética/normas , Marca-Passo Artificial , Segurança do Paciente/normas , Desfibriladores Implantáveis/efeitos adversos , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Imagem por Ressonância Magnética/enfermagem , Marca-Passo Artificial/efeitos adversos
2.
Int Heart J ; 60(5): 1206-1210, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484877

RESUMO

A 7-year-old female suffering from syncope attacks and deafness was genetically diagnosed with Jervell and Lange-Nielsen syndrome (JLNS). A transvenous-designed shock lead and implantable cardioverter-defibrillator (ICD) were atypically implanted subcutaneously, because the patient's body was small. Six years after implantation, we confirmed the patient's eligibility for a subcutaneous ICD (S-ICD) based on electrocardiogram screening. The implanted ICD system was replaced with a new standard S-ICD system. Implantation of the S-ICD may be considered a reliable and safe option in young patients with JLNS, even if their electrocardiograms show remarkable prolongation of the QT interval and T-wave alternans.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Eletrocardiografia/métodos , Síndrome de Jervell-Lange Nielsen/diagnóstico , Síndrome de Jervell-Lange Nielsen/terapia , Canal de Potássio KCNQ1/genética , Criança , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Predisposição Genética para Doença , Humanos , Síndrome de Jervell-Lange Nielsen/complicações , Linhagem , Retratamento , Síncope/diagnóstico , Síncope/etiologia , Síncope/terapia , Fatores de Tempo , Resultado do Tratamento
4.
Pol Merkur Lekarski ; 47(278): 65-66, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473754

RESUMO

A CASE REPORT: A 65-year-old male patient underwent left-sided placement of implantable cardioverter-defibrillator. At three years after implantation he emerged complaining on left upper limb and left-sided neck edema. Left brachicephalic vein thrombosis due to device leads was recognized. The attending cardiologist referred the patient to university radiology department for venous angioplasty but the patient was admitted to cardiology department. Coronary angiography was performed due to suspicion of ischemic heart disease. However, it showed the presence of foreign body in cardiovascular system - completely intravascular round-tipped guide wire used in Seldinger technique for insertion of the endocardial lead abandoned in left subclavian vein and reaching to superior vena cava. Patient was transferred to third-degree reference lead extraction center. The procedure was performed under general anesthesia in hybrid operating room. Via femoral vein access we introduced Needle's Eye Snare and grasped the guide wire. Then, using polytetrafluoroethylene sheath the tissue adhesions were dissected and the complete guide wire was retrieved.


Assuntos
Desfibriladores Implantáveis , Migração de Corpo Estranho , Síndrome da Veia Cava Superior , Idoso , Desfibriladores Implantáveis/efeitos adversos , Humanos , Masculino , Síndrome da Veia Cava Superior/etiologia , Veia Cava Superior
6.
Dermatol Surg ; 45(10): 1228-1236, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31318829

RESUMO

BACKGROUND: In dermatologic and procedural surgery settings, there are commonly encountered devices in patients. Safe surgical planning requires familiarity with these devices. OBJECTIVE: To review the current implanted devices in patients and recommendations for surgical planning around these devices. METHODS AND MATERIALS: A comprehensive review using PubMed and published device recommendations was performed, searching for those most relevant to dermatologic surgery. RESULTS: Devices such as pacemakers and implantable cardiac defibrillators, deep brain stimulators, cochlear implants, and various nerve stimulators are potential devices that may be encountered in patients and specific recommendations exist for each of these devices. CONCLUSION: Dermatologic surgeons' knowledge of implanted devices in patients is paramout to safe surgical procedures.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Planejamento de Assistência ao Paciente , Neoplasias Cutâneas/cirurgia , Implantes Cocleares/efeitos adversos , Estimulação Encefálica Profunda/instrumentação , Desfibriladores Implantáveis/efeitos adversos , Humanos , Neuroestimuladores Implantáveis/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Estimulação do Nervo Vago/instrumentação
8.
Medicine (Baltimore) ; 98(30): e16548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348275

RESUMO

The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead.This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/métodos , Desenho de Equipamento/efeitos adversos , Fluoroscopia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Feminino , Fluoroscopia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veia Cava Superior/patologia , Veia Cava Superior/cirurgia , Adulto Jovem
9.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31167936

RESUMO

We present the case of a girl aged 17 years and 10 months who has a strong family history of long QT syndrome and genetic testing confirming the diagnosis of long QT syndrome in the patient also. She was initially medically treated with ß-blocker therapy; however, after suffering 1 episode of syncope during exertion, she underwent placement of an implantable cardioverter defibrillator. Since then, she has never had syncope. However, during the few months before this presentation, she experienced shocks on multiple occasions without any underlying arrhythmias. These shocks are disconcerting for her, and she is having significant anxiety about them. She requests the defibrillator to be inactivated. However, her mother, who also shares the diagnosis of long QT syndrome, disagrees and wants the defibrillator to remain active. The ethics team is consulted in this setting of disagreement between an adolescent, who is 2 months shy of the age of maturity and medical decision-making, and her mother, who is currently responsible for her medical decisions. The question for the consultation is whether it would be ethically permissible for the doctors to comply with the patient's request to turn off the defibrillator or whether the doctors should follow the mother's wishes until the patient is 18 years of age.


Assuntos
Desfibriladores Implantáveis/ética , Consentimento Informado por Menores/ética , Síndrome do QT Longo/terapia , Consentimento dos Pais/ética , Participação do Paciente , Adolescente , Fatores Etários , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/psicologia , Feminino , Humanos , Consentimento Informado por Menores/psicologia , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/psicologia , Relações Mãe-Filho/psicologia , Consentimento dos Pais/psicologia , Participação do Paciente/psicologia , Relações Médico-Paciente/ética , Relações Profissional-Família/ética
10.
Cardiology ; 142(3): 129-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31189160

RESUMO

OBJECTIVE: This study sought to assess the impact of treatment with digitalis on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients with atrial fibrillation (AF) and heart failure (HF). BACKGROUND: The data regarding outcomes of digitalis therapy in ICD recipients are limited. METHODS: A large retrospective registry was used, including consecutive ICD recipients with episodes of ventricular tachyarrhythmia between 2002 and 2016. Patients treated with digitalis were compared to patients without digitalis treatment. The primary prognostic outcome was first recurrence of ventricular tachyarrhythmia at 5 years. Kaplan-Meier and multivariable Cox regression analyses were applied. RESULTS: A total of 394 ICD recipients with AF and/or HF was included (26% with digitalis treatment and 74% without). Digitalis treatment was associated with decreased freedom from recurrent ventricular tachy-arrhythmias (HR = 1.423; 95% CI 1.047-1.934; p = 0.023). Accordingly, digitalis treatment was associated with decreased freedom from appropriate ICD therapies (HR = 1.622; 95% CI 1.166-2.256; p = 0.004) and, moreover, higher rates of rehospitalization (38 vs. 21%; p = 0.001) and all-cause mortality (33 vs. 20%; p = 0.011). CONCLUSION: Among ICD recipients suffering from AF and HF, treatment with digitalis was associated with increased rates of recurrent ventricular tachyarrhythmias and ICD therapies. However, the endpoints may also have been driven by interactions between digitalis, AF, and HF.


Assuntos
Fibrilação Atrial/terapia , Desfibriladores Implantáveis/estatística & dados numéricos , Digitoxina/efeitos adversos , Insuficiência Cardíaca/terapia , Taquicardia Ventricular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/mortalidade , Desfibriladores Implantáveis/efeitos adversos , Digitoxina/uso terapêutico , Feminino , Alemanha/epidemiologia , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Taquicardia Ventricular/etiologia
11.
Orv Hetil ; 160(26): 1015-1024, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31230470

RESUMO

Over the past decades, 18F-FDG-PET/CT imaging has been recognized as an indispensable tool in the diagnosis, staging and treatment monitoring of cancer. This modern imaging technique combining functional and morphologic information has approved indications not only in oncology but in clinical cardiology as well. In the current review we discuss the specific requirements of patient preparation and image acquisition protocol for cardiac 18F-FDG-PET/CT. We review the literature in some cases highlighted by our own examinations of well-known "gold standard" viability and onco-cardiology examinations while placing special emphasis on inflammatory disorders involving the heart. This relatively newer class of indications includes prosthetic valve endocarditis, cardiac implantable device infection, myocardial inflammation of varying origin such as sarcoidosis where 18F-FDG-PET/CT appears to be particularly useful in the differential diagnosis of cases where standard investigation is non-diagnostic or equivocal. Orv Hetil. 2019; 160(26): 1015-1024.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/microbiologia , Miocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Cardiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Miocardite/microbiologia , Infecções Relacionadas à Prótese/etiologia , Compostos Radiofarmacêuticos
12.
Kardiol Pol ; 77(5): 561-567, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31066721

RESUMO

BACKGROUND: The rate of cardiac device-related infective endocarditis (CDRIE) is increasing worldwide, but no detailed data are available for Poland. AIMS: We aimed to evaluate clinical, diagnostic, and therapeutic data of patients hospitalized due to CDRIE in 22 Polish referential cardiology centers from May 1, 2016 to May 1, 2017. METHODS: Participating cardiology departments were asked to fill in a questionnaire that included data on the number of hospitalized patients, number and types of implanted cardiac electrotherapy devices, and number of infective endocarditis cases. We also collected clinical data and data regarding the management of patients with CDRIE. RESULTS: Overall, 99 621 hospitalizations were reported. Infective endocarditis unrelated to cardiac device was the cause of 596 admissions (0.6%), and CDRIE, of 195 (0.2%). Pacemaker was implanted in 91 patients with CDRIE (47%); cardioverter­defibrillator, in 51 (26%); cardiac resynchronization therapy­defibrillator, in 48 (25%); and cardiac resynchronization therapy­pacemaker, in 5 (2.5%). The most common symptoms were malaise (62%), fever/chills (61%), cough (21%), chest pain (19.5%), and inflammation of the device pocket (5.6%). Cultures were positive in 77.5% of patients. The cardiac device was removed in 91% of patients. The percutaneous approach was most common for cardiac device removal. All patients received antibiotic therapy, and 3 patients underwent a heart valve procedure. Transesophageal echocardiography was performed in 80% of patients. The most common complication was heart failure (25% of patients). CONCLUSIONS: The clinical profile, pathogen types, and management strategies in Polish patients with CDRIE are consistent with similar data from other European countries. Transesophageal echocardiography was performed less frequently than recommended. The removal rate in the Polish population is consistent with the general rates observed for interventional treatment in patients with CDRIE.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endocardite/etiologia , Marca-Passo Artificial/efeitos adversos , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Serviço Hospitalar de Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Endocardite/diagnóstico por imagem , Endocardite/epidemiologia , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/estatística & dados numéricos , Polônia/epidemiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia
13.
Kardiol Pol ; 77(6): 618-623, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31066727

RESUMO

BACKGROUND: High-energy implantable cardioverter-defibrillator (ICD) therapy may increase serum troponin (cTnI) concentration.   Aims: We aimed to assess an impact of cTnI concentration after ICD high-energy therapy on mortality. METHODS: A total of 150 patients aged 64.2 +/- 12.8 years admitted to the Emergency Departments (EDs) due to at least one electrical shock during the last 24 hours with measured serum cTnI concentration at admission were included. Age, gender, comorbidities, shocks' numbers, therapy appropriateness, serum creatinine concentration, and left ventricular ejection fraction were noted for the retrospective analysis. Survival was obtained using the personal identification numbers (PESEL), on November 2018 until death or a period of three years had elapsed (1057 days). RESULTS: cTnI concentration was increased in 92 (61.3%) patients. The mortality rate was related to age - HR: 1.04, 95% CI: 1.01-1.08, p = 0.026; increased cTnI concentration - HR: 2.88, 95% CI: 1.30-6.37, p = 0.009; diabetes - HR: 2.19, 95% CI: 1.09-4.39, p = 0.027; ischemic heart disease - HR: 2.96, 95% CI: 1.11-7.87, p = 0.030, serum creatinine concentration - HR: 2.17, 95% CI: 1.18-4.00, p = 0.013; LVEF (HR 0.95, 95% CI: 0.91-0.99, p = 0.009), and previous or current CABG or PCI (HR: 0.38, 95% CI: 0.15-0.96, p = 0.040 and HR: 0.29, 95% CI: 0.13-0.65, p = 0.003, respectively). CONCLUSIONS: Increased mortality rate in patients with ICD shocks is multifactorial. Increased cTnI concentration at ED admission, but not the number of ICD shocks, is an independent marker of higher long-term mortality.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Troponina I/sangue , Idoso , Traumatismos por Eletricidade/sangue , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 98(19): e15490, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083185

RESUMO

BACKGROUND: Lead-related complication is an important drawback of trans-venous implantable cardioverter-defibrillators (TV-ICD). The subcutaneous ICD (S-ICD) was developed to overcome ICD lead associated complications; however, whether the S-ICD confers enhanced clinical benefits compared with TV-ICD remains unclear. The present systematic review and meta-analysis aimed to assess TV-ICD and S-ICD for safety, efficacy, and in-hospital outcomes in the prevention of sudden cardiac death (SCD) in patients not requiring pacing. METHODS: The Medline, PubMed, EmBase, and Cochrane Library databases were searched for studies comparing TV-ICD and S-ICD. RESULTS: A total of 9 eligible studies, including 5 propensity-matched case-control, 3 retrospective, and 1 cross-sectional studies were identified, assessing 7361 patients in all. Pool analyses demonstrated that SICD were associated with lower lead-related complication rates [odds ratio (OR) = 0.13; 95% confidence interval [CI] 0.05-0.33; I = 0%], and S-ICD was more beneficial in terms of reducing ICD shocks [OR = 0.48; 95% CI 0.32-0.72, I = 4%]. In addition, the patients administered S-ICD tend to have shorter length of hospital stay after implantation (SMD = -0.06; 95% CI -0.11 to 0.00, I = 0%) and reduce total complication rates (OR = 0.72; 95% CI 0.50-1.03; I = 18%), non-decreased quality of life (QoL). Moreover, both devices appeared to perform equally well with respect to infection rate and death. CONCLUSIONS: Available overall data suggested that S-ICD is associated with reducing lead-related complications, ICD shocks. In addition, S-ICD has tendency to shorten hospitalization and reduce total complications, although the difference is no significant. Equivalent death rate, infection, and QoL were found between 2 groups. Therefore, S-ICD could be considered an alternative approach to TV-ICD in appropriate patients for SCD prevention.


Assuntos
Doenças Cardiovasculares/terapia , Desfibriladores Implantáveis , Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento , Humanos , Complicações Pós-Operatórias
15.
J Med Case Rep ; 13(1): 161, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-31126329

RESUMO

BACKGROUND: There are still many pendent issues about the effective evaluation of cardiac resynchronization therapy impact on functional mitral regurgitation. In order to reduce the intrinsic difficulties of quantification of functional mitral regurgitation itself, an automatic quantification of real-time three-dimensional full-volume color Doppler transthoracic echocardiography was proposed as a new, rapid, and accurate method for the assessment of functional mitral regurgitation severity. Recent studies suggested that images of left ventricle flow by echo-particle imaging velocimetry could be a useful marker of synchrony. Echo-particle imaging velocimetry has shown that regional anomalies of synchrony/synergy of the left ventricle are related to the alteration, reduction, or suppression of the physiological intracavitary pressure gradients. We describe a case in which the two technologies are used in combination during acute echocardiographic optimization of left pacing vector in a 63-year-old man, Caucasian, who showed worsening heart failure symptoms a few days after an implant, and the effect of the device's optimization at 6-month follow-up. DISCUSSION: The degree of realignment of hemodynamic forces, with quantitative analysis of the orientation of blood flow momentum (φ), can represent improvement of fluid dynamics synchrony of the left ventricle, and explain, with a new deterministic parameter, the effects of cardiac resynchronization therapy on functional mitral regurgitation. Real-time three-dimensional color flow Doppler quantification is feasible and accurate for measurement of mitral inflow, left ventricular outflow stroke volumes, and functional mitral regurgitation severity. CONCLUSION: This clinical case offers an innovative and accurate approach for acute echocardiographic optimization of left pacing vector. It shows clinical utility of combined three-dimensional full-volume color Doppler transthoracic echocardiography/echo-particle imaging velocimetry assessment to increase response to cardiac resynchronization therapy, in terms of reduction of functional mitral regurgitation, improving fluid dynamics synchrony of the left ventricle.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/terapia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/terapia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/terapia , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Grupo com Ancestrais do Continente Europeu , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/fisiopatologia
16.
JACC Cardiovasc Imaging ; 12(4): 622-636, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30947905

RESUMO

With the expanding use of cardiac implantable electronic device (CIEDs) in an ever-aging population, the looming problem of CIED-associated interference with the tricuspid valve is significant. The first pacemaker was implanted in 1958 for severe symptomatic bradycardia. The concept of a device to avert sudden cardiac death (i.e., the defibrillator) was first published in 1970 by Mirowski and Mower. The first reports of CIED-mediated tricuspid valve apparatus interference surfaced in the late 1900s, but it was not until recently that concentrated efforts have been made to better define the scope of CIED-mediated interference with the tricuspid valve apparatus. Because stopping implantation of these devices is not an option, better understanding of their mechanical complications could potentially lead to improvements in device design or epicardial device implantation, as an alternative, in select patients. This review covers existing evidence for CIED-mediated tricuspid regurgitation, discusses potential mechanisms of CIED-mediated interference of the tricuspid valve apparatus, provides an overview of how to diagnose CIED-mediated interference on echocardiography, and discusses management strategies for patients who have CIED-mediated severe tricuspid regurgitation.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Hemodinâmica , Marca-Passo Artificial/efeitos adversos , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/fisiopatologia , Cateterismo Cardíaco , Remoção de Dispositivo , Diuréticos/uso terapêutico , Ecocardiografia , Implante de Prótese de Valva Cardíaca , Humanos , Desenho de Prótese , Fatores de Risco , Índice de Gravidade de Doença , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/terapia
17.
Prog Cardiovasc Dis ; 62(3): 242-248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31004607

RESUMO

Patients with cardiomyopathy and reduced left ventricular (LV) ejection fraction are at risk of heart failure (HF) symptoms and sudden cardiac arrest (SCA). In selected HF patients, cardiac resynchronization therapy (CRT) provides LV reverse remodeling and improves the cellular and molecular function. However controversial results have been published regarding the effect of CRT on the residual ventricular arrhythmia risk. Indeed, the decrease in SCA risk is inconsistent and some factors strongly influence the residual post implantation arrhythmic risk. Conversely, proarrhythmic effect of CRT has been previously described. In this review we aim to describe the relationship between CRT implantation and the SCA risk decrease and discuss the patients who only require cardiac resynchronization therapy-pacemaker and those who need a concomitant implantable cardioverter defibrillator.


Assuntos
Terapia de Ressincronização Cardíaca , Morte Súbita Cardíaca/prevenção & controle , Insuficiência Cardíaca/terapia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/complicações , Humanos , Volume Sistólico , Disfunção Ventricular Esquerda/complicações
18.
J Card Surg ; 34(6): 424-427, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017328

RESUMO

BACKGROUND AND AIM OF THE STUDY: Cardiac implantable electronic device (CIED) implantation is associated with an increase in CIED infection. For pacemaker-dependent patients, temporary pacemaker leads are implanted until infection remission, which allows new CIED implantation. We compared the outcome of pacemaker-dependent patients with infected CIED based on whether a combined single procedure of epicardial pacemaker implantation with system extraction or a temporary transjugular pacemaker implantation with interval system implantation was performed. METHODS: This retrospective study included pacemaker-dependent patients with CIED infection who were divided into two groups: the Tempo and Epi groups. The Tempo group received temporary transvenous pacemaker connected to an external pulse generator. After infection remission, a new permanent pacemaker was implanted, and the temporary pacemaker leads were removed. The Epi group received implantable epicardial right-ventricular pacemaker through infrasternal inferior pericardiotomy, and a permanent pulse generator was implanted through the same incision between the subcutaneous tissue and abdominal fascia. RESULTS: Sixty-six patients were included. Forty-two patients with epicardial pacemakers were discharged after 9.5 ± 8.8 days without infection of the newly implanted epicardial pacemaker. Patients with temporary transjugular pacemaker lead were discharged 23 ± 15 days after receiving permanent pacemakers. No serious complications were recorded in the Epi group. CONCLUSIONS: CIED infections in pacemaker-dependent patients can be treated through epicardial pacemaker implantation that allows early patient mobility and reduces hospital stay with no risk of epicardial pacemaker infection. Epicardial pacemakers can be used as a bridge until permanent intravenous CIED is implanted or as a replacement for permeant intravenous CIED.


Assuntos
Desfibriladores Implantáveis , Remoção de Dispositivo/métodos , Marca-Passo Artificial , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Desfibriladores Implantáveis/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Pericardiectomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
19.
J Cardiovasc Med (Hagerstown) ; 20(6): 372-378, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30950985

RESUMO

BACKGROUND: Finding of intracardiac lead masses in patients with cardiac implantable electronic devices remains controversial, as such masses have been observed in cases of exclusively local infections whereas they have not been recognized in patients with positive cultures of intravascular lead fragments. In this study, we aim to describe the prevalence of intracardiac lead masses in true asymptomatic patients with cardiac implantable electronic devices, to identify their predictive factors and to define their prognostic impact at long-term follow-up. METHODS: Seventy-eight consecutive patients admitted over a 6-month period for elective generator replacement without clinical evidence of infection were evaluated by transthoracic and transesophageal echocardiography and prospectively followed at in-clinic follow-up visits. RESULTS: Lead masses were found in 10 patients (12.8%). These patients had more frequently right ventricular dysfunction at univariate analysis (OR 2.71, P = 0.010) and after baseline variables adjustment (hazard ratio 6.25, P = 0.012). At 5-year follow-up without any specific therapy, none of the patients suffered from any cardiac device infections, or developed clinical signs of infections. CONCLUSION: There is an evidence of clinical lead masses in asymptomatic patients with cardiac implantable electronic devices. The value of these findings is still debated for aetiological interpretation and for therapeutic strategy, but they are not necessarily associated with an infection.


Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Cardiopatias/epidemiologia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA