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1.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 848-852, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076622

RESUMO

Objective: To investigate the efficacy and safety of left bundle branch area pacing (LBBaP) with the new simplified approach (nine-partition method). Methods: A total of 118 patients with clinical indications and received pacemaker implantation from December 1, 2018 to December 31, 2019 in Beijing Anzhen Hospital were enrolled. LBBaP was performed with the nine-partition method (in the right anterior oblique 30° position, the ventriculogram was divided into nine partitions and the initial implant sites were located in the lower base 1/3 partitions). In X-ray image, the 3830 lead is located in the left bundle branch area, the unipolar pacing QRS wave is in the form of right bundle branch block, and the peak time from stimulation to left ventricular activation<90 ms is defined as successful operation. The clinical characters, such as the methods of venipuncture, electrode parameters, operation duration, fluoroscopy duration, the peak time from stimulation to left ventricular, pacemaker types, surgical success rate, complications, and immediate postoperative ECG parameters were collected. The patients were followed up after the operation, and the electrode parameters and postoperative complications were recorded. Results: This study is a retrospective study. There were 62 (52.5%) male patients in this cohort, the average age was (65.9±13.4) years old,and there were 49(41.5%) sick sinus syndrome, 6(5.1%) abnormal sinus node and atrioventricular node simultaneously, 63(53.4%) atrioventricular block, 26(22.0%) atrial fibrillation, 20(16.9%) cardiomyopathy; the baseline duration of QRS was (109.21±39.03) ms. Successful LBBaP was achieved in 109 patients with"nine-partition method"and the success rate was 92.4%; 104 patients (95.5%) were axillary vein puncture, 5 (4.6%) were subclavian vein puncture; the operation duration was (80.3±23.0) min, the fluoroscopy duration was (12.29±5.13) min; the QRS duration after LBBaP was (116.36±18.11) ms. The threshold of the left bundle branch (LBB) lead was (0.92±0.63) V, the R wave amplitude was (10.60±5.04) mV and the impedance was (798.71±194.90) Ω. In 1 V pacing, the peak time from stimulation to left ventricular activation was (67.91±12.15) ms, and in 5 V pacing was (67.52±12.45) ms; 1 case (0.9%) with a single-chamber pacemaker implanted, 106 cases (97.3%) with dual-chamber pacemaker and 2 cases (1.8%) with three-chamber pacemakers. There were no hematomas, pneumothorax, hemothorax, electrode dislocation, infection, and capsular hemorrhage and other serious surgery-related complications during the operation. A total of 97 patients (89.0%) were followed up for (6.21±2.90) months. The electrode parameters of all patients were stable and no complications observed. Conclusions: The LBBaP with nine-partition method is a simple, safe and effective physiological pacing approach. However, its long-term effect still needs to be further verified.


Assuntos
Bloqueio Atrioventricular , Estimulação Cardíaca Artificial , Idoso , Bloqueio de Ramo/terapia , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5012-5015, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019112

RESUMO

Accurate assessment of pacemaker function or malfunction is essential to make clinical interpretations on pacemaker therapy and patient symptoms. This article presents an innovative approach for detecting pacemaker pulses at sampling frequency as low as 125Hz. The proposed method is validated in wide range of simulated clinical ECG conditions such as arrhythmia (sinus rhythms, supraventricular rhythms, and AV blocks), pulse amplitudes (~100µV to ~3mV), pulse durations (~100µs to ~2ms), pacemaker modes and types (fixed-rate or on-demand single chamber, dual chamber, and bi-ventricular pacing), and physiological noise (tremor). The proposed algorithm demonstrates clinically acceptable detection accuracies with sensitivity and PPV of 98.1 ± 4.4 % and 100 %, respectively. In conclusion, the approach is well suited for integration in long-term wearable ECG sensor devices operating at a low sample frequency to monitor pacemaker function.Clinical Relevance- The proposed system enables real-time long-term continuous assessment of the proper functioning of implanted pacemaker and progression of treatment for cardiac conditions using battery-powered wearable ECG monitors.


Assuntos
Marca-Passo Artificial , Arritmias Cardíacas/diagnóstico , Estimulação Cardíaca Artificial , Eletrocardiografia , Frequência Cardíaca , Humanos
3.
Int Heart J ; 61(5): 1059-1069, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921666

RESUMO

Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.


Assuntos
Aorta Torácica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Aorta Torácica/anatomia & histologia , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Tamponamento Cardíaco/epidemiologia , Infarto Cerebral/epidemiologia , Infarto Cerebral/etiologia , Angiografia por Tomografia Computadorizada , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Marca-Passo Artificial , Pericardiocentese , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento
4.
Int Heart J ; 61(5): 922-926, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921670

RESUMO

The incidence of ventricular arrhythmia in patients with an implanted pacemaker is not yet known. The aim of this study was to analyze non-sustained ventricular tachycardia (NSVT) episodes based on stored electrograms (EGM) and determine the occurrence rate and risk factors for NSVT in a pacemaker population.This study included 302 consecutive patients with a dual-chamber pacemaker. A total of 1024 EGMs stored in pacemakers as ventricular high-rate episodes were analyzed. The definition of NSVT was ≥ 5 consecutive ventricular beats at ≥ 150 bpm lasting < 30 seconds.In baseline, most patients (94.8%) had ≥ 60% left ventricular ejection fraction. Of 1024 EGMs, 420 (41.0%) showed appropriate NSVT episodes, as well as premature atrial contractions, atrial tachyarrhythmia, or atrial fibrillation with a rapid ventricular response, whereas other EGMs did not show an actual ventricular arrhythmia. On EGM analysis, during a mean follow-up period of 46.1 months, NSVT occurred one or more times in 82 patients (33.1%). On multivariate analysis, ≥ 50% right ventricular pacing was an independent risk factor for NSVT (odds ratios, 4.519; P < 0.001), but NSVT was not associated with increased all-cause mortality.Moreover, in the pacemaker population, ≥ 50% right ventricular pacing is an independent risk factor for NSVT; however, NSVT was not associated with increased all-cause mortality because of the preserved left ventricular function.


Assuntos
Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Mortalidade , Marca-Passo Artificial , Taquicardia Ventricular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial , Complexos Atriais Prematuros , Feminino , Ventrículos do Coração , Humanos , Armazenamento e Recuperação da Informação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Taquicardia Supraventricular
5.
Int Heart J ; 61(5): 879-887, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921674

RESUMO

Since the number of elderly patients suffering from acute myocardial infarction (AMI) has been increasing in developed countries, primary percutaneous coronary intervention (PCI) for the very elderly aged ≥80 years old is already common. The study aimed to examine the determinants of in-hospital death among the very elderly with AMI in current PCI era. We included 412 consecutive AMI patients aged ≥ 80 years old who received PCI to the culprit lesion; however, 42 patients (10.2%) died during the index hospitalization. Thus, univariate and multivariate logistic regression analyses were performed to identify the determinants of in-hospital death. Of note, the modified KATZ index, which is a seven-point scale ranging from 0 to 6 (0 point indicating no dependence and six points indicating full dependence), was calculated to evaluate pre-admission activity of daily living (ADL). In multivariate analysis, cardiac arrest (OR 4.642, 95% CI 1.177-18.305, P = 0.028), Killip class IV (versus Killip class I: OR 5.732, 95% CI 1.076-16.630, P = 0.001), modified KATZ index (OR 1.212, 95% CI 1.001-1.469, P = 0.049), hemoglobin levels (OR 0.803, 95% CI 0.656-0.983, P = 0.033), use of temporary pacemaker (OR 2.603, 95% CI 1.010-6.709, P = 0.048), final Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (versus TIMI ≤ 2: OR 0.240, 95% CI 0.093-0.618, P = 0.003), and mechanical circulatory support (OR 4.264, 95% CI 1.818-10.005, P = 0.001) were found to be significantly associated with in-hospital death. In conclusion, in-hospital outcomes of the very elderly with AMI were still poor in the current PCI era. Poor pre-admission ADL as well as cardiogenic shock and anemia were determined to be strongly associated with in-hospital death.


Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Atividades Cotidianas , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Estimulação Cardíaca Artificial/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Parada Cardíaca/epidemiologia , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Masculino , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Choque Cardiogênico/epidemiologia
6.
Medicine (Baltimore) ; 99(32): e21602, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769916

RESUMO

INTRODUCTION: Recent studies have shown that His-bundle pacing could be an alternative in patients requiring cardiac resynchronization therapy as it is comparable or better in terms of amelioration of ventricular activation, narrowing of the QRS complex, or clinical outcomes. However, in case of high threshold at the level of His-bundle or inability to correct conduction through a diseased His-Purkinje system other option should be searched like left bundle pacing. PATIENT CONCERNS: A 77-year-old man presented to the Emergency Department for dizziness and dizziness and lightheadedness due to an intermittent 2:1 atrioventricular block with a QRS complex morphology of a major left branch block. DIAGNOSIS: Given the documented symptomatic 2:1 AV block, according to the European Guideliness the patient was considered to have a class 1 indication of permanent double chamber cardiostimulation. INTERVENTIONS: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead were placed at the His bundle area with important narrowing of the QRS complex but with an unacceptable high threshold. The delivery system was moved towards the apex 1,5 cm and the lead screwed deep into the septum until capture of the left bundle branch was achieved with complete normalization of the conduction troubles. OUTCOMES: At 3 month follow-up the patient was asymptomatic and the pacing and sensing thresholds remained at same values as during implantation: 0.75/0.4 ms and 14 mV respectively. CONCLUSION: Left bundle-pacing represents the next step of His-Purkinje system pacing to overcome all difficulties related to His-bundle pacing.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Idoso , Bloqueio Atrioventricular/terapia , Fascículo Atrioventricular/anormalidades , Estimulação Cardíaca Artificial/normas , Eletrocardiografia/métodos , Feminino , Fluoroscopia/métodos , Humanos
7.
Medicine (Baltimore) ; 99(32): e21633, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769928

RESUMO

INTRODUCTION: Pacing of the His bundle and conduction system seems an attractive site for pacing. Lead placement in His-pacing might be technically challenging due to surrounding structures and particular anatomic location. PATIENT CONCERNS: A 62-years old male patient was admitted for recurrent syncope. Electrocardiographic monitoring revealed periods of complete atrioventricular block with left branch block morphology and a QRS duration of 160 ms. DIAGNOSIS: A diagnosis of intermittent complete atrioventricular block was made with a Class I indication of permanent dual-chamber cardiac pacing. INTERVENTIONS: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead was placed at the septal area of the atrioventricular junction with good pacing and sensing thresholds. An important narowing of the QRS was observed. OUTCOMES: After the procedure, good pacing and sensing parameters were observed.Echocardiography revealed disappearance of the previously recorded ventricular dyssynchronism.Device follow-up at 1 month and 3 months showed stable pacing and sensing parameters. CONCLUSION: Pacing the distal His bundle normalized the QRS complex, therefore "curing" both the atrioventricular and the left bundle branch conduction abnormalities. As such, the technique can be used as an alternative to cardiac electrical resynchronization therapy with acceptable pacing and detection thresholds and better ventricular activation pattern.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Fascículo Atrioventricular/cirurgia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Síncope/terapia
8.
Pacing Clin Electrophysiol ; 43(10): 1199-1204, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32820823

RESUMO

BACKGROUND: Despite descriptions of various cardiovascular manifestations in patients with coronavirus disease 2019 (COVID-19), there is a paucity of reports of new onset bradyarrhythmias, and the clinical implications of these events are unknown. METHODS: Seven patients presented with or developed severe bradyarrhythmias requiring pacing support during the course of their COVID-19 illness over a 6-week period of peak COVID-19 incidence. A retrospective review of their presentations and clinical course was performed. RESULTS: Symptomatic high-degree heart block was present on initial presentation in three of seven patients (43%), and four patients developed sinus arrest or paroxysmal high-degree atrioventricular block. No patients in this series demonstrated left ventricular systolic dysfunction or acute cardiac injury, whereas all patients had elevated inflammatory markers. In some patients, bradyarrhythmias occurred prior to the onset of respiratory symptoms. Death from complications of COVID-19 infection occurred in 57% (4/7) patients during the initial hospitalization and in 71% (5/7) patients within 3 months of presentation. CONCLUSIONS: Despite management of bradycardia with temporary (3/7) or permanent leadless pacemakers (4/7), there was a high rate of short-term morbidity and death due to complications of COVID-19. The association between new-onset bradyarrhythmias and poor outcomes may influence management strategies for acutely ill patients with COVID-19.


Assuntos
Bradicardia/etiologia , Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Idoso , Betacoronavirus , Bradicardia/mortalidade , Comorbidade , Infecções por Coronavirus/mortalidade , Eletrocardiografia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/mortalidade , Prognóstico , Estudos Retrospectivos
9.
Rev Cardiovasc Med ; 21(2): 297-301, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706217

RESUMO

Myxedema coma occurs mostly in patients with long-standing untreated or undertreated hypothyroidism. Bradycardia is a well-known cardiac manifestation for myxedema coma; however, not all bradycardia with hypothyroidism are sinus bradycardia. Sick sinus syndrome is a group of arrhythmias caused by the malfunction of the natural pacemaker of the heart. Tachy-Brady syndrome is considered to be a type of sick sinus syndrome, where the heart alternates between tachycardia and bradycardia, and it is usually treated with pacemaker implantation along with rate slowing medical therapy. Here we report a case of an 83-year-old female who presented with myxedema coma and atrial fibrillation with tachycardia and intermittent slow ventricular response. We attempt to review the relationship between these two diseases and conclude that appropriate diagnosis of myxedema coma, may be beneficial in reducing the need for pacemaker implantation.


Assuntos
Bradicardia/etiologia , Coma/etiologia , Frequência Cardíaca , Hipotireoidismo/complicações , Mixedema/etiologia , Idoso de 80 Anos ou mais , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Coma/diagnóstico , Coma/tratamento farmacológico , Coma/fisiopatologia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Terapia de Reposição Hormonal , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/fisiopatologia , Mixedema/diagnóstico , Mixedema/tratamento farmacológico , Mixedema/fisiopatologia , Índice de Gravidade de Doença , Tiroxina/uso terapêutico , Resultado do Tratamento
10.
Methodist Debakey Cardiovasc J ; 16(2): 162-166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670478

RESUMO

Cardiac involvement of infiltrative disease, such as systemic sclerosis, carries significant morbidity and mortality. All parts of the heart may be affected, although the conduction system is less commonly involved. We report a rare case of systemic sclerosis causing third-degree atrioventricular block and the first known reported case to use cardiac magnetic resonance imaging (CMR) as a diagnostic and prognostic instrument. It is not known whether using cardiac CMR in systemic sclerosis with cardiac involvement could lead to earlier intervention with escalation of medical therapy or earlier referral for transplant evaluation.


Assuntos
Bloqueio Atrioventricular/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Escleroderma Sistêmico/complicações , Adulto , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Progressão da Doença , Evolução Fatal , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Valor Preditivo dos Testes , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/tratamento farmacológico , Resultado do Tratamento
11.
Am J Cardiol ; 128: 140-146, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650908

RESUMO

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


Assuntos
Neuropatias Amiloides Familiares/fisiopatologia , Bloqueio Atrioventricular/epidemiologia , Cardiomiopatias/fisiopatologia , Mortalidade , Idoso , Idoso de 80 Anos ou mais , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/genética , Amiloidose/complicações , Amiloidose/fisiopatologia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/etiologia , Estimulação Cardíaca Artificial , Cardiomiopatias/complicações , Cardiomiopatias/genética , Estudos de Coortes , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mutação , Marca-Passo Artificial , Pré-Albumina/genética , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome do Nó Sinusal/epidemiologia , Síndrome do Nó Sinusal/etiologia
12.
Am J Cardiol ; 128: 174-180, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650916

RESUMO

Patients with preserved left ventricular (LV) ejection function (EF) and atrioventricular block (AVB) who are anticipated for high-burden of right ventricular (RV) pacing possess a risk to develop pacing-induced cardiomyopathy (PIC) and adverse clinical outcomes. Hence, the aim of the study is to evaluate the incidence, predictors, and clinical outcomes of RV PIC in patients with preserved LVEF, AVB, and high-burden of RV pacing. One thousand and thirteen patients with second or third-degree AVB underwent first time pacemaker implantation between January 2002 and August 2016. A total of 203 patients with a newly implanted pacemaker, normal baseline LVEF, and high burden of RV pacing were included in the present study. Follow-up echocardiography was examined for a new decrease in LVEF of 10% or higher. Alternative causes for cardiomyopathy were ruled out. Patient characteristics, echocardiographic measurements, device clinic data, mortality, and hospitalizations for heart failure were collected and compared between the PIC and the non-PIC groups. Fifty-one patients (25%) developed LV dysfunction with 22 patients (11%), showing LVEF < 40%. During a mean follow-up of 49.2 months, the risk of heart failure hospitalization or all-cause mortality was significantly higher in the PIC group versus non-PIC group (35.3% vs 19.1%, p = 0.009). In conclusion the incidence of PIC in patients with normal LVEF and AVB, who are anticipated for high-burden of RV pacing is high. PIC in patients with a previously normal LV function is associated with unfavorable long-term clinical outcomes, including higher rates of heart failure hospitalizations and all-cause mortality.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Cardiomiopatias/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Ecocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade , Análise Multivariada , Marca-Passo Artificial , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
14.
Circ Arrhythm Electrophysiol ; 13(8): e008267, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32701363

RESUMO

BACKGROUND: Left bundle branch pacing (LBBP) is a technique for conduction system pacing, but it often results in right bundle branch block morphology on the ECG. This study was designed to assess simultaneous pacing of the left and right bundle branch areas to achieve more synchronous ventricular activation. METHODS: In symptomatic bradycardia patients, the distal electrode of a bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing (BBBP) was achieved by stimulating the cathode and anode in various pacing configurations. QRS duration, delayed right ventricular activation time, left ventricular activation time, and interventricular conduction delay were measured. Pacing stability and short-term safety were assessed at 3-month follow-up. RESULTS: BBBP was successfully performed in 22 of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3±7.1 versus 118.4±5.7 ms, P<0.001). LBBP resulted in a paced right bundle branch block configuration, with a delayed right ventricular activation time of 115.0±7.5 ms and interventricular conduction delay of 34.0±8.8 ms. BBBP fully resolved the right bundle branch block morphology in 18 patients. In the remaining 4 patients, BBBP partially corrected the right bundle branch block with delayed right ventricular activation time decreasing from 120.5±4.7 ms during LBBP to 106.1±4.2 ms during BBBP (P=0.005). CONCLUSIONS: LBBP results in a relatively narrow QRS complex but with an interventricular activation delay. BBBP can diminish the delayed right ventricular activation, producing more physiological ventricular activation. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Bradicardia/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Frequência Cardíaca , Idoso , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Função Ventricular Direita
15.
J Card Surg ; 35(8): 1933-1940, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32667084

RESUMO

BACKGROUND: Placement of temporary epicardial pacing wires (TEPW) at the end of open heart surgery cases is routine but can be associated with complications. Identification of patients who are high risk for requiring pacing would be beneficial on guiding selective TEPW placement. The purpose of this study was to identify predictors of temporary pacing immediately post cardiac surgery. METHODS: A retrospective analysis of patients undergoing cardiac surgery from 2005 to 2016 at the Maritime Heart Center was conducted. Analysis was performed of patients who require pacing on arrival to the cardiovascular intensive care unit (CVICU) compared with those who were not paced. Multivariable logistic regression was used to determine each variable's risk adjusted likelihood of pacing for the entire cohort. Subgroup analysis was performed in the isolated procedures. RESULTS: A total of 11 752 patient underwent surgery from the year 2005 to 2016. Two thousand and fifty-one (17.5%) required pacing on arrival to CVICU. Older age, female sex, preoperative renal failure, lower ejection fraction (EF), preoperative arrhythmia, preoperative use of calcium channel blockers, and longer cross-clamp times were risk factors for pacing. In the isolated coronary artery bypass grafting and aortic valve replacement groups, findings were similar to the overall cohort. Only age, obesity, and chronic obstructive pulmonary disease were risk factors for pacing in the isolated mitral valve (MV) repair group and only preoperative arrhythmia in the isolated MV replacement group. CONCLUSION: We have identified risk factors for TEPW use following cardiac surgery and in isolated procedure subgroups. These risk factors may help guide selective TEPW placement.


Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Marca-Passo Artificial/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas , Bloqueadores dos Canais de Cálcio , Constrição , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Duração da Cirurgia , Insuficiência Renal , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Volume Sistólico
16.
Arch Cardiovasc Dis ; 113(6-7): 473-484, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32473997

RESUMO

Magnetic resonance imaging (MRI) has become the reference imaging technique for the management of a large number of diseases. The number of MRI examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). The presence of a CEID was considered an absolute contraindication for MRI for many years. The progressive replacement of conventional pacemakers and defibrillators by "magnetic resonance (MR)-conditional" CEIDs and recent data on the safety of MRI in patients with "MR-non-conditional" CEIDs have gradually increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with MR-conditional devices, because these devices are not "MR safe". Specific programming of the device in "MR mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging describes the effect of and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional non-guaranteed" and MR-non-conditional devices.


Assuntos
Estimulação Cardíaca Artificial , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Cardiopatias/terapia , Imagem por Ressonância Magnética , Marca-Passo Artificial , Estimulação Cardíaca Artificial/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Cardiopatias/fisiopatologia , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Falha de Prótese , Fatores de Risco
17.
Internist (Berl) ; 61(8): 813-826, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32542492

RESUMO

Syncope is a frequent disorder, sometimes due to life-threatening causes. The uncertainty in its diagnosis requires a standardized approach. According to the 2018 European Society of Cardiology (ESC) guidelines, new aspects in evaluation and treatment include risk stratification and decision-making strategies during the initial evaluation in the emergency department, a reconsideration of diagnostic tests, algorithms for the treatment of reflex syncope, indications for an implantable cardioverter/defibrillator in high risk patients for sudden cardiac death, and organizational aspects such as interdisciplinary syncope units. The 2018 ESC guideline and the 2019 commentaries of the German Society of Cardiology (DGK) are an excellent and comprehensive instruction for safe, effective and efficient evaluation and therapy. However, some aspects require critical appraisal. The inadequate availability and reimbursement of pivotal diagnostic tests, such as tilt table testing and the implantable loop recorder is emphasized.


Assuntos
Estimulação Cardíaca Artificial/normas , Desfibriladores Implantáveis , Exame Físico/normas , Guias de Prática Clínica como Assunto , Síncope/diagnóstico , Síncope/terapia , Cardiologia/normas , Alemanha , Humanos , Sociedades Médicas , Teste da Mesa Inclinada
20.
Stud Health Technol Inform ; 271: 215-223, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32578566

RESUMO

BACKGROUND: Antitachycardial pacing (ATP) is a painless method for terminating ventricular tachycardias (VT) which would otherwise be treated using a painful high energy shock. However, it is well known that not each VT can be successfully terminated by ATP. Furthermore, ATP can be parametrized in several ways using scan, ramp or scan ramp approaches and can be applied in the right ventricle or in both ventricles (biventricular). In this work, we investigate the therapeutically most convenient ATP protocol based on a computer simulation using a patient individual model. METHODS: A patient individual model generated from a 3D/4D data set and a hybrid automaton was used for modeling and simulation of different VT scenarios. On the different VTs (from cycle length 288 ms up to 408 ms) different ATP approaches derived from the ADVANCE-CRT trial were applied in order to determine the effectiveness of these approaches. RESULTS: In this computer simulation study we were able to verify and validate the results from the ADVANCE-CRT trial. Biventricular ATP does not prove to be more effective than RV ATP but has a slight advantage in terminating fast VTs. CONCLUSIONS: The availability of a patient individual model and knowledge about the ischemic area and the underlying mechanism of the VTs will allow the use of these models to optimize ATP management.


Assuntos
Desfibriladores Implantáveis , Taquicardia Ventricular , Algoritmos , Estimulação Cardíaca Artificial , Simulação por Computador , Eletrocardiografia , Ventrículos do Coração , Humanos
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