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1.
Isr Med Assoc J ; 12(21): 790-795, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814341

RESUMO

BACKGROUND: Patients with right bundle branch block (RBBB) prior to transcatheter aortic valve implantation (TAVI) are at high risk for immediate post-procedural heart block and long-term mortality when discharged without a pacemaker. OBJECTIVES: To test whether prophylactic permanent pacemaker implantation (PPI) is beneficial. METHODS: Of 795 consecutive patients who underwent TAVI, 90 patients had baseline RBBB. We compared characteristics and outcomes of the prophylactic PPI with post-TAVI PPI. Need for pacing was defined as  greater than 1% ventricular pacing. RESULTS: Forty patients with RBBB received a prophylactic PPI (group 1), and in 50 the decision was based on standard post-procedural indications (group 2). There were no significant differences in clinical baseline characteristics. One patient developed a tamponade after a PPI post-TAVI. A trend toward shorter hospitalization duration in group 1 patients was observed (P = 0.06). On long-term follow-up of 848 ± 56 days, no differences were found in overall survival (P = 0.77), the composite event-free survival of both mortality and hospitalizations (P = 0.66), or mortality and syncope (P = 0.65). On multivariate analysis, independent predictors of the need for pacing included baseline PR interval increase of 10ms (odds ratio [OR] 1.21 per 10 ms increment 95% confidence interval [95%CI] 1.02-1.44, P = 0.028), and the use of new generation valves (OR 3.92, 95%CI 1.23-12.46, P = 0.023). CONCLUSIONS: In patients with baseline pre-TAVI RBBB, no outcome differences were found with prophylactic PPI. On multivariate analysis, predictors of the need for pacing included baseline long PR interval, and the use of newer generation valves.


Assuntos
Bloqueio de Ramo , Estimulação Cardíaca Artificial , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Estimulação Cardíaca Artificial/estatística & dados numéricos , Feminino , Humanos , Israel/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Mortalidade , Marca-Passo Artificial , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos
2.
Neurosurg Rev ; 42(4): 843-852, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31617125

RESUMO

To perform a systematic review of the techniques for transient circulatory arrest during intracerebral aneurysm surgery according to the PRISMA guidelines. Search of PubMed and Google Scholar using the following: ("heart arrest" OR "cardiac standstill"[All Fields]) AND ("intracranial aneurysm" OR "intracranial"[All Fields] AND "aneurysm"[All Fields]). A total of 41 original articles were retrieved, of which 17 were excluded (review articles, editorials and single-case reports). A total of 24 separate articles published between 1984 and 2018 were included in the final analysis, where the majority of patients harbored anterior circulation giant or large aneurysms. Adenosine-induced cardiac arrest gave a short, temporary asystole. The method had benefits in aneurysm with a broad neck, a thin wall, in specific localizations with narrow surgical corridors or in case of intraoperative rupture. Rapid ventricular pacing (RVP) allows a longer and more easily controlled hypotension. Its use is largely limited to elective cases. Deep hypothermic circulatory arrest required a complex infrastructure, and fatal procedure complications lead to a 11.5-30% 30-day mortality rate, limiting its application to giant or complex aneurysm of the basilar artery or to residual posterior circulation aneurysm after endovascular treatment. Adenosine and RVP are both effective options to facilitate clipping of complex aneurysms. However, their use in patient with ischemic heart disease and cardiac arrhythmias should be avoided, and their safety in the context of subarachnoid hemorrhage is yet to be determined. Today, deep hypothermic circulatory arrest is almost obsolete due to endovascular alternatives.


Assuntos
Parada Cardíaca Induzida/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adenosina/administração & dosagem , Estimulação Cardíaca Artificial/métodos , Fármacos Cardiovasculares/administração & dosagem , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Hipotensão/induzido quimicamente , Hipotensão/etiologia
3.
Med Clin North Am ; 103(5): 897-912, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378333

RESUMO

In this article, the authors review the different types of sinus node and atrioventricular node diseases that lead to bradyarrhythmias with their associated symptoms, the diagnostic investigations needed to assess the degree of disease, and the therapeutic management, including the indications for permanent pacing.


Assuntos
Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Humanos , Marca-Passo Artificial
4.
BMJ Case Rep ; 12(8)2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31387863

RESUMO

The pathophysiology of narrow complex dilated cardiomyopathy is not defined, so therapeutic options are limited. By utilising the velocity equation, the pathophysiology of narrow complex cardiomyopathy allows above normal conduction propagation velocities. There are two pathophysiological theories that allow above normal conduction velocities and failure to capture the myocardium: (1)insulating fibres of the conduction system extending beyond the apex and (2) reduction of axon branching. A patient with narrow complex cardiomyopathy was subjected to graded increase in amplitude and pulse width pacing to overcome the failure of native conduction to capture the myocardium. Peak systolic strain maps demonstrated a progressive increase in apical contractility with increasing pulse width and amplitude. Ejection fraction improved from 17% to 31%. Understanding the pathophysiology of narrow complex cardiomyopathy leads to proposed therapies. One potential pacing therapy is multi-lead pacing at high amplitude and pulse width to capture myocardial cells not captured by native conduction.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Idoso , Estimulação Cardíaca Artificial/métodos , Cardiomiopatia Dilatada/terapia , Desfibriladores Implantáveis , Feminino , Insuficiência Cardíaca/etiologia , Frequência Cardíaca , Humanos
5.
J Korean Med Sci ; 34(27): e187, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31293111

RESUMO

BACKGROUND: Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. METHODS: Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. RESULTS: During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling.


Assuntos
Estimulação Cardíaca Artificial/métodos , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Idoso , Algoritmos , Automação , Estimulação Cardíaca Artificial/efeitos adversos , Terapia de Ressincronização Cardíaca/efeitos adversos , Eletrocardiografia , Feminino , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Resultado do Tratamento
7.
Tex Heart Inst J ; 46(2): 136-138, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236081

RESUMO

Congenital complete heart block with concomitant biventricular noncompaction cardiomyopathy has been reported once previously. Although not universal, when restrictive physiology is present, impaired diastolic filling may pose a distinct challenge to pacing during the neonatal period. We present the case of a neonate with congenital complete heart block and biventricular noncompaction that resulted in severe diastolic dysfunction and atrioventricular dyssynchrony. We intentionally used 2:1 ventricular pacing to provide atrioventricular synchrony with every paced beat, and this resulted in hemodynamic and clinical improvement. This unconventional pacing technique may be beneficial in other neonates who have complete heart block and diastolic dysfunction.


Assuntos
Anormalidades Múltiplas , Estimulação Cardíaca Artificial/métodos , Bloqueio Cardíaco/congênito , Cardiopatias Congênitas/terapia , Ventrículos do Coração/anormalidades , Eletrocardiografia , Seguimentos , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Recém-Nascido , Masculino
9.
Ann Thorac Surg ; 108(3): 700-707, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31034827

RESUMO

BACKGROUND: Damage to the cardiac conduction system requiring permanent pacemaker implantation is a complication of aortic valve replacement (AVR) that may importantly affect quality of life. We investigated the prevalence of and preprocedure risk factors for new permanent pacemakers after surgical (SAVR) and transcatheter AVR (TAVR) at a single institution. METHODS: Preoperative variables and baseline electrocardiograms were reviewed for 5807 patients undergoing elective SAVR, with or without coronary artery bypass grafting, and 1292 undergoing TAVR, with or without percutaneous coronary intervention, from 2006 to 2017 at Cleveland Clinic. Patients with previous permanent pacemakers were excluded. Risk factors for permanent pacemaker implantation were identified using multivariable logistic regression analysis. RESULTS: New permanent pacemakers were implanted in 151 (2.6%) after SAVR and in 125 (9.7%) after TAVR (whole group SAVR vs TAVR, P <.0001). Risk factors for pacemaker implantation after TAVR included preoperative conduction disturbances and type of prosthesis (SAPIEN, 9.5%; SAPIEN XT, 4.8%; SAPIEN 3, 10% [Edwards Lifesciences, Irvine, CA]; CoreValve, 30% [Medtronic, Minneapolis, MN]; and other TAVR, 10%). There were no reliable risk factors for pacemaker implantation after SAVR. Bicuspid valves, mechanical vs bioprosthetic valves, higher Society of Thoracic Surgeons risk score, and concomitant coronary artery bypass grafting were not associated with elevated risk. CONCLUSIONS: At a high-volume institution in the current era, establishing a baseline for pacemaker implantation after AVR is necessary. Preoperative conduction disturbances and transcatheter valve type affect its prevalence. These data provide a benchmark that should be taken into account when considering TAVR in low-risk patients.


Assuntos
Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Benchmarking , Estimulação Cardíaca Artificial/efeitos adversos , Estudos de Coortes , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Assistência de Longa Duração , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
10.
Cardiol Clin ; 37(2): 231-240, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926024

RESUMO

Atrial fibrillation (AF) and heart failure (HF) are associated with high morbidity and mortality, which is particularly detrimental when patients develop rapid ventricular rates (RVR). Atrioventricular junction (AVJ) ablation with pacemaker implantation has been used as a method of achieving rate control in patients with incessant AF with RVR. Right ventricular only pacing is known to be harmful in the setting of HF. His bundle pacing (HBP) and biventricular (BiV) pacing both offer durable pacing solutions that offer more physiologic activation. This review describes the benefits and drawbacks of HBP and BiV pacing in HF patients after AVJ ablation.


Assuntos
Fibrilação Atrial/terapia , Nó Atrioventricular/cirurgia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Ablação por Cateter , Insuficiência Cardíaca/terapia , Volume Sistólico/fisiologia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Terapia de Ressincronização Cardíaca/métodos , Comorbidade , Saúde Global , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Resultado do Tratamento
12.
Pacing Clin Electrophysiol ; 42(5): 537-541, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30828826

RESUMO

BACKGROUND: Implantation of transvenous pacemaker systems is a standard method used to treat patients with bradycardia. There are some clinical settings in which that method cannot be used despite existing indications (such as developmental defects of the cardiovascular system and limited venous access or infections). In such cases, an epicardial pacing system may be implanted with cardiac surgery techniques, at a cost of certain surgical risks. The least invasive approach is subxyphoid, but it traditionally allows to place only a ventricular lead and achieve a single-chamber VVI pacing system. AIM: The aim of our study was to determine the feasibility of subxyphoid implantation of dual-chamber pacing systems using thoracoscopic tools, as well as to and examine the short- and mid-term outcomes of such procedures. METHODS: Patients were qualified for an epicardial pacemaker system in case of absolute indications for permanent pacing therapy and coexisting contraindications for a transvenous system. DDD systems were implanted in 10 consecutive patients, in general anesthesia, in a cardiac surgery operating room, using subxyphoid access to pericardial space and a standard set of minimally invasive thoracoscopic tools. RESULTS: Implantation of a dual-chamber pacing system using the above approach was successful in all attempts. No serious complications were observed. Pacing and sensing parameters were appropriate at implantation and remained such during the follow-up of 2-27 months. CONCLUSION: Implantation of a dual-chamber pacing system using a minimally invasive subxyphoid approach is feasible. Appropriate pacing and sensing values may be obtained and they remain stable during follow-up.


Assuntos
Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Procedimentos Cirúrgicos Cardíacos , Eletrodos Implantados , Procedimentos Cirúrgicos Minimamente Invasivos , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Pacing Clin Electrophysiol ; 42(5): 542-547, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30829416

RESUMO

BACKGROUND: Leadless pacemakers (LPMs) have been shown to have lower postoperative complications than traditional permanent pacemakers but there have been no studies on the outcomes of LPMs in patients with transcatheter heart valve replacements (THVRs). This study determined outcomes of LPMs compared to transvenous single-chamber pacemakers (SCPs) post-THVR. METHODS: This is a retrospective single-center study including 10 patients who received LPMs post-THVR between February 2017 and August 2018 and a comparison group of 23 patients who received SCP post-THVR between July 2008 and August 2018. LPM or SCP was implanted at the discretion of electrophysiologists for atrial fibrillation with slow ventricular response or sinus node dysfunction with need for single-chamber pacing only. RESULTS: LPMs were associated with decreased tricuspid regurgitation (P = 0.04) and decreased blood loss during implantation (7.5 ± 2.5 cc for LPMs vs 16.8 ± 3.2 cc for SCPs, P = 0.03). Five LPM patients had devices positioned in the right ventricular septum as seen on transthoracic echocardiogram. Frequency of ventricular pacing was similar between LPM and SCP groups. In the LPM group, one case was complicated by a pseudoaneurysm and one death was due to noncardiac causes. There was one pneumothorax and one pocket infection in the SCP group. CONCLUSIONS: In this small retrospective study, LPMs were feasible post-THVR and found to perform as well as SCPs, had less intraprocedural blood loss, and were associated with less tricuspid regurgitation. Further, larger studies are required to follow longer-term outcomes and complications.


Assuntos
Estimulação Cardíaca Artificial/métodos , Procedimentos Cirúrgicos Cardíacos , Marca-Passo Artificial , Complicações Pós-Operatórias/prevenção & controle , Substituição da Valva Aórtica Transcateter , Insuficiência da Valva Tricúspide/prevenção & controle , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos
14.
J Interv Card Electrophysiol ; 55(1): 105-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30863907

RESUMO

PURPOSE: A proportion of patients with vasovagal syncope (VVS) experience recurrence despite appropriate management. Closed loop stimulation (CLS) pacing is a promising treatment for a subgroup of patients with cardioinhibitory response on head-up tilt table test (HUTT). Nonetheless, its efficacy remains uncertain. We sought to assess the efficacy of CLS pacing in patients with cardioinhibitory VVS. METHODS: We searched PubMed, Google Scholar, and the Cochrane Central Register of controlled trials for relevant studies (last search date April 23, 2018). Data were pooled using the Mantel-Haenszel fixed-effects model. For cohort studies, we used a Freeman-Tukey transformation to calculate the weighted summary proportion. Primary outcomes are syncope and presyncope. RESULTS: Eight studies were included in the final analyses (two single-blinded and one double-blinded RCT, two prospective observational studies, and three retrospective observational studies). Two hundred ninety-one patients included, with an average age of 57 years. Quality of evidence is moderate. Use of CLS pacing was associated with reduced risk of syncope (OR 0.08; 95% CI 0.03-0.18; I2 32%) and presyncope (OR 0.34; 95% CI 0.18-0.63; I2 0.00%). Using proportion meta-analysis, the summary estimate of the proportion of cases that developed syncope during CLS pacing was similar between RCTs and prospective studies (3.2% and 3.1%), respectively. This is much lower than the rate of recurrence in the control arm of RCTs at 33.7%. Sensitivity analyses yielded similar results. CONCLUSION: CLS pacing is beneficial for patients with recurrent vasovagal syncope who demonstrate a cardioinhibitory response on HUTT.


Assuntos
Estimulação Cardíaca Artificial/métodos , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/terapia , Teste da Mesa Inclinada , Humanos , Recidiva
15.
Circ Arrhythm Electrophysiol ; 12(3): e006955, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30866664

RESUMO

Background Although entrainment mapping is an established approach to atypical atrial flutter ablation, postpacing intervals shorter than tachycardia cycle length (difference between postpacing interval and tachycardia cycle length [dPPI] <0 ms) remain of unknown significance. We sought to compare anatomic and electrophysiological properties of sites with dPPI <0, dPPI=0-30, and dPPI >30 ms. Methods We studied 24 noncavotricuspid isthmus-dependent macroreentrant atypical atrial flutter in 19 consecutive patients. Ultra high-density electroanatomic activation maps were acquired with a 64-electrode basket catheter. Entrainment mapping was performed at multiple candidate sites. Ablation was performed at the narrowest accessible slow-conducting critical isthmuses. Results Of 102 entrainment mapping sites, dPPI <30 was observed at 72 sites on complete maps of 24 atypical atrial flutter. Compared with dPPI=0-30 sites (N=45), dPPI<0 sites (N=27) were more commonly located within isthmuses <15 mm wide (67% versus 6.7%, P<0.00001; odds ratio, 28.0; 95% CI, 6.8-115.7), more frequently located within 5 mm of the leading wavefront (93% versus 64%, P=0.008), exhibited slower local conduction velocity (0.49±0.43 versus 0.93±0.57 m/s, P=0.0005), lower voltages (0.48±0.79 versus 0.92±0.97 mV, P=0.04), and more frequently fractionated electrograms (67% versus 24%, P=0.0004). High rates of arrhythmia termination or cycle length increase >15 ms by ablation were observed in both dPPI groups (94% versus 86%, P=0.53). Compared with all dPPI <30, dPPI >30 sites (N=30) were less commonly observed within isthmuses (3.3%, P<0.001) or within 5 mm of the leading wavefront (30%, P<0.0001); conduction velocity (1.0±0.7 m/s, P=0.002) and voltage (1.1±1.4 mV, P=0.049) were higher compared with dPPI<0 but similar to dPPI=0-30 sites. Conclusions In atypical atrial flutter, sites with dPPI <0 are markers of limited width critical isthmuses with slower conduction velocity, whereas sites with dPPI=0-30 ms are often not in close proximity to the reentry circuit. Virtual electrode simultaneous down and upstream (antidromic) capture of a confined isthmus of slow conduction can explain a dPPI <0. Identifying these sites may improve selective and efficient ablation strategies compared with the standard 30-ms threshold.


Assuntos
Potenciais de Ação , Flutter Atrial/diagnóstico , Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Flutter Atrial/fisiopatologia , Flutter Atrial/cirurgia , Ablação por Cateter , Tomada de Decisão Clínica , Bases de Dados Factuais , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Fatores de Tempo
16.
J Vet Cardiol ; 22: 20-39, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30709617

RESUMO

Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome.


Assuntos
Bradicardia/veterinária , Doenças do Gato/terapia , Doenças do Cão/terapia , Marca-Passo Artificial/veterinária , Animais , Bradicardia/diagnóstico , Bradicardia/etiologia , Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Estimulação Cardíaca Artificial/veterinária , Doenças do Gato/diagnóstico , Doenças do Gato/etiologia , Gatos , Doenças do Cão/diagnóstico , Doenças do Cão/etiologia , Cães
17.
Int Heart J ; 60(2): 457-461, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799381

RESUMO

Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal "jailed" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.


Assuntos
Angioplastia Coronária com Balão/métodos , Bloqueio Atrioventricular , Estimulação Cardíaca Artificial/métodos , Oclusão Coronária , Vasos Coronários , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Oclusão Coronária/diagnóstico , Oclusão Coronária/etiologia , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Remoção de Dispositivo/métodos , Septos Cardíacos , Humanos , Masculino , Marca-Passo Artificial , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recuperação de Função Fisiológica , Resultado do Tratamento
18.
Circ Arrhythm Electrophysiol ; 12(2): e006878, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30707036

RESUMO

BACKGROUND: The 12-lead ECG is considered the gold standard to differentiate between selective (S), nonselective (NS) His bundle pacing (HBP), and right ventricular septal capture in routine clinical practice. We sought to assess the utility of device EGM recordings as a tool to identify the type of HBP morphology. METHODS: One hundred forty-eight consecutive patients underwent HBP with a 3830 Select Secure lead (Medtronic, Inc) at 3 centers between October 2016 and October 2017. The near field V-EGM morphology (NF EGM), near field V-EGM time to peak (NFTime to peak), and far-field EGM QRS duration (QRSd) were recorded while pacing the His lead with simultaneous 12-lead ECG rhythm strips. RESULTS: Indications for HBP were sinus node dysfunction, atrioventricular conduction disease, and cardiac resynchronization therapy in 68 (46%), 56 (38%), and 24 (16%) patients, respectively. Baseline QRSd was 108±38 ms with QRSd >120 ms in 57 (39%) patients (27 right bundle branch block, 18 left bundle branch block, and 12 intraventricular conduction delay). S-HBP was noted in 54 (36%) patients. A positive NFEGM and NFTime to peak >40 ms were highly sensitive (94% and 93%, respectively) and specific (90% and 94%) for S-HBP irrespective of baseline QRSd. All 3 parameters (+NFEGM, NFTime to peak >40 ms, and far-field EGM QRSd <120 ms) had high negative predictive value (97%, 95%, and 92%). A novel device-based algorithm for S-HBP was proposed. EGM transitions correlated with ECG transitions during threshold testing and can help accurately differentiate between S-HBP, NS-HBP, and right ventricular septal pacing with a cumulative positive predictive value of 91% (positive predictive value =100% in patients with baseline QRSd <120 ms). CONCLUSIONS: We propose a novel and simple criteria for accurate differentiation between S-HBP, NS-HBP, and right ventricular septal capture morphologies by careful analysis of device EGMs alone. This study paves the way for future studies to assess autocapture algorithms for devices with HBP.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Insuficiência Cardíaca/terapia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Função Ventricular Direita
19.
Circ Arrhythm Electrophysiol ; 12(2): e007052, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30707037

RESUMO

BACKGROUND: During permanent nonselective His bundle (ns-HB) pacing, it is crucial to confirm HB capture/exclude that only right ventricle (RV) myocardial septal pacing is present. Because the effective refractory period (ERP) of the working myocardium is different than the ERP of the HB, we hypothesized that it should be possible to differentiate ns-HB capture from RV myocardial capture using programmed extrastimulus technique. METHODS: In consecutive patients during HB pacemaker implantation, programmed HB pacing was delivered from the screwed-in HB pacing lead. Premature beats were introduced at 10-ms steps during intrinsic rhythm and also after a drive train of 600 ms. The longest coupling interval that resulted in an abrupt change of QRS morphology was considered equal to ERP of HB or RV myocardium. RESULTS: Programmed HB pacing was performed from 50 different sites in 32 patients. In 34 of 36 cases of ns-HB pacing, the RV myocardial ERP was shorter than HB ERP (271.8±38 versus 353.0±30 ms; P<0.0001). Programmed HB pacing using a drive train resulted in a typical abrupt change of paced QRS morphology: from ns-HB to RV myocardial QRS (34 of 36 cases) or to selective HB QRS (2 of 36 cases). Programmed HB pacing delivered during native conduction resulted in obtaining selective HB QRS in 20 of 34 and RV myocardial QRS in 14 of 34 of the ns-HB cases. In RV myocardial-only pacing cases (false ns-HB pacing, n=14), such responses were not observed-the QRS morphology remained stable. Therefore, the programmed HB pacing correctly diagnosed all ns-HB cases and all RV myocardial pacing cases. CONCLUSIONS: A novel maneuver for the diagnosis of HB capture, based on the differences in ERP between HB and myocardium, was formulated, assessed, and found as diagnostically valuable. This method is unique in enabling to visualize selective HB QRS in patients with otherwise obligatory ns-HB pacing (RV myocardial capture threshold

Assuntos
Potenciais de Ação , Arritmias Cardíacas/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Insuficiência Cardíaca/terapia , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Refratário Eletrofisiológico , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Direita
20.
Circ Arrhythm Electrophysiol ; 12(2): e006801, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30739495

RESUMO

BACKGROUND: His bundle pacing (HBP) remains technically challenging and is currently guided by electrograms and 2-dimensional fluoroscopy. Our objective was to describe a new technique for HBP directly guided by electroanatomic mapping (EAM). METHODS: Twenty-eight patients were included. The atrioventricular septum was mapped via EAM, and His bundle (HB) electrograms, selective, and nonselective HB capture sites were tagged. Pacing leads were connected to EAM, navigated to tagged HB target sites and deployed. Intracardiac electrograms and pacing parameters were recorded. Lead location was tagged on the cloud of HB sites, which was divided into 3 arbitrary segments. In 5 patients, atrioventricular nodal ablation was performed with direct visualization of the HBP lead by EAM. RESULTS: Reproducible navigation of the pacing lead to predetermined HBP locations guided by EAM was achieved in all patients. The lead was successfully deployed in 25 patients. HB cloud area was 360 (212) mm2. There was no correlation between HBP threshold and lead location on the His cloud. The intracardiac electrograms atrial/ventricular ratio at the lead deployment site correlated with its EAM position on the His cloud ( P=0.045). Procedure, fluoroscopy, and mapping times were 116.0 (38.8), 8.6 (6.3), and 9.0 (11.4) minutes, respectively. HBP threshold at implant was 1.5 (2.3) V at 1.5 (1.0) ms. Distance between HB lead and ablation sites was 10.0 (1.3) mm in patients undergoing atrioventricular nodal ablation. CONCLUSIONS: Direct guidance of HBP by EAM allows for direct visualization of the pacing lead on the HB cloud and reproducible navigation to predetermined HB capture sites. Intracardiac electrograms atrial/ventricular ratio at the lead deployment site correlates with His cloud location. EAM can be applied during standard HBP procedures or combined with atrioventricular nodal ablation.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/terapia , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Insuficiência Cardíaca/terapia , Imagem Tridimensional , Processamento de Sinais Assistido por Computador , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento
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