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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
Circ Arrhythm Electrophysiol ; 13(6): e008186, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32434448

RESUMO

BACKGROUND: Repolarization alternans (RA) has been implicated in the pathogenesis of ventricular arrhythmias and sudden cardiac death. METHODS: We have developed a real-time, closed-loop system to record and analyze RA from multiple intracardiac leads, and deliver dynamically R-wave triggered pacing stimuli during the absolute refractory period. We have evaluated the ability of this system to control RA and reduce arrhythmia susceptibility, in vivo. RESULTS: R-wave triggered pacing can induce RA, the magnitude of which can be modulated by varying the amplitude, pulse width, and size of the pacing vector. Using a swine model (n=9), we demonstrate that to induce a 1 µV change in the alternans voltage on the body surface, coronary sinus and left ventricle leads, requires a delivered charge of 0.04±0.02, 0.05±0.025, and 0.06±0.033 µC, respectively, while to induce a one unit change of the Kscore, requires a delivered charge of 0.93±0.73, 0.32±0.29, and 0.33±0.37 µC, respectively. For all body surface and intracardiac leads, both Δ(alternans voltage) and ΔKscore between baseline and R-wave triggered paced beats increases consistently with an increase in the pacing pulse amplitude, pulse width, and vector spacing. Additionally, we show that the proposed method can be used to suppress spontaneously occurring alternans (n=7), in the presence of myocardial ischemia. Suppression of RA by pacing during the absolute refractory period results in a significant reduction in arrhythmia susceptibility, evidenced by a lower Srank score during programmed ventricular stimulation compared with baseline before ischemia. CONCLUSIONS: We have developed and evaluated a novel closed-loop method to dynamically modulate RA in a swine model. Our data suggest that suppression of RA directly reduces arrhythmia susceptibility and reinforces the concept that RA plays a critical role in the pathophysiology of arrhythmogenesis.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/prevenção & controle , Estimulação Cardíaca Artificial/métodos , Sistema de Condução Cardíaco/fisiopatologia , Período Refratário Eletrofisiológico , Animais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Modelos Animais de Doenças , Frequência Cardíaca , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Sus scrofa , Fatores de Tempo
8.
Int Heart J ; 61(3): 503-509, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32418967

RESUMO

High-resolution mapping is useful to identify reconnection gaps in the pulmonary vein after pulmonary vein isolation for atrial fibrillation. However, it is sometimes difficult to differentiate pulmonary vein potentials from far-field potentials because of very low amplitudes. Our purpose was to evaluate the usefulness of a novel differential atrial pacing method to differentiate reconnected pulmonary vein potentials from isolated pulmonary vein potentials. This retrospective observational study included 34 patients with atrial fibrillation (22 men; mean age, 64 ± 14 years; 28 with paroxysmal atrial fibrillation) who underwent radiofrequency or cryoballoon ablation. Following pulmonary vein isolation, we created a high-resolution activation map during pacing from both the coronary sinus and left atrial appendage. We compared the characteristics of the pulmonary vein potentials and the pattern of activation between the reconnected and isolated pulmonary veins. We analyzed 131 pulmonary veins and found reconnections in 41 pulmonary veins (R group); 90 pulmonary veins had no reconnection (NR group). The R group had a significantly shorter distance between the earliest pulmonary vein activation sites in both activation maps, compared with the NR group (5.22 ± 0.53 mm versus 17.08 ± 0.36 mm, respectively; P < 0.0001). The amplitude of the pulmonary vein potentials was higher in the R group versus the NR group (0.61 ± 0.05 mV versus 0.04 ± 0.03 mV, respectively; P < 0.0001). Six gaps (14%) in the R group that were unrecognized using a conventional method were identified using our novel method. In conclusion, differential atrial pacing was useful to identify pulmonary vein reconnection gaps during ablation using a novel high-resolution mapping system.


Assuntos
Fibrilação Atrial/cirurgia , Estimulação Cardíaca Artificial/métodos , Ablação por Cateter , Sistema de Condução Cardíaco , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares , Estudos Retrospectivos
9.
Life Sci ; 254: 117759, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32389830

RESUMO

OBJECTIVE: Metformin, introduced in 1957, is widely used as an anti-diabetic drug and has considerable benefits in cardiovascular disease reportedly, dependent or independent on its glucose-lowering effects. Aim of this study was to investigate the effect of metformin on gap junction and the inducibility of AF. METHODS: Beagle dogs were subjected to acute or chronic pacing at right atrial appendage by a pacemaker to develop an AF model and electrophysiological parameters were measured. In vitro study, a cell fast pacing model was developed by CardioExcyte 96. We performed Western blot, histology immunohistochemical staining and electron microscopy to detect the effect of metformin. RESULTS: In chronic AF model, the inducibility and duration of AF increased obviously after pacing for 6 weeks compared with sham-operated group (Inducibility, 3.33 ±â€¯5.77 vs. 85.33 ±â€¯7.89%, P<0.0001; Duration, 0.8 ±â€¯0.84 vs. 11 ±â€¯2.67 ms, P<0.0001). Effective refractory periods (ERP) decreased at left and right left atrium and atrial appendages compared with sham-operated group (123.95 ±â€¯6.57 vs. 89.96 ±â€¯7.39 ms P<0.0001). Metformin attenuated the pacing-induced increase in EPR (89.96 ±â€¯7.39 vs. 105.83 ±â€¯7.45 ms, P<0.05), AF inducibility and AF duration (Inducibility, 85.33 ±â€¯7.89 vs. 64.17 ±â€¯7.36%, Duration, 11 ±â€¯2.67 vs. 8.62 ±â€¯1.15 ms, P<0.05). The expression of Cx43 shows a significant downregulation(about 38%, P<0.001) after chronic pacing and treating with metformin could alleviate this decrease(P<0.01). However, the effect of metformin in acute pacing model is limited. The immunohistochemical staining of cardiac tissue also shown that there is more lateralized Cx43 under pacing condition (87.67 ±â€¯2.52 vs. 60.8 ±â€¯9.13%, P<0.005). These pacing-induced lateralize Cx43 could be alleviated by the metformin (48.4 ±â€¯8.62 vs. 60.8 ±â€¯9.13%, P<0.05). Additionally, metformin could affect the interactions of ZO-1 with p-Src/Cx43 via decrease the abnormal cAMP level after pacing (84.04 ±â€¯4.58 vs. 69.34 ±â€¯4.5 nmol/L, P<0.001). CONCLUSIONS: Metformin could alleviate the vulnerability of AF and attenuate the downregulation of gap junction under pacing condition via AMPK pathway and decreasing the P-Src level.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Cardiotônicos/metabolismo , Metformina/farmacologia , Proteínas Quinases Ativadas por AMP/metabolismo , Animais , Estimulação Cardíaca Artificial/métodos , Cardiotônicos/farmacologia , Conexina 43/metabolismo , Modelos Animais de Doenças , Cães , Junções Comunicantes/efeitos dos fármacos , Átrios do Coração/metabolismo , Masculino , Taquicardia/fisiopatologia
10.
Intern Med ; 59(7): 963-966, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32238662

RESUMO

To avoid the negative effects associated with pacing, pacemakers are designed to achieve a pacing cadence as close to physiological pacing as possible. In closed-loop stimulation (CLS; a type of rate-responsive functionality used in pacemakers), the changes in impedance (which correlates with the contractility of the myocardium around the lead tip electrode) are tracked, and the paced heart rate is adjusted accordingly. We herein report a case in which we implanted a pacemaker in a post-tricuspid valve replacement patient. A ventricular lead positioned in the coronary vein exhibited good CLS functionality, and the patient's dizziness and heart failure improved.


Assuntos
Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial , Síndrome do Nó Sinusal/terapia , Idoso , Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , Insuficiência Cardíaca/complicações , Frequência Cardíaca/fisiologia , Próteses Valvulares Cardíacas , Humanos , Desenho de Prótese , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/fisiopatologia , Valva Tricúspide
11.
Pediatr Cardiol ; 41(5): 910-917, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32107584

RESUMO

The implantation of pacemakers (PM) in neonates and infants requires particular consideration of small body size, marked body growth potential, and the decades of future pacing therapy to be expected. The aim of this study is to quantify the complications of implantation and outcome occurring at our center and to compare these with other centers. Retrospective analysis of 52 consecutive patients undergoing PM implantation at a single tertiary care center within the first year of life. PMs were implanted at a median age of 3 months (range 0-10 months). Structural heart defects were present in 44 of 52 patients. During a median follow-up time of 40.4 months (range 0.1-114 months), measurements for sensing, pacing thresholds, and lead impedance remained stable. No adverse pacing effect was observed in left ventricular function or dimensions over time. There were 20 reoperations in 13 patients at a median time of 4.7 years (range 0.05-8.2 years) after implantation, for end of battery life (n = 10), lead dysfunction (n = 3), device dislocation (n = 3), infection (n = 3), and diaphragmatic paresis (n = 1). No PM-related mortality occurred. Epicardial pacemaker implantation in neonates and infants is an invasive but safe and effective procedure with a relatively low risk of complications. Our current implantation technique and the use of bipolar steroid-eluting electrodes, which we prefer to implant on the left ventricular apex, lead to favorable long-term results.


Assuntos
Estimulação Cardíaca Artificial/métodos , Cardiopatias/terapia , Marca-Passo Artificial , Feminino , Seguimentos , Bloqueio Cardíaco/congênito , Bloqueio Cardíaco/cirurgia , Bloqueio Cardíaco/terapia , Cardiopatias/congênito , Cardiopatias/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Implantação de Prótese/métodos , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
12.
J Cardiovasc Electrophysiol ; 31(2): 560-569, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31919928

RESUMO

AIM: The aim of this study is to assess if left bundle branch pacing (LBBP) can preserve physiological cardiac synchrony and deliver favorable hemodynamic effects. METHODS: Consecutive patients undergoing dual chamber pacemaker implantation for sick sinus syndrome (SSS) and a normal cardiac function with a narrow QRS complex were recruited for the study. Electrocardiogram and echocardiographic examinations were performed during ventricular pacing-on and native-conduction modes. The QRS duration (QRSd), systolic dyssynchrony index (SDI), and the standard deviation of time-to-peak contraction velocity in left ventricular (LV) 12 segments (Tsd-12-LV) were measured to evaluate LV synchrony. The stroke volume (SV) and the degree of atrioventricular valvular regurgitation were also assessed. RESULTS: A total of 40 patients underwent LBBP, while another 38 patients underwent right ventricular septum pacing (RVSP) as control group. Baseline characteristics were similar between the two groups. With LBBP, the paced QRSd was slightly wider than the intrinsic QRSd (101.03 ± 8.79 ms vs 91.06 ± 14.17 ms, P < .0001) while the LV mechanical synchrony during LBBP pacing mode was similar to that of native-conduction mode (SDI, 3.14 ± 2.49 vs 2.70 ± 1.68, P = 0.129; Tsd-12-LV, 26.43 ± 15.55 vs 25.61 ± 16.07, P = .671) in the LBBP group. The LV synchrony in the LBBP group was superior to the RVSP group significantly. No significant differences in SV (64.08 ± 16.97 mL vs 65.45 ± 18.68 mL, P = .241) or the degree of atrioventricular valvular regurgitation were noted between LBBP capture and native-conduction modes. CONCLUSION: LBBP could preserve satisfactory LV synchrony and result in favorable hemodynamic effects.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Ecocardiografia , Frequência Cardíaca , Hemodinâmica , Síndrome do Nó Sinusal/terapia , Nó Sinoatrial/fisiopatologia , Função Ventricular Esquerda , Potenciais de Ação , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Síndrome do Nó Sinusal/diagnóstico por imagem , Síndrome do Nó Sinusal/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
13.
Curr Cardiol Rep ; 22(1): 5, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-31950297

RESUMO

PURPOSE OF REVIEW: Pacing in pediatric and adult patients with congenital heart disease requires careful evaluation and thoughtful planning. Review of current guidelines with assessment of risk/benefit must be performed along with planning on a case-by-case basis in order to achieve maximal success and reduce risk in this specialized population of patients that is rapidly increasing in size. RECENT FINDINGS: Guidelines for pacing in pediatric and congenital heart disease patients span many years. Most recent consensus and summary guidelines address pacing in adult patients with or without congenital heart disease. Pediatric recommendations from prior documents must be included in current decision-making. Pacing in pediatric and congenital heart disease patients is important therapy. Creation of an individualized plan of care with attention to risk/benefit decision-making regarding when and how to pace is critical in this population to maximize beneficial outcome.


Assuntos
Estimulação Cardíaca Artificial/métodos , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/prevenção & controle , Adulto , Criança , Consenso , Humanos , Guias de Prática Clínica como Assunto , Fatores de Tempo
15.
Am J Emerg Med ; 38(4): 819-822, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31864866

RESUMO

Temporary transvenous cardiac pacing is a life-saving procedure in an emergency. Transvenous cardiac pacing catheterization guided by intracavitary electrocardiogram (IC-ECG), instead of fluoroscope, is practical. Tips for controlling the orientation of the pacing catheter tip and utilizing IC-ECG to monitor the positions of electrodes make bedside temporary transvenous cardiac pacing catheter placement feasible and 'visible'. The technique discussed here is comparable to the operation under fluoroscopy,but without exposure to X-ray.


Assuntos
Marca-Passo Artificial , Sistemas Automatizados de Assistência Junto ao Leito , Cateterismo Cardíaco , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia , Humanos
16.
Ren Fail ; 42(1): 54-65, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31878817

RESUMO

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. QT interval prolongation is a congenital or acquired condition that is associated with an increased risk of torsade de pointes (TdP), sudden cardiac death (SCD), and all-cause mortality in the general population. The prevalence of acquired long QT syndrome (aLQTS) is high, and various acquired conditions contribute to the prolonged QT interval in patients with CKD. More notably, the prolonged QT interval in CKD is an independent risk factor for SCD and all-cause mortality. In this review, we focus on the epidemiological characteristics, risk factors, underlying mechanisms and treatments of aLQTS in CKD, promoting the management of aLQTS in CKD patients.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Síndrome do QT Longo/epidemiologia , Insuficiência Renal Crônica/complicações , Antiarrítmicos/uso terapêutico , Estimulação Cardíaca Artificial/métodos , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Frequência Cardíaca/efeitos dos fármacos , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/terapia , Prevalência , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Literatura de Revisão como Assunto , Fatores de Risco
17.
Am J Cardiol ; 125(1): 107-113, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31732136

RESUMO

The objective of this study was to determine the long-term (>1 year) electrocardiographic (ECG) and clinical outcomes of patients without significant changes in their electrocardiogram after transcatheter aortic valve implantation (TAVI; including patients with pre-existing ECG abnormalities). Among 772 consecutive patients who underwent TAVI in our institution, 397 patients (51%) without new ECG changes were included. TAVI patients were divided into 2 groups according to the presence of pre-existing ECG-conduction disturbances (ECG-CD: 140 patients, non-ECG-CD: 257 patients). Clinical follow-up (median: 35 [22 to 57] months) was complete in all patients but 5 (1.2%), and ECG data were available in 291 patients (84.3% of patients at risk) at a median of 29 (20 to 50) months. In the non-ECG-CD group, most patients (79.8%) remained without significant ECG changes at follow-up, and 16.9% developed first-degree atrioventricular block and/or bundle branch block over time. The rate of permanent pacemaker (PPM) implantation at follow-up was 3.5% (1.1%/year) in the non-ECG-CD group versus 15.7% (5.5%/year) in the ECG-CD group (p <0.001). The presence of pre-existing CD was an independent predictor of PPM at follow-up (hazard ratio [HR] 4.67, 95% confidence interval [CI] 2.15 to 10.16, p <0.001). The ECG-CD group exhibited a higher risk of heart failure hospitalization (non-ECG-CD: 25%, ECG-CD: 29%, log-rank p = 0.01), but not mortality (non-ECG-CD: 50%, ECG-CD: 46%, log-rank p = 0.60) at 5-year follow-up. In conclusion, the ECG remained unchanged in most TAVI recipients without new postprocedural CD. Pre-existing ECG-CD was associated with an increased risk of PPM and heart failure hospitalization at long-term follow-up. These results provide reassuring data in the era of TAVI expanding toward candidates with a longer life expectancy, and highlight the importance of a closer follow-up of those patients with pre-existing ECG-CDs.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/complicações , Bloqueio de Ramo/complicações , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
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 , Avaliação de Processos e Resultados em Cuidados de Saúde , 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
19.
Rev. esp. cardiol. (Ed. impr.) ; 72(11): 944-953, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190746

RESUMO

Introducción y objetivos: Se describe el resultado del análisis de los dispositivos de estimulación implantados y remitidos al Registro Español de Marcapasos en 2018. Métodos: Información que aporta la Tarjeta Europea del Paciente Portador de Marcapasos, así como los datos proporcionados por la industria sobre el número total de dispositivos implantados. Resultados: Se recibió información de 90 centros hospitalarios, con un total de 12.148 tarjetas, lo cual supone un 31% de la actividad total estimada. El consumo de generadores convencionales y de dispositivos de resincronización fue de 825 y 77 unidades por millón de habitantes respectivamente. La media de edad de los pacientes que recibieron un implante fue 78,3 años y un 54% de los dispositivos se implantaron en pacientes mayores de 80 años. El 77,1% de los procedimientos fueron primoimplantes y el 21,6%, recambios de generador. Aunque la estimulación secuencial bicameral sigue siendo mayoritaria, se utiliza menos en pacientes mayores de 80 años y en mujeres. Además, al 28% de los pacientes con enfermedad del nódulo sinusal y el 24,7% de aquellos con bloqueo auriculoventricular se los estimula en modo VVI/R pese a estar en ritmo sinusal. Conclusiones: El consumo total de generadores de marcapasos en España ha aumentado en un 1,2% con respecto al año 2017, fundamentalmente a expensas del aumento del consumo de generadores de terapia de resincronización cardiaca con marcapasos (8,7%). Los factores directamente relacionados con la elección del modo de estimulación son la edad y el sexo


Introduction and objectives: This report describes the result of the analysis of the implanted pacemakers reported to the Spanish Pacemaker Registry in 2018. Methods: The analysis is based on the information provided by the European Pacemaker Identification Card and supplier-reported data on the overall number of implanted pacemakers. Results: Information was received from 90 hospitals, with a total of 12 148 cards, representing 31% of the estimated activity. Use of conventional and resynchronization pacemakers was 825 and 77 units per million people, respectively. The mean age of the patients receiving an implant was 78.3 years, and 54% of the devices were implanted in people aged> 80 years. A total of 77.1% were first implants and 21.6% corresponded to generator exchanges. Bicameral sequential pacing was the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7% of those with atrioventricular block, despite being in sinus rhythm. Conclusions: The total consumption of pacemaker generators in Spain increased by 1.2% compared with 2017, mainly due to an 8.7% increase in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Marca-Passo Artificial/estatística & dados numéricos , Estimulação Cardíaca Artificial/métodos , Bloqueio Atrioventricular/cirurgia , Fibrilação Atrial/cirurgia , Síndrome do Nó Sinusal/cirurgia , Espanha/epidemiologia , Registros de Doenças/estatística & dados numéricos , Marca-Passo Artificial/classificação , Seleção de Pacientes , Fibrilação Atrial/epidemiologia , Bloqueio Atrioventricular/epidemiologia , Síndrome do Nó Sinusal/epidemiologia , Tecnologia sem Fio/tendências
20.
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
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