Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.896
Filtrar
1.
Medicine (Baltimore) ; 100(11): e25130, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725992

RESUMO

BACKGROUND: Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery. Studies suggest that corticosteroid can reduce the incident of POAF. However, the results remain controversial. This meta-analysis aimed to evaluate the efficacy and safety corticosteroid on the prevention of POAF following cardiac surgery. METHODS: Randomized controlled trials were identified through a systematic literature search. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Primary outcome was the incidence of POAF as well as length of hospital stay and intensive care unit stay, wound and other infection, mortality, duration of ventilation, myocardial infarction, gastrointestinal complications, high blood sugar, stroke, and postoperative bleeding. RESULTS: Fourteen studies with 13,803 patients were finally involved in the present study. Overall, corticosteroid significantly decreased the risk of POAF (relative risk [RR], 0.7; 95% confidence interval [CI], 0.55-0.89; P = .003). There were no significant differences in the incidence of length of intensive care unit stay (RR, -2.32; 95% CI, -5.44 to 0.80; P = .14) and hospital stay (RR, -0.43; 95% CI, -0.84 to -0.02; P = .04), infections (RR, 1.01; 95% CI, 0.83-1.23; P = .9), mortality (RR, 0.87; 95% CI, 0.71-1.06; P = .16), duration of ventilation (RR, -0.29; 95% CI, -0.65 to 0.07; P = .12), gastrointestinal complications (RR, 1.26; 95% CI, 0.91-1.76; P = .16), high blood sugar (RR, 1.98; 95% CI, 0.91-4.31; P = .09), stroke (RR, 0.9; 95% CI, 0.69-1.18; P = .45), postoperative bleeding (RR -44.54; 95% CI, -115.28 to 26.20; P = .22) and myocardial infarction (RR, 1.71; 95% CI, 0.96-1.43; P = .12). CONCLUSION: Our review suggests that the efficacy of corticosteroid might be beneficial to POAF development in patients undergoing cardiac surgery. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.


Assuntos
Corticosteroides/uso terapêutico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias , Idoso , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Fatores de Tempo , Resultado do Tratamento
2.
Kardiologiia ; 60(9): 134-148, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131484

RESUMO

This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.


Assuntos
Fibrilação Atrial , Isquemia Miocárdica , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco
3.
Am J Physiol Heart Circ Physiol ; 319(4): H873-H881, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32857593

RESUMO

Cardiac alternans, defined as beat-to-beat alternations in action potential duration, cytosolic Ca transient (CaT) amplitude, and cardiac contraction is associated with atrial fibrillation (AF) and sudden cardiac death. At the cellular level, cardiac alternans is linked to abnormal intracellular calcium handling during excitation-contraction coupling. We investigated how pharmacological activation or inhibition of cytosolic Ca sequestration via mitochondrial Ca uptake and mitochondrial Ca retention affects the occurrence of pacing-induced CaT alternans in isolated rabbit atrial myocytes. Cytosolic CaTs were recorded using Fluo-4 fluorescence microscopy. Alternans was quantified as the alternans ratio (AR = 1 - CaTsmall/CaTlarge, where CaTsmall and CaTlarge are the amplitudes of the small and large CaTs of a pair of alternating CaTs). Inhibition of mitochondrial Ca sequestration via mitochondrial Ca uniporter complex (MCUC) with Ru360 enhanced the severity of CaT alternans (AR increase) and lowered the pacing frequency threshold for alternans. In contrast, stimulation of MCUC mediated mitochondrial Ca uptake with spermine-rescued alternans (AR decrease) and increased the alternans pacing threshold. Direct measurement of mitochondrial [Ca] in membrane permeabilized myocytes with Fluo-4 loaded mitochondria revealed that spermine enhanced and accelerated mitochondrial Ca uptake. Stimulation of mitochondrial Ca retention by preventing mitochondrial Ca efflux through the mitochondrial permeability transition pore with cyclosporin A also protected from alternans and increased the alternans pacing threshold. Pharmacological manipulation of MCUC activity did not affect sarcoplasmic reticulum Ca load. Our results suggest that activation of Ca sequestration by mitochondria protects from CaT alternans and could be a potential therapeutic target for cardiac alternans and AF prevention.NEW & NOTEWORTHY This study provides conclusive evidence that mitochondrial Ca uptake and retention protects from Ca alternans, whereas uptake inhibition enhances Ca alternans. The data suggest pharmacological mitochondrial Ca cycling modulation as a potential therapeutic strategy for alternans-related cardiac arrhythmia prevention.


Assuntos
Antiarrítmicos/farmacologia , Fibrilação Atrial/prevenção & controle , Canais de Cálcio/efeitos dos fármacos , Sinalização do Cálcio/efeitos dos fármacos , Átrios do Coração/efeitos dos fármacos , Mitocôndrias Cardíacas/efeitos dos fármacos , Miócitos Cardíacos/efeitos dos fármacos , Espermina/farmacologia , Potenciais de Ação/efeitos dos fármacos , Animais , Fibrilação Atrial/metabolismo , Fibrilação Atrial/fisiopatologia , Canais de Cálcio/metabolismo , Átrios do Coração/metabolismo , Frequência Cardíaca/efeitos dos fármacos , Cinética , Masculino , Mitocôndrias Cardíacas/metabolismo , Miócitos Cardíacos/metabolismo , Coelhos
4.
Lancet ; 396(10244): 129-142, 2020 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-32653056

RESUMO

Stroke is a major cause of death and disability globally. Diagnosis depends on clinical features and brain imaging to differentiate between ischaemic stroke and intracerebral haemorrhage. Non-contrast CT can exclude haemorrhage, but the addition of CT perfusion imaging and angiography allows a positive diagnosis of ischaemic stroke versus mimics and can identify a large vessel occlusion target for endovascular thrombectomy. Management of ischaemic stroke has greatly advanced, with rapid reperfusion by use of intravenous thrombolysis and endovascular thrombectomy shown to reduce disability. These therapies can now be applied in selected patients who present late to medical care if there is imaging evidence of salvageable brain tissue. Both haemostatic agents and surgical interventions are investigational for intracerebral haemorrhage. Prevention of recurrent stroke requires an understanding of the mechanism of stroke to target interventions, such as carotid endarterectomy, anticoagulation for atrial fibrillation, and patent foramen ovale closure. However, interventions such as lowering blood pressure, smoking cessation, and lifestyle optimisation are common to all stroke subtypes.


Assuntos
Encéfalo/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Amilose/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Intervenção Médica Precoce/métodos , Endarterectomia das Carótidas/métodos , Procedimentos Endovasculares/métodos , Forame Oval Patente/cirurgia , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Imagem de Perfusão/métodos , Polímeros/uso terapêutico , Recidiva , Acidente Vascular Cerebral/epidemiologia , Succinatos/uso terapêutico , Trombectomia/métodos , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X/métodos
5.
Lancet ; 396(10245): 177-185, 2020 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-32682483

RESUMO

BACKGROUND: Atrial fibrillation and delirium are common consequences of cardiac surgery. Dexmedetomidine has unique properties as sedative agent and might reduce the risk of each complication. This study coprimarily aimed to establish whether dexmedetomidine reduces the incidence of new-onset atrial fibrillation and the incidence of delirium. METHODS: A randomised, placebo-controlled trial was done at six academic hospitals in the USA. Patients who had had cardiac surgery with cardiopulmonary bypass were enrolled. Patients were randomly assigned 1:1, stratified by site, to dexmedetomidine or normal saline placebo. Randomisation was computer generated with random permuted block size 2 and 4, and allocation was concealed by a web-based system. Patients, caregivers, and evaluators were all masked to treatment. The study drug was prepared by the pharmacy or an otherwise uninvolved research associate so that investigators and clinicians were fully masked to allocation. Participants were given either dexmedetomidine infusion or saline placebo started before the surgical incision at a rate of 0·1 µg/kg per h then increased to 0·2 µg/kg per h at the end of bypass, and postoperatively increased to 0·4 µg/kg per h, which was maintained until 24 h. The coprimary outcomes were atrial fibrillation and delirium occurring between intensive care unit admission and the earlier of postoperative day 5 or hospital discharge. All analyses were intention-to-treat. The trial is registered with ClinicalTrials.gov, NCT02004613 and is closed. FINDINGS: 798 patients of 3357 screened were enrolled from April 17, 2013, to Dec 6, 2018. The trial was stopped per protocol after the last designated interim analysis. Among 798 patients randomly assigned, 794 were analysed, with 400 assigned to dexmedetomidine and 398 assigned to placebo. The incidence of atrial fibrillation was 121 (30%) in 397 patients given dexmedetomidine and 134 (34%) in 395 patients given placebo, a difference that was not significant: relative risk 0·90 (97·8% CI 0·72, 1·15; p=0·34). The incidence of delirium was non-significantly increased from 12% in patients given placebo to 17% in those given dexmedetomidine: 1·48 (97·8% CI 0·99-2·23). Safety outcomes were clinically important bradycardia (requiring treatment) and hypotension, myocardial infarction, stroke, surgical site infection, pulmonary embolism, deep venous thrombosis, and death. 21 (5%) of 394 patients given dexmedetomidine and 8 (2%) of 396 patients given placebo, had a serious adverse event as determined by clinicians. 1 (<1%) of 391 patients given dexmedetomidine and 1 (<1%) of 387 patients given placebo died. INTERPRETATION: Dexmedetomidine infusion, initiated at anaesthetic induction and continued for 24 h, did not decrease postoperative atrial arrhythmias or delirium in patients recovering from cardiac surgery. Dexmedetomidine should not be infused to reduce atrial fibrillation or delirium in patients having cardiac surgery. FUNDING: Hospira Pharmaceuticals.


Assuntos
Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Delírio/prevenção & controle , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
6.
Thorac Surg Clin ; 30(3): 259-267, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593359

RESUMO

Enhanced recovery pathways (ERPs), used across multiple surgical subspecialties, is a multidisciplinary delivery of perioperative care designed to lessen the psychological stress of patients undergoing surgery. Thoracic ERP has been implemented but is not widespread, and variations exist between programs. Evidence of the benefit of thoracic ERP is emerging. This article presents common components of a thoracic surgery ERP and reviews contemporary outcomes.


Assuntos
Assistência Perioperatória , Reabilitação/métodos , Procedimentos Cirúrgicos Torácicos/reabilitação , Antibioticoprofilaxia , Fibrilação Atrial/prevenção & controle , Deambulação Precoce , Humanos , Terapia Nutricional , Complicações Pós-Operatórias/prevenção & controle , Trombose Venosa/prevenção & controle
7.
Nutr Metab Cardiovasc Dis ; 30(7): 1106-1114, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32448716

RESUMO

BACKGROUND AND AIMS: Glucagon-like Peptide 1 Receptor Agonists (GLP1-RA) has been associated with a reduction of major cardiovascular events (MACE) and mortality on the basis of the results of cardiovascular outcome trials (CVOT). Several meta-analyses on this issue have been recently published; however, they were all restricted to CVOT, with the exclusion of all studies designed for other endpoints; moreover, other cardiovascular endpoints, such as atrial fibrillation and heart failure have not been fully explored. METHODS AND RESULTS: A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥52 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. We included 43 trials, enrolling 63,134 patients. A significant reduction of MACE (MH-OR 0.87 [0.83, 0.92]), all-cause mortality (MH-OR 0.89 [0.83, 0.96]), and a nonstatistical trend toward reduction of heart failure (MH-OR 0.93 [0.85, 1.01]) was observed - GLP1-RA did not increase the risk of atrial fibrillation (MH-OR 0.94 [0.84, 1.04]). CONCLUSION: The present meta-analysis confirms the favorable effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events, cardiovascular and all-cause mortality, stroke, and possibly myocardial infarction. Conversely, the effects on heart failure remain uncertain. Available data on atrial fibrillation seems to exclude any major safety issues in this respect. REGISTRATION NUMBER (PROSPERO): CRD42018115577.


Assuntos
Fibrilação Atrial/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Insuficiência Cardíaca/prevenção & controle , Hipoglicemiantes/uso terapêutico , Incretinas/uso terapêutico , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipoglicemiantes/efeitos adversos , Incidência , Incretinas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/prevenção & controle , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
Arq. bras. cardiol ; 114(5): 775-782, maio 2020. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP | ID: biblio-1131230

RESUMO

Resumo Fundamento A ablação da fibrilação atrial (FA) e do flutter atrial dependente de istmo cavo-tricuspídeo (FLA-ICT) pode ser realizada simultaneamente quando as duas arritmias tenham sido registradas antes do procedimento. Entretanto, a melhor abordagem não é clara quando pacientes com FLA-ICT são encaminhados para ablação sem o registro prévio de FA. Objetivos Avaliar a prevalência e identificar os preditores de ocorrência do primeiro episódio de FA após ablação de FLA-ICT em pacientes sem o registro prévio de FA. Métodos Coorte retrospectiva de pacientes submetidos exclusivamente a ablação por cateter para FLA-ICT, sem registro prévio de FA. As características clínicas foram comparadas entre os grupos em que houve ocorrência de FA pós-ablação de FLA-ICT vs. sem ocorrência de FA. O nível de significância estatística adotado foi de 5%. Na análise de preditores, o desfecho primário avaliado foi ocorrência de FA após ablação de FLA-ICT. Resultados De um total de 227 pacientes submetidos a ablação de FLA-ICT (110 com registro de FA e 33 sem seguimento adequado), 84 pacientes foram incluídos, dos quais 45 (53,6%) apresentaram FA pós-ablação. Não houve variáveis preditoras de ocorrência de FA. Os escores HATCH e CHA2DS2-VASC foram semelhantes nos dois grupos. As taxas de recorrência de FLA-ICT e complicações após a ablação foram de 11,5% e 1,2%, respectivamente. Conclusões A ablação de FLA-ICT é eficaz e segura, mas 50% dos pacientes desenvolvem FA após ablação. Entretanto, ainda é incerto o papel da ablação combinada (FLA-ICT e FA) visando prevenção da ocorrência de FA. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. Objectives To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. Methods Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation. Results Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation. Conclusions Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Assuntos
Humanos , Fibrilação Atrial/epidemiologia , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Recidiva , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Ablação por Cateter/métodos
10.
Arq Bras Cardiol ; 114(5): 775-782, 2020 03 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32236324

RESUMO

BACKGROUND: Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. OBJECTIVES: To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. METHODS: Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation. RESULTS: Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation. CONCLUSIONS: Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Ablação por Cateter/métodos , Humanos , Prevalência , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
11.
Int Heart J ; 61(2): 263-272, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32132317

RESUMO

This study aims to evaluate the effect of dexmedetomidine (DEX) sedation for relieving anxiety and the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass graft (OPCABG).This randomized, double-blind, controlled trial was conducted on 196 patients who underwent OPCABG in Shandong Provincial Hospital from July 2017 to June 2018. The patients were randomly assigned to two groups, intervention of DEX group and Propofol (PROP) group. Episodes of postoperative AF (POAF) were identified within 5 days after OPCABG. Perioperative anxiety status was assessed using Zung's Self-Rating Anxiety Scale (SAS). The baseline demographic and surgical characteristics of the population and other outcome variables were evaluated.We analyzed 62 patients in the DEX group and 61 patients in the PROP group. There was no significant difference in SAS anxiety scores between two groups before surgery (P = 0.104), while SAS had significantly after surgery (P = 0.018). The incidence of POAF in the DEX group was lower than that of the PROP group (16.1% versus 32.8%, P = 0.037), and a total of 30 patients (30/123, 24.4%) manifested POAF after OPCABG. Some univariable predictors of POAF were detected. The conceptual model of mediator analyses showed DEX was not only directly related to POAF but was also indirectly related through the independent effect of anxiety level.The findings indicated that patients receiving DEX were more likely to have less incidence of POAF, also uniquely showed DEX administration and POAF processes as a function of anxiety status.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Ansiedade/prevenção & controle , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Dexmedetomidina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Idoso , Ansiedade/etiologia , Fibrilação Atrial/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
12.
Medicine (Baltimore) ; 99(2): e18517, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914024

RESUMO

Atrial fibrillation (AF) is an important complication of acute myocardial infarction (AMI). The association between AF and serum lipid profile is unclear and statin use for lowering the incidence of new-onset AF remains controversial. The objective of this study was to investigate whether statins confer a beneficial effect on AF after AMI.Data available in the Taiwan National Health Insurance Research Database on 32886 AMI patients between 2008 and 2011 were retrospectively analyzed. Total 27553 (83.8%) had complete 1-yr follow-up data. Cardiovascular outcomes were analyzed based on the baseline characteristics and AF type (existing, new-onset, or non-AF). AF groups had significantly higher incidence of heart failure (HF), stroke, all-cause death, and major adverse cardiac and cerebrovascular event (MACCE) after index AMI (all P < .05). In contrast, myocardial re-infarction (re-MI) was not significantly different among the three groups (P = .95). Statin use tended to be associated with lower risk of new-onset AF after AMI (HR: 0.935; 95% confidence interval (CI): 0.877-0.998; P = .0427).Existing AF and new-onset AF subgroups had similar cardiovascular outcomes after AMI and were both inferior to the non-AF group. Statin tended to reduce new-onset AF after AMI.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/complicações , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Taiwan/epidemiologia
13.
Br J Surg ; 107(4): 432-442, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31965568

RESUMO

BACKGROUND: Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real-world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all-cause mortality. METHODS: A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m2 or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery. RESULTS: A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45·3(10·5) years and 21·5 per cent (3265 of 15 165 participants) had T2DM. Median follow-up was 3·9 (i.q.r. 1·8- 6·4) years. Mean(s.d.) percentage weight loss was 20·0(13·2) and 0·8(9·5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0·80; 95 per cent c.i. 0·62 to 1·02; P = 0·074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0·53, 0·34 to 0·81; P = 0·003). Bariatric surgery was associated with significant reduction in all-cause mortality (adjusted HR 0·70, 0·55 to 0·89; P = 0·004), hypertension (adjusted HR 0·41, 0·34 to 0·50; P < 0·001) and heart failure (adjusted HR 0·57, 0·34 to 0·96; P = 0·033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group. CONCLUSION: Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care.


Assuntos
Fibrilação Atrial/epidemiologia , Cirurgia Bariátrica/mortalidade , Hipertensão/epidemiologia , Adulto , Fibrilação Atrial/prevenção & controle , Cirurgia Bariátrica/estatística & dados numéricos , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Estudos de Casos e Controles , Feminino , Derivação Gástrica/mortalidade , Derivação Gástrica/estatística & dados numéricos , Humanos , Hipertensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/prevenção & controle , Obesidade/complicações , Obesidade/mortalidade , Obesidade/cirurgia , Estudos Retrospectivos
14.
N Engl J Med ; 382(1): 20-28, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31893513

RESUMO

BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear. METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up. RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01). CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).


Assuntos
Abstinência de Álcool , Consumo de Bebidas Alcoólicas/efeitos adversos , Fibrilação Atrial/prevenção & controle , Idoso , Fibrilação Atrial/etiologia , Austrália , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária
15.
Anesthesiology ; 132(2): 267-279, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31939841

RESUMO

BACKGROUND: For cardiac surgery patients under chronic ß-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of ß-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. METHODS: This multicenter prospective French cohort study included patients on ß-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of ß-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of ß-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). RESULTS: Of 663 patients, ß-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of ß-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. CONCLUSIONS: ß-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) ß-blocker reintroduction after cardiac surgery.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/tendências , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Antagonistas Adrenérgicos beta/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos de Coortes , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos
16.
Circ Arrhythm Electrophysiol ; 13(2): e007626, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31940441

RESUMO

BACKGROUND: Obesity is an independent risk factor for atrial fibrillation (AF) and is associated with a higher AF burden. Recently, weight loss has been found to be associated with a significant reversal in AF type. Bariatric surgery (BS) is associated with reductions in inflammation, left atrial and ventricular remodeling, sleep apnea, blood pressure, and improved glycemic control, all of which may reduce AF burden. In this study, we sought to determine the impact of BS on AF type. METHODS: We studied AF type before and after BS in 220 morbidly obese patients (body mass index, ≥40 kg/m2). All patients underwent extended outpatient cardiac rhythm monitoring within 12 months of BS and at least 1 year after BS. RESULTS: There was a significant reduction in body mass index following BS from 49.7±9 to 37.2±9 kg/m2. Weight loss was the greatest in the gastric bypass group with a mean percentage weight loss of 25% compared with 19% in patients who underwent sleeve gastrectomy and 16% following gastric banding (P<0.0001). Significant reductions in CRP (C-reactive protein), NT-proBNP (N-terminal pro-B-type natriuretic peptide), HbA1C (glycated hemoglobin), and systolic blood pressure were observed in all 3 groups. Reversal of AF type occurred in 71% of patients following gastric bypass, 56% of patients who underwent sleeve gastrectomy, and 50% of patients following gastric banding (P=0.004). On Cox proportional hazards analyses, percentage weight loss was significantly associated with AF reversal (P=0.0002). CONCLUSIONS: BS is associated with significant reductions in weight, inflammatory markers, blood pressure, and AF type, and the beneficial effects appear to be the greatest in those undergoing gastric bypass surgery. This study further exemplifies the importance of weight loss and risk factor modification in AF management.


Assuntos
Fibrilação Atrial/prevenção & controle , Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Perda de Peso
17.
Medicine (Baltimore) ; 99(2): e18675, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914059

RESUMO

BACKGROUND: The efficacy of patent foramen ovale (PFO) closure remains controversial, and it is unclear which patient groups are best benefited. We performed this meta-analysis to clarify the efficacy of PFO closure of younger patients for prevention of recurrent ischemic neurological events. METHODS: We systematically searched for studies of PFO closure for younger patients under the age of 55, and pooled available data on PFO closure of younger vs older patients and on PFO closure of younger patients vs medical therapy. The primary endpoints were the composite outcome of recurrent ischemic neurological events [stroke and/or transient ischemic attack (TIA)]. The secondary endpoints included recurrent stroke, TIA, atrial fibrillation (AF) and bleeding events. We calculated the odds ratios (OR) and 95% confidence interval (CI) using fixed-effect and random-effect models. RESULTS: Three randomized controlled trials (RCT) and 13 observational studies were eligible. Compared with older patients undergoing PFO closure, younger patients undergoing closure had a lower risk of composite outcome (OR: 0.40, 95% CI: 0.28 to .56; P < .001) and AF (OR: 0.25, 95% CI: 0.10-0.61; P = .003). Compared with medical therapy, PFO closure of younger patients reduced the risk of composite outcome (OR: 0.50, 95% CI: 0.33-0.75; P<.001); there was no statistical difference in total complications of AF and bleeding events (OR: 2.15, 95% CI: 0.15-30.37; P = .57). Separate analysis of stroke and TIA showed that PFO closure in younger patients was more effective in preventing stroke (OR: 0.45, 95% CI: 0.28-0.72; P < .001) and TIA (OR: 0.35, 95% CI: 0.21-0.58); P < .001) compared with older patients. Compared with medical therapy, PFO closure of younger patients reduced the risk of stroke (OR: 0.26, 95% CI: 0.13-0.51; P < .001); but there was no difference in the risk of TIA (OR: 1.07, 95% CI: 0.16-7.01; P = .94). CONCLUSIONS: Compared with PFO closure of older patients and medical therapy, PFO closure of younger patients can benefit more for the prevention of recurrent ischemic neurological events. Our results indicate that PFO closure is the best treatment strategy for younger patients under the age of 55.


Assuntos
Forame Oval Patente/cirurgia , Ataque Isquêmico Transitório/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Adulto , Fatores Etários , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Feminino , Forame Oval Patente/complicações , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
18.
JAMA ; 323(3): 248-255, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31961420

RESUMO

Importance: Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation. Objective: To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy. Design, Setting, and Participants: The Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrial fibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrial fibrillation, and plans for ablation were enrolled from April 2013 to March 2018. Follow-up concluded in March 2019. Interventions: Patients were randomized to either pulmonary vein isolation alone (n = 148) or pulmonary vein isolation plus renal denervation (n = 154). Complete pulmonary vein isolation to v an end point of elimination of all pulmonary vein potentials; renal denervation using an irrigated-tip ablation catheter delivering radiofrequency energy to discrete sites in a spiral pattern from distal to proximal in both renal arteries. Main Outcomes and Measures: The primary end point was freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 12 months. Secondary end points included procedural complications within 30 days and blood pressure control at 6 and 12 months. Results: Of the 302 randomized patients (median age, 60 years [interquartile range, 55-65 years]; 182 men [60.3%]), 283 (93.7%) completed the trial. All successfully underwent their assigned procedures. Freedom from atrial fibrillation, flutter, or tachycardia at 12 months was observed in 84 of 148 (56.5%) of those undergoing pulmonary vein isolation alone and in 111 of 154 (72.1%) of those undergoing pulmonary vein isolation plus renal denervation (hazard ratio, 0.57; 95% CI, 0.38 to 0.85; P = .006). Of 5 prespecified secondary end points, 4 are reported and 3 differed between groups. Mean systolic blood pressure from baseline to 12 months decreased from 151 mm Hg to 147 mm Hg in the isolation-only group and from 150 mm Hg to 135 mm Hg in the renal denervation group (between-group difference, -13 mm Hg; 95% CI, -15 to -11 mm Hg; P < .001). Procedural complications occurred in 7 patients (4.7%) in the isolation-only group and 7 (4.5%) of the renal denervation group. Conclusions and Relevance: Among patients with paroxysmal atrial fibrillation and hypertension, renal denervation added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from atrial fibrillation at 12 months. The lack of a formal sham-control renal denervation procedure should be considered in interpreting the results of this trial. Trial Registration: ClinicalTrials.gov Identifier: NCT01873352.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Hipertensão/cirurgia , Rim/inervação , Veias Pulmonares/cirurgia , Simpatectomia , Idoso , Anti-Hipertensivos/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/prevenção & controle , Terapia Combinada , Resistência a Medicamentos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Método Simples-Cego
19.
Surg Today ; 50(8): 841-848, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31980932

RESUMO

PURPOSE: Tolvaptan administration in the early postoperative period after cardiac surgery rapidly treats fluid retention without affecting the renal function. Tolvaptan also has the benefit of not stimulating the renin-angiotensin and sympathetic nervous systems, which are risk factors for postoperative paroxysmal atrial fibrillation. In this study, we examined the hypothesis that tolvaptan administration reduces postoperative paroxysmal atrial fibrillation and worsening of the renal function incidence in patients who have undergone open-heart surgery. METHODS: From our previous randomized study, we selected 166 open-heart surgery patients, divided them into 2 groups [tolvaptan group, 83 patients; control (non-tolvaptan) group, 83 patients], and compared the incidence of postoperative paroxysmal atrial fibrillation and worsening of the renal function in the postoperative period between the groups. RESULTS: The incidence of worsening of the renal function was significantly lower in the tolvaptan group than in the control group (4.8% vs. 15.7%; P = 0.04). The incidence of postoperative paroxysmal atrial fibrillation within 14 days was also significantly lower in the tolvaptan group than in the control group (26.5% vs. 42.2%; P = 0.011). CONCLUSION: Tolvaptan administration in the early postoperative period after open-heart surgery may reduce the incidence of postoperative paroxysmal atrial fibrillation and worsening of the renal function.


Assuntos
Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Tolvaptan/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Tempo
20.
Blood ; 135(12): 904-911, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-31978224

RESUMO

Obesity has become a major threat to health worldwide. The prevalence of obesity is rapidly increasing, so much so that the World Health Organization has declared obesity as a global epidemic. Obesity is associated with multiple health problems, including venous thromboembolism and atrial fibrillation, both of which are treated with anticoagulation. However, obesity and treatments for obesity such as bariatric surgery can influence absorption, excretion, pharmacokinetics, and pharmacodynamics of various anticoagulants. This results in uncertainty regarding the best antithrombotic strategies in this population, particularly in the morbidly obese. In the recent years, several studies have attempted to investigate anticoagulation use in this population and provided more insight. Herein, we present 4 cases of anticoagulant use in the obese to illustrate the common challenges faced by clinicians and discuss our approach. Whenever possible, we provide a review of the literature and base our recommendations on the best available evidence.


Assuntos
Anticoagulantes/administração & dosagem , Obesidade/complicações , Administração Oral , Anticoagulantes/farmacocinética , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Monitoramento de Medicamentos , Humanos , Obesidade/terapia , Pré-Medicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Varfarina/administração & dosagem , Varfarina/farmacocinética
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...