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1.
Medicine (Baltimore) ; 99(2): e18658, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914051

RESUMO

RATIONALE: Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known. PATIENT CONCERNS: A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted. DIAGNOSIS: Cardiac arrest on LVAD. INTERVENTIONS: It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully. OUTCOMES: The patient became brain dead. LESSONS: There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.


Assuntos
Reanimação Cardiopulmonar/métodos , Coração Auxiliar , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Cardioversão Elétrica , Fontes de Energia Elétrica , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/complicações , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
2.
Int Heart J ; 60(5): 1161-1167, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484866

RESUMO

Therapy-resistant ventricular arrhythmias can occur during accidental advanced hypothermic conditions. On the other hand, hypothermic therapy using mild cooling has been successfully accomplished with infrequent ventricular arrhythmia events.To further clarify the therapeutic-resistant arrhythmogenic substrate which develops in hypothermic conditions, an experimental study was performed using a perfusion wedge preparation model of porcine ventricle, and electrophysiological characteristics, inducibility of ventricular arrhythmias, and effects of therapeutic interventions were assessed at 3 target temperatures (37, 32 and 28°C).As the myocardial temperature decreased, myocardial contractions and the number of spontaneous beats deceased. Depolarization (QRS width, stimulus-QRS interval) and repolarization (QT interval, ERP) parameters progressively increased, and dispersion of the ventricular repolarization increased. At 28°C, VF tended to be inducible more frequently (1/11 at 37°C, 1/11 at 32°C, and 5/11 hearts at 28°C), and some VFs at 28°C required greater defibrillation energy to resume basic rhythm.An advanced but not a mild hypothermic condition had an enhanced arrhythmogenic potential in our model. In the advanced hypothermic condition, VF with relatively prolonged F-F intervals and a greater defibrillation energy were occasionally inducible based on the arrhythmogenic substrate characterized as slowed conduction and prolonged repolarization of the ventricle.


Assuntos
Antiarrítmicos/administração & dosagem , Eletrocardiografia/métodos , Hipotermia Induzida/métodos , Fibrilação Ventricular/diagnóstico por imagem , Fibrilação Ventricular/terapia , Análise de Variância , Animais , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Eletrofisiologia Cardíaca/métodos , Modelos Animais de Doenças , Resistência a Medicamentos , Distribuição Aleatória , Medição de Risco , Suínos , Resultado do Tratamento
5.
J Neuroinflammation ; 16(1): 139, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31287006

RESUMO

BACKGROUND: Sympathetic overactivation and inflammation are two major mediators to post-myocardial ischemia-reperfusion (I/R)-induced ventricular arrhythmia (VA). The vicious cycle between microglia and sympathetic activation plays an important role in sympathetic hyperactivity related to cardiovascular diseases. Recently, studies have shown that microglial activation might be attenuated by light-emitting diode (LED) therapy. Therefore, we hypothesized that LED therapy might protect against myocardial I/R-induced VAs by attenuating microglial and sympathetic activation. METHODS: Thirty-six male anesthetized rats were randomized into four groups: control group (n = 6), LED group (n = 6), I/R group (n = 12), and LED+I/R group (n = 12). I/R was generated by left anterior descending artery occlusion for 30 min followed by 3 h reperfusion. ECG and left stellate ganglion (LSG) neural activity were recorded continuously. After 3 h reperfusion, a programmed stimulation protocol was conducted to test the inducibility of VA. Furthermore, we extracted the brain tissue to examine the microglial activation, and the peri-ischemic myocardium to examine the expression of NGF and inflammatory cytokines (IL-1ß, IL-18, IL-6, and TNF-α). RESULTS: As compared to the I/R group, LED illumination significantly inhibited the LSG neural activity (P < 0.01) and reduced the inducibility of VAs (arrhythmia score 4.417 ± 0.358 vs. 3 ± 0.3257, P < 0.01) in the LED+I/R group. Furthermore, LED significantly attenuated microglial activation and downregulated the expression of inflammatory cytokines and NGF in the peri-infarct myocardium. CONCLUSIONS: LED therapy may protect against myocardial I/R-induced VAs by central and peripheral neuro-immune regulation.


Assuntos
Traumatismo por Reperfusão Miocárdica/imunologia , Traumatismo por Reperfusão Miocárdica/terapia , Neuroimunomodulação/fisiologia , Fototerapia/métodos , Fibrilação Ventricular/imunologia , Fibrilação Ventricular/terapia , Animais , Masculino , Traumatismo por Reperfusão Miocárdica/metabolismo , Neuroimunomodulação/efeitos da radiação , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fibrilação Ventricular/metabolismo
6.
Cardiol Young ; 29(5): 701-703, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31097046

RESUMO

Subtotal tumour resection is used to treat infants with congenital cardiac fibroma and medication-resistant ventricular arrhythmias; however, complete elimination of arrhythmogenic substrates has been unclear. A 4-month-old male infant with congenital cardiac fibroma and ventricular fibrillation underwent subtotal tumour resection and implantable cardioverter-defibrillator implantation. Five years later, angiography revealed impending compression of the left coronary artery. Elimination of the arrhythmogenic substrate was confirmed and the device was removed successfully.


Assuntos
Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia , Procedimentos Cirúrgicos Cardíacos , Angiografia Coronária , Desfibriladores Implantáveis , Remoção de Dispositivo , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Lactente , Masculino , Medição de Risco , Tomografia Computadorizada por Raios X
7.
Int J Mol Sci ; 20(9)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31052231

RESUMO

We investigated the antiarrhythmic effects of ischemic preconditioning (IPC) and postconditioning (PostC) by intracardiac electrocardiogram (ECG) and measured circulating microRNAs (miRs) that are related to cardiac conduction. Domestic pigs underwent 90-min. percutaneous occlusion of the mid left anterior coronary artery, followed by reperfusion. The animals were divided into three groups: acute myocardial infarction (AMI, n = 7), ischemic preconditioning-acute myocardial infarction (IPC-AMI) (n = 9), or AMI-PostC (n = 5). IPC was induced by three 5-min. episodes of repetitive ischemia/reperfusion cycles (rI/R) before AMI. PostC was induced by six 30-s rI/R immediately after induction of reperfusion 90 min after occlusion. Before the angiographic procedure, a NOGA endocardial mapping catheter was placed again the distal anterior ventricular endocardium to record the intracardiac electrogram (R-amplitude, ST-Elevation, ST-area under the curve (AUC), QRS width, and corrected QT time (QTc)) during the entire procedure. An arrhythmia score was calculated. Cardiac MRI was performed after one-month. IPC led to significantly lower ST-elevation, heart rate, and arrhythmia score during ischemia. PostC induced a rapid recovery of R-amplitude, decrease in QTc, and lower arrhythmia score during reperfusion. Slightly higher levels of miR-26 and miR-133 were observed in AMI compared to groups IPC-AMI and AMI-PostC. Significantly lower levels of miR-1, miR-208, and miR-328 were measured in the AMI-PostC group as compared to animals in group AMI and IPC-AMI. The arrhythmia score was not significantly associated with miRNA plasma levels. Cardiac MRI showed significantly smaller infarct size in the IPC-AMI group when compared to the AMI and AMI-PostC groups. Thus, IPC led to better left ventricular ejection fraction at one-month and it exerted antiarrhythmic effects during ischemia, whereas PostC exhibited antiarrhythmic properties after reperfusion, with significant downregulaton of ischemia-related miRNAs.


Assuntos
Exossomos/metabolismo , Pós-Condicionamento Isquêmico , Precondicionamento Isquêmico Miocárdico , MicroRNAs/metabolismo , Infarto do Miocárdio/metabolismo , Fibrilação Ventricular/metabolismo , Animais , Feminino , Ventrículos do Coração/metabolismo , MicroRNAs/genética , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Suínos , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia , Função Ventricular
8.
Scand Cardiovasc J ; 53(2): 71-76, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30958708

RESUMO

OBJECTIVES: The study sought to assess the prognostic impact of recurrences of electrical storm (ES-R) on mortality, rehospitalization and major adverse cardiac events (MACE). BACKGROUND: Data on the prognostic impact of ES-R is rare. METHODS: All consecutive ES patients with an implantable cardioverter defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with ES-R were compared to patients without ES-R. The primary endpoint was all-cause mortality, secondary endpoints were in-hospital mortality, rehospitalization and MACE. RESULTS: A total of 87 consecutive ES patients with an ICD were included, of which 26% presented with ES-R at 2.5 years of follow-up. ES-R patients revealed lower LVEF compared to non-ES-R patients (91% vs. 61%; p = .081). There was a numerically higher rate of the primary endpoint of all-cause mortality at 2.5 years (50% vs. 32%; log-rank p = .137). Furthermore, ES-R was associated with increasing rates of rehospitalization (64% vs. 37%; p = .031; HR 1.985; 95% CI 1.025-3.845; log-rank p = .042), especially of acute heart failure (32% vs. 12%; p = .001; HR 3.262; 95% CI 1.180-9.023; log rank p = .023). MACE were higher in ES-R patients (55% vs. 35%; p = .113; log rank p = .141). ES patients with LVEF ≤35% were 12.4 times more likely to develop ES-R (HR 12.417; 95% CI 1.329-115.997; p = .027). CONCLUSION: At long-term follow-up of 2.5 years, ES-R was associated with numerically higher rates of long-term all-cause mortality and significantly higher rates of rehospitalization due to acute heart failure. LVEF ≤35% was associated with increased risk of ES-R. Condensed Abstract This study examined retrospectively the impact of recurrences of electrical storm (ES-R) on survival in 87 patients. ES-R was associated with numerically higher long-term all-cause mortality, whereas significantly higher rates of rehospitalization, respectively of acute heart failure were observed. Highlights ES-R is associated with numerically higher rates of all-cause mortality at long-term follow-up. ES-R is associated with significantly higher rates of rehospitalization and numerically higher rates of MACE at long-term follow-up, mainly due to acute heart failure. Patients with LVEF ≤35% were 12.4 times more likely to develop ES-R.


Assuntos
Cardioversão Elétrica , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desfibriladores Implantáveis , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Recidiva , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia , Função Ventricular Esquerda , Adulto Jovem
9.
Clin Cardiol ; 42(6): 612-617, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30989668

RESUMO

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous one. Defibrillation efficacy depends on maximum device output and on the optimal device location at device implantation. HYPOTHESIS: We sought to investigate the defibrillation safety margin in real life clinical practice. METHODS: We sought to understand what is the efficacy of induced ventricular fibrillation (VF) termination at S-ICD implantation using lower energies than the recommended 65 J. RESULTS: Sixty-four consecutive S-ICD recipients underwent VF termination attempts at implantation with energies ranging from 20 to 50 J. Overall, VF termination occurred in 84% of patients with ≤40 J, in 88% with 45 J, and in 100% with 60 J. Intermuscular S-ICD placement was associated with 94% VF termination at ≤40 J. An ejection fraction <35% was associated to higher energy requirement for defibrillation; however, an intermuscular S-ICD placement conferred 90% defibrillation efficacy at 31 ± 5 J in this patients subset. CONCLUSIONS: This is a hypothesis-generating observation that prompts a methodologically correct investigation to prove that a 60 J output S-ICD can provide an adequate safety margin to terminate VF in clinical practice. This would enable superior device longevity and/or device downsizing for pediatric/small size patients.


Assuntos
Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Eletrocardiografia , Frequência Cardíaca/fisiologia , Fibrilação Ventricular/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica , Resultado do Tratamento , Fibrilação Ventricular/fisiopatologia
12.
BMJ ; 364: l430, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819685

RESUMO

OBJECTIVE: To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest. DESIGN: Cohort study between January 2014 and December 2016. SETTING: Nationwide, population based registry in Japan (All-Japan Utstein Registry). PARTICIPANTS: Consecutive adult patients with out-of-hospital cardiac arrest, separated into two sub-cohorts by their first documented electrocardiographic rhythm: shockable (ventricular fibrillation or pulseless ventricular tachycardia) and non-shockable (pulseless electrical activity or asystole). Patients who received AAM during cardiopulmonary resuscitation were sequentially matched with patients at risk of AAM within the same minute on the basis of time dependent propensity scores. MAIN OUTCOME MEASURES: Survival at one month or at hospital discharge within one month. RESULTS: Of the 310 620 patients eligible, 8459 (41.2%) of 20 516 in the shockable cohort and 121 890 (42.0%) of 290 104 in the non-shockable cohort received AAM during cardiopulmonary resuscitation. After time dependent propensity score sequential matching, 16 114 patients in the shockable cohort and 236 042 in the non-shockable cohort were matched at the same minute. In the shockable cohort, survival did not differ between patients with AAM and those with no AAM: 1546/8057 (19.2%) versus 1500/8057 (18.6%) (adjusted risk ratio 1.00, 95% confidence interval 0.93 to 1.07). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35). CONCLUSIONS: In the time dependent propensity score sequential matching for out-of-hospital cardiac arrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.


Assuntos
Manuseio das Vias Aéreas/mortalidade , Reanimação Cardiopulmonar/mortalidade , Cardioversão Elétrica/mortalidade , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Reanimação Cardiopulmonar/métodos , Estudos de Coortes , Cardioversão Elétrica/métodos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Alta do Paciente/estatística & dados numéricos , Pontuação de Propensão , Sistema de Registros , Fatores de Tempo , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/terapia
13.
Am Heart J ; 210: 58-68, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30738245

RESUMO

Return of spontaneous circulation occurs in less than 10% of patients with cardiac arrest undergoing cardiopulmonary resuscitation (CPR) for more than 15 minutes. Studies suggest that extracorporeal life support during cardiopulmonary resuscitation (ECPR) improves survival rate in these patients. These studies, however, are hampered by their non-randomized, observational design and are mostly single-center. A multicenter, randomized controlled trial is urgently warranted to evaluate the effectiveness of ECPR. HYPOTHESIS: We hypothesize that early initiation of ECPR in refractory out-of-hospital cardiac arrest (OHCA) improves the survival rate with favorable neurological status. STUDY DESIGN: The INCEPTION trial is an investigator-initiated, prospective, multicenter trial that will randomly allocate 110 patients to either continued CPR or ECPR in a 1:1 ratio. Patients eligible for inclusion are adults (≤ 70 years) with witnessed OHCA presenting with an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT), who received bystander basic life support and who fail to achieve sustained return of spontaneous circulation within 15 minutes of cardiopulmonary resuscitation by emergency medical services. The primary endpoint of the study is 30-day survival rate with favorable neurological status, defined as 1 or 2 on the Cerebral Performance Category score. The secondary endpoints include 3, 6 and 12-month survival rate with favorable neurological status and the cost-effectiveness of ECPR compared to CCPR. SUMMARY: The INCEPTION trial aims to determine the clinical benefit for the use of ECPR in patients with refractory OHCA presenting with VF/VT. Additionally, the feasibility and cost-effectiveness of ECPR will be evaluated.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Estudos Multicêntricos como Assunto , Parada Cardíaca Extra-Hospitalar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo para o Tratamento , Adulto , Idoso , Circulação Sanguínea , Desfibriladores , Serviços Médicos de Emergência , Humanos , Análise de Intenção de Tratamento , Pessoa de Meia-Idade , Exame Neurológico , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Prospectivos , Taxa de Sobrevida , Taquicardia/terapia , Fatores de Tempo , Fibrilação Ventricular/terapia
15.
Int Heart J ; 60(2): 466-469, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30745542

RESUMO

A 28-year-old female presented with fulminant lymphocytic myocarditis. She developed cardiogenic shock, frequent sustained ventricular tachycardia, and fibrillation (VT and VF). The left ventricular ejection fraction improved from 5% to 40% after medical therapy, but the right ventricular systolic dysfunction and enlargement persisted. In addition, sustained VTs, requiring direct current cardioversion, occurred during oral administration of amiodarone following intravenous amiodarone, even after percutaneous stellate ganglion block. Standard body surface electrocardiogram (ECG) screening for an implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) (EMBLEM™ S-ICD, Boston Scientific, Marlborough, MA, USA) demonstrated that two of the three sensing vectors were eligible in spite of very low-amplitude QRS complexes in the body surface ECGs. After implantation of the S-ICD, the patient experienced repetitive, inappropriate shocks due to pectoral myopotential oversensing, which could not be resolved by reprogramming the device settings. Thus, the S-ICD lead was changed from the standard left parasternal position to the midline of the sternum to reduce muscular noise due to myopotentials. Thereafter, the patient experienced appropriate ICD shocks for sustained VT and VF but no inappropriate ICD sensing or shocks. Lead repositioning may be one of the feasible solutions in S-ICD patients with low-amplitude QRS complexes and inappropriate shocks due to myopotential oversensing which cannot be resolved by reprogramming the device settings.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/instrumentação , Falha de Equipamento , Sistema de Condução Cardíaco/fisiopatologia , Miocardite/complicações , Ajuste de Prótese/métodos , Fibrilação Ventricular , Adulto , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Resultado do Tratamento , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/etiologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
16.
Int Heart J ; 60(2): 470-473, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30745545

RESUMO

A 41-year-old man developed cardiac arrest. A resting 12-lead electrocardiogram showed a delta wave, suggestive of preexcitation syndrome. An electrophysiological test revealed the existence of inducible atrial fibrillation and a fasciculoventricular accessory pathway (FVAP). After these examinations, idiopathic ventricular arrhythmia was suspected. For evaluating concealed Brugada syndrome, pilsicainide was administered, which diminished the delta wave and no Brugada-like electrocardiogram was observed. Ventricular double extra-stimulation from the RV apex easily induced VF, which could not be defibrillated by an external defibrillator, and later stopped spontaneously. These results established the diagnosis of FVAP and idiopathic VF, and not pre-excited atrial fibrillation or Brugada syndrome.


Assuntos
Feixe Acessório Atrioventricular , Síndrome de Brugada/diagnóstico , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Síndromes de Pré-Excitação , Fibrilação Ventricular/terapia , Feixe Acessório Atrioventricular/diagnóstico , Feixe Acessório Atrioventricular/fisiopatologia , Feixe Acessório Atrioventricular/terapia , Adulto , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores , Diagnóstico Diferencial , Técnicas Eletrofisiológicas Cardíacas/métodos , Humanos , Masculino , Síndromes de Pré-Excitação/diagnóstico , Síndromes de Pré-Excitação/fisiopatologia , Síndromes de Pré-Excitação/terapia , Remissão Espontânea , Falha de Tratamento
18.
Int Heart J ; 60(2): 462-465, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30626767

RESUMO

Implantable cardioverter-defibrillators (ICDs) are an effective treatment to prevent sudden cardiac death; however, lead dysfunction is an important complication during the long-term follow-up period in ICD recipients. Careful device programming is required in accordance with the individual situation in patients with lead dysfunction. We herein present a patient in whom programming to AAI triggered palpitations during exercise.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/instrumentação , Falha de Equipamento , Doença Iatrogênica/prevenção & controle , Fibrilação Ventricular/terapia , Adulto , Artefatos , Morte Súbita Cardíaca/prevenção & controle , Remoção de Dispositivo/métodos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/métodos , Exercício/fisiologia , Humanos , Masculino , Condicionamento Físico Humano/efeitos adversos , Desenho de Prótese/métodos , Implantação de Prótese/métodos , Reoperação , Resultado do Tratamento
19.
Brain Stimul ; 12(3): 659-667, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30611705

RESUMO

BACKGROUND: Transcranial direct current stimulation (tDCS) modulates neuronal activity and is a potential therapeutic tool for many neurological diseases. However, its beneficial effects on post cardiac arrest syndrome remains uncertain. OBJECTIVE/HYPOTHESIS: We investigated the effects of repetitive anodal tDCS on neurological outcome and survival in a ventricular fibrillation (VF) cardiac arrest rat model. METHODS: Cardiopulmonary resuscitation was initiated after 6 min of VF in 36 Sprague-Dawley rats. The animals were randomized into three groups immediately after resuscitation (n = 12 each): no-treatment control (NTC) group, targeted temperature management (TTM) group, and tDCS group. For tDCS, 1 mA anodal tDCS was applied on the dorsal scalp for 0.5 h. The stimulation was repeated for four sessions with 1-h resting interval under normothermia. Post-resuscitation hemodynamic, cerebral, and myocardial injuries, 96-h neurological outcome, and survival were evaluated. RESULTS: Compared with the NTC group, post-resuscitation serum astroglial protein S100 beta and cardiac troponin T levels and 96-h neuronal and myocardial damage scores were markedly reduced in the tDCS and TTM groups. Myocardial ejection fraction, neurological deficit score, and 96-h survival rate were also significantly better for the tDCS and TTM groups. The period of post-resuscitation arrhythmia with hemodynamic instability was considerably shorter in the tDCS group, but no differences were observed in neurological outcome and survival between the tDCS and TTM groups. CONCLUSIONS: In this cardiac arrest rat model, repeated anodal tDCS commenced after resuscitation improves 96-h neurological outcome and survival to an extent comparable to TTM by attenuating post-resuscitation cerebral and cardiac injuries.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Fibrilação Ventricular/terapia , Animais , Parada Cardíaca/etiologia , Masculino , Ratos , Ratos Sprague-Dawley , Fibrilação Ventricular/complicações
20.
Prehosp Emerg Care ; 23(3): 430-433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30110189

RESUMO

We report a case of a 56 year old male in ventricular fibrillation (VF) cardiac arrest for a total of 2 hours and 50 minutes who was diagnosed with ST elevation myocardial infarction (STEMI) during a brief 10 min period of return of spontaneous circulation (ROSC). The patient underwent successful percutaneous coronary intervention (PCI) while receiving mechanical chest compressions for ongoing VF. Our case demonstrates the potential for neurologically intact survival in VF cardiac arrest patients despite prolonged periods of VF who are treated with mechanical CPR and intra-arrest PCI.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Desfibriladores , Parada Cardíaca/terapia , Intervenção Coronária Percutânea , Sobrevida , Serviços Médicos de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/terapia
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