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1.
Int Heart J ; 60(4): 788-795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31353344

RESUMO

Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Cardiomiopatias/complicações , Átrios do Coração/fisiopatologia , Sarcoidose/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Ablação por Cateter , Ecocardiografia , Eletrocardiografia Ambulatorial , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia
2.
Pediatr Cardiol ; 40(5): 1009-1016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31062060

RESUMO

Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Ablação por Cateter/efeitos adversos , Tetralogia de Fallot/mortalidade , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
3.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015234

RESUMO

Splenic laceration and rupture are common phenomena among patients in a traumatic setting, especially in blunt trauma. Much more unusual, however, is splenic injury without a known insult. Several case reports and studies have been written about spontaneous splenic injury in patients with viral, haematological or malignant processes. Recently, we encountered a patient with a spontaneous splenic rupture and no preceding trauma apart from semielective cardioversion. Operative decision-making was complicated by the fact that he required systemic anticoagulation for atrial fibrillation. He eventually underwent splenectomy and made an uneventful recovery.


Assuntos
Flutter Atrial/diagnóstico , Cardioversão Elétrica/efeitos adversos , Ruptura Esplênica/etiologia , Idoso , Flutter Atrial/diagnóstico por imagem , Flutter Atrial/fisiopatologia , Flutter Atrial/terapia , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/métodos , Hemoperitônio/diagnóstico por imagem , Humanos , Masculino , Baço/diagnóstico por imagem , Baço/lesões , Esplenectomia/métodos , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Am J Health Syst Pharm ; 76(4): 214-220, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715182

RESUMO

Purpose: The study was designed to characterize "on-label" use of i.v. diltiazem in patients with acute atrial fibrillation or flutter (AFF). Methods: An IRB-approved, single-center, retrospective, observational design was used. Eligible patients had acute AFF with heart rate >120 bpm and received i.v. diltiazem from June 1, 2012, to June 30, 2014. The primary outcome was frequency of on-label use of i.v. diltiazem, defined as use of at least one FDA-approved weight-based bolus dose followed by an infusion, if appropriate, in the absence of contraindications. Results: A total of 300 patients were screened; 97 patients were included for analysis. I.V. diltiazem was used on-label in only 14 patients (14%). Of the 96 patients who received an initial diltiazem bolus injection, the median dose was significantly higher in patients for whom the diltiazem dose was on-label, as follows: 17.5 mg (interquartile range [IQR]), 10-20 mg vs. 10.0 mg (IQR, 10-20 mg), p < 0.02). Twenty-nine patients (35%) in the off-label group had a therapeutic response to diltiazem alone compared with 8 patients (57%) in the on-label group (p = 0.11). More patients treated with off-label diltiazem bolus injection required additional rate control medications (41% vs. 7%, p < 0.04). Conclusion: In most patients, i.v. diltiazem was not used in accordance with FDA labeling. For most, i.v. diltiazem doses were lower than recommended and many of these patients required additional rate control medications to achieve a therapeutic response.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Flutter Atrial/tratamento farmacológico , Fármacos Cardiovasculares/administração & dosagem , Diltiazem/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Doença Aguda , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Relação Dose-Resposta a Droga , Feminino , Frequência Cardíaca/fisiologia , Humanos , Infusões Intravenosas , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Clin Cardiol ; 41(4): 458-464, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29663455

RESUMO

BACKGROUND: The clinical significance of atrial premature complexes (APCs) during exercise is unclear. HYPOTHESIS: Frequent APCs during exercise provides prognostic information. METHODS: A total of 998 patients were divided into 2 groups based on the presence of frequent APCs during treadmill testing (>5 beats per stage): the FAPC group (n = 128) vs the non-FAPC group (n = 870). The primary outcome was new-onset atrial fibrillation or flutter (AF/AFL) during follow-up period (356.2 ± 131.1 days). RESULTS: Mean age was 56.0 ± 10.2 years in the FAPC group and 52.6 ± 12.0 years in the non-FAPC group (P = 0.001). Baseline electrocardiographic and echocardiographic findings were not significantly different between the 2 groups. During exercise, maximal heart rate did not differ between the 2 groups. Chronotropic incompetence was more prevalent in the FAPC group than in the non-FAPC group (P = 0.04). During follow-up, the FAPC group had a higher incidence of AF/AFL than did the non-FAPC group (7 patients [5.5%] vs 5 patients [0.6%]; P < 0.001). Treadmill-induced frequent APCs (adjusted hazard ratio [HR]: 15.23, 95% confidence interval: 4.59-50.56, P < 0.001), chronotropic incompetence (adjusted HR: 19.95, 95% CI: 6.02-66.10, P < 0.001), and palpitation as a reason for treadmill testing (adjusted HR: 5.72, 95% CI: 1.64-20.00, P = 0.01) were independent risk factors that predicted new-onset AF/AFL. CONCLUSIONS: Frequent APCs during treadmill testing was associated with development of AF/AFL in this study. Close monitoring for further AF/AFL development is needed in these patients.


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Complexos Atriais Prematuros/epidemiologia , Exercício , Potenciais de Ação , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Complexos Atriais Prematuros/diagnóstico , Complexos Atriais Prematuros/fisiopatologia , Distribuição de Qui-Quadrado , Ecocardiografia , Eletrocardiografia , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Seul/epidemiologia , Fatores de Tempo
6.
Arch Cardiovasc Dis ; 111(5): 357-369, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29685722

RESUMO

BACKGROUND: Heart failure and atrial fibrillation share common mechanisms that may contribute to hypercoagulability and thrombotic risk. Elevated von Willebrand factor (vWF) concentration has been associated with increased risk of thromboembolism and cardiovascular events. AIM: To investigate whether increased vWF plasma concentration predicts occurrence of a composite endpoint (all-cause death and stroke) in patients with non-valvular atrial fibrillation (NVAF). METHODS: We prospectively studied 122 patients (mean age 70±14years; 46% men) hospitalized with NVAF, and followed over a median (interquartile range) of 5.4 (2.3-9.0)years. Cox proportional models were used to estimate the association of vWF concentration with time to stroke and death. RESULTS: Forty-three patients (35%) had at least a stroke or died during the 5-year follow-up. Kaplan-Meier curves using vWF plasma concentration tertiles (≤191IU/dL;>191 to≤295IU/dL;>295IU/dL) showed that vWF plasma concentrations discriminated groups of patients with higher cardiovascular event rates (log-rank P=0.01). In the multivariable analysis, higher vWF concentrations (middle tertile hazard ratio [HR] 4.59, 95% confidence interval [CI] 1.55-13.50 [P=0.006]; upper tertile HR 4.10, 95% CI 1.43-11.75 [P=0.009]), age≥75years (HR 5.02, 95% CI 1.53-16.49; P=0.008), heart failure (HR 2.05, 1.01-4.19; P=0.048), C-reactive protein, log2 per unit increase (HR 1.29, 95% CI 1.04-1.61; P=0.021), no warfarin at discharge (HR 4.96, 95% CI 2.02-12.20; P<0.0001) and no aspirin at discharge (HR 4.41, 95% CI 1.71-11.97; P=0.002) were independently associated with an increased risk of stroke and all-cause death, whereas female sex was a protective factor (HR 0.35, 0.16-0.78; P=0.01). CONCLUSIONS: High vWF plasma concentrations may discriminate patients with NVAF at greater risk of stroke or all-cause death.


Assuntos
Fibrilação Atrial/sangue , Flutter Atrial/sangue , Acidente Vascular Cerebral/sangue , Fator de von Willebrand/análise , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Flutter Atrial/complicações , Flutter Atrial/diagnóstico , Flutter Atrial/mortalidade , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Regulação para Cima
7.
Clin Cardiol ; 41(5): 666-670, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29532491

RESUMO

BACKGROUND: The relevance of transthoracic impedance (TTI) to electrical cardioversion (ECV) success for atrial tachyarrhythmias when using biphasic waveform defibrillators is unknown. HYPOTHESIS: TTI is predictive of ECV success with contemporary defibrillators. METHODS: De-identified data stored in biphasic defibrillator memory cards from ECV attempts for atrial fibrillation (AF) or atrial flutter (AFL) over a 2-year period at our center were evaluated. ECV success, defined as arrhythmia termination and ≥ 1 sinus beat, was adjudicated by 2 blinded cardiac electrophysiologists. The association between TTI and ECV success was assessed via Cochrane-Armitage trend and Spearman rank correlation tests, as well as simple and multivariable logistic regression. The influence of TTI on the number of shocks and on cumulative energy delivered per patient was also examined. RESULTS: 703 patients (593 with AF, 110 with AFL) receiving 1055 shocks were included. Last shock success was achieved in 88.0% and 98.2% of patients with AF and AFL, respectively. In patients with AF, TTI was positively associated with last shock failure (Ptrend =0.019), the need for multiple shocks (Ptrend <0.001), and cumulative energy delivered (ρ = 0.348; P < 0.001). After adjusting for first shock energy, 10-Ω increments in TTI were associated with odds ratios of 1.36 (95% CI: 1.24-1.49) and 1.22 (95% CI: 1.09-1.37) for first and last shock failure, respectively (P < 0.001 for both). CONCLUSIONS: Although contemporary defibrillators are designed to compensate for TTI, this variable continues to be associated with ECV failure in patients with AF. Strategies to lower TTI during ECV for AF may improve procedural success.


Assuntos
Fibrilação Atrial/terapia , Flutter Atrial/terapia , Cardiografia de Impedância , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Impedância Elétrica , Técnicas Eletrofisiológicas Cardíacas , Humanos , Valor Preditivo dos Testes , Retratamento , Fatores de Risco , Falha de Tratamento
8.
Clin Cardiol ; 41(5): 646-651, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29532536

RESUMO

BACKGROUND: Guidelines recommend performing atrial fibrillation (AF) catheter ablation without interruption of a direct oral anticoagulants (DOACs) and to administer unfractionated heparin (UFH) for an activated clotting time (ACT) ≥300 seconds, by analogy with vitamin K antagonist (VKA). Nevertheless, pharmacological differences between DOACs and VKA, especially regarding ACT sensitivity and UFH response, prevent extrapolation from VKA to DOACs. HYPOTHESIS: The level of anticoagulation at the time of the procedure in uninterrupted DOAC-treated patients is unpredictable and would complicate intraprocedural UFH administration and monitoring. METHODS: This prospective study included interrupted DOAC-treated patients requiring AF ablation. Preprocedural DOAC concentration ([DOAC]), intraprocedural UFH administration, and ACT values were recorded. A cohort of DOAC-treated patients requiring flutter catheter ablation was considered to illustrate [DOAC] without DOAC interruption. RESULTS: Forty-eight patients underwent AF and 14 patients underwent flutter ablation, respectively. In uninterrupted DOAC-treated patients, [DOAC] ranged from ≤30 to 466 ng/mL. When DOAC were interrupted, from 54 to 218 hours, [DOAC] were minimal (maximum: 36 ng/mL), preventing DOAC-ACT interference. Anyway, ACT values were poorly correlated with UFH doses (R 2 = 0.2256). CONCLUSIONS: Our data showed that uninterrupted DOAC therapy resulted in an unpredictable and highly variable initial level of anticoagulation before catheter ablation. Moreover, even with DOAC interruption preventing interference between DOAC, UFH, and ACT, intraprocedural UFH monitoring was complex. Altogether, our exploratory results call into question the appropriateness of transposing UFH dose protocols, as well as the relevance of ACT monitoring in uninterrupted DOAC-treated patients.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/terapia , Flutter Atrial/terapia , Coagulação Sanguínea/efeitos dos fármacos , Ablação por Cateter , Heparina/administração & dosagem , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/sangue , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Feminino , França , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Tempo de Coagulação do Sangue Total
9.
J Stroke Cerebrovasc Dis ; 27(6): 1692-1696, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29501269

RESUMO

BACKGROUND: Occult paroxysmal atrial fibrillation (AF) is detected in 16%-30% of patients with embolic stroke of unknown source (ESUS). The identification of AF predictors on outpatient cardiac monitoring can help guide clinicians decide on a duration or method of cardiac monitoring after ESUS. METHODS: We included all patients with ESUS who underwent an inpatient diagnostic evaluation and outpatient cardiac monitoring between January 1, 2013, and December 31, 2016. Patients were divided into 2 groups based on detection of AF or atrial flutter during monitoring. We compared demographic data, clinical risk factors, and cardiac biomarkers between the 2 groups. Multivariable logistic regression was used to determine predictors of AF. RESULTS: We identified 296 consecutive patients during the study period; 38 (12.8%) patients had AF detected on outpatient cardiac monitoring. In a multivariable regression analysis, advanced age (ages 65-74: odds ratio [OR] 2.36, 95% confidence interval [CI] .85-6.52; ages 75 or older: OR 4.08, 95% CI 1.58-10.52) and moderate-to-severe left atrial enlargement (OR 4.66, 95% CI 1.79-12.12) were predictors of AF on outpatient monitoring. We developed the Brown ESUS-AF score: age (65-74 years: 1 point, 75 years or older: 2 points) and left atrial enlargement (moderate or severe: 2 points) with good prediction of AF (area under the curve .725) and was internally validated using bootstrapping. The percentage of patients with AF detected in each score category were as follows: 0: 4.2%; 1: 14.8%; 2: 20.8%; 3: 22.2%; 4: 55.6%. CONCLUSIONS: The Brown ESUS-AF score predicts AF on prolonged outpatient monitoring after ESUS. More studies are needed to externally validate our findings.


Assuntos
Assistência Ambulatorial , Fibrilação Atrial/complicações , Flutter Atrial/complicações , Técnicas de Apoio para a Decisão , Embolia Intracraniana/etiologia , Monitorização Ambulatorial/métodos , Acidente Vascular Cerebral/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Cardiomegalia/complicações , Distribuição de Qui-Quadrado , Tomada de Decisão Clínica , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Curva ROC , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
10.
J Interv Card Electrophysiol ; 51(2): 125-132, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29435790

RESUMO

BACKGROUND: Radiofrequency catheter ablation (RFCA) of the cavo-tricuspid isthmus (CTI) is a common treatment for atrial flutter (AFL). However, achieving bi-directional CTI conduction block may be difficult, partly due to catheter instability. OBJECTIVE: To evaluate the safety and efficacy of the Amigo® Remote Catheter System (RCS) compared to manual catheter manipulation, during CTI ablation for AFL. METHODS: Fifty patients (pts) were prospectively randomized to robotically (25 pts) versus manually (25 pts) controlled catheter manipulation during CTI ablation, using a force-contact sensing, irrigated ablation catheter. The primary outcome was recurrence of CTI conduction after a 30-min waiting period. Secondary outcomes included total ablation, procedure, and fluoroscopy times, contact force measurement, and catheter stability. RESULTS: Recurrence of CTI conduction 30 min after ablation was less with robotically (0/25) versus manually (6/25) controlled ablation (p = 0.023). Total ablation and procedure times to achieve persistent CTI block (6.7 ± 3 vs. 7.4 ± 2.5 min and 14.9 ± 7.5 vs. 15.2 ± 7 min, respectively) were not significantly different (p = 0.35 and p = 0.91, respectively). There was a non-significant trend toward a greater force time integral (FTI in gm/s) with robotically versus manually controlled CTI ablation (571 ± 278 vs. 471 ± 179, p = 0.13). Fluoroscopy time was longer with robotically versus manually controlled CTI ablation (6.8 ± 4.4 min vs. 3.8 ± 2.3 min, p = 0.0027). There were no complications in either group. CONCLUSION: Robotically controlled CTI ablation resulted in fewer acute recurrences of CTI conduction compared to manually controlled CTI ablation, and a trend toward higher FTI. The longer fluoroscopy time during robotically controlled ablation was likely due to a steep learning curve. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02467179.


Assuntos
Flutter Atrial/cirurgia , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Robótica/instrumentação , Cirurgia Assistida por Computador/métodos , Idoso , Flutter Atrial/diagnóstico , Flutter Atrial/mortalidade , Cateteres Cardíacos , Desenho de Equipamento , Feminino , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Prospectivos , Recidiva , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento , Valva Tricúspide/cirurgia
11.
Clin Res Cardiol ; 107(7): 578-585, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29476203

RESUMO

AIMS: Zero- and near-zero-fluoroscopic ablation techniques reduce the harmful effects of ionizing radiation during invasive electrophysiology procedures. We aimed to test the feasibility and safety of a zero-fluoroscopic strategy using a novel integrated magnetic and impedance-based electroanatomical mapping system for radiofrequency ablation (RFA) of supraventricular tachycardias (SVTs). METHODS: We retrospectively studied 92 consecutive patients undergoing electrophysiology studies with/without RFA for supraventricular tachycardia (SVT) performed by a single operator at a single center. The first 42 (Group 1) underwent a conventional fluoroscopic-guided approach and the second 50 (Group 2) underwent a zero-fluoroscopic approach using the Ensite Precision™ 3-D magnetic and impedance-based mapping system (Abbott Inc). RESULTS: Group 1 comprised 14 AV-nodal re-entrant tachycardia (AVNRT), 12 typical atrial flutter, 4 accessory pathway (AP), 2 atrial tachycardia (AT), and 9 diagnostic EP studies (EPS). Group 2 comprised 16 AVNRT, 17 atrial flutter, 6 AP, 3 AT, 2 AV-nodal ablations, and 7 EPS. A complete zero-fluoroscopic approach was achieved in 94% of Group 2 patients. All procedures were acutely successful, and no complications occurred. There was a significant reduction in fluoroscopy dose, dose area product, and time (p < 0.0001, for all), with no difference in procedure times. Ablation time for typical atrial flutter was shorter in Group 2 (p = 0.006). CONCLUSIONS: A zero-fluoroscopic strategy for diagnosis and treatment of SVTs using this novel 3D-electroanatomical mapping system is feasible in majority of patients, is safe, reduces ionizing radiation exposure, and does not compromise procedural times, success rates, or complication rates.


Assuntos
Flutter Atrial/cirurgia , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas , Magnetismo/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/cirurgia , Feixe Acessório Atrioventricular , Potenciais de Ação , Adulto , Idoso , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Estudos de Viabilidade , Feminino , Fluoroscopia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Valor Preditivo dos Testes , Doses de Radiação , Exposição à Radiação , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 27(4): 914-918, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29306591

RESUMO

INTRODUCTION: Patients with myotonic dystrophy type 1 have several cardiac abnormalities, especially myocardial conduction disorders. Few studies have investigated cerebral infarction. We investigated the frequency of both symptomatic and asymptomatic ischemic strokes in patients with myotonic dystrophy type 1. METHODS: Patients who were diagnosed with myotonic dystrophy type 1 using genetic testing or clinical examinations at Asahikawa Medical Center were included. We retrospectively reviewed their medical history, neuroradiological imaging, electrocardiograms, and treatment. Their CHADS2 and CHA2DS2-VASc scores were calculated. RESULT: A total of 108 patients were diagnosed with myotonic dystrophy type 1. Magnetic resonance imaging was performed in 72 and 1 patient whose results were not available was excluded. Among these, 2 patients had atrial flutter and 3 had atrial fibrillation. Regarding the CHADS2 score, 11 patients scored more than 2. Regarding the CHA2DS2-VASc score, 22 patients scored more than 2. Ischemic strokes were found in 9 patients with 1 having an atrial flutter and 4 having atrial fibrillation. All patients with stroke had CHADS2 and CHA2DS2-VASc scores higher than 2. There were significant differences between the 2 groups in atrial fibrillation (P < .001), CHADS2 score (P < .001), and CHA2DS2-VASc score (P < .001). CONCLUSIONS: Ischemic stroke in patients with myotonic dystrophy type 1 is associated with atrial fibrillation. The CHADS2 score seems to be useful for the management of patients with myotonic dystrophy type 1. Repeated electrocardiograms are necessary for managing these patients.


Assuntos
Fibrilação Atrial/epidemiologia , Isquemia Encefálica/epidemiologia , Distrofia Miotônica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fibrilação Atrial/diagnóstico , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Isquemia Encefálica/diagnóstico , Eletrocardiografia , Feminino , Humanos , Incidência , Japão/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/genética , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
13.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(1): 13-16, jan.-mar. 2018. ilus
Artigo em Português | LILACS | ID: biblio-905674

RESUMO

Relatamos o caso de paciente portadora de anomalia de Ebstein, submetida a transplante cardíaco heterotópico após insucesso na correção cirúrgica. Apesar da melhora clínica inicial, a paciente permanecia dispneica em decorrência de dissincronia sistólica entre os corações gerada por flutter atrial do coração nativo. Após a cardioversão desse flutter, o eletrocardiograma já apresentava espontaneamente o sincronismo sistólico entre ambos os corações. Houve significativa melhora tanto clínica como ecocardiográfica do coração nativo. A redução da frequência cardíaca do coração nativo após reversão do flutter colaborou para a melhora de seu desempenho hemodinâmico, caracterizando ser essa disfunção secundária à taquicardia.


We report the case of a patient with Ebstein Anomaly, submitted to heterotopic cardiac transplantation after a failed surgical correction. Despite the initial clinical improvement, the patient remained dyspneic due to systolic dyssynchronism between the hearts, generated by atrial flutter of the native heart. After flutter cardioversion, the electrocardiogram already presented systolic synchronism between both hearts. There was a significant clinical and echocardiographic improvement of the native heart. The heart rate reduction of the native heart after flutter reversal led to hemodynamic improvements, characterizing it as being secondary to tachycardia


Assuntos
Humanos , Feminino , Criança , Coração , Cardiopatias Congênitas , Frequência Cardíaca , Transplante de Coração/métodos , Flutter Atrial/diagnóstico , Anomalia de Ebstein , Ecocardiografia/métodos , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Disfunção Ventricular Direita
15.
Clin Res Cardiol ; 107(4): 281-286, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29204691

RESUMO

BACKGROUND: Different types of irrigated-tip ablation catheters are available for ablation of atrial flutter (AFL). The aim of this study was to compare an established with a novel dedicated Gold irrigated-tip catheter for ablation of AFL. METHODS AND RESULTS: We compared consecutive patients undergoing ablation of AFL using a standard 3.5 mm irrigated-tip platinum-iridium (Pt-Ir) catheter (Thermocool, TC-group) and a 3.5 mm irrigated gold-tip catheter (Gold-group) specifically designed for cavotricuspid isthmus ablation (CTI). The primary endpoint was acute efficacy (net RF time) to achieve block across the CTI. Secondary endpoints included procedure time, fluoroscopy duration, complications, and recurrence of AFL.153 patients (age 68 ± 11 years, 74% male) were included. Net RF time to achieve CTI block was not different between the TC-group (793 ± 503 s) and the Gold-group (706 ± 422 s; p = 0.406). Total procedure time was not significantly different between the TC-group (70 ± 26 min) and the Gold-group (70 ± 27 min; p = 0.769). A significant difference between the groups was identified for the fluoroscopy duration (TC-group: 934 ± 537 s, Gold-group: 596 ± 362 s, p < 0.001). There were no major complications observed in the groups. Recurrence of AFL occurred in 3 of 66 (5%) in the TC-group and in 2 of 87 (2%) in the Gold-group (p = 0.652). CONCLUSIONS: In conclusion, acute and chronic efficacy of the irrigated Pt-Ir and gold-tip catheters were comparable. However, the dedicated catheter design was associated with decreased fluoroscopy duration.


Assuntos
Flutter Atrial/cirurgia , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Ablação por Cateter/instrumentação , Sistema de Condução Cardíaco/cirurgia , Irrigação Terapêutica/instrumentação , Idoso , Idoso de 80 Anos ou mais , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Desenho de Equipamento , Feminino , Ouro , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Irídio , Masculino , Pessoa de Meia-Idade , Platina , Complicações Pós-Operatórias/etiologia , Radiografia Intervencionista , Recidiva , Estudos Retrospectivos , Irrigação Terapêutica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 27(4): 839-844, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29223550

RESUMO

INTRODUCTION: The aim of this study was to compare the risk of ischemic stroke in patients who have atrial fibrillation and patients who have atrial flutter. METHODS: Using inpatient and outpatient Medicare claims data from 2008 to 2014 for a 5% sample of all beneficiaries 66 years of age or older, we identified patients diagnosed with atrial fibrillation and those diagnosed with atrial flutter. The primary outcome was ischemic stroke. In the primary analysis, patients with atrial flutter were censored upon converting to fibrillation; in a secondary analysis, they were not. Survival statistics were used to compare incidence of stroke in patients with flutter and patients with fibrillation. Cox proportional hazards analysis was used to compare the associations of flutter and fibrillation with ischemic stroke after adjustment for demographics and risk factors. RESULTS: We identified 14,953 patients with flutter and 318,138 with fibrillation. During a mean follow-up period of 2.8 (±2.3) years, we identified 18,900 ischemic strokes. The annual incidence of ischemic stroke in patients with flutter was 1.38% (95% confidence interval [CI] 1.22%-1.57%) compared with 2.02% (95% CI 1.99%-2.05%) in patients with fibrillation. After adjustment for demographics and stroke risk factors, flutter was associated with a lower risk of stroke compared with fibrillation (hazard ratio .69; 95% CI .60-.79, P < .05). Within 1 year, 65.7% (95% CI 64.9%-66.4%) of patients with flutter converted to fibrillation but remained at a lower risk of ischemic stroke (hazard ratio .85; 95% CI .78-.92). CONCLUSIONS: Patients with atrial flutter faced a lower risk of ischemic stroke than patients with atrial fibrillation.


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Demandas Administrativas em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Flutter Atrial/diagnóstico , Flutter Atrial/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Medicare , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Estados Unidos/epidemiologia
17.
Trends Cardiovasc Med ; 28(1): 53-61, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28797718

RESUMO

Atrial arrhythmias are a common complication after lung transplant (LT), occurring in about 16-46% of LT patients early postoperatively, and in about 14% during longer-term follow-up. They have a significant impact on postoperative in-hospital length of stay and may have an impact on overall mortality. In this report, we review the incidence and risk factors of post lung transplant AA, their pathogenesis and their impact on short- and long-term outcomes. Pharmacological management options are reviewed. In brief, early atrial arrhythmias tend to be mostly atrial fibrillation and are treated acutely with a rate control strategy followed if needed by rhythm control for 4-6 weeks. Late atrial arrhythmias >6 months after LT tend to be more frequently organized atrial flutters amenable to ablation therapy. Long-term anticoagulation is controversial especially in patients with bilateral lung transplant who received surgical pulmonic vein isolation, however anticoagulation is still favored especially in single LT patients. More studies are needed to further document the pathophysiology of early versus late atrial arrhythmias and whether long-term anticoagulation is needed.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/terapia , Flutter Atrial/tratamento farmacológico , Ablação por Cateter , Frequência Cardíaca/efeitos dos fármacos , Transplante de Pulmão/efeitos adversos , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Humanos , Incidência , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Clin Res Cardiol ; 107(1): 70-75, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28993851

RESUMO

AIMS: The wearable cardioverter defibrillator (WCD) is used for temporary protection of patients deemed to be at high risk for sudden death. There is limited experience regarding the clinical development of patients with tachymyopathy. We aimed to evaluate the clinical development of tachymyopathy patients protected with a WCD in a single-center non-randomized patient cohort. METHODS AND RESULTS: We fitted 130 consecutive patients deemed to be at high risk for ventricular tachyarrhythmias with the WCD. Of these, 20 patients (15%) presenting with newly diagnosed heart failure in the setting of rapidly conducted atrial fibrillation/flutter were suspected to suffer from tachymyopathy. The control group consisted of the remaining 110 patients with other indications for WCD therapy. LVEF increased by more than 10% in 13/20 (65%) tachymyopathy patients compared to 40/110 (36%) patients in the control population (p = 0.01). Similarly, BNP levels decreased in 15/20 (75%) tachymyopathy patients compared to 41/110 (37%) in the control group (p = 0.05). ICD implantation rates were lower in the tachymyopathy group (3/20) compared to the control population (40/110; p = 0.04). On further follow-up (mean 12 ± 8 months), patients with suspected tachymyopathy had no sustained ventricular arrhythmias. Compared to 5/110 patients in the control group, no tachymyopathy patient died. CONCLUSION: Most of the patients with suspected tachymyopathy have a favorable clinical outcome. The WCD is useful for temporary protection while LV function recovers.


Assuntos
Fibrilação Atrial/terapia , Flutter Atrial/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Adulto , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/complicações , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Estudos de Casos e Controles , Morte Súbita Cardíaca/etiologia , Desenho de Equipamento , Feminino , Alemanha , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
19.
Scand Cardiovasc J ; 52(1): 28-33, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29191055

RESUMO

OBJECTIVES: Recurrent arrhythmia after pulmonary vein isolation (PVI) by radiofrequency (RF) ablation in patients with atrial fibrillation (AFIB) remains a significant challenge. Using contact force (CF) sensing ablation catheters, we aimed to identify procedure related parameters associated with recurrence after de-novo PVI in patients with AFIB. METHODS: Consecutive patients undergoing a de-novo PVI procedure (n = 120, 63% paroxysmal and 37% persistent AFIB) employing a force-sensing ablation catheter were included. A clinical control including electrocardiogram and 120 hour of Holter-recording at 12-months was performed in all patients. Recurrence was defined as any documented AFIB or atrial flutter more than 30 seconds on Holter-recording after an initial blanking period of three months. RESULTS: Recurrence occurred in 44 patients (37%). Mean CF was lower in patients with recurrent arrhythmia (22.2 ± 9.5 vs. 28.8 ± 9.3 g, p < .001). In multi-variable analyses lower mean CF (OR 0.9 (95% CI 0.8-1.0), p = .03), and higher percentage of ablation time with a CF <10 grams (OR 1.1 (95% CI 1.0-1.1), p = .004) were both associated with recurrence in two distinct models. Dragging during ablation compared with point-by-point ablation technique was associated with recurrence in both models (OR 19.2 (95% CI 2.9-130.0), p = .002, and OR 21.7 (95% CI 2.7-176.2), p = .004). CONCLUSIONS: Low CF and dragging during ablation as compared with point-by-point ablation technique were associated with recurrent arrhythmia in patients with AFIB undergoing de-novo PVI by RF ablation.


Assuntos
Fibrilação Atrial/cirurgia , Flutter Atrial/etiologia , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Ablação por Cateter/instrumentação , Distribuição de Qui-Quadrado , Eletrocardiografia Ambulatorial , Desenho de Equipamento , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transdutores de Pressão , Resultado do Tratamento
20.
J Stroke Cerebrovasc Dis ; 27(1): 203-209, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29032886

RESUMO

INTRODUCTION: Long-term cardiac monitoring with implantable loop recorders (ILRs) has revealed occult paroxysmal atrial fibrillation and flutter (PAF) in a substantial minority of cryptogenic ischemic stroke (CIS) patients. Herein, we aim to define the prevalence, clinical relevance, and risk factors for PAF detection following early poststroke ILR implantation. MATERIALS AND METHODS: A retrospective study of CIS patients (n = 100, mean age 65.8 years; 52.5% female) who underwent ILR insertion during, or soon after, index stroke admission. Patients were prospectively followed by the study cardiac electrophysiologist who confirmed the PAF diagnosis. Univariate and multivariate analyses compared clinical, laboratory, cardiac, and imaging variables between PAF patients and non-PAF patients. RESULTS: PAF was detected in 31 of 100 (31%) CIS patients, and anticoagulation was initiated in almost all (30 of 31, 96.8%). Factors associated with PAF detection include older age (mean [year] 72.9 versus 62.9; P = .003), white race (odds ratio [OR], 4.5; confidence interval [CI], 1.8-10.8; P = .001), prolonged PR interval (PR > 175 ms; OR, 3.3; CI, 1.2-9.4; P = .022), larger left atrial (LA) diameter (mean [cm] 3.7 versus 3.5; P = .044) and LA volume index (mean [cc/m2]; 30.6 versus 24.2; P = .014), and lower hemoglobin (Hb)A1c (mean [%] 6.0 versus 6.4; P = .036). Controlling for age, obesity (body mass index > 30 kg/m2; OR, 1.2; CI, 1.1-1.4; P = .033) was independently associated with PAF detection. DISCUSSION: PAF was detected with high prevalence following early postcryptogenic stroke ILR implantation and resulted in significant management changes. Older age, increased PR interval, LA enlargement, and lower HbA1c are significantly associated with PAF detection. Controlling for age, obesity is an independent risk factor. A larger prospective study is warranted to confirm these findings.


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Flutter Atrial/diagnóstico , Flutter Atrial/tratamento farmacológico , Isquemia Encefálica/diagnóstico , Distribuição de Qui-Quadrado , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , New York/epidemiologia , Razão de Chances , Prevalência , Tecnologia de Sensoriamento Remoto , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Telemetria/instrumentação , Fatores de Tempo
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