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1.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 866-870, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076625

RESUMO

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.


Assuntos
Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2483-2486, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018510

RESUMO

Cellular and tissue level bioelectrical activity was simulated over structurally realistic 3D interstitial cell of Cajal (ICC) networks reconstructed from confocal images of a wild type (WT) mouse model with a normal ICC distribution and a Spry4 knockout (KO) mouse model with a mild ICC hyperplasia. First, the ICC pixels within the confocal images were segmented. Then, the segmented images were visually inspected and the 3D surface mesh of the ICC tissue network was created from the 90 slices spanning the myenteric plexus ICC network. After two additional concentric meshes (representing the non-ICC and tissue bath regions) surrounding the ICC region were added, a 3D tetrahedral volume mesh containing the three regions was reconstructed. The electrical propagation through the tissue network was simulated using the bidomain continuum model. The results showed that the ICC network of the WT mouse had a smaller volume than the KO mouse (0.008 vs 0.012 mm3). The simulated bioelectrical activity for both mice showed an isotropic propagation from the initial activation region. Mean velocities of 4.2±1.5 and 4.1±1.3 mm/s were reported for the WT and KO mice, respectively. The velocity in the x-direction was higher than the y-direction for the WT mouse with a percent difference of 14.8%. On the other hand, the velocity in the y-direction was higher for the KO mouse with a percent difference of 9.5%. For both cases, there was no propagation in the z-direction as all the solution points along the same z-depth were simultaneously activated.


Assuntos
Células Intersticiais de Cajal , Marca-Passo Artificial , Animais , Camundongos , Camundongos Knockout , Plexo Mientérico , Plexo Submucoso
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2504-2507, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018515

RESUMO

A potential treatment option for chronic and severe motility disorders such as gastroparesis is the implantation of a Gastric Electrical Stimulator (GES), which is designed to modulate the bio-electric slow waves. However, the effectiveness of current GESs remains uncertain since they do not work in a closed-loop by sensing, processing, and modulating the dysrhythmic patterns. This work presents the design of a GES model working in closed-loop with the network of the Interstitial Cells of Cajal (ICC). A pre-existing two-dimensional ICC network is enhanced by proposing an extracellular potential generation model, which can precisely capture the timing behaviour of slow wave propagation pattern of the simulated ICC network. The GES senses the extracellular potential, detects bradygastric patterns and finally modulates the activity to ensure normal conduction. The GES is designed to be practical for ease of validation and implementation.


Assuntos
Gastroparesia , Marca-Passo Artificial , Arritmias Cardíacas , Eletricidade , Gastroparesia/terapia , Humanos , Masculino , Próteses e Implantes
4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 837-841, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076620

RESUMO

Objective: To investigate the clinical characteristics of inpatients with the indication of cardiac implantable electronic devices (CIED) therapy and combined acute pulmonary thromboembolism (APTE). Methods: We retrospectively screened 8 641 inpatients who admitted with the indication of CIED implantation in Fuwai Hospital from January 2014 to May 2019. The clinical characteristics, management strategies and clinical outcome were analyzed for patients diagnosed as APTE. Results: APTE were identified in 45 (5‰) patients in this cohort, there were 18(40%) male patients, the average age was (73±8) years old and body mass index was (27±10) kg/m2.Thirty-two (70%) patients were at intermediate-risk and 13 (30%) at low-risk. Anti-coagulation therapy was initiated in 38(84%) patients, and 30 patients underwent CIED implantation (27 pacemaker, 2 CRT and 1 ICD). No postoperative bleeding or pocket hematoma were detected in the 23 patients taking anticoagulation medication before implantation. During an average of (30±7) months' follow up, thrombus was dissolved in 20 patients, hemorrhage complications were observed in 2 patients (1 cerebral hemorrhage and 1 hematuria), anticoagulation therapy was discontinued in these 2 patients. Among 15 patients without immediate CIED implantation and treated with anticoagulation therapy during hospitalization, 2 patients developed complete paroxysmal Ⅲ° atrioventricular block, and recovered after therapy during hospitalization. Seven patients were re-hospitalized for CIED implantation due to bradycardia. Five patients died during follow-up (3 sudden cardiac death, 1 APTE combined with cerebral infarction, and 1 pulmonary infection). Conclusion: APTE is not rare in patients with the indication of CIED implantation, CIED implantation and anti-coagulation therapy are safe for these patients, and transient atrioventricular block could be detected in APTE patients.


Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Embolia Pulmonar , Idoso , Idoso de 80 Anos ou mais , Morte Súbita Cardíaca , Feminino , Humanos , Masculino , Embolia Pulmonar/complicações , Estudos Retrospectivos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5012-5015, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019112

RESUMO

Accurate assessment of pacemaker function or malfunction is essential to make clinical interpretations on pacemaker therapy and patient symptoms. This article presents an innovative approach for detecting pacemaker pulses at sampling frequency as low as 125Hz. The proposed method is validated in wide range of simulated clinical ECG conditions such as arrhythmia (sinus rhythms, supraventricular rhythms, and AV blocks), pulse amplitudes (~100µV to ~3mV), pulse durations (~100µs to ~2ms), pacemaker modes and types (fixed-rate or on-demand single chamber, dual chamber, and bi-ventricular pacing), and physiological noise (tremor). The proposed algorithm demonstrates clinically acceptable detection accuracies with sensitivity and PPV of 98.1 ± 4.4 % and 100 %, respectively. In conclusion, the approach is well suited for integration in long-term wearable ECG sensor devices operating at a low sample frequency to monitor pacemaker function.Clinical Relevance- The proposed system enables real-time long-term continuous assessment of the proper functioning of implanted pacemaker and progression of treatment for cardiac conditions using battery-powered wearable ECG monitors.


Assuntos
Marca-Passo Artificial , Arritmias Cardíacas/diagnóstico , Estimulação Cardíaca Artificial , Eletrocardiografia , Frequência Cardíaca , Humanos
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 357-360, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018002

RESUMO

Automatic electrocardiogram (ECG) analysis for pacemaker patients is crucial for monitoring cardiac conditions and the effectiveness of cardiac resynchronization treatment. However, under the condition of energy-saving remote monitoring, the low-sampling-rate issue of an ECG device can lead to the miss detection of pacemaker spikes as well as incorrect analysis on paced rhythm and non-paced arrhythmias. To solve the issue, this paper proposed a novel system that applies the compressive sampling (CS) framework to sub-Nyquist acquire and reconstruct ECG, and then uses multi-dimensional feature-based deep learning to identify paced rhythm and non-paced arrhythmias. Simulation testing results on ECG databases and comparison with existing approaches demonstrate its effectiveness and outstanding performance for pacemaker ECG analysis.


Assuntos
Compressão de Dados , Marca-Passo Artificial , Arritmias Cardíacas/diagnóstico , Aprendizado Profundo , Eletrocardiografia , Humanos
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1408-1411, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018253

RESUMO

Interstitial Cells of Cajal (ICC) are specialized pacemaker cells that generate and actively propagate electrophysiological events called slow waves. Slow waves regulate the motility of the gastrointestinal tract necessary for digesting food. Degradation in the ICC network structure has been qualitatively associated to several gastrointestinal motility disorders. ICC network structure can be obtained using confocal microscopy, but the current limitations in imaging and segmentation techniques have hindered an accurate representation of the networks. In this study, supervised machine learning techniques were applied to extract the ICC networks from 3D confocal microscopy images. The results showed that the Fast Random Forest classification method using Trainable WEKA Segmentation outperformed the Decision Table and Naïve Bayes classification methods in sensitivity, accuracy, and F-measure. Using the Fast Random Forest classifier, 12 gastric antrum tissue blocks were segmented and variations in ICC network thickness, density and process width were quantified for the myenteric plexus ICC network (the primary pacemakers). Our findings demonstrated regional variation in ICC network density and thickness along the circumferential and longitudinal axis of the mouse antrum. An inverse relationship was observed in the distal and proximal antrum for density (proximal: 9.8±4.0% vs distal: 7.6±4.6%) and thickness (proximal: 15±3 µm vs distal: 24±10 µm). Limited variation in ICC process width was observed throughout the antrum (5±1 µm).Clinical Relevance- Detailed quantification of regional ICC structural properties will provide insights into the relationship between ICC structure, slow waves and resultant gut motility. This will improve techniques for the diagnosis and treatment of functional GI motility disorders.


Assuntos
Células Intersticiais de Cajal , Marca-Passo Artificial , Animais , Teorema de Bayes , Camundongos , Antro Pilórico , Aprendizado de Máquina Supervisionado
8.
Int Heart J ; 61(5): 1059-1069, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921666

RESUMO

Because of its rigidity and non-steerability, the presence of a horizontal aortic root poses a major anatomical issue during transcatheter aortic valve replacement (TAVR) with Evolut self-expanding valve. Previous studies have elucidated the difficulties of coaxial implantation of the self-expanding valve in patients with horizontal aorta, often resulting in increased complications and a lower device success rate. To date, most patients with extremely horizontal aorta (aortic root angle ≥ 70°) have been excluded from major TAVR clinical trials. Therefore, available data on TAVR with Evolut in this challenging anatomy are limited, and standardized treatment strategies and clinical results remain unknown. Herein, we report a clinical case series of TAVR with Evolut in extremely horizontal aorta. Among seven patients (aged 80-92 years; STS score, 12.6% ± 7.9%) who underwent TAVR with Evolut system, aortic root angle ranged from 71° to 83° (mean, 75.1°± 4.5°). All patients achieved device success with dedicated strategies and were clinically stable at 3-month follow-up. None of the patients had more than mild paravalvular leakage (PVL) at any point during follow-up.Complications in three patients included complete atrioventricular block requiring a permanent pacemaker implantation, cerebral infarction because of atrial fibrillation 3 days after TAVR, and cardiac tamponade requiring pericardiocentesis. In this case series, Evolut self-expanding TAVR in extremely horizontal aorta was effective and feasible with a high device success rate. Based on anatomical features, some dedicated strategies majorly contribute to the success of this procedure. Large-scale multicenter studies are required to confirm our findings.


Assuntos
Aorta Torácica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Aorta Torácica/anatomia & histologia , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Tamponamento Cardíaco/epidemiologia , Infarto Cerebral/epidemiologia , Infarto Cerebral/etiologia , Angiografia por Tomografia Computadorizada , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Marca-Passo Artificial , Pericardiocentese , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento
9.
Int Heart J ; 61(5): 922-926, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921670

RESUMO

The incidence of ventricular arrhythmia in patients with an implanted pacemaker is not yet known. The aim of this study was to analyze non-sustained ventricular tachycardia (NSVT) episodes based on stored electrograms (EGM) and determine the occurrence rate and risk factors for NSVT in a pacemaker population.This study included 302 consecutive patients with a dual-chamber pacemaker. A total of 1024 EGMs stored in pacemakers as ventricular high-rate episodes were analyzed. The definition of NSVT was ≥ 5 consecutive ventricular beats at ≥ 150 bpm lasting < 30 seconds.In baseline, most patients (94.8%) had ≥ 60% left ventricular ejection fraction. Of 1024 EGMs, 420 (41.0%) showed appropriate NSVT episodes, as well as premature atrial contractions, atrial tachyarrhythmia, or atrial fibrillation with a rapid ventricular response, whereas other EGMs did not show an actual ventricular arrhythmia. On EGM analysis, during a mean follow-up period of 46.1 months, NSVT occurred one or more times in 82 patients (33.1%). On multivariate analysis, ≥ 50% right ventricular pacing was an independent risk factor for NSVT (odds ratios, 4.519; P < 0.001), but NSVT was not associated with increased all-cause mortality.Moreover, in the pacemaker population, ≥ 50% right ventricular pacing is an independent risk factor for NSVT; however, NSVT was not associated with increased all-cause mortality because of the preserved left ventricular function.


Assuntos
Estimulação Cardíaca Artificial/métodos , Técnicas Eletrofisiológicas Cardíacas , Mortalidade , Marca-Passo Artificial , Taquicardia Ventricular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial , Complexos Atriais Prematuros , Feminino , Ventrículos do Coração , Humanos , Armazenamento e Recuperação da Informação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Taquicardia Supraventricular
13.
Orv Hetil ; 161(31): 1271-1280, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750015

RESUMO

The issue of postoperative arrhythmias requiring pacemaker therapy is widely studied in the field of cardiac surgery and it is a complex perioperative problem. The aim of this paper is to summarize the relevant international guidelines and recommendations and to present our hospital's experience. We present the current, decisive recommendations and important studies, and present patients who underwent pacemaker implantation within one month after cardiac surgery between 01. 01. 2014 and 31. 12. 2018 in our hospital and compare them with the international findings. According to the international literature, the rate of permanent pacemaker implantation after cardiac surgery ranges from about 1.5% to 5%, and this rate seems to increase later. We have detailed information and many identified predictors about the development of conduction disturbances, but the current guidelines provide only weak recommendations. In the early perioperative period (1 month), pacemaker implantation was required in 15 cases (0.55%); in the course of long-term follow-up, 6 patients were still pacemaker-dependent. Perioperative arrhythmias are frequent and serious complications after cardiac surgery, prolong patient recovery time and put financial burden on the hospitals. The rate of need for a permanent pacemaker is low in our hospital, and in the late follow-up we can find only a small part of patients with pacemaker dependency. It would be necessary to start a prospective study and to develop a standardized protocol based on the information currently available. This would be a useful and authoritative help for the postoperative care in cardiac surgery. Orv Hetil. 2020; 161(31): 1271-1280.


Assuntos
Arritmias Cardíacas/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Marca-Passo Artificial , Complicações Pós-Operatórias/prevenção & controle , Humanos , Período Pós-Operatório , Fatores de Risco , Resultado do Tratamento
14.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(4): 302-306, 2020 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-32762201

RESUMO

Concerning on the safety risks caused by electromagnetic interference of patients implanted with high-risk active implantable medical devices in the environment of domestic MUs, this study evaluates and focuses on the requirements of electromagnetic compatibility in domestic and international standards for rail transit vehicles, the main mechanism of risks caused by EMI, the actual measurement of environmental data in MUs and the working performance of various active implantables in the compartment. The test results shows that all kinds of active implantable medical device samples works normally in the CRH2A EMU in China, and there is still a large margin between the measured radiation emission in MU and the limit required by the standards.


Assuntos
Campos Eletromagnéticos , China , Radiação Eletromagnética , Humanos , Marca-Passo Artificial , Próteses e Implantes
15.
Dtsch Arztebl Int ; 117(22-23): 404, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762836
17.
Herzschrittmacherther Elektrophysiol ; 31(3): 273-287, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767089

RESUMO

Cardiac implantable electronic devices (CIEDs) are a cornerstone of arrhythmia and heart failure detection as well as management. In recent years new kinds of devices have emerged which can be used subcutaneously or worn on the skin. In particular for large-scale arrhythmia monitoring, small, unobtrusive gadgets seem positioned to upend paradigms and care delivery. However, the performance of CIEDs and wearables is only as good as their sensing and detection capacities. Whether for pacing, defibrillation or diagnostic monitoring, the device must be able to process and filter the sensed signal to reduce noise and to exclude irrelevant physiological signals. The demands on sensing and detection quality will differ depending on how the information is applied. With a pacemaker or implantable cardioverter/defibrillator, withheld or erroneous therapy can have severe consequences and accurate and reliable detection of cardiac function is crucial. Monitoring devices are usually used in risk assessment and management, with greater tolerance for isolated artefacts or lower quality of readings. This review discusses sensing and detection and the performance to date by CIEDs as well as subcutaneous and wearable devices.


Assuntos
Arritmias Cardíacas , Dispositivos Eletrônicos Vestíveis , Desfibriladores Implantáveis , Insuficiência Cardíaca , Humanos , Marca-Passo Artificial
18.
Proc Natl Acad Sci U S A ; 117(33): 19624-19626, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32759220
19.
Am J Cardiol ; 128: 113-119, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650903

RESUMO

The Center for Medicare & Medicaid Services has identified readmission as an important quality metric in assessing hospital performance and value of care. The aim of this study was to quantify the impact of "care fragmentation" on transcatheter aortic valve implantation (TAVI) outcomes. Readmission to nonindex hospitals was defined as any hospital other than the hospital where the TAVI was performed. In this multicenter, population-based, nationally representative study, a nationally weighted cohort of US adult patients who underwent TAVI in the National Readmission Database between 01/01/2010 and 9/31/2015 were analyzed. Patient characteristics, trends, and outcomes after 90-day nonindex readmission were evaluated. Thirty-day metric was used as a reference group for comparison. A weighted total of 51,092 patients met inclusion criteria. Overall, the 90-day readmission rate after TAVI was 27.6% (30-day reference group: 17.4%), and 42% of these readmissions were to nonindex hospitals. Noncardiac causes accounted for most nonindex readmissions, but major cardiac procedures were more likely performed at index hospitals during readmission within 90 days. Despite the high co-morbidity burden of patients readmitted to nonindex hospitals, unadjusted and risk-adjusted all-cause mortality, readmission length of stay and total hospital costs following nonindex readmission were lower compared with index readmission at 90 days. In conclusion, in this real world, nationally representative cohort of TAVI patients in the United States, care fragmentation remains prevalent and represent an enduring, residual target for future health policies. Although the impactful readmissions may be directed toward index hospitals, concerted efforts are needed to address mechanisms that increase care fragmentation.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/estatística & dados numéricos , Centers for Medicare and Medicaid Services, U.S. , Comorbidade , Angiografia Coronária/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Pneumopatias/epidemiologia , Masculino , Análise Multivariada , Marca-Passo Artificial , Readmissão do Paciente/tendências , Pericardiocentese/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
20.
Am J Cardiol ; 128: 140-146, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650908

RESUMO

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized infiltrative cardiomyopathy in which conduction system disease is common. The aim of our study was to define the incidence and prevalence of high-grade atrioventricular (AV) block requiring pacemaker implantation in our quaternary referral center. This was a single-center retrospective cohort study of 369 consecutive patients with ATTR-CA who underwent 12-lead electrocardiogram at the time of ATTR-CA diagnosis. During a mean follow-up of 28 months, serial ECGs and the electronic medical record were examined for the development of high-grade AV block and pacemaker implantation. Wild-type ATTR-CA (wtATTR-CA) was diagnosed in 261 patients and 108 had hereditary ATTR-CA (hATTR-CA). A total of 35 (9.5%) had high-grade AV block requiring pacemaker implantation at the time of diagnosis of ATTR-CA. The most common conduction abnormalities evident on the baseline ECG were a wide QRS complex, present in 51% with wtATTR-CA and 48% with hATTR-CA (p = 0.62), followed by first-degree AV block, which was present in 49% with wtATTR-CA and 43% with hATTR-CA (p = 0.31). During follow-up, high-grade AV block developed in 10% of those with hATTR-CA and 12% of patients with wtATTR-CA (p = 0.64). On multivariable models, high-grade AV block was not significantly associated with increased mortality. More advanced ATTR-CA stage and a history of obstructive coronary artery disease were associated with increased mortality on multivariable models. In conclusion, the incidence and prevalence of high-grade AV block is high in patients with ATTR-CA. Patients with ATTR-CA require close monitoring during follow-up for the development of conduction system disease.


Assuntos
Neuropatias Amiloides Familiares/fisiopatologia , Bloqueio Atrioventricular/epidemiologia , Cardiomiopatias/fisiopatologia , Mortalidade , Idoso , Idoso de 80 Anos ou mais , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/genética , Amiloidose/complicações , Amiloidose/fisiopatologia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/etiologia , Estimulação Cardíaca Artificial , Cardiomiopatias/complicações , Cardiomiopatias/genética , Estudos de Coortes , Eletrocardiografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mutação , Marca-Passo Artificial , Pré-Albumina/genética , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome do Nó Sinusal/epidemiologia , Síndrome do Nó Sinusal/etiologia
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