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1.
Praxis (Bern 1994) ; 110(11): 621-624, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34465188

RESUMO

CME-EKG 69/Answers: Sinus Pauses in Long-Term Monitoring Abstract. While the indication for a pacemaker therapy in patients with high-degree AV block or symptomatic bradycardias is straightforward in most cases, intermittent oligo- and asymptomatic sinus bradycardias and pauses turn out to be more challenging. In this case report potential causes, diagnostic steps and possible therapies will be discussed.


Assuntos
Bloqueio Atrioventricular , Marca-Passo Artificial , Bradicardia/terapia , Eletrocardiografia , Humanos , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/terapia
2.
Praxis (Bern 1994) ; 110(10): 555-560, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34344189

RESUMO

CME-EKG 69: Sinus Pauses in Long-Term Monitoring Abstract. While the indication for a pacemaker therapy in patients with high-degree AV block or symptomatic bradycardias is straightforward in most cases, intermittent oligo- and asymptomatic sinus bradycardias and pauses turn out to be more challenging. In this case report potential causes, diagnostic steps and possible therapies will be discussed.


Assuntos
Bloqueio Atrioventricular , Marca-Passo Artificial , Bradicardia/terapia , Eletrocardiografia , Humanos , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/terapia
3.
BMJ Case Rep ; 14(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344654

RESUMO

A 72-year-old man presented for routine dual chamber pacemaker interrogation 13 years following insertion for sick sinus syndrome. Increased noise, impedance and threshold of the right ventricular (RV) lead were identified. RV capture was maintained with an overall RV pacing burden of 47%. A routine generator replacement was scheduled alongside RV lead replacement. Fluoroscopy at the start of the procedure revealed an unexpected striking fracture of the RV pacing lead with complete separation of the proximal and distal portions within the RV. The patient was asymptomatic and described no predisposing factors. He underwent implantation of a new ventricular lead and generator and has remained well. This case demonstrates clear RV lead fracture as a late complication of pacemaker implantation despite maintained capture. This emphasises the need for a chest X-ray when a change in device parameters is noted at device interrogation even in the absence of symptoms.


Assuntos
Ventrículos do Coração , Marca-Passo Artificial , Idoso , Estimulação Cardíaca Artificial , Fluoroscopia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Miocárdio , Síndrome do Nó Sinusal/terapia
4.
BMJ Case Rep ; 14(8)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362750

RESUMO

We describe a case of a woman in her 80s with persistent atrial fibrillation (AF) despite being on flecainide who was admitted for AF with rapid ventricular response. Attempts with direct-current cardioversions were unsuccessful despite increased doses of the antiarrhythmic therapy. At atrioventricular (AV) nodal ablation, very high right ventricular capture thresholds resulted in abortion of the procedure as back-up ventricular pacing could not be assured with adequate margin for safety. Shortly following the electrophysiology (EP) study, the patient developed cardiogenic shock with new apical left ventricular regional wall motion abnormality suggestive of apical ballooning and a toxic-appearing wide QRS complex electrocardiogram (EKG). The patient was successfully treated with sodium bicarbonate infusion for presumed flecainide toxicity. The regional wall motion abnormality and EKG changes resolved along with normalisation of capture thresholds after 2 days of treatment. The patient underwent an uncomplicated successful AV nodal ablation several weeks later.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Marca-Passo Artificial , Cardiomiopatia de Takotsubo , Fibrilação Atrial/terapia , Estimulação Cardíaca Artificial , Feminino , Flecainida/efeitos adversos , Humanos
5.
Prog Cardiovasc Dis ; 66: 37-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332660

RESUMO

Aortic stenosis is the most common valvulopathy requiring replacement by means of the surgical or transcatheter approach. Transcatheter aortic valve replacement (TAVR) has quickly become a viable and often preferred treatment strategy compared to surgical aortic valve replacement. However, transcatheter heart valve system deployment not infrequently injures the specialized electrical system of the heart, leading to new conduction disorders including high-grade atrioventricular block and complete heart block (CHB) necessitating permanent pacemaker implantation (PPI), which may lead to deleterious effects on cardiac function and patient outcomes. Additional conduction disturbances (e.g., new-onset persistent left bundle branch block, PR/QRS prolongation, and transient CHB) currently lack clearly defined management algorithms leading to variable strategies among institutions. This article outlines the current understanding of the pathophysiology, patient and procedural risk factors, means for further risk stratification and monitoring of patients without a clear indication for PPI, our institutional approach, and future directions in the management and evaluation of post-TAVR conduction disturbances.


Assuntos
Estenose da Valva Aórtica/cirurgia , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter/efeitos adversos , Potenciais de Ação , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Humanos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
6.
Prog Cardiovasc Dis ; 66: 61-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332661

RESUMO

Leadless pacemakers (LPs) have revolutionized the field of pacing by miniaturizing pacemakers and rendering them completelty intracardiac, hence reducing complications related to pacemaker pockets and transvenous leads. However, first generation LPs appear to be associated with a higher rate of myocardial perforation as compared to transvenous pacemakers (TV-PPM). Currently, LPs are predominantly designed to pace the right ventricle with no LPs that provide atrial or biventricular pacing. In this article, we review the available data on LPs while advocating for the need for a randomized controlled trial comparing LPs to TV-PPMs. In addition, we review the future directions of leadless devices.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial/tendências , Marca-Passo Artificial/tendências , Potenciais de Ação , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Difusão de Inovações , Desenho de Equipamento , Previsões , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Humanos , Miniaturização , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Função Ventricular Direita
7.
Prog Cardiovasc Dis ; 66: 70-79, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332662

RESUMO

Electrical storm is present when a cluster of ventricular arrhythmias (VAs) occurs within a short time frame. The most widely accepted definition is 3 or more episodes of VA within a 24-h period, although prognostic risk begins to rise when 2 or more events occur within 3months. Electrical storm often presents as a medical emergency in the form of recurrent implantable cardiac defibrillator (ICD) shocks, recurrent syncope in patients with no ICD or low cardiac output symptoms. Management often requires a multimodality approach including ICD management, pharmacologic therapy, catheter ablation and modulations of the autonomic nervous system. In this article, we review the definition, prognosis and management of electrical storm.


Assuntos
Antiarrítmicos/uso terapêutico , Denervação Autônoma , Estimulação Cardíaca Artificial , Ablação por Cateter , Oxigenação por Membrana Extracorpórea , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Potenciais de Ação/efeitos dos fármacos , Antiarrítmicos/efeitos adversos , Denervação Autônoma/efeitos adversos , Denervação Autônoma/mortalidade , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/mortalidade , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Sistema de Condução Cardíaco/efeitos dos fármacos , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Marca-Passo Artificial , Recidiva , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia
8.
Am J Case Rep ; 22: e931247, 2021 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-34455414

RESUMO

BACKGROUND Post-cardiac injury syndrome, including pleural effusion as a delayed complication of permanent pacemaker implantation, has rarely been reported. To resolve pleural effusion, prolonged chest tube placement is often required. Anti-inflammatory agents combined with diuretics are also often prescribed. Saireito, a Japanese herbal medication, which is a combination of Goreisan and Shousaikoto, has both anti-inflammatory and water-modulation properties and has been used for edema (lymph edema, cerebral edema) and inflammation (chronic nephritis). CASE REPORT We describe a 71-year-old woman with a history of syncope and bradycardia who underwent dual permanent pacemaker implantation (placed in the right chest because of a persistent left superior vena cava) without complications. Two months later, she came to the hospital as an outpatient with a dry cough, and was diagnosed with right-sided pleural effusion. A pleural fluid analysis revealed exudative effusion, according to Light's criteria. The fluid was negative for infectious etiology. Chest X-ray, computed tomography, and echocardiography revealed no signs of pericardial effusion or perforation of the pacemaker lead to outside the heart. The pleural effusion persisted despite use of anti-inflammatory medication for several weeks and diuretics for a short period. Saireito was administered with good response; the pleural effusion resolved completely and there was no deterioration of renal function. CONCLUSIONS The present case highlights the clinical significance of Saireito as an effective therapeutic agent for late-onset pacemaker-related pleural effusion, without adverse effects such as renal dysfunction.


Assuntos
Marca-Passo Artificial , Derrame Pleural , Idoso , Medicamentos de Ervas Chinesas , Feminino , Humanos , Japão , Medicina Kampo , Derrame Pleural/etiologia , Derrame Pleural/terapia , Veia Cava Superior
9.
S D Med ; 74(7): 334-343, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34449999

RESUMO

The last decade has seen the introduction of a number of important technological innovations in the management of advanced cardiovascular disease. These include transcatheter aortic valve replacement systems, a transcatheter mitral valve repair device, a left atrial appendage occluder device, coronary bioresorbable vascular scaffolds, leadless fully implantable pacemaker systems, wireless implantable pulmonary artery pressure monitors, transcatheter left ventricular assist pumping devices, drug-coated balloons, and robotic percutaneous coronary intervention devices. With the exception of drug coated balloon platforms, all have been utilized in our institution for patients from South Dakota and neighboring states. The objective of this study is to briefly describe these innovative devices, summarize the evidence for their benefit, and offer helpful pearls for the primary care providers who are key members of the care team for these patients.


Assuntos
Marca-Passo Artificial , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Humanos , Tecnologia , Resultado do Tratamento
10.
Medicina (Kaunas) ; 57(7)2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-34356966

RESUMO

Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time > 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time > 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time > 60 min (odds ratio 11.3, 95% confidence interval 1.09-1.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05-2.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.


Assuntos
Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Resultado do Tratamento
11.
Medicina (Kaunas) ; 57(7)2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34356976

RESUMO

Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Eletrocardiografia , Humanos , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
12.
J Card Surg ; 36(10): 3519-3527, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34250647

RESUMO

OBJECTIVE: Permanent pacemaker implantation (PPI) after surgical aortic valve replacement (SAVR) remains a frequent complication. Predictors, however, have been mainly investigated in single-center studies. Therefore, nationwide data were used to identify patients-and procedural risk factors for postoperative PPI. MATERIALS AND METHODS: Data were retrospectively collected from the Netherlands Heart Registration (NHR). Patients enrolled in the NHR undergoing isolated SAVR from 2013 to 2019 were analyzed. Primary endpoint was in-hospital PPI during hospitalization after SAVR. RESULTS: From the NHR database, 5600 patients with symptomatic aortic valve stenosis were included in the study. Crude incidence of post-SAVR PPI was 4.0%. Backward regression analysis identified previous cardiac surgery (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.18-2.76), extra-corporeal circulation time (OR: 1.01; 95% CI: 1.00-1.01), vasopressor use (OR: 2.66; 95% CI: 1.79-3.96) and in-hospital cardiac conduction abnormalities (OR: 4.48; 95% CI: 3.36-5.98) as potential predictors for PPI. Across the time, PPI after SAVR significantly increased (OR: 1.11; 95% CI: 1.03-1.21). CONCLUSIONS: From this nationwide analysis, PPI after SAVR remains a low but increasingly frequent complication. Several predictive factors for postoperative PPI after SAVR have been identified and might be useful for patient informed consent about potential adverse event rate.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Incidência , Países Baixos/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
13.
Nat Commun ; 12(1): 4374, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34272375

RESUMO

Self-powered implantable devices have the potential to extend device operation time inside the body and reduce the necessity for high-risk repeated surgery. Without the technological innovation of in vivo energy harvesters driven by biomechanical energy, energy harvesters are insufficient and inconvenient to power titanium-packaged implantable medical devices. Here, we report on a commercial coin battery-sized high-performance inertia-driven triboelectric nanogenerator (I-TENG) based on body motion and gravity. We demonstrate that the enclosed five-stacked I-TENG converts mechanical energy into electricity at 4.9 µW/cm3 (root-mean-square output). In a preclinical test, we show that the device successfully harvests energy using real-time output voltage data monitored via Bluetooth and demonstrate the ability to charge a lithium-ion battery. Furthermore, we successfully integrate a cardiac pacemaker with the I-TENG, and confirm the ventricle pacing and sensing operation mode of the self-rechargeable cardiac pacemaker system. This proof-of-concept device may lead to the development of new self-rechargeable implantable medical devices.


Assuntos
Fontes de Energia Elétrica , Monitorização Fisiológica/instrumentação , Nanotecnologia/instrumentação , Marca-Passo Artificial , Animais , Fenômenos Biomecânicos , Cães , Eletricidade , Gravitação , Movimento (Física) , Próteses e Implantes , Dispositivos Eletrônicos Vestíveis
14.
Biomed Instrum Technol ; 55(3): 91-95, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34280956

RESUMO

Certain low-frequency magnetic fields cause interference in implantable medical devices. Electromagnetic compatibility (EMC) standards prescribe injecting voltages into a device under evaluation to simplify testing while approximating or simulating real-world exposure situations to low-frequency magnetic fields. The EMC standard ISO 14117:2012, which covers implantable pacemakers and implantable cardioverter defibrillators (ICDs), specifies test levels for the bipolar configuration of sensing leads as being one-tenth of the levels for the unipolar configuration. The committee authoring this standard questioned this testing level difference and its clinical relevance. To evaluate this issue of EMC test levels, we performed both analytical calculations and computational modeling to determine a basis for this difference. Analytical calculations based upon Faraday's law determined the magnetically induced voltage in a 37.6-cm lead. Induced voltages were studied in a bipolar lead configuration with various spacing between a distal tip electrode and a ring electrode. Voltages induced in this bipolar lead configuration were compared with voltages induced in a unipolar lead configuration. Computational modeling of various lead configurations was performed using electromagnetic field simulation software. The two leads that were insulated, except for the distal and proximal tips, were immersed in a saline-conducting media. The leads were parallel and closely spaced to each other along their length. Both analytical calculations and computational modeling support continued use of a one-tenth amplitude reduction for testing pacemakers and ICDs in bipolar mode. The most recent edition of ISO 14117 includes rationale from this study.


Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Campos Eletromagnéticos
15.
Am J Cardiol ; 153: 101-108, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34210502

RESUMO

Pulmonary hypertension (PH) is common in patients with left heart disease and is present in varying degrees in patients with severe mitral valve disease. There is paucity of data regarding outcomes following transcatheter mitral valve repair (TMVr) in patients with PH. For this study, we analyzed NIS data from 2014 to 2018 using the ICD-9-CM and 10-CM codes. Baseline characteristics were compared using a Pearson chi-squared test for categorical variables and independent samples t-test for continuous variables. To account for selection bias, a 1:1 propensity match cohort was derived using logistic regression. Trend analysis was- done using linear regression. Of 21,505 encounters, 6780 encounters had PH. 6610 PH encounters were matched with 6610 encounters without PH. In-hospital mortality (3.3% versus 1.9%, p <0.01) was higher in PH population. Complications such as blood transfusion (3.6% versus 1.7%, p <0.01), GI bleed (1.4% versus 1%, p = 0.04), vascular complications (5.3% versus 3.3%, p <0.01), vasopressors use (2.9% versus 1.7%, p <0.01) and pacemaker placement (1.3% versus 0.8%, p = 0.01) remained significantly higher for encounters with PH. Multiple Logistic regression showed PH was associated with higher mortality (adjusted odds ratio [AOR], 1.68 [95% confidence interval [CI], 1.39-2.05], p <0.01). The mean length of stay (6.2 versus 5.3 days, p <0.01) and cost per hospitalization ($53,780 versus $50,801, p <0.01) remained significantly higher in the PH group when compared to group without PH. In conclusion, TMVr in PH as compared to without PH is associated with higher mortality, post-procedure complication rates, length of stay, and cost of stay.


Assuntos
Cateterismo Cardíaco , Mortalidade Hospitalar , Hipertensão Pulmonar/epidemiologia , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Comorbidade , Feminino , Hemorragia Gastrointestinal/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Insuficiência da Valva Mitral/epidemiologia , Razão de Chances , Marca-Passo Artificial , Hemorragia Pós-Operatória/epidemiologia , Vasoconstritores/uso terapêutico
16.
Am J Cardiol ; 153: 94-100, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34217433

RESUMO

We aimed to investigate the relationship of modified body mass index (mBMI), the product of BMI and serum albumin, with survival after transcatheter (TAVI) and surgical aortic valve implantation (SAVI). Frailty is associated with poor outcomes after TAVI and SAVI for severe aortic stenosis (AS). However, clinical frailty is not routinely measured in clinical practice due to the cumbersome nature of its assessment. Modified BMI is an easily measurable surrogate for clinical frailty that is associated with survival in elderly cohorts with non-valvular heart disease. We utilized individual patient-level data from a pooled database of the Placement of Aortic Transcatheter Valves (PARTNER) trials from the PARNTER1, PARTNER2 and S3 cohorts. We estimated cumulative mortality at 1 year for quartiles of mBMI with the Kaplan-Meier method and compared them with the log-rank test. We performed Cox proportional hazards modeling to assess the association of mBMI strata with 1-year mortality adjusting for baseline clinical characteristics. A total of 6593 patients who underwent TAVI or SAVI (mean age 83±7.3 years, 57% male) were included. mBMI was independently associated with all-cause one-year mortality with the lowest mBMI quartile as most predictive (HR 2.33, 95% CI 1.80-3.02, p < 0.0001). Notably, mBMI performed as well as clinical frailty index to predict 1-year mortality in this cohort. In conclusion, modified BMI predicts 1-year survival after both TAVI and SAVI. Given that it performed similar to the clinical frailty index, it may be used as a clinical tool for assessment of frailty prior to valve implantation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Índice de Massa Corporal , Fragilidade/epidemiologia , Mortalidade , Albumina Sérica/metabolismo , Atividades Cotidianas , Injúria Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Fragilidade/diagnóstico , Fragilidade/metabolismo , Força da Mão , Implante de Prótese de Valva Cardíaca , Hemorragia/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Marca-Passo Artificial , Readmissão do Paciente , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter , Velocidade de Caminhada
17.
Herzschrittmacherther Elektrophysiol ; 32(3): 371-379, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34259933

RESUMO

BACKGROUND: Conduction disturbances are common complications of transcatheter aortic valve implantation (TAVI). One influencing factor is implantation depth (ID) of the TAVI prosthesis. Since this should be standardized, a differentiated consideration of ID is necessary. OBJECTIVE: Examination of the impact of ID at different anatomical regions of the left ventricular outflow tract on new conduction disturbances, new permanent pacemaker implantation (PPI) and survival. MATERIALS AND METHODS: The retrospective cohort study included 420 patients who underwent transfemoral TAVI with new-generation devices, including 352 patients without pre-existing pacemakers, for analyses on new pacemaker implantation. Of them, 46 patients underwent PPI. ID at non- (NCC) and left-coronary cusp (LCC) were measured using fluoroscopy after valve implantation. Deep ID was defined as the 4th quartile of each prosthesis' ID. Survival was determined from the two-year follow-up. RESULTS AND CONCLUSIONS: Deep ID was associated with higher PPI rate only at NCC (p = 0.013). At LCC deep ID resulted in more frequent permanent left bundle branch block (p = 0.014). DI, preexisting pacemaker or new PPI did not affect 2­year survival. No patients with new PPI suffered moderate to severe paravalvular leak. ID at NCC could be a predictor for PPI after TAVI. A detailed consideration of ID in intervention planning might predict outcome after TAVI and common complications. PPI after TAVI and deep ID at NCC and LCC can be considered safe regarding survival in absence of moderate-to-severe paravalvular leak.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/cirurgia , Eletrocardiografia , Fluoroscopia , Humanos , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
18.
Am J Cardiol ; 154: 67-77, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34256941

RESUMO

Gender-differences in survival following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have been suggested. The objective of this study was to analyze outcomes following TAVR according to gender and to compare outcomes between TAVR and SAVR in women, at a nationwide level. Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with TAVR and SAVR between 2010 and 2019. Outcomes were analyzed according to gender and propensity score matching was used for the analysis of outcomes. In total 71,794 patients were identified in the database. After matching on baseline characteristics, we analyzed 12,336 women and 12,336 men treated with TAVR. In a second matched analysis, we compared 9,297 women treated with TAVR and 9,297 women treated with SAVR. Long term follow-up showed lower risk of all-cause death (12.7% vs 14.8%, hazard ratio (HR) 0.85, 95% CI 0.81 to 0.90) in women than men. Although the difference in cardiovascular death remained non-significant (5.8% vs 6.0%, HR 0.96, 95% CI 0.88 to 1.05), non-cardiovascular death was less frequent in women than in men following TAVR (6.9% vs 8.8% HR 0.78, 95%CI 0.72 to 0.84).When TAVR was compared with SAVR in women, long-term follow-up with TAVR showed higher rates of all-cause death (11.2% vs 6.5%, HR 1.91, 95%CI 1.78 to 2.05), cardiovascular death (5.0% vs 3.2%, HR 1.44, 95%CI 1.30 to 1.59), and non-cardiovascular death (6.2% vs 3.3%, HR 2.48, 95% CI 2.25 to 2.72). In conclusion, we observed that women undergoing TAVR have lower long-term all-cause mortality as compared with TAVR in men, driven by non-cardiovascular mortality. SAVR was associated with lower rates of long-term cardiovascular adverse events in women as compared with TAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Mortalidade , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Estudos de Coortes , Feminino , França , Implante de Prótese de Valva Cardíaca , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Infarto do Miocárdio/epidemiologia , Marca-Passo Artificial , Hemorragia Pós-Operatória/epidemiologia , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia
20.
Mayo Clin Proc ; 96(8): 2133-2144, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34226024

RESUMO

OBJECTIVE: To evaluate outcomes of elective surgical management of tricuspid regurgitation (TR) in patients with transvenous right ventricular leads, and compare results between non-lead-induced and lead-induced TR patients. PATIENTS AND METHODS: We studied patients with right ventricular leads who underwent tricuspid valve surgery from January 1, 1993, through December 31, 2015, and categorized them as non-lead-induced and lead-induced TR. Propensity score (PS) for the tendency to have lead-induced TR was estimated from logistic regression and was used to adjust for group differences. RESULTS: From the initial cohort of 470 patients, 444 were included in PS-adjustment analyses (174 non-lead-induced TRs [123 repairs, 51 replacements], 270 lead-induced TRs [129 repairs, 141 replacements]). In PS-adjusted multivariable analysis, lead-induced TR was not associated with mortality (P=.73), but tricuspid valve replacement was (hazard ratio, 1.59; 95% CI, 1.13 to 2.25; P=.008). Five-year freedom from tricuspid valve re-intervention was 100% for non-lead-induced TR and 92.3% for lead-induced TR; rates adjusted for PS differed between groups (P=.005). There was significant improvement in TR postoperatively in each group (P<.001). In patients having tricuspid valve repair, TR grades tended to worsen over time, but the difference in trends was not significantly different between groups. CONCLUSION: Lead-induced TR did not affect long-term survival after elective tricuspid valve surgery. In patients with lead-induced TR, tricuspid valve re-intervention was more common. Improvement in TR was achieved in both groups after surgery; however, severity of TR tended to increase over follow-up after tricuspid valve repair.


Assuntos
Fibrilação Atrial/terapia , Anuloplastia da Valva Cardíaca/métodos , Ecocardiografia/métodos , Marca-Passo Artificial , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Função Ventricular Direita/fisiologia , Idoso , Fibrilação Atrial/complicações , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico
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