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1.
Acute Med ; 19(3): 145-148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33020758

RESUMO

Myocardial perforation is a rare yet serious complication following cardiac pacemaker or defibrillator device procedures. In this article, the authors describe a case of right ventricular pacemaker lead perforation presenting to our hospital's medical assessment unit with a clinical presentation suggestive of an acute pulmonary embolism. Treatment dose low molecular weight heparin (LMWH) was commenced while awaiting CT scan. CT images were negative for PE however demonstrated RV lead perforation. Echocardiogram demonstrated pericardial effusion with the tip of RV lead in the pericardial free space. A rapid deterioration in the patient's haemodynamics prompted an emergency pericardial drain insertion and successful RV lead re-position in the cardiac catheter lab. The patient recovered well and was discharged with routine pacemaker clinic follow-up.


Assuntos
Traumatismos Cardíacos , Marca-Passo Artificial , Embolia Pulmonar , Doença Aguda , Heparina de Baixo Peso Molecular , Humanos , Marca-Passo Artificial/efeitos adversos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia
2.
Herzschrittmacherther Elektrophysiol ; 31(4): 414-416, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33026472

RESUMO

The loss of a guidewire in the subclavian vein represents an unpleasant complication during pacemaker implantation with venous access by puncture in Seldinger's technique. Using another venous puncture and a gooseneck snare, this problem can be solved quickly and without any trace.


Assuntos
Marca-Passo Artificial , Veia Subclávia , Marca-Passo Artificial/efeitos adversos , Punções , Veia Subclávia/diagnóstico por imagem
3.
Herzschrittmacherther Elektrophysiol ; 31(4): 434-436, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33026473

RESUMO

Bradycardic arrhythmias have a broad spectrum of symptoms which range from mild dizziness to cardiac syncope. Pacemaker therapy continues to be the cornerstone of treatment and can effectively treat symptoms. Despite an implanted cardiac pacemaker, patients may experience continued or even new symptoms. We report on a 73-year-old woman with postoperative new palpitations due to a very rare intraoperative complication.


Assuntos
Marca-Passo Artificial , Idoso , Arritmias Cardíacas , Bradicardia , Feminino , Humanos , Marca-Passo Artificial/efeitos adversos , Síncope/diagnóstico , Síncope/etiologia
4.
J Card Surg ; 35(8): 1933-1940, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32667084

RESUMO

BACKGROUND: Placement of temporary epicardial pacing wires (TEPW) at the end of open heart surgery cases is routine but can be associated with complications. Identification of patients who are high risk for requiring pacing would be beneficial on guiding selective TEPW placement. The purpose of this study was to identify predictors of temporary pacing immediately post cardiac surgery. METHODS: A retrospective analysis of patients undergoing cardiac surgery from 2005 to 2016 at the Maritime Heart Center was conducted. Analysis was performed of patients who require pacing on arrival to the cardiovascular intensive care unit (CVICU) compared with those who were not paced. Multivariable logistic regression was used to determine each variable's risk adjusted likelihood of pacing for the entire cohort. Subgroup analysis was performed in the isolated procedures. RESULTS: A total of 11 752 patient underwent surgery from the year 2005 to 2016. Two thousand and fifty-one (17.5%) required pacing on arrival to CVICU. Older age, female sex, preoperative renal failure, lower ejection fraction (EF), preoperative arrhythmia, preoperative use of calcium channel blockers, and longer cross-clamp times were risk factors for pacing. In the isolated coronary artery bypass grafting and aortic valve replacement groups, findings were similar to the overall cohort. Only age, obesity, and chronic obstructive pulmonary disease were risk factors for pacing in the isolated mitral valve (MV) repair group and only preoperative arrhythmia in the isolated MV replacement group. CONCLUSION: We have identified risk factors for TEPW use following cardiac surgery and in isolated procedure subgroups. These risk factors may help guide selective TEPW placement.


Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Marca-Passo Artificial/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas , Bloqueadores dos Canais de Cálcio , Constrição , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Duração da Cirurgia , Insuficiência Renal , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Volume Sistólico
5.
Am J Cardiol ; 130: 85-93, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32622503

RESUMO

Cardiac implantable electronic devices (CIED) implantations may cause lead-induced tricuspid regurgitation (LITR). Although patients with CIED have the risk of functional non-lead induced TR (Non-LITR). This study aimed to compare of clinical outcome between LITR and Non-LITR. The mechanism of TR was determined by 3-dimensional echocardiography. The primary end point was heart failure (HF) hospitalizations after CIED implantation. In patients with HF events, subsequent clinical outcomes after HF hospitalization were compared between no TR, LITR, and Non-LITR groups. In eligible 373 patients, 67 patients had HF hospitalization, of whom worsened TR was observed in 49 patients. In the remaining 307 patients, worsened TR was observed in only 10 patients (3.3%). Of the 49 patients with worsened TR, 18 patients (37%) had LITR. In 67 patients with HF hospitalization, 25 patients (37%) met rehospitalization. All severe LITR persisted after HF events. Meanwhile, severe Non-LITR improved to moderate or mild level. Cox proportional hazard model analyses revealed LITR was the independent risk factor of rehospitalization. Both LITR and Non-LITR were common at HF events after CIED implantations. However, LITR persisted and might contribute to a worse prognosis. In patients with TR after CIED implantations, 3-dimensional echocardiography should be performed to diagnose the LITR accurately, which may contribute to improving the clinical outcome.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Marca-Passo Artificial/efeitos adversos , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
J Card Surg ; 35(10): 2598-2604, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32652752

RESUMO

OBJECTIVES: Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. METHODS: Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long-term risks of HF and mortality was investigated by multivariable Cox regression models. RESULTS: Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30-day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow-up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable-adjusted models, the hazard ratios associated with PPM were 1.00 (0.78-1.30), P = .93 for HF, and .96 (0.76-1.21), P = .72 for mortality. CONCLUSIONS: Postoperative implantation of a permanent RV pacemaker does not alter the long-term risks of HF and mortality following mitral valve surgery.


Assuntos
Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração , Valva Mitral/cirurgia , Resultados Negativos , Marca-Passo Artificial/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/mortalidade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Taxa de Sobrevida , Fatores de Tempo
8.
J Am Acad Orthop Surg ; 28(14): e612-e619, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692098

RESUMO

INTRODUCTION: We sought to identify the incidence of new 90-day cardiac events, 90-day mortality, 90-day unplanned readmissions, and 30-day emergency department (ED) visits after total joint arthroplasty (TJA) in patients with a history of a cardiac implantable electronic device (CIED) and compare these outcomes in TJA patients without a CIED. METHODS: Kaiser Permanente's Cardiac Device and Total Joint Replacement Registries were used to identify elective primary TJA performed for osteoarthritis. TJA with a CIED was matched with TJA without a CIED (n = 365 pairs) on patient characteristics, demographics, and procedure type. A McNemar test was used to evaluate categorical outcomes. RESULTS: Of the TJA with a CIED, there were 24 cardiac events (6.6%), 1 mortality (0.3%), 30 readmissions (8.2%), and 39 ED visits (10.7%). TJA patients with a CIED had a higher likelihood of cardiac events (odds ratio [OR] = 3.14, 95% confidence interval [CI] = 1.28 to 8.08). No difference was observed in mortality (OR = 0.50, 95% CI = 0.02 to 6.98), readmissions (OR = 1.26, 95% CI = 0.71 to 2.25), or ED visits (OR = 1.15, 95% CI = 0.71 to 1.88). CONCLUSION: In our matched cohort study, TJA patients with a history of a CIED had a higher likelihood of incident 90-day cardiac events when compared with patients without a CIED without a difference observed for 90-day mortality, unplanned readmission, and 30-day ED visit. LEVEL OF EVIDENCE: Level III.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Artroplastia , Terapia de Ressincronização Cardíaca/efeitos adversos , Doenças Cardiovasculares/etiologia , Desfibriladores Implantáveis/efeitos adversos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Osteoartrite/cirurgia , Marca-Passo Artificial/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo
9.
Circ Cardiovasc Imaging ; 13(6): e010600, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32507019

RESUMO

Background Infective endocarditis (IE) remains a difficult to diagnose condition associated with high mortality. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently emerged as another IE imaging modality, although diagnostic accuracy varies across observational studies and types of IE. This meta-analysis assessed the diagnostic performance of 18F-FDG PET/CT for IE and its subtypes. Methods We searched Pubmed, Cochrane, and Embase from January 1980 to September 2019 for studies reporting both sensitivity and specificity of 18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data for all cases of IE and its subgroups of native valve IE, prosthetic valve IE, and cardiac implantable electronic devices IE. Results We screened 2566 records from the search, assessed 52 full-text articles, and included 26 studies totaling 1358 patients (509 IE cases). Pooled sensitivity and specificity (95% CI, inconsistency I-square statistic) were 0.74 (0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of endocarditis. Corresponding parameters for native valve IE were sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99, 34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity 0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were higher for the 17 studies since 2015 than the 9 studies published before 2015. Conclusions 18F-FDG PET/CT had high specificity for all IE subtypes; however, sensitivity was markedly lower for native valve IE than prosthetic valve IE and cardiac implantable electronic devices IE. It is, therefore, a useful adjunct modality for assessing endocarditis, especially in the challenging scenarios of prosthetic valve IE and cardiac implantable electronic devices IE, with improving performance over time, related to advances in 18F-FDG PET/CT techniques.


Assuntos
Endocardite/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Valvas Cardíacas/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Desfibriladores Implantáveis/efeitos adversos , Endocardite/etiologia , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Valor Preditivo dos Testes , Prognóstico , Infecções Relacionadas à Prótese/etiologia , Reprodutibilidade dos Testes , Fatores de Risco
11.
J Ayub Med Coll Abbottabad ; 32(2): 165-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32583987

RESUMO

BACKGROUND: With increased rate of permanent pacemaker's (PPM) implantation, the rate of complication also increased many folds. Infection in pacemakers is one of the dreaded complications which need a multidisciplinary approach in its management. METHODS: All patients with permanent pacemakers, who presented with infection of device, were admitted in our unit. The infected device was explanted and wound left open. The same device was used as a temporary pacemaker with a new PPM screwing lead from internal jugular approach. Once the infection was under control, a new device was implanted on the other side and temporary wire (PPM screwing lead) pulled out. Wound on both side closed and patient kept on antibiotics for a week. RESULTS: Total 10 cases of infected device received. Single chambers devices with infection were six and dual chamber pacemakers were four. One case with infection had tine lead and nine patients presented with screwing leads. Male and female ratio was 2.3:1. All leads were explanted in our department with conventional gadgets using rotation and traction maneuvers. Culture sensitivity in all cases remained negative. Patients were kept on broad spectrum antibiotics till the wound was clear. One patient had small pericardial effusion soon after explantation of tine lead, which was treated conservatively. No other major or minor complication documented.. CONCLUSIONS: Scrupulous planning and preparation before system extraction and later on new Cardiac implantable electronic device re-implantation is essential for better patient outcome.


Assuntos
Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese , Feminino , Humanos , Masculino
12.
PLoS One ; 15(6): e0235230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589674

RESUMO

This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27-4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68-6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43-4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of open-heart surgery, and poorer cardiovascular outcomes.


Assuntos
Marca-Passo Artificial/efeitos adversos , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/epidemiologia , Idoso , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/etiologia
13.
N Engl J Med ; 382(19): 1823-1831, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32374963

RESUMO

BACKGROUND: Access to pacemakers and defibrillators is problematic in places with limited resources. Resterilization and reuse of implantable cardiac devices obtained post mortem from patients in wealthier nations have been undertaken, but uncertainty around the risk of infection is a concern. METHODS: A multinational program was initiated in 1983 to provide tested and resterilized pacemakers and defibrillators to underserved nations; a prospective registry was established in 2003. Patients who received reused devices in this program were matched in a 1:3 ratio with control patients who received new devices implanted in Canada. The primary outcome was infection or device-related death, with mortality from other causes modeled as a competing risk. RESULTS: Resterilized devices were implanted in 1051 patients (mean [±SD] age, 63.2±18.5 years; 43.6% women) in Mexico (36.0%), the Dominican Republic (28.1%), Guatemala (26.6%), and Honduras (9.3%). Overall, 85% received pacemakers and 15% received defibrillators, with one (55.5%), two (38.8%), or three (5.7%) leads. Baseline characteristics did not differ between these patients and the 3153 matched control patients. At 2 years of follow-up, infections had occurred in 21 patients (2.0%) with reused devices and in 38 (1.2%) with new devices (hazard ratio, 1.66; 95% confidence interval, 0.97 to 2.83; P = 0.06); there were no device-related deaths. The most common implicated pathogens were Staphylococcus aureus and S. epidermidis. CONCLUSIONS: Among patients in underserved countries who received a resterilized and reused pacemaker or defibrillator, the incidence of infection or device-related death at 2 years was 2.0%, an incidence that did not differ significantly from that seen among matched control patients with new devices in Canada.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Reutilização de Equipamento , Infecções/etiologia , Marca-Passo Artificial/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , Países em Desenvolvimento , Feminino , Seguimentos , Humanos , Incidência , Infecções/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Fatores de Risco , Esterilização
14.
J Card Surg ; 35(7): 1664-1668, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32383229

RESUMO

INTRODUCTION: In adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle. CASE REPORT: A 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, before the placement of a 10 × 27 mm Visipro balloon-expandable stent in the SVC baffle. CONCLUSIONS: Use of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk, further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.


Assuntos
Transposição das Grandes Artérias/métodos , Remoção de Dispositivo/instrumentação , Marca-Passo Artificial/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Transposição dos Grandes Vasos/cirurgia , Veia Cava Superior/patologia , Veia Cava Superior/cirurgia , Transposição das Grandes Artérias/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Remoção de Dispositivo/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Stents Metálicos Autoexpansíveis , Resultado do Tratamento
15.
Cancer Radiother ; 24(4): 340-344, 2020 Jul.
Artigo em Francês | MEDLINE | ID: mdl-32444285

RESUMO

PURPOSE: MRI is sometimes critical to optimal radiotherapy planning but may be contraindicated in increasing numbers of patients who carry an implantable cardiac device (ICD, pacemaker or defibrillator). MATERIAL AND METHODS: This literature search reviews studies of MRI in DCI patients, morbidity and procedures for the different types of ICD. RESULTS: Several retrospective studies and two recent large prospective studies have shown that the use of an ICD is not an absolute contraindication to MRI, given that specific DCI monitoring is performed under the tridisciplinary supervision of the oncologist, radiologist and cardiologist for MRI≤1.5T. The rate of major complications is less than 5% unless probe replacement is performed. When it can be anticipated, new MRI-compatible ICD can be implanted rather than conventional ICD, but probe replacement is not currently recommended. Data for MRI beyond 1.5T and in case of MRI repeatability in the context of MRI-Linac treatments are lacking. CONCLUSIONS: MRI may be performed in ICD patients, as the risk of morbidity is very low; provided that tridisciplinary evaluation is performed.


Assuntos
Desfibriladores Implantáveis , Imagem por Ressonância Magnética , Marca-Passo Artificial , Planejamento da Radioterapia Assistida por Computador , Fatores Etários , Contraindicações de Procedimentos , Desfibriladores Implantáveis/efeitos adversos , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo
17.
Circ Arrhythm Electrophysiol ; 13(5): e008280, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32281393

RESUMO

BACKGROUND: Current understanding of the impact of cardiac implantable electronic device (CIED) infection is based on retrospective analyses from medical records or administrative claims data. The WRAP-IT (Worldwide Randomized Antibiotic Envelope Infection Prevention Trial) offers an opportunity to evaluate the clinical and economic impacts of CIED infection from the hospital, payer, and patient perspectives in the US healthcare system. METHODS: This was a prespecified, as-treated analysis evaluating outcomes related to major CIED infections: mortality, quality of life, disruption of CIED therapy, healthcare utilization, and costs. Payer costs were assigned using medicare fee for service national payments, while medicare advantage, hospital, and patient costs were derived from similar hospital admissions in administrative datasets. RESULTS: Major CIED infection was associated with increased all-cause mortality (12-month risk-adjusted hazard ratio, 3.41 [95% CI, 1.81-6.41]; P<0.001), an effect that sustained beyond 12 months (hazard ratio through all follow-up, 2.30 [95% CI, 1.29-4.07]; P=0.004). Quality of life was reduced (P=0.004) and did not normalize for 6 months. Disruptions in CIED therapy were experienced in 36% of infections for a median duration of 184 days. Mean costs were $55 547±$45 802 for the hospital, $26 867±$14 893, for medicare fee for service and $57 978±$29 431 for Medicare Advantage (mean hospital margin of -$30 828±$39 757 for medicare fee for service and -$6055±$45 033 for medicare advantage). Mean out-of-pocket costs for patients were $2156±$1999 for medicare fee for service, and $1658±$1250 for medicare advantage. CONCLUSIONS: This large, prospective analysis corroborates and extends understanding of the impact of CIED infections as seen in real-world datasets. CIED infections severely impact mortality, quality of life, healthcare utilization, and cost in the US healthcare system. Registration: URL: https://www.clinicaltrials.gov Unique Identifier: NCT02277990.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/economia , Desfibriladores Implantáveis/economia , Custos de Cuidados de Saúde , Recursos em Saúde/economia , Marca-Passo Artificial/economia , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Causas de Morte , Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/economia , Custos de Medicamentos , Planos de Pagamento por Serviço Prestado/economia , Feminino , Gastos em Saúde , Custos Hospitalares , Humanos , Tempo de Internação/economia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Readmissão do Paciente/economia , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Qualidade de Vida , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
19.
J Card Surg ; 35(5): 1148-1151, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32293046

RESUMO

BACKGROUND AND AIM: Cardiac sarcoma is a rare condition and may mimic atrial myxoma. We present a case report of a man with a cardiac sarcoma. METHOD: Case report presentation. RESULTS: A 68-year-old man with a permanent pacemaker presented to us with a 4-month history of breathlessness. Echocardiography revealed a large right atrial mass adherent to the pacemaker lead and a provisional diagnosis of atrial myxoma was made based on echocardiographic appearance. A 60 x 30 x 30 mm irregular lobulated tumour was surgically resected from the right atrium. Upon histopathologic examination, the tumour was consistent with an undifferentiated pleomorphic sarcoma. CONCLUSION: Cardiac sarcomas have an extremely poor prognosis and more unfortunately this man developed a surgical site infection and died of acute mediastinitis. We discuss the presentation, imaging and current surgical approaches to cardiac sarcoma. Curative treatment is currently limited for this disease.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/cirurgia , Marca-Passo Artificial/efeitos adversos , Sarcoma/cirurgia , Idoso , Ponte Cardiopulmonar , Diagnóstico Diferencial , Ecocardiografia , Ecocardiografia Tridimensional , Evolução Fatal , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Masculino , Mediastinite , Complicações Pós-Operatórias , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Infecção da Ferida Cirúrgica
20.
Curr Opin Anaesthesiol ; 33(3): 441-447, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32324665

RESUMO

PURPOSE OF REVIEW: There have been both technological and philosophical advances over the last decade regarding pacemakers and implanted cardioverter defibrillators (ICDs). Collectively, these devices are currently referred to as cardiac implantable electronic devices (CIEDs). Technological advances include the introduction of leadless pacemakers, subcutaneous defibrillators and cardiac event recorders, enhancements regarding compatibility of CIEDs for MRI scanning, the ability to interrogate devices remotely, and improved programming modes that preserve battery life. Philosophical advances have been mainly in the area of perioperative management of CIED patients. RECENT FINDINGS: Current practice recommendations now acknowledge that not every patient requires a formal interrogation of their CIED before and after surgery (as was previously recommended). The response to magnet application is standardized across manufacturer's platforms, and it is known that sources of electromagnetic interference remote from the CIED and its leads do not usually cause any interference with device function. SUMMARY: Educated anesthesia teams can independently manage the vast majority of CIED patients perioperatively with magnet application alone. Furthermore, this portends enhanced patient safety and improved workflows in the perioperative period.


Assuntos
Anestesia/métodos , Anestesiologia/organização & administração , Marca-Passo Artificial , Assistência Perioperatória/métodos , Anestesia/efeitos adversos , Desfibriladores Implantáveis/efeitos adversos , Humanos , Complicações Intraoperatórias/prevenção & controle , Marca-Passo Artificial/efeitos adversos , Segurança do Paciente , Período Perioperatório , Fluxo de Trabalho
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