Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 347
Filtrar
1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 235-237, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460710

RESUMO

In order to improve the accuracy of the pacemaker's parameter adjustment and to avoid the surgical replacement of the pacemaker when the battery is exhausted, this paper designs a novel single-chamber pacemaker circuit based on low-power single-chip microcomputer. The circuit uses digital control to accurately control the amplitude, pulse width and frequency of the pacing pulse. The circuit is also designed with wireless charging function, and wireless communication with the programmer can wirelessly charge the pacemaker and know the charging information in real time. Wireless charging function can reduce the number of times the patient replaces the pacemaker or even completely avoid it.


Assuntos
Desenho de Equipamento , Marca-Passo Artificial , Fontes de Energia Elétrica , Humanos , Marca-Passo Artificial/normas , Marca-Passo Artificial/tendências
2.
J Cardiovasc Med (Hagerstown) ; 20(8): 531-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259858

RESUMO

AIMS: The aim of this survey was to assess the management and organization of cardiac implantable electronic device (CIED) replacement in Italy. METHODS: A questionnaire consisting of 24 questions on organizational aspects and on the peri-procedural management of anticoagulant therapies and antibiotic prophylaxis was sent via the Internet to 154 Italian arrhythmia centers. RESULTS: A total of 103 out of 154 centers completed the questionnaire (67% response rate). In 43% of the centers, the procedures were performed under day-case admission, in 40% under ordinary admission, and in 17% under either day-case or ordinary admission. The most frequent reason (66%) for choosing ordinary admission rather than day-case admission was to obtain full reimbursement. Although warfarin therapy was continued in 73% of the centers, nonvitamin K oral anticoagulants were discontinued, without bridging, 24 h or less prior to replacement procedures in 88%. Prophylactic antibiotic therapy was systematically administered in all centers; in 97%, the first antibiotic dose was administered 1-2 h prior to procedures. Local antibacterial envelopes were also used in 43% of the centers in patients with a higher risk of device infection. CONCLUSION: This survey provides a representative picture of how CIED replacements are organized and managed in current Italian clinical practice. The choice of the type of hospitalization (short versus ordinary) was more often motivated by economic reasons (reimbursement of the procedure) than by clinical and organizational factors. Peri-procedural management of anticoagulation and prophylactic antibiotic therapy was consistent with current scientific evidence.


Assuntos
Antibioticoprofilaxia/tendências , Anticoagulantes/administração & dosagem , Estimulação Cardíaca Artificial/tendências , Desfibriladores Implantáveis/tendências , Remoção de Dispositivo/tendências , Cardioversão Elétrica/tendências , Marca-Passo Artificial/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Ambulatórios , Estimulação Cardíaca Artificial/economia , Desfibriladores Implantáveis/economia , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/economia , Esquema de Medicação , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Custos de Cuidados de Saúde , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Tempo de Internação , Marca-Passo Artificial/economia , Admissão do Paciente , Padrões de Prática Médica/economia , Falha de Prótese , Fatores de Tempo , Resultado do Tratamento
4.
Int J Cardiol ; 282: 33-37, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30755335

RESUMO

BACKGROUND: The need for permanent pacing has been identified as a predictor of poor outcomes in the late survivors of Fontan surgery. However, it is not clear if the need for a pacemaker is a surrogate marker of a declining Fontan state, or if pacing is deleterious to the Fontan circulation. OBJECTIVES: We sought to compare the long-term outcomes of propensity-matched Fontan patients with and without a permanent pacemaker. METHODS: Patients who have survived Fontan completion with a documented history of cardiac arrhythmia were identified from the Australia and New Zealand Fontan Registry. Pacemaker insertion details, cardiac function and electrophysiological data were obtained for the patients with a permanent pacemaker. Survival analysis was performed with propensity score matching to compare late survival and outcomes in patients with versus without a pacemaker. RESULTS: There was a total of 310 patients with a history of cardiac arrhythmia, of which 126 (41%) had a permanent pacemaker. After propensity-score matching, 99 pairs were generated (n = 198). Patients with a permanent pacemaker had a higher risk of death (HR 3.32 95% CI 1.60-6.90, p = 0.001) and death or transplantation (HR 3.55 95% CI 1.87-6.73, p < 0.001). Patients who were only paced atrially were not at a significantly increased risk of death or transplantation. However, patients who were ventricular paced >50% of the time were much more likely to encounter late death or transplantation (HR 3.82 95% CI 1.64-8.95, p = 0.002). CONCLUSIONS: Having a permanent pacemaker and needing ventricular pacing is likely associated with an increased risk of death and transplantation in patients with a Fontan circulation.


Assuntos
Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/cirurgia , Técnica de Fontan/mortalidade , Transplante de Coração/mortalidade , Marca-Passo Artificial/efeitos adversos , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Técnica de Fontan/tendências , Transplante de Coração/tendências , Humanos , Masculino , Mortalidade/tendências , Nova Zelândia/epidemiologia , Marca-Passo Artificial/tendências , Sistema de Registros , Fatores de Risco
5.
Int J Cardiol ; 280: 89-94, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30658926

RESUMO

AIM: Post-mortem interrogation of the cardiac implantable electronic devices (CIEDs) in combination with autopsy findings can provide additional information regarding device functioning after implantation or the mechanism of death. The aim of the study is to review the available data on the post-mortem interrogation of CIEDs and its possible clinical implications. METHODS AND RESULTS: A systematic review of the published studies has been performed. Out of 762 unique citations 14 have been retained for final analysis. Post-mortem CIED interrogation reliably detects both serious device malfunctions and lead disorders but also improper device programming. As the need for CIED implantation is growing in the low-income countries, currently available data on battery longevity of devices explanted and destined for re-use have been reviewed. CONCLUSIONS: Post-mortem CIED interrogation provides a unique opportunity to explore different mechanisms of death, often unavailable for distinction during regular in-hospital observation or in autopsy analysis.


Assuntos
Autopsia/métodos , Causas de Morte , Desfibriladores Implantáveis , Remoção de Dispositivo/métodos , Autopsia/tendências , Causas de Morte/tendências , Desfibriladores Implantáveis/tendências , Remoção de Dispositivo/tendências , Humanos , Marca-Passo Artificial/tendências
6.
Int J Cardiol ; 279: 72-78, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30642645

RESUMO

BACKGROUND: Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs. METHODS: 136 CMR studies were performed in 133 consecutive patients (age 56 ±â€¯19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts. RESULTS: CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences. CONCLUSION: The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.


Assuntos
Cicatriz/diagnóstico por imagem , Desfibriladores Implantáveis/tendências , Imagem Cinética por Ressonância Magnética/tendências , Miocárdio/patologia , Marca-Passo Artificial/tendências , Adulto , Idoso , Cicatriz/etiologia , Desfibriladores Implantáveis/efeitos adversos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Distribuição Aleatória
7.
Minerva Cardioangiol ; 66(6): 762-769, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30468062

RESUMO

A very fast-paced improvement of technology in the field of cardiac implantable devices has been observed in the last ten years. The aim of this review is to highlight the most important innovations which have been recently introduced in this field, such as the leadless pacemaker (a heart stimulator without intracardiac leads), the subcutaneous defibrillator (a completely extracardiac defibrillator device), the injectable loop recorder (a miniaturized subcutaneous continuous echocardiographic monitor provided by alarms and telephonic transmission) and many other new devices which will completely change the clinical practice in this field over the next decade.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/tendências , Marca-Passo Artificial/tendências , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Desenho de Equipamento , Humanos
8.
BMC Geriatr ; 18(1): 223, 2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-30241511

RESUMO

BACKGROUND: With an ageing population and widening indications for pacemakers implantation, the number of persons carrying an implant is steadily increasing. The routine follow-up is thus a heavy burden for the respective NHS as well as for the patients and their relatives. Most of them of the studies have been performed in densely populated areas and nearby to the hospital. It is thus unknown whether these results could be applied also in rural areas such as Northern Norway with a more scattered population. The aim of this study was to assess the effectiveness of tele-monitoring (TM) in patients with pacemakers regarding reliability, safety and health-related quality of life, compared to traditional follow-up in outpatient clinic in a setting where geographical effects could possible influence the results. METHODS: The NORDLAND study is a controlled, randomized, non-masked clinical trial in pacemaker patients, with data collection carried out during the pre-implant stage and after 6 months. Between August of 2014 and November of 2015, 50 patients were assigned to either a tele-monitoring group (n = 25) or a conventional hospital monitoring (HM) group (n = 25). The EuroQol-5D (EQ-5D) utilities and visual analogue scale (VAS) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used to measure Health-Related Quality of Life. Baseline characteristics and number of hospital visits were also analyzed. RESULTS: The baseline characteristics of the two study groups were similar for EQ-5D utilities (TM:0.81; HM:0.76; p = 0.47), EQ-5D VAS (TM: 64.00; HM:64.88; p = 0.86) and the MLHFQ (TM:20.20; HM:28.96; p = 0.07). At the 6 month follow-up, there were no significant differences between the groups in EQ-5D utilities (TM: 0.81; HM: 0.76; p = 0.54) and EQ-5D VAS scores (TM: 72.71; HM: 59.79; p = 0.08). The MLHFQ score was improved in both groups (TM: -4.40; HM: -15.13; p <  0.001). The number of in-office visits was similar in both groups (TM: 1.24 vs HM: 1.12; P = 0.30). CONCLUSIONS: The NORDLAND trial shows that HRQoL is improved after implant in both groups. Without significant differences with regards to effectiveness and safety. In addition, provides a scientifically rigorous method to the field of HRQoL evaluations in patients with pacemakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT02237404 , September 11, 2014.


Assuntos
Marca-Passo Artificial/psicologia , Marca-Passo Artificial/tendências , Qualidade de Vida/psicologia , Telemedicina/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo , Escala Visual Analógica
9.
J Cardiovasc Electrophysiol ; 29(12): 1697-1704, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30168233

RESUMO

BACKGROUND: Transcatheter pacing systems (TPS) provide a novel, minimally invasive approach in which a miniaturized, leadless pacemaker (PM) is transfemorally implanted in the right ventricle. We evaluated the health-related quality of life (HRQoL) impact, patient satisfaction, and activity restrictions following TPS in a large prospective multicenter clinical trial. METHODS AND RESULTS: Patients who underwent a Micra TPS implantation between December 2013 and May 2015 were included. HRQoL impact was evaluated using the Short-Form-36 (SF-36) questionnaire at baseline, 3, and 12 months. Patient satisfaction was assessed using a three-item questionnaire determining recovery, activity level, and esthetic appearance at 3 months. Implanting physicians compared the patient activity restrictions for TPS to traditional PM therapy. A total of 720 patients were implanted with a TPS (76 ± 11 years; 59% male). Of these patients, 702 (98%), 681 (95%), and 635 (88%) completed the SF-36 at baseline, 3 and 12 months, respectively. Improvements were observed at 3 and 12 months in all SF-36 domains and all attained statistical significance. Of 693 patients who completed the patient satisfaction questionnaire, 96%, 91%, 74% were (very) satisfied with their esthetic appearance, recovery, and level of activity, respectively. TPS discharge instructions were rated less restrictive in 49%, equally restrictive in 47%, and more restrictive in 4% of cases compared with traditional PM systems. CONCLUSIONS: TPS resulted in postimplant HRQoL improvements at 3 and 12 months, and high levels of patient satisfaction at 3 months. Further, TPS was associated with less activity restrictions compared with traditional PM systems.


Assuntos
Estimulação Cardíaca Artificial/tendências , Doenças Cardiovasculares/cirurgia , Marca-Passo Artificial/tendências , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
13.
Int J Cardiol ; 273: 56-62, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30104033

RESUMO

OBJECTIVES: To analyze the timing of appearance of conduction abnormalities (CAs) after transcatheter aortic valve implantation (TAVI), to identify predictors of delayed CAs requiring pacemaker (PM) implantation and to provide guidance regarding the duration of telemetry monitoring. BACKGROUND: How long patients remain at risk of development of CAs requiring PM implantation after TAVI and for how long they should be monitored remains unclear but is crucial when considering early discharge. METHODS: Development of CAs was studied in 701 consecutive patients treated with Edwards Sapien 3 valves and monitored with telemetry for 7 days in a single center. After excluding valve-in-valve procedures and patients with previous PM, 606 patients remained for analysis. Predictors of CAs requiring PM and the time of onset of CAs were analyzed. RESULTS: Of 606 patients 76 (12.5%) required a PM after TAVI. CAs requiring PM implantation occurred after 48 h in 22.4% (17 patients) and in 10.5% (8 patients) even after 5 days. Of the patients who developed high grade CAs requiring PM after 48 h, 47.1% had no CAs prior to TAVI, and 23.5% had neither pre-existing CAs nor new-developed CAs within the first 48 h after TAVI. CONCLUSION: After TAVI using a new-generation balloon-expandable valve, delayed development of CAs requiring PM implantation is not uncommon, even after 5 days. More importantly, 23.5% of patients eventually requiring a delayed PM implantation had still no CAs at 48 h after TAVI in this study. These results question the safety of early discharge and support ECG monitoring for a longer time period. The most optimal way to monitor these patients is yet to be determined.


Assuntos
Eletrocardiografia Ambulatorial/tendências , Próteses Valvulares Cardíacas/tendências , Marca-Passo Artificial/tendências , Substituição da Valva Aórtica Transcateter/tendências , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia/mortalidade , Eletrocardiografia/tendências , Eletrocardiografia Ambulatorial/mortalidade , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Telemetria/métodos , Telemetria/mortalidade , Telemetria/tendências , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
14.
J Am Coll Cardiol ; 71(23): 2603-2611, 2018 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-29880119

RESUMO

BACKGROUND: Long-term continuous monitoring detects short-lasting, subclinical atrial fibrillation (SCAF) in approximately one-third of older individuals with cardiovascular conditions. The relationship between SCAF, its progression, and the development of heart failure (HF) is unclear. OBJECTIVES: This study examined the relationship between progression from shorter to longer SCAF episodes and HF hospitalization. METHODS: Subjects in ASSERT (Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial) were ≥65 years old, had history of hypertension, no prior clinical AF, and an implanted pacemaker or defibrillator. We examined patients whose longest SCAF episode during the first year after enrollment was >6 min but ≤24 h (n = 415). Using time-dependent Cox models, we evaluated the relationship between subsequent development of SCAF >24 h or clinical AF and HF hospitalization. RESULTS: Over a mean follow-up of 2 years, 65 patients (15.7%) progressed to having SCAF episodes >24 h or clinical AF (incidence 8.8% per year). Older age, greater body mass index, and longer SCAF duration within the first year were independent predictors of SCAF progression. The rate of HF hospitalization among patients with SCAF progression was 8.9% per year compared with 2.5% per year for those without progression. After multivariable adjustment, SCAF progression was independently associated with HF hospitalization (hazard ratio [HR]: 4.58; 95% confidence interval [CI]: 1.64 to 12.80; p = 0.004). Similar results were observed when we excluded patients with prior history of HF (HR: 7.06; 95% CI: 1.82 to 27.30; p = 0.005) or when SCAF progression was defined as development of SCAF >24 h alone (HR: 3.68; 95% CI: 1.27 to 10.70; p = 0.016). CONCLUSIONS: In patients with a pacemaker or defibrillator, SCAF progression was strongly associated with HF hospitalization.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Progressão da Doença , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Marca-Passo Artificial/tendências , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Marca-Passo Artificial/efeitos adversos , Fatores de Risco
15.
Aust J Gen Pract ; 47(5): 264-271, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29779297

RESUMO

BACKGROUND: The last decade has seen ongoing evolution and use of cardiac rhythm management devices, including pacemakers, cardiac resynchronisation therapy, implantable cardioverter defibrillators and loop recorders. General practitioners are increasingly involved in follow-up and management of patients with these devices. OBJECTIVE: The aim of this article is to provide an overview of different cardiac rhythm management devices, including their role, implant procedure, post-procedural care, potential complications and follow­up. We also include practical advice for patients regarding driving, exercise, sexual intimacy and precautions with regards to electromagnetic interference. DISCUSSION: Cardiac rhythm management devices perform many functions, including bradycardia pacing, monitoring for arrhythmias, cardiac resynchronisation for heart failure, defibrillation and anti-tachycardia pacing for tachyarrhythmias. Concerns regarding potential device-related complications should be discussed with the implanting physician. In the post-implant period, patients with cardiac rhythm management devices can expect to lead normal, active lives. However, caution must occasionally be exercised in certain situations, such as near appliances with electromagnetic interference. Future innovations will move away from transvenous leads to leadless designs with combinations of different components on a 'modular' basis according to the function required.


Assuntos
Arritmias Cardíacas/cirurgia , Desenho de Equipamento/normas , Marca-Passo Artificial/normas , Terapia de Ressincronização Cardíaca/métodos , Cardioversão Elétrica/instrumentação , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Humanos , Marca-Passo Artificial/efeitos adversos , Marca-Passo Artificial/tendências
16.
J Am Coll Cardiol ; 71(20): 2319-2330, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29535066

RESUMO

BACKGROUND: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP. OBJECTIVES: This study sought to evaluate clinical outcomes of HBP compared to RVP. METHODS: All patients requiring initial pacemaker implantation between October 1, 2013, and December 31, 2016, were included in the study. Permanent HBP was attempted in consecutive patients at 1 hospital and RVP at a sister hospital. Implant characteristics, all-cause mortality, heart failure hospitalization (HFH), and upgrades to biventricular pacing (BiVP) were tracked. Primary outcome was the combined endpoint of death, HFH, or upgrade to BiVP. Secondary endpoints were mortality and HFH. RESULTS: HBP was successful in 304 of 332 consecutive patients (92%), whereas 433 patients underwent RVP. The primary endpoint of death, HFH, or upgrade to BiVP was significantly reduced in the HBP group (83 of 332 patients [25%]) compared to RVP (137 of 433 patients [32%]; hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.534 to 0.944; p = 0.02). This difference was observed primarily in patients with ventricular pacing >20% (25% in HBP vs. 36% in RVP; HR: 0.65; 95% CI: 0.456 to 0.927; p = 0.02). The incidence of HFH was significantly reduced in HBP (12.4% vs. 17.6%; HR: 0.63; 95% CI: 0.430 to 0.931; p = 0.02). There was a trend toward reduced mortality in HBP (17.2% vs. 21.4%, respectively; p = 0.06). CONCLUSIONS: Permanent HBP was feasible and safe in a large real-world population requiring permanent pacemakers. His bundle pacing was associated with reduction in the combined endpoint of death, HFH, or upgrade to BiVP compared to RVP in patients requiring permanent pacemakers.


Assuntos
Fascículo Atrioventricular/diagnóstico por imagem , Estimulação Cardíaca Artificial/tendências , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Marca-Passo Artificial/tendências , Idoso , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial/métodos , Estudos de Coortes , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Ventrículos do Coração/diagnóstico por imagem , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Resultado do Tratamento
17.
Int J Cardiol ; 261: 37-41, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29572082

RESUMO

AIMS: Conduction abnormalities (CA), in particular complete atrioventricular block (CAVB), requiring permanent pacemaker (PPM) implantation, are frequent complications after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). However, the potential mechanisms are still incompletely understood. The objective of this retrospective study was to determine further predictors of CAVB after TAVI in patients without the known predictors. METHODS AND RESULTS: This study included patients without prior CA/PPM who underwent TAVI of a balloon-expandable valve (Sapien or Sapien XT or Sapien 3). Of 563 patients (81.2 ±â€¯6.9 years, 245 men [43.5%], logistic EuroSCORE 22.2 ±â€¯14.1%, STS PROM 5.9 [3.4-8.0]) who were treated by TAVI at our institution between July 2008 and January 2016, 61 (10.8%) developed a permanent CAVB after the procedure. In a multivariable logistic regression analysis moderate/severe tricuspid regurgitation (TR) (OR 2.05; 95% CI 1.18-3.55; p = 0.010) was identified as an independent predictor for new CAVB after TAVI. Moreover, patients with more pronounced TR presented with increased left and right ventricular overload (left ventricular (LV) end-diastolic diameter, LV end-diastolic pressure), pulmonary pressures, NT-proBNP, and prevalence of mitral regurgitation ≥II, whereas LV ejection fraction, TAPSE and cardiac output were decreased. CONCLUSIONS: PPM implantation is a frequent complication in patients undergoing TAVI. Increasing severity of TR seems to be a consequence of left and right ventricular overload caused by severe AS and is a significant predictor of new CAVB after TAVI. CONDENSED ABSTRACT: Conduction abnormalities (CA) requiring permanent pacemaker (PPM) implantation, are frequent complications after transcatheter aortic valve implantation (TAVI). This study included patients without prior CA/PPM who underwent TAVI. Of 563 patients 61 (10.8%) developed a permanent CAVB after the procedure. In a multivariable logistic regression analysis moderate/severe tricuspid regurgitation (TR) (OR 2.05; 95% CI 1.18-3.55; p = 0.010) was identified as an independent predictor for new CAVB. Therefore, in patients with moderate/severe TR utmost care should be taken to avoid procedural factors conducive to mechanical irritation of the conduction system, resulting in pacemaker dependency.


Assuntos
Bloqueio Atrioventricular/epidemiologia , Marca-Passo Artificial/tendências , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/tendências , Insuficiência da Valva Tricúspide/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Insuficiência da Valva Tricúspide/terapia
19.
Rev. esp. cardiol. (Ed. impr.) ; 71(3): 162-169, mar. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-172198

RESUMO

Introducción y objetivos: La cronología y la evolución de los trastornos de conducción (TdC) asociados con el implante percutáneo de válvula aórtica (TAVI) expandible con balón son poco conocidas. Este estudio examina la cronología de los TdC y el impacto de la valvuloplastia aórtica con balón (VAB) en su persistencia. Métodos: Se incluyó a 347 pacientes, y a 75 de ellos se les realizó una monitorización continua durante la TAVI y un electrocardiograma de 6 derivaciones en cada paso del procedimiento. Resultados: En los pacientes monitorizados, se registraron 48 (64%) bloqueos de rama izquierda (BRI) y 16 (21,3%) bloqueos auriculoventriculares completos, de los que el 51,5% apareció antes de implantar la válvula. Los BRI que aparecieron antes del implante valvular persistieron con mayor frecuencia al alta (el 53,8 frente al 22,7%; p = 0,028) y en el seguimiento a 30 días (el 38,5 frente al 13,6%; p = 0,054). Se realizó una VAB en 264 de los 347 pacientes (76,1%). En total, 78 pacientes (22,5%) presentaron un BRI o bloqueo auriculoventricular completo que requirió marcapasos permanente. Un BRI persistente o el bloqueo auriculoventricular no resuelto se observó más frecuentemente entre los pacientes con VAB (el 76,1 frente al 47,6%; p = 0,021), y la VAB se asoció con la persistencia del TdC (OR = 3,5; IC95%, 1,17-10,43; p = 0,021). Conclusiones: Más de la mitad de los TdC observados después de una TAVI ocurren antes del implante de la válvula. La aparición precoz de los TdC se asocia con una mayor persistencia del mismo a los 30 días. El uso de VAB se asocia con un aumento del riesgo de persistencia de los TdC (AU)


Introduction and objectives: Little is known about the timing of onset and outcome of conduction abnormalities (CA) following balloon-expandable transcatheter aortic valve implantation. The aim of this study was to examine the timing of CA and determine the impact of balloon aortic valvuloplasty (BAV) on the persistence of these abnormalities. Methods: A total of 347 patients were included. Of these, 75 had a continuous electrocardiogram recording and a 6-lead electrocardiogram at each step of the procedure. Results: In the transcatheter aortic valve implantation population undergoing continuous electrocardiogram monitoring, new-onset left bundle branch block (LBBB) or third-degree atrioventricular block occurred in 48 (64%) and 16 (21.3%) patients, with 51.5% of CA occurring before valve implantation. Left bundle branch block persisted more frequently at hospital discharge (53.8 vs 22.7%; P = .028) and at 1-month follow-up (38.5 vs 13.6%; P = .054) when occurring before valve implantation. Balloon aortic valvuloplasty prior to valve implantation was used in 264 (76.1%) patients, and 78 (22.5%) had persistent LBBB or complete atrioventricular block requiring pacemaker implantation. Persistent LBBB or unresolved atrioventricular block at 1 month occurred more frequently in the BAV group (76.1 vs 47.6%; P = .021), and the use of BAV was associated with a lack of CA resolution (OR, 3.5; 95%CI, 1.17-10.43; P = .021). Conclusions: In patients undergoing a balloon-expandable transcatheter aortic valve implantation, more than half of CA occurred before valve implantation. Early occurrence of CA was associated with a higher rate of persistence at 1-month follow-up. The use of BAV was associated with an increased risk of CA persistence (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Valvuloplastia com Balão/métodos , Estenose da Valva Aórtica/epidemiologia , Marca-Passo Artificial/tendências , Sistema de Condução Cardíaco/cirurgia , Valvuloplastia com Balão/efeitos adversos , Valvuloplastia com Balão/estatística & dados numéricos , Valva Aórtica/cirurgia , Eletrocardiografia/métodos , Análise Estatística
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA