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1.
Acta Med Indones ; 52(3): 290-296, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020340

RESUMO

Since the first case was reported at the end of 2019, COVID-19 has spread throughout the world and has become a pandemic. The high transmission rate of the virus has made it a threat to public health globally. Viral infections may trigger acute coronary syndromes, arrhythmias, and exacerbation of heart failure, due to a combination of effects including significant systemic inflammatory responses and localized vascular inflammation at the arterial plaque level. Indonesian clinical practice guideline stated that (hydroxy)chloroquine alone or in combination with azithromycin may be used to treat for COVID-19. However, chloroquine, hydroxychloroquine, and azithromycin all prolong the QT interval, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications. To date, there is still no vaccine or specific antiviral treatment for COVID-19. Therefore, prevention of infection in people with cardiovascular risk and mitigation of the adverse effects of treatment is necessary.


Assuntos
Antiarrítmicos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Morte Súbita Cardíaca/prevenção & controle , Pneumonia Viral/complicações , Taquicardia Ventricular/prevenção & controle , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico , Taquicardia Ventricular/etiologia
2.
Br J Sports Med ; 54(19): 1157-1161, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32878870

RESUMO

SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Miocardite/diagnóstico , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Transtornos Respiratórios/diagnóstico , Volta ao Esporte/normas , Atletas , Biomarcadores/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Miocardite/sangue , Miocardite/etiologia , Miocárdio/patologia , Necrose/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Transtornos Respiratórios/etiologia , Medicina Esportiva/normas , Avaliação de Sintomas , Troponina/sangue
3.
Int Heart J ; 61(5): 927-935, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879263

RESUMO

We prospectively collected device and heart rate data through remote monitoring (RM) of patients with an implantable cardioverter defibrillator (ICD). The objective was to identify the predictors of lethal arrhythmic events (VT/VF).Thirty-three patients (mean age: 50 years) with ICDs [with functionality of heart rate variability (HRV) analysis] were divided into two groups [VT/VF (+), VT/VF (-) ]. Clinical, device (ventricular lead impedance; amplitude of ventricular electrogram), and HRV data were compared between the two groups. The NN interval-index (SDNNi) was calculated for every 5 minutes, and the mean, maximum, minimum, and standard deviation of SDNNi during the 24-hour period were used.During the observation period of 13 ± 10 months, 10 patients experienced VT/VF events. Total mean, max, and min SDNNi were higher in the VT/VF (+) than the VT/VF (-) group (132.9 ± 9.3 versus 93.5 ± 6.1, P = 0.0013; 214.6 ± 10.6 versus 167.0 ± 7.0, P = 0.0007; 71.2 ± 7.5 versus 43.9 ± 4.9, P = 0.0047). On logistic regression analysis, a total mean SDNNi of 100.1, max SDNNi of 185.0 and min SDNNi of 52.0 as cut-off values for prediction of a VT/VF event demonstrated significant receiver operating characteristic (ROC) curves (AUC = 0.86, P = 0.0007; AUC = 0.84, P = 0.0005; AUC = 0.78, P = 0.0030). The max ΔSDNNi, i.e., difference from baseline SDNNi, and min ΔSDNNi in 7 and 28 days preceding VT/VF events were significant predictors of VT/VF events.Time-domain HRV analysis through a RM system may help identify patients at high risk of lethal arrhythmic events; in addition, it may help predict the occurrence of lethal arrhythmic events in specific cases.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Frequência Cardíaca , Taquicardia Ventricular/epidemiologia , Fibrilação Ventricular/epidemiologia , Adulto , Idoso , Síndrome de Brugada/fisiopatologia , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Tecnologia de Sensoriamento Remoto , Taquicardia Ventricular/fisiopatologia , Fibrilação Ventricular/fisiopatologia
4.
J Cardiopulm Rehabil Prev ; 40(5): 285-286, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32804796

RESUMO

PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic has been spreading rapidly worldwide since late January 2020. The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, has reduced the possibility of performing either outdoor or gym physical activity (PA). This study investigated and quantified the reduction of PA in patients with automatic implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death. METHODS: Daily PA of 24 patients was estimated by processing recorded data from ICD-embedded accelerometric sensors used by the rate-responsive pacing systems. RESULTS: During the forced 40-d in-home confinement, a mean 25% reduction of PA was observed as compared with the 40-d confinement-free period (1.2 ± 0.3 vs 1.6 ± 0.5 hr/d, respectively, P = .0001). CONCLUSIONS: This objective quantification of the impact of the COVID-19 pandemic on PA determined by an ICD device showed an abrupt and statistically significant reduction of PA in primary prevention ICD patients, during the in-home confinement quarantine. To counteract the deleterious effects of physical inactivity during the COVID-19 outbreak, patients should be encouraged to perform indoor exercise-based personalized rehabilitative programs.


Assuntos
Reabilitação Cardíaca , Infecções por Coronavirus , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Exercício Físico/fisiologia , Pandemias , Pneumonia Viral , Telerreabilitação/organização & administração , Idoso , Betacoronavirus , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/tendências , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Cardioversão Elétrica/instrumentação , Feminino , Humanos , Itália/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/métodos
6.
PLoS One ; 15(8): e0238029, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857782

RESUMO

BACKGROUND: This study analyzed the survival and protective predictors of in-hospital cardiopulmonary cerebral resuscitation (CPCR) to potentially help physicians create effective treatment plans for End-stage kidney disease (ESKD) patients. METHODS: We extracted the data of 7,116 ESKD patients who received their first in-hospital CPCR after initial dialysis between 2004 and 2012 from the National Health Insurance Research Database. The primary outcome was the survival rate during the first in-hospital CPCR. The secondary outcome was the median post-discharge survival. RESULTS: From 2004 through 2012, the incidence of in-hospital CPCR decreases from 3.97 to 3.67 events per 1,000 admission days (P for linear trend <0.001). The survival rate for the first in-hospital CPCR did not change significantly across the 9 years (P for trend = 0.244), whereas the median survival of post-discharge survival increased significantly from 3.0 months in 2004 to 6.8 months in 2011 (P for linear trend <0.001). In addition, multivariable analysis identified older age as a risk factor and prior intracardiac defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) implantation as a protective factor for in-hospital death during the first in-hospital CPCR. CONCLUSION: The incidence of in-hospital CPCR and the duration post-discharge among ESKD patients improved despite there being no significant difference in the survival rate of ESKD patients after CPCP. Either ICD or CRT-D implantation may be advisable for ESKD patients with a high risk of sudden cardiac death.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Falência Renal Crônica/patologia , Fatores Etários , Idoso , Comorbidade , Bases de Dados Factuais , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Feminino , Hospitais , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
7.
N Engl J Med ; 383(6): 526-536, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32757521

RESUMO

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (ICD) was designed to avoid complications related to the transvenous ICD lead by using an entirely extrathoracic placement. Evidence comparing these systems has been based primarily on observational studies. METHODS: We conducted a noninferiority trial in which patients with an indication for an ICD but no indication for pacing were assigned to receive a subcutaneous ICD or transvenous ICD. The primary end point was the composite of device-related complications and inappropriate shocks; the noninferiority margin for the upper boundary of the 95% confidence interval for the hazard ratio (subcutaneous ICD vs. transvenous ICD) was 1.45. A superiority analysis was prespecified if noninferiority was established. Secondary end points included death and appropriate shocks. RESULTS: A total of 849 patients (426 in the subcutaneous ICD group and 423 in the transvenous ICD group) were included in the analyses. At a median follow-up of 49.1 months, a primary end-point event occurred in 68 patients in the subcutaneous ICD group and in 68 patients in the transvenous ICD group (48-month Kaplan-Meier estimated cumulative incidence, 15.1% and 15.7%, respectively; hazard ratio, 0.99; 95% confidence interval [CI], 0.71 to 1.39; P = 0.01 for noninferiority; P = 0.95 for superiority). Device-related complications occurred in 31 patients in the subcutaneous ICD group and in 44 in the transvenous ICD group (hazard ratio, 0.69; 95% CI, 0.44 to 1.09); inappropriate shocks occurred in 41 and 29 patients, respectively (hazard ratio, 1.43; 95% CI, 0.89 to 2.30). Death occurred in 83 patients in the subcutaneous ICD group and in 68 in the transvenous ICD group (hazard ratio, 1.23; 95% CI, 0.89 to 1.70); appropriate shocks occurred in 83 and 57 patients, respectively (hazard ratio, 1.52; 95% CI, 1.08 to 2.12). CONCLUSIONS: In patients with an indication for an ICD but no indication for pacing, the subcutaneous ICD was noninferior to the transvenous ICD with respect to device-related complications and inappropriate shocks. (Funded by Boston Scientific; PRAETORIAN ClinicalTrials.gov number, NCT01296022.).


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis/efeitos adversos , Idoso , Cardiomiopatias/terapia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrodos Implantados/efeitos adversos , Falha de Equipamento , Feminino , Seguimentos , Cardiopatias/terapia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
8.
Am J Cardiol ; 128: 75-83, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650928

RESUMO

Highly reliable identification of adults with hypertrophic cardiomyopathy (HC) at risk for sudden death (SD) has been reported. A significant controversy remains, however, regarding the most reliable risk stratification methodology for children and adolescents with HC. The present study assesses the accuracy of SD prediction and prevention with prophylactic implantable cardioverter-defibrillators (ICDs) in young HC patients. The study group is comprised of 146 HC patients <20 years of age evaluated consecutively over 17 years with prospective risk stratification and ICD decision-making. We relied on ≥1 established individual risk markers considered major within each patient's clinical profile, based on an enhanced American College of Cardiology /American Heart Association (ACC/AHA) guidelines algorithm. Of the 60 largely asymptomatic patients implanted with primary prevention ICDs at age 15 ± 4 years, 9 (15%) experienced device therapy terminating potentially lethal ventricular tachyarrhythmias and restoring sinus rhythm at 19 ± 6 years (range 9 to 29), 5.1 ± 6.0 years after implant; 3 patients had multiple appropriate ICD discharges. The individual risk marker algorithm was associated with 100% sensitivity in predicting SD events (95%CI: 69, 100) and 63% specificity for identifying patients without events (95%CI: 54, 71). Of these patients with device therapy, massive left ventricular hypertrophy (absolute wall thickness ≥30 mm) was the most common predictor, present in 70% of patients either alone or in combination with other risk markers. Each of the 146 study patients have survived to date at 22 ± 5 years, including all 86 without ICD recommendations. In conclusion, an enhanced ACC/AHA risk stratification strategy, based on established individual risk markers, was highly reliable in prospectively predicting SD events in children and adolescents with HC, and preventing arrhythmia-based catastrophes in this susceptible high risk population.


Assuntos
Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Antiarrítmicos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatia Hipertrófica/complicações , Criança , Morte Súbita Cardíaca/etiologia , Disopiramida/uso terapêutico , Feminino , Humanos , Masculino , Prevenção Primária , Medição de Risco , Síncope/epidemiologia , Taquicardia Ventricular/epidemiologia , Adulto Jovem
9.
J Cardiovasc Magn Reson ; 22(1): 48, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32580786

RESUMO

BACKGROUND: The left ventricular ejection fraction (LVEF) is the key selection criterion for an implanted cardioverter defibrillator (ICD) in primary prevention of sudden cardiac death. LVEF is usually assessed by two-dimensional echocardiography, but cardiovascular magnetic resonance (CMR) imaging is increasingly used. The aim of our study was to evaluate whether LVEF assessment using CMR imaging (CMR-LVEF) or two-dimensional echocardiography (2D echo-LVEF) may predict differently the occurrence of clinical outcomes. METHODS: In this retrospective study, we reviewed patients referred for primary prevention ICD implantation to Caen University Hospital from 2005 to 2014. We included 173 patients with either ischemic (n = 120) or dilated cardiomyopathy (n = 53) and who had undergone pre-ICD CMR imaging. The primary composite end point was the time to death from any cause or first appropriate device therapy. RESULTS: The mean CMR-LVEF was significantly lower than the mean 2D echo-LVEF (24% ± 6 vs 28% ± 6, respectively; p < 0.001). CMR-LVEF was a better independent predictive factor for the occurrence of the primary composite endpoint with a cut-off value of 22% (Hazard Ratio [HR] = 2.22; 95% CI [1.34-3.69]; p = 0.002) than 2D echo-LVEF with a cut-off value of 26% (HR = 1.61; 95% CI [0.99-2.61]; p = 0.056). Combination of the presence of scar with CMR-LVEF< 22% improved the predictive value for the occurrence of the primary outcome (HR = 2.58; 95% CI [1.54-4.30]; p < 0.001). The overall survival was higher among patients with CMR-LVEF≥22% than among patients with CMR-LVEF< 22% (p = 0.026), whereas 2D echo-LVEF was not associated with death. CONCLUSIONS: CMR-LVEF is better associated with clinical outcomes than 2D echo-LVEF in primary prevention using an ICD. Scar identification further improved the outcome prediction. The combination of CMR imaging and echocardiography should be encouraged in addition to other risk markers to better select patients.


Assuntos
Cardiomiopatias/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Ecocardiografia , Cardioversão Elétrica/instrumentação , Imagem Cinética por Ressonância Magnética , Prevenção Primária/instrumentação , Volume Sistólico , Função Ventricular Esquerda , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Yakugaku Zasshi ; 140(6): 819-825, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32475932

RESUMO

The quality of chest compression affects survival after sudden cardiac arrest, particularly when it occurs out of hospital. Pharmacy students should acquire basic life support skills as part of the model core curriculum of pharmacy education. Here, we trained first-year students at the Faculty of Pharmacy to deliver cardiopulmonary resuscitation and used a manikin with a real-time feedback device that quantified chest compression skills. Students were classified into shallow compressions (SC; <50 mm) and deep compressions (DC; ≥50 mm) groups based on the depth of chest compressions measured prior to training. After training, the mean compression depth (mm) was significantly shallower for the SC, than the DC group and many students in the SC group did not reach a depth of 50 mm. Similarly, students were classified into slow compression rate (SR; ≤120/min) and rapid compression rate (RR; >120/min) groups based on the results of training in the rate of chest compressions. Significant differences in mean compression rates were not found between the groups. However, correct compression rate (%), the percentage of maintaining 100-120 compression/min was significantly higher in the SR, than in the RR group. Chest compression rates correlated with compression depth, and chest compression tended to be too shallow in group that was too fast. The quality of chest compression might be improved by delivering chest compressions at a constant rate within the recommended range.


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/métodos , Educação em Farmácia/métodos , Avaliação Educacional/métodos , Escolaridade , Feedback Formativo , Estudantes de Farmácia , Currículo , Morte Súbita Cardíaca/prevenção & controle , Humanos , Manequins
11.
High Blood Press Cardiovasc Prev ; 27(4): 291-297, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32519207

RESUMO

The implantable cardioverter-defibrillator (ICD) is the most effective therapy to prevent sudden cardiac death (SCD) in high-risk patients. To overcome infections and failure of transvenous leads, the most frightening complications of conventional ICDs, a completely subcutaneous ICD (S-ICD) has been developed and is currently adopted in routine clinical practice. In view of their long life-expectancy, low competitive risk of dying from non-arrhythmic causes, and high lifetime risk of lead-related complications requiring surgical revisions, young patients with cardiomyopathies and inherited arrhythmia syndromes have traditionally been considered ideal candidates for the S-ICD. However, as growing evidence supported S-ICD safety and efficacy, initial niche implant indications were abandoned in favor of a widespread use of this technology, that is currently adopted in common ICD candidates with severe left ventricular dysfunction. Indeed, guidelines recommend S-ICD implantation as an alternative to TV-ICDs in all ICD candidates, unless pacing is required. This review focuses on the contemporary experience with the S-ICD and explores future scenarios in which device-to-device communication will enable to combine leadless therapies.


Assuntos
Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Humanos , Desenho de Prótese , Fatores de Risco , Resultado do Tratamento
12.
J Cardiovasc Transl Res ; 13(3): 339-344, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32562212

RESUMO

We present here three different clinical scenarios that illustrate the complexity of taking decisions in sports cardiology. Despite the availability of consensus documents, in clinical practice, decision-making process is most of the times in the grey zone.


Assuntos
Atletas , Cardiologia , Tomada de Decisão Clínica , Cardiopatias/diagnóstico , Medicina Esportiva , Adulto , Morte Súbita Cardíaca/prevenção & controle , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Futebol , Natação , Esportes Aquáticos , Adulto Jovem
13.
Mayo Clin Proc ; 95(6): 1213-1221, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-167897

RESUMO

As the coronavirus disease 19 (COVID-19) global pandemic rages across the globe, the race to prevent and treat this deadly disease has led to the "off-label" repurposing of drugs such as hydroxychloroquine and lopinavir/ritonavir, which have the potential for unwanted QT-interval prolongation and a risk of drug-induced sudden cardiac death. With the possibility that a considerable proportion of the world's population soon could receive COVID-19 pharmacotherapies with torsadogenic potential for therapy or postexposure prophylaxis, this document serves to help health care professionals mitigate the risk of drug-induced ventricular arrhythmias while minimizing risk of COVID-19 exposure to personnel and conserving the limited supply of personal protective equipment.


Assuntos
Morte Súbita Cardíaca , Hidroxicloroquina , Síndrome do QT Longo , Lopinavir , Risco Ajustado/métodos , Ritonavir , Torsades de Pointes , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Reposicionamento de Medicamentos/ética , Reposicionamento de Medicamentos/métodos , Eletrocardiografia/métodos , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/mortalidade , Síndrome do QT Longo/terapia , Lopinavir/administração & dosagem , Lopinavir/efeitos adversos , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Ritonavir/administração & dosagem , Ritonavir/efeitos adversos , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/mortalidade , Torsades de Pointes/terapia
14.
Mayo Clin Proc ; 95(6): 1213-1221, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32359771

RESUMO

As the coronavirus disease 19 (COVID-19) global pandemic rages across the globe, the race to prevent and treat this deadly disease has led to the "off-label" repurposing of drugs such as hydroxychloroquine and lopinavir/ritonavir, which have the potential for unwanted QT-interval prolongation and a risk of drug-induced sudden cardiac death. With the possibility that a considerable proportion of the world's population soon could receive COVID-19 pharmacotherapies with torsadogenic potential for therapy or postexposure prophylaxis, this document serves to help health care professionals mitigate the risk of drug-induced ventricular arrhythmias while minimizing risk of COVID-19 exposure to personnel and conserving the limited supply of personal protective equipment.


Assuntos
Morte Súbita Cardíaca , Hidroxicloroquina , Síndrome do QT Longo , Lopinavir , Risco Ajustado/métodos , Ritonavir , Torsades de Pointes , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Reposicionamento de Medicamentos/ética , Reposicionamento de Medicamentos/métodos , Eletrocardiografia/métodos , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/mortalidade , Síndrome do QT Longo/terapia , Lopinavir/administração & dosagem , Lopinavir/efeitos adversos , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Ritonavir/administração & dosagem , Ritonavir/efeitos adversos , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/mortalidade , Torsades de Pointes/terapia
15.
Int J Cardiol ; 316: 280-284, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32439366

RESUMO

BACKGROUND: Hydroxychloroquine and azithromycin combination therapy is often prescribed for coronavirus disease 2019 (COVID-19). Electrocardiographic (ECG) monitoring is warranted because both medications cause corrected QT-interval (QTc) prolongation. Whether QTc duration significantly varies during the day, potentially requiring multiple ECGs, remains to be established. METHODS: We performed 12­lead ECGs and 12­lead 24-h Holter ECG monitoring in all patients aged <80 years admitted to our medical unit for COVID-19, in oral therapy with hydroxychloroquine (200 mg, twice daily) and azithromycin (500 mg, once daily) for at least 3 days. A group of healthy individuals matched for age and sex served as control. RESULTS: Out of 126 patients, 22 (median age 64, 82% men) met the inclusion criteria. ECG after therapy showed longer QTc-interval than before therapy (450 vs 426 ms, p = .02). Four patients had a QTc ≥ 480 ms: they showed higher values of aspartate aminotransferase (52 vs 30 U/L, p = .03) and alanine aminotransferase (108 vs 33 U/L, p < .01) compared with those with QTc < 480 ms. At 24-h Holter ECG monitoring, 1 COVID-19 patient and no control had ≥1 run of non-sustained ventricular tachycardia (p = .4). No patients showed "R on T" premature ventricular beats. Analysis of 24-h QTc dynamics revealed that COVID-19 patients had higher QTc values than controls, with no significant hourly variability. CONCLUSION: Therapy with hydroxychloroquine and azithromycin prolongs QTc interval in patients with COVID-19, particularly in those with high levels of transaminases. Because QTc duration remains stable during the 24 h, multiple daily ECG are not recommendable.


Assuntos
Azitromicina , Infecções por Coronavirus/tratamento farmacológico , Eletrocardiografia/métodos , Hidroxicloroquina , Síndrome do QT Longo , Pandemias , Pneumonia Viral/tratamento farmacológico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Azitromicina/administração & dosagem , Azitromicina/efeitos adversos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Monitoramento de Medicamentos/métodos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/complicações , Síndrome do QT Longo/diagnóstico , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia
16.
J Cardiovasc Magn Reson ; 22(1): 32, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32389126

RESUMO

BACKGROUND: Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. METHODS: 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. RESULTS: Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. CONCLUSIONS: CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Imagem Cinética por Ressonância Magnética , Taquicardia Ventricular/terapia , Idoso , Ablação por Cateter , Tomada de Decisão Clínica , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevenção Primária , Prevenção Secundária , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
17.
Cardiovasc Pathol ; 47: 107221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32371340

RESUMO

Unexpected sudden cardiac death (SCD), sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD) are major unsolved, devastating forms of death that occur frequently. Obstructive sleep apnea (OSA) has been associated with increased cardiovascular and cerebrovascular morbidity and mortality, including sudden cardiac death (SCD). This editorial will review the pathology of SCD, including sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD); OSA with its cardiovascular consequences; the possible link between SCD and OSA, discussing the potential mechanisms underlying these two frequent, but yet overlooked pathologies. Finally, the possible preventive benefits of treating OSA and identifying patients at common risk for OSA and SCD and SIDS-SIUD to prevent unexpected deaths will be discussed. Post-mortem examination is of great importance in every case of SCD sine materia, with examination of the brainstem and cardiac conduction system on serial sections, when general autopsy fails, but it should be stressed that also the investigations of patients suffering from OSA should focus on the possibility of pathological findings in common with cases of SCD.


Assuntos
Tronco Encefálico/patologia , Morte Súbita Cardíaca/patologia , Morte Fetal/etiologia , Sistema de Condução Cardíaco/patologia , Apneia Obstrutiva do Sono/patologia , Morte Súbita do Lactente/patologia , Tronco Encefálico/imunologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Morte Fetal/prevenção & controle , Sistema de Condução Cardíaco/imunologia , Humanos , Lactente , Recém-Nascido , Mediadores da Inflamação/imunologia , Gravidez , Prognóstico , Fatores de Risco , Apneia Obstrutiva do Sono/imunologia , Apneia Obstrutiva do Sono/mortalidade , Apneia Obstrutiva do Sono/terapia , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/imunologia , Morte Súbita do Lactente/prevenção & controle
18.
Arch Cardiovasc Dis ; 113(5): 359-366, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32334981

RESUMO

The introduction of a new technology always raises questions about its place compared with the reference technology. The use of an implantable cardioverter defibrillator to prevent sudden cardiac death is now a widely proven technique, with a clear statement of its indication in the guidelines. More recently, a subcutaneous implantable cardioverter defibrillator has been introduced, and appears to be an attractive technique as it removes the need to implant a lead inside the right ventricle to treat the patient, which should dramatically decrease the risk of complications over time. Currently, only one model of subcutaneous implantable cardioverter defibrillator is available on the market; its indications are the same as for transvenous implantable cardioverter defibrillators, except for patients who need stimulation because of conduction disorders or ventricular tachycardias that can potentially be treated effectively by antitachycardia pacing. The different technical characteristics of transvenous versus subcutaneous implantable cardioverter defibrillators therefore raise the question of which to choose in different clinical settings. The experts who participated in the preparation of this manuscript had three meetings, organized by the company Boston Scientific. Each expert prepared the draft of a section corresponding to a clinical situation. The choice between transvenous versus subcutaneous implantable cardioverter defibrillator was then voted on by all the experts. The results of the votes are presented in this manuscript, as it seemed important to us to show the disparities of opinion that can exist in certain situations. The votes were cast independently and anonymously.


Assuntos
Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Prevenção Primária , Prevenção Secundária , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Tomada de Decisão Clínica , Consenso , Morte Súbita Cardíaca/epidemiologia , Humanos , Seleção de Pacientes , Fatores de Risco , Resultado do Tratamento
19.
Diab Vasc Dis Res ; 17(2): 1479164120911560, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32292066

RESUMO

INTRODUCTION: Patients with diabetes mellitus are known to carry an increased risk for surgical site infections and perioperative complications. The subcutaneous implantable cardioverter defibrillator is an established treatment option in patients at risk for sudden cardiac death especially with an increased risk for infection over time. METHODS AND RESULTS: Forty-eight patients (mean age = 55.0 ± 21.3 years, 31.3% patients with diabetes mellitus, 75% male) who underwent consecutive subcutaneous implantable cardioverter defibrillator surgery between February 2016 and May 2019 were retrospectively analysed. Overall adverse events including relevant bleeding complications, any surgical wound problems and infections requiring reoperation or device malfunction were evaluated as primary combined safety endpoint. Patients with diabetes mellitus tended to be older with a higher body mass index compared to non-diabetes mellitus. Procedure duration and postsurgery hospital days were not different in diabetes mellitus versus non-diabetes mellitus patients. Analysis of the primary combined endpoint showed no significant difference but a trend towards higher event rates in the diabetes mellitus group (diabetes mellitus vs non-diabetes mellitus: 20% vs 12.1%, p = 0.119). CONCLUSION: Diabetes mellitus is a frequent and relevant variable in patients undergoing subcutaneous implantable cardioverter defibrillator implantation represented by 31.3% in this consecutive cohort. Our results suggest that diabetes mellitus is not associated with a prolonged hospital stay or increased rate of periprocedural adverse events.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Diabetes Mellitus , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Hemorragia Pós-Operatória/etiologia , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Adulto , Idoso , Diabetes Mellitus/diagnóstico , Feminino , Alemanha , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/terapia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
J Cardiovasc Transl Res ; 13(3): 284-295, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32270467

RESUMO

Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete's heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachycardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhythmias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar.


Assuntos
Arritmias Cardíacas/etiologia , Atletas , Morte Súbita Cardíaca/etiologia , Miocardite/complicações , Resistência Física , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Nível de Saúde , Humanos , Miocardite/mortalidade , Miocardite/fisiopatologia , Miocardite/terapia , Prognóstico , Medição de Risco , Fatores de Risco
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