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1.
J Cardiothorac Surg ; 14(1): 198, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727114

RESUMO

BACKGROUND AND AIM OF THE STUDY: Atrial fibrillation (AF) is the most common atrial arrhythmia. Our aim was to compare the outcomes of atrial fibrillation treatment with original modified minimally invasive MAZE using monopolar radiofrequency ablation (mi-MAZE) and open surgery MAZE using bipolar radiofrequency ablation (os-MAZE). METHODS: We searched the associated patients' information on the medical record system of the First Affiliated Hospital, School of Medicine, Zhejiang University. Statistical Package for Social Sciences (SPSS) was used to analyse the data. The primary outcome is the atrial fibrillation ablation rate 3 months, 6 months, 12 months after operation. And secondary outcome is the postoperative quality of life. RESULTS: The mi-MAZE group included 42 patients and the os-MAZE group had 65 patients. Three months after surgery, we found that 31 patients (77.5%) in the mi-MAZE group were sinus rhythm and 44 (71.0%) recovered sinus rhythm in the os-MAZE group. We followed up these patients on the phone or in person and scored them on the SF-36 scale. The results were found to be 120.2 ± 8.10 vs 110.6 ± 6.58 (mi-MAZE vs os-MAZE, P < 0.001). CONCLUSIONS: There was no significant difference of atrial fibrillation ablation rate (sinus rhythm recovery rate) between the mi-MAZE group and the os-MAZE group. The postoperative quality of life in mi-MAZE group was higher than that in os-MAZE group.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
3.
Undersea Hyperb Med ; 46(4): 421-427, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509898

RESUMO

Introduction: About 26% of diving-related fatalities are caused by cardiac disease, part of which might be associated with fatal arrhythmias. This raises the question as to whether fatal arrhythmias are being provoked by hyperbaric conditions themselves or if exercise or stress provokes the fatal arrhythmias in cases of underlying (ischemic) cardiac disease. Objective: To measure the influence of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers by means of ECG. Methods: This is a prospective study on military divers in a hyperbaric chamber with continuous ECG monitoring using Holter registrations. Supraventricular and ventricular ectopy was registered during hyperbaric conditions. RR, PR, QRS, QT and QTc intervals were calculated at 50 msw and compared with ECGs at rest. Results: Included were 17 male military divers who made 20 dives. A total of 10 PVCs, 45 PACs, four atrial runs and four atrial pairs were seen. Significant prolongation of the PR interval was seen and a decrease of in QRS duration at 50 msw. There was no significant change in the RR, QT and QTc intervals. Conclusion: In these divers, no clinically relevant arrhythmias were observed during wet dives in a recompression chamber at 50 msw. We observed a small prolongation of PR interval that is probably not clinically relevant in divers without any known conduction disorders.


Assuntos
Arritmias Cardíacas/diagnóstico , Mergulho/efeitos adversos , Pressão/efeitos adversos , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Descompressão , Mergulho/fisiologia , Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia Ambulatorial/métodos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Estudos Prospectivos , Água do Mar , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia
4.
Orv Hetil ; 160(37): 1447-1454, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31495190

RESUMO

Myotonic dystrophy is one of the most common, autosomal dominantly inherited adult-onset muscle disorders. Two types of the disease are known: type 1 is characterized by distal weakness and myotonia, but type 2 is associated with proximal weakness and milder clinical course. It is also called as Steinert Disease, which affects the heart conduction system, the internal secretional glands, the ocular lens as well as carbohydrate-, fat metabolism and gonadal functions. These systemic symptoms have high impact on the quality of life and might impact on patients' survival. Here we would like to emphasize these clinical conditions and the diagnostic possibilities. We hope our recommendations can help neurologists and general practitioners to achieve an optimal and individual care for patients suffering from this muscle disease. Orv Hetil. 2019; 160(37): 1447-1454.


Assuntos
Sistema de Condução Cardíaco/fisiopatologia , Distrofia Miotônica/diagnóstico , Adulto , Catarata/genética , Humanos , Resistência à Insulina/genética , Músculos/fisiopatologia , Distrofia Miotônica/complicações , Distrofia Miotônica/genética , Doenças do Sistema Nervoso , Qualidade de Vida , Expansão das Repetições de Trinucleotídeos
5.
BMJ Case Rep ; 12(8)2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31387863

RESUMO

The pathophysiology of narrow complex dilated cardiomyopathy is not defined, so therapeutic options are limited. By utilising the velocity equation, the pathophysiology of narrow complex cardiomyopathy allows above normal conduction propagation velocities. There are two pathophysiological theories that allow above normal conduction velocities and failure to capture the myocardium: (1)insulating fibres of the conduction system extending beyond the apex and (2) reduction of axon branching. A patient with narrow complex cardiomyopathy was subjected to graded increase in amplitude and pulse width pacing to overcome the failure of native conduction to capture the myocardium. Peak systolic strain maps demonstrated a progressive increase in apical contractility with increasing pulse width and amplitude. Ejection fraction improved from 17% to 31%. Understanding the pathophysiology of narrow complex cardiomyopathy leads to proposed therapies. One potential pacing therapy is multi-lead pacing at high amplitude and pulse width to capture myocardial cells not captured by native conduction.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Idoso , Estimulação Cardíaca Artificial/métodos , Cardiomiopatia Dilatada/terapia , Desfibriladores Implantáveis , Feminino , Insuficiência Cardíaca/etiologia , Frequência Cardíaca , Humanos
6.
J Card Surg ; 34(10): 1037-1043, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31374587

RESUMO

BACKGROUND: Endocardial catheter ablation has been shown to be effective in patients with paroxysmal atrial fibrillation (AF), and significantly less effective in patients with persistent AF (PAF). Lately, there is a trend toward a hybrid approach in the treatment of PAF that may be a more durable treatment for patients with PAF. In this manuscript we report our experience with the convergent ablation procedure in a PAF cohort. METHODS: This is a single center retrospective analysis of 31 patients with PAF who underwent the convergent procedure. All patients underwent surgical epicardial ablation of the posterior left atrial through a subxiphoid approach, followed by radiofrequency endocardial ablations on the same day. Patients were followed at 6 months intervals with static electrocardiograms or implanted devices. RESULTS: Sinus rhythm was achieved intraoperatively in all patients. Recurrence was defined according to Hearlt Rhythm Society definitions. At a median follow up of 17.7 months (IQR 11-24), the recurrence of atrial tachyarrhythmia (AF and atrial flutter) by Kaplan-Meier event free survival analysis occurred in 9 (29%) patients at 1-year follow up and 15 (48%) patients at 2-year follow up with or without the use of antiarrhythmic drugs. Recurrence of AF alone occurred in 4 (13%) patients at 1-year follow up and 9 (29%) patients at 2-year follow up patients. Complication rate in perioperative period was 12.9%. CONCLUSION: Our experience showed the hybrid procedure is a relatively safe and effective option for patients with PAF. Further studies are needed to better determine its long-term outcomes.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Idoso , Fibrilação Atrial/fisiopatologia , Intervalo Livre de Doença , Endocárdio/cirurgia , Feminino , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 28(11): 104308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416760

RESUMO

Stroke involving some areas of the cerebral hemisphere, such as insula, amygdala, and lateral hypothalamus, may cause changes in autonomic control of cardiac function. A 58-year-old woman presented to the emergency department for acute onset of left facial-brachial-crural hemiparesis and dysarthria. A brain CT scan showed subacute ischemic lesion with hemorrhagic infarction in right insular-rolandic cortex. Over the next few days ECG showed severe bradycardia with elongation of QTc, significative pauses (5 seconds), runs of nonsustained ventricular tachycardia and torsades de pointes. Drug induced and other several possible causes of elongation of QT and bradycardia such as hypokalemia, a history of heart failure, and structural heart disease were ruled out. The case confirms that insular cortex plays a major role in stroke-induced cardiovascular changes.


Assuntos
Córtex Cerebral/irrigação sanguínea , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Síndrome do QT Longo/etiologia , Acidente Vascular Cerebral/complicações , Torsades de Pointes/etiologia , Potenciais de Ação , Bradicardia/etiologia , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/terapia , Pessoa de Meia-Idade , Marca-Passo Artificial , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia , Resultado do Tratamento
8.
Clin Cardiol ; 42(10): 1041-1050, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31411347

RESUMO

Despite the technical improvements made in recent years, the overall long-term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re-entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Isquemia Miocárdica/complicações , Taquicardia Ventricular/diagnóstico , Humanos , Isquemia Miocárdica/diagnóstico , Prognóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia
9.
Interv Cardiol Clin ; 8(4): 403-409, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31445724

RESUMO

Conduction disturbances following TAVR are a common occurrence given the proximity of the various conduction system tissues, including the AV node, His-bundle, and bundle branches to the left ventricular outflow tract and aortic root. Impairment of these conduction system abnormalities may necessitate permanent pacemaker implantation, which increases morbidity and mortality, as well as length of stay, for the patient. The incidence, mechanisms, and predictors of conduction abnormalities and treatment options are discussed in this up-to-date review of the topic.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Eletrocardiografia , Sistema de Condução Cardíaco/lesões , Traumatismos Cardíacos/fisiopatologia , Complicações Intraoperatórias , Substituição da Valva Aórtica Transcateter/efeitos adversos , Sistema de Condução Cardíaco/fisiopatologia , Traumatismos Cardíacos/etiologia , Humanos
10.
Clin Cardiol ; 42(10): 966-973, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407347

RESUMO

BACKGROUND: The utility of an ultra-high-resolution electroanatomical mapping system (UHR-EAM, Rhythmia) for repeat atrial fibrillation (AF) ablation has not been evaluated. HYPOTHESIS: A second AF ablation procedure performed using UHR-EAM may demonstrate different outcomes compared with that using a conventional electroanatomical mapping system (C-EAM, CARTO3). METHOD: This observational study enrolled consecutive patients who underwent a second AF ablation procedure using UHR-EAM (n = 103) and C-EAM (n = 153). The second ablation procedure included re-isolation of reconnected pulmonary veins (PVs) and elimination of clinical or induced non-PV AF triggers and atrial tachycardia (AT). Other empirical ablations were additionally conducted at the discretion of the operators. RESULTS: Re-isolation of PVs was achieved in 196 patients who had ≥1 left atrial-PV reconnection. The elimination rate of AT was higher in the UHR-EAM group than the C-EAM group (87% vs 65%, P = .040), while that of non-PV AF triggers was similar (63% vs 63%, P = 1.00). The UHR-EAM demonstrated shorter radiofrequency application time (21.8 ± 16.8 vs 28.0 ± 21.3 minutes, P = .017), but longer fluoroscopic time (26.2 ± 12.6 vs 21.4 ± 9.3 minutes, P = .0001). No severe complication developed. The total 1-year AF/AT-free survival rates were similar between the two groups (off AADs, 59.2% vs 56.2%, P = .62; on AADs, 65.0% vs 69.3%, P = .49). CONCLUSION: The efficacy and safety outcomes of repeat AF ablation using UHR-EAM was comparable to those using C-EAM.


Assuntos
Fibrilação Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/instrumentação , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Aumento da Imagem/métodos , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Reoperação , Estudos Retrospectivos
11.
Cardiol Young ; 29(9): 1196-1201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31451125

RESUMO

BACKGROUND: In this study, we applied ultra-short time series of interbeat intervals (RR-intervals) to evaluate heart rate variability through default chaotic global techniques with the purpose of discriminating obese youths from non-obese youth patients. METHOD: Chaotic global analysis of the RR-intervals from the electrocardiogram and pre-processing adjustments was undertaken. The effect of cubic spline interpolations was assessed, while the spectral parameters remained fixed. Exactly, 125 RR-intervals of data were recorded. RESULTS: CFP1, CFP3, and CFP6 were the only significant combinations of chaotic globals when the standard conditions were enforced and at the level p<0.01 (or <1%). These significances were acheived via Kruskal-Wallis and Cohen's ds effects sizes tests of significance after Anderson-Darling and Lilliefors statistical tests indicated non-normal distributions in the majority of cases. Adjustments of the cubic spline interpolation from 1 to 13 Hz were revealed to be inconsequential when measured by Kruskal-Wallis and Cohen's ds, regarding the outcome between the two datasets. CONCLUSION: Chaotic global analysis was offered as a robust technique to distinguish autonomic dysfunction in obese youths. It can discriminate the two different groups using ultra-short data lengths, and no cubic spline interpolations need be applied.


Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Sistema Nervoso Autônomo/fisiopatologia , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/fisiologia , Obesidade/fisiopatologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Feminino , Humanos , Masculino , Obesidade/complicações , Adulto Jovem
12.
Medicina (B Aires) ; 79(3): 197-200, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284254

RESUMO

Functional bundle branch block during a supraventricular tachycardia can be observed with shorter cycle lengths and represent a physiologic response by the specialized intraventricular conduction system to accelerated AV nodal conduction. The present case corresponds to a young patient with exercise induced orthodromic A-V reentrant tachycardia and alternating bundle branch block. This unusual response is explained by the finding obtained during the electrophysiology study. An accelerated AV nodal conduction made the depolarizing wave front reach the bundle branches during their refractory period. Once block in one bundle was stablished, block persisted due to the linking phenomenon that is repetitive retrograde concealed conduction from the contralateral bundle. After catheter ablation of a concealed left-sided accessory A-V pathway, rapid atrial pacing at the same cycle length of the tachycardia reproduced the same aberrancies observed during tachycardia. This response proved that functional bundle branch block is due to the short cycle length and not the presence of an accessory A-V pathway.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Taquicardia Supraventricular/diagnóstico por imagem , Adolescente , Bloqueio de Ramo/etiologia , Ablação por Cateter , Eletrocardiografia , Eletrofisiologia , Sistema de Condução Cardíaco/diagnóstico por imagem , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Taquicardia Supraventricular/complicações
13.
Scand J Med Sci Sports ; 29(11): 1727-1735, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31302929

RESUMO

Some forms of early ECG repolarization QRS pattern (ERp) with J-point elevation of 0.1 mV in two contiguous inferior and/or lateral leads with or without ST-elevation are potentially associated with a higher arrhythmic risk in adults. We assessed the prevalence of ERp among non-professional adolescent athletes and correlated it with age, sex, ethnicity, and structural and electric cardiac parameters. We retrospectively analyzed 414 ECGs obtained from young athletes referred to our center from 2006 to 2017. We found ERp in 22% of cases. In the ERp group, we found a greater percentage of black athletes, a higher systolic blood pressure, and lower heart rate (HR) compared with the group without ERp. This pattern was less frequent in female athletes. In athletes with ERp, the occurrence of ventricular ectopic beats was less frequent and QRS-duration was shorter. They also exhibited greater (a) ECG-based left ventricular hypertrophy (LVH), (b) left ventricular mass, and (c) relative wall thickness (RWT), suggesting a tendency to concentric geometry. At logistic regression analysis, we found that HR (OR 0.98 [0.96-0.99] P = .013), QRS-duration (OR 0.96 [0.94-0.99], P = .003), LVH (OR 1.09 [1.05-1.12], P < .001), and RWT (OR 1.08 [1.01-1.16] P = .032) were significant predictors of ERp incidence. ERp is quite common in adolescent athletes and correlates with concentric LV remodeling. Specific clinical and ECG-findings related to training such as lower HR, LVH, and QRS-duration are also predictors of ERp. In adolescent non-professional athletes, ERp is a benign finding associated with some structural and electric cardiac modifications induced by training.


Assuntos
Doenças Cardiovasculares/diagnóstico , Ecocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Adolescente , Grupo com Ancestrais do Continente Africano , Atletas , Criança , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos
14.
Anesth Analg ; 129(1): 63-72, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31210652

RESUMO

BACKGROUND: Bupivacaine cardiotoxicity mainly manifests as inhibition of the cardiac sodium channel, which slows conduction, particularly at the ventricular level. Experimental studies have demonstrated that intravenous lipid emulsions (ILEs) can reduce the cardiotoxic effects of bupivacaine, but the extent of these effects is controversial. Sodium bicarbonate (B) represents the standard treatment of toxicity related to sodium channel-blocking drugs. The aim of this study was to compare the effects of ILEs and B on the speed of recovery from bupivacaine-induced effects on the electrocardiographic parameters. METHODS: Bupivacaine 4 mg/kg was administered to 24 anesthetized pigs. Three minutes after delivering the bupivacaine bolus, the animals were given the following: ILE 1.5 mL/kg followed by 0.25 mL/kg/min (ILE group) and B 2 mEq/kg followed by 1 mEq/kg/h (B group). Controls (C group) were given saline solution, 50 mL followed by 1 mL/kg/h. Electrophysiological parameters were evaluated in sinus rhythm and during right ventricular pacing at several time intervals up to 30 minutes. Data were analyzed as the area under the curve (AUC) for the first 10 minutes (AUC10) or 30 minutes (AUC30). RESULTS: Bupivacaine increased the sinus cycle length, PR interval, and QRS duration. AUC30 of the sinus rhythm QRS duration after antidote administration was significantly different among the 3 groups (P = .003). B group experienced faster recovery from intoxication than the C group (AUC10, P = .003; AUC30, P = .003) or the ILE group (AUC10, P = .018). During the first minute, 50% of the B group (versus 0% of the ILE and C groups) had recovered >30% of QRS duration (P = .011). The trend toward faster recovery in the ILE group than in the C group did not reach significance (AUC10, P = .23; AUC30, P = .06). Effects on the paced QRS duration at a rate of 150 bpm were more intense but with similar results (B versus C group: AUC10, P = .009; AUC30, P = .009; B versus ILE: AUC10, P = .015; AUC30, P = .024). The recovery process of the paced QRS tended to be slower for all antidotes. CONCLUSIONS: In a closed-chest swine model, B was an effective treatment for electrophysiological alterations caused by established bupivacaine toxicity. At clinical doses, B ameliorated bupivacaine electrocardiographic toxicity faster than ILE. Use-dependent effects of bupivacaine are prominent and delay the effects of both antidotes, but B produces faster recovery than ILE.


Assuntos
Anestésicos Locais , Antídotos/administração & dosagem , Arritmias Cardíacas/tratamento farmacológico , Bupivacaína , Emulsões Gordurosas Intravenosas/administração & dosagem , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Bicarbonato de Sódio/administração & dosagem , Potenciais de Ação/efeitos dos fármacos , Animais , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/fisiopatologia , Cardiotoxicidade , Modelos Animais de Doenças , Sistema de Condução Cardíaco/fisiopatologia , Recuperação de Função Fisiológica , Sus scrofa , Fatores de Tempo
15.
Cardiol Young ; 29(6): 744-748, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31198127

RESUMO

OBJECTIVES: First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility. DESIGN: Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed. RESULTS: A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG. CONCLUSIONS: This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.


Assuntos
Bloqueio Atrioventricular/etiologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Febre Reumática/diagnóstico , Adolescente , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Febre Reumática/complicações
16.
Cardiol Young ; 29(6): 793-799, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169097

RESUMO

INTRODUCTION: Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group. METHODS: A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients. RESULTS: The mean patient age was 12.7 years (range 2-16), and the mean patient weight was 51 kg (range 11-84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen. CONCLUSIONS: Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Fluoroscopia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Cirurgia Assistida por Computador/métodos , Taquicardia Ventricular/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Imagem Tridimensional , Masculino , Recidiva , Estudos Retrospectivos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento
17.
Int J Chron Obstruct Pulmon Dis ; 14: 1053-1061, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190790

RESUMO

Objectives: COPD is the fourth-leading cause of mortality worldwide. Prolonged QTc has been found to be a long-term negative prognostic factor in ambulatory COPD patients. The aim of this study was to evaluate the extent of prolonged-QTc syndrome in COPD patients upon admission to an internal medicine department, its relationship to hypomagnesemia, hypokalemia, and hypocalcemia, and the effect of COPD treatment on mortality during hospital stay. Methods: This prospective cohort study evaluated COPD patients hospitalized in an internal medicine department. The study evaluated QTc, electrolyte levels, and known risk factors during hospitalization of COPD patients. Results: A total of 67 patients were recruited. The median QTc interval was 0.441 seconds and 0.434 seconds on days 0 and 3, respectively. Prolonged QTc was noted in 35.8% of patients on admission and 37.3% on day 3 of hospitalization. The median QTc in the prolonged-QTc group on admission was 0.471 seconds and in the normal-QTc group 0.430 seconds. There was no significant difference in age, sex, electrolyte levels, renal function tests, or blood gases on admission between the two groups. Mortality during the hospital stay was significantly higher in the prolonged-QTc group (3 deaths, 12%) than in the normal QTc group (no deaths) (P=0.04). A subanalysis was performed, removing known causes for prolonged QTc. We found no differences in age, electrolytes, or renal functions. There was a small but significant difference in bicarbonate levels. Conclusion: Our findings demonstrated that there was no correlation between QTc prolongation in hospitalized COPD patients and electrolyte levels, comorbidities, or relevant medications. A higher rate of mortality was noted in patients with prolonged QTc in comparison to normal QTc. As such, it is suggested that prolonged QTc could serve as a negative prognostic factor for mortality during hospitalization in COPD patients.


Assuntos
Hospitalização , Síndrome do QT Longo/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Desequilíbrio Hidroeletrolítico/mortalidade , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Cálcio/sangue , Causas de Morte , Progressão da Doença , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Mortalidade Hospitalar , Humanos , Hipocalcemia/sangue , Hipocalcemia/mortalidade , Hipopotassemia/sangue , Hipopotassemia/mortalidade , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/diagnóstico
18.
Heart Vessels ; 34(12): 2052-2058, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31114962

RESUMO

The superior vena cava (SVC) is a main source of non-pulmonary vein (PV) ectopies that initiate atrial fibrillation (AF). Although the critical role of structural remodeling of the left atrium (LA) in the occurrence of AF was extensively investigated by atrial voltage mapping, that of PVs and the SVC has been less explored. Study subjects comprised 47 patients undergoing catheter ablation of lone AF. During sinus rhythm, PV, SVC, and atrial voltage maps were acquired, and sleeve length of each PV and SVC was determined by an electroanatomical mapping system. The sleeves of the superior PVs were significantly longer than those of the inferior PVs (left superior PV (LSPV): 21 ± 5, left inferior PV: 14 ± 4, right superior PV (RSPV): 19 ± 5, right inferior PV: 15 ± 5, and SVC: 23 ± 10 mm, p < 0.0001). The LSPV sleeve was longer in men than in women (22 ± 6 vs. 19 ± 4 mm, p < 0.05). The sleeve length in the LSPV correlated positively with the body surface area (BSA) (p = 0.003, R = 0.42). Of note, there was a significant correlation in sleeve length between the RSPV and SVC (p < 0.0001, R = 0.64). In conclusion, not right- but left-sided PV sleeves were associated with the BSA of the patients, whereas a structural relation between the right-sided PVs and the SVC was implied based on sleeve mapping. This novel finding may provide mechanistic implications for the development of AF in future studies.


Assuntos
Fibrilação Atrial/diagnóstico , Ablação por Cateter/métodos , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagem , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , Feminino , Humanos , Masculino , Prognóstico , Recidiva
19.
Clin Cardiol ; 42(6): 644-652, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31038759

RESUMO

The cardiac autonomic nerve system (CANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF). In this review, we focus on the relationship between the autonomic nervous system (ANS) and the pathophysiology of AF and the potential benefit and limitations of neuromodulation in the management of this arrhythmia from eight aspects. We conclude that Activation and Remodeling of CANS involved in the initiation and maintenance of AF. The network control mechanism, innervation regions, and sympathetic/parasympathetic balance play an important role in AF substrate. And the formation of Complex Fractional Atrial Electrograms also related to CANS activity. In addition, modulating CANS function by potential therapeutic applications include ganglionated plexus ablation, renal sympathetic denervation, and low-level vagal nerve stimulation, may enable AF to be controlled. Although the role of the ANS has long been recognized, a better understanding of the complex interrelationships of the various components of the CANS will lead to improvement of treatments for this common arrhythmia.


Assuntos
Fibrilação Atrial/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Ablação por Cateter/métodos , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Sistema Nervoso Autônomo/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco/cirurgia , Humanos
20.
Card Electrophysiol Clin ; 11(2): 261-281, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31084850

RESUMO

Sinus node dysfunction or atrioventricular blocks are the causes of bradycardias. Diagnosis and management begin with evaluation of patient's hemodynamic status and diagnosis of bradycardia's cause. This is followed by an in depth evaluation of pathophysiology of the arrhythmia, its severity, and likelihood of progression. Implementing emergent measures depends on the presence of subsidiary pace makers maintaining cardiac output. Many of these decisions are greatly helped by 12 lead electrocardiogram, because its tracings are often diagnostic of the cause of the bradycardia and help to assess its persistence and progression and to evaluate the presence and reliability of subsidiary pacemakers.


Assuntos
Bradicardia , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Eletrocardiografia , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos
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