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1.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518188

RESUMO

A 48-year-old man presented to the emergency department (ED) with exertional chest pressure associated with palpitations and lightheadedness. He was found to have non-sustained ventricular tachycardia (NSVT) in the ED, which resolved spontaneously. Given his history of hyperlipidaemia, unknown family history due to being adopted and episode of NSVT in the ED, he underwent cardiac catheterisation, which showed non-obstructive coronary artery disease and distal left anterior descending artery myocardial bridge (MB). The patient subsequently underwent ECG treadmill stress test with reproduction of chest pressure and NSVT. The patient was referred to cardiac surgery for definitive management of symptomatic MB and underwent resection of MB.


Assuntos
Doença da Artéria Coronariana , Taquicardia Ventricular , Artérias , Cateterismo Cardíaco , Teste de Esforço , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia
3.
Prog Cardiovasc Dis ; 66: 70-79, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34332662

RESUMO

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


Assuntos
Antiarrítmicos/uso terapêutico , Denervação Autônoma , Estimulação Cardíaca Artificial , Ablação por Cateter , Oxigenação por Membrana Extracorpórea , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Potenciais de Ação/efeitos dos fármacos , Antiarrítmicos/efeitos adversos , Denervação Autônoma/efeitos adversos , Denervação Autônoma/mortalidade , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/mortalidade , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Sistema de Condução Cardíaco/efeitos dos fármacos , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Marca-Passo Artificial , Recidiva , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia
4.
S D Med ; 74(7): 314-317, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34449993

RESUMO

Arrhythmogenic right ventricular cardiomyopathy is a predominantly inherited structural disease with a heterogeneous set of implicated genetic defects. For those patients not identified by targeted population screening programs, ventricular tachycardia can be their first presentation. We report a case of a female from the genetically isolated Hutterite colonies who presented with recurrent ventricular tachycardia. She was found to be homozygous for a truncated desmocollin-2 gene, with both severe right ventricular dysfunction and left ventricular involvement. Her medical management was complicated by the finding of concomitant pre-term pregnancy. Management options for arrhythmia suppression and treatment are reviewed taking into account her decompensated biventricular dysfunction and possible fetal effects.


Assuntos
Displasia Arritmogênica Ventricular Direita , Taquicardia Ventricular , Arritmias Cardíacas , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/genética , Feminino , Humanos , Período Periparto , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia
5.
Herzschrittmacherther Elektrophysiol ; 32(3): 389-390, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34235571

RESUMO

A 65-year-old patient received an implantable cardioverter-defibrillator shock that resulted in ventricular tachycardia termination but induction of atrial fibrillation. The possible consequences of this rarely reported event are discussed.


Assuntos
Fibrilação Atrial , Desfibriladores Implantáveis , Taquicardia Ventricular , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Desfibriladores Implantáveis/efeitos adversos , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/prevenção & controle
6.
Herzschrittmacherther Elektrophysiol ; 32(3): 353-358, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34269843

RESUMO

INTRODUCTION: Ablation of ventricular tachycardias (VTs) in patients with structural heart disease (SHD) has been associated with advanced heart failure and poor survival. METHODS AND RESULTS: This matched case-control study sought to assess the difference in survival after left ventricular assist device (LVAD) implantation and/or heart transplantation (HTX) in SHD patients undergoing VT ablation. From the initial cohort of 309 SHD patients undergoing VT ablation (187 ischemic cardiomyopathy, mean age 64 ± 12 years, ejection fraction of 34 ± 13%), 15 patients received an LVAD and nine patients HTX after VT ablation during a follow-up period of 44 ± 33 months. Long-term survival after LVAD did not differ from the matched control group (p = 0.761), although the cause of lethal events was different. All post-HTX patients survived during follow-up. CONCLUSION: In this matched case-control study on patients with SHD undergoing VT ablation, patients that received LVAD implantation had similar survival compared to the control group after 4­year follow-up, while the patients with HTX had a significantly better outcome.


Assuntos
Ablação por Cateter , Cardiopatias , Transplante de Coração , Taquicardia Ventricular , Idoso , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirurgia , Resultado do Tratamento
7.
Herzschrittmacherther Elektrophysiol ; 32(3): 383-388, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34279723

RESUMO

We report on a 67-year-old female patient with recurrent syncope induced by asystole and polymorphic ventricular tachycardia without relevant structural heart disease. After secondary prophylactic ICD implantation, beta-blocker and flecainide therapy, the patient suffered from recurrent syncope and ICD shocks due to ventricular fibrillation. A rare cause of polymorphic ventricular tachycardia in patients without structural heart disease was found and successfully treated.


Assuntos
Parada Cardíaca , Taquicardia Ventricular , Idoso , Morte Súbita Cardíaca , Eletrocardiografia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Humanos , Síncope/diagnóstico , Síncope/etiologia , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia
8.
Herzschrittmacherther Elektrophysiol ; 32(3): 308-314, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34185133

RESUMO

The autonomic nervous system (ANS) is an essential component of arrhythmogenicity, especially in the absence of structural heart disease and channelopathy. In this article, the authors review the role and characteristics of ANS in various channelopathies. Some of these, such as most long QT syndromes and catecholaminergic polymorphic ventricular tachycardia, are highly dependent on sympathetic activation, while parasympathetic tone is an important factor for arrhythmias in other channelopathies such as Brugada syndrome or early repolarisation syndrome. Recent advances highlighting the subtle role of ANS in channelopathies are presented here, demonstrating that all is far from being so simple and straightforward and revealing some paradoxical behaviours of channelopathies in relation to discrete ANS imbalance.


Assuntos
Síndrome de Brugada , Canalopatias , Síndrome do QT Longo , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/genética , Sistema Nervoso Autônomo , Canalopatias/genética , Morte Súbita Cardíaca , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/genética
9.
Cardiol Young ; 31(8): 1330-1332, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34162453

RESUMO

This image highlights a 38-year-old female with ventricular fibrillation and spontaneous return to sinus rhythm found on an implantable loop recorder inserted for recurrent syncope. Ultimately, she was diagnosed with catecholaminergic polymorphic ventricular tachycardia, a rare inherited arrhythmia disorder.


Assuntos
Taquicardia Ventricular , Fibrilação Ventricular , Adulto , Bradicardia , Feminino , Humanos , Síncope/diagnóstico , Síncope/etiologia , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico
10.
Methodist Debakey Cardiovasc J ; 17(1): 13-18, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104315

RESUMO

Catheter ablation is an effective treatment method for ventricular arrhythmias (VAs). These arrhythmias can often be mapped and targeted with ablation from the left and right ventricular endocardium. However, in some situations the VA site of origin or substrate may be intramural or epicardial in nature. In these cases, the coronary venous system (CVS) provides an effective vantage point for mapping and ablation. This review highlights situations in which CVS mapping may be helpful and discusses techniques for CVS mapping and ablation.


Assuntos
Ablação por Cateter , Vasos Coronários/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Flebografia , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
11.
Methodist Debakey Cardiovasc J ; 17(1): 24-35, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104317

RESUMO

Ventricular arrhythmias are potentially life-threatening disorders that are commonly treated with medications, catheter ablation and implantable cardioverter defibrillator (ICD). Adult patients who continue to be symptomatic, with frequent ventricular arrhythmia cardiac events or defibrillation from ICD despite medical treatment, are a challenging subgroup to manage. Surgical cardiac sympathetic denervation has emerged as a possible treatment option for people refractory to less invasive medical options. Recent treatment guidelines have recommendedcardiac sympathectomy for ventricular tachycardia (VT) or VT/fibrillation storm refractory to antiarrhythmic medications, long QT syndrome, and catecholaminergic polymorphic VT, with much of the data pertaining to pediatric literature. However, for the adult population, the disease indications, complications, and risks of cardiac sympathectomy are less understood, as are the most effective surgical cardiac denervation techniques for this patient demographic. This systematic review navigates available literature evaluating surgical denervation disease state indications, techniques, and sympathectomy risks for medically refractory ventricular arrhythmia in the adult patient population.


Assuntos
Frequência Cardíaca , Coração/inervação , Simpatectomia , Sistema Nervoso Simpático/cirurgia , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Humanos , Complicações Pós-Operatórias/etiologia , Recidiva , Medição de Risco , Fatores de Risco , Simpatectomia/efeitos adversos , Sistema Nervoso Simpático/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
12.
Methodist Debakey Cardiovasc J ; 17(1): 36-42, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104318

RESUMO

The treatment of drug-refractory chronic ventricular tachycardia (VT) has undergone a revolution over the last 50 years. We now have automatic implantable cardioverter defibrillator therapy with pace-terminating capabilities, and catheter ablation of VT has refined mapping and improved methods of lesion generation. Between 1980 and 1993, Houston Methodist Hospital became a leader in the diagnosis and surgical ablation of VT and other arrhythmias. This is a brief account of that period and some of the experiences and lessons that have led to significant advances used today.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Potenciais de Ação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/história , Difusão de Inovações , Técnicas Eletrofisiológicas Cardíacas , História do Século XX , História do Século XXI , Humanos , Complicações Pós-Operatórias/etiologia , Recidiva , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/história , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
13.
Methodist Debakey Cardiovasc J ; 17(1): 65-67, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104323

RESUMO

Loperamide, a µ-opioid receptor agonist, can cause cardiotoxicity by inhibiting the potassium ion channel and slowing cardiomyocyte repolarization. This, in turn, can lead to frequent early afterdepolarizations, the most common mechanism of drug-induced long QT syndrome and torsades de pointes. Apical hypertrophic cardiomyopathy (AHCM) is a nonobstructive hypertrophic cardiomyopathy rarely associated with malignant arrhythmias. We present a case of loperamide-induced malignant ventricular arrhythmia revealing underlying AHCM in a 25-year-old woman with a history of sudden cardiac arrest (SCA) and opioid use. It is important to evaluate for structural heart disease in all patients presenting with SCA, regardless of presumed etiology such as drug-induced cardiotoxicity, to prevent missed opportunities for adequate treatment. Furthermore, the diagnosis of AHCM in SCA warrants further genetic evaluation for variances with a predilection for malignant arrhythmias.


Assuntos
Antidiarreicos/efeitos adversos , Cardiomiopatia Hipertrófica/genética , Canal de Potássio Kv1.5/genética , Loperamida/efeitos adversos , Mutação , Transtornos Relacionados ao Uso de Opioides/complicações , Taquicardia Ventricular/etiologia , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiotoxicidade , Análise Mutacional de DNA , Eletrocardiografia , Feminino , Predisposição Genética para Doença , Humanos , Imageamento por Ressonância Magnética , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia
14.
Medicine (Baltimore) ; 100(25): e26372, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160410

RESUMO

RATIONALE: Idiopathic ventricular tachycardia (VT) occurs in individuals without structural abnormalities in the heart, accounts for approximately 10% of total VTs. Furthermore, approximately 70% of idiopathic VTs originate from Right ventricular outflow tract (RVOT). However, among perioperative arrhythmias, incidence of VT after surgery is extremely rare and most arrhythmias are atrial origin. PATIENT CONCERNS: A 69-year-old man with permanent pacemaker underwent colon surgery. DIAGNOSES: Patient suffered from low blood pressure and dizziness, sweating at post anesthetic care unit (PACU) and heart rate (HR) increased suddenly to 200 beats/min with monomorphic VT after bolus ephedrine administration and continuous dopamine infusion. INTERVENTIONS: Pacemaker interrogation followed by DC cardioversion was done. OUTCOMES: Patient's vital signs became normal and symptoms are subsided. LESSONS: RVOT VT can be caused by triggering activities, such as ephedrine, dopamine, and inadequate fluid management. These triggering activities are initiated by acceleration of HR from ventricles with infusion of catecholamine which lead monomorphic VT originating from RVOT.RVOT origin PVCs can be precipitated into monomorphic VT by administrating catecholamines such as ephedrine and dopamine even in patient with pacemaker. The mechanism of these VTs includes catecholamine induced acceleration of HR. Since RVOT PVCs can be recognize by 12 EKGs, we should be pay more attentions to the pre-operation EKG and be cautious using catecholamines.


Assuntos
Colectomia/efeitos adversos , Ventrículos do Coração/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Taquicardia Ventricular/diagnóstico , Idoso , Neoplasias do Colo/cirurgia , Ecocardiografia , Cardioversão Elétrica , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Marca-Passo Artificial , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Resultado do Tratamento
16.
Arch Cardiovasc Dis ; 114(5): 407-414, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34088625

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. AIMS: We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. METHODS: Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. RESULTS: A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. CONCLUSIONS: An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.


Assuntos
Arritmias Cardíacas/epidemiologia , COVID-19/epidemiologia , Desfibriladores Implantáveis , Monitorização Ambulatorial/métodos , Tecnologia de Sensoriamento Remoto/métodos , SARS-CoV-2 , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Feminino , Seguimentos , França/epidemiologia , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/estatística & dados numéricos , Estudos Prospectivos , Quarentena , Tecnologia de Sensoriamento Remoto/instrumentação , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia
17.
Methodist Debakey Cardiovasc J ; 17(1): 8-12, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104314

RESUMO

Catheter ablation is an established treatment strategy for ventricular arrhythmias. However, the presence of intramural substrate poses challenges with mapping and delivery of radiofrequency energy, limiting overall success of catheter ablation. Advances over the past decade have improved our understanding of intramural substrate and paved the way for innovative treatment approaches. Modifications in catheter ablation techniques and development of novel ablation technologies have led to improved clinical outcomes for patients with ventricular arrhythmias. In this review, we explore mapping techniques to identify intramural substrate and describe available radiofrequency energy delivery techniques that can improve overall success rates of catheter ablation.


Assuntos
Ablação por Cateter , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco/diagnóstico por imagem , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
18.
J Cardiovasc Electrophysiol ; 32(7): 1985-1994, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33993576

RESUMO

INTRODUCTION: Percutaneous epicardial access (EA) was first described more than two decades ago. Since its initial introduction, indications for its utilization in the field of electrophysiology have expanded dramatically. DISCUSSION: Epicardial mapping and ablation in patients with ventricular tachycardia is routinely performed in tertiary electrophysiology centers around the world. Although limited by lack of randomized controlled trials, epicardial ablation for atrial fibrillation has been suggested as a conjunctive strategy in patients who have failed an initial endocardial catheter ablation attempt, and it is necessary for placement of some left atrial appendage occlusion devices as well. An accurate understanding of the cardiac anatomy is crucial to avoid complications such as inadvertent right ventricular puncture, injury to the coronary arteries, abdominal viscera, phrenic nerves, and esophagus during both EA and catheter ablation. CONCLUSION: The aim of this review is to provide a comprehensive overview of the cardiac anatomy, technical aspects to optimize the safety of epicardial puncture, recognize and avoid potential complications.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Ventricular , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Eletrofisiologia Cardíaca , Ablação por Cateter/efeitos adversos , Mapeamento Epicárdico , Humanos , Pericárdio/cirurgia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia
19.
Arch Cardiovasc Dis ; 114(6-7): 443-454, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967015

RESUMO

BACKGROUND: Data regarding recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients according to atrial fibrillation is limited. OBJECTIVE: To assess the prognostic impact of atrial fibrillation on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients. METHODS: A large retrospective registry was used, including all ICD recipients with episodes of ventricular tachycardia or fibrillation from 2002 to 2016. Patients with atrial fibrillation were compared to those without atrial fibrillation. The primary endpoint was first recurrence of ventricular tachyarrhythmias at 5 years. Secondary endpoints comprised recurrences of ICD-related therapies, first cardiac rehospitalization and all-cause mortality at 5 years. Cox regression, Kaplan-Meier and propensity score-matching analyses were applied. RESULTS: A total of 592 consecutive ICD recipients were included (33% with atrial fibrillation). Atrial fibrillation was associated with reduced freedom from recurrent ventricular tachyarrhythmias (42% vs. 50%, log-rank P=0.004; hazard ratio 1.445, 95% confidence interval 1.124-1.858), mainly attributable to recurrent ventricular fibrillation in secondary-preventive ICD recipients. Accordingly, atrial fibrillation was associated with reduced freedom from first appropriate ICD therapies (31% vs. 42%, log-rank P=0.001; hazard ratio 1.598, 95% confidence interval 1.206-2.118). Notably, the primary endpoint of freedom from first episode of recurrent ventricular tachyarrhythmias was still reduced in those with atrial fibrillation compared to those without atrial fibrillation after propensity score matching. Regarding secondary endpoints, patients with atrial fibrillation still showed a trend towards reduced freedom from appropriate ICD therapies. CONCLUSIONS: Atrial fibrillation was associated with increased rates of recurrent ventricular tachyarrhythmias and appropriate device therapies in ICD recipients with ventricular tachyarrhythmias.


Assuntos
Fibrilação Atrial/fisiopatologia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia , Adulto Jovem
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