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1.
Medicine (Baltimore) ; 100(11): e25060, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725981

RESUMO

RATIONALE: The phrenic nerve stimulation (PNS) is a rare complication after pacemaker setting. We report a case report that describes this complication and how it can be resolved. PATIENT CONCERNS: An 88-year-old man presented himself to the emergency geriatric unit with intermittent painless abdominal contraction due to phrenic nerve stimulation. He has a history of transcatheter aortic valve implantation with cardiac resynchronization therapy pacemaker due to persistent left bundle branch block. DIAGNOSES: All the usual causes for abdominal spasms were eliminated and the possibility of a link with the pacemaker was considered. The phrenic nerve stimulation is a rare complication of a pacemaker implantation. It can be clinically nonrelevant but challenging to diagnose for those not familiar with cardiac devices technology. INTERVENTIONS: Initial setting was an axis of stimulation between distal left ventricular (LV) and right ventricular. It was changed to LV and D1-M2. OUTCOMES: This noninvasive procedure managed to eradicate the involuntary abdominal spasms. LESSONS: PNS could be challenging to diagnose for those not familiar with cardiac devices technology but easy to manage with noninvasive methods.


Assuntos
Bloqueio de Ramo/cirurgia , Terapia de Ressincronização Cardíaca/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Nervo Frênico/lesões , Idoso de 80 Anos ou mais , Humanos , Masculino , Substituição da Valva Aórtica Transcateter
2.
J Am Acad Orthop Surg ; 28(14): e612-e619, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692098

RESUMO

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


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Artroplastia , Terapia de Ressincronização Cardíaca/efeitos adversos , Doenças Cardiovasculares/etiologia , Desfibriladores Implantáveis/efeitos adversos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Osteoartrite/cirurgia , Marca-Passo Artificial/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo
3.
Circ Arrhythm Electrophysiol ; 13(7): e008210, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32538136

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) improves heart failure outcomes but has significant nonresponse rates, highlighting limitations in ECG selection criteria: QRS duration (QRSd) ≥150 ms and subjective labeling of left bundle branch block (LBBB). We explored unsupervised machine learning of ECG waveforms to identify CRT subgroups that may differentiate outcomes beyond QRSd and LBBB. METHODS: We retrospectively analyzed 946 CRT patients with conduction delay. Principal component analysis (PCA) dimensionality reduction obtained a 2-dimensional representation of preCRT 12-lead QRS waveforms. k-means clustering of the 2-dimensional PCA representation of 12-lead QRS waveforms identified 2 patient subgroups (QRS PCA groups). Vectorcardiographic QRS area was also calculated. We examined following 2 primary outcomes: (1) composite end point of death, left ventricular assist device, or heart transplant, and (2) degree of echocardiographic left ventricular ejection fraction (LVEF) change after CRT. RESULTS: Compared with QRS PCA Group 2 (n=425), Group 1 (n=521) had lower risk for reaching the composite end point (HR, 0.44 [95% CI, 0.38-0.53]; P<0.001) and experienced greater mean LVEF improvement (11.1±11.7% versus 4.8±9.7%; P<0.001), even among patients with LBBB with QRSd ≥150 ms (HR, 0.42 [95% CI, 0.30-0.57]; P<0.001; mean LVEF change 12.5±11.8% versus 7.3±8.1%; P=0.001). QRS area also stratified outcomes but had significant differences from QRS PCA groups. A stratification scheme combining QRS area and QRS PCA group identified patients with LBBB with similar outcomes to non-LBBB patients (HR, 1.32 [95% CI, 0.93-1.62]; difference in mean LVEF change: 0.8% [95% CI, -2.1% to 3.7%]). The stratification scheme also identified patients with LBBB with QRSd <150 ms with comparable outcomes to patients with LBBB with QRSd ≥150 ms (HR, 0.93 [95% CI, 0.67-1.29]; difference in mean LVEF change: -0.2% [95% CI, -2.7% to 3.0%]). CONCLUSIONS: Unsupervised machine learning of ECG waveforms identified CRT subgroups with relevance beyond LBBB and QRSd. This method may assist in objective classification of bundle branch block morphology in CRT.


Assuntos
Terapia de Ressincronização Cardíaca , Diagnóstico por Computador , Eletrocardiografia , Insuficiência Cardíaca/terapia , Processamento de Sinais Assistido por Computador , Aprendizado de Máquina não Supervisionado , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
4.
Int J Cardiovasc Imaging ; 36(8): 1507-1514, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32356183

RESUMO

Setting up a randomized trial to assess the association of mechanical dyssynchrony (MD) and the success of cardiac resynchronization therapy (CRT) in heart failure with a wide QRS complex is ethically challenging. We therefore investigated this association in a retrospective cohort study observing different treatment strategies which were chosen based on the availability of health care resources. The survival of 500 patients from six Western European centers treated with CRT was compared to their 137 Eastern European counterparts not treated with CRT, with regard to the presence of MD. MD was visually assessed and was defined as the presence of apical rocking and/or septal flash. Patients were followed for a mean of 26 ± 8 months for the occurrence of death of any cause. As compared with medical therapy alone, CRT was associated with a more favorable survival (hazard ratio (HR), 0.53; 95% confidence interval (CI) 0.35-0.79; P = 0.002). Patients with MD treated by CRT had better survival than patients belonging to all other groups-they showed 72%, 66% and 56% reduction in all-cause mortality, respectively, compared to patients with MD not treated by CRT (HR 0.28; 95% CI 0.17-0.44), patients without MD treated by CRT (HR 0.34; 95% CI 0.22-0.52) and patients without MD not treated by CRT (HR 0.44; 95% CI 0.25-0.76). Patients with wide QRS complex who are treated with CRT have a significantly better survival when MD is present.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Frequência Cardíaca , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Fármacos Cardiovasculares/uso terapêutico , Ecocardiografia , Europa (Continente) , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
5.
BMC Cardiovasc Disord ; 20(1): 221, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404049

RESUMO

BACKGROUND: Atrial fibrillation (AF), one of the most common comorbidities of heart failure (HF), is associated with worse long-term prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to identify CRT candidates with AF who are at high risk of mortality and hospitalization due to HF. METHODS: We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multiple imputation was used for missing values. With imputed datasets, a multivariate Cox regression model was performed for variable selection using the backward stepwise method to predict all-cause mortality and HF readmissions. A nomogram and nomogram-based scoring system were constructed from the selected predictors. Then, internal validation and calibration were achieved by the bootstrap method, deriving the corrected concordance index and calibration curves. Sensitivity analysis was also performed to validate our selected predictors. RESULTS: Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NT-proBNP) > 1745 pg/mL, history of syncope, previous pulmonary hypertension, moderate or severe tricuspid regurgitation, thyroid-stimulating hormone (TSH) > 4 mIU/L. The concordance index (0.70, 95% CI 0.62-0.77), corrected concordance index (0.67, 95% CI 0.59-0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. A significant difference in overall event-free survival was recognized by the nomogram-derived scores for patients with high risk (> 50 points), intermediate risk (21-50 points) and low risk (0-20 points) before CRT. CONCLUSION: Our internally validated nomogram may be an applicable tool for the early risk stratification of CRT candidates with AF.


Assuntos
Fibrilação Atrial/diagnóstico , Terapia de Ressincronização Cardíaca , Regras de Decisão Clínica , Insuficiência Cardíaca/diagnóstico , Nomogramas , Idoso , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Tomada de Decisão Clínica , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
Cardiovasc Diabetol ; 19(1): 55, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375806

RESUMO

Heart failure (HF) is a highly frequent disorder with considerable morbidity, hospitalization, and mortality; thus, it invariably places pressure on clinical and public health systems in the modern world. There have been notable advances in the definition, diagnosis, and treatment of HF, and newly developed agents and devices have been widely adopted in clinical practice. Here, this review first summarizes the current emerging therapeutic agents, including pharmacotherapy, device-based therapy, and the treatment of some common comorbidities, to improve the prognosis of HF patients. Then, we discuss and point out the commonalities and areas for improvement in current clinical studies of HF. Finally, we highlight the gaps in HF research. We are looking forward to a bright future with reduced morbidity and mortality from HF.


Assuntos
Terapia de Ressincronização Cardíaca , Fármacos Cardiovasculares/uso terapêutico , Cardioversão Elétrica , Terapia por Estimulação Elétrica , Insuficiência Cardíaca/terapia , Função Ventricular Esquerda/efeitos dos fármacos , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Dispositivos de Terapia de Ressincronização Cardíaca , Fármacos Cardiovasculares/efeitos adversos , Comorbidade , Desfibriladores Implantáveis , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/mortalidade , Terapia por Estimulação Elétrica/efeitos adversos , Terapia por Estimulação Elétrica/instrumentação , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Coração Auxiliar , Humanos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Estimulação do Nervo Vago
7.
BMC Cardiovasc Disord ; 20(1): 178, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299366

RESUMO

BACKGROUND: Heart failure is associated with ventricular dyssynchrony and energetic inefficiency, which can be alleviated by cardiac resynchronization therapy (CRT) with approximately one-third of non-response rate. Thus far, there is no specific biomarker to predict the response to CRT in patients with heart failure. In this study, we assessed the role of the blood metabolomic profile in predicting the response to CRT. METHODS: A total of 105 dilated cardiomyopathy patients with severe heart failure who received CRT were included in our two-stage study. Baseline blood samples were collected prior to CRT implantation. The response to CRT was defined according to echocardiographic criteria. Metabolomic profiling of serum samples was carried out using ultrahigh performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry. RESULTS: Seventeen metabolites showed significant differences in their levels between responders and non-responders, and these metabolites were primarily involved in six pathways, including linoleic acid metabolism, Valine, leucine and isoleucine biosynthesis, phenylalanine metabolism, citrate cycle, tryptophan metabolism, and sphingolipid metabolism. A combination of isoleucine, tryptophan, and linoleic acid was identified as an ideal metabolite panel to distinguish responders from non-responders in the discovery set (n = 51 with an AUC of 0.981), and it was confirmed in the validation set (n = 54 with an AUC of 0.929). CONCLUSIONS: Mass spectrometry based serum metabolomics approach provided larger coverage of metabolome which can help distinguish CRT responders from non-responders. A combination of isoleucine, tryptophan, and linoleic acid may associate with significant prognostic values for CRT.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/terapia , Isoleucina/sangue , Ácido Linoleico/sangue , Metabolômica , Triptofano/sangue , Idoso , Biomarcadores/sangue , Terapia de Ressincronização Cardíaca/efeitos adversos , Cromatografia Líquida de Alta Pressão , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento
8.
BMC Cardiovasc Disord ; 20(1): 205, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345229

RESUMO

BACKGROUND: Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. METHODS: A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. RESULTS: In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020-1.093, P = 0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131-2.844, P = 0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029-1.134 P = 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007-1.030, P = 0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007-1.030, P = 0.002]. The Alpha-score (Atrial diameter, non-LBBB, Pro-BNP, Hs-CRP, NYHA class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow test, P > 0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694-0.804), P < 0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639-0.745), P < 0.001]. CONCLUSION: The Alpha-score may enable improved discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.


Assuntos
Terapia de Ressincronização Cardíaca/mortalidade , Cardiomiopatias/terapia , Insuficiência Cardíaca/mortalidade , Hospitalização , Idoso , Terapia de Ressincronização Cardíaca/efeitos adversos , Cardiomiopatias/diagnóstico , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Regras de Decisão Clínica , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Remodelação Ventricular
9.
Open Heart ; 7(1): e001105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32153788

RESUMO

Aims: Body composition (BC) is known to alter in heart failure. Cardiac resynchronisation therapy (CRT) improves left ventricular geometry but the impact on BC is unknown. Our aim was to evaluate BC in these patients before and after CRT implantation. Methods: Prospective proof-of-concept pilot study of heart failure patients undergoing CRT between September 2014 and December 2015. Assessments performed pre-CRT and post-CRT (6 weeks and 6 months) were: BC parameters (using air-displacement plethysmography), New York Heart Failure classification for assessing symptom severity, echocardiography to assess left ventricular geometry, electrocardiography, Minnesota Heart Failure Questionnaire and N-terminal probrain natriuretic peptide (NT-pro-BNP). Repeated measures analysis of variance was performed to assess relative change over time and potential correlations. Results: Twenty-five patients were recruited; mean-age (±SD) was 73.4±10.0 years, 23 males, 18 CRT defibrillators (remainder CRT pacemakers), 16 had ischaemic aetiology, 6 diabetics, 17 with left bundle-branch morphology on ECG and 10 had atrial fibrillation. Significant inverse correlations were observed in the first 6 weeks following CRT between fat mass and left ventricular end-diastolic volume (r=-0.69, p<0.01) and NT-pro-BNP and fat mass (r=0.41, p=0.05). No significant differences were noted over 6 months. There was an observed trend towards reduced fat mass in the first 6 weeks post-CRT implant driven by non-responders. There was no significant difference between responders and non-responders in BC over 6 months. Conclusion: This is the first study to observe interplay between BC and cardiac geometry/function following CRT; a trend in overall fat mass reduction was noted following CRT and merits further study.


Assuntos
Adiposidade , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Idoso , Biomarcadores/sangue , Terapia de Ressincronização Cardíaca/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Projetos Piloto , Estudo de Prova de Conceito , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Remodelação Ventricular
10.
Int J Cardiovasc Imaging ; 36(7): 1203-1212, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32185626

RESUMO

This study aimed to test the hypothesis that left ventricular dyssynchrony may negatively affect left atrial (LA) dyssynchrony and reservoir function, and cardiac resynchronization therapy (CRT) may improve LA function. It also assessed, whether residual LA dyssynchrony affects the prognosis in patients with heart failure with reduced ejection fraction (HFrEF). Ninety subjects were included: 40 HFrEF patients with a wide-QRS complex (≧130 ms), 28 HFrEF patients with a narrow-QRS, and 22 normal controls. LA global longitudinal strain (LA-GLS) and LA dyssynchrony were quantified by speckle-tracking strain analysis. LA dyssynchrony was defined as the maximal difference of time-to-peak strain (LA time-diff). All patients with a wide-QRS underwent CRT, and event-free survival was tracked for 24 months. At baseline, LA dyssynchrony was significantly more pronounced in patients with a wide-QRS HFrEF (342 ± 126 ms) than that in patients with a narrow-QRS (236 ± 127 ms, P < 0.001) and controls (186 ± 78 ms, P < 0.001). Six months after CRT, LA-GLS significantly improved from 11.9 ± 4.7 to 19.6 ± 10.1% (P < 0.05) and LA time-diff was reduced from 338 ± 123 to 245 ± 141 ms (P < 0.05) in responders only. Patients with an LA time-diff < 202 ms and those with an LA-GLS ≧14.6% six months after CRT showed significantly better outcomes than the others (P < 0.05, respectively). Among the responders, those with an LA time-diff < 202 ms after CRT showed a better prognosis than others (P < 0.05). CRT improved LA dyssynchrony and reservoir function through the improved left ventricular coordination. Reduced LA dyssynchrony and improved LA reservoir function after CRT lead to better outcomes.


Assuntos
Função do Átrio Esquerdo , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Volume Sistólico , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca/efeitos adversos , Ecocardiografia Doppler de Pulso , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo
11.
Circ Arrhythm Electrophysiol ; 13(4): e008239, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32186936

RESUMO

Left bundle branch block may be due to conduction system degeneration or a reflection of myocardial pathology. Left bundle branch block may also develop following aortic valve disease or cardiac procedures. Patients with heart failure with reduced ejection fraction and left bundle branch block may respond positively to cardiac resynchronization therapy. Lead placement via the coronary sinus is the mainstay approach of cardiac resynchronization therapy. However, other options, including physiological pacing, are being explored. In this review, we summarize the salient pathophysiologic and clinical aspects of left bundle branch block, as well as current and future strategies for management.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Frequência Cardíaca , Potenciais de Ação , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/mortalidade , Bloqueio de Ramo/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Humanos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
12.
Circ Arrhythm Electrophysiol ; 13(4): e007925, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32202126

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) studies in pediatric or congenital heart disease patients have shown an improvement in ejection fraction and heart failure symptoms. However, a survival benefit of CRT in this population has not been established. This study aimed to evaluate the impact of CRT upon heart transplant-free survival in pediatric and congenital heart disease patients, using a propensity score-matched (PSM) analysis. METHODS: This single-center study compared CRT patients (implant date, 2004-2017) and controls, matched by 1:1 PSM using 21 comprehensive baseline indices for risk stratification. CRT patients were <21 years of age or had congenital heart disease, had systemic ventricular ejection fraction <45%, symptomatic heart failure, and had significant electrical dyssynchrony, all before CRT implant. Controls were screened from nonselective imaging and ECG databases. Controls were retrospectively enrolled when they achieved the same inclusion criteria at an outpatient clinical encounter, within the same time period. RESULTS: Of 133 patients who received CRT during the study period, 84 met all study inclusion criteria. One hundred thirty-three controls met all criteria at an outpatient encounter. Following PSM, 63 matched CRT-control pairs were identified with no significant difference between groups across all baseline indices. Heart transplant or death occurred in 12 (19%) PSM-CRT subjects and 37 (59%) PSM-controls with a median follow-up of 2.7 years (quartiles, 0.8-6.1 years). CRT was associated with markedly reduced risk of heart transplant or death (hazard ratio, 0.24 [95% CI, 0.12-0.46]; P<0.001). There was no CRT procedural mortality and 1 system infection at 54 months post-implant. CONCLUSIONS: In pediatric and congenital heart disease patients with symptomatic systolic heart failure and electrical dyssynchrony, CRT was associated with improved heart transplant-free survival. Visual Overview: A visual overview is available for this article.


Assuntos
Terapia de Ressincronização Cardíaca , Cardiopatias Congênitas/terapia , Insuficiência Cardíaca/terapia , Transplante de Coração , Adolescente , Fatores Etários , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
13.
J Cardiovasc Med (Hagerstown) ; 21(4): 299-304, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32108126

RESUMO

BACKGROUND AND AIM: Cardiac resynchronization therapy (CRT) reduces mortality and morbidity in chronic heart failure symptomatic patients with broad QRS who are already undergoing optimal medical treatment. However, approximately one-third of implanted patients do not show any benefit from this treatment. Right ventricle (RV) dysfunction leads to a worse outcome in patients with heart failure, but its role in predicting the response to CRT has shown conflicting results. The purpose of our study was to investigate how the RV function, assessed by cardiac magnetic resonance (CMR), could influence the outcome of heart failure patients treated with CRT. METHODS AND RESULTS: We retrospectively enrolled 72 heart failure patients, 38 affected by dilated cardiomyopathy (DCM) and 34 by ischemic dysfunction, with left bundle branch block, QRS greater than 120 ms and standard indications to CRT. We defined the response to CRT as an improvement of at least 10% of the left ventricular ejection fraction (LVEF) or at least one of the NYHA functional classes. We stratified the population into two groups based on the right ventricle ejection fraction (RVEF) at CMR: group 1 RVEF at least 55% (n = 32), group 2 RVEF less than 55% (n = 40). After a mean follow-up of 38 ±â€Š12 months, 44 patients (61%) were considered responders whereas 28 (39%) did not show any benefit. Patients in group 1 had a higher rate of response to CRT (75 vs. 50%, P = 0.03). At the univariate analysis RVEF [54 vs. 43%; confidence interval (CI) = 0.907-0.980; hazard ratio = 0.943; P = 0.003], RV end-systolic volume (56 vs. 84 ml; CI = 1.005-1.034; hazard ratio = 1.019; P = 0.008) and tricuspid annular plane systolic excursion (TAPSE) (16.4 vs. 14 mm; CI 0.745-0.976; heart rate = 0.853; P = 0.021) were the parameters most strongly associated with the response to CRT. Male sex, atrial fibrillation, and older age also negatively influenced the outcome. At a multivariate model, RVEF and older age remained significant. CONCLUSION: In our experience, patients with RV dysfunction less likely benefited from CRT. RV assessment, studied with CMR, appears to be a good predictor of the response to biventricular stimulation.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Imagem por Ressonância Magnética , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/terapia , Função Ventricular Direita , Fatores Etários , Idoso , Terapia de Ressincronização Cardíaca/efeitos adversos , Tomada de Decisão Clínica , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Direita/fisiopatologia
14.
J Cardiovasc Med (Hagerstown) ; 21(2): 123-127, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31789710

RESUMO

AIMS: Pocket hematoma is a common complication of cardiac implantable electronic device (CIED) procedures. the aim of the study was to research the clinical factors associated with pocket hematoma formation after CIED implantation or replacement and to identify the best perioperative antithrombotic management. METHODS: We retrospectively analyzed 500 consecutive patients who underwent to CIED implantation or replacement at our center from November 2014. RESULTS: Among our population, 206 patients (41.2%) were on anticoagulant therapy at the time of the intervention: 68 (13.6%) on ongoing Warfarin; 111 (22.2%) on low-molecular-weight heparin (LMWH); and 27 (5.4%) on ongoing direct oral anticoagulants. Antiplatelet therapy was present in 262 (52.4%) patients: in particular, 50 (10%) were on dual antiplatelet therapy, 64 (12.8%) were on single antiplatelet therapy and anticoagulant therapy, whereas 12 (2.4%) were on anticoagulant with dual antiplatelet therapy.Incidence of pocket hematoma after CIEDs implantation was of 4.6%. Considering the different perioperative anticoagulant strategies, patients on LMWH presented the higher hematoma rate [11/100 patients (11.0%), P < 0.001]. At the multivariate analysis, anticoagulant with dual antiplatelet therapy (P = 0.021, OR 6.3, IC 1.3-30.8), left ventricular ejection fraction (LVEF) less than 30% (P < 0.001, OR 7.4, IC 2.7-20.4), and use of LMWH (P = 0.008, OR 3.8, IC 1.4-10.6) resulted the strongest predictors of pocket hematoma (Hosmer test = 0.899).Considering replacement procedures, incidence of pocket hematoma was of 4.4%. The incidence was higher after ICD/CRT-D replacement. The majority of pocket hematoma occurred in patients with mechanical valve prosthesis (3/4 cases, 75%, P < 0.001). CONCLUSION: The use of LMWH and a low LVEF expose patients to a higher risk of pocket hematoma after CIED procedures. Anticoagulant with dual antiplatelet therapy and LMWH should be avoided.


Assuntos
Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Remoção de Dispositivo/efeitos adversos , Cardioversão Elétrica/instrumentação , Hematoma/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Terapia de Ressincronização Cardíaca/efeitos adversos , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia Antiplaquetária Dupla , Cardioversão Elétrica/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
15.
J Cardiovasc Electrophysiol ; 31(1): 286-292, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31724791

RESUMO

Pacing induced cardiomyopathy (PICM) is most commonly defined as a drop in left ventricle ejection fraction (LVEF) in the setting of chronic, high burden right ventricle (RV) pacing. Recent data suggest, however, that some individuals may experience the onset of heart failure symptoms more acutely after pacemaker implantation. Definitions of PICM which emphasize drop in LVEF may underestimate the incidence of deleterious effects from RV pacing. Treatment of PICM has primarily focused on upgrade to cardiac resynchronization therapy (CRT) when LVEF has dropped. However, emerging data suggest that conduction system pacing (CSP) may offer an opportunity to prevent PICM in the first place.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Cardiomiopatias/etiologia , Volume Sistólico , Função Ventricular Esquerda , Animais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/prevenção & controle , Humanos , Fatores de Risco , Resultado do Tratamento , Função Ventricular Direita
16.
Heart Vessels ; 35(1): 104-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31227877

RESUMO

The advantages of upgrade to cardiac resynchronisation therapy (CRT) have not been explored as carefully as the outcomes of de novo CRT implantations. Furthermore selection criteria for patients with the potential to benefit the most from this therapy are unknown. Therefore, we analyzed the long term outcome and its predictors in a real-world cohort receiving a CRT upgrade from previous pacemaker (PM) and defibrillator devices (ICD). We analyzed 86 patients (mean age 68 ± 9 years; 89% male) undergoing CRT upgrade procedures. Response to CRT as well as long term patient outcome was analyzed. NYHA class improved in majority of the patients during short term period (61%), and this trend remained constant during long term follow-up (54%). The observed all-cause mortality was 54% with mean survival of 49 ± 4 months. 11 patients underwent left ventricular assist device implantation or heart transplantation. In the multivariate analysis, only kidney function assessed by GFR (HR 0.97; 95% CI 0.95-0.99; p = 0.009) and LVEF (HR 0.92; 95% CI 0.87-0.97; p = 0.002) remain predictors for mortality. Patients who undergo an upgrade procedure to CRT demonstrate a significant response rate assessed by improvement in NYHA class, with initial baseline parameters such as LVEF and kidney function remaining significant predictors for mortality.


Assuntos
Estimulação Cardíaca Artificial , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Remoção de Dispositivo , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Marca-Passo Artificial , Idoso , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/mortalidade , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Causas de Morte , Desfibriladores Implantáveis , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
17.
JACC Cardiovasc Imaging ; 13(3): 851-865, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31326496

RESUMO

Recent technological advances in cardiac imaging allow the visualization of anatomic details up to millimeter size in 3-dimensional format. Thus, it is not surprising that electrophysiologists increasingly rely upon cardiac imaging for the diagnosis, treatment, and subsequent management of patients affected by various arrhythmic disorders. Cardiac imaging methods reviewed in the present work involve: 1) the prediction of arrhythmic risk for sudden cardiac death in patients with heart disease; 2) catheter ablation of atrial fibrillation or ventricular tachycardia; and 3) cardiac resynchronization therapy. Future integration of diagnostic and interventional cardiac imaging will further increase the effectiveness of cardiac electrophysiological procedures and will help in delivering patient-specific therapies with ablation and cardiac implantable electronic devices.


Assuntos
Arritmias Cardíacas/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Ablação por Cateter/instrumentação , Morte Súbita Cardíaca/prevenção & controle , Cirurgia Assistida por Computador/instrumentação , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Ablação por Cateter/efeitos adversos , Morte Súbita Cardíaca/etiologia , Humanos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento
18.
Clin Res Cardiol ; 109(2): 183-193, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31152199

RESUMO

BACKGROUND: Multipoint pacing [Multipoint™ Pacing (MPP), Abbott] via a single left ventricular lead (Quartet™ LV lead, Abbott) improves acute left ventricular (LV) function and response to cardiac resynchronization therapy (CRT). Aim of this study was to examine additional benefits in terms of LV reverse remodeling and CRT response by activating MPP in responders and non-responders to conventional biventricular pacing (CONV). METHODS: 43 consecutive patients receiving CRT (Quadra Assura MP™, Abbott) received LV dP/dtmax optimized CONV programming for 6 months. MPP programming with large anatomical electrode separation (> 30 mm) and basal LV1 pacing location was activated afterwards. Echocardiographic and clinical parameters were obtained at baseline, 6- and 12-month follow-up (FU). The response was defined as an improvement of LVESV ≥ 15% and super-response as improvement ≥ 30% relative to baseline. RESULTS: 41 patients completed FU (one died of non-cardiac cause and one was lost to FU) and after 6 months CONV, 26 patients (63%) were classified as CRT responders. With MPP, the response rate increased to 90% (p < 0.001). Super-response also improved significantly with MPP compared to CONV (71% vs. 22%; p < 0.005). LV reverse remodeling in terms of LVESV improved significantly with MPP compared to CONV (79 ± 45 ml vs. 103 ± 64 ml; p < 0.001). NYHA-class only improved significantly with CONV relative to baseline (1,8 ± 0,7 vs. 2,7 ± 0,5; p < 0.001), but not further with MPP (1,7 ± 0,6 vs. 1,8 ± 0,7; p = 0.49). CONCLUSION: Multipoint pacing significantly improves response and super-response to CRT as well as LV reverse remodeling compared to conventional biventricular pacing.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , Terapia de Ressincronização Cardíaca/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Pressão Ventricular
19.
Am J Emerg Med ; 38(5): 1044.e3-1044.e4, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31870671

RESUMO

Placement of a transvenous pacer is an important procedure mainly used to treat hemodynamically unstable brady-arrhythmias. In the Emergency Department (ED), wire placement into the right ventricle is typically performed blindly, or in some cases, under transthoracic ultrasound guidance. This case report describes a patient with extensive cardiac history who presented after a witnessed arrest, and after return of spontaneous circulation, sustained an unstable bradycardia requiring emergent transvenous pacer placement while in the ED. A temporary pacer wire was placed transvenously without successful capture. Transesophageal echocardiography was then utilized to guide and adjust the pacer wire placement helping to successfully achieve capture. To our knowledge, this is the first report to describe transesophageal echocardiogram-assisted placement of a transvenous pacer wire while in the ED.


Assuntos
Bradicardia/terapia , Cateterismo Cardíaco/métodos , Terapia de Ressincronização Cardíaca/métodos , Ventrículos do Coração/diagnóstico por imagem , Idoso de 80 Anos ou mais , Bradicardia/etiologia , Cateterismo Cardíaco/efeitos adversos , Terapia de Ressincronização Cardíaca/efeitos adversos , Ecocardiografia Transesofagiana , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos , Marca-Passo Artificial
20.
Nutr Metab Cardiovasc Dis ; 30(1): 77-83, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31662282

RESUMO

BACKGROUND AND AIMS: Adherence to the Mediterranean diet (MedDiet) has been associated with prolonged survival in older individuals. However, it is unknown whether adherence to MedDiet is associated with the prognosis in older patients scheduled to undergo cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the association between adherence to the MedDiet and clinical outcomes at 12 months follow-up after CRT implantation in older patients. METHODS AND RESULTS: Patients adherents to the MedDiet, defined as ≥ 9 of 14 points using the PREDIMED (Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Study) questionnaire, was assessed before device implantation in patient's ≥ 70 years candidates for CRT. The primary outcome was a combined endpoint at 12 months follow-up after CRT implantation, defined as cardiovascular death, cardiac transplantation or decompensated heart failure. The cohort study consisted of 284 patients with a mean age of 73 ± 3 years. One hundred and fifty-nine (55.9%) patients were classified as adherent to the MedDiet. Seventy (24.6%) patients showed the combined endpoint at one year follow-up. Subjects who did not developed the combined endpoint had higher proportion of adherent patients to the MedDiet compared to patients who developed the combined endpoint (85% vs 67.1%, p = 0.002). After adjustment by possible confounders, the adherence to the MedDiet was a protective and significant predictor of the combined endpoint (HR = 0.42, 95% CI 0.22-0.81; p = 0.01). CONCLUSION: Adherence to the MedDiet is inversely associated with outcome in older patients following CRT.


Assuntos
Terapia de Ressincronização Cardíaca , Dieta Saudável , Dieta Mediterrânea , Insuficiência Cardíaca/terapia , Cooperação do Paciente , Idoso , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Dieta Saudável/efeitos adversos , Dieta Saudável/mortalidade , Dieta Mediterrânea/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Fatores de Proteção , Risco Ajustado , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento
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