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1.
BMC Med ; 22(1): 61, 2024 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-38331876

RESUMO

BACKGROUND: Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE). METHODS: In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis. RESULTS: In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3-8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1-5.4), coronary angiogram (HR = 4.0, 95% CI 2.3-7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3-4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8-8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5-4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1-1.5, p = 0.002). CONCLUSIONS: The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.


Assuntos
Endocardite , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Humanos , Masculino , Idoso , Feminino , Estudos de Coortes , Próteses Valvulares Cardíacas/efeitos adversos , Austrália/epidemiologia , Valvas Cardíacas , Endocardite/epidemiologia , Endocardite/etiologia , Infecções Relacionadas à Prótese/cirurgia
2.
Heart Lung Circ ; 33(4): 470-478, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38365498

RESUMO

BACKGROUND & AIM: To develop prognostic survival models for predicting adverse outcomes after catheter ablation treatment for non-valvular atrial fibrillation (AF) and/or atrial flutter (AFL). METHODS: We used a linked dataset including hospital administrative data, prescription medicine claims, emergency department presentations, and death registrations of patients in New South Wales, Australia. The cohort included patients who received catheter ablation for AF and/or AFL. Traditional and deep survival models were trained to predict major bleeding events and a composite of heart failure, stroke, cardiac arrest, and death. RESULTS: Out of a total of 3,285 patients in the cohort, 177 (5.3%) experienced the composite outcome-heart failure, stroke, cardiac arrest, death-and 167 (5.1%) experienced major bleeding events after catheter ablation treatment. Models predicting the composite outcome had high-risk discrimination accuracy, with the best model having a concordance index >0.79 at the evaluated time horizons. Models for predicting major bleeding events had poor risk discrimination performance, with all models having a concordance index <0.66. The most impactful features for the models predicting higher risk were comorbidities indicative of poor health, older age, and therapies commonly used in sicker patients to treat heart failure and AF and AFL. DISCUSSION: Diagnosis and medication history did not contain sufficient information for precise risk prediction of experiencing major bleeding events. Predicting the composite outcome yielded promising results, but future research is needed to validate the usefulness of these models in clinical practice. CONCLUSIONS: Machine learning models for predicting the composite outcome have the potential to enable clinicians to identify and manage high-risk patients following catheter ablation for AF and AFL proactively.


Assuntos
Fibrilação Atrial , Flutter Atrial , Ablação por Cateter , Humanos , Ablação por Cateter/métodos , Ablação por Cateter/efeitos adversos , Flutter Atrial/cirurgia , Masculino , Feminino , Fibrilação Atrial/cirurgia , Idoso , Pessoa de Meia-Idade , New South Wales/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Prognóstico , Fatores de Risco , Seguimentos , Medição de Risco/métodos , Complicações Pós-Operatórias/epidemiologia
3.
Heart Lung Circ ; 33(6): 828-881, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38702234

RESUMO

Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Humanos , Fibrilação Atrial/cirurgia , Austrália , Cardiologia/normas , Ablação por Cateter/métodos , Ablação por Cateter/normas , Nova Zelândia , Sociedades Médicas
4.
Heart Lung Circ ; 32(2): 197-204, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36473791

RESUMO

INTRODUCTION: Epicardial access for mapping and ablation of the epicardial substrate may be required in catheter ablation of ventricular tachycardias (VT). However, high complication rates are associated with the standard epicardial access approach. Recently, a novel method of intentional coronary vein (CV) exit with pericardial CO2 insufflation to facilitate epicardial access has been described. This study describes our initial experience with this technique. METHODS: Patients undergoing epicardial VT ablation between 1 February 2021 to 31 May 2022 at the Royal Prince Alfred Hospital, Sydney, NSW, were included in this study. Via femoral venous access, a branch of the coronary sinus was sub-selected and intentional CV exit was performed with a high tip load coronary angioplasty wire. A microcatheter was then advanced over the wire into the pericardial space, followed by pericardial CO2 insufflation, facilitating subxiphoid pericardial puncture. RESULTS: Five (5) patients underwent epicardial access for VT mapping and ablation. All patients had successful intentional CV exit and CO2 facilitated epicardial access. The mean time to successful epicardial access was 37.2±17.5 minutes. With increasing operator experience, there was improvement in epicardial access times, with the fifth case requiring only 13 minutes. There was one case of inadvertent right ventricular puncture (without haemodynamic or ventilatory compromise) due to inappropriate CO2 insufflation into the right ventricle. Epicardial access was successful on the second attempt. CONCLUSION: This is the first case series of epicardial access facilitated by CO2 insufflation in Australia. This technique enabled successful epicardial access in all patients in our early experience, with no adverse outcomes from epicardial access. With increasing operator experience, this technique may allow for more widespread adoption of up-front epicardial access for the treatment of VT.


Assuntos
Ablação por Cateter , Insuflação , Taquicardia Ventricular , Humanos , Dióxido de Carbono , Arritmias Cardíacas , Taquicardia Ventricular/etiologia , Pericárdio/cirurgia , Ablação por Cateter/métodos , Resultado do Tratamento
5.
Heart Lung Circ ; 32(9): 1069-1075, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37419791

RESUMO

BACKGROUND: Sudden cardiac arrest (SCA) in young people aged 1 to 50 years often occurs with no presenting symptoms or risk factors prompting screening for cardiovascular disease prior to their cardiac arrest. Approximately 3,000 young Australians suffer from sudden cardiac death (SCD) each year, making this a major public health issue. However, there is significant variation in the way incidence is estimated resulting in discrepancy across reporting which impacts our ability to understand and prevent these devastating events. We describe the New South Wales (NSW) Sudden Cardiac Arrest Registry: a retrospective, data linkage study which will identify all SCAs in the young in NSW from 2009 through to June 2022. OBJECTIVE: To determine the incidence, demographic characteristics and causes of SCA in young people. We will develop an NSW-based registry that will contribute to a greater understanding of SCA including risk factors and outcomes. METHODS: The cohort will include all people who experience a SCA in the NSW community aged between 1 to 50 years. Cases will be identified using the following three datasets: the Out of Hospital Cardiac Arrest Register housed at NSW Ambulance, the NSW Emergency Department Data Collection, and the National Coronial Information System. Data from eight datasets will be collected, anonymised and linked for the entire cohort. Analysis will be undertaken and reported using descriptive statistics. CONCLUSIONS: The NSW SCA registry will be an important resource for the improved understanding of SCA and inform the widespread impacts it has on individuals, their families and society.


Assuntos
Morte Súbita Cardíaca , Parada Cardíaca Extra-Hospitalar , Humanos , Adolescente , Lactente , Pré-Escolar , Criança , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos de Coortes , New South Wales/epidemiologia , Estudos Retrospectivos , Austrália , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Sistema de Registros , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/etiologia , Armazenamento e Recuperação da Informação
6.
Heart Lung Circ ; 32(2): 184-196, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36599791

RESUMO

IMPORTANCE: Randomised trials have shown that catheter ablation (CA) is superior to medical therapy for ventricular tachycardia (VT) largely in patients with ischaemic heart disease. Whether this translates to patients with all forms and stages of structural heart disease (SHD-e.g., non-ischaemic heart disease) is unclear. This trial will help clarify whether catheter ablation offers superior outcomes compared to medical therapy for VT in all patients with SHD. OBJECTIVE: To determine in patients with SHD and spontaneous or inducible VT, if catheter ablation is more efficacious than medical therapy in control of VT during follow-up. DESIGN: Randomised controlled trial including 162 patients, with an allocation ratio of 1:1, stratified by left ventricular ejection fraction (LVEF) and geographical region of site, with a median follow-up of 18-months and a minimum follow-up of 1 year. SETTING: Multicentre study performed in centres across Australia. PARTICIPANTS: Structural heart disease patients with sustained VT or inducible VT (n=162). INTERVENTION: Early treatment, within 30 days of randomisation, with catheter ablation (intervention) or initial treatment with antiarrhythmic drugs only (control). MAIN OUTCOMES, MEASURES, AND RESULTS: Primary endpoint will be a composite of recurrent VT, VT storm (≥3 VT episodes in 24 hrs or incessant VT), or death. Secondary outcomes will include each of the individual primary endpoints, VT burden (number of VT episodes in the 6 months preceding intervention compared to the 6 months after intervention), cardiovascular hospitalisation, mortality (including all-cause mortality, cardiac death, and non-cardiac death) and LVEF (assessed by transthoracic echocardiography from baseline to 6-, 12-, 24- and 36-months post intervention). CONCLUSIONS AND RELEVANCE: The Catheter Ablation versus Anti-arrhythmic Drugs for Ventricular Tachycardia (CAAD-VT) trial will help determine whether catheter ablation is superior to antiarrhythmic drug therapy alone, in patients with SHD-related VT. TRIAL REGISTRY: Australian New Zealand Clinical Trials Registry (ANZCTR) TRIAL REGISTRATION ID: ACTRN12620000045910 TRIAL REGISTRATION URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377617&isReview=true.


Assuntos
Ablação por Cateter , Isquemia Miocárdica , Taquicardia Ventricular , Humanos , Antiarrítmicos/uso terapêutico , Volume Sistólico , Estudos Prospectivos , Resultado do Tratamento , Função Ventricular Esquerda , Austrália/epidemiologia , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/etiologia , Isquemia Miocárdica/cirurgia , Ablação por Cateter/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
7.
J Cardiovasc Electrophysiol ; 33(6): 1300-1311, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35441755

RESUMO

AIMS: The objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction. METHODS: We conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria. RESULTS: The analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure. CONCLUSION: The superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a "familiar approach" for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro-anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.


Assuntos
Técnicas Eletrofisiológicas Cardíacas , Cardiopatias Congênitas , Malformações Vasculares , Veia Cava Inferior , Eletrofisiologia Cardíaca , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Cava Inferior/anormalidades , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
8.
Heart Lung Circ ; 31(9): 1269-1276, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35623999

RESUMO

OBJECTIVE: To investigate clinical and health system factors associated with receiving catheter ablation (CA) and earlier ablation for non-valvular atrial fibrillation (AF). METHODS: We used hospital administrative data linked with death registrations in New South Wales, Australia for patients with a primary diagnosis of AF between 2009 and 2017. Outcome measures included receipt of CA versus not receiving CA during follow-up (using Cox regression) and receipt of early ablation (using logistic regression). RESULTS: Cardioversion during index admission (hazard ratio [HR] 1.96; 95% CI 1.75-2.19), year of index admission (HR 1.07; 95% CI 1.05-1.10), private patient status (HR 2.65; 95% CI 2.35-2.97), and living in more advantaged areas (HR 1.18; 95% CI 1.13-1.22) were associated with a higher likelihood of receiving CA. A history of congestive heart failure, hypertension, diabetes, and myocardial infarction were associated with a lower likelihood of receiving CA. Private patient status (odds ratio [OR] 2.04; 95% CI 1.59-2.61), cardioversion during index admission (OR 1.25; 95% CI 1.0-1.57), and history of diabetes (OR 1.6; 95% CI 1.06-2.41) were associated with receiving early ablation. CONCLUSIONS: Beyond clinical factors, private patients are more likely to receive CA and earlier ablation than their public counterparts. Whether the earlier access to ablation procedures in private patients is leading to differences in outcomes among patients with atrial fibrillation remains to be explored.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Diabetes Mellitus , Humanos , Recidiva , Fatores de Risco , Resultado do Tratamento
9.
Heart Lung Circ ; 30(5): 692-697, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33132050

RESUMO

INTRODUCTION: Tricuspid regurgitation (TR) is a known complication of cardiac implantable electronic devices (CIED). A better understanding of the patient population affected by this complication and their outcomes is needed. The aims of our study were to: 1) describe the incidence of CIED-related tricuspid regurgitation; 2) identify patient characteristics conferring risk; 3) assess the long-term risk of hospitalisation for heart failure and mortality in patients with this complication. METHODS: This was a retrospective cohort study of 2,265 patients that had a de novo device implantation at a tertiary referral centre between January 2010 and December 2017. Patients with echocardiograms prior to and at least 3 months after device implantation were included. Patients with moderate or severe TR at baseline were excluded. RESULTS: Following screening of medical records, 165 patients were analysed. Forty-four (44) (27%) patients developed new-onset moderate or severe device-related TR, without a significant difference between patients with permanent pacemaker (PPM) and implantable cardioverter-defibrillator (ICD). Patients with CIED-related tricuspid regurgitation had a higher rate of hospitalisation for heart failure than those without (63.6% vs 34.7%, p=0.001) during a median follow-up of 29 months (IQR 13-60 months). Subsequent analyses showed that the association between CIED-related TR and heart failure hospitalisation only became significant in the period beyond 12 months following CIED implantation. Piecewise Cox regression analysis stratified at 12 months of follow-up showed that CIED-related TR was associated with an increased risk of heart failure hospitalisation beyond 12 months after adjustment for differences in baseline characteristics (HR 1.99, 95% CI 1.05-3.76, p=0.03). There was a higher mortality rate in the group with CIED-related TR; however, this did not reach significance (36.3% vs 22.3%, p=0.09). CONCLUSION: CIED-related TR is common and clinically significant with serious implications for long-term outcomes, especially congestive heart failure.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca , Insuficiência da Valva Tricúspide , Desfibriladores Implantáveis/efeitos adversos , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Hospitalização , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Insuficiência da Valva Tricúspide/epidemiologia , Insuficiência da Valva Tricúspide/etiologia
10.
J Cardiovasc Electrophysiol ; 31(2): 465-473, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31930598

RESUMO

BACKGROUND: The prevalence and clinical course of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is well described, though less so for other inherited cardiomyopathies (familial dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction); and inherited arrhythmia syndromes (long QT syndrome, Brugada syndrome or catecholaminergic polymorphic ventricular tachycardia [CPVT]). We examined the frequency, clinical characteristics and AF-related management and outcomes amongst this patient population. METHODS: We retrospectively studied consecutive probands with inherited cardiomyopathy (n = 962) and inherited arrhythmia syndromes (n = 195) evaluated between 2002 and 2018. RESULTS: AF was observed in 5% to 31% of patients, with the highest frequency in HCM. Age of AF onset was 45.8 ± 21.9 years in the inherited arrhythmia syndromes compared with 53.3 ± 15.3 years in the inherited cardiomyopathies, with four CPVT patients developing AF at a median age of 20 years. Overall, 11% of patients with AF had a transient ischemic attack or stroke of which a total of 80% were anticoagulated; with 48% of events occurring at a CHA2 DS2 -VASc < 2. Amongst sarcomere-positive HCM, AF was independently associated with age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.08; P = .0014), left atrial area (OR, 1.11; 95% CI, 1.05-1.17; P = .0005) and MYH7 variants (OR, 2.55; 95% CI, 1.16-5.61; P = .020). CONCLUSION: Up to one-third of inherited heart disease patients will develop AF. While common general population risk factors are key in patients with HCM, the genotype is independently associated with AF. Amongst inherited arrhythmia syndromes, AF is less common, though often occurs below the age of 50 years.


Assuntos
Fibrilação Atrial/epidemiologia , Cardiopatias/epidemiologia , Frequência Cardíaca , Adulto , Idade de Início , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Feminino , Predisposição Genética para Doença , Cardiopatias/genética , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Frequência Cardíaca/genética , Hereditariedade , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
11.
Heart Lung Circ ; 29(4): 538-546, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31959551

RESUMO

Brugada syndrome (BrS) is a complex clinical entity with ongoing conjecture regarding its genetic basis, underlying pathophysiology, and clinical management. Within this paradigm of uncertainty, clinicians are faced with the challenge of caring for patients with this uncommon but potentially fatal condition. This article reviews the current understanding of BrS and highlights the "known unknowns" to reinforce the need for flexible clinical practice in parallel with ongoing scientific discovery.


Assuntos
Síndrome de Brugada , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/genética , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/terapia , Humanos , Medição de Risco , Fatores de Risco
12.
J Cardiovasc Magn Reson ; 21(1): 76, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31831077

RESUMO

BACKGROUND: The Task Force Criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC) was updated in 2010 to improve specificity. There was concern however that the revised cardiovascular magnetic resonance (CMR) criteria was too restrictive and not sensitive enough to detect early forms of the condition. We previously described patients with clinically suspected ARVC who satisfied criteria from non-imaging TFC categories and fulfilled parameters from the original but not the revised CMR criteria; as a result, these patients were not confirmed as definite ARVC but may represent an early phenotype. METHODS: Patients scanned between 2008 and 2015 who had either right ventricular (RV) dilatation or regional dyskinesia satisfying at least minor imaging parameters from the original criteria and without contra-indication underwent serial CMR scanning using a 1.5 T scanner. The aims were to assess the risk of progressive RV abnormalities, evaluate the accuracy of the revised CMR criteria and the need for guideline directed CMR surveillance in at-risk individuals. RESULTS: Overall, 48 patients were re-scanned; 24 had a first-degree relative diagnosed with ARVC using the revised TFC or a first-degree relative with premature sudden death from suspected ARVC and 24 patients had either left bundle branch morphology ventricular tachycardia or > 500 ventricular extra-systoles in 24-h. Mean follow up was 69+/- 25 months. The indexed RV end-diastolic, end-systolic volumes and ejection fraction were calculated for both scans. There was significant reduction in RV volumes and improvement in RV ejection fraction (EF) irrespective of changes to body surface area; - 11.7+/- 15.2 mls/m2, - 6.4+/- 10.5 mls/m2 and + 3.3 +/- 7.9% (p = 0.01, 0.01 and 0.04). Applying the RV parameters to the revised CMR criteria, two patients from the family history group (one with confirmed ARVC and one with a premature death) had progressive RV abnormalities satisfying major criteria. The remaining patients (n = 46) did not satisfy the criteria and either had normal RV parameters with regression of structural abnormalities (27,56.3%) or stable abnormalities (19,43.7%). CONCLUSION: The revised CMR criteria represents a robust tool in the evaluation of patients with clinical suspicion of ARVC, especially for those with ventricular arrhythmias without a family history for ARVC. For patients with RV abnormalities that do not fulfill the revised criteria but have a family history of ARVC or an ARVC associated gene mutation, a surveillance CMR scan should be considered as part of the clinical follow up protocol.


Assuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Adulto , Idoso , Displasia Arritmogênica Ventricular Direita/genética , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Progressão da Doença , Diagnóstico Precoce , Feminino , Seguimentos , Ventrículos do Coração/anormalidades , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Tempo , Disfunção Ventricular Direita/genética , Disfunção Ventricular Direita/fisiopatologia , Adulto Jovem
13.
Heart Lung Circ ; 28(1): 146-154, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30392982

RESUMO

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac condition, with an associated increased risk of ventricular arrhythmias and sudden cardiac death. Young and asymptomatic patients, including professional athletes, are not spared this risk. Implantable cardiac defibrillators (ICDs) are highly effective in terminating malignant ventricular arrhythmias in this group, but they are associated with significant morbidity, such as inappropriate shocks and device complications. Accurate prognostication to guide ICD implantation is therefore essential. The interplay of traditional risk factors, risk modifiers and predictive models creates a complex decision-making environment for the HCM clinician. Risk stratifying tools are expanding with improved understanding of advanced imaging modalities, such as late gadolinium enhancement on cardiac magnetic resonance imaging (cMRI). Once the decision to implant a defibrillator is reached, the choice of device and programming in HCM is unique and should take into account disease substrate and younger age of patients.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Morte Súbita Cardíaca/etiologia , Taquicardia Ventricular/complicações , Cardiomiopatia Hipertrófica/mortalidade , Morte Súbita Cardíaca/epidemiologia , Saúde Global , Humanos , Incidência , Taxa de Sobrevida/tendências , Taquicardia Ventricular/mortalidade
14.
Med J Aust ; 209(3): 123-129, 2018 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-30041593

RESUMO

OBJECTIVES: To quantify the number of implantable cardioverter-defibrillator (ICD) procedures in Australia by year, patient age and sex, and to estimate age group-specific population rates and the associated costs. Design, setting: Retrospective observational study; analysis of Australian National Hospital Morbidity Database hospital procedures data. PARTICIPANTS: Patients with an ICD insertion, replacement, adjustment, or removal procedure code, July 2002 - June 2015. MAIN OUTCOME MEASURES: Number of ICD procedures by procedure year, patient age (0-34, 35-69, 70 years or more) and sex; age group-specific population procedure rates; number of procedures associated with complications. RESULTS: The number of ICD procedures increased from 1844 in 2002-03 to 6504 in 2014-15; more than 75% of procedures were in men. In 2014-15, the ICD insertion rate for people aged 70 years or more was 78.1 per 100 000 population, 22 per 100 000 for those aged 35-69 years, and 1.40 per 100 000 people under 35. The reported complication rate decreased from 45% in 2002-03 to 19% in 2014-15, partly because of a change in the coding of complications. The number of removals corresponded to at least 4% of the number of insertions each year. The aggregate cost of hospitalisations with an ICD procedure during 2011-14 was $445 644 566. CONCLUSION: ICD procedures are becoming more frequent in Australia, particularly in people aged 70 or more. Patterns of care associated with ICD therapy, particularly patient- and hospital-related factors associated with adverse events, should be investigated to better understand and improve patient outcomes.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Adulto , Idoso , Austrália/epidemiologia , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/economia , Remoção de Dispositivo/economia , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Implantação de Prótese/economia , Implantação de Prótese/estatística & dados numéricos , Estudos Retrospectivos
15.
Heart Lung Circ ; 27(3): 291-300, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29097067

RESUMO

Cardiac resynchronisation therapy (CRT) is a cornerstone in the contemporary management of heart failure. The most effective way of predicting response to this therapy remains electrocardiographic (ECG) criteria of electromechanical dyssynchrony. The left bundle branch block (LBBB) pattern is currently the most robust ECG criterion in predicting improvement in symptoms and reduction in mortality. However, recent studies using three-dimensional (3D) mapping and cardiac magnetic resonance imaging (CMR) have demonstrated heterogeneous left ventricular activation patterns in patients with LBBB. This has led to intense debate on the activation pattern of "true LBBB" and resulted in the proposal of stricter criteria for defining LBBB. This review will focus on the definitions and implications of LBBB in the CRT era. At a minimum, the use of stricter ECG criteria appears warranted, and adjunctive pre-implant imaging or mapping may further identify patient-specific electrophysiological patterns that determine response to CRT.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Função Ventricular Esquerda/fisiologia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Prognóstico
16.
Heart Lung Circ ; 27(11): 1310-1317, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29705385

RESUMO

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy that predominantly affects the right ventricle. With a prevalence in the range of 1:5000 to 1:2000 persons, ARVC is one of the leading causes of sudden cardiac death in young people and in athletes. Although early detection and treatment is important, the diagnosis of ARVC remains challenging. There is no single pathognomonic diagnostic finding in ARVC; rather, current international task force criteria specify diagnostic major and minor criteria in six categories: right ventricular imaging (including echocardiography and cardiac magnetic resonance imaging (MRI)), histology, repolarisation abnormalities, depolarisation and conduction abnormalities, arrhythmias and family history (including genetic testing). Combining findings from differing diagnostic modalities can establish a "definite", "borderline" or "possible" diagnosis of ARVC. However, there are limitations inherent in the current task force criteria, including the lack of specificity for ARVC; future iterations may be improved, for example, by enhanced imaging protocols able to detect subtle changes in the structure and function of the right ventricle, incorporation of electro-anatomical data, response to adrenergic challenge, and validated criteria for interpreting genetic variants.


Assuntos
Displasia Arritmogênica Ventricular Direita , Ecocardiografia/métodos , Testes Genéticos/métodos , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/epidemiologia , Displasia Arritmogênica Ventricular Direita/genética , Saúde Global , Ventrículos do Coração/fisiopatologia , Humanos , Morbidade/tendências , Taxa de Sobrevida/tendências
17.
Heart Lung Circ ; 26(9): 950-959, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28652028

RESUMO

Catheter ablation has become a standard technique for the treatment of atrial fibrillation. Pulmonary vein isolation (PVI) is the most important component of catheter ablation of atrial fibrillation. Radiofrequency (RF) ablation and balloon cryoablation can be used to achieve PVI. This review examines the biophysics and clinical efficacy of balloon cryoablation and discusses the potential advantages and disadvantages compared to RF ablation.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Sistema de Condução Cardíaco/cirurgia , Humanos , Resultado do Tratamento
18.
Heart Lung Circ ; 25(8): 784-90, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27038767

RESUMO

Ventricular fibrillation (VF) electrical storm is a serious and life-threatening event, and is often triggered by premature ventricular complexes (PVCs). Catheter ablation of these PVC triggers have been described in a variety of clinical situations, including post-myocardial infarction (MI), patients with structurally normal heart, as well as in patients with Brugada Syndrome and Long QT Syndrome. We provide a literature review on this topic, using case examples for illustration.


Assuntos
Ablação por Cateter/métodos , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/cirurgia , Adulto , Síndrome de Brugada/fisiopatologia , Síndrome de Brugada/cirurgia , Feminino , Humanos , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/cirurgia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia
19.
Heart Lung Circ ; 25(12): 1164-1176, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27425183

RESUMO

Oral anticoagulation (OAC) has been the cornerstone for the prevention of thromboembolic complications in patients with atrial fibrillation (AF) at significant risk of stroke. Catheter ablation is an established efficacious technique for the treatment of AF. Ameliorating the risk of stroke or transient ischaemic attack (TIA) in patients with AF undergoing ablation requires meticulous planning of pharmacotherapy. The advent of non-vitamin K oral anticoagulants (NOACs) has broadened the therapeutic scope, representing a viable alternative to traditional vitamin K antagonists (VKA) in non-valvular AF. Potential advantages of NOACs include greater pharmacokinetic predictability, at least comparable efficacy as compared to VKA and a superior haemorrhagic complication profile. However, robust evidence for the safety and efficacy of periprocedural NOAC use for AF ablation remains uncertain with a non-uniform clinical approach between and within institutions. The following review will summarise the current and emerging evidence on periprocedural management of NOACs in patients undergoing catheter ablation of AF. An overview of NOAC pharmacology will provide a foundation for the review of reversal agents in the context of catheter ablation of AF. The purpose of the review is to outline key studies and identify key areas for further critical research with the ultimate aim of developing evidence-based guidelines for optimal care.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/terapia , Ablação por Cateter , Assistência Perioperatória/métodos , Administração Oral , Humanos
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