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1.
J Cardiovasc Electrophysiol ; 28(1): 85-93, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27862594

RESUMO

INTRODUCTION: Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry. METHODS: During the period 2011-2014 we enrolled 125 patients (80% males, age 74 [71-77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patient's cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed ≥10 were defined as highly experienced. RESULTS: Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3-10.4) minutes in cases versus 16 (11-26) minutes in controls (P < 0.001). Coronary sinus angiography was performed in 33 (26%) cases and 208 (83%) controls (P < 0.001). Complications occurred in 5 (4%) cases and 17 (7%) controls (P = 0.28). Median fluoroscopy time (median 11 minutes vs. 3 minutes, P < 0.001) and CS angiography rate (55% vs. 21%, P < 0.001) were significantly higher in low experienced centers, while success rate and complications rate were similar. CONCLUSIONS: EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ≈75% and angiography rate by ≈70%.


Assuntos
Arritmias Cardíacas/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Técnicas Eletrofisiológicas Cardíacas , Insuficiência Cardíaca/terapia , Imageamento Tridimensional , Terapia Assistida por Computador/instrumentação , Potenciais de Ação , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Estudos de Casos e Controles , Angiografia Coronária , Estudos de Viabilidade , Feminino , Fluoroscopia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Interpretação de Imagem Assistida por Computador , Itália , Masculino , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes , Radiografia Intervencionista , Sistema de Registros , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
2.
Pacing Clin Electrophysiol ; 40(7): 850-856, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28543265

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) has proved to be effective in patients with heart failure and left bundle branch block (LBBB). Recently, new electrocardiography criteria have been proposed for the diagnosis of LBBB. These criteria are stricter than the current American Heart Association (AHA) criteria. We assessed the rate of echocardiographic response to CRT in patients with traditional LBBB versus patients who met the new criteria (strict LBBB). METHODS: Consecutive patients undergoing CRT were enrolled in the CRT MORE registry. Patients with no-LBBB QRS morphology according to AHA criteria, atrial fibrillation, right bundle branch block, and right ventricular pacing were excluded. Strict LBBB was defined as: QRS ≥ 140 ms for men and ≥130 ms for women, QS or rS in V1-V2, mid-QRS notching or slurring in ≥2 contiguous leads. Patients showing a relative decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 12 months were defined as responders. RESULTS: Among 335 patients with LBBB, 131 (39%) had strict LBBB. Patients with and without strict LBBB showed comparable baseline characteristics, except for QRS duration (166 ± 20 ms vs 152 ± 25 ms, P < 0.001). On 12-month evaluation, 205 patients (61%) were responders; 85 of 131 (65%) had strict LBBB and 120 of 204 (59%) had traditional LBBB (P = 0.267). On multivariate analysis, a history of atrial fibrillation, larger LVESV, and the presence of mid-QRS notching in ≥1 lead (odds ratio 2.099; 95% confidence interval 1.061-4.152, P = 0.033) were independently associated with echocardiographic response. CONCLUSION: Stricter definition of LBBB did not improve response to CRT in comparison to the current AHA definition.


Assuntos
Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Eletrocardiografia , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , Sistema de Registros , Resultado do Tratamento
3.
Angiology ; : 33197231199229, 2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37651548

RESUMO

The platypnea-orthodeoxia syndrome (POS) is a rare and often suboptimally managed condition with a complex diagnostic workup, conversely displaying an easy treatment and a good recovery of symptoms, especially if consequent to an intracardiac shunt. However, its identification is challenging, due to the several clinical manifestations, the multiple etiologies, representing often the delayed presentation of a congenital heart disease. We present a case report and review of available literature on patients with the POS secondary to a patent foramen ovale successfully treated with its closure.

4.
Ital Heart J ; 4(12): 895-9, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14976858

RESUMO

5-Fluorouracil, a widely used drug in cancer treatment, is known to have cardiotoxic effects: chest pain with ECG changes, arrhythmias, arterial hypertension or hypotension, myocardial infarction, cardiogenic shock and sudden death have been described in the literature. Coronary artery vasospasm is the pathogenetic mechanism hypothesized in most cases, but mechanisms other than myocardial ischemia had been advocated in some patients. The approach to the patient with persistent chest pain, despite therapy and persistent ST-segment elevation mimicking an acute myocardial infarction, has not been well addressed, and the appropriate diagnostic and therapeutic pathways have not yet been defined. We present our experience regarding 2 patients treated with 5-fluorouracil and referred to our coronary care unit because of prolonged chest pain (in one case with clinical evidence of hemodynamic impairment) and persistent ST-segment elevation, in whom an acute myocardial infarction was suspected. One patient was treated with systemic fibrinolysis, and coronary angiography was performed 6 days later; the other was submitted to urgent coronary angiography shortly after admission. In both cases the ECG and echocardiographic abnormalities were transient and normalized within a few days, the serum markers of myocardial necrosis were persistently in the normal range and the coronary artery trees were normal. The diagnostic and therapeutic approach to patients with this unusual clinical presentation is also discussed.


Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Dor no Peito/induzido quimicamente , Dor no Peito/tratamento farmacológico , Eletrocardiografia , Fluoruracila/efeitos adversos , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/induzido quimicamente , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Captopril/uso terapêutico , Dor no Peito/diagnóstico , Neoplasias Colorretais/tratamento farmacológico , Angiografia Coronária , Digoxina/uso terapêutico , Gerenciamento Clínico , Ecocardiografia , Humanos , Neoplasias Laríngeas/tratamento farmacológico , Pessoa de Meia-Idade , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Nitratos/uso terapêutico , Verapamil/uso terapêutico
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