ABSTRACT
O presente estudo examinou pacientes submetidos a implante de marcapasso dupla-câmara em decorrência de doença do nó sinusal ou bloqueio atrioventricular de 3o ou 2o graus do tipo 2 na doençarenal crônica em estágios 2, 3 e 4. O estudo teve como objetivo registrar os eventos arrítmicos durante 12 mesesde acompanhamento e comparar a incidência e a gravidade deles nas diferentes fases da doença renal crônica.Método: No total, 305 pacientes foram avaliados a cada 4 meses até 12 meses de acompanhamento. Os eventosarrítmicos foram avaliados em cada visita de acompanhamento. Resultados: Dentro do mesmo grupo de estágio da doença renal crônica não houve diferença entre as causas doença do nó sinusal e bloqueio atrioventricular, a respeito da ocorrência de qualquer arritmia. No entanto, menor incidência de taquicardia atrial/fibrilação atrial foi observada para todas as comparações entre todos os pacientes e os mesmos subgrupos em pacientes no estágio 2 (total: 58%; doença do nó sinusal: 63%; bloqueio atrioventricular: 51%), comparativamente aos estágios 3 (total:87%, P < 0,0001; doença do nó sinusal: 89%, P = 0,0020; bloqueio atrioventricular: 84%, P = 0,0019) e 4 (total: 85%, P < 0,0001; doença do nó sinusal: 81%, P = 0,0409; bloqueio atrioventricular: 90%, P < 0,0001). Em relação à taquicardia ventricular não sustentada/taquicardia ventricular sustentada, foi observada incidência mais elevada para todas as comparações entre todos os pacientes e os mesmos subgrupos em pacientes no estágio 4 (total: 32%; doença do nó sinusal: 16%; bloqueio atrioventricular: 16%), comparativamente aos estágios 3 (total: 11%, P = 0,0007; doença do nó sinusal: 9%, P = 0,0110; bloqueio atrioventricular: 14%, P = 0,0441) e 2 (total: 3%, P < 0,0001; doença do nó sinusal: 3%, P < 0,0001; bloqueio atrioventricular: 4%, P < 0,0001). Conclusão: Nossos resultados sugerem que quanto mais avançado o estágio da doença renal crônica maior a incidência de arritmias malignas...
The present study evaluated patients who had received a dual chamber pacemaker implant due to sinus node disease or 3rd/2nd degree type 2 atrioventricular block in chronic kidney disease stages 2, 3 and 4. The study was aimed at registering arrhythmic events for 12 months of follow-up and comparing their incidence and severity in different stages of chronic kidney disease. Method: Three hundred and five patients were evaluated every 4 months up to 12 months of follow-up. Arrhythmic events were assessed at each follow-up visit. Results: Within the same chronic kidney disease stage group there was no difference between the causes ofsinus node disease and atrioventricular block for the occurrence of any arrhythmia. However, a lower incidence of atrial fibrillation/tachycardia was observed for all comparisons among all patients and the same subgroups in stage 2 patients (total: 58%; sinus node disease: 63%; atrioventricular block: 51%) compared to stages 3 (total: 87%,P < 0.0001; sinus node disease: 89%, P = 0.0020; atrioventricular block: 84%, P = 0.0019) and 4 (total: 85%,P < 0.0001; sinus node disease: 81%, P = 0.0409; atrioventricular block: 90%, P < 0.0001). Regarding nonsustained/ sustained ventricular tachycardia, a higher incidence was observed for all comparisons among all patients and the same subgroups in stage 4 patients (total: 32%; sinus node disease: 16%; atrioventricular block: 16%) compared to stages 3 (total: 11%, P = 0.0007; sinus node disease: 9%, P = 0.0110; atrioventricular block: 14%, P = 0.0441) and 2 (total: 3%, P < 0.0001; sinus node disease: 3%, P < 0.0001; atrioventricular block: 4%,P < 0.0001). Conclusion: Our findings suggest that the more advanced the stage of chronic kidney disease, thegreater the incidence of malignant arrhythmias...
Subject(s)
Humans , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Renal Insufficiency, Chronic/complications , Sinoatrial Node/physiopathology , Pacemaker, Artificial , Patients , Heart Atria/surgery , Sinoatrial Block/physiopathology , Cohort Studies , Risk Factors , Data Interpretation, Statistical , Treatment Outcome , Heart Ventricles/surgeryABSTRACT
Objetivo: el propósito de este estudio fue evaluar la eficacia y seguridad de la resincronización cardíaca agregada a la terapia con cardiodesfibrilador implantable (TRC-D) y la terapia con desfibrilador automático implantable (DAI) para el tratamiento de la insuficiencia cardíaca. A esos efectos se realizó un examen sistemático de ensayos controlados aleatorizados. Métodos y resultados: se revisaron las bases de datos de Medline, Embase y la Biblioteca Cochrane en busca de estudios publicados hasta el 31 de mayo de 2012. Se buscó también en las páginas web de clinicaltrials.gov y de la Administración de Alimentos y Medicamentos de EEUU. En el metaanálisis solo se incluyeron ensayos controlados aleatorizados que compararan la eficacia de la TRC-D con la terapia con DAI. Finalmente se incluyeron ocho ensayos controlados aleatorizados de 5.674 pacientes. El metaanálisis puso en evidencia que la terapia con TRC-D se acompañaba de una importante mejoría de las condiciones clínicas [odds ratio (OR): 1,66; 95% intervalo de confianza (IC) 1,33-2,07] y una reducción de la hospitalización (OR: 0,7; IC 95%: 0,6-0,81) y la mortalidad por todas las causas (OR: 0,8; IC 95%: 0,67-0,95). Si bien las ventajas de TRC-D con respecto a DAI resultaron obvias, los eventos adversos periimplantación de TRC-D siguen planteando inquietud. Conclusión: comparado con la terapia con DAI, los pacientes sometidos a TRC-D tienen resultados favorables en cuanto a las mejoras de las condiciones clínicas, la tasa de internaciones y la supervivencia global, pero presentan un riesgo significativamente mayor de eventos adversos periimplantación. Se requieren estudios adicionales para optimizar la aplicación clínica de TRC-D.
Aims: the purpose of this study was to evaluate the efficacy and safety of cardiac resynchronization plus implantable cardioverter defibrillator (CRT-D) therapy and implantable cardioverter defibrillator (ICD) therapy in treating heart failure by systematically reviewing randomized controlled trials. Methods and results: databases of Medline, Embase, and Cochrane Library were searched for published studies up to 31 May 2012. Clinicaltrials.gov and US Food and Drug Administration websites were searched as well. Only randomized controlled trials comparing the efficacy of CRT-D therapy with ICD therapy were enrolled in meta-analysis. Eight randomized controlled trials characterizing 5674 patients were finally included. Meta-analysis found that CRT-D therapy was associated with significant improvement in clinical conditions [odds ratio (OR): 1.66; 95% confidence interval (CI):1.33-2.07] and a reduction in hospitalization (OR: 0.7; 95% CI: 0.6 -0.81) and all-cause mortality (OR: 0.8; 95% CI: 0.67-0.95). Although advantages of CRT-D therapy over ICD therapy were obvious, the peri-implantation adverse events of CRT-D therapy remained to be concerns. Conclusion: compared with ICD therapy, patients receiving CRT-D therapy have favourable outcomes regarding improvement in clinical conditions, hospitalization rate, and overall survival, but at a significantly higher risk of peri-implantation adverse events. Future studies are warranted to optimize the clinical application of CRT-D.