Corrected sinus node recovery time as a screening test in patients with typical atrial flutter post-ablation to predict pacemaker implantation / Tiempo de recuperación del nodo sinusal corregido como prueba de tamizaje en pacientes con aleteo atrial típico postablación para predecir la implantación de marcapasos

Abstract Objective: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. Methods: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. Results: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. Conclusion: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.

Resumen Objetivo: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. Métodos: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. Resultados: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). Conclusiones: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

Taquicardia ventricular polimórfica tipo Torsadess de Pointes secundaria a estimulación por marcapasos

La taquicardia ventricular polimórfica se origina en los ventrículos, cuyos complejos QRS son de morfología, amplitud y dirección variable, con frecuencias que oscilan entre 200 y 250 lpm, pudiendo ser autolimitadas o degenerar en una fibrilación ventricular. La TdP es un tipo de taquicardia ventricular polimórfica caracterizada por complejos con un eje eléctrico que gira alrededor de la línea isoeléctrica y que está asociada a QT largo. Se presenta el caso de una paciente portadora de marcapaso que presenta episodios de taquicardia ventricular polimórfica, con una morfología típica de TdP, sin documentación de QT prolongado previo ni actual, generada por la estimulación ventricular sobre onda T, de forma accidental por desplazamiento del electrodo auricular a Ventrículo Derecho (VD).

Polymorphic ventricular tachycardia is a tachycardia originating in the ventricles, where the QRS complexes have variable morphology, amplitude, and direction, with frequencies ranging between 200 and 250 bpm; it may be self-limited or degenerate into ventricular fibrillation. Torsades de Pointes (TdP) is a type of polymorphic ventricular tachycardia characterized by complexes with an electrical axis that rotates around the isoelectric line and that is associated with long QT interval. We present the case of a patient with a pacemaker who presents episodes of polymorphic ventricular tachycardia, with a typical morphology of TdP, without documentation of previous or current prolonged QT, generated by ventricular stimulation on the T wave, accidentally due to displacement of the atrial electrode to the Right Ventricle (RV).

Embolia pulmonar en endocarditis infecciosa asociada a marcapasos: reporte de un caso y revisión de la literatura / Pulmonary embolism in infective endocarditis associated with pacemaker: report of a case and review of the literature

Introducción: Una de las complicaciones más temidas de la endocarditis infecciosa (EI) asociada a marcapasos es la embolia pulmonar. Presentamos el caso de una paciente con diagnóstico actual de EI asociada a marcapasos, que luego de la extracción del dispositivo por vía percutánea presentó síntomas de embolia pulmonar confirmada mediante estudios por imágenes. Objetivos: Conocer el manejo y la evolución intrahospitalarios y a los 18 meses de la embolia pulmonar en el contexto de una endocarditis infecciosa asociada a marcapasos. Materiales y métodos: Búsqueda bibliográfica efectuada en PubMed. Relato del caso clínico: evaluación clínica, presentación de los estudios complementarios y tratamiento. Seguimiento del caso. Resultados: Paciente de 68 años, sexo femenino, con antecedente de implantación de marcapaso definitivo bicameral hace 2 años. Síndrome febril prolongado sin foco aparente, con hemocultivos que fueron positivos para Staphylococcus aureus meticilino-resistente. En el ecocardiograma transesofágico presentaba múltiples vegetaciones en aurícula derecha asociadas con los catéteres. Con base en la anamnesis, el examen físico y los hallazgos en exámenes específicos, se pudo lograr el diagnóstico de EI asociada a marcapasos. Se indicó tratamiento antibiótico y la remoción completa percutánea del dispositivo. Luego del procedimiento presentó disnea súbita confirmándose mediante estudio de centellograma ventilación-perfusión el diagnóstico de embolia pulmonar. Completó el tratamiento antibiótico (vancomicina durante 6 semanas) y fue dada de alta. Durante el seguimiento no presentó nuevas infecciones u otras complicaciones. Conclusión: En nuestro caso, la embolia pulmonar no generó modificaciones en la morbimortalidad intrahospitalaria ni en el seguimiento a 18 meses.

Introduction: One of the most feared infective endocarditis (IE) complications associated with pacemaker is pulmonary embolism. We present the case of a patient with a current diagnosis of pacemaker-associated IE who presented symptoms of pulmonary embolism confirmed by imaging studies after percutaneous removal of the device. Objectives: to know the management and evolution, in-hospital and at 18 months of pulmonary embolism in the context of infective endocarditis associated with pacemaker. Materials and methods: Bibliographic search carried out in PubMed. Clinical case report: clinical evaluation, presentation of complementary studies, and treatment. Follow up on the case. Results: 68-year-old patient with a history of dual chamber permanent pacemaker implantation 2 years ago. Prolonged febrile syndrome with no apparent focus, with positive blood cultures for methicillin-resistant Staphylococcus aureus. The transesophageal echocardiogram showed multiple vegetations associated in right atrial with the catheters. Based on the history, physical examination, and findings in specific tests, the diagnosis of IE associated with DEIP could be achieved. Antibiotic treatment and complete percutaneous removal of the device were indicated. After the procedure, he presented sudden dyspnea, confirming the diagnosis of pulmonary embolism in a ventilation-perfusion scintigram study. She completed the antibiotic treatment (vancomycin for 6 weeks) and was discharged. During follow-up, there were no new infections or other complications. Conclusion: in our patient pulmonary embolism did not generate changes in in-hospital morbidity and mortality or in the 18-month follow-up.

Embolia pulmonar en endocarditis infecciosa asociada a marcapasos: reporte de un caso y revisión de la literatura

Introducción: Una de las complicaciones más temidas de la endocarditis infecciosa (EI) asociada a marcapasos es la embolia pulmonar. Presentamos el caso de una paciente con diagnóstico actual de EI asociada a marcapasos, que luego de la extracción del dispositivo por vía percutánea presentó síntomas de embolia pulmonar confirmada mediante estudios por imágenes. Objetivos: Conocer el manejo y la evolución intrahospitalarios y a los 18 meses de la embolia pulmonar en el contexto de una endocarditis infecciosa asociada a marcapasos. Materiales y métodos: Búsqueda bibliográfica efectuada en PubMed. Relato del caso clínico: evaluación clínica, presentación de los estudios complementarios y tratamiento. Seguimiento del caso. Resultados: Paciente de 68 años, sexo femenino, con antecedente de implantación de marcapaso definitivo bicameral hace 2 años. Síndrome febril prolongado sin foco aparente, con hemocultivos que fueron positivos para Staphylococcus aureus meticilino-resistente. En el ecocardiograma transesofágico presentaba múltiples vegetaciones en aurícula derecha asociadas con los catéteres. Con base en la anamnesis, el examen físico y los hallazgos en exámenes específicos, se pudo lograr el diagnóstico de EI asociada a marcapasos. Se indicó tratamiento antibiótico y la remoción completa percutánea del dispositivo. Luego del procedimiento presentó disnea súbita confirmándose mediante estudio de centellograma ventilación-perfusión el diagnóstico de embolia pulmonar. Completó el tratamiento antibiótico (vancomicina durante 6 semanas) y fue dada de alta. Durante el seguimiento no presentó nuevas infecciones u otras complicaciones. Conclusión: En nuestro caso, la embolia pulmonar no generó modificaciones en la morbimortalidad intrahospitalaria ni en el seguimiento a 18 meses.

Introduction: One of the most feared infective endocarditis (IE) complications associated with pacemaker is pulmonary embolism. We present the case of a patient with a current diagnosis of pacemaker-associated IE who presented symptoms of pulmonary embolism confirmed by imaging studies after percutaneous removal of the device. Objectives: to know the management and evolution, in-hospital and at 18 months of pulmonary embolism in the context of infective endocarditis associated with pacemaker. Materials and methods: Bibliographic search carried out in PubMed. Clinical case report: clinical evaluation, presentation of complementary studies, and treatment. Follow up on the case. Results: 68-year-old patient with a history of dual chamber permanent pacemaker implantation 2 years ago. Prolonged febrile syndrome with no apparent focus, with positive blood cultures for methicillin-resistant Staphylococcus aureus. The transesophageal echocardiogram showed multiple vegetations associated in right atrial with the catheters. Based on the history, physical examination, and findings in specific tests, the diagnosis of IE associated with DEIP could be achieved. Antibiotic treatment and complete percutaneous removal of the device were indicated. After the procedure, he presented sudden dyspnea, confirming the diagnosis of pulmonary embolism in a ventilation-perfusion scintigram study. She completed the antibiotic treatment (vancomycin for 6 weeks) and was discharged. During follow-up, there were no new infections or other complications. Conclusion: in our patient pulmonary embolism did not generate changes in in-hospital morbidity and mortality or in the 18-month follow-up.

Pacemaker Infective Endocarditis: Diagnostic and Therapeutic Particularities in 2 Case Reports Including One of the Left Heart

Pacemaker infective endocarditis is a more real diagnostic problem than a therapeutic one. The precise impact is not well known. Its incidence is poorly known, and it is a serious infection with an estimated mortality of around 25%. It is with this in mind that we report 2 clinical cases with a literature review. Case 1: An 88-year-old patient with a double chamber pacemaker was admitted for febrile syndrome with a fever at 39.2°. Transthoracic and transesophageal echocardiography (TOE) found an image of vegetation on the aortic valve measuring 9mm, located on the noncoronary cusp, and overflowing on the right coronary cusp. An inflammatory syndrome was found on blood tests. Blood culture, wound swab culture, and bacteriological study of material after removal revealed Staphylococcus Aureus Meti S. The patient was initially put on Vancomycin with a loading dose of 2g / 24h then 1g / 24h, and the pacemaker was extracted. Case 2: A 68-year-old with a double chamber pacemaker (PM) was admitted for fever at 39 ° c with suppuration of the PM pocket. Echocardiography identified an image on the tricuspid valve measuring 14x8 mm evoking vegetation given the context. Two blood cultures and swabs isolated a Staphylococcus aureus. The patient was administered Triaxon 2g / day for 4 weeks and gentamycin 180 mg for 15 days. The pacemaker was removed. Pacemaker Infective endocarditis is rare, poorly understood, very serious, and potentially fatal, accounting for up to about 7% in some case series. In half of the cases, they affect the endocavitary leads, but also the valves, and in 45% of cases the infection of the pocket. The average age is 65 years. The clinical symptoms are disparate making the diagnosis more difficult, it must be evoked in case of unexplained fever in a patient implanted with a Pacemaker. Bactericidal dual therapy should be administered after blood cultures in case of strong suspicion of infective endocarditis (IE) and adapted after identification of the germ in question. Most authors are adamant about extracting any pacemaker whenever possible.

Guía para identificar características específicas en dispositivos de estimulación cardiaca mediante figura radiológica / Guide to identify specific characteristics in cardiac pacing devices by radiological figure

Resumen Esta guía propone brindar una ayuda a todos los médicos para la identificación metódica de cada marca comercial de marcapasos por radiografía simple de tórax, por medio de sus componentes electrónicos (conectores de electrodos, circuito lógico y batería), siendo necesario para la interrogación de dispositivos de marcapasos posterior a su implante. Se describirán los diferentes tipos de marcapasos, electrodos y modos de programación más frecuentemente utilizados.

Abstract This guide provides help for medical doctors systematically identifying each commercial brand of pacemakers by thoracic radiography through their electronic components (electrode connectors, logic circuit, and battery); this is crucial for watching the pacemaker after being implanted. We aimed to describe the different cardiac stimulation devices, electrodes, and programming modes more frequently used.

Estimulación temporal mediante cable de fijación activa / Temporal stimulation by active fixation lead

Resumen Objetivo: Determinar seguridad y eficacia del marcapasos temporal mediante cable de fijación activa vía yugular y/o subclavia. Métodos: Se analizaron pacientes desde 2017 a 2021 postextracción de marcapasos dependientes de estimulación. Resultados: Se colocó estimulación temporal en 25 pacientes con una edad media de 68 ± 16 años. La media de duración de la estimulación temporal fue cinco días. No se registró mortalidad asociada a la estimulación temporal, sin embargo en un paciente se presentó desplazamiento de cable y falla de captura a los cuatro días de la colocación. Conclusiones: La estimulación temporal mediante cable de fijación activa es segura y eficaz.

Abstract Objective: To determine the efficacy and safety of temporary pacing with an active fixation lead placed trough the internal jugular vein and/or subclavian vein. Methods: We analyzed a consecutive series of 25 out of 73 patients that had a pacemaker extraction and were pacing dependent requiring temporary pacing with an active fixation lead until the new pacemaker implant, from 2017 to 2021. Results: After extraction 25 patients age 68 years ±16 years, required temporary pacing, the media for temporary pacing was 5 days. There were no mortality associated to temporary stimulation. Only one patient (4%) had a complication 4 days after the implant with capture fail due to a microdislogement requiring reintervention. Conclusion: Temporary stimulation through active fixation pacemaker lead it is safe and effective.

Application of nursing management based on self-efficacy theory in the patients of early functional exercise of the affected limb after permanent pacemaker implantation / 中国实用护理杂志

Objective:To study the application value of nursing management based on self-efficacy theory in the early functional exercise of the affected limb after permanent pacemaker implantation.Methods:This study was a randomized controlled trial. A total of 90 patients who underwent permanent pacemaker implantation in Wuxi Second People′s Hospital (the Affiliated Central Hospital of Jiangnan University) from May 2019 to March 2021 were enrolled. They were divided into observation group and control group with 45 patients each according to random number table. The control group received routine nursing intervention, and the observation group received supplemental management interventions based on self-efficacy theory. The rate of post-operative rehabilitation up to the standard, the scores of the Shoulder Pain and Disability Index (SPADI), Chronic Disease Self-Efficacy Scale (CDSES) and Quality of Life Instrument for Patients with Pacemaker (QLIPP) were compared.Results:The rate of observation group's post-operative rehabilitation up to the standard was 93.33% (42/45), which was higher than that of the control group 77.78% (35/45). The difference was statistically significant ( χ2 =4.41, P<0.05). The pain index of the observation group was (20.27 ± 4.13), (5.25 ± 2.64)points at 1 and 2 weeks after operation, which was significantly lower than (27.06 ± 5.30), (9.35 ± 4.22) points of the control group ( t=6.78, 5.53, both P<0.05). The dysfunction index of the observation group was (15.06 ± 5.96), (7.21 ± 3.68) points, which was significantly lower than (17.75 ± 6.04), (9.03 ± 4.06) points of the control group ( t=2.13, 2.23, both P<0.05). After 2 weeks of operation, the total score of CDSES in the observation group was (4.73 ± 1.68) points, which was higher than (3.67 ± 1.49) points in the control group, and the difference was statistically significant ( t=3.17, P<0.05). The total score of QLIPP in the observation group was (92.78 ± 6.26), (124.40 ± 4.91) points at 2 weeks and 1 month after operation, which was significantly higher than (83.50 ± 7.91), (112.42 ± 5.04) points in the control group ( t=6.17, 9.51, both P<0.05). Conclusions:The application of nursing care based on self-efficacy theory in the patients of early functional exercise of the affected limb after permanent pacemaker implantation can improve rehabilitation compliance, self-efficacy of patients, the function of the affected shoulder joint and the patient′s quality of life.

Implante de marcapasos a través de la vena cava superior izquierda persistente por ausencia de vena cava superior derecha. Reporte de un caso / Pacemaker implantation through the persistent left superior vena cava due to the absence of the right superior vena cava. Report of a case / Implante de marcapasso pela veia cava superior esquerda persistente devido à ausência da veia cava superior direita. Relato de um caso

Resumen: Introducción: la persistencia de la vena cava superior izquierda (PVCSI) tiene una prevalencia de 0.21% en la población general. Presentación del caso: masculino de 67 años de edad diagnosticado con bloqueo auriculoventricular (AV) de tercer grado y que requirió colocación de marcapasos; sin embargo, debido a la ausencia de la vena cava superior derecha, corroborado por angiotomografía, se colocó marcapasos definitivo a través de la vena cava superior izquierda persistente. Conclusión: la persistencia de la vena cava superior izquierda (PVCSI) es la anomalía venosa torácica más común. Puede causar una serie de síntomas clínicamente significativos, incluso en un corazón con anatomía normal. La colocación de marcapasos dificulta la fijación del electrodo debido al recorrido tortuoso que genera.

Abstract: Introduction: the persistence of the left superior vena cava (PLSVC) has a prevalence of 0.21% in the general population. Case presentation: 67-year-old male diagnosed with third-degree AV block, requiring pacemaker placement. However, due to the absence of a right superior vena cava, corroborated by CT angiography, a definitive pacemaker was placed through a persistent left superior vena cava. Conclusion: the persistence of the left superior vena cava (PLSVC) is the most common thoracic venous anomaly. It can cause a number of clinically significant symptoms, even in a heart with normal anatomy. Pacemaker placement makes electrode fixation difficult due to tortuous travel.

Resumo: Introdução: a persistência da veia cava superior esquerda (PVCSI) tem uma prevalência de 0.21% na população geral. Apresentação do caso: Homem de 67 anos com diagnóstico de bloqueio AV de terceiro grau, necessitando de colocação de marcapasso. No entanto, devido à ausência da veia cava superior direita, corroborada pela angiotomografia, colocou-se marcapasso definitivo através da veia cava superior esquerda persistente. Conclusão: a persistência da veia cava superior esquerda (PVCSI) é a anomalia venosa torácica mais comum. Pode causar uma série de sintomas clinicamente significativos, mesmo em um coração com anatomia normal. A colocação do marcapasso dificulta a fixação do eletrodo devido ao trajeto tortuoso.

Monocyte/High-Density Lipoprotein Ratio Is Associated with Atrial High-Rate Episodes within One Year Detected by Cardiac Implantable Electronic Devices

ABSTRACT Objective: To investigate the risk factors for predicting atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs). Methods: A total of 140 patients with CIED in our hospital from June 2013 to June 2018 were included and were followed up to observe whether they had AHREs. AHRE are defined as atrial rate ≥ 175 times/minute, lasting > 5 minutes, and reviewed by an experienced electrophysiologist with unclear clinical diagnosis. The patients fasted for 12 hours after implantation, and blood samples were collected for biochemical, lipid, and whole blood count detection. Follow-up was regular after discharge to record follow-up data of each patient and conduct statistical analysis. Results: One hundred and forty patients were implanted with dual-chamber pacemakers, their median age was 70 years old, 44.29% were male, 27 patients had AHRE within one year, and AHRE incidence rate was 19.29%. The microcytic to hypochromic (M/H) ratio was calculated for all AHRE patients and compared with the patients without AHRE; the M/H value of AHRE patients was significantly higher. Throughout the entire follow-up period, a total of 44 patients developed AHRE; when adjusted by multivariate analysis, only M/H ratio ≥ 4.5 vs. < 4.5 had statistical significance, and the adjusted hazard ratio value was 4.313 (1.675-11.105). Conclusion: As an indicator, M/H ratio may play an important role in the occurrence and development of atrial fibrillation and can be used as a predictor of AHRE in patients with CIED.

Development of educational technology for transcutaneous pacemaker management in older adults undergoing mobile pre-hospital assistance / Desarrollo de una tecnología educativa para el manejo de marcapasos transcutáneos en ancianos en el servicio de móvil de atención prehospitalaria / Desenvolvimento de tecnologia educacional para manejo do marca-passo transcutâneo em idosos no atendimento pré-hospitalar móvel

ABSTRACT Objective: to develop educational technology for nurses on transcutaneous pacemaker management in older adults undergoing mobile pre-hospital assistance. Method: a methodological study developed with the Advanced Support Units of the Mobile Urgency Care Service of the 2nd Metropolitan Health Region of Paraná, Brazil, in three phases: 1) Pre-production - preparation of the video script; 2) Production - script validation by expert judges, storyboard development, voiceover recording and selection of images; and 3) Post-production - evaluation of the video by expert judges and diffusion. 51 specialist judge nurses took part in validation of the script; and 47 of them assessed the video. The data were collected between April and May 2022 using instruments with a Likert scale, via Google Forms. Descriptive statistics was applied for data analysis and a Content Validity Index of at least 0.78 was considered. Results: the judges suggested less technical language, inclusion of a scene and a correction referring to the positioning of the transcutaneous pacemaker adhesive pads. A 2D video lasting 8 minutes and 30 seconds was produced, which addressed actions and care measures in managing pacemakers in older adults. The following items were considered adequate: language, images, voiceover, duration, guidelines proposed and memorization of the messages (CVI=1.0). Conclusion: the educational technology developed was considered validated for nurses regarding the transcutaneous pacemaker management in older adults. The educational video can support decision-making in favor of patient and team safety and treatment efficacy, in order to qualify the assistance provided.

RESUMEN Objetivo: desarrollar una tecnología educativa para enfermeros sobre el manejo de marcapasos transcutáneos en ancianos, en el Servicio Móvil de Atención Prehospitalaria. Método: estudio metodológico desarrollado con las Unidades de Soporte Avanzado pertenecientes al Servicio Móvil de Atención de Urgencias de la 2º Región de Salud Metropolitana de Paraná, Brasil, en tres fases: 1) Pre-producción - elaboración del guión del video; 2) Producción - validación del guión a cargo jueces especialistas, elaboración del storyboard, grabación de las narraciones y selección de las imágenes; y 3) Post-producción - evaluación del video a cargo de jueces especialistas y divulgación del video. Los participantes del proceso de validación del guión fueron 51 jueces especialistas y enfermeros de profesión; y 47 de ellos evaluaron el video. Los datos se recolectaron entre abril y mayo de 2022 por medio de instrumentos con una escala de Likert, a través de Formularios Google. Se aplicó estadística descriptiva para el análisis de los datos y se consideró un Índice de Validez de Contenido de al menos 0,78. Resultados: los jueces sugirieron lenguaje menos técnico, incluir una escena y correcciones referentes a la ubicación de los parches adhesivos del marcapasos transcutáneo. El video se produjo en 2D y duró 8 minutos con 30 segundos, analizando acciones y precauciones en el manejo de marcapasos en ancianos. Los siguientes elementos se consideraron adecuados: lenguaje, imágenes, narración, duración, pautas de orientación propuestas y memorización de los mensajes (IVC=1,0). Conclusión: la tecnología educativa que se desarrolló fue considerada validada para enfermeros en relación con el manejo de marcapasos transcutáneos en ancianos. El video educativo puede asistir en el proceso de toma de decisiones en pos de la seguridad del paciente y del equipo de atención, al igual que para la eficacia del tratamiento, a fin de calificar la asistencia provista.

RESUMO Objetivo: desenvolver tecnologia educacional para enfermeiros sobre manejo do marca-passo transcutâneo em idosos, em atendimento pré-hospitalar móvel. Método: estudo metodológico, desenvolvido junto às Unidades de Suporte Avançado do Serviço de Atendimento Móvel de Urgência da 2º Regional de Saúde Metropolitana do Paraná, Brasil, em três fases: 1) pré-produção - elaboração do roteiro do vídeo; 2) produção - validação do roteiro por juízes especialistas, elaboração do storyboard, gravação das narrações e seleção de imagens; 3) pós-produção - avaliação do vídeo por juízes especialistas e divulgação do vídeo. Participaram da validação do roteiro 51 enfermeiros juízes especialistas; e 47 deles avaliaram o vídeo. Coletaram-se os dados entre abril e maio de 2022, por meio de instrumentos, com escala de Likert, via Google Formulários. Aplicou-se estatística descritiva para análise dos dados e considerou-se Índice de Validade de Conteúdo de pelo menos 0,78. Resultados: os juízes sugeriram linguagem menos técnica, inclusão de cena e correção referente ao posicionamento das pás adesivas do marca-passo transcutâneo. Produziu-se vídeo em 2D de 8 minutos e 30 segundos, que abordou ações e cuidados no manejo do marca-passo em idosos. Consideraram-se adequados os quesitos: linguagem, imagens, narração, tempo de duração, orientações propostas e memorizações das mensagens (IVC =1,0). Conclusão: a tecnologia educacional desenvolvida foi considerada validada para enfermeiros quanto ao manejo do marca-passo transcutâneo em idosos. O vídeo educacional pode subsidiar a tomada de decisões em prol da segurança do paciente, da equipe e da eficácia no tratamento, de modo a qualificar a assistência.

Dispositivos cardíacos implantables y uso de resonancia magnética / Cardiac implantable devices and use of magnetic resonance / Dispositivos cardíacos implantáveis e utilização da ressonância magnética

El uso de la resonancia magnética (RM) en las distintas áreas de la medicina se ha expandido de manera significativa y de forma diaria se solicitan numerosos estudios. El hecho de que los resonadores pueden interaccionar con algunos objetos ha llevado a que históricamente se les niegue la realización de este estudio a pacientes portadores de dispositivos cardíacos porque se entiende que existen contraindicaciones absolutas. El avance de la tecnología de los dispositivos y la creciente evidencia publicada han cambiado este concepto. Nos proponemos revisar los mecanismos por los cuales un dispositivo implantable puede interactuar con el resonador y las implicancias clínicas que esto podría tener si las hubiera. La mayoría de los pacientes portadores de dispositivos cardíacos de estimulación podrán realizarse una RM, pero para que este procedimiento sea seguro es importante conocer las características y el tipo específico de dispositivo implantado. Proponemos finalmente puntos clave y algoritmos para tener en cuenta para el manejo adecuado de estos pacientes.

The use of magnetic resonance imaging (MRI) in different areas of medicine has expanded significantly and numerous procedures are indicated daily. The fact that resonators could interact with some objects has historically led to patients with cardiac devices being denied an MRI on the understanding that they suppose an absolute contraindication. Advances in device technology and the increasing evidence have changed this concept. We intend to review the mechanisms by which an implantable device could interact with the resonator and the clinical implications that this could have if any. Most patients will be able to undergo these studies, but to determine the safety of performing an MRI it is important to know the characteristics and specific type of implanted device. Finally, we provide key points and algorithms to take into account for these patients.

O uso da ressonância magnética em diferentes áreas da medicina tem se expandido significativamente e inúmeros exames são indicados diariamente. A possibilidade de que os ressonadores interajam com alguns objetos historicamente levou os pacientes com dispositivos cardíacos a terem a ressonância magnética negada por entender que existem contraindicações absolutas. Os avanços na tecnologia de dispositivos e o aumento das evidências publicadas mudaram esse conceito. Pretendemos revisar os mecanismos pelos quais um dispositivo implantável pode interagir com o ressonador e as implicações clínicas que isso pode ter, se houver. A grande maioria dos pacientes poderá se submeter a esses estudos, mas para determinar a segurança de realizar uma ressonância magnética é importante conhecer as características e o tipo específico de dispositivo implantado. Por fim, propomos pontos e algoritmos para a gestão dos pacientes.

Reprocessamento de Marca-Passos em Países de Língua Portuguesa: Uma Reflexão Clínica / Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection

Resumo Há uma enorme disparidade entre os países de alta renda e outros em termos de acesso a dispositivos médicos cardíacos, como marca-passos e desfibriladores implantáveis. Os custos são uma das principais barreiras ao uso de dispositivos cardíacos nesses países. Existem iniciativas internacionais que visam reduzir essa disparidade, e o reuso de marca-passos tem sido discutido como uma possível alternativa. O conceito de reutilização de marca-passos não é novo; entretanto, estudos recentes têm se mostrado seguros, éticos e eficazes para aqueles que precisam de dispositivos eletrônicos cardíacos implantáveis e não tem como adquiri-los. Parte dos países de língua portuguesa, especialmente na África, precisam de uma resposta imediata que beneficie seus inúmeros pacientes que sofrem de arritmias tratáveis.

Abstract There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.

Safety of leadless pacemaker implantation in super-elderly patients / 中华全科医师杂志

Objective:To evaluate the safety of leadless pacemaker implantation in super-elderly patients.Methods:Eleven patients with average age of 90 (86, 92) years who underwent leadless pacemaker implantation in the Department of Cardiology, Peking University People′s Hospital from March 2021 to May 2022 were included. The clinical data and implantation information were collected. The complications (cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection, femoral vein hematoma) and death of patients were documented at 24 h, 3 d, and 1, 3, 6 months after pacemaker implantation.Results:There were 9 males and 2 females with the body mass index of 21(19, 23)kg/m 2. The underlying diseases were hypertension, diabetes, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, previous cerebral infarction and moderate to severe tricuspid regurgitation in 9, 9, 9, 6, 4, 4, 4 patients, respectively. The left ventricular ejection fraction was 49% (45%, 52%), the hemoglobin concentration was 118 (114, 122)g/L, 4 patients were taking anticoagulant drugs, and 6 patients were taking antiplatelet drugs. Eight patients were newly implanted with a leadless pacemaker, 2 patients were implanted after removal the old ones, and 1 case was implanted at the same time as removal. The implantation time was 45(40, 47) minutes, the X-ray exposure time was 14 (13, 15) minutes, the release time was 1 (1, 2), the threshold value was 0.50(0.38, 0.75)V/0.24 ms, the impedance was 730 (700, 770) Ω, and the perceived R-wave amplitude 8.2(6.7, 12.8) mV. During the follow-up period of 8 (6, 10) months, no patient had pacemaker dysfunction; and the threshold, R wave sensing, and impedance were stable and maintained within the normal range. No cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection or death occurred perioperatively and during the follow-up period; 1 patient had hematoma after femoral vein puncture, which improved after compression treatment. Conclusion:This single-center and small-sample study shows that leadless pacemaker implantation is safe for super-elderly patients.

Acometimento do Ventrículo Direito na Cardiomiopatia por Depósito de Glicogênio (PRKAG2): Análise Ecocardiográfica Convencional e Avançada / Right Ventricle Involvement by Glycogen Storage Cardiomyopathy (PRKAG2): Standard and Advanced Echocardiography Analyses

Resumo Fundamento A síndrome do PRKAG2 é uma doença hereditária autossômica dominante rara, de início precoce. Objetivamos descrever os achados ecocardiográficos do ventrículo direito (VD) usando modalidades bi e tridimensionais (2D e 3D), incluindo índices de deformação miocárdica nesta cardiomiopatia. Também objetivamos demonstrar se esta técnica poderia identificar alterações na função do VD que pudessem distinguir quaisquer achados particulares. Métodos Trinta pacientes com síndrome do PRKAG2 (R302Q e H401Q) geneticamente comprovada, 16 (53,3%) do sexo masculino, com idade média de 39,1 ± 15,4 anos, foram submetidos a exame ecocardiográfico completo. A visão de 4 câmaras com foco no VD foi adquirida para medições 2D e 3D. Os testes t de Student ou Wilcoxon-Mann-Whitney foram usados para comparar as variáveis numéricas entre 2 grupos, e p < 0,05 foi considerado significativo. Resultados Doze pacientes (40%) tiveram marca-passo implantado por 12,4 ± 9,9 anos. A espessura diastólica média da parede livre do VD foi de 7,9 ± 2,9 mm. O strain longitudinal de 4 câmaras do VD (SL4VD), incluindo a parede livre e o septo interventricular, foi de -17,3% ± 6,7%, e o strain longitudinal da parede livre do VD (SLPLVD) foi de −19,1% ± 8,5%. A razão apical do SLPLVD mediu 0,63 ± 0,15. A fração de ejeção (FE) 3D média do VD foi de 42,6% ± 10,9% e abaixo dos limites normais em 56,7% dos pacientes. Correlação positiva ocorreu entre FE 3D do VD, SL4VD e SLPLVD, principalmente para pacientes sem marca-passo (p = 0,006). Conclusão O envolvimento do VD em PRKAG2 é frequente e ocorre em diferentes graus. A ecocardiografia é uma ferramenta valiosa na detecção de anormalidades miocárdicas do VD nesta condição. O uso de SL4VD 2D, SLPLVD e FE 3D oferecem indicadores confiáveis de disfunção sistólica do VD nesta cardiomiopatia rara e desafiadora.

Abstract Background PRKAG2 syndrome is a rare, early-onset autosomal dominant inherited disease. We aimed to describe the right ventricle (RV) echocardiographic findings using two and three-dimensional (2D and 3D) modalities including myocardial deformation indices in this cardiomyopathy. We also aimed to demonstrate whether this technique could identify changes in RV function that could distinguish any particular findings. Methods Thirty patients with genetically proven PRKAG2 (R302Q and H401Q), 16 (53.3%) males, mean age 39.1 ± 15.4 years, underwent complete echocardiography examination. RV-focused, 4-chamber view was acquired for 2D and 3D measurements. Student's t or Wilcoxon-Mann-Whitney tests were used to compare numerical variables between 2 groups, and p < 0.05 was considered significant. Results Twelve patients (40%) had a pacemaker implanted for 12.4 ± 9.9 years. RV free wall mean diastolic thickness was 7.9 ± 2.9 mm. RV 4-chamber longitudinal strain (RV4LS), including the free wall and interventricular septum, was -17.3% ± 6.7%, and RV free wall longitudinal strain (RVFWLS) was −19.1% ± 8.5%. The RVFWLS apical ratio measured 0.63 ± 0.15. Mean RV 3D ejection fraction (EF) was 42.6% ± 10.9% and below normal limits in 56.7% of patients. Positive correlation occurred between RV 3DEF, RV4LS, and RVFWLS, especially for patients without a pacemaker (p = 0.006). Conclusion RV involvement in PRKAG2 syndrome is frequent, occurring in different degrees. Echocardiography is a valuable tool in detecting RV myocardial abnormalities in this condition. The use of 2D RV4LS, RVFWLS, and 3DEF offers reliable indicators of RV systolic dysfunction in this rare, challenging cardiomyopathy.

RECURRENT SINUS ARREST DURING LAPAROSCOPIC SACRAL COLPOPEXY IN PATIENTS WITH SICK SINUS SYNDROME : A CASE REPORT

Sick sinus syndrome (SSS) is a disease in which the SA node fails to perform the function of pacemaking. ECG shows various rhythms including sinus arrest. We report recurrent sinus arrest during laparoscopic sacral colpopexy in a 77-year-old female patient with SSS. The patient was diagnosed with SSS, but as there were no symptoms, the operation was performed without pacemaker implantation. After induction of anesthesia, vital signs were stable, but sinus arrest repeatedly appeared due to elevated vagal tone during uterine traction. After operation, the patient underwent pacemaker implantation, and to this day, she is doing well without any symptoms. The anesthesiologist should pay close attention to the progress of the operation through much communication with operator during the surgery. Also, we recommend to considering temporary pacemaker implantation for patients with SSS who undergo surgery that can increase vagal tone.