Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 2.231
Filter
1.
Arq. bras. cardiol ; Arq. bras. cardiol;121(11): e20240357, 20240000. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1581703

ABSTRACT

Resumo Fundamento Estudos anteriores caracterizaram adequadamente a microbiota intestinal (MI) na fibrilação atrial (FA). No entanto, a causalidade precisa entre a MI e a FA permanece obscura. Objetivos O presente estudo utilizou dados públicos de estudos de associação genômica ampla para explorar a causalidade entre MI e FA. Métodos Na primeira de duas rodadas de análise de randomização mendeliana (RM), as variáveis instrumentais (VIs) incluíram polimorfismos de nucleotídeo único (SNPs) que ficaram abaixo do limite de significância estatística de todo o genoma (5 × 10-8). Para chegar a uma conclusão mais abrangente e inclusiva, selecionamos ainda SNPs abaixo do nível de significância de todo o lócus (1 × 10-5) como VIs para o segundo grupo. A análise de RM considerou o efeito causal estatisticamente significativo entre MI específica e FA quando p < 0,05. Além disso, na análise de sensibilidade, p > 0,05 não indicou heterogeneidade nem pleiotropia. Resultados No limiar de significância de todo o lócus, os resultados demonstraram um impacto causal da MI no risco de FA. O método de ponderação de variância inversa indicou que Actinobacteria, Firmicutes, Alloprevotella, Bifidobacterium, Blautia, Eggerthella, Howardella, Ruminococcaceae UCG004 e Ruminococcus1 foram negativamente correlacionados com FA, ao passo que Pasteurellales, Pasteurellaceae, Oxalobacter, Ruminiclostridium5 e Turicibacter foram positivamente correlacionados. Além disso, no limiar de significância de todo o genoma, Actinobacteria, Bifidobacteriaceae e Bifidobacterium foram fatores de proteção para o risco de desenvolver FA, ao passo que Oxalobacteraceae e Erysipelatoclostridium foram fatores de risco para FA. Entretanto, análises de sensibilidade mostraram heterogeneidade ou pleiotropia horizontal nos resultados para Actinobacteria, Howardella, Oxalobacter e Firmicutes. Conclusões Este estudo fornece evidências da existência de causalidade favorável e desfavorável da MI no risco de FA.


Abstract Background Previous studies have adequately characterized the gut microbiota (GM) in atrial fibrillation (AF). Nevertheless, the precise causality between GM and AF remains elusive. Objectives This study utilized public data from genome-wide association studies to explore the causality between GM and AF. Methods In the first of two rounds of Mendelian randomization (MR) analysis, the instrumental variables (IVs) comprised single nucleotide polymorphisms (SNPs) that fell below the genome-wide statistical significance threshold (5 × 10-8). To attain a more comprehensive and inclusive conclusion, we further selected SNPs falling below the locus-wide significance level (1 × 10-5) as IVs for the second group. The MR analysis considered the statistically significant causal effect between the specific GM and AF when p < 0.05. Furthermore, in sensitivity analysis, p > 0.05 indicated no heterogeneity and pleiotropy. Results At the locus-wide significance threshold, the findings demonstrated a causal impact of GM on AF risk. The inverse variance weighting method indicated that Actinobacteria, Firmicutes, Alloprevotella, Bifidobacterium, Blautia, Eggerthella, Howardella, Ruminococcaceae UCG004, and Ruminococcus1 were negatively correlated with AF, while Pasteurellales, Pasteurellaceae, Oxalobacter, Ruminiclostridium5, and Turicibacter were positively correlated. Furthermore, at the genome-wide significance threshold, Actinobacteria, Bifidobacteriaceae, and Bifidobacterium were protective factors for the risk of developing AF, whereas Oxalobacteraceae and Erysipelatoclostridium were risk factors for AF. However, sensitivity analyses showed heterogeneity or horizontal pleiotropy within the outcomes for Actinobacteria, Howardella, Oxalobacter, and Firmicutes. Conclusions This study provides evidence for the existence of both favorable and unfavorable causality of GM on AF risk.

2.
Article | IMSEAR | ID: sea-241286

ABSTRACT

Pre-excited atrial fibrillation (AF) is a significant clinical condition associated with Wolff-Parkinson-White (WPW) syndrome, characterized by an accessory pathway that enables rapid conduction of atrial fibrillatory waves to the ventricles, leading to dangerously elevated ventricular rates. While WPW syndrome is typically diagnosed in younger individuals, its occurrence in elderly patients is rare and often underreported. This case report discusses a 79-year-old male with well-controlled hypertension who was admitted for poorly tolerated irregular tachycardia with broad QRS complexes, indicative of pre-excited atrial fibrillation (AF). Urgent synchronized electrical cardioversion successfully restored sinus rhythm. Although catheter ablation was proposed as a definitive treatment, the patient chose to postpone the procedure, with close monitoring implemented afterward. This case underscores the challenges of diagnosing WPW syndrome in elderly patients, the potential dangers of pre-excited AF, and the importance of individualized management strategies tailored to patient preferences and comorbidities.

3.
Rev. méd. Maule ; 39(2): 48-53, sept. 2024. ilus
Article in Spanish | LILACS | ID: biblio-1578218

ABSTRACT

Ebstein's anomaly is a rare congenital heart defect that affects the right ventricle. It can cause paradoxical embolism, cyanosis and arrhythmias due to atrialization and apical descent of the tricuspid orifice. Arrhythmias are common in adults, and biventricular failure is associated with less favorable outcomes. Diagnosis is based on clinical and electrocardiographic criteria and treatment requires a multidisciplinary approach. CLINIC CASE: A 77-year-old Chilean male patient with a history of type 2 diabetes mellitus, high blood pressure, dyslipidemia, and atrial fibrillation (AF). Subsequently, he developed dyspnea and severe hypertension, acute heart failure. Left ventricular hypertrophy, severe atrial dilation, mild to moderate valvular insufficiency and possible pulmonary hypertension were found by echocardiograms. These results were confirmed by an Echo-Doppler, which revealed atrialization of the right ventricle and septal dyskinesia. DISCUSSION: Patient with valvular insufficiencies and persistent AF, identified by Doppler ultrasound, is an example of how Ebstein's Anomaly can be diagnosed later. The value of echocardiography in diagnosis and how comorbidities such as hypertension and dyslipidemia can worsen the condition is highlighted in this case. In patients with RV widening or severe tricuspid regurgitation, even without symptoms, early surgical intervention is essential to improve survival and cardiac function.


La anomalía de Ebstein es un defecto cardíaco congénito poco común que afecta al ventrículo derecho. Puede causar embolia paradójica, cianosis y arritmias por atrialización y descenso apical del orificio tricúspide. Las arritmias son comunes en los adultos y la insuficiencia biventricular está relacionada con resultados menos favorables. El diagnóstico se basa en criterios clínicos y electrocardiográficos y el tratamiento requiere un enfoque multidisciplinario. CASO CLÍNICO: Paciente masculino de 77 años, chileno, con antecedentes de diabetes mellitus tipo 2, hipertensión arterial, dislipidemia y fibrilación auricular (FA). Posteriormente, presentó disnea e hipertensión grave, insuficiencia cardíaca aguda. Hipertrofia ventricular izquierda, dilatación auricular severa, insuficiencia valvular leve a moderada y posible hipertensión pulmonar fueron hallados por ecocardiogramas. Estos resultados fueron confirmados por un Eco-Doppler, que reveló la atrialización del ventrículo derecho y la diskinesia septal. DISCUSIÓN: Paciente con insuficiencias valvulares y FA persistente, identificada por Eco-Doppler, es un ejemplo de cómo la Anomalía de Ebstein puede ser diagnosticada más tarde. El valor de la ecocardiografía en el diagnóstico y cómo las comorbilidades, tales como la hipertensión y la dislipidemia, pueden empeorar la condición, lo cual se resalta en este caso. En pacientes con ensanchamiento del VD o regurgitación tricuspídea grave, aunque no presenten síntomas, es fundamental una intervención quirúrgica temprana para mejorar la supervivencia y la función cardíaca.


Subject(s)
Humans , Male , Aged , Ebstein Anomaly/complications , Ebstein Anomaly/diagnosis , Atrial Fibrillation , Patient Care Management , Cardiotonic Agents/therapeutic use , Echocardiography, Doppler, Color , Rare Diseases , Ebstein Anomaly/physiopathology , Ebstein Anomaly/genetics , Ebstein Anomaly/therapy
4.
Article | IMSEAR | ID: sea-241272

ABSTRACT

Introduction: Cerebrovascular stroke is a public health problem. They are dominated by ischemic origin, of which cardioembolic etiology is a significant cause. The aim of our study is to determine the in-hospital prevalence of cardiovascular disease in patients with cerebrovascular stroke and the diagnostic and therapeutic impact of all the complementary examinations carried out. Materials and Methods: This is a retrospective descriptive and analytical study carried out over a 7-year period (July 2017-June 2024) compiling cases of ischemic stroke admitted to the cardiology and neurology departments of the Mohamed VI University Hospital in Marrakech. Routine examinations included ECG, transthoracic cardiac echocardiography and echocardiography-doppler of the neck vessels, while transesophageal echocardiography (TEE) and Holter ECG were performed only in a select cases. Results: Three hundred cases were collected and evaluated. The mean age of the patients was 68.3 ± 8.9 years (21-90 years), with a clear male predominance (64.3%). Eighty percent had at least one cardiovascular risk factor. A cardiovascular history of hypokinetic cardiomyopathy at the dilated stage was found in 7.6% of cases. The average consultation time was 26 hours. Clinical presentation according to NIHSS score was as follows: a score below 10 in 65% of cases, between 10 and 20 in 21% and above 20 in 14%. ECG was abnormal in 67.6% of cases (203 patients); TTE was abnormal in 63%, with dilatation of the left atrium (LA) the main abnormality. TEE in 8% of cases revealed 3 cases of inter-atrial aneurysm with patent foramen oval, seven cases of left atrial thrombus, one left atrial myxoma, 3 cases of mitral valve wing block and 2 cases of complex aortic atheroma exceeding 4 mm in thickness. Holter ECG revealed 27 cases of transition to atrial fibrillation Conclusion: Ischemic stroke etiologies are largely dominated by lacunar infarction and embolic heart disease, followed by atherosclerosis. This highlights the role of the cardiologist in both etiological management and in guiding the therapeutic approach. Thus, improving prognosis hinges on early diagnosis and a thorough etiological assessment before concluding a cryptogenic stroke.

5.
Article | IMSEAR | ID: sea-234240

ABSTRACT

This case report documents a woman in her sixties who initially presented with cardiac symptoms such as heart palpitations, shortness of breath, and fluctuating blood pressure. Following her hospital admission, she received a diagnosis of paroxysmal atrial fibrillation and underwent successful electrical cardioversion. Despite this intervention, her symptoms persisted, necessitating radiofrequency ablation of the Cavo-tricuspid isthmus, which proved to be highly effective. Subsequent diagnostic testing revealed the presence of coronary artery disease, atherosclerotic cardiosclerosis, and mitral valve abnormalities, all of which were managed appropriately. Upon discharge, the patient was prescribed a medication regimen comprising anticoagulants, hypotensive therapy, and statins, which she tolerated well. However, her symptoms deteriorated, leading to a referral to a specialized center where she was promptly diagnosed with cardiac amyloidosis (CA) and received appropriate treatment. Adjustments to her treatment plan were made based on this diagnosis, and a cardiac MRI confirmed the presence of amyloidosis. A biopsy of the buccal mucosa further confirmed the presence of AL-amyloidosis based on immunohistochemistry test results. The patient commenced chemotherapy, which unfortunately led to kidney damage but ultimately resulted in significant improvement in her condition. Recurrent atrial fibrillation episodes necessitated further interventions, which were performed swiftly and effectively. Multi-organ assessments revealed numerous abnormalities, guiding tailored management strategies. A multidisciplinary team comprising cardiology, hematology, and general practice specialists coordinated the patient's care, focusing on pharmacotherapy and lifestyle modifications, which were found to be highly effective. Emphasis was placed on continuous monitoring and adherence to treatment plans for long-term management, resulting in positive outcomes.

6.
Arch. cardiol. Méx ; Arch. cardiol. Méx;94(2): 151-160, Apr.-Jun. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1556911

ABSTRACT

Resumen Objetivo: El objetivo de este estudio fue estimar si el uso de anticoagulantes se asociaba con una diferencia en la frecuencia de trombosis de cualquier sitio, hemorragia mayor y mortalidad en adultos con coexistencia de ambas patologías. Método: Se realizó un estudio de cohorte retrospectivo en cuatro centros de alta complejidad. Se incluyeron mayores de 18 años con ERC en hemodiálisis y FA no valvular, con indicación de anticoagulación (CHA2DS2VASc ≥ 2). El desenlace primario fue la ocurrencia de sangrado mayor, evento trombótico (accidente vascular cerebral, infarto agudo al miocardio o enfermedad tromboembólica venosa) o muerte. Se realizó ajuste por variables de confusión por regresión logística. Resultados: De los 158 pacientes incluidos, el 61% (n = 97) recibieron anticoagulante. El desenlace principal se encontró en el 84% de quienes recibieron anticoagulación y en el 70% de quienes no la recibieron (OR: 2.12, IC95%: 0.98-4.57; luego del ajuste OR: 2.13, IC95%: 1.04-4.36). De los desenlaces mayores se presentaron sangrado en el 52% vs. el 34% (OR: 2.03; IC95%: 1.05-3.93), trombosis en el 35% vs. el 34% (OR: 1.03; IC95%: 0.52-2.01) y muerte en el 46% vs. el 41% (OR: 1.25; IC95%: 0.65-2.38). Conclusiones: Los resultados de este estudio sugieren un incremento en el riesgo de sangrado en los pacientes con FA y ERC en hemodiálisis que reciben anticoagulación, sin disminución del riesgo de eventos trombóticos ni de muerte.


Abstract Objective: The aim of this study was to estimate whether the consumption of anticoagulants was associated with a difference in the frequency of thrombosis of any site, major bleeding and mortality, in adults with both diseases. Method: A retrospective cohort study was carried out in four high complexity centers. Patients older than 18 years with CKD on hemodialysis and non-valvular AF, with an indication for anticoagulation (CHA2DS2VASc ≥ 2), were included. The primary outcome was the occurrence of: major bleeding, thrombotic event (cerebrovascular accident, acute myocardial infarction or venous thromboembolic disease) or death. Adjustment for confounding variables was performed using logistic regression. Results: From 158 patients included, 61% (n = 97) received an anticoagulant. The main outcome was found in 84% of those who received anticoagulation and 70% of those who did not (OR: 2.12, 95%CI: 0.98-4.57; after the adjusted analysis OR: 2.13, 95%CI: 1.04-4.36). Separate outcomes were bleeding in 52% vs. 34% (OR: 2.03; 95%CI: 1.05-3.93), thrombosis in 35% vs. 34% (OR: 1.03; 95%CI: 0.52-2-01) and death in 46% vs. 41% (OR: 1.25; 95%CI: 0.65-2.38). Conclusions: The results of this study suggest an increased risk of bleeding in patients with AF and CKD on hemodialysis receiving anticoagulation, without a decrease in the risk of thrombotic events or all-cause mortality.

7.
Arch. cardiol. Méx ; Arch. cardiol. Méx;94(2): 181-190, Apr.-Jun. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1556915

ABSTRACT

Resumen Una de las complicaciones durante un evento de síndrome coronario agudo es la presencia de arritmias. Dentro de ellas, las de tipo supraventricular, en especial fibrilación auricular, acarrea un mal pronóstico tanto a corto como a largo plazo y es la causa de situaciones como evento vascular cerebral, arritmias ventriculares y aumento de la mortalidad. Dicha arritmia tiende a aparecer en cierto grupo de población con particulares factores de riesgo durante el evento índice en aproximadamente 10% de los casos. Un tratamiento apropiado en el momento de su aparición, gracias al uso de fármacos que modulan la frecuencia cardiaca, el ritmo y el manejo anticoagulante en los grupos más vulnerables conllevará un desenlace menos sombrío para estos pacientes.


Abstract One of the complications during an acute coronary syndrome event is the presence of arrhythmias. Among them, those of the supraventricular type, especially atrial fibrillation, carry a poor prognosis both in the short and long term, being the cause of situations such as cerebrovascular event, ventricular arrhythmias, and increased mortality. The arrhythmia tends to appear in a certain population group with particular risk factors during the index event in approximately 10% of cases. Appropriate treatment at the time of its onset, thanks to the use of drugs that modulate heart rate, rhythm, and anticoagulant management in the most vulnerable groups, will lead to a less bleak outcome for these patients.

8.
Arq. bras. cardiol ; Arq. bras. cardiol;121(7): e20230856, jun.2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1568805

ABSTRACT

Resumo Fundamento A fibrilação atrial (FA) é uma complicação prevalente associada à levosimendana; no entanto, permanece incerto se existem disparidades nos efeitos da levosimendana na FA não pós-operatória e pós-operatória. Objetivos Este estudo teve como objetivo avaliar o efeito da levosimendana na FA não pós-operatória e pós-operatória conduzindo uma metanálise de ensaios clínicos randomizados (ECR). Métodos PubMed, Embase, Biblioteca Cochrane e outras bases de dados foram pesquisadas. Pares de revisores identificaram ECRs que compararam levosimendana e placebo ou outras terapias, e os resultados relataram dados de eventos de FA. Foram utilizados modelos de efeitos aleatórios (com nível de significância de 5%). Resultados Foram incluídos 29 ensaios elegíveis compreendendo 6.550 participantes, onze dos quais avaliaram a incidência de FA não pós-operatória e 18 incluíram FA pós-operatória. A análise revelou que a levosimendana elevou significativamente o risco de FA no grupo não pós-operatório (OR, 1,62; IC 95%: 1,19-2,20; p=0,002) e reduziu a incidência de FA no grupo pós-operatório (OR, 0,65; IC 95%: 0,44-0,96; p=0,03). A ocorrência de FA diminuiu mais significativamente em pacientes que usaram levosimendana após cirurgia cardíaca (OR, 0,53; IC 95%: 0,32-0,88; p=0,02) do que em pacientes que usaram levosimendana antes da cirurgia cardíaca (OR, 0,67; IC 95%: 0,42-1,06; p=0,09). O risco de FA foi significativamente elevado pela grande dose em bolus de levosimendana (dose em bolus ≥12 μg/kg) (OR, 1,44; IC 95%: 1,10-1,88; p=0,004) e diminuído pela pequena dose em bolus de levosimendana (dose em bolus <12 μg/kg) (OR, 0,64; IC 95%: 0,34-1,20; p=0,16). Conclusão A levosimendana foi associada a um aumento da incidência de FA não pós-operatória. O emprego da levosimendana foi eficaz na prevenção da FA pós-operatória.


Abstract Background Atrial fibrillation (AF) is a prevalent complication associated with levosimendan; however, it remains uncertain whether there are any disparities in the effects of levosimendan on non-postoperative and postoperative AF. Objectives This study aimed to evaluate the levosimendan effect on non-postoperative and postoperative AF by conducting a meta-analysis of randomized control trials (RCTs). Methods PubMed, Embase, Cochrane Library, and other databases were searched. Pairs of reviewers identified RCTs that compared levosimendan and placebo or other therapies, and the results reported AF events data. Random effects models were used (at a significance level of 5%). Results Twenty-nine eligible trials comprising 6550 participants were included, eleven of which evaluated the non-postoperative AF incidence, and 18 included postoperative AF. The analysis revealed that levosimendan elevated the AF risk significantly in the non-postoperative group (OR, 1.62; 95% CI: 1.19-2.20; p=0.002) and reduced the AF incidence in the postoperative group (OR, 0.65; 95% CI: 0.44-0.96; p=0.03). AF occurrence decreased more significantly in patients who used levosimendan after cardiac surgery (OR, 0.53; 95% CI: 0.32-0.88; p=0.02) than in patients who used levosimendan before cardiac surgery (OR, 0.67; 95% CI: 0.42-1.06; p=0.09). Moreover, The AF risk was significantly elevated by levosimendan large bolus dose (bolus dose≥12 μg/kg) (OR, 1.44; 95% CI: 1.10-1.88; p=0.004) and decreased by small bolus dose of levosimendan (bolus dose<12 μg/kg) (OR, 0.64; 95% CI: 0.34-1.20; p=0.16). Conclusion Levosimendan was linked to an increased non-postoperative AF incidence. The employment of levosimendan was effective in preventing postoperative AF.

9.
ABCS health sci ; 49: e024220, 11 jun. 2024. tab
Article in English | LILACS | ID: biblio-1572577

ABSTRACT

INTRODUCTION: Estimation of the prevalence of undiagnosed or untreated atrial fibrillation (AF) is crucial for the prevention of AF-related ischemic stroke. OBJECTIVE: To assess the prevalence of undiagnosed or untreated AF in primary care. METHODS: We conducted a prospective cross-sectional non-randomized study in Joinville, Brazil, among elderly individuals in primary care units (PCUs). RESULTS: One thousand individuals were included, with a mean age of 69±7 years, and 57% women. Prevalence of AF was 3%, with 50% of AF patients being previously undiagnosed and 33% of previously diagnosed AF patients not receiving oral anticoagulation despite clinical indication. Using age-standardized prevalences, we estimated 68 and 27,342 strokes per year due to untreated or undiagnosed AF in Joinville and Brazil, respectively. CONCLUSION: The observation that two out of three AF patients were either undiagnosed or untreated is very alarming. Screening strategies to uncover this population are urgently needed.


INTRODUÇÃO: A estimativa da prevalência de fibrilação atrial (FA) sem diagnóstico ou tratamento é crucial para a prevenção do acidente vascular cerebral isquêmico (AVCI) relacionado à FA. OBJETIVO: Avaliar a prevalência de FA sem diagnóstico ou tratamento na Atenção Primária à Saúde. MÉTODOS: Realizamos um estudo prospectivo transversal não randomizado em Joinville, Brasil, entre indivíduos idosos em Unidades Básicas de Saúde (UBS). RESULTADOS: Foram incluídos mil indivíduos, com idade média de 69 ± 7 anos, 57% dos quais eram mulheres. A prevalência de FA foi de 3%, com 50% dos pacientes com FA não-diagnosticada e 33% dos pacientes diagnosticados previamente sem receber anticoagulação oral apesar de indicação clínica. Usando prevalências padronizadas por idade, estimamos 68 e 27.342 AVCI por ano devido à FA sem diagnóstico ou tratamento em Joinville e no Brasil, respectivamente. CONCLUSÃO: A observação de que dois em cada três pacientes com FA estavam sem diagnóstico ou tratamento é muito alarmante. Estratégias de rastreamento para alcançar esta população são urgentemente necessárias.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Primary Health Care , Atrial Fibrillation/epidemiology , Health of the Elderly , Undiagnosed Diseases , Ischemic Stroke , Health Centers , Cross-Sectional Studies , Prospective Studies
10.
Article | IMSEAR | ID: sea-241258

ABSTRACT

Purpose: Coronary artery bypass grafting surgery (CABG) is a common surgical procedure used to treat coronary artery disease (CAD). Despite advancements in the surgical techniques and perioperative care, cardiac surgery patients remain at risk of developing complications, especially atrial fibrillation (AF), The present study aimed to investigate the impact of posterior pericardiotomy on the incidence of postoperative AF and other relevant complications following CABG. Methods: This study is a randomized controlled trial conducted at a single center. A total of 204 patients were randomly assigned to two groups: the pericardiotomy group and the non-pericardiotomy group (control group). The study assessed the incidence of postoperative atrial fibrillation within the first 7 days following CABG surgery. Results: Our findings revealed no statistically significant difference in the incidence of pericardial effusion and AF between the pericardiotomy and non-pericardiotomy groups. The lack of cardiopulmonary bypass (CPB) in the on-pump CABG method may have contributed to the absence of significant differences in pericardial effusion rates between the groups. Moreover, we found that posterior pericardiotomy did not significantly affect the intubation time, length of stay in the intensive care unit (ICU), and total hospital stay in either group. Our study differs from previous research that focused on off-pump CABG patients. Studies that utilized CPB reported a significant reduction in pericardial effusion and arrhythmias with posterior pericardiotomy. This discrepancy suggests that the use of CPB may play a crucial role in the occurrence of arrhythmias and subsequent complications. Conclusions: our study indicates that posterior pericardiotomy did not significantly influence the incidence of pericardial effusion and AF in on-pump CABG patients. Considering the differences in surgical techniques and patient populations, further research with larger sample sizes is warranted to provide more definitive insights into the role of posterior pericardiotomy in this specific setting. Comprehensive studies will be instrumental in guiding clinical decisions and establishing best practices for the prevention of postoperative pericardial effusion and arrhythmias in on-pump CABG patients.

11.
Rev. méd. Maule ; 39(1): 13-17, mayo. 2024. ilus
Article in Spanish | LILACS | ID: biblio-1562909

ABSTRACT

It is presented as an innovative technique in the treatment of atrial fibrillation, with the aim of improving the quality of life of affected patients. OBJECTIVES: The study aims to describe the ablation procedure using the Boston Scientific System Farapulse medical equipment and analyze the results in a specific clinical case. METHODS: A pulmonary vein ablation procedure was performed using the aforementioned equipment. Details of the procedure were recorded, including catheter placement and applications performed in each pulmonary vein. RESULTS: Good tolerance was observed by the patient during the procedure, with an adequate number of applications in each pulmonary vein. Postablation electrocardiogram showed no significant abnormalities, suggesting electrical stability of the heart. It is concluded that the pulsed field pulmonary vein ablation technique using the Boston Scientific System medical equipment is safe and effective in the treatment of atrial fibrillation.


Se presenta como una técnica innovadora en el tratamiento de la fibrilación auricular, con el objetivo de mejorar la calidad de vida de los pacientes afectados. OBJETIVOS: El estudio tiene como objetivo describir el procedimiento de ablación utilizando el equipo médico Boston Scientific System Farapulse y analizar los resultados en un caso clínico específico. Métodos: Se realizó un procedimiento de ablación de venas pulmonares utilizando el equipo mencionado. Se registraron los detalles del procedimiento, incluyendo la colocación de catéteres y las aplicaciones realizadas en cada vena pulmonar. RESULTADOS: Se observó una buena tolerancia por parte del paciente durante el procedimiento, con un número adecuado de aplicaciones en cada vena pulmonar. El electrocardiograma postablación no mostró anomalías significativas, lo que sugiere una estabilidad eléctrica del corazón. Se concluye que la técnica de ablación de venas pulmonares con campo pulsado utilizando el equipo médico Boston Scientific System es segura y eficaz en el tratamiento de la fibrilación auricular.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Veins/surgery , Atrial Fibrillation/surgery , Catheter Ablation/methods , Reproducibility of Results , Treatment Outcome , Catheter Ablation/adverse effects
12.
Article | IMSEAR | ID: sea-237086

ABSTRACT

NSAIDs, or nonsteroidal anti-inflammatory medications, are popular and efficient analgesis and frequent mainstay treatements for inflammatory disorders. However, their cardiovascular safety is questionable. The aims of the current study were: (1) to evaluate the comparative cardiovascular efficacy of NSAIDs; (2) to investigate the cardiovascular safety and risks associated with NSAID use; (3) to highlight the importance of alternative therapies for patients who display contraindications to NSAID. A number of digital databases were explored to retrieve relevant studies. These consist of ClinicalTrials.gov, PubMed, Google Scholar, ScienceDirect, etc. The final sample consisted of 17 primary studies.A total of 12/17 (71%) studies advocated the efficacy and safety of NSAIDs. The remaining 2/17 (11%) showed that there was no discernible difference between the NSAID and non-NSAID groups in terms of mortality, cardio-respiratory morbidity, and cardiovascular risk. A forest plot was created using data from eight distinct studies. The results for the incidence of cardiovascular events were found to be statistically significant. The heterogeneity was calculated to be Tau2= 0.15; Chi2=117.67; df=6; I2=95%. The overall effect size was found to be Z=0.08 (p<0.94); the Hazard Ratio was found to be 0.84, CI=95% (CI, 0.72 = 0.98). Certain agents have a higher risk of causing unfavorable cardiovascular events, although other agents might have a safer profile. Clinicians must have this comprehensive knowledge to balance the therapeutic benefits of NSAIDs with any potential cardiovascular hazards when making judgments.

13.
Arq. bras. cardiol ; Arq. bras. cardiol;121(4): e20230544, abr.2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1557038

ABSTRACT

Resumo Fundamento: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. Objetivos: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. Métodos: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p <0,05 foram aceitos como estatisticamente significativos. Resultados: Um total de 593 pacientes foram incluídos - 412 com FA paroxística e 181 com FA persistente. Durante o seguimento médio de 24±6 meses, 76,4% não apresentaram recidiva após ablação. Individualmente, os biomarcadores demonstraram um valor preditivo baixo ou nulo para recorrência. No entanto, TSH >1,8 μUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor "anormal" foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p<0,001). Doentes com três biomarcadores "anormais" apresentaram três vezes maior probabilidade de recorrência de FA, comparativamente aos que não apresentaram nenhum biomarcador "anormal" (HR=2,88 [IC95%, 1,39-5,17], p=0,003). Conclusões: Quando combinados, valores anormais de TSH, FT4 e BNP podem ser uma ferramenta útil para prever a recorrência de FA pós ablação guiada pelo AI.


Abstract Background: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. Objectives: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. Methods: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. Results: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 μUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). Conclusions: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.

14.
Rev. méd. hered ; 35(2): 103-110, abr.-jun. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1576619

ABSTRACT

RESUMEN Los antagonistas del receptor de mineralocorticoide (ARM) son beneficiosos en diversos estados patológicos. Se deben considerar a estos medicamentos como una nueva alternativa en el manejo de la fibrilación auricular (FA), ya que los resultados en múltiples ensayos clínicos muestran su beneficio en la reducción de la aparición de la FA, y así poder validar la implementación de este medicamento en la práctica clínica diaria. Por este motivo el objetivo de esta revisión fue dar a conocer la literatura que respalda a los ARM como un potencial fármaco antiarrítmico.


SUMMARY Mineralocorticoid receptor antagonists (MRAs) are beneficial in certain diseases. Results from multiple clinical trials support the indication for this class of drugs as an alternative for the management of atrial fibrillation. This review aims to show the evidence that supports the recommendation.

15.
Article | IMSEAR | ID: sea-242174

ABSTRACT

Cardiac arrhythmias are commonly encountered in the peri-operative period, out of which atrial fibrillation has a relatively higher prevalence. Tachyarrhythmias are associated with various underlying factors like hypertension, heart disease, long-standing chronic obstructive pulmonary disease, hyperthyroidism, electrolyte abnormalities, and diabetes. Hence, understanding the pathophysiology and the management of cardiac arrhythmias is paramount for the anesthesiologist. This series would focus on managing peri-operative cardiac arrhythmias in non-cardiac surgeries, with a particular emphasis on atrial fibrillation.

16.
17.
Arq. bras. cardiol ; Arq. bras. cardiol;121(3): e20230470, Mar.2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1557032

ABSTRACT

Resumo Fundamento: A doença por coronavírus 2019 (COVID-19) está associada à hipercoagulabilidade. Permanece incerto se a anticoagulação contínua para fibrilação atrial (FA) em pacientes que posteriormente contraem COVID-19 melhora os desfechos clínicos. Objetivos: Comparar a anticoagulação oral crônica com ausência de anticoagulação prévia em pacientes com FA que contraíram uma infecção por COVID-19 em relação aos desfechos de mortalidade por todas as causas, mortalidade por COVID-19, admissão em unidade de terapia intensiva (UTI) e hospitalização. Métodos: Buscamos sistematicamente no PubMed, Embase e Cochrane Library estudos elegíveis desde o início até dezembro de 2022. Incluímos estudos que compararam desfechos de COVID-19 em pacientes com e sem anticoagulação crônica prévia para FA. Foram agrupadas razões de risco (RR) com intervalos de confiança (IC) de 95% por meio de um modelo de efeitos aleatórios. O nível de significância foi estabelecido em p < 0,05. As avaliações da qualidade e do risco de viés foram realizadas de acordo com as recomendações da Cochrane. Resultados: Foram identificados 10 estudos abrangendo 1.177.858 pacientes com COVID-19 e FA, dos quais 893.772 (75,9%) estavam em anticoagulação crônica prévia para FA. Em pacientes com COVID-19, a anticoagulação crônica para FA reduziu significativamente a mortalidade por todas as causas (RR 0,75; IC 95% 0,57 a 0,99; p = 0,048; I2 = 89%) e a mortalidade relacionada à COVID-19 (RR 0,76; IC 95% 0,72 a 0,79; p < 0,001; I2 = 0%) quando comparada com a ausência de anticoagulação prévia. Em contrapartida, não houve diferença entre os grupos em relação à hospitalização (RR 1,08; IC 95% 0,82 a 1,41; p = 0,587; I2 = 95%) ou internação em UTI (RR 0,86; IC 95% 0,68 a 1,09; p = 0,216; I2 = 69%). Conclusões: Nesta metanálise, a anticoagulação crônica para pacientes com FA que contraíram COVID-19 foi associada a taxas significativamente mais baixas de mortalidade por todas as causas e mortalidade relacionada à COVID-19 em comparação com a ausência de anticoagulação anterior.


Abstract Background: Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability. It remains uncertain whether ongoing anticoagulation for atrial fibrillation (AF) in patients who later contract COVID-19 improves clinical outcomes. Objectives: To compare chronic oral anticoagulation with no previous anticoagulation in patients with AF who contracted a COVID-19 infection concerning the outcomes of all-cause mortality, COVID-19 mortality, intensive care unit (ICU) admission, and hospitalization. Methods: We systematically searched PubMed, Embase, and Cochrane Library for eligible studies from inception to December 2022. We included studies comparing COVID-19 outcomes in patients with versus without prior chronic anticoagulation for AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. The level of significance was set at p < 0.05. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Ten studies comprising 1,177,858 patients with COVID-19 and AF were identified, of whom 893,772 (75.9%) were on prior chronic anticoagulation for AF. In patients with COVID-19, being on chronic anticoagulation for AF significantly reduced all-cause mortality (RR 0.75; 95% CI 0.57 to 0.99; p = 0.048; I2 = 89%) and COVID-19-related mortality (RR 0.76; 95% CI 0.72 to 0.79; p < 0.001; I2 = 0%) when compared with no prior anticoagulation. In contrast, there was no difference between groups regarding hospitalization (RR 1.08; 95% CI 0.82 to 1.41; p = 0.587; I2 = 95%) or ICU admission (RR 0.86; 95% CI 0.68 to 1.09; p = 0.216; I2 = 69%). Conclusions: In this meta-analysis, chronic anticoagulation for patients with AF who contracted COVID-19 was associated with significantly lower rates of all-cause mortality and COVID-19-related mortality as compared with no previous anticoagulation.

18.
Rev. Finlay ; 14(1)mar. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1565159

ABSTRACT

Fundamento: Pese a la importancia del primer evento de fibrilación auricular como una de las urgencias médicas más tratadas, en Cienfuegos, son insuficientes los estudios en los que se describan las características clínico-epidemiológicas de estos pacientes. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con primer evento de fibrilación auricular en Cienfuegos entre los años 2020-2022. Método: Se realizó un estudio descriptivo y transversal. El universo estuvo conformado por 54 pacientes con diagnóstico de primer evento de fibrilación auricular ingresados en el Servicio de Cardiología del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos entre los años 2020-2022. Las variables estudiadas fueron: edad, sexo, color de la piel, hábitos tóxicos, antecedentes patológicos personales, manifestaciones clínicas, parámetros ecocardiográficos y tratamiento. Se calcularon la frecuencia absoluta y relativa de las variables. Los resultados se presentaron en tablas. Resultados: Predominó el sexo masculino, el grupo etáreo de 36-55 años, el color de piel blanca, y el tabaquismo. Los antecedentes patológicos personales más frecuentes fueron: la hipertensión arterial (74,1 %), la diabetes mellitus tipo 2 (16,7 %) y las valvulopatías (11,1 %). Las manifestaciones clínicas más frecuentes fueron: las palpitaciones (77,8 %), seguidas de la disnea (12,9 %). Los parámetros ecocardiográficos estuvieron en el rango de la normalidad. El tratamiento farmacológico se aplicó al 68,5 % seguido de cardioversión farmacológica y eléctrica en el 16,7 %. Conclusiones: El mayor número de pacientes con primer evento de fibrilación auricular, tienen un corazón estructuralmente sano, por lo que se considera de vital importancia la prevención de recurrencias, esto evitará la creación de condiciones eléctricas y anatómicas que perpetúen la arritmia.


Foundation: Despite the importance of the first event of atrial fibrillation as one of the most treated medical emergencies, in Cienfuegos, there are insufficient studies describing the clinical-epidemiological characteristics of these patients. Objective: To clinically and epidemiologically characterize patients with the first event of atrial fibrillation in Cienfuegos between the years 2020-2022. Method: A descriptive and cross-sectional study was carried out. The universe was made up of 54 patients diagnosed with a first event of atrial fibrillation admitted to the Cardiology Service of the Dr. Gustavo Aldereguía Lima General University Hospital in Cienfuegos between the years 2020-2022. The variables studied were: age, sex, skin color, toxic habits, personal pathological history, clinical manifestations, echocardiographic parameters and treatment. The absolute and relative frequencies of the variables were calculated. The results were presented in tables. Results: The male sex, the age group of 36-55 years, white skin color, and smoking predominated. The most common personal pathological history was: high blood pressure (74.1%), type 2 diabetes mellitus (16.7%) and valvular heart disease (11.1%). The most frequent clinical manifestations were: palpitations (77.8%), followed by dyspnea (12.9%). Echocardiographic parameters were within the normal range. Pharmacological treatment was applied to 68.5% followed by pharmacological and electrical cardioversion in 16.7%. Conclusions: The largest number of patients with a first event of atrial fibrillation have a structurally healthy heart, so the prevention of recurrences is considered of vital importance, this will avoid the creation of electrical and anatomical conditions that perpetuate the arrhythmia.

19.
Rev. colomb. cardiol ; 31(1): 48-56, ene.-feb. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1576226

ABSTRACT

Resumen La amiloidosis cardiaca es una enfermedad que se caracteriza por el depósito de material amiloide en la matriz extracelular del miocardio. Las arritmias son parte del amplio espectro de la enfermedad, de las cuales la fibrilación auricular (FA) es la más frecuente de todas. Debido a la heterogeneidad de la amiloidosis cardiaca, su incidencia real es desconocida, con lo que se denota un subdiagnóstico y en muchos casos estando oculta bajo la presentación de una enfermedad cardiaca habitual, lo que conlleva a una progresión silente de la misma y peores desenlaces. Se describe el caso clínico de un paciente con FA refractaria a cardioversión eléctrica y terapia ablativa en el contexto de amiloidosis cardiaca por transtirretina (ATTR) inicialmente inadvertida y descubierta como hallazgo incidental. El propósito de este reporte es revisar la asociación entre FA y ATTR, su epidemiología, fisiopatología, manifestación clínica, diagnóstico y tratamiento con el fin de ofrecer al personal médico herramientas para un diagnóstico oportuno de una enfermedad poco reconocida.


Abstract Cardiac amyloidosis is a disease characterized by the deposition of amyloid material in the extracellular matrix of the myocardium. Arrhythmias are part of the broad spectrum of the disease, with atrial fibrillation (AF) as the most common. Due to the heterogeneity of cardiac amyloidosis, its real incidence is unknown, denoting an underdiagnosis and in many cases being hidden under the presentation of a common heart disease, which leads to silent progression and worse outcomes. We describe the clinical case of a patient with AF refractory to electrical cardioversion and ablation therapy in the context of cardiac transthyretin amyloidosis (ATTR), initially unnoticed and found as an incidental diagnosis. The purpose of this report is to review the association between AF and ATTR, its epidemiology, pathophysiology, signs and symptoms, diagnosis and treatment in order to provide medical staff with tools for a timely diagnosis of a poorly recognized disease.

20.
Article | IMSEAR | ID: sea-242252

ABSTRACT

BACKGROUND: Atrial Fibrillation is the most commonly encountered irregular heart beat (arrhythmia) in our population, and it is the disordered supraventricular (atria) event characterized by irregular heart rhythm. Therefore, the role of clinical profile in atrial fibrillation patient needs to be further discussed. In order to analysis the above issue, our study investigated the association between stroke patient and their clinical profile. METHOD: The study included 50 patient admitted in the Iccu and fulfilling the inclusion criteria. The study consists of history taking, clinical examination and biochemical assay and radiological examimation. Study subjects were selected after obtaining consent. Patient were managed according to standard guidlines. RESULTS: Most common symptom in our study was palpitation. Most common etiology was Coronary heart disease. Most common Class of drugs used in treatment were B-blockers, followed by anti-arrhythmic. Heart failure was the commonest complication seen, followed by Cardiogenic shock. Mortality was observed in patients with complications, while no mortality was observed in uncomplicated patients. Conclusion: Male patients were more common than female patients. Most common symptom in our study was palpitation. Most common etiology was more commonly seen in younger age group. Valvular etioligy was more commonly seen in younger age group. Most common valvular abnormality was mitral stenosis. Paroxysmal AF was the most common type of AF. Paroxysmal AF was mostly seen in patient with new onset AF while persitent was seen in old onset Most common class of drug used in treatment were B-blockers, followed by anti arrythmic. Heart failure was the commonest complication seen, followed by cardiogenic shock

SELECTION OF CITATIONS
SEARCH DETAIL