Amiodarona: fortalezas y debilidades / Amiodarone strengths and weaknesses

Prescritos en la práctica clínica por su eficacia. En su inicio se utilizó para tratar la angina de pecho. hoy día es usado para el tratamiento de cualquier forma de taquicardia. Objetivo: Reconocer la prescripción de la Amiodarona y sus efectos adversos. Métodos: Se realizó una revisión descriptiva en las bases de datos de Lilacs donde se encontraron 18 artículos y en PubMed/Medline (Mesh) 206 artículos, de los cuales se le aplicaron los criterios de inclusión a 51 artículos. Conclusiones: La amiodarona es uno de los antiarrítmicos más utilizados para el tratamiento de las arritmias, su variedad de efectos adversos y toxicidad es conocida, por tanto, los pacientes en tratamiento ameritan un minucioso monitoreo(AU)

Introduction: Amiodarone is one of the most prescribed antiarrhythmic drugs in clinical practice due to its efficacy. Initially it was used to treat angina pectoris, however, today it is used to treat any form of tachycardia. Objective: To identify the prescription of amiodarone and its adverse effects. Methods: A descriptive review was carried out in Lilacs databases where 18 articles were found and in PubMed/Medline (Mesh) 206 articles were retrieved. The inclusion criteria were applied to 51 articles. Conclusions: Amiodarone is one of the most widely used antiarrhythmic drugs for the treatment of arrhythmias, its variety of adverse effects and toxicity is known, therefore, patients undergoing treatment justify careful monitoring(AU)

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Registro unicéntrico de ablaciones de taquiarritmias cardíacas en pacientes pediátricos. Seguridad y eficacia / Single-center registry of ablations of arrhythmogenic substrates in pediatric patients. Safety and efficacy

Introducción: Las taquiarritmias en pediatría son uno de las principales motivos cardiológicos de consulta a la guardia. Durante el primer año de vida presentan una significativa morbi-mortalidad, por lo que el tratamiento farmacológico inmediato es fundamental para reducir la misma. Hasta los 3 años existe la posibilidad de curación espontánea en un porcentaje de éstos pacientes. La indicación de procedimientos de ablación durante los primero 4 años de vida se limita a casos refractarios al tratamiento antiarrítmico, dado que cuanto menor peso presenta el paciente, más pequeño es el corazón y más riesgoso es el mismo. Las taquicardias en pacientes con cardiopatía empeora el pronóstico de la misma. A pesar que el tratamiento farmacológico ha permitido el control de la gran mayoría de ellas, en muchos casos se requieren más de una droga antiarrítmica, con mayor exposición a efectos adversos, y en muchos otros se vuelven refractarias. En las últimas 3 décadas se ha desarrollado en forma exponencial el tratamiento de las taquiarritmias por medio de la ablación por radiofrecuencia o por frío (crioablación). Estos procedimientos han permitido obtener la curación de la mayor parte de las taquiarritmias en pediatría. En nuestro trabajo se evaluaron las indicaciones de dichos procedimientos en una población pediátrica, como así también la tasa de éxito, recurrencia, y la morbimortalidad tanto globalmente, como en cada arritmia (AU)

In children, tachyarrhythmias are one of the main reasons for cardiological consultation at the Department of Emergency. In the first year of life, they are associated with significant morbiditymortality and therefore, immediate drug treatment is essential up to 3 years of age. The indication of ablation procedures during the first 4 years of life is limited to patients refractory to antiarrhythmic treatment, since the lower weight of the patient, the smaller the heart and the riskier the intervention. In patients with heart disease, tachycardia worsens the prognosis. Although pharmacological treatment controls the vast majority of tachyarrhythmias, more than one antiarrhythmic drug is often required, leading to greater exposure to adverse effects, and many become refractory. Over the past three decades, treatment of tachyarrhythmias has developed exponentially with the advent of radiofrequency or cold ablation (cryoablation). These procedures have led to the cure of most tachyarrhythmias in children. Our study assessed the indications for these procedures in a pediatric population, as well as the success and recurrence rates, and morbidity both overall and of each arrhythmia episode (AU)

Distrofia miotônica e cardiopatia: comportamento dos eventos arrítmicos e dos distúrbios da condução / Myotonic dystrophy and heart disease: behavior of arrhythmic events and conduction disturbances

OBJETIVO: Estudar a prevalência e a evolução natural dos eventos arrítmicos e distúrbios da condução, correlacionar o defeito genético com achados cardiovasculares, avaliar a mortalidade cardíaca, freqüência e fatores preditivos de morte súbita, correlacionar a gravidade do envolvimento neuromuscular e cardíaco e definir o papel do estudo eletrofisiológico (EEF), na distrofia miotônica. MÉTODOS: Realizados periodicamente avaliação clínica e exames complementares, exame genético, eletrocardiograma, ecocardiograma e Holter (exceto exame genético) em 83 pacientes consecutivos com tempo médio de seguimento de 42±30,63 meses, sendo o estudo eletrofisiológico realizado em 59 casos. RESULTADOS: Taquiarritmia atrial foi observada em 10 (12 por cento) pacientes, taquicardia ventricular não sustentada (TVNS) em 14 (17 por cento), bloqueio átrio-ventricular (BAV) 1° grau em 24 (29 por cento), bloqueio de ramo esquerdo (BRE) em 19 (23 por cento), bloqueio de ramo direito (BRD) em 13 (16 por cento). Sintomas, aumento do intervalo PR, alargamento do QRS, fração de ejeção do ventrículo esquerdo (FEVE) <60 por cento e idade foram preditivos de óbito. Ocorreram 9 mortes (4 súbitas; 2 insuficiência cardíaca; 3 outras). EEF: HV>70ms em 34 por cento e >100ms em 11 por cento (pós-procainamida). CONCLUSÃO: A prevalência dos eventos arrítmicos e distúrbios da condução foi de 50 por cento a 80 por cento após 6 anos, não se correlacionando ao defeito genético, sendo o flutter atrial, a arritmia sustentada mais freqüente. O envolvimento cardíaco aumentou com a piora da doença neuromuscular, mas essa progressão foi mais rápida que a neuromuscular. A mortalidade total foi baixa (11 por cento) e morte súbita ocorreu em metade dos casos. EEF identificou grupo de risco para implante de marcapasso.

Pediatric Radiofrequency Catheter Ablation: Results of Initial 100 Consecutive Cases Including Congenital Heart Anomalies

Radiofrequency catheter ablation (RFCA) has recently become a management option for pediatric tachycardia. We reviewed the records of a total of 100 patients (aged 10 months to 19 yr) who had undergone RFCA, from March 2000 to June 2004. Types of arrhythmia (age, acute success rate) were as follows: atrioventricular reentrant tachycardia (AVRT, 9.0+/-3.7 yr, 66/67), atrioventricular nodal reentrant tachycardia (AVNRT, 13+/-2.5 yr, 16/16), ectopic atrial tachycardia (6.4+/-3.3 yr, 5/5), junctional ectopic tachycardia (10 month, 1/1), ventricular tachycardia (12+/-4.9 yr, 6/6), postsurgical intraatrial reentrant tachycardia (15.6+/-4.1 yr, 2/3), twin node tachycardia (4 yr, 0/1), and His bundle ablation (9 yr, 1/1). The age of AVNRT was older than that of AVRT (p=0.002). Associated cardiac disease was detected in 17 patients, including 6 univentricular patients, and 3 Ebstein's anomaly patients. RFCA for multiple accessory pathways required longer fluoroscopic times than did the single accessory pathway (53.9+/-4.8 vs. 36.2+/-24.1 min; p=0.03), and was associated with a higher recurrence rate (3/9 vs. 3/53; p=0.03). Regardless of the presence or absence of cardiac diseases, the overall acute success rate was 97% without major complications, the recurrence rate was 8.2%, and the final success rate was 97%. This experience confirmed the efficacy and safety of RFCA in the management of tachycardia in children.