Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 2.556
Filter
1.
Rev. urug. cardiol ; 36(2): e201, ago. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1289996

ABSTRACT

La fibrilación auricular (FA) es un problema de salud pública que genera mortalidad y morbilidad, con su mayor impacto en mayores de 65 años. Su detección es especialmente relevante para la población de riesgo. Este estudio piloto propone valorar la utilidad de un dispositivo móvil de tecnología electrónica (DMTE) para el tamizaje de FA. Objetivo primario: evaluar la validez y confiabilidad de un DMTE para identificar FA. Objetivo secundario: validar los procesos de recolección, transmisión, almacenamiento, procesamiento e interpretación de los datos obtenidos. Método: los asistentes a 5 talleres del Plan Ibirapitá (entre el 15 de octubre y el 30 de noviembre de 2018) fueron invitados a participar del estudio. Se utilizó un DMTE (sensor KardiaMobile de AliveCor®) cuyo registro se contrastó con el trazado del ECG de 12 derivaciones realizado en forma casi simultánea. Se compararon los diagnósticos automáticos con los realizados por dos cardiólogos expertos de forma independiente, a partir de la lectura del registro realizado con el DMTE y de un ECG de 12 derivaciones. Resultados: participaron del estudio 114 beneficiarios del Plan Ibirapitá, 78 del sexo femenino. La edad fue de 72,5 ± 5,36 años (rango: 53-87 años). La sensibilidad para el diagnóstico de FA del DMTE fue de 100%, con una especificidad de 96,6%. (VPP = 57,1% VPN = 100%) y una proporción de diagnóstico correcto de 96,8%. El DMTE catalogó como "sin clasificar" al 18,4% de los trazados. Considerando esto, la proporción de diagnóstico correcto disminuyó a 78,9%, sin presentar falsos negativos. Conclusiones: el cribado de FA con la utilización de un DMTE en una población de adultos mayores es factible y confiable. El hallazgo de un 18,4% de trazados con diagnóstico automático "sin clasificar" hace necesario contar con recursos humanos calificados para realizar la confirmación diagnóstica en esos registros.


Atrial fibrillation (AF) is a public health problem generating important morbidity and mortality mainly in > 65 years old population. Detection is key in the population at risk. This pilot study was designed to assess a mobile electronic technology device (METD) usefulness in AF screening. Objective: evaluate validity and reliability of a METD in AF identification. Secondary objective: to validate the process of collection, transmission, storage, method and interpretation of obtained data. Method: participants in 5 Ibirapitá Plan workshops (October 15-November 30, 2018) were invited to participate in the study. A KardiaMobile Alive Cor® METD was used, whose ECG recording was compared with a 12L ECG taken almost at the same time. Automatic METD report was compared with 2 independent cardiologists report considering the METD recording and the 12L ECG. Results: 114 participants (78 female), mean age 72,5 y.o. (SD 5,36; range 53-87) were included. METD sensitivity for AF diagnosis was 100% with a 96.6% specificity (PPV=57,1% NPV=100%), and a 96.8% number of correct diagnosis. A 18.4% of recordings were catalogued as "unclassified" by the METD. Considering this, the proportion of correct diagnosis decreased to 78.9%; there were not false negatives. Conclusions: AF screening with a METD in an older population is feasible and reliable. The finding of 18.4% METD recordings as "unclassified" raises the needs for experts review during diagnosis confirmation.


A fibrilação atrial (FA) é um problema de saúde pública que gera mortalidade e morbidade, com maior impacto em pessoas com mais de 65 anos. Sua detecção é especialmente relevante para a população de risco. Este estudo piloto teve como objetivo avaliar a utilidade de um dispositivo móvel de tecnologia eletrônica (DMTE) para o monitoramento da FA. Objetivo principal: avaliar a validade e confiabilidade de um DMTE para identificar FA. Objetivo secundário: validar os processos de coleta, transmissão, armazenamento, processamento e interpretação dos dados obtidos. Método: participantes de 5 oficinas do Plano Ibirapitá (entre 15 de outubro e 30 de novembro de 2018) foram convidados a participar do estudo. Foi utilizado um DMTE (sensor AliveCor® KardiaMobile), cujo registro foi contrastado com o traçado do ECG de 12 derivações realizado quase simultaneamente. Os diagnósticos automatizados foram comparados com aqueles realizados por dois cardiologistas especialistas independentes, com base na leitura gráfica do DMTE e no ECG de 12 derivações. Resultados: participaram do estudo 114 beneficiários do Plano Ibirapitá, sendo 78 mulheres. A média de idade foi de 72,5 anos (DP 5,36; variação de 53-87 anos). A sensibilidade para o diagnóstico de FA no DMTE foi de 100% com especificidade de 96,6%. (VPP = 57,1% VPN = 100%) e proporção de diagnóstico correto de 96,8%. O DMTE definiu 18,4% dos registros como "não classificados". Portanto, a proporção de diagnósticos corretos diminuiu para 78,9% e não houve falsos negativos. Conclusões: a triagem para FA por meio de DMTE em uma população idosa é viável e confiável. A constatação de 18,4% dos registros com diagnóstico automático "não classificado" torna necessária a existência de recursos humanos qualificados para a realização da confirmação diagnóstica.


Subject(s)
Humans , Male , Female , Aged , Atrial Fibrillation/diagnosis , Electrocardiography , Telemonitoring , Mass Screening , Sensitivity and Specificity
3.
Rev. urug. cardiol ; 36(1): e36105, abr. 2021. ilus, graf
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1248118

ABSTRACT

Desde época temprana de la cirugía cardíaca (CC), la fibrilación auricular (FA) ha sido un acompañante frecuente del posoperatorio, y no es esperable su abatimiento en el futuro cercano. La interpretación de su significado clínico se ha modificado en los últimos años, tras conocerse su tendencia recurrente y su asociación con serias complicaciones inmediatas y a largo plazo. Esto deja entrever un nuevo desafío, dejando de ser un problema menor y de consideración puntual en el perioperatorio para constituir un tema de preocupación y seguimiento en el futuro alejado, aún con incertidumbres evolutivas y de manejo. La profilaxis efectiva de esta arritmia, una respuesta lógica al problema, es dificultosa por la multiplicidad de factores de riesgo y lo intrincado de su génesis, todavía no completamente dilucidada, sumadas a la edad creciente de los pacientes intervenidos, la complejidad mayor de los procedimientos, los posibles efectos colaterales de los fármacos empleados y la inexistencia de un algoritmo predictivo confiable que permita racionalizar las medidas preventivas. Además, muchas recomendaciones de las guías de práctica clínica actuales se basan en información obtenida en estudios realizados en la FA primaria, por lo que su adopción en el escenario de la CC ha sido menor a la deseable. Todos estos aspectos son objeto de análisis en esta revisión que finaliza con pautas de manejo práctico de la arritmia en el entorno perioperatorio.


Since an early age of heart surgery, atrial fibrillation has been a frequent companion of the postoperative period, and its decline is not to be expected in the near future. The interpretation of its clinical significance has changed in recent years, after knowing its recurrent trend and its association with serious immediate and long-term complications. This fact unveils a new challenge, as it is no longer a minor problem of consideration restricted to the perioperative period and has become a topic of concern and follow-up in the distant future, still with uncertainties as to its evolution and management. The effective prophylaxis of this arrhythmia, a logical response to the problem, has been difficult by the multiplicity of risk factors and the intricate of its genesis, not yet completely elucidated, added to the increasing age of the patients involved, the greater complexity of the procedures, the possible side effects of the drugs used and the absence of a reliable predictive algorithm that could allow to rationalize preventive measures. In addition, many recommendations from current clinical practice guidelines are based on information obtained from studies in primary atrial fibrillation, so their adoption in the heart surgery scenario has been less than desirable. All these aspects are analyzed in this review, which ends with directives for the practical management of the arrhythmia in the perioperative environment.


Desde os primeiros días da cirurgia cardíaca, a fibrilação atrial (FA) tem sido uma companheira frequente para o pós-operatório, e sua reduçao não é esperada em um futuro próximo. A interpretação de sua significância clínica mudou nos últimos anos, tendo conhecido sua tendência recorrente e sua associação com sérias complicações imediatas e de longo prazo. Este fato mostra um novo desafio, pois deixou de ser um pequeno problema e uma consideração oportuna no perioperatório para constituir um tema de preocupação e acompanhamento em um futuro distante, mesmo com incertezas quanto à sua evolução e gestão. A profilaxia efetiva dessa arritmia, uma resposta lógica ao problema, tem sido cercada pela multiplicidade de fatores de risco e pela intrincação de sua gênese ainda não completamente elucidada, juntamente com a idade crescente dos pacientes envolvidos, a maior complexidade dos procedimentos, os possíveis efeitos colaterais dos medicamentos utilizados e a ausência de um algoritmo preditivo confiável para racionalizar as medidas preventivas. Além disso, muitas recomendações das guias atuais de prática clínica são baseadas em informações obtidas em estudos conduzidos em FA primária, de modo que sua adoção no cenário da cirurgia cardíaca tem sido menos do que desejável. Todos esses aspectos são analisados nesta revisão, que termina com diretrizes práticas de gestão para arritmia no ambiente perioperatório.


Subject(s)
Humans , Atrial Fibrillation/etiology , Atrial Fibrillation/therapy , Atrial Fibrillation/epidemiology , Cardiac Surgical Procedures/adverse effects , Postoperative Period , Atrial Fibrillation/complications , Incidence , Risk Factors , Case Management , Stroke/etiology
4.
Nursing (Säo Paulo) ; 24(274): 5419-5432, mar.2021. tab
Article in Portuguese | LILACS, BDENF, SES-SP, CONASS, SESSP-IDPCPROD, SES-SP | ID: biblio-1223456

ABSTRACT

OBJETIVO: Avaliar a adesão do paciente com Fibrilação Atrial em Terapia com anticoagulante oral cumarínico. MÉTODO: Estudo descritivo-exploratório, transversal e prospectivo com intervenção não randomizado de abordagem quantitativa, realizado com 40 participantes, aplicou-se o Escore de Adesão Simonetti e a Escala de Avaliação Analógica Visual e após a intervenção educativa para análise de Time in Therapeutic Range sob CAAE: 79973017.1.0000.5462. RESULTADO: Identificou-se que 5% apresentaram risco baixo de adesão, 60% risco médio e 35% risco alto. Após análise dos oito meses do TTR pré e pós-intervenção, não houve mudança significativa entre os períodos (p=0,638). CONCLUSÃO: Evidenciou-se que o grupo de baixa adesão manteve melhor tempo na faixa terapêutica relacionado ao médio e alto risco. Indicativo este de maior impacto da intervenção educativa realizada pelo enfermeiro.


OBJECTIVE: to evaluate the adherence of the patient with Atrial Fibrillation in Therapy with oral coumarin anticoagulant. METHOD: Descriptive-exploratory, cross-sectional and prospective study with a non-randomized intervention with a quantitative approach, carried out with 40 participants, the Simonetti Adherence Score and the Visual Analog Evaluation Scale were applied and after the educational intervention for analysis of Time in Therapeutic Range under CAAE: 79973017.1.0000.5462. RESULT: It was identified that 5% had low risk of adherence, 60% medium risk and 35% high risk. After analyzing the eight months of TTR before and after intervention, there was no significant change between the periods (p = 0.638). CONCLUSION: It was evidenced that the low adherence group maintained a better time in the therapeutic range related to medium and high risk. Indicative of greater impact of the educational intervention carried out by the nurse.


OBJETIVO: evaluar la adherencia del paciente con fibrilación auricular en terapia con anticoagulante cumarínico oral. MÉTODO: Estudio descriptivo-exploratorio, transversal y prospectivo con una intervención no aleatorizada con abordaje cuantitativo, realizado con 40 participantes, se les aplicó el Simonetti Adherence Score y la Escala de Evaluación Visual Analógica y luego de la intervención educativa para el análisis del Tiempo en el Rango Terapéutico bajo CAAE: 79973017.1.0000.5462. RESULTADO: Se identificó que 5% riesgo bajo de adherencia, 60% riesgo medio y 35% riesgo alto. Después de analizar los ocho meses de TTR antes y después de la intervención, no hubo cambios entre los períodos (p = 0,638). CONCLUSIÓN: Se evidenció que el grupo de baja adherencia mantuvo el mejor tiempo en el rango terapéutico relacionado con riesgo medio y alto. Indicativo de mayor impacto de la intervención educativa realizada por la enfermera.


Subject(s)
Humans , Atrial Fibrillation , Medication Adherence , Anticoagulants , Therapeutics , Patient Compliance
5.
Ciudad Autónoma de Buenos Aires; Comisión Nacional de Evaluación de Tecnologías de Salud; Marzo 2021. 50 p. (Informe de Evaluación de Tecnologías Sanitarias N° 9, 9).
Monography in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1151682

ABSTRACT

El presente informe es producto del trabajo colaborativo de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC), dependiente del Ministerio de Salud de la Nación y creada por RM N° 623/2018. La CONETEC realiza evaluaciones y emite recomendaciones a la autoridad sanitaria sobre la incorporación, forma de uso, financiamiento y políticas de cobertura de las tecnologías sanitarias desde una perspectiva global del sistema de salud argentino. En sus evaluaciones y recomendaciones, la CONETEC tiene en cuenta criterios de calidad, seguridad, efectividad, eficiencia y equidad, evaluados bajo dimensiones éticas, médicas, económicas y sociales. Sus resultados son consensuados mediante discusiones públicas y ponderados a través de un marco de valor explícito, con la participación de todos los actores involucrados en el proceso de toma de decisiones en salud. Los informes y recomendaciones de esta comisión surgen de este proceso público, transparente y colaborativo, siendo de libre consulta y acceso para toda la sociedad.


Subject(s)
Atrial Fibrillation , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Anticoagulants
6.
Rev. bras. cir. cardiovasc ; 36(1): 71-77, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155790

ABSTRACT

Abstract Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Sorting nexin 10 (SNX10) has been reported to be an important regulator in embryonic development and human diseases, however, little is known about its role in cardiac disease. The aim of this study was to investigate the clinical significance of SNX10 expression in AF. Methods: Nineteen valvular heart disease patients with AF and nine valvular heart disease patients with sinus rhythm (SR) were enrolled. Atrial tissue samples from patients undergoing open heart surgery were examined. Atrial tissues of normal hearts were obtained from two cases' autopsies. The SNX10 expression and its associations with the degree of fibrosis were analyzed by immunohistochemistry and Masson's trichrome staining. Results: SNX10 expression was detected in the cytoplasm of cardiac cells in human myocardial tissue. The SNX10 expression level was higher in the SR group than in the AF group (P=0.023). SNX10 expression was negatively associated with the degree of fibrosis (P=0.017, Spearman rho=-0.447), the New York Heart Association degree (P=0.003, Spearman rho=-0.545), left atrial diameter (P=0.038, Spearman rho=-0.393), right atrial diameter (P=0.043, Spearman rho=-0.386), and the brain natriuretic peptide (BNP) level 24 hours after surgery (P=0.030, Spearman rho=-0.426), but not the BNP level before surgery and 72 hours after surgery. No statistical significance was observed between SNX10 and the level of troponin T and C-reactive protein. Conclusion: Decreased SNX10 might serve as a potential risk factor in AF of the valvular heart disease.


Subject(s)
Humans , Atrial Fibrillation/etiology , Atrial Appendage , Heart Valve Diseases/surgery , Case-Control Studies , Risk Factors , Sorting Nexins , Heart Atria
7.
Bol. méd. postgrado ; 37(1): 21-26, Ene-Jun 2021. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1147874

ABSTRACT

El tratamiento anticoagulante oral con fármacos inhibidores de la vitamina K como la warfarina se viene utilizando desde hace décadas para la terapia y prevención de la enfermedad tromboembólica con efectos secundarios ampliamente conocidos, pero con una utilidad clínica bien contrastada. El objetivo de este estudio fue determinar la proporción de mortalidad y hospitalización de la consulta de anticoagulación y trombosis del Centro Cardiovascular Regional ASCARDIO en el año 2017 para lo cual se realizó un estudio descriptivo transversal que incluyó una muestra de 294 pacientes. La principal indicación de anticoagulación fue la fibrilación auricular (73%) seguida de la enfermedad tromboembólica venosa (13%) e isquemia miocárdica (9%). Se registró una mortalidad de 11,7% siendo la principal causa de muerte de origen cardíaco (58%). La edad promedio de los pacientes fallecidos fue de 65 años, siendo 53% del sexo femenino; para el momento de la muerte, el 65% de los pacientes estaba tomando warfarina. La hospitalización se observó en el 10% de la muestra siendo la principal causa de la misma la cardíaca (60%) seguida de causas hemorrágicas (18%); de los pacientes hospitalizados, la edad promedio fue de 66 años siendo 52% del sexo femenino; el 90% de los pacientes estaba tomando warfarina al momento de la hospitalización. El análisis de riesgo para mortalidad y hospitalización según causa y estatus de warfarina no mostró significancia estadística. No se evidenció relación de riesgo estadísticamente significativa entre muerte, hospitalización y estatus de la warfarina. Hubo mayor proporción de muertes (45%) y hospitalización (17%) en el grupo que ingresó con diagnóstico de isquemia miocárdica(AU)


Oral anticoagulant treatment with vitamin K inhibitor drugs such as warfarin has been used for decades for the therapy and prevention of thromboembolic disease with widely known side effects but with well-proven clinical utility. To determine the proportion of mortality and hospitalization of the anticoagulation and thrombosis clinic of the ASCARDIO Regional Cardiovascular Center in 2017 a descriptive cross-sectional study was carried out that included a sample of 294 patients. The results show that the main indication for anticoagulation was atrial fibrillation (73%) followed by venous thromboembolic disease (13%) and myocardial ischemia (9%). An 11.7% mortality rate was observed. The mean age of the deceased was 65 years with a slight prevalence of the female sex (53%). The main cause of death was cardiac (58%) and 65% of the deceased patients were taking warfarin at the moment of death. A 10% hospitalization rate was observed with an average age of hospitalized patients of 66 years; 52% were females. The main cause of hospitalization was cardiac (60%) followed by hemorrhage (18%) and 90% of the patients were taking warfarin at the time of hospitalization. The risk analysis for mortality and hospitalization according to cause and status of warfarin did not show statistical significance. There was a higher proportion of deaths (45%) and hospitalization (17%) in the group admitted with a diagnosis of myocardial ischemia(AU)


Subject(s)
Humans , Male , Female , Aged , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Venous Thrombosis/drug therapy , Anticoagulants , Atrial Fibrillation/drug therapy , Thromboembolism , Vascular Diseases , Myocardial Ischemia/drug therapy
8.
Article in Chinese | WPRIM | ID: wpr-879279

ABSTRACT

This study aims to explore the intraventricular pressure difference (IVPD) within left ventricle in patients with paroxysmal atrial fibrillation (PAF) by using the relative pressure imaging (RPI) of vector flow mapping (VFM). Twenty patients with paroxysmal atrial fibrillation (PAF) and thirty control subjects were enrolled in the study. Systolic and diastolic IVPD derived from VFM within left ventricle and conventional echocardiographic parameters were analyzed. It was found that the B-A IVPD of left ventricle in PAF patients showed the same pattern as controls-single peak and single valley during systole and double peaks and double valleys during diastole. Basal IVPD was the main component of base to apex IVPD (B-A IVPD). The isovolumetric systolic IVPD was associated with early systolic IVPD, early systolic IVPD was associated with late systolic IVPD, and late systolic IVPD was associated with isovolumic diastolic IVPD (all


Subject(s)
Atrial Fibrillation/diagnostic imaging , Diastole , Heart Ventricles , Humans , Ventricular Function, Left , Ventricular Pressure
9.
Braz. j. med. biol. res ; 54(4): e10692, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153536

ABSTRACT

Fibrosis caused by the increase in extracellular matrix in cardiac fibroblasts plays an important role in the occurrence and development of atrial fibrillation (AF). The aim of this study was to investigate the role of hsa-miR-4443 in AF, human cardiac fibroblast (HCFB) proliferation, and extracellular matrix remodeling. TaqMan Stem-loop miRNA assay was used to measure hsa-miR-4443 expression in patients with persistent AF (n=123) and healthy controls (n=100). Patients with AF were confirmed to have atrial fibrosis by late gadolinium enhancement. At the cellular level, after hsa-miR-4443 mimic and inhibitor were transfected with HCFBs, proliferation, apoptosis, migration, and invasion were analyzed. Lastly, hsa-miR-4443-targeted gene and transforming growth factor (TGF)-β1/α-SMA/collagen pathway were evaluated by dual-luciferase reporter assay and western blot, respectively. In patients with AF, hsa-miR-4443 decreased significantly and collagen metabolism level increased significantly. Logistic regression analysis showed that low hsa-miR-4443 level was a risk factor of AF (P<0.001). The receiver operating characteristic curve revealed that hsa-miR-4443 was useful for predicting AF (area under the curve: 0.828, sensitivity: 0.71, specificity: 0.78, P<0.001). In HCFBs, hsa-miR-4443 targeted thrombospondin-1 (THBS1) and downregulated TGF-β1/α-SMA/collagen pathway. The inhibition of hsa-miR-4443 expression promoted HCFB proliferation, migration, invasion, myofibroblast differentiation, and collagen production. The significant reduction of hsa-miR-4443 can be used as a biomarker for AF. hsa-miR-4443 protected AF by targeting THBS1 and regulated TGF-β1/α-SMA/collagen pathway to inhibit HCFB proliferation and collagen synthesis.


Subject(s)
Humans , Atrial Fibrillation , MicroRNAs/genetics , Fibrosis , Collagen , Contrast Media , Thrombospondin 1/genetics , Cell Proliferation , Transforming Growth Factor beta1 , Fibroblasts , Gadolinium
12.
ABC., imagem cardiovasc ; 34(3)2021. ilus, graf
Article in Portuguese | LILACS | ID: biblio-1292127

ABSTRACT

Resumo Historicamente, o papel do ecocardiograma de estresse físico no manejo da cardiomiopatia hipertrófica tem sido negligenciado na prática clínica, de acordo com a análise das diretrizes do American College of Cardiology/ American Heart Association de 2002, que recomendavam cautela no uso dessa metodologia, em portadores de cardiomiopatia hipertrófica, devido ao risco de possível ocorrência tanto de arritmia cardíaca, como de colapso hemodinâmico no esforço. Atualmente, o estresse físico na cardiomiopatia hipertrófica integra a avaliação rotineira de pacientes sintomáticos com ou sem gradiente da via de saída do ventrículo esquerdo < 50 mmHg, em repouso. Para este grupo, é um método seguro e confiável para medir o gradiente da via de saída do ventrículo esquerdo durante o esforço e sólido diferenciador de pacientes com cardiomiopatia hipertrófica não obstrutivos (gradiente ausente, tanto em repouso quanto no esforço) daqueles com gradientes lábeis (gradiente ausente no repouso e presente no esforço). Portanto, na avaliação da cardiomiopatia hipertrófica, o estresse físico é igualmente útil na quantificação do grau de regurgitação mitral, nas alterações da contratilidade segmentar do ventrículo esquerdo e na avaliação da função diastólica do ventrículo esquerdo, diante do esforço, sendo capaz de predizer o futuro desenvolvimento de sintomas de insuficiência cardíaca. O método é também importante na determinação das diferentes estratégias de tratamento para cada paciente, desde a miomectomia cirúrgica ou a ablação septal alcoólica, para aqueles com gradiente lábil, com sintomas limitantes e refratários ao tratamento medicamentoso versus transplante cardíaco para aqueles sem gradiente.(AU)


Subject(s)
Humans , Male , Adult , Middle Aged , Atrial Fibrillation/complications , Hypertrophy, Left Ventricular/congenital , Cardiomyopathy, Hypertrophic, Familial , Heart Failure/complications , Mitral Valve , Stress, Physiological , Vibration/adverse effects , Magnetic Resonance Spectroscopy/methods , Ergometry/methods , Death, Sudden, Cardiac/etiology , Echocardiography, Stress/methods , Electrocardiography/methods , Ablation Techniques
13.
Rev. bras. cir. cardiovasc ; 35(6): 999-1002, Nov.-Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143991

ABSTRACT

Abstract Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage. We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up. This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.


Subject(s)
Humans , Atrial Fibrillation/surgery , Thrombosis/etiology , Catheter Ablation , Atrial Appendage/surgery , Atrial Appendage/diagnostic imaging , Thoracoscopy , Treatment Outcome
14.
Rev. Assoc. Med. Bras. (1992) ; 66(12): 1673-1678, Dec. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1143654

ABSTRACT

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.


RESUMO OBJETIVO: A fibrilação atrial pós-operatória de início recente (Poaf) é a arritmia mais comum após a cirurgia de revascularização do miocárdio (CABG) e associada a hospitalização prolongada, acidente vascular cerebral e mortalidade. O ângulo QRS-T [f(QRS-T)] do plano frontal, que é definido como o ângulo entre as direções da despolarização ventricular (eixo-QRS) e repolarização (eixo-T), é um novo marcador da heterogeneidade da repolarização ventricular. O ângulo f(QRS-T) está associado a desfechos cardíacos adversos. À luz desses achados, neste estudo, objetivamos investigar a relação potencial entre o ângulo f(QRS-T) e a Poaf. MéTODOS: Cento e oitenta pacientes submetidos a CABG entre agosto de 2017 e setembro de 2018 foram incluídos no estudo retrospectivamente. Dois grupos foram estabelecidos como pacientes com ritmo sinusal pós-operatório (n=130) e com Poaf (n=50). O ângulo f(QRS-T) e todos os dados foram comparados entre os grupos. RESULTADOS: Ângulo f(QRS-T) (p<0,001), escore Syntax (p=0,039), níveis séricos de PCR de alta sensibilidade (p=0,026), idade média (p<0,001), taxa de hipertrofia ventricular esquerda eletrocardiográfica (LVH) (p=0,019) e taxa de hipertensão (p=0,007) foram maiores; a fração de ejeção média do ventrículo esquerdo (LVEF) (p<0,001) foi menor no grupo com Poaf. As análises de regressão logística multivariável demonstraram que menor LVEF (p=0,004), LVH (p=0,041), maior idade (p=0,008) e maior ângulo f(QRS-T) (p<0,001) foram independentemente associados à Poaf. CONCLUSÕES: Níveis de ângulo altos f(QRS-T) estão intimamente associados à Poaf. O ângulo f(QRS-T) pode ser um indicador potencial de Poaf.


Subject(s)
Humans , Atrial Fibrillation/etiology , Postoperative Complications/etiology , Stroke Volume , Coronary Artery Bypass/adverse effects , Retrospective Studies , Risk Factors , Ventricular Function, Left
15.
Geriatr., Gerontol. Aging (Impr.) ; 14(4): 228-235, 31-12-2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1151608

ABSTRACT

INTRODUÇÃO: A fibrilação atrial aumenta o risco de eventos cerebrovasculares em cinco vezes. A anticoagulação reduz a incidência e a gravidade desses eventos, entretanto muitos pacientes deixam de receber tromboprofilaxia. OBJETIVOS: Avaliar a prevalência de fibrilação atrial em pacientes idosos acompanhados em um hospital universitário e identificar o percentual desses pacientes com prescrição de anticoagulantes. Os objetivos secundários foram identificar as opções terapêuticas, as justificativas para não indicar o uso e os fatores associados à ineficácia e/ou ausência de tratamento. METODOLOGIA: Em estudo transversal, uma amostra consecutiva de 1.630 pacientes do Hospital de Clínicas O de Porto Alegre foi rastreada entre abril e junho de 2017. Fibrilação atrial foi identificada em 220 (13,50%) indivíduos, dos quais 145 foram avaliados com base na revisão de prontuários e questionário telefônico. A associação entre as variáveis e os desfechos foi analisada por meio do Teste U de Mann-Whitney e do teste do qui-quadrado. RESULTADOS: A prevalência de fibrilação atrial foi de 13,50%. Em 77,93%, havia i-r anticoagulante prescrito. Em 76,11% dos anticoagulados, a opção foi varfarina. Houve tendência de não prescrição para idosos com histórico de sangramento (risco relativo ­ RR = 2,32; índice de confiança de 95% - IC95% 0,95 - 5,64; p = 0,06) e quedas (RR = 2,02; IC95% 0,82 - 5,03; p = 0,08). Houve associação significativa entre maior grau de limitação funcional e maior índice de tratamento no alvo terapêutico (razão de prevalência ­ RP = 022; IC95% 0,06 - 0,87; p = 0,04). CONCLUSÃO: A prevalência de fibrilação atrial foi de 13,5% e, em 77,93% dos casos, havia prescrição de anticoagulante. Houve associação entre incapacidade funcional e melhor índice de anticoagulação no alvo terapêutico.


INTRODUCTION: Atrial fibrillation increases five times the risk of stroke. Anticoagulation reduces the incidence of cerebrovascular events. However, many patients do not receive thromboprophylaxis. OBJECTIVES: To estimate the prevalence of atrial fibrillation in the older patients at a Brazilian university hospital and the proportion of anticoagulation prescription. Secondary objectives were to identify the therapeutic options, the main reasons for non-prescription and the factors associated with ineffectiveness or lack of treatment. METHODS: This was a cross-sectional study with a consecutive sample of 1,630 outpatients selected at Hospital de Clínicas de Porto Alegre between April and June of 2017. Atrial fibrillation was identified in 220 (13.50%) individuals. t Medical records from 145 patients were accessed, followed by a telephone interview. The association between variables and " outcomes was checked using the Mann-Whitney's U Test and a chi-squared test. RESULTS: The prevalence of atrial fibrillation was 13.50%. Anticoagulation therapy was prescribed in 77.93% of cases. In 76.11% of patients, warfarin was the chosen drug. < There was a tendency towards no prescription in patients with previous bleeding (RR = 2.32; 95%CI 0.95 - 5.64; p = 0.06) and falls (RR = 2.02; 95%CI 0.82 - 5.03; p = 0.08). We found an association between reduced functional capacity (Barthel's Activities of Daily Living Score < 80) and higher rate of anticoagulation in therapeutic target (RR = 0.22; 95%CI 0.06 - 0.87; p = 0.04). CONCLUSION: The prevalence of atrial fibrillation in this population was 13.50% and in 77.93% of cases anticoagulant were prescribed. Functional impairment was associated with a higher rate of anticoagulation in therapeutic target.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Anticoagulants/therapeutic use , Warfarin/therapeutic use , Brazil , Cerebral Infarction , Health of the Elderly
16.
Rev. colomb. nefrol. (En línea) ; 7(2): 104-112, jul.-dic. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1251570

ABSTRACT

Resumen La anticoagulación es la terapia de elección para la mayoría de pacientes con fibrilación auricular no valvular; sin embargo, en pacientes con enfermedad renal crónica con alto riesgo de sangrado se deben considerar terapias antitrombóticas locales como el cierre percutáneo de la orejuela izquierda con dispositivo Watchman. A continuación, se reporta el primer caso de implante de este dispositivo llevado a cabo en el Hospital de San José de Bogotá, Colombia, y se hace una revisión narrativa sobre este tema. El uso del dispositivo Watchman se asocia con menos accidentes cerebrovasculares hemorrágicos (0,15 vs. 0,96 eventos / 100 pacientes-año HR=0,22; p=0,004), menos muertes cardiovasculares o inexplicadas (1,1 vs. 2,3 eventos / 100 paciente-año; HR=0,48; p=0,006) y menos casos de sangrado no asociado al procedimiento (6,0 % vs. 11,3 %; HR=0,51; p=0,006) en comparación con la warfarina.


Resumen Anticoagulation remains the therapy of choice for the majority of patients with non-valvular atrial fibrillation, however, in patients with chronic kidney disease at high risk of bleeding, local antithrombotic therapies such as the left atrial closure with Watchman device should be considered. We report the first case of implant of this type device in the Hospital de San José at the City of Bogotá, Colombia, and a narrative review of the literature is made. Watchman's use is associated with fewer hemorrhagic strokes (0.15 versus 0.96 events / 100 patients-year HR: 0.22; p = 0.004), cardiovascular death / unexplained death (1.1 vs. 2.3 events / 100 patient-year; HR: 0.48; p = 0.006), and bleeding not associated with the procedure (6.0 % vs. 11.3 %; HR: 0.51; p = 0.006) compared to warfarin.


Subject(s)
Humans , Male , Female , Atrial Fibrillation , Patients , Peritoneal Dialysis , Colombia , Atrial Appendage , Narration
17.
Rev. colomb. cardiol ; 27(6): 607-610, nov.-dic. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289279

ABSTRACT

Resumen Se presenta el caso de un varón de 70 años de edad, quien debutó con fibrilación auricular no valvular, en quien, dos meses después y mediante ecocardiografía, se objetivaron dos masas contiguas en la aurícula derecha. Las masas eran dependientes de la válvula de Eustaquio, alcanzaban el septo interauricular y se asemejaban a un mixoma. Ambas fueron resecadas mediante cirugía, sin complicaciones intraoperatorias ni postoperatorias. El estudio anatomo-patológico concluyó que eran compatibles con trombos sin componente tumoral. Durante el seguimiento permaneció asintomático y en ritmo de fibrilación auricular.


Abstract The case is presented on a 70 year-old male who debuted with non-valvular atrial fibrillation. Two months later, and using cardiac ultrasound, two contiguous masses were observed in the right atrium. The masses were hanging from the Eustachian (inferior vena cave) valve, reached the interatrial septum and resembled a myxoma. Both were surgically resected, with no intra- or post-operative complications. The patient remained asymptomatic and in atrial fibrillation rhythm during follow-up.


Subject(s)
Humans , Male , Aged , Atrial Function, Right , Atrial Fibrillation , Thrombosis , Echocardiography , Myxoma
18.
Rev. colomb. cardiol ; 27(6): 560-566, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289272

ABSTRACT

Resumen Introducción: La fibrilación auricular es la arritmia más frecuente en el mundo y conlleva importantes consecuencias clínicas. Sin embargo, son pocos los datos de prevalencia o incidencia en Latinoamérica, específicamente en Colombia. Métodos: Estudio de corte transversal en el que se revisaron las historias clínicas electrónicas de pacientes hospitalizados por Medicina interna en el año 2016 en tres hospitales universitarios de Colombia, excluyendo pacientes de la Unidad de Cuidado Intensivo o que tenían soporte vasoactivo/inotrópico. Se calculó prevalencia global y por grupos de edad; además, se estimó la diferencia de prevalencias entre grupos etarios mediante el cálculo de la razón de prevalencias. Resultados: Se evaluaron 6.882 historias clínicas; se encontró una prevalencia global de fibrilación auricular de 4,8% (331 pacientes), más alta en mujeres (2,64%). La mediana de edad global fue 65 años con un rango intercuartílico (RIC) entre 49-78; para los pacientes con fibrilación auricular fue de 79 años (RIC 71-86). El 93,96% de los casos tenían una o más comorbilidades asociadas y, de éstas la más frecuente fue la hipertensión arterial crónica, con un 74,32%. Al pasar los 70 años, aumentó la prevalencia de fibrilación auricular 3.3 veces en comparación con los menores de este rango (razón de prevalencias 3.3). Conclusiones: La fibrilación auricular en las tres instituciones estudiadas, tiene una prevalencia global del 4,8%, y aumenta 3.3 veces al pasar los 70 años, hecho que demuestra que en Colombia esta enfermedad crece a mayor rango etario, datos útiles para sustentar políticas de tamizaje, que mejoren la calidad y el cubrimiento en salud.


Abstract Introduction: Atrial fibrillation is the most common arrhythmia in the world, and has significant clinical consequences. However, there are few data on the prevalence or incidence in Latin America, particularly in Colombia. Methods: A cross-sectional study was performed, in which a review was made of the computerised clinical records of patients admitted by Internal Medicine into three University Hospitals in Colombia. Patients admitted to Intensive Care or had vasoactive/ inotropic support were excluded. The overall prevalence was calculated, as well as by age group. The difference in prevalence between age groups was also calculated using the prevalence rates. Results: A total of 6,882 clinical records were reviewed, finding an overall prevalence of atrial fibrillation of 4.8% (331 patients), and was higher in women (2.64%). The overall median age was 65 years with an interquartile range (IQR) between 49 and 78 years. This increased to 79 years (IQR 71-86) for patients with atrial fibrillation. One or more associated comorbidities were found in 93.96% of cases, and of these the most common was chronic arterial hypertension in 74.32%. At greater than 70 years, atrial fibrillation increased 3.3 times more compared to those below this age range (prevalence ratio, 3.3). Conclusions: Atrial fibrillation in the three sites studied had an overall prevalence of 4.8%. This increased by 3.3 times in those patients over 70 years-old. This fact shows that the disease increases with increased age, making this useful data to maintain a screening policy that could improve health quality and coverage in Colombia.


Subject(s)
Humans , Male , Female , Aged , Atrial Fibrillation , Epidemiology , Prevalence , Hospitals, University , Internal Medicine
19.
Rev. colomb. cardiol ; 27(6): 541-547, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289270

ABSTRACT

Resumen Objetivo: Determinar la carga económica de la fibrilación auricular en Colombia. Materiales y métodos: Se realizó un estudio retrospectivo sobre bases de datos de atención de pacientes con diagnóstico de fibrilación auricular. Los pacientes fueron identificados a partir de los diagnósticos registrados en las atenciones ambulatorias y hospitalarias, utilizando como referencia el código diagnóstico CIE-10 de fibrilación auricular (I48x). Luego de la identificación de los pacientes se construyó un algoritmo que simulaba la historia natural y de atención de la enfermedad, el cual fue elaborado a partir de guías de manejo de la enfermedad. Se utilizó una técnica de microcosteo en función de una base de datos oficial de una aseguradora colombiana, teniendo en cuenta la historia natural de la enfermedad construida. Resultados: El costo anual de un paciente con fibrilación auricular diagnosticada correctamente es de $6.218.179, el de un paciente con evento tromboembólico agudo o signos inespecíficos como primera manifestación de la enfermedad es de $23.665.300, y el de un paciente con un infarto previo al diagnóstico de fibrilación auricular es de $37.493.968. Conclusiones: En términos de costos, el paciente que se mantiene controlado pese a que se incurra en costos de tecnologías para su control, es menos costoso que aquel que genera episodios agudos.


Abstract Objective: To determine the financial cost of atrial defibrillation in Colombia. Materials and methods: A retrospective study was carried out using health care data bases on patients with a diagnosis of atrial fibrillation. The patients were identified from the diagnoses recorded in ambulatory and hospital care registers, using the atrial fibrillation ICD-10 diagnostic (I48x). After the patients were identified, an algorithm was constructed by using the management guidelines for the disease and that simulated the natural history and care of the disease. A micro-costing technique was used in accordance with an official data base of a Colombian insurance Company, taking into account the natural history of the disease constructed. Results: The mean annual cost of a patient correctly diagnosed with atrial fibrillation is $6,218.179, that of the patient with an acute thrombo-embolic event or non-specific signs as a first manifestation of the disease is $23,665.300, and that of the patient with an infarction prior to the diagnosis of atrial fibrillation is $37,493.968. Conclusions: In terms of costs, the patient that is maintained under control, despite the technological costs of their control, is less costly than one that has acute episodes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation , Cross-Sectional Studies , Health Care Costs , Economics
20.
Rev. colomb. cardiol ; 27(6): 532-540, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289269

ABSTRACT

Resumen Introducción: La fibrilación auricular es la arritmia más frecuente, y a pesar de importantes avances en su tratamiento, sigue siendo una de las principales causas de accidente cerebrovascular, insuficiencia cardíaca, muerte súbita y morbimortalidad cardiovascular en el mundo (1,2). En Colombia se cuenta con muy pocos registros que determinen su prevalencia y patrón epidemiológico. Objetivo: Describir el tratamiento de los pacientes que ingresan al servicio de urgencias con diagnóstico de fibrilación auricular, así como establecer la prevalencia, epidemiología y eventos adversos asociados con el tratamiento. Materiales y método: Se utilizaron los programas EXCEL, para la organización de los datos, y SPSS versión 23, para el análisis. Resultados: Durante el periodo del estudio 105 pacientes fueron admitidos en el servicio de Urgencias con diagnóstico de fibrilación auricular. 58% eran hombres, con promedio de edad de 67.8 años. Las comorbilidades más asociadas a la fibrilación auricular fueron hipertensión arterial y falla cardiaca. El 35% de los pacientes habían tenido alguna complicación cardioembólica, principalmente ataque cerebrovascular, y 12% ingresaron por complicaciones derivadas de la anticoagulación. En la mayoría de los casos se prefirió una estrategia de control de frecuencia cardíaca y anticoagulación. En cuanto al manejo anticoagulante, el 45% fueron tratados con warfarina y el 37% con anticoagulantes orales directos. Se documentaron tres casos de sangrados mayores en pacientes tratados con warfarina y ninguno en pacientes tratados con anticoagulantes orales directos. Conclusión: La fibrilación auricular continúa siendo una de las principales causas de atención en el servicio de urgencias, así como una importante causa de accidente cerebrovascular. Las comorbilidades asociadas son hipertensión arterial y falla cardiaca. La estrategia terapéutica más utilizada es el control de la frecuencia cardiaca y la anticoagulación; adicionalmente, hay un porcentaje creciente de pacientes en tratamiento con anticoagulantes directos.


Abstract Introduction: Atrial fibrillation is the most common arrhythmia, and despite the significant advances in its treatment, it continues to be one of the main causes of cerebrovascular accident, heart failure, sudden death, and cardiovascular morbidity and mortality in the world. In Colombia, there are very few registers that help to determine its prevalence and epidemiological pattern. Objective: To describe the treatment of the patients admitted to the Emergency Department with a diagnosis of atrial fibrillation, as well as to establish the prevalence, epidemiology, and adverse events associated with the treatment. Materials and method: Excel programs were used for the organisation of the data, SPSS version 23, for the analysis. Results: During the study period, a total of 105 patients were admitted into the Emergency Department with a diagnosis of atrial defibrillation. The mean age was 67.8 years and the majority (58%) were males. Arterial hypertension and heart failure were comorbidities most associated with the atrial fibrillation. More than one-third (35%) of the patients had suffered some cardio-embolic complication, mainly a stroke, and 12% were admitted due to complications arising from anticoagulation. Monitoring heart rate and anticoagulation was the preferred strategy in the majority of patients. As regards anticoagulant management, 45% were treated with warfarin, and 37% with direct oral anticoagulants. Three cases of major bleeding were documented in patients on warfarin, and none in patients treated with direct oral anticoagulants. Conclusion: Atrial fibrillation continues to be one of the main causes in the Emergency Department, as well as a significant cause of cerebrovascular accident. Arterial hypertension and heart failure were the most associated comorbidities. The most used therapeutic strategy was monitoring of heart rate and the anticoagulation. Furthermore, there was an increasing percentage of patients on treatment with direct oral anticoagulants.


Subject(s)
Humans , Male , Aged , Atrial Fibrillation , Drug-Related Side Effects and Adverse Reactions , Emergencies , Heart Failure , Heart Rate , Anticoagulants
SELECTION OF CITATIONS
SEARCH DETAIL