Perfil dos usuários de dispositivos cardíacos eletrônicos implantavéis em um hospital universitário / Perfil de usuario de dispositivos cardíacos electrónicos implantables en un hospital universitario / User profile of implantable electronic cardiac devices in a university hospital

Objetivo:Identificar o perfil dos pacientes submetidos à inserção de dispositivos cardíacos eletrônicos implantáveis em um hospital de referência do Rio Grande do Norte.Método:Trata-se de um estudo descritivo, exploratório, retrospectivo dos últimos 03 anoscom abordagem quantitativa. Amostragem foiselecionada por conveniência. A coleta de dados ocorreu entre outubrode 2017 a março de 2018.Resultados: A amostra foi composta por 215prontuários,destes 182 foram analisados.Implantarammarca-passos63,7% e 28% cardiodesfibriladores, corresponderam ao sexo masculino69,3%,com média de idade 65 e 49.Entre as comorbidades,a Hipertensão Arterial Sistêmicaabrangeu 87,4%.Evidenciaram-se os bloqueios atrioventriculares como principal causa para implantes (35%), seguidos das miocardiopatias (12%).Conclusão:Percebeu-se que, os indivíduos que implantaram marcapassos eram acometidos por bradiarritmias,enquanto cardiodesfibriladores por taquiarritmias. As complicações pós-operatórias e intercorrências durante o procedimento foram de baixo risco. Salienta-se, que no manejo desses usuários é fundamental a elaboração de um protocolo, visando aperfeiçoar o cuidado.(AU)

Objective: Toidentifytheprofileofpatientsundergoinginsertionof implantable electroniccardiacdevices in a reference hospital in Rio Grande do Norte. Method: Thisis a descriptive, exploratory,retrospective studyofthelastthreeyearswith a quantitativeapproach. Samplingwasselectedby convenience. Data collectionoccurredbetweenOctober 2017 to March 2018. Results: Samplecomposedof 215 medical records, ofthese 182 wereanalyzed. Implantedpacemakers 63.7% and 28% cardiodesfibrillators, corresponded tothe male gender 69.3%, withaverageage 65 and 49. Amongthecomorbidities, Systemic Arterial Hypertensioncovered 87.4%. Theatrioventricular blocks wereevidenced as themain cause forimplantation (35%), followedbymyocardiopathies (12%). Conclusion: Itwasnoticedthatindividualswhoimplantedpacemakerswereaffectedbybradyarrhythmias, whilecardioverter-defibrillatorswereaffe ctedbytachyarrhythmias. Thepostoperativecomplications and complicationsduringtheprocedurewerelowrisk. Itisemphasizedthat in themanagementoftheseusersitisessentialtodevelop a protocol, aimingtoimprove care.(AU)

Objetivo: identificar el perfil de los pacientes sometidos a la inserción de dispositivos cardíacos electrónicos implantables en el hospital de referencia de Rio Grande do Norte. Método: se trata de un estudio descriptivo, exploratorio, retrospectivo de los últimos 3 años con enfoque cuantitativo. El muestreo fue seleccionado por conveniencia. La recolección de datos se llevó a cabo entre octubre de 2017 y marzo de 2018. Resultados: muestra compuesta por 215 historias clínicas, de las cuales se analizaron 182. Marcapasos implantados 63,7% y desfibriladores cardioversores 28%, correspondieron al sexo masculino 69,3%, con una edad media de 65 y 49 años. Entre las comorbilidades, la Hipertensión Arterial Sistémica cubrió el 87,4%. Los bloqueos auriculoventriculares se evidenciaron como la principal causa de implantes (35%), seguida de las miocardiopatías (12%). Conclusión: se notó que, los portadores de marcapasos se vieron afectados por bradiarritmias, mientras que los desfibriladores cardioversores por taquiarritmias. Las complicaciones postoperatorias y las complicaciones durante el procedimiento fueron de bajo riesgo. Cabe señalar que en el manejo de estos usuarios es fundamental la elaboración de un protocolo, con el fin de mejorar la atención.(AU)

Tecnologia educacional para o manejo do marca-passo transcutâneo em idosos no atendimento pré-hospitalar móvel / Educational technology for the management of transcutaneous pacemakers in the elderly in mobile pre-hospital care

Resumo: Esta pesquisa compreende a produção de um vídeo educativo sobre ações e cuidados do enfermeiro no manejo do marca-passo transcutâneo em idosos em atendimento pré-hospitalar. Destaca-se a necessidade de elucidar o conhecimento e qualificar a assistência ao idoso a partir de recursos didáticos como o vídeo educativo. A pesquisa teve por objetivo elaborar uma tecnologia educacional para enfermeiros sobre o manejo do marca-passo transcutâneo em idosos em Atendimento Pré-Hospitalar Móvel. Trata-se de pesquisa metodológica de produção tecnológica, do tipo quantitativa descritiva, a qual baseia-se na construção e validação de um vídeo educativo, desenvolvido nas Unidades de Suporte Avançado do Serviço de Atendimento Móvel de Urgência, da 2ª Regional de Saúde Metropolitana do Estado do Paraná. O método de produção do vídeo foi composto por três fases: a) pré-produção, que consistiu na elaboração do roteiro do vídeo; b) produção, na qual ocorreu a validação do roteiro do vídeo por um grupo de juízes especialistas seguido da elaboração dos "storyboards", seleção das imagens, gravação das narrações e edição do vídeo; c) pós-produção, que se traduziu na validação do vídeo pelo grupo de juízes especialistas. Para a validação do roteiro foi utilizado um instrumento do tipo escala de "Likert" e para validação do vídeo um questionário elaborado e adaptado a partir do modelo de Razera et al. (2016). Após a validação pelos juízes, o vídeo foi divulgado em um canal do Youtube. Quanto ao conteúdo do roteiro foram elencados quatro blocos: conhecimentos gerais sobre o MPTC em idosos, cuidados de enfermagem na utilização do MPTC, etapas para o manejo do MPTC e as possíveis complicações e limitações na utilização do MPTC, e foi validado por 51 juízes especialistas. O vídeo foi validado por 47 juízes especialistas que participaram da etapa anterior. Em relação ao gênero dos juízes especialistas, as mulheres representaram na fase 1 da pesquisa (F1) 56,9% e na fase 2 (F2) 57,4%. Quanto à idade dos participantes a maioria apresentou entre 35 e 45 anos (F1 62,7% e F2 61,7%). Produziu-se um vídeo de duração de oito minutos e 30 segundos em animação 2D, fundamentado a partir de uma revisão integrativa e consultas em guias e "guidelines" de sociedades de cardiologia nacional e internacional que abordam as ações e cuidados no manejo do marca-passo transcutâneo em idosos. Conclui-se que a tecnologia desenvolvida, nos quesitos: linguagem, imagens, narração, adequação quanto ao tempo de duração, orientações propostas e memorizações das mensagens, alcançou índices que demostram a viabilidade na identificação das ações e cuidados pelo enfermeiro no manejo do marca-passo transcutâneo em idosos no atendimento pré-hospitalar. Assim, foi elaborada e validada uma estratégia para a educação em saúde que contribui para subsidiar a equipe na tomada de decisões, colaborando para a segurança do paciente e da equipe, assim como para o sucesso no tratamento. A tecnologia educacional desenvolvida pode ampliar e reciclar continuamente o conhecimento dos enfermeiros da Unidade de Suporte Avançado de Vida sobre as ações e cuidados essenciais no manuseio do MPTC em idoso com bradiarritmias no Atendimento Pré-Hospitalar Móvel.

Abstract: This research grasps the production of an educational video about the handling of the transcutaneous pacemaker (TCPM) in elderly in Mobile Pre-Hospital Care. The need to clarify knowledge and qualify the elderly's care through didactic resources, such as the educational video, is highlighted. The aim of the research was to elaborate an educational technology for nurses about the handling of the transcutaneous pacemaker (TCPM) in elderly in Mobile Pre-Hospital Care. This is a methodological research of technology production, of the quantitative descriptive type, which is based in the construction and validation of an educational video, developed in Advanced Care Units (ACUs) of Mobile Emergency Medical Service, of the 2nd Metropolitan Health Regional of the State of Paraná. The production method of the video was composed by three phases: a) pre-production, which consisted in the screenplay elaboration; b) production, in which there was the validation of the video screenplay by a group of specialist judges followed by the elaboration of storyboards, selection of images, recordings of narrations and video editing; c) post-production, which consisted in the validation of the video by the group of specialist judges. For the validation of the screenplay a scale-like "likert" instrument was used, and for the validation of the video, a questionnaire made and adapted from Razera's et al model. (2016). After validation by the judges, the video was shared on a Youtube channel. As for the content of the screenplay, they were divided in four blocks: general knowledge about TCPM in elderly, nursing care when using TCPM, phases for the handling of TCPM and the possible complications and limitations utilizing TCPM, it was approved by 51 specialist judges. The video itself was approved by 47 specialist judges who took part in the former phase. With respect to gender of the specialist judges, women represented in phase 1 of the research (P1) 56.9% and in phase 2 (P2) 57.4%. As for the age of participants, most of them were between 35 and 45 years old (P1 62.7% and P2 61.7%). There was the production of a video lasting eight minutes and 30 seconds in 2D animation, reasoned by an integrative review and bibliographic research in guidelines of national and international cardiology societies that approach nurses' actions and care in the handling of the transcutaneous pacemaker in elderly in prehospital care. It concludes that the developed technology in terms of language, images, narration, adjustment to duration time, proposed guidance and message memorization, reached indexes that show viability in identification of nurses' actions and care in the handling of the transcutaneous pacemaker in elderly in pre-hospital care. Therefore, it was elaborated and validated a strategy for health education, that contributes to subsidize the team in decision making, contributing to the safety of the patient and the team, as well as for treatment success. The developed educational technology can broaden and continually recycle the knowledge of nurses from the Units of Intensive Life Support (SAV) about necessary actions and care in the handling of the transcutaneous pacemaker in elderly with bradyarrhythmia in Mobile Pre-Hospital Care.

Estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo / Long-term temporary cardiac pacing with active lead and external permanent pacemaker

INTRODUCCIÓN. La estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo es una técnica recientemente incluida en las guías de manejo de bradicardias sintomáticas. CASOS CLÍNICOS. Se describen 4 casos de pacientes sometidos a estimulación cardíaca temporal de larga duración con cable activo y marcapaso permanente externo de la unidad de Hemodinámica del Hospital de Especialidades Carlos Andrade Marín, con indicaciones diversas. DISCUSIÓN. El tiempo medio de permanencia con el cable activo y el marcapaso externalizado fue 23 días. No hubo complicaciones del procedimiento. Un paciente falleció por causas no relacionadas con la estimulación y 2 se recuperaron en sus domicilios. CONCLUSIÓN. La técnica de estimulación temporal utilizando marcapasos permanentes recuperados se muestra extremadamente útil para mantener un marcapaso cardíaco seguro, incluso ambulatorio y por largo tiempo, hasta el implante de dispositivos definitivos. Su limitación es la factibilidad de hacerlo solo en centros de tercer nivel.

INTRODUCTION. Long-duration temporary cardiac pacing with active lead and permanent external pacemaker is a technique recently included in the guidelines for the management of symptomatic bradycardias. CLINICAL CASES. We describe 4 cases of patients who underwent long-duration temporary cardiac pacing with active lead and external permanent pacemaker at the Hemodynamics Unit of the Hospital de Especialidades Carlos Andrade Marín, with different indications. DISCUSSION. The mean length of stay with the active lead and externalized pacemaker was 23 days. There were no procedural complications. One patient died of causes unrelated to pacing and 2 recovered at home. CONCLUSIONS. The technique of temporary pacing using retrieved permanent pacemakers is extremely useful for maintaining safe cardiac pacing, even on an outpatient basis and for a long period of time, until implantation of definitive devices. Its limitation is the feasibility of doing it only in third level centers.

Prevalence of Atrial Fibrillation in Pacemaker Patients

Abstract Background: Current pacemakers allow for the continuous recording of the occurrence of arrhythmic events. One of the most frequent arrhythmias after implantation of a device is atrial fibrillation (AF), an important risk factor for embolic events. The frequency of this arrhythmia in pacemaker patients has not been widely studied. Objectives: This study aimed to evaluate the prevalence, incidence, and predictors of the occurrence of AF in patients with double-chamber pacemakers and without a history of atrial fibrillation prior to implantation. Methods: A dynamic, retrospective, and prospective cohort study was carried out with 186 patients undergoing biannual follow-up of the double-chamber pacemaker, without previous AF, in a single service, between 2016 and 2018. Clinical data were collected from the medical records and the telemetry of the device and the prevalence, incidence rate, relative risk by univariate analysis (by chi-square), and risk ratio were calculated by multivariate analysis (by Cox regression); values of p<0.05 were considered significant. Results: There was a prevalence of 25.3% FA, with an incidence of 5.64 cases / 100 persons-year. The median time for the development of arrhythmia was 27.5 months. Multivariate analysis identified 5 statistically significant predictors: male gender, OR: 2.54 [1.04-6.15]; coronary artery disease, OR: 2.98 [1.20-7.41]; hypothyroidism, OR: 3.63 [1.46-9.07]; prior heart surgery, OR: 2.67 [1.01-7]; and left atrial enlargement, OR: 2.72 [1.25-5.92]. Conclusions: The prevalence and incidence of AF in this population are high. Risk factors for AF were: male gender, coronary artery disease, hypothyroidism, prior heart surgery, and left atrial enlargement.

Atribuições do enfermeiro no manejo do marcapasso transcutâneo em pacientes idosos: Uma revisão integrativa / Asignaciones del enfermero em el manejo del marcapasos transcutáneo en anciano: Una revisión integrativa / Nurse attributions in the handling of transcutaneous pacemaker in elderly patients: Integrative review

Objetivo: investigar a produção científica nacional e internacional sobre as ações e cuidados do enfermeiro no manejo do marca-passo transcutâneo em idosos. Método: revisão integrativa, realizada nas bases de dados "Scopus", "Web of Science", "EMBASE", "PUBMED", "MEDLINE", no período de 2012 a 2022. Resultados: foram selecionados oito artigos, todos internacionais, somente um conduzido por enfermeiros. Categorizados por: (1) Possibilidades e limitações no uso do marca-passo trânscutâneo na prática clínica; (2) Cuidados de enfermagem na utilização do marca-passo transcutâneo em idosos e (3) Sistematização da Assistência de Enfermagem e a abordagem ao paciente em uso de marca-passo transcutâneo. Conclusão: os principais cuidados de enfermagem ao idoso que utiliza o marca-passo transcutâneo são: prevenção de queimaduras cutâneas; administração de medicamentos; manejo da dor; monitoramento dos dados vitais; avaliação da captura mecânica; investigação do histórico familiar; medicações em uso; realização do exame físico e acesso venoso periférico.(AU)

Objective: : to investigate the national and international scientific production regarding the actions and handling of the transcutaneous pacemaker in elderly. Method: integrative review, made in the databases Scopus", "Web of Science", "EMBASE", "PUBMED", and "MEDLINE", for the period 2012 to 2022. Findings: there were selected eight articles, all international, and only one conducted by nurses. Categorized into: (1) Possibilities and limitations of the use from the transcutaneous pacemaker in clinical practice; (2) Nursing care when utilizing transcutaneous pacemaker in elderly and (3) Systematization of Nursing Care and approach to patients using transcutaneous pacemaker. Conclusion: the main Nursing Care approaches to elderly who use transcutaneous pacemaker are prevent skin burn; drug administration; pain management; monitoring vital signs; evaluation of heart activity; investigating family history and drugs in use; performing physical examination and peripheral venous access.(AU)

Objetivo: investigar cual és lá produccion científica nacional e internacional sobre Las acciones y cuidados del enfermero en el manejo del marca-pado intracutaneo en ancianos. Método: Revision Integrativa realizada en Las bases de datos "Scopus" web of Science", EMBASE", "PUBMED", "MEDLINE", durante el período 2012 a 2022. Resultados: fueron Seleccionados ocho articulos todos internacionales, solanemente uno fue llevado a cabo por enfermeros. Categorizado por (1) posibilidades y limitaciones en El uso del marca-paso intracutaneo en lá práctica clínica; (2) cuidados de enfermeria en lá utilização del marca-paso intracutaneo y (3) sistematizacion de la assistencia de enfermeria y el abordaje del paciente que usa marca-paso intracutaneo. Conclusion: Los principales cuidados de enfermeria Al anciano que utiliza marca-paso intracutaneo son: prevencion de quemaduras cutaneas; administracion de medicamentos, manejo del dolor, monitorizacion de datos vitales, evaluacion de lá captura mecanica, investigação del histórico famíliar, medicaciones en uso, realizacion de examen fisico y acceso venoso periférico.(AU)

Predictive value of impedance of leadless pacemaker during implantation on trend changes of pacing threshold / 中华心血管病杂志

Objective: To explore the predictive value of the impedance measured during leadless pacemaker Micra implantation on the trend of changes of pacing threshold post implantation. Methods: This is a retrospective cross-sectional study. Patients who received implantation of leadless pacemaker Micra at the Second Xiangya Hospital of Central South University from December 2019 to August 2020 were enrolled. The clinical data and the intraoperative electrical parameters during leadless pacemaker implantation were collected. The impedance and pacing threshold data were analyzed at three time points: immediate release, 5-10 min after release, and after traction test. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to analyze the value of the impedance at immediate release on predicting the trend of changes of pacing threshold post implantation. Results: A total of 21 patients (mean age: (72.2±12.5) years, 12 males) were included. The impedance of 21 patients was (798.1±35.3) Ω immediately after implantation, (800.9±35.6) Ω after 5-10 minutes of release, and (883.6±31.7) Ω after traction test. Impedance was similar between the three time points (P>0.05). The threshold was (0.97±0.11) V/0.24 ms immediately after implantation, (0.95±0.12) V/0.24 ms at 5-10 min after the release, and (0.59±0.06) V/0.24 ms after the traction test. The threshold was significantly lower after the traction test than that immediately after release (P=0.003) and than that at 5-10 minutes after release (P=0.008), suggesting a decreased tendency of the threshold over time. According to the analysis of the ROC curve, the immediate impedance after the release ≥680 Ω could predict the ideal pacing threshold after the traction test (AUC=0.989, 95%CI 0.702-0.964, P<0.001), the prediction sensitivity was 87%, and the specificity was 100%. The pacing threshold would be not ideal with the immediate impedance ≤ 520 Ω (95%CI 0.893-1.000, P<0.001), the sensitivity was 100%, and the specificity was 80%. Conclusions: The impedance immediately after the release has predictive value for the changing trend of threshold post leadless pacemaker Micra implantation. Impedance ≥680 Ω immediately after release is often related with ideal pacing threshold after the traction test. In contrast, the impedance ≤ 520 Ω pacing is often related with unsatisfactory threshold after the traction test, therefore, it is recommended to find a new pacing site to achieve the impedance ≥680 Ω immediately after release during leadless pacemaker Micra implantation.

Study on Impedance of Implantable Cardiac Pacemaker in Unipolar/Bipolar Pacing Mode by in Vitro Experiment / 中国医疗器械杂志

The unipolar/bipolar pacing mode of pacemaker is related to its circuit impedance, which affects the battery life. In this study, the in vitro experiment scheme of pacemaker circuit impedance test was constructed. The human blood environment was simulated by NaCl solution, and the experimental environment temperature was controlled by water bath. The results of in vitro experiments showed that under the experimental conditions similar to clinical human parameters, the difference between the circuit impedance of bipolar mode and unipolar mode is 120~200 Ω. The results of the in vitro experiment confirmed that the circuit impedance of bipolar circuit was larger than that of unipolar mode, which was found in clinical practice. The results of this study have reference value to the optimization of pacing mode and the reduction of pacemaker power consumption.

Research and Implementation of 433 MHz-based Wireless Implantable Pacing System / 中国医疗器械杂志

In order to solve the problem of communication interference and communication distance caused by the rapid pacing system when establishing the rapid atrial fibrillation model, a low-power implantable pacing system based on 433 MHz communication frequency to form a star network is designed. The system includes an implantable pacemaker, a programmer head, and programmer software. The pacemaker is composed of a wireless communication module, a pacing module, an ECG monitoring module, and a power management module. The programmer head acts as an intermediate node in the star network and is controlled by PC programmer software to program each pacemaker. This article introduces the hardware design and software flow of each part of the system, and describes the results of in vivo simulation and in vivo animal models of the system. The results show that the designed system and application method are effective and feasible for the rapid atrial pacing atrial fibrillation model. 433 MHz wireless communication, implantable, pacemaker system, low-power, ECG monitoring.

Linfoma cardíaco primário: o papel da multimodalidade de imagem na abordagem diagnóstica / Primary cardiac lymphoma: role of imaging multimodality in diagnosis

Massas intracardíacas constituem um desafio diagnóstico, já que os sintomas são comuns a patologias cardiovasculares ou não. Métodos ­ invasivos ou não ­ possibilitam o diagnóstico diferencial e a confirmação histológica, propiciando tratamento adequado. Para melhor compreender a importância da multimodalidade em imagem e a abordagem nos tumores cardíacos , relatamos o caso de um lifoma cardíaco primário, em que a abordagem multidisciplinar permitiu o rápido diagnóstico e seu tratamento, inclusive das intercorrências, com resposta inicial promissora, a despeito da evolução fatal durante a pandemia por SARS-CoV-2.(AU)

Intracardiac masses are a diagnostic challenge since their symptoms can be common to cardiovascular pathologies. Some methods, whether invasive or not, enable differential diagnosis, histological confirmation, and adequate treatment. To better understand the importance of imaging multimodality and the approach to managing cardiac tumors, we investigated a case of a primary cardiac lymphoma in which the multidisciplinary approach allowed rapid diagnosis and treatment, including of intercurrences, with a promising initial response despite fatal progression due to severe acute respiratory syndrome coronavirus 2 infection. (AU)

Síndrome de reel como causa del mal funcionamiento del marcapasos: A propósito de un caso / Reel syndrome as cause of pacemaker malfunction: Apropos of a case

Implantation of cardiac electronic devices is an increasingly common technique and the possibility of device dysfunction caused by electrode displacement should be taken into account. We describe the case of an 88-year-old patient with syncopes several months after pacemaker implantation in which a pacemaker dysfunction was found. Chest X-ray confirmed lead displacement reeled around the generator. Reel syndrome is an entity that should be ruled out as a possible cause of pacemaker malfunction mainly in patients with risk factors for developing this syndrome.

La implantación de dispositivos cardíacos electrónicos es una técnica cada vez más habitual y debe tenerse en cuenta la posibilidad de disfunción del dispositivo debido al desplazamiento de los electrodos. Describimos el caso de una paciente de 88 años que comenzó con clínica de cuadros sincopales varios meses después de la implantación de un marcapasos, y en la que se demostró una disfunción del dispositivo. Mediante radiografía de tórax se confirmó el desplazamiento de los electrodos debido a un enrollamiento alrededor del generador. El síndrome de reel es una entidad que debe ser descartada como una de las posibles causas de mal funcionamiento de un marcapasos, principalmente en pacientes con factores de riesgo para presentar dicho síndrome.

Alterações cardíacas em pacientes durante o primeiro ano de hemodiálise crônica: foco em preditores de fibrilação atrial / Cardiac changes in patients during the first year of chronic hemodialysis: focus on predictors of atrial fibrillation

Objetivos: Detecção precoce de alterações cardíacas, em especial de preditores de fibrilação atrial (FA), em pacientes renais crônicos dialíticos, permitem condutas terapêuticas que podem impactar na morbimortalidade cardiovascular desses pacientes. Descrevemos alterações elétricas e estruturais cardíacas nos pacientes durante o 1º ano de hemodiálise (HD). Métodos: Estudo observacional, transversal, prospectivo, em pacientes entre 20 e 80 anos, renais crônicos, pertencentes a serviços públicos de São Paulo, divididos pelo tempo de início de hemodiálise: grupo 1: 1 a 6 meses; grupo 2: 7 a12 meses. Coletados dados sociodemográficos, mórbidos, eletrocardiograma de repouso, Holter 48h, ecocardiograma transtorácico e exames de sangue pré e pós hemodiálise ( função renal, eletrólitos, bicarbonato e inflamatórios). Analisados por teste T student e Qui-quadrado. Resultados: 73 pacientes, hipertensos, predomínio homens, quinquagenários, escolaridade fundamental, brancos, não solteiros, procedentes da região sudeste metropolitana, com multimorbidades e polifarmácia. Grupo 2 apresentou maior idade (p=0,007), morbidades (p=0,04), medicações (p=0,02), preditores de FA caracterizados por extrassístoles ventriculares ( p=0,02), aumento dos volumes e diâmetros ventriculares e átrio esquerdo (todos p≤0,001), alteração do bicarbonato pré e pós hemodiálise (p<0,01). Grupo 1 apresentou maiores alterações eletrolíticas pós hemodiálise (p≤0,03). Conclusão: Além da hipertensão arterial, tempo de hemodiálise, acidose metabólica próxima dos limites de referência, associaram-se precocemente à progressiva disfunção sisto-diastólica de câmaras esquerdas cardíacas e preditores de fibrilação atrial, em especial o volume sistólico final, predominantemente no 2º semestre do início de hemodiálise. Sugere-se Holter e Ecocardiograma a partir do 7º mês de hemodiálise e controles mais rígidos de acidose para essa população.

Objectives: Early detection of cardiac alterations in chronic renal patients on hemodyalisis (HD), especially atrial fibrillation (AF) predictors, allows therapeutic approaches that can impact their cardiovascular prognosis. We describe electrical and structural cardiac alterations in patients during the 1st year of hemodyalisis. Methods: Observational, cross-sectional, prospective study. Chronic kidney patients on dyalisis aged between 20 and 80 years, wihout atrial fibrillation, from public hemodyalisis services were divided by the time of hemodyalisis onset: group 1: 1 to 6 months; group 2: 7 to 12 months. Sociodemographic and morbid data, electrocardiogram at rest, Holter 48h, transthoracic echocardiogram and pre and post hemodialysis blood tests (kidney function, electrolytes and inflammatory tests) were collected. Data analyzed by Chi-square and Student T tests. Results: 73 hypertensive patients, predominantly men, aged in their fifties, elementary school, white, not single, from the metropolitan southeast region, with multimorbidities and polypharmacy were analyzed. Group 2 presented more age (p<0.01), morbidities (p=0.04), medications (p=0.02), atrial fibrillation, predictors especially ventricular extrasystoles (VES, p=0.02), increased left venticular and atrium volumes and diameters (all p≤0.001) and lower bicarbonate before and after hemodyalisis (both p≤0,01). Group 1 presented more changes in eletrolytes (p≤0.03). Conclusion: In addition to arterial hypertension, hemodyalisis duration was associated to systolic and diastolic dysfunction of the left cardiac chambers, atrial fibrillation predictors especially end-systolic volume (ESV) and mild acidosis, in the 2nd semestre predominantly. Holter and echocardiography are suggested from the 7th month of hemodyalisis onset and tighter metabolic control in this population

Remoção Percutânea de Eletrodos de Estimulação Cardíaca Artificial em um Único Centro Sul-Americano / Percutaneous Removal of Cardiac Leads in a Single Center in South America

Resumo Fundamento: Nas últimas décadas, o número de dispositivos eletrônicos cardíacos implantáveis (DCEI) aumentou consideravelmente, assim como a necessidade de remoção destes. Neste contexto, a remoção percutânea apresenta-se como uma técnica segura e capaz de evitar uma cirurgia cardíaca convencional. Objetivos: Primário: descrever a taxa de sucesso e complicações da remoção percutânea de DCEI em um hospital público brasileiro. Secundário: estabelecer preditores de sucesso e complicações. Métodos: Serie de casos retrospectiva de todos os pacientes submetidos à remoção de DCEI em um hospital público brasileiro no período de janeiro de 2013 a junho de 2018. Remoção, explante e extração de eletrodos, complicações e desfechos foram definidos conforme a diretriz norte-americana de 2017. Variáveis categóricas foram comparadas pelos testes Qui-quadrado ou Fisher, enquanto variáveis contínuas, por testes não pareados. O nível de significância adotado nas análises estatísticas foi de 5%. Resultados: 61 pacientes foram submetidos à remoção de DCEI, sendo 51 extrações e 10 explantes. No total, 128 eletrodos foram removidos. Taxa de sucesso clínico foi 100% no grupo do explante e 90,2% no da extração (p=0,58). Complicações maiores foram encontradas em 6,6% dos pacientes. Falha do procedimento foi associada a eletrodos de ventrículo (p=0,05) e átrio (p=0,04) direito implantados há mais tempo. Duração do procedimento (p=0,003) e necessidade de transfusão sanguínea (p<0,001) foram associadas a maior índice de complicação. Conclusão: As taxas de complicação e sucesso clínico observadas foram de 11,5% e 91,8%, respectivamente. Remoções de eletrodos atriais e ventriculares mais antigos estiveram associados a menores taxa de sucesso. Procedimentos mais longos e necessidade de transfusão sanguínea foram associados a complicações.

Abstract Background: In the last decade, the number of cardiac electronic devices has risen considerably and consequently the occasional need for their removal. Concurrently, the transvenous lead removal became a safe procedure that could prevent open-heart surgery. Objective: The primary objective of this study was to describe the successful performance and the complication rates of pacemaker removals in a Brazilian public hospital. Our secondary aim was to describe the variables associated to successes and complications. Methods: A retrospective case series was conducted in patients submitted to pacemaker removal in a Brazilian public hospital from January 2013 to June 2018. Removal, explant, extraction, success and complication rates were defined by the 2017 Heart Rhythm Society Guideline. Categorical variables were compared using x2 or Fisher's tests, while continuous variables were compared by unpaired tests. A p-value of 0.05 was considered statistically significant. Results: Cardiac device removals were performed in 61 patients, of which 51 were submitted to lead extractions and 10 to lead explants. In total, 128 leads were removed. Our clinical success rate was 100% in the explant group and 90.2% in the extraction one (p=0.58). Major complications were observed in 6.6% patients. Procedure failure was associated to older right ventricle (p=0.05) and atrial leads (p=0,04). Procedure duration (p=0.003) and need for blood transfusion (p<0,001) were associated to more complications. Conclusion: Complications and clinical success were observed in 11.5% and 91.8% of the population, respectively. Removal of older atrial and ventricular leads were associated with lower success rates. Longer procedures and blood transfusions were associated with complications.

Health-Related Quality of Life in Elderly Patients with Pacemakers

Abstract Introduction: Cardiac pacemaker (PM) therapy is of paramount importance. PM use increases with age, with an estimated increased use of 70% to 80% in patients over 65 years. This study evaluated the perception of the health-related quality of life (HRQoL) of elderly patients with PM, comparing them with patients without PM, by applying two quality of life questionnaires: EuroQoL 5-dimensions (EQ-5D) and 36-Item Short Form Health Survey (SF-36). Methods: This study included elderly patients divided into a group with PM and another without PM. Information on HRQoL was obtained using the EQ-5D and SF-36 questionnaires. Results: The study involved 104 elderly patients with PM and 150 without PM. The distribution of responses to the EQ-5D was similar between groups. Statistical differences within the gender variable in the group of elderly people with PM were significant for the mobility, habitual activities, and anxiety/depression domains and for the average EQoL utility score and visual analogue scale (EQ-VAS). Elderly patients with PM presented significant differences between New York Heart Association classes 1 and 2 for the mobility domain and EQ-VAS, while those evaluated through SF-36 presented higher averages in vitality, general health status, and pain. However, a different analysis was observed in the physical aspect domain. Conclusion: The SF-36 demonstrated that elderly patients with PM had an HRQoL similar to or greater than those without PM. However, the results of the EQ-5D did not show significant differences regarding the implantation of PM and HRQoL between the two groups of elderly individuals in the study.

Association between fragmented QRS and postprocedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation

SUMMARY INTRODUCTION: According to recent studies, the rate of atrioventricular block requiring permanent pacing in patients following transcatheter aortic valve implantation varied between 5.7% and 42.5%. Fragmented QRS is a useful marker of myocardial scar and can predict adverse cardiac events. In this study, we examined association between f ragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation. OBJECTIVE: In this study, we examined association between fragmented QRS and postprocedural rhythm disturbances and the need for permanent pacing in patients who underwent transcatheter aortic valve implantation' sentence is enough for it. METHODS: We retrospectively analyzed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis was implanted. We examined 12-lead electrocardiogram before and after procedure along with one- and six-month follow-up. We documented QRS fragmentation and postprocedural rhythm disturbances. RESULTS: There was a significant increase in the frequency of left bundle branch block, (21.1 versus 0%, p<0.05) and the incidence of atrioventricular blocks requiring permanent pacing (21.1 versus 0%, p<0.05) following transcatheter aortic valve implantation in patients whose preprocedural electrocardiogram recordings revealed fragmented QRS compared to those without fragmented QRS. Based our collected data, the presence of QRS fragmentation in anterior derivations was the only independent factor associated with postprocedural rhythm disturbances (B-value 0.217; OR 0.805; 95%CI 0.136-4.78; p=0.004). CONCLUSION: Our data showed an increased risk for the development of new-onset left bundle branch block and atrioventricular blocks following transcatheter aortic valve implantation in patients whose baseline electrocardiogram recordings demonstrated QRS fragmentation.

Logic Analysis of Arrhythmia Triggered by Pacemaker Special Functions - An Educational Presentation

Abstract Dual-chamber pacemaker is a fully automatic pacemaker with the function of simulating human physiological pacing. It regulates pacing by programming different refractory periods and various special functions, which are closely related to arrhythmia. After in-depth understanding of these special functions, regular electrocardiogram follow-up analysis is required to provide individualized optimal program control and so is appropriate the administration of the pacemaker's special functions to better provide optimal clinical guidance for patients with arrhythmia.