Treatment of Hepatitis C with Direct-Acting Antivirals does not Induce Significant Arrhythmias

Abstract Background Chronic Hepatitis C (CHC) therapy with direct-acting antivirals (DAAs) has high efficacy and safety, but some cases of bradyarrhythmias have been described. Objective To evaluate heart rhythm disorders during DAA treatments. Methods Forty-eight patients with CHC (mean 61 years of age; 56% males; 73% HCV genotype 1) were evaluated before and during treatment with DAAs, analyzed by a resting 12-lead ECG [PR, QRS, and QT corrected (QTc) intervals measured] and a 24-h-Holter system, to evaluate the heart rate (HR) and the occurrence of arrhythmias. The Student's t-test or the Wilcoxon-Mann-Whitney test for continuous, independent variables were performed with a statistically significant p-value < 0.05. Results The electrocardiographic parameters before and during treatment were: PR interval (147.2 ± 15.6 vs 144.9 ± 15.6 ms; p = 0.21), QTc interval (427 ± 22.3 vs 421.7 ± 25.3 ms; p = 0.24), minimum HR (52.7 ± 8.4 vs 53.2 ± 8.5 bpm; p = 0.49), median HR (74.2 ± 10.4 vs 75.2 ± 9 bpm; p = 0.83), and maximum HR (117.4 ± 16.8 vs 117.9 ± 16.3 bpm; p = 0.25). These parameters proved to be similar among 11 beta-blockers or 22 ribavirin users. During treatment, the 21 cirrhotic patients presented significantly lower median HRs (72.1 ± 9.0 vs 77.9 ± 8.2 bpm; p = 0.02) and maximum HRs (108.9 ± 15.2 vs. 125.1 ± 13.2 bpm, p < 0.0001) through a 24-h-Holter monitoring than the patients without cirrhosis. No clinically relevant arrhythmias were detected. Conclusion DAAs do not significantly influence heart rate or induce significant cardiac arrhythmias in patients with CHC.

Recomendações para o manejo de dispositivos cardíacos eletrônicos implantáveis post mortem / Recommendations for the post-mortem management of cardiac implantable electronic devices

O manejo de dispositivos cardíacos eletrônicos implantáveis de pacientes que evoluem a óbito tem sido motivo de controvérsia. Em nosso meio, não há recomendações uniformes, estando baseadas exclusivamente em protocolos institucionais e em costumes regionais. Quando o cadáver é submetido para cremação, além de outros cuidados, recomenda-se a retirada do dispositivo devido ao risco de explosão e dano do equipamento crematório. Principalmente no contexto da pandemia causada pelo SARS-Cov-2, a orientação e organização de unidades hospitalares e serviços funerários é imprescindível para minimizar o fluxo de pessoas em contato com fluidos corporais de indivíduos falecidos por COVID-19. Nesse sentido, a Sociedade Brasileira de Arritmias Cardíacas elaborou este documento com orientações práticas, tendo como base publicações internacionais e recomendação emitida pelo Conselho Federal de Medicina do Brasil.

The management of cardiac implantable electronic devices after death has become a source of controversy. There are no uniform recommendations for such management in Brazil; practices rely exclusively on institutional protocols and regional custom. When the cadaver is sent for cremation, it is recommended to remove the device due to the risk of explosion and damage to crematorium equipment, in addition to other precautions. Especially in the context of the SARS-CoV-2 pandemic, proper guidance and organization of hospital mortuary facilities and funeral services is essential to minimize the flow of people in contact with bodily fluids from individuals who have died with COVID-19. In this context, the Brazilian Society of Cardiac Arrhythmias has prepared this document with practical guidelines, based on international publications and a recommendation issued by the Brazilian Federal Medical Council.

Cardiac Disorder in Chronic Hepatitis C

Chronic hepatitis C (CHC) has a high prevalence in the world. In addition to hepatic complications with cirrhosis in about 20% of patients and high risk for hepatocarcinoma, extrahepatic manifestations may also occur. Cardiac involvement in patients with CHC is associated with several factors, such as increased risk for coronary artery disease, primary cardiomyopathies, or hemodynamic and electrophysiological changes observed in liver cirrhosis. Furthermore, antiviral treatment may, in rare cases, causes cardiovascular adverse effects. Cardiac arrhythmias are the main form of clinical presentation, and, often, markers of poor prognosis in individuals with advanced liver disease. Although some mechanisms that justify these changes have already been reported, many questions remain unanswered, especially about the true involvement of the hepatitis C virus in the genesis of primary cardiac abnormalities, and the risk factors for cardiac-related complications of antiviral treatment

Ablaçäo por cateter do flutter atrial. Caracterizaçäo eletrofisiológica da interrupçäo da conduçäo pelos istmos posterior e septal / Catheter ablation of atrial flutter. Electrophysiological characteriztion of posterior and septal isthmus block

Objetivo - Avaliar os tipos de bloqueio obtidosno istmos posterior (entre o anel tricuspídeo e veia cava inferior) e septal ( entre o anel tricuspídeo e óstio do seio coronário), após ablaçäo do flutter atrial (FLA). Métodos - Foram submetidos à ablaçäo por radiofrequência (RF) 14 pacientes com FLA tipo I (9 homens) em 16 procedimentos. A ativaçäo atrial ao redor do anel tricuspídeo foi avaliada em ritmo sinusal utilizando-se cateter "Halo" com 10 pares de eletrodos (Hl-2 a H19-20), durante estimulaçäo do seio coronário proximal (SCP) e regiäo póstero-lateral do átrio direito (Hl-2), antes e após ablaçöes lineares. De acordo com a frente de programaçäo do impulso definiu-se: ausência de bloqueio (conduçäo bidirecional com retardo num dos sentidos) e bloqueio completo (ausência de conduçäo pelo istmo). O intervalo desta ativaçäo ("delta"SCP/H1-2) foi analisado. Resultados - Bloqueio completo foi obtido em 7 procedimentos (44 "por cento") e incompleto em 4 (25 "por cento"). O "delta"SCP/H1-2 foi de 74 "mais ou menos" 26ms no primeiro grupo e de 30,5 "mais ou menos" 7,5ms no segundo (p "menos" 0,05). Em 5 casos näo demonstrou-se bloqueio. Num seguimento médio de 12 meses, ocorreu recorrência do FLA nos 6 pacientes com bloqueio incompleto ou ausente e e nenhum com bloqueio completo (p "menor" 0,001). Conclusäo - A verificaçäo de bloqueio completo pelo mapeamento multipolar atrial é uma estratégia eficaz para definir o sucesso e recorrência clínica na ablaçäo do FLA tipo I.