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1.
Arq. bras. cardiol ; 121(4): e20230544, abr.2024. tab, graf
Article Dans Portugais | LILACS-Express | LILACS | ID: biblio-1557038

Résumé

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


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

2.
Int. j. cardiovasc. sci. (Impr.) ; 37: e20230105, 2024. tab, graf
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1534624

Résumé

Abstract Background A recently identified viral illness called coronavirus disease 2019 (COVID-19) is spreading quickly. Numerous cardiovascular issues such as arrhythmias and electrocardiogram (ECG) alterations have been linked to COVID-19. Objective In this investigation, we compared ECG indicators of depolarization and repolarization heterogeneity between symptomatic individuals who complained of palpitations and chest discomfort following COVID-19 and those who did not. Methods In this prospective case-control study, 56 post-COVID-19 patients who did not have any symptoms of chest discomfort or palpitations were included in the control group and compared with a study group comprising 73 post-COVID-19 patients who presented at the outpatient clinic with complaints of chest pain and palpitation. Electrocardiographic (ECG) measures were used to assess depolarization and repolarization of the ventricles. These measures included the Tpeak-Tend (Tp-e) interval, QT dispersion (QTd), Tp-e/QT ratio, Tp-e/QTc ratio, frontal QRS-T (fQRS-T) angle, and fragmented QRS (FQRS). Two cardiologists recorded the patients' ECG data. A statistically significant result was defined as a p value less than 0.05. Results The results of multivariate analysis including FQRS, Tp-e interval, Tp-e/QT, and Tp-e/cQT showed that presence of FQRS (OR: 6.707, 95% CI: 1.733-25.952; p = 0.006) was an independent predictor of symptomatic post-COVID -19 patients. Conclusion In our study, FQRS was found to be significantly higher in symptomatic post-COVID-19 patients than in non-symptomatic post-COVID-19 patients, while Tp-e interval was found to be lower.

5.
Nursing (Ed. bras., Impr.) ; 26(300): 9625-9632, ju.2023. ilus
Article Dans Anglais, Portugais | LILACS, BDENF | ID: biblio-1444206

Résumé

Objetivo: relatar a elaboração de um algoritmo para facilitar a interpretação rápida das principais arritmias cardíacas no eletrocardiograma. Método: estudo descritivo, exploratório, com abordagem qualitativa, do tipo relato de experiência, realizado mediante um projeto de intervenção em educação em saúde durante o ano de 2021. Resultados: a elaboração do algoritmo denominado Scaritmo contribuiu para sistematizar as etapas de identificação de arritmias cardíacas, favorecendo o processo didático e aprendizado dos estudantes e otimizando a interpretação rápida do eletrocardiograma. Conclusão: o uso do algoritmo Scaritmo permite a sistematização teórico-prática das etapas necessárias para a interpretação do eletrocardiograma tornando sua avaliação mais didática e assertiva pelo examinador em treinamento.(AU)


Objective: to report the development of an algorithm to facilitate the rapid interpretation of the main cardiac arrhythmias in electrocardiogram. Method: a descriptive, exploratory study with qualitative approach, of experience report type, conducted through an intervention project in health education during the year 2021. Results: The development of the algorithm called Scaritmo contributed to systematize the steps of cardiac arrhythmia identification, favoring the didactic process and student learning, and optimizing the rapid interpretation of the electrocardiogram. Conclusion: The use of the Scaritm algorithm allows the theoretical and practical systematization of the steps necessary for the interpretation of electrocardiograms, making its evaluation more didactic and assertive by the examiner in training.(AU)


Objetivo: relatar el desarrollo de un algoritmo para facilitar la interpretación rápida de las principales arritmias cardíacas en electrocardiograma. Método: estudio descriptivo, exploratorio, con abordaje cualitativo, de tipo relato de experiencia, realizado a través de un proyecto de intervención en educación para la salud durante el año 2021. Resultados: el desarrollo del algoritmo denominado Scaritmo contribuyó para sistematizar los pasos de identificación de arritmias cardíacas, favoreciendo el proceso didáctico y el aprendizaje de los alumnos y optimizando la rápida interpretación del electrocardiograma. Conclusión: El uso del algoritmo Scaritmo permite la sistematización teórica y práctica de los pasos necesarios para la interpretación del electrocardiograma, tornando su evaluación más didáctica y asertiva por el examinador en formación.(AU)


Sujets)
Troubles du rythme cardiaque , Éducation pour la santé , Électrocardiographie
7.
Clinics ; 78: 100243, 2023. graf
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1506020

Résumé

Abstract Aims Although reduced life expectancy in Parkinson's Disease (PD) patients has been related to severe cardiac arrhythmias due to autonomic dysfunctions, its molecular mechanisms remain unclear. To investigate the role of cardiac β1-Adrenergic (β1AR) and A1-Adenosine (A1R) receptors in these dysfunctions, the pharmacological effects of stimulation of cardiac β1AR (isoproterenol, ISO), in the absence and presence of cardiac β1AR (atenolol, AT) or A1R (1,3-dipropyl-8-cyclopentyl xanthine, DPCPX) blockade, on the arrhythmias induced by Ischemia/Reperfusion (CIR) in an animal PD model were studied. Methods PD was produced by dopaminergic lesions (confirmed by immunohistochemistry analysis) caused by the injection of 6-hydroxydopamine (6-OHDA, 6 μg) in rat striatum. CIR was produced by a surgical interruption for 10 min followed by reestablishment of blood circulation in the descendent left coronary artery. On the incidence of CIR-Induced Ventricular Arrhythmias (VA), Atrioventricular Block (AVB), and Lethality (LET), evaluated by Electrocardiogram (ECG) analysis, the effects of intravenous treatment with ISO, AT and DPCPX (before CIR) were studied. Results VA, AVB and LET incidences were significantly higher in 6-OHDA (83%, 92%, 100%, respectively) than in control rats (58%, 67% and 67%, respectively). ISO treatment significantly reduced these incidences in 6-OHDA (33%, 33% and 42%, respectively) and control rats (25%, 25%, 33%, respectively), indicating that stimulation of cardiac β1AR induced cardioprotection. This response was prevented by pretreatment with AT and DPCPX, confirming the involvement of cardiac β1AR and A1R. Conclusion Pharmacological modulation of cardiac β1AR and A1R could be a potential therapeutic strategy to reduce severe arrhythmias and increase life expectancy in PD patients.

8.
Arch. pediatr. Urug ; 94(2): e601, 2023. ilus, tab
Article Dans Espagnol | LILACS, UY-BNMED, BNUY | ID: biblio-1520098

Résumé

El pectus excavatum (PEX) es una deformación de la pared torácica que obedece a una alteración de los cartílagos costales con el consiguiente hundimiento del esternón. Históricamente, se clasificaba como un defecto únicamente estético o cosmético, sin embargo, en los últimos años se han desarrollado nuevos métodos de estudio para la valoración de las repercusiones de esta patología. Existe cada vez más bibliografía que demuestra importantes repercusiones funcionales. Se realizó una puesta al día de las repercusiones cardíacas de la patología y un análisis de los artículos más relevantes de los últimos años. La evidencia actual permite afirmar que existe una afectación cardíaca por compresión esternal en la mayoría de los pacientes con PEX. Las afectaciones incluyen alteraciones anatomofuncionales (trastornos del ritmo, disminución del llenado ventricular), del volumen sistólico, aumento de la presión de la aurícula derecha, valvulopatías, compresión del ventrículo derecho, derrame pericárdico, entre otras. Todo lo cual permite concluir que el PEX puede presentar importantes alteraciones cardíacas que deben ser tenidas en cuenta a la hora de valorar los pacientes con esta patología.


Pectus excavatum (PEX) is a deformation of the chest wall caused by an alteration of the costal cartilages with the consequent collapse of the sternum. Historically, it had been classified as a solely aesthetic or cosmetic defect, however, in recent years new study methods have been developed to assess the repercussions of this pathology, with increasing bibliography showing important functional consequences. We updated the cardiac pathological repercussions and analyzed the most relevant articles of recent years. The current evidence suggests that there is cardiac involvement due to sternal compression in most patients with PEX. These affectations include anatomical functional alterations: rhythm disorders, decreased ventricular filling, decreased stroke volume, increased right atrial pressure, valve disease, right ventricular compression, pericardial effusion, among others. All of which enables us to conclude that PEX can present important cardiac alterations that must be taken into account when assessing patients with this pathology.


Pectus excavatum (PEX) é uma deformação da parede torácica decorrente de uma alteração das cartilagens costais com consequente colapso do esterno. Historicamente, foi classificado como um defeito exclusivamente estético ou cosmético, porém, nos últimos anos, novos métodos de estudo foram desenvolvidos para avaliar as repercussões dessa patologia, com crescente bibliografia mostrando importantes repercussões funcionais. Foi realizada uma atualização das repercussões cardíacas da patologia e análise dos artigos mais relevantes dos últimos anos. As evidências atuais permitem afirmar que há acometimento cardíaco por compressão esternal na maioria dos pacientes com PEX. As afecções incluem alterações anatomofuncionais: distúrbios do ritmo, diminuição do enchimento ventricular, diminuição do volume sistólico, aumento da pressão atrial direita, doença valvular, compressão do ventrículo direito, derrame pericárdico, entre outras. Tudo isso permite concluir que o PEX pode apresentar alterações cardíacas importantes que devem ser levadas em consideração na avaliação de pacientes com essa patologia.


Sujets)
Humains , Thorax en entonnoir/complications , Cardiopathies/étiologie , Thorax en entonnoir/physiopathologie , Cardiopathies/physiopathologie
9.
Arq. bras. cardiol ; 120(10): e20230188, 2023. graf
Article Dans Portugais | LILACS-Express | LILACS | ID: biblio-1520134

Résumé

Resumo Fundamento A alta incidência de arritmias atriais na hipertensão pulmonar (HP) pode estar associada a um prognóstico ruim, e o átrio esquerdo (AE) pode desempenhar um papel neste quadro. Um achado importante nos estudos de HP é que a remodelação do AE é subestimada. Objetivo Este estudo investigou a morfologia e a função mecânica do AE, bem como a suscetibilidade ao desenvolvimento de arritmias em um modelo de HP induzida por monocrotalina (HP-MCT). Métodos Ratos Wistar com 4 semanas de idade receberam 50 mg/kg de MCT. Foram realizadas análises eletrocardiográficas e histológicas para avaliar o estabelecimento do modelo de HP-MCT. O tecido foi montado em banho de órgão isolado para caracterizar a função mecânica do AE. Resultados Em comparação com o grupo controle, o modelo de HP-MCT apresentou hipertrofia do AE e alterações da atividade elétrica cardíaca, conforme evidenciadas pelo aumento da duração da onda P, PR e intervalo QT. Não foi observada alteração no inotropismo do AE isolado de ratos com HP-MCT; no entanto, o tempo para atingir a contração máxima foi atrasado. Finalmente, não observamos diferença na suscetibilidade à arritmia no AE dos ratos com HP-MCT após o protocolo de estimulação intermitente. Conclusão A remodelação morfofuncional do AE não levou ao aumento da suscetibilidade à arritmia ex vivo após a aplicação do protocolo de estimulação intermitente.


Abstract Background The high incidence of atrial arrhythmias in pulmonary hypertension (PH) might be associated with poor prognosis, and the left atrium (LA) may play a role in this. An important finding in PH studies is that LA remodeling is underestimated. Objective This study investigated LA morphology and mechanical function, as well as the susceptibility to develop arrhythmias in a monocrotaline-induced PH (MCT-PH) model. Methods Wistar rats aged 4 weeks received 50 mg/kg of MCT. Electrocardiography and histology analysis were performed to evaluate the establishment of the MCT-PH model. The tissue was mounted in an isolated organ bath to characterize the LA mechanical function Results Compared with the control group (CTRL), the MCT-PH model presented LA hypertrophy and changes in cardiac electrical activity, as evidenced by increased P wave duration, PR and QT interval in MCT-PH rats. In LA isolated from MCT-PH rats, no alteration in inotropism was observed; however, the time to peak contraction was delayed in the experimental MCT-PH group. Finally, there was no difference in arrhythmia susceptibility of LA from MCT-PH animals after the burst pacing protocol. Conclusion The morphofunctional remodeling of the LA did not lead to increased susceptibility to ex vivo arrhythmia after application of the burst pacing protocol.

10.
Rev. bras. cir. cardiovasc ; 38(6): e20220447, 2023. tab, graf
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1514973

Résumé

ABSTRACT Introduction: This study evaluated myocardial protection and clinical outcomes when using lactated Ringer's solution as the base solution for del Nido cardioplegia compared with histidine-tryptophan-ketoglutarate (HTK) solution in valvular surgery. Methods: From January 2017 to May 2018, 71 adult patients who underwent valvular surgery with del Nido cardioplegia (n=37) or HTK cardioplegia (n=34) were retrospectively analyzed. Results: Patients' characteristics were comparable between groups. Postoperative peak troponin T levels were similar. The del Nido group had a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (13.51 vs. 55.88%; P<0.001), lower total volume of cardioplegia administered (1,000 [1,000, 1,250] vs. 1,800 [1,500, 2,000] mL; P<0.001), shorter hospital stay (6 [5, 8] vs. 7 [6, 10] days; P=0.03), and less postoperative red cell transfusion (34.29 vs. 61.11%; P=0.024). There is no difference in aortic cross-clamping time, postoperative change in left ventricular ejection fraction, intensive care unit stay, duration of inotropic support, new onset of atrial fibrillation, in-hospital mortality, complications, and three-year overall survival rate. Conclusion: Lactated Ringer's-based del Nido cardioplegia can be safely used for valvular surgery with acceptable clinical outcomes compared to HTK cardioplegia.

11.
Rev. bras. cir. cardiovasc ; 38(6): e20220326, 2023. tab, graf
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1514974

Résumé

ABSTRACT Introduction: Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 - 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review and meta-analysis aimed to evaluate the outcomes of the conservative approach to treat chyle leakage after cardiothoracic surgeries. Methods: A systematic review was conducted in PubMed®, Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saúde) databases; a manual search of references was also done. The inclusion criteria were patients who underwent cardiothoracic surgery, patients who received any nonoperative treatment (e.g., total parenteral nutrition, low-fat diet, medium chain triglycerides), and studies that evaluated chylothorax resolution, length of hospital stay, postoperative complications, infection, morbidity, and mortality. Central Message Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates. Results: Twenty-two articles were selected. Pulmonary complications, infections, and arrhythmia were the most common complications after surgical procedures. The incidence of chylothorax in cardiothoracic surgery was 1.8% (95% CI 1.7 - 2%). The mean time of maintenance of the chest tube was 16.08 days (95% CI 12.54 - 19.63), and the length of hospital stay was 23.74 days (95% CI 16.08 - 31.42) in patients with chylothorax receiving nonoperative treatment. Among patients that received conservative treatment, the morbidity event was 0.40 (95% CI 0.23 - 0.59), and reoperation rate was 0.37 (95% CI 0.27 - 0.49). Mortality rate was 0.10 (95% CI 0.06 - 0.02). Conclusion: Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.

12.
Article | IMSEAR | ID: sea-220280

Résumé

Background: The Symptomatic manifestation of pediatric arrhythmias varies according to the age. Patients with disturbances in cardiac rhythm have several complaints, but also could be totally asymptomatic. This study aimed to assess clinical characteristics of Tachy and Brady arrhythmia in neonates, infant, children and adolescents of various age groups. Methods: This cross-sectional study included 253 patients of pediatric age below 18 years old presented with different types of tachyarrhythmia or bradyarrhythmia. All patients were subjected to clinical general examination of patient, vital data collection, local cardiac examination, 12 leads electrocardiography, ambulatory ECG Holter monitoring, exercise ECG stress testing if indicated and transthoracic echocardiography. Results: There was a significant relation between age of presentation of the study patients and classification of arrhythmia (P < 0.001). Palpitations was the most common presentations of arrhythmia in our study patients (32%) followed by dyspnea in 17.8 % of the patients. 20.6 % of the study patients with arrhythmias were asymptomatic. Congenital heart anomalies were in 43 % of the patients. Conclusion: Pediatric arrhythmia can be totally asymptomatic and discovered accidentally. Congenital cardiac anomalies and cardiac arrhythmias are closely correlated. Holter monitoring and exercise ECG testing can help in diagnosing pediatric arrhythmia. Untreated or persistent arrhythmia causes LV myopathy and dilatation. Antiarrhythmic drugs can have their harmful effect on the growing child.

13.
Arq. bras. cardiol ; 119(5): 681-688, nov. 2022. tab, graf
Article Dans Portugais | LILACS-Express | LILACS | ID: biblio-1533700

Résumé

Resumo Fundamento A síndrome do PRKAG2 é uma rara doença genética autossômico dominante, fenocópia da miocardiopatia hipertrófica, caracterizada pelo acúmulo intracelular de glicogênio. Manifestações clínicas incluem pré-excitação ventricular, hipertrofia ventricular, distúrbio de condução cardíaca e arritmias atriais. Objetivo Comparar características clínicas e eletrofisiológicas observadas em pacientes com flutter atrial, com e sem síndrome do PRKAG2. Métodos Estudo observacional, comparativo de pacientes com flutter atrial: grupo A, cinco pacientes de família com síndrome do PRKAG2; e grupo B, 25 pacientes sem fenótipo da síndrome. O nível de significância foi de 5%. Resultados Todos os pacientes do grupo A apresentaram pré-excitação ventricular e bloqueio de ramo direito; quatro tinham marca-passo (80%). Pacientes do grupo A tinham menor idade (39±5,4 vs. 58,6±17,6 anos, p=0,021), e maior espessura de septo interventricular (mediana=18 vs. 10 mm; p<0,001) e parede posterior (mediana=14 vs. 10 mm; p=0,001). Quatro do grupo A foram submetidos a estudo eletrofisiológico, sendo observada via acessória fascículo-ventricular; em três foi realizada ablação do flutter atrial. Todos os do grupo B foram submetidos à ablação do flutter atrial, sem evidência de via acessória. Observado maior prevalência no grupo B de hipertensão arterial, diabetes mellitus, doença coronariana e apneia do sono, sem diferença estatisticamente significante. Conclusão Portadores da síndrome do PRKAG2 apresentaram flutter atrial em idade mais precoce, e menos comorbidades, quando comparados a pacientes com flutter atrial sem fenótipo da mutação. Importante suspeitar de miocardiopatia geneticamente determinada, como síndrome do PRKAG2, em jovens com flutter atrial, especialmente na presença de pré-excitação ventricular e hipertrofia ventricular familiar.


Abstract Background PRKAG2 syndrome is a rare autosomal dominant disease, a phenocopy of hypertrophic cardiomyopathy characterized by intracellular glycogen accumulation. Clinical manifestations include ventricular preexcitation, cardiac conduction disorder, ventricular hypertrophy, and atrial arrhythmias. Objective To compare the clinical and electrophysiological characteristics observed in patients with atrial flutter, with and without PRKAG2 syndrome. Methods An observational study comparing patients with atrial flutter: group A consisted of five patients with PRKAG2 syndrome from a family, and group B consisted of 25 patients without phenotype of PRKAG2 syndrome. The level of significance was 5%. Results All patients in group A had ventricular preexcitation and right branch block, and four had pacemakers (80%). Patients in group A were younger (39±5.4 vs 58.6±17.6 years, p=0.021), had greater interventricular septum (median=18 vs 10 mm; p<0.001) and posterior wall thickness (median=14 vs 10 mm; p=0.001). In group A, four patients were submitted to an electrophysiological study, showing a fasciculoventricular pathway, and atrial flutter ablation was performed in tree. All patients in group B were submitted to ablation of atrial flutter, with no evidence of accessory pathway. Group B had a higher prevalence of hypertension, diabetes mellitus, coronary artery disease and sleep apnea, with no statistically significant difference. Conclusion Patients with PRKAG2 syndrome presented atrial flutter at an earlier age and had fewer comorbidities when compared to patients with atrial flutter without mutation phenotype. The occurrence of atrial flutter in young individuals, especially in the presence of ventricular preexcitation and familial ventricular hypertrophy, should raise the suspicion of PRKAG2 syndrome.

14.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 68(10): 1394-1399, Oct. 2022. tab
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1406548

Résumé

SUMMARY OBJECTIVE: This study aimed to evaluate the correlation between Nonalcoholic fatty liver disease and cardiac abnormalities. METHODS: Patients with Nonalcoholic fatty liver disease who attended an outpatient clinic in Southern Brazil were prospectively evaluated. Patients should be older than 18 years and have steatosis. RESULTS: A total of 174 patients were evaluated. The mean age was 63±12 years, 65% were women, 71% white, 82.2% hypertensive, 52.3% diabetic, 56.3% obese, and 30% dyslipidemic. There was no association between Nonalcoholic fatty liver disease and cardiac abnormalities, even after adjusting for age, sex, and metabolic syndrome. CONCLUSIONS: The present study did not show a direct correlation between Nonalcoholic fatty liver disease and cardiac abnormalities, regardless of metabolic syndrome.

15.
Rev. colomb. cardiol ; 29(3): 364-367, mayo-jun. 2022. graf
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1407990

Résumé

Resumen Los complejos ventriculares prematuros (CVP) son hallazgos frecuentes en individuos con o sin enfermedad estructural cardiaca. Los CVP cuyo origen se localiza en la región parahisiana son poco frecuentes y su manejo a través de ablación con catéter de radiofrecuencia es un reto, pues su localización favorece un alto riesgo de desarrollo de bloqueo aurículo-ventricular. Se describen dos casos de pacientes con CVP parahisianos llevados a ablación con catéter de radiofrecuencia.


Abstract Premature ventricular complexes (PVC) are common findings in patients with or without structural heart disease. Parahisian PVC are uncommon and their management through radiofrequency catheter ablation remains a challenge, since their location favors a high risk for developing atrioventricular block. Two cases of patients with parahisian PVC undergoing radiofrequency catheter ablation are described.

16.
Rev. colomb. cardiol ; 29(2): 150-154, ene.-abr. 2022. tab, graf
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1376872

Résumé

Resumen Introducción: La fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano y su manejo requiere un abordaje holístico para que los resultados sean óptimos. Objetivo: Describir las características sociodemográficas y clínicas de los pacientes hospitalizados o intervenidos, con diagnóstico de fibrilación auricular, atendidos en una clínica de cuarto nivel de complejidad en Colombia. Método: Se realizó un estudio observacional, retrospectivo, a partir de registros de pacientes hospitalizados o intervenidos con diagnóstico de fibrilación auricular. Se tomó como referencia el diagnóstico de fibrilación auricular (CIE 10 I48X), durante los años 2017 y 2018. Se realizó análisis univariado y bivariado con Excel, SPSS y Epidat. Resultados: El promedio de edad de los pacientes hospitalizados fue de 69.81 años, con ligera predominancia del sexo masculino. La estancia hospitalaria fue de 6.62 en 2017 y de 5.29 días en 2018. Se encontró correlación entre los días de estancia hospitalaria y la edad de los pacientes. La comorbilidad más frecuentes en los pacientes hospitalizados fue hipertensión arterial, cardiopatía isquémica y enfermedad pulmonar obstructiva crónica. El 18.04% no tuvieron comorbilidad. Las muertes intrahospitalarias estuvieron asociadas, con mayor frecuencia, a insuficiencia cardíaca. La cardioversión eléctrica fue el procedimiento electrofisiológico más usado, seguida del aislamiento de venas pulmonares. El porcentaje de complicaciones fue menor en 2018 que en 2017. Conclusiones: Existe menor proporción de comorbilidad cuando se compara esta serie con otros reportes. Los días de estancia hospitalaria fueron superiores a los encontrados en la literatura mundial.


Abstract Introduction: Atrial fibrillation is the most frequent sustained tachyarrhythmia in humans and its management requires an integral approach in order to get optimal results. Objective: To describe the sociodemographic and clinical characteristics of patients hospitalized or on surgical procedures with a diagnosis of atrial fibrillation, managed in a Fourth level of Complexity clinic in Colombia. Method: An observational, retrospective study was conducted from records of patients hospitalized or operated with a diagnosis of atrial fibrillation. The diagnosis of atrial fibrillation (ICD-10 I48X) was taken as a reference, during the years 2017 and 2018. Univariate and bivariate analysis was performed with Excel, SPSS and Epidat. Results: The average age of hospitalized patients was 69.81 years, with a slight predominance of males. The hospital stay was 6.62 and 5.29 days, during 2017 and 2018 respectively. Correlation was found between the days of hospital stay and the age of the patients. The most frequent comorbidities in hospitalized patients were arterial hypertension, ischemic heart disease and chronic obstructive pulmonary disease. 18.04 % of patients had no comorbidities. In-hospital deaths were more frequently associated with heart failure. Electrical cardioversion was the most frequent electrophysiological procedure followed by the isolation of pulmonary veins. The percentage of complications was lower in 2018 compared to 2017. Conclusions: There are a lower proportion of comorbidities when this series is compared with other reports. The days of hospital stay were superior to those found in the world literature.

17.
Rev. méd. Hosp. José Carrasco Arteaga ; 13(2): 95-99, 20-12-2021. Tablas
Article Dans Espagnol | LILACS | ID: biblio-1352313

Résumé

INTRODUCCIÓN: Las arritmias cardiacas son enfermedades cardiovasculares, causadas por alteraciones en la conducción o formación de estímulos eléctricos. La detección oportuna de estas alteraciones es crucial, pues a largo plazo mejora la calidad de vida de las personas que padecen estas patologías. El objetivo del presente estudio fue determinar la prevalencia de arritmias cardiacas supraventriculares y sus factores asociados en paciente adultos atendidos en la consulta externa de la unidad de cardiología del Hospital José Carrasco Arteaga, Cuenca, 2018. MATERIALES Y MÉTODOS: Se realizó un estudio observacional, transversal, descriptivo y de correlación con una muestra de 608 pacientes mayores de 18 años atendidos en la Institución mencionada que se realizaron electrocardiograma durante el año 2018. Se estudiaron las variables: estado nutricional, hipertensión arterial, diabetes, tabaquismo, medicamentos utilizados; edad y sexo; presencia de arritmia supraventricular. Se utilizó la prueba Chi cuadrado para buscar asociación entre las variables cualitativas; considerando diferencias estadísticamente significativas una p < 0.05. RESULTADOS: De 608 pacientes, el 57.1% fueron mujeres; 61.84% fueron menores de 65 años. El 43.9% tuvo sobrepeso, el 27.6% presentó IMC normal. Las enfermedades crónicas como HTA y Diabetes tuvieron una frecuencia de 44.4% y 16% respectivamente. La prevalencia de las arritmias supraventriculares fue del 3.8%. La fibrilación auricular fue la arritmia supraventricular más frecuente con el 47.8%, seguida de la arritmia sinusal con el 26.08%. Hubo mayor prevalencia de arritmias supraventriculares en el sexo femenino que en el masculino (4.6% vs 2.7%), en los pacientes con sobrepeso u obesidad que en los que tenían IMC normal ( 4.4% vs 2.3%), en los pacientes hipertensos en relación a los que no padecían de hipertensión (5.2% vs 2.7%), en los pacientes usuarios de medicamentos antitiroideos en relación a los que los consumían (50% vs 3.6%); sin embargo no se encontró asociación estadísticamente significativa con ninguna de estas variables. CONCLUSIÓN: La prevalencia de las arritmias supraventriculares fue del 3.8%. La principal de arritmia cardiaca diagnosticada fue la fibrilación auricular seguida de la arritmia sinusal. No se encontró asociación estadísticamente significativa entre la frecuencia de las arritmias supraventriculares y las variables estudiadas.(AU)


BACKGROUND: Cardiac arrhythmias are cardiovascular diseases, caused by disturbances in the initiation or conduction of electrical stimuli. The timely detection of these alterations is crucial, since in the long term it improves the quality of life of people suffering from these pathologies. The aim of this study was to determine the prevalence of supraventricular cardiac arrhythmias and their associated factors in adult patients treated in the outpatient clinic of the cardiology unit of Hospital José Carrasco Arteaga, Cuenca, 2018. METHODS: An observational, cross-sectional, descriptive and correlation study was carried out with a sample of 608 patients older than 18 years, at the mentioned Institution, who underwent electrocardiography during 2018. We studied the variables: nutritional status, arterial hypertension, diabetes, smoking, used drugs; age and sex; presence of supraventricular arrhythmia. We used Chi Square test to search for an association between the qualitative variables; considering statistical significance a p <0.05. RESULTS: of 608 patients, 57.1% were women; 61.84% were under 65 years of age. 43.9% were overweight, 27.6% had normal body mass index (BMI). Chronic diseases such as hypertension and diabetes had a frequency of 44.4% and 16% respectively. The prevalence of supraventricular arrhythmias was 3.8%. Atrial fibrillation was the most frequent supraventricular arrhythmia with 47.8%, followed by sinus arrhythmia with 26.08%. There was a higher prevalence of supraventricular arrhythmias in females than males (4.6% vs 2.7%), in overweight or obese patients than in those with normal BMI (4.4% vs 2.3%), in hypertensive patients than in those who didn't suffer from hypertension ( 5.2% vs 2.7%), in patients who used antithyroid drugs than in those who didn't use them (50% vs 3.6%); however, no statistically significant association was found with any of these variables. CONCLUSION: The prevalence of supraventricular arrhythmias was 3.8%. The most common cardiac arrhythmia was atrial fibrillation followed by sinus arrhythmia. No statistically significant association was found between the frequency of supraventricular arrhythmias and the variables studied.(au)


Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Troubles du rythme cardiaque , Arythmie sinusale , Fibrillation auriculaire , Cardiologie , Maladies cardiovasculaires , Trouble lié au tabagisme , Fumer , Surpoids
18.
Rev. mex. anestesiol ; 44(4): 277-281, oct.-dic. 2021.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1347754

Résumé

Resumen: Introducción: La electroporación irreversible (EIR) es una técnica conocida desde 1972; fue incorporada al ámbito oncológico en el año 2005 como técnica de ablación tumoral basada en pulsos eléctricos cortos de alto voltaje y es utilizada para introducir elementos químicos por difusión, alterar la estructura genética celular, fusionar una célula con otra (reversible) o provocarle la muerte (irreversible). Estas descargas eléctricas conllevan un riesgo asociado de arritmias cardíacas, contracciones musculares severas y convulsiones. Mantener un adecuado plano anestésico, analgesia óptima, relajación neuromuscular profunda y electrocardiograma sincronizado a los pulsos eléctricos son los objetivos principales del manejo anestésico. Objetivo: Describir las implicaciones anestésicas de la EIR en el paciente pediátrico. Material y métodos: Revisión narrativa basada en una búsqueda de artículos relacionados con la EIR en las principales bases de datos, donde la principal fuente de información son los reportes de casos y las revisiones no sistemáticas de la literatura, tanto del área de anestesiología y dolor como de ingeniería, radiología intervencionista vascular y cardiovascular, y cirugía. Resultados: Se encontraron y revisaron un total de 17 referencias bibliográficas. Conclusión: La anestesia para EIR en el paciente pediátrico debe garantizar un adecuado plano anestésico idealmente con intubación endotraqueal, analgesia óptima, relajación profunda y control de arritmias cardíacas con sincronización del electrocardiograma.


Abstract: Introduction: Irreversible electroporation (IRE) is a technique known since 1972 incorporated into the oncological field in 2005 as a tumor ablation technique based on short high-voltage electrical pulses used to introduce chemical elements by diffusion, alter the cellular genetic structure, fuse a cell with other (reversible) or cause death (irreversible). These electric shocks carry an associated risk of cardiac arrhythmias, severe muscle contractions and seizures. Maintain an adequate anesthetic plane, optimal analgesia, deep neuromuscular relaxation and an electrocardiogram synchronized to the electrical pulses are the main objectives of anesthetic management. Objective: Describe the anesthetic implications of IRE in the pediatric patient. Material and methods: Narrative review based on a search for articles related to IRE in the most important databases, where the main source of information is case reports and non-systematic reviews of the literature, both in the area of anesthesiology and pain as well as engineering, vascular and cardiovascular interventional radiology, and surgery. Results: A total of 17 bibliographic references were found and reviewed. Conclusion: The anesthesia for IRE in the pediatric patient should guarantee an adequate anesthetic plane ideally with endotracheal intubation, optimal analgesia, deep relaxation and control of cardiac arrhythmias with electrocardiogram synchronization.

19.
J. Card. Arrhythm. (Impr.) ; 34(3): 91-99, Dec., 2021.
Article Dans Anglais | LILACS | ID: biblio-1359635

Résumé

Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.


Sujets)
Troubles du rythme cardiaque , Tétralogie de Fallot , Électrophysiologie cardiaque
20.
Arq. bras. cardiol ; 117(5): 1010-1015, nov. 2021. tab, graf
Article Dans Anglais, Portugais | LILACS | ID: biblio-1350021

Résumé

Resumo Fundamento: A doença pelo novo coronavírus (COVID-19) está associada a manifestações clínicas cardiovasculares, incluindo a ocorrência de arritmias cardíacas. Objetivos: Avaliar a incidência de arritmias cardíacas (taquiarritmia atrial, bradiarritmia e taquicardia ventricular sustentada) e de parada cardiorrespiratória (PCR) em uma coorte de pacientes internados com COVID-19 em hospital universitário terciário. Métodos: Estudo de coorte retrospectivo realizado por meio de revisão dos registros de prontuário médico. Para comparação entre os grupos, foi considerado como estatisticamente significativo valor de P < 0,05. Resultados: Foram incluídos 241 pacientes consecutivos com diagnóstico de COVID-19 (idade média, 57,8 ± 15,0 anos; 51,5% homens; 80,5% de raça branca) e 35,3% com necessidade de ventilação mecânica invasiva (VM). A mortalidade geral foi de 26,6%, sendo de 58,8% entre aqueles em VM. Arritmias cardíacas ocorreram em 8,7% dos pacientes, sendo a mais comum taquiarritmia atrial (76,2%). Pacientes com arritmias apresentaram maior mortalidade, 52,4% versus 24,1% (p=0,005). Em análise multivariada, apenas a presença de insuficiência cardíaca foi associada a maior risco de arritmias ( hazard ratio , 11,9; IC 95%: 3,6-39,5; p<0,001). Durante a internação, 3,3% dos pacientes foram atendidos em PCR, com predomínio de ritmos não chocáveis. Todos os atendidos em PCR evoluíram com óbito durante a internação. Conclusão: A incidência de arritmias cardíacas em pacientes internados com COVID-19 em hospital terciário brasileiro foi de 8,7%, sendo a mais comum taquiarritmias atrial. A presença de insuficiência cardíaca foi associada a maior risco de arritmias. Pacientes com COVID-19 atendidos em PCR apresentam elevada mortalidade.


Abstract Background: The coronavirus disease 2019 (COVID-19) is associated with cardiovascular clinical manifestations, including cardiac arrhythmias. Objective: To assess the incidence of cardiac arrhythmias (atrial tachyarrhythmia, bradyarrhythmia, and sustained ventricular tachycardia) and cardiac arrest (CA) in a cohort of patients hospitalized with COVID-19 in a tertiary university-affiliated hospital. Methods: Cohort study with retrospective analysis of electronic medical records. For comparison between groups, a value of p <0.05 was considered statistically significant Results: We included 241 consecutive patients diagnosed with COVID-19 (mean age, 57.8 ± 15.0 years; 51.5% men; 80.5% white), 35.3% of whom received invasive mechanical ventilation (MV). The overall mortality was 26.6%, being 58.8% among those on MV. Cardiac arrhythmias were identified in 8.7% of the patients, the most common being atrial tachyarrhythmia (76.2%). Patients with arrhythmias had higher mortality (52.4% versus 24.1%, p = 0.005). On multivariate analysis, only the presence of heart failure (HF) was associated with a higher risk of arrhythmias (hazard ratio, 11.9; 95% CI: 3.6-39.5; p <0.001). During hospitalization, 3.3% of the patients experienced CA, with a predominance of non-shockable rhythms. All patients experiencing CA died during hospitalization. Conclusions: The incidence of cardiac arrhythmias in patients admitted with COVID-19 to a Brazilian tertiary hospital was 8.7%, and atrial tachyarrhythmia was the most common. Presence of HF was associated with an increased risk of arrhythmias. Patients with COVID-19 experiencing CA have high mortality.


Sujets)
Humains , Mâle , Femelle , Adolescent , Adulte , Tachycardie ventriculaire/étiologie , Tachycardie ventriculaire/épidémiologie , COVID-19 , Troubles du rythme cardiaque/étiologie , Troubles du rythme cardiaque/épidémiologie , Études rétrospectives , Facteurs de risque , Études de cohortes , Mortalité hospitalière , SARS-CoV-2 , Adulte d'âge moyen
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