Trastornos de la conducción en el posoperatorio de cirugía cardíaca / Conduction disorders in the postoperative period of cardiac surgery / Distúrbios de condução no pós-operatório de cirurgia cardíaca

Resumen: Durante el posoperatorio de cirugía cardíaca es frecuente observar trastornos en la generación o conducción del ritmo cardíaco, o en ambos, los cuales en su mayoría son transitorios. Sin embargo, un porcentaje de ellos requerirán implante de marcapasos definitivo. Conocer los predictores preoperatorios que se asocian a implante de marcapasos definitivo (características del paciente, tipo de cirugía, etcétera) nos permitirá adecuar el tratamiento y reducir la morbimortalidad, la estadía hospitalaria y los costos sanitarios durante el posoperatorio.

Summary: During postoperative care of cardiac surgery heart rhythm disorders are frequently seen. Most of them are transient, but some may need permanent pacemaker implantation. Knowing preoperative permanent pacemaker implantation predictors (i.e. patients characteristics, surgery type, etc.) will allow us to provide a better patient treatment, reduce morbidity and mortality, in-hospital length of stay and health care costs.

Resumo: Durante o período pós-operatório de cirurgia cardiaca é comum observar distúrbios na geração e/ou condução do ritmo cardíaco, que em sua maioria, são transitórios. No entanto, uma porcentagem deles exigirá o implante do marcapasso definitivo. Por este motivo, é fundamental o conhecimento dos preditores pré-operatórios associados à implantação definitiva do marcapasso (características do paciente, tipo de cirurgia, etc.) para que se possa melhorar o tratamento e reduzir a morbimortalidade, o tempo de internação e os custos de saúde.

Implante de marcapasos transitorio en una terapia intensiva municipal / Implantation of temporary pacemaker in a municipal intensive care unit

Introducción: Las bradi-arritmias son cardiopatías graves que ocasionan trastornos hemodinámicos severos; llevar al paciente a un gasto cardiaco normal puede implicar que se implante un marcapasos. Objetivo: Describir algunos aspectos clínicos y epidemiológicos de pacientes que recibieron la técnica de implantar un marcapasos. Métodos: Se realizó un estudio descriptivo y transversal, con 36 pacientes que necesitaron marcapasos transitorio, ingresados en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo" de Contramaestre, en el período desde octubre de 2015 hasta mayo de 2019. Las variables utilizadas fueron: grupo de edades y sexo, causas de arritmias y antecedentes patológicos personales, medicamentos más usados previos al ingreso, tiempo de uso del marcapasos transitorio y necesidad de implantación del permanente. Resultados: Predominó el sexo masculino y edades de 80 y más años, el trastorno de la conducción auriculoventricular más frecuente fue el bloqueo auriculoventricular de tercer grado; el tiempo promedio de uso de marcapaso transitorio fue entre 2 y 6 días. Conclusiones: La implantación precoz en esta entidad municipal mejoró notablemente la supervivencia de los pacientes(AU)

Introduction: Bradyarrhythmias are serious heart diseases that cause severe hemodynamic disorders. Bringing the patient to normal cardiac output may imply that a pacemaker be implanted. Objective: To describe some clinical and epidemiological aspects of patients who received the technique of implanting a pacemaker. Methods: A descriptive and cross-sectional study was carried out with 36 patients who needed a temporary pacemaker, admitted to the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestrem, in the period from October 2015 to May 2019. The variables used were age group and sex, causes of arrhythmias, and personal pathological history, most used medications prior to admission, time of usage of the temporary pacemaker, and the need for permanent implantation. Results: The male sex and ages 80 and older predominated, the most frequent atrioventricular conduction disorder was the third-degree atrioventricular block. The average time of temporary pacemaker usage was between two and six days. Conclusions: Early implantation in this municipal institution significantly improved patient survival(AU)

Incidence of cardiac conduction disorders in patients with rheumatic disease receiving hydroxychloroquine.

Background: Hydroxychloroquine (HCQ) used for long-term management of rheumatic diseases. Prolonged use of antimalarials has been implicated in the development of conduction disorders particularly with chloroquine. Since limited data are available with HCQ, we studied electrocardiograms (ECG’s) of 122 patients with rheumatic diseases treated with HCQ. This is the first study with large cohort evaluating conduction disorders in those receiving HCQ. Methods: To evaluate cardiac conduction disorders in patients receiving HCQ as a part of their treatment, during 1-year follow-up and to note other related adverse reactions with a hypothesis to determine, how common are conduction disorders with HCQ. This is longitudinal prospective observational study over 1-year in the tertiary referral of south India. All patients who were started on HCQ (200-400 mg/day) as a part of their treatment were included. Patients with established cardiac diseases, electrolyte abnormalities and who were on drugs that cause conduction disorders were excluded. All ECG’s were cross-checked by a cardiologist. Results: A total of 276 patients were screened at baseline and 270 patients were enrolled in the study. Patients of rheumatoid arthritis, lupus, Sjogren’s syndrome, undifferentiated connective tissue disease, palindromic rheumatism were included after satisfying respective classification criteria. The mean age is 38.85 (standard deviation [SD] 8.34) years. Females are 82.8% (n=101) and males are 17.2% (n=21). The baseline mean heart rate is 81.4 beats/min (SD=11.04), PR interval is 141.5 ms (SD=13.90), QRS is 84.8 ms (SD=13.90), QTc is 421.5 ms (SD=35.65). At 6 months, mean heart rate is 80.4 beats/min (SD=9.99), PR interval is 141.9 ms (SD=16-37), QRS is 81.5 ms (SD=11.82), QTc is 427.4 ms (SD=34.56). At the end of study period, mean heart rate is 81.8 beats/min (SD=9.49), PR interval is 140 ms (SD=21.33), QRS is 84.6 ms (SD=15.72), QTc is 422.7 ms (SD=36.2). During study period four events occurred. A young girl with lupus developed ventricular ectopics on hiking dose of HCQ from 200 mg to 400 mg with a cumulative drug intake of 9.8 g, which has resolved completely on stopping drug without any other intervention. A lupus patient died at home and the cause was not known. A 36-year-old male with rheumatoid arthritis of 4 years duration developed prolonged PR interval with 6 months of drug intake with cumulative was drug intake of 30.6 g with no available follow-up data. A 30-year-old female with undifferentiated arthritis developed skin rash which is pruritic, exfoliative with tiny blisters, 3 days after starting drug. The incidence of cardiac conduction defects in 1-year of follow-up in patients started on HCQ is 0.84. Conclusion: This study highlights need for periodic cardiac evaluation of patients receiving long-term antimalarials. Reversibility of antimalarial toxicity is also highlighted in this study. Conduction disorders observed were similar to that expected in general population thus adding further evidence on safety of HCQ.