Subject(s)
Atrial Fibrillation/psychology , Catheter Ablation/psychology , Cognitive Dysfunction/psychology , Heart Arrest/psychology , Stroke/psychology , Tachycardia, Supraventricular/psychology , Arrhythmias, Cardiac/psychology , Atrial Fibrillation/complications , Brain/diagnostic imaging , Cardiac Resynchronization Therapy Devices , Cognition , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/prevention & control , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Humans , Prosthesis Implantation/psychology , Societies, Medical , Stroke/etiologyABSTRACT
AIMS: To assess the results of transcatheter ablation of cardiac arrhythmias in Latin America and establish the first Latin American transcatheter ablation registry. METHODS AND RESULTS: All ablation procedures performed between 1 January and 31 December 2012 were analysed retrospectively. Data were obtained on the characteristics and resources of participating centres (public or private institution, number of beds, cardiac surgery availability, type of room for the procedures, days per week assigned to electrophysiology procedures, type of fluoroscopy equipment, availability and type of electroanatomical mapping system, intracardiac echo, cryoablation, and number of electrophysiologists) and the results of 17 different ablation substrates: atrio-ventricular node reentrant tachycardia, typical atrial flutter, atypical atrial flutter, left free wall accessory pathway, right free wall accessory pathway, septal accessory pathway, right-sided focal atrial tachycardia, left-sided focal atrial tachycardia, paroxysmal atrial fibrillation, non-paroxysmal atrial fibrillation, atrio-ventricular node, premature ventricular complex, idiopathic ventricular tachycardia, post-myocardial infarction ventricular tachycardia, ventricular tachycardia in chronic chagasic cardiomyopathy, ventricular tachycardia in congenital heart disease, and ventricular tachycardias in other structural heart diseases. Data of 15 099 procedures were received from 120 centres in 13 participating countries (Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, El Salvador, Guatemala, Mexico, Peru, Dominican Republic, Uruguay, and Venezuela). Accessory pathway was the group of arrhythmias most frequently ablated (31%), followed by atrio-ventricular node reentrant tachycardia (29%), typical atrial flutter (14%), and atrial fibrillation (11%). Overall success was 92% with the rate of global complications at 4% and mortality 0.05%. CONCLUSION: Catheter ablation in Latin America can be considered effective and safe.
Subject(s)
Arrhythmias, Cardiac/surgery , Catheter Ablation , Registries , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/physiopathology , Catheter Ablation/adverse effects , Catheter Ablation/mortality , Health Services Accessibility , Healthcare Disparities , Humans , Latin America/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Objetivo: Determinar si la estimulación medioseptal genera menor disincronía interventricular e intraventricular que la apical evaluada mediante ecocardiografía en pacientes con fracción de eyección conservada sometidos al implante de marcapasos VVI. Método: Estudio prospectivo que incluyó a 19 pacientes > 70 años, con indicación de implante de marcapasos VVI por bloqueo auriculoventricular completo degenerativo, frecuencia ventricular ≤ 50 lpm y fracción de eyección ≥ 45%. Se excluyeron portadores de fibrilación auricular, insuficiencia cardiaca, aquellos que en ritmo sinusal presentaron QRS > 120 mseg o bloqueo de rama izquierda. Se aleatorizaron 19 pacientes a 2 grupos: grupo A (47%) a implante apical y grupo B (53%) a implante septal. Resultados: La edad media fue de 75 años (± 8). Ninguno tuvo diagnóstico de insuficiencia cardiaca o cardiopatía isquémica. La disincronía intraventricular fue de A: 14.44 ± 19.76 mseg vs. B: 9 ± 36.45 mseg; A: 6.11 ± 62.11 mseg vs. B: 13 ± 38.31 mseg; A: 77 ± 53.51 mseg vs. B: 24.29 ± 80.90 mseg, p = NS. La disincronía interventricular fue de A: 46.44 ± 19.76 mseg vs. B: 42.20 ± 29.56 mseg; A: 45.33 ± 45.67 mseg vs. B: 29.80 ± 44.66 mseg; A: 46.38 ± 20 .mseg vs. B: 21 ± 27.20 mseg, p = NS) a las 48 h, 5 y 48 meses, respectivamente. Conclusión: El sitio de estimulación no generó diferencias en la disincronía biventricular. La estimulación septal presentó una tendencia no significativa a menor disincronía interventricular.
Objective: To determine in patients with normal ejection fraction, undergoing permanent VVI pacing, if medial septal stimulation has lower dyssynchrony than apical stimulation assessed by echocardiography. Method: A prospective trial, 19 patients > 70 years old, scheduled for VVI pacemaker implantation for complete degenerative atrioventricular block, ventricular frequency < 50 beat per minute and ejection fraction ≥ 45%. Patients with atrial fibrillation, heart failure, left bundle branch block and QRS durations longer than 120 milliseconds in surface electrocardiogram with sinus rhythm were excluded. Patients were randomized to apical implantation group A: 47% and septal implantation group B: 53%. Echocardiographic parameters were measured previous to the implant, 48 h, 5 and 48 months after implantation. Results: No patients had diagnosis of ischemic cardiomyopathy or heart failure. Echocardiographic parameters for interventricular dyssynchrony between groups were A: 14.44 ± 19.76 msec vs. B: 9 ± 36.45 msec; A: 6.11 ± 62.11 msec vs. B: 13 ± 38.31 msec; A: 77 ± 53.51 msec vs. B: 24.29 ± 80.90 msec, P = NS). For interventricular dyssynchrony were A: 46.44 ± 19.76 msec vs. B: 42.20 ± 29.56 msec; A: 45.33 ± 45.67 msec vs. B: 29.80 ± 44.66 msec; A: 46,38 ± 20 msec vs. B: 21 ± 27.20 msec, P = NS) at 48 h, 5 and 48 months, respectively. Conclusion: Apical site of stimulation does not increase ventricular dyssynchrony rate in patients with preserved ejection fraction. Septal stimulation showed decreased trend in interventricular dyssynchrony.
Subject(s)
Aged , Female , Humans , Male , Cardiac Resynchronization Therapy , Heart Ventricles/physiopathology , Stroke Volume , Prospective StudiesABSTRACT
OBJECTIVE: To determine in patients with normal ejection fraction, undergoing permanent VVI pacing, if medial septal stimulation has lower dyssynchrony than apical stimulation assessed by echocardiography. METHOD: A prospective trial, 19 patients>70 years old, scheduled for VVI pacemaker implantation for complete degenerative atrioventricular block, ventricular frequency<50beat per minute and ejection fraction≥45%. Patients with atrial fibrillation, heart failure, left bundle branch block and QRS durations longer than 120milliseconds in surface electrocardiogram with sinus rhythm were excluded. Patients were randomized to apical implantation group A: 47% and septal implantation group B: 53%. Echocardiographic parameters were measured previous to the implant, 48h, 5 and 48 months after implantation. RESULTS: No patients had diagnosis of ischemic cardiomyopathy or heart failure. Echocardiographic parameters for interventricular dyssynchrony between groups were A: 14.44±19.76msec vs. B: 9±36.45msec; A: 6.11±62.11msec vs. B: 13±38.31msec; A: 77±53.51msec vs. B: 24.29±80.90msec, P=NS). For interventricular dyssynchrony were A: 46.44±19.76msec vs. B: 42.20±29.56msec; A: 45.33±45.67msec vs. B: 29.80±44.66msec; A: 46,38±20 msec vs. B: 21±27.20msec, P=NS) at 48h, 5 and 48 months, respectively. CONCLUSION: Apical site of stimulation does not increase ventricular dyssynchrony rate in patients with preserved ejection fraction. Septal stimulation showed decreased trend in interventricular dyssynchrony.
