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1.
Artigo em Inglês | MEDLINE | ID: mdl-38083486

RESUMO

The development of high-density multielectrode catheters has significantly advanced cardiac electrophysiology mapping. High-density grid catheters have enabled the creation of a novel technique for reconstructing electrogram (EGM) signals known as "omnipole," which is believed to be more reliable than other methods, especially in terms of orientation independence. This study aims to evaluate how distance affects the omnipolar reconstruction of EGMs by comparing different configurations. Using an animal set up of perfused isolated rabbit hearts, recordings were taken using an ad hoc high-density epicardial multielectrode catheter. Inter-electrode distances ranging from 1 to 4 mm were analysed for their effect on the quality of resulting EGMs. Two biomarkers were computed to evaluate the robustness of the reconstructions: the areas contained within the bipolar loops and the amplitudes of the omnipoles. We hypothesised that both bipolar and omnipolar electrograms would be more robust at shorter inter-electrode distances. The results showed that an increase in distance triggers an increase in loop areas and amplitudes, which supports the hypothesis. This finding provides a more reliable estimate of wavefront propagation for the cross-omnipolar reconstruction method. These results emphasise the importance of distance in cardiac electrophysiology mapping and provide valuable insights into the use of high-density multielectrode catheters for EGM reconstruction.Clinical Relevance- The results of this study have direct clinical relevance in the application of the described techniques to recording systems in the cardiac electrophysiology laboratory, enabling clinicians to obtain more precise characterisation of signals in the myocardium.


Assuntos
Técnicas Eletrofisiológicas Cardíacas , Miocárdio , Animais , Coelhos , Técnicas Eletrofisiológicas Cardíacas/métodos , Eletrodos , Eletrofisiologia Cardíaca , Pericárdio
2.
Ann Cardiol Angeiol (Paris) ; 70(4): 203-209, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34274112

RESUMO

INTRODUCTION: According to many studies, exposure to air pollution increases cardiovascular morbidity and mortality. It has also been shown that the frequency of heart rhythm disorders in Region wallonne is very high. OBJECTIVES: The objective of this study is to test the hypothesis of a link between rhythm disorders measured by cardiac holters and data from devices measuring the concentration of air pollutants present in ambient air. METHODOLOGY: The health data were obtained via the Erasme hospital's cardiology center. This is a retrospective data collection over the last 2 to 5 years. The environmental data are: PM2.5, PM10, NO2, O3 and temperature. The statistical models were based on "cross-case" analyses. RESULTS: An association between PM10 and the number of ESAs was observed. An increase of 10µg/m3 of PM10 increases the number of ESAs by 20% (P=0.040). The number of ESAs increases with age (63% more ESAs when age increases by 10 years). A history of intervention also decreases the number of ESAs (-35%), the same phenomenon is observed for pacemaker wearers (-66%). The strongest association observed between NO2 and ESA with an OR of 1.37 (P=0.027) in the final model. No significant association was observed between the effects of air pollution and VPCs. CONCLUSION: Our analyses resume the effects of the different pollutants on rhythm disorders, the effects adjusted for treatment and co-morbidities. They open the door to other more refined studies based on individual measurements.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Criança , Exposição Ambiental/análise , Humanos , Material Particulado/efeitos adversos , Material Particulado/análise , Estudos Retrospectivos
3.
Neth Heart J ; 29(3): 158-167, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33411231

RESUMO

BACKGROUND: Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban. METHODS: With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15-50 ml/min, weight ≤60 kg, and/or use of strong p­glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). RESULTS: Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. CONCLUSION: There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation. TRIAL REGISTRATION: NCT02944019; Date of registration 24 October 2016.

4.
J Electrocardiol ; 51(6): 1035-1038, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497726

RESUMO

Dobutamine when used for stress echocardiography (DSE), it rarely causes transient atrio-ventricular (AV) block. We report a heart transplant patient with high cardiovascular risk who developed symptomatic advanced AV block during DSE which persisted after termination of dobutamine administration, necessitating pacemaker implantation. To our knowledge, this is the first published case of persistent high grade AV block in a heart transplant patient induced by DSE.


Assuntos
Bloqueio Atrioventricular/etiologia , Cardiotônicos/efeitos adversos , Dobutamina/efeitos adversos , Ecocardiografia sob Estresse/efeitos adversos , Transplante de Coração , Bloqueio Atrioventricular/diagnóstico , Cardiotônicos/administração & dosagem , Dobutamina/administração & dosagem , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Acta Clin Belg ; 72(5): 369-371, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28222655

RESUMO

We report the case of a 74-year-old woman admitted to the emergency unit for resting dyspnea. Clinical presentation, cardiac MRI and echocardiography were consistent with cardiac tamponade requiring emergency pericardiocentesis. Cytologic examination of the pericardial fluid revealed the presence of CD68pos CD1aneg S100neg foamy histiocytes (Fig. 1). Additional investigations complied with the diagnosis of Erdheim-Chester histiocytosis. Treatment with αIFN was initiated but the patient developed severe neutropenia that contraindicated further administration. The detection of BRAFV600E mutation on histiocytes isolated from the pericardial liquid and CNS involvement (cerebral masses) prompted the administration of vemurafenib, a selective BRAFV600E kinase inhibitor. Four months after the initiation of low-dose vemurafenib, pericarditis almost resolved and cerebral masses decreased by 50% (Fig. 2). To our knowledge, analysis of pericardial fluid allowing the diagnosis of Erdheim-Chester disease and the detection of the BRAFV600E mutation has in fact been rarely described in the literature. This case report and the successful evolution under vemurafenib also support the use of BRAFV600E inhibitors in αIFN-intolerant patients with BRAFV600E mutation, particularly in case of heart and central nervous system involvement.


Assuntos
Doença de Erdheim-Chester/diagnóstico , Líquido Pericárdico/citologia , Idoso , Doença de Erdheim-Chester/tratamento farmacológico , Doença de Erdheim-Chester/patologia , Feminino , Humanos , Indóis/farmacologia , Indóis/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Sulfonamidas/farmacologia , Sulfonamidas/uso terapêutico , Vemurafenib
6.
Rev Med Brux ; 35(4): 314-20, 2014 Sep.
Artigo em Francês | MEDLINE | ID: mdl-25675636

RESUMO

Atrial fibrillation is the most common cardiac arrhythmia. Pharmacological treatment plays still an important role in the management of this disease. However, pulmonary vein isolation techniques are more and more important due to the high rate of recurrences and many side effects associated with antiarrhythmic drugs. This article is focused on the main changes that are important for the general practitioner in his daily clinical practice.


Assuntos
Fibrilação Atrial/terapia , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/classificação , Ablação por Cateter , Humanos , Seleção de Pacientes , Prognóstico , Acidente Vascular Cerebral/prevenção & controle
8.
Aliment Pharmacol Ther ; 37(7): 738-48, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23413984

RESUMO

BACKGROUND: Assessment of both GI and CV risks vs. the benefits of low-dose aspirin for individual patients can be difficult in clinical practice. AIM: To develop a tool to estimate CV and GI risks to facilitate the clinical decision-making process. METHODS: We constructed risk-ratio estimations and determined the incidence of CV events and upper GI complications according to the presence of different risk factors. For upper GI complications we assumed a baseline incidence of 1 case/1000-persons-year, a twofold increased risk with low-dose aspirin, and estimated a 60% GI risk reduction with proton pump inhibitors (PPI) co-therapy and a 60% risk reduction with H. pylori eradication in patients with a history of peptic ulcer. RESULTS: The calculator can be found at http://www.asariskcalculator.com. In patients with low CV risk the number of GI complications induced by low-dose aspirin may be greater than the number of CV events prevented. In patients with high CV risk, low-dose aspirin is recommended, but the number of GI complications induced may still overcome the CV events saved. The use of PPI reduces the number of complication events induced by low-dose aspirin, but the number of CV events saved may still be offset by the number of GI complications induced in patients at very high GI risk. CONCLUSIONS: There are many clinical situations where the number of potential upper GI complications induced by low-dose aspirin may exceed the number of potentially prevented CV events. A risk calculator should guide physicians in choosing appropriate therapy and maximise the aspirin benefit.


Assuntos
Algoritmos , Aspirina/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Hemorragia Gastrointestinal/induzido quimicamente , Inibidores da Agregação Plaquetária/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Doenças Cardiovasculares/prevenção & controle , Relação Dose-Resposta a Droga , Feminino , Hemorragia Gastrointestinal/prevenção & controle , Trato Gastrointestinal/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Medição de Risco/métodos , Fatores de Risco , Adulto Jovem
9.
Int J Sports Med ; 32(5): 327-31, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21547864

RESUMO

The impact of intermittent exercise on cardiac biomarker release has not been clearly established. In experienced athletes, we examined the acute effect of a heavy resistance training session (n=18 males) and an indoor soccer match (n=21, 11 males, 10 females) on the release of cTnI, cTnT, and NT-proBNP. Biomarkers were assayed from blood samples collected at rest, immediately post- and at 1, 3, 6, 12, and 24 h post-exercise. The heavy resistance training session resulted in an increase in NT-proBNP (pre: 15 ± 17, peak post: 41 ± 56 ng L (-1); p=0.001) but not in cTnI (pre: 0.024 ± 0.009, peak post: 0.025 ± 0.011 µg L (-1), p=0.809) or cTnT (undetectable in all samples). The indoor soccer match led to an increase in the release of NT-proBNP (pre: 28 ± 32, peak post: 66 ± 56 ng L (-1); p=0.000) and cTnI (pre: 0.026 ± 0.047, peak post: 0.033 ± 0.051 µg L (-1); p=0.008) in both males and females but not cTnT (detectable in only one subject). The current data suggest that intermittent bouts of exercise result in only modest perturbations of cardiac biomarkers with very limited evidence of myocyte injury/insult.


Assuntos
Coração/fisiologia , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Futebol/fisiologia , Troponina I/metabolismo , Troponina T/metabolismo , Levantamento de Peso/fisiologia , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Miócitos Cardíacos/fisiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue , Troponina T/sangue , Adulto Jovem
10.
Aliment Pharmacol Ther ; 32(5): 689-95, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20626380

RESUMO

BACKGROUND: Proton pump inhibitors (PPIs) are the preferred agents for the prevention of aspirin-associated upper gastrointestinal bleeding (UGIB). Data are limited to determine whether PPIs are being used to reduce UGIB risk. AIM: To evaluate the implementation of PPI treatment to reduce the GI risk in two cardiology centres from Europe and the United States. METHODS: A retrospective cross-sectional study was carried out at the University of Michigan and University Hospital-Zaragoza in 429 consecutive patients hospitalized for percutaneous coronary intervention (PCI) on dual antiplatelet therapy. RESULTS: Admission for PPI co-therapy was similar (34% vs. 30%) in both centres. At discharge, the proportion of high-risk patients receiving PPI therapy in the Spanish centre (75.4%) was higher than their American peers (55.6%) (OR: 2.5; 95% CI; 1.3-4.7). No differences in PPI prescription rates were found among Spanish patients with/without GI risk factors. The opportunity to initiate PPI co-therapy in high-risk patients was missed in 81.8% (36/44) of those not on PPI at admission in US patients vs. 24.1% (19/79) (P < 0.0001) in Spanish patients. CONCLUSIONS: There are important differences concerning PPI prescription and risk stratification in the two centres when managing PCI patients. Efforts to stratify risks and utilize appropriate strategies for UGIB prophylaxis in high-risk patients are warranted.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Hemorragia Gastrointestinal/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Michigan , Estudos Retrospectivos , Fatores de Risco , Espanha , Estatística como Assunto
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