RESUMO
Occurrence of supraventricular tachycardia is a common cause of clinical impairment for patients implanted with CRT devices. We report the case of atrial activity oversensing by the left ventricular (LV) lead during typical flutter, which led to LV pacing inhibition. Temporary reprogramming of the LV detection from standard bipolar to extended bipolar and cavotricuspid isthmus ablation solved this problem.
Assuntos
Flutter Atrial/diagnóstico , Flutter Atrial/prevenção & controle , Eletrocardiografia/métodos , Falha de Equipamento , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/prevenção & controle , Terapia Assistida por Computador/métodos , Idoso , Eletrodos Implantados , Ventrículos do Coração , Humanos , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: Previous studies indicate that mortality from acute coronary syndromes is higher in women than in men, especially in case of interventional strategy. AIM: To assess whether the in-hospital mortality rate differs between genders during the first 48h after emergency percutaneous coronary intervention for ST-elevation myocardial infarction (emergency PCI-STEMI) or after non-emergency PCI. METHODS: All patients treated with PCI between January 2005 and June 2008 were included. The primary endpoint was frequency of death within 48h after the PCI procedure; secondary endpoints included frequency of recurrent myocardial infarction, new PCI or coronary artery bypass graft surgery, stroke, and major vascular or renal complications. Data were analysed via logistic regression with and without propensity-score matching. RESULTS: More than 9000 patients underwent PCI. In the emergency PCI-STEMI group (n=1753), 48-hour mortality occurred in 2.2% of men and 4.9% of women (p=0.004). However, gender disparity occurred only in elderly patients; the rate was significantly (p=0.02) higher in women (8.1%) than in men (3.3%) aged > or =75 years. There was no evidence of gender disparity in the non-emergency PCI group (n=7336) or in secondary endpoints for either PCI group. Similar results were obtained in pair analyses of men and women with matching propensity scores. CONCLUSIONS: Elderly women have a disproportionately high in-hospital mortality rate during the first 48h after emergency PCI for treatment of STEMI; however, there is no gender discrepancy in younger patients or patients of any age who receive non-emergency procedures.
Assuntos
Angioplastia Coronária com Balão/mortalidade , Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/efeitos adversos , Distribuição de Qui-Quadrado , Feminino , França/epidemiologia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
Atrioventricular block is usually transient during the course of infectious myocarditis. We report the case of a patient presenting with complete infra-hisian atrioventricular block occurring in the setting of infectious myocarditis and in whom a pacemaker should be finally implanted. Borderline serologies for picornavirus were present 6 weeks later. Complete atrioventricular block persisted during the two years of follow-up despite otherwise complete regression of the myocarditis. We then discuss the main features of conduction disturbances complicating infectious myocarditis, including a list as complete as possible of all the causal agents possibly involved.
