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2.
Rev. bras. cir. cardiovasc ; 35(6): 999-1002, Nov.-Dec. 2020. tab, graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1143991

RESUMO

Abstract Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage. We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up. This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.


Assuntos
Humanos , Fibrilação Atrial/cirurgia , Trombose/etiologia , Ablação por Cateter , Apêndice Atrial/cirurgia , Apêndice Atrial/diagnóstico por imagem , Toracoscopia , Resultado do Tratamento
3.
Braz J Cardiovasc Surg ; 35(6): 999-1002, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33113312

RESUMO

Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage. We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up. This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Trombose , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Humanos , Toracoscopia , Trombose/etiologia , Resultado do Tratamento
4.
Europace ; 20(2): 234-242, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28521022

RESUMO

Pharmacologic challenge with sodium channel blockers is part of the diagnostic workout in patients with suspected Brugada syndrome. The test is overall considered safe but both ajmaline and flecainide detain well known pro-arrhythmic properties. Moreover, the treatment of patients with life-threatening arrhythmias during these diagnostic procedures is not well defined. Current consensus guidelines suggest to adopt cautious protocols interrupting the sodium channel blockers as soon as any ECG alteration appears. Nevertheless, the risk of life-threatening arrhythmias persists, even adopting a safe and cautious protocol and in absence of major arrhythmic risk factors. The authors revise the main published case studies of sodium channel blockers challenge in adults and in children, and summarize three cases of untreatable ventricular arrhythmias discussing their management. In particular, the role of advanced cardiopulmonary resuscitation with extra-corporeal membrane oxygenation is stressed as it can reveal to be the only reliable lifesaving facility in prolonged cardiac arrest.


Assuntos
Síndrome de Brugada/diagnóstico , Reanimação Cardiopulmonar , Eletrocardiografia , Oxigenação por Membrana Extracorpórea , Sistema de Condução Cardíaco/efeitos dos fármacos , Bloqueadores dos Canais de Sódio/efeitos adversos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Potenciais de Ação/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ajmalina/administração & dosagem , Ajmalina/efeitos adversos , Síndrome de Brugada/fisiopatologia , Criança , Feminino , Flecainida/administração & dosagem , Flecainida/efeitos adversos , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Bloqueadores dos Canais de Sódio/administração & dosagem , Taquicardia Ventricular/induzido quimicamente , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/induzido quimicamente , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Adulto Jovem
5.
Am J Cardiovasc Dis ; 8(5): 48-57, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30697450

RESUMO

BACKGROUND: CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke/TIA) score has been validated as a risk stratification score to predict stroke in patients with atrial fibrillation (AF). The objective of this analysis was to assess whether patient risk factors, in particular CHADS2 score, identified patients at risk of mortality. METHODS: 821 patients with an implantable cardioverter defibrillator were prospectively followed-up in 11 cardiology centers. Patients were grouped in 3 groups according to pre-specified risk classes: low (CHADS2 = 0), moderate (CHADS2 = 1, 2), and high (CHADS2 = 3-6). Information on clinical status and events, were collected during scheduled and unscheduled follow-up visits. Deaths were retrieved from medical records, or through the Regional Office of Vital Statistics. RESULTS: Over a mean follow-up of 44±26 months, 135 deaths occurred in the overall population: 6 (7.7%) in the low-risk population, 69 (13.8%) in moderate-risk patients and 60 (24.6%) in high-risk patients. Kaplan-Meier estimated of patient survival were significantly different in 3 patients groups (93.0%, 90.1%, 78.5% in low, moderate and high risk patients respectively, at 4 years P<0.001). A sub-analysis on patients without history of AF showed similar results. Multivariate regression analysis adjusted for baseline characteristics confirmed the high risk status (HR 1.88, 95% CI 1.27-2.80; P = 0.002) as an independent predictor of mortality adjusted for the baseline characteristics. CONCLUSIONS: In our multicenter research, the long-term mortality was higher in patients with high CHADS2 score than in those with lower risk score regardless the presence of history of AF. CHADS2 score could be considered a toll to predict all causes mortality.

8.
J Cardiovasc Med (Hagerstown) ; 16 Suppl 1: S5-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23448965

RESUMO

We report the case of a patient with a previously implanted pacemaker, who suffered cardiac arrest due to ventricular fibrillation requiring cardiopulmonary resuscitation (CPR) manoeuvres and electrical cardioversion to restore sinus rhythm. Analysis of the pacemaker's stored electrograms showed the arrhythmia progression from monomorphic ventricular tachycardia to ventricular fibrillation and the electrophysiological effects of CPR manoeuvres and epinephrine administration before successful cardioversion.


Assuntos
Reanimação Cardiopulmonar/métodos , Eletrocardiografia , Parada Cardíaca/complicações , Marca-Passo Artificial/estatística & dados numéricos , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Idoso , Cardioversão Elétrica/estatística & dados numéricos , Epinefrina/uso terapêutico , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Humanos , Masculino , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/fisiopatologia
10.
Indian Pacing Electrophysiol J ; 12(1): 19-23, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22368378

RESUMO

Atrial fibrillation is a common arrhythmia in patients suffering from acute myocardial infarction, however its pathophysiological mechanisms are not fully understood. We describe the unusual case of a 76-year old woman admitted for non-ST-segment elevation myocardial infarction, who developed multiple episodes of paroxysmal atrial fibrillation triggered by monomorphic ventricular couplets. Beta-blocking and amiodarone therapy resulted efficacious in preventing arrhythmic recurrences. We then discuss the possible arrhythmogenic mechanisms, with special emphasis on the unique electrophysiological, hemodynamic, cellular and anatomical milieu created by acute myocardial ischemia.

12.
Indian Pacing Electrophysiol J ; 11(6): 176-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22090732

RESUMO

Upgrading of a pacing system in the presence of a subclavian occlusion is technically challenging. We describe the case of a patient who underwent a successful upgrading procedure of an implantable cardioverter-defibrillator (ICD) to a biventricular defibrillator (ICD-CRT) in the presence of a suboccluded left subclavian vein, using a collateral vein that drained into the contralateral subclavian vein.

14.
Europace ; 9(12): 1119-23, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17959682

RESUMO

AIMS: In patients with atrial fibrillation (AF) and uncontrolled ventricular rate, radiofrequency (RF) ablation of the atrioventricular (AV) node and pacemaker (PM) implantation (ablate and pace) is a valid therapeutic approach, especially in elderly patients. The aim of our study was to evaluate the PM dependence and the incidence of correlated clinical phenomena in a patients population with AV block induced by RF ablation of the AV junction. METHODS AND RESULTS: One-hundred and sixty-three patients (71 men; mean age 71 +/- 8 years) who had undergone ablate and pace therapy were evaluated. The patients underwent assessment of quality of life, impairment of consciousness, stroke/transient ischaemic attack (TIA), hospitalizations for heart failure, episodes of palpitations, and instrumental evaluation of PM dependence during PM inhibition (absence of escape rhythm; asystolic pause >5 s; escape rhythm <30 bpm after rhythm stabilization). Correlation between instrumentally evaluated PM dependence and clinical history was analysed. Hundred and thirty-two patients were evaluated after a mean follow-up period of 36 months [31 subjects (19%) died before the evaluation]; 55 patients (42%) were classified as PM-dependent: 38 (69%) complained of disturbances (19 dizziness, 15 pre-syncope, 4 syncope); 77 patients (58%) were considered non-PM-dependent: symptoms (dizziness, flush) were reported by only 3 (4%). No significant differences emerged between PM-dependent and non-PM-dependent patients with regard to episodes of pre-syncope, syncope, stroke/TIA, hospitalizations for heart failure, and quality of life. CONCLUSION: This study confirms that ablate and pace is an effective and safe approach in subjects with chronic or recurrent AF and uncontrolled ventricular rate.


Assuntos
Fibrilação Atrial/terapia , Nó Atrioventricular/cirurgia , Estimulação Cardíaca Artificial , Ablação por Cateter , Marca-Passo Artificial , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Estimulação Cardíaca Artificial/efeitos adversos , Ablação por Cateter/efeitos adversos , Terapia Combinada , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/prevenção & controle , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Qualidade de Vida , Síncope/etiologia , Síncope/prevenção & controle , Resultado do Tratamento
16.
J Cardiovasc Med (Hagerstown) ; 7(8): 637-40, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16858245

RESUMO

The antimetabolite 5-fluorouracil is frequently used in the therapy of various malignancies. Cardiotoxicity has frequently been described during treatment, but there is no common agreement on the need to perform cardiovascular monitoring of patients during 5-fluorouracil administration. We report the case of a young patient with an head-neck cancer on whom a continuous electrocardiogram recording was performed, documenting serious ventricular dysrhythmias in the presence of myocardial ischemia during 5-fluorouracil and cis-platin infusion.


Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Cisplatino/efeitos adversos , Isquemia Miocárdica/induzido quimicamente , Adulto , Antimetabólitos Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Eletrocardiografia , Fluoruracila/administração & dosagem , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Humanos , Infusões Intravenosas , Masculino
17.
J Heart Valve Dis ; 15(2): 206-8, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16607902

RESUMO

Severe symptomatic aortic stenosis (AS) is an indication for surgical replacement of the aortic valve in adults. Patients are often affected by comorbidities, and the surgical indication is sometimes problematic. Non-surgical techniques have been developed during the past few years, though their roles have not yet been established. Cardiac resynchronization therapy has been shown to be effective in selected patients, but no data yet exist on the role of this therapy in AS patients. The case is presented of a patient with non-operable severe symptomatic AS and cardiac dissynchrony who showed significant improvement following the implantation of a biventricular pacemaker.


Assuntos
Estenose da Valva Aórtica/terapia , Estimulação Cardíaca Artificial , Implante de Prótese de Valva Cardíaca , Disfunção Ventricular Esquerda/terapia , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Contraindicações , Seguimentos , Humanos , Masculino , Contração Miocárdica , Estudos Retrospectivos , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Remodelação Ventricular
19.
Ital Heart J Suppl ; 5(9): 735-40, 2004 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-15568612

RESUMO

In acquired human immunodeficiency virus (HIV) infection, a long depolarization period at ECG may be the consequence of cardiac complications due to viral myocarditis or cardiomyopathy or indirectly due to autonomic neuropathy, or sometimes resulting from pharmacological treatments. Several drugs administered for direct treatment of HIV disease or its complications, such as antiretrovirus, fluconazole, and antibiotics, may induce ventricular arrhythmias due to long QT prolonged depolarization period. Also methadone, frequently associated with HIV therapy to treat patients with opiate addiction, is described in the literature to have cardiac inotropic effects. It has also the potential to increase the QT period and to develop ventricular torsade de pointes, primarily through interference with the rapid component of the delayed rectifier potassium ion current. Moreover, the use of methadone associated with other inhibitors of cytochrome P450 might increase plasma concentrations and contribute to methadone cardiac toxicity. We report the case of an HIV patient receiving antiretroviral treatment, fluconazole and high-dose methadone, who suddenly complained of vertigo, dizziness, pre-syncope and syncope due to severe ventricular arrhythmias that disappeared after discontinuation of all treatments.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Sistema Enzimático do Citocromo P-450/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Torsades de Pointes/induzido quimicamente , Analgésicos Opioides/administração & dosagem , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Combinação de Medicamentos , Eletrocardiografia , Fluconazol/administração & dosagem , Fluconazol/efeitos adversos , Humanos , Síndrome do QT Longo/fisiopatologia , Masculino , Metadona/administração & dosagem , Torsades de Pointes/fisiopatologia , Resultado do Tratamento
20.
Ital Heart J ; 4(2): 92-8, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12762271

RESUMO

BACKGROUND: The management of patients with acute chest pain is a common and difficult challenge for clinicians. In our emergency department (ED) a systematic protocol that involves the use of the exercise test for the management of patients with chest pain of suspected cardiac origin is presently running. The aim of the present study was to evaluate the feasibility of such a test in this setting, in terms of the safety and satisfactory follow-up of these patients discharged home. METHODS: Patients with chest pain lasting < or = 24 hours, aged > 18 years, without a history of trauma or of any other evident medical cause of chest pain and without high-risk characteristics were included in the present study. These patients, defined as low-risk patients for acute coronary events on admission, were evaluated in the ED area and submitted to serial ECG and blood sampling for the determination of the creatine kinase-MB mass and troponin I serum levels on admission and at 6 and 12 hours after admission. A symptom-limited maximal exercise was performed in the patients with a negative clinical observation and typical chest pain or atypical chest pain but multiple coronary risk factors. RESULTS: In the year 2000, 1370 patients were evaluated in the ED for chest pain. In 150 (11%) an exercise test was performed. The test was positive in 24 patients (16%). The criteria for a positive test were only clinical in 3 patients, only ECG in 13 patients, and both in 8 patients. Inconclusive tests were observed in 27 patients (18%) and the test was negative in 99 patients (66%). There were no complications during the exercise test. At a median follow-up of 237 days (range 11-443 days), 11 clinical events were recorded (4 acute coronary syndromes and 7 revascularization procedures). Patients with a non-negative exercise test had a significantly shorter event-free survival (p < 0.005). CONCLUSIONS: The exercise test performed in selected patients coming to the ED with acute chest pain is safe and useful for further risk assessment.


Assuntos
Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência , Teste de Esforço , Seleção de Pacientes , Doença Aguda , Idoso , Dor no Peito/mortalidade , Dor no Peito/terapia , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/mortalidade , Estenose Coronária/terapia , Intervalo Livre de Doença , Eletrocardiografia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Admissão do Paciente , Fatores de Tempo , Tomografia Computadorizada de Emissão , Resultado do Tratamento
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