Incidência de acidente vascular encefálico e insuficiência renal aguda em pacientes com fibrilação atrial no pós-operatório de cirurgia de revascularização do miocárdio / Incidence of stroke and acute renal failure in patients of postoperative atrial fibrillation after myocardial revascularization

INTRODUÇÃO: A fibrilação atrial pós-operatória é a arritmia mais comum em cirurgia cardíaca; estima-se sua incidência entre 20% e 40%. OBJETIVO: Avaliar a incidência de acidente vascular encefálico e insuficiência renal aguda nos pacientes que apresentaram fibrilação atrial no pós-operatório de cirurgia de revascularização miocárdica. MÉTODOS: Estudo coorte longitudinal, bidirecional, realizado no Hospital da Beneficência Portuguesa (SP), com levantamento de prontuários de pacientes submetidos à cirurgia de revascularização miocárdica, de junho de 2009 a julho de 2010. De um total de 3010 pacientes foram retirados 382 pacientes, que apresentavam fibrilação atrial no pré-operatório e/ou cirurgias associadas). O estudo foi conduzido em conformidade com as seguintes resoluções nacionais e internacionais: ICH Harmonized Tripartite Guidelines for Good Clinical Practice - 1996; Resolução CNS196/96; e Declaração de Helsinque. RESULTADOS: Os 2628 pacientes incluídos neste estudo foram divididos em dois grupos: grupo I, que não apresentou fibrilação atrial no pós-operatório, com 2302 (87,6%) pacientes; e grupo II, com 326 (12,4%) que evoluíram com fibrilação atrial no pós-operatório. A incidência de acidente vascular encefálico nos pacientes foi de 1,1% sem fibrilação atrial no pós-operatório vs. 4% com fibrilação atrial no pós-operatório (P<0,001). Insuficiência renal aguda pós-operatória ocorreu em 12% dos pacientes com fibrilação atrial no pós-operatório e 2,4% no grupo sem fibrilação atrial no pós-operatório (P<0,001), ou seja, uma relação 5 vezes maior. CONCLUSÃO: Neste estudo verificou-se alta incidência de acidente vascular encefálico e insuficiência renal aguda nos pacientes com fibrilação atrial no pós-operatório, sendo as taxas maiores que as referidas na literatura.

INTRODUCTION: Postoperative atrial fibrillation is the most common arrhythmia in cardiac surgery, its incidence range between 20% and 40%. OBJECTIVE: Quantify the occurrence of stroke and acute renal insufficiency after myocardial revascularization surgery in patients who had atrial fibrillation postoperatively. METHODS: Cohort longitudinal bidirectional study, performed at Portuguese Beneficent Hospital (SP), with medical chart survey of patients undergoing myocardial revascularization surgery between June 2009 to July 2010. From a total of 3010 patients were weaned 382 patients that presented atrial fibrillation preoperatively and/or associated surgeries. The study was conducted in accordance with national and international following resolutions: ICH Harmonized Tripartite Guidelines for Good Clinical Practice - 1996; CNS196/96 Resolution, and Declaration of Helsinki. RESULTS: The 2628 patients included in this study were divided into two groups: Group I, who didn't show postoperative atrial fibrillation, with 2302 (87.6%) patients; and group II, with 326 (12.4%) who developed postoperative atrial fibrillation. The incidence of stroke in patients was 1.1% without postoperative atrial fibrillation vs. 4% with postoperative atrial fibrillation (P<0.001). Postoperative acute renal failure was observed in 12% of patients with postoperative atrial fibrillation and 2.4% in the group without postoperative atrial fibrillation (P<0.001), that is a relation 5 times greater. CONCLUSION: In this study there was a high incidence of stroke and acute renal failure in patients with postoperative atrial fibrillation, with rates higher than those reported in the literature.

Incidence of stroke and acute renal failure in patients of postoperative atrial fibrillation after myocardial revascularization.

INTRODUCTION: Postoperative atrial fibrillation is the most common arrhythmia in cardiac surgery, its incidence range between 20% and 40%. OBJECTIVE: Quantify the occurrence of stroke and acute renal insufficiency after myocardial revascularization surgery in patients who had atrial fibrillation postoperatively. METHODS: Cohort longitudinal bidirectional study, performed at Portuguese Beneficent Hospital (SP), with medical chart survey of patients undergoing myocardial revascularization surgery between June 2009 to July 2010. From a total of 3010 patients were weaned 382 patients that presented atrial fibrillation preoperatively and/or associated surgeries. The study was conducted in accordance with national and international following resolutions: ICH Harmonized Tripartite Guidelines for Good Clinical Practice - 1996; CNS196/96 Resolution, and Declaration of Helsinki. RESULTS: The 2628 patients included in this study were divided into two groups: Group I, who didn't show postoperative atrial fibrillation, with 2302 (87.6%) patients; and group II, with 326 (12.4%) who developed postoperative atrial fibrillation. The incidence of stroke in patients was 1.1% without postoperative atrial fibrillation vs. 4% with postoperative atrial fibrillation (P<0.001). Postoperative acute renal failure was observed in 12% of patients with postoperative atrial fibrillation and 2.4% in the group without postoperative atrial fibrillation (P<0.001), that is a relation 5 times greater. CONCLUSION: In this study there was a high incidence of stroke and acute renal failure in patients with postoperative atrial fibrillation, with rates higher than those reported in the literature.

Bidirectional ventricular tachycardia with alternating right and left bundle branch block morphology in a patient with metastatic cardiac tumors.

A case is reported of bidirectional ventricular tachycardia and syncope in a 16-year-old male with a previous history of a paratesticular rhabdomyosarcoma that achieved complete remission with treatment. At the electrophysiological study, frequent ectopy of both right and left bundle branch block pattern were present, with runs of monomorphic and bidirectional VT alternating the two morphologies. The study suggested a single focus at the interventricular septum with two exit sites, depolarizing the right and left ventricle in an alternate fashion. Reassessment of the malignancy status showed multiple cardiac metastases with a 4 mm nodule at the interventricular septum.