Instrumento para la evaluación del riesgo de arritmias durante el entrenamiento no aeróbico en pacientes con enfermedad cardiovascular / Prediction of arrhythmias during non-aerobic training in patients with cardiovascular disease

Objetivo: El entrenamiento físico de fuerza, flexibilidad, coordinación, propiocepción y equilibrio neuromuscular (fisioterapia) está recomendado en programas de rehabilitación cardiaca. Sin embargo, los pacientes pueden presentar arritmias no pronosticadas en la estratificación del riesgo. El objetivo de este estudio fue realizar un modelo de predicción de arritmias en las sesiones de fisioterapia. Material y método: Estudiamos una cohorte de pacientes (n = 412) que realizaron ejercicios de fisioterapia durante 30 min al día, 3 veces por semana, a intensidad moderada, mientras un cardiólogo supervisaba el trazo electrocardiográfico. Se comparó la presencia de arritmias en sesiones de fisioterapia según su aparición en la prueba de ejercicio (PE) de estratificación. Todo valor de p < 0,05 fue significativo. Finalmente, se realizó un modelo multivariable de regresión logística. Resultados: De los 412 pacientes, 270 (65%) presentaron arritmias en kinesioterapia y no hubo complicaciones mayores. El riesgo relativo para tener arritmias en fisioterapia fue de 1,89 (IC95% 1,25-2,86, p < 0,01), acorde a su presencia en la PE. Otras variables asociadas fueron miocardiopatía dilatada, baja fracción de eyección, uso de digoxina, diuréticos, bajo consumo pico de oxígeno y baja eficiencia ventilatoria (VE/VCO2). En el modelo de regresión, las variables que se mantuvieron significativas fueron: arritmias en la PE, consumo pico de oxígeno y uso de diuréticos. Conclusión: Las arritmias son frecuentes en pacientes con cardiopatía durante las sesiones de fisioterapia y las variables predictivas fueron el uso de diuréticos, el consumo pico de oxígeno y la ocurrencia de arritmias en la PE. Se recomienda supervisar con monitorización electrocardiográfica continua estas sesiones en sujetos de riesgo

Aim: Non-aerobic physical training (NAPhT) sessions with strength, flexibility, coordination, proprioception and neuromuscular balance exercises is recommended in cardiac rehabilitation programs. However, some patients have arrhythmias that are not detected in the risk stratification. The aim of this study was to make a prediction model of arrhythmias during NAPhT sessions. Material and method: We studied a cohort of patients (n= 412) undergoing NAPhT for 30 min, 3 times a week, with a moderate intensity. A cardiologist monitored the electrocardiographic signal. The occurrence of arrhythmia during NAPhT was compared with its presence in the risk stratification stress testing. All P values <.05 were considered significant. Multivariate logistic regression model was also performed. Results: From a total of 412 patients, 270 (65%) showed arrhythmias in NAPhT, without major complications. Relative risk of arrhythmia in NAPhT was 1.89 (95% CI 1.25-2.86, P < .01), when arrhythmia was present during stress testing. In the bivariate analysis, other variables associated were dilated cardiomyopathy, low ejection fraction, use of digoxin, diuretics, low peak oxygen uptake and low ventilatory efficiency. In the regression model, 3 variables remained significant: arrhythmias in stress test, peak oxygen uptake and diuretic. Conclusion: The presence of arrhythmias during NAPhT sessions in patients with heart disease is elevated, and they are associated with diuretic use, peak oxygen uptake values and the presence of arrhythmias in stress testing. Therefore, continuous electrocardiographic monitoring is recommended in these kind of patients

South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation / Diretriz Sul-Americana de Prevenção e Reabilitação Cardiovascular

In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

Com este documento, o Comitê Interamericano de Prevenção e Reabilitação Cardiovascular, em posição conjunta com a Sociedade Sul-Americana de Cardiologia, mostra seu interesse no desenvolvimento de estratégias, medidas e intervenções para a prevenção e a reabilitação cardiovascular. Com o objetivo de implementar na América Latina uma política de saúde regional e nacional dos países membros, tem-se o objetivo de promover a saúde cardiovascular e, consequentemente, diminuir a morbimortalidade. O grupo de estudos em Reabilitação Cardiopulmonar e Metabólica do Departamento de Exercício, Ergometria e Reabilitação Cardiovascular de Sociedade Brasileira de Cardiologia (DERC/SBC) criou uma comissão de experts para revisar a versão em português e adaptá-la à realidade nacional. Este documento tem como missão principal auxiliar os profissionais de saúde a alcançarem medidas efetivas de prevenção e reabilitação cardiovascular (RCV) na prática clínica diária. Com a difusão deste documento, bem como com a sua implementação de forma mais abrangente, contribuiremos com a meta da Organização Mundial de Saúde de diminuir a mortalidade cardiovascular no mundo em 25% até o ano de 2025. As prioridades deste grupo de trabalho são: • Enfatizar o caráter prioritário da RCV como instrumento de prevenção secundária com importante impacto na morbimortalidade cardiovascular; • Unir esforços para melhorar o conhecimento da RCV, sua difusão e aplicação na maioria dos centros e institutos cardiovasculares da América do Sul, priorizando a utilização de um método de prevenção cardiovascular integral, prático, de fácil aplicação e de custo/benefício comprovado; • Melhorar a educação do pessoal da saúde e dos pacientes por meio de programas educativos dirigidos, que permitam envolver diretamente os sistemas de saúde, pessoal médico, pacientes e líderes comunitários sobre a importância dos serviços de RCV, a fim de diminuir as barreiras para a sua implantação.

[Malfunction of a permanent pacemaker]. / Disfunción de marcapaso definitivo.

Forty years have gone by since the first pacemaker implant; this fact had strong impact in the life of thousands of persons. The objective of this work is to report the case of definitive pacemaker malfunction with epicardiac lead and review the literature concerning the important aspects of the causes and diagnosis of pacemaker malfunction. We consider that physicians dealing with patients implanted these devices must be prepared to diagnose and treat them adequately.

Kearns-Sayre syndromes an absolute indication for prophylactic implantation of definitive pacemaker?

Kearns-Sayre syndrome is a mitochondrial cytopathy characterized by chronic progressive external ophthalmoplegia, retinitis pigmentosa and heart block, the last of which determines the survival of these patients. The case of a 23 year old man with Kearns-Sayre syndrome, conduction disturbances and mitral valve prolapse is presented. The characteristics of this syndrome are described and the criteria for prophylactic installation of a pacemaker discussed.