Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/mortalidade , Volume Sistólico , Doença das Coronárias/classificação , Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/complicações , Humanos , Complicações Pós-Operatórias , Prognóstico , Análise de Regressão , Risco , Índice de Gravidade de DoençaAssuntos
Ambulâncias , Desfibriladores Implantáveis , Análise de Falha de Equipamento , Marca-Passo Artificial , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Ablação por Cateter , Terapia Combinada , Eletrocardiografia , Átrios do Coração/fisiopatologia , Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Software , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Transporte de PacientesRESUMO
BACKGROUND: The Telectronics 330-801 atrial J (801) lead was recalled after reports implicated lead fracture/retention wire protrusion in patient mortality and morbidity. Recent reports suggest that 801 lead extraction may be associated with substantial morbidity and, possibly, excess mortality. We hypothesized that the 801 lead could be extracted using the subclavian approach with a high success rate and acceptable morbidity. METHODS: We analyzed the clinical outcomes in 60 consecutive patients who underwent 801 lead extraction. RESULTS: Sixty patients (34 women) with a mean age of 67 +/- 14.8 years had 18 class I, 13 class II, and 29 class III fractures. The lead age was 39 +/- 17 months. The subclavian approach was successful in 58 of 60 patients (96%). Complications, three major and eight minor, occurred in 10 of 60 patients (16%). All complications were successfully treated. There were no deaths. Only concurrent ventricular lead extraction was associated with complications (p = 0.008 by Fisher's exact test). CONCLUSIONS: Telectronics 801 leads can be successfully extracted using the subclavian approach with acceptable short-term morbidity, low mortality, and excellent long-term results.
Assuntos
Eletrodos , Marca-Passo Artificial , Próteses e Implantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Complicações Pós-Operatórias , Veia SubcláviaRESUMO
The mechanism of torsades de pointes as a proarrhythmic response to antiarrhythmic drugs is not clear. We hypothesized that the difference in the corrected QT interval (QTc, Bazett's formula) with varying autonomic tone and heart rate during 24-hour ambulatory ECG would help identify patients at risk. Ten patients with antiarrhythmic drug-induced torsades de pointes were compared with 28 controls. The QTc at maximal and minimal heart rate during antiarrhythmic drug-free ambulatory ECGs were measured. The mean QTc at minimal heart rates for patients was 0.413 +/- 0.102 seconds and 0.420 +/- 0.072 seconds and for controls (P = 0.715). The mean QTc at maximal heart rates for patients was 0.555 +/- 0.022 seconds and for controls was 0.439 +/- 0.011 seconds (P = 0.001). Mean QTc between minimal and maximal heart rates were significantly different for patients (P = 0.015) but were not for controls (P = 0.151). Using an arbitrary QTc difference cutoff of 0.075 seconds, this approach identified patients at risk for antiarrhythmic drug-induced torsades de pointes with a sensitivity of 70% (7 of 10) and a specificity of 89% (P < or = 0.003 by Chi-square analysis with Yates' correction). In conclusion, patients with antiarrhythmic drug-induced torsades de pointes had a greater rise in QTc from minimal to maximal heart rate during ambulatory ECG than controls. Further larger prospective trials will be required to establish the value of this approach to identify patients at risk for this type of proarrhythmia.