Assessing cardiac resynchronization therapy response in heart failure patients: a comparative analysis of efficacy and outcomes between transvenous and epicardial leads.

Cardiac resynchronization therapy (CRT) is an effective treatment for selected heart failure (HF) patients. Although transvenous implantation is the standard method, it is not feasible in some patients, so the epicardial lead emerges as an alternative. We aim to compare CRT response, procedure-related complications, and the occurrence of clinical outcomes between patients with transvenous and epicardial leads. In a single-center retrospective study, we enrolled consecutive HF patients submitted to CRT implantation with a defibrillator between 2013 and 2022. Clinical response was defined as an improvement of at least one of the New York Heart Association classes with no occurrence of cardiovascular death or HF hospitalization in the first year of follow-up. Echocardiographic response was attained with an increase in left ventricular ejection fraction 10% or a reduction of left ventricular end-diastolic volume >15% at 6-12 months after CRT implantation. Major adverse cardiovascular events (MACE) (cardiovascular mortality and HF hospitalization) and all-cause mortality were evaluated. From a total of 149 patients, 38% (n=57) received an epicardial lead. Clinical (63% versus 60%, p=0.679) and echocardiographic (63% versus 60%, p=0.679) responses were similar between the transvenous and epicardial groups. Patients in the transvenous group had a shorter hospital stay (2 versus 7 days, p<0.001). Procedure-related complications were comparable between groups (24% versus 28%, p=0.572), but left ventricular lead-related complications were more frequent in the transvenous group (14% versus 2%). During a median follow-up of 4.7 years, the rate of MACE was 30% (n=44), with no differences in both groups (p=0.591), neither regarding HF hospitalization (p=0.917) nor cardiovascular mortality (p=0.060). Nevertheless, the epicardial group had a higher rate of all-cause mortality (35% versus 20%, p=0.005), the majority occurring during long-term follow-up (>12 months), with no deaths in the postoperative period. Considering the comparable rates of CRT response, procedure-related complications, and MACE between groups, we conclude that epicardial lead is a feasible alternative for CRT when transvenous lead implantation is not possible. The occurrence of a higher number of all-cause deaths in epicardial patients in the long-term follow-up was mainly due to infectious complications (unrelated to the lead) and the progression of oncological/chronic diseases.

Fulminant Necrotizing Eosinophilic Myocarditis Successfully Treated With Veno-Arterial Extracorporeal Membrane Oxygenation and High-Dose Steroids

Abstract Fulminant necrotizing eosinophilic myocarditis (FNEM) is a rare form of EM characterized by biventricular heart failure with hemodynamic deterioration, often requiring inotropes or mechanical circulatory support. Here, we report a case of a 43-year-old healthy woman with FNEM who was admitted with acute heart failure that rapidly progressed to cardiogenic shock and electrical storm, culminating in cardiac arrest. Early diagnosis and prompt administration of corticosteroids in combination with veno-arterial extracorporeal membrane oxygenation allowed complete recovery of biventricular systolic function.

Perimyocarditis Following COVID-19 Vaccination.

A 39-year-old male was admitted in the emergency room with chest pain. He had been given the second dose of Pfizer-BioNTech COVID-19 vaccine 3 days before. The patient denied taking any other medication beyond the usual. He didn't feel sick in the previous days/weeks. Laboratory studies revealed elevated serum levels of troponin and C-reactive protein. An autoantibody screen and a serologic panel to detect common viruses were negative. A cardiac MRI showed myocardial edema/inflammation and confirmed the diagnosis of perimyocarditis which was considered to be a consequence of COVID-19 vaccination. Physicians should be aware of the possibility of cardiovascular complications after COVID-19 vaccination.

A relação saúde / doença no processo de trabalho dos Agentes Comunitários de Saúde: uma revisão de literatura / The relationship between health / illness in the work process of the Community Health Agents: a literature review

O presente estudo está voltado para os trabalhadores que se empenham em direcionar o olhar para o cuidado do outro e que carecem de cuidar da própria saúde e reavaliar as condições de seu trabalho. Buscamos trazer um panorama aprofundado e referenciado nos trabalhos científicos sobre a saúde do Agente Comunitário de Saúde (ACS) em relação ao processo de trabalho. Há fatores que podem ser fonte de prazer e satisfação para alguns ACS, e para outros, o mesmo elemento pode ser fonte de estresse e adoecimento. Nosso objetivo é identificar os efeitos produzidos na saúde dos Agentes Comunitários de Saúde pelo processo de trabalho, a partir de uma detalhada revisão de literatura. Pretendemos compreender, através da análise dos artigos científicos, as repercussões que o trabalho exerce sobre o ACS e os problemas de saúde que porventura a atividade laboral pode gerar. Todavia, nossa pretensão com esse estudo não é apenas direcionar nosso olhar para a nocividade do trabalho que o ACS desenvolve, mas também identificar os fatores produtores de qualidade de vida, satisfação e bem-estar. Como ferramenta metodológica, utilizamos a Revisão Integrativa norteados pela pergunta: Quais os efeitos produzidos na saúde dos Agentes Comunitários de Saúde a partir do processo de trabalho? Foram selecionados 37 artigos científicos disponibilizados no portal de bases de dados como Biblioteca Virtual em Saúde (BVS), Scielo e CAPES, em bases de dados como Lilacs e Scopus, utilizando descritores, palavras-chave e operadores boleanos (AND, OR) como auxílio para a estratégia de busca. A identificação dos trabalhos foi complementada pela busca em cascata, incluindo a identificação de referências citadas nos trabalhos recuperados da busca inicial...

This study is focused to workers who are engaged in directing his gaze to the care of the other and in need of care for their health and reassess the conditions of their work. We seek to bring an overview and referenced in scientific work on the health of Community-based Health Workers (CHW) in relation to the work process. There are factors that can be a source of pleasure and satisfaction for some CHW, and for others, the same element can be a source of stress and sickness. Our target is to identify the effects on the health of Community Health Workers by the work process, from a detailed literature review. We want to understand, through the analysis of scientific articles, the impact that work has on the CHW and the health problems that may labor activities can generate. However, our intention with this study is not only direct our gaze to the noxiousness of the work the CHW develops, but also identify the factors producing quality of life, satisfaction and welfare. As a methodological tool, made an Integrative Review guided by the question: What are the effects produced on the health of Community Health Workers from the work process? Were selected 37 scientific articles available on the portal database as the Biblioteca Virtual em Saúde (BVS), SciELO and CAPES in databases like as Lilacs and Scopus, using descriptors, keywords and Boolean operators (AND, OR) as aid for the search strategy. The identification of the works was complemented by secondary search, including the identification of references cited in the recovered studies in the initial search...