IntroductionChronic stimulation of the right ventricle with pacemaker is associated with ventricular dyssynchrony and loss of contractility, even in subjects without previous dysfunction. In these patients, there is a debate of which pacing site is less associated with loss of ventricular function.ObjectiveTo compare pacemaker-induced dyssynchrony among different pacing sites in right ventricular stimulation.MethodsCross-sectional study of outpatients with right ventricle stimulation higher than 80% and preserved left ventricular ejection fraction. Pacing lead position (apical, medial septum or free wall) was assessed through chest X-rays. Every patient underwent echocardiogram to evaluate for dyssynchrony according to CARE-HF criteria: aortic pre-ejection time, interventricular delay and septum/posterior wall delay on M mode.ResultsForty patients were included. Fifty-two percent had apical electrode position, 42% mid septum and 6% free wall. Mean QRS time 148.97±15.52 milliseconds. A weak correlation between the mean QRS width and pre-aortic ejection time (r=0.32; P=0.04) was found. No difference in QRS width among the positions could be noted. Intraventricular delay was lower in apical patients against mid septal (34.4±17.2 vs. 54.3±19.1 P<0.05) - no difference with those electrode on the free wall. No difference was noted in the pre-aortic ejection time (P=0.9).ConclusionApical pacing showed a lower interventricular conduction delay when compared to medial septum site. Our findings suggest that apical pacing dyssynchrony is not ubiquitous, as previously thought, and that it should remain an option for lead placement.
Introdução: As Doenças Cerebrovasculares (DCV) ou Acidentes Vasculares Cerebrais (AVC), atualmente, constituem uma das principais causas de mortalidade no mundo, além de ser a principal patologia a acarretar incapacidade física na população brasileira. Sendo assim, o conhecimento profundo da doença é de grande relevância ao identificar seus principais fatores de riscos e dessa forma planejar e executar ações preventivas visando reduzir a incidência de óbitos causados pelo AVC. Objetivo: Apresentar o perfil epidemiológico dos óbitos por doenças cerebrovasculares no estado do Paraná de acordo com a faixa etária, sexo e raça desde o ano de 2008 a 2017. Metodologia: Análise de dados disponíveis pela Secretaria de Saúde do governo do estado do Paraná através de um estudo quantitativo, descritivo, observacional e retrospectivo. Consideraram-se os dados referentes ao sexo, faixa etária e raça. Resultados: O número de óbitos em decorrência de doenças cerebrovasculares correspondeu a 62.739, de um total de 201.006 óbitos por doenças do aparelho circulatório. Entre as mortes causadas pelo AVC, de acordo com o sexo, 53,1% eram indivíduos do sexo masculino, enquanto que 46,9% do sexo feminino. Com relação à faixa etária, a predominância se deu entre os maiores de 80 anos, com 35,5% dos óbitos, seguido de 29,6% no intervalo etário dos 70 aos 79 anos. Em contrapartida, as faixas etárias menos acometidas foram entre os menores de 1 ano de idade e maiores que 1, porém, menores que 4 anos de idade, correspondendo ao número de 10 e 8 óbitos, respectivamente. Por fim, a raça branca obteve o maior número de óbitos com 79,6%. Na outra ponta, com menor número, os indígenas, com 66 óbitos (0,1%). Considerações finais: Os resultados obtidos através da análise dos dados coincidem com a literatura nacional no quesito de predominância de doenças cerebrovasculares em homens e a incidência da doença aumentada de acordo com o avanço da idade. No entanto, diferem quanto à raça mais acometida, visto que, na maior parte do mundo, o AVC atinge, principalmente, indivíduos negros. Sendo assim, o conhecimento do perfil epidemiológico dos óbitos causados por doenças cerebrovasculares no estado do Paraná é de alta magnitude, especialmente, para se obter o conhecimento de onde atuar as ações preventivas e terapêuticas, que visam diminuir a frequência da doença, assim como, complicações que o AVC pode ocasionar.
Isolated congenital atrioventricular block (ICAVB) is a rare, and pacemaker implantation is the only effective treatment. We sought to identify the predictive factors of adverse events related to pacemaker implantation in ICAVB. This is a cohort study of patients diagnosed with ICAVB who underwent pacemaker implantation from 1980 to 2014 in a single center. During the studied period, a total of 647 patients underwent implantation of their first permanent cardiac pacemaker before 30 years of age. Of these, only 62 (9.5 %) were diagnosed with ICAVB. This condition was diagnosed in utero in 15 (24.2 %) cases, 5 (8.1 %) in the neonatal period, 32 (51.6 %) during childhood, and 10 (16.1 %) during adolescence and young adulthood. The presence of autoantibodies (anti-Ro/SSA) was observed in 41 % of mothers who underwent serological evaluation. Age at the time of the initial pacemaker implant was 9.8 ± 9 years. During a mean follow-up time of 15 years, 1 (1.7 %) death occurred due to infectious endocarditis. Complications related to pacemaker implant were reported in 24 patients (38.7 %). The number of complications was significantly higher in the group with an epimyocardial implantation site (HR 6; CI 2.45-14.95). Ventricular dysfunction occurred in 6 (11.7 %) patients; however, we were not able to identify any predictors of it. Our results showed a low mortality rate after permanent therapy. However, these patients exhibited high morbidity related to the pacemaker system, and the epimyocardial implant site was an independent predictor of complications. Predictors of left ventricular dysfunction were not found in the present study.
The best approach of multivessel coronary artery disease in the context of acute myocardial infarction with ST segment elevation and primary percutaneous coronary intervention is one of the main reasons for controversy in cardiology. Although the main global guidelines do not recommend routine complete revascularization in these patients, recent randomized clinical trials have demonstrated benefit of this approach in reducing cardiovascular outcomes. For this reason, an adequate review of this evidence is essential in order to establish scientifically based strategy and achieve better outcomes for these patients who present with acute myocardial infarction. This review aims to present objectively the most recent evidence available on this topic.
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