Chronic hepatitis C (CHC) has a high prevalence in the world. In addition to hepatic complications with cirrhosis in about 20% of patients and high risk for hepatocarcinoma, extrahepatic manifestations may also occur. Cardiac involvement in patients with CHC is associated with several factors, such as increased risk for coronary artery disease, primary cardiomyopathies, or hemodynamic and electrophysiological changes observed in liver cirrhosis. Furthermore, antiviral treatment may, in rare cases, causes cardiovascular adverse effects. Cardiac arrhythmias are the main form of clinical presentation, and, often, markers of poor prognosis in individuals with advanced liver disease. Although some mechanisms that justify these changes have already been reported, many questions remain unanswered, especially about the true involvement of the hepatitis C virus in the genesis of primary cardiac abnormalities, and the risk factors for cardiac-related complications of antiviral treatment.Rezende et al.Cardiac disorders in chronic hepatitis C
Purpose -Evaluate the different types of conduction blocks obtained between inferior vena cava-tricuspid annulus (posterior isthmus) and between tricuspid annulus-coronary sinus ostium (septal isthmus) after radiofrequency (RF) catheter ablation of atrial flutter (AFL)Methods 30,5 ± 7,5ms no segundo (p<0,05 Objetivo -Avaliar os tipos de bloqueio obtidos nos istmos posterior (entre o anel tricuspídeo e veia cava inferior) e septal (entre o anel tricuspídeo e óstio do seio coronário), após ablação do flutter atrial (FLA). Métodos -Foram submetidos à ablação por radiofreqüência (RF) 14 pacientes com FLA tipo I (9 homens) em 16 procedimentos. A ativação atrial ao redor do anel tricuspídeo foi avaliada em ritmo sinusal utilizando-se cateter "Halo" com 10 pares de eletrodos (H1-2 a H19-20), durante estimulação do seio coronário proximal (SCP) e região póstero-lateral do átrio direito (H1-2), antes e após ablações lineares. De acordo com a frente de programação do impulso definiu-se: ausência de bloqueio (condução bidirecional), bloqueio incompleto (condução bidirecional com retardo num dos sentidos) e bloqueio completo (ausência de condução pelo istmo). O intervalo desta ativação (∆SCP/H1-2) foi analisado. Resultados -Bloqueio completo foi obtido em 7 procedimentos (44%) e incompleto em 4 (25%). O ∆ SCP/H1-2 foi de 74 ± 26ms no primeiro grupo e de
Background: Chronic Hepatitis C (CHC) therapy with direct-acting antivirals (DAAs) has high efficacy and safety, but some cases of bradyarrhythmias have been described.Objective: To evaluate heart rhythm disorders during DAA treatments.Methods: Forty-eight patients with CHC (mean 61 years of age; 56% males; 73% HCV genotype 1) were evaluated before and during treatment with DAAs, analyzed by a resting 12-lead ECG [PR, QRS, and QT corrected (QTc) intervals measured] and a 24-h-Holter system, to evaluate the heart rate (HR) and the occurrence of arrhythmias. The Student's t-test or the Wilcoxon-Mann-Whitney test for continuous, independent variables were performed with a statistically significant p-value < 0.05. Results:The electrocardiographic parameters before and during treatment were: PR interval (147.2 ± 15.6 vs 144.9 ± 15.6 ms; p = 0.21), QTc interval (427 ± 22.3 vs 421.7 ± 25.3 ms; p = 0.24), minimum HR (52.7 ± 8.4 vs 53.2 ± 8.5 bpm; p = 0.49), median HR (74.2 ± 10.4 vs 75.2 ± 9 bpm; p = 0.83), and maximum HR (117.4 ± 16.8 vs 117.9 ± 16.3 bpm; p = 0.25). These parameters proved to be similar among 11 beta-blockers or 22 ribavirin users. During treatment, the 21 cirrhotic patients presented significantly lower median HRs (72.1 ± 9.0 vs 77.9 ± 8.2 bpm; p = 0.02) and maximum HRs (108.9 ± 15.2 vs. 125.1 ± 13.2 bpm, p < 0.0001) through a 24-h-Holter monitoring than the patients without cirrhosis. No clinically relevant arrhythmias were detected. Conclusion:DAAs do not significantly influence heart rate or induce significant cardiac arrhythmias in patients with CHC.
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