Introdução: As síncopes podem representar elevado risco de morbimortalidade em determinadas populações. Objetivo: Investigar os resultados dos métodos complementares utilizados no diagnóstico das síncopes em portadores de marca-passos (MP). Metodologia: Foram recrutados participantes do ambulatório de Arritmias e Marca-passo do Hospital Universitário Walter Cantídio, sendo incluídos portadores de MP uni ou bicameral implantados nos últimos 10 anos por doença do nó sinusal ou bloqueio atrioventricular, com capacidade analítica dos eletrogramas endocavitários (EGM), sendo avaliados clinicamente por questionários específicos e análise dos EGM. Demais exames foram solicitados de acordo com a suspeita clínica, como o Holter 24h, Tilt teste, Teste de Hipersensibilidade do Seio Carotídeo ou Estudo Eletrofisiológico. Resultados: O Tilt teste diagnosticou síncopes neuromediadas em quase 1/3 dos casos. A análise computadorizada dos EGM apresentou elevada capacidade diagnóstica, tendo determinado a etiologia arrítmica ou por falhas do MP em 27,6% dos casos. O Holter 24hs auxiliou na investigação em 18,7% dos casos. Conclusão: Os testes do marca-passo com as análises de seus eletrogramas armazenados e o Tilt teste foram os melhores métodos para o diagnóstico etiológico das síncopes em portadores de MP cardíaco.
Introduction Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure’s outcome but have economic implications. Objective The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices. Methods This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes. Results The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases. Conclusion This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.
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