A total of 46 consecutive Chagas' disease patients had an automatic cardioverter defibrillator implanted at our institution from October 1998 to January 2004. A retrospective longitudinal study was carried out to identity type of life-threatening ventricular arrhythmias as well as type of therapy delivered. Of these, 41 (91%) had been recovered from cardiac arrest. Five (15%) of 33 patients in whom echocardiography was done had no left ventricular function. Antiarrhythmic therapy was delivered to 37 (80%) patients during postimplant follow-up. Thirty-one of 37 (84%) patients received both shock and antitachycardia pacing, five (13%) only antitachycardia pacing, and one (3%) patient only shock. Median time to first shock was 16 days, varying from 1 to 576 days. Ventricular fibrillation was the cause of first shock in 12 patients (32%), ventricular tachycardia in 11 (29%), and ventricular tachycardia not responding to antitachycardia pacing degenerating into ventricular fibrillation in nine (24%). Five patients with ventricular tachycardia were treated with antitachycardia pacing. Probability of freedom from device discharged was 47% at 90 days, 34% at 180 days, and 9% at 360 days in the postimplant follow-up. Thus, patients with chronic Chagas' heart disease recovered from cardiac arrest have a peculiar arrhythmogenic profile characterized by a high frequency of ventricular fibrillation and no left ventricular systolic dysfunction and a short period of time for first shock.
From 1977 to 1988, 10,812 bovine pericardial valves were produced by IMC Biomédica and implanted. One thousand one hundred ninety‐three were implanted by our group at IMC, including 666 exclusively in the mitral position. We are presenting our study of those mitral patients. Of the 663 patients, 586 were adults (over 21 years of age) and 77 were youngsters (under 21). Hospital mortality was 9.2%; 13.2% for the first 5.5 years (group I) and 6.3% for the second 5.5 years (group II). Eleven year follow‐up was 98.8% complete and the mean time was 3.8 years. The actuarial survival was 74.3% ± 6.5% for the youngsters and 73.0% ± 3.7% for the adults. The fatal valve‐related late complications (death from thromboembolism, calcification, and endocarditis) had an incidence of 1% per patient‐year as follows: (1) endocarditis, 0.6% per patient‐year; (2) calcification 0.1% per patient‐year; and (3) cerebral vascular accident, 0.3% per patient year. The actuarial study revealed 95.0 % ± 1.0% freedom from fatal complications related to the prosthesis. The nonfatal valve‐related late complications had an incidence of 2.9% per patient‐year as follows: (1) endocarditis, 0.5% per patient‐year; (2) calcification, 1.8% per patient‐year; (3) cerebral vascular accident, 0.3% per patient‐year; (4) periprosthetic leakage, 0.2% per patient‐year; and (5) rupture, 0.1% per patient‐year. The actuarial study revealed 55.2% ± 8.6% freedom from all complications including thromboembolism, endocarditis, calcification, periprosthetic leakage, and rupture. The actuarial study of the bioprosthesis revealed 95.8% ± 1.6% freedom from thromboembolism (linearized rate of 0.6% per patient‐year); 99.1 % ± 0.6% freedom from rupture (linearized rate of 0.08% per patient‐year); 90.1% ± 4.08% freedom from endocarditis in the young group (linearized rate of 1.5% per patient‐year); and 95.2% ± 1.03% for adults (linearized rate of 1.0% per patient‐year). Freedom from calcification was 43.1% ± 12.25% for the young group (linearized rate of 7.5% per patient‐year) and 68.8% ± 9.3% for adults (linearized rate of 1.1% per patient‐year) in the 11th year. We conclude that the IMC pericardial bioprosthesis performed well in a period of 11 years with low rates of fatal complication, ruptures, and thromboembolism without the use of anticoagulants. Calcification was the major complication mainly in youngsters.
ReI'. Bras. Cir. Cardiovasc INTRODUçAOA estimulação fisiológica, em que átrio e ventrf· culo são acoplados e ajustados em um intervalo PR, consiste, atualmente, no mais avançado modo de estimulação card(aca artificial.Foi concebido há mais de 20 anos, porém. somente com o avanço tecnológico, tomou-se possfvel este modo de estimulação.
RESUMO: Quarenta e oito pacientes com marcapasso unicameral de ajuste automático de freqüência de pulso mediado por movimentação corporal (AAI-RNVI-R) foram avaliados através da eletrocardiografia dinãmica, para correlacionar a atividade física com a variação da freqüência de estímulos e teste ergométrico em esteira (pareados e randomizados em modo AAINVI e modo AAI-RNVI-R) , para quantificar a capacidade de realizar esforço físico , um mês após o implante do gerador de pulso Activitrax 8400. A idade média dos pacientes era de 46 anos e a etiologia predominante da arritmia que motivou o implante era a miocardiopatia chagásica. O eletrocardiograma ambulatorial mostrou modificações apropriadas na freqüência cardíaca (exceto em 1 paciente, que permaneceu em ritmo sinusal) . Teste ergométrico no modo AAI-RNVI-R mostrou elevação significativ. a na freqüência cardíaca com relação ao valor médio controle : de 66,9 +0,8 ppm para 84,6 +2,1 ppm aos 14 minutos 90,5'2,8 ppm aos 6 minutos e 95,7 + 2,9 ppm aos 8 minutos (P < 0,05). O modo AAI-RNVI-R possibilitou um aumento no tempo de exercício de 20,2% quando comparado ao modo AAINVI (P < 0,05) . Em 12 pacientes, arritmias ventriculares foram detectadas durante o exercício em modo AAINVI , mas não no modo AAI-RNVI-R. No curto período avaliado (1 mês), os pacientes referiram melhora clfnica e puderam reassumir vida mais ativa. O gerador de pulsos Activitrax 8400 mostrou-se efetivo e seguro. A estimulação unicameral com variação da freqüência de pulso melhorou a capacidade de realizar exercícios físicos, quando comparada com a estimulação em freqüência pré-determinada. DESCRITORES: marcapassos cardíacos, ajuste automático.
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