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Post-Cardiac Injury Syndrome (PCIS) akin to Dressler's syndrome is late-onset pericarditis that is triggered by the body's immune system and presents commonly as pleuro- pericardial symptoms and raised inflammatory markers. Its occurrence following the insertion of a pacemaker has been reported infrequently and varies in different studies with an estimated prevalence of 1-2%. Our case reports a unique incidence of isolated pleural effusion following the implantation of a pacemaker in a 62-year-old female with complete heart block with no evidence of pericardial effusion on imaging. She developed dyspnoea, pleuritic chest pain, and lethargy. She successfully responded to treatment with NSAIDs and colchicine with no recurrence. This report demonstrates the uncommon course of the disease and highlights the need to consider PCIS as a possible diagnosis in patients presenting with predominant pulmonary findings and suspect it early so that timely treatment can be started, thereby preventing complications.

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Introdução: Entre os tratamentos atuais para controle de arritmias, os mais comuns são os dispositivos cardíacos eletrônicos implantáveis, capazes de controlar o ritmo do coração por meio de diferentes terapias, de acordo com as necessidades do paciente. Embora proporcionem maior longevidade às pessoas, a dependência de um dispositivo biomecânico geralmente exige mudança no estilo de vida do portador. Objetivos: Caracterizar o perfil sociográfico e clínico dos pacientes com dispositivos cardíacos eletrônicos implantáveis e identificar o conhecimento adquirido após intervenção educativa do enfermeiro. Material e Métodos: Pesquisa transversal, quantitativa, descritiva, com correlação entre as variáveis. Participaram 30 portadores de dispositivos, por meio de intervenção educativa do enfermeiro e uso de um folheto ilustrativo sobre cuidados pós-implante, disponibilizado ao paciente. Em seguida, foi realizada entrevista estruturada com questões referentes às orientações feitas sobre os cuidados. Resultados: A maioria dos participantes acertou todas as respostas sobre as recomendações de cuidados pós-operatórios de forma imediata. Quanto às orientações referentes ao tempo de repouso para voltar às atividades cotidianas, 28 (93,3%) acertaram; como proceder diante de detectores de metal 25 (83,3%) acertaram e sobre o uso de colchão magnético, 25 (83,3%) acertaram, demonstrando que estes conhecimentos precisam de maior esclarecimento. Conclusão: A intervenção educativa e o uso de folheto ilustrativo sobre cuidados pós-implante de dispositivos cardíacos implantáveis facilitou a explicação e propiciou a assimilação do conhecimento, sendo um recurso importante para o enfermeiro que atua na área cardiológica

Introduction: Among the current treatments for arrhythmias control, the most common are implantable electronic cardiac devices, capable of controlling the heart rhythm through different therapies, according to the needs of the patient. Although they provide greater longevity to people, dependence on a biomechanical device usually requires a change in the lifestyle of the carrier. Objectives: To characterize the sociographic and clinical profile of patients with implantable electronic cardiac devices and to identify the knowledge acquired after nurses' educational intervention. Material and Methods: Cross-sectional, quantitative, descriptive research, with correlation between variables. Thirty patients with devices participated, through the nurse's educational intervention and the use of an illustrative leaflet on post-implant care, made available to the patient. Then, a structured interview was conducted with questions regarding the guidelines made about care. Results: The majority of the participants answered all the recommendations for postoperative care immediately. Regarding the guidelines regarding rest time to return to daily activities, 28 (93.3%) agreed; how to proceed before metal detectors 25 (83.3%) agreed and on the use of magnetic mattress, 25 (83.3%) proved that this knowledge needs further clarification. Conclusion: The educational intervention and the use of illustrative leaflet on post-implantation care of implantable cardiac devices facilitated the explanation and provided the assimilation of knowledge, being an important resource for the nurse who works in the cardiological area

Introducción: Entre los tratamientos actuales para el control de la arritmia, los más comunes son los dispositivos cardíacos electrónicos implantables, capaces de controlar el ritmo cardíaco a través de diferentes terapias, según las necesidades del paciente. Si bien brindan a las personas una mayor longevidad, la dependencia de un dispositivo biomecánico suele requerir un cambio en el estilo de vida del usuario. Objetivos: Caracterizar el perfil sociográfico y clínico de pacientes portadores de dispositivos cardíacos electrónicos implantables e identificar los conocimientos adquiridos después de una intervención educativa por parte de enfermeros. Material y Métodos: Investigación transversal, cuantitativa, descriptiva, con correlación entre variables. Participaron 30 portadores de dispositivos, a través de una intervención educativa por parte de enfermeras y el uso de un tríptico ilustrativo sobre los cuidados post-implante, a disposición del paciente. Luego, se realizó una entrevista estructurada con preguntas sobre las pautas dadas sobre el cuidado. Resultados: La mayoría de los participantes acertaron en todas las recomendaciones de cuidados postoperatorios inmediatos. En cuanto a las orientaciones sobre el tiempo de descanso para la reincorporación a las actividades cotidianas, 28 (93,3%) fueron correctas; cómo proceder frente a los detectores de metales 25 (83,3%) fueron correctos y sobre el uso de un colchón magnético, 25 (83,3%) fueron correctos, lo que demuestra que este conocimiento necesita mayor aclaración. Conclusión: La intervención educativa y el uso de un tríptico ilustrativo sobre cuidados post-implante de dispositivos cardíacos implantables facilitó la explicación y facilitó la asimilación de conocimientos, siendo un recurso importante para los enfermeros que actúan en el área de cardiología

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Purpose: Clinically significant pocket hematoma (CSH) is a common complication to cardiac implantable electronic device (CIED) surgery. We aimed to evaluate predictors of CSH after CIED surgery. Methods: We performed a nationwide population-based prospective cohort study with systematic patient chart review of all Danish patients undergoing CIED surgery during a 12-month period. Multiple logistic regression analysis was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for association between predictors and CSH. Results: We included 5918 consecutive patients, 63% males, mean age 72.6 years. A total of 148 (2.5%) patients experienced CSH, including 10 patients (0.2%) requiring re-operation with hematoma evacuation. The risk of CSH was significantly increased in patients treated with aspirin (aOR 1.8; 1.2-2.7), aspirin and clopidogrel (aOR 3.9; 2.3-6.5), or heparin (aOR 2.1; 1.1-4.1), and in patients with INR≥2.0 (aOR 2.0; 1.2-3.2). Patients operated by low-volume operators (aOR 2.7; 1.6-4.6) or undergoing more complex CIED surgery such as cardiac resynchronization therapy (aOR 2.0; 1.1-3.5) or dual-chamber defibrillator (aOR 2.1; 1.2-3.8) also had significantly increased CSH risk. Conclusion: In a large nationwide cohort of consecutive patients undergoing CIED surgery, the risk of CSH was 2.5%, with 0.2% necessitating evacuation. CSH risk was increased both in patients receiving aspirin, dual antiplatelet therapy or continued vitamin K-antagonist therapy. Dual antiplatelet therapy had the highest risk (aOR) of CSH. Both low operator volume and more complex CIED surgery were independently associated with higher CSH risk. These data should be considered when planning CIED surgery.

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INTRODUCTION: Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. METHODS AND RESULTS: Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. CONCLUSION: This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.

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For many cardiologists in training, interrogation of implantable cardiac devices is the first step into the fascinating world of electrophysiology. A growing number of patients implanted with pacemakers, implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy devices (CRTs) fuels the need for a basic understanding of those devices by every cardiologist. This article is meant to address the most important theoretical points to facilitate an easy, quick but still comprehensive device interrogation in nine steps.

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Insertion of an epicardial pacemaker is a useful treatment for pediatric patients with an abnormal heart rhythm. However, there are limitations and concerns when implanting epicardial pacemakers in infants and neonates due to their small body size. We report a patient who experienced rare complications after implantation of a permanent pacemaker.

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The combination of magnetic resonance imaging (MRI) and active cardiac implants, such as pacemakers and implantable cardioverter defibrillators (ICD) has been a challenge for electrophysiologists and imaging for many years. Diagnostic and therapeutic possibilities on the one hand and technical hazards on the other hand highlight the need for improvements and algorithms that enable a safe approach to these challenges. The advent of so-called MRI conditional implants provides safe procedures for at least some of the patients with an implant and the need for MRI. Recently published data encourage clinicians not to completely excluded an imaging modality as promising as MRI in clinically urgent cases in the presence of conventional implants. The interdisciplinary consensus paper of the German Society of Cardiology and the German Society of Radiology provides recommendations for these situations. This review article discusses these recommendations and provides an overview of the most recent publications with a focus on the long-term course of device parameters.

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Traditionally, the presence of cardiac implanted electronic devices (CIEDs) was a contra-indication to magnetic resonance (MR) imaging. Professional groups from around the world are releasing updated guidelines for the imaging of MR-conditional and legacy CIEDs, reflecting increasing evidence that this can be performed safely when strict protocols are followed. KEY POINTS: • The presence of a pacemaker or automatic implanted cardioverter defibrillator is no longer an absolute contraindication to magnetic resonance imaging. • Strict protocols enable diagnostic quality images to be obtained with minimal risk. • Close collaboration among radiologists, cardiologists and device manufacturer representatives is required.

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ABSTRACT Objective: To verify the comprehension of the education handout and the level of Functional Health Literacy of individuals with cardiac pacemaker (PM) and whether there is correlation between the comprehension and Functional Health Literacy (FHL). Method: Cross-sectional study with 63 individuals with PM who answered to comprehension tests of the handout, literacy assessment (SAHLPA-50) and cognition (MMSE). Measurements of dispersion, Pearson correlation and multiple linear regression were calculated. Results: Most women, study time ≤ 9 years, 66.21 (average age) presented no cognitive changes. An adequate literacy level was evidenced in 50.8% individuals with PM and satisfactory comprehension of the handout. No correlation was identified between FHL, handout comprehension, age, years of study and cognition. Conclusion: The handout comprehension assessed by individuals with appropriate FHL indicated that it can be a printed material suitable for use, aiming to improve care process and knowledge of individuals with PM.

RESUMEN Objetivo: Verificar la comprensibilidad de prospecto de facilitación del aprendizaje y nivel de Instrucción Funcional en Salud de individuos con marcapasos cardíaco (MP), y la existencia de correlación entre comprensibilidad e Instrucción Funcional en Salud (IFS). Método: Estudio transversal, con 63 individuos con MP, que respondieron testes de comprensibilidad del prospecto, de evaluación de instrucción (SAHLPA-50) y cognición (MEEM). Se calcularon medidas de dispersión, correlación de Pearson y regresión lineal múltiple. Resultados: Mayoría de mujeres, escolarización ≤ 9 años, media etaria de 66,21 años, sin alteraciones cognitivas. Evidenciado nivel adecuado de instrucción en 50,8% de individuos con MP y comprensibilidad satisfactoria del prospecto. No se identificó correlación entre IFS, comprensibilidad del prospecto, escolarización y cognición. Conclusión: La comprensibilidad del prospecto evaluada por individuos con IFS adecuada indicó que resulta potencial impreso educativo utilizable, en pos de mejorar el proceso de cuidar y el conocimiento de los individuos con MP.

RESUMO Objetivo: Verificar a legibilidade de prospecto facilitador da aprendizagem e o nível de Letramento Funcional em Saúde de indivíduos com marcapasso cardíaco (MP) e se há correlação entre a legibilidade e Letramento Funcional em Saúde (LFS). Método: Estudo transversal com 63 indivíduos com MP, que responderam testes de legibilidade do prospecto, de avaliação do letramento (SAHLPA-50) e cognição (MEEM). Foram calculadas medidas de dispersão, correlação de Pearson e regressão linear múltipla. Resultados: Maioria mulheres, tempo de estudo ≤ 9 anos, idade média de 66,21 anos, sem alteração cognitiva. Evidenciado nível adequado de letramento em 50,8% dos indivíduos com MP e legibilidade satisfatória do prospecto. Não foi identificada correlação entre LFS, legibilidade do prospecto, idade, anos de estudo e cognição. Conclusão: A legibilidade do prospecto avaliada por indivíduos com adequado LFS indicou que pode ser um impresso educativo apropriado para uso, visando aprimorar o processo de cuidar e o conhecimento dos indivíduos com MP.

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Inadvertent endocardial placement of a pacing lead in the left ventricle through the aortic valve is a rare complication with an unknown incidence because of inadequate reporting. Reported cases are usually the result of lead insertion via the subclavian artery. A possible but very unusual situation is endocardial lead insertion in the left ventricle after aortic arch perforation. We report the case of a 72-year-old woman in whom a screw-in pacing lead accidentally perforated the aortic arch and continued its way through the ascending aorta, aortic valve and left ventricle, after insertion through the left subclavian vein. We describe how this complication was diagnosed, the predisposing factors, the risks it carries and the ways in which devastating consequences have so far been avoided, as the patient refused any surgical intervention including lead removal.

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Cardiac pacemakers, implantable cardioverter defibrillators (ICD) and systems for cardiac resynchronization therapy (CRT) represent an important component of heart failure therapy. Pacemakers only play a role in bradycardia-associated heart failure and require optimal programming to prevent ventricular desynchronization. Primary prophylactic ICD implantation is indicated in patients with a left ventricular ejection fraction of ≤ 35 %, clinical stages NYHA II-III and a life expectancy > 1 year. The CRT is indicated in patients with a left bundle branch block but only in individual cases for other QRS morphologies of < 150 ms duration. The combination of CRT with a pacemaker or defibrillator must be decided on an individual basis. Device therapy in heart failure should always include remote monitoring to detect events early and to implement treatment accordingly. New developments include quadripolar left ventricular leads and pacing from multiple sites simultaneously thus enabling better resynchronization. Stimulation for modulation of cardiac contractility and the autonomous nervous system are currently being clinically tested. The optimal utilization of device therapy improves the course of heart failure and prevents cardiac decompensation and fatalities.

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INTRODUCTION: Neonatal lupus syndrome (NLS) is a passively acquired autoimmune condition due to the transplacental passage of maternal anti-Ro/SSA and anti-La/SSB antibodies in mothers with systemic lupus erythematosus (SLE), and congenital complete heart block (CHB) is its most serious manifestation. Skin and hepatic involvement may occur in later infancy. CASE PRESENTATION: A term infant with fetal bradycardia, detected at the 23rd gestational age, was diagnosed with CHB due to NLS and was successfully treated with a permanent epicardial pacemaker. The patient was reported here due to rarity of the procedure in neonatal period. CONCLUSIONS: Mothers with SLE should be screened and closely followed up during pregnancy for the development of fetal atrioventricular (AV) block.

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A flexible single-crystalline PMN-PT piezoelectric energy harvester is demonstrated to achieve a self-powered artificial cardiac pacemaker. The energy-harvesting device generates a short-circuit current of 0.223 mA and an open-circuit voltage of 8.2 V, which are enough not only to meet the standard for charging commercial batteries but also for stimulating the heart without an external power source.

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A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.

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Introducción Se ha demostrado que la estimulación definitiva en el ápex del ventrículo derecho provoca disincronía ventricular izquierda y eventualmente deterioro contráctil y ello ha llevado a la búsqueda de otros sitios alternativos de estimulación. Las indicaciones y los resultados de la estimulación septal, así como las dificultades técnicas del implante, se encuentran actualmente en estudio. Objetivos Analizar la indicación, la factibilidad y el seguimiento en un grupo de pacientes con estimulación septal parahisiana. Material y métodos Se evaluaron 22 pacientes con edades entre 27 y 68 años, con complejo QRS angosto sin trastorno de conducción intraventricular, con indicación de marcapasos. Se utilizaron catéteres comunes para la aurícula con fijación activa y catéteres con vaina deflectable para la estimulación septal. Durante el implante y el seguimiento se midieron los umbrales y la amplitud de la onda R. Resultados Los umbrales durante el implante fueron menores de 2 voltios/0,50 mseg y la onda R mayor de 5 m V. El tiempo de implante promedio de los catéteres convencionales fue de 30 ± 10 min y el de los catéteres especiales, de 15 ± 5 min. El seguimiento promedio fue de 24 meses. Los umbrales crónicos fueron de 2,5 ± 1,5 voltios con una amplitud de onda R media de 5 ± 2 voltios. Hubo un desplazamiento durante el seguimiento. Conclusiones La estimulación septal parahisiana presentó un índice bajo de complicaciones. El uso de catéteres y vainas especiales redujo el tiempo de implante. La ubicación parahisiana se caracterizó por umbrales más altos y amplitud de la onda R menor que en la comunicada durante estimulación convencional. La estimulación septal parahisiana sería una alternativa válida para evitar la disincronía producida por la estimulación del ventrículo derecho en pacientes sin trastornos de la conducción intraventricular.

Background It has been demonstrated that permanent right ventricular apical pacing produces left ventricular dyssynchrony and decreases contractile function. For this reason other sites of stimulation have been explored. The indications, outcomes and technical difficulties of para-hisian pacing are currently under investigation. Objectives To analyze the indications, feasibility and follow-up in a group of patients undergoing para-hisian pacing. Material and Methods A total of 22 patients between 27 and 68 years with indication of permanent pacing, narrow QRS complexes and preserved intraventricular conduction were evaluated. Activefixation atrial leads and ventricular leads with a deflectable sheath for parahisian stimulation were used. Pacing thresholds and R-wave amplitude were measured during implantation and follow-up. Results During implantation, pacing thresholds were <2 V/0.50 ms and R-wave amplitude was >5 m V. The average duration of placement of conventional leads and special leads were 30±10 min and 15±5 min, respectively. Mean follow-up was 24 months. Chronic thresholds were 2.5±1.5 Volts, and mean R-wave amplitude was 5±2 Volts. One lead displacement was reported during follow-up. Conclusions Para-hisian pacing presented a low rate of complications. The use of special leads and sheaths reduced the implantation time. Compared to conventional pacing, para-hisian pacing presented higher thresholds and lower R-wave amplitude. Para-hisian pacing would be a valid option to avoid ventricular dyssynchrony related to right ventricular pacing in patients with preserved intraventricular conduction.

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Objetivo - Avaliar o uso de marcapasso antitaquicardia em portadores de taquicardia supraventricular paroxística refratária à farmacoterapia. Casuística e Métodos - Oito casos com implante em posiçäo atrial e um em ventricular. As idades variaram de 32 a 63 anos e a duraçäo dos sintomas de 2 a mais de 40 anos. O tratamento com até seis drogas antiarrítmicas foi ineficaz em todos os casos; a freqüência de crises variou de mensal até 3 vezes ao dia. Quatro pacientes necessitaram cardioversäo das taquicardias, demonstrando em estudo eletrofisiológico, foi a reentrada nodal atrioventricular (AV) em 6 casos e a reentrada AV por via acessória AV em 4 (em 1 paciente contribuíram ambos mecanismos). O acompanhamento pós-implante variou de 2 a 18 meses. Resultados - Todos os pacientes experimentaram significativa melhora. Dois episódios näo interrompidos ocorreram em 2 pacientes; foi observada, em um deles, taquicardia supra ventricular paroxística induzida pelo marcapasso, como conseqüência de taquicardia sinusal. Estes eventos foram resolvidos pela reprogramaçäo. O tratamento farmacológico foi suspenso em 7 pacientes. Conclusäo - A utilizaçäo de marcapasso antitaquicardia demonstrou ser efetiva no tratamento da taquicardia supraventricular paroxística, refratária à farmacoterapia

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