RESUMO
The efficacy and safety of intravenous propafenone for conversion of recent-onset and chronic atrial fibrillation was assessed in 46 patients. 40 with atrial fibrillation associated with or without structural heart disease (mean age 63 +/- 14 years) and 6 patients with atrial fibrillation related to the Wolff-Parkinson-White syndrome (mean age 34.8 +/- 13 years). Propafenone treatment was administered at 2 mg/kg over 15 minutes under continuous electrocardiographic monitoring. In 28 of 32 (87.5%) patients with paroxysmal and/or recent-onset atrial fibrillation a stable sinus rhythm was restored within 1 hour after propafenone (mean 17 +/- 11 minutes) and in only 3 of 8 (37.5%) with chronic atrial fibrillation (p < 0.05). Conversion to sinus rhythm was obtained in 5 of 6 (83.3%) patients with atrial fibrillation related ventricular preexcitation, mean time 21 +/- 12 minutes. Propafenone had an additional effect reducing mean heart rate (141 +/- 21 to 102 +/- 15 beat per minute, p < 0.05) and the shortest preexcited R-R intervals was increased, mean 231.6 +/- 27.8 to 355 +/- 37.2 milliseconds (p < 0.001) in cases associated with ventricular preexcitation. Dizziness, hypotension and transient conduction disturbances occurred in only one patient with rheumatic valvular heart disease: EF 40%. Propafenone is an effective and safe antiarrhythmic drug for converting paroxysmal and/or recent-onset atrial fibrillation of various origins with a more limited efficacy in chronic atrial fibrillation.
Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Propafenona/administração & dosagem , Idoso , Fibrilação Atrial/complicações , Interpretação Estatística de Dados , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/complicaçõesRESUMO
This article reports the clinical and angiographic aspects of three patients with congenital coronary arteriovenous fistula to the main pulmonary artery, which manifested as dyspnea crisis and angina. This three cases were found in the course of 4,400 consecutive cardiac catheterization procedures to study coronary artery disease. The interest of the cases reported is based on the peculiar anatomy of the fistula. Prompt diagnosis is relevant for better prognosis and treatment.
Assuntos
Fístula Artério-Arterial/complicações , Aneurisma Coronário/complicações , Isquemia Miocárdica/etiologia , Artéria Pulmonar , Fístula Artério-Arterial/diagnóstico por imagem , Aneurisma Coronário/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Radiografia , Estudos RetrospectivosRESUMO
The use of antibiotics in patients who undergo cardiac catheterization, by percutaneous approach, using re-sterilized catheters, is controversial, and there is not clear information in this regard. We investigated the frequency of bacteremia during cardiac catheterization and the evidence of later infection, using re-sterilized material. We studied 227 consecutive patients over one year, and we obtained 200 blood cultures of the beginning and the end of the procedure. All the cultures were negative and there was not evidence of clinical infection in the year following the study. These results indicated that bacteremia is rare during cardiac catheterization, if aseptic technics are followed. Based on these result we do not recommend the use of antibiotics in patients undergoing cardiac catheterization. The sex, age, type of heart disease and re-sterilized material do not alter this recommendation.