1,721,179 research outputs found
Aritimie cardiache, morte cardiaca improvvisa, sincope
No full textDefinizione e trattamento delle aritmi
Letter regarding article by Bokhari et al, "Long-term comparison of the implantable cardioverter defibrillator versus amiodarone: eleven-year follow-up of a subset of patients in the Canadian Implantable Defibrillator Study (CIDS)"
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Uneventful right ventricular perforation with displacement of a pacing lead into the left thorax.
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Reply to reader's comment: "Electrocardiographic optimization of cardiac resynchronization devices: simple, but not so simple!" by Mont et al
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Heart failure after myocardial revascularization: Risk markers
No full textWe investigated the prognostic weight of several risk factors for heart failure
in patients undergoing CABG. We followed 351 consecutive patients for 18+/-12
months after surgery to assess clinical outcome, presence and degree of heart
failure. The risk of developing heart failure >class 2 at 1 year was
investigated by logistic regression on the following preoperative variables:
sex, age, left ventricular EF, QRS duration, previous MI, history of heart
failure, atrial fibrillation (AF), hypertension, hypercholesterolemia, diabetes,
previous stroke. Age was 70+/-8 years and EF was 54+/-12% at the time of
surgery. Heart failure >class 2 occurred in 95/351 patients (27%) at follow up.
Logistic regression identified QRS duration (OR=1.02), a history of stroke
(OR=3.94), and diabetes (OR=1.98) as predictors of CHF at follow up. All the
other variables were not risk markers for heart failure at logistic regression.
Thirty five patients (10%) had QRS>/=140 ms before surgery; 51% of them had CHF
at follow up compared to 24% of patients with QRS<140 ms (p<0.05). In the
current surgical era, candidates to CABG (50% of patients older than 70 years)
have a relevant likelihood of heart failure at follow up, despite myocardial
revascularization. Risk stratification may rely upon inexpensive variables as
previous stroke, diabetes, and QRS duration. A minority of patients (5%) could
benefit from LV-based pacing, which should be considered at the same surgical
time via an epicardial implantation
Pharmacological cardioversion of atrial fibrillation: current management and treatment options.
No full textAtrial fibrillation (AF) is the most common form of arrhythmia, carrying high social costs. It is usually first seen by general practitioners or in emergency departments. Despite the availability of consensus guidelines, considerable variations exist in treatment practice, especially outside specialised cardiological settings. Cardioversion to sinus rhythm aims to: (i) restore the atrial contribution to ventricular filling/output; (ii) regularise ventricular rate; and (iii) interrupt atrial remodelling. Cardioversion always requires careful assessment of potential proarrhythmic and thromboembolic risks, and this translates into the need to personalise treatment decisions. Among the many clinical variables that affect strategy selection, time from onset is crucial. In selected patients, pharmacological cardioversion of recent-onset AF can be a safely used, feasible and effective approach, even in internal medicine and emergency departments. In most cases of recent-onset AF, pharmacological cardioversion provides an important--and probably more cost effective--alternative to electrical cardioversion, which can then be employed as a second-line therapy for nonresponders. Class IC agents (flecainide or propafenone), which can be safely used in hospitalised patients with recent-onset AF without left ventricular dysfunction, can provide rapid conversion to sinus rhythm after either intravenous administration or oral loading. Although intravenous amiodarone requires longer conversion times, it is still the standard treatment for patients with heart failure. Ibutilide also provides good conversion rates and could be used for AF patients with left ventricular dysfunction (were it not for high costs). For long-lasting AF most pharmacological treatments have only limited efficacy and electrical cardioversion remains the gold standard in this setting. However, a widely used strategy involves pretreatment with amiodarone in the weeks before planned electrical cardioversion: this provides optimal prophylaxis and can sometimes even restore sinus rhythm. Dofetilide may also be capable of restoring sinus rhythm in up to 25-30% of patients and can be used in patients with heart failure. The potential risk of proarrhythmia increases the need for careful therapeutic decision making and management of pharmacological cardioversion. The results of recent trials (AFFIRM [Atrial Fibrillation Follow-up Investigation of Rhythm Management] and RACE [Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation]) on rate versus rhythm control strategies in the long term have led to a generalised shift in interest towards rate control. Although carefully designed studies are required to better define the role of pharmacological rhythm control in specific AF settings, this alternative option remains a recommendable strategy for many patients, especially those in acute care
Performance of seven ECG interpretation programs in identifying arrhythmia and acute cardiovascular syndrome
Full text linkBackground: No direct comparison of current electrocardiogram (ECG) interpretation programs exists. Objective: Assess the accuracy of ECG interpretation programs in detecting abnormal rhythms and flagging for priority review records with alterations secondary to acute coronary syndrome (ACS). Methods: More than 2,000 digital ECGs from hospitals and databases in Europe, USA, and Australia, were obtained from consecutive adult and pediatric patients and converted to 10 s analog samples that were replayed on seven electrocardiographs and classified by the manufacturers' interpretation programs. We assessed ability to distinguish sinus rhythm from non-sinus rhythm, identify atrial fibrillation/flutter and other abnormal rhythms, and accuracy in flagging results for priority review. If all seven programs' interpretation statements did not agree, cases were reviewed by experienced cardiologists. Results: All programs could distinguish well between sinus and non-sinus rhythms and could identify atrial fibrillation/flutter or other abnormal rhythms. However, false-positive rates varied from 2.1% to 5.5% for non-sinus rhythm, from 0.7% to 4.4% for atrial fibrillation/flutter, and from 1.5% to 3.0% for other abnormal rhythms. False-negative rates varied from 12.0% to 7.5%, 9.9% to 2.7%, and 55.9% to 30.5%, respectively. Flagging of ACS varied by a factor of 2.5 between programs. Physicians flagged more ECGs for prompt review, but also showed variance of around a factor of 2. False-negative values differed between programs by a factor of 2 but was high for all (>50%). Agreement between programs and majority reviewer decisions was 46–62%. Conclusions: Automatic interpretations of rhythms and ACS differ between programs. Healthcare institutions should not rely on ECG software “critical result” flags alone to decide the ACS workflow
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