47 research outputs found
Remote Monitoring of Implantable Pacemaker, Cardioverter Defibrillator, and Cardiac Resynchronizer
Acute and long-term success of ventricular tachycardia ablation in patients with ischemic heart disease in a Mexican center
Objective. To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. Materials and methods. We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. Results. Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66–6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08–5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06–5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34–6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR0.29, IC95% 0.12–0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48–0.86, p=0.013) were protective factors. Conclusions. Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it.Objective. To report the results of ventricular tachycardia (VT) catheter ablation in ischemic heart disease (IHD), and to identify risk factors associated with recurrence in a Mexican center. Materials and methods. We made a retrospective review of the cases of VT ablation performed in our center from 2015 to 2022. We analyzed the characteristics of the patients and those of the procedures separately and we determined factors associated with recurrence. Results. Fifty procedures were performed in 38 patients (84% male; mean age 58.1 years). Acute success rate was 82%, with a 28% of recurrences. Female sex (OR 3.33, IC 95% 1.66–6.68, p=0.006), atrial fibrillation (OR 3.5, IC 95% 2.08–5.9, p=0.012), electrical storm (OR 2.4, IC 95% 1.06–5.41, p=0.045), functional class greater than II (OR 2.86, IC 95% 1.34–6.10, p=0.018) were risk factors for recurrence and the presence of clinical VT at the time of ablation (OR0.29, IC95% 0.12–0.70, p=0.004) and the use of more than 2 techniques for mapping (OR 0.64, IC 95% 0.48–0.86, p=0.013) were protective factors. Conclusions. Ablation of ventricular tachycardia in ischemic heart disease has had good results in our center. The recurrence is similar to that reported by other authors and there are some factors associated with it
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Trastornos del ritmo y de la conducción en pacientes operados de corrección total de tetralogía de Fallot
La tetralogía de Fallot es la cardiopatía congénita cianógena más común en la infancia. La reparación quirúrgica correctiva se ha utilizado por más de 40 años con excelentes resultados. Sin embargo, se ha reportado que las arritmias ventriculares malignas y la muerte súbita son las causas más frecuentes de mortalidad tardía después de la cirugía. Se ha utilizado el estudio electrofisiológico en pacientes seleccionados, pero su valor predictivo positivo aún es limitado a un pequeño grupo de pacientes. Los métodos exitosos de prevención de las arritmias ventriculares (la ablación y el desfibrilador ventricular implantable) en pacientes con alto riesgo han sido de mucha utilidad en estos enfermos
La anomalía de Ebstein asociada al síndrome de Wolff-Parkinson-White
La anomalía de Ebstein es un trastorno poco común del desarrollo, que ocurre en menos del 1% de todas las malformaciones congénitas. Según algunos autores, el síndrome de Wolff-Parkinson-White (WPW) se asocia a la anomalía de Ebstein hasta en un 20-30% de los casos. La conexión aurícula-ventrículo a través de haces anómalos, en este grupo de enfermos, se localiza fundamentalmente en el anillo auriculoventricular derecho, dando la imagen electrocardiográfica de WPW tipo B. Una de nuestras finalidades principales fue la de localizar, por medio del electrocardiograma de superficie estas zonas de preexcitación tanto en porciones posteriores o posteroseptales (56%), laterales (38%) y anteriores (3%). La ausencia de BRD-HH en pacientes con anomalía de Ebstein y taquicardias supraventriculares recurrentes tiene 98% de sensibilidad y 92% de especificidad para el diagnóstico de síndrome de Wolff-Parkinson-White asociado. Concluimos que un 30% de los pacientes con anomalía de Ebstein y taquicardias supraventriculares tiene un ECG con ausencia o mínimo grado de preexcitación. En este grupo de enfermos la ausencia de BRDHH es altamente sugestivo de la presencia de una vía accesoria tipo Kent ipsilateral al sitio del bloqueo
Genética en los Síndromes de QT prolongado
El síndrome de QT largo (SQTL) es un trastorno genético que se caracteriza por prolongación del intervalo QT en el electrocardiograma (ECG) y propensión a la taquicardia ventricular polimorfa "torsades de pointes", la que con frecuencia origina síncope, falla cardiaca o muerte súbita, por lo general en individuos jóvenes y sanos. El síndrome de QT largo es causado por mutaciones de los genes de los canales iónicos de potasio y de sodio o de las proteínas relacionadas con esos canales, lo que produce una sobrecarga positiva de la célula del miocardio con la consecuente prolongación heterogénea de la repolarización en varias capas y regiones del miocardio. Estas condiciones facilitan posdespolarizaciones tempranas y fenómenos de reentrada, que de forma subyacente desarrollan la taquicardia ventricular polimorfa observada en estos pacientes. La historia clínica detallada con respecto a eventos cardiacos en el paciente y miembros de su familia en combinación con la interpretación cuidadosa del ECG de 12 derivaciones (con la medición del intervalo QT en todos los ECG disponibles y la evaluación morfológica de la onda T) son suficientes para diagnosticar el síndrome. El SQTL presenta gran heterogeneidad genética y se han identificado ya más de 500 mutaciones distribuidas hasta ahora en 10 genes: KCNQ-1, HERG, SCN-5A, KCNE-1, KCNE-2, ANKB, KCNJ-2, CACNA-1, CAV-3 y SCN-4B. A pesar de los avances en la materia, aún 25% a 30% de los pacientes permanece sin diagnóstico genético. Los estudios de genética juegan un papel importante y son útiles en casos con resultados no diagnósticos o de ECG limítrofes
La resincronización biventricular en el tratamiento coadyuvante de la insuficiencia cardíaca
La insuficiencia cardíaca crónica (ICC) causada por disfunción sistólica es una enfermedad de proporciones epidémicas. Aunque el tratamiento médico disminuye los síntomas y ha mejorado la sobrevida de estos enfermos, este síndrome crónico sigue siendo una enfermedad progresiva, causando una morbilidad elevada con alta mortalidad. Estudios preliminares han demostrado que la resincronización ventricular mejora significativamente la tolerancia al ejercicio y la calidad de vida de los pacientes con ICC quienes se encuentran en ritmo sinusal y trastornos de la conducción intraventricular. La terapia de resincronización cardíaca requiere la estimulación simultánea de ambos ventrículos en sincronía con la actividad auricular. La estimulación atriobiventricular mejora significativamente los síntomas, la tolerancia al ejercicio y la calidad de vida. El uso de este procedimiento debe ser individualizado. No obstante, se requieren más estudios para evaluar los efectos clínicos a largo plazo de esta nueva modalidad terapéutica
Genetic in long QT syndromes
The long QT syndrome (LQTS) is a genetic disorder characterized by prolongation of the QT interval in the electrocardiogram (ECG) and a propensity to "torsades de pointes" ventricular tachycardia frequently leading to syncope, cardiac arrest, or sudden death usually in young otherwise healthy individuals. LQTS caused by mutations of predominantly potassium and sodium ion channel genes or channel-interacting proteins leading to positive overcharge of myocardial cell with consequent heterogeneous prolongation of repolarization in various layers and regions of myocardium. These conditions facilitate the early after-depolarization and reentry phenomena underlying development of polymorphic ventricular tachycardia observed in patients with LQTS. Obtaining detailed patient history regarding cardiac events in the patient and his/her family members combined with careful interpretation of standard 12-lead ECG (with precise measurement of QT interval in all available ECGs and evaluation of T-wave morphology) usually is sufficient to diagnose the syndrome. The LQTS show great genetic heterogeneity and has been identified more than 500 mutations distributed in 10 genes: KCNQ1, HERG, SCN5A, KCNE1, KCNE2, ANKB, KCNJ2, CACNA1A, CAV3 and SCN4B. Despite advances in the field, 25-30% of patients remain undiagnosed genetic. Genetic testing plays an important role and is particularly useful in cases with nondiagnostic or borderline ECG findings
Contributions of the Instituto Nacional de Cardiología in the diagnosis and treatment of the Wolff-Parkinson-White syndrome
Since the first description of the disease now known as Wolff-Parkinson-White syndrome, much knowledge has been gained through several experimental and clinical studies all over the world. The Instituto Nacional de Cardiología Ignacio Chávez in Mexco City has not been the exception. In this report, we describe the clinical, electrocardiographic and electrophysiologic contributions of past and present researchers at the Institute, as well as the experience in the diagnosis and treatment of the W-P-W syndrome at this Instituto Nacional de Cardiología Ignacio Chávez