7 research outputs found
Clinical outcome of patients with the Brugada type 1 electrocardiogram without prophylactic implantable cardioverter defibrillator in primary prevention: a cumulative analysis of seven large prospective studies.
Risk stratification in individuals with the Brugadatype 1 ECG pattern without previous cardiacarrest: usefulness of a combined clinical andelectrophysiologic approach.
Event rates and risk factors in patients with Brugada syndrome and no prior cardiac arrest: A cumulative analysis of the largest available studies distinguishing ICD-recorded fast ventricular arrhythmias and sudden death
BackgroundAll available studies that have addressed the issue of risk stratification in patients with type 1 Brugada electrocardiographic (ECG) pattern have considered a combined end point constituted by implantable cardioverter-defibrillator–recorded fast ventricular arrhythmias (ICD-FVA) and sudden death (SD) in patients without ICD.ObjectiveAs ICD-FVA are only a surrogate of SD, we tried to focus on the prognostic value of classical risk factors by separating patients with ICD-FVA from those without ICD who suffered SD.MethodsWe made a cumulative analysis of the largest available studies. Studies were selected in which the incidence of FVA and SD could be determined in patients with and without ICD separately. In addition, we tried to analyze the prognostic value of risk factors in patients with and without ICD separately.ResultsA total of 2176 patients were recruited from 5 studies, about one-third of whom had an ICD and two-thirds did not. Event rates per 1000 patient-years of follow-up were 31.3 (25–39) and 6.5 (4–10) in patients with and without ICD, respectively (P < .001). When considering FVA in patients with ICD, each single risk factor (spontaneous type 1 ECG pattern, familial juvenile SD, and +EPS) displayed limited clinical value, mainly owing to its low specificity (21%–61%) and low positive predictive value (9%–15%).ConclusionsIn patients with type 1 Brugada ECG pattern, most arrhythmic events occur in patients with an ICD while SD is rare in patients without an ICD. While we have an acceptable ability to predict ICD-FVA, we have insufficient data to predict SD
Management of Pacemaker Implantation during COVID-19 Infection
The management of device implantation during the COVID-19 infection has not well defined yet. This is the first case of complete atrioventricular block in a symptomatic patient affected by the COVID-19 infection treated with early pacemaker implantation to minimize the risk of virus contagion
Cardiac arrest and Brugada syndrome: Is drug-induced type 1 ECG pattern always a marker of low risk?
Adherence to guidelines for atrial fibrillation management of patients referred to cardiology departments: Studio Italiano multicentrico sul trattamento della fibrillazione atriale (STAF)
Aims The purpose of this study was to evaluate adherence to national guidelines on the non-pharmacologic (ablative) treatment
of atrial fibrillation (AF).
Methods
and results
This prospective, observational, transversal study enrolled 1256 consecutive in- and outpatients referred to 43 cardiology
departments between 1 and 31 October 2008 for the management of AF as a primary diagnosis. A rhythmcontrol
strategy (cardioversion, antiarrhythmic medication, pace-maker implantation, substrate ablation, alone or in
combination) was prescribed in 865 (69%) of the patients and a rate-control strategy [drugs, atrioventricular junction
ablation and pace-maker implantation (Ablate and Pace)] in 285 (23%). Specifically, substrate catheter ablation was
indicated by the attending cardiologist in 187 (14.9%) patients and Ablate and Pace in 29 (2.3%). According to guideline
indications, substrate catheter ablation would have been indicated in 183 (14.6%) patients, but only 105 (57%) of
these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.49). Atrioventricular
junction ablation and pace-maker implantation would have been indicated in 108 (8.6%) patients, but only
29 (27%) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications
0.06).
Conclusion About a quarter of patients referred to cardiology departments for AF management have potential indications for
non-pharmacological treatment according to the guidelines. Substrate catheter ablation was offered by the attending
cardiologist in a percentage similar to that expected, but concordance with guideline indications was moderate. Atrioventricular
junction ablation and pace-maker implantation was largely underused