2 research outputs found
Ventricle Dyssynchrony in Right Ventricle Apex and Right Ventricle Outflow Tract Pacing: Evaluation by Tissue Doppler Imaging
Background : Pacemaker lead implantation at right ventricular apex (RVA) or right ventricular outflow tract (RVOT) have different haemodynamic consecuences, due to ventricular dyssynchrony difference. Tissue Dop-pler Imaging (TDI) clearly shown ventricle dyssynchrony, this modality is better than convensional echo. This research was performed using TDI to describe ventricle dyssynchrony in RVA and RVOT pacing.
Method and Result: Twenty four patients with VVI/VVIR pacemaker in-serted at the Catheterization Laboratory National Cardiac Centre Harapan Kita Hospital were evaluated using TDI modality for ventricle dyssynchrony. Subject characteristic consist of 13 men (54,8%) and 11 (45,8%) women, with average of age were 61,38 12,41 years. Base rhythm were Sick Sinus Syndrome/SSS (37,5%) and Total Atrioventricular Block/TAVB (62,5%). The duration of implantation was 24,83 16,88 months, with minimal duration of pacing 1 month and maximal duration 63 months. The average of ventricular ejection fraction was 0,450,15. Chi Square ana-lyze have shown that there were no difference dyssynchrony between RVA and RVOT pacing, p=0,408 for inter ventricular delay and p=0,423. for intra ventricular delay. QRS duration after pacing have shown signifi-cant difference between the two groups (p=0.01).
Conclusion : There were no difference in ventricular dyssynchrony be-tween RVA and RVOT pacing, but QRS duration at the RVOT pacing is significantly shorter than RVA pacing
Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry
Objective: We studied the characteristics of patients
with ST segment elevation myocardial infarction
(STEMI) after expansion of a STEMI registry as part of
the STEMI network programme in a metropolitan city
and the surrounding area covering ∼26 million
inhabitants.
Design: Retrospective cohort study.
Setting: Emergency department of 56 health centres.
Participants: 3015 patients with acute coronary
syndrome, of which 1024 patients had STEMI.
Main outcome measure: Characteristics of
reperfusion therapy.
Results: The majority of patients with STEMI (81%;
N=826) were admitted to six academic percutaneous
coronary intervention (PCI) centres. PCI centres
received patients predominantly (56%; N=514) from a
transfer process. The proportion of patients receiving
acute reperfusion therapy was higher than nonreperfused
patients (54% vs 46%, p<0.001), and
primary PCI was the most common method of
reperfusion (86%). The mean door-to-device (DTD)
time was 102±68 min. In-hospital mortality of nonreperfused
patients was higher than patients receiving
primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs
3.8%, p<0.001). Compared with non-academic PCI
centres, patients with STEMI admitted to academic PCI
centres who underwent primary PCI had shorter mean
DTD time (96±44 min vs 140±151 min, p<0.001),
higher use of manual thrombectomy (60.2% vs13.8%,
p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intraaortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%,
respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to doorout (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions: In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres.
Trial registration number: NCT02319473