Aspectos Epidemiológicos, Etiologia e Classificaçao da Fibrilaçao Atrial

A fibrilaçao atrial (FA) é a arritmia sustentada mais freqüente. Sua prevalência é rara antes dos 40 anos, mas, aumenta progressivamente a partir desta idade. Como a proporçao de idosos está crescendo, a sua ocorrência será cada vez mais freqüente. O seu aparecimento está relacionado a aumento de duas vezes na mortalidade e de 5 vezes nos acidentes vasculares cerebrais. As causas mais freqüentes sao a cardiopatia hipertensiva, a insuficiência cardíaca, as valvopatias mitrais e a insuficiência coronariana. Outras causas sao a tireotoxicose, doenças pulmonares obstrutivas, distúrbios eletrolíticos, stress, álcool, cardiomiopatia hipertrófica, Wolf-Parkinson-White, valvopatia aórtica, cardiopatia chagásica, doença do nó sinusal etc. Cerca de 15 a 30% nao apresentam causas definidas (FA isolada). Nao existe uma classificaçao consensual para a FA. De acordo com o tempo de evoluçao, a FA pode se

Aspectos Epidemiológicos, Etiologia e Classificaçao da Fibrilaçao Atrial

A fibrilaçao atrial (FA) é a arritmia sustentada mais freqüente. Sua prevalência é rara antes dos 40 anos, mas, aumenta progressivamente a partir desta idade. Como a proporçao de idosos está crescendo, a sua ocorrência será cada vez mais freqüente. O seu aparecimento está relacionado a aumento de duas vezes na mortalidade e de 5 vezes nos acidentes vasculares cerebrais. As causas mais freqüentes sao a cardiopatia hipertensiva, a insuficiência cardíaca, as valvopatias mitrais e a insuficiência coronariana. Outras causas sao a tireotoxicose, doenças pulmonares obstrutivas, distúrbios eletrolíticos, stress, álcool, cardiomiopatia hipertrófica, Wolf-Parkinson-White, valvopatia aórtica, cardiopatia chagásica, doença do nó sinusal etc. Cerca de 15 a 30% nao apresentam causas definidas (FA isolada). Nao existe uma classificaçao consensual para a FA. De acordo com o tempo de evoluçao, a FA pode se

A CONVENÇÃO DA ONU DE 2006 PARA AS PESSOAS COM DEFICIENCIA: A UNIVERSALIZACÃO DO CONCEITO DE DEFICIÊNCIA SOB A ÓTICA DOS DIREITOS HUMANOS

O presente artigo buscou identificar o motivo pelo qual foi necessário aprovar uma Convenção específica, no âmbito da ONU, destinada à proteção dos direitos das pessoas com deficiência sob a ótica dos direitos humanos, bem como verificar qual o enfoque acerca do conceito de deficiência foi dado pelo seu texto. A metodologia utilizada foi a revisão bibliográfica e a análise documental. Como resultado, estabeleceu que a aprovação da Convenção Internacional sobre os Direitos das Pessoas com Deficiência justifica-se pela inexistência de um documento internacional vinculante, no âmbito da ONU, que fosse destinado à proteção dos direitos das pessoas com deficiência

OS PARADIGMAS ACERCA DOS DIREITOS DAS PESSOAS COM DEFICIÊNCIA: PARA ALÉM DA DISTINÇÃO ENTRE EXCLUSÃO E INCLUSÃO.

O artigo abordou os diferentes paradigmas acerca dos direitos das pessoas com deficiência, adotados pela legislação internacional e nacional. A metodologia utilizada foi análise documental e revisão bibliográfica. Nesse contexto, verificou-se que o paradigma da integração toma por base a ideia de que são as pessoas com deficiência que devem adaptar-se aos sistemas sociais comuns, ao passo que o paradigma da inclusão pressupõe que a sociedade deve passar por adaptações. Conclui-se que nem mesmo a inclusão afastar-se-ia da tendência de reproduzir a desigualdade enraizada nos países periféricos, o que justifica avançar para além da distinção clássica entre exclusão e inclusão

Ablaçao e mapeamento eletroanatômico na displasia arritmogênica ventricular direita

Alteraçoes estruturais provenientes da displasia arritmogênica ventricular direita criam um importante substrato para focos de taquicardias ventriculares por reentrada. Pacientes com alto risco de desenvolverem essas arritmias sao submetidos a tratamento farmacológico associado ao uso de cardiodesfibriladores implantáveis. Porém, em casos mais complexos e refratários, nos quais as terapias adequadas pelo cardiodesfibrilador implantável sao frequentes, uma nova estratégia se fez necessária, visando à diminuiçao da morbidade desse subgrupo de pacientes. Estudos recentes demonstram que o mapeamento eletroanatômico associado a ablaçoes por radiofrequência endocárdica e epicárdica foi eficaz nesse tratamento adjuvante, diminuindo o número de recorrências das taquicardias ventriculares

Ablaçao e mapeamento eletroanatômico na displasia arritmogênica ventricular direita

Alteraçoes estruturais provenientes da displasia arritmogênica ventricular direita criam um importante substrato para focos de taquicardias ventriculares por reentrada. Pacientes com alto risco de desenvolverem essas arritmias sao submetidos a tratamento farmacológico associado ao uso de cardiodesfibriladores implantáveis. Porém, em casos mais complexos e refratários, nos quais as terapias adequadas pelo cardiodesfibrilador implantável sao frequentes, uma nova estratégia se fez necessária, visando à diminuiçao da morbidade desse subgrupo de pacientes. Estudos recentes demonstram que o mapeamento eletroanatômico associado a ablaçoes por radiofrequência endocárdica e epicárdica foi eficaz nesse tratamento adjuvante, diminuindo o número de recorrências das taquicardias ventriculares

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Comunicación inalámbrica basada en tecnología Bluetooth para la automatización de procesos industriales

Este artículo presenta básicamente la implementación de un sistema de comunicación inalámbrica a través de la configuración de un PC, PLC y SCADA, mediante la tecnología Bluetooth. La aplicación se realizó por el adaptador industrial PARANISD1000 y el PLC OMRON-CQM1H, CPU 51, acoplado a la interface hombre-máquina “Intouch”. El sistema de control y supervisión se acondicionó a partir de un proceso simulado, lo cual permitió validar la comunicación inalámbrica a través del tiempo de respuesta o latencia y estabilidad. Este tipo de aplicación abre un gran rango de posibilidades para ser implementado en diferentes campos de la automatización industrial

Acute and chronic effects of epicardial radiofrequency applications delivered on epicardial coronary arteries

Epicardial coronary injury is by far the most feared complication of epicardial ablation. Little information is available regarding the chronic effects of delivering radiofrequency in the vicinity of large coronary vessels, and the long-term impact of this approach for mapping and ablation on epicardial vessel integrity is poorly understood. Therefore, the aim of this study was to characterize the acute and chronic histopathologic changes produced by in vivo epicardial pulses of radiofrequency ablation on coronary artery of porcine hearts. Seven pigs underwent a left thoracotomy. The catheter was sutured adjacent to the left anterior descending artery and left circumflex artery, and 20 pulses of radiofrequency energy were applied. Radiofrequency lesions located no more than 1 mm of the vessel were used for this analysis. Three animals were euthanized 20 days (acute phase) after the procedure and 4 animals after 70 days (chronic phase). The following parameters were obtained in each vessel analyzed: (1) internal and external perimeter; (2) vessel wall thickness; (3) tunica media thickness, and (4) tunica intima thickness. The presence of adipose tissue around the coronary arteries, the distance between the artery and the epicardium, and the anatomic relationship of the artery with the coronary vein was also documented for each section. Sixteen of 20 (80%) sections analyzed, showed intimal thickening with a mean of 0.18 ± 0.14 mm compared with 0.13 ± 0.16 mm in the acute phase (P = 0.331). The mean tunica media thickness was 0.25 ± 0.10 mm in the chronic phase animals compared with 0.18 ± 0.03 mm in the acute phase animals (P = 0.021). A clear protective effect of pericardial fat and coronary veins was also present. A positive correlation between depth of radiofrequency lesion and the degree of vessel injury expressed as intimal and media thickening (P = 0.001) was present. A negative correlation was identified (r = -0.83; P = 0.002) between intimal thickening and distance between epicardium and coronary artery. In this porcine model of in vivo epicardial radiofrequency ablation in proximity to coronary arteries leads to acute and chronic histopathologic changes characterized by tunica intima and media thickening, with replacement of smooth muscle cells with extracellular matrix, but no significant stenosis was observed up to 70 days after the ablation. The absence of acute coronary occlusion or injury does not preclude subsequent significant arterial damage, which frequently occurs when epicardial radiofrequency applications are delivered in close vicinity to the vessels

Acute and Chronic Effects of Epicardial Radiofrequency Applications Delivered on Epicardial Coronary Arteries

Background-Epicardial coronary injury is by far the most feared complication of epicardial ablation. Little information is available regarding the chronic effects of delivering radiofrequency in the vicinity of large coronary vessels, and the long-term impact of this approach for mapping and ablation on epicardial vessel integrity is poorly understood. Therefore, the aim of this study was to characterize the acute and chronic histopathologic changes produced by in vivo epicardial pulses of radiofrequency ablation on coronary artery of porcine hearts. Methods and Results-Seven pigs underwent a left thoracotomy. The catheter was sutured adjacent to the left anterior descending artery and left circumflex artery, and 20 pulses of radiofrequency energy were applied. Radiofrequency lesions located no more than 1 mm of the vessel were used for this analysis. Three animals were euthanized 20 days (acute phase) after the procedure and 4 animals after 70 days (chronic phase). The following parameters were obtained in each vessel analyzed: (1) internal and external perimeter; (2) vessel wall thickness; (3) tunica media thickness, and (4) tunica intima thickness. The presence of adipose tissue around the coronary arteries, the distance between the artery and the epicardium, and the anatomic relationship of the artery with the coronary vein was also documented for each section. Sixteen of 20 (80%) sections analyzed, showed intimal thickening with a mean of 0.18 +/- 0.14 mm compared with 0.13 +/- 0.16 mm in the acute phase (P=0.331). The mean tunica media thickness was 0.25 +/- 0.10 mm in the chronic phase animals compared with 0.18 +/- 0.03 mm in the acute phase animals (P=0.021). A clear protective effect of pericardial fat and coronary veins was also present. A positive correlation between depth of radiofrequency lesion and the degree of vessel injury expressed as intimal and media thickening (P=0.001) was present. A negative correlation was identified (r = -0.83; P=0.002) between intimal thickening and distance between epicardium and coronary artery. Conclusions-In this porcine model of in vivo epicardial radiofrequency ablation in proximity to coronary arteries leads to acute and chronic histopathologic changes characterized by tunica intima and media thickening, with replacement of smooth muscle cells with extracellular matrix, but no significant stenosis was observed up to 70 days after the ablation. The absence of acute coronary occlusion or injury does not preclude subsequent significant arterial damage, which frequently occurs when epicardial radiofrequency applications are delivered in close vicinity to the vessels. (Circ Arrhythm Electrophysiol. 2011;4:526-531.