Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-07-14T11:34:00Z No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-07-14T11:45:20Z (GMT) No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-07-14T11:45:20Z (GMT). No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-12-12 / Background: Chagas’s heart disease remains a major public health problem in Brazil. Sudden death is the leading cause of decease, because of that, the implantable cardioverter defibrillator (ICD) has become an important therapeutic option in this disease. Objective: To define the prevalence and predictors of electrical storm (ES) in patients with Chronic Chagas Heart Disease (CCh) with an ICD. Methods: We retrospectively studied 81 consecutive patients with CCh in whom an ICD was implanted between January 2004 to December 2007, with a mean follow up of 45,9 ± 15 months. Patients were classified into two groups according to the presence of ES episodes. We compared baseline and funcional characteristics. p values less than 0,05 were considered statistically significant. Results: Thirty five patients (43,2%) developed TE during follow up. By univariate analysis, QRS width ≥ 150 ms (p=0,001), previous pacemaker (p=0,001), ventricular tachycardia (VT) for indication of ICD (p=0,001) and cumulative percent ventricular pacing (C%VP) > 40%/80%) were all predictors of TE. However, by multivariate analysis only the indication of ICD for VT (odds ratio (OR) = 9.16, 95% CI: 1.98 to 42.78, p = 0.005) and C%VP > 40%/80% (OR = 6.30, 95% CI: 1.56 to 25.49, p = 0.010) were independent predictors of TE. Conclusion: 1- ES is very frequent in subjects with CCh and ICD; 2- Indication of ICD for VT and C%VP > 40%/80% were independent predictors of TE. / Fundamento: A Cardiopatia Chagásica ainda é um importante problema de saúde pública no Brasil. A morte súbita é a principal causa de óbito, por isto, o cardioversor desfibrilador implantável (CDI) tornou-se importante opção terapêutica nesta doença. Objetivos: Avaliar a prevalência e fatores preditores da tempestade arritmogênica ou elétrica (TA ou TE) em pacientes chagásicos portadores de CDI. Metodologia: Estudo retrospectivo de uma coorte de 81 pacientes chagásicos submetidos a implante de CDI entre Janeiro de 2004 a Dezembro de 2007, com seguimento médio de 45,9 ± 15 meses.Os pacientes foram classificados em dois grupos de acordo com a presença ou não de TE. Comparou-se as características basais e funcionais da amostra utilizando-se testes estastísticos (t student, qui-quadrado e, quando necessário, Fisher). Resultados: A idade foi de 57,0 ± 9,5 anos, sexo masculino 60 (74,1%), a fração de ejeção (FE) média foi de 43,8 ± 7,6. Dos 81 casos da amostra, 35 (43,2%) apresentaram pelo menos um episódio de TE. Estes tiveram um total de 378 TE com média de 10,8 ± 11,6. Em análise univariada, identificou-se que a indicação do CDI por taquicardia ventricular sustentada espontanea (TVSE) (p=0,001), duração do QRS (dQRS) ≥ 150ms (p= 0,001), ser portador de marcapasso (MP) (p=0,001) , percentagem de estímulo de ventrículo direito (PEVD) > 40%/80% (p= 0,001) e classe funcional (CF) final III/IV (p= 0,015), foram fatores preditores de TE nesta coorte. Porém, a análise multivariada demonstrou que apenas a indicação de CDI por TVSE ( odds ratio (OR)= 9,16; IC 95%: 1,98- 42,78; p= 0,005) e PEVD > 40%/80% ( OR=6,30; IC 95%: 1,56-25,49; p=0,010 ) foram fatores preditores independentes para TE. Conclusão: Nos pacientes chagásicos portadores de CDI, houve elevada prevalência de TE (43,3%). Os fatores preditores independentes para TE foram: TVS (TVSE) prévia e PEVD > 40%/80%.

A estratificação de risco para morte súbita em pacientes com cardiomiopatia hipertrófica ainda é um desafio. Sua prevenção pelo cardiodesfibrilador automático é eficaz, porém, onerosa e não isenta de riscos. Pacientes com indicação de cardiodesfibrilador automático para prevenção primária, baseada em fatores de risco clínicos, apresentam baixa taxa de terapias apropriadas. Estudos que validem novos fatores de risco são necessários, visando identificar pacientes com maior probabilidade de morte súbita e, portanto, que se beneficiam do implante do dispositivo. Estudos que correlacionam a presença de realce tardio com arritmias ventriculares e morte súbita foram realizados, entretanto, sua aplicabilidade clinica ainda não é consenso. Objetivos: Avaliar, em portadores de cardiomiopatia hipertrófica, se a presença e a extensão de realce tardio, identificado pela tomografia computadorizada, correlaciona-se com a ocorrência de taquiarritmias ventriculares registradas no monitor de eventos do cardiodesfibrilador automático, durante um seguimento clínico ambulatorial. Métodos: Foram incluídos pacientes com cardiomiopatia hipertrófica dos ambulatórios de Eletrofisiologia e Miocardiopatias do Instituto Dante Pazzanese de Cardiologia. Os pacientes foram divididos em dois grupos: grupo I composto por aqueles que receberam terapia apropriada pelo cardiodesfibrilador automático ou tiveram apenas a documentação de taquicardia ventricular não sustentada pelo cardiodesfibrilador automático; grupo II, composto por pacientes sem documentação de arritmias ventriculares no monitor de eventos. As variáveis contínuas foram comparadas utilizando-se testes t de Student pareado ou Wilcoxon; para as categóricas o teste do x2. Para análise dos dados, utilizou-se o programa SPSS. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Sessenta e um pacientes (idade média 39±15 anos, 51% mulheres, com seguimento médio 5,13±3,0 anos) foram avaliados. Em 91,8%, a indicação do cardiodesfibrilador automático foi por prevenção primária. Durante o seguimento clínico, cinco pacientes (8,2%) apresentaram terapias apropriadas e 15 (24,6%) tiveram taquicardia ventricular não sustentada, mas sem terapia. A densidade de fibrose (incluindo massa de ventrículo esquerdo acometida e percentual de acometimento) não foi estatisticamente diferente entre os grupos I e II (4,3±4,8% vs 7,0±7,7% nos grupos I e II, respectivamente, p = 0,13). Entretanto, 85% dos pacientes com taquicardia ventricular apresentavam fibrose à tomografia computadorizada. Maiores densidades de fibrose se correlacionaram com idades mais jovens, com menores frações de ejeção e sexo masculino. Espessura septal >= 30mm se correlacionou à maior massa de fibrose. Houve correlação entre o surgimento de fibrilação atrial e maior porcentual de fibrose do ventrículo esquerdo. Dentre os fatores que se correlacionaram com maior densidade de fibrose, nenhum deles se correlacionou com eventos arrítmicos ventriculares. A associação dos fatores clínicos ou fatores clínicos isolados que motivaram a indicação do implante do cardiodesfibrilador automático não se correlacionou com eventos arrítmicos. Os pacientes do grupo I apresentaram maior diâmetro diastólico do ventrículo esquerdo e maior diâmetro do átrio esquerdo quando comparado com os pacientes do grupo II (47,7±4,7mm vs 43.1±5,4 mm, p = 0,002 e 47,8±8mm vs 41,5±7,1mm, p = 0,003, respectivamente). Conclusões: 1. A presença de fibrose detectada pela tomografia computadorizada apresenta razoável sensibilidade para identificação de pacientes com risco para taquicardia ventricular; 2. A densidade de fibrose foi similar nos pacientes dos grupos I e II; 3. Pacientes com fibrilação atrial apresentaram maior densidade de fibrose ventricular detectada pela tomografia computadorizada em comparação aos pacientes sem fibrilação atrial; 4. O diâmetro diastólico final de ventrículo esquerdo e o diâmetro atrial esquerdo associaram-se à maior risco de taquicardia ventricular; 5. Os fatores de risco convencionais, associados ou não à fibrose, não se correlacionaram com maior probabilidade de ocorrência de eventos arrítmicos ventriculares. / Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy patients is still challenging. Primary prevention of sudden death with implantable cardioverter-defibrillator is an effective, however, costly and not risk-free method. Patients with implantable cardioverter-defibrillator indicated for primary prevention based on clinical risk factors display low rates of appropriate therapies. Studies evaluating new risk factors are needed seeking to identify who would be mostly at risk of sudden cardiac death, and therefore benefit from cardioverter-defibrillator. Studies have been conducted to establish a correlation between late enhancement and ventricular arrhythmias and sudden cardiac death; however, its clinical applicability is still controversial. Objective: To evaluate if the presence and extension of late enhancement, identified by computed tomography, correlates with the occurrence of ventricular arrhythmias in hypertrophic cardiomyopathy patients. Methods: Patients with hypertrophic cardiomyopathy followed in Electrophysiology and Cardiomyopathies divisions at Dante Pazzanese Institute of Cardiology were included in the study. Patients were divided into two groups: group I composed by those with appropriate therapies (shock or overdrive) or non-sustained ventricular tachycardia; and group II, composed by patients without documented ventricular arrhythmias. Continuous variables were compared using paired t-student test or Wilcoxon test. Categorical variables were analyzed using chi-square test. For data analysis, the SPSS program was used. P values < 0.05 were considered statistically significant. Results: Sixty one patients (mean age 39 ± 15 years, 51% female, average follow up 5.13 ± 3 years) were evaluated. In 91.8%, cardioveter-defibrillator was indicated by primary prevention. During the follow up, five patients (8.2%) had appropriate therapies and 15 (24.6%) presented non-sustained ventricular tachycardia without therapies. Fibrosis density, (including left ventricular mass compromise and percentage) was not statistically different between the groups (4.3±4.8% for group I vs. 7.0±7.7% for group II, p =0.13). However, 85% of patients with ventricular tachycardia had fibrosis on cardiac computed tomography. Larger fibrosis density correlated with younger age, reduced ejection fraction and male gender. Septum >30 mm correlated with fibrosis mass. There was a correlation between atrial fibrillation and higher left ventricular fibrosis percentage. Among the factors that correlated with higher fibrosis density, none of them had correlation with ventricular arrhythmic events. The combination of clinical factors that motivated the implantation of cardioverter-defibrillator did not correlate with arrhythmic events. Patients at group I had larger left ventricular diastolic diameter (47.7±4.7 vs. 43.1±5.4mm, respectively, p= 0.002) and left atrium diameter (47.8±8.2 vs. 41.5±7.1 mm, respectively, p=0.003). Conclusions: 1. The presence of fibrosis detected by cardiac tomography had reasonable sensitivity to identify patients at risk of ventricular tachycardia; 2. Fibrosis density was similar between groups I and II; 3. Patients with atrial fibrillation had more fibrosis density detected by cardiac tomography compared to patients without atrial fibrillation; 4. Left ventricular end diastolic diameter and left atrial diameter correlated with increased risk of ventricular tachycardia; 5. Classical risk factors, associated or not with fibrosis, did not correlate with increased probability of ventricular arrhythmic events.

No description available.

This thesis deals with electromagnetic compatibility of implantable electro-medical devices using in cardiology. The main aim of this thesis is detection of the resistance of implantable pacemakers (PM) and implantable cardioverter defibrillators (ICD) to the electromagnetic interference. In the first part of this thesis, a function of the heart, which is necessary for understanding of PM and ICD operation, is described. The function and construction of PM and ICD is detailed in the theoretical part as well. The next part is focused on the electromagnetic compatibility. The next part is description of the measurement method and the experimental arrangement used for practical experiments with electromagnetic resistance of PM and ICD.

Varje år drabbas ca 10 000 människor av hjärtstopp utanför sjukhus och av dem är det endast 500 som överlever. Sannolikheten för överlevnad ökar upp mot 75% vid användning av hjärtstartare.   Kandidatexamensarbetet gjordes i uppdrag av Servicia Medical, där målet var att analysera den nordiska marknaden för AED, utifrån att undersöka största återförsäljarna, attraktiva platser för placering av AED, prisutveckling och tillväxt. Marknadsundersökningen omfattar enbart Sverige, Finland och Danmark. För att ta reda på vilka återförsäljare som är störst utfördes en webbaserad informationssökning, samt telefonsamtal och mejlväxling med generalagenter. Data för attraktiva platser och tillväxt erhölls från olika verksamheter. Intervjuer, mejl och telefonsamtal utnyttjades för att få fram prisutvecklingen.   Återförsäljarna delades in i två kategorier, där den ena avsåg företag som har fokus på första hjälpen och den andra företag med ospecifik fokusering.  Information som krävdes för att undersöka vilka platser som är mest attraktiva, samt tillväxten i Finland och Danmark saknades. Gator och torg, tåg, buss, båt och spårtrafik är de mest attraktiva platserna för placering av AED i Sverige. Under de senaste fem åren har priset sjunkit i Sverige och Danmark. Tillväxten i dessa länder är olika där Sverige har en växande trend, medan Danmark har en ojämn och otydlig. Ingen slutsats kan dras för tillväxten i Finland. / Each year about 10 000 people get a cardiac arrest outside hospital and only 500 of them survives. Defibrillators are an efficient treatment for cardiac arrest, where the probability of survival increases up to 75%.   This Bachelor project is done on behalf of Servicia Medical, where the goal is to analyze the Nordic market of AED by investigating the greatest retailers, the most attractive locations to place AED, price development and growth. The market research covers only Sweden, Finland and Denmark. To discover the greatest retailers, web-based research was performed as well as phone-calls and e-mail exchanges with general agents. Data for analyzing attractive locations and growth were obtained from various businesses. Interviews, e-mails and phone calls were used to derive price development.   The found retailers were divided into two categories. The first category was companies that focus on first aid and the second one had a non-specific focus. Some Finnish and Danish businesses had a lack of required information to examine the most attractive locations and growth. Streets and squares, trains, busses, boats and rail traffic are the most attractive locations in Sweden to place AED. During the past five years prices have decreased in Sweden and Denmark. The growth in these countries is different. Whilst Sweden has a growing trend, Denmark has an uneven and unclear trend. No conclusion can be drawn for the growth in Finland.

Abstract Background: Implantable cardioverter-defibrillator (ICD) surgery in patients with implanted left ventricular assist devices (LVAD) is associated with an increased risk of bleeding complications because of the need to ensure that these patients are adequately anticoagulated. Our study aimed to evaluate the safety of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging during the surgical interval. Methods: Between January 2009 and January 2020, 116 patients with LVAD underwent ICD surgery. Since January 2015, 60 patients were operated under continued sufficient oral anticoagulation with a vitamin k antagonist (VKA group). Fifty-six patients underwent a heparin-bridging regimen (heparin group). Demographics, perioperative data, complications, and mortality were analyzed. Results: Bleeding complications attributable to the surgical intervention occurred more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re-exploratory surgery (14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical significance. Moreover, the heparin group patients' postoperative total length of stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were no procedure-related deaths, no thromboembolic events, and no LVAD-related thrombosis. Conclusion: Our strategy of uninterrupted oral anticoagulation is safe and results in a reduction by more than half the number of days in hospital without an increase in adverse events.

No description available.

No description available.

Le taux de mortalité chez les patients à risque d’arythmies cardiaques menaçantes à la vie a été considérablement réduit grâce au défibrillateur cardiaque implantable (DCI). Toutefois, des préoccupations uniques face au DCI, y compris les chocs que l’appareil peut déclencher, sont susceptibles de provoquer des symptômes d'anxiété et une limitation perçue des activités chez les porteurs de DCI. Ces réactions émotives et modifications de comportement peuvent affecter l’acceptation du patient envers le DCI. Cette étude pilote randomisée avec groupe contrôle (n=15 /groupe) visait à examiner la faisabilité et l'acceptabilité d'une intervention infirmière individualisée de même que ses effets préliminaires sur l’anxiété, le fonctionnement dans les activités de la vie quotidienne et l’acceptation du DCI auprès de nouveaux porteurs de DCI. L'intervention infirmière, basée sur la théorie du Human Caring et teintée d’une approche cognitive comportementale, ciblait les préoccupations individuelles face au DCI. À partir des préoccupations identifiées, l’infirmière intervenait en mettant l'accent sur les croyances contraignantes du patient, qui pouvaient mener à de l’anxiété et des comportements d'évitement. Après randomisation, les patients du groupe intervention (GI) ont participé à un premier entretien en face-à-face avant le congé hospitalier. Subséquemment, deux entretiens se sont faits par téléphone, à environ 7 et 14 jours suite au congé hospitalier. Les résultats soutiennent la faisabilité et l’acceptabilité du devis de l’étude et de l’intervention évaluée. De plus, ils soulignent le potentiel de l’intervention à diminuer les sentiments anxieux chez les participants du GI. Les résultats de cette étude pilote offrent des pistes de recherches futures et permettront de guider la pratique clinique. / Patients with an implantable cardiac defibrillator (ICD) decrease their risk of mortality related to life threatening arrhythmias. However, multiple concerns about this device exist, including ICD shocks, which may result in increased anxiety and a perceived limitation in performing everyday activities. These emotional reactions and behavioral changes may have a negative impact on the acceptance of the device. The purpose of this randomized pilot study with a group control (n=15 / group), was to verify the feasibility and acceptability of an individualized nursing intervention aiming to decrease anxiety, improve performance in everyday activities and device acceptance in patients with newly implanted ICDs. Based on Human Caring theory and a cognitive behavioral approach, this intervention addressed each patient’s unique concerns. From the identified concerns, the nurse intervened focussing on the patient’s dysfunctional beliefs that can lead to anxiety and avoidance behavior. After randomization, the first encounter for the experimental group (EG) was face-to-face before hospital discharge. Subsequently, two encounters were made via telephone, 7 and 14 days after discharge. The results support the feasibility and acceptability of the study design and the intervention evaluated. In addition, they emphasize the potential of the intervention to reduce symptoms of anxiety among the participants of the EG. The results of this pilot study may provide directions for future research and help guide clinical practice.

Afin d’apporter les soins adéquats aux victimes d'arrêt cardiaque extrahospitalier, l'évaluation de leur état hémodynamique est primordiale. La prise de pouls manuelle ne permet pas une identification fiable de l'arrêt cardiaque par les profanes ou une discrimination des rythmes organisés par les premiers intervenants. Dans ce contexte, l'entreprise Schiller Médical a cherché à intégrer dans sa gamme de défibrillateurs un module de détection de l'hémodynamique systémique par analyse de l'électrocardiogramme et des variations d'impédance transthoracique recueillis via les électrodes de défibrillation. Ce travail de recherche mené en partenariat entre l'entreprise Schiller Médical et l'Institut Pluridisciplinaire Hubert Curien de l’Université de Strasbourg a consisté dans un premier temps a recherché, lors d'arrêt cardiaque induit électriquement chez l'homme, des descripteurs des variations d'impédance transthoracique marqueurs de l’hémodynamique systémique. L’identification des descripteurs les plus pertinents a par la suite permis de construire des modèles prédictifs des défaillances circulatoires. Nous avons mis en lumière des limites à l’utilisation des variations d’impédance transthoracique. Elles sont prises en considération pour la documentation des interventions extrahospitalières destinée à l’apprentissage des algorithmes de classification des rythmes perfusants et rythmes sans pouls. / Providing suitable emergency care during out of hospital cardiac arrest requires the diagnostic of the circulatory status. Manual pulse check does not provide a reliable way for laypersons to identify cardiac arrest or for first responders to discriminate organized rhythms. Thus, Schiller Medical sought to embed an hemodynamic sensor in its external defibrillators by analyzing the electrocardiogram and transthoracic impedance recorded via the defibrillation pads. This thesis work stemmed from a partnership between Schiller Medical and the Institut Pluridisciplinaire Hubert Curien of the Université de Strasbourg. We first identified transthoracic impedance featureslinked with the circulatory status by studying clinically induced cardiac arrest. The most relevant features were later selected to form predictive models of hemodynamic collapse. We uncovered restrictions to the use of transthoracic impedance. We took them into account for the annotation of out of hospital cardiac arrests aimed at training algorithms for the classification of pulseless electrical activity and pulsatile rhythms.