coronary-progenitor-cells-soluble-biomarkers-cardiovascular-prognosis

Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty

Major adverse cardiovascular events (MACEs) negatively impact the cardiovascular prognosis of patients undergoing coronary angioplasty due to coronary ...

Centro Médico Nacional "20 de Noviembre" ISSSTE

The chronic cardiac stimulation is know since 1958, pacemaker implant was considered a difficult procedure that was performed through cardiovascular surgery and the patient required several in hospital days. On the grounds of new surgical techniques and development of new materials for pacemakers, as well as the rise of Ambulatory Surgery and its application in pacemaker implants, the hospital stay and consequently, costs have decreased significantly. In 1986, Zegelman reported 583 patients subjected to ambulatory pacemaker surgery without mortality. The purpose of this report it to evaluate the efficacy and safety of ambulatory pacemaker surgery. One hundred seventy seven patients from an ambulatory program and 95 from a traditional program were included. Hospitalization time was 15.7 +/- 15.1 hours in the first group and 238 +/- 188 hours for the second, prevalence of complications was 2.2% in the 272 patients. Complications for both groups were similar and were solved, without mortality. We conclude that the ambulatory pacemaker surgery is effective and safe for patients and is cheaper for hospitals. The success of this program depends on the number of implants in each hospital and the operator's experience.

[Ambulatory pacemaker surgery].

Congestive heart failure (HF) remains a major and growing public health problem despite recent therapeutical developments. Thirty to sixty percent of patients with dilated cardiomyopathy (DCM) die suddenly from cardiac arrhythmias. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD) therapy are effective treatments for HF with a wide QRS and for ventricular arrhythmias respectively. Several trials are currently being performer to evaluate the cardiac resynchronization and implantable cardioverter defibrillator therapy with good results. The objective of this paper is to report the first three patients, in Mexico, that have received this combined therapy. In one patient, a three cameral pacemaker was associated with a unicameral ICD and the other two received a device with both functions. Patients were men, aged 63, 65, and 54 years, two of them with previous myocardial infarct and functional class II to IV of the NYHA. Left ventricular ejection fraction was of 25% in two patients and of 35% in the other. All patients improved their functional class and LVFE, two patients presented discharges of the ICD.

[Association of biventricular resynchronizer and implantable cardioverter defibrillator].

Pacemakers are used in small children with increasing frequency for the treatment of life-threatening bradyarrhythmias. The epicardial approach is generally preferred in these patients, to avoid the risks of vessel thrombosis. We examined the feasibility and safety of transvenous pacemaker implantation in children weighing <10 kg, via subclavian puncture, using a 4 Fr sheath introduced after a venogram was performed to evaluate the vein diameter. Progressive dilation with 5, 6, and 7 Fr sheaths preceded the insertion and placement of the endocardial lead. A subaponeurotic pocket was created in the abdominal or pectoral regions, depending upon the patient's size. Between 2001 and 2007, we treated 12 patients (median age = 16 months; range 1-32; median weight = 7.9 kg; range 2.3-10.0; 7 males), of whom four weighed <5 kg. Indications for permanent pacing included postsurgical complete atrioventricular block (n = 8), sinus node dysfunction (n = 2), congenital atrioventricular block (n = 1), and long QT syndrome (n = 1). Single-chamber pacemakers were implanted in 10, and dual-chamber pacemakers in two patients. The patients were evaluated at 48 hours, 10 days, and at 3 and 6 months. The mean follow-up was 31.8 +/- 23.5 months. There were no procedural complications. Lead dislodgment occurred in one patient and required replacement of the ventricular lead. One patient died from septicemia. Endocardial pacemaker implantation was feasible and safe in children weighing <10 kg. This procedure is less invasive than the standard epicardial approach.

Transvenous pacing in children weighing less than 10 kilograms.

Pacemaker-mediated tachycardia (PMT) remains a clinical problem in patients with dual-chamber pacemaker despite technological advances. The onset mechanism of this tachycardia is sensing of retrograde atrial activation after ventricular stimulation. Repeated retrograde conduction perpetuates tachycardia. Postventricular atrial refractory period prolongation has been used for prevention of PMT, but this is not the solution in all cases. We present a case with PMT where the retrograde limb is a left accessory pathway, which is treated with radiofrequency ablation successfully.

Article	Year
[Ambulatory pacemaker surgery]. Archivos de cardiologia de Mexico\| PubMed ID: 16294817	2005
[Association of biventricular resynchronizer and implantable cardioverter defibrillator]. Archivos de cardiologia de Mexico\| PubMed ID: 16366173	2005
Transvenous pacing in children weighing less than 10 kilograms. Pacing and clinical electrophysiology : PACE\| PubMed ID: 19250088	2009
Catheter ablation of accessory pathway in the treatment of pacemaker-mediated tachycardia. Pacing and clinical electrophysiology : PACE\| PubMed ID: 21954936	2012

Rogelio Robledo-Nolasco

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