Objetivos Específicos - JUSTIFICATIVA E OBJETIVOS

2- JUSTIFICATIVA E OBJETIVOS

2.3 Objetivos Específicos

1- Quantificar os episódios de FA paroxística durante o Holter de 24h.

2- Quantificar a correlação entre a presença de FA paroxística e sintomas durante o Holter de 24h.

3- Determinar a presença de fatores preditores de maior sensibilidade à sintomatologia da arritmia como, por exemplo: sexo, drogas.

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4-Artigo

CORRELAÇÃO ENTRE FIBRILAÇÃO ATRIAL PAROXÍSTICA

E SINTOMAS NA MONITORIZAÇÃO

Artigo original – submetido São Paulo Medical Journal

CORRELAÇÃO ENTRE FIBRILAÇÃO ATRIAL PAROXÍSTICA

E SINTOMAS NO HOLTER DE 24 HORAS

Marcelo Lapa Kruse

Programa de Pós-Graduação em Ciências da Saúde - Instituto de Cardiologia do Rio Grande do Sul / Fundação Universitária de Cardiologia

Av. Princesa Isabel, 395 Santana Unidade de Pesquisa Porto Alegre 90.620-001

Artigo Original

IS THERE A RELATIONSHIP BETWEEN SILENT ATRIAL FIBRILLATION AND THE MAXIMUM HEART RATE ON 24-HOUR HOLTER?

FIBRILAÇÃO ATRIAL PAROXÍSTICA SILENCIOSA PODE SER DETERMINADA PELA FC MÁXIMA NO HOLTER?

Marcelo Lapa Kruse1, José Cláudio Lupi Kruse2, Tiago Luiz Luz Leiria3, Leonardo Martins Pires4, Caroline Saltz Gensas5, Daniel Garcia Gomes6, Douglas

Boris7, Augusto Mantovani8, Gustavo Glotz de Lima9 1

MD, MSc. Electrophysiologist at the Electrophysiology Service, Instituto de

Cardiologia / Fundação Universitária de Cardiologia. Porto Alegre, Rio Grande do Sul, Brasil.

MD. Cardiologist, Instituto de Cardiologia / Fundação Universitária de Cardiologia. Porto Alegre, Rio Grande do Sul, Brasil.

MD, MSc, PhD. Electrophysiologist at the Electrophysiology Service, Instituto de Cardiologia / Fundação Universitária de Cardiologia. Porto Alegre, Rio Grande do Sul, Brasil.

MD, MSc. Electrophysiologist at the Electrophysiology Service, Instituto de

Cardiologia / Fundação Universitária de Cardiologia. Porto Alegre, Rio Grande do Sul, Brasil.

Medical Student, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA). Scientific Initiation Student, Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brasil.

MD. Resident in the Electrophysiology Service, Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brasil.

MD, MSc, PhD. Adjunct Professor, Cardiology, Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA). Head of the Electrophysiology Service, Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brasil.

This study was developed at Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil

ABSTRACT

Context and objective: The occurrence of asymptomatic atrial fibrillation (AF) is common. It is important to identify AF as it increases morbimortality. The 24-hour Holter has been used for the detection of paroxysmal AF (PAF). The objective of this study is to correlate the presence of symptoms and PAF in the 24h Holter in the studied population. Design and setting: Retrospective observational study performed at Instituto de Cardiologia do Rio Grande do Sul. Methods: Analysis of 11321 consecutive 24-hour Holter monitoring tests performed at a referral service. Patients with pacemaker or with AF throughout the whole recording time were excluded. Results: 75 (0.67%) of tests presented PAF. The average age was 67 ± 13 years and 45% were female. The heart rate (HR) range was a minimum of 45 ± 8 bpm, a mean of 74 ± 17 bpm and a maximum of 151 ± 32 bpm. Among the tests showing PAF, only 26% had symptoms. The maximum HR was higher in the group with symptomatic correlation with the arrhythmia (165 ± 34 vs 147 ± 30 bpm) (p = 0.03). The use of betablockers have a protective effect on PAF symptoms (OR: 0.24, P = 0.031). Conclusions: PAF is rare in the 24h Holter and is often asymptomatic. The maximum HR during the 24 hours test was the only factor associated with symptomatic AF and betablockers which had a protective effect on symptoms occurrence.

Key words: atrial fibrillation; symptoms; electrocardiography, ambulatory; arrhythmias, cardiac; electrophysiology.

RESUMO

Contexto e objetivo: A ocorrência de Fibrilação Atrial (FA) assintomática é comum. A identificação da FA é importante e está associada com maior morbimortalidade. O

Holter de 24h vem sendo utilizado para a detecção de FA paroxística (FAp). O objetivo desse estudo é correlacionar a ocorrência de FAp no Holter de 24 horas e de sintomas na população estudada. Tipo de estudo e local: Estudo retrospectivo observacional realizado no Instituto de Cardiologia do Rio Grande do Sul. Métodos: Análise de 11321 exames consecutivos de Holter de 24 h realizados serviços de referência. Foram excluídos pacientes com marcapasso e aqueles com FA durante toda a gravação. Resultados: Foram identificados 75 (0,67%) exames apresentando FAp. A idade média foi de 67±13 anos e 45% eram do sexo feminino. A freqüência cardíaca (FC) encontrada nas 24h foi mínima de 45±8 bpm, média de 74± 17 bpm e máxima de 151± 32 bpm. Entre os exames apresentando FAp, apenas 26% apresentaram sintomas. O único fator testado que evidenciou correlação com FA sintomática foi a FC máxima (165± 34 vs 147± 30 bpm) (p=0,03). Conclusões: A FAp é um evento raro em Holter de 24h. A FC máxima nas 24h foi o único fator relacionado com FA sintomática e o uso de betabloqueadores teve efeito protetor para ocorrência de sintomas na FA.

Palavras-chave: fibrilação atrial; sintomas; eletrocardiografia ambulatorial; arritmias cardíacas; eletrofisiologia.

INTRODUCTION

Atrial Fibrillation is the most common sustained arrhythmia in the medical practice.1 It is often associated to a significant increase in morbidity and mortality mainly in elderly patients. Atrial fibrillation is the leading cause of embolic episodes. Cerebrovascular²,³ causes account for 75% of these embolic phenomena.

The diagnosis of atrial fibrillation can be based on patient’s symptoms, but in several cases it may also be asymptomatic. Sometimes, it is occasionally identified by chance or when the patient has a thromboembolic event. Early diagnosis is important in preventing morbimortality that is largely due to stroke.4,5

Several tools for the assessment of atrial fibrillation were developed such as transtelephonic monitoring, 24-hour Holter and implantable loop monitors electrocardiogram (ECG) changes.6 All this techniques were evaluated to better define the presence of paroxysmal arrhythmias such as paroxysmal atrial fibrillation. This can be also done in the post treatment scenario, such as the post atrial fibrillation ablation

No documento Dissertação CORRELAÇÃO ENTRE FIBRILAÇÃO ATRIAL PAROXÍSTICA E SINTOMAS NA MONITORIZAÇÃO ELETROCARDIOGRÁFICA AMBULATORIAL DE 24 HORAS (páginas 38-72)