Browsing by Author "Paredes, Alejandro"

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    Cardiogenic shock due to arrhythmia-induced cardiomyopathy and its recovery after radiofrequency ablation under extracorporeal membrane oxygenation support
    (Elsevier B.V., 2022) Sanhueza, Sebastián; Vergara, Ismael; Bittner, Alex; Paredes, Alejandro; Garrido, Luis; Besa, Santiago; Castillo, Josefina; Acevedo, Mónica
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    Desfibriladores automáticos implantables y su desactivación, una conversación necesaria. Revisión de la literatura y propuesta multidisciplinaria
    (Sociedad Medica de Santiago, 2023) Cerda, Tomás; Crispino, Luciana; Paredes, Alejandro
    © 2023 Sociedad Medica de Santiago. All rights reserved. The use of implantable cardioverter-defibrillators (ICDs) has been on the rise. Patients using ICDs inevitably transit towards the end of life at some point, including some who develop terminal illnesses. In this context, it is relevant to discuss and evaluate the deactivation of these devices with the aim of addressing patients' comfort and avoiding shocks during the end-of-life phase. There are multiple communicational and operational barriers when considering ICDs deactivation. Firstly, many patients have not discussed this issue with their physicians despite international guidelines recommending such discussions before device installation. Secondly, there is a significant lack of knowledge among patients, family members, and even doctors about the benefits of ICDs, as well as the deactivation process and ethics considerations, which leads them to believe that immediate death will occur, considering it as euthanasia or assisted suicide. Finally, the management of hospice patients or end-of-life ICDs users is poorly standardized, with low rates of deactivation, resulting in shocks in the last minutes of life, which can cause marked distress to patients and families. It is necessary to address these barriers and discuss these issues with patients to inform and educate them about the functioning of their devices, with the ultimate goal of enabling informed and shared decision-making for patient well-being.
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    Dolor torácico y alteración electrocardiográfica
    (2017) Paredes, Alejandro; Bittner Braemer, Alex Gerhard; Vergara Saavedra, Ismael Antonio
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    Heart transplant recipient patient with palpitations
    (CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2024) Sanhueza, Sebastián; Paredes, Alejandro; Bittner, Alex; Vergara, Ismael
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    Reverse Remodeling in Human Heart Failure after Cardiac Resynchronization Therapy Is Associated With Reduced RHO-Kinase Activation
    (2021) Ocaranza Jeraldino, Maria Paz; Jalil Milad, Jorge Emilio; Altamirano Assad, Rodrigo Patricio; De León Soto, Ana María; Moya López, Jackeline Trinidad; Lonis Álvarez, María Alejandra; Gabrielli Nervi, Luigi Arnaldo; Mac Nab, Paul; Cordova Alvestegui, Samuel Edmundo; Paredes, Alejandro; Vergara Saavedra, Ismael Antonio; Bittner Braemer, Alex Gerhard; Sabat Sarras, Karime Alejandra; Pastorini, Karla
    ["Background: Reverse remodeling is a clinically relevant endpoint in heart failure with reduced ejection fraction (HFrEF). Rho-kinase (ROCK) signaling cascade activation correlates with cardiac remodeling and left ventricular (LV) systolic dysfunction in HFrEF patients. Cardiac resynchronization therapy (CRT) is effective in HFrEF, especially when there is a left bundle block, as this treatment may stimulate reverse remodeling, thereby improving quality of life and prolonging survival for patients with this severe condition. Here, we evaluate the hypothesis that ROCK activation is reduced after effective CRT in HFrEF.", "Methods: ROCK activation in circulating leukocytes was evaluated in 28 HFrHF patients, using Western blot (myosin light chain phosphatase subunit 1 phosphorylation, MYPT1p/t), before and three months after initiation of CRT. LV systolic function and remodeling were assessed by echocardiography.", "Results: Three months after CRT, LV ejection fraction increased an average of 14.5% (p < 0.001) in 13 patients (responders), while no change was observed in 15 patients (non-responders). End-systolic diameter decreased 16% (p < 0.001) in responders, with no change in non-responders. ROCK activation in PBMCs decreased 66% in responders (p < 0.05) but increased 10% in non-responders (NS). LV end-diastolic diameter was also 5.2 mm larger in non-responders vs. responders (p = 0.058). LV ejection fraction, systolic diameter, and ROCK activation levels were similar in both groups at baseline.", "Conclusion: In HFrEF patients, 3 months of effective CRT induced reverse myocardial remodeling, and ROCK activation was significantly decreased in circulating leukocytes. Thus, decreased ROCK activation in circulating leukocytes may reflect reverse cardiac remodeling in patients with heart failure."]