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estes doentes apresentam frequentemente uma doen&#231;a latente do sistema de condu&#231;&#227;o&#44; existindo poucos dados relativos &#224; recorr&#234;ncia de bradidisrritimias nesta popula&#231;&#227;o e &#224; necessidade futura de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#8208;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">De acordo com estudos pr&#233;vios&#44; cerca de 25&#37; das bradidisrritmias n&#227;o s&#227;o causadas pela terap&#234;utica&#44; mas&#44; sim&#44; reveladas por esta&#44; sendo os beta&#8208;bloqueantes os &#171;f&#225;rmacos <span class="elsevierStyleItalic">culprits</span>&#187; mais frequentes&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es metab&#243;licas&#44; nomeadamente as altera&#231;&#245;es i&#243;nicas&#44; apresentam na sua maioria um perfil benigno&#44; com maior percentagem de revers&#227;o da bradidisrritmia&#44; sendo por este motivo frequentemente exclu&#237;das de estudos em bradidisrritmias iatrog&#233;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">No presente estudo pretendemos avaliar a necessidade de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo em internamento ou ap&#243;s a alta numa amostra de doentes com bradidisrritmia associada a iatrogenia medicamentosa ou a outra causa potencialmente revers&#237;vel&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Amostra</span><p id="par0030" class="elsevierStylePara elsevierViewall">A amostra deste estudo foi constitu&#237;da por 153 doentes consecutivos admitidos no servi&#231;o de urg&#234;ncia num per&#237;odo de seis anos&#44; entre 2010 e 2015&#44; com o diagn&#243;stico principal de bradidisrritmia sintom&#225;tica &#40;doen&#231;a do n&#243;dulo AV&#58; bloqueio auriculoventricular completo &#91;BAVC&#93; e bloqueio auriculoventricular de 2&#46;&#176; grau &#91;BAV2&#93;&#59; bradicardia sinusal &#91;BS&#93; e bradifibrilha&#231;&#227;o auricular &#91;BFA&#93;&#41;&#44; no contexto de iatrogenia medicamentosa e&#47;ou altera&#231;&#245;es metab&#243;licas&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Vari&#225;veis</span><p id="par0035" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o do estudo foi caracterizada de acordo com as caracter&#237;sticas basais&#44; quadro cl&#237;nico&#44; tipo de bradidisrritmia&#44; terap&#234;utica de ambulat&#243;rio e altera&#231;&#245;es i&#243;nicas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de BAV 2&#46;&#176; grau neste estudo corresponde especificamente &#224; condu&#231;&#227;o auricular 2&#58;1&#44; sem registo na nossa amostra de algum caso de bloqueio Mobitz tipo I ou II&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os doentes com FA e BAVC foram englobados no grupo do BAVC&#44; no grupo FA apenas foram inclu&#237;dos doentes com resposta ventricular lenta sem perturba&#231;&#227;o da condu&#231;&#227;o AV&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Na iatrogenia medicamentosa foram considerados os seguintes f&#225;rmacos&#58; beta&#8208;bloqueantes&#59; antagonistas dos canais de c&#225;lcio&#59; antiarr&#237;tmicos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nas altera&#231;&#245;es metab&#243;licas&#44; apenas foi considerada a hipercaliemia&#44; sendo inclu&#237;dos no estudo doentes com n&#237;veis de pot&#225;ssio s&#233;rico &#62; 6&#46;5 mEq&#47;L&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o do impacto da terap&#234;utica farmacol&#243;gica com a necessidade de PM&#44; a amiodarona foi agrupada &#224; digoxina de modo a conseguir uma amostra maior de antiarr&#237;tmicos quando comparado com o grupo dos beta&#8208;bloqueantes e tendo em conta a frequ&#234;ncia destes antiarr&#237;tmicos isolados e combinados na faixa et&#225;ria da popula&#231;&#227;o em estudo&#44; ao contr&#225;rio do sotalol e propafenona que s&#227;o menos frequentes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095"><span class="elsevierStyleItalic">Endpoint</span></span><p id="par0065" class="elsevierStylePara elsevierViewall">Com base na resposta &#224; suspens&#227;o do f&#225;rmaco e&#47;ou &#224; corre&#231;&#227;o i&#243;nica&#44; avali&#225;mos a percentagem de doentes em que houve necessidade de implanta&#231;&#227;o de PM no internamento ou durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; para a popula&#231;&#227;o total e para cada tipo de bradidisrritmia&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100"><span class="elsevierStyleItalic">Follow&#8208;up</span></span><p id="par0070" class="elsevierStylePara elsevierViewall">A dura&#231;&#227;o m&#233;dia do <span class="elsevierStyleItalic">follow&#8208;up</span> foi 24 &#177; 2 meses&#44; e durante este per&#237;odo foi avaliada a recorr&#234;ncia de bradidisrritmia clinicamente significativa e sintom&#225;tica&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">Para realizar a an&#225;lise estat&#237;stica utilizou&#8208;se o programa <span class="elsevierStyleItalic">IBM SPSS Statistics vers&#227;o 20</span> para <span class="elsevierStyleItalic">Windows 8&#46;</span> As vari&#225;veis cont&#237;nuas foram expressas em valor m&#233;dio &#177; desvio&#8208;padr&#227;o e comparadas com o <span class="elsevierStyleItalic">test T&#8208;Student&#769;s&#46;</span> As vari&#225;veis categ&#243;ricas foram expressas em valor absoluto e&#47;ou percentagem e comparadas com o teste qui&#8208;quadrado&#46; As associa&#231;&#245;es foram consideradas estatisticamente significativas na presen&#231;a de p&#8208;value &#60; 0&#44;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas basais da popula&#231;&#227;o total e de acordo com o tipo de bradidisrritmia s&#227;o apresentadas nas <a class="elsevierStyleCrossRefs" href="#tbl0005">tabelas 1 e 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Estudaram&#8208;se 153 doentes com idade m&#233;dia de 82 &#177; 11 anos&#44; sendo 47&#37; &#40;n &#61; 72&#41; do sexo masculino&#46; Cerca de 63&#37; &#40;n &#61; 97&#41; dos doentes apresentavam BAVC&#44; 16&#37; &#40;n &#61; 24&#41; Bradicardia sinusal&#44; 12&#37; &#40;n &#61; 18&#41; BAV 2&#46;&#176; grau e 9&#37; &#40;n &#61; 14&#41; Bradifibrilha&#231;&#227;o auricular&#46; A apresenta&#231;&#227;o cl&#237;nica mais frequente foi s&#237;ncope&#44; presente em 42&#37; &#40;n &#61; 64&#41; dos doentes&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A etiologia potencialmente revers&#237;vel associada &#224;s altera&#231;&#245;es eletrocardiogr&#225;ficas em 85&#37; &#40;n &#61; 130&#41; dos doentes foi atribu&#237;da &#224; terap&#234;utica farmacol&#243;gica&#59; em 12&#37; &#40;n &#61; 19&#41; terap&#234;utica farmacol&#243;gica associada a altera&#231;&#245;es i&#243;nicas e 3&#37; &#40;n &#61; 4&#41; a altera&#231;&#245;es i&#243;nicas isoladas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Dos doentes com iatrogenia medicamentosa isolada&#44; 38&#37; &#40;n &#61;49&#41; dos doentes encontrava&#8208;se sob terap&#234;utica beta&#8208;bloqueante&#44; 15&#37; &#40;n &#61; 20&#41; sob amiodarona&#44; 12&#37; &#40;n &#61; 16&#41; sob antagonistas dos canais de c&#225;lcio&#44; 5&#37; &#40;n &#61; 6&#41; sob digoxina&#59; 2&#37; &#40;n &#61; 2&#41; sob sotalol&#44; 3&#37; &#40;n &#61; 4&#41; sob propafenona e&#44; por sua vez&#44; 25&#37; &#40;n &#61; 33&#41; sob terap&#234;utica dupla ou tripla &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A implanta&#231;&#227;o de PM foi necess&#225;ria em 55&#37; &#40;n &#61; 84&#41; da popula&#231;&#227;o&#44; sendo que em 40&#37; dos doentes &#40;n &#61; 61&#41; este foi implantado no primeiro internamento&#46; Cerca de 15&#37; &#40;n &#61; 23&#41; da popula&#231;&#227;o apresentou revers&#227;o da bradidisrritmia ap&#243;s a suspens&#227;o do f&#225;rmaco&#47;corre&#231;&#227;o i&#243;nica&#44; contudo&#44; ao fim de um tempo mediano de 18 meses&#44; os doentes apresentaram novo epis&#243;dio de bradidisrritmia&#44; sem uma aparente etiologia revers&#237;vel e com necessidade de implanta&#231;&#227;o PM&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dos doentes submetidos a implanta&#231;&#227;o de PM&#44; o BAVC foi o tipo de bradidisrritmia mais frequente&#44; presente em 77&#37; &#40;n &#61; 65&#41; destes doentes&#44; seguindo&#8208;se o BAV 2&#46;&#176; grau em 17&#37; &#40;n &#61; 14&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cerca de 62&#37; &#40;n &#61; 81&#41; dos doentes sob terap&#234;utica farmacol&#243;gica&#44; apesar da suspens&#227;o da terap&#234;utica apresentaram necessidade de implanta&#231;&#227;o PM&#46; A terap&#234;utica farmacol&#243;gica isolada esteve associada a menor reversibilidade da bradidisrritmia&#44; com significado estat&#237;stico&#44; quando comparada com as restantes causas potencialmente revers&#237;veis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Quarenta e seis por cento dos doentes estava medicado com um beta&#8208;bloqueante&#44; 24&#37; faziam amiodarona e&#47;ou digoxina e 12&#37; estavam sob antagonistas dos canais de c&#225;lcio&#44; contudo sem significado estat&#237;stico &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">A necessidade de PM provis&#243;rio ocorreu em 28&#37; &#40;n &#61; 43&#41; da popula&#231;&#227;o&#44; sobretudo em contexto de BAVC&#44; destes 53&#37; &#40;n &#61; 23&#41; apresentou indica&#231;&#227;o para PM definitivo&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Doentes com revers&#227;o da bradidisrritmia e sem necessidade de PM apresentaram significativamente mais insufici&#234;ncia renal &#40;24 <span class="elsevierStyleItalic">versus</span> 5&#59; p &#60; 0&#44;001&#41;&#46; Dos doentes sem necessidade de PM a grande maioria tinha HTA &#40;hipertens&#227;o arterial&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quatro doentes morreram&#44; sendo que tr&#234;s doentes faleceram previamente &#224; implanta&#231;&#227;o de PM no internamento e um doente faleceu no internamento ap&#243;s implanta&#231;&#227;o do PM&#46; N&#227;o houve qualquer registo de morte nos doentes ap&#243;s a alta sem PM&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Nesta popula&#231;&#227;o&#44; a maioria dos doentes apresentou necessidade de implanta&#231;&#227;o de PM ap&#243;s a suspens&#227;o&#47;corre&#231;&#227;o da potencial causa revers&#237;vel&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A propor&#231;&#227;o de doentes que descontinua a terap&#234;utica e que requer a implanta&#231;&#227;o de PM &#233; desconhecida e o progn&#243;stico destes doentes ap&#243;s a alta sem PM &#233; igualmente desconhecido&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Em rela&#231;&#227;o &#224;s altera&#231;&#245;es metab&#243;licas a informa&#231;&#227;o &#233; escassa&#44; tendo em conta o aparente perfil benigno s&#227;o exclu&#237;das da maioria dos estudos de bradidisrritmias iatrog&#233;nicas&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es i&#243;nicas isoladas&#44; apesar do n&#250;mero reduzido de doentes com hipercaliemia estiveram em 75&#37; dos casos associadas a uma verdadeira bradidisrritmia iatrog&#233;nica com normaliza&#231;&#227;o do ritmo ap&#243;s a corre&#231;&#227;o da altera&#231;&#227;o&#44; sendo que apenas um doente apresentou necessidade de PM&#44; o que &#233; favor do seu car&#225;cter mais benigno&#46; Por sua vez&#44; 96&#37; &#40;n &#61; 81&#41; dos doentes que necessitaram de PM estavam sob terap&#234;utica farmacol&#243;gica&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Cerca de 25&#37; de doentes com bradidisrritmia induzida pela terap&#234;utica&#44; a disritmia n&#227;o &#233; causada pela terap&#234;utica mas&#44; sim&#44; revelada por esta&#44; sendo os beta&#8208;bloqueantes os principais &#171;f&#225;rmacos <span class="elsevierStyleItalic">culprits</span>&#187;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Zelter&#44; <span class="elsevierStyleItalic">et al&#46;</span> demonstraram que 56&#37; dos doentes com resolu&#231;&#227;o inicial do BAV ap&#243;s suspens&#227;o da terap&#234;utica apresentaram recorr&#234;ncia da bradidisrritmia e Knudsen&#44; <span class="elsevierStyleItalic">et al&#46;</span> retiraram a mesma conclus&#227;o em 25&#37; dos seus doentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;6</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Nesta popula&#231;&#227;o&#44; 25&#37; dos doentes que tiveram alta sem PM&#44; por aparente resolu&#231;&#227;o da bradidisrritmia&#44; apresentaram recorr&#234;ncia das altera&#231;&#245;es eletrocardiogr&#225;ficas com necessidade de PM durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">De acordo com a literatura&#44; f&#225;rmacos em doses terap&#234;uticas&#44; geralmente n&#227;o causam bradicardia significativa em doentes sem patologia card&#237;aca estrutural&#44; no entanto&#44; na presen&#231;a de doen&#231;a latente do n&#243;dulo sinusal e&#47;ou n&#243;dulo AV&#44; a terap&#234;utica farmacol&#243;gica pode ser o <span class="elsevierStyleItalic">trigger</span> para induzir a bradidisrritmia&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#8208;6</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Apesar de sem significado estat&#237;stico&#44; os beta&#8208;bloqueantes foram os f&#225;rmacos com menor reversibilidade da bradidisrritmia ap&#243;s a sua suspens&#227;o quando comparados com os antiarr&#237;tmicos&#44; o que foi igualmente evidenciado em outros estudos publicados&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Apesar da idade avan&#231;ada e antecedentes de cardiopatia isqu&#233;mica serem considerados preditores de risco pr&#243;&#8208;arr&#237;tmico&#44; nesta popula&#231;&#227;o este grupo de doentes n&#227;o apresentou maior taxa de implanta&#231;&#227;o de PM&#44; embora a idade m&#233;dia da popula&#231;&#227;o seja superior a 65 anos e 26&#37; tenha doen&#231;a coron&#225;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A bradidisrritmia no contexto de fibrilha&#231;&#227;o auricular &#233; relativamente frequente&#44; por sua vez&#44; a necessidade de PM&#44; de acordo com alguns estudos&#44; &#233; de 1&#44;4&#37; nos doentes sob amiodarona e 2&#44;5&#37; sob sotalol&#46; Israel&#44; <span class="elsevierStyleItalic">et al&#46;</span> mostraram que em 78 doentes com dupla cam&#226;ra com adapta&#231;&#227;o de frequ&#234;ncia card&#237;aca &#40;DDDR&#41; implantado no contexto de bradicardia sintom&#225;tica e FA parox&#237;stica&#47;permanente&#44; a bradicardia foi induzida por f&#225;rmacos em 33&#37; dos doentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;5</span></a> No nosso estudo&#44; apenas dois doentes&#44; ap&#243;s suspens&#227;o&#47;corre&#231;&#227;o da potencial causa revers&#237;vel&#44; apresentaram necessidade de PM&#44; o que &#233; a favor de um perfil com maior benignidade&#44; logo&#44; mais reversibilidade da bradifibrilha&#231;&#227;o auricular&#44; quando comparada com a doen&#231;a do n&#243;dulo AV&#46; Nenhum dos doentes com bradifibrilha&#231;&#227;o auricular que teve alta sem PM apresentou ao longo do <span class="elsevierStyleItalic">follow&#8208;up</span> novo epis&#243;dio de disritmia com necessidade de PM&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A doen&#231;a do n&#243;dulo AV &#40;BAVC e BAV 2&#46;&#176; grau&#41; apresentou menor reversibilidade&#44; sendo necess&#225;ria implanta&#231;&#227;o de PM em 55&#37; &#40;n &#61; 79&#41; dos doentes&#46; Cerca de 37&#37; &#40;n &#61; 21&#41; dos doentes com doen&#231;a do n&#243;dulo AV que tiveram alta sem PM apresentaram recorr&#234;ncia da disrritmia no <span class="elsevierStyleItalic">follow&#8208;up</span>&#46; Esta informa&#231;&#227;o coloca uma quest&#227;o pertinente&#58; devemos ponderar a implanta&#231;&#227;o PM logo ap&#243;s o primeiro epis&#243;dio desta disritmia&#63; Esta &#233; uma quest&#227;o com que v&#225;rios autores se depararam e para a qual ainda n&#227;o h&#225; uma resposta exata&#46; V&#225;rios estudos evidenciam que a doen&#231;a do n&#243;dulo AV n&#227;o surge em cora&#231;&#245;es normais&#44; quando surge&#44; mesmo que induzida pela terap&#234;utica&#44; est&#225; associada a doen&#231;a latente do sistema de condu&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">No presente estudo&#44; a grande maioria dos doentes com insufici&#234;ncia renal apresentou revers&#227;o da bradidisrritmia e&#44; consequentemente&#44; n&#227;o teve necessidade de implanta&#231;&#227;o de PM&#46; De acordo com a literatura&#44; a necessidade de PM &#233; mais frequente nos doentes com insufici&#234;ncia renal cr&#243;nica do que na popula&#231;&#227;o em geral&#46; O aumento de dist&#250;rbios da condu&#231;&#227;o AV em doentes com insufici&#234;ncia renal cr&#243;nica avan&#231;ada pode n&#227;o ser apenas consequ&#234;ncia da hipercaliemia&#44; mas por outros fatores como altera&#231;&#245;es no metabolismo do c&#225;lcio&#44; levando a fibrose e calcifica&#231;&#227;o das vias de condu&#231;&#227;o&#47;mioc&#225;rdio&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Provavelmente&#44; a gravidade da insufici&#234;ncia renal na nossa popula&#231;&#227;o era menor&#44; existindo revers&#227;o da bradidisrritmia apenas com corre&#231;&#227;o da iatrogenia &#40;metab&#243;lica e&#47;ou farmacol&#243;gica&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">A HTA &#233; uma comorbilidade cardiovascular frequente na popula&#231;&#227;o geral&#44; bem como no nosso estudo&#46; A HTA de acordo com a gravidade e dura&#231;&#227;o induz <span class="elsevierStyleItalic">remodelling</span> card&#237;aco&#44; o que pode interferir com a atividade el&#233;trica&#44; sendo frequente as disritmias&#44; sobretudo supraventriculares e ventriculares&#46; Os estudos multic&#234;ntricos referentes a altera&#231;&#245;es na condu&#231;&#227;o AV s&#227;o raros&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">A instabilidade hemodin&#226;mica e a consequente necessidade de PM provis&#243;rio n&#227;o foram associadas significativamente a maior necessidade de implanta&#231;&#227;o de PM definitivo&#44; provavelmente na presen&#231;a de uma amostra maior mais conclus&#245;es poderiam ser obtidas&#46; Nesta popula&#231;&#227;o a instabilidade hemodin&#226;mica n&#227;o foi associada &#224; perman&#234;ncia da bradidisrritmia&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Os tr&#234;s doentes que faleceram no internamento&#44; perante a instabilidade hemodin&#226;mica tiveram necessidade de PM provis&#243;rio&#44; contudo sem uma resposta eficaz e a morte n&#227;o foi considerada complica&#231;&#227;o deste procedimento&#46; Estes doentes apresentavam uma idade avan&#231;ada &#40;&#62; 80 anos&#41; e consequentemente diversas comorbilidades associadas&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Apesar da recorr&#234;ncia de bradidisritmia&#44; a aus&#234;ncia de mortalidade cardiovascular no <span class="elsevierStyleItalic">follow&#8208;up</span> transmite alguma seguran&#231;a em rela&#231;&#227;o &#224; atual pr&#225;tica cl&#237;nica&#44; em que a maioria dos doentes ap&#243;s resolvida a aparente iatrogenia tem alta sem PM definitivo&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limita&#231;&#245;es</span><p id="par0215" class="elsevierStylePara elsevierViewall">A natureza retrospetiva do estudo e a reduzida dimens&#227;o da amostra constituem as principais limita&#231;&#245;es do estudo&#46; Por sua vez&#44; o per&#237;odo relativamente curto de <span class="elsevierStyleItalic">follow&#8208;up</span> pode subestimar a frequ&#234;ncia de bradicardia&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">N&#227;o foi poss&#237;vel avaliar para todos os doentes a dosagem de cada f&#225;rmaco associado &#224; bradidisrritmia&#44; por falta desse registo na admiss&#227;o dos doentes&#44; bem como a informa&#231;&#227;o referente ao ritmo de escape e largura do QRS&#46; Esta &#250;ltima caracter&#237;stica cl&#237;nica tamb&#233;m n&#227;o foi poss&#237;vel caracterizar pela aus&#234;ncia de ECG &#40;eletrocardiograma&#41; digitalizados no per&#237;odo temporal do estudo&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Os doentes n&#227;o foram avaliados com monitoriza&#231;&#227;o de ambulat&#243;rio de 24<span class="elsevierStyleHsp" style=""></span>h &#40;Holter&#41;&#46; Os doentes podiam apresentar bradicardias assintom&#225;ticas ou bloqueios auriculoventriculares que poderiam ser identificados no Holter&#46; No estudo apenas avali&#225;mos as bradicardias sintom&#225;ticas com indica&#231;&#227;o para PM definitivo&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclus&#245;es</span><p id="par0230" class="elsevierStylePara elsevierViewall">Em doentes admitidos com bradidisrritmia associada a uma causa potencialmente revers&#237;vel&#44; principalmente no contexto de iatrogenia farmacol&#243;gica&#44; elevada percentagem de doentes apresenta persist&#234;ncia ou recorr&#234;ncia do quadro com necessidade de coloca&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Os doentes com iatrogenia associada a doen&#231;a do nodulo AV constituem um subgrupo de doentes com risco de recorr&#234;ncia mais elevado&#44; necessitando de maior vigil&#226;ncia durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; devendo&#8208;se ponderar nestes doentes a coloca&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo no primeiro epis&#243;dio&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflitos de interesse</span><p id="par0240" class="elsevierStylePara elsevierViewall">Os autores n&#227;o declaram conflitos de interesse&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Na bradidisrritmia &#40;BD&#41;&#44; associada a iatrogenia medicamentosa ou potenciais causas revers&#237;veis&#44; est&#225; recomendada a suspens&#227;o ou corre&#231;&#227;o das mesmas&#44; antes da implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo &#40;PM&#41;&#46; No entanto&#44; estes doentes &#40;dts&#41; apresentam frequentemente doen&#231;a do sistema de condu&#231;&#227;o&#44; existindo poucos dados relativos &#224; recorr&#234;ncia de BD e &#224; necessidade futura de PM&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o da necessidade de coloca&#231;&#227;o de PM em dts com BD iatrog&#233;nica ou associada a outra causa potencialmente revers&#237;vel&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados dts consecutivos sintom&#225;ticos admitidos no servi&#231;o de urg&#234;ncia com o diagn&#243;stico de BD &#40;Doen&#231;a do n&#243;dulo AV &#8211; bloqueio auriculoventricular e bloqueio auriculoventricular 2&#46;&#176; grau &#40;2&#58;1&#41;&#59; Bradicardia Sinusal &#40;BS&#41; e Bradifibrilha&#231;&#227;o auricular &#40;BFA&#41;&#41; no contexto de iatrogenia medicamentosa ou altera&#231;&#245;es metab&#243;licas&#46; Foi avaliada a percentagem de dts com necessidade de coloca&#231;&#227;o de PM&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estudaram&#8208;se 153 dts &#40;47&#37; sexo masculino&#41; admitidos com BS 16&#37;&#59; bloqueio auriculoventricular 63&#37;&#59; bloqueio auriculoventricular 2&#46;&#176; grau 12&#37;&#59; BFA 10&#37;&#46; Verificou&#8208;se iatrogenia medicamentosa em 85&#37; dos dts&#44; hipercaliemia em 3&#37; e etiologia combinada em 12&#37;&#46; Ap&#243;s suspens&#227;o da &#171;iatrogenia&#187;&#44; 55&#37; dos dts &#40;n &#61; 84&#41; colocou PM&#44; sendo o bloqueio auriculoventricular o tipo de bradidisrritmia mais frequente&#44; presente em 77&#37; &#40;n &#61; 65&#41; destes doentes&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Em dts admitidos com BD associada a uma potencial causa revers&#237;vel&#44; elevada percentagem de dts apresentam persist&#234;ncia ou recorr&#234;ncia do quadro com necessidade de PM&#46; Os dts com iatrogenia associada a doen&#231;a do n&#243;dulo AV constituem um subgrupo com risco de recorr&#234;ncia mais elevado&#44; necessitando de maior vigil&#226;ncia durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; devendo&#8208;se ponderar PM no primeiro epis&#243;dio&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In iatrogenic or potentially reversible bradyarrhythmia&#44; drug discontinuation or metabolic correction is recommended before permanent cardiac pacemaker &#40;PM&#41; implantation&#46; These patients often have conduction system disease and there are few data on recurrence or the need for a permanent PM&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">To analyze the need for PM implantation in patients with iatrogenic bradyarrhythmia or bradyarrhythmia associated with other potentially reversible causes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">We assessed consecutive symptomatic patients admitted to the emergency department with a primary diagnosis of bradyarrhythmia &#40;atrioventricular &#91;AV&#93; node disease &#8211; complete or second&#8208;degree AV block &#40;AVB&#41; &#91;CAVB&#58; 2nd&#8208;degree AVB &#8211; 2&#58;1&#93;&#44; sinus bradycardia &#91;SB&#93; and atrial fibrillation &#91;AF&#93; with slow ventricular response &#91;SVR&#93;&#41; in the context of iatrogenic causes or metabolic abnormalities&#46; We determined the percentage of patients who required PM implantation&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">We studied 153 patients &#40;47&#37; male&#41; admitted for iatrogenic or potentially reversible bradyarrhythmia&#46; Diagnoses were SB 16&#37;&#44; CAVB 63&#37;&#44; second&#8208;degree AVB 12&#37;&#44; and AF with SVR 10&#37;&#46; Eighty&#8208;five percent of patients were under negative chronotropic therapy&#44; 3&#37; had hyperkalemia and 12&#37; had a combined etiology&#46; After correction of the cause&#44; 55&#37; of patients &#40;n&#61;84&#41; needed a PM&#46; In these patients the most common type of bradyarrhythmia was CAVB&#44; in 77&#37; &#40;n&#61;65&#41; patients&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">In a high percentage of patients with bradyarrhythmia associated with a potentially reversible cause&#44; the arrhythmia recurs or does not resolve during follow&#8208;up&#46; Patients with AV node disease constitute a subgroup with a higher risk of recurrence who require greater vigilance during follow&#8208;up and should be considered for PM implantation after the first episode&#46;</p></span>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagrama&#58; Descri&#231;&#227;o da popula&#231;&#227;o com bradidisrritmia iatrog&#233;nica de acordo com a etiologia e a resposta &#224; suspens&#227;o da causa potencialmente revers&#237;vel&#46; PM&#58; <span class="elsevierStyleItalic">pacemaker</span> definitivo&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">BS&#58; bradicardia sinusal&#59; BAVC&#58; bloqueio auriculoventricular completo&#59; BFA&#58; bradifibrilha&#231;&#227;o auricular&#59; HTA&#58; hipertens&#227;o arterial&#59; DRC&#58; doen&#231;a renal cr&#243;nica&#59; PM&#58; <span class="elsevierStyleItalic">pacemaker</span>&#59; ACC&#58; antagonista dos canais de c&#225;lcio&#59; BB&#58; beta&#8208;bloqueantes&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o &#40;n &#61; 153&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BS &#40;n &#61; 24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BAVC &#40;n &#61; 97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BAV 2&#46;&#176; grau &#40;n &#61; 18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BFA &#40;n &#61; 14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80 &#177; 12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#177; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#177; 13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#37; &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&#37; &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#37; &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&#37; &#40;n &#61; 9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes Pessoais</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopatia Isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#37; &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92&#37; &#40;141&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#37; &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#37; &#40;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89&#37; &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#37; &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ncope&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tonturas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prosta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cansa&#231;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mal&#8208;estar inespec&#237;fico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dor precordial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dispneia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Morte Intra&#8208;hospitalar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pr&#233;&#8208; PM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ap&#243;s PM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necessidade de pm provis&#243;rio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Digoxina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Propafenona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; sotalol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#37; &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; propafenona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; AA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#37; &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#37; &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; digoxina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; ACC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; AA &#43; digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACC &#43; sotalol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Digoxina &#43; AA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; ACC &#43; digoxina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACC &#43; AA &#43; digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Altera&#231;&#245;es I&#243;nicas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipercaliemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terap&#234;utica &#43; altera&#231;&#245;es i&#243;nicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PM internamento &#40;n &#61; 61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem necessidade PM &#40;n &#61; 92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;<span class="elsevierStyleItalic">value</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PM total &#40;n &#61; 84&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem necessidade PM &#40;n &#61; 69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sexo Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#37; &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37; &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#37; &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45&#37; &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopatia isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37; &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#37; &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37; &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37; &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#37; &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#37; &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#37; &#40;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#37; &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#37; &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#37; &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#37; &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37; &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37; &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#37; &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37; &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37; &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37; &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#37; &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necessidade de PM provis&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37; &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37; &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#37; &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bradicardia sinusal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BAV completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77&#37; &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#37; &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BAV 2&#46;&#176; grau &#40;2&#58;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#37; &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">8&#37; &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">17&#37; &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bradifibrilha&#231;&#227;o auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#37; &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#37; &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F&#225;rmacos &#43; altera&#231;&#227;o i&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es i&#243;nicas &#40;hipercaliemia&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PM internamento&nbsp;\t\t\t\t\t\t\n
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Artigo Original
Bradidisrritmia puramente iatrogénica…existe?
Permanent cardiac pacing for patients with iatrogenic or potentially reversible bradyarrhythmia
Tatiana Duarte
Autor para correspondência
tatiana.isabel.duarte@gmail.com

Autor para correspondência.
, Sara Gonçalves, Catarina Sá, Rita Marinheiro, Marta Fonseca, José Farinha, Rita Rodrigues, Filipe Seixo, Leonor Parreira, Rui Caria
Serviço de Cardiologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
Lido
6235
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estes doentes apresentam frequentemente uma doen&#231;a latente do sistema de condu&#231;&#227;o&#44; existindo poucos dados relativos &#224; recorr&#234;ncia de bradidisrritimias nesta popula&#231;&#227;o e &#224; necessidade futura de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#8208;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">De acordo com estudos pr&#233;vios&#44; cerca de 25&#37; das bradidisrritmias n&#227;o s&#227;o causadas pela terap&#234;utica&#44; mas&#44; sim&#44; reveladas por esta&#44; sendo os beta&#8208;bloqueantes os &#171;f&#225;rmacos <span class="elsevierStyleItalic">culprits</span>&#187; mais frequentes&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es metab&#243;licas&#44; nomeadamente as altera&#231;&#245;es i&#243;nicas&#44; apresentam na sua maioria um perfil benigno&#44; com maior percentagem de revers&#227;o da bradidisrritmia&#44; sendo por este motivo frequentemente exclu&#237;das de estudos em bradidisrritmias iatrog&#233;nicas&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">No presente estudo pretendemos avaliar a necessidade de implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo em internamento ou ap&#243;s a alta numa amostra de doentes com bradidisrritmia associada a iatrogenia medicamentosa ou a outra causa potencialmente revers&#237;vel&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Amostra</span><p id="par0030" class="elsevierStylePara elsevierViewall">A amostra deste estudo foi constitu&#237;da por 153 doentes consecutivos admitidos no servi&#231;o de urg&#234;ncia num per&#237;odo de seis anos&#44; entre 2010 e 2015&#44; com o diagn&#243;stico principal de bradidisrritmia sintom&#225;tica &#40;doen&#231;a do n&#243;dulo AV&#58; bloqueio auriculoventricular completo &#91;BAVC&#93; e bloqueio auriculoventricular de 2&#46;&#176; grau &#91;BAV2&#93;&#59; bradicardia sinusal &#91;BS&#93; e bradifibrilha&#231;&#227;o auricular &#91;BFA&#93;&#41;&#44; no contexto de iatrogenia medicamentosa e&#47;ou altera&#231;&#245;es metab&#243;licas&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Vari&#225;veis</span><p id="par0035" class="elsevierStylePara elsevierViewall">A popula&#231;&#227;o do estudo foi caracterizada de acordo com as caracter&#237;sticas basais&#44; quadro cl&#237;nico&#44; tipo de bradidisrritmia&#44; terap&#234;utica de ambulat&#243;rio e altera&#231;&#245;es i&#243;nicas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de BAV 2&#46;&#176; grau neste estudo corresponde especificamente &#224; condu&#231;&#227;o auricular 2&#58;1&#44; sem registo na nossa amostra de algum caso de bloqueio Mobitz tipo I ou II&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Os doentes com FA e BAVC foram englobados no grupo do BAVC&#44; no grupo FA apenas foram inclu&#237;dos doentes com resposta ventricular lenta sem perturba&#231;&#227;o da condu&#231;&#227;o AV&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Na iatrogenia medicamentosa foram considerados os seguintes f&#225;rmacos&#58; beta&#8208;bloqueantes&#59; antagonistas dos canais de c&#225;lcio&#59; antiarr&#237;tmicos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nas altera&#231;&#245;es metab&#243;licas&#44; apenas foi considerada a hipercaliemia&#44; sendo inclu&#237;dos no estudo doentes com n&#237;veis de pot&#225;ssio s&#233;rico &#62; 6&#46;5 mEq&#47;L&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Na avalia&#231;&#227;o do impacto da terap&#234;utica farmacol&#243;gica com a necessidade de PM&#44; a amiodarona foi agrupada &#224; digoxina de modo a conseguir uma amostra maior de antiarr&#237;tmicos quando comparado com o grupo dos beta&#8208;bloqueantes e tendo em conta a frequ&#234;ncia destes antiarr&#237;tmicos isolados e combinados na faixa et&#225;ria da popula&#231;&#227;o em estudo&#44; ao contr&#225;rio do sotalol e propafenona que s&#227;o menos frequentes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095"><span class="elsevierStyleItalic">Endpoint</span></span><p id="par0065" class="elsevierStylePara elsevierViewall">Com base na resposta &#224; suspens&#227;o do f&#225;rmaco e&#47;ou &#224; corre&#231;&#227;o i&#243;nica&#44; avali&#225;mos a percentagem de doentes em que houve necessidade de implanta&#231;&#227;o de PM no internamento ou durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; para a popula&#231;&#227;o total e para cada tipo de bradidisrritmia&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100"><span class="elsevierStyleItalic">Follow&#8208;up</span></span><p id="par0070" class="elsevierStylePara elsevierViewall">A dura&#231;&#227;o m&#233;dia do <span class="elsevierStyleItalic">follow&#8208;up</span> foi 24 &#177; 2 meses&#44; e durante este per&#237;odo foi avaliada a recorr&#234;ncia de bradidisrritmia clinicamente significativa e sintom&#225;tica&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lise estat&#237;stica</span><p id="par0075" class="elsevierStylePara elsevierViewall">Para realizar a an&#225;lise estat&#237;stica utilizou&#8208;se o programa <span class="elsevierStyleItalic">IBM SPSS Statistics vers&#227;o 20</span> para <span class="elsevierStyleItalic">Windows 8&#46;</span> As vari&#225;veis cont&#237;nuas foram expressas em valor m&#233;dio &#177; desvio&#8208;padr&#227;o e comparadas com o <span class="elsevierStyleItalic">test T&#8208;Student&#769;s&#46;</span> As vari&#225;veis categ&#243;ricas foram expressas em valor absoluto e&#47;ou percentagem e comparadas com o teste qui&#8208;quadrado&#46; As associa&#231;&#245;es foram consideradas estatisticamente significativas na presen&#231;a de p&#8208;value &#60; 0&#44;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas basais da popula&#231;&#227;o total e de acordo com o tipo de bradidisrritmia s&#227;o apresentadas nas <a class="elsevierStyleCrossRefs" href="#tbl0005">tabelas 1 e 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Estudaram&#8208;se 153 doentes com idade m&#233;dia de 82 &#177; 11 anos&#44; sendo 47&#37; &#40;n &#61; 72&#41; do sexo masculino&#46; Cerca de 63&#37; &#40;n &#61; 97&#41; dos doentes apresentavam BAVC&#44; 16&#37; &#40;n &#61; 24&#41; Bradicardia sinusal&#44; 12&#37; &#40;n &#61; 18&#41; BAV 2&#46;&#176; grau e 9&#37; &#40;n &#61; 14&#41; Bradifibrilha&#231;&#227;o auricular&#46; A apresenta&#231;&#227;o cl&#237;nica mais frequente foi s&#237;ncope&#44; presente em 42&#37; &#40;n &#61; 64&#41; dos doentes&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A etiologia potencialmente revers&#237;vel associada &#224;s altera&#231;&#245;es eletrocardiogr&#225;ficas em 85&#37; &#40;n &#61; 130&#41; dos doentes foi atribu&#237;da &#224; terap&#234;utica farmacol&#243;gica&#59; em 12&#37; &#40;n &#61; 19&#41; terap&#234;utica farmacol&#243;gica associada a altera&#231;&#245;es i&#243;nicas e 3&#37; &#40;n &#61; 4&#41; a altera&#231;&#245;es i&#243;nicas isoladas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Dos doentes com iatrogenia medicamentosa isolada&#44; 38&#37; &#40;n &#61;49&#41; dos doentes encontrava&#8208;se sob terap&#234;utica beta&#8208;bloqueante&#44; 15&#37; &#40;n &#61; 20&#41; sob amiodarona&#44; 12&#37; &#40;n &#61; 16&#41; sob antagonistas dos canais de c&#225;lcio&#44; 5&#37; &#40;n &#61; 6&#41; sob digoxina&#59; 2&#37; &#40;n &#61; 2&#41; sob sotalol&#44; 3&#37; &#40;n &#61; 4&#41; sob propafenona e&#44; por sua vez&#44; 25&#37; &#40;n &#61; 33&#41; sob terap&#234;utica dupla ou tripla &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A implanta&#231;&#227;o de PM foi necess&#225;ria em 55&#37; &#40;n &#61; 84&#41; da popula&#231;&#227;o&#44; sendo que em 40&#37; dos doentes &#40;n &#61; 61&#41; este foi implantado no primeiro internamento&#46; Cerca de 15&#37; &#40;n &#61; 23&#41; da popula&#231;&#227;o apresentou revers&#227;o da bradidisrritmia ap&#243;s a suspens&#227;o do f&#225;rmaco&#47;corre&#231;&#227;o i&#243;nica&#44; contudo&#44; ao fim de um tempo mediano de 18 meses&#44; os doentes apresentaram novo epis&#243;dio de bradidisrritmia&#44; sem uma aparente etiologia revers&#237;vel e com necessidade de implanta&#231;&#227;o PM&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dos doentes submetidos a implanta&#231;&#227;o de PM&#44; o BAVC foi o tipo de bradidisrritmia mais frequente&#44; presente em 77&#37; &#40;n &#61; 65&#41; destes doentes&#44; seguindo&#8208;se o BAV 2&#46;&#176; grau em 17&#37; &#40;n &#61; 14&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cerca de 62&#37; &#40;n &#61; 81&#41; dos doentes sob terap&#234;utica farmacol&#243;gica&#44; apesar da suspens&#227;o da terap&#234;utica apresentaram necessidade de implanta&#231;&#227;o PM&#46; A terap&#234;utica farmacol&#243;gica isolada esteve associada a menor reversibilidade da bradidisrritmia&#44; com significado estat&#237;stico&#44; quando comparada com as restantes causas potencialmente revers&#237;veis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Quarenta e seis por cento dos doentes estava medicado com um beta&#8208;bloqueante&#44; 24&#37; faziam amiodarona e&#47;ou digoxina e 12&#37; estavam sob antagonistas dos canais de c&#225;lcio&#44; contudo sem significado estat&#237;stico &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">A necessidade de PM provis&#243;rio ocorreu em 28&#37; &#40;n &#61; 43&#41; da popula&#231;&#227;o&#44; sobretudo em contexto de BAVC&#44; destes 53&#37; &#40;n &#61; 23&#41; apresentou indica&#231;&#227;o para PM definitivo&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Doentes com revers&#227;o da bradidisrritmia e sem necessidade de PM apresentaram significativamente mais insufici&#234;ncia renal &#40;24 <span class="elsevierStyleItalic">versus</span> 5&#59; p &#60; 0&#44;001&#41;&#46; Dos doentes sem necessidade de PM a grande maioria tinha HTA &#40;hipertens&#227;o arterial&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Quatro doentes morreram&#44; sendo que tr&#234;s doentes faleceram previamente &#224; implanta&#231;&#227;o de PM no internamento e um doente faleceu no internamento ap&#243;s implanta&#231;&#227;o do PM&#46; N&#227;o houve qualquer registo de morte nos doentes ap&#243;s a alta sem PM&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discuss&#227;o</span><p id="par0135" class="elsevierStylePara elsevierViewall">Nesta popula&#231;&#227;o&#44; a maioria dos doentes apresentou necessidade de implanta&#231;&#227;o de PM ap&#243;s a suspens&#227;o&#47;corre&#231;&#227;o da potencial causa revers&#237;vel&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A propor&#231;&#227;o de doentes que descontinua a terap&#234;utica e que requer a implanta&#231;&#227;o de PM &#233; desconhecida e o progn&#243;stico destes doentes ap&#243;s a alta sem PM &#233; igualmente desconhecido&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Em rela&#231;&#227;o &#224;s altera&#231;&#245;es metab&#243;licas a informa&#231;&#227;o &#233; escassa&#44; tendo em conta o aparente perfil benigno s&#227;o exclu&#237;das da maioria dos estudos de bradidisrritmias iatrog&#233;nicas&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As altera&#231;&#245;es i&#243;nicas isoladas&#44; apesar do n&#250;mero reduzido de doentes com hipercaliemia estiveram em 75&#37; dos casos associadas a uma verdadeira bradidisrritmia iatrog&#233;nica com normaliza&#231;&#227;o do ritmo ap&#243;s a corre&#231;&#227;o da altera&#231;&#227;o&#44; sendo que apenas um doente apresentou necessidade de PM&#44; o que &#233; favor do seu car&#225;cter mais benigno&#46; Por sua vez&#44; 96&#37; &#40;n &#61; 81&#41; dos doentes que necessitaram de PM estavam sob terap&#234;utica farmacol&#243;gica&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Cerca de 25&#37; de doentes com bradidisrritmia induzida pela terap&#234;utica&#44; a disritmia n&#227;o &#233; causada pela terap&#234;utica mas&#44; sim&#44; revelada por esta&#44; sendo os beta&#8208;bloqueantes os principais &#171;f&#225;rmacos <span class="elsevierStyleItalic">culprits</span>&#187;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Zelter&#44; <span class="elsevierStyleItalic">et al&#46;</span> demonstraram que 56&#37; dos doentes com resolu&#231;&#227;o inicial do BAV ap&#243;s suspens&#227;o da terap&#234;utica apresentaram recorr&#234;ncia da bradidisrritmia e Knudsen&#44; <span class="elsevierStyleItalic">et al&#46;</span> retiraram a mesma conclus&#227;o em 25&#37; dos seus doentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;6</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Nesta popula&#231;&#227;o&#44; 25&#37; dos doentes que tiveram alta sem PM&#44; por aparente resolu&#231;&#227;o da bradidisrritmia&#44; apresentaram recorr&#234;ncia das altera&#231;&#245;es eletrocardiogr&#225;ficas com necessidade de PM durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">De acordo com a literatura&#44; f&#225;rmacos em doses terap&#234;uticas&#44; geralmente n&#227;o causam bradicardia significativa em doentes sem patologia card&#237;aca estrutural&#44; no entanto&#44; na presen&#231;a de doen&#231;a latente do n&#243;dulo sinusal e&#47;ou n&#243;dulo AV&#44; a terap&#234;utica farmacol&#243;gica pode ser o <span class="elsevierStyleItalic">trigger</span> para induzir a bradidisrritmia&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#8208;6</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Apesar de sem significado estat&#237;stico&#44; os beta&#8208;bloqueantes foram os f&#225;rmacos com menor reversibilidade da bradidisrritmia ap&#243;s a sua suspens&#227;o quando comparados com os antiarr&#237;tmicos&#44; o que foi igualmente evidenciado em outros estudos publicados&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Apesar da idade avan&#231;ada e antecedentes de cardiopatia isqu&#233;mica serem considerados preditores de risco pr&#243;&#8208;arr&#237;tmico&#44; nesta popula&#231;&#227;o este grupo de doentes n&#227;o apresentou maior taxa de implanta&#231;&#227;o de PM&#44; embora a idade m&#233;dia da popula&#231;&#227;o seja superior a 65 anos e 26&#37; tenha doen&#231;a coron&#225;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A bradidisrritmia no contexto de fibrilha&#231;&#227;o auricular &#233; relativamente frequente&#44; por sua vez&#44; a necessidade de PM&#44; de acordo com alguns estudos&#44; &#233; de 1&#44;4&#37; nos doentes sob amiodarona e 2&#44;5&#37; sob sotalol&#46; Israel&#44; <span class="elsevierStyleItalic">et al&#46;</span> mostraram que em 78 doentes com dupla cam&#226;ra com adapta&#231;&#227;o de frequ&#234;ncia card&#237;aca &#40;DDDR&#41; implantado no contexto de bradicardia sintom&#225;tica e FA parox&#237;stica&#47;permanente&#44; a bradicardia foi induzida por f&#225;rmacos em 33&#37; dos doentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;5</span></a> No nosso estudo&#44; apenas dois doentes&#44; ap&#243;s suspens&#227;o&#47;corre&#231;&#227;o da potencial causa revers&#237;vel&#44; apresentaram necessidade de PM&#44; o que &#233; a favor de um perfil com maior benignidade&#44; logo&#44; mais reversibilidade da bradifibrilha&#231;&#227;o auricular&#44; quando comparada com a doen&#231;a do n&#243;dulo AV&#46; Nenhum dos doentes com bradifibrilha&#231;&#227;o auricular que teve alta sem PM apresentou ao longo do <span class="elsevierStyleItalic">follow&#8208;up</span> novo epis&#243;dio de disritmia com necessidade de PM&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A doen&#231;a do n&#243;dulo AV &#40;BAVC e BAV 2&#46;&#176; grau&#41; apresentou menor reversibilidade&#44; sendo necess&#225;ria implanta&#231;&#227;o de PM em 55&#37; &#40;n &#61; 79&#41; dos doentes&#46; Cerca de 37&#37; &#40;n &#61; 21&#41; dos doentes com doen&#231;a do n&#243;dulo AV que tiveram alta sem PM apresentaram recorr&#234;ncia da disrritmia no <span class="elsevierStyleItalic">follow&#8208;up</span>&#46; Esta informa&#231;&#227;o coloca uma quest&#227;o pertinente&#58; devemos ponderar a implanta&#231;&#227;o PM logo ap&#243;s o primeiro epis&#243;dio desta disritmia&#63; Esta &#233; uma quest&#227;o com que v&#225;rios autores se depararam e para a qual ainda n&#227;o h&#225; uma resposta exata&#46; V&#225;rios estudos evidenciam que a doen&#231;a do n&#243;dulo AV n&#227;o surge em cora&#231;&#245;es normais&#44; quando surge&#44; mesmo que induzida pela terap&#234;utica&#44; est&#225; associada a doen&#231;a latente do sistema de condu&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;4</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">No presente estudo&#44; a grande maioria dos doentes com insufici&#234;ncia renal apresentou revers&#227;o da bradidisrritmia e&#44; consequentemente&#44; n&#227;o teve necessidade de implanta&#231;&#227;o de PM&#46; De acordo com a literatura&#44; a necessidade de PM &#233; mais frequente nos doentes com insufici&#234;ncia renal cr&#243;nica do que na popula&#231;&#227;o em geral&#46; O aumento de dist&#250;rbios da condu&#231;&#227;o AV em doentes com insufici&#234;ncia renal cr&#243;nica avan&#231;ada pode n&#227;o ser apenas consequ&#234;ncia da hipercaliemia&#44; mas por outros fatores como altera&#231;&#245;es no metabolismo do c&#225;lcio&#44; levando a fibrose e calcifica&#231;&#227;o das vias de condu&#231;&#227;o&#47;mioc&#225;rdio&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Provavelmente&#44; a gravidade da insufici&#234;ncia renal na nossa popula&#231;&#227;o era menor&#44; existindo revers&#227;o da bradidisrritmia apenas com corre&#231;&#227;o da iatrogenia &#40;metab&#243;lica e&#47;ou farmacol&#243;gica&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">A HTA &#233; uma comorbilidade cardiovascular frequente na popula&#231;&#227;o geral&#44; bem como no nosso estudo&#46; A HTA de acordo com a gravidade e dura&#231;&#227;o induz <span class="elsevierStyleItalic">remodelling</span> card&#237;aco&#44; o que pode interferir com a atividade el&#233;trica&#44; sendo frequente as disritmias&#44; sobretudo supraventriculares e ventriculares&#46; Os estudos multic&#234;ntricos referentes a altera&#231;&#245;es na condu&#231;&#227;o AV s&#227;o raros&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">A instabilidade hemodin&#226;mica e a consequente necessidade de PM provis&#243;rio n&#227;o foram associadas significativamente a maior necessidade de implanta&#231;&#227;o de PM definitivo&#44; provavelmente na presen&#231;a de uma amostra maior mais conclus&#245;es poderiam ser obtidas&#46; Nesta popula&#231;&#227;o a instabilidade hemodin&#226;mica n&#227;o foi associada &#224; perman&#234;ncia da bradidisrritmia&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Os tr&#234;s doentes que faleceram no internamento&#44; perante a instabilidade hemodin&#226;mica tiveram necessidade de PM provis&#243;rio&#44; contudo sem uma resposta eficaz e a morte n&#227;o foi considerada complica&#231;&#227;o deste procedimento&#46; Estes doentes apresentavam uma idade avan&#231;ada &#40;&#62; 80 anos&#41; e consequentemente diversas comorbilidades associadas&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Apesar da recorr&#234;ncia de bradidisritmia&#44; a aus&#234;ncia de mortalidade cardiovascular no <span class="elsevierStyleItalic">follow&#8208;up</span> transmite alguma seguran&#231;a em rela&#231;&#227;o &#224; atual pr&#225;tica cl&#237;nica&#44; em que a maioria dos doentes ap&#243;s resolvida a aparente iatrogenia tem alta sem PM definitivo&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limita&#231;&#245;es</span><p id="par0215" class="elsevierStylePara elsevierViewall">A natureza retrospetiva do estudo e a reduzida dimens&#227;o da amostra constituem as principais limita&#231;&#245;es do estudo&#46; Por sua vez&#44; o per&#237;odo relativamente curto de <span class="elsevierStyleItalic">follow&#8208;up</span> pode subestimar a frequ&#234;ncia de bradicardia&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">N&#227;o foi poss&#237;vel avaliar para todos os doentes a dosagem de cada f&#225;rmaco associado &#224; bradidisrritmia&#44; por falta desse registo na admiss&#227;o dos doentes&#44; bem como a informa&#231;&#227;o referente ao ritmo de escape e largura do QRS&#46; Esta &#250;ltima caracter&#237;stica cl&#237;nica tamb&#233;m n&#227;o foi poss&#237;vel caracterizar pela aus&#234;ncia de ECG &#40;eletrocardiograma&#41; digitalizados no per&#237;odo temporal do estudo&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Os doentes n&#227;o foram avaliados com monitoriza&#231;&#227;o de ambulat&#243;rio de 24<span class="elsevierStyleHsp" style=""></span>h &#40;Holter&#41;&#46; Os doentes podiam apresentar bradicardias assintom&#225;ticas ou bloqueios auriculoventriculares que poderiam ser identificados no Holter&#46; No estudo apenas avali&#225;mos as bradicardias sintom&#225;ticas com indica&#231;&#227;o para PM definitivo&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclus&#245;es</span><p id="par0230" class="elsevierStylePara elsevierViewall">Em doentes admitidos com bradidisrritmia associada a uma causa potencialmente revers&#237;vel&#44; principalmente no contexto de iatrogenia farmacol&#243;gica&#44; elevada percentagem de doentes apresenta persist&#234;ncia ou recorr&#234;ncia do quadro com necessidade de coloca&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Os doentes com iatrogenia associada a doen&#231;a do nodulo AV constituem um subgrupo de doentes com risco de recorr&#234;ncia mais elevado&#44; necessitando de maior vigil&#226;ncia durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; devendo&#8208;se ponderar nestes doentes a coloca&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo no primeiro epis&#243;dio&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflitos de interesse</span><p id="par0240" class="elsevierStylePara elsevierViewall">Os autores n&#227;o declaram conflitos de interesse&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Na bradidisrritmia &#40;BD&#41;&#44; associada a iatrogenia medicamentosa ou potenciais causas revers&#237;veis&#44; est&#225; recomendada a suspens&#227;o ou corre&#231;&#227;o das mesmas&#44; antes da implanta&#231;&#227;o de <span class="elsevierStyleItalic">pacemaker</span> definitivo &#40;PM&#41;&#46; No entanto&#44; estes doentes &#40;dts&#41; apresentam frequentemente doen&#231;a do sistema de condu&#231;&#227;o&#44; existindo poucos dados relativos &#224; recorr&#234;ncia de BD e &#224; necessidade futura de PM&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o da necessidade de coloca&#231;&#227;o de PM em dts com BD iatrog&#233;nica ou associada a outra causa potencialmente revers&#237;vel&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados dts consecutivos sintom&#225;ticos admitidos no servi&#231;o de urg&#234;ncia com o diagn&#243;stico de BD &#40;Doen&#231;a do n&#243;dulo AV &#8211; bloqueio auriculoventricular e bloqueio auriculoventricular 2&#46;&#176; grau &#40;2&#58;1&#41;&#59; Bradicardia Sinusal &#40;BS&#41; e Bradifibrilha&#231;&#227;o auricular &#40;BFA&#41;&#41; no contexto de iatrogenia medicamentosa ou altera&#231;&#245;es metab&#243;licas&#46; Foi avaliada a percentagem de dts com necessidade de coloca&#231;&#227;o de PM&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Estudaram&#8208;se 153 dts &#40;47&#37; sexo masculino&#41; admitidos com BS 16&#37;&#59; bloqueio auriculoventricular 63&#37;&#59; bloqueio auriculoventricular 2&#46;&#176; grau 12&#37;&#59; BFA 10&#37;&#46; Verificou&#8208;se iatrogenia medicamentosa em 85&#37; dos dts&#44; hipercaliemia em 3&#37; e etiologia combinada em 12&#37;&#46; Ap&#243;s suspens&#227;o da &#171;iatrogenia&#187;&#44; 55&#37; dos dts &#40;n &#61; 84&#41; colocou PM&#44; sendo o bloqueio auriculoventricular o tipo de bradidisrritmia mais frequente&#44; presente em 77&#37; &#40;n &#61; 65&#41; destes doentes&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Em dts admitidos com BD associada a uma potencial causa revers&#237;vel&#44; elevada percentagem de dts apresentam persist&#234;ncia ou recorr&#234;ncia do quadro com necessidade de PM&#46; Os dts com iatrogenia associada a doen&#231;a do n&#243;dulo AV constituem um subgrupo com risco de recorr&#234;ncia mais elevado&#44; necessitando de maior vigil&#226;ncia durante o <span class="elsevierStyleItalic">follow&#8208;up</span>&#44; devendo&#8208;se ponderar PM no primeiro epis&#243;dio&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In iatrogenic or potentially reversible bradyarrhythmia&#44; drug discontinuation or metabolic correction is recommended before permanent cardiac pacemaker &#40;PM&#41; implantation&#46; These patients often have conduction system disease and there are few data on recurrence or the need for a permanent PM&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">To analyze the need for PM implantation in patients with iatrogenic bradyarrhythmia or bradyarrhythmia associated with other potentially reversible causes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">We assessed consecutive symptomatic patients admitted to the emergency department with a primary diagnosis of bradyarrhythmia &#40;atrioventricular &#91;AV&#93; node disease &#8211; complete or second&#8208;degree AV block &#40;AVB&#41; &#91;CAVB&#58; 2nd&#8208;degree AVB &#8211; 2&#58;1&#93;&#44; sinus bradycardia &#91;SB&#93; and atrial fibrillation &#91;AF&#93; with slow ventricular response &#91;SVR&#93;&#41; in the context of iatrogenic causes or metabolic abnormalities&#46; We determined the percentage of patients who required PM implantation&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">We studied 153 patients &#40;47&#37; male&#41; admitted for iatrogenic or potentially reversible bradyarrhythmia&#46; Diagnoses were SB 16&#37;&#44; CAVB 63&#37;&#44; second&#8208;degree AVB 12&#37;&#44; and AF with SVR 10&#37;&#46; Eighty&#8208;five percent of patients were under negative chronotropic therapy&#44; 3&#37; had hyperkalemia and 12&#37; had a combined etiology&#46; After correction of the cause&#44; 55&#37; of patients &#40;n&#61;84&#41; needed a PM&#46; In these patients the most common type of bradyarrhythmia was CAVB&#44; in 77&#37; &#40;n&#61;65&#41; patients&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">In a high percentage of patients with bradyarrhythmia associated with a potentially reversible cause&#44; the arrhythmia recurs or does not resolve during follow&#8208;up&#46; Patients with AV node disease constitute a subgroup with a higher risk of recurrence who require greater vigilance during follow&#8208;up and should be considered for PM implantation after the first episode&#46;</p></span>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagrama&#58; Descri&#231;&#227;o da popula&#231;&#227;o com bradidisrritmia iatrog&#233;nica de acordo com a etiologia e a resposta &#224; suspens&#227;o da causa potencialmente revers&#237;vel&#46; PM&#58; <span class="elsevierStyleItalic">pacemaker</span> definitivo&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">BS&#58; bradicardia sinusal&#59; BAVC&#58; bloqueio auriculoventricular completo&#59; BFA&#58; bradifibrilha&#231;&#227;o auricular&#59; HTA&#58; hipertens&#227;o arterial&#59; DRC&#58; doen&#231;a renal cr&#243;nica&#59; PM&#58; <span class="elsevierStyleItalic">pacemaker</span>&#59; ACC&#58; antagonista dos canais de c&#225;lcio&#59; BB&#58; beta&#8208;bloqueantes&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Popula&#231;&#227;o &#40;n &#61; 153&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BS &#40;n &#61; 24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BAVC &#40;n &#61; 97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BAV 2&#46;&#176; grau &#40;n &#61; 18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BFA &#40;n &#61; 14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80 &#177; 12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#177; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#177; 13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#37; &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&#37; &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#37; &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&#37; &#40;n &#61; 9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes Pessoais</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopatia Isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#37; &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92&#37; &#40;141&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#37; &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#37; &#40;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89&#37; &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#37; &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ncope&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tonturas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prosta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cansa&#231;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mal&#8208;estar inespec&#237;fico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dor precordial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dispneia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Morte Intra&#8208;hospitalar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pr&#233;&#8208; PM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ap&#243;s PM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necessidade de pm provis&#243;rio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Digoxina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Propafenona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; sotalol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#37; &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; propafenona&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; AA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#37; &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#37; &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; digoxina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; ACC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; AA &#43; digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACC &#43; sotalol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Digoxina &#43; AA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BB &#43; ACC &#43; digoxina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACC &#43; AA &#43; digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;6&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Altera&#231;&#245;es I&#243;nicas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipercaliemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terap&#234;utica &#43; altera&#231;&#245;es i&#243;nicas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PM internamento &#40;n &#61; 61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem necessidade PM &#40;n &#61; 92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;<span class="elsevierStyleItalic">value</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PM total &#40;n &#61; 84&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem necessidade PM &#40;n &#61; 69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sexo Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#37; &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37; &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#37; &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45&#37; &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopatia isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37; &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#37; &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37; &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia card&#237;aca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37; &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#37; &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#37; &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#37; &#40;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#37; &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#37; &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#37; &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#37; &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37; &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37; &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#37; &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37; &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37; &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insufici&#234;ncia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37; &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#37; &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necessidade de PM provis&#243;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37; &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37; &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#37; &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bradicardia sinusal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37; &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BAV completo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77&#37; &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#37; &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BAV 2&#46;&#176; grau &#40;2&#58;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#37; &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">8&#37; &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">17&#37; &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bradifibrilha&#231;&#227;o auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#37; &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#37; &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F&#225;rmacos &#43; altera&#231;&#227;o i&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Altera&#231;&#245;es i&#243;nicas &#40;hipercaliemia&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PM internamento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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Informação do artigo
ISSN: 08702551
Idioma original: Português
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2022 Dezembro 74 23 97
2022 Novembro 63 35 98
2022 Outubro 74 40 114
2022 Setembro 46 45 91
2022 Agosto 72 43 115
2022 Julho 65 46 111
2022 Junho 37 33 70
2022 Maio 56 45 101
2022 Abril 53 41 94
2022 Maro 44 43 87
2022 Fevereiro 60 49 109
2022 Janeiro 74 51 125
2021 Dezembro 49 40 89
2021 Novembro 54 52 106
2021 Outubro 175 56 231
2021 Setembro 85 35 120
2021 Agosto 56 48 104
2021 Julho 45 28 73
2021 Junho 60 37 97
2021 Maio 54 37 91
2021 Abril 105 51 156
2021 Maro 109 24 133
2021 Fevereiro 89 26 115
2021 Janeiro 59 34 93
2020 Dezembro 42 22 64
2020 Novembro 57 26 83
2020 Outubro 69 29 98
2020 Setembro 45 18 63
2020 Agosto 45 13 58
2020 Julho 39 26 65
2020 Junho 58 16 74
2020 Maio 51 17 68
2020 Abril 44 16 60
2020 Maro 51 16 67
2020 Fevereiro 77 53 130
2020 Janeiro 44 16 60
2019 Dezembro 69 20 89
2019 Novembro 33 15 48
2019 Outubro 32 22 54
2019 Setembro 83 15 98
2019 Agosto 39 11 50
2019 Julho 29 16 45
2019 Junho 57 39 96
2019 Maio 42 20 62
2019 Abril 66 34 100
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Revista Portuguesa de Cardiologia
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