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Brito J, Cortez-Dias N, da Silva GL, Ferreira AN, Ricardo IA, Cunha N, António PS, Neves I, Paiva S, Paixão A, Gaspar F, Silva A, Magalhães A, Marques P, Pinto FJ, de Sousa J. Association between the number of altered late potential criteria and increased arrhythmic risk in Brugada syndrome patients. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01685-8. [PMID: 37966657 DOI: 10.1007/s10840-023-01685-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Brugada syndrome (BrS) is associated with abnormal electrophysiological properties at right ventricular epicardium, consisting of fragmented electrograms extending well beyond QRS termination. We aimed to evaluate the utility of signal-averaged electrocardiogram (SA-ECG) for the noninvasive assessment of late potentials (LP) and risk stratification of BrS patients. METHODS A prospective, observational, single-center study of BrS patients is submitted to SA-ECG with the determination of the total filtered QRS duration (fQRS), root mean square voltage of the 40 ms terminal portion of the QRS (RMS40), and duration of the low-amplitude electric potential component of the terminal portion of the QRS (LAS40). LP were considered positive when above standard cut-offs: fQRS > 114 ms, RMS40 < 20 µV, and LAS40 > 38 ms. The rates of malignant arrhythmic events (MAEs), defined as sudden death or appropriate shocks, were compared in relation to clinical characteristics and SA-ECG findings. RESULTS A total of 106 BrS patients (mean age, 48 ± 12 years, 67.9% male) were studied, 49% with type-1 spontaneous pattern and 81% asymptomatic. During a median follow up of 4.7 years, 10 patients (7.1%) suffered MAEs, including 4 sudden deaths. The presence of LP was significantly associated with the arrhythmic risk, which increased with the number of altered LP criteria. In comparison to the patients who had none or 1 altered LP criterium, MAE risk was 4.7 times higher in those with 2 altered criteria and 9.4 times higher in those with 3 altered LP criteria. CONCLUSIONS SA-ECG may be a useful tool for risk stratification in BrS. The presence of 2 or 3 abnormal LP criteria could identify a subset of asymptomatic patients at high risk of arrhythmic events.
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Affiliation(s)
- Joana Brito
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal.
| | - Nuno Cortez-Dias
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Gustavo Lima da Silva
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Afonso Nunes Ferreira
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Inês Aguiar Ricardo
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Nelson Cunha
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Pedro Silvério António
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Irina Neves
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Sandra Paiva
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Ana Paixão
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Fernanda Gaspar
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Adília Silva
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Andreia Magalhães
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Pedro Marques
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Fausto J Pinto
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - João de Sousa
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
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Brito J, Rodrigues T, António PS, Ferreira AN, da Silva GL, Bernardes A, Barreiros C, Ribeiro J, Carpinteiro L, Cortez-Dias N, Pinto FJ, de Sousa J. Does a left common pulmonary trunk anatomy represent a real limitation for atrial fibrillation cryoablation success? J Interv Card Electrophysiol 2023; 66:1333-1335. [PMID: 37014481 DOI: 10.1007/s10840-023-01537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Joana Brito
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
| | - Tiago Rodrigues
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Silvério António
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Afonso Nunes Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana Bernardes
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Céu Barreiros
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
| | - João Ribeiro
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Luís Carpinteiro
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João de Sousa
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
- Cardiovascular Centre of the University of Lisbon (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Carrington M, António PS, Rodrigues N, Nunes-Ferreira A, Bernardes A, Pinto FJ, Sousa JD, Marques P. New Technique for Preserving Cephalic Vein Flow in Pacemaker Implantation Ipsilateral to Arteriovenous Fistula. Arq Bras Cardiol 2023; 120:e20220926. [PMID: 37377197 DOI: 10.36660/abc.20220926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/08/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Mafalda Carrington
- Serviço de Cardiologia, Hospital do Espírito Santo de Évora, Évora - Portugal
| | - Pedro Silvério António
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Natacha Rodrigues
- Serviço de Nefrologia e Transplante Renal, Departamento de Medicina, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Ana Bernardes
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - João de Sousa
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
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Cortez-Dias N, Lima da Silva G, Nunes Ferreira A, Quaresma J, Sobral S, Carpinteiro L, de Sousa J. SparkleMap-based left atrial flutter mapping and ablation. Rev Port Cardiol 2023; 42:385-389. [PMID: 36893834 DOI: 10.1016/j.repc.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 06/30/2020] [Accepted: 08/09/2020] [Indexed: 03/09/2023] Open
Abstract
Ablation of atypical left atrial flutters (LAF) is very challenging due to the complexity of the underlying atrial substrate and diverse arrhythmia mechanisms. The interpretation of the arrhythmia mechanism is usually difficult, even using advanced three-dimensional (3D) mapping systems. SparkleMap is a novel mapping algorithm that displays each electrogram as a green dot that lights up at the point corresponding to the local activation time, superimposed either on the substrate or the local activation time 3D-maps. It is not affected by the setting of the "window of interest" and there is no need for user post-processing. We present the case of patient with a persistent atypical LAF in whom we tested the concept of complex arrhythmia interpretation exclusively based on the analysis of the substrate and evaluation of SparkleMap-derived wavefront propagation. We describe the workflow for map collection and the systematic approach for arrhythmia interpretation that resulted in the identification of a dual loop perimitral mechanism with a common slow conducting isthmus inside a scar at the septum/anterior atrial wall. This new method of analysis enabled the use of a specifically targeted and precise approach for ablation, with restoration of sinus rhythm within five seconds of radiofrequency application. After 18 months of follow-up, the patient remains free from recurrences, without anti-arrhythmic medication. This case report exemplifies how helpful new mapping algorithms can be in the interpretation of the arrhythmia mechanism in patients with complex LAF. It also suggests an innovative workflow to integrate the SparkleMap into the mapping approach.
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Affiliation(s)
- Nuno Cortez-Dias
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal.
| | - Gustavo Lima da Silva
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal
| | - Afonso Nunes Ferreira
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal
| | - Joana Quaresma
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal
| | - Sílvia Sobral
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal
| | - Luís Carpinteiro
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal
| | - João de Sousa
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon, Faculty of Medicine, Portugal
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Lima da Silva G, Cortez-Dias N, Nunes Ferreira A, Nakar E, Francisco R, Pereira M, Moreno J, Martins RP, Pinto FJ, de Sousa J. Impact of different activation wavefronts on ischemic myocardial scar electrophysiological properties during high-density ventricular tachycardia mapping and ablation. J Cardiovasc Electrophysiol 2023; 34:389-399. [PMID: 36335623 DOI: 10.1111/jce.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Scar-related ventricular tachycardia (VT) usually results from an underlying reentrant circuit facilitated by anatomical and functional barriers. The later are sensitive to the direction of ventricular activation wavefronts. We aim to evaluate the impact of different ventricular activation wavefronts on the functional electrophysiological properties of myocardial tissue. METHODS Patients with ischemic heart disease referred for VT ablation underwent high-density mapping using Carto®3 (Biosense Webster). Maps were generated during sinus rhythm, right and left ventricular pacing, and analyzed using a new late potential map software, which allows to assess local conduction velocities and facilitates the delineation of intra-scar conduction corridors (ISCC); and for all stable VTs. RESULTS In 16 patients, 31 high-resolution substrate maps from different ventricular activation wavefronts and 7 VT activation maps were obtained. Local abnormal ventricular activities (LAVAs) were found in VT isthmus, but also in noncritical areas. The VT isthmus was localized in areas of LAVAs overlapping surface between the different activation wavefronts. The deceleration zone location differed depending on activation wavefronts. Sixty-six percent of ISCCs were similarly identified in all activating wavefronts, but the one acting as VT isthmus was simultaneously identified in all activation wavefronts in all cases. CONCLUSION Functional based substrate mapping may improve the specificity to localize the most arrhythmogenic regions within the scar, making the use of different activation wavefronts unnecessary in most cases.
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Affiliation(s)
- Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiac Rhythm Abnormalities Unit, Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiac Rhythm Abnormalities Unit, Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Afonso Nunes Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiac Rhythm Abnormalities Unit, Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Elad Nakar
- Research and Development Department, Biosense Webster, Johnson & Johnson, Yokneam, Israel
| | - Raquel Francisco
- Biosense Webster, Johnson & Johnson, EMEA Clinical Development, Diegem, Belgium
| | - Mariana Pereira
- Biosense Webster, Johnson & Johnson, Clinical Support, Porto Salvo, Portugal
| | - Javier Moreno
- Cardiology Department, Arrhythmia Unit, University Hospital Ramón y Cajal and CIBER-CV Madrid, Madrid, Spain
| | - Raphaël P Martins
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiac Rhythm Abnormalities Unit, Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - João de Sousa
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiac Rhythm Abnormalities Unit, Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
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Cortez-Dias N, da Silva GL, Ferreira AN, Nakar E, Francisco R, Pereira M, Carpinteiro L, Pinto FJ, de Sousa J. NOVEL "LATE POTENTIAL MAP" ALGORITHM: ABNORMAL POTENTIALS AND SCAR CHANNELS DETECTION FOR VENTRICULAR TACHYCARDIA ABLATION. J Cardiovasc Electrophysiol 2022; 33:1211-1222. [PMID: 35338745 DOI: 10.1111/jce.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/27/2022] [Accepted: 03/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Automated systems for substrate mapping in context of ventricular tachycardia (VT) ablation may annotate far-field rather than near-field signals, rendering the resulting maps hard to interpret. Additionally, quantitative assessment of local conduction velocity (LCV) remains an unmet need in clinical practice. We evaluate whether a new Late Potential Map (LPM) algorithm can provide an automatic and reliable annotation and localized bipolar voltage measurement of ventricular electrograms, and if LCV analysis allows to recognize intra-scar conduction corridors acting as VT isthmuses. METHODS In 16 patients referred for scar-related VT ablation, 8 VT activation maps and 29 high-resolution substrate maps from different activation wavefronts were obtained. In offline analysis, the LPM algorithm was compared to manually annotated substrate maps. Locations of the VT isthmuses were compared with the corresponding substrate maps in regard to LCV. RESULTS The LPM algorithm had an overall/local abnormal ventricular activity (LAVA) annotation accuracy of 94.5%/81.1%, which compares to 83.7%/23.9% for the previous Wavefront algorithm. The resultant maps presented a spatial concordance of 88.1% in delineating regions displaying local abnormal ventricular activity (LAVA). LAVA median localized bipolar voltage was 0.22 mV, but voltage amplitude assessment had modest accuracy in distinguishing LAVA from other abnormal electrograms (AUC:0.676; p<0.001). LCV analysis in high-density substrate maps identified a median of 2 intra-scar conduction corridors per patient (IQR: 2-3), including the one acting as VT isthmus in all cases. CONCLUSION The new LPM algorithm and LCV analysis may enhance substrate characterization in scar-related VT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Afonso Nunes Ferreira
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Elad Nakar
- Biosense Webster, Johnson & Johnson, Research and Development Department, Yokneam, Israel
| | - Raquel Francisco
- Biosense Webster, Johnson & Johnson, EMEA Clinical Development, Diegem, Belgium
| | - Mariana Pereira
- Biosense Webster, Johnson & Johnson, Clinical Support, Porto Salvo, Portugal
| | - Luís Carpinteiro
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - João de Sousa
- Cardiology Department, Santa Maria University Hospital (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal.,Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
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Lima da Silva G, Cortez-Dias N, Carpinteiro L, Pinto FJ, de Sousa J. Outcome of ventricular tachycardia catheter ablation in ischemic heart disease patients using a high-density mapping substrate-based approach: A prospective cohort study. Rev Port Cardiol 2022; 41:325-335. [DOI: 10.1016/j.repc.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/25/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
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Nunes-Ferreira A, Alves M, Lima da Silva G, Cortez-Dias N, de Sousa J, Pinto FJ, Caldeira D. Anticoagulation after typical atrial flutter ablation: Systematic review and meta-analysis. Pacing Clin Electrophysiol 2021; 44:1701-1710. [PMID: 34409630 DOI: 10.1111/pace.14342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 07/15/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cavotricuspid isthmus (CTI) ablation in typical atrial flutter (AFL) restores sinus rhythm in 95% of patients, which may lead to the discontinuation of oral anticoagulation during follow-up. Therefore, we aimed to systematically review the clinical impact of oral anticoagulation in the incidence of thromboembolic events (TE) after typical AFL ablation. METHODS We searched for controlled studies evaluating the impact of anticoagulation in the incidence of TE in patients submitted to AFL ablation in MEDLINE, CENTRAL, PsycINFO database (June/2021). The primary outcome was TE events (ischemic stroke or systemic embolism). A meta-analysis was performed deriving risk ratios (RR) and 95% confidence intervals (CI). Statistical heterogeneity was measured through I2 metric. The confidence in the evidence was appraised with Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Eight observational studies with 4870 patients were included. TE events were not significantly reduced (RR 1.18, 95% CI 0.59-2.36; n = 4870; GRADE very low). A meta-regression showed that for each 10% increase in the prevalence of previous AF in the studied population, anticoagulation reduced TE risk in 32%. There were no significant differences regarding bleeding events (RR 2.16, 95% CI 0.43-10.97, I2 = 0%; GRADE low), but there was a lower all-cause mortality (RR 0.24, 95% CI 0.17-0.32, GRADE low). CONCLUSION The best available evidence lacks robustness and the data did not definitely associate anticoagulation after typical AFL ablation with reduced TE.
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Affiliation(s)
- Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Alves
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
- Serviço de Medicina III, Hospital Pulido Valente, CHULN, Lisboa, Portugal
| | - Gustavo Lima da Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Nuno Cortez-Dias
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Daniel Caldeira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Marques P, Nunes-Ferreira A, Silvério António P, Aguiar-Ricardo I, Rodrigues T, Badie N, Marcos I, Bernardes A, Pinto FJ, de Sousa J. Clinical impact of MultiPoint pacing in responders to cardiac resynchronization therapy. Pacing Clin Electrophysiol 2021; 44:1577-1584. [PMID: 34255874 DOI: 10.1111/pace.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy demonstrated benefits in heart failure. However, only 60-70% are responders and only 22% are super-responders. MultiPoint pacing (MPP) improves structural remodeling, but data in responder patients is scarce. METHODS A prospective, randomized study of the efficacy of MPP was conducted in patients who were CRT responders after 6 months of bi-ventricular (BiV) therapy. At 6 months, responder patients (LV end-systolic volume [LVESV] reduction ≥15%) were randomized to either continued BiV therapy or to MPP programmed with wide anatomical separation ≥30 mm, and followed until 12 months. Efficacy was determined by 6-12 month changes in LVESV and LV ejection fraction (LVEF). Evaluations of super-responder rate (LVESV reduction ≥30%) and quality of life (NYHA, EQ-5D, MLHFQ) were also performed. RESULTS From February 2017 to February 2019, 73 CRTs with Quartet LV leads were implanted (42.9% female, 65.7 ± 10.8 years old, 79.5% dilated cardiomyopathy). At 6 months, 74.2% responded to BiV and were randomized to BiV (n = 25) or MPP (n = 24). MPP versus BiV delivered greater LVESV improvement (8.3% decrease in MPP vs. 10.3% increase in BiV patients, p = .047), greater increase in LVEF (7.7% vs. 1.8%, p = .008), and higher 0-12 month super-responder rate (86.4% vs. 56.0%, p = .027). More MPP vs. BiV patients experienced an improvement in NYHA (84.6% vs. 50.0%, p = .047) and EQ-5D (94.4% vs. 54.0%, p = .006). CONCLUSIONS MPP with wide anatomical spacing in CRT responder patients resulted in improved LV reverse remodeling with higher rates of super-responders, and better quality of life metrics.
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Affiliation(s)
- Pedro Marques
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Silvério António
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | | | - Ivo Marcos
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ana Bernardes
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
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10
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Boersma L, Koźluk E, Maglia G, de Sousa J, Grebe O, Eckardt L, Hokanson RB, Hemingway LA, Ostern E, Park HS, Rovaris G, Arribas F, Scharf C, Csanádi Z, Arenal Á, Laurenzi F, Klaver M, Goette A. Paroxysmal and persistent atrial fibrillation ablation outcomes with the pulmonary vein ablation catheter GOLD duty-cycled phased radiofrequency ablation catheter: quality of life and 12-month efficacy results from the GOLD Atrial Fibrillation Registry. Europace 2021; 22:888-896. [PMID: 32219388 PMCID: PMC7273334 DOI: 10.1093/europace/euaa042] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
Aims The GOLD AF Registry has been designed to prospectively assess the population, indications, and outcomes using second-generation phased radiofrequency (RF) ablation (pulmonary vein ablation catheter GOLD) in a global examination of standard-of-care use for the treatment of paroxysmal and persistent atrial fibrillation (AF). Methods and results GOLD AF (NCT02433613) is a prospective, observational, multi-centre registry designed to characterize efficacy and safety of phased RF ablation in patients with AF. The primary endpoint was freedom from AF recurrence at 12-month follow-up after a 90-day blanking period. Ancillary objectives include safety, procedural efficiency, and quality of life (QoL). The QoL assessment using the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and the European Heart Rhythm Association (EHRA) Score of AF-related symptoms was collected at baseline and 12 months. In total, 1054 patients were included in this analysis (age 60.6, 67.6% male, 26.5% PersAF). Kaplan–Meier estimate of freedom from AF recurrence was 77.7% at 12 months. Peri-procedural device or procedure-related complications were observed in 26 (2.5%) patients, with a low stroke rate of 0.3%. One-year post-ablation, the EHRA AF Symptom score decreased in 68% of patients. The AFEQT score improvement was observed in 88.4% and 90.4% of patients who completed the questionnaire in-person or interviewed by phone at 12 month follow-up, respectively. Conclusion Phased RF ablation for the treatment of paroxysmal and persistent AF demonstrated a 77.7% freedom from AF recurrence at 12 months in addition to a significant reduction in arrhythmia symptoms and clinically meaningful improved QoL. Low peri-procedural complication rate of <3% was reported.
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Affiliation(s)
- Lucas Boersma
- Department of Cardiology, St. Antonius Ziekenhuis, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam, UMC, The Netherlands
| | - Edward Koźluk
- Cardiology Department, Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Giampiero Maglia
- Cardiology Department, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - João de Sousa
- Cardiology Department, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria E.P.E., Lisboa, Portugal
| | - Olaf Grebe
- Cardiology Department, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Lars Eckardt
- Cardiology Department, Universitätsklinikum Münster, Münster, Germany
| | | | | | | | - Hyoung-Seob Park
- Cardiology Department, Keimyung University Dongsan Hospital, Daegu, South Korea
| | | | - Fernando Arribas
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Christoph Scharf
- Cardiology Department, Hirslanden-Klinik Im Park Zürich, Zürich, Switzerland
| | - Zoltán Csanádi
- Cardiology Department, University of Debrecen, Debrecen, Hungary
| | - Ángel Arenal
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Martijn Klaver
- Department of Cardiology, St. Antonius Ziekenhuis, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam, UMC, The Netherlands
| | - Andreas Goette
- Cardiology Department, St. Vincenz-Krankenhaus Paderborn, Medizinische Klinik II, Paderborn, Germany
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11
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Katritsis G, Luther V, Cortez-Dias N, Carpinteiro L, de Sousa J, Lim PB, Whinnett Z, Ng FS, Koa-Wing M, Qureshi N, Chow A, Agarwal S, Jamil-Copley S, Peters NS, Linton N, Kanagaratnam P. Electroanatomic Characterization and Ablation of Scar-Related Isthmus Sites Supporting Perimitral Flutter. JACC Clin Electrophysiol 2021; 7:578-590. [PMID: 33516707 DOI: 10.1016/j.jacep.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The authors reviewed 3-dimensional electroanatomic maps of perimitral flutter to identify scar-related isthmuses and determine their effectiveness as ablation sites. BACKGROUND Perimitral flutter is usually treated by linear ablation between the left lower pulmonary vein and mitral annulus. Conduction block can be difficult to achieve, and recurrences are common. METHODS Patients undergoing atrial tachycardia ablation using CARTO3 (Biosense Webster Inc., Irvine, California) were screened from 4 centers. Patients with confirmed perimitral flutter were reviewed for the presence of scar-related isthmuses by using CARTO3 with the ConfiDense and Ripple Mapping modules. RESULTS Confirmed perimitral flutter was identified in 28 patients (age 65.2 ± 8.1 years), of whom 26 patients had prior atrial fibrillation ablation. Scar-related isthmus ablation was performed in 12 of 28 patients. Perimitral flutter was terminated in all following correct identification of a scar-related isthmus using ripple mapping. The mean scar voltage threshold was 0.11 ± 0.05 mV. The mean width of scar-related isthmuses was 8.9 ± 3.5 mm with a conduction speed of 31.8 ± 5.5 cm/s compared to that of normal left atrium of 71.2 ± 21.5 cm/s (p < 0.0001). Empirical, anatomic ablation was performed in 16 of 28, with termination in 10 of 16 (63%; p = 0.027). Significantly less ablation was required for critical isthmus ablation compared to empirical linear lesions (11.4 ± 5.3 min vs. 26.2 ± 17.1 min; p = 0.0004). All 16 cases of anatomic ablation were reviewed with ripple mapping, and 63% had scar-related isthmus. CONCLUSIONS Perimitral flutter is usually easy to diagnose but can be difficult to ablate. Ripple mapping is highly effective at locating the critical isthmus maintaining the tachycardia and avoiding anatomic ablation lines. This approach has a higher termination rate with less radiofrequency ablation required.
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Affiliation(s)
| | | | | | | | | | | | | | - Fu Siong Ng
- Imperial College Healthcare, London, United Kingdom
| | | | | | | | | | | | | | - Nick Linton
- Imperial College Healthcare, London, United Kingdom
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12
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Matos TK, Guedes J, Alves Filho E, Luz L, Lopes GS, do Nascimento R, de Sousa J, Canuto K, de Brito E, Dias-Pini N, Zocolo G. Integrated UPLC-HRMS, Chemometric Tools, and Metabolomic Analysis of Forage Palm (Opuntia spp. and Nopalea spp.) to Define Biomarkers Associated with Non‑Susceptibility to Carmine Cochineal (Dactylopius opuntiae). J BRAZIL CHEM SOC 2021. [DOI: 10.21577/0103-5053.20210060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Metabolomics, together with analytical methods and chemometric tools, point to new paths for selecting species that are resistant to pests and diseases. In this work, the forage palm species’ metabolomic profile was investigated, and the relation between the chemical composition and resistance to Dactylopius opuntiae (carmine cochineal). The study was performed in cladodes of different non-susceptible cultivars (Nopalea cochenillifera (L.) Salm-Dyck, Opuntia stricta (Haw.), Nopalea cochenillifera and susceptible cultivar (Opuntia ficus‑indica (L.) Mill.)). Metabolic profile showed 28 metabolites detected in the four species. From these total, 18 metabolites were annotated using UPLC‑QTOF‑MSE (ultra-performance liquid chromatography coupled with an electrospray ionization quadrupole time‑of-flight mass spectrometry operating in MSE mode). By comparing the chemical profiles of non-susceptible and susceptible species through the application of chemometric tools, it was possible to obtain biomarkers (quercetin-3‑O‑2’,6’‑dirhamnosylglucoside, quercetin rhamnosyl dihexoside, and isorhamnetin-3-sophoroside-7‑rhamnoside) that may be associated with resistance to carmine cochineal. Metabolomics based on UPLC-QTOF-MSE and chemometric allowed to establish the biomarkers knowledge of the resistance present in forage palm species. These results contribute to developing the initial understanding of flavonoids’ role in the defense mechanisms of cactaceans and can be useful for application in breeding programs; it can increase the chances of success in creating new varieties of plants not susceptible to carmine cochineal.
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13
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Honarbakhsh S, Providencia R, Garcia-Hernandez J, Martin CA, Hunter RJ, Lim WY, Kirkby C, Graham AJ, Sharifzadehgan A, Waldmann V, Marijon E, Munoz-Esparza C, Lacunza J, Gimeno-Blanes JR, Ankou B, Chevalier P, Antonio N, Elvas L, Castelletti S, Crotti L, Schwartz P, Scanavacca M, Darrieux F, Sacilotto L, Mueller-Leisse J, Veltmann C, Vicentini A, Demarchi A, Cortez-Dias N, Antonio PS, de Sousa J, Adragao P, Cavaco D, Costa FM, Khoueiry Z, Boveda S, Sousa MJ, Jebberi Z, Heck P, Mehta S, Conte G, Ozkartal T, Auricchio A, Lowe MD, Schilling RJ, Prieto-Merino D, Lambiase PD. A Primary Prevention Clinical Risk Score Model for Patients With Brugada Syndrome (BRUGADA-RISK). JACC Clin Electrophysiol 2020; 7:210-222. [PMID: 33602402 DOI: 10.1016/j.jacep.2020.08.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The goal of this study was to develop a risk score model for patients with Brugada syndrome (BrS). BACKGROUND Risk stratification in BrS is a significant challenge due to the low event rates and conflicting evidence. METHODS A multicenter international cohort of patients with BrS and no previous cardiac arrest was used to evaluate the role of 16 proposed clinical or electrocardiogram (ECG) markers in predicting ventricular arrhythmias (VAs)/sudden cardiac death (SCD) during follow-up. Predictive markers were incorporated into a risk score model, and this model was validated by using out-of-sample cross-validation. RESULTS A total of 1,110 patients with BrS from 16 centers in 8 countries were included (mean age 51.8 ± 13.6 years; 71.8% male). Median follow-up was 5.33 years; 114 patients had VA/SCD (10.3%) with an annual event rate of 1.5%. Of the 16 proposed risk factors, probable arrhythmia-related syncope (hazard ratio [HR]: 3.71; p < 0.001), spontaneous type 1 ECG (HR: 3.80; p < 0.001), early repolarization (HR: 3.42; p < 0.001), and a type 1 Brugada ECG pattern in peripheral leads (HR: 2.33; p < 0.001) were associated with a higher risk of VA/SCD. A risk score model incorporating these factors revealed a sensitivity of 71.2% (95% confidence interval: 61.5% to 84.6%) and a specificity of 80.2% (95% confidence interval: 75.7% to 82.3%) in predicting VA/SCD at 5 years. Calibration plots showed a mean prediction error of 1.2%. The model was effectively validated by using out-of-sample cross-validation according to country. CONCLUSIONS This multicenter study identified 4 risk factors for VA/SCD in a primary prevention BrS population. A risk score model was generated to quantify risk of VA/SCD in BrS and inform implantable cardioverter-defibrillator prescription.
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Affiliation(s)
| | - Rui Providencia
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Jorge Garcia-Hernandez
- Farr Institute of Health Informatics Research, University College London, London, United Kingdom
| | - Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ross J Hunter
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wei Y Lim
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Claire Kirkby
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Adam J Graham
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ardalan Sharifzadehgan
- Cardiology Department, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Carmen Munoz-Esparza
- Inherited Cardiac Disease Unit, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Javier Lacunza
- Inherited Cardiac Disease Unit, University Hospital Virgen Arrixaca, Murcia, Spain
| | | | - Benedicte Ankou
- Rhythmology Department, Hôpital Cardiovasculaire Louis Pradel, Claude Bernard University, Lyon, France
| | - Philippe Chevalier
- Rhythmology Department, Hôpital Cardiovasculaire Louis Pradel, Claude Bernard University, Lyon, France
| | - Nátalia Antonio
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Luís Elvas
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Silvia Castelletti
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Lia Crotti
- Laboratory of Cardiovascular Genetics, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico, Italiano, Milan, Italy
| | - Peter Schwartz
- Laboratory of Cardiovascular Genetics, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico, Italiano, Milan, Italy
| | - Mauricio Scanavacca
- Arritmia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Darrieux
- Arritmia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Sacilotto
- Arritmia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Nuno Cortez-Dias
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Pedro Silverio Antonio
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - João de Sousa
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Pedro Adragao
- Cardiology Department, Santa Cruz Lisboa Hospital, Lisbon, Portugal
| | - Diogo Cavaco
- Cardiology Department, Santa Cruz Lisboa Hospital, Lisbon, Portugal
| | | | | | | | | | | | - Patrick Heck
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarju Mehta
- Addenbroke's Hospital, Cambridge, United Kingdom
| | - Giulio Conte
- Cardiac Electrophysiology Unit, Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tardu Ozkartal
- Cardiac Electrophysiology Unit, Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Angelo Auricchio
- Cardiac Electrophysiology Unit, Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Martin D Lowe
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | | | - David Prieto-Merino
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pier D Lambiase
- The Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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14
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Gonçalves IS, Agostinho JR, Silva G, Guimarães T, Bernardes A, Santos I, Pinto P, Bárbara C, de Sousa J, Pinto FJ, Marques P. Accuracy and utility of a pacemaker respiratory monitoring algorithm for the detection of obstructive sleep apnea in patients with atrial fibrillation. Sleep Med 2019; 61:88-94. [DOI: 10.1016/j.sleep.2019.01.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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15
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Luther V, Agarwal S, Chow A, Koa-Wing M, Cortez-Dias N, Carpinteiro L, de Sousa J, Balasubramaniam R, Farwell D, Jamil-Copley S, Srinivasan N, Abbas H, Mason J, Jones N, Katritsis G, Lim PB, Peters NS, Qureshi N, Whinnett Z, Linton NW, Kanagaratnam P. Ripple-AT Study. Circ Arrhythm Electrophysiol 2019; 12:e007394. [DOI: 10.1161/circep.118.007394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Ripple mapping (RM) is an alternative approach to activation mapping of atrial tachycardia (AT) that avoids electrogram annotation. We tested whether RM is superior to conventional annotation based local activation time (LAT) mapping for AT diagnosis in a randomized and multicenter study.
Methods:
Patients with AT were randomized to either RM or LAT mapping using the CARTO3v4 CONFIDENSE system. Operators determined the diagnosis using the assigned 3D mapping arm alone, before being permitted a single confirmatory entrainment manuever if needed. A planned ablation lesion set was defined. The primary end point was AT termination with delivery of the planned ablation lesion set. The inability to terminate AT with this first lesion set, the use of more than one entrainment manuever, or the need to crossover to the other mapping arm was defined as failure to achieve the primary end point.
Results:
One hundred five patients from 7 centers were recruited with 22 patients excluded due to premature AT termination, noninducibility or left atrial appendage thrombus. Eighty-three patients (pts; RM=42, LAT=41) completed mapping and ablation within the 2 groups of similar characteristics (RM versus LAT: prior ablation or cardiac surgery n=35 [83%] versus n=35 [85%],
P
=0.80). The primary end point occurred in 38/42 pts (90%) in the RM group and 29/41pts (71%) in the LAT group (
P
=0.045). This was achieved without any entrainment in 31/42 pts (74%) with RM and 18/41 pts (44%) with LAT (
P
=0.01). Of those patients who failed to achieve the primary end point, AT termination was achieved in 9/12 pts (75%) in the LAT group following crossover to RM with entrainment, but 0/4 pts (0%) in the RM group crossing over to LAT mapping with entrainment (
P
=0.04).
Conclusions:
RM is superior to LAT mapping on the CARTO3v4 CONFIDENSE system in guiding ablation to terminate AT with the first lesion set and with reduced entrainment to assist diagnosis.
Clinical Trials Registration:
https://www.clinicaltrials.gov
. Unique identifier: NCT02451995.
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Affiliation(s)
- Vishal Luther
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | | | - Anthony Chow
- Barts Heart Centre, London, United Kingdom (A.C., N.S., H.A.)
| | - Michael Koa-Wing
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Nuno Cortez-Dias
- Hospital de Santa Maria, Lisbon, Portugal (N.C.-D., L.C., J.d.S.)
| | - Luís Carpinteiro
- Hospital de Santa Maria, Lisbon, Portugal (N.C.-D., L.C., J.d.S.)
| | - João de Sousa
- Hospital de Santa Maria, Lisbon, Portugal (N.C.-D., L.C., J.d.S.)
| | | | | | | | - Neil Srinivasan
- Barts Heart Centre, London, United Kingdom (A.C., N.S., H.A.)
| | - Hakam Abbas
- Barts Heart Centre, London, United Kingdom (A.C., N.S., H.A.)
| | - James Mason
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Nikki Jones
- Royal Bournemouth & Christchurch Hospital (R.B., N.J.)
| | - George Katritsis
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Phang Boon Lim
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Nicholas S. Peters
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Norman Qureshi
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Zachary Whinnett
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Nick W.F. Linton
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
| | - Prapa Kanagaratnam
- Imperial College Healthcare, London (V.L., M.K.-W., G.K., P.B.L., N.S.P., N.Q., Z.W., N.W.F.L., P.K.)
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16
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Lima da Silva G, Cortez-Dias N, Carpinteiro L, de Sousa J. Identification of a critical isthmus in complex macroreentrant atrial tachycardia using Ripple mapping in a patient with surgically repaired Ebstein's anomaly. Rev Port Cardiol 2019; 38:385.e1-385.e4. [PMID: 31256796 DOI: 10.1016/j.repc.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/02/2017] [Accepted: 08/16/2017] [Indexed: 11/17/2022] Open
Abstract
Ripple mapping is a novel, three-dimensional, electroanatomic mapping tool that displays each electrogram at its corresponding 3-dimensional coordinate as a dynamic moving bar, which changes in length according to the electrogram voltage-time relationship. We present the case of a 43-year-old male patient with surgically repaired Ebstein's anomaly who previously underwent two unsuccessful ablation procedures for right atrial flutter (cavotricuspid isthmus and intercaval lines). Ripple mapping was decisive, enabling the arrhythmia mechanism to be appropriately recognized, and a distinction to be made between critical areas of the circuit and delayed activated bystander regions.
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Affiliation(s)
- Gustavo Lima da Silva
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, Lisboa, Portugal.
| | - Nuno Cortez-Dias
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, Lisboa, Portugal
| | - Luís Carpinteiro
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, Lisboa, Portugal
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Costa MC, Cortez-Dias N, Gabriel A, de Sousa J, Fiúza M, Gallego J, Nobre Â, Pinto FJ, Enguita FJ. circRNA-miRNA cross-talk in the transition from paroxysmal to permanent atrial fibrillation. Int J Cardiol 2019; 290:134-137. [PMID: 31097202 DOI: 10.1016/j.ijcard.2019.04.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in western countries. The factors governing the progression of AF to a permanent chronic condition are still not well characterized. Among epigenetic factors, non-coding RNAs (ncRNAs) such as miRNAs and lncRNAs have been recently described as important players involved in the AF progression. We hypothesize about the existence of additional regulatory layers in AF involving an intricate cross-talk between different ncRNA species, namely miRNAs and circRNAs for the establishment of a chronic AF condition. METHODS AND RESULTS We have performed an unbiased study analyzing the expression profile for miRNAs and circRNAs in left-atrial biopsies from patients with paroxysmal and permanent AF by RNA-seq. The transition from paroxysmal to permanent AF is characterized by a pattern of down-regulated miRNAs, concomitant to the appearance of specific circRNA species. The analysis of the sponging activities of the circRNAs exclusively expressed in permanent AF samples, allowed us to determine that they could be responsible for the downregulation of specific miRNAs in establishment of a permanent AF condition. CONCLUSION Sponging activity of circRNAs sequestering specific miRNAs is an important factor to be considered for the determination of the molecular mechanisms involved in AF progression.
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Affiliation(s)
- Marina C Costa
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Nuno Cortez-Dias
- University Hospital Santa Maria, Department of Cardiology, Lisbon Academic Medical Centre, CCUL, Lisbon University, Lisbon, Portugal; Programme for Advanced Medical Education, Fundação Calouste Gulbenkian, Ministry of Health and Foundation for Science and Technology, Lisbon, Portugal
| | - André Gabriel
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - João de Sousa
- University Hospital Santa Maria, Department of Cardiology, Lisbon Academic Medical Centre, CCUL, Lisbon University, Lisbon, Portugal
| | - Manuela Fiúza
- University Hospital Santa Maria, Department of Cardiology, Lisbon Academic Medical Centre, CCUL, Lisbon University, Lisbon, Portugal
| | - Javier Gallego
- University Hospital Santa Maria, Department of Cardiothoracic Surgery, Lisbon Academic Medical Centre, CCUL, Lisbon University, Lisbon, Portugal
| | - Ângelo Nobre
- University Hospital Santa Maria, Department of Cardiothoracic Surgery, Lisbon Academic Medical Centre, CCUL, Lisbon University, Lisbon, Portugal
| | - Fausto J Pinto
- University Hospital Santa Maria, Department of Cardiology, Lisbon Academic Medical Centre, CCUL, Lisbon University, Lisbon, Portugal
| | - Francisco J Enguita
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal.
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Lima da Silva G, Cortez-Dias N, Carpinteiro L, de Sousa J. Identification of a critical isthmus in complex macroreentrant atrial tachycardia using Ripple mapping in a patient with surgically repaired Ebstein's anomaly. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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de Sousa J, Marques P, Martins V, Hipólito-Reis A, Duarte L, Joaquim I, Monteiro D, Boriani G, Wolff C, Grammatico A, Padeletti L. Health care cost analysis of enhanced pacing modalities in bradycardia patients: Portuguese case study on the results of the MINERVA trial. Rev Port Cardiol 2018; 37:973-978. [PMID: 30528686 DOI: 10.1016/j.repc.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The MINERVA trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduces progression to permanent atrial fibrillation (AF) in patients with paroxysmal or persistent AF and bradycardia who need cardiac pacing, compared to standard dual-chamber pacing (DDDR). It was shown that AF-related health care utilization was significantly lower in the DDDRP + MVP group than in the control group. Cost analysis demonstrated significant savings related to this new algorithm, based on health care costs from the USA, Italy, Spain and the UK. OBJECTIVE To calculate the savings associated with reduced health care utilization due to enhanced pacing modalities in the Portuguese setting. METHODS The impact on costs was estimated based on tariffs for AF-related hospitalizations and costs for emergency department and outpatient visits in Portugal. RESULTS The MINERVA trial showed a 42% reduction in AF-related health care utilization thanks to the new algorithm. In Portugal, this represents a potential cost saving of 2323 euros per 100 patients in the first year and 17118 euros over a 10-year period. Considering the number of patients who could benefit from this new algorithm, Portugal could save a total of 75369 euros per year and 555410 euros over 10 years. Additional savings could accrue if heart failure and stroke hospitalizations were considered. CONCLUSION The combination of atrial preventive pacing, atrial antitachycardia pacing and an algorithm to minimize the detrimental effect of right ventricular pacing reduces recurrent and permanent AF. The new DDDRP + MVP pacing mode could contribute to significant costs savings in the Portuguese health care setting.
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Affiliation(s)
| | | | | | | | - Luís Duarte
- Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
| | | | | | - Giuseppe Boriani
- University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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de Sousa J, Marques P, Martins V, Hipólito-Reis A, Duarte L, Joaquim I, Monteiro D, Boriani G, Wolff C, Grammatico A, Padeletti L. Health care cost analysis of enhanced pacing modalities in bradycardia patients: Portuguese case study on the results of the MINERVA trial. Revista Portuguesa de Cardiologia (English Edition) 2018. [DOI: 10.1016/j.repce.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Silva GLD, Cortez-Dias N, Sousa JD, Nobre Â, Pinto FJ. Surgical Epicardial CRT-D Implantation in a Patient with Complete Obstruction of the Superior Vena Cava. Arq Bras Cardiol 2018; 110:490-492. [PMID: 29898049 PMCID: PMC5967145 DOI: 10.5935/abc.20180070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nuno Cortez-Dias
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa - Portugal
| | - João de Sousa
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa - Portugal
| | - Ângelo Nobre
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa - Portugal
| | - Fausto J Pinto
- Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa - Portugal
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Marques P, Nobre Menezes M, Lima da Silva G, Guimarães T, Bernardes A, Cortez-Dias N, Carpinteiro L, de Sousa J, Pinto FJ. Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation: follow-up results from a prospective observational study. Europace 2018; 20:986-992. [PMID: 28430960 DOI: 10.1093/europace/eux036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/16/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Cardiac Resynchronization Therapy (CRT) is associated with a particularly high non-response rate in patients with atrial fibrillation (AF). We aimed to assess the effectiveness of triple-site (Tri-V) pacing CRT in this population. Methods and results Prospective observational study of patients with permanent AF who underwent CRT implantation with an additional right ventricle lead in the outflow tract septal wall. After implantation, programming mode (Tri-V or biventricular pacing) was selected based on cardiac output determination. Patients were classified as responders if NYHA class was reduced by at least one level and echocardiographic ejection fraction (EF) increased ≥ 10%, and as super-responders if in NYHA class I and EF ≥ 50%. Forty patients (93% male, mean age 72 ± 10 years) were included. Thirty-three were programmed in Tri-V. The following results pertain to this subgroup. At baseline, 58% were in NYHA class III and 36% NYHA class II. At 1 year follow-up, Minnesota QoL score was reduced (36 ± 23 vs. 8 ± 6; P = 0.001) and the 6MWT distance improved (384 ± 120 m to 462 ± 87 m, P = 0.003). Mean EF increased (26% ± 8 vs. 39 ± 10; P < 0.001 at 6 months and 41 ± 10; P < 0.001 at 12 months). Responder rate was 59% at 6 months and 79% at 12 months. Super-responder rate was 9% at 6 months and 16% at 12 months. One year survival free from heart failure hospitalization was 87.9%. Conclusion Tri-V CRT yielded higher response and super-response rates than usually reported for CRT in patients with permanent AF using clinical and remodeling criteria.
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Affiliation(s)
- Pedro Marques
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Miguel Nobre Menezes
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Gustavo Lima da Silva
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Tatiana Guimarães
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Ana Bernardes
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Nuno Cortez-Dias
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Luis Carpinteiro
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João de Sousa
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre, Cardiovascular Centre of the University of Lisbon, Faculty of Medicine, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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Guimarães T, Bernardes A, de Sousa J, Marques P. Persistent left superior vena cava - A vascular access without limitations. Rev Port Cardiol 2018; 37:627-628. [PMID: 29804886 DOI: 10.1016/j.repc.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/19/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tatiana Guimarães
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal.
| | - Ana Bernardes
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - João de Sousa
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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Lima da Silva G, Cortez Dias N, Carpinteiro L, de Sousa J. Electroanatomical mapping of coronary artery anatomy to guide epicardial ventricular tachycardia ablation. Europace 2018; 20:419. [PMID: 29016750 DOI: 10.1093/europace/eux083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gustavo Lima da Silva
- Invasive Arrhythmia Unit, Department of Cardiology, Santa Maria University Hospital/CHLN, CAML, CCUL, FMUL, Lisbon, Portugal
| | - Nuno Cortez Dias
- Invasive Arrhythmia Unit, Department of Cardiology, Santa Maria University Hospital/CHLN, CAML, CCUL, FMUL, Lisbon, Portugal
| | - Luís Carpinteiro
- Invasive Arrhythmia Unit, Department of Cardiology, Santa Maria University Hospital/CHLN, CAML, CCUL, FMUL, Lisbon, Portugal
| | - João de Sousa
- Invasive Arrhythmia Unit, Department of Cardiology, Santa Maria University Hospital/CHLN, CAML, CCUL, FMUL, Lisbon, Portugal
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Lima da Silva G, Cortez-Dias N, Bernardes A, de Sousa J. Mahaim fiber-mediated tachycardia. Revista Portuguesa de Cardiologia (English Edition) 2018. [DOI: 10.1016/j.repce.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lima da Silva G, de Sousa J, Marques P. Utilisation of the snare technique for left ventricular lead placement in a patient with persistent left superior vena cava. Rev Port Cardiol 2018; 37:201.e1-201.e3. [PMID: 29398393 DOI: 10.1016/j.repc.2017.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/06/2017] [Indexed: 10/17/2022] Open
Abstract
Persistence of the left superior vena cava occurs in about 0.3-0.7% of the general population. It is of particular importance in patients who need cardiac resynchronisation therapy. We present a unique case in which a snare system and tunnelling tool were used to place the left ventricular lead in a patient with persistence of the left superior vena cava.
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Affiliation(s)
- Gustavo Lima da Silva
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal.
| | - João de Sousa
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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Lima da Silva G, de Sousa J, Marques P. Utilisation of the snare technique for left ventricular lead placement in a patient with persistent left superior vena cava. Revista Portuguesa de Cardiologia (English Edition) 2018. [DOI: 10.1016/j.repce.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lima da Silva G, Cortez-Dias N, Neves I, Almeida AG, de Sousa J. Always look at the sinus rhythm electrocardiogram in patients with ventricular tachycardia. Rev Port Cardiol 2017; 36:961-964. [PMID: 29225102 DOI: 10.1016/j.repc.2016.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/27/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gustavo Lima da Silva
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal.
| | - Nuno Cortez-Dias
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - Irina Neves
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - Ana G Almeida
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
| | - João de Sousa
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
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de Sousa J. Resynchronization therapy in patients with atrial fibrillation: What are the results? Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Dias M, Gonçalves I, Amann B, Marques P, Martinho C, Leitão C, Basto RP, de Sousa J, Pinto P, Bárbara C. Utility of new-generation pacemakers in sleep apnea screening. Sleep Med 2017; 37:27-31. [DOI: 10.1016/j.sleep.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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Luther V, Cortez-Dias N, Carpinteiro L, de Sousa J, Balasubramaniam R, Agarwal S, Farwell D, Sopher M, Babu G, Till R, Jones N, Tan S, Chow A, Lowe M, Lane J, Pappachan N, Linton N, Kanagaratnam P. Ripple mapping: Initial multicenter experience of an intuitive approach to overcoming the limitations of 3D activation mapping. J Cardiovasc Electrophysiol 2017; 28:1285-1294. [PMID: 28776822 DOI: 10.1111/jce.13308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/07/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ripple mapping (RM) displays electrograms as moving bars over a three-dimensional surface displaying bipolar voltage, and has shown in a single-center series to be effective for atrial tachycardia (AT) mapping without annotation of local activation time or window-of-interest assignment. We tested the reproducibility of these findings in operators naïve to RM, using it for the first time in postablation AT. METHODS Maps were collected with multielectrode catheters and CARTO ConfiDENSE. A diagnosis of the tachycardia mechanism was made using RM and an assessment of operator confidence was made according to a three-grade scale (1 highest-3 lowest). RESULTS The first 20 patients (64 ± 9 years, median two previous ablations) undergoing RM-guided AT ablation across five sites were studied. High-density maps (2,935 ± 1,328 points) in AT (CL = 296 ± 95 milliseconds) were collected. Macroreentrant ATs bordered by scar or anatomical obstacles were identified in n = 12 (60%), small reentrant ATs around scar in n = 3 (15%), and focal ATs from scar in n = 5 (25%). Diagnostic confidence with RM was grade 1 in n = 13 (65%), where operators felt confident to proceed to ablation without entrainment. Ablation offered the correct diagnosis n = 18 (90%). Retrospective review of the accompanying LAT maps demonstrated potential sources for error related to the window of interest selection, interpolation, and differentiating regions of scar during tachycardia on the voltage map. CONCLUSION RM was easy to adopt by operators using it for the first time, and identified the correct target for ablation with high diagnostic confidence in most cases of complex AT.
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Affiliation(s)
- Vishal Luther
- Cardiac Electrophysiology Laboratories, Imperial College Healthcare, London, UK
| | - Nuno Cortez-Dias
- Department of Cardiac Electrophysiology, Hospital de Santa Maria, Lisbon, Portugal
| | - Luís Carpinteiro
- Department of Cardiac Electrophysiology, Hospital de Santa Maria, Lisbon, Portugal
| | - João de Sousa
- Department of Cardiac Electrophysiology, Hospital de Santa Maria, Lisbon, Portugal
| | - Richard Balasubramaniam
- Cardiac Electrophysiology Laboratories, Royal Bournemouth & Christchurch Hospital, Bournemouth, UK
| | - Sharad Agarwal
- Cardiac Electrophysiology Laboratories, Papworth Hospital, Cambridge, UK
| | - David Farwell
- Cardiac Electrophysiology Laboratories, Essex Cardiothoracic Centre, Basildon, UK
| | - Mark Sopher
- Cardiac Electrophysiology Laboratories, Royal Bournemouth & Christchurch Hospital, Bournemouth, UK
| | - Girish Babu
- Cardiac Electrophysiology Laboratories, Royal Bournemouth & Christchurch Hospital, Bournemouth, UK
| | - Richard Till
- Cardiac Electrophysiology Laboratories, Royal Bournemouth & Christchurch Hospital, Bournemouth, UK
| | - Nikki Jones
- Cardiac Electrophysiology Laboratories, Royal Bournemouth & Christchurch Hospital, Bournemouth, UK
| | - Stuart Tan
- Cardiac Electrophysiology Laboratories, Essex Cardiothoracic Centre, Basildon, UK
| | - Anthony Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, London, UK
| | - Martin Lowe
- Department of Cardiac Electrophysiology, Barts Heart Centre, London, UK
| | - Jem Lane
- Department of Cardiac Electrophysiology, Barts Heart Centre, London, UK
| | - Naveen Pappachan
- Cardiac Electrophysiology Laboratories, Imperial College Healthcare, London, UK
| | - Nicholas Linton
- Cardiac Electrophysiology Laboratories, Imperial College Healthcare, London, UK
| | - Prapa Kanagaratnam
- Cardiac Electrophysiology Laboratories, Imperial College Healthcare, London, UK
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Cortez-Dias N, Costa MC, de Sousa J, Fiúza M, Gallego J, Nobre Â, Pinto FJ, Enguita FJ. Expanding the functional role of miRNAs in the establishment of permanent atrial fibrillation. Int J Cardiol 2016; 222:340-341. [DOI: 10.1016/j.ijcard.2016.07.296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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Guimarães T, Lima da Silva G, Bernardes A, de Sousa J, Marques P. Active fixation coronary sinus lead extraction – A safe procedure. Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2015.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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de Sousa J. O Registo Nacional de Eletrofisiologia Cardíaca (2013/2014): uma análise. Rev Port Cardiol 2016; 35:413-4. [DOI: 10.1016/j.repc.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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de Sousa J. Portuguese National Registry on Cardiac Electrophysiology, 2013 and 2014: An analysis. Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lima da Silva G, Nobre Menezes M, Bernardes A, Lopes P, de Sousa J, Marques P. Twiddler's syndrome, a rare cause of pacemaker malfunction. Rev Port Cardiol 2016; 35:69-70. [DOI: 10.1016/j.repc.2015.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022] Open
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Magalhães A, Menezes M, Cortez‐Dias N, de Sousa J, Marques P. Utilização de sistema de extração Snare para implantação de eletrocateter ventricular esquerdo na ressincronização cardíaca. Rev Port Cardiol 2015; 34:221-2. [DOI: 10.1016/j.repc.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/15/2014] [Indexed: 11/25/2022] Open
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Nobre Menezes M, Cortez-Dias N, Carpinteiro L, de Sousa J. One-Shot Ablation For PV Isolation. J Atr Fibrillation 2014; 7:1111. [PMID: 27957104 DOI: 10.4022/jafib.1111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 12/20/2022]
Abstract
Atrial fibrillation ablation has evolved considerably over the last few years. In this article we review current and past catheter ablation techniques, with a special focus on new simplified systems that allow a faster and simpler procedure, so called "one-shot" atrial fibrillation ablation.
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Affiliation(s)
- Miguel Nobre Menezes
- Invasive Arrhythmology Unit, Cardiology Department, Santa Maria University Hospital
| | - Nuno Cortez-Dias
- Invasive Arrhythmology Unit, Cardiology Department, Santa Maria University Hospital
| | - Luís Carpinteiro
- Invasive Arrhythmology Unit, Cardiology Department, Santa Maria University Hospital
| | - João de Sousa
- Invasive Arrhythmology Unit, Cardiology Department, Santa Maria University Hospital
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Cortez-Dias N, Plácido R, Marta L, Bernardes A, Sobral S, Carpinteiro L, de Sousa J. Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada syndrome. Rev Port Cardiol 2014; 33:305.e1-7. [PMID: 24931179 DOI: 10.1016/j.repc.2014.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/23/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 60-year-old woman with Brugada syndrome, permanent type 1 electrocardiographic pattern, who had previously received an implantable cardioverter-defibrillator. She suffered frequent syncopal episodes and multiple appropriate shocks (around five per month) due to polymorphic ventricular tachycardia/ventricular fibrillation, refractory to quinidine therapy. Combined epicardial and endocardial electroanatomical mapping was performed with a view to substrate ablation. An area of abnormal fractionated electrograms, lasting up to 370 ms and up to 216 ms after the end of the surface QRS, was identified in the epicardium in the lower anterior part of the right ventricular outflow tract. Extensive epicardial ablation of this area, which eliminated the fractionated electrograms, led to the disappearance of the Brugada electrocardiographic pattern six weeks after ablation. Despite discontinuation of quinidine, no further ventricular arrhythmias occurred during follow-up, which is still of short duration.
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Affiliation(s)
- Nuno Cortez-Dias
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Rui Plácido
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Liliana Marta
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Serviço de Cardiologia, Hospital Distrital de Santarém, Santarém, Portugal
| | - Ana Bernardes
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Sílvia Sobral
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Luís Carpinteiro
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João de Sousa
- Unidade de Arritmologia Invasiva, Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Cortez-Dias N, Plácido R, Marta L, Bernardes A, Sobral S, Carpinteiro L, de Sousa J. Epicardial ablation for prevention of ventricular fibrillation in a patient with Brugada Syndrome. Revista Portuguesa de Cardiologia (English Edition) 2014. [DOI: 10.1016/j.repce.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Boriani G, Tukkie R, Manolis AS, Mont L, Pürerfellner H, Santini M, Inama G, Serra P, de Sousa J, Botto GL, Mangoni L, Grammatico A, Padeletti L. Atrial antitachycardia pacing and managed ventricular pacing in bradycardia patients with paroxysmal or persistent atrial tachyarrhythmias: the MINERVA randomized multicentre international trial. Eur Heart J 2014; 35:2352-62. [PMID: 24771721 PMCID: PMC4163193 DOI: 10.1093/eurheartj/ehu165] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aims Atrial fibrillation (AF) is a common comorbidity in bradycardia patients. Advanced pacemakers feature atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), which minimizes unnecessary right ventricular pacing. We evaluated whether DDDRP and MVP might reduce mortality, morbidity, or progression to permanent AF when compared with standard dual-chamber pacing (Control DDDR). Methods and results In a randomized, parallel, single-blind, multi-centre trial we enrolled 1300 patients with bradycardia and previous atrial tachyarrhythmias, in whom a DDDRP pacemaker had recently been implanted. History of permanent AF and third-degree atrioventricular block were exclusion criteria. After a 1-month run-in period, 1166 eligible patients, aged 74 ± 9 years, 50% females, were randomized to Control DDDR, DDDRP + MVP, or MVP. Analysis was intention-to-treat. The primary outcome, i.e. the 2-year incidence of a combined endpoint composed of death, cardiovascular hospitalizations, or permanent AF, occurred in 102/385 (26.5%) Control DDDR patients, in 76/383 (19.8%) DDDRP + MVP patients [hazard ratio (HR) = 0.74, 95% confidence interval 0.55–0.99, P = 0.04 vs. Control DDDR] and in 85/398 (21.4%) MVP patients (HR = 0.89, 95% confidence interval 0.77–1.03, P = 0.125 vs. Control DDDR). When compared with Control DDDR, DDDRP + MVP reduced the risk for AF longer than 1 day (HR = 0.66, 95% CI 0.52–0.85, P < 0.001), AF longer than 7 days (HR = 0.52, 95% CI 0.36–0.73, P < 0.001), and permanent AF (HR = 0.39, 95% CI 0.21–0.75, P = 0.004). Conclusion In patients with bradycardia and atrial tachyarrhythmias, DDDRP + MVP is superior to standard dual-chamber pacing. The primary endpoint was significantly lowered through the reduction of the progression of atrial tachyarrhythmias to permanent AF. ClinicalTrials.gov Identifier NCT00262119.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | | | - Antonis S Manolis
- First Department of Cardiology, Evagelismos General Hospital, Athens, Greece
| | - Lluis Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Massimo Santini
- Cardiology Department, S. Filippo Neri Hospital, Rome, Italy
| | - Giuseppe Inama
- Institute of Cardiology, Maggiore Hospital, Crema, Italy
| | - Paolo Serra
- Cardiology Department, G. Mazzini Hospital, Teramo, Italy
| | - João de Sousa
- Institute of Cardiology, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Lorenza Mangoni
- Medtronic Clinical Research Institute, Regional Clinical Centre, Rome, Italy
| | - Andrea Grammatico
- Medtronic Clinical Research Institute, Regional Clinical Centre, Rome, Italy
| | - Luigi Padeletti
- Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy
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Jorge C, Marques JS, Veiga A, Nóbrega J, Cruz J, Peralta R, Correia MJ, de Sousa J, Miltenberger-Miltényi G, Nunes Diogo A. Nova mutação na síndroma de QT Longo em doente com diagnóstico prévio de epilepsia. Rev Port Cardiol 2011; 30:929-35. [DOI: 10.1016/j.repc.2011.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/28/2011] [Indexed: 10/15/2022] Open
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Silva Marques J, Varela MG, Ferreira R, Nobre A, Almeida AG, de Sousa J. Intracardiac sterile pacemaker lead thrombosis. Rev Esp Cardiol 2011; 65:193-4. [PMID: 21783309 DOI: 10.1016/j.recesp.2011.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/19/2011] [Indexed: 11/30/2022]
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Abstract
Pandemic H1N1 influenza A virus is spreading worldwide. We report a case of electrical storm during H1N1 influenza A infection in a patient with congenital long-QT syndrome (LQTS) that was previously stable on beta-blocker therapy. Possible causes for the association of A flu and LQTS recurrent ventricular arrhythmias are discussed.
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Affiliation(s)
- João Silva Marques
- Department of Cardiology I, CHLN, EPE - Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal.
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da Silva MN, Bonhorst D, de Sousa J. National Registry on Cardiac Electrophysiology 2007 and 2008. Rev Port Cardiol 2009; 28:1291-1306. [PMID: 20222352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Clinical electrophysiology remains one of the most dynamic areas of cardiology, with continuing developments in equipping centers with more modern mapping and navigation systems. This has enabled an increase in the number and variety of interventions, resulting in significant improvements in results of therapeutic ablation of arrhythmias and prevention of sudden cardiac death. In this phase of transition towards implementation of a computerized national registry with nationwide data transmitted via the internet, publication of the registry in its previous form, although requiring more work, still seems justified, in order to appraise and disseminate qualitative and quantitative developments in this activity and enable comparisons with what is being done internationally, assess the centers' training capacity and inform national and European health authorities of the activities and real needs in this sector. The authors analyze the number and type of procedures performed during 2007 and 2008 based on a survey sent to centers performing diagnostic and interventional electrophysiology (16 centers in 2007 and 2008) and/or implanting cardioverter-defibrillators (ICDs) (19 centers in 2007 and 21 in 2008). Compared to 2006, one more center began interventional electrophysiology in 2007 and two centers began implanting ICDs in 2008. In the years under review, 2060 electrophysiological studies were performed in 2007 and 2007 were performed in 2008, of which 74 and 79.5% respectively were followed by therapeutic ablation, making totals of 1523 and 1596 ablations (increases of 10.7 and 4.6% from previous years). Atrioventricular nodal reentrant tachycardia was the main indication for ablation (28.4 and 28.7%), followed by accessory pathways (26.8 and 25.4%), atrial flutter (20.8 and 19.7%), atrial fibrillation (13.9 and 14.6%), ventricular tachycardia (4.7 and 5.1%), atrial tachycardia (2.8 and 2.6%) and atrioventricular junction ablation (2.7 and 3.9%). Regarding ICDs, a total of 890 devices were implanted in 2007 and 1040 devices in 2008, of which 63 and 75 respectively were battery replacements and 827 and 965 were first implantations, with the following distribution: single chamber--53.7% in 2007 and 61.4% in 2008; dual chamber--13.8 and 8.4% respectively in 2007 and 2008; resynchronization systems with ICD--32.5% in 2007 and 30.2% in 2008. The figures for first implantations show growth of 18.5% between 2006 and 2007 and 14.3% between 2007 and 2008. First implantations increased from 67.4 devices per million population in 2006 to 82.7 in 2007 and 96.5 in 2008.
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da Silva MN, Bonhorst D, de Sousa J. National Registry on Cardiac Electrophysiology--2006. Rev Port Cardiol 2008; 27:691-702. [PMID: 18717217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Clinical electrophysiology is one of the areas of cardiology that has seen most growth in Portugal, particularly in interventional cardiology, which includes ablation of arrhythmias and prevention of sudden cardiac death. The annual publication of a national registry enables us to assess qualitative and quantitative progress, compare our results with international data, assess the centers' training capabilities and inform health authorities of the activities and needs of the sector. The authors analyze the number and type of procedures performed during 2006 based on a survey sent to 19 national centers (15 public and 4 private) that performed diagnostic and interventional electrophysiology (15 centers) and/or implanted cardioverter-defibrillators (ICDs) (19 centers) in that year. The number of electrophysiology centers remained unchanged from 2005, but four new centers began implanting ICDs in 2006. In the year under review, 1805 electrophysiological studies were performed, 75.3% of which were followed by ablation therapy, a total of 1360 ablation procedures (a 22.3% increase over the previous year). Accessory pathways were the main indication for ablation (32%), followed by atrial flutter (25%), atrioventricular nodal reentrant tachycardia (23%), atrial fibrillation (10%), ventricular tachycardia (5%), atrial tachycardia (3%) and atrioventricular junction ablation (2%). In 2006, a total of 738 ICD devices were implanted, of which 64 were battery replacements and 674 were first implantations, with the following distribution: 346 single chamber (51.3%), 98 dual chamber (14.5%) and 230 integrated in ventricular resynchronization systems (34.1%). These figures reflect a lower growth rate than that of 2005, even though in 2006 first implantations rose from 54.7 to 67.4 devices per million population. The ICD implantation rate in Portugal is still far below the European average, which means there is a continuing need to raise awareness of this therapeutic option among the Portuguese medical community. With regard to the training capabilities currently available in Portugal, only 5 centers (all public) had a sufficient level of activity to fulfill the requirements stipulated for the subspecialty of cardiac electrophysiology. As for implantation of ICDs, 12 centers implanted more than 10 units, the minimum annual curricular limit for this subspecialty.
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de Sousa J. Assessment of T-wave alternans for arrhythmic risk stratification after myocardial infarction: is it useful in all patients? Rev Port Cardiol 2006; 25:389-94. [PMID: 16869204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Bonhorst D, de Sousa J, Adragão P. National Registry on Cardiac Electrophysiology--2004. Rev Port Cardiol 2006; 25:353-61. [PMID: 16789408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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de Sousa J, Bonhorst D, Adragão P. National Registry on Cardiac Electrophysiology--2003. Rev Port Cardiol 2004; 23:1485-93. [PMID: 15693699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- João de Sousa
- Associação Portuguesa de Arritmologia, Pacing e Electrofisiologia Lisboa, Portugal.
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de Sousa J, Gonçalves C, Pedro P. VDD pacemaker introduced via persistent left superior vena cava into the coronary sinus. Rev Port Cardiol 2004; 23:931-2. [PMID: 15376739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Affiliation(s)
- João de Sousa
- Departamento de Cardiologia, Hospital dos SAMS, Lisboa, Portugal
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