TAN CHEN WU
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer(2018) VERONESE, Pedro; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio Ibrahim; HAJJAR, Ludhmila Abrahao; WU, Tan Chen; SACILOTTO, Luciana; VERONESE, Carolina; DARRIEUX, Francisco Carlos da CostaAim Acute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as QTc dispersion (QTdc) and transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unclear whether breast cancer patients who undergo the ACT chemotherapy regimen of anthracycline (doxorubicin: A), cyclophosphamide (C) and taxane (T) may present with QTc, QTdc and DTpTe prolongation. Methods Twenty-three consecutive patients with breast cancer were followed prospectively during ACT chemotherapy and were analyzed according to their QT measurements. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), immediately after the first phase of anthracycline and cyclophosphamide (AC) treatment, and immediately after T treatment. Serum troponin and B-type natriuretic peptide (BNP) levels were also measured. Results Compared to baseline values, the QTc interval was significantly prolonged after the AC phase (439.7 +/- 33.2 ms vs. 472.5 +/- 36.3 ms, p = 0.001) and after T treatment (439.7 +/- 33.2 ms vs. 467.9 +/- 42.6 ms, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0-85.0] vs. 6.0 pg/mL [min-max: 6.0-22.0], p < 0.001) and after T treatment (25.0 pg/mL [min-max: 6.0-80.0] vs. 6.0 pg/mL [min-max: 6.0-22.0], p < 0.001) compared to baseline values. Conclusion In this prospective study of patients with non-metastatic breast cancer who underwent ACT chemotherapy, significant QTc prolongation and an elevation in serum troponin levels were observed.
- Is It Safe for Patients With Cardiac Channelopathies to Undergo Routine Dental Care? Experience From a Single-Center Study(2019) OLIVEIRA, Ana Carolina Guimaraes; NEVES, Itamara Lucia Itagiba; SACILOTTO, Luciana; OLIVETTI, Natalia Quintella Sangiorgi; SANTOS-PAUL, Marcela Alves dos; MONTANO, Tania Cristina Pedroso; CARVALHO, Cintia Maria Alencar; WU, Tan Chen; GRUPI, Cesar Jose; BARBOSA, Silvio Alves; PASTORE, Carlos Alberto; SAMESIMA, Nelson; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio Ibrahim; NEVES, Ricardo Simoes; DARRIEUX, Francisco Carlos CostaBackground-Brugada syndrome and long-QT syndrome may account for at least one third of unexplained sudden cardiac deaths. Dental care in patients with cardiac channelopathies is challenging because of the potential risk of life-threatening events. We hypothesized that the use of local dental anesthesia with lidocaine with and without epinephrine is safe and does not result in life-threatening arrhythmias in patients with channelopathies. Methods and Results-We performed a randomized, double-blind pilot trial comparing the use of 2% lidocaine without a vasoconstrictor and with 1:100 000 epinephrine in 2 sessions of restorative dental treatment with a washout period of 7 days (crossover trial). Twenty-eight-hour Holter monitoring was performed, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments were also conducted at 3 time points. Fifty-six dental procedures were performed in 28 patients (18 women, 10 men) with cardiac channelopathies: 16 (57.1%) had long-QT syndrome, and 12 (42.9%) had Brugada syndrome; 11 (39.3%) of patients had an implantable defibrillator. The mean age was 45.9 +/- 15.9 years. The maximum heart rate increased after the use of epinephrine during the anesthesia period from 82.1 to 85.8 beats per minute (P=0.008). In patients with long-QT syndrome, the median corrected QT was higher, from 450.1 to 465.4 ms (P 0.009) at the end of anesthesia in patients in whom epinephrine was used. The other measurements showed no statistically significant differences. No life-threatening arrhythmias occurred during dental treatment. Conclusions-The use of local dental anesthesia with lidocaine, regardless of the use of a vasoconstrictor, did not result in life-threatening arrhythmias and appears to be safe in stable patients with cardiac channelopathies.
- Catheter Ablation of Focal Atrial Tachycardia with Early Activation Close to the His-Bundle from the Non Coronary Aortic Cusp(2021) CHOKR, Muhieddine; MOURA, Lucas G. de; SOUSA, Italo Bruno dos Santos; PISANI, Cristiano Faria; HARDY, Carina Abigail; MELO, Sissy Lara de; PONTE FILHO, Arnobio Dias da; COSTA, Ieda Prata; TAVORA, Ronaldo Vasconcelos; SACILOTTO, Luciana; WU, Tan Chen; DARRIEUX, Francisco Carlos da Costa; HACHUL, Denise Tessariol; AIELLO, Vera; SCANAVACCA, MauricioBackground: Atrial tachycardia (AT) ablation with earliest activation site close to the His-Bundle is a challenge due to the risk of complete AV block by its proximity to His-Purkinje system (HPS). An alternative to minimize this risk is to position the catheter on the non-coronary cusp (NCC), which is anatomically contiguous to the para-Hisian region. Objectives: The aim of this study was to perform a literature review and evaluate the electrophysiological characteristics, safety, and success rate of catheter-based radiofrequency (RF) delivery in the NCC for the treatment of para-Hisian AT in a case series. Methods: This study performed a retrospective evaluation of ten patients (Age: 36 +/- 10 y-o) who had been referred for SVT ablation and presented a diagnosis of para-Hisian focal AT confirmed by classical electrophysiological maneuvers. For statistical analysis, a p-value of <0.05 was considered statistically significant. Results: The earliest atrial activation at the His position was 28 +/- 12ms from the P wave and at the NCC was 3 +/- 2ms earlier than His position, without evidence of His potential in all patients. RF was applied on the NCC (4-mm-tip catheter; 30W, 55 degrees C), and the tachycardia was interrupted in 5 +/- 3s with no increase in the PR interval or evidence of junctional rhythm. Electrophysiological tests did not reinduce tachycardia in 9/10 of patients. There were no complications in all procedures. During the 30 +/- 12 months follow-up, no patient presented tachycardia recurrence. Conclusion: The percutaneous treatment of para-Hisian AT through the NCC is an effective and safe strategy, which represents an interesting option for the treatment of this complex arrhythmia.
- QT Interval Control to Prevent Torsades de Pointes during Use of Hydroxychloroquine and/or Azithromycin in Patients with COVID-19(2020) WU, Tan Chen; SACILOTTO, Luciana; DARRIEUX, Francisco Carlos da Costa; PISANI, Cristiano Faria; MELO, Sissy Lara de; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio
- Peculiar Aspects of Patients with Inherited Arrhythmias during the COVID-19 Pandemic(2021) SACILOTTO, Luciana; OLIVETTI, Natalia Quintella Sangiorgi; PISANI, Cristiano Faria; WU, Tan Chen; HAJJAR, Ludhmila Abrahao; MELO, Sissy Lara de; BUENO, Savia Christina Pereira; RIVAROLA, Esteban Wisnivesky Rocca; CHOKR, Muhieddine Omar; HARDY, Carina Abigail; HACHUL, Denise Tessariol; DARRIEUX, Francisco Carlos da Costa; SCANAVACCA, Mauricio IbrahimSince December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2). The impact of the clinical course of a respiratory infection is little known in patients with hereditary arrhythmias, due to the low prevalence of these diseases. Patients who present with infectious conditions may exacerbate hidden or well-controlled primary arrhythmias, due to several factors, such as fever, electrolyte disturbances, drug interactions, adrenergic stress and, eventually, the septic patient's own myocardial damage. The aim of this review is to highlight the main challenges we may encounter during the Covid 19 pandemic, specifically in patients with hereditary arrhythmias, with emphasis on the congenital long QT syndrome (LQTS), Brugada syndrome (SBr), ventricular tachycardia polymorphic catecholaminergic (CPVT) and arrhythmogenic right ventricular cardiomyopathy. Since December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2), the first cases of which arose in Wuhan, China, subsequently arriving in Brazil. Retrospective studies have shown that old age was an independent predictor of mortality by COVID-19. Other risk factors impacting mortality were systemic arterial hypertension, chronic pulmonary obstructive disease, immunosuppression, type-2 diabetes mellitus, obesity, and severe cardiopathy (heart failure, coronary disease, or cardiomyopathies).1,2 Overall, complications due to arrhythmias in patients with pneumonia, particularly atrial fibrillation, are relatively common.3,4 Cardiac arrest occurs in about 3% of hospitalized patients;5 however, less than 20% of cardiac rhythms of in-hospital events are reported as being electrically reversible to sinus rhythm (by cardioversion or defibrillation), i.e., ventricular tachycardia/fibrillation (VT/VF).6 In such patients, the primary arrhythmogenic mechanism is myocardial injury due to ischemia or inflammation.
- Effect of Occurrence of Lamin A/C (LMNA) Genetic Variants in a Cohort of 101 Consecutive Apparent ""Lone AF"" Patients: Results and Insights(2022) PESSENTE, Gabrielle D'Arezzo; SACILOTTO, Luciana; CALIL, Zaine Oliveira; OLIVETTI, Natalia Quintella Sangiorgi; WULKAN, Fanny; OLIVEIRA, Theo Gremen Mimary de; PEDROSA, Anisio Alexandre Andrade; WU, Tan Chen; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio Ibrahim; KRIEGER, Jose Eduardo; DARRIEUX, Francisco Carlos da Costa; PEREIRA, Alexandre da CostaObjectiveMutations in the Lamin A/C (LMNA) gene are commonly associated with cardiac manifestations, such as dilated cardiomyopathy (DCM) and conduction system disease. However, the overall spectrum and penetrance of rare LMNA variants are unknown. The present study described the presence of LMNA variants in patients with ""lone atrial fibrillation (AF)"" as their sole clinical presentation. MethodsOne-hundred and one consecutive patients with ""lone AF"" criteria were initially screened by genetic testing. Genetic variants were classified according to the American College of Genetic and Genomic criteria. All subjects were evaluated through clinical and familial history, ECG, 24-h Holter monitoring, echocardiogram, cardiac magnetic resonance, treatment response, and the present relatives of LMNA carriers. In addition, whole-exome data from 49,960 UK Biobank (UKB) participants were analyzed to describe the overall penetrance of rare LMNA missense and loss of function (LOF) variants. ResultsThree missense variants in LMNA were identified in probands with AF as their first and unique clinical manifestation. Other five first-degree relatives, after the screening, also presented LMNA gene variants. Among 49,960 analyzed UKB participants, 331 carried rare LMNA missense or LOF variant. Participants who carried a rare LMNA variant were significantly associated with higher odds of arrhythmic events and of an abnormal ECG in the per-protocol ECG exam (p = 0.03 and p = 0.05, respectively). ConclusionAlthough a rare occurrence, our findings emphasize the possibility of an initial presentation of apparently ""lone AF"" in LMNA gene variant carriers.
- Favorable Safety Experience of Local Dental Anesthesia in ICD Recipients with Cardiac Channelopathies(2023) OLIVEIRA, Ana Carolina Guimarães; NEVES, Itamara Lucia Itagiba; SACILOTTO, Luciana; OLIVETTI, Natália Quintella Sangiorgi; BUENO, Savia Christina Pereira; PESSENTE, Gabrielle D’Arezzo; SANTOS-PAUL, Marcela Alves dos; MONTANO, Tânia Cristina Pedroso; CARVALHO, Cíntia Maria Alencar de; GRUPI, Cesar José; BARBOSA, Sílvio Alves; PASTORE, Carlos Alberto; SAMESIMA, Nelson; WU, Tan Chen; HACHUL, Denise Tessariol; SCANAVACCA, Maurício Ibrahim; NEVES, Ricardo Simões; DARRIEUX, Francisco Carlos da CostaAbstract Background Dental anesthetic management in implantable cardioverter defibrillator (ICD) recipients with cardiac channelopathies (CCh) can be challenging due to the potential risk of life-threatening arrhythmias and appropriate ICD therapies during procedural time. Objectives The present study assessed the hypothesis that the use of local dental anesthesia with 2% lidocaine with 1:100,000 epinephrine or without a vasoconstrictor can be safe in selected ICD and CCh patients, not resulting in life-threatening events (LTE). Methods Restorative dental treatment under local dental anesthesia was made in two sessions, with a wash-out period of 7 days (cross-over trial), conducting with a 28h - Holter monitoring, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments in 3 time periods. Statistical analysis carried out the paired Student’s t test and the Wilcoxon signed-rank test. In all cases, a significance level of 5% was adopted. All patients were in stable condition with no recent events before dental care. Results Twenty-four consecutive procedures were performed in 12 patients (9 women, 3 men) with CCh and ICD: 7 (58.3%) had long QT syndrome (LQTS), 4 (33.3%) Brugada syndrome (BrS), and 1 (8.3%) Catecholaminergic polymorphic ventricular tachycardia (CPVT). Holter analysis showed no increased heart rate (HR) or sustained arrhythmias. Blood pressure (BP), electrocardiographic changes and anxiety measurement showed no statistically significant differences. No LTE occurred during dental treatment, regardless of the type of anesthesia. Conclusion Lidocaine administration, with or without epinephrine, can be safely used in selected CCh-ICD patients without LTE. These preliminary findings need to be confirmed in a larger population with ICD and CCh.
- Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort(2023) OLIVETTI, Natalia Sangiorgi; SACILOTTO, Luciana; WULKAN, Fanny; PESSENTE, Gabrielle D'Arezzo; CARVALHO, Mariana Lombardi Peres de; MOLETA, Danilo; HACHUL, Denise Tessariol; VERONESE, Pedro; HARDY, Carina; PISANI, Cristiano; WU, Tan Chen; VIEIRA, Marcelo Luiz Campos; FRANCA, Lucas Arraes de; FREITAS, Matheus de Souza; ROCHITTE, Carlos Eduardo; BUENO, Savia Christina; LOVISI, Vitor Bastos; KRIEGER, Jose Eduardo; SCANAVACCA, Mauricio; PEREIRA, Alexandre da Costa; DARRIEUX, Francisco da CostaBackground:Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. Methods:The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. Results:The 5-year cumulative probability of LTAE was 30% and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P=0.010), HF symptoms (HR: 4.37; P=0.010), epsilon wave (HR: 4.99; P=0.015), and number of leads with low QRS voltage (HR: 1.28; P=0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P=0.040), number of leads with T wave inversion (HR: 1.17; P=0.039), low QRS voltage (HR: 1.12; P=0.021), younger age (HR: 0.97; P=0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P=0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P=0.023) was independently associated with HF-death/HTx. Conclusions:Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
bookPart Síncope e hipotensão(2016) WU, Tan Chen; HACHUL, Denise Tessariol- Enhancing Arrhythmogenic Right Ventricular Cardiomyopathy Detection and Risk Stratification: Insights from Advanced Echocardiographic Techniques(2024) OLIVETTI, Natalia; SACILOTTO, Luciana; MOLETA, Danilo Bora; FRANCA, Lucas Arraes de; CAPELINE, Lorena Squassante; WULKAN, Fanny; WU, Tan Chen; PESSENTE, Gabriele D'Arezzo; CARVALHO, Mariana Lombardi Peres de; HACHUL, Denise Tessariol; PEREIRA, Alexandre da Costa; KRIEGER, Jose E.; SCANAVACCA, Mauricio Ibrahim; VIEIRA, Marcelo Luiz Campos; DARRIEUX, FranciscoIntroduction: The echocardiographic diagnosis criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are highly specific but sensitivity is low, especially in the early stages of the disease. The role of echocardiographic strain in ARVC has not been fully elucidated, although prior studies suggest that it can improve the detection of subtle functional abnormalities. The purposes of the study were to determine whether these advanced measures of right ventricular (RV) dysfunction on echocardiogram, including RV strain, increase diagnostic value for ARVC disease detection and to evaluate the association of echocardiographic parameters with arrhythmic outcomes. Methods: The study included 28 patients from the Heart Institute of S & atilde;o Paulo ARVC cohort with a definite diagnosis of ARVC established according to the 2010 Task Force Criteria. All patients were submitted to ECHO's advanced techniques including RV strain, and the parameters were compared to prior conventional visual ECHO and CMR. Results: In total, 28 patients were enrolled in order to perform ECHO's advanced techniques. A total of 2/28 (7%) patients died due to a cardiovascular cause, 2/28 (7%) underwent heart transplantation, and 14/28 (50%) patients developed sustained ventricular arrhythmic events. Among ECHO's parameters, RV dilatation, measured by RVDd (p = 0.018) and RVOT PSAX (p = 0.044), was significantly associated with arrhythmic outcomes. RV free wall longitudinal strain < 14.35% in absolute value was associated with arrhythmic outcomes (p = 0.033). Conclusion: Our data suggest that ECHO's advanced techniques improve ARVC detection and that abnormal RV strain can be associated with arrhythmic risk stratification. Further studies are necessary to better demonstrate these findings and contribute to risk stratification in ARVC, in addition to other well-known risk markers.