TAN CHEN WU
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
11 resultados
Resultados de Busca
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- First-Degree Atrioventricular Block: A Finding Not Always Benign!(2022) WU, Tan Chen
- Trombo Atrial Esquerdo e Contraste Espontaneo Denso no Uso de Anticoagulante Oral de Acao Direta em Fibrilacao Atrial: Visao de Centro Referenciado(2022) MARQUES, Thiago; DARRIEUX, Francisco; GOUVEA, Fabio; GARAMBONE, Leandro; LINDOSO, Ana Paula; LAGE, Joao; SACILOTTO, Luciana; COIMBRA, Ana Lucia; PINHEIRO, Martina; OLIVETTI, Natalia; LARA, Sissy; HARDY, Carina; ATHAYDE, Guilherme; HACHUL, Denise; PISANI, Cristiano; WU, Tan Chen; SCANAVACCA, MauricioBackground: In the treatment of atrial fibrillation (AF), the most frequently sustained arrhythmia, with catheter ablation (CA) or electrical cardioversion (ECV), the periprocedural period is one of the most critical phases. Currently, the use of new direct action oral anticoagulants (DOAC) is increasingly frequent; however, in the real world, there are still few data on studies on the thrombus incidence in the left atrium (TrLA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE). Objective: To evaluate the prevalence of events and association with risk factors in patients using DOACs. Primary objective: to analyze the prevalence of thrombus in the LA by TEE in patients using DOAC undergoing ECV/CA. Second, evaluate the association of comorbidities with the presence of thrombi and DSC. Methods: Retrospective cohort, single-center study with patients followed at the Arrhythmia Outpatient Unit (InCor-HCFMUSP). Patients indicated for procedures and using DOACs were selected, and their clinical/echocardiographic data were analyzed. A significance level of 5% was considered. Results: 354 patients were included, a total of 400 procedures, from March 2012-March 2018. Thrombus in the LA was found in 11 patients (2.8%), associated with advanced age (p=0.007) and higher CHA2DS2-VASc (p<0.001) score. DSC in the LA before TEE was found in 29 patients (7.3%), with lower LVEF (p<0.038) and greater LA dimension (p<0.0001). Conclusion: The incidence of LA thrombus and DSC in patients using DOC in the context of AF ECV/CA, although small, is not negligible. Patients with higher CHA2DS2-VASc scores, especially older and with larger LA diameter, are more prone to these echocardiographic findings.
article Cardiac Arrhythmias Guideline in Children and Congenital Cardiomyopathies SOBRAC and DCC - CP(2016) MAGALHAES, L. P.; GUIMARAES, I. C. B.; MELO, S. L.; MATEO, E. I. P.; ANDALAFT, R. B.; XAVIER, L. F. R.; LORGA FILHO, A. M.; FAGUNDES, A. A.; MOREIRA, D. A. R.; HACHUL, D. T.; STERNICK, E. B.; ANDREA, E. M.; CANNAVAN, F. P. S.; OLIVEIRA, F. J. B.; DARRIEUX, F. C. C.; LIMA, G. G.; ATIE, J.; ELIAS NETO, J.; ZIMERMAN, L. I.; MIANA, L.; PELLANDA, L. C.; SACILOTTO, L.; JATENE, M. B.; SOARES, M. M.; BINOTTO, M. A.; SCANAVACCA, M. I.; OLIVEIRA JUNIOR, N. A.; ZIELINSKY, P.; SALERNO, P. R.; TEIXEIRA, R. A.; KUNIYOSHI, R. R.; COSTA, R.; SCHAMES NETO, S.; PEDRA, S. R. F. F.; GIMENEZ, S. C.; WU, T. C.; AIELLO, V. D.- 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.
- Clinical Management of Patients with First-Episode Atrial Fibrillation Detected in the Acute Phase of Myocardial Infarction(2019) SCANAVACCA, Mauricio; WU, Tan Chen
- Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method(2018) WU, Tan Chen; HACHUL, Denise T. L.; DARRIEUX, Francisco Carlos da Costa; I, Mauricio ScanavaccaBackground: Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of <= 85 mmHg to refine the vasodepressor (VD) response diagnosis. Objective: To determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria. Methods: (3M was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole >= 3 seconds, or as VD for SBP decrease >= 50 mmHg. Results: No differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value < 0.050 was considered statistically significant. During the maneuvers, 45 (45.45%) and 34 (51.5%) patients in the symptomatic and asymptomatic groups achieved SBP below <= 85 mmHg. Symptoms were reported especially in those patients in whom CSM caused a SBP decrease to below 90 mmHg and/or asystole > 2.5 seconds, regardless of the pattern of response or the presence of previous syncope. Conclusion: The response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.