FRANCISCO CARLOS DA COSTA DARRIEUX
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
40 resultados
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- Accessory Atrioventricular Pathways Refractory to Catheter Ablation Role of Percutaneous Epicardial Approach(2015) SCANAVACCA, Mauricio Ibrahim; STERNICK, Eduardo Back; PISANI, Cristiano; LARA, Sissy; HARDY, Carina; D'AVILA, Andre; CORREA, Frederico Soares; DARRIEUX, Francisco; HACHUL, Denise; MARCIAL, Miguel Barbero; SOSA, Eduardo A.Background-Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed. Methods and Results-We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access. Conclusions-Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial-epicardial approach.
- 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.
conferenceObject Brugada syndrome: value of electrophysiologic study in the risk stratification(2017) PAIXAO, G.; LAMES, C.; ROSA, X.; SACILOTTO, L.; DARRIEUX, F.; CHORK, M.; WU, T. C.; PISANI, C.; HACHUL, D.; SCANAVACCA, M.- Age is associated with time in therapeutic range for warfarin therapy in patients with atrial fibrillation(2016) MARCATTO, Leiliane Rodrigues; SACILOTTO, Luciana; DARRIEUX, Francisco Carlos da Costa; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio Ibrahim; KRIEGER, Jose Eduardo; PEREIRA, Alexandre Costa; SANTOS, Paulo Caleb Junior LimaBackground: Warfarin is the most prescribed oral anticoagulant used for preventing stroke in patients with atrial fibrillation. Time in the therapeutic range (TTR) has been accepted as the best method to evaluate the quality of warfarin therapy. The main aim of the present study was to evaluate the impact of variables on the time in the therapeutic range for warfarin therapy in patients with atrial fibrillation from a referral cardiovascular hospital. Methods: This retrospective study included 443 patients were included (190 patients with age < 65 years and 253 patients with age >= 65 years) from 2011 to 2014 and TTR was computed according to Rosendaal's method. Results: Patients with age >= 65 years had higher TTR value (67+/-22%) compared with patients with < 65 years (60+/-24%) (p = 0.004). In a linear regression model, only age >= 65 years emerged as a significant predictor of greater TTR values. In multivariate logistic regression model, the variable age = 65 years was associated with higher OR for having a TTR higher than the median value (OR = 2.17, p < 0.001). Conclusion: We suggest that the age influenced TTR through greater drug adherence. Strategies for increasing drug adherence might improve quality of warfarin anticoagulation.
- Compound Heterozygous SCN5A Mutations in a Toddler - Are they Associated with a More Severe Phenotype?(2017) SACILOTTO, Luciana; EPIFANIO, Hindalis Ballesteros; DARRIEUX, Francisco Carlos da Costa; WULKAN, Fanny; OLIVEIRA, Theo Gremen Mimary; HACHUL, Denise Tessariol; PEREIRA, Alexandre da Costa; SCANAVACCA, Mauricio IbrahimCompound heterozygosity has been described in inherited arrhythmias, and usually associated with a more severe phenotype. Reports of this occurrence in Brugada syndrome patients are still rare. We report a study of genotype-phenotype correlation after the identification of new variants by genetic testing. We describe the case of an affected child with a combination of two different likely pathogenic SCN5A variants, presenting sinus node dysfunction, flutter and atrial fibrillation, prolonged HV interval, spontaneous type 1 Brugada pattern in the prepubescent age and familiar history of sudden death.
- Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms(2015) KAISER, Elisabeth; DARRIEUX, Francisco C. C.; BARBOSA, Silvio A.; GRINBERG, Rodrigo; ASSIS-CARMO, Andre; SOUSA, Julio C.; HACHUL, Denise; PISANI, Cristiano F.; KOSA, Eva; PASTORE, Carlos A.; SCANAVACCA, Mauricio I.This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): Brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of wide QRS-complex tachycardia (WCT) in emergency situations were made. Fifty-one consecutive patients with 12-lead ECG registered during EPS-induced regular WCT were selected. Each ECG was split into two parts: HP (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and HP algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose VT in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for VT probability. Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish VT from SVT.
conferenceObject Clinical Results of Scar Related Ventricular Tachycardia Ablation Performed in a South America School Hospital(2015) PISANI, Cristiano; HARDY, Carina; LARA, Sissy; CHOKR, Muhieddine; BELLOTTI, Hugo; HACHUL, Denise; DARRIEUX, Francisco; SOSA, Eduardo; SCANAVACCA, Mauricio- Percutaneous Transatrial Access to the Pericardial Space for Epicardial Mapping and Ablation(2011) SCANAVACCA, Mauricio I.; VENANCIO, Ana Claudia; PISANI, Cristiano F.; LARA, Sissy; HACHUL, Denise; DARRIEUX, Francisco; HARDY, Carina; PAOLA, Edna; AIELLO, Vera D.; MAHAPATRA, Srijoy; SOSA, EduardoBackground-Puncture of the atrial appendage may provide access to the pericardial space. The aim of this study was to evaluate the feasibility of epicardial mapping and ablation through an endocardial transatrial access in a swine model. Methods and Results-An 8-F Mullins sheath was used to perforate the right (n=16) or left (n=1) atrial appendage in 17 pigs (median weight, 27.5 kg; first and third quartiles [Q1, Q3], 25.2, 30.0 kg). A 7-F ablation catheter was introduced into the pericardial space to perform epicardial mapping and deliver radiofrequency pulses on the atria. The pericardial space was entered in all 17 animals. In 15 (88%) animals, there was no hemodynamic instability (mean blood pressure monitoring, initial median, 80 mm Hg; Q1, Q3, 70, 86 mm Hg; final median, 88 mm Hg; Q1, Q3, 80, 96 mm Hg; P=0.426). In these 15, a mild hemorrhagic pericardial effusion was identified and aspirated (median, 20 mL; Q1, Q3, 15, 30 mL) during the procedure, and postmortem gross analysis revealed that the atrial perforation was closed in these animals. In 2 (12%) of the 17 animals, there was major pericardial bleeding with hemodynamic collapse. On gross examination, it was found that pericardial space was accessed through right ventricular perforation in 1 animal and the tricuspid annulus in the other. After the initial study, we used an occlusion device in 3 other animals to attempt to seal the puncture (2 at the right atrial appendage and 1 at the right ventricle). These 3 animals had no significant pericardial bleeding. Conclusions-Transatrial endovascular right atrial appendage puncture may provide a potential alternative route for pericardial access. Further studies are needed to evaluate its safety with longer and more-complex procedures before being applied in clinical settings. (Circ Arrhythm Electrophysiol. 2011;4:331-336.)
- 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.
conferenceObject Atrial fibrillation as a cornerstone of laminopathy(2018) CALIL, Z. O.; PESSENTE, G. A.; SACILOTTO, L.; OLIVETTI, N. Q. S.; HACHUL, D. T.; WU, T. C.; GRUPPI, C. J.; CARVALHO, M. L. P.; ARANHA, A. F.; PEDROSA, A. A. A.; HARDY, C. A.; PISANI, C. F.; PEREIRA, A. C.; SCANAVACCA, M. I.; DARRIEUX, F. C. C.