VERA DEMARCHI AIELLO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
7 resultados
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conferenceObject Mechanical Esophageal Displacement for Esophageal Safety of Mechanical Esophageal Displacement for Esophageal Thermal Injury Prevention During Atrial Fibrillation Ablation in Swine(2019) PEREIRA, Renner; PISANI, Cristiano F.; AIELLO, Vera; CESTARI, Idagene A.; MOURA, Daniel; CHOKR, Muhieddine; HARDY, Carina; SISSY, Melo; SCANAVACCA, Mauricio; HACHUL, Denise- 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.)
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.
- Safety of an esophageal deviator for atrial fibrillation catheter ablation(2023) PEREIRA, Renner; PISANI, Cristiano; AIELLO, Vera; CESTARI, Idagene; OYAMA, Helena; SANTOS, Osmar; OTUBO, Jorge; MOURA, Daniel; SCANAVACCA, MauricioBACKGROUND Esophageal thermal injury is a complication of atrial fibrillation (AF) ablation, and it can be avoided by esophageal deviation during left atrial posterior wall radiofrequency catheter ablation.OBJECTIVE This study aimed to evaluate the safety of a nitinol-based mechanical esophageal displacement device (MEDD) and its performance.METHODS This preclinical safety study was conducted on 20 pigs, with 10 undergoing radiofrequency AF ablation using the MEDD and 10 serving as a control group under anticoagulation but without radiofrequency application. Esophageal traumatic injuries were classified from 0 to 4 and were grouped as absent (grade 0), minor (grade 1 or 2), moderate (grade 3), or major risk lesions (grade 4) by anatomopathological study. Grades 1 and 2 were considered accept-able. Fluoroscopy was used to measure displacement.RESULTS Five (25%) pigs developed traumatic lesions, 4 with grade 1 and 1 with grade 2 (2-mm superficial ulcer). There was no difference in lesion occurrence between the radiofrequency and control groups (30% and 20%, respectively; P = .43). Under rightward displacement, the right edge moved 23.9 (interquartile range [IQR] 21.3- 26.3) mm and the left edge moved 16.3 (IQR 13.8-18.4) mm (P , .001) from baseline. Under leftward displacement, the right edge moved 13.5 (IQR 10.9-15.3) mm and the left edge moved 16.5 (IQR 12.3-18.5) mm (P = .07). A perforation to the pharyngeal diverticulum occurred in 1 pig, related to an accidental extubation.CONCLUSION In pigs, the MEDD demonstrated safety in relation to esophageal tissue, and successful deviation. Esophageal traumatic injuries were acceptable, but improper manipulation led to pharyngeal lesion.
- Catheter ablation of the parahisian accessory pathways from the aortic cusps-Experience of 20 cases-Improving the mapping strategy for better results(2020) CHOKR, Muhieddine O.; MOURA, Lucas G. de; AIELLO, Vera D.; SOUSA, Italo B. dos Santos; LOPES, Hugo B.; CARMO, Andre A. L. do; PISANI, Cristiano F.; HARDY, Carina A.; MELO, Sissy L. de; SCANAVACCA, Mauricio I.Introduction Catheter ablation of the parahisian accessory pathways (PHAP) has been established as the definitive therapy for this type of arrhythmia. However, the PHAP proximity to the normal atrioventricular conduction system makes the procedure technically challenging. Here, we have reported a case series of 20 patients with PHAP who underwent aortic access ablation to evaluate the safety and efficacy of this approach in the PHAP ablation. Methods and Results The ablation through the aortic cusps was the successful approach in 13 of 20 (65%) of the cases. In 11 patients, the aortic approach was the initial strategy for ablation, and the accessory pathway was eliminated in seven (63.6%) of them. The aortic approach followed a failed right-sided attempt in nine patients. In six (66.7%) patients, the ablation was successful with the aortic approach. The only independent predictor for the successful ablation with each approach was the earliest ventricular activation before delta wave (predelta time) and a right-sided earliest ventricular activation of more than 23 ms had high sensitivity and specificity for right-sided success. Systematically using the two strategies (right and left approaches), the ablation of the PHAP was successful in 18 (90%) patients. Conclusion The aortic approach seems to be a safe and effective strategy for the ablation of PHAP. It can be used when the right-sided approach fails or even considered as an initial strategy when the predelta time is less than 23 ms in the right septal region. When combining the right- and left-sided approaches, the success rate is high. We believe that the retrograde aortic approach remains a key tool for this challenging ablation.
- The morphology of the coronary sinus in patients with congenitally corrected transposition: implications for cardiac catheterisation and re-synchronisation therapy(2016) AIELLO, Vera D.; FERREIRA, Flavia C. N.; SCANAVACCA, Mauricio I.; ANDERSON, Robert H.; D'AVILA, AndrePatients with congenitally corrected transposition frequently benefit from re-synchronisation therapy or ablation procedures. This is likely to require catheterisation of the coronary sinus. Its anatomy, however, is not always appreciated, despite being well-described. With this caveat in mind, we have evaluated its location and structure in hearts with congenitally corrected transposition in order to reinforce the guidance needed by the cardiac interventionist. We dissected and inspected the coronary sinus, the oblique vein of the left atrium, and the left-sided-circumflex venous channel in eight heart specimens with corrected transposition and eight controls, measuring the orifice and length of the sinus and the atrioventricular valves. In two-thirds of the malformed hearts, the sinus deviated from its anticipated course in the atrioventricular groove, ascending obliquely on the left atrial inferior wall to meet the left oblique vein. The maximal deviation coincided in all hearts with the point where the left oblique vein joined the left-sided-circumflex vein to form the coronary sinus. We describe a circumflex vein, rather than the great cardiac vein, as the latter venous channel is right-sided in the setting of corrected transposition. The length of the sinus correlated positively with the diameter of the tricuspid valve (p=0.02). Compared with controls, the left oblique vein in the malformed hearts joined the circumflex venous channel significantly closer to the mouth of the sinus. The unexpected course of the coronary sinus in corrected transposition and the naming of the cardiac veins have important implications for venous cannulation and interpretation of images.