CARLOS ALBERTO PASTORE
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/65, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/65, Hospital das Clínicas, Faculdade de Medicina - Líder
4 resultados
Resultados de Busca
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- 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.
- 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.
- 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.
article III DIRECTIVES OF THE BRAZILIAN SOCIETY OF CARDIOLOGY ON ANALYSIS AND ISSUANCE OF ELECTROCARDIOGRAPHIC REPORTS Introduction(2016) PASTORE, C. A.; PINHO, J. A.; PINHO, C.; SAMESIMA, N.; PEREIRA-FILHO, H. G.; KRUSE, J. C. L.; PAIXAO, A.; PEREZ-RIERA, A. R.; RIBEIRO, A. L.; OLIVEIRA, C. A. R.; GOMES, C. I. G.; KAISER, E.; GALVAO, F.; DARRIEUX, F. C. C.; FRANCA, F. F. A. C.; FEITOSA-FILHO, G.; GERMINIANI, H.; AZIZ, J. L.; LEAL, M. G.; MOLINA, M.; OLIVEIRA, N. M. T.; OLIVEIRA, P. A.; SANCHES, P. C. R.; ALMEIDA, R. M.; BARBOSA, R.; TEIXEIRA, R. A.; DOUGLAS, R. A. G.; GUNDIM, R. S.; ATANES, S. M.