EDUARDO ARGENTINO SOSA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
5 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.
- Selective atrial vagal denervation guided by spectral mapping to treat advanced atrioventricular block(2016) RIVAROLA, Esteban; HARDY, Carina; SOSA, Eduardo; HACHUL, Denise; FURLAN, Valter; RAIMUNDI, Fabrizio; SCANAVACCA, MauricioAsymptomatic nocturnal long ventricular pauses are usually detected accidentally and it has been suggested that they may lead to sudden death. Identification of predisposing factors could prevent cardiovascular events. We report the case of a patient with frequent asymptomatic nocturnal ventricular pauses of 3-11 s, characteristic of a vagally mediated atrioventricular (AV) block. Echocardiography, treadmill test, thyroid function test levels, and polysomnogram were normal. In an attempt to reduce the risk, it was decided that an atrial vagal denervation induced by radiofrequency (RF) ablation (cardioneuroablation) could be useful. Spectral mapping was used to localize endocardial vagal innervation in the right and left aspects of the inter-atrial septum, responsible for the sinus node and AV node modulation, and RF pulses were applied in those sites only. After finishing the procedure, significant changes were observed in the heart rate (66-90 b.p.m.), atrial-His interval (115-74 ms), Wenckebach cycle length (820-570 ms), and sinus node recovery time (1100-760 ms). Follow-up Holter recording demonstrated that the number of ventricular pauses had reduced from 438 to 0. Heart rate and time domain characteristics were compatible with vagal denervation. Ablation of the endocardial vagal innervation sites seems to be safe and efficient in reducing the frequency and the length of the ventricular pauses. It was possible by identifying certain spectral components of the atrial electrogram, resulting in a conservative approach.
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.)
- Radiofrequency Ablation of Childhood Arrhythmia. Observational Registry in 125 Children(2012) MELO, Sissy Lara de; SCANAVACCA, Mauricio Ibrahim; PISANI, Cristiano; DARRIEUX, Francisco; HACHUL, Denise; HARDY, Carina; CAMARGO, Paulo Roberto; ATIK, Edmar; SOSA, Eduardo ArgentinoBackground: Radiofrequency ablation (RFA) in children is an increasingly common practice. Objective: To evaluate, in our institution, the results of RFA in children younger than 15 years. Methods: A total of 125 children submitted to RFA between May 1991 and May 2010 were analyzed. Results: Sixty-seven (53.6%) children were males, aged between 44 days and 15 years (mean 8.6 +/- 3.3 years) with median weight of 31 kg. Heart disease was present in 21 (16.8%) patients. The RFA of accessory pathways (AP) was the most common procedure (62 children - 49.6%). The RFA of nodal reentrant tachycardia (NRT) was the second most common arrhythmia in 27 (21.6%), followed by atrial tachycardia (AT) in 16 (12.8%) and ventricular tachycardias (VT) in 8 (6.4%) children. The success criteria were achieved in 86.9%, 96.1%, 80% and 62.5% of patients undergoing RFA of AP, NRT, AT and VT, respectively. Transient AVB occurred during RFA in 4 (3.2%) and LBBB in 7 (5.6%) children. Twenty-five children underwent a new RFA due to initial failure or recurrence. During the mean follow up of 5.5 +/- 3.4 years, 107 (88.4%) remained without recurrence. There was no statistical difference regarding the results and the age at which the patient underwent the procedure. No child had persistent AVB or required a permanent pacemaker. Conclusion: Catheter ablation is a safe and effective alternative therapy in children with recurrent tachycardias refractory to medical treatment. (Arq Bras Cardiol 2012;98(6):514-518)