Índice h a partir de 2011
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Agora exibindo 1 - 2 de 2
  • article 7 Citação(ões) na Scopus
    Strategies to manage obstructive sleep apnea to decrease the burden of atrial fibrillation
    (2018) GOES, Creuza M.; FALCOCHIO, Paola P. N. F.; DRAGER, Luciano F.
    Introduction: In the last decades, consistent data derived from experimental, epidemiological, and clinical studies pointed obstructive sleep apnea (OSA), the most common sleep disordered breathing worldwide, as a potential risk factor for incidence and recurrence of atrial fibrillation (AF). Areas covered: This review article describes the impact of OSA on AF and discusses potential strategies for managing OSA in the AF scenario. Expert commentary: Untreated OSA seems to be one important predictor of AF treatment failure after chemical or electrical cardioversion as well as after a successful AF ablation. There is biological plausibility for this association including the effects of intermittent hypoxia and sleep fragmentation promoting sympathetic activation, blood pressure instability, inflammation, and oxidative stress. The negative swings derived from the obstructive events also increases left ventricle afterload contributing to cardiac remodeling. Altogether, these factors provide a structural and electrical substrate for AF. Despite this evidence, however, OSA remains still poorly recognized and consequently undertreated in clinical practice. Therefore, active programs to incorporate valid screening for cardiologists to work in partnership to sleep medicine experts may ultimately contribute to decreasing the burden of AF.
  • article 1 Citação(ões) na Scopus
    Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?
    (2023) PICHARA, Nemer L.; SACILOTTO, Luciana; I, Mauricio Scanavacca; CARDOSO, Acacio Fernandes; SOARES, Beatriz Moreira Ayub Ferreira; FALCOCHIO, Paola P. P. N. F.; FALCAO, Andrea M. G.; OLIVETTI, Natalia; DARRIEUX, Francisco Carlos da Costa; CHALELA, William A.
    Aims High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG. Methods and results 74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including 'quick lay down'). For heart rate recovery (HRR) measurements and comparisons, a Student's t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 & PLUSMN; 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone. Conclusion Stress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.