FRANCISCO CARLOS DA COSTA DARRIEUX
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
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- Diretriz Brasileira de Dispositivos Cardiacos Eletronicos Implantaveis-2023(2023) TEIXEIRA, Ricardo Alkmim; FAGUNDES, Alexsandro Alves; JR, Jose Mario Baggio; OLIVEIRA, Julio Cesar de; MEDEIROS, Paulo de Tarso Jorge; VALDIGEM, Bruno Pereira; TENO, Luiz Antonio Castilho; SILVA, Rodrigo Tavares; MELO, Celso Salgado de; ELIAS NETO, Jorge; JR, Antonio Vitor Moraes; PEDROSA, Anisio Alexandre Andrade; PORTO, Fernando Mello; JR, Helio Lima de Brito; SOUZA, Thiago Goncalves Schroder e; MATEOS, Jose Carlos Pachon; MORAES, Luis Gustavo Belo de; FORNO, Alexander Romeno Janner Dal; D'AVILA, Andre Luiz Buchele; CAVACO, Diogo Alberto de Magalhaes; KUNIYOSHI, Ricardo Ryoshim; PIMENTEL, Mauricio; CAMANHO, Luiz Eduardo Montenegro; SAAD, Eduardo Benchimol; ZIMERMAN, Leandro Ioschpe; OLIVEIRA, Eduardo Bartholomay; SCANAVACCA, Mauricio Ibrahim; MARTINELLI FILHO, Martino; LIMA, Carlos Eduardo Batista de; PEIXOTO, Giselle de Lima; DARRIEUX, Francisco Carlos da Costa; DUARTE, Jussara de Oliveira Pinheiro; GALVAO FILHO, Silas dos Santos; COSTA, Eduardo Rodrigues Bento; MATEO, Enrique Indalecio Pachon; MELO, Sissy Lara De; RODRIGUES, Thiago da Rocha; ROCHA, Eduardo Arrais; HACHUL, Denise Tessariol; LORGA FILHO, Adalberto Menezes; NISHIOKA, Silvana Angelina D'Orio; GADELHA, Eduardo Barreto; COSTA, Roberto; ANDRADE, Veridiana Silva de; TORRES, Gustavo Gomes; OLIVEIRA NETO, Nestor Rodrigues de; LUCCHESE, Fernando Antonio; MURAD, Henrique; WANDERLEY NETO, Jose; BROFMAN, Paulo Roberto Slud; ALMEIDA, Rui M. S.; LEAL, Joao Carlos Ferreira
- 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.
- 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.
- Long-Term Outcome of Cardiac Denervation Procedures The Anatomically Guided Septal Approach(2023) RIVAROLA, Esteban W. R.; HACHUL, Denise; WU, Tan Chen; PISANI, Cristiano; SCARIOTI, Vinicius D.; HARDY, Carina; DARRIEUX, Francisco; SCANAVACCA, MauricioBACKGROUND Functional bradycardia is a challenging condition that affects a healthy population. Ganglionated plexus ablation has emerged as a therapeutic alternative to avoid a pacemaker. OBJECTIVES The purpose of this study is to evaluate long-term effects of anatomically guided cardiac denervation. METHODS This is a prospective longitudinal study that included 36 patients with symptomatic functional bradycardia. Electroanatomic reconstruction of both atria was carried out, and the main septal ganglionated plexi were anatomically located and targeted.RESULTS Ablation endpoints were: 1) heart rate increment; 2) Wenckebach cycle length shortening; and 3) atrio-Hisian (AH) interval shortening. A sinus node denervation was obtained in all patients with an increment of 21.6% in the mean heart rate. All patients presented a negative atropine test after ablation. Twenty-eight (77.7%) patients presented immediate sings of atrioventricular node denervation, with a shortening of 15.6% of mean Wenckebach cycle length and 15.9% of the mean AH interval. All heart rate variability parameters showed a significant reduction after 12 months, enduring after 18 months. Thirty (83.3%) patients remained free of events after a mean follow-up of 52.1 & PLUSMN; 35.2 months. One patient (2.77%) presented acute sinus node artery occlusion during ablation with persistent sinus dysfunction and had a pacemaker implantation; 3 (8.3%) other patients evolved with sinus tachycardia, and 4 (11.1%) patients presented syncope recurrence during follow-up, 3 (8.3%) of them requiring a pacemaker implantation. No other tachyarrhythmia was observed.CONCLUSIONS The anatomically guided septal approach is an effective technique for syncope prevention, promoting long-lasting autonomic changes. No significant proarrhythmia effect has been observed during the long-term follow-up. (J Am Coll Cardiol EP 2023;9:1344-1353) & COPY; 2023 by the American College of Cardiology Foundation.
- Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort(2023) OLIVETTI, Natalia Sangiorgi; SACILOTTO, Luciana; WULKAN, Fanny; PESSENTE, Gabrielle D'Arezzo; CARVALHO, Mariana Lombardi Peres de; MOLETA, Danilo; HACHUL, Denise Tessariol; VERONESE, Pedro; HARDY, Carina; PISANI, Cristiano; WU, Tan Chen; VIEIRA, Marcelo Luiz Campos; FRANCA, Lucas Arraes de; FREITAS, Matheus de Souza; ROCHITTE, Carlos Eduardo; BUENO, Savia Christina; LOVISI, Vitor Bastos; KRIEGER, Jose Eduardo; SCANAVACCA, Mauricio; PEREIRA, Alexandre da Costa; DARRIEUX, Francisco da CostaBackground:Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. Methods:The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. Results:The 5-year cumulative probability of LTAE was 30% and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P=0.010), HF symptoms (HR: 4.37; P=0.010), epsilon wave (HR: 4.99; P=0.015), and number of leads with low QRS voltage (HR: 1.28; P=0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P=0.040), number of leads with T wave inversion (HR: 1.17; P=0.039), low QRS voltage (HR: 1.12; P=0.021), younger age (HR: 0.97; P=0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P=0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P=0.023) was independently associated with HF-death/HTx. Conclusions:Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
- Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trial(2023) PEREIRA, M. D. P.; LIMA, E. G.; PITTA, F. G.; GOWDAK, L. H. W.; MIOTO, B. M.; CARVALHO, L. N. S.; DARRIEUX, F. C. D. C.; MEJIA, O. A. V.; JATENE, F. B.; SERRANO JR., C. VObjectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.
bookPart Taquiarritmias de intervalo QRS largo(2023) MAYRINK, Marina Pereira; GONçALVES, André Luis Martins; KULCHETSCKI, Rodrigo Melo; DARRIEUX, Francisco Carlos da CostabookPart Taquiarritmias de intervalo QRS estreito(2023) GONçALVES, André Luis Martins; MAYRINK, Marina Pereira; KULCHETSCKI, Rodrigo Melo; DARRIEUX, Francisco Carlos da Costa