MARTINO MARTINELLI FILHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
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- Effectiveness of epicardial atrial pacing using a bipolar steroid-eluting endocardial lead with active fixation in an experimental model(2013) BUENO, Savia Christina Pereira; TAMAKI, Wagner Tetsuji; SILVA, Marcelo Fiorelli Alexandrino da; ZAMBOLIM, Cristiane Maciel; SILVA, Katia Regina da; MARTINELLI FILHO, Martino; COSTA, RobertoPURPOSE: To assess the effectiveness of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead implanted on the atrial surface in an experimental model. METHODS: A total of ten Large White adult pigs underwent pacemaker implantation under general anesthesia. Atrial pacing and sensing parameters were obtained at the procedure, immediate postoperative period and on the 7th and the 30th postoperative in unipolar and bipolar configurations. RESULTS: All procedures were successfully performed. There were no perioperative complications and no early deaths. Atrial pacing and sensing parameters for both unipolar and bipolar modes remained stable throughout the study. We observed a progressive increase in atrial thresholds, ranging from 0.49 +/- 0.35 (at implantation) to 1.86 +/- 1.31 volts (30th postoperative day), in unipolar mode. Atrial impedance measurements decreased slightly over time, ranging from 486.80 +/- 126.35 Ohms (at implantation) to 385.0 +/- 80.52 Ohms (30th postoperative day). Atrial sensing measures remained stable from the immediate postoperative period until the end of the study. CONCLUSION: The bipolar active fixation endocardial lead implanted epicardially can provide stable conditions of pacing and sensing parameters throughout the postoperative follow-up.
- Glocal Clinical Registries: Pacemaker Registry Design and Implementation for Global and Local Integration - Methodology and Case Study(2013) SILVA, Katia Regina da; COSTA, Roberto; CREVELARI, Elizabeth Sartori; LACERDA, Marianna Sobral; ALBERTINI, Caio Marcos de Moraes; MARTINELLI FILHO, Martino; SANTANA, Jose Eduardo; VISSOCI, Joao Ricardo Nickenig; PIETROBON, Ricardo; BARROS, Jacson V.Background: The ability to apply standard and interoperable solutions for implementing and managing medical registries as well as aggregate, reproduce, and access data sets from legacy formats and platforms to advanced standard formats and operating systems are crucial for both clinical healthcare and biomedical research settings. Purpose: Our study describes a reproducible, highly scalable, standard framework for a device registry implementation addressing both local data quality components and global linking problems. Methods and Results: We developed a device registry framework involving the following steps: (1) Data standards definition and representation of the research workflow, (2) Development of electronic case report forms using REDCap (Research Electronic Data Capture), (3) Data collection according to the clinical research workflow and, (4) Data augmentation by enriching the registry database with local electronic health records, governmental database and linked open data collections, (5) Data quality control and (6) Data dissemination through the registry Web site. Our registry adopted all applicable standardized data elements proposed by American College Cardiology/American Heart Association Clinical Data Standards, as well as variables derived from cardiac devices randomized trials and Clinical Data Interchange Standards Consortium. Local interoperability was performed between REDCap and data derived from Electronic Health Record system. The original data set was also augmented by incorporating the reimbursed values paid by the Brazilian government during a hospitalization for pacemaker implantation. By linking our registry to the open data collection repository Linked Clinical Trials (LinkedCT) we found 130 clinical trials which are potentially correlated with our pacemaker registry. Conclusion: This study demonstrates how standard and reproducible solutions can be applied in the implementation of medical registries to constitute a re-usable framework. Such approach has the potential to facilitate data integration between healthcare and research settings, also being a useful framework to be used in other biomedical registries.
- CHronic use of Amiodarone aGAinSt Implantable cardioverter-defibrillator therapy for primary prevention of death in patients with Chagas cardiomyopathy Study: Rationale and design of a randomized clinical trial(2013) MARTINELLI, Martino; RASSI JR., Anis; MARIN-NETO, Jose Antonio; PAOLA, Angelo Amato Vincenzo de; BERWANGER, Otavio; SCANAVACCA, Mauricio Ibraim; KALIL, Roberto; SIQUEIRA, Sergio Freitas deBackground The implantable cardioverter defibrillator (ICD) is better than antiarrhythmic drug therapy for the primary and secondary prevention of all-cause mortality and sudden cardiac death in patients with either coronary artery disease or idiopathic dilated cardiomyopathy. This study aims to assess whether the ICD also has this effect for primary prevention in chronic Chagas cardiomyopathy (CCC). Methods In this randomized (concealed allocation) open-label trial, we aim to enroll up to 1,100 patients with CCC, a Rassi risk score for death prediction of >= 10 points, and at least 1 episode of nonsustained ventricular tachycardia on a 24-hour Holter monitoring. Patients from 28 centers in Brazil will be randomly assigned in a 1: 1 ratio to receive an ICD or amiodarone (600 mg/d for 10 days, then 200-400 mg/d until the end of the study). The randomization sequence will be generated by computer, and the members of the committees responsible for end point validation and data analysis will be blinded to study assignment. The primary end point is all-cause death, and enrolment will continue until 256 patients have reached this end point. Key secondary end points include cardiovascular death, sudden cardiac death, hospitalization for heart failure, and quality of life. We expect follow-up to last 3 to 6 years, and data analysis will be done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov number NCT01722942. Conclusion CHAGASICS is the first large-scale trial to assess the benefit of ICD therapy for the primary prevention of death in patients with CCC and nonsustained ventricular tachycardia, who have a moderate to high risk of death.
- Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy(2013) SHIOZAKI, Afonso Akio; SENRA, Tiago; ARTEAGA, Edmund; MARTINELLI FILHO, Martino; PITA, Cristiane Guedes; AVILA, Luis Francisco R.; PARGA FILHO, Jose Rodrigues; MADY, Charles; KALIL-FILHO, Roberto; BLUEMKE, David A.; ROCHITTE, Carlos EduardoBackground: Myocardial fibrosis (MF) occurs in up to 80% of subjects with asymptomatic or mildly symptomatic hypertrophic cardiomyopathy (HCM) and can constitute an arrhythmogenic substrate for re-entrant, life-threatening ventricular arrhythmias in predisposed persons. Objective: The aim was to investigate whether MF detected by delayed enhancement cardiac CT is predictive of ventricular tachycardia (VT) and fibrillation (VF) that require appropriate therapy by an implantable cardioverter defibrillator (ICD) in patients with HCM. Methods: Twenty-six patients with HCM with previously (for at least 1 year) implanted ICD underwent MF evaluation by cardiac CT. MF was quantified by myocardial delayed enhanced cardiac CT. Data on ICD firing were recorded every 3 months after ICD implantation. Risk factors for sudden cardiac death in patients with HCM were evaluated in all patients. Results: MF was present in 25 of 26 patients (96%) with mean fibrosis mass of 20.5 +/- 15.8 g. Patients with appropriate ICD shocks for VF/VT had significantly greater MF mass than patients without (29.10 +/- 19.13 g vs 13.57 +/- 8.31 g; P = .01). For a MF mass of at least 18 g, sensitivity and specificity for appropriate ICD firing were 73% (95% CI, 49%-88%) and 71% (95% CI, 56%-81%), respectively. Kaplan-Meier curves indicated a significantly greater VF/VT event rate in patients with MF mass >= 18 g than in patients with MF <18 g (P = .02). In the Cox regression analysis, the amount of MF was independently associated with VF/VT in ICD-stored electrograms. Conclusion: The mass of MF detected by cardiac CT in patients with HCM at high risk of sudden death was associated with appropriate ICD firings.
- Improved relationship between left and right ventricular electrical activation after cardiac resynchronization therapy in heart failure patients can be quantified by body surface potential mapping(2013) SAMESIMA, Nelson; PASTORE, Carlos Alberto; DOUGLAS, Roberto Andres; MARTINELLI FILHO, Martino; PEDROSA, Anisio A.OBJECTIVES: Few studies have evaluated cardiac electrical activation dynamics after cardiac resynchronization therapy. Although this procedure reduces morbidity and mortality in heart failure patients, many approaches attempting to identify the responders have shown that 30% of patients do not attain clinical or functional improvement. This study sought to quantify and characterize the effect of resynchronization therapy on the ventricular electrical activation of patients using body surface potential mapping, a noninvasive tool. METHODS: This retrospective study included 91 resynchronization patients with a mean age of 61 years, left ventricle ejection fraction of 28%, mean QRS duration of 182 ms, and functional class III/IV (78%/22%); the patients underwent 87-lead body surface mapping with the resynchronization device on and off. Thirty-six patients were excluded. Body surface isochronal maps produced 87 maximal/mean global ventricular activation times with three regions identified. The regional activation times for right and left ventricles and their interregional right-to-left ventricle gradients were calculated from these results and analyzed. The Mann-Whitney U-test and Kruskall-Wallis test were used for comparisons, with the level of significance set at p <= 0.05. RESULTS: During intrinsic rhythms, regional ventricular activation times were significantly different (54.5 ms vs. 95.9 ms in the right and left ventricle regions, respectively). Regarding cardiac resynchronization, the maximal global value was significantly reduced (138 ms to 131 ms), and a downward variation of 19.4% in regional-left and an upward variation of 44.8% in regional-right ventricular activation times resulted in a significantly reduced inter-regional gradient (43.8 ms to 17 ms). CONCLUSIONS: Body surface potential mapping in resynchronization patients yielded electrical ventricular activation times for two cardiac regions with significantly decreased global and regional-left values but significantly increased regional-right values, thus showing an attenuated inter-regional gradient after the cardiac resynchronization therapy.
- Novel approach to epicardial pacemaker implantation in patients with Limited venous access(2013) COSTA, Roberto; SCANAVACCA, Mauricio; SILVA, Katia Regina da; MARTINELLI FILHO, Martino; CARRILLO, RogerBACKGROUND Limited venous access in certain patients increases the procedural risk and complexity of conventional transvenous pacemaker implantation. OBJECTIVE The purpose of this study was to determine a minimally invasive epicardial approach using pericardial reflections for dual-chamber pacemaker implantation in patients with limited venous access. METHODS Between June 2006 and November 2011, 15 patients underwent epicardial pacemaker implantation. Procedures were performed through a minimally invasive subxiphoid approach and pericardial window with subsequent fluoroscopy-assisted lead placement. Mean patient age was 46.4 +/- 15.3 years (9 male [(60.0%], 6 female [40.0%]). The new surgical approach was used in patients determined to have limited venous access due to multiple abandoned leads in 5 (33.3%), venous occlusion in 3 (20.0%), intravascular retention of lead fragments from prior extraction in 3 (20.0%), tricuspid valve vegetation currently under treatment in 2 (13.3%), and unrepaired intracardiac defects in 2 (13.3%). RESULTS All procedures were successful with no perioperative complications or early deaths. Mean operating time for isolated pacemaker implantation was 231.7 +/- 33.5 minutes. Lead placement on the superior aspect of right atrium, through the transverse sinus, was possible in 12 patients. In the remaining 3 patients, the atrial lead was implanted on the left atrium through the oblique sinus, the postcaval recess, or the left pulmonary vein recess. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 36.8 +/- 25.1 months. CONCLUSION Epicardial pacemaker implantation through pericardial reflections is an effective alternative therapy for those patients requiring physiologic pacing in whom venous access is limited.
- Quality of Life and Functional Capacity after Long-Term Right Ventricular Pacing in Pediatrics and Young Adults with Congenital Atrioventricular Block(2013) SILVA, Katia Regina da; COSTA, Roberto; OLIVEIRA JR., Roberto Marcio De; LACERDA, Marianna Sobral; HUANG, Adriana I. Un; ROSSI, Marina Bertelli; CREVELARI, Elizabeth Sartori; TAMAKI, Wagner Tetsuji; MARTINELLI FILHO, Martino; PIETROBON, RicardoBackgroundAlthough several studies have demonstrated deleterious consequences of chronic right ventricular (RV) pacing on ventricular function and synchronicity, its effects on health-related quality of life (HRQoL) and functional exercise capacity remain uncertain. We aimed to evaluate the effect of RV pacing on HRQoL and functional capacity of children and young adults with congenital complete atrioventricular block (CCAVB). MethodsWe included 66 consecutive subjects with RV cardiac pacemaker due to CCAVB and under clinical follow-up for more than 1 year. Multidimensional HRQoL scores were evaluated by Short Form-36 Health Survey (SF-36) and Child Health Questionnaire-Parent Form 50 (CHQ-PF50). Functional capacity was tested by a 6-minute walk distance test (6MWDT). Association analysis was performed to examine if any demographic and clinical characteristics were associated with lower HRQoL scores and shorter distances at the 6MWDT. ResultsDomains presenting lower HRQoL scores were vitality (64.0 17.3), mental health (67.3 +/- 8.0), role emotional (69.7 +/- 35.8) in the SF-36 questionnaire; general health perceptions (61.3 +/- 8.3), general behavior (61.9 +/- 15.6), parental impactemotional (67.7 +/- 28.7) in the CHQ-PF50. Female gender (P = 0.009), left ventricular ejection fraction lower than 55% (P = 0.013), cardiovascular drugs (P = 0.003) were significantly associated with lower HRQoL scores. Average distance traveled during the 6MWDT was 539.8 +/- 82.9 m. The 6MWDT showed significant association with age (P = 0.006) and cardiovascular drugs (P = 0.024). ConclusionsChronic RV pacing did not affect the HRQoL and physical capacity of pediatrics and young subjects. Female gender, ventricular function, and cardiovascular drugs were associated with lower HRQoL scores. Older subjects walked shorter distances in the 6MWDT, as well as subjects who were taking cardiovascular drugs.
conferenceObject Exercise Training Associated With Cardiac Resynchronization Therapy Improves Peripheral Vasoconstriction and Functional Capacity in Heart Failure Patients(2013) NOBRE, Thais S.; ANTUNES-CORREA, Ligia M.; GROEHS, Raphaela V.; ALVES, Maria J.; RONDON, Maria U.; MARTINELLI FILHO, Martino; OLIVEIRA, Patricia A.; LIMA, Marta F.; SARMENTO, Adriana O.; MIDDLEKAUFF, Holly R.; NEGRAO, Carlos E.