LUCIANA SACILOTTO FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
Resultados de Busca
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- Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: A randomized controlled study(2020) PISANI, Cristiano F.; ROMERO, Jorge; LARA, Sissy; HARDY, Carina; CHOKR, Muhieddine; SACILOTTO, Luciana; WU, Tan Chen; DARRIEUX, Francisco; HACHUL, Denise; KALIL-FILHO, Roberto; BIASE, Luigi Di; SCANAVACCA, MauricioBACKGROUND Epicardial mapping and ablation are frequently necessary to eliminate ventricular tachycardia (VT) in patients with Chagas disease. Nonetheless, there are no randomized controlled trials demonstrating the role of this strategy. OBJECTIVE We conducted this randomized controlled trial to evaluate the efficacy and safety of combined epicardial ablation in patients with Chagas disease. METHODS We randomized patients with Chagas disease and VT in a 1:1 fashion to either the endocardial (endo) mapping and ablation group or the combined endocardial/epicardial (endo/epi) mapping and ablation group. The efficacy end points were measured by VT inducibility and all-ventricular arrhythmia recurrence. Safety was assessed by the rate of periprocedural complications. RESULTS Thirty patients were enrolled, and most were male. The median age was 67 (Q1: 58; Q3: 70) years in the endo group and 58 (Q1: 43; Q3: 66) years in the endo/epi group. The left ventricular ejection fraction was 33.0% +/- 9.5% and 35.2% +/- 11.5%, respectively P = .13. Acute success (non-reinducibility of clinical VT) was obtained in 13 patients (86%) in the endo/epi group and in 6 patients (40%) in the endo-only group (P = .021). There were 12 patients with VT recurrence (80%) in the endo-only group and 6 patients (40%) in the endo/epi group (P = .02) (by intention-to-treat analysis). Epicardial ablation was ultimately per formed in 9 patients (60%) in the endo-only group because of an absence of endocardial scar or maintenance of VT inducibility. There was no difference in complications between the groups. CONCLUSION Combining endo/epi VT catheter ablation in patients with Chagas disease significantly increases shortand long-term freedom from all-ventricular arrhythmias. Epicardial access did not increase periprocedural complication rates.
- Low rate of life-threatening events and limitations in predicting invasive and noninvasive markers of symptoms in a cohort of type 1 Brugada syndrome patients: Data and insights from the GenBra registry(2020) SACILOTTO, Luciana; SCANAVACCA, Mauricio I.; OLIVETTI, Natalia; LEMES, Carolina; PESSENTE, Gabrielle D.; WULKAN, Fanny; HACHUL, Denise T.; KRIEGER, Jose E.; PEREIRA, Alexandre C.; DARRIEUX, Francisco C. C.Background Brugada syndrome (BrS) has diagnostic challenges and controversial risk assessment. We aimed to investigate invasive and noninvasive parameters in symptomatic and asymptomatic patients from a Brazilian cohort of type-1 BrS. Methods Patients with spontaneous and drug-induced type-1 BrS were classified into two groups, asymptomatic (n = 116, 84.1%) and symptomatic (n = 22, 15.9%; 13 with arrhythmogenic syncope, 9 with aborted sudden cardiac death). Genetic testing, EPS parameters, and electrocardiogram (ECG) parameters were analyzed. Results A total of 138 consecutive patients were eligible, 101 men (73.2%), mean 41.4 years, mostly probands (79%). Spontaneous pattern, observed in 77.5% of the patients, was associated with symptoms only if expressed in V1 and V2 standard position (not high precordial leads; p = .014). All symptomatic patients were probands. The presence of right ventricular outflow tract conduction delay (RVOTcd) signs, positive EPS, and SCN5A status was similar between symptomatic and asymptomatic subjects. During the mean 75-month follow-up, eight patients had appropriate therapies. All had spontaneous type-1 ECG pattern and 2/8 (25%) were asymptomatic, with positive EPS. The overall LAE incidence of 1.1% per year dropped to 0.27% in asymptomatic patients. RVOTcd occurred more frequently in SCN5A carriers (QRS-f 33.3% vs. 7.7%;p = .005, AVR sign 58.3% vs. 13.6%;p < .001; deep S in lead I 75% vs. 48.5%,p = .025%), as well as longer HV interval (66 vs. 49 ms;p < .001). Conclusions Spontaneous type-1 Brugada pattern in standard leads and proband status were more frequent in symptomatic subjects. RVOTcd, more common in SCN5A carriers, did not predict symptoms in BrS patients. EPS exhibited limited prognostic value for this low-risk population.
- QT Interval Control to Prevent Torsades de Pointes during Use of Hydroxychloroquine and/or Azithromycin in Patients with COVID-19(2020) WU, Tan Chen; SACILOTTO, Luciana; DARRIEUX, Francisco Carlos da Costa; PISANI, Cristiano Faria; MELO, Sissy Lara de; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio
- Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy(2020) MARCATTO, Leiliane Rodrigues; SACILOTTO, Luciana; TAVARES, Leticia Camargo; SOUZA, Debora Stephanie Pereira; OLIVETTI, Natalia; STRUNZ, Celia Maria Cassaro; DARRIEUX, Francisco Carlos Costa; SCANAVACCA, Mauricio Ibrahim; KRIEGER, Jose Eduardo; PEREIRA, Alexandre Costa; SANTOS, Paulo Caleb Junior LimaBackground Warfarin is the most common oral anticoagulant drug, especially in low-income and emerging countries, because of the high cost of direct oral anticoagulant (DOACs), or when warfarin is the only proven therapy (mechanical prosthetic valve and kidney dysfunction). The quality of warfarin therapy is directly associated with dose management. Evidence shows that pharmaceutical care achieves a better quality of therapy with warfarin. However, there are no studies showing this intervention in a specific patient group with poor quality of anticoagulation in a long period after the end of the follow-up by a pharmacist. Thus, the aim of this study was to evaluate whether the quality of warfarin therapy driven by a pharmacist remains stable in the long term after the end of follow up with a pharmacist, in AF patients with poor quality of anticoagulation. Methods This is a prospective study, which evaluated about 2,620 patients and selected 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR<50% - based on the last three values of international normalized ratio). Pharmacist-driven therapy management was performed up to 12 weeks. Data from patients were evaluated 1 year after the end of the follow-up with pharmacist. Results Comparison between mean TTR after 12 weeks of pharmaceutical care (54.1%) and mean TTR one year after the end of the pharmaceutical care (56.5%; p=0.081) did not achieve statistical difference, demonstrating that the increment of quality due to intervention of 12 weeks was maintained for 1 year after intervention. Conclusion The long-term impact of pharmaceutical care was beneficial for patients with AF and poor quality of warfarin anticoagulation. This design might be an important strategy to treat a subgroup of patients without proven effectiveness of warfarin.
- Natural History and Risk Stratification in Andersen-Tawil Syndrome Type 1(2020) MAZZANTI, Andrea; GUZ, Dmitri; TRANCUCCIO, Alessandro; PAGAN, Eleonora; KUKAVICA, Deni; CHARGEISHVILI, Tekla; OLIVETTI, Natalia; BIERNACKA, Zbieta Katarzyna; SACILOTTO, Luciana; SARQUELLA-BRUGADA, Georgia; CAMPUZANO, Oscar; NOF, Eyal; ANASTASAKIS, Aristides; SANSONE, Valeria A.; JIMENEZ-JAIMEZ, Juan; CRUZ, Fernando; SANCHEZ-QUINONES, Jessica; HERNANDEZ-AFONSO, Julio; FUENTES, Maria Eugenia; SREDNIAWA, Beata; GAROUFI, Anastasia; ANDRSOVA, Irena; IZQUIERDO, Maite; MARINOV, Rumen; DANON, Asaf; EXPOSITO-GARCIA, Victor; GARCIA-FERNANDEZ, Amaya; MUNOZ-ESPARZA, Carmen; ORTIZ, Martin; ZIENCIUK-KRAJKA, Agnieszka; TAVAZZANI, Elisa; MONTEFORTE, Nicola; BLOISE, Raffaella; MARINO, Maira; MEMMI, Mirella; NAPOLITANO, Carlo; ZORIO, Esther; MONSERRAT, Lorenzo; BAGNARDI, Vincenzo; PRIORI, Silvia G.BACKGROUND Andersen-Tawil Syndrome type 1 (ATS1) is a rare arrhythmogenic disorder, caused by loss-of-function mutations in the KCNJ2 gene. We present here the largest cohort of patients with ATS1 with outcome data reported. OBJECTIVES This study sought to define the risk of life-threatening arrhythmic events (LAE), identify predictors of such events, and define the efficacy of antiarrhythmic therapy in patients with ATS1. METHODS Clinical and genetic data from consecutive patients with ATS1 from 23 centers were entered in a database implemented at ICS Maugeri in Pavia, Italy, and pooled for analysis. RESULTS We enrolled 118 patients with ATS1 from 57 families (age 23 +/- 17 years at enrollment). Over a median follow-up of 6.2 years (interquartile range: 2.7 to 16.5 years), 17 patients experienced a first LAE, with a cumulative probability of 7.9% at 5 years. An increased risk of LAE was associated with a history of syncope (hazard ratio [HR]: 4.54; p = 0.02), with the documentation of sustained ventricular tachycardia (HR 9.34; p = 0.001) and with the administration of amiodarone (HR: 268; p < 0.001). The rate of LAE without therapy (1.24 per 100 person-years [py]) was not reduced by beta-blockers alone (1.37 per 100 py; p = 1.00), or in combination with Class Ic antiarrhythmic drugs (1.46 per 100 py, p = 1.00). CONCLUSIONS Our data demonstrate that the clinical course of patients with ATS1 is characterized by a high rate of LAE. A history of unexplained syncope or of documented sustained ventricular tachycardia is associated with a higher risk of LAE. Amiodarone is proarrhythmic and should be avoided in patients with ATS1. (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.
conferenceObject Novel insights on Andersen-Tawil syndrome type 1(2020) MAZZANTI, A.; GUZ, D.; TRANCUCCIO, A.; PAGAN, E.; CHARGEISHVILI, T.; BIERNACKA, E. K.; SACILOTTO, L.; ZORIO, E.; BRUGADA, G.; NOF, E.; ANASTASAKIS, A.; SANSONE, V; JIMENEZ-JAIMEZ, J.; CRUZ, F.; PRIORI, S. G.