LUCIANA SACILOTTO FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
Resultados de Busca
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- Nonstructural Genetic Cardiac Disease as the Most Common Cause of Sudden Cardiac Death in the Young Athlete: Is This True?(2023) STEIN, Ricardo; FERRARI, Filipe; BEUREN, Thais M. A.; SILVEIRA, Anderson D. D. da; SACILOTTO, LucianaPurpose of reviewThis review is aimed at summarizing and discussing the primary causes of sudden cardiac death (SCD) in young athletes.Recent findingsSCD in young athletes is a dramatic event, with an incidence rate that can reach 13 deaths per 100,000 athletes. Occasionally, exercise can trigger SCD, and unfortunately, this event may be the first manifestation of an underlying and silent cardiac condition. In the USA, hypertrophic cardiomyopathy is reported as the leading cause of SCD among young athletes, whereas arrhythmogenic right ventricular cardiomyopathy has been reported as the main cause in the Veneto region of Italy. However, emerging evidence has demonstrated that in many cases, athletes who experience sudden death have a seemingly normal cardiac structure, suggesting the possibility of sudden arrhythmic death syndrome. In recent decades, it has been possible to determine the causes of many SCDs that occur in the presence of nonstructural cardiac diseases. It is worth noting that routinely used cardiovascular screening methods, such as electrocardiogram and echocardiogram, may fail to detect nonstructural genetic cardiac diseases. In turn, in some circumstances, genetic testing may play a role in identifying individuals at risk of SCD due to these conditions.Understanding the underlying causes of SCD in young athletes is noteworthy for developing effective prevention and screening strategies. A multidisciplinary approach involving cardiologists, clinical sports physicians, pathologists, and geneticists collaborating represents an opportunity to enhance and optimize patient care and can play a crucial role in the prevention of SCD among young athletes.
- 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.
bookPart Arritmias(2023) TOLEDO, Laís de Oliveira; SACILOTTO, Luciana- 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.
- 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.