LUCIANA SACILOTTO FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
39 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 39
- 3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY(2017) GUALANDRO, D. M.; YU, P. C.; CARAMELLI, B.; MARQUES, A. C.; CALDERARO, D.; FORNARI, L. S.; PINHO, C.; FEITOSA, A. C. R.; POLANCZYK, C. A.; ROCHITTE, C. E.; JARDIM, C.; VIEIRA, C. L. Z.; NAKAMURA, D. Y. M.; IEZZI, D.; SCHREEN, D.; ADAM, Eduardo L.; D'AMICO, E. A.; LIMA, M. Q.; BURDMANN, E. A.; PACHON, E. I. M.; BRAGA, F. G. M.; MACHADO, F. S.; PAULA, F. J.; CARMO, G. A. L.; FEITOSA-FILHO, G. S.; PRADO, G. F.; LOPES, H. F.; FERNANDES, J. R. C.; LIMA, J. J. G.; SACILOTTO, L.; DRAGER, L. F.; VACANTI, L. J.; ROHDE, L. E. P.; PRADA, L. F. L.; GOWDAK, L. H. W.; VIEIRA, M. L. C.; MONACHINI, M. C.; MACATRAO-COSTA, M. F.; PAIXAO, M. R.; OLIVEIRA JR., M. T.; CURY, P.; VILLACA, P. R.; FARSKY, P. S.; SICILIANO, R. F.; HEINISCH, R. H.; SOUZA, R.; GUALANDRO, S. F. M.; ACCORSI, T. A. D.; MATHIAS JR., W.
conferenceObject Brugada syndrome: value of electrophysiologic study in the risk stratification(2017) PAIXAO, G.; LAMES, C.; ROSA, X.; SACILOTTO, L.; DARRIEUX, F.; CHORK, M.; WU, T. C.; PISANI, C.; HACHUL, D.; SCANAVACCA, M.- 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families(2021) STILES, Martin K.; WILDE, Arthur A. M.; ABRAMS, Dominic J.; ACKERMAN, Michael J.; ALBERT, Christine M.; BEHR, Elijah R.; CHUGH, Sumeet S.; CORNEL, Martina C.; GARDNER, Karen; INGLES, Jodie; JAMES, Cynthia A.; JUANG, Jyh-Ming Jimmy; KAAB, Stefan; KAUFMAN, Elizabeth S.; KRAHN, Andrew D.; LUBITZ, Steven A.; MACLEOD, Heather; MORILLO, Carlos A.; NADEMANEE, Koonlawee; PROBST, Vincent; V, Elizabeth Saarel; SACILOTTO, Luciana; SEMSARIAN, Christopher; SHEPPARD, Mary N.; SHIMIZU, Wataru; SKINNER, Jonathan R.; TFELT-HANSEN, Jacob; WANG, Dao WuThis international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Gass of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
- 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.
- Compound Heterozygous SCN5A Mutations in a Toddler - Are they Associated with a More Severe Phenotype?(2017) SACILOTTO, Luciana; EPIFANIO, Hindalis Ballesteros; DARRIEUX, Francisco Carlos da Costa; WULKAN, Fanny; OLIVEIRA, Theo Gremen Mimary; HACHUL, Denise Tessariol; PEREIRA, Alexandre da Costa; SCANAVACCA, Mauricio IbrahimCompound heterozygosity has been described in inherited arrhythmias, and usually associated with a more severe phenotype. Reports of this occurrence in Brugada syndrome patients are still rare. We report a study of genotype-phenotype correlation after the identification of new variants by genetic testing. We describe the case of an affected child with a combination of two different likely pathogenic SCN5A variants, presenting sinus node dysfunction, flutter and atrial fibrillation, prolonged HV interval, spontaneous type 1 Brugada pattern in the prepubescent age and familiar history of sudden death.
- 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families(2021) STILES, Martin K.; WILDE, Arthur A. M.; ABRAMS, Dominic J.; ACKERMAN, Michael J.; ALBERT, Christine M.; BEHR, Elijah R.; CHUGH, Sumeet S.; CORNEL, Martina C.; GARDNER, Karen; INGLES, Jodie; JAMES, Cynthia A.; JUANG, Jyh-Ming Jimmy; KAAB, Stefan; KAUFMAN, Elizabeth S.; KRAHN, Andrew D.; LUBITZ, Steven A.; MACLEOD, Heather; MORILLO, Carlos A.; NADEMANEE, Koonlawee; PROBST, Vincent; SAAREL, Elizabeth V.; SACILOTTO, Luciana; SEMSARIAN, Christopher; SHEPPARD, Mary N.; SHIMIZU, Wataru; SKINNER, Jonathan R.; TFELT-HANSEN, Jacob; WANG, Dao WuThis international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
- Evaluation of a pharmacogenetic-based warfarin dosing algorithm in patients with low time in therapeutic range - study protocol for a randomized controlled trial(2016) MARCATTO, Leiliane Rodrigues; SACILOTTO, Luciana; BUENO, Carolina Tosin; FACIN, Mirella; STRUNZ, Celia Maria Cassaro; DARRIEUX, Francisco Carlos Costa; SCANAVACCA, Mauricio Ibrahim; KRIEGER, Jose Eduardo; PEREIRA, Alexandre Costa; SANTOS, Paulo Caleb Junior LimaBackground: Time in therapeutic range (TTR) is a measurement of quality of warfarin therapy and lower TTR values (<50%) are associated with greater risk of thromboembolic and bleeding events. Recently, we developed a pharmacogenetic-based warfarin dosing algorithm specifically calibrated for a Brazilian patient sample. The aims of this study are: to evaluate the impact of a genetic-based algorithm, compared to traditional anticoagulation, in the time to achieve the therapeutic target and in TTR percentage; and to assess the cost-effectiveness of genotype-guided warfarin dosing in a specific cohort of patients with low TTR (<50%) from a tertiary cardiovascular hospital. Methods/design: This study is a randomized controlled trial in patients (n = 300) with atrial fibrillation with TTR <50%, based on the last three INR values. At the first consultation, patients will be randomized into two groups: TA group (traditional anticoagulation) and PA group (pharmacogenetic anticoagulation). For the first group, the physician will adjust the dose according to current INR value and, for the second group, a pharmacogenetic algorithm will be used. At the second, third, fourth and fifth consultations (with an interval of 7 days each) INR will be measured and, if necessary, the dose will be adjusted based on guidelines. Afterwards, patients who are INR stable will begin measuring their INR in 30 day intervals; if the patient's INR is not stable, the patient will return in 7 days for a new measurement of the INR. Outcomes measures will include the time to achieve the therapeutic target and the percentage of TTR at 4 and 12 weeks. In addition, as a secondary end-point, pharmacoeconomic analysis will be carried out. Ethical approval was granted by the Ethics Committee for Medical Research on Human Beings of the Clinical Hospital of the University of Sao Paulo Medical School. Discussion: This randomized study will include patients with low TTR and it will evaluate whether a population-specific genetic algorithm might be more effective than traditional anticoagulation for a selected group of poorly anticoagulated patients.
- Transient ascending ST-segment depression and widening of the S wave in 3-channel Holter monitoring-A sign of dromotropic disturbance in the right ventricular outflow tract in the Brugada syndrome: A report of five cases(2022) ANDRADE, Antonio Thomaz de; BARBOSA-BARROS, Raimundo; NIKUS, Kjell; RAIMUNDO, Rodrigo D.; ABREU, Luiz C. de; SACILOTTO, Luciana; DARRIUEX, Francisco C. C.; YANOWITZ, Frank G.; BRUGADA, Pedro; PEREZ-RIERA, Andres RicardoBackground Brugada syndrome (BrS) is somewhat a challenging diagnosis, due to its dynamic pattern. One of the aspects of this disease is a significant conduction disorder located in the right ventricular outflow tract (RVOT), which can be explained as a consequence of low expression of Connexin-43. This decreased conduction speed is responsible for the typical electrocardiographic pattern. Opposite leads located preferably in inferior leads of the electrocardiogram may show a deep and widened S wave associated with ascending ST segment depression. Holter monitoring electrocardiographic (ECG) aspects is still a new frontier of knowledge in BrS, especially in intermittent clinical presentations. Methods We describe, as an exploratory analysis, five case series of intermittent type 1 BrS to demonstrate the appearance of ascending ST segment depression and widening of the S wave, during 3-channel 24h-Holter monitoring (C1, C2 and C3) with bipolar leads. Results In the five cases described, the ST segment depression was observed mainly in C2, but in some cases also in C1 and C3. Only case 1 presented concomitant intermittent elevation of the ST segment in C1. All cases were intermittent. Conclusion The recognition of an ECG pattern with ascending ST-segment depression and widening of the S wave in 3-channel Holter described in this case series should raise a suspicion of the BrS and suggests the counterpart of a dromotropic disturbance registered in the RVOT and/or reciprocal changes.
- Coexistence of Wolff-Parkinson-White and Brugada Syndrome: Mere Curiosity?(2014) KAISER, Elisabeth; SACILOTTO, Luciana; DARRIEUX, Francisco; SOSA, EduardoThe association between Brugada syndrome (BS) and ventricular preexcitation is a rare condition, with sporadic cases already reported. We report the case of a 29-year-old man, with palpitation unrelated to physical or emotional stress. The electrocardiogram of the first visit revealed a ventricular preexcitation pattern and an end-conduction delay, with negative T wave in V-1 and intraventricular conduction disturbance in V-2 (atypical for BS). The typical aspect of BS occurred after introduction of propafenone for the prevention of atrioventricular tachycardia. We discuss the recognition of this rare association, the proarrhythmic effects of some drugs, treatment options, and prognosis.
- Trombo Atrial Esquerdo e Contraste Espontaneo Denso no Uso de Anticoagulante Oral de Acao Direta em Fibrilacao Atrial: Visao de Centro Referenciado(2022) MARQUES, Thiago; DARRIEUX, Francisco; GOUVEA, Fabio; GARAMBONE, Leandro; LINDOSO, Ana Paula; LAGE, Joao; SACILOTTO, Luciana; COIMBRA, Ana Lucia; PINHEIRO, Martina; OLIVETTI, Natalia; LARA, Sissy; HARDY, Carina; ATHAYDE, Guilherme; HACHUL, Denise; PISANI, Cristiano; WU, Tan Chen; SCANAVACCA, MauricioBackground: In the treatment of atrial fibrillation (AF), the most frequently sustained arrhythmia, with catheter ablation (CA) or electrical cardioversion (ECV), the periprocedural period is one of the most critical phases. Currently, the use of new direct action oral anticoagulants (DOAC) is increasingly frequent; however, in the real world, there are still few data on studies on the thrombus incidence in the left atrium (TrLA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE). Objective: To evaluate the prevalence of events and association with risk factors in patients using DOACs. Primary objective: to analyze the prevalence of thrombus in the LA by TEE in patients using DOAC undergoing ECV/CA. Second, evaluate the association of comorbidities with the presence of thrombi and DSC. Methods: Retrospective cohort, single-center study with patients followed at the Arrhythmia Outpatient Unit (InCor-HCFMUSP). Patients indicated for procedures and using DOACs were selected, and their clinical/echocardiographic data were analyzed. A significance level of 5% was considered. Results: 354 patients were included, a total of 400 procedures, from March 2012-March 2018. Thrombus in the LA was found in 11 patients (2.8%), associated with advanced age (p=0.007) and higher CHA2DS2-VASc (p<0.001) score. DSC in the LA before TEE was found in 29 patients (7.3%), with lower LVEF (p<0.038) and greater LA dimension (p<0.0001). Conclusion: The incidence of LA thrombus and DSC in patients using DOC in the context of AF ECV/CA, although small, is not negligible. Patients with higher CHA2DS2-VASc scores, especially older and with larger LA diameter, are more prone to these echocardiographic findings.