CARINA ABIGAIL HARDY
Índice h a partir de 2011
10
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
41 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 41
- Accessory Atrioventricular Pathways Refractory to Catheter Ablation Role of Percutaneous Epicardial Approach(2015) SCANAVACCA, Mauricio Ibrahim; STERNICK, Eduardo Back; PISANI, Cristiano; LARA, Sissy; HARDY, Carina; D'AVILA, Andre; CORREA, Frederico Soares; DARRIEUX, Francisco; HACHUL, Denise; MARCIAL, Miguel Barbero; SOSA, Eduardo A.Background-Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed. Methods and Results-We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access. Conclusions-Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial-epicardial approach.
conferenceObject Mechanical Esophageal Displacement for Esophageal Safety of Mechanical Esophageal Displacement for Esophageal Thermal Injury Prevention During Atrial Fibrillation Ablation in Swine(2019) PEREIRA, Renner; PISANI, Cristiano F.; AIELLO, Vera; CESTARI, Idagene A.; MOURA, Daniel; CHOKR, Muhieddine; HARDY, Carina; SISSY, Melo; SCANAVACCA, Mauricio; HACHUL, Denise- Outcomes of a combined vs non-combined endo-epicardial ventricular tachycardia ablation strategy(2023) MATOS, Daniel; ADRAGAO, Pedro; PISANI, Cristiano; HATANAKA, Vinicius; FREITAS, Pedro; COSTA, Francisco; CHOKR, Muhiedinne; HARDY, Carina; FERREIRA, Antonio Miguel; CARMO, Pedro; LAURA, Sissy; MORGADO, Francisco; CAVACO, Diogo; MENDES, Miguel; SCANAVACCA, MauricioBackground Direct comparisons of combined (C-ABL) and non-combined (NC-ABL) endo-epicardial ventricular tachycardia (VT) ablation outcomes are scarce. We aimed to investigate the long-term clinical efficacy and safety of these 2 strategies in ischemic heart disease (IHD) and non-ischemic cardiomyopathy (NICM) populations. Methods Multicentric observational registry included 316 consecutive patients who underwent catheter ablation for drug-resistant VT between January 2008 and July 2019. Primary and secondary efficacy endpoints were defined as VT-free survival and all-cause death after ablation. Safety outcomes were defined by 30-day mortality and procedure-related complications. Results Most of the patients were male (85%), with IHD (67%) and mean age of 63 +/- 13 years. During a mean follow-up of 3 +/- 2 years, 117 (37%) patients had VT recurrence and 73 (23%) died. Multivariate survival analysis identified electrical storm (ES) at presentation, IHD, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class III / IV, and C-ABL as independent predictors of VT recurrence. In 135 patients undergoing repeated procedures, only C-ABL and ES were independent predictors of relapse. The identified independent predictors of mortality were C-ABL, ES, LVEF, age, and NYHA class III / IV. C-ABL survival benefit was only seen in patients with a previous ablation (P for interaction = 0.04). Mortality at 30 days was similar between NC-ABL and C-ABL (4% vs. 2%, respectively, P = 0.777), as was complication rate (10.3% vs. 15.1%, respectively, P = 0.336). Conclusion A combined or sequential endo-epicardial TV ablation strategy was associated with lower VT recurrence and lower all-cause death in IHD and NICM patients undergoing repeated procedures. Both approaches seemed equally safe.
conferenceObject Transseptal puncture using electroanatomical mapping: a safe and cost-effective technique(2023) BRIGIDO, A. Dantas; RASSI, G. M.; RODRIGUES, L. V.; LOVISI, V. B.; PISANI, C. F.; CHOKR, M. O.; HARDY, C. A.; MELO, S. L.; GONCALVES, A. L. M.; MAYRINK, M. P.; KULCHETSCKI, R. M.; SCANAVACCA, M. I.- Bipolar radiofrequency ablation of septal ventricular tachycardia in a patient with dilated cardiomyopathy using two 8-mm tip catheters-case report(2022) FERRAZ, Alberto Pereira; ANDERE, Tamer El; GONCALVES, Andre Luis Martins; CHOKR, Muhieddine Omar; MELO, Sissy Lara; HARDY, Carina; PISANI, Cristiano Faria; SCANAVACCA, Mauricio IbrahimSeptal ventricular tachycardiac exhibit high recurrence rates after radiofrequency ablation, which is mainly attributed to the deep intramyocardial circuits and the inability to create transmural lesions with the conventional unipolar ablation. Bipolar radiofrequency ablation is feasible and it has been reported as a valid technique in these cases, leading to deeper lesion formation, high non-inducibility rates, and acceptable recurrence rates during follow-up. Our goal is to report a successful case of bipolar ablation of a septal ventricular tachycardia using a simple bipolar ablation configuration with two 8-mm tip catheters.
- Management of massive hemopericardium in the electrophysiology laboratory: The double long sheath technique(2022) CHOKR, Muhieddine Omar; SANTOS, Italo Bruno dos Santos Sousa; GOUVEA, Fabio Cesar; KULCHETSCKI, Rodrigo; ANDERE, Tamer El; HARDY, Carina; PISANI, Cristiano; MELO, Sissy; SCANAVACCA, MauricioAim To describe a simple and useful technique for acute management of massive hemopericardium inside the Electrophysiology (EP) laboratory Methods and results Five patients from a single center experience were identified, all with blood loss above 1000 ml after initial pericardiocenthesis. Using two long 8.5 F transseptal sheaths inside the pericardium space, with continuous negative pressure, allowed the complete cessation of bleeding or hemodynamic maintenance until definitive surgical repair in all patients Conclusion The use of two long sheaths for blood drainage, instead of conventional pericardiocenthesis, might be helpful to manage massive hemopericardium inside EP lab, avoiding urgent cardiac surgery or maintaining clinical stability until surgical staff is available.
- Selective atrial vagal denervation guided by spectral mapping to treat advanced atrioventricular block(2016) RIVAROLA, Esteban; HARDY, Carina; SOSA, Eduardo; HACHUL, Denise; FURLAN, Valter; RAIMUNDI, Fabrizio; SCANAVACCA, MauricioAsymptomatic nocturnal long ventricular pauses are usually detected accidentally and it has been suggested that they may lead to sudden death. Identification of predisposing factors could prevent cardiovascular events. We report the case of a patient with frequent asymptomatic nocturnal ventricular pauses of 3-11 s, characteristic of a vagally mediated atrioventricular (AV) block. Echocardiography, treadmill test, thyroid function test levels, and polysomnogram were normal. In an attempt to reduce the risk, it was decided that an atrial vagal denervation induced by radiofrequency (RF) ablation (cardioneuroablation) could be useful. Spectral mapping was used to localize endocardial vagal innervation in the right and left aspects of the inter-atrial septum, responsible for the sinus node and AV node modulation, and RF pulses were applied in those sites only. After finishing the procedure, significant changes were observed in the heart rate (66-90 b.p.m.), atrial-His interval (115-74 ms), Wenckebach cycle length (820-570 ms), and sinus node recovery time (1100-760 ms). Follow-up Holter recording demonstrated that the number of ventricular pauses had reduced from 438 to 0. Heart rate and time domain characteristics were compatible with vagal denervation. Ablation of the endocardial vagal innervation sites seems to be safe and efficient in reducing the frequency and the length of the ventricular pauses. It was possible by identifying certain spectral components of the atrial electrogram, resulting in a conservative approach.
- A novel treatment for esophageal lesions following atrial fibrillation ablation(2021) RIVAROLA, Esteban W. R.; MOURA, Eduardo; CHOU, Marco; SEABRA, Luciana Feitosa; HARDY, Carina; SCANAVACCA, MauricioThis study presents a novel technique for the treatment of a deep esophageal ulcer after ablation of paroxysmal atrial fibrillation (AF). Pulmonary vein isolation was performed using a radiofrequency irrigated tip catheter. On Day 5 of follow-up, a deep esophageal ulcer was observed. No significant visual improvement was observed after conventional treatment. Endoscopic negative pressure therapy in the esophagus was then applied for 5 days. A significant decrease in diameter and depth of the lesion was observed, possibly preventing perforation. Endoscopic negative pressure therapy can be used to heal thermal lesions after AF ablation procedures.
conferenceObject Clinical Results of Scar Related Ventricular Tachycardia Ablation Performed in a South America School Hospital(2015) PISANI, Cristiano; HARDY, Carina; LARA, Sissy; CHOKR, Muhieddine; BELLOTTI, Hugo; HACHUL, Denise; DARRIEUX, Francisco; SOSA, Eduardo; SCANAVACCA, Mauricio- 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.