CARINA ABIGAIL HARDY

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • 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
  • article 5 Citação(ões) na Scopus
    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, Mauricio
    Background 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.
  • article 0 Citação(ões) na Scopus
    Initial experience on cardiac magnetic resonance-aided VT ablation in South America
    (2023) PISANI, Cristiano F.; ALEXANDRE, Felipe Kalil; KULCHETSCKI, Rodrigo; MAYRINK, Marina; WU, Tan Chen; CHOKR, Muhieddine; HARDY, Carina; MELO, Sissy Lara; ROCHITTE, Carlos; NOMURA, Cesar; SCANAVACCA, Mauricio
    Background: Cardiac magnetic resonance (CMR) allowed to precisely identify the substrate in scar-related ventricular tachycardia (VT). New software has been developed to define the 3D scar and corridors to help VT ablation by integrating the scar and electroanatomical mapping (EAM). The objective of this study is to evaluate the results of VT ablation aided by the integration of EAM and CMR software processed scar.Methods: We selected patients that underwent VT ablation with the integration of EAM and CMR processed using ADAS software and imported to the CARTO system using VTK file format.Results: From 2019 to 2021, eight patients (mean age 63 +/- 4.4, 62.5% male; EF 47 +/- 12%) underwent CMR-aided VT ablation. Mean procedural time was 281 +/- 77 min. There was of 9 +/- 4.4 epicardial and 7.9 +/- 4.3 endocardial bulls eye segments with at least 2 g of border zone or core scar. In a median follow-up time of 532 days (Q1: 284, Q3: 688), three patients (37.5%) presented VT recurrence, all three underwent a second procedure, with no VT recurrence on the follow-up. No patient died in the follow-up.Conclusion: CMR aided is ablation is feasible and effective in patients with scar related VT.
  • article 0 Citação(ões) na Scopus
    Feasibility of Transatrial Access for Epicardial Ablation Evaluation of 2 Different Techniques in Swine
    (2023) CHOKR, Muhieddine O.; VANDONI, Pedro Mario Pinto; NETO, Jose Nilo de Carvalho; MOURA, Lucas G. de; SOUSA, Italo Bruno dos Santos; AIELLO, Vera D.; BRITO, Fabio Sandoli de; PISANI, Cristiano F.; HARDY, Carina A.; MELO, Sissy L. de
    BACKGROUND The subxiphoid pericardial access is technically difficult and has a considerable rate of complications, thus transatrial access may be an alternative. OBJECTIVES This study sought to assess the feasibility and safety of this strategy regarding periprocedural period and after 1-week follow-up. METHODS The investigators performed epicardial mapping through transatrial puncture in 20 swine. Animals were divided into group A, in which aspiration of the sheath was performed to maintain negative pressure after the withdraw of the catheters, and group B, in which a device (Konar-MF VSD Occluder) was delivered to occlude the right atrial appendage perforation. Bleeding was investigated immediately and 1 week after. RESULTS Access was safe in 19 of 20 animals (95%) with small amount of bleeding (6.4 +/- 6 mL). In group A (n = 10), 1 animal presented hemopericardium right after the puncture. In the other 9, epicardial ablation was performed and 60.0 +/- 28.0 mL of blood was aspirated without events. After 1 week, fibrin-hemorrhagic pericarditis was identified in 3 animals. In group B (n = 10), reaching the epicardial surface was possible in all animals. An adequate position of the prosthesis was obtained in 90% (9 of 10). One death occurred in the immediate postoperative period, secondary to pneumothorax. After 1 week, postmortem analysis showed absence of pericardial bleeding and a normal-appearing pericardium in the 8 animals with adequate prosthesis position. CONCLUSIONS Transatrial access allows epicardial mapping and ablation. Sheath removal after negative pressure contributes to achieving acute bleeding control but does not prevent its occurrence. The use of the device prevents bleeding and hemorrhagic pericarditis.
  • article 4 Citação(ões) na Scopus
    Long-Term Outcome of Cardiac Denervation Procedures The Anatomically Guided Septal Approach
    (2023) RIVAROLA, Esteban W. R.; HACHUL, Denise; WU, Tan Chen; PISANI, Cristiano; SCARIOTI, Vinicius D.; HARDY, Carina; DARRIEUX, Francisco; SCANAVACCA, Mauricio
    BACKGROUND Functional bradycardia is a challenging condition that affects a healthy population. Ganglionated plexus ablation has emerged as a therapeutic alternative to avoid a pacemaker. OBJECTIVES The purpose of this study is to evaluate long-term effects of anatomically guided cardiac denervation. METHODS This is a prospective longitudinal study that included 36 patients with symptomatic functional bradycardia. Electroanatomic reconstruction of both atria was carried out, and the main septal ganglionated plexi were anatomically located and targeted.RESULTS Ablation endpoints were: 1) heart rate increment; 2) Wenckebach cycle length shortening; and 3) atrio-Hisian (AH) interval shortening. A sinus node denervation was obtained in all patients with an increment of 21.6% in the mean heart rate. All patients presented a negative atropine test after ablation. Twenty-eight (77.7%) patients presented immediate sings of atrioventricular node denervation, with a shortening of 15.6% of mean Wenckebach cycle length and 15.9% of the mean AH interval. All heart rate variability parameters showed a significant reduction after 12 months, enduring after 18 months. Thirty (83.3%) patients remained free of events after a mean follow-up of 52.1 & PLUSMN; 35.2 months. One patient (2.77%) presented acute sinus node artery occlusion during ablation with persistent sinus dysfunction and had a pacemaker implantation; 3 (8.3%) other patients evolved with sinus tachycardia, and 4 (11.1%) patients presented syncope recurrence during follow-up, 3 (8.3%) of them requiring a pacemaker implantation. No other tachyarrhythmia was observed.CONCLUSIONS The anatomically guided septal approach is an effective technique for syncope prevention, promoting long-lasting autonomic changes. No significant proarrhythmia effect has been observed during the long-term follow-up. (J Am Coll Cardiol EP 2023;9:1344-1353) & COPY; 2023 by the American College of Cardiology Foundation.
  • article 1 Citação(ões) na Scopus
    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 Costa
    Background: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.
  • conferenceObject
    OUTCOMES OF CATHETER ABLATION OF ELECTRICAL STORM IN CHAGAS DISEASE
    (2023) KULCHETSCKI, Rodrigo; PISANI, Cristiano F.; MAYRINK, Marina; ALEXANDRE, Felipe Kalil; CHOKR, Muhieddine; HARDY, Carina; II, Sissy Lara Melo; SCANAVACCA, Mauricio Ibrahim