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
5 resultados
Resultados de Busca
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- 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.
- 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.
- Update on ablation of ventricular tachyarrhythmias(2022) MATHEW, S.; MüLLER, P.; HARDY, C.; SCANAVACCA, M. I.; DENEKE, T.Catheter ablation of ventricular tachycardia (VT) is performed with increasing frequency in clinical practice. Whereas the reported success rates of idiopathic VT are high, catheter ablation of VT in patients with structural heart disease with its scar-related re-entry mechanism may remain a challenge especially if deep intramyocardial or epicardial portions exist. The integration of modern cardiac imaging, new functional mapping strategies and catheter technologies allow optimized identification and characterization of the critical arrhythmogenic substrate and hence a more targeted VT ablation. The extent to which these innovations will have the potential to improve VT ablation success rates will be determined by future studies. © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
- 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.
- Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy(2021) SANTACRUZ, D.; ROSAS, F.; HARDY, C. A.; OSPINA, D.; ROSAS, A. N.; CAMARGO, J. M.; BERMúDEZ, J. J.; BETANCOURT, J. F.; VELASCO, V. M.; GONZáLEZ, M. D.Chagas cardiomyopathy is a parasitic infection caused by Trypanosoma cruzi. Structural and functional abnormalities are the result of direct myocardial damage by the parasite, immunological reactions, dysautonomia, and microvascular alterations. Chronic Chagas cardiomyopathy (CCC) is the most serious and important manifestation of the disease, affecting up to 30% of patients in the chronic phase. It results in heart failure, arrhythmias, thromboembolism, and sudden cardiac death. As in other cardiomyopathies, scar-related reentry frequently results in ventricular tachycardia (VT). The scars typically are located in the inferior and lateral aspects of the left ventricle close to the mitral annulus extending from endocardium to epicardium. The scars may be more prominent in the epicardium than in the endocardium, so epicardial mapping and ablation frequently are required. Identification of late potentials during sinus rhythm and mid-diastolic potentials during hemodynamically tolerated VT are the main targets for ablation. High-density mapping during sinus rhythm can identify late isochronal regions that are then targeted for ablation. Preablation cardiac magnetic resonance imaging with late enhancement can identify potentials areas of arrhythmogenesis. Therapeutic alternatives for VT management include antiarrhythmic drugs and modulation of the cardiac autonomic nervous system. © 2021 Heart Rhythm Society