Claudio Cirenza

Sleep-disordered breathing and chronic atrial fibrillation

BACKGROUND Little has been known about the prevalence of sleep apnea in patients with atrial fibrillation (AF). Studies have suggested that the prevalence of AF is increasing in patients with sleep-disordered breathing. We hypothesize that the prevalence of OSA is higher in chronic persistent and permanent AF patients than a sub-sample of the general population without this arrhythmic disorder. OBJECTIVE Evaluate the frequency of Obstructive Sleep Apnea in a sample of chronic AF compared to a sub-sample of the general population. METHODS Fifty-two chronic AF patients aged (60.5 +/- 9.5, 33 males) and 32 control (aged 57.3 +/- 9.6, 15 males). All subjects were evaluated by a staff cardiologist for the presence of medical conditions and were referred for polysomnography. The differences between groups were analyzed by ANOVA for continuous variables, and by the Chi-square test for dichotomous variables. Statistical significance was established by alpha=0.05. RESULTS There were no differences in age, gender, BMI, sedentarism, presence of hypertension, type 2 diabetes mellitus, abdominal circumference, systolic and diastolic blood pressure, and sleepiness scoring between groups. Despite similar BMI, AF patients had a higher neck circumference compared to control group (39.9cm versus 37.7cm, p=0.01) and the AF group showed higher percentage time of stage 1 NREM sleep (6.4% versus 3.9%, p=0.03). Considering a cut-off value for AHI >= 10 per hour of sleep, the AF group had a higher frequency of OSA compared to the control group (81.6% versus 60%, p=0.03). All the oxygen saturation parameters were significantly worse in the AF group, which had lower SaO(2) nadir (81.9% versus 85.3%, p=0.01) and mean SaO(2) (93.4% versus 94.3%, p=0.02), and a longer period of time below 90% (26.4min versus 6.7min, p=0.05). CONCLUSION Sleep-disordered breathing is more frequent in chronic persistent and permanent AF patients than in age-matched community dwelling subjects.

Angiographic and electrophysiologic substrates of ventricular tachycardia in chronic Chagasic myocarditis

Forty-three consecutive symptomatic patients with chronic Chagasic myocarditis and ventricular tachycardia (VT) underwent clinical evaluation, 24-hour Holter monitoring, left ventricular angiography and electrophysiologic testing including programmed ventricular stimulation at 3 drive cycle lengths at 2 sites in the right ventricle. The mean ejection fraction was 42 +/- 10%. Sixteen patients had clinical sustained VT and 27 nonsustained VT. VT was reproducibly initiated in 13 of 16 (81%) patients with sustained VT and in 14 of 27 (52%) patients with nonsustained VT. Electrocardiographic conduction disturbances were seen in 15 of 16 (94%) patients with sustained VT and in 17 of 27 (63%) patients with nonsustained VT (p less than 0.05). Five of 16 (31%) sustained VT and none of nonsustained VT patients had left ventricular aneurysms (p less than 0.05). These data indicate that VT is frequently inducible in patients with sustained VT and nonsustained VT and chronic Chagasic myocarditis. An association appears to be present between conduction disturbances on the electrocardiogram, left ventricular aneurysms and development of sustained ventricular arrhythmias.

Sinus node artery occlusion for treatment of chronic nonparoxysmal sinus tachycardia

Abstract Chronic nonparoxysmal sinus tachycardia has been described as an inappropriate and persistent sinus tachycardia that is not related to organic, physiologic and adrenergic states or automatic dysfunction. Some cases are very symptomatic and refractory to conventional therapy. In this report, we describe an unusual therapy for a refractory case of chronic nonparoxysmal sinus tachycardia.

Naproxen as Prophylaxis against Atrial Fibrillation after Cardiac Surgery: The NAFARM Randomized Trial

PURPOSE We sought to assess the effect of naproxen versus placebo on prevention of atrial fibrillation after coronary artery bypass graft (CABG) surgery. METHODS In this randomized, double-blind, placebo-controlled, single-center trial of 161 consecutive patients undergoing CABG surgery, patients received naproxen 275 mg every 12 hours or placebo at the same dosage and interval over 120 hours immediately after CABG surgery. The primary outcome was the occurrence of atrial fibrillation in the first 5 postoperative days. RESULTS The incidence of postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus 7.3% (6/82) in the naproxen group (P=.11). The duration of atrial fibrillation episodes was significantly lower in the naproxen (0.35 hours) versus placebo group (3.74 hours; P=.04). There was no difference in the overall days of hospitalization between placebo (17.23±7.39) and naproxen (18.33±9.59) groups (P=.44). Intensive care unit length of stay was 4.0±4.57 days in the placebo and 3.23±1.25 days in the naproxen group (P=.16). The trial was stopped by the data monitoring committee before reaching the initial target number of 200 patients because of an increase in renal failure in the naproxen group (7.3% vs 1.3%; P=.06). CONCLUSIONS Postoperative use of naproxen did not reduce the incidence of atrial fibrillation but decreased its duration, in a limited sample of patients after CABG surgery. There was a significant increase in acute renal failure in patients receiving naproxen 275 mg twice daily. Our study does not support the routine use of naproxen after CABG surgery for the prevention of atrial fibrillation.

Ablation of Ventricular Tachycardia in Chronic Chagasic Cardiomyopathy With Giant Basal Aneurysm Carto Sound, CT, and MRI Merge

Chronic chagasic cardiomyopathy (CCC) is a parasitic disease that presents with life-threatening ventricular arrhythmias, dilated cardiomyopathy, or sudden death. Basal and posterior wall motion abnormalities and left apical aneurysms are common. We present a report of a patient with CCC, sustained ventricular tachycardia (Vt) refractory to amiodarone 400 mg/day and carvedilol 25 mg/day BID with a giant left basal aneurysm as visualized by CT scan and intracardiac echocardiogram 3D reconstruction(Carto Sound). The patient underwent preprocedural CT scan data acquisition with 64-slice MDCT scanner Aquilion (Toshiba, Tochigi, Japan), and the images were used for 3D reconstruction with Cartomerge (Biosense Webster, Inc., Diamond Bar, CA). Images acquired using cardiac MRI confirmed the size and shape of …

Correlation between heart rate control during exercise and exercise capacity in patients with chronic atrial fibrillation.

Rate control is an acceptable alternative to rhythm control in patients with chronic atrial fibrillation (AF).

Influence of Heart Rate on Quality of Life in Patients With Chronic Atrial Fibrillation

Current criteria for rate control in atrial fibrillation (AF) treatment are empirical and based on a small amount of scientific data.

Noncompaction of the myocardium, Chagas' disease and dysfunction: a case report.

Relatamos la asociacion entre la cardiopatia asociada al miocardio no compactado del ventriculo izquierdo (MNCVI) con la cardiopatia chagasica cronica (CCC) en paciente con clinica de insuficiencia cardiaca, accidente vascular cerebral isquemico y arritmia cardiaca. Las imagenes tipicas de MNCVI y CCC fueron documentadas por resonancia magnetica cardiaca (RMC).Miocardio ventricular no compactado, enfermedad de Chagas, disfunción ventricular izquierda. Relatamos la asociación entre la cardiopatía asociada al miocardio no compactado del ventrículo izquierdo (MNCVI) con la cardiopatía chagásica crónica (CCC) en paciente con clínica de insuficiencia cardíaca, accidente vascular cerebral isquémico y arritmia cardíaca. Las imágenes típicas de MNCVI y CCC fueron documentadas por resonancia magnética cardíaca (RMC). Miocardio no Compactado, Enfermedad de Chagas y Disfunción Caso Clínico

Cross-sectional study of treatment strategies on atrial fibrillation

FUNDAMENTO: A dieta influencia diretamente a hipertensao arterial (HAS), que e um dos principais fatores de risco da doenca cardiovascular. OBJETIVO: Associar a HAS com fatores dieteticos de adultos clinicamente selecionados para programa de mudanca de estilo de vida. METODOS: Estudo transversal composto por 335 individuos, com idade entre 44 e 65 anos, clinicamente selecionados para um programa de mudanca de estilo de vida. Foram avaliados os dados antropometricos (IMC, % de gordura e circunferencia abdominal), os componentes bioquimicos (concentracoes plasmaticas de glicose, triglicerideos, colesterol total, HDL-c e LDL-c) e a dieta, por meio do recordatorio de 24 horas. A qualidade da dieta foi avaliada pelo Indice de Alimentacao Saudavel. A pressao arterial foi mensurada de acordo com a V Diretriz Brasileira de Hipertensao Arterial e classificada de acordo com o NCEP-ATPIII. A regressao logistica foi realizada para determinar a probabilidade de alteracoes na PAS e PAD de acordo com a ingestao dietetica. Adotou-se como significante o valor de p < 0,05. RESULTADOS: Observou-se correlacao positiva da pressao arterial diastolica com o consumo de colesterol e acucar; e negativa com a ingestao de fibras, porcoes de oleo e qualidade da dieta. A variedade da dieta ≥ 8 itens alimentares apresentou efeito protetor para alteracoes da pressao arterial sistolica; OR = 0,361 (0,148-0,878). CONCLUSAO: A maior variedade da dieta ofereceu efeito protetor para alteracao da pressao arterial sistolica.BACKGROUND Despite the high prevalence and clinical importance of atrial fibrillation (AF), there is no Brazilian study describing the clinical profile of patients with AF and the most used treatment strategy (rhythm control vs. rate control). OBJECTIVE Assess the most common treatment on AF in an outpatient specialized clinic for management of AF. In addition, the clinical profile of the population studied was provided. METHODS Cross-sectional study assessing the most used strategy for atrial fibrillation control in 167 patients. The clinical profile was also described. A standardized form was used for data collection and statistical analysis was performed by SPSS 13.0 software. RESULTS In This high risk population for thromboembolic events (61% had CHADS(2) ≥ 2), 54% of patients had paroxysmal or persistent AF, 96.6% were on vitamin K antagonists or acetylsalicylic acid, and 76.6% on beta-blocker (rate control 81,2% x rhythm control 58,8%; p < 0.05). Heart rate control was the most used strategy (79.5% x 20.5%; p < 0.001). A statistical tendency towards more patients with ventricular dysfunction (15.2% x 2.9%; p = 0.06), CHADS(2) ≥ 2 (60.5% x 39.5%; p = 0.07) and heart valve diseases (25.8% x 11.8%; p = 0.08) was observed in the heart rate control group. CONCLUSION In this high risk population for thromboembolic events, the rate control strategy was the most used.FUNDAMENTO: A despeito de elevada prevalencia e importância clinica da Fibrilacao Atrial (FA), nao existem ate o momento publicacoes brasileiras informando o perfil clinico e a estrategia de tratamento (controle de ritmo vs. controle de frequencia cardiaca) mais utilizada nesse universo de pacientes. OBJETIVO: Avaliar a estrategia de tratamento mais empregada na FA em ambulatorio especializado no manejo dessa doenca. Secundariamente, procurou-se descrever o perfil clinico dessa populacao. METODOS: Estudo transversal que avaliou sequencialmente, em 167 portadores de FA, a estrategia de tratamento mais empregada, bem como o perfil clinico desses pacientes. Utilizou-se questionario padronizado para coleta de dados. A analise estatistica foi realizada por meio do software SPSS® versao 13.0. RESULTADOS: Nessa populacao de alto risco para eventos tromboembolicos (61% com score CHADS2 > 2), em que 54% dos individuos apresentavam fibrilacao atrial paroxistica ou persistente, 96,6% utilizavam antagonistas da vitamina K ou AAS, e 76,6% faziam uso de betabloqueador (81,2% frequencia x 58,8% ritmo, p 2 (60,5% x 39,5%; p = 0,07) e valvopatias (25,8% x 11,8%; p = 0,08) no segmento de controle da frequencia. CONCLUSAO: Nessa populacao de alto risco para eventos tromboembolicos, a estrategia de controle de frequencia cardiaca foi a mais empregada.

Miocardio no compactado, Enfermedad de Chagas y disfunción: caso clínico

Relatamos la asociacion entre la cardiopatia asociada al miocardio no compactado del ventriculo izquierdo (MNCVI) con la cardiopatia chagasica cronica (CCC) en paciente con clinica de insuficiencia cardiaca, accidente vascular cerebral isquemico y arritmia cardiaca. Las imagenes tipicas de MNCVI y CCC fueron documentadas por resonancia magnetica cardiaca (RMC).Miocardio ventricular no compactado, enfermedad de Chagas, disfunción ventricular izquierda. Relatamos la asociación entre la cardiopatía asociada al miocardio no compactado del ventrículo izquierdo (MNCVI) con la cardiopatía chagásica crónica (CCC) en paciente con clínica de insuficiencia cardíaca, accidente vascular cerebral isquémico y arritmia cardíaca. Las imágenes típicas de MNCVI y CCC fueron documentadas por resonancia magnética cardíaca (RMC). Miocardio no Compactado, Enfermedad de Chagas y Disfunción Caso Clínico