Cristiano Dietrich

Ablação da atividade simpática renal com cateter de ponta irrigada: uma opção atraente?

BACKGROUND: Catheter-based renal sympathetic denervation has emerged as an adjunct strategy to control refractory hypertension. No studies have yet compared the tissue effects of different catheters, powers and time periods of radiofrequency application, which was the objective of this study. METHODS: Six porcine renal arteries were sectioned in their longitudinal axis and placed in the flow chamber designed to simulate physiological renal flow conditions. The catheters were placed obliquely to the artery with constant contact pressure. Radiofrequency ablations were performed using three different catheters: 4 mm/5 F solid-tip electrode, 4 mm/7 F solid-tip electrode, and open irrigated-tip 4 mm/7 F electrode. Two different powers were used (8 W and 15 W) for 30, 60 and 120 seconds. RESULTS: A total of 18 ablations were performed. More significant nerve damage was observed with the 4 mm/5 F catheter and power of 8 W only when the application duration was extended to 120 seconds. On the other hand, significant nerve damage was observed with the 4 mm/7 F catheter with all power (8 W and 15 W) and duration (30, 60, and 120 seconds) options tested. Deeper lesions were observed with the use of the irrigated catheter, regardless of power and time periods of radiofrequency application. CONCLUSIONS: The irrigated-tip catheters produce deeper lesions than solid-tip catheters and their use might be more beneficial in treating patients with renal sympathetic denervation. The clinical applicability of these results, however, should be confirmed.

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 …

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

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

Stroke Prevention in Atrial Fibrillation: Latest Clinical Trials and Guidelines

Atrial Fibrillation (AF) is the most common sustained arrhythmia and 1/6 strokes is attributed to AF. The cornerstone of treatment remains maintaining sinus rhythm or appropriate ventricular rate control in addition to prevention of stroke. Oral anticoagulation therapy (OAC) with vitamin K antagonists (VKAs) has been the gold standard for almost 50 years and a significant reduction in the risk of stroke in patients with AF has been demonstrated. Nonetheless, only 50% of patients with guideline recommendations for OAC treatment actually receive VKAs and half of these will discontinue therapy within 3 to 5 years with only another half achieving therapeutic ranges more than 50% of the time. The aforementioned limitations in addition with frequent blood monitoring have prompted the development of a series of new OAC therapies. The present review focuses on the current pharmacological management for stroke prevention in patients with AF based on current and emerging evidence.

Ablation of epicardial ventricular tachycardia in a chagasic patient with situs inversus totalis: A case report

Figure 1 Magnetic resonance images (MRI) and pericardial puncture. A: Frontal axis and B: lateral views of a cardiac MRI display the situs inversus, dextrocardia, apical left ventricle pointing to the right, and the inverted position of the liver and its relation to the heart. C: Electrocardiogram shows the morphology of ventricular tachycardia recorded with right precordial lead position. D: A 45 right anterior oblique view showing a guidewire in the pericardial space encircling the cardiac silhouette (red arrows) through a 16GTuohy needle (orange arrow). A quadripolar catheter (blue arrow) is positioned in the apex of the right ventricle as a guide for puncturing. E: A 0 anterior-posterior view displaying the catheters positioned in the epicardial space (blue arrows: ablation catheter in the epicardial space through the epicardial sheath), a quadripolar catheter in the right ventricle through the inferior vena cava (orange arrows), and a second ablation catheter in the left ventricular outflow tract through the aortic root (red arrows). The precordial electrocardiogram leads are also positioned in the right aspect (V1 to V5).

Strategies to Improve Safety and Efficacy of Atrial Fibrillation Ablation Using Electrode Multipolar Phased RF PVAC™ Catheter: a Case Report

Phased radiofrequency ablation with a single catheter technique, using a 9-electrode circumferential catheter, is a viable approach to pulmonary vein isolation for the treatment of atrial fibrillation. However, creating effective transmural lesions with such technique, while avoiding serious complications like atrioesophageal fistula, can be difficult. This case illustrates a challenging scenario, where catheter maneuvers fail to allow safe radiofrequency delivery, due to esophageal temperature rise, despite extensive navigating maneuvers. Changing the bipolar-to-unipolar ratio of energy delivery, from 2:1 to 4:1, allowed the creation of effective lesions, avoiding excessive increase in esophageal temperature.

Miocárdio não compactado, Doença de Chagas e disfunção: relato de caso

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