Luiz Eduardo Montenegro Camanho

Very low risk of thromboembolic events in patients undergoing successful catheter ablation of atrial fibrillation with a CHADS2 score ≤3: a long-term outcome study.

Background— Long-term cessation of oral anticoagulation (OAC) after catheter ablation of atrial fibrillation (AF) has been deemed controversial. The safety of this management strategy in patients without recurrent AF and with historically elevated risks for thromboembolism remains largely unknown. In this study, we sought to evaluate the long-term results of OAC cessation after successful catheter ablation of AF. Methods and Results— OAC and antiarrhythmic drugs (AADs) were discontinued irrespective of AF type or baseline CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack) risk score in 327 patients (mean age, 63±13 years; 79% men) with drug-refractory AF after catheter ablation (mean CHADS2 score, 1.89±0.95; median, 2.0). Patients with a CHADS2 score of 2 (45.4%) and 3 (23.2%) accounted for 68.8% of this cohort. In patients with a high risk of recurrence or prior thromboembolic complications, OAC was continued for up to 6 to 12 months postablation and antiplatelet therapy was administered to all patients who maintained sinus rhythm upon OAC interruption. After a follow-up of 46±17 months (range, 13–82 months), 82% remained AF free (off AADs). Significant predictors of late AF recurrence (P<0.05) were nonparoxysmal AF (hazard ration [HR], 1.83), female sex (HR, 2.19), age ≥60 years (HR, 1.81), left atrial size >40 mm (HR, 3.52), CHADS2 score ≥2 (HR, 1.81), and early recurrences (HR, 5.52). No symptomatic ischemic cerebrovascular events were detected during follow-up despite interruption of OAC in 298 (91%) patients and AADs in 293 (89%) patients. Conclusions— No significant thromboembolic-related morbidity is observed when AADs and OAC are discontinued after successful catheter ablation of AF in patients with a CHADS2 score ⩽3 who are maintained on antiplatelet therapy during long-term follow-up.

Use of intracardiac echocardiography in the electrophysiology laboratory

The intracardiac echocardiography (ICE) offers a detailed visualization of the cardiac structures, in association with hemodynamic information, allowing the precise and real-time positioning of the catheters, decreasing the time of exposure to fluoroscopy and the monitoring of acute complications during the electrophysiological procedure (i.e., formation of thrombi, pericardial effusion, cardiac tamponade), Consequently, its use has progressively increased, mainly in the ablation of atrial fibrillation and ventricular arrhythmias. It has shown to be very useful in the ablation of atrial fibrillation by providing anatomic data on the left atrium and pulmonary veins, helping in transseptal punctures, locating the ostium and antrum of the pulmonary veins, monitoring tissue injury during radiofrequency (RF) use, preventing esophageal injury by monitoring the injuries caused by RF on the left atrial posterior wall and assessing the pulmonary vein flow.El ecocardiograma intracardiaco (EIC) proporciona una visualizacion detallada de las estructuras cardiacas, combinada a informaciones hemodinamicas, permitiendo posicionamiento preciso y en tiempo real del posicionamiento de los cateteres, reduccion del tiempo de exposicion a la fluoroscopia, y el monitoreo de complicaciones agudas durante el procedimiento electrofisiologico (ex. formacion de trombos, derrame pericardico, taponamiento cardiaco). Por eso, su utilizacion ha sido creciente, principalmente en la ablacion de la fibrilacion atrial y de las arritmias ventriculares. En la ablacion de fibrilacion atrial demuestra gran utilidad por proveer datos anatomicos del atrio izquierdo y venas pulmonares, auxiliar en las punciones transeptales, localizar el ostio y antro de las venas pulmonares, monitorear la lesion tisular durante la aplicacion de radiofrecuencia (RF), prevenir injuria esofagica a traves del monitoreo de las lesiones por RF en la pared posterior del atrio izquierdo y evaluar el flujo de las venas pulmonares.

Postpartum torsades de pointes and long QT syndrome.

This article reports the case of a puerperal patient admitted with diagnosis of urinary tract infection and heart failure. This condition evolved with torsades de pointes ventricular arrhythmias, then, hypokalemia, and use of Ciprofloxacin. Ventricular arrhythmias did not present any improvement after potassium and magnesium replacement, but after implantation of temporary pacemaker, this condition showed signs of improvement. The patient was discharged with QTc at 490 ms, taking Propranolol.This article reports the case of a puerperal patient admitted with diagnosis of urinary tract infection and heart failure. This condition evolved with torsades de pointes ventricular arrhythmias, then, hypokalemia, and use of Ciprofloxacin. Ventricular arrhythmias did not present any improvement after potassium and magnesium replacement, but after implantation of temporary pacemaker, this condition showed signs of improvement. The patient was discharged with QTc at 490 ms, taking Propranolol.

Intra-His bundle block: clinical, electrocardiographic, and electrophysiologic characteristics

OBJECTIVE To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). METHODS We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS. RESULTS Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; 4 (25%) pt had intra-His Wenckebach phenomenon, which correlated with Mobitz I (MI) atrioventricular block on the electrocardiogram. Seven (44%) pt had 2:1 atrioventricular block, 2 of whom were asymptomatic (12.5%). One (6%) pt had intra- and infra-His bundle block. Clinically, 11 (68%) pt had syncope or presyncope, 3 (18%) had dyspnea on exertion, and 2 (12.5%) were asymptomatic. Eight (50%) pt had bundle-branch block as follows: 4 (25%) pt had left bundle-branch block, and 4 (25%) had right bundle-branch block. Left anterosuperior divisional block was observed in 3 pt (19%), 2 of whom with associated right bundle-branch block. CONCLUSION Intra-His bundle block was observed in 11% of the pt with second-degree atrioventricular block, syncope or presyncope, or both, it being the most frequent clinical presentation. Intra-His bundle block was more common in the elderly (> 60 years) and among females. The most frequent electrocardiographic presentations were second-degree Mobitz I or type 2:1 atrioventricular block.

Implante de eletrodo em veia ázigos: uma opção terapêutica para limiar de desfibrilação elevado

The evaluation of the defibrillation threshold (DFT) during the implantation of a cardioverter-defibrillator (ICD) is an important stage of the procedure, as a high DFT can be found in up to 16% of patients. We report a patient with idiopathic dilated cardiomyopathy (DCM) submitted to a biventricular ICD implantation. During the procedure, the patient showed a high DFT and showed to be resistant to usual therapeutic modalities. We opted for the azygos vein defibrillation lead implantation, with good resolution.

Very Low Risk of Thromboembolic Events in Patients Undergoing Successful Catheter Ablation of Atrial Fibrillation With a CHADS2 Score ≤3Clinical Perspective

Background— Long-term cessation of oral anticoagulation (OAC) after catheter ablation of atrial fibrillation (AF) has been deemed controversial. The safety of this management strategy in patients without recurrent AF and with historically elevated risks for thromboembolism remains largely unknown. In this study, we sought to evaluate the long-term results of OAC cessation after successful catheter ablation of AF. Methods and Results— OAC and antiarrhythmic drugs (AADs) were discontinued irrespective of AF type or baseline CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack) risk score in 327 patients (mean age, 63±13 years; 79% men) with drug-refractory AF after catheter ablation (mean CHADS2 score, 1.89±0.95; median, 2.0). Patients with a CHADS2 score of 2 (45.4%) and 3 (23.2%) accounted for 68.8% of this cohort. In patients with a high risk of recurrence or prior thromboembolic complications, OAC was continued for up to 6 to 12 months postablation and antiplatelet therapy was administered to all patients who maintained sinus rhythm upon OAC interruption. After a follow-up of 46±17 months (range, 13–82 months), 82% remained AF free (off AADs). Significant predictors of late AF recurrence (P<0.05) were nonparoxysmal AF (hazard ration [HR], 1.83), female sex (HR, 2.19), age ≥60 years (HR, 1.81), left atrial size >40 mm (HR, 3.52), CHADS2 score ≥2 (HR, 1.81), and early recurrences (HR, 5.52). No symptomatic ischemic cerebrovascular events were detected during follow-up despite interruption of OAC in 298 (91%) patients and AADs in 293 (89%) patients. Conclusions— No significant thromboembolic-related morbidity is observed when AADs and OAC are discontinued after successful catheter ablation of AF in patients with a CHADS2 score ⩽3 who are maintained on antiplatelet therapy during long-term follow-up.

Very Low Risk of Thromboembolic Events in Patients Undergoing Successful Catheter Ablation of Atrial Fibrillation With a CHADS2 Score ≤3Clinical Perspective: A Long-Term Outcome Study

Background— Long-term cessation of oral anticoagulation (OAC) after catheter ablation of atrial fibrillation (AF) has been deemed controversial. The safety of this management strategy in patients without recurrent AF and with historically elevated risks for thromboembolism remains largely unknown. In this study, we sought to evaluate the long-term results of OAC cessation after successful catheter ablation of AF. Methods and Results— OAC and antiarrhythmic drugs (AADs) were discontinued irrespective of AF type or baseline CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack) risk score in 327 patients (mean age, 63±13 years; 79% men) with drug-refractory AF after catheter ablation (mean CHADS2 score, 1.89±0.95; median, 2.0). Patients with a CHADS2 score of 2 (45.4%) and 3 (23.2%) accounted for 68.8% of this cohort. In patients with a high risk of recurrence or prior thromboembolic complications, OAC was continued for up to 6 to 12 months postablation and antiplatelet therapy was administered to all patients who maintained sinus rhythm upon OAC interruption. After a follow-up of 46±17 months (range, 13–82 months), 82% remained AF free (off AADs). Significant predictors of late AF recurrence (P<0.05) were nonparoxysmal AF (hazard ration [HR], 1.83), female sex (HR, 2.19), age ≥60 years (HR, 1.81), left atrial size >40 mm (HR, 3.52), CHADS2 score ≥2 (HR, 1.81), and early recurrences (HR, 5.52). No symptomatic ischemic cerebrovascular events were detected during follow-up despite interruption of OAC in 298 (91%) patients and AADs in 293 (89%) patients. Conclusions— No significant thromboembolic-related morbidity is observed when AADs and OAC are discontinued after successful catheter ablation of AF in patients with a CHADS2 score ⩽3 who are maintained on antiplatelet therapy during long-term follow-up.

Aplicações do ecocardiograma intracardíaco no laboratório de eletrofisiologia

The intracardiac echocardiography (ICE) offers a detailed visualization of the cardiac structures, in association with hemodynamic information, allowing the precise and real-time positioning of the catheters, decreasing the time of exposure to fluoroscopy and the monitoring of acute complications during the electrophysiological procedure (i.e., formation of thrombi, pericardial effusion, cardiac tamponade), Consequently, its use has progressively increased, mainly in the ablation of atrial fibrillation and ventricular arrhythmias. It has shown to be very useful in the ablation of atrial fibrillation by providing anatomic data on the left atrium and pulmonary veins, helping in transseptal punctures, locating the ostium and antrum of the pulmonary veins, monitoring tissue injury during radiofrequency (RF) use, preventing esophageal injury by monitoring the injuries caused by RF on the left atrial posterior wall and assessing the pulmonary vein flow.El ecocardiograma intracardiaco (EIC) proporciona una visualizacion detallada de las estructuras cardiacas, combinada a informaciones hemodinamicas, permitiendo posicionamiento preciso y en tiempo real del posicionamiento de los cateteres, reduccion del tiempo de exposicion a la fluoroscopia, y el monitoreo de complicaciones agudas durante el procedimiento electrofisiologico (ex. formacion de trombos, derrame pericardico, taponamiento cardiaco). Por eso, su utilizacion ha sido creciente, principalmente en la ablacion de la fibrilacion atrial y de las arritmias ventriculares. En la ablacion de fibrilacion atrial demuestra gran utilidad por proveer datos anatomicos del atrio izquierdo y venas pulmonares, auxiliar en las punciones transeptales, localizar el ostio y antro de las venas pulmonares, monitorear la lesion tisular durante la aplicacion de radiofrecuencia (RF), prevenir injuria esofagica a traves del monitoreo de las lesiones por RF en la pared posterior del atrio izquierdo y evaluar el flujo de las venas pulmonares.

Aplicaciones del ecocardiograma intracardíaco en el laboratorio de electrofisiología

The intracardiac echocardiography (ICE) offers a detailed visualization of the cardiac structures, in association with hemodynamic information, allowing the precise and real-time positioning of the catheters, decreasing the time of exposure to fluoroscopy and the monitoring of acute complications during the electrophysiological procedure (i.e., formation of thrombi, pericardial effusion, cardiac tamponade), Consequently, its use has progressively increased, mainly in the ablation of atrial fibrillation and ventricular arrhythmias. It has shown to be very useful in the ablation of atrial fibrillation by providing anatomic data on the left atrium and pulmonary veins, helping in transseptal punctures, locating the ostium and antrum of the pulmonary veins, monitoring tissue injury during radiofrequency (RF) use, preventing esophageal injury by monitoring the injuries caused by RF on the left atrial posterior wall and assessing the pulmonary vein flow.El ecocardiograma intracardiaco (EIC) proporciona una visualizacion detallada de las estructuras cardiacas, combinada a informaciones hemodinamicas, permitiendo posicionamiento preciso y en tiempo real del posicionamiento de los cateteres, reduccion del tiempo de exposicion a la fluoroscopia, y el monitoreo de complicaciones agudas durante el procedimiento electrofisiologico (ex. formacion de trombos, derrame pericardico, taponamiento cardiaco). Por eso, su utilizacion ha sido creciente, principalmente en la ablacion de la fibrilacion atrial y de las arritmias ventriculares. En la ablacion de fibrilacion atrial demuestra gran utilidad por proveer datos anatomicos del atrio izquierdo y venas pulmonares, auxiliar en las punciones transeptales, localizar el ostio y antro de las venas pulmonares, monitorear la lesion tisular durante la aplicacion de radiofrecuencia (RF), prevenir injuria esofagica a traves del monitoreo de las lesiones por RF en la pared posterior del atrio izquierdo y evaluar el flujo de las venas pulmonares.

Síndrome do QT longo e torsades de pointes pós-parto

This article reports the case of a puerperal patient admitted with diagnosis of urinary tract infection and heart failure. This condition evolved with torsades de pointes ventricular arrhythmias, then, hypokalemia, and use of Ciprofloxacin. Ventricular arrhythmias did not present any improvement after potassium and magnesium replacement, but after implantation of temporary pacemaker, this condition showed signs of improvement. The patient was discharged with QTc at 490 ms, taking Propranolol.This article reports the case of a puerperal patient admitted with diagnosis of urinary tract infection and heart failure. This condition evolved with torsades de pointes ventricular arrhythmias, then, hypokalemia, and use of Ciprofloxacin. Ventricular arrhythmias did not present any improvement after potassium and magnesium replacement, but after implantation of temporary pacemaker, this condition showed signs of improvement. The patient was discharged with QTc at 490 ms, taking Propranolol.