Ricardo Garbe Habib

6-Month Outcomes in Patients With Implantable Cardioverter-Defibrillators Undergoing Renal Sympathetic Denervation for the Treatment of Refractory Ventricular Arrhythmias.

OBJECTIVES This study aimed to assess 6-month outcomes in patients with implantable cardioverter-defibrillators (ICDs) undergoing renal sympathetic denervation (RSD) for refractory ventricular arrhythmias (VAs). BACKGROUND ICDs are generally indicated for patients at high risk of malignant VAs. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of VAs. METHODS A total of 10 patients with refractory VA underwent RSD. Underlying conditions were Chagas disease (n = 6), nonischemic dilated cardiomyopathy (n = 2), and ischemic cardiomyopathy (n = 2). Information on the number of ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes and device therapies (antitachycardia pacing/shocks) in the previous 6 months as well as 1 and 6 months post-treatment was obtained from ICD interrogation. RESULTS The median number of VT/VF episodes/antitachycardia pacing/shocks 6 months before RSD was 28.5 (range 1 to 106)/20.5 (range 0 to 52)/8 (range 0 to 88), respectively, and was reduced to 1 (range 0 to 17)/0 (range 0 to 7)/0 (range 0 to 3) at 1 month and 0 (range 0 to 9)/0 (range 0 to 7)/0 (range 0 to 3) at 6 months afterward, respectively. There were no major procedure-related complications. Two patients experienced sustained VT within the first week; in both cases, no further episodes occurred during follow-up. Two patients were nonresponders: 1 with persistent idioventricular rhythm and 1 with multiple renal arteries and incomplete ablation. Three patients died during follow-up. None of the deaths was attributed to VA. CONCLUSIONS In patients with ICDs and refractory VAs, RSD was associated with reduced arrhythmic burden with no procedure-related complications. Randomized controlled trials investigating RSD for treatment of refractory VAs in patients with increased sympathetic activity are needed.

Experiência Inicial com o Novo Amplatzer TM Cardiac Plug para Oclusão Percutânea do Apêndice Atrial Esquerdo

BACKGROUND: Thrombus formation in the left atrial appendage (LAA) is the main cause of thromboembolic events in patients with non-valvular atrial fibrillation (AF). Oral anticoagulants are considered first-line therapy for stroke prevention in AF patients. Despite its proven efficacy, long-term oral anti-coagulation is associated to innumerous limitations. Percutaneous LAA closure has emerged as a new strategy for stroke prevention in high risk AF patients who are not candidates for long term oral anticoagulation therapy. METHODS: We report the initial experience with percutaneous occlusion of the LAA using the new AmplatzerTM Cardiac Plug (ACP - AGA Medical Corp., Golden Valley, USA) in patients with AF and CHADS2 score > 2 who were not eligible for anti-coagulation therapy. Procedures were carried out under general anesthesia and 3D transesophageal echocardiography monitoring in real time. RESULTS: Three male patients, mean age of 79 years and CHADS2 2, 3 and 5 scores had the device successfully implanted using a transeptal approach with no complications, resulting in immediate LAA occlusion and hospital discharge two days later. At the 50-day follow-up, all patients were clinically well with complete LAA occlusion and no complications at transthoracic echocardiography. CONCLUSIONS: Percutaneous LAA occlusion with the new ACP seems to be an attractive alternative to prevent thromboembolic events in patients with AF and contraindications or limitations for anticoagulation therapy.

Electrocardiography scar quantification correlates with scar size of hypertrophic cardiomyopathy seen by multidetector computed tomography

Hypertrophic cardiomyopathy (HCM), a genetically transmitted disease, is the most common genetic cardiovascular disease. Current strategies to stratify risk are expensive and concentrated in wealthy centers. Twelve‐lead electrocardiography (ECG) is inexpensive, universally available, and can be readily used for Selvester QRS scoring, which estimates scar size. This study aimed to establish the relation between ECG scar quantification and myocardial fibrosis (extent of myocardial delayed enhancement) in multidetector computed tomography (MDCT).

Renal sympathetic denervation: a new catheter in a new scenario

ABSTRACT Renal sympathetic denervation (RSD) has emerged as an adjunct strategy in the treatment of resistant hypertension. Several other clinical conditions are characterized by sympathetic hyperactivity and could theoretically benefit from RSD. We report the first case of RSD performed in Brazil in a patient with Chagas’ disease and refractory arrhythmia, treated by the EnligHTN® multi-electrode catheter.