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- ItemAcesso aberto (Open Access)Ablação da fibrilação atrial no Brasil: resultados do registro da Sociedade Brasileira de Arritmias Cardíacas(Sociedade Brasileira de Cardiologia - SBC, 2007-11-01) Fenelon, Guilherme [UNIFESP]; Scanavacca, Maurício [UNIFESP]; Atié, Jacob [UNIFESP]; Zimerman, Leandro [UNIFESP]; Magalhães, Luiz Pereira De [UNIFESP]; Lorga Filho, Adalberto [UNIFESP]; Maia, Henrique [UNIFESP]; Martinelli Filho, Martino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Aiming to define the profile of curative atrial fibrillation (AF) ablation in Brazil, the Brazilian Cardiac Arrhythmia Society [Sociedade Brasileira de Arritmias Cardíacas] (SOBRAC) created the Brazilian Registry of AF Ablation [Registro Brasileiro de Ablação da FA]. OBJECTIVE: To describe the results of this registry. METHODS: A questionnaire was sent to SOBRAC members asking about data on patients submitted to AF ablation between September 2005 and November, 2006. RESULTS: A total of 29 groups from 13 states completed the forms. Of these, 22 (76%) had performed AF ablations. Between 1998 and 2001, 7 groups (32%) initiated AF ablations and between 2002 and 2006, 15 groups began to perform them (68%). From 1998 to 2006, 2,374 patients were submitted to ablation, 755 (32%) of them during the registry period. Most (70%) were males and 89% presented with paroxysmal or persistent AF. Ancillary imaging methods (intracardiac echocardiography and electroanatomic mapping) were used by 9 groups (41%). During an average five-month follow-up period, total success was 82% and success without use of antiarrhythmic agents was 57%. Nevertheless, 35% of the patients required two or more procedures. There were 111 complications (14.7%) and 2 deaths (0.26%). CONCLUSION: Curative AF ablation has been increasing significantly in our country, with success rates comparable to international indexes, but often more than one procedure is necessary. Despite promising results, AF ablation still results in significant morbidity. Supplementary imaging methods have been used more and more in an effort to increase efficacy and safety of the procedure. These findings should be considered by public and private funding agencies.
- ItemSomente MetadadadosCaracterização dos efeitos eletrofisiológicos cardíacos da intoxicação alcóolica aguda em cães anestesiados com coração normal(Universidade Federal de São Paulo (UNIFESP), 2007) Balbao, Carlos Eduardo Bissolli [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]Introdução: O alcool tem sido relacionado a arritmias, principalmente atriais (Holiday Heart Syndrome), porem seus reais efeitos eletrofisiologicos permanecem desconhecidos. Metodos: Nos avaliamos os efeitos do etanol em 23 caes anestesiados no basal e apos 2 doses cumulativas endovenosas de alcool anidro ou solucao salina no grupo controle: primeira dose 1,5 ml/kg (nivel plasmatico de 200 mg/dl), segunda dose de 1,0 ml/kg (279 mg/dl) que correspondem respectivamente a uma intoxicacao alcoolica aguda moderada e severa. Os caes foram divididos em 05 grupos: Grupo I - Grupo Etanol com torax fechado, sem bloqueio autonomico (n=5); Grupo 11 - Grupo Controle (n=3) com torax fechado no qual foi infundida solucao salina em vez de etanol; Grupo 111 - Grupo Etanol com torax fechado e bloqueio autonomico completo (n=5), Grupo IV - Grupo Etanol com torax fechado, sem bloqueio autonomico, avaliacao da fracao de ejecao do ventriculo esquerdo pelo ecocardiograma e coleta de tecido atrial para analise histologica e ultraestrutural (n=5) e Grupo V - Grupo Etanol sem bloqueio autonomico, torax aberto e mapeamento epicardico biatrial (n=5). Foram avaliadas variaveis hemodinamicas, eletrocardiograficas e eletrofisiologicas. O potencial de acao monofasico foi registrado em atrio direito alto nos grupos I, II e 111. No grupo IV foi feita avaliacao da funcao ventricular esquerda e coleta de tecido atrial para microscopia optica e eletronica. No grupo V o torax foi aberto e foi colocada uma placa com 6 pares de eletrodos bipolares ao longo do feixe de Bachmann. Resultados: nos grupos I, 11 e 111 o etanol nao alterou significativamente as variaveis hemodinamicas, eletrocardiograficas e eletrofisiologicas. No grupo V (torax aberto e mapeamento epicardico biatrial) o etanol nao afetou o tempo de conducao interatrial, a velocidade de conducao nem o comprimento de onda. Em nenhum grupo foram induzidas arritmias atriais ou ventriculares. A analise histologica e ultraestrutural foi normal em todos os 5 animais do grupo IV. A fracao de ejecao, tambem avaliada no grupo IV, diminuiu significantemente com a dose cumulativa de etanol (77vs73vs66 por cento; p=O,04). Conclusao: Etanol em doses moderadas e severas diminuiu a fracao de ejecao do ventriculo esquerdo, porem nao alterou os parametros eletrocardiograficos, eletrofisiologicos, histologicos e ultraestruturiais estudados, nem induziu arritmias, sugerindo que a intoxicacao alcoolica aguda nao promove diretamente arritmias atriais
- ItemAcesso aberto (Open Access)Desenvolvimento e validação de questionário específico para a avaliação da qualidade de vida em pacientes com fibrilação atrial(Universidade Federal de São Paulo (UNIFESP), 2009-04-29) Braganca, Erika Olivier Vilela [UNIFESP]; Luna Filho, Bráulio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)O autor só colocou Abstract -Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, and has major impact on health-relatedquality of life, thus, there is a need for a specific instrument to assess AF symptoms and quality of life. Methods: We developed and validated a specific questionnaire for quality of life inAF patients (QLAF) based on clinicalmanifestations (palpitation,breathlessness, dizziness and chest pain), and the usual treatments (medication, cardioversion and ablation). For validation, the new questionnaire was compared with the generic SF-36 questionnaire. Reproducibility was tested using 40 questionnaires administered by two different observers at distinct times and places. Responsiveness was evaluated based on variation of the QLAF score over time. Results: There were a total of 462 questionnaires (231 SF-36 and 231 QLAF) administered at baseline, 3, 6, 9 and 12 months. Construct validity was demonstrated by the negative correlation between QLAF and SF-36 scores that was observed over the follow-up period. Analysis of internal consistency for reproducibility showed excellent Cronbach's alpha coefficients (inter- and intraobserver coefficients of 0.98 and 0.96, respectively). QLAF was responsive as indicated by significant differences in mean domain scores from the beginning to the end of follow-up. It took much less time to administer the QLAF than the SF-36 (3:08±0:33 min vs. 9:25±1:14 min, pb0.001). Conclusion: The QLAF questionnaire is easy to understand and can be administered rapidly in the outpatient setting. Furthermore, the QLAF score is valid and reproducible and responsive to a change in clinical status..
- ItemAcesso aberto (Open Access)Estudo do perfil demográfico e do risco tromboembólico associados à fibrilação atrial na atenção básica do sistema único de saúde brasileiro utilizando-se a tecnologia da telemedicina(Universidade Federal de São Paulo (UNIFESP), 2018-12-10) Moraes, Eraldo Ribeiro Ferreira Leao de [UNIFESP]; Paola, Angelo Amato Vincenzo de [UNIFESP]; http://lattes.cnpq.br/6259836166380719; http://lattes.cnpq.br/8936079749176279; Universidade Federal de São Paulo (UNIFESP)Background: The worldwide prevalence of atrial fibrillation (AF) varies between 0.1% and 4.0% and has been increasing. Little is known about the prevalence, stroke risk assessment and treatment of AF in Brazil. Methods: Our objective was to estimate the general prevalence of AF in several regions of Brazil using recordings of longdistance electrocardiogram (ECG) transmission. Patients from 125 outpatient general practitioner units covered by the telemedicine service of the Federal University of São Paulo were included. Only one ECG was considered per patient. A scripted telephone interview was also performed. Using the Brazilian Institute of Geography and Statistics (IBGE) method, we analyzed the data to project the prevalence of AF in the Brazilian population and estimate it for the year 2025. Results: Based on 676,621 ECG exams from January 2009 through April 2016, the mean age (±SD) of patients was 51.4 (±19.1) years, with 57.5% being female. The 7year period prevalence of AF was 2.2% (n=14,968). Based on the IBGE method, the prevalence of AF countrywide was projected to be 1.5% in 2016 and 1.7% in 2025. In the subset of patients with AF who were interviewed (n=301), 91 (30.2%) were not receiving any type of treatment for rate or rhythm control. Overall, 136 (64.7%) of the patients were on acetylsalicylic acid alone, 39 (18.7%) were using oral anticoagulants (OACs), and 7 (3.3%) reported concomitant use of acetylsalicylic acid and an OAC. Among patients interviewed, 189 (62.8%) were at high risk for stroke; only 28 (14.8%) were regular OAC users. Conclusions: Our study highlights the importance of screening for AF in the primary care setting in Brazil and identifies important gaps in the treatment of AF in this population.
- ItemAcesso aberto (Open Access)Fibrilação atrial crônica e apnéia obstrutiva do sono(Universidade Federal de São Paulo (UNIFESP), 2009-10-28) Silva, Betania Braga [UNIFESP]; Paola, Angelo Amato Vincenzo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Little has been known about the relation of sleep apnea and atrial fibrillation. Recent studies have suggested that the prevalence of atrial fibrillation is increasing in patients with sleep-disordered breathing and it is possible that the sleep apnea contributes to arrhythmogenesis in these patients.We hypothesize that the prevalence of obstructive sleep apnea is higher in chronic atrial fibrillation patients, and the arrhythmia occurrence may be associated to alterations in the sleep patterns. Objectives: To evaluate the prevalence of obstructive sleep apnea, and the sleep respiratory parameters in a sample of chronic atrial fibrillation compared to a sub-sample of the general population. Methods: Fifty-two chronic persistent and permanent atrial fibrillation patients, aged (60.5 } 9.5, 33 males) and 32 control subjects were taken from a sample of an epidemiological study on sleep disorders in the general population of the city of Sao Paulo, Brazil (EPISONO), mean aged 57.3 } 9.6 years old, 15 males. All subjects were evaluated by a staff cardiologist for the presence of medical conditions, and were referred for polysomnography. Results: Considering a cut-off value for apnea hypopnea index . 10 per hour of sleep, the atrial fibrillation group had a higher prevalence of obstructive sleep apnea compared to the control group (81.6% and 60.0%, respectively, p = 0.03). All the oxygen saturation parameters were significantly worse in the AF group, such as: lower oxygen saturation nadir (81.9 } 5.8% and 85.3 } 5.2%, p = 0.01), lower mean oxygen saturation (93.4 } 2.1% and 94.3 } 1.5%, p = 0.02), and longer period of time below 90% (26.4 } 55.8 min and 6.7 } 12.3 min, p = 0.05).There were no differences in age, gender, body mass index, sedentarism, presence of hypertension, type 2 diabetes mellitus, abdominal circumference, systolic and diastolic blood pressure, and sleepiness scoring between groups. Despite similar body mass index, atrial fibrillation patients had a higher neck circumference compared to control group (39.9 } 2.3 cm and 37.7 } 4.5 cm, p = 0.01) and the atrial fibrillation group showed higher percentage time of stage 1 non-REM sleep, superficial sleep (6.4 } 5.9% and 3.9 } 2.6%, p = 0.03). Conclusions: Sleep-disordered breathing is more prevalent in chronic atrial fibrillation patients than in general population subjects. The oxygen saturation parameters and percentage of time spent in superficial sleep were worse in the atrial fibrillation group than in control group. Overall, these data suggest alteration of the cardio respiratory coupling during sleep, in these patients.
- ItemAcesso aberto (Open Access)Importância da anatomia da circulação coronária atrial na operação de Cox para controle da fibrilação atrial(Sociedade Brasileira de Cirurgia Cardiovascular, 1999-01-01) Jatene, Marcelo B.; Hervoso, Cristina M. [UNIFESP]; Terra, Ricardo M.; Guimarães, Maria Helena; Monteiro, Rosangela; Jatene, Fabio Biscegli; Jatene, Adib D.; Universidade deUniversidade deUniversidade de; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Since the appearance of new surgical techniques such as Cox surgery employed for the treatment of cardiac arrhythmia, especially for atrial fibrillation, the knowledge of coronary artery characteristics and courses has been of increasing importance. The aim of this study was the analysis of this circulation and definition of atrial irrigation patterns. Hence, the coronary arteries of 30 normal human hearts were injected with colored resin and carefully dissected. After macroscopic evaluation of the hearts, no atrial irrigation patterns were found. However, when only the sinus atrial node was analyzed, it showed origin patterns as well as course patterns. Seven origin and route patterns of this artery are described, considering the anatomical structure of the atria as reference points. The described patterns, differently from others found in the literature, are easy to understand and apply in surgical techniques which deal with the atria.
- ItemAcesso aberto (Open Access)Influência da freqüência cardíaca na qualidade de vida e capacidade física em pacientes com fibrilação atrial crônica(Universidade Federal de São Paulo (UNIFESP), 2008-09-24) Jaber, Jefferson [UNIFESP]; De Paola, Angelo Amato Vincenzo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Rate control is an acceptable alternative to rhythm control in patients with chronic atrial fibrillation. However, current criteria for rate control are empirical and based on a small amount of scientific data. Objective: This study was designed to analyse the influence of heart rate measured by the 6-minute walk test, 24-hour Holter monitoring and cardiopulmonary exercise test on quality of life and exercise capacity in patients with atrial fibrillation. Methods: Eighty-nine males patients with chronic atrial fibrillation and resting heart rate < 90 bpm were included. These patients underwent a quality of life questionnaire (assessed by Medical Outcomes Study Short Form Health Survey SF-36), 6-minute walk test, cardiopulmonary exercise test and 24-hour Holter monitoring. Results: There was a significant difference on quality of life in physical and mental summary scores in patients with maximal heart rate . 110 bpm on 6-minute walk test in comparison with heart rate > 110 bpm (284.10 } 81.37 vs 247.45 } 85.03, p = 0.04 and 316.59 } 75.91 vs 266.84 } 93.75, p = 0.01, respectively) and in physical summary score in patients with average heart rate . 80 bpm on Holter monitor in comparison with heart rate > 80 bpm (284.25 } 70.91 vs 240.81 } 93.55, p = 0.02). There was no significant difference on quality of life in patients with maximal heart rate between 85 and 115% of the maximum age-predicted heart rate at peak exercise in comparison with peak heart rate > 115% of the maximum age-predicted heart rate. Quality of life was also compared among 3 groups of patients classified by heart rate testing results (Group 1 had heart rate . 110 bpm on 6-minute walk test and . 80 bpm on Holter monitor; Group 2 had heart rate in the target area by one but no both tests; and Group 3 had heart rate > 110 bpm on 6-minute walk test and > 80 bpm on Holter monitor), demonstrating significant difference among 3 groups in physical and mental component summary scores (p = 0.035 e p = 0.026, respectively). Exercise capacity assessment demonstrated that patients with heart rate variation index not over 10 bpm/min showed higher maximal oxygen uptake compared to patients with heart rate variation index > 10 bpm/min (26.76 } 6.17 vs 22.83 } 4.84 ml O2/Kg/min, p = 0.002). Conclusions: Patients with both heart rate . 110 bpm on 6-minute walk test and heart rate . 80 bpm on Holter monitor had better quality of life than patients with higher average heart rates. Holter monitoring and 6-minute walk test shoud be performed as complementary methods to better predict quality of life. The simple heart rate control at rest was not sufficient when we desire to obtain better qualty of life. Better heart rate variation control on cardiopulmonary exercise test was correlated with better exercise capacity in patients with chronic atrial fibrillation.
- ItemAcesso aberto (Open Access)Inquérito soroepidemiológico de COVID-19 em pacientes com fibrilação atrial anticoagulados(Universidade Federal de São Paulo, 2022-10-25) Chaves, Ana Paula Cunha [UNIFESP]; Bellei, Nancy Cristina Junqueira [UNIFESP]; http://lattes.cnpq.br/1571196803842272; http://lattes.cnpq.br/4966463979479065Objetivo: Investigar prospectivamente a soroprevalência e a incidência da soroconversão de anticorpos para SARS-CoV-2 em pacientes portadores de fibrilação atrial anticoagulados com risco para complicações da COVID-19, decorrente de infecção ou após a imunização, avaliando a dinâmica da produção de anticorpos no período do estudo. Métodos: Pacientes adultos acompanhados pelo Casa da Arritmia do HSP/UNIFESP, tiveram suas amostras de plasma e soro submetidas a técnicas de detecção de anticorpos IgG anti-RBD contra SARS-CoV-2 por até um ano a partir da data de inclusão no estudo. A análise estatística foi feita usando modelos de regressão linear e logística. Resultados: Foram incluídas 1318 amostras de 152 pacientes, com mediana de idade de 67 anos (IIQ: 59-73). Foi detectada uma taxa de infecção prévia por COVID-19 em 18,42% dos pacientes. Durante o período de acompanhamento, três pacientes (1,90%) vieram à óbito por COVID-19. Foram observadas altas taxas de aderência ao esquema vacinal básico e reforço (96,71% e 94,08%, respectivamente). Após uma dose de vacina, 68,49% dos pacientes apresentaram resposta dos quais 38% atingiram títulos ≥506 UI/ml associado a infecção prévia (p=<0,001) (OR: 9,35; IC: 2,50 a 35,07). Após a segunda dose vacinal, 86,11% dos pacientes responderam e 22,5% atingiram anticorpos ≥506 UI/ml, sendo associado significativamente a plataforma vacinal (BNT162b2: p=0,006/ OR: 32,58; IC: 3,27 a 324,72) e infecção prévia (p=<0,001/ OR7: 75; IC: 1,96 a 30,70). Entre 90 e 120 dias após a segunda dose vacinal, foi possível detectar anticorpos em 59,52% dos pacientes e apenas 3,36% dos pacientes mantiveram níveis de anticorpos ≥506 UI/ml, somente associado a infecção prévia (p=0,002). 95,56% dos pacientes responderam após o reforço vacinal e 70,13% atingiram anticorpos ≥506 UI/ml. Ter recebido a vacina BNT162b2 como reforço (p=0,02) e ter tido infecção prévia (p=0,03) influenciaram na quantificação da resposta. A vacina CoronaVac quando administrada no esquema vacinal básico se associou maior produção de anticorpos quando comparada à ChAdOx1 (p=0,003) e BNT162b2 (p=0,02) após o reforço com esquema heterólogo. Conclusão: As variáveis que demonstrara maior influência na detecção e produção de anticorpos foram a presença de infecção prévia e a plataforma vacinal vacina administrada, enquanto sexo e comorbidades não demostrou relação no presente estudo.