Denervação simpática renal em pacientes com cardiodesfibrilador implantável e tempestade elétrica

ResumoIntroduçãoCardiodesfibriladores implantáveis (CDIs) são geralmente indicados para pacientes com arritmias malignas considerados de alto risco. A hiperatividade simpática desempenha um papel crítico no desenvolvimento, na manutenção e no agravamento de arritmias ventriculares. Novas opções de tratamento nessa população representam uma necessidade clínica. Nosso objetivo foi relatar os resultados de pacientes com CDIs e tempestade elétrica submetidos à denervação simpática renal para controle da arritmia.MétodosOito pacientes com CDIs internados por tempestade elétrica refratária ao tratamento médico otimizado foram submetidos à denervação simpática renal. Condições subjacentes foram: doença de Chagas (n = 6), cardiomiopatia dilatada não isquêmica (n = 1) e cardiomiopatia isquêmica (n = 1). As informações sobre o número de taquicardias ventriculares/fibrilações ventriculares e episódios de terapias antitaquicardia na última semana pré‐procedimento e nos 30 dias pós‐tratamento foram obtidas por meio de interrogação dos CDIs.ResultadosAs medianas dos episódios de taquicardias ventriculares/fibrilações ventriculares, sobre‐estimulação e choques na semana que antecedeu a denervação simpática renal foram de 29 (9 a 106), 23 (2 a 94) e 7,5 (1 a 88), sendo significativamente reduzidas para 0 (0 a 12), 0 (0 a 30) e 0 (0 a 1), respectivamente, 1 mês após o procedimento (p = 0,002; p = 0,01; p = 0,003). Nenhum paciente morreu durante o acompanhamento. Não ocorreram complicações maiores relacionadas ao procedimento.ConclusõesEm pacientes com CDIs e tempestade elétrica refratária ao tratamento médico otimizado, a denervação simpática renal reduziu significativamente a carga de arritmia e, consequentemente, as sobre‐estimulações e os choques. Ensaios clínicos randomizados, no contexto de denervação simpática renal para controle de arritmias cardíacas refratárias, são necessários para trazer maior robustez aos nossos achados.AbstractBackgroundImplantable cardioverter‐defibrillators (ICDs) are usually indicated for patients with malignant arrhythmias considered as high risk. Sympathetic hyperactivity plays a critical role in the development, maintenance, and worsening of ventricular arrhythmias. New treatment options in this population represent a clinical necessity. This study's objective was to report the outcomes of patients with ICDs and electrical storm submitted to renal sympathetic denervation for arrhythmia control.MethodsEight patients with ICDs admitted for electrical storm refractory to optimal medical therapy underwent renal sympathetic denervation. Underlying diseases included Chagas disease (n = 6), non‐ischemic dilated cardiomyopathy (n = 1), and ischemic cardiomyopathy (n = 1). Information on the number of episodes of ventricular tachycardia/ventricular fibrillation and antitachycardia therapies in the week before the procedure and 30 days after treatment were obtained through interrogation of the ICDs.ResultsThe median numbers of episodes of ventricular tachycardia/ventricular fibrillation, antitachycardia pacing, and shocks in the week before renal sympathetic denervation were 29 (9 to 106), 23 (2 to 94), and 7.5 (1 to 88), and significantly reduced to 0 (0 to 12), 0 (0 to 30), and 0 (0 to 1), respectively, 1 month after the procedure (p = 0.002; p = 0.01; p = 0.003, respectively). No patients died during follow‐up. There were no major complications related to the procedure.ConclusionsIn patients with ICDs and electrical storm refractory to optimal medical treatment, renal sympathetic denervation significantly reduced arrhythmia load and, consequently, antitachycardia pacing and shocks. Randomized clinical trials in the context of renal sympathetic denervation to control refractory cardiac arrhythmias are needed to further support these findings

Renal Sympathetic Denervation and Quality of Life

ABSTRACTBackgroundRenal sympathetic denervation (RSD) is a promising strategy in the treatment of resistant hypertension. No studies have assessed the effect of RSD on quality of life in our country, which was the aim of this study.MethodsThe EuroQol5 Dimensions questionnaire (EQ5D5L) was chosen to evaluate quality of life in 10 patients undergoing RSD, and it was applied before and 3 months after the procedure.ResultsMean age was 47.3 ± 12 years and 90% of the patients were female. Baseline blood pressure was 187 ± 37.5/104 ± 18.5mmHg and the number of antihypertensive drugs was 7.6 ± 1.3. Before the procedure, the value assigned to health status was 37.5 ± 22.7, increasing at 3 months to 70.5 ± 20.9 (P = 0.01). In the follow-up, in addition to a decrease in the number of antihypertensive drugs (7.6 ± 1.3 vs. 6 ± 2.2; P = 0.05), a trend towards reduced levels of systolic blood pressure (187 ± 36mmHg vs 170 ± 44mmHg; P = 0.10) and diastolic blood pressure (104 ± 18mmHg vs 98 ± 20mmHg; P = 0.20) was observed. Health status improvement resulted from a reduction of problems related to mobility, usual activities, pain/discomfort and anxiety/depression. The magnitude of blood pressure reduction was not associated with improved quality in all of the patients. On the other hand, those who had a decrease in the number of antihypertensive drugs reported a better health status.ConclusionsPatients with resistant hypertension have poor health status scores. RSD improved quality of life in most patients. Further studies are required to confirm consistent benefits

Do Omega-3 fatty acids prevent atrial fibrillation after open heart surgery? A meta-analysis of randomized controlled trials

OBJECTIVES: N-3 polyunsaturated fatty acids have been proposed as a novel treatment for preventing postoperative atrial fibrillation due to their potential anti-inflammatory and anti-arrhythmic effects. However, randomized studies have yielded conflicting results. The objective of this study is to review randomized trials of N-3 polyunsaturated fatty acid use for postoperative atrial fibrillation. METHODS: Using the CENTRAL, PUBMED, EMBASE, and LILACS databases, a literature search was conducted to identify all of the studies in human subjects that reported the effects of N-3 polyunsaturated fatty acids on the prevention of postoperative atrial fibrillation in cardiac surgery patients. The final search was performed on January 30, 2011. There was no language restriction, and the search strategy only involved terms for N-3 polyunsaturated fatty acids (or fish oil), atrial fibrillation, and cardiac surgery. To be included, the studies had to be randomized (open or blinded), and the enrolled patients had to be >18 years of age. RESULTS: Four randomized studies (three double-blind, one open-label) that enrolled 538 patients were identified. The patients were predominantly male, the mean age was 62.3 years, and most of the patients exhibited a normal left atrial size and ejection fraction. N-3 polyunsaturated fatty acid use was not associated with a reduction in postoperative atrial fibrillation. Similar results were observed when the open-label study was excluded. CONCLUSIONS: There is insufficient evidence to suggest that treatment with N-3 polyunsaturated fatty acids reduces postoperative atrial fibrillation. Therefore, their routine use in patients undergoing cardiac surgery is not recommended

Renal sympathetic ablation using an irrigated-tip catheter: an attractive option?

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.INTRODUÇÃO: A denervação simpática renal por meio de cateteres surgiu como estratégia adjunta para o controle da hipertensão arterial resistente. Nenhum estudo até o momento comparou os efeitos teciduais de diferentes cateteres, potências e tempos de aplicação da radiofrequência, objetivo do presente estudo. MÉTODOS: Seis artérias renais de porco foram seccionadas em seu eixo longitudinal e colocadas em uma câmara projetada para simular condições fisiológicas de fluxo renal. Os cateteres foram posicionados obliquamente à artéria, mantendo-se pressão de contato constante. Aplicações de radiofrequência foram realizadas utilizando-se três diferentes dispositivos: eletrodo de ponta sólida 4 mm/5 F, eletrodo de ponta sólida 4 mm/7 F, e eletrodo com ponta aberta irrigada 4 mm/7 F. Duas energias foram aplicadas (8 W e 15 W), durante 30 segundos, 60 segundos e 120 segundos. RESULTADOS: No total foram realizadas 18 aplicações. Injúria neural renal mais significativa foi observada utilizando-se cateter 4 mm/5 F e energia de 8 W apenas quando a duração da aplicação foi estendida a 120 segundos. Por outro lado, significante dano neural foi observado com o cateter 4 mm/7 F com todas as potências (8 W e 15 W) e durações testadas (30 segundos, 60 segundos e 120 segundos). Lesões mais profundas foram notadas quando o cateter irrigado foi utilizado, independentemente da potência e da duração da aplicação. CONCLUSÕES: O cateter com ponta irrigada produz lesões mais profundas que os cateteres de ponta sólida e seu uso pode ser mais vantajoso na denervação simpática renal. A aplicabilidade clínica desses resultados, entretanto, deve ser confirmada.Invasiva do Instituto Dante Pazzanese de CardiologiaInstituto Dante Pazzanese de CardiologiaUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de PatologiaUNIFESP, Depto. de PatologiaSciEL

Associação entre variantes do gene de leptina e obesidade e biomarcadores metabólicos em indivíduos brasileiros

OBJECTIVE: The relationship between variants of the leptin gene (LEP) and obesity and metabolic biomarkers was investigated in Brazilian individuals. SUBJECTS AND METHODS: One-hundred-ten obese (BMI > 30 kg/m²) and 100 non-obese individuals (145 women and 65 men, aged 49 ± 14 years) were randomly selected. Plasma leptin, glycemia, serum lipid measurements and LEP -2548G>A and 3'HVR polymorphisms were analyzed. RESULTS: The LEP -2548GG genotype was associated with a 2.2% and 2.0% increase in BMI (p = 0.009) and plasma leptin (p = 0.031), respectively. 3'HVR I/II (classes I/I+I/II) genotypes contributed with 1.8% of BMI values (p = 0.046). LEP I/G combined genotypes (I/IGG, I/IGA and I/IIGG) were associated with obesity, and increased BMI, waist circumference, leptin and triglycerides (p < 0.05). These relationships were found in women (p < 0.05) but not in men. LEP I/G combined genotypes were not associated with hypertension, hyperglycemia, dyslipidemia and coronary artery disease. CONCLUSIONS: LEP I/G combined genotypes are associated with obesity-related metabolic biomarkers and phenotype in a gender-dependent manner.OBJETIVO: A relação entre as variantes do gene da leptina (LEP) e obesidade e biomarcadores metabólicos foi investigada em indivíduos brasileiros. SUJEITOS E MÉTOODS: Cento e dez indivíduos obesos (IMC > 30 kg/m²) e 100 não obesos (145 mulheres e 65 homens, idade 49 ± 14 anos) foram selecionados aleatoriamente. Leptina plasmática, glicemia, lípides séricos e polimorfismos LEP -2548G>A e 3'HVR foram analisados. RESULTADOS: O genótipo -2548GG foi associado com aumento de 2,2% e 2,0% no IMC (p = 0,009) e leptina plasmática (p = 0,031), respectivamente, enquanto os genótipos 3´HVR I/II (classes I/I+I/II) contribuíram com 1,8% dos valores de IMC (p = 0,046). Os genótipos combinados LEP I/G (I/IGG, I/IGA e I/IIGG) foram associados com obesidade e IMC aumentado, circunferência abdominal, leptina e triglicérides aumentados (p < 0,05). Essas relações foram encontradas em mulheres (p < 0,05), mas não em homens. Os genótipos LEP I/G combinados não foram associados com hipertensão, hiperglicemia, dislipidemia e doença arterial coronariana. CONCLUSÕES: Genótipos combinados LEP I/G são associados com biomarcadores metabólicos e fenótipo de obesidade de forma gênero-dependente

Polimorfismo do promotor do gene da leptina está associado ao aumento de leptina plasmática e IMC em mulheres brasileiras

Variants in leptin gene (LEP) have been implicated in the pathogenesis of obesity. The relationship between LEP G-2548A polymorphism and obesity-related traits was evaluated in a sample of Brazilian women (n = 228) who were randomly selected from two clinical centers in Sao Paulo city. Blood samples were collected for DNA extraction, plasma leptin and serum lipids measurements. LEP G-2548A genotypes were identified by a PCR- RFLP strategy using the endonuclease Alw44I. LEP G-2548A was associated with obesity after adjustment for covariates (age, hypertension, coronary artery disease, smoking and physical activity). Women carrying G allele had a four times higher risk of obesity than the A allele carriers (OR: 4.11, CI95%: 1.06-15.90, p = 0.041). G allele was also related to increased plasma leptin (p = 0.024) and body mass index (p = 0.027). Hypertension, hyperglycemia, dyslipidemia and coronary artery disease were associated with obesity. However LEP G-2548A polymorphism was not related to these variables. All together these data suggest that LEP G-2548A polymorphism has an important role in regulating plasma leptin levels and body mass index in women.Variantes no gene da leptina (LEP) foram implicados na patogênese da obesidade. A relação entre o polimorfismo LEP G-2548A e as características relacionadas com a obesidade foram avaliadas em mulheres brasileiras (n = 228), que foram selecionadas randomicamente de dois centros de pesquisa clínica na cidade de São Paulo. As amostras de sangue foram coletadas para extração de DNA e determinações de leptina plasmática e lipídeos séricos. Os genótipos do LEP G-2548A foram identificados pela estratégia de PCR-RFLP, empregando a endonuclease Alw44I. O polimorfismo LEP G-2548A foi associado com obesidade, após ajuste para as covariáveis: idade, hipertensão, doença arterial coronariana, tabagismo e atividade física. Mulheres com alelo G tiveram quatro vezes maior risco de obesidade que as portadoras do alelo A (OR: 4,11, CI95%: 1,06-15,90; p = 0,041). O alelo G também foi relacionado com leptina plasmática (p = 0,024) e o índice de massa corporal (p = 0,027) aumentado. A hipertensão, a hiperglicemia, a dislipidemia e a doença arterial coronariana foram associadas com obesidade. Entretanto, o polimorfismo LEP G-2548A não foi relacionado com essas variáveis. Os resultados deste estudo são sugestivos de que o polimorfismo LEP G-2548A tem papel importante na regulação da leptina plasmática e no índice de massa corporal em mulheres

Taquicardia ventricular idiopática em portador de miocárdio não compactado

Relatamos o caso de paciente do sexo masculino, com 23 anos de idade, portador de miocárdio não compactado e taquicardia ventricular monomórfica sustentada. O paciente foi submetido a implante de cardiodesfibrilador implantável após diagnóstico confirmado por meio de ressonância nuclear magnética cardíaca e mantido em tratamento clínico com medicação antiarrítmica, sem recorrência de arritmia ventricular no acompanhamento ambulatorial

Doença do nó sinusal em paciente jovem com síndrome de Mayer-Rokitansky-Küster-Hauser

Relato do caso de uma paciente de 39 anos de idade com síndrome de Mayer-Rokitansky-Küster-Hauser, apresentando doença do nó sinusal e necessidade de implante de marcapasso bicameral. Por se tratar de paciente jovem, sem outras causas secundárias de bradicardia, sugerese a hipótese de relação entre as duas doenças, visto que já há descrição de associação de síndrome de Mayer-Rokitansky-Küster-Hauser e cardiopatias estruturais, sem referências de relação com bradicardia até o momento

Relationship of short tandem repeats flanking leptin-melanocortin pathway genes with anthropometric profile and leptinemia in Brazilian individuals

Objective: To investigate the relationship of short tandem repeats (STR) near genes involved in the leptin-melanocortin pathway with body mass index (BMI) and leptinemia. Subjects and methods: Anthropometric variables and leptinemia were measured in 100 obese and 110 non-obese individuals. D1S200, D2S1788, DS11912, and D18S858 loci were analyzed by PCR and high-resolution electrophoresis. Results: Overall STR allele frequencies were similar between the obese and non-obese group (p &gt; 0.05). Individual alleles D1S200 (17), D11S912 (43), D18S858 (11/12) were associated with obesity (p &lt; 0.05). Individuals carrying these alleles showed higher BMI than non-carriers (p &lt; 0.05). Moreover, a relationship between D18S858 11/12 alleles and increased waist circumference was found (p = 0.040). On the other hand, leptinemia was not influenced by the studied STRs (p &gt; 0.05). Conclusions: D1S200, D11S912, and D18S858 loci are associated with increased BMI and risk for obesity in this sample. Arq Bras Endocrinol Metab. 2012;56(1):47-53Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), Sao Paulo, SP, BrazilFundacao de Amparo a Pesquisa do Estado de Sao Paulo (Fapesp), Sao Paulo, SP, Brazil [01/10708-3]FapespFAPESPCNPq, BrazilCNPq (Brazil