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

Síndrome do QT longo congênito: o que sabemos até o momento?

Síndrome do QT longo congênito é uma síndrome arrítmica hereditária caracterizada por prolongamento do intervalo QT no eletrocardiograma de 12 derivaçoes, torsades de pointes e maior chance de morte súbita cardíaca. A síndrome do QT longo congênito possui padrao autossômico dominante (síndrome de Romano-Ward), bem como padrao autossômico recessivo raro (síndrome de Jervell e Lange-Nielsen). Desde 1957, quando Jervell e Lange-Nielsen relataram os primeiros casos de síndrome do QT longo congênito familiar com surdez congênita, a compreensao dos mecanismos genéticos e eletrofisiológicos dessa afecçao melhorou significativamente os métodos diagnósticos e os tratamentos. No entanto, tornou-se evidente que a síndrome do QT longo congênito nem sempre pode ser explicada pela mutaçao de um único gene. Esta revisao teve por objetivo resumir as características da síndrome do QT longo congênito (principalmente LQT1, LQT2 e LQT3) e descrever brevemente os mais recentes avanços no diagnóstico clínico e no tratamento da afecçao

Feasibility and safety of renal sympathetic denervation with radiofrequency using the irrigated cateter in patients with resistant hypertension

A elevada prevalência da hipertensão arterial sistêmica e as reduzidas taxas de controle tensional obtidas com o tratamento farmacológico despertaram interesse por estratégias alternativas. A denervação simpática renal percutânea surgiu como perspectiva no tratamento de pacientes com hipertensão arterial resistente. As vantagens do cateter irrigado nas ablações cardíacas fomentaram a hipótese de que esse também poderia ser benéfico no contexto da denervação renal. Objetivos: Avaliar a factibilidade e a segurança da denervação simpática renal com cateter irrigado em pacientes com hipertensão arterial resistente. Métodos: O objetivo primário do estudo foi a análise de segurança do procedimento avaliada pela: 1) quantificação de eventos adversos vasculares (em sítio de punção e artéria renal) periprocedimento; 2) Comprometimento da função renal durante o seguimento; 3) ocorrência de estenose/aneurisma da artéria renal, seis meses após a intervenção. Os objetivos secundários foram avaliar: 1) o efeito da denervação renal no comportamento da pressão arterial (aferida em consultório e na MAPA) e no número de anti-hipertensivos, seis meses após a intervenção; 2) o efeito do procedimento na qualidade de vida, aos três meses de seguimento. As variáveis contínuas, ao longo do tempo, foram comparadas utilizando-se os testes t de Student pareado ou Wilcoxon. Para a análise dos dados, utilizaram-se os programas SPSS e STATA11 SE. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Vinte pacientes (idade 50 ± 9,8 anos, 75% mulheres) foram submetidos à denervação renal. As médias das pressões arteriais sistólica e diastólica aferidas no consultório foram de 194,8 ± 36,5mmHg e 112 ± 16,8mmHg, respectivamente. As médias das pressões arteriais sistólica e diastólica aferidas na MAPA foram de 168,4 ± 22,2mmHg e 101,3 ± 19,1mmHg, respectivamente. O número médio de antihipertensivos foi de 7,1 ± 1,5. O procedimento foi realizado sem complicações em 95% dos casos. Em um caso, houve dissecção da artéria renal por trauma mecânico causado pela bainha introdutora. Não foram observadas complicações relacionadas à punção femoral ou elevação dos níveis séricos de creatinina no seguimento. Após seis meses, todos os pacientes foram submetidos à avaliação da integridade vascular. Houve um caso de estenose significativa em artéria renal esquerda, sem repercussão clínica. Ao final de seis meses, observou-se redução de 29,7 ± 33,1mmHg na PAS (p = 0,001) e 14,6 ± 18,9mmHg na PAD (p = 0,003) aferida em consultório, respectivamente. A redução na média da PAS e da PAD, aferida na MAPA, foi de 17,4 ± 33,4mmHg (p = 0,03) e 10,0 ± 21,3mmHg (p = 0,05), respectivamente. Em média, houve redução de 2,6 ± 2,0 anti-hipertensivos (p < 0,01). Antes do procedimento, o valor médio atribuído ao estado de saúde foi de 37,5 ± 22,7 e aumentou para 70,5 ± 20,9 (p = 0,01), três meses após a intervenção. Pacientes que experimentaram redução no número de anti-hipertensivos relataram melhora do estado de saúde. Conclusões: A denervação simpática renal com cateter irrigado é factível e segura. Hipertensos resistentes têm baixos escores do estado de saúde e de qualidade de vida. Os resultados sugerem que esse procedimento reduz os valores pressóricos e melhora a qualidade de vida, na maioria dos pacientes.The high prevalence of hypertension and reduced blood pressure control obtained with pharmacological treatment aroused interest in alternative therapies. Percutaneous renal sympathetic denervation has emerged as an alternative in the treatment of resistant hypertension. The benefits of irrigated catheter in cardiac ablations fostered the hypothesis that these catheters may also be beneficial for renal denervation. Objectives: To evaluate the feasibility and safety of renal sympathetic enervation for resistant hypertension using an irrigated catheter. Methods: The primary endpoint was the safety of the procedure by means of: 1) periprocedural adverse vascular (puncture site and renal artery) events; 2) changes on renal function during follow-up; 3) evidence of renal artery stenosis/aneurysm at 6 months post-intervention. Secondary objectives were to assess the effects of renal denervation on: 1) blood pressure (difference on office and ABPM between baseline and 6 months of follow-up); 2) number of antihypertensive drugs (difference between baseline and 6 months post-intervention); 3) quality of life (comparison between baseline and 3 months). Continuous variables were compared using the paired Student t test or Wilcoxon test. Data was examined using the SPSS software and STATA11 SE. P values < 0.05 were considered statistically significant. Results: 20 patients (age 50 ± 9.8 years, 75% female) underwent renal denervation. Mean office systolic and diastolic blood pressure was 194.8 ± 36.5mmHg and 112.0 ± 16.8mmHg, respectively. Mean blood pressure on 24 hour ABPM was 168.4 ± 22.2mmHg e 101.3 ± 19.1mmHg, respectively. The mean number of anti-hypertensive drugs was 7.1 ± 1.5; 95% of cases were performed without complications. In one patient, there was a renal artery dissection by mechanical trauma caused by the sheath, resulting in stent implantation. There were no complications related to femoral puncture or elevation of creatinine values during the follow up. All patients were evaluated for vascular integrity at 6months. In one patient, significant left renal artery stenosis was diagnosed. At 6 months, office systolic and diastolic blood pressure reduced 29.7 ± 33.1mmHg (p = 0.001) and 14.6 ± 18.9mmHg (p = 0.003) respectively; Systolic and diastolic blood pressure on ABPM reduced 17.4 ± 33.4mmHg (p = 0.03) and 10.0 ± 21.3mmHg (p = 0.05), respectively. On average, there was a reduction of 2.6 ± 2.0 (p < 0.01) antihypertensive drugs. Before the procedure, the average value attributed to health status was 37.5 ± 22.7 and improved significantly at 3 months (70.5 ± 20.9, p = 0.01). Patients who experienced a reduction in the number of antihypertensive drugs reported improved health status. Conclusions: Renal sympathetic denervation with irrigated catheter is feasible and safe. Hypertensive patients have low quality of life scores. Comparison to post-renal denervation results showed a reduction in blood pressure and better quality of life in most patients

Value of the Qrs-T Angle in Predicting the Induction of Ventricular Tachyarrhythmias in Patients with Chagas Disease

Background:The QRS-T angle correlates with prognosis in patients with heart failure and coronary artery disease, reflected by an increase in mortality proportional to an increase in the difference between the axes of the QRS complex and T wave in the frontal plane. The value of this correlation in patients with Chagas heart disease is currently unknown.Objective:Determine the correlation of the QRS-T angle and the risk of induction of ventricular tachycardia / ventricular fibrillation (VT / VF) during electrophysiological study (EPS) in patients with Chagas disease.Methods:Case-control study at a tertiary center. Patients without induction of VT / VF on EPS were used as controls. The QRS-T angle was categorized as normal (0-105º), borderline (105-135º) or abnormal (135-180º). Differences between groups for continuous variables were analyzed with the t test or Mann-Whitney test, and for categorical variables with Fisher's exact test. P values < 0.05 were considered significant.Results:Of 116 patients undergoing EPS, 37.9% were excluded due to incomplete information / inactive records or due to the impossibility to correctly calculate the QRS-T angle (presence of left bundle branch block and atrial fibrillation). Of 72 patients included in the study, 31 induced VT / VF on EPS. Of these, the QRS-T angle was normal in 41.9%, borderline in 12.9% and abnormal in 45.2%. Among patients without induction of VT / VF on EPS, the QRS-T angle was normal in 63.4%, borderline in 14.6% and abnormal in 17.1% (p = 0.04). When compared with patients with normal QRS-T angle, those with abnormal angle had a fourfold higher risk of inducing ventricular tachycardia / ventricular fibrillation on EPS [odds ratio (OR) 4; confidence interval (CI) 1.298-12.325; p = 0.028]. After adjustment for other variables such as age, ejection fraction (EF) and QRS size, there was a trend for the abnormal QRS-T angle to identify patients with increased risk of inducing VT / VF during EPS (OR 3.95; CI 0.99-15.82; p = 0.052). The EF also emerged as a predictor of induction of VT / VF: for each point increase in EF, there was a 4% reduction in the rate of sustained ventricular arrhythmia on EPS.Conclusions:Changes in the QRS-T angle and decreases in EF were associated with an increased risk of induction of VT / VF on EPS

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Note: These guidelines are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient

Apixaban versus warfarin in patients with atrial fibrillation

BACKGROUND: Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin. METHODS: In this randomized, double-blind trial, we compared apixaban (at a dose of 5 mg twice daily) with warfarin (target international normalized ratio, 2.0 to 3.0) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke. The primary outcome was ischemic or hemorrhagic stroke or systemic embolism. The trial was designed to test for noninferiority, with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause. RESULTS: The median duration of follow-up was 1.8 years. The rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group (hazard ratio with apixaban, 0.79; 95% confidence interval [CI], 0.66 to 0.95; P<0.001 for noninferiority; P = 0.01 for superiority). The rate of major bleeding was 2.13% per year in the apixaban group, as compared with 3.09% per year in the warfarin group (hazard ratio, 0.69; 95% CI, 0.60 to 0.80; P<0.001), and the rates of death from any cause were 3.52% and 3.94%, respectively (hazard ratio, 0.89; 95% CI, 0.80 to 0.99; P = 0.047). The rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group (hazard ratio, 0.51; 95% CI, 0.35 to 0.75; P<0.001), and the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group and 1.05% per year in the warfarin group (hazard ratio, 0.92; 95% CI, 0.74 to 1.13; P = 0.42). CONCLUSIONS: In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality. Copyright © 2011 Massachusetts Medical Society. All rights reserved

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes